Phyllis Sharps, PhD, RN, FAAN, Professor Associate Dean Community and Global Programs
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ENGAGING COMMUNITY IN IMPLEMENTING A RESEARCH PROTOCOL:DOVE HOME VISIT INTERVENTION FOR ABUSED PREGNANT WOMEN
Phyllis Sharps, PhD, RN, FAAN, Professor Associate Dean Community and Global
Programs
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Session Objectives
Describe approaches to research with communities.
Discuss DOVE approach to community based research.
Discuss lessons learned and strategies for thriving in community based research.
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Research and Communities
Approaches to Research with Communities
Community Based Research
Community Based Participatory Research
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Community Based Research
Research that strives to be: Community situated
Research topic relevant to community (not researcher)
Carried out in community settings Collaborative
Community members and research equitable share research agenda
Active and reciprocal roles in design, implementation and dissemination
Action-oriented Process and Results useful to community to make
positive change and promote social equity
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Characteristics of Community Based Research
Relevance of research identified by community
Resources are shared with community (financial, expertise)
Research process recognizes & uses expertise of community
Research process recognizes & addresses power imbalances
Research values emphasizes empowerment, supportive relationships, social change, learning as ongoing, respect for diversity
Research process & results accessible & understandable to community
Research process & results adapt to context of community
Research leaves a legacy; use of results and future collaborations among partners
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Community Based Participatory Research
Collaborative research project that: Involves all partners in the
research process Recognizes unique strengths that
each brings Begins with research topic
important to community Aims to combine knowledge with
action and achieve social change
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Characteristics of CBPR
Community residents participates actively in all aspects of research – from concept – to conclusions and dissemination of findings
Build community trust and community capacity with goal of increasing community participation in the research process
CBPR – is essential to public health research that is Action –oriented Community driven
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Research Addressing Professional and
Participant Communities
Community Based Research
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NIH/NINR - R01 NR009093
DOMESTIC VIOLENCE ENHANCED HOME VISITATION
PROGRAM: (DOVE)
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Hatching DOVE
Research and Practice Interests: Reducing Infant Mortality Rate among African American women
Depressive symptoms in pregnant and parenting low income women
IPV and perinatal health outcomes
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Hatching DOVE Community Based Experiences
Observing impact of violence on pregnancy and maternal and infant outcomes
Working and listening to community – shelter nurse
Research assistant for community projects Member of interdisciplinary research teams
implementing community based projects All contributed to my keen desire to do
research with communities aimed at reducing violence against pregnant women
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Background for DOVE
IPV violence during pregnancy linked with adverse outcomes for: Mothers Infants
More than 3 million children witness IPV of mother each year
More than 50% of these children are under 6 years old
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Purpose of DOVE
DOmestic Violence Enhanced Home Visitation Program Rigorous test of structured IPV
intervention Empowerment intervention aimed at
reducing IPV Mothers and infants 2 Sites and Settings
Urban – Baltimore City HDUrban – Missouri HDRural – Missouri HD
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Design 3 different designs in 3 different settings RCT Mixed methods – quantitative &
qualitative BCHD (women and infants)
Eligible women = R→ DOVE vs. UC MOHD (women and infants)
12 HDs = R→ 6 HD DOVE vs. 6 UC NFP (Olds HV model; mothers and
infants) DOVE vs. Olds database
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Schema for DOVE Project
URBAN (Baltimore City Health Dept.)
ò
Referrals
ò
BCHD
òRANDOMIZE
÷ ø
RURAL (Missouri Health Dept.)
ò
12 HD’s (N=160)
ò
÷ ø
-
Kansas City, Missouri
ò
1 NFP (N=40)
ò
REFERRAL
Data Collection/Follow Up AssessmentsBaseline, Delivery, 3,6,12,18 24 M post-delivery
Usual Care(M&I)
DOVE(M&I & DOVE)
Usual Care(6 HD’s)
DOVE(6 HD’s)
DOVE-NFP
RANDOMIZE
Selected from NFPNational Data
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Methods
Quantitative Study: Measures IPV Maternal Mental Health
(stress, depression, PTSD)
Parenting (stress, stimulation)
Infant Growth & Development Use of Community Resources
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Methods
Qualitative Study Patterns of IPV Urban/Rural influences on patterns of IPV
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Lessons Learned
Developing Partnerships
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Academic-Community Partnership
Johns Hopkins School of Nursing (JHUSON)
Location: Baltimore, Maryland, USA Mission: To provide leadership to improve
health care and advance the profession through education, research, practice, and service.
Baltimore City Health Department (BCHD)
Location: Baltimore, Maryland, USA Mission: Maternal and Infant (M&I) Nursing
Program provides home visiting and case management services to pregnant women and infants in Baltimore City in order to improve maternal health, birth and infant outcomes.
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Partnership Benefits Established Infrastructures
JHUSON Academic Resources BCHD-M&I Program Community Resources
Sharing of Resources DOVE Intervention Nurse=Liaison
Between JHUSON & BCHD-M&I Implementation of DOVE intervention into
existing BCHD-M&I program Application of evidenced based research into
real practice setting – a test of efficacy Potential Positive Impact on MCH
Outcomes
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Preparing to Launch DOVE
Developing The Town (Home Visitors) and Gown (Research team) Partnership
Both Health Departments: The Missouri Department of Health and Senior
Services (MoDHSS) Baltimore City Health Department Maternal
and Infant Home Visit programs
Extremely supportive of identifying IPV and working with both research teams
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Developing the Town/Gown Partnership
Examples of activities to develop partnership
Research team members made frequent visits to the DOVE sites and reviews the research protocol with trained HV and new staff
Monthly meeting with BCHD to discuss DOVE protocols
DOVE Nest newsletter sent monthly to all health departments
Conducted professional in service training for health departments
We have conducted 10 different workshops regarding screening
for IPV with the home visitors over a four -year period at both sites
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Issues for the Partnership
Challenges of partnering with urban and rural health departments
Home Visitors lack of educational preparation regarding research protocols
Lack of understanding of the importance of screening for IPV
Discomfort with screening for IPV Rural Settings - distance that has to be traveled by
the research team to maintain relationships with the staff
Urban Settings – bureaucratic procedures that hinder recruitment process
Urban Settings – large case loads limit time available for intervening
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Threat To The Study’s Integrity
After 3 ½ years of recruitment – referrals made at both sites (Baltimore and MO) have not met targeted goals
PIs at both sites hypothesized that: There may be an issue with women disclosing:
Because of the rural setting of the MO site Because of the urban setting of Baltimore site
The HVs are not comfortable screening women for IPV
Barriers Study
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Partnership Limitations
Control Interdependence of each entity for
project results
Communication Ensuring all team members are up-to-
date
Motivation Team members professional investment
in project
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Clinical Significance DOVE combines
evidenced based protocols
DOVE an be integrated into existing culturally based approaches
DOVE intervention is low cost
DOVE intervention requires training and “buy-in”
Women had many positive comments about DOVE
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Strategies for Community Based Research
Shared passion – Community & Researcher Community – Research Team a true team or
partnership Caring and Nurturing is the norm Committed to success of all members Mutual benefits
Expected, spelled out, agreed upon Establishment of trust Clear expectations – but some give and
take Meeting deadlines – mutual respect not
obligations
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Strategies for Community Based Research
Community Connections Be a part of the community – a real
commitment Community is also a part – a real commitment Meaningful and important roles and
involvement for community members Do no harm Share what you learn with the community Include community in dissemination and
presentations Enhance the community – a legacy for the
community
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Strategies for Community Based Research Have Fun Along the Way !!
Celebrate the achievements of all (new personnel, new grants/awards, publications, presentations, recruitment goals, enrolling in courses)
Celebrate the milestones
Support each other over the rejections and disappointments (cuts/no funding, personnel changes, rejections, slow recruitment, grants, abstracts, manuscripts, slow recruitment)
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DOVE WEBSITE
http://www.son.jhmi.edu/research/dove
Thank You !!!
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