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CCTSI’s Community Engagement research improves mortality rates in five Denver neighborhoods

By Wendy S. Meyer, Kathryn Nearing and Christine Velez

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​It may not surprise anyone that clinical trials in patients can save lives (most people probably know someone enrolled in a cancer trial or other life-saving clinical research protocol). But did you know that the work conducted by researchers from CCTSI’s Community Engagement program can be just as effective at saving lives?

One example lies in the work of Comilla Sasson, MD, PhD, University of Colorado Anschutz Medical Campus and Ricardo Padilla, MD, Denver Health. In 2011, CCTSI awarded the researchers with a Community Engagement Joint Pilot grant. The focus of their project was to explore factors underlying higher rates of out-of-hospital cardiac arrest in five predominantly Latino neighborhoods in Denver: Villa Park, Valverde, Baker, West Colfax and Whittier. After receiving the pilot grant, the researchers went on to win additional awards to continue their work.
The results of the project, five years later, have been life-changing, and in many cases, life-saving—and have expanded beyond Denver neighborhoods to cities across the nation. Specifically, the community-based participatory research (CBPR) project explored factors contributing to the higher mortality rates documented in the census tracts in these five Denver neighborhoods, as well as culturally-responsive approaches to address the health disparity.
What Researchers Learned
Through focus groups and in-depth interviews, researchers learned about cultural beliefs and communities’ experiences surrounding cardiac episodes. They found that barriers existed to both calling 911 and performing Cardiopulmonary Resuscitation (CPR). Barriers to calling 911 ranged from distrust of law enforcement (which hindered individuals’ willingness to become involved), language barriers and immigration status (e.g., fear about being required to show documentation). Barriers to performing CPR included fear of legal ramifications (e.g., as a result of doing CPR incorrectly or the victim not recovering), concern about being perceived as having touched someone inappropriately (i.e., hesitancy about breathing into someone else’s mouth or touching a woman’s chest) and perceptions of risk to personal health (e.g., being too old to perform CPR effectively, being in an unsafe setting, etc.).

“This research has directly led to a community-based, targeted and tailored CPR educational program in these neighborhoods," said Dr. Sasson. “The CCTSI grant was integral in moving us beyond documenting disparities, to actually working within the neighborhoods to fix them.” 
How the Research Team Responded
In response to these findings, the research team partnered with the local chapter of the American Heart Association to increase access to information and provide training for “hands only” CPR—an approach that does not require mouth-to-mouth contact and for which community members expressed acceptance. The model was piloted in all five neighborhoods, addressed structural barriers, such as access to information made available in Spanish and empowered residents to act as health educators in their own communities. In addition, with this model, residents taught others how to address cardiac arrest in a community-based setting and in a culturally-responsive manner.
The local chapter of the American Heart Association created new avenues for funding and generated interest in this as a national model for effectively reaching diverse communities. Project partners were able to leverage the $30,000 pilot award to secure a total of $200,000 from the American Heart Association and Emergency Medicine Foundation. With this additional funding support, project partners conducted a Metro Denver community-based trial, ultimately training residents as trainers at home, distributing 344 CPR Anytime kits and training an additional 886 people. 
The CCTSI’s Partnership of Academicians and Communities for Translation (PACT) enabled the model to be translated for African American and Asian communities. The Salah Foundation funded additional outreach in Denver and rural public schools to deliver training and 2,000 more CPR hands-only kits. An interdisciplinary group of Anschutz students from Medicine, Pharmacy, Physical Therapy, Nursing and Dentistry continue to train community members using this method and have reached 1,000-2,000 people a year for the past three years.
In addition, the American Heart Association has brought the hands-only model to three additional U.S. cities: Chicago, IL, Columbus, OH and Tampa, FL. This work has been featured in three publications to date. You can learn more about the program at the American Heart Association​.
“When I think of the trajectory of this research—from pilot project that started in a few neighborhoods to a program that has been embraced and implemented nationally—I am deeply gratified. Stories like this one fuel my passion about the work we do,” said Donald Nease, MD, Community Engagement Director at the CCTSI.

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