- Email: [email protected]
Establishing a Multidisciplinary Academic Group to Address Health Disparities
Establishing a Multidisciplinary Academic Group to Address Health Disparities MARTHA I. ARRIETA, MD, MPH, PHD; ROMA HANKS, PHD; NORMAN B. BRYAN, PHD
ABSTRACT: Health disparities are common and a major focus of attention among health care researchers. The reasons for these disparities are several in number and broad in scope. Therefore, it will require a broadbased, multidisciplinary approach to fully understand and significantly reduce health disparities. Researchers with expertise in business and economics, public policy, education, language and communication, and social work will have to team with more traditional health researchers to achieve the desired goal. Our approach to this challenge was to develop a Health
D
isparities in health are well documented and a major focus of research efforts. The reasons for these disparities are several in number and broad in scope. Differences in access to health services, quality of health care, health literacy, economic and educational attainment, culture, language, and location contribute to health disparities.1 It is likely that many other unidentified contributing factors exist. Therefore, it will require a broad-based, multidisciplinary approach to fully understand and significantly reduce health disparities. Researchers with expertise in business and economics, public policy, education, language and communication, and social work will have to team with more traditional health researchers to achieve the desired goal.2,3 In this article, we describe efforts of the University of South Alabama Center for Healthy Communities EXPORT (Centers of Excellence in Partnerships for Outreach, Research and Training in Health Disparities) program to develop a multidisciplinary team of academic faculty to address issues in health disparities.
From the University of South Alabama Center for Healthy Communities, Mobile, Alabama. Submitted December 19, 2007; accepted in revised form January 23, 2008. This work was supported by NIH (NCMHD) grant no. 5R24 MD 001094-02. Correspondence: Martha Arrieta, MD, MPH, PhD, Center for Healthy Communities, University of South Alabama College of Medicine, Mastin, 5th Floor, Suite 524, 2451 Fillingim Street, Mobile, AL 36617 (E-mail: [email protected]). THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES
Disparities Research Group, a multidisciplinary group of university faculty with an interest in health disparities. University faculty from the disciplines mentioned above, plus others with varying amounts of research experience, have come together to form the group. In this article, we describe how this group was formed and some of its activities to assist in development of other such research teams across the nation. KEY INDEXING TERMS: Health disparities; Research team; Community-based participatory research. [Am J Med Sci 2008;335(4):275–277.]
Initial Efforts Our endeavors started with the awarding of an EXPORT program planning grant to the University of South Alabama Center for Healthy Communities in the fall of 2004. The focus was on addressing health disparities in Mobile, Alabama. The health disparate populations of interest were those of African American ethnicity and the economically impoverished. The overall strategy for the Center for Healthy Communities was to implement community based participatory research (CBPR) approaches.4,5 As part of this strategy, the intellectual resources at the University of South Alabama specifically, and Mobile in general, were considered an integral part of the community. We sought to develop broad-based collaborative efforts between the researchers and other community members. To achieve this goal we developed the concept of a Health Disparities Research Group (HDRG). Understanding that the success of the overall EXPORT program and the HDRG in particular would require buy-in from university leadership, we informed university deans and department heads of plans to establish the multidisciplinary research group. Following these efforts we invited the entire university faculty to discuss the concept of health disparities and the HDRG. From among those showing interest, a steering committee was established to guide the group’s activities. Spearheaded by the HDRG Steering Committee, a university-wide assembly was organized as a “kickoff” event. This 1-day health disparities assembly featured invited speakers from outside the univer275
Health Disparities Research Group
sity with considerable experience in health disparities research and the CBPR model. In addition, the university faculty members with interest, experience, and skills important for health disparities investigation were personally recruited to the event as participants and attendees. Also in attendance were the key representatives of important agencies that are partners in the fight against health disparities: the State and County Health Departments, important safety net primary healthcare providers that focus on health disparate populations, local hospitals, community advocates, and local elected officials. Ultimately, the assembly allowed for interaction among the university faculty from a variety of disciplines and introduced these potential health disparities researchers to some of their community partners. Maintenance and Expansion of Efforts One month following the assembly, the HDRG had the first of what became monthly meetings. At that meeting, the group’s general goals were presented: (1) foster the integration of university faculty into a multidisciplinary group focusing on health disparities research, with an emphasis on CBPR; (2) promote the interaction of faculty and community to advance CBPR; (3) develop and implement a plan to insure sustainability of the group at the university. Over the next several months members of the HDRG became familiar with each other’s research, education, and outreach interests. They provided valuable direction for the future of the group. Early strategies to enhance HDRG efforts included awarding of travel grants to national conferences on health disparities and CBPR. Several members took advantage of these awards and shared their experiences with the rest of the group via formal presentations at subsequent meetings. Such reports increased enthusiasm for the EXPORT program and HDRG’s goals. Another initiative to increase health disparities research efforts was the awarding of 3 pilot research funds to university faculty. Those who applied for the awards were encouraged to participate in HDRG. Those receiving the awards were required to periodically report to the HDRG on the progress of their research activities. We found that such reports fostered interesting conversation and led to the development of new ideas and collaborations. The early efforts described above were successful and resulted in at least 30 faculty being involved with HDRG at some level, with about 10 faculty members very actively concerned with further establishing the group. These core members suggested a retreat to establish a more formal mission, vision, and goals for the group, which were developed in a series of meetings culminating in a retreat (Table 1). 276
Table1. Self-Developed Vision, Mission and Goals of HDRG VISION: “To become an integral facilitator in eliminating health disparities thorough partnerships with our community” MISSION: “The Mission of the University of South Alabama Health Disparities Research Group is to foster interdisciplinary, collaborative research toward eliminating health disparities. HDRG will realize its mission through the strengthening of faculty capabilities, the garnering of resources, the provision of an intellectual forum for disparities research, the engagement of the community as a partner in its endeavors, and the establishment of an interface with policy makers” GOALS: 1. Conduct and support health disparities research. 2. Garner adequate resources for the HDRG to become selfsustaining. 3. Engage community stakeholders in the process of developing research and collaboration. 4. Strengthen faculty capabilities to conduct health disparities research. 5. Translate and disseminate research findings related to health disparities.
The result was a blueprint for the HDRG’s activities over the next 2 years. There was considerable interest in developing a joint research project among the members of the HDRG. The concept of a review of best practices to eliminate health disparities—the so called third-generation research—received considerable interest. We focused on strategies that addressed disparities in cardiovascular disease. Several members participated in the design, literature search, literature review, data analysis, and writing of this project. Representatives from the biomedical library, education, business, nursing, interdisciplinary studies, sociology, and internal medicine joined the EXPORT staff and investigators in this effort. This initiative has created tighter collaborative relationships, increased knowledge in health disparities, and increased enthusiasm for health disparities research. The strategy employed can be applied to determine the best practices to eliminate health disparities in other disease areas. Finally, several members of the HDRG have participated in the EXPORT outreach activities. They have served as speakers for community groups, participated in health fairs, and worked with youth programs. Importantly, HDRG members took leadership roles in organizing the EXPORT’s annual Regional Health Disparities Symposium. Challenges and Future Directions The biggest challenge to the HDRG is maintaining the initial enthusiasm for the project. Multiple competing priorities for faculty time constitute a major barrier and sometimes limit the ability to participate. It is not clear whether the university leadership understands and values the HDRG April 2008 Volume 335 Number 4
Arrieta et al
mission, and it may not be fully supportive of it. This represents a challenge for the faculty from those departments. Fortunately, many core members of the HDRG are in leadership or senior faculty positions, which helps meet this challenge in some areas. A second challenge related to the need to provide the HDRG faculty with a stimulating task to test the potential for collaborative work among group members. After the first several meetings, it became evident that the time for action had come as educational efforts had succeeded and were no longer seen as value added when taken in isolation. The literature review of the third-generation health disparities research in cardiovascular disease provided some of the action that this group needed. It allowed for them to use their skills in design and implementation of a study. It allowed for them to tell their respective department leaders that they were involved in projects that will have tangible outcomes such as publications and enhancement of their knowledge base for classroom educational activities. The project also allowed the HDRG members to form new collaborations outside their departments. Another major challenge was for HDRG faculty to understand and embrace CBPR as a major strategy for health disparities research.6,7 Fortunately, some HDRG faculty had experience with CBPR and were instrumental in helping the rest of the group subscribe to the concept. Finally, we were also challenged with dwindling numbers of members and the potential for participation fatigue among the core members. Candid, open dialogue among the HDRG faculty has allowed the core members to remain enthusiastic for the HDRG and its mission. We will strive to adhere to the group’s vision, mission, and goals. In doing this, we hope to create an atmosphere where attention to health disparities will be part of the cultural fabric of the University of South Alabama.8 It will be critical to develop permanent links between the faculty and the communitybased organizations to ensure full adoption and
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES
maintenance of CBPR.9 –11 The HDRG faculty will need to recruit new members and develop new initiatives that allow research collaborations. It will be critical for the HDRG faculty to promote involvement of students in health disparities-related activities and to discuss these issues in the classroom. Finally, we look forward to developing innovative, investigatorinitiated research projects from the HDRG faculty that will be “EXPORTable” frameworks to address the health disparities worldwide. References 1. Fiscella K, Williams DR. Health disparities based on socioeconomic inequities: implications for urban health care. Acad Med 2004;79:1139 – 47. 2. Olshansky E, Sacco D, Braxter B, et al. participatory action research to understand and reduce health disparities. Nurs Outlook 2005;53:121– 6. 3. Carey TS, Goldmon M, Roberson JT, et al. Developing effective interuniversity partnerships and community-based research to address health disparities. Acad Med 2005;80: 1039 – 45. 4. Faridi Z, Grunbaum JA, Gray BS, et al. Communitybased participatory research: necessary next steps. Prev Chronic Dis [Serial online] 2007;4:1–5. 5. Israel B, Schulz AJ, Parker EA, et al. Community-based participatory research: policy recommendations for promoting a partnership approach in health research. Educ Health 2001;14:182–97. 6. Norris KC, Brusuelas R, Jones L, et al. Partnering with community-based organizations: an academic institution’s evolving perspective. Ethn Dis 2007;17(suppl 1):S1-27–S1-32. 7. Ahmed SM, Beck B, Maurana CA. overcoming barriers to effective community-based participatory research in US medical schools. Educ Health 2004;17:141–51. 8. Nyden P. Academic incentives for faculty participation in community-based participatory research. J Gen Intern Med 2003;18:576 – 85. 9. Adams A, Miller-Korth N, Brown D. Learning to work together: developing academic and community research partnerships. WMJ 2004;103:15–19. 10. Srinivasan S, Collman GW. Evolving partnerships in community. Environ Health Perspec 2005;113:1814 –16. 11. Wallerstein NB, Duran B. Using community-based participatory research to address health disparities. Health Promot Pract 2006;7:312–23.
277
ABSTRACT: Health disparities are common and a major focus of attention among health care researchers. The reasons for these disparities are several in number and broad in scope. Therefore, it will require a broadbased, multidisciplinary approach to fully understand and significantly reduce health disparities. Researchers with expertise in business and economics, public policy, education, language and communication, and social work will have to team with more traditional health researchers to achieve the desired goal. Our approach to this challenge was to develop a Health
D
isparities in health are well documented and a major focus of research efforts. The reasons for these disparities are several in number and broad in scope. Differences in access to health services, quality of health care, health literacy, economic and educational attainment, culture, language, and location contribute to health disparities.1 It is likely that many other unidentified contributing factors exist. Therefore, it will require a broad-based, multidisciplinary approach to fully understand and significantly reduce health disparities. Researchers with expertise in business and economics, public policy, education, language and communication, and social work will have to team with more traditional health researchers to achieve the desired goal.2,3 In this article, we describe efforts of the University of South Alabama Center for Healthy Communities EXPORT (Centers of Excellence in Partnerships for Outreach, Research and Training in Health Disparities) program to develop a multidisciplinary team of academic faculty to address issues in health disparities.
From the University of South Alabama Center for Healthy Communities, Mobile, Alabama. Submitted December 19, 2007; accepted in revised form January 23, 2008. This work was supported by NIH (NCMHD) grant no. 5R24 MD 001094-02. Correspondence: Martha Arrieta, MD, MPH, PhD, Center for Healthy Communities, University of South Alabama College of Medicine, Mastin, 5th Floor, Suite 524, 2451 Fillingim Street, Mobile, AL 36617 (E-mail: [email protected]). THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES
Disparities Research Group, a multidisciplinary group of university faculty with an interest in health disparities. University faculty from the disciplines mentioned above, plus others with varying amounts of research experience, have come together to form the group. In this article, we describe how this group was formed and some of its activities to assist in development of other such research teams across the nation. KEY INDEXING TERMS: Health disparities; Research team; Community-based participatory research. [Am J Med Sci 2008;335(4):275–277.]
Initial Efforts Our endeavors started with the awarding of an EXPORT program planning grant to the University of South Alabama Center for Healthy Communities in the fall of 2004. The focus was on addressing health disparities in Mobile, Alabama. The health disparate populations of interest were those of African American ethnicity and the economically impoverished. The overall strategy for the Center for Healthy Communities was to implement community based participatory research (CBPR) approaches.4,5 As part of this strategy, the intellectual resources at the University of South Alabama specifically, and Mobile in general, were considered an integral part of the community. We sought to develop broad-based collaborative efforts between the researchers and other community members. To achieve this goal we developed the concept of a Health Disparities Research Group (HDRG). Understanding that the success of the overall EXPORT program and the HDRG in particular would require buy-in from university leadership, we informed university deans and department heads of plans to establish the multidisciplinary research group. Following these efforts we invited the entire university faculty to discuss the concept of health disparities and the HDRG. From among those showing interest, a steering committee was established to guide the group’s activities. Spearheaded by the HDRG Steering Committee, a university-wide assembly was organized as a “kickoff” event. This 1-day health disparities assembly featured invited speakers from outside the univer275
Health Disparities Research Group
sity with considerable experience in health disparities research and the CBPR model. In addition, the university faculty members with interest, experience, and skills important for health disparities investigation were personally recruited to the event as participants and attendees. Also in attendance were the key representatives of important agencies that are partners in the fight against health disparities: the State and County Health Departments, important safety net primary healthcare providers that focus on health disparate populations, local hospitals, community advocates, and local elected officials. Ultimately, the assembly allowed for interaction among the university faculty from a variety of disciplines and introduced these potential health disparities researchers to some of their community partners. Maintenance and Expansion of Efforts One month following the assembly, the HDRG had the first of what became monthly meetings. At that meeting, the group’s general goals were presented: (1) foster the integration of university faculty into a multidisciplinary group focusing on health disparities research, with an emphasis on CBPR; (2) promote the interaction of faculty and community to advance CBPR; (3) develop and implement a plan to insure sustainability of the group at the university. Over the next several months members of the HDRG became familiar with each other’s research, education, and outreach interests. They provided valuable direction for the future of the group. Early strategies to enhance HDRG efforts included awarding of travel grants to national conferences on health disparities and CBPR. Several members took advantage of these awards and shared their experiences with the rest of the group via formal presentations at subsequent meetings. Such reports increased enthusiasm for the EXPORT program and HDRG’s goals. Another initiative to increase health disparities research efforts was the awarding of 3 pilot research funds to university faculty. Those who applied for the awards were encouraged to participate in HDRG. Those receiving the awards were required to periodically report to the HDRG on the progress of their research activities. We found that such reports fostered interesting conversation and led to the development of new ideas and collaborations. The early efforts described above were successful and resulted in at least 30 faculty being involved with HDRG at some level, with about 10 faculty members very actively concerned with further establishing the group. These core members suggested a retreat to establish a more formal mission, vision, and goals for the group, which were developed in a series of meetings culminating in a retreat (Table 1). 276
Table1. Self-Developed Vision, Mission and Goals of HDRG VISION: “To become an integral facilitator in eliminating health disparities thorough partnerships with our community” MISSION: “The Mission of the University of South Alabama Health Disparities Research Group is to foster interdisciplinary, collaborative research toward eliminating health disparities. HDRG will realize its mission through the strengthening of faculty capabilities, the garnering of resources, the provision of an intellectual forum for disparities research, the engagement of the community as a partner in its endeavors, and the establishment of an interface with policy makers” GOALS: 1. Conduct and support health disparities research. 2. Garner adequate resources for the HDRG to become selfsustaining. 3. Engage community stakeholders in the process of developing research and collaboration. 4. Strengthen faculty capabilities to conduct health disparities research. 5. Translate and disseminate research findings related to health disparities.
The result was a blueprint for the HDRG’s activities over the next 2 years. There was considerable interest in developing a joint research project among the members of the HDRG. The concept of a review of best practices to eliminate health disparities—the so called third-generation research—received considerable interest. We focused on strategies that addressed disparities in cardiovascular disease. Several members participated in the design, literature search, literature review, data analysis, and writing of this project. Representatives from the biomedical library, education, business, nursing, interdisciplinary studies, sociology, and internal medicine joined the EXPORT staff and investigators in this effort. This initiative has created tighter collaborative relationships, increased knowledge in health disparities, and increased enthusiasm for health disparities research. The strategy employed can be applied to determine the best practices to eliminate health disparities in other disease areas. Finally, several members of the HDRG have participated in the EXPORT outreach activities. They have served as speakers for community groups, participated in health fairs, and worked with youth programs. Importantly, HDRG members took leadership roles in organizing the EXPORT’s annual Regional Health Disparities Symposium. Challenges and Future Directions The biggest challenge to the HDRG is maintaining the initial enthusiasm for the project. Multiple competing priorities for faculty time constitute a major barrier and sometimes limit the ability to participate. It is not clear whether the university leadership understands and values the HDRG April 2008 Volume 335 Number 4
Arrieta et al
mission, and it may not be fully supportive of it. This represents a challenge for the faculty from those departments. Fortunately, many core members of the HDRG are in leadership or senior faculty positions, which helps meet this challenge in some areas. A second challenge related to the need to provide the HDRG faculty with a stimulating task to test the potential for collaborative work among group members. After the first several meetings, it became evident that the time for action had come as educational efforts had succeeded and were no longer seen as value added when taken in isolation. The literature review of the third-generation health disparities research in cardiovascular disease provided some of the action that this group needed. It allowed for them to use their skills in design and implementation of a study. It allowed for them to tell their respective department leaders that they were involved in projects that will have tangible outcomes such as publications and enhancement of their knowledge base for classroom educational activities. The project also allowed the HDRG members to form new collaborations outside their departments. Another major challenge was for HDRG faculty to understand and embrace CBPR as a major strategy for health disparities research.6,7 Fortunately, some HDRG faculty had experience with CBPR and were instrumental in helping the rest of the group subscribe to the concept. Finally, we were also challenged with dwindling numbers of members and the potential for participation fatigue among the core members. Candid, open dialogue among the HDRG faculty has allowed the core members to remain enthusiastic for the HDRG and its mission. We will strive to adhere to the group’s vision, mission, and goals. In doing this, we hope to create an atmosphere where attention to health disparities will be part of the cultural fabric of the University of South Alabama.8 It will be critical to develop permanent links between the faculty and the communitybased organizations to ensure full adoption and
THE AMERICAN JOURNAL OF THE MEDICAL SCIENCES
maintenance of CBPR.9 –11 The HDRG faculty will need to recruit new members and develop new initiatives that allow research collaborations. It will be critical for the HDRG faculty to promote involvement of students in health disparities-related activities and to discuss these issues in the classroom. Finally, we look forward to developing innovative, investigatorinitiated research projects from the HDRG faculty that will be “EXPORTable” frameworks to address the health disparities worldwide. References 1. Fiscella K, Williams DR. Health disparities based on socioeconomic inequities: implications for urban health care. Acad Med 2004;79:1139 – 47. 2. Olshansky E, Sacco D, Braxter B, et al. participatory action research to understand and reduce health disparities. Nurs Outlook 2005;53:121– 6. 3. Carey TS, Goldmon M, Roberson JT, et al. Developing effective interuniversity partnerships and community-based research to address health disparities. Acad Med 2005;80: 1039 – 45. 4. Faridi Z, Grunbaum JA, Gray BS, et al. Communitybased participatory research: necessary next steps. Prev Chronic Dis [Serial online] 2007;4:1–5. 5. Israel B, Schulz AJ, Parker EA, et al. Community-based participatory research: policy recommendations for promoting a partnership approach in health research. Educ Health 2001;14:182–97. 6. Norris KC, Brusuelas R, Jones L, et al. Partnering with community-based organizations: an academic institution’s evolving perspective. Ethn Dis 2007;17(suppl 1):S1-27–S1-32. 7. Ahmed SM, Beck B, Maurana CA. overcoming barriers to effective community-based participatory research in US medical schools. Educ Health 2004;17:141–51. 8. Nyden P. Academic incentives for faculty participation in community-based participatory research. J Gen Intern Med 2003;18:576 – 85. 9. Adams A, Miller-Korth N, Brown D. Learning to work together: developing academic and community research partnerships. WMJ 2004;103:15–19. 10. Srinivasan S, Collman GW. Evolving partnerships in community. Environ Health Perspec 2005;113:1814 –16. 11. Wallerstein NB, Duran B. Using community-based participatory research to address health disparities. Health Promot Pract 2006;7:312–23.
277