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

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

3. 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

4. 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)

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

6. 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)

7. 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

8. 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)

9. 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

10. Traditional Research and CBPR- Parallels
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

11. 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)

12. 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)

13. 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

14. 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

15. 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

16. 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