Peer Research in Health and Social Development

International Perspectives on Participatory Research

Stephen Bell, Peter Aggleton, Ally Gibson, Stephen Bell, Peter Aggleton, Ally Gibson

• Publisher: Routledge
• Year: 2021
• ISBN:
  9781000380521
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

Peer research is increasingly used in international academic, policy and practice environments. It engages members of a group or social network as trusted members of a research team working in communities and settings they are familiar with.

Critics, however, point to methodological concerns with peer research. These include the extent to which peer researchers genuinely represent the populations under study; data confidentiality; the emotional burden of enquiring into sensitive issues peers may experience in their own lives; and the reliability and credibility of data collected by people who do not have academic training. The book seeks to counter the marginalisation of research experience and skills derived from close relationships with people and communities, while reflecting critically on the strengths and limitations of peer research. Chapters by a wide range of international contributors illustrate the potential of peer research to facilitate an in-depth understanding of health and social development issues and enhance policy and practice.

This interdisciplinary book provides students and professionals working in health, social science and development studies with a thorough grounding in this new style of research. It will appeal to those interested in research and evaluation; sexual health and public health; mental health, disability and social care; gender and sexuality; conservation and environmental management; migration and citizenship studies; humanitarian issues; and international development.

Section I

Critical perspectives on peer research

1 Peer research in health and social development

Understandings, strengths and limitations

Stephen Bell, Peter Aggleton and Ally Gibson

Introduction

Since the 1970s, there has been growing interest in research that takes informants’ perspectives seriously, not only for the sake of understanding but also for the development of policy and practice in tune with people’s everyday lives and needs. One increasingly favoured approach is peer research, which describes a cluster of methodologies and methods underpinned by a commitment to recognising grass-roots expertise on health and social issues, and to working closely with community members as researchers on studies to enhance health and social well-being.

Despite differences, peer research approaches are based on the idea that ‘peer researchers’ have privileged access to groups that may be difficult to reach using conventional research methods (Price and Hawkins 2002; Coupland and Maher 2005). They aim to facilitate access to ‘insider’ or emic understandings of the health and well-being issues under study (Mutchler et al. 2013; Lorway et al. 2018). Despite the growing use of peer research approaches, working with lay community researchers is not without its drawbacks. Ethical concerns may arise about the extent to which peer researchers genuinely represent the population(s) under study; how best to manage trust and confidentiality during data collection; and how to cope with the burden of researching sensitive, and possibly harmful, issues that peers may experience in their own lives (Greene et al. 2009; Logie et al. 2012; Kelly et al. 2020). Questions have also been raised about the reliability and credibility of the data collected and analysed by people who do not have academic training, and who are required to manage multiple identities – as researcher, friend, family member, confidante and so forth – as part of the research process (Sterk-Elifson 1993; Coupland and Maher 2005; Greene et al. 2009).

This book derives from concern about the use of peer research in diverse sociocultural and institutional settings without critical engagement with fundamental issues underlying this research approach. At the same time, however, we are keen to challenge the values that privilege the expertise gained through academic training above that derived from personal insight and experience in community settings. In particular, this book seeks to counter the marginalisation of research experience and skills derived from people’s local relationships and communities, while reflecting critically on the strengths and limitations of peer research itself. Chapters illustrate the potential for rigorous peer research to facilitate an in-depth understanding of health and social development among diverse populations in international settings, together with its impact on policy and practice, as well as for the individuals and communities involved.

Understanding peer research

Roles and definitions

Peer research seeks to engage with the everyday realities of the individuals, groups and communities under study, positioning members at the centre of the research process (Price and Hawkins 2002; Guta et al. 2013). Generally speaking, peer researchers are members of a group or social network who become trusted, equal members of a research team and work as researchers within their own communities (Price and Hawkins 2002; Greene et al. 2009; Logie et al. 2012; Guta et al. 2013). Peer researchers do not need to have prior research experience. Training is often provided for the demands of their roles, covering issues including recruitment and sampling, data collection, verbal and non-verbal communication, and research ethics (Price and Hawkins 2002; Coupland and Maher 2005; Mutchler et al. 2013; Bell et al. 2021).

Peer researchers typically take responsibility for looking after one or more aspects of research, from research question identification and study design, through participant recruitment and data collection, to data interpretation and analysis, and research dissemination. A range of peer research roles have been identified, and the terminology used to describe them varies across studies. It includes ‘peer research associate’ (Kaida et al. 2019; Zalazar et al. 2020), ‘peer research assistant’ (Greene et al. 2009; Logie et al. 2018), ‘peer ethnographer’ (Mutchler et al. 2013), ‘lay researcher’ (Nichter 1984), ‘co-researcher’ (Miled 2020), or ‘community researcher’ (Mosavel and Sanders 2014; Goodman et al. 2018; Lorway et al. 2018) – depending on the researcher’s role and responsibilities.

Different models of peer research exist (Roche et al. 2010). In an ‘advisory’ model, for example, peer researchers join a steering, advisory or governance committee to provide insight and guidance at specific points in the research cycle, but may not be involved in the day-to-day implementation of research studies. In an ‘employment’ model, on the other hand, peer researchers are recruited as research staff and trained in skills specific to fulfil their role but may have little input into initial study conceptualisation and design. In a ‘partnership’ model, peer researchers are more likely to be leaders in a study, fulfilling an active, equitable role across all stages of research.

The origins of peer research

In the 1970s, social research in health witnessed growing interest in interpretive styles of enquiry, complementing earlier more positivist forms of understanding (Bell and Aggleton 2016). Positivist research tends to be hypothetico-deductive in nature, using quantitative methods to study and develop ‘law-like’ statements connecting human knowledge, attitudes and behaviour. Interpretive research, in contrast, tends to use qualitative methods with the aim of accessing diverse, locally situated, subjective understandings of social life, recognising that how people see themselves and others is heavily contextual and located in social relationships. This growth of interest in interpretive approaches created space and legitimacy for innovative ways of engaging community members in social, health and international development research.

Peer research emerged from the participatory research paradigm promoted around this same time. This called for grass-roots, community-led problem identification and planning to solve local problems, and was based on recognition that community members are experts on their own lives, with a wealth of ‘insider’ knowledge and insight that outsiders likely lack (Chambers 1983). Nichter (1984), for example, described an early example of peer research as far back as 1979 in which ‘lay researchers’ conducted health research in rural communities in South India. The study provides an early illustration of a ‘de-professionalisation’ of social science research, signalling the ability of study participants to take a leading role in research due to their intimate understanding of local issues and concerns.

Since then, the use of peer research has grown in response to national and international agendas supportive of the right of individuals and communities to participate in planning and decision making that affects their lives. High-profile examples of this tendency can be seen in the 1978 WHO Declaration of Alma-Ata on primary health care (WHO and UNICEF 1978), the 1989 UN Convention on the Rights of the Child (UN General Assembly 1989), the 1999 UNAIDS statement on the Greater Involvement of People Living with HIV/AIDS (UNAIDS 1999), and the 2007 UN Declaration on the Rights of Indigenous Peoples (UN General Assembly 2007). Each of these declarations, conventions or statements signals the importance of meaningful participation and involvement by ordinary people and lay or community members in health and social development decision making.

But peer research also has origins of a rather different kind – in sociological and anthropological approaches to enquiry. The ‘insider’ research much favoured by interpretive sociologists holds that when there is a subjective or cultural proximity between the researcher and the communities, cultures, subcultural groups or institutions under study, more fruitful findings are likely to emerge (Hodkinson 2005). Similarly, the ethnographic approach favoured by anthropologists and some sociologists holds that building relationships of trust and rapport with communities is a prerequisite for good quality research to understand culture. What people say about their lives varies according to the familiarity and trust established between the researcher and the researched over time (Price and Hawkins 2002). Because of this, in anthropology, sociology and related disciplines, ‘gatekeepers’ may be used to facilitate introductions and support participant recruitment, and ‘key informants’ may provide advice, insight and interpretation of data.

While late 20th-century moves towards an interpretive paradigm supported a renewed emphasis on socially constructed lived experience, they did little to shift the fundamental ‘social relations of research production’ (Oliver 1992). A clear distinction between the researcher (as the one with specialist knowledge and skills) and the researched (as relatively powerless research subjects) tended to remain in place, and individual and community participation in some forms of interpretive enquiry could be as objectifying and alienating as involvement in positivist research. In consequence, alongside social movements for patient involvement in health, critical health and social scientists demanded change, to rebalance ownership and involvement and give power to populations who otherwise would remain marginalised, powerless or colonised (Oliver 1992; Kiernan 1999; Tuhiwai Smith 2012). In this way, peer research approaches can become a vehicle for emancipation and self-determination (Oliver 1992; Hecker 1997; Bell et al. 2021), especially when trained researchers work as ‘activists’ (Kiernan 1999) to support research instigated and led by marginalised peoples, with the goal of overcoming experiences of oppression and colonisation.

Contexts and application

Since their initial development, peer research approaches have been used in diverse contexts in South America (Fortin and Bertrand 2013; Zalazar et al. 2020), Africa (Price and Hawkins 2002; Chappell et al. 2014; Logie et al. 2018; Lorway et al. 2018), Asia (Brown et al. 2017; Lorway et al. 2017), North America (Sterk-Elifson 1993; Greene et al. 2009; Mutchler et al. 2013), Europe (Longfield et al. 2007; Buffel 2019; Hintjens et al. 2020) and Australia (Coupland and Maher 2005; Bell et al. 2021). In such settings, peer research studies have engaged a wide variety of populations. These include younger and older people (Buffel 2019; Bell et al. 2021), Indigenous peoples (Hecker 1997; Mistry et al. 2015; Goodman et al. 2018; Bell et al. 2021), migrant and refugee populations (Hintjens et al. 2020; Miled 2020), and people of diverse sexualities and genders (Longfield et al. 2007; Mutchler et al. 2013; Logie et al. 2018; Zalazar et al. 2020), among others.

Peer research approaches have been used to understand lived experiences of a broad range of health issues including HIV (Fortin and Bertrand 2013; Logie et al. 2018; Zalazar et al. 2020); sexual, reproductive and maternal health (Price and Hawkins 2002; Brown et al. 2017; Bell et al. 2021); autism (Aabe et al. 2019) and other forms of disability (Kiernan 1999; Chappell et al. 2014; Burke et al. 2019); dementia (Stevenson and Taylor 2019); and cancer (Mosavel and Sanders 2014). Social issues examined include sex work (Collumbien et al. 2009; Lorway et al. 2017; Lorway et al. 2018), housing and homelessness (Greene et al. 2009), natural disasters (Kita 2017), drug use (Sterk-Elifson 1993; Coupland and Maher 2005; True et al. 2017) and religious persecution (Vassadis et al. 2015; Miled 2020). In each of these fields, the aim has been to instigate and facilitate change informed by the life circumstances and experiences of those involved.

A range of research techniques has been used in peer research. They include participant observation (Mutchler et al. 2013; Lorway et al. 2018; Northcote and Phillips 2019), in-depth interviews (Price and Hawkins 2002; Bell et al. 2021; Hintjens et al. 2020), focus group discussions (Burke et al. 2019), Photovoice (Miled 2020) and participatory film (Mistry et al. 2015), among other visual techniques.

Strengths of peer research

Enhanced access

One of the main advantages of peer research is that it provides access to people and communities that may be hard to reach using conventional research methods (Elliott et al. 2002; Coupland and Maher 2005; Greene et al. 2009; Vassadis et al. 2015; Porter 2016). For instance, using purposive and snowball sampling, peer researchers can gain access to otherwise difficult to reach settings (Price and Hawkins 2002; Coupland and Maher 2005; Logie et al. 2012; Vassadis et al. 2015; Logie et al. 2018). These include nightlife settings – such as pubs, clubs, house parties and outdoor festivals – in which young people consume alcohol at harmful levels (Northcote and Phillips 2019), and locations in which drug use occurs, which may be intimidating or unsafe to ‘outsider’ researchers (True et al. 2017).

From the perspective of study participants, peer researchers can provide a ‘safe’ space in which to talk openly about otherwise difficult issues in a context devoid of serious power imbalances. The enhanced rapport that peer research can create has been reported in studies with people who use drugs in Australia (Coupland and Maher 2005), in research with young people in Ghana, Malawi and South Africa (Porter 2016), and with older people who felt more at ease and emotionally connected with peer researchers when discussing the development of age...

Table of contents

• Cover
• Half-Title
• Series
• Title
• Copyright
• Dedication
• Contents
• List of figures
• List of contributors
• Acknowledgements
• SECTION I Critical perspectives on peer research
• SECTION II Working with hard to reach participants
• SECTION III Understanding diverse issues
• SECTION IV Ethical considerations
• SECTION V Influencing policy and practice
• Index