conducting community health research alexis m. stoner, mph, phd candidate clinical instructor and...
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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
activitiesBlumenthal, 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
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
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
ImplementEvaluation 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
ImplementEvaluation 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
ImplementEvaluation 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
ImplementEvaluation 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