This dissertation examines the processes by which multiple positioned actors in Participatory Action Research or Community-Based Participatory Research (PAR/CBPR) understand, reproduce, and contest systems of power and oppression in the context of their relationships and collaborations to support community-driven change efforts. The first chapter serves as a preface by reviewing relevant literature on participatory action research and power. The rest of the dissertation consists of three empirical papers. The first of these papers examined the extent to which scholars interrogate systems of power and oppression in (PAR/CBPR) to advance social justice. Scoping review methodology was employed to systematically review scholarly literature written in English and published between 2010 and 2020 across 5 databases. Thematic analysis and data charting yielded six scholarly articles using critical self-reflexive qualitative methodologies to explore manifestations of power within the partnership. Articles describe researchers employing individual critical reflections to confront individual assumptions, modify individual collaboration practices, and identify multilevel structures restraining participatory action approaches to research. The second paper explored the perceptions of researchers and community stakeholders regarding key processes questioning and addressing power issues within the (PAR/CBPR) collaborations. Individual in-depth semi-structured interviews (n=23) were conducted with social work researchers (n=13) and community stakeholders (n=10) with current or prior experience engaging in (PAR/CBPR) to examine the ways they define, negotiate, and address power differentials and oppression within their collaborations. Key emerging themes and discourses merged into a conceptual model illustrated with a metaphor of a river to highlight key social sites, paradigms of knowledge production, and the degree to which it aligns with the pursuit of social justice. Downstream strategies that sustain colonial forms of knowledge production included othering, disembodiment, and extraction. Conversely, upstream approaches underscored the centrality of redefining social relationships and ethical commitments within PAR/CBPR collaborations through the cultivation of unsettling counterspaces, counternarratives, and dialogical brave spaces. Finally, the third paper explored researchers and community stakeholders’ conceptualization and understanding of social justice as well as recommendations for social work research, practice, and policy to contest power and oppression in the context of PAR/CBPR. A second wave of individual in-depth semi-structured interviews with social work researchers (n=11) and community stakeholders (n=11) with current or prior experience engaging in PAR/CBPR were conducted and analyzed using thematic analysis. Findings illustrated converging and diverging understandings of social justice, in particular, community stakeholders emphasized an understanding of social justice interdependent of systemic transformations through dialogical processes among stakeholders, researchers, and social institutions. PAR/CBPR was described as a facilitating factor of social justice by fostering counterspaces and counternarratives. Additionally, PAR/CBPR was defined as a factor limiting the pursuit of social justice and deeply entrenched with tenure-track promotion and funding mechanisms perpetuating top-down configurations of power. Together and independently these papers further our understanding of the ways in which structural oppression and power in (PAR/CBPR) can be addressed. Research findings from all three studies highlighted participatory action research is not exempt from power hierarchies, and that multilevel strategies promoting counterspaces, counternarratives, and institutional changes are essential when redressing, negotiating, and contesting power and oppression. Findings inform best practices for the development of PAR/CBPR collaborations embodying ethical relationality across social work research, practice, education, and policy. Future studies should consider the use of longitudinal and critically in-depth dialogical approaches between multiple positioned actors in PAR/CBPR when defining social justice, PAR/CBPR, and power. / 2028-04-30

As a result of advances in treatment over the past 30 years, the number of older people living with HIV is growing. This is of particular concern for Indigenous populations in Canada given continuing over representation in HIV diagnoses. While there has been an increase in research on aging with HIV within the general population, little is known about the experiences of older positive Indigenous peoples. Research was conducted in partnership with the Canadian Aboriginal AIDS Network (CAAN) at CAAN's Wise Practices V conference. Participants were conference delegates, representing a sample of First Nations, Inuit and Métis people living with HIV and/or service providers from across Canada. Participants ranged in age from 32 to 63 and had been positive for 5 to 29 years. Data was collected through four sharing circles (two with women, one with men and one with service providers) and four interviews (n=34). An open analytic approach was used to explore the content of the transcripts and codes were collaboratively developed by the research team through an inductive and iterative process. From our analysis we were able to develop an Indigenous model of successful aging (SA). This proposed Indigenous model of SA represents a holistic and subjective model that is far more achievable than traditional models of SA. Within this model five dimensions of health and wellness emerged as facilitators of SA: physical, emotional, spiritual, mental and social health. Additionally, resilience, age and culture were found to be protective factors to SA. The goal of this project was to identify facilitators and individual strategies which enable SA within this population, in order to develop culturally mediated responses. Ideally, this knowledge can be used to help structure community and primary health services to promote SA with HIV in ways which are congruent with Indigenous culturally-defined notions of health. / Thesis / Master of Arts (MA)

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Participatory action research (PAR) methodologies attract researchers both because they open up space to apply the values and principles associated with social justice and because they have the potential to deepen our understanding of an issue by giving us the opportunity to explore contexts and processes through people's experiences. This allows for new insights to emerge and relevant solutions to be discovered and implemented through emancipatory practices. However, choosing to do this type of research for a thesis as a master's of social work student without lived or research experience complicates an already complex endeavor and raises many dilemmas, questions and challenges. Reflecting on my experience of working with a peer-led community organization in Southern Ontario that provides services for people who have experienced mental health or substance use challenges and have interacted with the mental health system, this thesis will explore my journey of joining a research team that set out to use PAR to better understand peer support. Using a narrative inquiry approach, I will explore the tensions that occurred throughout the process of attempting PAR with a community agency within the university framework of completing a thesis. In the spirit of PAR and its intention to disrupt dominant approaches to research processes, I will use an alternative, storytelling format in order to best illustrate my circumstances, perspectives and the difficulties I faced as an outsider, student, university researcher trying to follow PAR principles. The lessons I learned will also be provided in an effort to make this type of undertaking easier for future students. Overall, I learned that we need to find ways to bridge and support the two cultures of graduate students and community groups in working together in PAR. / Thesis / Master of Social Work (MSW)

Background: Water quality in on-reserve Indigenous communities in Ontario is concerning, with issues ranging from deteriorating water quality to issues with regulation and support. As a result, many communities are placed under a Drinking Water Advisory (DWA), which, at its most severe, indicates water is not safe for use or consumption. Between 2004 and 2013, approximately 70% of all on-reserve communities in Ontario were under at least one DWA. While designed to protect physical health, DWAs have widespread impacts on health and wellbeing. However, little is known about First Nation individuals’ thoughts, feelings, and experiences living under a DWA. Purpose: To unpack and explore the broad impacts of a Boil Water Advisory (BWA) from the perspective of community members on a reserve in Northern Ontario and provide considerations for current and future BWA management. Methods: Methodological choices were driven by the principles of community-based participatory research. Questionnaires and interviews were used to collect data. Two hundred and twenty-six questionnaires were distributed. Fifteen Elders and 22 key informants (KIs) were contacted for an interview. Results: Forty-four (19.5%) individuals completed a questionnaire. Eight Elders and 16 KIs participated in 20 interviews. Questionnaire sections were used to frame the data analysis, which fell under five major themes: 1) Community Context; 2) Knowledge of BWAs; 3) Living Under a BWA; 4) Water and Health; and, 5) Pathways Forward. Conclusions: Responses illuminated gaps where education surrounding best practices for protecting health would be crucial moving forward. They also highlighted that women are an important target audience for education. Points also emerged where communication with community members and stakeholders would be key to understanding the impacts and outcomes of DWAs. Additionally, this community, and others experiencing a DWA, should consider greater involvement in water management by younger individuals, to ensure that all perspectives are adequately represented. / Thesis / Master of Public Health (MPH) / When water is known, or suspected, to be unsafe for human consumption, communities are placed under a Drinking Water Advisory (DWA). Indigenous communities have some of the worst water quality in Canada and many are subsequently under DWAs. Despite the widespread impact of DWAs on health and wellbeing, little is known about First Nation individuals’ thoughts, feelings, and experiences living under one. The goal of this thesis was to unpack and explore the broad health, social, cultural, and economic impacts of a Boil Water Advisory (BWA) from the perspective of community members on a reserve in Northern Ontario and provide considerations for BWA management. Responses pointed to gaps where education surrounding how to best protect health would be crucial, especially for women who were highlighted as an important target audience. Points also emerged where communication would be key to understanding the impacts and outcomes of DWAs moving forward.

While community gardens (CG) have emerged as a popular public health strategy to improve fruit and vegetable access and consumption, few studies provide evidence-based principles to inform the initiation and maintenance of CG. Grounded in Community-based Participatory Research and guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework, this mixed methods case study explores the potential public health impact of CG in the DRR. Six CG completed harvest logs during the 2011 season. Following the growing season, CG leader key informant interviews (N=6) and CG participant focus groups were conducted (N=21) using a semi-structured script, guided by RE-AIM dimensions. The five RE-AIM dimensions and associated components were used to develop a coding matrix and identify emerging themes. Three researchers coded the transcribed interviews using a deductive approach, which included coding raw data into meaning units. The six CG yielded 811 pounds of produce. The majority of focus group participants (95%) stated they would continue CG participation. From qualitative analysis, themes emerged such as increased the number of residents participating in CG, increased consumption of produce, key characteristics of successful CG leaders and locations, programs associated with CG, and adequate funding and resources necessary for maintenance. This study provides important insights to promote the potential public health impacts of CG in the DRR. Findings provide best-practice opportunities to promote the successful adoption, implementation, and maintenance of CG in similar communities. / Master of Science

Background: Opioid use disorder (OUD), prescription opioid misuse, and increased heroin use are major public health crises in the US. Excessive non-medical use of prescription opioids and illicit drugs can alter the brain, disrupt mental health, and increase the risk of blood-borne illnesses and bacterial infections. The CDC reported that opioids caused nearly 70% of the 67,367 overdose deaths in 2018. Rural areas have high prescription and illicit drug use rates, limited resources, and unique challenges. There is an emerging need to understand rural residents' perspectives on OUD and substance use disorder (SUD) in their community in order to implement efforts. A community-based participatory research (CBPR) approach addresses the need for a systematic participatory solutions, and reduces community opposition and promotes sustainable, culturally appropriate interventions that can reduce the health-related harms caused by substance abuse. Methods: Two studies were conducted using CBPR principles to address the opioid crisis in a rural Southern Virginia community. Study I aimed to provide insight into community members' perceptions, knowledge, and experiences with OUD/SUD to inform community-led strategies. Study II assessed whether a virtual community platform with a Nominal Group Technique (NGT) can build consensus around Comprehensive Harm Reduction (CHR) in the same rural Southern Virginia community. Study II used the Community Readiness Model (CRM) and assessment tool. Stakeholder focus groups were conducted by a participatory research team, EM, as part of a larger project using the Stakeholder Engagement in quEstion Development (SEED) method. To assess the community's readiness to implement CHR using the CRM, Study II used semi-structured qualitative interviews with key stakeholders. The results of the readiness assessment were then used to inform a virtual community forum with members of a drug-free coalition. On the basis of CRM interview themes and findings, the forum used the NGT consensus-building technique. Results: The primary themes identified in the analysis of the community stakeholder focus groups conducted for Study I included the importance of family dynamics and social networks as risk and resiliency factors, addressing hopelessness as a preventive strategy, the need for holistic approaches to treatment, childhood exposure resulting in intergenerational substance use, the needs of overburdened healthcare providers, the expansion of long-term rehabilitation programs, and the need for judicial reform towards those with OUD. Comprehensive methods to address OUD's complexity require specific and well-defined strategies. Understanding the factors that contribute to OUD in rural communities should be the first step in developing actions. The overall community readiness score for Study II was 4.07, indicating the community is still in the pre-planning stage for bring CHR to the community. The majority of key informants believe that leaders and community members recognize the problem of SUD/OUD harms and that something should be done to improve and integrate harm reduction efforts. The forum had 12 attendees. The community forum produced 13 topics and a list of action priorities that at least 80% of participants agreed on. The two areas of high priority included: (1) raising awareness of secondary harms of SUD/OUD and available resources to assist the community, and (2) reducing the stigma associated with CHR and appeal to people's sense of humanity in order to create an environment conducive to understanding and increase buy-in around CHR. Implications: Both studies show rural stakeholders can help curb the drug epidemic. Their knowledge of internal community dynamics and needs allows them to prioritize actions to improve health outcomes. In addition, Study II demonstrated the effectiveness of the CR Model in determining community readiness to adopt CHR and the value of a virtual community forum in conjunction with an NGT process in fostering stakeholder consensus. / Doctor of Philosophy / Background: Opioid use disorder (OUD), prescription opioid misuse, and rising heroin use are major public health crises in the US. Taking too many prescription opioids or illegal drugs can be harmful. This can alter the brain, cause stress, and increase the risk of blood-borne illnesses and infections. Opioids caused nearly 70% of the 67,367 overdose deaths in 2018, according to the Centers for Disease Control and Prevention. Rural areas have high prescription and illicit drug use rates, limited resources, and unique issues. There is an emerging need to understand rural residents' perspectives on OUD and substance use disorder (SUD) in their community in order to implement efforts. Thus, this research which is based on the principles of Community-Based Participatory Research (CBPR) was conducted to help address this need. To reduce the health-related harms caused by substance abuse, CBPR promotes sustainable, culturally applicable interventions. Methods: Two studies used CBPR to address the opioid crisis in rural Southern Virginia. The goal of Study I was to gain insight into community members' perspectives, knowledge, and experiences to inform community-led action. For the first study, a community-research team, EM, conducted group discussions with community members as part of a larger project that used a participatory approach to unite the community in actions to address OUD in their community. Study II used the Community Readiness Model (CRM) and an assessment tool to determine community readiness for comprehensive harm reduction (CHR). The study also wanted to see how a virtual community platform with a consensus building process could help build agreement around CHR. In Study II, key stakeholders were interviewed to assess the community's readiness for CHR. Then a virtual community forum with members of a drug-free coalition was held. The forum got responses and put them in order based on themes and results from CRM interviews. Results: We learned from the first study, family dynamics, social networks, hopelessness, intergenerational substance use, and healthcare provider needs all influence risk and resilience. Long-term rehab programs should be expanded, and the justice system should treat OUD differently. Detailed methods to address OUD's complexity require specific and well-defined strategies. Understanding what causes OUD in rural communities should be the first step in finding solutions. Study II found that the community is still in the pre-planning stage, with a score of 4.07 out of 9, indicating that leaders and community members recognize that the harms associated with OUD are a problem and something should be done to improve and incorporate harm reduction efforts. The results of the community forum also show a list of important topics on which at least 80% of participants agreed. The two areas of high importance were: (1) raising awareness of secondary harms and available resources to help the community, and (2) lowering the stigma associated with CHR to make it easier for people to understand, but be deliberate in appealing to people's sense of humanity to get them to buy into CHR. Conclusions: Both studies show that people who live in rural areas can help solve the local drug problem. Their understanding of how needs change within a community gives us a unique way to improve health outcomes. Study II found that using CRM and a virtual consensus-building process can aid stakeholders in reaching an agreement on how to address issues. Study II also showed how useful it is to use a virtual community forum and an NGT process to figure out if a community is ready for CHR.