1. Use of Community Based Participatory Research (CBPR) to Develop Nutrition Programs for Chronic Disease Prevention Elena Carbone, Dr.P.H., R.D., L.D.N. Associate Professor of Nutrition University of Massachusetts, Amherst September 14, 2010

2. Outline I. Introduction II. Definition III. Traditional vs. CBPR Approaches IV. Research Examples V. Implications

3. I.Introduction  Poor dietary behavior is a risk factor for numerous chronic diseases in Russia and the United States, including: Cardiovascular disease Stroke Maternal and infant health Diabetes Obesity

4. I.Introduction  Different research and program approaches are used to understand dietary behaviors in relation to chronic disease risk, with varying success.  Goal: Introduce CBPR as one approach to help address significant diet-related chronic diseases in Russia.

5. II.Definition: CBPR A collaborative approach to research that combines methods of inquiry with community capacity- building strategies to bridge the gap between knowledge produced through research and what is practiced in communities to improve health. …increases the value of studies for both researchers and the community being studied. Viswanathan et al., 2004

6. III.Traditional vs. CBPR Approach Research Steps Traditional Approach CBPR Approach 1. Identify health concernBased on epidemiologic evidence and funding priorities. Involves full participation of community.

7. III.Traditional vs. CBPR Approach Research Steps Traditional Approach CBPR Approach 1. Identify health concernBased on epidemiologic evidence and funding priorities. Involves full participation of community. 2. Design study, seek funding Design based on scientific rigor and feasibility. Funding requested primarily for research expenses. Community involved in study design and proposal submission.

8. III.Traditional vs. CBPR Approach Research Steps Traditional Approach CBPR Approach 1. Identify health concernBased on epidemiologic evidence and funding priorities. Involves full participation of community. 2. Design study, seek funding Design based on scientific rigor and feasibility. Funding requested primarily for research expenses. Community involved in study design and proposal submission. 3. Recruit participants, implement retention strategy Based on scientific issues and “best guesses” about recruitment and retention of community members. Community provides guidance regarding recruitment and retention strategies.

9. III.Traditional vs. CBPR Approach Research Steps Traditional Approach CBPR Approach 4. Design measurement instruments and collect data Instruments adopted or adapted from other studies. Tested primarily with psychometric analytic methods. Instruments developed and pilot tested with community input.

10. III.Traditional vs. CBPR Approach Research Steps Traditional Approach CBPR Approach 4. Design measurement instruments and collect data Instruments adopted or adapted from other studies. Tested primarily with psychometric analytic methods. Instruments developed and pilot tested with community input. 5. Design and implement intervention Researchers design intervention based on literature and theory. Community helps guide intervention development.

11. III.Traditional vs. CBPR Approach Research Steps Traditional Approach CBPR Approach 4. Design measurement instruments and collect data Instruments adopted or adapted from other studies. Tested primarily with psychometric analytic methods. Instruments developed and pilot tested with community input. 5. Design and implement intervention Researchers design intervention based on literature and theory. Community helps guide intervention development. 6. Analyze and interpret data, disseminate, and translate findings Researchers report findings from statistical analyses and publish in peer-reviewed journals. Community assists researchers with interpretation, dissemination, and translation of findings. Adapted from: Viswanathan et al., 2004

12. IV.Research Example #1: Diabetes  Purpose: Examine self-management practices, knowledge, and beliefs of Latino patients with type 2 diabetes and their health care practitioners. Inform development of a diabetes intervention.  Setting: Community-based health clinic.  Study Design: Cross-sectional, descriptive.

13. IV.Research Example #1: Diabetes  Methods: Two practitioner focus groups Four patient focus groups  Findings: Important knowledge gaps regarding diabetes causation and self-management were identified.  Benefits: Step 1(identify health concerns), Step 5 (design intervention).  Challenge: Extensive time needed to get community input and approval for analysis, interpretation, and publication of results.

14. IV.Research Example #2: Hypertension  Purpose: Examine knowledge, beliefs, and practices about hypertension management among older Latino adults. Inform development of a hypertension intervention.  Setting: Community-based senior center.  Study Design: Descriptive, feasibility.

15. IV.Research Example #2: Hypertension  Methods: Three focus groups.  Findings: Important knowledge gaps, and beliefs about hypertension management were identified; the role of family and learning style preferences were defined.  Benefits: Step 4 (design measures), Step 5 (design intervention).  Challenge: Lack of experience, confidence, and trust by community members initially limited meaningful input.

16. IV.Research Example #3: Obesity  Purpose: Marketing-based o besity prevention program for 11-14 year old Latino and White adolescents.  Setting: Two low-income communities.  Study Design: Two-group intervention.  Methods: One-year formative work (interviews and focus groups), four-year community-based intervention.

17. IV.Research Example #3: Obesity  Findings: Significant increase in food label reading and awareness of food marketing strategies.  Benefits : Step 2 (design study), Step 3 (recruit participants), Step 4 (pilot test measures), Step 5 (design and implement intervention).  Challenges: Perceived community burden. Initial lack of experience by graduate research assistants.

18. V.Implications Community  Increased acceptance.  Greater sensitivity to cultural and social norms.  Increased motivation.  Increased chances for meaningful results. Researchers  Enhanced recruitment and retention.  Increased measurement validity and reliability.  Increased sustainability.  Increased chances for meaningful results.

19. V.Implications  In what ways do you see CBPR working to address some of the significant health priorities in Russia?  What benefits do you envision in using CBPR?  What challenges do you envision in using CBPR?

20. V.Implications 1. Ask: “Is CBPR the right fit for this community and for this research?” 2. Conduct initial research 3. Conduct additional preliminary research 4. Conduct “key informant” interviews 5. Meet with potential partners 6. Plan for sustainability

21. References Community-Campus Partnerships for Health. Accessed September 10, 2010, http://depts.washington.edu/ccph/commbas.html Israel B, Schulz A, Parker E and Becker A. Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19, pp. 173-202; 1998. Viswanathan M, et al., Community-Based Participatory Research: Assessing the Evidence. Evidence Report/ Technology Assessment No. 99 (Prepared by RTI–University of North Carolina Evidence- based Practice Center under Contract No. 290-02-0016). AHRQ Publication 04-E022-2. Rockville, MD: Agency for Healthcare Research and Quality. July 2004.