7A1-9 – Action Research: Analysis of Study Design. see details below. Follow instructions and answer all questions.

Assignment Instructions:

You will apply your new knowledge of research design to refine the research question in a way the reflects community values and concerns. Unit activities include integration of a logic model that reflects action research design. 

Objectives

To successfully complete this learning unit, you will be expected to:

1. Apply community-based participatory research (CBPR) methodology. 
2. Develop a CBPR logic model using appropriate measures. 
3. Analyze the objectives and research design in a CBPR study. 
4. Communicate through writing that is concise, balanced, and logically organized. 

The work:

-Read the first three chapters in Community-Based Participatory Research. 

-Additionally, the 2011 article by Gonzalez et al., “Community-Based Participatory Research and Policy Advocacy to Reduce Diesel Exposure in West Oakland, California,” [S166 ] will be the research journal article that provides the context for your analysis. The Gonzalez et al. article is an example of a community-based participatory research (CBPR) study that examines and evaluates other community-based participatory research studies. 

*Pay careful attention to the CBPR study that Gonzalez et al. are undertaking versus those of the other CBPR studies in the article.

In your assignment, address the following:

*Analyze the objectives of the community-based participatory research (CBPR) study presented in the Gonzalez et al. article.     

*What were the primary objectives of the researchers?

*Analyze the working relationships with community partners.   

*What did Gonzalez et al. find when examining the working relationships with community partners?

*Assess the strengths and weaknesses of the CBPR approach in the Gonzalez et al. study.     

*What did the Gonzalez et al. study find when examining the challenges and benefits of a CBPR approach?

*Analyze the findings of the Gonzalez et al. study with regard to data.    

*What did the Gonzalez et al. study find when examining the data collection processes of the CBPR approach?

Other Requirements:

*Justify your rationale throughout your assignment with information from the Gonzalez et al. article as well as from your textbook readings.

*Communicate through writing that is concise, balanced, and logically organized.

*Communicate through writing that applies current APA style and formatting and conforms to all assignment instructions.

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.

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.

Qualitative Needs Assessment Methods

Aspect Group Forums Focus Groups Nominal Groups Other Methods

Purpose Determine the
perceptions of problems,
needs, and issues from
large groups (>>40).

Obtain feedback on work
done to date.

Understand how small,
generally homogeneous
groups view an issue
regarding an area of need.

Learn how issues and/or
needs are referred to as a
prelude to survey
development.

Small-sized groups
generate multiple ideas
about needs or concerns
in a short period of time.

Obtain priorities about
those ideas.

Interviews, observations,
etc. – mostly, but not
exclusively, used to collect
data on the “what should
be” states.

Ease of Implementation Seemingly simple, but
significant behind the
scenes work.

Highly dependent on skills
and experience of group
leader.

Straightforward, but care
should be taken in
selecting facilitator so
groups will open up for
that individual.

Procedural rules must be
followed, or the properties
of the technique
disappear.

While most of the other
techniques are easily
implemented, they will
require extensive
preparation in some
cases.

Cost Considerations Relatively inexpensive, but
there are upfront costs for
planning, publicity,
refreshments, and
especially for a good
external leader.

Participants are usually
paid a stipend, and
appropriate leadership is a
must that requires
additional expenditure.

Relatively inexpensive way
to generate ideas.

Generally inexpensive, but
methods such as mailed
Delphis and future
scenarios may take
extensive time to have
returned and developed
for content.

Value of Information
Obtained

High value especially in
regard to feedback on
directions taken, findings,
community views, etc.

High value for
understanding frames of
reference, and/or for the
generation of instruments.

High value in terms of
producing and prioritizing
many ideas in a short time
period.

Can be high depending on
what kind of information
is required (e.g. the
DACUM process and
critical incidence
technique for task
analyses).

Issues Usually occurs after the
fact (i.e., following a
number of other activities)
and is not a substitute for
them.

Most of the time will not
produce discrepancies.

Very limited ability to get
at discrepancies.

What people say at a focus
group may not relate to
how they will act at a later
time.

Good at generating ideas,
but does not yield
discrepancy information.

Discussion only occurs
toward to end of the
season.

Some of the techniques
are not often observed in
the literature of Needs
Assessments.

L i c e n s e d u n d e r a C r e a t i v e C o m m o n s A t t r i b u t i o n 3 . 0 L i c e n s e .

FOCUSING THE NEEDS ASSESSMENT

Introduction
Needs assessments require diligent preparation in order to be carried out effectively. Before assembling
your needs assessment committee (NAC) you should follow a few steps to be sure you are asking the
right questions and involving the right stakeholders.

The purpose of focusing the needs assessment is to ensure that you gain the proper perspective of the
situation before delving too far into the issue at hand. These public decision issues can be big and messy,
and it’s easy to get off track or try to take on too much in one needs assessment effort.

Focusing is important!

PHASE ONE

Preliminary scoping of the situation
The purpose of these activities is to conduct an initial scan to guide the course of your needs assessment.

During this preliminary phase you will attempt to discover other relevant stakeholder groups and areas
of information.

Ask questions
Ask those requesting the needs assessment (this very well might be yourself) simple questions as:

• What is the size of the problem area? How frequently does the problem occur? How big is it?

• What data is needed?

◦ What type? Qualitative, quantitative, or both?
◦ Where can you gather this data? Does it already exist? If so, is it still relevant?
◦ Will you need to gather it yourself? How? What tools are available, cost effective, and won’t

take too much time?

• Who else should be involved? Who else is affected by this problem area? Who would be needed on
a NAC?

• What is the timeline? Does this need to be done by a certain date?

• What funds are available to support NAC activities? What about funds to solve the problem?

Find others to interview
In asking the previous questions, you should be able to determine who else might be affected by the
results of the needs assessment. You will want to meet with them to determine their perspective.

These individuals very well may be involved on your NAC. Meeting with them will prepare you for
reactions they may have at the initial NAC meeting.

Brief literature search
Once you have determined the scope of the problem, you will want to determine what type of
information exists.

What other agencies in other parts of the country have conducted similar projects?

What was the result?

Doing this will prepare you for possible barriers, and may help to either widen or narrow your scope
further.

Consolidate thoughts
After you have met with possible NAC members and stakeholders, you will want to organize your
thoughts in order to gain a clear picture of your needs assessment environment. You may want to create
a mind map to plot out relationships between stakeholder groups and possible data.

Remember, focusing the issue is important!

While you may present various options, this is the time to begin the process of narrowing the issue to
something that can be achieved with a reasonable amount of effort.

Construct summary
Summarize your thoughts in a way to effectively communicate your initial reactions to others.

• Where do you think this needs assessment should focus?

• Who should be involved?

• What data should be gathered?

• What do you think the result may be?

By covering these areas, you will give others perspective into your goals and direction for the needs
assessment.

Have others review summary
Having peers review your summary will help to prevent your own personal biases from creeping in early
in the project and point out some areas you may have missed.

While these individuals may or may not be directly involved with the needs assessment, having another
perspective will help focus your assessment.

PHASE TWO

Coming to an agreement on next activity
It is critical that those involved with the needs assessment are on board with your plan. Without their
approval, you run the risk of the results being ignored, or going down the wrong path completely.

By engaging the group to brainstorm next steps and agree to a plan of action, it allows you as a facilitator
or participant in the needs assessment to hold others involved responsible for the project and its end
result.

Ask group for next steps

• Based on your summary, what do those involved with the needs assessment feel is the best plan of
action?

• Should a larger NAC be created?

• Who do they feel should be involved?

• What data would they like to see gathered?

By asking those involved to help with the next steps, you not only gain another perspective but you will
also assure they have more ownership in the project. When asked to work on a task that is their own
idea, members are more likely to follow through.

Construct memorandum of agreement
Having those involved with the needs assessment formally agree to a plan of action is critical to the
success of your project. This will increase the likelihood your plan will be followed by members by
allowing others to agree on the direction of the project thus giving them a larger stake in the project.

CREDITS Subject Matter Expert:
Interactive Design:

Instructional Designer:

Project Manager:

Yvonne Kochanowski

Christopher Schons

Brian Powers

Kristin Staab

L i c e n s e d u n d e r a C r e a t i v e C o m m o n s A t t r i b u t i o n 3 . 0 L i c e n s e .

PRACTICALITIES OF ACTION RESEARCH

APPROACHING AN ORGANIZATION
I think it is important to strategically plan how you approach an organization. In my situation I had
various situations. In some cases I was contracted to go into an organization, they sought me out, so I
had entrée into the management level, and it was very simple to just arrange a meeting and begin to
work. In other cases, I was tasked with recruiting organizations for particular programs, could be grant
initiatives, other initiatives that, in many cases, the Federal Government was promoting, and I was tasked
with being the performance consultant for those initiatives. So in those cases, where these were more or
less cold calls, I had the greatest success with focusing on a Return On Investment sort of approach.
Really approaching organizations with a, what is in it for them presentation. So that took some
groundwork, really had to do some researching on the organization, take a look at what is important to
them, set up an initial meeting with folks to find out what is their bottom-line, what matters most to that
organization. And then we of course had to make a presentation as to how we felt we could impact that
bottom-line. So in many cases, to deal with anything from improving customer service and customer
satisfaction. It could deal with retention issues, for students or for employees that were costing the
organization money for folks who were not retaining. They could do with improving test scores, reducing
waste rates, for manufacturing type of organizations. But my job was to figure out what was really
important to management and the folks that were approving the work, and then make it very clear to
them how we could impact those particular elements for them, and how we would present that to them.
So it was a very involved — there was a lot of homework involved in approaching an organization. We did
not just walk in there cold. That would have been a death nail to us. We really had to have our homework
done and be able to show them the kind of impact we could have. We would generally try to approach
initially by phone to set up a face-to-face interview, face-to-face appointment. We prefer to do things
face-to-face. We had a strong record of performance improvement with these types of initiatives that we
could display, and we felt that was based done face-to-face. That did not mean that we always got first
entrée with the highest management level, sometimes it would be mid-management or supervisory level,
but somewhere we wanted to get in that first level, and then we could often work our way up. So
oftentimes that would result in two or three meetings, and we were amenable to however they wanted to
do that. Some organizations, it was easier to get to top management than others, just depends how
stratified. But again, we made it very clear from the onset that we wanted to impact their bottom-line. We
felt we could do that. We had a history we wanted to show, and we felt that we could best do that with a
face-to-face meeting, and that made them much more receptive to freeing up a little time for us.

REACHING DECISION MAKERS
In many organizations when you are trying to figure out, who is the individual who will make this final
decision, you really do have to go through some layers. The bigger the organization, the larger the onion,
you have to peel back the layers. Probably the best way to demonstrate that, I will share a little story with
you. At one point I was mentoring new performance consultants in the field of Federal Government as

one of six individuals in the state to go around and mentor folks, to train them to do what I did, because
they wanted a bigger cadre of folks that were working effectively in the field. So I had a mentee who had
been contacted by a huge banking organization, just the most grand banking organizations that we have,
very well-known name here in city, and was asked if they wanted to competitively bid for a project, to
come in and do some customer service kind of performance improvement. So she was extremely
nervous, and she called me and she said, can you help me, this is huge for my first time out of the box,
can you come along with me to this meeting? So since I knew there would be a number of folks going, I
suspected that it might not be top management, we would be going through a filtering kind of system. So
when we got there, we were fingerprinted, lenses of our eyes were read for identification. We had to
nearly be frisked. I mean, it was incredible security. They whisked us up in the private elevator to the top
floor. The Director of Training, Seth, met with us, asked us to make a presentation and talk about what
we could do. We started the conversation with, we want to know what is important to you, and we want
to impact your bottom-line. This is all about Return On Investment for you. Immediately he said he had to
stop the meeting, which I was a little concerned about, because typically that is a pretty positive approach
with folks. He ran and got a phone, with the speaker phone attached, and he put the speaker phone in
the middle of the table, he said, I need to call our VP of Operations who is working in the Boston office
today, and get her on the phone. He called her up. We heard this voice from the phone. He explained
what had just transpired. And she said, I just want to let you know, not only do you have the contract, but
I want to know why the other dozen folks that we interviewed had no interest in our bottom-line, we are
a bank, we are about money, why was not anybody interested in impacting our bottom-line, that is what
this is about? So she congratulated us. We got a very nice contract out of that. But we definitely had to go
through that filtering process and work through the training director to get to that VP, who was in an
entirely different city. She told the training director she did not want to be bothered until somebody
started talking Return On Investment, and then he could call her, and she would get involved with the
interview. They will set the playing field, and you really need to work your way along until you get to that
individual at management that can make the final decision.

PITFALLS OF ACTION RESEARCHM
I think it is very important to approach action research projects without preconceptions. We have a
hunch that something is going on, or something needs addressed, but oftentimes there is a tremendous
back story in that organization, even if it is your own organization, you might not be fully aware of it
impacting that performance, or impacting those results. Many times I would go into an organization
being told that I would be conducting one type of training and then discover that something else entirely
was needed to impact the bottom-line. I think it is important for those trainees and those participants to
trust you. If there is not a level of trust, they are not going to divulge what that back story is. I will share
one quick story with you, I think illustrates that pretty clearly. I was contracted to come in and work with a
number of master carpenters to do remedial mathematics, which sounds extremely odd, it sounded odd
to me at the time that master carpenters would not know how to do mathematics since that is what they
do for a living. But there was such a tremendous waste rate at this organization, which was a custom
cabinetry business, that the VP was extremely concerned, they were just wasting too much product. They
took too much wood to build the products that they did on, and they were breaking even, they were not
making any money. So the assumption was, these folks do not know how to read a rule, they cannot read
a blueprint, and they are making mistakes. When I got into that organization and those workers began to
trust me, I found out that they really did know how to do mathematics, they were exceptionally skilled at
it, but they were treated extremely poorly by the management. So their method of retaliation was, we will
figure out exactly where this business breaks even on a contract, so we get paid, and then we will start to
waste product after that, so that the organization does not see any profit, because they are not going to
make a profit off our backs when they treat us so poorly. When they treat us better, they will make more

money. So what I was contracted to do and what I ended up doing were two completely different things.
It really needed to be some coaching of management versus some remediation for mathematics, for
some carpenters. So you really have to be open and have that sixth sense of, something is not right here,
I need to dig deeper and find out what the root cause is of this performance issue, and sometimes it is
quite surprising. In a situation where what management perceives to be the problem versus what
actually is the problem, I think you need to be very, very careful in how you approach management about
that. And again, I always kept my focus on what is profitable to this business, what is important to this
business. That is our focus and everybody is focused on that. In this particular case that I just shared, I
brought in an outside consultant to work with management, who specialized in those kind of very
sensitive situations, but always couched around, your job is extremely difficult, you are under
tremendous amount of stress, we have coaching and strategic training that can help you deal with the
situation for being a manager at this level. Let us help you make this business profitable and make this
work climate more amenable to everybody that works here. So that was generally well received.

COMMUNICATING RESULTS
I think that communicating of the result is one of the most critical pieces of the work that you will do,
because that is the take away that everyone has from the project that is done. My favorite quote is from
Jack Phillips of the ROI Institute, who says, if you do not plan to communicate your data effectively, do not
bother spending the time to collect it. People really need to understand what happened, and you need to
be able to present that in a way that is well received by them. So very early in the conversations with
management or whoever the individual was that I was working with, I would spend time talking about,
what do you expect to see as results, and how do you expect those results to be portrayed? What kind of
platform can you give me to talk about the impact that we had? And that would include, not only the
impact at the very end of the intervention, but I would come back, in some cases several months, several
weeks later to make sure there really was a transfer of learning, that people really did implement what
we had been training them to do. So I would negotiate all that upfront. I would make sure that I had time,
and I had the resources available, I had access to the people to come back and collect that post-
intervention data. Otherwise I could not prove that I had an impact. And as a person who made their
living as performance and consulting, that was critical to my survival. So we often had to negotiate that
upfront, because if things went well, oftentimes it was, well, the production line is going well now or test
scores are increasing now, and we are very busy, so we cannot have you come back in here, and if that
was not negotiated in my contract, it could be a problem. So needs to be talked about upfront. Need to
talk with management about what kind of data they like to see. Are they numbers people or are they
stories people? Do they want to see hard data from production, from waste rates, from test scores, what
are they looking for? That way I could be very clear about what kind of baseline I collected, so I knew what
the picture was in that organization before I started, and then my post-intervention data, and those two
would correlate so that I could show a change, because it would not make any sense not to have that
baseline if I could not show that I increased or improved anything. I learned a very difficult lesson as a
performance improvement specialist and that was, I always negotiated to have a face-to-face meeting
about the results. I learned early on that just writing up a narrative report and handing it off to a
supervisor often was the end of the interaction with all that work that I had done, no one had read it, the
supervisor, at that particular level, knew things had gone well, and we would be done. So I would arrange
very early on in those discussions to have a time to get back and present the results, maybe it was at a
board meeting, or maybe it was at a management meeting, or some type of event that they already had
scheduled, but I would want 15, 20 minutes of time to get out there and display what we had done. I used
a lot of graphic representation of data, so it could be quick. I could show a quick slide with a graph and
show, here is where we were, here is how we improved. I used a lot of stories from the participants and
trainees, in their own voices. I would put their picture up. I would record their voice, talking about how

wonderful this particular intervention had been. So they really could connect with their own people, and
the impact that we had, and I had hard data to back it up, that was displayed in a way that was very easy
to read, very easy to communicate, and something that they would take with them. And then I always left
them with the hard copy as well, along with my business card of course, so they could contact me for
future work. But my greatest advice is, do not just hand off a report, get some face time with people, and
give them something powerful to look at during that face time, that will really help them connect with the
results that you had. I think in the presentation of your data, it is important to remember that
academicians will be very interested in the letter of your dissertation, every element of your dissertation,
every paragraph, and that you have followed all five chapters, and that you have met all the criteria of
academicians. Management will most likely not have time to sit down and read your dissertation. They
tend to like business oriented type of reports, bulleted statements, graphs, very quick and dirty. I typically
had about 15 minutes to present my data at meetings. 15, 20 minutes would be the average. So I could
not stand there and recite my dissertation. But definitely that work I had done for my dissertation
provided me with the background and the confidence and the experience to do an effective executive
summary in 15 minutes. The key was, I just really had to focus on the results with management, that is
what they were interested in, that would get me back in the door the next time. And I would certainly
have all that background available for anyone that needed it. But you really need to communicate
effectively for your particular audience, so that can mean a variety of things, whether you are writing an
article on the study, whether you are writing the dissertation, whether you are doing an executive
summary for management, you really need to be able to massage that data in a way that is effective for
that particular audience.

CREDITS Subject Matter Expert:
Interactive Design:

Instructional Design:

Project Management:

Dr. Jamie Barron

Patrick Lapinski, Marc Ashmore

Liz Anderson

Julie Greunke

L i c e n s e d u n d e r a C r e a t i v e C o m m o n s A t t r i b u t i o n 3 . 0 L i c e n s e .

Spink And Forcible

Various Artists

Coraline, track 16/32, disc 1/1

2009

Soundtrack

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Community-Based Participatory Research and Policy Advocacy
to Reduce Diesel Exposure in West Oakland, California
Priscilla A. Gonzalez, MPH, Meredith Minkler, DrPH, MPH, Analilia P. Garcia, MPH, Margaret Gordon, Catalina Garzón, MCP, Meena Palaniappan, MSc,
Swati Prakash, MS, and Brian Beveridge

We conducted a multimethod case study analysis of a community-based

participatory research partnership in West Oakland, California, and its efforts to

study and address the neighborhood’s disproportionate exposure to diesel air

pollution. We employed 10 interviews with partners and policymakers, partici-

pant observation, and a review of documents. Results of the partnership’s truck

count and truck idling studies suggested substantial exposure to diesel pollution

and were used by the partners and their allies to make the case for a truck route

ordinance. Despite weak enforcement, the partnership’s increased political

visibility helped change the policy environment, with the community partner

now heavily engaged in environmental decision-making on the local and

regional levels. Finally, we discussed implications for research, policy, and

practice. (Am J Public Health. 2011;101:S166–S175. doi:10.2105/AJPH.2010.

196204)

Located on the San Francisco Bay, and
bounded by freeways, West Oakland is a small
but vibrant community of predominately low-
income African American and Latino resi-
dents. Home to nearly 22 000 people in 10
distinct neighborhoods, the community also
contains thousands of moving and stationary
sources of diesel pollution.1 From the buses
and trucks on surrounding freeways, to the
container trucks moving through neighbor-
hoods as they take goods to and from the Port
of Oakland and a major US Post Office distri-
bution center, residents have long experi-
enced disproportionate exposure to diesel
exhaust and traffic-related air pollutants. Al-
though such exposures are known to ad-
versely affect cardiovascular health outcomes,
including premature mortality,2—4 of greatest
concern to West Oakland residents is the role of
these pollutants in exacerbating asthma and
related respiratory conditions in children and
their families. Recent prospective studies have
shown a positive relationship between traffic-
related air pollution and the onset of asthma in
children,5 as well as adverse effects of such
exposure on the growth of lung functioning in
children aged 10—18 years.6 In a nested case—
control study in British Columbia, Canada,

elevated exposure to traffic-related air pollutants,
such as nitrogen dioxide, carbon monoxide, and
black carbon, in utero or in infancy was also
recently found to be associated with higher risk
of asthma in children under age 5.7

In many low income urban neighborhoods,
and particularly communities such as West
Oakland with major ‘‘goods movement’’ activity
related to international trade, a larger than
normal percentage of traffic consists of diesel
trucks,8 including those moving containers.9 The
emissions from diesel exhaust are a combination
of gases and particles, including a high number
of ultrafine particles shown to be especially
hazardous because they can escape many of
the body’s defenses, allowing them to enter the
lungs and the systemic circulation.10 Although
automobile emissions also include ultrafine par-
ticulate matter, for residents of West Oakland,
who see relatively little car traffic in the neigh-
borhood itself but regularly find diesel exhaust
soot on their window sills and heating vents
from the high volume of truck traffic, diesel air
pollution is of far greater local concern.

In West Oakland, as in a growing number of
low income communities disproportionately
impacted by environmental hazards, commu-
nity-based participatory research (CBPR) has

been used by local residents, in partnership
with outside researchers, to help study and
address neighborhood challenges, while build-
ing local capacity.11—19 Green et al20 defined
CBPR as ‘‘systematic inquiry, with the participa-
tion of those affected by the issue being studied,
for the purposes of education and taking action
or effecting change.’’ Among the core principles
of this approach to research are that it recognizes
community as a unit of identity; it entails an
empowering, colearning process that ‘‘equitably’’
involves all partners; and it includes systems
development and increases local problem-solving
ability. It also achieves a balance of research and
action, and ‘‘involves a long term process and
a commitment to sustainability.’’21 Finally, CBPR
pays serious attention to issues of research rigor
and validity. However, it also ‘‘broadens the
bandwidth of validity’’22 to ask whether the
research question is ‘‘valid,’’ in the sense of
coming from or being meaningful to the involved
community. With its commitment to action as
part of the research process itself, CBPR has
increasingly been utilized by community—aca-
demic partnerships interested in using their
research findings, together with advocacy and
organizing, to help move policy that may
improve conditions and environments in
which people can be healthy.17,19

Our primary research goal was to analyze
a CBPR partnership between a community-
led and -based organization, the West Oak-
land Environmental Indicators Project
(WOEIP), and its academically trained re-
search partners at the Pacific Institute in
Oakland, California. We examined the pro-
cesses by which community and academically
trained research partners collaborated to
study a community-identified issue (i.e., die-
sel traffic in West Oakland23) and then
worked with other stakeholders to use the
findings and residents’ experience to advocate
for policy change.

FRAMING HEALTH MATTERS

S166 | Framing Health Matters | Peer Reviewed | Gonzalez et al. American Journal of Public Health | Supplement 1, 2011, Vol 101, No. S1

METHODS

The collaboration between community
members and partners at WOEIP and their
research collaborators at the Pacific Institute
was 1 of 36 current or recent policy-focused
CBPR partnerships in California that our re-
search team at the University of California,
Berkeley and PolicyLink, Inc., identified in
2008 as appearing to have played a role in
contributing to policy level change. With
funding from The California Endowment, we
designed a study to explore CBPR as a strategy
for linking place-based work and policy toward
building healthier communities. As part of
this broader study, and in consultation with an
advisory committee, we selected for in-depth
analysis 6 of the 36 partnerships that met the
following criteria: (1) demonstrated the CBPR
core principles previously noted,21,22,24 (2)
substantially contributed to either a specific pol-
icy change or a change in the policy environ-
ment, and (3) helped capture the diverse range of
such projects in the state. A 28 item in-depth,
semistructured interview schedule was devel-
oped for administration to key community and
academic partners, along with a shorter phone
interview guide for relevant policymakers at each
site. The on-site interviews (range, 60—90 min-
utes) included questions designed to explicate
partnership genesis and evolution; research aims,
methods, and findings; policy goals, steps, and
activities; success factors and barriers; and per-
ceived contributions to helping change a specific
policy or the broader policy environment.

As 1 of the 6 partnerships that comprised the
final sample, WOEIP and the Pacific Institute
were visited 4 times by members of the re-
search team who conducted 7 key source
interviews, 3 phone interviews with local policy
makers, observed a WOEIP training for local
residents, and analyzed relevant internal doc-
uments and media coverage. Audiotapes of the
7 interviews were transcribed and coded in-
dependently by 3 research team members
using a 16-item coding template, with subcodes
whose code categories were related to each
major domain of interest (e.g., partnership
creation and evolution; partner involvement in
conducting the research; policy goals, stages,
activities, and outcomes; facilitating factors and
obstacles faced; and sustainability indicators).
We conducted interrater reliability checks,

reconciling discrepancies. Next, we employed
the qualitative software package, ATLAS.ti,
version 5.5 (Atlas.ti GmbH, Berlin, Germany
Version 5.5) to group all key domains by site
and generate reports, facilitating an additional
layer of coding following a similar technique.
Finally, we shared preliminary case study re-
ports based on the reconciled findings with
community partners at WOEIP and their col-
laborators at the Pacific Institute for member
checking as an added means of ensuring the
accuracy of data interpretation. In the spirit of
CBPR, both community and academically
trained researchers in the WOEIP partnership
participated in coauthoring this paper.

RESULTS

The West Oakland EIP began in 2000 as
a project partnership between a nonprofit
research organization, the Pacific Institute, and
the 7th Street-McClymonds Neighborhood
Improvement Initiative. This early collaboration
undertook research, in which ‘‘residents se-
lected the indicators they wanted to track;
collected, analyzed, and reported on selected
indicators, and supported the continued use of
this data to advocate for positive change in
West Oakland.’’23 A Task Force of 16 residents
identified 17 key indicators (e.g., toxic exposure,
illegal dumping, and asthma rates), each related
to a topic of major concern in the neighborhood
(e.g., air quality and health, physical environ-
ment, and transportation). The academic partner
then collected and examined both survey data
collection and secondary data on the municipal
and state levels, and drew comparisons between
indicator data for West Oakland and that for the
city and state as a whole. Released in 2002,
the West Oakland EIP report, Neighborhood
Knowledge for Change,23 which summarized
study findings and forwarded recommendations,
was cited in the local media, with some of its
findings (e.g., children younger than 15 years in
West Oakland had asthma rates 7 times the
state’s average) drawing particular attention. This
visibility, together with the high quality of the
research, contributed to WOEIP’s spinning off to
become a community-led organization in its own
right and incorporating as a nonprofit in 2004.

The processes and outcomes of the Neigh-
borhood Knowledge for Change project laid the
groundwork for a true CBPR partnership

between community members engaged with
the newly formed community organization,
WOEIP, and the Community Strategies pro-
gram of the Pacific Institute to study and
address a key concern raised in the original
study but for which insufficient data existed:
the high volume of diesel truck traffic in West
Oakland.23

Although we focus here primarily on 2 of
the resultant CBPR studies (the truck count
and truck idling studies) and subsequent
policy work to secure a truck route ordinance,
these were part of a range of intersecting
efforts to study and address disproportion-
ate exposures and environmental injustice,
and in the words of a partner, to increase
‘‘democratic community participation in
decision making in West Oakland.’’

Research Design, Methods, and

Participant Roles

The initial idea for conducting the truck
count and truck idling studies emerged from
initial community meetings held as part
of the Neighborhood Knowledge for Change
project. When residents and staff realized
there were insufficient data to allow the in-
clusion of indicators related to diesel truck
traffic in the original study, they left this as 1 of
several ‘‘indicators not included’’ in the report,
‘‘as a placeholder’’ for subsequent study.
WOEIP and their Pacific Institute research
partners then returned to this issue to develop
and conduct studies to better understand
the residents’ key concern. Although commu-
nity residents played important roles in the
planning and implementation of the truck
count and idling studies, this research was
preceded by considerable background study
by the Pacific Institute partners, including
a review of existing research to determine
what methods had already been employed for
estimating diesel sources. The Pacific Institute
also conducted secondary data analysis to
estimate diesel pollution in West Oakland
and its potential sources, which provided
important background and context for the
truck count and truck idling studies that
followed.

Building on this preliminary work, the
WOEIP partnership and the Pacific Institute
jointly designed and conducted the truck count
and idling studies, together with a third study of

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indoor air quality (not detailed here because
of small sample size), with funding from the
federal Environmental Protection Agency and
the California Department of Health Services.
One partner described these studies as ‘‘re-
search with a purpose,’’ with the 2 studies we
explored designed to ‘‘better understand truck
patterns and behaviors’’ so that the partnership
could identify strategies to reduce pollution
and other impacts of the heavy truck presence
in this community.1

To provide additional background for the
work, the Pacific Institute partners conducted
an in-house diesel inventory and helped de-
velop a request for application for firms in-
terested in providing technical assistance with
the truck count and truck idling studies. Com-
munity members played a key role in inter-
viewing 2 potential subcontractors, and the
transportation technologies consulting firm
TIAX, Cupertino, California, was unanimously
chosen through this process. TIAX trained 10
community residents and WOEIP staff while
also learning about the community’s lay
knowledge to enrich the research. TIAX and
the community residents worked together, for
example, to identify key street intersections at
which the studies should take place. After some
background study, TIAX generated a potential
list, with community residents and WOEIP
staff then using their ‘‘in the trenches’’ knowl-
edge to add additional potential locations and
actively participate in selecting final locations.
These included intersections with high truck
traffic and/or those where large (4.5 ton) trucks
were prohibited.25 TIAX then trained the resi-
dents as truck observers. After learning to iden-
tify different types of trucks (e.g., container and
noncontainer trucks, 2- and 3-axle trucks), the
observers counted the number and types of
trucks, and which direction they were traveling,
on 5 neighborhood streets over 3 days. Similarly,
they observed and tracked truck idling at the
Port of Oakland for 2 different 24-hour pe-
riods.25 TIAX also conducted informal inter-
views with truckers from an independent truck-
ing company and community members to gather
their opinions on and experiences with truck
traffic.

Throughout these studies, researchers at the
Pacific Institute ‘‘were behind the scenes as
much as possible.’’ Community residents and
WOEIP staff worked on data collection, with

guidance from TIAX, and subsequently
worked with the Pacific Institute on data
analysis. Although engaging in rigorous re-
search was an exciting and critical part of the
work, both community and academically
trained partners noted that there were initial
tensions in ‘‘not having residents at the same
technical level as the Pacific Institute.’’ As
a community member commented, this
resulted in ‘‘a certain amount of pushback,’’
with residents wanting ‘‘a bigger role in de-
signing and conducting the studies and con-
cerned about ‘‘having PhDs just come and do
the research and then leave.’’ However, trans-
parency on both sides allowed communication
to flow and partners to work out their differ-
ences. In the words of another WOEIP leader
and community resident, ‘‘We’ve always been
able to stop a meeting and find the common
ground, come to an agreement and resolve the
skills difference, and most times after it was
explained, we could move on.’’ In this case, the
community learned to appreciate through di-
alogue that they could not ‘‘learn in a week’’
what outside researchers had spent years
learning, yet could still play a vital (and deeply
appreciated) part in the research, partially
based on their wealth of lay knowledge of the
location of heavily trafficked intersections.

WOEIP Study Findings

The truck count study revealed that 6300
truck trips occurred daily through West Oak-
land, some in areas prohibited to trucks.27

Trucks traveled through local neighborhoods to
find truck services, such as fuel, truck repair,
food, and overnight parking. The trained resident
observers also found that approximately 40 large
trucks per day drove on streets prohibited for
trucks over 4.5 tons.1,25

Findings from the truck idling study were
similarly striking: community partner ob-
servers found that trucks were idling outside
the Port of Oakland terminal gates an estimated
combined 280 truck-hours per day––the
equivalent of nearly 12 trucks idling for 24
hours a day. They further found that most of
the idling trucks were doing so inside the
terminal gates where data collection was pre-
cluded. By conservative estimate, however,
each truck appeared to be spending about 1.5
hours per trip idling or moving at a very slow
pace for container pick up or delivery.1 The

combined results of these studies revealed that
approximately 64 lbs/day of diesel particulate
matter emissions were generated from truck
traffic and truck idling.25

Although these studies were based on small
samples, the partners extrapolated from their
findings that West Oakland might be exposed
to ‘‘90 times more diesel particulates per
square mile per year than the state of Califor-
nia.’’1 They further suggested that this figure
could translate into an increased risk of 1
additional case of cancer per 1000 residents over
a lifetime.1 These findings, moreover, were given
additional weight by a third, albeit very small
CBPR study on indoor air quality (not described)
suggesting that some West Oakland residents
were likely being exposed to almost 5 times more
diesel particulates than residents in other parts of
the city.1

From Research to Action

As Bardach,26 Kingdon,27 and others28 have
suggested, although the policy making process
often is messy and circuitous, several key steps
and activities typically are involved, including
problem identification, creating awareness, get-
ting on the agenda, constructing policy alterna-
tives, deciding on a policy to pursue, and policy
enactment and implementation. For CBPR prac-
titioners interested in helping effect policy level
change, relevant research findings, education
and policy advocacy frequently are used in
conjunction with these steps or activities.28

Building on earlier work that demonstrated
very high youth asthma rates and diesel truck
traffic as a top neighborhood concern,23 the
WOEIP partnership used findings from its
recent truck count and truck idling studies
to further define the problem and create
awareness, in part by gaining the buy-in of
a growing number of stakeholders. After the
partnership and a handful of community
members crafted initial recommendations
based on the study findings, for example, the
partners met independently with local orga-
nizations, businesses, truckers, and relevant
government entities (e.g., the Port Commis-
sion, Department of Public Works, and the
Police Department) to elicit their feedback.
This inclusive strategy was widely credited to
the former director of the Pacific Institute’s
Community Strategies program. In the words
of a EIP community resident and leader:

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I don’t think I was ever in a meeting with [her]
when she didn’t say, ‘‘who else do we need to
have at the meeting?’’ She was never willing to
rush to judgment . . . there was always the
potential that you would get a better perspective
if you got a few more people to the table.

Involving the truckers was not always easy
for WOEIP, one of whose leaders noted that:

In the beginning, this was a tension, because we
did not have a good relationship with truckers. I
was very adamant dealing with [them], but that
was the beginning of my education.

She went on to add that over the course of
this and subsequent meetings, ‘‘we began to
understand the needs of truckers, the labor
piece, and began forming our relationship with
[them]. We still have this relationship.’’

The truckers and other stakeholders were
also invited to a larger half day release event
and community workshop where the WOEIP
and Pacific Institute presented the study
results and initial recommendations, and re-
ceived feedback,. Additional community
members were then trained to conduct door-
to-door outreach and advertise a follow-up
meeting with WOEIP where residents could
further discuss and prioritize the recommen-
dations. The close to 3 dozen residents who
attended this release event also shared their
experience in relation to diesel exposures and
truck traffic in their community. However, as a
Pacific Institute partner commented, the other
groups present at this meeting (e.g., truckers
and the Port Commission) felt buy-in because
their ideas, expressed earlier in the more in-
dividualized stakeholder group meetings, were
represented along with those of community
members. Further, when truckers heard resi-
dents’ stories of how diesel exposure was af-
fecting their children and grandchildren, they
expressed more understanding of the com-
munity’s concerns about their heavy presence
in the neighborhood. Similarly, when commu-
nity members learned about the truckers’ expe-
riences and hardships (typically as immigrants of
quite modest means), they began forming better
relationships and worked to find common
ground that would be mutually beneficial.

The follow-up community workshop was
attended primarily by 20—25 residents. Although
it did not involve a formal process of weighing
a range of policy alternatives, this interactive
session was described by a community partner as

leading to ‘‘a smaller set of solutions.’’ Resident
‘‘voting’’ through dots on a collective list of
finalized recommendations clarified their
overwhelming priority: designating a truck
route that would prevent trucks from traveling
through West Oakland neighborhoods. Resi-
dents further emphasized their desires for
community participation in the process of de-
termining what an alternate truck route would
look like, and ensuring that report findings
were taken seriously. Their final 13 recom-
mendations were highlighted, along with the
study findings, in the partnership’s report,
Clearing the Air: Reducing Diesel Pollution in
West Oakland released in November 2003,
and an accompanying press release, ‘‘West
Oakland residents choking on diesel,’’ which
emphasized, in particular, residents’ desire for
a designated truck route.3

Policy Action Strategies and Approaches

The EIP partnership showed considerable
policy acumen in its efforts to get the truck
route proposal on the agenda of policy
makers. Although safety and health
concerns were the initial catalyst for the truck
count and truck idling studies, for example,
when moving into the policy advocacy
phase of the work, the partnership was
strategic in framing their findings and their
policy objective even more explicitly in
terms of health. As a community partner
noted,

We could have said the truck route was about
traffic. We could have said it was about walk-
ability in the neighborhood. We could have said
it was about a whole lot of things [but] we said it
was about health. And so it was really grounded
in something no one could really argue with,
especially if they were local.

In underscoring the ‘‘health angle,’’ the
partnership also provided important backing
for their key policy ally: a city councilwoman
with strong roots in West Oakland. In her
words:

State law, city law looks at commerce [but] we
wanted to look at health issues—they were not
part of agenda. There was community advocacy
[framing the problem as a health issue]; com-
munity voice added to mine.

The partnership also worked with commu-
nity members to conduct a power analysis to
identify decision makers who could bring
policy change and bridge gaps with the city. A

strategic method in policy advocacy, power
analysis (or power mapping) helped identify,
for a given policy objective, targets with de-
cision-making power on the issue, as well as
potential allies, opponents, and other stake-
holders and their relative strength and de-
grees of overlap or independence.29 Such an
analysis helped partners create a strategic plan of
action to neutralize or win over opponents,
mobilized constituents, and brought appropriate
arguments and advocacy methods to bear on
a target or group of targets.28 In West Oakland,
where many key players had already been
identified, the power analysis process high-
lighted the importance of the Port as a key
decision maker, and of the district’s local city
councilmember as a potent ally. However,
it also shone a spotlight on West Oakland
businesses as an under appreciated group that
would be impacted by the proposed new truck
route and that they needed to be included
in subsequent planning.

Policy makers frequently note the impor-
tance of being presented not simply with
problems, but also with solutions––ideally so-
lutions that have ‘‘buy in’’ from multiple stake-
holders. The WOEIP partnership was strategic
in creating a truck route committee that met
monthly from October 2004 through Septem-
ber 2005 and included such diverse yet critical
stakeholders as local residents, the Port of
Oakland, an independent trucking company,
the Police Department, the Department of
Public Works, the District Air Board, and the
West Oakland Commerce Association. The
committee’s goal was to negotiate an actual
truck route that could address community
concerns without unduly burdening other
stakeholders.

To reinforce the collaborative spirit that
had been evident in earlier multistakeholder
meetings while assuring continued high level
resident engagement, the WOEIP partnership
established a collaborative process for the truck
route committee in which no one entity took
over the agenda. As a community partner stated:

[We] had an agency and a resident, or a business
person and a resident. It [was] never one single
entity in the lead. And we would go through the
process of training each other on how to get
along, how this would work. . . that was a new
policy for them, a new action for them . . . of the
community being a part of defining who were the
stakeholders.

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Although initially concerned about the im-
plications of having truckers and businesses
at the table, for example, just as WOEIP
leaders had been early on, community resi-
dents gained a better appreciation and un-
derstanding of the labor hardships of truckers
and the concerns of ‘‘mom-and-pop’’ store
owners and other small businesses who
benefited from the revenue generated by the
truckers’ presence in the neighborhood. Con-
versely, the truckers became more accepting
of a route that would take them out of the
neighborhood, whereas business owners be-
gan to recognize that as local shopkeepers,
they or their employees were also likely to
have their health adversely impacted by
heavy diesel truck traffic exposure.

By far the greatest challenge, however,
remained getting buy-in from the Port, whose
leadership, according to one community
leader, ‘‘thought that the community shouldn’t
be telling the Port what to do.’’ To better
engage this and other city partners in the
process, WOEIP’s local city councilwoman
and informal policy mentor offered to hold
the monthly meetings at her office:

so that people showed up: Other city depart-
ments showed up, the Commerce Association,
the Port, traffic department, truckers association
showed up, so we had buy in from all. . . The
power to change policy came out of that.

The city councilwoman was cited as key to
getting the Port as part of this process and
eventually agreeing to support the new truck
route.

Throughout this process, WOEIP leaders
and local residents frequently ‘‘made the
rounds’’ of neighborhood organizations, get-
ting on the agenda, keeping them informed on
‘‘where the routing discussion was going,’’
and getting their feedback on possible un-
intended consequences. In this way, even less
directly involved residents could have their
issues raised and discussed by the truck route
committee.

Once the committee agreed on a route,
and pushed for a city ordinance to implement
it, they engaged in several steps to help increase
awareness and support for the proposed
policy change. EIP leveraged its alliances with
other community and statewide groups orga-
nizing to combat diesel pollution, key among
them the West Oakland Toxics Reduction

Collaborative30 and the Ditching Dirty Diesel
Collaborative.31

Several town hall meetings and community
forums were held to further engage the larger
community and generate support for the
ordinance, and attracted up to 30 local partic-
ipants. Residents who expressed interest in
providing testimony at the upcoming City
Council meeting were also encouraged to do so,
and reminded to ‘‘stay on the mark’’ in telling

their own stories because ‘‘you’re here to put
a human face to the issue.’’

Getting to Policy Implementation: Two

Steps Forward, One Step Back

In September 2005, the WOEIP partnership
and its allies achieved a key victory when the
City Council unanimously passed a Truck
Route ordinance that adhered closely to the
specific truck routes the partnership proposed

Source. City of Oakland, California. Available at: http://clerkwebsvr1.oaklandnet.com/attachments/11326 . Accessed

May 14, 2010.

FIGURE 1—Designated truck routes as proposed by truck route committee, West Oakland,

California.

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(Figure 1). Several of the policy makers inter-
viewed noted that the partnership, and partic-
ularly its sound research and the strong com-
munity voice represented by WOEIP
community members, deserved substantial
credit both for this particular victory and for
subsequent broader efforts. The combined
presence and participation of grassroots resi-
dents and ‘‘grass-tops’’ level opinion leaders
(e.g., community-based organization heads),
together with researchers and representatives
of the truckers, the Port, etc., helped achieve
a unanimous vote that was ‘‘almost anticlimac-
tic’’ given all the work that had preceded it. As
a decision maker said of the WOEIP Pacific
Institute partnership,

Their research and advocacy have been critical––
critical––in making the Port recognize its re-
sponsibility to the surrounding neighborhoods––
that they should do their operations in a way that
doesn’t hurt the community.

Unfortunately, the most visible policy win
for which the partnership was given substantial
credit was also the most frustrating and in-
complete: as the partnership members and
policy makers interviewed all commented,
failure to enforce the new truck ordinance
made it, in many ways, a somewhat hollow
victory. As a Pacific Institute partner put it:

We had this great truck route, we had new signs,
we had brochures and maps that were suppos-
edly getting distributed through the Port of
Oakland, but there was no enforcement. And
without that, there’s no point. . . . [Enforcement]
was overlooked.

Other stakeholders pointed to the City’s
police officers being spread thin––and mostly
focused on violent crime–– as a key reason for
the lack of enforcement. A community partner
similarly noted that there was significant re-
sistance from the city in actually implementing
the truck route because it would generate more
work and require additional staff time. What-
ever the cause, failure to enforce the truck
route ordinance was a major disappointment to
the partnership, community members, and
other stakeholders who worked hard for its
passage. In retrospect, as Pacific Institute part-
ner reflected:

Often times the most easily identified policy
outcome is also the one that is least significant
from a community health perspective. Pre-
cisely because decision makers realize that the

easiest way to get a community off its back is to
pass something, without being committed in any
way to do all the hard work it takes to actually
realize the spirit and the vision of what the
community needs.

Although lack of policy enforcement was
a critical setback, this work has helped
prompt other environmental justice initiatives
addressing diesel pollution while further
building the capacity of WOEIP and its resident
leaders and activists. Several of the policy
makers interviewed credited WOEIP commu-
nity partners’ advocacy and perceived profes-
sionalism, in addition to the still much cited
CBPR truck studies conducted with Pacific
Institute, as having helped spur other local,
regional, and statewide changes. Together,
these changes have helped create a more fa-
vorable policy environment with respect to
environmental justice. The partnership’s work,
for example, prompted other agencies and
institutions to conduct their own studies in this
heavily impacted community. In 2006, the
California Air Resources Board (CARB) began
a comprehensive health risk assessment for
diesel exhaust in West Oakland, a multiyear
intensive endeavor to formally document the
sources, extent, and impact of diesel pollution
on health risk for West Oakland residents.32 In
the words of one Pacific Institute partner, ‘‘CARB
started paying attention, the Air District started
paying attention. These studies put diesel in
West Oakland on the map,’’ with the Air District
itself subsequently conducting follow-up studies
in this community.

As WOEIP gained recognition and an in-
creasing voice through the truck count and
truck idling work at the local level, it expanded
its focus to other air quality efforts happening
regionally and reframed them to increase their
local relevance. As a community leader
explained, ‘‘If you do ‘regional’ it will be
watered down [in terms of ] local impacts.’’
WOEIP therefore partnered with the Air Dis-
trict and the Port staff to design an air plan to
benefit West Oakland as part of the broader
goods movement efforts taking place region-
ally, statewide, and nationally. In the course of
this work, WOEIP also helped change the
structure of the planning group, so that a com-
munity member of WOEIP now serves as a
cochair. As an WOEIP leader and long time
resident pointed out:

We have moved from doing this truck thing to
being engaged in goods movement, identifying
something that’s local and then actually dealing
with what a clean air plan should look like locally.

Partners and policymakers described
WOEIP’s recent work as critical in getting the
Port of Oakland to commit to an 85% re-
duction of the community health risk caused by
its diesel operations by 2020. Although the
process has been challenging and the details of
the air plan are still being worked out, partners
have described how their work has improved
organizational structures so that the community
and other important stakeholders are now rep-
resented in air planning groups. As another
WOEIP community leader commented:

We’ve been successful on [many] procedural
levels. We were able to change the entire
structure of that air planning group [getting]
a community member on as a co-chair. After we
did that, we said, ‘‘Who else isn’t here? . . . we
think the industry ought to have a co-chair seat
and the health department [too].’’. . . So we
expanded the agenda, setting part of that to
include two other groups we thought were
important, some as allies and some as adversar-
ies, but voices that needed to be at the table. That
kind of approach gets us respect and changes our
perspective as a community organization. It adds
to our reputation in a positive way.

Finally, both the partnership’s early work
and subsequent efforts helped create condi-
tions in which partnership colearning could
occur, and the research and advocacy capacity
of the West Oakland community could grow,
fostering sustainability. As one community
partner noted:

As we did our own research and thought about
things, we were able to ask other questions. It
was good. . .much more of folks’ unknown in-
formation [was brought] out into the community.
Our ability to question, ‘‘Why was this? Why was
this happening here?’’ We were able to do much
more proactive advocacy on a lot of different
levels at the same time.

Similarly, a research partner at the Pacific
Institute spoke of how much she and her
organization continued to learn from the com-
munity and the leadership of WOEIP, particu-
larly about community organizing and advocacy.

New Directions and Building

Sustainability

An important hallmark of CBPR involves
its commitment to building community ca-
pacity as a means of ensuring long-term

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sustainability.21,33 After the truck count and
idling studies and subsequent work to establish
a truck route, WOEIP expanded its own initia-
tives on several fronts, including conducting
a second truck count in partnership with the Air
Quality Management District in 2008, playing
a key role in the formation of the West Oakland
Toxics Reduction Collaborative, and receiving
both a planning grant from the US Environ-
mental Protection Agency and a grant from the
Air District in support of its work. With assistance
from the Pacific Institute, WOEIP also has con-
tinued to build local leadership capacity, offering
a 4-week intensive training for West Oakland
residents on topics including environmental
health and land use planning, an understanding
of the policymaking process, and skill-building in
policy advocacy. Further, and in a major victory
for the West Oakland community, WOEIP’s
executive director was appointed a Commis-
sioner of the Oakland Port Authority in 2007.

The relationships formed between the
WOEIP community partnership and agencies
including the Air District, the Port of Oakland,
and private trucking industry have also con-
tinued to develop. Recently, for example, when
over 1200 independent truckers were threat-
ened with losing the ability to service the Port
due to a delay in getting grants for needed
retrofitting equipment, WOEIP supported the
truckers’ request for an extension, and in the
process helped prevent many of these pre-
dominately immigrant workers from losing
their jobs.

WOEIP’s and the Pacific Institute’s truck
count and related studies and policy level work
continue to serve as a model for others of how
CBPR can help produce solid data and use it to
move forward environmental policy efforts in
a way that empowers and respects the com-
munity. Recently, for example, WOEIP pro-
vided technical assistance and loaned equip-
ment to another nonprofit organization,
Communities for a Better Environment, which
used the partnership’s truck count model in
doing its own truck count study in East Oak-
land.

Finally, and in a further effort to help take
this work to scale, without losing sight of local
concerns, WOEIP helped design the statewide
Goods Movement Action Plan, and WOEIP’s
executive director also served on the working
group of the US Enviromental Protection

Agency’s National Environmental Justice Ad-
visory Council (NEJAC). Drawing on the re-
search of the WOEIP partnership and numer-
ous other groups and organizations, NEJAC
produced a major report with recommenda-
tions for federal, state, tribal, local, and other
agencies on how best to identify, prevent, and
eliminate the disproportionate burden of air
pollution from goods movement in low-income
communities of color.34

Without ignoring the hurdles faced in this
work––and in particular, the failure to get
adequate enforcement of the truck route
ordinance––the value of the partnership’s con-
tributions and their ripple effects in other
communities and on the state and even
national levels, were highlighted by policy-
makers and other key informants. Finally,
the role of this partnership in showcasing the
utility of research collaborations that ‘‘put
community leaders in the drivers seat’’ was
underscored. In the words of a Pacific Institute
partner:

We were not doing the research ‘on them,’ but
they were leading the research effort. They were
asking the questions, choosing the contractor,
deciding the policy solutions, and we were
supporting them with technical and facilitation
support throughout the process. This is com-
pletely the reverse of the typical academic—
community partnerships. What if a high-pow-
ered research institution could be put at the
service of communities (instead of industries and
others)––what dramatic changes could result?
Well, we’ve seen them.

DISCUSSION

Our research goal examined the CBPR pro-
cesses and outcomes involved in the West
Oakland EIP partnership’s efforts to study and
address, through policy level change, the
problem of disproportionate exposure to diesel
truck exhaust in this community. The partner-
ship’s struggles and successes in this regard
were highlighted, as a means of illustrating how
community-led partnerships may use CBPR to
help change environmental health policy or
the broader policy environment.

Although the use of multiple methods of
data collection helped increase our confidence
in the study findings, several limitations should
be noted. Recall problems, particularly sur-
rounding the original research studies con-
ducted in 2003, may have led to inaccuracies

in the reporting of study methodology. To
minimize this, we carefully studied the outside
consultant’s (TIAX) detailed report that helped
corroborate the interviewees’ description of
study procedures. Partners and policy makers
interviewed may have over or underempha-
sized the role of the WOEIP partnership’s
research and advocacy efforts in helping move
policy, and may similarly have under or over-
estimated the role of other stakeholders and
contextual factors. The use of triangulation of
data sources was helpful in partially mitigating
this problem, as we found a high level of
consistency in responses among the 7 key
partners interviewed; their responses were well
corroborated by the policymaker interviews
and archival reviews. However, it remained
impossible to determine with any certainty the
extent to which the WOEIP’s partnership’s
work contributed to policy outcomes. As Ster-
man35 noted, the lengthy time delays in policy-
related work precluded understanding the long-
term consequences of the actions of any in-
dividual actors. As a result, ‘‘Follow up studies
must be carried out over decades or life-
times. . . .’’35 Finally, the nature of this small
qualitative study meant that by definition, the
findings were not generalizable.

The results of this case study complemented
those of a number of other studies in suggesting
the utility of a CBPR approach in producing
credible research that may help promote envi-
ronmental health policy change.11—18,36,37 Con-
sistent with the WOEIP partnership’s experience,
for example, studies credited CBPR efforts with
playing a key role in helping implement policies
to reduce exposures to diesel bus emissions in
Harlem, New York38 and Roxbury, Massachu-
setts11 and to secure the renegotiation of a rule
governing maximum allowable cancer risk from
stationary facilities in southern California.18,39

Moreover, similar to the work of the WOEIP
partnership, several of these efforts have been
credited with helping change the broader policy
environment. The Southern California Environ-
mental Justice Collaborative, for example,
received substantial credit for the state Environ-
mental Protection Agency and other decision-
making bodies increasingly thinking in terms of
cumulative rather than individual risk and taking
community health impacts into account in their
policy deliberations.18,39 In New York City, the
West Harlem Environmental ACTion, Inc. (WE

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ACT) partnership’s high quality research and
effective community-based advocacy helped se-
cure the community partner’s executive director
a leadership role on the task force charged with
developing a statewide environmental justice
policy.38

Finally, and in addition to its role in several
specific policy wins in Long Beach, Los
Angeles, and the Inland Valleys (e.g., adoption
of the joint Ports’ ‘‘Clean Air Action Plan’’),
Trade, Health & Environment (THE) Impact
project was credited with helping

change the debate on neighborhood contamina-
tion through increased community participation
and recognition of the health impacts from living
in close proximity to mobile source air pollution.

A recent decision to delay expansion of
a major freeway to enable more community
input in the deliberations was credited in part
to THE Impact Project and its successes in
changing the policy environment by ‘‘[elevating]
community voices in the policy arena, while also
using the science and policy work of the aca-
demic partners to strengthen those voices.’’40

Several of the factors identified in the pres-
ent study as critical to the WOEIP partnership’s
success also reflect those of other community—
academic partnerships with a similar goal of
helping to redress environmental injustice
through policy change. The need for a strong
community base including effective alliance
and community leadership has been widely
cited.14,15,19,33,38,39,41 Links to coalitions, for ex-
ample, have been shown to help ‘‘reframe an
issue so as to broaden support.’’41 The impor-
tance of credible science that can ‘‘stand up to
careful scrutiny’’ additionally has been widely
emphasized,18,36—38,42 as has the effective com-
bining of research, community organizing, and
policy advocacy.11—14,17—19,43

Other CBPR case studies highlighted the
importance, especially early on, of strong
technical assistance as both strengthening the
research and helping open doors and forge
alliances with respected entities that could be of
strategic importance in the future.12,14,17,36

Although academics sometimes are reticent to be
involved with the mass media, Farquhar and
Wing44 noted:

Environmental health findings presented via
mainstream media channels can protect exposed
community members, motivate participation in

democratic processes, and influence public
opinion and policymakers.

Effective media advocacy, in which the mass
media were used strategically to promote
a community or public policy agenda, contrib-
uted substantially to the visibility and impact of
the WOEIP partnership’s work, and have like-
wise been important to other environmental
policy-oriented CBPR collaborations.11,14,17—-
19,42,46 Ritas’45 online resource ‘‘Speaking Truth,
Creating Power: A Guide to Policy Work for
Community based Participatory Research Prac-
titioners’’ may be useful to partnerships wishing
to incorporate this and other forms of policy
advocacy in their CBPR efforts.

The high value that the WOEIP partnership
assigned to building collaborative relation-
ships with potential policy allies and regula-
tors, as well as other community-based
organizations and local and regional coali-
tions, was reminiscent of the work of other
successful environmental justice efforts
around the country.11—12,14—19,39,42,43,45 Yet the
WOEIP partnership’s inclusion of representa-
tives of the trucking industry, whose behavior
they sought to change, may have set an impor-
tant new standard in such work. This inclusive
approach, captured in the catch phrase ‘‘who else
should be at the table?’’ appeared critical to such
policy wins as getting a truck route ordinance
and more recently, getting the Port of Oakland to
commit to an 85% reduction in the community
health risk caused by its diesel operations by
2020––a policy that could ultimately have greater
health payoff for the community than the ill-fated
truck route. The community organizing maxim
that there are ‘‘no permanent friends, no perma-
nent enemies’’ appears to have held the WOEIP
partnership in particularly good stead in this work.

Yet as this and other CBPR case studies
focused on environmental justice illus-
trated,36,38,45,47 tensions emerged throughout
this process that should be addressed openly and
with an eye toward finding ‘‘common ground.’’
The need for WOEIP and Pacific Institute
partners to become comfortable with their dif-
ferent skill levels and roles in the more technical
aspects of the research was critical for the process
to go forward, as was the subsequent working
out the tensions some community partners felt
about including truckers in policy deliberations.
Finally, as this and other environmental justice

projects case studies illustrated36,38,48 policy
wins can be shallow victories if not followed by
strong implementation commitment and over-
sight. Each of the 7 community and outside
research partners interviewed commented on
the failure to enforce the 2006 truck route
ordinance as a bitter pill to take, even if not
entirely unexpected, in the aftermath of a strong,
inclusive, and well-fought campaign. In retro-
spect, it would have been useful for the com-
munity and the WOEIP partnership to include in
their data collection documentation regarding
implementation of the ordinance, and further, for
residents to work with local law enforcement
to cite offenders. Yet as noted previously, the
dearth of sufficient police officers, and their
understandable focus on problems such as vio-
lent crime, probably doomed the ordinance
strategy from the outset. Further, as several of
those interviewed commented, relatively easy
policy wins like the passage of an ordinance,
although important symbolically and in increas-
ing community visibility, may not in themselves
be strong enough to bring about real change.

In retrospect, and in addition to its sound
research, the major accomplishment of the
WOEIP partnership may well have been in
substantially amplifying community voices in
the policy arena: WOEIP and its partners are
routinely consulted by key decision-making
bodies and are often ‘‘at the table’’ when
important decisions are being made. The ap-
pointment of WOEIP’s director to the Port
Commission further stands as an important
signal that West Oakland and its leaders and
organizations are making headway in attain-
ing the ‘‘procedural justice’’ (having a say in
decision-making affecting their community)49

that is an integral part of environmental justice
for low income communities of color.17

The fact that WOEIP conducted its own
truck count study and brought in its own
federal and local grant funding, are suggestive
of the longer term contributions of this CBPR
partnership to the community capacity building
that can further sustainable change. As Srini-
vasan and Collman52 and others46,47 pointed
out, building such capacity and striving ‘‘for
a more equitable partnership––not only in the
distribution of resources but also in power/
authority, the process of research, and its out-
comes’’ is a goal for which CBPR partnerships
need to strive.50

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Recent changes in the context within which
environmental health-focused CBPR takes
place must be carefully monitored for their
potential impacts, however. On the positive
side, increasing collaboration between multiple
partnerships and organizations concerned with
diesel emissions and their health impacts, in-
cluding, in California, the Ditching Dirty Diesel
Collaborative,31 and the statewide coalition,
Community Action to Fight Asthma51 may be
increasing the clout of community, health de-
partment, and academic partners working to
secure broader policy change in this area.
Conversely, major cutbacks associated with the
severe recession may also take a toll on this
work, both in constraining funding and resulting
in a weakening of regulations or implementation
in the name of cost containment. Finally, as
Sterman35 noted, ‘‘Complexity hinders the gen-
eration of evidence’’ and any efforts to discuss
the contributions of CBPR partnerships to
changes in policy or the policy environment must
be undertaken with considerable caution.

Bearing these precautions in mind, however,
the WOEIP partnership may serve as a useful
model for community and academically trained
researchers interested in establishing sustain-
able local partnerships that can produce cred-
ible research, build community capacity, and
potentially contribute to changes in policy and
the policy environment that may promote
environmental health. j

About the Authors
Priscilla A. Gonzalez is with the Berkeley Media Studies
Group, Berkeley, CA. Meredith Minkler and Analilia P.
Garcia are with the School of Public Health, University of
California, Berkeley. Margaret Gordon and Brian Beveridge
are with the West Oakland Environmental Indicators Project,
Oakland, CA. Catalina Garzón and Meena Palaniappan are
with the Pacific Institute, Oakland, CA. At the time of the
study, Swati Prakash was with the Pacific Institute, Oakland.

Correspondence may be sent to Meredith Minkler, DrPH,
MPH, School of Public Health, University of California,
Berkeley, 50 University Hall, Berkeley, CA. 94720-7360
(e-mail mink@berkeley.edu). Reprints can be ordered at
http://www.ajph.org by clicking the ‘‘Reprints/Eprints’’ link.

This article was accepted July 12, 2010.

Contributors
M. Minkler originated and supervised the study including
conceptualization, data collection, analysis and interpre-
tation, and the writing of this article. P. A. Gonzalez and
A. P. Garcia assisted with data collection, analysis and
interpretation, and in the writing and editing of the
article. M. Gordon, B. Beveridge, M. Palanippan, C. Garzón,
and S. Prakash all provided valuable information and

feedback, including help with interpretation of findings
and editing of the final version of the article.

Acknowledgments
This study was supported by a grant from The
California Endowment and the authors are grateful
to the Endowment, and particularly former Research
Director Will Nicholas, for their support.

The authors also acknowledge project team
members Victor Rubin, Angela Blackwell, Mildred
Thompson, and other colleagues at PolicyLink, Inc.,
and research consultant, Nina Wallerstein, as well
research assistant, Alice Ricks, for their contributions.
Steve Mastronarde also provided helpful perspec-
tives. We are especially grateful to the many com-
munity and academic partners and policymakers
who generously shared their time and their insights
to make this study possible.

Human Participant Protection
This study was approved by the institutional review
board of the University of California, Berkeley. All
key informants signed informed consent letters be-
fore their participation, and safeguards were taken to
ensure confidentiality.

References
1. Palaniappan M, Wu D, Kohleriter J. Clearing the Air:
Reducing Diesel Pollution in West Oakland. Oakland, CA:
Pacific Institute; 2003.

2. Brugge D, Durant J, Rioux C. Near-highway pollut-
ants in motor vehicle exhaust: a review of epidemiologic
evidence of cardiac and pulmonary health risks. Environ
Health. 2007;6(1):23.

3. Schwartz J. Air pollution and blood markers of
cardiovascular risk. Environ Health Perspect. 2001;
109(suppl 3):405—409.

4. Wichmann H. Diesel exhaust particles. Inhalation
Toxicol. 2007;19(supp 1):241—244.

5. Jerrett M, Shankardass K, Berhane K, et al. Traffic-
related air pollution and asthma onset in children: a pro-
spective cohort study with individual exposure mea-
surement. Environ Health Perspect. 2008;116(10):
1433—1438.

6. Gauderman WJ, Avol E, Gilliland F, et al. The effect
of air pollution on lung development from 10-18 years of
age. N Engl J Med. 2004;351(11):1057—1067.

7. Alderson L. Traffic marker? Early exposure to air
pollution associated with childhood asthma. Environ
Health Perspect. 2010;118:A80.

8. Schulz A, Northridge ME. Social determinants of
health: implications for environmental health promotion.
Health Educ Behav. 2004;31(4):455—471.

9. Houston D, Krudsz M, Winer A. Diesel truck
traffic in low income and minority communities adja-
cent to ports: environmental justice implications of
near-roadway land use conflicts. Transportation Re-
search Record. J Transportation Res Board. 2008;
(2067):38—46.

10. Fruin S, Westerdahl D, Sax T, Sioutas C, Fine P.
Measurements and predictors of on-road ultrafine parti-
cle concentrations and associated pollutants in Los
Angeles. Atmos Environ. 2008;42(2):207—219.

11. Brown P, Mayer B, Zavestoski S, et al. The health
politics of asthma: environmental justice and collective

illness experience in the United States. Soc Sci Med.
2003;57:453—464.

12. Brugge D, Hynes PH. Community Research in
Environmental Health: Studies in Science, Advocacy and
Ethics. Burlington, VT: Ashgate; 2005.

13. Northridge M, Shoemaker K, Jean-Louis B, et al.
What matters to communities? Using community-based
participatory research to ask and answer questions re-
garding the environment and health. Environ Health
Perspect. 2005;113(Suppl 1):34—41.

14. Corburn J. Street Science: Community Knowledge and
Environmental Health Justice. Cambridge, MA: MIT Press;
2005.

15. Shepard PM, Northridge ME, Prakash S, Stover G.
Preface: advancing environmental justice through com-
munity-based participatory research. Environ Health
Perspect. 2002;110:139—140.

16. O’Fallon LR, Dearry A. Community-based partici-
patory research as a tool to advance environmental
health sciences. Environ Health Perspect. 2002;110(S2):
155—159.

17. Minkler M. Linking science and policy through
community-based participatory research to address
health disparities. Am J Public Health. 2010;100(S1):
S81—S87.

18. Morello-Frosch R, Pastor M Jr, Sadd J, Porras C,
Prichard M. Citizens, science and data judo: leveraging
secondary data analysis to build a community-academic
collaborative for environmental justice in Southern
California. In: Israel B, Eng E, Sulz AJ, Parker EA, eds.
Methods in Community-Based Participatory Research for
Health. San Francisco, CA: Jossey-Bass; 2005:371—
393.

19. Wing S, Horton RA, Muhammad N, et al. In-
tegrating epidemiology, education, and organizing for
environmental justice: community health effects of in-
dustrial hog operations. Am J Public Health. 2008;
98(8):1390—1397.

20. Green LW, George MA, Daniel M, et al. Study of
Participatory Research in Health Promotion. Ottawa, Can-
ada: The Royal Society of Canada; 1994.

21. Israel BA, Eng E, Shulz AJ, Parker EA. Introduction
to methods in community-based participatory research
for health. In: Israel BA, Eng E, Shulz AJ, Parker EA, eds.
Methods in Community-Based Participatory Research for
Health. San Francisco, CA: Jossey-Bass; 2005:3—26.

22. Reason P, Bradbury H. Conclusion: broadening the
bandwidth of validity: issues and choice-points for im-
proving the quality of action research. In: Reason P,
Bradbury H, eds. Handbook of Action Research. Thou-
sand Oaks, CA: Sage Publications; 2006:343—351.

23. Costa S, Palaniappan M, Wong AK, Hays J, Landeiro
C, Rongerude J. Neighborhood Knowledge for Change: The
West Oakland Environmental Indicators Project. Oakland,
CA: Pacific Institute; 2002.

24. Israel BA, Schulz AJ, Parker EA, et al. Review of
community-based research: assessing partnership ap-
proaches to improve public health. Annu Rev Public
Health. 1998;19:173—202.

25. Buchan W, Jackson MD, Chan M. Container Truck
Traffic Assessment and Potential Mitigation Measures for
the West Oakland Diesel Truck Emission Reduction Ini-
tiative. Cupertino, CA: TIAX, LLC; 2003. Technical
Report TR-03-176. Case D5247. Sponsored by The
Pacific Institute.

FRAMING HEALTH MATTERS

S174 | Framing Health Matters | Peer Reviewed | Gonzalez et al. American Journal of Public Health | Supplement 1, 2011, Vol 101, No. S1

26. Bardach E. A Practical Guide For Policy Analysis: The
Eightfold Path To More Effective Problem Solving. 2nd ed.
Washington, DC:CQ Press; 2004.

27. Kingdon JW. Agendas, Alternatives, and Public
Policies. 2nd ed. New York, NY: Addison-Wesley
Educational Publishers Inc.; 2003.

28. Themba-Nixon M, Minkler M, Freudenberg N.
The role of CBPR in policy advocacy. In: Minkler M,
Wallerstein N, eds. Community-Based Participatory Research
for Health. San Francisco: Jossey-Bass; 2008:307—322.

29. Ritas C, Minkler M, Ni A, Halpin H. Using CBPR to
promote policy change: exercises and online resources.
In: Minkler M, Wallerstein N, eds. Community-Based
Participatory Research for Health. San Francisco: Jossey-
Bass; 2008:459—464.

30. West Oakland Toxics Reduction Collaborative.
Available at: http://www.epa.gov/care/west_oa-
kland.htm. Accessed May 14, 2010.

31. Ditching Dirty Diesel. Available at: http://www.
pacinst.org/topics/community_strategies/ditching_
dirty_diesel/index.html. Accessed March 20, 2010.

32. Pingkuan D. Diesel Particulate Matter Health Risk
Assessment for the West Oakland Community. Sacramento,
CA: California Environmental Protection Agency Air
Resources Board; 2008.

33. Minkler M, Wallerstein N. Introduction to commu-
nity-based participatory research: new issues and em-
phases. In: Minkler M, Wallerstein N, eds. Community-
Based Participatory Research for Health. San Francisco:
Jossey-Bass; 2008:5—19.

34. National Environmental Justice Advisory Council
(NEJAC). Reducing Air Emissions Associated With Goods
Movement: Working Towards Environmental Justice.
Washington: NEJAC; 2009.

35. Sterman JD. Learning from evidence in a complex
world. Am J Public Health. 2006;96(3):505—514.

36. Minkler M, Breckwich Vásquez V, Chang C, et al.
Promoting Healthy Public Policy Through Community-
Based Participatory Research: Ten Case Studies. Oakland,
CA: PolicyLink; 2008.

37. Hricko A. Global trade comes home: community
impacts of goods movement. Environ Health Perspect.
2008;116(2):A78—A81.

38. Vásquez VB, Minkler M, Shepard P. Promoting
environmental health policy through community based
participatory research: a case study from Harlem, New
York. J Urban Health. 2006;83(1):101—110.

39. Petersen D, Minkler M, Breckwich Vásquez V,
Corage Baden A. Community-based participatory re-
search as a tool for policy change: a case study of the
Southern California Environmental Justice Collaborative.
Rev Policy Res. 2006;23(2):339—354.

40. The Impact Project. Trade, Impact, Environment:
Making the Case for Change. THE Impact Project, 2009.
Available at: http://hydra.isc.edu/scehsc/web?Index.
html. Accessed September 29, 2009.

41. Freudenberg N. Community-capacity for environ-
mental health promotion: determinants and implications
for practice. Health Educ Behav. 2004;31(4):472—490.

42. Pastor M, Sadd J, Morello-Frosch R. Who’s minding
the kids? Pollution, public schools, and environmental
justice in Los Angeles. Soc Sci Q. 2002;93(1):263—280.

43. Brugge D, Rivera-Carrasco E, Zotter J, Leung A.
Community-based participatory research in Boston’s

neighborhoods: a review of asthma case examples. Arch
Environ Occup Health. 2010;65(1):38—44.

44. Farquhar SA, Wing S. Methodological and ethical
considerations in community-driven environmental jus-
tice research: two case studies from rural North Carolina.
In: Minkler M, Wallerstein N, eds. Community-Based
Participatory Research for Health. San Francisco: Jossey-
Bass; 2008:263—283.

45. Ritas C. Speaking Truth, Creating Power: A Guide
to Policy Work for Community based Participatory
Research Practitioners; 2003. Available at: http://
depts.washington.edu/ccph/pdf_files/ritas . Accessed
January 15, 2010).

46. Minkler M, Breckwich Vásquez V, Tajik M, Petersen D.
Promoting environmental justice through community-based
participatory research: the role of community and partner-
ship capacity. Health Educ Behav. 2008;35:119—137.

47. Israel BA, Krieger J, Vlahov D, et al. Challenges and
facilitating factors in sustaining community-based
participatory research partnerships: lessons learned from
the Detroit, New York City and Seattle Urban Research
Centers. J Urban Health. 2006;83(6):1022—1040.

48. Minkler M, Garcia AP, Williams J, et al. Si se puede:
using participatory research to promote environmental
justice in a Latino community in San Diego, CA. J Urban
Health. 2010;87:796—812.

49. Kuehn RR. A taxonomy of environmental justice.
Environ Law Report. 2000;30:10681—10703.

50. Srinivasan S, Collman GW. Evolving partnerships in
community. Environ Health Perspect. 2005;113(12):
1814—1816.

51. Community Action to Fight Asthma. Available at:
http://www.rampasthma.org/about/the-cafa-network.
Accessed May 12, 2010.

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