Community-Based Participatory Research to Improve Community Health in Kuc, Uganda

The case study we focus on concerns a study on improving community health in Northern Uganda. The study is conducted by Nicholar Dowhaniuk, Susan Ojok, and Sarah McKune, who want to foster the engagement of communities and public-health end-users in setting a research agenda on the topic of health improvement. The researchers’ motivation to do so stems from the fact that, as they explain in their paper, “health and development research remains an area where priorities are set almost exclusively by a researcher’s individual interests or by funding organization priorities, while end-users (especially those from marginalized communities) remain “researched on” and not “researched with” (Dowhaniuk, Ojok & McKune, 2021). 

 

Through the inclusion of marginalized communities, Dowhaniuk, Ojok, and McKune conduct a so-called Community-Based Participatory Research (CBPR). Through CBPR, vulnerable and marginalized communities are given greater involvement and control in the research process, which allows them to make an actual impact in practice. 

 

In the section that follows, we will explain how mixed methods are used in the study by Dowhaniuk, Ojok, and McKune to allow for such a CBPR approach.

Dowhaniuk, Ojok, and McKune make use of a so-called Photovoice method. This method allows for the active participation of participants by handing out photo cameras to them so they can capture their own perspectives and experiences, based on the question "What in your community has a negative or positive impact on your health?". The Community Advisory Board (CAB), consisting of three influential individuals representing diverse community interests, selected eight community members to participate in this method. Below you find an overview of the participants' demographic information.

 

 

The participants were selected based on their involvement in the community (e.g. knowing what issues are at stake), their sense of responsibility, and recommendations given by other community members. Before participants started collecting their photos, an eight hour photography workshop was provided by the researchers to train the participants in photography and ethics.

 

After the collection of photos, semi-structured interviews were conducted with all participants. Here, participants were asked five questions about their interpretations of the photos, as well as their view on the community health as it was. See the overview below for the method questions that were used in this study.

 

 

At the end of all the interviews, a focus group was organized for all participants. Here, the participants discussed the five best photographs they took, as well as their interpretations of it, their perspectives on certain health issues, and what they considered as suitable solutions to these issues. A translator ensured that the English speaking researchers and Acholi speaking community members were indirectly able to communicate in a language fluent for them.

Based on the Photovoice method, the semi-structured interviews and the focus group, four priority health themes emerged:

 

1. Alcohol-Use Disorders (AUD)

 

 

2. Sanitation and compound cleanliness

 

 

3. Water quality and access

 

4. Infrastructure

 

As the following section will show, the first theme on AUD is further explored in the quantitative method used by Dowhanjuk, Ojok, and Mckune.

Apart from the qualitative methods described above, Dowhaniuk, Ojok, and McKune also made use of a quantitative survey. Based on the World Health Organisation’s (WHO) survey on the consumption of alcohol - the Alcohol Use Disorder Identification Test (AUDIT) - 327 community members above eighteen years old answered ten questions about Alcohol-Use Disorders to triangulate the Photovoice findings. Triangulation allows for the converging of findings from multiple methods, so that a comprehensive understanding of the theme is developed.

 

The table below shows the prevalence of Alcohol-Use Disorders in Kuc, based on the AUDIT survey.

 

 

From their survey, Dowhaniuk, Ojok, and McKune found that in order to address the relative high prevalence of Alcohol-Use Disorders, most participants prefer putting a time limitation in place for legal alcohol consumption over a complete alcohol prohibition strategy.

Another notable finding from this research relates to the high numbers of AUD in comparison to earlier studies in the North of Uganda. The researchers explain this difference by the lack of attention given to unrecorded alcohol brewage in previous studies, even though unrecorded alcohol is often consumed particularly in Uganda’s rural areas.

Based on both qualitative and quantitative findings, the community identified issue of AUD will be the topic in the long-term CBPR inspired project. The project goal is the development, impoementation, and evaluation of a community-driven public health program that builds on community strengths to address Alcohol-Use Disorders in Kuc. Thus, we clearly see the impact of community participation translated in practice here.

When it comes to interdisciplinarity, the study by Dowhaniuk, Ojok, and McKune (2021) shows the benefits of working from an interdisciplinary framework due to the fact that the researchers come from several different disciplinary backgrounds. In total, five different research departments and projects are represented here: Geography, Environmental and Global Health, Tropical Conservation and Development Program, Uganda Women’s Action Program, and African Studies Program. Having such a broad perspective to work from allows for a more holistic approach, also when it comes to finding practical solutions to improve community health. After all, combining practices, theories and ideas of different disciplines often leads to innovative outcomes and contributions to knowledge, theory and applied interventions (Pink, 2012).

Besides, combining disciplines of Health, Inclusive Development, Cultural Anthropology, Sociology, and Media Studies, this study builds towards a comprehensive bottom-up understanding of major health dynamics in Kuc. The provision of camera's, and a photography and ethics workshop, invites participants to creatively search their community for impactful health factors. The selection of representative and involved community members increases the effectiveness of the outcome. The selection process furthermore requires an understanding and involvement of current local power dynamics, combined with the historical context of the insurrection of the Lords Resistance Army from 1986 till 2006. This historical conflict turned 95 per cent of the population into Internally Displaced People (IDP) and was a major turning point towards an increasing use of alcohol.

All in all, for us this case study not only illustrates the benefits of the mixed-methods approach and the engagement of marginalized groups in research, but also the use of an interdisciplinary framework that looks at emerging issues from a broader perspective. The success of this research lies in its conjunction of all disciplines involved.

We definitely learned a lot from the approach of Dowhaniuk, Ojok, and McKune, and we hope you did too!

Dowhaniuk, N., Ojok, S., & McKune, S. L. (2021). Setting a research agenda to improve community health: An inclusive mixed-methods approach in Northern Uganda. PloS ONE, 16(1), 1-25. Retrieved from https://doi.org/10.1371/journal.pone.0244249.

Pink, Sarah (Ed.) (2012). Advances in Visual Methodology. London: SAGE Publications.

This research was funded by the National Geographic Society Early Career Grant and the Tropical Conservation and Development Field Research Grant from the University of Florida.