文章基本信息

标题：A Network Assessment of Community-Based Participatory Research: Linking Communities and Universities to Reduce Cancer Disparities
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作者：Thomas W. Valente ; Kayo Fujimoto ; Paula Palmer 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2010
卷号：100
期号：7
页码：1319-1325
DOI：10.2105/AJPH.2009.171116
语种：English
出版社：American Public Health Association
摘要：Objectives. We sought to determine whether a community-based initiative designed to reduce cancer disparities among Pacific Islanders in Southern California increased communications between community-based organizations and university researchers. Methods. We conducted network analysis among 11 community-based organizations (CBOs) and 5 universities by interviewing 91 and 56 members of these organizations, respectively, at 2 points in time. We estimated random effects probit regression and stochastic actor-oriented network dynamic models. Results. We found that, during the 2-year study period, CBOs increased their connectedness with one another (b= 0.44; P < .05) and to the universities (b = 0.46; P < .05), but that university researchers did not increase their connectedness to each other or to CBOs. Conclusions. Cancer awareness, cancer education, and access to cancer services are low among Pacific Island groups, and this study provides an initial attempt to reduce these disparities. Community-based initiatives can strengthen a CBO network, creating the potential for increased community-informed cancer research and improved community access to cancer research resources. Community-based participatory research (CBPR) is increasingly viewed as a promising approach to cancer health disparities research that can bridge the enduring divide between scientific discovery and community impact.¹ Although CBPR methodologies vary, at their core they promote translational research by forging ties between community members and university researchers throughout the research development, implementation, and translation processes.^{2 – 4} Additionally, such processes yield longer-term benefits to CBPR partners, including the creation of communities that can effectively advocate their needs and create institutional changes that can reduce community cancer health disparities.⁵ As the CBPR field has grown, so, too, has the number of empirical studies on various aspects of its conduct and impacts⁶; however, there remains a dearth of studies evaluating the effectiveness of CBPR programs. We report the results of the Weaving an Islander Network for Cancer Awareness Research and Training (WINCART) initiative designed to reduce cancer disparities among Pacific Islanders in Southern California.⁷ The WINCART initiative was created as a forum for university researchers and Pacific Islander community leaders to meet and establish linkages and has involved both a scientific advisory board (SAB; comprised of cancer-related researchers from 5 universities) and a community advisory board (CAB; comprised of representatives from 11 community-based organizations [CBOs]) to guide WINCART's collaborative activities. A stated objective of the WINCART initiative is to create linkages between CBOs and academic institutions conducting cancer education, research, and training.⁸ The CBOs are all nonprofit entities that conduct health and social service programs for Pacific Islanders in Southern California. The linkages created by WINCART would enable CBOs to disseminate information about cancer prevention, early detection, research, and treatment developments to their constituents. At the same time, WINCART was designed to create linkages from cancer researchers in 5 academic institutions (3 of which have comprehensive cancer centers) to CBOs so that cancer research, education, and training would be more community-informed. Public health researchers and advocates have long recognized that health disparities research often is not informed by community partners, and the gap between the academy and community persists today. Since its inception in May 2005 (with $2.5 million in funding over 5 years from the National Cancer Institute's Center to Reduce Cancer Health Disparities), WINCART has conducted many activities to bridge the gaps between community and academy. Some of these activities have included bimonthly trainings of community leaders (usually by SAB members), retreats in which community and university researchers have focused on collaboration-building exercises and discussions, and events where community and university researchers have shared research activities and findings. Behind the scenes, WINCART has also facilitated relationship-building between community and university network members with mutual research interests, resulting in 6 National Cancer Institute–funded research projects on cancer epidemiology, prevention (nutrition and physical activity), and survivorship issues. Several activities were initiated by core WINCART staff to promote collaboration between university and community partners. With regard to education, 3 researchers in the network were asked to train CAB members on the topics of “cancer 101,” physical activity, and cancer survivorship. These training sessions helped increase the capacities of CAB members to provide cancer-related outreach education to their communities, which, for the first year, included a total of 223 events that educated 27 886 individuals. With regard to research, SAB and CAB members attended 2 all-day meetings on networking and collaboration, including the annual WINCART fall event that reviewed the network's yearly activities and progress and an SAB orientation that introduced university researchers to the network's mission and to potential community collaborators. We used social network analysis to evaluate the effectiveness of these activities. The stated goal of the project was to increase connections among and between CBOs and university organizations; thus, social network analysis was a logical methodology to use. Social network analysis is a set of theories, methods, and models for understanding how connections and relationships among entities are formed, evolve, and influence behaviors and actions.^{3 , 9 – 11} There have been several notable prior network studies of interorganizational relations in the public health and health care delivery fields.^{3 , 9 , 12 – 14} Generally these studies measure the degree of communication, collaboration, client referral, and formal agreements among organizations. The connections are mapped with specialty software and individual and network-level indicators are calculated (UCINET for Windows; Analytic Technologies, Lexington, KY).^{9 , 15} This study was designed to determine whether community-based outreach activities can increase cancer-related networks connecting CBOs and university researchers. Specifically, we expected networks to become denser overall and more heterogeneous such that communications between CBOs and universities show an increase over time. To test this hypothesis, we collected network data at 2 time points and employed several statistical modeling techniques.