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Introduction to Health Services Research : A Self-Study Course
Case Description | Case Background | Case Objectives | Case Exercise
Case 1. Health Disparities Research Case (Page 35 of 37)
Phase Two: Finding the Information
Q13. How would you design a study to ascertain whether or not health disparities existed?
Suggested Solution
Approaches to studying health disparities covers most of the research approaches used in health services research. Quantitative methods include regression analysis of administrative data such as utilization of procedures, discharge summaries etc, and survey research. Qualitative research includes in-depth case studies and focus groups.
Another method popular in the 1970s and 1980s is regaining popularity, Community-Based Participatory Research. In this approach a body such as a university department partners on an equal footing with communities that are affected by health disparities and, in the process of the research, teach the community participants the process of doing research and ensure that they share equally in all stages of the research, from defining the question to credit for publications.
The following sections are elements that you might want to think about as you prepare to set up your research project.
Steps in Developing a Community-Based, Participatory Research Program: Steps
- Identify and develop relationships with community partners. The importance of community partners cannot be stressed enough. Suggestions for possible partners include community health clinics, public health departments, local non-profit community development agencies and community-specific organization such as African-American, Hispanic, Asian-American and related organizations.
- Establish a board with representatives from participating organizations.
- Establish mutually agreed upon principles for research and intervention work. One of the processes identified as both time consuming and critical is developing an acceptable set of principles on which all parties agree before proceeding further (Israel, 2001; Krieger, 2002). These principles need to clarify such issues as the definition of community for the project partners, the commitment to equal power sharing between university and community, returning results of the research to the community, and the commitment to long term relationship with the community...
- Jointly identify community priorities and research topics. An important, but time-intensive and important step is to jointly identify priorities. The university researcher needs to relinquish more control than in other approaches to research.
- Undertake intervention and research. A range of intervention and research projects may suggest themselves out of the above steps. The board may want to establish guidelines for not only topics to be researched but levels of involvement in future projects (Israel, 2001).
- Maintain relationships. It is important to emphasize that one of the aspects of this approach is long-term commitment to and involvement in the community and therefore establishing methods to facilitate maintaining relationships over the long haul is important.
Some Issues to Consider when Using Community-Based Participatory Research
- Additional time is needed for this community-based participatory process (Baker, 1999; Israel, 2001; Krieger, 2002)
- Balancing process-focus and task-focus can be a challenge (Israel, 2001)
- Evaluation process needs to be consistent with overall approach (Baker, 1999) For example, the Detroit URC emphasis on participatory and formative research shaped approaches selected: board members were active participants in the evaluation, and results were regularly fed back to the board for consideration and action (Israel, 2001)
Advantages and Disadvantages of Community Based Participatory Research
- Improved interpretation of results of research
- Potential for improvement in validity of findings
- Findings more readily lead to community change
- Very time and effort intensive
- Requires special skills and personalities of researchers and community members
- Cross-cultural communication is difficult, there is often underlying lack of trust
- Different groups have different goals and time frames that must be balanced
- Validity of findings may be questioned and not valued by the university
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