THE DETROIT COMMUNITY-ACADEMIC URBAN RESEARCH CENTER: PRINCIPLES, RATIONALE, CHALLENGES AND LESSONS LEARNED THROUGH A COMMUNITY- BASED PARTICIPATORY RESEARCH PARTNERSHIP Barbara A. Israel* Presented at the “Summer Public Health Research Institute and Videoconference on Minority Health” Chapel Hill, NC June 16, 2000 *With acknowledgment to my colleagues and co-authors in conducting community-based participatory research: A. Allen, E. Baker, A. Becker, R. Guzman, C. Heaney, J. House, M. Hugentobler, P. Lantz, R. Lichtenstein, B. Maciak, R. McGranaghan, E. Parker, A. Schulz, S. Schurman, D. Softley and the many other community partners with whom I have worked (some sections of this presentation adapted from selected references, listed at the end). The Center is supported through a Cooperative Agreement with the Centers for Disease Control and Prevention. Copyright  2000, Barbara Israel

MODIFYING VARIABLES: Individual or Situational Characteristics Social Psychological Behavioral Biophysical Genetic Psychosocial- Environmental Conditions (Stressors) Perceived Stress Short-Term Responses to Stress (Strain) 1. Physiological 2. Psychological 3. Behavioral Enduring Health Outcomes 1. Physiological 2. Psychological 3. Behavioral Conceptual Framework of the Stress Process Copyright  2000, Barbara Israel

Implications of the Stress Model for Prevention Interventions Context-specific interventions Comprehensive approach to prevention interventions Primary, secondary and tertiary prevention Different types of stressors Copyright  2000, Barbara Israel

Implications of the Stress Model for Prevention Interventions (continued) Objective conditions Multiple outcomes Collective action and broad scale change Participants’ involvement and control Inter-disciplinary teams Copyright  2000, Barbara Israel

DEFINITION OF COMMUNITY- BASED PARTICIPATORY RESEARCH Community-based participatory research in public health is a partnership approach to research that equitably involves, for example, community members, organizational representatives, and researchers in all aspects of the research process; with all partners contributing their expertise and sharing responsibility and ownership to enhance understanding of a given phenomenon, and to integrate the knowledge gained with action to improve the health and well-being of community members. Copyright  2000, Barbara Israel

Key Principles of Community- Based Participatory Research 1. Recognizes community as unit of identity 2. Builds on strengths and resources 3. Facilitates collaborative partnership 4. Integrates knowledge and intervention for mutual benefit of all partners 5. Promotes co-learning and empowering process Copyright  2000, Barbara Israel

Key Principles of Community- Based Participatory Research (continued) 6. Involves a cyclical, iterative process 7. Addresses health from positive and ecological perspectives 8. Disseminates findings and knowledge gained to all partners 9. Involves a long-term commitment by all partners Copyright  2000, Barbara Israel

Rationale/Advantages of CBPR Enhances relevance and use of data Joins partners with diverse expertise to address complex problems Improves quality and validity of research Knowledge gained is used to benefit the community Increases possibility of overcoming community’s distrust of research Copyright  2000, Barbara Israel

Rationale/Advantages of CBPR (continued) Has potential to “bridge cultural gaps” between partners Overcomes separation of individual from culture and context that often occurs with categorical approaches Provides resources for communities involved Aims to improve health and well-being of communities involved Copyright  2000, Barbara Israel

Detroit Community-Academic Urban Research Center (URC) Partner Organizations Butzel Family Center Community Health and Social Services (CHASS) Detroit Health Department Friends of Parkside Henry Ford Health System Kettering Butzel Health Initiative Latino Family Services University of Michigan School of Public Health Warren/Conner Development Coalition Copyright  2000, Barbara Israel

Overall Mission of the Detroit URC Establish an effective community-based participatory research partnership to jointly identify factors affecting the health and well-being of residents on the east and southwest sides of Detroit, and to implement and evaluate interventions and policies to address these factors in ways that recognize, build upon and enhance the resources and strengths in the communities involved. Copyright  2000, Barbara Israel

Processes Involved in Developing the Center and URC Board Grant proposal submission Meetings with partner organizations Developing the URC Board –establishment of operating norms –adoption of CBPR principles Copyright  2000, Barbara Israel

Processes Involved in Developing the Center and URC Board (continued) Process of setting priorities –identification of community strengths and problems –discussion of issues partner organizations address –selection of levels of affiliation and participation –further identification of problems and selection of priorities Establishing an infrastructure Copyright  2000, Barbara Israel

Evaluation Design and Methods Participatory case study design Process and impact evaluation Qualitative and quantitative methods Copyright  2000, Barbara Israel

Evaluation Results: Major Accomplishments Adopting and following operating procedures and CBPR principles Creating effective team and partnership Creating and maintaining trust Building new relationships –linking east and southwest sides –linking University and community-based organizations Copyright  2000, Barbara Israel

Evaluation Results: Major Accomplishments (continued) Developing proposals and acquiring funding –7 Level 1 CBPR projects –Over 8 million dollars received Implementing CBPR projects Beginning to focus and conduct dissemination regarding CBPR Copyright  2000, Barbara Israel

Evaluation Results: Challenges Significant time and effort required to build trust and working relationships among partners Articulating and agreeing upon a common purpose Seeking a balance between task and process/research and action Working together amidst ethnic, cultural, social class and organizational differences Copyright  2000, Barbara Israel

Evaluation Results: Challenges (continued) Following agreed-upon CBPR principles in practice Competing institutional demands and risks Working toward equitable or fair distribution of resources and benefits Proving partnership/intervention success Copyright  2000, Barbara Israel

Evaluation Results: Facilitating Factors, Lessons Learned and Recommendations for Conducting CBPR Jointly develop operating norms and CBPR principles Create a balance between time spent on process issues and tasks/ products Select mutually defined priority issues, goals and objectives Focus on community strengths as well as problems Copyright  2000, Barbara Israel

Evaluation Results: Facilitating Factors, Lessons Learned and Recommendations (continued) Start small, involving a few highly regarded CBOs within communities of identity Obtain support and involve top leadership from partner organizations Use informal democratic processes and consensus decision-making Build on prior history of positive working relationships Copyright  2000, Barbara Israel

Evaluation Results: Facilitating Factors, Lessons Learned and Recommendations (continued) Researcher orientation and commitment Methodological flexibility and different criteria for judging effectiveness Establish and maintain infrastructure Reach a balance in the distribution of benefits and resources Promote policy changes consistent with and supportive of CBPR Copyright  2000, Barbara Israel

Concluding Remarks Need for greater: awareness and recognition of the meaning and value of community-based participatory research; funding support from public and private funding institutions, particularly in communities that experience a disproportionate burden of health disparities ; Copyright  2000, Barbara Israel

Concluding Remarks (continued) Need for greater: emphasis on capacity building and training of all partners to enhance skills needed to conduct CBPR; benefits and reward structures for involvement in CBPR; and use of multiple case study evaluations to assess the context, process and outcomes of CBPR endeavors. Copyright  2000, Barbara Israel

Selected References* Israel BA, Schurman SJ, House JS Action research on occupational stress: Involving workers as researchers. International Journal of Health Services, 19: Israel BA, Baker EA, Goldenhar LM, Heaney CA, Schurman SJ Occupational stress, safety and health: Conceptual framework and principles for effective prevention interventions. Journal of Occupational Health Psychology, 1(3): Israel BA, Schulz AJ, Parker EA, Becker AB Review of community- based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19: Israel BA, Schulz AJ, Parker EA, Becker AB Community-based participatory research: Engaging communities as partners in health research. Presented at the Community-Campus Partnerships for Health’s 4 th Annual Conference, Washington, DC, April 29, Israel BA, Lichtenstein RL, Lantz P, McGranaghan RJ, Allen A, Guzman JR, Softley D, Maciak BJ. The Detroit Community-Academic Urban Research Center: Lessons learned in the development, implementation and evaluation of a community-based participatory research partnership. Submitted for review. Copyright  2000, Barbara Israel

Selected References* (continued) Parker EA, Schulz AJ, Israel BA, Hollis RM Eastside Detroit Village Health Worker Partnership: Community-based lay health advisor intervention in an urban area. Health Education & Behavior, 25(1): Schulz AJ, Israel BA, Selig SM, Bayer IS Development and implementation of principles for community-based research in public health. In R.H. MacNair (Ed.), Research Strategies for Community Practice. New York: Haworth Press, pp Schulz AJ, Parker EA, Israel BA, Becker AB, Maciak BJ, Hollis RM Conducting a participatory community-based survey: Collecting and interpreting data for a community health intervention on Detroit’s east side. Journal of Public Health Management and Practice, 4(2): Schurman SJ, Israel BA Redesigning work systems to reduce stress: A participatory action research approach to creating change. In L. Murphy, J. Hurrell, S. Sauter and G. Keita (eds.) Job Stress Interventions, Washington DC: American Psychological Association. * Some sections of this presentation are adapted from these references Copyright  2000, Barbara Israelv