Community-based participatory research (CBPR) : co-creating guidelines and a conceptual framework from the social capital perspective, illustrated with an example of a mental health literacy promotion project in Chinese communities

Abstract

Although community-based participatory research (CBPR) enhances the validity of an intervention, the effectiveness of CBPR interventions in mental health outcomes and the adherence level to CBPR principles remains unclear. Furthermore, the practice of CBPR in a non-Western context lags behind the West, with guidelines and a conceptual framework to explain network, resource, and information sharing during the CBPR process lacking in a non-Western context. Therefore, this thesis aims to explore the effectiveness of CBPR interventions in mental health outcomes and the adherence level to CBPR principles, and co-develop guidelines and a conceptual framework with Chinese stakeholders to understand the mechanism of CBPR from the social capital perspective, illustrated with an example of a mental health literacy promotion project in Chinese communities.

Study 1 (Chapter 2) reports the findings of a systematic review examining the effectiveness of CBPR interventions for mental health outcomes and assessing the adherence level to CBPR principles. Fourteen studies were reviewed. Our review produced two major findings. First, although all the reviewed articles reported positive mental health outcomes, the quality of these studies varied. Second, most studies did not adhere to CBPR principles according to our four-dimensional rating scheme (degree of community involvement in the research process; level of shared decision-making between researchers and the community; level of contribution to community capacity building; level of addressing original health problems in the community). The scheme could be helpful for future research to implement and report the CBPR process and outcomes.

Study 2 (Chapter 3) reports the findings of focus group discussions with 28 participants to co-create guidelines with stakeholders in Chinese communities. We formed a panel with community stakeholders to co-analyze and co-interpret the data and findings. We identified six guidelines pertinent to CBPR practice and implementation in Chinese communities: (i) highlighting an ‘acceptance and openness’ mentality in the CBPR training; (ii) navigating the hierarchical culture to facilitate an equal partnership; (iii) breaking the project into smaller action tasks to facilitate design and implementation; (iv) fostering collective harmony through team-building activities and informal gatherings; (v) encouraging open discussion of mental health; (vi) leveraging informal networks in mental health literacy promotion.

Study 3 (Chapter 4) reports the findings of focus group discussions with 8 participants to co-create a conceptual framework with stakeholders in Chinese communities. Again, we formed a panel with community stakeholders to co-analyze and co-interpret the data and findings. Our data suggested that three main forms of social capital, encompassing six critical elements, underlie the process of CBPR: emotional meaningfulness within a group as a foundation for sustainability, characterized by collective harmony, shared values and norms, and role models (bonding social capital); co-learning and co-production of resources across the groups, sparked by knowledge exchange environment (bridging social capital); and breaking hierarchical gaps and fostering equal partnership, induced by resource contribution from each stakeholder and the existence of super connectors (linking social capital).

This thesis furthers the understanding of the CBPR approach. The findings could guide future research and provide practical implications in the field.