Building Trust Through CBPR Principles

CBPR has arisen in the past several decades as a democratic approach to research that embraces and incorporates concepts from Kurt Lewin’s action research to Paulo Freire’s popular education.

The CBPR approach deeply involves pro­cesses of communication; therefore, attention to the dialogic environment is essential. Freire (1993) stated that the act of creating true dialogue is based on love, humility, faith in people, hope, and critical thinking. True dia­logue is difficult to create, though the reward is trust. “Trust is contingent on the evidence which one party provides the others of his true, concrete intentions; it cannot exist if the party’s words do not coincide with their actions” (p. 91). Given the inherent nature of conflict, conscious intention and action are necessary to keep the partnership moving forward.

Individuals enter research partnerships with previous experiences, are capable of contributing to spheres of knowledge, and have to learn to balance power in relation­ships. Concentrated efforts, therefore, on the communication process are needed to create shared visions and meaning. Scholars (Gaya Wicks & Reason, 2009; Kemmis, 2008) have proposed incorporating Habermas’s (1987) theory of communicative action to open com­municative space, “that delicate place where the lifeworld meets the system, a liminal, in-between space where two opposing quali­ties meet” (Gaya Wicks & Reason, 2009, p.

CBPR has the potential to construct a trust­ing communicative and dialogic space through its intentionality to redress power imbalances within partnerships, facilitate mutual ben­efit for community and academic partners, as well as promote reciprocal knowledge creation by incorporating indigenous theories and lived experience into the research process. As a corollary, CBPR is seen as an important strategy to address the mistrust and inherent conflict that characterizes community position about research and to help promote commu­nity participation in improving health. CBPR principles can thus promote the development of culturally centered health interventions, supporting both community research infra­structure and capacity to engage communities (Burdine, McLeroy, Blakley, Wendel, & Felix, 2010; Dutta, 2007). Israel and colleagues (Israel et al., 2008; Israel, Schulz, Parker, & Becker, 1998) proposed a set of CBPR princi­ples that showcase the potential for addressing conflict and building trust and that serve as a guide for conducting CBPR in community­academic partnerships. Presented here is how each CBPR principle intersects with the dif­ferent stages of trust development: KBT, CBT, and IBT (Lewicki & Bunker, 1995).

1. Recognize community as the unit of identity. This principle aligns with the concepts of multiple contacts in CBT and “fit” within KBT in that academic partners need to be aware of community culture and history.

In addition, the community and research team members must understand the university or other academic commu­nity. Although many academics, especially those from underrepresented backgrounds, subtly separate themselves from the insti­tution as a form of gentle protest against patriarchy and other forms of institutional oppression, community members may not distinguish this separation. From the com­munity perspective, at least initially, an academic researcher is a member of the academic institution and, thus, is bound by the rules and regulations of that institution. Therefore, it is necessary that all research team members understand the rules, regu­lations, and limitations, so as not only to overestimate their power and thus steer clear of conflict but also to use the power they may have within the institution to benefit their community partners. Those with power have the responsibility to use it to better the lives of those with less power.

2. Build on strengths and resources within the community. “Resources may include skills and assets of individuals; networks of relationships characterized by trust, coop­eration, and mutual commitment; and mediating structures such as organiza­tions where community members come together” (Israel et al., 2008, p.

3. Facilitate collaborative, equitable partnerships in all phases of the research. This principle overlaps with the previous one to create partnership synergy. Creating collaborative and equitable partnerships requires that participants feel comfortable and respected while voicing their thoughts, opinions, and perspectives. The combination of perspec­tives, resources, and skills in a partnership is called partnership synergy (Lasker et al., 2001). Partnership synergy can be difficult to achieve in hierarchical partnerships where researchers have more power related to scientific knowledge than community part­ners. However, community partners have street knowledge necessary for research project momentum. Street knowledge is commonly considered lay knowledge and is not as highly regarded as formal education.

4. Promote colearning and capacity building among all partners. Fundamental to this principle, and colearning in particular, is the recognition that every member of the partnership has knowledge and expertise to share. Capacity building is a “by-product” of the partnership process (Viswanathan et al., 2004) and a significant commu­nity benefit (Jagosh et al., 2012), where research skills are learned or developed by being engaged in the research process.

5. Integrate and achieve a balance between research and action for the mutual benefit of all partners. This approach incorporates a commitment to the translation and integration of research results with com­munity priorities and values. It is impor­tant at the onset of the project that skills and knowledge of the research team and overall partnership are assessed to deliver what is promised. The research team must also be pragmatic in what they say they can deliver. Many times, researchers will say what they think the community wants to hear when in reality it is not reason­able. It is also important to recognize that partners may have different ideas of “ben­efit”; thus, it is important to begin conver­sations about what research is, expected outcomes of the research, and priorities and values of both community and aca­demics at the beginning and throughout the life of the project. Academics must be forthcoming about their need to dis­seminate information about the research process and its outcomes. This principle aligns with repeated interactions and mul­tiple contacts in CBT, regular communica­tion and “fit” in KBT, and shared values, goals, and products within IBT. Complete congruence of values, goals, and products is not necessary as long as partners can accept each other’s agenda.

6. Emphasize local relevance of health problems and ecological perspectives that recognize and attend to the multiple determinants of health and disease. Health is a complex phenom­enon that encompasses the totality of one’s environment, including individual behaviors and attitudes as well as those influences from family, social networks, community, and society. This is known as the ecological perspective (McLeroy, Bibeau, Steckler, & Glanz, 1988). This perspective challenges mainstream heath disparities research that concentrates on one factor at a time instead of investigat­ing complex interactions within multiple levels of the system. The focus on one cause of illness or disease ignores ecologic complexity and loses the ability to identify parts and functions of the whole system. Because health depends on interconnected determinants, the issue that community members find important to investigate may differ from that of academics.

The ecological perspective is similar to Habermas’s (1987) conceptualization of the “horizon of the situation” (p. 123). He stated that situations always have a “horizon” that shifts according to people’s position; therefore, importance of a health issue will vary depending on whose opinion is being given. The horizon of the situation is the segment of the lifeworld relevant to the situation for which mutual understand­ing is required in view of the options for action that have been determined. In CBPR partnerships, the action is the intervention or policy initiative, and the options are the methods used to collect data. Taken as a whole, action and options are otherwise referred to as the action situation. It is through the action situation that the com­plexity of the issue is understood. It almost suggests a research paradox—that a part­nership will not completely understand the ecology of the problem until the investiga­tion has begun. This ties back to colearning found in Principle Four. Therefore, this prin­ciple aligns with multiple contacts in CBT to understand what is important to com­munity partners, regular communication and fit in KBT, and shared product, goals, and values in IBT. Again, local relevance of a health problem will not be actualized without communicative space and multiple community members voicing their concerns.

7. Involve systems development through a cycli­cal and iterative process. As previously mentioned, it is imperative for success­ful community-academic partnerships to negotiate governance, decision making, and priorities and values among partners. Yet the partnership may change over time, requiring that the negotiated terms be revisited. Development of a cyclical and iterative process creates the opportunity to revise decisions and ensures that the research project and its evaluation are on the right track. In terms of conflict man­agement, it is necessary to know whether adjustments should or need to be made in order to maintain alignment with com­munity needs. Development of this system depends on the partnership parameters and dynamics, such as partnership function and length of time. This principle aligns with repeated and multiple interaction in CBT, regular communication and “fit” in KBT, and shared products and goals in IBT. Inherent in this principle is the need to regularly revisit Principles One to Seven. This constant revisiting will begin to cre­ate a “context of relevance” (Habermas, 1987, p. 124), which are connected situ­ational elements that find their way into the lifeworld. Consequently, interdepen­dence grows, conflict is reduced, and trust is becoming relational.

8. Disseminate findings and knowledge gained to all partners and involve all partners in the dissemination process. A function of ownership and production of shared products is dissemination of project out­comes. Community members and aca­demics decide what, how, and where to copresent project outcomes. Recall that dissemination is a risk for community partners, accordingly what to share and how to represent it require negotiation and time. Regarding issues of governance, if agreements were made so that the com­munity owns the data, all dissemination reports, manuscripts, and presentations require approval from the owner of the data. As previously mentioned, this is another source of conflict and the reason why project governance should be clearly defined in the beginning. However, within the community, data are often shared between departments, so that other com­munity programs are informed of findings and have the opportunity to use data for other projects or future research endeav­ors. This means that the academic may be approached to consult about the meaning and potential use of the data. As expected, this principle requires repeated interac­tions and multiple contacts that align with CBT as well as regular communication and fit in KBT and shared products and goals in IBT.

9. Long-term process and commitment. The CBPR research process seeks to maintain long-term commitments to communities. This time frame has the potential to go beyond the length of any grant period but provides the opportunity to build genuine relational trust over the long term. Even if a partnership decides to dissolve itself, personal relationships have the potential to be maintained from CBPR practices and new partnership based on previous relationships may grow. Commitment as demonstrated as opposed to stated is a major factor in trust development. This principle requires repeated interactions in CBT, regular communication and fit in KBT, shared product and goals and shared values in IBT. In addition, because of the long-term partnership, these principles are cycled through ensuring that governance, goals, action, and outcomes are meeting the needs of the overall partnership and its individual members. Table 20.1 illustrates the links between CBPR principles and the stages of trust development.

When aligning the CBPR principles and stages of trust development model, the salience of CBT is seen in both repeated interactions and multiple contacts, both aligned with six principles each. Given the nature of CBPR, the ability to repeatedly interact with multiple contacts is essential for moving the research

Table 20.1 CBPR Principles Aligned With the Stages of Trust Development Model

NOTE: CBT = calculus-based trust; KBT = knowledge-based trust; IBT = identification-based trust.

project from inception to completion. KBT was also extremely relevant. Within com­munity-academic relationships, participation among members varies. There may be a small network of individuals who are highly involved, whereas other members are less involved and require ongoing regular commu­nication about project activities and progress. Regular communication occurs through meet­ings, phone calls, and e-mail among other media. Regular communication was found to be very important to the development of a “context of relevance” and, subsequently, trust; it aligned with all but two principles. Overwhelmingly, fit was necessary for all principles, which makes perfect sense, since any action must align with the needs and relevance of all partners. Within IBT, shared product, goals, and values were significant for trust building in community-academic part­nerships. Shared products and goals aligned with seven or nine principles, and shared values aligned with five principles. Proximity, as defined by D. L. Shapiro et al. (1992), is concerned with teams that are separated by distance. Physical distance causes difficulty for team functioning. Technological develop­ment of other forms of communication like e-mail, Skype, and tele- and videoconferencing have reduced the need for physical proximity; therefore, this variable did not align with any principles.

By aligning the principles of CBPR and Lewicki and Bunker’s (1995) model of trust development and decline shows that CBPR has true potential to be a trust-building approach in the span of community-academic partnerships. CBPR offers added value beyond “traditional” research, and perhaps beyond other academic-community collaborations, to reduce risk, negotiate conflict, increase fit with community needs and values, increase interde­pendence by building capacity, accounting for mutual benefit of all parties, while respecting relationship parameters.