Health Education Research, Vol. 18, No. 5, 637-638,
October 2003
© 2003 Oxford University Press
Book Review |
Book Reviews
Community-Based Participatory Research for HealthM. Minkler and N. Wallerstein (eds)
Jossey-Bass, San Francisco, CA, 2002
490 pp. ISBN 0-7879-6457-3 (pb)
Co-Director and Assistant Professor, Social and Behavioral Health Sciences, Specialization Department of Public Health Sciences, University of Hawaii at Manoa
Can research and practice co-exist? Is research with no a priori hypotheses or significance tests really research? What can scientists learn from the homeless about conducting research? Does taking pictures constitute a research project? All of these questions and more are examined in this edited work on community-based participatory research for health (CBPRH). The book explores both the conceptual and practical promises and pitfalls of CBPRH and does an excellent job tackling the issues surrounding this difficult, time-consuming, but important and rewarding research. The 19 chapters and nine appendices by dozens of different authors are particularly well written and for the most part avoid excessive use of technical jargon, which makes this book accessible not only to researchers, but also to community members involved in participatory research. In Part 1, community-based participatory research is introduced. Part 2 addresses issues about power, trust and dialogue in working with populations in which power differentials are inherent. Part 3 identifies issue selection in communities and introduces two tools: the Internet and the photovoice technique for conducting CPRH. In Part 4, case studies provide the context of addressing methodological issues. Part 5 examines CBPRH in several diverse communities including village health workers, Cambodian girls in California and the transgender community. Part 6 addresses issues surrounding social change and public policy. The appendices includes an excellent set of references and tools for conducting CBPRH.
Although the concept of CBPR dates back to the work of Kurt Lewin in the 1940s, this topic has really only gained momentum during the past 20 years. Many of today’s health researchers may not have been trained in these topics during graduate school and might be uncomfortable with this type of research. One of the core hallmarks of CBPRH is the relinquishing of control by the researcher by entering into a partnership with members of the community. This can be a very difficult concept for many researchers. Chapter 4 does an excellent job of examining the underlying, sometimes covert, aspects of power that exist in academic–community partnerships. Randy Stoecker asks the questions ‘Are academics irrelevant’ and ‘What role does the researcher bring to CBPRH?’ This chapter explores possible roles including the initiator, the consultant and the collaborator. Stoecker provides several checklists to help guide the researcher through the process of CBPRH. Chapter 6 expands on these themes by exploring the roles of community members in this process. Sullivan et al. present real-life experiences from Seattle Partners to explain how they have worked with community members to create successful projects.
The most important part of this book is the inclusion of dozens of real-life field experiences of CBPRH. The text brings us beyond the dry descriptions and significance tests which are common in journal articles, to the real experiences of academics and community members who are struggling with difficult work. The authors are not afraid to admit when something did not work out the way they planned. These lessons from the field are valuable instructions for the reader. The field of CBPRH is broad and encompasses many diverse areas. The book covers this diverse field beautifully by providing a range of examples, including the following: the placement of hog farms in North Carolina; the epidemiology of HIV/AIDS in the transgender population; sexual harassment among Cambodian girls; and hotel room cleaners and substance abuse in Harlem. These are all real-life problems which were addressed because of community interest and participation.
With any new field, the development of new tools is necessary to study emerging problems in different ways. Two emerging tools described in this book are photovoice and the Internet. Caroline Wang does an outstanding job of describing the photovoice technique among a homeless population in Ann Arbor. This technique of empowering community members to tell their story via photographs is a powerful tool which is applicable to many settings. Wang leads us through her study and provides excellent examples of how this can be done successful in a population at risk. In Chapter 8, Stephen Fawcett et al. describe how the Internet can be used to develop capacity and promote community health development. This chapter is a clearing house of websites available to build capacity as well as describing the Community Toolbox. The Community Toolbox provides a long list of resources to do community health improvement as well as the ability to document and evaluate the success of an initiative.
The appendices are very useful and cover a wide variety of topics. Included in the appendices are guidelines for CBPRH, a history of Federal funding for this type of research, tips for faculty on documenting and assessing community based scholarship, and several tools to assist in conducting CBPRH. These tools are easily available and a valuable reference for anyone doing this type of work.
The only place where this book does not provide good answers is in the area of methodology, due largely to the limitations of the state of the science and not the failing of the authors. CBPRH remains difficult to conduct, assess and evaluate. The diverse methodologies, community-driven nature of the projects and long time frames for change make assessment difficult. Although some innovations such as the Community Toolbox have been developed, much more innovation is needed. Also, objective evaluations of the success of these programs are lacking.
In summary, this book covers the topic of CBPRH quite well. All of the major topics are covered with a diverse array of examples highlighting the potential of these research methods. This book is a great tool for graduate students and anyone interested in starting community-based research. Even seasoned veterans of CBPRH will find this book a useful reference as they are deal with emerging issues. I highly recommend this book and will be using it with my students.
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