Using principles of community participatory research

Social Science & Medicine

Silva

Soriano

2012

Self Cite

Community Health Workers (CHWs) play a pivotal role in primary care, serving as liaisons between community members and medical providers. However, the growing reliance of health care systems worldwide on CHWs has outpaced research explaining their praxis – how they combine indigenous and technical knowledge, overcome challenges and impact patient outcomes. This paper thus articulates the CHW Praxis and Patient Health Behavior Framework. Such a framework is needed to advance research on CHW impact on patient outcomes and to advance CHW training. The project that originated this framework followed Community-Based Participatory Research principles. A team of U.S.-Brazil research partners, including CHWs, worked together from conceptualization of the study to dissemination of its findings. The framework is built on an integrated conceptual foundation including learning/teaching and individual behavior theories. The empirical base of the framework comprises in-depth interviews with 30 CHWs in Brazil's Unified Health System, Mesquita, Rio de Janeiro. Data collection for the project which originated this report occurred in 2008–10. Semi-structured questions examined how CHWs used their knowledge/skills; addressed personal and environmental challenges; and how they promoted patient health behaviors. This study advances an explanation of how CHWs use self-identified strategies – i.e., empathic communication and perseverance – to help patients engage in health behaviors. Grounded in our proposed framework, survey measures can be developed and used in predictive models testing the effects of CHW praxis on health behaviors. Training for CHWs can explicitly integrate indigenous and technical knowledge in order for CHWs to overcome contextual challenges and enhance service delivery.

Section: Methodsmentioning

confidence: 99%

Community Health Workers in Brazil’s Unified Health System: A framework of their praxis and contributions to patient health behaviors

Social Science & Medicine

Silva

Soriano

2012

Self Cite

“…39, 40 We conducted research grounded in participatory research principles 41 to improve provider training and transdisciplinary collaboration. Our pilot work included in-depth interview data from 42 providers to better understand service integration in Brazil.…”

Section: Methodsmentioning

confidence: 99%

Primary Care and Public Health Services Integration in Brazil’s Unified Health System

Wall

et al. 2012

Am J Public Health

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Objectives We examined associations between transdisciplinary collaboration, evidence-based practice, and primary care and public health services integration in Brazil’s Family Health Strategy. We aimed to identify practices that facilitate service integration and evidence-based practice. Methods We collected cross-sectional data from community health workers, nurses, and physicians (n = 262). We used structural equation modeling to assess providers’ service integration and evidence-based practice engagement operationalized as latent factors. Predictors included endorsement of team meetings, access to and consultations with colleagues, familiarity with community, and previous research experience. Results Providers’ familiarity with community and team meetings positively influenced evidence-based practice engagement and service integration. More experienced providers reported more integration and engagement. Physicians reported less integration than did community health workers. Black providers reported less evidence-based practice engagement than did Pardo (mixed races) providers. After accounting for all variables, evidence-based practice engagement and service integration were moderately correlated. Conclusions Age and race of providers, transdisciplinary collaboration, and familiarity with the community are significant variables that should inform design and implementation of provider training. Promising practices that facilitate service integration in Brazil may be used in other countries.

“…CBPR principles have played an important role in health research (see, for example, Minkler & Wallerstein, 2003;Pinto, Schmidt, Rodriguez, & Solano, 2006), and may be particularly suitable in HIV prevention research, a more overall controversial and sensitive issue, compared with other diseases (Morisky, Ang, Coly, & Tiglao, 2004). However, it also suggests that the dynamics in HIV prevention participatory research may differ from research on other diseases that are not as stigmatizing and ostracizing as HIV/AIDS.…”

Section: Challenges In Hiv Prevention Participatory Researchmentioning

confidence: 99%

“You've Gotta Know the Community”: Minority Women Make Recommendations About Community-Focused Health Research

McKay

Escobar³

2008

Women & Health

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Objectives-To determine what ethnic and racial minority women recommend as the best approaches to participatory health research in their communities. To achieve this goal, this study focused on HIV prevention research. Results-Women's voices and expertise can help guide health-related research. This study shows that: (1) participatory HIV prevention research should be founded on trust and commitment, leading to social support; (2) research partners ought to come from diverse backgrounds and be knowledgeable about the community and willing to work on common objectives; and (3) collaborative partnerships ought to portray an image of strength and cohesion, and a clear articulation of the mission around a research project. Methods-InImplications-To develop meaningful health research, researchers need to establish long-term ongoing relationships with community collaborators, including minority women from diverse backgrounds. Researchers ought to take a holistic approach working with communities, and ought to consider their research interests vis-à-vis the community's needs.