Community‐Based Participatory Research Skills and Training Needs in a Sample of Academic Researchers from a Clinical and Translational Science Center in the Northeast

Abstract

Purpose: To determine the community‐based participatory research (CBPR) training interests and needs of researchers interested in CBPR to inform efforts to build infrastructure for conducting community‐engaged research.

Method: A 20‐item survey was completed by 127 academic health researchers at Harvard Medical School, Harvard School of Public Health, and Harvard affiliated hospitals.

Results: Slightly more than half of the participants reported current or prior experience with CBPR (58 %). Across all levels of academic involvement, approximately half of the participants with CBPR experience reported lacking skills in research methods and dissemination, with even fewer reporting skills in training of community partners. Regardless of prior CBPR experience, about half of the respondents reported having training needs in funding, partnership development, evaluation, and dissemination of CBPR projects. Among those with CBPR experience, more than one‐third of the participants wanted a mentor in CBPR; however only 19 % were willing to act as a mentor.

Conclusions: Despite having experience with CBPR, many respondents did not have the comprehensive package of CBPR skills, reporting a need for training in a variety of CBPR skill sets. Further, the apparent mismatch between the need for mentors and availability in this sample suggests an important area for development. Clin Trans Sci 2012; Volume #: 1–5

Introduction

To improve the efficiency and quality of clinical and translational research, the National Institutes of Health (NIH) implemented the Clinical and Translational Research Awards (CTSA) starting in 2006, funding 60 centers nationwide as of 2011. The intent was to transform the research and training environment and to foster nationwide collaboration to facilitate the timely translation of research into evidence‐based policy and practice. ¹ Recognizing that many health problems are attributable, in part, to social determinants of health, ² , ³ community engagement is an important mechanism for this translation process. ⁴

The NIH considers Community‐Engaged Research (CEnR), including Community‐Based Participatory Research (CBPR), to be the T3‐T4 tier of translational research; that is ensuring discoveries are translated into policies at the practice and community level. ² CEnR calls for the engagement of communities in the research process. ⁵ This spans the gamut from conducting research in communities to participatory research with communities as fully engaged partners in all aspects of the research process.

Community engagement can improve research relevance by facilitating the choice of research questions, recruitment and retention of participants, and the translation of findings to benefit communities. ¹ This, in turn, can increase the adoption of evidence‐based practices at the community level. The practice of community engagement spans a range of strategies. Of these, CBPR is an approach to research that attempts to foster equitable partnerships between academia and the community to address health problems. The CBPR framework engages community members in a participatory manner in all aspects of the research process, including design, conduct, analysis, and dissemination of findings to achieve sustainable change. ² , ⁶

For CEnR to be effective in ensuring discoveries are translated into policies at the practice and community level, academic institutions need to invest in infrastructure to ensure faculty members are prepared to conduct CEnR. ⁴ The CTSA recipients are uniquely positioned to attain this goal given their explicit mission to build infrastructure for CEnR. Today, there are multiple examples of CTSAs building infrastructure to support CEnR. For example, the University of Michigan clinical and translational research Centers for Excellence have partnered with Practice‐Based Research Networks to create the Michigan Clinical Research Collaboratory to support community‐based research. ⁷ The Clinical and Translational Science Institute (CTSI) Community Engagement program at the University of California San Francisco has developed a series of guides and resource manuals written by faculty and community members to aid researchers and community members in conducting CEnR. ⁸ At Duke University, the Center for Community Research has compiled documents describing the best practices for CEnR discussed at several regional workshops. ⁹ Despite these recent efforts there is little in the literature describing the baseline needs of investigators with regards to CEnR, or specifically related to using the CBPR approach.

To better understand the needs of investigators at Harvard Medical School (HMS), Harvard affiliated hospitals, and the Harvard School of Public Health (HSPH), the Harvard CTSA, also known as Harvard Catalyst, chose to survey investigators to assess their current CBPR skills and training needs. The data provided would serve as a foundation for future infrastructure building efforts. What follows is a description of the findings from the survey.

Methods

Study sample

The sample included Harvard affiliated investigators at the HMS, HSPH, and Harvard affiliated hospitals. In an effort to gain the widest distribution, we used a variety of methods to identify potential participants. First, the survey was distributed to key individuals identified by Harvard Catalyst leadership (n= 67 department directors and chiefs) who were encouraged to forward the survey to their listservs, and in the case of HSPH, to all primary and secondary faculty members (n= 400). Second, the survey was emailed to 41 individuals from these same institutions who had previously expressed interest in CBPR (i.e., involved in CBPR efforts or discussions). In addition, the survey was posted on the Harvard CTSA website, accessible to the Harvard community. Because further tracking of the population of potential respondents (i.e., those who actually received the survey) beyond the initial distribution was not possible, no information is available on how many individuals received the survey, making it difficult to compute an actual response rate. Data were collected from September 2008 through October 2010. The study was reviewed and exempted by the Cambridge Health Alliance Institutional Review Board.

Development of the survey

The survey consisted of 20 closed‐ and open‐ended questions. It was developed collaboratively by researchers at the Institute for Community Health and faculty members at the HMS and HSPH to better understand Harvard investigators’ CBPR experience, interest, skills, and training needs. Sample questions included: “What research skills do you have related to CBPR?” and “Would you be interested in gaining additional skills or training in any of the following areas (e.g., Introduction to CBPR, CBPR Partnership development, etc)?” The survey elicited information on respondent characteristics, including institutional affiliation, academic rank, and specialty.

The survey was piloted with 15 faculty members and staff at HSPH and HMS with expertise in CBPR, and subsequently revised (four of the pilot participants eventually completed the final survey). Dissemination and administration of the survey was done electronically using Survey Monkey (Surveymonkey. com LLC, Palo Alto, CA, USA).

Variable creation

Data were collected on degree, academic rank, institutional affiliation, field of interest, and prior CBPR experience. Information on degree was collapsed into categories that reflected similar levels of experience: (1) “M.D./D.M.D.,” (2) “Ph.D., Sc.D., Ed.D., M.D./Ph.D.,” and (3) “Other” which included Bachelor and Masters Degrees. Those with an M.D./Ph.D. were included within the doctoral category to reflect those with more research training and background. Academic rank was collapsed into the categories of “Junior Faculty” (i.e., Fellows, Instructors, Lecturers, Assistant Professors); “Mid‐to‐Senior level Faculty” (i.e., Associate Professors, Professors, and Professors Emeritus); and “No Academic Rank” which included professionals such as administrators and project managers.

Data on institutional affiliation were collapsed into categories of “HMS”; “HSPH”; and “Other” (e.g., Brigham and Women's Hospital, Massachusetts General Hospital). Those with similar fields of interest were grouped together to form the categories of: “Medicine/Dentistry/Science,”“Public Health,” and “Humanities/ Social‐Behavioral/Other.” Finally, for the current analysis, those with any prior or current CBPR experience (as Principal Investigator, Collaborator, or other role) were distinguished from those without any CBPR experience and those reporting no knowledge of prior CBPR experience.

Analysis

Data from the online surveys were downloaded to Microsoft Excel (Microsoft, Redmond, WA, USA) for data cleaning and then transferred into SAS 9.2 (SAS Institute, Cary, NC, USA) for analysis. Descriptive statistics were calculated (i.e., frequency and percent) for all survey items and the created variables noted above.

Results

Sample characteristics

A total of 131 respondents completed the survey; four of these respondents were students who did not meet criteria as investigators and were therefore excluded from the final analytic sample. In all, 127 eligible investigators completed the survey. Demographic characteristics are shown in Table 1 . A fairly even number of respondents had doctoral (43 %) or medical (42 %) degrees with fewer having bachelor or masters degrees. The majority of respondents were Junior Faculty (49 %) and most were from the medical school (48 %). Fifty‐eight percent of the sample reported having prior or current CBPR experience.

Table 1.

Investigator demographic characteristics (n= 127).

	N (%)
Degree*
M.D., D.M.D.	51 (41.5)
Ph.D., Sc.D., Ed.D., M.D./Ph.D.	53 (43.1)
Other†	19 (15.4)
Academic rank‡,§
Junior Faculty	57 (48.7)
Mid to Senior‐Level Faculty	37 (31.6)
None	23 (19.7)
Institutional affiliations§
Harvard Medical School	56 (47.8)
Harvard School of Public Health	27 (23.1)
Other	34 (29.1)
Field of interest¶
Medicine/Dentistry/Science	65 (53.7)
Public health	42 (34.7)
Humanities/Social‐Behavioral/Other	14 (11.6)
Current or prior involvement in CBPR#
Yes (e.g., PI, collaborator, other)	69 (58.0)
No or do not know	50 (42.0)

*Missing N, 4 (not included in %); ^†Other, Masters and Bachelor degrees; ‡Junior Faculty (Fellow, Instructor, Lecturer, Assistant Professor); Mid to Senior‐Level Faculty (Associate Professor, Professor, Professor‐Emeritus); §Missing, 10 (not included in %); ¶Missing, 6 (not included in %); #Missing, 8 (not included in %).

CBPR skills and training needs by academic rank

Skills and training needs were examined by CBPR experience and across all levels of academic rank (i.e., Junior Faculty, Mid‐Senior level faculty, No academic rank; Table 2 ). Across all levels of academic rank, approximately half of the participants with CBPR experience did not have skills in research methods and dissemination, with even fewer reporting skills in coalition building or training of community partners. CBPR skill set and training needs varied by academic rank and by CBPR experience. Among those with CBPR experience, skills in community relation building and coalition building were less common among Junior or Mid‐Senior level faculty compared with those with no academic rank.

Table 2.

CBPR skill set and training needs by academic rank for participants with and without CBPR experience (N= 115)*.

	All		Junior faculty†		Mid‐sr level faculty‡		No academic rank
	CBPR experience		CBPR experience		CBPR experience		CBPR experience
	Yes (n= 68) %	No/DK (n= 47) %	Yes (n= 32) %	No (n= 23) %	Yes (n= 19) %	No (n= 18) %	Yes (n= 17) %	No (n= 6) %
Current CBPR skill set (% Yes)§
Research methods	55.9	n/a	59.4	n/a	57.9	n/a	47.1	n/a
Community relation building	50.0	n/a	34.4	n/a	57.9	n/a	70.6	n/a
Analysis	42.6	n/a	40.6	n/a	57.9	n/a	29.4	n/a
Dissemination	47.1	n/a	46.9	n/a	47.4	n/a	47.1	n/a
Coalition building	39.7	n/a	21.9	n/a	47.4	n/a	64.7	n/a
Training to community partners	33.8	n/a	31.3	n/a	47.4	n/a	23.5	n/a
None	4.4	n/a	9	n/a	0	n/a	0	n/a
CBPR Training needs (% Yes)§
Introduction to CBPR	33.8	63.8	34.4	65.2	21.1	50.0	47.1	100.0
CBPR partnership development	44.1	57.4	46.9	65.2	31.6	38.9	52.9	83.3
Funding CBPR projects	51.5	57.4	56.3	56.5	26.3	50.0	70.6	83.3
Evaluation of CBPR projects	42.6	48.9	43.8	60.9	26.3	33.3	58.8	50.0
Dissemination of CBPR findings	47.1	46.8	50.0	60.9	36.8	22.2	52.9	66.7
CBPR mentorship§
Willing to act as mentor	19.1	4.3	15.6	4.3	36.8	5.6	5.9	0.0
Interest in having mentor	36.8	42.6	46.9	56.5	5	17	52.9	66.7

*Sample based on participants with data on academic rank and CBPR experience; Junior Faculty, Fellow, Instructor, Lecturer, Assistant Professor; ‡Mid‐Sr Level Facultys; Categories not mutually exclusive.

Regardless of prior CBPR experience, approximately half of the respondents (ranging from 46 % to 54 %) reported a need for training in funding, evaluation, partnership development, and dissemination of CBPR projects. A slightly higher percentage of those with no academic rank reported having needs in these areas than either Junior or Mid‐Senior level faculty, with the exception of evaluation—a higher percentage of Junior Faculty with no CBPR experience seemed to report an interest in training in evaluation of CBPR projects. In general, a lower percentage of Mid‐Senior level faculty expressed a need for training in CBPR compared to Junior Faculty and those with no academic rank.

Overall, few respondents (12 %) reported being willing to act as a mentor in CBPR, with the exception of Mid‐Senior level faculty with CBPR experience (37 % willing to serve as a mentor). In contrast, for Junior Faculty and those with no academic rank, with and without CBPR experience, approximately half or more reported being interested in obtaining a CBPR mentor. This is in contrast to the small percentage (11 %) of Mid‐Senior level faculty interested in obtaining a mentor.

CBPR skills and training needs by academic degree

Similar to academic rank, respondents with “Other” degrees were more likely to report skills in community relation building and coalition building than either medically or doctoral trained respondents ( Table 3 ). Doctoral trained respondents more frequently reported skills in analysis, dissemination, and community partner training than the other groups. In terms of CBPR training needs, fewer respondents with doctoral degrees reported an interest in receiving training across all areas of training when compared to those who were medically trained or with other degrees. A small percentage of medically and doctoral trained respondents (14 % and 13 %, respectively) reported willingness to act as a CBPR mentor; however there was substantial interest in having a mentor across all three groups, with M.D./D.M.D. and Other groups expressing the most interest.

Table 3.

CBPR skill set and training needs by degree (N= 123)*.

	M.D./D.M.D. (n= 51) %	Ph.D., Sc.D., Ed.D., M.D./Ph.D. (n= 53) %	Other† (n= 19) %
	Current CBPR skill set (% Yes)‡
Research methods	33.3	32.1	26.3
Community relation building	17.6	30.2	52.6
Analysis	17.6	32.1	21.1
Dissemination	19.6	32.1	26.3
Coalition building	9.8	28.3	36.8
Training to community partners	15.7	24.5	10.5
None	3.9	2	0
CBPR training needs (% Yes)‡
Introduction to CBPR	56.9	34.0	47.4
CBPR partnership development	54.9	41.5	52.6
Funding CBPR projects	56.9	47.2	52.6
Evaluation of CBPR projects	52.9	35.8	42.1
Dissemination of CBPR findings	52.9	41.5	42.1
CBPR mentorship‡
Willing to act as mentor	13.7	13.2	5.3
Interest in having mentor	45.1	30.2	47.4

*Sample based on participants with data on degree; ^†Other, Masters and Bachelor degrees; ^‡Categories not mutually exclusive.

Discussion

Given the increasing interest among researchers and healthcare providers in community engaged research, the need for academic institutions to invest in infrastructure to ensure faculty members have the skills and resources to effectively conduct and guide this research is critical. Results from this survey provide some insight into the current training needs and interests of medical and public health researchers. Approximately half of those who completed the survey reported some experience with CBPR; however, many of the respondents did not have the comprehensive package of CBPR skills, reporting a need for training in a variety of CBPR skill sets (e.g., partnership development; funding; evaluation; dissemination). Nor were there enough willing mentors to meet the demand expressed by respondents. Many junior faculty (more so than senior faculty) self‐identified a need for more CBPR mentoring. Although clearly a diverse group, this study was useful in identifying a target group most in need of CBPR mentoring.

The growing interest in engaging communities in the research process is also accompanied by a growing need for more skills and training in this area, as noted by researchers in this study. CTSA recipients are in a prime position to build infrastructure and provide much needed training in CEnR for faculty at all levels and from various disciplines. Elements of such a training program should include many of the areas noted in the current survey. Topics to be covered might include developing and maintaining partnerships with community organizations, analysis and dissemination strategies using CBPR principles, obtaining funding for CBPR projects, and participatory evaluation techniques.

In addition to identifying the key elements of training in CEnR, programs must choose from a variety of methods for building training and mentoring capacity among interested researchers and healthcare workers. As noted earlier, several CTSAs have developed written resources or guidelines for conducting CEnR and best practices. ⁸ , ⁹ Responding to the results from this survey, the Harvard CTSA developed a consultation service for both researchers and community partners to provide ongoing support and guidance in CBPR during proposal writing and throughout the life of a project. They have also provided a variety of forums, conferences, and other capacity building sessions on topics related to CBPR (e.g., introduction to CBPR, participatory evaluation, proposal writing), during which both researchers and community partners are brought together for discussion and to learn from one another. A course in CBPR has been developed for the HSPH at the graduate student level. Furthermore, researchers interested in CBPR can elect to receive information about opportunities and resources for conducting CBPR and networking with others with similar interests. Harvard Catalyst will continue to monitor the success of these efforts via individual consultations and educational forums. CTSAs may want to consider additional methods such as the development of CBPR fellowships, training sessions, networking opportunities and structural efforts including pilot grant programs to support experiential learning. ¹⁰ , ¹¹

Although training opportunities for CBPR are increasing, ¹² , ¹³ , ¹⁴ identifying, engaging, and training academic researchers in this area remains a persistent challenge ¹¹ , ¹⁵ In part, this may be due to lack of available mentorship. Mentoring young investigators, those interested in CBPR, or those involved in mid‐career transitions is vitally important in skills development, ¹⁴ but as shown in the current survey, there is often a mismatch in demand and availability of mentors in CBPR. With a growing emphasis on CBPR and CEnR, the path to academic careers will likely expand, thus providing more senior researchers to mentor junior colleagues. However, other barriers to conducting CEnR may include the time and resources necessary for building effective partnerships, the differing demands and timelines in the academic and community environments, and the need for academic incentives. To truly support ongoing infrastructure in CEnR, institutions must incorporate this approach in both the tenure and promotional process, and funding must be made available for developing strong partnerships between investigators and community partners.

The current study is not without limitations. Given its focus on one university, results may not be generalizable to other universities. In addition, despite broad distribution, it is unlikely that the survey included all Harvard investigators involved or interested in CBPR. Subsequent surveys in other settings should attempt to replicate results among a larger sample. Despite this limitation, the survey helped to identify a substantial number of investigators interested in CBPR across the University, a fact previously unknown to Catalyst leadership. It also provided critical information on the need for training, skill development, and mentorship. This information has proved enormously helpful in developing CBPR programming.

Although we did not address the community perspective in this survey, it is important that parallel opportunities for training and capacity building in CBPR should be developed for community partners concurrent with faculty development. Examples include providing sessions in which researchers and community partners participate jointly and learn from one another, ¹⁴ and bidirectional mentoring among faculty at academic health centers and members of target communities. The Harvard Catalyst implemented a joint workshop for investigators and community partners to collaboratively discuss capacity building and sustainability in the context of health interventions. ¹⁶ They also implemented a small grants program in which community organizations received money (e.g., range of 2000 to 8000) to partner with a Harvard researcher in addressing a public health problem of relevance to their community. ¹¹

Conclusion

In summary, the current study suggests that the growing interest in CEnR by the NIH and other funders should be done in concert with the development of individual and group training and mentoring in a defined CBPR skill set. CTSAs should assess the needs of their investigators before launching their infrastructure efforts. With this information in hand, they can play a key role in providing training, building the necessary infrastructure, and developing internal promotional policies to effectively support this important approach to research.