Advancing Anti-Oppressive International Research through Community-Based Participatory Randomized Controlled Trials

Background

Randomized controlled trials (RCTs) are considered the gold standard for clinical and social research despite the fact that RCT methodologies can perpetuate oppressive and imperialist practices, especially when researchers conduct studies with marginalized populations or in low-resource settings (e.g., Benatar, 1998; Rink et al., 2020). In these contexts, RCTs can reinforce power differentials between researchers and local communities, perpetuate cultural insensitivity, impose external priorities, and prioritize White/Western ways of knowing over indigenous and traditional knowledge (Rogers, 2012; Sanchez et al., 2023). Community-based participatory research (CBPR), with its core principles of equity, co-learning, shared power in decision making, reciprocity, and mutual benefit (Israel et al., 2017) offers an anti-oppressive approach to research inquiry. Yet, CBPR has been widely regarded as incongruent or in direct conflict with RCTs (Goodkind et al., 2017; Rosenthal et al., 2014). As one step toward addressing the conference theme of strengthening social impact through collaborative research, this presentation examines how CBPR and RCTs can be combined to advance anti-oppressive international research using a study in Zimbabwe as a case example.

Methods

An explicit CBPR approach was utilized to collaboratively design the study in three phases over an 8-month period. First, a series of video meetings were held involving the U.S.-based PI, Zimbabwean community partners, and staff representing the funding organization. These initial meetings explored possible study designs, including weighing the merits and logistics of RCTs, and resulted in a collective decision to incorporate mixed methods. Second, the PI traveled to Zimbabwe to continue study planning meetings within the local context, including meeting with each staff member of the community partner organization, attending a staff training, visiting sites in the local communities, and meeting with citizens connected to schools where the study would take place. Mutual capacity building between the PI and Zimbabwean community partners was a key activity at this stage. In the last stage, the study design was finalized remote collaboration largely based on changes made and insights gathered from the PI’s Zimbabwe visit, and then protocols were submitted to Zimbabwe’s national research council and the PI’s university IRB.

Results

This collaborative process of study co-design with community partners impacted the study in 6 key areas: (1) Identifying research questions guided by community priorities; (2) Randomization protocols and qualitative methods employed; (3) Community-driven selection of measures; (4) Data co-ownership and analysis; (5) Community-focused dissemination plan; and (6) Collaborative budgeting of research funds. Tensions and agreements between researcher and community priorities in each study element will be discussed to illustrate the collective decision making process.

Conclusion and Implications

While integrating CBPR and RCTs can introduce challenges such as increased planning time and potential conflicts between community priorities and Western-dominant conceptualizations of methodological rigor, these challenges are outweighed by the benefits of community-focused collaborative research. Social work is uniquely positioned to lead the academy in advancing rigorous research that centers communities in low-resource contexts who have traditionally been marginalized and exploited (Waller et al., 2022), and the case example presented offers one possible approach for doing so.