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