Facilitating Research Faculty Participation in CBPR: Development of a Model Based on Key Informant Interviews

Abstract

Community‐based participatory research (CBPR) may enhance the translational research process; however, this would require increased institutional capacity for community engaged research. In this paper, we first present results of key informant interviews with academic health center faculty regarding facilitators to faculty participation in CBPR partnerships and then propose a model arising from these results describing how increased capacity may be achieved. Participants were 13 key informant faculty of varying levels of expertise in CBPR at a large university academic health center. Interviews were recorded and transcribed. A thematic content analysis of each interview was conducted by research team members. Facilitators reported by faculty representing five health science schools were grouped into five thematic areas: (1) researcher personal attributes including an innate orientation toward working with community, (2) positive attitudes toward collaboration, (3) a partnership‐building skill set, (4) community partners who are ready and eager to collaborate, and (5) supportive institutional policies and procedures. We propose a model describing the relationship between personal attributes, learned/environmental factors, and community facilitators that may be utilized to promote increased institutional capacity for CBPR and thus increase the likelihood of the successful translation of research findings into community settings. Clin Trans Sci 2010; Volume 3: 233–238.

Background

The national focus on translational research has raised awareness of the role community plays in the successful uptake of evidence‐based health interventions that may improve health outcomes and reduce disparities. ¹ Community‐based participatory research (CBPR) is a research approach that may address challenges to the translational research process including those of external validity, lack of community trust in research, and sustainability of programming in community settings. ² In CBPR, researchers and community members co‐create partnerships where each partner’s expertise is recognized and valued with the goal of producing knowledge that may be applied to improving community health. ³ , ⁴ , ⁵ , ⁶ Using CBPR to explore a health issue can result in more valid and reliable information, which is more applicable to creating sustainable programs, interventions, or solutions. ⁷ , ⁸ , ⁹ Despite the potential contribution of CBPR, community‐engaged research represents only a fraction of all health research. ¹⁰ Few models exist for how to promote CBPR.

Barriers to utilization of CBPR have been well defined and include those at the partnership level such as lack of funding supporting partnership development, ¹¹ , ¹² mistrust, ⁹ and challenges of power‐sharing. ¹³ Institutional level barriers include lack of support for the time required to develop and maintain partnerships, ³ , ¹⁴ inadequate value attributed to CBPR, ¹⁵ challenges related to promotion and tenure, and a lack of mentorship. ¹²

The literature suggests potential facilitators to CBPR participation. First are personal attributes including a capacity for introspection and reflection, ¹² , ¹⁶ the ability to collaborate, ¹³ and character traits that engender productive responses to challenges. ¹⁷ Second are processes that positively influence group dynamics—such as techniques to develop open communication, establish norms for decision making, address conflict, and promote shared power and influence. ¹⁸ , ¹⁹ , ²⁰ Potential institutional facilitators include support for the formation of academic‐community partnerships, ²¹ , ²² institutional funds to seed CBPR, and making CBPR a focus at the leadership level. ²²

These facilitators are likely targets for training and institutional policy change, but the literature largely represents the learned experiences of pioneers in the field. ²² The present study contributes to the literature by first, directly assessing the combined perspectives of aspirant, novice, and seasoned researchers to better understand the perspectives of faculty who have limited exposure to CBPR. Second, we use this information to develop a model for promoting faculty participation in CBPR partnerships. This model may contribute to the translational research process and improve community health by defining groups of factors to be targeted in programs designed to increase capacity for CBPR within health research institutions.

Methods

Partners in Research: Improving the Health and Wellness of Immigrants and Refugees in St. Paul, MN is a National Institutes of Health funded study to evaluate a model to promote effective CBPR partnerships between academic health center faculty and immigrant and refugee community members. The research team is composed of two university researchers (Schools of Medicine and Public Health), and two community collaborators (physician and a community organizer/project coordinator).

Prior to designing a CBPR training curricula for faculty and community members, we conducted in‐depth interviews with key informant faculty. A list of faculty members using or interested in using CBPR was generated in collaboration with university leaders working to promote CBPR. We intentionally sought a diverse set of faculty in terms of academic rank, gender, membership across Academic Health Center schools, and experience using CBPR. This project was reviewed by the University of Minnesota Institutional Review Board and determined to be exempt.

Procedures and data collection

Fourteen faculties were identified as potential key informants; one was not interviewed due to scheduling conflicts. One‐on‐one hour‐long audio taped interviews were conducted by two members of the research team. Eleven interviews were performed by the project coordinator who was unknown to all but one respondent, and two interviews were conducted by the university principal investigator with respondents she did not know personally. The respondents were asked to rank their level of experience with, and interest in CBPR. Subsequent questions focused on challenges and benefits of CBPR and topics that could inform the trainings ( Table 1).

Table 1.

Faculty key informant interview questions.

Level of experience in CBPR

How would you rank yourself on interest and experience in CBPR? Low, moderate, or high?

Tell me about your experiences with CBPR/

Benefits and challenges of CBPR

What do you perceive to be the main benefits of CBPR?

What do you perceive to be the main challenges of CBPR?

CBPR training for faculty and community

What training topics would be most useful in helping faculty prepare for engaging in CBPR?

Who should be invited to participate in the trainings?

How can we encourage faculty to come to the trainings?

What training topics would be most useful in preparing community members for engaging in CBPR?

Data analysis

Each audio tape was transcribed, and transcripts were loaded into Nvivo version 8 (QRS International, Cambridge, MA, USA). A thematic content analysis of each interview was conducted by the research team and a research assistant. ²³ First, each analyst read the transcripts and generated initial coding categories. Then, the research team discussed the coding categories and schema and developed the final coding categories through consensus. Subsequently, three research team members independently coded each interview. Any coding discrepancies were discussed until consensus was reached. Descriptive statistics described key informants’ demographic and background data.

Results

As desired from this intentional sample, there was an even distribution between tenured and nontenured faculty, and CBPR experience was varied while interest was high ( Table 2). Although the interview questions did not ask explicitly about factors that would ease faculty participation in CBPR, respondents frequently identified factors that facilitate their participation in collaborative research. Facilitators were therefore identified as an overall theme of the interviews.

Table 2.

Characteristics of interview participants (n= 13).

Institutional affiliation
School of public health	2
School of nursing	4
School of medicine	5
School of pharmacy	1
School of dentistry	1
Position
Tenured	6
Nontenured	7
Gender
Female	10
Male	3
Race/ethnicity
African American	1
Caucasian	12
Degree of interest in CBPR
High	11
Moderate	2
Low	0
Degree of experience in CBPR
High	6
Moderate	5
Low	2

Respondents identified five key areas that facilitate academic researchers’ participation in CBPR: researchers’ personal attributes, researchers’ attitudes toward collaboration, researchers’ partnership‐building skills, community facilitators, and institutional facilitators ( Table 3).

Table 3.

Themes, subthemes, and sample quotes.

Themes and subthemes	Sample quotes
Researcher’s personal attributes (coded for 32 times)
1. Innate orientation—“hard wired”	What really is going to count is eventually people see that I’m genuine, that I’m a real good listener. And I’m respectful, and I really value their opinion. And that’s something you can’t fake…and that’s where I say, you’re either hard‐wired to do this or you’re not. [11]
2. Internal values/passion/commitment to community	It’s much more satisfying than any other intervention work that I’ve done.… I have learned a lot about CBPR, but (I have) also expanded my worldview tremendously. I just feel like it’s been an incredible experience for me personally. [02]
3. Openness to personal learning that arises from the research experience	You have to be comfortable not knowing a lot. Learning to walk in a new community is like being a child. You need introduction and instruction. You need to learn your place and how much you don’t know. [05]
4. Ability to tolerate ambiguity and uncertainty
Researcher’s attitudes toward collaboration (coded for 31 times)
1. Being respectful	To think about what is considered knowledge in a …particular community context…(P)eople need to know, that the knowledge that they learn in school is one kind of knowledge (but) that it does not represent the range of knowledge or even (all) types of knowledge. [02]
2. Orientation towards working in non‐hierarchical ways	I think the other piece is with having community partners on board. From very early on, what are the benefits to the community? They need to be articulated. [15]
3. Appreciate multiple types of knowledge including community wisdom
4. Willingness/ability to work collaboratively
5. Willingness to work on items of importance to the community
Researcher’s partnership building skills (coded for 27 times)
1. Negotiate roles and responsibilities early in the relationship (to prevent misunderstandings)	But because the academician and the community partner come from so‐called different cultures… probably the potential for conflict is a little bit higher than if you were working with people within the same culture. (E)ncourage community partners and academicians to think about what plan they would have in place if conflict arises so they can try to at least minimize the tension as they work through the conflict. [09]
2. Facilitate relationship development as the project evolves	Researchers need to approach community by letting them know, “I’m a resource…I’m a tool kit that may be useful to you.” If other skills are needed, they have the official responsibility to direct them to another person. These can be difficult and dynamic relationships. [05]
3. Ability to compromise to accommodate community’s priorities	Active listening is key. We just don’t know how to listen. You have to listen to know whether the community is really engaged or not. You have to know their priorities. [13]
4. Flexible project management and group process skills
5. Communication skills
6. Conflict resolution skills
Community facilitators (coded for 36 times)
1. Bridging person	And I think that’s another key to success – having a community partner who really knows the culture of the community, the politics of the community. [15]
2. Connected partner	(C)ommunities need to understand that they have been doing research forever. In terms of developing ways of improving their communities, they have a knowledge base that may be as articulated….in the same way (as academic knowledge). [02]
3. “Activated Community”	I think it would be important to share with the community how academicians have to balance their own needs for promotion and what I call the “bean counting” that we are forced to do as faculty, with the realities of doing (CBPR) research. Again, if the community members haven’t been part of the academic world, they likely will not know what benchmarks we have to meet for our own careers. [09]
4. Understanding of research process	They (the community) should know that we are people too, that there is a human being underneath and that sometimes we don’t know what they know. It’s not as if we are the expert in their world. … but there needs to be some sensitivity that we’re trying. [08]
5. Communication/group process skills

Researcher’s personal attributes

Interviewees identified personal attributes that predisposed faculty to utilizing CBPR and made participating in CBPR partnerships easier by helping researchers cope with the complexities and uncertainties of community collaborations. For example, attributes such as patience, caring, humility, authenticity, and flexibility were considered more than virtuous personality traits; they contributed to successful community‐based research.

“(If) as a researcher you need more certainty or you need…stability, this is not an approach that would be good for that type of researcher. [04]”

Respondents described a strong sense of personal satisfaction and transformative personal experiences that came out of working with communities. They pointed to a commitment to serving the community as an orientation for CBPR that is critical to project success, and drew a strong contrast between themselves and researchers who did not hold the community’s priorities in similar regard.

“I’m concerned. Some people can talk the (CBPR) talk. They’ve read something. And I’ve seen a project really burn up because that person really was not committed to the community’s priorities but rather the commitment was to their own agenda. [05]”

There was general agreement that these attributes are “hard‐wired.” As one respondent said, “I have that community thing in my heart. [02],” and “I’m not one of the ‘you‐can‐make‐anybody‐into‐a‐CBPR‐person.’[02]” Others affirmed innate personal attributes, but recognized that conventional training may hinder faculty’s ability to use participatory approaches.

“Sometimes (I) think that you’re either born with it or you’re not…I personally know researchers who want to be more participatory, but they just, to me, they’re not wired that way. Or…it’s probably their training. [11]”

Researcher’s attitudes toward collaboration

Respondents identified key attitudes for faculty utilizing CBPR that potentially required “unlearning” ways of thinking reinforced through professional education. First was an attitude of respectfulness toward the community in acknowledging the legitimacy and contribution of nonacademic knowledge. The role that traditional research training plays in socializing faculty into hierarchical ways of working was raised as a barrier to effective CBPR collaboration. Finally, they identified an omission in graduate education in the area of collaborative research generally. These topics were acknowledged to be important targets amenable to training.

“(I)t’s definitely a paradigm shift in our mind(s) to engage in CBPR because we do it after a lot of socialization of working in a top‐down type of system. And so, as we do CBPR projects and we involve other providers, we see …that providers have to learn a different way of working with folks. [03]”

Finally, respondents conveyed that research must be driven by community‐defined needs that are articulated early in collaboration and continue to be prioritized across projects. The benefits of this approach were described as meeting community needs, creating successful interventions, and ensuring project sustainability.

Researcher’s partnership‐building skills

Researchers’ partnership‐building skills, described as “a different world from what most academics know,” were thought to contribute to increased trust and sustainability of partnerships. Involving the community early in projects and clearly deciding upon and articulating priorities, goals, roles, and responsibilities for each phase of the project (with renegotiation as needed) were identified as vital to building and maintaining successful partnerships. Communication skills were thought to facilitate these types of conversations and prevent conflict. The ability to navigate and resolve conflict should it occur was equally emphasized.

Community facilitators

Faculty also described community attributes that facilitate effective working relationships. The most often praised facilitator was the presence of a “bridging” person or well‐connected partner who could increase the researchers’ understanding of and connection to the community, and frankly point out researchers’ errors related to cultural misunderstandings. Respondents also identified a set of attributes that we have termed “activated community.” They recognized that it was in the best interest of the partnership to have community members who mirror the traits that faculty asked of themselves in these partnerships: desiring a reduction in hierarchies, holding a belief that community knowledge has equal value to academic knowledge, and having commitment to the CBPR project. Additional facilitators included the community members having an understanding of fundamental principles of research (process, methods, human subjects) and a set of group process and communication skills that were parallel to those of faculty partners.

There was disagreement, however, about whether the communities should understand the academic culture and pressures experienced by faculty. The majority of key informants stated that it would be helpful for community partners to have some understanding of the demands of the promotion and tenure process, the pressure to publish, and requirement that faculty fund their salaries. Most recognized that it was their job to describe these job requirements to community and explore how those issues might affect the partnership. The dissenting viewpoint was expressed by a senior faculty member who asserted that communities were not responsible for accommodating researchers.

“Because this research is situated in the community, it’s incumbent upon us academics to adapt ourselves and our culture to the culture in the community and not vice versa. I just feel very strongly that … it’s incumbent upon academics to overcome the barriers of their academic culture. [02]”

Some faculty expressed a personal need to be understood and for the lack of understanding on both sides to be recognized, understood, and approached delicately. In summary, faculty generally acknowledged that the partnership depended on characteristics and skills possessed by both partners, and described areas of training that could support the development of these skills on the community side.

Institutional facilitators

Many faculty identified institutional factors that would aid participation in CBPR including community‐friendly human subjects training and a more flexible IRB processes. Comments focused on support for CBPR at multiple levels including through senior mentorship in CBPR, at the promotion and tenure phase that acknowledges challenges such as the time required to engage in this type of research, and through institutional level policies affirming CBPR’s value.

Comparisons across researcher experience level

Researchers across CBPR experience levels identified facilitators that contributed to the development of all themes. In general, however, experienced researchers were more likely to identify the importance of personal attributes and interpersonal attitudes toward collaboration as necessities for engaging in CBPR. Due to their experience, seasoned researchers’ statements reflected a realistic understanding of the challenges associated with CBPR and insight into personal characteristics that contribute to successful partnership development. They also identified more often than less experienced researchers the importance of strong community connections through a bridging person and connected community partner. Less experienced CBPR researchers strongly identified the needs for mentorship, training, and support at the institutional level, as would be expected for those experiencing early barriers to community engagement.

Model of facilitators to faculty participation in CBPR partnerships

Through the process of analyzing the data a model describing how facilitators may relate to the likelihood of faculty participating in community‐based projects emerged ( Figure 1). In this model, capacity for CBPR research begins with individual researcher’s personal attributes contributing to ease of collaborative work. The second component includes learned and environmental factors that may be targets of training and policy at the research institutional level including (1) researcher’s attitudes toward collaboration, (2) researcher’s partnership building skills and knowledge, and (3) institutional facilitators. Once a researcher is prepared for collaboration, community facilitators contribute to a successful outcome.

Figure 1.

Model for facilitators to faculty participation in CBPR partnerships.

Discussion

Given the lack of progress in reducing health disparities and lack of return on government investment in research, there is a need to conduct research differently. Integrating the collaborative strengths of CBPR with the translational research enterprise holds promise for moving the field forward. Many facilitators proposed previously by expert opinion have been echoed here by faculty representing a range of experience levels and academic ranks, in the areas of personal attributes and attitudes, group process and partnership‐building skills, and institutional factors. ¹⁶ , ¹⁹ , ²¹ , ²² , ²⁴ In addition, our results identify a need for concurrent training of community partners in a parallel set of attitudes and skills. Our work builds on current literature by developing a model that proposes relationships between sets of facilitators contributing to the likelihood of faculty successfully participating in CBPR projects.

Our results suggest that this model should begin with an assessment of personal attributes contributing to successful faculty participation in CBPR partnerships. The suggestion has been made that CBPR might be promoted amongst faculty by raising awareness of the need for and advantages of this approach; ²² however, our findings suggest that some caution may be warranted in this regard. Researchers who are not oriented toward collaborating with community may find the work frustrating and may develop problematic partnerships that dampen community members’ willingness to collaborate with other academics in the future. Future research should identify the most appropriate means for self‐assessments researchers could utilize to evaluate their own aptitude for working in CBPR partnerships. Many respondents emphasized learned and environmental factors as key contributors to successful participation in CBPR. Successful community‐academic partnerships could develop easier if professional students were trained in a manner that validates community‐generated knowledge and emphasizes nonhierarchical collaboration. Informants also identified a trainable skill‐set including group process and communication skills. Finally, as has been discussed in detail elsewhere, ¹² , ²² the academic environment fostered by institutional culture and policies contributes greatly to faculty choosing to invest in CBPR partnerships. It is important to note that this model is based on researchers’ perceptions of facilitators to CBPR. A broader approach to promoting successful, enduring, partnerships could also involve training community members; community collaborators may have differing opinions on what training would best facilitate their own participation in CBPR and what attitudes, skills, and perspectives academic partners would ideally bring to the collaboration.

This study has limitations, most notably that the results represent the opinions of faculty at one university and so may differ from those in other research institutions. Though limited, the number of faculty interviewed is appropriate for qualitative theory building and was balanced by the range of faculty included.

In sum, results of this study suggest that many faculty interested in collaborative research may benefit from training and policy initiatives supportive of CBPR. The model proposed from our study has the potential to inform the development and evaluation of programs seeking to support CBPR at an institutional level.