Implementing a community-based physical activity program within a randomized controlled trial: A confessional tale of philosophical and methodological tensions

INTRODUCTION: Randomized controlled trials (RCTs) are the gold standard design to evaluate physical activity interventions. Community-based participatory research (CBPR) approaches are increasingly embedded within RCTs to improve the application and impact of such interventions, particularly when they involve equity-owed communities. Longstanding critiques of this methodological fusion highlight key philosophical and methodological tensions between the underlying principles of CBPR and RCTs which may impact researchers' capacity to meaningfully conduct an RCT with a CBPR approach. Such critiques primarily revolve around differences in philosophical orientation (i.e. postpositivist vs. interpretivist/critical paradigms) and their impact on methods, procedures, and knowledge generation and outputs. Despite these critiques, little has been written about the realities of implementing an RCT using CBPR approaches and contending with these tensions in real time. PURPOSE: This study seeks to address this gap by describing our experiences designing and implementing a community-based dance program with, by, and for women living with HIV. METHODS: Using a confessional tales approach, we reflect on the tensions between RCTs and CBPR and present our experiences delivering a dance program and our process in adapting and responding to the challenges we encountered. RESULTS: Our reflections focus on three themes: (i) The importance of articulating values and axiological commitments; (ii) Navigating the complexities of building trust and emergent contextual factors; and (iii) Emphasizing capacity building to promote sustainability.