Academic journal article Health and Social Work

Using Community-Based Participatory Research to Ameliorate Cancer Disparities

Academic journal article Health and Social Work

Using Community-Based Participatory Research to Ameliorate Cancer Disparities

Article excerpt

Health disparities in the United States exist by race and ethnicity, gender, age, disability status, sexual orientation, socioeconomic status (SES), and geography and can occur in screening, incidence, mortality, survivorship, and treatment. To date, disparities by race and ethnicity have received the most attention and have been noted for all major diseases. It is alarming that the gap between racial and ethnic groups continues to increase through time for many diseases. Although cancer mortality decreased between 1975 and 2004 for the U.S. population as a whole, significant African American and white gaps persist for both women and men (Horner et al., 2009).

Disparities in health and health care began to receive major attention in 1998 with the launch of the Racial and Ethnic Health Disparities Initiative and its charge to public officials to address disparities. Subsequently, reducing health disparities is one of the two major goals of Healthy People 2010 and continues to be a major focus of federal research and policy interventions. Yet, despite this attention, little progress has been made in what is basic to the enterprise, namely, developing interventions to reduce disparities (Voelker, 2008). In a meta-analysis of interventions developed to reduce racial and ethnic disparities, Chin and colleagues (Chin, Wakers, & Cook, 2007) concluded that too few interventions have been launched that are based on rigorous empirical studies, and that "multi-factorial, culturally-tailored interventions that target different causes of disparities hold the most promise" (p. 7).

Achieving the multifactorial approach to eliminating disparities suggested by Chin et al. (2007) requires that disciplinary scholars work more closely than they have traditionally done (Gehlert et al., 2010). Likewise, the culturally tailored interventions suggested can be achieved only when academic researchers draw on the knowledge and resources of communities vulnerable to adverse health conditions.

Community-engaged research (CEnR) is a means of drawing on the expertise and resources of communities that has proven effective in improving health outcomes among racial and ethnic group members (Two Feathers et al., 2005). Broadly defined, CEnR is a set of approaches that focuses on the creation of a working and learning environment between academic researchers and community stakeholders that extends from before a research project begins to beyond its completion (Ross et al., 2010). CEnR approaches can be arrayed along a continuum from low to high community engagement in research (see Figure 1).

Three approaches on the high end of community engagement are community-partnered participatory research, tribal participatory research, and community-based participatory research (CBPR). All three CEnR approaches hold potential for ameliorating health disparities, by virtue of their ability to improve health outcomes for racial and ethnic minority group members (see, for example, Wells et al., 2000), with consequent narrowing of the gap between groups. CBPR, which also has been referred to as participatory research or participatory action research, arguably, is the most versatile of the three approaches and thus, arguably, is the most useful for social work researchers. Although community-partnered participatory research and tribal participatory research share the same perspective as CBPR, they are tailored to specific partner groups. Community-partnered participatory research (Jones & Wells, 2007), for example, is more likely to be conducted by physicians than by members of other disciplines and takes into account their unique challenges, such as balancing the roles of clinician and researcher and having limited encounter time. Tribal participatory research is designed specifically to infuse the research process with an understanding of the impact of historical events on the lives of American Indians and Alaska Natives (Fisher & Ball, 2002, 2003). …

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