Challenges and Rewards of Community Based Participatory Research CBPR

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Challenges and Rewards of Community Based
Participatory Research (CBPR)

• Nicolette Teufel-Shone, PhD
• College of Public Health
• University of Arizona
• Louis Teufel-Shone
• Diné Nation (Navajo)
• Native American Church

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Presentation Objectives

• Overview of CBPR
• Guiding concepts
• Strengths in specific contexts
• Challenges in specific contexts and relative to
  human subjects protection
• CBPRs potential to contribute to practice based
  evidence

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Community Based Participatory Research (CBPR)

• CBPR has emerged as a alternate research paradigm
• Builds on the expertise of community members,
  insiders
• Orientation to research that focuses on the
  relationship between and strengths of academic
  and community partners
• Not a set of research methods
• Has a goal of social change

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Key Principles of CBPR (Israel et al. 1998)

• Recognizes the community as a unit of identity
  (need for collective engagement)
• Builds on strengths and resources of all partners
• Facilitates collaborative, equitable involvement
  of all partners in all phases of research
• Promotes co-learning and an empowering process
  that addresses social inequalities.
• Engages both the community and outside partners
  in making decisions and sharing in the
  responsibility for the research
• Involves a long-term commitment by all partners

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CBPR is distinct from..

• Community-placed research in which the community
  is the setting or place of the research
• Community outreach which emphasizes service
• Engagement of community members in the review
  and/or oversight
• Hiring community members to translate research
  materials and survey instruments
• Hiring and training community members to collect
  data using outsider investigator methods and
  instruments

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Strength of a CBPR approach

• Supports the development of research questions
  and goals relevant to the concerns of community
  members
• Enhances the cultural and local relevance of
  research methods
• Can positively impact recruitment and retention
• Increases community trust and ownership thus
  promoting application of research results

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CBPR and Research Cautious Populations

• CBPR has been well received by populations
  historically hesitant to participate in research
• Minority populations (Duran et al. 2008
  Teufel-Shone et al. 2006 Rhodes et al. 2007)
• Adolescent populations (Suleiman et al. 2007
  Scheve 2006)
• Rural populations (Garth et al. 2004)
• CBPR is a means of empowerment and tempers the
  qualities of scrutiny and judgment associated
  with non-participatory research

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CBPR Addresses Origins of Distrust

• Historical and current exploitation of peoples
  rights as research participants
• Full disclosure of the purpose of research and
  benefits
• Discontinuance without negative ramifications
• Misinterpretation of cultural behaviors and
  public dissemination of de-contextualized
  research results

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CBPR logically leads to

• Outside research partners learning about
  community concerns of research designs and
  methods appreciating the insiders perspective
• Communities understanding the rationale behind
  specific research practices, e.g. case-control
  design, random sampling appreciating the
  outsiders perspective
• Greater collaboration and trust

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Research Quality is Maintained and Enhanced

• Comparison of data collected by a team of trained
  graduate students and community members (Brugge
  et al. 2008)
• New collaborative analytical methods
  (Teufel-Shone et al. 2006)
• New insights in contextual factors influencing
  research outcome (Sanderson et al. 2009)

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CBPR poses Methodological Challenges

• Who is the community?
• Differential partner goals knowledge production
  vs improving programs
• Time
• Challenge of integrating different skills and
  ways of knowing (framing the question and
  problem solving)
• Achieving a balance in power and privilege
  between the research and tribal community
• Are communities ready?

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CBPR and Human Subjects Protection

• Community researchers
• Concerns of confidentiality
• Potential introduction of bias
• Human Subjects Protection certification
• Who is the final authority on approving research
  process?
• Research Institution?
• Community board?

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Questions presented by CBPR

• Readiness
• Community
• Academic or research institutions
• Are community organizing or capacity building
  precursors to CBPR?
• Evidence of CBPRs effectiveness
• What is primary indicator of research
  significance?
• Does CBPR need other indicators of impact, e.g.
  increase in local capacity to affect change?

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Does CBPR represent a ScientificRevolution in
Public Health Research? (Following the work of T.
Kuhn 1960)

• Revolution linked to frustration with the
  outcomes of the accepted paradigm
• Development of a new and accepted paradigm
• Question once time honored beliefs/methods
• A shift in the standard of what counts as an
  admissible problem or as a legitimate
  problem-solution
• Shifts in NIH RFAs 1980s Models of Obesity
  Prevention vs 1990s School-based Prevention of
  Childhood Obesity vs 2006 Community
  Participation in Research

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Acceptance of a New Paradigm

• New paradigm must seem better than competitors
• Acceptance seems natural to the next generation
  of practitioners
• Specialized journals
• Foundation of specialists societies
• Claim for a special place in the curriculum
• Individual practitioner can take the paradigm for
  granted, no longer needs to justify the use of
  the concept (knowledge of shared paradigm is
  assumed)

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Acceptance

• Textbooks are the source of founding principles
• New research can concentrate on subtle aspects of
  the phenomena
• Translation of principles to the layman
• New paradigm begins to guide research

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CBPR - a promising approach

• An alternate research approach
• Demonstrated success
• Promoting physical activity in Native communities
  (Teufel-Shone et al. 2006)
• Promoting health choices in adolescents (Suleiman
  et al. 2006)
• HIV risk reduction in gay communities (erzel and
  DAfflitti 2003)
• Reducing diabetes risk factors in Hispanic border
  communities (Teufel-Shone and Drummond 2005)

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CBPR informs evidence based practice

• To advance our evidence based evidence, we need
  more practice based evidence (Green 2006 AJPH)
• Too much of our evidence is coming from
  artificially controlled research that does not
  fit the realities of practice (Green 2006406)
• CBPR offer one approach to exploring causation

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An Practical Outcome of Community-Academic
Partnership Diné Educational Philosophy and
Process of Inquiry
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Thank you

• Contact information
• Nicky Teufel-Shone, teufel_at_u.arizona.edu
• Louis Teufel-Shone, teufelshone_at_juno.com