Community Level Models; Participatory Research and Challenges Alexandra Varga H571

Public Health Public health is “the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals.” Winslow, C.E. (1920). The untilled fields of public health. Science, 51(1306), 23-33.

CDC: Colorectal Cancer Control Program (CRCCP) Social Ecological Model Centers for Disease Control and Prevention. (2013). Colorectal Cancer Control Program; Social Ecological Model. Retrieved from http://www.cdc.gov/cancer/crccp/sem.htm

Community Level Models Strategies for a variety of settings Address individual, group, institutional, and community issues Community: “a group of people with diverse characteristics who are linked by social ties, share common perspectives, and engage in joint action in geographical locations or settings.” aMacQueen, K.M. et al. (2001). What is community? An evidenced- based definition for participatory public health. American Journal of Public Health, 91 (12), 1929-1939.

Strategies for Community Level Intervention Community organization and other participatory models Diffusion of innovations theory Communications theory

Community Organization Seeks to expand participants sense of self interest (i.e. from the individual to neighborhood to state, etc.) Communities are helped to identify, assess, and solve a problem PH professionals may use methods that reflect community priorities and initiate the program More likely to succeed with community’s priorities (as opposed to external agenda)

3 General Types of Community Organizing Orientation Goal Community development process oriented aim of developing group identity Social planning task oriented goal of problem solving *Social action process and task oriented; grassroots based; conflict oriented increase community capacity and solve problems; concrete change to social injustice (policy change)

6 Common Elements of Community Organization that are key to achieving and measuring change Definition Empowerment Social action process though which people gain confidence and skills to improve quality of life Community Capacity Characteristics of a community that allow it to identify and address problems Participation in organizing process Engagement of community members Relevance Participants identify issues that are important to them Issue Selection Problems are dissected into solvable pieces Critical Consciousness Awareness of social, political and economic factors contributing to social problems

Media Advocacy An essential tactic in community organizing Definition: “the strategic use of mass media and community advocacy to advance environmental change or a public policy initiative” Purpose: Advocate for the goals of safe, healthy and prosperous communities; identify barriers to strategic policy implementation; and share current research through Centers for Disease Control and Prevention. Media Advocacy. Designing and Implementing an Effective Tobacco Counter Marketing Campaign. Retrieved from http://www.cdc.gov/tobacco/stateandcommunity/counter_marketing/manual/pdfs/chapter9.pdf

Participatory Action Research (PAR) People who are being studied take an active role in the research Beneficiaries take a lead role “One clear result … was successful mobilization and organization of communities around an externally defined public health objective. All the communities were successful in developing an organizational structure and using that structure to accomplish a defined set of objectives contained in the COMMIT protocol”

Disparities in health status due to: Exposures Health care access Social experience/support Community level interventions must address these issues to address health disparities

Challenges to PAR Competing institutional demands Time requirements for other parts of job Volunteers vs paid participants Risks associated with tenure and promotion Based on grants and publication Time involved in building relationship within community and collaborating in all steps (longer time to publication)

Expectations and demands of funding institution Harder to obtain funding Non traditional study design Different outcomes (not causal/association based) Community based research takes longer Requires longer grant period and maybe more resources Political and social dynamics within the community Deterrents to change inequitable distribution of power history of discrimination

Facilitating Factors Factors for successful PAR Top level support from organizations involved Allow participants to devote necessary time Rewarding participation Effect change when indicated Incentives Compensation for all participants Provision of training Public events recognizing contributions

Support for Community-based Research Universities more supportive Efforts to change tenure policy Journals devote theme issues to community approach Funding initiatives Foundations allow more time and resources for planning and partnership building Foundations may leverage government funding

Diffusion of Innovations Theory “ the process by which an innovation is communicated through certain channels over time among the members of a social system” How “new” ideas, products and social practices spread Used to study adoption of PH programs and health behaviors Programs must be disseminated to be effective

What Affects Diffusion? Key factors Advantage- better than current Compatibility- fit with intended audience Complexity- easy to use Trialability- can it be tested Observability- measurable results Communication channels and setting Formal and informal mass media and interpersonal Social network