When it comes to rural health, it comes as no surprise that many challenges still abound. The negatives such as high mortality rates, lack of services and/or distance to resources, aging populations and youth flight to the cities tend to be emphasized with little agreement on how they can be improved. There is also the issue of often not being able to adequately report the rural experience due to small population sizes and thus the amount of suppressed data. Because rural communities in this country have such a profound impact on just about every aspect of American lives, it is important that their stories be told in a truthful, valid and real way. Perhaps when telling the rural health story researchers should be more earnest in including the voices of those that live the rural reality.
Community-based participatory research (CBPR) is a collaborative approach to research that involves an equitable partnership between the researchers and the population being studied. Community members and stakeholders are involved and contribute to all aspects of the research process including decision making and ownership of the results. The CBPR approach is used by academics and public health professionals to address health disparities and to influence policy change particularly in priority populations such as racial and ethnic minorities; low-income, rural, and inner-city populations; women; and children.
One of the characteristics unique to CBPR is the sharing of power and the principal of mutual respect. In other words, no one entity calls all of the shots, as can be the case in more traditional research endeavors where researchers swoop into a community, study them and leave. In CBPR, researchers recognize that the community members have a better idea of what the problems are and they possess expertise and resources that are beneficial to the process of solving those problems.
This relationship does not develop overnight. Time must be taken to build trust relationships, particularly with community gatekeepers, in order to gain access to the population. This is a key step and must be approached with care.
The CBPR process is intended to be mutually beneficial to all parties involved. In order for this to work, all egos must be checked at the door. The researchers and communities learn from each other and bring their knowledge, skills and assets to the table. Researchers benefit by learning things about the community, such as its history and culture, and community members learn about the process of scientific inquiry and how to go about obtaining external funding. The resulting information and findings are the shared with the community at large in ways that will be easily understood and useful.
Finally, CBPR requires long-term commitment and should lead to the establishment of sustainable relationships. It should be a foundation upon which future collaborative efforts between researchers and communities can be built and continue.
When attempting to tell the rural health story, researchers would do well to partner with communities and include them as narrators. Employing the community-based participatory research method may very well lead to the realization that the answers that we seek are right there in the communities themselves.