IDENTIFYING PRIORITY HEALTH CONCERNS AND RESEARCH QUESTIONS

Too often, researchers have tried to impose participatory research on communities based on funding opportunities, high profile issues in the media, current sociopolitical agendas, or emerging epidemiological trends. This approach does not take into account community priorities, which may not align with research or public health agendas. Nor does this approach take into consideration the context in which the chosen research issue is embedded. Further, many research concerns are embedded in social inequalities, historical injustices, and involve challenges related to race, gender, power, and turf. Identifying a research area of mutual interest often takes considerable discussion of priorities, potential approaches, feasibility issues, organizational structure, and operating processes. This must be accomplished through dialogue, compromise, and consensus among partners. Unless the research team has a strong relationship with the community and had a history of successfully navigating these issues, the partnership and project are unlikely to succeed.

Rigorous community needs assessments can be important tools for understanding community priorities, the community’s understanding of the underlying determinants of identified research questions, and sources of insight into potential solutions. They also can be a vehicle for developing community rapport and creating community relationships. For example, in a CBPR violence reduction project, one of the authors of this chapter was the lead investigator on an initial 18-month multicomponent community needs assessment.22 The first step was a pair of community forums designed to introduce the initiative to the larger community and elicit community views on the definition of violence, its causes, and its prevention. At the forums, attended by over 125 people, a call for applications to serve on the project steering committee was issued. Subsequently, a steering committee was convened and began meeting regularly over an 18-month period to (1) establish specific, long-term goals of the project; (2) develop a detailed implementation plan to reduce violence and increase community capacity to conduct violence prevention projects; and (3) provide leadership and oversight of project activities.

In addition to the steering committee, a community asset team conducted a series of community forums, workgroups, and assessments to elicit community perspectives on the definition of violence, its underlying causes, priority populations to target for prevention, and recommendations for intervention. Staff first conducted 62 individual interviews with key informants from a broad spectrum of community sectors including grass-roots and community leaders, community- based agencies, social-service agencies, school systems (public, private, charter), faith-based institutions, business, public, law enforcement, judicial/l egal agencies, neighborhood associations, medical and mental health providers, funders, academia, media, and the arts. Staff also conducted analyses of 10 high-risk zip codes in the target city to identify and map community assets and needs. A summary report of these two assessments was prepared and discussed in three focus groups with 16 stakeholders who had participated in the interviews. Participant feedback was elicited about the face validity of the report and the implications of the findings for violence prevention efforts. Key recommendations of these community assessment activities were that the violence prevention efforts should focus on youth, take a comprehensive approach to prevention, and involve diverse community partnerships.

Subsequently, two additional community forums attended by 169 participants to present findings from the stakeholder interviews, stakeholder focus groups, and community mapping analyses elicited additional feedback about (1) how to build alliances and navigate community politics in local prevention efforts, (2) best strategies to listen to and give voice to youth, (3) novel ideas to address youth violence in the target city, (4) how best to deliver technical assistance resources to existing initiatives that were currently addressing youth violence prevention, and (5) training and education needed to advance policy addressing youth violence.

All of the activities listed above were designed to elicit information to inform the steering committee and the community about stakeholder definitions of violence, its causes, and its prevention. Next, four community action workgroups (involving 64 stakeholders who participated in one or more workgroups) were convened to translate the community assessment findings into concrete action recommendations for consideration by the steering committee. These community action workgroups made recommendations around four broad content areas: (1) community coalition building and collaboration, (2) community- academic capacity, (3) policy and advocacy development, and (4) youth asset development. Workgroup participants were recruited through open invitations at the 2009 community forums and through an e-distribution list. The workgroups were facilitated by steering committee members and community leaders. Both large- and small-group discussion formats were used to generate action recommendations.

The final phase of the community assessment was designed to elicit youth perspectives on violence, its causes, and its prevention. We conducted 18 individual interviews with high-risk youth recruited in street settings through key informant contacts. We also conducted six focus groups with youth (n = 64) recruited through agencies that serve high-risk youth. Finally, we held two youth summits (n = 140 participants) to present findings from the youth interviews and focus groups, elicit feedback about what we learned, and hear youth testimonials about their own experiences with violence. Summary reports of all these activities were then combined into a comprehensive summary report that was widely distributed to stakeholders throughout the city.

 
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