Community-Based Organizational Capacity Building as a Strategy to ...

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J Primary Prevent (2010) 31:31–39 DOI 10.1007/s10935-010-0202-z

ORIGINAL PAPER

Community-Based Organizational Capacity Building as a Strategy to Reduce Racial Health Disparities Derek M. Griffith • Julie Ober Allen • E. Hill DeLoney • Kevin Robinson E. Yvonne Lewis • Bettina Campbell • Susan Morrel-Samuels • Arlene Sparks • Marc A. Zimmerman • Thomas Reischl



Published online: 2 February 2010 Ó Springer Science+Business Media, LLC 2010

Abstract One of the biggest challenges facing racial health disparities research is identifying how and where to implement effective, sustainable interventions. Community-based organizations (CBOs) and community-academic partnerships are frequently utilized as vehicles to conduct community health promotion interventions without attending to the D. M. Griffith (&)  J. O. Allen  S. Morrel-Samuels  M. A. Zimmerman  T. Reischl Department of Health Behavior & Health Education, School of Public Health, University of Michigan, 1415 Washington Heights, 3806 SPH I, Ann Arbor, MI 48109-2029, USA e-mail: [email protected] E. H. DeLoney Flint Odyssey House Health Awareness Center, 1225 Dr. Martin Luther King Jr. Ave., Flint, MI 48503, USA K. Robinson Graduate School of Social Work and Social Research, Bryn Mawr College, 300 Airdale Road, Bryn Mawr, PA 19010-1697, USA E. Y. Lewis Faith Access to Community Economic Development, 310 East Third Street, 5th Floor, Flint, MI 48503, USA B. Campbell YOUR Center, 4002 N. Saginaw St., Flint, MI 48505, USA A. Sparks GCCARD, 601 N. Saginaw Street, Suite 2-C, Flint, MI 48502, USA

viability and sustainability of CBOs or capacity inequities among partners. Utilizing organizational empowerment theory, this paper describes an intervention designed to increase the capacity of CBOs and community-academic partnerships to implement strategies to improve community health. The Capacity Building project illustrates how capacity building interventions can help to identify community health needs, promote community empowerment, and reduce health disparities. Keywords Community-based participatory research  Capacity building  Community-based organizations  Health disparities

In the US, racial inequities in health are substantial despite unprecedented resources and interventions committed to reducing and eliminating racial disparities (Griffith et al. 2006; Williams and BraboyJackson 2005). Addressing racial health disparities is challenging in large part because health behaviors and health outcomes are rooted in distal and pervasive disparities in education, justice, social and political power, and economics (Griffith et al. 2006; Link and Phelan 1995; Williams 2003; Williams 2005). Although it is difficult to address the fundamental determinants of health directly (Link and Phelan 1995; Schulz et al. 2002), it is critical to improve the underlying environmental conditions that unequally expose people to factors that adversely affect their

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health. One way to improve the environmental conditions that affect community health is by enhancing the capacity of community-based organizations (CBOs) to identify community health needs and implement contextually and culturally appropriate health promotion and disease prevention interventions (Freudenberg 2004; Goodman et al. 1998). This paper describes a Capacity Building project designed to promote the empowerment of CBOs to engage in prevention research to address racial health disparities. A CBO is a public or private nonprofit organization that represents a specific population, community, or segment of a community and provides educational, social, health, or other services to individuals in that community (Patsy T. Mink Equal Opportunity in Education Act 1972). CBOs are often central to the viability and life of communities, particularly urban African American communities. CBOs often develop as a response to the failure of government agencies and professional service providers to meet community needs. Programs that originate from CBOs or are developed with community involvement from their inception can be critical assets in addressing health disparities (Griffith and Bediako 2007; Miller and Shinn 2005). CBO-driven programs often are culturally appropriate and ecologically congruent with community capacity and norms (Griffith and Bediako 2007; Miller and Shinn 2005), even if the internal validity and reliability of the programs have not been established. Collaborating with other institutions in partnerships that strive to utilize community-based research approaches is another way CBOs can address health disparities. Despite their various strengths, many CBOs are challenged in their ability to effectively use their local knowledge, expertise, and reputations to improve community health due to their small staffs, narrow skill sets, limited resources, and financial instability. Identifying and building the capacity of key CBOs may be an effective strategy to build community capacity and to eliminate racial health disparities. An essential component of community capacity is the ability to identify community characteristics that affect health and to mobilize people to address health problems. Building community capacity also involves cultivating and employing transferable knowledge, skills, networks, and resources for individual- and communitylevel change that are consistent with identified public health goals and objectives (Goodman et al. 1998). If, however, CBOs do not have the organizational

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resources to persist in their efforts, they will have a difficult time remaining financially solvent, participating in other collaborative community-based research, and having an effect on health disparities. Without adequately attending to both the knowledge and skills of local CBO partners and the viability and sustainability of their organizations, the fundamental resource and power inequities that plague urban communities of color are likely to continue. Organizational empowerment provides a useful theoretical framework for examining and building the skills and resources necessary for increasing the capacity of CBOs to influence community residents’ health status and social determinants of health. Organizational empowerment focuses attention on the structures and practices of organizations at the intraorganizational, interorganizational, and extraorganizational levels (Peterson and Zimmerman 2004). The intraorganizational component represents the internal structure and functions of an organization, which provides the foundation for participants to engage in proactive behaviors necessary for community change. This component includes organizational viability, leadership, and the mutual trust of members. The interorganizational component enables the development and utilization of connections for mobilizing and sharing resources, gaining credibility and standing in the community, and creating opportunities for participants to develop networks and relationships. Included in this component are the linkages and relations between organizations (e.g., collaboration, accessing social networks of other organizations, alliance building). The extraorganizational component refers to actions taken by organizations to influence community life and policy, such as disseminating information, procuring and marshalling resources to benefit the community, establishing new projects and programs, and harnessing collective power to influence public policy and practice (Griffith et al. 2008). This paper describes the efforts of the Prevention Research Center of Michigan (PRC/MI) to address a fundamental challenge facing community-based prevention research interventions to address health disparities: How do we ensure that we have strong, independent, and viable community partners that are able to equally participate in our research to reduce health disparities? We begin by describing the intervention strategy employed in the PRC/MI’s Community Capacity Building to Reduce Health Disparities

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Project. This is a community health intervention research project designed to help CBOs collaborate with other partners to address the health needs of urban African Americans in Flint, Michigan. Next, we describe two case examples—the Speak to Your Health! Community Survey and the YOUR Blessed Health (YBH) intervention—to illustrate the processes and methods used in an intervention guided by organizational empowerment to increase the capacity of CBOs to collaborate on improving community health and addressing racial health disparities. We conclude by discussing ways in which CBOs can provide an important foundation for building community capacity to address complex and persistent community health problems such as racial health disparities.

Community Capacity Building to Address Health Disparities Project The Community Capacity Building to Address Health Disparities Project is a research project of the PRC/ MI that began in 2004. At the time, the PRC/MI was one of 33 centers nationwide funded by the Centers for Disease Control and Prevention to conduct and disseminate prevention research. The PRC/MI builds upon existing long-term partnerships between the University of Michigan School of Public Health, University of Michigan-Flint, CBOs, the local health department, the local health system, the Michigan Department of Community Health, and other statewide health associations to create and foster knowledge for more effective public health programs and policies. The Center conducts community-based prevention research to improve health and prevent disease, especially focused on populations with a disproportionate share of poor health outcomes. The PRC/MI has worked on following community-based research principles since its inception in 1998, but early experiences made collaborating challenging. Our CBO partners’ capacity to meaningfully contribute to the Center and its research projects was limited by power and capacity inequities inside and outside the partnership. Our experiences and discussions during the early years of the PRC/MI’s activities led members of the partnership to conclude that our efforts to improve community health and diminish racial health disparities would be enhanced by lessening the inequity gaps between our partners.

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Our community partners often use the metaphor of a four-legged stool to illustrate the importance of capacity, power, and equity in CBPR partnerships (Genesee County Health Department 2003). The four legs of the stool represent the four constituency groups: the university, the health department, the health system infrastructure, and the CBOs. If any one of the legs is shorter than the others (i.e., not equal in power and resources), the stool will be unstable and may even fall over. For the partnership to be strong and successful, each leg should be equally long and strong. Universities and other institutions, however, typically wield more power and resources than CBOs. Because CBOs are usually in the position of greatest vulnerability, it is critical for partnerships to undertake interventions to begin to systematically insure that the CBO leg of the stool is strengthened to equal the other partners’. Representing the shortest leg of the partnership stool, the CBO members of the PRC/MI were challenged in fulfilling many of the fundamental needs of their own organizations while also trying to acquire the skills necessary to actively engage in a research-oriented Center. The CBO partners tended to be small, grassroots service organizations that were created by Flint residents in order to address their community’s unmet needs. The CBOs had strong relationships and extensive experience working with one another, partnering with academic and health system partners, engaging community members, identifying community needs (though not systematically), and building trust and respect of community members. Compared to the other institutional partners within the PRC/MI, however, the CBOs tended to have fewer human resources and time to devote to PRC/MI projects; less organizational stability and uncertain sustainability; less access to influence and resources; limited familiarity with research principles, technical skills, and jargon; and less power within the partnership. Structures were created in the partnership to address some of these differences; however, inequities remained. At a renewal grant proposal planning meeting, members from each PRC/MI constituent group decided that the partnership should make an explicit effort to attend to enhancing the capacity of the CBOs in order to improve partnership trust, equity, effectiveness, and sustainability. The conceptual foundation for the Capacity Building Project was organizational empowerment theory

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(Griffith, et al. 2008; Peterson and Zimmerman 2004). As opposed to strategies that seek to simply impart information, empowerment approaches have the goal of helping people within organizations to become more effective actors in their own lives and society (Wallerstein and Bernstein 1988). Organizational empowerment theory builds on a conceptualization of relational, informational, and resource power. Empowering processes included procedures and projects that built upon the expertise of the CBOs to enhance their organizations, the partnership, and community health (Freire 1973; Wallerstein and Bernstein 1988). Consistent with asset-based approaches (e.g., Kretzmann and McKnight 1993) and CBPR principles (Israel et al. 1998), the project’s goal was not simply to chronicle community strengths but also to engage in experiential, practical learning opportunities, technical assistance, workshops, networking, and financial support. These activities were intended to build on the expertise of the CBOs in three ways: (a) make their organizations more independent, strong, and viable; (b) enhance the CBOs capacity to reduce health disparities through the work of their organizations; and (c) enhance CBOs’ meaningful contributions to the PRC/MI partnership and PRC/MI research projects. The project was governed by a committee with representatives from the four PRC/MI constituent groups and including representatives of all the partner CBOs. The Capacity Building Project sought to determine if increasing the capacity of CBOs, individually and collectively, has the potential to be a valuable strategy for enhancing community health (Griffith et al. 2008; Peterson and Zimmerman 2004; Speer and Hughley 1995). The primary foci of the Capacity Building project were to increase intraorganizational capacity and extraorganizational capacity of the CBOs in the PRC/MI: Increasing the skills of the leadership and the existing organizational infrastructure (intraorganizational capacity) of the CBOs was an intermediate goal, and the ultimate goal was to enhance the community health infrastructure and overall community health of Flint residents (extraorganizational capacity) by maximizing the effectiveness of PRC/MI research and intervention projects through taking full advantage of what all our partners had to contribute. Our two case examples illustrate two strategies for building capacity: (a) the community survey that

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focused primarily on building the intraorganizational capacity of the PRC/MI partnership and (b) the individual CBOs and the YBH intervention that focused on building both the intraorganizational and extraorganizational capacity of one of our CBO partners and African American faith-based organizations in Flint, MI. Following our discussion of the setting, we will examine each of these case examples in turn. Study Context The population in the city of Flint, Michigan is 56% African American, although the surrounding Genesee County is predominantly European American (US Census Bureau 2006). Unemployment was higher in Flint (17.6%) in July 2009 than for Michigan (15.0%), which had the highest state unemployment rate in the nation (US Bureau of Labor Statistics 2009). After two decades of decline in the number of automobile manufacturing jobs at General Motors factories, Flint has struggled to redefine its economy. This formerly prominent center for the automobile manufacturing industry also has lost a significant portion of its population since the 1970s, leaving a largely African American urban core fraught with a number of poor health outcomes. Despite these challenges, Flint has a number of community strengths. The city is proudly recognized nationally as the birthplace of the United Auto Workers. Community leaders have developed African-centered approaches to education, a commitment to addressing racism and celebrating African American culture, and leadership in promoting communitybased public health nationwide. The city also has a history of effective community organizing and activism. This context provides not only unique challenges but also important strengths that enhance the effectiveness of local CBOs to reduce health disparities. Case Examples Case Example I: PRC/MI’s Speak to Your Health! Community Survey The PRC/MI’s Speak to Your Health! Community Survey illustrates the effects of building strong and equal legs in a partnership stool. All of the PRC/MI’s

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constituency groups recognized the importance of strong community participation for the success of the Community Survey project, but the CBO partners expressed a great deal of skepticism about the survey’s usefulness and concerns that gathering data diverted resources away from providing more community programs. Despite these misgivings, the CBO partners agreed to participate in the survey, although they did not consider it a priority. It was also noted that involvement in the Community Survey could be a capacity building opportunity for the CBO partners if they could develop skills to use the survey to support their programs. Initially the Capacity Building Project did not focus on the survey, but the Capacity Building Committee members recognized that the CBOs were the only partners who were not utilizing or benefiting from this unique local resource. Though CBOs are often required to document community needs for their programs and to identify community problems they hope to address, systematic needs assessment is rarely the top priority for CBOs. CBOs tend to be more interested in addressing what they perceive to be critical health and social needs in the community, whether through their programs or by raising awareness. The Capacity Building Project, however, helped to show how utilizing the survey could help the CBOs demonstrate the need for their interventions and services to potential funding agencies and help evaluate the impact of their efforts. Therefore, the Capacity Building Committee turned its attention to building the capacity of the CBO partners to shape and utilize the Community Survey, thus facilitating their intraorganizational and extraorganizational empowerment. The PRC/MI’s Speak to Your Health! Community Survey is a biennial telephone survey of approximately 1,700 households in Genesee County. This is the only population-level survey conducted in the county that collects data on a broad range of health behaviors and a variety of social determinants of health. The survey is composed almost entirely of closed-ended questions and covers a breadth of topics rather than concentrating on exploring a smaller number of topics in depth. The survey was first completed in 2003 and repeated in 2005, 2007, and 2009. Each iteration of the survey includes many of the same questions; however, additional topics and questions are added or deleted each year based on the

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interests and needs of the partners. Due to the reasonable time commitment expected of survey respondents, the survey cannot address all the interests of all involved partners. A committee representing the four constituency groups in the PRC/MI partnership makes decisions about what questions to include. Shirey et al. (2008) describe the Community Survey and its development as a community-academic project (see also the PRC/MI website: www.sph.umich.edu/prc). Initially, a university partner and a health department partner consulted individually with CBO partners to help them develop survey items that better met their needs. The PRC/MI also provided two training sessions on understanding and using survey data, facilitated by a professional data analyst. Though participants appeared to find these efforts to be useful, their use of the survey data and participation in the survey development process remained limited. Although the CBO partners had extensive knowledge of program development and the needs experienced in their community, many lacked familiarity with population-level survey development and data analysis. Whereas the goal was not to make them quantitative researchers or data analysts, it was critical to enhance their ability to participate effectively in developing the survey item content, to think about how the data could advance their goals, and to disseminate the results. The Capacity Building project developed a strategy to enhance intraorganizational capacity to participate in the survey development process and extraorganizational influence through dissemination and utilization of survey data. The Capacity Building Committee participated in a series of trainings on developing survey items. This training workshop began with helping the CBO leadership describe the focus and goals of their current and future projects. Next, the trainers helped the CBO partners identify questions that would help them to better understand the issues that underlie and were associated with the health topics of interest. Third, the trainers helped the partners examine the strengths and weaknesses of survey methodology, particularly focusing on exploring the characteristics of good and bad survey questions. The final part of the training was brainstorming and refining potential research areas and associated questions that could be asked in the upcoming survey and that could be addressed through

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analyzing existing survey data. By incorporating more hands-on learning experiences, these trainings resulted in CBO partners bringing suggested survey items directly to the Survey Committee for discussion and further revision. Following the trainings related to the survey, CBO partners collaborated to yield survey results that were more relevant and useful for their organizations. The training also increased the ability of the CBO partners to critique survey items and increased their participation in other aspects of the survey development process. In addition to skills development (intraorganizational empowerment) resulting from the Capacity Building project’s efforts around the Community Survey, CBOs’ extraorganizational capacity also increased. Teams of university and community partners collaborated to share the community survey findings with local and nationwide audiences in presentations, publications, health promotional materials, and proposals for funding. One successful proposal was for the YBH project, described below in our second case example. The enhanced intraorganizational capacity of CBOs and the CBOs’ participation in the Community Survey development process enhanced the external validity and ecological specificity of the survey. The CBOs also increased their use of the Community Survey to raise awareness of and quantify health issues of concern and garner external funding for new projects. Finally, the CBOs’ participation gave them exposure and visibility within and beyond their local community. CBO participation in these efforts also have enhanced the quality of the products emanating from the survey data. Though their priority remains direct service to their community, the CBO partners are beginning to benefit from the availability of local data on the health priorities that they seek to address. In addition, because the survey provides a central source of data for the PRC/MI partners and other community institutions, the new areas of interest identified in the survey can serve as a catalyst for identifying other issues that may adversely affect community health. These additional priorities may prompt efforts to foster new relationships with other organizations and institutions (e.g., criminal justice system, educational institutions). More remains to be done to make the survey a catalyst for the reduction of health disparities, but the legs of the partnership stool are more equal as a result of this project.

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Case Example II: YOUR Center’s YBH Project While many interventions and efforts originate from evidence-based literature and academic researchers, YBH is an intervention that originated from and was named after YOUR Center, a CBO partner in the Capacity Building Project. This case example highlights how the Capacity Building Project focused on both the intraorganizational and extraorganizational empowerment of a CBO to help this organization shape its intervention idea into a successful pilot project. This example also illustrates how CBOs can simultaneously receive assistance to build their intraorganizational capacity, help to build the capacity of other CBOs, and enhance their extraorganizational empowerment by addressing community health. Despite the critical role that the African American church plays in the Black community, faith-based organizations have struggled to respond effectively to the HIV/AIDS epidemic occurring among urban African Americans (Campbell et al. 2007b). In order to address this health issue, YBH had three primary goals: (a) increase the extraorganizational empowerment of YOUR Center, (b) enhance the capacity of faith-based institutions and faith leaders to address more effectively HIV/AIDS and sexually transmitted infections in youth, and (c) change the norms of churches to provide a more open and accepting setting where youth and adults could discuss and address the behaviors that put them at risk for acquiring these infections. YOUR Center was able to secure funding and implement a 6-month pilot demonstration project in response to the community’s need for this type of intervention. During the pilot project from October 2006 to March 2007, YBH successfully engaged 11 churches and two housing communities (Campbell et al. 2007a). The intervention staff trained more than 365 youth, adults, pastors’ wives, and church leaders. YBH directly reached 1,507 people and indirectly reached over 4,000 congregants across the 11 churches. As a result of participating in YBH, the adolescents reported in qualitative interviews increased awareness, knowledge and understanding of HIV/AIDS transmission, safer sex negotiation skills and practices, and confidence in discussing abstinence with their peers. The pastors felt that the YBH intervention increased awareness of HIV/AIDS and decreased stigma

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regarding individuals with HIV/AIDS among their congregations. Eighty people were tested for HIV at YBH events, including several pastors. The most salient lessons learned from the YBH project were that it was critical to create a safe place to openly discuss sexual health and that churches are uniquely gifted to minister in HIV/AIDS education and prevention efforts. Although YBH may have occurred regardless of YOUR Center’s participation in the PRC/MI Capacity Building Project, the intervention was demonstrably strengthened by the project. The interorganizational empowerment activities included in the Capacity Building project, particularly the input and collaboration from CBO, university, and health department partners, enhanced YOUR Center’s ability to bring the project idea to fruition. For example, two of the CBOs engaged in the Capacity Building Project contributed their expertise: (a) Faith Access to Community Economic Development helped train the pastors’ spouses and adult facilitators on the potential of the church as an agent of social change and how to conduct faith-based health interventions and (b) Flint Odyssey House’s Health Awareness Center provided workshops to YBH project staff on how racism affects health and health disparities and the historical and cultural processes that mediate this relationship. Additionally, YOUR Center staff recognized that it was critical for adult and youth participants to understand the effect of the HIV/AIDS epidemic on the African American community. Therefore, they invited the local health department, another PRC/MI partner, to contribute pamphlets and provide health nurses to assist YOUR Center staff with HIV testing, counseling, and referral services at all communitywide events. YOUR Center also sought the technical assistance and consultation of the university partners to assist with the evaluation design, data analysis, and report writing. The PRC/MI Capacity Building Project utilized interorganizational empowerment structures and processes to capitalize on the collective strengths and expertise of the PRC/MI. Though deficit-based approaches can help to identify and address organizational needs, this project illustrated how CBOs can provide the motivation and opportunity for collaborative research and partnership growth through focusing on ways to promote intraorganizational, interorganizational, and extraorganizational

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empowerment. Not only did the YBH project provide a new model for improving health in this community context, it also provided a tangible and successful opportunity for partners to help enhance each other’s capacity by contributing individual expertise to a common, community-driven project. In addition to improving the YBH project, the Capacity Building project and contributions of different PRC/MI partners built the intraorganizational empowerment component of YOUR Center. Throughout this project, the YOUR Center staff enhanced their skills in grant writing and incorporating evaluation into a public health practice-oriented intervention. The director of YOUR Center opted to seek funding from a local foundation by collaborating with the university partners in the PRC/MI Capacity Building project. Through the process of receiving and carrying out the pilot YBH project, YOUR Center developed a solid relationship with a new collaborator in their HIV-prevention efforts and a strong local funding source. This interorganizational relationship led to a second grant to expand the YBH project from the original 11 churches to an additional 30 churches. The university partners helped prepare a final report for the pilot project, which played a considerable role in impressing the foundation representatives with the successes of the YBH project. They also collaborated with YOUR Center staff on writing the subsequent proposal to expand the project, including helping to design a more developed project plan building on YOUR Center’s previous efforts and a stronger evaluation component. The university partners also were able to help YOUR Center successfully articulate why the level of funding requested for the expanded project was justified, despite suggestions from the foundation staff that the budget be reduced dramatically while expecting YOUR Center to fulfill the activities and outcomes of the original grant proposal. The success of the YBH project increased YOUR Center’s visibility and expanded its network by providing opportunities for YOUR Center to present this project at a national public health conference. YOUR Center also has been able to build its success with the YBH pilot and expansion projects into opportunities for fulfilling community leadership roles in several other PRC/MI projects, thus securing more funding, respect, and influence for the organization within the PRC/MI partnership.

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Discussion Building the capacity of CBOs and partnerships to produce effective interventions is essential to improving programs to address racial health disparities (Griffith et al. 2006; Miller and Shinn 2005; Wandersman 2003). We described two case examples of projects that were part of a community health intervention designed to increase the capacity of CBOs to understand and address the health needs of urban African Americans and to collaborate as equal partners in prevention research as part of the PRC/ MI. This intervention sought to enhance individual CBOs, a partnership, and ultimately community health through a community survey and an HIVprevention intervention. The empowerment processes that constituted the Capacity Building intervention sought to marshal assets among PRC/MI partners to provide the resources and technical assistance necessary to help the CBOs integrate and apply these to improve community health. Empowerment theory provides a useful conceptual foundation for capacity building because it is grounded in values of social justice, equity, and participation (Zimmerman 2000). Organizational empowerment focuses attention on those characteristics of organizations that both enhance individual development and community change (Peterson and Zimmerman 2004). Organizational empowerment, therefore, is a useful framework to guide a capacity building intervention because the goal is to increase the capacity of individual organizations (and their staffs) and partnerships to promote community health and reduce health disparities. Because it stresses resource identification, mobilization, and utilization (Peterson and Zimmerman 2004), organizational empowerment theory provides a framework for considering both short-term outcomes and long-term impacts, both of which are critical for effective, sustained efforts to reduce health disparities. This theoretical foundation and CBPR principles helped provide a conceptual foundation to guide our work and a process for achieving more equal relationships. The insight of CBOs who know their communities’ strengths, weaknesses, cultures, resources, and contexts may prove to be particularly effective in addressing racial health disparities (Wandersman 2003). Thus, developing the capacity of CBOs and

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researchers to work as equal partners may be an important step for addressing the insidious effects of health disparities. Integrating CBO and academic perspectives and expertise can lead to new knowledge and intervention approaches, making CBOs essential partners for helping to address and eliminate social, environmental, and behavioral aspects of health disparities (Bediako and Griffith 2007; Eng et al. 2005). Promising programs are already functioning in many communities and it is worthwhile for researchers to identify and study them to determine their active ingredients and effectiveness (Miller and Shinn 2005). While many studies include CBO partners as members of advisory groups or partnerships, little attention is paid to the quality of community participation and the challenges community representatives face to remain a part of the partnership and to participate effectively in it. Building relationships that can enhance CBO access to resources, community decision-making bodies, and information can be a critical step in increasing CBO capacity to be equal partners and more effective change agents. CBOs can play a central role in community-level prevention initiatives, but it is critical that they develop strong fiscal foundations, access and utilize data and information, and build relationships that can help them wield and increase power and influence. Often, community members have untapped expertise and ideas that could shape important modifications to existing programs or novel approaches to addressing a seemingly intractable problem. It remains critical to focus on addressing health disparities through community health interventions, but it is important to focus increased attention on increasing the capacity of community representatives to be viable organizations and to understand and address community health. University-based researchers and service providers will always have an important place in community-based research, but without a strong and viable community presence, there is little chance that these efforts can benefit fully from the years of experience and expertise of community members. Our efforts to reduce racial disparities may hinge on CBOs’ ability to effectively represent and advocate for community needs and to be involved with efforts to solve this most pernicious public health dilemma.

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