With increased awareness of disparities in health and well-being outcomes, Dr. Paul Gilbert views community-based participatory research as a necessary part of addressing social issues that influence health.
“If we’re going to prioritize health equity and eliminating disparities, we must involve the community in whatever we’re doing,” said the Associate Professor and Director of Graduate Studies in Community and Behavioral Health at the University of Iowa.
While not all of his research uses a full community-based participatory research (CBPR) model, he infuses a variety of strategies that intentionally engage community members and stakeholders in his work. This has especially been important as he’s examined drinking patterns, risk of alcohol use disorders, and use of treatment services with a deeper dive into understanding differences among gender, race/ethnicity, and sexual orientation.
With a growing interest in community-involved research, he offers these insights to keep in mind with this work:
The model requires complete collaboration with all partners, especially community members, starting with defining the project all the way through research dissemination. This is often opposed to the other end of the continuum that is more like “helicopter research,” says Gilbert, where researchers drop into a community, do their work, and then disappear. They may go on to publish papers in academic journals, but the community likely doesn’t see the findings.
Between the two approaches are models that could include asking community members or stakeholders for feedback while maintaining control of the process or having an advisory board that helps plan and design the research but doesn’t have power to make decisions about the research.
This model is defined by sharing decision-making power with the community and other stakeholders.
“I come in as the university person with this scientific expertise, but I don’t make the decisions,” he said. “It’s the group that makes the decisions, and whatever we do, it has to be a benefit to everybody, especially the community.”
One example of this kind of approach is the community health assessment Gilbert conducted in West Liberty to identify the strengths of living in the community and health concerns. The town had an equal mix of Latino and non-Latino residents, and leaders wanted to understand how both groups viewed the community and what they wanted to see happen. The community was engaged in defining what to measure, how the assessment was implemented, dissemination of the research, and planning next steps.
For the West Liberty study, Gilbert spent time at the community’s restaurants, churches, and public library, where he met people and had conversations before the project began.
“You can’t just show up and expect people to trust you and be willing to work with you,” he said. “They have to know you over time.”
Gilbert also is active in building relationships and participating in coalitions looking at alcohol-related issues, which informs his research and their efforts. For one research project, he’s enlisting stakeholders of these coalitions to join a national data collection effort, where they will order and track how alcohol is delivered to homes or provided for curbside pickup. This research is seeing how laws enacted during the pandemic are being implemented in communities and whether they increase minors’ access to alcohol.
As Gilbert enters a community to conduct research, he goes in with this understanding: “I’m the academic. I’m the technical expert. I’ve got all sorts of book learning, but I don’t always know what’s going on in the real world, in communities.”
In some cases, there isn’t enough data to provide a clear picture of an issue, so a CBPR approach can help generate that data. For the West Liberty project, for example, the town population was too small for the Census methods to supply reliable data. The research Gilbert conducted provided more robust information, as well as showed similarities and differences among the two largest demographic populations. For example, the research revealed that while Hispanic and non-Hispanic residents agreed on what they appreciated about the town, there were different health priorities that concerned them. This informed how the city needed to make decisions so as not to prioritize addressing one effort over another and risk creating deeper social divisions among community members.
A true community-based participatory research model takes time to implement, because it starts by getting to know people and developing trust. Once the work begins, it’s about taking time to understand how each stakeholder is showing up and what they want to get out of the project.
His dissertation advisor for his Ph.D. gave him this advice: “Be prepared for conflict. Conflict doesn’t mean that you are having shouting arguments in your group; it just means that you’re going to have to work out different needs or desires or priorities and they’re not always going to be in alignment. You have to figure out the compromise.”
It can also mean being prepared for different kinds of research and different outcomes than you expect. For example, one research project was aimed at studying the effectiveness of Iowa’s social host ordinances or laws, where adults are held accountable for providing alcohol to underaged minors or allowing underaged drinking to happen on their property. As Gilbert got into the research and spoke with different stakeholders, however, the focus shifted to an understanding of what makes a successful coalition that leads to passing these kinds of laws, especially in a state that strongly permits alcohol use.
Gilbert says by doing research in partnership with communities and other stakeholders, you compromise what your vision is with what the community also wants to see. This can ensure that researchers are doing research that meets community needs and will be applied in the real world, going beyond the academic space.
“If the community is part of the team planning and designing a research project, and knows how it’s going to be used,” he said. “You know it’s going to be responsive to the community.”
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