6D2-9 – Generating Community Interest in CBPR. see details. Please answer all questions and follow the instructions given.

Discussion Instructions:

Imagine a scenario where you are not part of the community that you plan on engaging in a CBPR project. Then discuss at least three different strategies for getting to know a community of interest.

I

1

Principles of Community-Based Participatory Research

“Community-based participatory research is a collaborative research approach that is designed to ensure and establish structures for
participation by communities affected by the issue being studied, representatives of organizations, and researchers in all aspects of the
research process to improve health and well-being through taking action, including social change.”1

n this chapter, I will provide an overview of community-based participatory research (CBPR) and accomplish the
following objectives:

• Review the principles and foundations of CBPR
• Discuss the rationale for involvement in CBPR and when to use it (why bother?)
• Introduce cases in which CBPR was used to investigate

Policy issues
Urgent health crises
Health disparities

• Compare CBPR with traditional research
• Describe the strengths and weaknesses of a CBPR approach

OVERVIEW OF COMMUNITY-BASED PARTICIPATORY RESEARCH

As is so often the case in community health practice, a problem is met head on with a solution. Unfortunately, while the
solution represents a response to an urgent identified need, it often lacks an evidence base. We recognize that research-
based innovations make their way slowly, if at all, into community practice.2, 3 This has been documented extensively
in the literature with regard to health in particular and speaks to the breakdown between academic and community-
based practitioners. How can we speed the uptake of evidence into community practice? How can we identify the
appropriate community-relevant research questions? How can we break down the barriers between researchers and
community partners? How can communities translate their own practice-based evidence for consumption by the
research community? There is a great deal of current interest in strategies to improve the rapidity of the translational
research process.4 Engaging the community may be one way to bridge the gap between science and practice.

Community-engaged research (CeNR) exists on a continuum ranging from research in the community setting to
research that fully engages community partners. CBPR represents one end of this CeNR spectrum (Figure 1.1). The
CBPR approach encourages engagement and full participation of community partners in every aspect of the research
process from question identification to analysis and dissemination.

The goal of CBPR is to create an effective translational process that will increase bidirectional connections between
academics and the communities that they study. This approach is not limited to specific disciplines but can be utilized
whenever conducting community research. CBPR hinges on the relationship between the researcher and the community
under study. The equitable aspects of the partnership and the participatory nature of the work differentiates CBPR from
other traditional research approaches. In addition, in CBPR, there is a close linkage between the academic pursuit of
generalizable knowledge and the use of that knowledge for action at the local level. Thus the practice of CBPR takes a
somewhat different track than that of traditional research. Throughout this chapter, I will focus on the rationale for
CBPR, the principles, and the strengths and weaknesses of the approach in order to prepare the investigator to engage in
CBPR projects.

Figure 1.1 Community-Engaged Research Continuum

Source: Virginia Commonwealth University Center for Clinical and Translational Research 2008 (Looking at CBPR Through the Lens of the
IRB. Cornelia Ramsey, PhD, MSPH Community Research Liaison, Center for Clinical and Translational Research, Division of Community
Engagement, Department of Epidemiology & Community Health) http://www.research.vcu.edu/irb/Looking-at-CBPR-Through-the-Lens-of-
the-IRB.ppt

Historically, research involving communities has not always included community partners in a participatory manner.
Rather, research may be done in communities or on community residents, using the community as a laboratory. As a
result, members of underserved communities often have negative perceptions of research and may feel exploited by
investigators who conduct research, depart, and leave nothing behind. The worst-case scenarios such as the Tuskegee
experiment have left many community members, particularly those of color, feeling distrustful and reluctant to
participate in research.5 Thus, research that may improve health and other outcomes may not include populations at
highest risk or result in action or sustainable change at the community level.

In order to improve the relevancy and acceptability of research to communities and break down translational barriers,
community members are increasingly demanding equality in the development and conduct of research. In addition, they
are interested in shared ownership of the resulting data and in the application of results to action in practice or policy. In
short, they want to have their voices heard and to participate in shaping the topics for study, identifying the emergent
questions, and conducting investigations into the issues that are meaningful to their communities. They want to be part
of the research team and see that the results are utilized to remedy problems at the community level.

Changing the research paradigm to include community members in a participatory manner requires a new approach
that includes the formation of equitable partnerships between academia and community members in which there is
mutual respect and both parties contribute and benefit. Thus, the goal of the CBPR approach is to produce research that
is relevant to the life circumstances of communities and the people who reside within them.6 When embraced by
community partners as a shared endeavor, CBPR has the potential to catalyze actionable health improvement in real
time.

THE FOUNDATIONS OF CBPR

CBPR is only recently finding its way into the biomedical literature. However, it has been previously used in a variety
of disciplines ranging from anthropology to education and psychology. Sometimes called “action research,”
“participatory research,” “participatory action research,”7 or even “street science,”8 it has been used to examine
environmental health issues, educational strategies, and international health issues.9 These “participatory research”
approaches share a core philosophy of inclusivity and of engaging the beneficiaries of research in the research process
itself.10 Similarly, CBPR is built on a foundation of social justice and empowerment, with its roots in feminist theory
and community organizing. Feminist theory focuses on the historical and cultural oppression of women and drives
toward gender equality and empowerment.11 Community organizing purports that individuals together can make a
difference in their own communities through group action.12, 13 Both of these theories recognize that empowerment of
the oppressed can result in community action for social change.

Two distinct traditions—that of Kurt Lewin, who coined the term action research, and that of Paulo Freire, who
developed “emancipator research”—stand out as having influenced CBPR. Kurt Lewin in the 1940s was one of the first
to use the term action research. Lewin sought to solve practical problems using a research cycle that involved planning,
action, and investigation of the results of action.7, 14 This iterative process paired the researcher with community
members as partners in the investigative process. In 1970, Paulo Freire, the Brazilian educator, changed the power

dynamics in research by depicting the researcher as facilitator and catalyst rather than director in his book, Pedagogy of
the Oppressed.15 As Freire noted, knowledge is connected to power—but whose power? Knowledge does not only
emanate from academia; rather, “people” also create and possess knowledge. This perspective shifts the concept of
research from one in which the community is a laboratory for investigation to one in which community members not
only participle in the inquiry process but also contribute their own knowledge. Freire framed the concept of “popular
education” and argued that the teacher must be open to learning from the student. This colearning process based on
emancipator conceptions has greatly influenced the use of CBPR approaches.7

In CBPR, the basic tenets of this participatory approach assume that there is knowledge and benefit in the shared
partnership between academia and community. In Street Science, Corburn delineates where the power lies in the
production of knowledge and highlights the value of local knowledge as an important component of the research
process. In his examples, community members are the first to identify the question for study, and researchers are called
to assist in solving real-world, practical problems8 (Table 1.1).

Today, many view the CBPR process as iterative, similar to that described by Lewin. This allows the
academic/community partnership to utilize data, refine programs, and ask additional questions. This is not unlike the
Plan Do Study Act Cycle (PDSA) used in quality improvement (Figure 1.2). The systematic collection of data provides
the community with opportunities for reflection, adjustment, and improvement in real time. CBPR offers access to data
and skill sets that support this process. For example, in the following Everett example, community members observed
an issue in their community that they wanted to address. Their question—Was the presence of Immigration and
Customs Enforcement (ICE) impacting the health of the immigrant community?—required additional data. While they
lacked the skills to conduct the investigation, they possessed an extensive knowledge of the community context, and
they were invested in participating in the data collection, interpretation, and its ultimate use to shape local policy.

Table 1.1 “Street Science”: Where Is the Power in Knowledge Production?

Knowledge Production Local Knowledge Professional Knowledge
Who holds it? Members of community—often identity

group/place specific
Members of a profession, university, industry,
government agency

How is it acquired? Experience; interpersonal communication;
cultural tradition

Experimental; epidemiologic; systematic data
collection

What makes evidence
credible?

Evidence of one’s eyes, experience; personal
communications

Often instrumentally mediated; statistical
significance; legal standard

Forums where it is
tested?

Public narratives; community stories, media Peer review; courts; media

Source: Corburn, Jason., Street Science: Community Knowledge and Environmental Health Justice, Table 2.1, page 52, © 2005 Massachusetts
Institute of Technology, by permission of The MIT Press.

Figure 1.2 Research for Process Improvement

Source: Reproduced by permission from the Institute for Community Health, Cambridge, MA; 2011.

Example 1: Immigration: CBPR and Local Policy

In the last 20 years, Everett, Massachusetts, has seen an influx of immigrants coming from countries such as Brazil,
Haiti, Guatemala, and Morocco. Everett is a small city of about 37,000 people with affordable rents and proximity to
Boston. While there have been tensions in the community about issues related to immigration, such as housing and
parking, it is only recently that the increased activity of Immigration and Customs Enforcement (ICE) has created
challenges for the immigrant community. In particular, with increases in deportation and detention, immigrants fear that
they will be picked up by authorities and deported. Stories of immigrants missing health appointments because ICE was
in the vicinity or having stress-related conditions such as sleeplessness, headaches, and weight loss are common. These
concerns were raised by various immigrant advocacy groups and Everett community leaders to institutional leaders. To
facilitate changes in local policy, evidence was needed to support advocacy efforts and bring attention to the issue. So
they approached a familiar academic partner to join them in an investigation of the problem, “the impact of ICE activity
on immigrant health.” Their goal was to learn more about the issue and solve the problem by developing a policy or
programmatic intervention that would alleviate some of the stress that immigrants were experiencing.16

In the Everett CBPR project, the process started with a question that came from prior experience and community
discourse. Community members wanted to validate their suspicions through rigorous methodology. Members
approached a local researcher to assist them in their investigation, thus expanding their own skill sets. They were
engaged in every step of the research process, including data collection. They ultimately took the results to action.
Today, they are using the research for process-improvement cycles, asking additional questions, and sorting through
methods with their academic partners to pursue new research projects.

WHY BOTHER USING CBPR?

What are the forces driving us toward a CBPR approach? Today, as noted, there is an emerging realization that we must
improve clinical translational research in order to improve human health.17 CBPR holds promise as a strategy that
would help to improve this process. Second, in the United States and abroad, we continue to have gross disparities in

health outcomes. Minority racial/ethnic populations suffer disproportionately from many chronic disease conditions,
and social determinants of health are heavily contributing to these disparities. Strategies for addressing these disparities
require approaches that engage those most impacted in design and implementation. CBPR represents a promising
approach to address these issues, as it relies on the community’s self-determination of the research agenda and
redistributes institutional resources into marginalized communities toward community benefit.18

There is also pressure from community partners who want to participate actively in research that involves them. They
no longer want to be “laboratories” for research but, rather, they want to have access to data, solve their own local
health and social issues, and drive policy. Community members want to conduct and participate in their own research
endeavors. A CBPR approach validates this desire by not only including community members in all aspects of the
research but also by building their capacity to lead and contribute to research projects. Simultaneously, it helps to build
the capacity of academics to understand community context and improve the relevancy of their research. This
colearning process is an important outcome of the CBPR approach.

WHEN TO USE CBPR

A CBPR approach may be particularly useful for emergent problems for which community partners are in search of
solutions but evidence is lacking. CBPR can be helpful in completing rapid assessments and as a strategy to engage
hard-to-reach populations who may be less inclined to participate in research. And CBPR is exceptionally helpful in the
formative phases of research when little is known about a topic area. CBPR helps academics understand the community
perspective as they develop research questions and hypotheses together. Community partners can deepen the
interpretation process once results are available, as they are intimately familiar with the context and meaning.
Alternatively, CBPR is less likely to be helpful for study designs that require highly controlled methodology, as the
participatory nature of the work tends to require flexibility and adaptation as part of the research process.

CBPR can be used when a specific issue emerges from the community and research partners are needed to rigorously
assess the evidence and provide data. For example, CBPR has been used effectively for the study of environmental
health issues. In some cases, CBPR is part of a real-time situation that demands answers and action. In others, it
provides an important approach for understanding issues of vulnerable populations.

Example 2: Somerville: CBPR and Youth Suicide: Real-Time Health Crisis

Somerville, Massachusetts, is an urban city of 70,000 people that borders Cambridge. Historically, Somerville has
been home to working-class populations, and in recent years, between gentrification and new immigration, the city
demography has changed substantially. Somerville has also been affected by long-term substance abuse problems,
especially heroin and alcohol. In 2001, a young person took his own life, and this was followed soon after by
oxycodone overdoses of two high school students. A local researcher with an interest and experience in adolescent
suicide was concerned that this might represent the beginning of a suicide cluster. She had prior relationships with
community partners and so approached the Health Department director and mayor to discuss her concerns and interest.

Loss of youth life to suicide and overdose sends enormous ripples of concern through any community, and in
Somerville, the Health and School Departments examined data from their biannual teen health survey to determine if
suicidal behaviors had changed. The teen survey noted that 21% of the students had seriously considered suicide, and
14% had attempted suicide during the last 12 months. This was substantially elevated over previous years and higher
than the state average overall.

In order to respond to the situation and investigate further, the mayor convened several task forces and asked the
researcher to join with community members and colead one of the task forces along with the Health Department
director. Other members included representation from the schools, the police, and community members as well as
additional experts in suicide clusters. The questions posed by the community to the researcher were these:

• Was this suicide and overdose activity significantly elevated from baseline?
• Were there common links between victims and was this a contagion/cluster?

The overall aim of the partnership was to identify potential causes and strategies for action. In addition, the group
wanted to establish a sustainable system that would effectively address the problem of suicide or additional crises in the
long term.19

CBPR has also been used extensively to understand and explore health care disparities.20 As per Dr. Wallerstein,
CBPR has enhanced the effectiveness of interventions by integrating culturally based evidence and internal validity. In
the following example, while the research question focused on disparities did not specifically come from the

community, its application and acceptance were clearly driven by the perspectives of the community partners. And the
ability to negotiate the investigation was grounded in a long-term academic/community partnership.

Example 3: BMI Disparities in Cambridge, Massachusetts

In Cambridge, Massachusetts, over a 10-year period, a coalition of school staff, public health personnel, and local
researchers had been tracking childhood indicators of obesity. Using annual height and weight measurements of
children that had been reported for many years, one researcher noted that there were glaring disparities in childhood
obesity among racial/ethnic groups.2 Blacks and Hispanics were carrying an undue burden of obesity. The researcher
approached a long-time community colleague, and together they began to discuss the issue with other community
members. The community colleague provided entrée to a social network of African American leaders and community
members and helped engage them in conversation and the research process. Thus, the CBPR partnership expanded to
include other members of the community, particularly the minority community, who came together to examine why
disparities in obesity rates persisted even when general trends were declining (Source: Virginia R. Chomitz, Ph.D.,
Tufts Medical School).

In this example, a CBPR approach provided inroads into important community voices that could lend meaning to the
disparities identified. Without their understanding of the issue and participation in the research process, it would be
unlikely that findings would be either relevant or valid for the population of concern.

PRINCIPLES OF CBPR

The three examples described thus far illustrate many of the important principles of CBPR put forth by Dr. Barbara
Israel and colleagues at the University of Michigan.21 They are discussed below and described in greater detail
elsewhere.21, 22

CBPR Acknowledges Community as a Unit of Identity

Understanding and identifying “the community” for the purposes of CBPR projects is an important first step in the
CBPR process. Communities are made up of people linked by social ties who share common perspectives or interests
and may also share a geographic location.23 In our Everett example, the community was identified as
“immigrants—documented and un-documented—living in Everett” and included the various community agencies
(churches, immigrant advocacy groups, health and school departments, community organizations) that supported them.
In our Somerville example, the community was identified as youth and youth-serving agencies throughout the city of
Somerville. In our Cambridge example, the African American community was the focus.

CBPR Builds on Strengths and Resources Within the Community

In CBPR, the community as represented by its members, is a participant in the process and brings a variety of skill
sets that are different than but equally as valuable as academic skills. Corburn refers to this knowledge as “street
knowledge.”8 A community store owner, a pastor, a schoolteacher, a community member living in low-income housing
understands community needs and the realities of daily life far better than a researcher does. In addition, the strengths of
a given community can be brought to bear to implement solutions once identified. This offers the potential for
sustainable change. As the action arm of CBPR, the community and its strengths play a particularly important role in
carrying forward lessons learned. In all three of our examples, the community partners had a multiplicity of skill sets
and “street knowledge” that was critical to the CBPR process. In Everett, community partners brought their extensive
knowledge of the immigrant groups, including language skills and cultural experience. In Somerville, partners knew the
history of the community and had intimate knowledge of the families who lost their children to substance abuse and
suicide. In Cambridge, community partners provided access to diverse community members and leaders. In all three
communities, the connections and social networks that community partners provided were the only avenues for
academics to gain access to the population at risk and to understand the aftermath of losses. In addition, in all cases,
community partners had the political and resource access necessary to ultimately translate findings into action.

CBPR Facilitates a Collaborative, Equitable Partnership in All Phases of Research, Involving an Empowering and Power-Sharing Process
That Attends to Social Inequalities

CBPR hinges on the academic/community partnerships that are formed.24 These partnerships are built on mutual
respect and trust. Academics should recognize the inherent inequities that exist between community members and
academics and try to address them via transparency, communication, shared decision making, and appropriate

allocation of resources. In our examples, new partnerships were built on existing partnerships with a known researcher.
The trust had, to some extent, already been built, thus opening the door for future projects. When the need arose,
community partners were able to activate the partnership and participate from the beginning in all phases of the
research, from identification of the problem to decisions about the methods and data collection.

CBPR Fosters Colearning and Capacity Building Among All Partners

One of the outcomes of a CBPR approach is the colearning that takes place by both community members and
academics. As the academic learns of the community realities and the meaning of interactions from community
members, so too the community members gain competencies in data use, critical thinking, and evaluation. All of this
builds mutual capacity that will translate to other projects and enrich an understanding of community issues. As an
example, in Everett, community partners identified the lack of driver’s licenses as a major intervening factor in the
relationship between ICE and immigrant health. That is, when an immigrant was stopped by police, the lack of a license
led to arrest, and regardless of realities, immigrants believed that arrest by local police could lead to deportation. This
was not something that the researchers were aware of. Similarly, the researchers actively educated the community
partners on subjects ranging from how to develop a hypothesis to how to conduct focus groups.

CBPR Integrates and Achieves a Balance Between Knowledge Generation and Intervention for the Mutual Benefit of All Partners

CBPR is nested in real-world issues, and the relevant problems of interest demand action. Balancing the demands of
community action with the needs of research can be challenging. Pacing may differ, analytic methods may clash, and
dissemination efforts may conflict. When the CBPR process works best, it can satisfy both needs. These issues should
be discussed up front and frequently throughout the process so that difficult issues can be effectively navigated. In our
Somerville example, in the midst of a crisis, community members wanted and demanded action. Researchers provided
information on existing evidence-based practices for their adoption, including the Centers for Disease Control and
Prevention (CDC) recommendations. They also were instrumental in collecting and mapping data in an ongoing
manner. In this case, knowledge generation and interventions were happening simultaneously, and while the balance
was achieved to some extent, it was necessary to prioritize action given the urgency of the situation.

CBPR Focuses on the Local Relevance of Public Health Problems and on Ecological Perspectives That Attend to the Multiple Determinants of
Health

The problems explored in CBPR studies are generally of great relevance to the communities involved. As such,
CBPR necessarily will involve the “social determinants” as important factors to be considered and explored.

The examples offered were not only relevant to community public health problems but also took a larger perspective,
recognizing that the external conditions had much to do with the issues under study. These types of projects demand
multidisciplinary teams of community members and scientists. In Everett, we worked with lawyers, demographers, and
physicians as well as immigrant leaders, clergy, and local government officials, all of whom contributed their
knowledge to the process.

CBPR Involves Systems Development Using a Cyclical and Iterative Process

CBPR is often perceived as a cyclical process involving numerous phases from question development to data
collection and analysis. As with the quality-improvement cycles used in health care improvement and business (Plan Do
Study Act), the process often opens the door to new and emerging questions, which in turn requires an investigative
process.

In all of our examples, initial data collection and analysis sparked new lines of inquiry. As data became available
during the suicide crisis, community members sought to explore and answer these new questions: that is, were these
suicides related to drug use? In addition, they used the data to refine their interventions, including educational efforts
and outreach to subpopulations within the community. In the Cambridge example, data that had been collected over
time (BMI data) focused on the entire school-aged population, but further examination of this data sparked a whole new
line of inquiry: that of disparities in obesity rates.

CBPR Disseminates Results to All Partners and Involves Them in the Wider Dissemination of Results

The dissemination process in CBPR is somewhat different than that typically used in traditional research endeavors.
Dissemination needs to benefit all parties and means different things to academics than it does to community partners.
For example, dissemination from a community perspective may require different formats and venues than the peer-
reviewed journal. In addition, the time sequencing may be different, as there is often a more rapid demand for results at
the community level than in academic realms. Thus, negotiating types of dissemination and what can be disseminated

when, is an important element in CBPR work. In Everett, dissemination took the form of a community forum that
presented the data back to members of the affected community for their consideration. In Somerville, dissemination was
happening in an ongoing manner throughout the project. However, ultimately, all the partners were involved in
developing a final synopsis of the work. This ended up as a peer-reviewed paper aimed at providing information for
other communities that might encounter similar events.19 Similarly, in Cambridge, the data were used both for a report
to the community and the advisory group and for a peer-reviewed paper.

CBPR Involves a Long-Term Process and Commitment to Sustainability

To fully engage in CBPR, the researcher needs to consider the time involved for specific projects but also to nurture
relationships outside of projects. How do researchers get to know their partners? How much time is spent in the
community at nonwork events? Do they make the long-term commitment to improving the community situation, or is
this a “one-shot” research project? In order to establish the trust needed to fully engage in CBPR, a long-term
commitment will likely extend beyond the specific project to other worthy projects that partners feel are appropriate.

CBPR VS. TRADITIONAL RESEARCH

CBPR changes the power dynamics inherent in traditional research. Researchers are typically seen as the experts and in
possession of knowledge. In CBPR, the community members possess knowledge and are experts in community context,
norms, and issues. CBPR attempts to establish equitable partnerships with mutual responsibility. This is in direct
contrast to more traditional forms of research (Table 1.2) in which the investigator leads and is responsible for both the
conduct and outcomes of the process. For example, where traditional research identifies the question of interest, in
CBPR, community partners are the initiators of the research question.

Table 1.2 Differences Between Traditional Research and Community-Engaged Research

Community-Engaged Research
Traditional research approach Research with the community Community-based participatory research

approach
Researcher defines problem Research IN the community or WITH the

community
Community identifies problem or works
with researcher to identify the problem

Research IN or ON the
community

Research WITHcommunity as partner Research WITH community as full
partner

People as subjects People as participants People as participants and collaborators
Community organizations may
assist

Community organizations may help recruit
participants and serve on advisory board

Community organizations are partners
with researchers

Researchers gain skills and
knowledge

Researchers gain skills and knowledge,
some awareness of helping community
develop skills

Researcher and community work
together to help build community
capacity

Researchers control process,
resources, and data
interpretation

Researchers control research; community
representatives may help make minor
decisions

Researcher and community share control
equally

Researchers own data and
control use and dissemination

Researchers own the data and decide how
they will be used and disseminated

Data are shared, researchers and
community decide how they will be used
and disseminated

Source: From “Practicing Community Engaged Research,” © 2007 by Mary Anne McDonald, MA, DrPH. Duke Center for Community
Research, Dept of Community and Family Medicine, Duke University Medical Center, Durham, NC 27710. Adapted from Community Campus
Partnerships for Health online curriculum: Developing and Sustaining Community-Based Participatory Research Partnerships: A Skill Building
Curriculum (http://www.ccph.info/)

Whether initiators or collaborators, the study question will need to be of interest to both the researcher and the
community partners. Concepts of collaboration, equity, power sharing, and consensus are all elemental to CBPR.
Research with rather than on the community is the focus, and the participatory nature of the process requires
investigators to be attuned to the perspectives of community partners. These differences in approach are well illustrated

in our examples, where community partners and researchers were engaged in a partnership to address the research
questions.

STRENGTHS AND WEAKNESSES OF CBPR

Now that you are familiar with the “what” and “why” of CBPR, it is important to also understand the strengths and
limitations of this approach (Table 1.3). CBPR is likely to facilitate more relevant research given its community-
embedded nature. Community input may reveal information that would have been otherwise undiscovered and that
potentially greatly enhances the research process and the results. This additional value encourages community
ownership and may support sustainability. CBPR also helps build community and researcher capacity to understand and
utilize data and to think critically about impact and outcomes. For example, in Everett, the findings from the immigrant
study were used to establish police/immigrant dialogue and change local policy related to traffic stops. Local police no
longer arrested people for lacking driver’s licenses but, rather, issued citations instead, which substantially decreased
fear in the immigrant community. The acquisition of new skills and access to resources for community partners are also
benefits of the CBPR process. In Somerville, community members learned mapping techniques and continued to
monitor 911 data on overdoses and suicide as part of health department responsibilities. CBPR is also likely to improve
participation and retention in studies, particularly for populations that are unlikely to be involved in research. This was
certainly true in the Everett study, in which more than half the participants in the study were undocumented immigrants.
Other studies have identified recruitment and retention as major benefits of CBPR, particularly important for research
on disparities.1

As partnerships deepen, CBPR may effectively blur the separation between academic researchers and community
partners. Members of marginalized communities embark on an investigative process to understand their own
circumstances through the systematic collection of data. They become researchers themselves. So, too, as the
researchers engage in CBPR, they will gain a whole new set of skills that stems from their understanding of appropriate
language, methods, meaning, and context. These skills and enhanced knowledge of community needs and assets will
lead to improved validity and value of their projects. It is this transformative process that builds colearning and mutual
respect within the partnership.

Table 1.3 Strengths and Weaknesses of a CBPR Approach

Strengths Weaknesses
Relevancy to local community (authenticity) Time needed to form partnerships
Community ownership Potential loss of control
Builds local capacity and community skills May not be generalizable (external validity)
Builds researcher skills Requires flexibility given changes in contextual factors
Builds trust and bridges community academic barriers Time frames for reporting results may differ
Supports social action Conflict between partners on dissemination, strategies,

decisions
Imparts in-depth knowledge of community context, needs,
and assets

May impact method choice

Deepens interpretation of results May not be valued in academic environment
Results directly used for sustainable changes

However, CBPR also has it challenges. A major weakness from a researcher perspective is that CBPR takes time:
time to build relationships with partners, time to manage a participatory group, and time beyond specific projects to
maintain partnerships.25 This is unlikely to be compensated by academic institutions. In addition, given that the
contextual environment is constantly changing, there may be difficulties maintaining partnerships as priorities shift and
personnel change within the community. For example, if you are working with a mayor and local leadership and the
mayor loses an election, you may be faced with developing new partnerships with different leaders to continue the
work.

A participatory approach also requires an academic partner to be flexible, creative, and able to facilitate group
processes. Given that decision making is shared and plans may change, these attributes are important in the conduct of
CBPR. For example, should a new issue emerge in the community under study, it may be hard to maintain focus on the

research initiative, as partners may divert their attention elsewhere. You may be working on asthma-related
environmental issues when a local leader becomes a victim of violence. In response, the community members turn their
attention toward the new, pressing issue, which takes precedent. This forces an unexpected slowdown in the project.

The participatory process also forces potential compromises in research design. For example, the researcher may
want the strongest design, such as randomization of participants to test an educational intervention, but community
partners feel that they do not want to limit access to any new educational resource regardless of whether it is proven
effective. Randomization may therefore be considered unethical in a school environment. In another situation,
community partners may be concerned that implementing a research protocol in a busy youth program does not work
well with the delivery of service. They may restrict access to clients or limit the amount of information that can be
obtained. Overall, given that decision making is shared, research design must be negotiated and determined feasible by
the community under investigation.

One of the major issues raised regarding CBPR is that given its local focus, can it be generalizable to other
environments? That is, do CBPR studies have sufficient external validity?20 While CBPR tends to be used at the local
level, generalizable validity (external validity) is dependent on how conclusions drawn from one community can be
translated to other communities. Much of this question is dependent on how well the investigators were able to limit
bias, on how “comparable” other communities might actually be, and most importantly, on how well community
partners are able to adapt the research to meet their needs and unique assets. Each community exists in a frame of
contextual variables that can range from population demographics to a host of contextual factors, including local
politics, regulations, physical environment, and so on. These make it difficult to strictly transfer the knowledge learned
in one community to others. While achieving external validity is challenging in CBPR, it can be done, and I will
address methods in a later chapter.

The CBPR process also requires negotiation and compromise. Researchers must develop listening skills. Data and
results are products of a shared enterprise, which requires an agreed upon set of rules. I will discuss partnership building
and management in a later chapter.

While there are numerous challenges inherent in CBPR partnerships, it is the very process of working through these
challenges that makes the projects and partnerships stronger, builds community capacity, enhances investigator skills,
and empowers community partners. The process of colearning benefits all involved and yields important findings for
direct application to real-life situations.

CONCLUSION

CBPR is an approach that engages the community under study in every aspect of the research process. In so doing, it
improves the relevancy and appropriateness of research. It encourages a team approach to some of the world’s most
immutable problems and helps to translate research into practical, real-world interventions. The foundational
underpinnings of the approach from Lewin to Freire discuss the need to develop equitable meaningful partnerships to
meet these goals. There are challenges to doing CBPR, but there are many benefits. Over the course of this book, we
will help the reader understand the major steps in doing CBPR. We hope the reader will consider when and how to use
CBPR and that this approach will be benefit communities nationwide.

QUESTIONS AND ACTIVITIES

Activities

Invite a local community partner to join the class discussion and provide his or her perspective on research. Then
have students break up into discussion groups to identify the challenges and benefits of a CBPR approach to research.

Have students read a CBPR study and provide a critique of the strengths and weaknesses of the approach for the
problem under study.

Questions for Discussion

1. How does CBPR challenge and contribute to the fundamental constructs of research?

2. What is the benefit of identifying and using local knowledge?

3. What are the potentially conflicting agendas of communities and academics?

4. What are some of the challenges inherent in CBPR?

5. Discuss the threats to external validity when using a CBPR approach. Brainstorm strategies for improving
external validity when working with community partners.

NOTES

1. Viswanathan M, Ammerman A, Eng E, Gartlehner G, Lohr KN, Griffith D, Rhodes S, Samuel-Hodge C, Maty S, Lux, L, Webb L, Sutton
SF, Swinson T, Jackman A, Whitener L. Community-Based Participatory Research: Assessing the Evidence. Evidence Report/Technology
Assessment No. 99 (Prepared by RTI–University of North Carolina Evidence-based Practice Center under Contract No. 290-02-0016). AHRQ
Publication 04-E022-2. Rockville, MD: Agency for Healthcare Research and Quality; 2004:22.

2. Szilagyi PG. Translational research and pediatrics. Academic Pediatrics. 2009 Mar-Apr;9(2):71–80.
3. Heller C, de Melo-Martin I. Clinical and translational science awards: can they increase the efficiency and speed of clinical and

translational research? Academic Medicine. 2009 Apr;84(4):424–32.
4. Glasgow RE, Emmons KM. How can we increase translation of research into practice? Types of evidence needed. Annual Review of

Public Health. 2007 Jan 1;28:413–33.
5. Corbie-Smith G, Thomas SB, St George DM. Distrust, race, and research. Archives of Internal Medicine. 2002 Nov 25;162(21):2458–63.
6. Horowitz CR, Robinson M, Seifer S. Community-based participatory research from the margin to the mainstream: are researchers

prepared? Circulation: Journal of the American Heart Association. 2009;119:2633–42.
7. Wallerstein N, Duran B. The theoretical, historical, and practice roots of CBPR. In: Minkler M, Wallerstein N, eds. Community-Based

Participatory Research for Health. 2nd ed. San Francisco, CA: Jossey-Bass; 2008:26–46.
8. Corburn J. Street Science: Community Knowledge and Environmental Health Justice. Cambridge, MA: MIT Press; 2005.

9. Minkler M, Wallerstein N., eds. Community-Based Participatory Research for Health. San Francisco: Jossey-Bass; 2003.
10. Cargo M, Mercer SL. The value and challenges of participatory research: strengthening its practice. Annual Review of Public Health.

2008 April;29:325–50.
11. Devault M, Ingraham C. Metaphors of silence and voice in feminist thought. In: Devault M, ed. Liberating Method. Philadelphia, PA:

Temple University Press; 1999:175–86.
12. Bobo K, Kendall J, Max S. Organizing for Social Change. 3rd ed. Santa Ana, CA: Seven Locks Press; 2001.
13. Chambers E, Cowan MA. Roots for Radicals: Organizing for Power, Action, and Justice. New York: Continuum International Publishing

Group; 2003.
14. Lewin K. Resolving Social Conflicts and Field Theory in Social Science. Washington, DC: American Psychological Association; 1997.
15. Freire P. Pedagogy of the Oppressed. New York, NY: Continuum International; 1970.
16. Hacker K, Chu J, Leung C, Marra R, Pirie A, Brahimi M, English M, Beckmann J, Acevedo-Garcia D, Marlin RP. The impact of

Immigration and Customs Enforcement on immigrant health: perceptions of immigrants in Everett, Massachusetts, USA. Social Science &
Medicine. 2011 Aug;73(4):586–94.

17. Heller C, de Melo-Martin I. Clinical and translational science awards: can they increase the efficiency and speed of clinical and
translational research? Academic Medicine. 2009 Apr;84(4):424–32.

18. Minkler M. Linking science and policy through community-based participatory research to study and address health disparities. American
Journal of Public Health. 2010 Apr 1;100 Suppl 1:S81–87.

19. Hacker K, Collins J, Gross-Young L, Almeida S, Burke N. Coping with youth suicide and overdose: one community’s efforts to
investigate, intervene, and prevent suicide contagion. Crisis. 2008;29(2):86–95.

20. Wallerstein N, Duran B. Community-based participatory research contributions to intervention research: the intersection of science and
practice to improve health equity. American Journal of Public Health. 2010 Apr 1;100 Suppl 1:S40–46.

21. Israel BA, Eng E, Schulz AJ, Parker EA, eds. Introduction to methods in community-based participatory research for health. In Israel BA,
Eng E, Schulz AJ, Parker EA, eds. Methods in Community-Based Participatory Research for Health. San Francisco, CA: Jossey-Bass; 2005:

2

–26

22. Wallerstein NB, Duran B. Using community-based participatory research to address health disparities. Health Promotion Practice. 2006
Jul;7(3):312–23.

23. MacQueen KM, McLellan E, Metzger DS, Kegeles S, Strauss RP, Scotti R, Blanchard L, Trotter RT. What is community? An evidence-
based definition for participatory public health. Ameican Journal of Public Health. 2001 Dec;91(12):1929–38.

24. Christopher S, Watts V, McCormick AK, Young S. Building and maintaining trust in a community-based participatory research
partnership. American Journal of Public Health. 2008 Aug;98(8):1398–406.

25. Norris K, Brusuelas R, Jones L, Miranda J, Duru O, Mangione C. Partnering with community-based organizations: an academic
institution’s evolving perspective. Ethnicity & Disease. 2007 Winter;17(1 Suppl 1):S27–32.

2

Defining the Community and Power Relationships

“Reviews of the effectiveness of collaborations for improving community health indicate that they can be effective but that there are many
potential obstacles to realizing the benefits of a participatory approach in both public health research and programs. In particular, the
lack of an accepted definition of community can result in different collaborators forming contradictory or incompatible assumptions about
community and can undermine our ability to evaluate the contribution of community collaborations to achievement of public health
objectives.”1

In this chapter we will explore some important questions:

• What is community?
• Who represents community?
• What is a community advisory board?
• Who are the right stakeholders?
• What are the existing power relationships between academics and community partners?
• What are the rules of CBPR partnerships?
• What are strategies for assessing community readiness for research?

WHAT IS COMMUNITY?

When embarking on a CBPR project, one of the first challenges is to define the community of interest. Who is the
population of interest? What are the boundaries of their “community”? Is this a community that is geographically
bounded (city, neighborhood, county) or one that is nongeographically defined by a common culture (Latinos, African
Americans) or condition (parents of children with special needs) or other shared concern? Are you planning to work
with those directly impacted by the issue or with the organizations that represent or serve them? The CBPR approach is
often used to examine issues for underserved populations, to give voice to their concerns and help identify their
perspective on the problem. However one chooses to define “community,” it remains the conceptual underpinning of
CBPR, influencing who collaborates and participates, how sampling is conducted, where dissemination takes place,
and, most importantly, how relevant the work is to the community of interest.

Example 1: Everett Immigrant Health

A community coalition in Everett was interested in engaging a researcher to learn more about the health implications
of Immigration and Customs Enforcement (ICE) on immigrant health in their community. The coalition had a diverse
membership, including agency directors, school administrators, several teachers, and representatives from several
immigrant advocacy groups. Many were leaders in local Everett institutions (schools, community-based organizations).
They had come together previously around a multiplicity of health and social service issues and together had
successfully garnered resources for new programming. They shared common interests in wanting to make a difference
in their city. While they generally defined their “community” as geographic—that is, those who worked and lived in
Everett—they were particularly concerned with the most vulnerable populations (e.g., the poor, recent immigrants, and
youth). Thus, for the CBPR project, they defined community as Everett, Massachusetts, but more specifically, as the
underserved population of recent immigrants and, in particular, immigrants who were undocumented.

The term community has many meanings throughout the social sciences.2 Hillery (1955) identified more than 90
different definitions of community in prior literature.3 The majority of authors, however, consistently cite certain
characteristics in their definitions, including social interaction, geographic area, and common ties.1 Anthropology,
sociology, public health, and psychology have all looked at communities slightly differently. Even within a discipline,
there is no consistent agreement on the definition. Cultural anthropology tends to take an ethnographic perspective of
community, examining the structure, norms, and social mores that bind individuals together.4 Sociology builds upon the
concept of social capital and the interconnectedness of community members.5 Public health identifies the social and
political responsibility of community and sees the community as a population. Psychology brings up the concepts of “a
sense of community” and shared emotional connection.9–11 All of these elements are part of our understanding of
“community” (Table 2.1).

Table 2.1 Examples of Key Constructs in Defining “Community”

Thus, as we think about community and working with communities, we may consider different ways of realizing the
concept. For example, many define community by its geographic and political boundaries (city, county), while others
may consider it any group of people that share a common set of characteristics (immigrants, women, parents).
Community can also refer to a group of people bound together by shared condition or concern, such as a community of
diabetics or a community of parents with children who have special needs. MacQueen and colleagues conducted a
series of interviews to determine what community meant and identified a common definition that works well: a group
of people with diverse characteristics who are linked by social ties, share common perspectives, and engage in joint
action in geographical locations or settings.1 However, more importantly, she found that different groups had slightly
different definitions about how they saw their communities. Today, with the advent of the Internet and social
networking, communities cross geographic boundaries as well as age, gender, and race/ethnicity. As these tools become
more and more popular, we need to broaden our definitions of community beyond physical geography.12 Wellman and
Wortley have argued that community locus is less important and that “personal networks” are better used in defining
community.8 There may be multiple communities within communities, and individuals may be members of multiple
communities.

When the term community is used, it often assumes homogeneity, singularity, cohesiveness, and consensus: what
community X wants or what community Y believes. In fact, no community is homogeneous; there will always be a
diversity of ideas, beliefs, and even communities within communities. In CBPR, it is important to recognize the
diversity of community and learn from its members how it is defined and conceptualized. Recognizing how you are
operationalizing your definition of “community” for the purposes of a CBPR project is the first step in your process.
And your definition of community will also influence what the research project may or may not do or show for that
community.

Once identified, the process of learning about a community is a pivotal task for the CBPR researcher. This takes time.
It is an exploration that involves gathering existing and new data, meeting individuals and groups, building
relationships, assessing strengths and weaknesses, and learning about the culture. To gain this knowledge, the
researcher needs to spend time in the community learning about the existing social networks and the community
institutions, organizations, and coalitions. The researcher needs to become familiar with the formal and informal leaders
who can also provide insight into the political landscape and provide entrée into the community of interest. For those
interested in pursuing CBPR, it is best to develop these relationships prior to launching a research project. Showing up
at meaningful community events, having coffee with community members outside of work hours, or visiting
organizations and sitting down with their directors are all ways of building relationships and demonstrating your
commitment to the community that will be appreciated by your community partners. This process will help the
researcher decide who to approach in the community engagement process and provides the foundation for the
academic/community research partnership. In addition, through this “getting to know the community” process, the
researcher should start to understand and map out the community strengths and assets.

WHO REPRESENTS COMMUNITY?

In CBPR, there is tacit agreement that “community” should include those impacted by the research issue13—that is,
those patients, community members, and residents who are impacted by the issue under study. However, it is
challenging to think about engaging community members, one individual at a time. Unless you have extensive
community organizing skills, this can be a difficult challenge. Rather, many who conduct CBPR will work with
organizations that represent the community of interest or with communities that have some organizational structure
(representative leadership). This might include community coalitions, community-based organizations, advocacy
groups, or local institutions such as schools, mayors’ offices, or health care providers. Both strategies can work well in
CBPR; however, this author believes that while a participatory approach may be utilized with any group of interested
community members, a CBPR project that does not elicit the experience of those impacted by the problem under study
does not fully meet the goals of CBPR.

This brings us to the question of who represents community in a CBPR project. While working with institutions
(government, community-based organizations, churches, and their leaders) provides the infrastructure necessary to
forge CBPR relationships and conduct research, these organizations have differing abilities to represent the community
voice. The experience will be quite different than working with a grassroots organization or a community coalition. A
CBPR investigator needs to be aware of the strengths and limitations of working with different types of community
groups and/or institutions. Important questions to ask of the group you choose to partner with are noted in Table 2.2.

Table 2.2 Questions to Consider in Community Group Engagement

Does this community group have representation of the
population of interest?

Is the membership stable? Is the leadership engaged?

Does this group have long-standing ties to the
community?

How long has the group existed? What’s their reputation? Can
they get things done?

Do they have the ability to outreach to the population
of interest or the community at large?

Have they done outreach before? Does their staff have
experience and success with outreach?

Do they have adequate infrastructure to participate in
partnership?

Can they enter into contracts? Are they incorporated? Have
they done CBPR before? Can they manage grants?

The CBPR investigator also needs to understand the strengths and limitations of the representatives at the table. Israel
and colleagues note that participatory approaches that rely on choosing representatives of community can be fraught
with potential conflicts.14 Often, community leaders are identified as the representatives of the community, and while
they have an understanding from their vantage point about the community, they may or may not be viewed by the
populace as appropriate representatives. It is impossible to achieve full community representation in CBPR, but
learning about the community and identifying leaders is a process. Constructing a community advisory group to
facilitate representation is one strategy used in many CBPR projects.

THE COMMUNITY ADVISORY BOARD AND MEMBERSHIP

CBPR requires community participation. Participation requires a structured relationship with community partners so
that members can engage throughout the project. Working with a “community advisory board” (CAB) is one way that
an investigator can interface with community members and maintain an open dialogue.15–18 The CAB can act in an
advisory role for multiple projects,15 or it can function as the community members of the research team for one project.
It can be fluid or rigorously constructed with elected or appointed members, depending on partner preferences. How
does this CAB get established? In some cases, such as in our Everett example, the advisory group was ready-made.
There was an informal coalition of concerned leaders who approached the researcher. Their collaboration was based in
previous activities including a Multicultural Affairs Commission. As their coalition evolved, they added leaders from
different institutions (schools, after-school programs, churches) and additional members to fill in perceived gaps and
expand the diversity of their membership. The following describes members of the Everett advisory group; these
representatives joined the research team for the duration of the immigrant project.

“Six Everett community agencies, many members of the MAC, who had been actively involved in addressing immigrant issues in Everett,
were involved in the research project: the Joint Committee for Children’s Health Care in Everett (JCCHCE), the Everett Literacy Program,
the Muslim American Civic and Cultural Association (MACCA), Immaculate Conception and St. Anthony’s Catholic churches, La
Comunidad, Inc., and the Everett police department. The JCCHCE focuses its efforts on improving access to health care and is actively
involved in enrollment in both insurance and in the state Health Care Safety Net program.19 The two Catholic churches’ congregations
include large numbers of Haitians and Brazilians. La Comunidad and MACCA are emerging immigrant service organizations focused on
Latinos and the Arab and Muslim population respectively and both are led by immigrants. The Everett Literacy Program provides the
majority of English Second Language courses in Everett. Representatives from these groups had extensive experience in coalition
building, community organizing, and addressing immigrant concerns.”20

Unfortunately, an existing activated coalition or the “right” coalition is not always available or interested in
partnering. It is often incumbent on the investigator to make contacts, develop relationships, and assess potential
partners toward convening their own CAB. As investigators get to know the community, they may find that there are
smaller groups of community members who want to work on an issue. There may be community activists who have
strong opinions and want action. In every community, there are the go-to individuals, who may be formal or informal
leaders. Their ability to organize community members and facilitate CBPR is a critical asset; however, it is equally
important to understand their role in the political matrix of the community. In short, it is important to know whether
they have clout and whether they have access to the community of interest.

Example 2: Somerville Youth Suicides and Overdoses

In the midsized urban community of Somerville, Massachusetts, there was a suicide cluster that affected young
people over the course of a 5-year period. During this crisis, the mayor brought together a task force—the Mayor’s
Suicide and Mental Health Task Force—that included many of his department heads (schools, police, health
department), leaders of local youth-serving agencies, health organizations, mental health and substance abuse
organizations, and a CBPR research organization. Many of these leaders did not live in Somerville or had short-term
histories in the city, and they did not have direct connections to the population at highest risk. It was important to add
representation from long-standing community members who knew the families and the children. Several community
activists became involved in the task force, and they were able to reach out to those most at risk in a way that was
impossible for many of the professionals involved. These informal leaders acted as connectors between the
professionals and academics and the population at risk. Finding these individuals can be a challenge, but their
contribution to CBPR efforts is invaluable.21

In establishing a CAB, both the investigator and the community partners need to ask whether the current
representatives are the “right” representatives. Any community group wishing to engage in CBPR should do a self-
assessment to determine if the right people are part of the process. The investigator may not have the in-depth
knowledge of the community to make this determination. Here is where community insight provides guidance to
identify the appropriate membership for a CAB. They know who the players are and understand how to avoid the
political minefields. The strength of their relationships in the community will benefit the CBPR project, as they can
utilize their own social networks to engage other community members. In our Everett example, we added several new
members to the research team, including youth and immigrant leaders, to help us access the populations of interest.
These individuals were invited by CAB members who were building on their existing relationships. In CBPR, existing
social networks are a powerful tool for community engagement.12

POWER DYNAMICS

“What is important and interesting for me is how you enter a partnership. The transparency principle is key but it’s difficult because the
community does not like the word research. But it’s important to be open about this and say that I’m an academic. It’s important [that] the
agenda of the researchers are known” (Community partner-conference participant).22

“Trust is not something you hand to people. You have to earn it.” (Community partner-conference participant)22

Elements of successful partnerships include power sharing, open communication, equitable division of labor and
resources, and mutual recognition.23 Partnerships are based on mutual respect and trust. Building partnerships is a
challenging endeavor, especially since academics and community partners may differ dramatically in their professional
experiences, their access to resources, their research literacy, and their comfort level in the community. The power and
privilege connected with race, class, and educational attainments may be a wedge that separates the investigator from
the community.24 The researcher may be associated with unearned advantages just by being affiliated with an academic
institution or by having letters after his or her name. This is particularly true for communities that have been historically
marginalized with deeply rooted experiences of discrimination and disadvantage. Throughout history, there are
examples of unethical research that has impacted disadvantaged and minority populations, leaving a legacy of mistrust
and disappointment. In addition, communities have experienced years of “being studied” by universities who don’t give
back.

“Communities have no motivation because these research projects go on yet there is no investment in the community after….”
(Community partner-conference participant)22

The academic/community conflicts of long standing are played out in town/gown politics and exemplified by ivory
tower mentalities. Academic institutional resources, whether real or perceived, are generally unavailable to the
community. Thus, while CBPR is rooted in social justice and requires “collaborative, equitable partnerships” that
“promote co-learning and capacity building among partners,”14 dealing with power and privilege can present critical
challenges in the CBPR process.24 Researchers must ask themselves about their own commitment and capabilities to
engage in a CBPR project. Do they possess the skills and knowledge that will enable them to be effective partners?

How do we negotiate the inherent power dynamics of academic community partnerships? Respect and trust are not
automatic. Investigators need to get to know the community. They need to spend time just “showing up” at events
unrelated to the research. They need to be collaborative in their approach and humble in their demeanor. The term
cultural humility, coined by Tervalon and Murray-Garcia (1998), refers to “a process that requires humility as
individuals continually engage in self-reflection and self-critique as lifelong learners….”25 While cultural humility was
initially applied in the realm of clinical care, it can be applied to CBPR. Investigators involved in CBPR need to assess
their own cultural beliefs and assumptions in order to address power imbalances and develop partnerships based in
mutual trust.24 They need to listen and demonstrate their commitment to the community long before and after the actual
project begins. Then they need to negotiate the research agenda with their partners in an equitable manner that extends
from decisions about design to those about budgetary concerns. Throughout the process, they need to be transparent.
You may never be able to completely erase the historical experiences or the reality of resources, but through the
practice of cultural humility and by explaining the situation to your partners from the beginning, you are more likely to
build the trusting relationships that are needed for successful CBPR. Building partnerships is a long-term commitment
that can take years.

“While this person is a community member that may not have a Ph.D., they have input that is just as equally important and applicable.”
(Community partner-conference participant)22

In Somerville, as a researcher, my most important mentor was a community activist who had grown up in Somerville
and owned the local tattoo parlor. She knew the families and peers of the young people who had committed suicide. She
warned me not to try to go directly to the young people to do the investigation of the suicides. She said I would be
perceived as a privileged outsider who was going to tell them they had mental health problems. Instead, she urged me to
work with her to create a conduit to these youth. This was very difficult, as I thought myself an expert in the field. But
her advice proved critical as we addressed the problems in the community. She was a trusted insider who was able to
act as a liaison between the affected community and the professionals.

As with any relationship, CBPR partnerships depend on mutual trust, credibility, and strong personal relationships.
Practicing and demonstrating cultural humility, a willingness to share power, to engage in collaborative decision
making, to show up, and to demonstrate your commitment to the community after the specific research project is over
are all important lessons in CBPR.

COMMUNITY READINESS FOR RESEARCH

As part of building a CBPR partnership, there are many considerations that both community partners and researchers
should consider prior to and throughout the engagement process. A pre–CBPR assessment can help both parties avoid
pitfalls during the study itself. Table 2.3 notes the list of questions that should be considered before engaging in CBPR.
Answering these questions will help both parties understand the challenges and benefits of participation. In particular,
as part of the development of a partnership pre–CBPR, community members should ask several specific questions to
assess their own readiness for research. Do they have the time to participate without sacrificing their other
responsibilities? Are they going to get appropriate financial resources to support their work from the researcher? Do
they have the organizational capacity to participate in the research project? Each of these issues can create problems if it
is inadequately addressed beforehand.

Table 2.3 Readiness for CBPR

Questions for community partners to ask researcher prior to engaging in CBPR

1. What kind of partnership does the researcher have in mind? Is it really to be participatory?
2. How will decisions get made?
3. What are the research aims?
4. Who is the target population of interest?
5. How will the research be funded?
6. What will be our organization’s and/or my role in the project?
7. Will the time be compensated?
8. Who will own the data? What will happen to the data in the future after the project is completed?
9. What benefits will the project leave behind in the community (skills, programming, policy, infrastructure,

capacity building)?
10. What is the dissemination plan for this research?

Questions for community partners to ask themselves prior to engaging in CBPR

1. Does this study address an important problem relevant to my community and my constituents?
2. How does the research aim fit with the mission of my organization?
3. Do we have the capacity to participate? Space? Staff? Time?
4. What are our conflicting priorities?
5. What will be the impact of doing research on my organization’s ability to get its core work accomplished?
6. Will the results lead to action that will help my community?

Questions for CBPR researchers to ask themselves prior to engaging in CBPR

1. Do I have connections in the community?
2. Do I know enough about the community, its makeup, assets, and challenges?
3. Do I have the time to invest in and develop relationships?
4. Do I have the support of a mentor who has experience in CBPR?
5. Do I possess cultural humility?

Specific details for assessing readiness from the community perspective will be further discussed in Chapter 5.

RULES OF PARTNERSHIP

Once a CBPR partnership is established, it is important that roles and responsibilities are outlined. By answering the
questions posed for research readiness, partners can explore the details of who will do what, where, and when and
mutually determine the organizational structure for the project itself. Some CBPR investigators and their community
partners will choose to enter into more formal relationship in order to clarify roles and responsibilities. A memorandum
of understanding, or MOU, can be used to outline the expectations. The development of an MOU will require consensus
from the entire group. Examples of areas to be addressed in a MOU include the following:

• Overview of the project
• Description of each party’s responsibilities

• Time frame
• Deliverables or milestones
• Budget
• Publication/dissemination requirements

This MOU can help both academic and community partners negotiate up front how the project will unfold and may
help avoid future disagreement. With or without an MOU, it is important to have a transparent process in which these
items are outlined early in the CBPR project. Baker and colleagues (1999) point to a set of principles that may be
helpful in guiding effective academic/community partnerships that include mutual respect, trust, and honoring partners’
agendas.26 Each partnership may want to discuss its governance structure and decision-making strategies as part of this
process. How will conflict be handled? What does each party hope to gain from the project and what are their plans for
dissemination? In the Everett process, at the very beginning, the researcher said that one of her goals was to write an
article for a peer-reviewed journal. She offered authorship to anyone in the group who was interested and discussed
what would be expected of authors. Several community members said they wanted to be included, while others opted
out. Similarly, the community partners wanted to host a large community forum to discuss the results of the research at
the end of the project. There was money set aside for this activity in the budget, and a timeline was agreed upon in the
CAB’s first meeting. While this dual strategy does not always result in a smooth CBPR process, it can help avert pitfalls
and satisfy the goals of both the academics and the community partners.

MAINTAINING PARTNERSHIPS

As a CBPR partnership moves forward through a project, there will be an ongoing need to maintain transparency,
communication, and engagement. New concerns will emerge from the community that will need to be addressed. The
researcher will need to be fully prepared to listen to all the voices, and the partnership will need to navigate difficult
decisions. However, with a strong foundation of mutual trust, these obstacles can be overcome and a fruitful
relationship developed.

CONCLUSION

In summary, community in CBPR can be defined in multiple ways. In general, it represents groups of people with
shared concerns. As CBPR researchers define the community in which they intend to work, they need to learn about the
strengths and assets of that community. This is a process that requires actively engaging with community members,
learning about community norms, and visiting the community. As they begin to engage with community partners, they
must understand the context in which these partners live their lives. The success or failure of a CBPR project rests on
the strength of the academic/community partnership regardless of whether the community engages the researcher or the
researcher seeks out community members.

QUESTIONS AND ACTIVITIES

Activities

In the classroom: Have students map out a community as a group that they are familiar with, including its assets. Have
them brainstorm strategies for getting to know the community, including suggestions about key stakeholders.

Out of the classroom: Have students take a tour of a local community, including institutions as well as important
community landmarks (houses of worship, city hall, schools, parks, memorials). When they return, have the group
discuss what their observations told them about the nature of the community (i.e., Were buildings in good repair? Were
stores open? Were people walking about?).

Using a fishbowl exercise, have students role-play a first meeting between a researcher and a community partner
while other students watch. The researcher’s agenda is to find and seek out potential areas for research, while the
community partner’s agenda is to garner resources for her or his community program for youth development.

After the role play, have student observers describe what went well and what could improve in this relationship. Have
students who participated in the role play describe their inner dialogue during the meeting.

1. What was the primary objective of the researcher? Was he or she able to establish a relationship with the
community partner?

2. Were the agendas of researcher and community partner at odds? Compatible? Did they trust one another?

3. What challenges did you see in the interaction?

Questions for Discussion

1. What are some of the major strategies for getting to know a community of interest?

2. What might be the makeup of a community advisory board for a CBPR study on HIV/AIDs in an urban
community. How might you go about convening such a group?

3. How do power dynamics influence in a CBPR project?

NOTES

1. MacQueen KM, McLellan E, Metzger DS, Kegeles S, Strauss RP, Scotti R, Blanchard L, Trotter RT. What is community? An evidence-
based definition for participatory public health. American Journal of Public Health. 2001 Dec;91(12):1929–38.

Action Research Inquiry Cycle

INQUIRY CYCLE PHASE

2

Implement actions
and measure results

INQUIRY CYCLE PHASE

1

Plan for research and
addressing the problem

INQUIRY CYCLE PHASE

3

Evaluate and reflect
on results of actions

Assess the
Core Issues

1

Review the
Literature

2

Design the Projected
Intervention

3

Implement the
Intervention

4

Collect and
Analyze Data

5

Communicate

Results

6

Evaluate
Outcomes

7

9

Recommend or Decide on
Next Steps

Reflect on and
Dialogue about

Results

8