摘要：Objectives. We examined how National Cancer Institute–funded Community Network Programs (CNPs) operationalized principles of community-based participatory research (CBPR). Methods. We reviewed the literature and extant CBPR measurement tools. On the basis of that review, we developed a 27-item questionnaire for CNPs to self-assess their operationalization of 9 CBPR principles. Our team comprised representatives of 9 of the National Cancer Institute's 25 CNPs. Results. Of the 25 CNPs, 22 (88%) completed the questionnaire. Most scored well on CBPR principles of recognizing community as a unit of identity, building on community strengths, facilitating colearning, embracing iterative processes in developing community capacity, and achieving a balance between data generation and intervention. CNPs varied in the extent to which they employed CBPR principles of addressing determinants of health, sharing power among partners, engaging the community in research dissemination, and striving for sustainability. Conclusions. Although the development of assessment tools in this field is in its infancy, our findings suggest that fidelity to CBPR processes can be assessed in a variety of settings. Despite a national commitment to reduce health disparities, 1 , 2 recent studies show persistent differences in cancer incidence and mortality among racial/ethnic, social, and geographic groups. 3 , 4 Cancer-related health disparities across groups are caused by numerous interwoven factors, such as differences in environmental stressors, socioeconomic status, health care coverage, providers’ racial/ethnic and social biases, access to cancer screening and care, cultural beliefs about cancer, lifestyle behaviors, participation in routine cancer screening, and biological characteristics of the cancer. 5 Attempts to reduce disparities through research are complicated by the fact that many vulnerable groups face a broad array of barriers that reduce their willingness or ability to participate in research. 6 – 12 For some disadvantaged communities, research has failed to address community concerns, has not benefited the community, has been exploitive, or has caused harm because findings attached unfavorable notoriety to the group. 6 , 9 – 11 Community-based participatory research (CBPR) seeks to improve the capacity of research to decrease cancer rates and reduce other enduring health disparities. 13 CBPR emerges from the social justice and action research traditions, both of which recognize the unique strengths and perspectives of community partners and aim to produce tangible benefits for communities participating in research. 14 – 16 CBPR principles require that academic and community partners work together to design studies, collect and interpret data, and disseminate results. As a result of this collaboration, community members should gain skills and see tangible benefits of having participated. Such endeavors can improve research methods and enhance the relevance of findings. 6 , 8 , 15 – 19 Despite these aims, there is little evidence regarding the extent to which CBPR projects have involved communities in research. Processes associated with developing, implementing, analyzing, and disseminating research are poorly documented and have been infrequently evaluated across a range of CBPR projects. In their review of 60 CBPR studies, Viswanathan et al. found varying degrees of community involvement in priority setting, methods selection, proposal development and funding, study design and implementation, translation of research findings, integration and sustainability of programs, and community capacity building, all essential characteristics of CBPR. 18 Recognizing the potential strengths of CBPR, in 2005 the National Cancer Institute (NCI) Center to Reduce Cancer Health Disparities funded 25 Community Network Programs (CNPs) to employ CBPR methods to reduce the unequal burden of cancer in minority and disadvantaged communities across the United States and American Samoa. 20 Although CNPs were funded at different levels (by geographic scope), each CNP was charged with developing a research infrastructure that operated on CBPR principles. CNPs were required to convene a community advisory group, sponsor cancer education and outreach, train researchers and community members in CBPR methods, and conduct intervention studies. Community and academic partners were asked to work together to define research priorities in a way that was unconstrained by their biases and that afforded the freedom to address research across the cancer research continuum from discovery to dissemination. 21 Engaging communities in research is consistent with the NCI's commitment to interdisciplinary and team research, 22 intentionally extending team membership to community members who are experts in community culture and resources. The CNPs provided an opportunity to explore how measures of adherence to CBPR principles—especially the extent to which community members are engaged in the design and dissemination of research—can be operationalized across a diverse sample of CBPR projects. In 2009, we spearheaded a self-evaluation process among CNPs to help us understand the extent to which each network's research effort reflected CBPR principles. As part of this process, we aimed to design and field-test a quantitative tool to measure adherence to CBPR principles. We also considered how such knowledge might be used to improve participatory processes and outcomes of CBPR endeavors within and beyond the CNPs.
