Promoting Community and Population Health in Public Health and Medicine: A Stepwise Guide to Initiating and Conducting Community-engaged Research

Various methods, approaches, and strategies designed to understand and reduce health disparities, increase health equity, and promote community and population health have emerged within public health and medicine. One such approach is community-engaged research. While the literature describing the theory, principles, and rationale underlying community engagement is broad, few models or frameworks exist to guide its implementation. We abstracted, analyzed, and interpreted data from existing project documentation including proposal documents, project-specific logic models, research team and partnership meeting notes, and other materials from 24 funded community-engaged research projects conducted over the past 17 years. We developed a 15-step process designed to guide the community-engaged research process. The process includes steps such as: networking and partnership establishment and expansion; building and maintaining trust; identifying health priorities; conducting background research, prioritizing “what to take on”; building consensus, identifying research goals, and developing research questions; developing a conceptual model; formulating a study design; developing an analysis plan; implementing the study; collecting and analyzing data; reviewing and interpreting results; and disseminating and translating findings broadly through multiple channels. Here, we outline and describe each of these steps

Bioturbation in a Declining Oxygen Environment, in situ Observations from Wormcam

Bioturbation, the displacement and mixing of sediment particles by fauna or flora, facilitates life supporting processes by increasing the quality of marine sediments. In the marine environment bioturbation is primarily mediated by infaunal organisms, which are susceptible to perturbations in their surrounding environment due to their sedentary life history traits. Of particular concern is hypoxia, dissolved oxygen (DO) concentrations ≤2.8 mg l−1, a prevalent and persistent problem that affects both pelagic and benthic fauna. A benthic observing system (Wormcam) consisting of a buoy, telemetering electronics, sediment profile camera, and water quality datasonde was developed and deployed in the Rappahannock River, VA, USA, in an area known to experience seasonal hypoxia from early spring to late fall. Wormcam transmitted a time series of in situ images and water quality data, to a website via wireless internet modem, for 5 months spanning normoxic and hypoxic periods. Hypoxia was found to significantly reduce bioturbation through reductions in burrow lengths, burrow production, and burrowing depth. Although infaunal activity was greatly reduced during hypoxic and near anoxic conditions, some individuals remained active. Low concentrations of DO in the water column limited bioturbation by infaunal burrowers and likely reduced redox cycling between aerobic and anaerobic states. This study emphasizes the importance of in situ observations for understanding how components of an ecosystem respond to hypoxia

Understanding how adherence goals promote adherence behaviours: a repeated measure observational study with HIV seropositive patients

Background The extent to which patients follow treatments as prescribed is pivotal to treatment success. An exceptionally high level (> 95 %) of HIV medication adherence is required to suppress viral replication and protect the immune system and a similarly high level (> 80 %) of adherence has also been suggested in order to benefit from prescribed exercise programmes. However, in clinical practice, adherence to both often falls below the desirable level. This project aims to investigate a wide range of psychological and personality factors that may lead to adherence/non-adherence to medical treatment and exercise programmes. Methods HIV positive patients who are referred to the physiotherapist-led 10-week exercise programme as part of the standard care are continuously recruited. Data on social cognitive variables (attitude, intention, subjective norms, self-efficacy, and outcome beliefs) about the goal and specific behaviours, selected personality factors, perceived quality of life, physical activity, self-reported adherence and physical assessment are collected at baseline, at the end of the exercise programme and again 3 months later. The project incorporates objective measures of both exercise (attendance log and improvement in physical measures such as improved fitness level, weight loss, improved circumferential anthropometric measures) and medication adherence (verified by non-invasive hair analysis). Discussion The novelty of this project comes from two key aspects, complemented with objective information on exercise and medication adherence. The project assesses beliefs about both the underlying goal such as following prescribed treatment; and about the specific behaviours such as undertaking the exercise or taking the medication, using both implicit and explicit assessments of patients' beliefs and attitudes. We predict that i) the way people think about the underlying goal of their treatments explains medication and exercise behaviours over and above the effects of the behaviour-specific thinking and ii) the relationship between adherence to exercise and to medical treatment is stronger among those with more favourable views about the goal. Results from this study should identify the key contributing factors to inform subsequent adherence research and afford a more streamlined assessment matrix. The project also aims to inform patient care practices. UK Clinical Research Network registration number: UKCRN 7842

Engaging Men as Promotores de Salud: Perceptions of Community Health Workers Among Latino Men in North Carolina

The promotor de salud, or community health worker (CHW) role, is highly feminized and little is known about how men view their participation in CHW programs. We conducted in-depth interviews with Latino men in North Carolina to explore this gap. We used systematic coding and display procedures informed by Grounded Theory to analyze the data. Men described their communities as lacking cohesion, making integration of Latino immigrants difficult. Most did not consider themselves leaders or feel they had leaders in their communities. Their perceptions of the feminized CHW role as well as the volunteer or low-paid nature of CHW work conflicted with men’s provider role. They also did not think they could perform the CHW role because they lacked education, skills, and broad networks. Efforts to increase male participation in CHW programs in new Latino immigrant destinations will need to understand and address these gender and migration-related dynamics in order to engage both women and men in improving the health of their communities