- Email: [email protected]
Challenges and Lessons Learned From a Prevention Research Center Partnership
SPECIAL ARTICLE
Challenges and Lessons Learned From a Prevention Research Center Partnership Lesley Cottrell, PhD,1 Karen Northrup, RN,2 Richard Wittberg, PhD3 For more than a decade, the West Virginia Prevention Research Center, Mid-Ohio Valley Health Department, and the Wood County Schools have built and sustained a partnership to reduce health disparities and promote population health. Specifically, this partnership has contributed significantly to the peer-reviewed literature on children’s physical activity, fitness, and academic achievement, as well as identifying possible areas for physical activity interventions (within the school and community settings) that would improve health and academic outcomes. This case study describes the partnership among a University Prevention Research Center, a local health department, and a local school system. In the description of the partnership, this paper sequentially explores characteristics of the partnership that were advantageous or challenging over time. It details the interface among state and local partner interest, resources, and goals all directed toward enhancing children’s physical activity, fitness, cardiovascular risk, and academic improvement. The paper concludes with lessons learned that may contribute to the science and practice of multilevel collaborations in child health. Am J Prev Med 2017;52(3S3):S255–S257. & 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
INTRODUCTION
E
nsuring research is conducted outside of a vacuum and that it is translatable to best practices and policy development can be challenging but not impossible. Sharing, and receiving, knowledge with community members involved in the research is one way to translate research; however, this process can be challenging.1,2 The different perspectives, goals, and areas of emphasis can sometimes require translations, negotiations, and open communication.3,4 Most commonly reported challenges include shifting agendas, miscommunication of activities and goals, and delays in timelines.3–6 Solutions to many of the challenges with communitybased research have been creative and sustainable. For instance, providing community-engaged research training to researchers to improve their knowledge of community engagement and skills in areas such as community history, conditions, trends assessment, sharing power, and showing respect, including partners in all phases of research and planning, and equity of community partner compensation has been shown to limit many challenges regarding miscommunication and perceptions of community neglect.7,8 This case study isolates factors that may have led to a successful partnership among a local school system, a local health department, and a rural, statefocused University Prevention Research Center (PRC).
IT STARTED WITH A CALL Two of the three partners (local school nurse [Northrup] and local health department director [Wittberg]) in this case study were in the same region and had previously collaborated on community projects. The school nurse had also worked with the university faculty member (PRC: Cottrell) while working on two prior projects. In 2006, Northrup and Wittberg started to identify physical activity (PA)-related programs (e.g., family-based community walks). Having had a positive experience previously, the school nurse also reached out to the university member for additional obesity programming ideas. She knew initial research would be needed to better identify the most efficient interventions for the school setting. The long-term goal of this potential collaboration From the 1Department of Pediatrics, Prevention Research Center, West Virginia University, Morgantown, West Virginia; 2Wood County Schools, Parkersburg, West Virginia; and 3Mid-Ohio Valley Health Department, Parkersburg, West Virginia Address correspondence to: Lesley Cottrell, PhD, Department of Pediatrics, P.O. Box 9214 RCBHSC, Morgantown WV 26506-9214. E-mail: [email protected]. This article is part of a supplement issue titled Prevention Research Centers Program – 30th Anniversary: Translating Applied Public Health Research into Policy and Practice. 0749-3797/$36.00 http://dx.doi.org/10.1016/j.amepre.2016.08.016
& 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. Am J Prev Med 2017;52(3S3):S255–S257 S255 This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
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Cottrell et al / Am J Prev Med 2017;52(3S3):S255–S257
was to establish the local school system’s provision of PA and physical education and consider potential interventions that would easily fit the limited daily school schedule. If successful, the partnership would identify gaps in current practices where additional PA and education might be warranted, identify the importance of incorporating these elements into the school day, and begin to examine potential programming that could improve outcomes important to the school system. Initial conversations were utilized to define interests, goals, terminology, and research questions the collective team (rather than each individual) was most interested in answering. The team outlined specific tasks and responsibilities. Both practice (e.g., what school interventions would be needed) and policy changes (e.g., whether school policies regarding the academic schedule needed to incorporate PA) were desired for the school, local community, and larger theoretic literature levels. Throughout the initial partnership planning phase, the school nurse was the facilitator. Because she knew the skill sets of the partners, she was able to provide the collective focus that was much larger than each individual’s interest. The collective project plan, by nature, could not have been completed without the three entities involved. It required the community planning and staffing resources of the local health department, the medical knowledge and understanding of school policy from the school nurse, and the more advanced research and application experience of the university member to develop a strong, peer-reviewed product in the end. There were no resources beyond volunteer efforts in the beginning, thus, those activities and goals that were short term (e.g., determining if PA, obesity, and academics were associated) and required fewer resources but could increase awareness of PA and its impact on student health and academics were targeted. The partnership’s initial work focused on the association between PA and academic performance based on secondary data from the school system available to the team depending on the school nurse’s participation and familiarity with the data collection system. The finding that fitness, rather than body composition, was strongly associated with increased standardized test scores was unique to the literature and informed the team (and school administrators) that improving fitness could possibly improve test scores, with more research needed to understand the relationship.9
A SMALL SUCCESS BREEDS INVESTMENT The initial project offered potential benefits to understanding current school practices, potential opportunities for intervention, and additional knowledge that, when shared through in-person presentations with the local
school board, health department board, and national peer review audience, created interest (e.g., types of activities that could improve academic testing). Simultaneously, the feedback of current PA and physical education practices and the association of those practices with student academic outcomes raised awareness of the potential of this work. Information was disseminated after the local school board had reviewed and had the opportunity to provide input. This was very important given that the project had been based on school data and that the board had an opportunity to interpret the findings first. With success, the team continued to work on other studies. The university member offered example data sharing practices, authorship discussion points, and sample descriptions of methodology. The school nurse continued to collect information on school policy and factors contributing to PA during the school day (e.g., space, time). The health department director considered intervention programming. Possible interventions were initiated and piloted by the health department in parallel to continued research to better understand the relationship among PA, fitness, and academics (e.g., gender differences, dose response). From 2009 to 2012, the team found themselves balancing excitement and an increased awareness of the potential for PA within the school setting with the importance of continuing to conduct rigorous research studies.10–12 The additional research gave the team and partners (school system, health department, university members) opportunities to test and share evidence-based practices and information about the mechanism for how PA was improving students’ academic test scores over time. Funds remained limited; however, longitudinal data became available with the initial success. Continued review of the initial research plan was key to maintaining focus while incorporating new opportunities and areas of study when identified. By 2012, the partnership had published six manuscripts. The school nurse was approved to spend time on this area of work. The health department expressed an increasing interest to develop a research-based alliance where research would become an important mission of their work. Finally, the university member’s work contributed to an increased awareness of the connection between health behaviors and academic/goal-minded outcomes for youth in West Virginia.
SYSTEM-BASED IMPACT Arguably, the partnership has had the most significant impact on the university PRC mission and focus. In 2013, the PRC declared an interest in the work the team had conducted. The focus on child health expanded the existing PRC focus into the areas of PA, obesity, and www.ajpmonline.org
Cottrell et al / Am J Prev Med 2017;52(3S3):S255–S257
nutrition. This expansion would open the PRC to a new, yet related, group of partners and exploration.
CONCLUSIONS In summary, this partnership was developed based on the knowledge of what each individual was able to provide rather than what institution they represented; however, the institutions they represented were uniquely posed to provide support that would later contribute to the sustainability of the work. Each team member provided resources natural to their skill set. Sustainability of the partnership was produced from initial success, frequent dissemination of findings at multiple levels, and a thoughtful consideration of all partners’ needs in the planning.
ACKNOWLEDGMENTS The work depicted in this case study was partially funded by the Centers for Disease Control and Prevention, Prevention Research Center Network (West Virginia University Prevention Research Center 1-U48-DP-005004). The findings and conclusions in this paper are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. We would like to thank all of the students and their families who participated in this research agenda. We are also grateful for our partners throughout the years from the school system, health department, and higher education system. No financial disclosures were reported by the authors of this paper.
REFERENCES 1. Baker EA, Homan S, Schonhoff SR, Kreuter M. Principles of practice for academic/practice/community research partnerships. Am J Prev Med. 1999;16(3):86–93. http://dx.doi.org/10.1016/S0749-3797(98)00149-4.
March 2017
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2. Jagosh J, Macaulay AC, Pluye P, et al. Uncovering the benefits of participatory research: implications of a realist review for health research and practice. Milbank Q. 2012;90(2):311–346. http://dx.doi. org/10.1111/j.1468-0009.2012.00665.x. 3. Soska T, Butterfield AKJ. University-Community Partnerships: Universities in Civic Engagement. New York: Routledge; 2013. 4. Minkler M. Community-based research partnerships: challenges and opportunities. J Urban Health. 2005;82:ii3–ii12. http://dx.doi.org/ 10.1093/jurban/jti034. 5. Benoit C, Jansson M, Millar A, Phillips R. Community-academic research on hard-to-reach populations: benefits and challenges. Qual Health Res. 2005;15(2):263–282. http://dx.doi.org/10.1177/10497 32304267752. 6. Lloyd Michener M, Cook J, Ahmed SM, Yonas MA, Coyne-Beasley T, Aguilar-Gaxiola S. Aligning the goals of community-engaged research: why and how academic health centers can successfully engage with communities to improve health. Acad Med. 2012;87(3):285. http://dx. doi.org/10.1097/ACM.0b013e3182441680. 7. Shoultz J, Oneha MF, Magnussen L, et al. Finding solutions to challenges faced in community-based participatory research between academic and community organizations. J Interprof Care. 2006;20 (2):133–144. http://dx.doi.org/10.1080/13561820600577576. 8. Michener L, Cook J, Ahmed SM, Yonas MA, Coyne-Beasley T, AguilaGaxiola S. Aligning the goals of community-engaged research: why and how academic health centers can successfully engage with communities to improve health. Acad Med. 2012;87(3):285–291. http://dx.doi. org/10.1097/ACM.0b013e3182441680. 9. Cottrell LA, Northrup K, Wittberg R. The extended relationship between child cardiovascular risks and academic performance measures. Obesity (Silver Spring). 2007;15(12):3170–3177. http://dx.doi. org/10.1038/oby.2007.377. 10. Wittberg RA, Northrup KL, Cottrel L. Children’s physical fitness and academic performance. Am J Health Educ. 2009;40(1):30–36 http://dx.doi.org/10.1080/19325037.2009.10599076. 11. Wittberg R, Cottrell LA, Davis CL, Northrup KL. Aerobic fitness thresholds associated with fifth grade academic achievement. Am J Health Educ. 2010;41(5):284–291. http://dx.doi.org/10.1080/1932 5037.2010.10599155. 12. Wittberg RA, Northrup KL, Cottrell LA. Children’s aerobic fitness and academic achievement: a longitudinal examination of students during their fifth and seventh grade years. Am J Public Health. 2012;102(12):2303–2307. http://dx.doi.org/10.2105/ AJPH.2011.300515.
Challenges and Lessons Learned From a Prevention Research Center Partnership Lesley Cottrell, PhD,1 Karen Northrup, RN,2 Richard Wittberg, PhD3 For more than a decade, the West Virginia Prevention Research Center, Mid-Ohio Valley Health Department, and the Wood County Schools have built and sustained a partnership to reduce health disparities and promote population health. Specifically, this partnership has contributed significantly to the peer-reviewed literature on children’s physical activity, fitness, and academic achievement, as well as identifying possible areas for physical activity interventions (within the school and community settings) that would improve health and academic outcomes. This case study describes the partnership among a University Prevention Research Center, a local health department, and a local school system. In the description of the partnership, this paper sequentially explores characteristics of the partnership that were advantageous or challenging over time. It details the interface among state and local partner interest, resources, and goals all directed toward enhancing children’s physical activity, fitness, cardiovascular risk, and academic improvement. The paper concludes with lessons learned that may contribute to the science and practice of multilevel collaborations in child health. Am J Prev Med 2017;52(3S3):S255–S257. & 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
INTRODUCTION
E
nsuring research is conducted outside of a vacuum and that it is translatable to best practices and policy development can be challenging but not impossible. Sharing, and receiving, knowledge with community members involved in the research is one way to translate research; however, this process can be challenging.1,2 The different perspectives, goals, and areas of emphasis can sometimes require translations, negotiations, and open communication.3,4 Most commonly reported challenges include shifting agendas, miscommunication of activities and goals, and delays in timelines.3–6 Solutions to many of the challenges with communitybased research have been creative and sustainable. For instance, providing community-engaged research training to researchers to improve their knowledge of community engagement and skills in areas such as community history, conditions, trends assessment, sharing power, and showing respect, including partners in all phases of research and planning, and equity of community partner compensation has been shown to limit many challenges regarding miscommunication and perceptions of community neglect.7,8 This case study isolates factors that may have led to a successful partnership among a local school system, a local health department, and a rural, statefocused University Prevention Research Center (PRC).
IT STARTED WITH A CALL Two of the three partners (local school nurse [Northrup] and local health department director [Wittberg]) in this case study were in the same region and had previously collaborated on community projects. The school nurse had also worked with the university faculty member (PRC: Cottrell) while working on two prior projects. In 2006, Northrup and Wittberg started to identify physical activity (PA)-related programs (e.g., family-based community walks). Having had a positive experience previously, the school nurse also reached out to the university member for additional obesity programming ideas. She knew initial research would be needed to better identify the most efficient interventions for the school setting. The long-term goal of this potential collaboration From the 1Department of Pediatrics, Prevention Research Center, West Virginia University, Morgantown, West Virginia; 2Wood County Schools, Parkersburg, West Virginia; and 3Mid-Ohio Valley Health Department, Parkersburg, West Virginia Address correspondence to: Lesley Cottrell, PhD, Department of Pediatrics, P.O. Box 9214 RCBHSC, Morgantown WV 26506-9214. E-mail: [email protected]. This article is part of a supplement issue titled Prevention Research Centers Program – 30th Anniversary: Translating Applied Public Health Research into Policy and Practice. 0749-3797/$36.00 http://dx.doi.org/10.1016/j.amepre.2016.08.016
& 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. Am J Prev Med 2017;52(3S3):S255–S257 S255 This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
S256
Cottrell et al / Am J Prev Med 2017;52(3S3):S255–S257
was to establish the local school system’s provision of PA and physical education and consider potential interventions that would easily fit the limited daily school schedule. If successful, the partnership would identify gaps in current practices where additional PA and education might be warranted, identify the importance of incorporating these elements into the school day, and begin to examine potential programming that could improve outcomes important to the school system. Initial conversations were utilized to define interests, goals, terminology, and research questions the collective team (rather than each individual) was most interested in answering. The team outlined specific tasks and responsibilities. Both practice (e.g., what school interventions would be needed) and policy changes (e.g., whether school policies regarding the academic schedule needed to incorporate PA) were desired for the school, local community, and larger theoretic literature levels. Throughout the initial partnership planning phase, the school nurse was the facilitator. Because she knew the skill sets of the partners, she was able to provide the collective focus that was much larger than each individual’s interest. The collective project plan, by nature, could not have been completed without the three entities involved. It required the community planning and staffing resources of the local health department, the medical knowledge and understanding of school policy from the school nurse, and the more advanced research and application experience of the university member to develop a strong, peer-reviewed product in the end. There were no resources beyond volunteer efforts in the beginning, thus, those activities and goals that were short term (e.g., determining if PA, obesity, and academics were associated) and required fewer resources but could increase awareness of PA and its impact on student health and academics were targeted. The partnership’s initial work focused on the association between PA and academic performance based on secondary data from the school system available to the team depending on the school nurse’s participation and familiarity with the data collection system. The finding that fitness, rather than body composition, was strongly associated with increased standardized test scores was unique to the literature and informed the team (and school administrators) that improving fitness could possibly improve test scores, with more research needed to understand the relationship.9
A SMALL SUCCESS BREEDS INVESTMENT The initial project offered potential benefits to understanding current school practices, potential opportunities for intervention, and additional knowledge that, when shared through in-person presentations with the local
school board, health department board, and national peer review audience, created interest (e.g., types of activities that could improve academic testing). Simultaneously, the feedback of current PA and physical education practices and the association of those practices with student academic outcomes raised awareness of the potential of this work. Information was disseminated after the local school board had reviewed and had the opportunity to provide input. This was very important given that the project had been based on school data and that the board had an opportunity to interpret the findings first. With success, the team continued to work on other studies. The university member offered example data sharing practices, authorship discussion points, and sample descriptions of methodology. The school nurse continued to collect information on school policy and factors contributing to PA during the school day (e.g., space, time). The health department director considered intervention programming. Possible interventions were initiated and piloted by the health department in parallel to continued research to better understand the relationship among PA, fitness, and academics (e.g., gender differences, dose response). From 2009 to 2012, the team found themselves balancing excitement and an increased awareness of the potential for PA within the school setting with the importance of continuing to conduct rigorous research studies.10–12 The additional research gave the team and partners (school system, health department, university members) opportunities to test and share evidence-based practices and information about the mechanism for how PA was improving students’ academic test scores over time. Funds remained limited; however, longitudinal data became available with the initial success. Continued review of the initial research plan was key to maintaining focus while incorporating new opportunities and areas of study when identified. By 2012, the partnership had published six manuscripts. The school nurse was approved to spend time on this area of work. The health department expressed an increasing interest to develop a research-based alliance where research would become an important mission of their work. Finally, the university member’s work contributed to an increased awareness of the connection between health behaviors and academic/goal-minded outcomes for youth in West Virginia.
SYSTEM-BASED IMPACT Arguably, the partnership has had the most significant impact on the university PRC mission and focus. In 2013, the PRC declared an interest in the work the team had conducted. The focus on child health expanded the existing PRC focus into the areas of PA, obesity, and www.ajpmonline.org
Cottrell et al / Am J Prev Med 2017;52(3S3):S255–S257
nutrition. This expansion would open the PRC to a new, yet related, group of partners and exploration.
CONCLUSIONS In summary, this partnership was developed based on the knowledge of what each individual was able to provide rather than what institution they represented; however, the institutions they represented were uniquely posed to provide support that would later contribute to the sustainability of the work. Each team member provided resources natural to their skill set. Sustainability of the partnership was produced from initial success, frequent dissemination of findings at multiple levels, and a thoughtful consideration of all partners’ needs in the planning.
ACKNOWLEDGMENTS The work depicted in this case study was partially funded by the Centers for Disease Control and Prevention, Prevention Research Center Network (West Virginia University Prevention Research Center 1-U48-DP-005004). The findings and conclusions in this paper are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention. We would like to thank all of the students and their families who participated in this research agenda. We are also grateful for our partners throughout the years from the school system, health department, and higher education system. No financial disclosures were reported by the authors of this paper.
REFERENCES 1. Baker EA, Homan S, Schonhoff SR, Kreuter M. Principles of practice for academic/practice/community research partnerships. Am J Prev Med. 1999;16(3):86–93. http://dx.doi.org/10.1016/S0749-3797(98)00149-4.
March 2017
S257
2. Jagosh J, Macaulay AC, Pluye P, et al. Uncovering the benefits of participatory research: implications of a realist review for health research and practice. Milbank Q. 2012;90(2):311–346. http://dx.doi. org/10.1111/j.1468-0009.2012.00665.x. 3. Soska T, Butterfield AKJ. University-Community Partnerships: Universities in Civic Engagement. New York: Routledge; 2013. 4. Minkler M. Community-based research partnerships: challenges and opportunities. J Urban Health. 2005;82:ii3–ii12. http://dx.doi.org/ 10.1093/jurban/jti034. 5. Benoit C, Jansson M, Millar A, Phillips R. Community-academic research on hard-to-reach populations: benefits and challenges. Qual Health Res. 2005;15(2):263–282. http://dx.doi.org/10.1177/10497 32304267752. 6. Lloyd Michener M, Cook J, Ahmed SM, Yonas MA, Coyne-Beasley T, Aguilar-Gaxiola S. Aligning the goals of community-engaged research: why and how academic health centers can successfully engage with communities to improve health. Acad Med. 2012;87(3):285. http://dx. doi.org/10.1097/ACM.0b013e3182441680. 7. Shoultz J, Oneha MF, Magnussen L, et al. Finding solutions to challenges faced in community-based participatory research between academic and community organizations. J Interprof Care. 2006;20 (2):133–144. http://dx.doi.org/10.1080/13561820600577576. 8. Michener L, Cook J, Ahmed SM, Yonas MA, Coyne-Beasley T, AguilaGaxiola S. Aligning the goals of community-engaged research: why and how academic health centers can successfully engage with communities to improve health. Acad Med. 2012;87(3):285–291. http://dx.doi. org/10.1097/ACM.0b013e3182441680. 9. Cottrell LA, Northrup K, Wittberg R. The extended relationship between child cardiovascular risks and academic performance measures. Obesity (Silver Spring). 2007;15(12):3170–3177. http://dx.doi. org/10.1038/oby.2007.377. 10. Wittberg RA, Northrup KL, Cottrel L. Children’s physical fitness and academic performance. Am J Health Educ. 2009;40(1):30–36 http://dx.doi.org/10.1080/19325037.2009.10599076. 11. Wittberg R, Cottrell LA, Davis CL, Northrup KL. Aerobic fitness thresholds associated with fifth grade academic achievement. Am J Health Educ. 2010;41(5):284–291. http://dx.doi.org/10.1080/1932 5037.2010.10599155. 12. Wittberg RA, Northrup KL, Cottrell LA. Children’s aerobic fitness and academic achievement: a longitudinal examination of students during their fifth and seventh grade years. Am J Public Health. 2012;102(12):2303–2307. http://dx.doi.org/10.2105/ AJPH.2011.300515.