Written by Meaghan Bailey, MPH, assistant director, Center for Community Health Partnership & Research
James Krings, MD
Assistant Professor of Medicine, Division of Pulmonary and Critical Care
Washington University School of Medicine in St. Louis
James Krings has focused his career on helping people with asthma receive better care. As a faculty in Pulmonary Critical Care Medicine with an interest in dissemination & implementation science, Krings sees that “we know what ought to be done, but that does not happen in real-world care.” St. Louis’ problems from asthma, he says, are clustered in lower socioeconomic neighborhoods, where patients do not receive optimal care. To address this, Krings has worked to develop trusted community partnerships. Together they are working to try to implement the latest asthma guidelines in more clinical encounters.
Over the last few years, Krings has worked to develop strong partnerships with community health centers, working through the St. Louis Integrated Health Network’s Network Community Academic Partnerships (NCAP) process. We recently spoke with Krings, also an Institute for Public Health faculty scholar, about his partnerships, projects, and lessons learned.
Tell us about your experiences with community engagement and community-engaged research.
Overall, Krings has had positive experiences when working with the community and believes that community engagement in research is important. Krings is working in a space with bad asthma outcomes; he tells us that partnering with the community means that he and his team have a greater opportunity to be of benefit to asthma patients.
However, he emphasizes that researchers “can’t come into [community-engaged research] in a hurry.” It takes time – researchers need to build trust and to understand the needs of the community. “Once you learn what the [community’s] needs are and you build that trust, your ability to contribute markedly increases,” Krings says.
Currently, Krings and his team are working with community partners to create and disseminate an implementation plan that includes education on asthma guidelines and a new asthma action plan. At first, the research team had their own ideas about what to include in the asthma action plan. After they asked community patients and providers for feedback, though, the action plan changed drastically. The final, collaborative version of the action plan is “dramatically better,” “more relevant to community,” and has “enhanced [the] possibility of having success on [our] primary outcome.” The research team recently presented the asthma action plan at an academic conference (where it received praise for its innovation) and plans to present it with community partners at another conference this fall.
Share about how you’ve developed partnerships with community health providers and leaders through the NCAP process.
The Network Community Academic Partnerships process is “…an opportunity for academic providers and researchers to discuss proposals and work with community health providers and leaders.”
After reaching out to the NCAP’s administrator, Krings scheduled a time to meet with the NCAP board during their regularly scheduled meetings. He was given an allotted time to present his proposal to work with St. Louis’s Federally Qualified Health Centers and community health leaders. The members of the NCAP board provided feedback and connection to community health organizations interested in working on the project together.
Members of the board, Krings says, may ask tough questions and push back: “Their priority, as it ought to be, is on being positive that proposals are in line with the goals of the community partners, and are realistic, and offer more benefit to the community than they are a burden.”
What are some tips for success for working through NCAP?
For researchers interested in connecting with community health centers through the NCAP process, Krings encourages researchers to think about their work through the lens of the community: “How will it be perceived?” “Is it a priority to the community?” “What are researchers asking partners to do?” For example, signing informed consents, pulling outcomes data, and other similar tasks take time and resources away from organizations that are already overburdened.
With that in mind, the presentation to NCAP “ought to be very focused on what the pros and cons for the community partners are. Be very mindful that…you’re not overburdening them with stuff that doesn’t have immediate benefit.”
What are some general suggestions for working with community partners?
Simply: trust the process. Working with community partners, Krings admits, takes a lot more time, but the end result is going to be a lot better. He expands that community engagement sometimes is just checking a box (because of time, resources, and other factors) but researchers won’t get the end result they’re after without genuinely engaging early. He says researchers should talk with people early, learning about their priorities and opinions about planned research.
Community-engaged research, he says, creates more opportunity to affect outcomes. “Sometimes you don’t realize the immediate benefit, so you have to trust the process.”
For more information about the Integrated Health Network’s NCAP process to connect researchers with community health organizations, visit their website.