Building the capacity of early-stage investigators to conduct community-engaged health disparities research

Abstract

This paper describes an NIH funded Pilot Awards Program in Cleveland, Ohio, focused on developing the capacity of new and early-stage academic investigators to conduct community-engaged research. After a competitive application process, the program selected 18 early-stage investigators (post-doctoral fellows and junior faculty) who had partnered with at least one community organization to conduct pilot health disparities research projects, awarding up to $50,000 per project for one year. The program’s development, project selection, and findings from survey and focus group data collected from the first two cohorts of awardees are discussed. Lessons learned and the implications of the importance of investing in a supportive infrastructure to enhance early-stage investigators’ involvement in community-engaged research to ultimately affect health disparities are also discussed.

1. Introduction

Health and health care disparities have been widely documented among underrepresented racial and ethnic groups and other vulnerable populations across a broad range of disease outcomes (Office of Disease Prevention and Health Promotion, 2030). Community-engaged research (CEnR) is increasingly understood as essential to developing effective interventions for addressing health disparities. Conducting CEnR effectively, however, requires researchers to have fundamental skills and values such as the commitment to be an equitable partner and to create sustainable changes (Nguyen et al., 2021). While medical schools and healthcare institutions have been implementing curricula in cultural competence and community engagement, few programs offer research training for addressing health disparities. Those that do offer such training tend to have a single clinical focus, such as cardiovascular disease or cancer (Johnson et al., 2018). Building an evidence base for CEnR addressing health disparities more broadly requires investigators who are specifically trained, not only in traditional research skills, but also in recognizing communities’ expertise. Researchers must have the awareness, knowledge, and skills to study health disparities with affected communities (Johnson et al., 2018). While early training is necessary to support traditionally trained researchers in cultivating strong, long-term community-partnered research committed to eliminating health disparities (Heerman et al., 2018), ESIs face several challenges as they seek research funding.

The current hypercompetitive funding environment (particularly at the federal level), in which researchers compete for limited resources, has meant talented researchers at all levels struggle to succeed and remain in science, but such a funding environment is especially challenging for new- and mid-career investigators (Lauer, 2018; National Institutes of Health, 2017a). NIH funding trends indicate that between 2009 and 2016, NIH increased its number of awards, however the increase primarily benefited experienced investigators, while new and early-stage investigators (referred to here as ESIs), especially if they were “women, underrepresented racial minority, and Hispanic researchers” were much less likely to be funded (Lauer, 2018, para. 4; Nikaj et al., 2018). Because NIH funding is highly valued by academic researchers, it is important to determine strategies to increase ESI funding rates.

Most training programs for academically trained health equity researchers seek to increase knowledge; fewer programs emphasize skill development or attitude change (Cooper, 2018). However, the skills and attitudes researchers bring to their work affect their ability to interact effectively with participants from diverse communities, disciplines, and sectors of society. Previous research indicates training programs should allow early-stage investigators to share their experiences, learn from one another, and build a network of similar colleagues (Collins et al., 2025; Cooper, 2018). They may also need significant mentoring, both formal (e.g., how to: develop effective proposals, research partnerships, develop study aims, meet institutional review board and funders requirements) and informal (e.g., encouragement, support, networking) (Cooper, 2018; Ransdell et al., 2021). Research has found that even a virtual community that provides social support, accountability, constructive feedback, and access to peer networks can help investigators overcome barriers to submitting competitive grants (Hall et al., 2018). Beyond having support, to close the health disparities research evidence gap, researchers must have skills to develop sustainable interventions and disseminate and translate their research to communities (Cooper, 2018).

How do we best develop ESIs’ skills? An integrative review covering 46 articles over 10 years of research found both that ESIs and UF face individual and institutional barriers and facilitators to obtaining research funding, with institutional barriers being most common (Ransdell et al., 2021). All three investigator types experienced individual barriers including lacking time and finding work-life balance. UFs’ most frequent individual barriers included bias, discrimination, and isolation. All three investigator types experienced institutional barriers including a lack of mentors (especially those who matched mentees in areas of expertise, diversity, or mentors skilled in addressing their mentee’s research deficits) and lack of access to resources (e.g., research assistance and networks). UF also experienced institutional-level bias, devaluation of their academic degree(s), experience, and/or expertise. The most frequent facilitators of research success among all investigator types included technical skills (e.g., writing manuscripts and grants), analytical skills, and interpersonal skills (e.g., the ability to find productive collaborators and network). Common institutional facilitators included access to expertise and mentoring, professional development opportunities, science culture, proportion of workload assigned to research, and funding. These findings indicate the breadth of skills needed to be a successfully funded researcher without considering the necessary skills for working with community.

While many ESIs (especially those with Ph.Ds.) often have completed extensive research training in graduate school, they have not always been mentored on how to write grants, create budgets, and/or carry out an independent research project. Because completing a pilot project lays the foundation for further funding and signals to funders that an investigator is a capable researcher, it is important to support ESIs in establishing themselves as competent researchers. Such support may improve the likelihood of ESIs’ pilot projects being successful and leading to larger projects and long-term collaborations which could not only enhance their careers but also improve community health. Unfortunately, organic mentors tend to be in short supply; senior academic researchers are often too busy and simply do not have time to mentor ESIs as intensively as they might need, and/or may not be knowledgeable about effectively partnering with communities. The logistical knowledge and time commitment CEnR and partnership development require are often too extensive for senior researchers to commit to.

1.1. Program context

The Center for Health Equity Engagement Education and Research (CHEEER), a joint effort of the MetroHealth Medical Center System and Case Western Reserve University (CWRU) in Cleveland, Ohio, works to reduce health disparities through research and educating students, healthcare providers, and policymakers. It also partners with community organizations and government agencies to create durable academic-community partnerships to achieve measurable reductions in health disparities in the Greater Cleveland area; promote successful intervention strategies that can be replicated; and train a new generation of researchers and activists committed to eliminating health disparities. This study focuses on the last of these initiatives. Seeking to fill literature gaps on best practices in supporting ESIs to successfully obtain NIH grant funding, the study describes the development and implementation of the Pilot Awards Program, an innovative community-academic partnership aimed at building ESIs’ capacity to conduct CEnR on health disparities with communities.

2. Methods

2.1. Program background

The Pilot Awards Program grew from a five-year NIH funded CHEEER program which trained community-based non-profit professionals to increase their organization’s research and evaluation capacity, the Community Research Scholars Initiative (CRSI; Collins et al., 2023; Theurer et al., 2015). CRSI Scholars’ positive experiences led them to create a Community-Based Research Network (CBRN), a structured monthly meeting space where academic researchers and community organizations interested in research meet, network, and learn from one another. As of this writing, nearly 10 years after CRSI’s end, the Scholars remain engaged with the CBRN, have expanded their research networks, and actively partner with new academic investigators and community agencies on research and evaluation projects. The CBRN is a sustainable and equitable bidirectional partnership in which academics, community partners, CRSI Scholars and other representatives from their organizations, and CHEEER staff regularly engage, and has become a model of community-academic partnership in the community. The Pilot Awards Program evolved from CRSI, focusing on fostering academic/community partnerships.

2.2. Program design

The Pilot Awards Program was an initiative of CHEEER’s U54 award (National Institutes of Health (NIH), 2017b) which focused on building ESIs’ capacity to engage in community partnerships to conduct health disparities research and best practices for supporting them in doing so. ESIs held doctoral (Ph.D. or M.D.) degrees and had a CWRU appointment no higher than assistant professor. Post-doctoral fellows, junior faculty, and other ESIs underrepresented in science were eligible. The program defined “research” broadly to include not only hypothesis-driven scientific investigation, but also needs assessment, quality improvement, and program evaluation to maximize studies’ usefulness to communities, not just academics, and had greater potential to decrease community health disparities. Applicants were required to equitably partner with a community organization and demonstrate they valued their partner’s expertise on the community and the clients they serve. The program expected participating pilot awardees and community partners to be equal partners in their efforts to maximize their projects’ impacts and assumed that combining partners’ strengths would “accomplish more together than could be accomplished alone” (Coombe et al., 2020, p. 435; National Academies of Sciences, Engineering, and Medicine, 2016). The program was designed to support one-year community-engaged pilot health disparities-focused research, awarding up to $50,000 in direct costs. Applicants could allocate up to 10 % of the budget in ESI salary support, but also had to demonstrate appropriate financial support for the community organization.

A logic model (see Fig. 1) provided scaffolding for the program. The program planned to leverage its resources, including the NIH funding, institutional resources and supports available through CWRU and MetroHealth, and extensive network of community connections built over more than 10 years of outreach and projects (of which the CBRN and CRSI are two examples). Strategies included formal and informal support in the form of mentoring, CHEEER’s Research Consult Service, existing and new community partnerships, and the CBRN, which provided ongoing support throughout the program. Expected outputs included completed projects, CBRN attendance, connection with organizational support, and partner organizations’ collaboration.

Fig. 1.

Program logic model.

The request for applications (RFA) was distributed via various channels at CWRU, including community outreach, emails, and newsletters. Hoping to elicit a broad range of applications and interest areas, the program announcement was sent to CWRU-affiliated hospitals, schools, and departments with health disparity research interests (social work, medicine, dentistry, nursing, epidemiology, etc.). To maximize the diversity of the applicant pool, the program staff reached out specifically to organizations that serve UF, including the offices of Diversity, Equity, and Inclusion at CWRU and MetroHealth, the Black Nurses Council, and made brief presentations about the program whenever possible at organizations’ meetings. A frequently asked questions document and a technical assistance session (a presentation followed by a question-and-answer session) and individualized research consultation services for potential applicants were included in the outreach efforts.

2.3. Support for applicants

The RFA and all program advertising and outreach strongly encouraged all applicants to request a consultation with CHEEER’s Research Consult Service, a core service that provides no-cost research consultations to faculty, health providers, students, and community organizations (see Pelfrey et al., 2017). For Pilot Award Program applicants, it offered individualized advice on research methods, partnership development, and budget considerations. The Research Consult Service’s consultants included three staff members (who handled administration, logistics, community engagement, and networking) and two CHEEER faculty members based at MetroHealth Medical Center who had diverse academic, medical, research, and cultural backgrounds and expertise in health disparities, hard-to-reach populations, clinical medicine, needs assessment, study design, recruitment methods, community-based research, complex surveys, psychometrics, focus groups, institutional review boards, quality improvement, participatory research, lay health interventions, program evaluation, electronic health records, Health Insurance Portability and Accountability Act (HIPAA)-compliant data management, statistical analysis, grant writing, and dissemination methods. Community members are not currently consultants for the Research Consult Service; however, this is a potential growth area.

Pilot Award Program applicants requesting a consultation completed an online form describing themselves and their organizations, research questions, and the assistance they sought. This information helped CHEEER faculty and staff prepare for the consultation. After an hour-long meeting with the applicant, the consultation team prepared a written summary of the meeting which they distributed to all attendees, including contact information, additional resources and expertise, and next steps. Between follow-up emails, document reviews, and providing resources, the consultation team provided 2–4 additional hours of consultation to each applicant.

2.4. Application survey, submission, and evaluation

Program applicants completed a survey as part of the application process. The questions asked applicants to indicate whether they had used CHEEER’s support services (e.g., consultation) and resources, and to evaluate the services’ usefulness. Usefulness was evaluated using a Likert type scale (1 = Not at All Useful; 5 = Extremely Useful). Applicants also offered open-ended suggestions about how the application process should change.

Applicants submitted their completed applications through an online portal. A study section, mirroring NIH proposal evaluation processes, consisting of faculty and community members with expertise in health disparities and community engagement reviewed each application. The study section was composed of approximately 19 faculty reviewers that remained the same over the five cohorts. Between one and three faculty reviewers changed from year to year depending on their availability and/or the need for expertise that matched an application. Eight community reviewers from community organizations (affiliated with the CRSI) were asked to review applications based on the match between the applicant’s research area and their area of expertise. Community reviewers received $100 per review ($50 for the review and $50 to attend the study section meeting).

Following the NIH study section model, three reviewers were assigned to each application (two faculty reviewers and one community reviewer). The study section employed discussion templates, based on both Patient-Centered Outcomes Research Institute (PCORI) and NIH reviewer guidelines. Each project’s evaluation form described the project and reminded reviewers that the applications were expected to leverage the experience and understanding of the community in identifying root causes of health disparities that adversely affect health. Project feasibility and possibility of future success were emphasized more than statistical power and sample size. Reviewers scored five categories (overall rating; significance of the research; feasibility; likelihood of future success) using a 1–9 scale (1 = “essentially no weaknesses” and 9 = “essentially no strengths and many major weaknesses”) and commented on specific strengths and weaknesses (see Table 1). CHEEER staff sent each applicant their critiques.

Table 1.

Study section scoring questions.

Scoring Category	Questions
Overall Proposal Rating	(1) Does the application identify a health disparity that is being addressed? (2) Does the application have a community-based organization identified to partner with? (3) Would research findings from the study have the potential to fill these evidence gaps?
Significance of the Proposed Research	(1) Does the application describe a clear conceptual framework anchored in background literature which informs the design, key variables, and relationship between interventions and outcomes being tested? (2) Does the research plan describe how the community will be involved? Is the overall study design justified? (3) Are the patient population and study setting appropriate for the proposed research question?
Project Feasibility	(1) Is the study plan feasible? Is the project timeline realistic for the proposed year long duration of the grant? (2) Is the study design (e.g., cluster randomized design, randomized controlled trial, or observational study) accounted for?
Likelihood of Future Success	(1) Does this project show a clear path to larger grant submissions? Are specific funding mechanisms mentioned? (2) Does this project have promise for publication? (3) Would this grant lead to any other career advancements for the early-stage investigator? (4) Does project mention future plans and/or sustainable relationship with community partner?

CHEEER staff sent NIH the study section’s top five highest scoring applications. NIH reviewed each application and made the final decision on each award, awarding funding to 3–5 of the submitted applications per year. NIH program officers gave applicants additional feedback on their applications and commented on additional information that was needed, and/or requested changes. CHEEER staff offered awardees assistance with making the requested changes.

2.5. Supporting awardees: the community based research network (CBRN)

To support awardees to successfully complete their projects, the program provided administrative support on an ad hoc basis both pre- and post-award. Budgets were an area in which much assistance was provided. Pre-award, program staff helped applicants determine their budget needs, and post-award, day-to-day budget management, including identifying local vendors, hiring research assistants, and general grants administration. The program also assisted awardees with community partner subcontracts, MOUs, and institutional review board applications. In short, the program staff’s support was tailored to the individual needs of each awardee on a day-to-day basis.

Pilot awardees automatically became members of the CBRN as a way to provide support, resources, and decrease the sense of isolation that can accompany applying for grants. Pilot Award Program awardees had specific roles in CBRN meetings during their cohort year and their attendance at the meeting was mandatory. The awardees presented both formally about their projects, with their community partners, and informally at the monthly meeting (held since March 2020 on Zoom²), updating the group on their progress. Discussions have included strategies for participant recruitment (especially during COVID), tackling project barriers, identifying additional community partners, partnership sustainability, dissemination, and future funding opportunities. Former CRSI scholars serve as community mentors and assist awardees in addressing community-related challenges.

Beyond the CBRN, pilot awardees have also been incorporated into other CHEEER programs, presenting at health disparities seminars, interacting with visiting speakers, contributing to a transdisciplinary health disparities course, and participating in community dissemination forums.

2.6. Focus group: awardees’ program perspectives

2.6.1. Participants and procedures

Five awardees from the first two cohorts who had completed data collection and were either currently analyzing data or had completed analyses were invited to participate in a focus group. A focus group was ideal because the participants knew each other and could reflect on their experiences as a group. All data collection materials and protocols were approved by a university-based institutional review board. Before the focus group, the participants completed informed consent documents and confidentiality was assured to the extent possible (recognizing confidentiality in focus groups depends on its members keeping the information confidential). An external evaluator facilitated the focus group on Zoom in April 2020. The focus group lasted about one hour, was recorded using an MP3 recorder and transcribed by a professional transcriptionist.

The focus group questions explored participants’ experiences with their projects, partners, program staff, and CBRN meetings. They were asked for suggestions for improving the program, including topics they thought should be covered at CBRN meetings.

2.6.2. Analysis and establishing trustworthiness of qualitative data

The external evaluator coded the data, analyzing the focus group transcript line-by-line to identify portions of the transcript that addressed participants’ experiences with the program, especially ways the awardees felt the program could be improved. The evaluator used Microsoft Word to highlight significant excerpts, organize the excerpts, apply codes, and share her interpretations of the data with the larger project team (five CHEEER faculty and staff). The evaluator and coders met over Zoom to discuss the themes the data suggested.

Trustworthiness was established using techniques to ensure credibility, transferability, and dependability (Patton, 2015). First, the evaluator worked with CHEEER programs for more than 10 years and had a deep knowledge of the context in which the Pilot Awards Program was developed. To establish credibility, we used multiple data sources and analysts (in selecting the final themes), including the original program proposal, other program documents (e.g., scoring sheets, comments), survey data, and focus group transcripts. We enhanced transferability by purposively selecting the most knowledge-rich participants to offer reflections in the focus group. We established dependability by using clear, consistent procedures and peer debriefing (having the project team review the interpretations).

3. Results

3.1. Application survey findings

Table 2 displays the findings from the application survey. About two-thirds of applicants reported having worked with community organizations in the past. Just under two-thirds had worked in a practice relationship (e.g., as a clinical, student, volunteer); more than half had previously partnered in research; and a little more than one-quarter had conducted research at organizations. Of those who had worked with organizations previously, they reported working with organizations once or twice, and did so over an average of about five years. About 36 % had worked with organizations five or more times.

Table 2.

Application survey findings.

Item	N = 42
Have you worked with community organizations in the past? % Yes	67.0 %
Research partner	57.1 %
Conducted research	28.6 %
Practice (clinical, student, volunteer, etc.)	64.3 %
If yes, # times you worked with organizations
1–2 times	43.0 %
3–4 times	21.4 %
5–6 times	17.9 %
7 + times	17.9 %
Over how many years? M(SD), Median	5.43 (4.9), 4.0
Relationship with community partner
I selected the community partner specifically for the purpose of this funding opportunity (% Yes)	52 %
I had worked with this organization previously (% Yes)	31 %
I have a longstanding relationship with this organization (% Yes)	29 %
If not selected, likelihood of working with community organization
Extremely likely	40.4 %
Very likely	38.1 %
Somewhat likely	11.9 %
Not very likely	4.8 %
Not at all likely	0 %
Neither likely nor unlikely	2.4 %
Community partner was actively involved in developing study idea
Extremely	48.0 %
Somewhat	35.7 %
Little/Not at All	11.9 %
Community partner was actively involved developing study design
Extremely	38.0 %
Somewhat	33.3 %
Little/Not at All	16.7 %
Community partner was actively involved in developing methods
Extremely	36.0 %
Somewhat	35.7 %
Little/Not at All	19.0 %
Community partner was actively involved in developing the budget
Extremely	43.0 %
Somewhat	21.4 %
Little/Not at All	23.8 %
Community partner was actively involved in writing the proposal
Extremely	29.0 %
Somewhat	33.3 %
Little/Not at All	23.8 %
Utilized the research consult service? %Yes	90.5 %
Usefulness of consult service
Extremely	73.7 %
Very	15.8 %
Moderately	5.3 %
Slightly	0 %
Not at all	0 %

^*Where percentages do not add to 100, data were missing.

In reporting their prior relationship with their selected community partner, a little more than half of the applicants reported selecting the community organization for the purpose of applying for the funding opportunity, and a little less than one-third worked with the organizational partner in some way before writing the proposal and one-third reported having a longstanding relationship with the organization. More than three-quarters indicated that if they were not selected for the program, they were extremely or very likely to continue working with their partner organization, while less than 5 % reported they were not at all or very unlikely to continue working with them.

Applicants also reported their community partner’s engagement with the application, and any considerations and/or hesitations the applicant had about working with community organizations. Less than half of applicants reported that their community partners were extremely actively involved in developing the study idea and less than one-third reported they had been extremely involved with writing the proposal. Thirty-eight applicants offered open-ended feedback about considerations and hesitations in engaging in community-engaged research. More than one-third wrote about the importance of considering the extent to which research meets the community needs and matches their priorities (e.g., “Benefit to the community needs to be clear to all groups”), and the extent to which there is shared vision, goals, and power (e.g., “whether our goals and vision are well-aligned”). Just under one-quarter wrote about the importance of recognizing community expertise and minimizing burden (e.g., “As a researcher, you will also have to be considerate of the time commitment of the community partners”). Other issues mentioned in open-ended comments included the need for flexibility, considering feasibility, gaining trust, ensuring logistics were handled (including time and follow-through), project sustainability, and building organizational research capacity (to reduce misunderstanding of research issues, especially regarding the institutional review board process, and/or data use issues). Additional concerns included navigating community organizations; navigating community organizations’ politics and staff turnover and how these might affect research timelines, the organization’s level of commitment to the research, and transparency about partners’ roles.

Finally, applicants also offered feedback about their experiences with the Research Consult Service and the application process. Nearly all applicants reported using the Research Consult Service before submitting their applications, and of those who used it, nearly 90 % rated it as very or extremely useful. Most–about two-thirds of applicants–reported that the submission portal was at least moderately easy to use. The most common comment among the 18 applicants who provided open-ended feedback about application submission process included: some application questions were not clear (e.g., “a bit more info on what exactly is desired in each part would have been helpful”); there needed to be more room for narrative; more time; technical issues with the submission portal; and one applicant noted more assistance would have been helpful. One applicant noted that the budget manager had been extremely helpful and other applicants should be encouraged to meet with them.

3.2. Funded applications

A total of 55 applications were submitted for the program over the five-year period. One cohort of ESIs was awarded per year over five years; three to five applicants were selected for each cohort. A total of 18 proposals, reflecting a 33 % acceptance rate, were funded. Table 3 displays the number of consultations conducted, applications received, and awards made. Between 9–13 applications were submitted and 11–15 consultations were conducted per year. Unfunded applicants were encouraged to arrange additional consultations for feedback about how to improve their applications and/or about seeking out other partnerships; about 90 % did so. Unfunded applicants were also invited to attend CBRN meetings to increase their knowledge about CEnR and enhance their community networks.

Table 3.

Numbers of consults, applications, awards, and acceptance rates by cohort.

	Cohort 1 (2017)	Cohort 2 (2018)	Cohort 3 (2019)	Cohort 4 (2020)	Cohort 5 (2021)	Total
Number of Consults	11	15	14	15	12	67
Number of Applications	9	12	13	10	11	55
Number of Awards	3	3	4	3	5	18
Acceptance Rate (%)	33 %	25 %	31 %	23%	42 %	33 %

Table 4 displays the characteristics of the pilot awardees. Only one of the 18 awardees was male. In terms of racial/ethnic background, two awardees were Black, one, Asian, one, Middle Eastern, and the rest were White. Most (72 %) had a primary affiliation at CWRU while the remainder came from affiliated hospitals. Nine pilot awardees (50 %) were Assistant Professors, four were post-doctoral fellows, and the remainder held other junior faculty positions.

Table 4.

Characteristics of pilot awardees.

Characteristic	Pilot Investigator Awardees (N = 18)	(%)
Gender
Women	17	94.4
Men	1	5.5
Race/ethnicity
White	14	77.7
Black	2	11.1
Asian	1	5.5
Middle Eastern	1	5.5
Faculty status
Assistant Professor	10	55.5
Post-Doctoral Fellow	5	27.8
Affiliated Clinical Faculty	3	16.7
School/Hospital/Department
Medicine	13	33.3
Nursing	3	16.6
Social Work	2	11.1

Note: All awardees were affiliated with Case Western Reserve University.

Funded projects received scores between 2 and 5. The highest scoring projects demonstrated feasibility to complete in one year; sustainable partnerships; and long-term interest in health disparities research (vs. one-time project funding). An example of open-ended feedback on an unfunded application’s weaknesses included “The budget is far more geared to the investigator and research coordinator than the community and community partner,” while a strength for a funded project included “Clearly defines expected role and contributions of the community partner and the community member participants.” Table 5 lists each of the 18 funded projects and includes a summary of each project and the community partner(s) with whom they worked. As the table shows, pilot awardees’ projects covered a wide range of topics, community partners, health issues, and health disparity populations.

Table 5.

Pilot project name, partner, and project goals.

Pilot Project Name	Partner(s)	Project Goal(s)
Cohort 1
The Impact of Trusting Relationships for Youth Struggling with Depression	Cleveland Metropolitan School District (CMSD)	To test the Trust-building depression Self-Management Together (TRUST) intervention among low-income adolescents with moderate depressive symptoms. Follow adolescent-parent dyads over 6 months, measure changes in adolescent depression management behaviors (sleep, stress management, medication adherence, appointment keeping), quality of life, markers of adolescent/parent trust.
The Impact of Social Support on Mental Health for LGBTQ+ Foster Care Youth	LGBT Community Center Greater Cleveland	To investigate the relationship between sexual and gender minority status and mental health among child-welfare involved youth (12–17 years) and youth who have transitioned from foster care (18–25 years); evaluating self-reported depression/anxiety, self-harm, and suicidality.
Breast Cancer Treatment and Survival: Experiences of African American Women	Susan G. Komen Foundation	To identify barriers to and facilitators of timely breast cancer treatment in a Cleveland community with high rates of treatment delay. Develop sociodemographic “phenotypes” to indicate high-risk markers for delayed breast cancer treatment, conduct in-depth individual interviews to understand barriers to timely and consistent treatment and strategize about practical interventions to address barriers.
Cohort 2
COACHMAN: African American Patients Using Technology to Help Manage High Blood Pressure	Cleveland Council of Black Nurses, American Heart Association, Cleveland Office of Minority Health	To investigate the effectiveness of a community outreach program combined with a technology-based intervention for hypertension self-management to improve blood pressure control. Determine usability from patient perspective and feasibility for future use of tech-based interventions among African American patients.
TRANSLATE: How Transgender and Nonbinary People Navigate and Advocate for Themselves in Medical Systems and the Response of Medical Providers	LGBT Community Center Greater Cleveland	Using participatory action research as an intervention, improve quality of life among transgender and gender nonconforming (TGNC) individuals and increase their access to and use of primary health care. Implement mixed methods design to determine increase in personal knowledge, identify barriers, and promote skills such as confidence & cultural competence in interacting with medical providers and clinic staff.
Utilizing a Clinical Registry and Environmental Screening Tool to identify children with asthma most likely to benefit from Home Based Assessment and Remediation	Environmental Health Watch	To increase families’ access to primary care and reduce environmental exposure burdens that often result in increased emergency room visits and missed days of work and school. Intervention sought to provide home lead remediation in combination with easily accessible clinical services through a School Based Health Clinic. Attendance, grades and instances of ER use evaluated utilizing a clinical informatics registry.
Cohort 3
Youth Lens: Conceptualizations of the Neighborhood Environment & its impact on Health & Wellbeing	MyCom	To explore children and youths’ perceptions of how experiences of poverty, stress, the COVID-19 pandemic, and adversity within their neighborhood environment shape their health. Create a Youth Participatory Action Research group in Cleveland to prioritize child-centered strategies for creating neighborhood environments to promote their health and well-being.
Increasing PrEP uptake in a high HIV prevalence neighborhood in Cleveland, Ohio	University Settlement	To improve the understanding of the barriers African American and Latino MSM individuals face in obtaining HIV pre-exposure prophylaxis (PrEP) in a high HIV prevalence neighborhood.
The Impact of Poverty on Cognitive Decline and School Reentry After Pediatric Critical Illness	Cleveland Metropolitan School District	To assess the prevalence of educational decline in children living in neighborhoods of varying incomes after hospitalization for critical illness, identify facilitators and barriers to children’s academic success after recovery, and identify approaches to effective school reentry.
Understanding archetypes and recovery pathways-associated with child sexual abuse	Canopy Child Advocacy Center in Cleveland	To understand the barriers and facilitators associated with child and family recovery after experiencing child sexual abuse. To construct, describe, and identify intervention priorities for archetypal categories based on child mental health status; determine key contextual factors that influence recovery pathways across archetypes.
Cohort 4
The Impact of Stigma on Sex and Gender Minorities with Chronic Overlapping Pain Conditions	MetroHealth PRIDE Clinic, the Cleveland LGBT Center	To understand the effects of stigma on the experiences of LGBTQ+ persons with chronic pain conditions using informed knowledge of Health Stigma, a discrimination framework and multi grounded theory, semi-structured interviews.
Advancement of Care for Transgender and Gender Diverse people	LGBT Community Center Greater Cleveland	To understand the surgical need among the TGGD community and the barriers they encounter in accessing medical care needed to affirm their gender using a mixed-methods approach.
Emergency Food Assistance and Food Security	Greater Cleveland Food Bank	To explore spatial and temporal patterns to classify pantry users and food pantries, use qualitative research methods to explore pantry users and pantry sites within the typologies identified to understand food needs and the value of food pantry to clients and community and individual barriers that affect food pantry utilization and efficiency.
Cohort 5
Using a Community-Based Participatory Approach to Reduce Disparities in Cervical Cancer Prevention, Screening, and Diagnosis Among Hispanic Women in Cleveland	BREAST/Amigas, Metro West Community Development Corporation	To evaluate the impacts of a community-based breast cancer screening program for Hispanic women in Cleveland on general cancer screening services, examine and address disparities in cervical cancer prevention, screening, and diagnosis by multilevel determinants of health.
Social Determinants of Sleep Health and Cardiovascular Risk Among African American Family Caregivers	Fairhill Partners and the McGregor Foundation	To understand the social determinants of sleep and atherosclerotic cardiovascular (ASCVD) risk among African American family caregivers, identify resources to promote sleep and reduce ASCVD risk.
Social Media as a Decision Aid to Improve Cancer Screening Among Transgender and Gender Diverse People	LGBT Community Center Greater Cleveland	Use mixed methods to examine social media as a potential shared decision-making aid to improve cancer screening and preventive health services among transgender and gender diverse people in Northeast Ohio.
Local Level Air Pollution Exposure and Respiratory Outcomes among Migrant Agricultural Workers	HOLA Cleveland	To develop a low cost, easily reproducible mechanism for evaluating ambient pesticide and particulate matter exposure among farm workers to improve worker’s health.
Investigating Family-Centered Treatment Approaches to Managing Depression in Hispanic Youth within Integrated Primary Care	Catholic Charities Diocese of Cleveland	To explore whether a family-centered treatment approach improves depression outcomes for both Hispanic teens and parents identified in primary care by incorporating mental health services in pediatric visits and providing subsequent mental health referrals for parents.

In line with our logic model, all 18 awardees completed their projects. In some cases, project implementation started later than usual due to delayed IRB approvals, which led to delayed funding awards, and the COVID-19 pandemic (participant recruitment and data collection were severely restricted and delayed). All awardees participated in the CBRN during their award year and maintained collaborations with their partner organizations.

3.3. Focus group findings

Participating awardees were at different stages of their research projects; three had completed some initial dissemination activities, including conference presentations and journal manuscript submissions, while the others were in the process of analyzing their data. We developed three key themes that addressed needed program improvements from the awardees’ responses, including the need for clarifying CBRN roles, the necessity for mentors, and the importance of organizational support.

3.3.1. Clarification of roles in the CBRN was necessary

The first theme suggested the need for more structure and clarity in the CBRN. The awardees said they were unsure about the roles their community partners and CRSI Scholars were supposed to play in the CBRN and recommended these be clarified.

We shared space with a lot of those CRSI Scholars, some of us for over two years, and I liked meeting those people, …and I liked building those relationships, ‘cause I’m a relational person and I always learn from people, but it was never totally clear to me what their role with us was really supposed to be.

The awardees noted that the CRSI Scholars’ roles were more “aspirational” than realized, and they did not want to burden their community partners by inviting them to the meetings that felt more directed to academic investigators.

3.3.2. Mentorship was needed

The awardees also discussed the need for more academic mentorship and guidance on submitting grant applications that would follow their pilot projects. One awardee said they had applied to the program because their mentor told them they should, and that the program was “for people like me.” The awardee appreciated the guidance because junior faculty find it difficult to discern which projects to pursue, noting, “as new investigators, we don’t always know what’s worth our time.” The awardee went on:

These pilot programs don’t always find their audience. For us, early-stage investigators doing health disparities work who are tenure track and [must] meet all those kind of criteria… To get the kind of support we need to do it, …[programs should make sure] that they’re recruiting the right investigators and encouraging mentors to encourage their mentees to apply.

This quote indicates the importance of CHEEER’s reaching mentors and recruiting program participants through them, but the awardees also wished for more individualized mentoring during the program. Praising the usefulness of CBRN sessions that covered issues like journal article writing and other topics, they also suggested additional individualized focused mentoring/coaching during the program would have been helpful. “Maybe a paired mentor, assigned mentor during the developing or actually data collection phase for the projects to get you to that next step.” While CHEEER faculty could help from time to time, they were also busy with multiple projects and could not offer each awardee individualized assistance over time.

3.3.3. Organizational support was critical

Considering the lack of mentorship, awardees noted that having an organizational point-person at CHEEER who was knowledgeable, helpful, and responsive was very important.

[CHEEER staff member] gets so many points for always responding to requests super-quickly, and stuff that is even not her job, just being like ‘I need these gift cards,’ and “We’re struggling,” whatever, she’d be like “I’m on it.” So she was amazing and responsive.

The awardees agreed, with one noting, “I hope [staff member] is paid well. That’s all I can say. Definitely I don’t know what they would do without her. She’s certainly the glue.” The awardees also recognized that the program connected them with CHEEER faculty who were experienced NIH primary investigators who could provide them with letters of support in the future. Taken together, the organizational support offered by faculty and staff was highly valued.

4. Discussion

The Pilot Awards Program was developed to support ESIs and UF traditionally underrepresented in NIH funding in obtaining and managing partnered CEnR on health disparities. The promise of NIH funding was attractive to applicants who hoped to secure federal funding and build steppingstones for their research careers. Specifically designed to eliminate barriers ESI and UF faculty experience, the program offered pre- and post-award supports, including application preparation consultation, day-to-day project management assistance, and the supportive infrastructure of monthly CBRN meetings, all of which the awardees found helpful. However, program awardees felt they could have used stronger mentoring and more clarity around CBRN roles. Overall, the data support the feasibility of this program and early evaluation findings helped improve the program for subsequent cohorts (see also Collins et al., 2025).

The program’s emphasis on partnering academics and community members to utilize the strengths of each and ensure findings could be directly applied to decrease health disparities important to the community is a unique and important contribution. The emphasis challenges traditional approaches to valuing and primarily utilizing academic knowledge. By requiring applicants to demonstrate their value of community expertise, prioritizing projects that could demonstrate long-term commitment to the work, and requiring community partners be appropriately financially supported, the program was designed to stimulate programs of applied research with the greatest potential for affecting community health disparities in the Cleveland area. The number and variety of community partnerships the awardees established suggests a broad coverage of the local area, and some organizations serve large catchment areas. While the projects’ sample sizes varied depending on project methodology, and because the projects lasted only one year, we would expect more coverage and reach as projects scale up.

4.1. Mentoring and the importance of institutional support

While existing CBPR frameworks (e.g., Israel et al., 2008) emphasize co-learning, capacity-building among partners, and building on strengths and resources within the community, the importance of organizational support has received less attention. Strong institutional support is important to developing and strengthening health disparities researchers’ skills across the learning continuum, from foundational learning for new investigators to continuing professional development for more senior ones (National Academies of Sciences, Engineering, and Medicine, 2016). CHEEER’s previous experiences with community research recognized the power of organizational support and highly engaged staff. Thus, the program was designed and implemented prioritizing organizational support to maximize awardees’ successfully completing their projects. Combining unique, built-in support structures, including pre-award support through the Research Consult Service, post-award tailored, individualized grant management support, and the CBRN, were intended to reduce ESIs’ sense of social isolation and break down other barriers found in past research (Cooper, 2018; Ransdell et al., 2021).

Although awardees valued the organizational infrastructure and pre- and post-award supports the program provided, awardees emphasized that mentoring was needed for junior faculty, for determining funding opportunity “fit,” guiding awardees through research, and strategizing about leveraging their current grants into future ones. This finding is consistent with other studies on this program (Collins et al., 2025). While programs like the Pilot Award Program have the potential to fill mentoring gaps using tools like consultation, mentoring, networking and other supports described here, ESIs also need institutional support from their home departments and colleges, beyond the program level. Academic institutions need to better recognize and reward community-engaged researchers in promotion and tenure guidelines and encourage researchers to develop long-term partnerships (Ward et al., 2018). Unfortunately, “few academic institutions invest in the infrastructure that can enable faculty members to work in and with communities” (National Academies of Sciences, Engineering, and Medicine, 2016, p. 88). Advancing in a research career requires investigators to move beyond the limited gains of short-term funding, transitioning to becoming independently funded scientists, and for ESIs to accomplish this, serious, active support for ESIs must include investments in infrastructure such as training and mentoring, that comprehensively support their CEnR.

4.2. Improvement for subsequent cohorts

The evaluation findings led to our introducing programmatic changes for subsequent cohorts. In response to the feedback about a need for CBRN role clarification, CHEEER modified the meetings’ structure and management and worked to define the aims of the network and the roles of its members more clearly—especially community members. Also, because CBRN meeting attendees can fluctuate, CRSI Scholars regularly introduce themselves, their projects, and area(s) of expertise, offer periodic overviews of their community-based work. These introductions give awardees a better understanding of the Scholars’ networks, skill sets, and areas of expertise.

To clarify the role of their community partners, and to make the CBRN more relevant for community members the program staff gave new awardees and their partners explicit guidance, strongly encouraging both to attend the CBRN meetings so the partner could learn from peers about other local community-academic research partnerships in a safe space. Community partners also regularly presented at CBRN meetings to educate the CBRN about their organizations, about past research experiences, and about how research can help or has helped their clients and/or organization. The program staff also selected specific speakers and topics that were especially useful for community partners new to academic research. The program staff also sought to broaden investigators’ networks by bringing experts to CBRN meetings to speak about strategies for leveraging their projects to obtain additional grant funding.

In response to the focus group feedback about mentoring, to better support awardees, cohorts 3–5 were required to have a formal mentor sign on to support their application. Although CHEEER’s senior scholars assisted ESIs, this assistance tended to be short-term and for specific issues, rather than regular, ongoing support. The program staff also paid close attention to applicants during consultations, informing them that CHEEER could connect them with an academic mentor if they did not already have one. Mentors were not offered compensation. The program staff created a monthly writing group to encourage collaboration, feedback, and peer support as awardees work on project dissemination and follow-up funding. This was a way for the awardees to reduce isolation and connect with other CEnR-focused academics as they prepared their dissemination products.

4.3. Program replicability and measuring long-term impact

Beyond improving the Pilot Award Program for future cohorts, the evaluation findings have had a substantial impact on the newly formed Population Health Research Institute (PHRI) at MetroHealth Medical Center, which modeled its pilot award program for ESIs on this one. That program also emphasizes supportive organizational infrastructure, uses an online grant submission portal, offers application formatting assistance, conducts pre-application consults, utilizes advertising strategies, incentivizes mentoring, and modeled reviewer and study section guidance from this program. PHRI staff consult with the program team as they prepare to launch their first round of pilot funding.

While short-term community/academic partnership benefits include partnership synergy and the exchange of knowledge, more research is needed on longer-term outcomes (D’Agostino McGowan et al., 2015; Drahota et al., 2016, p. 190). We hope our evaluation of the full project will contribute to this area. Anecdotal information from this program indicates the ESI cohorts have submitted or received new grant funding based on their pilot projects and are continuing their work in CEnR health disparities research, and data are currently being systematically collected from all cohorts. A mixed methods study demonstrated that the program has accomplished the goal of launching pilot awardees into a community-engaged research career aimed toward reducing health disparities (Collins et al., 2025).

We have developed tools and are tracking the sustainability of ESIs’ research programs, including how many and what types of grants they pursued and were awarded; publications, presentations, and community dissemination events; continued engagement with community partners; and their community partners’ involvement in different stages of the projects (e.g., number of community partners included on publications, other dissemination venues, and/or future grant proposals) and are gauging longer-term community engagement beyond their projects. Importantly, we also have explored extent to which the awardees feel the program increased their commitment to health equity, increased their understanding of and health disparities, and/or changed their understanding of strategies for eliminating health disparities, and/or approach for addressing them. It is also critical to examine how the projects have contributed to changes in social conditions related to health equity.

One key strength of this program is that this program was developed as a natural outgrowth of years of CHEEER’s community-engaged work. CHEEER has worked in Cleveland communities for many years and is an established, trusted institution. Although we cannot say for certain that the program could be replicated in other areas in which the work has not been as longstanding and the organization less established and trusted, consistent with the literature, we believe individualized, responsive support and mentoring for new researchers can be invaluable.

4.4. Lessons learned

This project yields several important lessons future similar projects should consider, including ensuring the recruitment of diverse faculty participants, ways of improving mentoring, and changes we would make to the program evaluation design.

4.4.1. Increasing participant ethnic and racial diversity

Although the program staff sought to recruit ESIs interested in health disparities research, it also intended to recruit investigators who are underrepresented in NIH funding, including “individuals from racial and ethnic groups such as Blacks or African Americans, Hispanics or Latinos, American Indians or Alaska Natives, Native Hawaiians, and other Pacific Islanders; individuals with disabilities; individuals from disadvantaged backgrounds” and “women from the above backgrounds at the graduate level and beyond in scientific fields” (National Institutes of Health (NIH), 2022a, 2022b, paras. 3–4). Our awardee pool was more than three-quarters White, and nearly all were women (Collins et al., 2025). While the award rate for women, was about 2.75 times higher than NIH’s record of funding women researchers (34 %) (National Institutes of Health (NIH), 2022a, 2022b), the awardees overrepresented both White faculty at CWRU and women faculty (Case Western Reserve University, 2018). While these data suggest the program successfully funded women at a higher rate, the program was not successful in recruiting a racially or ethnically diverse applicant pool. One reason for this might be because the program required applicants to be affiliated with CWRU, an elite private university. If other local universities had been included, the applicant pool might have been more diverse.

4.4.2. Mentoring should be incentivized

As we have discussed, mentoring is essential, especially for facilitating ESI and UF research success. While junior faculty are interested in being mentored on CEnR, relatively few senior academic researchers are able or willing to provide this mentoring (Cooper, 2018; DiGirolamo et al., 2012; Ransdell et al., 2021). Providing appropriate incentives for mentors is worth exploring. Building appropriate community support into budgets, mentoring stipends and/or service credit may be ways to incentivize mentoring.

4.4.3. Evaluation: implementing a mixed methods design at baseline to track change

Given the research literature’s focus on mentoring and specific barriers, if we were to re-evaluate this program, we would include standardized measures to track changes in awardees’ perceptions of support, mentorship, discrimination, and access to resources over time. A mixed methods approach, incorporating both standardized scales and qualitative data would have allowed us to draw more robust conclusions about the program’s impact. Our long-term data will attempt to collect some of this information. We would also use our Research Consultation Service writeups as an evaluation data source to reflect applicants’ areas of growth around CEnR and identify the most common patterns and issues applications needed to address.

Finally, were we to re-imagine the evaluation of the full program, we would continuously examine community partners’ experiences with the program. Although as discussed, the program highly valued community partners, most of program efforts beyond the CBRN were focused on building awardees’ skills and supporting them. The awardees were counted upon to appropriately foster their community partner relationships. Given the awardees’ and community partners’ different focus, priorities, and expertise, this was at times challenging. We would have liked to have capture this information during the program.

5. Conclusion

Community-academic research partnerships have the potential to affect health disparities, as they combine the unique knowledge and skills of both researchers and the community to identify and intervene to address disparities. Programs that support community/academic partnered research among early-stage investigators must prioritize community knowledge and expertise and provide strong organizational and institutional support, and mentors. Giving ESIs access to networks of community-engaged researchers and community members who can help them navigate challenges, build their understanding of both research design and processes, and sustain and build their research programs can simultaneously promote equity in research funding and improve community health through research. Appropriately training, supporting, and connecting ESIs with communities thus has strong prospects to generate transformative, translational research that may lead to reducing or eliminating health disparities in communities.

Biographies

Mona Shediac Rizkallah is a public health professional with previous faculty appointments at the Johns Hopkins School of Public Health, the American University of Beirut, and Case Western Reserve University. She is now an Independent Consultant working with the Case Center for Reducing Health Disparities on the NIH-funded grant “Involving Communities in Delivering and Disseminating Health Disparity Interventions”. Dr. Shediac Rizkallah has approximately 25 years’ experience in the development, implementation, evaluation and sustainability of community-based programs. She has published on community-based breast and cervical cancer screening and cardiovascular disease prevention programs, adolescent health-related behaviors, and women’s experiences of maternity care.

Cyleste Collins is Associate Professor in the School of Social Work at Cleveland State University. She has more than 20 years’ experience evaluating community-based programs, including the NIH-funded health disparities programs at the Case Center for Reducing Health Disparities since 2012. Dr. Collins has also published on the impact of paid sick leave policies, substance abuse, child abuse and neglect, domestic violence, homeless and housing unstable families, families experiencing foreclosure, refugee health, infant mortality, and university-community partnerships. She is an abstract reviewer for the Collaborative, Participatory, and Empowerment Topical Interest Group for the American Evaluation Association.

Jacqueline Dolata is the manager of the Case Center for Reducing Health Disparities and has over 15 years of research experience, focused mainly on community engagement. Her work has involved training non-profit professionals in research methods, creating a practice-based research network of community organizations, as well as development of an online community-academic partnership toolkit. She also helped develop the center’s pilot award program which seeks to train early-stage investigators working to conduct community engaged research. She has published on the distribution of funds in CBPR projects, CKD progression, training of non-profit professionals in research, and depression among dialysis patients.

Elodie Nonguierma is a public health professional employed by the MetroHealth system in Cleveland. She has been working for the Center for Reducing Health Disparities (CRHD) at MetroHealth highlighting and emphasizing participatory community-based research. Her work focuses on reducing health disparities in the region, where she also serves as an advocate for health equity issues. She is also the teaching assistant of the Climate Change and Health course at Case Western Reserve University. Elodie graduated from the Baldwin Wallace University Public Health curriculum, where she also earned a Bachelor of Science in chemistry.

Erika Hood is a public health professional employed by the Center for Reducing Health Disparities in Cleveland, Ohio. Her focus is community-based participatory research where she thrives in a role that connects community to critical research that impacts the health of black and brown residents. Erika has a deep understanding of the social determinants that perpetuate health disparities. She serves as an advocate to find ways to get to the core of SDOH and racism as a public health crisis. She facilitates community-led initiatives to address infant mortality and barriers to public health research for black and brown communities.

J. Daryl Thornton is Co-Director of the Case Western Reserve University Center for Reducing Health Disparities, Director of the Medical Intensive Care Unit of The MetroHealth System, and an Associate Professor at the MetroHealth System. He has served as the PI of several federally-funded, community-based randomized controlled trials to reduce disparities. He has mentored over 15 young investigators ranging from undergraduate students to assistant professors. Dr. Thornton has served on PhD dissertation committees and served as the advisor as well as primary mentor to students with NIH training T35 grants. Over 25 % of his publications have been co-authored with mentees.