Community-based participatory research and the challenges of qualitative analysis enacted by lay, nurse, and academic researchers.

There are multiple challenges in adhering to the principles of community-based participatory research (CBPR), especially when there is a wide range of academic preparation within the research team. This is particularly evident in the analysis phase of qualitative research. We describe the process of conducting qualitative analysis of data on community perceptions of public maternity care in the Dominican Republic, in a cross-cultural, CBPR study. Analysis advanced through a process of experiential and conversational learning. Community involvement in analysis provided lay researchers an imperative for improvements in maternity care, nurses a new perspective about humanized care, and academic researchers a deeper understanding of how to create the conditions to enable conversational learning.

Team process in community-based participatory research on maternity care in the Dominican Republic.

A cross-cultural team consisting of US trained academic midwife researchers, Dominican nurses, and Dominican community leaders have partnered in this international nursing and midwifery community-based participatory research (CBPR) project in the Dominican Republic to understand the community experience with publicly funded maternity services. The purpose of the study was to understand community perceptions of maternity services. This article highlights the activities that the research team carried out during each phase of the research process, and how they established team identity, team trust, and team efficacy. This research has created a platform for new avenues for health providers and community to partner to improve maternal-newborn care. Community-based participatory research is one way forward to address the past and present inequities constitutive of global health disparities.

A community-based participatory research approach to explore community perceptions of the quality of maternal-newborn health services in the Dominican Republic.

OBJECTIVE: to understand both men's and women's beliefs and attitudes regarding public maternity and newborn services, care and quality. DESIGN: qualitative, cross-sectional, retrospective study with an observation arm, using community-based participatory research as both the mechanism of enquiry and catalyst for change. SETTING: four urban neighbourhoods in the Dominican Republic, selected in collaboration with the Provincial Medical Public Health Director and the partnering local public hospital. PARTICIPANTS: adolescent women (15-20 years of age), adult women (21-49 years of age) and adult men (>19 years of age) from the four neighbourhoods were recruited to participate in focus sessions, personal interviews and/or antenatal observations. A total number of 137 participants were recruited: 27 males, 51 adolescent females and 59 adult females. The attrition rate was 17% (n=23). Dominican and US midwives and nurses, as well as community leaders, comprised the research team. MEASUREMENTS AND FINDINGS: following informed consent, self-reported demographics and obstetric history were collected. Twelve focus groups and 12 individual interviews were recorded and transcribed, then qualitatively analysed for content and interpretation of salient themes. Antenatal observations were performed by community leaders to identify patterns of antenatal health-care delivery and utilisation. The main over-riding theme uncovered by the research was 'no me hace caso', or that women and men accessing the maternal health system did not feel valued. The significant amount of time required to receive care was interpreted by the participants as a lack of respect. Finally, the idea of 'cuña' emerged, in which participants noted special treatment for those with social connections to health-care providers. Presentation to the hospital was challenging but resulted in hospital volunteers joining the community volunteer group to collaborate on improving services. KEY CONCLUSIONS AND IMPLICATIONS: this study, conducted in the Dominican Republic, illustrates international collaboration between university researchers, maternity service providers and community members. Community-based participatory research may be an effective mechanism to unite community members and health providers in the common mission to improve maternal-newborn health services.