Lasting impact: A co-led community-academic model for a sustainable community-based participatory research training program

Abstract

Community-Based Participatory Research (CBPR) is a critical component in building trust and trustworthiness, as well as mitigating power differentials – all of which are essential for building and sustaining community-academic partnerships. Since 2017, the University of Rochester Medical Center has co-created and co-facilitated a CBPR Training Program with community partners and academics to address these dynamics through didactic modules and group conversations. Innovations and pivots such as adding additional educational modules on grant writing and dissemination and implementation, plus redefining meeting times and locations have occurred in response to evaluation data and continuous quality improvement. Annual program evaluation, measured through surveys and focus groups, found program participants demonstrated a statistically significant increase in CBPR knowledge, CBPR skills, and ability to partner in a CBPR context before and after the program (<0.05), a result that was sustained when stratified by several program years. Qualitative results highlighted the importance of building and nurturing relationships built on trust, sharing resources, and ensuring students end the course ready to engage in CBPR. This project provides a model of teaching CBPR within a milieu that breaks down barriers to effective and meaningful CBPR.

Significance for public health

Utilizing community-based participatory research methods engages community members most impacted by research findings in every stage of research, from development to implementation of findings. This paper describes the creation, implementation, and sustainability plans of a CBPR training program at an academic medical center. The program aimed to address specific principles of community engagement, specifically being clear about the population being engaged and engagement goals, building and sustaining partnerships built on trustworthiness, appreciating the historical power inequities between institutions and communities, and increasing resources to sustain partnerships.

Introduction

Now more than ever, it is vital that academic and research centers adapt and function in ways that directly prioritize health equity ¹ and prioritize transformational healthcare and research via evidence-based knowledge generation, continuous quality improvement, and broad interest-holder engagement. ² Engagement includes building authentic partnerships between individuals in our communities and researchers from academic-medical institutions. Community-based participatory research (CBPR) prioritizes the fair and equitable participation of both community members and academic collaborators at every stage of the research process. ³ This research approach has been increasingly used over the past few decades to address health inequities^4–6 because it recognizes the power of community perspectives and addressing health inequities that matter most within communities. This paper describes the development of a CBPR training program at an academic medical center that aims to address specific principles of community engagement, specifically being clear about the population being engaged and engagement goals, building and sustaining partnerships built on trustworthiness, appreciating the historical power inequities between institutions and communities, and increasing resources to sustain partnerships. ⁷ This work aligns with current national efforts to ensure that meaningful community engagement is defined and measured through the lens of the impact and priorities that are most important within communities. ⁸

The backdrop of historical and structural inequities in a region creates the context through which partnerships for addressing health and creating long-term impact take form and reverberate over time. While the existence of community and academic relationships are not unique to the work of the University of Rochester (UR) Clinical and Translational Science Institute (CTSI), the formation of the CTSI Community Engagement Function almost 20 years ago sought to redefine how power was and is distributed and enacted in research relationships. The work of the Function has been to consistently reposition the expectation of community-based research partnerships; these must be driven by academic and community partners in equal measure. Preparation at the partnership formation and implementations stages was identified as a key area for greater influence to policy and future outcomes, areas also being identified by other institutions.^9,10

To support the goal of increased capacity to conduct CBPR and community-engaged research across the full spectrum of translational research, from bench to patient bedsides, in 2017 the UR CTSI partnered with the community-based Center for Community Health & Prevention (CCHP) to develop a CBPR Training Program based on the Columbia University Irving Institute model. ¹¹ Established as a separate infrastructure within the University of Rochester in 2006, and with the mission “to join forces with the community to promote health equity; improve health through research, education and services, and policy,” CCHP is a local model for community engagement and team science. Programs of CCHP provide direct service to people in need of health promotion and support within our local region and forge partnerships for long-term community health impact. The partnership between CCHP and CTSI is unique in that it intentionally connects a CTSA hub with a community-based prevention-focused center, combining the CTSI’s research infrastructure with CCHP’s longstanding community relationships to advance health equity. Staff and faculty in community-engaged research and CBPR have joint appointments within CTSI and CCHP, further increasing the connection and reach of this critical work.

Using principles of community engagement, the CBPR Training Program goals were twofold: (1) to develop a comprehensive curriculum for CBPR training that reflects the needs, priorities, and expertise of both community members and researchers and (2) to cultivate a sense of shared ownership and commitment to the success of the CBPR Training Program among all priority groups involved in co-development and co-facilitation.

Our CBPR Training Program is unique because it was co-created and is co-delivered by a rotating mix of community and academic partners, including past program participants, ensure diverse perspectives, and shared ownership. It is also programmatically responsive, adding and changing modules as needs evolve, and it combines didactic content with separate time for teambuilding to strengthen collaboration. The program also demonstrated that requiring pre-formed pairs to enroll is not necessary for successful CBPR training. Participants were able to identify shared research interests and naturally create a number of fruitful community–academic teams by bringing together academics and community members who had not previously partnered.

Training program development

Drawing on the unique partnership with CCHP and leveraging the existing relationships with community members, six faculty and staff members from the UR (AA, JPC, TG, GN, SS, & AMW) plus six community partners (SB, JD, JE, MF, AP, & JW), all with experience in CBPR, formed a task force to co-create the CBPR Training Program. The task force draws on long-standing relationships among CCHP, CTSI, URMC, UR faculty and staff, and community partners, which were established through years of collaboration on a variety of local health equity initiatives and research projects. Some members of the task force had also served on our URMC Community Advisory Council, which was created in 2006 to represent the community and guide and support URMC’s missions of education, research, patient care, and community health. All of these connections and relationships, built on trust and accountability, provided a strong foundation for the task force’s work, and can serve as a model for other teams developing similar curricula. Over a period of 8 months from June 2017 to January 2018 the group met for 10 two-hour meetings. The task force utilized CBPR principles and followed community-led priorities to determine the important, needed content for the curriculum. ¹² Facilitators for each planning session ensured that community partners’ expertise was centered in the discussions, and conversations included building trust and sharing power.

Based on CBPR principles of building and sustaining trustworthy partnerships and increasing resources, the task force chose to implement several components of the Columbia program, including enrolling both researchers and community partners to learn together and providing an opportunity to apply for pilot research funding after program completion. Based on the same CBPR principles in addition to appreciating historical power inequities, the UR CTSI task force team suggested several innovations, including identification of co-facilitators for each class which incorporated diverse perspectives and expertise throughout the community and open enrollment of teams or individuals, with the intention and hope of fostering the organic development of relationships and collaborative groups.

As part of curriculum development, a Community Engagement Studio was held to solicit additional feedback about the proposed topic areas and format for the CBPR course. ¹³ Community Engagement Studios, consisting of a brief presentation and facilitated discussion, are opportunities for direct feedback and input from people impacted most by research and programs. ¹⁴ Important input was received during this session from an additional eight community members and four academic researchers who were recruited through the task force’s personal and professional networks, with all participants having prior experience in CBPR. Aligned with CBPR principles of community engagement, the most common themes included the need to address research stigma, power, building relationships and trust, communication skills, cultural understanding, designing research relevant to the community, challenges of doing community-engaged research, institutional practices, and demystification of words. This feedback was incorporated into the course content.

The task force agreed to base the program on the evidence-based published curriculum “Developing and Sustaining Community-Based Participatory Research Partnerships: A Skill Building Curriculum,” consisting of seven modules, developed by Community-Campus Partnerships for Health (Figure 1). ¹⁵ This curriculum addressed most topics prioritized by all input sessions. Dyads of task force members, consisting of a community member and a UR faculty/staff person who had an already established long-standing relationship, agreed to develop and deliver the content for each module based on expertise. The dyads were intended to model effective community-academic partnerships for CBPR and to help participants create opportunities for building sustainable partnerships in research.

Figure 1.

Components of original CBPR program, following the framework of Community Campus Partnerships for Health and modeled from the Columbia University Irving Institute program,^11,15 and the current CBPR program, which incorporated continuous quality improvement and evaluation results.

As a critical aside, it is a value of trustworthy academic-community partnerships, including those the UR CTSI builds and sustains, to ensure equitable compensation commensurate with the depth and extent of work conducted together. The fight for equitable compensation for community members’ expertise and time has long been a problem for community-academic partnerships. This is postulated to be primarily due to a disparity in resource allocation practices in traditional university systems that value the degrees earned by academics more than the years of experience earned by community members. ¹⁶ To address historical power inequities, a discussion of community member compensation was initiated at the first task force meeting. As a result, community members were financially compensated for all time spent on the project, including co-developing and co-delivering their assigned modules and task force planning meetings. Community partners on the planning task force were compensated $100 for each 2-hour meeting. Each community didactic co-facilitator receives $500 per presentation, which reflects both preparation and content delivery time in the class setting.

Course implementation

The course pilot took place over seven weekly sessions in February and March 2018. This free course was open to UR faculty, staff, and trainees as well as community members (typically from community-based organizations). The training program was intended for university faculty, staff, and trainees or community members, typically from community-based organizations, who are interested in learning more about, or conducting CBPR, and/or addressing local health inequities through research. Anyone can register, and applicants are asked to share any relevant experience, their reasons for signing up, and the types of research they are most interested in.

The training program was promoted through regular communications channels including social media, newsletters, and university and community listservs. The concept of “breaking bread” or sharing a meal has historically been associated with relationship building with potential benefits observed at communal, networking, and personal levels. ¹⁷ To that end, we promoted the training program through three information-sharing dinners at various urban community locations. These events provided an opportunity for interested UR faculty, staff, and trainees and community members to learn more about the training program, engage with CBPR research teams and course facilitators, and ask any questions they had, all while enjoying a meal together.

A total of 38 individuals enrolled in the first-year pilot, including 20 community members and 18 UR affiliated faculty, staff, and trainees. All modules were delivered weekly on Tuesdays, from 6 pm to 8 pm, in-person at the CCHP, located in the heart of the Rochester community with free parking available. The course participants all had common interests and objectives centered on acquiring comprehensive knowledge about CBPR (as assessed during the first group session). As a result, the group advanced through the course as a collaborative community of peers, engaging in mutual learning and benefiting from each other’s insight. ¹⁸

The current enrollment practice is if we receive more registrations than available spots, ²² we prioritize participants who show strong desire and commitment to engaging in this work. Participants enter the program with a wide range of prior experiences, from those new to CBPR to those with some previous exposure seeking to deepen their skills. Typically, all participants have the support of their respective organizations that enabled them to fully commit to participate in the training and apply what they learned to their current or future work.

Practical adaptations

Due to continuous quality improvement and entrepreneurial, innovative mindsets of the coordinators and facilitators, the course has evolved over time. Continuous review of the objectives, format and outcomes of a CBPR training program, including individual and group readiness for teaming, contributes to the relevance and impact of each iteration of the program. Considering feedback after the first year that 7 weeks was not long enough to form and build relationships, we extended the CBPR Training Program to a weekly, 7-month format that has continued since the second cohort began in August 2018. The training program did not take place in 2020; the program was canceled due to the COVID-19 pandemic. The CBPR training program now includes several different approaches, including in-person meetings to form and foster partnerships, didactic modules delivered by research dyads (a UR representative and community researcher) and learning activities that are designed to understand personal biases and research interests both individually and within the group (Figure 2).^19,20

Figure 2.

Timeline of CBPR Training Program process improvements.

Building trust, trustworthiness, and addressing historical power inequities continue to be hurdles to building partnerships between individuals in our communities with researchers from academic-medical institutions broadly.^21–23 The COVID-19 pandemic intensified these challenges, making community-engaged interactions both more needed and more difficult. ²⁴ The connections built through in-person interactions can create mutually comfortable, collaborative interactions, making community/academic partnerships possible. In the wake of the pandemic, the CBPR Training Program shifted to accommodate the changing dynamics of work, family, and social distancing requirements. The course was not held during the first year of the pandemic and underwent substantial shifts in 2021. Instead of all meetings taking place in person with food, the entire course shifted to being held online. We were concerned about the effects of this shift on trust building, but the group still bonded. The transformations continued as the program further developed into a hybrid format; since 2022, online didactic modules are paired with in-person group meetings. Additionally, the class time was altered from 5:30–7:30 pm to 3:30–5:30 pm to better meet the needs of individuals with evening caregiving duties.

Additional modules have been added to the training program curriculum over the years in response to identifying gaps in knowledge and educational needs. For example, the CBPR course now includes modules on Dissemination and Implementation, grant seeking and writing, and learning directly from those individuals previously funded for community research. Additional modules encompass an expanded focus on increasing resources by including seeking, finding, writing, and tracking grant applications, components taught by expert community grant writers. Lastly, the UR’s Wilmot Cancer Institute hosts a module focused on CBPR cancer research case studies.

The full course now includes both didactic modules taught by community/academic partner teams as well as group meetings facilitated by the co-leads from the UR CTSI Community Engagement Function and CCHP (JC & LS). In the current format, 1-h in-person sessions take place in the weeks between the didactic sessions. These sessions are essential for establishing a sense of community and fostering relationships, as they permit for deeper personal connections and spontaneous interactions. Additionally, they allow for real-time check-in on participants’ well-being and identification of any course-related needs. An example of an impactful activity is for the community members to work in one group and academic researchers in another, to list words that they associate with the word “research.” Strategies for course sustainability continue to be developed and implemented and have included ongoing evaluation and feedback for continuous quality improvement, covering community member co-facilitator compensation and costs for food/snacks, and recruiting course participants to become subsequent co-facilitators.

Assessing program impact

Within 2 weeks of completing the course, participants received a REDCap^25,26 evaluation survey (Appendix 1) to assess the extent to which the CBPR Training Program addressed the knowledge, skills, and ability to partner. After the initial email invitation containing the link to the survey, two more weekly reminders followed. The 16-item survey measured level of knowledge of CBPR before and after the program on a 4-point Likert scale from “no knowledge” to “advanced.” The survey also measured perceived skills in CBPR and ability to partner with an academic/community counterpart before and after the program with a 4-point Likert scale from “no skill” to “very skilled.” To account for the ordinal nature of data, a Wilcoxon signed-rank test, stratified by year, was conducted to compare the response scores of participants before and after the course, using an exact probability < 0.05 to determine statistical significance (Stata version 18).

To identify areas of possible improvement and uncover strengths of the program, three graduate students (NB, VL, & MR) from the University of Rochester Warner School of Education conducted a quality improvement evaluation including two virtual focus groups with participants in the 2023–2024 cohort. Focus group participants were asked a set of predetermined questions that were informed by measuring readiness for CBPR engagement, specifically how ready they were for engaging in CBPR, positive interactions, areas for potential growth, and recommendations.^27,28 The qualitative data was analyzed using inductive coding and mind map creation.

Evaluation results

Since the pilot cohort in 2017, 139 individuals have participated in the program; 48 community members and 69 UR faculty, staff, and trainees. This program currently hosts at least 20 individuals each year. All participants received the overall program evaluations with a final response rate of 39% (n = 54). A Wilcoxon signed-rank test revealed a statistically significant difference in the participants’ level of CBPR knowledge over time (z = −6.07, p < 0.001, n = 53), CBPR skills (z = −6.35, p < 0.001, n = 54), and ability to partner with an academic/community counterpart (z = −5.99, p < 0.001, n = 54).When stratified by program year, statistical significance (p < 0.05) remained for all measures of CBPR knowledge, CBPR skills, and ability to partner for all years except 2020 and 2023, in which only three and seven students completed the survey, respectively, and in 2019 only for ability to partner. It is important to note that to ensure anonymity, respondents were not asked whether they were from UR or a community organization.

Participants for the focus groups were recruited through a convenience sample, and the evaluation team, consisting of three part-time graduate students in evaluation and higher education, used reflexive practices to account for positionality in interpreting findings. Data from the focus groups underwent thematic analysis using a line-by-line transcript review, supported by mind mapping to identify patterns and relationships. The mind map helped visualize connections between data by showing the frequency with which similar sentiments were expressed during the focus groups. Four themes emerged from the analysis and were depicted in the final mind-map.

The focus groups consisted of cohort participants who self-selected to participate during their already scheduled group meeting time. Three researcher/trainees and four community members participated (n = 7/20 course participants equaling final participation rate of 35%). Themes that emerged from the focus groups, that were illustrated in a mind map included: (1) Engagement and Participation (which included community involvement, nurturing relationships, and active participation in the course), (2) Partnership and Collaboration (which included initiatives to develop and sustain partnerships and sharing resources), (3) Training and Preparedness (which included the courses’ effectiveness in preparing participants to engage in CBPR and readiness to engage in CBPR), and (4) Support and Resources (which included mentorship support systems and accessible resources to support CBPR collaborations). The evaluation team collectively determined that emergent subthemes for participant experience would help inform suggestions for continuous improvement.

Evaluation limitations include inability to link final evaluations to registration and that the perspectives of the small number of qualitative focus group participants (who were drawn from the most recent participants of the course) may not have been representative of those of early class cohorts. Similarly, the low response rate to the surveys may mean that the responses reflected only the most enthusiastic participants’ opinions. However, the evaluation is strengthened by the evaluators practicing reflexivity, including consistently examining their positionalities, assumptions, and biases influencing the evaluation process.

Discussion

The UR CTSI has effectively created and disseminated a CBPR training program in partnership with our community collaborators that is based on principles of community engagement and appropriately reflects the needs, priorities, and expertise of both community members and researchers. Overarching goals in developing a CBPR Training Program included (1) developing a comprehensive, responsive curriculum and (2) maintaining a commitment to shared ownership. This was achieved by continuous quality improvement and evaluation, iteratively incorporating participant feedback, and co-developing additional modules as needed to fill identified knowledge gaps.

For the first goal, Program successes emerged through the qualitative inquiry. Specifically, the activities that engaged all aspects of participants’ identities and perspectives, the active reflection upon the learning needs, and the focus on a supportive environment had reverberations for programmatic success. For each of the CBPR training program cohorts over the past 7 years, updates, changes, and innovations were part of the fabric of the program delivery. The relationships built were not only between the individuals in the course; relationships also are forged with the community engagement staff and faculty.

For the goal of shared ownership and commitment to the success of the CBPR Training Program, the involvement of many diverse groups in co-development and co-teaching was key. Shared ownership was also apparent in the continued involvement of many task force members as co-facilitators, as well as their peer-referrals to which led to continued new enrollment in the course. To support sustainability, we annually offer a minimum of one competitive 1-year CBPR Pathway-to-Pilot (P2P) Awards through the CTSI that is open to all program alumni. Nine P2P awards of $15,000 or more have been awarded to graduates of the program over a period of 6 years. Each funded project has community and academic co-principal investigators, and proposals are peer reviewed by community and academic CBPR experts. Notably, a new community-academic partnership that formed during our first cohort received a CBPR P2P award to start a research project and subsequently obtained NIH funding, illustrating the program’s role in fostering partnerships that can attract sustained external support. Original program development task force members and graduates of the program continue to advance the goals of CBPR in the region. An example is the community-driven request for more opportunities to meet each other and coordinate ideas and action. To that end, “CBPR Day” was developed as an opportunity to share and receive feedback on work, potentially find new collaborators, and strengthen relationships. This joyful venue is a way to engage around emergent, current and long-term projects.

Institutional support for the CBPR training program resides in both CTSI and CCHP and includes administration, funding, promotion and marketing. Collaborations with clinical and community engagement teams across the entire medical center ensure that faculty, staff, and trainees are not only aware of the program but feel actively engaged to invite current and future program partners to participate. Future work to expand and enhance the CBPR training program will focus on sustaining partnerships through collaborative networking and research exploration events featuring past course participants, both areas for which community partners have expressed the need to grow.

Conclusions

The UR CTSI and the CCHP are committed to continued resources to support CBPR participants who want to further deepen their understanding of partnership and advance community research agendas. As the evaluation shows, being responsive to the development and expansion of partnerships between academic and community researchers involves an ongoing and continuous improvement approach that is informed by the needs of the learners with a focus on the priorities of communities. Currently the course is offered free of charge, and there is every intention to keep this same structure moving forward.

This training program is broadly applicable, because its co-presenter model, which pairs community and academic researchers, can be replicated anywhere. While our co-presenters use local examples of CBPR research, institutions in other regions could change the content by engaging their own community-academic teams to develop and deliver the program in a locally relevant way.

Offering a CBPR Training Program presents a unique and consistent opportunity to engage in difficult conversations and speak uncomfortable truths. It is through these supported and equitable communications that trustworthiness may be attained. Increased trust in research and the vision that research will authentically place the priorities of the community at the center of importance, as well as impact community health outcomes, is a process of close connections and honest interactions. Perhaps even more important are the opportunities to better understand one another and share activities that break barriers of varying backgrounds and perspectives.

Although the program previously required pre-formed pairs to enroll, we have learned that this is not necessary for successful CBPR training. Participants are now able to identify shared research interests and naturally create impactful community–academic teams within each cohort. Bringing together academics and community members who have not previously partnered increases collaboration capacity. Many of these teams continue to work together.

Supplemental Material

sj-pdf-1-phj-10.1177_22799036251395258 – Supplemental material for Lasting impact: A co-led community-academic model for a sustainable community-based participatory research training program

Supplemental material, sj-pdf-1-phj-10.1177_22799036251395258 for Lasting impact: A co-led community-academic model for a sustainable community-based participatory research training program by Laura Sugarwala, Nathaniel Bloemke, Veronica Leva, Magaly Rosario, Sherita Bullock, Jackie Dozier, James Evans, Melanie Funchess, Amen Ptah, Paula Amina Alio, Theresa Green, Gail Newton, Silvia Sörensen, John Walker, Ann Marie White, Brooke A. Levandowski and John P. Cullen in Journal of Public Health Research