Understanding Occupational Identities and Roles on a Community-Based Participatory Research Team

BACKGROUND AND PURPOSE: Occupational therapy practitioners have long been interested in strengthening the dialectic between theory and practice. Recently, scholars have argued for the need to understand the dynamic interplay among researchers, practitioners, and the community (Hammel et al., 2015). To this end, occupational therapy practitioners increasingly use community-based participatory research (CBPR) to address social justice issues (e.g., health care disparities).

However, there is a dearth of research examining the collaborative process—that is, how CBPR team members from different communities come together. The purpose of this study was to understand how academic, disability community, and managed care partners came together collaboratively on a federally funded CBPR team as they developed and piloted a peer health navigator intervention. This study asked two questions: (1) How does the CBPR team come together collaboratively throughout the project? (2) How do the various occupational identities of research team members influence the collaborative process?

METHOD: This 9-mo ethnographic study (12/1/16 to 8/15/17) used participant observation and interviews. All research team members were eligible to participate. Author A.A. recruited at team meetings and via email. Participants were six academic (and clinical) team members, one managed care community partner, one disability community partner, and four peer health navigators (PHNs). The PHNs, who had lived experience as people with physical disabilities, provided health care navigation for Medicaid recipients with physical disabilities who participated in the intervention.

The data corpus consisted of 27 field notes, 11 interviews, and 1 focus group. A.A. collected the data. Author A.F. transcribed the data verbatim. A.A. and A.F. read through the entire data set and coded separately using open coding and content analysis. Then the authors compared, discussed, and revised the themes, resulting in 10 themes and 11 subthemes.

RESULTS: The CBPR team members navigated two occupational identity and role continua as they engaged with the team, moving along the continua in a fluid and dynamic way. The first continuum ranged from Disability Identity to Professional Identity. Disability community team members emphasized the importance of maintaining a strong disability identity. The PHNs sought both to gain professional skills (or return to a professional role that had been disrupted by the onset of their disability) and to maintain their “peerness” and disability identity. The second continuum ranged from Academic Roles to CBPR Roles. The team sought to find a balance between (1) maintaining scientific rigor along with CBPR principles of equality and (2) valuing experiential (over expert) knowledge.

Some research team members held dual identities and roles, which presented challenges at times when they felt pulled in two directions. However, many team members also expressed that it was beneficial for the team to have members with dual identities and roles because they contributed to the team’s ability to come together. One team member who held dual identities said, “I felt like I was a pretty good bridge.”

CONCLUSION AND IMPACT STATEMENT: These findings provide insight into the collaborative process of CBPR teams, which are an important way to link theory, practice, and the community. Compared with an observational or clinical study, a CBPR study can heighten tensions within the research team as they bring together various perspectives and priorities. Our findings suggest that dual occupational identities can be challenging for CBPR team members to navigate, but they may also be beneficial and a critical part of the success of a project because these members can serve as a bridge to facilitate collaboration among members from different communities.

References

Chapman, S., Blash, L., & Chan, K. (2015). The peer provider workforce in behavioral health: A landscape analysis. San Francisco: UCSF Health Workforce Research Center on Long-Term Care.

Hammel, J., Magasi, S., Mirza, M. P., Fischer, H., Preissner, K., Peterson, E., & Suarez-Balcazar, Y. (2015). A scholarship of practice revisited: Creating community-engaged occupational therapy practitioners, educators, and scholars. Occupational Therapy in Health Care, 29, 352–369. https://doi.org/10.3109/07380577.2015.1051690

Rudman, D. L., & Dennhardt, S. (2008). Shaping knowledge regarding occupation: Examining the cultural underpinnings of the evolving concept of occupational identity. Australian Occupational Therapy Journal, 55, 153–162. https://doi.org/10.1111/j.1440-1630.2007.00715.x