CHL 620 Week 2 Community-Based Participatory Research Plan Example

Residents as Co-Researchers: A Community-Based Participatory Research Study of Why East Side Adults Delay Primary Care

[Student Name]

University of Phoenix

CHL/620: Community Health Engagement and Organizing

Week 2 Assignment

[Instructor Name]

[Date]

The neighborhoods, university partner, research team, study design, agreements and findings are composites written for a model paper modeled on Yakima, Washington; research findings come from the sources cited.

After the community health assessment, a professor at the regional university offered to study why east side adults delay primary care. The access workgroup welcomed the offer but set a condition: residents would be co-researchers, not subjects. The professor agreed, and the partners designed a community-based participatory research study. This paper describes the plan, how it unfolded and what it produced.

What CBPR Is

Community-based participatory research is a collaborative approach that combines systematic inquiry, participation and action. A review for urban health researchers argues that many complex health problems are poorly suited to traditional approaches and presents CBPR as a promising alternative, highlighting partnership synergy and cultural humility as tools for handling the ethical challenges that partnership research can raise (Minkler, 2005).

How CBPR Differs From Traditional Research

In traditional research, investigators choose the question, design the study, collect data from participants and publish results, often with little return to the community. In CBPR, community members and researchers share decisions in every phase, and the research is expected to lead to action that benefits the community.

Guiding Principles

The partners adopted principles from a review of community-based research: recognize the community as a unit of identity, build on its strengths, facilitate equitable partnership in all phases, integrate knowledge and action for mutual benefit, promote co-learning and address health from positive and ecological perspectives (Israel et al., 1998). The principles were written into the partnership agreement.

Power and Reciprocal Learning

CBPR is also a way to address inequities in who produces knowledge. Wallerstein and Duran see in CBPR a way to close the gap between what science learns and what communities experience. Its tools, in their account, include deliberately rebalancing power, making sure both residents and academics gain from the work and letting knowledge flow in both directions, so that residents' own explanations of their lives enter the research as theory (Wallerstein & Duran, 2010). The east side partners took that seriously: residents' explanations for delays would be treated as hypotheses, not anecdotes.

The Partnership Agreement

The written agreement covered six points. Decisions about the question, methods and dissemination require agreement of the university team and the resident co-researchers. Data belong jointly to the workgroup and the university, and no data leave the partnership without joint approval. Findings go first to the community, then to academic journals. Resident co-researchers are paid for their time and listed as authors where they contribute. Disagreements go to a small committee with equal membership. The university returns a share of grant overhead to the coalition.

Phase One: Choosing the Question

The university team proposed a question about insurance enrollment. Residents argued that many insured people also delayed care, for reasons the survey had only hinted at. After discussion, the partners agreed on a broader question: what leads east side adults, insured or not, to delay primary care, and what would help them get care sooner?

Phase Two: Designing the Methods

Residents shaped the methods. They recommended in-depth interviews in homes and churches rather than clinic waiting rooms, where people might hesitate to criticize the clinic. They insisted on questions about work schedules and transportation, which the university's draft lacked. The design combined 40 interviews with a short follow-up survey of 300 adults at community events.

Phase Three: Training Co-Researchers

Eight residents, including two promotoras and two farmworkers, were trained over five sessions in research ethics, interviewing, note-taking and confidentiality. They completed the university's human subjects training, adapted into Spanish with the review board's approval.

Budget for Participation

The study budget reflected shared work. Resident co-researchers were paid the same hourly rate as graduate research assistants, and the budget included child care, interpretation, meals for community meetings and translation of the final report. These items made up about a fifth of the budget, a share the university initially questioned and later described as the best investment in the study.

Phase Four: Collecting Data

Co-researchers conducted most interviews in Spanish or English, in settings participants chose. They reported that people talked more openly with neighbors than they had in previous surveys. The follow-up survey was administered at the flea market, church festivals and soccer games.

Phase Five: Analyzing Together

Analysis was shared. University staff transcribed and prepared interviews; co-researchers and faculty coded them together in four working sessions, debating the meaning of themes. Residents recognized patterns that faculty missed, such as the role of adult children as interpreters and drivers, whose own work schedules shaped when parents could see a doctor.

What the Study Found

Five reasons for delay emerged: clinic hours that conflict with work, especially for hourly and seasonal workers; difficulty getting appointments by phone; dependence on adult children for rides and interpretation; fear of costs even among insured people, due to past surprise bills; and distrust after experiences of disrespect. The follow-up survey confirmed that 44% of adults had delayed care because of work schedules. Insurance opened the door, but work hours, rides and past bills kept people from walking through it.

Ethical Challenges

Three challenges arose. First, co-researchers learned sensitive information about neighbors, including immigration status; the team adopted a rule that such details were never written down. Second, the university wanted to publish before the community meeting; the agreement required the community to hear first, and the timeline was adjusted. Third, a clinic partner was uncomfortable with findings about disrespect; the partners agreed to share findings privately first and involve the clinic in responding.

What Co-Researchers Gained

The eight co-researchers gained skills and standing. Two enrolled in community college health programs, one joined the clinic's patient advisory board and several presented findings to the hospital board. Building local capacity is part of CBPR's purpose: the community should be better able to study and solve its own problems when the project ends.

Sharing Findings

Findings were presented first at a community meeting in Spanish and English, then to the clinic and hospital, then in a report for partners and finally in an academic article with resident co-authors.

From Findings to Action

The findings shaped action. The clinic added two evening sessions a week and a Saturday morning, created a text-message appointment line, trained front desk staff in respectful communication and joined the hospital in posting clear cost information. The workgroup began planning a community health worker program to help with appointments, rides and bills.

Lessons

The partners learned that residents improved the science, not just the ethics: they reframed the question, redesigned methods and interpreted findings more accurately. They also learned that CBPR takes longer and requires budgeting for resident time.

Conclusion

Residents as co-researchers turned a study of insurance into a study of why people delay care, with findings that led directly to evening hours, text appointments and a planned community health worker program. CBPR principles, a written partnership agreement and attention to power and ethics made that possible, and the research strengthened the partnership for the work ahead.

References

Israel, B. A., Schulz, A. J., Parker, E. A., & Becker, A. B. (1998). Review of community-based research: Assessing partnership approaches to improve public health. Annual Review of Public Health, 19, 173-202. https://doi.org/10.1146/annurev.publhealth.19.1.173

Minkler, M. (2005). Community-based research partnerships: Challenges and opportunities. Journal of Urban Health, 82(Suppl. 2), ii3-ii12. https://doi.org/10.1093/jurban/jti034

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(S1), S40-S46. https://doi.org/10.2105/AJPH.2009.184036