title: Community-based participatory research in complex settings: clean mind-dirty hands.
abstract: Despite the abundance of the literature which discusses factors supporting or inhibiting effective participation of community members in community-based research, there is a paucity of publications analysing challenges to participation in complex settings. This manuscript describes an intervention built on researcher-community partnership amid complex social conditions which challenged participation of community members at different stages of the research process. The research took place in a Palestinian refugee camp in Beirut, Lebanon and 1 of 12 in Lebanon which suffer from deteriorating social, economic and physical conditions perpetuated by state-imposed restrictions. The research team developed a community coalition which was involved in all stages of planning, designing, implementation and dissemination. In all those stages the aim was to maintain rigorous research, to follow a 'clean mind' approach to research, but maintain principles of community participation which necessitate 'a dirty hand'. Despite commitment to the principles of community-based participatory research, participation of community members (including youth, parents and teachers) was affected to a great extent by the social, physical and structural conditions of the community context. Characteristics of the context where research is conducted and how it affects community members should not be overlooked since multiple factors beyond the researchers' control could interfere with the rigour of scientific research. Researchers need to develop a plan for participation with the community from the beginning with an understanding of the community forces that affect meaningful participation and address possible deterrence.
authors.affiliation: Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
authors.forename: Jihad
authors.initials: J
authors.lastname: Makhoul
authors.affiliation: Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon rn06@aub.edu.lb.
authors.forename: Rima
authors.initials: R
authors.lastname: Nakkash
authors.affiliation: London South Bank University, London, UK London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Trudy
authors.initials: T
authors.lastname: Harpham
authors.affiliation: Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
authors.forename: Yara
authors.initials: Y
authors.lastname: Qutteina
mesh_terms: D000293:Adolescent; D018912:Arabs; D002648:Child; D055812:Community-Based Participatory Research; D005260:Female; D019983:Guideline Adherence; D006293:Health Promotion / Q000458:organization & administration*; D006301:Health Services Needs and Demand; D006801:Humans; D007861:Lebanon; D008297:Male; D010934:Planning Techniques; D016730:Program Development; D015397:Program Evaluation; D012036:Refugees; D055815:Young Adult
keywords: community participation; community-based research