Download Instructor`s Manual - Program in Health Disparities Research

Partners In Research
Instructor’s Manual:
Faculty CBPAR Training
6 total hours of instruction to be divided as needed
Materials:
1. Attendance Sign- in sheets
2. Name tags
3. Overhead computer projector
Visual aids
Power Point Slides (1-56)
Handouts:
1. Workshop Overview
2. Power point handouts
3. CBPR Scenario
4. Course evaluation sheet
5. Articles and Documents:
a. Minkler and Wallerstein, Editors. Community-Based Participatory Research for
Health: From Process to Putcomes. Chapter 3. Second Edition. 2008
b. Minkler and Wallerstein, Editors. Community-Based Participatory Research for
Health: From Process to Outcomes. Chapter 7. Second Edition. 2008
c. Community Campus Partnerships for Health. www.ccph.info
Developing and Sustaining Community Based Participatory Research Partnerships:
A Skill Building Perspective. Unit 1. Section 1.3: Ethics and CBPR.
d. North American Primary Care Research Group: Responsible Research with
Community Policy Statement. www.napcrg.org/responsibileresearch.pdf
e. Wellesley Central: Sample Terms of Reference Contract.
www.depts.washington.edu/ccph/pdf_files/MOU6.pdf

A note on timing. This document describes the timing of the training as it was delivered in
the Partners in Research project (2009-2010). We were able to commit to 6 total hours of
faculty trainings given our funding and institutional parameters. We acknowledge that this
may be inadequate to fully prepare faculty for a partnership, depending upon the faculty’s
familiarity with CBPR. We encourage those utilizing the curricula to adjust the length of
the training as needed to accommodate their audience. Particular areas for expansion could
be Topic 2 (challenges in CBPR) and Topic 3 (strategies to overcome challenges). Guest
partnerships can be invited to describe their experiences around utilizing sound
communication to overcome challenges in partnerships. In addition, greater time can be
spent in practicing communication strategies and discussing the community perspective on
the issues of trust, decision-making, and power-sharing.
Plan
Review Logistics of the Seminar (slide 1)
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Notes
Aprox.
Time
5 min
Review Seminar Topics (slide 2):
1. Is there a need for community engaged research and
what is the benefit?
2. What are common challenges in CBPAR
partnerships?
3. How can sound group dynamic processes
(communication, shared decision making, and
conflict resolution) overcome common challenges?
4. What are the nuts and bolts of initiating a CBPAR
project including financial and IRB issues?
5. What ethical issues are involved in developing and
implementing CBPAR projects?
Introductions (Slide 3): Ask participants to introduce
themselves by stating their name, and the following:
 One sentence describing your research topic and, if
you are currently doing any community based work,
the communities you collaborate with.
 How would you describe your level of experience in
CBPAR (low/medium/high)?
 What do you hope to get out of this training?
Let participants know
that you will attempt to
adapt the seminar based
on their goals/priorities
and experiences.
20 min
Topic 1: Is There a Need for Community Engaged Research
and What are the Benefits? (Slide 4)
Slides 5-13 delivered in
didactic format.
20 min
A. Background on CBPAR (Slide 5)
• Since 1994, NIH has required that all research involving
human subjects include a plan for enrolling minority
racial/ethnic groups, but recruitment rates remain low
• Suspicion of research is common
• There has been poor uptake of evidence based
programming
B. Gaps in Applying “Best Practices” (Slide 6)
• Between efficacy in research studies & effectiveness
with underserved groups
• Between research and appropriate adaptation for
underserved groups
• Between success in achieving behavior change in
affluent/educated and those less so
• Between research and local relevance
C. Need New Methods to Address: (Slide 7)
• Low recruitment and participation of diverse ethnic
groups in research
• Application of research findings that make a difference
for population health especially in vulnerable
communities
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D. Definition of CBPR (Slide 8)
CBPR is a partnership approach to research that
equitably involves all participants in all aspects of the
research process where each person shares his/her
expertise in order to enhance knowledge and develop
interventions that will benefit the whole community
E. Discuss the Spectrum of Research (Slide 9)
From entirely participatory to entirely researcher driven
F. Discuss the Degrees of Community Engagement in
Research (Slide 10)
G. CBPR Assumptions (Slide 11)
• Potential to create more relevant, sustainable research
outcomes
• Interventions strengthened by community participation,
insight and theories
• Translation of interventions to diverse settings enhanced
and made more sustainable by CBPR
• Added health value from participation
H.
1.
2.
3.
4.
5.
Key Principles of CBPR (Slide 12)
Focuses on community
Builds on community strengths and resources
Facilitates collaborative partnerships
Integrates knowledge and action
Promotes a co-learning and empowering process that
attends to social inequities
6. Involves a cyclical and iterative process
7. Disseminates findings and knowledge gained to all
partners
I. CBPR Definition of Community (Slide 13)
• Community as a unit of identity characterized by:
– Identification with and emotional connection to
other members
– Common symbol systems
– Shared values and norms
– Mutual (but not necessarily equal) influence
– Common interests
– Joint commitment to meeting shared needs
• May be geographical or group with a sense of common
identity and shared fate
• CBPR attempts to identify existing communities and
strengthen this sense of community through collective
engagement
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Slide 15. Frame
discussion in
acknowledgement that
A. Discussion: What Challenges Have You Experienced challenges in CBPR are
common and to be
with CBPR? (Slide 15)
expected
B. Key Challenges to CBPR Partnerships (Slide 16)
• Trust
• Decision making
• Challenges of power-sharing
20 min
Slide 17-25. Lead
discussion, placing the
problems they identified
from scenario into these
4 categories: Trust,
Power Differences,
Decision-Making, and
Conflict.
40 min
Slides 27-32
20 min
Topic 2: What are Common Challenges in CBPR
Partnerships and How Can We Address Them? (Slide 14)
C. CBPR Scenario (Slide 17)
• Divide into groups
• Read through the scenario sections as instructed
1. Take a moment to discuss with others 3 reasons
why community partners in the scenario might not
trust researchers. (Slide 18)
2. Challenges to Developing Trust (Slide 19)
• History of bad experiences with researchers
• Historical and recent injustices and racism in research
• Lack of understanding of other partner’s priorities
• Differing levels of commitment to the project
• Actions are not consistent with words
3. Take a moment to discuss with others 3 decision
making issues which might arise in the scenario.
(Slide 20)
4. Challenges to dealing with Decision Making (Slide
21)
• Partners have different goals, values, priorities
• Clashing organizational cultures
• Lack of clear process for making decisions
5. Take a moment to discuss with others 3 power
sharing issues which might arise in the scenario.
(Slide 22)
6. Challenges of Power Differences (Slide 23)
• Discrimination: Racism, Sexism, Ageism, etc.
• Control of resources
• Lack of respect for expertise of all partners
7. Challenges often lead to Conflict (Slide 24)
•
•
•
•
•
Contrasting goals, values, priorities
Clashing organizational cultures
Budget difficulties or resource allocation
Power imbalances
Communication break down underlies many of
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Outer blue ring: time
constraints, culture,
identity, environment,
these problems
Topic 3: How can sound group dynamic processes
(communication, shared decision making, and conflict
resolution) overcome common challenges? (Slide 25)
1. Communication: Communication can help to address
many of these challenges.
How do you define “communication”? (Slide 26)
2. Discuss the Communication Model (Slide 27)
3. What makes communication difficult? (Slide 28)
• Context (outer blue ring):
– Cultural context of communication: verbal/ nonverbal
– Preferred communication styles: direct/ indirect
– Preferred approach to conflicts: direct/ indirect
– Assumptions & expectations about goal/ agenda/
decision making/ power
• Noise (inner box):
– Garbled message: mumble/ softly/ unclear
message
– Language: type/ proficiency/ literacy
– Use of academic jargon
– Non-verbal communication
4. Bases of Communication (Slide 29)
 Speaker: (Speak to be heard; Know your message;
Be aware of emotions; Be aware of non-verbals: eyecontact, distance, timing, posture, touch; Know
listener’s preferred communication style

Message: Be clear

Listener: Listen actively; Repeat message back; Ask
for clarification; Be aware of non-verbal: eye-contact,
distance, timing, posture, touch; Know speaker’s
preferred communication style
5. Active Listening (Slide 30)
 Listening isn’t always easy. It requires:
 Concentration: Minimize distractions. Tell the
person if it is a bad time.
 Patience: Let the other person tell you what you
need to hear. If you’re not sure you understood,
ask him/her to explain.
 Empathy: Put yourself in the speaker’s place,
from their cultural perspective. Understand the
speaker’s preferred communication styles
(verbal/ non-verbal/ direct/ non-direct).
Partners In Research
experience, expectations,
Noise: physical
environment,
hearing/listening, how
message is conveyed,
openness
Differences in:
Languages (proficiency
and literacy)
Communication styles
(verbal/non-verbal) –
Personal space, looking
into the other’s eyes,
Styles of dealing with
conflicts
Assumptions/
expectations
- What are you bringing
to the conversation?
Problem you were
having with a colleague
before the conversation?
Issues with your kids?
Etc…..
Communication is the
foundation for all
relationships.
When avenues for
communication are
present, the individuals
in the relationship feel
validated and supported.
If communication breaks
down, the relationship
suffers.
All communication
involves 3 components:
the speaker, the
message, and the
listener. Remember that
body language/ nonverbal is expressed by
gestures, posture, touch,
appearance, and silence.
The nonverbal
expression is easy to
interpret. Also, when
the verbal message
conflicts with the
nonverbal message, the
nonverbal message is
usually the one believed.
Each link in the
communication chain is
just as important as the
others. Each part has
specific tasks.
Partners In Research

True especially
across cultures,
experiences, and
expectations.

Concentration:
Maintain eye contact
if it is appropriate.
Minimize distraction
around you. It is
difficult to
concentrate on what
someone is saying if
you are
concentrating on
something else. Tell
the person if it is a
bad time to talk.
Tell the person you
want to hear what he
or she has to say,
then set up a better
time to talk.

6. Why Do Community and Academic Partners Do
CBPAR? (Slide 31)
• Why might community partners want to become
involved in CBPAR partnerships?
• Why might academic partners want to become
involved in CBPAR partnerships?
Patience: You really
can’t concentrate on
what’s being said if
you insist on
interrupting with
your own opinions.
Let the other person
tell you what you
need to hear. If
you’re not sure you
understood, ask
him/her to explain a
little more.
Empathy: Put yourself in
the speakers place. Try
to understand what the
speaker is thinking and
feeling, not what you
would be thinking or
feeling in the same
situation
Go around the room and 20 min
ask for input from each
participant. List
responses in 2 columns.
Community Examples:
Access Resources,
Advocate for policy
change, Build bridges
with other organizations,
create jobs, address
inequities and injustices,
demonstrate a program’s
impact, improve
services, solve a
problem
Academic Examples:
attract and support
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students, advance
careers, build
partnerships, address
inequities and injustices,
formulate policy,
generate knowledge, link
personal and
professional goals and
values, obtain funding,
meet funding agency
expectations.
So without good
communication, there
could be different
motivations and
priorities for
participating in a project.
Each partner could
easily make assumptions
about why the other
wants to be involved.
7. Communicating to Address Challenges to CBPR
Partnerships (Slide 32)
• Trust
• Decision-making
• Power-sharing
• Conflicts
8. How Can Good Communication Build Trust? (Slide 33)
• Start conversations about partnership as soon as
possible
• Clearly identify priorities of each partner
(and their organizations)
• Clearly identify goals of project
• Discuss prior experiences (positive or negative) with
CBPAR partnerships that seem appropriate
• Assume good intentions / make good on your
promises
9.
Strategies for Building Trust (Slide 34)
• Learn about the communities you’re working with:
History, Cultural beliefs and practices, Religion/
ethical values, Socio-economic- political issues,
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Slides 34-44. Clearly
20 min
establishing a process
for making decisions can
prevent
problems/conflict
Consider and talk about
whether empowering
one partner to make
certain decisions makes
sense. For example,
should the research
partner be able to decide
on how to analyze the
data? Should the
community partner
decide on how to recruit
participants?
•
•
•
•
•
Generational/ acculturation issues, Preferred
communication styles, Languages/ non-verbal
behaviors
Be careful that generalities =/= stereotypes
Be attentive to heterogeneity in community
Practice cultural humility
Build relationships with people over time
Find confidants/ key informants
10. How Can Good Communication Help With Decision
Making? (Slide 35)
Establishing a clear process for making decisions can
prevent problems/conflict
11. Types of Decision Making (Slide 36)
• Autocratic – leader decides without necessarily
gaining or responding to input from others
• Consultation - leader or co-leaders decide after
gaining input from others
• Democratic – group decides by majority rule,
whether straw polling, voting, delegation
• Consensus – group finds a common decision that
everyone can live with - “70% rule”
12. Strategies for Improved Decision Making (Slide 37)
• Decide together about how to make decisions
• Make sure everyone has the same understanding
about how decisions will be made
• Talk openly when making decisions
• Be aware of one’s assumptions
13. How Can Good Communication Help Power Sharing?
(Slide 38)
• Reflect upon and acknowledge socially defined
power differentials
– Race/ethnicity: White privilege
– Class:
Economic privilege
– Education: Academic privilege
– Gender: Male privilege
– Knowledge systems: Western privilege
• Strive to lessen impact of privilege by creating an
equitable partnership
14. Strategies For Addressing Power Inequities (Slide 39)
• Acknowledge and value the expertise and
skills of all partners
• Emphasize needs identified by community
• Talk early about financial arrangements and
control of resources
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•
•
•
Share control of meetings/agendas
Have transparent decision making
Make partners co-PIs
15. How Can Good Communication Help Prevent Conflict?
(Slide 40)
• Establish positive communication strategies early in
the beginning of the partnership
• Understand that different people have different ways
of doing and thinking about things
• Talk about & resolve differences as they arise
16. How Can Good Communication Help Resolve Conflict?
(Slide 41)
• Assume there is a good reason for the conflict
• Identify the most likely causes of the conflict
• Work together to find solutions using a problemsolving approach without blaming/ shaming
17. Strategies for Preventing/ Resolving Conflict (Slide 42)
• Be open and honest
• Respectfully present one’s viewpoint
• Respectfully listen to others’ viewpoints
• Negotiate solutions
18. Written Agreements (Slide 43)
Written agreements between researchers and community
members can guide partnership during research project.
–
Purpose of the project
–
Guiding principles
–
Ownership
–
Participation: roles and responsibilities
–
Decision-making processes
–
Evaluation
–
Dissemination
Examples (see handouts): MOU, code of ethics, etc.
5 min
19. Final Thoughts on Steps to Successful Collaborations
(Slide 44)
• Establish good communication early!
• Find a committed community partner
• Outline common goals, roles, privileges, and rules of
engagement
• Make financial agreements clear
• Spend TIME on relationships/ partnerships
Topic 4: What are the nuts and bolts of initiating a CBPAR
project including financial and IRB issues? (Slide 45)
Partners In Research
10 min
1. Financial (Slide 46)
• Careful budget consideration is crucial in CBPR.
• Models include:
– Subcontracting
– Dividing budget
– Fixed price contracts
• There are positives and negatives for each approach
2. IRB Consideration in CBPR (Slide 47)
3. IRB Consideration in CBPR (Slide 48)
4. IRB Consideration in CBPR (Slide 49)
5. IRB Consideration in CBPR (Slide 50)
6. IRB Consideration in CBPR (Slide 51)
7. IRB Consideration in CBPR (Slide 52)
8. Promotion and Tenure (Slide 53)
• CBPR takes time and this can be an issue for P&T
• Check your department’s tenure code
• Community Campus Partnership for Health has a
“Community Engaged Scholar Toolkit.”
http://www.ccph
20 min
Topic 5: Review ethical issues in developing and
implementing CBPAR projects (Slide 54)
1. Ethics and CBPR (Slide 55)
• The ethical practice of CBPR requires researchers to
be vigilant about the way the partnership is developed,
implemented, and sustained.
• The following questions are adapted from the
Community-Campus Partnerships for Health
2. Ethical Issues: Who is community? (Slide 56)
• Is it ethical for community members to come from
only a few neighborhoods or social identity groups,
thus benefiting some communities more than others?
• Do academic researchers have a responsibility to seek
participation from all communities, or just work with
the groups who are the most outspoken or easiest to
work with?
• How “voluntary” is participation in research sponsored
by community organizations?
3. Ethical Issues: Approach to Research (Slide 57)
• Is the research project justified?
• Who benefits from engaging in the research and
how?
• Does the project include actionable outcomes?
• Are there potential risks to communities?
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4. Ethical Issues: Partnership Roles (Slide 58)
• When should a researcher take ownership of critical
measurement or methodological questions?
• When might community member’s input on design
issues feel burdensome?
• How will you balance inclusivity of data analysis
with privacy concerns?
• How does “equity” in practice translate so that
divisions of labor are not exploitative to any one
partner?
5. Ethical Issues: Dissemination (Slide 59)
• How do research results get re-presented and whose
voices are heard?
• Are the findings presented in an accessible and
meaningful way for community members?
• What if research findings reinforce negative
stereotypes?
• Would it do more harm to the community to report
such findings?
6. Seminar Sponsors/Funders (Slide 60)
7. References (Slide 61)
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