Berkeley, CA: University of Calfornia, 2010, Apr; :1-93
Interest in community-based participatory research (CBPR) continues to grow in public health across diverse populations and settings, and over the past two decades, the field has gained a great deal of experience in understanding what makes for successful CBPR. In spite of its increasing application, however, there is still much to be learned in terms of systematic evaluation in CBPR, how it is that CBPR partnerships adapt principles and practices to local context, and the nature of the specific adaptations they make. This dissertation looks at the state of the field in terms of recommended principles and practices of CBPR and then centers on the experience of the San Francisco Chinatown Restaurant Worker Health and Safety Project, a CBPR partnership focused on studying and addressing working conditions for Chinese immigrant restaurant workers. First, an examination of the major CBPR review literature finds that the existing guidance on recommended CBPR principles and practices is large in volume and generally in agreement. But it also finds inconsistent use of terminology and typology with regard to CBPR characteristics and an overall lack of specificity associated with how the concepts should be applied in evaluation, particularly for partnership goal-setting and prioritization. Second, using a recently developed CBPR process-to-outcomes model as a reporting framework, the dissertation details the salient contextual, group dynamics, intervention and research, and outcome factors emerging from the Chinatown partnership evaluation. Contexts of interest include the broader social and immigration environment of the community, historical trust and mistrust, and university and community capacity. In terms of group dynamics factors, partnership diversity and complexity, resource availability, and roles of individuals were important in shaping partnership dynamics, with formal partnership agreements playing less of a role. "Process outcomes" of dialogue, mutual learning, and communication; power dynamics; decision-making; leadership; trust; and perceptions of CBPR authenticity were in turn all affected and structured by the contexts. Research dynamics and capacity change outcomes were generally perceived positively, particularly with regard to the leadership development of restaurant worker partners. Finally, the dissertation draws on evaluation data to focus on the CBPR principle of "equitable participation," particularly for Chinese immigrant worker partners on the project. The research finds that the social context and political or participatory "starting points" of the immigrant community, social justice values and drivers of the community-based organization partner, linguistic and cultural diversity within the partnership, and constrained resources led to specific adaptations in the structure and processes of the collaboration. Partner reflections on the outcomes of the adaptations are discussed. Implications for this research suggest that further elucidation of the concepts and functions of CBPR principles and practices will advance the field's ability to effectively evaluate CBPR efforts and further understanding of CBPR "authenticity." Future evaluation efforts may find use of a model of CBPR process to outcomes helpful in systematically designing and reporting on evaluations. Attention to contextual variables of particular communities and partnerships can contribute to understanding how adaptations unfold in CBPR efforts, what the adaptations actually entail, and to what extent they are consistent with CBPR principles and practices.