A community-based participatory planning process and multilevel intervention design: toward eliminating cardiovascular health inequities.

The elimination of persistent health inequities requires the engagement of multiple perspectives, resources, and skills. Community-based participatory research (CBPR) is one approach to developing action strategies that promote health equity by addressing contextual as well as individual-level factors, and that can contribute to addressing more fundamental factors linked to health inequity. Yet many questions remain about how to implement participatory processes that engage local insights and expertise, are informed by the existing public health knowledge base, and build support across multiple sectors to implement solutions. This article describes a CBPR approach used to conduct a community assessment and action planning process, culminating in development of a multilevel intervention to address inequalities in cardiovascular disease in Detroit, Michigan. The authors consider implications for future efforts to engage communities in developing strategies toward eliminating health inequities.

Psychosocial stress and social support as mediators of relationships between income, length of residence and depressive symptoms among African American women on Detroit's eastside.

Patterns of mental health are clearly associated with life circumstances, including educational and economic opportunities, access to safe and supportive neighborhoods, socially structured exposures to stressors and to supportive relationships. In this article, we examine the social and economic correlates of depressive symptoms among African American women residing within a predominantly African American urban neighborhood in Detroit, USA, with relatively few economic resources. We identify distinct stressors associated with financial strain, neighborhood social disorder (concern about police responsiveness, safety stress), and experiences of discrimination. We test the extent to which each of these stressors mediates relationships between household income, length of residence in the neighborhood, social support and depressive symptoms. Our results suggest that for women in this racially segregated area with a high concentration of poverty, relationships between household income and symptoms of depression are partially mediated by financial stress and social support, but that stressors associated with neighborhood disorder and discrimination influence depressive symptoms independent of household income. Furthermore, we find that length of residence in the neighborhood is negatively associated with financial stress and positively associated with police stress and social support, with no significant net effect on symptoms of depression. We conclude that higher household income may help reduce symptoms of depression by reducing financial stress and strengthening social support even within neighborhoods with high concentrations of poverty. However, increased household income does not protect African American women residing in a high poverty community from distress associated with neighborhood disorder or experiences of discrimination.

The Healthy Connections project: a community-based participatory research project involving women at risk for diabetes and hypertension.

BACKGROUND: The Healthy Connections (HC) project was a community health worker (CHW) intervention that built upon existing social networks to encourage African American and Latina women to obtain screening for type 2 diabetes and hypertension. OBJECTIVES: This community-based participatory research (CBPR) project involved identifying and training CHWs, known as HC Advocates (HCAs). The HCAs provided screening through House Parties and shared health information and practical support with members of their social networks and broader networks of individuals. METHODS: Data collection methods included project documentation, participant observation, group interviews, closed-ended surveys, and written examinations to ensure HCAs had the required knowledge and skills to perform their roles. Data collection and analysis incorporated both qualitative and quantitative methods, and used a formative approach that integrated results from key aspects of the project into ongoing decision-making and project activities. RESULTS: Eight community residents completed training and the required exams to become HCAs. Together, they conducted 124 House Parties, screened 1,428 individuals for high blood pressure and glucose levels, and shared health information with those individuals as well as 218 additional members of HCAs informal social networks. Of those who attended the House Parties, 93% were African American, 4% Latina, 2% non-Hispanics whites, and 1% other racial and ethnic groups. CONCLUSION: The HC project demonstrated the potential for using a CBPR approach to develop, implement, and evaluate a CHW intervention designed to reach African American and Latina women at high risk for hypertension and type 2 diabetes. Participation from relevant communities in the design of the intervention and evaluation, with particular attention to recruitment and retention of representatives from communities who face challenges accessing health care, can help to increase involvement of community residents in screening and educational programs aimed at addressing disparities in type 2 diabetes and hypertension.

Piloting interventions within a community-based participatory research framework: lessons learned from the healthy environments partnership.

BACKGROUND: Community-based participatory research (CBPR) partnerships experience unique opportunities and dilemmas when implementing pilot interventions. OBJECTIVES: We describe challenges and opportunities associated with conducting a pilot intervention within a longstanding CBPR partnership, lessons learned for use of a participatory process to pilot community interventions, and recommendations to funders on mechanisms for funding pilot interventions to help address these challenges. METHODS: We conducted key informant interviews and convened a group discussion with host organization leaders and project personnel. LESSONS LEARNED: Findings highlight the opportunities and challenges related to needs and desires of community constituents and the ability of pilot interventions to meet those needs, and the importance of ongoing communication to address anticipated and unanticipated challenges that arise in the context of short-term pilot interventions in community settings. CONCLUSION: We suggest several funding mechanisms for supporting the implementation of larger scale interventions following promising pilot efforts in community settings.

A community-based participatory approach to personalized, computer-generated nutrition feedback reports: the healthy environments partnership.

BACKGROUND: Computer tailoring and personalizing recommendations for dietary health-promoting behaviors are in accordance with community-based participatory research (CBPR) principles, which emphasizes research that benefits the participants and community involved. OBJECTIVE: To describe the CBPR process utilized to computer-generate and disseminate personalized nutrition feedback reports (NFRs) for Detroit Healthy Environments Partnership (HEP) study participants. METHODS: The CBPR process included discussion and feedback from HEP partners on several draft personalized reports. The nutrition feedback process included defining the feedback objectives; prioritizing the nutrients; customizing the report design; reviewing and revising the NFR template and readability; producing and disseminating the report; and participant follow-up. LESSONS LEARNED: Application of CBPR principles in designing the NFR resulted in a reader-friendly product with useful recommendations to promote heart health. CONCLUSIONS: A CBPR process can enhance computer tailoring of personalized NFRs to address racial and socioeconomic disparities in cardiovascular disease (CVD).