When researchers work in a community, one of the most important things they can do is to communicate with community members. Health research is most effective when community members understand and benefit from the research process. It also reduces confusion, unrealistic expectations and even resistance.
Stroke patient with extended family
Gerry Mshana and Richard Walker explain more about their approach.
What do we mean by community?
The term ‘community’ means different things to different people. It may refer to individuals living within a particular geographical area, or to individuals with common social, economic and political interests. When talking about community engagement, it is important to be clear about what it means. For example, does it only refer to ‘ordinary’, and in many cases non-literate, residents in research localities, or does it include the resident elites and professionals as well?
What do we mean by power?
Engaging communities in health research is essentially an interactive process. First, there are interactions between researchers and community members. Secondly, there are interactions between individuals, or groups of people, within communities. In all these interactions, power relations are inherent. Broadly defined, power is the production of causal effect (1). From a social perspective, it is ‘a form of causation that has its effects in and through social relations’ (2). Michel Foucault (a famous social theorist) argued that power relations are present in every aspect of social interaction (3). He and other social theorists, such as Pierre Bourdieu (4), highlighted the influential aspects of power and studied its strategies and techniques.
Research and community engagement
Women participating in a mapping exercise about stroke services in Hai district, Tanzania
We researched people’s attitude to stroke in urban (Dar-es-Salaam) and rural (Hai district) Tanzania. Through this, and previous research and community engagement activities, we realised the importance of analysing power relations in order to come up with a meaningful community engagement strategy. The social dynamics taking place in the areas where we work made us critically reflect on the concept of community. It was evident that the community was fragmented and had different groups of people with different viewpoints of stroke. Such groups of people had ‘symbolic power’, such as traditional and faith healers, or real power, such as religious and village officials. These groups had great influence on the way stroke was imagined and dealt with by other community members. They had influence through their interactions with others in the context of treatment, or social and economic support. Other residents, who had advanced education and exposure to outside life (such as retired workers) had the same kind of influence.
Some residents of Hai district (not belonging to the groups described above) had relatives who were professionals (medical experts and researchers), who lived in distant towns, but visited these areas frequently during vacation. These were ‘proxy’ community members, because though they were not long term residents, they participated in village life through their periodic visits. Their opinion influenced the participation of their relatives in our research activities. During their visits, the ‘proxy’ community members demanded to see the information sheets and other study materials their relatives had received from us. Through such power dynamics, the ‘proxy’ community members shaped how we (as researchers) interacted with community members and also how residents participated in our activities. In other words, they were an important part of the engagement process. This is a critical point for researchers. If certain categories of community members, or the dynamics they introduce in study areas, are viewed as either ‘not being part’ of the community or ‘time wasters’, and as such overlooked, such a move could lead to serious counter-productive consequences.
The third group of residents were those who did not possess the characteristics of the two groups described above, but they were probably the most important group, as they form the majority. These are the ‘ordinary’ community members and are mainly youth and women, who are often under-represented in research processes.
These complex power dynamics made us realise how central power relations are to the whole research and engagement enterprise. It made our team devise better and more appropriate strategies to make certain that the research process was not only participatory, but more democratic, by actively seeking the representation of all groups of people and their interests.
Gerry Mshana
National Institute for Medical Research, P.O. Box 1462, Mwanza, Tanzania. Email: gmshana@nimr.or.tz
Richard Walker
North Tyneside General Hospital, Rake Lane, North Shields, Newcastle, UK. Email: Richard.walker@nhct.nhs.uk
1. Scott, J., Power. 2001, Cambridge: Polity Press.
2. Isaac, J.C., Beyond the free faces of power: A realist critique in Rethinking Power, T. Wartenberg, Editor. 1992, State University of New York Press: Albany.
3. Foucault, M., The Archaeology of Knowledge and the Discourse on Language. 1972, New York: Pantheon.
4. Bourdieu, P., Social Space and Symbolic Power. Sociological Theory, 1989. 7: p. 14-25.
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Filed under: Public engagement in health research Tagged: | community engagement, health research
