community-based participatory research: a summary of the evidence on research methodology and...
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Community-Based Participatory Research:
A Summary of the Evidence on Research Methodology and Community Involvement
Presented byMeera Viswanathan, PhD*, Alice Ammerman, DrPH, RD, Gerald Gartlehner, MD, MPH, Eugenia Eng PhD, Kathleen N. Lohr, PhD, Lucille Webb, MA
Meera Viswanathan, PhD,1 Alice Ammerman,DrPH, RD,2 Gerald Gartlehner, MD, MPH,3 Eugenia Eng PhD,4
Kathleen N. Lohr, PhD1, Lucille Webb, MA5
1Health, Social, and Economic Research, RTI International, Research Triangle Park, NC 277092Department of Nutrition, School of Public Health, University of North Carolina, Chapel Hill, NC 275993Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC 275994Department of Health Behavior and Health Education, CB #7440, School of Public Health, University of North Carolina, Chapel Hill, NC 275995Strengthening the Black Family, Inc., Raleigh, NC 27610
Funded by Agency for Healthcare Research and Quality
Research Team
Evidence-Based Review of CBPR
• Context for the evidence-based review of CBPR– Health disparities persist
– Knowledge is not always translated into appropriate action in communities of need
– Community-based participatory research (CBPR) offers an alternative approach to translating research into practice
Evidence-Based Review of CBPR
• Research Questions– How has CBPR been implemented to
date with regard to the quality of research methodology and community involvement?
– What is the evidence that CBPR efforts have yielded the intended outcomes?
Evidence-Based Review of CBPR
Identify and refine key scientific questions through
Consultation with a large group of experts prior to the study
Consultation with a standing Technical Expert Advisory Group during the course of the study
Identify sources of evidence to address key questions MEDLINE®
Psycinfo
Generate consistent search terms for each source
Conduct searches and compile all obtained literature
Evaluate each study against prespecified criteria
Sociofile Cochrane Collaboration resources
All included studies meet the following criteria:
English languageSet in U.S. or Canada
Extract data from each study using a data abstraction form
Synthesize data
Judge strength of evidence
Report results
Health outcome At least one community
collaborator
Systematic Review Methods
Design a data abstraction form
Conduct additional searches where necessary to obtain all published articles relevant to a study
Evidence-Based Review of CBPR
CharacteristicsNumbe
r
General characteristics
Total number of studies identified 60
Average number of publications per study 2
Publication dates of the first article from the study Percent
Before 1980 2%
1980-1985 0%
1986-1990 3%
1991-1995 13%
1996-2000 42%
2001 to 2003 40%
Characteristics of CBPR studies
Evidence-Based Review of CBPR
Substantive TopicsPercen
t
General health concerns 18%Environmental hazards 15%Hypertension/heart disease/diabetes 13%Services for HIV/AIDS 10%Substance abuse including smoking 8%Cancer screening and prevention 7%Women’s health 7%Asthma prevention 3%Occupational health 3%Seniors’ health 3%Other miscellaneous concerns (disabilities, hospice access, childhood immunization, nutrition, mental health) 12%
Characteristics of CBPR studies
Evidence-Based Review of CBPRType of funding sources
(of all identifiable funding sources)Percent
Federal agencies 57%
National Institute of Environmental Health Sciences
15%
Centers for Disease Control and Prevention 13%National Cancer Institute 4%US Environment Protection Agency 4%National Institute on Alcohol Abuse and Alcoholism
3%
Other agencies 19%
Foundations or private sources 20%
W.J. Kellogg Foundation 4%Robert Wood Johnson Foundation 3%Other foundations or private sources 13%
State funding 15%
Universities 8%
Type of Study and Research Design
0%
20%
40%
60%
80%
100%
Evaluatedintervention
Intervention eitherincomplete or not
evaluated fully
Non-interventional
Type of Study
Perc
ent o
f Stu
dies
NonexperimentaldesignsOne-group pre andposttest studiesObservational
Quasi-experimentaldesignsExperimental designs
0% 25% 50% 75% 100%Percent of Studies
Application of Findings to Health Concern Identified
Dissemination of Findings
Interpretation of Findings
Intervention Development, Implementation
Measurement Instruments and Data Collection
Recruitment and Retention
Study Design
Financial Responsibility for Grant Funds
Proposal Development
Selection of Research Question
Type of Community Involvement
Community Involvement
Comparing Research Quality and Community Involvement across Study Designs
1
1.5
2
2.5
3
Experimentaldesigns
Quasi-experimental
designs
Observational One-group preand posttest
studies
Nonexperimentaldesigns
Study Design
Scor
es (1
–3)
Scores for research quality
Scores for community involvement
Evidence-Based Review of CBPR
• Research Questions
– How has CBPR been implemented to date with regard to the quality of research methodology and community involvement?
– What is the evidence that CBPR efforts have yielded the intended outcomes?
Implementing CBPR: Research Quality
• We found very few complete and fully evaluated interventions that provide detailed information on community-based components
• Limitations on funding length and flexibility incomplete or unevaluated intervention
• Limitations on page length in journals incomplete documentation in peer reviewed journals
• However, we did not find evidence that high-quality scores in community collaboration are associated with low-quality scores for research
Implementing CBPR: Level of Community Involvement
• Community involvement extends through all areas of research with variable involvement in different stages. Self reported benefits include:
– community involvement leading to greater participation rates
– increased external validity
– decreased loss of followup
– increased individual and community capacity
Implementing CBPR: Level of Community Involvement
• Disadvantages of such methods, although infrequently reported, include:
– loss of internal validity
– introduction of selection bias
– lack or loss of randomization if contamination occurs
– highly motivated intervention groups not representative of the broader population
Achieving Intended Outcomes: Improving Research Quality • Reports of improved research quality
through the CBPR approach were primarily anecdotal
• Possible solutions:– A head-to-head test of CBPR versus
conventional research?• Conclusive proof vs. thorny ethical issues
– CBPR researchers should present the potential costs and benefits of CBPR, and document these in the course of their research
Achieving Intended Outcomes: Enhancing Community Capacity • Authors rarely cited enhanced community
capacity as an explicit goal of their projects, although it was often included in descriptions of the collaborative process
• Studies were much more likely to report capacity building on the part of the community than on the part of the researchers or their institutions
• Studies that report a higher level of community involvement were more likely to recognize and report capacity building on the part of the researchers
Achieving Intended Outcomes: Improving Health Outcomes
• Stronger or more consistent positive health outcomes were generally found in the higher quality research designs
• Unintended positive health outcomes (or intended, but unrelated to intervention) likely?– Yes
• Measured in these studies? – No
Implications for Practice
• Proof of concept:– High quality research and intense
community involvement are not contrary to each other. Our review uncovered several examples of outstanding research combined with collaborative community participation throughout the research process
Questions ?
