Research-what is it and why do we do it?

Research and Public Health

Science looks for truth, practice looks for what works. What works is true, and what is true works.

-Guy Steuart, 1963

Background

Academic Researcher Teacher

Practitioner Community Health Educator Trainer

Heritage Physician to last Empress of China Truck farmer growing Chinese

vegetables in Jacksonville, Florida

Research and Public Health

Research Individual

Responsibility Needs-Based

Practice Common Good Human Rights-Based

Contradictions

Protection of human subjects has guarded communities of color from the research process

Research on communities of color has rarely been directly beneficial and sometimes has actually done harm.

Contradictions

Problems of disease, illness, and risk are selected based on epidemiological data

Issues selected based on everyday life experience

Contradictions

Study design and budget proposed reflects review of scientific literature and feasibility

Study design, budget, and proposal reflects community ownership and authenticity

Contradictions

Recruitment and retention based on science and “best guesses”

Recruitment and retention based on trustworthiness of viewpoints

Contradictions

Psychometric testing of measures adopted or adapted from other studies

Measures developed and tested to increase credibility and dependability of data

Contradictions Effective and sustainable interventions

are informed by the concerns, culture, and assets of participating community

Effective and sustainable interventions are informed by theory and “best practices” of other studies

Contradictions

Interpretation, dissemination, and translation of findings aimed at transferability through CBO channels of communication

Interpretation, dissemination, and translation of findings aimed at generalizability and publications in peer reviewed literature

Partnership Approach toResearch

Equitably involves research partners in all aspects of research

Mutual learning is an on-going process Equitably contributes expertise and sharing responsibility

and ownership Integrates knowledge gained with interventions to improve

the health and well-being of community members

Necessary Conflict

By whom research is to be conducted (Which groups come to the table?)

For whom research is to be conducted (Which issues get to the table?)

How research is to be conducted (Which groups shape awareness of the issues?)

Which Groups Come to the Table?

University at the Table

Investigators from Epidemiology and Health Behavior & Health Education

Community Outreach Specialist

Ethnographer

Graduate Students

Funder at the Table

CDC, Boston University School of Public Health Partners in Health and Housing Prevention Research Center

Community & Agency at the Table: Formative Phase Community Advisory Group

Church Leaders Public Housing Residents

Police Outreach workers Nurse from the State Health

Department Social worker at shelter for

battered women Job trainer at Community

Action Agency

Public Housing Residents and Community Health

Community

Advocacy

Specialist

Family and

Community

Collaborations with local, stateNational MCH

agencies

Family Health Policy

Agency

PHRs

BHA

Which Issues Get to the Table?

University Issues that Get to the Table

Community is ranked third among the State in highest rate of new HIV infections for 2008-2009: 20 per 100,000 person-years

Gonorrhea rate in 2008-2009 was comparable to two major US cities with the highest 2009 rates: 1746 cases per 100,000 person-years

Community Issues that Get to the Table

Community assessment found STDs among top 3 priority issues

Condoms are used only with side partners because unprotected sex with a main partner defines a committed relationship

Perceived barriers to prompt seeking of STD care are lack of anonymity and feeling misunderstood at the community health centers

Community Issues that Get to the Table

Men and women at risk for STDs seek information, assistance, and advice about sexual intimacy from women, who are not members of their social networks

Women at risk for STDs are connected to the wider community through women who assist them with basic needs such as childcare, jobs, transportation, and housing

Which Groups Shape Awareness of Issues?

Community & Agency at the Table:Design Phase Community Resource Group

Social Worker at Shelter for Battered Women

President of Ministerial Alliance & Housing Authority Board Member

Director of Community Center & Part-time Police Officer

Announcer at WILD Radio Station & Ex-Drug Abuser

Director of Day Care Center Counselor at High School

Job Training Instructor at Community Action Agency

Unit coordinator at Community Health Center

Social Worker at Department of Social Services

Groups that Shape Awareness of Issues

Community Outreach workers and RHAs

Lay HealthAdvisors

Community’sNatural Helping

Networks

Agencies’ Formal Helping

System

Community Resource Group

CDC-PRC

BHA and PRC Engaging the Community Conduct focus groups

Design and implement strategy to recruit RHAs

Develop training curriculum to include session on Finding Out if the Program Works

Construct community survey questionnaire-FISP

Funder ConcernsPlace no one at risk

External ReviewAn intervention focused on assisting

women at-risk for STDs may place them at-risk for violence from partners

Men should be included as lay health advisors

Outcomes

Among women reporting symptoms, increase of 60% seeking STD care within 3 days of symptoms

Among women reporting care seeking, increase of 26% seeking STD care when thought had STD but no symptoms

0

10

20

30

40

50

60

70

<3 dayssymptoms

Nosymptoms

Baseline

18 mos

Thomas, Earp & Eng, 2000

Power of Community as Co-Practitioner

When key community members… are asked to help set priorities and to identify related health concerns, [they] may become committed to the program and can be helpful in unleashing the voluntary energy that is to be tapped through [this] network.

-CDC’s Guidelines for Community Demonstration Projects

Power of Community as Co-Investigator

[T]he opportunity…for communities and science to work in tandem to ensure a more balanced set of political, social, economic, and cultural priorities, which satisfy the demands of both scientific research and communities at higher risk.

-John Hatch et al., 1993

Power of a Bowl

How does the community benefit from research?