Our Communications Manager, Katie M. Kanagawa, interviewed core faculty member, Lisa Goldman Rosas about her exciting and important work in community engagement. This interview was originally conducted in February 2020 and updated, with new content, in October 2021.
Can you please start by telling us a bit about yourself?
I’m actually from Palo Alto. I was born at Stanford Hospital, and now I find myself back here. My first stint out of college was working with a migrant farmworker health program and I migrated with the migrant stream on the East Coast from North Carolina down to Florida and then back to North Carolina, as the migrant farmworker migration happened. So I got the opportunity to work in a lot of community health centers, providing technical assistance to serving migrant farmworkers, and I was out in the field a lot, doing health education and case management and things like that.
It was a really good experience, and I would say a lot of that shapes how I address my research. I can remember, back then, researchers coming to our clinic and wanting to do focus groups and recruit farmworkers, and I was really kind of irritated with them about how they did it, and if they really had the community’s interest in mind. So I always kind of think about that, now that I am on the other side.
How did you first become involved in outreach? Is there anything you want to add to that story?
My official role when I started in migrant health was as an outreach worker. I’ve evolved over time, and we’ve moved beyond the term “outreach” and we now use the term “engagement.” So I think outreach can be one of the necessary steps of getting people engaged, but now we recognize that just letting people know what we’re doing is not enough; we really want to share leadership with community in the research projects that we’re conducting.
What excites you about community engagement and working with local communities?
I’ve come to view it as one of many tools that our community partners use. Research is starting to be recognized by them as a really strong tool to affect change. There are some groups who are more reluctant. For example, lots of our American Indian and African American partners have been adversely affected by research in the past. With all of the groups, I am really excited to provide the opportunity to get engaged in research, demystify science, and increase science literacy.
How would you characterize the ideal relationship between community engagement and research?
There is no one or right way to do community engagement. I think there can be a perception that unless you’re doing community-based participatory research, you might as well not try. However, there are lots of ways to incorporate engagement without adopting a shared leadership model like in community-based participatory research. So I tell researchers that there’s a community engagement strategy that’s right for you; we just have to find what it is and how it can match your research!
In my own research, I get to do it exactly how I want it. The ideal way for me is when I’m engaged in the community, and a community partner recognizes “I would really like to pursue research in this way.” They initiate the relationship and the partnership, and I find that that just sets us off on the right path. Maybe it’s about the power balance that sets the tone for the research project, but I find that it makes the work more sustainable, impactful, and rewarding for me.
Please describe your work as Director of Stanford Medicine’s Office of Community Engagement (OCE). What do you think is most important for people to know about the work that’s being done there?
Our Office of Community Engagement is here to serve our faculty, staff, and trainees, as well as our community partners, to bridge the gap between research and practice, and between academia and community. We provide a technical assistance service to help researchers and community partners form community-engaged research projects and even carry them out. It is best if we are included at the outset of a research project – while writing the grant or designing the study – so we can design engagement approaches to ensure success. In addition, we pursue our own research around community engagement, so we advance understanding of effective strategies for diverse research projects.
Can you tell us a bit about your work as Associate Director of the Stanford Cancer Institute's Center for Cancer Health Equity and Community Engagement, and the nature of the community-engaged research projects being done in that program?
I am honored to partner with director Alyce Adams and Dr. Lidia Schapira from the Division of Oncology to conduct several community-engaged research projects. One is the African American Peer Navigator Project, and the goal was to get a better understanding of why African Americans don’t enroll in clinical trials, and to do engagement to raise awareness around breast cancer and breast cancer clinical trials among African Americans. That group has evolved; they got a second seed grant, and now they are looking for ways to improve physical fitness for African American cancer survivors, and we’re submitting a new grant to look at peer navigation during the diagnosis phase for breast cancer. This project is a small step towards demonstrating the ability to conduct engagement in cancer research.
The group has formalized their organization and is now called Black Ladies Advocating for Cancer Care (BLACC). Our partnership received a third round of funding from the California Breast Cancer Research Program to develop a peer navigation program for African American Breast Cancer patients. We trained the women of BLACC in qualitative methods and they conducted over 20 storytelling sessions to better understand African American women's breast cancer journey. Together, we will apply the findings from the storytelling to develop a peer navigation program.
I would love to hear about your role in the Our Voice Citizen Science Project, and your favorite thing about it.
I’ve had the honor and privilege to work on that since I came to Stanford a long time ago. I was an instructor then and we were just starting the Our Voice approach. The app wasn’t as professional as it is now [laughs], and we were using these really old, clunky tablets to take pictures and things. I got to do one of the first projects, in the North Fair Oaks neighborhood near Redwood City, a largely low-income latino immigrant group. We had just completed a clinical trial there around weight management for diabetics and pre-diabetics at a community health center.
Although the trial was somewhat successful, we could have done better. We were looking at various different barriers that patients were facing in implementing the diet and physical activity recommendations. So one of the things we did was to use the Our Voice approach to change the neighborhood environment to promote physical activity. We combined older adults and adolescents together, powerful agents of change. It was wildly successful. We had an amazing experience, and I was really hooked when I saw that the residents could collect the data and use it themselves to change their neighborhood - it was really a transformative process.
I also know you work on other community-based projects that you are running with communities in the Bay Area. Can you introduce us to one of these projects, and tell us about the kind of change you are hoping to inspire in the Bay Area?
I’ll talk about the Recipe 4 Health initiative in Alameda County, since it’s my newest project. The community partner found us, thankfully, and they are combining what is called a behavioral pharmacy with a food farmacy. The idea is that people are food insecure, and even when you provide access to healthy food, it can still be hard for people to incorporate those foods into their meals. It’s not because they lack education, but because they lack the support to. They’ve likely experienced, across generations, food insecurity that has shaped the way their families eat. It’s a logical response to being food insecure to pick calorie-dense foods. That’s what happens when you’re stressed, and it happens to people who are food insecure all the time.
So, in a community health center in Alameda County, we’re implementing the food farmacy, which gives community members healthy produce, and then the behavioral pharmacy, which is an evidence-based behavioral intervention that supports healthy diet, physical activity, self efficacy, and social support. When the community partner arrived and said, “We really want to study this while we’re implementing it,” we saw an opportunity, because they’re going to eventually roll this program out to several other community health centers. We’ll be able to get data for the food farmacy, the behavioral pharmacy, and the clinic, link them all together, and really understand the effectiveness and the potential for this approach. The Center for Medicaid Services in California is closely watching this because there’s a real opportunity to provide healthy food in clinics.
This work is now funded by Stanford Impact Labs [read more]. I also received two additional grants for work in this area. One from PCORI for the ADELANTE Trial that will test the effectiveness of a behavioral intervention combined with providing high-fiber foods like produce and whole grains for Latino primary care patients with diabetes [read more]. Another grant is an R01 from NIMHD for the Vida Sana y Completa Trial to test the effectiveness of a behavioral intervention with boxes of healthy foods for preventing diabetes among Latina women. Both projects build on strong partnerships with local Federally Qualified Health Centers.