Table 2 CMO configurations depicting a composite summary of the findings

Context¹

New academic-community relationships were often initiated in a backdrop of community mistrust of the intentions underpinning research, or alternatively, community members may have an overly positive, naïve trust of academics. As members of a partnership began working together, accomplishing early intermediate goals and dealing with conflict and conflict resolution, trust was built and maintained over time.

Mechanism¹

Perceived trustworthiness of CBPR partnership maintained over the course of time. Trust responses were expressed continually, and were intensified in times of disagreement and conflict. Contextual factors, such as history of oppression and research abuse, and the harsh reality of community health morbidity and mortality, may have triggered trust or mistrust responses. Continually on trial, trust was contingent on how members responded to all circumstances and resources of research.

Trust building, conflict resolution, and trust sustainment over time were intermediary effects that facilitate intended and unintended health improvement outcomes. Trust enabled the sustainment of efforts, new spin-off projects, and systemic change. What was achieved after years of trust-building was done with much less effort and resources when compared to outcomes from early stages of partnerships with little or no trust.

Context¹

Academic and community members formed partnerships, which transformed into long-term working relationships; over time they became experts in applying research methods and fundraising for complex community health needs.

Mechanism¹

Partnership stakeholders felt inspired to work on unrelated projects, while relying on expertise and research savvy gained in the former experiences as well as in developing relationships with other community and academic members. In the process of partnering, community members may have gained a sense of empowerment and an appreciation of the value of research and evaluation; through interaction with academics, community members identifies unhealthy cultural taboos, academics gained insight into community strengths and experiences of vulnerability and oppression; expertise was realized in the co-production of ethically sensitive research in complex community contexts.

New appreciation of research and evaluation by community members and health service organizations led to the use of newly acquired research skills in community service delivery -- opening the door to improving the way community services were developed and evaluated. Community organizations were transformed from service delivery entities to community-based research resources, thus transferring research expertise from universities to communities. Communities, through a realization of self-empowerment took actions to improve local conditions and infrastructure. Communities broke taboos that were impeding health promoting behaviors. Academic members used their university positions to spread their gained expertise back to the university, promoting the impact of community strengths and engagement on research, knowledge production, spin-off products and systemic transformations.