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Aligning Community Engagement With Traditional Authority Structures in Global Health Research: A Case Study From Northern Ghana
Paulina O. Tindana, MHSc, Linda Rozmovits, DPhil, MA, Renaud F. Boulanger, BSc, Sunita V. S. Bandewar, PhD, MHSc, Raymond A. Aborigo, BA, Abraham V. O. Hodgson, PhD, MPH, Pamela Kolopack, MSc, and James V. Lavery, PhD, MSc
Despite the recognition of its importance, guidance on community engagement practices for researchers remains underdeveloped, and there is little empirical evidence of what makes community engagement effective in biomedical research.
We chose to study the Navrongo Health Research Centre in northern Ghana because of its well-established community engagement practices and because of the opportunity it afforded to examine community engagement in a traditional African setting.
Our findings suggest that specific preexisting features of the community have greatly facilitated community engagement and that using traditional community engagement mechanisms limits the social disruption associated with research conducted by outsiders. Finally, even in seemingly ideal, small, and homogeneous communities, cultural issues exist, such as gender inequities, that may not be effectively addressed by traditional practices alone.
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I think that all you can do as an individual researcher is just do the best you can do to be respectful, show gratitude to the community, and share the results of your research with them. I don't think communities always expect employment or other benefits. People just want to be treated with respect at the end of the day. I have friends who carry out research among people living with HIV in Brazil. Despite the progressiveness of our government, there is still stigma against those living with HIV, especially if they are sex workers or men who have sex with men. When carrying out his research, my colleague adopts a 'human rights-based approach', which is possibly similar to CE, but more rigorous, I think. He covers the participants' transportation costs if they travel to meet with him, but otherwise does not provide any explicit benefits to the research participants. However, he has managed to win their trust by simply treating them with respect and dignity.
I think the main reason the community was happy here was because of all the benefits from the research - e.g. the employment. I'm a student, and if I want to carry out a study as part of my dissertation research, I can't afford to hire anyone. I will just have to go into a community, try (somehow) to get their acceptance, do my research, and then leave. I won't be able to provide the community with any actual, tangible benefits. So...communities will never be as pleased with us, individual researchers as they are with big companies who can promise years of employment or other benefits. How is an individual researcher who can promise the community nothing supposed to win the trust of the community?
This paper presents a fascinating example of successful community engagement - built carefully over a long period of time. I was impressed with the lengths the NHRC went to in order to build such good relationships with the community. It looks like a 3-step model for community engagement was used:
1) Investigators conducted an exercise in social mapping to figure out the pathways through which they could respectfully enter the community;
2) A meeting was held with relevant chiefs to obtain permission to engage with the specific communities where the research was to be carried out. This meeting then led to other, wider meetings with the community that involved men, women, and children;
3) Throughout the study, researchers continued to regularly meet with the chief and engage with the community (according to traditional methods of CE), as well as to provide benefits to the community in terms of health-care and employment.
I wonder if this is a model that could be more widely applied or adapted in other contexts? I would be interested to know if there are competing models of CE that are very different to this?
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I've always been a bit skeptical about the seemingly blind enthusiasm for community engagement. Nonetheless, I found this paper to be well written and very interesting. (For those who wish to read the full paper, clicking on the link above did not work for me. I had to copy and paste the link into a new page on my browser). I was glad to see the authors clearly admit that "little empirical evidence exists of what makes CE effective in biomedical research".
The paper describes very well what the researchers did in order to 'engage' with the community and be accepted. I understand the importance of this, but am not convinced that everyone's motivations are pure. For example, the paper states that chiefs in Navrongo expected gifts at the initial meeting with the researchers. The authors explain that the traditional presentation of gifts is a required cultural practice and a symbol of respect, and not an individualized benefit to the chief. But isn't this view rather naive? Can't the giving of gifts be seen as bribery? If the chief receives his gift of tobacco and alcohol, will he still feel free to say no to the research?
In addition, it seems that one of the big reasons the community in this case study had such a good relationship with the researchers is because the researchers (the NHRC) managed to provide tangible benefits to the community - such as bringing in more nurses, providing transport to hospital, increasing the number of doctors, and so forth. But surely these kinds of benefits are rare in research? Many studies (especially smaller studies) are not capable of providing such benefits. How do you win the support of the community in such cases?