Research-what is it and why
do we do it?
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

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
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
 Practice
 Common Good
 Human Rights-Based
 Research
 Individual
Responsibility
 Needs-Based
Contradictions
Research on communities of
color has rarely been directly
beneficial and sometimes has
actually done harm.
Protection of
human
subjects has
guarded
communities
of color from
the research
process
Contradictions
Issues selected based on
everyday life experience
Problems of
disease, illness,
and risk are
selected based
on
epidemiological
data
Contradictions
Study design, budget, and
proposal reflects community
ownership and authenticity
Study design and
budget
proposed reflects
review of
scientific
literature and
feasibility
Contradictions
Recruitment and retention
based on trustworthiness of
viewpoints
Recruitment
and retention
based on
science and
“best guesses”
Contradictions
Measures developed and tested
to increase credibility and
dependability of data
Psychometric
testing of
measures
adopted or
adapted from
other studies
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 to
Research
 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?)
Which Groups Come to the Table?
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
Family
Health
Policy
Agency
Collaborations
with local, state
National MCH
agencies
Community
Advocacy
Specialist
Family
and
Community
BHA
PHRs
Which Issues Get to the Table?
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
Which Groups Shape Awareness
of Issues?
Community & Agency at the Table:
Design Phase Community Resource Group

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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


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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’s
Natural Helping
Networks
Agencies’
Formal Helping
System
Lay Health
Advisors
Community Outreach
workers and RHAs
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 Concerns
Place no one at risk

External Review
 An
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
70

60
50
40
Baseline
18 mos
30
20

10
0
<3 days
symptoms
No
symptoms
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
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
Power of a Bowl
How does the community
benefit from research?