Module 6:Research to Practice

Developed through the APTR Initiative to Enhance Prevention and Population Health Education in collaboration with the Brody School of Medicine at East Carolina University with funding from the Centers for Disease Control and Prevention

Community Engagement

Acknowledgments

APTR wishes to acknowledge the following individuals who developed this module:

Anh Tran, PhD, MPHDuke University School of Medicine , Department of Community & Family MedicineDuke Center for Community Research

Victoria S. Kaprielian, MD, FAAFP Duke University School of Medicine , Department of Community & Family Medicine

This education module is made possible through the Centers for Disease Control and Prevention (CDC) and the Association for Prevention Teaching and Research (APTR) Cooperative Agreement, No. 5U50CD300860. The module represents the opinions of the author(s) and does not necessarily represent the views of the Centers for Disease Control and Prevention or the Association for Prevention Teaching and Research.

Presentation Objectives

1. Define the concept of community, community health, and community engagement.

2. Identify and define the fundamental principles of working with a community.

3. List actions to implement the aims of the fundamental principles of community engagement.

4. Explain some of the complexities of working with a community.

5. Delineate a structured process to plan for community health programs.

What is Community?

A group of people who:

Are linked by social ties Share common perspectives or interests

May or may not share a geographic location

What is Community Health?

Clinical discipline that combines health care delivery and public health. By combining these fields, health care is moved beyond

medical centers and into communities.

Develop programs that build bridges between medical centers and communities by using: Evidence-based medicine Public health methods Infrastructure and health care delivery resources

What Are the Advantages of Community Health for Practitioners? Can reach more than one patient at a time

Broader impact on health

More cost effective

Effective and well developed community health programs can have a sustained impact on the health of a community.

What is Community Engagement? The Centers for Disease Control and Prevention

(CDC) defines community-engagement as:

“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.”

(CDC/ATSDR Committee on Community Engagement,1997)

Population Health and Ethical Considerations

Making assumptions about the health needs of a group

Not meeting with community members to discuss health issues and solicit feedback

Some communities feel over-researched.

Researchers come to take data and don’t give back.

Communities may feel that researchers will “drain” their resources.

“Turf issues” among community members can hinder trust.

The Legacy of Insensitive Research in Community Settings

Fundamentals for Working With the Community

Understand community context/geography Respect social customs Respect cultural beliefs and behaviors Recognize that people communicate differently Be approachable Observe community etiquette Work towards becoming culturally competent

Fundamental 1: Understand the community

context and geography

Actions

Do an inventory clinical resources social services other agencies

Talk to people race relations political issues social and environmental conditions

Read about history of the area Read the local paper to know current issues

Fundamental 2: Respect social customs

Actions

Observe how community members interact with each other and with visitors.

Be aware of group norms regarding physical contact.

Unless directed otherwise, address people formally, not by first name.Ultimately respect the views and decisions of community members.

Fundamental 3: Respect cultural beliefs and

behaviors

Actions

Observe interactions carefully to develop sensitivity to cultural differences.

Respect cultural differences when interacting with community members.

Understand the role that culture plays in: Overall health care Prevention attitudes Treatment decisions

Fundamental 4: Recognize that people

communicate differently

Actions

Awareness of: regional speech differences cultural variations in meaning of words

Maintain eye contact /general communication with the person speaking. especially when working with interpreter

Ask questions if you do not understand what is being said.

Paraphrase what you think the person said to make sure you have understood them.

Fundamental 5: Be friendly, approachable, and attentive in order to learn from

community members

Actions

Remember that you are a guest when you are visiting in a community.

Be open and ready to learn.

Be patient and polite. Take the time to listen carefully to community stories and discussions.

Fundamental 6: Observe community etiquette

Actions

As a representative of your institution, be mindful of being on time and of your overall presentation.

If not sure of how to dress or how to negotiate community norms, ask a community member.

Be aware of the power hierarchy and of community gatekeepers who can provide helpful insight.

Fundamental 7: Work towards becoming

culturally competent

Actions

How to increase cultural competency for community work:

Examine your own cultural assumptions and beliefs Consider every encounter as a cross-cultural

experience Be flexible and adaptable Be aware of the differences within groups Be prepared to address communication barriers

Steps for Planning Community Health Programs

1. Respectfully approach community leaders/residents.

2. Talk to community leaders/members about their health concerns.

3. Match your interests with a community’s areas of concern.

4. Form a community advisory board (CAB).5. Solicit help from CAB and others to develop

a program plan. 6. Make plans for financial sustainability.

Steps for Planning Community Health Programs

7. With the CAB, plan program evaluations to monitor progress and results.

8. Implement the program. 9. Use progress data to modify the program to

improve it. 10. Use results data to document the program's

impact. 11. Thank all who have contributed to the program.12. Disseminate outcomes to all involved and to wider

audiences.

Summary

Determinants of community health are often multi-layered and interrelated

Practicing the fundamentals of community engagement can help gain a community’s trust and determine a community’s true health needs.

Implementing successful community health programs require thoughtful planning and collaboration with community partners.

Collaborating Institutions

Department of Public HealthBrody School of Medicine at East Carolina University

Center for Public Health Continuing EducationUniversity at Albany School of Public Health

Advisory Committee

Mike Barry, CAELorrie Basnight, MDNancy Bennett, MD, MSRuth Gaare Bernheim, JD, MPHAmber Berrian, MPHJames Cawley, MPH, PA-CJack Dillenberg, DDS, MPHKristine Gebbie, RN, DrPHAsim Jani, MD, MPH, FACP

Denise Koo, MD, MPHSuzanne Lazorick, MD, MPHRika Maeshiro, MD, MPHDan Mareck, MDSteve McCurdy, MD, MPHSusan M. Meyer, PhDSallie Rixey, MD, MEdNawraz Shawir, MBBS

APTR

Sharon Hull, MD, MPHPresident

Allison L. LewisExecutive Director

O. Kent Nordvig, MEdProject Representative