Integrating community voices in the research continuum: Perspectives on a consultation service.

The Community Research Advisory Council (C-RAC) of the Johns Hopkins Institute for Clinical and Translational Research was established in 2009 to provide community-engaged research consultation services. In 2016-2017, C-RAC members and researchers were surveyed on their consultation experiences. Survey results and a 2019 stakeholder meeting proceeding helped redesign the consultation services. Transitioning to virtual consultations during COVID-19, the redesigning involved increasing visibility, providing consultation materials in advance, expanding member training, and effective communications. An increase in consultations from 28 (2009-2017) to 114 (2020-2022) was observed. Implementing stakeholder-researcher inputs is critical to holistic and sustained community-engaged research.

A Dietary Intervention in Urban African Americans: Results of the "Five Plus Nuts and Beans" Randomized Trial.

INTRODUCTION: Unhealthy diets, often low in potassium, likely contribute to racial disparities in blood pressure. We tested the effectiveness of providing weekly dietary advice, assistance with selection of higher potassium grocery items, and a $30 per week food allowance on blood pressure and other outcomes in African American adults with hypertension. DESIGN: We conducted an 8-week RCT with two parallel arms between May 2012 and November 2013. SETTING/PARTICIPANTS: We randomized 123 African Americans with controlled hypertension from an urban primary care clinic in Baltimore, Maryland, and implemented the trial in partnership with a community supermarket and the Baltimore City Health Department. Mean (SD) age was 58.6 (9.5) years; 71% were female; blood pressure was 131.3 (14.7)/77.2 (10.5) mmHg; BMI was 34.5 (8.2); and 28% had diabetes. INTERVENTION: Participants randomized to the active intervention group (Dietary Approaches to Stop Hypertension [DASH]-Plus) received coach-directed dietary advice and assistance with weekly online ordering and purchasing of high-potassium foods ($30/week) delivered by a community supermarket to a neighborhood library. Participants in the control group received a printed DASH diet brochure along with a debit account of equivalent value to that of the DASH-Plus group. MAIN OUTCOME MEASURES: The primary outcome was blood pressure change. Analyses were conducted in January to October 2014. RESULTS: Compared with the control group, the DASH-Plus group increased self-reported consumption of fruits and vegetables (mean=1.4, 95% CI=0.7, 2.1 servings/day); estimated intake of potassium (mean=0.4, 95% CI=0.1, 0.7 grams/day); and urine potassium excretion (mean=19%, 95% CI=1%, 38%). There was no significant effect on blood pressure. CONCLUSIONS: A program providing dietary advice, assistance with grocery ordering, and $30/week of high-potassium foods in African American patients with controlled hypertension in a community-based clinic did not reduce BP. However, the intervention increased consumption of fruits, vegetables, and urinary excretion of potassium.

Enhancing fire department home visiting programs: results of a community intervention trial.

This study evaluates the impact of an enhanced fire department home visiting program on community participation and installation of smoke alarms, and describes the rate of fire and burn hazards observed in homes. Communities were randomly assigned to receive either a standard or enhanced home visiting program. Before implementing the program, 603 household surveys were completed to determine comparability between the communities. During a 1-year intervention period, 171 home visits took place with 8080 homes. At baseline, 60% of homes did not have working smoke alarms on every level, 44% had unsafe water temperatures, and 72% did not have carbon monoxide alarms. Residents in the enhanced community relative to those in the standard community were significantly more likely to let the fire fighters into their homes (75 vs 62%). Among entered homes, those in the enhanced community were significantly more likely to agree to have smoke alarms installed (95 vs 92%), to be left with a working smoke alarm on every level of the home (84 vs 78%), and to have more smoke alarms installed per home visited (1.89 vs 1.74). The high baseline rates of home hazards suggest that fire department home visiting programs should take an "all hazards" approach. Community health workers and community partnerships can be effective in promoting fire departments' fire and life safety goals. Public health academic centers should partner with the fire service to help generate evidence on program effectiveness that can inform decision making about resource allocation for prevention.

Faculty beliefs, perceptions, and level of community involvement in their research: a survey at one urban academic institution.

Health researchers are increasingly interested in how best to engage communities in their health-related research studies. To help determine how researchers have interacted with community members in their research, we conducted a survey of full-time faculty from the Johns Hopkins Medical Institutions regarding researchers' beliefs and experiences with community-based research. Approximately 41% of respondents who conducted human subject studies had enrolled local residents in their research. Researchers whose studies were based in the surrounding community were significantly more likely to involve community members in all stages of their research (e.g., selection of the problem, project planning, data collection, interpretation and dissemination of results, or developing an intervention) than were faculty whose studies enrolled community members as research participants but whose studies were not set in the community. Over 90% of all faculty respondents agree that community involvement improves the relevance of their research, although almost 60% had not done so. Most faculty value community involvement, but they want more institutional support for such activities and they seek better skills to involve community. Few studies have surveyed researchers who enroll community members as research participants to document practices regarding community involvement in the research process. Given that the majority (73.6%) of faculty responded that they intend to include local residents in their upcoming studies, future research to evaluate interventions designed to facilitate community involvement, especially in the inner city, would help stakeholders identify best practices for involving and engaging communities in health research.

"You've got to understand community": community perceptions on "breaking the disconnect" between researchers and communities.

BACKGROUND: Community-based participatory research (CBPR) is a growing approach to research yet its implementation does not come without challenges. Incorporating CBPR may be especially difficult for large academic medical institutions where research is conducted by different stakeholders operating under different paradigms. The Environmental Justice Partnership (EJP) is a community-academic partnership that sought to understand and address these challenges. OBJECTIVES: To know how to effectively foster collaboration between a large academic medical center and its surrounding urban community, the EJP sought to understand community stakeholders' views on research, the research process, and how to improve researcher-community collaborations. METHODS: This study used a qualitative approach to gather information from residents and representatives from community-based organizations (CBOs) and city agencies. The data are from 17 semistructured interviews and 8 focus groups (n = 80) conducted from October 2003 to May 2004. RESULTS: Respondents emphasized the importance of disseminating research findings, working closely with the community before research starts and throughout the study, and listening to community members' priorities and needs. Those with personal research experience had more positive attitudes about research than respondents who had not been in research. CONCLUSIONS: Academic institutions need to make greater effort to involve communities regularly in their community-based research to identify community priorities and concerns. Institutions may want to develop strategies for their affiliated researchers to facilitate partnership building. Especially for large academic institutions in urban settings, such efforts may help to bridge distance between researchers and community to promote the shared goal of improved public health.