The Community Engagement Core

Specific Aims

The Community Engagement Core (CEC) advances methods for stimulating research participation, recruitment, and participant retention through collaborations between community residents and the RCMI faculty. The CEC will establish "long-term partnerships with community-based organizations" that are programmatically equipped to address health and socioeconomic disparities among disadvantaged populations. The CEC Leader has developed relationships with the Southern Christian Leadership Foundation (SCLF), the Tuskegee Citizens Power Lunch, and the Macon County School System. We will leverage resources from each organization to form a mutually effective link between CEC faculty and Tuskegee/Macon County residents. The CEC will accomplish this by instituting community-involved scientific discoveries that include the following specific Aims:

  • Specific Aim 1: Converse a council of community representatives and RCMI faculty to complete a needs assessment containing community-based recommendations for dissemination of effective obesity and HIV education.
  • Specific Aim 2: Engage residents in town hall meetings serving as a medium for dissemination of faculty research. Measure the effectiveness of these meetings through surveys. Compare survey outcomes.
  • Specific Aim 3: Develop a model of optimal participation based on the scientific assessment of town hall meetings.
  • Specific Aim 4: Promote community-engaged, interdisciplinary learning and mentorship.

The direction of any project is determined at its onset. Projects, especially those that purport to be community-based and participatory, that begin on the institution level and trickle down to community may not be resident-friendly. The Tuskegee RCMI CEC begins at the community level. The first Specific Aim ask residents what benefits them in terms of scientific research and dissemination. Thus, the CEC is designed to rise from the community, not trickle down from the institution.

The Core Leader and SCLF representatives will nominate Healthy Equity Resource Officers (HERO’s) to serve as liaisons between the community and the faculty. HERO’s will take the lead in expressing the perspectives that faculty should take to serve the community. HERO’s will then meet with RCMI faculty to discuss best practices for dissemination of education using a town hall format. By providing a regular stream of education, the town hall meetings will extend the existing work on HIV education conducted by the SCLF.

Sustainability will be enhanced through the interdisciplinary, innovative learning and mentorship program that will train a new generation of researchers to identify and then address existing health disparities. Similarly, the SCLF has student interns who work with the organization. These interns are trained in education dissemination, social media marketing, and interpersonal community outreach. They represent the next generation of community health advocates. By providing facilities, classrooms, and students, Tuskegee University will be a partner in the CEC.

Research Strategy

Significance and Impact:

Project significance is revealed in the socioeconomic character of the Black Belt region, where residents often struggle with the basic needs. In a region where residents have substantial potential to make contributions to society, progress is slowed as economic problems persist with the out-migration of textile manufacturing, voter redistricting favoring urban population centers, a brain drain, and the lack of state funding for infrastructure.

The roots of health disparities are embedding in the socioeconomic disadvantages experienced by African Americans. The Core Leader has demonstrated how housing, labor, and tax distribution policy is used to manipulate market forces, which leads to a vicious cycle that includes poor development of human capital, low participation in the labor force, unstable family circumstances, and disadvantaged neighborhood environments. These economic effects disproportionately affect African American social and health outcomes and create inequities between African Americans and more advantaged groups.

As described above, health disparities are mediated by human capital, which is the amount of scholastic and experimental knowledge that, when translated into skills, can be exchanged in an economy. Human capital places value on the level of education, technical skills, and personal experiences possessed by an individual or group. Human capital therefore affects health disparities through the distribution of education, as knowledge affects health behavior. It also affects health disparities through financial empowerment, as knowledge determines if one can procure health services and resources for a healthy lifestyle. Furthermore, because it links individuals to causes beyond the self, human capital is the linchpin holding together interest in research participation, interest in research findings, self-efficacy, health behavior, and health beliefs.

This proposed project is also relevant because it seeks to empower a community that has experienced racial, political, and economic disadvantages. There are extensive social and economic disparities, especially in the city of Tuskegee, compared to the rest of Alabama. According to data of the 2010 Census, Tuskegee is 95.8% African American, and 22% of households in Tuskegee report an annual income below the Federal poverty level, compared to 13% for the state. Median household income in Tuskegee is $24,251, compared t0 $42,081 for the state. Furthermore, 30.4% of Tuskegee residents receive food stamp benefits, compared to 11.4% for the state. Housing is a key element of the neighborhood environment. Tuskegee has a vacancy rate of approximately 19%, compared to 13% for the state and a homeownership rate of 46.6%, compared to 24.2% of the houses having values less than 50,000, compared to 133,800 and 10.3%, respectively, for the among residents of the Black Belt, specifically Tuskegee.

Innovation - To Engage is to Power

 The CEC leverages expertise in human capital to develop a research and community engagement strategy that empowers faculty and residents by integrating individuals from traditionally disadvantaged groups into the scientific enterprise. When there are high levels of disparities between advantaged and disadvantaged groups, distrust in institutions becomes commonplace. Empowering residents by giving them more control over the research process helps to mitigate this distrust.

The SCFL recently hosted a Partnering and Communicating Together (PACT)- sponsored town hall meeting on HIV titled “Youth and Community Town Hall: Hearing Impactful Voices.” It was streamed on Facebook Live on World AIDS Day, December 1, 2016. The use of Facebook live provided an opportunity to bring local event to a national audience. Questions and comments were filed locally at the event and nationally through social media. This innovative strategy for dissemination mixes a modern medium for communication (social media) with a traditional format (town hall meeting).

Approach

Specific Aim 1: Convene a council of community representatives and RCMI faculty to complete a needs assessment containing community-based recommendations for dissemination of effective obesity and HIV education. Develop 5-7 theories for hoe such dissemination can promote community participation in research.

Residents connect with research by understanding how scientific outcomes affect them. The CEC will convene a council of TU RCMI faculty and HEROs. They will devise a strategy to strengthen the nexus between faculty research and interests of residents. The strategy will be based on best practices for translating research into participation. From this, the council will determine what methods connect with residents. The council will commence at the beginning of the funding period, and they will convene twice a month for the first three months, for a total of 6 sessions.

The council will produce 5-7 key theories of participation. Each theory will determine how to tailor research dissemination to capture the economic, cultural, and social nuances that are relevant to residents but are often lost in scientific expression. The theories can be conceptualized as “if-then” hypotheses. For example, if RCMI faculty translates scientific lingo into practical, everyday language, community residents will have a better understanding of how results affect them and will be more likely to join in the research process. The RCMI-HERO council will have latitude to suggest various types of delivery, including multi-media, language, dialect, and presenters.

The CEC will produce a series of town hall meetings (Specific Aim 2), each based on theories developed by the council. The meetings are designed to test theory effectiveness in optimizing participation via tailored research dissemination. David Nganwa, a RCMI faculty member with expertise in developing survey instruments, will develop a pre- and post-test survey to assess effectiveness. The survey will measure the following 1) resident likelihood in participating in research before and after the meeting; 2) The elements of the town hall dissemination that resonated with participants, and 3) Demographic characteristics of the residents.

Specific Aim 2: Engage residents in town hall meetings serving as a medium for dissemination of faculty research. Measure the effectiveness of these meetings through surveys. Compare survey outcomes.

The HERO and TU Research faculty council will produce an outline for six town hall meetings based on theories of participation developed during Specific Aim 1. Pre- and post-town hall surveys will be administered to assess the correlation between knowledge of research topics and the willingness of residents to participate in research. If the theories are effective, participants will have enhanced knowledge of the research topic, which creates a stronger connection between them and the science. This connection is hypothesized to increase their likelihood of participating in scientific studies.

The survey is an 8-item, Likert instrument. Four items measure resident knowledge of the topic presented, and four measure the likelihood that they would participate in a scientific study given what they know. We will calculate the correlation between knowledge and likelihood of participation before ad after each meeting. Stronger positive correlations after meetings would indicate an effective strategy for dissemination. Effect sizes using the separate variables (education, likelihood of participation) will also be calculated.

The town hall meetings will be facilitated by the SCLF (please see http://www.sclfoundation.org/ ), a national nonprofit with strong roots in the Tuskegee community. (The national headquarters is based in Tuskegee.) Several of its employees and volunteers are students at TU or are residents of Tuskegee, creating a rare environment of cooperation between the university and the town. The SCLF has experience in delivering health education. The SCLF is the recipient of the Partnering and Communicating Together (PACT) grant from the CDC. The objective of the grant is to administer HIV education through community events, media impressions, and social media. The Community Engagement Core Leader serves as the Evaluator of this grant.

The town hall meetings will borrow from the Tuskegee Citizens Power Lunch, and existing program in Tuskegee intended to promote economic empowerment through collective efficacy, a measure that assesses the ability of residents to accomplish shared goals through community engagement. The Core Leader serves as Principal Investigator for the Tuskegee Citizens Power Lunch Program. A goal of the Power Lunch is to provide a mechanism for increasing collective efficacy among residents using a community-centered forum that addresses key problems associated with economic disadvantage. The Power Lunches (ongoing) have produced the following:

  1. A large cadre of recorded dialogue that can be transcribed into qualitative data
  2. Increased student involvement with business leaders and residents in Tuskegee
  3. Business sponsorship
  4. Enduring relationships with businesses leaders
  5. An “economic needs” assessment report for Tuskegee

In addition to testing the theories of participation from Specific Aim 1, the town hall meetings will address the primary issue of the economic needs- assessment report developed during the Power Lunch: Unity among the university community and Tuskegee residents.

HEROs. Mrs. Bernice Frazier, the Executive Director of the SCLF, will organize the HERO team of community leaders and concerned citizens. The HEROs will be selected from the civic leaders, business leaders, ordinary residents, and students involved in the Power Lunches as well as from the PACT Board of Directors. There will be amplifying the research, health, and economic needs of the community.

Given its experience and expertise, the SCLF will market, host, and produce bimonthly town hall meetings, ensuring that they serve as a mechanism for the following:

  1. Testing the viability of each theory of participation through effective dissemination. A pre and post-test survey will determine if the method of dissemination in each town hall meeting was effective in increasing the likelihood of future research participation and retention.
  2. Dissemination of education resources. Education resources consist of HERO-recommend content delivered to a local, in-person audience and to a wider audience via Facebook live stream.
  3. Recruitment of study participants. The town hall meetings are structured to educate, which promotes human capital among the audience. By increasing individual human capital – in this case in the form of health education – potential participants will control the spread of information, minimizing distrust. (Distrust is a key factor in reducing participation rates.) Furthermore, the town hall meetings will have a five-minute segment dedicated to recruitment advertising in which HEROs will discuss the importance of participation. The local audience will receive study materials.
  4. Retention of study participants. Study participants will have a stake in the information they produce, as it becomes sections of the town hall content.
  5. Dissemination of research findings. HERO-developed content for the town hall meetings will emphasize study results.

Streaming of the town hall meetings will allow information emanating from Tuskegee to spread across a national audience. With this method, the meetings will combine traditional, in-person collaboration with modern social media networking. The meetings will therefore maintain a small-town character while appealing to a larger audience. Facebook Analytics will allow us to collect data on viewership.

In years 2-5, TU faculty members will continue to empower the community using the method of dissemination empirically proven to be the most effective in year 1.

Specific Aim 3: Develop a model of optimal participation based on the scientific assessment of town hall meetings.

Data from each meeting will be collected and securely stored by Research Associates. The RCMI Leadership will analyze the data. Analysis involves examining pre and post town hall surveys. The meeting that has the largest effect size will be selected as the strongest connector of residents with scientific research.

TU faculty and HEROs will examine the theory and dissemination strategy associated with the strongest town hall meeting. From this, TU faculty will develop a model illustrating best practices in community engagement.

Evaluation

The model developed from assessments of town hall meetings will serve as the benchmark for connecting residents with scientific investigations in the Tuskegee/Macon County area. In Years 2-3, the model will be tested again during town hall meetings. Stable or increased effect sizes over time would reflect sustainability of the delivery method.

Specific Aim 4: Promote Community-Engagement Interdisciplinary Learning and Mentorship.

The Core Leader is committed to student development and to the long-term goal of promoting community-engaged, interdisciplinary learning focused on health and social science-related research careers that promote health equity. To this end, the Core will partner with two under-resourced area high schools to establish a training pipeline of high school students to enter a four-year undergraduate degree programs and thereby increase diversity in the scientific workforce.

The Innovative Learning and Mentorship team will develop a series of health education modules using the delivery method defined in Specific Aim 2 and 3. The modules will be shared with students participating in a group to be defined as future Black Belt health and economic researchers. The innovative learning and mentorship program seeks to: 1) introduce students to healthy-equity, health disparities, and human capital educational modules and corresponding health and social science-related careers; 2) introduce students to leadership training through mentorship delivered by local community members; 3) introduce students to research methods such as qualitative, quantitative, and community-based participatory research: 4) utilize non-traditional, innovative methods to engage students in research dissemination; and 5) enhance idea production and development intended to ignite future innovation in the social and behavioral sciences.

The program, administered in years 2-5, will be implemented by Dr. Faith Fletcher, a graduate of Tuskegee University. Relevant to this application, she received bioethics training through the National Center for Bioethics in Research and Health at Tuskegee University and graduate-level training through Michigan State University’s interdisciplinary program in Bioethics, Humanities, and Society. Dr. Fletcher also completed her PhD in Health Promotion, Education, and Behavior at the University of South Carolina School of Public Health, and a postdoctoral fellowship in Behavioral Sciences and Cancer Prevention at the University of Texas MD Anderson Cancer Center. Dr. Fletcher has more than a decade of experience in designing health behavioral interventions for disadvantaged populations, health disparities research, publishing, and grantsmanship. She has also developed a student-based, health behavior intervention for Carver High School in Birmingham, Alabama.

The schematic approach to Specific Aim 4 promotes community engagement by integrating high school students into the research process at its initial stage. By engaging students in innovative learning and mentoring, they gain human capital development that includes:

  1. Learning the conceptual nuances of conducting basic research
  2. Developing presentation skills (public speaking)
  3. Understanding hoe economic factors and health disparities are linked
  4. Developing a network of mentor advocates

In her role, Dr. Fletcher will borrow from the NIH-funded HiStep program (http://www.training.nih.gov/histep ). HiStep combines an introduction to scientific, professional, and personal skills with leadership training and an exploration of STEM-M (science, technology, engineering, math, and medically-related) careers. In addition, it provides college and career advice that assists participants in receiving future scholarships and internships.

Overall, mentoring will promote a virtuous circle of healthy lifestyle practices, human capital development, economic development, and a high quality of life. At the end of each semester, students will be required to develop a presentation reflecting what they learned and how it is affecting their lives.