11.1 - Communities and Health Research

Some propose that a community should be an intregal part of the process of solving community problems. "If the problem is in the community, the solution is in the community, " claims Dr. Gilbert H. Friedell, M.D., Director Emeritus, Markey Cancer Control Program, who has worked effectively with members of rural Kentucky communities to improve population health.

In Rural Kentucky, A Surprising Twist On The Health Debate

Israel, et al (2005) consider a community to be "a group of people who share an identity that is based upon geography, political affiliation, culture, race or ethnicity, faith or religion, sovereign tribal nationhood, institutional connections, or other shared identification."

Community health research can be defined as theory-based investigation or experimentation intended to derive generalizable knowledge about the health and disease status of the people in one or more communities.

"Community research" takes several forms:

Community research
– research about the health of people in one or more communities
Community-placed research
– health research that involves community members
Community-based research
– research that addresses health and disease of members of the community
Community-based, participatory research (CBPR)
– health research that equitably involves community stakeholders in all aspect of research

Strengths to community research include the following:

  • external validiy (generalizability)
  • can be the only ethical option in some situations (for example, we can randomize people to practice a behavior that is know to be harmful, like smoke cigarettes)
  • high impact
  • allows evaluation of risks from socioeconomic factors
  • can address multiple risk factors
  • results in reduction of disease burden and disparities in groups of people

Community-based participatory research also has limitations:

  • long lead-time before initiation of projects
  • effective, frequent communication is required
  • may be less highly regarded in the research community

Principles of community-based participatory research have been set forth by Israel, et al (2003) as follows:

  1. Partners share mission, values, goals, and measurable outcomes
  2. Relationships between partners are characterized by mutual trust, respect, genuineness, and commitment
  3. Partnership is built upon identified strengths and assets
  4. Partners share power and resources
  5. Partners are accessible and communicate clearly and openly
  6. Partners have established roles, norms and processes
  7. Feedback is provided to, between and by all partners
  8. Partners share credit for accomplishments
  9. Partners recognize that the partnership will develop with time