This article describes how a new regional campus of an academic health center engaged in a community-based participatory research (CBPR) process to set a community-driven research agenda to address health disparities. The campus is situated among growing Marshallese and Hispanic populations that face significant health disparities. In 2013, with support from the Translational Research Institute, the University of Arkansas for Medical Sciences Northwest began building its research capacity in the region with the goal of developing a community-driven research agenda for the campus. While many researchers engage in some form of community-engaged research, using a CBPR process to set the research agenda for an entire campus is unique. Utilizing multiple levels of engagement, three research areas were chosen by the community: 1) chronic disease management and prevention; 2) obesity and physical activity; and 3) access to culturally appropriate healthcare. In only 18 months, the CBPR collaboration had dramatic results. Ten grants and five scholarly articles were collaboratively written and 25 community publications and presentations were disseminated. Nine research projects and health programs were initiated. In addition, many interprofessional educational and service learning objectives were aligned with the community-driven agenda resulting in practical action to address the needs identified.
Background
The Pacific Islander population in the United States is growing rapidly. However, research on Pacific Islanders in the US is limited, or sometimes misleading due to aggregation with Asian Americans. This project seeks to add to the dearth of health literature by conducting a health assessment of Marshallese in northwest Arkansas.
Methods
Using a community-based participatory research approach, nine health screening events were conducted at local Marshallese churches. Participants completed the Behavioral Risk Factors Surveillance Survey core questionnaire and diabetes module if applicable. Biometric data, including Hemoglobin A1c, blood pressure, and body mass index, was gathered by an interprofessional team.
Results
401 participants completed health screenings. High proportions of diabetes, obesity, and hypertension were found. A high percentage of participants were uninsured, and multiple barriers to health care were found within the sample.
Discussion
This project represents one of the first broad health assessments of Pacific Islanders in the US. Proportions of diabetes, hypertension, obesity, and uninsured found in the sample are much higher than national proportions.
Structured Abstract
Purpose
The purpose of this study is to use a community-based participatory approach to pilot test a family model of diabetes education conducted in participants’ homes with extended family members. Approximately 50% of Marshallese adults have type 2 diabetes, and prior attempts at diabetes education have not been shown effective due in large part to very high attrition.
Research Design and Methods
The pilot test included six families (27 participants) who took part in a family model of diabetes self-management education (DSME) using an intervention driven pre-test/post-test design with the aim of improving glycemic control as measured by A1C. Questionnaires and additional biometric data were also collected. Researchers systematically documented elements of feasibility using participant observations and research field reports.
Results
Over three-fourths (78%) of participants were retained in the study. Post-test results indicated a 5% reduction in A1C across all participants and a 7% reduction among those with type 2 diabetes. Feasibility of an in-home model with extended family members was documented, along with observations and recommendation for further DSME adaptations related to blood glucose monitoring, physical activity, nutrition, and medication adherence.
Conclusions
The information gained from this pilot helps bridge the gap between knowledge of an evidence-based intervention and the actual implementation of the intervention within a unique minority population with especially high rates of type 2 diabetes and significant health disparities. Building on the emerging literature of family models of DSME, this study shows that the family model delivered in the home had high acceptance and that the intervention was more accessible for this hard-to-reach population.
The program had to be flexible enough to meet the educational requirements and class schedules of the different health professions' education programs. The target community spoke limited English, so providing interpretation services using bilingual Marshallese community health workers was integral to the program's success.
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