Building partnerships for better health
In the arena of health research, there has been a revolution of sorts, encapsulated by a relatively new term: translational research.
In 2006, the National Institutes of Health (NIH) instituted a new emphasis on translational research, which is research that focuses on the acceleration and translation of scientific discoveries into practical applications for the betterment of human health.
A key component of translational research is community-engaged research (CEnR), an area in which Virginia Commonwealth University is on the national forefront. As a result of VCU adopting community-engaged research as a core goal in its strategic roadmap,Quest for Distinction, the university has a robust and rigorous CEnR portfolio. Collectively, VCU has more than 250 active CEnR projects and more than 1,000 community partnerships.
CEnR is not a research methodology; it is a framework or approach to research. What characterizes community-engaged research is not the methods used, but the principles that guide the research and the relationships between researchers and the community.
“Community-engaged research is about building authentic partnerships between researchers and the community,” said John Clore, M.D., director of the VCU Center for Clinical and Translational Research (CCTR). “Through the CCTR’s Community Engagement Core, we help VCU researchers to foster and enhance community-academic partnerships with the goal of improving health outcomes for Virginia communities.”
The Centers for Disease Control Prevention (CDC) define 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.”
Strong community partnerships that are focused on mutual benefit for both university and community partners and agenda setting are the foundation for the success of CEnR projects, according to Alex Krist, M.D., the director of the CCTR Community Engagement Core and a recognized national expert on CEnR.
“The overall goal of community-engaged research is to improve the health and well-being of Virginians and the nation,” Krist said. “A core tenet of our CEnR approach is to engage stakeholders across the continuum of clinical and translational science. Accordingly, the focus of specific CEnR activities is determined by our stakeholder partners.”
Research subjects vs. participants
Health researchers at VCU and across the country have been working in communities for decades. Researchers have traditionally turned to communities to recruit research “subjects” or to conduct a study on a community. Communities, particularly minority and low-income communities, felt that they seldom received benefits from this type of research.
“It was typical that residents in divested communities were irritated and frustrated that researchers completed their research and left, without sharing their findings or creating a mechanism to continue successful programs,” said Albert Walker, community-academic liaison for the CCTR Community Engagement Core.
Moreover, research topics were selected by researchers without determining whether those topics address the perceived needs or concerns of the community, adding to the sense that research was not intended to help communities address problems but was based entirely on the researcher’s own interests and area of expertise.
With a CEnR approach, communities are seen as partners and collaborators, and community members are viewed as research participants, not as research subjects.
“Researchers and community agencies or groups form a partnership and may collaborate in many different ways, including defining the problems, planning the research, making decisions about elements of intervention implementation and sharing the presentation of research results,” Walker said.
The spectrum of CEnR
The term “community-engaged” is broad and includes the full spectrum of approaches that involve the community in the research process. It includes research that incorporates only a few elements of community engagement and a minimal collaboration to research in which community organizations and researchers are equal partners throughout the process.
The extent of the collaboration, when it occurs in the research process, and the relationships among researchers and the community may be very different from project to project.
Within the CEnR approach, community-based participatory research (CBPR) is at the very end of the spectrum since it embraces the greatest degree of relationship building, strong community partnership and collaboration throughout every step of the research process.
The definition of CBPR most commonly used is that from the W.K. Kellogg Foundation, a leader in the funding of contemporary CBPR: “... collaborative approach to research that equitably involves all partners in the research process and recognizes the unique strengths that each brings ... (It) begins with a research topic of importance to the community, has the aim of combining knowledge with action and achieving social change to improve health outcomes and eliminate health disparities.”
Benefits of using CEnR
There are many concrete benefits for researchers to use a CEnR approach. First, the research questions about health issues come from the concerns of the community itself. Community members also can help researchers compose questions and design procedures for data collection that can take into account cultural sensitivities. This helps to produce accurate and valid measures, strengthening the research.
“Perhaps where community involvement is most beneficial is in the analysis and interpretation of the findings. Community members may view the results differently than the researchers, and local interpretation may provide ideas researchers had not considered,” Krist said.
“The bottom line is that CEnR can enable researchers to conduct research and produce results that may be directly translated to improve human health,” Krist said. “This is an exciting and important time for human health research with great opportunity to accelerate discoveries into better preventative interventions and advanced patient treatments, helping communities become stronger and healthier.”