Product Details

Author Information

Corresponding Author
Lisa Hardy
Northern Arizona University
Department of Anthropology
575 East Pine Knoll
Flagstaff, AZ 86011
United States
p: 928.523.0735
lisa.hardy@nau.edu

Authors (listed in order of authorship):
Alejandra Figueroa
Northern Arizona University

Amy Hughes
Northern Arizona University

Elizabeth Hulen
Northern Arizona University

Candi Corrales
Northern Arizona University

Rebecca Scranton
University of Arizona

Cruz Begay
Northern Arizona University

Product Description and Application Narrative Submitted by Corresponding Author

What general topics does your product address?

Public Health, Social & Behavioral Sciences

What specific topics does your product address?

Community-based clinical care , Access to health care, Advocacy, Built environment, Community assessment, Community coalition , Community development, Community engagement, Community health , Community organizing, Community-based education, Domestic violence, Health behavior, Health disparities, Health equity, Housing, Immigrant/refugee health, Nutrition/food security, Partnership building , Physical activity/exercise, Rural health, Social determinants of health, Social services, Community-based participatory research

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

American Indian/Alaska Native

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

Asset-mapping, Community needs assessment, Community-academic partnership, Community-based participatory research , Qualitative research

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

Manual/how to guide, Training material

Application Narrative

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

The Community-engaged Wellness Mapping toolkit contains templates for asset mapping, documentation, and analysis. Templates and descriptions are based on research conducted in 2013 as part of a National Institutes of Health (NIH) funded study, Health Resilience among American Indians in Arizona. The toolkit is designed for use by groups that are operating with community-engaged project structures that include at least one academically trained researcher and a team of community researchers who may or may not have formal training in research and methods prior to the beginning of the project. Ideally, community researchers possess insider knowledge insights on a local population through ongoing research and analysis.

The Wellness Mapping toolkit is designed to collect data in a way that engages participants to describe how they perceive their environment and how their perceptions contribute to their achievement of wellness. It is a flexible toolkit for researchers with different levels of comfort and training in qualitative research, and serves as a guide to build relationships between researchers and members of a team. The toolkit may also be used by non-academic partners for purposes other than research, such as identifying common health coalition goals and engaging a diverse group in discussions about health assets and common values. For data analysis, the toolkit works well with an ongoing, iterative analysis process in which academically trained researchers and community researchers collaborate to identify major themes within the data.

2. What are the goals of the product?

Goals of the Community-engaged Wellness Mapping toolkit are to provide 1) a method of data collection and analysis process that can be modified to fit the needs of specific projects in varied settings; and, 2) an opportunity for training and capacity building for community researchers who may have little prior knowledge of data collection and analysis techniques.

The toolkit is designed as a practical starting place for trained researchers to work side-by-side with team members who may have little or no research training and background and hold rich knowledge on local present and historical realities impacting health. Depending on the local population and the goals of the project, a community-engaged team selects and modifies components of the toolkit for use in various research projects. The analysis tools are designed to provide a clear framework for multiple researchers to make sense of data through the use of project-defined themes, compare and contrast findings, and analyze data with the goal of helping project partners move toward identifying and developing strategies for civic engagement and health equity. In addition to providing a tool for research, the toolkit provides the opportunity for initiating interest in professional development of members of the community who have persistent interest, inclination, and propensity for becoming researchers themselves.

In Health Resilience among American Indians in Arizona, the Wellness Mapping activities enabled researchers to identify challenges that may have influenced participant abilities to find resilience strategies. Furthermore, the use of Wellness Mapping allowed participants to reflect on – and communicate to researchers – a sense of (participant defined) wellbeing or healthy living. The research team analyzed patterns in all maps and applied team-defined codes to each visual map using Atlas.ti.

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

The toolkit is designed for community-engaged research and thus, different types of partnerships may use it for their own purposes. Ideally use of the toolkit in community and academic partnerships will employ at least one person who has extensive training in data collection, analysis, and theory. This foundation adds flexibility to use he toolkit beyond research projects to group activities such as a relationship building exercise for communities and organizations. Members of nonprofits, public sector employees, or Community Health Workers (CHWs) could use it as a way to build relationships and engage in discussion about wellness, built environments, and local assets in events eliminating the need for in-depth qualitative research trainings prior to its use.

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.

Complete instructions for introducing and implementing the Community-engaged Wellness Mapping toolkit are included on the mapping template.

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.

Use of the Wellness Mapping in Health Resilience among American Indians in Arizona is rooted within literature on community engagement and health disparities research, and draws on scholarship indicating a need for greater communication between patients and providers. Literature on patient-provider relationships emphasizes the need to modify traditional models of patient-provider interaction in diverse populations.1 Scholars indicate mistrust towards medical professionals and hospital providers are potential factors that prevent American Indians and other populations from responding to health related informatio.2,3 A community-based research team developed the toolkit to identify areas of resilience and wellness in the lives of American Indians that they could then communicate to medical providers in order to enhance providers’ abilities to understand and address the needs of their patients.

For several decades, scholars have documented the usefulness of approaches such as Community-based Participatory Research (CBPR), 4-6 and Rapid Assessment, Response, and Evaluation (RARE).7-10 to understand local populations and environments and to design interventions. Indeed, several researchers indicate that these approaches offer the ability to reach hidden populations and young people to explore information on cultural landscapes through social mapping tools.11-13 Although the toolkit is a recently developed research tool, similar research tools such as “concept mapping,” “vision mapping,” and “asset mapping” also purport the usefulness of mapping for community-engaged research. 5, 14-15 Concept mapping in particular continues to gain prominence as a valuable qualitative research method. 15-17

While some forms of mapping tend to be literal, such as researchers’ work with indigenous community members to develop topographical maps for the purpose of protecting land claims,11,18 others employ more abstract concepts, such as local perceptions on crime and safety or ways to improve access to care.19,20 In our project, wellness mapping activities in combination with interviews, focus groups and observations were implemented to investigate areas of health equity research and develop and disseminate findings to support resilience. The team also used the toolkit as a teaching tool for increasing the understanding that researchers and health care providers have of a particular place and group.21

In addition to increasing recognition of community engagement for outcome and results, capacity building was also a goal of the project. The toolkit is designed to increase the ability for community members to participate in analysis beyond recruitment and data collection and therefore is a resource for capacity building.

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. Agarwal AK, Murinson BB. New Dimensions in Patient–Physician Interaction: Values, Autonomy, and Medical Information in the Patient-Centered Clinical Encounter. RMMJ 2012; 3(3):e0017. doi:10.5041/RMMJ.10085
2. Canales MK, Weiner D, Samos M, Wampler NS. Multi-generational perspectives on health, cancer, and biomedicine: Northeastern Native American perspectives shaped by mistrust. J Health Care Poor Underserved. 2011 Aug; 22(3):894-911. doi: 10.1353/hpu.2011.0096.
3. Geana MV, Greiner KA, Cully A, Talawyma M, Daley CM. Improving health promotion to American Indians in the midwest United States: preferred sources of health information and its use for the medical encounter. J Community Health. 2012 Dec; 37(6):1253-63. doi: 10.1007/s10900-012-9564-x.
4. Burhansstipanov L, Christopher S, Schumacher SA (2005). Lessons learned from community-based participatory research in Indian country. Cancer Control. 2005 November; 12(2): 70-76.
5. Minkler M, Wallerstein N, editors. Community-based participatory research for health. San Francisco: Jossey-Bass; c2003. 508 p.
6. Shore N, Brazauskas R, Drew E, Wong KA, Moy L, Baden AC, Cyr K, UlevicusJ, Seifer SD. Understanding community-based processes for research ethics review: A national study. Am J Public Health. 2010 December; e1-e6. doi:10.2105/AJPH.2010.194340
7. Needle RH, Trotter RT 2nd, Goosby E, Bates C, Von Zinkernagel D. Methodologically sound rapid assessment and response: providing timely data for policy development on drug use interventions and HIV prevention. International Journal of Drug Policy. 2000 March; 11(1): 19-23.
8. Trotter RT 2nd, Needle RH, Goosby E, Bates C, Singer M. A methodological model for rapid assessment, response, and evaluation: the RARE program in public health. Field Methods. 2001 May; 13(2): 137-159.
9. Trotter RT 2nd, Needle RH. RARE Project community guide. Washington DC: Department of Health and Human Services; c2000a.
10. Trotter RT 2nd, Needle RH. RARE Project field assessment training methods workbook. Washington DC: Department of Health and Human Services; c2000b. 107 p.
11. Smith DA, Herlihy PH, Ramos Vieira A, Kelly JH, Hilburn AM, Aguilar Robledo M, Dobson JE. Using participatory research mapping and GIS to explore local geographic knowledge of indigenous landscapes in Mexico. American Geographical Society's Focus on Geography. 2012 Winter; 55(4): 119-124.
12. Bahn S, Weatherill P. Eliciting data from participants using visual mapping as a collection technique. Qualitative Social Work. 2012 July; 11(4): 431-444.
13. Literat I. Participatory mapping with urban youth: the visual elicitation of socio-spatial research data. Learning, Media & Technology. 2013 March; 38(2): 198-216. doi:10.1080/17439884.2013.782037
14. Dennis SF, Gaulocher S, Carpiano RM, Brown D. Participatory photo mapping (PPM): Exploring an integrated method for health and place research with young people. Health & Place. 2009 June; 15(2): 466-473. doi:10.1016/j.healthplace.2008.08.004
15. Daley BJ. Using concept maps in qualitative research. Concept Maps: Theory, Methodology, Technology. Proceedings of the First International Conference on Concept Mapping. Pamplona, Spain. 2004:14-17.
16. Butler-Kisber L, Poldma T. The power of visual approaches in qualitative inquiry: The use of collage making and concept mapping in experiential research. Journal of Research Practice. 2010;6(2).
17. Wheeldon J, Faubert J. Framing experience: Concept maps, mind maps, and data collection in qualitative research. International Journal of Qualitative Methods. 2009;8(3).
18. Murry AT, James K, Drown D (2013). From pictures to numbers: Vision mapping and sustainability collaboration between Native American community members and mainstream scientists. American Indian Culture and Research Journal. 2013, November, 37(4): 1-24.
19. Baohua, Z. Mapping communities: Ethics, value, practice. Honolulu: East-West Center;
c.2005. Chapter, Empowering communities through mapping; p. 57-72.
20. Liebermann S, Coulson J. Participatory mapping for crime prevention in South Africa: Local solutions to local problems. Environment and Urbanization. 2004 October; 16(2): 125-134.
21. Kathirvel S, Jeyashree K, Patro B. Social mapping: A potential teaching tool in public health. Medical Teacher. 2012; 34(7): e529-e531. doi:10.3109/0142159X.2012.670321

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.

Dr. Lisa Hardy and Dr. Cruz Begay are the project leads for Health Resilience among American Indians in Arizona, a pilot research project funded by the National Institutes of Health (NIH) National Institute on Minority Health Disparities (NIMHD) through the Center for American Indian Resilience (CAIR). The project investigates health equity by using a community-engaged and resilience approach to research, analysis, and strategy development. Four distinct goals of the project include:

Aim 1: Identify current knowledge, attitudes, beliefs, and behaviors among American Indians related to increased fitness and demonstrated resilience through lifestyle changes.
Aim 2: Assess patient-provider communication about overweight and obesity.
Aim 3: Determine evidence-based, culturally appropriate strategies which provide primary, secondary or tertiary prevention against health risks.
Aim 4: Make policy and procedural recommendations to inform CAIR and community stakeholders.
The overall research design is based on community-engaged decision making in partnership with a trained medical anthropologist and public health scholar. The analysis design included a group process based on RARE whereby the research team met for half or full day analysis meetings once a week in order to conduct iterative processes of theme identification and the development of a codebook. During these weekly meetings each researcher shared his or her notes from the research they conducted the previous week, including data from mapping activities, interviews, focus groups, and observations. The team discussed progress and any necessary revisions to tools and procedures. The majority of the meeting time was spent on reporting back what was heard from research participants and reflecting, as a group, on trends identified in stories and data collection. At the conclusion of the weekly meetings the research team had identified a full code list. The full code list was then used to transcribe recordings from interviews and focus groups.

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.

At the beginning of the project, the project leads developed a strategy to recruit and hire a group of community researchers, which included multiple strategies for disseminating a job description and an interview structure that matched the need for researchers who had the ability to listen well and understand stories and qualitative data. Based on these criteria, project leads interviewed and hired the following community researchers: Jamie Esplain, Travis Pinn, Candi Corrales, and Fermina Tewa. The team also included Amy Hughes, an academic librarian, and Rebecca Scranton, an intern and undergraduate student studying public health.

The project leads developed and conducted a training workshop for the community researchers based on Rapid Assessment Response and Evaluation (RARE).7-10 The training included an introduction to the foundations of the research, ethics, and methods. During the training the group discussed the focus of the project and worked to come to some consensus on key definitions, such as the meaning of resilience. Once the group established a common language, research methods were selected based on whether they were locally-appropriate, and how well suited each was to answer the questions of the project about wellness and health. During the group process, there were team members who had differing ideas about how to best elicit information and what they would like to report post-analysis. Rebecca Scranton proposed the use of a mapping tool that would allow researchers to identify perceptions of wellness and stress. The group quickly agreed this would be a useful tool and implemented it together, discussing the insights each group member had while completing the activity and the patterns that group members identified when looking at the maps each person created.

Project leads then developed templates to accompany the mapping activity for use by team members to, 1) assist with their ability to use the tool in different situations; 2) increase consistency across uses of the tool; and, 3) enhance analysis for each individual researcher and the group as a whole once the data was collected. Researchers used these tools to take notes on each data collection activity (map), and later, record patterns and themes they identified from their own data set of multiple maps prior to meeting with the entire team. Team members also developed a preliminary theme list during day-long or half-day sessions in which they reviewed data collected during the previous week. The researchers investigated further by fully transcribing each mapping interview and applying codes using coding software.

The toolkit builds upon existing RARE methodology as described in the literature, in which community members trained in some qualitative research methods develop and refine the tools needed for data collection and analysis. As explained above, the wellness-mapping tool helped enhance a group process of analysis by providing a specific template for three levels: individual data for each interview, data collected by each community researcher, and overall themes surfacing from the data collection process. The toolkit also helped team members to clarify the connections between the data collection process and the identification of themes and larger issues in the data set, providing the community researchers with a tool to organize and compare the information quickly during weekly analysis meetings.

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.

The Community-engaged Wellness Mapping toolkit contributes to the ability to engage community researchers with different levels of training and background into the process of research and analysis quickly and easily. The attached tools help streamline the analysis process, and allow researchers to make connections between data collection and themes easier and faster. This feature enhances the functionality of the original RARE toolkit, because it makes it applicable for projects with shorter deadlines and large groups of community researchers. The toolkit can help make the data analysis process more collaborative because each of the community researchers has their data already organized by levels (each level corresponds to a different template) and therefore are easily accessible for group discussions and analysis. The toolkit has the potential to increase the engagement of community members beyond the data collection, which in turn benefits the community as it provides the opportunity to use qualitative data for their own purposes like grant writing or steering programs.

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

The collaborative team feels strongly about wanting to provide instruments and tools to community groups in an accessible and timely way. We developed the toolkit with the intent of sharing our resources and experiences with others who may find them useful. The research team also shared the toolkit with colleagues in unrelated projects, including a process of community collaboration for identifying cultural aspects of food in the community, and with a graduate student project in applied anthropology. Researchers in these other projects found the Wellness Mapping toolkit to be worthy of use, and have included it in their data collection and analysis process.

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.

The toolkit is designed to be adaptable. Ideally, groups will find the product useful especially in the beginning, during the process of developing tools in collaboration with local partnerships, and in meeting the goals and needs of specific projects. Our own use of these tools developed out of our campus-community engagement process, including oversight by trained researchers and collaboration with community researchers at every step.

The strengths of this toolkit include its accessibility for groups working together who may have different levels of training and knowledge of communities. It is limited, however, in that it does not provide the ability of a group to complete in-depth analysis over time. Therefore each group will want to carefully determine who is positioned to utilize this tool and in what ways. The toolkit can be used as a way to collect and analyze information for a number of projects and initiatives, although the research team feels that for use in academic settings there is a need to have a trained researcher as part of the team in order to provide the theoretical foundations and analytic skills that are valued in academia. This could be a limitation for some potential users.

Our project data collection period lasted four months. The timeline provided the strength of rapid and intense collaborative work with community researchers who may have multiple jobs and responsibilities. Our research team was composed of four community researchers, one undergraduate intern, two lead researchers, one research coordinator, and several volunteers. The four community researchers had varied experience: two had done interviews before for personal projects, and the other two had no previous experience with qualitative data collection and analysis.

Meeting planning and logistics were conducted by the researchers and the coordinator, but agendas were built in a way that encouraged participation and feedback from all team members. For that purpose, the data collection tools and analysis tools were shared in advance, so team members had a chance to look over the instruments and bring their suggestions to the weekly meetings. Furthermore, team members provided insight after testing the instruments on the field, a process that lead to several changes in the early weeks of the data collection process. Employing a coordinator to manage logistics and the collaborative nature of sharing suggestions at weekly meetings were noted process strengths.

Over the course of the data collection and preliminary analysis process, the analysis templates included in the toolkit proved to be a useful instrument to organize the data and have it accessible for discussions, which led to full participation of all team members in the identification of themes and patterns within the data set.

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.

This project began with a training session in RARE methods during which community researchers learned about data collection instruments and determined a vision for the goals of the project. The researchers then discussed and chose from a toolkit of methods. Our Wellness Mapping instrument emerged out of a discussion that took place on day two of the training, allowing all group members to work together to develop an instrument to assess wellness and resilience. The other templates included in this toolkit were created in a collaborative way between researchers and the team, as a way to clarify the analysis process and give community researchers tools to encourage their participation in that stage of the research.

The leads of this project obtained approval from their university and the local hospital Institutional Review Boards. Upon funding, one of the project’s community partners suggested that the leads also seek approval and permission from the Navajo Nation IRB, the Hopi tribe, and Indian Health Services. The project leads and partners obtained approval from all of these entities. All project team members and members of the Navajo Nation IRB have been notified of the submission of the Wellness Mapping Toolkit to CES4Health.