Perinatal disparities: A CPBR example

Researchers use community-based participatory research to develop effective programs

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Rates of infant death among African-Americans are more than twice the national average, according to the United States Department of Health and Human Services, Office of Minority Health.

That’s a striking and troubling statistic. And in Richmond, the problem is even more pronounced. In the past decade, the rate of infant deaths among African-Americans in Richmond has consistently been three to four times higher than that of non-Hispanic whites.

A group of researchers from Virginia Commonwealth University teamed up with the Richmond Healthy Start Initiative (Department of Social Services), Richmond Health District, community representatives and other governmental and nonprofit agencies to address the disparities in infant mortality using Richmond as the project site. The group is using the community-based participatory research (CBPR) approach to foster collaborative relationships with community members to develop effective and sustainable interventions and programs targeting needs of the community.

“Infant mortality is a complex issue that is affected by socioeconomic conditions such as poverty, racism, access to care, poor health behaviors and violence,” said Saba Masho, M.D., Dr.PH., associate professor of family medicine and population health in the VCU School of Medicine and lead investigator on the project. “These problems cannot be solved by a single organization. As such, community-based participatory research is an ideal mechanism to begin to address the problem. We have found that this approach has been effective in developing recruitment strategies and planning for data collection.”

To address the racial disparities in the Richmond infant mortality rate, the Healthy Start Consortium was formed to facilitate communitywide partnerships. The consortium is composed of social service recipients, neighborhood residents, medical, mental health and social service providers, nonprofit organizations, higher education institutions, faith and business community representatives. The consortium represents more than 50 agencies and has 139 members.

“Infant mortality is a major public health problem that requires community participation,” said Rose Stith Singleton, Richmond Healthy Start Initiative project director.

According to Masho, this study highlights the importance of utilizing CBPR methods to promote community-academic partnerships. Rather than researchers imposing pre-determined objectives onto the community, the two groups were able to come together and mutually determine the direction of their collaboration through the use of data coming directly from the community of interest.”

“For more than a decade, researchers have sought to explain the causes and identify solutions for the substantial racial disparity in infant mortality,” Masho said. “Similarly, communities have invested considerable time and energy developing programs and initiatives to combat this problem. The CBPR partnerships allow each group to bring their insights, knowledge and experiences to the table and, through this combined perspective, generate solutions that may lead to healthier and sustainable outcomes.”

A key aspect of the CBPR framework is that the targeted communities are involved in all stages of the research development. This involvement eases the translation of research to practice, which is a common barrier in more traditional research processes. The CBPR framework has been shown to be particularly useful in working with communities that have historically experienced distrust of researchers.

“CBPR methods utilizing high levels of community involvement in the planning process are more likely to result in high levels of benefit, trust and satisfaction within the population being served, which in turn broadens the scope and sustainability of the intervention, or solution,” Masho said.

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