A systematic review of community-based participatory research to enhance clinical trials in racial and ethnic minority groups.The value of fostering community engagement in health disparities research has long been apparent (Kindon, Pain, and Kesby 2007; Minkler and Wallerstein 2008). Engaging community members in interventional studies and projects is an attractive approach through which researchers may more effectively increase racial and ethnic minority participation in trials, theoretically improving measurement of health disparities and yielding more valuable research data (Minkler and Wallerstein 2008). Community-based participatory research (CBPR) is an approach to research that takes community involvement beyond the subject participant level. Studies employing CBPR engage community members not as subjects, but rather as partners, involving the community in every stage of research, ideally from identifying the study question at hand, to developing an intervention, recruiting participants, collecting data, interpreting research findings, delivering interventions, and disseminating results (Israel et al. 2005).Community-based participatory research theory suggests that engaging community members as collaborators in health disparities research is powerful on multiple levels. Developing a research project from the bottom-up (starting with community members to identify salient issues important to a particular population) rather than the traditional top-down approach (where researchers identify an agenda that may not be reflective of a community's needs) would inherently appear to improve a population's participation and enthusiasm for an intervention. Since CBPR researchers approach community members as partners, not subjects, one would expect that the community's engagement and retention would be maximized, as the community would be invested in the intervention and outcomes. One could therefore argue that CBPR could be a powerful tool for researchers to improve measurement of health disparities and to analyze health care delivery to particular communities, as well as for policy makers interested in legislating effective and meaningful change for these communities. Though appealing on many levels, CBPR is often a challenging investment for researchers. Often, the level of time commitment required is substantial, given the time needed for researchers to build and sustain community partnerships (Kindon, Pain, and Kesby 2007; Minkler and Wallerstein 2008). Furthermore, few studies have been identified that successfully combine the approach of community collaboration with rigorous research methods. In 2004, the Agency of Healthcare Research and Quality (AHRQ) published a review of the CBPR literature spanning the years 1975-2003, which revealed that while many studies employed the methods of CBPR, few combined this collaborative approach with rigorous methods of scientific inquiry such as randomized-controlled designs (Viswanathan et al. 2004). The report provided guidelines for researchers on how to increase the scientific rigor of studies employing CBPR. Since the AHRQ report was released, however, there has been no further examination of the quality, scientific rigor, and effectiveness of published CBPR studies. To address this knowledge gap, we performed a systematic review of published articles from 2003 to 2010 that employed CBPR methodology in clinical trials. Our study aims to establish the rigor and effectiveness of current CBPR clinical trials and thereby describe the current state of CBPR in the clinical trial literature. By examining the CBPR trials published during this time period and the effectiveness of interventions, we hope to assess whether this method of research holds promise as a meaningful method of investigation for health services research. METHODS Overview Recognizing that the body of CBPR literature is far more extensive than the studies indexed on Index Medicus (Wallerstein et al. 2008) and in keeping with the AHRQ systematic review method, we chose to review only those articles indexed in databases of peer-reviewed literature, which represent the journals with reliable peer-reviewed processes and are the most reliably accessible methods of study retrieval for researchers and policy makers. We therefore performed a systematic review of PubMed and CI-NAHL databases from 2003 to 2010 to find all English-language clinical trials in English-speaking North America that employed CBPR. We defined our limit starting in 2003 given the AHRQ review of the CBPR literature up until that year. This study was approved by the Humans Subjects Committee of Partners Health Care. In efforts to specifically address the conclusions learned from the AHRQ report, we chose to include only clinical trials, or research studies in which an intervention was compared to usual care or another intervention, in our systematic review. We chose to focus our review on interventional studies so as to highlight how a CBPR approach might improve the validity of interventional studies with diverse populations, as clinical trials are currently a prominent focus of clinical research. It is of utmost importance to note, however, that a vital portion of the CBPR literature involves research that would not be categorized as interventional trials. Although there is much to learn from noninterventional studies, we hope that analysis of interventional trials in this article will better allow for comparison of how CBPR can improve on the existing clinical trial model. Search Strategy The year 2009 marked the inception of the Medical Subject Heading (MESH) "Community-based participatory research" in literature search databases. With the guidance of experienced research librarians, we identified relevant clinical trials using a combination of the formal MeSH "community-based participatory research," the MeSH "cooperative behavior" which was utilized prior to the introduction of CBPR as a MeSH heading from 1997 to 2008, the MeSH "community-institutional relations," and informal search terms, including "participatory research," "community-based participatory action," and "clinical trials." Our search identified 369 abstracts for review. One of the authors (D. D.) thereafter assessed the appropriateness of the studies for review. Articles were excluded initially if they were conducted outside of the United States or Canada or were not clinical trials. After this initial review, 161 articles remained for data abstraction. This process was similar to that employed in the AHRQ systematic review (Viswanathan et al. 2004). Figure 1 illustrates the detailed search strategy employed for this review. Data Abstraction Four reviewers independently conducted a systematic review of the CBPR studies using the PRISMA approach as a guideline for data abstraction and assessment (Moher et al. 2009). After consensus was obtained on the abstraction tool, all four reviewers used a small sample of studies (three articles) and tested reviewer agreement (kappa = 0.87). From each article, eligibility was first identified based on the following criteria: (1) employment of CBPR methodology; (2) whether the article was a clinical trial; (3) whether the study reported clinical results. These criteria led to the final inclusion of only 19 of the 161 articles for further extraction. From these 19 articles, the following data were extracted: (1) clinical trial design (controlled versus noncontrolled, randomized versus nonrandomized, and level of randomization); (2) rigor of the CBPR method (including whether descriptions of community partner involvement were cited in recruitment of subjects, development of interventions, delivery of interventions, and interpretation of research findings); (3) racial and ethnic composition of participants, as well as subject recruitment and retention; and (4) intervention effects. [FIGURE 1 OMITTED] Analysis We present data from all included studies regarding methodology of CBPR, recruitment and retention of research participants, and presentation of clinical results. Although the studies were too heterogeneous to perform a meta-analysis, aggregate frequencies, means, and proportions of data are identified as appropriate. RESULTS Article Characteristics Our systematic review covered 19 peer-reviewed articles of which 13 were randomized-control trials (Table 1). Of the 19 studies, 18 reported the numbers of individual participants. Of these, 17 studies (representing 18,818 participants) reported the racial and ethnic composition of participants. Six studies had samples that were >50 percent Latino, six studies recruited participant pools that were >50 percent non-Hispanic black, one study reported a subject population that was 100 percent Asian, and the remainder had a majority of non-Hispanic white study participants (Table 1). The majority of the trials (68 percent) were randomized-control trials, and of these studies, 23 percent were randomized at the level of the individual, with the remaining 77 percent employing cluster randomization. Of the six nonrandomized trials, 50 percent had a control group, with the remaining trials comparing measures preintervention and postintervention in a given cohort. Rigor of CBPR Approach Table 2 presents the level of involvement of community partners in each interventional trial, among the studies reporting the degree to which community members participated. The majority of studies reported community involvement in identifying study questions (63 percent), recruitment of subjects (84 percent), development of the intervention (74 percent), delivery of the intervention (84 percent), data collection (68 percent), or the formation of a community advisory committee (63 percent). However, very few of the studies cited involvement of the community in the interpretation of either quantitative or qualitative research findings (21 and 37 percent, respectively) or in efforts to disseminate trial findings (47 percent) (Table 2). Presentation of Results For each of the 19 reviewed articles, we describe the presentation of their clinical results in Table 3. The majority of reviewed trials (14/19) examined behavioral outcomes (such as daily salt intake or level of physical activity), either alone (5/19), in combination with clinical outcomes (such as body mass index or blood pressure) (7/19), or in combination with process measures (such as recruitment of participants) (2/19). The majority of the trials (17/19) included a control group, and of these, 10 studies (59 percent) described baseline differences between control and intervention participants. Of the 17 articles examining either a concurrent or historical control group, 13 reported a significant difference in outcomes among the intervention group when compared with controls; however, four of these studies did not adjust for baseline differences between groups in the analyses (Table 3). Overall, the majority of studies we reviewed (89 percent) demonstrated a statistically positive effect of their interventions. DISCUSSION In our comprehensive systematic review of all North American CBPR clinical trials published since 2003, we found 19 articles reporting clinical trial results. To our knowledge, this study is the first detailed examination of the progress CBPR has made in publishing interventional research and provides a benchmark for the effectiveness of utilizing CBPR in clinical trials. Despite the paucity of published clinical trials utilizing CBPR, particularly in the examination of health care oriented interventions, the results of our review suggest that the state of the published CBPR clinical trial literature has actually grown significantly since the findings of the 2004 AHRQ report (Viswanathan et al. 2004). Viswanathan et al. identified 30 interventional studies in a 28-year period, whereas our findings reveal 19 clinical trials published recently in just 7 years, a fourth of the time period investigated for the AHRQ report. We also found that these peer-reviewed articles describe some measures of community participation in research in fair detail, but that other parts of CBPR methodology, most notably involvement in interpretation of research findings and dissemination efforts, are poorly described. Lastly we found that although CBPR trials examined a wide range of behavioral, process-related, and clinical outcomes, such trials had very high success rates in recruiting and retaining minority participants and achieving significant intervention effects. Prior examination of the state of CBPR has suggested that published interventional studies are relatively few, and when published, frequently do not report final analytic results. In their examination of 60 CBPR articles published from 1975 to 2003, the AHRQ group found that 30 of the studies did not report an intervention (Viswanathan et al. 2004). Of the remaining 30 studies, only 12 (20 percent) evaluated an intervention and the remaining 18 had not completed or fully evaluated an intervention. Further, they found that CBPR was frequently published in special issues related to CBPR. For example, of the 12 CBPR articles that evaluated an intervention, three (25 percent) were published in the same special issue (Viswanathan et al. 2004). Similarly, we found 19 published interventional studies utilizing CBPR from 2003 to 2010. There may, however, be positive trends both in the number of journals publishing CBPR research and in the number of CBPR interventions being published. The 19 studies in our review were published in 13 different journals. Of the 19 trials identified, the majority (68 percent) were randomized trials utilizing control groups and therefore may be considered to have a strong evidence base in their findings. We also found that 14 (74 percent) of the articles in our review were published since 2007, representing a stark contrast to the low number (5) of CBPR interventional studies published in the 3-year period from 2003 to 2006. Furthermore, in 2007, a peer-reviewed journal specifically dedicated to CBPR, the journal Progress in Community Health Partnerships, was released. This journal may become a forum for more CBPR interventional research to be published in peer-reviewed literature moving forward. The degree to which community participation in research is the key factor separating CBPR from other research paradigms is thought to be a critical component of improving both the measurement and the elimination of health disparities. We found that the community involvement described in recently published CBPR trials is variable (Horowitz, Robinson, and Seifer 2009). In our review, community partners were most frequently described as being involved in participant recruitment and in the development and delivery of the intervention. However, community partners were only described as participating in the interpretation of quantitative research findings 21 percent of the time and in dissemination efforts in 47 percent of the studies. Our findings are supported by prior evaluations that demonstrate community involvement in intervention development in over 90 percent of CBPR trials, though CBPR articles rarely, if ever, mention involvement of community partners in interpretation of research findings, the manuscript preparation process, or other dissemination efforts (Viswanathan et al. 2004). One possible explanation for this variability may be that researchers have yet to identify the best strategies for community inclusion in analysis. This may be in part due to differences in research knowledge and in part due to differences in interest. In addition, both community and academic research partners may feel far less comfortable with the process and time required to teach community partners analytic and manuscript writing skills. It is reasonable to assume that community partners may prefer to limit involvement to their particular strengths, such as community recruitment and intervention delivery. Our findings underscore the need to further emphasize the importance of knowledge sharing activities in CBPR partnerships in an effort to increase research literacy among community partners. Many authors have suggested that the role community partners and liaisons play in recruitment may significantly improve the effectiveness and retention of minority participation in research. For example, in a recent systematic review, Yancey et al. examined the relative effectiveness of strategies for recruiting racial and ethnic minorities and concluded that among factors most associated with success, active involvement of existing community stakeholders was critical (Yancey, Ortega, and Kumanyika 2006). In another study, researchers found that among veterans, most minorities recruited for focus groups were recruited with the help of community-based liaisons (Dhanani et al. 2002). Our finding that the majority of participants in 13 (68 percent) of the published CBPR interventional trials were racial and ethnic minorities supports the assertion that CBPR may be particularly effective in the recruitment of minorities in clinical research. For those articles that reported retention (16/19 trials), retention was notably favorable (average retention rate 65 percent), indicating that CBPR may be effective not only for recruitment of participants but also for retention. Furthermore, the success rate of the interventions reported in our review was extremely high (89 percent); while this finding is likely influenced by a significant bias toward publication of positive results and must be interpreted with caution (Emerson et al. 2010), our review suggests that CBPR may also be effective in improving behavioral- and health-related outcomes among largely minority populations. Lastly, most (15/19) of the clinical trials identified in our review were designed for addressing clinical or behavioral outcomes among minority communities. The goal of these studies was to identify methods through which clinicians and researchers can improve the health behaviors and outcomes of disadvantaged communities, thereby addressing the disparities in health outcomes that currently exist. Given the effectiveness of CBPR in improving outcomes from behaviorally targeted interventions, our findings suggest that CBPR is underutilized in interventions aimed at health care improvement (e.g., improving blood pressure or cancer screening rates) and that future research investigating health services interventions may benefit from the CBPR paradigm. This review is subject to several limitations. Chiefly, our examination of the state of CBPR was limited only to examining clinical trials. We chose to limit our assessment to clinical trials because prior research has documented that CBPR publications are historically lacking in this methodology. We aimed to go beyond heralding the potential of CBPR by more concretely examining the scientific rigor and effectiveness of the research. Second, we chose to limit our analysis to an examination of only those CBPR clinical trials published in peer-reviewed literature and indexed in Index Medicus. We acknowledge that this renders our analysis subject to publication bias in the literature; a recent article in Archives of Internal Medicine highlights that positive-outcome studies are more likely to be published in peer-reviewed journals than equally methodologically sound null studies (Emerson et al. 2010). However, in keeping with the PRISMA approach for reporting systematic reviews (Moher et al. 2009), we chose to limit our initial search strategy to only those studies published in peer-reviewed literature and indexed in Index Medicus, which we acknowledge as the most reliable and most easily accessible database utilized by researchers and policy makers. We nevertheless advocate that continued research focused on the critical analysis of all study designs employed with the CBPR methodology in both the published and nonpublished literature is needed to fully explore the unique contributions of the CBPR model to interventional research, as recently reinforced by two of the field's leading researchers (Wallerstein and Duran 2010). Since one limitation of systematic reviews is that they are cross-sectional in nature, it is possible that our search did not yield eligible articles published from 2003 to 2010 that had not been indexed at the time of our search. In addition, there remain the possibilities that a significant publication lag in CBPR exists when compared with other research paradigms, and that much of the CBPR interventional research conducted in recent years has not yet been submitted or completed the peer-review process. Our finding of a significantly increasing trend in the rate of CBPR clinical trials published over the past few years may suggest such a lag exists and is supported by a prior review that demonstrated that 67 percent of published CBPR interventional trials were either in progress or the intervention had not fully been evaluated (Viswanathan et al. 2004). Furthermore, our review was limited to studies published in English and conducted in North America; we anticipate that the state of CBPR conducted outside of the North America and its effectiveness in recruiting minority subjects may differ. Lastly, the studies included in our analyses employed a wide variety of intervention strategies and examined a myriad of clinical and behavioral outcomes, precluding our ability to conduct a more detailed meta-analysis examining the effectiveness of CBPR interventions. As a result, we remain unable to compare outcomes of CBPR studies to other interventional research strategies. Limitations aside, our study highlights that CBPR excels in two areas: (1) recruitment and retention of racial and ethnic minority participants, a population that has traditionally been difficult to engage in clinical trials, and (2) effectiveness of interventions geared toward these communities. We therefore theorize that CBPR can be an incredibly rich and effective approach to the research of health care delivery, resource allocation, and health care utilization. A recently published study of the use of patient navigators for promotion of colorectal cancer screening among patients at community health centers, for example, revealed a statistically significant increase in colon cancer screening rate with the use of patient navigators, compared with the population of patients who received routine colon cancer screening recommendations alone without the aid of a patient navigator (Lasser et al. 2009, 2011). Lessons learned from such a study can be used by policy makers to help fund patient navigators in community health care center settings, increase cancer screening rates, and thereby improve long-term outcomes in this population. Our results suggest that CBPR is a promising tool that may contribute to interventional studies and analyses and therefore could play a role in facilitating research's impact on health care policy and resource allocation. CONCLUSION We found that the state of CBPR interventional research is rapidly evolving with a significant increase in both the number of journals publishing CBPR and the number of interventional studies published. However, there remains a relative lack of published peer-reviewed CBPR interventional studies and a significant gap in publication between CBPR and other interventional research methods. Our findings demonstrate that CBPR is particularly effective in increasing participation of racial and ethnic minority subjects in research and may be a powerful tool to improve both the measurement of health disparities and in testing the generalizability of effective interventions among populations traditionally under-represented in clinical trials. For these reasons, CBPR is a promising research approach that may be useful in analyses of health care delivery for disadvantaged patients. REFERENCES Balcazar, H. G., T. L. Byrd, M. Ortiz, S. R. Tondapu, and M. Chavez. 2009. "A Randomized Community Intervention to Improve Hypertension Control among Mexican Americans: Using the Promotoras de Salud Community Outreach Model." Journal of Health Care for the Poor and Underserved 20 (4): 1079-94. Balcazar, H., H. De Heer, L. Rosenthal, M. Aguirre, L. Flores, F. A. Puentes, V. M. Cardenas, M. O. Duarte, M. Ortiz, and L. O. Schulz. 2010. 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"Using Community-Based Participatory Research Methods to Reach Women with Health Messages: Results from the North Carolina BEAUTY and Health Pilot Project." Health Promotion Practice 6 (2): 164-73. Mikami, A. Y., M. A. Boucher, and K. Humphreys. 2005. "Prevention of Peer Rejection through a Classroom-Level Intervention in Middle School." Journal of Primary Prevention 26 (1): 5-23. Minkler, M., and N. Wallerstein. 2008. Community-Based Participatory Research for Health: from Process to Outcomes. San Francisco: Jossey-Bass. Moher, D., A. Liberati, J. Tetzlaff, D. G. Altman, and The PRISMA Group. 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement." Annals of Internal Medicine 151 (4): 264-9. Nguyen, T. T., S. J. McPhee, N. Bui-Tong, T. N. Luong, T. Ha-Iaconis, T. Nguyen, C. Wong, K. Q. Lai, and H. Lam. 2006. "Community-Based Participatory Research Increases Cervical Cancer Screening among Vietnamese-Americans." 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M., M. L. Prelip, J. T. Erausquin, and S. A. Kim. 2010. "A Worksite Obesity Intervention: Results from a Group-Randomized Trial." American Journal of Public Health 100 (2): 327-33. Two Feathers, J., E. C. Kieffer, G. Palmisano, M. Anderson, B. Sinco, N. Janz, M. Heisler, M. Spencer, R. Guzman, J. Thompson, K. Wisdom, and S. A. James. 2005. "Racial and Ethnic Approaches to Community Health (REACH) Detroit Partnership: Improving Diabetes-Related Outcomes among African American and Latino Adults." American Journal of Public Health 95 (9): 1552-60. Viswanathan, M., A. Ammerman, E. Eng, G. Gartlehner, K. N. Lohr, D. Griffith, S. Rhodes, C. Samuel-Hodge, S. Maty, L. Lux, L. Webb, S. F. Sutton, T. Swinson, A. Jackman, and L. Whitener. 2004. Community-Based Participatory Research: Assessing the Evidence. Evidence Report/Technology Assessment No. 99. AHRQ Publication 04-E022-2. Rockville, MD: Agency for Healthcare Research and Quality. Wallerstein, N., and B. Duran. 2010. "Community-Based Participatory Research Contributions to Intervention Research: The Intersection of Science and Practice to Improve Health Equity." American Journal of Public Health 1 (100): S40-6. Wallerstein, N., J. Oetzel, B. Duran, G. Tafoya, L. Belone, and R. Rae. 2008. "What Predicts Outcomes in CBPR? In Community-Based Participatory Research for Health: from Process to Outcomes, edited by M. Minkler and N. Wallerstein, pp. 371 -92. San Francisco: Jossey-Bass. Yancey, A. K., A. N. Ortega, and S. K. Kumanyika. 2006. "Effective Recruitment and Retention of Minority Research Participants." Annual Review of Public Health 27: 1-28. SUPPORTING INFORMATION Additional supporting information may be found in the online version of this article: Appendix SA1 : Author Matrix. Please note: Wiley-Blackwell is not responsible for the content or functionality of any supporting materials supplied by the authors. Any queries (other than missing material) should be directed to the corresponding author for the article. Address correspondence to Denise De Las Nueces, M.D., Commonwealth Fund/Harvard University Fellowship in Minority Health Policy, 164 Longwood Avenue, 2nd Floor, Boston, MA 02115; e-mail: ddelasnu@hsph.harvard.edu. Karen Hacker, M.D., M.P.H., is with the Community-Based Participatory Research Program, Harvard Medical School, Boston, MA, and the Institute for Community Health, Cambridge Health Alliance, Cambridge, MA. Ann DiGirolamo, Ph. D., M.P.H., is with the Health Equity Unit, Program, Partnerships, Learning and Advocacy, CARE USA, Atlanta, GA. LeRoi S. Hicks, M.D., M.P.H., is with the Division of Hospital Medicine, University of Massachusetts Memorial Health Care, Worcester, MA, and the Department of Quantitative Sciences, University of Massachusetts Medical School, Worcester, MA. DOI: 10.1111/j.1475-6773.2012.01386.x
Table 1: Characteristics of Articles Included in Analysis (N = 19)
Primary Type of
Author, Year Clinical Type of Area
of Article Trial Randomization of Focus
Balcazar Randomized Individual Participant
et al. (2009) control participant behavior
Balcazar Randomized Individual Participant
et al. (2010) control participant behavior
Blumenthal Randomized Cluster Clinical
et a1. (2010) control randomization
by site of
recruitment
(church,
community
center, or clinic)
Estabrooks Nonrandomized NA Participant
et al. (2008) behavior
Feinberg Randomized Cluster Other
et al. (2007) control randomization
by community
Froelicher Randomized Cluster Participant
et al. (2010) control randomization behavior
by groups
Horowitz Randomized Individual Other
et al. (2009) control, participant
delayed
intervention
Kim Nonrandomized, NA Participant
et al. (2008) concurrent control behavior
Leeman Nonrandomized NA Participant
Castillo behavior
et al. (2010)
Levine Randomized Cluster Health care
et al. (2003) control randomization delivery
by census blocks
Linnan Nonrandomized NA Other
et al. (2005)
Mikami, Randomized Cluster Other
Boucher, control randomization
and by classroom
Humphreys
(2005)
Nguyen Nonrandomized, NA Health care
et al. (2006) cross-sectional, delivery
with control
community
Parikh Randomized Cluster Participant
et al. (2010) control with randomization behavior
delayed by recruitment
intervention site
Redmond Randomized Cluster Participant
et al. (2009) control randomization behavior
by community
Reed and Randomized Cluster Participant
Kidd (2004) control randomization behavior
by school
Riggs, Randomized Cluster Other
Nakawatase, control randomization
and Pentz by community
(2008)
Siegel Randomized Cluster Participant
et al. (2010) control randomization behavior
by school
Two Feathers Nonrandomized NA Participant
et al. (2005) behavior
Number of
Primary Participants Number of Number of Percent
Author, Year Eligible Participants Participants Retained
of Article for Study Enrolled Retained
Balcazar 98 98 98 100
et al. (2009)
Balcazar 568 328 284 87
et al. (2010)
Blumenthal 645 369 259 70
et a1. (2010)
Estabrooks 4,609 1,190 1,045 88
et al. (2008)
Feinberg 157 53 29 55
et al. (2007)
Froelicher 191 60 22 37
et al. (2010)
Horowitz 249 99 Not NA
et al. (2009) reported
Kim Not 73 61 84
et al. (2008) reported
Leeman 333 299 245 82
Castillo
et al. (2010)
Levine 817 789 471 60
et al. (2003)
Linnan Not 162 83 51
et al. (2005) reported
Mikami, Not 24 classrooms Not NA
Boucher, reported (individuals reported
and not reported)
Humphreys
(2005)
Nguyen Not 1,566, 2009 NA NA
et al. (2006) reported (at each cross
sectional
survey)
Parikh 103 99 72 73
et al. (2010)
Redmond 13,257 11,931 9,438 79
et al. (2009)
Reed and Not 1,138 373 33
Kidd (2004) reported
Riggs, 431 431 154 36
Nakawatase,
and Pentz
(2008)
Siegel Not 413 125 30
et al. (2010) reported
Two Feathers 300 1.51 111 74
et al. (2005)
Ethnic
Composition of
Primary Participants
Author, Year (%)
of Article
Balcazar Latino (100)
et al. (2009)
Balcazar Latino (100)
et al. (2010)
Blumenthal Non-Hispanic
et a1. (2010) black (100)
Estabrooks Non-Hispanic
et al. (2008) white (95)
Latino (1)
Native
American (1)
Not cited (3)
Feinberg Not cited
et al. (2007)
Froelicher Non-Hispanic
et al. (2010) black (100)
Horowitz Latino (89)
et al. (2009) Non-Hispanic
black (9)
Asian (1)
Native
American (1)
Kim Non-Hispanic
et al. (2008) black (100)
Leeman Latino (100)
Castillo
et al. (2010)
Levine Non-Hispanic
et al. (2003) black (100)
Linnan Non-Hispanic
et al. (2005) black (68.5)
Non-Hispanic
white (31.5)
Mikami, Not reported
Boucher,
and
Humphreys
(2005)
Nguyen Asian (100)
et al. (2006)
Parikh Latino (89)
et al. (2010) Non-Hispanic
black (9)
Not reported
(2)
Redmond Non-Hispanic
et al. (2009) white (83)
Non-Hispanic
black (3)
Latino (5)
Not reported (9)
Reed and Non-Hispanic
Kidd (2004) white (98)
Not reported (2)
Riggs, Not reported
Nakawatase, (100)
and Pentz
(2008)
Siegel Latino (48.4
et al. (2010) control, 60.8
intervention)
Non-Hispanic
white (27
control, 19.8
intervention)
Non-Hispanic
black (9.7
control, 4.1
intervention)
Not reported
(17.8 control,
15.5
intervention)
Two Feathers Non-Hispanic
et al. (2005) black (64)
Latino (36)
Table 2: Description of Community Partners' Involvement in Clinical
Trials (N = 19)
Identifying
Primary Study Recruitment Development of
Author Questions of Subjects Intervention
Balcazar Yes Yes Yes
'(2009)
Balcazar Yes Yes Yes
'(2010)
Blumenthal No Yes Yes
Estabrooks Yes Yes Yes
Feinberg Yes Yes No
Froelicher No Yes Yes
Horowitz Yes Yes Yes
Kim Yes Yes Yes
Leeman-Castillo No Yes No
Levine Yes Yes No
Linnan Yes Yes Yes
Mikami No No No
Nguyen Yes Yes Yes
Parikh Yes Yes Yes
Redmond No Yes Yes
Reed Yes No Yes
Riggs No Yes No
Siegel No No Yes
Two Feathers Yes Yes Yes
Quantitative
Primary Delivery of Data Interpretation
Author Intervention Collection of Findings
Balcazar Yes Yes No
'(2009)
Balcazar Yes Yes No
'(2010)
Blumenthal Yes Yes No
Estabrooks Yes Yes No
Feinberg No No Yes
Froelicher No No No
Horowitz Yes Yes No
Kim Yes Yes No
Leeman-Castillo Yes No No
Levine No Yes Yes
Linnan Yes Yes Yes
Mikami Yes Yes No
Nguyen Yes Yes Yes
Parikh Yes Yes No
Redmond Yes No No
Reed Yes Yes No
Riggs Yes Yes No
Siegel Yes No No
Two Feathers Yes No No
Qualitative Presence of
Primary Interpretation Dissemination Advisory
Author of Findings Efforts Committee
Balcazar Yes Yes No
'(2009)
Balcazar Yes No No
'(2010)
Blumenthal No Yes Yes
Estabrooks No No Yes
Feinberg Yes Yes No
Froelicher No Yes No
Horowitz No No Yes
Kim Yes No Yes
Leeman-Castillo No No No
Levine Yes Yes Yes
Linnan Yes Yes Yes
Mikami No No No
Nguyen No Yes Yes
Parikh Yes Yes Yes
Redmond No No Yes
Reed No No Yes
Riggs No No No
Siegel No No Yes
Two Feathers No Yes Yes
Table 3: Presentation of Results in CBPR Clinical Trials (N = 19)
Significant
Differences Significant
between Baseline
Control and Differences Type (s) of Baseline
Primary Study Adjusted for Outcomes Measures
Author Group Noted? in Results under Study Reported
Balcazar Yes Yes Clinical Yes
(2009) behavioral
Balcazar Yes Yes Clinical Yes
(2010) behavioral
Blumenthal Yes No Clinical Yes
knowledge,
behavioral
Estabrooks No NA Behavioral Yes
Feinberg No NA Process Yes
Froelicher Yes No Behavioral Yes
Horowitz NA NA Process Yes
(recruitment)
Kim Yes Yes Clinical Yes
behavioral
Leeman- NA NA Behavioral Yes
Castillo
Levine No NA Clinical Yes
Linnan NA NA Process No
(communication
regarding health
messages)
Mikami No NA Report of peer Yes
relations
Nguyen No NA Behavioral Yes
process
(capacity
building
infrastructure)
Parikh Yes No Clinical Yes
behavioral
Redmond No No Behavioral No
attitudes
Reed Yes No Behavioral No
attitudes
Riggs Yes No Behavioral Yes
process
(community
organization
empowerment)
Siegel Yes Yes Clinical Yes
behavioral
Two Yes Yes Clinical Yes
Feathers behavioral
other
Outcome
Primary Measures Primary Outcomes
Author Reported of Study
Balcazar Yes No difference in waist
(2009) circumference or BM I;
significant differences
among perceived
benefits and salt,
cholesterol, and
fat intake
Balcazar Yes Significant improvement
(2010) in diastolic BP, weight
control practices, salt,
cholesterol, and fat intake
Blumenthal Yes Significant increase in
colorectal cancer
knowledge, increase
in colorectal cancer
screening rates within
6 months of intervention
Estabrooks Yes Inactive or insufficiently
active participants at
baseline experienced
significant increases in
both moderate and
vigorous physical activity
Feinberg Yes Coalition functioning in
a youth recruitment
intervention
Froelicher Yes No statistically significant
differences in smoking
between control group
and interventional group
Horowitz Yes Recruitment of minority
populations
Kim Yes Anthropometrics (BMI,
waist: hip ratio) and
health behaviors
Leeman- Yes Nutritional intake by
Castillo guidelines, physical
activity by guidelines,
smoking cessation
Levine Yes Mean systolic and
diastolic blood
pressure
Linnan Yes Discussion/
communication
of health behaviors
Mikami Yes Ratings of peer
relationships
Nguyen Yes Pap test outcomes
Parikh Yes Weight loss
Redmond Yes Youth, parent and
family relationship
(general child
management,
parent-child
effective quality,
parent-child
activities)
Reed No Farm safety attitudes
Riggs Yes Quality of strategic
plans; committee
functioning;
prevention plan
activities
Siegel Yes BMI, waist: hip
ratio, minutes
of physical
activity, fruit
and vegetable
intake
Two Yes Change in Hg
Feathers A1C, weight,
BMI, BP
Study
Successful in
Achieving
Primary Primary
Author Outcome
Balcazar Yes
(2009)
Balcazar Yes
(2010)
Blumenthal Yes
Estabrooks Yes
Feinberg Yes
Froelicher No
Horowitz Yes
Kim Yes; reduced weight,
reduced hip and
weight girth, and
increased physical
activity compared
with control
Leeman- Yes; improved fruit
Castillo and vegetable intake,
increased levels of
physical activity
Levine No; both groups
exhibited increased
BP control, no
difference between
more versus less
intensive care
Linnan Yes; high levels of
self-reported
discussions of
health behaviors,
and high recall
of discussions
after 12 months
Mikami Yes; intervention
group had improved
peer relationships
over time
Nguyen Yes
Parikh Yes; significant
weight loss noted
in intervention group
Redmond Yes; general
child management,
parent child
activities, and skill
outcomes improved
in intervention group
Reed Yes; positive changes
in farm safety
attitudes and
discussions related
to injury prevention,
and improved safety
behavior
Riggs Yes; increased quality
of strategic plans;
higher committee
functioning;
increased prevention
plan activities
Siegel Yes; reduction in BMI
Two Yes
Feathers
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