Community Based Participatory Research Approaches: Experiences from St. James Town Initiative

Community-Based Participatory Research Approaches: Experiences from St. James

Town Initiative

Dr. Nasim Haque

Wellesley Institute

1 November-17-11 | www.wellesleyinstitute.com

Social Aetiology of Mental Illness (SAMI)

CIHR Strategic Training Program Center of Addiction & Mental Health (CAMH)

November 16, 2011

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Objectives for today’s session

1) Provide an overview of community-based participatory research (CBPR) techniques

2) Emphasize the importance of social determinants of health and health equity and the use of CBPR

3) Introduce three CBPR techniques and illustrate using examples from St. James Town Initiative research work

November 16, 2011 www.wellesleyinstitute.com | www.sjtinitiative.com

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SJT Initiative is a 5 year CBPR Initiative

Research Question:

What implications do neighbourhoods have on the health & wellbeing of immigrants?

Results:

Inform policy & support social change at neighbourhood level

About St James Town Initiative


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• Illness is a state of poor health and is considered a synonym for disease

• Health is a state of complete physical, mental and social well-being (WHO, 1986)

Difference between Illness & Health

Social Aetiology of Mental Illness (SAMI)


Factors Effecting Health & Wellbeing

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The social & economic

environment

The physical environment

Person’s individual / biological

characteristics & behaviours

SDoH & Health Inequity


H E A L T H

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14,666 Residents on 0.23 km2 of

Land

64,636 People / km2

(Unofficial Estimate: 25,000)

64% Immigrants

18 Aging High-Rise Buildings

Community Action

Strategies & Activities

Participatory Action

Research

Skill enhancing opportunities

Student internships

Work with multiple

stakeholders

SJT Initiative Website

1) Adult Photo Voice

2) Community Mapping

3) Concept Mapping

5) Focus groups/interviews (CAC)

SJT Residents Action Group

COMMUNITY ENGAGEMENT

6) Sample Survey (CIHR funded)

4) Youth Photo Voice

Multi-pronged Approach

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• Action research is “learning by doing” - a group of people identify a problem, do something to resolve it, see how successful their efforts were, and if needed, try again.

• Examples of participatory action research?

What is Participatory Action Research?


Community Mapping: Arts-Based Participatory Research

Approach

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What is Community Mapping?

• Community mapping is a cartographic (map making) practice that honours the local and personal knowledge of ordinary people

• Through this process participants share their knowledge by making maps as a way to spatially and visually represent their experiences, which include the social, economic, and cultural contexts of their lives.

• It is a research and learning process that focuses on coming to a greater understanding of the intersection of ‘self and place’


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Purpose of Community Mapping?

• Encourages ordinary people and those who are marginalized from public life and political process to come together to record significant aspects of their neighbourhood and their relation to it.

• Facilitates the process of learning and facilitates dialogue among members of the community from the ‘bottom up” as a way to transform traditional “top down” power relationships into more equitable, transparent, and participatory political process.


Community Mapping (Map Anchored Interviews) “When we first came here, we had very high expectations because we were

coming to Toronto…but it is not good. Nobody takes care of the surroundings.

On apartment terraces, you cannot see flowers. People are always storing things

there. It is ugly. I can find gardens near my building, but they are not managed

nicely. There is a lot of garbage here. Surroundings are important - they

make me smile and relax, so I can go with a smiling face.”

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“The Bleeker St. basketball court is not a safe or healthy place for kids. That’s

where older kids hang out with younger kids and smoke and sell drugs.

....Younger kids look up to older kids and respond to peer pressure. That’s why

younger teens are getting into trouble with the law and stuff like that.”

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“…People here are busy. They work 2 jobs to cover their costs. You can’t find

anyone to talk to. Sometimes you need to sit and chat and have a conversation

with people. Usually, I meet some people in the library...Every time you meet a

new person you may not see them again. This is frustrating. If a person has

friends, relations, that they can meet, talk together, have conversation with,

maybe they will feel like they are someone. …You ask yourself “What is going on

here?” Maybe the culture is different. Different from mine.”

Photovoice : Arts-Based Participatory Research

Approach


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What is Photovoice?

Photovoice asks you to take photographs of things that are important to you - and to tell the story of why these things are

important. The visual images and accompanying stories are the tools used

to reach policy- and decision-makers.

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Why use Photovoice?

• Powerful way to approach empowerment and advocacy

• Rewards of taking photographs are immediate

• Photography is fun and creative

• Taking photographs can change participants’ perceptions about their social and physical environment

• Basic photography is easy to learn and accessible to all

• “A picture is worth a thousand words”

• Images are understood regardless of language or culture

• Policy makers & program planners cannot deny reality when images are staring them in the face


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A few examples: • Children and youth in difficult circumstances e.g. orphans, children

forced into job market, children and youth living under the threat of violence because of war or crime

• Homeless adults and families

• People with disabilities or mental health issues

• People with chronic diseases/medical conditions e.g. HIV, TB etc.

• Members of racial, ethnic, linguistic, or cultural minorities

• People who are discriminated against because of class, caste, way of life

• The urban poor, whose concerns and strengths are often different from those of the larger society

• Women and men, to highlight gendered social and health issues

Who should use Photovoice?


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One way of exploring photographs: • What do you See here?

• What’s really Happening here?

• How does this relate to Our lives?

• Why does this problem/condition/strength exist?

• How could this image Educate the community/policy makers/ etc?

• What can we Do to improve the situation, or two enhance these strengths?

For more detailed description on Photovoice, visit:

www. SJTinitiative.com

SHOWED: Guideline for story writing


A few examples of the range of information that can be collected

using Photovoice


As a child, one way I kept myself occupied with my time was through playing basketball. It not only

kept me off the streets, but also wasted the majority of my time, keeping me active. If more

community programs ran such activities, it would bring the community closer and keep children off

the streets away from any type of violence. These activities are strengths in our community as children are kept away from trouble. (Youth,SJT. 2010)

PHYSICAL ATTRIBUTES ©

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... In a neighbourhood such as St. James Town where most people live in high rise buildings and come from low income families it may not seem like the best idea to build more buildings when we don’t already have that much green space around. This issue relates to your lives because we need more things than buildings around our community, such as more parks, centres for youth but instead we invest in building and more buildings. (Youth,SJT. 2010)

Overcrowding PHYSICAL ATTRIBUTES

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SOCIAL ATTRIBUTES

Safety, Crime, Drugs, Fear

The picture shows a memorial of a residence of St. James Town whose life was robbed off him last

year due to gun violence. The person who murdered “Juice” is yet to be found. It just comes to

show that more security is needed in the area. A lot of undercover police are the area dressing up

as drug dealers or buyers but they are usually easily spotted and pin pointed.

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This is related to our lives because every day we are witness to some type of harmful carcinogens produced by these cigarettes. Whether second hand, or first hand smoke, living in St. James Town means a high chance of encountering cigarettes. Because of this more people are exposed to harmful chemicals.

SOCIAL ATTRIBUTES

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These different flowers represent people from different places and the vase represents this country. If we arrange the flowers properly, they turn into a beautiful flower arrangement. If people of different backgrounds are given equal opportunities and are accepted, everyone benefits.

“The Tsismis Tree” Tsismis is a word in Tagalog that means gossip. This tree is treasured by many immigrants because we meet here to share experiences and support each other. Common spaces are important to the wellbeing of both individuals and the community.

SOCIAL ATTRIBUTES

© Wellesley Institute

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This tiny tunnel connects one of the poorest neighbourhoods in Canada, St. James Town, to one of the most affluent, Rosedale. The short journey of crossing the bridge is actually painful, arduous, and for the most part, impossible for the most, if not all, of the individuals living in SJT. Despite being highly educated, newcomers have difficulty gaining recognition, and consequently, employment.

ECONOMIC ATTRIBUTES ©

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Food Quality

How much can we trust our food supply? We don’t only care about the price of goods, we also pay attention to our health. We want to get good service when we go to the supermarket.

ECONOMIC ATTRIBUTES ©

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“Anyone out there?” Our plea for help went unheeded and we were buried in an overwhelming wave of ‘that’s not our problem’. Anyone out there? Are you listening?

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Concept Mapping: Semi-Quantitative Participatory

Planning and Evaluation Tool


What is Concept Mapping?

Concept mapping is a process for gathering and organizing the input of many different people into a single, shared conceptual framework. This framework forms the basis for further value analysis, planning, action, or evaluation.

Bill Trochim

30 November 16, 2011 www.wellesleyinstitute.com | www.sjtinitiative.com

© The Wellesley Institute

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Planning: Planners and key issue advisors

develop a focus prompt and identify participants

Idea Generation: Communities of interest and

expertise are identified, and respond with brainstormed

ideas

Structuring: Communities of interest and expertise sort

and rate the results of the idea development, authoring

the structure and value domain of the issue

Representation: Compute the maps, pattern matches

and “go zones,” and prepare them for interpretation by

communities of interest.

Interpretation and Use: Strategies and tactics for action

follow directly from the interpretation of the results. Pattern

matches and go zones help build consensus on action.

CM Methodology Steps Through Photovoice

Planning: Planners and key issue advisors

develop a focus prompt and identify participants

Idea Generation: Communities of interest and

expertise are identified, and respond with brainstormed

ideas

Structuring: Communities of interest and expertise sort

and rate the results of the idea development, authoring

the structure and value domain of the issue

Representation: Compute the maps, pattern matches

and “go zones,” and prepare them for interpretation by

communities of interest.

Interpretation and Use: Strategies and tactics for action

follow directly from the interpretation of the results. Pattern

matches and go zones help build consensus on action.

CM Methodology Steps Through Photovoice

What is Concept Mapping of Photovoice ?

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Work quickly

and effectively under

pressure 49

Organize the work when directions

are not specific.

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Decide how to manage

multiple tasks.

20 Manage resources effectively.

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…are sorted into groups…

… and rated on two

areas.

Ideas represented in

photographs…


Concept Mapping

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Sorting the Photovoice Photos Examining the Relationships in the Concept Map

Concept Mapping takes the ideas of individuals and combines using multivariate statistical methods to form unique visual representations

called Concept Maps.

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Concept Mapping Results: a CBPR project on Neighbourhood & Health and Wellbeing

A Shared Framework: regional view of CM

Green Space

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67

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Each cluster retains the details

This is a soothing sight for tired eyes,

an effective distraction from the barren

concrete jungle around...(6)

Green space is very important. The addition of

green space to a building can provide a sense of

community since tenants can get to know one

another as they enjoy this space together. This is

Allen gardens. Residents should not have to go

outside the community to find quality parks with

good amenities. (67)

We live in such a crowded place and we don’t have

enough green space. Plants give us oxygen & give

us a beautiful visual sense as well. (76)

..... making SJT look beautiful and clean

would make residents feel good about

themselves (53)

The hopes and dreams of the residents could be

expressed in the development of a beautiful

common space tegether. A lush green urban

space is the dream of everyone in SJT; however

this is difficult because residents do not own

this land or feel a sense of ownership. (9)

Pattern Match: Average ratings of Clusters in terms of Importance and Action

r = .12

Importance Action Potential

4.12

3.56

3.51

3.08

Education Society

Need Social and Protection Lack of Maintenance

Attractions Sense of Pride

Lack of Maintenance &Improvement Green Space

Green Space Education

Safety Attractions

Environment Need Social & Protection

Sense of Pride

Environment Improvement for Health

Safety

Society Improvement for Health

Pattern

Matching is a

process that

allows the

comparison of

opinions or view

to determine the

degree to which

groups or ideas

match or

disconnect.

* Absolute values for ratings range from 1-5

3.82.39 4.54

2.39

4.03

Importance

Acti

on

Po

ten

tial

3.29

1

2

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5

6 7

89

10

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1314

15 1617

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2425

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2728 29

3031

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3334

3536

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3839

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484950

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5253

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r = .61

A Go-Zone

Report is a

bivariate

scatter plot

that shows

how the

items in a

cluster are

related.

Go-Zones: Comparing Statements in a Cluster

Low Importance

High Action Potential

Low Importance

Low Action Potential

High Importance

Low Action

Potential

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• Non threatening methods

• Usually not conceived as “research”

• Engage disadvantaged population in research and advocacy

• Builds trust & empowers disadvantaged population

• Transfer ownership of the project to participants

• Help common voices heard by decision makers

• Understand participants perspectives on health and other issues through their lenses

Advantages of Using Arts-Based Research Techniques


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• The time commitment necessary may be daunting for participants and researchers

• Participants may have difficulty in presenting complex or abstract ideas through images and drawings

• Limitations of cross sectional design and qualitative design applies to arts-based study designs

Limitations of using Arts-based Techniques


Building Partnerships with Stakeholders



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SJT Initiative Youth Photo Voice Project


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Photo Journalist: Training Workshop 1 ©

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Important Stakeholders: Training Workshop 2 ©

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Community Level Actions



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Community Forum & Expo: March 20, 2008 ©

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Community Forum & Expo: September 18, 2010




Resident Group Presenting at Counselor ’s Office

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Change & Action

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Estelle Sun: RA, Wellesley Institute

Ali Moallim & Gene Lara: Community Leaders, SJT

Sean McIntyre: Constituency Assistant to Area Councillor

St. James Town residents and project participants

Previous RAs (Anissa, Emily, Erin) and WI staff &colleagues

Acknowledgement


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These speaking notes, reports using Photovoice and other participatory research methodologies, and policy briefs aimed at advancing health equity and social determinants of health are available on our site at www.sjtinitiative.com and www.wellesleyinstitute.com

My email: [email protected]

Following - Up



ST. JAMES TOWN INITIATIVE www.sjtinitiative.com

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