Center for Reducing Health Disparities Engaging communities and researchers to advance implementation science and address health disparities Keyonna King, DrPH, MA Assistant Professor Center for Reducing Health Disparities College of Public Health, Department of Health Promotion, Social and Behavioral Health

Today’s presentation will cover: Overview of community-based participatory research (CBPR) Barriers and solutions to engaging community How to build a community-academic partnership Recommendations for engaging community in implementation science research

Community Based Participatory Research (CBPR) Provide a means of collaboration between academia and the community in examining key community issues, and developing appropriate interventions to address the issues (Israel, Eng, Schulz, & Parker, 2005) Most well known and evidenced-based public health approach used to address health-related issues utilize best practices in community and outreach research Intent: translate research so that community can reap the benefits of the research about them! Community is involved in ALL phases of the project including definition of research questions and methods “Community-Partnered Participatory Research” (CPPR) to emphasize partnering with communities rather than merely possessing a location within the community to conduct research

Community Based Participatory Research (CBPR) Characteristics: Is an approach, not a research method or design Focus on population Takes place in the community setting not in a laboratory or hospital/clinic setting Fully partnering with the community Conducts research with the community not on a community or in a community Influences outcomes at the community level

Community Based Participatory Research (CBPR) Communities should be seen as PARTNERS. Not as: Laboratories – reduced to status of being guinea pigs (Research) Classrooms – reduced to status of being props for a teaching exercise (Teaching) Charity cases – reduced to status of being unable to take care of themselves (Service)

Implementation science Implementation is the use of strategies to adopt and integrate evidence-based health interventions and change practice patterns within specific settings.... (Department of Health and Human Services. Part 1 Overview Information Dissemination and Implementation Research in Health (R01). http://grants.nih.gov/grants/guide/pa-files/PAR-13-055.html.)

Implementation strategies “…Methods or techniques used to enhance the adoption, implementation, and sustainability of a clinical program or practice.” OR The “how” of implementation (Proctor, Powell, & McMillen, 2013)

Barriers & solutions to cbpr/cppr To engage the community, understand the barriers and address them when applicable (bodison et al., 2015) Barrier 1: researchers seldom allow communities to define the problems they want solved Barrier 2: during research development, key stakeholders are left out of the process Barrier 3: lack of trust Barrier 4: competing demands Barrier 5: dissemination of research seldom reach community and are not meaningful to the communities of study

Barrier 1: researchers seldom allow communities to define the problems they want solved Research related to health interventions developed in isolation of community input (t1 and t2 phases) Expectation that findings translated into community settings (t3 and t4 phases) Implies researchers alone are experts Researchers interact telling community what to do Academic driven “shared” interaction less likely to authentically engage in process Community less prone to adopt or promote recommendations

Solutions to barrier 1 Use cbpr/cppr “in all phases of the translational science pipeline to foster future incorporation of research discoveries into day-to- day clinical practice” (bodison et al., 2015, p. 816) Develop community-academic partnerships before specific research questions are developed so that community needs can be explored

Barrier 2: during research development, key stakeholders are left out of the process question that does not get answered very well or often during the development phases of community-based intervention research: How do collaborators determine their partners? Researchers may have best intentions, but may not have necessary contacts or avenues to begin this dialogue Community partners need confidence there are no stakeholders with hidden agendas

Solutions to barrier 2 Transdisciplinary approaches Common question that should be consistently asked: Who is not at the table that should be? Development and maintenance of catalogue of key community contacts Also consider survivors of health related concerns of interest for research projects

Barrier 4: competing demands Barrier 3: lack of trust Lack of trust between minority communities and researchers (e.g. Tuskegee study; sterilization of native Americans Barrier 4: competing demands Limits participation in research for low resourced communities Examples: location/transportation, inconvenient times

Solutions to barriers 3 & 4 Generate plans in advance to mitigate potential issues before they arise to facilitate trust Engagement of community partners Ethnically, linguistically-matched researchers Culturally-appropriate educational materials and health messages Respect socioeconomic and cultural differences – not just “lip service” Thoughtful actions guided by stakeholders

Barrier 5: dissemination of research seldom reach community and are not meaningful to the communities of study Community participants feel their time and efforts to a research agenda will not significantly or positively influence their communities Researchers/academic partners must work diligently to keep-up with academic expectations for promotion & tenure Publications and grants Nonscientific, jargon-free materials may not be valued for promotion & tenure Community being used to generate findings for more affluent and/or nonminority communities

Solutions to barrier 5 Community-partnered research conferences with jargon-free language Use traditional media outlets Social media outlets Develop dissemination plans

How to build community-academic partnerships

King et al., 2015

Recommendations to engage community in implementation science Develop/build community-academic partnerships Involve community in all phases of the research: development  implementation  dissemination Allow community to define problem/priority need Creates potential to sustain/take ownership of the intervention Better and sustainable outcomes Define implementations strategies within context of cbpr/cppr Reinvention/adaptation Avoid the use of jargon to explain strategies Be open and patient with differences in knowledge about research and community

THANK YOU! KEYONNA KING, DRPH, MA ASSISTANT PROFESSOR email: Keyonna.king@UNMC.EDU CENTER FOR REDUCING HEALTH DISPARITIES website: https://unmc.edu/publichealth/crhd/

CBPR and Implementation Science D & I Level CBPR Model ENVIRONMENT CONTEXT History, Funding Trends, Capacities INTERORGANIZATIONAL MIX OF PARTNERS ORGANIZATION EQUITABLE PARTNERSHIPS Structural and relationship dynamics PROJECT Re: Organization Re: Decision Re: Implementation SPECIFIC RESEARCH PROJECT Re: Specific health outcomes Re: Research design shaped by partners Re: Fits local/cultural knowledge and theories Re: Outcomes of sustainability/capacity, etc. INNOVATION HYBRID KNOWLEDGE (Wallerstein and Duran, 2016)

Examples of tailoring strategies to determinants within cbpr context Identified Determinants Implementation Strategies Lack of knowledge Interactive education sessions Perception/reality mismatch Audit and feedback Lack of motivation Incentives/sanctions Beliefs/attitudes Peer influence/opinion leaders Systems of care Process redesign (Powell, 2016; Bhattacharyya, 2012; Palda, 2007)

Tailoring implementation strategies have missed the mark “…results suggest a mismatch between identified barriers and the quality improvement interventions selected for use” (Bosch et al., 2007) There is a need for “systematic and rigorous methods…to enhance the linkage between identified barriers and change strategies (grol et al., 2013) This mismatch is an example of where CBPR can be used to provide clarity about the barriers and insight into which implementation strategy would be best to address the needs of the community. (Powell, 2016)