Research Feature

The Trolley Effect: getting to know the neighborhood

The Trolley Effect: getting to know the neighborhood

It is sometimes known as the "helicopter effect": researchers drop into a poor neighborhood to study some aspect of poverty and health and then pop back out, almost airlifted back to academia to pore over the data they've collected. In and out. It's a practice that doesn't engender trust or build the relationships that can help researchers better understand the lives and needs of the people in the neighborhood.

That's why a School of Medicine collaborative came up with a cultural competency tour. Call it the "Lolly the Trolley effect." Some 80 researchers climbed aboard two trolleys for tours of Cleveland neighborhoods with guides who live and work in those communities.

"We had a narrator," says Kari Colón-Zimmermann, a research assistant in the Department of Bioethics and the Center for Genetic Research Ethics and Law, who is studying underserved communities and their perspectives on health disparities and genetic research.

On the trolley and at stops in the Stockyard neighborhood on Cleveland's west side, people from the community explained what the researchers were seeing—where people live and go for food and medical care. And, perhaps most importantly, the researchers made contacts in neighborhoods where people can be skeptical of researchers who swoop in to study them. "It opened a lot of doors for us," Zimmermann says.

Since the tour and conference, Zimmermann's team has developed an ongoing rapport with Neighborhood Family Practice, a nonprofit community health center with an office on Ridge Road that has helped them access underserved minorities and individuals needed for research.

"The trust piece is huge," says Mary Ellen Lawless, RN, MA, a nurse and manager of community development and programming at Case Western Reserve's Center for Reducing Health Disparities. "A lot of people have this idea about research and they don't want to have any part of it."

But, she says, it's important for researchers to engage the community early in their studies in order to better understand the environment and the people and to make sure they're asking the right questions. Lawless organized the trolley tour, which was followed by a conference on cultural competency. One of the trolleys toured the Stockyard and Asiatown neighborhoods, while the other toured the Hough and Asiatown neighborhoods.

Chrisandra Allen, a blood pressure coach involved in a research project at the Center for Reducing Health Disparities, said the tour gave her a better understanding of people in the visited neighborhoods and changed how she interacts with patients who need to make lifestyle changes for their health.

"I let the patient coach me on how to help them change," she says. Ash Sehgal, MD, the Duncan Neuhauser Professor of Community Health Improvement, director of the Center for Reducing Health Disparities and nephrologist at MetroHealth Medical Center, says that while much is being done to help health care providers become more attuned to racial, ethnic and cultural differences among patients, "it's also important for clinical researchers to be culturally competent." He says he expects the cultural competency tour to become a regular event, noting they didn't have enough room for everyone who wanted to participate.