Nina Wallerstein, Dr.P.H.

Professor, Public Health Program

University of New Mexico

Visiting Distinguished Faculty

San Francisco State University

“ Collaborative approach to research that equitably involves all partners in the

research process and recognizes the unique strengths that each brings. CBPR begins

with a research topic of importance to the community with the aim of combining

knowledge and action for social change to improve community health and eliminate

health disparities.”

W.K. Kellogg Community Scholar’s Program (2001)

CBPR is an orientation to research/data

Changes the role of researcher and researched

CBPR is not a method or set of methods

Qualitative and Quantitative

Assessment/Descriptive/GIS/Other tools

Epidemiology AND Intervention Research

CBPR is an applied approach

Goal is to influence change in community

health, systems, programs, or policies

Purpose: To Improve CBPR Science 1) To identify facilitators and barriers to effective CBPR across

diverse populations and settings 2) To assess variability of CBPR across populations/settings 3) To test CBPR conceptual model and associations partnering &

outcomes

Partners: 1) National Congress of American Indians Policy Research Center

(M. Villegas, PI) 2) University of Washington (B. Duran, co-PI)

3) University of New Mexico (N. Wallerstein, co-PI)

NIH/NARCH III: Pilot Funding (2006-2009): NIMHD NIH/NARCH V: Funding (2009-2013): NIGMS, NIDA, NCRR, NCI, NIMHD, OBSSR (with Indian Health Service)

Interactive Model linked to instruments and to variables/ measures: http://fcm.unm.edu/cpr/cbpr_project.html

Literature review of measurement tools/metrics

258 articles: 46 unique studies; 224 process/outcome measures Sandoval JA, Lucero J, Oetzel J, Avila M, Belone L, Mau M, Pearson C, Tafoya G, Duran B, Iglesias Rios L, Wallerstein N.(2011) Process &outcome constructs for evaluating community-based participatory research projects: a matrix of existing measures. Health Educ Research

Pearson, C., Duran, B., Lucero, Sandoval, J., Oetzel, J., Tafoya, G., Belone, L., Avila, M., Martin, D., Wallerstein, N., Hicks, S., (2012), CBPR Variable Matrix: CES4Health.info

Project code of ethics and integrity, protocols for students, publications, communication, tools: http://narch.ncaiprc.org

Mixed Methods Research: Internet Survey/Case Studies Hicks, S., Duran, B., Wallerstein, N., et al, Evaluating Community-Based

Participatory Research (CBPR) to improve community-partnered science and community health, Progress in Community Partnerships, Fall, 2012

National cross-sectional survey of all federally funded CBPR projects

(criteria = working with community partner or CAB, or any

level of community engagement. If unsure, left in sample)

Extramural funded studies in 2009 NIH RePORTER database

A “research” project with at least 2 years of funding (not training grants or pilot studies)

▪Mechanisms: R01, R18, R24, R34, RC1, RC2, U01, U19, U26, U28, U54

What is the variability across different dimensions of model?

What are associations between partnership processes and CBPR outcomes?

Two Surveys:

Key Informant (~15 minutes):

Taken by Principal Investigator/Program Director Community Engagement (~ 30 minutes)

Taken by PI/PD, 2nd academic investigator, and 2-4 community partners

Conducted from 12/2011 – 8/2012

Project Demographics and

Features (49)

PI team and partners ethnicity,

position, gender, SO, etc.

Partnership dates, funding, type

of research,# of partners, staff

diversity, etc.

Resource/Decision sharing (4)

Who decides hiring/, budgets,

resources shared

Research Integrity (4)

Confidentiality/IRB training,

approval decisions

Partner Research Roles (13)

Community Engaged Research Index (CERI)

Governance (15)

Formal MOU’s & DSOA’s, dissemination approvals, $, conflict resolution

Formal Training (8)

▪ Racism/sexism/privilege/cultural humility/CBPR-collective reflection

▪ Contact info for Partners

Context (10)

Community Capacity, Project has what it needs to work effectively towards its aims

Social & Human Capital (3)

Knowledge, skills, connections

Alignment with CBPR Principles (8)

Builds on resources and strengths, equitable partnerships in all phases of the research, emphasizes what is important to the community, etc.

Core values (4)

Shared understanding of the missions and the strategies

Power dynamics (9)

Power sharing, influence, decision making

Dialogue, Listening, co-learning Conflict resolution, emotional

intelligence

Governance Mechanisms Competency of leadership in diversity,

communication, planning, efficiency, financial management, etc.

Partnership Synergy (Proximal) (5)

Come together and work well

Culture Centeredness (5)

Community theories, ownership, etc.

Concrete & Perceived Outcomes (8)

Index of Perceived Community/Policy Level Outcomes (IPCPLO).

Improved services, policy change, health improvement, etc.

Personal, Political, Professional Level Outcomes (13)

New knowledge, relationships, power, visibility, skills, etc.

Health Outcome

68.7% 70.5% 76.5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Key Informant Survey byacademic PI

Com Eng Survey byacademic PI

Com Eng Survey byacademic & community

partners

N = 200 N = 310

N = 141

How do context/group processes/ individual issues shape facilitators and barriers to effective CBPR?

How do differing contextual conditions and perceptions/meanings interact with partnering processes to produce differing outcomes?

Healing of the Canoe: Youth Life Skills/Substance Abuse-Washington tribes

Men on the Move: Cardio-Vascular/Sustainable Agriculture/Rural-AA

Lay Health Worker Intervention: Colorectal Cancer Screening/San Francisco-Chinatown

South Valley Partnership Environmental Justice Semi-urban, Southwest - Latino

Cancer Coalition and Tribal Approval Processes Rural – Plains Tribe

Bronx Faith-Based Initiative

Diabetes and Medical Apartheid

Center for Deaf Health, Rochester

Quantitative Survey: Two scales

Views on how trust has evolved (type/when) Level of trust between team members

◦ Trust of decisions, comfort asking others to take responsibility,

Qualitative Case Studies Questions: How do you describe trust in this partnership? Has it changed over the life of the partnership? If so, how has it changed?

• Quantitative Survey: • To what extent was the community partner's

knowledge and voices included in research processes?

• How well did this project engage reciprocal learning and capacity building?

• Mohan Dutta

• Qualitative Case Study: • To what extent does your project fit

local/cultural beliefs, norms, and practices? •

Voice in Research: (Community Engaged Research Index)

Partners involved in three aspects: a) problem-definition/background research; b) data collection; and c) dissemination

Power Relations/Voice in Partnership: Reflexivity: Have increased research participation/talk about research

Decision-Making: Feel comfortable with opinions being heard

Outcomes:

System Changes: Resulted in policy changes/improved health

Community Capacity: Partnership with skills and expertise to work

towards aims/Partnership has legitimacy Mohan Dutta

Role of Identity and Power in CBPR (Critical Sociology, in press)

Cultural Centeredness as Integration of Cultural Norms, Values, Knowledge

Role of Individual Motivation and Values in Partnership Practices and Personal Outcomes

CBPR as Integration of Utilitarian and Broader Capacity Outcomes

CBPR as Social Movement (Based on Historical Contexts of Inequities)

Multiple mixed methods, quantitative and qualitative articles.

Oetzel et al, Psychometrics, American Journal of Health Promotion (in press)

Other articles: Structural Characteristics/Mixed Methods/Outcomes/Case Studies

National Institute of Nursing Research RO1: Advancing CBPR Practice with Collective Reflection and Measurement Toolkit.

Training in Emerging and Best Practices

To team members: UNM: Magdalena Avila, Lorenda Belone, Lisa

Herrera, Julie Lucero, Michael Muhammad, Emma Noyes, Patricia Rodriguez, Andrew Sussman, Greg Tafoya, Belinda Vicuna, Shannon Youngman-Sanchez

UW: Bonnie Duran, Leo Egashira, Maya Magarati, Myra Parker, Cynthia Pearson

NCAIPRC: Malia Villegas, Emily White Hat

Nina Wallerstein, Co-Principal Investigator, UNM Qualitative Case Study Analysis

Email: nwallers@sfsu.edu nwallerstein@salud.unm.edu

http://fcm.unm.edu/cpr/cbpr_project.html Bonnie Duran, Co-Principal Investigator

Quantitative Survey Analysis

Email: bonduran@u.washington.edu

Malia Villegas, PhD, Overall PI

National Congress of American Indians

Policy Research Center

Email: mvillegas@ncai.org