Exploring and evaluating community-based participatory research in a household and ambient air pollution project: assessing the impact on community capacity building

Background: Household and ambient air pollution (HAAP) remains a serious public health problem in low-resource settings, especially where people lack access to clean fuels. It contributes to major health inequalities and environmental pollution. Community-based participatory research (CBPR) aims to support equity and shared decision-making in health research, but often, it is used tokenistically, without real benefit to the communities involved. There is also limited understanding of how CBPR processes lead to real change or how to measure their impact on building community capacity.This thesis explored how a CBPR approach could strengthen community capacity within an air pollution project in rural Malawi.Methods: Using a multi-method qualitative case study design, the study applied three key frameworks: Wallerstein’s CBPR model, Israel’s CBPR principles, and Liberato’s domains of community capacity building (CCB). The study had four main objectives:
A scoping review to find practical, effective air pollution interventions suitable for community decision-making.Interviews with 13 key informants (researchers, policymakers, and community members) to understand what supports CBPR and air pollution action in real-world settings.Participatory walks with community members to explore current practices and place the intervention in local context.Implementation and evaluation of CBPR activities over the course of the project, using Liberato’s CCB framework to assess their impact.Data came from four Photovoice sessions, one talking circle, 16 focus groups, seven reflection meetings with community change agents, and follow-up transect walks. A continuous process evaluation helped monitor and adjust activities as needed. Data were analysed using a combination of framework and thematic analysis.Results: The project showed improved community capacity in all nine domains of Liberato’s framework, including mobilising resources, commitment to action, and long-term sustainability. Communication stood out as the strongest domain and helped link the others. Activities like intervention ranking, using local change agents, and a "train-the-trainer" model encouraged local leadership, group decision-making, and long-term use of the interventions. Challenges included the need for fair compensation, adequate funding, and climate-adapted strategies for sustaining change.Discussion: The study found that grounding CBPR in the local cultural, social, and economic context, starting with community voices and choosing practical, affordable solutions, can strengthen a community’s ability to take action. This helps promote long-lasting behaviour change and supports continued use of interventions. A key contribution of the study is its practical framework that links CBPR activities to measurable community outcomes, providing useful guidance for similar projects in the future.Conclusion: CBPR should not be tokenistic; it must be intentional, context-aware, and focused on real partnership to improve health equity. By centring community voices and lived experience, this study highlights the need for better tools and stronger policies to support meaningful collaboration between researchers and communities. Achieving this also means recognising and building on community strengths to ensure ownership and long-term impact on health and social wellbeing.