Collaborative, Participatory & Empowerment Evaluation
Latrice Pichon, PhD, MPH, CHES
Associate Professor
The University of Memphis School of Public Health, United States
Reighan E. Diehl, MPH
Research Coordinator
The University of Memphis School of Public Health, United States
Andrea Stubbs, MPA
Doctoral Student
The University of Memphis School of Public Health, United States
Headliners Memphis, BA
Co-Chairs
Grassroots Organization, United States
Meredith Brantley, PhD
HIV Director
formerly TDH, United States
Michelle Teti, DrPH, MPH
Professor
Department of Public Health, University of Missouri, United States
Location: White River Ballroom C
Abstract Information: Memphis, TN is a high HIV burden city located in the U.S. South rooted in religious culture and conservative viewpoints. Such polarizing components shape HIV racial disparities and exacerbate HIV-related stigma towards people living with HIV (PLWH) and LGBTQ+ communities, necessitating anti-stigma interventions. A community-academic research partnership sought to explore and respond to HIV stigma among PLWH. Using existing behavioral surveillance data gathered from interviewer-administered questionnaires and photovoice (PV) images, researchers helped participants capture what stigma meant to them. Photovoice, a participatory action research method in which participants identify, document, discuss, and share their experiences then generate solutions, allowed participants to capture and discuss their images and the corresponding meanings in small groups and one-on-one, in-depth interviews. Reoccurring images indicative of stigma experienced by PLWH included churches, medication, and cleaning supplies. Emergent themes revealed the church to be both a facilitator of stigma and supportive environment, highlighting the need to create HIV health education for faith spaces. In response, an additional thematic analysis of images and discussions was conducted, and triangulated with local behavioral surveillance data assessing HIV stigma, HIV risk, and access to HIV prevention among vulnerable populations. These results are being used to create a health education intervention for predominantly Black churches in Memphis using Intervention Mapping (IM). This approach begins with a planning team of faith- and community-based experts who are involved across all six IM steps. Participatory processes like PV and IM are necessary to incorporate in study design and intervention implementation to equitably address stigmatizing culture and context across Southern Black communities disproportionately affected by HIV and LGBTQ+ stigma.
Relevance Statement: The significance of this work to the field of evaluation takes a multipronged approach. First, we are triangulating data from multiple sources (focus group discussion, interviews, questionnaires) to develop and inform an intervention for religious congregations. Anecdotally, as evaluators, we frequently get questions from our community stakeholders wanting to know what local data exists. This is an opportune time to present local HIV data and incorporate community-driven experiences to characterize the current problem.
Second, intervention development traditionally occurs unidirectionally, and in this case, we are working with an established community advisory board to bi-directionally translate findings from our local community to create a home-grown program by the community and for the community.
Thirdly, evaluators across all levels of experience may appreciate the use of multiple sources and approaches to design a culturally-congruent faith-based intervention. Our project aims to present factual health information that is sensitive to and mindful of faith settings, while maintaining evidence-based strategies.
Finally, our approach adds to the growing field of culturally responsive equitable evaluation (CREE) by using a form of storytelling from personal accounts of PLWH through photovoice to share intimate details of trauma as well as triumph. We believe the use of photovoice can be a method of inquiry in program evaluation and our work with this project thus far serves as a reminder of its importance when both creating and evaluating programs. With PV, we were reminded of the unique but integral ways we must structure and undertake evaluation and data analysis to highlight community needs and assets. Photovoice assists with providing accurate and useful evaluations that are of value to the community they impact and researchers, alike, by combining traditional research methods with community input.
Application of CBPR and CREE, are foundational to the 6 non-linear steps of intervention mapping, an iterative process beginning with an established planning group. Step 1 allows us to present behavioral surveillance data to our partnership describing current testing behaviors and social determinants of HIV risk to assess community needs and assets. Step 2 we prepare matrices of change objectives. In step 3, the planning team identifies theoretical objectives to increase knowledge of the importance of HIV testing and awareness of HIV prevention. Step 4 centers around production of faith-inspired program materials such as the PV exhibit. Step 5 includes plans for implementation of the church-based intervention led and ultimately sustained by faith champions from local congregations. Step 6 involves planning for a culturally responsive evaluation to measuring the effect of the health education program. This project highlights the importance of IM throughout evaluative practice and emphasizes how, in theory and practice, this approach can create a positive advancement of social education and address gaps that are not apparent without the input of the community itself.
We continue to utilize interpersonal relationships, research-backed methodologies, intensive project planning, and social context to respond to Memphis-centralized health needs. We aim to provide inclusive, intentional, and pragmatic forms of evaluation to improve quality of life for PLWH and faith-based organizations alike.