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Community-based participatory research methods allow for community engagement in the effort to reduce cancer health disparities. Community engagement involves health professionals becoming a part of the community in order to build trust, learn from the community and empower them to reduce disparities through their own initiatives and ideas. Audience Response Systems (ARS) are an innovative and engaging way to involve the community and obtain data for research purposes using keypads to report results via power point. The use of ARS within communities is very limited and serves to widen the disparity gap by not delivering new advances in medical knowledge and technology among all population groups. ARS was implemented at a community town hall event sponsored by a National Institute on Minority Health and Health Disparities Exploratory Center of Excellence, the Center for Equal Health. Participants appreciated being able to see how everyone else answered and felt included in the research process. ARS is beneficial because the community can answer truthfully and provides instant research results. Additionally, researchers can collect large amounts of data quickly, in a non-threatening way while tracking individual responses anonymously. Audience Response Systems proved to be an effective tool for successfully accomplishing community-based participatory research.
As health professionals and researchers strive to reduce or eliminate health disparities within their communities, the need to include the community members in the process has become more evident (Smedley & Syme, 2000). Community-based participatory research methods allow for community involvement in this effort to reduce health disparities (Wallerstein & Duran, 2006). In addition, community engagement and outreach activities can play a vital role in addressing health disparities (Partridge & Fouad, 2010; Meade et al., 2007). Community engagement is an ongoing effort for health professionals and researchers and many are already engaging the community in an attempt to get their input. Community engagement involves health professionals and researchers becoming a part of the community in order to build trust, share their expertise, learn from the community’s expertise, and empower the community to reduce disparities through their own initiatives and ideas (Partridge & Fouad, 2010). As researchers continue their efforts in community-based participatory research, more and more innovative ways for community engagement are being considered. One such way, proposed in this article, is through the use of Audience Response Systems.
The Audience Response System (ARS) is an innovative and engaging way to involve the community and obtain data for research purposes. ARS is a technological, interactive-polling device that reports live results via power point. The system comes with keypads or “remotes” for each audience member to record their responses. The system tallies all audience responses and then produces bar graphs or pie charts of the results. Although ARS has mostly been used in educational/classroom settings (Abate et al., 2011; Wait et al., 2009; McRae & Elgie-Watson, 2010; Filer, 2010), it is now being considered as a way to engage the community. The use of ARS within communities, specifically with underserved populations, unfortunately is very limited. These limitations serve to widen the disparity gap by not delivering new advances in medical knowledge and technology among all population groups (Fremont et al., 2003; Glied & Lleras-Muney, 2008). One documented use of ARS within the community, specifically Native American communities, has shown positive results in which community members felt ARS enhanced their learning experience and participants expressed wishes to use it again in the future (Gamito et al., 2005). ARS has also been previously used in a community-based colorectal cancer screening intervention as an assessment instrument used to evaluate participants’ self reported medical history, knowledge of screening recommendations, and attitudes regarding preventive behaviors in an effort to reduce cancer disparities in Arkansas (Yeary et al., 2011). Additionally, to address depression in the African American community in Los Angeles, ARS was used within CBPR initiatives and was well received as a way for the community to give their feedback (Patel et al., 2006).
The Center for Equal Health (CEH), a National Institute on Minority Health and Health Disparities Exploratory Center of Excellence, is a collaborative, transdisciplinary approach between the University of South Florida and Moffitt Cancer Center. The aim of CEH is to address and reduce cancer health disparities within minority and underserved populations in the Tampa Bay community and throughout the state of Florida. CEH is made up of five cores working towards this aim; these include the Administrative Core, Research Core, Research Training and Education Core, Comparative Effectiveness Research in Eliminating Disparities Core, and Community Engagement and Outreach Core. Specifically, the Community Engagement and Outreach Core (CEOC) has been working to strengthen, enhance, and expand meaningful community-academic partnerships within the Tampa Bay area. This has been accomplished through innovative community awareness and outreach activities such as implementing a community health advisor program; conducting talking circles, cancer education workshops, health fairs, and science tours; and creating a series of cancer prevention and research messages delivered via print, radio, or podcasts.
In an effort to fulfill the Center’s goal to actively be involved in the community, CEOC has utilized the Audience Response Systems in the community for two separate events. One was at a community health fair event while educating the community about clinical research. The other event, which this manuscript focuses on, was a cancer education workshop called the Gathering of Neighborhood Voices Town Hall. The CEOC piloted the Audience Response System during the Town Hall event to give the community an enjoyable experience and to reach out to community members in an innovative way. The event included a local news anchor as the moderator, expert panelists and community members who engaged in a dialogue about cancer health disparities. The panelists represented a physician, a pharmacist, a public health researcher, a health communications expert, and a community-based organization worker. The Town Hall event was held in the community of East Tampa. East Tampa is made up of 95% African Americans and has an estimated 38% of people who are below the poverty line (Florida Department of Community Affairs, 2007). In addition, East Tampa has been considered a Community Redevelopment Area, a designation determined by factors of slum and/or blight, as defined by Florida Statutes (East Tampa Community Revitalization Partnership, n.d.). The designation is intended to help communities improve infrastructures, preserve historic structures, and ultimately enhance the community through local government tax increment revenues. The determination of East Tampa as a Community Redevelopment Area emphasizes the needs and disparities that are within this community.
The purpose of the Gathering of Neighborhood Voices Town Hall event was to: increase community members’ knowledge and awareness of cancer health disparities; obtain feedback from the community about their needs and their views of cancer; engage in an open dialogue with the community and answer questions about cancer health disparities they might have; educate the community about the Center for Equal Health; and build a partnership and trust with the community. Research approval was received from the University of South Florida Institutional Review Board for the Town Hall event. ARS was used to assess the community’s demographic characteristics, basic pre and post knowledge of cancer health disparities, and satisfaction of the Town Hall.
At the start of the event, an explanation on how to use the ARS keypads was given. There is a frequency box attached to the laptop with the PowerPoint presentation which picks up the keypad signals. We explained the similarities between the ARS keypads and TV remotes which helped the audience understand how to use the keypads. Additionally, the audience was asked to answer a simple yes/no question to practice with the keypad before beginning the program. The questions asked during the program using the ARS are listed in Table 1. The participants were asked to answer basic demographic questions first, which helped them become even more familiar with the keypads before answering questions related to cancer health disparities. The moderator read aloud each question and gave participants enough time to answer using the ARS keypads. After the questions related to cancer health disparities were answered, the panelists would give his or her input and then open a discussion up for audience feedback and questions.
There were about 60 people in attendance at the Town Hall event and everyone was willing to use the ARS keypads. A majority were female (62%), ages 30–59 years old (73%) and African American (80%). Participants responded favorably toward using ARS, enjoyed the added interactions that resulted from this approach, and appreciated being able to see how everyone else answered. Table 2 shows selected results from the ARS and the percentages of the responses. When asked how much the audience liked using ARS, 93% of them responded they either liked or loved using the system. Importantly, participants stated on comment cards that they felt “included in the research process.”
The use of Audience Response Systems within the community benefits both community members and health researchers. The system lets the community answer truthfully, with anonymity, and without fear of repercussion. About 78% of participants at the Town Hall agreed or strongly agreed that they felt comfortable sharing their thoughts and opinions during the event, as shown in Table 2. It allows audience members the ability to easily engage during the event. ARS also gives the community instant research results, which addresses the ethical concerns of returning data to community participants (Chen et al., 2010).
Audience Response Systems provide opportunities for health researchers to collect a large amount of data quickly and to track individual responses anonymously. Researchers can collect data in a non-threatening way that is very insightful and useful. For example, some useful data collected at the Town Hall event included the fact that about 63% of participants had never heard of or knew very little about health disparities at the beginning; however, after the discussion with the panelists, 97% of the audience felt health disparities existed within their community (Table 2). Over one-half of the participants felt unsatisfied that their community met their needs in regards to access and awareness of health services.
Additionally, ARS has the potential to create a participatory learning environment by stimulating discussions with community members. The system can also be utilized for community-based research on a variety of health topics that affect a community. ARS may also be used to anonymously assess the participants’ health status and what specific health issues are of most concern to them. At events like the Town Hall, questions asking about specific disease states such as cancer, diabetes, and hypertension may be used to assess the level of disease prevalence in the community and even the level of interest in these issues. Using the information gathered, participants can then be referred to healthcare professionals who specialize in these particular diseases at the event to further answer their questions. The ARS will provide an insight into the types of health professionals that are in highest demand to ensure their presence at future events, both for first-time participants and as a follow-up to previously sponsored events. General health assessments may also be attained using ARS, with the possibility of assessing improvements in knowledge, health interventions, and access to healthcare over time at events hosted within the same communities.
Several lessons were learned from utilizing the Audience Response System at the Center for Equal Health’s Town Hall event. First, the need for researchers to become familiar with the technology before initial use is extremely important. There can be certain malfunctions that occur during the set-up and actual use of the system, as with any technology. Some suggestions are to implement an ARS training for the research staff prior to the event and to pilottest the ARS at the actual event location within the community. This will help to minimize any problems that may arise during the event. A second suggestion is to include a blank slide between any data collection slides in the Power Point. As the movement from one slide to another initiates the data collection procedure, utilizing a blank slide can minimize any errors from accidently doubleclicking during the presentation. Moreover, questions need to be developed that are appropriate for the intended audience members. Researchers should make sure to understand the community they are serving and what appropriate literacy level is necessary. It is also important to use the ARS keypads during only one portion of the event, rather than going back and forth between the ARS and an open discussion. This will ensure higher response rates since the audience members are eagerly answering the ARS questions. Lastly, the use of ARS requires technological equipment in order to fully function properly in the community. The necessary equipment include: a laptop with the installed ARS software and Microsoft Power Point, a projector and screen, extension cords, and most importantly, access to electricity.
The Gathering of Neighborhood Voices Town Hall and the use of ARS has led to developing several future Center for Equal Health endeavors based on the results and input from the participants at the event. First, it was vital for CEH to report back to the community about this event and the data that were collected. So, the Community Engagement and Outreach Core published an article in a local newspaper after the event summarizing the purpose of the event and some of the major results from those who participated. The CEOC will continue to have more events using the ARS, similar to the Town Hall event, in other communities within the Tampa Bay area. Several comments received from participants indicated that the event was “very helpful and informative” and participants wanted the Center to make “another attempt to reach a larger section of community to come out.” CEH plans to participate in conferences and meetings where the Audience Response System can be utilized since it is important to develop more partnerships in the community to disseminate information about how the Center for Equal Health is working to reduce and eliminate cancer health disparities. For example, CEH will be conducting a panel session at a national conference held in the Tampa Bay area to teach the audience about health disparities and will use the ARS for an interactive and engaging experience for attendees. Additionally, CEH plans to host a Health Disparities Symposium to educate community members, physicians, nurses, and researchers about health disparities. At this symposium, the Audience Response System will also be incorporated throughout the event. The Center for Equal Health continues to work to address the needs of the community in order for community members to feel better satisfied with their health services.
Community-based participatory research warrants the involvement of the community for successful research outcomes. The use of an Audience Response System holds great promise to enable communities to become more actively involved in the research process. The goal of the Center for Equal Health is to continue to engage the community in its work to reduce cancer health disparities. The success of the center will be dependent on how strong the relationships become with the community. The Gathering of Neighborhood Voices Town Hall event is one example of how the Center for Equal Health successfully implemented the Audience Response System in the community. The Audience Response System was beneficial to get feedback from the community on cancer health disparities and issues that are important to them. In addition, the use of ARS solved the ethical dilemma that the Center faces when trying to ensure that community partners receive the results of the research in which they have contributed. By including the community in all stages of the research process, a true partnership can develop in which all members feel equally valued. The Audience Response System proved to be an effective, popular, and interactive tool for successfully accomplishing community-based participatory research.
Jenna L. Davis, Moffitt Cancer Center.
Kara E. McGinnis, University of South Florida.
Margaret L. Walsh, University of South Florida.
Coni Williams, University of South Florida.
Kevin B. Sneed, University of South Florida.
Julie A. Baldwin, University of South Florida.
B. Lee Green, Moffitt Cancer Center.