Community-Based Participatory Research

(CBPR) to Reduce Women’s Health Disparities thru TANF

Study

Shawn M. Kneipp, ARNP, Ph.D.University of Florida College of Nursing

NIH/NINR #R01 NR009406-01

Study TeamShawn M. Kneipp, PhD, ARNP – PIBarbara Lutz, PhD, RN – Co-I, PHHPDeidre Pereira, PhD – Co-I, PHHPAllyson Hall, PhD – Co-I, PHHPJoan Flocks, JD – Consultant, UF College of LawJohn Kairalla, PhD - StatisticianLinda Beeber, PhD, RN – Consultant, UNC-Chapel Hill

SON

Community Advisory Group (17 members)

Cynthia Allen – Study CoordinatorDeirdra Means -- Research Assistant Toni Watson – Research Assistant

Michelle Galin, BSN, MPH Cathy Levonian, MSN, PhD Student Ashley Kairalla, BSN Daryl Lazaro, BSN, MSN in PHN Student

Intervention PHNs

WTP Demographics & Health: Trends

Loprest & Zedlewski (2003). The Changing Role of Welfare in the Lives of Low-Income Families with Children. The Urban Institute.

Preliminary Work, HistoryTwo Major Preliminary Studies: 2000 – 2004

All in conjunction with FLWorks/WTP

Findings:

1) Stress / mental health worsening in ~ 50% of women after leaving TANF for work.

2) No systematic, clinically sound method for identifying mental/physical health needs in this population.

Aim 1

• To redesign the current Welfare Transition Program (WTP) clinical health screening tool so that it is culturally relevant, sensitive, and acceptable for use in testing the efficacy of a Welfare Participant Centered Health Program (WPCHP) using a participatory research methodology.

Aim 2

To test the efficacy of a PHN intervention in:

a) increasing rates of voluntary screening, identification, and treatment for chronic health conditions,

b) increasing ability to navigate the Medicaid system,

c) improving functional and health status over time, and,

d) increasing employment duration among women with chronic health conditions using a participatory research methodology.

CBPR RCTStudy Years 2, 3, & 4 (&5!)

Intervention Group(IG)

O1

(Baseline)O2

(3 mo)O3

(6 mo)

O4

(9 mo)

Control Group(CG)

O1

(Baseline)O2

(3 mo)O3

(6 mo)

O4

(9 mo)

Intervention Delivery over 9 mo

‘Wait’ CG offered Screening/Referral and Medicaid Knowledge/Skills components of the WPCHP Intervention: no 9 mo case-management or further follow up.

Study Progress / Findings

• Aim 1 – Focus Groups– n = 60 Women, 10 FGs over 5 months

• Aim 1 – Testing of Screening Tool– n = 111 Women, 5 Days– Favorable findings

Study Progress / Enrollment

• Aim 2 – RCT – COC Received– Data Collection Began 2/26/07– Sample Size Target: n=432 – 432 enrolled as of 7/2009– Follow-up will continue through April

2010– Follow-up rates between 73% - 85%

Preliminary RCT Findings

Sample Demographics

Race Caucasian 40% Black/AA 58% Other 2%

Education < HS Dip/GED 32% HS Dip/GED 28% Some Coll/Tech 34% College Degree 7%

80% Alachua County20% Bradford County

Mean Age: 29.8 Yrs

Mean # of Children: 2.5

Mean Age of Children: 7 Yrs

Number Times Welfare Receipt Prior to Current: Never 23% 1-2 Times 39% 3-4 Times 15% >4 Times 14%

Health-Related Preliminary Findings

Mean # Diagnosed Chronic Health Conditions: 3.9

Mean # Symptoms: 8

Worsening Health Problems: No 31% Yes 69%

Depression (BDI-II) Minimal 34.3% Mild 22.8% Moderate 19.0% Severe 23.9%

Suicidal Thoughts No thoughts 86.3% + thoughts, would not 13.2% Would like to kill self 1%

+Possible PTSD 68% Weight Concerns 77%

+ Domestic Violence 15%

# of Jobs Over 9 Mo0 Jobs 29%1 Job 40%2 Jobs 25%3 – 5 Jobs 7%

Employment Related Data

0.01

.02

.03

.04

.05

Density

0 20 40 60 80 100workrate2

Questions?

CBPR Definition

CBPR is defined as: “. . . a 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 Foundation Program (2001). In: Minkler & Wallerstein (2003),

p.4.

Community PartnersEastside Community Practice

African American Community (2)Eastside Community Practice (1)TANF/WTP Administrators (1)WTP Direct Service Staff (2)Employers of WTP Participants (2)Core Community: ♀ in WTP/RWG (3)Core Community: ♀ in WTP non-RWG (3)Academic Community/Researchers (5)

Community Advisory Group

Research Work GroupCore Community: ♀ from WTP (3)Academic Researchers (5)