Box

Community Perspectives on Research

A qualitative study by public health researchers and community members in Seattle, Washington, uncovered mostly negative community perceptions of the research conducted in their communities. Respondents noted a power imbalance between researchers and community members and described researchers as focused solely on community needs and things to be fixed. They also expressed a lack of trust in their relationship with researchers and a perception that researchers did not respect the community and were impatient for results (Sullivan et al., 2001: 137). There is "so much rhetoric around this whole issue of community-based [research], it takes an enormous amount of investment of time and energy and expertise and skill and patience in getting the foundation laid properly. . . . [Y]ou spend . . . three or four years, and a lot of funding institutions would probably go faint at that, but it really does take that kind of effort" (Sullivan et al., 2001: 139).

of those most affected not only may make it more difficult to develop and implement effective interventions for improvements in the health of the community but may also raise ethical questions (see Box 4-6). Furthermore, research has typically adhered to a scientific paradigm of objectivity and "universal" truth, whereas the issues, dynamics, and stories of communities are generally local, subjective, and unique (Schwab and Syme, 1997). This tension between the nature of the community and the nature of science may help explain why researching the effectiveness of community coalitions and community intervention has been a complicated endeavor and why investment in community-based research has been limited.

Community-based participatory research seeks to overcome some of the criticisms and distrust of academic research by emphasizing the participation and influence of nonacademic researchers in the process of creating knowledge (Israel et al., 1998). However, community members are frequently skeptical that proposed research efforts will be truly collaborative in nature. The promise of community-based participatory research brings with it the need to establish true partnerships with equal decision-making authority, mutual benefit, and shared responsibility. Major issues that must be confronted in such research include power and control, conflicts over funding, and who will be recognized as the community representative. Additionally, according to Israel and colleagues (1998), "emphasis needs to be placed on developing norms and ways of operating that promote understanding and demonstrate sensitivity and competence in working with diverse cultures." All of these factors lead to the need for a well-developed review of ethical issues involved in community-based research and an ongo ing discussion of how to ensure that such research is conducted with the highest regard for those who participate. The committee believes that discussion and debate about the ethics of community-based research are necessary and that creating a forum for such dialogue is important.

Because the community is a complex and dynamic subject, the committee agrees with those who assert that entirely new paradigms of research and analysis must be developed, along with a "postmodern epidemiology" or a "participatory eco-epidemiology" that does not sacrifice rigor but that shares power and involves all local perspectives and opinions (Schwab and Syme, 1997). Collaborative public health research that engages the community at every possible level may mean that research will be applicable and useful to them (Israel et al., 1998; Sullivan et al., 2001). Furthermore, the expertise of local community members and groups would constitute a valuable addition to a research project's assets (Omenn, 1999; Schwab and Syme, 1997).

A social marketing project to improve the health of agricultural workers in Florida provides an example of a fruitful partnership in community-based research (Flocks et al., 2001). Florida nursery and fernery workers, who are primarily Hispanic and Haitian, are exposed through their work to a large volume of pesticides known to be harmful to humans. In 1997, health researchers from the University of Florida entered into a partnership with a union, the Farmworker Association of Florida, and a social marketing firm for a project to help expand existing educational efforts and focus them into an effective, wide-scale intervention. Fernery employees participated at all stages of the research, contributing valuable cultural and occupational insights and information. The process has been lengthy and challenging because of the varied interests of the parties involved (workers, unions, health care providers, industry, academia, government agencies), but the initial work has begun to pay off. More funding has been secured, additional research has been launched, and work has begun on social marketing interventions to change employer practices and worker behaviors and on efforts to address barriers to adequate health care for this vulnerable population of workers exposed to environmental hazards (Flocks et al., 2001; L. Clarke, personal communication, April 9, 2002).

Additional discussion of issues in community-based research and the benefits of academic collaboration with communities appears in Chapter 8, which focuses on the role of academia in the public health system.

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