Community-based research is grounded in the power of interdisciplinary and interprofessional collaborations—both within and outside of the academy. Community health researchers partner with community leaders, such as legislators, business executives, educational leaders, social workers, public health personnel, and grassroots advocates. These partnerships provide a novel way to address issues of wellbeing that relate to health care disparities due to differences in quality of care based on race or ethnicity. Progress using this fresh tactic indicates that improvements can and do happen.
Stepping outside of the classic laboratory or medical settings into neighborhoods challenges established academic procedures. Selection of alternative inadequately understood methods such as qualitative analyses or action research raises eyebrows in conventional medical circles. Several tenets of community-based research conflict with the traditional review, promotion, and tenure decisions. When faculty engage in community-based research, controversial questions arise:
- What constitutes scholarship versus service or education?
- Which outcomes and measures meet the rigorous standards of the review process?
- How can the work of individual faculty be teased out for fair assessment at promotion and tenure time?
Answers to these questions will encourage greater faculty participation and expand grant-makers’ interest in funding scholarship for this new approach to research.
Community-based Research: Concepts and Rationale
Community-based research is a shared approach to conducting research with four common features. Investigators
- Address social, political, cultural, and economic systems to change health behaviors and outcomes;
- Employ community members in choosing research topics, developing projects, collecting data, and interpreting and disseminating results;
- Utilize both qualitative and quantitative research methods; and
- Place a high priority on converting findings into new practices and policies (Viswanathan, 2004).
Advocates argue that a community-based approach to medical research has benefits for both the community and medical science.
The Report of the Commission on Community-Engaged Scholarship in the Health Professions summarizes the benefits to community and medicine that flow from community-engaged scholarship:
- The development and diversity of the health workforce
- The delivery of quality health care
- The relevance of research and its translation into practice and policy
- The health and economic vitality of communities
Needs and Benefits for the Public
Despite an overall trend of better health for United States citizens, health care disparities remain an entrenched problem. The Agency for Healthcare Research Quality (AHRQ) issues annual statistics for quality of and access to care that compare and track many kinds of health care disparities. As the United States continues to grow and diversify, disparities are affecting ever-larger segments of the nation.
Community researchers frame questions from social, economic or political contexts to engage community members as partners. What does that mean in practice? Typically, the community participates in a needs assessment to identify specific health issues they would like to see addressed:
- Activities lay the foundation to strengthen the entire community infrastructure;
- Community ownership of the project continues to grow with identification of the research focus and becomes stronger as project planning and implementation develops. Participants write or translate health education materials, build a cadre of patient recruiters within the community, and even invest in office space and computers for data collection and storage;
- As the project ends, the community shows its ownership by sharing in the evaluation of the project, dissemination of the results and the determination of next steps.
With this approach, community members build their own capacity to take issues in hand that affect their health and health care. Outcomes translate into long term gains. Accomplishments occur, in part, by increasing health literacy (i.e., the ability to get and understand information that is important to health care). Activities also can help repair trust and raise the profile of health professions in communities that have been previously underserved. For these reasons, community-based research is being increasingly recommended as a strategy to address health care disparities (Gerberding, 2005 and Zerhouni, 2005).
Challenges for Medical Academics
Despite its many benefits, faculty engaged in community-based research face unique challenges. Although medical professionalism has historically included service to communities in need through pro bono care, ways to provide this care have evolved dramatically. Community-based research exemplifies this transformation.
Some aspects of traditional research and promotion expectations do not match those of community-based research methods. Jones and Wells explain that attributes of community-based research, “spending time in the community, power sharing, and action research methods” often contradict the prevailing models of physicians’ clinical training, practice, and advancement, which “often requires interactions under time pressure, the hierarchical structure of academic medicine, and the focus of medical research on controlled trials as the standard for evidence" (2007).
Assessing the Scholarship of Community-based Research
New measures of scholarship are needed to support professional development and advancement of faculty engaged in community-based research. Calleson, Jordan, and Seifer recommend two alternatives:
- Glassick et al., evaluate faculty scholarship “on the degree to which a faculty member establishes clear goals, is adequately prepared, uses appropriate methods, has significant results, creates an effective presentation of the work, and reflects critical activity.” This approach has been referenced in the national consensus work on educational scholarship led by the AAMC Group on Educational Affairs.
- Diamond and Adam describe a model of scholarship that, “requires a high level of discipline-related expertise, breaks new ground or is innovative, can be replicated, documented, peer-reviewed and has significant impact” (2005).
Using these more fitting measures, Calleson and colleagues propose that scholarly assessment focus upon three components of community-based research:
- Process measures: the collaborative inquiry and the relationships that form between faculty and communities to examine and address problems;
- Products: innovative intervention programs, policies, training materials and resource guides, technical assistance, in addition to peer-reviewed articles and grant rewards; and
- Impact and project outcomes: changes in health policy, improvements in community health outcomes, improvements in community capacity and leadership, and increased funding for community health project (2005).
Institutional Benefits
Expanding the vocabulary and benchmarks used to evaluate community-based research will be insufficient, however, without organizational leadership that recognizes the value of aligning the health of an academic medical center with the health of its surrounding communities. Institutional advantages include the ability to:
- Demonstrate tangible community health gains,
- Expand networks within the institution, across disciplines, and with external entities, and
- Create opportunities to strengthen the education pipeline that brings diversity to the health professions workforce.
The partnership of Shaw University, with its historical commitment to underserved communities and the research-intensive University of North Carolina at Chapel Hill strategically combines resources and new initiatives for mutual benefit. Since its inception in 2000, staff and faculty of the two universities have worked through differences in administration, culture, and research bureaucracies to enhance their collective ability to work within the community to address health care disparities in communities in North Carolina and to enhance cross-training opportunities for faculty development and collaborative interdisciplinary pilot studies (Carey, 2005). Concurrently, the increasing availability of grants to support community-based research allowed the universities to strengthen their research infrastructures.
Summary
The many complex and centuries-old issues that have resulted in health care disparities in our country call for innovative research. Community-based research holds promise as just such an innovation. Its power for change emerges from a new lens of cooperation between academia and communities. The continued success of community-based research depends, in large part, on the willingness of medical schools and grant makers to expand their recognition of scholarship to coincide with community-based research practices.
References
- Viswanathan M, Ammerman A, Eng E, et al. Community-Based Participatory Research: Assessing the Evidence. Rockville, MD: Agency for Healthcare Research and Quality, 2004. https://www.ncbi.nlm.nih.gov/books/bv.fcgi?rid=hstat1a.chapter.44133 > Accessed 3/14/2007.
- Gerberding JL. Protecting health—the new research imperative. JAMA. 2005;294:1403-1406.
- Zerhouni EA. Translational and clinical science—time for a new vision. NEJM. 2005;353:1621-3.
- Jones L, Wells K. Strategies for academic and clinician engagement in community-participatory partnered research. JAMA. 2007;297:407-410.
- Calleson DC, Jordan C, Seifer SD. Community-engaged scholarship: is faculty work in communities a true academic enterprise? Acad Med. 2005;80:317-321.
- Carey TS, Howard DL, Goldman M, Roberson JT, Godley PA, Ammerman A. Developing effective interuniversity partnerships and community-based research to address health disparities. Acad Med. 2005;80:1039-1045.