DrPH Dissertation: Nancy Andrade

Dissertation title: Building Resilience to the Health Impacts of Climate Change: Examining How Community-Based Organizations Use Evidence to Select Practices for Implementation

Dissertation Chair: Dr. Harry J. Heiman

Dissertation Abstract:

Background: Community-based organizations (CBOs) play a critical role in building resilience to the health impacts of climate change in a time of reduced federal support and growing climate threats. Though limited, evidence on how to adapt to negative health impacts of climate change and promote resilience is growing. However, little is known about how CBOs perceive and use this evidence. This study examined how CBOs that build community resilience to the health effects of climate change define, perceive, and use evidence to select activities. Additionally, the study applied the Exploration, Preparation, and Sustainment implementation science framework to assess facilitators and barriers to using evidence.

Methods: This phenomenological qualitative study used in-depth, semi-structured interviews with 14 community-based organization representatives. NVivo software was used to perform inductive and deductive thematic analysis of interview transcripts. An independent secondary coder coded a subset of transcripts.

Results: Using evidence to select strategies is important to CBOs. They use a range of evidence sources, including datasets and reports from governmental agencies as well as community expertise and examples. Notably, evidence was predominantly defined as community-lived experience and information about health threats, rather than solutions. Staff and volunteers gather evidence through interactions and systematic data collection and apply it through knowledge translation and by informing and affirming future activities. External experts help CBOs gather and apply evidence. Barriers and facilitators to using evidence including external social, political, and inter-organizational factors; funding; and CBO characteristics. Activity qualities that led them to be selected included whether activities were perceived as being workable and community-focused or too onerous.

Conclusions: CBOs value and use various types of evidence, especially the lived experience of community members, to select activities they carry out to build community climate and health resilience. They employ several processes to use evidence and experience numerous barriers and facilitators to using evidence. Findings suggest that researchers should conduct more climate and health adaptation-focused implementation, translation, and dissemination science studies, practitioners should further support the use of evidence, to include community lived experience, in programs, and policymakers should make funding decisions based on the best scientific and community-informed evidence available.