Methods In Community Based Participatory Research For
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S S
Methods in Community-Based
Participatory Research
for Health
Barbara A. Israel, Eugenia Eng,
Amy J. Schulz, and Edith A. Parker
Editors
Foreword by David Satcher
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Copyright © 2005 by John Wiley & Sons, Inc. All rights reserved.
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Portions of Chapter Eight have appeared in Zenk, S. N., Schulz, A. J., Israel, B. A., House, J. S., Benjamin, A.,
& Kannan, S. (2005). Use of community-based participatory research to assess environmental determinants of
health: Challenges, facilitators, and implications for universities. Metropolitan Universities Journal, 16(1),
107–125. Included with the permission of the publisher. Reprinted with permission from Indiana University
Purdue University Indianapolis (IUPUI), University College.
Library of Congress Cataloging-in-Publication Data
Methods in community-based participatory research for health/Barbara A.
Israel . . . [et al.]; foreword by David Satcher.—1st ed.
p.; cm.
Includes bibliographical references and index.
ISBN-13 978-0-7879-7562-3
ISBN-10 0-7879-7562-1 (alk. paper)
1. Public health—Research—Citizen participation—Case studies. 2.
Public health—Research—Methodology—Case studies. 3. Community health
services—Case studies.
[DNLM: 1. Public Health—methods—Case Reports. 2.
Research—methods—Case Reports. 3. Consumer Participation—methods—Case
Reports. 4. Cultural Diversity—Case Reports. WA 20.5 M592 2005]. I.
Israel, Barbara A.
RA440.85.M475 2005
362.1'072—dc22
2005012788
Printed in the United States of America
FIRST EDITION
HB Printing 10 9 8 7 6 5 4 3 2 1
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S S
CONTENTS
Figures and Tables xi
Foreword xiii
David Satcher
Acknowledgments xvii
The Editors xxi
The Contributors xxv
PART ONE: INTRODUCTION TO METHODS IN COMMUNITY-BASED PARTICIPATORY
RESEARCH FOR HEALTH 1
1 Introduction to Methods in Community-Based Participatory
Research for Health 3
Barbara A. Israel, Eugenia Eng, Amy J. Schulz, and Edith A. Parker
PART TWO: PARTNERSHIP FORMATION AND MAINTENANCE 27
2 Developing and Maintaining Partnerships with Communities 31
Nina Wallerstein, Bonnie Duran, Meredith Minkler, and Kevin Foley
v
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vi CONTENTS
3 Strategies and Techniques for Effective Group Process in CBPR
Partnerships 52
Adam B. Becker, Barbara A. Israel, and Alex J. Allen III
PART THREE: COMMUNITY ASSESSMENT AND DIAGNOSIS 73
4 Insiders and Outsiders Assess Who Is “The Community”: Participant
Observation, Key Informant Interview, Focus Group Interview, and
Community Forum 77
Eugenia Eng, Karen Strazza Moore, Scott D. Rhodes, Derek M. Griffith, Leo L. Allison,
Kate Shirah, and Elvira M. Mebane
PART FOUR: DEFINITION OF THE ISSUE 101
5 CBPR Approach to Survey Design and Implementation: The Healthy
Environments Partnership Survey 107
Amy J. Schulz, Shannon N. Zenk, Srimathi Kannan, Barbara A. Israel,
Mary A. Koch, and Carmen A. Stokes
6 Using a CBPR Approach to Develop an Interviewer Training Manual
with Members of the Apsáalooke Nation 128
Suzanne Christopher, Linda Burhansstipanov, and Alma Knows His
Gun-McCormick
7 The Application of Focus Group Methodologies to Community-Based
Participatory Research 146
Edith C. Kieffer, Yamir Salabarría-Peña, Angela M. Odoms-Young,
Sharla K. Willis, Kelly E. Baber, and J. Ricardo Guzman
8 Application of CBPR in the Design of an Observational Tool: The
Neighborhood Observational Checklist 167
Shannon N. Zenk, Amy J. Schulz, James S. House, Alison Benjamin, and
Srimathi Kannan
9 Mapping Social and Environmental Influences on Health: A Community
Perspective 188
Guadalupe X. Ayala, Siobhan C. Maty, Altha J. Cravey, and Lucille H. Webb
10 Community-Based Participatory Research and Ethnography: The
Perfect Union 210
Chris McQuiston, Emilio A. Parrado, Julio César Olmos-Muñiz, and
Alejandro M. Bustillo Martinez
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CONTENTS vii
11 What’s with the Wheezing? Methods Used by the Seattle-King
County Healthy Homes Project to Assess Exposure to Indoor
Asthma Triggers 230
James Krieger, Carol A. Allen, John W. Roberts, Lisa Carol Ross, and Tim K. Takaro
PART FIVE: DOCUMENTATION AND EVALUATION OF PARTNERSHIPS 251
12 Documentation and Evaluation of CBPR Partnerships: In-Depth
Interviews and Closed-Ended Questionnaires 255
Barbara A. Israel, Paula M. Lantz, Robert J. McGranaghan, Diana L. Kerr,
and J. Ricardo Guzman
PART SIX: FEEDBACK, INTERPRETATION, DISSEMINATION, AND APPLICATION
OF RESULTS 279
13 Developing and Implementing Guidelines for Dissemination:
The Experience of the Community Action Against Asthma Project 285
Edith A. Parker, Thomas G. Robins, Barbara A. Israel, Wilma Brakefield-Caldwell,
Katherine K. Edgren, and Donele J. Wilkins
14 Creating Understanding and Action Through Group Dialogue 307
Elizabeth A. Baker and Freda L. Motton
15 Photovoice as a Community-Based Participatory Research Method:
A Case Study with African American Breast Cancer Survivors in
Rural Eastern North Carolina 326
Ellen D. S. López, Eugenia Eng, Naomi Robinson, and Caroline C. Wang
16 Policy Analysis and Advocacy: An Approach to Community-Based
Participatory Research 349
Nicholas Freudenberg, Marc A. Rogers, Cassandra Ritas, and Sister Mary Nerney
17 Citizens, Science, and Data Judo: Leveraging Secondary Data Analysis
to Build a Community-Academic Collaborative for Environmental Justice
in Southern California 371
Rachel Morello-Frosch, Manuel Pastor Jr., James L. Sadd, Carlos Porras,
and Michele Prichard
APPENDIXES 393
A Instructions for Conducting a Force Field Analysis 395
Adam B. Becker, Barbara A. Israel, and Alex J. Allen III
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viii CONTENTS
B Community Member Key Informant Interview Guide 397
Eugenia Eng, Karen Strazza Moore, Scott D. Rhodes, Derek M. Griffith, Leo L. Allison,
Kate Shirah, and Elvira M. Mebane
C Selected New and Revised Items Included in the HEP Survey After Input
from the Steering Committee or Survey Subcommittee (SC), Focus Group
Themes (FG), or Pilot Testing (PT) of Existing Items 400
Amy J. Schulz, Shannon N. Zenk, Srimathi Kannan, Barbara A. Israel,
Mary A. Koch, and Carmen A. Stokes
D Selected HEP Measures by Survey Categories, with Sources and Scale
Items 402
Amy J. Schulz, Shannon N. Zenk, Srimathi Kannan, Barbara A. Israel,
Mary A. Koch, and Carmen A. Stokes
E Healthy Environments Partnership: Neighborhood Observational
Checklist 408
Shannon N. Zenk, Amy J. Schulz, James S. House, Alison Benjamin,
and Srimathi Kannan
F Field Notes Guide 423
Chris McQuiston, Emilio A. Parrado, Julio César Olmos, and Alejandro
M. Bustillo Martinez
G Detroit Community-Academic Urban Research Center: In-Depth,
Semistructured Interview Protocol for Board Evaluation,
1996–2002 425
Barbara A. Israel, Paula M. Lantz, Robert J. McGranaghan, Diana L. Kerr,
and J. Ricardo Guzman
H Detroit Community-Academic Urban Research Center: Closed-Ended
Survey Questionnaire for Board Evaluation, 1997–2002 430
Barbara A. Israel, Paula M. Lantz, Robert J. McGranaghan, Diana L. Kerr,
and J. Ricardo Guzman
I Philosophy and Guiding Principles for Dissemination of Findings of the
Michigan Center for the Environment and Children’s Health (MCECH)
Including Authorship of Publications and Presentations, Policies and
Procedures, Access to Data, and Related Matters 434
Edith A. Parker, Thomas G. Robins, Barbara A. Israel, Wilma Brakefield-Caldwell,
Katherine K. Edgren, and Donele J. Wilkins
J Community Action Against Asthma: Fact Sheet on “Particulate
Matter” 438
Edith A. Parker, Thomas G. Robins, Barbara A. Israel, Wilma Brakefield-Caldwell,
Katherine K. Edgren, and Donele J. Wilkins
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CONTENTS ix
K Community Action Against Asthma: Summary of Air Sampling Data
in Your Community and Home, 2000–2001 442
Edith A. Parker, Thomas G. Robins, Barbara A. Israel, Wilma Brakefield-Caldwell,
Katherine K. Edgren, and Donele J. Wilkins
L The Planning Grant: In-Depth Group Interview Protocol: Questions for
Community and Coalition Members 445
Elizabeth A. Baker and Freda L. Motton
M Inspirational Images Project: Fact Sheet and Informed Consent Form for
Study Participants 447
Ellen D. S. López, Eugenia Eng, Naomi Robinson, and Caroline C. Wang
N Inspirational Images Project: Consent for Adults Who May Appear in
Photographs 451
Ellen D. S. López, Eugenia Eng, Naomi Robinson, and Caroline C. Wang
O Community Reintegration Network: Policy Report—Coming Back to
Harlem from Jail or Prison: One-Way or Round-Trip 453
Nicholas Freudenberg, Marc A. Rogers, Cassandra Ritas, and Sister Mary Nerney
P Southern California Environmental Justice Collaborative (the
Collaborative): Partnership Agreed upon Mechanism for Deciding on
Research Activities 459
Communities for a Better Environment, Liberty Hill Foundation,
and The Research Team
Name Index 461
Subject Index 468
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FIGURES AND TABLES
FIGURES
12.1 Conceptual Framework for Understanding and Assessing the
Effectiveness of the CBPR Partnership Process 258
15.1 Conceptual Framework of Rural African American Breast Cancer
Survivors’ Quality of Life 338
K.1 Average Levels of Particulate Matter in Your Home and Community,
2000–2001 443
TABLES
6.1 Indian Health Service (IHS) Age-Adjusted Cervical Cancer Mortality
Rates, by Region, 1994–1998 129
8.1 Design and Implementation of the Neighborhood Observational
Checklist: Major Tasks, Participants, and Timeline 173
8.2 Examples of Neighborhood Stressors Identified by Residents in Focus
Groups, Included in the HEP Survey, and Included in the HEP
Neighborhood Observational Checklist 175
xi
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xii FIGURES AND TABLES
10.1 Community Ethnographers’ Predictions and Results from the
Ethnosexual Survey for Household Division of Labor in Mexico and
the United States 221
11.1 Exposure Assessment Measures 237
13.1 Types and Numbers of CAAA Dissemination Activities over Five
Years 294
16.1 Key Partners in the Project 355
16.2 Methods Used to Understand and Change Jail Reentry Policies 356
C.1 Selected New and Revised Items Included in the HEP Survey After
Input from the Steering Committee or Survey Subcommittee (SC),
Focus Group Themes (FG), or Pilot Testing (PT) of Existing
Items 400
D.1 Selected HEP Measures by Survey Categories, with Sources and
Scale Items 402
H.1 Detroit Community-Academic Urban Research Center:
Closed-Ended Survey Questionnaire for Board Evaluation,
1997–2002 430
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S S
FOREWORD
David Satcher, M.D., Ph.D.
s director of the Centers for Disease Control and Prevention (CDC) in the
A mid-1990s, I had the opportunity to initiate the Urban Research Centers
Program. At that time, we were able to fund three inaugural programs rep-
resenting partnerships between communities and academic institutions. The
original programs were in Detroit, Michigan, Seattle, Washington, and New
York, New York. Although we were not able to expand the programs as we had
hoped, we learned and continue to learn valuable lessons from them. Many of
these lessons were included in the first comprehensive federal programs geared
toward the reduction and ultimate elimination of disparities in health: The
CDC’s Racial and Ethnic Approaches to Community Health (REACH). Currently,
more than forty communities have been funded through REACH. These com-
munities are funded and empowered to contract with academic health centers
to conduct community-based participatory research.
Community-based participatory research brings the best and latest technol-
ogy for design and measurement to the major issues impacting community
health. In communicating the goals, objectives, and strategies of Healthy Peo-
ple 2010, we settled on a design that showed the interaction among determi-
nants of health. The major components included the individual and his or her
behavior (downstream), the physical and social environment including health-
care (midstream), and the various policies that impact this interaction
(upstream). We tried to show that the components do not exist in isolation; that
there is intense interaction among them. It is increasingly clear that in order to
xiii
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xiv FOREWORD
reach the goals of improving quality as well as increasing years of healthy life
and eliminating disparities in health among different racial, ethnic, and socio-
economic groups, we must target all of the determinants of health where dis-
parities have their roots. We must close the gaps that exist in access to quality
health care, practice of healthy lifestyles, quality of physical and social
environments, and policies that impact these areas. For research aimed at under-
standing and closing these gaps, community-based participatory research is a
viable approach.
As more and more programs in community-based participatory research are
funded and initiated, it is important that the lessons learned and problems solved
in this area over the last thirty or more years are captured and shared. This book,
Methods in Community-Based Participatory Research for Health, is a major con-
tribution to this field. The editors are some of our most outstanding leaders in
community-based participatory research. The writing of this book represents an
unusual partnership among diverse participants whose involvements with com-
munities make them experts in their own right. They bring a broad range of per-
spectives to this research approach, grounded in extensive community
involvement and experience. What brings them together in this book is their
respect for the dignity of community and the tremendous challenges and oppor-
tunities found in communities for enhancing health. Because they have found
each other, and have come together around this common theme from their
diverse backgrounds of race, ethnicity, and perspective, we are the beneficiaries
of this outstanding text.
Critical to each case example of community-based participatory research
discussed in this book is the development of meaningful partnerships. These part-
nerships must exist in order that when the question is asked, “Who is the com-
munity?,” the answer can reliably be, “We are the community,” who have engaged
in meaningful partnerships, made the investments, developed the relationships,
suffered the pains, and reaped the benefits of the community. These partnerships
are entrenched in the community, they are as diverse as the community, and
they are devoted to meaningful change and progress in the community. They
share knowledge, resources, and control at every level of the community.
They are trusted, not because of what they say, but because of who and where they
are, and with whom they share information, methodology, and control of the
research agenda. They are interested in bringing the best technology and method-
ology to bear on problems and opportunities within the community. Community-
based participatory research deals with all the determinants of health and the
dynamic nature of the interactions within the community. This research approach
holds the promise of getting to the root cause of disability and of strategies
for enhancing health as well as the involvement of persons at every level of
community. In her book Night Falls Fast, which deals with teenage suicide,
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FOREWORD xv
Kay Redfield Jamison says, “The gap between what we know and what we do
is lethal.” Community-based participatory research holds the promise of removing
these tremendous gaps and adding significantly to what we know.
To move our field forward in accomplishing these aims, this volume provides
an excellent compendium of chapters on the methods and processes of
community-based participatory research.
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S S
ACKNOWLEDGMENTS
his book would not have been possible without the insightful contributions
T from the numerous authors who so graciously shared their time and experi-
ences in writing these chapters. It was important to us that each chapter
reflected the principles of community-based participatory research (CBPR),
involving community partners as well as academics and health practitioners as
coauthors. We extend to each writing team, therefore, our deepest apprecia-
tion for the privilege of witnessing, and temporarily joining, their collaboration
throughout the writing process.
And to those with whom we have collaborated through our CBPR partner-
ships over the years we are tremendously indebted. We consider ourselves most
fortunate to have worked with, learned from, and been inspired by many part-
ners. To our community and health practitioner partners and staff we are espe-
cially grateful for their wisdom and tireless efforts to effect meaningful change in
their communities, and in us. We have also been most fortunate to count among
our academic partners faculty colleagues, students, and postdoctoral fellows
whose hard work and enthusiastic engagement continue to renew our energy
and our perspectives on the value of CBPR. Specifically, although too numerous
to mention by name, we would like to acknowledge and thank the many com-
munity and academic partners who have been involved with us through the fol-
lowing CBPR partnerships: Bi-Cultural Bi-Lingual Medicaid Managed Care
Project, Broome Team in Flint, Carolina-Shaw Partnership to Eliminate Health
Disparities, Chatham Communities in Action, Chatham Social Health Council,
xvii
