1. Community-Based Participatory Research in Indian Country
Dr. Bonnie Duran
University of Washington
Moderator: Dr. Francine Gachupin
University of Arizona

2. American Indian and Alaska Native NPA Caucus
Community-Based Participatory Research in “Indian Country”: A Grounding for Action and Social Change
American Indian and Alaska Native NPA Caucus
April 5, 2018
Bonnie Duran DrPH Professor,
University of Washington School Social Work & Public Health
Director, Center for Indigenous Health Research
Indigenous Wellness Research Institute

3. Madame Chair and the Navajo Nation HRRB
Dine Unity Project et. al
Social Location
4CC Project

4. Objectives
Define and describe community-based participatory research (CBPR) and other approaches along the spectrum
Rationale for CBPR
Methods: Developing and Maintaining Partnerships in Indian Country
Promising practices for CBPR process and outcomes

5. Community-Based Participatory Research (CBPR)
“ CBPR refers to a partnership approach to research that equitably involves community members, organization representatives, and researchers in all aspects of the research process.”*
Israel BA, Eng E, Schulz AJ, et al., eds. Methods in Community-Based Participatory Research for Health. San Francisco, Calif: Jossey-Bass; 2005

6. CBPR Definitions
“Systematic inquiry, with the participation of those affected by an issue for the purpose of education and action or effecting change.” Green et al., 1994, 2003
“ A collaborative research approach that is designed to ensure and establish structures for participation by communities affected by the issue being studied, representatives of organizations, and researchers in all aspects of the research process to improve health and well-being through taking action, including social change.” AHRQ Report, 2004

7. Participatory Research is an Umbrella Term:
Action Research
Participatory Action Research
Emancipatory Research
COMMUNITY-BASED PARTICIPATORY RESEARCH
popular epidemiology
cooperative inquiry
empowerment evaluation
Practice Based Research Networks
Patient Centered Outcomes Research
PARTICIPATORY RESEARCH

8. Principles of CBPR
Emphasizes local relevance and ecological perspective that recognizes multiple determinants
Involves system development through cyclical and iterative process
Disseminates findings and knowledge to all
Involves long-term process and commitment
Israel, Schulz, Parker, Becker, Allen, Guzman, “Critical Issues in developing and following CBPR principles,” Community-Based Participatory Research in Health, Minkler and Wallerstein, Jossey Bass, 2000.

9. Principles of CBPR Recognizes community as a unit of identity
Builds on strengths and resources
Facilitates partnership in all research phases
Promotes co-learning and capacity building
Seeks balance between research and action

10. Principles for Tribes Don’t plan about us without us
All tribal systems shall be respected and honored, emphasizing policy building and bridging, not a policy wall
Policies shall not bypass Tribal government review and approval prior to implementation
Tribally specific data shall not be published without prior consultation
Data belongs to tribe
Turning Point Collaboration for a New Century of Public Health, Spring Forum 2001, NACCHO,W.K.K Kellogg, Robert Wood Johnson Foundations

11. Rationale for Partnership Research

12. History is written by people in power Controlled Research
Mistrust of Research
History is written
by people in power
Research
Controlled

13. Epistemicide

14. Surveillance and Normalizing Judgment = Discipline
Hoffman, F. (1928). The Navajo Population Problem. Proceedings of the twenty-third International Congress of Americanists 23,
Hoffman, F. (1930). Are the Indians Dying Out? American Journal of Public Health, 20,

15. 1920 & years later
Hoffman, F. (1920). Health Conditions among the Indians. JAMA, 75(7),

16. Emerging Scientific Rationale for Research Engagement

17. Dissemination & Implementation of EBI
Implementation research is the study of activities and strategies to successfully integrate an evidence-based public health intervention within specific settings (e.g., primary care clinic, community center, school).
Dissemination research is the study of the distribution of information and intervention materials to achieve greater use and impact of the intervention.

18. CEnR in Implementation Research
Challenge of bringing evidence to practice
Moving from efficacy to effectiveness trials
Internal validity insufficient for translational research
External validity: Implementation/Role of context
Challenge of community complexities
Challenge of what is evidence
Evidence-Based Practice vs. Practice-/Indigenous-/Community- Based Evidence
Challenge of one-way orientation
Challenge to translate action and policy

19. Google: Epistemologies of the South PDF
Knowledge Democracy
The understanding of the world is much broader than the Western understanding of the world.
There is no global social justice without global cognitive justice.
Ecology of knowledges: alternatives to a monolithic knowledge enterprise based on the domination of the Global North and the marginalization and subordination of other knowledges.
Google: Epistemologies of the South PDF

20. Epistemic Injustice PDF
Distributive epistemic injustice: “the unfair distribution of epistemic goods such as education or information” 
Discriminatory epistemic injustice: a more specifically epistemic kind of wrong, which itself comes in two kinds 
Testimonial injustice: a reduction in the credibility of a speaker due to prejudice in the hearer
Hermeneutical injustice: a reduction in the intelligibility of the experience of a person who is a member of a marginalized group, either to herself or to others, due to a lack of hermeneutical resources in the community
Google
Epistemic Injustice PDF

21. Present impact: Indigenous Framing
9/17/2018
B. Duran

22. Research for Health AND Engage for Equity
Funding NIDA, OBSSR, NCRR, NINR, NIMHD

23. On Models
Models are “an idealized representation of reality that highlights some aspects and ignores others.”*
“Models of course are never true, but fortunately it is only necessary that
they be useful”**
* Pearl, J. (2000). Causality: Models, reasoning, and inference. Cambridge, England: Cambridge University Press.
** Box, G. E. P. (1979). Some problems of statistics and everyday life. Journal of the American Statistical Association, 74, 1–4

25. Context
Social-Economic Status, Place, History, Environment, Community Safety, Institutional Racism, Culture, Role of Education and Research Institutions
National/ Local Governance / Stewardship/ Approvals of Research; Policy & Funding Trends
Capacity
&
Readiness
Collaboration
Trust &
Mistrust
Political
Policy
Social
& Structural
Health
Issue Importance
Perceived Severity by Partners
Community/Academic, History of Organizing
Partnership Capacity
Historic Trust / Mistrust between Partners

26. Partnership Processes
Safety
Trust / Respect
Influence /Voice
Flexibility
Dialogue and Listening / Mutual Learning
Conflict Management
Leadership
Collective Reflection / Reflexivity
Resource Management
Participatory Decision-Making
Task Roles Recognized
Motivation to Participate
Cultural Identities / Humility
Personal Beliefs /Values
Spirituality
Reputation of P.I.
Partnership Structures
Relationships
Individual Charateristics
Health Care
Agency
Government
Community
CBOs
Funders
Academic
Diversity
Complexity
Control of Resources
% $ to Community
CBPR Principles
Formal Agreements
Partnership Values
Bridging Social Capital
Time in Partnership

27. Intervention & Research Processes Outputs
Processes that honor community, cultural knowledge and voice, fit local settings, and use academic & community language lead to Culture-Centered Interventions
Integrate Community Knowledge
Culture-Centered Interventions
Empowering Processes
Partnership Synergy
Appropriate Research Design
Community Involved in Research
Processes
Outputs
Empowering Co-Learning Processes lead to Partnership Synergy
Community Members Involved in Research leads to Research/ Evaluation Design that Reflects Community Priorities
Multi-directional Translation, Implementation & Dissemination

28. Outcomes Sustained Partnership & Projects
Intermediate
Policy Environment
Sustained Partnership
Empowerment
Shared Power Relations in Research
Cultural Reinforcement
Individual Partner / Agency Capacities
Research Productivity
University & Community Environments
Sustained Partnership & Projects
Individual, Organizational, Community
Stronger Community Voice in Research/ Knowledge Democracy
Growth in Skills and Capacities
Research Outcome, Papers, Grant Applications & Awards
Long-term
Future Policies / Social Transformation/
Research Meeting Community Needs
Community/Transformation
Social Justice
Health / Health Equity
Health Behaviors and Health Status Changes

29. What Predicts CBPR Outcomes?SE p
Capacity: Project has what it needs to work effectively towards its aims
.113
.059
.055
Alignment of CBPR Principles: Builds on resources and strengths, equitable partnerships in all phases of the research
.230
.068
.001
Level of Involvement: Task roles and communication (CERI)
.188
.046
.000
Communication Quality: Degree to which partners cooperation to resolve disagreements
.039
.137
Stewardship: Use of financial & in-kind resources
.086
.048
.072
Partnership synergy: Partners ability to develop goals, recognize challenges, respond to needs, work together
.249
Trust: Level of trust at the beginning of the partnership
.063
.073
R2: 0.467

30. E2 Pathway Analysis: Relational/Structural
179 Partnerships/ 381 Respondents

31. Culture Centeredness Influence/Voice Reflexivity Community Fit
CBPR Principles

32. Key Promising Practices

33. Key Promising Practices Measures

34. Developing and Maintaining Partnerships with Communities

35. How do we start?

36. Importance of Self-Reflexivity and Cultural Humility
Life-Long Learning and being Self-Reflexive of Own Location: gender, age, race/ethnicity, sexual orientation, education, power and privilege
Ask Ourselves Core Questions:
What is problem from each point of view?
What should be done about this problem from each point of view?
What can we do together

37. Decolonizing Practice
Grounds efforts in Native community values, theories: Historical Trauma, Indigenous Knowledge
Acknowledges existing community health and wellness approaches and endeavors;
Maintains and promotes community sovereignty and control.

38. Stages of Research: where do you see power sharing?
Identifying a problem
Literature review/Theory Development
Pulling the team together: support letters
Research proposal
Getting the funds
Ethics review
Making a plan
Data collection
Analyzing data
Interpreting data
Dissemination of results
Advocacy: policy and services

39. Questions for Ourselves
1. How do we ‘decolonize’, ‘deracialize’, ‘demasculanize’ and ‘degender’ our inherited ‘intellectual spaces’?
2. How do we support the opening up of spaces for epistemologies, ontologies, theories, methods, and questions other than those that have exercised dominance over (perhaps have even suffocated) intellectual and scholarly thought and writing?
3. How do we contribute to the building of new academic and other institutional cultures that genuinely respect and appreciate difference and diversity of class, gender, nationality, language, religious belief or sexual orientation?
4. How do we become a part of a new architecture of knowledge that
allows co-construction of knowledge between intellectuals in academia and intellectuals located in community settings?

40. Deep Listening and Learning
“Deep learning involves the whole body, blood and bone, not just the theoretical or cataloguing of insightful facts and analyses. Deep learning moves the feet to walk in a new way, moves the eyes to see from the new perspective won by that walking, and moves the hands to fashion the tangible world into a new image envisioned by the new seeing.”
Moriary, P, “Deep Learning for Earthquake Country,” 1993, Future of Prophetic Christianity: Essays in Honor of Robert McAfee Brown, Orbis Books, NY

41. CBPR & You

42. Experience & plans for Community Engagement?
Quick review of your CEnR experience
Aspirations for future engagement

43. History of Medicine 2000 B.C. -Here, eat this root.
1000 A.D. -That root is heathen. Here, say this prayer.
1850 A.D. -That prayer is superstition. Here, drink this potion.
1940 A.D. -That potion is snake oil. Here, swallow this pill.
1985 A.D. -That pill is ineffective. Here, take this antibiotic.
2000 A.D. -That antibiotic is artificial. Here, eat this root.

44. Questions and Answer Session
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