Unit 4 Section 4.2: Working Towards Trust

Successful CBPR partnerships are characterized by trusting relationships among partners. There are many factors that can hinder trust-building in CBPR partnerships.   It is critical for CBPR partnerships to examine these factors and commit to addressing them in a trust-building manner.

Below are some of the reasons that developing trusting relationships in CBPR partnerships can prove challenging:

The history that partners bring with them

• Some communities feel over-researched. For example, more marginalized communities including people of color, lesbian/gay/bisexual/transgender, new immigrants and refugees, people with HIV/AIDS, and native born people.  The experience of the participants in the Tuskegee syphilis experiments and the subsequent fall-out when that became public news added greatly to the distrust among many marginalized community members and the organizations serving them towards researchers and research in general.

• When researchers come in as outside experts, take data, and don’t give back. This is what Aboriginal people in Canada, for example, refer to as ‘helicopter research” and others have called “”parachute research” and drive-by research.”   Researchers “fly in” to reserve communities, administer surveys, and leave.

• When researchers come in as outside experts and define research priorities and a research agenda but don’t give back and even cause harm.

• Community-based partners may feel that researchers will “drain” their resources and hamper the work of their mission (for example, taking staff away from their usual responsibilities to attend meetings and perform tasks related to the research).

• “Turf issues” among community members may also hinder trust.  Community groups may be in direct competition for scarce funding dollars which may lead to feelings of “why do we need to spend money to research what we already know”?

The intimidation factor related to research

• Community members may feel intimidated by the technical training of researchers (PhD, MD, MA, etc.) and the jargon associated with research – e.g., multivariate analyses, prospective cohort studies, sampling frameworks.

• Community members may also be suspicious of (and at the same time intimidated by) the “culture of expertise and mysticism” surrounding the domain of research – after all, “science is science, isn’t it and what do I have to contribute to it"?

The characteristics of the institutional researchers

• Community members may be suspicious of the agenda of researchers.  For example, some may be cautious (especially if their communities are already vulnerable or stigmatized in some way) about how data should be collected or used and still others may question the manner in which resources are allocated.  This is especially true if the research funding is solely administered through the university or health department and doesn’t benefit the community partners in any tangible way.

• When researchers are new to a community.  For example, when researchers are not community members themselves and have no pre-existing relationship with community, suspicions can be heightened and working to build trust may be a longer process.

• When researchers are only willing to commit to a partnership for the duration of a grant.  This is an on-going issue for communities.  Institutional researchers should be willing and able to make a long-term commitment to the mission of the partnership beyond specific funding periods.  This speaks to the need for the partnership to address the issue of sustainability early on, and to clarify in the early stages the levels of commitment of the partners involved.

Building trust

Now that we’ve discussed the factors that can hinder trust, it is important to understand how to build trust between CBPR partners to ensure the involvement of community representatives in all aspects of a research project.

For trusting relationships to develop over time, the individuals and organizations involved in partnerships need to consistently exhibit certain behaviors and characteristics. These include:

• Being open and honest

• Being able to listen well

• Using appropriate humor to add levity and build group cohesion

• Being able to directly address and speak frankly about contentious but important issues, such as power differentials, racism, and financial decisions

The following offers a simple model for thinking about community involvement in CBPR that also has significant influence on enhancing trust in partnerships:

At the International Inner City Health Conference in Toronto in 2002, a community-based researcher outlined a three-pronged strategy for how CBPR differs from more traditional forms of research in terms of community involvement (Paez-Victor):

• Input  - Research is driven by community needs.

• Process - Community plays a role in gathering, analyzing and disseminating information.

• Outcome - Research is intended to be used by the community to enhance health and build on community assets.

Paez-Victor emphasized that this model encompasses the core principles of CBPR and designing projects around this model can significantly build trust among research team members, as demonstrated below:

1. Input from community representatives into the initiation and start-up phase of a CBPR project:

Ideally, a partnership is in place prior to a research question or project being determined. Many of us, however, come to develop partnerships when a project is already well into its development stages.  Expecting the community to become involved enough to “take ownership” of the research process, interventions and results when the project is institutionally driven can undermine the possibility for an authentic partnership. Similarly, partnerships that are initiated by institutional partners under the constraints of a short timeline for responding to a funding agency request for proposals can undermine community trust and involvement.

The following strategies to address the “trust issue” should be considered during the early stages of a partnership:

• Be inclusive at the start of the partnership in terms of who is invited to  initial planning meetings.

• Value and take seriously community input. A researcher validating a community member’s input is crucial to community representatives finding and being able to claim their place in a research partnership.

• Listening to and addressing needs identified by community partners.  Community partners are more likely to get involved and stay involved in a partnership when their issues are emphasized.

• Elevate the importance of the community’s research priorities over those that are pre-determined by external interests. If funding is available for asthma research, but the community is most concerned about domestic violence, a successful CBPR partnership focused on asthma will be difficult to develop and sustain. 

• Demonstrate positive regard for other ways of thinking, especially about research. All partners bring knowledge, skills, and expertise to the table and challenging underlying assumptions about research methods and community issues are important steps in moving from rhetoric to reality.

2. Community engagement throughout the Process of doing CBPR:

• Recognize and conduct ongoing analysis of the community’s strengths and resources.

• Examine the consistency and shifting of the relationships.  It helps to understand the dynamic nature of trust, and thus a process evaluation is an imperative exercise in CBPR projects.

• Define roles and responsibilities based on assets and strengths and capacity-building needs.

• Identify capacity-building needs and schedule them into the structure of the research project. For example, if community partners want to learn more about collection, analysis and interpretation of data, then tasks, community interns, student placements, volunteer opportunities, etc. can be structured around those needs.

• Sharing power and control.  This can be achieved in terms of who facilitates or chairs the partnership’s board (community representative or rotating leadership among institutional and community members), how decisions are made, how funds are distributed (community-based organizations as lead organizations on grants, for example), and community representatives serving as Principal Investigators and/or Co-Investigators (with attendant responsibilities of those roles).

• Work through discussions of potentially divisive issues (e.g. budget cuts, issues of racism, partners are not getting work done) before they arise.  Use role play exercises to prompt frank discussion and promote a better understanding between partners.

3. Community involvement in determining the Outcome of research:

• Agree that research is intended to be used by the community to achieve social justice, enhance health and build on community assets.

• Determine the role that community representatives play in disseminating project outcomes, including interpretation and translation of findings into policy and action.

• Decide how dissemination strategies are defined and carried through.

• “Deliver on the promise” and ensure that research findings are used in valuable and meaningful ways that enhance quality of life in communities.

• Conduct dissemination strategies that are consistent with the original goals and objectives of the research and not for simple, personal gain.

• Disseminate results with community input regarding how and when all data are released and to whom. “Sensitive” data (i.e., those that cast a community in a negative light or reinforce negative stereotypes) should not be disseminated or talked about publicly without significant community control and agreement to a process.

The following activity provides an example of one strategy for helping partners get to know one another and in the process, help to build cohesion and trust.