Participatory Process for Implementing a Colorectal Cancer Screening Intervention: an Action Plan for Local Sustainability

Background: Rigid protocols can hamper translation of evidence-based interventions from research to real-world settings. This investigation aimed to develop procedures for modifying the study protocol of a community-based participatory research (CBPR) project and to analyze the theoretical constructs that underlie this process. Methods: The research project is a dissemination and implementation study of the Educational Program to Increase Colorectal Cancer Screening (EPICS), an evidence-based intervention targeting African Americans in the United States. The study is being conducted in a partnership with community coalitions in 15 different cities. Each site initially presented unique issues that required modification of the study protocol. Results: In order to honor underlying CBPR theory, it was necessary to negotiate protocol changes with the community coalition at each site, while insuring preservation of the core elements of the intervention. Conclusions: We discuss the ways in which this represents a narrowing of the gap between CBPR and traditional research approaches

A Community-Based Wellness Program to Reduce Depression in African Americans: Results From a Pilot Intervention

Background African-Americans are less likely than non-Hispanic Whites to find antidepressants acceptable or seek care for depression. Objective To develop and pilot-test a culturally-tailored, community-based, psycho-educational wellness and exercise promotion program to reduce depressive symptoms in African-Americans. Methods Participants were African-Americans with moderate depressive symptoms, who were interested in exercise, but were not exercising regularly. They attended a 6-week psycho-educational group program during which they set personal activity goals and learned depression self-management skills. We conducted pre- and post-intervention surveys and post-intervention feedback sessions. Results 21 African-Americans participated in the intervention. The program had excellent attendance and satisfaction. We found a large reduction in depressive symptoms, with mean Patient Health Questionnaire-9 scores dropping from 14.8 to 7.1 (p Conclusions This pilot-study offers promising preliminary evidence to inform further research on the use of community-based, culturally tailored wellness programs to address depression

Ethics and Community-Based Participatory Research: Perspectives From the Field

Exploring the importance of ethical issues in the conduct of community-based participatory research (CBPR) continues to be an important topic for researchers and practitioners. This article uses the Beyond Sabor Project, a CBPR project implemented in the Lower Rio Grande Valley, as a case example to discuss ethical issues such as the importance of increasing community involvement in research, ensuring that communities benefit from the research, sharing leadership roles, and sensitive issues regarding data collection and sharing. Thereafter, this article concludes with a brief discussion of six principles that can inform the practice of ethical conduct when implementing CBPR studies. This article also lists additional reading resources on the importance of ethics in the conduct of CBPR

Delivery System Partnerships Empower Large Pragmatic Trials: The Case of Diabetes Prevention in Kaiser Permanente

Background/Aims: Successful pragmatic trials require close partnership between researchers and health care organizations. We describe the process by which we engaged clinical and operational leaders from three Kaiser Permanente (KP) regions to design a trial to test alternative population-based models for diabetes prevention. Methods: The study leveraged ongoing efforts in each region to develop a populationwide approach to diabetes prevention. Working with clinical leaders from KP Northwest (KPNW), we designed an initial study that we then took to the leadership of KP Southeast and KP Hawaii. We also obtained the endorsement of KP’s national Care Management Institute (CMI). After submitting a successful letter-of-intent to the Patient-Centered Outcomes Research Institute, we worked with our health plan partners to develop a full proposal that is presently under review. Results: Throughout the proposal development process, we consulted key regional and national health plan stakeholders on various design issues. We also included the KPNW lead for diabetes management as a full co-investigator and regular member of our weekly planning meetings. As a direct result of these interactions, we dropped our initial three-arm design in favor of a two-arm design because it became clear that our planned low-intensity arm would likely be obsolete by the time the grant was funded. We also decided to focus our study on those at highest risk for progressing to diabetes since this was where the organization clearly intended to focus its greatest energy. Finally we leveraged an ongoing demonstration project being coordinated by the CMI to evaluate an online diabetes prevention curriculum that was seen as a scalable model for providing a proven lifestyle change program to our members nationwide. We incorporated this program into our intervention design and conducted interviews with patients to better understand their perspective regarding the overall usefulness of the program and barriers to participation. To meet the needs of members who preferred face-face classes, we also partnered with local diabetes programs in our communities to provide this option. Discussion: Our process of stakeholder engagement directly informed the design of the trial and helped to ensure strong institutional support for the study should it be funded

Delivery System Partnerships Empower Large Pragmatic Trials: The Case of Diabetes Prevention in Kaiser Permanente

Background/Aims: Successful pragmatic trials require close partnership between researchers and health care organizations. We describe the process by which we engaged clinical and operational leaders from three Kaiser Permanente (KP) regions to design a trial to test alternative population-based models for diabetes prevention. Methods: The study leveraged ongoing efforts in each region to develop a populationwide approach to diabetes prevention. Working with clinical leaders from KP Northwest (KPNW), we designed an initial study that we then took to the leadership of KP Southeast and KP Hawaii. We also obtained the endorsement of KP’s national Care Management Institute (CMI). After submitting a successful letter-of-intent to the Patient-Centered Outcomes Research Institute, we worked with our health plan partners to develop a full proposal that is presently under review. Results: Throughout the proposal development process, we consulted key regional and national health plan stakeholders on various design issues. We also included the KPNW lead for diabetes management as a full co-investigator and regular member of our weekly planning meetings. As a direct result of these interactions, we dropped our initial three-arm design in favor of a two-arm design because it became clear that our planned low-intensity arm would likely be obsolete by the time the grant was funded. We also decided to focus our study on those at highest risk for progressing to diabetes since this was where the organization clearly intended to focus its greatest energy. Finally we leveraged an ongoing demonstration project being coordinated by the CMI to evaluate an online diabetes prevention curriculum that was seen as a scalable model for providing a proven lifestyle change program to our members nationwide. We incorporated this program into our intervention design and conducted interviews with patients to better understand their perspective regarding the overall usefulness of the program and barriers to participation. To meet the needs of members who preferred face-face classes, we also partnered with local diabetes programs in our communities to provide this option. Discussion: Our process of stakeholder engagement directly informed the design of the trial and helped to ensure strong institutional support for the study should it be funded