8: No. 3, May 2011
TOOLS AND TECHNIQUES
Community Advisory Boards in Community-Based Participatory Research: A Synthesis of Best Processes
Susan D. Newman, PhD, RN, CRRN; Jeannette O. Andrews, PhD, APRN-BC, FNP; Gayenell S. Magwood, PhD, RN; Carolyn Jenkins, DrPH, APRN, BC-ADM, RD, LD, FAAN; Melissa J. Cox, MPH; Deborah C. Williamson, DHA, MSN, CNM
Suggested citation for this article: Newman SD, Andrews JO, Magwood GS, Jenkins C, Cox MJ, Williamson DC. Community advisory boards in community-based participatory research: a synthesis of best processes. Prev Chronic Dis 2011;8(3):A70.
http://www.cdc.gov/pcd/issues/2011/may/10_0045.htm. Accessed [date].
Community-based participatory research (CBPR) is a paradigm to study and reduce disparities in health outcomes related to chronic disease. Community advisory boards
(CABs) commonly formalize the academic–community partnerships that guide CBPR by providing a mechanism for
community members to have representation in research activities. Researchers and funding agencies increasingly recognize the
value of the community’s contribution to research and acknowledge that community advisory boards are a key component of successful CBPR projects. In this article, we describe the best processes for forming, operating, and maintaining
CABs for CBPR. We synthesize the literature and offer our professional experiences
to guide formation, operation, and maintenance of CABs.
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Community advisory boards (CABs) often serve as a source of leadership in the
partnerships of community-based participatory research (CBPR) and provide
structure to guide the partnership’s activities. CAB composition typically
reflects the community of interest; its members may share a common interest,
identity, illness experience, history, language, or culture (1). CABs provide an
infrastructure for community members to voice concerns and priorities that
otherwise might not enter into the researchers’ agenda, and advise about
suitable research processes that are respectful of and acceptable to the
community (2). Research assessing the roles, responsibilities, and processes of
CABs supports their effectiveness in building mutually beneficial partnerships
between academic researchers and communities (3-7). However, not all
community-based researchers have incorporated CABs, nor have CABs been
successful in every setting or situation (8,9).
The Center for Community Health Partnerships at the Medical University of
South Carolina (MUSC) is a group of community partners, researchers, clinicians,
and educators whose purpose is to engage and mobilize academic–community
partnerships that promote health and lessen the impact of chronic illness (10).
The Center provides a systems-level infrastructure for MUSC academic–community
partnerships and promotes institutionalization and sustainability of these
partnerships and their products. The Center’s founding members formed a CAB to
guide its vision and mission. This process prompted a review of the literature
and discussions about the purpose of the board, membership, operating procedures
and principles, leadership roles, training needs, sustainability, and
evaluation. Our immediate goal was to identify the best processes for forming,
operating, and maintaining a CAB. To accomplish this goal, we adopted the
integrative practice framework from Cargo and Mercer, which identifies a
continuum of CBPR processes from initial engagement to maintenance (11). We
based the concept of best processes on Green’s recommendations that
academic–community partnerships tailor established processes to meet their
unique needs (12). A central issue in the adoption of these processes is the
transfer of knowledge to the practitioners in the field, whether academic or
community, and to recognize the multiple factors that influence adoption and
implementation of these processes in all settings and stages (13). In this
article we present best processes for forming, operating, and maintaining CABs
that guide CBPR, by synthesizing processes reported in the literature and
demonstrating their adoption and implementation in the field using exemplars
from our Center members’ experiences.
Two of the Center’s academic researchers (S.D.N., J.O.A.) conducted a review
of the literature to identify processes of CAB functioning. We searched
Ovid/Medline, CINAHL, and
PsycINFO databases for manuscripts published in
English from 2000 to 2009 by using the following search terms: “community
advisory boards,” “advisory boards,” or “community steering committees,” and
“community-based participatory research” or “participatory research.” Inclusion
criteria were descriptions of CABs, which included in-depth discussion of roles,
purpose, and structure in guiding community research. Our search revealed few
published, peer-reviewed articles that focused solely on the development and
functioning of a CAB (2,4,5-7,9,14-16). Rather, we found discussions of CABs
embedded in articles discussing CBPR, often making this valuable information
difficult to find through traditional search strategies. Additionally,
bibliographies provided a rich resource for other publications and sources that
described CABs. Additional searches were conducted in CBPR textbooks (17-19) and
other CBPR-related documents, such as websites and listserves (20).
During our analysis and synthesis of the literature, we identified key
processes of CAB functioning and coded our findings in an organizational
matrix with 3 domains (formation, operations, maintenance) on the basis of an
adaptation of Cargo and Mercer’s framework (11). We then solicited input from
Center members (G.S.M., C.J., M.J.C., D.C.W.) who had experience with CABs and
requested that they review the matrix and reflect on best processes on
the basis of their experiences. We held team meetings to cross-check the literature synthesis
and personal experiences, reconcile analyses to identify processes for each
domain of the matrix, then refine description of the processes on
the basis of discussion and consensus. We quickly determined that the processes of CAB
functioning are not linear but are iterative and cyclical, and may overlap or be
revisited. We presented the initial findings at a national conference of
academic CBPR researchers and to the Center’s academic and community
representatives to further validate the findings. We held subsequent team
discussions to refine the findings on the basis of feedback we received.
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Overview of Research at the Center for Community
The Center houses 45 projects
with approximately $6.5 million annual expenditures. The projects involve
partnerships with various communities and are at various stages in partnership
development and research implementation. Approximately half of the projects have
study-related CABs. We will describe the Center’s overall CAB and 3
(Appendix A). All
studies received approval from the MUSC institutional review board.
The Center’s 20-member CAB is composed of representatives from regional
for-profit, nonprofit, school, faith-based, and government organizations, as
well as community members. The purposes of the Center’s CAB are to 1) identify
community priorities, needs, and interests; 2) set research priorities; 3)
provide input or resources or both for the Center’s research activities; 4)
identify community members to participate on project steering committees; and 5)
promote community support for and involvement with research.
Partnership with people with spinal cord injury (Photovoice)
The Photovoice study (21,22) aimed to identify and address barriers and
supports to community participation for people who use wheelchairs for mobility
and was the catalyst for the formation of a CAB representing their interests.
Wallerstein and Duran contend that the best CBPR practices require an emancipatory
perspective that promotes the participation of community members to transform
their lives (23). People with disabilities have expressed a need for inclusive, action-based
research methods in which they function as partners and consultants, not as
research subjects (24-26). Our 6-member CAB is composed of people with spinal
cord injury and the director of a nonprofit disability advocacy organization.
People who participated in the Photovoice project and expressed an interest in
continuing their role as a partner in research agreed to create a more
formalized CAB. This CAB continues to serve as a partner with the academic
researcher (S.D.N.) and share decision-making power regarding conduct of
research and use and ownership of the products.
Partnership with public housing residents (Sister-to-Sister)
In 2001, an inner-city school
official invited the academic investigator (J.O.A.) to work with the community
to help women and families to quit smoking (27,28). The academic and community
partners agreed to form a 5-member working group of local laypersons
(“insiders”) to provide guidance on community preferences, contexts, and a
comprehensive community assessment. The following year, on the basis of community
interest and initial compatibility of the project, an 8-member CAB was formed,
consisting of housing authority officials, members of for-profit and nonprofit
community organizations, and lay community members. The purpose of the CAB is to
guide the development, implementation, and evaluation of a smoking cessation
intervention tailored for women (ie, Sister-to-Sister) living in public housing
neighborhoods. After several feasibility and pilot studies, this collaborative
partnership is now engaged in a randomized controlled trial that is testing the
effectiveness of a multilevel smoking cessation intervention in public housing
neighborhoods in 2 states. Because of the complexity, scope, and expansion of
the study, neighborhood advisory boards
in each of the intervention neighborhoods ensure that the intervention
activities are relevant to each site.
Partnership with coalition on diabetes (Charleston-Georgetown Diabetes Coalition)
In 1999, the Charleston-Georgetown Diabetes Coalition applied for a Centers
for Disease Control and Prevention (CDC) Racial and Ethnic Approaches to
Community Health (REACH) grant and asked the MUSC (C.J., G.S.M.) to lead the
group’s efforts (29-31). Each of the organizations or communities that are part
of the coalition selected 1 representative to become a lead member of the
coalition. The group has 10 funded partner members and 4 other members who are
engaged in community activities in the 2-county area. Members are added by
invitation of a coalition partner and approval by 70% of current members. All
members work together to direct research and support community efforts related
to diabetes in the African American community. Anyone from the community or
local organizations may bring issues, concerns, suggestions, or requests to the
group for action.
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Defining Processes for Formation, Operation, and
CABs may engage in processes of formation, operation, and maintenance to
accommodate the realities of working in a dynamic community setting (12).
Formation processes address key activities related to defining the role and
purpose of a CAB and subsequent identification and recruitment of key
stakeholders from the community for participation in the CAB. Operation
processes address the development of procedures to guide the logistical
operation of the CAB, the development of guiding principles to assure the values
of the community are represented and respected, and the establishment of
leadership and decision-making protocols. Maintenance processes address
evaluation of CAB actions and outcomes and plans for sustainability. Ongoing
attention to evaluation and sustainability is essential to the maintenance of
both newly formed and long-standing CABs. Results of evaluation assessments and
strategic planning for sustainability may require CABs to address processes of
formation and operations once again.
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Best Processes: Formation
Clarifying purpose, functions, and roles
CBPR teams often form a CAB to gain representation of community perceptions,
preferences, and priorities in the development of a research agenda and research
processes (32). Examples of additional board functions include advising on study
protocol design and implementation, facilitating community consent, evaluating
and communicating the risks and benefits of research, helping provide resources,
evaluating education materials, disseminating information, and using research
findings to advocate for policy change (5,6,9,27,33).
Ideally, CAB members function as partners in CBPR; however, members are often
placed in the role of advisors. “Partners” and “advisors” each operate at a
different level in the partnership power gradient. Members in a partnering
role bring issues and concerns from the community to the table, which the
board discusses and resolves in a manner that is mutually beneficial to both the
research team and the community (7). Members serving in an advisory role
provide information, guidance, or suggestions from the community; however, the
research team may choose to accept or reject the advisors’ input (7).
Clarification of both the intended purpose of the CAB and intended roles of CAB
members facilitates the selection and recruitment of appropriate community
representatives to serve on the board and maximizes their contribution as
research partners. The members of our individual study CABs work in a partnering
role with the academic partners, making collaborative decisions in their
respective studies through each stage of the research process (Appendix A).
Determining membership composition and recruitment strategies
To select appropriate board members, specific inclusion criteria should be
established that reflect the goals of the research and the intended functions
and purpose of the CAB (19). Brainstorming to identify potential members and
determine the best recruitment and selection strategies is an iterative process
requiring input from all members of the research team (32). The process requires
consideration of types of expertise and resources needed and who can bring that
expertise to the partnership. The intended outcomes of the study facilitate
determining what type of person (eg, service provider, consumer, community
leader) or agency is represented on the CAB (34). Identification of people or
agencies with specific expertise in the topic of interest is necessary to create
a knowledgeable CAB and to help position the research project favorably in the
community. New partnerships are often encouraged to start small and to involve a
few community-based organizations that are highly regarded by community members
(35). The composition of the CAB for people with spinal cord injury increases
consumer direction of disability and rehabilitation research. As the research
program progresses, the CAB can decide whether to expand CAB membership by
inviting service providers, agency leaders, and other community stakeholders to
participate in an advisory or partnering role.
Our Center assesses community and capacity to guide identification of
potential partners (36,37). Center organizers created a “potential member
matrix” that includes the types of organizations to be considered; their
reputation, activities, and achievements in the community; their capability to
contribute resources; their self-interests; and their potential conflicts. The
matrix facilitated preliminary fieldwork to identify potential CAB members (19).
Once people or agencies meeting the initial inclusion criteria were identified,
a process of screening (telephone and personal interview) and recruitment
(personal invitations followed by letters to the organization) was used to
refine the selection process, to carefully evaluate those who expressed an
interest in serving, and to assure a good fit with the intent and purpose of the
Before gaining final commitment to serve, the CAB and potential member should
review the potential member’s intended role and clarify expectations, including
and defining mechanisms of communication to help ensure a shared understanding
of the requirements of the board member position. A signed letter of commitment
provides documentation of the agreement and helps to minimize potential
misunderstandings. The REACH Charleston-Georgetown Diabetes Coalition uses a
document outlining the roles and scope of work for each partnering organization:
the document is signed by both the partner representing the community
organization and the academic partner and is renegotiated annually.
Generating a new CAB to work on a community issue may not always be the right
approach or the best use of resources. Locating a CAB partnership in an existing
community structure may be a more effective strategy; in such a situation, the
academic partner asks for admission to the partnership and in turn forms a work
group within the existing organization. Partnering with an existing group may
also promote sustainability; however, this approach is not well described in the
CAB literature and requires further examination to determine the benefits and
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Best Processes: Operation
Establishing operating procedures
Operating procedures provide logistical guidance regarding how the team works
together to complete tasks, including setting the agenda and documenting
minutes. When establishing procedures, consideration of group dynamics and
accepted social norms must be considered to ensure open communication (38).
Procedures that address group dynamics include having everyone listen to one
another and demonstrate mutual respect, letting members agree to disagree,
having all members participate in board meetings and activities, and having
meetings start and end on time (35,39). Members periodically reassess and revise
the procedures, on the basis of process evaluations, to maintain an equitable balance
of power (36)
Establishing operating principles
Defining the community values or principles that guide research is another
initial task of a CAB (15). The process of developing principles that reflect
the local context provides the opportunity to develop trust and build
relationships among board members. The CAB then uses these principles to
evaluate research protocols to assure that they honor and protect the values of
the community (15). Resources (40,41) provide a framework on which a CAB can
build principles that are specific to the context of its community and the
research project. The CAB of the REACH Charleston-Georgetown Diabetes Coalition
used the Community-Campus Partnerships framework to develop partnership
Establishing leadership, balancing power, and making decisions
A key element of effective group process is the fair and appropriate
distribution of power and leadership; however, balancing power among diverse
partners who represent multiple levels of social hierarchy is challenging (38).
A potential strategy is to maintain community and academic cochairs; 2
community cochairs may lessen the possibility that academia dominates the
community, especially in settings with a history of extreme power imbalance
(32). The CAB for the Sister-to-Sister study uses a written protocol that
clearly delineates the responsibilities of the partnership’s cochairs
(Appendix D). Effective
leadership and balancing of power supports members’ satisfaction, participation,
and overall effectiveness by using democratic and consensus-based
CABs generally find that the decision process runs more smoothly if they
establish a protocol for decision-making. For example, a designated member may
make low-stakes decisions independently, such as determining the typeface for a
brochure (38). Having small subcommittees is an effective approach to making decisions
on issues that do not require input from the entire CAB membership.
Subcommittees decentralize decision making, help balance power, and provide the
opportunity for partners, who may feel intimidated in large groups, to
participate freely in small group discussions (38). Complex, high-stakes issues
generally require a decision by consensus; however, gaining consensus does not
mean that the decision must be unanimous (19). The 70% majority is a common
strategy for meeting consensus that works well for the Sister-to-Sister CAB.
Consensus decision making is often a more time-consuming process; however,
incorporating everyone’s opinions results in collective support by the CAB
membership and increased group solidarity on the decision (19).
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Best Processes: Maintenance
Evaluating partnership processes
A multimethod approach to collecting evaluation data increases the
likelihood of a well-rounded assessment of the CAB structure and processes. Key
informant interviews, meeting observations, focus groups, documents such as
activity logs, and member surveys provide different perspectives of the
partnership and enhance the comprehensiveness and credibility of evaluation
(43). Qualitative methods, such as key informant interviews, provide a platform
for CAB partners to address frustrations and concerns (44)
Quantitative methods, such as surveys, provide a standardized measure of
partnership processes that allows a baseline measure to be established and
reevaluated over time to gauge continued effectiveness (45). Measures of
process evaluation incorporate items to assess group dynamics within a CAB
partnership framework, including shared leadership, open communication,
mechanisms for resolving conflicts, and trust and cohesion (44,46,47).
Evaluation of CAB leadership considers whether leaders provide praise and
recognition, seek out members’ opinions, and approach members for help with
specific tasks (45). Process evaluation also includes assessment of more
pragmatic issues such as turnover rate of board members, success in recruiting
members with specific skills or connections to influential leaders, members’
perceptions of the benefits and costs of participation, and the degree to which
members perceive the partnership to be effective and sustainable over time
(45,47). Evaluations that address partnership priorities increase the likelihood
that partnership collaboration continues, thus promoting sustainability (19,43).
A plan for sustainability is essential during the early stages of
partnership. CAB functioning influences the survival of partnerships, because
well-managed boards are often able to continue even amid funding difficulties
(48). Formal sustainability planning ideally begins before initiation of
research, but at a minimum of 1 year before the active project or current
funding ends (49). The CAB defines the meaning of sustainability for the
partnership and the criteria for sustainability that members will use to
evaluate components of the partnership or program.
Strategies that instill a sense of empowerment and capacity building are
essential to promote the retention and satisfaction of CAB members. Training in
the principles of CBPR and the language and skills of research helps build the
capacity of the CAB and generate belief in the partnership’s ability to enact
change in the community.
Recognition of CAB members’ contributions of time, resources, and expertise,
through some type of compensation, promotes continued engagement in the
partnership (49). Many partnerships do not have the means to provide monetary
remuneration. Identifying other means to promote member retention and ensuring
that the benefits of membership outweigh the costs is essential. Such
strategies may include adequate orientation and training of new members,
opportunities for social interaction and participation, adequate access to
information and resources, influence in decision making, and recognition for
contributions (19). Inexpensive strategies to recognize members’ contributions
include potluck dinner parties, awards or honors given by the partnership,
positive letters to a member’s colleagues or superiors, and public recognition
in local media (49).
Continuing relationships informally during gaps in funding or activities helps
to maintain communication between partners and provides the opportunity for
brainstorming about the next steps for the partnership. Gaps in
funding also provide an opportunity to think ahead and plan for ways to avoid,
or at least minimize, these gaps in the future. When sustainability is not
possible, clear communication between the researchers, the CAB, and community
members will leave the door open for future collaborations. The partnership
developed in the Photovoice study has experienced gaps in funding yet remains
viable and is currently engaged in another funded project.
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A CAB provides a focus for research efforts, an ongoing partnership to
address community health concerns, and a mechanism for building capacity in the
community and the academic institution. Establishing and sustaining a CAB is a
time- and labor-intensive process — which many new partnerships underestimate.
Careful initial consideration of the desired functions of a CAB will indicate
whether the need is to create a new or expand an existing partnership to improve
the health of the community. Continuing to share successes and challenges
related to the processes of forming, operating, and maintaining effective CABs
promotes ongoing learning and provides a frame of reference for continuing
action and research on the best processes in CBPR.
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We thank our community and academic partners for their collaboration and selfless contributions in building community partnerships. Without their wisdom and support, our work together would not be possible.
The Sister-to-Sister smoking cessation intervention study is supported by the National Heart, Lung, and Blood Institute (5R01HL090951-02). The
diabetes coalition is supported by the REACH Charleston-Georgetown Diabetes Coalition CDC
grant/cooperative agreements (U50/CCU422184-05 and 1U58DP001015-01 and 02).
The Photovoice study was supported by the Agency on
Healthcare Research and Quality (1R36HS016941-01) and the Rehabilitation Nursing
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Corresponding Author: Susan D. Newman, PhD, RN, CRRN, Assistant Professor, 99 Jonathan Lucas St, MSC 160, Charleston, SC 29425. Telephone: 843-792-9255. E-mail:
Author Affiliations: Jeannette O. Andrews, Gayenell S. Magwood, Carolyn Jenkins, Melissa J. Cox, Deborah C. Williamson, Medical University of South Carolina, College of Nursing, Charleston, South Carolina.
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