Engage for Equity Key Informant Survey

ASSESSMENT INSTRUMENT BACKGROUND

Context of instrument development/use
The articles discuss a range of academic-community collaborations and efforts across the United States that have focused on understanding “which partnering practices, under which contexts and conditions, contribute to research, community, and health equity outcomes.”^3,9 Efforts were aimed at developing actionable knowledge that improves CBPR, CEnR, and participatory action research science. Efforts also focused on translating data to support equity and recognizing the struggles and gifts within the community.³ The articles discuss findings from three funding stages from the National Institutes of Health. Funding supported the development of the CBPR conceptual model, which contains four domains (context, equitable partnerships, research design/interventions, and outcomes). The model was refined through the development, testing, and implementation of two complementary assessment instruments – the KIS (described here) and the CES (described in another assessment instrument summary).^2,3,9 The instruments are for use by academic and community partners to assess and understand their perceptions of the partnering process and outcomes.³ ​

Instrument description/purpose
The KIS is completed mainly by the PIs or project director(s) of academic-community partnerships to describe project-level features. The 97 questions in the instrument assess the following 18 validated (i.e., construct, factorial) focus areas:

• Project features
• Length and size of project and partnership
• Type of study
• Populations and communities involved in project
• PI racial or ethnic groups
• PI population groups
• PI gender identity
• Community challenges
• Reflective practices
• Training topics
• Hiring and resource sharing
• Research integrity and governance practices
• Approvals
• Advisory boards or groups
• Roles of advisory boards or groups
• Formal agreements
• Institutional practices
• Project outcomes^1,3,5,7

Studies have also used the KIS to explore the relationship between the type of final approval used in CEnR projects (e.g., no community approval, agency staff approval) with governance processes (e.g., control of resources and agreements), productivity measures, and perceived outcomes.^1,6,8

KIS presents questions with open-ended, yes/no, various Likert scales, and “check the answers that apply” response options.

The KIS instrument in English and Spanish can be accessed here: https://engageforequity.org/tool_kit/surveys/key-informant-survey-introduction/.

Engagement involved in developing, implementing, or evaluating the assessment instrument
While the research that formed the foundation for the KIS took place over three funding stages, the entire research trajectory grew to be called “Engage for Equity”. Across these stages, academic and community collaborations took place between a range of partners including: Community-Campus Partnerships for Health, the National Indian Child Welfare Association, the Rand Corporation, the University of Waikato (New Zealand), the National Congress of Americans Indians (NCAI) Policy Research Center (PRC), the University of New Mexico Center for Participatory Research (UNM-CPR), the University of Washington’s Indigenous Wellness Research Institute (UW-IWRI), and a think tank of academic and community CBPR experts.^3,9 These partnerships supported the development, refinement, and pretesting of the KIS, including its “readability, length, content, sequence, and usability.”³

A shortened pragmatic version of the KIS and CES, called Partnership for Health Improvement and Research Equity (PHIRE), with 30 questions (also available in Spanish) was developed based on extensive statistical analyses and expert feedback from communities and academic partners. PHIRE represents the same focus areas as the longer instruments, with emphasis on a few core questions from the KIS and the CES. PHIRE has been piloted in multiple research, coalition, and engagement settings, and can be used for annual reflection and evaluation for partners who want to assess their strengths and areas to grow (please contact [email protected] to obtain use of the PHIRE).

Additional information on populations engaged in instrument use
Two sets of internet surveys were conducted in 2009 and 2015. The first set of surveys were included in the mixed-methods research project Research for Improved Health.^3,8 PIs with research-focused funding and a minimum of two years of remaining in projects completed KIS. “Of these projects, 47 were located in Native communities (single or intertribal communities) and 153 were located in other communities (including 24 Hispanic, 21 multiple ethnicities, 20 African American, 7 Asian American, and 87 no specific ethnicity).”⁸ In 2009, the questions were refined and translated into Spanish.

In 2015, a total of 179 federally funded CBPR and CEnR projects of diverse populations across the United States participated in an analysis of KIS. Among the funded projects, 189 PIs (53% response rate) completed KIS. “Gift cards of $20.00 were sent as incentives in advance of participants receiving their KIS … Internet links.”³

Notes

• Potential limitations: Several articles in this summary referenced self-reported response bias and selection/sampling biases. The articles indicated that bias may have been introduced due to the fact that only projects identified as CBPR or CEnR in the federal RePORTER register were included.  These results may not be applicable to other research projects with limited community engagement.^1-3,5,7 The cross sectional analysis of internet survey and cases studies of only NIH-funded partnerships noted that the results do not support “causal/temporal inferences particularly as they relate to health improvement or reduced inequities.”^2,5 Lastly, one article noted that considerations of survey length prevented thorough exploration of all aspects of structural governance.¹
• Important findings: One article on the Engage for Equity effort noted “that the theoretical grounding and extant literature supports CEnR projects to engage in collective reflection to reap the full benefits of community engagement.” The effort supported understanding of the role of power within partnerships, including CBPR and CEnR projects. The Engage for Equity study design allowed for the opportunity to also conduct a randomized control trial of delivery of tools and resources developed in the effort through workshops or through the web, collect longitudinal data from 68 partnerships of the total sample, and analyze approaches to “building empowerment through collective-reflection” and action. The authors believe that “other tools and trainings, such as resources to help partnerships choose an equitable decision-making model or combatting racism, may be needed after partners identify areas of strength or concern.”³

Further analysis of the KIS among CEnR projects in Native communities found that involving tribal governments or health boards (TB/HG) resulted in “greater community control of resources, greater data ownership, greater authority on publishing, greater share of financial resources for the community partner, and an increased likelihood of developing or revising IRB policies.” The results provided evidence that supports the need for strong governance in communities (i.e., “regulation as the focus is on balancing the needs of protection of individuals from harm while trying to foster scientific innovation”), and stewardship over projects, benefit, and control over research. Strong governance could take place through “community-driven agreements, access to resources, and development or revision of IRB policies.”⁸

Analysis of the 2015 surveys of the KIS found that counter to principles of CBPR, where shared decision-making and co-administration of the research are expected, among funded CEnR projects examined, decisions tended to be made more by academic partners than community members. However, shared decision-making related to financial resources and hiring personnel did take place in approximately 30–40% of projects.¹ Additionally, budget sharing between academic and community partners seemed relatively low for these kinds of collaborative projects (an average of 28.5% of projects), though higher for Native projects. “Approval on behalf of the community, community-based advisors as co-leadership, joint decision-making, and resource-sharing practices can help identify potential areas for partners to strengthen along their CBPR journey.”¹

• Future research needed: Research exploring all aspects of structural governance is needed.¹ Longitudinal study designs were also referenced as an area of further research.²
• Supplemental information: Additional analysis has been conducted using KIS on multiple kinds of partnerships, beyond the two internet survey sets in 2009 and 2015 (i.e., projects involving healthcare and government partners). The findings from the research, the most complete version of the KIS (see Dickson, 2020 below), and other information on the development and use of this instrument can be found in the following articles:

  • Oetzel, J. G., B. Boursaw, M. Magarati, E. Dickson, S. Sanchez-Youngman, L. Morales, S. Kastelic, M. M. Eder, and N. Wallerstein. 2022. Exploring theoretical mechanisms of community-engaged research: a multilevel cross-sectional national study of structural and relational practices in community-academic partnerships. International Journal for Equity in Health 21(1). https://doi.org/10.1186/s12939-022-01663-y.

  • Boursaw, B., J. G. Oetzel, E. Dickson, T. S. Thein, S. Sanchez-Youngman, J. Pena, M. Parker, M. Magarati, L. Littledeer, B. Duran, and N. Wallerstein. 2021. Scales of Practices and Outcomes for Community-Engaged Research. American Journal of Community Psychology 67(3-4):256-270. https://doi.org/10.1002/ajcp.12503.

  • Hanza, M., A. L. Reese, A. Abbenyi, C. Formea, J. W. Njeru, J. A. Nigon, S. J. Meiers, J. A. Weis, A. L. Sussman, B. Boursaw, N. B. Wallerstein, M. L. Wieland, and I. G. Sia. 2021. Outcomes of a Community-Based Participatory Research Partnership Self-Evaluation: The Rochester Healthy Community Partnership Experience. Progress in Community Health Partnerships 15(2):161-175. https://doi.org/10.1353/cpr.2021.0019.

  • Dickson, E., M. Magarati, B. Boursaw, J. Oetzel, C. Devia, K. Ortiz, and N. Wallerstein. 2020. Characteristics and Practices Within Research Partnerships for Health and Social Equity. Nursing Research 69(1):51-61. https://doi.org/10.1097/NNR.0000000000000399.

  • Duran, B., J. Oetzel, M. Magarati, M. Parker, C. Zhou, Y. Roubideaux, M. Muhammad, C. Pearson, L. Belone, S. H. Kastelic, and N. Wallerstein. 2019. Toward Health Equity: A National Study of Promising Practices in Community-Based Participatory Research. Progress in Community Health Partnerships 13(4):337-352. https://doi.org/10.1353/cpr.2019.0067.

  • Reese, A. L., M. H. Marcelo, A. Abbenyi, C. Formea, S. J. Meiers, J. A. Nigon, A. Osman, M. Goodson, J. W. Njeru, B. Boursaw, E. Dickson, M. L. Wieland, I. G. Sia, and N. Wallerstein. 2019. The Development of a Collaborative Self-Evaluation Process for Community-Based Participatory Research Partnerships Using the Community-Based Participatory Research Conceptual Model and Other Adaptable Tools. Progress in Community Health Partnerships 13(3):225-235. https://doi.org/10.1353/cpr.2019.0050.

  • Lucero, J., N. Wallerstein, B. Duran, M. Alegria, E. Greene-Moton, B. Israel, S. Kastelic, M. Magarati, J. Oetzel, C. Pearson, A. Schulz, M. Villegas, and E. R. White Hat. 2018. Development of a Mixed Methods Investigation of Process and Outcomes of Community-Based Participatory Research. Journal of Mixed Methods Research 12(1):55-74. https://doi.org/10.1177/1558689816633309.