Community-based participatory research in complex settings: clean mind-dirty hands

The increasing use of participatory research (PR) approaches to address pressing public health issues reflects PR's potential for bridging gaps between research and practice, addressing social and environmental justice and enabling people to gain control over determinants of their health. Our critical review of the PR literature culminates in the development of an integrative practice framework that features five essential domains and provides a structured process for developing and maintaining PR partnerships, designing and implementing PR efforts, and evaluating the intermediate and long-term outcomes of descriptive, etiological, and intervention PR studies. We review the empirical and nonempirical literature in the context of this practice framework to distill the key challenges and added value of PR. Advances to the practice of PR over the next decade will require establishing the effectiveness of PR in achieving health outcomes and linking PR practices, processes, and core elements to health outcomes.

The modern environmental management literature stresses the need for community involvement to identify indicators to monitor progress towards sustainable development and environmental management goals. The purpose of this paper is to assess the impact of participatory processes on sustainability indicator identification and environmental management in three disparate case studies. The first is a process of developing partnerships between First Nations communities, environmental groups, and forestry companies to resolve conflicts over forest management in Western Canada. The second describes a situation in Botswana where local pastoral communities worked with development researchers to reduce desertification. The third case study details an on-going government led process of developing sustainability indicators in Guernsey, UK, that was designed to monitor the environmental, social, and economic impacts of changes in the economy. The comparative assessment between case studies allows us to draw three primary conclusions. (1) The identification and collection of sustainability indicators not only provide valuable databases for making management decisions, but the process of engaging people to select indicators also provides an opportunity for community empowerment that conventional development approaches have failed to provide. (2) Multi-stakeholder processes must formally feed into decision-making forums or they risk being viewed as irrelevant by policy-makers and stakeholders. (3) Since ecological boundaries rarely meet up with political jurisdictions, it is necessary to be flexible when choosing the scale at which monitoring and decision-making occurs. This requires an awareness of major environmental pathways that run through landscapes to understand how seemingly remote areas may be connected in ways that are not immediately apparent.

Although intervention research is vital to eliminating health disparities, many groups with health disparities have had negative research experiences, leading to an understandable distrust of researchers and the research process. Community-based participatory research (CBPR) approaches seek to reverse this pattern by building trust between community members and researchers. We highlight strategies for building and maintaining trust from an American Indian CBPR project and focus on 2 levels of trust building and maintaining: (1) between university and community partners and (2) between the initial project team and the larger community. This article was cowritten by community and academic partners; by offering the voices of community partners, it provides a novel and distinctive contribution to the CBPR literature.