Community-Based Participatory Research (CBPR)

Summary / Explanation

Community-based participatory research (CBPR) is a unique and evolving area of medical research.  CBPR is a collaborative field in which scientific researchers and community members of a population work jointly to address diseases, environmental, and other health conditions that affect that population. This is especially helpful when addressing health disparities that play a powerful role in social determinants of healthcare. A key aspect that makes CBPR unique in the research realm is that the community stakeholders are equal partners with the scientists. “CBPR is a cyclical and iterative process that includes building partnerships and community trust, community assessment, problem definition, development of research methodology, data collection, and analysis, interpretation of data, determination of action and policy implications, dissemination of results, action, and plans for sustainability.”[1][2]

The goals of this summary are to:

1. Educate physicians on CBPR and its applications, ethics, and social implications for patients.
2. Differentiate CBPR from biomedical and other types of patient-centered research approaches.
3. Identify how clinicians can help their patients on CBPR and facilitate community participation.

The education of clinicians on CBPR requires a perspective change for many clinicians and researchers. The overarching goals of CBPR are social policy change and community improvement that hopefully results from the research conducted.[2] CBPR’s community and social focus creates unique ethical considerations. There is potential for a blurring of the line between researcher and research participants.[3] The understanding of how consent is obtained and the rights and protections the consent offers likely differs between academic and lay researchers on the project.[4][5] Challenges and political implications occur as researchers, members of the community, and power structures in the community share power and responsibility.[5]

CBPR differs from traditional academic and biomedical research in key ways. First, traditional researchers and those who fund the research are the ones who create and push the research agenda. Many believe their agenda is important to patients and healthcare professionals; however, multiple reports suggest that a researcher’s priority often does not correlate to community and societal wishes.[6] Second, CBPR focuses on issues of local relevance, often taking place more on a grassroots level, as opposed to research conducted at academic or medical centers.[7] Third, performing and publishing the CBPR is not the end goal; instead, the research continues to drive the implementation and improvement of sustainable community healthcare policies.[7]

Physicians may encourage patient participation in local CBPR in many ways. Clinicians can educate patients on the significance of CBPR and its intent to resolve local, real-world problems that impact their community. Fostering joint ownership in choosing the CBPR goals, protocols, study design, and implementation of findings assists in empowering patients to get involved for the good of their community.[8] Physicians can help articulate that this unique form of collaborative research creates not a “doctor” or “patient” perspective, but a human perspective.[2]

A local example of the need for CBPR in public policy decision-making is the water crisis in Flint, Michigan.[9] In 2014, the government-appointed emergency manager made the decision to change the water source for the city of Flint from Lake Huron to the Flint River. This decision was made to save the city money; concerns for potential health risks to the people living in Flint were largely ignored. Large amounts of lead were later discovered in the water supply and citizens were harmed because of it. A CBPR team consisting of researchers, physicians, and community stakeholders could have investigated the potential risks and weighed the benefits before switching water sources, which most likely would have prevented the crisis.[9]

CBPR has also been used to review current and possible future policies stemming from the COVID-19 pandemic. Two excellent examples are the work conducted by Grant et al and Hoerger et al.[10] Grant et al utilized a CBPR approach to study the impact of COVID-19 on patients who benefit from publicly available community health services.[10] Hoerger et al performed CBPR to analyze partnership and prioritization in the food services industries during the COVID-19 pandemic.[11] The politicization of the COVID-19 pandemic, unfortunately, also resulted in many community members mistrusting the medical establishment. The use and publishing of CBPR as a joint venture among healthcare workers and community members are positive steps toward the healthcare industry regaining public trust.

In summary, CBPR is a new and distinctive form of research that combines science with social policy improvement. CBPR is an important method of reaching solutions as medicine continues to focus on ways to improve patient outcomes related to social determinants influencing health and healthcare inequities. The importance of the unique working relationship between the scientific researchers and the community members for whom the research directly benefits cannot be understated.