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Interventions to Help and Aid the Underserved Population

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There are four phases to enforce translational research. However, there is a hidden phase. The preliminary phase (T0) involves all activities prior to clinical research (Gannon, 2014). Typically, T0 could be combined with T1 phase (Gannon, 2014). Phase one (T1) research involves groundwork and pre-clinical research (Roberts, 2019). In phase two (T2), it involves the formation of practice and clinical guidelines from evidence-based research or evaluations (Roberts, 2019). Phase three (T3) applies the newly formed evidence-based guidelines into clinical practice (Roberts, 2019). Phase four (T4) evaluates and analyzes the results of real-world application and the population health (Roberts, 2019). Furthermore, the clinical application is translated into practice (Roberts, 2019). Overall, these phases are meant to bridge the gaps in research translation.

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There are two gaps in research translation (Davis, 2018). The first gap is moving from basic science discoveries into clinical research (Davis, 2018). The application of results from clinical research into medical practice and health decision-making is the second gap (Davis, 2018). In other words, the two gaps are from bench to bedside and bedside to practice (Davis, 2018). The following two articles will be discussing methods used to combat both gaps: Helping Basic Scientists Engage with Community Partners to Enrich and Accelerate Translational Research and Community Engagement Studios: A Structured Approach to Obtaining Meaningful Input from Stakeholders to Inform Research. These two articles show various methods in closing or bridging the gap by facilitating collaboration. This is the point of focus for both articles.

In the article, “Helping Basic Scientists Engage with Community Partners to Enrich and Accelerate Translational Research,” Kost discusses the creation of community engaged research navigation (CEnR-Nav) program (Kost, 2017). CEnR-Nav program was created through a collaboration between the Rockefeller University Center for Clinical and Translational Science and Clinical Directors Network (Kost, 2017). Clinical directed network is a practice-based research network (PBRN) (Kost, 2017). The program aim was to foster research by pairing basic science and community-driven scientific aims (Kost, 2017). Specifically, they develop a process to facilitate the collaboration of researchers with individuals representing the aims and health priorities of communities (Kost, 2017). These two groups were the target populations. The point of the collaboration is to develop joint projects (Kost, 2017). These projects will integrate the basic sciences (T0) with aims with early translational (T1–T2) aims and community, clinical, or public health (T3–T4) aims (Kost, 2017). Overall, it facilitates the conduct of research projects that address both scientific and community health aims (Kost, 2017).

On the other hand, Community Engagement Studios: A Structured Approach to Obtaining Meaningful Input from Stakeholders to Inform Research discusses the development of the Community Engagement Studio (CE Studio). It was created by the Meharry-Vanderbilt Community-Engaged Research Core (Joosten, 2015). CE Studio model was financially funded by two Clinical and Translational Science Award (CTSA) (Joosten, 2015). This model allows representative groups to provide their input to researchers (Joosten, 2015). Like the CEnR-Nav program, CE studio provides experience faculty and staff to aid researchers (Joosten, 2015). The staff are experienced in community and patient engagement (Joosten, 2015). The faculty also identify stakeholders, prepare the investigator, and facilitate the interaction (Joosten, 2015). This will minimize burden on the investigator and maximize efficiency (Joosten, 2015). This structured program follows the integrated knowledge translation and patient-oriented research framework (Joosten, 2015). Community and patient stakeholders provide their input for enhancement of research design, implementation, and dissemination (Joosten, 2015). The generated research findings will be translated into approaches for assessment, prevention and treatments at the bedside (Mayan, 2016). The team science approach was used in training and recruiting the stakeholders (Joosten, 2015). It facilitates one on one meetings between researchers and stakeholders (Joosten, 2015).

Approximately nine researchers utilize forty-four preliminary projects under the CEnR-Nav program (Kost, 2017). Fifty seven percent (25 programs) became either approved protocols or sub studies (Kost, 2017). These projects involved clinical scholar trainees, early-career physician–scientists, faculty, students, postdoctoral fellows, and others (Kost, 2017). The remaining forty-four percent (19 projects) were able to identify community partners (Kost, 2017). Nine out of nineteen projects label the community partners as co-investigators (Kost, 2017). T3 -T4 translational aims were added to nine projects (Kost, 2017). Seven projects gain external funding. Eleven projects disseminated results through presentations or publications (Kost, 2017). Five projects publishing results included a community partner as a coauthor (Kost, 2017). In the author’s perspective, this high yield demonstrates that multidisciplinary and community collaborations are plausible and successful. Furthermore, it exemplifies the framework of team science. Team science highlights the need for researchers and other stakeholders to work together in teams to spark discovery and form solutions (Harowitz 2017).

For CE studios program, it has engaged twenty-three researchers and 152 community stakeholders for twenty-eight CE Studios (Joosten, 2015). There was an average of eight stakeholders per session (Joosten, 2015). At the end of the program, a paper evaluation was completed by researchers and stakeholders (Joosten, 2015). The multi-disciplined researchers found stakeholder’s input valuable in project feasibility (Joosten, 2015). They stated that stakeholders input helped improve research designs and implementation (Joosten, 2015). Stakeholders had positive reviews of the CE studio (Joosten, 2015). They felt that CE studios are good for engagement and grew a better understanding of overall research (Joosten, 2015). To disseminate the approach, a tool kit was developed for model replication (Joosten, 2015). CE studios and CEnR-Nav program could be implemented into multiple and various health topics and types of research.

CE Studio and CEnR-Nav program are a multi-disciplinary model that followed the integrated knowledge translation methodology. Integrated Knowledge Translation is the collaboration between community partners and researchers (Mayan, 2016). Additionally, they incorporate other elements such as stakeholders, community engagement, team science, and community-engaged participatory research (Kost, 2017). CE Studio utilizes the stakeholders within its program. Stakeholders help with recruitment and interviewing in research (Mayan, 2016). They are not community partners or members of the core research team (Mayan, 2016). Stakeholders are introduced to researchers involved in CEnR-Nav program too.

Despite the similarities, the two programs differ in the process of making the collaboration occurred. Based on researcher’s population interest, a panel of stakeholders was individualized for each CE studio project (Joosten, 2015). CE studio stakeholders are practically compensated consultants (Joosten, 2015). During the two-hour face to face meeting at the CE studio, the neutral moderator keeps the stakeholder comfortable in voicing their thoughts and ensure the researcher’s questions are answered properly (Joosten, 2015). In the CEnR-Nav program, an academic navigator and a PBRN navigator lead the program (Kost, 2017). They used meetings and joint activities to facilitate basic science and community partnerships (Kost, 2017). Eventually, it will develop and conduct joint research protocols (Kost, 2017). Kost states that “Under the guidance of the navigators, the basic science investigator and other stakeholders then move sequentially through the stages of building a partnership, aligning goals, jointly developing protocols and funding applications, conducting the study, analyzing and disseminating the results, and preparing applications for additional funding to sustain the partnership into subsequent projects.” (Kost, 2017, p. 375). These navigators actively and explicitly connect basic scientists to community clinicians, patients, and other collaborators (Kost, 2017). The interdisciplinary research teams are developed through the navigators (Kost, 2017). Overall, the navigators are more advanced than CE Studio faculty because they become a part of the research team. It should be noted that all projects with long-term navigator participation had incorporated T3–T4 aims and secured external funding (Kost, 2017).

In CE studio program, it was reported that 39% (nine out of twenty-three) of studios were focused on minorities and underrepresented groups (Joosten, 2015). It is a positive aspect because there is a huge disparity and wider gap in research translation in and for underserved populations. Both programs may aid in closing this gap, but CE studios (although small) has actual data aimed toward these groups. Due to historical (and current) mistreatment, underserved populations are still underrepresented in research due various factors. In the article Leveraging Implementation Science to Address Health Disparities in Genomic Medicine, it discusses barrier to genomic applications and puts an emphasis on underserved populations (Roberts, 2019). It lists some barriers in research for underserved populations. Some factors that play a role in research barriers are low patient awareness and knowledge, stigma, cost, fear, distress (medical mistrust), patient education level, and family concerns (Roberts, 2019). Although the article’s focus was on genomic applications, these barriers are applicable across the board in any discipline and research. CE Studio and CEnR-Nav program has the potential to increase patient recruitment in underserved populations. These models can also lead to Community-based participatory research (CBPR), interventions, and studies geared to improve the quality of life in underserved populations. The facilitation of collaboration between researchers and community is huge and detrimental aspect in closing the gap in research translation.

Some negative aspects that I have found is that the researchers may have an overreliance on the programs. The collaborations should not only be facilitated, but the researchers should be trained to be able to implement methodology post-program. The programs should include a teaching tools that should make lasting change in the researcher’s arena. The researcher’s population is a community that needs to learn how to facilitate their own conversations and collaborations. These programs are a good start, but for lasting change actual training should be incorporated. The researchers must learn how to effectively facilitate community collaboration. The infamous proverb or quote from an unknown author place an important role in my thoughts on the matter. From my perspective, the infamous proverb, ‘If you give a man a fish, and you feed him for a day; However, if you teach a man to fish, and you feed him for a lifetime” is useful to consider in thinking about this matter. These two programs are not real solutions unless they make a permanent change. Sadly, they are only a temporary solution to a major problem. This does not take away the achievements, potential, and important progress made through these models. There are no perfect solutions. Community Engagement is an ongoing process. The models are still valid if research is involved. The models were used as researcher’s tools rather than permanent change. The goals of CE Studio and CEnR-Nav program has aided in community engagement. Both aided in building capacity in community and forming sustainable community intervention. Nevertheless, I did not find any substantial unethical issue with both articles and programs.

Despite the teaching aspect, both interventions are great ideas with huge potential. They truly assist in facilitating collaborations and conversations from researchers to community. Community stakeholders, navigators, faculty, and staff were essential components for effective translational research. Although both programs can be utilized at any stage, both articles states that the program can be best utilized if the study joins program during the preclinical stage (T0-T1). Both programs are easily adaptable across multiple disciplines. This is because they are developed under multiple perspectives and frameworks (team science and integrated knowledge translation). Both programs can aid in developing interventions geared for underserved or vulnerable populations. To help the community, we must work with the community and their needs. In conclusion, both programs can be a major catalyst in bridging the ever-growing gap in research translation.  

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