Thursday, February 21, 2013

Heart Health Indiana: Trust in a culturally-centered heart health campaign

When we began the partnership between the Indiana Minority Health Coalition, Lake County Minority Health Coalition, Minority Health Coalition of Marion County and Purdue University, we had two broad pictures in mind: (a) our partnership was focused on building health information capacities among African Americans in Lake and Marion Counties of Indiana, so that community members would have access to the health information they needed in addressing their heart health issues; and (b) our partnership began with the understanding that local community values, beliefs, and understandings ought to be centered in how problems and solutions came to be understood, implemented and evaluated. Now, as our culturally-centered heart health campaign wraps up the initial phase, I am struck by some key lessons regarding culturally-centered processes of social change, both in terms of research methodology as well as in terms of the development and evaluation of the campaign.

The first lesson I have learned through this process is one of trust, a concept that has often been highlighted in community-driven projects. Trusting community members translates into transferring the landscape of decision-making into the hands of community members, beginning from problem identification to solution development, to design, to strategy development and implementation, to evaluation. Trust in the voices of the community means that the academic and community partners continually question the ways in which they second guess community decisions, and to reflexively be aware of the impulse to second guess.

Transferring decision-making into the hands of community members is not a simple process of power transfer, but one that works through continual reflections, conversations, adaptations, and a commitment to sharing. Power almost always exists in the relationship between the academic and the community organization, and to create spaces for community members to have a voice calls for continual reflections on the privilege that is embodied in the academic roots of the collaboration (the principal investigator being an academic, the funding coming to academia, larger portions of the project funding being allocated to academic etc,). From these reflections, entry points can be co-constructed for undoing old relational patterns and continually searching for new ones.

Trust also relates to the relationship of the academic and community partners with the CCA. As ideas emerge organically, as consensus at times seems difficult to arrive at, it becomes easy to yearn for the top-down forms of traditional campaigns where experts make the much-needed decisions.Trusting the community to come up with locallly meaningful decisions then also relates to the idea of developing trust in the listening-based framework of the CCA. That listening to community voices offers vital opportunities for identification of problems and development of solutions that are locally meaningful provides the impetus for CCA, as opposed to top-down frameworks that have little patience for community-driven processes, and little respect for community-driven decision-making capacities.

When trust is built in a relationship, it is not understood with the taken-for-granted notion that one can walk into a community and develop trust. Rather, trust is a dynamic negotiation that is constituted in the conversations and partnerships among the academic partners, community organization, and community members. Trust is also not a constant, but rather something thar is worked through as the relationship moves through the various stages of the project/partnership. Whereas some aspects of trust are more easily negotiated, there are other aspects that are more difficult to negotiate.

Trust also means that the partnership is based on open communication, sharing deadlines, information about resources, parameters for design etc. mutually as the partnership progresses. The various partners at the table enable trust when they openly communicate about the key problems, point out the dynamics of power that works out as the problem is being worked, become cognizant of the relationships of power in decision-making, and simultaneously arrive at decisions that are open to fostering community voices in policy platforms, program circles, and in everyday interactions of community members.

In sum then, trust in culturally-centered processes is both a possibility and an impossibility. Trust is both a given, as well as an impossibility. It is this paradox that constitutes the ways in which academics, community organizations, and community members work together. Trust is constituted in relationships of power, and power remains at the center of how we come to negotiate trust even as we seek to de-center the traditional organizing of power in how academics engage with communities.

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