Engaging Communities in Obesity Prevention: A Case Study of Partnership Dynamics and Participant Experience in Community Based Participatory Research.
Based Participatory Research (CBPR) has been proposed as a potentially effective
research approach for addressing complex public health issues such as obesity,
particularly in traditionally marginalized populations such as new immigrants. However,
much remains to be understood about creating and maintaining successful CBPR
partnerships. Additionally, the potential pathways... read morefor CBPR efficacy have been
understudied. This dissertation conducted a case study of Live Well, a CBPR trial to
prevent obesity in new immigrant women, in order to contribute to our understanding of
the operationalization and mechanisms of CBPR, exploring portions of the pathway from
CBPR process to outcomes by analyzing both the CBPR partnership and the study
participants. For the first study, interviews were conducted with community-academic
partners in fall 2010 and winter-spring 2012 (n = 16 at each point). Interviews were
coded for themes related to organizational dimensions. Ten interrelated themes arose:
goals, roles, sociometric structure, power structure, decision making, perception of
conflict, communication, capacity, contextual influences, and complexity. Analysis
showed that over time informal interpersonal structures superseded formalized structures
and helped the group to work from a foundation of a sense of shared purpose and mutual
respect and commitment to one another. The second study explored associations of the
Live Well participants' perceptions of intervention relevance and responsiveness with
their attendance and self-reported adherence to the intervention. Participants (n =124)
reported overall high perceived relevance and responsiveness. Relevance of information
(p <.01), relevance of activities (p< .00), and sense of voice being considered
(p=.02) were each significantly positively associated with self-reported adherence but
not with group or individual session attendance, after adjusting for covariates. In the
third study, 13 Live Well participants were interviewed about their experience of Live
Well. Interviews were analyzed for themes related to the project's integration into
their lives. Seven dominant themes arose including: summary statements, activities or
information experienced as useful, the social experience, family effect,
empowering/empowered experiences, experiences with the staff, and changes in lives.
Overall participants reported having very positive, even life changing, experiences in
the Live Well program and that it integrated well into their lives. The elements that
the women described as most important in their experiences were also components of the
intervention that had specifically been co-created by the academic-community
partnership. We conclude that using CBPR is complex, but has the potential to increase
the efficacy of public health research and interventions at least insofar as it may
contribute to more appropriate and relevant research design and this may enhance study
acceptance and adherence. The findings of this thesis particularly underscore the
critical human element that makes participation
Thesis (Ph.D.)--Tufts University, 2014.
Submitted to the Dept. of Food Policy & Applied Nutrition.
Advisor: Christina Economos.
Committee: Nesly Metayer, Raymond Hyatt, and Alice Ammerman.
Keywords: Nutrition, and Public health.read less