UCSF

Background. Community -based participatory research (CBPR) is an egalitarian approach to research that is gaining popularity due to its success in achieving long-term sustainable improvements in community health, yet little CBPR is currently underway in Malawi, Central Africa. Malawians suffer from poverty, food insecurity, HIV and AIDS and have a reported life expectancy of 48 years of age. Although non-governmental organizations (NGOs) have pivotal roles in their work with donors and local communities in addressing these issues, little CBPR literature reflects NGO perspectives.

Theoretical framework. Ecosocial theory underpins the study with its dual emphasis on social justice and scientific methods. Health disparities are examined in light of social, environmental and economic constructs as well as from a biological basis.

Purpose. The purpose of this research was to explore perspectives of NGO staff in order to understand barriers and facilitators in their work with communities. The study addressed three primary questions: 1) How do NGOs build trust and relationships with community members and agencies?; 2) What are the perspectives of NGO staff regarding their interactions or experiences with donors?; 3) How do Malawi women effect change in their communities?

Methods. Using a qualitative, public ethnographic method, 26 semi-structured interviews were conducted in the US and Malawi of staff, volunteers, board members and partners of NGOs and community-based organizations (CBOs). Interviews were audio-taped, transcribed and the data input into Atlas.ti, and analyzed.

Findings. Three themes emerged: 1) how NGOs gain community trust; 2) donor power; and 3) how socially disempowered Malawi women effect change in their communities. Study participants consistently advised a bottom-up approach when working with communities and stated that donors and NGOs need to respect cultural norms, listen to community members' priorities, engage communities in activities or research and recognize that communities possess important knowledge. Participants cautioned that while it is easy to slip back into top-down roles, the time and patience required to work from a bottom-up approach does produce long-term sustainable results. Although most participants were unfamiliar with CBPR, their recommendations concur with CBPR principles.

Conclusion Community -based participatory research is an appropriate approach to working with Malawian communities.