Collaboration and Context in the Design of Community-Engaged Research Training.

Collaboration between academic researchers and community members, clinicians, and organizations is valued at all levels of the program development process in community-engaged health research (CEnR). This descriptive study examined a convenience sample of 30 projects addressing training in CEnR methods and strategies within the Clinical and Translational Science Awards (CTSA) consortium. Projects were selected from among posters presented at an annual community engagement conference over a 3-year period. Study goals were to learn more about how community participation in the design process affected selection of training topics, how distinct community settings influenced the selection of training formats, and the role of evaluation in preparing training participants to pursue future health research programming. Results indicated (1) a modest increase in training topics that reflected community health priorities as a result of community (as well as academic) participation at the program design stage, (2) a wide range of community-based settings for CEnR training programs, and (3) the majority of respondents conducted evaluations, which led in turn to revisions in the curricula for future training sessions. Practice and research implications are that the collaboration displayed by academic community teams around CEnR training should be traced to see if this participatory practice transfers to the design of health promotion programs. Second, collaborative training design tenets, community formats and settings, and evaluation strategies should be disseminated throughout the CTSA network and beyond. Third, common evaluative metrics and indicators of success for CEnR training programs should be identified across CTSA institutions.

The Communication Gap Between the Medical System and Community Resources for Dementia-Related Behavioral Symptom Management: Family Caregiver Perspectives.

OBJECTIVE: To examine family caregiver perspectives on cooperative communication surrounding pharmacologic and nonpharmacologic resources for the treatment of dementia-related behavioral symptoms. METHODS: Personal narrative interviews were conducted by the primary investigator with 13 family caregivers from October 2014 to April 2015. The recorded interviews were then transcribed and coded. Models detailing the caregivers' resource utilization in regard to behavioral symptom management were produced for each participant and then summarized on the basis of recurring themes. RESULTS: There is a significant gap in the coordination and communication between physician services and caregiver community resources to aid in the behavioral management of family members with dementia. Physicians tend to rely on pharmacologic management independent of community resources and did not seem to be integrated or involved with recommendations from community resources. CONCLUSIONS: Better integration of caregiver resources is necessary to help caregivers in the management of dementia-related behavioral symptoms.

An exploratory study of Clinical and Translational Science Award community-engaged research training programs.

BACKGROUND: The Clinical and Translational Science Award (CTSA) institutions are increasing development of training programs in community-engaged research (CEnR) to support translational science. METHODS: This study sampled posters at CTSA national meetings to identify CEnR training approaches, topics, and outcomes. RESULTS: Qualitative analysis of 30 posters revealed training topics and outcomes focused primarily on CEnR capacity building, overcoming barriers, systems change, and sustainability. CONCLUSION: Further research should focus on development and results of CTSA CEnR training program metrics.

Towards a unified taxonomy of health indicators: academic health centers and communities working together to improve population health.

The Clinical and Translational Science Awards (CTSA) program represents a significant public investment. To realize its major goal of improving the public's health and reducing health disparities, the CTSA Consortium's Community Engagement Key Function Committee has undertaken the challenge of developing a taxonomy of community health indicators. The objective is to initiate a unified approach for monitoring progress in improving population health outcomes. Such outcomes include, importantly, the interests and priorities of community stakeholders, plus the multiple, overlapping interests of universities and of the public health and health care professions involved in the development and use of local health care indicators.The emerging taxonomy of community health indicators that the authors propose supports alignment of CTSA activities and facilitates comparative effectiveness research across CTSAs, thereby improving the health of communities and reducing health disparities. The proposed taxonomy starts at the broadest level, determinants of health; subsequently moves to more finite categories of community health indicators; and, finally, addresses specific quantifiable measures. To illustrate the taxonomy's application, the authors have synthesized 21 health indicator projects from the literature and categorized them into international, national, or local/special jurisdictions. They furthered categorized the projects within the taxonomy by ranking indicators with the greatest representation among projects and by ranking the frequency of specific measures. They intend for the taxonomy to provide common metrics for measuring changes to population health and, thus, extend the utility of the CTSA Community Engagement Logic Model. The input of community partners will ultimately improve population health.

Strategies to prevent and reduce diabetes and obesity in Sacramento, California: the African American Leadership Coalition and University of California, Davis.

BACKGROUND: Diabetes is one of the leading causes of illness and death for African Americans and people of African descent throughout the United States and in the city and county of Sacramento, California. The involvement of families and communities in developing prevention strategies can increase the likelihood that behavioral changes will be sustained. CONTEXT: Three member organizations of the African American Leadership Coalition (AALC) entered into a partnership with the University of California, Davis (UC Davis) to engage families in developing a process to identify barriers to diabetes and obesity prevention and reduction, exchange strategies, and create action plans for prevention. METHODS: The intervention comprised 3 phases: 1) coalition formation and training; 2) data collection, analysis, and dissemination of results; and 3) development of family and community action plans. Academic and community partners planned and implemented all project phases together. OUTCOMES: Sources of information about diabetes and obesity were primarily doctors and the Internet; barriers were related to lack of time needed to prepare healthy meals, high food costs, transportation to fresh markets, motivation around healthy habits, and unsafe environments. Action plans addressed behavioral change and family cohesion. The group discussion format encouraged mutual support and suggestions for better eating and physical exercise habits. INTERPRETATION: This collaborative partnership model can strengthen existing group relationships or promote new affiliations that form the basis for future action coalitions. Participants worked both within and across groups to exchange information, stories of success and challenges, and specific health improvement strategies.

Improving dietary and physical activity practices in group homes serving residents with severe mental illness.

BACKGROUND: People with severe mental illness (SMI) are at least 50% more likely to be overweight for various reasons, including poor nutrition, sedentary lifestyles, and side effects of antipsychotic medications. OBJECTIVES: Among residents with SMI who live in group homes, we examined (1) factors that affected the motivations of both group home operators and residents around improvement of residents' diet and physical activity, (2) how operators and residents viewed responsibility for maintaining good health in group homes, and (3) strategies from operators and residents for improving diet and exercise. METHODS: The research team conducted 6 focus groups-3 with group home operators and 3 with residents, using a community-based participatory research (CBPR) process and qualitative data analysis. RESULTS: Both group home operators and residents discussed conflicting feelings about foods they know as healthy and foods they prefer to eat. Operators attributed barriers to better health to the perceived negative attitudes of residents and providers, lack of communication with health care providers, and poor working relationships with the state licensing body that protects individual rights on lifestyle choices. Residents reported barriers of their own negative attitudes, limited menu options, lack of organized activities, existing health problems, and side effects of medications. CONCLUSION: Residents and operators had concrete suggestions for changes they could make individually, as well as recommendations for systemic changes to support healthier lifestyles. These recommendations provide a basis for designing an urgently needed pilot intervention program to address the current epidemic of obesity and diabetes in people with SMI residing in group homes.

Clinical and translational science awards and community engagement: now is the time to mainstream prevention into the nation's health research agenda.

Although much attention is devoted to the slow process of cutting-edge "bench science" finding its way to clinical translation, less attention is paid to the fact that basic prevention messages, tests, and interventions never find their way into communities. The NIH Clinical & Translational Science Awards program seeks to address a broad mission of improving health, including both speeding up the incorporation of basic science discoveries throughout the clinical research pipeline and incorporating concerns of communities and practices into research agendas. The preventive medicine community now has an important opportunity to marry their mission of promoting and expanding prevention in communities to the nation's medical research agenda. This article suggests opportunities for collaboration.