Table 3. Lessons Learned from Citizen Health Care CBPR Research.

This work is about identity transformation as a citizen professional, not just about learning a new set of skills. This work is about identifying and developing leaders in the community more than about a specific issue or action. This work is about sustained initiatives, not one-time events. Citizen initiatives are often slow and messy during in the gestation period. You need a champion with influence in the institution. Until grounded in an institution’s culture and practices, these initiatives are quite vulnerable to shifts in the organizational context. A professional who is putting too much time into a project is over-functioning and not using the model. We have found the average time commitment to be on the order of 6-8 hours per month, but over a number of years. External funding at the outset can be a trap because of timelines and deliverables, but funding can be useful for capacity building to learn the model, and for expanding the scope of citizen projects once they are developed. The pull of the traditional provider-consumer model is very strong on all sides; democratic decision making requires eternal vigilance. You cannot learn this approach without mentoring, and it takes two years to get good at it.