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The Future of the Public’s Health in the 21st Century
BOX 4–6Community Perspectives on Research
A qualitative study by public health researchers and community members in Seattle, Washington, uncovered mostly negative community perceptions of the research conducted in their communities. Respondents noted a power imbalance between researchers and community members and described researchers as focused solely on community needs and things to be fixed. They also expressed a lack of trust in their relationship with researchers and a perception that researchers did not respect the community and were impatient for results (Sullivan et al., 2001:137). There is “so much rhetoric around this whole issue of community-based [research], it takes an enormous amount of investment of time and energy and expertise and skill and patience in getting the foundation laid properly. . . . [Y]ou spend . . . three or four years, and a lot of funding institutions would probably go faint at that, but it really does take that kind of effort” (Sullivan et al., 2001:139).
of those most affected not only may make it more difficult to develop and implement effective interventions for improvements in the health of the community but may also raise ethical questions (see Box 4–6). Furthermore, research has typically adhered to a scientific paradigm of objectivity and “universal” truth, whereas the issues, dynamics, and stories of communities are generally local, subjective, and unique (Schwab and Syme, 1997). This tension between the nature of the community and the nature of science may help explain why researching the effectiveness of community coalitions and community intervention has been a complicated endeavor and why investment in community-based research has been limited.
Community-based participatory research seeks to overcome some of the criticisms and distrust of academic research by emphasizing the participation and influence of nonacademic researchers in the process of creating knowledge (Israel et al., 1998). However, community members are frequently skeptical that proposed research efforts will be truly collaborative in nature. The promise of community-based participatory research brings with it the need to establish true partnerships with equal decision-making authority, mutual benefit, and shared responsibility. Major issues that must be confronted in such research include power and control, conflicts over funding, and who will be recognized as the community representative. Additionally, according to Israel and colleagues (1998), “emphasis needs to be placed on developing norms and ways of operating that promote understanding and demonstrate sensitivity and competence in working with diverse cultures.” All of these factors lead to the need for a well-developed review of ethical issues involved in community-based research and an ongo-