A global perspective on community-based participatory research: The Roxbury & Kenya: Heart and sole programs

Background: Cardiovascular disease (CVD) is a leading cause of death worldwide with a disproportionate burden of disease borne by the African diaspora. The emergence of CVD in Africa challenges many assumptions; for example, physical inactivity has been implicated in increased CVD morbidity for African American (AA). In our prior work, however, although the prevalence of hypertension for Kenyans and AA were similar (43% vs. 42% respectively), Kenyan blacks were not sedentary and this needs to be better understood. Central to eliminating disparities in CV outcomes are culturally appropriate, feasible, effective and sustainable interventions targeted to the African diaspora. Community-Based Participatory Research (CBPR) provides a model for engaging the community in the design and conduct of relevant clinical trials, enhancing the probability of success. Our work in Roxbury (US African American [AA] community) and Kenya employs CBPR to address multiple CV risk reduction. Objectives: The purpose of the Heart and Sole studies is to propose and test a heart disease prevention program, emanating from CBPR. Methods: We involved the Roxbury community in developing a multiple risk factor intervention (Heart and Sole) that includes; exercise, nutrition, relaxation techniques and cognitive-behavioral therapy. Grassroots presence included partnerships with a community coalition of; residents, civic organizations, health centers and elected officials. In Kenya, we established partnerships with key stakeholders including Ministry of Health, Academia, Community Health Centers, and Village Chiefs. We used CBPR to conduct community screenings and carry out a community asset assessment. Results: Outcomes from Roxbury suggest that CBPR enhanced the success of both recruitment and selected CV endpoints. In Kenya we successfully screened 966 individuals and assessed one community; gleaning important information to further our understanding of CVD prevalence/characteristics. Conclusions: CBPR has been integral to the conduct and success of our studies and can contribute to the goal of improving CV health outcomes in people of African diaspora. To insure successful outcomes and translation of findings, collaboration between researchers and the community of interest is essential.