Written by Vetta Sanders Thompson, the E. Desmond Lee Professor of Racial and Ethnic Diversity and Associate Dean for Diversity, Inclusion & Equity at the Brown School; and co-director the Center for Community Health Partnership and Research at the Institute for Public Health
Community engagement involves conversations, sharing of insights and diverse perspectives that allow consensual problem identification among defined constituencies.
Advocacy for identified issues is achieved through coalition and consensus building, constituency and community outreach and networking, communication including negotiation, grassroots organizing, as well as efforts related to organizational development (Adler & Goggin, 2016; Zakus & Lysack, 1998). Hopefully, the decisions, solutions, interventions and actions developed in response to identified issues are informed by data and information that include and are relevant to the history and experience of the community.
Community Engagement
Within the sphere of public health research, the hope and appeal of community engagement is the contribution it can make to the understanding of health problems and the relevance of interventions addressing these problems. The expectation is that community engagement will lead to higher participation rates, insightful interpretation of findings and greater reliability and validity of measures in community-based settings (Cargo & Mercer, 2008; Jagosh et al., 2011; Minkler, 2005; Wallerstein & Duran, 2010). In turn, these changes in process can increase the quality of research, conducted within diverse populations (Cargo & Mercer, 2008; Jagosh et al., 2011, 2012; Nueces et al., 2012). Public health discussions of community-engaged research often focus on one form of engagement on one end of the engagement spectrum, typically community-based participatory research. However it is important to note that there are levels of stakeholder engagement, variously defined.
There are a number of descriptions of community and participatory engagement strategies (Arnstein, 1969; Frey, Lohmeier, Lee & Tollefson, 2006; Goodman & Thompson, 2017). There is discussion within the literature related to where genuine engagement begins. Clearly there are strategies that lack the level of community involvement required to be considered to be engaged. Non-participatory strategies include information and education campaigns, as well as some forms of outreach. Most researchers agree that for genuine engagement to occur researchers must intend to have some community involvement in the planning, implementation, evaluation, and decision-making related to the research effort. Moving along the engagement continuum, there are strategies that are classified as consultation, coordination, and finally collaborative. Each of these categories may be identified using other terms and can be further divided (Frey et al., 2006; Goodman & Thompson, 2017). The coordination and consultation levels of engagement bring community members and stakeholders to the table to share their insights and opinions which may inform the work at the discretion of the researcher (Goodman & Thompson, 2017). Stakeholders are in the role of advisors. There is undoubtedly benefit to the researcher and the research from this arrangement. And, in this vein the improved research may benefit the community. Collaborative community-engagement strategies require that community health stakeholders, including patients, caregivers, and advocacy groups, that traditionally have limited power share in decision-making authority with academic researchers, hospital systems, and health center leadership, forming a partnership that collaboratively manages the project based on stakeholder priorities (Arnstein, 1969). Community-based participatory research is the most frequently discussed collaborative research strategy (Minkler, 2005; Wallerstein & Duran, 2010).
Community-Engaged Research Factors
Efforts to conduct community-engaged research must recognize the numerous factors that influence the success of these efforts. There are frequently diverse perspectives, needs, resources, skills, and interests among community institutions and organizations engaged in community research partnerships. Effort is required to understand the implications of this diversity when building partnerships and to assess the extent to which partners, organizations, and individuals represent the perspectives or interests of those they serve or are perceived to represent.
In addition, organizations differ in size, resources, expertise, and capacity and individuals differ in knowledge, time, and ability. It is important to understand how differences in cognitive, physical, financial and social capital among potential partnership participants will affect readiness and ability to engage in the research enterprise. Finally, research differs in complexity, resource needs, and ability to accommodate community perspectives and needs. This places constraints on community-engagement options. Most importantly, researchers differ in commitment and capacity to conduct community-engaged research and academic institutions may exhibit characteristics that place additional constraints on this capacity. For example, expectations for publication rates, preferences for randomized control trials and funded research may not be consistent with the community and stakeholder perceptions of need. There is a need to further the science of community-engaged research. Ideally future research will evaluate how partner characteristics (size, resources and capacity), researcher attitudes and commitment affect the levels of engagement possible in research. In addition, there is a need to determine how these variables and level of engagement affect research outcomes. Finally, there is a need to strengthen measurement and methodology in this area of research.
The Center for Community Health Partnership and Research
The Center for Community Health Partnership and Research seeks to assist and support health and public health researchers at Washington University in St. Louis interested in community-engaged research and the science of community-engaged research. The Center offers consultation and assistance to researchers initiating and/or working to establish new partnerships. Center consultants can assist researchers and community organizations to select the level of engagement and strategies appropriate to the research under consideration. CCHPR maintains references and resources for scholars interested in independent reading and research in the area, including websites, toolkits, and templates. Look for CCHPR conferences and seminars designed to stimulate discussions of the practice and science of community-engaged research in 2018.
References
Adler, R. P. & Goggin, J. (2016). What do we mean by “Civic Engagement”? Journal of Transformative Education, 3(3), 236-253.
Arnstein SR. A ladder of citizen participation. Journal of the American Planning Association, 1969; 35(4), 216-224
Cargo, M., & Mercer, S. L. (2008). The value and challenges of participatory research: strengthening its practice. Annual Review of Public Health, 29, 325–350. http://doi.org/10.1146/annurev.publhealth.29.091307.083824
Frey, B. B., Lohmeier, J. H., Lee, S. W., & Tollefson, N. (2006). Measuring collaboration among grant partners. American Journal of Evaluation, 27(3), 383-392.
Jagosh, J., Macaulay, A. C., Pluye, P., Salsberg, J., Bush, P. L., Henderson, J., … Greenhalgh, T. (2012). Uncovering the benefits of participatory research: implications of a realist review for health research and practice. The Milbank Quarterly, 90(2), 311–46. http://doi.org/10.1111/j.1468-0009.2012.00665.x
Jagosh, J., Pluye, P., Macaulay, A. C., Salsberg, J., Henderson, J., Sirett, E., … Green, L. W. (2011). Assessing the outcomes of participatory research: protocol for identifying, selecting, appraising and synthesizing the literature for realist review. Implementation Science : IS, 6(1), 24. http://doi.org/10.1186/1748-5908-6-24
Minkler, M. (2005). Community-based research partnerships: challenges and opportunities. Journal of Urban Health, 82(2), Supplement 2 ii3–ii12.
Nueces, D. D. Las, Hacker, K., DiGirolamo, A., Hicks, S., De las Nueces, D., & Hicks, L. S. (2012). A systematic review of community-based participatory research to enhance clinical trials in racial and ethnic minority groups. Health Services Research, 47(3 Pt 2), 1363–86. http://doi.org/10.1111/j.1475-6773.2012.01386.x
Wallerstein, N., & Duran, B. (2010). Community-based participatory research contributions to intervention research: the intersection of science and practice to improve health equity. American Journal of Public Health, 100 Suppl , S40–6. http://doi.org/10.2105/AJPH.2009.184036
Zakus, J. D. & Lysack, C. L. (1998). Revisiting community participation. Health Policy & Planning, 13(1):1-12