Nina Wallerstein

Using community-based participatory research to address health disparities.

Community-based participatory research (CBPR) has emerged in the past decades as an alternative research paradigm, which integrates education and social action to improve health and reduce health disparities. More than a set of research methods, CBPR is an orientation to research that focuses on relationships between academic and community partners, with principles of colearning, mutual benefit, and long-term commitment and incorporates community theories, participation, and practices into the research efforts. As CBPR matures, tensions have become recognized that challenge the mutuality of the research relationship, including issues of power, privilege, participation, community consent, racial and/or ethnic discrimination, and the role of research in social change. This article focuses on these challenges as a dynamic and ever-changing context of the researcher-community relationship, provides examples of these paradoxes from work in tribal communities, discusses the evidence that CBPR reduces disparities, and recommends transforming the culture of academia to strengthen collaborative research relationships.

Powerlessness, empowerment and health : implications for health promotion programs

Purpose and Scope. This article reviews the health and social science research relevant to both the role of powerlessness as a risk factor for disease, and the role of empowerment as a health-enhancing strategy. The research literature surveyed includes studies that address these key concepts from the fields of social epidemiology, occupational health, stress research, social psychology, community psychology, social support and networks, community competence and community organizing. Definitions are provided to operationalize these sometimes loosely-applied terms. Important Findings. Powerlessness, or lack of control over destiny, emerges as a broad-based risk factor for disease. Empowerment, though more difficult to evaluate, can also be demonstrated as an important promoter of health. Major Conclusions. Given the importance and currency of these concepts of powerlessness and empowerment, a model of empowerment education is proposed for health-promotion practitioners. Measurement of empowerment raises issues for researchers on how to test the multiple personal and community changes that may result from an empowering education intervention.

Identifying and Defining the Dimensions of Community Capacity to Provide a Basis for Measurement

Although community capacity is a central concern of community development experts, the concept requires clarification. Because of the potential importance of community capacity to health promotion, the Division of Chronic Disease Control and Community Intervention, Centers for Disease Control and Prevention (CDC), convened a symposium in December 1995 with the hope that a consensus might emerge regarding the dimensions that are integral to community capacity. This article describes the dimensions that the symposium participants suggested as central to the construct, including participation and leadership, skills, resources, social and interorganizational networks, sense of community, understanding of community history, community power, community values, and critical reflection. The dimensions are not exhaustive but may serve as a point of departure to extend and refine the construct and to operationalize ways to assess capacity in communities.

Community-Based Participatory Research Contributions to Intervention Research: The Intersection of Science and Practice to Improve Health Equity

Community-based participatory research (CBPR) has emerged in the last decades as a transformative research paradigm that bridges the gap between science and practice through community engagement and social action to increase health equity. CBPR expands the potential for the translational sciences to develop, implement, and disseminate effective interventions across diverse communities through strategies to redress power imbalances; facilitate mutual benefit among community and academic partners; and promote reciprocal knowledge translation, incorporating community theories into the research. We identify the barriers and challenges within the intervention and implementation sciences, discuss how CBPR can address these challenges, provide an illustrative research example, and discuss next steps to advance the translational science of CBPR.

Empowerment Education: Freire's Ideas Adapted to Health Education

Empowerment Education is proposed as an effective health education and preven tion model that promotes health in all personal and social arenas. The model suggests that participation of people in group action and dialogue efforts directed at commun ity targets enhances control and beliefs in ability to change peoples own lives. The article is divided into three parts: a literature review demonstrating that powerlessness is linked to disease, and conversely, empowerment linked to health; an exposition of Brazilian educator Paulo Freires empowering education theory with a comparison to traditional health education; and a case study of an empowering education substance abuse prevention project. The Alcohol and Substance Abuse Prevention (ASAP) Program is a University of New Mexico School of Medicine, Emergency Center, and community and school-based prevention project for adolescents. The case study will present ASAPs theoretical underpinnings and social practice, evaluation results, preliminary understandings of the stages for an empowering process, and future questions for practitioners interested in this approach. Empowerment education with its emphasis on organizing is recom mended to be integrated into other prevention strategies of health promotion, disease prevention, and health policy.

Introduction to Community Empowerment, Participatory Education, and Health

Nina Wallerstein is Assistant Professor, Department of Family and Community Medicine, University of New Mexico, Albuquerque, New Mexico. Edward Bernstein is Associate Professor, Boston University School of Public Health, Boston City Hospital, Boston, Massachusetts. Address reprint requests to Nina Wallerstein, Department of Family and Community Medicine, University of New Mexico, Albuquerque, NM 8713

The power and the promise: Working with communities to analyze data, interpret findings, and get to outcomes

Although the intent of community-based participatory research (CBPR) is to include community voices in all phases of a research initiative, community partners appear less frequently engaged in data analysis and interpretation than in other research phases. Using 4 brief case studies, each with a different data collection methodology, we provide examples of how community members participated in data analysis, interpretation, or both, thereby strengthening community capacity and providing unique insight. The roles and skills of the community and academic partners were different from but complementary to each other. We suggest that including community partners in data analysis and interpretation, while lengthening project time, enriches insights and findings and consequently should be a focus of the next generation of CBPR initiatives.

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.

Empowerment to reduce health disparities

This article articulates the theoretical construct of empowerment and its importance for health-enhancing strategies to reduce health disparities. Powerlessness is explored as a risk factor in the context of social determinants, such as poverty, discrimination, workplace hazards, and income inequities. Empowerment is presented and compared with social capital and community capacity as strategies to strengthen social protective factors. A case study of a youth empowerment and policy project in New Mexico illustrates the usefulness of empowerment strategies in both targeting social determinants, such as public policies which are detrimental to youth, and improving community capacities of youth to be advocates for social change. Challenges for future practice and research are articulated.

Strengthening Individual and Community Capacity to Prevent Disease and Promote Health: In Search of Relevant Theories and Principles

The dominant theoretical models used in health education today are based in social psychology. While these theories have increasingly acknowledged the role of larger social and cultural influences in health behavior, they have many limitations. Theories seek to explain the causes of health problems, whereas principles of practice, which are derived from practical experience, assist intervenors to achieve their objectives. By elucidating the relationships between theory and practice principles, it may be possible to develop more coherent and effective interventions. The key research agenda for health education is to link theories at different levels of analysis and to create theory-driven models that can be used to plan more effective interventions in the complex environments in which health educators work.