The Center for Healthy Communities is pleased at the news that Dr. Bobbie Holt-Ragler, a long-serving Community Health Advocate (CHA), will receive the Lillian B. Smith Award at the Annual Convention of the Alabama State Nurses Association (ASNA) in October. Named for a long serving executive director of the ASNA, the Lillian B. Smith Award recognizes association members demonstrating long-term commitment both by service in the organization and in their communities.
Dr. Holt-Ragler received her Doctorate in Nursing Practice in 2007 and served for 30 years in the University of South Alabama hospital system. She also worked as a worked as a nurse educator at Mobile Infirmary Hospital. Now retired and a CHA, Dr. Holt-Ragler uses her knowledge and expertise in helping people gain important information about disease, disease prevention, and how to access medical assistance.
The Sentinel Surveillance to Monitor Progress toward Health Equity project aims to develop and implement a surveillance system to capture the information necessary to monitor progress towards health equity for health disparate populations. One key element of this project is the engagement of community members through a Community Advisory Board (CAB). Recently, Mrs. Leevones Fisher, a community activist and member of the CAB, shared a little about her reasons for participating in the CAB and the importance of continued investment in research.
Tell us a little bit about yourself and your background.
I grew up in the Trinity Gardens community of Mobile, AL. My family of nine consisted of mom, dad, and six siblings. After attending school at Trinity Lutheran School and graduating from Trinity Gardens High School, I did undergraduate studies at Talladega College where I majored in chemistry with a minor in math. After receiving my degree, I moved to Atlanta, GA, to teach school for five years. I returned to Mobile when my mother fell ill with cancer. I started working in Alabama, married and had one son. I’ve been in Mobile ever since.
I stared the Bay Area Women Coalition (BAWC) in 1997 in response to the many problems with crime in the neighborhood. My brother had been murdered. The children of friends had been murdered. Crime in our community was bad at that time with police and service workers afraid to come into the neighborhood. As a result of the organizations advocacy and focus on improved housing, the crime rate has gone down. We’ve constructed 50 new homes and build two affordable housing subdivisions – with one made up of apartments for seniors. We’ve also renovated or repaired over 400 houses and are currently working with community gardens to improve access to healthy food.
How did you become involved with the Community Advisory Board for the Sentinel Surveillance Project?
It all started when I attended a workshop at Bishop State Community College 10 years ago. Dr. Crook and Dr. Arrieta came to the workshop to talk about health. I talked to them about health and how the university needs to be more involved with the community. The relationships shouldn’t be a one-way thing.
Why did you decide to become part of the CAB?
One reason I joined the CAB is I wanted to give my opinion on the neighborhood and what is happening as a community member. Being a apart of the group provided an opportunity to see things improve and grow; and I wanted to monitor the growth of the impact the project would have on the community.
Give us a few highlights of your time as a CAB member. Is there any one memory that stands out?
One thing that stands out is when I got the chance to go to the national conference and meet others from across the country and share during the poster session. It was an eye-opening experience to find out that so many people were interested in what we are doing.
What community needs are you most concerned about?
Health is a big concern, especially women’s health. Most of the women in our community are the heads of households and they are not in good health. When we don’t take care of ourselves, it means that we are not taking good care of our family.
How do you see the sentinel surveillance project addressing these issues in the community?
Poor housing is a big issue. But, I’ve learned that health is also one of the main issues. Poor housing and poor health go together. If people are not healthy, they don’t care about the housing part. They are just trying to get well. Health helps housing and housing helps health. The two go together. Poor health means that you can’t keep up your house.
Have you ever been involved in research before, if so how is this similar or different?
Yes has been involved in research before this project. I did a lot with with the College of Business, Dr. Semon Chang. He had us go door to door to do an assessment of the community, a housing assessment. With Dr. Ken Hudson, we tried to figure out why the housing and health issues were such a detriment in the neighborhood. Both surveys were done because we had gone out to find the information we needed to make a change on the housing issue. The impact was we learned that poor housing had an impact on health conditions. This led to trying to find out what could be done about health conditions.
What have you learned about research through this process?
It has to continue. When you start looking at one thing, you find something else that has to be addressed. We need to continue investing in research to address issues in the community with people. Housing work led to health research, and we learned that it is big and needs to be narrowed down to certain areas. There are so many issues with health, which is very different than housing. So we must continue researching to understand the issues and how they work together and how they can be addressed.
Has the experience changed the way you consider or approach research in other areas of your life?
Yes… keep researching looking at every facet from infancy to old age. Pick an age and you can research and find out so many fascinating facts about that age. Whether it is finance or spiritual needs, there is so much that can be researched. I used to think of research as trying to find a cure for cancer or something. But, it is multifaceted.
Would you encourage others people in your life to participate in or be a part of leading/shaping research projects as a result of your involvement with Sentinel Surveillance?
I would. I would like for them to be a part of it not just because they are receiving something; but, because they want to see a different in their community. We need to research how this could happen. I think of President Kennedy saying, “Ask not what your country can do for you – ask what you can do for your country.” This always resonated in my mind because most people when asked to participate in research want something in return.
Any final thoughts on research.
We need to keep the ball rolling because I don’t think the need for research will ever end.
Recently, a the United Nations Educational, Scientific, and Cultural Orgnaization (UNESCO) released the manual Training the Next Generation of Community Based researchers: A Guide for Trainers. An initiative of the UNESCO Chair in Community Based Research and Social Responsibility in Higher Education, the guide focuses on community based research (CBR) as “an approach to co-creation of knowledge based on the acknowledgement that multiple sites, modes and forms of knowledge production co-exist in society today. “
Section of the guide include:
Part 1: Understanding community based research
How can CBR help strengthen community-university engagement?
CBR vis-à-vis conventional research
Benefits of doing CBR
Part 2: Key findings of the global study on ‘Building the Next Generation of Community-Based Researchers’
(The NextGen Project)
Recommendations and suggestions
Part 3: Pedagogical framework for training of next generation community based researchers
An orientation towards research ethics and values
Development of a deep understanding of power and partnerships
Incorporation of multiple modes of inquiry
Participation in learning CBR and ensuring a balance between classroom (theory) and field (practice)
During the 2015-2016 academic year, several faculty members at Virginia Commonwealth University worked together in a Faculty Learning Community to explore using web-based platforms to disseminate research findings. The result is an online guide on research dissemination.
Addressing health disparities requires a broad understanding of the underlying causes as well as approaches to increasing health equity. Such understanding grows through the development of relationships and partnerships around specific issues and approaches. Community-Based Participatory Research (CBPR) offers opportunities for equitable relationships between community members and academic researchers to identify areas of research and intervention development. During its 10-year history, the Center for Healthy Communities’ Health Disparities Research Group (HDRG) has developed a track record of nurturing partnerships with community organizations, undertaking CBPR projects, and promoting the CBPR practice throughout the university.
Membership in HDRG is open to faculty, staff and students throughout the university community. Its multidisciplinary character is broad-based with members from seven colleges within the university and incorporating the disciplines of Public Health, Medicine, Nursing, Allied Health, Psychology, Sociology, Social Work, Political Science, Education, Business, Engineering, and Library Science. The richness of the collaboration growing from such interaction across disciplines can be seen in the research projects that have been undertaken by group members over the years. Informed by the values of CBPR, these projects not only include academic researchers from across disciplines but also community organizations such as a local health center based in a low income community, churches, and a local advocacy group.
One example of community engagement is HDRGs continuing relationship with the Bay Area Women’s Coalition, Inc. (BAWC). The partnership first developed around BAWC’s need to gather neighborhood health information as part of substantiating the need for a clinic in the Trinity Gardens community of Mobile County. Through the partnership, HDRG members and BAWC leadership worked together to develop and field a health status and access to care survey among neighborhood residents. As a part of the partnership, HDRG members assisted BAWC leadership and volunteers with training on research methodology, working with human subjects, and basic computing, and data analysis. The collaboration continues as BAWC leadership are included in new project proposals and research design processes.
With the experiences and capacities developed through conducting CBPR based research projects, HDRG has established a reputation for expertise and leadership in this area. The group is now focused on a CBPR dissemination plan to establish CBPR as a model for research at the Local, State and Regional levels.
HDRG Meetings are held every third Friday throughout the academic year. Individuals interested in attending should contact Shannon Shelley-Tremblay.
The reduction of health inequities in minorities and economically deprived groups is an overarching societal goal. To that end, theResearch Core, a division of the USA Center for Healthy Communities, seeks to expand the capacity and competence of the CHC’s Center of Excellence as a leader in research and dissemination of outcomes that address minority health and health disparities. Key to the Research Core’s strategy is its focus on building collaborative relationships for further implementation of Community-Based Participatory Research (CBPR).
The Research CORE sponsors the Health Disparities Research Group (HDRG) as a multidisciplinary assembly of faculty, students, and staff with a vision “to become an integral facilitator in eliminating health disparities through partnerships with the community.” Currently, the HDRG is embarked in a CBPR dissemination effort to consolidate and expand CBPR efforts at the university and the community. It works to:
Educate interested faculty and community organizations on CBPR
Bring awareness to ongoing CBPR efforts
Disseminate this type of research at local, state and regional levels
As a part of the Center for Excellence Funding from the National Institutes of Health, the Research Core also supports three major research projects:
Project 3: Heat Shock Protein 27 (HSP27) as a Marker of Atherosclerosis (PI: Dr. Bill Gerthoffer) addresses the lack of accurate predictive biomarkers of plaque instability, particularly in health disparate populations. This is a translational research project done in collaboration with the Division of Cardiology, which hopes to establish a method to identify those at risk for heart disease at an earlier point than currently available. If successful, interventions may be started to prevent heart disease rather than having to treat heart disease after its development.
Each of these projects will be explored further in future editions of this newsletter.
People don’t exist as isolated entities, and social programs, movements, or data analytic methods that assume they do are not aligned with reality—and may be doomed to fail. We all know that providing therapy or tutoring to a child may be less effective than hoped if the child’s parents, peers, school, and neighborhood are not also operating in a way that’s conducive to the child’s growth and well-being. Yet too often, we pass social policies or create interventions that are targeted only at the individual level. In a culture that overemphasizes the individual, community research draws on truths that are frequently ignored.
Community Psychology is probably one of the more complex fields in the social sciences because it embraces multiple levels of influence rather than simple individual differences. We are not always aware of the potent effects of an individual’s context, and there is evidence that the environment can have profound effects even on things that have been considered genetically derived. Before Community Psychology really began to form cohesive ideas around contextual impacts, sociologists were attempting to develop theories and methods that capture social contexts. Their Sociology-of-Knowledge theories are illustrative and have been used to understand people’s perceptions of reality, social change, and the role of social institutions. Present-day community researchers are not only interested in understanding the different levels of influence, but also in understanding the interplay between these levels, and working with community members to use this knowledge to build stronger communities.
Our methods of analysis reflect a focus on a systems point of view — on complex transactional systems in particular. For example, dynamic social network analyses are now being used to model how social relationships affect long-term sobriety in Oxford Houses, which are a national network of self-help operated sober living residential settings. In DePaul’s 25 year collaborative relationship with Oxford House, many of the topics studied were initially raised by members of the self-help organization, such as the social dynamics within houses and the best predictor for long-term recovery. Previous studies performed in partnership with this community based organization have incorporated a wide range of quantitative, qualitative, and mixed methods.
The integration of community members in the research and design process has led to deep understanding of the unique cultural context of the communities in which they’re implemented, which can be furthered by the use of qualitative or mixed methods. Participatory practices and methodological pluralism are requirements for community researchers, as we understand that statistics and stories both provide valuable information. A more diverse toolbox makes us better equipped to address a wide range of issues in varied and changing contexts.
The discussion highlighted the research training experienced by the Research Apprentices who are members of the community who have a wide variety of backgrounds and interests, but no prior formal education in the research process. Additionally, the group provided an overview of the Sentinel Surveillance Project and why the inclusion of community members as a part of the research team is integral to meeting the goals of and adhering to the values of community-based participatory research. Structured in an interview format, the team described recruitment and training of research apprentices, the work done in collecting, managing, and analyzing data gathered from the community.
While describing their participation in the research team, the various research apprentices discussed both what they had brought to the research project and what they had learned. Sherron Dortch, a senior research apprentice, stated that her attention to detail and strong organizational skills allowed her to focus on quality data management while at the same time providing her with the opportunity to develop computer skills. At the same time, Sherron shared that through this research project she developed a deeper awareness and understanding of the health disparities that exist in a neighborhood and community where many of her friends and relatives live. This sentiment was echoed by Valerie Grimes and Carla Taylor who also work as Research Apprentices.
Marcellus Hudson, currently a Research Technician II with the Research Core, described his journey from Research Apprentice to a full-time staff member at the University. He talked about the many ways the experience provided avenues to foster his interest in computer programming and further enhanced his desire to learn and pursue his education. Marcellus also talked about the importance of uncovering the health situation in the community where he and many of his relatives live.
From the article by Marshall Terrill from Arizona State University:
…[Barber Marvin] Davis is the manager of Ageez Hair Center in Chandler and is one of a handful Phoenix-area barbers who sit on the steering committee of the African American Cardiovascular Disease Health Literacy Demonstration Project . The project puts an emphasis on prevention and health literacy through culturally grounded community efforts for African-American men in the greater Phoenix area. Participating barbershops and hair centers are supplied with blood-pressure monitors — and training — to give readings to their customers.
“Barbers hold a unique and esteemed place in the African-American community,” said Dr. Olga Idriss Davis, who is principal investigator for the project and for community engagement at the Southwest Interdisciplinary Research Center (SIRC).
“The culture of the black barbershop is a folk tradition, a gathering place in the male community, a site where knowledge can be traded, disputes resolved and wisdom transferred from generation to generation. It’s a wonderful microcosm of society.
“Barbers are looked upon as leaders in the African-American community. Clients often tell their barbers intimate things, sometimes things they would never tell their partners and family members.”
Dr. Davis, who started the project in 2013, admits it took her a while to earn the trust of the barbershops and the surrounding communities in which they serve.
“Researchers employed by institutions of higher learning have not had the best interactions with African-American and Native American communities. Historically, they smile at the door, gather data and leave without any follow-up that supports the community,” Dr. Davis said.
Dr. Davis said even though she’s African-American, it didn’t entitle her to a free pass or easy entree into the community. That trust had to be earned over a long period of time.
“Early in my research and fieldwork there was a woman from the community who frequented a barbershop, and all of the barbers were her ‘babies.’ She walked into the shop one day, and asked the barbers, ‘Who is this chick on my turf?’ ” Dr. Davis said. “She then got an inch away from my face and said, ‘I wanna talk to you. You’re one of them and you’re here to take our stories. You’re part of the establishment.’ ”
Dr. Davis calmly explained to her that nearly 50 million men in the U.S. have high blood pressure, 40 percent of whom are African-Americans. She added that African-American males are particularly at risk because they are often unaware of the disease, do not receive treatment and rarely adhere to a treatment regimen if one is prescribed. That had to change, Dr. Davis said.
She then explained a vision: transforming barbershops into a health-care space where barbers become “community health advocates.” Dr. Davis said it was a moment where she could see the woman’s defiance morph into understanding.
“I told her, ‘I want this to have a ripple effect throughout the entire African-American population, not just in this community … but I’m going to need your help, too,’ ” Dr. Davis said. “She finally got it and smiled, then said, ‘You all right, sister.’ I said, ‘You’re all right, too, sister.’ We’ve been good ever since.”
So has the program, which had made serious headway in the African-American communities in Chandler and south Phoenix. Barbers are casually talking to their clients about their health and discreetly taking blood-pressure readings.