Participatory Approaches: How Can CBPR Guide Translation and Dissemination?

Transcription

1 Participatory Approaches: How Can CBPR Guide Translation and Dissemination? Alicia L. Salvatore, DrPH Stanford Prevention Research Center Stanford School of Medicine

2 Mind the Gap Bridge to Nowhere, taken in Grindstone Rancheria by Vanessa Martin, youth researcher, 2010

3 Objectives 1. Introduce community participation & CBPR, specifically 2. Present cases that illustrate benefits of CBPR 3. Reflect and discuss ways that community participation and/or CBPR can benefit D&I research and your work

4 Start where the people are 1. Your experience with partnerships? - Who - What - How 1. Your experience with CBPR?

5 Continuum of Participation Contractual take part in researchers studies. Consultative asked their opinions before projects/interventions. Collaborative work together on projects designed, initiated and managed by researchers. Collegiate work as colleagues with different skills to offer; mutual learning; local control over process. Briggs, 1989

6 What is CBPR? a collaborative approach to research that begins with a research topic of importance to the community and combines community and academic knowledge toward a goal of promoting social change to improve community health and reduce disparities. Office of Behavioral and Social Science Research, US Department of Health and Human Services Summer Institute on the Design and Development of Community-Based Participatory Research in Health. Available at:

7 CBPR Principles Recognizes community as a unit of identity Builds on community strengths & resources Facilities equitable participation in all phases of the process Fosters co-learning & capacity building Balances knowledge generation & intervention Involves systems development using a cyclical, iterative process Disseminates results to all partners; involves them in wider dissemination Balances research & action Involves long term process, commitment to sustainability Israel et al., 2005, 1998

8 Ultimate Form of T3 CBPR may be the ultimate form of translational research sometimes labeled T3 moving discoveries bidirectionally from bench to bedside to el barrio (the community) to organizations and policy makers. Horowitz, C.R. et al. Community-Based Participatory Research From the Margin to the Mainstream: Are Researchers Prepared? Circulation. 2009;119:

9 What s the value? Help ensure the relevance of the research topic Enhance the quality, sensitivity, and practicality of research instruments by involving local knowledge of community members Extend the likelihood over overcoming distrust Enhance the likelihood of success by increasing the relevance of research interventions Improve data analysis & interpretation by enhancing our understanding of meaning & context Improve potential for disseminating findings to diverse audiences & translating evidence-based research into sustainable change Minkler & Salvatore, 2012

10

11 CBPR can increase the relevance and uptake of interventions

12 Practice-Based Evidence CBPR has gained greater recognition in recent years as a promising way to generate practice-based evidence for addressing complex health and social conditions that exist in communities. - Green & Glasgow, 2006

13 Reducing Pesticide Exposures to Farmworkers Children Funded by the NIEHS and the U.S. EPA

14 University Agriculture Project Partnership Advocates Clinic Workers Farmworker Council

15

16 Study Participants 82% Male All born in Mexico Mean ~6 yrs. in U.S. and agriculture 54% living within 200% of poverty 80% < 6 th grade education 94% living with other farmworkers 67% > 1 child in household Salvatore, A.L. et al. Results from a Community-Based Participatory Worksite Intervention to Reduce Pesticide Exposures to Farmworkers and their Children. American Journal of Public Health Nov; 99: S578-S581.

17 Worksite Intervention Clothing to reduce the take home of pesticides to children. Lightweight coverall Shirts for women - for modesty Gloves Salvatore, A.L. et al. Results from a Community-Based Participatory Worksite Intervention to Reduce Pesticide Exposures to Farmworkers and their Children. American Journal of Public Health.2009 Nov; 99: S578-S581.

18 Worksite Intervention Farmworkers concerned that washing hands in cold water causes arthritis. Provided warm water handwashing developed system Field-based educational sessions. Salvatore, A.L. et al. Results from a Community-Based Participatory Worksite Intervention to Reduce Pesticide Exposures to Farmworkers and their Children. American Journal of Public Health Nov; 99: S578-S581.

19 Mixed Methods Pre and post behavioral surveys Interviews and focus groups with farmworkers and growers. Measures of pesticides on clothing patch and hands

20 How did the intervention work? Control Intervention Interaction Behavior Wore coverall Used gloves Washed hands before going home Pre Post Pre Post Effect (95% CI) P n=56 n=34 n=74 n= % 0 0.0% 1 1.4% % % % % % ** 15.5 a (2.5, 94.4) % % % % ** 4.3 (0.9, 20.3) p <0.10 ** p<0.05 Beta coefficient showing that intervention group was 15.5 times more likely to use gloves than the control group. [Baseline-to-end odds ratio of behavior change in the intervention group]/[baseline-to-end odds ratio of behavior change in the control group ] Salvatore, A.L. et al. Results from a Community-Based Participatory Worksite Intervention to Reduce Pesticide Exposures to Farmworkers and their Children. American Journal of Public Health Nov; 99: S578-S581.

21 Stanford University Chronic Disease Self-Management Program

22 Estimated age-adjusted total prevalence of diabetes in Adults, by race/ethnicity, U.S. (2005) American Indians/Alaska Natives Non-Hispanic Blacks Hispanic Non-Hispanic Whites Center for Disease Control and Prevention, Retrieved on 10/03/08 from

23 Adapting Stanford s Internet Diabetes Self- Management Program for American Indians CBPR study & workshops to adapt program for AI/AN Native peer educators Blessing, smudging ceremony Class sessions 30 minutes late longer to allow storytelling Jernigan, V. Community based participatory research with Native American communities: The Chronic Disease Self-Management Program. Health Promotion Practice. November 2010 Vol. 11, No. 6,

24 Adapting Stanford s Internet Diabetes Self- Management Program for American Indians Used curriculum elements adapted in CBPR study Quotes & photos from AI/AN Pilot (n=27 from 18 tribes) Natives know Natives, and are sensitive to the needs of Natives. I am on a reservation and life is different. There is no culture, it is a way of life, it is how we live, so I think from Native to Native we understand this way of life. - Participant

25 Intervention Effects Baseline-to-6 month changes: SIDSMP for AI/AN (n=110 from 70 tribes) Lorig, K. et al. Online Diabetes Self-Management Program. Diabetes Care. 33:

26 CBPR can enhance real time dissemination and translation of results into action

27 Chinatown Restaurant Worker Health & Safety Study Funded by CDC/NIOSH and The California Endowment

28 University Community Health Department Chinatown Restaurant Worker Project Steering Committee Workers Restaurant Worker Leadership Group

29 Study Methods Worker Survey N = 433 Worker characteristics Physical and psychosocial working conditions Physical and mental health Restaurant Observations N=106 Restaurant characteristics Physical working conditions Compliance with labor law (posters) Cross-sectional survey Questionnaire developed by partnership Observations by SFDPH during food safety inspections 13-item Checklist

30 Main Findings: Worker Survey (N=405) Poor working conditions - Multiple physical hazards (e.g., wet floors) - Psychosocial stressors (e.g., high effort, low rewards) - High injuries (e.g., 48% burned in past 12 mo.) - Psychological distress (e.g., 25% depressed)

31 Wage Theft (N=405) Hourly wage (dollars), M+SD Make less than minimum wage % Do not receive paid sick days % Do not receive 30 minute lunch break a % Do not receive breaks b % Initial pay withheld (1 or more pay periods) c % Wages paid late % Owed backwages 33 8 % a 144 (36%) only sometimes got breaks. b 114 (29%) only sometimes got breaks. c 45% of those who had wages withheld were eventually paid. Minimum wage was $9.36 for those who were currently working in a Chinatown restaurant at the time of the survey (i.e. 2008); $9.14 for those who last worked in 2007; and $8.82 for those who last worked in 2006.

32 Restaurant Worker Leaders

33 Actively involved in study design, implementation & interpretation of findings Identified questions for survey Mapped restaurants & identified risks for observation Pre-tested study instruments Trained survey workers Collected survey data (n=433) Interpreted findings & did reality checks with community

34 and dissemination Additional funding for comprehensive dissemination Not just journals & presentations! Ethnic & mainstream media Worker events (e.g., workshops, Worker Teas) Outreach to state regulatory agencies & employers Worker Tea Chinese Newspaper Letter to Dept. of Industrial Relations

35 and translation to action Community-authored report Contextualized study data with worker stories & data on other low-wage worker groups Focus on Action Recommendations for change Introduced Low-wage Worker Bill of Rights introduced Leave behind for decision makers

36 Report launch September 17, 2010 Watch media coverage of event at =96dQzjKXFoE

37

38 Rallies & Press Events at City Hall in support of Wage Theft Ordinance

39

40 SF Wage Theft Prevention Ordinance 8/2/11: Unanimously passed by 11 City Supervisors 9/16/11: Signed into law by Mayor Ed Lee "I am proud to be introducing local legislation that is drawn from action-based research & bottom-up grassroots organizing that will help strengthen labor law enforcement in San Francisco & give workers a meaningful voice in stopping WAGE THEFT in our City." Eric Mar, Supervisor District 1

41 Changing policies provides an intermediate level of action that transcends the limitations of individual and community level work while offering more immediate health payoffs than the distant and difficult structural changes that are also needed. N. Freudenberg

42 Take Home Points Action-oriented partnership approaches like CBPR promising for D&I research Adaptation, participatory starting points CBPR not always appropriate/necessary Community participation enhances relevance, rigor and reach Process & process evaluation important Bridging/boundary spanners vital Sustainability and potential for greater change

43 When I first got involved in this survey project, I thought it was impossible to change anything in Chinatown. But now that we have done so much work in the community and helped other workers recover wages, I see that change is possible. We can improve things. We must! Restaurant Worker Partner

44 Acknowledgements Dr. Meredith Minkler, Dr. Brenda Eskenazi, and other mentors. Partners, collaborators, and participants from Reducing Pesticide Exposures to Farmworkers Children and Worker Health and Safety in Chinatown Restaurants.

45 Thank you Please feel free to send me questions or comments: