Nina Wallerstein, Dr.P.H. · CBPR is an orientation to research/data Changes the role of researcher...
Transcript of Nina Wallerstein, Dr.P.H. · CBPR is an orientation to research/data Changes the role of researcher...
Nina Wallerstein, Dr.P.H.
Professor, Public Health Program
University of New Mexico
Visiting Distinguished Faculty
San Francisco State University
“ Collaborative approach to research that equitably involves all partners in the
research process and recognizes the unique strengths that each brings. CBPR begins
with a research topic of importance to the community with the aim of combining
knowledge and action for social change to improve community health and eliminate
health disparities.”
W.K. Kellogg Community Scholar’s Program (2001)
CBPR is an orientation to research/data
Changes the role of researcher and researched
CBPR is not a method or set of methods
Qualitative and Quantitative
Assessment/Descriptive/GIS/Other tools
Epidemiology AND Intervention Research
CBPR is an applied approach
Goal is to influence change in community
health, systems, programs, or policies
Purpose: To Improve CBPR Science 1) To identify facilitators and barriers to effective CBPR across
diverse populations and settings 2) To assess variability of CBPR across populations/settings 3) To test CBPR conceptual model and associations partnering &
outcomes
Partners: 1) National Congress of American Indians Policy Research Center
(M. Villegas, PI) 2) University of Washington (B. Duran, co-PI)
3) University of New Mexico (N. Wallerstein, co-PI)
NIH/NARCH III: Pilot Funding (2006-2009): NIMHD NIH/NARCH V: Funding (2009-2013): NIGMS, NIDA, NCRR, NCI, NIMHD, OBSSR (with Indian Health Service)
Interactive Model linked to instruments and to variables/ measures: http://fcm.unm.edu/cpr/cbpr_project.html
Literature review of measurement tools/metrics
258 articles: 46 unique studies; 224 process/outcome measures Sandoval JA, Lucero J, Oetzel J, Avila M, Belone L, Mau M, Pearson C, Tafoya G, Duran B, Iglesias Rios L, Wallerstein N.(2011) Process &outcome constructs for evaluating community-based participatory research projects: a matrix of existing measures. Health Educ Research
Pearson, C., Duran, B., Lucero, Sandoval, J., Oetzel, J., Tafoya, G., Belone, L., Avila, M., Martin, D., Wallerstein, N., Hicks, S., (2012), CBPR Variable Matrix: CES4Health.info
Project code of ethics and integrity, protocols for students, publications, communication, tools: http://narch.ncaiprc.org
Mixed Methods Research: Internet Survey/Case Studies Hicks, S., Duran, B., Wallerstein, N., et al, Evaluating Community-Based
Participatory Research (CBPR) to improve community-partnered science and community health, Progress in Community Partnerships, Fall, 2012
National cross-sectional survey of all federally funded CBPR projects
(criteria = working with community partner or CAB, or any
level of community engagement. If unsure, left in sample)
Extramural funded studies in 2009 NIH RePORTER database
A “research” project with at least 2 years of funding (not training grants or pilot studies)
▪Mechanisms: R01, R18, R24, R34, RC1, RC2, U01, U19, U26, U28, U54
What is the variability across different dimensions of model?
What are associations between partnership processes and CBPR outcomes?
Two Surveys:
Key Informant (~15 minutes):
Taken by Principal Investigator/Program Director Community Engagement (~ 30 minutes)
Taken by PI/PD, 2nd academic investigator, and 2-4 community partners
Conducted from 12/2011 – 8/2012
Project Demographics and
Features (49)
PI team and partners ethnicity,
position, gender, SO, etc.
Partnership dates, funding, type
of research,# of partners, staff
diversity, etc.
Resource/Decision sharing (4)
Who decides hiring/, budgets,
resources shared
Research Integrity (4)
Confidentiality/IRB training,
approval decisions
Partner Research Roles (13)
Community Engaged Research Index (CERI)
Governance (15)
Formal MOU’s & DSOA’s, dissemination approvals, $, conflict resolution
Formal Training (8)
▪ Racism/sexism/privilege/cultural humility/CBPR-collective reflection
▪ Contact info for Partners
Context (10)
Community Capacity, Project has what it needs to work effectively towards its aims
Social & Human Capital (3)
Knowledge, skills, connections
Alignment with CBPR Principles (8)
Builds on resources and strengths, equitable partnerships in all phases of the research, emphasizes what is important to the community, etc.
Core values (4)
Shared understanding of the missions and the strategies
Power dynamics (9)
Power sharing, influence, decision making
Dialogue, Listening, co-learning Conflict resolution, emotional
intelligence
Governance Mechanisms Competency of leadership in diversity,
communication, planning, efficiency, financial management, etc.
Partnership Synergy (Proximal) (5)
Come together and work well
Culture Centeredness (5)
Community theories, ownership, etc.
Concrete & Perceived Outcomes (8)
Index of Perceived Community/Policy Level Outcomes (IPCPLO).
Improved services, policy change, health improvement, etc.
Personal, Political, Professional Level Outcomes (13)
New knowledge, relationships, power, visibility, skills, etc.
Health Outcome
68.7% 70.5% 76.5%
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Key Informant Survey byacademic PI
Com Eng Survey byacademic PI
Com Eng Survey byacademic & community
partners
N = 200 N = 310
N = 141
How do context/group processes/ individual issues shape facilitators and barriers to effective CBPR?
How do differing contextual conditions and perceptions/meanings interact with partnering processes to produce differing outcomes?
Healing of the Canoe: Youth Life Skills/Substance Abuse-Washington tribes
Men on the Move: Cardio-Vascular/Sustainable Agriculture/Rural-AA
Lay Health Worker Intervention: Colorectal Cancer Screening/San Francisco-Chinatown
South Valley Partnership Environmental Justice Semi-urban, Southwest - Latino
Cancer Coalition and Tribal Approval Processes Rural – Plains Tribe
Bronx Faith-Based Initiative
Diabetes and Medical Apartheid
Center for Deaf Health, Rochester
Quantitative Survey: Two scales
Views on how trust has evolved (type/when) Level of trust between team members
◦ Trust of decisions, comfort asking others to take responsibility,
Qualitative Case Studies Questions: How do you describe trust in this partnership? Has it changed over the life of the partnership? If so, how has it changed?
• Quantitative Survey: • To what extent was the community partner's
knowledge and voices included in research processes?
• How well did this project engage reciprocal learning and capacity building?
• Mohan Dutta
• Qualitative Case Study: • To what extent does your project fit
local/cultural beliefs, norms, and practices? •
Voice in Research: (Community Engaged Research Index)
Partners involved in three aspects: a) problem-definition/background research; b) data collection; and c) dissemination
Power Relations/Voice in Partnership: Reflexivity: Have increased research participation/talk about research
Decision-Making: Feel comfortable with opinions being heard
Outcomes:
System Changes: Resulted in policy changes/improved health
Community Capacity: Partnership with skills and expertise to work
towards aims/Partnership has legitimacy Mohan Dutta
Role of Identity and Power in CBPR (Critical Sociology, in press)
Cultural Centeredness as Integration of Cultural Norms, Values, Knowledge
Role of Individual Motivation and Values in Partnership Practices and Personal Outcomes
CBPR as Integration of Utilitarian and Broader Capacity Outcomes
CBPR as Social Movement (Based on Historical Contexts of Inequities)
Multiple mixed methods, quantitative and qualitative articles.
Oetzel et al, Psychometrics, American Journal of Health Promotion (in press)
Other articles: Structural Characteristics/Mixed Methods/Outcomes/Case Studies
National Institute of Nursing Research RO1: Advancing CBPR Practice with Collective Reflection and Measurement Toolkit.
Training in Emerging and Best Practices
To team members: UNM: Magdalena Avila, Lorenda Belone, Lisa
Herrera, Julie Lucero, Michael Muhammad, Emma Noyes, Patricia Rodriguez, Andrew Sussman, Greg Tafoya, Belinda Vicuna, Shannon Youngman-Sanchez
UW: Bonnie Duran, Leo Egashira, Maya Magarati, Myra Parker, Cynthia Pearson
NCAIPRC: Malia Villegas, Emily White Hat
Nina Wallerstein, Co-Principal Investigator, UNM Qualitative Case Study Analysis
Email: [email protected] [email protected]
http://fcm.unm.edu/cpr/cbpr_project.html Bonnie Duran, Co-Principal Investigator
Quantitative Survey Analysis
Email: [email protected]
Malia Villegas, PhD, Overall PI
National Congress of American Indians
Policy Research Center
Email: [email protected]