A Pipeline Program to Address the South African Crisis in Human Resources for Health

Background: The WHO Africa Region faces a shortage of health workers due to inadequate production of health workers and emigration of physicians and nurses to wealthier countries. South Africa and the United States share a history of discriminatory policies and practices resulting in groups that are under-represented amongst health professionals. One US response is the Area Health Education Centers Program (AHEC), a pipeline program to recruit members of under-represented groups into the health professions. Objectives: (1) Compare and contrast the United States’ AHEC model with that developed in South Africa by Stellenbosch University Faculty of Medicine and Health Sciences SA AHEC in partnership with Morehouse School of Medicine in the United States. (2) Describe a formative evaluation of the Stellenbosch AHEC Program. Methods: Four hundred students (grades 7–12) and 150 teachers participated in SA AHEC with the goal of preparing the students to better compete for university admission. Students received after-school tutoring, holiday schools, and counselling on study skills, health careers, and university entry. Educators received continuing professional education, classroom observation, and feedback. The program was evaluated through a series of interviews and focus groups involving AHEC staff, educators, and parents and caregivers. Results: Program strengths included educator training, collaboration, and increased student maturity, motivation, and academic success. Challenges included limited time with students, the location of some sites, and the educators’ need for more engagement with AHEC staff and schools. Quarterly workshops were conducted to address challenges. Over 50% of program alumni are currently enrolled in institutions of higher education. Students will be tracked to determine whether they are able to complete their health professions studies and return to the communities where they grew up, or to similar communities. Conclusions: With appropriate adaptation and attention to context, it might be possible to implement similar programmes in other African countries. The comparison of the United States and South African models suggested that more parent and teacher participation in an advisory capacity might help to avoid some challenges

Assessment of the Building Collaborative Research Capacity Model: Bridging the community-academic researcher divide

Background: Community–based Participatory Research (CBPR) can be challenging when community leaders and academic researchers have not previously co-led research or worked together with established rules guiding their relationships, roles, and respective functions. The objective of this investigation was to assess the processes and outcomes of the Building Collaborative Research Capacity Grant Program, sponsored by the Community Engagement Research Program of The Atlanta Clinical and Translational Science Institute and designed to foster CBPR. Methods: Four competitively selected community-based organizations (CBOs) participated in capacity-building workshops designed to build research skills and receive technical assistance to plan a pilot study with academic researchers. Pre- and postsurveys were used to assess the impact of the training and technical assistance on the CBOs’ knowledge and skills and abilities to plan, implement, and evaluate research. Key informant interviews were conducted with academic researchers and CBO dyads to identify experiences, perceptions, and recommendations related to the program model, and seven identified domains of collaborative research including research skills, attitudes toward collaboration, shared goals, institutional factors, mutual respect, human and fiscal resources, and partnering skills. Results: Areas of research competency increased from pre- to post-survey, with statistically significant increases in Community Assessment (p= 0.046) and Program Planning (p= 0.046). Each partnership had inherent characteristics related to strengths and barriers affecting the research outcomes. Conclusions: The present results contribute to the literature through assessment of processes, outcomes, and partner insights of a model designed to facilitate collaborative community-engaged research partnerships. Future research should examine the model to expand understanding of the dimensions of effective community and academic research collaboration

The Photo Essay: A Visual Research Method for Educating Obstetricians and Other Health Care Professionals

When it comes to issues related to low-income women seeking early, adequate, or continuous prenatal ca re, the public health and medical communities continue to tell women to take responsibility for their actions. Rarely are messages aimed at providers. To help physicians see how factors in their offices and clinics can affect service utilization, the photo essay, a visual qualitative research strategy was developed using low- income minority and disenfranchised women who had recently given birth or were near to giving birth. Eight photo essays were completed. Together, the narratives, in collaboration with the photos, provided an opportunity for physicians to hear and observe women, as consumers, as they expanded their descriptions of their prenatal care experience

Community-based Approaches to Reduce Chronic Disease Disparities in Georgia

Background: Among underserved and racial/ethnic minority populations in Georgia, there are profound health disparities and a burden of chronic diseases. Such diseases, which are preventable, are influenced by risk factors, including poor nutrition, physical inactivity, lack of quality health care, and tobacco use and exposure. Awardees of the Racial and Ethnic Approaches to Community Health (REACH) and Partnerships to Improve Community Health (PICH) are implementing community-based initiatives using evidence-based, policy, systems, and environmental approaches to reduce racial and ethnic health disparities and the chronic disease burden in underserved urban and rural Georgia communities. Methods: Within the context of a social ecological framework, the REACH and PICH awardees selected interventions. Their impact in the areas of tobacco use and exposure, chronic disease prevention and management, and nutrition are described. Results: To date, the interventions of Georgia’s PICH and REACH awardees have reached approximately 805,000 Georgia residents. Conclusions: By implementing strategies for community-based policy, systems, and environmental improvement, Georgia’s PICH and REACH awardees are reducing tobacco use and exposure; increasing access to healthy foods; and providing chronic disease prevention, risk reduction, and management opportunities for underserved communities in urban and rural Georgia communities. Their efforts to address chronic disease risk factors at various social and ecological levels are contributing to a reduction in racial/ethnic health disparities and the chronic disease burden in Georgia

Context Matters: A Community-Based Study of Urban Minority Parents’ Views on Child Health

Background: Among children, there are substantial ethno-racial minority disparities across a broad range of health-related behaviors, experiences, and outcomes. Addressing these disparities is important, as childhood and adolescence establish health trajectories that extend throughout life. Methods: The current study employed a community-based participatory research approach to gain community insight on child health priorities and to frame an intervention aimed at improving the health of minority children. Eight focus groups were conducted among seventy-five African American parents in a Southeastern city. The current study was guided by an ecological theoretical framework. Results: Although the focus of this investigation was on community identification of child health priorities, participants cited, as root determinants, contextual factors, which included lack of healthy food options, lack of spaces for physical activity, and community violence. These co-occurring factors were related to limited engagement in outdoor activities and physical activity, increased obesity, and poor mental health and coping. Poor parenting was cited as the most substantial barrier to improving child health outcomes, and quality parenting was identified as the most important issue to address for community programs focused on promoting the health and success of children. For improving health outcomes for children in their neighborhoods, establishment of positive social capital and constructive activities were also cited. Conclusions: These results reinforce social determinants of health as influences on child health outcomes and describe how community engagement can address potential solutions through interventions that resonate with program participants

Utilization of a Community-based Participatory Approach to Design and Implement a Peer-led Parenting Pilot Intervention to Influence Child Nutritional and Physical Activity Behaviors

Parents and primary child guardians within the household play critical roles in shaping their children’s nutritional and physical activity behaviors, which are among the individual-level determinants of childhood obesity and other chronic conditions. There are well-established correlations between race, socioeconomic status and the risk for obesity calling for both contextually- and individual-centered interventions that are community-driven. The Using Quality Parenting (UQP) pilot intervention was a peer-led, parenting education intervention developed in collaboration with community residents in Atlanta, Georgia to influence child nutritional and physical activity behaviors in African American low socioeconomic status communities. A community-based participatory research (CBPR) framework was used to conduct a mixed-methods needs assessment designed to the UQP curriculum. The UQP program targeted parents of children ages 6-14. The overarching aim was to increase quality parenting and address community identified child obesity disparities and inequities in early and middle childhood. The topics pertaining to parenting to children’s health/well-being addressed by the UQP included nutrition, physical activity, socio-emotional development, positive parenting, coping skills, child advocacy, and community development. Analyses were conducted using PSAW 18 statistical software. Descriptive statistics, including frequencies, means, standard deviations, and ranges for the individual survey items were conducted. A t-test was performed comparing pre- and post-program participation. A repeated measure analysis of variance was conducted on the items that demonstrated a significant t-test. The analytic sample was composed of 46 African American parents, with over 50% of the sample earning an annual household income of $25,000 or less. Participating parents reported significantly higher levels of water consumption for their children post-program in comparison to pre-test reports (p = .010). Additionally, based on t-test analyses, parents reported that their children consumed significantly higher levels of proteins, grains, fruits and vegetables at each meal, post-program (p=0.03). These findings highlight the potential efficacy of community-informed, parent-led interventions in improving health disparities and related outcomes for children

Community engagement practices at research centers in U.S. minority institutions: Priority populations and innovative approaches to advancing health disparities research

This paper details U.S. Research Centers in Minority Institutions (RCMI) Community Engagement Cores (CECs): (1) unique and cross-cutting components, focus areas, specific aims, and target populations; and (2) approaches utilized to build or sustain trust towards community participation in research. A mixed-method data collection approach was employed for this cross-sectional study of current or previously funded RCMIs. A total of 18 of the 25 institutions spanning 13 U.S. states and territories participated. CEC specific aims were to support community engaged research (94%); to translate and disseminate research findings (88%); to develop partnerships (82%); and to build capacity around community research (71%). Four open-ended questions, qualitative analysis, and comparison of the categories led to the emergence of two supporting themes: (1) establishing trust between the community-academic collaborators and within the community and (2) building collaborative relationships. An overarching theme, building community together through trust and meaningful collaborations, emerged from the supporting themes and subthemes. The RCMI institutions and their CECs serve as models to circumvent the historical and current challenges to research in communities disproportionately affected by health disparities. Lessons learned from these cores may help other institutions who want to build community trust in and capacities for research that addresses community-related health concerns

The community engagement course and action network: strengthening community and academic research partnerships to advance health equity

BackgroundHistorically Black Colleges and Universities and Minority Serving Institutions are uniquely positioned to implement community-campus research partnerships based on a history of service, the pursuit of community trustworthiness and student demographics often similar to surrounding marginalized communities. The Morehouse School of Medicine Prevention Research Center collaborates with members of Historically Black Colleges and Universities, Minority Serving Institutes, and community organizations on the Community Engaged Course and Action Network. This network is the first of its kind and aims to strengthen members’ ability to implement Community-Based Participatory Research (CBPR) principles and partnerships. Projects address public health priorities including mental health among communities of color, zoonotic disease prevention, and urban food deserts.Materials and methodsTo assess the effectiveness of the network, a Participatory Evaluation framework was implemented to conduct process evaluation which included review of partnership structures, operations, project implementation processes, and preliminary outcomes of the research collaborations. A focus group of Community Engagement Course and Action Network members (community and academic) was also conducted to identify benefits and challenges of the network with emphasis on key areas for improvement to further enhance the relationships between partners and to facilitate their subsequent community-campus research.ResultsNetwork improvements were tied to themes strengthening community-academic partnerships including sharing and fellowship, coalition building and collaboration, and greater connections and awareness of community needs through their current community-academic partnerships. The need to conduct ongoing evaluation during and after implementation, for determining the early adoption of CBPR approaches was also identified.ConclusionEvaluation of the network’s processes, infrastructure, and operation provides early lessons learned to strengthen the network. Ongoing assessment is also essential for ensuring continuous quality improvement across partnerships such as determining CBPR fidelity, assessing partnership synergy, and dynamics, and for quality improvement of research protocol. The implications and potential for advancing implementation science through this and similar networks are great towards advancing leadership in modeling how foundations in community service can advance to CBPR partnership formation and ultimately, health equity approaches, that are local defined and assessed

Analysis of the role of residential segregation on perinatal outcomes in Florida, Georgia, and Louisiana

The purpose of this study was to investigate the relationship between residential segregation (the physical separation of Blacks and Whites in residential contexts) and adverse perinatal outcomes (low birth weight, preterm delivery and small for gestational age births) in Florida, Georgia and Louisiana. The study determined the independent effect of the level of residential segregation on the likelihood of adverse perinatal outcomes after controlling for contextual and individual factors. The study also assessed whether the relationship between residential segregation and adverse perinatal outcomes were moderated by ethnicity and median income.The studied employed an observational, cross-sectional study design that utilized secondary data. Live birth certificates between 1999 and 2001 provided information on individual covariates and perinatal outcomes. Structural indicators of residential segregation and contextual covariates were obtained from the U.S. Census Bureau. Th e nested data structure for each birth outcome model was composed of individual, contextual, and structural data. Three-level, hierarchical generalized linear models were used to test research hypotheses.The study population consisted of non-Hispanic White and Black primaparous women between 15 and 49 years of age experiencing singleton live births delivered at less than or equal to 45 weeks gestation. The final sample consisted of 255,548 women nested within 4,360 census tracts and 63 Metropolitan or Micropolitan Statistical Areas. Residential segregation did not have a direct relationship with low birth weight, preterm delivery or small for gestational age, after controlling for other variables in multilevel models. Models testing the moderating effects of ethnicity indicated that increased Isolation decreased the risk of LBW among Black women. Several contextual --level variables and the majority of individual-level variables were significantly associated with perinatal outcome risk .Findings indicate that effects of residential segregation may be birth outcome and ethnic group specific. Relationships between individual factors, contextual factors and adverse perinatal outcomes signal the importance of proximal factors to perinatal outcomes. There is a need for specification of a broader constellation of biological, social and spatial factors and a thorough assessment of residential preferences and experiences in order to better understand the associations between neighborhoods and perinatal outcomes