Phyllis Sharps, PhD, RN, FAAN, Professor Associate Dean Community and Global Programs

1

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

2

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.

3

Research and Communities

Approaches to Research with Communities

Community Based Research

Community Based Participatory Research

4

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

5

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

6

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

7

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

8

Research Addressing Professional and

Participant Communities

Community Based Research

9

NIH/NINR - R01 NR009093

DOMESTIC VIOLENCE ENHANCED HOME VISITATION

PROGRAM: (DOVE)

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

10

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

11

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

12

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

13

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

14

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

15

Methods

Quantitative Study: Measures IPV Maternal Mental Health

(stress, depression, PTSD)

Parenting (stress, stimulation)

Infant Growth & Development Use of Community Resources

16

Methods

Qualitative Study Patterns of IPV Urban/Rural influences on patterns of IPV

17

Lessons Learned

Developing Partnerships

18

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.

19

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

20

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

21

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

22

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

23

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

24

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

25

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

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

27

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

28

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)

29

DOVE WEBSITE

http://www.son.jhmi.edu/research/dove

[email protected]

Thank You !!!

30