Beyond the Manuscript: Podcast Interview Transcript

In each volume of Progress in Community Health Partnerships: Research, Education, and Action, the editors select one article for our Beyond the Manuscript podcast interview with the authors. Beyond the Manuscript provides authors with the opportunity to tell listeners what they would want to know about the project beyond what went into the final manuscript. Beyond the Manuscript podcasts are available for download on the journal's website (http://www.press.jhu.edu/journals/progress_in_community_health_partnerships/multimedia.html). This Beyond the Manuscript podcast is with Professor Susana Helm of the University of Hawai`i at Manoa, Scott Okamoto of Hawai`i Pacific University, and Howard Medeiros and Jay Kimura, Office of the Prosecuting Attorney, County of Hawai`i, authors of Participatory Drug Prevention Research in Rural Hawai`i with Native Hawaiian Middle School Students. Deputy Editor Darius Tandon conducted the interview. The following is an edited transcript of the Beyond the Manuscript podcast.

Darius Tandon:            You bring up an important and often discussed point about the tension between evidence-based practices and culturally appropriate interventions; do you plan to use your findings to modify an existing evidence based intervention in the next phase of your partnership? If not, what is the rationale for developing a new intervention?

Susana Helm:              Howard, why don't you go ahead and start with that question.

Howard Medeiros:          About three years ago we were requested to write a grant for Title V funding, which is basically a prevention program utilizing a best practice. The best practices that they had suggested were either those that were listed with SAMHSA Student Health or the Blueprints books or Helping America's Youth. In looking for a good prevention program, I looked at several and talked to some of the lead investigators and some of the program managers, and at that point, they had put me in contact with Scott Okamoto who at that point was at the University of Arizona. Scott was moving back to Hawai`i to continue his research and looking for a program that was culturally sensitive to Hawai`i. Scott provided a great input.

Susana Helm:              In addition to Scott's project, in our office we did some other investigations, I suppose similar to what Howard did for the county there. We were looking at what are the substance abuse prevention programs that are culturally relevant for youth, and when we went onto the recently revised SAMHSA website we found very few that were considered relevant for Native Hawaiians, other Pacific Islanders and Asian Americans.

                          We pulled from the list about six or so different programs and then looked at the evidence that said that those would be appropriate for the majority populations here, which are Native Hawaiians, Asian Americans, and other Pacific Islanders. The evidence was not strong so we, I guess what we are looking for would be to develop a contextually relevant project, and I think Scott can speak a little more about the actual, the methodology and the phases of the research.

Scott Okamoto:             Getting back to the question and kind of leading off of what Susana referenced about the research that she did in her office, there was not a whole lot that was really focused on effective practices for Hawaiian youth. The overall goal for our project is to develop a new intervention based on the world-views of Hawaiian youth on the Big Island of Hawai`i. Recent research has shown that evidence-based prevention programs that have not been developed for indigenous youth populations may actually increase drug usage for these youths, and I am specifically referring to the Dixon et al. study that was published in 2007 in the Journal of Primary Prevention.

                            While it is unclear whether these types of iatrogenic effects are the result of the content or the delivery of prevention programs for these youth, it really points to the need to develop programs that have a foundation in the values, beliefs, and world-views of them. We feel that this can only be achieved by developing a program from the ground up rather than through some sort of adaptation or modification of an existing program.

                            Adaptations or modifications may alter the surface structure of an existing program, but ultimately they cannot compare to programs grounded in the social and cultural realities of the youth that they intend to serve. Based on some of this prior research and based on the needs of the community we want to develop something that is new and grounded in the realities of these kids.

Susana Helm:              Howard, did you want to add anything to that?

Howard Medeiros:         Prior to joining the prosecutor's office ten years ago I had been in the field of prevention for over 20 years. One of the main things, I think, that any researcher should focus on is cultural sensitivity. Here in Hawai`i, while we have a variety of cultures, we also have a local culture that is a combination of Asian, Pacific, such that we need to understand that our youth, our combination of cultures, their sensitivities are different. Meanwhile we have had many good, solid evidence-based programs, they may not be appropriate for our island, or even the rural area.

Darius Tandon:           Thanks all for your response to that. Just as a follow up to that question thinking about the work that you plan to do in the future to develop your own new intervention, as you said using the cultural world-views of the youth, can you talk a little bit about how you plan to involve your community partners in the next steps of developing your intervention?

Scott Okamoto:             I can speak a little bit to that. Community partners such as Hawaiian youth, elders, and youth serving practitioners in the communities on the Big Island will become more involved in the latter stages of this current study. At that time, what we are going to do is we are going to ask for the suggestions related to the development of the prevention program, which is actually going to develop in another grant that follows this current grant. The roles will probably become more operationalized in the development of the next grant proposal, but at a minimum we're thinking that they're going to be involved in the creation and the validation of the program in some form.

                     This study that we're talking about today is one study that is part of a larger five year multi-year research project funded by the National Institute on Drug Abuse which examines the social, environment, and cultural context of drug offers for Hawaiian youth in rural communities. Right now, we are moving into year three, at the end of year five what we hope to have is a set of the most relevant drug related problem situations that the youth on the Big Island face and a matched set of responses that these youth use to deal with these situations. That information will become the foundation for the next grant, which is will focus on drug prevention.

Darius Tandon:           Moving to the present study, you talk about your liaisons. Often in community based participatory research liaisons bridge the gap between academic and community partners yet there's not a lot of description in published CBPR articles about the manner in which these liaisons work with academic researchers and the challenges that there may be if employing liaisons. You say that you had a liaison in each of the schools in which you worked. I am wondering if you can describe how your liaisons were in contact with the academic team and if there were any challenges in working with the liaisons.

Susana Helm:              We were introduced, through Howard, to the complex superintendents and other lead administrators in the Department of Education on the Big Island. Through those lead administrators there was an understanding of what we were trying to accomplish, because it fit with their overall plans to prevent substance abuse with their students too as well as the strategic plans for the Big Island which Howard and Jay can say a little bit more about, I suppose. We were very fortunate that these lead administrators felt that the project was worthwhile and valuable and aligned with their goals.

                            They introduced us to some of the principals and the principals also said, "Hey, we like this study." Then they appointed liaisons within their school to assist with the actual project implementation. That flow I think really worked well for us. If it had not been for Howard, it would have been a much more trickier process.

                            As far as challenges, like I said we were very lucky. However, both Scott and I, our universities are on the island of O`ahu and the project is on the island of Hawai`i. The main challenge is that we are just not able to be there as much as we would like to. It is the time and distance.

                            To surmount that, the main thing is that we try to keep in contact with the liaisons either through e-mails and phone calls. We set up an 800 number so that the folks in the schools are not charged when they want to call us. I think that is a small expense for us, but I think it is a huge benefit for our project having that more easily accessible phone contact. Of course, we do presentations, and meetings face to face when we do go to the Big Island.

                            Howard and Jay, did you want to say a little bit more about your role in facilitating that?

Jay Kimura:             We were very fortunate, I am glad Howard found Scott and Susana. We were very fortunate on the Big Island we were selected by OJJDP to start a conferences strategy process on the Big Island to Barry Krisberg from Oakland. We got the community together and were able to focus on four major challenges to the juvenile justice system on the Big Island. The first is availability of drugs, family conflict, family management, early onset of antisocial behaviors. So the community itself, which includes the Department of Education, I mean we have very close cooperation from the Department of Education we worked together to develop this strategic plan and I think that is of a continuation of the ongoing effort.

                           We have very little resources here and what little resources we have we are hoping by connecting with the academic arena that we can use those resources to the community's benefit.

Howard Medeiros:         I think one of the important parts of this entire program is that both Scott and Susana were open to not only speaking about the program, but also listening to the administrators' and principals' concerns regarding research in their schools. Through Jay's leadership, we have really networked well on this island. When we do allow someone to come in, they need to understand our values, our game plan, our ability to work together and support each other. Both Scott and Susana were very open, very honest about their research. They listened, they answered questions, and they followed through on our requests. I cannot overemphasize the need for the right follow through, which Scott and Susana provided.

Darius Tandon:           The next question has to do with your point about how your partnership has increased community members' understanding of research methods. Can you provide some more detail on how this was done during your project and any recommendations you may have for other research teams looking to use a similar process of promoting community partners' capacity.

Scott Okamoto:             Prior to beginning our study we discussed with the prosecuting attorney's office really the desire of our community partners to develop an evidence based practice that could be used by the community, but to also attract future funding to benefit youth programs.

                          Increasingly our community partners have understood that in order to have your own evidence you need to have your own research. Based on their goals we discussed the types of evidentiary support a prevention program would need in order to be included as an evidence based practice. The research methods that are typically used to achieve this type of support and how the present study contributes to these types of programs.

                          Because the present study is considered pre-prevention in nature, it is intended to create the foundation for the development of a culturally grounded prevention program for rural Hawaiian youth. Overall, our community partners understand the scope of the work involved in the development of a culturally-grounded prevention intervention and how this particular study fits into this overall endeavor. In sum, I feel that our collaboration really has increased our community partner's awareness of the importance of research in really meeting their programmatic goals.

                          Jay and Howard, do you want to add anything?

Howard Medeiros:         Just the fact that in the past, prior to my working here I worked in the field of prevention and I have seen the schools' reluctance to take on research and the more positive experience they have the more open they will be. Being that this has turned out to be a very positive experience so far, I think that this will be the community feeling that they're more open to research in the future.

Jay Kimura:             I think using the research not only for attracting grants, but for part of the conference strategy was to look for funding that matched our strategies. We are hoping that the research will continue to provide us meaningful data that we can use to attract appropriate grants for our community.

Scott Okamoto:             In reference to your second question about research teams looking to use a similar process, I think that Howard really emphasized this point a couple of times and I have to re-emphasize it because I think it's so important. The most important aspect really is developing a close working relationship with your community partners, and this is just so important in Hawai`i. I have seen so many researchers at the University of Hawai`i, at different universities here, that have really struggled to do research here because they do not understand that there is very much a relational aspect to doing research in Hawai`i, particularly community-based research.

Scott Okamoto:             By developing a close working relationship trust has developed between the academic and community partners and information such as that related to research methods can be shared openly between the two parties. I think that when we have these experiences like we're having now with our collaboration I really think it helps set the tone for future research to occur that can benefit communities and youth in Hawai`i.

Darius Tandon:           We are going to move into the last question that we have planned and that speaks to the participation of youth during your project. There was clearly participation from school personnel throughout the project, but it did not appear in the manuscript that the youth of the schools where this work was taking place were part of the group of community collaborators. You talked a little bit earlier in the podcast about how you plan to use them in the future, but I'm wondering if your choice not to involve youth in this phase of the project was a conscious decision or whether there were some challenges that kept you from getting the youth participation in the work that you did.

Scott Okamoto:             As you mentioned earlier the research design of the overall study, the five-year study, progressively incorporates more and more input from youth. As I referenced earlier, in the next phases of the study we really plan on developing and evaluating youth responses to drug related problem situations based on the perceived social competency. What this will mean is that it will involve both middle school and high school aged youth in the assessment of social competency of each of the responses.

                          So while the initial phases really did not incorporate a lot of collaboration actively with the youth, they're going to start getting more and more involved in the later stages. Then when, when we move into the next grant and develop the prevention programs, youth will be heavily involved in creating the prevention messages and skills in the program. We are really looking at something that kids on the Big Island of Hawai`i can really respond to and react. What research shows is that programs that show settings that they are familiar with, with faces that they're familiar with, things that look very familiar to them and that are very real to them and relevant to them, those are the messages that they internalize more versus messages that are given by adults, that may or may not be part of their community or things like that.

                          Because we are going to be looking more toward that in the future we're really going to need to invest in bringing kids on more in creating those messages for us.

Darius Tandon:           Do you think part of that may be helping you further analyze and interpret some of the qualitative data reported in your manuscript?

Susana Helm:              That is a good question Darius, because unfortunately for us when we set this project up we did not anticipate that and so it's not part of our IRB protocol, so it is not possible. We also made commitments to the kids who shared information for these focus groups that it would not be shared outside of our research team, and we were explicit about what would be included. So at this point, it's not possible. It would be violating – although it sounds like a good idea on the face value, but it would not be okay given our prior commitments to the kids who participated initially.

                            I think the other thing I wanted to say about that is, which is I think a huge credit to Scott, this project wasn't initially designed as a CBPR project. When I came on board, I'm a community psychologist with some background in both community development work outside of academia and then also some of my training has been in CBPR and participatory action research. So when I came on board we discussed where the points of flexibility are in his study design, the one that got funded, to figure out how do we make this more collaborative, more participatory? I think it's not just to be participatory because it sounds nice, it's actually going to create some credibility and value for the project.

                            I think the more the community, including youth over time, participates the more relevant it becomes. I think that's the main point about becoming culturally relevant is getting the mana`o (thoughts) from the kids from this community about their own place.

                            Howard or Jay, did you want to share anything about that?

Howard Medeiros:         Our comprehensive strategy for juvenile justice also includes a youth component, so we have annual youth summits to bring kids from all the schools and preferably we prefer not only the highly academic kids but also the at risk kids to be part of it. They have helped us identify issues within the schools currently going on. They always identify drug use as a problem area. People do not understand, the Big Island is very large. I mean all the other islands in the state would fit physically on the Big Island. We also have very small communities, or very remote, and we are very interested in involving the young people because hopefully they stay in their communities or come back to their communities and hopefully can continue whatever promising practices can be developed.

Darius Tandon:           This is an exciting project and we wish you the best of luck in your future work. Are there any last comments you wanted to share with our listeners about other aspects of the study that were not captured in your manuscript?

Susana Helm:              Actually, we wanted to mahalo a lot of people. I think Scott has a lot to say about that.

Scott Okamoto:             Yes, a lot of, there were a lot of people, who were involved in really making this project a success. I just have a short list right now, but it's the National Institutes of Health and the National Institute on Drug Abuse, Hawai`i Pacific University, the University of Hawai`i at Manoa, the Asian/Pacific Islander Youth Violence Prevention Center, the State of Hawai`i Department of Education, the Hawai`i County Office of the Prosecuting Attorney, and the Southwest Interdisciplinary Research Center at Arizona State University, which helped a lot with the conceptualization of this study and the pre-award work that went into it.