Research with an Aboriginal Health Service: Building an effective partnership, step by step

Brief report

Published in the HealthBulletin

Posted on:

28 November, 2016

Issue

Vol 16 No 4, October 2016 – December 2016

Introduction

Principles to guide new researchers working in Aboriginal and Torres Strait Islander health have been defined to ensure that relevant, effective and culturally respectful research relationships are formed [1]. This paper describes how a PhD candidate applied these principles in practice to establish a research partnership with an Aboriginal Community Controlled Health Service (ACCHS). A series of steps outline the development of the research partnership. The research explored how organisational capacity could be strengthened to deliver health promotion using a participatory action research approach. Data was gathered from staff and through analysis of organisational systems.

Research relationships in Aboriginal health

Primary health research partnerships must be effectively planned to provide new knowledge on priority areas and inform future practice. To ensure both parties achieve their desired outcomes, the partnership between the researchers and the participants needs to be nurtured throughout the duration of the research. This is especially so for research relationships with Indigenous Australians that in the past have viewed Aboriginal and Torres Strait Islander participants as subjects only, rather than participants in the research process [2].

National Health and Medical Research Council (NHMRC) guidelines outline values for ethical conduct in Aboriginal and Torres Strait Islander health research [3]. The researcher demonstrates how the values of: spirit and integrity; reciprocity; respect; equality; survival and protection; and, responsibility will be applied to their research [3]. Additional guiding documents have been developed to ensure Aboriginal and Torres Strait Islander participants are explicitly involved in the planning and the conduct of the research [1, 4-6].

A group of experienced Indigenous health researchers have collectively defined 10 principles to assist new researchers to apply the NHMRC guidelines [3], and to involve Aboriginal and Torres Strait Islander participants in the planning and conduct of the research [1]. Five principles are essential: addressing a priority health issue determined by the community; conducting research within a mutually respectful partnership framework; capacity building is a key focus of the research partnership; flexibility in study implementation while maintaining scientific rigour; and, respecting communities’ past and present experience of research. The remaining principles are desirable. Three are relevant to the example used in this paper: ensuring extended timelines do not jeopardise projects; preparing for Indigenous leadership turnover; and, supporting community ownership [1].

Other authors have acknowledged the contribution these principles have provided to new researchers. Gwynn and colleagues applied the principles retrospectively to describe effective governance structures of existing research projects [7]. O’Donohoo and Ross expand on the principles to capture culturally appropriate engagement, particularly in remote communities [8]. Our paper describes how the principles can be applied in practice to establish and manage a research partnership with an ACCHS. The following distinctive steps describe the development of the research partnership and highlight how the principles were applied in practice.

Step 1. Seeking a research partner

Principles for:

Addressing a priority health issue determined by the community/organisation;
Respecting the organisations’ past and present experiences of research; and
Capacity building as a key focus of the research partnership [1].

The PhD candidate, now referred to as the ‘researcher’, led the engagement to seek a research partner. The ACCHS was presented with an overview of the research process. This included the research question, proposed involvement of staff, types of access and data sources, possible outputs and timeframe. This allowed two-way discussion of how the research aligned with current organisational priorities and how the research could benefit the ACCHS.

Existing research projects were acknowledged and current opportunities or barriers were discussed that might impact on the research process. Consideration was given to staff capacity to participate in this research opportunity. The ACCHS shared previous research experiences detailing what has worked well to engage staff. The existing research structure with the ACCHS provided guidance on how the relationship would be managed and what they required to establish the partnership.

The researcher provided an overview of her research and professional experience in health promotion capacity building work with Indigenous communities. There was a level of pre-established trust as the researcher had worked with some staff previously, and others were familiar with her work. This existing familiarity with the researcher was beneficial in building the research partnership in this early phase.

The ACCHS considered whether the topic aligned with their research priorities and timeframes, whether the proposed process and outputs would build capacity of staff, and if they could support the researcher over the agreed time period. To maintain the research focus and timeframe, the researcher, in consultation with staff, negotiated how to best adapt the research to meet the ACCHS priorities and available resources.

Step 2. Establishing the partnership

Principles for:

Conducting research within a mutually respectful partnership framework; and
Flexibility in study implementation while maintaining scientific rigour [1].

Once the researcher and the ACCHS agreed in principle that the research process met both parties’ expectations, firming up of the research question and outputs occurred. To achieve this, the researcher met with senior staff and provided an overview of the research aim, process and timeframe. This allowed staff to identify potential concerns and suggest how and when to engage staff. These meetings initiated development of key staff relationships that championed the research project within the ACCHS.

Based on conversations with staff, the researcher drafted how the research could demonstrate the values and ethical guidelines for working in Aboriginal and Torres Strait Islander health research [3]. Once drafted, further input was sought from key staff to clarify and discuss the values in practice.

The research process was documented using the university’s ethics template for research with Indigenous populations. The template articulated clearly the involvement of the ACCHS and its staff, identified how and when data would be gathered, and how the data would be used. The ACCHS’ research committee reviewed this document and formalised their commitment to the project by providing a letter of support to accompany the ethics application.

Step 3. Commitment

Principles for:

Supporting community ownership; and
Preparing for Indigenous leadership turnover [1].

A Memorandum of Understanding (MOU) was drafted to outline how the researcher and the ACCHS would interact. The MOU detailed: conduct; Intellectual Property and publications; ethics and data management; risk and liability; term and termination processes; as well as a dispute process.

The MOU defined responsibilities of both parties and stated the organisation’s commitment to the project beyond individual staff members’ interests or personal support. The ACCHS led this process, demonstrating their commitment to being an active participant throughout the research project.

A project schedule was included in the MOU. This covered objectives of the research, timeframe, project deliverables, budget, and requirements of both the researcher and the ACCHS. Each partner was responsible for a number of tasks. The researcher needed to: comply with policies, procedures and codes of conduct; translate and disseminate research results; facilitate the action research process; and, provide training and mentoring in research processes. The ACCHS agreed to: participate in the action research process; provide office space and access to relevant organisational systems and internal documents; assist with recruitment; and, participate in preparation of publications and research feedback.

At the end of this step, both parties had a clear understanding of how the research partnership would operate. The needs and safe guards for both parties were outlined and agreed to.

Step 4. Managing the partnership throughout the relationship

Principles for:

Conducting research within a mutually respectful partnership framework;
Ensuring extended timelines do not jeopardise the project;
Preparing for Indigenous leadership turnover; and
Supporting community ownership [1].

The ACCHS established a reference group to support the researcher and research process. The group assisted in clarifying processes, identifying opportunities, troubleshooting any difficulties in accessing staff or documents and championing the project throughout its duration. Regular meetings allowed timeframes to be monitored and encouraged organisational ownership.

Utilising existing communication methods such as the staff newsletter, internal posters and attendance at team meetings allowed research progress to be shared across the organisation and assisted in fostering a respectful research partnership.

Members of the reference committee changed due to staff turnover. New staff were invited to join to assist the ongoing monitoring and championing of the project. The structures established in the early phases of the project acknowledged and prepared for staff turnover.

Step 5. Planning to end the partnership

Principles for:

Supporting community ownership; and
Respecting the organisations future experience of research [1].

Planning the end of the partnership meant knowing what commitments were agreed to and delivering on them. Agreed commitments and deliverables were outlined at the start of the project and were monitored by both parties via the reference group. The key deliverable was sharing and providing direction on how the research outcomes could be applied to practice. Considering how the research aligned with organisational priorities in the initial steps strengthened the ability to sustain the research outcomes. For the researcher, it is crucial that the research process and outputs align.

Meeting agreed commitments allowed both parties to reflect positively on the research partnership, even after the project has ended. The legacy of the research partnership displays the commitment of the staff and researcher, and will influence future research partnerships. What worked well or not so well in the management of the partnership, will affect how the ACCHS negotiates in future research. A positive experience for the researcher will likewise, influence their future research.

Discussion

The principles for establishing an effective research relationship outlined how the researcher and the organisation interact [1]. A number of documents can assist ACCHS to represent their communities’ values when negotiating research partnerships [4-6]. As stated in step two, it was also necessary to distinguish how the values defined in the NHMRC guidelines [3] were demonstrated when the researcher interacts with staff as participants to ensure the values cascade from research partnership to research participation.

The series of deliberate steps aided two-way engagement to operationalise the research partnership. Aligning relevant principles with each step assisted in applying the NHMRC ethical guidelines into practice [1, 3]. There was a clear overlap with the values of reciprocity, respect, equality, responsibility and survival and protection. In addition, following the steps allowed identification of the responsibilities and accountabilities for both parties in a transparent way. Trust and honesty, an important part of ethical practice, was built through this transparent process. We suggest that an additional principle should be considered to complement the 10 outlined by Jamieson et al [1], that is, transparency of roles and responsibilities throughout the research relationship.

Conclusion

A successful research partnership requires clear planning and transparency of how the two parties will interact from initial engagement to research completion. Considering the principles for effective health research with Aboriginal and Torres Strait Islander populations through each step of the research process was found to be an effective way to establish and manage a long term research partnership with an ACCHS and researcher.

Acknowledgements

Apunipima Cape York Health Council Research Governance Committee and the project reference group who made the research project possible.

References

Jamieson LM, Paradies YC, Eades S, Chong A, et al. Ten principles relevant to health research among Indigenous Australian populations. The Medical Journal of Australia. 2012;197(1):16.
Humphery K. Dirty questions: Indigenous health and ‘Western research’. Australian and New Zealand Journal of Public Health. 2001;25(3):197-202.
National Health and Medical Research Council. Values and Ethics: Guidelines for Ethical Conduct in Aboriginal and Torres Strait Islander Health Research. Canberra: Commonwealth of Australia; 2003.
South Australian Health and Medical Research Institute. South Australian Aboriginal Health Research Accord: Companion Document 2014. Available from: https://www.sahmri.com/user_assets/2fb92e8c37ba5c16321e0f44ac799ed581adfa43/companion_document_accordfinal.pdf.
National Health and Medical Research Council. The NHMRC Road Map II: A strategic framework for improving the health of Aboriginal and Torres Strait Islander people through research. Canberra: Commonwealth of Australia; 2010.
National Health and Medical Research Council. Keeping research on track. A guide for Aboriginal and Torres Strait Islander peoples about health research ethics. Canberra: Australian Government; 2006.
Gwynn J, Lock M, Turner N, Dennison R, et al. Aboriginal and Torres Strait Islander community governance of health research: Turning principles into practice. Australian Journal of Rural Health. 2015;23:235-42.
O’Donahoo FJ, Ross KE. Principles Relevant to Health Research among Indigenous Communities. International Journal of Environmental Research and Public Health. 2015;12(5):5304-9.