Module 6: Research to Practice

1. Module 6:Research to Practice Community Engagement Developed through the APTR Initiative to Enhance Prevention and Population Health Education in collaboration with the Brody School of Medicine at East Carolina University with funding from the Centers for Disease Control and Prevention

2. Acknowledgments This education module is made possible through the Centers for Disease Control and Prevention (CDC) and the Association for Prevention Teaching and Research (APTR) Cooperative Agreement, No. 5U50CD300860. The module represents the opinions of the author(s) and does not necessarily represent the views of the Centers for Disease Control and Prevention or the Association for Prevention Teaching and Research. APTR wishes to acknowledge the following individuals who developed this module: Anh Tran, PhD, MPH Duke University School of Medicine , Department of Community & Family Medicine Duke Center for Community Research Victoria S. Kaprielian, MD, FAAFP Duke University School of Medicine , Department of Community & Family Medicine

3. Presentation Objectives • Define the concept of community, community health, and community engagement. • Identify and define the fundamental principles of working with a community. • List actions to implement the aims of the fundamental principles of community engagement. • Explain some of the complexities of working with a community. • Delineate a structured process to plan for community health programs.

4. What is Community? A group of people who: • Are linked by social ties • Share common perspectives or interests • May or may not share a geographic location

5. What is Community Health? • Clinical discipline that combines health care delivery and public health. • By combining these fields, health care is moved beyond medical centers and into communities. • Develop programs that build bridges between medical centers and communities by using: • Evidence-based medicine • Public health methods • Infrastructure and health care delivery resources

6. What Are the Advantages of Community Health for Practitioners? • Can reach more than one patient at a time • Broader impact on health • More cost effective Effective and well developed community health programs can have a sustained impact on the health of a community.

7. What is Community Engagement? (CDC/ATSDR Committee on Community Engagement,1997) The Centers for Disease Control and Prevention (CDC) defines community-engagement as: “The process of working collaboratively with and through groups of people affiliated by geographic proximity, special interest, or similar situations to address issues affecting the well-being of those people.”

8. Population Health and Ethical Considerations • Making assumptions about the health needs of a group • Not meeting with community members to discuss health issues and solicit feedback

9. The Legacy of Insensitive Research in Community Settings • Some communities feel over-researched. • Researchers come to take data and don’t give back. • Communities may feel that researchers will “drain” their resources. • “Turf issues” among community members can hinder trust.

10. Fundamentals for Working With the Community Understand community context/geography Respect social customs Respect cultural beliefs and behaviors Recognize that people communicate differently Be approachable Observe community etiquette Work towards becoming culturally competent

11. Fundamental 1:  Understand the community context and geography

12. Actions • Do an inventory • clinical resources • social services • other agencies • Talk to people • race relations • political issues • social and environmental conditions • Read about history of the area • Read the local paper to know current issues

13. Fundamental 2:  Respect social customs

14. Actions Observe how community members interact with each other and with visitors. Be aware of group norms regarding physical contact. Unless directed otherwise, address people formally, not by first name. Ultimately respect the views and decisions of community members.

15. Fundamental 3:  Respect cultural beliefs and behaviors

16. Actions • Observe interactions carefully to develop sensitivity to cultural differences. • Respect cultural differences when interacting with community members. • Understand the role that culture plays in: • Overall health care • Prevention attitudes • Treatment decisions

17. Fundamental 4:  Recognize that people communicate differently

18. Actions • Awareness of: • regional speech differences • cultural variations in meaning of words • Maintain eye contact /general communication with the person speaking.  • especially when working with interpreter • Ask questions if you do not understand what is being said. • Paraphrase what you think the person said to make sure you have understood them.  

19. Fundamental 5:  Be friendly, approachable, and attentive in order to learn from community members

20. Actions Remember that you are a guest when you are visiting in a community. Be open and ready to learn. Be patient and polite.  Take the time to listen carefully to community stories and discussions.

21. Fundamental 6:  Observe community etiquette

22. Actions As a representative of your institution, be mindful of being on time and of your overall presentation. If not sure of how to dress or how to negotiate community norms, ask a community member. Be aware of the power hierarchy and of community gatekeepers who can provide helpful insight.

23. Fundamental 7:  Work towards becoming culturally competent

24. Actions How to increase cultural competency for community work: • Examine your own cultural assumptions and beliefs • Consider every encounter as a cross-cultural experience • Be flexible and adaptable • Be aware of the differences within groups    • Be prepared to address communication barriers  

25. Steps for Planning Community Health Programs • Respectfully approach community leaders/residents. • Talk to community leaders/members about their health concerns.  • Match your interests with a community’s areas of concern.  • Form a community advisory board (CAB). • Solicit help from CAB and others to develop a program plan.  • Make plans for financial sustainability. 

26. Steps for Planning Community Health Programs • With the CAB, plan program evaluations to monitor progress and results. • Implement the program.  • Use progress data to modify the program to improve it.  • Use results data to document the program's impact.  • Thank all who have contributed to the program. • Disseminate outcomes to all involved and to wider audiences.

27. Summary Determinants of community health are often multi-layered and interrelated Practicing the fundamentals of community engagement can help gain a community’s trust and determine a community’s true health needs. Implementing successful community health programs require thoughtful planning and collaboration with community partners.

28. Collaborating Institutions Department of Public Health Brody School of Medicine at East Carolina University Center for Public Health Continuing Education University at Albany School of Public Health

29. Advisory Committee Mike Barry, CAE Lorrie Basnight, MD Nancy Bennett, MD, MS Ruth Gaare Bernheim, JD, MPH Amber Berrian, MPH James Cawley, MPH, PA-C Jack Dillenberg, DDS, MPH Kristine Gebbie, RN, DrPH Asim Jani, MD, MPH, FACP Denise Koo, MD, MPH Suzanne Lazorick, MD, MPH Rika Maeshiro, MD, MPH Dan Mareck, MD Steve McCurdy, MD, MPH Susan M. Meyer, PhD Sallie Rixey, MD, MEd Nawraz Shawir, MBBS

30. APTR • Sharon Hull, MD, MPH President • Allison L. Lewis Executive Director • O. Kent Nordvig, MEd Project Representative