Collecting and communicating perishable data in a post-disaster context: rapid research and rapid dissemination.

Context: Puerto Rico experienced four natural disasters in 4 years (2017-2021): Hurricanes Irma and Maria, thousands of earthquakes reaching 6.4 magnitude, and the COVID-19 pandemic. In this context, our team sought to understand the impact of disaster aid distribution on poverty and economic inequality, and their relationship to the spread of COVID-19 across Puerto Rico. Rapid research was required to ensure we could collect perishable data within this ever-changing context. Challenges: Our mixed methods design relied on both secondary and primary data. Because analyses of the former were to inform where and how to collect the latter, timing was of the essence. The data sources identified were not readily available to the public, and thus required gaining access through direct requests to government agencies. The requests coincided with a transition between administrations after an election. This resulted in unexpected delays. Once in the field, the team had to balance the rapid nature of the research with the mindful work to avoid compounding traumas experienced by participants, heightened risk for re-traumatization and fatigue, the risk of COVID-19, the digital divide, and intermittent electrical and telecommunication services. Adaptations: In response to the delayed access to secondary data, we adjusted our research question. We continued to collect data as they became available, incorporating some immediately into analyses, and cleaning and storing others for future research opportunities. To overcome ongoing trauma challenges and prevent fatigue, we recruited and hired a large temporary team, including members of communities where we collected data. By recruiting participants and co-researchers at the same time and place, we both collapsed time between these activities and increased our team's contextual competency. To adapt to challenges presented by the pandemic, we created hybrid data collection procedures where some data were collected online, and some in person, while maintaining COVID-19 protections. We used similar adaptations for dissemination. Lessons: Rapid research needs to be agile. Working within a convergence framework to investigate wicked problems had the unexpected added benefit of providing our team with a variety of disciplinary approaches which proved helpful in adapting to the changing conditions in the field. In addition to the resourcefulness of a transdisciplinary team, it is important to be willing to pivot in response to changes and to collect data where and when you can. To increase participation, opportunities need to be designed with flexibility, mindful of competing demands faced by individuals willing to collaborate. Collecting and analyzing data iteratively and utilizing local resources can enable rapid research that is rigorous and yields rich data. Contributions: Our team applied the lessons learned to structure a rapid and iterative dissemination plan. We combined member-checking with community-level dissemination, enabling us to hone findings further before presenting to policy makers and media. Rapid research creates opportunities to make data-informed program and policy adjustments when they can be most impactful. Both the media and policy makers pay closer attention to research on current events. Hence, our recommendation is to do more rapid research! The more we do, the better we will get at it, and the more accustomed community leaders, policy makers, and program designers will become to using data to inform decisions.

Multilevel Factors Influencing Young Mothers' Breastfeeding: A Qualitative CBPR Study.

BACKGROUND: Young mothers (age 14-24 years), who are often low income, are less likely than other mothers to breastfeed for 6 months. They also are more likely to be diagnosed with aggressive forms of breast cancer; breastfeeding significantly reduces this risk. While adolescent breastfeeding has been investigated from the perspective of the individual, the social ecological model recognizes the influence of factors at multiple levels. RESEARCH AIM: The aim was to identify social and structural barriers to and motivators of breastfeeding that young mothers may encounter. METHODS: Using a cross-sectional prospective qualitative design with a community-based participatory research approach, we sought to identify influential factors at each social ecological level: individual, relationship, community, and societal/structural. We used purposeful sampling, and enlisted snowball sampling. We interviewed stakeholder experts ( n = 9) and dyads ( n = 6) consisting of a young mother and her decision-making partner. Groups of young mothers ( n = 6 groups) collectively created community maps while discussing their feelings about infant feeding in different locations. Using collaborative data analysis, we identified themes and categorized barriers and facilitators according to the social ecological levels. RESULTS: Four meta-themes emerged: roles, place, stigma, and support. While some barriers and facilitators were similar to those experienced by mothers of all ages, participants reported multiple overlapping stigmas, requiring more support. CONCLUSION: Young mothers who decide to breastfeed encounter barriers at multiple levels. Policies and programs aiming to increase breastfeeding rates in this group must address these barriers and enlist identified facilitators.

School climate and physical adolescent relationship abuse: Differences by sex, socioeconomic status, and bullying.

Little is known about the association between school climate and adolescent relationship abuse (ARA). We used 2011-2012 data from surveys of California public school students (in the United States of America) who were in a dating relationship in the last year (n = 112 378) to quantify the association between different school climate constructs and physical ARA. Fifty-two percent of students were female, and all students were in 9th or 11th grade (approximately ages 14-17). Over 11% of students reported experiencing physical ARA in the last year. Increased school connectedness, meaningful opportunities for participation, perceived safety, and caring relationships with adults at school were each significantly associated with lower odds of physical ARA. Increased violence victimization and school-level bullying victimization were associated with higher odds of physical ARA. These school climate-ARA associations were significantly moderated by student sex, school socioeconomic status, and school-level bullying victimization. School climate interventions may have spillover benefits for ARA prevention.

Reproductive health in indigenous Chihuahua: giving birth 'alone like the goat'.

INTRODUCTION: Indigenous peoples in the state of Chihuahua, Mexico, are known to outsiders as the Tarahumaras. The Tarahumaras are one of the few cultural groups known to have no traditional birth attendants, and Tarahumara women often give birth alone and outdoors. Currently, little is known about this group, their health status or their culture. OBJECTIVE: The objective of this study was to assess the state of reproductive health outcomes, risks, protective factors, beliefs and behaviors in the Tarahumara population. DESIGN: This paper reports on the qualitative results of a mixed methods study, comprised of focus groups, interviews, participatory exploratory methods, ethnographic observation and household surveys investigating the reproductive health status of the Tarahumara peoples and contextual factors influencing it. Qualitative data is presented, supported by preliminary quantitative findings. RESULTS: This study supports speculation that the Tarahumara population is burdened by severe maternal health problems. The sample size was too small to definitively assess risk factors for the outcome of maternal mortality, but qualitative findings point to some important contextual issues that contribute to participants' perceptions of susceptibility to and severity of the problem, their reproductive health beliefs and behaviors, and barriers to behavior change. Major issues included disparities in biomedical knowledge, trust between non-indigenous providers and indigenous patients, and structural issues including access to medical facilities and infrastructure. CONCLUSION: Qualitative data is drawn upon to make recommendations and identify lessons applicable to similar situations where cultural minorities suffer serious health inequities. This study underscores the importance of needs and assets assessment, as it reveals unique contextual factors that must be taken into account in intervention design. Also, collaborative partnership with community members and leaders proved to be invaluable in the research, warranting further collaboration by both governmental and non-governmental groups attempting to improve the health of this population. This becomes especially important when making and enforcing health policy.

Developing and using a partnership covenant to guide a study of late HIV diagnosis.

BACKGROUND: Late diagnosis of HIV is an important problem in the United States, particularly in ethnically and socially diverse communities. OBJECTIVES: We created and used a partnership covenant to ensure our adherence to community-based participatory research (CBPR) principles as we began studying and addressing individual and structural barriers to timely HIV testing. METHODS: Sample CBPR principles were used to help develop a partnership covenant that in turn was used in steering committee (SC) meetings to gauge our adherence to CBPR in our work together and in the field. RESULTS: Continuing dialogue around our fidelity to the covenant resulted in concrete changes including a "crash course" on sampling for community partners and development of a community advisory board (CAB). Our ability to meet the project's specific aims was enhanced by using the covenant. CONCLUSIONS: Although time consuming, development and use of a CBPR covenant can improve high-level engagement and help to accomplish a study's specific aims.