- This document proposes a community-based participatory research project in Cleveland's Central neighborhood to address barriers to healthy food access and cooking education. - The project will use CBPR principles to form a community advisory board who will lead all phases of the research and intervention design. Surveys, interviews, photovoice, and focus groups will assess food access and design an appropriate cooking education program. - The 18-month project will have two phases - developing partnerships and needs assessment in the first year, then implementing and evaluating the cooking education program in the second year. Community members will be hired and trained to lead data collection, analysis, and program implementation.

1. MPH 609 WEEK 8 ASSIGNMENT
We Can Cook!
A Community Based Participatory Research
Project Proposal for Cleveland’s Central
Neighborhood
Steven C. Banjoff
8/9/2015

2. Aim, Target Population, and Significance
It is widely accepted that Americans in general do not eat enough healthy, fresh, fruits,
and vegetables (United States Department of Agriculture, 2009). The tide does seem to be
turning, and public health efforts over the past decade may have contributed to a behavioral shift
in diet seen amongst U.S. consumers (Ng, Slining, & Popkin, 2014). Unfortunately, research also
indicates correlations between access to food retailers and quality of diet, and many studies show
limited food access associated with greater consumption of non-nutritious foods. Research also
reveals a relationship with quality of diet, chronic disease, and obesity (USDA, 2009). The
United States Department of Agriculture has identified farmers markets as excellent avenues to
increase healthy food access and help stimulate local economies (Cleveland-Cuyahoga County
Food Policy Coalition, 2011). This program seeks to examine barriers, consumption,
motivations, policies, and access of healthy foods in marginalized community of the Central
neighborhood in the city of Cleveland, Ohio, especially those currently receiving SNAP
subsidies.
The Central neighborhood is considered a food desert community using the USDA one
mile from a grocery store (USDA, 2009). Central is surrounded by farmers markets, most of
which participate in SNAP, and the double value produce perks program, making it an excellent
location to investigate the viability of improving healthy food access to this community. It is
hoped the use of Community Based Participatory Research will identify community strengths,
facilitate collaboration, provide intimate insights behind the drivers of dietary behavior, and help
design the most appropriate educational cooking experience that will provide the best chance for
success in all aspects of the program.

3. The Central neighborhood is 95% Black, with 79% of the children residing in poverty,
64% of households receive SNAP benefits, high unemployment, low educational attainment, and
a median household income of $9,418 (Cleveland City Planning, 2014). Community health
assessments that have been currently conducted in Cleveland show that chronic disease impact
the black community of Cleveland and Cuyahoga County far more significantly than the white
community (Health Improvement Partnership-Cuyahoga Initiative, 2013). These devastating
numbers have led to heavy grant investment and program investment over the past decade,
giving Central many assets and existing organizations that can be utilized in our We Can Cook!
research and intervention project.
Central, has a high volume of public housing throughout the neighborhood, and was one
of the first areas in the nation to have such housing constructed (Sisters of Charity Foundation of
Cleveland, 2014). In person interviews, revealed information is spread by word of mouth,
additional communication strategies and methods need exploration, and social media is used
sparingly within the Central neighborhood. Food and nutrition literacy is quite low, and many of
the residents practice a diet that is familiar, convenient, and of low cost. Shopping at the corner
store or other fast food options to fulfill their dietary needs is the dominate practice in the
neighborhood, making a high-energy, low nutritional value diet commonplace. Central lies in a
corridor with the highest obesity rates in the city, with 40.4% of the area residents considered
obese, and overall 42.4% of the black community of Cleveland is considered obese (Bruckman,
Jewett-Tennant, & Borawski, 2012). A community advisory board will be critical in providing
insight, recruitment, intervention formation, and selection of housing development(s) to target
our program.

4. According to the Center for Disease Control and Prevention, improved access to
healthier food retailers has been adopted as a promising strategy to improve dietary quality
(Grimm, Moore, & Scanlon, 2013). With non-traditional farmer market points of access
surrounding the Central neighborhood, it is crucial to uncover methods and motivations that
consider socioeconomic, cultural, transportation, and awareness factors related to their use that
exist within the community to improve consumption of healthy foods. Doing so may contribute
substantially to improving the health of the residents while providing avenues of empowerment
to a historically marginalized community. It is the aim of this project to give community
members the lead role throughout the process and increase the self-determination of the
community.
Methods
When asked to describe the health priorities of Central, Dawn Glasco a Cleveland Central
Promise Neighborhood Engagement Coordinator, stated, the top priority issues as “the lack of
money, education, and knowledge to live a decent quality of life.” This indicates it is crucial to
develop a program that can empower the community, improve economic conditions, and build
on marketable skills as well as the benefits in terms of chronic disease and obesity prevention.
Community Based Participatory Research principles acknowledge the community’s identity,
builds on strengths, facilitates collaboration equitably, uses an ecological perspective, while
reporting results to all parties involved, and achieve sustainability (Israel, Eng, Schulz, & Parker,
2013).
The use of these CBPR principles provides the best method to ensure the program
addresses these priorities in a manner that is sensitive to the community’s wants and needs,

5. empowers the community to take control of their situation with solutions and methods they help
create. Provides research and learning opportunities that improve marketable skills, builds
partnerships, provides ownership, empowerment, and ensures existing assets within the
community are utilized, identified, and hopefully improved upon. Trust will be fostered
throughout the process from recruitment process which will entail individual and small group
work, establishing mechanisms to ensure follow through of commitments and confidentiality,
mechanisms to ensure continual engagement and on-going relationship building, shared
leadership guidelines, and ensuring there is a balance of power and influence (Israel, Eng,
Schulz, & Parker, 2013).
CBPR goes beyond the traditional research and intervention project, by striving to be a
social change process, with goals of learning and knowledge relevant to the task, building
relationships and solidarity, and engaging in action that wins victories and builds self-sufficiency
(Stoecker, 2008). With these goals in mind, a central tenet of CBPR is to address community-
identified concerns, and a formation of a community advisory board (CAB) similar to the board
formed in the Transgender Community Health Project (TCHP) (Clements-Nolle & Bachrach,
2008). The community advisory board of the TCHP was integral in design and implementation
of quantitative protocols, designing the interview process, simplified data collection,
empowerment of the community, inspiring further research, new initiatives, and opening new
career opportunities (Clements-Nolle & Bachrach, 2008). The use of a CAB will also facilitate
easing of tensions, misconceptions, and distrust that may be a result of white privilege of
academic researchers (Chavez, B, Baker, Avila, & Wallerstein, 2008), historic miscarriages of
justice during research, such as the Tuskegee experiment, and other notorious human research
projects. Building alliances across differences may increase the demand for justice, and provide

6. greater examination of systemic and personal barriers (Chavez, B, Baker, Avila, & Wallerstein,
2008), and failing to address racism in a community that is over 95% black would be a fatal
mistake.
The, We Can Cook! research and intervention project strives to be led by community
members during all phases. This necessitates training of investigative staff, and community
advisory board members, in team building skills, organization skills, data collection, and
analysis, which fosters leadership and empowers (Cheathem-Rojas & Shen, 2008). Incentives
will be offered for participation in the training sessions. The incentives will include a stipend of
pay, refreshments, and transportation, and will provide an opportunity to strengthen dialogue
concerning the research, how it pertains to the community, and builds marketable skills. Due to
the high level of activism, community projects, and established community engagement
organization may not need to be intensive or have a long duration, and may serve as a refresher
course.
Supplementing existing food behavior surveys that have been adapted and added to
fitting the community through a team effort of academic researchers and the CAB investigating
quantitative and qualitative data, will be photovoice. Photovoice was first developed by Wang,
Burris and colleagues in the Ford Foundation, and is an innovative method to use visual image as
an aid to critical think about the root causes related to historical and social patterns. It “builds on
commitment to social and intellectual change through community members’ critical production
and analysis of visual image (Wang & Pies, 2008). Photovoice will be used twice during the
project. The first use will be between academic researchers, investigators, and the CAB before
finalization of the written survey to be given. It will be used again with the program participants

7. before they answer the written survey, and begin the educational and skill-building portion of the
project.
Staffing and Implementation
Staffing for the project will begin streamlined, and will include; project manager whose
duties include smooth functioning between investigators, participants, partners, and community
advisory board members to ensure project remains on agenda and community focused. The
manager will also team with community ambassadors to handle delicate matters of performance,
attendance, etc… with community team members. The project manager will take the lead in
organizing, evaluation efforts, data analysis collaboration, and presenting results.
At least four graduate students to act as data collection support and training, initial draft
of additional grant proposals that may be relevant, moderate photovoice and focus group
discussions. Training in moderating skills may be necessary, as graduate students may have little
experience in moderating skills.
Four community investigators, this may change once interest and participation numbers
are revealed. Responsibilities will include data collection on research and program evaluation.
At least two community ambassadors, which will aid in the recruitment of the CAB and study
participants, help to develop a communication program, and aid in conflict resolution and
performance issues. There is also a need for six intervention assistants whose duties will include
aid in organizing cooking sessions, make necessary travel arrangements, distribute incentives,
and aid in logistics of educational experience of the program.
Necessary partnerships include but not limited to, Burton Bell Carr a community
development company, Friendly Inn Settlement House, Outhwaite Community Center, and

8. Sisters of Charity Foundation of Cleveland. These partners have needed resources, meeting
space, and deep community connections that are vital to the success of the program. Graduate
students will be compensated in accordance of University policy and will receive state minimum
wage currently at $8.10 an hour (National Conference of State Legislatures, 2015). To show
respect for their hard work, contribution, and dedication community members who fill the
investigator, ambassador, and intervention roles will be paid $15 an hour, with their subordinates
receiving $12.50 an hour. This higher hourly rate will not only help convey respect and gives
comparatively fair compensation, but will also help in the retention of staff, saving on training
costs as well as maintaining established relationships.
The project will be split in two phases, with an initial period of eighteen months per
phase. Phase 1 will start with small group discussions facilitated by Dawn Glasco, a Cleveland
Central Promise Neighborhood Engagement Coordinator, DeEtta Brown a Cleveland Central
Promise Neighborhood Ambassador, to determine who to recruit for CAB members and
community filled positions of the project. These group sessions can also aid in discovering of
hidden assets, institutions, and organizations that would be useful to approach for included
partnership. The development of these partnerships, filling of positions, and formation of the
CAB is given a year timetable to be accomplished, though provisions are in place in case this
happens faster or slower than expected.
After all positions have been established, all team members will participate in a
photovoice session. This will provide an opportunity to strengthen relationships, reveal differing
points of view, aid in the discussion and confrontation issues of race and privilege that may be
felt among team members. It fosters critical thinking and social examination (Wang & Pies,
2008), and offers an opportunity for two-way learning between the community and academia.

9. First on the agenda after this team building experience is completed is deciding whom we are
going to specifically target within the community. Stakeholder interviews have revealed child
mortality rates, teen pregnancy, and child abuse issues are some of the most prominent in the
neighborhood. Central also has the youngest demographic in Cleveland with 0-20 year olds far
above the city average (Statistics Atlas, 2015) so it may be determined to target a young age
group or partner with an existing program.
Once the determination of target audience is completed, the work on devising a relevant
survey that assesses healthy food access and consumption barriers and motivations begins. It
will first be determined if adaptation of previously, evidence based surveys, or a completely
designed by scratch survey using accepted appropriate theory will be used. Discussions will be
had on the added time, and difficulties in publishing, comparative use a “from scratch” survey
may entail. Work will also begin on tailoring the educational and cooking experience to the
target audience. Much like the survey, the program will be adapted from other successful
community cooking CBPR projects such as Cook It Up!, a community cooking program for at
risk youth (Thomas & Irwin, 2011), Jamie’s Ministry of Food Australia, a community based
cooking skills program primarily aimed at improving skills and confidence (Herbert, et al.,
2014). Discussions will also be held on optimal duration of the program, with original designs
seeing it lasting eighteen months happening once a month with two educational experiences
within that month. This may be too long of a commitment, and it may be determined that
shortening to six months with more frequent cooking sessions may be deemed most appropriate.
The use of focus groups and opinions of the CAB, along with weekly or bi-weekly meetings
between team members to discuss these elements will be the driving force of the final program

10. design, all relevant issues will be hammered out during this period, including appropriate
incentives that will be needed for success.
Phase 2 will commence by first obtaining informed consent of all participants, literacy
and language concerns will be accommodated. A general overview of the program will be
presented, and obligations, incentives, and research relevance will be explained. Photovoice will
be used prior to the survey being given to allow for a more critical thought approach to the initial
survey, as well as revealing qualitative information not appropriate for a written survey. The
participants will then embark on a predetermined educational and cooking experience. The
initial survey will also be given upon completion of the program. Because surveys can become
tiresome, in person interviews will be conducted on a regular basis throughout the duration of the
program. These interviews will not only be designed to gather data on food access and
consumption to track progress, but also as a program evaluation tool. This will allow us to tweak
the intervention as the process unfolds and unforeseen problems reveal themselves.
Analysis and Evaluation
Involving the community in the analysis portion of the program will be of high
importance. As the Minkler text shows community involvement lends expert knowledge
concerning the community not possessed by the researcher, add nuance to drawing conclusions,
help to adjust methods in the most efficient way, and provides greater quality of data (Minkler &
Wallerstein, 2008). It also enables the data to be interpreted from a lens of a very different life
experience angle and richness and a sense of social justice perspective that would be absent
without their inclusion. The statistics will be generated by the appropriate entity, but the
codification of the elements, data questions, and format were all provided by community

11. members so their exclusion from analysis and interpretation would be unethical. It will also be
important to give credit to all team members, and discussions will be held to determine primary
authors, while also crediting those who contributed to the project.
Guidelines for mechanisms that are agreed upon by the partnership must be developed,
and a good starting point would be examining and adapting appendix M of the Israel textbook to
ensure the research and collaborative process remains on task (Israel, Eng, Schulz, & Parker,
2013). It will also be important to provide investigators, ambassadors, and other relevant team
members the materials and training to take relevant and uniform field notes. Evaluation methods
that seek to understand the environmental, structural, and group dynamics of the partnership
need development that also examine interventions, intermediate success, and overall partnership
effectiveness (Israel, Eng, Schulz, & Parker, 2013). Data analysis and interpretation will begin
with scheduled meetings with all team members, then results will be presented to the community
in a town hall fashion with the audience able to question team members about the project and
what the data means, and where do we go from here discussion. This will all take place before
the final results and report are submitted for publication.
Continued Engagement
It is the hoped the community-centered nature of this program will give it sustainability,
and inspire a continuation of the intervention program even after the research is concluded. The
community may decide to make this a longitudinal study, and we should be prepared to assist
them in this endeavor. We may not be directly financing this endeavor (i.e. pay for
investigators), but we will aid in grant writing, data analysis, and publishing. It will also be

12. documented and reminded that the community is a trusted partner of the University, and a culture
of openness and friendship will be fostered amongst the staff and students.
The project uses elements that inspire thinking on a social and institutional level, which
could inspire partnerships with lead organizers of the Black Lives Matter movement sweeping
across Cleveland and the nation due to the rash of recent police shootings. This collaboration
can lift food access issues in a prominent social justice light changing the dominate view in the
neighborhood of “that’s just the way things are”, and provide motivation to change behavior
born from barriers, environment, habit, and convenience.
On a smaller scale, the cooking sessions can provide an avenue for recipe exchanges,
cookbook creations, organization of block parties, or awaken a new interest. The skills learned
from participation can lead to further educational attainment, greater community activism, and
feelings of greater self-determination, and inspire policy change. The success or failure of the
program can lead to the creation of more effective programs, and increase community capacity
and greater asset recognition. Because CBPR is such a dynamic and “hands on” process, the
possibilities are truly endless once the passion and empowerment have been experienced. That is
why it is paramount the University remains a trusted source of assistance, even if that role is
trusted advisor, to help ensure the flames of change are not extinguished even after our role in
the project is complete.
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