Beginning Community-Based Participatory Research : Gaining Entry to Systems

System or community entry refers to a process of initiating, nurturing, and sustaining relationships in order to enter a community space. Community entry involves discovery of the principles and techniques of participation and mobilization for community transformation. It also involves discernment of who the leadership and community members are in order to achieve an effective way of meeting and interacting with them. The principles of Community Based Participatory Research (CBPR) provide a framework for using a community approach to discover solutions to health disparities. However, there is an evidentiary dearth of instruction about how one begins and maintains community entry. In this paper, the novice CBPR researcher is instructed in participation strategies, informed of sensitivity factors involved with new cultures, and apprised of the community consciousness of the system where gaining entry is planned. Additionally, a case study is used to present strategies for system entry and the participation processes involved to discover leadership and community members as part of the process of beginning a community based research study. Beginning Community-Based Participatory Research: Gaining Entry to Systems Publication History: Received: March 25, 2017 Accepted: September 25, 2017 Published: September 27, 2017


Participation
Community involves a sense of place, both geographic and emotional; shared experience and values, and social ties.These constructs involve the participation of a variety of players: clients, providers, groups, and individuals.An individual who is not a member of the community needs to participate as well.Participation begins with clarity of purpose.The purpose of a project may closely align with the community of interest and encompass the notion of "institutional fit".In statistics, goodness of fit refers to how well a model fits normal distribution [1].In developmental psychology, goodness of fit may signify the factors from social relationships that children appropriate contextually [2][3].The institutional fit includes the norms and values of the community and, as such, community members protect the "institution".Hence, as both health care and research continue to extend into community, people associated with health care services and research teams become participants in the community.People from the health care and research systems have areas of expertise they want to use in community.However, this is

International Journal of Nursing & Clinical Practices
Elizabeth Bonham *   College of Nursing and Health Professions, University of Southern Indiana, 8600 University Blvd, Evansville, IN 47712, USA not the same as being an expert about the community.One must take the time to participate and learn about the community.Having a relationship with a community makes participation easier; when there is none and one must be forged, it takes time, effort, and hard work [4].Without the important front-end work, it may be very difficult to initiate a community based study.
Israel and colleagues [5] described principles that are fundamental to successful partnerships.The principles include 1) recognizing community identity; 2) building on strengths and resources; 3) developing systems in an iterative and cyclical process; 4) developing equitable involvement of all parties in all phases of the research; 5) engaging in colearning and capacity building; 6) establishing mutually beneficial integration and balance of research and action; 7) addressing public health issues of local importance; 8) sharing participation in the dissemination of research findings; and 9) committing to a longterm process of sustainability.
Participation involves connection, collaboration, and communication.Connection occurs on many levels and in a variety of contexts.Connection may begin by an initiation with a community contact.Of note is the strength of having a contact or knowing someone in a community.The contact serves a powerful purpose of opening doors and creating pathways.This important first step of having a 'contact of a contact' in the community cannot be overstated.The first step of participation is contingent on this relationship.Once connection occurs, people involved can contribute to the participation process.In this regard, connection is an example of recognizing community identity and building on its strengths and resources.

Special Issue: Community-Based Participatory Research Practices
Collaboration is an often stated term that may not be well understood or operationalized.Collaboration is a complex and sophisticated relationship between people, not institutions [6].It is a process where an interdisciplinary focus is ideal.It is a process that requires people to learn the language, values, and expectations of each other.Interdisciplinary collaborations can identify a wicked problem that a team of disciplinary experts together can more effectively develop a solution to [7].While health care seems to be a natural place for collaboration to occur, learning to collaborate takes time, patience, and practice.Gardner [8] offers 10 competencies for collaboration that include competencies such as knowing yourself, developing constructive conflict resolution skills, and mastering interpersonal and process skills.Developing constructive conflict resolution skills and mastering interpersonal skills are the foundation of communication.
Communication is a process that everyone does; the actual act of communication is complex and can be fraught with nuance that may be misinterpreted.Thus, having a clear purpose of why entry to a particular system is beneficial for all stakeholders is imperative.Communicating who is responsible for what, what needs to be done, and how knowledge will be disseminated are items that are key to a successful enterprise.Communication strategies need to be consistent as there will be different stakeholders asking about the same things depending on their role in the system.One communication strategy is patience when a different person asks the same question the last two people spoken with did -since the person trying to gain entry does not know all the rules or roles, being patient and answering consistently assists the growing trust in the relationship.

Cultural Sensitivity
Cultural sensitivity requires that a group's values, beliefs, norms, and life practices, or social capital, are respected for what they are and the role they play in the system.Culture guides thinking, decision making, and actions in specific ways.It provides the basis for values which identify ways of thinking or acting.Values are usually held for a long time and help to guide decision making in the culture.Cultural competence is the ability to understand, appreciate, and interact with persons from cultures unfamiliar to the researcher.When gaining entry to a system, in some cases a different culture, it is imperative that the person trying to enter a new system personally view the process of doing so as one of acculturation.In other words, the researcher begins adapting to the new system or culture as a process of fitting in as a way to ensure relationship building.
Campinha-Bacote's Culturally Competent Model of Care [9] is a model that reminds one to remember that cultural awareness, knowledge, and encounter are critical to cultural competence.In addition, the model describes cultural desire as a spiritual and pivotal construct that provides the energy source and foundation for the journey toward cultural competence.When cultural desire erupts, it gives forth the desire to enter the process of becoming culturally competent by being humble to the process of seeking awareness, skill, knowledge, and encounters [9].A spirit of humility may aid in facilitating the trust that is essential in relationship building.

Community Consciousness
Community consciousness is a phenomenon where people of the community have a sense of themselves, an identity that is specific to that community.While a prevailing notion may be that the community in CBPR is a geographic locale, a system of care, such as a youth detention center, is a community as well.Each system has processes whereby individual and collective actions maintain and transform community.The system has norms, beliefs, and values that are inculcated into members.This identity and a shared belief system facilitates partnerships [10].Therefore, the researcher must understand how the community defines itself and how it partners with other people.Boswell and Cannon [11] describe partnership as an association with others for a joint interest.A joint interest is similar to the CBPR principle of recognizing the community as a unit with views and values similar to the researcher's intention.Identifying and placing multiple resources together using a team effort is an example of an effective partnership.

A Case Study
The system to which the author researcher wanted to gain entry was a juvenile detention center.Not being a member of the professional or juvenile justice community, the author asked a colleague of longstanding community membership for access to her community behavioral health network as a place to start.A contact from that network began the process of finding the key to community (juvenile detention center) entry.Since the research involved the mental health of youth in juvenile detention, the researcher, through multiple telephone calls, discussed the study intention with contact after contact until the internal stakeholder was identified and contacted (Figure 1).
Once that stakeholder was identified, he advised who within the system the author needed to talk with next.The identified people were the system's legal counsel and the detention center program director.Subsequent meetings and email communication with legal and the program director occurred over four weeks until all internal stakeholders were clear about the study, what the author's role was, what the legal contract stipulated, and what procedures would be in place for safety and access.In discussing the study with the program director, it became clear that detention center staff, as important stakeholders, would also need to be informed about the study.The researcher developed a fact sheet about the study and presented the research study procedure several times at staff meetings.
In order to gain system entry, the author initially explained her role and the research seven times.Contact and connection ensued with nine more people or groups that included multiple meetings with legal counsel, detention center program director, detention center staff, and the juvenile court administrator over a six (6) week period before the first youth interview occurred.A flow chart of contacts for gaining entry to the system can be viewed in Figure 1.

Discussion
It may seem from the case described above that there were many participation interactions to gain entry.In one sense, this is so because the study population possessed what could be perceived as triple jeopardy: minor age, detention by court, and possible mental health disorder.The safeguards in place were appropriate to protect this vulnerable population.By the same token, the many interactions that were described instruct the reader how patient and persistent one may need to be in order to gain entry.The entry to system case study presented exemplifies what Yin [12] identified as investigating a phenomenon in its real life context.In this study, the phenomenon of the voice of the youthful offender who was detained could best be obtained in the juvenile justice detention system in order to study the real life experience of the detained youth.A case study may focus on an individual but that individual may be a person, group, or institution [13].The case study demonstrates how an institution and its procedures can also be used or studied in addition to the individual.
Gaining entry to the institution required acknowledging the norms of the system as well as finding out who the key stakeholders were.In this institution, additional stakeholders such as the legal counsel required taking the time to establish a relationship with legal through various modes of communication.Doing so was key to gaining entry and an example of the process of engaging in colearning, capacity building, and iterative processes [5].Interpersonal and process skills [8] were employed by the author to communicate with three system stakeholders to discern what the system identity and requirements (strengths) were in order to gain entry.For example, learning a system norm included learning how to use different words when it was suggested by those in the community to do so.Thus, it was important to use the word 'researcher' to explain the author's role, rather than 'investigator' , because the word 'investigator' had a much different meaning for people within the culture and community who were involved with law enforcement.required helped clarify the subsequent message of study purpose in discussions with the detention program director and staff.For example, since time was taken to ensure that staff understood what the study entailed, they were helpful in explaining the norms of the detention unit and how the author could access parents in order to explain the study to them.
In the juvenile detention center system, an interdisciplinary focus and collaboration were present.The interdisciplinary focus encompassed criminal justice, rehabilitation, law and psychiatric nursing disciplines.It was well worth the time to forge the relationships with colleagues in the juvenile center.Discussions to learn language, values, and expectations of each other contributed to system entry and developing strategies for initiating the research study.Being sensitive to a new system required learning the system's values, beliefs, and norms.Becoming competent in a new culture -the juvenile detention center was a new culture to the authorentailed a heightened awareness and sensitivity [9].
Discovering a new culture imparted a sense of humility in the author.Asking questions opened doors and helped to establish new relationships.Furthermore, the people of a culture have their own identity and a sense of themselves in that culture.To go into a system with all the answers and no attempt to understand the cultural identity is a guaranteed way to fail at gaining entry to a system.An approach that is mutually beneficial using participation, communication, collaboration, cultural sensitivity, and an appreciation for community consciousness is a skillset that will help the researcher gain entry.Gaining entry requires strategies that are further discussed in the next section.

Strategies and Skills
System entry refers to a process of initiating, nurturing, and sustaining relationships.A researcher utilizes strategic thinking when considering entrance to a system where she knows no one and does not have a contact.In the research context, the entry is usually to conduct a study.Ideally, the study findings are shared with the system so that there is mutual benefit and a participation of dissemination of research findings [5].A researcher never wants to leave a system with the stakeholders feeling they have been taken advantage of or used.The purpose of the study and the role of the researcher are made explicit so that system stakeholders are clear about what will be accomplished and who will do it.To begin to learn and know about the community, there are critical actions the researcher will do.
First, the community system must be identified and recognized as a unit of identity; there are many ways to obtain information about the community before that first personal contact.Collect informal information about the community.Carefully review the system's website.Find out who the leadership is and how the system is organized.Many systems post their organizational charts for viewing.Read available literature such as newspapers, special reports, or journals.Request a copy of annual reports or other documents used to broadcast the system.If there is any kind of public event or fundraiser, attend it.Be prepared to inform people of who you are and what your interest is -be prepared to talk to people and introduce yourself.
Second, ask yourself why you want to enter this system.What do you have to offer them?What value will you bring or add to the partnership?Recognize the people who present themselves to you as the stakeholders can open doors for you.In this way, the stakeholders will facilitate subsequent cooperation and implementation.As you gain entry, you want to tell people time and again who you are (wearing a nametag is a good idea), what you are doing there, and how you are doing your study.The more transparent you can be, the more trustworthy you become to the stakeholders and the more successful you will be in conducting your study.

Conclusion
A CBPR approach is an excellent way to understand and ultimately, change community issues.However, the researcher who uses a CBPR approach needs a skill set for system entry in addition to the research methodology the researcher applies.Knowing and clearly articulating the purpose of researcher focus and partnership is key from the beginning.This assists in finding contacts that can facilitate gaining entry.Building capacity and sustainability in, and of a community system, are noble goals for a researcher; however, the community context is one of partnership and those goals are accomplished with a variety of stakeholders, patience, and persistence.In this paper, the importance of knowing about how participation works, how cultural sensitivity is useful to understand a new culture, and community consciousness in relation to gaining entry were presented.Skills and strategies that can be used for successful entry were also presented.Next steps for the novice researcher include reviewing of the principles and policies of CBPR [5]; discerning one's own active listening skills and practice them; and developing clear explanations of the research one wants to do and how the community and researcher can mutually benefit from the partnership [5].
Being clear about what was Third, have your "elevator speech" ready for quick interactions.Be able to quickly state who you are and what you would like to do.Doing so requires clarity and purpose on your part.Eventually, as you glean more information of potential gaps in the system, such as what the author found with the detention staff and what they knew about normal adolescent behavior, you might suggest what you could offer, depending on your expertise, in the way of a workshop or continuing education seminar.This strategy is especially helpful if your plan is to continue a long term partnership with the system depending on your research plans.Writing thank you notes is a way to express your sincere appreciation as well as to comment on what you know about the community.In this way, you become aligned with the community and are in a position to create sustainability, again depending on what your research plans are.In Table 1, several strategies and skills are presented.Bonham E (2017) Beginning Community-Based Participatory Research: Gaining Entry to Systems.Int J Nurs Clin Pract 4: 252.doi: https://doi.org/10.15344/2394-4978/2017/252 Int J Nurs Clin Pract IJNCP, an open access journal ISSN: 2394-4978 Volume 4. 2017.252Citation: