Conducting Community Health Research Alexis M. Stoner, MPH, PhD Candidate Clinical Instructor and Course Director of Epidemiology, Clinical Prevention and Population Health – Carolinas Campus

Community Health Research Clinical Research Basic/Bench Research

Why Conduct Community Health Research? Health of the community is dependent on many factors affecting an entire population. Using a population as an organizing principle for preventive action has the potential to have a great impact on the entire population’s health. It takes partnering at all levels to fully realize the impact of any health intervention.

Why Conduct Community Health Research? Addresses barriers between researchers and participants Provides action and methods that leave a community with improvements Creates new knowledge and directly benefits a community

Continuum of Community Based Research for Health Traditional (On) Community- Engaged Research (In) Community Based Participatory Research (CBPR) (With)

Key Characteristics Prevention focus Population-Centered Partnership with the Community Multidisciplinary Approach Often participants continue their usual activities Blumenthal, D. S., Yancey, E. Community-based health research: Issues and methods (2004).New York: Springer Pub. Israel, B. A. (2005). Methods in community-based participatory research for health (1st ed.). San Francisco, CA: Jossey-Bass

Key Characteristics Acknowledge community as a unit of identity Build on strengths and weaknesses in community Generates knowledge and intervention for mutual benefit of all partners Typically addresses issues of local relevance Uses a cyclical, iterative process Disseminates results to all partners Blumenthal, D. S., Yancey, E. Community-based health research: Issues and methods (2004).New York: Springer Pub. Israel, B. A. (2005). Methods in community-based participatory research for health (1st ed.). San Francisco, CA: Jossey-Bass.

CBPR Research Process Maintaining Partnership Community Assessment and Diagnosis Defining the Issue and forming a research question Implement Evaluation and interpreting results Disseminating and translating research findings CBPR Research Process Israel, B. A. (2005). Methods in community-based participatory research for health (1st ed.). San Francisco, CA: Jossey-Bass

Cardiovascular Risk Reduction Community Trials Framingham Heart Study Established link between behavior and heart attacks and strokes Series of randomized controlled trials developed to address multiple behavioral risk factors Intervention at the community level to effect individual behavior and health outcomes Stanford Five Cities Project, Minnesota Heart Health Program, Pawtucket Heart Health Program

Defining a Community What do we mean by community?

Cardiovascular Community Trial Studies Large scale Long-term in duration Chose multiple cities as units of community to examine intervention

CBPR Research Process Maintaining Partnership Community Assessment and Diagnosis Defining the Issue and forming a research question Implement Evaluation and interpreting results Disseminating and translating research findings

Community Assessment Establish a baseline for which objectives, outcomes, and measures of change can be developed Gain an “insiders’” view into the community you are working with Comprehensive understanding of influences on conditions for a population to be in good health Biomedical, social, behavioral, political, cultural, economic

Community Assessment Case Study Research Design Data Collection Demographic data Secondary data – perspectives from both insiders and outsiders Secondary data on history and geography Field notes Interview notes/transcripts Case is the community

Cardiovascular Community Trial Studies Results from Framingham Health Study Conducted surveys to random samples Epidemiologic Surveillance

CBPR Research Process Maintaining Partnership Community Assessment and Diagnosis Defining the Issue and forming a research question Implement Evaluation and interpreting results Disseminating and translating research findings

Defining the Issue/Forming a Research Question Seeking to determine If a certain condition exists To what extent it exists How and to what extent a condition impacts the community The outcome of an intervention in addressing a condition Conduct a thorough literature review Identify what is most important and pertinent to the community!

Cardiovascular Community Trial Studies Wanted to determine if risk-reduction health promotion messages delivered through multiple channels would lead to a reduction in cardiovascular morbidity and mortality.

CBPR Research Process Maintaining Partnership Community Assessment and Diagnosis Defining the Issue and forming a research question Implement Evaluation and interpreting results Disseminating and translating research findings

Implementation Grimes, D. A., & Schulz, K. F. (2002). An overview of clinical research: The lay of the land. The Lancet, 359(9300), 57-61.

Cardiovascular Community Trial Studies Quasi-experimental 3 intervention cities 3 control cities

Implementation Consistency Adherence to good research practices Account for environmental variability Communication

CBPR Research Process Maintaining Partnership Community Assessment and Diagnosis Defining the Issue and forming a research question Implement Evaluation and interpreting results Disseminating and translating research findings

Evaluation and Interpreting Results Organized data management system Working with a biostatistician Formative or summative evaluation

CBPR Research Process Maintaining Partnership Community Assessment and Diagnosis Defining the Issue and forming a research question Implement Evaluation and interpreting results Disseminating and translating research findings

Disseminating and Translating Research Findings Results should be shared with community members When reporting remember limitations of study design – poor generalizability, ecological fallacy How do these results translate into lasting principles to improve the health of the population?

Cardiovascular Community Trial Studies Challenges Results were modest if positive at all Competing with other interventions Sample size Differences among subgroups within the populations

Benefits Provides a complete picture of the community Meets a community’s needs Helps build relationships and creates interdisciplinary collaboration Translation across similar communities

Limitations External validity (generalizability) Time commitment Sample size

Informal Exercise Who is the community? What is the problem? What is your research question? How would you implement your research or intervention?

Questions?

References Blumenthal, D. S., Yancey, E. Community-based health research: Issues and methods (2004).New York: Springer Pub. Grimes, D. A., & Schulz, K. F. (2002). An overview of clinical research: The lay of the land. The Lancet, 359(9300), 57-61. Israel, B. A. (2005). Methods in community-based participatory research for health (1st ed.). San Francisco, CA: Jossey-Bass A Manual for Community Based Participatory Research. http://www.theceal.org/images/Documents/CEAL-UNC-Manual-for-Community-Based-Participatory-Research-1.pdf