A brief explanation of the significance of using community-based participatory research (CBPR) in public health practice and one way you might use CBPR in the development of your public health campaign. Then describe one ethical issue and one legal issue you might need to consider prior to the implementation of your public health campaign
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Community Based Participatory Research (CBPR) was developed originally in South America for the purpose of helping public health officials in Latin America better address the myriad health issues in that vast region associated with wide-spread poverty and substandard sanitation systems, which contributed greatly to the spread of infectious diseases. Today, it is commonly-accepted method of incorporating all relevant parties into research projects designed to break through social and cultural barriers prevalent in countries with wide gaps between the wealthy and the poor. Communities historically distrustful of government because of corruption and questionable human rights practices were drawn into public health programs as full participants rather than as research subjects, which not only enabled such individuals and groups to view public health agencies from a more practical perspective, but also enabled them to contribute more substantively through cooperative measures.
CBPR is used today in much of the world, including in the United States, because it does represent a more holistic approach to conducting research in the realm of public health, and because it is viewed as more “democratic” by inviting communities and categories of individuals united by a common medical concern or condition to be active participants in the research to which they are also subjects. Families affected by H.I.V./AIDS, for instance, can constitute a valuable resource for research into the social, economic, and medical components of those conditions. A public health campaign focused, say, on identifying risk factors for a particular sexually-transmitted disease, would benefit greatly from the incorporation of all relevant communities, including those who could reasonably be associated with the risk of attracting or spreading such a disease, into discussions free of moral judgments and clearly intended to protect the public.
Ethical considerations in the use of the CBPR approach include the need to protect patient confidentiality in an environment in which research subjects are also active participants in the research. Protection of medically-sensitive information is essential in the medical realm, and constitutes one of the American Medical Association’s most important ethical priorities. Research projects that include a vast array of interested professions and at-risk groups contain a higher level of risk that personal information will be inadvertently released simply by virtue of the greater number of individuals and organizations with access to information.
Legal considerations are a little trickier to postulate, but overlap with ethical considerations in the priority given to provision of consent on the part of patients/participants for the use of their personal medical information – an ethical quandary even with the promise of anonymity. One article published in the American Medical Association Journal of Ethics notes the following legal risks associated with CBPR:
“Of the solutions that Ross et al. do propose, some seem made to contain legal liability rather than to foster trust and active partnerships. They propose, for example, documenting agreed-upon terms in a memorandum of understanding or other written document “delimitating the expectations of both parties and documenting the terms of agreement” . Given that researchers are almost certainly more able to envision what activities will actually need to occur through the course of the research, such a document may well conform more to the desires and expectations of the researchers than of the community, which will probably be experiencing the research process for the first time.”
Ensuring full and fully-recognized consent on the part of participants is a serious issue for the coordinators of such projects. Failure to consider legal obstacles or challenges can jeopardize the entire project and damage reputations.
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