1. Challenges Conducting Research at Community Health Centers Mario Orozco, DDS, MPH GIFT Project Director morozco@dentistry.ucla.edu

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

3. Challenges = Learning experiences

4. 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

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

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

7. The Divorce

9. 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

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

13. 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

14. Challenges Conducting Research at CHCs 1. Planning Underestimation of start-up, recruitment, hiring, transfer of funding, etc Eskenazi BR, et al. 2005. 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 113:1419-1429

15. 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

16. 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

17. 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

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

19. Challenges Conducting Research at CHCs 6. Ethical issues – Informed consent: lengthy and complex forms Reading level Specialized vocabulary Eskenazi BR, et al. 2005. Methodologic and Logistic Issues in Conducting Longitudinal Birth Cohort Studies: Lessons Learned from the Centers for Children's Environmental Health and Disease Prevention Research

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

21. 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

22. THANK YOU!