Synergy between community-based participatory research and community health worker community advocacy as a force for policy change

Public health advocacy is by necessity responsive to shifting political climates and thus a challenge of advocacy research is that the intervention must by definition be flexible. Moving beyond the classification of advocacy efforts to measurable indicators of policy change and outcomes therefore requires a dynamic research approach. In this presentation, we will engage in a critical reflection on the use of the community based participatory research approach (CBPR) to develop and measure the impact of Acción, a community advocacy intervention in which community health workers (CHWs) engage community members in making positive changes to their communities. The Kingdon 3-streams model of policy change provided a theoretical framework for the Acción intervention. Research and community partners collaboratively developed research methods to identify and collect Acción intervention data. Over the course of the intervention, the flexible nature of CBPR led to the integration of additional data collection strategies and theoretical frameworks that allowed us to better understand and describe how CHWs were using community advocacy as a form of community engagement. We developed a model to describe the synergistic relationship between the CBPR approach and the Acción intervention in which what we chose to measure influenced intervention activities which concurrently influenced the identification and measurement of research outcomes. Key assumptions of CBPR, community needs driving the research; responsiveness of research measures to community context; and ongoing flexibility in defining research outcomes were crucial in our ability to develop a CHW community advocacy intervention and to adequately document its impact on communities.