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Community Based Participatory Research Approaches: Experiences from St. James Town Initiative

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This presentation is an overview of community based participatory research methodologies. It draws on examples from work in St. James Town to illustrate the range of information that could be drawn using an arts-based participatory research method. The aim of this presentation is to illustrate how participatory research methodologies can be effectively used in research resistant communities for: 1) engaging and empowering marginalized populations; 2) enabling communities to advocate for social changes; and 3) developing new partnerships with stakeholders and initiating community-level changes.

Nasim Haque, MD, DrPH
Director of Community Health
www.wellesleyinstitute.com
Follow us on twitter @wellesleyWI

Published in: Education, Health & Medicine
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Community Based Participatory Research Approaches: Experiences from St. James Town Initiative

  1. 1. Social Aetiology of Mental Illness (SAMI) CIHR Strategic Training Program Center of Addiction & Mental Health (CAMH) November 16, 2011 Community-Based Participatory Research Approaches: Experiences from St. James Town Initiative Dr. Nasim Haque Wellesley InstituteNovember-17-11 | 1www.wellesleyinstitute.com
  2. 2. Objectives for today’s session 1) Provide an overview of community-based participatory research (CBPR) techniques 2) Emphasize the importance of social determinants of health and health equity and the use of CBPR 3) Introduce three CBPR techniques and illustrate using examples from St. James Town Initiative research workNovember 16, 2011 2www.wellesleyinstitute.com | www.sjtinitiative.com
  3. 3. About St James Town Initiative SJT Initiative is a 5 year CBPR Initiative Research Question: What implications do neighbourhoods have on the health & wellbeing of immigrants? Results: Inform policy & support social change at neighbourhood levelNovember 16, 2011 3www.wellesleyinstitute.com | www.sjtinitiative.com
  4. 4. Difference between Illness & Health Social Aetiology of Mental Illness (SAMI) • Illness is a state of poor health and is considered a synonym for disease • Health is a state of complete physical, mental and social well-being (WHO, 1986)November 16, 2011 4www.wellesleyinstitute.com | www.sjtinitiative.com
  5. 5. Factors Effecting Health & WellbeingSDoH & Health Inequity The social & economic environment HEALTH Person’s The physical individual / environment biological characteristics & behaviours November 16, 2011 5 www.wellesleyinstitute.com | www.sjtinitiative.com
  6. 6. 14,666 Residents on 0.23 km2 of Land 64,636 People / km2 (Unofficial Estimate: 25,000) 64% Immigrants 18 Aging High-Rise Buildings 11/ 17/6 201
  7. 7. Strategies & Activities Multi-pronged Approach COMMUNITY ENGAGEMENTParticipatory Skill enhancing Student Work with SJT Initiative Action opportunities internships multiple Website Research stakeholders Community Action SJT Residents Action Group 1) Adult Photo Voice 4) Youth Photo Voice 2) Community Mapping 5) Focus groups/interviews (CAC) 3) Concept Mapping 6) Sample Survey (CIHR funded)
  8. 8. What is Participatory Action Research?• Action research is “learning by doing” - a group of people identify a problem, do something to resolve it, see how successful their efforts were, and if needed, try again.• Examples of participatory action research?November 16, 2011 8www.wellesleyinstitute.com | www.sjtinitiative.com
  9. 9. Community Mapping: Arts-Based Participatory Research ApproachNovember-17-11 |November 16, 2011 9www.wellesleyinstitute.com | www.sjtinitiative.com
  10. 10. What is Community Mapping?• Community mapping is a cartographic (map making) practice that honours the local and personal knowledge of ordinary people• Through this process participants share their knowledge by making maps as a way to spatially and visually represent their experiences, which include the social, economic, and cultural contexts of their lives.• It is a research and learning process that focuses on coming to a greater understanding of the intersection of ‘self and place’ November 16, 2011 10 www.wellesleyinstitute.com | www.sjtinitiative.com
  11. 11. Purpose of Community Mapping?• Encourages ordinary people and those who are marginalized from public life and political process to come together to record significant aspects of their neighbourhood and their relation to it.• Facilitates the process of learning and facilitates dialogue among members of the community from the ‘bottom up” as a way to transform traditional “top down” power relationships into more equitable, transparent, and participatory political process.November 16, 2011 11www.wellesleyinstitute.com | www.sjtinitiative.com
  12. 12. Community Mapping (Map Anchored Interviews)“When we first came here, we had very high expectations because we werecoming to Toronto…but it is not good. Nobody takes care of the surroundings.On apartment terraces, you cannot see flowers. People are always storing thingsthere. It is ugly. I can find gardens near my building, but they are not managednicely. There is a lot of garbage here. Surroundings are important - theymake me smile and relax, so I can go with a smiling face.” 12
  13. 13. “The Bleeker St. basketball court is not a safe or healthy place for kids. That’swhere older kids hang out with younger kids and smoke and sell drugs.....Younger kids look up to older kids and respond to peer pressure. That’s whyyounger teens are getting into trouble with the law and stuff like that.” 13
  14. 14. “…People here are busy. They work 2 jobs to cover their costs. You can’t findanyone to talk to. Sometimes you need to sit and chat and have a conversationwith people. Usually, I meet some people in the library...Every time you meet anew person you may not see them again. This is frustrating. If a person hasfriends, relations, that they can meet, talk together, have conversation with,maybe they will feel like they are someone. …You ask yourself “What is going onhere?” Maybe the culture is different. Different from mine.” 14
  15. 15. Photovoice : Arts-Based Participatory Research ApproachNovember-17-11 |November 16, 2011 15www.wellesleyinstitute.com | www.sjtinitiative.com
  16. 16. What is Photovoice?Photovoice asks you to take photographsof things that are important to you - and to tell the story of why these things are important. The visual images andaccompanying stories are the tools used to reach policy- and decision-makers. 16
  17. 17. Why use Photovoice? • Powerful way to approach empowerment and advocacy • Rewards of taking photographs are immediate • Photography is fun and creative • Taking photographs can change participants’ perceptions about their social and physical environment • Basic photography is easy to learn and accessible to all • “A picture is worth a thousand words” • Images are understood regardless of language or culture • Policy makers & program planners cannot deny reality when images are staring them in the faceNovember 16, 2011 17www.wellesleyinstitute.com | www.sjtinitiative.com
  18. 18. Who should use Photovoice? A few examples: • Children and youth in difficult circumstances e.g. orphans, children forced into job market, children and youth living under the threat of violence because of war or crime • Homeless adults and families • People with disabilities or mental health issues • People with chronic diseases/medical conditions e.g. HIV, TB etc. • Members of racial, ethnic, linguistic, or cultural minorities • People who are discriminated against because of class, caste, way of life • The urban poor, whose concerns and strengths are often different from those of the larger society • Women and men, to highlight gendered social and health issuesNovember 16, 2011 18www.wellesleyinstitute.com | www.sjtinitiative.com
  19. 19. SHOWED: Guideline for story writing One way of exploring photographs: • What do you See here? • What’s really Happening here? • How does this relate to Our lives? • Why does this problem/condition/strength exist? • How could this image Educate the community/policy makers/ etc? • What can we Do to improve the situation, or two enhance these strengths? For more detailed description on Photovoice, visit: www. SJTinitiative.comNovember 16, 2011 19www.wellesleyinstitute.com | www.sjtinitiative.com
  20. 20. A few examples of the range of information that can be collected using PhotovoiceNovember-17-11 |November 16, 2011 20www.wellesleyinstitute.com | www.sjtinitiative.com
  21. 21. PHYSICAL ATTRIBUTES© Wellesley InstituteAs a child, one way I kept myself occupied with my time was through playing basketball. It not onlykept me off the streets, but also wasted the majority of my time, keeping me active. If morecommunity programs ran such activities, it would bring the community closer and keep children offthe streets away from any type of violence. These activities are strengths in our community aschildren are kept away from trouble. (Youth,SJT. 2010)
  22. 22. PHYSICAL ATTRIBUTES Overcrowding... In a neighbourhood such as St. JamesTown where most people live in high risebuildings and come from low incomefamilies it may not seem like the bestidea to build more buildings when wedon’t already have that much greenspace around. This issue relates to yourlives because we need more things thanbuildings around our community, such asmore parks, centres for youth butinstead we invest in building and morebuildings.(Youth,SJT. 2010) © Wellesley Institute 22
  23. 23. SOCIAL ATTRIBUTES Safety, Crime, Drugs, Fear© Wellesley InstituteThe picture shows a memorial of a residence of St. James Town whose life was robbed off him lastyear due to gun violence. The person who murdered “Juice” is yet to be found. It just comes toshow11/17/2011 security is needed in the area. A lot of undercover police are the area dressing up that more 23as drug dealers or buyers but they are usually easily spotted and pin pointed.
  24. 24. SOCIAL ATTRIBUTES © Wellesley InstituteThis is related to our lives because every day we are witness to some type of harmfulcarcinogens produced by these cigarettes. Whether second hand, or first hand smoke, living inSt. James Town means a high chance of encountering cigarettes. Because of this more peopleare exposed to harmful chemicals.
  25. 25. SOCIAL ATTRIBUTES “The Tsismis Tree” Tsismis is a word in Tagalog that means gossip. This tree is treasured by many immigrants because we meet here to share experiences and support each other. Common spaces are important to the wellbeing of both individuals and the community. These different flowers represent people from different places and the vase represents this country. If we arrange the flowers properly, they turn into a beautiful flower arrangement. If people of different backgrounds are given equal opportunities and are accepted, everyone benefits. 11/17/2011 25© Wellesley Institute
  26. 26. ECONOMIC ATTRIBUTES© Wellesley InstituteThis tiny tunnel connects one of the poorest neighbourhoods in Canada, St. James Town, to oneof the most affluent, Rosedale. The short journey of crossing the bridge is actually painful,arduous, and for the most part, impossible for the most, if not all, of the individuals living in SJT.Despite being highly educated, newcomers have difficulty gaining recognition, andconsequently, employment. 11/17/2011 26
  27. 27. ECONOMIC ATTRIBUTES Food Quality How much can we trust our food supply? We don’t only care about the price of goods, we also pay attention to our health. We want to get good service when we go to the supermarket.© Wellesley Institute 11/17/2011 27
  28. 28. © Wellesley Institute “Anyone out there?” Our plea for help went unheeded and we were buried in an overwhelming wave of ‘that’s not our problem’. Anyone out there? Are you listening?
  29. 29. Concept Mapping: Semi-Quantitative Participatory Planning and Evaluation ToolNovember-17-11 |November 16, 2011 29www.wellesleyinstitute.com | www.sjtinitiative.com
  30. 30. What is Concept Mapping?Concept mapping is a process for gathering andorganizing the input of many different people into asingle, shared conceptual framework. This frameworkforms the basis for further value analysis, planning,action, or evaluation. Bill Trochim November 16, 2011 30 www.wellesleyinstitute.com | www.sjtinitiative.com
  31. 31. ThroughPhotovoice CM Methodology StepsPlanning: Planners and key issue advisorsdevelop a focus prompt and identify participants Idea Generation: Communities of interest and expertise are identified, and respond with brainstormed ideas Structuring: Communities of interest and expertise sort and rate the results of the idea development, authoring the structure and value domain of the issue Representation: Compute the maps, pattern matches and “go zones,” and prepare them for interpretation by communities of interest. Interpretation and Use: Strategies and tactics for action follow directly from the interpretation of the results. Pattern matches and go zones help build consensus on action. © The Wellesley Institute www.wellesleyinstitute.com | www.sjtinitiative.com
  32. 32. ThroughPhotovoice CM Methodology StepsPlanning: Planners and key issue advisorsdevelop a focus prompt and identify participants Idea Generation: Communities of interest and expertise are identified, and respond with brainstormed ideas Structuring: Communities of interest and expertise sort and rate the results of the idea development, authoring the structure and value domain of the issue Representation: Compute the maps, pattern matches and “go zones,” and prepare them for interpretation by communities of interest. Interpretation and Use: Strategies and tactics for action follow directly from the interpretation of the results. Pattern matches and go zones help build consensus on action.
  33. 33. What is Concept Mapping of Photovoice ? Ideas represented in photographs… …are sorted into groups… … and rated on two Decide how to manage multiple tasks. Manage resources effectively. 20 4 Work quickly and areas. effectivel y under pressure 49 Organize the work when directions are not specific. 39 November 16, 2011 33 www.wellesleyinstitute.com | www.sjtinitiative.com
  34. 34. Concept Mapping Sorting the Photovoice Photos Examining the Relationships in the Concept Map 11/ 17/34 201
  35. 35. Concept Mapping Results: a CBPR project on Neighbourhood & Health and Wellbeing A Shared Framework: regional view of CMConcept Mappingtakes the ideas ofindividuals andcombines usingmultivariatestatistical methodsto form uniquevisualrepresentationscalled ConceptMaps. 35
  36. 36. Each cluster retains the details The hopes and dreams of the residents could be expressed in the development of a beautiful common space tegether. A lush green urbanWe live in such a crowded place and we don’t have space is the dream of everyone in SJT; howeverenough green space. Plants give us oxygen & give this is difficult because residents do not ownus a beautiful visual sense as well. (76) this land or feel a sense of ownership. (9) This is a soothing sight for tired eyes, an effective distraction from the barren concrete jungle around...(6) 76..... making SJT look beautiful and clean 72 Green Spacewould make residents feel good aboutthemselves (53) 6 9 53 74 67 Green space is very important. The addition of green space to a building can provide a sense of community since tenants can get to know one another as they enjoy this space together. This is Allen gardens. Residents should not have to go outside the community to find quality parks with good amenities. (67)
  37. 37. Pattern Match: Average ratings of Clusters in terms of Importance and Action Importance Action PotentialPattern 4.12 3.51 Improvement for Health SocietyMatching is a Safetyprocess that Improvement for Health Environmentallows the Need Social & Protection Sense of Pride Environmentcomparison of Attractionsopinions or view Safety Education Green Spaceto determine the Green Space Lack of Maintenance &Improvementdegree to which Sense of Pride Attractionsgroups or ideas Lack of Maintenance Need Social and Protectionmatch or Society Educationdisconnect. 3.56 3.08 r = .12 * Absolute values for ratings range from 1-5
  38. 38. Go-Zones: Comparing Statements in a Cluster r = .61 4.03 56A Go-Zone 61 Low ImportanceReport is a High Action Potential 17 37 62 22 15 16 32 12bivariate 65 6714 42 13 44 29 4 27 39 710 54 16 28 23 3433 3138 Action Potentialscatter plot 3 41 63 18 66 71 50 49 48 3.29 25 3046 53 4311 69 245 58 21 64 75that shows 36 26 35 47 52 72 74 55 70 20 68 408 76 51 9 73how the 60 77 57 45items in a Low Importance 2 High Importance Low Action Potential Low Actioncluster are 19 Potential 59related. 2.39 2.39 3.8 4.54 Importance
  39. 39. Advantages of Using Arts-Based Research Techniques • Non threatening methods • Usually not conceived as “research” • Engage disadvantaged population in research and advocacy • Builds trust & empowers disadvantaged population • Transfer ownership of the project to participants • Help common voices heard by decision makers • Understand participants perspectives on health and other issues through their lensesNovember 16, 2011 39www.wellesleyinstitute.com | www.sjtinitiative.com
  40. 40. Limitations of using Arts-based Techniques • The time commitment necessary may be daunting for participants and researchers • Participants may have difficulty in presenting complex or abstract ideas through images and drawings • Limitations of cross sectional design and qualitative design applies to arts-based study designsNovember 16, 2011 40www.wellesleyinstitute.com | www.sjtinitiative.com
  41. 41. Building Partnerships with StakeholdersNovember-17-11 |November 16, 2011 41www.wellesleyinstitute.com | www.sjtinitiative.com
  42. 42. SJT Initiative Youth Photo Voice Project © The Wellesley Institute11/17/2011 www.wellesleyinstitute.com | www.sjtinitiative.com 42 © Wellesley Institute
  43. 43. Photo Journalist: Training Workshop 1© Wellesley Institute September 23, 2011 | 43 www.wellesleyinstitute.com/sjtinitiative.com
  44. 44. Important Stakeholders: Training Workshop 2© Wellesley Institute September 23, 2011 | 44 www.wellesleyinstitute.com/sjtinitiative.com
  45. 45. Community Level ActionsNovember-17-11 |November 16, 2011 45www.wellesleyinstitute.com | www.sjtinitiative.com
  46. 46. Community Forum & Expo: March 20, 2008© Wellesley Institute © The Wellesley Institute www.wellesleyinstitute.com | www.sjtinitiative.com
  47. 47. Community Forum & Expo: September 18, 2010 © The Wellesley Institute www.wellesleyinstitute.com | www.sjtinitiative.com 47© Wellesley Institute
  48. 48. Resident Group Presenting at Counselor ’s Office© Wellesley Institute © The Wellesley Institute 11/17/2011 www.wellesleyinstitute.com | www.sjtinitiative.com 48
  49. 49. Change & Action © The Wellesley Institute11/17/2011 www.wellesleyinstitute.com | www.sjtinitiative.com 49
  50. 50. AcknowledgementEstelle Sun: RA, Wellesley InstituteAli Moallim & Gene Lara: Community Leaders, SJTSean McIntyre: Constituency Assistant to Area CouncillorSt. James Town residents and project participantsPrevious RAs (Anissa, Emily, Erin) and WI staff &colleagues November 16, 2011 50 www.wellesleyinstitute.com | www.sjtinitiative.com
  51. 51. Following - UpThese speaking notes, reports using Photovoice and other participatory research methodologies, and policy briefs aimed at advancing health equity and social determinants of health are available on our site at www.sjtinitiative.com and www.wellesleyinstitute.comMy email: nasim@wellesleyinstitute.com 51
  52. 52. ST. JAMES TOWN INITIATIVE www.sjtinitiative.comTHANK YOU © The Wellesley Institute11/17/2011 52 www.wellesleyinstitute.com | www.sjtinitiative.com

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