Community-Based Participatory Research

Community-Based Participatory Research Isabel C. Scarinci, Ph.D., M.P.H. University of Alabama at B’ham Division of Preventive Medicine

Road Map • Definition of Community-Based Participatory Research (CBPR) • History • Core values • Parallel with traditional research • Principles • How to begin ??? • Advantages and challenges

Introduction • While great progress has been made on the research on health promotion and disease prevention, we have failed in the translation of this research to practice. Some of the reasons: • Academic institutions and communities may use different “tools” to address health promotion and disease prevention • Communities are often not consulted on the design and conduct of research projects • Communities may not have access to research findings or they disregard the research findings as “not applicable” to them • If partnerships are established between academic institutions and communities they are based on the biomedical model rather than participatory research

Definition • Community-Based Participatory Research(CBPR) -“ a partnership approach to research that equitably involves, for example, community members, organizational representatives, and researchers in all aspects of the research process” (Israel et al., 2003)

That is … • Everyone works together toward an established common goal with everyone bringing different “instruments” and talents…

But, first we need to know the history … • 1940s – Action research (Kurt Lewin) as well as other European social scientists • Behavior occurs within a historical/social context • Behavior is determined by the totality of an individual’s situation • Individuals interact in inter-connected groups as actors as well as authors of their own reality • A fundamental premise of community-based action research is that it commences with an interest in the problems of a group, a community, or an organization. Its purpose is to assist people in extending their understanding of their situation and thus resolving problems that confront them…. (Stringer, 1999)

History • 1970 – Empowerment Model (Paulo Freire) • Before community members address particular social change goals introduced from the outside, they must first be organized and empowered to address their own concerns and goals

History – Empowerment Model • It begins with a true dialogue in which everyone participates equally to identify common problems and solutions • Once the individual strengths and the shared responsibilities are identified, the group can work together toward a common goal – participatory process “Washing one’s hands from a conflict between the powerful and the powerless means to side with the powerful, not be neutral” (Paulo Freire)

Core Values • Participation, influence, and control of non-academics in the process of generating knowledge and change • Sharing in decision making • “Mutual ownership” of the processes and products of research • Co-learning by researchers and community collaborators and “mutual transfer” of expertise and insights

Traditional Research and CBPR- Parallels Traditional Research • Community is a passive subject of study • Research Design – done a priory by academic institution • Needs assessment, data collection, implementation, and evaluation – academic institution’s responsibility • Usually sustainability plan is not included CBPR • Involves the community being studied in the research • Research Design –done with representatives from community & academic institution • Needs assessment, data collection, implementation, & evaluation – everyone’s responsibility • Sustainability is priority that begins at program’s inception

Principles CBPR … • Recognize the community has it own identity • Builds on strengths & resources within the community • Facilitates collaborative, equitable coalition in all phases of the program • Promotes co-learning capacity building among all partners • Integrates and achieves a balance between research and action for the mutual benefits of all partners • Emphasizes local relevance of public health problems and ecological perspectives that recognize and attend to the multiple determinants of health and disease • Involves systems development through a cyclical and iterative process • Disseminates findings and knowledge gained to all partners and all partners will be involved in the dissemination process • Involves a long-term process and commitment (Israel et al., 2003)

Other Important Points • Recognize and highlight community assets and strengths (for example, view community members as advisers and experts) • Provide real service to communities by addressing the community's needs • Build and maintain respecting, trusting relationships within/across the community. In particular, develop relationships with opinion leaders in the community • Sustain relationships beyond the research study itself • Include communities in planning the study • Welcome new participants into the discussion • Acknowledge and make use of existing community structures (for example, powerful CBOs and grass-roots groups) (AHRQ, 2003)

How do you begin? • Select the community • “unit of identity” • Select your initial partners – individuals, representatives of organizations or both • True dialogue with partners (and others that should be at the table) before the proposal is written and throughout the process • Identification of WHAT, HOW, WHO, WHEN • WHAT – research question • HOW – research design • WHO – who is responsible for what? • WHEN - timeline • Sustainability plans from the beginning

Issues to keep in mind • Willingness to truly “listen” – which applies to everyone (academics, community, etc) • Willingness to share power – financial issues • Trust is earned and it takes time • Slow process • Clash between community needs and funding restrictions (e.g., disease-focused; time limitations) • Patience

Advantages • ↑ Participation (recruitment and retention) • ↓ Loss to follow-up - loss of participants during the process • ↑ External validity – practical and easy to apply to other places and realities • ↑ Individual and community capacity • ↑ Sustainability

Challenges • Threats to internal validity – it is difficult to account for all the factors that can play a role in the targeted behaviors • Difficulties with randomization • Highly motivated intervention groups • Expectations vs. results – interpretation? • Interpersonal conflicts and individual “agendas” • Scientific publications

Community-Based Participatory Research