In speaking of ways to incorporate community-based participatory research (CBPR) principles in public health intervention programs, it is best if terms are defined. Community-based participatory research (CBPR) is “an approach to health and environmental research meant to increase the value of studies for both researchers and the community being studied.” The source of this quote (AHRQ, 2004) goes on to list four of the main positive qualities of CBPR: 1. It creates bridges between scientists and communities through the use of shared knowledge and valuable experiences; 2. It makes projects more effective and efficient by using culturally-appropriate measurement instruments; 3. It enhances the quantity and quality of the data collected by establishing a mutual trust; and, finally, 4. It helps to establish a deeper understanding of a community’s unique circumstances, thus leading to a more accurate framework for testing and adapting best practices in keeping with a community’s needs.
In keeping with the inherent wisdom of these parameters, intervention researchers and organizers should include input from the targeted community at every level of the intervention/health education initiative, i.e., if feasible, meet with the leaders of said community to see if the surveys/questionnaires generally used to gather necessary data are culturally appropriate (either by adding or subtracting from questions originally proposed by researchers, or wording such in ways that respect that community’s values and beliefs); moreover, researchers should be ready to change or alter any aspect of the research, according to how each step is received or responded to. If something is objected to, try to discover why and, if the reason is something that can be realistically addressed, take appropriate action to alter the original approach.
By all means, avoid plunging into the same mistake research scientists often make, i.e., working under the arrogant assumption that they as scientists know better and can, therefore, dictate to the general public what is best for them; what is even more flagrant is the arbitrary conclusion that they have all the answers and have all the tools needed to intervene on a community’s behalf about a problem they “know” is there and which they stubbornly (often without scientific justification) “insist” needs correction.
As for the scientific efficacy of CBPR, there is overwhelming proof of its effectiveness. In a study to see how a CBPR program helped to reduce asthma-related morbidity among children in New York City, for example, it was discovered that, after the program was implemented, there were fewer reports of school absences among children enrolled in the program; in addition to that, there were fewer Hospital Emergency Room and unscheduled doctor visits for treatment of asthma after 18 months of the program. All this was attributed to improved asthma management and more appropriate use of healthcare services by enrollees, through a program using CBPR concepts and tools (MMWR, 2001). This type of data strongly supports the assertion that health education programs and other public health intervention programs produce very useful results, if the programs in question strongly espouse these CBPR concepts.
Another aspect of CBPR that needs to be made more heavy use of is the idea that all health promotion/education initiatives should include a comprehensive accountability and efficacy assessment component, one as specific, detailed and proven as Canada’s Results-Based Management and Accountability Framework (RMAF), which ideally is “completed at the outset of any new policy, program or initiative” (Health Policy Research Bulletin, 2006). In going for efficacious intervention initiatives, strive to inject several measurement schemes that will, not only assess progress, but will provide detailed information as to how the project was conducted and how or why one can rely on the results thereof. This can be as simple as being able to provide actual surveys/questionnaires that were filled out by the participants, or “bothering” to provide actual calculations for all statistical conclusions or assertions made. Too many reports only give “final tally” numbers, sometimes even not including the formulas or processes used. What can be far more impressive, though, are those studies that include detailed tables of all data obtained, as well as statistical calculations, and how they were derived.
Finally, follow the parameters suggested by the National Institute of Health, which strongly subscribes to principles of CBPR. These “parameters” include: 1. Striving to provide the scientific basis and foundation in understanding the impact of the environment on human health; 2. Finding and demonstrating appropriate ways to translate this information into prevention and intervention strategies; and 3. Finding appropriate ways to communicate this information to the public (NIH, 1999). Without doubt, public health interventions and initiatives can have far-reaching, positive effects, but only if they are planned and implemented using the most efficient, cost-effective, practical, and scientifically sound (i.e., based on solid theories and hypotheses) thinking and methods available. CBPR methodology is one readily-available tool which can greatly enhance any public health intervention.
References
AHRQ. Agency for Healthcare Research and Quality. (2004). “Community-based participatory research: assessing the evidence.”
Health Policy Research Bulletin. (September, 2006).”Social capital and health: maximizing the benefits.”
MMWR. (2005, January). “Reducing childhood asthma through community-based service delivery-New York City, 2001-2004.”
NIH. (1999, September). NIH Guide: “Community-based prevention and intervention research.”