Using a mixed-methods approach to identify health concerns in an African American community

Objectives. We used qualitative and quantitative data collection methods to identify the health concerns of African American residents in an urban community and analyzed the extent to which there were consistencies across methods in the concerns identified.Methods. We completed 9 focus groups with 51 residents, 27 key informant interviews, and 201 community health surveys with a random sample of community residents to identify the health issues participants considered of greatest importance. We then compared the issues identified through these methods.Results. Focus group participants and key informants gave priority to cancer and cardiovascular diseases, but most respondents in the community health survey indicated that sexually transmitted diseases, substance abuse, and obesity were conditions in need of intervention. How respondents ranked their concerns varied in the qualitative versus the quantitative methods.Conclusions. Using qualitative and quantitative approaches simultaneously is useful in determining community health concerns. Although quantitative approaches yield concrete evidence of community needs, qualitative approaches provide a context for how these issues can be addressed. Researchers should develop creative ways to address multiple issues that arise when using a mixed-methods approach.Community-based participatory research is a collaborative process in which academic and community investigators work together to develop, implement, and evaluate interventions to improve the health of community residents.^1–4 As part of these partnerships, formative research that includes focus groups and key informant interviews may be conducted to identify the health priorities and concerns of community residents and to obtain guidance from stakeholders on how these issues should be addressed and how to develop interventions.^5,6 Although this information is critical to the implementation of intervention strategies, the generalizability of data obtained from these methods may be limited because individuals may self-select for participation in focus groups, and key informants are often identified using nonrandom methods. Thus, it may be important to use quantitative methods such as population-based random surveys along with qualitative approaches to ensure that the health priorities and concerns identified during the formative phase of academic–community partnerships are most representative of the community. However, limited empirical data exist on the congruence of data obtained using different methods.In 2005, members of 4 community-based organizations in Philadelphia, Pennsylvania, and researchers and staff at the University of Pennsylvania ( Figure 1) established the West Philadelphia Consortium to Address Disparities with funding from the National Center on Minority Health and Health Disparities.⁷ The purpose of our academic–community partnership is to conduct collaborative research to address disparities in chronic diseases that disproportionately affect African Americans in terms of morbidity and mortality using a community-based participatory framework. In keeping with the principles of community-based participatory research, the leaders of each community partner are listed as coinvestigators (R. R., V. B., E. D., J. P.) in the research alongside the academic-based coinvestigators. Moreover, each community partner receives its share of the funding directly. The organizations involved have all worked with academic investigators previously and realized that they share similar interests and could work together in a mutually beneficial way.Open in a separate windowFIGURE 1Overview of mixed-methods approach: West Philadelphia Consortium to Address Disparities, Philadelphia, PA, 2006–2007.Note. COCCDC = Christ of Calvary Community Development Corporation; HPC = Health Promotion Council of Southeastern Pennsylvania; NBLIC = National Black Leadership Initiative on Cancer; Penn = University of Pennsylvania; SWAC = Southwest Action Coalition.We used a mixed-methods⁸ approach that consisted of focus groups, key informant interviews, and a fixed choice community health survey (CHS) with a random sample of residents to identify the health concerns of African American residents in the West Philadelphia community to determine the focus for pilot interventions that the partnership would develop and implement. We describe analyses that were undertaken to determine the extent to which there was consistency in the concerns residents identified using qualitative and quantitative methods, and we offer suggestions for managing inconsistencies that may arise when using a mixed-methods approach.     

A community approach to health

Improving the health and well-being of a community may seem like a daunting task-particularly when you consider the vast number of factors that can influence the quality of life of a neighborhood or a region. It's not impossible, however, as six widely different communities across the U.S. are discovering. The Accelerating Community Transformation (ACT) project--now underway by The Healthcare Forum through a five-year, $5 million grant from pharmaceutical joint venture Astra Merck Inc.--is an innovative attempt to create real-life learning laboratories in communities as diverse as an inner-city neighborhood on the west side of Chicago; the small southern town of Aiken, S.C.: the semi-desert city of San Bernardino, Calif.; a corner of America's heartland where Missouri, Kansas. Nebraska and Iowa meet; the new town of Celebration, Fla.; and St. Louis, Mo. The goals: to evaluate and accelerate community-wide efforts that result in healthier, more desirable places for people to live, work and play; to build community capacity; and to achieve measurable improved health and quality of life outcomes.     

Moonlighting policy and practice in family practice residencies

Moonlighting by residents is a controversial, but little-studied topic. A survey on moonlighting policy and practice was sent to all family practice residency program directors, and an 87 percent response rate obtained. Moonlighting is permitted by 97 percent of nonmilitary programs and is generally thought of by program directors as a positive educational experience. It is practiced by over two thirds of the second- and third-year residents in programs that monitor moonlighting. These residents spend an average of 28 hours each month moonlighting. The most commonly used moonlighting sites are hospital emergency rooms, followed by coverage for private practice physicians. Seventy percent of programs require approval for extracurricular work activity. Only 23 percent of residencies limit moonlighting for all residents, but 47 percent have had occasion to deny moonlighting privileges to individual residents.     

A community expands access to health care: the case of access health in Michigan

Access Health, a Michigan-based "three-share plan," is viewed as a successful community-based approach to expanding health benefits in the workplace. It was the stimulus for recently proposed legislation to federally fund similar plans nationally. The program evolved with the support of the W.K. Kellogg Foundation. Its sustained viability is attributable in part to the creative use of a state statute to draw down federal Medicaid disproportionate-share hospital (DSH) funds. Although it faces obstacles common to programs of its type, the program's greatest financial vulnerability rests on the uncertain continued availability of the monies it uses to subsidize the program.     

Clostridium difficile in general practice and community health.

The isolation rate for Clostridium difficile in diarrhoeal stools was investigated in patients from general practice and community health centres over a 14-month period. C. difficile or its cytotoxin was detected in specimens from 89 (4.7%) of 1882 patients studied and accounted for 30.3% of all enteropathogenic micro-organisms isolated. Overall C. difficile was second only to Giardia lamblia in frequency. Recovery rates in the different groups of patients surveyed varied from 3.6 to 27.5%. The relationship between stool culture results and stool cytotoxin assay also varied considerably between groups of patients studied. Coincident infections with a variety of enteropathogenic bacteria and intestinal parasites were diagnosed in 14 of the 89 patients. It was concluded that laboratories servicing this type of practice should be aware that C. difficile may be a cause of diarrhoea. An adequate clinical history should facilitate proper processing of the specimen.     

A new approach to community health

This article deals with the local health care among the Shipibo-Conibo in eastern Peru. A project called AMETRA--application of traditional medicine--is functioning in the area. The aim of AMETRA is to give courses and stimulate co-operation between traditional medical practice and Western medicine. The solutions to the health problems are seen in direct relation to the socio-economic structure and to the environmental prerequisites. The aim and purposes of AMETRA are described and analysed. It is proposed that the two medical systems should co-operate in such a manner that their complementary nature is emphasized and fully utilized.     

A stakeholder approach to community health management

Although community health management has become an important issue for health care organizations, there is little information on the roles that they and other community institutions ought to play in this area. This article develops a stakeholder approach to community health management, identifies the set of community health stakeholders, determines their salience to health care organizations, discusses the strategies they use to influence organizational involvement in community health management, and examines the responses of health care organizations. Implications for community institutions, health care managers, and researchers are discussed.