COMMUNITY-BASED HEALTH PROMOTION Kaia Gallagher, Ph.D. Douglas Easterling, Ph.D. Dora Lodwick, Ph.D.

SESSON OBJECTIVES Define the various roles of the community in C-B health promotion Provide concrete examples of how C-B health promotion projects can be organized, implemented and evaluated Summarize a continuum of outcomes from C-B health promotion efforts

BACKGROUND Project examples are derived from 7 initiatives funded by The Colorado Trust during the 1990s More detailed summaries of these initiatives are provided in the book PROMOTING HEALTH AT THE COMMUNITY LEVEL Purpose of this session is to synthesize the broader cross-site findings from these initiatives

WHAT IS COMMUNITY-BASED HEALTH PROMOTION? The defining feature of community- based health promotion lies in the role given to community residents and their representatives in planning, implementing and evaluating health promotion initiatives.

RANGE OF C-B INITIATIVES EXAMINED Healthy Communities29 communities Community Indicators15 communities Teen Pregnancy5 communities Community Action for Health Promotion 48 organizations Volunteers for Rural Seniors 34 agencies School Health Education 21 school districts Home Visitation5 groups

COMMON ELEMENTS ACROSS THE INITIATIVES Overall purpose was to enhance health promotion at the community level Communities were given a role to increase the effectiveness and relevance of the strategies adopted. An expected secondary benefit was that the grantees and communities would increase their capacity to address health-related problems.

CONTINUUM OF ROLES FOR THE COMMUNITY Community-defined, community-controlled health interventions Health interventions monitored by community-based stakeholder groups Agency-based health interventions utilizing community advisory boards Agency-based health interventions seeking ways to become more community-responsive

STRUCTURAL IMPLICATIONS OF COMMUNITY INVOLVEMENT C-B interventions are located in community settings. C-B interventions are sponsored by non- traditional organizations and community-based agencies. Community stakeholders assume a broader leadership role.

FUNCTIONAL IMPLICATIONS OF COMMUNITY INVOLVEMENT Health becomes more defined beyond the absence of disease. Non-health related contextual factors assume greater prominence. Scope of interventions becomes encompasses community health in its broadest terms.

HOW CAN THE SUCCESS OF THESE C-B INITIATIVES BE JUDGED? Case examples describe scope of efforts and level of effort. Assessments of outcomes include consideration of community capacity. Evaluations of C-B health promotion should include both direct and contextual measures of success.

OPTIONAL MEASURES OF COMMUNITY CAPACITY Knowledge and skills Leadership Collective efficacy Social capital

BENEFITS OF INCREASED COMMUNITY CAPACITY Communities will have an increased ability to respond to health issues. C-B responses are likely to be more responsive to community needs and thereby more effective in community terms. Increases in social capital will have more generalized benefits in terms of health improvements.

CHALLENGES Providing mechanisms for authentic community participation on the part of the larger community. Developing effective health promotion strategies that are community-based Sharing decision-making Providing appropriate technical assistance Clarifying expectations

TAKE-AWAY LESSONS C-B health promotion efforts can take many forms, but offer promise in being responsive and effective vis-à-vis community needs. The value of C-B health promotion extends beyond the immediate outcomes of the initiatives. More needs to be learned about how to implement and evaluate C-B health promotion efforts.