Enhancing capacity building in community-based research

A report to the Canadian Institutes of Health Research HIV/AIDS Research Initiative

January 2011

Produced by Michelle Campbell

Executive Summary

  1. Introduction
  2. Key priorities for capacity building
  3. Existing CBR funding mechanisms
  4. Potential new CBR funding mechanisms
  5. Options for future CBR funding

Next steps


Key messages from the community

  • Respondents laud CIHR for the excellent support it has provided to community-based research
  • The greatest capacity gap is the lack of community-based research resources and infrastructure, especially the time and money needed to engage in the developmental phases of research
  • In the Aboriginal stream, an additional key priority is expanding the cadre of researchers
  • Although some substantially different challenges were described by respondents addressing the Aboriginal and General Research streams, overall they prioritized similar solutions and supports
  • Most community-based capacity building has addressed individual research skills within small projects; most of these skills are lost for lack of practice and high staff turnover
  • Capacity building would have greater impact if efforts were more systemic; integrated across projects and programs; focused on organizational - rather than individual - capacity; and undertaken within long-term and supportive community-academic partnerships
  • Many different approaches are needed to build many kinds of capacity for many kinds of people under many kinds of circumstances: no one mechanism is the answer to capacity building
  • The CBR Program has limited funds, and should seek all possible opportunities to add incremental value to existing activities within and beyond the CBR Program, rather than create new structures
  • Key next steps to enhance capacity for community-based research include:
    • Partnering with key funders of community organizations to support research infrastructure
    • Adapting grant funding to better support infrastructure development in community organizations, and unique funding challenges such as travel to rural and remote communities
    • Building training approaches which embed trainees in supportive environments, and integrate their expertise and ongoing work into their training and research experience
    • Restructuring and resourcing a more widely-accessible facilitating mechanism focused on brokering/ training; creating grant mentoring structures
    • The most requested support was a developmental approach to merit review, which could provide substantive grant mentorship, increase resubmissions and reduce frustration over rejection of applications which are highly-supported and valued by the community
    • Phased grant funding could build community infrastructure at the earliest phases, where it is most urgently needed and hardest to fund, while supporting the development of larger scale and more sustainable programs of research, and ongoing capacity use
    • Building opportunities for face-to-face sharing of CBR best practices and findings

Executive Summary

1. Introduction

The HIV/AIDS Community-Based Research (CBR) Program is a component of the Canadian Institutes of Health Research (CIHR) HIV/AIDS Research Initiative. The CBR Program invests $2.7M annually in catalyst, operating, and workshop grants, Master's and Doctoral awards, and Community-Based Research Facilitators, through an Aboriginal Stream and a General Stream. A 2009 evaluation identified the need to further strengthen capacity-building efforts within the Program.

Consultation was undertaken through a web survey and key respondent interviews to identify priority needs and preferred approaches to capacity building. This report presents the community feedback and some options for addressing the gaps and opportunities identified by respondent; it is intended to help the CIHR HIV/AIDS CBR Program Steering Committee and the CIHR HIV/AIDS Research Advisory Committee (CHARAC) chart a path forward for the Program.

2. Key priorities for capacity building

The highest priority capacity gaps identified in the consultation were:

  1. Developing the community-based research infrastructure required to be full partners in research
  2. Building a new cadre of researchers in the Aboriginal stream

Even when research funding is tight, the university environment still provides a significant range of research-supportive resources and infrastructure which doesn't exist in community organizations. While an academic who wants to write a grant is 'ready to go', for a community-based organization, the actual writing of an application might be closer to step ten than step one. Prerequisites may include creating the basic research capacities, infrastructure, policy and priorities which are taken for granted in an academic environment, and which an organization needs in order to be able to engage meaningfully in research planning, let alone to obtain, implement, and administer a research grant.

Time and dedicated resources are the crucial capacity gaps topping most respondents' lists, and few mechanisms exist to help build the basic research infrastructure in communities. While writing grants is part of an academic researcher's job, communities usually engage at the expense of their front-line services. The cost of applying is thus much higher for community-based organizations than for traditional research applicants, as is the impact of rejection. Although CIHR's success rates rise rapidly for re-submissions, few community-based teams - especially in the Aboriginal stream – ever re-apply.

Ultimately, respondents from both the General and Aboriginal streams, researchers and community organizations alike, suggest that what is most needed is support which helps build the organizational research capacity and infrastructure necessary before writing a successful grant – but instead, research support usually only comes after the grant has been successful. Providing external grant-writing support does help an organization succeed at obtaining a grant. However, it does little to build the organization's capacity to implement the resulting research, and manage the team and the grant.

Many respondents are concerned that much individual capacity is being built but not sustained, as community members and staff have no opportunities to practice their skills, and staff experiences high turnover. Respondents suggest more systemic approaches are needed, ones which focus on organizational development rather than individual skills building. Key approaches include creating roles, resources and infrastructure which are constantly in use (not set up only within and for a single project), whose function is to permeate the organization through the front-lines, the Board and management, and are thus less vulnerable to individual job changes.

With respect to training, more attractive and relevant opportunities for Aboriginal researchers are needed to expand the pool of applicants, and to support applicants from communities in both streams.

Respondents strongly supported a partnership model of CBR, in which community and academia share leadership and each contributes their substantive and unique expertise; teams need help finding potential partners, and building and sustaining partnerships. Rural and remote communities are particularly challenged, as they have very little access to research expertise, and huge cost barriers in engaging with researchers and with each other.

In academia there remain major disincentives to engaging in community-based research, while review panels still need to develop a better understanding of how CBR works and should be reviewed. Community organizations also seek skills and resources to support them as users of research.

3. Existing CBR funding mechanisms

Grants

The three existing CBR grants programs – MPDs, catalyst and operating grants – were generally considered useful and appropriately structured. The idea of "progression" from developmental to larger grants is important, but not seen as happening in practice. The proliferation of smaller grants, and the lack of connection between catalyst grants and subsequent operating grants, were particular concerns.

Respondents described CBR as a particularly lengthy and expensive approach to research, yet uniquely hindered by funding caps. Grants need to be able to support community-based research infrastructure, and better deal with the huge travel costs of working within rural and remote communities. Application processes and CVs continue to be a major barrier to community participation.

Awards

Awards are seen as an important idea, but perhaps not achieving the outcomes they ought to. The low application pressure to Aboriginal Stream awards is an urgent and critical problem. While in the Aboriginal Stream, most awards are taken up by more mature, community-based professionals returning to school (as opposed to younger, academic-track students), few respondents in the General Stream have ever considered them as possible tools for communities to build their research capacity.

Respondents saw the need to embed trainees in more supportive training environments – especially when trainees come from the community – and provide them with research experiences that allow them to contribute and build on their considerable expertise as community leaders in addition to gaining experience as research trainees. Supporting part-time studies, non-academic career tracks, and research projects linked into the "trainees" ongoing professional work were all important needs.

Community-Based Research Facilitators

The Community-Based Research Facilitator (CBRF) mechanism generated significant debate. Most respondents agreed that there was need for a mechanism which facilitates community engagement, but the current mechanism wasn't well-structured to deliver what most saw as the desired outcomes. In consequence, most respondents suggested keeping, but substantially restructuring, the mechanism, or replacing it with one with similar purpose and a continued core focus on community support.

Facilitators have made substantive contributions to a range of projects, often taking on the responsibilities of research coordinator or unacknowledged co-investigator. However, respondents suggested the need to shift from providing resources to a few projects, towards helping build capacity across many teams. They suggested a focused and clear core role, mostly as brokers – connecting teams to resources and skills – rather than being the team's resources and skills. Respondents also suggested a stronger emphasis on facilitating larger-scale training, and organizational development.

A number of respondents suggested it would be helpful to develop the CBRFs' role and resources more systematically and as a group. Training, tools, and on-going opportunities for face-to-face sharing of best practices would all be important, as would access to funds for travel and to hold workshops. Respondents suggested a wide variety of mechanisms which might provide both for a more functional career path, and would also increase community access to facilitators. Most suggestions involved creating more explicit ties between facilitators and CIHR, either by making the role a staff position, or funding it via personnel awards.

Respondents saw the need for a range of facilitating mechanisms targeting different aspects of capacity building, acknowledging the diversity of needs and the range of expertise needed to support them. Along with brokering, the other biggest gap identified is in grant mentoring; respondents suggested a wide range of approaches to make different kinds of mentors widely available to the community.

4. Potential new CBR funding mechanisms

Strategic initiatives and networks

Neither of the two potential new approaches suggested by CIHR - networks and strategic initiatives – garnered much support: respondents had difficulty seeing how either approach could make a clear contribution to addressing the critical capacity gaps they had identified. Respondents were also concerned about diverting funds from already stretched, nascent programs in order to launch new ones, and suggested that CIHR build on existing CBR networks, including Universities Without Walls and REACH, rather than duplicating or diluting them. Respondents also had significant concerns about those who would inevitably be excluded from such large structures, and shifting funds towards academia.

Developmental funding

A number of respondents, particular those addressing the Aboriginal stream, suggested a smaller, seed-type grant was needed to support the development of larger grant proposals. It could fund, for example, the time needed for relationship-building and grant writing to develop a catalyst grant.

Developmental review

A large number of respondents strongly recommended creating a more iterative, developmental approach to merit review, in which "almost there" applications were given substantive feedback and support to make the needed changes and develop a fundable proposal. They note that the current review process is resulting in substantial wasted effort and ill will, and very few resubmissions.

Alternative training models

Many respondents saw the need to ultimately move towards larger training programs such as NETS and STIHRs which embed trainees in more relevant and supportive environments – but not yet. The CBR Program lacks the funds to support such large structures, and for now would be better building on existing efforts such as Universities Without Walls, and trying to expand its reach more nationally.

Knowledge exchange and lessons learned

Many respondents emphasized the need for more opportunities to meet face-to-face, to share lessons learned and research findings. Important goals would be to better connect with partners and get more research into use, as well as support the development of CBR methodology and practice.

5. Options for future CBR funding

CIHR will likely need to pursue a range of approaches to enhancing capacity building for community-based research in HIV/AIDS. Over the long term, CIHR may ultimately choose to pursue some aspects of all of the options suggested below. The options are described in more detail in Section 5; more immediate next steps for the CBR Program are summarized in Section 6.

Clarifying roles and engaging partners: CIHR could play a major role in coordinating and supporting a shared effort, especially among Health Canada and Indian and Northern Affairs, to jointly address infrastructure gaps which support both research and broader organizational goals in communities.

Grant support: The CBR program could strengthen the focus and role of capacity building across its grants. It could adapt budget requirements to better support community infrastructure and the high cost of working within rural and remote communities; it might increase the caps on catalyst grants.

Merit review training: The program could adapt its review criteria for CBR applications to more explicitly address its unique challenges, and increase training and preparatory discussion among panel members.

Facilitating and mentoring: The CBR program could restructure a facilitating mechanism to focus on brokering community-academic partnerships and helping a wide scope of teams access needed resources, rather than trying to provide core resources to a small number of teams. Facilitators could be provided with systematic training, tools and meeting opportunities, and be funded as CIHR staff or personnel awards. Complementary mechanisms could address the need for grant mentoring.

Developmental merit review: A widely-supported option was to create a more iterative and developmental approach to merit review, in which strongly supported and "almost there" applications could be helped to address the key gaps to their success.

Developmental grant system: A phased approach to grant funding could address the need for seed funding, especially requested within the Aboriginal Stream, but do it by building organizational capacity and providing for a more explicit progression from smaller grants to larger programs of research.

Training: In the absence of new funding to support the development of larger and more supportive training environments through STIHRS and NETs, CIHR could seek opportunities to connect trainees and larger research endeavours through approaches such as attaching research funds to training awards, and attaching training stipends to larger research grants within and beyond the CBR Program. CIHR could also look for ways to adapt the CBR awards to be more meaningful to mature and more experienced applicants, and more able to build on and integrate their existing work and expertise.

Advancing the science: CIHR could provide an annual opportunity for face-to-face exchange of best practices and findings, as well as identify on-going opportunities to piggy-back on other networks and events to provide regular opportunities to enhance research use and develop CBR methodology.

Next steps

The options presented in section 5 describe a range potential changes to the CBR Program, including both enhancements to existing funding mechanisms and the development of new approaches to support capacity development. To identify its priorities amongst these options, the key questions for the CBR Program become: how feasible is this change, and what is its likely impact?

Each option has thus been considered with respect to how effectively it will address the two priority capacity barriers identified by respondents, that is: 1) to build sustainable community-based research infrastructure (especially pre-project); and 2) to expand the cadre of Aboriginal Stream researchers.

Respondents report that Canadian community-based research has developed and strengthened considerably over the last ten years; academic capacity in the General Stream has particularly matured with CIHR's support. Community-based capacity, especially within Aboriginal community-based organizations, on the other hand, remains more limited. Respondents suggest that CIHR has made good use of the tools available to it. It is thus perhaps inevitable that the key remaining capacity gaps are those which are the least amenable to addressing within the boundaries of existing – and traditionally academic-oriented – CIHR approaches and mechanisms.

In consequence, those options which readily implemented in the short-term involve changes whose impact will be primarily in making it easier for those already active in CBR to do more research, more effectively. The medium term-options are more challenging to implement, but have greater reach into communities and not just academia, and are more likely to enable capacity building and strengthening within communities. The long-term options are the most challenging to CIHR's traditional modes of supporting and reviewing research, but also offer the greatest opportunities to use new translational mechanisms in order to achieve CIHR's new translational goals.

Short-term activities to support CBR

These activities are consistent with, and build on, enhancements CIHR has already made to the existing CBR funding mechanisms, and should be relatively easy to implement. They involve some new costs, but respondent feedback suggests that there would be community support for the necessary trade-offs. The primary outcomes of the short-term changes will be to make it easier for those already active in CIHR-funded CBR to do more research, more effectively.

Enhance grant programs

  • Revamp Program guidelines to maximize coherency, consistency, integration and mutual support among funding mechanisms; define allowed uses and evaluation criteria more explicitly
  • Adapt budget guidelines as possible to better support unique CBR needs
  • Work with other panels to enhance their capacity to review larger CBR operating grants

Enhance merit review criteria and processes

  • Expand review criteria for different types of CBR application, and training for merit reviewers
  • Support panels in providing more detailed and more constructive feedback

Promote and enhance training awards

  • Promote Aboriginal stream awards among undergraduates and community members; identify potential mentors to help them move towards and prepare for graduate level studies
  • Allow applicants from knowledge-user communities to undertake part-time studies, if supported by their community organization to build translational research capacity
  • Provide awardees with a research stipend commensurate with CBR costs and needs
  • Encourage stronger connections between training awards and research grants

Create fora for sharing best practices and findings

  • Develop annual meeting for funded CBR teams and trainees
  • Create HIV/AIDS CBR events and fora attached to other meetings and networks

Medium term activities

The medium term-options are more challenging to implement, as they require much longer lead time, and the development of new partnerships and/ or programs, as well as the shift of significant CBR Program funds from existing mechanisms into new or adapted mechanisms. These approaches can, however, build on existing CIHR funding tools (used outside the CBR Program) to achieve their goals. The medium-term options have greater potential to reach communities and not just academia, and are more likely to enable new capacity building and strengthening within communities, particularly enhancing access to support within the Aboriginal Stream.

There are many possible ways of structuring support designed to achieve the goals of each of these options; based on respondents' advice, it is likely that CIHR would pursue a mix of approaches to both community support and training. The most effective approach for the CBR Program would be to identify its long-term intentions for CBR support before addressing the medium-term activities, in order to select the medium-term structures and mechanisms which best support, and provide foundations for, the effective implementation of longer-term support mechanisms.

Partner with other funders to develop research infrastructure

Work with major funders of HIV/AIDS and Aboriginal community organizations to identify shared interests and approaches in investing in infrastructure which supports both research and service functions.

Revamp/ create community support mechanisms

Identify preferred structures, consistent with long-term planning, to provide support in the key areas identified by respondents: brokering, expert grant mentoring, training, and organizational development

  • A facilitating mechanism should include: an explicit focus on brokering and/ or training; funding facilitators as CIHR staff or awardees; integration with other programs and funded teams; and training, resources and regular meetings to exchange best practices, and funds to deliver workshops
  • A grant mentoring mechanism might include individual mentors supported as one or more of staff advisors, mentors supported via awards and/ or sabbaticals, and volunteer retirees; it could involve funding an external mentoring service, and/or workshops and other events

Training

  • Identify opportunities to expand the reach and training available through Universities Without Walls and the IAPH-funded NEAHRs, as well as other strategic training programs and funded teams
  • Develop structures which connect CBR awards and grants in a way which enhances the work of both the trainee and the researcher
  • When CBR Program funds allow it, support NETs and/or STIHRs designed to attract, support and build on the expertise of established professionals, especially in Aboriginal communities

Long-term activities

The long-term options address the most acute needs described by respondents, but present the most significant implementation challenges for the CBR Program, as they involve CIHR undertaking new approaches to programming and peer review, and their cost is primarily in staff time. However, the challenges created by engaging user communities as full and equal research partners are being increasingly experienced across CIHR, and are not unique to community-based research. The CBR Program therefore has a significant challenge – but also a considerable opportunity - to incubate novel approaches to delivering on the still-challenging knowledge translation half of CIHR's mandate.

Developmental merit review

Work with CIHR as a whole to identify an acceptable approach to piloting an iterative and developmental merit review process – suggested by respondents as the most useful change which could be made in the current CBR Program. A developmental merit review process could increase resubmissions, reduce community frustration, and help build stronger teams and research proposals.

Developmental grant program

Work with CIHR as a whole to identify an acceptable approach to piloting phased grant funding within the CBR Program. A developmental grant program could be based on existing grant tools, but would require significant changes in the application and review process to become more constructive, iterative and flexible, and more responsive to the needs, timing and size of the applications coming in. A developmental approach to grants could reduce the stakes and the risk, for both applicants and the funder, by starting with small steps and small funds which are easy to obtain, and increasing the funding and demands commensurately as the team builds its infrastructure and capacity, gains experience and establishes its track record. This approach would provide a significant pathway to support the development of community-based research infrastructure and resources when it is most need, as they begin to engage in research planning and development.

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