By David Robinson
UAMS’ Nancy Greer-Williams, Ph.D., M.P.H., is a newcomer to the South, but her earnest, low-key manner and a $25 gift card helped her record the stories of nearly 100 marginalized Arkansans.
“I wish I had a reality television show because it’s amazing what we don’t know, what we don’t see when we’re driving down the street,” said Greer-Williams, a researcher who spent six months in Texarkana as part of a health disparities study.
While she was interviewing Hispanics, blacks and whites, Greer-Williams also was getting to know health care providers and finding prospective community health workers to assist those who lack access to health care. Her brand of health disparities research includes the community in determining what future research projects could best address their needs. »
Her immersion into Texarkana’s underserved population is part of a long-term project that relies on community trust and lasting community partnerships. In academic circles it is known as “community-engaged research.”
‘To Make a Difference’
The practice of community engagement has been gaining steam in the public health arena over the last 20 years, and more recently it has become a national movement. Community-engaged research is considered so vital to advancing science that it’s a core component of the federally funded Clinical and Translational Science Awards (CTSA) granted to UAMS and 59 other academic medical research institutions. UAMS, which is using the CTSA grant to support its Translational Research Institute, has made community engagement a priority.
Community engagement goes to the heart of why we’re doing research, which is to make a difference in the real world,” said UAMS’ Greer Sullivan, M.D., who has 15 years experience in community engagement and is leading the Translational Research Institute’s Community Engagement Component. “It’s especially important for Arkansas, which is a poor, unhealthy state with serious health disparities.”
UAMS has more than 40 community engagement researchers, including Kate Stewart, M.D., M.P.H., who for 10 years has led the College of Public Health’s Office of Community-Based Public Health. Stewart has used a participatory approach to community engagement to form strong partnerships with groups in the east Arkansas Delta. Her research also has helped sustain community programs financially by showing that they actually save tax dollars.
In one example, Stewart, UAMS’ Holly Felix, Ph.D., and Glen Mays, Ph.D., partnered with the Tri-County Rural Health Network, which trains and hires “community connectors” who live and work in Phillips, Lee and Monroe counties. Those connectors help people who need long-term care to access home and community-based services. Stewart and Felix became particularly interested in their work helping the elderly and adults with disabilities remain in their homes, avoiding placement in nursing homes.
The research project that studied the savings generated by helping people remain in their homes found that the Tri-County Rural Health Network saved almost $3 per dollar spent by Medicaid. The Community Connector Program has since been recognized nationally, and Medicaid has funded its expansion into 15 Delta counties.
“The partnership between UAMS and Tri County is a good example of how research can help sustain good programs,” Stewart said. “The Translational Research Institute’s support is now funding both Dr. Felix and me to do further research with Tri County on the connector model.”
The emphasis on community-engaged research is an outgrowth of tightening research budgets and some hard questions from national leaders about the kinds of research being funded with tax dollars. That narrowing of priorities helped spur the parallel movement toward clinical and translational science, which puts a premium on research that is most useful and relevant to public health, and a system for efficiently moving those discoveries into the public domain.
In that vein, UAMS’ community engagement scientists have distanced themselves from a time when a van full of well-meaning researchers with an esoteric study topic might have driven to a community whose residents had no input in the planning, fanned out with questionnaires for a few days to mine data, and then returned to their university campus, never to be heard from by the community again.
“The old model wasn’t working,” said Robert Price, Ph.D., a veteran community engagement researcher who leads the Division of Research and Practice Improvement for the AHEC program and the Center for Rural Health, where Greer-Williams also is based. “Today’s model of community-engaged research helps ensure that our science is relevant to the people.”
Community input is vital for vetting research ideas, said Ronda Henry-Tillman, M.D., who has 12 years of community engagement experience and directs the Cancer Control Program in the UAMS Winthrop P. Rockefeller Cancer Institute.
“Sometimes our agenda is not the community’s agenda,” said Henry-Tillman, whose research includes the Mobile Mammography Program and colorectal cancer education and screening in Mississippi and St. Francis counties. “I think a lot of times we think, ‘Well, we’ve got all this science and all we need to do is get it out there.’ What we need to do is work with the community on how to translate it; how does it fit in their community? Who is the target and how do you get that target?”
UAMS hopes to fuel its community engagement momentum with resources provided by the Translational Research Institute’s Community Engagement Component. In 2012, the institute will establish a pool of commonly used equipment in community-engaged research, such as tent canopies and portable DVD players used in presentations, and iPads for data collection.
“The Community Engagement Component of the Translational Research Institute has identified almost 50 funded community engagement projects across UAMS’ colleges, but many of our researchers are unaware of their colleagues’ work,” Sullivan said. “So the institute is acting as an umbrella organization to bring them together for networking, collaboration and training.”
In 2011 the component embraced Greer-Williams’ idea to create the Community Engagement/Health Disparities Research Interest Group, which held its first meeting that May. The group plans to hold future meetings, which include regular workshops and small-group discussions, to advance community-engaged research.
During its 2011 meeting, local health providers, community groups and nonprofit organizations joined with researchers representing the five UAMS colleges and Graduate School, as well as UAMS’ Center for Rural Health, Area Health Education Centers (AHEC), Psychiatric Research Institute, Dennis Developmental Center, Arkansas Aging Initiative and Arkansas Children’s Hospital.
The Community Engagement Component also has identified key partners, including the Clinton School of Public Service, Arkansas Coalition for Obesity Prevention, the Central Little Rock Promise Neighborhood, and the Arkansas Community Foundation.
In spring 2012, the component will establish a Translational Research Institute community advisory board with membership from key community leaders in Arkansas. The board will provide direction and advice to the institute and its Community Engagement Component.