1. 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

2. 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

3. 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

4. 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

5. 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)

7. 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).

8. 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)

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

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

18. How to build community-academic partnerships

19. King et al., 2015

20. 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

21. THANK YOU!
KEYONNA KING, DRPH, MA ASSISTANT PROFESSOR CENTER FOR REDUCING HEALTH DISPARITIES website:

23. 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)

24. 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)

25. 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)