The Promise of Community-Based Participatory Research for Health Equity: A Conceptual Model for Bridging Evidence With Policy

摘要

Insufficient attention has been paid to how research can be leveraged to promote health policy or how locality-based research strategies, in particular community-based participatory research (CBPR), influences health policy to eliminate racial and ethnic health inequities. To address this gap, we highlighted the efforts of 2 CBPR partnerships in California to explore how these initiatives made substantial contributions to policymaking for health equity. We presented a new conceptual model and 2 case studies to illustrate the connections among CBPR contexts and processes, policymaking processes and strategies, and outcomes. We extended the critical role of civic engagement by those communities that were most burdened by health inequities by focusing on their political participation as research brokers in bridging evidence and policymaking. Landmark studies have helped keep race and ethnic health inequalities on the national political agenda for more than 3 decades. These studies have included the Secretary’s Task Force on Black and Minority Health, 1 Unequal Treatment, 2 and Examining the Health Disparities Research Plan. 3 Despite the continued research evidence of disproportionate adverse health impacts on racial/ethnic minorities, 4 insufficient attention has been paid to the role of governmental action or inaction on these health disparity outcomes. How research can be leveraged to promote health equity policy, or the role of locality-based research strategies, in particular community-based participatory research (CBPR), is less understood. Two major challenges inhibit our knowledge about the link between research and policy change: (1) the gap between scientific evidence and policy action based on evidence, and (2) the difficulty of mobilizing civic engagement for policymaking in the United States. We sought to help fill these gaps by exploring 2 locality-based CBPR initiatives that have effected policy change to promote health equity. After brief overviews of the social justice basis for CBPR and health equity, the literature on CBPR policymaking for health equity, and the issues underlying the research to policy gap, we presented a new conceptual model for better understanding of the pathways and connections between CBPR contexts and processes, policymaking strategies, and policy outcomes. We summarized our case studies and then used detailed findings to illustrate the model’s utility for showcasing how CBPR might contribute, along with other efforts, to local and regional policy change. We concluded by comparing our findings with those of earlier research, and highlighted how further refinement of the conceptual model might assist CBPR partnerships in promoting health equity policy.