1. Bonnie Duran DrPH Professor,
University of Washington School SocialWork & Public Health
Director, Center for Indigenous Health Research
IndigenousWellness Research Institute www.iwri.org
Sitting Bull College
11/6/19
1
2. 4CC Project
Dine Unity Project
et. al
Madame Chair and the Navajo
Nation HRRB
Social Location
3. 1. Define and describe the role of Science in
Colonization
2. Rationale for CBPR
3. Methods: Developing and Maintaining
Partnerships
3
6. 1. Control of Economy-land appropriation, labor
exploitation, control of natural resources
2. Control of Authority-government, normative social
institutions, army
3. Control of Gender and Sexuality- family, education
4. Control of Subjectivity and Knowledge -epistemology,
education and formation of subjectivity
Quijano A. Coloniality and modernity/rationality. Cultural Studies 2007;21(2-3):168-178.
7. Western values and culture are
universal and the pinnacle of
social evolution;
Science is neutral;
Subjectivity is universal and
transparent;
Resistance is ignorance;
Learning is uni-linear
10. Garth, T. R. (1923). A Comparison of the Intelligence
of Mexican and Mixed and Full Blood Indian Children.
Psychological Review, 30, 388-401.
Parker, T. (1891). Concerning American
Indian Womanhood-An Ethnological Study.
American Gynecology and Pediatrics, 5, 330-341.
14. The understanding of the world is
much broader than theWestern
understanding of the world.
There is no global social justice
without global cognitive justice.
A crucial epistemological
transformation is required to
reinvent social emancipation on a
global scale.
14
15. Distributive epistemic
injustice: “the unfair
distribution of epistemic goods
such as education or
information”
Discriminatory epistemic
injustice: a more specifically
epistemic kind of wrong, which
itself comes in two kinds:
Testimonial injustice
Hermeneutical injustice
15
16. Testimonial Injustice: a
reduction in the credibility of a
speaker due to prejudice in the
hearer
Hermeneutical Injustice: a
reduction in the intelligibility of
the experience of a person who
is a member of a marginalized
group, either to herself or to
others, due to a lack of
hermeneutical resources in the
community
e.g. Sexual Harassment 16
17. Knowledge, race and social position
Interpreter, health educator, health systems navigator,
medicine person…
•…driver
Nursing outlook,
June 1961
18. MODELSARE “AN IDEALIZED
REPRESENTATIONOF REALITYTHAT
HIGHLIGHTS SOMEASPECTSAND IGNORES
OTHERS.”*
“MODELSOF COURSE ARE NEVERTRUE,
BUT FORTUNATELY IT IS ONLY
NECESSARYTHAT
THEY BE USEFUL”**
18
* Pearl, J. (2000). Causality: Models, reasoning, and inference.
Cambridge, England:Cambridge University Press.
** Box, G. E. P. (1979). Some problems of statistics and everyday
life. Journal of the American Statistical Association, 74, 1–4
19. “ CBPR refers to a partnership approach to
research that equitably involves
community members, organization
representatives, and researchers in all
aspects of the research process.”*
Israel BA, Eng E, Schulz AJ, et al., eds. Methods in Community-Based
Participatory Research for Health. San Francisco, Calif: Jossey-Bass; 2005
19
20. 20
“Systematic inquiry, with the participation of those
affected by an issue for the purpose of education and
action or effecting change.” Green et al., 1994, 2003
“ 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.” AHRQ Report, 2004
21. Participatory Research is an Umbrella Term:
Action Research
Participatory Action Research
Emancipatory Research
COMMUNITY-BASED PARTICIPATORY RESEARCH
popular epidemiology
cooperative inquiry
empowerment evaluation
Practice Based Research Networks
Patient Centered Outcomes Research
PARTICIPATORY RESEARCH
23. Spectrum of Participation:
(Cornwall 2008)
Compliance
Co-option
Consultation
Co-operation
Co-learning
Collective action
Cornwall, A (2008) Unpacking “Participation” Models, Meanings and Practices. Community
Development Journal; 43(3): 269–283.
“Token” involvement of
knowledge users
Possible “Token”
involvement of
academic researchers
Equitable
Co-governance
24. Emphasizes local relevance and ecological perspective
that recognizes multiple determinants
Involves system development through cyclical and
iterative process
Disseminates findings and knowledge to all
Involves long-term process and commitment
Israel, Schulz, Parker, Becker, Allen, Guzman, “Critical Issues in developing and following CBPR principles,”
Community-Based Participatory Research in Health, Minkler and Wallerstein, Jossey Bass, 2000.
24
25. Recognizes community as a unit of identity
Builds on strengths and resources
Facilitates partnership in all research phases
Promotes co-learning and capacity building
Seeks balance between research and action
25
26. Don’t plan about us without us
All tribal systems shall be respected and honored,
emphasizing policy building and bridging, not a
policy wall
Policies shall not bypass Tribal government review
and approval prior to implementation
Tribally specific data shall not be published without
prior consultation
Data belongs to tribe
Turning Point Collaboration for a New Century of Public Health, Spring Forum 2001, NACCHO,W.K.K Kellogg,
Robert Wood Johnson Foundations 26
27. Who chose the
problem to be studied?
How is the budget
divided?
What is the etiologic or
causal theory?
Is there an intervention
or service component?
Where are the results
disseminated?
Who designed the
intervention?
Who made the
research policy
decisions? (e.g. is there
a control group?)
Who writes
papers/makes
presentations? Who
owns the data?
27
31. Partnership Structures
Relationships
Individual Characteristics
Health Care
Agency
Government
Community
CBOs
Funders Academic
•Formal Agreements
•Partnership Values
•Bridging Social Capital
•Time in Partnership
•Diversity: Who is involved
•Complexity
•Resource Management
•% Dollars to Community
•CBPR Principles
33. Long-term
Intermediate
•Policy Environment
•Sustained Partnership
•Empowerment
•Shared Power Relations in
Research
•Cultural Reinforcement
•Individual Partner / Agency
Capacities
•Research Productivity
•Community/Transformation
•Social Justice
•Health / Health Equity
Future Policies / Social Transformation/
Research Meeting Community Needs
University & Community Environments
Sustained Partnership & Projects
Individual, Organizational, Community
Stronger Community Voice in Research/
Knowledge Democracy
Growth in Skills and Capacities
Health Behaviors and Health Status
Changes
Research Outcome, Papers, Grant
Applications & Awards
34. Partnership Structures:
• Diversity: Who is involved
• Complexity
• Formal Agreements
• Resource Management
• % Dollars to Community
• CBPR Principles
• Partnership Values
• Bridging Social Capital
• Time in Partnership
• Social-Structural: Social-Economic
Status, Place, History,
Environment, Community Safety,
Institutional Racism, Culture, Role
of Education and Research
Institutions
• Political & Policy: National / Local
Governance/Approvals of
Research; Policy & Funding
Trends
• Health Issue: Perceived Severity
by Partners
• Collaboration: Historic
Trust/Mistrust between Partners
• Capacity: Community History of
Organizing / Academic Capacity/
Partnership Capacity
Partnership Processes
Contexts Outcomes
Intervention &
Research
Relationships: How we interact
• Safety
• Respect / Trust
• Community Voice / Influence
• Flexibility
• Dialogue and Listening /
Mutual Learning
• Conflict Management
• Leadership
• Self & Collective Reflection/
Reflexivity
• Participatory Decision- Making
• Task Roles Recognized
Commitment to Culture-
Centeredness
Individual Characteristics:
• Motivation to Participate
• Cultural Identities/Humility
• Personal Beliefs/Values
• Spirituality
• Reputation of P.I.
• Processes that honor cultural
knowledge & community voice, fit
local settings; and use both
academic & community language
lead to culturally-centered
Interventions
• Co-Learning Processes lead to
Partnership Synergy
• Community Members Involved in
Research Activities leads to
Research/Evaluation Design that
Reflects Community Priorities
• Bidirectional Translation,
Implementation & Dissemination
Intermediate System & Capacity Outcomes
• Policy Environment: University & Community
Changes
• Sustainable Partnerships and Projects
• Empowerment – Multi-Level
• Shared Power Relations in Research /.
Knowledge Democracy
• Cultural Reinforcement / Revitalization
• Growth in Individual Partner & Agency Capacities
• Research Productivity: Research Outcomes,
Papers, Grant Applications & Awards
Long-Term Outcomes: Social Justice
• Community / Social Transformation: Policies &
Conditions
• Improved Health / Health Equity
Visual from amoshealth.org 2017
CBPR Conceptual Model
Partnership
Structures
Relationships
Individual
Characteristics
Health Care
Agency
Government
Intervention
& Research
Outcomes
Long-term
Intermediate
• Policy Environment
• Sustained Partnership
• Empowerment
• Shared Power Relations
in Research
• Cultural Reinforcement
• Individual / Agency
Capacity
• Research Productivity
Adapted from Wallerstein et al, 2008 & Wallerstein and Duran, 2010
Community
CBOs
Contexts
Capacity
&
Readiness
Collaboration
Trust &
Mistrust
Political
&
Policy
Social
&
Structural
• Community
Transformation
• Social Justice
• Health / Health Equity
Health
Issue
Importance
Funders
Integrate
Cultural
Knowledge
Culture-
Centered
Interventions
Empowerin
g Processes
Partnership
Synergy
Appropriate
Research
Design
Community
Involved in
Research
Academic
Partnership Processes
Processes Outputs
37. 1. Self-reflecting on our own and our
institutional base’s capacities, resources,
and potential liabilities as health
professionals/academics interested in
engaging with the community, including
identifying historical and current
relationships between the university and
community;
38.
39. 2. Identifying potential partners and
partnerships through appropriate networks,
associations, and leaders;
42. 3. Negotiating a research agenda based on a
common framework on mechanisms for
change;
Where does community assessment come in?
STEP UP AND STEP BACK
43. 4. Using up, down, and peer mentoring and
apprenticeship across the CBPR partnership.
What else do you do beyond the research?
44. 5. Creating and nurturing structures to sustain
partnerships, through constituency building
and organizational development.
Informal capacity development - Gifting
Third Space….
Universalizing their subjectivity
46. Quick review of your
CEnR experience
Aspirations for future
engagement
46
47. 2000 B.C. -Here, eat this root.
1000 A.D. -That root is heathen. Here, say this
prayer.
1850 A.D. -That prayer is superstition. Here, drink
this potion.
1940 A.D. -That potion is snake oil. Here, swallow
this pill.
1985 A.D. -That pill is ineffective. Here, take this
antibiotic.
2000 A.D. -That antibiotic is artificial. Here, eat
this root.
