Don't Start with the Leaders! Re-thinking Development and CBPR Approaches in Santo Domingo, Dominican Republic

• In Event: 334 - Section on Medical Sociology Paper Session. Patient, Stakeholder, and Community Engagement in Health Research

Abstract

Scholars and practitioners in development and community-based participatory research (CBPR) often begin community health interventions by identifying leaders or socially active individuals and then designing interventions based on their input and guidance. However, the opinions and experiences of these individuals may be a poor representation of the community as a whole, and the result may be health interventions that lack community participation, community ownership, and sustainability. We report an alternative approach: grounding efforts in sociological theory regarding marginalization, alienation, and community capacity and using the methods of participant observation, semi-structured interviews, focus group meetings, and community meetings within the CBPR paradigm to learn about a small, peri-urban community in Santo Domingo with which we sought to partner. Informed by these data, we nurtured an organic, social infrastructure of informal relationships in order to develop our partner community’s capacity for collective action. In this paper, we report social network analyses and a qualitative analysis of social organization using the Domains-Tasks-Resources-Activities framework to characterize the limited initial community capacity in 2009, the gains made by 2014, and the methods of partnering and organizing we used to help bring about this change. Our findings suggest that using systematic research methods to investigate and nurture the prospects for collective action is a better initial strategy for health interventions than traditional approaches that rely on individual leadership and informants in formal positions of power.

Authors

• John Pothen, Emory University

• David P. Aday, College of William & Mary