Breakout Group Reports

CommunityBased Participatory Research: Conference Summary (continued)

A diverse group met November 27-28, 2001, in a conference to improve the health of disadvantaged populations through community-based participatory research (CBPR), which is a collaborative process of research involving researchers and community representatives. Participants developed strategies to support and promote CBPR; they also addressed barriers to CBPR.

Conference organizers divided participants into three breakout groups to develop strategies to:

  • Overcome barriers identified for communities, academics, and funding organizations.
  • Discuss community, academic, and funder incentives and capacity building.

Breakout groups consisted of participants from diverse experiences, but each focused on incentives and capacity building from one perspective. Conference organizers provided a set of ground rules and specific questions for each breakout group. Questions for each group are presented prior to each group's report. Facilitators and notetakers were present in each group to help it formulate a report to the larger body when participants reconvened.

Participants recommended numerous action steps. Conference organizers highlighted the following 13 recommendations in order to focus attention on those that had greatest consensus and presented opportunities for immediate action:

  1. CBPR projects should enter the communities through appropriate gatekeepers/links within the communities.
  2. Academic institutions should develop educational programs to train academicians to conduct CBPR.
  3. Federal agencies should work together to advance and foster CBPR.
  4. Funders should develop funding aimed specifically at enhancing community research capacity.
  5. Funders should develop and expand funding mechanisms that will support CBPR as well as enhance capacity to conduct CBPR. Funders need to focus on three issues: who defines the research question, who conducts the research, and who oversees the funds.
  6. Funders should train reviewers to understand CBPR grant applications (i.e., include panelists who have CBPR experience, provide a criteria list, and train reviewers to evaluate community inclusion).
  7. Researchers and community members should develop an advocacy strategy for sharing the benefits of this work (e.g., through the media and targeting legislators).
  8. Researchers should learn to communicate effectively with the community using appropriate languages and literacy levels and grassroots venues and to enhance the community members' ability to communicate.
  9. A national organization with interest and experience in CBPR should build a national network for information on CBPR.
  10. The field should develop CBPR curricula.
  11. The field should develop guidelines/principles for the conduct of CBPR.
  12. An Evidence-based Practice Center should synthesize evidence on the conduct and evaluation of CBPR in order to provide funders and others with criteria to assess the quality of CBPR.
  13. Funders should change the scope of activities under funding support (e.g., translational activities and sustainability of partnerships).

These highlighted recommendations are also listed throughout this summary as they occurred in the discussion.

Community Group Report

Participants of the community breakout group spent time explaining and clarifying their perspectives. They discussed systemic discrimination and the need for those engaging in CBPR to have this difficult conversation. From the community perspective, it is critical for researchers to "walk the walk" and establish mechanisms in the research project that integrate community members as equal partners.

Conference organizers focused community breakout group participants on the following questions:

  • What are the community barriers to conducting CBPR? What community factors facilitate CBPR? How can these factors be influenced in order to support CBPR?
  • What accountability mechanisms and systems within CBOs are required to facilitate their full participation in research?
  • What activities and resources are needed to facilitate the development of community capacity to engage in CBPR, including improving community capacity to initiate projects and to obtain grant funding?
  • What is community consent for research and how do CBOs assess and support community consent?

Barriers

The group identified the following barriers to conducting CBPR from the community perspective:

  • The reality of racism.
  • The history of institutions using and abusing communities.
  • Severe underrepresentation of people of color and low-income individuals in health professions and research.
  • Perceptions that motives for conducting CBPR may be self-serving (e.g., to get funding or enroll minority populations) so that the work does not benefit the community.
  • CBOs and "community gatekeepers" do not always represent the entire community.

These are difficult and sensitive issues, but they must be discussed among CBPR partnerships from the beginning.

Facilitators

The group identified the following facilitators to conducting CBPR from the community perspective:

  • Recognize and emphasize community assets and strengths (e.g., viewing community members as mentors and experts).
  • Provide real service to assist communities—i.e., understand and try to meet their needs.
  • Be willing to face the reality of negative history in working with communities.
  • Conduct research while understanding the complex, interconnected context of people's lives.
  • Build and maintain a good relationship within/across the community.
  • Build and maintain good relationships outside a formal research context.
  • Include multiple communities in the planning process.
  • Welcome new participants into the dialog.
  • Build on community assets.
  • Develop relationships with community gatekeepers.
  • Develop relationships with powerful individuals to create change.
  • Establish and sustain respecting, trusting relationships.
  • Acknowledge and incorporate existing community structures (e.g., powerful CBOs and grass-roots groups).
  • Share the realities partners face in a nondefensive manner to enhance understanding.

Recommendations

The group suggested that CBPR projects incorporate the following:

  • Opportunities to exchange perspectives.
  • Those engaged in CBPR need to educate institutional review board (IRB) panelists and ensure that panelists understanding this approach to research (i.e., in terms of research content and review panel representation).
  • IRBs should have community members.
  • Understand specific communities.
  • CBPR projects should hire from within the community.
  • Entering the community through appropriate gatekeepers/links within communities.

Action Items

All CBPR partners need to build capacity, not just communities. The group suggested the following activities and resources to build the capacity of all partners:

  • Academic institutions should build power-sharing procedures into institutional procedures concerning externally conducted research projects.
  • Academic institutions should develop educational programs to train academicians to conduct CBPR.
  • Academic institutions should create a "brain train" rather than a "brain drain" (i.e., build pipelines to have wider representation among health professions and positions of power).
  • Academic institutions must educate IRBs about CBPR and work to increase representation of community members.
  • Academic institutions should provide information to funders (and others) about CBPR and when it is an appropriate approach.
  • Academic institutions should provide indirect costs to community members and CBOs.
  • Community members should serve on IRBs.
  • CBOs with successful, funded projects should mentor CBOs at earlier stages of readiness in CBPR.
  • Federal agencies should work together to advance and foster CBPR.
  • Funders should develop funding specifically aimed at enhancing community research capacity.
  • Funders should publicize programs available for institutions, faculty members, and communities that are interested in engaging in CBPR.
  • Funders should share specific funding mechanisms and processes to enhance the number of investigators engaged in CBPR.
  • Funders should build power sharing procedures among partners into the request for applications.
  • Funders should ensure that funds reach a variety of academic institutions (not just large research institutions) and different research models and increase the inclusion of researchers of color.
  • Funders should adapt the PHS 398 forms for this type of research (evaluation criteria include: community members on boards, capacity sharing, dissemination to the community, specific training program, and demonstration that the projects responds to the community's priority issues).
  • Funders should train reviewers to understand CBPR grant applications (i.e., include panelists who have CBPR experience, provide a criteria list, and train reviewers to evaluate community inclusion).
  • Researchers (with their academic institutions) should examine different educational processes/models so community members obtain skills and educational credit.
  • Researchers should increase academic capacity to engage in this work by extending it to more institutions.
  • Researchers should increase training of community members to conduct programs, research, and evaluation.
  • Researchers and community members should create a strategy to obtain broader community input regarding resource allocation.
  • Researchers and community members should develop an advocacy strategy for sharing the benefits of this work (e.g., through the media and targeting legislators).
  • Researchers should conduct qualitative research to understand the community and its assets.
  • Researchers should learn to communicate effectively with the community using appropriate languages and literacy levels and grassroots venues and to enhance the community members' ability to communicate.
  • Researchers should share information from evaluation and research with communities.

The group described how researchers and funders might begin and sustain a dialog with communities about their priorities. It is critical to include community members as project staff members and for faculty to reflect the characteristics of the community. These actions help researchers develop trust and a good relationship with the community. Researchers must acknowledge that the project involves multiple communities and that there are differences within communities. Power sharing among partners must be built into the institutions. Academic partners should provide community members with some authority to direct financial resources.

Members of the group did not like the term "community consent" because CBPR does not involve a single community. They generally agreed that a consenting community stays with a project. Perhaps "community participation" is a more appropriate term. Participants stressed the researchers need to obtain community and CBO consent. They should recognize that not all CBOs represent the community, that there are multiple levels of community, and that the extent to which a CBO represents a community can change. Perhaps a model of community consent is provided by a Tribal council resolution to grant access and authority to conduct research with their community. Community advisory boards help define projects and ensure regular community inclusion. Researchers should discuss the definition of consent and the mechanisms that they want to use to obtain consent with the community. Sometimes consultation allows researchers to ignore the community voice, so the community must specify their requirements for consent. To engage a community in a project, investigators should conduct qualitative research to assess the community's view on the conduct of research. Researchers should also engage CBOs to encourage and assess community consent for programs. Finally, the community consent process must be fluid and dynamic. Communities and academicians must share an ongoing dialog to identify what action should occur and whether actions should continue.

Academic Group Report

Participants in the academic breakout group discussed the academic culture and its effect on researchers interested in CBPR. As CBPR is a non-traditional type of research, those who work in this field must educate their colleagues about this approach and convince funders and promotion/tenure committees of its value. Participants identified barriers, but they dedicated considerable energy to generating solutions and developing recommendations that will enhance academic capacity to engage in CBPR.

Conference organizers focused academic breakout group participants on the following questions:

  • What are the academic barriers to conducting CBPR? Which academic factors facilitate CBPR?
  • How can these factors be influenced in order to support CBPR? Examples of barriers include publication, teaching responsibility, and tenure/promotion requirements.
  • Which academic models have successfully overcome these barriers? Which elements do these models share? Examples of models include centers like CURL and science shops.
  • What opportunities exist for inter-funding organization collaboration to develop methodologies and/or databases to advance the field?
  • How might academic institutions develop institutional and faculty capacity to conduct CBPR?
  • How much of this capacity development needs to occur at the individual faculty member level versus the organizational level?
  • What organizational changes can be instituted to facilitate CBPR and what institutional resources in addition to financial support are needed for this type of research?
  • What is the future need for CBPR researchers and how will this need be met?

Barriers

Participants identified the following barriers to academic participation in CBPR:

  • The faculty members who choose to do CBPR are less valued than those who engage in traditional research.
  • High competition for funds.
  • Universities are not sensitized to community building as a civil rights issue.
  • Engaging in non-traditional research has an impact on tenure prospects.
  • The field needs performance measures to legitimize CBPR.
  • The field needs to build faculty capacity in terms of increasing the number of CBPR investigators and enhancing their skills.
  • Competition for funding, scarce faculty positions, and promotion creates disincentives for collaboration.
  • The power inequality between researchers and the community.

Participants focused on this last barrier and generated the following suggestions for improving investigator-community relationships:

  • Investigators should demystify research for community members (educate them about the problem and foster joint ownership of the issue).
  • The community should be part of the grant application and award process.
  • Communities need resources to build capacity. Workshops could help community-based research organizations build capacity, especially scientific writing workshops.
  • The academic sector has to make a commitment to partnership including:
    • Community reciprocity in initiating research questions.
    • Some CBOs can receive money and contract with university as a collaborator.
    • Lessons to be learned in partnering with Historically Black Colleges and Universities and Tribal colleges.
  • The research should always have a positive impact on the community involved.
    • Different communities may perceive benefit in different ways.
    • Does research design incorporate community needs and wants?
    • Is the intent of the project to help bring about structural change?
  • Benefit of research participation for the community could include more or better information and employment or skill development.
  • Some research should not be conducted as CBPR.
  • The community must have a broad interest in research beyond acquiring resources.

Facilitators and Solutions

Participants noted that some academic models have overcome these barriers. These models are characterized by the following facilitating factors:

  • Community advocates sit with academic representatives and create a relationship.
  • CBPR partners contribute to mutual education efforts.
  • Faculty members are committed and are supportive of community organizations to prevent burnout.
  • Researchers understand how to work with the community and have access to community leaders.

Participants identified the following general solutions to promote CBPR:

  • Community organizations should proactively create a dialog with universities and discuss the mutual benefit of CBPR. However, sometimes CBOs/community representatives do not represent the entire community.
  • CBPR investigators should look for support in multi-disciplinary departments (medicine, public health, nursing, anthropology, and sociology).
  • Student advocacy could be a vehicle for advancing CBPR (students could advocate for CBPR inclusion in conferences; faculty could partner with student organizations).
  • The field should develop strategies to increase CBPR publication output.
  • Journals and funders should provide awards for excellent CBPR faculty.
  • Awards are also needed to recognize community participants, but a standard for community participation should be developed.

The group recommended the following four initiatives to help overcome the challenges of building academic capacity to conduct CBPR:

  1. Build a national network for information on CBPR—The network would serve as a support system for all parties and a repository for models. The network's structure would include academics, CBOs, funders, and students and would be accessible to the community. Finding a home and the necessary infrastructure funding for the network might be challenging, but possibilities include the Loka Institute, the APHA Caucus, or Community-Campus Partnerships for Health (CCPH). Specific network functions include the following:
    • Provide information on CBPR methods, skills, tools, and strategies.
    • Support junior faculty, student advocacy, and award developments.
    • Disseminate funding information and enhance opportunities for collaboration.
  2. Develop CBPR curricula—In these efforts, developers must recognize that one size does not fit all. Teaching and learning must be reciprocal, so communities teach academics and academics demystify research for communities. The curricula should include workshops and courses on scientific writing. To develop CBPR curricula, the field could work with foundations to obtain support. Foundations might also support the development of distance learning. Special training modules might be developed for people in positions of power (e.g., politicians and deans of academic institutions). Such modules would describe how CBPR overlaps with their interests and agendas. The curricula should encourage discussion of social justice and include results of CBPR work.
  3. Develop guidelines/principles for the conduct of CBPR to provide funders and others with criteria to assess the quality of CBPR—CBPR needs a community-driven "gold standard" to describe high-quality research using this approach. An AHRQ Evidence-based Practice Center might review the evidence and write a report describing the conduct and evaluation of CBPR. The report would form the basis of guidelines for conducting CBPR, including standards for publication, funding, and community group participation. Guidelines might advise those entering CBPR agreements. Case studies of CBPR work by schools of public health would also be helpful. These should describe the impact of CBPR and include the principles and values connected with this approach.
  4. Request that an Evidence-based Practice Center synthesize evidence on the conduct and evaluation of CBPR—Such a review would be used as the basis for guidelines/principles for CBPR developed by a nationally recognizable entity. The guidelines might be disseminated through professional associations (e.g., APHA Caucus). The group noted that developing CBPR guidelines/principles would have the following benefits:
    • Guidance to groups entering CBPR.
    • Standards for peer-reviewed journals
    • An improved tenure and promotion process by providing metrics of quality.
    • Enhanced stature for CBPR.
    • Improved assessment capacity for funders.
    • Enhanced curriculum development.

Funding Group Report

The group focused on making general recommendations with specific action steps for funders. They talked about the lack of resources among those interested in CBPR and the frustrations that result when funding and personnel are "spread thinly" across many projects. However, the group committed itself to identifying positive actions that funders might take to promote CBPR.

Conference organizers focused funding breakout group participants on the following questions:

  • What are the elements of a successful partnership and how do funders identify and evaluate these partnerships and their output? (Output includes research findings, dissemination of results, and translation into practice and programs.)
  • How should funders evaluate the feasibility, merit, and sustainability of CBPR projects? Given the long time horizon needed for developing CBPR projects, how should funders evaluate accountability throughout the life of these projects?
  • How can funders use the knowledge generated from these partnerships and research projects to guide program development?

Participants made the following recommendations for funders and specified action steps for each recommendation:

  1. Facilitate partnership building and community capacity development—Funders need to facilitate partnerships and increase community capacity to do research. They can take the following actions to do so:
    • Provide seed money to CBOs for infrastructure to build research capacity.
    • Fund activities that develop partnerships over an extended period of time. These activities should be funded both in the context of specific research projects and as separate partnership-development activities. Funding should be available directly to communities, rather than the traditional model of providing funding through research institutions.
    • Fund training to enable communities and researchers to work together. Place an emphasis on creative models for working together, on developing communication skills that enable communication from different perspectives, and on consensus building. Work to build the capacity of academic researchers to talk to and work with communities.
    • Develop a balanced portfolio that both supports existing partnerships and enables the development of new partnerships.
    • Recommend particular partnerships to other funders. If a funder has worked with a successful partnership, they could vouch for grantees to other funders. This is particularly helpful for grantees working with private funders.
    • Provide funding for community partners to attend national academic meetings with researchers and conduct joint presentations on their research. Also require joint presentations to the community.
    • Place equal value on the contributions of researchers and of community members in the research process. Recognize that each brings a unique set of skills and knowledge to the process.
    • Develop a set of templates to assist community organizations in the grant writing process. These templates would provide more specific guidance and sample language for completing grant applications.
  2. Explore new funding mechanisms—Funders need to focus on three issues: who defines the research question, who conducts the research, and who oversees the funds. They can enhance the capacity to conduct CBPR by developing new funding mechanisms as follows:
    • Use a variety of alternate funding mechanisms to help build partnerships and facilitate the conduct of CBPR, including (1) microgrants; (2) phased funding to enable partnership building before applying for research funding; and (3) partnership/research long-term funding.
    • Investigate alternative ways to dispense funds, ensuring that funding gets to community organizations at the beginning of a project. Actively seek to provide funds directly to communities, rather than solely through researchers.
    • Establish and fund an inter-agency/inter-foundation group charged with promoting CBPR.
    • Create and fund community-based research centers which would serve as coordinating and technical assistance centers for community based grantees, and which could themselves receive grant money (similar to an office of sponsored research, but located in the community rather than in the university). Initially fund one per region, then one per state, then ideally one per community. Consider both physical centers and virtual centers—the structure of the center needs to be responsive to community needs.
    • Develop new funding mechanisms that develop skills within multiple communities. Communicate these opportunities directly to communities, rather than working through researchers.
  3. Require changes to grant applications and change the scope of activities under funding support—Funders can enhance CBPR by changing the information required in grant applications and changing the activities funded under their grants (e.g., translational activities and sustainability of partnerships). Specific actions include:
    • Require CBPR grantees to translate research into practice and policy and to disseminate their research and translation in the community and to the media.
    • Require budgets for CBPR research activities to include a set aside for translation and dissemination activities.
    • Require CBPR projects to have a final presentation to the community on the grant activities and findings, in addition to the final written report to the funder.
    • Emphasize grants that build the sustainability of partnerships and the sustainability of the interventions developed in CBPR.
    • Require community involvement in data acquisition and analysis. Insist on joint researcher-community ownership of the data and joint responsibility for analysis, moving away from the more traditional notion that researchers own and analyze the data.
    • Require grantees to document intended community benefits in their application. These benefits go beyond the findings of the research to focus on the benefits of participating in the research process, including increasing community capacity and well-being (e.g., number of jobs to be created by the project, increased community capacity to conduct research).
    • Change the requirements for documenting a partnership in a grant application. The current use of letters of support and memoranda of understanding is meaningless, as these are often drafted by the researcher and then signed by the community members. Develop a checklist of items to be addressed in describing the partnership, including issues such as:
      • How long has the relationship existed?
      • What activities has the partnership done together?
      • How often do the partnerships meet?
      • Who comes to the meetings?
      • How are decisions made?
      • Does the grant application include funding for community partners to attend national meetings and conduct joint presentations on their research?
      • Does the grant application include plans to make a community presentation in addition to a final report to funders?
      • Does the grant application include plans to translate research into policy and practice, and to disseminate research findings and their translation within the community?
      • Does the grant application demonstrate a plan for joint researcher/community ownership of data and joint analysis?
      • What is the proposed distribution of grant funds between researchers and community organizations?
    • Require documentation that the community organization actively participated in writing the grant application and reviewed the final application before its submission.
    • Require a certain dollar amount or proportion of grant funding to go directly to the community, rather than leaving it to the researcher's discretion.
    • Seek to fund grants that incorporate multi-method research.
  4. Change the grant review process—There are a number of changes to the peer review process that funders could make which would enhance CBPR, including the following:
    • Allow a longer timeframe for responses to RFAs. Researchers and community organizations working in partnership requires time.
    • Have peer reviewers examine the list of research and community partners and the assets they will contribute to the project.
    • Have a structured method for peer reviewers to use when assessing partnerships. This could include guidelines for interpreting the checklist described above. Peer reviewers need to understand the criteria for good researcher-community partnerships.
    • Consider "reverse site visits" when evaluating applications. Such visits would involve contacting community partners and asking them structured questions to determine the extent of their involvement in the project and the nature of the partnership.
    • Include peer reviewers who have a clear understanding of CBPR in study sections.
    • "Re-view" the review process to examine ways to make CBPR more competitive in study section review.
  5. Develop and implement new evaluation tools—Funders need to be able to evaluate both the usefulness of CBPR and the quality of research partnerships with community organizations. They can:
    • Fund research to help define what constitutes good CBPR in the United States.
    • Develop process evaluations for partnerships.
    • Define the elements of success in ongoing partnerships.
    • Require evaluations to take place throughout the partnership process, not solely at the end.
    • Build partnership evaluation into RFAs.
    • Funders could ask communities how they would like accountability and health outcomes to be evaluated.
    • Focus on a process of mutual accountability, in which community organizations and researchers are accountable to one another, and are jointly accountable to the funding organization.
  6. Other—Several additional suggestions for funders include:
    • Allow time and funding for translation of research materials into other languages, going beyond translation and back-translation to ensure that all materials are meaningful to the community members participating in the research.
    • Think strategically about community needs when making funding decisions about CBPR.
    • Use CBPR as an opportunity to think about building public health infrastructure within communities.
    • Create an interactive Web-based electronic site for CBPR researchers and community leaders to use to discuss issues and share experiences.

Apart from the above six recommendations, participants suggested action items for funders in specific areas.

Funding policies and priorities. The group suggested the following action steps:

  • Change RFA requirements and targets.
  • Shift priorities about funded topics and funding allocation (this is a long-term goal).
  • Create new funding mechanisms, including community research centers (e.g., phased funding).
  • Work together (funders and public agencies) to develop funding mechanisms and research agendas.

Responding to RFAs. The group suggested the following action steps:

  • Promote true partnership in the responding entity (i.e., joint responses to RFAs between community and academics).
  • Convene more pre-planning/discussion meetings around RFAs and target these to community organizations.
  • Provide capacity building and technical assistance to both academic and community organizations (include training funds and technical assistance provided directly to communities).
  • Require that grant applicants demonstrate the project's benefit to the community.

Peer review process. The group suggested the following action steps:

  • Review the review process.
  • Determine peers for CBPR peer review.
  • Clarify expectations and criteria for good partnerships for the benefit of grant applicants and reviewers.
  • Increase community representation on IRBs and include requirements for disseminating results to the community in institutional research policies.

Funding decisions. The group suggested the following action steps:

  • Apply the same concepts used in peer review to making funding decisions (changes need to move beyond study section to where the funding decisions are made).
  • Include a new criterion in funding decisions: what benefits and services are provided to the community?

Execution of research. The group suggested the following action steps:

  • Use multiple methods for conducting research.
  • Have the community be full partners in designing project evaluations.
  • Conduct an ongoing process evaluation of partners, with a feedback loop throughout the research project.
  • Evaluate how projects increase community capacity as it progresses.

Post-research activities. The group suggested the following action steps:

  • Funders should partner directly with communities to work on translation and dissemination.
  • Focus on sustaining projects, partnerships, and environments conducive to partnerships and community building.
  • Determine data ownership and sharing mechanisms.
  • Create a working group for funders on CBPR to encourage collaboration and raise the conversation to a national level.

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Conclusion

Participants identified three activities that they would personally undertake to advance CPBR in their organizations. Ms. Tucker also requested that participants make a commitment to contact a fellow participant about CBPR. She summarized three key principles from the conference as follows:

  • True partnership with an equitable structure is fundamental to CBPR.
  • Multiple training opportunities are needed by the community, academic researchers, and funders to enhance capacity building.
  • A CBPR network is needed to encourage collaboration and information sharing and CBPR guidelines must be created to strengthen and advance this research model.

Throughout the conference, participants submitted comments on the ideas and discussions. They also submitted their greatest hopes and fears regarding CBPR. Summaries of comments and greatest hopes and fears are presented in Appendix A and B respectively. Unedited participant comments can be obtained from conference organizers.

Dr. Stryer thanked participants for their enthusiasm, passion, energy, and commitment. He appreciated the frustrations expressed, but thought the discussion raised awareness. He remarked that the conference would be successful if participants could translate ideas into actions. Committing to three activities would be participants' last action of the conference, but the beginning of translating ideas into actions. AHRQ staff will recommend changing solicitations for research to include language targeting CBPR and research on health disparities. He encouraged participants to evaluate the conference using the forms provided or other means. The evaluation would help AHRQ improve the process of obtaining input. He thanked conference co-sponsors, conference center staff, Cygnus staff, and participants for sharing their wisdom and passion.

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Current as of June 2002


Internet Citation:

Community-Based Participatory Research. Conference Summary. June 2002. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/cbpr/cbpr1.htm

Current as of October 2012
Internet Citation: Breakout Group Reports: CommunityBased Participatory Research: Conference Summary (continued). October 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/events/other/cbpr/cbpr4.html