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Community-based Participatory     Research (CBPR)                Thira Woratanarat MD    Department of Preventive and Soci...
“The real challenge lies not in debating whether  disparities exist, but in developing and  implementing strategies to red...
Challenges for Bridging Science to Practice:                  Need for CBPR• Challenge of bringing evidence to practice   ...
Tabula Rasa• Individuals are born without built-in mental  content and that their knowledge comes  from experience and per...
CBPR Definition“ Collaborative approach to research that equitably    involves all partners in the research process and   ...
But, first we need to know the history …• 1940s – Action research (Kurt Lewin) as well as  other European social scientist...
History• 1970 – Empowerment  Model (Paulo Freire)  Before community members   address particular social   change goals in...
History – Empowerment Model It begins with a true dialogue in which everyone  participates equally to identify common  pr...
What it is and What it isn’t• CBPR is an orientation to research   Changes the role of researcher and researched• CBPR is...
Principles of CBPR                          Recognizes community as a unit of identity                  Builds on strength...
• Don’t plan about us, without us• All tribal systems shall be respected and honored,• Tribal government review and approv...
Sustainability
COMPARE RESEARCH                  APPROACHES:                     TRADITIONAL VERSUS                     CBPRHartwig K, Ca...
Full participation of        Community representatives              Community representativesCBPR              community i...
Measurement instruments        Community members help guide Community members assist              developed with community...
Traditional Research VS CBPRTraditional Research            CBPR Community is a passive         Involves the community b...
Challenges in Researcher-community Relationships   Nuances of participation   Power and privilege: Who sets the research...
CBPR Conceptual Logic Model                    Contexts                                                            (adapte...
Challenge of Translational Research         How CBPR Addresses the Challenge*                                             ...
Benefits of CBPR• Enhances community relevance of research questions• Strengthens interventions within cultural and local ...
Limitations• Threats to internal validity – it is difficult to  account for all the factors that can play a role in  the t...
How do you begin?• Select the community    “unit of identity”• Select your initial partners – individuals, representative...
Issues to keep in mind   Willingness to truly “listen” – which applies to    everyone (academics, community, etc)   Will...
IDENTIFYING & SELECTING                PARTNERSSarah Flicker, Kirsten Senturia and Kristine Wong Unit 2 Developing a CBPR ...
Characteristics of Effective Partners• They are willing and committed• Their organizational mission is in alignment• They ...
Characteristics of Effective Partners•   They strive for cultural competency•   They have skills in collaboration•   They ...
Incentives to Partner (Community)•   Access resources•   Advocate for policy change•   Create jobs•   Improve services•   ...
Incentives to Partner (Academics)•   Attract and support students•   Advance careers•   Demonstrate/address inequities and...
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Community based participatory research (cbpr)

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Community based participatory research (cbpr)

  1. 1. Community-based Participatory Research (CBPR) Thira Woratanarat MD Department of Preventive and Social Medicine Faculty of Medicine, Chulalongkorn University
  2. 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 Healthdeterminants ? outcomesof health
  3. 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. 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. 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. 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. 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. 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 withthe powerful, not be neutral” (Paulo Freire)
  9. 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. 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 partnersIsrael et al, 1998 and 2003
  11. 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. 12. Sustainability
  13. 13. COMPARE RESEARCH APPROACHES: TRADITIONAL VERSUS CBPRHartwig K, Calleson D and Williams M. Unit 1: Community-Based Participatory Research: GettingGrounded. In: The Examining Community-Institutional Partnerships for Prevention ResearchGroup. Developing and Sustaining Community-Based Participatory Research Partnerships: A Skill-Building Curriculum. 2006. www.cbprcurriculum.info
  14. 14. Full participation of Community representatives Community representativesCBPR 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) systemTraditional 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. 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 fromTraditional 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. 16. Traditional Research VS CBPRTraditional 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. 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. 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. 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 knowledge2) What is evidence: Privileging of Creates space for post-colonial and hybridacademic knowledge knowledge including culturally-supported interventions/indigenous theories and community advocacy3) Language: Incompatible discourse Broadens discourse to include “life world”between academia and community cultural and social meanings4) Business as usual within universities Shifts power through bi-directional learning, shared resources, collective decision-making, and outcomes beneficial to the community5) Non-sustainability of programs beyond Sustains programs though integration withresearch funding existing programs, local ownership, and capacity development6) Lack of trust Uses formal agreements and sustains long- term relationships to equalize partnership and promote mutual benefit
  20. 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. 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. 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. 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. 24. IDENTIFYING & SELECTING PARTNERSSarah Flicker, Kirsten Senturia and Kristine Wong Unit 2 Developing a CBPR Partnership-GettingStarted. In: The Examining Community-Institutional Partnerships for Prevention ResearchGroup. Developing and Sustaining Community-Based Participatory Research Partnerships: A Skill-Building Curriculum. 2006. www.cbprcurriculum.info
  25. 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. 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. 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. 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

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