Community-Based Participatory Research

Community-based participatory research (CBPR) is a collaborative approach to developing replicable models for understanding health and disease determinants, and supporting mechanisms for promoting healthier lives for individuals, families, neighborhoods, and communities. Using CBPR principles, the Community Medicine Unit has developed collaborative relationships based on trust for better understanding the true causes of disease and developing means for eliminating disease causality in communities of need. Examples of this research are:

Homelessness: Union Gospel Mission, Center of Hope Shelter for Women and Children (2009-Present)

The Center of Hope (COH) provides shelter for approximately 1,800 women and children each year. About 30 percent of those sheltered are children under the age of 12. The typical length of stay is less than 90 days, while about 15-20 percent of the women join a long-term rehabilitation program that can extend their stay up to two years. The COH operates a small clinic that addresses acute illnesses for all of the residents. Children receive special attention through well child exams and vaccinations so that they may attend the day care located within the shelter. The most common problems encountered in this clinic are diabetes, hypertension, and infectious diseases.

Medical students and Family Medicine residents have the opportunity to experience health care in a homeless shelter for women and children, assist in locating resources for a homeless population, provide health promotion and disease prevention that addresses the needs of a homeless population, and connect homeless women and children to a medical home. Two projects conducted by students at the Center of Hope include: 1) Vaccinations for homeless and high-risk children via the Center of Hope and 2) a needs assessment.

Assessing the Needs of Women and Their Children at a Homeless Shelter in Dallas, TX (2010)

The purpose of this study is to identify the health needs of women living in a homeless shelter to develop novel health care services to address these needs in a cost-effective manner. Participants will complete a comprehensive needs assessment, including their sociodemographics, overall health, medical conditions, preventive screening practices, length of stay at the shelter, number of children, and reason for shelter stay. Questionnaires will be administered face-to-face by trained personnel. We expect to find low health screening utilization prior to attending the shelter. A majority of women will have untreated chronic diseases due to lack of access, mistrust of health care providers, and low health literacy. Depression and a history of physical domestic violence will be prevalent. We expect that expressed needs will differ based on age, severity and type of medical condition, parenthood, and perceptions of personal health care needs.

The results of our study will contribute to the research literature as a comprehensive needs assessment of women and their children in an urban setting. Results will be used to develop cost-effective intervention programs to better address homeless women’s needs, and these interventions can be replicated in other homeless shelters for women and their children.

Student Investigator: Tammy Lightfoot, M.P.H. Candidate
Principal Investigator: Patti Pagels, M.P.A.S., PA-C
Contact: Tiffany Billmeier, M.P.H.

Geriatric Education: Health Promotion and Disease Prevention for Community-Based Seniors: Teaching Patient Education Skills to Medical Students and Residents (2010-2011)

The goals of this project are: to enhance the current geriatric curriculum for medical students and family medicine residents; to teach chronic disease prevention and wellness skills; to increase health literacy; and to enhance quality of life among an underserved geriatric community based on needs previously identified. The increasing aging population, prevalence of chronic disease, and risk for limited health literacy among this group emphasizes the importance for future physicians to be adequately trained in geriatrics. Although current medical students and residents receive geriatric education in a clinical setting, they lack the skills necessary to promote wellness and prevent chronic disease complications among the aging population in a community-based environment.

In order to enhance our current geriatric curriculum, we will design, pilot, implement, and evaluate a community-based health promotion and disease prevention curriculum to advance geriatric training for medical students and Family Medicine residents. We will also develop an online "toolbox” consisting of a series of healthy aging modules for local and/or national use. Community member and learner outcomes will be assessed based on Kirkpatrick’s Four Levels of Evaluation, health literacy level, and quality of life as determined by the EQ-5D. We will examine learners’ reactions to curriculum, change in attitudes, knowledge and skills toward geriatric education and community engagement, change in residents’ behavior, and change in clinical practice benefits to patients and the community.

Principal Investigator: Nora Gimpel, M.D.
Co-Investigator: Patti Pagels, M.P.A.S., PA-C
Contact: Tiffany Billmeier, M.P.H.

Health Literacy: Assessing Health Literacy Levels in Family Medicine Clinics (2009)

The purpose of this study was to evaluate the health literacy levels of adult patients visiting two family medicine clinics in Dallas, Texas, and to determine the association between health literacy level, health information access, diagnosis of diabetes, and sociodemographic (SES) characteristics.

In this cross-sectional study, we surveyed 498 patients in the waiting room from the Parkland Family Medicine Clinic (clinic 1) and the UT Southwestern Family Medicine clinic (clinic 2). Participants clinics completed: (1) a health information questionnaire addressing sociodemographic characteristics, internet access, and utilization for health information and (2) the “Newest Vital Sign,” a validated tool (English and Spanish) assessing health literacy. In clinic 1, the majority of participants were Hispanic (64%), low income (less than $19,000 annually), and reported lower education (< high school), whereas participants in clinic 2 were predominately black (44%) and white (42%) with higher education and income. The majority of the patients in clinic 2 had an adequate health literacy level  (72%) and in clinic 1, a high likelihood of limited health literacy (46%).

After adjusting for potential confounders, patients who were black, older, or had low income had lower health literacy levels. Understanding health literacy with the Newest Vital Sign will help health care professionals increase quality of care. Health care providers need to be more perceptive regarding health literacy, especially in the underserved population with diabetes. This knowledge can help providers and the medical system they interact with tailor their patient education appropriately based on the individual’s health literacy level.

Co-Investigators: Tiffany Billmeier, M.P.H.; Patti Pagels, M.P.A.S., PA-C; Nora Gimpel, M.D.
Contact: Tiffany Billmeier, M.P.H.

GoodNEWS (Genes, Nutrition, Exercise, Wellness and Spiritual Growth) (2007–2012)

Physicians and other health care providers are being called upon to treat and manage epidemic levels of chronic disease. Chronic diseases currently account for the majority of deaths each year and for about 75 percent of the nations medical care costs. Chronic disease prevalence is an especially significant problem among low-income individuals and ethnic minorities who suffer a disproportionate share of the chronic disease burden.

There is overwhelming evidence that the disorders and enormous direct and indirect costs associated with chronic illnesses are in large part preventable. Modifiable disease risk factors based on lifestyle and behavior, for example, account for about 50 percent of health outcomes and significantly affect rates of death from lung cancer, colon cancer, cirrhosis, coronary heart disease, chronic obstructive pulmonary disease, diabetes mellitus, and injuries resulting from risky behavior. However, the present health care delivery system devotes 95 percent of its resources to treating heart disease, hypertension, diabetes and obesity, and only 5 percent to preventing them.

The GoodNEWS program provides education, motivation, and opportunity for adopting and practicing more healthful lifestyle practices, and is based on a community medicine approach. Community medicine exists at the intersection of clinical medicine, public health, and social science, and is dedicated to preventing and reducing the disproportionate burden of disease affecting society's most vulnerable communities.

The program's goal is to improve quality of life for participants and reduce the burden of chronic disease in congregations and the surrounding community. Its objectives are to: 1) improve individuals' knowledge, attitudes, and behaviors in six dimensions of health (physical, mental, intellectual, spiritual, social, and environmental); 2) modify disease risk factors and decrease disease prevalence through promoting healthful lifestyle practices; and 3) increase the capacity of communities to support community-based health promotion and disease prevention activities.

During the past three years, the Division of Community Medicine has collaborated with numerous community partners and congregations throughout the Dallas-Fort Worth Metroplex to develop a GoodNEWS Community of Churches. Lay Health Promoters (LHPs) in participating congregations receive education and training from the GoodNEWS project team in healthful living principles and chronic disease management, and learn how to access community-based health resources. Preliminary data analysis indicates that the program is effective in stimulating the lifestyle changes that can reduce chronic disease prevalence and health disparities in underserved communities.

Principal Investigator: Mark DeHaven, Ph.D.
Co-Investigator & Contact: Nora Gimpel, M.D.

Childhood Obesity Project (2004)

This project identifies perceptions and behaviors related to childhood obesity and overweight children among students, caregivers, and teachers. The purpose of this pilot study is to describe the knowledge, attitudes, and behaviors of students, caregivers, and teachers regarding the eating habits and physical activity patterns of children that may be contributing to obesity. This pilot project is gathering qualitative data from third-grade students, parents/caregivers, and teachers in the Dallas Independent School District (DISD) through focus groups, as well as an online teacher questionnaire for third-grade teachers. The pilot study findings will be used to design a comprehensive school-based intervention for reducing and preventing childhood obesity.

Principal Investigator: Nora Gimpel, M.D.
Contact: Nora Gimpel, M.D.

Social Networks: Community Connections and the Flow of Health Information (2003)

Improving effective health information outreach in a community requires a needs assessment that captures the multidimensional factors influencing the flow of health information. The purpose of the project is to identify and document how health information is disseminated within the larger social network of the community by using a scientific technique known as Social Network Analysis (SNA), which maps individual relationships and information flow. Adult participants receiving services from the Central Dallas Ministries (CDM) Food Pantry are interviewed to obtain both qualitative and quantitative data for analysis. The study is funded by the Network of Libraries of Medicine South Central Region.

Co-Investigators: Nora Gimpel, M.D.; Alice Marcee, D.V.M., M.S.
Contact: Nora Gimpel, M.D.