Table 2.

Lessons learned from using a holistic, agency-based theoretical lens to understand the research process: understanding how agency influences health promotion research

Participation takes multiple forms: There is a tendency to approach CBPR with a rigid, structured vision of what participation looks like. Our experience follows that of Ponic and Frisby (2010) who found that participants may make decisions that do not fit with the vision of the researchers. It is important to create diverse mechanisms for participation (a SP Team, individual input conveyed to the project coordinator, project champions, train-the-trainer events, etc.). The value of fluid structure and flexible roles of principal stakeholders: A fluid structure for implementing research and flexibility for incorporating stakeholder roles can allow an intervention to better reflect the needs of participants and the realities of the research context, in the long run making the intervention more appropriate, valuable, and successful.

The importance of intangibles: Individuals at all levels of the process (project team members, teachers, principals, community members, DOH staff), especially those with charismatic personalities or those in positions of leadership, can have an exaggerated influence on the process and the outcomes of health promotion—both positively and negatively.

The key role of stakeholder agency: The data presented here demonstrate the extent to which stakeholders actively and passively transform both the research context and the research itself in both direct and indirect ways. This fact is often treated as an artifact of the research rather than acknowledged, accounted for or embraced.

The significance of context: Social and cultural dynamics impact the research process itself and cannot be seen merely as something external that exists to be transformed or changed, a common underlying assumption in health research.

The need for an Integrated/recursive conceptual framework: Our analysis demonstrates that we need to take a broader view of the research process in order to develop a more comprehensive understanding of community health. This analysis demonstrates a perspective on the research itself and on the nature of the outcomes that would not have emerged with a project-specific, non-theoretical approach.