Collaborative Research with Communities: Value Added and Challenges Faced Meredith Minkler, DrPH University of California, Berkeley The 8 th Annual William T. Small, Jr. Keynote Lecture 27 th Annual Minority Health Conference UNC-CH School of Public Health, February 24, 2006
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Collaborative Research with Communities: Value Added and
Challenges Faced
Meredith Minkler, DrPHUniversity of California, Berkeley
The 8th Annual William T. Small, Jr. Keynote Lecture27th Annual Minority Health Conference
UNC-CH School of Public Health, February 24, 2006
Community Based Participatory Research
Participation&
EducationResearch Action
CBPR“a collaborative process that equitably involves all partners in the research process and recognizes the unique strengths that each brings. CBPR begins with a research topic of importance to the community with the aim of combining knowledge and action for social change to improve community health and eliminate health disparities.”
CHSP, 2001; Israel et al, 1998
IOM’s 8 new competency areas• Informatics• Genomics• Cultural competence• Communications• Community based participatory research• Ethics• Policy and law• Global health
Gebbie et al 2001
Roots of CBPR
Kurt Lewin’s action Research, 1940’s, U.S.A.
Alternative research paradigms from 3rd
world, 1970’s (Paulo Freire and others)
CBPR
CBPR Principles
• Participatory• Cooperative• Co-learning process• Systems development & local capacity
building• Empowering• Balances research and action
Israel et al, 1998
RacismRacism is like the elephant in the is like the elephant in the living room. Itliving room. It’’s running through s running through the place, making noises, and the place, making noises, and everyone is trying to sit politely everyone is trying to sit politely and ignore it.and ignore it.””
MakaniMakani ThembaThemba, 1999, 1999
Cultural Humility:
“A life long commitment to self evaluation and self critique” to redress power imbalances and “develop and maintain respectful and dynamic partnerships with communities”
Tervalon & Garcia, 1998
Broadening the bandwidth of validity
Is the research question valid (coming from or important to the community) ?
Is there an interplay between different forms of knowing?
adapted from Bradbury and Reason, 2003
Professional Malady: Terminal Hardening of the Categories
J. MacKinlay
Grandmother Caregiver Study
Minkler & Roe, 1993
Oakland, CA
“What is your income?”
How much money is available to help you in raising this child?
• Depressed or very unhappy 78%• Exhausted even though early in the day 72%• You could not get going 70%• You need a break or you’ll go crazy 58%• Lonely 40%• Appreciated 89%• Meeting your responsibilities 96%
During the past week have you felt…?
Regional Coalition on Grandparents Raising Grandchildren
East Bay, CA
Concerned Citizens of Tillery
North Carolina Hog Population 1970-1996
- Furuseth 1997
“We don’t empower people –we just awaken the power people already have.”
- Gary GrantExecutive Director, CCT
Changing the Vision of Community
Deficit MentalityBundle
ofPathologies
Epidemiology ofStrengths
Community Assets &
Strengths
Source: H. Jack Geiger
Community Assets Map
Inventory of Community Assets
Primary Building Blocks
Secondary Building Blocks
- Indigenous leaders- Talents of residents- Churches- Neighborhood Organizations
- Public schools- Parks- Vacant land
Community Oriented Planning Process
The Healthy Neighborhoods Project (HNP)
Identifying Natural Community Leaders
When you have a problem, who do you go to for advice?
Who do others go to?
When people in the neighborhood have come together around a problem in the past, did a particular individual or group play a key role?
What things do people tell you you’re good at?Eng et al, 1990; Israel, 1985; Sharpe, 2000
Healthy Neighborhoods Project Components
Convening Neighborhood Task ForcesTraining residents as Health Advocates
Assessing neighborhood resources through door-to-door interviewsMapping community assets and problem areasMobilizing residents to develop and implement Action Plans
Some Outcomes
• Evening and night bus service restored in north Richmond
• Improved lighting
• A youth soccer team
• Reactivated tenant association and got a $100,000 grant for a job training program
More Outcomes
• Bucket brigade to measure air quality
• HNP members on local and regional councils and task forces; running for office
• Greater update of new child health insurance program in HNP communities
Measuring Perceived ControlSample Scale Items
• I have control over the decisions that affect my life.
• My community has influence over decisions that affect my life.
• I can influence decisions that affect my community.
• By working together, people in my community can influence decisions that affect the community.
- Israel, et al. 1994
Peggy ShepardExecutive Director, WE ACT
Minkler, 2004
8-Hour Vehicle Count
45 75.5
529
1,403
13.5 28
403
1,064
0200400600800
1,0001,2001,4001,600
Edgecombe Ave. Bus Depot Harlem Hospital Amsterdam Ave.
Trucks
Bus
8-Hour Car and Ped Count
2,302
14,328
18,372
421
16,761
11,246
1,2251,126
02,0004,0006,0008,000
10,00012,00014,00016,00018,00020,000
Edgecombe Ave. Bus Depot Harlem Hospital Amsterdam Ave.
CarsPedestrians
Kinney et al, 2000
WE ACT post card campaign
Outcomes• MTA conversion of
entire fleet to “less dirty diesel”
• EPA initiation of community based air monitoring in northern Manhattan
• Tighter air quality standards
• Adoption of New York State Environmental Justice Policy
Community-Campus Partnerships for HealthAvailable from: http://depts.washington.edu/ccph/commbas.html#Conf
Enhance the connection between public health research and relevant theory-driven interventions(address the why? & so-what? questions)
Social determinants of health
? Health outcomes
Literacy for Environmental Justice/SFDPH
LEG Survey of Products Sold in 11 BV/HP Corner Stores
39%
26%
17%
13%
3%2%
Packaged Food
Alcohol & Cigarettes
Other Beverages
Non-Food Products
Meat
Produce
Economic Incentives• Store Branding
• Free Marketing• Energy Efficient Appliances
• Marketing Assistance
• Group Buying
• Building Improvements
• Personnel Training
• City Recognition
% Change in Salesover 7 Months
Produce 5 15%Alcohol 25 15%
Hurricane Katrina
“Blacks stayed at school on floors … whites stayed in Hope House Plantation.”
- Hurricane Floyd Survivor
U n i t y a n d E m p o w e r m e n t : L i f t i n g t h e V o i c e s o f t h e F l o y d S u r v i v o r s !
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W o r k e r s a n d C o m m u n i t y R e l i e f a n d A i d P r o j e c t [ W C R A P ]
H U R R I C A N E F L O Y D S U R V I V O R S ’ S U M M I T
Insider-Outsider Tensions
• Power dynamics; the “power of authority”of the outsider’s often multiple sources of unspoken privilege (Wallerstein, 1999)
• Conflicting time tables & demands
• Differential reward structures
Challenges Faced by Community Partners as “Outsiders Within”
Constraints of community involvement
• Goal v. reality of extensive participation• Differential costs by gender
Perceived clash between community desires and
“good science”
Tribal Efforts Against Lead
Research Aims
•Assess blood lead levels in children
•Evaluate lay health worker model
Community Action Against Asthma: Detroit, Michigan
Detroit, Michigan
Community Environmental Specialists
Community Action Against Asthma
Jean
Adriana
Ursula
CAAA End of Project Party for Participating Families
• Photos of Party-
Sample IRB Questions• Will the methods used be sensitive and
appropriate to various communities?
• What training or capacity building opportunities will you build in?
• How will you balance scientific rigor and accessibility?
• Are there built-in mechanisms for how unflattering results will be dealt with?
Travers and Flicker 2004, wellesleycentral.com
Dilemmas in the Action Component of CBPR
• Waiting to publish v. taking action
• Reluctance to associate with research that appears connected to broader political agenda
• Funding constraints on policy-level activity
“We don’t do policy – we just educate legislators!”
– Community Partner, Tillery,NC
Instructions to AuthorsEpidemiology
“Opinions or recommendations about public health policy should be reserved for editorials, letters, or commentary, not presented as the conclusions of scientific research.”
““DonDon’’t tell us how much you t tell us how much you know until you show us how know until you show us how much you caremuch you care””