Using community-based participatory research to develop a culturally sensitive smoking cessation intervention with public housing neighborhoods

Purpose: To describe surface and deep structure dimensions of a culturally sensitive smoking cessation intervention developed with southeastern US public housing neighborhoods. Procedures: Community-based participatory research (CBPR) methods were used to develop this culturally sensitive smoking cessation intervention by the following research partners: academicians, neighborhood residents, community health workers, and community advisory board. This CBPR involved a cyclical process with the following phases: assembling a research team; identifying smoking cessation as the health need of interest; developing the research method; establishing evaluation, feedback, and dissemination mechanisms; implementing the initial "Sister to Sister" community trial; analyzing and interpreting the data; disseminating the results; revising the intervention; and, establishing mechanisms to sustain outcomes. Culturally sensitive dimensions emerged during this process and were categorized as surface structure and deep structure. Findings: Surface structure dimensions included written materials, incentives and food, and protocol delivery strategies. Deep structure dimensions included kinships, collectivism, storytelling, and spiritual expressions. Community health workers and the advisory board contributed to the identification and integration of both surface and deep structure dimensions. The six-month continuous smoking abstinence outcomes from the initial community trial were 27.5% vs 5.77% for the intervention and comparison groups, respectively. Conclusions: Community-based participatory research (CBPR) methods facilitate processes in which culturally sensitive dimensions can be effectively identified and integrated into health promotion interventions for marginalized populations. The incorporation of surface structure dimensions increases acceptance and feasibility, while deep structure improves overall impact and efficacy of the intervention.