community based participatory research: evaluating processes and outcomes

Nina Wallerstein, DrPHUniversity of New Mexico

nwallerstein@salud.unm.edu

Malia Villegas, EdDNational Congress of American Indians Policy Research

Centermvillegas@ncai.org

Community Campus Partnerships for HealthHouston, April 18, 2012

Research for Improved Health: A National Study of Community-

Academic PartnershipsOverall Goal:

To examine the facilitators and barriers to effective community-academic partnerships to improve health and health equity in AI/AN communities and other communities which face disparities

Partners: (2009-2013)National Congress of American Indians Policy Research CenterUniversity of New Mexico Center for Participatory ResearchUniversity of Washington Indigenous Wellness Research Institute

Funding: Native American Research Centers for Health (NARCH V): NIH/Indian Health Service partnership

Three-Year Pilot: National Center of Minority Health and Health Disparities (2006-2009) (Wallerstein/Duran: PI)National Advisory Board (CBPR Think Tank)Literature Review (2003-2008): PubMed, Business Premier, Psych Info, SciSearch, Communication and Mass Media; Key Words: Community Based Participatory Research, CBPR, participatory research, action

research, participatory action research, participatory evaluation, community driven research, action science, collaborative inquiry, empowerment evaluation

From over 2000 articles, 287 reviewed, used to generate model characteristics

Internet Survey (Appropriateness of Characteristics)Development of Model (Wallerstein et al, 2008; Chapter

in CBPR and Health: Process to Outcomes, 2nd edition)

History

Research for Improved Health

Examples of items in MatrixThe political and social climate seem "right" for starting

a collaborative project like this one.I have a lot of respect for the other people involved in

this collaboration.I can talk openly and honestly at the Board meetings.

I am comfortable expressing my point of view.The partnership has been successful at preparing tribal

leadership.To what extent has your partnership strengthened

ATOD-related policies and regulations in the community?‘

The partnership positively influences community health.

Research for Improved Health

Specific aims: Describe the variability of CBPR

partnerships/projects Describe the impact of governance on CBPR

processes and outcomes Examine associations among partnering processes

and intermediate system/capacity and health outcomes

Identify promising practices, assessment tools, and future research needs.

Research for Improved Health Methodology:

Quantitative: Internet survey of 327 federally funded CBPR projectsKey informant interview surveys (PIs) to enhance recruitment and

validate dataCommunity Engagement survey of perceptions(Identified in 2009 RePORT data base & NARCH Projects).

Qualitative: At least 6 case studies of partnerships (originally 8)Examine similarities and differences across key contexts, partnering

processes, and outcomes Deepen interpretations of survey

Research for Improved Health Select Hypotheses

The more a CBPR partnership integrates local knowledge into the research, the greater likelihood the project will result in intermediate system and capacity outcomes, ie., cultural renewal, sustainability, community capacity, policy & practice changes.

The more a project is aligned with CBPR principles, the better quality of intermediate system and capacity outcomes.

The more there is resource-sharing, participatory decision-making and reciprocal learning, the better the capacity outcomes.

The longer the CBPR partnership has been in operation, the more the project will result in intermediate outcomes which lead to improved health outcomes.

Research for Improved Health Accomplishments since Fall, 2009

Application of the conceptual model to study designLiterature review publication: measurement tools and

constructs (Sandoval et al, Health Education Research) http://hsc.unm.edu/SOM/fcm/cpr/cprmodel/Instruments/CBPR-InteractiveModel/CBPRInstruments-Matrix/InstrumentsMatrix--abstract.pdf

Project code of ethics and integrity, protocols for student involvement, publications, & communications: Study website: http://narch.ncaiprc.org/

Variable Matrix (Pearson et al, 2011, CES4Health; Web availability of Interactive Model linked to instruments and to variables/measures: http://hsc.unm.edu/SOM/fcm/cpr/cprmodel.shtml

Research for Improved Health Case StudiesPersonal Involvement/MotivationContext Emphasized:

History of Community: in Research/Social Movements Partnership/Group Dynamics:

Governance/Approval Processes Facilitators and BarriersPowerTrust

Interventions or Policy EmphasisCBPR Research

Themes in FindingsContext Matters:

Historic trust/mistrust readily present Urban/rural access

Governance Matters: Tribal Sovereignty and community accountabilityStructural agreements and approvals vary considerably

Identity of Researcher(s) Matter:Shared ethnic/racial identity enable bridging role

Interventions impacted by cultural embeddedness Partnership and Capacity Outcomes:

Community sustainability of interventionUniversity approval policies

Internet Survey DomainsContext : Community CapacityGroup Dynamics: Bridging

Alignment with Principles/Core ValuesTask RolesPower Dynamics/Decision-makingLeadership/StewardshipTrust

Intervention/Research: Partnership SynergyOutcomes

System and Capacity Changes: Policy/Quality/Access Changes in Power RelationsSustainabilityCultural Centeredness

Julie Lucero, 2012

Contact Information

Malia Villegas, Principal InvestigatorPrincipal Investigator, NCAI PRC NARCH Project

Email: mvillegas@ncai.org

Nina Wallerstein, Co-Principal Investigator, UNMQualitative Data Collection & AnalysisEmail: nwallerstein@salud.unm.edu

Bonnie Duran, Co-Principal Investigator, UWQuantitative Data Collection & Analysis

Email: bonduran@u.washington.edu