A Public Health Example – NIH
Community-based Participatory Research
An Approach to Intervention Research With a Native American Community
Patricia A. Holkup, PhD, RN, Toni Tripp-Reimer, PhD, RN, FAAN, Emily Matt Salois, MSW, ACSW, and Clarann Weinert, SC, PhD, RN, FAAN
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Community-based participatory research (CBPR), with its emphasis on joining with the community as full and equal partners in all phases of the research process, makes it an appealing model for research with vulnerable populations. However, the CBPR approach is not without special challenges relating to ethical, cultural, and scientific issues. In this article, we describe how we managed the challenges we encountered while conducting a CBPR project with a Native American community. We also suggest criteria that will enable evaluation of the project.
Keywords: action research, elder mistreatment, ethnogerontology, family interventions, health disparities, Native Americans, research methodology, rural nursing
IT is well documented that people of ethnically and racially diverse minority groups experience poorer health than do the majority population. In 1998, President Clinton took a bold approach to this long-standing and unacceptable inequity by introducing an initiative that set, as a national goal, the elimination of racial and ethnic health disparities in 6 areas by the year 2010.1 One of the steps outlined in this Presidential initiative was the need to augment existing knowledge and best practices with the development of new approaches to addressing health inequities. Current research strategies, with “outside expert” perspectives, have proven to be poorly suited to address the issues that are related to racial and ethnic health disparities.2 New methods and models for conducting research among people of minority groups are needed.
In accord with the national goal of eliminating health disparities, the National Institute of Nursing Research (NINR) and the National Center for Minority Health and Health Disparities (NCMHHC) convened a multidisciplinary workshop in November 2001. The focus of this meeting was to explore the use of community-partnered interventions in nursing research as an approach that might be effective for conducting research in minority populations. One outcome of that meeting was NINR’s announcement, in July 2002, inviting applications for community-partnered interventions to reduce health disparities in racial and ethnically diverse minority populations.3
Community-based participatory research (CBPR), with its emphasis on partnering with communities, provides an alternative to traditional research approaches that assume a phenomenon may be separated from its context for purposes of study. Such approaches, arising from a positivistic philosophical framework, lie at the base of separating research from practice. In contrast, CBPR recognizes the importance of involving members of a study population as active and equal participants, in all phases of the research project, if the research process is to be a means of facilitating change. CBPR shows promise as an approach that can be used to work toward the reduction of health disparities.
The purpose of this article is to (a) situate the CBPR approach within a historical context, (b) define CBPR and discuss principles of the approach, (c) describe how this approach was used to explore the issue of elder mistreatment in a Native American community, (d) describe some of the challenges that were encountered when using this approach and how these were addressed, and (e) discuss which evaluative criteria can be applied to a CBPR project.
Historical Context of CBPR
CBPR falls under the rubric of action research. The beginnings of action research have been credited to Kurt Lewin, a social scientist, who, in the 1940s, developed the method as a way to use research for making planned social change.4 Lewin used action research to blend the experimental approach used by social scientists with “programs of social action to address social problems.”5(p1) Approaches to participatory methods of inquiry are multiple and are employed in such diverse fields and settings as the social sciences, education, organizational science, nursing, and public health. Names for this methodology include terms such as action research, participatory research, participatory action research, community-based research, action science, action inquiry, and cooperative inquiry. Some authors use the terms action research and participatory action research synonymously. Others distinguish between them, placing the 2 terms on opposite ends of a continuum, with action research representing utilitarian, problem-solving approaches on one end and participatory action research representing emancipatory or transformative action on the other end of the continuum.6 Others assert that action research represents a broad umbrella under which participatory research may be subsumed.2 Despite the apparent difficulties in determining a taxonomy of types of action research, it can be asserted that all, at least, belong to the same genre. They all emanate from the same ontological paradigm, one embracing a participative reality.7 They rely on an epistemology of experiential and participative knowing,8 informed by critical subjectivity and participatory transaction.7 All link action with research, and all recognize the importance of involving members of the study population in the research process. Additionally, knowledge gained from participatory approaches to research continues to increase understanding of what it means to work within the subjective spaces created when people from diverse cultures collaborate to work toward a common goal.9,10
Definition and Principles of CBPR
Israel et al defined CBPR as focusing on social, structural, and physical environmental inequities through active involvement of community members, organizational representatives, and researchers in all aspects of the research process. Partners contribute their expertise to enhance understanding of a given phenomenon and integrate the knowledge gained with action to benefit the community involved.11(p182)
Characteristics of the CBPR approach include (a) recognizing the community as a unit of identity, (b) building on the strengths and resources of the community, (c) promoting colearning among research partners, (d) achieving a balance between research and action that mutually benefits both science and the community, (e) emphasizing the relevance of community-defined problems, (f) employing a cyclical and iterative process to develop and maintain community/research partnerships, (g) disseminating knowledge gained from the CBPR project to and by all involved partners, and (h) requiring long-term commitment on the part of all partners.12
The strengths or advantages of CBPR are that it allows for the innovative adaptation of existing resources13; explores local knowledge and perceptions11,13; empowers people by considering them agents who can investigate their own situations13-15; the community input makes the project credible, enhancing its usefulness by aligning it with what the community perceives as social and health goals11,13; joins research participants who have varied skills, knowledge, and expertise to address complex problems in complex situations11; provides resources for the involved communities11; through its collaborative nature, provides a forum that can bridge across cultural differences among the participants11; and helps dismantle the lack of trust communities may exhibit in relation to research.11,15