Participatory Action Research for Occupational Health

Report
THE DETROIT COMMUNITY-ACADEMIC
URBAN RESEARCH CENTER: PRINCIPLES,
RATIONALE, CHALLENGES AND LESSONS
LEARNED THROUGH A COMMUNITYBASED PARTICIPATORY RESEARCH
PARTNERSHIP
Barbara A. Israel*
Presented at the “Summer Public Health Research Institute and
Videoconference on Minority Health”
Chapel Hill, NC
June 16, 2000
*With acknowledgment to my colleagues and co-authors in conducting community-based
participatory research: A. Allen, E. Baker, A. Becker, R. Guzman, C. Heaney, J. House, M.
Hugentobler, P. Lantz, R. Lichtenstein, B. Maciak, R. McGranaghan, E. Parker, A. Schulz,
S. Schurman, D. Softley and the many other community partners with whom I have worked
(some sections of this presentation adapted from selected references, listed at the end). The
Center is supported through a Cooperative Agreement with the Centers for Disease Control
and Prevention.
Copyright 2000, Barbara Israel
MODIFYING VARIABLES: Individual or Situational Characteristics
Social
Psychological
PsychosocialEnvironmental
Conditions (Stressors)
Behavioral
Biophysical
Genetic
Short-Term Responses
to Stress (Strain)
Perceived
Stress
1. Physiological
2. Psychological
3. Behavioral
Enduring Health
Outcomes
1. Physiological
2. Psychological
3. Behavioral
Conceptual Framework of the Stress Process
Copyright 2000, Barbara Israel
Implications of the Stress Model for
Prevention Interventions
• Context-specific interventions
• Comprehensive approach to prevention
interventions
• Primary, secondary and tertiary
prevention
• Different types of stressors
Copyright 2000, Barbara Israel
Implications of the Stress Model for
Prevention Interventions (continued)
• Objective conditions
• Multiple outcomes
• Collective action and broad scale
change
• Participants’ involvement and control
• Inter-disciplinary teams
Copyright 2000, Barbara Israel
DEFINITION OF COMMUNITYBASED PARTICIPATORY
RESEARCH
Community-based participatory research in
public health is a partnership approach to research
that equitably involves, for example, community
members, organizational representatives, and
researchers in all aspects of the research process;
with all partners contributing their expertise and
sharing responsibility and ownership to enhance
understanding of a given phenomenon, and to
integrate the knowledge gained with action to
improve the health and well-being of community
members.
Barbara
Copyright 2000,
Israel
Key Principles of CommunityBased Participatory Research
1. Recognizes community as unit of
identity
2. Builds on strengths and resources
3. Facilitates collaborative partnership
4. Integrates knowledge and intervention
for mutual benefit of all partners
5. Promotes co-learning and empowering
process
Copyright 2000, Barbara Israel
Key Principles of CommunityBased Participatory Research
(continued)
6. Involves a cyclical, iterative process
7. Addresses health from positive and
ecological perspectives
8. Disseminates findings and knowledge
gained to all partners
9. Involves a long-term commitment by all
partners
Copyright 2000, Barbara Israel
Rationale/Advantages of CBPR
• Enhances relevance and use of data
• Joins partners with diverse expertise to
address complex problems
• Improves quality and validity of research
• Knowledge gained is used to benefit the
community
• Increases possibility of overcoming
community’s distrust of research
Copyright 2000, Barbara Israel
Rationale/Advantages of CBPR
(continued)
• Has potential to “bridge cultural gaps”
between partners
• Overcomes separation of individual
from culture and context that often
occurs with categorical approaches
• Provides resources for communities
involved
• Aims to improve health and well-being
of communities involved
Copyright 2000, Barbara Israel
Detroit Community-Academic
Urban Research Center (URC)
Partner Organizations
Butzel Family Center
Community Health and Social Services (CHASS)
Detroit Health Department
Friends of Parkside
Henry Ford Health System
Kettering Butzel Health Initiative
Latino Family Services
University of Michigan School of Public Health
Warren/Conner Development Coalition
Copyright 2000, Barbara Israel
Overall Mission of the Detroit URC
Establish an effective community-based
participatory research partnership to
jointly identify factors affecting the
health and well-being of residents on the
east and southwest sides of Detroit, and
to implement and evaluate interventions
and policies to address these factors in
ways that recognize, build upon and
enhance the resources and strengths in
the communities involved.
Copyright 2000, Barbara Israel
Processes Involved in Developing
the Center and URC Board
• Grant proposal submission
• Meetings with partner organizations
• Developing the URC Board
– establishment of operating norms
– adoption of CBPR principles
Copyright 2000, Barbara Israel
Processes Involved in Developing the
Center and URC Board (continued)
• Process of setting priorities
– identification of community strengths and
problems
– discussion of issues partner organizations
address
– selection of levels of affiliation and
participation
– further identification of problems and selection
of priorities
• Establishing an infrastructure
Copyright 2000, Barbara Israel
Evaluation Design and Methods
• Participatory case study design
• Process and impact evaluation
• Qualitative and quantitative methods
Copyright 2000, Barbara Israel
Evaluation Results:
Major Accomplishments
• Adopting and following operating
procedures and CBPR principles
• Creating effective team and partnership
• Creating and maintaining trust
• Building new relationships
– linking east and southwest sides
– linking University and community-based
organizations
Copyright 2000, Barbara Israel
Evaluation Results:
Major Accomplishments (continued)
• Developing proposals and acquiring
funding
– 7 Level 1 CBPR projects
– Over 8 million dollars received
• Implementing CBPR projects
• Beginning to focus and conduct
dissemination regarding CBPR
Copyright 2000, Barbara Israel
Evaluation Results: Challenges
• Significant time and effort required to build
trust and working relationships among
partners
• Articulating and agreeing upon a common
purpose
• Seeking a balance between task and
process/research and action
• Working together amidst ethnic, cultural,
social class and organizational differences
Copyright 2000, Barbara Israel
Evaluation Results: Challenges
(continued)
• Following agreed-upon CBPR principles in
practice
• Competing institutional demands and risks
• Working toward equitable or fair
distribution of resources and benefits
• Proving partnership/intervention success
Copyright 2000, Barbara Israel
Evaluation Results: Facilitating Factors,
Lessons Learned and Recommendations for
Conducting CBPR
• Jointly develop operating norms and
CBPR principles
• Create a balance between time spent on
process issues and tasks/ products
• Select mutually defined priority issues,
goals and objectives
• Focus on community strengths as well as
problems
Copyright 2000, Barbara Israel
Evaluation Results: Facilitating Factors,
Lessons Learned and Recommendations
(continued)
• Start small, involving a few highly regarded
CBOs within communities of identity
• Obtain support and involve top leadership
from partner organizations
• Use informal democratic processes and
consensus decision-making
• Build on prior history of positive working
relationships
Copyright 2000, Barbara Israel
Evaluation Results: Facilitating Factors,
Lessons Learned and Recommendations
(continued)
• Researcher orientation and commitment
• Methodological flexibility and different
criteria for judging effectiveness
• Establish and maintain infrastructure
• Reach a balance in the distribution of
benefits and resources
• Promote policy changes consistent with and
supportive of CBPR
Copyright 2000, Barbara Israel
Concluding Remarks
Need for greater:
• awareness and recognition of the meaning
and value of community-based participatory
research;
• funding support from public and private
funding institutions, particularly in
communities that experience a
disproportionate burden of health
disparities;
Copyright 2000, Barbara Israel
Concluding Remarks (continued)
Need for greater:
• emphasis on capacity building and training
of all partners to enhance skills needed to
conduct CBPR;
• benefits and reward structures for
involvement in CBPR; and
• use of multiple case study evaluations to
assess the context, process and outcomes of
CBPR endeavors.
Copyright 2000, Barbara Israel
Selected References*
Israel BA, Schurman SJ, House JS. 1989. Action research on occupational
stress: Involving workers as researchers. International Journal of Health
Services, 19: 135-155.
Israel BA, Baker EA, Goldenhar LM, Heaney CA, Schurman SJ. 1996.
Occupational stress, safety and health: Conceptual framework and
principles for effective prevention interventions. Journal of
Occupational Health Psychology, 1(3): 261-286.
Israel BA, Schulz AJ, Parker EA, Becker AB. 1998. Review of communitybased research: Assessing partnership approaches to improve public
health. Annual Review of Public Health, 19: 173-202.
Israel BA, Schulz AJ, Parker EA, Becker AB. 2000. Community-based
participatory research: Engaging communities as partners in health
research. Presented at the Community-Campus Partnerships for
Health’s 4th Annual Conference, Washington, DC, April 29, 2000.
Israel BA, Lichtenstein RL, Lantz P, McGranaghan RJ, Allen A, Guzman
JR, Softley D, Maciak BJ. The Detroit Community-Academic Urban
Research Center: Lessons learned in the development, implementation
and evaluation of a community-based participatory research partnership.
Submitted for review.
Copyright 2000, Barbara Israel
Selected References* (continued)
Parker EA, Schulz AJ, Israel BA, Hollis RM. 1998. Eastside Detroit Village
Health Worker Partnership: Community-based lay health advisor intervention
in an urban area. Health Education & Behavior, 25(1): 24-45.
Schulz AJ, Israel BA, Selig SM, Bayer IS. 1998. Development and
implementation of principles for community-based research in public health.
In R.H. MacNair (Ed.), Research Strategies for Community Practice. New
York: Haworth Press, pp. 83-110.
Schulz AJ, Parker EA, Israel BA, Becker AB, Maciak BJ, Hollis RM. 1998.
Conducting a participatory community-based survey: Collecting and
interpreting data for a community health intervention on Detroit’s east side.
Journal of Public Health Management and Practice, 4(2): 10-24.
Schurman SJ, Israel BA. 1995. Redesigning work systems to reduce stress: A
participatory action research approach to creating change. In L. Murphy, J.
Hurrell, S. Sauter and G. Keita (eds.) Job Stress Interventions, Washington
DC: American Psychological Association.
* Some sections of this presentation are adapted from these references
Copyright 2000, Barbara Israelv

similar documents