Search

Application of life course theory (LCT) holds promise for advancing knowledge toward the elimination of health disparities. This article validates the usefulness of employing a life course perspective when conducting health disparities research. We provide an overview of LCT as it applies to our research program in prevention of human immunodeficiency virus (HIV) among Latino teen parents. We illustrate the goodness-of-fit of our research with the basic premises of LCT. Though early adverse life experiences impact health over the lifespan, strength-based HIV prevention programs designed for Latino teen parents that recognize the reality of their lives may alter their health trajectory.

Background: Questionable occlusal caries (QOC) can be defined as clinically suspected caries with no cavitation or radiographic evidence of occlusal caries. To the authors' knowledge, no one has quantified the prevalence of QOC, so this quantification was the authors' objective in conducting this study, Methods: A total of 82 dentist and hygienist practitioner-investigators (P-Is) from the United States and Denmark in The Dental Practice-Based Research Network (DPBRN) participated. When patients seeking treatment had at least one unrestored occlusal surface, P-Is quantified their number of unrestored occlusal surfaces and instances of QOC, if applicable. P-Is also recorded information about characteristics of patients who had QOC and had provided informed consent. The authors adjusted for patient clustering within practices., Results: Overall, 6,910 patients had at least one unrestored occlusal surface, with a total of 50,445 unrestored surfaces. Thirty-four percent of all patients and 11 percent of unrestored occlusal tooth surfaces among all patients had QOC. Patient- and surface-level QOC prevalences varied significantly according to DPBRN region (P < .001 and P = .03, respectively). The highest percentages for patient- and surface-level prevalence occurred in Florida and Georgia (42 percent and 16 percent, respectively)., Conclusions: To the authors' knowledge, this is the first study in which investigators have quantified the prevalence of QOC in routine clinical practice. These results document a high prevalence overall, with wide variation in prevalence among The DPBRN's five main regions., Clinical Implications: QOC is common in routine practice and warrants further investigation regarding how best to manage it.

Thirty-five U.S. states and territories have implemented policies requiring insurers to cover patient care costs in the context of cancer clinical trials; however, evidence of the effectiveness of these policies is limited. This study assesses the impact of state insurance mandates on clinical trial accrual among community-based practices participating in the NCI Community Clinical Oncology Program (CCOP), which enrolls approximately one-third of all NCI cancer trial participants. We analyzed CCOP clinical trial enrollment over 17 years in 37 states, 14 of which implemented coverage policies, using fixed effects least squares regression to estimate the effect of state policies on trial accrual among community providers, controlling for state and CCOP differences in capacity to recruit. Of 91 CCOPs active during this time, 28 were directly affected by coverage mandates. Average recruitment per CCOP between 1991 and 2007 was 95.1 participants per year (SD=55.8). CCOPs in states with a mandate recruited similar numbers of participants compared to states without a mandate. In multivariable analysis, treatment trial accrual among CCOPs in states that had implemented a coverage mandate, was not statistically different than accrual among CCOPs in states that did not implement a coverage mandate (β=2.95, p=0.681). State mandates did not appear to confer a benefit in terms of CCOP clinical trial accrual. State policies vary in strength, which may have diluted their effect on accrual. Nonetheless, policy mandates alone may not have a meaningful impact on participation in clinical trials in these states., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: Epidemiological research often requires collection of data from a representative sample of the community or recruitment of specific groups through broad community approaches. The population coverage of traditional survey methods such as mail-outs to residential addresses, and telephone contact via public directories or random-digit-dialing is declining and survey response rates are falling. There is a need to explore new sampling frames and consider multiple response modes including those offered by changes in telecommunications and internet technology., Methods: We evaluated response rates and cost-effectiveness for three modes of survey administration (postal invitation/postal survey, postal invitation/internet survey and postal invitation/telephone survey) and two styles of contact approach (personalised and generic) in a community survey of greywater use. Potential respondents were contacted only once, with no follow up of non-responders., Results: The telephone survey produced the highest adjusted response rate (30.2%), followed by the personalised postal survey (10.5%), generic postal survey (7.5%) and then the internet survey (4.7% for the personalised approach and 2.2% for the generic approach). There were some differences in household characteristics and greywater use rates between respondents to different survey modes, and between respondents to personalised and generic approaches. These may be attributable to the differing levels of motivations needed for a response, and varying levels of interest in the survey topic among greywater users and non-users. The generic postal survey had the lowest costs per valid survey received (Australian $22.93), followed by the personalised postal survey ($24.75)., Conclusions: Our findings suggest that postal surveys currently remain the most economic option for population-based studies, with similar costs for personalised and generic approaches. Internet surveys may be effective for specialised groups where email lists are available for initial contact, but barriers other than household internet access still exist for community-based surveys. Given the increasing recruitment challenges facing community-based studies, there is an imperative to gather contemporary comparative data on different survey modes and recruitment approaches in order to determine their strengths, limitations and costs. Researchers also need to document and report on the potential biases in the target and respondent populations and how this may affect the data collected.

Issue Addressed: There is limited evaluation on the impact of community-based walking groups on physical activity (PA). This study examined the amount of walking and total PA minutes when adults joined the Just Walk It (JWI) program in Queensland, and changes over time., Methods: All adult participants (n=1258) were sent a survey on registration with the JWI program between April 2002 and December 2003, and after 6 and 12 months. Outcomes included self-reported minutes of walking and total PA in the past week and the proportion meeting PA recommendations., Results: Of the 1,258 registrants, 601 returned the 12-month survey; 423 of these confirmed they still participated. At baseline, 36 (8.5%) of these were inactive, 280 (66.2%) were insufficiently active to meet PA recommendations and 107 (25.3%) met PA recommendations. Among these groups, the largest 12-month increases in walking and total PA were in participants who were inactive (177 minutes, 95% CI 144-210, p<0.001 and 233 minutes, 95% CI 169-297, p<0.001, respectively) and in participants who were insufficiently active (63 minutes, 95% CI 39-86, p<0.001 and 122 minutes, 95% CI 81-162, p<0.001, respectively). Walking minutes increased more for men (n=92) [100 minutes, 95% CI 51-150] than for women (n=331) [52 minutes, 95% CI 32-72, p=0.044], as did total PA minutes (158 minutes, 95% CI 61-247 compared to 67 minutes, 95% CI 31-103, p=0.038). Furthermore, compared with participants aged 18-44 years (n=41) [-12 minutes, 95% CI -75-50] and 65 and older (n=183) [57 minutes, 95% CI 27-87], walking increased more in those aged 45-64 years (n=199) [83 minutes, 95% CI 56-110, p=0.018)., Conclusions: Participation in a community-based walking group for 12 months increased both walking and total PA, especially in men, mid-aged participants and those who were inactive or insufficiently active at registration.

Objectives: To design and test HIV-RAAP (HIV/AIDS Risk Reduction Among Heterosexually Active African American Men and Women: A Risk Reduction Prevention Intervention) a coeducational, culture- and gender-sensitive community-based participatory HIV risk reduction intervention., Methods: A community-based participatory research process included intervention development and implementation of a 7-session coeducational curriculum conducted over 7 consecutive weeks., Results: The results indicated a significant intervention effect on reducing sexual behavior risk (P=0.02), improving HIV risk knowledge (P=0.006), and increasing sexual partner conversations about HIV risk reduction (P= 0.001)., Conclusions: The HIV-RAAP intervention impacts key domains of heterosexual HIV transmission.

Purpose: To determine the community-based participatory research (CBPR) training interests and needs of researchers interested in CBPR to inform efforts to build infrastructure for conducting community-engaged research., Method: A 20-item survey was completed by 127 academic health researchers at Harvard Medical School, Harvard School of Public Health, and Harvard affiliated hospitals., Results: Slightly more than half of the participants reported current or prior experience with CBPR (58 %). Across all levels of academic involvement, approximately half of the participants with CBPR experience reported lacking skills in research methods and dissemination, with even fewer reporting skills in training of community partners. Regardless of prior CBPR experience, about half of the respondents reported having training needs in funding, partnership development, evaluation, and dissemination of CBPR projects. Among those with CBPR experience, more than one-third of the participants wanted a mentor in CBPR; however only 19 % were willing to act as a mentor., Conclusions: Despite having experience with CBPR, many respondents did not have the comprehensive package of CBPR skills, reporting a need for training in a variety of CBPR skill sets. Further, the apparent mismatch between the need for mentors and availability in this sample suggests an important area for development., (© 2012 Wiley Periodicals, Inc.)

The rates of obesity, diabetes, and heart disease in Native Americans and Alaska Natives far exceed that of the general US population. There are many postulating reasons for these excessive rates including the transition from a traditional to a contemporary diet. Although information on the dietary intakes of Native American and Alaska Native communities are limited, there seems to be a consensus that the Native American and Alaska Native diet is high in total fat, saturated fat, cholesterol, and sodium. Further information on the diet needs to be attained so that dietary interventions can effectively be implemented in these communities. An approach that is community based is proposed as the best solution to understanding the Native diet and developing culturally tailored interventions to sustainably improve diet., (© 2012 Wiley Periodicals, Inc.)

Participatory evaluation can be an essential tool for community-based organizations in tailoring programs to the needs of the populations they serve. This article provides a case study of Salud Sí, a promotora-driven health promotion program designed to encourage physical activity, fruit and vegetable consumption, and stress reduction among Mexican American women. Through a partnership between a community health center and an academic institution, we describe how the participatory evaluation framework is applied over a 10-year period throughout the stages of program development, implementation, and sustainability. Partners used the results to identify the essential elements of the health promotion program.

Objective: To study the effect of two compensation approaches, continuing medical education (CME) credits (5 hours) or monetary ($150), on the participation rate of a physician needs assessment study., Methods: Physicians representing family medicine, internal medicine, pediatric, and geriatrics specialties, and practicing in ambulatory primary care clinics affiliated with the North Texas Primary Care (NorTex) PBRN clinics, were recruited to complete a survey relevant to their subspecialty and to conduct a self-audit/abstraction of five medical records. Physicians were recruited from four health care systems, and the recruiting methods varied by system. Study outcome was the rate of study completion by type of incentive., Results: One hundred five of 211 (49.8%) physicians approached to participate gave consent and 84 (39.8%) completed the study. There was no difference in the number of physicians randomly assigned to monetary compared with CME compensation for giving consent to participate (adjusted odds ratio = 1.42, confidence interval = 0.69, 2.93). However, physicians in the monetary compensation group were more likely to complete the study after giving consent (adjusted odds ratio = 4.70, confidence interval = 1.25, 17.58). This monetary effect was also significant from the perspective of all physicians approached initially (adjusted odds ratio = 2.78, confidence interval = 1.16, 6.67)., Discussion: This study suggests that future PBRN investigators should receive monetary compensation for the opportunity cost of adding research activities to their already busy practices. This compensation may be especially vital for PBRNs to complete more ambitious projects requiring a significant time commitment from the participating physicians.

Objectives: We evaluated the effectiveness of a community-based participatory research-grounded intervention among women receiving Temporary Assistance for Needy Families (TANF) with chronic health conditions in increasing (1) health care visits, (2) Medicaid knowledge and skills, and (3) health and functional status., Methods: We used a randomized controlled trial design to assign 432 women to a public health nurse case management plus Medicaid intervention or a wait-control group. We assessed Medicaid outcomes pre- and posttraining; other outcomes were assessed at 3, 6, and 9 months., Results: Medicaid knowledge and skills improved (P < .001 for both). Intervention group participants were more likely to have a new mental health visit (odds ratio [OR] = 1.92; P = .007), and this likelihood increased in higher-risk subgroups (OR = 2.03 and 2.83; P = .04 and .006, respectively). Depression and functional status improved in the intervention group over time (P = .016 for both). No differences were found in routine or preventive care, or general health., Conclusions: Health outcomes among women receiving TANF can be improved with public health interventions. Additional strategies are needed to further reduce health disparities in this population.

Objective: To examine the effects of a community-based intervention on decisions about prostate-specific antigen (PSA) screening using multiple measures of informed decision making (IDM)., Data Sources/study Setting: Nonequivalent control group time series design collecting primary data in late 2004 and 2005., Study Design: We developed a multimodal intervention designed to convey the medical uncertainty about the benefits of PSA screening and early treatment and the limited predictive ability of both the PSA test and pathological specimens collected from prostate biopsy. We examined (1) patients' recognition that there is a decision to be made about PSA screening, (2) prostate cancer knowledge levels, (3) their preferred and actual levels of participation in decision making about screening at three points in time, and (4) screening decision., Data Collection: Baseline data collection occurred in community-based organizations. These organizations served as recruiting sources and as sites for the intervention. We collected follow-up data by mail with telephone reminders., Principal Findings: Our intervention was associated with greater recognition of the PSA test as a decision to be made, levels of knowledge, both preferred and actual levels of involvement in decision making, but did not have an impact on the screening decision., Conclusions: Community-based interventions can influence key measures of IDM about PSA screening., (© Health Research and Educational Trust.)

Purpose: Effective strategies to recruit minority elders into health research (e.g., through churches, partnering with community gatekeepers) often involve nonrandom sampling methods. The current study has two aims: (a) to examine some new practices in recruitment of African American elders and (b) to determine the similarities and differences of the volunteers in the Healthier Black Elders (HBE) Participant Resource Pool (PRP), with a population-based community sample from the Detroit Health Needs Assessment (Chapleski, E. E. (2002). Facing the future: City of Detroit needs assessment). Detroit, MI: Wayne State University., Design and Methods: A community-based participatory research approach was used to establish the HBE as an educational and support program in Detroit and to use HBE to launch a research participant registry of older Black adults. Data were drawn from a community-based telephone survey of 723 older African American elders aged 60 years and older recruited into the PRP registry., Results: PRP participants had some differences from those in the Detroit Health Needs Assessment. These included that older women had a significantly higher participatory rate compared with their male counterparts. African American women in the PRP reported a modestly healthier life with less disability compared with their Detroit Health Needs Assessment counterparts, whereas for men, it was the reverse for chronic diseases. The PRP was able to attract a significantly higher percentage of older old compared with the population = based survey., Implications: Study findings suggest that the HBE approach of recruiting African American elders in health research appears effective and to have some unique strengths.

Purpose: To make recommendations for American Indian/Alaska Native (AI/AN) nurse practitioners (NPs) and university partners who are partnering on community-based participatory (CBPR) research projects. An example of a CBPR study using focus groups to assess an important adolescent health problem is used to illustrate opportunities and challenges for AI/AN NPs., Data Sources: Thirteen focus groups were held with 95 participants on the reservation where the AI/AN NP was a member and working. Results indicated that a majority of the community represented in the focus groups were concerned about substance abuse among its youth., Conclusions: The NP faced several challenges, including remembering emotional events recounted during focus groups differently than participants. This necessitated debriefing and a recommendation to carefully form policies and procedures before collecting data to anticipate such events. By far, the benefit of the NP's involvement was her ability to identify key members for focus groups, to assist in tribal council meetings, and to schedule meetings., Implications for Practice: CBPR research partnerships are enhanced by NPs that are members of the community. CBPR partnerships present opportunities for NPs and university faculty to work on relevant community problems together., (©2011 The Author(s) Journal compilation ©2011 American Academy of Nurse Practitioners.)

Photovoice is a participatory action research methodology that involves the use of photography and enables people to document, reflect upon, and communicate community needs to policymakers for the purpose of promoting social change. We describe how Photovoice was used to engage rural youth in childhood obesity prevention research and obtain their perspectives of community assets and barriers that influenced children's physical activity and diets in their county. The photographs and stories produced by the youth garnered public interest and were beneficial in raising community awareness of community conditions that may contribute to childhood obesity and the need for environmental change. Utilization of the method also provided a beneficial leadership experience for the youth participants., (© 2010 Wiley Periodicals, Inc.)

Public stigma robs people with mental illnesses from rightful opportunities related to work and other important life goals. Advocates have developed anti-stigma programs meant to address the prejudice and discrimination associated with these conditions. Evidence is now needed to make sense of program impact; this paper looks at measurement issues related to stigma change. Community-based participatory research is central to this research and includes the involvement of a diverse collection of stakeholders in all phases of evaluation. Investigators should be cautious about measures vis-à-vis social desirability effects and should directed by social validity of targeted audiences. Conceptual domains with some research support that correspond with assessments include behavior, penetration, psychological perspective, knowledge, and physiological/information processes. These issues are summarized as ten recommendations for evaluation of anti-stigma programs., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Objectives: Student health, well-being, and productivity are determined in part by attending school daily. Increased annual average daily attendance (ADA) increases public funding for school district-based enrichment programs. Asthma is reported as the number 1 cause of American school absenteeism due to chronic illness; however, only limited, estimated national data exist. Accurate, precise ways to assess potential disparities in disease-driven absence do not yet exist. The authors summarize part of their community-based participatory research (CBPR), namely planning then testing a set of matching field sheet (data collection) and computer-based spreadsheets (database) based on previous school-based research to track attendance and reasons for absence., Methods: The CBPR process occurred mid-2005 to mid-2008, with final activities in DeKalb County, Georgia, August-December 2007 (fall semester) for this portion. The authors tracked absence, with an ability to examine data overall and at classroom, grade, and school levels by gender, race/ethnicity, and doctor-diagnosed asthma as reported to schools on student emergency cards., Results: The authors characterized their study sample, consisting of 914 4th-5th grade children (overall, 9.2% of children with asthma) from seven randomly selected, consenting participating schools (n = 21 classrooms per grade, 2 to 4 classrooms per grade per school). Six schools used paper versions of tools while one school used electronic versions. The authors presented attendance results in various aggregated manners. Absence was higher (ADA lower) among 4th grade asthmatic students compared to the entire classroom., Conclusions: This study can inform future interdisciplinary school-based research combining health and student academic productivity, adult work performance outcomes, and other measures.

Background: The epidemiology of fecal incontinence (FI) remains incompletely understood. The use of different interview questions in highly selected populations has resulted in widely varying reported rates., Aim: To define the prevalence of idiopathic FI in a Canadian urban community sample using a validated interview questionnaire., Methods: Respondents completed a telephone interview regarding bowel health as part of the 2006 Winnipeg Area Study (WAS). The WAS has been conducted annually by the Department of Sociology at the University of Manitoba (Winnipeg, Manitoba) since 1981. The household was the primary sampling unit. An eligible respondent was an individual 18 years of age or older who lived at that address, matched a randomly preassigned sex and provided consent. Respondents were asked whether they had ever been diagnosed by a physician with colon cancer, ulcerative colitis, Crohn's disease or irritable bowel syndrome. They were also asked, 'In the past 12 months have you experienced accidental leakage of liquid or solid stool?' Respondents were asked not to consider short-term diarrheal illness. Finally, respondents were asked to rank eight attributes of bowel habit on a 10-point scale. Answers ranking 5 points or greater were defined as having the attribute., Results: In the city of Winnipeg, population 650,000, 1153 households were contacted. Of these, 727 (63%) agreed to participate and formed the study sample. Of the respondents, 361 were men and 366 were women (mean age 47 years). The sociodemographics of these respondents were comparable with those reported in previous WAS samples and the 2001 Canadian census data. Respondent cooperation, high interview quality and willingness for repeat contact were rated by the interviewers at 93%, 89% and 90%, respectively. FI was reported by 3.7% of the sample. There was no difference in sex or age of those reporting FI when compared with the rest of the sample. With physician-diagnosed gastrointestinal conditions removed from the analysis, 2.0% of the sample reported FI. Of the gastrointestinal conditions, only irritable bowel syndrome demonstrated a significant correlation with FI (one-sided X(2) test 11.567, degrees of freedom = 1; P=0.001). Four bowel habit attributes demonstrated strong correlation with FI (P=0.0001 for each t test): admission to any type of bowel accident, inability to delay toileting, inability to control passage of stool and need to wear a pad due to soiling. These four bowel habit attributes were reported (ranked 5 points or greater) by 1.5%, 22%, 2.4% and 1.5% of the sample, respectively., Conclusion: The prevalence of idiopathic FI in a well-defined community sample was 2.0%. There was no sex preference and the mean age of affected individuals was 47 years - demographic variables that did not vary among the sample. These findings suggest the need to develop a new paradigm beyond aging and childbirth injury to study the pathophysiology of FI. It is imperative to control for subjects with known irritable bowel syndrome in epidemiological studies because their inclusion in the present analysis doubled the calculated prevalence of FI.

This community-based participatory research (CBPR) project utilized a mixed-methods survey design to identify urban (Tulsa, OK) American Indian (AI) strengths and needs. Six hundred fifty AIs (550 adults and 100 youth) were surveyed regarding their attitudes and beliefs about their community. These results were used in conjunction with other community research efforts to inform program development, support proposals for external funding, and develop a comprehensive service system model to be implemented in the community.

Growing evidence suggests that the built environment features found in many high-poverty urban areas contribute to negative health outcomes. Both built environment hazards and negative health outcomes disproportionately affect poor people of color. We used community-based participatory research and Photovoice in inner-city Atlanta to elicit African Americans' perspectives on their health priorities. The built environment emerged as a critical factor, impacting physical and mental health outcomes. We offer a conceptual model, informed by residents' perspectives, linking social, economic, and political processes to built environment and health inequities. Research, practice, and policy implications are discussed within an environmental justice framework.

In this research we examined the processes involved in implementing and maintaining a participatory action research (PAR) project by uncovering how theoretical PAR tenets hold up in the reality of a community-based project addressing immigrants' and refugees' mental health needs. Qualitative data from focus groups with these newcomers were analyzed for thematic content. Findings reveal that active participation is seen as the gateway into a PAR project, whereas knowledge attainment and empowerment are the stimuli for continued participation. The data also suggest that newcomers' motivations to participate in a PAR-oriented project might vary across ethno-cultural groups. Practitioners working in community-based initiatives would do well to appeal to the diversity of motivational factors, while endorsing individual and group strengths.

Background: Minority populations have been under-represented in mental health research studies. The systematic treatment enhancement program for bipolar disorder developed the Community Partners Program (CPP) to address this issue in a large, prospective treatment study of persons with bipolar disorder., Purpose: The primary goal of CPP was to develop a community-based infrastructure for studying bipolar disorder that would enhance the ethnic/racial and socioeconomic diversity of participants., Methods: Selected academic sites partnered with local clinics (n = 6 partnerships in five cities). This report describes the conceptualization, implementation, and qualitative evaluation of CPP, as well as quantitative analysis of clinical and sociodemographic differences between the samples recruited at academic versus community sites., Results: Quantitative analysis of the 155 participants from the six partnerships revealed enrollment of 45% from minority populations (vs. 15% in academic sites). Significant sociodemographic differences were evident not only between academic and community sites, but within minority and non-minority groups across site types. Notably, clinical differences were not evident between participants from academic and community sites. Review of qualitative data suggests that certain factors around implementation of research protocols may enhance community participation., Conclusions: Moving research recruitment and participation into community sites was more successful in increasing minority enrollment than efforts to attract such individuals to academic sites. Recommendations for creating and maintaining academic/community partnerships are given., Limitations: Several important variables were not considered including mood severity, hospitalization, or treatment differences. Minority participants were grouped by combining African American and Hispanics, which may have obscured subgroup differences. A derivation of standard qualitative methods was used in this study.

Background: We tested the effectiveness of a theory-guided, culturally tailored cervical cancer education program designed to increase Pap smear use among Samoan women residing in the U.S. Territory of American Samoa., Methods: We used a two-group, pretest-posttest design. The sample comprised 398 Samoan women age 20 and older recruited from Samoan churches. Women in the intervention group received a culturally tailored cervical cancer education program in three weekly sessions. The primary outcome was self-reported receipt of a Pap smear., Results: Overall, there was a significant intervention effect, with intervention compared with control group women twice (adjusted odds ratio = 2.0, 95% confidence interval = 1.3-3.2, p < .01) as likely to self-report Pap smear use at the posttest., Conclusions: The findings support the efficacy of the multifaceted, theory-guided, culturally tailored community-based participatory cervical cancer education program for Samoan women in effecting positive changes in Pap smear use and cervical cancer related knowledge and attitudes.

Walking Forward is a community-based participatory research program in western South Dakota funded by the National Cancer Institute (NCI). The primary goal of this initiative is to address the high and ominously increasing cancer mortality rates among American Indians by facilitating access to innovative clinical trials, behavioral and genetic research and tailored patient navigation. The critical outcomes include: an unprecedented accrual rate of 25 percent in clinical trials, including cancer treatment and cancer control trials; a significant reduction in the number of missed treatment days among navigated American Indian cancer patients undergoing radiation therapy; and most importantly, establishment of trusting partnerships with the American Indian communities as reflected in enrollment in a genetic study involving the ataxia telangiectasia mutated gene. The results indicate that the Walking Forward approach presents an effective strategy to overcome the barriers to cancer care in this underserved community.

Although it is recognized that community health promotion succeeds or fails by level of participation, effectiveness and benefits of community programs are underestimated, because participation is seldom monitored and evaluated. In the Dutch "Healthy Lifestyle Westerpark" program in Amsterdam, participation was both the main working principle and the main goal.Between 2003 and 2006, the Municipal Health Service (MHS) carried out a qualitative study on the background of overweight in Turkish and Moroccan women aged 25 to 45 years and on possibilities for promoting health with and for the target group. The aim of the program was to increase the women's participation and to evaluate participation levels in all phases. The research aim of this paper is to contribute to the development of participatory methods.Needs assessment and intervention development phases resulted in implementation of aerobic lessons and nutrition interventions. In the evaluation phase, participation levels were measured using Pretty's typology in focus groups.Results show that women appreciate participating in the program. Increase in physical activity was not measured. Women's knowledge about healthy food increased, women changed behavior by buying healthier food ingredients and women continued to participate.Participatory approaches facilitate participation at the desired level in the different phases of the program. Participatory approaches are time-consuming but worthwhile. Pretty's typology is useful to measure degree of participation, although methods can be improved and the meaning of participation should be reconsidered.The added value of this article is twofold: 1. it demonstrates that participatory methods and tools both facilitate and evaluate participation, and 2. it shows how to evaluate the degree of participation.

Objective: The aim of this study was to design and validate an interviewer-administered pelvic floor questionnaire suitable for community-dwelling women to assess female bladder, bowel, and sexual function; pelvic organ prolapse; and condition-specific quality-of-life issues., Design: The questionnaire was developed and administered during interviews of 493 community-dwelling women aged 40 to 79 years originally recruited from an age-stratified random sample from the electoral roll who were involved in a longitudinal study of aging in women. Full psychometric testing was performed. To assess discriminant validity, 55 consecutive patients attending a tertiary referral urogynecology clinic served as a comparison group., Results: Face validity: The interviewer-administered questionnaire was easily administered and missing data did not exceed 2%. Discriminant validity: The questionnaire clearly discriminated the community population from the urogynecology patients in all pelvic floor domains. Convergent validity: The bladder function domain score correlated with the validated short version of the Urogenital Distress Inventory score. Bowel function scores correlated highly with corresponding items in an established bowel questionnaire. Prolapse symptoms correlated significantly with the pelvic organ prolapse quantification. Sexual function score (n = 257) correlated with the validated McCoy Female Sexuality Questionnaire score. Reliability: Cronbach's alpha for the bladder, bowel, prolapse, and sexual function domains was adequate (alpha >or= 0.7). Kappa values in the test-retest analyses varied between 0.63 and 1.0 (test-retest reproducibility)., Conclusions: The interviewer-administered questionnaire assesses all aspects of pelvic floor function including condition-specific quality-of-life issues in a reliable and valid fashion. It is suitable for researchers investigating pelvic floor function.

Objective: The aim of this article was to describe a pragmatic approach to the menopausal status classification of clinical research study participants that allows for women who have gynecological circumstances that mask their natural menstrual pattern., Design: We demonstrate the application of an algorithm for the Health and Wellbeing After Breast Cancer study based on self-reported menstrual cycle pattern, gynecological history, presence or absence of vasomotor symptoms, and systemic hormone use to classify women with newly diagnosed breast cancer as premenopausal, perimenopausal, or postmenopausal for research purposes., Results: Within 12 months of their breast cancer diagnosis, 1,684 participants, mean +/- SD age 57.4 +/- 11.9 years, completed a comprehensive women's health questionnaire. Menopausal status in 71.8% of the women was classified by reported bilateral oophorectomy, age, greater than 12 months of amenorrhea, or regular menstrual cycles and absence of symptoms. Status in the remainder was classified by progression through the decision tree., Conclusions: The Health and Wellbeing After Breast Cancer study menopausal classification algorithm is a useful tool for research involving female participants that allows for the classification of women who have had a hysterectomy and/or use systemic hormonal contraception or hormone therapy.

While the existence of racial disproportionality has been well documented, the causes of disproportionality are less clear. Studies identifying contributing factors have relied largely on analyses of state and national data sets, which may lack the robust data necessary to fully explain the factors related to this issue. Further, a limitation of existing research is the lack of data from the voice of those in communities affected by disproportionality. This study was designed to develop a deeper understanding of disproportionality from the views of multiple community stakeholders. Using a qualitative approach, data were collected to provide a greater depth of information that can be used alongside existing studies toward developing an enhanced understanding of disproportionality in child welfare.