Infusing Community Engagement in Health Behavior Theory and Research: From Design to Dissemination

Sheri Rowland, PhD, APRN-BC FNP; Patricia Rodriguez Espinosa, PhD, MPH; Angela Bryan, PhD; Renee Martin-Willett, MA; Dylan Serpas, MS; the Health Equity SIG & the Theories and the Techniques of Behavior Change Interventions SIG

Research on health behavior theory has been built on a narrow foundation. Theory and intervention development has in large part, excluded socially marginalized populations with respect to race/ethnicity, socioeconomic status, sexual orientation, gender identity, disability status, and other important elements of identity. Moreover, studies have mostly focused on individual-level predictors of behavior and health outcomes without addressing broader socio-ecological contextual factors known to influence behavior and access to health enhancing opportunities. This scientific gap impacts community-based organizations and non-governmental organizations who may seek public funds to improve the health of their communities. These grant applications often require the use of evidence-based interventions grounded in health behavior theory. Thus, it is crucial to ensure that our theory-based approaches incorporate the voices and needs of the communities they are intended for. Below, we highlight some examples infusing community engagement across the spectrum of behavioral medicine research.

Design

Using a health equity lens, investigators might begin a project by reflecting on their assumptions and positionality with the communities of interest.¹ Then, incorporation of real-world data to inform and center the intervention within the cultural, socioeconomic, and contextual factors salient to the population of focus is recommended. For example, Sweeney et al. (2022) developed a self-determination theory-based intervention to increase physical activity in African American women.² Based on focus groups held with the women, the intervention was designed with the community-identified barriers and facilitators in mind and an optimal study site was identified.

Implementation

Intervention implementation should follow careful consideration of the community accessibility with the methods, tools, capacity and setting to be used. An exemplar for participant-centered implementation strategies is described by Jemmott et al. (2020) who worked withing African American churches to develop an abstinence only intervention for young adolescents grounded in social cognitive theory and delivered by church leaders.³

Evaluation

Intervention evaluation must expand beyond an individual-level focus to include outcomes of relevance to the community. For example, Thomas et al. (2010) worked with Native communities in the Pacific Northwest to design a youth substance use intervention protocol which included continuous evaluation alongside community members.⁴

Dissemination

Dissemination can also be enhanced with community voice if academic journals and reviewers set reporting standards that call for detailed description of engagement strategies utilized at each phase of the research process. Likewise, emphasis should be placed on dissemination strategies using culturally and linguistically appropriate channels (e.g., radio, community events, reports, social media) to share information with the community. Finally, investigators are encouraged to make co-designed tools and methods publicly available. Diverse dissemination strategies can support communities in determining whether and which theory-based interventions will be most effective for them, and in accessing the needed information for implementation and impact.

Theory-based health behavior interventions have the maximum probability of success when researchers broaden their focus and infuse community engagement at each stage of the research process. Use of the newly published conceptual model, Assessing Meaningful Community Engagement, is encouraged to measure and evaluate meaningful community engagement used in theory-based health behavior research.⁵

References

1. Darawsheh, W. (2014). Reflexivity in research: promoting rigour, reliability and validity in qualitative research. International Journal Of Therapy & Rehabilitation, 21 (12), 560-568.
2. Sweeney, A.M., Wilson, D.K., Van Horn, M.L., Zarrett, N., Resnicow, K., Brown, A., Quattlebaum, M., & Gadson, B. (2022). Results from "Developing Real Incentives and Volition for Exercise" (DRIVE): A pilot randomized controlled trial for promoting physical activity in African American women. Journal of Consulting and Clinical Psychology, 90, 747-759. doi: 10.1037/ccp0000740.
3. Jemmott, L.S., Jemmott, J.B. 3rd, Icard, L.D., & Hsu, J. (2020). Effects of church-based parent-child abstinence-only interventions on adolescents' sexual behaviors. Journal of Adolescent Health, 66, 107-114.
4. Thomas, L. R., Donovan, D. M., & Sigo, R. L. (2010). Identifying community needs and resources in a Native community: A research partnership in the Pacific Northwest. International Journal of Mental Health and Addiction, 8(2), 362-373.
5. Organizing Committee for Assessing Meaningful Community Engagement in Health & Health Care Programs & Policies. 2022. Assessing Meaningful Community Engagement: A Conceptual Model to Advance Health Equity through Transformed Systems for Health. NAM Perspectives. Commentary, National Academy of Medicine, Washington, DC. https://doi.org/10.31478/202202c.