1. Conducting Community Health Research
Alexis M. Stoner, MPH, PhD Candidate
Clinical Instructor and Course Director of Epidemiology, Clinical Prevention and Population Health – Carolinas Campus

2. Community Health Research
Clinical Research
Basic/Bench Research

3. 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.

4. 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

5. Continuum of Community Based Research for Health
Traditional
(On)
Community- Engaged Research
(In)
Community Based Participatory Research (CBPR)
(With)

6. 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

7. 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.

8. CBPR Research Process Maintaining Partnership
Community Assessment and Diagnosis
Defining the Issue and forming a research question
Implement
Evaluation and interpreting results
Disseminating and translating research findings
CBPR Research Process
Israel, B. A. (2005). Methods in community-based participatory research for health (1st ed.). San Francisco, CA: Jossey-Bass

9. 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

10. Defining a Community
What do we mean by community?

11. Cardiovascular Community Trial Studies
Large scale
Long-term in duration
Chose multiple cities as units of community to examine intervention

12. CBPR Research Process Maintaining Partnership
Community Assessment and Diagnosis
Defining the Issue and forming a research question
Implement
Evaluation and interpreting results
Disseminating and translating research findings

13. 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

14. 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
Case is the community

15. Cardiovascular Community Trial Studies
Results from Framingham Health Study
Conducted surveys to random samples
Epidemiologic Surveillance

16. CBPR Research Process Maintaining Partnership
Community Assessment and Diagnosis
Defining the Issue and forming a research question
Implement
Evaluation and interpreting results
Disseminating and translating research findings

17. 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!

18. 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.

19. CBPR Research Process Maintaining Partnership
Community Assessment and Diagnosis
Defining the Issue and forming a research question
Implement
Evaluation and interpreting results
Disseminating and translating research findings

20. Implementation
Grimes, D. A., & Schulz, K. F. (2002). An overview of clinical research: The lay of the land. The Lancet, 359(9300),

21. Cardiovascular Community Trial Studies
Quasi-experimental
3 intervention cities
3 control cities

22. Implementation Consistency Adherence to good research practices
Account for environmental variability
Communication

23. CBPR Research Process Maintaining Partnership
Community Assessment and Diagnosis
Defining the Issue and forming a research question
Implement
Evaluation and interpreting results
Disseminating and translating research findings

24. Evaluation and Interpreting Results
Organized data management system
Working with a biostatistician
Formative or summative evaluation

25. CBPR Research Process Maintaining Partnership
Community Assessment and Diagnosis
Defining the Issue and forming a research question
Implement
Evaluation and interpreting results
Disseminating and translating research findings

26. 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?

27. Cardiovascular Community Trial Studies
Challenges
Results were modest if positive at all
Competing with other interventions
Sample size
Differences among subgroups within the populations

28. Benefits Provides a complete picture of the community
Meets a community’s needs
Helps build relationships and creates interdisciplinary collaboration
Translation across similar communities

29. Limitations External validity (generalizability) Time commitment
Sample size

30. Informal Exercise Who is the community? What is the problem?
What is your research question?
How would you implement your research or intervention?

31. Questions?

32. 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),
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.