[MUSIC] So we've talked about the Tumaini Hope for Health Programs, and now Dr. Goode Jr. is going to talk about her work on the west and east side of Baltimore. >> So I think that the Tumaini is a really good example of CBPR principles within a demonstration project, more along the lines of sort of that health systems innovation and improvement. What I'm going to talk about is really more of a research program that I've been developing using CBPR methods among public housing residents in Baltimore City. First, I want to gave a little bit background about public housing. Currently 1.2 million households reside in public housing. These folks are disproportionately impacted by chronic diseases. Nearly 50% of adults who live in public housing are obese, that's compared to the national average, which is just about a third. They also have a twofold greater risk of hypertension. A number of years ago, back in 2011 actually, there was a demonstration project called Moving to Opportunities that was funded by HUD. In this project public housing residents were given vouchers to move to neighborhoods that actually had higher income levels, others were given vouchers just to move in general. And finally, other residents actually stayed basically within the same public housing community where they were living. Ten years after getting these vouchers, they looked at some health outcomes. And actually found that the prevalence of extreme obesity and diabetes was substantially lower amongst those people who actually had that opportunity to move to a higher income neighborhood. What this is really telling us is, that there seemed to be some environmental risks factors that might confer the increased disease risk within the public housing. That there's something about public housing that is contributing to a higher burden of health disparities. So the results to that study were very intriguing to me, and there's quite a number of public housing developments within Baltimore City. So before moving too far into that, I actually started to engage what my community is, and so that actually is two primary partners for me. First is the Housing Authority of Baltimore City, which is the local government agency that manages all of the public housing neighborhoods, and then also the public housing residents themselves. The residents are represented by an elected board within each neighborhood to represent their interests, both with the housing authority and with outside interests, like myself. Thinking about CBPR principles, I didn't want to go in and assume [LAUGH] that I knew really anything about what the major factors and concerns were amongst residents living in public housing. And so to start of this process, I actually conducted focus groups, actually with Dr. Ibe. [LAUGH] >> [LAUGH] >> Thinking about, what are the challenges, and also what are the resources that are actually available within these communities? And so this is a model based out of this focus group work, which has shaped really my thinking in how I've approached the community since then. It uses principles from the ecologic model, so we have three concentric circles. The innermost circle is really thinking about the individual level. And here, the community actually identified diet and exercise as primary factors that affect their health, their well-being, and their weight status. They were very motivated that these were things that they felt that were really important, that they themselves and their neighbors could actually work on. And talking further, the next circle out, we have social factors. And what came up again and again was socioeconomic status. So really the idea that limited finances to purchase healthy foods or cover recreation expenses, negatively impacted diet and exercise, and therefore their health and well-being. The final circle is thinking about more environmental factors. This ranged from low income housing, oftentimes they brought up that there was unsanitary or unsafe conditions that directly impacted their health and well-being. We also had the idea of food deserts or food swamps. A food desert where you have limited access to healthy foods, so a lack of grocery stores. A food swamp, you have a lack of grocery stores, but you are sort of inundated by other unhealthy food outlets, like corner stores and fast food. This they felt negatively impacted their diet, which, again, then negatively impacted health and well-being. Limited recreation space, so there was limited access to recreation facilities, due to poor upkeep locally within the neighborhood ,which, again, negatively impacted their exercise and well-being. And the final environmental factor was crime, so that people were scared to go outside, that there wasn't a safe space, which, again, negatively impacted the individual level. However, it wasn't all bad news. And the two things that I'd like to highlight actually within the social factors realm, which have popped up now, is actually the community. So there were two facets that people brought up that they actually thought could help mitigate a lot of those negative environmental factors. The first being that neighborhood cohesion, so how tight the neighborhood was. But then they could potentially attract things like grocery stores or other more positive resources to come into the community. If they portrayed themselves as being together and collected, that then people would want to come and invest in them. The second was that networks of family and neighbors could help improve conditions, whether that is in the physical environment or potentially the social environment, and that this could improve safety, and actually help support behavior change. So I think that it's, again, not all negative. There are some things, as a researcher, that unfortunately it's hard to make an impact on, like crime rates and redeveloping recreation spaces aren't typically feasible within a normal budget. However, actually leveraging that community aspect of networks and neighborhood cohesion could be something that we actually tap into to help think about improving the individual health. So this led me to start thinking about social networks, and in particular thinking about obesity. So social networks are not just Facebook, but [LAUGH] also the people that we know and interact with, and that's predominantly what I focus on. So social networks are thought to influence an individual's behavior through different mechanisms, particularly social influence, modeling of others' behaviors, as well as social reinforcement. So if you engage in a certain behavior that could be positively rewarded or actually negatively reinforced to stop that behavior, and this all comes under the tenets of social cognitive theory. Ultimately, all of this led to two projects being created, and the figure that we have describes those two projects. We have boxes that describe the aim of the project, the study design, and then the outcomes that we are looking at. The series of boxes on the top, of which there are three, represent the first project. The aim of that first project was to characterize the relationship between the social network and lifestyle behaviors, such as diet, exercise, and eating habits, among adults living in public housing developments. In order to accomplish that, I designed a study, which was a cross-sectional survey that actually included not only ascertainment of the individual's diet and exercise habits, but what they perceive was happening, as far as diet, exercise, and eating habits, within their social network. And what we were really looking at to try to find is, how does diet, eating habits, exercise, and weight, how does that relate between what your own habits are, and what those habits are within your social network? Trying to think about, can we leverage some feature of social networks to actually improve lifestyle behaviors? Because not a lot was known, we needed to take this first step to really understand what might be feasible. The second project's aim was to design actually a social network intervention to facilitate a lifestyle behavior change, and to test it in a pilot study. There have been social network interventions tested in the past, typically they are more acute behaviors. So something like within IV drug users not sharing needles, which is a much different behavior than something chronic, like eating [LAUGH] or physical activity, which you have to do every day, multiple times a day. Once we identified what might be amenable in the first project, we wanted to actually create an intervention and test that in the second. So that design for that pilot intervention would really apply the tenants of the CBPR, along with mixed methods, to really develop and test this social network intervention. Really with our primary outcomes, because this is a very small [LAUGH] pilot study, to look at feasibility, acceptability, and to get an idea of whether we're actually perhaps having an effect. Ultimately hoping to lead to a larger trial down the road. So I want to go into a little bit more detail now on how these projects unfolded, and I'll describe the research as well, as I'd like to highlight how the CBPR principles and how the community engagement came in at both of these levels. The first thing that I should mention is, that in applying for the funding for this, the Housing Authority and the residents were actually engaged and involved in providing feedback on what we were going to do [LAUGH] and what we were going to look at, even beyond those focus groups. The focus groups were kind of meant to represent a broader voice, but ultimately we need some leaders within that to give us focused feedback. And they helped out and really directed us on where this should take place, how it should take place. So in Project 1, which again was a cross-sectional survey of randomly selected households in public housing developments. The survey design actually was done in collaboration with the housing authority and their residents. So while my role as a researcher was to try to identify the most robust evidence based measures that I could, ultimately, it was the Housing Authority and the residents that provided feedback that guided what measures we actually included in there. To give a concrete example, initially I was hoping to be able to do a very exhausted food frequency [LAUGH] examination, which really gives us very robust measures of all types of dietary intake and caloric intake. All residents that we talked to, and when we were doing the pilot testing, basically balked on doing that, that it just takes too long, too intensive. They didn't really see the value in spending that much time. As a result, we switched to a shorter, more abbreviated, modified measure that we could both agree on that still has scientific validity, but also met the community's needs of not spending two hours talking about how many cucumbers they ate within [LAUGH] the last month. Once the survey then was finalized, we also sought their feedback on how we should even go about recruiting people. So a lot of times in traditional research, we will send out a mailer or we will do a cold phone call. So that wasn't really possible within this community. First of all, even just the availability of having a stable phone number isn't known, and knowing who actually has a good phone number isn't a known entity that the Housing Authority has. So that was off the table. We talked about doing a mailer, and while we did end up mailing postcards to the randomized households as a first pass to let them know that they had been selected, both the Housing Authority and the residents were not very optimistic, shall we say, [LAUGH] that we would really recruit very many people. That they just get so much mail, that something like that is really only going to be noticed by a select few, which ended up being the case. Ultimately, we only recruited about somewhere between 15 and 20% of our final sample from those postcards. Ultimately, what the residents felt very strongly was the best way to go out and recruit people was going around and knocking on people's doors. If someone wasn't home, that the best way to communicate was actually leaving a flyer attached to their doorknob. This was a method that locally the community used if there was a resident council meeting or a health fair coming into the community, that's how they let everybody know. And so we used that similar strategy, and by and large that's [LAUGH] how I recruited most of the people that participated in the study. Ultimately, we randomized 600 households, of those, 556 were eligible. There were a number of vacant addresses within that, and then we had overall 266. So just about half of the households, at least one person agreed to participate. Again, when reflecting that change in the measures, we used the National Health Interview Survey's five-factor dietary screener, which is very abbreviated, usually doesn't take more than five minutes to complete, versus usually upwards over an hour of a typical food frequency. And we also tested with them the social network inventory, doing the data collection was actually the most fun part I think for all of the participants. Quite a number of them when we got to the end, we're actually sad that it was over, which [LAUGH] I think is a little bit unusual. But thinking about what do your family and friends do, and what do they eat, and insights into their lives is actually quite a fun experience for a lot of folks. So we have completed data collection of this study, and this slide shows a table of the characteristics of the study sample. Again, of which there was 266 head of households included here. We find that 86% were women and 95% were African American, which are very typical of the public housing population within Baltimore City. The other two things that I would like to highlight in this table, first is that the self reported history of hypertension. 57% of our participants said that they had been diagnosed with high blood pressure, which given that the mean age of our sample is only 44 years, is really extremely high. Again, sort of highlighting that disparity in greater risk of hypertension in this population. The other thing that I'd like to focus on is that 63% of our sample was current cigarette smokers, which again is, relative to the US general population, is astronomically high. It's about on par with other studies of low income populations within Baltimore, but again really highlights that disparity. So this slide shows a column graph that compares the daily dietary intakes within our community, which is in the dark yellow, to what the American Heart Association recommends, and that's in the light yellow. And this is for both added sugar intake, which is measured in teaspoons per day, and then fruit and vegetable intake, which is in servings per day. I think the thing that is really striking is that the average intake with respect to added sugar in our community was 21.1 teaspoons per day. The American Heart Association recommends that you consume nine teaspoons or less. So, again, a huge difference there. And then as far as fruit and vegetables, the American Heart Association recommends on average about eight servings of fruit and vegetables a day, our community only took in about 4.3. So again, we are getting a lot of added sugar, [LAUGH] with very low amounts of fruit and vegetables within this community. When we saw these results, we were very interested in thinking about one of these two elements as a potential target for that social network intervention. Since we had collected all of that social network data, this table is actually looking at the relationship between having a high added sugar intake, and then what you perceived your social network to be doing as far as taking in related foods. So the first outcome would be high added sugar intake which, as the previous slide showed, average was 21 teaspoons per day. Then, our sample, the upper quarter was actually about 40 teaspoons of sugar per day. So we really wanted to capture sort of that extreme amount of high sugar intake. And then, looking at the relationship between that and perceiving that within your social network, the higher proportion were drinking sugar sweetened beverages daily or consuming sweets like cakes and cookies daily. And we see a really strongly significant relationship. So as the number of people in your network you perceive to drink sugar sweetened beverages or sweets daily, the odds of you having that higher added sugar intake were three-fold greater. Similarly, looking at fruit and vegetable, so thinking about having a healthier diet, high fruit and vegetable intake in our sample was having about 6.7 servings of fruit and vegetables per day. Again, the average was 4.3, so while these people are higher, they're notably still not even getting the AHA recommendations. But they at least doing better. And then, looking at the relationship between what they perceived the daily fruit and vegetable intake to be within their social network, while there is a relationship there that you have, the odds ratio there is 1.7, this is not statistically significant. So based on these results, it really seemed to us that we were going to have more likelihood of having some intervention effect of using that social network approach within that high added sugar focused foods rather than the fruit and vegetables. Really saying this another way is that what you perceived or how many sodas you perceived your network to drink every day was much more likely to influence how many sodas you yourself were actually drinking. Where that was not true as far as if you perceive or how you perceive people to be eating fruit and vegetables, didn't really dictate or influence [LAUGH] what you were doing yourself. That social influence is really important in thinking about network interventions. And so, that guided us into thinking about really having a network intervention focused on the high added sugar intake. One of the things that we've sort of highlighted is feeding back information to the community. And so, not only are these really high intakes of added sugar, the high rate of cigarette smoking, as well as the low fruit and vegetable consumption, were really concerns. And while we didn't obviously survey everyone in the community, the characteristics of the people that we did survey really tended to be representative of public housing residents. And so, one of the steps that we took was actually collating all of these results, putting them in a way that would be understandable. And then, actually providing resources that are available in the community to help reduce your sugary beverage intake, increase your fruit and vegetables, and actually to help you quit smoking. And every single household in each of these communities actually got a letter detailing not only the results of our study but then what are some actions that can be taken if they themselves engaged in these habits. So all of that was vetted through the Housing Aurhtority as well as run by the resident council to make sure that we were communicating back our results to the communities themselves. In addition, we have presented the results actually to one of the executive boards at the Housing Aurhtority to really feed them information that they oftentimes don't know about their residents. And thinking about potential targets for their own programing as well as sharing the results at resident council meetings within, again, trying to make sure that we are having a two-way communication. In addition, it's also very interesting to hear their perceptions about all of these results and thinking about ways that have actually informed the pilot. So the second project was the Social Network Pilot. And so, within this, residents who lived in these communities were trained to be peer educators. So basically, they would come together and participate in group classes along with role play exercises. We had six core sessions and then three booster sessions. They learned information about added sugars, particularly sugar-sweetened beverages and their health risks, training on behavior change strategies to reduce the intake of sugary beverages themselves. But then, most importantly, actually communication skills because they were actually recruited along with someone from their social network. It could be a family member, a friend, whoever they had regular contact with and wanted to work with so that they were actually the ones tasked with communicating all the information they learned in the group sessions and working on those behavior change modalities with that person who we called the sidekick. Initially, we were very focused on just added sugars in general. But in developing this pilot, we actually did a series of focus groups with residents as well as reviewing the protocol with the Housing Aurhtority executives. In that preliminary formative work, the focus on added sugars in general was much too complicated. And so, really, they encouraged us to focus just on the sugar-sweetened beverages. And so, we adapted the intervention to actually only have that focus. In addition, they were involved in even sort of what do we call these people? And so, they liked the name peer educators. And then, the family member or friend, they ended up liking the term sidekick the best. [LAUGH] We have come up with a lot of different names for what that person should be called, but sidekick ended up being the best. Those groups actually did a test run of the pilot, providing feedback on how the materials look, what was understandable, what was not, what was too burdensome, what actually made sense. And so, it was really critical in having the community engaged so that we actually created an intervention that was tailored to the needs of the community. But it was also appropriate as far as education-wise, cultural-wise, which was really, really essential. The first stage within this project was adapting and combining programs. So in order to do this, there have been previously tested interventions on social network interventions to reduce HIV risk behaviors, as well as program called the Diabetes Prevention Program, which really focuses on lifestyle behavior change. And so, this is really where I sort of started at finding and identifying key principles and strategies that have been effective previously to kind of come up with an idea or a model of what we're going to really work on. Then, that second stage was the focus groups. Again, as I mentioned before, was a series of three groups that all had the same people in them, which was really essential. And we did that in both communities. And here, we got the feedback from the residents on sort of that preliminary design from stage one. We wanted something that was evidence-based and tested before, not to reinvent the wheel entirely. But at the same time, adaptation tailoring is really critical since this is a sort of a new area, and that's where the communities really played a key role. And then, stage three of this was actually doing the pilot or the proof of concept trial to really test this intervention. So we ended up recruiting 17 peer educator sidekick pairs, so a total of 34 people. To date, we've completed baseline data collection, the six-week intervention, as well as the three-month follow-up data collection. Currently, as of November, 2017, we are in process of collecting the final six-month data. I did want to share with you, though, some preliminary results of the data that we do have. So our population that we recruited is very similar to the one that we surveyed for that first project. So mean age was 45 years old, 79% were women, and the mean BMI is 32.1 which falls into the range of Class 1 Obesity. At baseline, their median added sugar intake was 38 teaspoons per day at baseline. So again, coming very close to that average that we found before of that upper quartile 40 teaspoons per day. So these are folks that are taking in a lot of added sugars. At the three month point, though, participants actually and this is both the peer educators and the sidekicks together. Actually decrease their added sugar intake by over 13 teaspoons per day which is a 34% reduction in what they were taking. So we still are waiting to see that the final results to see if this improvement continues. So that will be to come, but we are optimistic that using this kind of network approach as well as engaging the community the whole way through. That we have created an intervention that is evidence based but at the same time is tailored to meet a critical health need and health concern within the community. As well as using approaches that are really tailored to meet the needs both educational, economic wise, culturally tailored to this population. So while I've highlighted a number of stages throughout this when I engaged the community, sort of a quick overview. And so the preliminary studies, those focus groups are really critical in understanding the community. And also getting buy in from both the Housing Authority and the residents that this is something that we could work on together. They were key during the grant proposal, as I mentioned, obviously during the post funding study development for both projects. In project 1, they were critical in pilot testing, designing the measures that we even asked them really key on recruitment methods, strategies, as well as data collection. A lot of folks who knew that a neighbor also got randomized would sort of spread the good word and kind of vet that we were okay to talk with which ended up being very helpful. They helped in evaluating the results and then we also shared with the broader community what we found. For project 2, they were critical for intervention design and tailoring, also important for recruitment and data collection. And were planning similarly as we did project 1, thinking about evaluating the results and getting folks' feedbacks. The final things that we have been thinking about sustainability from the outset similar to what Tumaini did. And one of the key partners, the Housing Authority is sort of essential in this. And so they're very interested in understanding what the effect was, because they see potential in training some of their local staff actually in each community to potentially deliver this type of intervention. To not only improve dietary outcomes but also thinking how can we build stronger communities within these neighborhoods? The final thing that I would like to highlight that isn't on this slide, because it's not directly related to my research. Is ways that I've engaged and worked with the community throughout this is now seven year relationship that I've built. Often times, these are things that the community has identified as a priority and now seeing me as a partner or someone that they can go to and actually ask for help on things. So this has ranged from participating in quite a number of health fairs. Most of the communities have a healthy fair at least once a year and so they asked us to come in and just do blood pressure screening and counseling. Again, this is not something we collect data on, we do it because the community asks us to that this is a way that we can be helpful for them. And we've also helped out at back to school events, I'm actually designing a whole event with the community input to have a food drive as well as handing out school supplies. And at the same time, having a whole event talking about healthy diets and drinking water, and arts projects to really engage the kids. And at that event, there was over 100 people actually showed up to participate. In a way again, this is a two way partnership. And while ultimately we hope that the research benefits the community. At the same time I think it's important for researchers to think that oftentimes it's going to be years down the road before the community sees that direct benefit. And so having ways to engage to start providing benefits now really helps promote a sense of respect, to build trust. And again, to really have a true relationship with the people that you're working with. Again, I think that's often not times spoken about or described but has been a really critical facet of my own work to really think of this as a two-way street and two groups that I really value their input. And that this is something that we're all invested in this community and these people. And so I think that's really important to think about. >> So I think the points that Dr. Gudzune just raised not only in discussing the work that she's done over the past seven years. But even the most recent point she made about making sure that you're not just focusing on the research itself. But engaging community members every step of the way in terms of nor short term outcomes and objectives that are meaningful to them. Really dovetails nicely with this particular slide which talks about Facilitators of Research Faculty Participation in CBPR. And what this slide displays is kind of a conceptual model of sorts where there is a top box that highlights the researchers' personal attributes. And tries to show that there is a connection between their research attributes with the learned or the environmental factors that the researcher is embedded in. Whether it's the researcher's attitudes toward collaboration or their building skills and knowledge. And then within this bigger box of the learning and environmental factors are institutional factors. All of these things affect faculty participation in CBPR projects. But there are also some community facilitators that affect this relationship as well. So when we think about the research, personal attributes, there's certain things that make some researchers better suited to do CBPR than others. There is an innate orientation, so some researchers are hardwired to do this type of work for various reasons. They may also have internal values, passion, or commitment to community that makes them distinct from their colleagues. And then is an attribute that makes them particularly poised to do effective CBPR work. Openness to personal learning that arises from the research experience as well as the ability to tolerate ambiguity and uncertainty are also attributes are critical on the personal level when it comes to doing this work. And I think the things that Dr. Gudzune and I have both talked about kind of speak to that sort of thing, not to toot our horns but I'll toot Dr. Gudzune's horn. [LAUGH] Because I think that a lot of those personal attributes are very prevalent in the work that she's done with Public Housing residents. There's also a partnership building skill set that is really critical to this work. It's really important to be able to have the skills of negotiating roles and responsibilities early in the relationship, that is really critical to preventing misunderstandings. Facilitating relationship development as the project evolves, is also something that I think may be evident in both of the projects that we discussed during this lecture. Ability to compromise to accommodate community's priorities is also essential in both of the things that we discussed, whether it was the Tumaini (Hope) for Health Program or the research that's being conducted in Public Housing. It's really been important for both of us to be able to listen to what people are saying. And to compromise and make sure that our vision is aligned with their vision so that we're doing things in a manner that is really respectful to what they would like to see accomplished. Having flexible project management and group process skills is also really important in this process, as well as just general communication skills and conflict resolution skills, because of course there's not enough time to go into. Some of the delicate realities of our work, but there have certainly been several times where we've both been confronted with the need to resolve conflicts as quickly as possible in a way that maintains the relationships that we've fostered with our community partners. One of the major community facilitators is having partners who are ready and eager to collaborate. One of the things that kind of is a commonality between both of the work that we've highlighted in this lecture is that this work is located in communities that have historically had very poor relationships with academic medical institutions. And so it's really critical that anyone who embarks on CBPR research, that they have someone who is willing to serve as a bridge between the researcher and the community. Whether that is a community based organization, a housing project, or any other type of community entity. You also need a connected partner, someone who has a vested interest in the project itself and the outcomes of the study or the project itself. And a community that is to varying degrees activated toward doing this type of work, where they perceive the value of this work and have some level of commitment to partnering with you. There also is a need for working with community members who have some understanding of the research process. And a lot of times, if that isn't present, it's important for the CBPR faculty members to be skilled in providing an overview of what the research process entails. Because research is not something that is always easy to grasp, even for those of us who are doing this as our primary jobs. And so it's really important for those of us who have the opportunity to be CBPR faculty and researchers to be able to share it in a way that is easy to understand, so that a community member who may not be as versed in this process understands the fundamentals of what this type of work entails. Community partners who also have group and process skills are important, as well as community partners that have an understanding of the academic culture. And again, part of that will also be shaped by the community partner's familiarity with doing this type of work with other researchers. But there's another key part of this as well, and it kind of speaks to what Dr Gudzune said earlier, community partners who understand the researcher as a person. So that they're not just seeing you as someone who is coming from for example in our case from Johns Hopkins University. But they really see us as people who are individuals with our own hopes and aspirations that are not too dissimilar from them, and are working with them to hopefully make a difference in whatever arena we're working in. In terms of other attitudes and attributes that are critical for doing this work, it's important that the CBPR faculty member or researcher has a positive attitude toward collaboration. That means that they're respectful, that they have an orientation towards working in a non-hierarchical manner. So that they're not seeing themselves as above anyone, but really seeing themselves as being on equal footing with their community partners or other stakeholders. That they appreciate multiple types of knowledge, including community wisdom. So not just the knowledge that one acquires over the course of receiving formal education or even over the course of doing research, but also the types of knowledge that different community members bring to bear on the project. A willingness or ability to work collaboratively and a willingness to work on items of importance to the community. And what this last point really means or really suggests is that you may come in with one idea and think that it's important, for example, to work on high blood pressure. But they may be telling you, well, high blood pressure is important, but what we're really worried about is the fact that we don't have access to healthy foods. And so there's this notion of flexibility, again, of accommodating other people's priorities and being willing to adjust to what their needs are. Institutional factors also play a significant role in serving as a barrier or facilitator for involvement in CBPR research. There's a mentorship, which is critical not only in terms of having someone who has gone before you and has done this type of work or has some level of familiarity with it and respect for it. But also peer mentors who are colleagues that you can walk through the journey of CBPR with, ongoing support both financial and any other type of support in any dimension. Understanding CBPR at all levels, so being in an institution where there are individuals who understand what CBPR looks like conceptually and then practically in terms of the realities of conducting this type of work. And then institutional reviewed boards, so having IRBs that have members who are familiar with the CBPR process, which is also critical for supporting the progression of a project from an idea to something that is actually carried out. >> I think one other point that is important to highlight within all of this is that while I think both Dr. Ibe and I believe strongly in the role of CBPR in our own research, I think it's an endeavor that really shouldn't be taken upon lightly. And that CBPR isn't the right approach for all research projects. And so I think to some of the things that we've talked about, does this make sense to your own research project? Does it add value, and can you really engage in this in an ethical way and in a way that builds relationships? If you can't answer yes [LAUGH] to all of those questions, I think it's really important to take pause and reevaluate whether CBPR is really the right approach and method for you, because it isn't always the right approach. And as far as thinking about health disparities, health inequalities and promoting health equity, for all the reasons that we talked about, and that engagement of the community throughout every stage, we feel is really critically important for that. But if your research path takes on a different route or a different strategy, it's not to say that that is negative in any way, it's just a matter of finding the best fit for what your research path is. And that this diagram of facilitators are really, I think, as the final checklist before delving down this path, to make sure that all of these things are really in place. While I find the community is both the most rewarding and also the most frustrating [LAUGH] thing that I work with, that you have days where really amazing things happen and you actually feel like you're making a difference in people's lives, which is amazing. At the same time, it really takes an inordinate amount of time and patience and talking to build those relationships, and that isn't everyone's cup of tea [LAUGH]. >> Yeah. >> And again, it's not a value judgment, but really we're trying to set this up to think about empowering you all to have the best information in thinking about considering this pathway. >> Excellent points, I whole-heartedly agree. CBPR is hard work, it's not easy, it's not for the faint of heart. But like you said, it is extremely rewarding, and you shouldn't embark on it lightly. It's not just this romantic, I want to save the world type of thing, there's a lot of work that goes into making sure that what you're doing really is ethical and meaningful for the people that you're working with and really meaningful even for the intended beneficiaries of the interventions too. >> Ultimately, I think most people's heart is in the right place, but not following the real principles and values and steps within CBPR, you can actually potentially do more harm in the community or even harm the university within the community. And so if you're going to enter down this path to really be committed to it and to doing it right. >> We have a number of suggested readings to help shore up your understanding of CBPR falling under research, education and clinical or quality improvement. And we hope that these are just some readings that will serve as a foundation of sorts to orient you to CBPR and activate your interest in doing this work, if you think that this model of research is appropriate for you and desirable for you. Thank you for listening to this lecture and for your time. And if you decide to pursue CBPR, we hope that you enjoy it as much as Dr. Gudzune and I have. [MUSIC]
