Exploring theoretical mechanisms of community-engaged research: a multilevel cross-sectional national study of structural and relational practices in community-academic partnerships.

BACKGROUND: Community-Based Participatory Research (CBPR) is often used to address health inequities due to structural racism. However, much of the existing literature emphasizes relationships and synergy rather than structural components of CBPR. This study introduces and tests new theoretical mechanisms of the CBPR Conceptual Model to address this limitation. METHODS: Three-stage online cross-sectional survey administered from 2016 to 2018 with 165 community-engaged research projects identified through federal databases or training grants. Participants (N = 453) were principal investigators and project team members (both academic and community partners) who provided project-level details and perceived contexts, processes, and outcomes. Data were analyzed through structural equation modeling and fuzzy-set qualitative comparison analysis. RESULTS: Commitment to Collective Empowerment was a key mediating variable between context and intervention activities. Synergy and Community Engagement in Research Actions were mediating variables between context/partnership process and outcomes. Collective Empowerment was most strongly aligned with Synergy, while higher levels of Structural Governance and lower levels of Relationships were most consistent with higher Community Engagement in Research Actions. CONCLUSIONS: The CBPR Conceptual Model identifies key theoretical mechanisms for explaining health equity and health outcomes in community-academic partnerships. The scholarly literature's preoccupation with synergy and relationships overlooks two promising practices-Structural Governance and Collective Empowerment-that interact from contexts through mechanisms to influence outcomes. These results also expand expectations beyond a "one size fits all" for reliably producing positive outcomes.

Culture-centeredness in community-based participatory research: contributions to health education intervention research.

Health education research emphasizes the importance of cultural understanding and fit to achieve meaningful psycho-social research outcomes, community responsiveness and external validity to enhance health equity. However, many interventions address cultural fit through cultural competence and sensitivity approaches that are often superficial. The purpose of this study was to better situate culture within health education by operationalizing and testing new measures of the deeply grounded culture-centered approach (CCA) within the context of community-based participatory research (CBPR). A nation-wide mixed method sample of 200 CBPR partnerships included a survey questionnaire and in-depth case studies. The questionnaire enabled the development of a CCA scale using concepts of community voice/agency, reflexivity and structural transformation. Higher-order confirmatory factor analysis demonstrated factorial validity of the scale. Correlations supported convergent validity with positive associations between the CCA and partnership processes and capacity and health outcomes. Qualitative data from two CBPR case studies provided complementary socio-cultural historic background and cultural knowledge, grounding health education interventions and research design in specific contexts and communities. The CCA scale and case study analysis demonstrate key tools that community-academic research partnerships can use to assess deeper levels of culture centeredness for health education research.

Positive Indian Parenting: A Unique Collaborative Study in the Age of COVID-19.

Positive Indian Parenting (PIP) is a culturally based training developed by the National Indian Child Welfare Association in the mid-1980s that has been widely used across Indian Country. However, quantitative studies on its efficacy have not been conducted. This manuscript reports on the study design and development of an ongoing pilot study evaluating PIP and related adaptations that occurred within the context of the COVID-19 pandemic. Adaptations to the study were required to accommodate social distancing requirements, including changing to virtual platforms for curriculum delivery, fidelity monitoring, and data collection. Lessons learned include the importance of flexibility and supportive collaborations among study partners, including unique relationships with funders, that have enabled the ongoing study adaptations during the pandemic.

Engage for Equity: A Long-Term Study of Community-Based Participatory Research and Community-Engaged Research Practices and Outcomes.

Community-based participatory research (CBPR) and community-engaged research have been established in the past 25 years as valued research approaches within health education, public health, and other health and social sciences for their effectiveness in reducing inequities. While early literature focused on partnering principles and processes, within the past decade, individual studies, as well as systematic reviews, have increasingly documented outcomes in community support and empowerment, sustained partnerships, healthier behaviors, policy changes, and health improvements. Despite enhanced focus on research and health outcomes, the science lags behind the practice. CBPR partnering pathways that result in outcomes remain little understood, with few studies documenting best practices. Since 2006, the University of New Mexico Center for Participatory Research with the University of Washington's Indigenous Wellness Research Institute and partners across the country has engaged in targeted investigations to fill this gap in the science. Our inquiry, spanning three stages of National Institutes of Health funding, has sought to identify which partnering practices, under which contexts and conditions, have capacity to contribute to health, research, and community outcomes. This article presents the research design of our current grant, Engage for Equity, including its history, social justice principles, theoretical bases, measures, intervention tools and resources, and preliminary findings about collective empowerment as our middle range theory of change. We end with lessons learned and recommendations for partnerships to engage in collective reflexive practice to strengthen internal power-sharing and capacity to reach health and social equity outcomes.

Toward Health Equity: A National Study of Promising Practices in Community-Based Participatory Research.

OBJECTIVES: In the first nationwide study of community- academic research partnerships, we identified contextual and partnership practices that were significantly correlated with successful partnership outcomes guided by a community-based participatory research (CBPR) conceptual model. METHODS: Data collection included three stages: 294 community-engaged research (CEnR) projects in 2009 identified from federally funded grant databases; 200 (68.0%) principal investigators (PI) completed a key informant survey that included measures of power/resource sharing and structural characteristics of projects; 312 (77.2% of invited) community partners and 138 PI (69.0% of invited) responded to a survey including research context, process, and outcome measures. RESULTS: Context and process correlates accounted for 21% to 67% of the variance in the specific outcomes. Seven categories of research partnership practices were positively associated with successful synergy, capacity, and health outcomes: power sharing, partnership capacity, bridging social capital, shared values, community involvement in research, mutuality, and ethical management. CONCLUSIONS: Through empirical testing of an innovative, multidisciplinary CBPR model, key context and process practices were identified that confirm the positive impact of partnership evaluation and self-reflection on research outcomes. Further, these findings provide academic and other key stakeholders with real-world practical recommendations to engage agencies, groups, and individuals who suffer most from inequities and may have unrecognized or indigenous knowledge, experience, and leadership to contribute to health and social research and to the creation of paths to wellness.

Development of a Mixed Methods Investigation of Process and Outcomes of Community-Based Participatory Research.

This article describes a mixed methods study of community-based participatory research (CBPR) partnership practices and the links between these practices and changes in health status and disparities outcomes. Directed by a CBPR conceptual model and grounded in indigenous-transformative theory, our nation-wide, cross-site study showcases the value of a mixed methods approach for better understanding the complexity of CBPR partnerships across diverse community and research contexts. The article then provides examples of how an iterative, integrated approach to our mixed methods analysis yielded enriched understandings of two key constructs of the model: trust and governance. Implications and lessons learned while using mixed methods to study CBPR are provided.