Every March, people all over the world commemorate Women’s History Month and International Women’s Day by honoring women who strive to make a positive impact on the world around them.
At the Cancer Awareness, Research, Engagement, and Support (CARES) Center—which is facilitated by the UAB Minority Health & Health Equity Research Center and the O’Neal Comprehensive Cancer Center at the University of Alabama at Birmingham—an all-women leadership team is pioneering the effort to reduce the burden of cancer and cancer disparities in areas across Alabama.
Funded by the National Institutes of Health’s (NIH) Persistent Poverty Initiative, these seven women are leading one of only five funded programs under this initiative and one of the biggest grants for Heersink School of Medicine in 2023. In an effort to alleviate the effects of persistent poverty on cancer outcomes, these investigators share what makes the CARES Center special, as well as what it means to them and advice for how they stay inspired to lead.
Building a Dream Team
After learning about a new opportunity from NCI, Multiple Principal Investigators, Maria Pisu, Ph.D. and Mona Fouad, M.D., MPH, knew they had to seize the opportunity. “This is an important grant for UAB and Alabama in general because of its focus on persistent poverty.”
Areas characterized by Persistent poverty are those that for 30+ years have had 20 percent or more of their residents living at or below the poverty line. In the United States, this is equivalent to $30,000 household income for families with four members.
According to the United States Census Bureau, 9 percent of the country’s residents live in a persistent poverty area. In Jefferson County, Alabama, the U.S. Economic Development Administration estimates this number jumps to 18.3 percent—9.3 percent higher than the national average—making Drs. Pisu and Fouad even more determined to bring resources to the community.
Fouad explained, “Through the lessons we’ve learned at the MHERC, we know that the circumstances in which people are born, live, work, and age—also known as the social determinants of health—are critical and should be considered when conducting research. This grant allows us to focus on persistent poverty areas and work to reduce cancer risk and improve outcomes in these areas.”
Together, Pisu and Fouad identified experts who were conducting great work and implementing impactful projects in the community. After brainstorming with the researchers on how their projects could complement one another, they felt confident in applying. Pisu stated, “It was not intentional [having a team of all women]. We just looked at who was doing the best work and we put a team together.”
“It was not intentional [having a team of all women]. We just looked at who was doing the best work and we put a team together.”
MARIA PISU, ph.d.
“It wasn’t until we got funded that we looked around and realized that we are all women. But it’s a great thing and we are very proud of this group,” added Fouad.
Relational Leadership at all Levels
In addition to Multiple Principal Investigators (MPIs), Pisu and Fouad, the CARES Center is guided by Steering Committee members Marie Bakitas, DNSC, NP-C, FAAN, Career Enhancement Core Leader; Lori Bateman, Ph.D., PREEmPT MPI; Gabriela Oates, Ph.D., Research and Methods Core Co-Leader, PREEmPT MPI; Laura Rogers, M.D., MPH, LEAP MPI; and Lisa Zubkoff, Ph.D., Research and Methods Core Co-Leader, LEAP MPI.
Through the center’s Cancer Prevention through Enhanced Environment (PREEmPT) project, MPIs Bateman and Oates are exemplifying relational leadership skills by partnering with Live HealthSmart Alabama, a transformational movement to make good health simple. Relational leadership is a style of management that leverages people working together to achieve a goal or to make change happen. This model focuses on the ability of a leader to develop and maintain relationships within a team or organization. For the CARES Center, these are relationships among the leadership team, with fellow faculty members and staff, and with the community.
By examining the outcomes of Live HealthSmart Alabama in five Birmingham neighborhoods, she and Oates, are testing whether a comprehensive multilevel intervention which addresses the built and social environment of a community can reduce community cancer risk in persistent poverty areas.
Bateman, who has been the recipient of several grants addressing health disparities, explains her position in the group as an early-stage investigator, “As an MPI of the PREEMpT project, one of the two research projects of the Center, I ensure the project maintains scientific integrity. But beyond that, this is an unparalleled opportunity for me to work with such incredible women and learn from them. The group has a very relational view on leadership—everyone is there to support you professionally and personally.”
Bateman finished by saying, “It has helped me to watch senior investigators throughout this process, because they are role models. The respect they show me empowers me to be a stronger leader.”
Fouad shared an additional perspective on building leaders, “Our pilot projects and junior scholars training programs are great opportunities for us to grow and bring more junior faculty into the field. When you’re an early-career scientist, you really need a safe environment where it’s okay to not know something. With this team, you’re going to be developed, not criticized.”
“Someone would say, ‘You know, there is a person who is doing their research in xyz,’ so we would reach out to them and get them thinking about their work in a persistent poverty context,” added Pisu. “Then we invite them to apply for a pilot project.”
But it’s not just junior faculty who are learning from the leadership within the CARES Center. With the group’s dynamic, even senior investigators find themselves on an ever-learning journey. “My comfort zone is behind the computer, making sense of data. But this opportunity challenged me to step out of that space and get involved in a different way,” shared Pisu.
Cultivating a Psychologically Safe Environment
To cultivate an environment where people feel free to be themselves, take risks, ask questions, fail, and learn, psychological safety is paramount. Without this security, individuals may feel the need to limit their ideas or may not speak up.
Laura Rogers, M.D, MPH, another member of the leadership team and a general internist by training, serves as the MPI for the center’s Leading Healthy Eating and Activity Promotion (LEAP) project alongside Lisa Zubkoff, Ph.D. Being board certified in internal medicine, and in obesity medicine, Rogers is uniquely qualified to oversee the program’s implementation of efficacious diet and physical activity interventions in the center’s designated communities. To do this, Rogers strives to create a psychologically safe place where others feel their perspectives and ideas are being heard.
“I approach each project from a pragmatic standpoint, each with a different set of needs,” commented Rogers. “It’s important to remember everyone has bias, whether conscious or unconscious, and we don’t make assumptions. I try to make sure that people know I appreciate when they engage with the process and give ideas.”
One key to Rogers’ success is focusing on communication. Within her program team, she reflects on what it means to have a long view of communication. “I have to remember when we bring new people into the fold, it can take a minute to get everyone up to speed. But it’s critical for our success to have everyone involved and pulling in the same direction.”
Connecting with the Community
Investigators like Rogers, Bateman, Oates, and Zubkoff rely on the expert advice of the MHERC’s Community Engagement team, led by Tiffany Osborne. Osborne and her team have engaged the community on several grants throughout UAB, including Live HealthSmart Alabama.
“They [Tiffany and her team] have a lot of understanding when it comes to working with the community and establishing Community Advisory Boards or PIE [Planning, Implementing, and Evaluation] groups, so it’s been great to have her perspective,” remarked Rogers.
To ensure that the projects the CARES Center brings to the community have a rigorous design, application, and evaluation, is the task of Rogers’ LEAP co-leader, Zubkoff—an implementation scientist. Having established her own independent research in cancer-care delivery, Zubkoff has experience supporting oncology clinics with implementing early palliative care interventions.
“Equity and diversity, particularly as it relates to persistent poverty areas, are important aspects to consider,” explained Zubkoff. “Certain components and factors of the communities we are working in that may or may not influence the uptake of our interventions. Finding the most appropriate research methods, implementations, and strategies is where I fit in.”
At the heart of what the team is trying to accomplish is to implement interventions that change lives, an impossible task for those disconnected from their audience.
“With the CARES Center, we have a partnership with the community, and it changes the dynamic completely. We are learning from them as much as they are learning from us.”
Lisa Zubkoff, Ph.D.
“As scientists and researchers, we are not always aware of the realities of an environment. It’s not about us showing up and saying, ‘Here’s an intervention,” explained Zubkoff. “With the CARES Center, we have a partnership with the community, and it changes the dynamic completely. We are learning from them as much as they are learning from us.”
Demonstrating this collaboration is the iterative process the team takes with community residents. After the CARES Center team meets with neighborhood representatives, community engagement coordinators work with the researchers to ensure the needs and concerns that are expressed by the community are being addressed. Once feedback has been implemented, the CARES Center team takes its work back to the community to not only show them what changes have been made, but to say, ‘We’re here, we’re listening, and we heard you.’
Remembering Your ‘Why’
As with many in leadership positions, calendars are filled with meetings, deadlines quickly approach, and there are 183 unread emails in Outlook. One could easily start feeling overwhelmed. That’s why our leadership team encourages people to find ways to recharge. Here are some ways they stay inspired:
“If I’m not taking care of myself, I’m not able to perform as well. It’s about finding balance and celebrating your successes.” – Lisa Zubkoff
“Celebrate your victories and be grateful for your team members, staff, and the opportunities you have. If you have stories where somebody has been positively impacted by your work, hold on to those. They can make a big difference.” – Laura Rogers
“Having relationships within the team that are positive, uplifting, and motivating is really important. Together, you can focus on the big picture of what you’re doing because it’s easy to get lost in the weeds.” – Lori Bateman
“Talk to the people who your research is affecting. I love getting to do qualitative work because I hear stories from cancer survivors and it’s inspiring. I keep pushing my research forward to do something to improve their conditions.” – Maria Pisu
“Remember why you’re doing the work that you do. Everybody has their own reasons but remember yours and don’t lose sight of it.” – Mona Fouad
Additional members of the CARES Center Steering Committee include Gabriela Oates and Marie Bakitas who were unavailable for interview leading up to the time of publication. For more information on the center or its leadership, please visit our website.
