Community-based participatory research (CBPR) is an increasingly used approach for conducting research to improve community health. Using Rogers' diffusion of innovations theory as a framework, it follows that future adoption of CBPR will occur if academic and community partners perceive CBPR to have greater relative advantage, compatibility, trialability, and observability, and less complexity than other research approaches. We propose that articles published in our new peer-reviewed journal—Progress in Community Health Partnerships: Research, Education, and Action (PCHP)—can influence academic and community partners' perceptions of CBPR that promote its adoption. Eight areas of scholarly activity are described that can promote health partnership research, education, and action: (1) original research, (2) work-in-progress and lessons learned, (3) policy and practice, (4) theory and methods, (5) education and training, (6) practical tools, (7) systematic reviews, and (8) community perspectives. These eight areas correspond with the eight main sections of PCHP. A brief description of each area's importance in promoting CBPR is provided along with examples of completed and ongoing work. Specific recommendations are made regarding issues, problems, and topics within each area on which CBPR work should focus. These recommendations, which present a vision for progress in community health partnerships, are based on idea generation and prioritization by a group of CBPR experts—PCHP's editors and editorial board.
Background: Community-based participatory research (CBPR) is an approach to research that seeks equitable and collaborative involvement of community members and researchers in all aspects of the research process. It has moved slowly into the areas of health and public health research. In 1995, the National Institute for Environmental Health Sciences (NIEHS) launched the first research initiative at NIH specifying the use of the CBPR approach.
Objectives: The purpose of this paper is to provide the historical record and to identify factors and events that led to the development of the policy creating the CBPR initiative at NIEHS.
Methods: The study used Kingdon's policy streams model as an analysis framework. The policy streams model explains that policies are developed when three "streams" (problem, policy and political) come together at a point called the policy window. Information collected from key informant interviews and document analyses were coded to the components of the policy streams model.
Results: The study documented factors and events in each of the three streams of the model. All these occurred about the same time to bring together the three streams, causing the opening of a policy window. This analysis demonstrates an importance of problem awareness and changes in leadership positions or ideology/mood to bring a policy option to the attention of policymakers, and the importance of a policy entrepreneur to advocate for a particular policy when the opportunity arises.
Conclusions: Policy entrepreneurs should be alert for opportunities to take advantage of the open policy windows when they emerge, thereby achieving success in moving policy ideas forward.
Background: Members of a Lower Mississippi Delta community and university partners used the Comprehensive Participatory Planning and Evaluation (CPPE) model to assess nutrition and health problems and develop a menu of interventions.
Objectives: We sought to identify and prioritize nutrition and physical activity problems in the community and to identify interventions to address the problems.
Methods: Community members and university partners used the CPPE process to identify and prioritize nutrition and physical activity problems. The participants developed causal models to break down the identified problems to their root causes. They then developed a menu of interventions and criteria to rank the interventions.
Results: The identified problems were intake of unhealthy foods, lack of nutrition education, and lack of adequate physical activity. The menu of interventions consisted of seven objectives to address poor nutrition and physical activity as well as a total of 19 interventions to meet these objectives.
Conclusion: Directly involving community members in identifying health problems and solutions results in the development of interventions that are likely to have greater acceptability with the community.
Background: A collaborative community–university–U.S. Department of Agriculture(USDA)/Agricultural Research Service (ARS) partnership developed and implemented a 6-month walking intervention whereby volunteer coaches were trained to lead community walking groups in a rural Mississippi Delta Community.
Objective: Assess the feasibility of implementing community-based participatory research (CBPR), increase physical activity, and improve anthropometric and biological measures.
Methods: This quasi-experimental design examined body mass index, percent body fat, waist circumference, blood pressure, blood glucose, lipid profile, self-reported walking, stages of change, social support, self-efficacy, and decisional balance at enrollment, 3 months, and 6 months. Participants were primarily African-American (99%) women (97%). Changes were evaluated using repeated measures analysis of variance (ANOVA) and Friedman's test.
Results: Community members actively participated in assessing the problem, identifying the intervention, intervention planning, data collection, and evaluation. Of the 83 enrolled participants, 66 (80%) completed the intervention. Participants exhibited significant improvements in waist circumference (–1.4 inches), systolic blood pressure (–4.3 mmHg), and high-density lipoprotein (HDL) cholesterol (+7.9 mg/dL); (P < .001). Self-reported walking per day was 44.8 (SD+52.2) minutes at enrollment, 76.6 (SD+166.6) minutes at 3-months, and 65.9 (SD+89.7) minutes at 6 months (P = .154). A positive stage of change shift occurred in 57% of participants; however, no significant positive changes occurred in the other psychosocial variables.
Conclusion: The process of developing and implementing this CBPR walking intervention was considered successful as evidenced by the community's active contribution and participation in each phase of this research, the undertaking and application of basic research components, significant improvements in several anthropometric and biological values, and sustainability of the collaborative partnership.
The Problem: Community, migrant, and homeless health centers (CHCs) are an integral component of the nation's safety net with a proven record of success in access, quality, and cost effectiveness. Still, as CHCs face rising numbers of vulnerable patients and shrinking resources, they must continue to improve quality of care to further narrow health disparities, as well as demonstrate their cost effectiveness and value to policymakers.
Purpose: CHCs, researchers, national partners, and others met in December 2005 to produce a consensus-driven research agenda that lays out research priorities for CHCs and the medically underserved. This article details the meeting process and resulting research agenda.
Key Points: The meeting focused on three domains that touch on community need: health information technology (HIT), quality improvement, and cost effectiveness and value. Community representatives helped to drive research priorities.
Conclusions: CHCs must continually demonstrate their efficiency and effectiveness. Accordingly, the research agenda must be continually revisited through a collaborative process.
The Problem: Community health centers (CHCs) are part of the United States' medical care safety net. Cost effectiveness is a critical element of value in today's health policy environment. Not all cost-effectiveness studies employ formal peer-reviewed methodologies. A review of the literature on CHCs' cost effectiveness is necessary to assess whether a higher level of evidence is needed to guide future policy.
Purpose: We sought to review the quality of the evidence on the economic value of CHCs and indicate whether a higher of level evidence would be useful for making policy.
Key Points: Evidence exists to support the general value of care in CHCs, but no evidence comes from formal economic evaluations of CHC care.
Conclusion: More formal cost-effectiveness evaluations would enhance the economic argument for CHCs but will remain difficult to conduct and may be unnecessary in light of other work on the value of care in CHCs.
Problem: Community health centers (CHCs) face a unique set of challenges and can learn much from each other as they prepare for the adoption of health information technology (HIT).
Purpose: This paper presents a research agenda aimed at providing information CHCs will need to successfully implement HIT.
Key Points: Community health centers must be able to evaluate whether an investment in HIT is the best way to achieve improvements in health outcomes for their communities given the limited resources and high demands they face. Community health centers need better information to guide them in selecting and implementing information technology that will result in improved health quality and safety. Guidance in optimal use of the system, particularly in the effective use of data made available through electronic health records, is needed to realize health care goals. Community health centers need to be active participants in HIT developments in their communities to ensure that their patients benefit from technological advancements that improve health care.
Background: Education and training build community research capacity and have impact on improvements of health outcomes.
Objectives: This manuscript describes the training and educational approaches to building research capacity that were utilized in a community-based participatory research program serving a Puerto Rican population and identifies barriers and strategies for overcoming them.
Methods: A process evaluation identified a multitiered approach to training and education that was critical to reaching the broad community.
Results: This approach included four major categories providing a continuum of education and training opportunities: networking, methods training, on-the-job experience, and community education. Participation in these opportunities supported the development of a registry, the implementation of a survey, and two published manuscripts.
Barriers included the lack of a formal evaluation of the education and training components, language challenges that limited involvement of ethnic groups other than Puerto Ricans, and potential biases associated with the familiarity of the data collector and the participant. The CBPR process facilitated relationship development between the university and the community and incorporated the richness of the community experience into research design. Strategies for improvement include incorporating evaluation into every training and educational opportunity and developing measures to quantify research capacity at the individual and community levels.
Conclusions: Evaluating training and education in the community allows researchers to quantify the impact of CBPR on building community research capacity.
Taking Culture Seriously in Community Mental Health is a community-based participatory action research project in Ontario devoted to developing, pilot testing, and evaluating mental health service models grounded in the concept of "cultural empowerment." To ensure that the knowledge generated in the project is shared and used, the research collaborative places a heavy emphasis on communicating with stakeholder groups. This paper provides an overview of a communications policy designed to facilitate such sharing and use. It describes the development and key features of the policy, focusing on the broad issues of principles, authorship and acknowledgment, and planning and procedures.
Background: Leaders and policymakers need an accurate appraisal of the federally qualified community health center (CHC) quality improvement (QI) literature to make informed decisions for the CHC program.
Objectives: This paper aims to (1) summarize the content and findings of CHC QI studies to date, (2) systematically rate the quality of those studies, and (3) outline 10 important areas for future CHC QI research.
Methods: We searched medical and nonmedical databases to identify QI studies in CHC settings. We systematically reviewed identified studies for the features of their QI interventions and for the methodological quality of their evaluations. We combined results from the review with input from the CHC community to generate an agenda for future CHC QI research.
Results: Eighteen studies were identified and reviewed. Interventions mainly targeted chronic conditions and screening practices and used 1 to 11 of 14 different QI tactics; evaluations comprised 14 observational and 4 randomized study designs. CHC QI interventions have been effective in improving processes of care for diabetes and cancer screening in the short term; their effectiveness in the long term and regarding outcomes of care have not been demonstrated.
Conclusions: QI interventions in CHC setting are promising, but future interventions and evaluations should answer critical basic questions about QI, including the following: What are the best models of QI? How can QI improvements be effectively implemented and sustained? What are the global effects of QI (positive and negative)? How can QI be made financially viable and sensible from both the CHC and societal perspectives?