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Community-Based Participatory Research- Enhancing Quality and Access to Lifestyle Counseling and Health Behavior Change: A PPRNet Dissemination and Implementation ProjectMedical University of South CarolinaChanita Hughes Halbert, Ph.D.Steve Ornstein, M.D.Cathy Melvin, PhDLynn Nemeth, Ph.D.Andrea Wessell, Ph.D.Ruth Jenkins, Ph.D.Paul Nietert, Ph.D.

1Community EngagementWorking Definition

the process of working collaboratively with and through groups of people affiliated by geographic proximity, special interest, or similar situations to address issues affecting the well-being of those people. It is a powerful vehicle for bringing about environmental and behavioral changes that will improve the health of the community and its members. It often involves partnerships and coalitions that help mobilize resources and influence systems, change relationships among partners, and serve as catalysts for changing policies, programs, and practices (CDC, 1997, p.9) 2Primary Goals of CBPR/CEEnhance the value and applicability of research to all potential users through shared learning, decision-making, and ownership of research activities and products

Increase the communitys ability to address its own problems and is intended to leave something positiveVishwanathan et al., Community-based participatory research: assessing the evidence. Evidence Report: AHRQ, 2004; MacQueen and Mercer, Am J Public Health, 2001;91:19263Who should participate?Often assumed to be the lay community, where the community is defined by a physical space (e.g., neighborhoods)

However, participants can also be public health practitioners and agencies, health care providers, and their constituents and clients

Green and Mercer, Am J Public Health, 20014How much community participation?Minimumstakeholders involved at the beginning (formulating research questions) and end (interpreting and applying the findings)

Maximumstakeholders involved as active partners throughout the research process

Right level of participation depends on the type of research, etc.Green and Mercer, Am J Public Health, 20015Benefits of CBPR/CEInforms current and future research agenda

Improves study design and delivery

Accelerates use of research findings to achieve change

Creates opportunities to improve and facilitate research ethics processes

Enhances public knowledge and skills to lay the groundwork for future research

6Benefits of CBPR/CEEnhances academic partner understanding and appreciation of issues relevant to the community

Eases individual concerns about participation in research

Helps community organizations gain knowledge, visibility, capacity, and partnerships to lay groundwork for future collaborations

General public is likely to be more receptive to research and reap greater benefits from it

7Community Involvement in the Research ProcessPlanningIssue identification and selectionDevelopment of research questions and hypothesesDevelopment of interventionsEligibility criteria

ImplementationRecruitment and retentionData collection and quality assuranceEvaluationInterpretation of results within the context of the community

DisseminationSharing results with other stakeholders and constituents

8ConclusionsCommunity members and academic investigators can work together to address lifestyle health behaviors

It is important to disseminate and implement interventions into community and clinical settings

Scaling up evidence-based interventions to different geographic regions is needed

Put new title; something about how we can use this approach in research with PCPs and their patients9Structures that are Important to Have in Place to Facilitate Community EngagementLeadership committee

Working groups that address specific issuesIntervention developmentEvaluationDissemination and outreach

Advisory boards

10Advisory BoardsIdentify and establish priorities

Provide advice about research activities and study implementation

Ensure dissemination of findings to key stakeholders

11What would be the value of establishing a Patient Advisory Board in PPRNet?

12How could a Patient Advisory Board be established in PPRNet?

13Dissemination and Implementation Science to Address Racial and Ethnic Disparities in Lifestyle and Health Behavior Change Counseling

14Health DisparitiesDifferences in the quality of health care that are not due to access-related factors or clinical needs, preferences and appropriateness of interventionDifferences in the incidence, prevalence, mortality, and burden of cancer that exist among specific population groups in the US15

Social Determinants of Health16Health care providers are important for promoting lifestyle behavior change among patients

There are many barriers to provider counseling about lifestyle changes and patient acceptance of these recommendations

Efforts are needed to increase the translation of evidence-based strategies for lifestyle modification and health behavior change counseling into primary care PPRNet 2013 17SPECIFIC AIMSIdentify and synthesize evidence-based strategies for lifestyle modification and health behavior counseling among racial and ethnic minorities

Identify and prioritize concerns and preferences about the delivery and use of lifestyle modification and health behavior counseling among health care providers and patients

Develop implementation and evaluation plans that specify the procedures for delivering evidence-based strategies in primary care

Evaluate the process of engaging provider and patient stakeholders in efforts to reduce disparities in quality and access to lifestyle modification and health behavior change counseling18Conceptual Model and Study ProceduresAbbreviations: Clin=Clinical; Soc=Social; Epidemiol=Epidemiological; Behav=Behavioral; Environ=Environmental; Eval=Evaluation; Dissemin=Dissemination; Implement=ImplementationData Integration19Phase I MethodsEvidence synthesis review

Focus groups with patients

Key informant interviews with health care providers

Lifestyle and health behavior survey with patients20Phase II MethodsEvidence disseminationAcademic detailing with practices

Develop implementation plans

Develop evaluation plans

Dissemination of implementation and evaluation plans

Impact evaluation21DiscussionInitial reactions to the project aims

Relevance for PCP practicesHow does the project meet patient needs?How much does the project match provider priorities?How much does this project match patient priorities?

Reactions to project activitiesWhat is missing?Are there any barriers?

BREAK23EVIDENCE SYNTHESIS REVIEW24OBJECTIVES

To examine the evidence base for the effects of lifestyle modification counseling and alternate methods for integrating health behavior change strategies into primary care, especially for specific chronic conditions such as diabetes and cardiovascular disease

To determine the extent to which the effects of counseling for lifestyle modification and health behavior change have been examined in racial and ethnic minorities and other medically underserved populations25METHODSTraditional SearchesUtilized established databases for peer-reviewed research (e.g., PUBMED, MEDLINE, CINAHL, SCOPUS, PSYCHINFO, Cochrane Libraries)

Conventional SearchesUtilized NCI RTIPS and AHRQ Innovations Exchange databases to extract relevant articles from research-tested programs

Hand SearchesUtilized reference lists from literature reviews and meta-analysis to extract relevant studies

26SEARCH TERMS USEDTraditional SearchesCommunity-based participatory researchPrimary care and/or ambulatory carephysiciansdiet and/or nutritionPhysical activity and/or exerciseWeight loss and/or weight managementBMIObesityCounseling and/or nutritional counselingLifestyle changes or lifestyle Cardiovascular disease HypertensionStrokeDiabetesPrevention or primary preventionBehavior modificationHealth or health behaviorRace and/or ethnicity

Conventional SearchesDiet and nutritionObesityEndocrinologic/Metabolic careDiabetesCardiovascular care Physical activityInformed decision makingPrimary carePhysician officeAmbulatory settingHealth plans and managed care organizationsClinicalUnited StatesMale and FemaleAll race/ethnicityYoung AdultsAdultsOlder AdultsCommunityRuralSuburbanUrban

27METHODS cont.CATEGORYINCLUSION CRITERIAEXCLUSION CRITERIAStudy DesignAll trials including RCT, Comparative Effectiveness studies, etc. (should have a comparator such as another intervention or usual care control group)Observational Cross-SectionalQualitativeEditorialNewspaper articlePress releaseCommentaryConference talkCase studiesSettingPrimary CareAmbulatory CareUniversity Internal MedicineHealth Clinic (FQHC or public health clinic)Hospital/InpatientCommunityAcademic Timeframe:2004-2014Prior to 2004LanguageEnglish-speakingNot English-speakingCountryOnly U.S.Not U.S.PopulationAdults ages 18-75Adults aged 75InterventionLifestyle counseling related to diet, physical activity or obesityInterventions with a nutrition and/or weight management componentIntervention components that pertain to counseling, printed materials, coaching, etc.Outcomes related to diet/nutrition, physical activity, weight loss, BMI, and disease management relating to CVD, diabetes and obesityDoesnt have components aforementioned in inclusion criteriaNo lifestyle counseling or diet/physical activity activities integrated into the intervention28

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GROUP ARTICLE REVIEW

Could the intervention strategies be implemented in your practice?What would be facilitators of implementation?What would be barriers to implementation?How would your patients respond to interventions?

NEXT STEPS FOR ESRComplete full-text article reviews of all included articles

Develop final evidence tables

Develop final synthesis report

Disseminate synthesis report through academic detailing to PPRnet primary care clinics

Develop implementation tool kits

31Roles and Responsibilities of Participating Practices32

DISCUSSION AND NEXT STEPSReactions to the overall approach for the project

Ideas for completing activities in their practice

Identifying the best person from their practice with whom we will work34