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University of Florida Thesis Or Dissertation Formatting TRANSLATING COMMUNITY-BASED PARTICIPATORY RESEARCH INTO NURSING PRACTICE: CLOSING THE HEALTH DISPARITIES GAP By CATHERINE LEVONIAN A DISSERTATION PRESENTED TO THE GRADUATE SCHOOL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY UNIVERSITY OF FLORIDA 2010 1 © 2010 Catherine Levonian 2 To my daughters: Jennifer and Lisa Levonian 3 ACKNOWLEDGMENTS This dissertation would not be possible without the gentle guidance of my chair, Shawn Kneipp. Through her dedication to her mentorship role in developing nurse researchers she has motivated me daily. Each of my committee members (Barbara Lutz, Ellen Lopez and David Miller) shared their particular research expertise and specific manner of support during this long marathon called doctoral education. I would like to thank the Florida Nurses Association, Florida Public Health Association and the Florida Department of Health for their support of this research. Thank you to all the public health nurses who took their precious time to participate and share their knowledge in either the national or Florida survey. No one gets through a rigorous program without help and at UF the list of my helpers is quite long. It runs from the many faculty members in nursing and public health, the staff of ORS and IT, the invincible Cecile Kiley, to the awesome CBPR research team. Along this journey, I met some new friends that I hope will be my colleagues for life. Tina and Ann shared visionary moments, mountains and valleys but we leave UF stronger for them. At mile 22 of this marathon of a program, Maryann and I found that we were at the same point in this doctoral education journey; it was nice to finish the last miles together. Most of all and in all things I thank my family. My family has been my solid base from which I even hoped to soar to a doctoral education. My brother and sister in law were cheerleaders for me. Somehow my husband Don always knew what I needed during this time and helped me in innumerable ways. Jennifer challenged me and offered her specialized talents for assistance. Lisa made me laugh and smile which always lifted my spirit to continue. Thank you to all my friends and family for their unending support. 4 TABLE OF CONTENTS page ACKNOWLEDGMENTS.................................................................................................................... 4 LIST OF TABLES................................................................................................................................ 7 LIST OF FIGURES .............................................................................................................................. 8 ABSTRACT .......................................................................................................................................... 9 CHAPTER 1 INTRODUCTION....................................................................................................................... 11 Problem and Purpose .................................................................................................................. 12 Significance ................................................................................................................................. 13 Definition of Terms ..................................................................................................................... 15 2 LITERATURE REVIEW ........................................................................................................... 18 Partnering to Address Health Disparities .................................................................................. 18 Translating CBPR into Practice ................................................................................................. 19 Call for CBPR ...................................................................................................................... 19 Community-Based Participatory Approach to Practice .................................................... 20 Working with communities ................................................................................................. 21 Review of CBPR studies ..................................................................................................... 22 CBPA: Innovation in public health nursing practice ......................................................... 26 Trends in Public Health Nursing: A Slow Return to Community Roots ................................. 27 General Public Health Nursing Competencies and Community Based Practices................... 32 Summary of Relevant Literature ................................................................................................ 35 Significance of Study .................................................................................................................. 36 3 METHODOLGY ......................................................................................................................... 40 Conceptual Framework. .............................................................................................................. 40 Research Design .......................................................................................................................... 45 Study Aims ........................................................................................................................... 45 Samples and Settings ........................................................................................................... 46 Sample .................................................................................................................................. 46 Aim 1 Inclusion criteria ............................................................................................... 47 Aim 1 Exclusion criteria for ........................................................................................ 47 Aims 2 & 3 Inclusion criteria ...................................................................................... 47 Aims 2 & 3 Exclusion criteria ..................................................................................... 47 Setting ................................................................................................................................... 48 Procedure for Protection of Human Subjects ..................................................................... 49 Potential Risks ..................................................................................................................... 50 5 Measures ...................................................................................................................................... 50 Aim 1: ................................................................................................................................... 50 Content Validity ................................................................................................................... 53 Data Collection for Instrument Testing ..................................................................................... 54 Procedures/Study Protocol for Aims 2 & 3 ............................................................................... 55 Statistical Analyses ..................................................................................................................... 57 Data Screening ..................................................................................................................... 58 Statistical Analysis Assumptions ........................................................................................ 59 4 RESULTS .................................................................................................................................... 63 Part I – Aim 1: Instrument Development .................................................................................. 64 Sample .................................................................................................................................. 64 Analysis ................................................................................................................................ 65 Part II – Aims 2 & 3 .................................................................................................................... 66 Sample .................................................................................................................................. 66 Sample Demographics ......................................................................................................... 67 Missing Data ........................................................................................................................ 69 Regression One .................................................................................................................... 75 Regression Two ................................................................................................................... 76 Regression Three ................................................................................................................. 77 5 DISCUSSION AND RECOMMENDATIONS ........................................................................ 90 Overview of Study ...................................................................................................................... 90 Major Findings ............................................................................................................................ 90 Recruitment and Response Rates
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