UC Berkeley

The Role of Women and Youth in Policy-Focused Community-Based Participatory Research: A Multi-Case Study Analysis

By

Analilia Patino Garcia

Doctor of Public Health

University of California, Berkeley

Professor Meredith Minkler, Chair

Communities that are marginalized by unequal distribution of resources and power are at an increased risk of suffering an undue burden of illness and premature death. Staggering health disparities persist throughout the United States, a collective result of a lack of affordable, accessible and culturally relevant health care services, missed opportunities for preventive services, and public health interventions grounded in approaches that focus too narrowly on individual behavior change. Such approaches cease to capture the complexities of local social, economic and political environments, which contribute to the myriad of inequalities that unjustly perpetuate disenfranchised communities. The active engagement of low-income individuals and communities of color who are disproportionately affected by health inequities can serve as a powerful tool to advocate for policies that can contribute to reversing health disparities. Increasingly, Community-Based Participatory Research (CBPR), as an orientation to research, has garnered attention and respect from academics and community-based organizations alike, as an approach that equitably engages community residents as part of the research process-- making it accessible and relevant--with a focus on action-oriented solutions to community identified problems of greatest importance.

This dissertation aims to illustrate the role of promotoras (lay health workers) and youth involvement in research and their subsequent contributions to policy change outcomes. Through a retrospective case study analysis of three CBPR partnerships in California, I describe their individual and collective contributions to the research process, and in leveraging research results to advocate for and bring about policy change. The first case is a partnership in Los Angeles' Skid Row with youth living in Single Occupancy Rooms (SROs), who were galvanized to action by violence in their community, discrimination they face at school, and their lack of access to the only park in their neighborhood. Their actions led to national media attention, which resulted in school district policy changes, and increased, albeit still limited, access to their local park. The second case involved youth in a Bakersfield community that worked collaboratively with adults from various city agencies and community organizations to achieve environmental changes that led to the creation of safe open spaces for families. The final case focused on a partnership in Old Town National City involving a group of women who were transformed into powerful advocates in the pursuit of environmental justice. Through culturally and linguistically appropriate trainings, the promotoras (lay health workers) who were also residents of National City, made significant contribution to the research process, that in turn contributed to subsequent policy wins.

The various participatory methods employed by each of the three partnerships explored facilitated participation and empowered participants to have an active voice through numerous community engagement activities. CBPR is well positioned to effectively mobilize residents, including, in the case for this dissertation, women and youth, and to build capacity within communities that will outlast any funded intervention.

Collectively, the three CBPR case studies offer exciting, innovative possibilities in the engagement of promotoras and youth as equitable partners in the research process. At the same time, the cases offer lessons learned and important implications for research, practice and policy. The voices of the women and youth involved in the partnerships are captured throughout the dissertation, a unique gift to this dissertation, on the insider perspectives they bring as they share their experiences, leadership development, and individual level outcomes as a result of their participation.