Community-based participatory research for health.

Minkler, M., & Wallerstein, N. (Eds.).(2003). Community-based participatory research for health. San Francisco, CA: Jossey-Bass. [Paperback; ISBN# 0-7879-6457-3]

Centers for Disease Control and Prevention (CDC) has a federally approved funding program through twenty-eight Prevention Research Centers located around the country that supports and conducts community-based participatory research (CBPR). These days a growing number of funding organizations require demonstration of CBPR as an approach for the projects they fund. Many Masters of Public Health (MPH) programs and other graduate programs in health-related fields around the nation require that community-based participatory research be a core course. As a consequence, a book in this area would be quite popular for both graduate students as well as practitioners. Perhaps keeping in mind both these audiences, this book has been written.

The book is organized into six parts with multiple authors writmg various essays within each part. The first part is the introduction to CBPR where its conceptual and historical roots have been traced. The introduction is very well written and sets the stage for the entire book. In tracing the historical and conceptual roots, the authors have done a remarkable job in discussing the work of Brazilian adult educator Paulo Freire (1970) and linking it with Lewin's (1948) action research, feminism, poststructuralism, and postcolonialism. However, one feels that equal treatment has not been given to all the paradigms, and the write-up weighs heavily on the work of Freire. The concluding chapter in the introductory part addresses key issues in CBPR that include community being the unit of identity, egalitarian partnership, collaborative capacity building, balance between research and action, addressing the multi- level web of causation, and adherence to a cyclical and long process. The chapter is able to sensitize the reader to all the salient issues in CBPR.

The second part deals with issues of power, trust and two-way exchange between researchers and participants. The first essay in this part examines the issues of race and ethnicity, racism and white privilege in CBPR. The essay concludes with practical tips on how to create alliances when differences exist. The next chapter critically examines the role for academicians in CBPR. It provides specific guidelines for participation by academicians. The final chapter discusses aspects of community researcher partnerships through a case study from Seattle, Washington. This chapter describes the process of community interviews and addresses the findings through active involvement of the community.

The third part deals with initiating work with communities by identifying strengths. In the first chapter of this part, processes of community driven issue selection are presented. The roles of researchers are especially described. Techniques such as walking and windshield tours, leaders interviews, Delphi process, capacity inventories, community asset maps, risk mapping, community dialogues, voting with your feet, developing community leaders, visioning processes, and use of creative arts are discussed. The next chapter discusses the role of internal resources in assisting CBPR. A premise is made that all communities have access to the internet and capacity to do work in a rapidly changing internet environment. This may not be necessarily true for developing country settings and may alienate readership practicing in these settings. The final chapter is a case study from Michigan that uses inexpensive cameras and trains marginalized groups to capture the images of what matters to them. These photographs serve as starting points for Freirian dialogue. This is a very interesting account of an innovative methodology.

The fourth part deals with methodological and ethical considerations in planning and implementing CBPR. The first chapter in this part discusses the issues and "choice points" for improving the quality of action research. The term "choice point" has been used to depict a new set of validity criteria. Quality issues of equality, practical usefulness, plurality of research outcomes, significance of work and development of new and enduring infrastructure have been presented and discussed. The next chapter deals with two case studies from rural North Carolina. The first one is about industrialized hog production while the second one is about discrimination in disaster relief. Both the case studies expose the influence of politicians and decision makers in CBPR. The next chapter deals with a case study from the San Francisco Bay area community and discusses the ethical issues of CBPR. The issues discussed include selecting a priority when there are divisive opinions, inclusion and exclusion criteria in selecting study participants, conflicts between insiders and outsiders, and diverse opinions regarding sharing and use of findings. The final chapter discusses issues in participatory evaluation. The chapter reinforces some of the principles already discussed in earlier chapters. A little more in-depth discussion on "how to" conduct participatory techniques would have added usefulness to this chapter.

The fifth part has accounts of CBPR with diverse populations. The first chapter in this part is a case study of village health workers involving women. The next chapter is a case study of CBPR work with Cambodian girls in Long Beach, California. The final case study in this section is about an epidemiological CBPR study involving transgender community in the San Francisco area.

The final part has essays that discuss the role of CBPR in influencing social change and promoting healthy public policies. The first chapter of this section presents two conceptual models in making policies. Issues surrounding the process of defining and framing a policy goal, selecting a policy approach, and identifying a target are discussed. The next chapter presents a case study of a campaign to change local policies that contribute to the adverse health consequences of illegal drug use in two New York City neighborhoods. It is an interesting account that provides guidance to CBPR workers involved in initiating policy level changes. The last chapter is a case account of a union-supported CBPR project undertaken by the faculty at the University of California, Berkeley and a group of twenty-five immigrant women hotel room cleaners. The case studies in this book are either directly or indirectly related to health; however, it would have been nice to have a majority of the case accounts directly address priority issues in health. This could, of course, be due to either lack of such studies or community-driven selection in which direct health issues may be a low priority.

One of the highlights of this book are its nine appendices, namely, protocol for CBPR, federal support, guidelines, documenting and assessing CBPR, thirteen policy principles, neighborhood level indicators, risk mapping, North American centers, and dialogue questions. These items in the appendices have practical unity, for both novices as well as experts in CBPR. On the whole this is a very useful, practical, and helpful book.

References

Freire, P. (1970). Pedagogy of oppressed. New York: Seabury Press.

Lewin, K. (1948). Resolving social conflicts and field theory in social science. Washington D.C: American Psychological Association