Community-Based Participatory Research

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There is increased interest in research that aims to improve the health of disadvantaged (minority, low-income, rural, central city, and other) populations. However, conventional research in these communities has a contentious history and offers limited opportunities to improve the health and well being of these communities.

Community-based participatory research (CBPR) is a collaborative process of research involving researchers and community representatives. In the process and products of research, it:

• Engages community members.
• Employs local knowledge in the understanding of health problems and the design of interventions.
• Invests community members in the processes and products of research.

In addition, community members are invested in the dissemination and use of research findings and ultimately in the reduction of health disparities.

Participatory research in disadvantaged communities has a long and successful history in the social sciences and international and rural development. There is a growing recognition of the importance and promise of this type of research within health services and public health institutions and funding organizations. However, in spite of the increased interest expressed by communities, universities, and funders, CBPR is underutilized. Practitioners of CBPR have identified several barriers to CBPR. These barriers include:

• Poor community incentives and capacity to conduct CBPR.
• Lack of academic incentives and the need to develop capacity for researchers and community-based organizations (CBOs) to partner in CBPR projects.
• Inadequate funding and insensitive funding mechanisms.

The Agency for Healthcare Research and Quality (AHRQ), in collaboration with the W.K. Kellogg Foundation and Federal partners, convened a diverse group of participants for the Conference on Community-Based Participatory Research. Academic researchers, community representatives, private and government funding agencies, and others met on November 27-28, 2001, in Rockville, MD, to:

• Promote and support the use of CBPR.
• Develop strategies to advance CBPR.
• Explore the use of CBPR as a resource for policymakers to help guide their program development.

Participants developed strategies that support CBPR within the community, academy, and funding organizations and generated ways to encourage the use of local community knowledge in program development and administration. Participants addressed barriers in the three key areas.

The keynote speaker, Dr. Barbara Israel, described current disparities in health and explained how participation of the community in research enhances the resulting knowledge and interventions. Dr. Israel identified key principles of CBPR and described the positive outcomes of this approach. Subsequent sessions addressed barriers, solutions, and capacity building for communities and researchers. Presenters identified successful models of CBPR and explained how these models integrated facilitating factors and established capacity building mechanisms.

For each conference session, reactor panels composed of representatives of funding organizations, researchers, community representatives and advocacy groups, and professional organization journal representatives responded to the papers presented. All participants engaged in a facilitated and open discussion on the papers. The facilitator focused participants on generating specific action items for different CBPR partners (community members, researchers, and funders), identifying barriers, and developing solutions.

On the second day of the conference, participants divided into breakout groups and worked on the three topics to develop recommendations and strategies. The groups reconvened to share their findings and engage in open discussion. From the breakout group reports, conference organizers derived three sets of recommendations aimed at funders, community members, and academics. They compiled participant comments generated after each session and participants' greatest hopes and fears regarding CBPR. The information generated from the conference will be used to describe the current context or environment for CBPR, to develop strategies to promote CBPR, and to provide funding organizations with input from communities as they work together to improve the health and well being of those communities.

Participants recommended numerous action steps. Conference organizers highlighted the following 13 recommendations 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 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).

To disseminate conference work, AHRQ will develop a supplement in the Journal of General Internal Medicine that summarizes the proceedings and presents original CBPR findings. AHRQ will also prepare and distribute a meeting summary for community-based organizations with the hope that the recommendations from the conference and enthusiasm of the participants stimulate further steps to foster CBPR.