Research-what is it and why do we do it?

Research and Public Health Science looks for truth, practice looks for what works. What works is true, and what is true works. - Guy Steuart, 1963

Background Academic  Researcher  Teacher Practitioner  Community Health Educator  Trainer Heritage  Physician to last Empress of China  Truck farmer growing Chinese vegetables in Jacksonville, Florida

Research and Public Health  Research  Individual Responsibility  Needs-Based  Practice  Common Good  Human Rights-Based

Contradictions Protection of human subjects has guarded communities of color from the research process Research on communities of color has rarely been directly beneficial and sometimes has actually done harm.

Contradictions Problems of disease, illness, and risk are selected based on epidemiological data Issues selected based on everyday life experience

Contradictions Study design and budget proposed reflects review of scientific literature and feasibility Study design, budget, and proposal reflects community ownership and authenticity

Contradictions Recruitment and retention based on science and “best guesses” Recruitment and retention based on trustworthiness of viewpoints

Contradictions Psychometric testing of measures adopted or adapted from other studies Measures developed and tested to increase credibility and dependability of data

Contradictions Effective and sustainable interventions are informed by the concerns, culture, and assets of participating community Effective and sustainable interventions are informed by theory and “best practices” of other studies

Contradictions Interpretation, dissemination, and translation of findings aimed at transferability through CBO channels of communication Interpretation, dissemination, and translation of findings aimed at generalizability and publications in peer reviewed literature

Partnership Approach to Research  Equitably involves research partners in all aspects of research  Mutual learning is an on-going process  Equitably contributes expertise and sharing responsibility and ownership  Integrates knowledge gained with interventions to improve the health and well-being of community members

Necessary Conflict By whom research is to be conducted (Which groups come to the table?) For whom research is to be conducted (Which issues get to the table?) How research is to be conducted (Which groups shape awareness of the issues?)

Which Groups Come to the Table?

University at the Table Investigators from Epidemiology and Health Behavior & Health Education Community Outreach Specialist Ethnographer Graduate Students

Funder at the Table CDC, Boston University School of Public Health Partners in Health and Housing Prevention Research Center

Community & Agency at the Table: Formative Phase Community Advisory Group Church Leaders Public Housing Residents Police Outreach workers Nurse from the State Health Department Social worker at shelter for battered women Job trainer at Community Action Agency

Public Housing Residents and Community Health Community Advocacy Specialist Family and Community Collaborations with local, state National MCH agencies Family Health Policy Agency PHRs BHA

Which Issues Get to the Table?

University Issues that Get to the Table Community is ranked third among the State in highest rate of new HIV infections for : 20 per 100,000 person-years Gonorrhea rate in was comparable to two major US cities with the highest 2009 rates: 1746 cases per 100,000 person-years

Community Issues that Get to the Table Community assessment found STDs among top 3 priority issues Condoms are used only with side partners because unprotected sex with a main partner defines a committed relationship Perceived barriers to prompt seeking of STD care are lack of anonymity and feeling misunderstood at the community health centers

Community Issues that Get to the Table Men and women at risk for STDs seek information, assistance, and advice about sexual intimacy from women, who are not members of their social networks Women at risk for STDs are connected to the wider community through women who assist them with basic needs such as childcare, jobs, transportation, and housing

Which Groups Shape Awareness of Issues?

Community & Agency at the Table: Design Phase Community Resource Group Social Worker at Shelter for Battered Women President of Ministerial Alliance & Housing Authority Board Member Director of Community Center & Part-time Police Officer Announcer at WILD Radio Station & Ex-Drug Abuser Director of Day Care Center Counselor at High School Job Training Instructor at Community Action Agency Unit coordinator at Community Health Center Social Worker at Department of Social Services

Groups that Shape Awareness of Issues Community Outreach workers and RHAs Lay Health Advisors Community’s Natural Helping Networks Agencies’ Formal Helping System Community Resource Group CDC-PRC

BHA and PRC Engaging the Community Conduct focus groups  Design and implement strategy to recruit RHAs  Develop training curriculum to include session on Finding Out if the Program Works  Construct community survey questionnaire-FISP

Funder Concerns Place no one at risk External Review  An intervention focused on assisting women at-risk for STDs may place them at-risk for violence from partners  Men should be included as lay health advisors

Outcomes Among women reporting symptoms, increase of 60% seeking STD care within 3 days of symptoms Among women reporting care seeking, increase of 26% seeking STD care when thought had STD but no symptoms Thomas, Earp & Eng, 2000

Power of Community as Co-Practitioner When key community members… are asked to help set priorities and to identify related health concerns, [they] may become committed to the program and can be helpful in unleashing the voluntary energy that is to be tapped through [this] network. - CDC’s Guidelines for Community Demonstration Projects

Power of Community as Co-Investigator [T]he opportunity…for communities and science to work in tandem to ensure a more balanced set of political, social, economic, and cultural priorities, which satisfy the demands of both scientific research and communities at higher risk. -John Hatch et al., 1993

Power of a Bowl How does the community benefit from research?