Maternal Centric Measurement and Data Gaps in Addressing Maternal Morbidities: A Scoping Review.

OBJECTIVE: The objectives of this project were to (1) describe maternal-centric measures and survey data which are publicly available to evaluate the incidence, frequency, and distribution of maternal morbidity in the postpartum period, and (2) to identify postpartum care quality improvement targets and outline the types of measurement and data required to support them. METHODS: We conducted a scoping review of two types of data sources: maternal health quality measures used by providers and payers and nationally-representative survey data sets administered by federal agencies. Each source was searched for keywords associated with pregnancy and the postpartum period. We included quality measures and survey questions that are maternal-centric and addressed the postpartum period. We excluded infant-centric measures and data. Quality measures were organized according to the Donabedian quality model. RESULTS: Our analysis demonstrates that existing maternal-centric quality measures and survey data offer limited insight into diagnosis and patient care delivery experiences associated with maternal morbidities during the postpartum period. CONCLUSION: There is inadequate maternal-centric data on the incidence, frequency, and distribution of postpartum maternal morbidities and associated care use. This gap reduces the ability of research to estimate the incidence of illness and injury among postpartum women and create targeted quality improvement efforts. Our findings highlight the need for quality measure stewards and data sponsors to enhance data collection and methods to become more inclusive of maternal-centric outcomes during the postpartum period.

A Retrospective on the Vision for Progress in Community Health Partnerships: Research, Education, and Action.

The organizers founded Progress in Community Health Partnerships with a commitment to improving our understanding of community-based participatory research (CBPR) and its use in community-academic/institutional health partnerships. Following Rogers's Diffusion of Innovations, they reasoned that expanded adoption would occur through academic and community partner recognition of CBPR's relative advantage over previous approaches; its compatibility with the values, past experience and needs of potential adopters; its ease of understanding and use; its capacity for experimentation and refinement; and its production of observable results. We now assess the journal's progress toward realizing the vision, as well as issues and problems the organizers identified. We map the journal's content over its first decade onto the initial vision by examining the record of submissions and publications across the eight types of articles and the journal's record of rejections and publications. In remembering that Rogers's study of innovations requires both technical and social change, we discuss the difference between understanding how to do something and actually putting an innovation into action that becomes standard practice at both individual and systemic levels. We observe that the large number of Original Research and Works-in-Progress/Lessons Learned manuscripts, submitted and published, reflect traditional expectations for faculty research productivity. We suggest that sustainability, which rated of lower importance within the initial vision, has gained in importance among community and academic partners; however, it will gain added attention only with changed university expectations of researchers. We further suggest that the study of partnerships involved in researching and improving public health should be expanded beyond the current focus on CBPR.

Evaluating community engagement in global health research: the need for metrics.

BACKGROUND: Community engagement in research has gained momentum as an approach to improving research, to helping ensure that community concerns are taken into account, and to informing ethical decision-making when research is conducted in contexts of vulnerability. However, guidelines and scholarship regarding community engagement are arguably unsettled, making it difficult to implement and evaluate. DISCUSSION: We describe normative guidelines on community engagement that have been offered by national and international bodies in the context of HIV-related research, which set the stage for similar work in other health related research. Next, we review the scholarly literature regarding community engagement, outlining the diverse ethical goals ascribed to it. We then discuss practical guidelines that have been issued regarding community engagement. There is a lack of consensus regarding the ethical goals and approaches for community engagement, and an associated lack of indicators and metrics for evaluating success in achieving stated goals. To address these gaps we outline a framework for developing indicators for evaluating the contribution of community engagement to ethical goals in health research. There is a critical need to enhance efforts in evaluating community engagement to ensure that the work on the ground reflects the intentions expressed in the guidelines, and to investigate the contribution of specific community engagement practices for making research responsive to community needs and concerns. Evaluation mechanisms should be built into community engagement practices to guide best practices in community engagement and their replication across diverse health research settings.

Veteran PTSS and spouse relationship quality: The importance of dyadic coping.

Research with combat veterans and their spouses has documented the harmful impact of posttraumatic stress symptoms (PTSS) on relationships, yet few studies have evaluated theoretically based models of relational processes among these couples. In this study, the authors tested 2 moderators of the association between male combat veterans' PTSS and their female spouses' reported relationship quality based on Bodenmann's (1997, 2005) systemic transactional theory of dyadic coping. We hypothesized that supportive dyadic coping and common dyadic coping would moderate the association of PTSS and spouses' relationship quality. Hypotheses were supported. The degree to which a veteran's PTSS was negatively associated with his spouse's relationship quality depended on whether she perceived him as supportive when she experiences stress (i.e., supportive dyadic coping) and the degree to which she perceived the couple as working together to manage difficulties (i.e., common dyadic coping). The significant interactions of PTSS with supportive and common dyadic coping accounted for 11.95% and 10.58% of the variance, respectively. Tests of conditional effects showed veterans' PTSS was only significantly negatively associated with spouses' relationship quality when supportive and common dyadic coping were low. Findings highlight the importance of adaptive dyadic coping behaviors as a protective factor for spouses of veterans and hold implications for research and practice.

Understanding the supports of and challenges to community engagement in the CTSAs.

BACKGROUND: The Clinical and Translational Science Award (CTSA) program has raised the profile and the available funding for engagement in biomedical research. Such increased funding and attention may address known barriers to engagement. However, little work has been done to describe experiences across multiple CTSAs, especially how the CTSA structure supports or challenges engagement. OBJECTIVE: We sought to understand the supports and challenges experienced by multiple CTSAs as they pursued community engagement. This knowledge may help guide future efforts to support and enhance community engagement in biomedical research. METHODS: We conducted semi-structured, in-depth interviews with CTSA community engagement core leaders and staff from the 2006 cohort of CTSAs (n = 12). RESULTS: A total of 17 interviews with respondents from nine institutions identified three support themes, including: funding, existing relationships with communities, and leadership and a partnership approach at the institution. Six challenge themes arose: need for capacity development, lack of positive relationships with communities, lack of leadership, funding constraints, time and staff constraints, and unsustainable models. CONCLUSION: The CTSAs have brought much-needed attention to community engagement in research, but more can be done to adequately support engagement. Challenges remain that need to be addressed to achieve the potential benefits of engagement.

County-level correlation between adult obesity rates and prevalence of dentists.

BACKGROUND: Investigators of previous studies regarding the correlation between area-level health care resources and obesity have not examined the association between the prevalence of dentists and rates of adult obesity. The authors conducted a study to address that knowledge gap. METHODS: Using data compiled in the Robert Wood Johnson County Health Rankings and Roadmaps database, the authors conducted multivariable analyses of the relationship between the prevalence of dentists (from the 2011 Health Resources and Services Administration Area Resource File) and rates of obesity within counties. The authors controlled for prevalence of primary care providers, measures of the built environment (for example, number of recreational facilities per 10,000 population, the percentage of restaurants serving fast food) and county-level sociodemographic and economic factors. RESULTS: When the authors conducted a multivariable analysis adjusted for state-level fixed effects, they found that having one additional dentist per 10,000 population was associated significantly with a 1-percentage point reduction in the rate of obesity (P < .001). This effect was significantly larger in counties in which 25 percent of children or more (versus less than 25 percent of children) lived in poverty and in counties that had more primary care physicians per 10,000 population (P ≤ .009). CONCLUSIONS: The association between the prevalence of dentists and obesity, even after adjusting for primary care resources and sociodemographic factors, was evident. Although these data could not be used to assess causality, given the strength of the ecological, cross-sectional association, additional research involving person-level, longitudinal data is warranted. PRACTICAL IMPLICATIONS: The correlation between the prevalence of dentists and obesity rates highlights the potential for dental professionals, as well as other primary care providers, to provide meaningful health education and support for improved nutritional behaviors, although the increased obesity rates in counties with fewer dentists per capita present challenges.

Why we need community engagement in medical research.

BACKGROUND: The medical research enterprise depends on public recognition of its societal value. In light of evidence indicating public mistrust, especially among minorities, inadequate enrollment as well as diversity of research participants, and poor uptake of findings, medical research seems to fall short of sufficient public regard. Community engagement in medical research, with special attention to minority communities, may help to remedy this shortfall by demonstrating respect for the communities in practical ways. APPROACH: We provided 3 case examples that illustrate how specific approaches to community-engaged research can build trust between researchers and communities, encourage participation among underrepresented groups, and enhance the relevance as well as the uptake of research findings. DISCUSSION: A common attribute of the specific approaches discussed here is that they enable the researchers to demonstrate respect by recognizing community values and interests. The demonstration of respect for the communities has intrinsic ethical importance. CONCLUSIONS: The 2 potential outgrowths of demonstrating respect specifically through community engagement are (1) the production of research that is more relevant to the community and (2) the mitigation of asymmetry in the researcher-community relationship. We summarized practical resources available to researchers who seek to incorporate community engagement in their research.

Community engagement strategies in the original and renewal applications for CTSA grant funding.

PURPOSE: The Clinical and Translational Science Award (CTSA) program has highlighted community engagement in research by requiring institutions to develop bidirectional relationships with communities to obtain funding. Little is known about how institutions have operationalized that requirement. This study aimed to describe the strategies proposed by the first institutions to receive CTSA funding and to undergo the CTSA renewal process. METHODS: The authors conducted a qualitative document analysis of the community engagement section of 12 original and 10 renewal grant applications of the 12 institutions awarded CTSA funding in 2006 and renewed in 2010. RESULTS: Institutions employed - and research engagement strategies. Capacity-building strategies included education, pilot grants, connecting potential partners, and community research centers. Research engagement strategies ranged from those that allowed for very little input from communities, such as announcements, to those that allowed for a high amount of input from communities, such as community-researcher teams. CONCLUSION: CTSA funding has supported capacity-building for institutions and communities to partner. Engagement strategies employed by the institutions are largely known from prior community-engaged research. Based on the grants from these institutions, the CTSA funding has largely enabled institutions to develop capacity to engage.

Association between parents' PTSD severity and children's psychological distress: a meta-analysis.

The authors conducted a meta-analysis of studies on the correlation between parents' PTSD symptom severity and children's psychological status. An extensive search of the literature yielded 550 studies that were screened for inclusion criteria (i.e., parent assessed for PTSD, child assessed for distress or behavioral problems, associations between parent PTSD and child status examined). Sixty-two studies were further reviewed, resulting in a final sample of 42 studies. Results yielded a moderate overall effect size r = .35. The authors compared effect sizes for studies where only the parent was exposed to a potentially traumatic event to studies where both parents and children were exposed. A series of moderators related to sample characteristics (sex of parent, type of traumatic event) and study methods (self-report vs. diagnostic interview, type of child assessment administered) were also evaluated. The only significant moderator was type of trauma; the effect size was larger for studies with parent-child dyads who were both exposed to interpersonal trauma (r = .46) than for combat veterans and their children (r = .27) and civilian parent-child dyads who were both exposed to war (r = .25). Results support the importance of considering the family context of trauma survivors and highlight areas for future research.

Impact of posttraumatic stress disorder on the relationship quality and psychological distress of intimate partners: a meta-analytic review.

The authors conducted a meta-analysis of the literature on associations between trauma survivors' PTSD symptoms and the (a) relationship quality and (b) psychological distress of intimate partners. Results yielded a small combined effect size (r = -.24) for the association between PTSD and partners' perceived relationship quality. Gender and military status moderated this association with a larger effect size for female partners of male trauma survivors than for male partners of female trauma survivors and a larger effect size for military samples than for civilians. The effect size of the association between PTSD and partners' psychological distress was moderate in magnitude (r = .30). Analysis of hypothesized moderators indicated this association was stronger among military than civilian samples. The association was also stronger among samples of survivors who experienced traumatic events in the more distant past compared with those who experienced more recent events. Results support the systemic impact of one family member's PTSD symptoms and highlight areas for future research.