Eliminating Health Disparities: CommunityBased Participatory Research and Loan Repayment Program

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Eliminating Health Disparities Community-Based
Participatory Research and Loan Repayment Program

• Francisco S. Sy, MD, DrPH
• Chief, Office of Community-Based Participatory
  Research and Outreach
• National Center on Minority Health Health
  Disparities
• National Institutes of Health
• July 27, 2006
• Hispanic Association of Colleges and Universities
• Capacity Building Workshop

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OBJECTIVES

• To give an overview of the research programs at
  NIH/NCMHD
• To discuss the definition, principles, challenges
  and rationale for using community-based
  participatory research (CBPR) in eliminating
  health disparities
• To describe the NCMHD CBPR intervention research
  initiative
• To describe the NCMHD loan repayment (LRP)
  program for health disparities research (HDR) and
  clinical research for individuals from
  disadvantaged background (ECR)

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Public Law 106-525 The Minority Health and
Health Disparities Research and Education of 2000
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NCMHD MISSION

• To promote minority health and to lead,
  coordinate, support,
• and assess the NIH effort to reduce and
  ultimately eliminate
• health disparities. In this effort, the NCMHD
  will
• conduct and support basic, clinical, social
  science, and behavioral
• research
• promote research infrastructure and training
• foster emerging programs
• disseminate information
• reach out to minority and other health
  disparity communities.

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Public Law 106-525
PRIORITY FOR NCMHD

• Minority Health Disparities Research
• Basic, clinical, and behavioral research on
• minority health conditions

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NCMHD Statutorily Mandated Programs

• Centers of Excellence (Project EXPORT)
• Community-Based Participatory Research and
  Outreach
• Endowment
• Loan Repayment

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• NCMHD Programs
• Centers of Excellence Program ( Project EXPORT)
  N77
• Community-Based Participatory Research and
  Outreach N25
• Research Endowment Program N12
• Research Infrastructure in Minority
  Institutions Program N21
• Loan Repayment Program (LRP) Scholars N474
• Small Business Innovation Research (SBIR)
  Program N18
• Small Business Technology Transfer (STTR)
  Program N3
• Minority Health International Research Training
  Program N24

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NCMHD Community-Based Participatory Research
Initiative
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RFA-MD-05-002 NCMHD Community Participation in
Health Disparities Intervention Research

• The goal is to support community intervention
  research studies using CBPR principles to reduce
  and eliminate health disparities in any disease
  or condition of major concern to the community
  with emphasis on racial ethnic minorities.
• This initiative will start with a 3 year planning
  grant, followed by a competitive 5 year
  intervention research grant, and conclude with a
  competitive
• 3 year dissemination research grant.
• In the 3 year planning grant, the first year is
  devoted to partnership development, community
  needs assessment, identifying the
  disease/condition for intervention research,
  planning the intervention methodology. A pilot
  intervention research study will be conducted
  during the second and third year.

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Definition of CBPR

• Collaborative approach to research that
  equitably involves all partners in the research
  process and recognizes the unique strengths that
  each brings. CBPR begins with a research topic
  of importance to the community with the aim of
  combining knowledge and action for social change
  to improve community health and eliminate health
  disparities.
• W.K. Kellogg Community Scholars Program (2001)

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CBPR Relevance in U.S.

• Paradoxical Timing for Interest in CBPR
• Biotechnology and genetic revolution, yet
• Biomedical and behavioral advances insufficient
• Impact of Hurricane Katrina
• Foundations Kellogg, Ford, Annie E. Casey,
  Aspen, California Endowment, others
• Government NCMHD, NCI, AHRQ, CDC, NIH Health
  Disparities/CBPR grants, Reports
• Academic AJPH, AJPM, AJPHMP, Env. Health
  Perspectives, HEB, JGIM, New books
• IOM Report Who Will Keep the Public Healthy?
  Educating Public Health Professionals for the
  21st Century, 2002

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Principles of CBPR

• Recognizes community as a unit of identity
• Builds on strengths and resources
• Facilitates partnership and capacity building in
  all research phases
• Emphasizes socio-ecological perspective of
  multiple determinants
• Disseminates findings and knowledge to all
• Involves long-term process and commitment
• Seeks balance between research and action
• Israel, Schulz, Parker, Becker, Allen, Guzman,
  Critical Issues in developing and following CBPR
  principles, Community-Based Participatory
  Research in Health, Minkler and Wallerstein,
  Jossey Bass, 2000.

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Rationale for CBPR in Eliminating Health
Disparities

• Complex health and social problems ill-suited to
  outside expert research
• Increasing community and funder demands for
  community-driven research /collaboration
• Disappointing results in intervention research
• Increasing understanding of importance of local
  context
• Increasing interest in use of research to improve
  best practices /best processes

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Challenge of Research/ Community Relationships
Shared University/ Community Control
Shared University/ Community Control
University Control
Community Control
CBPR
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Challenge of Participation in Community

• Minimal Consultative versus Comprehensive
  throughout Process
• Participation Questions
• Who is included? Who is excluded?
• Who is representing the community?
• Service providers vs. community members
• Hidden discourse (what will never be known)
• Scientific/Academic Time vs. Community Time

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Ethnic/Racial Challenges

• Institutional Racism
• Predominance of white academics working in
  minority communities
• Historical helicopter research
• Social labeling of communities
• Reproduced inaccurate representations
• Resistance is ignorance
• Academy norm of research
• Western approaches are universal
• Knowledge is uni-linear

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Centers of Excellence Program
Centers of Excellence in Partnerships for
Community Outreach, Research on Health
Disparities and Training (Project EXPORT)
Purpose Support biomedical and behavioral
research training for members of health
disparity populations Award Period Not
more than 5 years, pending annual approval of
the NCMHD Director and availability of
appropriations for the program
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CENTERS OF EXCELLENCE PROGRAM STRUCTURE

• Administrative Core (required)
• Research Core (required)
• Community Outreach and Information Dissemination
  Core
• Training/Mentoring Core
• Minority Health and Health Disparity Education
• Shared Resource Core

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CENTERS OF EXCELLENCE FUNDING MECHANISMS
The P20 or Exploratory Grant Awards are targeted
to institutions that have research programs but
need additional funding to develop a health
disparity research program. Funds will provide a
mechanism to strengthen the infrastructure for
minority health and other health disparities
research and training. In addition, program
funds will provide resources to assist successful
applicants in the development of innovative
partnership models.
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CENTERS OF EXCELLENCE FUNDING MECHANISMS
The P60 Center Awards are targeted for
research-intensive institutions pursuing research
in health disparities. Funds will be used to
establish a health disparities research center.
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RESEARCH ENDOWMENT PROGRAM

• Purpose To build Health Disparities Research
  Capacity
• and other health disparities research
• Participants Targets Section 736 Public Health
  Service Act (PHS)
• Institutions with currently funded Programs
  of Excellence in Health Professions Education
  for Underrepresented Minority Individuals
  (HRSA)
• Eligibility Non-research Intensive Institutions
• Research Institutions with endowment
  investments
• below the ceiling established in Public Law
  106-525

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Research Infrastructure in Minority Institutions
Program (RIMI)

• USE OF FUNDS
• The RIMI Program was originally created by the
  Office of Research on
• Minority Health (ORMH), the predecessor to
  the NCMHD, and the National
• Center for Research Resources (NCRR).
• The program provides support for institutions
  that enroll a significant number
• of students from minority health disparity
  populations to develop and enhance
• their capacity and competitiveness to conduct
  biomedical or behavioral research
• .
• Specifically, the RIMI program assists
  non-doctoral degree institutions in
• the development of their research
  infrastructure, primarily through
• collaborations with research-intensive
  universities

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LOAN REPAYMENT PROGRAM

• Health Disparities Research (HDR-LRP)
• Encourages health professionals to engage in
  basic, clinical or behavioral research
  directly relevant to health disparities issues.
• The program seeks to recruit and retain highly
  qualified health professionals in
  research careers that focus on minority health
  disparities research related to the medically
  underserved.
• The HDR program serves as an avenue for NIH to
  engage and promote the development of research
  programs that reflect the variety of issues and
  problems associated with disparities in health
  status.

• Extramural Clinical Research (ECR-LRP)
• Encourages health professionals from
  disadvantaged backgrounds to conduct
• clinical research.  The emphasis on clinical
  researchand on individuals from
• disadvantaged backgrounds highlight the need
  for the involvement of a cadre of
• physician scientist in clinical research to
  strengthen the twenty first century
• biomedical and behavioral workforce.

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NCMHD Health Disparities Research (HDR)
Loan Repayment Program New Applications and
Awards, 2002-2005
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NCMHD Health Disparities Research (HDR) Loan
Repayment Program Renewal Applications and
Awards, 2002-2005
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NCMHD Clinical Research for Individuals from
Disadvantaged Background (ECR) Loan Repayment
Program New Applications and Awards, 2002-2005
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NCMHD Clinical Research for Individuals from
Disadvantaged Background (ECR) Loan Repayment
Program Renewal Applications and Awards,
2002-2005
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NCMHD LRP Funding, 2002-2005

• HDR ECR Total
• FY02 5,040,000 2,020,000 7,060,000
• FY03 6,212,000 2,131,000 8,343,000
• FY04 8,702,000 1,672,000 10,374,000
• FY05 9,092,000 1,562,000 10,654,000

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Current NCMHD Funding Opportunities

• RFA-MD-06-003
• Establishing Exploratory NCMHD Research Centers
  of Excellence (P20)
• RFA-MD-06-002
• Establishing Comprehensive NCMHD Research
  Centers of Excellence (P60)
• See handouts for additional funding
  opportunities

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You must be the change you want to see in the
world.
Mahatma Gandhi
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Facing the future ...
The best way to Predict the future Is to invent
it
Alan Kay