The type of community-based research that I want to gain greater familiarity in is community-based participatory research. To be more specific, I wanted to go further in my findings and look upon community-based participatory research within the public health setting such a funding, health equity, and health disparities. The CBPR approach has taught me how to better involve those in the research process and how communication is a key aspect when taking part in discussion, receiving and giving feedback. CBPR has also shown me the importance of the challenges that are faced throughout different communities and how to develop effective solutions for them. The thesis of this reflection is to understand how to apply CBPR by working together in a public health community setting to improve health equity and reduce health disparities.
The Principles of Community-Based Participatory Research
According to the article by Israel, Schulz, Parker and Becker 1998, “Community-based research in public health focuses on social, structural, and physical environmental inequities through active involvement of community members, organizational representatives, and researchers in all aspects of the research process” (Israel, Schultz, Parker and Becker, 1998). Those involved in the research give input on what they know about the topic in order to gain a further understanding and to discuss further knowledge with intentions to benefit the community involved. The principles of CBR is “to recognize community as a unit of identity, build community strengths and resources, facilitate partnerships in all research phases, and promote co-learning and capacity building” (Jackson, 2018).
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With participatory research, it is a process of using research methods and methodology within communities. It is meant to influence changes in social policy or practice and it is important to discuss it with the community that is involved to interpret and apply the research findings and outcomes. Participatory research is developed upon several key values including “mutual respect and trust, capacity building, empowerment, accountability, and ownership” (Jackson, 2018). Community-based participatory research begins with a research topic that is of importance to the community with the goal of combining all knowledge to improve community and take action on advancing social change. Within public health, CBPR has developed immensely, and is being recognized by many health scholars and funders that are acting upon addressing the many health disparities all over the world.
Looking at public health funding, there are many government officials and private interests who support CBPR. According to the article Community-Based Participatory Research: Implications for Public Health Funding, “In the United States, both large and small philanthropic organizations, including the W.K. Kellogg Foundation, the Ford Foundation, the Annie E, Casey Foundation, the California Endowment, and the Aspen Institute, have begun providing substantial support for action oriented participatory research approaches in health and related fields” (Minkler, Blackwell, Thompson, and Tamir). Some of these foundations have taken part in advocating for CBPR and creating a form of empowerment evaluation. With this, I found that they wanted to increase capacity within the community while engaging those who are affected by the specific program and improve the outcomes and effectiveness.
Community-based participatory research has developed over the last decade as “a transformative research paradigm that bridges the gap between science and practice through community engagement and social action to increase health equity” (Wallerstein and Duran, 2010). With this method, it has the ability to develop effective interventions across diverse communities through ways in which to help redirect power to all involved in the community, create equal rights and benefits between the community and academic partners, and promote knowledge of bettering the community through research. There is little attention being paid on how research can promote health policy or how community-based participatory research influences health policy to eliminate health inequalities between different racial ethnicities. CBPR puts emphasis on having equal engagement of partners through the research process. This is shown through defining the problem, data collection and analysis, and the use of findings through the research to create effective change within the community. Minkler et al. describes these CBPR policies strategies as “addressing both distributive justice and procedural justice” (Minkler, 2010).
In eliminating health disparities, CBPR calls for community and academic partnerships that will enhance policy and advocacy that is aimed at decreasing health disparities within the public health system. Community-based participatory research is that type of partnership approach that is able to facilitate capacity building and changes to policy through equal community engagement of different ethnic backgrounds. This approach allows all partners to be involved in the research and contribute their expertise in sharing responsibility and ownership. CBPR has been carried out more often in low-income communities and in communities of different racial backgrounds. It is best used in addressing health disparities within these communities involved.
Findings Throughout the Research
What I have found throughout the research is that CBPR is about facilitating capacity building and increasing policy change through equal engagement between a diverse group of partners within the community. It has also been applied by many health researchers and practitioners to address the many different health disparities and community involvement to promote health equity. What these articles also mention is that community based participatory research projects have shown little effort within the literature that evaluates CBPR and if the interventions are successful or unsuccessful. What I found useful about CBPR, is that its approach can be used to implement research that identifies social determinants of health. It can also be used to find disparities in health-related risk factors or status and explains them into a better understanding. With participatory research, I find that it helps to better connect researchers and partners in the project and community to help identify needs and problems in special communities where there is a chance to create positive changes. There should be more attention granted to the use of CBPR because it has increased the chance for a higher financial support from funding agencies and many agencies agree that this type of research design shows positive effects. I further learned that the principles of community-based participatory research are important in defining the research approach and how it can impact everyone involved in the process. Compared to community-based research, CBPR shows many similarities that are highly beneficial to the research process.
There are many benefits in the partnership between researcher and community that are shown throughout the evaluation of the CBPR principles. These benefits contribute to healthcare and understanding the many relationships between clients and health care providers in representing trust, government involved and positive communication. What I also found was how CBPR empowers the community, especially communities that are of low-income, and gives opportunities to those regardless of who they are or where they come from. It gives individuals a sense of control over their community and the outcomes that follow. As seen throughout the research, much involved was given to those participating in the study, especially those living in a lower income community, to give feedback on what lacks in that community and what type of improvements are needed in eliminating health disparities.
Ethical Issues and Challenges
Throughout the articles, I found that community based participatory research is a true CBPR study that reflects on the many strengths and limitations of CBR. It has many ethical issues that are found within the public health spectrum and there were also many challenges that were faced when using participatory research such as partnerships and the role of funders, community building, time requirement, flexible funding and socioeconomic status. The CBPR approach does not show much data that is relevant to community concerns. Having the inclusion of community partners helps to protect the community from harm, however, it can lead to unnatural ethical research practices, even though there are important challenges that are found with CBPR that go undiscussed. With the individuals who are funding the research project, they may find it difficult to know where they stand and what their role is in the partnership relation. In low-income communities where much of CBPR takes place, “funders may need to invest in front-end processes, including supporting intermediary organizations that can facilitate the community building that is often an important precursor” (Minkler, Blackwell, Thompson and Tamir, 2003).
Conclusion
I found that the CBPR approach is a valuable research tool in which can involve everyone in the process of positive changes within a community. This type of research searches for solutions for the communities that they are partnered with and I believe that having a long-term end goal, resulting in positive change for a struggling community, is the best way to resolve any issues especially in the public health setting.
References
Cacari-Stone, L., Wallerstein, N., Garcia, A. P., & Minkler, M. (2014). The Promise of Community-Based Participatory Research for Health Equity: A Conceptual Model for Bridging Evidence With Policy. American Journal of Public Health, 104(9), 1615–1623. http://doi.org/10.2105/AJPH.2014.301961
Israel, B. A., Coombe, C. M., Cheezum, R. R., Schulz, A. J., McGranaghan, R. J., Lichtenstein, R, Burris, A. (2010). Community-Based Participatory Research: A Capacity-Building Approach for Policy Advocacy Aimed at Eliminating Health Disparities. American Journal of Public Health, 100(11), 2094–2102.http://doi.org/10.2105/AJPH.2009.170506
Israel, B., Schulz, A., Parker, E., & Becker, A. (1998). Review of Community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health. Vol. 19: 173202. DOI:10.1146/annurev.publhealth.19.1.173
Minkler, M., Blackwell, A. G., Thompson, M., & Tamir, H. (2003). Community-Based Participatory Research: Implications for Public Health Funding. American Journal of Public Health, 93(8), 1210–1213.
Minkler, M. (2004). Ethical challenges for the “Outside” Researcher in Community-Based Participatory Research. Health Education & Behavior, Vol. 31 (6): 684-697. DOI: 10.1177/1090198104269566
Salimi, Y., Shahandeh, K., Malekafzali, H., Loori, N., Kheiltash, A., Jamshidi, E., Majdzadeh, R. (2012). Is Community-based Participatory Research (CBPR) Useful: A Systematic Review on Papers in a Decade. International Journal of Preventive Medicine, 3(6), 386–393.
Steven, S. Coughlin, Selina A. Smith, Maria E. Fernandez. (2017). Handbook of Community-Based Participatory Research. DOI: 10.1093/acprof:oso/9780190652234.003.0005
Wallerstein, N., & Duran, B. (2010). Community-Based Participatory Research Contributions to Intervention Research: The Intersection of Science and Practice to Improve Health Equity. American Journal of Public Health, 100(Suppl 1), S40–S46. http://doi.org/10.2105/AJPH.2009.184036
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