Reflecting on the Backstage and Frontstage of Community-Based Participatory Research: Ethics and Collaboration in the CATALYST Study

Abstract

Community-based participatory research (CBPR) is critical for promoting health equity through the incorporation of equitable decision-making and participatory processes into health equity research. Yet, research processes often fail to align with community realities. Drawing on Goffman’s frontstage–backstage framework, this paper examines how a community–academic partnership navigated and negotiated processes to support ethical inclusion of community researchers and participants in a CBPR qualitative study conducted in Orange County, California, focused on the roles of Community Health Workers (CHWs) during the COVID-19 pandemic. We share how backstage processes of trust-building and negotiation directly informed frontstage strategies to strengthen ethical research practices with community participants. We explore considerations for key components of qualitative research processes that have consequences for participatory research approaches: (a) partnership formation (b) inclusive consent processes, (c) inclusive recruitment processes, (d) facilitating direct community participation in qualitative research methods, and (e) full integration of community members as researchers across all stages through, for example, allocating resources to support equitable decision-making processes that center community expertise. Barriers including bureaucratic processes (e.g., complex consent requirements, language accessibility, cumbersome processes, and budget constraints) and power imbalances in research roles are discussed. Strategies to address these challenges include relationship-centered and community-focused ethical review processes to improve the potential for informed consent and authentic participation, and structural support for sustained participation of community researchers throughout the research process, which often extends beyond the lifecycle of the research grant. Recommendations are provided to enhance future research practices to prioritize equity, accessibility, and community leadership, such as integrating community members into IRB oversight processes, discussing risks of research participation that may extend beyond the methods or substance of the project, and reducing academic barriers to supporting community researchers.