Sowing the seeds for sustainable change: a community-based participatory research partnership for health promotion in Indiana, USA and its aftermath

Community-based participatory research (CBPR) increasingly is being used in both developed and developing countries to study and address community-identified issues through a collaborative and empowering action-oriented process. In 2003-2005, a study was undertaken to document the impacts of CBPR on healthy public policy in the US. From an initial review of 80 partnership efforts, 10 were selected as best capturing the range and diversity of projects meeting the study criteria, and were the subject of in-depth case study analysis. This article presents and analyzes one of these cases, a collaboration between researchers at the Indiana University School of Nursing and the Healthy Cities Committee of New Castle, IN, USA. With its action component still underway a decade after the formal study's completion, the partnership was selected to enable an examination of sustainable change through CBPR. Beginning with a participatory door-to-door health survey of 1000 households using a non-probability quota sampling strategy, the project involved community members in many stages of the research process. A smoking rate of twice the national average was among the study findings that helped to galvanize the community into action. A variety of health promoting environmental and 'small p policy' changes were undertaken ranging from a bill restricting indoor smoking in public places to an initiative to develop a system of trails throughout the county to promote physical fitness and decreased reliance on automobiles. This article examines the evolution of the original CBPR partnership, its research methods and findings, and the environmental changes it sought to promote healthier lifestyles. Success factors, barriers and sustainability benchmarks are discussed. The case study offers an example of the potential of CBPR for helping to lay the groundwork for long-term sustainable change in support of healthier communities.