Engaging Community in Implementing a Research Protocol: - PowerPoint Presentation

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Engaging Community in Implementing a Research Protocol:DOVE Home Visit Intervention for Abused PREGNANT WOMEN

Phyllis Sharps, PhD, RN, FAAN, Professor Associate Dean Community and Global Programs

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Session Objectives 2Describe approaches to research with communities.Discuss DOVE approach to community based research.Discuss lessons learned and strategies for thriving in community based research.Slide3

Research and Communities 3Approaches to Research with Communities Community Based ResearchCommunity Based Participatory Research Slide4

Community Based Research 4Research that strives to be:Community situated Research topic relevant to community (not researcher)Carried out in community settingsCollaborativeCommunity members and research equitable share research agendaActive and reciprocal roles in design, implementation and disseminationAction-oriented Process and Results useful to community to make positive change and promote social equity Slide5

Characteristics of Community Based ResearchRelevance of research identified by communityResources are shared with community (financial, expertise)Research process recognizes & uses expertise of communityResearch process recognizes & addresses power imbalances Research values emphasizes empowerment, supportive relationships, social change, learning as ongoing, respect for diversity Research process & results accessible & understandable to communityResearch process & results adapt to context of communityResearch leaves a legacy; use of results and future collaborations among partners 5Slide6

Community Based Participatory Research 6Collaborative research project that:Involves all partners in the research processRecognizes unique strengths that each bringsBegins with research topic important to communityAims to combine knowledge with action and achieve social change Slide7

Characteristics of CBPR7Community residents participates actively in all aspects of research – from concept – to conclusions and dissemination of findingsBuild community trust and community capacity with goal of increasing community participation in the research processCBPR – is essential to public health research that is Action –orientedCommunity driven Slide8

Research Addressing Professional and Participant Communities Community Based Research 8Slide9

NIH/NINR - R01 NR009093Domestic Violence Enhanced Home Visitation Program: (DOVE)9Slide10

Hatching DOVEResearch and Practice Interests:Reducing Infant Mortality Rate among African American womenDepressive symptoms in pregnant and parenting low income womenIPV and perinatal health outcomes10Slide11

Hatching DOVECommunity Based ExperiencesObserving impact of violence on pregnancy and maternal and infant outcomes Working and listening to community – shelter nurseResearch assistant for community projectsMember of interdisciplinary research teams implementing community based projectsAll contributed to my keen desire to do research with communities aimed at reducing violence against pregnant women11Slide12

Background for DOVEIPV violence during pregnancy linked with adverse outcomes for:MothersInfantsMore than 3 million children witness IPV of mother each yearMore than 50% of these children are under 6 years old12Slide13

Purpose of DOVEDOmestic Violence Enhanced Home Visitation ProgramRigorous test of structured IPV interventionEmpowerment intervention aimed at reducing IPV Mothers and infants2 Sites and Settings Urban – Baltimore City HDUrban – Missouri HDRural – Missouri HD13Slide14

Design3 different designs in 3 different settingsRCTMixed methods – quantitative & qualitative BCHD (women and infants)Eligible women = R→ DOVE vs. UCMOHD (women and infants)12 HDs = R→ 6 HD DOVE vs. 6 UCNFP (Olds HV model; mothers and infants)

DOVE vs. Olds database14Slide15

Schema for DOVE ProjectURBAN (Baltimore City Health Dept.)ò

ReferralsòBCHD ò

RANDOMIZE÷

ø

RURAL (Missouri Health Dept.)

ò

12 HD’s (N=160)

ò

÷

ø

-

Kansas City, Missouri

ò

1 NFP (N=40)

ò

REFERRAL



Data Collection/Follow Up

Assessments

Baseline, Delivery, 3,6,12,18 24 M post-delivery

Usual Care

(M&I)

DOVE

(M&I & DOVE)

U

sual

Care

(

6 HD’s)

DOVE

(6 HD’s)

DOVE-NFP

RANDOMIZE

Selected from NFP

National Data

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MethodsQuantitative Study: MeasuresIPVMaternal Mental Health (stress, depression, PTSD)Parenting (stress, stimulation)Infant Growth & DevelopmentUse of Community Resources16Slide17

MethodsQualitative Study Patterns of IPVUrban/Rural influences on patterns of IPV17Slide18

Lessons Learned Developing Partnerships 18Slide19

Academic-Community PartnershipJohns Hopkins School of Nursing (JHUSON)Location: Baltimore, Maryland, USAMission: To provide leadership to improve health care and advance the profession through education, research, practice, and service. Baltimore City Health Department (BCHD)Location: Baltimore, Maryland, USAMission: Maternal and Infant (M&I) Nursing Program provides home visiting and case management services to pregnant women and infants in Baltimore City in order to improve maternal health, birth and infant outcomes.

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Partnership BenefitsEstablished InfrastructuresJHUSON Academic ResourcesBCHD-M&I Program Community ResourcesSharing of ResourcesDOVE Intervention Nurse=LiaisonBetween JHUSON & BCHD-M&IImplementation of DOVE intervention into existing BCHD-M&I programApplication of evidenced based research into real practice setting – a test of efficacyPotential Positive Impact on MCH Outcomes

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Preparing to Launch DOVEDeveloping The Town (Home Visitors) and Gown (Research team) PartnershipBoth Health Departments:The Missouri Department of Health and Senior Services (MoDHSS) Baltimore City Health Department Maternal and Infant Home Visit programsExtremely supportive of identifying IPV and working with both research teams21Slide22

Developing the Town/Gown Partnership Examples of activities to develop partnershipResearch team members made frequent visits to the DOVE sites and reviews the research protocol with trained HV and new staff Monthly meeting with BCHD to discuss DOVE protocolsDOVE Nest newsletter sent monthly to all health departmentsConducted professional in service training for health departments We have conducted 10 different workshops regarding screening for IPV with the home visitors over a four -year period at both sites 22Slide23

Issues for the PartnershipChallenges of partnering with urban and rural health departmentsHome Visitors lack of educational preparation regarding research protocolsLack of understanding of the importance of screening for IPV Discomfort with screening for IPV Rural Settings - distance that has to be traveled by the research team to maintain relationships with the staffUrban Settings – bureaucratic procedures that hinder recruitment process Urban Settings – large case loads limit time available for intervening23Slide24

Threat To The Study’s IntegrityAfter 3 ½ years of recruitment – referrals made at both sites (Baltimore and MO) have not met targeted goals PIs at both sites hypothesized that:There may be an issue with women disclosing:Because of the rural setting of the MO siteBecause of the urban setting of Baltimore siteThe HVs are not comfortable screening women for IPVBarriers Study24Slide25

Partnership LimitationsControlInterdependence of each entity for project resultsCommunicationEnsuring all team members are up-to-dateMotivationTeam members professional investment in project25Slide26

Clinical SignificanceDOVE combines evidenced based protocolsDOVE an be integrated into existing culturally based approachesDOVE intervention is low costDOVE intervention requires training and “buy-in”Women had many positive comments about DOVE Slide27

Strategies for Community Based Research Shared passion – Community & Researcher Community – Research Team a true team or partnershipCaring and Nurturing is the norm Committed to success of all membersMutual benefitsExpected, spelled out, agreed uponEstablishment of trustClear expectations – but some give and takeMeeting deadlines – mutual respect not obligations27Slide28

Strategies for Community Based Research Community ConnectionsBe a part of the community – a real commitmentCommunity is also a part – a real commitmentMeaningful and important roles and involvement for community membersDo no harmShare what you learn with the community Include community in dissemination and presentationsEnhance the community – a legacy for the community28Slide29

Strategies for Community Based Research Have Fun Along the Way !!Celebrate the achievements of all (new personnel, new grants/awards, publications, presentations, recruitment goals, enrolling in courses)Celebrate the milestonesSupport each other over the rejections and disappointments (cuts/no funding, personnel changes, rejections, slow recruitment, grants, abstracts, manuscripts, slow recruitment)29Slide30

DOVE WEBSITEhttp://www.son.jhmi.edu/research/dovepsharps1@jhu.edu410-614-5312Thank You !!!

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