Letter to the Editor
RE: “ADVANCING NURSING SCIENCE THROUGH COMMUNITY ADVISORY BOARDS”
The recent publication of “Advancing Nursing Science Through Community Advisory Boards: Working Effectively Across Diverse Communities” provided an insightful perspective on both the utilitarian and ethical values of community advisory boards (CABs) in research with vulnerable populations.1 The move across our discipline toward a greater valuing of the voices of those whom we seek to study is an important step in ensuring the maximization of positive impact and simultaneous minimization of negative impact.1 The article provides relevant guidance to researchers beginning work with CABs, while also updating the scientific literature to incorporate the experience and wisdom from many successful CAB partnerships throughout recent years.
Despite the great value of this article to the current standards of research engagement with vulnerable populations, there is an unaddressed theoretical assumption regarding power dynamics in the researcher-researched relationship. Throughout descriptions of each of the 5 components of community-engaged research2 presented, there is little attention given to the rationale for each of these elements. Within the elaboration upon “Incorporating real power sharing,” specifically, one would expect an explicit recognition of the well-documented inherent power imbalance that favors the researcher3–5. There is, however, no clear acknowledgment of the inherent power differential between the researcher and the researched that the CAB seeks to overcome. Drawing from the work of Wallerstein,6 explicit address of this power differential can be a powerful tool in working toward shared power. As is made clear in that work,6 there must be a restructuring of inherent power dynamics to establish an equitable and mutually beneficial partnership.1 This restructuring necessarily begins, however, with the realization that researcher-initiated projects, by nature, favor the researcher.5 , 6
I do not claim here that the authors ignore this power differential in practice. The provided vignettes, specifically The Workplace Violence Community Advisory Board, are clear evidence that power relations are taken into account.1 However, to forgo explicit address of power imbalance in the proliferation of a framework for other researchers is to run the risk of false impression for those only novice in community-based work. Without emphasizing understanding of power dynamics that rationalize collaboration with a CAB, one may falsely believe a CAB to be a tool to enhance or clarify the researcher's work, rather than as an effort to correct historic power discrepancies.6 , 7 Recent research by Jamshidi et al4 illuminates the potential for negative effects in poorly conceived community-based participatory approaches to investigation. Participants made it clear that the use of a community-based framework does not immediately resolve issues of power.4 Furthermore, members of poorly executed community involvement efforts are described as perceiving their inclusion to be tokenism, rather than a true effort at sharing power.4 Explicit recognition of imbalanced power is discussed as an approach for resolving this concern.4
Resituating the components of effective work with CABs within explicit recognition of power imbalance in the researcher-CAB relationship would allow for a more thorough presentation of the importance and necessary operation of CABs. Through this lens, researchers who are just beginning to work with CABs will have an accurate understanding of the true purpose of CAB involvement.6 , 7 This view also provides proper warning of the potential for negative outcomes and the responsibility that all researchers have to correct for this imbalance in their work.4 Furthermore, explicit acknowledgment of this dynamic, in turn, acknowledges the often unrewarded labor endeavored by many researchers of vulnerable populations to restructure such dynamics.
I hope to express a small amount of the great deal of thankfulness owed to these researchers. The researchers published here are to be thanked not only for this presently discussed article but also for their efforts to ensure that community engagement and involvement in the research process become standard practice. Even the critique presented here would not be possible without the authors' former efforts to promote the conversation about community representation in nursing research.
School of Nursing
University of Michigan
1. Gonzalez-Guarda RM, Jones EJ, Cohn E, Gillespie GL, Bowen F. Advancing nursing science through community advisory boards: working effectively across diverse communities. Adv Nurs Sci. 2017;40(3):278–288.
2. Cyril S, Smith BJ, Possamai-Inesedy A, Renzaho AM. Exploring the role of community engagement in improving the health of disadvantaged populations: a systematic review. Glob Health Action. 2015;8:29842.
3. Strickland CJ. Challenges in community-based participatory research implementation: experiences in cancer prevention with Pacific Northwest American Indian tribes. Cancer Control. 2006;13(3):230–236.
4. Jamshidi E, Morasae EK, Shahandeh K, et al Ethical considerations of community-based participatory research: contextual underpinnings for developing countries. Int J Prev Med. 2014;5(10):1328–1336.
5. Minkler M. Ethical challenges for the “outside” researcher in community-based participatory research. Health Educ Behav. 2004;31(6):684–697.
6. Wallerstein N. Power between evaluator and community: research relationships within New Mexico's healthier communities. Soc Sci Med. 1999;49(1):39–53.
7. Minkler M, Wallerstein N. Community-Based Participatory Research for Health: From Process to Outcomes. San Francisco, CA: John Wiley & Sons; 2011.