Zachary Rowe

Community-Based Participatory Research: Lessons Learned from the Centers for Children's Environmental Health and Disease Prevention Research

Over the past several decades there has been growing evidence of the increase in incidence rates, morbidity, and mortality for a number of health problems experienced by children. The causation and aggravation of these problems are complex and multifactorial. The burden of these health problems and environmental exposures is borne disproportionately by children from low-income communities and communities of color. Researchers and funding institutions have called for increased attention to the complex issues that affect the health of children living in marginalized communities—and communities more broadly—and have suggested greater community involvement in processes that shape research and intervention approaches, for example, through community-based participatory research (CBPR) partnerships among academic, health services, public health, and community-based organizations. Centers for Children’s Environmental Health and Disease Prevention Research (Children’s Centers) funded by the National Institute of Environmental Health Sciences and U.S. Environmental Protection Agency were required to include a CBPR project. The purpose of this article is to provide a definition and set of CBPR principles, to describe the rationale for and major benefits of using this approach, to draw on the experiences of six of the Children’s Centers in using CBPR, and to provide lessons learned and recommendations for how to successfully establish and maintain CBPR partnerships aimed at enhancing our understanding and addressing the multiple determinants of children’s health.

Discrimination, Symptoms of Depression, and Self-Rated Health Among African American Women in Detroit: Results From a Longitudinal Analysis

OBJECTIVES Our understanding of the relationships between perceived discrimination and health was limited by the cross-sectional design of most previous studies. We examined the longitudinal association of self-reported everyday discrimination with depressive symptoms and self-rated general health. METHODS Data came from 2 waves (1996 and 2001) of the Eastside Village Health Worker Partnership survey, a community-based participatory survey of African American women living on Detroits east side (n=343). We use longitudinal models to test the hypothesis that a change in everyday discrimination over time is associated with a change in self-reported symptoms of depression (positive) and on self-reported general health status (negative). RESULTS We found that a change over time in discrimination was significantly associated with a change over time in depressive symptoms (positive) (b=0.125; P<.001) and self-rated general health (negative) (b=-0.163; P<.05) independent of age, education, or income. CONCLUSIONS The results reported here are consistent with the hypothesis that everyday encounters with discrimination are causally associated with poor mental and physical health outcomes. In this sample of African American women, this association holds above and beyond the effects of income and education.

Community action against asthma: examining the partnership process of a community-based participatory research project.

AbstractBACKGROUND: Community Action Against Asthma (CAAA) is a community-based participatory research (CBPR) project that assesses the effects of outdoor and indoor air quality on exacerbation of asthma in children, and tests household- and neighborhood-level interventions to reduce exposure to environmental asthma triggers. Representatives of community-based organizations, academia, an integrated health system, and the local health department work in partnership on CAAA’s Steering Committee (SC) to design and implement the project. OBJECTIVE: To conduct a process evaluation of the CAAA community-academic partnership. DESIGN: In-depth interviews containing open-ended questions were conducted with SC members. Analysis included established methods for qualitative data, including focused coding and constant comparison methods. SETTING: Community setting in Detroit, Michigan. PARTICIPANTS: Twenty-three members of the CAAA SC. MEASUREMENTS: Common themes identified by SC members relating to the partnership’s ability to achieve project goals and the successes and challenges facing the partnership itself. MAIN RESULTS: Identified partnership accomplishments included: successful implementation of a complex project, identification of children with previously undiagnosed asthma, and diverse participation and community influence in SC decisions. Challenges included ensuring all partners’ influence in decision-making, the need to adjust to “a different way of doing things” in CBPR, constraints and costs of doing CBPR felt by all partners, ongoing need for communication and maintaining trust, and balancing the needs of science and the community through intervention. CONCLUSIONS: CBPR can enhance and facilitate basic research, but care must be given to trust issues, governance issues, organizational culture, and costs of participation for all organizations involved.

Identification of gaps in the diagnosis and treatment of childhood asthma using a community-based participatory research approach

The goal of this investigation was to use a community-based participatory research approach to develop, pilot test, and administer an asthma screening questionnaire to identify children with asthma and asthma symptoms in a community setting. This study was conducted as the recruitment effort for Community Action Against Asthma, a randomized trial of a household intervention to reduce exposure to environmental triggers of asthma and was not designed as a classic prevalence study. An asthma screening questionnaire was mailed and/or hand delivered to parents of 9,627 children, aged 5 to 11 years, in two geographic areas of Detroit, Michigan, with predominantly African American and Hispanic populations. Additional questionnaires were distributed via community networking. Measurements included parent report of their childs frequency of respiratory symptoms, presence of physician diagnosis of asthma, and frequency of doctor-prescribed asthma medication usage. Among the 3,067 completed questionnaires, 1,570 (51.2% of returned surveys, 16.3% of eligible population) were consistent with asthma of any severity and 398 (12.9% of returned surveys, 4.1% of eligible population) met criteria, for moderate-to-severe asthma. Among those meeting criteria for moderate-to-severe asthma, over 30% had not been diagnosed by a physician, over one half were not taking daily asthma medication, and one quarter had not taken any physician-prescribed asthma medication in the past year. Screening surveys conducted within the context of a community-based participatory research partnership can identify large numbers of children with undiagnosed and/or undertreated moderate-to-severe asthma. These children are likely to benefit from interventions to reduce morbidity and improve quality of life.

A community-based participatory planning process and multilevel intervention design: toward eliminating cardiovascular health inequities.

The elimination of persistent health inequities requires the engagement of multiple perspectives, resources, and skills. Community-based participatory research (CBPR) is one approach to developing action strategies that promote health equity by addressing contextual as well as individual-level factors, and that can contribute to addressing more fundamental factors linked to health inequity. Yet many questions remain about how to implement participatory processes that engage local insights and expertise, are informed by the existing public health knowledge base, and build support across multiple sectors to implement solutions. This article describes a CBPR approach used to conduct a community assessment and action planning process, culminating in development of a multilevel intervention to address inequalities in cardiovascular disease in Detroit, Michigan. The authors consider implications for future efforts to engage communities in developing strategies toward eliminating health inequities.

Handheld Computers for Direct Observation of the Social and Physical Environment

This article evaluates the use of handheld computers for systematic observation of the social and physical environments. Handheld computers, also known as personal digital assistants (PDAs), make the advantages of computer-assisted data collection (CADC) more accessible to field-based researchers. In particular, CADC with handheld computers may improve data quality, reduce turnaround time, and enhance research capacity for community-academic partnerships. Here, we describe our experiences using handheld computers for the Healthy Environments Partnerships Neighborhood Observational Checklist, an instrument for systematic observation of the social and physical environments. We discuss hardware and software considerations, observer training and implementation strategies, and observer attitudes toward using handhelds in the field. We conclude that handheld computers are a feasible alternative to pen-and-paper forms, and we identify ways that future researchers can maximize the advantages of CADC with handheld computers to advance our understanding of how neighborhood context relates to individual-level outcomes.

Piloting interventions within a community-based participatory research framework: lessons learned from the healthy environments partnership.

Background: Community-based participatory research (CBPR) partnerships experience unique opportunities and dilemmas when implementing pilot interventions. Objectives: We describe challenges and opportunities associated with conducting a pilot intervention within a longstanding CBPR partnership, lessons learned for use of a participatory process to pilot community interventions, and recommendations to funders on mechanisms for funding pilot interventions to help address these challenges. Methods: We conducted key informant interviews and convened a group discussion with host organization leaders and project personnel. Lessons Learned: Findings highlight the opportunities and challenges related to needs and desires of community constituents and the ability of pilot interventions to meet those needs, and the importance of ongoing communication to address anticipated and unanticipated challenges that arise in the context of short-term pilot interventions in community settings. Conclusion: We suggest several funding mechanisms for supporting the implementation of larger scale interventions following promising pilot efforts in community settings.

A Community-Based Participatory Approach to Personalized, Computer-Generated Nutrition Feedback Reports: The Healthy Environments Partnership

Background: Computer tailoring and personalizing recommendations for dietary health-promoting behaviors are in accordance with community-based participatory research (CBPR) principles, which emphasizes research that benefits the participants and community involved.Objective: To describe the CBPR process utilized to computer generate and disseminate personalized nutrition feed-back reports (NFRs) for Detroit Healthy Environments Partnership (HEP) study participants.Methods: The CBPR process included discussion and feedback from HEP partners on several draft personalized reports. The nutrition feedback process included defining the feedback objectives; prioritizing the nutrients; customizing the report design; reviewing and revising the NFR template and readability; producing and disseminating the report; and participant follow-up.Lessons Learned: Application of CBPR principles in designing the NFR resulted in a reader-friendly product with useful recommendations to promote heart health.Conclusions: A CBPR process can enhance computer tailoring of personalized NFRs to address racial and socioeconomic disparities in cardiovascular disease (CVD).

Effectiveness of a Walking Group Intervention to Promote Physical Activity and Cardiovascular Health in Predominantly Non-Hispanic Black and Hispanic Urban Neighborhoods Findings From the Walk Your Heart to Health Intervention

Objectives. The purpose of this study was to evaluate the effectiveness of the Walk Your Heart to Health (WYHH) intervention, one component of the multilevel Community Approaches to Cardiovascular Health: Pathways to Heart Health (CATCH:PATH) intervention designed to promote physical activity and reduce cardiovascular risk among non-Hispanic Black and Hispanic residents of Detroit, Michigan. The study was designed and implemented using a community-based participatory research approach that actively engaged community residents, health service providers and academic researchers. It was implemented between 2009 and 2012. Method. WYHH was a 32-week community health promoter–facilitated walking group intervention. Groups met three times per week at community-based or faith-based organizations, and walked for 45 to 90 minutes (increasing over time). The study used a cluster randomized control design to evaluate effectiveness of WYHH, with participants randomized into intervention or lagged intervention (control) groups. Psychosocial, clinical, and anthropometric data were collected at baseline, 8, and 32 weeks, and pedometer step data tracked using uploadable peisoelectric pedometers. Results. Participants in the intervention group increased steps significantly more during the initial 8-week intervention period, compared with the control group (β = 2004.5, p = .000). Increases in physical activity were associated with reductions in systolic blood pressure, fasting blood glucose, total cholesterol, waist circumference and body mass index at 8 weeks, and maintained at 32 weeks. Conclusion. The WYHH community health promoter–facilitated walking group intervention was associated with significant reductions in multiple indicators of cardiovascular risk among predominantly Hispanic and non-Hispanic Black participants in a low-to-moderate income urban community. Such interventions can contribute to reductions in racial, ethnic, and socioeconomic inequities in cardiovascular mortality.

Leader Behaviors, Group Cohesion, and Participation in a Walking Group Program

INTRODUCTION Less than half of all U.S. adults meet the 2008 Physical Activity Guidelines. Leader behaviors and group cohesion have been associated with increased participation or adherence in sports team and exercise class settings. Physical activity interventions in community settings that encompass these factors may enhance intervention adherence. The purpose of this study is to examine the impact of Community Health Promoter leader behaviors and group cohesion on participation in a walking group intervention among racially/ethnically diverse adults in low to moderate-income communities in Detroit, Michigan. DESIGN Data for the current study were drawn from the Walk Your Heart to Health (WYHH) data set. WYHH was a multisite cluster RCT with a lagged intervention and outcome measurements at baseline and 4, 8, and 32 weeks. Pooled survey data from both intervention arms were used for the current study. Data were analyzed between August 2013 and October 2014. SETTING/PARTICIPANTS A total of 603 non-Hispanic black, non-Hispanic white, and Hispanic adults across five cohorts that began the 32-week WYHH intervention between March 2009 and October 2011. INTERVENTION The intervention was a 32-week walking group program hosted by community- and faith-based organizations and facilitated by Community Health Promoters. Walking groups met three times per week for 90 minutes per session. To promote participation in or adherence to WYHH, Community Health Promoters used evidence-based strategies to facilitate group cohesion. Group members assumed increasing leadership responsibility for facilitating sessions over time. MAIN OUTCOME MEASURES Participation in WYHH as measured by consistency of attendance. RESULTS Community Health Promoter leader behaviors were positively associated with participation in WYHH. Social but not task cohesion was significantly associated with consistent participation. Social cohesion may mediate the relationship between leader behaviors and walking group participation. CONCLUSIONS Providing leaders with training to build socially cohesive groups may help motivate individuals to continue participation in community-based physical activity programs.