Challenges Conducting Research at Community Health Centers Mario Orozco, DDS, MPH GIFT Project Director

In just two phrases Yes = no now = tomorrow sí = no )#*KZ)^% = ?

Challenges = Learning experiences

OVERVIEW Challenges Conducting research activites Planning Recruitment & Enrollment Implementation of interventions Retention Research infrastructure Ethics Disseminaiton of findings Recruiting CHCs Marketing Projects CHCs buying into projects

CHALLENGES 1. Recruiting Community Health Centers (CHC) 2. Conducting research activities at CHCs

1. Recruiting Community Health Centers (CHCs) A. Investigators marketing projects to CHCs B. CHCs buying into research activities

The Divorce

Challenges Recruiting CHCs A. Academic institutions marketing projects to CHCs – Research activities are not a priority and compete with other needs of CHCs – Oral health may not be a priority for CHCs or perceived as urgent – Breaking myths about oral health

B. CHCs buying into research activities 1. Mistrust – Previous unpleasant experiences – Unknown researcher(s)/institution(s) Challenges Recruiting CHCs

2. Lack of interest – Research activities are not a priority 3. Mismatch between the mission of CHCs and project’s mission - Size of CHC - Target population - Location

Challenges Conducting Research at CHCs 1. Planning Underestimation of start-up, recruitment, hiring, transfer of funding, etc Eskenazi BR, et al Methodologic and Logistic Issues in Conducting Longitudinal Birth Cohort Studies: Lessons Learned from the Centers for Children's Environmental Health and Disease Prevention Research. Environ Health Perspect 113:

Challenges Conducting Research at CHCs 2. Recruitment and enrollment – Barriers to participation Number of visits Time required at each visit Length of follow-up period Language and cultural barriers Distrust and lack of understanding of what research entails Underestimation of oral health Eligibility criteria

Challenges Conducting Research at CHCs 3. Implementation of interventions – Informant has multiple children (distraction, lack of space in operating rooms) – Missed visits and tardiness – Lack of/unreliable transportation – Literacy, language and culture – Incompetent staff (language & cultural barriers, computer literacy) – Adherence to interventions

Challenges Conducting Research at CHCs 4.Retention – Inability to locate participants (disconnected phones, frequent moves) – Lack of interest induced by fatigue – Lack of or small budgets for incentives – Death of caregiver/participant

Challenges Conducting Research at CHCs 5. Research infrastructure – Data and specimen management systems – Collection and shipment of specimens

Challenges Conducting Research at CHCs 6. Ethical issues – Informed consent: lengthy and complex forms Reading level Specialized vocabulary Eskenazi BR, et al Methodologic and Logistic Issues in Conducting Longitudinal Birth Cohort Studies: Lessons Learned from the Centers for Children's Environmental Health and Disease Prevention Research

Challenges Conducting Research at CHCs 7. Communication of results – Longitudinal studies: time elapsed from data collection, analyses, interpretation and disseminaiton may be too long

A few thoughts The start is painful Think about your goals Do not lose direction Think high, but keep your feet on the ground Keep it simple Be honest Be humble

THANK YOU!