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![[Read Comment]](/icons/misc/sectionDOWN.gif){kind=icon}
Show me some outcomes for CBPR
Community Based Participatory Research: Worth Doing Badly?
Levels of community
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Ian M Bennett, Philadelphia, USA Assistant Professor, University of Pennsylvania
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I am very much an advocate of the principles of CBPR and feel that it captures idealized goals of mine. What I am getting a bit impatient for is a clear example of the benefits of the approach from the point of view of outcomes. It is time for investigators to start evaluating the benefits of this approach in a manner that would be similar to our assessment of any intervention. Until that occurs it will be hard to sustain support for all of the work that is required to carry off CBPR either well or badly for that matter. If someone has an example of a CBPR project that was evaluated in that manner and showed benefit (or not) please send it off to me. Competing interests: None declared |
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Peter C. Smith, MD, Aurora, CO, USA Assistant Professor of Family Medicine, University of Colorado Health Sciences Center
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In the words of the English wit G.K. Chesterton, “If a thing is worth doing, it is worth doing badly.” In this issue of The Annals Westfall et al describe the current state of Community Based Participatory Research (CBPR) in the world of Practice Based Research Networks (PBRNs). The picture is as varied as the networks themselves and the communities they serve. The only commonality I see is that most of us have heeded Chesterton’s advice. Some have wholeheartedly adapted the CBPR model with the conviction that it represents an important sea change in how and for whom research is conducted. , And while there is little outspoken dissent, others consider CBPR to be another unfunded mandate that only requires rarely-fulfilled “boilerplate” promises on the PHS 398. For most, the truth likely lies in the broad continuum between these extremes. Like Community Oriented Primary Care (COPC) before it, CPBR may be another compelling idealized model that is drastically altered by the ugly facts on the ground. And like COPC, and indeed like Family Medicine itself, CPBR maybe worth doing badly rather than not at all. I encourage you to read the online supplement to the article describing the High Plains Research Network (HPRN)’s experience with their Community Advisory Council (CAC). I initially watched the birth of the CAC with curious bemusement. But I now see their radical metamorphosis, from a clever grantsmanship maneuver into an important enterprise, as a revolutionary challenge to how research is conceptualized, conducted, and disseminated. Of course, they have had advantages: access to scarce dedicated resources for CBPR and, especially, an actual community with well-demarcated geographical, political, economic, and cultural boundaries. The mind reels at any attempt to describe my practice’s “community” (not to mention our PBRN): Russians, Afghanis, Iraqis, Pakistanis, Ethiopians and Eritreans, Bosnians and Herzegovinans, African- Americans, Hispanics of every conceivable national origin, and Caucasians; the homeless, suburbanites, ex-burbanites, and hip loft-dwellers; and every conceivable economic class from unemployed single mothers to corporate executives; all stretched over 4500 square miles. Is this a “community”, and can it have meaningful and equitable representation? CBPR is in its infancy. Family Medicine and I are both in our 37th year and we’re still struggling to get it right. But for CPBR to meet its full promise, we must respond not with struggle but with letting go. We will have to let go of established norms, of cherished definitions of research, of ways of doing business, of our “researchy language” and “objective detachment”, of our comfort zones, of control. I’m reminded of those revelatory moments in practice when, through humility and shared vulnerability, we suddenly become human to our patients. Sometimes the relationship deteriorates and a distance grows between us. But usually, it blossoms, and we become more than just “doctor and patient.” And we both benefit from a relationship that exists on a whole new level. And so I look forward to your responses to the fundamental questions left unanswered about CBPR: Are PBRN’s participatory? Should they be? How should we define the “C” in CPBR? Should efforts at including CBPR elements be required, as they are for race, gender, and ethnicity? How should we deal with such seemingly irrevocable conflicts community advisory groups and funding agencies, a PBRNs’ practices, or even IRBs? How do we ensure that diverse communities have equal representation? How do we support these efforts on a long-term basis, both financially and within the greater “community of research”? Is fitting CBPR into pre- existing PBRNS and an exercise in square peg/round hole futility? And finally, is CBPR really worth doing badly, rather than not at all? 1. Westfall JM. Van Vorst RF. Main DS. Herbert C. Community-Based Participatory Research in Practice-Based Research Networks. Annals of Family Medicine. 2006;4:8-14. 2. Macaulay AC. Ryan JG. Community needs assessment and development using the participatory research model. [News] Annals of Family Medicine.2003;1:183-4. 3. Potvin L. Cargo M. McComber AM. Delormier T. Macaulay AC. Implementing participatory intervention and research in communities: lessons from the Kahnawake Schools Diabetes Prevention Project in Canada. Social Science & Medicine.2003;56:1295-1305. 4. Williams RL. Motherhood, apple pie, and COPC. Annals of Family Medicine.2004;2:100-102. Peter C. Smith, MD, Assistant Professor of Family Medicine, University of Colorado Health Sciences Center; Director, BIGHORN research network, Peter.Smith@UCHSC.edu Competing interests: None declared |
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Lucinda L. Bryant, Denver CO USA Assistant Professor, Dept of Preventive Medicine, U of Colorado at Denver & Health Sciences Center
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Comment on: Westfall JM, VanVorst RF, Main DS, Herbert C. Community-based participatory research in practice-based research networks. Annals of Family Medicine 2006;4:8-14. This article and accompanying case report add important observations from practical experience to the literature on community-based participatory research. The authors have identified levels of community involvement, from minimal input from advisory groups that meet only occasionally to full participation by community members in all aspects of research. One hopes for a prompt answer to their call for the development of a taxonomy to define these various levels of community participation, which also likely represent “teachable” stages in the learning process for new and developing collaborations. Another dimension of levels exists as well, that of community itself. As the authors state, their findings are not unique to practice-based research networks. I conduct research under the auspices of a member center of the Healthy Aging Research Network (PRC-HAN), a subset of 9 of the 33 Centers for Disease Control and Prevention-funded academic- community partner Prevention Research Centers (PRCs). The PRCs strive to “connect science and practice through a network of academic, public health, and community partnerships engaged in scholarly, community-based prevention research, research translation, and education.” The PRC-HAN similarly aims “to better understand the determinants of healthy aging in older adult populations; identify interventions that promote healthy aging; and help translate this knowledge into sustainable community-based programs throughout the nation.”1 As member centers, we collaborate with and within the following multiple communities: national (the PRC-HAN itself and representatives from a number of national organizations), state (public health and aging services departments), university colleagues, and local partner communities (rural and urban, ethnically and socioeconomically diverse). It can be challenging to determine which ones of these communities are participating in a given research endeavor and to balance inputs and expectations from each. Working with multiple levels (e.g., designing tools or interventions at the national PRC-HAN level and then piloting them in local partner communities, in ways that meet local needs and expectations) requires compromise, tact, and patience with inter -institutional processes such as human subjects’ approval. Nonetheless, as Westfall et al. suggest, community involvement contributes to higher quality, more relevant research. We need to continue to work together to address the challenges and barriers. 1 Healthy Aging Research Network Writing Group. The Prevention Research Centers Healthy Aging Research Network. Prev Chronic Dis [serial online] 2006 Jan [cited January 30, 2006]. Available from: http://www.cdc.gov/pcd/issues/2006/jan/05_0054.htm. Competing interests: None declared |
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