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The Power of Poetry in Participatory Research

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The Power of Poetry in Participatory Research

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“Poetry, I think, is an interruption of silence.  The poem makes sense largely because it has this space around it.  It is inhabiting a part of this space but leaving space around it.  So a poem is an interruption of silence, and occupation of science; whereas public language is a continuation of noise.” – Billy Collins, former U.S. Poet Laureate  (in Leavy, 2015, p. 77).

“Poems are not threatening and open up the room in a non-aggressive way.” – A community health worker for the City of San Antonio Healthy Neighborhoods program.

Poetry is almost otherworldly; it reaches something visceral inside the reader.  Coupled with participatory research, it has the power to transform, to bring awareness and understanding to cultural or social issues and connect the writer with the reader in a profound way.  Carl Leggo, a pioneer in poetic inquiry explains that “poetry invites us to experiment with language, to create, to know, to engage creatively and imaginatively with experience’’ (in Leavy, 2015, p. 77).  Consequently, using poetry as an arts-based methodology to embody meaning in participatory research is a powerful way to start conversations, engage participants, and interpret data.  The following situations provide examples as to how poetry became a part of a project, engaging the participants, and influencing outcomes.

The Spoken Word Project
Spoken Word is a form of poetic expression performed as a dramatic monologue in front of an audience.  Researchers in North Carolina used spoken word poetry as a method to bring HIV and AIDS awareness and prevention.  Through poetry, the group was able to disseminate information, dispel misinformation and myths that may be common to the local setting, and provide educational messages about transmission and protective barriers regarding HIV and AIDS.  The Spoken Word Project was a collaborative effort between residents of two rural counties and a community-based participatory research collaboration aimed at reducing health disparities in African American communities.  Results indicated that spoken-word poetry had the ability to build upon local resources, generate community reflection, and engage a broad spectrum of performers and audiences. Findings also showed that the effect of stigma and limited community conversations about HIV in rural communities could be abated through the use of spoken-word (Isler, et al, 2015).

River of Life
In their 2004 book, Wallerstein and Auerbach describe the River of Life activity as an exercise that “can simultaneously build community and...uncover generative themes” (p. 32).   This strategy was employed by Alfredo Ortiz-Aragon and Raphael Hoetmer, along with Juan Carlos Giles as part of a “participatory strategic planning process” while working with a diverse group of participants in Peru. (2020, p. 114).  What follows is a moment in which the use of poetry invigorated the gathering:
Ironically, a moment occurred in the systematization workshop where the River of Life process had itself had become tiring, with participants becoming lethargic. One participant asked if he could perform the poem “El Río” by Javier Heraud, to help us “row out” of the workshop eddy we were experiencing! He performed one stanza of the poem using spoken-word style, which led to a full performance by two others the following morning. The full performance was followed by a reflective plenary session in which it became evident that the poem performance and the significance of the river metaphors that it emphasized had recharged the workshop with meaning, beyond that which was occurring through River of Life method on its own (p. 118).

African American Mothers and Breastfeeding
In participatory research, the use of poetry connects people in ways that mere words don’t.  It took the use of a poem about a wet-nurse and slave to spark interest in developing conversations and community involvement regarding African American mothers and breastfeeding within the Healthy Neighborhoods program in San Antonio.  Sharing this poem with the other community health workers on the Breastfeeding Initiative opened their eyes to the realization that the challenges and barriers facing Black mothers can be traced back to slavery when Black women didn’t own their own bodies and weren’t allowed to feed and care for their own children...to such an extent that those children died while their mothers nursed the children of their white masters.  This was the push the community health workers needed, and within a month, the community health workers were able to gather community members from all walks of life to have meaningful conversations about the importance of breastfeeding.  (Ortiz-Aragon, Hernandez, Vasquez, & Gonzalez, 2020).

Poetry, along with other artistic forms of expression, has a rich history as a tool for community mobilization and has the potential to provide an innovative approach to dismantling social challenges (Isler, et al, 2015).  The use of words, rhythm, and breath create spaces for meaning to emerge and understanding to take place while engaging participants with the issues on a deeper level.  When poetry is introduced, it adds another layer to the research, prompting more thoughtful interactions and reaching participants in ways that other, more traditional methodologies may not.

References
Isler, M. R., Dave, G., Jones, H. L., Stith, D., Richwood, T., Griffith, T., . . . Corbie-Smith, G. (2015). The Spoken Word Project: Using Poetry in Community Dialogue and Mobilization for HIV Prevention. Journal of Community Engagement and Scholarship, 8(1). doi:http://jces.ua.edu/the-spoken-word-project-using-poetry-in-community-dialogue-and-mobilization-for-hiv-prevention/
Leavy, P. (2015). Method meets art: Arts-based research practice. New York, NY: The Guilford Press.
Ortiz-Aragon, A., Hernandez, A., Vasquez, M. & Gonzalez, N. (2020). Initial conversations between UIW and HN participants regarding the Healthy Neighborhoods Breastfeeding Initiative [Online interview].
Ortiz-Aragon, A., & Hoetmer, R. (2020). Flowing with the River's Go: Seeking Ethical, Pragmatic, and Strategic Participation in the Design of a Regional Funding Strategy. International Review of Qualitative Research, 13(2), 112-139.
Wallerstein, N., & Auerbach, E. (2004). Problem-posing at work: Popular educator’s guide. Grass Roots Press

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Understanding the Complexities of African American Moms & Breastfeeding

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Understanding the Complexities of African American Moms & Breastfeeding

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As a young, African American woman, wife, and soon-to-be mom of our first child, I was intrigued by the notion of breastfeeding. Although my mom chose not to, I knew my grandma had done it, which I believe in some way influenced my ultimate decision. I discussed my options with my prenatal health care provider, husband, mom, grandma and received an abundance of support. Being able to stay home during my time nursing both my sons added an additional layer of comfort, support, and happiness that proved a healthy choice for both my babies and me.

Unfortunately, for many young women in the African American community this is not the case. In fact, at the time, I was unaware of the many socioeconomic and health issues that challenge many young moms and soon-to-be moms in their decision to breastfeed.

While many young African American mothers are aware of the health benefits to mom and baby associated with breastfeeding; too often, life circumstances, feelings of failure, lack of information, lack of support at home and or work, and the overall health of the moms are contributing influences that act as barriers to the mother’s decision to nurse her baby (Gill & McGlothen, 2017). Chopel et al. (2018) found that while many of these challenges were not exclusive to African American mothers, they were found to be more pronounced among this population. Data from the Texas Women, Infants and Children (WIC) supplemental nutritional program for pregnant, breastfeeding women and families with children younger than 5, reveal that there are fewer African American babies (78.6%) that are breastfed than the overall percentage (85.3%) of breastfed babies (Williams, 2019). To improve these statistics, Texas WIC is prioritizing breastfeeding support for African American moms such as lactating programs, training, education, awareness, and partnership arrangements (Williams, 2019). Notwithstanding these important program initiatives, research into the multilayered complexities that African American mothers face in their home, work, and community warrants further study.

A CBPR approach can be instrumental in exploring the phenomenon of such multilayered complexities. Addressing the barriers and challenges of breastfeeding among African American has shown to have made positive inroads into collaborative community relationships as co-researchers. Citing Wallerstein et al. (2017), researchers Chopel, et al. (2018) agreed that “unlike traditional investigator-driven research models, CBPR enables stakeholders to actively participate in determining research aims, collecting, analyzing, and interpreting data, and disseminating and applying results” (p. 302). In a pilot support intervention, results among young African American mothers revealed a preference for partnering with their community for support (2018). Findings such as these lay the groundwork for the usefulness of CBPR in working with communities to identify resources for sustainable programs for African American breastfeeding women. Overcoming barriers, improving health for both mom and baby, promoting family and community support leads to a healthier community overall.

In McCallum’s (2017) article, Giving Back to the Community: How African Americans Envision Utilizing Their PhD, she shared the desire of research participants to honor their community for giving them encouragement and support. To leverage their position to pay it forward by returning to help to raise awareness, inspire empowerment through community voice, and engage in participatory partnerships that positively affects the lives of those within the community. As a doctoral student, I share these sentiments and stand ready to bring my participatory efforts and personal experience to a CBPR project focused on the community health initiative of African American women and breastfeeding.

References
Chopel, A., Soto, D., Joiner, B., Benitez, T., Konoff, R., Rios, L., & Castellanos, E. (2018). Multilevel factors influencing young mothers’ breastfeeding: A qualitative CBPR study. Journal of Human Lactation, 35(2), 301-317.
Gill, S., & McGlothen, K. (2017, February 9). Breastfeeding beliefs and attitudes among Black Americans. Retrieved from Women’s Health Today: https://womenshealthtoday.blog/2017/02/09/breastfeeding-beliefs-and-attitudes-among-black-americans/
McCallum, C. (2017). Giving back to the community: How African Americans envision utilizing their PhD. The Journal of Negro Education, 86(2), 138-153.
Williams, C. (2019, August 2). Texas aims to improve health of women, babies. Retrieved from Texas Health and Human Services: https://hhs.texas.gov/about-hhs/communications-events/news/2019/08/texas-aims-improve-health-women-babies
Photograph: KidStock/Getty Images

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"Everyone, including ourselves, comes with a particular lens through which we view the world” (Abma et al., 2019, p. 24). Lenses serve as evolving frameworks through which we gain deeper insight and understanding (Abma et al., 2019). These frameworks often do not permeate our immediate consciousness, and have been forged through our life experiences, environment, education, and positionalities (Abma et al., 2019). It is necessary to facilitate the emergence of these frameworks, so that they can be used to make sense of the world around us (Abma et al., 2019). An awareness of our own frameworks will also enhance our ability to comprehend the frameworks of others, as well (Abma et al., 2019).

The framework utilized by CPBR is structured into a transformational paradigm which adheres to a set of core guiding principles (Abma et al., 2019). This paradigm is centered around the process of sharing and co-creating knowledge, and therefore has the capacity to accommodate the complexities of societal relationships and power-sharing dynamics (Abma et al., 2019). The transformative nature of this framework also lends itself to the promotion of change, and knowledge gained during the research process can be used to inform social justice efforts (Abma et al., 2019).

CBPR's transformational paradigm has the inherent ability to inform our understanding through synergistic relationships with a multitude of other frameworks, as well (Ward et al., 2018). Although structural differences exist between these frameworks, all share in a common overarching purpose, and serve to provide “ways of understanding our world and tools for meaning making and discovery” (Abma, 2019, p. 27) Practitioners use these ideas to develop the conceptual frameworks which ultimately  guide their approach to specific research initiatives. These frameworks are meant to "undergird your thinking with regards to how you understand and plan to research your topic" (Grant & Osanloo, 2018, p. 13). Given the focus of our inquiry team, which frameworks might we use to gain further insight as we explore racial disparities in breastfeeding?

References
Abma, T., Banks, S. Cook, T., Dias, S. Madsen, W., Springett, J., & Wright, M. (2019). Participatory research for health and social well-being. Cham, Switzerland: Springer International Publishing.
Grant, C., Osanloo, A. (2014). Understanding, selecting, and integrating a theoretical framework in dissertation research, Administrative Issues Journal, 4(2), 12 - 26. https:doi.org/10.5929/2014.4.2.9
Wallerstein, N., Duran, B., Oetzel, J., & Minkler, M. (2018). Community based participatory research for for health; Advancing social and health equity. 3rd Edition. San Francisco, CA: Jossey-Bass.

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TRUST BUILDING WITH COMMUNITY AND INTERDISCIPLINARY TEAMS IN SETTING OF AFRICAN AMERICAN BREASTFEEDING.    

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TRUST BUILDING WITH COMMUNITY AND INTERDISCIPLINARY TEAMS IN SETTING OF AFRICAN AMERICAN BREASTFEEDING.    

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Lack of support for breast feeding has been consistently found to be a major reason for a resistance to its use in disadvantaged populations (Ringel-Kulka, 2011).  This lack of support includes family, friends, other community members, other community organizations and healthcare providers.  Community Based Participatory Research (CBPR) provides the ideal tool to increase the community support for breast feeding efforts, particularly in disadvantaged populations.  However, resistance to participating in research projects, which has been shown to be increased in disadvantaged populations, stems from a lack of trust originating in a history of unethical research experiments.  This resistance is reinforced by culturally insensitive research which does not incorporate their needs or provide demonstrable value to the participants.

Ammerman et al. (2003) found African Americans were more likely to believe research places them at personal risk and not all risks are fully disclosed.  The tradition models of research create a strong power imbalance by placing researchers as the experts and the participants as merely objects to be studied.  Often research studies swoops in briefly, quickly collects some data and leaves.  The selection of relevant data, collection and interpretation is done through the lens of the biases of the researchers, placed in a journal only accessible to other researchers and provides no tangible benefits to the participants.  Often no actual changes occur which are valued for the participants of the study and this lack of value over time increases distrust.

Creating actual change driven by the needs of the community and building trust between community members and multiple institutions is both an advantage of the CBPR model and a requirement for it to be successful.  Early CBPR studies often merely involved the community in the research process, but it has evolved so true CBPR gives control over every aspect of the research to the community.  Health and wellness CBPR should become a partnership among community members, healthcare organizations, social service providers and researchers.  These multiple stakeholders have several barriers they need to cross to create partnerships and include: interpersonal conflict and long standing feuds, lack of genuine inclusion, hidden agendas, lack of group ownership of research, poor information flow, lack of cultural competence and developing effective leadership (Holden et al., 2016).

Building trust and developing relationships between the community members working on the CBPR project is key to overcoming these barriers.  Each member must first learn what each other finds valuable in participating in the research and then learn to respect and value each other other’s perspectives (Orpinas, 2020).  This is done through a process of dialogue with community members and organizations on what they need and what they could offer; while working through the disagreements and finding compromise.

Identifying organizations which are sincerely motivated to help community members and are meaningful to the community members can help this dialogue reach successful agreements.  Once an agreement is reach, efforts to address health disparities are more likely to be successful.  Falcone et al. (2006) found churches the organization which provided the best partnerships for culturally relevancy and trust with African Americans.  They found churches as the partnerships of choice as African American communities largely trusted churches as advocates for their best interests.  Churches are but one example, and many others influential organizations are trusted in these close-knit protective communities (Baker et al. 2006; Belin et al. 2006).  The key to identifying the proper organizations which are valued by the communities is building relationships with these communities and asking them.                                                                                                                                                                                             Once genuine trusting partnerships are developed between community members, optimal development and maintenance of these relationships requires: long range planning, inter- and intra-coalition communication, and monitoring of legislative and fiscal changes affecting the members (Holden et. al, 2016).  It also requires task-oriented and interpersonal-oriented leadership, conflict management, shared ownership of project, diverse socialization opportunities, mentoring, training, fundraising and appropriate resource allocation.  When done successful CBPR provides a powerful model for addressing healthcare disparities such as community support for African American breastfeeding through building mutually beneficial long-term relationships between communities and organizations.  Enabling culturally sensitively addressing the needs of the community through extensive community and coordinated multiple organization based efforts.

References

Ammerman, A., Corbie-Smith, G., St. George, D.M., Washington, C., Weathers, B., & Jackson-Christian, B. (2003). Research expectations among African American church leaders in the PRAISE! Project: A randomized trial guided by community-based participatory research. American Journal of Public Health,93(10), 1720-1727

Baker, E.A., Kelly, C, Barnidge, E., Strayhorn, J., Schootman, M., Struthers, J., & Griffith, D. (2006). The Garden of Eden: Acknowledging the impact of race and class in efforts to decrease obesity rates. American Journal of Public Health,96(7), 1170-1174

Belin, PL., Washington, T.A., & Greene, Y (2006). Saving grace: A breast cancer prevention program in the African American community. Health and Social Work, 31(1), 73-76

Falcone, R.A., Brentley, A.L., Ricketts, CD, Allen, S.E., & Garcia,V.F. (2006). Development, implementation, and evaluation of a unique African American faith-based approach to increase automobile restraint use. Journal of the National Medical Association, 98(8), 1335-134

Holden, K., Akintobi, T., Hopkins, J., Belton, A., McGregor, B., Blanks, S., & Wrenn, G. (2016). Community Engaged Leadership to Advance Health Equity and Build Healthier Communities. Social Sciences, 5(1), 2. https://doi.org/10.3390/socsci5010002

Orpinas, P., Matthew, R. A., Bermúdez, J. M., Alvarez‐Hernandez, L. R., & Calva, A. (2020). A multistakeholder evaluation of Lazos Hispanos: An application of a community-based participatory research conceptual model. Journal of Community Psychology, 48(2), 464–481. https://doi.org/10.1002/jcop.22274

Ringel-Kulka, T., Jensen, E., McLaurin, S., Woods, E., Kotch, J. B., Labbok, M., Bowling, J. M., Dardess, P., & Baker, S. (2011). Community-Based Participatory Research of Breastfeeding Disparities in African American Women. ICAN: Infant, Child, & Adolescent Nutrition, 3(4), 233–239. https://doi.org/10.1177/1941406411413918