Product Details

Author Information

Corresponding Author
Linda Highfield
University of Texas School of Public Health
1200 Hermann Pressler
RAS Bldg., E913
Houston, TX 77030
United States
p: 7135009389
linda.d.highfield@uth.tmc.edu

Authors (listed in order of authorship):
Linda Highfield
University of Texas School of Public Health

Karen Williams

John Cooks
Episcopal Health Foundation

John Sullivan
University of Texas Medical Branch at Galveston

William Bush
Episcopal Health Foundation

Valerie Ausborn
Episcopal Health Foundation

Mary Ford
Episcopal Health Foundation

Marlynn May
Episcopal Health Foundation

Product Description and Application Narrative Submitted by Corresponding Author

What general topics does your product address?

Public Health

What specific topics does your product address?

Biostatistics, Community engagement, Community health , Community-based education, Epidemiology, Health education , Interdisciplinary collaboration, Research ethics, Geographic information systems/mapping, Community-based participatory research

Does your product focus on a specific population(s)?

underserved

What methodological approaches were used in the development of your product, or are discussed in your product?

Arts-informed methodologies, Community-academic partnership, Community-based participatory research , Problem-based learning, Qualitative research, Quantitative research, Survey

What resource type(s) best describe(s) your product?

Curriculum

Application Narrative

1. Please provide a 1600 character abstract describing your product, its intended use and the audiences for which it would be appropriate.*

Camp Boot is designed to teach community residents the principles of community based participatory research. The purpose is to prepare community residents as lay researchers with the capacity to partner with academic and/or community-based researchers to co-design and co-implement health-related studies. The title, Camp Boot, is intentional. “Boot Camp” is usually based on a command and control, top down philosophy. Camp Boot intends to reverse that philosophy in its teaching approach, drawing on practices of Participatory Rural Appraisal (PRA), Rapid Rural Appraisal (RRA), Community-Based Participatory Research (CBPR) and similar approaches (1-3). Adapted from the Partners in Research: Community and Faculty Training Curricula to Prepare Partners for Community-based Participatory Research Collaborations (4), Camp Boot includes more quantitative information. Camp Boot was developed and piloted in collaboration with a group of 40 African American and Hispanic residents representing medically underserved areas in Houston and Galveston neighborhoods (approximately 50% from each area). Participants were recruited by the advisory board (see question 7). Participants were paid a stipend of $600 for completing the 5 day, 40 hour training. Though our focus for the pilot project was with underserved populations, the curriculum is appropriate for a general audience of community residents interested in learning more about the basics of research, including non-geographically based communities and who have a desire to partner with academic researchers on CBPR projects. While the pilot implementation focused on training community residents, the curriculum could also be used for training and preparing community based organizations to integrate a research component into their programming.

2. What are the goals of the product?

The goals of the curriculum are to (a) provide knowledge for community residents about community based participatory research and the culture of community engaged research, (b) teach basic methodological skills (mixed methods) (c) prepare lay, co-research partners who bring community concerns and knowledge to the design and implementation of community health research and (d) to lay the foundation for future research partnering. This latter point is highly important, since doing CBPR-based projects is not just “doing research,” but is also about developing skills for partnering with other persons and organizations.

3. Who are the intended audiences or expected users of the product?

The intended audiences for the Camp Boot curriculum are academic researchers interested in building collaborative community-based research partnerships and community residents and/or organizations interested in educating academic researchers about community engagement while learning about research themselves. For example, academic researchers could use this curriculum to assist their community partners and help prepare them for partnered community-academic research projects. The curriculum is particularly geared toward community residents and organizational representatives who are interested in learning about research in order to partner more effectively with academics. The curriculum is most appropriate for audiences with a high school education or higher due to some content on statistics and data analysis. With some modification, however, it could easily be used for lower litercy or numeracy audiences.

4. Please provide any special instructions for successful use of the product, if necessary. If your product has been previously published, please provide the appropriate citation below.

The training slides with instructor notes, activities, evaluation questions and pre and post-tests are available for download through CES4Health. Camp Boot can be used as a complete curriculum, or as a modular curriculum, meaning that each unit can stand alone and future instructors can select units based on their local context and training needs. We suggest that instructors use units 4&5 together due to their methods focus. We encourage the use of local data throughout. We also provide examples of what we taught for future users. The GIS session requires local data to make use of the curriculum most effectively as noted in the instructor notes. Users interested in obtaining a copy of the pre-post test may contact the author at tbush@episcopalhealth.org or 832-807-2563.

5. Please describe how your product or the project that resulted in the product builds on a relevant field, discipline or prior work. You may cite the literature and provide a bibliography in the next question if appropriate.

CBPR approaches seek to equitably involve communities of focus in all states of the research process, including formulation of the research question, study design, data collection, data analysis, and dissemination of results(4). Principles of CBPR include recognizing the community partner as a unit of identity, building upon community strengths, facilitating collaborative decision making, fostering co-learning, balancing knowledge creation with direct community benefit, focusing on system level change, disseminating benefits to all partners, with a focus on multiple social determinants of health and a long-term commitment to social change(4-6). A variety of research capacity building training programs have been developed to enhance the understanding and uptake of CBPR approaches by both academic and community audiences with the intent to improve capacity and partnership opportunities (7-11). However, previous curriculae have focused either on specific methods related to planned research projects or heavily privileged qualitative methods (7-11). Camp Boot builds on previous curriculae for CBPR training by using a mixed methods approach with new units on biostatistics, epidemiology and geographic information systems to balance the qualitative and quantitative methods taught in previous CBPR training programs. Additionally, Camp Boot extends previous curricula by being based on the popular education models of Paulo Freire and the community theater forums of Augusto Boal. These models emphasize the importance of an empowered citizenry and the embodiment of learned knowledge to push for community change. We operationalized these concepts in two ways: 1) we used small group work so that participants could individually and literally perform the research tasks: i.e. search the internet for research on a health topic, see a map of their own neighborhood as viewed by the U.S. Census Bureau, define a research question and 2) we added a unit on the techniques of community theater forums to help participants embody and communicate concerns over health issues (sculpting health research concepts with “human” clay, role playing power differentials, and practicing communication games). As a final effort in hands-on, participatory learning, we also released a small Request for Proposals to participants, asking participants to submit a proposal on a specific area of interest (materials for proposal writing are available for download).

6. Please provide a bibliography for work cited above or in other parts of this application. Provide full references, in the order sited in the text (i.e. according to number order). .

1. Chambers, R. Whose reality counts? Putting the first last. Second ed. Colchester, UK: ITDG Publishing; 1997.

2. Rothman, J. Three models of community organizing in Planning and organizing for social change; New York: Columbia University Press; 1979.

3. Vasquez P & Minkler M. Promoting environmental health policy through community based participatory research: a case study from Harlem, New York.
J Urban Health. 2006 January; 83(1): 101–110.

4. Israel BA, Schulz AJ, Parker EA, Becker AB. Review of community-based research: assessing partnership approaches to improve public health. Annu Rev Public Health 1998;19:173-202.

5. Bartholomew LK, Parcel GS, Kok G, Gottlieg NH, Fernandez ME. Planning health promotion programs: an intervention mapping approach. Third ed. San Francisco: Jossey Bass; 2011.

6. Israel BA, Schulz AJ, Parker EA, Allen AJ, Guzman JR. Critical issues in developing and following community-based participatory research principles. In: Minkler M, Wallerstein N, editors. Community-based participatory research for health.San Francisco: Jossy Bass; 2003.

7. Allen ML, Culhane-Pera K, Call KT, Pergament S. (2010) Partners in Research: Curricula to Prepare Community and Faculty for CBPR Partnerships. CES4Health.info, 2011.

8. A capacity building program to promote CBPR partnerships between academic researchers and community members. Allen ML, Culhane-Pera KA, Pergament S, Call KT.Clin Transl Sci. 2011 Dec;4(6):428-33.

9. Capacity building through focus group training in community-based participatory research. Amico KL, Wieland ML, Weis JA, Sullivan SM, Nigon JA, Sia IG.Educ Health (Abingdon). 2011 Dec;24(3):638.

10. Walk together children with no wasted steps: community-academic partnering for equal power in NIH proposal development. Williams KJ, Cooks JM, May M, Peranteau J, Reifsnider E, Hargraves MA.Prog Community Health Partnersh. 2010 Winter;4(4):263-77.

11. Transferring Knowledge About Human Subjects Protections and the Role of Institutional Review Boards in a Community-Based Participatory Research Project. Raymond R. Hyatt, PhD, MS, David M. Gute, PhD, MPH, Alex Pirie, BA, Helen Page, EdD, Ismael Vasquez, andFranklin Dalembert, BA.Am J Public Health. 2009 November; 99(S3): S526–S531.

7. Please describe the project or body of work from which the submitted product developed. Describe the ways that community and academic/institutional expertise contributed to the project. Pay particular attention to demonstrating the quality or rigor of the work:

• For research-related work, describe (if relevant) study aims, design, sample, measurement instruments, and analysis and interpretation. Discuss how you verified the accuracy of your data.
• For education-related work, describe (if relevant) any needs assessment conducted, learning objectives, educational strategies incorporated, and evaluation of learning.
• For other types of work, discuss how the project was developed and reasons for the methodological choices made.

The Camp Boot curriculum directly reflects the field of Community-Based Participatory Research (CBPR) and is a product built on the prior work of the Center for Community Based Research (CCBR) at St. Luke’s Episcopal Health Charities (the Charities). The Charities is a philanthropic foundation, with a research program. The research program has practiced a grassroots form of CBPR called Healthy Neighborhood Initiatives (HNIs) for over a decade. In HNIs, a research project grew directly out of a specific request from a community in which the Charities had contacts and/or provided funding for an intervention program. The methodology used in the HNIs was primarily a grassroots qualitative approach, utilizing a series of community key informants and focus group interviews with community residents. Also prominently featured in the HNIs in recent years was research capacity building with selected community residents. In every HNI project, a core of community residents was collaboratively selected by St. Luke’s researchers and community residents to become research partners in the project. Every community member was provided research capacity building training, which in the case of the HNIs was exclusively focused on interviewing and qualitative analysis skills. These were called the CCBR “community faculty.”
Beginning in 2009, conditions changed at St. Luke’s that set in motion a review process leading toward a more formal CCBR research organization and program. Where the CCBR had before had only one Director (a qualitative methodologist with other, non-research responsibilities), two new Directors of Quantitative and Qualitative were hired, both fully devoted to research and the development of the CCBR. A review and rethinking of the CCBR’s goals, objectives and strategies followed, out of which came a comprehensive strategic plan to guide the CCBR’s future. In this new strategic plan, CBPR principles continue at the core, but added was a commitment to a more rigorous engagement of mixed methods in every part of the new CCBR. This meant that the community research capacity training curriculum had to be expanded to include quantitative, alongside qualitative research, skills.
The Camp Boot curriculum is the initial result of the rethinking and reflects our commitment to mixed methods. Other curriculae in the literature tend to focus on specific methods related to a specific planned research project, often most heavily focused on qualitative methods (4-8). Camp Boot builds on previous curriculae for CBPR training by using a mixed methods approach with new units on biostatistics, epidemiology and geographic information systems to balance the qualitative methods training. Camp Boot began with a desire to provide community residents’ the basics of mixed methods research practice using a participatory, process-oriented teaching philosophy (See Question 1). We began with the creation of an Advisory Board consisting of both CCBR researchers from St. Luke’s and community members from Galveston and Houston, Texas communities in which the Camp Boot curriculum was to be piloted. The Advisory Board’s function was to guide each step of the curriculum’s development, to oversee implementation of its initial application and to recruit participants based on their knowledge of who at the grass roots level would be interested in learning research skills to address local health problems.
Learning objectives were developed for each unit of the curriculum by having the CCBR researchers develop a set of slides, getting feedback from the community members of the Advisory Board, modifying the content based on the feedback, and continuing this process until a consensus was reached. Learning strategies were also agreed upon to recognize multiple learning capacities - lecture, discussion, small group interactive activities, community theater and facilitated group discussions.
At the time of the pilot implementation of the Camp Boot curriculum, all training participants were given a pre-training test of their baseline knowledge of CBPR, qualitative and quantitative methods (available for download). Subsequently, each unit was evaluated at its completion using open-ended questions, followed at the end of the 5 days of training by a post-test (available for download). The post-test evaluation included the same evaluation materials as the pre-test evaluation to gain a global evaluation of learning from all units of the curriculum.

8. Please describe the process of developing the product, including the ways that community and academic/institutional expertise were integrated in the development of this product.

The development of the outline and concept for each curriculum unit was discussed first with the Advisory Board, seeking their advice on scope, content, learning objectives and teaching method. The actual detailed teaching materials were subsequently developed by the lead developer/presenter for each unit. The materials in each unit were reviewed by the Advisory Board once in draft form and adjusted based on their feedback. Final decisions on all curriculum materials was by concensus. All members were given the opportunity to voice opinions, concerns, suggestions and general feedback prior to a vote to accept the materials.

9. Please discuss the significance and impact of your product. In your response, discuss ways your product has added to existing knowledge and benefited the community; ways others may have utilized your product; and any relevant evaluation data about impact, if available. If the impact of the product is not yet known, discuss its potential significance.

Our curriculum has added to the knowledge base of CBPR training materials by incorporating new units on biostatistics, epidemiology and GIS. These added materials provide a more balanced mixed methods approach to CBPR and enhance the knowledge base of trainees. In the pilot program, these new units were well received and rated highly in the evaluations (see question 11). During the pilot program, a total of 40 community residents were trained in the curriculum and 36 of these completed human subjects training through the St. Luke’s Health System institutional review board (IRB). The protection of human subjects training was done electronically through the Collaborative Institutional Training Initiative (CITI), which all St. Luke's Episcopal Health Charities research personnel are required to pass to comply with the St. Luke's Episcopal Hospital IRB requirements. In addition, the human subjects training provided a certification that allows the community participants to market their skills to researchers for various components of community research projects.


All participants took a pre-test to assess their knowledge regarding the learning objectives for the curriculum. Then at the end of the training, they took the same test as a post-test; the scores of the post-test were compared to the pre-test. The pre-test average score was 41, compared to 62 on the post-test (an increase of 51%). The minimum score increased from 18 to 27 and the high score increased from 64 to 100. Overall, the Camp Boot training increased community residents knowledge of CBPR, mixed methods, research ethics, GIS and research proposal development.

The Camp Boot curriculum benefited the community participants and, potentially, the communities in which they reside. It did so through providing basic knowledge of the research process in which community members are asked to participate, often minus a full understanding of that process or what elements push that process forward. In essence, the community is now an informed participant. As an example, one Camp Boot participant later communicated directly with the researchers (not related to Camp Boot) that she was involved in conducting a survey in her neighborhood schools. Although she had to request the survey multiple times from the academic investigator, she eventually received a copy and was able to share it with community members. This same community member is quick to ask whether researchers have IRB approval for their projects when she is approached regarding research. Another community respondent used what she learned to organize a church-based mammography screening day. Community members are, in general, more vigilant about the research process following the Camp Boot training, asking how it will benefit their community.

10. Please describe why you chose the presentation format you did.

We chose the presentation format (Powerpoint) because we were conducting a five day, 40 hour face-to-face training program. This format allowed us to move easily from lecture to discussion and group exercises.

11. Please reflect on the strengths and limitations of your product. In what ways did community and academic/institutional collaborators provide feedback and how was such feedback used? Include relevant evaluation data about strengths and limitations if available.

From the open ended evaluation questions for each unit taught, the majority of responses were positive and indicated that the curriculum and format were achieving the learning objectives set forth. Example of comments include:

(I learned) “how to plan a research project. To collect qualitative and quantitative data. How to reach out to your community, make a map of my community strengths and needs, write an agreement with university partners.”

(I learned) “ a new way to engage the community in problem identification and discussion, the role of theater and imagery can be used in the CBPR process, I am open/responsive to these methods, this was unexpected.”

“As many times as I have looked at my demographic data---I saw it today with a fresh eye. It was great to obtain a new…understanding.”

(What went well) “Linda’s explanation and presentation (on mapping). It gave us a guideline to reevalute the community…..we discuss our community differences….a discussion was awarded based on comments.”

The main areas noted for improvement were: more time, more training and more hands on activities. Examples of comments include:

“There was not enough time to get the full understanding.”

“Some way to keep us aware of what we work on in the future—maybe email a quarterly newsletter.”

“I think we should have received all the data maps of all areas so we could have followed the data on paper-I know copies cost $!”

“Presentation of qualitative—time and questions.”

“I wanted to hear more about the mistakes in order to avoid making the same ones.”

Additional strengths of the pilot training included: participant retention which was almost 100% over the five day period; only one person did not complete the training. We also kept community members engaged by reimbursing them for their time with a realistic stipend, using participatory exercises reflecting data from their home communities, and responding instantly to evaluations sessions. Generally, participants responded to the content enthusiastically, noting that they desired additional time and training. There were very few comments that the material was too difficult. Another general comment was that the balance between active participation and distracting side conversations could be better managed.

12. Please describe ways that the project resulting in the product involved collaboration that embodied principles of mutual respect, shared work and shared credit. If different, describe ways that the product itself involved collaboration that embodied principles of mutual respect, shared work and shared credit. Have all collaborators on the product been notified of and approved submission of the product to CES4Health.info? If not, why not? Please indicate whether the project resulting in the product was approved by an Institutional Review Board (IRB) and/or community-based review mechanism, if applicable, and provide the name(s) of the IRB/mechanism.

The Camp Boot curriculum embodied the characteristics of mutual respect, shared work and shared credit. It was truly a team effort to adapt and create the new units in the curriculum. All group members who directly developed curriculum materials (e.g., slides, activities) are included as authors on this publication. Mutual respect was embodied through the Advisory Board process where professional researchers and community faculty (lay researchers) had equal voice in advising the development of the curriculum. We operationalized this by rotating the leadership of the team meetings between the Advisory Board Community Faculty and the Charities Staff members. We relied heavily on the Advisory Board for telling us which elements of the curriculum to emphasize, which graphics to choose, recruitment of participants, and follow-up with participants. Operationalization of equal voice came from learning to resolve conflict and concerns at the group level during the week-long intense training. We used a tehcnique called passing the stone when an issue arose that we felt needed input from all participants. This involved allowing every participant to comment on an issue without interruption (the person holding the stone). We took time for this activity, even if it meant falling behind on the technical parts of the curriculum, thus giving equal voice to community members when issues came up as a result of ongoing evaluations. Example: In this process, we learned that the participant group was not homogenous and that participants and staff alike had to recognize critical differences in sensitivy to research, given participants’ personal and professional histories. After opinions on this were aired, the group recognized a concensus on the issues and moved back to the formal curriculum. All collaborators have been notified of the submission of the curriculum to CES4Health and are excited to share this product with other groups interested in similar work. Because Camp Boot was a pilot teaching program, the St. Luke's Episcopal Health System’s IRB was consulted and indicated that IRB approval was not required for the training program.