Community Based Participatory Research (CBPR) February 28,2008

CBPR Not simply a strategy, but an ideology People should be able to determine what is happening to their community – They will have to live with it! (compatibility) – Research dollars run out, so what will happen later on? (sustainability) – Not a laboratory in the traditional sense (fidelity)

“Traditional” Approaches Researchers pre-define “problem” – Little community involvement / paternalistic – Researchers offer solutions, implement, evaluate and leave – Programs are typically not feasible “real-world” solutions Communities – Define problem within context – Develop intervention – Evaluation / measurement may not be adequate

Considerations Community members – What benefit will become of the research for my community? Researchers – What benefit will become of the research for my needs? – Papers, grant funding, promotion, etc. Funding agencies – What benefit will become of the research for our organization? – Increased evidence-base, quality outcomes, achieving organization’s mission

Compatibility As researchers, we are typically outsiders (and usually viewed as such) While we bring a technical expertise to the table, community members bring a contextual expertise Both are CRITICAL – Some types of interventions work well, others work not so well DARE, Taxation of tobacco – Some types of interventions are contextually appropriate, others are not VCR Tapes, TV Commercials While our interventions may or may not work, we’ll get an article or some benefit from the work (at least a lesson learned) The community will have to live with this intervention

Sustainability “Traditional” research programs involve a research team entering community – Conducting some form or forms of interventions – Observing changes – Consider limitations / changes needed for future interventions – Good process and immediate outcome evaluations – Funding is over – Short time frame (months to a couple of years)

Sustainability (cont.) Community programs (i.e., local health dept) – May use pre-fab or “canned” programs – May implement due to mandate from supervising agency – May be designed due to perceived or measured need within community – Context specific (probably not generalizable to other communities) – Can probably be sustained longer in the community (DARE) – Evaluation of effect / outcomes may not be adequate

Principles of CBPR CBPR facilitates collaborative, equitable partnerships in all phases of the research. CBPR integrates and achieves a balance between research and action for the mutual benefit of all partners. CBPR recognizes community as a unit of identity

Principles of CBPR CBPR builds on strengths and resources within the community CBPR promotes co-learning and capacity building among all partners

Principles of CBPR CBPR involves a long-term process and commitment CBPR emphasizes local relevance of public health problems and ecological perspectives that recognize and attend to the multiple determinants of health and disease

Principles of CBPR CBPR disseminates findings and knowledge gained to all partners and involves all partners in the dissemination process CBPR involves systems development through a cyclical and iterative process

Process is Dynamic Nature of the process requires flexibility – Communities are different – Various time frames (hard to create timelines) – Various personalities Communities (Bryan vs. College Station vs. New York City) Organizations (Cooperative Extension Agencies in various counties) Individuals (county judges, mayors, etc.)

Goal Setting Good to set a defined ultimate goal Also good to define smaller “baby-step” goals – Offers group a sense of success early on – “We can do this after all” Definition of success and failure is important – Multiple definitions are important – Developed intervention to obesity problem that was not very effective, but was able to have the two local physicians, the local pharmacist, and a competing health system’s representative all collaborate and agree (or maybe simply sit at the same table)

Rules of Engagement (or as John likes to call it: CBPR camping rules) Always leave the site in better shape than when you arrive Before jumping into a river/lake, always investigate thoroughly (ask locals about stumps, overhangs, safe areas to “swim”) Not a good idea to leave fires burning when you leave with no one left to manage them or put them out

Is CBPR always the best approach? Not necessarily Very popular approach Many are conducting research under the title of CBPR, but are not – Simply forming coalition to inform what is going on