Using Constructivist Grounded Theory to Generate Participatory Research Empowerment Guideposts (PREGs) for African American Communities to Address Racial Health Disparities

Background/Purpose: Structural racism is the root cause of health and well-being disparities for African Americans including disproportionately higher rates of morbidity and mortality, of deprivation and disorder for Black communities, and of system-involved individuals. Additionally racism in research has an extensive history of unethical and exploitative practices with African Americans resulting in generational distrust. In response empowerment-based participatory research is being used to collaborate with communities in health equity efforts. Yet given its context specific nature, there is lack of consensus in the field on empowerment’s operationalization and measurement. Additionally current empowerment frameworks lack experiential and cultural reflectiveness because they are not derived from the experiences of the Black communities they seek to empower. To address these deficiencies this study explored the empowerment experiences of African American participants taking part in Community Cafes used to address racial disparities in risk for child abuse and neglect toward informing a set of Participatory Research Empowerment Guideposts (PREGs).

Methods: Using a Critical Race Theory orientation and constructivist grounded theory (CGT) methods, in-depth interviews were conducted with sixteen (n=16) purposively and theoretically sampled adult Community Café participants. Grounded theory is a systematic qualitative research approach used to depict social processes and imply theoretical formulations ‘grounded’ in data. Given its epistemological underpinnings, CGT was particularly suitable for this study because it assumes social reality as multiple and co-constructed, attends to issues of power by locating the societal positionalities of participants, and centers their self-defined meaning and actions. As outlined by CGT, data collection, analysis, and sampling took place concurrently. Analysis techniques consisted of the constant comparison and initial and focused coding.

Results: Five primary themes and five subthemes of empowerment emerged from the interviews: Sharing and Learning in Power, Safety Seeding Safety-Nurturing Trust including sub-theme Restricting Trust and Safety, Fostering Equity Through Power Sharing including sub-theme Inhibiting Equitable Power-Sharing, and Honoring and Centering the African American Experience with sub-themes Reflecting Racial and Cultural Identity, Prioritizing Discussions about Racism, and Centralizing Healing, and the final theme Strengthening the Impact of the Café. From these empowerment themes six PREGs were derived and provide recommendations for researchers wanting to use participatory research to empower African American communities to address racial health disparities. Each guidepost includes grounding principles which help describe their use in practice: Seeding Safety-Nurturing Trust with principles Consensus, Consistency, Predictability, Transparency, and Choice; Liberating Communication grounded in Mutuality and Vulnerability; Fostering Connections with principles Building Relationship, Networking, and Diversity; Providing Supportive Acts & Resources activated by Increasing Access to Resources and Actualizing Equity; Centering the Black Experience using principles Cultural and Experiential Reflectiveness and Prioritizing Discussions about Racism; and Prioritizing Acts for Collective Healing with Communal Acts of LOVE and Truth and Reconciliation.

Conclusions/Implications: The findings help to bring clarity to the field by providing instructions to uplevel generic participatory research to empowerment-centered engagement for African Americans. Future research should diversify respondent pool to recruit more professional partners, explore integrating discussions of racism and healing into engagement, and “test” the applicability of PREGs in research settings.