VICKI HINES-MARTIN, PHD, RN, FAANPROFESSOR AND DIRECTOR OFFICE OF DISPARITIES AND COMMUNITY ENGAGEMENT

SCHOOL OF NURSINGFACULTY SCHOLAR AND ACTING ASSOCIATE VICE PRESIDENT

OFFICE OF THE VICE PRESIDENT FOR COMMUNITY ENGAGEMENT&

SHARON BOWLAND PHD, LCSWASSISTANT PROFESSOR AND DIRECTOR GERONTOLOGY PROGRAM

HARTFORD GERIATRIC RESEARCH SCHOLARKENT SCHOOL OF SOCIAL WORK

UNIVERSITY OF LOUISVILLEKENTUCKY

Connecting the Dots: Partnering with Community

to Build CBPR Research Skills Among Graduate Students

2012 IARSLCE Conference

Baltimore MD

September 24, 2012

Students

The purpose of the project was two-fold

1) To conduct a research study to complete a comprehensive assessment of health status, quality of life indicators and community residents’ perceptions to determine strengths and challenges of community living from residents with chronic health and aging concerns;

2) To provide health and service professions graduate students with real world experience with Community Based Participatory Research (CBPR) with community members with complex health and resource needs.

*Study funded by a University of Louisville Office of Community Engagement Faculty Grant

PROJECT PURPOSE

The study was based upon the Social Ecology model which stresses the importance of the context in which the

individual exists, interact; and the affect those interactions have on their health status and behaviors and their quality

of life.

1) environmental,

2) social,

3) interpersonal aspects of experience and

4) individual

PROJECT FRAME WORK

Community-Based Participatory Research

Building on a 3-year relationship with this community in which services and student learning activities had been identified, developed, implemented and evaluated with

community partners

The First Research Project with this community which was initiated based on community identified needs

Multiple partners – university faculty and students, gerontology service, community mental health agency, local public housing authority, residents’ council and interested

community residents

RESEARCH METHOD

1) low-income, public housing complex built in the 1960’s within one city-centre block,

2) built as one of five housing complexes targeted for seniors only.

3) last 7 years, transitioned from seniors only to residents across the lifespan.

4) approximately 650 residents, primarily African American with an almost equal division between males and females.

5)~70% of residents were 59 years or younger, all of whom had chronic, disabling health conditions.

THE COMMUNITY

PROJECT SETTING

Extensive collaboration and communication with the community and project partners to accomplish each of the following:

Project recruitment, scheduling and interviewing

Problem-solving

Activity coordination

Progress updates

Reporting to multiple audiences

Critical thinking to address emergent issues

Priority setting

Professional presentation development and delivery

Publication development

STUDENT ACTIVITIES

Measurement of Student Outcomes

1) Objective (Scholarly Outcomes resulting from the project in which students were involved)

2) Subjective (Reflection of students regarding their cognitive and emotional response to involvement in the project)

SERVICE-LEARNING MEASUREMENT

Objective Measurement of CBPR Service-learning

Outcomes from the service-learning project involved faculty and students.

Overall there were 7 presentations that resulted from the project (local – international) and student posters won two

research awards (1 local and 1 regional)

Examples include….

SCHOLARLY OUTCOMES

Needs of Aging Adults Living In Urban Public Housing

Sharon Bowland, PhD, LCSW1, Vicki Hines-Martin, PhD, RN, FAAN2, Jean Edward, BSN, RN2, & John Myers, PhD2,3

University of Louisville, Departments of Social Work1 Nursing,2 & Public Health3Introduction

PurposeEarlier nursing clinical evidence about the needs amongst individuals in this population led to systematically assessing their needs through a community assessment study.

Methods Community-based participatory research approach. Participants were recruited by students, on-site program workers, and flyers. Participants completed two interviews consisting of demographic data, access to shopping, the SF-36 Health Survey, Ferrans & Powers’ Quality of Life Index(QLI), the Lubben Social Network Scale (LSNS), and the Camberwell Assessment of Need (CAN-R & CANE) to assess unmet needs. Volunteers were given $15 in household items for their time. Interviews were conducted by faculty and students in social work and nursing. Referrals for follow-up were made to an on-site program for case management when needs were identified. A crisis protocol was in place for residents with acute needs.

Sample (N = 100) :- Age 25-76 years (average

54.9). - 77% of the total population (N

= 660) were aged 50+. - Predominantly African-

American (78%) - Average of 2.45 chronic

health conditions (HTN, diabetes, arthritis) and physical disabilities.

- >50 % identified having a mental illness (depression,

bipolar disorder, anxiety).- Most rated health as fair or

poor. - Physical and/or emotional

health was frequently reported as interfering with social activities. 37% of participants reported that their physical or emotional health interfered quite a bit (n= 24) or extremely (n=13) with normal social activities with family, friends, neighbors, or groups. The importance of emotional support received from family was rated as very important by 71.7% (n=66) on the QLI. Nevertheless, residents often reported estrangement or difficulty with family.

Results

Acknowledgement

Results

Predictor Older, n=24Mean (SD)

Younger, n=76Mean (SD)

p-value

Age 64.5 (0.9) 51.8 (0.8) 0.002**Length in Residence

8.6 (1.5) 3.6 (0.5) <0.001**

QLI Total 20.8 (4.1) 18.6 (7.9) 0.194 Health & Functioning

18.9 (5.5) 17.8 (8.8) 0.543

Social & Economic

19.8 (3.5) 16.5 (7.2) 0.036**

Psych/Spiritual 23.7 (4.2) 20.7 (9.0) 0.121 Family 20.7 (5.6) 19.3 (8.6) 0.468Social Network (LSNS)

12.8 (6.2) 13.3 (6.5) 0.780

Unmet Needs (CAN/E)

5.2 (4.7) 8.3 (5.7) 0.020**

TABLE 2. COMPARISON OF OLDER /YOUNGER ON HEALTH INDICATORS

SF-36 Health Survey

Older, n = 24Mean (SD)

Younger, n = 76Mean (SD)

p-value

Total 52.2 (11.6) 48.8 (12.7) 0.248Physical Health 34.0 (10.8) 32.6 (8.9) 0.266Mental Health 17.2 (11.9) 16.2 (11.3) 0.456Physical Functioning

55.0 (6.0) 50.4 (3.1) 0.481

Role-Physical 26.6 (6.2) 22.7 (3.2) 0.557Role-Emotional 21.3 (6.0) 20.4 (3.4) 0.898Vitality 49.6 (5.1) 48.4 (2.2) 0.799Emotional Well-Being

59.0 (3.0) 56.8 (2.5) 0.646

Social Functioning

64.1 (7.2) 57.2 (3.6) 0.372

Bodily Pain 22.7 (3.3) 22.8 (1.9) 0.976General Health 48.1 (5.4) 43.1 (2.7) 0.382

TABLE 1. COMPARISON OF OLDER /YOUNGER ON DEMOGRAPHIC & PSYCHO-SOCIAL FACTORS

This research was supported by a grant from University of Louisville’s Office of Community Engagement

DiscussionOlder adults had fewer unmet needs than their younger counterparts, which may be partially due to the inability of younger residents to secure health and mental health care for disabling conditions, (some were not on disability, although they had filed), whereas older residents had access to Medicare and senior services. Older adults had higher needs for support in housekeeping and self care when compared with the younger group. Both groups had low functioning in health & mental healthEducation about existing services, advocacy to improve access to community services, programs that provide social contact, and health promotion activities may be keys to reducing health disparities in this community.

Dosker Manor is a community with health challenges. It has a mixture of approximately 660 adults and older adults with chronic health and mental health disabilities. The community is uniquely situated in one downtown city block (3 high rise buildings). Agencies serving Dosker Manor, including ElderServe, Inc., Seven Counties Services, Louisville Metro Housing Authority and the Residents’ Council collaborated to assess the needs and strengths of residents. Students & faculty from nursing and social work worked with an on-site program in completing this project.

Objective Measurement of CBPR Service-Learning

Students and faculty collaborated on the development of three manuscripts

One manuscript is in review (Journal of Higher Education Outreach and Engagement)

Two manuscripts are currently in development (aging population, and social determinants and mental health)

SCHOLARLY OUTCOMES (CONT.)

Subjective Measurement

Reflection – use of cognitive and metacognitive skills.

Requested after the project was completed

Electronic journals

Responses to the following questions

How they viewed the community over time

How they evaluated their experience with community

If experience affected professional development (how)

Experience on a multidisciplinary (inter-professional) team

SERVICE-LEARNING MEASUREMENT

Student Reflection Themes

Changing Perspectives (I found myself inspired by the residents who had so little yet content with what they did have)

Working with an interdisciplinary team (we each use a different set of skills, … [which used together] helped to identify needs)

Importance of ethical considerations

Gaining organizational and research skills

Mutual positive regard (… participants let us know that our work was really appreciated. I looked forward to going…and meeting these amazing people.)

SUBJECTIVE OUTCOMES

TangibleMultiple projects (funded & unfunded), support group on

trauma, political advocacy

IntangibleStrengthened partnership, trust, appreciation and

communication

vphine01@louisville.edu

OUTCOMES FOR THE COMMUNITY