Action Research
http://arj.sagepub.com
Reciprocity: An ethic for community-based participatory action research
Sarah Maiter, Laura Simich, Nora Jacobson and Julie Wise
Action Research 2008; 6; 305
DOI: 10.1177/1476750307083720
The online version of this article can be found at:
http://arj.sagepub.com/cgi/content/abstract/6/3/305
Published by:
http://www.sagepublications.com
Additional services and information for Action Research can be found at:
Email Alerts: http://arj.sagepub.com/cgi/alerts
Subscriptions: http://arj.sagepub.com/subscriptions
Reprints: http://www.sagepub.com/journalsReprints.nav
Permissions: http://www.sagepub.co.uk/journalsPermissions.nav
Citations (this article cites 26 articles hosted on the
SAGE Journals Online and HighWire Press platforms):
http://arj.sagepub.com/cgi/content/refs/6/3/305
Downloaded from http://arj.sagepub.com by Maura Fulton on October 1, 2008
Action Research
Volume 6(3): 305–325
Copyright© 2008 SAGE Publications
Los Angeles, London, New Delhi and Singapore
www.sagepublications.com
DOI: 10.1177/1476750307083720
ARTICLE
Reciprocity
An ethic for community-based participatory
action research
Sarah Maiter
York University, Canada
Laura Simich and Nora Jacobson
University of Toronto, Canada
Julie Wise
Centre for Research and Education in Human Services,
Canada
ABSTRACT
KEY WORDS
•
community mental
health
•
community-based
participatory
research
•
immigrant mental
health
•
multiculturalism
•
reciprocity
Ethical issues have been of ongoing interest in discussions of
community-based participatory action research (CBPAR). In this
article we suggest that the notion of reciprocity – defined as an
ongoing process of exchange with the aim of establishing and
maintaining equality between parties – can provide a guide to
the ethical practice of CBPAR. Through sharing our experiences
with a CBPAR project focused on mental health services and
supports in several cultural-linguistic immigrant communities in
Ontario, Canada, we provide insights into our attempts at
establishing reciprocal relationships with community members
collaborating in the research study and discuss how these
relationships contributed to ethical practice. We examine the
successes and challenges with specific attention to issues of
power and gain for the researched community. We begin with a
discussion of the concept of reciprocity, followed by a description of how it was put into practice in our project, and, finally,
conclude with suggestions for how an ethic of reciprocity might
contribute to other CBPAR projects.
305
Downloaded from http://arj.sagepub.com by Maura Fulton on October 1, 2008
306 • Action Research 6(3)
Introduction
Ethical issues have been of ongoing interest in social science and health research
(Trimble & Fisher, 2006), including in discussions of participatory action
research (PAR) and related approaches like action research (AR) and community-based participatory action research (CBPAR) (Beauvais, 2006; Khanlou &
Peter, 2005). Based on a philosophy of partnership and principles of selfdetermination, equity, and social justice, these approaches aim to break down
barriers between the researcher and the researched (Cornwall & Jewkes, 1995)
by assuming that people are able to assess their own needs and to act upon
them (Minkler, 2004; Minkler & Wallerstein, 2003) and by valuing community
partners as equal contributors to the research project (Minkler, 2004).
Bradbury and Reason (2003) note five characteristics of action research –
emergent developmental form, human flourishing, practical issues, participation
and democracy, and knowledge in action – and argue that these characteristics
result in a broad range of choices, which have implications for the validity and
quality of action research. We would argue that the principle and practice of
reciprocity represents a similar choice, which, like the five characteristics identified by Bradbury and Reason, has important implications for the quality of
relationships, outcomes, knowledge, significance, and consequences of community-based participatory action research.
In this article we suggest that the notion of reciprocity can provide a guide
to the ethical practice of CBPAR. Although we may presume that reciprocity is a
core consideration for all CBPAR researchers and that it finds expression in many
of our familiar practices, we believe that we can enhance its importance by
framing it as an ethical matter. Our aim in this article is not to discuss how
researchers and ethics boards should interact, but to discuss the value of reciprocity in the broader context of CBPAR research, in other words, interactions
among researchers and communities. Through sharing our experiences with a
CBPAR project focused on mental health services and supports in several
cultural-linguistic communities in Ontario, Canada, we provide insights into our
attempts at establishing reciprocal relationships with community members with
whom the research was being conducted and discuss how these relationships
contributed to ethical practice. We examine the successes and challenges with
specific attention to issues of power and gain for the researched community. We
begin with a discussion of reciprocity, followed by a description of how it was put
into practice in our project, and, finally, conclude with suggestions for how an
ethic of reciprocity might contribute to other CBPAR projects.
Downloaded from http://arj.sagepub.com by Maura Fulton on October 1, 2008
Maiter et al.
Reciprocity • 307
Reciprocity as an ethical basis for research relationships
Ethical research is about relationships founded on trust and reciprocity. Our contribution to the discussion of CBPAR and research ethics is to raise awareness
of how reciprocity underlies social relationships in general and ethical research
relationships with diverse communities specifically. Reciprocity describes the
respectful nature of good research relationships and exchanges that are essential
in participatory and other types of research. ‘Reciprocal dialogue’, in which an
individual researcher and study participant communicate as equals, may even
have the potential to help resolve ethical problems in research (Trimble & Fisher,
2006; Yassour-Borochowitz, 2004).
We suggest that the practice of reciprocity be taken beyond the individual
level in conducting health research. The recent health research literature in fact
illustrates growing theoretical interest in reciprocity and trust as fundamental
health promoting factors that are usually couched in terms of ‘social capital’ on
the community level (Portes, 1998). A common definition of social capital, for
example, includes characteristics of social networks, civic engagement and identity, trust and ‘reciprocity and norms of cooperation, or a sense of obligation to
help others, along with a confidence that such assistance will be returned’
(Putnam, 1993; Whitely & McKenzie, 2005, p. 72). An earlier seminal definition
of social capital also emphasized expectations of reciprocal exchange, but factored in the way in which power and structural inequalities are reproduced in the
process (Bourdieu, 1986). Debating social capital is beyond the scope of this article. However, in light of the growing recognition that social capital and reciprocity are associated with community wellbeing and have the potential to facilitate
mental health care (Sartorius, 2003), we also suggest that reciprocity is an integral social process in the context of participatory action research, especially
research aimed at community mental health promotion. Practically speaking,
there is much to learn about the construction of trust and reciprocity in local contexts that is essential for community health promotion research (Hawe & Shiell,
2000).
The contemporary view of social capital and reciprocity has earlier roots in
social science. Having engaged in cross-cultural research for over a century, for
example, anthropologists have long encountered similarities and variations in
ethical interpretations and social relations. One ubiquitous observation from the
field is that people in all societies are bound to one another in basic social
exchanges that consolidate social relationships, ranging from marriage and
kinship in small-scale societies to complex economic transactions among global
trading partners. The simplest mode of social exchange is reciprocity, which is
defined as ‘exchange between social equals’ (Kottak, 1986, p. 136). Reciprocity is
a personalized form of exchange in which there is an expectation of return that
takes place between people who have a social bond, which is strengthened by the
Downloaded from http://arj.sagepub.com by Maura Fulton on October 1, 2008
308 • Action Research 6(3)
exchange. It reinforces egalitarian relationships, but carries moral weight and
therefore has inherent psychological power over the recipient until the obligation
to reciprocate is eventually met (Kleinman, 1995; Mauss, 1954). As a fundamental form of exchange, reciprocity co-exists in our society with more complex
forms of economic exchange, such as redistributive (social welfare) and market
economies that exist in prevailing situations of social inequality.
The practice of reciprocity in anthropological research is underscored by
professional ethical standards that emphasize not only the avoidance of harm, but
also ‘active consultation with the goal of establishing a working relationship that
can be beneficial to all parties involved’ (American Anthropological Association,
1998). The professional code explicitly states that anthropologists ‘should recognize their debt to the societies in which they work and their obligation to
reciprocate with people studied in appropriate ways’ (Section IIIA, point 6).
Transparent social relationships in reciprocal exchanges are fundamental as well.
Kim Hopper’s (1996) groundbreaking ethnographic research among the homeless in New York City initially involved researchers pretending to be homeless to
‘blend in’ with study participants; however, he writes that they were forced to
change their approach to data collection. Feeling that the pretence betrayed
trust and abused participants’ ability to connect with others in distress, Hopper
reflected that reciprocity might take the form of ‘simply being honest in setting up
research relationships’ (p. 168). Reciprocity is not only necessary to accomplish
research in an ethical manner, but it is also illuminating, since the process of
negotiating priorities and learning what study participants expect to obtain from
cooperating with researchers reveals valuable cultural knowledge (Wax, 1952).
Reciprocity, although a fundamental form of social interaction and
exchange, has not often been emphasized as an integral part of health sciences
research. Perhaps this is because medical science has typically not been attentive
to social relationships ‘inside’ the research process. Instead, most researchers
embrace the ‘expert’ perspective, adopting an objectivist stance that does not
encourage introspection regarding social interdependencies among researchers
and researched (Boser, 2006). However, reciprocity as an ethical basis for
research relationships may be especially significant for health research. Drawing
on ethnographies from societies as diverse as Taiwan, Rwanda, and Malaysia in
his critical analysis of biomedicine, Kleinman (1995) touches on the fundamental
role of reciprocity in healing in many cultures. The social dialectic of reciprocity
organizes society, ensures fulfillment of obligations and defines the moral self,
thereby assuring emotional wellbeing. He states quite plainly, ‘Good exchange is
good health’ (Kleinman, 1995, p. 220). Basic ties engendered by reciprocity in
traditional small-scale societies may, however, be altered under the growing pressures of commodification of exchange in complex large-scale societies. As social
exchanges become more attenuated and alienating, as in modern biomedical
research and practice, the potential for healing embedded in reciprocal social ties
Downloaded from http://arj.sagepub.com by Maura Fulton on October 1, 2008
Maiter et al.
Reciprocity • 309
is weakened. Focusing anew on the ethics of reciprocity in health and social
research may therefore strengthen both health research relationships and health
outcomes.
One recent exception to the objectivist stance in health research may be
seen in the contributions of aboriginal researchers to developing collaborative
methodologies (Smith, 1999). Reflexive discussions about the reciprocity inherent in the process of in-depth, unstructured interviewing also have appeared in
the literature. Corbin and Morse (2003), for example, describe the interview
process as a dialogue and ‘an exchange’ in which participants divulge personal
information. In return, participants receive the attention of the interviewer,
validation, the chance to be unburdened, to sort things out, and to help others by
sharing experience. They write, the ‘human connection intensifies’ over the
course of the interview during which ‘a conscientious researcher will try to
discern what it is participants are seeking, then, if possible, provide that either
during the interview or once it’s over’ (p. 342).
The ethics of health research may be at least as much about collective as
individual morality. Often our efforts as concerned scientists have been focused
on resolving ethical dilemmas by inserting cultural differences into existing
ethical frameworks that still emphasize (in the western ethical tradition) confidentiality, securing individual informed consent, or assessing individual risks.
Although important, this individualistic point of view may be a conceptual limitation when considering participatory forms of research with diverse cultural and
linguistic populations. Indeed, the more relevant framework may draw from that
of public health in the developing world, where individual rights may not be the
foremost concern. As Benetar (2002) has asserted, ‘It is vital now for the ethics
debate to include the best interests of whole populations, the ethics of how institutions should function, and the ethics of international relations’ (p. 1132).
Related challenges occur in many research settings. Discussing clinical research
with immigrants and refugees, for example, Marshall, Koenig, Grifhorst, and van
Ewijk (1998) note that several ethical issues commonly arise: the utility of culture
and respect for the individual; issues of confidentiality; communication, and
interpretation; and problems associated with discrimination and political repression. Most social scientists would agree that these issues are problematic and formidable, but not surprising obstacles to conducting impeccable research. Yet, as
these problems concern difficulties in social relations, could we not find solutions
by improving social relationships? Can we adopt a broad view of research as a
process of reciprocal social exchanges on a collective level?
Downloaded from http://arj.sagepub.com by Maura Fulton on October 1, 2008
310 • Action Research 6(3)
Taking culture seriously in community mental health: An
example of reciprocity in community-based participatory
action research practice
We now turn to examining reciprocity within the context of our five-year CBPAR
project in Ontario, Canada. This project, entitled ‘Taking Culture Seriously in
Community Mental Health’, is a collaboration among academics (from three
universities and one university-affiliated hospital), a community-based research
center, four community-based mental health/health organizations, two umbrella
organizations (in mental health and diversity), and five cultural-linguistic communities: immigrants and refugees originating from Somalia, Poland, China
(Mandarin-speaking), Latin America (Spanish-speaking), and India (Punjabispeaking Sikhs) in two sites – Toronto and Waterloo Region. Its purpose is to
explore, develop, pilot and evaluate innovative ways of providing mental health
services and supports to people from diverse cultural backgrounds. In the first
phase of the work, academic and community researchers gathered data to
develop a framework that will form the basis for pilot projects. In the second
phase, these pilot projects will be designed and implemented by communities in
partnership with organizational partners. The research team will evaluate the
pilot projects in the third phase, with findings shared among the collaborating
partners, the larger communities, policy-makers, funders, as well as local, provincial, and federal government.
The focus of the project is on the active participation of all collaborators
towards tangible and meaningful change. However, the underlying strength of
the project, and its potential for success, lies in the relationships that are being
created, tested, and deepened with each new stage of the project. In order to
examine these relationships, and the concept of reciprocity inherent in them, our
description of the project will be divided into four stages: planning and design;
initiation; data collection and analysis; and dissemination.
Planning and design (initiating relationships)
Establishing good working relationships based on reciprocity with study communities may help eliminate some of the ethical and methodological problems
identified in the literature as being associated with doing research with diverse
communities. For example, negative stereotypes and lack of perspective on the
real needs of minority communities often lead to problem-focused research on
ethnic minority populations (Gil & Bob, 1999). Therefore, including people from
the culture or cultures being studied in the planning, implementation, interpretation, and dissemination of the research will increase the likelihood that crosscultural research will be respectful of those it studies (Fontes, 1997).
The first challenge is to ensure that the topic being studied is truly one
Downloaded from http://arj.sagepub.com by Maura Fulton on October 1, 2008
Maiter et al.
Reciprocity • 311
that the community wants investigated. Building relationships and exchanging
information with the community at this early stage to make sure that the research
investigation meets the concerns of the community can be done by seeking a
person from the community who can help in networking with the community,
linking with ethno-specific community-based agencies, and putting together community advisory boards (Roe, Minkler, & Saunders, 1995). Throughout this
process efforts must be made to ensure that reciprocity is a guiding principle for
the research relationship.
The idea for this CBPAR project originated from two of the culturallinguistic communities with whom the lead organization had a previous working
relationship. Having experienced positive community outcomes on earlier projects, and having developed trust in the CBPAR approach to research, members of
these communities approached the lead organization about a growing need within their communities for mental health services and supports, coupled with a
lack of awareness of, and access to, such support. The lead organization
approached academic and organizational partners in Toronto and Waterloo
Region to discuss the possibility of submitting a proposal for a study on the issue
of mental health and cultural diversity. Additional cultural-linguistic communities were approached to explore the possibility of collaborating on the project.
Most were communities that partnering organizations were connected to through
previous projects. Leaders in each community were approached initially through
face-to-face meetings. The purpose of the study was discussed, as well as the
opportunities for collaboration and reciprocal benefits. In some cases, the communities had already initiated local research in the area of mental health and
were, therefore, eager to become involved in a larger study provided there would
be tangible benefits to their community. In other cases, the communities were
willing to support the proposal, acknowledging the lack of information and
awareness about mental health issues, yet cautious about committing their
involvement until more discussion could take place among community members.
As a result of these initial discussions, however, organizations within the five
cultural-linguistic communities in both sites were willing to provide letters of
support for the proposal.
Initiation of the study (developing relationships)
Once funding was received, key leaders and other initial contacts of the partner
organizations in the five cultural-linguistic communities in both sites were invited
to the official launch of the project. The launch was an opportunity for communities, organizations, and academics to meet on common ground, and initiate
relationships that would continue to grow over the next five years. It was a
crucial stage in the building of reciprocal relationships both with individuals and
with the communities. All present participated in an informal buffet lunch, which
Downloaded from http://arj.sagepub.com by Maura Fulton on October 1, 2008
312 • Action Research 6(3)
gave everyone the opportunity to network with others, to compare notes, and to
feel part of the overall project. Individual community members were recognized
for their crucial contributions to the proposal development stage of the project
and other work they had already put in and community and organizational partners looked forward to the next five years. Like the rest of the research team, the
participants certainly gained prestige for being associated with the project. What
was striking about the project launch was that unlike many large academic
meetings, speakers and attendees at the launch were from diverse cultural backgrounds, a good indication of the importance of the issues and the strong interest
within the cultural-linguistic communities in being active collaborators in the
study.
After the launch, the focus was on expanding awareness of the project within the communities. Discussions were held with key members of the communities
to share ideas about how to approach the community and organize site visits. In
all, 17 community meetings were held, organized by community members at a
time and location suitable for the community. At least two researchers attended
each meeting, which was co-facilitated (in the language of the community as
needed) by the community contacts.
Establishing relationships with communities, whether through community
advisory boards or other means, can contribute to information exchange and
sharing of cultural knowledge. One area where this information exchange can be
valuable is obtaining understanding of what constitutes ‘the community’. Crosscultural research often assumes homogeneity in the group that is ‘other’, or within each group that is being compared (Fontes, 1997). This ‘theoretical myth of
sameness’ (Hardy, 1989, as cited in Fontes, 1997), results in ethnic groups being
described as if they were monolithic. Yet communities are not homogeneous
(Labonte, 1989) even if they share common geography, language, and sense of
identity. Communities are not static places where researchers conduct research,
but social arenas that are negotiated and may be defined differently depending on
who one speaks to in the community, which can be divided on the basis of religion, assimilation, and gender (Yoshihama & Carr, 2002). Much heterogeneity
within ethnic groups and the broad groupings that are commonly used in research
(e.g. African Americans, Asian Americans) obscure this within-group heterogeneity (Beutler, Brown, & Crothers, 1996; Hall, 2001; Sue, 1999). Sources of heterogeneity include immigration history and length of time after arrival, language
skills, acculturation, ethnic-racial identity, perceived minority status, experiences
with discrimination, and socio-economic status (Alvidrez, Azocar, & Miranda,
1996; Hall, 2001).
During the site visits, researchers asked community participants how they
defined their ‘community’. This was essential given the heterogeneity among,
for example, Mandarin speakers (mainland China, Hong Kong, Malaysia,
Singapore), and among Latin Americans (over 20 countries), all with their own
Downloaded from http://arj.sagepub.com by Maura Fulton on October 1, 2008
Maiter et al.
Reciprocity • 313
distinct political histories, cultures, and migration experiences. In this way,
participants were recognized as being the experts within their own communities,
sharing their expertise with the researchers and shaping the scope of the project.
Even if communities are well delineated, they may be deeply divided over
issues of investigation (Fontes, 2004; Labonte, 1989). In such situations
researchers will need to help the community partners to think through the benefits and pitfalls of the project (Minkler, 2004). Kelly, Mock, and Tandon (2001)
suggest that ultimately if a community is deeply divided on the issue to be
studied, careful negotiation should take place with the community to arrive at a
common issue for study. Additionally, researchers, who also have their own
needs, skills, and interests, should not be fearful of introducing topics for study
for a community if a topic has not emerged from the community itself but from
the researcher’s knowledge of the community’s issues. Minkler (2004) notes that
even if a topic originates from outside the community, involvement of community
members can result in a sense of ownership and development of emergent
projects by community members.
In order to develop trust, especially among communities that have had
negative prior experiences with research, there are moments in which the credibility of the project and the researchers are tested. In several of the site visits, for
example, participants pushed researchers to define ‘mental illness’, pointing out
that the concept does not exist in their language in the same way, and the words
may connote a range of symptoms or disorders from depression to severe mental
illnesses such as schizophrenia. The researchers were clear that the community
could define the term in the way that was most appropriate for that community.
Once participants realized that they had the power to set some of the research
parameters in this way, the sense shifted to one of mutual ownership of the
research process.
Exchange of information and cultural sharing can also help in ensuring
cultural sensitivity when conducting research. Cultural sensitivity and the need to
be open to diverse cultural patterns (Baubock, 1996; Denzin & Lincoln, 1994; De
Vault, 1995; Vargas, 1998) requires awareness of biases, flexibility, and adaptability on the part of researchers and is critical to cross-cultural research relationships (Vargas, 1998). Reciprocity cannot be entirely symmetrical and one
cannot fully understand another’s culture or standpoint due to asymmetrical
relations (Maiter, 2003; Young, 1997). However, by gaining some familiarity
with the participants’ culture(s) and context, researchers can enlarge their understanding of the people they are studying (Fontes, 1997; Kelly et al., 2001) and
plan appropriately for research meetings and exchanges. Transparency in relationship building also requires that community partners have opportunities to
learn more about the researchers.
Site visits provided opportunities for information exchange and cultural
sharing. These discussions also focused on the ways in which the community
Downloaded from http://arj.sagepub.com by Maura Fulton on October 1, 2008
314 • Action Research 6(3)
could actively participate in the project – as project steering committee representatives, community facilitator/co-researchers, focus group participants, and
through individual interviews, community forums, and conferences. In these
exchanges the researchers gained a greater understanding of the community and
their fears and concerns even as the community gained greater understanding of
the project. Some of their fears and concerns were allayed while they also realized
that they could have voice in this project. On a larger level they began to feel
hopeful that their concerns regarding mental health issues and lack of access for
their community were being heard.
The project steering committees (one in Toronto, one in Waterloo Region)
include representatives of the partner academics, community organizations and
umbrella organizations, as well as one representative from each of the five
cultural-linguistic communities for that site. The role of the steering committees
is to review and guide the research. Representatives receive an annual honorarium in recognition of their commitment to four to five meetings per year. In
order to ensure equal contributions and responsibility, at the first steering committee meeting, principles of working together were collaboratively developed.
Development of these principles in itself was a process of forming trusting relationships as participants could evaluate whether their concerns were being noted.
At this meeting the members appeared to become quite comfortable in noting
their points of view. The principles developed are open to revision and expansion
as the project moves forward.
One of the strongest examples of reciprocity in this project is the community facilitators/co-researchers – 10 people hired from (and with the active
participation of) each of the five cultural-linguistic communities in both sites.
Community facilitators/co-researchers have a two-fold role: as researchers,
recruiting for, and co-facilitating, focus groups, and conducting individual interviews; and as community ambassadors, raising awareness within their communities around mental health issues. Although a few had previous research
experience in their countries of origin, most did not. Some view the position as an
opportunity to gain Canadian work experience; for others, it is a chance to
supplement their family income; still others, who currently work as practitioners
(settlement workers, outreach workers, counselors) sought the job because of
their awareness of their community’s need for change in this area.
For the first six months of employment, the community researchers met
every two weeks with the core research team. All of these meetings included
opportunities to share food and updates from both personal and professional
lives. At the first meeting, principles of working together were jointly drafted. At
subsequent meetings, as community researchers learned about the project in
detail, there were discussions about risks and benefits for them as researchers and
for their communities. Since each community researcher comes from a distinct
community (even across the two sites, the five cultural-linguistic communities
Downloaded from http://arj.sagepub.com by Maura Fulton on October 1, 2008
Maiter et al.
Reciprocity • 315
have different needs and characteristics), these discussions have helped the team
find ways of adapting the approach for each community while remaining true to
the purpose and methods of the research. Each meeting includes a chance for
the community researchers to reflect on their experiences and celebrate their
successes, which has resulted in a growing sense of mutual support, among the
community research team as well as among the core researchers and the community researchers. After only a few meetings, several community researchers
expressed their sense of being part of a ‘family’ where they could feel safe
and comfortable, talk about their feelings and concerns, and find support and
encouragement. Surprisingly, despite differences amongst the communities, the
researchers have been able to share considerable information with each other
regarding recruitment of participants, barriers, and how to overcome these while
also engaging in many other discussions.
In addition, community researchers have developed working relationships
with the steering committee representative for their communities. A joint social
gathering was held in the first few months so that all the steering committee
members could get to know the community researchers. Community researchers
and steering committee representatives worked together to raise awareness of the
project within their communities and to recruit participants for focus groups,
sometimes co-facilitating focus groups together. This teamwork has strengthened
connections within the communities.
The insights of community researchers have provided the research team
with valuable cultural information, including ideas for sharing information about
the project through media outlets and community events. In turn, community
researchers are encouraged to take the lead in pursuing avenues of information
sharing and project promotion that are appropriate for their community, with
support from the core research team as needed. Reciprocity here is evident at both
the individual and community levels. Community researchers are taking on
leadership roles in their communities and are being recognized for having knowledge and information while the communities are becoming more aware of ways
to access needed resources.
Data collection (exchange of knowledge and capacity building)
The project’s research activities included an extensive review and analysis of the
literature pertaining to mental health and cultural diversity; a web-based survey
of service provision organizations aimed at determining their current policies and
practices related to cultural diversity; key informant interviews with experts in, or
long-time observers of, mental health and cultural diversity in Ontario; focus
groups with members of the five participating cultural-linguistic communities;
and in-depth case studies of individual members of those communities who have
experienced mental health issues.
Downloaded from http://arj.sagepub.com by Maura Fulton on October 1, 2008
316 • Action Research 6(3)
Although this article is not a report of research findings, quotes from
research participants from selected data collection methods noted above provide
useful insight into what community members think about the reciprocal value of
research participation: the potential for the research to be an effective means to
open up discussion and, eventually, to make change. From the key informant
interviews, for example, one participant, a man of color who worked as director
of diversity for a large organization, said:
I hope this research leads to something that will make a difference. We don’t have
enough research around race and mental health in Canada. That is the first thing.
And the second thing is we don’t have, this is not part of the public discourse at all.
It is not something that is talked about and so I think anything that really supports
us opening up and, you know, generating new knowledge and exchanging knowledge between us and normalizing this . . . is always good.
While an immigrant woman of color who had worked as a social worker at
several social service agencies noted:
I have never seen who could broker that . . . We can’t change, we the diverse
community can’t change one single system, it takes this grant maybe, and your, the
council. The research folks that you are working with, the Centre. It is going to take
some privileged people to switch this system because the people without power can’t
switch anything. We can rave and rant but I don’t know how to make the system
change.
The focus group activity may provide the best example of reciprocity in
data collection because of its emphasis on relationship building. Community
researchers drafted lists of people in their communities whom they recognized as
key representatives, as well as media contacts and people active in the community. They worked with their steering committee representative to connect
with these people, sharing information about the project, and asking for their
assistance in inviting people to the focus groups. At subsequent meetings, community researchers reported that the majority of participants for their focus
groups were recruited through these existing and newly formed relationships.
Thus, recruitment provided the opportunity to expand relationships and raise
awareness of the project and the issue of mental health within each community.
One participant from the mixed gender Mandarin speaking focus group notes:
Events like today’s focus group are quite good . . . if someone is experiencing
mental stress and he participates in such a group and communicates with others, it
will help his mental health greatly. Such events should be held regularly.
This participant talks about the benefit of participating in the focus group that
resulted in knowledge that was gained:
Some people were not just feeling low; they were having mental illness . . . If they or
their family members realize it and . . . see a doctor, they can get help . . . If we have
Downloaded from http://arj.sagepub.com by Maura Fulton on October 1, 2008
Maiter et al.
Reciprocity • 317
knowledge about mental health, when we meet mental health problems at our work
place or in family life, we are able to deal with our stresses.
A Punjabi (Sikh) man notes the need for networking and sharing when faced with
mental health issues:
Before reaching the medication stage, a person may go some place like a community
centre . . . you may find . . . people to share or consult with about your situation.
A Spanish-speaking woman from one of the sites notes the importance of
religion but also the need for professionals to be involved for coordinating
services:
Religious institutions can play a vital role in this area, but mental health professionals should coordinate . . . like a ‘train the trainer’ program [to] impart education.
Although concerns have been raised that researchers may develop relationships with the purpose of coercing participants to reveal stories that they do
not want to reveal (Fontes, 2004), Yassour-Borochowitz (2004) makes a strong
argument that researcher–participant relationships that are reciprocal and based
on dialogue are ethical. This relationship can result in a deeper understanding of
participants’ life experiences, benefiting both researchers and participants and
resulting in empowerment and change for the group under study (Hill, 2004;
Yassour-Borochowitz, 2004). Another statement from a focus group participant
captures the desire to develop resources as a result of the study:
We should take mental health seriously but not be afraid of it. We should learn
about mental health and pay more sympathy to those people who need help . . . We
could organize a committee . . . do something to build our own healthy community.
Indeed, as a direct result of the focus groups, a number of the culturallinguistic communities are considering setting up regular opportunities for their
community members to hold similar discussions and share the benefits of talking
about mental health issues. This is a good example of community empowerment
and health promoting activities being triggered by the project, yet leading to an
activity outside of the project itself.
Dissemination (exchange of information and resources)
Reciprocal research relationships provide the context for providing clear
information about the outcomes of the study and the benefits to the community
participating in the study. However, collaborating in a CBPAR project may raise
expectations about immediate benefits to the community, such as increased funding for the issues being investigated. Yet some expected outcomes may not be
possible from the research, while others may not occur immediately. Beiser
(2003) cautions against raising unrealistic expectations; he suggests that
Downloaded from http://arj.sagepub.com by Maura Fulton on October 1, 2008
318 • Action Research 6(3)
researchers are rarely in a position to affect policy or to allocate resources.
Throughout the research process, researchers can, however, provide knowledge
that can then be used by participants and the community to maximize their
potential to obtain resources. Knowledge must be provided in a manner that communities find useful and that helps in their efforts to obtain resources.
Knowledge dissemination is a key component of this project. Dissemination
has been occurring since the launch, both within and outside of the project itself.
Within the project, there are regular email updates, as well as informal updates at
the start of every meeting (partnership group, steering committees, community
researchers, sub-committees, and working groups). There is also an interactive
website with updates about the project. We continue to share information within
each of the five communities through the steering committee representatives
(each of whom have a network of interested service providers and community
members), through the community researchers (displays at community events and
information sessions), and through community media.
As part of the project’s commitment to take action to ensure that research
findings lead to change, project newsletters and research updates are sent to a
growing list of policy-makers, politicians, funders, and the media as well as
project partners. The intent is to share knowledge gained throughout the project,
so that policy-makers, government, and funders are receptive to recommendations for change at the end of the project.
The first project-sponsored conference was held in December 2007.
Participants included members of diverse cultural-linguistic communities, service
providers, academics, students, policy-makers, and funders. A second conference,
international in scope, will be held at the end of the project, in December 2009.
In addition, community forums were held in the spring of 2007 to give each
of the five communities in both sites the opportunity to contribute to the framework that will be the basis for pilot projects to be implemented and evaluated in
the second phase of the project. For some of the cultural-linguistic communities,
these pilot projects are the main reason they are collaborating. Through partnerships with other communities and community-based mental health organizations,
they see the pilot projects as an opportunity to move their communities forward
in ways they have not been able to on their own.
Considering power and gain in the practice of reciprocity
Central to the notion of reciprocity and reciprocal relationships are two ideas:
equality and exchange. Building equality in relationships means addressing power
explicitly. Wallerstein and Duran (2003) remind us that ‘CBPR researchers who
hope to act on the most important problems in society, such as disparities based
on race, class, gender, and other socially constructed domains, need to produce
knowledge that clarifies and seeks to change the maldistribution of power and
Downloaded from http://arj.sagepub.com by Maura Fulton on October 1, 2008
Maiter et al.
Reciprocity • 319
resources’ (p. 37). These disparities can also be present in research relationships
between researchers and communities. Despite the good intentions of CBPAR
researchers, hidden dimensions of power can result in bias that continues to favor
dominant knowledge while discrediting other bases of knowledge. Some knowledges and interests are unconsciously favored over others resulting in minority
voices being silenced. Chavez, Duran, Baker, Avila, and Wallerstein (2003),
drawing on the work of Camara Jones, suggest that ‘people of color involved in
CBPAR may not be able to identify their community’s assets due to feelings of
internalized oppression that make them undervalue community resources’
(p. 85). Thus, in order to generate knowledge that is emancipatory, the CBPAR
research process itself must challenge such inequalities. Committing time to
develop reciprocal relationships means addressing power differentials and creating environments where meaningful exchanges can occur.
Within our project, having just one representative from each community at
meetings could leave the representative feeling unable to contribute equally or to
be critical in the presence of participants who are seemingly more powerful
because of their professional status as well as other demographic issues of race,
gender, socio-economic status, and language fluency. Indeed, a number of authors
note that power can restrict complaints by preventing conflict from emerging. We
found that several factors can help equalize these very real power differentials.
First, having multiple community representatives at each meeting results in a
more equitable forum because the community members then are not outnumbered by researchers. Second, all community steering committee members were
clearly told that they were being asked to be part of the committee because of the
cultural and work-related expertise they possessed, that this expertise was valued,
and that their contributions would result in richer and more meaningful results.
Because all members of the research team believed this to be true, this message
was easy to convey initially and has been reinforced throughout the course of
the project. Furthermore, the steering committee representatives have developed
relationships amongst themselves, and draw on common experiences to support
one another. They are also comfortable about having discussions amongst themselves and then speaking up as a group when they feel that one person’s voice has
not been heard.
Exchange, the second idea at the heart of reciprocity, speaks to both the
substance of what is exchanged and to the impact of the exchange. Here, we
consider the benefits of the exchanges that have occurred in this CBPAR project.
Each of the participants has different interests in the project and thus may benefit from different aspects of it. Benefit also may be considered at two different
levels: that of the individual and that of the collective.
In terms of benefit at the individual level, participation in the project
addressed the interests of community representatives by providing them with
opportunities to enhance their knowledge and skill and, very importantly, to
Downloaded from http://arj.sagepub.com by Maura Fulton on October 1, 2008
320 • Action Research 6(3)
make meaningful contributions to the communities they represent. Their participation in project meetings has allowed them to gain research knowledge and
skills and knowledge about mental health in communities other than their own.
Other benefits, both in the short and long term, are also present. Having the position listed on a curriculum vitae may be a source of prestige and career enhancement. Knowledge about community empowerment may be passed on to the
community. Greater knowledge and understanding of the mental health system
may also prove both professionally and personally beneficial.
Collectively, communities have their own interests, including promoting
their own visibility and status in order to improve the health and wellbeing of
their members. The participating communities stand to gain by having their
concerns about mental health presented to service providers, policy-makers, and
other decision-makers. At the conference held in December 2006, for example,
attendees included representatives of the new regional health boards that are
being developed in Ontario. Without their participation in this project, the
cultural-linguistic groups might have found it difficult to gain access to these individuals. The opportunity to be involved in developing pilot projects that will meet
specific needs of their members is another benefit to the communities, one that is
being facilitated by the design of the CBPAR project.
As critiques of the concept of social capital have noted, empowerment as a
result of exchange of resources has different meanings on different levels, from
the individual to the collective and beyond. For example, organizations, social
groups and processes are empowering for individuals when they enhance competencies and control, but they are not necessarily empowered, that is, able to make
a difference in policy processes (Zimmerman, 1990). Judging from our experiences and those of our community partners and participants in this project,
individual and community empowerment are linked, because reciprocity has a
multiplier effect, at least within groups and potentially within communities.
Time, and future reports about this research project, will tell if power differences
both inside and outside the project itself can ultimately be addressed.
Finally, the benefits of exchange have flowed both ways. The researchers
involved in this project have their own professional and personal interests and
have gained both professionally and personally by their participation. In addition
to the academic currency of papers and conference presentations, the researchers
have been given opportunities to hone their skills in the design and management
of a large CBPAR project. They have been privileged to learn more about the
cultural-linguistic groups whose concerns are not often voiced in mainstream,
public venues. Relationships built through this project are likely to be drawn
upon and enhanced in future work. The research team includes a number of individuals who are themselves immigrants to Canada; participation in this project
has given them new lenses through which to view and reflect upon their own
immigrant experiences.
Downloaded from http://arj.sagepub.com by Maura Fulton on October 1, 2008
Maiter et al.
Reciprocity • 321
An ethic of reciprocity
Reciprocity can contribute to discussions of validity and quality in CBPAR as presented by Bradbury and Reason (2003) and should be reflected on throughout the
research endeavor. A focus on relationships in evaluating the validity of CBPAR
and quality as relational praxis provides dimensions within which reciprocity can
be considered. By conceptualizing the practices in our CBPAR project as ethical
actions and grouping them under the rubric of reciprocity we also hope to contribute to the development of ethical practice in CBPAR. Reciprocity can be
defined as an ongoing process of exchange with the aim of establishing and maintaining equality between parties. Reciprocity requires reflexivity. When working
as a research team with multiple perspectives, adequate representation and ongoing discussions help in thinking critically about issues of power, social location,
and perspective. Reciprocity promotes recognition that partners have varying
amounts and types of power in different situations and different interests in a
specific project – and thus will benefit from different things. Knowledge, skills,
and support are exchanged among all parties, but these exchanges may occur at
different points in time, just as the underlying relationships among involved
parties evolve over time. Indeed, just as the process of CBPAR is cyclical and
ongoing, so too is the process of reciprocity.
As we attempt to build reciprocity into research projects, some limitations
must be recognized and discussed among participants. Just as we have learned to
see that many cultures view the individual in a more collective way, we have to
understand that we, as individual researchers, may well be viewed through the
same collective lens – that is, as representatives of our institutions, which are
assumed by research participants to be willing to take responsibility for research
outcomes. The limits of reciprocity fall into two categories – structural
(researchers do not have control of broader societal resources and therefore may
not be able to realize direct and immediate impact on resource distribution and
allocation; community partners are limited in their ability to represent a heterogeneous community) and organizational (institutional incentives in the academy
limit the ability of researchers to do advocacy work; turn-over and other personnel changes in community agencies or groups can disrupt the reciprocal relationships and commitments established). Finally, an ethic of reciprocity will not
protect a project from bad acts or actors. In order to guard against malfeasance
or simple carelessness, project-specific oversight procedures, as well as standard
processes of ethics review, are still necessary.
The following guidelines can help researchers use an ethic of reciprocity to
conceive and conduct CBPAR projects with diverse communities:
1
Recognize respectful relationships as primary and agree to devote project
resources (especially time) to relationship building and maintenance;
Downloaded from http://arj.sagepub.com by Maura Fulton on October 1, 2008
322 • Action Research 6(3)
2
3
4
5
Think of a particular project as a cross-section in time of a longer relationship
and a longer cycle of exchange;
Make reflexive exploration of power/interests and possible outcomes a
priority;
Assess research activities vis-à-vis short- and long-term benefits for parties
and think about ways in which information and resource exchange activities
might be modified to build community capacity and increase benefit for both
individuals and collectives;
Be aware of circumstances in which reciprocity may be limited, and plan
structures/processes to address these limitations.
Acknowledgements
The work reported in this article emerged within a research program entitled ‘Taking
Culture Seriously in Community Mental Health’. This Community University
Research Alliance (CURA) is funded by the Social Sciences and Humanities Research
Council of Canada. We would like to acknowledge the many CURA partners for their
part in shaping the ideas and practices presented here. For a list of CURA partners see:
www.crehscura.com/about_partners.php. Direct requests for further information
about the study can be made to the authors via email.
References
Alvidrez, J., Azocar, F., & Miranda, J. (1996). Demystifying the concept of ethnicity
for psychotherapy researchers. Journal of Consulting and Clinical Psychology,
64, 903–908.
American Anthropological Association. (1998). Code of ethics of the American
Anthropological Association, Washington, DC. Retrieved 21 October 2005
from: http://www.aaanet.org/committees/ethics/ethcode.htm
Baubock, R. (1996). Cultural minority rights for immigrants. International Migration
Review, 30, 203–250.
Beauvais, F. (2006). Changing models of research ethics in prevention research within ethnic communities. In J. E. Trimble & C. B. Fisher (Eds.), The handbook of
ethical research with ethnocultural populations and communities (pp. 241–
256). Thousand Oaks, CA: SAGE.
Beiser, M. (2003). Why should researchers care about culture? Canadian Journal of
Psychiatry, 48(3), 154–160.
Benetar, S. (2002). Reflections and recommendations on research ethics in developing
countries. Social Science & Medicine, 54, 1131–1141.
Beutler, L. E., Brown, M. T., & Crothers, L. (1996). The dilemma of factitious
demographic distinctions in psychological research. Journal of Consulting and
Clinical Psychology, 64, 892–902.
Boser, S. (2006). Ethics and power in community-campus partnerships for research.
Action Research, 4, 9–21.
Downloaded from http://arj.sagepub.com by Maura Fulton on October 1, 2008
Maiter et al.
Reciprocity • 323
Bourdieu, P. (1986). Forms of capital. New York: Free Press.
Bradbury, H., & Reason, P. (2003). Issues and choice points for improving the
quality of action research. In M. Winkler & N. Wallerstein (Eds.), Communitybased participatory research for health (pp. 201–220). San Francisco, CA:
Jossey Bass.
Chavez, V., Duran, B., Baker, Q. E., Avila, M. M., & Wallerstein, N. (2003). The
dance of race and privilege in community based participatory research. In M.
Winkler & N. Wallerstein (Eds.), Community-based participatory research for
health (pp. 81–97). San Francisco, CA: Jossey Bass.
Corbin, J., & Morse, J. M. (2003). The unstructured interactive interviews: Issues of
reciprocity and risks when dealing with sensitive topics. Qualitative Inquiry,
9(3), 335–354.
Cornwall, A., & Jewkes, R. (1995). What is participatory research? Social Science &
Medicine, 41(12), 1667–1676.
Denzin, N. K., & Lincoln, Y. S. (1994). Handbook of qualitative research. Thousand
Oaks, CA: SAGE.
DeVault, M. L. (1995). Ethnicity and expertise: Racial-ethnic knowledge in sociological research. Gender & Society, 9, 612–631.
Fontes, L. A. (1997). Conducting ethical cross-cultural research on family violence. In
G. K. Kantor & J. L. Jansinki (Eds.), Out of darkness: Contemporary perspectives on family violence (pp. 296–312). Thousand Oaks, CA: SAGE.
Fontes, L. A. (2004). Ethics in violence against women research: The sensitive, the
dangerous, and the overlooked. Ethics & Behavior, 14(2), 141–174.
Gil, E. F., & Bob, S. (1999). Culturally competent research: An ethical perspective.
Clinical Psychology Review, 19(1), 45–55.
Hall, G. C. N. (2001). Psychotherapy research with ethnic minorities: Empirical, ethical, and conceptual issues. Journal of Consulting & Clinical Psychology,
Special Issue 69(3), 502–510.
Hawe, P., & Shiell, A. (2000). Social capital and health promotion: A review. Social
Science & Medicine, 51, 871–885.
Hill, S. (2004). Doing collaborative research: Doing what feels right and makes sense.
International Journal of Social Research Methodology, 7(2), 109–126.
Hopper, K. (1996). Fresh thickets of trouble: Unresolved ethical issues of research in
the urban public domain, a commentary. City & Society, 3, 155–172.
Kelly, J. G., Mock, L. O., & Tandon, D. S. (2001). Collaborative inquiry with
African-American community leaders: Comments on participatory action
research process. In P. Reason & H. Bradbury (Eds.), Handbook of action
research (pp. 548–555). London: SAGE.
Khanlou, N., & Peter, E. (2005). Participatory action research: Considerations for
ethical review. Social Science & Medicine, 60, 2333–2340.
Kleinman, A. (1995). Writing at the margin: Discourse between anthropology and
medicine. Berkeley: University of California Press.
Kottak, C. P. (1986). Cultural anthropology (4th edn). New York: Random House.
Labonte, R. (1989). Community empowerment: The need for political analysis.
Canadian Journal of Public Health, 80(2), 87–88.
Maiter, S. (2003). The context of culture: Social work practice with Canadians of
South Asian Background. In J. R. Graham & A. Al-Krenawi (Eds.), Multicultural social work in Canada: Working with diverse ethno-racial communities
(pp. 365–387). Don Mills, Canada: Oxford University Press.
Downloaded from http://arj.sagepub.com by Maura Fulton on October 1, 2008
324 • Action Research 6(3)
Marshall, P. A., Koenig, B. A., Grifhorst, P., & van Ewijk, M. (1998). Ethical issues
in immigrant health care and clinical research. In S. Loue (Ed.), Handbook of
immigrant health (pp. 203–226). New York: Plenum Press.
Mauss, M. (1954). The gift: Forms and functions of exchange in archaic societies.
New York: Free Press (originally published 1925).
Minkler, M. (2004). Ethical challenges for the ‘outside’ researcher in communitybased participatory research. Health Education & Behavior, 31(6), 684–697.
Minkler, M., & Wallerstein, N. (2003). Introduction to community-based participatory research. In M. W. Minkler & N. Wallerstein (Ed.), Community-based
participatory research (pp. 3–26). San Francisco, CA: Jossey Bass.
Portes, A. (1998). Social capital: Its origins and applications in modern sociology.
Annual Review of Sociology, 24, 1–24.
Putnam, R. (1993). Making democracy work: Civic traditions in modern Italy.
Princeton, NJ: Princeton University Press.
Roe, K. M., Minkler, M., & Saunders, F. F. (1995). Combining research, advocacy
and education: The methods of the grandparent caregiving study. Health
Education Quarterly, 22(4), 458–475.
Sartorius, N. (2003). Social capital and mental health. Current Opinion in Psychiatry,
16(Suppl. 2), S101–S105.
Smith, L. T. (1999). Decolonizing methodologies: Research and indigenous peoples.
New York: Zed Books.
Sue, S. (1999). Science, ethnicity, and bias: Where have we gone wrong? American
Psychologist, 54(12), 1070–1077.
Trimble, J. E., & Fisher, C. B. (2006). Our shared journey: Lessons from the past to
protect the future. In J. E. Trimble & C. B. Fisher (Eds.), The handbook of
ethical research with ethnocultural populations and communities (pp. xv–xxix).
Thousand Oaks, CA: SAGE.
Vargas, C. M. (1998). Ethical challenges in refugee research: Troublesome questions,
difficult answers. Refuge, 17, 35–46.
Wallerstein, N., & Duran, B. (2003). The conceptual, historical, and practice roots of
community based participatory traditions. In M. Winkler & N. Wallerstein
(Eds.), Community-based participatory research for health (pp. 27–52). San
Francisco, CA: Jossey Bass.
Wax, R. H. (1952). Field methods and techniques: Reciprocity as a field technique.
Human Organization, Fall, 34–37.
Whitley, R., & McKenzie, K. (2005). Social capital and psychiatry: Review of the
literature. Harvard Review of Psychiatry, March/April, 71–84.
Yassour-Borochowitz, D. (2004). Reflections on the researcher–participant relationships and the ethics of dialogue. Ethics & Behavior, 14(2), 175–186.
Yoshihama, M., & Carr, E. S. (2002). Community participation reconsidered:
Feminist participatory action research with Hmong women. Journal of
Community Practice, 10(4), 85–103.
Young, I. M. (1997). Asymmetrical reciprocity: On moral respect, wonder, and
enlarged thought. In Dilemmas of gender, political philosophy, and policy
(pp. 39–59). Princeton, NJ: Princeton University Press.
Zimmerman, M. A. (1990). Taking aim on empowerment research: On the distinction
between individual and psychological conceptions. American Journal of
Community Psychology, 18, 169–177.
Downloaded from http://arj.sagepub.com by Maura Fulton on October 1, 2008
Maiter et al.
Reciprocity • 325
Sarah Maiter is Associate Professor in the School of Social Work at York University,
Ontario, Canada. Her teaching and research interests include: anti-oppressive and
anti-racist approaches to social work; child welfare practice; mental health services
for immigrants and refugees; including the voices of diverse populations into social
work theory, research and practice; and developing prevention and social support
programs for diverse populations. [Email: [email protected]]
Laura Simich is a Scientist in the Social Equity and Health Program at the Centre for
Addiction and Mental Health and Assistant Professor in the Departments of
Psychiatry and Anthropology, University of Toronto. She conducts qualitative,
community-based research on refugee resettlement, sociocultural factors in immigrant mental health, social support and mental health promotion.
Nora Jacobson is a Scientist in the Health Systems Research and Consulting Unit at
the Centre for Addiction and Mental Health in Toronto, Canada and an Assistant
Professor at the University of Toronto. She is an interpretive social scientist who
uses qualitative research methods to study issues in the delivery of mental health
services and the design of mental health policy.
Julie Wise is a Researcher at the Centre for Research and Education in Human
Services in Kitchener, Ontario, and the coordinator for ‘Taking Culture Seriously in
Community Mental Health’, a five-year Community University Research Alliance
study. Her community development experience has had a cross-sectoral approach,
incorporating a variety of methodologies, on projects in Canadian and international
settings. Her main areas of focus are women’s and children’s issues, cultural diversity, and health care.
Downloaded from http://arj.sagepub.com by Maura Fulton on October 1, 2008