Translating research into well-being: The need for communities and collaboration

Professor May C. Wang is a senior faculty member at the UCLA Fielding School of Public Health, an Adjunct Faculty at GERI and has held visiting professor appointments at the NUS Saw Swee Hock School of Public Health (SSHSPH). She has interests and expertise in transdisciplinary research and training. Trained in nutritional sciences, community nutrition and nutritional epidemiology, she leads interdisciplinary teams on research aiming to address food insecurity in vulnerable populations throughout the life-course.

In collaboration with NUS SSHSPH, Professor Wang was in-residence at GERI as a visiting expert to share her wealth of experience in working with communities. We sat down with Professor Wang to discuss the need to go deeper in involving communities in research, to understand their lived experiences and to work collaboratively beyond siloes—all for the larger goal of impacting health and well-being.

​When Professor May Wang was a graduate student, she once interned at a clinic that provided nutrition education to low-income expecting mothers. One day, a heavily pregnant woman walked in covered with bruises inflicted by her husband.

As a then-trainee nutritionist, Professor Wang's main job was to provide dietary advice. In that moment, however, she knew that she could not simply follow the rulebook.

“I had the good sense not to talk to her about nutrition and tell her how she should feed her baby. She wanted to be referred to a shelter, but nobody knew where. In what was supposed to be my 10-minute interview with her, I spent 45 minutes just calling different people before I found a place that could help her," she recalled.

That incident served as a microcosm of what it meant to understand the real priorities and needs of vulnerable communities in a holistic sense, so that the right resources could reach them and help them.

“In public health, we define health not only as the absence of disease, but as well-being," said Professor Wang.

“The ultimate goal is to improve the health and well-being of people. Nutrition, or whatever we specialise in, is just a means to that. That is the subtle difference between really caring about having population health impact, versus simply staying in our own specialised streams.

Involving communities in research—and doing it right​

Community-engaged research (CER) is the process of incorporating input from community stakeholders whom the research will impact and involving them in the research process.^[1] CER approaches lie on a continuum with varying degrees of engagement.​​

The misconception, Professor Wang says, is that many researchers may think that they are already doing deep community-engaged research when their forays into the community are often just surface-level.

“So you could go out of your clinic, into the community, and say, 'I am doing community-engaged research!' Or, you could say that you are giving out education materials and 'working' in the community. That is not all of it," observed Professor Wang.

“I have been very vocal in the last few years about the need for community-engaged research done correctly. And that means identifying the community stakeholders and engaging them appropriately, often from the very beginning of the research process," she added.​

Asking the right questions to avoid “rubbish in, rubbish out"

Enter: Community-based participatory research (CBPR), an approach on the CER continuum that includes all community stakeholders and partners equitably in the research project, so that each partner's unique expertise informs the research, from conception to dissemination.^[2]

CBPR is important because in working with communities, researchers cannot always assume that they know these populations well and are able to appreciate their needs. Instead, researchers need to dig deeper to get a better handle of the things that really matter, in order to ask the right research questions. CBPR lends itself well to this task.

“If you are not asking the right questions, you think you have identified the barriers, but you have not gotten to the bottom of what is really affecting people's lives. Some of these things are so sensitive that you cannot just put it in a question and check a box. It may not even be on the questionnaire, because you did not think to ask it," she explained.

In that scenario, even the most rigorous of statistical models will not generate meaningful findings. “This is where it becomes 'rubbish in, rubbish out'," she quipped.

“We need to want to make sure that our research is actually relevant, can be used and can be translated."

CBPR: You cannot go it alone

Despite its merits, many researchers have been slow to adopt the CBPR approach. The reasons for this, Professor Wang observes, are often structural.

For example, some quantitative researchers may question its rigour. However, Professor Wang points out that CBPR can actually help researchers explore and identify the right research questions, which can be eventually used to inform the development of more rigorous surveys and quantitative sampling designs.

Connecting the dots to translate research findings requires collaboration amongst a variety of partners – such as clinicians, community workers and public health professionals – but the siloes that exist among disciplines can present a challenge.

“We often work in our own fields and struggle to work effectively with each other in an integrated way. This is one barrier to our (efforts at) translating knowledge more efficiently," she opined. “We need to work across disciplines and sectors more efficiently and effectively in order to be able to solve some of the world's very complex problems."

Professor Wang is seeking to change this and is passionate about helping young researchers from different disciplines to learn to communicate and work better with each other. She co-leads a training programme funded by the National Institutes of Health (USA), designed to bring together researchers from across various disciplines. The programme helps trainees apply systems and data science methods, using a community-engaged research approach, to accelerate the translation of research.​​

Going further in working with communities: Advice for researchers

In her time with GERI as a visiting expert, Professor Wang engaged and mentored faculty and researchers to share her knowledge on community-engaged research and evaluation, as well as stakeholder engagement.

“I think there is a real interest and earnestness to want to do something that has population impact. This has come across consistently from all the people I have spoken to here," she said.

For researchers who want to go deeper into CER but feel daunted, Professor Wang offers some suggestions—starting with the self. “CBPR is a different way of thinking about intervention research. It is hard, because it requires humility and acknowledging that a shift in research paradigm may be needed," she said.

“Researchers do not need to have all the skills right away. Often, it takes years of experience – and making mistakes – to appreciate, value and apply the CBPR approach to intervention research. Collaborating with other researchers who are more experienced in working with communities is helpful, if not critical."

In addition to bringing in the right collaborators, it is also important for researchers to feel confident and supported when they push for more research that truly engages more communities, and not be seen as less rigorous.

“People are drawn to the profession of public health for different reasons. For those interested in addressing health disparities, and promoting health and well-being for every segment of the population, it is important to not lose sight of the need to ensure that interventions reach all, including vulnerable communities," she urged.

References

[1] "What is Community Engaged Research (CER)?" Equity Research and Innovation Center (ERIC), Yale School of Medicine (yale.edu)

[2] "What is Community-Engaged Research?" Center for Healthy Communities, University of California Riverside School of Medicine (ucr.edu)