Newswise — Too often, Valparaiso University nursing professor Dr. Amy Cory says medical professionals visit communities in developing nations and make the mistake of deciding what their most serious health problems are without talking to the people they are trying to help.
"Nursing and medicine have traditionally been top-down, directive professions, rather than asking the people being served for guidance," Dr. Cory says.
Dr. Cory and a team of nursing students from Valparaiso - a member of the Council on Undergraduate Research - are working to avoid that mistake during a multi-year partnership with a rural Nicaraguan village that aims to improve health inequities related to gender, ethnicity and socioeconomic status. Participating in the project are juniors Tricia Erdmann of Racine, Wis., and Katherine Thomas of Evanston, Ill.; senior Rebekah Schmerber of Elgin, Ill.; and sophomore Kerstin Kost of Avon.
The project " "Beyond the Volcanoes: A Community Partnership for Health in Rural Nicaragua" " started in August 2007, when the University was approached by an alumnus with an interest in humanitarian medical work in Central America.
Rather than going to the village and addressing only immediate medical needs, Valparaiso's nursing team decided to undertake a longer-term project referred to as community-based participatory action research. It's a process that involves six phases: partnership, assessment, planning, implementation, evaluation and dissemination.
Erdmann said the community-based research model being used by Valparaiso's team is based on the notion that the most effective ideas are driven by community perspectives, with a health assessment completed based on the community's input and health initiatives implemented in close coordination with the community.
She and Thomas first traveled to Nicaragua in November 2007 to start a conversation with community leaders about health and environmental issues, with Dr. Cory and Schmerber making a second trip in March 2008 for a series of exhaustive interviews with community leaders and a survey of 77 community members from 47 households.
That time devoted to talking to community members about what health improvements would make the biggest impact on their quality of life paid off. While the team thought that clean water would turn out to be the village's primary health issue, respiratory issues were identified as the biggest problem.
"One of the most important benefits of doing this type of community-based research is that it's easier to get community buy-in when they give input about the most important problems," Erdmann said. "People are more apt to listen and take action when they understand something is a problem."
With the partnership and assessment phases completed, Valparaiso's nursing team made another trip in November 2008 to launch the planning phase and share the health survey results with the community. During that trip, Dr. Cory said the team held a community health forum and discussed actions the community could take to prevent its most serious health issues. In the midst of that meeting, the community decided at the suggestion of a Valparaiso alumna accompanying the team to use poetry and socio-drama plays to spread important health messages.
"Poetry and socio-dramas are a big part of the culture in Central America, and a definite benefit of this type of research is that we can learn from the community," Thomas said. "That forum really showed the power of the community-driven process."
On Feb. 27, the team departs on its fourth trip to Central America for the start of the intervention phase. Dr. Cory said there will be more community forums making use of socio-dramas and poetry during the students' week in the village, and the team will work with the community to design an evaluation process to determine whether the key health messages are being learned.
The team plans to return for the evaluation phase next November and to complete their work with the community in March 2010.
Yet Valparaiso's nursing students and Dr. Cory want the impact of project to extend beyond one community.
"Our hope is that after this project we will be able to work with other communities in Central America and will know whether the socio-dramas are something other people can benefit from using," Dr. Cory said.
The community-based participatory action research process is relatively new to health care, and Dr. Cory said she is unaware of any other undergraduate nursing students doing similar research in an international setting.
"From a stand point of sustainability, it's easier if we go into communities and ask people what they need to improve their situation rather than going in and saying 'This is what we will give you'," she said.
In October, the team was invited to make a presentation on its project at the annual conference of the American Public Health Association, a gathering of approximately 14,000 doctors, nurses and other public health professionals. Dr. Cory said it's extremely rare for undergraduate nursing students to present research at the conference, but Valparaiso's students attracted so much interest that the organization is considering expansion of its mentoring/scholarship program for master's and Ph.D. students so that undergraduate students also are eligible.
"The public health nurses really embraced Valpo's students like I haven't seen them embrace other nursing students, which speaks volumes about how much effort the team has put into its work," Cory said.
Each of the students said an interest in international service drew them to the Nicaragua project.
"I really love Central America and when I learned about the project I was really interested in helping," said Thomas, who previously had traveled to El Salvador and studied at Valparaiso's Puebla Study Center in Mexico. "I've been able to see so much more what opportunities nurses having working around the world or in non-traditional settings."
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