Setting the Stage for CBPR: Theories and Principles

1. Setting the Stage for CBPR: Theories and Principles Julie A. Baldwin, Ph.D. Department of Community and Family Health College of Public Health, USF Health

2. Objectives • Describe the background of community-based participatory research (CBPR) • Describe and critically discuss key concepts and principles of CBPR • Discuss some of the challenges of CBPR, as well as the benefits to public health research

4. Community • Numerous definitions • As place - traditional notion • As social interaction - network of relationships • As social & political responsibility -shared concerns

5. Key Characteristics of Community • Shared sense of belonging and connectedness • “Manifested in common symbols, language and emotional connections” (Israel et al., 1994, p.151). • Best Definition: a group of people sharing a sense of collective identity, common values, goals, and institutions

6. Distinguishing Features of Community Organization • Community participation • Community ownership • Community competence and empowerment • Recognition and use of community assets • Participatory research

7. Community Participation • People affected by problem should: • Set goals • Plan steps to resolve problem • Implement changes • Establish structures to sustain changes • Outside experts may assist by providing data, models for selecting goals

8. Community Ownership • Closely-related to participation • Local people select issue to address • Local people have sense of responsibility for and control over programs • Contributes to likelihood of success, esp. Ability to sustain change

9. Benefits of Participation • Participants motivated change • Activities reinforce commitment • Opportunitiesto make public commitment • Program designers gain participant’s views • Stronger program design • Participants gain information

10. Community Competence • Community’s ability to set goals and solve its problems • Outside experts may assist with process • Help community set goals • Assist them as they solve problems

11. Empowerment • Process of gaining mastery and power over oneself/community to change • Implications: • Individuals and communities gain tools and take responsibility for making decisions that affect them

12. Community-Based Participatory Research (CBPR) • Term used widely in health research • In order for research to be participatory, must meet three goals: • Research, Action, and Education (which are interconnected)

13. Community Based Participatory Research Participation & Education Research Action

14. CBPR “a collaborative process 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.” Israel et al, 1998

16. Ethical Challenges in CBPR • Community-Driven Issue Selection • Involves commitment, time, and skills from the community members (issue: may have other commitments, jobs, family obligations) • Can true CBPR take place when the research questions come from an outsider to the community? • Can an outsider with diverse background, ethnicity, and education play a role in the community? • Community may internally be divided on issues

17. Ethical Challenges in CBPR • Participation and its limitations • Challenge: who truly represents “the community” – constant negotiations to define community • Community wants different research design than outside researchers; • Sharing findings and taking action • Findings may be thought as harmful by the community members; how do you balance researchers’ feelings of obligations to make all findings public? • Many CBPR programs now have formal or informal research protocols and MOU’s

18. Ethical Challenges in CBPR • Researchers may not share the similar community culture • Cultural misunderstandings, and real or perceived racism, may occur • Institutionalized racism • Personally mediated racism based on stereotypic race-based assumptions and judgments • Internalized racism (reflected in people’s own acceptance of negative messages concerning their own race or ethnic group)

19. Cultural Competence vs. Cultural Humility • “None of us can truly become ‘competent’ in another culture. We can approach cross-cultural situations with “cultural humility.” • Cultural humility is “a lifelong commitment to self evaluation and self-critique,” to redress power imbalances and “develop and maintain mutually respectful and dynamic partnerships with communities.” Tervalon and Murray-Garcia, 1998

20. Changing the Vision of Community Deficit Mentality Bundle of Pathologies Epidemiology of Strengths Community Assets & Strengths Source: H. Jack Geiger

21. Community Assets: Map and Enhance • Individuals • Leaders • Regular citizens • Marginalized members • Groups and associations • Local institutions • Physical assets

22. Identifying Natural Community Leaders • When you have a problem, who do you go to for advice? • Who do others go to? • When people in the neighborhood have come together around a problem in the past, did a particular individual or group play a key role? • What things do people tell you you’re good at?Eng et al, 1990; Israel, 1985; Sharpe, 2000

23. Community-Campus Partnerships for Health Available from: http://depts.washington.edu/ccph/commbas.html#Conf

24. Community Based Participatory Research in Health (CBPR) Research topic /problem of importance to the community Combination of knowledge and action for social change Impact health disparities

25. “Don’t tell us how much you know until you show us how much you care” Anonymous