Research-what is it and why do we do it?
Dec 15, 2015
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?)
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
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
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