Salihu Hamisu M, Salinas-Miranda Abraham A, Wang Wei, Turner DeAnne, Berry Estrellita Lo, Zoorob Roger
Department of Family and Community Medicine, Baylor College of Medicine , Houston, TX, USA.
Department of Epidemiology and Biostatistics, College of Public Health, University of South Florida , Tampa, FL, USA.
J Public Health Res. 2015 Jul 20;4(2):443. doi: 10.4081/jphr.2015.443. eCollection 2015 Jul 16.
Providing practitioners with an intuitive measure for priority setting that can be combined with diverse data collection methods is a necessary step to foster accountability of the decision-making process in community settings. Yet, there is a lack of easy-to-use, but methodologically robust measures, that can be feasibly implemented for reliable decision-making in community settings. To address this important gap in community based participatory research (CBPR), the purpose of this study was to demonstrate the utility, applicability, and validation of a community priority index in a community-based participatory research setting.
Mixed-method study that combined focus groups findings, nominal group technique with six key informants, and the generation of a Community Priority Index (CPI) that integrated community importance, changeability, and target populations. Bootstrapping and simulation were performed for validation.
For pregnant mothers, the top three highly important and highly changeable priorities were: stress (CPI=0.85; 95%CI: 0.70, 1.00), lack of affection (CPI=0.87; 95%CI: 0.69, 1.00), and nutritional issues (CPI=0.78; 95%CI: 0.48, 1.00). For non-pregnant women, top priorities were: low health literacy (CPI=0.87; 95%CI: 0.69, 1.00), low educational attainment (CPI=0.78; 95%CI: 0.48, 1.00), and lack of self-esteem (CPI=0.72; 95%CI: 0.44, 1.00). For children and adolescents, the top three priorities were: obesity (CPI=0.88; 95%CI: 0.69, 1.00), low self-esteem (CPI=0.81; 95%CI: 0.69, 0.94), and negative attitudes toward education (CPI=0.75; 95%CI: 0.50, 0.94).
This study demonstrates the applicability of the CPI as a simple and intuitive measure for priority setting in CBPR. Significance for public healthCommunity-based participatory research (CBPR) has been credited to be a promising approach for the reduction of health disparities and as an effective way to create sustainable community outcomes. Priority setting is an essential decision-making step in community-based participatory research. Issue prioritization must be driven not just by the importance of the issue, but also what realistically can be changed with available funds. However, there is little guidance on how to approach priority setting with objective and subjective measures while implementing CBPR. This study depicts the invention of a Community Priority Index (CPI), which can be used to prioritize community health issues by combining subjective and objective markers into a single measure. The CPI shown in this study represents a viable systematic approach to improve the objectivity and reliability of community-based decision-making.
为从业者提供一种直观的优先事项设定方法，并使其能够与多种数据收集方法相结合，是促进社区环境中决策过程问责制的必要步骤。然而，目前缺乏易于使用且方法稳健的措施，难以在社区环境中切实可行地实施以进行可靠决策。为解决社区参与式研究（CBPR）中的这一重要空白，本研究旨在证明社区优先指数在社区参与式研究环境中的实用性、适用性和有效性。
混合方法研究，结合焦点小组结果、与六位关键信息提供者的名义小组技术，以及生成整合了社区重要性、可变性和目标人群的社区优先指数（CPI）。采用自举法和模拟法进行验证。
对于孕妇，最重要且最具可变性的前三项优先事项为：压力（CPI = 0.85；95%置信区间：0.70，1.00）、缺乏关爱（CPI = 0.87；95%置信区间：0.69，1.00）和营养问题（CPI = 0.78；95%置信区间：0.48，1.00）。对于非孕妇，首要优先事项为：健康素养低（CPI = 0.87；95%置信区间：0.69，1.00）、教育程度低（CPI = 0.78；95%置信区间：0.48，1.00）和缺乏自尊（CPI = 0.72；95%置信区间：0.44，1.00）。对于儿童和青少年，前三项优先事项为：肥胖（CPI = 0.88；95%置信区间：0.69，1.00）、自尊低（CPI = 0.81；95%置信区间：0.69，0.94）和对教育的消极态度（CPI = 0.75；95%置信区间：0.50，0.94）。
本研究证明了CPI作为CBPR中一种简单直观的优先事项设定方法的适用性。对公共卫生的意义社区参与式研究（CBPR）被认为是减少健康差距的一种有前景的方法，也是创造可持续社区成果的有效途径。优先事项设定是社区参与式研究中至关重要的决策步骤。问题的优先级确定不仅要依据问题的重要性，还要考虑可用资金实际能改变的方面。然而，在实施CBPR时，关于如何采用客观和主观措施进行优先事项设定的指导很少。本研究描述了一种社区优先指数（CPI）的发明，它可通过将主观和客观指标整合为单一指标来确定社区健康问题的优先级。本研究中展示的CPI代表了一种可行的系统方法，可提高基于社区的决策的客观性和可靠性。
