Power in Communities: Why Does Analysis Matter for Health Research?

This article discusses the importance of communication with community members when researchers work in communities because, as stated here: "Health research is most effective when community members understand and benefit from the research process. It also reduces confusion, unrealistic expectations and even resistance."

The authors first ask if community engagement is limited to "ordinary residents", to the exclusion of elites and professional community members. They then consider aspects of power in engaging communities, including interactions between researchers and communities and interactions within communities.

The authors discuss their work on people's attitudes toward stroke in urban (Dar-es-Salaam) and rural (Hai district) Tanzania as examples of various social dynamics in communities. They found that groups identified within communities are often fragmented, with differing viewpoints. Some are influenced by powerful leaders in the community. Traditional and faith healers and religious and village officials, for example, can hold symbolic and real power in communities. In the authors’ research, these individuals were influential in the way stroke was imagined and dealt with by other community members. "They had influence through their interactions with others in the context of treatment, or social and economic support. Other residents, who had advanced education and exposure to outside life (such as retired workers) had the same kind of influence."

In addition, "relatives who were professionals (medical experts and researchers)...visited these areas frequently during vacation. These were ‘proxy’ community members....During their visits, the ‘proxy’ community members demanded to see the information sheets and other study materials their relatives..." were providing to researchers. These power dynamics shaped the research as this group became an influential part of the process. The group with characteristics of neither type of power and influence was the majority, the "ordinary residents" - in large part, the youth and women who are often underrepresented in the research process. In conclusion: "These complex power dynamics made us realise how central power relations are to the whole research and engagement enterprise. It made our team devise better and more appropriate strategies to make certain that the research process was not only participatory, but more democratic, by actively seeking the representation of all groups of people and their interests."