Principle 6:

Focus on the local relevance of public health problems with an ecological approach to health

An ecological approach accepts that health and well-being are affected by interpersonal dynamics, societal structures, biology, behaviour and the environment (17, 18). This principle stresses the importance of considering health issues and the local context in which they occur in a holistic manner, with data that is relevant, timely, and inclusive. It emphasises an approach to health that extends beyond the individual, to the immediate and larger contexts in which families live, work, and play (1, 17). In CBPR partnerships, the multiple determinants of health, such as social, economic, and physical environmental factors are examined through an interdisciplinary lens, and their interactions stressed (1).

Capacities (competencies and conditions)

●        Critical understanding of current local public health issues and theories on the determinants of health

●        Appreciation for multiple methods and analytical traditions in population and health services policy research

●        Ability to link immediate local issues to broader concerns, such as  environmental justice or improved housing

●       Understanding of broader social, environmental, and economic issues and ‘education for political literacy and informed citizenship’ (19)

  • Potential outcomes

    ●        Community leaders can link immediate problems with deeper aspirations (20)

    ●        Awareness about root causes consistent with the emancipatory ideal of CBPR

    ●        Enriched understandings of the needs, priorities, and health concerns of communities

    ●        Enhanced relevance, usefulness, and use of the research data

    ●        Improved quality and validity of research

    ●        Development of practical, feasible, innovative and sustainable solutions that address some of the causes of health inequities 

     ●        Research products that are tailored to meet the needs of implementers and communities (10)

  • Potential activities

    ●        Awareness raising about the root causes underlying health issues using problem tree (page 41) analysis and other tools

    ●        Present opportunities for community partners to educate academic partners on community needs and preferences

    ●        Use mapping exercises with community members to provide powerful visual data to help address a wide range of health disparities – see community research blog

    ●        Use creative research methods to identify and highlight public health problems in relation to wider context.

    Examples:

    o   Photovoice or participatory photography

    o   Participatory video  

    ●        Engage with public health agencies to help citizen groups gather and analyse information, negotiate public bureaucracies, interpret previous studies and advocate for enforcement of existing laws and policies

    ●        Create fora to bring formal and informal community leaders together to consider health issues within the socioecological setting

    ●        Offer skills workshops and technical assistance on understanding health issues

    ●        Support community events that build a sense of identity; create safe spaces for community members to discuss and analyse health issues

    ●        Conduct reflexivity sessions to ensure that the partnership analyses and reflects on successes and limitations of their actions within the wider socioecological context
  • Examples of benchmarks to assess progress 

    ●        Number of workshops exploring public health issues within the wider context

    ●        Enhanced knowledge and understanding about community dynamics and conditions that affect health

    ●        Knowledge sharing about theories on the determinants of health

    ●        Exploring  health and wellbeing issues across different global contexts and their links to ecological perspectives that could be learned from

    ●        Agreement on the health or related issues that community partners wish to address, and if needed, reframing the problem to ensure maximum relevance and the outcome(s) with which they are concerned

    ●        Refined research questions based on increased community awareness of public health issues

    ●        Research/action proposals designed and developed in full partnership to ensure cultural relevance, and benefits for the broader community

    ●        Evidence of transdisciplinary approaches to health and wellbeing issues

  • Examples of source of evidence

    ●        Audio visual outputs such as blogs, vlogs and podcasts

    ●        List of disciplines engaged in the research

    ●        Co-analysis workshops/processes documentation

    ●        Minutes from meetings between research partners and local organisations to jointly explore problems and solutions

    ●        Documentation of sessions exploring local health issues, roots causes and wider social determinants of health

    ●        Reflexivity sessions – Audio/written documents 

*Please note that some statements are adaptations or direct quotes from the papers listed in the reference section