The Centre for Community-Based Research (CCBR) partnered with the Family and Child Health Initiative (FCHI) to enhance community-based research capacity across their four CIHR-funded projects. These initiatives were integral to a comprehensive research program aimed at enhancing the health and welfare of children, youth, and families in Peel Region, Ontario. Leveraging CCBR's proficiency in community-based participatory research, FCHI utilized our expertise in addressing childhood and family health through a structural and social determinants of health perspective.

FCHI is an Institute for Better Health led initiative at Trillium Health Partners in Mississauga, Ontario, one of the largest, most diverse and growing communities in Ontario.

Projects include:

• Peer Support and Type 1 Diabetes: Incorporating Experiential Knowledge into Service Design with Adolescents and Their Caregivers 
• Evaluating the Peel Community Health Ambassador Program: Building trusting, equitable, and responsive healthcare during the COVID-19 pandemic
• Collective Action for COVID-19 Recovery: Co-designing physical activity interventions with adolescents and caregivers Peel Region
• A collaborative response to addressing family violence with racialized and diverse communities during pandemic recovery in Peel region

Each project, while unique in its design and area of focus integrates community-based research principles and practice by working directly with affected communities to design culturally-relevant health interventions in the Peel Region. A peer research model is integrated through all projects. Each study employs participatory visual methods (e.g., photovoice, digital storytelling) or other interactive methods to engage communities in issue identification and prioritization.

Finally, led by the Family Child and Health Initiative, each research team is expertly composed of stakeholders with vast and unique knowledge sets that combine to expertly address each issue under study. As research team members, CCBR contributed to these 4 projects as follows:

1) designing and co-facilitating capacity building training to community advisory board members, or other team members less familiar with a CBR approach;

2) coaching to FCHI on hiring, training, and best practices for supporting peer researchers across various projects, as well as participatory visual methods support where required;

3) co-design of evaluation frameworks;

4) support on toolkit development across 3 studies.

For a description of each project, see below:

Peer Support and Type 1 Diabetes: Incorporating Experiential Knowledge into Service Design with Adolescents and Their Caregivers

Type 1 diabetes (T1D) is a lifelong disease that impacts the everyday lives of adolescents with T1D and their families. Research shows that adolescents with T1D and their caregivers can benefit when learning from other adolescents and caregivers who share similar experiences.

In this collaborative 2-year project we and our partners worked with adolescents with T1D and their caregivers to understand how peer support is helpful for improving disease self-management. This 4-phase project used a participatory research approach by working in partnership with adolescents with T1D and their caregivers. Phase 1 established a Community Advisory Board made up of adolescents, caregivers, clinicians, community partners, and researchers to guide all stages of the project. Adolescents with T1D and caregivers will be recruited and formally trained as Peer Co-Researchers to help with all project activities. In Phase 2, adolescents and caregivers made digital stories to share their perspectives about peer support in T1D. In Phase 3, adolescents with T1D and their caregivers attended an event to view the digital stories, generate ideas, and prioritize what should be included in peer support interventions. In Phase 4, the adolescents and caregivers participated in a ‘Hackathon’ to co-design accessible, inclusive, and equitable peer support interventions and ideas for research studies to test the interventions. The phased evaluation findings of this project supported the development of a Toolkit, with comprehensive learnings, that will be shared with diabetes clinicians, researchers, people with lived experience, and community partners provincially, nationally, and internationally across various research, clinical, and lived experience networks. This project demonstrated that T1D services can be more meaningful, accessible, and inclusive if they are intentionally co-designed with service users and align with community needs and values.

Collective Action for COVID-19 Recovery: Co-designing physical activity interventions with adolescents and caregivers Peel Region

Peel region has been a hotspot during the COVID-19 pandemic, resulting in strict lockdowns for long periods of time. In response to the devastating impacts of the pandemic on families, 26 community organizations came together, as the Peel Family Support Network (PFSN), to provide collective resources and support. Our research team is currently leading a community needs assessment alongside the PFSN to understand the nature and impacts of COVID-19 restrictions on children, youth, and families in Peel and to identify resources and services required to support and sustain health and well-being during pandemic recovery. Based on responses from over 1,860 caregivers and youth, engaging in physical activity has been identified as a priority area for adolescents (aged 12-18) and caregivers of adolescents. To meet the needs of Peel’s diverse communities, this project engages a Community Advisory Board of adolescents, caregivers, service providers, and researchers to guide all project activities. Photo-based methods, a community prioritization activity, and a “hackathon-style” event, will be used to explore the physical activity experiences of adolescents and their caregivers throughout the pandemic and co-create physical activity interventions to move knowledge to action to promote and sustain physical activity during pandemic recovery. As many communities lack adequate resources for physical activity, COVID-19 recovery presents an opportunity for collective innovation, where adolescents and caregivers can co-create meaningful and accessible physical activity interventions with service providers. By conducting this work in partnership with the PFSN and community members, we expect these physical activity interventions can be adapted for use with other age groups, will be relevant to diverse communities across different geographical settings, and can be tested and evaluated in other regions of Ontario and Canada.

Evaluating the Peel Community Health Ambassador Program: Building trusting, equitable, and responsive healthcare during the COVID-19 pandemic

The Peel region of Ontario has experienced one of the highest positivity rates for COVID-19 across Canada. Individuals and families from Peel’s diverse communities have experienced negative impacts to their overall health and well-being including barriers to accessing care, psychological stress, trauma and poor mental health, lack of physical activity, and social isolation. Data collected throughout the pandemic show that certain communities have been disproportionately impacted by COVID-19 based on race, immigration, gender, housing, and employment. In response to the structural inequalities and barriers that have impacted COVID-19 testing and vaccination, the Community Health Ambassador (CHA) Program was developed and implemented in high priority communities in Peel through Ontario’s High Priority Communities Strategy. Starting in January 2021 and implemented through six community agencies, the purpose of the CHA Program was to provide culturally specific community outreach, education, and support during the COVID-19 pandemic. Through partnership between community agencies, healthcare workers, researchers, Community Health Ambassadors, and community members in Peel, this mixed methods evaluation of the CHA Program will fill a critical research gap and yield timely, high-quality, and relevant evidence about how communities can respond effectively to the ongoing pandemic and minimize the direct and indirect impacts on people who identify from racialized communities experiencing structural inequalities. These findings will be valuable for diverse communities experiencing disproportionate impacts of COVID-19 across Canada and globally.

A collaborative response to addressing family violence with racialized and diverse communities during pandemic recovery in Peel region.

The COVID-19 pandemic has greatly impacted the health and well-being of individuals, families, and communities around the world. Public health interventions such as social distancing and “lock-downs” have led to indirect and wider health consequences such as family violence. Improving access to survivor-centred services and community resources can help improve outcomes for people experiencing family violence, yet many survivors and their families face barriers to accessing holistic and culturally appropriate services. Previous research with racialized and diverse communities shows the need for multilevel approaches that consider individual, family, community, and systemic factors. The Peel region, Ontario, in which our project is based, has seen some of the highest rates of COVID-19 infections in Canada and is an ideal setting for understanding how racialized and diverse communities have experienced family violence throughout the pandemic. Building from the region's Community Safety and Well-being plan, we will engage a diverse group of community members who have experienced family violence, service providers, and researchers to guide all project activities. Through photo-narrative methods, a community prioritization activity, and a hackathon-style event, we will explore experiences of family violence and co-create preventative interventions during pandemic recovery that are evidence-informed and culturally sensitive to help racialized and diverse families at-risk of experiencing family violence in Peel. This project presents an opportunity for collective innovation to develop meaningful and accessible interventions that could prevent family violence during future health emergencies and pandemics. By centering community voices, we expect these family violence preventative interventions will be relevant to diverse communities across geographical settings and can be tested and evaluated in other regions of Ontario and Canada.