HIV and sexually transmitted human papillomavirus (HPV) are associated with each other and with the development of comorbid cancer. Current epidemiology indicates that among Pacific Islanders in the United States, young adults are at highest risk of HIV and HPV. In our inductive community based participatory research study, we used focus groups and key informant interviews (March – August 2010) with young adults, parents, community leaders, and providers (n = 95) to identify and contextualize factors that shape HIV and HPV risk and prevention among young adults in Chamorro and Tongan communities in Southern California. We identified nine themes that incorporated the following principal factors: misinformation and otherization; dominant concerns regarding premarital pregnancy; restricted intergenerational communication; family shame and privacy; gendered manifestations of religio-cultural norms; barriers impeding access to sexual health resources; parents’ role in prevention; community vs. individual responsibility; and family and ethnic pride. Our thematic findings fit well with Rhodes’ “risk and enabling environment” heuristic (2009), which we used to contextualize risk and prevention at micro and macro levels of physical, social, economic, and policy environments. We propose the addition of a separate cultural environment to the heuristic and conclude that a focus on applying individual and community agency at the micro-level would be an approachable starting point for intervention for our local Pacific Islander communities and groups in similar ecological contexts globally. Enhanced community-led education programs and engagement of religious and other community leaders to facilitate intergenerational communication could counteract taboos that obstruct prevention.
We describe ethical issues that emerged during a one-year CBPR study of HIV and human papillomavirus (HPV) vulnerabilities and prevention in two Pacific Islander (PI) communities, and the collaborative solutions to these challenges reached by academic and community partners. In our project case study analysis, we found that ethical tensions were linked mainly to issues of mutual trust and credibility in PI communities; cultural taboos associated with the nexus of religiosity and traditional PI culture; fears of privacy breaches in small, interconnected PI communities; and competing priorities of scientific rigor versus direct community services. Mutual capacity building and linking CBPR practice to PI social protocols are required for effective solutions and progress toward social justice outcomes.
Background Challenges in community-based participatory research (CBPR) partnerships often pertain to trust and power, dilemmas posed by funding sources, and equitable community participation. Although challenges in CBPR can be welcomed because they present opportunities for growth and development of partnerships, tools are needed to facilitate issue identification and resolution. Moreover, such tools need to align with CBPR principles involving equal feedback among partners to improve the partnership and its outcomes. Objective To describe how appreciative inquiry (AI) was used as an evaluation tool to contribute to the strengthening of empowerment of ongoing and future community–university relationships in CBPR collaborations. Methods AI was applied at the end of a community–university partnership to promote breast and cervical cancer screening among Tongan women in Southern California. Through individual interviews and group discussion, tensions were identified and discussed in light of partnership and community strengths. Results Through AI, program staff emphasized community and university strengths of shared key values related to the program and aspects of program management that enabled them to contribute to successful program outcomes. They also discussed the following challenges: 1) approach of partners, 2) role definition, and 3) and time span of program development and implementation. Based on these discussions, recommendations were made to overcome current challenges and improve ongoing and future CBPR collaborations. Conclusions The AI process helped the partners recommit to collaborate with each other, renewed their excitement about working together, and assisted with reclarification of their roles to inform future collaborations.
Community-based participatory research (CBPR), applied authentically according to its principles, is inherently conducive to empowerment and capacity building for academic and community partners by promoting egalitarian collaborations through all stages of research. During an intensive qualitative study exploring the intersection of HIV-HPV and cancer in the Pacific Islander (PI) communities of Southern California, we strengthen effective collaborations between an academic research team and two PI community-based organizations (CBOs). Responding to an NCI call for research exploring AIDS-related cancers, our CBOs worked closely with the academic team to examine HIV-HPV factors among Chamorro and Tongan young adults. Key informant and focus groups interviews were collaboratively chosen as the grounded theory research design. Community partners lead the process in: 1) determining most locally relevant and culturally appropriate point of entry for the study investigating HIV and its potential connections to HPV; 2) establishing and convening project specific community advisory board; 3) recruiting study participants; and 4) collecting data. The academic team conducted trainings on HIV, HPV, sampling, data collection, and analysis. Partners jointly lead dissemination efforts. The decision-making process incorporated culturally appropriate meeting protocols of sharing food and experiences through “talk story.” Through our successful CBPR collaboration, we ensured a shared discourse on cancer-related and comorbid topics, and we solidified and reaffirmed our relationship for ongoing and future projects. Thus, CBPR is critical, as the need to address cancer health disparities through collaborative research continues to play a key role in shaping the racial/ethnic minority and medically underserved healthcare landscape. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):B14.
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