Evaluation of a participatory action project to address opioid misuse: Breaking down barriers through partnership processes
Main Article Content
Abstract
Community based participatory research and participatory action research are increasingly being used to engage communities in addressing social and health disparities. There is a need to develop broadly applicable evaluation methods that can be used across participatory project environments to identify the processes critical for addressing complex public health issues, as well as the productiveness of community research partnerships. We present a case study of a community participatory project conducted over three years and our evaluation approach. We used the Community Based Participatory Research Conceptual Model as the framework for the evaluation surveys (n=9) and interviews (n=7) with project participants, querying perspectives on the four model domains: community context, partnership processes, intervention and research and outcomes. In addition, we conducted a Ripple Effects Mapping (REM) exercise with ten community members to determine the broader impacts of the project on the community. This mixed-methods approach permitted us to confirm findings from quantitative surveys with qualitative findings from interviews and the REM. Key processes identified as facilitators to a productive partnership and positive outcomes include a context of trust, effective implementation of processes that establish equitable partner relationships and partnership synergy, a clearly defined focus for the partnership and a structured participatory research method that helped break down silos and mobilise the community for action. Our project evaluation approach, combining the CBPR model and REM, guided measurement of common metrics that are key to effective community engagement as well as exploration of unanticipated outcomes.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who submit articles to this journal from 31st March 2014 for publication, agree to the following terms:
a) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share and adapt the work with an acknowledgement of the work's authorship and initial publication in this journal.
b) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
c) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Open Access Citation Advantage Service). Where authors include such a work in an institutional repository or on their website (ie. a copy of a work which has been published in a UTS ePRESS journal, or a pre-print or post-print version of that work), we request that they include a statement that acknowledges the UTS ePRESS publication including the name of the journal, the volume number and a web-link to the journal item.
d) Authors should be aware that the Creative Commons Attribution (CC-BY) License permits readers to share (copy and redistribute the work in any medium or format) and adapt (remix, transform, and build upon the work) for any purpose, even commercially, provided they also give appropriate credit to the work, provide a link to the license, and indicate if changes were made. They may do these things in any reasonable manner, but not in any way that suggests you or your publisher endorses their use.
For Volume 6 (2013) and before, the following copyright applied:
Articles published by UTSePress are protected by copyright which is retained by the authors who assert their moral rights. Authors control translation and reproduction rights to their works published by UTSePress. UTSePress publications are copyright and all rights are reserved worldwide. Downloads of specific portions of them are permitted for personal use only, not for commercial use or resale. Permissions to reprint or use any materials should be directed to UTSePress.
References
Chazdon, S., Emery, M., Hansen, D., Higgins, L., & Sero, R. (2017). A Field Guide to Ripple Effects Mapping. University of Minnesota Libraries Publishing.
Dedding, C., Goedhart, NS., Broerse, JE., & Abma, TA. (2021). Exploring the boundaries of ‘good’ participatory action research in times of increasing popularity: dealing with constraints in local policy for digital inclusion. Educational Action Research, 29(1), 20-36. https://doi.org/10.1080/09650792.2020.1743733
Emery, M., Higgins, L., Chazdon, S., & Hansen, D. (2015). Using Ripple Effect Mapping to evaluate program impact: Choosing or combining the methods that work best for you. Journal of Extension 53(2). Retrieved from http://www.joe.org/joe/2015april/tt1.php
Engage for Equity. Expanding Community Engaged Surveys to More Partners. https://engageforequity.org/tool_kit/surveys/. Accessed on January 2, 2021.
Hargrove AJ, Rafie C, Zimmerman E, Moser DE., (2022). A rural community's perspective on the causes of and solutions to the opioid crisis in southern Virginia: a qualitative study. Rural Remote Health, Jun;22(2):7152. doi: 10.22605/RRH7152.
Hicks, S., Duran, B., Wallerstein, N., Avila, M., Belone, L., Lucero, J., Magarati, M., Mainer, E., Martin, D., Muhammad, M., Oetzel, J., Pearson, C., Sahota, P., Simonds, V., Sussman, A., Tafoya, G., & Hat, EW. (2012). Evaluating community-based participatory research to improve community-partnered science and community health. Progress in community health partnerships:research, education, and action, 6(3), 289–299. https://doi.org/10.1353/cpr.2012.0049
HHS.gov. HHS Acting Secretary Declares Public Health Emergency to Address National Opioid Crisis. U.S. Department of Health and Human Services. October 26, 2017. https://www.hhs.gov/about/news/2017/10/26/hhs-acting-secretary-declares-public-health-emergency-address-national-opioid-crisis.html
Hoffman, A, Montgomery, R, Aubry, W, Tunis, SR., (2010). How best to engage patients, doctors, and other stakeholders in designing comparative effectiveness studies. Health Aff (Millwood), 29(10):1834-1841. http://dx.doi.org/10.1377/hlthaff.2010.0675.
Höppner, C. (2009). Trust—A monolithic panacea in land use planning? Land Use Policy, 26(4), 1046-1054. https://doi.org/10.1016/j.landusepol.2008.12.007
Israel, BA., Coombe, CM., Cheezum, RR., Schulz, AJ., McGranaghan, RJ., Lichtenstein, R., Reyes, A. G., Clement, J., & Burris, A. (2010). Community-based participatory research: a capacity-building approach for policy advocacy aimed at eliminating health disparities. American journal of public health, 100(11), 2094–2102. https://doi.org/10.2105/AJPH.2009.170506
Israel, BA., Lachance, L., Coombe, CM., Lee, SD., Jensen, M., Wilson-Powers, E., Mentz, G., Muhammad, M., Rowe, Z., Reyes, AG., & Brush, BL. (2020). Measurement Approaches to Partnership Success: Theory and Methods for Measuring Success in Long-Standing Community-Based Participatory Research Partnerships. Progress in community health partnerships : research, education, and action, 14(1), 129–140. https://doi.org/10.1353/cpr.2020.0015
Jagosh, J., Bush, PL., Salsberg, J., Macaulay, AC., Greenhalgh, T., Wong, G., Cargo, M., Green, LW., Herbert, CP., & Pluye, P. (2015). A realist evaluation of community-based participatory research: partnership synergy, trust building and related ripple effects. BMC public health, 15, 725. https://doi.org/10.1186/s12889-015-1949-1
Jagosh, J., Macaulay, AC., Pluye, P., Salsberg, J., Bush, PL., Henderson, J., Sirett, E., Wong, G., Cargo, M., Herbert, CP., Seifer, SD., Green, LW., & Greenhalgh, T. (2012). Uncovering the benefits of participatory research: implications of a realist review for health research and practice. The Milbank quarterly, 90(2), 311–346. https://doi.org/10.1111
Kapiriri, L, Norheim, OF. (2002). Whose priorities count? Comparison of community-identified health problems and Burden-of-Disease assessed health priorities in a district in Uganda. Health Expect, 5:55-62. doi: 10.1046/j.1369-6513.2002.00161.x
Khodyakov, D., Stockdale, S., Jones, F., Ohito, E., Jones, A., Lizaola, E., & Mango, J. (2011). An exploration of the effect of community engagement in research on perceived outcomes of partnered mental health services projects(). Society and Mental Health, 1(3), 185–199. https//doi.org/10.1177/2156869311431613
Lasker, RD., Weiss, ES., & Miller, R. (2001). Partnership synergy: a practical framework for studying and strengthening the collaborative advantage. The Milbank quarterly, 79(2), 179–IV. https://doi.org/10.1111/1468-0009.00203
Lomas, J, Fulop, N, Gagnon, D, Allen P. (2013). On being a good listener: setting priorities for applied health services research. Milbank Q, 81(3):363-88. doi:10.1111/1468-0009.t01-1-00060
Lucero, JE. (2013) Trust as an Ethical Construct in Community Based Participatory Research Partnerships. https://digitalrepository.unm.edu/cj_etds/43
McElfish, PA., Kohler, P., Smith, C., Warmack, S., Buron, B., Hudson, J., Bridges, M., Purvis R., Rubon-Chutaro, J. (2015). Community-Driven Research Agenda to Reduce Health Disparities. Clinical and Translational Science, 8(6), 690-695. https://doi.org/10.1111/cts.12350
Meyer, J. (2000). Evaluating action research. Age and ageing, 29(suppl_2), 8-10. https://doi.org/10.1093/oxfordjournals.ageing.a008104
Oetzel, JG., Wallerstein, N., Duran, B., Sanchez-Youngman, S., Nguyen, T., Woo, K., Wang, J., Schulz, A., Keawe'aimoku Kaholokula, J., Israel, B., & Alegria, M. (2018). Impact of Participatory Health Research: A Test of the Community-Based Participatory Research Conceptual Model. BioMed research international, 2018, 7281405. https://doi.org/10.1155/2018/7281405
O’Haire, C, McPheeters, M, Nakamoto, EK, LaBrant, L, Most, C, Lee, K, Graham, E, Cottrell, E, Guise, JM. (2011). Engaging stakeholders to identify and prioritize future research needs. Methods Future Research Needs Reports, No. 4. Rockville, MD: Agency for Healthcare Research and Quality.
Oliver, S, Clarke-Jones, L, Rees R, Milne R, Buchanan P, Gabbay J, Gyte G, Oakley A, Stein K., (2004). Involving consumers in research and development agenda setting for the NHS: developing an evidence- based approach. Health Technol Assess., 8(15):1-148. https://doi.org/10.3310/hta8150
Organizing Committee for Assessing Meaningful Community Engagement in Health & Health Care Programs & Policies. 2022. Assessing Meaningful Community Engagement: A Conceptual Model to Advance Health Equity through Transformed Systems for Health. NAM Perspectives. Commentary, National Academy of Medicine, Washington, DC. https://doi.org/10.31478/202202c.
Peralta, AM., Smihtwick, J., & Torres, ME. (2020). Perceptions and determinants of partnership trust in the context of Community-Based Participatory Research. Journal of health disparities research and practice, 13(1),67-95. https://digitalscholarship.unlv.edu/jhdrp/vol13/iss1/4
Pohl, C., & Hadorn, GH. (2008). Methodological challenges of transdisciplinary research. Natures Sciences Sociétés, 16(2),111-121. https://doi.org/10.1051/nss:2008035
QuickFacts. United State Census Bureau. Accessed May 14, 2020. https://www.census.gov/quickfacts/
Rafie C, Zimmerman EB, Moser DE, Cook S, Zarghami F. (2019). A lung cancer research agenda that reflects the diverse perspectives of community stakeholders: process and outcomes of the SEED method. Research Involvement and Engagement, 5:3. doi.org/10.1186/s40900-018-0134-y
Reason, P., & Bradbury, H. (2001). Handbook of action research: Participative inquiry and practice: Sage.
Reese, AL., Hanza, MM., Abbenyi, A., Formea, C., Meiers, SJ., Nigon, JA., Osman, A., Goodson, M., Njeru, JW., Boursaw, B., Dickson, E., Wieland, ML., Sia, IG., & Wallerstein, N. (2019). The Development of a Collaborative Self-Evaluation Process for Community-Based Participatory Research Partnerships Using the Community-Based Participatory Research Conceptual Model and Other Adaptable Tools. Progress in community health partnerships:research, education, and action, 13(3), 225–235. https://doi.org/10.1353/cpr.2019.0050
Sandoval, JA., Lucero, J., Oetzel, J., Avila, M., Belone, L., Mau, M., Pearson, C., Tafoya, G., Duran, B., Iglesias Rios, L., & Wallerstein, N. (2012). Process and outcome constructs for evaluating community-based participatory research projects: a matrix of existing measures. Health education research, 27(4),680–690. https://doi.org/10.1093/her/cyr087
Study: Martinsville Opioid Prescriptions in Country:A new report finds the city of Martinsville was first in the nation in per-capita opioid prescriptions. (2017, July 12). US News & World Reports. https://www.usnews.com/news/best-states/virginia/articles/2017-07-12/study-martinsville-opioid-prescriptions-highest-in-country.
UNM Health Sciences Center: Center for Participatory Research. CBPR Model. (n.d.) https://cpr.unm.edu/research-projects/cbpr-project/cbpr-model.html.
Virginia Department of Health. Opioid Data:Data. https://www.vdh.virginia.gov/opioid-data/data/.
Wallerstein, N, Duran, B. (2006). Using Community-Based Participatory Research to Address Health Disparities. Health promotion practice, 7(3),312-323. doi:10.1177/1524839906289376
Wallerstein N, Duran B. (2010). Community-Based Participatory Research Contributions to Intervention Research: The Intersection of Science and Practice to Improve Health Equity. Am J Public Health. 100:S40–S46. doi:10.2105/AJPH.2009.184036
Wallerstein N, Oetzel J, Duran B, Tafoya G, Belone L, Rae R. (2008). What predicts outcomes in CBPR? In:Minkler M, Wallerstein N, eds. Community Based Participatory Research for Health: Process to Outcomes. 2nd ed. San Francisco, CA: Jossey-Bass; pgs.371–392.
Wallerstein, N., Oetzel, JG., Sanchez-Youngman, S., Bursaw, B., Dickson, E., Kastelic, S., Koegel, P., Lucero, JE., Magarati, M., Ortiz, K., Parker, M., Peña, J., Richmond, A., & Duran, B. (2020). Engage for Equity: A Long-Term Study of Community-Based Participatory Research and Community-Engaged Research Practices and Outcomes. Health Education & Behavior. 47(3):380-390. doi:10.1177/1090198119897075
Windsor, LC. (2013). Using Concept Mapping in Community-Based Participatory Research: A Mixed Methods Approach. J Mix Methods Res., 7(3):274–293. doi:10.1177/1558689813479175.
Wold, B, & Mittelmark, MB. (2018). Health-promotion research over three decades: The social-ecological model and challenges in implementation of interventions. Scandinavian journal of public health, 46(20_suppl), 20-26.
Zimmerman EB, Cook SK, Haley AD, Woolf SH, Price SK., (2017). A patient and provider research agenda on diabetes and hypertension management. Amer J Prev Med. 53(1):123-129. http://dx.doi.org/10.1016/j.amepre.2017.01.034
Zimmerman EB, Cook SK, Woolf SH, Price SK, Haley A, Rafie C, Moser D. (2020). Developing a Method for Engaging People in Setting Research Agendas. Patient-Centered Outcomes Research Institute (PCORI). https://doi.org/10.25302/04.2020.ME.131007664
Zimmerman EB, Rafie C, Moser DE, Hargrove A, Noe T, Adams Mills C. (2020). Participatory action planning to address the opioid crisis in a rural Virginia community using the SEED Method. J Particip Res Methods, 1(1). https://jprm.scholasticahq.com/article/13182.