Harnessing the power of the grassroots to conduct public health research in sub-Saharan Africa: a case study from western Kenya in the adaptation of community-based participatory research (CBPR) approaches

Abstract

BackgroundCommunity-based participatory research (CBPR) is a collaborative approach to research that involves the equitable participation of those affected by an issue. As the field of global public health grows, the potential of CBPR to build capacity and to engage communities in identification of problems and development and implementation of solutions in sub-Saharan Africa has yet to be fully tapped. The Orphaned and Separated Children’s Assessments Related to their Health and Well-Being (OSCAR) project is a longitudinal cohort of orphaned and non-orphaned children in Kenya. This paper will describe how CBPR approaches and principles can be incorporated and adapted into the study design and methods of a longitudinal epidemiological study in sub-Saharan Africa using this project as an example.MethodsThe CBPR framework we used involves problem identification, feasibility and planning; implementation; and evaluation and dissemination. This case study will describe how we have engaged the community and adapted CBPR methods to OSCAR’s Health and Well-being Project’s corresponding to this framework in four phases: 1) community engagement, 2) sampling and recruitment, 3) retention, validation, and follow-up, and 4) analysis, interpretation and dissemination.ResultsTo date the study has enrolled 3130 orphaned and separated children, including children living in institutional environments, those living in extended family or other households in the community, and street-involved children and youth. Community engagement and participation was integral in refining the study design and identifying research questions that were impacting the community. Through the participation of village Chiefs and elders we were able to successfully identify eligible households and randomize the selection of participants. The on-going contribution of the community in the research process has been vital to participant retention and data validation while ensuring cultural and community relevance and equity in the research agenda.ConclusionCBPR methods have the ability to enable and strengthen epidemiological and public health research in sub-Saharan Africa within the social, political, economic and cultural contexts of the diverse communities on the continent. This project demonstrates that adaptation of these methods is crucial to the successful implementation of a community-based project involving a highly vulnerable population.

Sexual Behavior Among Orphaned Adolescents in Western Kenya: A Comparison of Institutional- and Family-Based Care Settings

“…The project follows a cohort of orphaned and separated children from communities within 8 administrative Locations in UG County, and includes 300 households, 19 Charitable Children’s Institutions (CCIs), and 100 street-involved children and youth [35]. This study includes any orphaned or separated (a child whose biological parent(s) are absent from their life) [6] child aged 18 years of age or less, living within the sampled care environment, regardless of the reason for orphanhood.…”

“…Households were recruited following extensive community consultations, establishment of a sampling frame, and approached individually by Community Health Workers [35]. In depth details regarding the study’s sampling strategy can be found elsewhere [35].…”

“…Households were recruited following extensive community consultations, establishment of a sampling frame, and approached individually by Community Health Workers [35]. In depth details regarding the study’s sampling strategy can be found elsewhere [35]. In brief, there were 2181 households identified caring for orphaned and separated adolescents that became the sampling frame, from which the project randomly sampled 300 households.…”

“…Consent, registration, enrolment and all individual study procedures for recruited households took place at the central OSCAR clinic located at MTRH. Additional details about eligibility, sampling, and recruitment, and an in-depth description of family-based and institutional care environments can be found in the respective publications [8,35]. …”

Working with teams of "insiders"

“…Community Based Participatory Research [CBPR] approaches, common in the Global South, reflect engagement with "insiders" at the community level, rather than as members of a discrete research team (Kamanda et al 2013;Minkler 2005;Mosavel et al 2005). CBPR usually incorporates the research team and community in all parts of the research process, from determining the problem and gaining participant consent to how to address the problem, analyze the data, and provide feedback to the community for community action (Foster et al 2010;Minkler 2005).…”