Trickett Responds

In my original response¹ to Katz et al.,² I pointed out three ideas: (1) that relegating community-based participatory research (CBPR) to the implementation phase of the intervention process represents a truncated instrumental conception of CBPR that differs substantially from the CBPR worldview described by its most active proponents, (2) that the representation of form and function distinction by Hawe et al.³ represented a distortion of its intended meaning, and (3) that the logic of translational research includes the broader scientific issues of how to assess the external validity of findings with respect to specific communities. The third point was in essence a restatement of the comment by Glasgow et al. that

the assumption that effectiveness research naturally and logically follows from successful efficacy research … is inherently flawed, or at least incomplete.^4(p1262)

One reason I viewed the role of CBPR as subservient and not “blended” in the Katz et al. article was that the authors seemed to accept at face value the external validity of findings. The seeming acceptance of the findings as givens not to be questioned but rather tailored represents what a colleague of mine called “double-blind faith”: in the context- and culture-free generalizability of findings and in the belief that intervention effects lie in the faithful application (even if tailored) of a technology rather than as emerging from a more complex technology-relationship-system dynamic system perspective outlined by Hawe et al.³ The notion that after spending millions of dollars and achieving a finding that “it stands to reason” that translational efforts should follow makes sense from a “double-blind faith” perspective but is questioned from the more contextualist and empowerment worldview of CBPR.

While the “pure” view of CBPR may indeed be neither feasible nor indeed desirable depending on context, the spirit and goals of CBPR can still permeate translational research. First comes the scientific mandate to question double-blind faith and review carefully the constraints on the findings underlying the proposed translational project as they apply to the community of relevance. The extraordinary level of resources employed in the example program cited by Katz et al. coupled with the stringent inclusion criteria for participants underscores the value of this scientific assessment of external validity. Moving the intervention to included strategies to assess, target, and improve community capacity as explicit, measureable goals can be incorporated into translational efforts. Furthermore as Katz et al. note, there are many candidate programs available for translational efforts across communities. Here the spirit of CBPR may be manifest in promoting informed community choice in selecting what they deem most relevant among those programs showing empirical promise.⁵

Once again I appreciate the opportunity to engage in this important discussion. However, I respectfully feel that characterizing the discussion as primarily one of miscommunication obscures deeper differences in worldview.