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  40. I liked these readings because, more than to know about how to conduct CBPR and the things that you need to be “successful” by doing that type of research, it is important to see what has really happened in real life by presenting case studies. I liked Ellis & Walton chapter on building partnerships between local health departments and communities because of the way they described the Healthy Neighborhoods Project (HNP) in Contra Costa and how they also addressed cultural humility. In terms of HNP, I liked how they described they achievements but also the challenges presented with both, the community and health departments. Issues presented in the HNP like research saturation using the same community, to look at the problem rather than to the community assets, the sense of no benefits by participating in a research, and/or the researchers’ private agendas, are issues that have been also discussed in other research studies as challenges when trying to get into the community. As researchers, we often think that, by knowing about the potential barriers that might appear in a research study, we will correctly avoid them. The truth is that the way of how the community would react when the academia or community organizations approach to them is not granted. Given that often the communities in need or that have issues that directly affect their health are those that are composed by minorities such as African Americans and Latinos, understanding how to approach to them and the difference between these approaches is essential. Therefore, that’s when I think cultural humility could help to build the partnerships between the community and health professionals. As described by Ellis & Walton cultural humility is “the ability to listen both to persons from other cultures and to our own internal dialogue” (p. 131). Thus, including cultural humility as the training for capacity building between organizations and health departments could ensure a better approach to the community and eventually better research outcomes.

    Regarding Wang & Pies’ chapter about photovoice, I consider this is a good participatory visual and digital method to be used with the community, especially with those people that might not be able to express themselves about their concerns. As expressed by the authors “using photography as community voice to reach policymakers, photovoice tries to go beyond the personal voice to political” (p. 185). I also like this type of research method because it allows research participants to be part of a study by doing something that nowadays is considered a must: people take pictures every day, about almost everything. So, by guiding participants to reflect about what they took a picture about and how it could be related to their community needs and/or assets, researchers might be building a sense of empowerment in the community they are working with. Moreover, by including the community using photovoice, and other types of participatory visual and digital methods like digital storytelling, researchers could ensure that community members’ voices are being herd, and that advocacy and policy maker with the results are possible.

    Finally, I consider that getting to know about methodological and ethical considerations in community environmental research (Farquhar & Wing) is very important. Honestly, even that I’m concern and aware of the environmental health problems that are present everywhere, this issue is not in my top 5 topics of interests. I should be ashamed, I know, but sometimes I don’t feel that the research that has been done regarding environmental health is the better. However, knowing about environmental justice research caught my attention. It’s so sad, but also well-known, that industries and big companies take advantage of poor and underserved neighborhoods or communities to build or develop their “businesses”. But it’s saddest to know that the government and/or the people that should ensure the safety and quality of life of those less privilege are the ones that sometimes get benefited of those businesses. The case about industrialized hog production brought me memories about my childhood. In Puerto Rico I grew up in a poor neighborhood within a rural town and even though, my direct family didn’t have to struggle with lack of resources, I could often witness how other neighbors suffered from it. I could see how little children ran barely naked (because they didn’t have good clothes or even shoes) through the neighborhood, playing with animals and jumping in the dirty ponds that were often produced by the combination of rain and deeply potholes in the ground. I also sometimes saw them with rash in their skins and getting sick really often. At that time I just saw those situations as lack of hygiene or careless parents, but now that I reflect, I can see that that was part of the reproduction of poverty and social injustice that have always happened in my neighborhood. I know that this sounds like a cliché, but I hope that one day I would go back to my community to help my neighbors to see that poverty doesn’t have to be reproduced and that they have voice to stand up for their rights and fight for a better environment.

  41. In chapter 8 (Minkler), it is about effective partnership between local health departments and communities. Partnership synergy brings the power to combine the perspectives, resources, and skills of a group of people and organizations. Cultural humility and sharing power can contribute to build a good partnership. For improving health outcomes, resident-driven community development, increasing the community-based capacities of public health staff, cultural and systems change with public agencies are needed. However, we need to think that it is not easy to build trust between them.

    In chapter 11 (Wang & Pies), it is talked about “photovoice” to participate community members into process of research for health. As chapter said, I totally agree with that visual images have a huge power to move people’s mind and thought. Also, it is a good method to see a real problem in the community. But it also has a limitation that policy makers do not change the policies immediately. When I read this chapter, I felt like how “photovoice” can be seen as data to prove what their real problem is. There should be a time consuming task to choose what is more important in the community. With this priority list, researchers can collect related data or literatures which should help to persuade the policy makers.

    Chapter 15 (Farquhar & Wing) talked about involving community members in research process. Involving community members in research process has a power when community members and researchers work together early in the project (p.275). This process may need many time for the researchers to teach the community members about some special skills that researchers only have. But once community members understand and have skills, the project will be more easily maintained. Although there are some barriers working between community members and researchers, I think most important thing is how to keep doing the project with high responsibility of community members. Money is not the best solution. Maybe build trust and give authorization to community members gradually are possible ways to maintain the project. I do not mean that researchers tasks are totally gone. Evaluation of the project can be done by researchers. This needs some special skills that researchers can do.

  42. In Ellis & Walton’s paper they focus on two important aspects of CBPR: the sharing of power and the true commitment required to both the project and community where the project is based. Ellis & Walton, in quoting Lasker, highlights that the objective of CBPR is the co production of new knowledge and ideas, that stem from “combining the individual perspectives, resources, and skills of the partners” involved (Ellis & Walton, p. 131). They are also quick to point out that this coproduction of new knowledge does not necessarily come easily or quickly, and that the “commitment to process of sharing power must be unwavering, consistent, and authentic” (Ellis & Walton, p. 143). The three programs Ellis & Walton described (in following the model of the Healthy Neighborhood Project) prioritized the training of multiple people in applied concepts of cultural humility in order to facilitate a paradigm shift towards shared power. As they describe, this is key for public health professionals used to fulfilling the role of “caregiver.” Although care taking is inherently good and comes from a space of good intentions, it also perpetuates a power dynamic that reinforces a deficit versus an asset perception of a community. In all of their examples, what I saw as a common theme that supported the programs’ success, was a committed public health leadership at the decision making level. The Public Health Departments in each project remained invested in the projects by training staff and for having the flexibility to be accessible to the community (being available during non-traditional work hours, for example). I enjoyed their descriptions of the implementation of each project, and particularly liked the idea of using “timebanking” as a tool to make connections between groups who may share similar space, but don’t necessarily interact. I see this as a really innovative, yet relatively simple and low cost way to tap into and increase awareness of community assets from the inside.

    Wang & Pies describe Photovoice as a tool to “build community and equity”. In the “Picture This” project, photos were used as a means to enhance needs assessment data that was traditionally captured with epidemiological data that was not representational of the diversity within the community. I have always considered Photovoice to be something that is more stand-alone, but I think it is really valuable to consider it as a tool to make traditional data more representative and real. In addition, the ‘Picture This” project brought to light issues that would have been overlooked with data that only came from state or local databases. One of my classes last semester used a similar approach to use of photo data. I wouldn’t consider it Photovoice, but community members were given cameras on one day to take pictures of Springfield. At least one of the participants shared that they went into the project assuming they wouldn’t learn anything new about their city, but that the process of slowing down and framing images allowed them to notice aspects of the city they had passed by many times until that moment.

    The Farquhar & Wing chapter brings up important methodological and ethical concerns in this type of work. What is of interest to me in terms of methodological issues is the lack of common definitions and processes for participatory research projects. As we discussed before, community participation is not the same as participatory, yet community based projects are at times labeled as participatory. To me the interchangeable use of a term that has significant meaning is a concern; at this point I don’t have ideas about how to approach it. Repeating and reconsidering Ellis & Walton’s quote that I wrote at the beginning is a good place to start: the “commitment to process of sharing power must be unwavering, consistent, and authentic” (Minkler, p. 143).

    At the beginning of Farquhar & Wing’s chapter they state “participation in democracy requires access to knowledge, including research” (p. 264). As their research in North Carolina shows, control of information is a significant ethical consideration in CBPR. The breach of confidentiality with participant information to the industrial pig company was one example in which community members were put at risk as a result of too much of the wrong information. In contrast, after Hurricane Floyd, when low-income African-American residents were unknowingly relocated to a coal ash landfill, limited information was the issue. I was interested to read about the difficulty of obtaining state data about the timeline and potential risks of the site, even for a student researcher that had access to more databases and resources than the typical community member. This issue has come to light recently in Springfield in regards to data about infant mortality rates. Until very recently, the data for African-American and Latino infants was recorded as N/A. It has now been included in the MassCHIP database, but not prioritizing this basic information impacted what programs were prioritized by the local Department of Health. I do like how Farquhar & Wing close their chapter by discussing the importance of making scientific findings accessible to the public so that it is not misinterpreted or taken out of context. I think delivering findings in a simple and clear way would make communities more likely to get involved in community level work.

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  43. I feel like there are so many things I can write back after reading these case studies. Before doing the readings I was not to familiar with Photovoice. I had to look at example of Photovoice projects. In the beginning I thought Photovoice was another word for Digital Story telling. I wish the readings did a better job at describing what Photovoice was or even provide some examples from the case study. I enjoyed reading the about the different case studies. It really put the material into context when I can read about places that try to implement these different projects and programs. I feel like a lot of programs or projects look good on paper but the reality is they are not as good when put into practice. I like being able to read about the different themes, challenges, success, and best practices. Reading about the different case studies and Photovoice made me think about the work I am doing with Digital story telling with young parents at the Care Center in Holyoke. The Contra Costa County sounds like it is similar to Holyoke. Similar to Photovoice, Digital Stories allow the person who creates the piece tell their own story. A lot of the same questions that have come up in the project came up for me when I was doing the reading like:

    Who are making these stories?
    Who will see these stories?
    How will these stories be used?
    Can these forms of media really influence or chance policy?

    I would of liked to know more about the research team and the people facilitating these Photovoice workshops. Are these people from the community? What was their agenda? As a person from Holyoke working on a project in Holyoke I really enjoyed reading some of the staff in one of the case studies feeling like “outsiders within”. I feel like I am often balancing different roles as a person from the community working on a project in the community. I feel like the term “outsiders within” perfectly captures the way I feel.

  44. It was interesting to learn about cultural humility from Ellis & Walton. The case studies clearly demonstrate that how critical is the community involvement in any public health interventions. The commitment to community engagement in Healthy Neighborhood Project illustrates a successful partnership is a good example. My attention was drawn to an important perception while reading the points highlighted at the beginning of that case study: “…many residents have concluded that the primary benefits of such programs are salaries for outside professional and publications for faculty members…” (Ellison & Walton, p. 132).

    Somewhat similar to this is what I’d experienced back in 2007 when a donor USAID funded capacity building project was launched in Universities of my country. The program following a quick needs assessment – but not in an in-depth scale, was supposed to enhance faculties’ teaching capacity through conducting short-courses and series of in-campus trainings. Awhile after the launch of the program the university leadership and some faculty members began complaining about the components of program. Majority of the target faculties stopped attending the trainings. They, as some of them frankly stated, were assuming that the program staff/outsiders intend to impose project-developed activities on the faculties without adequate involvement of the university in the designing phase of the project. Ultimately, the project had to bring some alteration/modification in its original structure and design by agreeing to at least one new component proposed by the university – the new component was establishment of English training unit for the use of faculty members which was highly welcomed throughout the project.

    Photo-voice described by Wang & Paies apparently seems an interesting tool through which people can document and discuss the realities of their lives though it might not be applicable in everywhere and every situation. Given this limitation, we may have communities where some individuals are not so willing to visualize the sensitive problems of their lives particularly if it leads to the loos of their privacy – but I believe it is an absolute way of capturing positive side and strengths of communities. For instance, photo-voice would be a good means when needs assessments are performed within communities. It can demonstrate a purer picture of people’s live which will help the researcher to have a better interpretation of the gathered data.

  45. As Sabina mentioned, many of the concepts of CBPR were not new to me before reading the articles for this week. However, I did gain some new perspective through the description of the process of the case studies as well as the critical analysis.

    The framework discussed by Ellis and Walton was really interesting- a combination of the ABCD model, partnership synergy, and cultural humility applied to two Healthy Neighborhood projects in California. The thing that stood out the most to me was the importance of the dedication of the public agencies to undergo cultural and systems change. After working in a local health department this past summer, I know the mentality of seeing community members as recipients of service is common. I loved this quote from the article, “Not to reveal our pain, our limitations, our mistakes, and our own process of opening and evolving itself is a barrier to the kinds of connections that must be made to build community” (pg. 135).

    As I have mentioned in class, I participated in a photovoice project a few years ago with a youth group in Holyoke. Our photovoice project had a slightly different slant that a general assessment of the community, we used the process to highlight a specific strength that was important to the youth- the local farm to school path. Our photovoice project mainly resulted in the youths’ development of being involved in local policy change and how they felt about it. Although I think this was a great project, I do think it was missing one of the core components of photovoice- the participants drive the process. The youth did not have total say in what was prioritized, which was a limitation.

    I thought the article by Farquhar and Wing did a great job at highlighting the challenges that arise when trying to balance community/academic partnerships in CBPR projects. As seen in the case studies, ethical dilemmas do arise and are not often easy to navigate. In the second case study, the NC Pork Council requested all materials to do a re-analysis but there was risk of community members being disclosed. As this breach of confidentiality could have had a major impact on the relationship, certain information was not disclosed to the council. I think the take-away message for me, is what the authors emphasize at the end of the article, “Meaningful and influential community involvement in research studies can help public health researchers to address the structural and power issues that perpetuate inequity” (pg.280).

  46. In reflecting on previous readings in the Minkler text, again I appreciated the way in which community asset mapping and the promotion of community strengths was promoted in the Wang & Pies chapter. Photography can be used in such a variety of ways from evidence to protest, dialogue to memory-keeper; in this way photovoice as a technique for public health can touch on all these complex pieces of individual understanding of health and wellbeing. The authors of this text connect the method of photovoice to Freire’s dialogic approach that was so pivotal in working with people of limited written literacies. In using disposable cameras, a tactile element was bought into the project done in Contra Costa, which also had elements of mapping in it. The process of framing photos, winding film and walking from place to place then sending off cameras and awaiting their return brought the project into another realm of sensory exploration. In relating this to the work that I do with youth I find myself dreaming of finding a way to use cellphone apps to draw in the mapping side of this and create an interactive platform and piece of art.

    The limitations of this project were similar to the limitations of the Hear Our Stories Project, in that participants live complicated lives and follow-up can be a struggle, as can consent and safety surrounding images. In relating this reading to the Ellis & Walton piece remaining humble and being aware that each participating group has its own unique negotiations to be made, be they inter-personal or bureaucratic, is essential. Again one of the potential assets of photovoice is illustrating injustices such a structural violence, racism and apathetic responses from organizations in positions of power. Conversely though community members (such as the ones in the Farquhar & Wing chapter) may fear their safety after speaking out, especially in a highly visible way. This is of course a possible struggle for visual methods, but also a place for allies in the CBPR process to use their channels to support the safety of participants, and to promote values of sharing data etc… from the project itself.

  47. I feel that in mostly, if not all circumstances, people want help and want to create change. However, they do not necessarily know how they can do it, they may not feel that their single voice will make a difference, or they just don’t feel as if it will matter because they will be living in the same conditions. In the article by STEPHANIE ANN FARQUHAR & STEVE WING when they described Eastern North Carolina as “The Black Belt” and gave a description as to why, I am sure that the people whom live there does not want to live in conditions of poverty, discrimination, unemployment and poor sewer systems. But how do they change that? And they may not know. It is important to realize that we as future public health professionals see and understand the value of the community and use them to actually make an impact on the target population. So that is why it is important, that more of an emphasis be on the CBPR approach.

    I love the idea of photovoice. I feel that it stands for something far more than just pictures. But that those pictures can and will be able to reach an audience further than voices can carry or ears will hear. However, when eyes see and realization sets in on the situations, then I believe more people will be inclined to act and change will occur. I am actually doing a photo-voice activity associated with my MPH project and i am interested to see what they bring back, how it made them feel while doing it, and also what they feel are the best methods of dissemination. However, the only thing that I questioned before I gave the cameras out to my group was actually giving them the bulky disposable cameras. In fact, some laughed and decided not to take one because they did not want to be seen with such an old/cheap camera. Which makes me wonder that their perception of how others feel about them are more valuable to the impact they could make on change to the community. Therefore, I encouraged them that if they still wanted to take pics, then to use their camera phones.

    Lastly, I feel that most of the responsibility falls on the public health practitioner within any environment that is specifically dealing with CBPR. As noted before, often the community members may not understand how to create change. Therefore, it is the duty of the public health worker to create an environment where they feel comfortable enough to engage and be open to express thoughts as well as encourage the community that their efforts are not in vain; that there will be an result; but most importantly that their voice matters in any way that it is heard.

  48. This was not my first time learning about concept of community-driven method. Concepts such as “starting where the people are” and “equal-partnership” are not new concepts, I think this is true for many of us in the class…especially those that have taken Community Development. However, we do not always learn or see how that actually unfolds in practice. I think by now we know the importance of involving community collaboration, but again how that actually looks like is not always made clear. For that reason, I really appreciated the articles from this week because it provided detailed information on doing a research that was truly community driven. The two case studies presented by Farquhar & Wing (2002) in particular were very helpful.

    There were various lessons to be learned in doing a research that is actually community-driven. One of the first was the importance of returning findings to the community first. In the case study about Hog Production in North Carolina, the researchers shared the result of their collaborative study was first shared with the community and they were asked to provide feedback prior to submitting the findings to the state. Very rarely have I heard of research findings being shared with communities before publishing or reporting to the government. I do not think it is done on purpose. Often time research such as these are on strict time constrains and already community-driven approach takes longer time. So they have to prioritize their time and efforts often. The case study provided in the chapter 15 by (Farquhar & Wing, 2002) helps us to reconsider those priorities set in research.

    In the case study, we learn that community wanted to changed the way in which the findings was going to be presented to the state. The community did not want names of their communities to be included in the report. And what the researchers did next is really commendable. “Respecting and responding to this feedback, researchers removed from the report the data on numerous households, population size, race, and income characteristic of the census block group in the study. Along with information about the exact size of the hog and cattle operations” (Farquhar & Wing, 2002, p. 269). Now from a research point of view this probably was not the best idea and that it would hurt the research. And as expected the state responded by saying“ in order to evaluate the quality, internal consistency, and analytical methods in the study, the industry would need to be able to conduct independence reanalysis” (270). Most often in researchers that are said to be community centered, I have seen community be involved in assessment, data collection, implementation and now more in data analysis and evaluation. Community input often stops there. But this case study highlights the importance of including community in reporting. Yes, it takes even longer to do so. I mean we clearly saw here that researchers had to omit information and re-work their report but here that was important. I can not help but think that had they not seeked community feedback and actually “respected and responded” to community concerns would the community ever again be involve in research? I would take a wild guess and say probably not! In our field we want to help fix the problems and want to do that fast. But there are a lot of advantages to slowing down and reprioritizing what we (researchers) think is important. Because it is not so much about the researcher and what he/she thinks is right, rather the starting point should be what the community thinks is important (even in disseminating findings).

  49. When I think of community voice and involvement in the most simplistic form—I think of petitions. I imagine grassroots, door-to-door acquisition of signatures to support a cause within the community; the idea being that, enough signatures would demonstrate the severity of the issue and community support for change. Community-Based Participatory research is a living breathing petition that is dynamic and so incredibly important. Yet, we see a petition to deport Justin Bieber back to Canada reach the President’s desk before any of these community-based movements gain policy-maker attention. I know the comparison between CBPR and petitions may be a mild stretch, but the underlying message is that the importance of community participation and ownership of change is extremely important to community progress. And despite incomplete or undesirable outcomes with regard to the attention of policy-makers, as analyzed in the case studies by Farqhar & Wing; CBPR still maintains integral role in identifying and addressing structural and power-related issues that perpetuate inequities.

    Ellis & Walton posed some excellent information in using 3 main concepts to support the Healthy Neighborhoods Project (HNP): the asset-based community development (ABCD) model, partnership synergy, and cultural humility. I found this reading to be particularly helpful in understanding CBPR in a real-life scenario and was able to apply concepts to my own community-based experiences. One aspect of the HNP case that made complete sense to me, but I had never previously considered, was the idea of inviting providers and elected leaders to attend resident training sessions, but only to observe and be available as resources—while refraining from advocating or voting during the decision-making process. All 3 of the case studies examined the concept of power in one way or another and I felt that the HNP example provided an excellent approach to the reassignment of power in this situation. However, one question arose for me: Would simply the presence of these individuals influence the community opinion in some way? Would their implicit possession of power play a role?

    Wang & Pies offered additional insight when speaking about photovoice, which is one of my favorite research methods! “…power accrues to those who have voice, set language, make history, and participate in decisions (Smith, 1987)” pp.185. This quote is where we see cross over from the Ellis & Walton reading—where the community empowerment exemplified in HNP is similar to those who participate in photovoice. Another important concept that I believe carries through across each article was best explained by Ellis & Walton, “…the essential capacity [of a culturally humble and synergistic partnership] is to suspend beliefs long enough to hear and accept the truth of another” pp.134. I think this is where many health professionals struggle in forming this relationship with the community. Additionally, this may be where the lack of acceptance from policy/decision-makers stems from—no desire to be criticized. In my opinion the most difficult piece of CBPR is this idea of humility. In order to successfully achieve the desired change and truly HEAR what the community is saying, we as academics, advocates, policy-makers, groups, and individuals need to take a step back and realize it is not an attack, but is coming from a place of true emotion and can be a building block toward achieving desired goals.

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