Community-Based Participatory Research and Policy Advocacyto.docx

Community-Based Participatory Research and Policy Advocacy
to Reduce Diesel Exposure in West Oakland, California
Priscilla A. Gonzalez, MPH, Meredith Minkler, DrPH, MPH,
Analilia P. Garcia, MPH, Margaret Gordon, Catalina Garzón,
MCP, Meena Palaniappan, MSc,
Swati Prakash, MS, and Brian Beveridge
We conducted a multimethod case study analysis of a
community-based
participatory research partnership in West Oakland, California,
and its efforts to
study and address the neighborhood’s disproportionate exposure
to diesel air
pollution. We employed 10 interviews with partners and
policymakers, partici-
pant observation, and a review of documents. Results of the
partnership’s truck
count and truck idling studies suggested substantial exposure to
diesel pollution
and were used by the partners and their allies to make the case
for a truck route
ordinance. Despite weak enforcement, the partnership’s
increased political
visibility helped change the policy environment, with the

community partner
now heavily engaged in environmental decision-making on the
local and
regional levels. Finally, we discussed implications for research,
policy, and
practice. (Am J Public Health. 2011;101:S166–S175.
doi:10.2105/AJPH.2010.
196204)
Located on the San Francisco Bay, and
bounded by freeways, West Oakland is a small
but vibrant community of predominately low-
income African American and Latino resi-
dents. Home to nearly 22 000 people in 10
distinct neighborhoods, the community also
contains thousands of moving and stationary
sources of diesel pollution.1 From the buses
and trucks on surrounding freeways, to the
container trucks moving through neighbor-
hoods as they take goods to and from the Port
of Oakland and a major US Post Office distri-
bution center, residents have long experi-
enced disproportionate exposure to diesel
exhaust and traffic-related air pollutants. Al-
though such exposures are known to ad-
versely affect cardiovascular health outcomes,
including premature mortality,2---4 of greatest
concern to West Oakland residents is the role of
these pollutants in exacerbating asthma and
related respiratory conditions in children and
their families. Recent prospective studies have
shown a positive relationship between traffic-

related air pollution and the onset of asthma in
children,5 as well as adverse effects of such
exposure on the growth of lung functioning in
children aged 10---18 years.6 In a nested case---
control study in British Columbia, Canada,
elevated exposure to traffic-related air pollutants,
such as nitrogen dioxide, carbon monoxide, and
black carbon, in utero or in infancy was also
recently found to be associated with higher risk
of asthma in children under age 5.7
In many low income urban neighborhoods,
and particularly communities such as West
Oakland with major ‘‘goods movement’’ activity
related to international trade, a larger than
normal percentage of traffic consists of diesel
trucks,8 including those moving containers.9 The
emissions from diesel exhaust are a combination
of gases and particles, including a high number
of ultrafine particles shown to be especially
hazardous because they can escape many of
the body’s defenses, allowing them to enter the
lungs and the systemic circulation.10 Although
automobile emissions also include ultrafine par-
ticulate matter, for residents of West Oakland,
who see relatively little car traffic in the neigh-
borhood itself but regularly find diesel exhaust
soot on their window sills and heating vents
from the high volume of truck traffic, diesel air
pollution is of far greater local concern.
In West Oakland, as in a growing number of
low income communities disproportionately
impacted by environmental hazards, commu-
nity-based participatory research (CBPR) has

been used by local residents, in partnership
with outside researchers, to help study and
address neighborhood challenges, while build-
ing local capacity.11---19 Green et al20 defined
CBPR as ‘‘systematic inquiry, with the participa-
tion of those affected by the issue being studied,
for the purposes of education and taking action
or effecting change.’’ Among the core principles
of this approach to research are that it recognizes
community as a unit of identity; it entails an
empowering, colearning process that ‘‘equitably’’
involves all partners; and it includes systems
development and increases local problem-solving
ability. It also achieves a balance of research and
action, and ‘‘involves a long term process and
a commitment to sustainability.’’21 Finally, CBPR
pays serious attention to issues of research rigor
and validity. However, it also ‘‘broadens the
bandwidth of validity’’22 to ask whether the
research question is ‘‘valid,’’ in the sense of
coming from or being meaningful to the involved
community. With its commitment to action as
part of the research process itself, CBPR has
increasingly been utilized by community---aca-
demic partnerships interested in using their
research findings, together with advocacy and
organizing, to help move policy that may
improve conditions and environments in
which people can be healthy.17,19
Our primary research goal was to analyze
a CBPR partnership between a community-
led and -based organization, the West Oak-
land Environmental Indicators Project
(WOEIP), and its academically trained re-

search partners at the Pacific Institute in
Oakland, California. We examined the pro-
cesses by which community and academically
trained research partners collaborated to
study a community-identified issue (i.e., die-
sel traffic in West Oakland23) and then
worked with other stakeholders to use the
findings and residents’ experience to advocate
for policy change.
FRAMING HEALTH MATTERS
S166 | Framing Health Matters | Peer Reviewed | Gonzalez et al.
American Journal of Public Health | Supplement 1, 2011, Vol
101, No. S1
METHODS
The collaboration between community
members and partners at WOEIP and their
research collaborators at the Pacific Institute
was 1 of 36 current or recent policy-focused
CBPR partnerships in California that our re-
search team at the University of California,
Berkeley and PolicyLink, Inc., identified in
2008 as appearing to have played a role in
contributing to policy level change. With
funding from The California Endowment, we
designed a study to explore CBPR as a strategy
for linking place-based work and policy toward
building healthier communities. As part of
this broader study, and in consultation with an
advisory committee, we selected for in-depth
analysis 6 of the 36 partnerships that met the

following criteria: (1) demonstrated the CBPR
core principles previously noted,21,22,24 (2)
substantially contributed to either a specific pol-
icy change or a change in the policy environ-
ment, and (3) helped capture the diverse range of
such projects in the state. A 28 item in-depth,
semistructured interview schedule was devel-
oped for administration to key community and
academic partners, along with a shorter phone
interview guide for relevant policymakers at each
site. The on-site interviews (range, 60---90 min-
utes) included questions designed to explicate
partnership genesis and evolution; research aims,
methods, and findings; policy goals, steps, and
activities; success factors and barriers; and per-
ceived contributions to helping change a specific
policy or the broader policy environment.
As 1 of the 6 partnerships that comprised the
final sample, WOEIP and the Pacific Institute
were visited 4 times by members of the re-
search team who conducted 7 key source
interviews, 3 phone interviews with local policy
makers, observed a WOEIP training for local
residents, and analyzed relevant internal doc-
uments and media coverage. Audiotapes of the
7 interviews were transcribed and coded in-
dependently by 3 research team members
using a 16-item coding template, with subcodes
whose code categories were related to each
major domain of interest (e.g., partnership
creation and evolution; partner involvement in
conducting the research; policy goals, stages,
activities, and outcomes; facilitating factors and
obstacles faced; and sustainability indicators).
We conducted interrater reliability checks,

reconciling discrepancies. Next, we employed
the qualitative software package, ATLAS.ti,
version 5.5 (Atlas.ti GmbH, Berlin, Germany
Version 5.5) to group all key domains by site
and generate reports, facilitating an additional
layer of coding following a similar technique.
Finally, we shared preliminary case study re-
ports based on the reconciled findings with
community partners at WOEIP and their col-
laborators at the Pacific Institute for member
checking as an added means of ensuring the
accuracy of data interpretation. In the spirit of
CBPR, both community and academically
trained researchers in the WOEIP partnership
participated in coauthoring this paper.
RESULTS
The West Oakland EIP began in 2000 as
a project partnership between a nonprofit
research organization, the Pacific Institute, and
the 7th Street-McClymonds Neighborhood
Improvement Initiative. This early collaboration
undertook research, in which ‘‘residents se-
lected the indicators they wanted to track;
collected, analyzed, and reported on selected
indicators, and supported the continued use of
this data to advocate for positive change in
West Oakland.’’23 A Task Force of 16 residents
identified 17 key indicators (e.g., toxic exposure,
illegal dumping, and asthma rates), each related
to a topic of major concern in the neighborhood
(e.g., air quality and health, physical environ-
ment, and transportation). The academic partner
then collected and examined both survey data

collection and secondary data on the municipal
and state levels, and drew comparisons between
indicator data for West Oakland and that for the
city and state as a whole. Released in 2002,
the West Oakland EIP report, Neighborhood
Knowledge for Change,23 which summarized
study findings and forwarded recommendations,
was cited in the local media, with some of its
findings (e.g., children younger than 15 years in
West Oakland had asthma rates 7 times the
state’s average) drawing particular attention. This
visibility, together with the high quality of the
research, contributed to WOEIP’s spinning off to
become a community-led organization in its own
right and incorporating as a nonprofit in 2004.
The processes and outcomes of the Neigh-
borhood Knowledge for Change project laid the
groundwork for a true CBPR partnership
between community members engaged with
the newly formed community organization,
WOEIP, and the Community Strategies pro-
gram of the Pacific Institute to study and
address a key concern raised in the original
study but for which insufficient data existed:
the high volume of diesel truck traffic in West
Oakland.23
Although we focus here primarily on 2 of
the resultant CBPR studies (the truck count
and truck idling studies) and subsequent
policy work to secure a truck route ordinance,
these were part of a range of intersecting
efforts to study and address disproportion-
ate exposures and environmental injustice,

and in the words of a partner, to increase
‘‘democratic community participation in
decision making in West Oakland.’’
Research Design, Methods, and
Participant Roles
The initial idea for conducting the truck
count and truck idling studies emerged from
initial community meetings held as part
of the Neighborhood Knowledge for Change
project. When residents and staff realized
there were insufficient data to allow the in-
clusion of indicators related to diesel truck
traffic in the original study, they left this as 1 of
several ‘‘indicators not included’’ in the report,
‘‘as a placeholder’’ for subsequent study.
WOEIP and their Pacific Institute research
partners then returned to this issue to develop
and conduct studies to better understand
the residents’ key concern. Although commu-
nity residents played important roles in the
planning and implementation of the truck
count and idling studies, this research was
preceded by considerable background study
by the Pacific Institute partners, including
a review of existing research to determine
what methods had already been employed for
estimating diesel sources. The Pacific Institute
also conducted secondary data analysis to
estimate diesel pollution in West Oakland
and its potential sources, which provided
important background and context for the
truck count and truck idling studies that
followed.

Building on this preliminary work, the
WOEIP partnership and the Pacific Institute
jointly designed and conducted the truck count
and idling studies, together with a third study of
Supplement 1, 2011, Vol 101, No. S1 | American Journal of
Public Health Gonzalez et al. | Peer Reviewed | Framing Health
Matters | S167
indoor air quality (not detailed here because
of small sample size), with funding from the
federal Environmental Protection Agency and
the California Department of Health Services.
One partner described these studies as ‘‘re-
search with a purpose,’’ with the 2 studies we
explored designed to ‘‘better understand truck
patterns and behaviors’’ so that the partnership
could identify strategies to reduce pollution
and other impacts of the heavy truck presence
in this community.1
To provide additional background for the
work, the Pacific Institute partners conducted
an in-house diesel inventory and helped de-
velop a request for application for firms in-
terested in providing technical assistance with
the truck count and truck idling studies. Com-
munity members played a key role in inter-
viewing 2 potential subcontractors, and the
transportation technologies consulting firm
TIAX, Cupertino, California, was unanimously

chosen through this process. TIAX trained 10
community residents and WOEIP staff while
also learning about the community’s lay
knowledge to enrich the research. TIAX and
the community residents worked together, for
example, to identify key street intersections at
which the studies should take place. After some
background study, TIAX generated a potential
list, with community residents and WOEIP
staff then using their ‘‘in the trenches’’ knowl-
edge to add additional potential locations and
actively participate in selecting final locations.
These included intersections with high truck
traffic and/or those where large (4.5 ton) trucks
were prohibited.25 TIAX then trained the resi-
dents as truck observers. After learning to iden-
tify different types of trucks (e.g., container and
noncontainer trucks, 2- and 3-axle trucks), the
observers counted the number and types of
trucks, and which direction they were traveling,
on 5 neighborhood streets over 3 days. Similarly,
they observed and tracked truck idling at the
Port of Oakland for 2 different 24-hour pe-
riods.25 TIAX also conducted informal inter-
views with truckers from an independent truck-
ing company and community members to gather
their opinions on and experiences with truck
traffic.
Throughout these studies, researchers at the
Pacific Institute ‘‘were behind the scenes as
much as possible.’’ Community residents and
WOEIP staff worked on data collection, with
guidance from TIAX, and subsequently
worked with the Pacific Institute on data

analysis. Although engaging in rigorous re-
search was an exciting and critical part of the
work, both community and academically
trained partners noted that there were initial
tensions in ‘‘not having residents at the same
technical level as the Pacific Institute.’’ As
a community member commented, this
resulted in ‘‘a certain amount of pushback,’’
with residents wanting ‘‘a bigger role in de-
signing and conducting the studies and con-
cerned about ‘‘having PhDs just come and do
the research and then leave.’’ However, trans-
parency on both sides allowed communication
to flow and partners to work out their differ-
ences. In the words of another WOEIP leader
and community resident, ‘‘We’ve always been
able to stop a meeting and find the common
ground, come to an agreement and resolve the
skills difference, and most times after it was
explained, we could move on.’’ In this case, the
community learned to appreciate through di-
alogue that they could not ‘‘learn in a week’’
what outside researchers had spent years
learning, yet could still play a vital (and deeply
appreciated) part in the research, partially
based on their wealth of lay knowledge of the
location of heavily trafficked intersections.
WOEIP Study Findings
The truck count study revealed that 6300
truck trips occurred daily through West Oak-
land, some in areas prohibited to trucks.27
Trucks traveled through local neighborhoods to
find truck services, such as fuel, truck repair,

food, and overnight parking. The trained resident
observers also found that approximately 40 large
trucks per day drove on streets prohibited for
trucks over 4.5 tons.1,25
Findings from the truck idling study were
similarly striking: community partner ob-
servers found that trucks were idling outside
the Port of Oakland terminal gates an estimated
combined 280 truck-hours per day––the
equivalent of nearly 12 trucks idling for 24
hours a day. They further found that most of
the idling trucks were doing so inside the
terminal gates where data collection was pre-
cluded. By conservative estimate, however,
each truck appeared to be spending about 1.5
hours per trip idling or moving at a very slow
pace for container pick up or delivery.1 The
combined results of these studies revealed that
approximately 64 lbs/day of diesel particulate
matter emissions were generated from truck
traffic and truck idling.25
Although these studies were based on small
samples, the partners extrapolated from their
findings that West Oakland might be exposed
to ‘‘90 times more diesel particulates per
square mile per year than the state of Califor-
nia.’’1 They further suggested that this figure
could translate into an increased risk of 1
additional case of cancer per 1000 residents over
a lifetime.1 These findings, moreover, were given
additional weight by a third, albeit very small
CBPR study on indoor air quality (not described)
suggesting that some West Oakland residents

were likely being exposed to almost 5 times more
diesel particulates than residents in other parts of
the city.1
From Research to Action
As Bardach,26 Kingdon,27 and others28 have
suggested, although the policy making process
often is messy and circuitous, several key steps
and activities typically are involved, including
problem identification, creating awareness, get-
ting on the agenda, constructing policy alterna-
tives, deciding on a policy to pursue, and policy
enactment and implementation. For CBPR prac-
titioners interested in helping effect policy level
change, relevant research findings, education
and policy advocacy frequently are used in
conjunction with these steps or activities.28
Building on earlier work that demonstrated
very high youth asthma rates and diesel truck
traffic as a top neighborhood concern,23 the
WOEIP partnership used findings from its
recent truck count and truck idling studies
to further define the problem and create
awareness, in part by gaining the buy-in of
a growing number of stakeholders. After the
partnership and a handful of community
members crafted initial recommendations
based on the study findings, for example, the
partners met independently with local orga-
nizations, businesses, truckers, and relevant
government entities (e.g., the Port Commis-
sion, Department of Public Works, and the
Police Department) to elicit their feedback.
This inclusive strategy was widely credited to

the former director of the Pacific Institute’s
Community Strategies program. In the words
of a EIP community resident and leader:
101, No. S1
I don’t think I was ever in a meeting with [her]
when she didn’t say, ‘‘who else do we need to
have at the meeting?’’ She was never willing to
rush to judgment . . . there was always the
potential that you would get a better perspective
if you got a few more people to the table.
Involving the truckers was not always easy
for WOEIP, one of whose leaders noted that:
In the beginning, this was a tension, because we
did not have a good relationship with truckers. I
was very adamant dealing with [them], but that
was the beginning of my education.
She went on to add that over the course of
this and subsequent meetings, ‘‘we began to
understand the needs of truckers, the labor
piece, and began forming our relationship with
[them]. We still have this relationship.’’
The truckers and other stakeholders were
also invited to a larger half day release event
and community workshop where the WOEIP

and Pacific Institute presented the study
results and initial recommendations, and re-
ceived feedback,. Additional community
members were then trained to conduct door-
to-door outreach and advertise a follow-up
meeting with WOEIP where residents could
further discuss and prioritize the recommen-
dations. The close to 3 dozen residents who
attended this release event also shared their
experience in relation to diesel exposures and
truck traffic in their community. However, as a
Pacific Institute partner commented, the other
groups present at this meeting (e.g., truckers
and the Port Commission) felt buy-in because
their ideas, expressed earlier in the more in-
dividualized stakeholder group meetings, were
represented along with those of community
members. Further, when truckers heard resi-
dents’ stories of how diesel exposure was af-
fecting their children and grandchildren, they
expressed more understanding of the com-
munity’s concerns about their heavy presence
in the neighborhood. Similarly, when commu-
nity members learned about the truckers’ expe-
riences and hardships (typically as immigrants of
quite modest means), they began forming better
relationships and worked to find common
ground that would be mutually beneficial.
The follow-up community workshop was
attended primarily by 20---25 residents. Although
it did not involve a formal process of weighing
a range of policy alternatives, this interactive
session was described by a community partner as
leading to ‘‘a smaller set of solutions.’’ Resident

‘‘voting’’ through dots on a collective list of
finalized recommendations clarified their
overwhelming priority: designating a truck
route that would prevent trucks from traveling
through West Oakland neighborhoods. Resi-
dents further emphasized their desires for
community participation in the process of de-
termining what an alternate truck route would
look like, and ensuring that report findings
were taken seriously. Their final 13 recom-
mendations were highlighted, along with the
study findings, in the partnership’s report,
Clearing the Air: Reducing Diesel Pollution in
West Oakland released in November 2003,
and an accompanying press release, ‘‘West
Oakland residents choking on diesel,’’ which
emphasized, in particular, residents’ desire for
a designated truck route.3
Policy Action Strategies and Approaches
The EIP partnership showed considerable
policy acumen in its efforts to get the truck
route proposal on the agenda of policy
makers. Although safety and health
concerns were the initial catalyst for the truck
count and truck idling studies, for example,
when moving into the policy advocacy
phase of the work, the partnership was
strategic in framing their findings and their
policy objective even more explicitly in
terms of health. As a community partner
noted,
We could have said the truck route was about
traffic. We could have said it was about walk-

ability in the neighborhood. We could have said
it was about a whole lot of things [but] we said it
was about health. And so it was really grounded
in something no one could really argue with,
especially if they were local.
In underscoring the ‘‘health angle,’’ the
partnership also provided important backing
for their key policy ally: a city councilwoman
with strong roots in West Oakland. In her
words:
State law, city law looks at commerce [but] we
wanted to look at health issues---they were not
part of agenda. There was community advocacy
[framing the problem as a health issue]; com-
munity voice added to mine.
The partnership also worked with commu-
nity members to conduct a power analysis to
identify decision makers who could bring
policy change and bridge gaps with the city. A
strategic method in policy advocacy, power
analysis (or power mapping) helped identify,
for a given policy objective, targets with de-
cision-making power on the issue, as well as
potential allies, opponents, and other stake-
holders and their relative strength and de-
grees of overlap or independence.29 Such an
analysis helped partners create a strategic plan of
action to neutralize or win over opponents,
mobilized constituents, and brought appropriate
arguments and advocacy methods to bear on
a target or group of targets.28 In West Oakland,
where many key players had already been

identified, the power analysis process high-
lighted the importance of the Port as a key
decision maker, and of the district’s local city
councilmember as a potent ally. However,
it also shone a spotlight on West Oakland
businesses as an under appreciated group that
would be impacted by the proposed new truck
route and that they needed to be included
in subsequent planning.
Policy makers frequently note the impor-
tance of being presented not simply with
problems, but also with solutions––ideally so-
lutions that have ‘‘buy in’’ from multiple stake-
holders. The WOEIP partnership was strategic
in creating a truck route committee that met
monthly from October 2004 through Septem-
ber 2005 and included such diverse yet critical
stakeholders as local residents, the Port of
Oakland, an independent trucking company,
the Police Department, the Department of
Public Works, the District Air Board, and the
West Oakland Commerce Association. The
committee’s goal was to negotiate an actual
truck route that could address community
concerns without unduly burdening other
stakeholders.
To reinforce the collaborative spirit that
had been evident in earlier multistakeholder
meetings while assuring continued high level
resident engagement, the WOEIP partnership
established a collaborative process for the truck
route committee in which no one entity took
over the agenda. As a community partner stated:

[We] had an agency and a resident, or a business
person and a resident. It [was] never one single
entity in the lead. And we would go through the
process of training each other on how to get
along, how this would work. . . that was a new
policy for them, a new action for them . . . of the
community being a part of defining who were the
stakeholders.
Matters | S169
Although initially concerned about the im-
plications of having truckers and businesses
at the table, for example, just as WOEIP
leaders had been early on, community resi-
dents gained a better appreciation and un-
derstanding of the labor hardships of truckers
and the concerns of ‘‘mom-and-pop’’ store
owners and other small businesses who
benefited from the revenue generated by the
truckers’ presence in the neighborhood. Con-
versely, the truckers became more accepting
of a route that would take them out of the
neighborhood, whereas business owners be-
gan to recognize that as local shopkeepers,
they or their employees were also likely to
have their health adversely impacted by
heavy diesel truck traffic exposure.
By far the greatest challenge, however,

remained getting buy-in from the Port, whose
leadership, according to one community
leader, ‘‘thought that the community shouldn’t
be telling the Port what to do.’’ To better
engage this and other city partners in the
process, WOEIP’s local city councilwoman
and informal policy mentor offered to hold
the monthly meetings at her office:
so that people showed up: Other city depart-
ments showed up, the Commerce Association,
the Port, traffic department, truckers association
showed up, so we had buy in from all. . . The
power to change policy came out of that.
The city councilwoman was cited as key to
getting the Port as part of this process and
eventually agreeing to support the new truck
route.
Throughout this process, WOEIP leaders
and local residents frequently ‘‘made the
rounds’’ of neighborhood organizations, get-
ting on the agenda, keeping them informed on
‘‘where the routing discussion was going,’’
and getting their feedback on possible un-
intended consequences. In this way, even less
directly involved residents could have their
issues raised and discussed by the truck route
committee.
Once the committee agreed on a route,
and pushed for a city ordinance to implement
it, they engaged in several steps to help increase
awareness and support for the proposed
policy change. EIP leveraged its alliances with

other community and statewide groups orga-
nizing to combat diesel pollution, key among
them the West Oakland Toxics Reduction
Collaborative30 and the Ditching Dirty Diesel
Collaborative.31
Several town hall meetings and community
forums were held to further engage the larger
community and generate support for the
ordinance, and attracted up to 30 local partic-
ipants. Residents who expressed interest in
providing testimony at the upcoming City
Council meeting were also encouraged to do so,
and reminded to ‘‘stay on the mark’’ in telling
their own stories because ‘‘you’re here to put
a human face to the issue.’’
Getting to Policy Implementation: Two
Steps Forward, One Step Back
In September 2005, the WOEIP partnership
and its allies achieved a key victory when the
City Council unanimously passed a Truck
Route ordinance that adhered closely to the
specific truck routes the partnership proposed
Source. City of Oakland, California. Available at:
http://clerkwebsvr1.oaklandnet.com/attachments/11326.pdf.
Accessed
May 14, 2010.
FIGURE 1—Designated truck routes as proposed by truck route

committee, West Oakland,
California.
101, No. S1
(Figure 1). Several of the policy makers inter-
viewed noted that the partnership, and partic-
ularly its sound research and the strong com-
munity voice represented by WOEIP
community members, deserved substantial
credit both for this particular victory and for
subsequent broader efforts. The combined
presence and participation of grassroots resi-
dents and ‘‘grass-tops’’ level opinion leaders
(e.g., community-based organization heads),
together with researchers and representatives
of the truckers, the Port, etc., helped achieve
a unanimous vote that was ‘‘almost anticlimac-
tic’’ given all the work that had preceded it. As
a decision maker said of the WOEIP Pacific
Institute partnership,
Their research and advocacy have been critical––
critical––in making the Port recognize its re-
sponsibility to the surrounding neighborhoods––
that they should do their operations in a way that
doesn’t hurt the community.
Unfortunately, the most visible policy win

for which the partnership was given substantial
credit was also the most frustrating and in-
complete: as the partnership members and
policy makers interviewed all commented,
failure to enforce the new truck ordinance
made it, in many ways, a somewhat hollow
victory. As a Pacific Institute partner put it:
We had this great truck route, we had new signs,
we had brochures and maps that were suppos-
edly getting distributed through the Port of
Oakland, but there was no enforcement. And
without that, there’s no point. . . . [Enforcement]
was overlooked.
Other stakeholders pointed to the City’s
police officers being spread thin––and mostly
focused on violent crime–– as a key reason for
the lack of enforcement. A community partner
similarly noted that there was significant re-
sistance from the city in actually implementing
the truck route because it would generate more
work and require additional staff time. What-
ever the cause, failure to enforce the truck
route ordinance was a major disappointment to
the partnership, community members, and
other stakeholders who worked hard for its
passage. In retrospect, as Pacific Institute part-
ner reflected:
Often times the most easily identified policy
outcome is also the one that is least significant
from a community health perspective. Pre-
cisely because decision makers realize that the
easiest way to get a community off its back is to

pass something, without being committed in any
way to do all the hard work it takes to actually
realize the spirit and the vision of what the
community needs.
Although lack of policy enforcement was
a critical setback, this work has helped
prompt other environmental justice initiatives
addressing diesel pollution while further
building the capacity of WOEIP and its resident
leaders and activists. Several of the policy
makers interviewed credited WOEIP commu-
nity partners’ advocacy and perceived profes-
sionalism, in addition to the still much cited
CBPR truck studies conducted with Pacific
Institute, as having helped spur other local,
regional, and statewide changes. Together,
these changes have helped create a more fa-
vorable policy environment with respect to
environmental justice. The partnership’s work,
for example, prompted other agencies and
institutions to conduct their own studies in this
heavily impacted community. In 2006, the
California Air Resources Board (CARB) began
a comprehensive health risk assessment for
diesel exhaust in West Oakland, a multiyear
intensive endeavor to formally document the
sources, extent, and impact of diesel pollution
on health risk for West Oakland residents.32 In
the words of one Pacific Institute partner, ‘‘CARB
started paying attention, the Air District started
paying attention. These studies put diesel in
West Oakland on the map,’’ with the Air District
itself subsequently conducting follow-up studies
in this community.

As WOEIP gained recognition and an in-
creasing voice through the truck count and
truck idling work at the local level, it expanded
its focus to other air quality efforts happening
regionally and reframed them to increase their
local relevance. As a community leader
explained, ‘‘If you do ‘regional’ it will be
watered down [in terms of ] local impacts.’’
WOEIP therefore partnered with the Air Dis-
trict and the Port staff to design an air plan to
benefit West Oakland as part of the broader
goods movement efforts taking place region-
ally, statewide, and nationally. In the course of
this work, WOEIP also helped change the
structure of the planning group, so that a com-
munity member of WOEIP now serves as a
cochair. As an WOEIP leader and long time
resident pointed out:
We have moved from doing this truck thing to
being engaged in goods movement, identifying
something that’s local and then actually dealing
with what a clean air plan should look like locally.
Partners and policymakers described
WOEIP’s recent work as critical in getting the
Port of Oakland to commit to an 85% re-
duction of the community health risk caused by
its diesel operations by 2020. Although the
process has been challenging and the details of
the air plan are still being worked out, partners
have described how their work has improved
organizational structures so that the community
and other important stakeholders are now rep-
resented in air planning groups. As another
WOEIP community leader commented:

We’ve been successful on [many] procedural
levels. We were able to change the entire
structure of that air planning group [getting]
a community member on as a co-chair. After we
did that, we said, ‘‘Who else isn’t here? . . . we
think the industry ought to have a co-chair seat
and the health department [too].’’. . . So we
expanded the agenda, setting part of that to
include two other groups we thought were
important, some as allies and some as adversar-
ies, but voices that needed to be at the table. That
kind of approach gets us respect and changes our
perspective as a community organization. It adds
to our reputation in a positive way.
Finally, both the partnership’s early work
and subsequent efforts helped create condi-
tions in which partnership colearning could
occur, and the research and advocacy capacity
of the West Oakland community could grow,
fostering sustainability. As one community
partner noted:
As we did our own research and thought about
things, we were able to ask other questions. It
was good. . .much more of folks’ unknown in-
formation [was brought] out into the community.
Our ability to question, ‘‘Why was this? Why was
this happening here?’’ We were able to do much
more proactive advocacy on a lot of different
levels at the same time.
Similarly, a research partner at the Pacific
Institute spoke of how much she and her
organization continued to learn from the com-

munity and the leadership of WOEIP, particu-
larly about community organizing and advocacy.
New Directions and Building
Sustainability
An important hallmark of CBPR involves
its commitment to building community ca-
pacity as a means of ensuring long-term
Matters | S171
sustainability.21,33 After the truck count and
idling studies and subsequent work to establish
a truck route, WOEIP expanded its own initia-
tives on several fronts, including conducting
a second truck count in partnership with the Air
Quality Management District in 2008, playing
a key role in the formation of the West Oakland
Toxics Reduction Collaborative, and receiving
both a planning grant from the US Environ-
mental Protection Agency and a grant from the
Air District in support of its work. With assistance
from the Pacific Institute, WOEIP also has con-
tinued to build local leadership capacity, offering
a 4-week intensive training for West Oakland
residents on topics including environmental
health and land use planning, an understanding
of the policymaking process, and skill-building in

policy advocacy. Further, and in a major victory
for the West Oakland community, WOEIP’s
executive director was appointed a Commis-
sioner of the Oakland Port Authority in 2007.
The relationships formed between the
WOEIP community partnership and agencies
including the Air District, the Port of Oakland,
and private trucking industry have also con-
tinued to develop. Recently, for example, when
over 1200 independent truckers were threat-
ened with losing the ability to service the Port
due to a delay in getting grants for needed
retrofitting equipment, WOEIP supported the
truckers’ request for an extension, and in the
process helped prevent many of these pre-
dominately immigrant workers from losing
their jobs.
WOEIP’s and the Pacific Institute’s truck
count and related studies and policy level work
continue to serve as a model for others of how
CBPR can help produce solid data and use it to
move forward environmental policy efforts in
a way that empowers and respects the com-
munity. Recently, for example, WOEIP pro-
vided technical assistance and loaned equip-
ment to another nonprofit organization,
Communities for a Better Environment, which
used the partnership’s truck count model in
doing its own truck count study in East Oak-
land.
Finally, and in a further effort to help take
this work to scale, without losing sight of local
concerns, WOEIP helped design the statewide

Goods Movement Action Plan, and WOEIP’s
executive director also served on the working
group of the US Enviromental Protection
Agency’s National Environmental Justice Ad-
visory Council (NEJAC). Drawing on the re-
search of the WOEIP partnership and numer-
ous other groups and organizations, NEJAC
produced a major report with recommenda-
tions for federal, state, tribal, local, and other
agencies on how best to identify, prevent, and
eliminate the disproportionate burden of air
pollution from goods movement in low-income
communities of color.34
Without ignoring the hurdles faced in this
work––and in particular, the failure to get
adequate enforcement of the truck route
ordinance––the value of the partnership’s con-
tributions and their ripple effects in other
communities and on the state and even
national levels, were highlighted by policy-
makers and other key informants. Finally,
the role of this partnership in showcasing the
utility of research collaborations that ‘‘put
community leaders in the drivers seat’’ was
underscored. In the words of a Pacific Institute
partner:
We were not doing the research ‘on them,’ but
they were leading the research effort. They were
asking the questions, choosing the contractor,
deciding the policy solutions, and we were
supporting them with technical and facilitation
support throughout the process. This is com-
pletely the reverse of the typical academic---

community partnerships. What if a high-pow-
ered research institution could be put at the
service of communities (instead of industries and
others)––what dramatic changes could result?
Well, we’ve seen them.
DISCUSSION
Our research goal examined the CBPR pro-
cesses and outcomes involved in the West
Oakland EIP partnership’s efforts to study and
address, through policy level change, the
problem of disproportionate exposure to diesel
truck exhaust in this community. The partner-
ship’s struggles and successes in this regard
were highlighted, as a means of illustrating how
community-led partnerships may use CBPR to
help change environmental health policy or
the broader policy environment.
Although the use of multiple methods of
data collection helped increase our confidence
in the study findings, several limitations should
be noted. Recall problems, particularly sur-
rounding the original research studies con-
ducted in 2003, may have led to inaccuracies
in the reporting of study methodology. To
minimize this, we carefully studied the outside
consultant’s (TIAX) detailed report that helped
corroborate the interviewees’ description of
study procedures. Partners and policy makers
interviewed may have over or underempha-
sized the role of the WOEIP partnership’s
research and advocacy efforts in helping move
policy, and may similarly have under or over-

estimated the role of other stakeholders and
contextual factors. The use of triangulation of
data sources was helpful in partially mitigating
this problem, as we found a high level of
consistency in responses among the 7 key
partners interviewed; their responses were well
corroborated by the policymaker interviews
and archival reviews. However, it remained
impossible to determine with any certainty the
extent to which the WOEIP’s partnership’s
work contributed to policy outcomes. As Ster-
man35 noted, the lengthy time delays in policy-
related work precluded understanding the long-
term consequences of the actions of any in-
dividual actors. As a result, ‘‘Follow up studies
must be carried out over decades or life-
times. . . .’’35 Finally, the nature of this small
qualitative study meant that by definition, the
findings were not generalizable.
The results of this case study complemented
those of a number of other studies in suggesting
the utility of a CBPR approach in producing
credible research that may help promote envi-
ronmental health policy change.11---18,36,37 Con-
sistent with the WOEIP partnership’s experience,
for example, studies credited CBPR efforts with
playing a key role in helping implement policies
to reduce exposures to diesel bus emissions in
Harlem, New York38 and Roxbury, Massachu-
setts11 and to secure the renegotiation of a rule
governing maximum allowable cancer risk from
stationary facilities in southern California.18,39
Moreover, similar to the work of the WOEIP
partnership, several of these efforts have been

credited with helping change the broader policy
environment. The Southern California Environ-
mental Justice Collaborative, for example,
received substantial credit for the state Environ-
mental Protection Agency and other decision-
making bodies increasingly thinking in terms of
cumulative rather than individual risk and taking
community health impacts into account in their
policy deliberations.18,39 In New York City, the
West Harlem Environmental ACTion, Inc. (WE
101, No. S1
ACT) partnership’s high quality research and
effective community-based advocacy helped se-
cure the community partner’s executive director
a leadership role on the task force charged with
developing a statewide environmental justice
policy.38
Finally, and in addition to its role in several
specific policy wins in Long Beach, Los
Angeles, and the Inland Valleys (e.g., adoption
of the joint Ports’ ‘‘Clean Air Action Plan’’),
Trade, Health & Environment (THE) Impact
project was credited with helping
change the debate on neighborhood contamina-
tion through increased community participation
and recognition of the health impacts from living

in close proximity to mobile source air pollution.
A recent decision to delay expansion of
a major freeway to enable more community
input in the deliberations was credited in part
to THE Impact Project and its successes in
changing the policy environment by ‘‘[elevating]
community voices in the policy arena, while also
using the science and policy work of the aca-
demic partners to strengthen those voices.’’40
Several of the factors identified in the pres-
ent study as critical to the WOEIP partnership’s
success also reflect those of other community---
academic partnerships with a similar goal of
helping to redress environmental injustice
through policy change. The need for a strong
community base including effective alliance
and community leadership has been widely
cited.14,15,19,33,38,39,41 Links to coalitions, for ex-
ample, have been shown to help ‘‘reframe an
issue so as to broaden support.’’41 The impor-
tance of credible science that can ‘‘stand up to
careful scrutiny’’ additionally has been widely
emphasized,18,36---38,42 as has the effective com-
bining of research, community organizing, and
policy advocacy.11---14,17---19,43
Other CBPR case studies highlighted the
importance, especially early on, of strong
technical assistance as both strengthening the
research and helping open doors and forge
alliances with respected entities that could be of
strategic importance in the future.12,14,17,36
Although academics sometimes are reticent to be

involved with the mass media, Farquhar and
Wing44 noted:
Environmental health findings presented via
mainstream media channels can protect exposed
community members, motivate participation in
democratic processes, and influence public
opinion and policymakers.
Effective media advocacy, in which the mass
media were used strategically to promote
a community or public policy agenda, contrib-
uted substantially to the visibility and impact of
the WOEIP partnership’s work, and have like-
wise been important to other environmental
policy-oriented CBPR collaborations.11,14,17----
19,42,46 Ritas’45 online resource ‘‘Speaking Truth,
Creating Power: A Guide to Policy Work for
Community based Participatory Research Prac-
titioners’’ may be useful to partnerships wishing
to incorporate this and other forms of policy
advocacy in their CBPR efforts.
The high value that the WOEIP partnership
assigned to building collaborative relation-
ships with potential policy allies and regula-
tors, as well as other community-based
organizations and local and regional coali-
tions, was reminiscent of the work of other
successful environmental justice efforts
around the country.11---12,14---19,39,42,43,45 Yet the
WOEIP partnership’s inclusion of representa-
tives of the trucking industry, whose behavior
they sought to change, may have set an impor-
tant new standard in such work. This inclusive

approach, captured in the catch phrase ‘‘who else
should be at the table?’’ appeared critical to such
policy wins as getting a truck route ordinance
and more recently, getting the Port of Oakland to
commit to an 85% reduction in the community
health risk caused by its diesel operations by
2020––a policy that could ultimately have greater
health payoff for the community than the ill-fated
truck route. The community organizing maxim
that there are ‘‘no permanent friends, no perma-
nent enemies’’ appears to have held the WOEIP
partnership in particularly good stead in this work.
Yet as this and other CBPR case studies
focused on environmental justice illus-
trated,36,38,45,47 tensions emerged throughout
this process that should be addressed openly and
with an eye toward finding ‘‘common ground.’’
The need for WOEIP and Pacific Institute
partners to become comfortable with their dif-
ferent skill levels and roles in the more technical
aspects of the research was critical for the process
to go forward, as was the subsequent working
out the tensions some community partners felt
about including truckers in policy deliberations.
Finally, as this and other environmental justice
projects case studies illustrated36,38,48 policy
wins can be shallow victories if not followed by
strong implementation commitment and over-
sight. Each of the 7 community and outside
research partners interviewed commented on
the failure to enforce the 2006 truck route
ordinance as a bitter pill to take, even if not
entirely unexpected, in the aftermath of a strong,
inclusive, and well-fought campaign. In retro-

spect, it would have been useful for the com-
munity and the WOEIP partnership to include in
their data collection documentation regarding
implementation of the ordinance, and further, for
residents to work with local law enforcement
to cite offenders. Yet as noted previously, the
dearth of sufficient police officers, and their
understandable focus on problems such as vio-
lent crime, probably doomed the ordinance
strategy from the outset. Further, as several of
those interviewed commented, relatively easy
policy wins like the passage of an ordinance,
although important symbolically and in increas-
ing community visibility, may not in themselves
be strong enough to bring about real change.
In retrospect, and in addition to its sound
research, the major accomplishment of the
WOEIP partnership may well have been in
substantially amplifying community voices in
the policy arena: WOEIP and its partners are
routinely consulted by key decision-making
bodies and are often ‘‘at the table’’ when
important decisions are being made. The ap-
pointment of WOEIP’s director to the Port
Commission further stands as an important
signal that West Oakland and its leaders and
organizations are making headway in attain-
ing the ‘‘procedural justice’’ (having a say in
decision-making affecting their community)49
that is an integral part of environmental justice
for low income communities of color.17
The fact that WOEIP conducted its own
truck count study and brought in its own

federal and local grant funding, are suggestive
of the longer term contributions of this CBPR
partnership to the community capacity building
that can further sustainable change. As Srini-
vasan and Collman52 and others46,47 pointed
out, building such capacity and striving ‘‘for
a more equitable partnership––not only in the
distribution of resources but also in power/
authority, the process of research, and its out-
comes’’ is a goal for which CBPR partnerships
need to strive.50
Matters | S173
Recent changes in the context within which
environmental health-focused CBPR takes
place must be carefully monitored for their
potential impacts, however. On the positive
side, increasing collaboration between multiple
partnerships and organizations concerned with
diesel emissions and their health impacts, in-
cluding, in California, the Ditching Dirty Diesel
Collaborative,31 and the statewide coalition,
Community Action to Fight Asthma51 may be
increasing the clout of community, health de-
partment, and academic partners working to
secure broader policy change in this area.
Conversely, major cutbacks associated with the
severe recession may also take a toll on this
work, both in constraining funding and resulting

in a weakening of regulations or implementation
in the name of cost containment. Finally, as
Sterman35 noted, ‘‘Complexity hinders the gen-
eration of evidence’’ and any efforts to discuss
the contributions of CBPR partnerships to
changes in policy or the policy environment must
be undertaken with considerable caution.
Bearing these precautions in mind, however,
the WOEIP partnership may serve as a useful
model for community and academically trained
researchers interested in establishing sustain-
able local partnerships that can produce cred-
ible research, build community capacity, and
potentially contribute to changes in policy and
the policy environment that may promote
environmental health. j
About the Authors
Priscilla A. Gonzalez is with the Berkeley Media Studies
Group, Berkeley, CA. Meredith Minkler and Analilia P.
Garcia are with the School of Public Health, University of
California, Berkeley. Margaret Gordon and Brian Beveridge
are with the West Oakland Environmental Indicators Project,
Oakland, CA. Catalina Garzón and Meena Palaniappan are
with the Pacific Institute, Oakland, CA. At the time of the
study, Swati Prakash was with the Pacific Institute, Oakland.
Correspondence may be sent to Meredith Minkler, DrPH,
MPH, School of Public Health, University of California,
Berkeley, 50 University Hall, Berkeley, CA. 94720-7360
(e-mail [email protected]). Reprints can be ordered at
http://www.ajph.org by clicking the ‘‘Reprints/Eprints’’ link.
This article was accepted July 12, 2010.

Contributors
M. Minkler originated and supervised the study including
conceptualization, data collection, analysis and interpre-
tation, and the writing of this article. P. A. Gonzalez and
A. P. Garcia assisted with data collection, analysis and
interpretation, and in the writing and editing of the
article. M. Gordon, B. Beveridge, M. Palanippan, C. Garzón,
and S. Prakash all provided valuable information and
feedback, including help with interpretation of findings
and editing of the final version of the article.
Acknowledgments
This study was supported by a grant from The
California Endowment and the authors are grateful
to the Endowment, and particularly former Research
Director Will Nicholas, for their support.
The authors also acknowledge project team
members Victor Rubin, Angela Blackwell, Mildred
Thompson, and other colleagues at PolicyLink, Inc.,
and research consultant, Nina Wallerstein, as well
research assistant, Alice Ricks, for their contributions.
Steve Mastronarde also provided helpful perspec-
tives. We are especially grateful to the many com-
munity and academic partners and policymakers
who generously shared their time and their insights
to make this study possible.
Human Participant Protection
This study was approved by the institutional review
board of the University of California, Berkeley. All
key informants signed informed consent letters be-
fore their participation, and safeguards were taken to
ensure confidentiality.

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In: Minkler M, Wallerstein N, eds. Community-Based
Participatory Research for Health. San Francisco: Jossey-
Bass; 2008:263---283.
45. Ritas C. Speaking Truth, Creating Power: A Guide
to Policy Work for Community based Participatory
Research Practitioners; 2003. Available at: http://
depts.washington.edu/ccph/pdf_files/ritas.pdf. Accessed
January 15, 2010).
46. Minkler M, Breckwich Vásquez V, Tajik M, Petersen D.
Promoting environmental justice through community-based
participatory research: the role of community and partner-
ship capacity. Health Educ Behav. 2008;35:119---137.
47. Israel BA, Krieger J, Vlahov D, et al. Challenges and
facilitating factors in sustaining community-based
participatory research partnerships: lessons learned from
the Detroit, New York City and Seattle Urban Research
Centers. J Urban Health. 2006;83(6):1022---1040.
48. Minkler M, Garcia AP, Williams J, et al. Si se puede:
using participatory research to promote environmental
justice in a Latino community in San Diego, CA. J Urban
Health. 2010;87:796---812.

49. Kuehn RR. A taxonomy of environmental justice.
Environ Law Report. 2000;30:10681---10703.
50. Srinivasan S, Collman GW. Evolving partnerships in
community. Environ Health Perspect. 2005;113(12):
1814---1816.
51. Community Action to Fight Asthma. Available at:
http://www.rampasthma.org/about/the-cafa-network.
Accessed May 12, 2010.
Matters | S175
PRACTICALITIES OF ACTION RESEARCH
APPROACHING AN ORGANIZATION
I think it is important to strategically plan how you approach an
organization. In my situation I had
various situations. In some cases I was contracted to go into an
organization, they sought me out, so I
had entrée into the management level, and it was very simple to
just arrange a meeting and begin to
work. In other cases, I was tasked with recruiting organizations
for particular programs, could be grant
initiatives, other initiatives that, in many cases, the Federal
Government was promoting, and I was tasked
with being the performance consultant for those initiatives. So
in those cases, where these were more or
less cold calls, I had the greatest success with focusing on a

Return On Investment sort of approach.
Really approaching organizations with a, what is in it for them
presentation. So that took some
groundwork, really had to do some researching on the
organization, take a look at what is important to
them, set up an initial meeting with folks to find out what is
their bottom-line, what matters most to that
organization. And then we of course had to make a presentation
as to how we felt we could impact that
bottom-line. So in many cases, to deal with anything from
improving customer service and customer
satisfaction. It could deal with retention issues, for students or
for employees that were costing the
organization money for folks who were not retaining. They
could do with improving test scores, reducing
waste rates, for manufacturing type of organizations. But my
job was to figure out what was really
important to management and the folks that were approving the
work, and then make it very clear to
them how we could impact those particular elements for them,
and how we would present that to them.
So it was a very involved -- there was a lot of homework
involved in approaching an organization. We did
not just walk in there cold. That would have been a death nail to
us. We really had to have our homework
done and be able to show them the kind of impact we could
have. We would generally try to approach
initially by phone to set up a face-to-face interview, face-to-
face appointment. We prefer to do things
face-to-face. We had a strong record of performance
improvement with these types of initiatives that we
could display, and we felt that was based done face-to-face.
That did not mean that we always got first
entrée with the highest management level, sometimes it would
be mid-management or supervisory level,
but somewhere we wanted to get in that first level, and then we

could often work our way up. So
oftentimes that would result in two or three meetings, and we
were amenable to however they wanted to
do that. Some organizations, it was easier to get to top
management than others, just depends how
stratified. But again, we made it very clear from the onset that
we wanted to impact their bottom-line. We
felt we could do that. We had a history we wanted to show, and
we felt that we could best do that with a
face-to-face meeting, and that made them much more receptive
to freeing up a little time for us.
REACHING DECISION MAKERS
In many organizations when you are trying to figure out, who is
the individual who will make this final
decision, you really do have to go through some layers. The
bigger the organization, the larger the onion,
you have to peel back the layers. Probably the best way to
demonstrate that, I will share a little story with
you. At one point I was mentoring new performance consultants
in the field of Federal Government as
one of six individuals in the state to go around and mentor
folks, to train them to do what I did, because
they wanted a bigger cadre of folks that were working
effectively in the field. So I had a mentee who had
been contacted by a huge banking organization, just the most
grand banking organizations that we have,
very well-known name here in city, and was asked if they
wanted to competitively bid for a project, to
come in and do some customer service kind of performance
improvement. So she was extremely
nervous, and she called me and she said, can you help me, this
is huge for my first time out of the box,

can you come along with me to this meeting? So since I knew
there would be a number of folks going, I
suspected that it might not be top management, we would be
going through a filtering kind of system. So
when we got there, we were fingerprinted, lenses of our eyes
were read for identification. We had to
nearly be frisked. I mean, it was incredible security. They
whisked us up in the private elevator to the top
floor. The Director of Training, Seth, met with us, asked us to
make a presentation and talk about what
we could do. We started the conversation with, we want to know
what is important to you, and we want
to impact your bottom-line. This is all about Return On
Investment for you. Immediately he said he had to
stop the meeting, which I was a little concerned about, because
typically that is a pretty positive approach
with folks. He ran and got a phone, with the speaker phone
attached, and he put the speaker phone in
the middle of the table, he said, I need to call our VP of
Operations who is working in the Boston office
today, and get her on the phone. He called her up. We heard this
voice from the phone. He explained
what had just transpired. And she said, I just want to let you
know, not only do you have the contract, but
I want to know why the other dozen folks that we interviewed
had no interest in our bottom-line, we are
a bank, we are about money, why was not anybody interested in
impacting our bottom-line, that is what
this is about? So she congratulated us. We got a very nice
contract out of that. But we definitely had to go
through that filtering process and work through the training
director to get to that VP, who was in an
entirely different city. She told the training director she did not
want to be bothered until somebody
started talking Return On Investment, and then he could call
her, and she would get involved with the

interview. They will set the playing field, and you really need
to work your way along until you get to that
individual at management that can make the final decision.
PITFALLS OF ACTION RESEARCHM
I think it is very important to approach action research projects
without preconceptions. We have a
hunch that something is going on, or something needs
addressed, but oftentimes there is a tremendous
back story in that organization, even if it is your own
organization, you might not be fully aware of it
impacting that performance, or impacting those results. Many
times I would go into an organization
being told that I would be conducting one type of training and
then discover that something else entirely
was needed to impact the bottom-line. I think it is important for
those trainees and those participants to
trust you. If there is not a level of trust, they are not going to
divulge what that back story is. I will share
one quick story with you, I think illustrates that pretty clearly. I
was contracted to come in and work with a
number of master carpenters to do remedial mathematics, which
sounds extremely odd, it sounded odd
to me at the time that master carpenters would not know how to
do mathematics since that is what they
do for a living. But there was such a tremendous waste rate at
this organization, which was a custom
cabinetry business, that the VP was extremely concerned, they
were just wasting too much product. They
took too much wood to build the products that they did on, and
they were breaking even, they were not
making any money. So the assumption was, these folks do not
know how to read a rule, they cannot read
a blueprint, and they are making mistakes. When I got into that
organization and those workers began to
trust me, I found out that they really did know how to do

mathematics, they were exceptionally skilled at
it, but they were treated extremely poorly by the management.
So their method of retaliation was, we will
figure out exactly where this business breaks even on a contract,
so we get paid, and then we will start to
waste product after that, so that the organization does not see
any profit, because they are not going to
make a profit off our backs when they treat us so poorly. When
they treat us better, they will make more
money. So what I was contracted to do and what I ended up
doing were two completely different things.
It really needed to be some coaching of management versus
some remediation for mathematics, for
some carpenters. So you really have to be open and have that
sixth sense of, something is not right here,
I need to dig deeper and find out what the root cause is of this
performance issue, and sometimes it is
quite surprising. In a situation where what management
perceives to be the problem versus what
actually is the problem, I think you need to be very, very
careful in how you approach management about
that. And again, I always kept my focus on what is profitable to
this business, what is important to this
business. That is our focus and everybody is focused on that. In
this particular case that I just shared, I
brought in an outside consultant to work with management, who
specialized in those kind of very
sensitive situations, but always couched around, your job is
extremely difficult, you are under
tremendous amount of stress, we have coaching and strategic
training that can help you deal with the
situation for being a manager at this level. Let us help you make
this business profitable and make this

work climate more amenable to everybody that works here. So
that was generally well received.
COMMUNICATING RESULTS
I think that communicating of the result is one of the most
critical pieces of the work that you will do,
because that is the take away that everyone has from the project
that is done. My favorite quote is from
Jack Phillips of the ROI Institute, who says, if you do not plan
to communicate your data effectively, do not
bother spending the time to collect it. People really need to
understand what happened, and you need to
be able to present that in a way that is well received by them.
So very early in the conversations with
management or whoever the individual was that I was working
with, I would spend time talking about,
what do you expect to see as results, and how do you expect
those results to be portrayed? What kind of
platform can you give me to talk about the impact that we had?
And that would include, not only the
impact at the very end of the intervention, but I would come
back, in some cases several months, several
weeks later to make sure there really was a transfer of learning,
that people really did implement what
we had been training them to do. So I would negotiate all that
upfront. I would make sure that I had time,
and I had the resources available, I had access to the people to
come back and collect that post-
intervention data. Otherwise I could not prove that I had an
impact. And as a person who made their
living as performance and consulting, that was critical to my
survival. So we often had to negotiate that
upfront, because if things went well, oftentimes it was, well, the
production line is going well now or test
scores are increasing now, and we are very busy, so we cannot
have you come back in here, and if that

was not negotiated in my contract, it could be a problem. So
needs to be talked about upfront. Need to
talk with management about what kind of data they like to see.
Are they numbers people or are they
stories people? Do they want to see hard data from production,
from waste rates, from test scores, what
are they looking for? That way I could be very clear about what
kind of baseline I collected, so I knew what
the picture was in that organization before I started, and then
my post-intervention data, and those two
would correlate so that I could show a change, because it would
not make any sense not to have that
baseline if I could not show that I increased or improved
anything. I learned a very difficult lesson as a
performance improvement specialist and that was, I always
negotiated to have a face-to-face meeting
about the results. I learned early on that just writing up a
narrative report and handing it off to a
supervisor often was the end of the interaction with all that
work that I had done, no one had read it, the
supervisor, at that particular level, knew things had gone well,
and we would be done. So I would arrange
very early on in those discussions to have a time to get back and
present the results, maybe it was at a
board meeting, or maybe it was at a management meeting, or
some type of event that they already had
scheduled, but I would want 15, 20 minutes of time to get out
there and display what we had done. I used
a lot of graphic representation of data, so it could be quick. I
could show a quick slide with a graph and
show, here is where we were, here is how we improved. I used a
lot of stories from the participants and
trainees, in their own voices. I would put their picture up. I
would record their voice, talking about how

wonderful this particular intervention had been. So they really
could connect with their own people, and
the impact that we had, and I had hard data to back it up, that
was displayed in a way that was very easy
to read, very easy to communicate, and something that they
would take with them. And then I always left
them with the hard copy as well, along with my business card of
course, so they could contact me for
future work. But my greatest advice is, do not just hand off a
report, get some face time with people, and
give them something powerful to look at during that face time,
that will really help them connect with the
results that you had. I think in the presentation of your data, it
is important to remember that
academicians will be very interested in the letter of your
dissertation, every element of your dissertation,
every paragraph, and that you have followed all five chapters,
and that you have met all the criteria of
academicians. Management will most likely not have time to sit
down and read your dissertation. They
tend to like business oriented type of reports, bulleted
statements, graphs, very quick and dirty. I typically
had about 15 minutes to present my data at meetings. 15, 20
minutes would be the average. So I could
not stand there and recite my dissertation. But definitely that
work I had done for my dissertation
provided me with the background and the confidence and the
experience to do an effective executive
summary in 15 minutes. The key was, I just really had to focus
on the results with management, that is
what they were interested in, that would get me back in the door
the next time. And I would certainly
have all that background available for anyone that needed it.
But you really need to communicate
effectively for your particular audience, so that can mean a

variety of things, whether you are writing an
article on the study, whether you are writing the dissertation,
whether you are doing an executive
summary for management, you really need to be able to massage
that data in a way that is effective for
that particular audience.
CREDITS Subject Matter Expert:
Interactive Design:
Instructional Design:
Project Management:
Dr. Jamie Barron
Patrick Lapinski, Marc Ashmore
Liz Anderson
Julie Greunke
L i c e n s e d u n d e r a C r e a t i v e C o m m o n s A t t r i
b u t i o n 3 . 0 L i c e n s e .
FOCUSING THE NEEDS ASSESSMENT
Introduction
Needs assessments require diligent preparation in order to be
carried out effectively. Before assembling
your needs assessment committee (NAC) you should follow a
few steps to be sure you are asking the
right questions and involving the right stakeholders.

The purpose of focusing the needs assessment is to ensure that
you gain the proper perspective of the
situation before delving too far into the issue at hand. These
public decision issues can be big and messy,
and it's easy to get off track or try to take on too much in one
needs assessment effort.
Focusing is important!
PHASE ONE
Preliminary scoping of the situation
The purpose of these activities is to conduct an initial scan to
guide the course of your needs assessment.
During this preliminary phase you will attempt to discover other
relevant stakeholder groups and areas
of information.
Ask questions
Ask those requesting the needs assessment (this very well might
be yourself) simple questions as:
• What is the size of the problem area? How frequently does the
problem occur? How big is it?
• What data is needed?
◦ What type? Qualitative, quantitative, or both?
◦ Where can you gather this data? Does it already exist? If so, is
it still relevant?
◦ Will you need to gather it yourself? How? What tools are
available, cost effective, and won't
take too much time?

• Who else should be involved? Who else is affected by this
problem area? Who would be needed on
a NAC?
• What is the timeline? Does this need to be done by a certain
date?
• What funds are available to support NAC activities? What
about funds to solve the problem?
Find others to interview
In asking the previous questions, you should be able to
determine who else might be affected by the
results of the needs assessment. You will want to meet with
them to determine their perspective.
These individuals very well may be involved on your NAC.
Meeting with them will prepare you for
reactions they may have at the initial NAC meeting.
Brief literature search
Once you have determined the scope of the problem, you will
want to determine what type of
information exists.
What other agencies in other parts of the country have
conducted similar projects?
What was the result?
Doing this will prepare you for possible barriers, and may help
to either widen or narrow your scope
further.

Consolidate thoughts
After you have met with possible NAC members and
stakeholders, you will want to organize your
thoughts in order to gain a clear picture of your needs
assessment environment. You may want to create
a mind map to plot out relationships between stakeholder groups
and possible data.
Remember, focusing the issue is important!
While you may present various options, this is the time to begin
the process of narrowing the issue to
something that can be achieved with a reasonable amount of
effort.
Construct summary
Summarize your thoughts in a way to effectively communicate
your initial reactions to others.
• Where do you think this needs assessment should focus?
• Who should be involved?
• What data should be gathered?
• What do you think the result may be?
By covering these areas, you will give others perspective into
your goals and direction for the needs
assessment.
Have others review summary
Having peers review your summary will help to prevent your
own personal biases from creeping in early
in the project and point out some areas you may have missed.

While these individuals may or may not be directly involved
with the needs assessment, having another
perspective will help focus your assessment.
PHASE TWO
Coming to an agreement on next activity
It is critical that those involved with the needs assessment are
on board with your plan. Without their
approval, you run the risk of the results being ignored, or going
down the wrong path completely.
By engaging the group to brainstorm next steps and agree to a
plan of action, it allows you as a facilitator
or participant in the needs assessment to hold others involved
responsible for the project and its end
result.
Ask group for next steps
• Based on your summary, what do those involved with the
needs assessment feel is the best plan of
action?
• Should a larger NAC be created?
• Who do they feel should be involved?
• What data would they like to see gathered?
By asking those involved to help with the next steps, you not
only gain another perspective but you will
also assure they have more ownership in the project. When

asked to work on a task that is their own
idea, members are more likely to follow through.
Construct memorandum of agreement
Having those involved with the needs assessment formally agree
to a plan of action is critical to the
success of your project. This will increase the likelihood your
plan will be followed by members by
allowing others to agree on the direction of the project thus
giving them a larger stake in the project.
CREDITS Subject Matter Expert:
Interactive Design:
Instructional Designer:
Project Manager:
Yvonne Kochanowski
Christopher Schons
Brian Powers
Kristin Staab
b u t i o n 3 . 0 L i c e n s e .
Qualitative Needs Assessment Methods
Aspect Group Forums Focus Groups Nominal Groups Other
Methods

Purpose Determine the
perceptions of problems,
needs, and issues from
large groups (>>40).
Obtain feedback on work
done to date.
Understand how small,
generally homogeneous
groups view an issue
regarding an area of need.
Learn how issues and/or
needs are referred to as a
prelude to survey
development.
Small-sized groups
generate multiple ideas
about needs or concerns
in a short period of time.
Obtain priorities about
those ideas.
Interviews, observations,
etc. - mostly, but not
exclusively, used to collect
data on the "what should
be" states.
Ease of Implementation Seemingly simple, but
significant behind the
scenes work.

Highly dependent on skills
and experience of group
leader.
Straightforward, but care
should be taken in
selecting facilitator so
groups will open up for
that individual.
Procedural rules must be
followed, or the properties
of the technique
disappear.
While most of the other
techniques are easily
implemented, they will
require extensive
preparation in some
cases.
Cost Considerations Relatively inexpensive, but
there are upfront costs for
planning, publicity,
refreshments, and
especially for a good
external leader.
Participants are usually
paid a stipend, and
appropriate leadership is a
must that requires
additional expenditure.

Relatively inexpensive way
to generate ideas.
Generally inexpensive, but
methods such as mailed
Delphis and future
scenarios may take
extensive time to have
returned and developed
for content.
Value of Information
Obtained
High value especially in
regard to feedback on
directions taken, findings,
community views, etc.
High value for
understanding frames of
reference, and/or for the
generation of instruments.
High value in terms of
producing and prioritizing
many ideas in a short time
period.
Can be high depending on
what kind of information
is required (e.g. the
DACUM process and
critical incidence
technique for task
analyses).

Issues Usually occurs after the
fact (i.e., following a
number of other activities)
and is not a substitute for
them.
Most of the time will not
produce discrepancies.
Very limited ability to get
at discrepancies.
What people say at a focus
group may not relate to
how they will act at a later
time.
Good at generating ideas,
but does not yield
discrepancy information.
Discussion only occurs
toward to end of the
season.
Some of the techniques
are not often observed in
the literature of Needs
Assessments.
b u t i o n 3 . 0 L i c e n s e .

I
1
Principles of Community-Based Participatory Research
“Community-based participatory research is a collaborative
research approach that is designed to ensure and establish
structures for
participation by communities affected by the issue being
studied, representatives of organizations, and researchers in all
aspects of the
research process to improve health and well-being through
taking action, including social change.”1
n this chapter, I will provide an overview of community-based
participatory research (CBPR) and accomplish the
following objectives:
• Review the principles and foundations of CBPR
• Discuss the rationale for involvement in CBPR and when to
use it (why bother?)
• Introduce cases in which CBPR was used to investigate
Policy issues
Urgent health crises
Health disparities
• Compare CBPR with traditional research
• Describe the strengths and weaknesses of a CBPR approach
OVERVIEW OF COMMUNITY-BASED PARTICIPATORY
RESEARCH
As is so often the case in community health practice, a problem

is met head on with a solution. Unfortunately, while the
solution represents a response to an urgent identified need, it
often lacks an evidence base. We recognize that research-
based innovations make their way slowly, if at all, into
community practice.2, 3 This has been documented extensively
in the literature with regard to health in particular and speaks to
the breakdown between academic and community-
based practitioners. How can we speed the uptake of evidence
into community practice? How can we identify the
appropriate community-relevant research questions? How can
we break down the barriers between researchers and
community partners? How can communities translate their own
practice-based evidence for consumption by the
research community? There is a great deal of current interest in
strategies to improve the rapidity of the translational
research process.4 Engaging the community may be one way to
bridge the gap between science and practice.
Community-engaged research (CeNR) exists on a continuum
ranging from research in the community setting to
research that fully engages community partners. CBPR
represents one end of this CeNR spectrum (Figure 1.1). The
CBPR approach encourages engagement and full participation of
community partners in every aspect of the research
process from question identification to analysis and
dissemination.
The goal of CBPR is to create an effective translational process
that will increase bidirectional connections between
academics and the communities that they study. This approach
is not limited to specific disciplines but can be utilized
whenever conducting community research. CBPR hinges on the
relationship between the researcher and the community
under study. The equitable aspects of the partnership and the
participatory nature of the work differentiates CBPR from
other traditional research approaches. In addition, in CBPR,

there is a close linkage between the academic pursuit of
generalizable knowledge and the use of that knowledge for
action at the local level. Thus the practice of CBPR takes a
somewhat different track than that of traditional research.
Throughout this chapter, I will focus on the rationale for
CBPR, the principles, and the strengths and weaknesses of the
approach in order to prepare the investigator to engage in
CBPR projects.
Figure 1.1 Community-Engaged Research Continuum
Source: Virginia Commonwealth University Center for Clinical
and Translational Research 2008 (Looking at CBPR Through the
Lens of the
IRB. Cornelia Ramsey, PhD, MSPH Community Research
Liaison, Center for Clinical and Translational Research,
Division of Community
Engagement, Department of Epidemiology & Community
Health) http://www.research.vcu.edu/irb/Looking-at-CBPR-
Through-the-Lens-of-
the-IRB.ppt
Historically, research involving communities has not always
included community partners in a participatory manner.
Rather, research may be done in communities or on community
residents, using the community as a laboratory. As a
result, members of underserved communities often have
negative perceptions of research and may feel exploited by
investigators who conduct research, depart, and leave nothing
behind. The worst-case scenarios such as the Tuskegee
experiment have left many community members, particularly
those of color, feeling distrustful and reluctant to
participate in research.5 Thus, research that may improve health
and other outcomes may not include populations at

highest risk or result in action or sustainable change at the
community level.
In order to improve the relevancy and acceptability of research
to communities and break down translational barriers,
community members are increasingly demanding equality in the
development and conduct of research. In addition, they
are interested in shared ownership of the resulting data and in
the application of results to action in practice or policy. In
short, they want to have their voices heard and to participate in
shaping the topics for study, identifying the emergent
questions, and conducting investigations into the issues that are
meaningful to their communities. They want to be part
of the research team and see that the results are utilized to
remedy problems at the community level.
Changing the research paradigm to include community members
in a participatory manner requires a new approach
that includes the formation of equitable partnerships between
academia and community members in which there is
mutual respect and both parties contribute and benefit. Thus, the
goal of the CBPR approach is to produce research that
is relevant to the life circumstances of communities and the
people who reside within them.6 When embraced by
community partners as a shared endeavor, CBPR has the
potential to catalyze actionable health improvement in real
time.
THE FOUNDATIONS OF CBPR
CBPR is only recently finding its way into the biomedical
literature. However, it has been previously used in a variety
of disciplines ranging from anthropology to education and
psychology. Sometimes called “action research,”
“participatory research,” “participatory action research,”7 or
even “street science,”8 it has been used to examine

environmental health issues, educational strategies, and
international health issues.9 These “participatory research”
approaches share a core philosophy of inclusivity and of
engaging the beneficiaries of research in the research process
itself.10 Similarly, CBPR is built on a foundation of social
justice and empowerment, with its roots in feminist theory
and community organizing. Feminist theory focuses on the
historical and cultural oppression of women and drives
toward gender equality and empowerment.11 Community
organizing purports that individuals together can make a
difference in their own communities through group action.12,
13 Both of these theories recognize that empowerment of
the oppressed can result in community action for social change.
Two distinct traditions—that of Kurt Lewin, who coined the
term action research, and that of Paulo Freire, who
developed “emancipator research”—stand out as having
influenced CBPR. Kurt Lewin in the 1940s was one of the first
to use the term action research. Lewin sought to solve practical
problems using a research cycle that involved planning,
action, and investigation of the results of action.7, 14 This
iterative process paired the researcher with community
members as partners in the investigative process. In 1970, Paulo
Freire, the Brazilian educator, changed the power
dynamics in research by depicting the researcher as facilitator
and catalyst rather than director in his book, Pedagogy of
the Oppressed.15 As Freire noted, knowledge is connected to
power—but whose power? Knowledge does not only
emanate from academia; rather, “people” also create and
possess knowledge. This perspective shifts the concept of
research from one in which the community is a laboratory for
investigation to one in which community members not
only participle in the inquiry process but also contribute their

own knowledge. Freire framed the concept of “popular
education” and argued that the teacher must be open to learning
from the student. This colearning process based on
emancipator conceptions has greatly influenced the use of
CBPR approaches.7
In CBPR, the basic tenets of this participatory approach assume
that there is knowledge and benefit in the shared
partnership between academia and community. In Street
Science, Corburn delineates where the power lies in the
production of knowledge and highlights the value of local
knowledge as an important component of the research
process. In his examples, community members are the first to
identify the question for study, and researchers are called
to assist in solving real-world, practical problems8 (Table 1.1).
Today, many view the CBPR process as iterative, similar to that
described by Lewin. This allows the
academic/community partnership to utilize data, refine
programs, and ask additional questions. This is not unlike the
Plan Do Study Act Cycle (PDSA) used in quality improvement
(Figure 1.2). The systematic collection of data provides
the community with opportunities for reflection, adjustment,
and improvement in real time. CBPR offers access to data
and skill sets that support this process. For example, in the
following Everett example, community members observed
an issue in their community that they wanted to address. Their
question—Was the presence of Immigration and
Customs Enforcement (ICE) impacting the health of the
immigrant community?—required additional data. While they
lacked the skills to conduct the investigation, they possessed an
extensive knowledge of the community context, and
they were invested in participating in the data collection,
interpretation, and its ultimate use to shape local policy.
Table 1.1 “Street Science”: Where Is the Power in Knowledge

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