This document provides an overview of Community-Based Participatory Research (CBPR) including its history, principles, challenges, and benefits. Some key points: 1) CBPR aims to equitably involve community partners in all stages of research to address issues important to the community and promote social change. 2) Its roots trace back to action research and empowerment models that recognize communities as partners rather than subjects. 3) Challenges include balancing academic and community priorities, building trust over time, and ensuring research is culturally appropriate and sustainable. 4) Benefits include enhancing relevance, validity, translation and sustainability of research findings to improve community health.

1. Community-based Participatory
Research (CBPR)
Thira Woratanarat MD
Department of Preventive and Social Medicine
Faculty of Medicine, Chulalongkorn University

2. “The real challenge lies not in debating whether
disparities exist, but in developing and
implementing strategies to reduce and eliminate
them.”
—IOM Committee Chair
Social Health
determinants ? outcomes
of health

3. Challenges for Bridging Science to Practice:
Need for CBPR
• Challenge of bringing evidence to practice
 Moving from efficacy to effectiveness trials
 Internal validity focus insufficient for translational research
 External validity: Contextualization/Implementation process
• Challenge of what is evidence
 Practice and Culturally-based Evidence/Indigenous theories,
norms, practices
• Challenge of one-way translation orientation
 Assumes community tabula rasa

4. Tabula Rasa
• Individuals are born without built-in mental
content and that their knowledge comes
from experience and perception.
• “Blank slate” in computer science

5. CBPR Definition
“ Collaborative approach to research that equitably
involves all partners in the research process and
recognizes the unique strengths that each brings.
CBPR begins with a research topic of importance to
the community with the aim of combining
knowledge and action for social change to improve
community health and eliminate health disparities.”
W.K. Kellogg Community Scholar’s Program (2001)

6. But, first we need to know the history …
• 1940s – Action research (Kurt Lewin) as well as
other European social scientists
 Behavior occurs within a historical/social context
 Behavior is determined by the totality of an individual’s
situation
 Individuals interact in inter-connected groups as actors as
well as authors of their own reality
 A fundamental premise of community-based action
research is that it commences with an interest in the
problems of a group, a community, or an organization. Its
purpose is to assist people in extending their
understanding of their situation and thus resolving
problems that confront them…. (Stringer, 1999)

7. History
• 1970 – Empowerment
Model (Paulo Freire)
Before community members
address particular social
change goals introduced from
the outside, they must first
be organized and empowered
to address their own
concerns and goals

8. History – Empowerment Model
It begins with a true dialogue in which everyone
participates equally to identify common
problems and solutions
Once the individual strengths and the shared
responsibilities are identified, the group can
work together toward a common goal –
participatory process
“Washing one’s hands from a conflict between the powerful and the powerless means to side with
the powerful, not be neutral” (Paulo Freire)

9. What it is and What it isn’t
• CBPR is an orientation to research
Changes the role of researcher and researched
• CBPR is not a method or set of methods
Qualitative and quantitative
Epidemiology and intervention research
• CBPR is an applied approach
Goal is to influence change in community
health, systems, programs, or policies

10. Principles of CBPR
Recognizes community as a unit of identity
Builds on strengths and resources within the community
Facilitates collaborative partnerships in all phases of the research
Integrates knowledge and action for mutual benefit of all partners
Promotes a co-learning and empowering process that attends to social inequalities
Involves a cyclical and incremental process
Addresses health from both positive and ecological perspectives
Disseminates findings and knowledge gained to all partners
Israel et al, 1998 and 2003

11. • Don’t plan about us, without us
• All tribal systems shall be respected and honored,
• Tribal government review and approval prior to
implementation
• Tribally specific data shall not be published without
prior consultation; data belongs to tribe
• Core Values: trust, respect, self-determination,
mutuality of interests, perspective taking, reciprocity
Turning Point Collaboration for a New Century of Public Health, Spring Forum 2001, NACCHO,W.K.K
Kellogg, Robert Wood Johnson Foundations; (1) Manson SM, Garroutte E, Goins RT, Nez Henderson, P.. 2004;
Norton IM, Manson SM. 1996.

12. Sustainability

13. COMPARE RESEARCH
APPROACHES:
TRADITIONAL VERSUS
CBPR
Hartwig K, Calleson D and Williams M. Unit 1: Community-Based Participatory Research: Getting
Grounded. In: The Examining Community-Institutional Partnerships for Prevention Research
Group. Developing and Sustaining Community-Based Participatory Research Partnerships: A Skill-
Building Curriculum. 2006. www.cbprcurriculum.info

14. Full participation of Community representatives Community representatives
CBPR
community in identifying involved with study design and provide guidance regarding
issues of greatest proposal submission. recruitment and retention
importance. strategies.
Increased motivation to Increased acceptability of Enhanced recruitment and
participate in research study approach, include funds retention.
process. for community.
Participant
Identified
Study design recruitment
health
and funding and retention
concern(s)
system
Traditional
Issues identified based on Design based entirely on Approaches to recruitment
epidemiologic data and scientific rigor and feasibility; and retention based on
funding opportunities. funding requested primarily scientific issues and “best
for research expenses. guesses” regarding reaching
community members and
keeping them involved in the
study.

15. Measurement instruments Community members help guide Community members assist
developed with community intervention development. researchers with interpretation,
input and tested in similar dissemination, and translation of
population. findings.
CBPR
Potentially sensitive issues Assures greater cultural and Assures greater sensitivity to
handled better and increased social relevance to the cultural and social norms and
reliability and validity of population served, increasing climate and potential group harm
measures. the likelihood of producing and enhances potential for
positive change. translation of findings into
practice.
Data analyzed
Measurement
Intervention and interpreted,
instrument(s)
design and findings
designed and
implemented disseminated and
data collected
translated
Researchers design intervention Researchers report findings from
Traditional
Measurement instruments
adopted/adapted from other based on literature and theory. statistical analysis and publish in
studies. Tested chiefly with peer-reviewed journals.
psychometric analytic
methods.

16. Traditional Research VS CBPR
Traditional Research CBPR
 Community is a passive  Involves the community being
subject of study studied in the research
 Research Design – done a  Research Design –done with
priory by academic representatives from community
institution & academic institution
 Needs assessment, data  Needs assessment, data
collection, implementation collection, implementation, &
, and evaluation – evaluation – everyone’s
academic institution’s responsibility
responsibility  Sustainability is priority that
 Usually sustainability plan begins at program’s inception
is not included

17. Challenges in Researcher-community Relationships
Nuances of participation
Power and privilege: Who sets the research agenda?
Historical and current research abuse/racism
Specific university and research team reputation and
community relationship
Challenge of research team having necessary skills and
values (cultural humility, listening, patience)
Challenge of individual vs. community benefit
Challenge of needs of academics (publishing) vs.
community (immediate actions)

18. CBPR Conceptual Logic Model
Contexts
(adapted from: Wallerstein , Oetzel, Duran, Tafoya, Belone, Rae, “What Predicts Outcomes in CBPR,” in CBPR:
From Process to Outcomes, Minkler and Wallerstein (eds). San Francisco, Jossey-Bass, 2008.)
Socio-Economic, Cultural,
Geography & Environment
Group Dynamics
National & Local Outcomes
Policies/Trends/Governance Equitable Partnerships Intervention
System & Capacity Changes
Historic Collaboration: Community Fits Local /Cultural Beliefs,
Norms & Practices
Trust & Mistrust Structural Agencies
Policies/Practices
Dynamics
Relational Sustained Interventions
Reflects Reciprocal Learning
Changes in Power Relations
Community Capacity Dynamics
Individual Cultural Renewal
& Readiness CBO’s Appropriate
Dynamics
Research Design Improved Health
University
University Capacity
& Readiness Disparities
Social Justice
Health Issue Importance
Contexts Group Dynamics/Equitable Partnerships Intervention Outcomes
Structural Dynamics: Relational Dynamics: CBPR System & Capacity Changes:
•Social- • Diversity • Safety •Intervention adapted or created •Changes in policies /practices
economic, cultural, geographic, political- • Complexity • Dialogue, listening & mutual within local culture -In universities and communities
historical, environmental factors • Formal Agreements learning •Intervention informed by local •Culturally-based & sustainable
•Policies/Trends: National/local • Real power/resource sharing • Leadership & stewardship settings and organizations
interventions
governance & political climate • Alignment with CBPR principles • Influence & power dynamics •Shared learning between
•Changes in power relations
•Historic degree of collaboration and trust • Length of time in partnership • Flexibility academic and community
• Self & collective reflection knowledge •Empowerment:
between university & community
Individual Dynamics: -Community voices heard
•Community: capacity, readiness & • Participatory decision-making •Research and evaluation design
• Core values reflects partnership input -Capacities of advisory councils
experience & negotiation
• Motivations for participating -Critical thinking
•University: capacity, readiness & • Integration of local beliefs to •Bidirectional translation,
• Personal relationships implementation & dissemination •Cultural revitalization & renewal
reputation group process
• Cultural identities/humility
•Perceived severity of health issues • Task roles and communication
• Bridge people on research team Health Outcomes:
• Individual beliefs, spirituality & meaning •Transformed social /econ conditions
• Community reputation of PI •Reduced health disparities

19. Challenge of Translational Research How CBPR Addresses the Challenge*
Wallerstein and Duran, AJPH, (Supplement) April, 2010.
1) External validity Engages community stakeholders in
adaptation within complex systems of
organizational and cultural context and
knowledge
2) What is evidence: Privileging of Creates space for post-colonial and hybrid
academic knowledge knowledge including culturally-supported
interventions/indigenous theories and
community advocacy
3) Language: Incompatible discourse Broadens discourse to include “life world”
between academia and community cultural and social meanings
4) Business as usual within universities Shifts power through bi-directional learning,
shared resources, collective decision-making,
and outcomes beneficial to the community
5) Non-sustainability of programs beyond Sustains programs though integration with
research funding existing programs, local ownership, and
capacity development
6) Lack of trust Uses formal agreements and sustains long-
term relationships to equalize partnership and
promote mutual benefit

20. Benefits of CBPR
• Enhances community relevance of research questions
• Strengthens interventions within cultural and local context
• Enhances reliability/validity of measurement tools
• Improves response rates/recruitment & retention
• Increases accurate and culturally sensitive interpretation of
findings
• Increases translation of evidence-based research into sustainable
community change
• Facilitates effective dissemination of findings to impact public
health and policy
• Increases research trust

21. Limitations
• Threats to internal validity – it is difficult to
account for all the factors that can play a role in
the targeted behaviors
• Difficulties with randomization
• Highly motivated intervention groups
• Expectations vs results – interpretation?
• Interpersonal conflicts and individual “agendas”
• Scientific publications

22. How do you begin?
• Select the community
 “unit of identity”
• Select your initial partners – individuals, representatives of
organizations or both
• True dialogue with partners (and others that should be at
the table) before the proposal is written and throughout the
process
• Identification of WHAT, HOW, WHO, WHEN
 WHAT – research question
 HOW – research design
 WHO – who is responsible for what?
 WHEN - timeline
• Sustainability plans from the beginning

23. Issues to keep in mind
 Willingness to truly “listen” – which applies to
everyone (academics, community, etc)
 Willingness to share power – financial issues
 Trust is earned and it takes time
 Slow process
 Clash between community needs and funding
restrictions (e.g., disease-focused; time limitations)
 Patience

24. IDENTIFYING & SELECTING
PARTNERS
Sarah Flicker, Kirsten Senturia and Kristine Wong Unit 2 Developing a CBPR Partnership-Getting
Started. In: The Examining Community-Institutional Partnerships for Prevention Research
Group. Developing and Sustaining Community-Based Participatory Research Partnerships: A Skill-
Building Curriculum. 2006. www.cbprcurriculum.info

25. Characteristics of Effective Partners
• They are willing and committed
• Their organizational mission is in alignment
• They have trust and a history of engagement in the
community
• They have staff and/or volunteer capacity to participate
• They have engaged, competent researchers and
research staff
• They have support and involvement from leaders at all levels
• They are knowledgeable about the community

26. Characteristics of Effective Partners
• They strive for cultural competency
• They have skills in collaboration
• They have interpersonal and facilitation skills
• They have technical skills
• They have commitment and connections to the community
• They are committed to the partnership process and the
substantive issues being addressed by the partnership

27. Incentives to Partner (Community)
• Access resources
• Advocate for policy change
• Create jobs
• Improve services
• Protect the community
• Solve a problem
• Gain political capital

28. Incentives to Partner (Academics)
• Attract and support students
• Advance careers
• Demonstrate/address inequities and injustices
• Generate knowledge
• Link personal and professional goals and values
• Meet funding agency expectations
• Obtain institutional funding