Transcript Setting the Stage for CBPR

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
Objectives
• Describe the background of communitybased 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
Community
• Numerous definitions
• As place - traditional notion
• As social interaction - network of
relationships
• As social & political responsibility shared concerns
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
Distinguishing Features of
Community Organization
• Community participation
• Community ownership
• Community competence and
empowerment
• Recognition and use of community
assets
• Participatory research
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
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
Benefits of Participation
• Participants motivated change
• Activities reinforce commitment
• Opportunities to make public
commitment
• Program designers gain participant’s
views
• Stronger program design
• Participants gain information
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
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
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)
Community Based
Participatory Research
Participation
&
Education
Research
Action
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
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
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
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)
Cultural Competence vs. Cultural
Humility
• “None of us can truly become ‘competent’ in
another culture. We can approach crosscultural 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
Changing the Vision of Community
Deficit Mentality
Epidemiology of
Strengths
Bundle
of
Pathologies
Community Assets
&
Strengths
Source: H. Jack Geiger
Community Assets: Map and
Enhance
• Individuals
• Leaders
• Regular citizens
• Marginalized members
• Groups and associations
• Local institutions
• Physical assets
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
Community-Campus Partnerships for Health
Available from: http://depts.washington.edu/ccph/commbas.html#Conf
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
“Don’t tell us how much
you know until you show
us how much you care”
Anonymous