Community based participatory research
Research into health disparities has benefited from long standing and expanding relationships with local medical schools, other research institutions, community based organizations, and community serving agencies. Over the past decade, there has been a progressive evolution and restructuring of the relationship between CDU and many community based organizations. This restructuring has followed the “participatory model” of research, which supports an ongoing, mutually beneficial dialogue between the research enterprise of the University and the community at large.
Current national health policy has been shaped by documentation of the persistence of variation in health status and quality of health care by race. Landmark reports and policy directives such as Healthy People 2010 and the Institute of Medicine/National Academy of Sciences report (Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, 2002) declare conclusively that “a large body of research underscores the existence of disparities”. In the face of these challenging inequities, there is a general consensus that alternatives to traditional methods of scientific inquiry are needed. These alternatives include asking questions in new ways, including a broader range of people in the investigations, and most important, looking past the individual to include the community and community-level systems. Traditional investigations have a tendency to separate researchers from the object of their research. Within this framework, the complex environmental, socioeconomic, and political issues that compromise the health of minorities are neglected. To fully understand and change these conditions, researchers and community members have come to recognize the need for:
- integration of research and practice;
- a renewed link between ‘knowledge’ and ‘practice’;
- a more comprehensive approach to health research;
- recognition of the value of community contributions to the research process;
- an appreciation of the reality that ‘researcher’ and ‘participant’ are intimately connected in the research process and that a continuing dialogue between them is an essential part of the process; recognition of the limits of the scientific ‘positivist’ paradigm that an objective, value-free, single reality exists that elevates scientific knowledge over experiential knowledge.
Definitions and key principles.
These and other factors within the study of public health and health disparities have led to the concept of ‘partnership’ approaches to health research. There are many names and definitions for these alliances, such as “participatory action research”; “community-based action research”; “community engagement’; “community-centered research”; “community-academic partnerships”; “health promotion coalitions”; etc. In this particular document, we have chosen the term ‘community based participatory research’ (CBPR). There is general consensus regarding the overarching principles and characteristics of CBPR endeavors.
Based upon over a decade of experience and study, Barbara Israel and her colleagues at the University of Michigan have identified nine key principles of community-based participatory research that support successful research partnerships and are widely cited [Israel B, Schulz A, Parker E and Becker A. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19, pp. 173-202]
- Recognizes community as a unit of identity
- Builds on strengths and resources within the community
- Facilitates collaborative, equitable involvement of all partners in all phases of the research
- Integrates knowledge and intervention for mutual benefit of all partners
- Promotes a co-learning and empowering process that attends to social inequalities
- Involves a cyclical and iterative process
- Addresses health from both positive and ecological perspectives
- Disseminates findings and knowledge gained to all partners
- Involves long-term commitment by all partners.
While principles are a useful guide, Israel and her colleagues caution that they should not be imposed upon a project, and that they should be allowed to continually evolve to reflect changes in the research context, purpose and participants. The process of developing principles and making decisions about the partnership's characteristics is essential to building the infrastructure of the partnership. http://depts.washington.edu/ccph/commbas.html#Principles