The Multisite Translational Community Trial and Community-Based Participatory Research: A Failure to Communicate?

Trickett¹ highlights the potential contribution of the multisite translational community trial (mTCT)² to the form and function distinction for clinical trials established by Hawe et al.,³ but perceives a threat to the scope of community partnership. He suggests that some of what community-based participatory research (CBPR) should be will be lost in the translational research method we have introduced. Were we attempting to translate the methods of CBPR where these are spoken fluently, such a risk might exist. But there is no such threat, because the intent of the mTCT is to expand the breadth of CBPR, not to diminish its depth; to expand its lexicon, not alter its vernacular.

We cite the Diabetes Prevention Program (DPP)⁴ as an illustration of a randomized controlled trial (RCT) with results ripe for uptake into diverse community settings. The DPP is merely an illustration; any other such study would be equally germane. After millions of dollars have been spent showing that a particular intervention can improve a particular outcome, it stands to reason that the next step is to “translate” that insight into real-world practice. Pure CBPR that begins with “Is this really the topic we want to focus on?” is simply a non sequitur in such circumstances. The condition and intervention are established: The mTCT provides a means for local customization of methods to prevail nonetheless. Communities not inclined to embrace the imperatives borne of a given RCT would simply opt out.

But for those who opt in, the mTCT opens up the means to honor local ownership and control when something larger than the priority of just one community is in play. CBPR must consider that even communities are part of something larger–a community of communities. The goal of chronic disease prevention is not exclusive to any location; it is a national health priority.⁵ CBPR must acknowledge that no community doing something genuinely important is an island; it is part of an archipelago. The mTCT honors the separateness of sites while providing for the connection among them.

Where CBPR as currently spoken serves, CBPR as currently practiced should hold sway. But when a community of communities shares a priority, the mTCT expands the CBPR lexicon so that it may be spoken there as well. Trickett warned of potential losses to CBPR in the translational methods of the mTCT. We respectfully disagree and suggest instead an apparent failure to communicate⁶ the intended function of the mTCT.

Travis Brown soars like a bird with his daughter Cambria, aged 4 years, during Fun Family Fitness Week at Pigeon Forge Primary School in Pigeon Forge, Tennessee, on February 1, 2012. The school is encouraging parents to join their children in physical education class where special programs to challenge the body and mind are highlighted. Photograph by Curt Habraken. Printed with permission of AP World Wide.