Methods for Community-Based Participatory Research for Health

Barbara A. Israel, Eugenia Eng, Amy J. Schulz, Edith A. Parker, Barbara A. Israel, Eugenia Eng, Amy J. Schulz, Edith A. Parker

• Publisher: Jossey-Bass
• Year: 2012
• ISBN:
  9781118282120
• Edition: 2
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

This thoroughly revised and updated second edition of Methods for Community-Based Participatory Research for Health provides a step-by-step approach to the application of participatory approaches to quantitative and qualitative data collection and data analysis. With contributions from a distinguished panel of experts, this important volume shows how researchers, practitioners, and community partners can work together to establish and maintain equitable partnerships using a Community-Based Participatory Research (CBPR) approach to increase knowledge and improve the health and well-being of the communities involved.

Written for students, practitioners, researchers, and community members, the book provides a comprehensive presentation of innovative partnership structures and processes, and covers the broad spectrum of methods needed to conduct CBPR in the widest range of research areas—including social determinants of health, health inequities, health promotion, community interventions, disease management, health services, and environmental health. The contributors examine effective methods used within the context of a CBPR approach including survey questionnaire, in-depth interview, focus group interview, ethnography, exposure assessment, and geographic information system mapping. In addition, each chapter describes a case study of the application of the method using a CBPR approach. The book also contains examples of concrete tools and measurement instruments that may be adapted by others involved in CBPR efforts.

PART ONE
INTRODUCTION TO METHODS FOR COMMUNITY-BASED PARTICIPATORY RESEARCH FOR HEALTH

Chapter 1
INTRODUCTION TO METHODS FOR CBPR FOR HEALTH

BARBARA A. ISRAEL
EUGENIA ENG
AMY J. SCHULZ
EDITH A. PARKER

Public health problems are complex, and their solutions involve not only political and social but also biomedical dimensions. Researchers, practitioners, community members, and funders continue to recognize the importance of comprehensive and participatory approaches to research and intervention, and opportunities for such partnership approaches continue to emerge. As they do, so does the demand for concrete skills and knowledge about how to conduct community-based or other participatory approaches to research. Both new and established partnerships continue to search for information about strategies, skills, methods, and approaches that support the equitable participation and influence of diverse partners in developing a clearer understanding of public health problems and in working collectively to address them. Like the first edition, this book is a resource for students, practitioners, researchers, and community members seeking to use community-based parti­cipatory research (CBPR) approaches to improve the health and well-being of communities in general and to eliminate health inequities in particular. In the introduction to this volume, we discuss the background to and support for CBPR, principles of CBPR, core components/phases of CBPR, and the broad cultural, socioeconomic, and environmental context in which CBPR is conducted. Finally, we describe the purposes and goals of this book, and present the organization and brief descriptions of the chapters.

BACKGROUND

Over the past decade, there has continued to be increasing recognition that more comprehensive and participatory approaches to research and interventions are needed in order to address the complex set of social and environmental determinants associated with population health and those factors associated more specifically with racial and ethnic inequities in health (Commission for the Social Determinants of Health, 2008; Commission to Build a Healthier America, 2009; Israel, Schulz, Parker, & Becker, 1998; Mercer & Green, 2008; Minkler & Wallerstein, 2008; Schulz, Williams, Israel, & Lempert, 2002). Concomitantly, funding opportunities that support partnership approaches to research addressing these problems continue to grow (Catalani & Minkler, 2009; Chen, Diaz, Lucas, & Rosenthal, 2010; Cook, 2008). These include, for example, the National Institute on Minority Health and Health Disparities’ Community-Based Participatory Research Initiative (NIMHD, 2011); the Centers for Disease Control and Prevention’s Prevention Research Centers program (CDC, 2011); the National Cancer Institute’s Center to Reduce Cancer Health Disparities Community Networks Program (NCI, 2012); the National Institutes of Health’s Clinical and Translational Science Awards Program, Community Engagement Core (NIH, 2011); and the Office of Behavioral and Social Sciences Research’s opportunities for community participation in research (OBSSR, 2012).

Partnership approaches to research exist in many different academic disciplines and fields. In the field of public health, partnership approaches to research have been called, variously, “community-based participatory,” “community-involved,” “collaborative,” and “community-centered-research” (see Israel et al., 1998, for a review of this literature). In addition, a large social science literature has examined research approaches in which participants are actively involved in the process. Examples include discussions of “participatory research” (deKoning & Martin, 1996; Green et al., 1995; Hall, 1992; Kemmis & McTaggart, 2000; Park, 1993; Tandon, 1996), “participatory action research” (Whyte, 1991), “action research” (Peters & Robinson, 1984; Reason & Bradbury, 2006, 2008; Stringer, 2007), “participatory feminist research” (Maguire, 1987, 1996; Joyappa & Miartin 1996), “action science/inquiry” (Argyris, Putnam, & Smith, 1985; Torbert & Taylor, 2008), “cooperative inquiry” (Heron & Reason, 2001; Reason, 1994), “critical action research” (Kemmis & McTaggart, 2000), “participatory community research” (Jason, Keys, Suarez-Balcazar, Taylor, & Davis, 2004), “tribally driven participatory research” (Mariella, Brown, Carter, & Verri, 2009), “community engagement” (Clinical and Translational Science Awards Community Engagement Key Function Committee Task Force, 2011), and “community-based collaborative action research” (Pavlish & Pharris, 2012). Although there are differences among these approaches, they all involve a commitment to conducting research that to some degree shares power with and engages community partners in the research process and that benefits the communities involved, either through direct intervention or by translating research findings into interventions and policy change.

In public health, nursing, social work, and related fields, the term community-based participatory research (CBPR) has been increasingly used to represent such collaborative approaches (Israel et al., 2001; Minkler & Wallerstein, 2008; Viswanathan et al., 2004), while recognizing that there are other approaches with different labels that share similar values and methods. CBPR in public health is a partnership approach to research that equitably involves, for example, community members, organizational representatives, and researchers in all aspects of the research process and in which all partners contribute expertise and share decision making and ownership (Israel et al., 1998, 2008). The aim of CBPR is to increase knowledge and understanding of a given phenomenon and integrate the knowledge gained with interventions and policy and social change to improve the health and quality of life of community members (Israel et al., 1998, 2008).

Associated with the developments described above, the Institute of Medicine Report, Who Will Keep the Public Healthy? Educating the Public Health Professionals for the 21st Century (Gebbie, Rosenstock, & Hernandez, 2003), identifies CBPR as one of the eight areas in which all public health professionals need to be trained. As stated in the report, “the committee believes that public health professionals will be better prepared to address the major health problems and challenges facing society if they achieve competency in the following eight content areas,” and then lists and discusses CBPR as one of “these eight areas of critical importance to public health education in the 21st century” (p. 62).

Further recognition of the relevance of CBPR for professionals can be found in the increasing number of participatory research courses being taught in schools and departments of public health, nursing, sociology, social work, and psychology, among others. In addition, the number of CBPR workshops and conference sessions offered in local communities as well as at regional, national and international meetings has expanded over the past decade as participants strive to enhance their knowledge and skills related to partnership approaches to research. A number of excellent books examine the theoretical underpinnings of participatory approaches and provide case studies that illustrate implementation issues (see, for example, deKoning & Martin, 1996; Jason et al., 2004; Minkler & Wallerstein, 2008; Reason & Bradbury, 2006, 2008; Stringer, 2007). In 2004, the Agency for Healthcare Research and Quality commissioned a systematic, evidence-based review examining definitions of, and the evidence base regarding implementation and outcomes of CBPR approaches in population health interventions (Viswanathan et al., 2004). Over the past decade, several journals, such as the Journal of General Internal Medicine (“Community-Based Participatory Research,” 2003) and Health Education & Behavior (“Community-Based Participatory Research—Addressing Social Determinants of Health: Lessons from the Urban Research Center,” 2002), published entire issues devoted to CBPR, and special sections on CBPR appeared in such journals as the American Journal of Public Health (“Community-Based Participatory Research,” 2001) and Environmental Health Perspectives (“Community-Based Participatory Research,” 2005). In 2007, a new journal was launched dedicated entirely to CBPR, Progress in Community Health Partnerships: Research, Education and Action. Indicative of these activities may be the increase in the use of the term, “Community-Based Participatory Research,” in the title or abstract of PubMed cited articles from 25 in 2001 to 226 in 2011. There have also been a number of training manuals and downloadable courses developed on CBPR (Israel, Coombe, & McGranaghan, 2010; Zimmerman, Tilly, Cohen, & Love, 2009).

As opportunities for conducting and learning about CBPR expand, so does the demand for knowledge and skills in this area. Practitioners and scholars ask for information about specific participation structures and procedures needed to establish and maintain equitable partnerships among individuals and groups from diverse cultures. They ask how specific data collection methods, such as survey questionnaires, in-depth interviews, focus groups, ethnography, and mapping can be designed and implemented to follow participatory principles, and how to engage all CBPR partners in disseminating research findings and translating results into action and policy change. This book is designed as a resource for students, practitioners, community members, and researchers in public health and related disciplines to expand their repertoire of skills and methods for supporting partnership approaches to research intended to improve the health and well-being of communities in general and to eliminate health inequities in particular.

PRINCIPLES OF CBPR

Based on an extensive review of the literature, the following discussion briefly presents nine guiding principles of CBPR (see Israel et al., 1998 and 2008, for a more detailed examination). These principles are offered with the caution that no one set of principles is applicable to all partnerships. Rather, the members of each research partnership need to jointly decide on the core values and guiding principles that reflect their collective vision and basis for decision making. However, as partnerships go about the process of making these decisions, they may be informed by the considerable experience and lessons learned over the past several decades of participatory forms of research as well as by the literature on partnerships and group functioning. Developing or existing partnerships may choose to draw on the principles presented here, as appropriate, as well as to develop additional or alternative principles that facilitate equitable participation and influence in each partnership’s particular context. We suggest that partnerships consider the principles they adopt as ideals or goals to strive toward, and evaluate the extent to which they are able to adhere to those principles as one aspect of partnership capacity building (Cornwall, 1996; Green et al., 1995; Israel et al., 2008). We clearly do not think that there is one “best” set of principles, and believe that such principles can also be considered on a continuum, for example, by differing levels of community involvement. At the same time, we argue that as CBPR continues to grow in recognition and stature, care should be taken that its more widespread adoption not result in CBPR being “selectively invoked to accomplish predetermined aims or goals not collaborative...

Table of contents

• COVER
• TABLE OF CONTENTS
• TITLE
• COPYRIGHT
• FIGURES AND TABLES
• FOREWORD
• DEDICATION
• ACKNOWLEDGMENTS
• THE EDITORS
• THE CONTRIBUTORS
• PART ONE: INTRODUCTION TO METHODS FOR COMMUNITY-BASED PARTICIPATORY RESEARCH FOR HEALTH
• PART TWO: PARTNERSHIP FORMATION AND MAINTENANCE
• PART THREE: COMMUNITY ASSESSMENT AND DIAGNOSIS
• PART FOUR: DEFINE THE ISSUE, DESIGN AND CONDUCT THE RESEARCH
• PART FIVE: DOCUMENTATION AND EVALUATION OF PARTNERSHIPS
• PART SIX: FEEDBACK, INTERPRETATION, DISSEMINATION, AND APPLICATION OF RESULTS
• APPENDIXES
• INDEX
• End User License Agreement