Chapter 5: Enhancing the Health of Our Communities and the Nation
To ensure that broad and unique community health needs are addressed, it is crucial for research institutions to collaborate with community organizations. To this end, CTSA institutions have implemented a broad range of programs that engage communities in dialogue about their health concerns and about clinical research. Partnering with federal and nonprofit agencies, CTSA institutions collaborate with public health professionals, health care providers, researchers and community-based groups to do the following:
- Define community health needs
- Ensure that updated health information is widely available
- Provide information and access to clinical trials and studies
Building Community Trust and Increasing Research Participation
To achieve successful community engagement, partnerships must be built on respect and trust. In addition, community members must see and experience the benefits of participating in clinical research. CTSA Consortium members value the role of community participation in translating research results into new treatments to improve health, especially in underserved communities. For example:
- Community-based center provides St. Louis residents with health, research opportunities
The Washington University Institute of Clinical and Translational Science created HealthStreet, a community-based service center in the Southeast neighborhood of St. Louis, to provide residents with opportunities to learn about medical research, register in research studies, obtain free testing for sexually transmitted diseases, and learn about and apply for jobs. At HealthStreet, community health workers establish relationships with neighborhood residents to learn about their health concerns. Interested residents are linked to services and research opportunities at Washington University. Linda Cottler, who initially spearheaded the project, reported that as of October 2011, HealthStreet had linked 2,852 residents to relevant studies; enrolled 1,033 individuals in research studies, 80 percent of whom were minorities, a historically hard-to-reach group; and provided a total of 8,657 medical care and referral services to community residents. - Sentinel Network increases study participation of hard-to-reach groups, meets local health needs
The Sentinel Network for Community-based Participatory Research, a collaborative project of five CTSA institutions, facilitates community engagement across the CTSA Consortium. Community health workers at these CTSA Sentinel Network sites around the country work with partner organizations to find ways to increase community participation in clinical research, especially among women, the elderly, racial and ethnic minorities, and patients from rural communities. Along with their partner organizations, Patient Advocates in Research and Community-Campus Partnerships for Health, these institutions strive to educate community members and provide referrals to area health agencies. Over the past two years, community health workers have surveyed more than 5,000 community members about barriers to research participation, top health and neighborhood concerns, health conditions, clinical study participation and the kinds of studies in which they would participate. Currently, the network is adding a sixth site and expanding efforts to include follow-up after study participation to assess patient satisfaction.
Collaborating to Meet Community Needs
CTSA-supported staff conduct their research and outreach efforts through neighborhood service and community centers, as well as in mobile units. Projects include education, prevention and management of a variety of conditions, including obesity, high blood pressure (hypertension), type 2 diabetes, dental disorders and drug addiction. Through two-way dialogue, community members provide their input on clinical studies and health programs by serving on advisory boards to CTSA institutions. Following are several examples of how CTSA institutions serve their local communities:
- A model of diabetes prevention and treatment
In San Diego, the Scripps Translational Science Institute partnered with the Scripps Whittier Diabetes Institute to create a model of diabetes health care. This model is designed to improve diabetes prevention and treatment for local residents of Mexican ancestry, who are known to be at especially high risk for developing the disease.1 - Improving the health of Southern Californians
With funding from the American Recovery and Reinvestment Act,2 the University of California, Irvine's Institute for Clinical and Translational Science partnered with California State University, Fullerton, the Community Action Planning Group, and several other community agencies to establish the Orange County Center for Community Health Research. The goal of this center is to improve the health of underrepresented populations in Orange County by fostering two-way communication, collaboration and training between academic researchers and community organizers. Through the center, these groups identify county priority health issues and develop projects to target these community health concerns.
Addressing National Health Issues through Community Engagement
CTSA-funded investigators are working directly with the community to ensure that they are meeting local health needs. Building upon this knowledge base, the CTSA Consortium collectively gathers this information and uses it to address some of our nation's chronic health problems, such as asthma.
Several CTSA institutions participate in the NIH-funded Inner-City Asthma Consortium (ICAC). The ICAC is a multi-study, multicenter initiative to examine the characteristics of asthma in inner city children, which may contribute to a greater prevalence and severity in this population, and develop immune-based treatments to improve asthma control for these residents. Participating CTSA institutions contributed clinical and facilities expertise to discoveries that may benefit inner-city youth who suffer from a high burden of allergy-related asthmatic illness. ICAC recently demonstrated that inner-city youth who received the drug, omalizumab, which blocks the response of the allergic antibody IgE, in addition to the standard of care for asthma, had better control of their asthma, were less likely to have serious asthma attacks, and had fewer hospitalizations from asthma.3 ICAC and its research are supported by NIH's National Institute of Allergy and Infectious Diseases and led by the University of Wisconsin–Madison. CTSA institutions that were part of the study, screened, treated and gathered data on the children and young adults participating in the research.
Building Upon Existing NIH Frameworks
CTSA institutions also build upon existing frameworks established by other NIH- and NCRR-supported programs within their academic health centers, such as NCRR's Institutional Development Award (IDeA) program. IDeA fosters health-related research and improves the competitiveness of investigators in states that historically have not received significant levels of competitive research funding from NIH. Following are two examples:
- Uncovering cadmium levels in children
The University of Arkansas Medical Science Center for Clinical and Translational Research is collaborating with Arkansas' IDeA-supported program to investigate cadmium levels in children. Cadmium is an extremely toxic metal commonly found in industrial workplaces. To support the study, the university enlisted help from local health practitioners through the state's eight Area Health Education Centers. These centers provide rural residents with access to medical services and education opportunities for students and professionals. By combining efforts, the research team could access children in these remote areas. Connecting with community colleges and local universities, they engaged local health practitioners in an innovative approach to community-based research. - Community-based approach to oral health and diabetes
Researchers from the CTSA-supported South Carolina Clinical and Translational Research Institute (SCTR) and the IDeA-funded program at the Medical University of South Carolina's Center for Oral Health Research are exploring the relationship between periodontal disease and type 2 diabetes in South Carolina's Gullah African American population. Dentist and lead investigator Renata Leite, a successful IDeA investigator and SCTR-funded pilot researcher, developed strong ties with Gullah community leaders and outreach clinics in the Charleston area while serving as an IDeA-mentored junior investigator and later as a scholar in the SCTR-funded community engaged scholars program. Now, data from this community-based research project are being analyzed, and with the support of the SCTR community engagement program, may lead to additional research geared toward culturally sensitive oral health education for Gullah African American patients with type 2 diabetes.4
1 The Scripps Translational Science Institute community engagement website, 2011.
2 The American Recovery and Reinvestment Act is a federal program designed to preserve and create jobs, promote economic recovery and provide investments to increase economic efficiency by propelling technological advances in science and health. Recovery.gov, 2009.
3 Busse WW, Morgan WJ, Gergen PJ, et al. Randomized trial of omalizumab (anti-IgE) for asthma in inner-city children. N Engl J Med 364:1005–1015, 2011.
4 Marlow NM, Slate EH, Bandyopadhyay D, et al. Health insurance status is associated with periodontal disease progression among Gullah African-Americans with type 2 diabetes mellitus. J Public Health Dent 71:143–51, 2011.
