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CBPR 101: Making it Relevant
Juan Carlos Belliard, PhD, MPH
Partners for Health: Communities and Researchers Working Together
Outline»Defining CBPR, what it is, what it isn’t
»Rationale for CBPR
»Guiding Principles
»Ethical Issues
»Forming a CBPR Partnership
»CBPR Resources
LEARNING OBJECTIVES
Learning Objectives»Explain the theoretical basis, definition, rationale and
key principles of CBPR
»Describe how CBPR differs from traditional research approaches
»Identify ethical considerations for researchers and community partners
Acknowledgements
This presentation is an introductory review of Developing and Sustaining Community-Based Participatory Research Partnerships: A Skill-Building Curriculum.
We would like to thank Community Campus Partnerships for Health (CCPH) for granting us the permission to use this curriculum to promote Community Based Participatory Research.
Within each of us is a hidden store of energy. Energy we can release to compete in the marathon of life. Within each of us is a hidden store of courage, courage to give us the strength to face any challenge. Within each of us is a hidden store of determination.Determination to keep us in the race when all seems lost.
— Roger Dawson
DEFINITION & RATIONALE
Definition
“A 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 and has the aim of combining knowledge with action and achieving social change...”
(Community Health Scholars Program)
Brookings Institution Report –“The 3rd California”
“The 3rd California”
• Underdevelopment. • Fast growth (200-2005)
• Lower %of high income households
(Kotkin, Joel and Frey, (2007).
California County Health Rankings – San
Bernardino
http://www.countyhealthrankings.org/california
San Bernardino county is ranked as one of the unhealthiest counties in CA
Rank (of 56)
Overall Health Outcomes
45
Mortality (premature deaths)
37
Morbidity 48
Health Factors 50
Clinical Care 54
Social & Economic Factors
37
Physical Environment
54
Foundations for CBPR»Action Research (Kurt Lewin, 1946)
»Empowerment Education (Paulo Freire, 1970)
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
Rationale
»Traditional research has failed to solve complex health disparities
»Community burn out
»Community input can improve the research design and results
Rationale
»Research findings can be applied more effectively
»Improved researcher-community relationships
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
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
Identified health
concern(s)
Study design and funding
Participant recruitment
and retention system
Full participation of community in identifying issues of greatest importance.
Community representatives involved with study design and proposal submission.
Community representatives provide guidance regarding recruitment and retention strategies.
Issues identified based on epidemiologic data and funding opportunities.
Design based entirely on scientific rigor and feasibility; funding requested primarily for research expenses.
Approaches to recruitment and retention based on scientific issues and “best guesses” regarding reaching community members and keeping them involved in the study.
Increased motivation to participate in research process.
Increased acceptability of study approach, include funds for community.
Enhanced recruitment and retention.
Measurement instrument(s) designed and data collected
Intervention design and implemented
Data analyzed and interpreted, findings disseminated and translated
Measurement instruments developed with community input and tested in similar population.
Community members help guide intervention development.
Community members assist researchers with interpretation, dissemination, and translation of findings.
Measurement instruments adopted/adapted from other studies. Tested chiefly with psychometric analytic methods.
Researchers design intervention based on literature and theory.
Researchers report findings from statistical analysis and publish in peer-reviewed journals.
Potentially sensitive issues handled better and increased reliability and validity of measures.
Assures greater cultural and social relevance to the population served, increasing the likelihood of producing positive change.
Assures greater sensitivity to cultural and social norms and climate and potential group harm and enhances potential for translation of findings into practice.
PRINCIPLES OF CBPR
Israel, B. Schulz, A., Parker, E., Becker, A., Allen, A., and Guzman, J. R. (2003). Critical issues in developing and following community based participatory principles. In M. Minkler and N. Wallerstein (Eds.), Community-based participatory research for health (pp. 53-76). San Francisco, CA: Jossey-Bass/Wiley
Principles of CBPRRecognizes 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
Discussing the Definitions, Principles and Rationale of CBPR-Exercise• Do you believe it is necessary to discuss these definitions
and principles of CBPR and their rationale at the first meeting? Why or why not?
• If you decide to include discussions of some or all of them, who should bring these up and how?
• What power dynamics would you want to consider in a discussion of this nature?
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
ETHICAL ISSUES IN 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
Who is “The Community”?
»Who represents the community?
»Who represents the community?
»Who speaks for the community?
More Questions on Ethics»Is it legitimate or ethical for community members to come
from only a few neighborhoods or social identity groups, thus benefiting some communities more than others?
»What if certain neighborhoods or communities are more outspoken, have greater community organizing skills, or are more comfortable negotiating with academic researchers than others?
»Do academic researchers have a responsibility to seek participation from all communities, or just work with the groups who are the most outspoken, or easiest, to work with?
Ethical Research Principles»Respect for human dignity»Respect for free and informed consent»Respect for vulnerable persons»Respect for privacy and confidentiality»Respect for justice and inclusiveness»Balancing harms and benefits»Minimizing harms»Maximizing benefits
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
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
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
Incentives to Partner (Community)»Access resources»Advocate for policy change»Create jobs»Improve services»Protect the community»Solve a problem»Gain political capital
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
IS CBPR RIGHT FOR YOU?
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
Questions to Ask Before Starting»Is opportunism and self-interest driving the agenda?
»Do you and your team have the necessary skills?~ Cultural competence~ Communication~ Listening~ Sharing power and control over decisions
Questions to Ask»Are you as a researcher uncomfortable with changing your
methods and/or approach to working with participants?
»Are you a community member who simply wants an intervention or community service but who has no interest in research questions?
»Do the ethical considerations related to burden and benefits to the community outweigh potential research benefits?
»What if you don’t “buy into” the values and principles of CBPR?
"Education either functions as an instrument which is used to facilitate integration of the younger generation into the logic of the present system and bring about conformity or it becomes the practice of freedom, the means by which men and women deal critically and creatively with reality and discover how to participate in the transformation of their world.” — Paulo Freire (Pedagogy of the Oppressed)
RESOURCES
Journals
» Progress in Community Health Partnerships: Research, Education, and Action. http://pchp.press.jhu.edu
» An increasing number of peer-reviewed journals are publishing articles and theme issues on CBPR. For example:
~ The November 2004 issue of the Journal of Interprofessional Care http://journalsonline.tandf.co.uk/link.asp?id=WP6TA2TN1HAJ
~ The July 2003 issue of the Journal of General Internal Medicine http://depts.washington.edu/ccph/pdf_files/JGIM3.pdf
» For a listing of journals that publish CBPR, visit http://depts.washington.edu/ccph/links.html#Journals .
Funding» Directory of Funding Sources for Community-Based Participatory Research. Prepared by
Community-Campus Partnerships for Health for a June 2004 Conference on Improving the Health of Our Communities through Collaborative Research sponsored by the Northwest Health Foundation. This directory includes funding agency descriptions, deadlines, contact information, examples of previously funded CBPR projects, and an annotated listing of funding resource websites. http://depts.washington.edu/ccph/pdf_files/directory-062704f.pdf
» Funding resources for CBPR include:
~ Robert Wood Johnson
~ Kellogg
~ National Institutes of Health (NIH)
Training» Health Leadership Training Guide (HLTG): A Training Guide For Community Members Dedicated to
Becoming Effective Health Leaders. Produced by the City of Long Beach Department of Health and Human Services, the HLTG can be used by residents, community-based organizations, and health departments that are interested in training residents to become effective health leaders in their community. The HLTG is grounded in solid experience of the Long Beach Partnership in planning, developing, and implementing a yearlong Health Leadership Training program. The HLTG is a tool that will increase the internal capacity of residents to build and hone their community leadership skills. The guide is organized in to five main sections: 1) Identifying and Assessing Community Problems, 2) Solving Community Health Problems, 3) Community leadership Skills, 4) Group Retreat, and 5) Graduation. Each section provides a workshop description, learning objectives, teaching materials, quizzes, trainer’s note, and references. http://partnershipph.org/col2/showcase/pdf/hltg_eng.pdf
» 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
» Community-Based Participatory Research: A Partnership Approach for Public Health . Israel, Coombe, & McGranaghan, University of Michigan Office of Public Health Practice (www.cbpr-training.org)