Community-based Methodology Research Articles

Teen Perspectives on Suicides and Deaths in an Affluent Community: Perfectionism, Protection, and Exclusion.

Clusters of youth suicide and death are tragic for communities and present long-term consequences for the surviving youths. Despite an awareness of community-based patterns in youth suicide, our understanding of the social and community factors behind these events remains poor. While links between poverty and suicide have been well documented, wealthy communities are rarely targeted in suicide research. In response to this gap, we conducted ethnographic research in a wealthy U.S. town that, over a recent 10-year period, witnessed at least four youth suicides and seven more youth accidental deaths. Our interviews (n = 30) explored community values and stressors, interpersonal relationships, and high school experiences on participant perceptions of community deaths. Youth participants characterize their affluent community as having (1) perfectionist standards; (2) permissive and sometimes absent parents; (3) socially competitive and superficial relationships; and (4) a "bubble" that is protective but also exclusionary. Our qualitative findings reveal network influence in teen suicides and accidental deaths in a wealthy community. Greater attention paid to the negative effects of subcultural values and stressors in affluent communities is warranted. Further, our work promotes the value of ethnographic, community-based methodologies for suicidology and treatment.

Social Innovation in Sustainable Tourism Projects: A Community-Based Methodology

Social Innovation in Sustainable Tourism Projects: A Community-Based Methodology

Psychedelic Research and Therapeutic Practices: Embracing Communities, Groups, and Traditional Knowledge

ABSTRACTThe global prevalence of substance abuse and mental disorders continues to challenge healthcare systems, with one in eight individuals affected. The therapeutic potential of psychedelics is recognized not only for treating mental disorders but also for enhancing well-being and promoting pro-social behaviors. Conventional biomedical research models fall short in addressing the broader health needs of populations and poorly suited for overcoming barriers to service delivery. This special issue includes six articles that explore alternative approaches to psychedelic research and practice, emphasizing collaboration with diverse actors, including indigenous communities, and incorporating traditional knowledge systems into contemporary psychedelic research. They underscore the need for innovative research methods that engage multidisciplinary approaches while promoting culturally relevant outcome measures. They emphasize the importance of shifting from punitive drug policies to those grounded in public health and human rights, allowing for multi-country studies and the development of evidence-based care models for community mental health. Incorporating traditional knowledge and community-based methodologies into psychedelic science is vital for its evolution beyond biomedical research for widespread dissemination, offering new avenues for improved health outcomes and promotion of human flourishing.

Beautiful vulvas: expanding illustrative visual imagery of female genital cutting types.

Visual imagery has been used to educate healthcare providers, patients, and the lay public on female genital cutting (FGC) typology and reconstructive procedures. However, culturally inclusive, diverse, and anatomically accurate representation of vulvas informed by women possessing lived experience of FGC is lacking. We sought to apply World Health Organization (WHO) FGC typology to the development of type-specific visual imagery designed by a graphic artist and culturally informed by women with lived experience of FGC alongside a panel of health experts in FGC-related care. Over a 3-year process, a visual artist created watercolor renderings of vulvas with and without FGC across varying WHO types and subtypes using an iterative community-based approach. Somali women possessing lived experience of FGC were engaged alongside a team of clinician experts in FGC-related care. Women and clinicians provided descriptive input on skin color variation, texture, and skin tone, as well as the visual depiction of actions necessary in conducting a genital examination. A series of vulvar anatomic illustrations depicting WHO FGC typology. FGC types and subtypes are illustrated alongside culturally informed descriptors and clinical pearls to strengthen provider competency in the identification and documentation of FGC WHO typology, as well as facilitate patient education, counseling, shared decision making, and care. Ensuring equitable representation of race, gender, age, body type, and ability in medical illustrations may enhance patient education, counseling, and shared decision making in medical and/or surgical care. FGC provides a lens through which the incorporation of patient-informed and culturally relevant imagery and descriptors may enhance provider competency in the care of FGC-affected women and adolescents. The strengths of this study include the development of visual imagery through an iterative community-based process that engaged women with lived experience of FGC alongside clinicians with expertise in FGC-related care, as well as the representation of historically underrepresented bodies in the anatomical literature. Study limitations include the lack of generalizability to all possible forms or practices of FGC given the focus on one geographically distinct migrant community, as well as the reliance on self-report given the inability to clinically verify FGC status due to the community-based methodology employed. Patient-informed and culturally representative visual imagery of vulvas is essential to the provision of patient-centered sexual health care and education. Illustrations developed through this community-engaged work may inform future development of visual educational content that advances equity in diverse representation of medical illustrations.

Female genital cutting (FGC) type: proposing a multifaceted, interactive method for FGC self-assessment.

Self-reporting female genital cutting (FGC) status and types by patients and clinicians is often inconsistent and inaccurate, particularly in community settings where clinically verifiable genital exams are not feasible or culturally appropriate. In this study we sought to discern whether integrating multiple dimensions of participant engagement through self-reflection, visual imagery, and iterative discourse informed the determination of FGC status by a panel of health and cultural experts using World Health Organization (WHO) typology. Using community-based participatory research, we recruited 50 Somali women from the Minneapolis-St. Paul, MN, metropolitan area through convenience and snowball sampling to participate in semi-structured interviews. Participants were asked to discuss their recollection of their original circumcision-including the procedure itself and their assessment of the type of circumcision they experienced. Anatomical drawings of uncircumcised and circumcised vulvas were shown to participants to assist them in identifying their FGC type. A panel of health and cultural experts reviewed and independently assessed participant FGC type. Interrater reliability and degree of concordance between participants and panel were determined. Outcomes included the following: (1) development of WHO-informed, anatomically accurate visual depictions of vulvas representing FGC typology, (2) development of an iterative, self-reflective process by which participants self-described their own FGC status aided by visual depictions of vulvas, (3) application of WHO FGC typology by a panel of health and cultural experts, and (4) determination of the degree of concordance between participants and panel in the classification of FGC type. High interrater reliability (kappa = 0.64) and concordance (80%) between panel and participants were achieved. Incorporation of FGC visual imagery combined with women's empowered use of their own self-described FGC status would optimize clinical care, patient education, and informed decision making between patients and their providers when considering medical and/or surgical interventions, particularly among women possessing limited health and anatomic literacy. Strengths of this study include the incorporation of anatomically accurate visual representations of FGC types; the iterative, educational process by which participants qualitatively self-described their FGC status; and the high interrater reliability and concordance achieved between panel and participants. Study limitations include the inability to conduct clinical genital exams (due to the community-based methodology used), recall bias, and small sample size (n = 50). We propose a new patient-informed educational method for integrating anatomically accurate visual imagery and iterative self-reflective discourse to investigate sensitive topics and guide clinicians in providing patient-centered, culturally informed care for patients with FGC.

Geographies of Hope-in-Praxis: Collaboratively decolonizing relations and regenerating relational spaces

As burgeoning new forms of authoritarianism and fascism expand their reach, Geographies of Hope-in-Praxis stem from the locus of the present moment. Constellations of peoples re-rooted into place refuse Western ideals of democracy and development and engage with one another in new arrangements based on ancestral ways of knowing. In this Environment and Planning E: Nature and Space issue on Geographies of Hope-in-Praxis (GgsHope-in-Praxis), we step into ongoing conversations about hope, push back on business as usual, and amplify understandings of initiatives to (re)assemble different kinds of wor(l)ds. Our collection “geographizes” hope by digging into hope’s praxes—theories with action. Resurgent versions of hope can be better understood within the contexts of six dimensions—place, alliance, the unthinkable, perseverance, resilience, and the (im)possible—that provide diverse lenses for delving deeper into hope's complex topographies. Together, the articles reach across regional differences and bridge on-the-ground approaches. We activate hope through long-term, reciprocal, and accountable community-based methodologies in Brazil, Ecuador, the Philippines, and Southeast Alaska, California, and Kentucky in the USA. GgsHope-in-Praxis come to life in the process of collaboratively decolonizing relations and regenerating relational spaces. Vines of hope creep into crevices to interrupt and transform oppressive systems, intertwine to (re)weave localized communities together in living networks, and expand realities to increasingly join in solidarity with one another and amplify diverse pathways towards environmental-with-racial justices.

What happens after climate change adaptation projects end: A community-based approach to ex-post assessment of adaptation projects

Over the last decade, hundreds of climate change adaptation projects have been funded and implemented. Despite the importance of these first-generation adaptation projects for establishing funders and implementors’ “best practices,” very little is known about how early adaptation projects have endured, to what ends, and for whom. In this article, I propose a community-based methodology for ex-post assessment of climate change adaptation projects. This methodology contributes to recognitional justice by asking the individuals and collectives tasked with sustaining adaptation initiatives to define adaptation success and what criteria for success should be assessed. I apply this subjective assessment approach in 10 communities across Ecuador that participated in an internationally funded adaptation project that concluded in 2015. My analysis draws together participatory mapping, walking interviews with local leaders, participant observation, and surveys with former project participants. The results highlight that even adaptation projects that were deemed highly successful at their closure have uncertain futures. I find that the sustainability mechanisms that were envisioned by project implementors have not functioned, and communities are shouldering the burden of reviving failing adaptation interventions. These findings highlight that the current model of episodic funding for climate change adaptation projects and evaluation processes needs to be revisited to acknowledge the long-term challenges faced by communities. This analysis also calls attention to the importance of ex-post assessment for adaptation projects and the potential of subjective assessment approaches for building more ontological and epistemological pluralism in understandings of successful climate change adaptation.

Racial differences in transfusion practices: Time to address structural racism

See article on page 1519–1526, in this issue

Energy Islands: Metaphors of Power, Extractivism, and Justice in Puerto Rico

Energy Islands: Metaphors of Power, Extractivism, and Justice in Puerto Rico

지역사회 기반 미술치료의 확장을 위한 공동체 기반 공공미술과의 접점 모색과 치유적 함의

The purpose of this study is to explore intersections between art therapy and public art and to reveal therapeutic implications in order to expand community-based art therapy to establish psychoemotional safety network for the community. This study attempted to analyze and examine the cases of community-based art therapy and community-based public art with similar categorical characteristics, focusing on overseas cases. As a result of the study, the similarities and differences between the two fields were revealed in goals, awareness of social issues, use of communities, roles of art, and therapeutic properties. Based on this, this study proposed a point that can be introduced in community-based art therapy by referring to the precedent of public art, and expect collaboration in the two fields based on the safety of art therapy and the dynamics of public art. It is hoped that this study will be used as basic data for the establishment of the concept of community-based art therapy and specific methodology that is insufficient in Korea.

“Postulating Penis: What Influences the Interest of Transmasculine Patients in Gender Affirming Penile Reconstruction Techniques?”

The limitations of metoidioplasty and phalloplasty have been reported as deterrents for transgender and other gender expansive individuals (T/GE) desiring gender affirming surgery, and thus penile transplantation, epithesis, and composite tissue engineering (CTE) are being explored as alternative interventions. We aim to understand the acceptability of novel techniques and factors that may influence patient preferences in surgery to best treat this diverse population. Descriptions of metoidioplasty, phalloplasty, epithesis, CTE, and penile transplant were delivered via online survey from January 2020 to May 2020. Respondents provided ordinal ranking of interest in each intervention from 1 to 5, with 1 representing greatest personal interest. Demographics found to be significant on univariable analysis underwent multivariable ordinal logistic regression to determine independent predictors of interest. Sexual orientation, gender, and age were independent predictors of interest in interventions. There were 965 qualifying respondents. Gay respondents were less likely to be interested in epithesis (OR: 2.282; P = .001) compared to other sexual orientations. Straight individuals were the least likely to be interested in metoidioplasty (OR 3.251; P = .001), and most interested in penile transplantation (OR 0.382; P = .005) and phalloplasty (OR 0.288, P < .001) as potential interventions. Gay and queer respondents showed a significant interest in phalloplasty (Gay: OR 0.472; P = .004; Queer: OR 0.594; P = .017). Those who identify as men were more interested in phalloplasty (OR 0.552; P < .001) than those with differing gender identities. Older age was the only variable associated with a decreased interest in phalloplasty (OR 1.033; P = .001). No demographic analyzed was an independent predictor of interest in CTE. A thorough understanding of patient gender identity, sexual orientation, and sexual behavior should be obtained during consultation for gender affirming penile reconstruction, as these factors influence patient preferences for surgical interventions. This study used an anonymous online survey that was distributed through community channels and allowed for the collection of a high quantity of responses throughout the T/GE population that would otherwise be impossible through single-center or in-person means. The community-based methodology minimized barriers to honesty, such as courtesy bias. The survey was only available in English and respondents skewed young and White. Despite previously reported concerns about the limitations of metoidioplasty, participants ranked it highly, along with CTE, in terms of personal interest, with sexual orientation, gender, and age independently influencing patient preferences, emphasizing their relevance in patient-surgeon consultations.

Participatory Process for Regenerating Rural Areas through Heritage-Led Plans: The RURITAGE Community-Based Methodology

Rural areas in Europe host more than 55% of the overall population and embed a unique and peculiar cultural and natural heritage. Nevertheless, they are facing common issues of disengagement, depopulation and economic and social crises. Rural communities are increasingly interested in setting up inclusive and participatory regeneration processes, but participatory planning experiences in rural areas are still limited. This paper introduces the Community-based Heritage Management and Planning methodology (CHMP) developed within the RURITAGE project, and analyzes and presents the results of its implementation in six demonstrators around Europe and beyond. The methodology is based on the establishment of Rural Heritage Hubs (RHH), intended as the community of local stakeholders and a physical place to run the co-creation activities. We used four types of feedback—online survey, in-presence survey, consultations and interviews with RHH Coordinators—to analyze the implementation of the CHMP. The research findings show that through built capital (RHH places activated) and through the activation of local social and human capitals (RHH communities engaged in the process), participatory processes can attract local communities and engage them into the development and the implementation of local regeneration plans, fostering heritage ownership and inclusion.

Community and Information Science Converging: Co-Development of Digital Storytelling in the Inuvialuit Digital Library

The Inuvialuit Voices Project is a collaboration between the Inuvialuit Cultural Centre, the Inuvialuit Regional Corporation, and communities within the Inuvialuit Settlement Region to enhance the Inuvialuit Digital Library (https://inuvialuitdigitallibrary.ca/) with real-time digital storytelling functionality. In this presentation, the authors will describe the community-based methodology being used to co-develop the system, report on a recent elder storytelling gathering that was held to better understand storytelling in-context to inform the design and functionality of the system, and discuss next steps in the development process.

PhotoVoice: An Ideal Methodology for Use within Recovery-Oriented Mental Health Research

At the heart of recovery-orientated mental health care and the Patient and Public Involvement (PPI) movement, is the inclusion of experts by experience as collaborators on mental health research projects. However, embedding Public and Patient Involvement (PPI) can be challenging in academic institutions that have long-standing researcher-as-expert structures in place. PhotoVoice is a collaborative, participant-centric community-based methodology that has potential to overcome some of the challenges encountered within Public and Patient Involvement (PPI). This discursive paper describes what PhotoVoice is, why it was developed, it’s application in research and its alignment to recovery principles. Thereby arguing that PhotoVoice is an ideal methodology for use within recovery-orientated research.

Mixed-blood: Indigenous-Black identity in colonial Canada

In thinking through Indigenous-Blackness in colonial Canada, we explored the ramifications of the intersections of mixed-blood Indigenous-Black identity with colonialism, racism, gender, and social determinants of health, and how the outcomes of such intersections manifest as erasure, racism, and fractured identity. This critical research is nested within the larger Proclaiming Our Roots project, which uses an arts-based community-based methodology to respect and represent local and global Indigenous ontologies and epistemologies, and utilizes digital oral storytelling, community mapping, and semi-structured interviews as research methods. Community members gathered in workshops held in Toronto and Halifax/Dartmouth, Canada, as these are sites where Indigenous and Black communities came together in the face of white colonial oppression. Community members and researchers told their stories and reshaped their geographies as acts of resistance. This work brings to the forefront Indigenous-Black identity, and how Indigenous-Black people manoeuvre within Western settler society.

‘Hard to reach’ parents but not hard to research: a critical reflection of gatekeeper positionality using a community-based methodology

ABSTRACT Conducting research with under-represented, overlooked and service resistant groups poses challenges but can lead to valuable discoveries that inform the development of policy or practice. In this paper, a reflective account of a community-based methodology will be provided which targeted families in poverty who did not engage with the school system. The research discussed provides a phenomenological understanding of how these parents perceived their role in their child’s education, and what challenges they felt they faced, both at home and in school. This community-based methodology proved effective in recruiting and obtaining data from five focus groups (n = 27) and a series of in-depth interviews (n = 50). The perceived positionality of the gatekeeper is discussed, explained using Tajfel and Turner’s social identity theory [(1979). An Integrative Theory of Intergroup Conflict.’ In The Social Psychology of Intergroup Relations, edited by W. G. Austin, and S. Worchel, 33–37. Monterey, CA: Brooks/Cole], with particular focus on in-group/out-group identity perceptions. The efficacy of the strategies used are discussed and recommendations for a community-based methodology for educational research is provided.

Targeting vulnerable households in rural Mali: Effectiveness of a community-based methodology, with or without addition of a proxy-mean test, 2016

Introduction In 2016, in four municipalities of the Gao district in rural Mali, two similar nutrition-sensitive programmes were conducted simultaneously. Both programmes aimed to target vulnerable households (HH) but used two different methodologies: –a community-based method: the household economy approach (HEA); –a community-based method combined with a proxy-mean test (PMT). This offered a unique opportunity to compare the effectiveness of both methods. Methods A cross-sectional survey was conducted among randomly selected HH from the four municipalities: 545 HH targeted by the first method (group 1), 513 HH targeted by the second method (group 2), 526 HH that were not targeted by any of the two methods (group 3). Socioeconomic and demographic characteristics, expenditure, dietary diversity and food security data were collected through a standardized questionnaire. Characteristics of HH from groups 1 and 2 were compared using linear models. Performances of both targeting methods were assessed against a gold-standard measure of vulnerability, namely the household's monthly food expenditures (HMFE) per adult-equivalents living in the HH. Cut-off points for HMFE targeting were set at the level corresponding to the actual targeting rate observed in each municipality. The targeting effectiveness was assessed using the leakage rate and undercoverage rates. Sensitivity (Se) and specificity (Sp) were computed as well as the targeting differential [Se - (1-Sp)]. Results HH from groups 1 and 2 had the same mean size (7.0 and 7.2 - P = 0.32); same youth ratio (1.0 and 1.0 - P = 0.64) and same dependency ratio (1.6 and 1.5 - P = 0.47). They were mainly headed by a male (75.1% and 72.3% - P = 0.33). In both groups 27% of the heads of HH were literate (P = 0.87). Groups 1 and 2 had approximately the same HMFE (2810 CFA francs and 2316 CFA francs, per adult-equivalent - P = 0.22) and the same dietary diversity score (2.9 and 3.0 food groups, out of 12 - P = 0.37). However, group 1 had a lower proportion of food secure HH (6.4% vs. 7.5% - P = 0.02) according to the Food Insecurity Experience Scale. Forty-one percents of HH were miss-targeted by the first method and 43% by the second one. The leakage rates were 60% and 64% and the undercoverage rates 31% and 33% for methods one and two, respectively. Sensitivities were respectively 40% and 34% and specificities 69% and 68%, leading to targeting differentials equal to 8% and 3%. Conclusions Community-based method and community-based method combined with a PMT exhibited similar targeting performances, the former being slightly better.

An Innovative Methodological Approach to Building Successful Community Partnerships for Improving Insurance Coverage, Health, and Health Care in High-Risk Communities.

More than 48% of U.S. children are racial/ethnic minorities, 21% are poor, and 6% are uninsured. It is unclear, however, what methods are most effective for identifying and engaging community partners in study enrollment of these children in high-risk communities. Evaluate a new methodological approach to the screening, identification, and intervention study enrollment of uninsured minority children. We developed, implemented, and evaluated a methodological approach consisting of four components: (1) identify communities with the highest proportions of low-income minority families with uninsured children, (2) hire minority research staff responsible for community engagement and data collection, (3) implement and evaluate a parent mentor (PM) intervention built on community partnerships and which creates jobs, and (4) successfully execute the research by engaging appropriate community partners. PMs were successfully recruited (n = 15) and trained (test scores significantly improved). Large numbers (n = 97) of appropriate, diverse community partners were engaged.The most productive community partners for recruitment were schools and childcare establishments, community-based organizations, discount and niche stores, supermarkets, and churches. Community partnerships resulted in 49,631 candidate participants screened and 329 enrolled in the study. The intervention was highly successful, with PMs significantly more effective and faster than traditional outreach/enrollment in insuring uninsured minority children, sustaining coverage, improving care access, reducing out-of-pocket costs, and achieving parental satisfaction and care quality, while saving $6,045 per child insured per year. This innovative, community-based methodology is highly effective, and could prove useful for community-based interventions targeting a variety of childhood and adult health, health-care, and equity issues.

Pursuing Authenticity From Process to Outcome in a Community-Based Participatory Research Study of Intimate Partner Violence and HIV Vulnerability in North Karnataka, India.

Community-based participatory research has been seen to hold great promise by researchers aiming to bridge research and action in global health programs and practice. However, there is still much debate around whether achieving authenticity in terms of in-depth collaboration between community and academic partners is possible while pursuing academic expectations for quality. This article describes the community-based methodology for a qualitative study to explore intimate partner violence and HIV/AIDS among women in sex work, or female sex workers, and their male partners in Karnataka, South India. Developed through collaborative processes, the study methodology followed an interpretive approach to qualitative inquiry, with three key components including long-term partnerships, knowledge exchange, and orientation toward action. We then discuss lessons learned on how to pursue authenticity in terms of truly collaborative processes with inherent value that also contribute to, rather than hinder, the instrumental goal of enhancing the quality and relevance of the research outcomes.

A safe place to reflect on the meaning of recovery: a recovery community co-productive approach using multimedia interviewing technology

Purpose– The purpose of this paper is to develop further the understanding of co-productive methodological practice for substance use research by demonstrating the use of a mobile, multimedia interviewing aid by members of a UK recovery community.Design/methodology/approach– A co-productive approach to data collection was piloted using a bespoke, audio-visual booth located in a range of recovery and community-focused social events. Audio-visual data were collaboratively selected, curated and analysed by recovery community partners and researchers.Findings– Findings illustrate how a mobile audio-visual booth can be used successfully within co-productive research. This approach facilitated a better understanding of the experiences and practices of self-reflection within the recovery community as they worked together to create a meaningful recovery largely independent of conventional recovery services.Research limitations/implications– This research was performed with one cohort of co-production members. However, the co-productive nature of the enquiry and the rich data this provided invites the making of cautious but firmer claims with regard to the transferability of this approach to similar recovery contexts.Social implications– Co-productive approaches confer a meaningful impact upon members of the recovery community, and wider understanding of this approach will promote an impact upon others engaging in recovery, supporting growth of a practice-based and theoretically underpinned evidence base.Originality/value– This study highlights use of digital technologies within co-productive community-based methodologies, reducing reliance upon academic expertise, and facilitating participant leadership in research. The analysis also signposts new areas for scholarly discussion in the area of co-productive, community-driven research.