Corresponding Author: Nina Wallerstein, Professor, Center for Participatory Research, College of Population Health, University of New Mexico, MSC09 5070, University of New Mexico, Albuquerque, NM 87131, USA. ude.mnu.dulas@nietsrellawn
The publisher's final edited version of this article is available at Health Educ BehavCommunity-based participatory research (CBPR) and community-engaged research have been established in the past 25 years as valued research approaches within health education, public health, and other health and social sciences for their effectiveness in reducing inequities. While early literature focused on partnering principles and processes, within the past decade, individual studies, as well as systematic reviews, have increasingly documented outcomes in community support and empowerment, sustained partnerships, healthier behaviors, policy changes, and health improvements. Despite enhanced focus on research and health outcomes, the science lags behind the practice. CBPR partnering pathways that result in outcomes remain little understood, with few studies documenting best practices. Since 2006, the University of New Mexico Center for Participatory Research with the University of Washington’s Indigenous Wellness Research Institute and partners across the country has engaged in targeted investigations to fill this gap in the science. Our inquiry, spanning three stages of National Institutes of Health funding, has sought to identify which partnering practices, under which contexts and conditions, have capacity to contribute to health, research, and community outcomes. This article presents the research design of our current grant, Engage for Equity, including its history, social justice principles, theoretical bases, measures, intervention tools and resources, and preliminary findings about collective empowerment as our middle range theory of change. We end with lessons learned and recommendations for partnerships to engage in collective reflexive practice to strengthen internal power-sharing and capacity to reach health and social equity outcomes.
Keywords: community–academic partnerships, community-based participatory research, community-engaged research, measures, tools, resources, participatory action research
Community-based participatory research (CBPR) and community-engaged research (CEnR) have established themselves in the past 25 years as valued research approaches within health education and other health and social science disciplines for their effectiveness in reducing inequities (Israel, Eng, Schulz, & Parker, 2013; Wallerstein, Duran, Oetzel, & Minkler, 2018). CBPR, as the most recognized form of health-focused CEnR, has sought to integrate community partners throughout research processes, aiming to prevent stereotyping, stigmatizing, or other research practices that have historically harmed communities (Tuck & Yang, 2012). CBPR is committed to principles of colearning and health equity actions (Israel et al., 2013; Israel, Schulz, Parker, & Becker, 1998), with goals to equalize power between researchers and researched (Cornwall & Jewkes, 1995; Gaventa & Cornwall, 2015). CBPR has drawn from the Global South tradition of activist participatory research from the 1970s (Wallerstein & Duran, 2018), and from Brazilian Paulo Freire’s praxis-based empowerment education, recognizing “expertise in the world of practice, beyond academia” (Freire, 1970; Hall, Tandon, & Tremblay, 2015). Praxis, or reflexive practice, means cycles of theory and practice, such that research results and theorizing lead to transformative actions, followed by continuous listening/dialogue/action/reflection (Wallerstein & Auerbach, 2004).
Early attention to CEnR and CBPR principles and practices has turned increasingly to outcomes, including accelerated publication of systematic reviews identifying changes in support networks, empowerment, sustainable partnerships, and health status (Anderson et al., 2015; Drahota et al., 2016; O’Mara-Eves et al., 2015). A new scoping review (Ortiz et al., 2020) identified 100 English-language reviews of distinct outcomes and populations since the groundbreaking Agency for Healthcare Research Quality 2004 review (Viswanathan et al., 2004). CBPR policy impacts on health have been well-documented (Cacari-Stone, Minkler, Freudenberg, & Themba, 2018; Minkler, Garcia, Rubin, & Wallerstein, 2012), and seen as equally important to partnership success as specific grant outcomes (Devia et al., 2017; Jagosh et al., 2012). Despite greater focus on outcomes, the science regarding effective CBPR lags practice, particularly how best to understand power-sharing practices that create pathways toward outcomes (Wallerstein, Muhammad, et al., 2019).
Since 2006, the University of New Mexico Center for Participatory Research (UNM-CPR), with University of Washington’s Indigenous Wellness Research Institute (UW-IWRI) and partners across the country, has engaged in a targeted investigation to fill this gap in science and practice of CBPR. Our inquiry seeks to identify which partnering practices, under which contexts and conditions, contribute to research, community, and health equity outcomes. Our investigation has spanned three National Institutes of Health (NIH) funding stages, first identifying a CBPR conceptual model and measures of partnering practices and outcomes, next surveying partnerships across the country and conducting case studies, and currently, testing intervention collective-reflection processes and tools to strengthen partnering and societal equity outcomes. Our national team has also sought to understand how to achieve equitable partnering, through reflection on power across positionalities of hierarchy across university–community structures, funding streams, and societal inequities.
This article presents the design of our third-stage National Institute of Nursing Research–funded grant, Engage for Equity (E2): its history, aims, foundational theory, instruments, intervention tools, and resources. It complements two other articles in this Special Collection, one on E2 Tools and one on Trust. We end with learnings and recommendations related to collective-reflection practice and outcomes.
In 2006, UNM-CPR received pilot NIMHD funding, through the Native American Centers for Health mechanism to partner with UW-IWRI for an exploratory study of CBPR. With guidance from a think tank of national academic and community CBPR experts and community consultations, we produced a CBPR conceptual model (Belone et al., 2016; Wallerstein & Duran, 2010; Wallerstein et al., 2008) with four domains (see Figure 1 ): contexts (i.e., policies, historic trust/mistrust, community capacities); partnering processes (structural, individual, and relational dynamics); intervention and research designs as outputs of shared decision making; and CBPR, capacity, and health outcomes.