Meredith Minkler

Community-based research partnerships: Challenges and opportunities

The complexity of many urban health problems often makes them ill suited to traditional research approaches and interventions. The resultant frustration, together with community calls for genuine partnership in the research process, has highlighted the importance of an alternative paradigm. Community-based participatory research (CBPR) is presented as a promising collaborative approach that combines systematic inquiry, participation, and action to address urban health problems. Following a brief review of its basic tenets and historical roots, key ways in which CBPR adds value to urban health research are introduced and illustrated. Case study examples from diverse international settings are used to illustrate some of the difficult ethical challenges that may arise in the course of CBPR partnership approaches. The concepts of partnership synergy and cultural humility, together with protocols such as Green et al.’s guidelines for appraising CBPR projects, are highlighted as useful tools for urban health researchers seeking to apply this collaborative approach and to deal effectively with the difficult ethical challenges it can present.

Photovoice: A Review of the Literature in Health and Public Health:

Although a growing number of projects have been implemented using the community-based participatory research method known as photovoice, no known systematic review of the literature on this approach has been conducted to date. This review draws on the peer-reviewed literature on photovoice in public health and related disciplines conducted before January 2008 to determine (a) what defines the photovoice process, (b) the outcomes associated with photovoice, and (c) how the level of community participation is related to photovoice processes and outcomes. In all, 37 unduplicated articles were identified and reviewed using a descriptive coding scheme and Viswanathan et al.’s quality of participation tool. Findings reveal no relationship between group size and quality of participation but a direct relationship between the latter and project duration as well as with getting to action. More participatory projects also were associated with long-standing relationships between the community and outside researcher partners and an intensive training component. Although vague descriptions of project evaluation practices and a lack of consistent reporting precluded hard conclusions, 60% of projects reported an action component. Particularly among highly participatory projects, photovoice appears to contribute to an enhanced understanding of community assets and needs and to empowerment.

Ethical Challenges for the “Outside” Researcher in Community-Based Participatory Research

Although community-based participatory research (CBPR) shares many of the core values of health education and related fields, the outside researcher embracing this approach to inquiry frequently is confronted with thorny ethical challenges. Following a brief review of the conceptual and historical roots of CBPR, Kelly’s ecological principles for community-based research and Jones’s three-tiered framework for understanding racism are introduced as useful frameworks for helping explore several key challenges. These are (a) achieving a true “community-driven” agenda; (b) insider-outsider tensions; (c) real and perceived racism; (d) the limitations of “participation”; and (e) issues involving the sharing, ownership, and use of findings for action. Case studies are used in an initial exploration of these topics. Green et al.’s guidelines for appraising CBPR projects then are highlighted as an important tool for helping CBPR partners better address the challenging ethical issues often inherent in this approach.

Community-Based Participatory Research: Lessons Learned from the Centers for Children's Environmental Health and Disease Prevention Research

Over the past several decades there has been growing evidence of the increase in incidence rates, morbidity, and mortality for a number of health problems experienced by children. The causation and aggravation of these problems are complex and multifactorial. The burden of these health problems and environmental exposures is borne disproportionately by children from low-income communities and communities of color. Researchers and funding institutions have called for increased attention to the complex issues that affect the health of children living in marginalized communities—and communities more broadly—and have suggested greater community involvement in processes that shape research and intervention approaches, for example, through community-based participatory research (CBPR) partnerships among academic, health services, public health, and community-based organizations. Centers for Children’s Environmental Health and Disease Prevention Research (Children’s Centers) funded by the National Institute of Environmental Health Sciences and U.S. Environmental Protection Agency were required to include a CBPR project. The purpose of this article is to provide a definition and set of CBPR principles, to describe the rationale for and major benefits of using this approach, to draw on the experiences of six of the Children’s Centers in using CBPR, and to provide lessons learned and recommendations for how to successfully establish and maintain CBPR partnerships aimed at enhancing our understanding and addressing the multiple determinants of children’s health.

New Health Promotion Movement: A Critical Examination

In the last decade, a revolution has been occurring in the field of health promotion. Guided to a large extent by position papers disseminated by the World Health Organization (WHO) Europe Health Promotion Office, and furthered by the Ottawa Charter, the Epp Report in Canada, the Healthy Cities project, as well as by other efforts, this new health promotion movement has introduced new ideas, new language, and new concepts about what constitutes health and how health promotion efforts should be configured to achieve health.

Grandmothers as caregivers : raising children of the crack cocaine epidemic

Foreword - Troy Duster Introduction Social and Cultural Contexts of Caregiving Hearing the Voices, Telling the Stories The Grandparent Caregiver Study Assuming the Caregiver Role The Health Status of Grandmother Caregivers The High Costs of Caring Economic Considerations Social Networks and Social Support Coping with the New Caregiving Combining Work and Childcare The Continuity of Caregiving Raising the Children of the Crack Cocaine Epidemic Special Considerations Community Interventions to Support Grandparent Caregivers Implications for Policy

Personal Responsibility for Health? A Review of the Arguments and the Evidence at Century’s End

This article examines the continuing controversies regarding personal versus social responsibility for health as they are being played out at the turn of the century. Following a brief examination of the contested meaning of “personal responsibility for health” in recent historical context, attention is focused on the arguments for and against holding the individual to be primarily accountable for his or her health behavior. The paper then makes the case for more balanced, ecological approaches that stress individual responsibility for health within the context of broader social responsibility. The article concludes by briefly summarizing the Canadian approach to health promotion as a useful example of what such a balanced, ecological approach might look like.

The health of grandparents raising grandchildren: results of a national study.

OBJECTIVES This study sought to compare the functional and self-rated health of grandparents raising grandchildren with that of noncaregiving grandparents. METHODS A secondary analysis of data from the 1992 to 1994 National Survey of Families and Households was conducted. Bivariate and logistic analyses compared 173 custodial and 3304 noncustodial grandparents in terms of functional health limitations, self-rated health, and satisfaction with health. RESULTS Custodial grandparents were significantly more likely to have limitations in 4 of the 5 activities of daily living (ADLs) examined, with more than half reporting some limitation in 1 of the 5 ADLs. A logistic regression analysis indicated that caregiving grandparents had 50% higher odds of having an ADL limitation. Caregivers were significantly more likely to report lower satisfaction with health, and a statistical trend indicated that the caregivers had lower self-rated health. CONCLUSIONS Further research is needed to determine whether the differences observed reflect artifacts or actual differences in functional abilities and other health measures. The need for policies that support rather than penalize grandparents raising grandchildren is stressed.

Engaging Young Adolescents in Social Action Through Photovoice: The Youth Empowerment Strategies (YES!) Project

The Youth Empowerment Strategies (YES!) project is an afterschool empowerment program and research project for underserved early adolescents. Central to YES! is an empowerment intervention that provides early adolescents with opportunities for civic engagement with other youth around issues of shared concern in their schools and neighborhoods. This article specifically focuses on the use of Photovoice as a promising way to engage youth in social change as they take photos capturing strengths and issues in their environment and use these as the basis of critical dialogue and collective action plans. Adding to a growing body of information on using Photovoice, this article reports how early adolescents in the YES! afterschool program experienced the Photovoice process, moving from photography and writing to initiate group-designed social action projects. Recommendations are offered for others engaged in empowerment work with early adolescents.

Linking Science and Policy Through Community-Based Participatory Research to Study and Address Health Disparities

With its commitment to balancing research and action, community-based participatory research (CBPR) is well suited to efforts at the intersections of science, practice, and policy to eliminate health disparities. Drawing on a larger study, we use 2 case studies to highlight the role of CBPR in helping achieve policy changes promoting, respectively, access to healthy foods (Bayview, San Francisco, CA) and higher air quality standards (Harlem, New York, NY). We then present facilitating factors and challenges faced across all 10 case studies from the larger study. Although we underscore the importance of analyzing contribution rather than claiming attribution in policy-focused work, CBPRs attention to both the distributive and the procedural justice necessary for eliminating health disparities may make it a particularly relevant approach in such work.