Creating a Culture of Empowerment in Research: Findings from a Capacity-Building Training Program

Abstract

Background

This paper uses a theory from educational research – “the culture of power” – to explore power differentials between academic researchers and community partners in community engaged research partnership programs.

Objectives

This paper describes how a capacity-building program illuminated the tensions between academics and community partners related to power differentials and offers strategies for how to balance the power dynamic.

Methods

This paper relies on semi-structured interviews from 30 community partners who participated in the “Building your capacity” program.

Results

The framework of “culture of power” applied to research relationships helps us understand the following: (1) The power differentials between academic institutions and community agencies are deeply entrenched. That is there is a “culture of power.” (2) This culture of power is often reinforced through the cultural rules and dominant language of the academy. (3) Academic institutions, by and large, have created and perpetuated the rules that have led to these uneven power relationships. (4) Being told explicitly about the rules of academic culture make acquiring power easier for community partners. (5) Community partners are often more aware of the culture of power in research and more willing to acknowledge these differentials than academic researchers.

Conclusions

Academic partners who want to work with community partners need to acknowledge these power imbalances and be intentional about shifting these power dynamics.

Capacity-building programs can help to shift these power imbalances because they help community partners acquire the confidence, knowledge and skills to advocate for more equitable research relationships

Community engagement is increasingly seen as an important component of clinical and translational research that seeks to improve health.^1,2 The involvement of community members is viewed as crucial to the creation of well-informed, sustainable, successful community-based interventions aimed at improving health outcomes.^3–5 Community partners can contribute invaluable insight about internal needs, culturally appropriate responses, and offer linkages to existing resources and relationships needed to mobilize collective action.^7–9

One challenge associated with community-engaged research is the unequal power dynamic that usually exists between researchers and community members.^2,10–12 Lasker et al.¹³ argue that power differentials between partners must be explicitly recognized and addressed. Power, defined by the ability to exert influence and effect change, is determined by a myriad of factors inclusive of the possession of skills, competencies, and fiscal as well as social resources. In turn, these variables effect self-perceptions of efficacy, confidence, and worth or social standing in relation to others.¹⁴ Both tangible and intangible elements ultimately determine the ways and magnitude in which one is able to actively participate and contribute within a partnership.¹⁵

Several National Institutes of Health Clinical and Translational Science Award–sponsored organizations have recognized these inequities and implemented capacity-building training programs with the goal of mitigating this imbalance. Capacity-building programs play a generative role in demystifying the research process, deconstructing power, and democratizing knowledge.^16–19 Although existing programs vary in scope and duration, they all provide community partners with guidance on how to better foster community–academic relationships through actionable steps.^2,20–26

In this paper, we draw on the experience of community partners in a capacity-building program to understand why power asymmetries exist and how they are manifested in research relationships. We use a theory from the field of education developed by scholar and activist Lisa Delpit, the “culture of power”²⁷ to understand these power imbalances and consider implications for capacity-building programs (Table 1). Using a case example of the Building Your Capacity (BYC), we qualitatively examine community partners’ perspectives before and after program participation to illuminate how Delpit’s theory can be applied to the context of research relationships.

Table 1.

Five Tenets of the Culture of Power²⁷

Delpit’s Tenet	Description/Definition
Issues of power are enacted in classrooms.	There is a power differential between teachers and students.
There are codes or rules for participating in power; that is, there is a “culture of power.”	There is an unspoken set of rules that govern these settings.
The rules of the culture of power are a reflection of the rules of the culture of those who have power.	These unspoken rules reflect the experiences of those in power.
If you are not already a participant in the culture of power, being told explicitly the rules of that culture makes acquiring power easier.	Making explicit these unspoken rules helps those with less power in the situation access power.
Those with power are frequently least aware of—or least willing to acknowledge—its existence. Those with less power are often most aware of it’s existence.	Those in power are not willing to acknowledge the existence of a power differential.

METHODS

Program

BYC was designed by a collaboration among three funded Clinical Translational Science Award programs at Tufts, Harvard, and Boston Universities and two key community partners: the Center for Community Health Education, Research and Services, Inc., and the Immigrant Services Providers Group/Health and funded through an Administrative Supplement from the National Institutes of Health. Members of the BYC Steering Committee had backgrounds in medicine, public health, education, community organizing, and occupational and environmental health. All the members of the BYC Steering Committee had prior experience with community-engaged research. The intent of BYC was to strengthen the research capacity of community leaders and provide them with the skills necessary for participating in community–academic research partnerships.

Recruitment

The BYC Program was a 2-year endeavor with two sequential cohorts participating in a 6-month course. To recruit community leaders to participate in the BYC program, a request for application was sent out through various list-serves. In each year, this outreach resulted in 30 applications from as far as Springfield, Massachusetts, and Providence, Rhode Island. Applicant organizations included community health centers and community-based organizations representing particular neighborhoods and populations, as well as disease-specific communities. The application required a letter of interest from the candidate and a letter from organizational leadership. There were no explicit eligibility criteria. Several organizations had prior relationships with Tufts, Harvard or Boston University; however, having experience with or plans to engage in research with academic partners was not a criteria for acceptance into the program. At the same time, prospective fellows represented the communities that academics were trying to partner with and ranged in their prior knowledge and experience with academics.

The BYC Steering Committee reviewed the applications and selected each cohort of Community Research Fellows. Each application was read and scored by three members of the steering committee using a standardized review sheet. The steering committee then met to collectively decide whom to accept into the program. During the selection process, attention was paid to putting together a diverse cohort. We sought organizational, target population, and geographic diversity, as well as diversity in how health was conceptualized by applicants and level of experience with research partnerships. Fellows and their organizations did receive a $5000 honorarium for participation in the BYC program—$3500 of the honorarium went to the organization and $1500 went to the fellow. (If there was more than one fellow representing the organization, the $1500 was split among those fellows.) As part of their participation, fellows were asked to propose a plan for their organization for a research project they would like to pursue as a requisite for participation in BYC.

Sample

Thirty individuals participated in the BYC program over the two years of funding period. Table 2 summarizes participant gender, education level, and racial and ethnic identification. Categories included to describe race and ethnicity were African American, Latino/Hispanic, Asian American Native American, other, and unspecified. The category defined as other included Brazilian and multiracial individuals.

Table 2.

Demographics of Building Your Capacity Fellows from Both Cohorts (N = 30)

	n	% of Total
Race/ethnicity
African American	5	16.6
Latino/Hispanic	4	13.3
Asian American	5	16.6
Native American	1	3.3
Other	7	23.3
Unspecified	8	26.7
Gender	raw total	% of total
Male	6	20.0
Female	19	63.3
Unspecified	5	16.7
Age (y), mean (range)	39.3	(23–60)
Highest education	Raw total	% of total
High school/GED	0	0
Some college	4	13.3
Bachelor’s degree	8	26.7
Master’s degree	10	33.3
Other professional degree	3	10.0
Unspecified	5	20.0

Data Collection

Human subjects approval was obtained from the Tufts Medical Center Institutional Review Board. Qualitative data were collected via semistructured interviews conducted before the initiation of the program and after completion. In the pre and post interviews, there were common questions related to opinion about the role of research in addressing a community problem or issue, whether the organization would benefit from a partnership with a research institution, and comfort in working with or approaching academic researchers. The pre-interview had additional questions about the target population for the organization, prior conceptions of research, prior experience in conducting research with academics, opinion about the value of research to address community problems, goals for the training program, and any prior problems working with researchers. The post-interviews had additional questions about knowledge and skills gained through the program and questions about how to improve the program, and whether the Fellow believed the organization benefitted from the program.

Upon being notified of their acceptance into the program, fellows were asked to meet with two members of the BYC Steering Sub-Committee for an hour-long interview 1 month before the start of the training. Within 1 month after the end of the program, 1-hour exit interviews were conducted. All interviews were conducted in-person and lasted between 45 and 60 minutes. All interviews were recorded and transcribed verbatim by a professional transcription company.

Analysis

All fellows completed both the pre and post interviews. A subcommittee of the BYC Steering Committee developed the interview guide, collected the data, and analyzed the data. This subcommittee collectively reviewed a sample of transcripts selected at random to identify emergent themes and develop a codebook. Three members of the subcommittee then thematically coded each transcript and supplementary memo. Coding discrepancies were reconciled after a discussion between both coders.

In the coding process, first, a set of etic (deductive) codes were developed based on the community engagement literature and applied to the interviews. Second, a set of emic (inductive) codes were identified through a secondary review of the transcripts. It was through the process of inductive coding that issues around power emerged from the transcripts.

All codes were entered into NVIVO. Summary reports of themes were generated. Members of the research team then further analyzed passages in support of each theme, to understand meaning-making of the fellows. These themes were then presented to a self-selected group of fellows (n = 6) for member checking and for consideration of future directions for capacity-building programs

PROGRAM IMPLEMENTATION

The fellows were a diverse group that represented the nonprofit sector in the Boston community. With respect to gender representation, women outnumbered men three to one; this may be because we drew our sample from non profit health and social service organizations, in which women are overrepresented. The majority of our sample had a college degree or higher, which is consistent with the educational level for mid-level and entry-level positions at non profit health and human service organizations.

The overall objective of BYC was to build capacity of community partners to participate in community-engaged research projects with academics. In its first iteration in January through June 2010, community partners participated over a 6-month period in monthly sessions. Based on their feedback, changes in the overall curricular design and format were made. Fellows in the second iteration, which ran from January to June 2011, participated in biweekly sessions over 6 months with additional topic areas incorporated. Sessions were facilitated by members of the BYC Steering Committee as well as by local community members with CBPR experience. Learning objectives for both cohorts are listed in Table 3.

Table 3.

Learning Objectives for Building Your Capacity

Objective	Cohort I	Cohort II
Introduction and community building	Establish ground rules and build a learning community Identify the similarities and differences between research and activism Discuss the specific components of a CBPR partnership	Establish ground rules and build a learning community Identify the similarities and differences between research and activism Discuss the specific components of a CBPR partnership
CBPR partnerships	Identify the strengths and assets of CBPR Discuss how to build an authentic CBPR partnership	Identify the strengths and assets of CBPR Discuss how to build an authentic CBPR partnership
Ethics	Discuss ethics within the context of community research	Discuss ethics within the context of community research
Research design	Identify what research design is most appropriate for one’s research project	Identify what research design is most appropriate for one’s research project
Research design II	Expand the discussion on research design	—
Qualitative methods	—	Learn the basics of qualitative methods
Policy	Learn and the role of CBPR in policymaking	—
Quantitative methods		Learn the basics of quantitative methods
Quality improvement	—	Learn about the similarities and differences between quality improvement and research
Using existing databases	—	Learn how to access data on one’s community from existing databases
Data analysis	—	Learn the basics of qualitative data analysis
Policy	—	Learn the role of CBPR in policymaking

CBPR, community-based participatory research.

From this work emerged a pedagogical approach we termed “community-engaged pedagogy,” which captured the core tenets of our teaching philosophy. The approach, detailed elsewhere,²⁸ has five components (Table 4). The BYC Steering Committee emphasized a relational approach to working with fellows. Emphasis was placed on building relationships with the fellows and their respective organizations. At the onset of the program, ground rules were established to build a supportive learning community among fellows. Sessions were not didactic, but incorporated interactive learning activities such as reflection on a movie about the Tuskegee experiments, a drawing activity about research and activism, and small group discussions around case studies of CBPR projects.

Table 4.

Tenets of Community-Engaged Pedagogy

Relational approach to partnership building	Establishment of relationships with fellows and their respective organizations was a priority as well as connecting fellows to academic researchers.
Establishing a learning community	Attention was paid building a sense of community among fellows and with the training faculty.
Organic curriculum model	Initial training content and on-going sessions was modified depending on the expressed needs of the fellows.
Collaborative teaching mechanism with diverse faculty	Interactive, experiential, and hands-on activities were used by a faculty that included academic and community partners with diverse racial backgrounds.
Applied learning	Fellows were asked to develop a project proposal based on their learning in the program.

During the program a member of the BYC Steering Committee was paired with each organization represented to help them work on a research plan. Research plans gave the fellows an opportunity to put what they were learning into practice. As an example, one fellow wrote a set of guidelines for her organization on how to work with academic partners. This document can be found at: www.tuftsctsi.org/wpcontent/uploads/2015/08/MacPolicyStatement.pdf.

RESULTS

Power, as experienced in the relationship between communities and academics and their institutions, emerged as a central theme throughout the pre and post interviews with both cohorts. This was particularly striking, given that fellows were never asked explicitly about power dynamics during the interviews. Upon analysis, the narrative about power that emerged from the interviews mapped well onto Delpit’s theory of the culture of power, and demonstrated applicability regarding how to build equitable academic–community research partnerships. We describe our findings within the context of Delpit’s five tenets.²⁷

Application of Delpit’s Theory to the BYC Program

Issues of Power Are Enacted in Classrooms

Delpit’s first tenet argues that issues of power are deeply entrenched within classrooms and we argue, by extension, organizations, be they academic institutions or community centers. This power differential manifests itself in the dominance of those who are “inside” the organization versus those who are seen as outsiders. Although individual fellows reported positive relationships with individual researchers, overall, fellows perceived researchers as often having their own set agendas and goals, and being largely unaware of the possible advantages of input from community leaders. As one fellow stated at the onset of the program,

I think they [researchers] are difficult to approach. I think that they have the experience and the knowledge and don’t have the desire to sit down and share their experiences. I think they think they’re on a higher level than the community because they have some educational background on subject matter. I think they feel superior, that you should listen if they do talk, you should listen, but not raise any questions.

There Are Codes and Rules of Power, that is, a “Culture of Power” Exists

Delpit posits that power is conveyed in the cultural rules that govern the ways in which one speaks, writes, dresses, and interacts with others. Fellows commonly described researchers often entering into a negotiation with community members and using the cultural rules and dominant language of academia. In particular, the choice of language perpetuated the problem of power differentials. Fellows commented that academic researchers did not always communicate in ways that lay people understand, leading to frustration and alienation. The use of research language also promoted unidirectional rather than bidirectional communication. One fellow remarked on this sentiment before she started the program:

You cannot come into a community using a vernacular that researchers and scientific people would use. I think you have to be able to transform your own information to be able to give it to the community to encourage them to participate in research because it’s going to benefit everyone.

The Rules of the Culture of Power Are a Reflection of the Rules of the Culture of Those Who Have Power

Delpit’s third tenet implies that those who hold the power determine the culture, language, and rules of the game as well those individuals who are recognized as the “key players.” This limits not only who is invited to participate, but who is listened to. Fellows were often struck by the incongruity of the apparent lack of interest in community leaders’ perspectives, although researchers ultimately needed the support of community organizations for recruitment purposes at a minimum. One fellow critiqued academics before the training by expressing the following:

Whether it’s an institution or large medical research facilities, pharmaceutical facilities and stuff like that because, you know, there’s always gonna be studies. All those institutions are always gonna need smaller organizations to partner with the community and for recruitment purposes. It’s just like, you know, organizations have been used as a guinea pig just as equipment tools so just to recruit them and just say, “Okay, let’s put 10,000 dollars aside just for partnering with this organization just for equipment purposes” and that’s it. You don’t have any other say in terms of the research and the data evaluation, nothing. It’s just your job. [We] give you a portion of that grant and we don’t want to hear anything from you, so we’ll call you or we’ll need you based on what we need.

Indeed, one major request of fellows was the desire to enhance the control, choice, and contributions of fellows in research partnerships. Fellows wanted to be recognized as “equal partners in the conversation,” fulfilling the role of co-leaders rather than followers in community–academic relationships and sought to acquire more facility with the language of the dominant academic culture. One fellow stated that before the BYC program, he had felt hesitant about approaching researchers because he “wouldn’t know how to word things right or something.”

If You Are Not Already a Participant in the Culture of Power, Being Told Explicitly the Rules of that Culture Makes Acquiring Power Easier

Fellows acknowledged that being explicitly told about research processes (eg, grant applications, finances, institutional review boards’ roles, study design and analysis) made it easier and would facilitate leadership roles and communication amongst different members of the research collaboration. Fellows appreciated the establishment of baseline knowledge—research jargon, technical skills, and a sense of the “frameworks” and “principles” that guide research projects. Acquiring this knowledge helped to demystify the research process for community partners and allowed for more effective communication with researchers, facilitating a reciprocal exchange of ideas between partners that could have equivalent albeit different expertise. After participating in the program, one fellow highlighted the role of BYC:

I think it equips us as an organization to engage much more effectively in conversations about research and how we are doing research because it gives us a language, how are other people talking about research and that’s incredibly valuable.

Similarly, another described after completion of the program how understanding the potentials and pitfalls of research helped them to be a more equal partner:

I feel like I understand academia to the extent that I need to, to be an equal partner in the conversation. I don’t expect an academic to completely understand what we do, so I would think that they won’t expect me to completely understand. But between some of the issues they face and some of the issues we face, I think I have an understanding of where people are coming from.

Improving the research literacy of fellows was perceived as not only helping to minimize the knowledge, communication, and power gap between academics and community partners, but also to foster relationships of trust and equity. Specifically, through the training program, fellows reported identifying ways in which academic’s research goals could be aligned with the goals for the constituents of their respective organizations. At the end of the training, one fellow reflected on the following:

In the beginning, maybe it seemed like we didn’t have as much in common. I gained the skill to listen. Also, knowing the process and why research projects in our community and how our community benefits—not just funding but in ways, like in the long run, and the skill of learning that universities are not just here to give education but to give something to the community.

Those with Power Are Frequently Least Aware of—or Least Willing to Acknowledge—Its Existence. Those with Less Power Are Often Most Aware of Its Existence

Fellows were aware of issues of power enacted in research settings but relayed experiences with researchers who were unaware of these issues of power. Several of the fellows came to BYC with a negative opinion of academic researchers based on prior experiences. Some shared feelings of feeling “used” or “manipulated” by academic researchers. Some described being approached without sufficient time to consider the implications to the organization’s mission and staff. Others described researchers “helicoptering” in to conduct research and cultivating a relationship with community leaders only to terminate the relationship if the grant was not funded. Issues of ownership of data collected as part of the research process were also raised. Fellows and their organizations were concerned about the results of the research not being fed back to the community of interest. They also perceived a lack of interest or commitment to the implications for organizations on the part of the researcher and saw this as a major barrier to their willingness to participate.

Participation in BYC helped fellows gain the knowledge of knowing what to ask for in a collaboration. Another fellow described a negotiation with a researcher that occurred during her participation in BYC:

I asked who owns it in the end. She said the researcher owns it. I said could it be jointly owned? We have a huge stake in what this shows us. There is a question of ownership of data and us being sufficiently compensated. She wanted to know how much. It has to be equivalent to what the researches are getting paid. I felt totally empowered to do this and that I wasn’t cheating the community from getting an opportunity.

Many fellows identified a need for negotiation skills, recognizing that partnerships with academics are not always inherently mutually beneficial or fair. Fellows recognized that, when approached by researchers, it was not in their best interest to automatically agree to what the researcher asked. Instead, it was incumbent upon the fellow to explicitly sort out with the researcher what was being asked of the organization or community.

Potential Strategies to Address Power Differentials

Because of funding constraints, there was no further implementation of BYC after the initial cohorts. However, several of the community partners involved in BYC continue to work with academic partners. Two organizations received seed funding to do formative research immediately after participation in BYC and three different organizations continue to serve on the steering committee of two academic–community research collaboratives through Tufts. Also, to capture and share the lessons learned from the program, several tools (described below) were developed. These tools have been used by groups not affiliated with the Tufts CTSI who seek to implement similar programs.

One product for several of the organizations after participation in BYC was developing a document expressing organizational standards for working with researchers (available from: www.tuftsctsi.org/Services-and-Consultation/Community-Engagement/Community-Engagement-Tools-and-Resources.aspx#SampleDocs for examples). Moreover, as a result of BYC, the Tufts CTSI developed a guide for community members who were submitting federal grants in collaboration with academic researchers (available from: www.tuftsctsi.org/Services-and-Consultation/Community-Engagement/Community-Engagement-Tools-and-Resources/Community-Members-Guide-to-Submitting-a-Research-Grant-Application.aspx). Another product developed as a result of BYC was a series of self-study questions for community organizations and researchers to explore together when developing an application that the questions specifically address issues related to power (available from: www.tuftsctsi.org/Services-and-Consultation/Community-Engagement/Community-Engagement-Tools-and-Resources.aspx#selfassessment).

DISCUSSION

Before their participation in BYC, many fellows did not have a positive view of researchers and were often skeptical of research collaborations benefitting their communities. Because of their distrust of researchers and their skepticism about the utility of research for their communities, many were ambivalent about working with researchers. Before starting BYC, fellows knew that there was a culture of power in research, but they did not have the knowledge, language or confidence to name it as such or have the tools to shiff the power dynamics.

Through BYC, fellows were able to deconstruct the culture of power in research. Delpit’s theory of power is a useful framework to understand that there is a culture of power in community-engaged research that may lead to a deep disconnect between academic researchers and community leaders. Delpit’s theory highlights that inequalities of power are often overlooked or not openly discussed, especially by those in power, but that disparities are frequently recognized and readily acknowledged by those who feel as if they are at a disadvantage.

BYC provided the roadmap in the form of technical knowledge and skills about the research process and, in doing so, gave fellows the language and tools to deconstruct and reconstruct conversations around power in community–researcher relationships. Fellows were able to enhance their knowledge to better navigate university bureaucracy and potential barriers intrinsic to working with academic researchers. Through the program, fellows felt an increase in their ability to negotiate roles, responsibilities, and decision-making power with academic researchers. As a result, they began to understand the rules of the culture of power in research and felt less intimidated approaching or being approached by academics after participation in BYC.

Capacity-building programs provide the unique opportunity for academics and community partners to have a common conversation about the strengths and limitations of CBPR. We recommend that for capacity-building programs to be able to promote the establishment of mutually beneficial and synergic collaborations between academics, community leaders, public health practitioners, and researchers, power inequities must be openly acknowledged and addressed in the curriculum. Our experience with the BYC program demonstrated that having honest discussions about the power that is embedded in research relationships can contribute to capacity building among and empowerment of community leaders, as well as improved relationships. We recommend using Delpit’s “culture of power” framework to analyze, understand, and stimulate productive conversations about the culture of power. In doing so, research partnerships may become less influenced by a culture of power and instead, begin to embody a culture of shared negotiation and learning.

Limitations of this study include that its conclusions are based on the expressed opinions of fellows who participated in BYC. We did not interview the academics about their awareness of power issues. No follow-up data beyond the initial post-interview were collected on what fellows accomplished with the knowledge and skills that they gained after leaving the program. Nor did we examine potential changes in relationships with researchers after participation in BYC.

Despites these limitations, qualitative inquiry enabled us to explore participant’s experience in-depth. Presented are the unique perspectives of community partners on the asymmetry of power that marks their relationship with academic partners. Identified are barriers to the full engagement of community partners in research and potential strategies, such as capacity building, for mitigating existent challenges and possible curricular elements and tools that arose from the stated needs of the community participants of the BYC program.