Evaluation of a school-based participatory intervention to improve school environments using the Consolidated Framework for Implementation Research.

BACKGROUND: Participatory research offers a promising approach to addressing health inequities and improving the social determinants of health for diverse populations of adolescents. However, little research has systematically explored factors influencing the implementation of participatory health interventions targeting health disparities. OBJECTIVE: This study examined the utility of the Consolidated Framework for Implementation Research (CFIR) in identifying and comparing barriers and facilitators influencing implementation of participatory research trials by employing an adaptation of the CFIR to assess the implementation of a multi-component, urban public school-based participatory health intervention. METHODS: We collected qualitative data over a one-year period through weekly team meeting observational field notes and regular semi-structured interviews with five community-based participatory researchers, one school-based partner, and four school principals involved in implementing a participatory intervention in five schools. Adapted CFIR constructs guided our largely deductive approach to thematic data analysis. We ranked each of the three intervention components as high or low implementation to create an overall implementation effectiveness score for all five schools. Cross-case comparison of constructs across high and low implementation schools identified constructs that most strongly influenced implementation. RESULTS: Ten of 30 assessed constructs consistently distinguished between high and low implementation schools in this participatory intervention, with five strongly distinguishing. Three additional constructs played influential, though non-distinguishing, roles within this participatory intervention implementation. Influential constructs spanned all five domains and fit within three broad themes: 1) leadership engagement, 2) alignment between the intervention and institutional goals, priorities, demographics, and existing systems, and 3) tensions between adaptability and complexity within participatory interventions. However, the dynamic and collaborative nature of participatory intervention implementation underscores the artificial distinction between inner and outer settings in participatory research and the individual behavior change focus does not consider how relationships between stakeholders at multiple levels of participatory interventions shape the implementation process. CONCLUSIONS: The CFIR is a useful framework for the assessment of participatory research trial implementation. Our findings underscore how the framework can be readily adapted to further strengthen its fit as a tool to examine project implementation in this context.

They Just Respect You for Who You Are: Contributors to Educator Positive Youth Development Promotion for Somali, Latino, and Hmong Students.

Youth from immigrant communities may experience barriers to connecting with schools and teachers, potentially undermining academic achievement and healthy youth development. This qualitative study aimed to understand how educators serving Somali, Latino, and Hmong (SLH) youth can best promote educator-student connectedness and positive youth development, by exploring the perspectives of teachers, youth workers, and SLH youth, using a community based participatory research approach. We conducted four focus groups with teachers, 18 key informant interviews with adults working with SLH youth, and nine focus groups with SLH middle and high school students. Four themes emerged regarding facilitators to educators promoting positive youth development in schools: (1) an authoritative teaching approach where teachers hold high expectations for student behavior and achievement, (2) building trusting educator-student relationships, (3) conveying respect for students as individuals, and (4) a school infrastructure characterized by a supportive and inclusive environment. Findings suggest a set of skills and educator-student interactions that may promote positive youth development and increase student-educator connectedness for SLH youth in public schools.

Somali, Latino, and Hmong Youth Perceptions of School Connectedness.

Purpose: School connectedness positively influences adolescent health outcomes and is a key social determinant of health, yet, contributors to school connectedness for youth from immigrant communities remain poorly defined. Methods: This community-based participatory research study uses thematic analysis to identify contributors to Somali, Latino, and Hmong (SLH) adolescents' school connectedness. We conducted nine focus groups with 71 SLH male and female adolescents, the majority aged 13-18 years, in a United States Midwestern metropolitan area. Results: SLH students described contributors to their school connectedness that fit within three broad themes: (1) SLH students desire to be known and supported by their teachers as individuals, (2) specific teacher instructional approaches reinforce or undermine SLH student-school connections, and (3) transparency and fairness in school disciplinary practices are especially important for promoting Latino student-school connectedness. Conclusion: SLH youth perspectives offer ways for educators to foster increased school connectedness to improve academic and health outcomes among increasingly diverse student populations.

Lessons Learned in Implementing Youth and Parent Participatory Action Research in a School-Based Intervention.

BACKGROUND: Participatory action research (PAR) empowers youth and parent stakeholders to address school connectedness and school environment inequities to improve educational social determinants of health. OBJECTIVES: To identify lessons learned when implementing school-based youth and parent PAR (YPAR and PPAR) targeting health and academic outcomes for Indigenous students and students of color. METHODS: We collected data from five community-academic research team members who coordinated YPAR and PPAR implementation across five middle and high schools and used thematic analysis with deductive and inductive coding to identify contributors to successful PAR implementation. RESULTS: Experiential learning strengthened youth and parent researcher skills and maintained their engagement, community-building supported the PAR process, PAR required support from facilitators with diverse skill sets, and individuals in bridging roles positioned researchers for success within institutions. CONCLUSIONS: PAR holds promise for application in other settings to address institutional change and social determinants of health.

Improving health through community-based participatory action research. Giving immigrants and refugees a voice.

Community-based participatory action research (CBPAR) gives people a voice in identifying and solving the health problems affecting their communities. Researchers from the University of Minnesota, health care professionals from West Side Community Health Services, and members of the Somali, Latino, and Hmong communities in St. Paul are using CBPAR to identify and study health-related problems in those communities and design initiatives to solve them.This article describes CBPAR and four projects that are currently underway within West Side's SoLaHmo Partnership for Health and Wellness: Caafimad- Salud - Kev Nyob Zoo.

Process Evaluation for Improving K12 Program Effectiveness: Case Study of a National Institutes of Health Building Interdisciplinary Research Careers in Women's Health Research Career Development Program.

INTRODUCTION: Process evaluation is an important tool in quality improvement efforts. This article illustrates how a systematic and continuous evaluation process can be used to improve the quality of faculty career development programs by using the University of Minnesota's Building Interdisciplinary Research Careers in Women's Health (BIRCWH) K12 program as an exemplar. METHODS: Data from a rigorous process evaluation incorporating quantitative and qualitative measurements were analyzed and reviewed by the BIRCWH program leadership on a regular basis. RESULTS: Examples are provided of how this evaluation model and processes were used to improve many aspects of the program, thereby improving scholar, mentor, and advisory committee members' satisfaction and scholar outcomes. CONCLUSIONS: A rigorous evaluation plan can increase the effectiveness and impact of a research career development plan.

Concept Mapping as an Approach to Facilitate Participatory Intervention Building.

BACKGROUND: A challenge to addressing community-defined need through community-based participatory intervention building is ensuring that all collaborators' opinions are represented. Concept mapping integrates perspectives of individuals with differing experiences, interests, or expertise into a common visually depicted framework, and ranks composite views on importance and feasibility. OBJECTIVES: To describe the use of concept mapping to facilitate participatory intervention building for a school-based, teacher-focused, positive youth development (PYD) promotion program for Latino, Hmong, and Somali youth. Particiants were teachers, administrators, youth, parents, youth workers, and community and university researchers on the projects' community collaborative board. We incorporated previously collected qualitative data into the process. METHODS: In a mixed-methods process we 1) generated statements based on key informant interview and focus group data from youth workers, teachers, parents, and youth in multiple languages regarding ways teachers promote PYD for Somali, Latino and Hmong youth; 2) guided participants to individually sort statements into meaningful groupings and rate them by importance and feasibility; 3) mapped the statements based on their relation to each other using multivariate statistical analyses to identify concepts, and as a group identified labels for each concept; and 4) used labels and statement ratings to identify feasible and important concepts as priorities for intervention development. RESULTS: We identified 12 concepts related to PYD promotion in schools and prioritized 8 for intervention development. CONCLUSIONS: Concept mapping facilitated participatory intervention building by formally representing all participants' opinions, generating visual representation of group thinking, and supporting priority setting. Use of prior qualitative work increased the diversity of viewpoints represented.