Beyond Research: A Passion for CBPR in Rural Communities
The CCPH Featured Member is Beverly McCabe-Sellers, a Research Coordinator and Nutritionist at the US Department of Agriculture (USDA), Agricultural Research Service Lower Mississippi Delta Nutrition Intervention Research Initiative (Delta NIRI).
The mission of Delta NIRI is to improve the health of rural residents of the Lower Mississippi Delta through nutrition intervention research and intervention methodology research that is sustainable. Their approach is to fully develop the community-based participatory research (CBPR) model of equitable partnerships among community members, university faculty, and USDA research scientists.
In her interview, Beverly describes her passion for CBPR and the work
that she is doing to enhance and sustain rural communities. When you take
the CBPR approach, she believes that "you're not just doing research,
you are becoming involved in the lives of real people." Read Beverly's
interview to learn about her unique view of the benefits of CBPR.
The mission of the USDA, Agricultural Research Service Lower Mississippi Delta Nutrition Intervention Research Initiative (Delta NIRI) is to improve the health of rural residents of the Lower Mississippi Delta through nutrition intervention research and intervention methodology research that is sustainable. Our approach is to fully develop the community based participatory research (CBPR) model of equitable partnerships among community members, university faculty, and USDA research scientists.
Our consortium of partnerships involves Agricultural Research Service (ARS), ten universities and three communities, one each in the three states of Arkansas, Louisiana, and Mississippi. In each state, university partners include a predominantly research university, a 1890 Land Grant university that is historically black, and a cooperative extension service. In one state we also have a college of public health as a partner. We are unique in being a complex and distant partnership that is being funded longitudinally to build community and university capacity in doing CBPR and in achieving sustainable benefits for rural communities. ARS is unique perhaps in being not only the funding agency through cooperative agreements, but also a full partner in the research itself.
My passion arises from two very different aspects. One is that community based participatory research (CBPR) holds so much more promise in producing lasting and sustainable changes in health, especially in rural and minority populations. The opportunity to test and to demonstrate the value of CBPR excites me as a health care professional who sees the failure of many interventions to significantly impact health in the long run. The second aspect is the people of the Delta themselves. Working with these caring and fun people has given me a great appreciation of the collective wisdom that exists in these communities. We are truly blessed to be a part of these communities and these lives beyond the science and research data.
My dream is that our organization and partnerships will demonstrate the value of CBPR and impact health policies on the local, state, regional, and national level. Our hope is that these communities will retain their local organization and activities by incorporating these into the fiber of their communities. Rural communities have seen dramatic declines in the past few decades and we hope that these partnerships will enhance and sustain the communities.
The old adage that "teaching begins when telling stops" is that people learn when they become active, involved, and appreciated. Community members can and will be valuable team members not only in designing, implementing, and collecting data but also in interpretation and evaluation of research. Community members who want to be active in the research process can and will become Institutional Review Board (IRB) and Health Insurance Portability and Accountability Act (HIPAA) certified with support and encouragement.
Creating local research assistant positions rather than university based positions builds individual capacity and promotes participant recruitment in both the research study and in the local partnership. Establishing a service project that the community needs and wants is one way of developing interest and participation in future research studies. Turning the research study into a service project is a way of sustaining the outcomes of a good intervention.
Community based research requires strong listening skills, openness to
ideas different from your own, asking others to weigh different possibilities
and help decide the question, objectives, procedures, and other details
in the study. When you enter CBPR, you leave behind "my research"
and enter into "our research." Ownership belongs to all the
partners and not to one individual or small group of individuals. You're
not just doing research, you are becoming involved in the lives of real
people. While CBPR can be frustrating and time consuming compared to more
traditional research, it can be so much more rewarding and important than
simple numbers, publications, or presentations.
The rural nature of our communities is the biggest challenge because of travel distances for researchers, less technology access, more limited physical facilities, and more limited supply sources. We have as many face-to-face meetings as possible but also use conference calls and emails to carry on collaboration and monitoring. The most important element, however, is the personal relationship that needs to develop between the various partners as individuals. An adequate amount of physical and social presence in the community is critical to having the equitable relationships essential to CBPR.
The best policy for health promotion and disease prevention is to listen to what specific communities see as their priorities, strengths, and barriers to good health. Design of effective interventions has to come from knowledge of the realities of the communities, the culture, the spirit, and the strengths of the communities. This means working with and for the people in that community. What works in a large urban center, a wealthy suburb, or in one region of the country will not work equally in another part of the country with limited access to services and resources. While a clinical trial may demonstrate efficacy of a given treatment, it says nothing about how well the treatment will be accepted or can be followed in a given community. We need clinical trials but we equally need community based interventions to translate the "evidence" from the clinical trial to the reality of community life.
Having been a clinician and an educator for most of my life, my first reason was to come up the learning curve fast on community based participatory research when I became an ARS scientist to study CBPR nutrition research. CCPH members come from very diverse backgrounds but share a common appreciation of the wisdom of people and strengths of community regardless of educational level, wealth, or other social elements. Some are more interested in service learning, some are more interested in community research, and some are more interested in community building. The mix of these interests makes CCPH a strong resource for sharing and growing and having fun together.
To me, it's an equal sharing of responsibility, decision making, and producing outcomes that primarily benefit the community and secondarily benefit the campus. It means full involvement in the entire research process for us and not just having community members advise in the beginning. Full involvement means full and meaningful communication between and among partners and individuals.
CCPH can serve as a valuable training tool for new community members and for new researchers. The opportunity to come together with others who have faced or are facing the same challenges as our organization stimulates new thoughts about potential solutions and sometimes just reinforces the need to change directions a little to achieve goals. Hearing others have had to take hard actions to keep the partnership on track or funded can provide insight as to how to be prepared to meet future challenges. My favorite part has been building relationships and receiving the benefit of others' wisdom and experiences while having a little fun as well.
The joy of working with people and learning from them. Driving in the Delta develops a love for the land and an understanding of why people chose to live there rather than seek fortune elsewhere. I believe in community based participatory research as a sound approach to making a real impact on the lives of people and in expanding our professional knowledge of how to promote better health.