R-10: Community Engagement Initiative Knowledge Transfer Research Project

Methods

Participatory Action Research (PAR)

CEI will make use of participatory action research (PAR), as conceived by the Oregon Disability Commission (ODC) in the evolution of the methodology. Implementation of CEI has been accomplished through partnerships with local disability organizations, including independent living centers. Analysis and publication of the CEI results have included individuals with disabilities. Implementation of the current project will include individuals with disabilities, family members, and disability organizations.

Fidelity and Reinvention

Unlike effectiveness studies of interventions, the present study of the use of research findings is expected to result in modifications to the CEI process. Larsen, for example, argued that knowledge utilization can include significant changes or reinvention during implementation. Although we anticipate that the “up-take” and implementation of CEI may result in changes to the original process, we will also ask all community project sites to document modifications or changes they make. In addition, sites receiving the intensive KT assistance intervention (including a greater degree of training and onsite technical assistance by the research team) are hypothesized to adhere to the established CEI process more closely.

Site Selection and Sample

A list of all Mississippi, Montana, and New Hampshire incorporated towns with populations between 2,500 and 10,000 located in on-metropolitan counties (counties with at least one town over 10,000 in population but no city with more than 50,000) will be compiled. Potential intervention sites will then be matched on size of the community’s population, including percentage of individuals with disabilities, racial and ethnic demographics, urban and rural designation, budget, and similar number and type of community recreation opportunities. Inclusion of sites in Mississippi and Montana will provide both geographic distribution and the inclusion of communities with minority populations (African-Americans and Hispanics, respectively).



From this pool, three communities from each state will be randomly selected and assigned to the different intervention categories or levels of assistance in implementing CEI (KT Minimal Assistance, KT Moderate Assistance, KT Intensive Assistance, described in Procedures below).

Study Design

The main purpose of this project is to study knowledge transfer and use by communities as a unit of measure. To accomplish this purpose, the CEI KT Project will use an Equivalent Materials Design. In the Equivalent Materials Design, different, equivalent materials are applied and then observed. An equivalent materials sample design involves exposure of equivalent forms of an intervention which are presented sequentially and their differential effect on the experimental variables are assessed at different points across time. This is similar to an equivalent time samples design and may, in fact, incorporate comparisons across groups or settings. This design protects against threats to internal validity posed by history, maturation, testing, regression, and selection.

Procedures

For this study, we will conduct three distinct categories of “dose,” according to varying levels of exposure to “up-take” and CEI implementation assistance. KT Minimal Assistance sites will receive a summary of previous CEI research and intervention results, a “how to guide” on using CEI, and financial support to the community. KT Moderate Assistance sites will receive a summary of previous CEI research results, a “how to guide” on using CEI, financial support to the community, and training from project staff on how to conduct CEI. KT Intensive Assistance sites will receive a summary of previous CEI research results, a “how to guide” on using CEI, financial support, training, and onsite technical assistance by the research team.



Disability organizations and/or local recreation agencies in the communities randomly selected for the project will receive an invitation to participate in the project, including a description of the availability of $4,000 in financial support for each site. If a selected community declines to participate, we will select replacement community at random from the sample pool. Subsequently, a set of interlocking procedures will be implemented for the project. First, the project will create a brief summary of previous implementations of CEI and a “how to guide.” All communities will receive these documents. Subsequently, a CEI training will be held for KT Moderate and Intensive communities. Lastly, onsite technical assistance will be given to the KT Intensive communities implementing CEI.

Data Collection

To answer the project’s research questions, we will collect outcome measures at the levels of program adoption and implementation, community engagement process, environmental and systems change, and individual participation. First, we will assess the adoption behavior of each community organization by monitoring the components of the CEI process they adopt unchanged, modify, or drop, and any components that they might add to the process.



Second, at the community engagement process level, implementers of CEI will be asked to complete action logs of meetings, steps taken, results, estimates of time spent on the actions taken, etc. We will also ask them to report outcomes such as policies changed, barriers removed, and costs associated with the efforts to achieve those ends.



Third, at the community level, the number and type of identified, prioritized, and validated barriers to recreation will be collected by the CEI implementers. In addition, a modified version of Larsen’s utilization scale, which contains seven ranked stages of knowledge utilization, will be used to assess recreation barriers. At the end of the Mobilization phase of CEI, infrastructure meeting participants will be asked by the CEI implementers to assign a rank value based on an ordinal scale outlined in the following modified list from Larsen’s scale of the Mobilization efforts:



1. Considered and rejected

2. Nothing done

3. Under consideration

4. Steps toward resolution

5. Partially resolved

6. Resolved as presented

7. Resolved and adapted



This raw data will be provided to the research team by the CEI implementers. At 9-months post CEI, the research team will repeat this measure with the CEI participants via a mail survey. Resolved barriers will be used to create an Opportunity Index to assess the potential participation levels of people with disabilities in each community. In addition, the research staff will track the name and location of specific recreation sites identified as having barriers to participation. Those sites will receive a brief retrospective survey asking if the site operators perceive an increase in the participation levels of people with disabilities. Recreation sites will receive the post-retrospective survey at 9-months post CEI and will be asked to return the surveys to the research team for analysis.



Finally, the impact on actual participation by people with disabilities will be assessed at baseline (prior to implementing CEI) and nine months post-CEI. The Community Participation and Perceived Receptivity Survey (CPPRS) will be used. The CPPRS is a valid and reliable measure of participation levels, accessibility of locations, and how individuals with disabilities perceive they are treated at different locations. Only the recreation sections of CPPRS will be administered, including public parks, sports arenas, movie theaters, etc. At the beginning of each town hall meeting, town hall attendees (roughly 30 per site) will provide baseline data via the portion of the CPPRS referring to recreation locations. These individuals will be contacted again at the end of the 9-month intervention period to provide post-intervention CPPRS data on accessibility of recreation facilities. Scores are calculated based on combining subscores for frequency of visiting the location; importance, choice, and satisfaction; characteristics of the respondent, use of personal assistants and assistive technology; and environmental features that facilitate utilization of those locations.

Measurement

At the beginning of each Town Hall meeting, attendees (individuals with disabilities and families, roughly 30 per site) will provide baseline data via the portion of the CPPRS referring to recreation to the CEI implementers. Town Hall attendees will be contacted again by the research team at the end of the 9-month intervention period to provide post-intervention CPPRS data. At the end of the Infrastructure meeting, attendees (community infrastructure representatives and Town Hall participants, roughly 30 per site) will provide baseline data using Larsen’s utilization scale to the CEI implementers. These individuals will be contacted at the end of the 9-month intervention period by the research team to provide post-intervention data.

Data Analysis

All data will be returned to the research team for analysis. Results will also be compared by level of KT assistance.



Adoption and reinvention. The data on the number of components adopted, modified, dropped, or added will be presented for each cite. Rationale for each action by the site coordinators will be summarized according to categories suggested by Schumacher such as simplicity, compatibility with local values, etc.



Community engagement process. Researchers will review the action logs. The number of actions taken on each prioritized issue will be calculated, along with the time and number of people involved in each. This same data will be assessed by examining the actions by outcomes reported.



Larsen’s utilization scale & Actualized Participation scale. Change from baseline to post-intervention assessment will be analyzed within each community site using Wilcoxon-Mann-Whitney U tests. This nonparametric test compares the median of two groups on data measured on an ordinal scale. It is appropriate for small or non-normally distributed samples. Responses will also be combined across sites, and pre-post differences will be analyzed using either a Wilcoxon-Mann-Whitney U test or an independent samples t test, depending on how closely the responses adhere to a normal distribution. Individual responses at each time point will be anonymous and not linked to each other. Thus, pre- and post-intervention data will be analyzed as independent, rather than paired, samples. Similarly, participation rates at the recreation sites will be assessed at baseline and 9-months post CEI and pre-post differences will be analyzed using either a Wilcoxon-Mann-Whitney U test or an independent samples t test.



CPPRS data analysis at the level of individual participation. Change from baseline to post-intervention assessment will be analyzed within each community site using Wilcoxon-Mann-Whitney U tests. This nonparametric test compares the median of two groups on data measured on an ordinal scale. It is appropriate for small or non-normally distributed samples. Responses will also be combined across sites, and pre-post differences will be analyzed using either a Wilcoxon-Mann-Whitney U test or an independent samples t test, depending on how closely the responses adhere to a normal distribution. Individual responses at each time point will be anonymous and not linked to each other. Thus, pre- and post-intervention data will be analyzed as independent, rather than paired, samples.