Community Based Participatory Research: Evaluating Processes and Outcomes

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Community Based Participatory Research
Evaluating Processes and Outcomes

• Nina Wallerstein, DrPH
• University of New Mexico
• nwallerstein_at_salud.unm.edu
• Malia Villegas, EdD
• National Congress of American Indians Policy
  Research Center
• mvillegas_at_ncai.org
• Community Campus Partnerships for Health
• Houston, April 18, 2012

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Research for Improved Health A National Study
of Community-Academic Partnerships

• Overall Goal
• To examine the facilitators and barriers to
  effective community-academic partnerships to
  improve health and health equity in AI/AN
  communities and other communities which face
  disparities
• Partners (2009-2013)
• National Congress of American Indians Policy
  Research Center
• University of New Mexico Center for Participatory
  Research
• University of Washington Indigenous Wellness
  Research Institute
• Funding Native American Research Centers for
  Health (NARCH V) NIH/Indian Health Service
  partnership

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History

• Three-Year Pilot National Center of Minority
  Health and Health Disparities (2006-2009)
  (Wallerstein/Duran PI)
• National Advisory Board (CBPR Think Tank)
• Literature Review (2003-2008)
• PubMed, Business Premier, Psych Info, SciSearch,
  Communication and Mass Media
• Key Words Community Based Participatory
  Research, CBPR, participatory research, action
  research, participatory action research,
  participatory evaluation, community driven
  research, action science, collaborative inquiry,
  empowerment evaluation
• From over 2000 articles, 287 reviewed, used to
  generate model characteristics
• Internet Survey (Appropriateness of
  Characteristics)
• Development of Model (Wallerstein et al, 2008
  Chapter in CBPR and Health Process to Outcomes,
  2nd edition)

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Research for Improved Health
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Examples of items in Matrix

• The political and social climate seem "right" for
  starting a collaborative project like this one.
• I have a lot of respect for the other people
  involved in this collaboration.
• I can talk openly and honestly at the Board
  meetings.
• I am comfortable expressing my point of view.
• The partnership has been successful at preparing
  tribal leadership.
• To what extent has your partnership strengthened
  ATOD-related policies and regulations in the
  community?
• The partnership positively influences community
  health.

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Research for Improved Health

• Specific aims
• Describe the variability of CBPR
  partnerships/projects
• Describe the impact of governance on CBPR
  processes and outcomes
• Examine associations among partnering processes
  and intermediate system/capacity and health
  outcomes
• Identify promising practices, assessment tools,
  and future research needs.

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Research for Improved Health Methodology

• Quantitative
• Internet survey of 327 federally funded CBPR
  projects
• Key informant interview surveys (PIs) to enhance
  recruitment and validate data
• Community Engagement survey of perceptions
• (Identified in 2009 RePORT data base NARCH
  Projects).
• Qualitative
• At least 6 case studies of partnerships
  (originally 8)
• Examine similarities and differences across key
  contexts, partnering processes, and outcomes
• Deepen interpretations of survey

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Research for Improved Health Select Hypotheses

• The more a CBPR partnership integrates local
  knowledge into the research, the greater
  likelihood the project will result in
  intermediate system and capacity outcomes, ie.,
  cultural renewal, sustainability, community
  capacity, policy practice changes.
• The more a project is aligned with CBPR
  principles, the better quality of intermediate
  system and capacity outcomes.
• The more there is resource-sharing, participatory
  decision-making and reciprocal learning, the
  better the capacity outcomes.
• The longer the CBPR partnership has been in
  operation, the more the project will result in
  intermediate outcomes which lead to improved
  health outcomes.

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Research for Improved Health Accomplishments
since Fall, 2009

• Application of the conceptual model to study
  design
• Literature review publication measurement tools
  and constructs (Sandoval et al, Health Education
  Research) http//hsc.unm.edu/SOM/fcm/cpr/cprmodel/
  Instruments/CBPR-InteractiveModel/CBPRInstruments-
  Matrix/InstrumentsMatrix--abstract.pdf
• Project code of ethics and integrity, protocols
  for student involvement, publications,
  communications Study website
  http//narch.ncaiprc.org/
• Variable Matrix (Pearson et al, 2011, CES4Health
  Web availability of Interactive Model
  linked to instruments and to variables/measures
  http//hsc.unm.edu/SOM/fcm/cpr/cprmodel.shtml

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Research for Improved Health Case Studies

• Personal Involvement/Motivation
• Context Emphasized
• History of Community in Research/Social
  Movements
• Partnership/Group Dynamics
• Governance/Approval Processes
• Facilitators and Barriers
• Power
• Trust
• Interventions or Policy Emphasis
• CBPR Research

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Themes in Findings

• Context Matters
• Historic trust/mistrust readily present
• Urban/rural access
• Governance Matters
• Tribal Sovereignty and community accountability
• Structural agreements and approvals vary
  considerably
• Identity of Researcher(s) Matter
• Shared ethnic/racial identity enable bridging
  role
• Interventions impacted by cultural embeddedness
• Partnership and Capacity Outcomes
• Community sustainability of intervention
• University approval policies

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Internet Survey Domains

• Context Community Capacity
• Group Dynamics Bridging
• Alignment with Principles/Core Values
• Task Roles
• Power Dynamics/Decision-making
• Leadership/Stewardship
• Trust
• Intervention/Research Partnership Synergy
• Outcomes
• System and Capacity Changes Policy/Quality/Access
  
• Changes in Power Relations
• Sustainability
• Cultural Centeredness

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Julie Lucero, 2012
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Contact Information

• Malia Villegas, Principal Investigator
• Principal Investigator, NCAI PRC NARCH Project
• Email mvillegas_at_ncai.org
• Nina Wallerstein, Co-Principal Investigator, UNM
• Qualitative Data Collection Analysis
• Email nwallerstein_at_salud.unm.edu
• Bonnie Duran, Co-Principal Investigator, UW
• Quantitative Data Collection Analysis
• Email bonduran_at_u.washington.edu