Community engagement is an on-going, arduous, and necessary process for developing effective health promotion programs. The challenges are amplified when the particular health issue or research question is not prominent in the consciousness of the targeted community. In this paper, we explore the community-based participatory research (CBPR) model as a means to negotiate a mutual agenda between communities and researchers.The paper is focused on the (perceived) need for cervical cancer screening in an under-resourced community in Cape Town, South Africa. Cervical cancer is a significant health problem in this community and elsewhere in South Africa. Unlike HIV-AIDS, however, many Black South Africans have not been educated about cervical cancer and the importance of obtaining screening. Many may not consider screening a priority in their lives.Our research included extensive consultations and informal interviews with diverse community and regional stakeholders. Following these, we conducted 27 focus groups and 106 demographic surveys with randomly selected youth, parents, local health care personnel, educators and school staff. Focus group data were summarized and analyzed cross-sectionally. Community stakeholders were involved throughout this research.Our consultations, interviews, and focus group data were key in identifying the concerns and priorities of the community. By engaging community stakeholders, we developed a research framework that incorporated the community's concerns and priorities, and stressed the intersecting roles of poverty, violence, and other cultural forces in shaping community members' health and wellbeing. Community members helped to refocus our research from cervical cancer to 'cervical health,' a concept that acknowledged the impact on women's bodies and lives of HIV-AIDS and STDs, sexual violence, poverty, and multiple social problems. We conclude that the research agenda and questions in community-based health research should not be considered immutable. They need to be open to negotiation, creativity, and constant reinvention.

In this paper, we consider some of the challenges associated with the ethical need to conduct locally relevant international health research. We examine a cervical cancer research initiative in a resource-poor community in South Africa, and consider the extent to which this research was relevant to the expressed needs and concerns of community members. Results from informal discussions and a series of 27 focus groups conducted in the community provide insight into the community's needs and concerns, and its recommendations for how the research could be made more relevant to the community. We discuss these findings in the context of recent theory and literature on the role of community engagement in promoting local relevance and responsiveness in community-based health research. We anticipate that the paper's findings may help international health researchers better identify and assess the challenges of conducting locally relevant research across major global gaps in wealth and health.

In this article we examine the potential influence of adolescent girls on mothers' health-related knowledge and behaviors. Surveys were conducted with 131 mothers and 145 daughters to explore the extent of shared social activities between mothers and their adolescent daughters in a low-income South African community, and the degree to which mothers are receptive to advice from daughters. Eighty-six percent of daughters reported that their mothers had asked them for advice, and 93% of mothers indicated that they would listen to health advice from their daughters. This analysis suggests that the mother-daughter relationship may be a potential asset for culturally viable, community-based health promotion.