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 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