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November 2011, Vol 101, No. 11 | American Journal of Public Health Weathers et al. | Peer Reviewed | Research and Practice | 2087
RESEARCH AND PRACTICE
2088 | Research and Practice | Peer Reviewed | Weathers et al. American Journal of Public Health | November 2011, Vol 101, No. 11
RESEARCH AND PRACTICE
adapted from the Behavioral Risk Factor Sur- 1 condition, we included the first 1 recorded in RESULTS
veillance System Survey.13 We also asked re- our list. We then generated frequencies to
spondents to provide information about their characterize the number of individuals who We asked focus group participants and key
socioeconomic background (e.g., income, marital identified each type of condition. We also gen- informants to identify the most important
status, education level) and medical history (e.g., erated frequencies to describe the extent to health issues that need to be addressed in their
diagnosis of high blood pressure, cancer). For this which participants were concerned about these community. We used key informant interviews
report, we analyzed responses to items in the conditions that they identified a priori. to get at a range of issues and, within the
CHS that asked respondents to identify a health focus group discussions, we used the nominal
issue in their community that they would im- Sample Characteristics group technique to arrive at consensus on
prove, and we evaluated concerns about specific We completed 9 focus groups with 51 the issues that emerged. Further, we analyzed
conditions because they were those most appro- African American West Philadelphia residents the focus group and key informant interview
priate for comparing the concerns that partici- and 27 key informant interviews; 201 resi- data separately. However, despite differences
pants identified in focus groups and key infor- dents completed the CHS. As shown in Table in education and employment factors between
mant interviews. 1, there was some variation in the samples key informants and focus group participants,
The Center for Survey Research at the from these activities. For example, although there was tremendous overlap in the responses
University of Virginia generated the sample for focus group participants and key informants from these 2 groups; therefore, we report the
the CHS. Center for Survey Research staff were fairly evenly split with regard to gender, analyses of these methods as concerns identi-
generated a random-digit dial sample of tele- the majority of participants in the CHS were fied using qualitative methods.
phone numbers in the 4 zip codes for West women (71%). In addition, more of the key
Philadelphia. To enhance response rates, we informants we interviewed had some college Health Concerns Identified Using
matched the random-digit dial sample against education or were college graduates and were Qualitative Methods
the telephone directory of listed numbers. We more likely to be employed compared with The majority of both key informants and focus
mailed introductory letters with information participants in the focus group and CHS. Most group participants identified chronic diseases,
about the survey to households identified in participants in all 3 study activities were not such as cancer and cardiovascular diseases, be-
this list. The contact rate for the survey was married, and the mean age was approximately cause of their personal health history and those of
67% (American Association for Public Opinion 50 years. family, friends, and community members:
Research [AAPOR] contact rate 3), the coop-
eration rate was 43% (AAPOR cooperation
rate 4), and the response rate was 24% TABLE 1—Sample Characteristics (n = 279): West Philadelphia Consortium to Address
(AAPOR response rate 4).14 Once we reached Disparities, Philadelphia, PA, 2006–2007
an eligible household, we selected respondents
Key Informant
for participation in the survey using the ‘‘last
Focus Groups, Interviews, CHS, No.
or next birthday’’ method.15 We mailed individ- No. (%) or No. (%) or (%) or Mean
uals who completed the survey a $25 gift Variable Mean (SD; range) Mean (SD; range) (SD; range)
certificate.
Gender
Men 26 (51) 13 (48) 59 (29)
Data Analysis
16,17 Women 25 (49) 14 (52) 142 (71)
We used grounded theory to code the
Marital status
qualitative data and elicit key themes. We used
Not married 37 (77) 13 (54) 145 (74)
the constant comparative method to compare
Married 11 (23) 11 (46) 52 (26)
themes across groups and key informants and to
Education level
determine relationships among them. Trained
‡ some college 22 (46) 25 (93) 112 (58)
research assistants coded and analyzed focus
£ high school 26 (54) 2 (7) 85 (42)
group and key informant transcripts using N6,
Employment status
2006 version (QSR International, Melbourne,
Not employed 25 (52) 4 (15) 86 (44)
Australia) for analyzing qualitative data. For the
Employed 23 (48) 22 (85) 109 (56)
quantitative CHS, we first generated descriptive
Income level
statistics to characterize respondents in terms of
< $20 000 (< $15 000 in CHS) 26 (60) 2 (9) 36 (25)
socioeconomic background. We then generated
‡ $20 000 (‡ $15 000 in CHS) 17 (40) 21 (91) 107 (75)
a list of the conditions that respondents identified
Age, y 50 (11.25; 23–72) 51 (11.29; 32–74) 51 (15.54; 21–65)
when we asked them whether there was one that
needed to be improved. In the small number of Note. CHS = community health survey.
cases in which respondents identified more than
November 2011, Vol 101, No. 11 | American Journal of Public Health Weathers et al. | Peer Reviewed | Research and Practice | 2089
RESEARCH AND PRACTICE
I have a couple of friends with breast cancer and [It’s important to] eliminate some of these envi- conditions were identified. The top 10 condi-
prostate cancer, and a friend who died a couple ronmental hazards and educate people around
tions are shown in Figure 2. Of these condi-
of years ago, she had cancer. (Focus group environmental issues. (Key informant)
participant) tions, most respondents (n = 28) identified
Participants also stated that interventions STDs, primarily HIV/AIDS, and the fewest
Well a good friend of mine, he died of cancer.
And my father, he had different cancers. And should focus on increasing access to informa- respondents (n = 6) identified environmental
um, I see it throughout the community and how tion about these issues through education pro- issues (e.g., pollution, neighborhood cleanli-
it [can] ravage your body, and the changes it take grams delivered to individuals: ness). The same number of respondents identi-
’em through. I notice it’s a horrible way to go.
(Focus group participant) fied several conditions. For instance, 24 re-
Well, they have that thing called the wellness
center. We need more centers like that that’s spondents identified obesity as the condition
My family has a history of cancer. I’ve had 2
mastectomies. I’ve had breast cancer twice. (Key designed to reach out to the community and bring that most needed to be improved, and 24 other
you in and to assist with your medical problems
informant) respondents identified substance abuse as a pri-
slightly free of charge. (Focus group participant)
High blood pressure, stroke, cancer, diabetes— ority. Figure 3 shows responses to concerns
But having access to programs that benefit the
either the individual has contracted one or maybe about specific conditions that were identified
more of these diseases personally or someone in residents and even having the folk that are af-
fected by the problems to help design the pro- a priori. Participants were most concerned about
their family has been affected by it. Certainly,
somebody that each member of the community grams . . . folk that are affected by the problem cancer, violence, and STDs and were least
knows has this issue. (Key informant) need to be a part of the solution. (Key informant)
concerned about asthma and arthritis.
I picked high blood pressure and diabetes ’cause Violence and sexually transmitted diseases
they affect people in my family. People I know (STDs), particularly HIV/AIDS, also emerged Community Forum
[are] always talking about blood pressure and Upon completion of data analysis, we invited
diabetes. (Focus group participant) as health concerns, but to a much lesser degree
than those reported. key informants and focus group participants to
In addition to identifying chronic illnesses, a community forum at which we shared our
participants also identified risk factors such as Health Concerns Identified Using findings and asked for input about the accuracy
obesity and being overweight, as well as envi- Quantitative Methods of the results and the extent to which they felt
ronmental factors that contribute to the excess Overall, 94% of respondents in the CHS the results were representative of members
burden of disease among African Americans identified a health condition that they be- of the West Philadelphia community. We also
as conditions that need to be addressed: lieved needed to be improved; 29 different sought their input about the best ways to
2090 | Research and Practice | Peer Reviewed | Weathers et al. American Journal of Public Health | November 2011, Vol 101, No. 11
RESEARCH AND PRACTICE
November 2011, Vol 101, No. 11 | American Journal of Public Health Weathers et al. | Peer Reviewed | Research and Practice | 2091
RESEARCH AND PRACTICE
(e.g., obesity) and ways to reduce exposure to Philadelphia. Jerry C. Johnson is with the Division of Geriatric planning community interventions. Health Promot Pract.
Medicine, University of Pennsylvania. Joseph Purnell is with 2004;5(1):59–68.
these factors.7 The effects of this intervention on
the Southwest Action Coalition, Philadelphia. Rodney Rogers is 7. Halbert CH, Kumanyika S, Bowman M, et al. Par-
fruit and vegetable intake and physical activity with Christ of Calvary Community Development Corporation, ticipation rates and representativeness of African Amer-
are now being evaluated in a randomized trial Philadelphia. icans recruited to a health promotion program. Health
Correspondence should be sent to Benita Weathers,
funded by the National Center on Minority Educ Res. 2010;25(1)6–13.
MPH, or Chanita Hughes Halbert, PhD, 3535 Market
Health and Health Disparities. An additional Street, Suite 4100, Philadelphia, PA 19104 (e-mail: 8. Creswell JW, Plano Clark VL, Gutmann ML, Hanson
weather@mail.med.upenn.edu or chanita@mail.med.upenn. WE. Advanced mixed methods research designs. In:
issue we faced was that more concerns were
edu). Reprints can be ordered at http://www.ajph.org by Tashakkori A, Teddlie C, eds. Handbook of Mixed Methods
identified than we had resources to address in in Social and Behavioral Research. Thousand Oaks, CA:
clicking the ‘‘Reprints/Eprints’’ link.
the short term. This article was accepted July 21, 2010. Sage; 2003:209–240.
Community-based research is a long-term 9. Dobbie A, Rhodes M, Tysinger JW, Freeman J. Using
a modified nominal group technique as a curriculum
endeavor, and the data obtained from both the Contributors evaluation tool. Fam Med. 2004;36(6):402–406.
quantitative and qualitative methods provide B. Weathers analyzed focus group and key informant
data, provided oversight for study implementation, and 10. Levine DA, Saag KG, Casebeer LL, et al. Using
critical information that community and aca- a modified nominal group technique to elicit director of
lead the writing efforts. F. K. Barg analyzed focus group
demic members of our partnership can use to and key informant data. C. H. Halbert completed quan- nursing input for an osteoporosis intervention. J Am Med
Dir Assoc. 2006;7(7):420–425.
develop relevant intervention strategies. For in- titative data analyses, supervised the implementation of
the study, and analyzed focus group and key informant 11. Hughes C, Lerman C, Lustbader E. Ethnic differences
stance, because health care access was identified
data. All authors contributed to the study conceptuali- in risk perception among women at increased risk for
as an issue in the CHS and was an underlying zation and design as well as the writing of or providing breast cancer. Breast Cancer Res Treat. 1996;40(1):
theme in the focus groups and key informant substantial feedback on this article. 25–35.
interviews, we developed a community-based 12. National Cancer Institute. Health Information Na-
Acknowledgments tional Trends Survey. Available at: http://hints.cancer.
navigator program for cancer control recently
The National Center on Minority Health and Health gov/hints. Accessed October 10, 2006.
funded by the National Cancer Institute.
Disparities (grant R24MD001594), the National Cancer 13. Centers for Disease Control and Prevention. Be-
Institute (grant R01CA132656), and the National Center havioral Risk Factor Surveillance System Survey Question-
Conclusions
for Research Resources (grant RR024133) supported naire. Atlanta, GA: US Department of Health and Human
Obtaining input from community stake- this research. Services; 2006.
holders is a critical component of community- We give special thanks to interviewers at the Center 14. American Association for Public Opinion Research.
for Survey Research at the University of Virginia who
based participatory research that is necessary Standard definitions. Final dispositions of case codes and
used the random-digit dial technique to complete our outcomes for surveys. Available at: http://www.aapor.
for obtaining guidance to develop interven- community health surveys. org/Standard_Definitions/1818.htm. Accessed June 4,
tions.1–3 Although we found that different con- 2010.
cerns may emerge when using both qualitative Human Participant Protection 15. Salmon CT, Nichols JS. The next-birthday method of
and quantitative approaches, both approaches Institutional review board no. 8 at the University of respondent selection. Public Opin Q. 1983;47:270–276.
Pennsylvania approved this research.
were useful in determining health concerns of 16. Charmaz K. Grounded theory: objectivist and
We obtained written informed consent from the focus constructivist methods. In: Denzin NK, Lincoln YS, eds.
community residents and developing creative group and key informant interview participants and Handbook of Qualitative Research. Thousand Oaks, CA:
intervention approaches for addressing those verbal consent from the CHS survey participants. Sage; 2000:509–535.
concerns. For community–academic partner- 17. Glaser BG, Strauss AL. The Discovery of Grounded
ships, it is important to plan strategies for reach- Theory: Strategies for Qualitative Research. Chicago:
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2092 | Research and Practice | Peer Reviewed | Weathers et al. American Journal of Public Health | November 2011, Vol 101, No. 11