Promoting environmental justice through community-based participatory research: the role of community and partnership capacity.

Community-based participatory research (CBPR) increasingly is being used to study and address environmental justice. This article presents the results of a cross-site case study of four CBPR partnerships in the United States that researched environmental health problems and worked to educate legislators and promote relevant public policy. The authors focus on community and partnership capacity within and across sites, using as a theoretical framework Goodman and his colleagues' dimensions of community capacity, as these were tailored to environmental health by Freudenberg, and as further modified to include partnership capacity within a systems perspective. The four CBPR partnerships examined were situated in NewYork, California, Oklahoma, and North Carolina and were part of a larger national study. Case study contexts and characteristics, policy-related outcomes, and findings related to community and partnership capacity are presented, with implications drawn for other CBPR partnerships with a policy focus.     

Meeting the needs of rural populations through interdisciplinary partnerships

This article describes the organization and outcomes of a Rural Health Outreach Initiative (RHOI) designed to increase collaboration between the medical education and health care delivery sectors to improve the quality of health care delivery and health outcomes in rural communities. Two inter-related partnership strategies were utilized in rural communities to address the health and social service needs of rural populations. The partnerships were created through the efforts of a rural health professions education program located in a community-based medical school. The two partnership models were implemented at the same time and target the same rural populations. Both strategies relied upon interdisciplinary collaborations to achieve their goals and outcomes. One strategy involved the creation of partnerships among rural medical students and the projects they initiate, using the model of community oriented primary care (COPC). The second strategy involved the establishment of partnerships by a variety of rural, community-based entities that resulted from a three-year Health Resources and Services Administration Rural Health Outreach grant that supported a "mini-grant" program. This article summarizes the process and results of these innovative collaborations that occurred at two levels: (1) between health and service institutions representing multiple disciplines and (2) between academic institutions and local communities. Specific attention is given to projects that resulted from the work of the partnerships that address the needs of older adults residing in the rural communities. The two strategies are compared and implications for the success of similar efforts are discussed.     

Community-based participatory research as a tool to advance environmental health sciences

The past two decades have witnessed a rapid proliferation of community-based participatory research (CBPR) projects. CBPR methodology presents an alternative to traditional population-based biomedical research practices by encouraging active and equal partnerships between community members and academic investigators. The National Institute of Environmental Health Sciences (NIEHS), the premier biomedical research facility for environmental health, is a leader in promoting the use of CBPR in instances where community-university partnerships serve to advance our understanding of environmentally related disease. In this article, the authors highlight six key principles of CBPR and describe how these principles are met within specific NIEHS-supported research investigations. These projects demonstrate that community-based participatory research can be an effective tool to enhance our knowledge of the causes and mechanisms of disorders having an environmental etiology, reduce adverse health outcomes through innovative intervention strategies and policy change, and address the environmental health concerns of community residents.     

Using a Community-based Participatory Research Approach to Implement a Health Fair for Children

When devising strategies to combat obesity, strategies focusing on children should be utilized since health-related behaviors track into adulthood. One strategy that begins to address, and brings awareness to, the rising obesity rates and other health disparities in adults is the utilization of community health fairs. Previous literature has described how to conduct an adult health fair using a community-based participatory research (CBPR) approach, but no study has shown how to conduct a health fair for children. This article explains how a CBPR approach was used to develop a health fair focused on obesity prevention for children. A partnership between the community and a local university was formed to assist in the planning and implementation of a health fair. While the data obtained from the health fair served as a needs assessment for future projects, the health fair was also a good first step in developing relationships and trust among the partners.     

The Detroit Community-Academic Urban Research Center: development, implementation, and evaluation.

There is increasing research evidence that stressors in the social and physical environment (e.g., poverty, inadequate housing, air pollution, and racism) are associated with poor health outcomes. Given the complex set of determinants of health status, the disproportionate burden of disease experienced within marginalized communities, and the limited effectiveness of traditional prevention research, particularly within communities of color, there have been growing calls for more comprehensive and participatory approaches to public health research and practice. The purpose of this article is to describe and analyze the process of establishing, implementing, and evaluating the Detroit Community-Academic Urban Research Center (URC), a community-based participatory research (CBPR) partnership involving community-based organizations, a local health department, academia, and an integrated health care system. Lessons learned and recommendations for creating effective CBPR partnerships are presented.     

Sí Se Puede: Using Participatory Research to Promote Environmental Justice in a Latino Community in San Diego,California

Community-based participatory research (CBPR) increasingly is seen as a potent tool for studying and addressing urban environmental health problems by linking place-based work with efforts to help effect policy-level change. This paper explores a successful CBPR and organizing effort, the Toxic Free Neighborhoods Campaign, in Old Town National City (OTNC), CA, United States, and its contributions to both local policy outcomes and changes in the broader policy environment, laying the groundwork for a Specific Plan to address a host of interlocking community concerns. After briefly describing the broader research of which the OTNC case study was a part, we provide background on the Environmental Health Coalition (EHC) partnership and the setting in which it took place, including the problems posed for residents in this light industrial/residential neighborhood. EHC’s strong in-house research, and its training and active engagement of promotoras de salud (lay health promoters) as co-researchers and policy change advocates, are described. We explore in particular the translation of research findings as part of a policy advocacy campaign, interweaving challenges faced and success factors and multi-level outcomes to which these efforts contributed. The EHC partnership's experience then is compared with that of other policy-focused CBPR efforts in urban environmental health, emphasizing common success factors and challenges faced, as these may assist other partnerships wishing to pursue CBPR in urban communities.     

Using community-based participatory research to ameliorate cancer disparities

Although much attention has been paid to health disparities in the past decades, interventions to ameliorate disparities have been largely unsuccessful. One reason is that the interventions have not been culturally tailored to the disparity populations whose problems they are meant to address. Community-engaged research has been successful in improving the outcomes of racial and ethnic minority groups and thus has great potential for decreasing between-group health disparities. In this article, the authors argue that a type of community-engaged research, community-based participatory research (CBPR), is particularly useful for social workers doing health disparities research because of its flexibility and degree of community engagement. After providing an overview of community research, the authors define the parameters of CBPR, using their own work in African American and white disparities in breast cancer mortality as an example of its application. Next, they outline the inherent challenges of CBPR to academic and community partnerships. The authors end with suggestions for developing and maintaining successful community and academic partnerships.     

Overcoming barriers to effective community-based participatory research in US medical schools

Research to improve the health of communities benefits from the involvement of community members. Accordingly, major federal and foundation funding agencies are soliciting health promotion/disease prevention programme proposals that require active community participation. However, creating such partnerships is difficult. Communities often perceive conventional research as paternalistic, irrelevant to their needs, manipulative, secretive and invasive of privacy. Many institutions and researchers view community knowledge as lacking in value. Community-based participatory research (CBPR) is a collaborative partnership approach to research that equitably involves community members, organizational representatives and researchers in all aspects of the research process. In this article the authors consider the barriers to institutional change and faculty participation in CBPR, and propose some steps for overcoming the barriers and making CBPR an integral part of a medical institution's research agenda. Training and supporting faculty in the philosophy and methods of this approach is the cornerstone of improved community-based research.     

Addressing urban health in Detroit,New York City,and Seattle through community-based participatory research partnerships

OBJECTIVE: This study describes key activities integral to the development of 3 community-based participatory research (CBPR) partnerships. METHODS: We compared findings from individual case studies conducted at 3 urban research centers (URCs) to identify crosscutting adaptations of a CBPR approach in the first 4 years of the partnerships' development. RESULTS: Activities critical in partnership development include sharing decision-making, defining principles of collaboration, establishing research priorities, and securing funding. Intermediate outcomes were sustained CBPR partnerships, trust within the partnerships, public health research programs, and increased capacity to conduct CBPR. Challenges included the time needed for meaningful collaboration, concerns regarding sustainable funding, and issues related to institutional racism. CONCLUSIONS: The URC experiences suggest that CBPR can be successfully implemented in diverse settings.     

Measuring the success of community science: the northern California Household Exposure Study

Background: Environmental health research involving community participation has increased substantially since the National Institute of Environmental Health Sciences (NIEHS) environmental justice and community-based participatory research (CBPR) partnerships began in the mid-1990s. The goals of these partnerships are to inform and empower better decisions about exposures, foster trust, and generate scientific knowledge to reduce environmental health disparities in low-income, minority communities. Peer-reviewed publication and clinical health outcomes alone are inadequate criteria to judge the success of projects in meeting these goals; therefore, new strategies for evaluating success are needed.Objectives: We reviewed the methods used to evaluate our project, “Linking Breast Cancer Advocacy and Environmental Justice,” to help identify successful CBPR methods and to assist other teams in documenting effectiveness. Although our project precedes the development of the NIEHS Evaluation Metrics Manual, a schema to evaluate the success of projects funded through the Partnerships in Environmental Public Health (PEPH), our work reported here illustrates the record keeping and self-reflection anticipated in NIEHS’s PEPH.Discussion: Evaluation strategies should assess how CBPR partnerships meet the goals of all partners. Our partnership, which included two strong community-based organizations, produced a team that helped all partners gain organizational capacity. Environmental sampling in homes and reporting the results of that effort had community education and constituency-building benefits. Scientific results contributed to a court decision that required cumulative impact assessment for an oil refinery and to new policies for chemicals used in consumer products. All partners leveraged additional funding to extend their work.Conclusions: An appropriate evaluation strategy can demonstrate how CBPR projects can advance science, support community empowerment, increase environmental health literacy, and generate individual and policy action to protect health.     

Advancing community health through community health partnerships

Improving a community's health is a key goal of health services organizations. Effectively pursuing that goal requires health services organizations to create partnerships with other organizations to help identify community health needs and to create and carry out programs that bring together community members and needed health services. Drawing on community systems concepts and a recent study of community health partnership efforts in three cities, this article provides a framework for such partnerships. Types of partnerships described include: Community action partnerships, in which the partnership forms to address a specific problem or pursue a specific opportunity. Community organization partnerships, in which a set of organizations in a similar service sector agree to collaborate for mutually agreed upon goals; and Community development partnerships, in which a partnership attempts to increase participation by people and organizations in collaborative activities that advance the community on multiple fronts or that contribute to community assets and services in multiple areas. The article also describes how the pressures to create large integrated delivery systems can affect creation of partnerships to improve community health. Increasingly, healthcare leaders are being held accountable for the health of communities they serve. When creating partnerships for community health and carrying out health-improvement activities, leaders should be aware of and respond to four key dimensions of accountability: political accountability, commercial accountability, clinical/patient accountability, and community accountability.     

Bringing Healthy Retail to Urban “Food Swamps”: a Case Study of CBPR-Informed Policy and Neighborhood Change in San Francisco

In urban “food swamps” like San Francisco’s Tenderloin, the absence of full-service grocery stores and plethora of corner stores saturated with tobacco, alcohol, and processed food contribute to high rates of chronic disease. We explore the genesis of the Tenderloin Healthy Corner Store Coalition, its relationship with health department and academic partners, and its contributions to the passage and implementation of a healthy retail ordinance through community-based participatory research (CBPR), capacity building, and advocacy. The healthy retail ordinance incentivizes small stores to increase space for healthy foods and decrease tobacco and alcohol availability. Through Yin’s multi-method case study analysis, we examined the partnership’s processes and contributions to the ordinance within the framework of Kingdon’s three-stage policymaking model. We also assessed preliminary outcomes of the ordinance, including a 35% increase in produce sales and moderate declines in tobacco sales in the first four stores participating in the Tenderloin, as well as a “ripple effect,” through which non-participating stores also improved their retail environments. Despite challenges, CBPR partnerships led by a strong community coalition concerned with bedrock issues like food justice and neighborhood inequities in tobacco exposure may represent an important avenue for health equity-focused research and its translation into practice.     

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.     

Mano a Mano: Improving health in impoverished Bolivian communities through community-based participatory research

Mano a Mano (Spanish translation: "Hand to Hand") is a nonprofit organization that is working in partnership with underserved Bolivian communities to cocreate medical infrastructures and to improve health. Using community-based participatory research (CBPR) methods, Mano a Mano engages local government and community leaders, health care providers, educators, and ordinary citizens in a manner that taps local strengths and resources to allow all participants to work together to realize this mission. After describing Bolivia's call for improved access to high quality care in its poor and underserved rural areas, we outline the Mano a Mano's CBPR approach and sequence to answer this call, the culmination of its efforts to date (including the establishment of 119 health care facilities), lessons learned, and next steps in the formal evaluation and extension of this collaborative work.     

Racism,Health Status,and Birth Outcomes: Results of a Participatory Community-Based Intervention and Health Survey

Many community-based participatory research (CBPR) partnerships address social determinants of health as a central consideration. However, research studies that explicitly address racism are scarce in the CBPR literature, and there is a dearth of available community-generated data to empirically examine how racism influences health disparities at the local level. In this paper, we provide results of a cross-sectional, population-based health survey conducted in the urban areas of Genesee and Saginaw Counties in Michigan to assess how a sustained community intervention to reduce racism and infant mortality influenced knowledge, beliefs, and experiences of racism and to explore how perceived racism is associated with self-rated health and birth outcomes. We used ANOVA and regression models to compare the responses of intervention participants and non-participants as well as African Americans and European Americans (N = 629). We found that intervention participants reported greater acknowledgment of the enduring and differential impact of racism in comparison to the non-intervention participants. Moreover, survey analyses revealed that racism was associated with health in the following ways: (1) experiences of racial discrimination predicted self-rated physical health, mental health, and smoking status; (2) perceived racism against one’s racial group predicted lower self-rated physical health; and (3) emotional responses to racism-related experiences were marginally associated with lower birth-weight births in the study sample. Our study bolsters the published findings on perceived racism and health outcomes and highlights the usefulness of CBPR and community surveys to empirically investigate racism as a social determinant of health.     

Developing a bidirectional academic-community partnership with an Appalachian-American community for environmental health research and risk communication

Background: Marietta, Ohio, is an Appalachian-American community whose residents have long struggled with understanding their exposure to airborne manganese (Mn). Although community engagement in research is strongly endorsed by the National Institutes of Health and the National Institute of Environmental Health Sciences in particular, little has been documented demonstrating how an academic–community partnership that implements the community-based participatory research (CBPR) principles can be created and mobilized for research.Objectives: We created a bidirectional, academic–community partnership with an Appalachian-American community to a) identify the community’s thoughts and perceptions about local air quality, its effect on health, and the perception of risk communication sources and b) jointly develop and conduct environmental health research.Methods: We formed a community advisory board (CAB), jointly conducted pilot research studies, and used the results to develop a community-driven research agenda.Results: Persons in the community were “very concerned” to “concerned” about local air quality (91%) and perceived the air quality to have a direct impact on their health and on their children’s health (93% and 94%, respectively). The CAB identified the primary research question: “Does Mn affect the cognition and behavior of children?” Although the community members perceived research scientists as the most trusted and knowledgeable regarding risks from industrial emissions, they received very little risk information from research scientists.Conclusions: Engaging a community in environmental health research from its onset enhanced the quality and relevance of the research investigation. The CBPR principles were a useful framework in building a strong academic–community partnership. Because of the current disconnect between communities and research scientists, academic researchers should consider working collaboratively with community-based risk communication sources.     

The Promise of Community-Based Participatory Research for Health Equity: A Conceptual Model for Bridging Evidence With Policy

Insufficient attention has been paid to how research can be leveraged to promote health policy or how locality-based research strategies, in particular community-based participatory research (CBPR), influences health policy to eliminate racial and ethnic health inequities. To address this gap, we highlighted the efforts of 2 CBPR partnerships in California to explore how these initiatives made substantial contributions to policymaking for health equity. We presented a new conceptual model and 2 case studies to illustrate the connections among CBPR contexts and processes, policymaking processes and strategies, and outcomes. We extended the critical role of civic engagement by those communities that were most burdened by health inequities by focusing on their political participation as research brokers in bridging evidence and policymaking.Landmark studies have helped keep race and ethnic health inequalities on the national political agenda for more than 3 decades. These studies have included the Secretary’s Task Force on Black and Minority Health,1 Unequal Treatment,2 and Examining the Health Disparities Research Plan.3 Despite the continued research evidence of disproportionate adverse health impacts on racial/ethnic minorities,4 insufficient attention has been paid to the role of governmental action or inaction on these health disparity outcomes. How research can be leveraged to promote health equity policy, or the role of locality-based research strategies, in particular community-based participatory research (CBPR), is less understood. Two major challenges inhibit our knowledge about the link between research and policy change: (1) the gap between scientific evidence and policy action based on evidence, and (2) the difficulty of mobilizing civic engagement for policymaking in the United States.We sought to help fill these gaps by exploring 2 locality-based CBPR initiatives that have effected policy change to promote health equity. After brief overviews of the social justice basis for CBPR and health equity, the literature on CBPR policymaking for health equity, and the issues underlying the research to policy gap, we presented a new conceptual model for better understanding of the pathways and connections between CBPR contexts and processes, policymaking strategies, and policy outcomes. We summarized our case studies and then used detailed findings to illustrate the model’s utility for showcasing how CBPR might contribute, along with other efforts, to local and regional policy change. We concluded by comparing our findings with those of earlier research, and highlighted how further refinement of the conceptual model might assist CBPR partnerships in promoting health equity policy.     

A community-based participatory research approach to the development of a Peer Navigator health promotion intervention for people with spinal cord injury

BackgroundRecent trends indicate research targeting outcomes of importance to people with disabilities, such as spinal cord injury (SCI), may be best informed by those individuals; however, there are very few published rehabilitation intervention studies that include people with disabilities in the research process in a role beyond study participant.ObjectiveTo describe a community-based participatory research (CBPR) approach to the development and pilot testing of an intervention using community-based Peer Navigators with SCI to provide health education to individuals with SCI, with the goal of reducing preventable secondary conditions and rehospitalizations, and improving community participation.MethodsA CBPR framework guides the research partnership between academic researchers and a community-based team of individuals who either have SCI or provide SCI-related services. Using this framework, the processes of our research partnership supporting the current study are described including: partnership formation, problem identification, intervention development, and pilot testing of the intervention. Challenges associated with CBPR are identified.ResultsUsing CBPR, the SCI Peer Navigator intervention addresses the partnership's priority issues identified in the formative studies. Utilization of the framework and integration of CBPR principles into all phases of research have promoted sustainability of the partnership. Recognition of and proactive planning for challenges that are commonly encountered in CBPR, such as sharing power and limited resources, has helped sustain our partnership.ConclusionsThe CBPR framework provides a guide for inclusion of individuals with SCI as research partners in the development, implementation, and evaluation of interventions intended to improve outcomes after SCI.     

Conducting a participatory community-based survey for a community health intervention on Detroit's east side.

This article describes a participatory action research process that brought together community members, representatives from community-based organizations and service providers, and academic researchers to collect, interpret, and apply community information to address issues related to the health of women and children in a geographically defined urban area. It describes the development and administration of a community-based survey designed to inform an intervention research project; discusses the establishment of a community/research partnership and issues that the partnership confronted in the process of developing and administering the survey; and examines the contributions of participants, and implications for research and collective action.