David Nelson1 and Leslie Ruffalo1
There is an extraordinary burden placed upon the healthcare system and people as a
result of health disparities that exist within the United States. If there is going to be
a concerted effort to develop innovative strategies to reduce health disparities, input
from the community and behavioral scientists can and should be included in this
approach and narrative. Grant writing provides one vehicle to express the narrative
and to provide a means to fund research and programs within clinic-based and com-
munity settings. This paper describes a four-step inquiry process to guide healthcare
professionals with varying degrees of clinical and scholarship interests through the grant
writing process. They include: (1) Why write grants (motivations), (2) what is the area
of focus? (Interests), (3) whom should be on the project? (partnerships), and (4) what
needs to happen next to move the idea forward? (actions) The complexity of psycho-
social issues means that behavioral science is well suited to develop both hypotheses-
driven and phenomenological research to understand bio-psycho-social health issues.
Grant writing does not need to be mysterious or daunting. It can provide a means to an
end, not only to fund research but also as a means to an end of health disparities.
grant writing, research, community
1Medical College of Wisconsin, Milwaukee, WI, USA
David Nelson, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA.
The International Journal of
Psychiatry in Medicine
2017, Vol. 52(3) 236–244
! The Author(s) 2017 Reprints and permissions:
There is an extraordinary burden placed upon the healthcare system and people as a result of health disparities that exist within the United States. The economic burden alone for health inequities is estimated to be in the trillions of dollars and eliminating health inequities would save more than one trillion dollars.1 There are thoughts that it is a “moral imperative” to address health disparities by multiple organizations from individuals, to private philanthropies, to community-based organizations, and government.2,3 Despite the commitment to eliminate health disparities, the failure to do so places a considerable cost on society and future progress will require efforts from a variety of disciplines.4
More needs to be done to eliminate health disparities and there is a place for behavioral scientists in these efforts. The purpose of this paper is to describe a four-step process in which behavioral scientists can be involved in the writing of grants to fund clinic-based and community-based research and service projects.
The concept of “giving science away” is not a new one to the field of behav- ioral science as the scientist and the citizen are both observers and interpreters of human behavior.5 If there is going to be a concerted effort to develop inno- vative and different strategies to eliminate health disparities, community can and should be included in this approach and narrative.6–8 Behavioral scientists within primary care not only possess a keen understanding of psychosocial issues related to patients but also how these issues connect to the community. Such an understanding not only provides a tangible benefit to their patients but also provides the basis for research questions that can potentially be supported by grants. As others have previously noted, there are many barriers to engaging in the writing process and yet many health professionals find a way to leverage barriers in order to write successful grant proposals.9 And, despite the con- straints of multiple factors, placing greater emphasis on grantsmanship and research may yield breakthroughs to reduce health disparities especially relevant to family medicine.
Grant writing has been described as a writing style that is not the same as writing for peer-reviewed audiences.10 Grant writing opposes traditional academic writing’s method of looking back at what happened as result of a program, inter- vention or clinical practice. It looks ahead as to what might happen in the future and proposes innovative strategies to facilitate the unveiling of new knowledge.10
Despite the existence of numerous guidelines that provide a formula for writing grants,11,12 many health professionals struggle with the grant writing process at all levels. Even greater difficulties face those individuals who write grants on com- munity issues without the benefit of working with community partners.13,14
This paper is designed for both experienced and novice individuals interested in writing grants. Special attention is provided to those interested not only in devel- oping grants applicable to behavior science and clinical practice but also those relevant to the community.
Nelson and Ruffalo 237
To develop the framework and context for this article, the authors relied from a combined 27 years of grant experience and numerous presentations on grantsman- ship including two previous sessions at the Forum for Behavioral Health in Family Medicine Conference. Although we have received federal grants and understand the importance of this funding mechanism, the emphasis for this article is much broader. For example, we both frequently use community-engaged research meth- odologies and partner with community-based organizations in many of our fund- ing proposals from the local level to federal proposals.15 As such, prior to any writing or grant submission, we spend time reflectively considering and collabo- rating to determine bringing the right people to the right project at the right time. Another hallmark of our work is to consider revising and resubmitting unfunded projects. After all, in many instances, an unfunded research or project does not mean the idea was bad or unimportant. It may be that the research ideas need to be strengthened and resubmitted. This sentiment is especially true when the concepts are still important to the community or there is a strong need for the project. Given that overview, we will shift the discussion to introduce a four-step inquiry process designed to facilitate potential projects from idea formation, to grant writing, and to grant submission.
The four steps to the inquiry process include:
1. Why write grants (motivations)? 2. What is the area of focus? (interests) 3. Whom should be on the project? (partnerships)? 4. How to move forward? (actions)?
We first introduced this process during a session at the Forum for Behavioral Science in Family Medicine.16 We set the stage for attendees by providing a work- sheet with questions that each attendee completed both individually and in small groups. The questions focused on the four areas listed: motivations, interests, partnerships, and actions. After individual, small group discussion and group brief back, attendees completed a second worksheet (Figure 1) to identify the overlap in personal, clinic-based, and community interests to serve as the basis for moving from just thinking about writing a grant to the actual process. In the following paragraphs, we will introduce each step of the inquiry process and apply it to an example that is taken from our own work on a project that is currently funded on a two-year $250,000 grant that partners family medicine researchers, a public school district, and an after-school community learning center (CLC). The purpose of the project is to adopt system changes within both the school district and the CLC to provide additional support to students that do not meet physical education standards. The project uses a response to intervention framework to provide tiered support to all students based on need. We call this project the Physical Education—Response to Intervention project (PE RtI).17
238 The International Journal of Psychiatry in Medicine 52(3)
Why write grants? (motivation)
The “why” is arguably the most important question to ask oneself prior to engag- ing in the grant writing process. Answering this question, in some ways, sets the tone for the rest of the process. Motivation is critical to any successful grant writing endeavor. If the right people are not contributing with the right mind set, the work will be slow and tenuous or not go forward at all. Academics and community stakeholders engage in the grant writing process for a myriad of rea- sons. Many researchers are scientifically motivated to write grants to study com- plex issues, discover new knowledge, experiment/test novel approaches to solve problems, or establish ways of thinking long-term about specific phenomena. Other researchers may find motivation in pursing grant writing for reasons that are more personally derived, like topics they are passionate about or as a way to serve the community. And, at the end of the day, motivation to write grants may
Grant Ideas Personal Interests
Figure 1. Steps to identify interests and motivations to write grants among stakeholders.
Nelson and Ruffalo 239
be simply rooted in practicality. Some professionals wish to improve the effective- ness or efficiency of clinical services provided to specific patient groups. Grants create economy, provide resource sustainability (of both personnel and direct expenses), and are a means for academics to professionally develop. Most health professionals who pursue grant writing will not be able to isolate their motivation to a single factor but rather can attribute their motivation to an intermingled set of factors that ultimately propels them assemble a team and put “pen to paper.”
Figure 1 can be used to assist grant writers to begin the grantsmanship process. As a pre-grant writing exercise, one should complete the table by identifying interests and motivators among the three key stakeholders represented in the table. As an example, both of us have a research agenda related to healthy eating, active living strategies, and school-based wellness. Our motivation to write the PE RtI grant was partially grounded in our shared goal to produce research that adds to the body of knowledge on how schools can adopt efficacious systems to best assist students to be successful in physical education. But our sense of motivation did not end there. We have worked in partnership with the school district and CLC for over a decade and have witnessed first-hand undeniable reasons for why this project was worthy of a grant. In many respects, we felt personally compelled to write this grant to serve the school community by creating an educational environment that would best support an individual student with long term has population health impacts on the student body at large. Not only was it an important contextual reason, but one that was also grounded in the partnership that had developed over the past decade.
What is the area of focus? (interests)
The “what” to write a grant about always needs to be rooted in a gap or need that is unfilled or needs further investigation, and supported with evidence to validate the gap. The “what” also needs to be mutually agreed upon by all collaborators. Identifying the topic to write a grant about should start with an idea. Ask the team: “What topic is your team interested in studying or learning more about?” Once the topic is identified, a literature search is the next step. Research teams should conduct a literature review that examines what is known and unknown about the topic. The review should hone in on data to demonstrate the need for additional study in the area. A good needs assessment often uses a funneled approach that identifies data to support the need for the project at a national, state, and local level.
In our team’s project, the need for additional support at the school and com- munity was evident in local Youth Risk Behavior Survey data that showed 35% of high school student were overweight or obese compared to our state average of 25%. The collaborators were also able to cite additional data points to underscore that healthy behaviors were difficult for students to achieve and that an integrated, multi-pronged approach was needed to impact positive change for the commun- ity’s youth. When we think about health disparities, in this instance, a difference in
240 The International Journal of Psychiatry in Medicine 52(3)
BMI, we think about it not only at an individual level but also at the level of systems change that is needed to eventually decrease the disparity.
Whom should be on the project? (partnerships)
Grant writing and carrying out the work of a grant is rarely done in solitude. Indeed, there is an increased expectation among funders (and peer-reviewed jour- nals) to demonstrate multidisciplinary and interdisciplinary teamwork approaches to address health disparities research. The same phenomenon is seen in clinical and educational settings to emphasize interprofessional and team-based care. We know reducing health disparities requires expertise and contributions from individuals across multiple sectors. As such, it is important to critically think about identifying the right people to join the grant team. Understanding the “who” can be summa- rized into three statements:
• Those who recognize a NEED for an initiative • Those who desire to COLLABORATE with other entities • Those who are COMMITTED to the project to completion
If a potential collaborator satisfies each of these statements, they will likely serve the project in a productive and meaningful way. Figure 1 can also be helpful in the “who” process. Once you have identified the interests and motivators across mul- tiple stakeholders, the next step is to look for overlap in motivation. If the overlap exists, demonstrating mutual interest and motivation, the stakeholders should col- lectively purse the topic further.
Identifying our collaborators in our own research project was relatively straight- forward, owing to our decade-long history of working with our collaborators. As a partnership, we had a track record of making programmatic and system changes within the school district and community. We collaborated to successfully imple- ment activity-based curricula in grade K-8, created and led in the adoption of a BMI policy for the school district, and implemented a wellness policy for a net- work of neighborhood and community centers throughout our city. All of our partners have unwavering commitment to use the school and after-school environ- ment as a mechanism to promote health and wellness among the youth in our communities. The years spent together provide us with a venue where we not only support one another, but we are able to critique one another to improve the work. A key takeaway is that success can build upon success when you have the right collaborators at the table to engage in sustained work together.
How to move forward? (actions)
Crafting your grant writing text is heavily contingent on the type of grant you are applying for. In the health arena, there are three traditional types of grants that partnerships apply for: (1) health promotion programs, (2) health initiatives, and (3)
Nelson and Ruffalo 241
health research. The first step in the “how” to write a grant is to identify which of the three categories your idea fits with. Next, grant writing teams should move from idea formation to pushing their ideas into a goal statement with associated objectives. Ask questions like: at the end of the grant, what will you have accomplished? And, what will you do to accomplish your goal? When teams can articulate a goal state- ment with objectives, you are then ready to find a funder. We recommend consid- ering funding at all levels: small local grants, one-page grants at $5,000, regional foundations, all the way to national grants. No grant can study everything, but all grants, linked together build a professional portfolio that helps define a successful career in both peer-reviewed article and grant writing. It is also important to recog- nize that some grants have deadlines and some have a rolling submission process.
The “how” of writing grants can also follow a planned approach. Some indi- viduals new to grant writing will often ask the question: when is the right time to write a grant? Our response is: TODAY! There is lots of planning involved in the grant writing process. Your plan should consider the following activities:
• Formulate goal and objectives • Search for funding sources • Identify people that need to be involved • Vet the idea to stakeholders • Write the grant
These activities take time and can sometimes be overwhelming to make time for. A key tip in the grant writing process is to take things one purposeful step at a time. Two top “start-up” priorities that we recommend are to:
1. Identify your idea based on the needs of your community 2. Assemble a team that will be engaged with the project and support the project
throughout its duration.
In regard to our project, the “how” we wrote our grant can be summed up in one word: “collaboratively.” Each of our partners brings a unique perspective and exper- tise to the team. We rely on this expertise and hold each other accountable to provide content for a grant proposal. We will identify one person to take the lead on pulling all text together to cohesively articulate the project under one unified voice, but we believe that everyone’s voice should be represented in the grant appli- cation. Coming full circle on these four steps to inquiry process, this collaborative approach to writing grants is made possible because all members of our partnership find deep-rooted motivation to advance community wellness in our city and state.
Making progress on reducing health disparities requires a coordinated and inte- grated process to first understand and then apply research that can make an impact
242 The International Journal of Psychiatry in Medicine 52(3)
at the individual, community, and clinic-based levels. The complexity of psycho- social issues means that behavioral science is well suited to develop both hypotheses-driven and phenomenological research to understand bio-psycho- social health issues. In addition, the complexity of the issues also fosters develop- ment of multidisciplinary partnerships to both understand and develop efficacious interventions in behavioral science and family medicine. As part of the process toward development of interventions, grant writing does not need to be mysterious or out of reach for healthy professionals and community-based organizations. This statement is true for those either new to the process or those previously unsuccess- ful in grant writing. Grants come in many shapes and sizes. It starts with gener- ating ideas, assembling the right team, and identifying logical next steps to build local economy and careers in a manner that is both productive and enjoyable. Grants and grant writing provide a means to an end, not only to fund research but also to meaningfully address key aspects of the issue of health disparities.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, author-
ship, and/or publication of this article.
The author(s) received no financial support for the research, authorship, and/or publication
of this article.
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3. Jones CM. The moral problem of health disparities. Am J Publ Health 2010; 100: S47–S51. doi: 10.2105/AJPH.2009.171181.
4. Dankwa-Mullan I and Maddox YT. Embarking on a science vision for health dispar- ities research. Am J Publ Health 2015; 105: S369–S371. doi: 10.2105/AJPH.2015.302756.
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