Asthma is a chronic disease with important environmental and lifestyle components. Successful management depends on engagement of patients and their families/households. As suggested by the higher asthma prevalence among Puerto Ricans in Buffalo’s Lower West Side, it is likely that cultural factors also play a role. The organizers of the WSCAP decided, therefore, that engaging the community in the design and implementation of asthma interventions could improve the probability of success. Specifically, they adopted an approach based on the NIEHS model, which states that CBPR “(1) promotes active collaboration and participation of every stage of research, (2) fosters co-learning, (3) ensures projects are community-driven, (4) disseminates results in useful terms, (5) ensures research and intervention strategies that are culturally appropriate, and (6) defines community as a unit instead of identity.”5
Community research capacity represents the skills and knowledge individuals within the community have that enable them to participate in research activities. Building community research capacity through training and education ensures that co-learning is occurring. Understanding and adapting research methodologies to meet community needs develops trust between researchers and the community to facilitate research by translating the research paradigm into language that is meaningful to the community. For example, learning about misperceptions of disease, alternative methods for treating disease, and appropriate dissemination of information are important in the translation of research. Zayas and colleagues highlighted that lay definitions of disease do not always match the biomedical model that drives treatment.6
Understanding these differences may lead to more meaningful interventions that improve health outcomes.
Examples of building research capacity are documented in the literature. In Roxbury, Massachusetts, youth were trained to educate the community on the relationship between air pollution and health, empowering them as leaders.7
The Community Action Against Asthma program trained outreach workers as “Community Environmental Specialists” to conduct household assessments and personal monitoring of exposure.8
In Brooklyn, New York, community health educators were trained to conduct interviews and facilitate focus groups.9
Adams and colleagues described the importance of co-learning through building research capacity to ultimately empower the community to initiate and participate in future research agendas.10
In the WSCAP, the framework for action was similar to the “Pathways to Health Model,” recently described by Wallerstein,11
in which community-based participatory research acts through training and education to improve employment opportunities, income, and the potential for advocacy or policy changes. These empowerment and community capacity outcomes in turn drive positive health outcomes.11
Specifically, Wallerstein’s model states that “empowering strategies” create “empowerment and capacity outcomes.” These outcomes, in turn, have a direct impact on “health outcomes” and “developed effectiveness.” All of this occurs within the context of ‘global, national, and local contexts” in addition to “political, human rights, economic, socio-cultural, racial, and environmental contexts.” shows how this model was adapted to address the WSCAP. The training and educational opportunities were empowerment strategies that led to empowerment and capacity outcomes such as skill development and increased confidence. The community member became a university partner and was recognized as the local expert. These outcomes lead to improved health outcomes through community participation in the registry, survey, and focus groups. Personal wellness can also be expected from improved capacity.
Pathways to health model (Wallerstein) adapted for the West Side Community Asthma Project.