A community based participatory approach to improving health in a Hispanic population

Abstract

Background: The Charlotte-Mecklenburg region has one of the fastest growing Hispanic communities in the country. This population has experienced disparities in health outcomes and diminished ability to access healthcare services. This city is home to an established practice-based research network (PBRN) that includes community representatives, health services researchers, and primary care providers. The aims of this project are: to use key principles of community-based participatory research (CBPR) within a practice-based research network (PBRN) to identify a single disease or condition that negatively affects the Charlotte Hispanic community; to develop a community-based intervention that positively impacts the chosen condition and improves overall community health; and to disseminate findings to all stakeholders.

Methods/design: This project is designed as CBPR. The CBPR process creates new social networks and connections between participants that can potentially alter patterns of healthcare utilization and other health-related behaviors. The first step is the development of equitable partnerships between community representatives, providers, and researchers. This process is central to the CBPR process and will occur at three levels -- community members trained as researchers and outreach workers, a community advisory board (CAB), and a community forum. Qualitative data on health issues facing the community -- and possible solutions -- will be collected at all three levels through focus groups, key informant interviews and surveys. The CAB will meet monthly to guide the project and oversee data collection, data analysis, participant recruitment, implementation of the community forum, and intervention deployment. The selection of the health condition and framework for the intervention will occur at the level of a community-wide forum. Outcomes of the study will be measured using indicators developed by the participants as well as geospatial modeling.On completion, this study will: determine the feasibility of the CBPR process to design interventions; demonstrate the feasibility of geographic models to monitor CBPR-derived interventions; and further establish mechanisms for implementation of the CBPR framework within a PBRN.

Figure 1

Maps showing the growth of the Hispanic population in Mecklenburg County between 1990 and 2005. Map A demonstrates minimal Hispanic penetration into the county in 1990. The safety-net clinics are labeled (+) along with the hospital emergency departments (H). Map B reveals the striking increase in the Hispanic population by the year 2005. Use of maps such as this will be a key step in engaging participants in the research project.

Figure 2

Study design overview: flow diagram of CBPR guided intervention development.

Figure 3

Flow diagram of data collection and processing plan for community needs assessment.

Figure 4

Sample geospatial models showing patterns of community healthcare utilizations. Map A. Hispanic settlement patterns by census tract (target clinic noted with circle). Map B The geographic retrofitting model demonstrates the actual service area for the target clinic (note - many patients come to the clinic from distant parts of the city). Map C Complete models showing areas in need of improved access to primary care based on the retrofitting model of the safety-net, settlement patterns, and inappropriate ED utilization identified by the NYU algorithm.