Formal research projects are traditionally not a primary focus of outreach programs. However, a relatively new research methodology, Community-Based Participatory Research, relies on principles congruent with those of a comprehensive outreach program. Regardless of whether your program plans to conduct formal research projects or not, Community Based Participatory Research principles shed light on techniques for building empowering and equitable community partnerships. This article will define Community-Based Participatory Research and highlight outreach-specific benefits and lessons from putting the principles into practice.
What is Community-Based Participatory Research?
Community-Based Participatory Research (CBPR) is a research methodology which includes the participation of those who are affected by the issue or problem being studied for the dual purpose of creating knowledge and social change. CBPR recognizes and appreciates the unique strengths and resources each partner brings to the “research table.” Consequently, all research partners are treated equitably through a collaborative research approach. Research questions are formed with the community rather than on or about the community to combine knowledge with actions that improve community health. Research then becomes a partnership between academics, community-based organizations, and community members rather than a process where study participants act as subjects for the sole purpose of institutional knowledge gain.
Within CBPR, strategies to reduce health disparities are more effective because community partners shape the study’s design and implementation. Furthermore, when community members are invested in the processes and products of research, dissemination and use of findings occur at higher rates within the community.
Are we ready to participate in CBPR?
Outreach workers are in a unique position to participate in CPBR. Outreach staff understand the local community and how to work within this context to improve health outcomes. They have built trusted relationships with community members who represent underserved and hard-to-reach populations. In order not to jeopardize these relationships, it is important that outreach staff carefully assess whether CPBR is right for them, their organization, and the community. Before engaging in CBPR, outreach professionals should ask themselves questions such as these:
- Is self-interest or opportunism driving the project?
- Do I want a service but have no interest in research?
- Do I have the necessary skills or resources? Does my organization have the necessary skills or resources? Will my organization allow for participation in CBPR?
- Do I and my organization have the time for CBPR and the relationship-building involved with this type of research?
- How will my community react to CBPR? Is the research question something the community feels is a priority? What are the community’s expectations if I do engage in CBPR?
- What are the ethical considerations? Do the potential burdens or harms of the research outweigh the benefits?
- Do I agree with the researcher’s goals and objectives?
- Am I comfortable working with a researcher? Am I interested in co-learning and collaborating with the academic partner?
After asking these questions, outreach staff should consider whether they believe in the principles of CBPR. The key principles of CBPR, as developed by Israel, et al., include:
- Acknowledging the community as a unit of identity. In other words, acknowledging that the community as a whole has importance and should have its thought, opinions, and values heard and honored.
- Building on the strengths and resources of the community.
- Facilitating a collaborative, equitable partnership in all phases of research. Involving an empowering and power-sharing process that attends to social inequalities.
- Fostering co-learning (exchanging information and skills) and capacity building among all partners.
- Achieving a balance between generating new knowledge and development of an intervention, such as pesticide-safety education classes. Both the new knowledge and the intervention should be for the mutual benefit of all partners.
- Focusing the local relevance of public health problems and ecological perspectives[1] on multiple determinants of health.
- Involving systems development using a cyclical and iterative process, whereby the system, such as a health education program, is continuously developed in a repetitive manner so as to reach the desired goal or outcome of the system (in this case the management or elimination of a health problem).
- Disseminating results to all partners and involving them in the wider dissemination of results[2].
- Involving a long-term process and commitment to sustainable research projects.
Because the principles of CBPR emphasize co-learning, capacity building, and sustainability, there are many benefits to this type of research from a community-level perspective.
What are the benefits of CBPR?
There are many benefits for outreach staff and community members who take part in CBPR. Although the specific benefits for each community partaking in CBPR will be different, there are some general advantages to involvement. The participating community organization can ultimately have its needs better met through collaborative research that focuses on solving a community-identified problem. Through CBPR, academic resources such as time, money, and knowledge are shared with the community partner. Additionally, outreach staff can build their capacity for research, shifting the power-balance between academic institutions and the community (who historically have had little say in the research process) to build better relations. Finally, data may be obtained that validate community concerns and provide “proof” that policymakers, the media, and other high-level decision makers require before they attempt to solve a problem. CBPR increases the likelihood that sustainable, appropriate, and effective solutions or systems are put into practice to reduce health disparities.
What are three ways CBPR principles apply to outreach programs?
Even if an outreach program does not participate in CBPR, there are lessons to be learned from this research orientation. Principles from CBPR can be applied to collaborations, how to work with the local community, and how to sustain relationships.
In terms of collaboration, CBPR emphasizes that partnerships be a mutual engagement, where all partners have their strengths and skills acknowledged and equally utilized. Outreach staff should consider documenting this commitment within a “Memorandum of Understanding” or a “Memorandum of Agreement,” whereby outreach programs and partnering organizations clearly outline the framework of cooperation and what is expected of each other. This is particularly important in preventing one partner from feeling “left-out” or “used”. By equitably sharing power within a collaborative relationship, an outreach program can help ensure its collaboration will be more sustainable, effective, and can establish a foundation of accountability.
Additionally, CBPR strongly emphasizes community involvement and engagement. Comprehensive outreach programs draw upon the knowledge of community members in order to focus their activities and, often limited, resources. For example, consider doing a needs assessment of the community to determine topics for health education sessions. This needs assessment could consist of a written and/or verbal survey of the local community asking them what health issues, such as dental decay or youth drug use, are of concern to them.
Finally, a core principle of CBPR is sustainability and a commitment to the long-term development of the community. Outreach programs can adapt this principle to their own work by looking at their relationship with the community through a broader lens. Anything the outreach program does in the community extends beyond just a particular project or event. Consequently, quality outreach programs attempt to sustain relationships with partners and other community members through staffing changes and budget cuts. For instance, outreach protocols formalize a program so as to maintain a consistent presence through staff changes.
In conclusion, outreach programs and CBPR operate in similar frameworks. This alignment can work toward the benefit of both the outreach program and the partnering institution in a CBPR project. If CBPR is not an option or does not seem appropriate, this type of research comprises of some enlightening principles, which are relevant to all outreach programs.
Resources
In order to get started with CBPR, find out if it is right for your program, or see how the principles can help guide your outreach program, check-out these resources:
- Community-Campus Partnerships for Health (http://depts.washington.edu/ccph/commbas.html) – hosts many links to CBPR resources, including reports/publications, examples of funded proposals, peer-reviewed journal article, electronic discussion groups, principles and policies, Memorandums of Understanding (MOUs), Memorandums of Agreement (MOAs), etc.
- Explore why CBPR is a valuable process and what the incentives are for participating in CBPR the Agency for Healthcare Research and Quality (AHRQ) (http://www.ahrq.gove/research/cbpr/cbpr1.htm)
- The Community Toolbox has resources and information on building skills to promote healthy communities (http://ctb/ku.edu/en/default.aspx)
- You can determine if your project aligns with the principles of CBPR by visiting (http://lgrean.net/guidelines.html).
[1] An ecologic perspective in health refers to seeing health as influenced by a broad range of factors at several levels, including the interpersonal level, the organizational level, the community level, and the public policy level. For example, obesity can be viewed from an ecological perspective. At the interpersonal level, obesity occurs when an individual eats too much and does not exercise enough. At the organizational level, obesity may occur because an employer has their employees work long hours, so exercise and the preparation of healthy meals is not an option. At the community level, obesity can occur because there are no healthy foods available and/or there are no safe spaces available for exercise. At the public policy level, obesity can arise from the subsidies the government gives to, for example, dairy farmers who are able to produce lots of cheese at a low cost for consumers, allowing for unhealthy amounts of cheese to be consumed by the public.
[2] For example, a CBPR project may find wage theft occurring among a certain population. This information, according to CBPR principles, should be shared with all partners, who are expected to help spread this information to the appropriate audiences.