Facilitating Empowerment and Self-Determination Through Participatory Action Research

Ethics

Ethics approval for the project was granted by the Human Research Ethics Committee at the University of Western Australia and the Western Australian Aboriginal Health Ethics Committee.

Engaging and training community coresearchers

In each of the 11 project sites, formal relationships were established between the university-based project team and local Aboriginal community partner organizations. The aim of this process was to formally embed the project within local community controlled structures and ensure activities and outcomes were relevant and owned by each respective community. Each local partner organization was involved in identifying, and/or recruiting, suitable local community people to be trained as the project’s researchers, referred to as community coresearchers. Two community coresearchers were appointed at each site with a preference for one male and one female consultant in recognition of gender equity and cultural norms. Twenty-two community coresearchers were recruited for the project, although not all sites identified coresearchers of each gender—in some sites, two female or two male coresearchers were appointed.

There were a number of criteria for selecting community coresearchers:

demonstrated ability and willingness to enact the values and principles of the NEP;

A set of deliverables was developed for the community coresearchers to complete. These included:

development of project principles,

Members of the project team developed and delivered the 5-day training program to the community coresearchers. The training included basic project management, PAR processes, culturally safe and responsive research methods such as “yarning,” research ethics, qualitative data collection, and thematic analysis and critical reflection of their own practice and processes. The community coresearchers also participated in focus group and interview role-plays to learn more about the research methodology. They were also provided with a research kit developed specifically to assist them to undertake community consultations, which included basic instructions, project information, and consent forms to use with participants.

Given the nature of the topics they were covering with community groups and the complex and potentially difficult experiences that people were sharing, community coresearchers completed training in first aid and received a Mental Health First Aid certificate.

Development of the project’s principles

At the commencement of the project, the community coresearchers were asked to workshop their expectations, training needs, and community aspirations and to devise a set of core principles for the implementation of the project. These principles were designed to guide the way the project team worked with individuals, families, and communities as follows:

Human rights and social justice involves the recognition and attainment of Indigenous human rights and social justice; the right for participants to be treated as equals, to have cultural differences recognized and respected, to have a voice, and to be heard as part of ongoing healing process.

Importantly, these principles strongly align with PAR principles and processes which recognize and respect the identity, knowledge, and experiences of the community and build on the strengths and resources; facilitate a collaborative, equitable partnership in research through an empowering and power-sharing process that address social inequalities; facilitate colearning and capacity building among partners; attain a balance between data generation and intervention; focus on the local relevance of policy and programs and generate perspectives that attend to multiple determinants of health; involve a cyclical and iterative process; involve all partners in the dissemination of results; and commit to sustainability (Braun et al., 2014; Israel, Schulz, Parker, & Becker, 1998).

Deliver community consultations

The community consultations were designed to provide individuals with the opportunity to discuss aboriginal holistic conceptions of health and well-being, as well as space to reflect on their own lives and sense of well-being, and on what they needed to make themselves strong (as individuals, families, and communities). Consultations were conducted by the community coresearchers in their respective communities and included interviews (where individuals could convey personal stories and life experiences) and focus groups, where collective attitudes and experience could be gathered. Both processes were guided by a set of 12 discussion prompts that helped participants to explore their understandings of cultural, social, and emotional well-being, empowerment, leadership, and healing. These prompts included:

the challenges faced by individuals, families, and the community overall;

In each of the sites, approximately 40 participants were invited by information flyers and word of mouth to participate in a structured community consultation process led by the local community coresearchers.

Production of community reports

The key discussion points and outcomes from each community consultation process were recorded and then subsequently analyzed by the community coresearchers and the project team. This involved examining the data and discussing the emergent themes. Triangulation between members of the project team and the community coresearchers provided an opportunity to examine different perspectives. The findings and analysis of the issues and solutions were collated and written up, printed, and presented back to each community in a dedicated site report in keeping with the key steps in PAR. Each report was around 60 pages in length and contained detailed analysis and synthesis of approximately 40 community participants and about 8 key stakeholders in each community.

The community reports are an important aspect of the project’s PAR process and provided a means of reciprocating and disseminating research findings back to the community and stakeholders. The reports were a mechanism for the community coresearchers to reengage community participants, and other community members and relevant stakeholders including the partner organizations, facilitating a range of important discussions regarding how to act on the findings to initiate change. Different communities focused on different priorities. An example of this was the decision in one of the sites to focus on youth activities to address issues related to substance misuse, while another community chose to focus on family issues. Throughout the research process, the project team and community coresearchers reassured communities that information in their site reports belonged to their community who were encouraged to “own” them.

Project support and capacity building

The role of the project team and the local partner organizations was decisive in ensuring the community coresearchers felt supported and were able to achieve outcomes. The project team developed a number of strategies to address the, at times, high level of need from the community coresearchers for the ongoing support and mentoring. Initially, this involved regular communication and contact, assistance with data analysis and compiling of the site reports, and conducting a 2-day social and emotional well-being workshop at each community to strengthen the resolve and ability of coresearchers and community participants to deal with the ongoing challenges. However, based on the feedback from community coresearchers, it became increasingly evident that there needed to be much more to ensure their enthusiasm was sustained. The next phase of the project involved the development and implementation of additional support, training, advocacy, and research strategy. This extended to on-site one-on-one and group workshops, as well as ongoing mentoring via phone and e-mails, including how to deal with sensitive personal and community issues.

An important part of the project’s strategy was to develop a team mentality between the community coresearchers. Crucial to this was bringing them all together in Perth on a regular basis for workshops and training sessions and ensuring they felt a part of a unique team. All the community coresearchers work in difficult circumstances within communities that experience high levels of trauma and distress and thus the debriefs and support provided was critical to their sustained commitment.

The project team also facilitated a “learning community” or collaborative network of community coresearchers through developing a dedicated website depicting images of the “NEP team” and on an online forum to create discussions posts, share experiences, and seek feedback and suggestions. Other strategies included appointing local Indigenous facilitators and engaging local partner organizations with strong Indigenous affiliations as comanagers of the research process. This is a crucial point—community-controlled organizations are often the “heart” of community—part of the project’s success resides in using their links to improve “buy in,” driven by organizations and community researchers to build local community capacity and empowerment and strengthen their well-being.

The project’s National Advisory Committee (NAC) was another key factor in the successful support provided and the delivery of the project at each of the community sites. The NAC comprises prominent Indigenous experts in mental health, suicide prevention, and social and emotional well-being across health and policy sectors and was formed to provide guidance on research methods and implementation. The NAC reviewed and discussed each of the site reports, providing their expert input and advice. Their role was also to ensure that all of the Indigenous communities maintained an empowered and equal position in the research activities, analysis, and outcomes.

Completed consultations

By 2015, some 457 participants have been involved in the consultation processes. Led by the community coresearchers, community representatives (project participants) came together to identify the issues in their own lives as well as in their families and community. These focus groups and interviews were designed to identify the issues confronting individuals, families, and communities and explore solutions to address these issues. Participants were also asked to consider what needed to be included in any community-based programs. The consultations also involved asking participants to explore their strengths and identify ways they could exercise greater control over their social and emotional well-being. Across all sites, communities identified a similar set of responses to the issues they identified and a similar set of strategies. Although the communities are very different in size, location, history, and levels of remoteness, they all identified problems with youth; family disharmony, feuding, and violence; substance abuse; mental health issues; racism; and a lack of education, employment, housing, transport, and services, as impacting negatively on their well-being. Ways to address these concerns included strengthening connections to family, community, country, spirit and spirituality, body, mind, and emotions. Participants also said they wanted to be involved in designing and delivering any subsequent programs for their communities and to be part of ensuring that this occurs.

Facilitating local solutions

An underlying principle of empowerment approaches is that only solutions driven from within a vulnerable, disadvantaged community will ultimately be successful in reducing community-based risk conditions (Tsey et al., 2007). A key aspect critical for the success of the project implementation and outcomes was ensuring that each local community drove its own processes of identifying and taking ownership of any problems and vulnerabilities and seeking solutions from within. The community reports provided the community with a snapshot of the key issues identified by workshop participants in the consultations and a blueprint for moving forward and enacting local change. At least 40 hard copies of the community reports were sent to each of the project sites for dissemination and full pdf copies were made available on the project’s website and sent to the Australian Department of Health.

The reports provided each community with the opportunity to establish priorities for action at a local level, creating individual and community empowerment, as well as evidence to support their advocacy activities and to inform broader social and emotional well-being and suicide prevention policy initiatives and other policy and programs. Some community coresearchers claimed that service providers in their communities are “missing the mark” in funding allocation and program design. They believed that given the reports reflected real community involvement in their formation, they could assist communities to engage agencies to address issues and, particularly, to ensure service providers address what community wants and need. The community coresearchers recognized the site reports reflected a preferred process whereby community members were taking responsibility for what they said needed to change in their lives and their community. Production and dissemination of the NEP site reports demonstrated to each of the communities that their voices had been heard and enabled outcomes such as increased level of individual and community empowerment from the PAR process to be seen immediately at the community level in each of the sites. This was central to the integrity of the project.

Outcome

Reflecting on the conduct of the research with their communities, the community coresearchers identified that the PAR approach and the culturally relevant yarning format used to conduct focus group discussions and individual interviews (Bessarab & Ng’andu, 2010) allowed the participants the freedom to discuss a range of issues and experiences, many of which were deeply personal. The community coresearchers observed that for some participants, these workshops provided a rare opportunity for individual self-reflection and for participants to consider their own issues as opposed to always prioritizing the needs of others in their family or community. The questions also helped participants to recognize the interconnectedness of their lives and issues and their relationships to their family and community.

In reflecting on their experiences, the community coresearchers identified other factors as key considerations for an effective PAR process within Aboriginal community contexts. These included negotiating the various cultural dynamics, including acknowledging community-level tensions and divisions, and creating a space where people feel safe to fully and openly participate. Timing of the consultations was also important, as was the selection of venues and the way the material and research topics were presented. Local autonomy was assisted by acknowledging that these factors varied at each site according to what best suited the particular community and reflecting these differences in local delivery. In their feedback on the research consultation processes, many of the community participants reported that having local Aboriginal facilitators (our people) was an important feature that contributed to the high quality and integrity the information collected and confirmed that the “researchers” were perceived as being able to relate to the discussions and to the participants. Many acknowledged the benefits of using PAR and the sense of empowerment and self-efficacy in knowing that the community findings were being acted on (Cox et al., 2014).

Feedback received during the project’s evaluation described the positive reception community coresearchers received when they took the site reports back to their organizations and communities and the pride and recognition they themselves felt in what they had achieved. One community consultant described how their community “felt deadly seeing the reports” and regarded the process of completing the reports as “empowerment in action.”

Project support

The role of the project team was critical to the community coresearchers and was an important aspect for the achievement of effective PAR processes. The ongoing training was an important component—contributing to capacity building and local knowledge transference. The integration of the principles into the project facilitated genuine ownership of the project and sense of self-efficacy. The support and time out provided through debriefing sessions in Perth all contributed to the sustainability of the community coresearchers and the project.

Information obtained from observations and interviews with community coresearchers on the six separate occasions they came together over the 2 years confirmed the significant benefits of taking time out from the community and their work to debrief, share their stories, and support each other, not only regarding their experiences using PAR processes but also in their roles as community workers on the frontline. This “coming together” created a synergy and energy and shared understanding and sense of belonging to a community of “coresearchers.”

Creating community ownership

All of the community coresearchers described very positive experiences from all aspects of the project. This started with developing the project principles, attending the training, and then facilitating workshops and discussions at a local level as well as reporting and sharing the findings with the wider project team and then feeding back to local groups involved in the workshops and to key local stakeholders and program and service providers. They reported on all of this as very beneficial with many describing it as “affirming,” “inspiring,” and “beyond their imagining” to be able to work like this with their communities, share their experiences with other Aboriginal people, and provide support to their communities through the site reports.

The application of PAR processes by local community coresearchers allowed for an extensive amount of information and insights obtained locally to be shared nationally and to identify the types and extent of change communities both want and need. This process was positive for those involved, as it confirmed the similarities in issues and solutions across diverse communities. One-to-one interviews conducted with the community coresearchers highlighted the positive experiences associated with their participation.

I have been inspired by the many fantastic strong Aboriginal and Torres Strait Islander people who have been and those who still are involved. The Project has reminded me that my contribution, along with others is welcomed, supported and valued…Personally the project has reinforced my strong belief in the value of community input and control. It has strengthened me as a person. (CC 1)

The program has helped me to make positive changes in my life, has brought my family closer together. (CC 2)

The important things about being involved with NEP professionally and personally is being proactive in the community, being involved in culture, in family, friends, work mates. (CC 4)

Being part of the NEP FAMILY is also healing for me. (CC 7)

It’s given me skills to educate the wider community and enabled me to showcase what issues affect ATSI peoples and how organisations and government bodies can support what we are trying to do for our people. (CC 3)

The project created opportunities for the empowerment of the community researchers themselves, as they led the research processes and worked with their communities to directly confront challenges and collectively identify new strategies and mechanisms for change.

I was able to gain confidence in my ability to become a leader for my community. (CC 2)

Meeting co-researchers and consultants from across Australia has been rewarding. I have also learnt a considerable amount that personally and positively empowers me and my family. (CC 5)

Facilitating community participation

The 11 communities involved in the project were an integral part of the research process and outcomes and were actively engaged as partners with the project team. Building the capacity of the nominated community coresearchers from each of the communities to conduct the consultations and data analysis represents a best practice example of community-based research with Aboriginal and Torres Strait Islander peoples and exemplifies the standards and goals of the Australian National Health and Medical Research Council ethical guidelines for working in Indigenous contexts. These guidelines require evidence of genuine negotiation with, and participation of, Indigenous people through all phases of a research project (i.e., conceptualization, analysis, development, data collection, reporting, and dissemination) to ensure aboriginal input and control National Health and Medical Research Council (NHMRC, 2007). Moreover, these guidelines require researchers to demonstrate how they have upheld the six values generated by Australian Indigenous communities in developing the NHMRC guidelines: spirit and integrity, reciprocity, respect, equality, survival and protection, and responsibility through all phases of the research process.

The project allowed for a context-specific approach—a crucial element in the conduct of appropriate Indigenous research. While sharing common features in terms of process and broad outcomes (identifying and addressing community challenges), the diversity among communities was able to be acknowledged through the voices and concerns expressed by participants that then enabled each community to prioritize their own responses. The diversity and commonalities within and between communities were accommodated, avoiding the pitfalls of a “one-size-fits-all” approach to understanding issues and their solutions within aboriginal communities.

Generating feelings of control

The project is an exemplar of the way that PAR research can privilege the views of communities and enable Indigenous people to recognize that they are best placed to identify factors impacting on their social and emotional well-being and the necessary actions to benefit their communities. The research process empowered individuals by enhancing their ability to exert greater control over their lives—an important outcome in and of itself. The way the project enacted PAR processes, appointing community coresearchers to work with their own community to identify and address local priority issues, also facilitated the acquisition of better data than may otherwise have been obtained, thus potentially leading to better outcomes.

The primary focus is that a program has been developed from information given by community members. It is being delivered by and for Aboriginal community members. (CC 5)

Though there are other great programs which provide a range of services for our mob nationally—I feel (through working on NEP) that the NEP program has a greater success factor because it is community developed owned and delivered and it empower our people to be leaders in their own communities/this being one of the major ingredients to successful outcomes. (CC 7)

The project team’s application of PAR as culturally responsive was predicated on the belief that self-determination and empowerment are effective strategies for improving the ability of individuals to take action and the capacity of communities to influence factors impacting on their lives. Empowerment is recognized both as an outcome in itself and as an intermediate step to being able to deliver improved health and well-being outcomes (Wallerstein & Duran, 2006). Ensuring the community drives the process is a significant factor in achieving sustainable community outcomes. Key approaches within the project reflect the fact that successful empowering interventions cannot simply be transferred or “standardized” across diverse populations but must be created within or adapted to local contexts by community members themselves (Lord & Hutchison, 2009).

Facilitating engagement

The project generated a high level of community participation across the diverse sites and assisted in embedding ownership and action for change within the communities. The local partner organizations involved at each of the project sites were welcoming of the project and its processes. As one CEO remarked:

When I talked with (project team member) about the national empowerment project I thought that sounds exactly what we need, we want to go through a rigorous research process to provide evidence at our local level. We are involved in two other national projects and this one in particular is great because while it has a national impact it is responsive to the community at a local level. (Walker & Scrine, 2014)

Engaging in PAR processes has included developing community capacity to participate as coresearchers in developing, implementing, disseminating, and translating the research to enact changes at local community, state, and national levels. This empowered the community coresearchers and provided them with important tools with which to facilitate a sense of generating action and momentum in their communities. Ultimately, the project confirms that through an Aboriginal-led PAR process, individuals, families, and communities can become empowered to identify their own sources of strength and resilience as well as what people need to support and enhance their strengths and address risk factors.

The application of PAR in this project has created a space where genuine community and stakeholder engagement could occur. This is reflected in the respectful partnerships between the project team with local communities and organizations at each project site and the selection and capacity building of local community coresearchers. A key outcome is the effective engagement process and shared research journey between community coresearchers, socially disadvantaged and vulnerable communities, and the project team.

Privileging aboriginal knowledges and experience

Production of the site reports demonstrated genuine commitment to articulating and honouring aboriginal people’s experiences through the creation of a tangible product for use by the community that privileged Aboriginal experience and knowledges. Development of the site reports and their dissemination back to community has played a critical role in validating the views and insights provided by the community participants. This represented the voices of community constituting the research outcomes and, as such, being taken seriously. The site reports also provide direct access to the lived experiences and perspectives of Aboriginal people and represent a significant body of knowledge about aboriginal people’s health and social and emotional well-being and the constraints many encounter. Importantly, they also present a positive, strengths-based discourse on Indigenous social and emotional well-being. As one participant noted on what was required to help their community:

We need to come together to work with each other in the community to create programs, etc. to keep our community alive and we need to act as ONE. (Duffin et al., 2013)

In a broad sense then, the research outcomes outlined a practical and flexible approach for responding to the cultural stresses and the social determinants that challenge many Aboriginal communities. The site reports make an important contribution to the evidence based regarding both the research approach to empower and support communities and the content of community-based programs aimed at improving Indigenous mental health and well-being. They are an important and practical tool for use by communities, government agencies, researchers, and service providers.

The evaluation report notes that one of the project’s strengths is:

incorporating Aboriginal knowledges and concepts regarding mental health, health and wellbeing and acknowledging the pivotal role of family and culture in developing and implementing programs that facilitate community transformation and empowerment. (Walker & Scrine, 2014)

Use of community coresearchers

The project team encountered a number of issues in implementing PAR approaches in the various sites that required ongoing consideration and resources to ensure the community coresearchers achieved their objectives. Recruiting local community members with little or no research experience to carryout intensive PAR processes, ensure the maximum engagement of community participants, and compile the wealth of material for the site reports, inevitably presented some challenges. Along with the initial training provided, the project team were required to ensure the community coresearchers had access to ongoing support and mentoring through regular contact in person, via phone and e-mail and through the dedicated project portal. This required the project team to source adequate resources to be able to meet the needs of the community coresearchers.

There were also many challenges associated with engaging in PAR experienced by the community coresearchers. It proved challenging to complete large consultative and research processes in addition to the requirements of their paid employment as well as other family and community demands. These included the time pressures and workloads involved, everyday real-life difficulties experienced specifically by members of marginalized groups including unstable living arrangements, lack of transport, and financial obligations to large family networks. They also faced pressures associated with meeting high expectations of the research from their communities, and dealing with the painful issues that arose during the consultations that at times echoed their own lived experiences. There were also challenges in trying to balance ongoing participation in the project and other commitments including the demands of paid employment. Some community coresearchers were expected to maintain their ongoing work commitments full time and either incorporate the project work within this or find time outside their work hours. Some identified ways to do this more effectively than others.

A debrief workshop in Perth was held to provide some time away from the pressures of the project as well as seek to address many of the personal and research issues arising for the community coresearchers. This workshop, which included sessions on self-care, saw some community coresearchers identifying that they felt “rushed” to gather participants and complete the consultations and workshop. It was also acknowledged that they became sidetracked and consumed with their normal tasks and jobs and that they needed to better manage their own schedules in order to complete their project commitments.

Community engagement

Appointing local aboriginal facilitators and engaging local partner organizations with strong Aboriginal affiliations as comanagers were key aspects to trust in the research project and community engagement. That said, the community coresearchers faced challenges associated with implementing strategies to maximize community participation. In particular, they had to identify ways to increase the participation of men and young people in the community consultations. The community coresearchers were able to utilize their networks to approach people and encourage their participation. For some participants, an interview or family-based focus group was offered. Alternative settings, such as the local river, were also utilized, as was the provision of childcare to enable parents to attend.

There were also some mixed views in some project sites as to how people were selected to be included in the consultation process, whether the participants involved are representative of different families, and whether the consultations had been adequately promoted in the town. These issues were addressed as they arose and in some instances community coresearchers were unable to appease everyone and in others were able to address concerns. Community coresearchers were quick to also reassure community about the benefits of participating in the consultations and their commitment to reciprocity in terms of producing the community reports.

Maintaining the enthusiasm and morale of the community coresearchers was a decisive factor in achieving the project’s outcomes and the overwhelmingly positive impact the PAR process had on the community coresearchers as seen in their commitment, personal growth, and learning experiences. One NAC member described the role of the community coresearchers as evidence of the impact that can come from “catalytic leadership,” and the project’s PAR processes as “genuine empowerment from the ground up, putting tools into people’s hands where they can support and change their own community”.

Support of partners organizations

Understandably, many of the community coresearchers indicated the need for a higher level of support, mentoring, and communication to complete tasks and maintain momentum. The local partner organizations involved in the project were required to ensure the community coresearchers were provided with the time, resources, and capacity to properly undertake the research project. The support of the partner organizations was a determining factor in the effectiveness of the community coresearchers and the ongoing progress of the project, especially using the site reports as an advocacy tool. In some sites, support provided by other local Aboriginal organizations in the community also created local partnerships on the ground, which in turn created greater support and acknowledgment of the work by local community members because of this partnership and collaboration.

Some of the community coresearchers expressed concerns that the partner organization did not understand the demands of the PAR processes and the requirements on their time. The community coresearchers requested that the project team ensure the level of support they could reasonably expect from the partner organization be embedded through a memorandum of understanding or service agreements to ensure greater accountability and commitment.

Insufficient support from some partner organizations also resulted in an increased demand for support and mentoring from the project team to ensure the community coresearchers competed their required tasks and responsibilities. Again, this meant the project team needed to identify sufficient resources to provide additional support to those community coresearchers where this was not being provided by the partner organizations.