Conducting Community Health Research
Alexis M. Stoner, MPH, PhD Candidate
Clinical Instructor and Course Director of Epidemiology, Clinical
Prevention and Population Health – Carolinas Campus
Basic/Bench
Research
Community
Health
Research
Clinical Research
Why Conduct Community
Health Research?
• Health of the community is dependent on many
factors affecting an entire population.
• Using a population as an organizing principle for
preventive action has the potential to have a great
impact on the entire population’s health.
• It takes partnering at all levels to fully realize the
impact of any health intervention.
Why Conduct Community
Health Research?
• Addresses barriers between researchers
and participants
• Provides action and methods that leave a
community with improvements
• Creates new knowledge and directly
benefits a community
Continuum of Community
Based Research for Health
Traditional
(On)
CommunityEngaged Research
(In)
Community Based
Participatory
Research (CBPR)
(With)
Key Characteristics
•
•
•
•
•
Prevention focus
Population-Centered
Partnership with the Community
Multidisciplinary Approach
Often participants continue their usual
activities
Blumenthal, D. S., Yancey, E. Community-based health research: Issues and methods (2004).New York: Springer Pub.
Israel, B. A. (2005). Methods in community-based participatory research for health (1st ed.). San Francisco, CA: Jossey-Bass
Key Characteristics
• Acknowledge community as a unit of identity
• Build on strengths and weaknesses in community
• Generates knowledge and intervention for mutual
benefit of all partners
• Typically addresses issues of local relevance
• Uses a cyclical, iterative process
• Disseminates results to all partners
Blumenthal, D. S., Yancey, E. Community-based health research: Issues and methods (2004).New York: Springer Pub.
Israel, B. A. (2005). Methods in community-based participatory research for health (1st ed.). San Francisco, CA: Jossey-Bass.
CBPR Research
Process
Community
Assessment
and Diagnosis
Disseminating
and translating
research
findings
Maintaining
Partnership
Evaluation
and
interpreting
results
Israel, B. A. (2005). Methods in community-based participatory research for health (1st ed.). San
Francisco, CA: Jossey-Bass
Defining the
Issue and
forming a
research
question
Implement
Cardiovascular Risk Reduction
Community Trials
• Framingham Heart Study
– Established link between behavior and heart
attacks and strokes
• Series of randomized controlled trials
developed to address multiple behavioral
risk factors
• Intervention at the community level to
effect individual behavior and health
outcomes
• Stanford Five Cities Project, Minnesota
Heart Health Program, Pawtucket Heart
Health Program
Defining a Community
• What do we mean by community?
Cardiovascular Community Trial
Studies
• Large scale
• Long-term in duration
• Chose multiple cities as units of
community to examine intervention
CBPR Research
Process
Community
Assessment
and Diagnosis
Disseminating
and
translating
research
findings
Evaluation
and
interpreting
results
Maintaining
Partnership
Defining the
Issue and
forming a
research
question
Implement
Community Assessment
• Establish a baseline for which objectives, outcomes,
and measures of change can be developed
• Gain an “insiders’” view into the community you are
working with
• Comprehensive understanding of influences on
conditions for a population to be in good health
– Biomedical, social, behavioral, political, cultural, economic
Community Assessment
• Case Study Research Design
• Data Collection
– Demographic data
– Secondary data – perspectives from both insiders and
outsiders
– Secondary data on history and geography
– Field notes
– Interview notes/transcripts
Cardiovascular Community Trial
Studies
• Results from Framingham Health Study
• Conducted surveys to random samples
• Epidemiologic Surveillance
CBPR Research
Process
Community
Assessment
and
Diagnosis
Disseminating
and
translating
research
findings
Maintaining
Partnership
Evaluation and
interpreting
results
Defining the
Issue and
forming a
research
question
Implement
Defining the Issue/Forming a
Research Question
• Seeking to determine
–
–
–
–
If a certain condition exists
To what extent it exists
How and to what extent a condition impacts the community
The outcome of an intervention in addressing a condition
• Conduct a thorough literature review
• Identify what is most important and pertinent to the
community!
Cardiovascular Community Trial
Studies
• Wanted to determine if risk-reduction
health promotion messages delivered
through multiple channels would lead to a
reduction in cardiovascular morbidity and
mortality.
CBPR Research
Process
Community
Assessment
and Diagnosis
Disseminating
and
translating
research
findings
Maintaining
Partnership
Evaluation and
interpreting
results
Defining the
Issue and
forming a
research
question
Implement
Implementation
Grimes, D. A., & Schulz, K. F. (2002). An overview of clinical research: The lay of the land. The Lancet, 359(9300), 57-61.
Cardiovascular Community Trial
Studies
• Quasi-experimental
• 3 intervention cities
• 3 control cities
Implementation
•
•
•
•
Consistency
Adherence to good research practices
Account for environmental variability
Communication
CBPR Research
Process
Community
Assessment
and Diagnosis
Disseminating
and
translating
research
findings
Maintaining
Partnership
Evaluation and
interpreting
results
Defining the
Issue and
forming a
research
question
Implement
Evaluation and Interpreting
Results
• Organized data management system
• Working with a biostatistician
• Formative or summative evaluation
CBPR Research
Process
Community
Assessment
and Diagnosis
Disseminating
and
translating
research
findings
Maintaining
Partnership
Evaluation and
interpreting
results
Defining the
Issue and
forming a
research
question
Implement
Disseminating and Translating
Research Findings
• Results should be shared with community
members
• When reporting remember limitations of study
design – poor generalizability, ecological fallacy
• How do these results translate into lasting
principles to improve the health of the population?
Cardiovascular Community Trial
Studies
• Challenges
– Results were modest if positive at all
– Competing with other interventions
– Sample size
– Differences among subgroups within the
populations
Benefits
• Provides a complete picture of the
community
• Meets a community’s needs
• Helps build relationships and creates
interdisciplinary collaboration
• Translation across similar communities
Limitations
• External validity (generalizability)
• Time commitment
• Sample size
Informal Exercise
•
•
•
•
Who is the community?
What is the problem?
What is your research question?
How would you implement your research
or intervention?
Questions?
References
• Blumenthal, D. S., Yancey, E. Community-based health research:
Issues and methods (2004).New York: Springer Pub.
• Grimes, D. A., & Schulz, K. F. (2002). An overview of clinical
research: The lay of the land. The Lancet, 359(9300), 57-61.
• Israel, B. A. (2005). Methods in community-based participatory
research for health (1st ed.). San Francisco, CA: Jossey-Bass
• A Manual for Community Based Participatory Research.
http://www.theceal.org/images/Documents/CEAL-UNC-Manual-forCommunity-Based-Participatory-Research-1.pdf