Community Needs First:
A Collaborative Research Approach
The picture shows a medical office, obscured by scaffolding, with abandoned cars parked in front. The photograph could be a metaphor, or even a call to arms, about access to health care and prevention services in this community.
This picture was part of PhotoVoice: Documenting Community Strengths & Health Disparities, a participatory research project conducted by the Community Collaborative Board (CCB). This group of New York City-based researchers, social and medical services providers and residents took more than a hundred photos documenting both the strengths and challenges facing their neighborhoods with regards to health and social issues. Dr. Rogério M. Pinto, an assistant professor at the Columbia University School of Social Work and a Community-Based Participatory Research (CBPR) expert, says that PhotoVoice helped the Board come together as a community, integrate diverse sources of knowledge, and develop research goals that reflect the realities of community-based partners.
"It helped us figure out what ourvision was and what it was we were going to address," said Dr. Pinto, who heads the Board. "It helped usdefine more specifically the research priorities we needed to engage."
Forming a connection between communities and policymakers has been a guiding principle in Dr. Pinto's life. As a child growing up in Brazil, he experienced poverty and political isolation firsthand. "My formative years were lived under a dictatorship," said Dr. Pinto. "It made me concerned about how policies affected people's everyday lives and about how we can involve people in research that has personal, practice and policy implications." Dr. Pinto came to the United States after he obtained an undergraduate degree in biological sciences in his hometown of Belo Horizonte, in the Brazilian Southeast. In the U.S. he worked as a volunteer in an HIV/AIDS Service Organization, and, inspired by the work and dedication he witnessed, he decided to pursue a career in social work. He received his master's from Yeshiva University in 1997. While earning his Ph.D. at Columbia and pursuing a post-doctoral fellowship at the HIV Center for Clinical and Behavioral Studies at New York State Psychiatric Institute, Dr. Pinto maintained his connection with those who had inspired him to enter the field. "I never took my foot out of the community," he said. It was during his fellowship that his expertise in CBPR took hold.
The creation of PhotoVoice has been just one method used by Dr. Pinto in his participatory research. CBPR is a paradigm, a collaborative approach which involves the community in all phases of research, from the development of areas of interest to collecting and analyzing data to disseminating findings. "The mostbasic principle of CBPR is to tackle issues that are important to the community," said Dr. Pinto. "If, as a researcher, I am not clearly aware of what is meaningful to the communities I work with, I may engage in research that will have little or no impact in peoples' lives. For example, through PhotoVoice, it became clear that providers and female community representatives on our collaborative board were interested in understanding the factors that influence women's involvement in HIV-prevention research and services."
Based on their recommendations, Dr. Pinto developed a quantitative study, accepted for publication by the American Journal of Orthopsychiatry, to identify key factors that affected women's attendance at a 12-session cognitive behavioral intervention. "Many factors were revealed," he said. "However, on a practical level, we found that sites offering child care and strong therapeutic alliances between therapists and participants helped enhance retention."
Dr. Pinto believes that research questions ought to drive the methods we use to answer them, and not the other way around. "To pursue CBPR," Pinto says, "one must be competent in quantitative and qualitative research. My research uses a mixed-method approach to include communities in the collection, analysis, interpretation and dissemination of data. Qualitative research is helpful to identify opinions and attitudes of communities and to develop models of community-researcher collaboration. I use quantitative methods to measure aspects of research collaboration that have not yet been systematically documented." Dr. Pinto has contributed an entry, "Mixed Methods Design" to theEncyclopedia of Research Design, to be published in 2010.
Onaje Muid, a member of the CCB and clinical director of Reality House, a substance abuse treatment facility in Long Island City, describes the impact of this type of research collaboration from a community perspective. "As a substance abuse treatment provider concerned with high rates of HIV among substance abuse users, I take the position that the person using drugs is an expert on their own life," said Mr. Muid. "This is a principle of CBPR that is directly applicable in service provision. It's a marriage of research and service provision competencies that helps both researchers and providers work together to make meaningful changes in our clients' lives."
Dr. Pinto notes that community involvement can help ensure that important research findings do not end their useful life in the pages of a journal. "If you develop an intervention," said Dr. Pinto, "people who have been involved with it are much more likely to use the results to guide their day-to-day behaviors, whether it is using science-based HIV-prevention methods in one's own life or teaching clients about these methods."
"My formative years were lived under a dictatorship. It made me very concerned about how policies affected people's everyday lives and about how we can involve people in research that has personal, practice and policy implications."