Practical Tools for Ethical Engagement in Health Research, Part II

Community Engagement and Power Dynamics

By Ogai Sherzoi

Historically, research involving communities has not engaged and involved the community partners in an active and meaningful way (just one example are the nutrition experiments conducted in residential schools in the 40s and 50s [1]). As a result, many communities in our society feel that research has been conducted on them rather than with them. Communities are calling for new approaches in which they are equal participants in the research decision-making process, and where research conducted has a direct benefit for people involved. One example includes the slogan rooted in the disability rights movement NOTHING ABOUT US WITHOUT US.

Today, patient and public engagement in health research is slowly changing direction to a research paradigm that actively involves target communities as partners, exemplified by the Canadian Institutes for Health Research’s Strategy for Patient-Oriented Research (SPOR). To ensure history does not repeat itself and continue on the path of improving health and well-being of all Canadians, it is important that we talk about ethics, power dynamics, and rules of partnership. The ideas, questions, and concepts discussed in this blog series are adopted from Karen Hacker’s Community-based participatory research [2].

Missed part one? Read it here.

In the previous post on ethics in community-based research, we discussed some of the ethical concerns that may arise in working with communities to do research, and questions researchers can ask to address these concerns. In this post, we discuss the role of power dynamics in developing research partnerships with communities, and learn how we can start to even out the balance.

Elements of Successful Partnerships [1]

As mentioned previously, one of the most important aspects of engagement with communities is to create relationships and build partnerships based on mutual respect and trust. Successful relationships between communities and researchers include:

1. Power sharing;
2. Open communication/transparency;
3. Equitable division of labour and resources; and
4. Mutual recognition.

Challenges to Consider When Building Partnerships

In order for successful partnerships to take place, the potential challenges that arise must be taken into consideration from the very start. This is especially true where there is a dramatic difference in power or social status between community partners and researchers. Power imbalances can result from differences in professional experience, lived experience, access to resources, research literacy, and comfort level in the community. Differences in power due to socially constructed systems of power and oppression may effectively drive a ‘wedge’ between researchers and the community, and both sides must put in substantial effort to mitigate these imbalances. For example, a researcher may already come with unearned privileges by just being associated with a university or having letters after their names [1].

Many communities historically, and even today experience discrimination and disadvantages. Looking at our history, there are several examples of unethical research which impacted disadvantaged communities and minority populations. For decades certain communities have been “studied” by universities, without giving back to the communities and acknowledging their expertise and knowledge they shared to inform the research. Effective partnerships are rooted in collaborative, equitable partnerships that enhance and promote co-learning and capacity building among partners. It is the role of the researcher to ask themselves — “do I possess the skills, time, and resources to engage communities in a safe and collaborative manner in order to be an effective partner”? [1].

Overcoming Power Imbalance

Building trust with communities requires committing to developing respectful, mutual relationships; it is not automatic. This process that takes time, and the length of time may vary from community to community. It is important not to rush this process and give ample enough time to ensure authenticity and meaningfulness in these relationships. The following are a few suggestions for developing relationships with communities [1]:

Spend Time in the Community

To help form relationships, attend community events unrelated to research, such as concerts, dinners, etc.

Humility

In approaching relationship-building, put aside preconceptions, and bring an attitude of humility and collaboration.

Reflexivity

Be reflexive in your work and aware of your own biases and privileges (see Carolyn’s blog for some reflexive practice questions).

Address Power Imbalances

Assess your own cultural beliefs and assumptions, in order to address power imbalances and to develop partnerships based on mutual respect.

Curiosity

Be curious and open, and learn from the community members about their values, culture, and ways of living.

Active Listening

Listen to the members of the community and demonstrate your commitment to building relationships before the project actually begins.

Equitable Partners

Negotiate the research agenda with the partners in an equitable manner, from decisions around research design to budgetary concerns and dissemination.

Patience

Realize that building relationships may take years — if this doesn’t fit with your research timeline, you should not attempt to conduct community-based research

What are other ways that we could overcome power dynamics when coming together in partnerships? Tell us in the comments or on Twitter at @KnowledgeNudge.

In Part 1 of the series, we discussed ethics in community engagement; and in Part 3, the rules of partnership.

References

1. Hacker K. Community-based participatory research. Thousand Oaks, CA: SAGE Publishing, 2013.

About the Author

Ogai Sherzoi is a knowledge broker for the Knowledge Translation platform at the George & Fay Yee Centre for Healthcare Innovation (CHI).