Participatory research with Travellers in Brighton

Abstract

BackgroundCommunity engagement is important when addressing health inequalities. In recognition of this strategy, public health departments are commissioning participatory research. However, the involvement of communities as equal partners poses challenges for public health professionals. In this study, we explored these challenges using an example project with Travellers in Brighton. MethodsThe public health team worked with peer researchers to conduct primary qualitative research that focused on access to primary care and specialist health services. A commitment to a participatory approach informed all stages. The establishment of a partnership with the community was fundamental. Working through a third-sector organisation, two peer researchers with research experience and links across the community were identified. Training was provided to the peer researchers who conducted 15 semi-structured interviews with local Travellers. There was strong focus on reflective practice with ongoing evaluation of research tools and iterative data analysis. FindingsThe participatory approach had several advantages: it could access hard-to-reach subgroups (young men); allow exploration of stigmatised issues (mental health, infant mortality); and provide insights into how beliefs shaped health-seeking behaviour. Peer researchers ensured that recommendations were practical and specific. However, there were also challenges and limitations to this approach. Research that is fully owned by the community is not always realistic or practical. The project was initiated by the Council, with the public health team accountable for the results. That peer researchers often lacked confidence and sought direction from the perceived experts, highlights the difficulty in addressing power imbalances in a short timeframe and the need to clarify what level of participation is sought by the community. The peer researchers developed their interviewing technique, and transferred these skills to other roles. However, the rationale for consent, confidentiality, and accountability over expenses required repeated re-emphasis; this could be addressed by earlier involvement of peer researchers in budget planning and ethics approval. InterpretationParticipatory research has potential to empower those involved and to lead to interventions that have an effect on socially excluded populations. However, there are justified concerns about academic rigour with limited guidance on how to overcome practical challenges. With increasing adoption of this approach, opportunities for sharing best practice need to be developed. FundingThe project was funded by Brighton & Hove City Council (Communities and Equalities' team).