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Community-based participatory research (CBPR) is an increasingly popular form of public health research. However, little is known about the application of CBPR and the levels of involvement for partners in specific phases of the partnership. This phenomenological study addressed the application of CBPR from the perspectives of 7 academic researchers and 6 community members experienced in CBPR. Arnstein's ladder of citizenship participation and the community coalition action theory provided the framework for the study. Semi-structured interviews addressed participants' levels of involvement in the CBPR process, as well as challenges, concerns, successes, and recommendations for improvement. Interview transcripts were analyzed by identifying recurrent themes relevant to the experience of being a CBPR partner. These themes were then used to develop descriptions of their experience. Results indicated that participants knew the term CBPR and had experienced it, but not all participants understood the depth of CBPR and how much bargaining power they could have for their community. Sustainability of partnerships and programs was a major concern. Ethical problems were also raised regarding the long-term commitment to projects and the need for CBPR partnership evaluation. Results may be used to strengthen awareness of the principles of CBPR to advance culturally tailored public health interventions.

Pain is a growing national public health problem that contributes to spiraling health care costs and significant societal burden in the United States. It is the most common reason for seeking health care services, and is the leading cause of disability (CDC, 2008). Inadequately treated pain has profound social, psychological, economic, and physiological consequences for patients, their families, and society (American Pain Society, 2009).A community-based participatory research (CBPR) approach was used for this project to develop a knowledge base about issues associated with chronic pain and its treatment among Native American people in Winslow, AZ. Mixed methods (qualitative and quantitative) were used to gain insight into the local factors that contribute to the self-management and treatment of chronic pain.The results of a provider survey indicated that there are negative psychological traits toward patients with chronic pain such as authoritarianism, intolerance of ambiguity, reliance on technology, and locus of control which are factors that are known to negatively influence pain care (Weinstein et al, 2000). Lack of knowledge regarding pain and pain management along with perceptions and fears related to drug regulatory agencies were additional factors that were found, constituting additional barriers. Patient participants were generally dissatisfied with the pain care practices at Winslow Indian Health. Patient reported treatment goals that included relief of pain, improved quality of life, the ability to return to work, the ability to perform household chores, and the ability to participate in more physical leisure activities.This results of this practice inquiry indicate there is a disconnect between patient and provider views and expectations around pain treatment and the need for further studies to determine the best ways to address chronic pain at the local level. The development of a pain management program is recommended to address the unmet needs of patients with chronic pain. Education in pain management is recommended for healthcare providers, including information regarding the benefits of non-pharmacologic therapies for pain management. The practice inquiry also supports the need for new policies at the local, tribal, and national levels to address pain as a growing public health issue.

Background: This research was designed to understand factors influencing Motor Vehicle Crashes (MVCs) on or near the Hualapai Tribe’s reservation in northwestern Arizona. The goal is to enable the Tribe to develop and implement a locally relevant MVC intervention program. The specific aims were to: i) compile and analyze 2010-2016 MVC data from Hualapai and federal sources to assess distributions of frequency, rates, high risk-locales, causes, days, times, age and sex of the drivers, in addition to assessing related conditions; ii) document local perceptions of environmental, social, and behavioral barriers to safe driving practices, and knowledge of MVC risk factors and existing tribal laws; and iii) provide evidence-based recommendations using the results from quantitative and qualitative data analyses. Approach/Methods: The research process applied a Community-Based Participatory Research approach and mixed methods using: a) secondary data analyses of records from six tribal programs and Indian Health Service (IHS), and b) qualitative analyses of data from two focus groups and field documents. Sensitivity analyses were conducted of IHS and Tribal Driving Under the Influence (DUI) data, using the 2010 U.S. Census as the denominator after adjusting for an undercount of up to 25%. Descriptive statistics, Fisher’s Exact Test, and linear and logistic regressions were used to examine significance. MVCs per 10 miles per year were estimated for State Route 66 and Diamond Bar Road/Grand Canyon West on or near the reservation due to higher numbers of crashes. Statistical process control charts, especially g-charts monitoring time between events, were plotted to examine the stability in the number of MVCs over time for each road. NVivo11Pro© was used to code and analyze the focus group data, guided by both inductive and deductive theories. Results: Driver’s seatbelt use in the Hualapai community increased from 2010 to 2012 (p < .0005), and reported DUIs decreased from 2010 to 2016 (p = .027). Similarly, car/booster seat use improved from 2014 to 2015 (p < .0005). Two hundred and fifty (N = 250) MVC-related injuries were registered at IHS facilities for Hualapai community members between 2006 and 2015. The highest rate, 22.4%, was observed in 15- to 24-year-olds, followed by 21.6% in 55- to 64-year-olds. For several combinations of numerators and denominators, sensitivity analysis of the IHS data shows a clear disparity between the Tribe’s MVC rate compared to the 2008 U.S. rate of 771.4 nonfatal injuries per 100,000 persons and the national goal for Healthy People 2020 (694.3 nonfatal injuries/100,000 persons). The major themes emerged from qualitative analyses of the focus groups were: i) unsafe traffic infrastructures, ii) DUI, iii) repeated DUI offenders driving on the reservation, and iv) a perception of lenient tribal traffic laws and enforcement on the reservation. Using study results, five Public Service Announcements were co-developed to inspire community-members to continue the trends noted from 2010-2016 and be aware of continued risks. Conclusions: MVCs are a multidimensional issue needing communitywide awareness of the range of risk factors. An intervention that addresses human and structural risks requires an alliance of tribal programs and external partners (e.g., IHS, university, federal, and state). Recommendations: Local recommendations include providing school- and institution-based education about alcohol/alcoholism and DUI consequences, and ongoing culturally and locally relevant communitywide education through the local newsletter and radio station.

This case study is a qualitative examination of a health promotion project conducted in collaboration with members of the mental health peer community. More specifically, it explores the community based participatory research (CBPR) implementation process used to conduct this health promotion project to gain a deeper understanding of the mechanisms at work in the implementation process. While there has been considerable attention to the principles that guide CBPR (Braun et al., 2012; Israel et al., 2008; LaVeaux & Christopher, 2009), there remains important work to be done in bridging these principles to implementation; what processes or mechanisms translate these principles to action. Four mechanisms were initially proposed by this writer, derived from extant literature in this area (Wallerstein & Duran, 2003). These provided the initial framework for analyzing the data gathered throughout the case study. The case report discusses the findings of how these initially proposed mechanisms have been transformed and redefined in the context of this case. The resultant mechanisms, knowledge sharing, power sharing, task sharing, resource sharing, and shared purpose (there are five, as one additional new mechanism emerged in the analysis), are described with examples of how they were reflected in this case. Implications for these findings for CBPR research, collaborative health promotion with the mental health peer community, and the social work profession are shared.

Many public health and social issues faced by society today are multifaceted and require joint and collaborative efforts through health promotion partnerships. Community-based participatory research (CBPR) is one strategy that consists of engaging community stakeholders from various sectors to pool their expertise and resources in addressing health and social issues holistically. The literature indicates that the effectiveness of partnerships, such as those established within CBPR initiatives, is influenced by collaborative mechanisms that promote the creation of synergy among partners. There is, however, a lack of knowledge with regards to synergy and its key determinants in the context of health promotion partnerships. This qualitative thesis study is conducted as part of The EnRiCH Project, a CBPR initiative conducted in four communities across Canada, which aims at enhancing resilience and preparedness for disasters among high-risk populations. It explores the creation of synergy through the study of dynamics of collaboration shaping the EnRiCH-Québec City partnership and influencing its ability to leverage community resources for emergency preparedness. Emergent themes highlight that optimal collaboration in the EnRiCH-Québec City partnership is about having the “right people, in the right place, at the right time”. These findings provide evidence to inform community stakeholders, researchers and decision-makers on the dynamics of synergy creation and its implications for partnership growth and effectiveness.

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Background: Community gardens have existed in America since the late 1800s and have served multiple purposes from food subsidies to neighborhood beautification. The use of community gardens has grown in popularity and has been recommended as a way to encourage healthy eating habits in youth. Though the health benefits of having a diet high in fruits and vegetables is well known, youth in the United States do not meet recommendations for fruit and vegetable intake. Under-consumption of fruits and vegetables is problematic in youth, as eating habits are established in childhood. Community gardens have been successfully used to improve access, self-efficacy, preference, and consumption of fruits and vegetables. However, few published community garden studies have focused on low socioeconomic youth. The Dan River Partnership for a Healthy Community (DRPHC) was developed according to community-based participatory research (CBPR) principles. With a mission to reduce obesity using healthy lifestyle initiatives, community gardens are an evolving DRPHC initiative. Objective: To evaluate the feasibility (i.e., demand, acceptability, implementation, and limited-effectiveness testing) of a 10-week experiential theory-based gardening and nutrition education program targeting youth living in two public housing sites in the Dan River Region. Methods: Using pre- and post-program questionnaires/interviews, demand and acceptability were measured among youth, parents and site leaders. Implementation was measures via field notes and attendance. Limited-effectiveness was measured among youth using a pre-post design. Three researchers independently coded the qualitative transcripts, met to resolve disagreements, and built consensus through discussion of the codes. Similarly, field notes were reviewed and evaluated for reoccurring themes regarding barriers, facilitators, and other observations. For the quantitative measures, descriptive statistics were used to summarize the variables and Cronbach's alphas used to assess the reliability of each scale at baseline. Overall effects were tested with repeated measures ANOVA. An intent-to-treat analysis using the last observation carried forward method was used. A critical value of .05 was used for significance testing. A standard equation for reporting effect sizes on a single-group, pre-post study design is also reported. Results: Program enrollment included 43 youth, primarily African American. The positive demand and acceptability findings indicate the potential of the program to be used and suitable for the youth, parents, and site leaders. Field notes revealed numerous implementation facilitators and barriers. Youth weekly attendance averaged 4.6 of 10 sessions. Significant improvements (p<0.05) were found for some (e.g., FV asking self-efficacy, overall gardening knowledge, knowledge of MyPlate recommendations), but not all limited-effectiveness measures (e.g., willingness to try FV, FV eating self-efficacy). Study Implications: This study addresses recommendations for utilizing CBPR in community garden efforts and builds on community identified research priorities of the DRPHC. Results demonstrate the feasibility of a gardening and nutrition program targeting youth in public housing. Lessons learned are being used to adapt and strengthen the program for future efforts targeting FV behaviors. Findings will be shared with local community stakeholders and used to adapt and strengthen the program for future efforts in the Dan River Region targeting of fruit and vegetable behaviors. / Master of Science

Environmental justice communities, those disproportionately affected by pollutants, are simultaneously exposed to multiple environmental stressors and also experience social and cultural factors that may heighten their health risks in comparison to other communities. In addition to being more susceptible to toxic exposures and being exposed to more toxins, such communities may have weakened abilities to combat or rebound from such exposures. Many communities that are overburdened by environmental exposures reject traditional risk assessment approaches that solely consider the effects of single chemicals or mixtures of like chemicals and instead have advocated for the use of place-based approaches and collaborative problem solving models that consider cumulative exposures and impacts. Cumulative risks are the combined risks from aggregate exposures to multiple agents or stressors, including chemical, biological or physical agents and psychosocial stressors. This dissertation adapts three research approaches that each use either publicly available data (“expert” data) or community-generated data about environmental and social factors in Northwest Atlanta’s Proctor Creek Watershed. Through this work, we were able to define cumulative environmental and social impacts experienced by watershed residents and to prioritize geographic areas and environmental challenges for investments in environmental monitoring and further research, community capacity-building, and policy change. A principal finding of the study is that local community knowledge is helpful to fill critical gaps about local conditions and pollution sources than a reliance on expert data alone.

Despite a significant increase in the demands for teachers’ professional development, the work environments of teachers have not developed at a comparable rate. Due to research on inequity in teacher work environment, the purpose of this case study was to explore the role of empowerment in the early childhood education (ECE) workforce, using Community Based Participatory Research (CBPR) as a framework. This project was done with 5 educators in a for‑profit ECE center. Over the course of five weekly sessions, the educators completed questionnaires, interviews, and engaged in weekly focus groups geared towards providing the teachers with an opportunity to share their experiences and collaborate on solutions for change in their work environment. Overall, descriptive statistics of the quantitative data did not demonstrate an increase in empowerment over the course of the project. However, the six emerging themes (i.e., Frustration with Center Operations and Corporate, Empowerment, Communication, Emotional and Physical Well‑Being, Teacher Unity, and Teacher Training and Education) provided important insights into the nature of teacher empowerment in the ECE setting, which informed lessons learned and future directions for research.