Resident-Led Research Policy and Power (RRPP): A Framework for Centering Community Voice in Participatory Research.

For decades, health equity scholars and advocates have described that to build more equitable health policies, programs, and systems, researchers must first build authentic partnerships with communities that are marginalized and apply community members’ perspectives and expertise to collectively examine and develop solutions to health challenges [2, 6, 9, 13]. In response, participatory research methods that emphasize empowering communities to define research questions, implement studies, conduct analysis, and act on their findings are growing in popularity in the health research community [7, 16]. Despite its conceptual appeal, many researchers face challenges in its implementation, including funding infrastructures that do not adequately support participatory research and a lack of training and tools for researchers and community members seeking to develop productive, equitable partnerships [4, 5].

For 3 years, mothers and grandmothers in East Harlem who belong to a community group called the East Harlem Action Collaborative for Child Health and Well-Being (EHAC) and staff at the New York Academy of Medicine (NYAM) have engaged in a community-based participatory research (CBPR) partnership. Together, our team has developed the Resident-led Research Policy and Power (RRPP) framework to help guide conversations between researchers and community members to elicit communities’ expertise to inform various stages of health research. RRPP is a five-part framework that reflects the groups’ conversational themes that were the most challenging, engaging, and foundational for our collective research and policy advocacy. The purpose of this commentary is to describe RRPP and to recommend its use as a tool to support the implementation of participatory research in a variety of contexts.

Challenges and Opportunities in Community-Based Participatory Research

CBPR is a collaborative research approach based in an equitable partnership between communities affected by the issue being studied and researchers in all phases of the research process [15, 17, 18]. This approach to research has particular appeal in the field of public health because community members with expertise on the dynamic social, environmental, and behavioral contexts that interact to impact health experiences and health outcomes are uniquely able to inform epidemiology and the development of effective preventative and remediating policies. In addition, community leadership and participation in health research and policy solutions through CBPR has the potential to transform the narrative on who is a part of, and whose interests are being served by the health research community [8, 10] and could potentially increase trust in and uptake of public health initiatives [1, 11]. Current public attention to developing more equitable systems means that this approach to research will likely grow in popularity and attempts at implementation.

Funding requirements can be a key challenge to implementing CBPR. Often, funding agencies expect fully designed research studies at the time of grant submission. This expectation, however, can thwart the earnest implementation of CBPR, which is premised on community members having an equitable role throughout the research process, including defining the research question(s). Funding sources that provide the time and resources essential to develop relationships and foster trust with communities and to engage in co-learning, co-identification of issues in a particular area of interest, and the co-development of research studies are critically necessary to support full implementation of CBPR [14]. Without these relationships and the process of mutual learning to develop research plans, the power dynamics inherent in the study design will continue to advantage researchers and disadvantage communities.

Another challenge to the successful implementation of CBPR is that many researchers and community members lack experience in developing equitable relationships with each other. For academically trained researchers, CBPR may be taught in a methods course, but opportunities to apprentice within a CBPR research project are circumscribed in part due to the limited number of such projects being implemented [4]. As the field of research becomes more inclusive of researchers who come from communities that are historically marginalized, and inclusive of individuals who have deep experience working with communities experiencing historic disinvestment, the prospects of developing more equitable partnerships between researchers and community members are improved. In addition, as community members continue to organize around issues important to them, they increase their ability to engage in CBPR partnerships to address these topics. Finally, and to the purpose of this commentary, as CBPR teams share their lessons and strategies for implementing their work, they provide guidance for future participatory research efforts.

Origins of the East Harlem Action Collaborative for Child Health and Well-Being

In 2019, with seed funding from the New York Academy of Medicine and the New York Community Trust, Dr. Kimber Bogard and Shaneah Taylor began an initiative to partner with members of the East Harlem community to learn how the NYAM can support the health and well-being of children of the community [3]. NYAM staff member, Gloria Maldonado, recruited community members to this initiative by posting flyers throughout the community and doing active recruitment of parents with young children outside of early childcare centers. Over the course of the now 3-year partnership, 11 of the original 13 members of EHAC remain engaged in this work. Lessons learned over the course of three years of relationship building and organic conversations to learn from each other in the domain of child health and well-being led to the development of the Resident -led Research Policy and Power framework (RRPP). RRPP is a five-part framework that grew out of conversational themes that were the most engaging and foundational for our partnership.

Explanation of RRPP

RRPP centralizes individuals who reside in the community, their vision, their strengths, and their agency to inform the development of research, ultimately, policies. RRPP engages community residents as the experts in a series of conversations that begins with residents defining their hopes and dreams in specific contexts and concludes with them developing a plan for bringing their hopes and dreams into fruition. The RRPP framework is flexible and can be adapted to a variety of program and policy contexts. The five parts of RRPP are described below, and Table 1 presents the RRPP framework and guiding questions adapted to the policy area of maternal health.

Table 1

RRPP framework and guiding questions (adapted for maternal health)

RRPP theme	RRPP guiding questions
Dream It	What are your hopes and dreams for maternal health in your community?
Support It	What strengths do you, your family, and your community have to support your hopes and dreams for maternal health?
Change It	What changes are needed for you, your family, and your community to be able to support the maternal health that you desire for your community?
Measure It	How would you know/measure that maternal health goals are being achieved?
Speak It/Do It	How can you lift your voices and act in support of your maternal health hopes and dreams?

Dream It. This conversation topic encourages community members to think broadly about their desired experiences and outcomes in a given policy domain or context. Participants are encouraged to think outside of the confines of existing programs and systems to describe their vision for what could be. This initial topic is foundational and guides later stages of RRPP conversation.

Support It. This area of conversation asks community members to identify their personal strengths as well as the strengths in their families and communities for achieving their desired outcomes and experiences. This strength-based conversation is inspired by asset-based community development [12] and stands in contrast to common conversations that seek to discuss problems, challenges, or needs. Findings from this stage of conversation will be used to inform and guide later stages.

Change It. This topic encourages participants to identify the changes needed to support their ability to achieve their desired outcomes and experiences. These conversations stand in contrast to typical deficit-oriented to conversations by asking participants to apply an action-orientation to their discussion.

Measure It. This area of conversation asks participants to describe how they would know or measure, through qualitative or quantitative metrics whether or not their desired outcomes and experiences are being achieved.

Speak It/Do It. This topic area encourages participants to develop personal, group, and community-based plans for action and advocacy. Conversations in this final stage of the RRPP framework incorporate and reflect discussions that occurred in the previous stages.

Information and knowledge gained through these conversations can be instrumental for informing and co-developing research to bring desired outcomes into fruition.

Experience Using RRPP in Various Policy Contexts

Researchers at NYAM are currently using the RRPP framework in four community-based and participatory research initiatives: (1) with our continued work with EHAC, (2) with young adults describing their hopes and dreams for their East Harlem community in the context of COVID-19, (3) with Head Start parents developing parent and school engagement strategies, and (4) with communities across New York City working to promote maternal health. In each of these initiatives, researchers are partnering with individuals from diverse racial and ethnic demographic populations, working with community groups that vary in size from 6 to up to 25 participants, and addressing a variety of health policy areas. NYAM researchers are also experimenting with implementing the RRPP framework in different formats (e.g., in person and virtual conversations and on social media platforms). Researchers are documenting their process of implementing RRPP across these various community initiatives with plans to synthesize and share methodological findings.

EHAC and researchers at NYAM share RRPP as a flexible framework that we are successfully implementing in multiple community-based and participatory research projects. We invite other institutions, researchers, and community groups to use this framework to integrate community voice, leadership, and decision-making power into the design, development, and implementation of research and ultimately, policy development.