Principles and strategies of effective community participation

A framework is offered for understanding the conceptual basisand the strategic implications of community participation, inachieving Health for All goals. Special focus is given to themeaning, settings and levels of participation in official decision-makingstructures and at the community level. Questions such ‘howis participation facilitated?’, ‘who participates?’and ‘what are the benefits and obstacles to participation?’are geared primarily towards the needs of individuals who functionat the city level and expect practical strategic advice andguidance. The structure of the 1989 WHO Healthy Cities Symposiumwhich was devoted to community action was based on the frameworkand conceptual approach of this paper.     

Healthy communities: reflections on building alliances in Canada. A view from the middle

The author is currently working in the office of Health Promotion,Ministry of Health in British Columbia. For the past 17 yearsshe has worked in Health and Welfare Canada as an advocate forcitizen participation in developing health programs and policies. This article is based on her experience as an advocate and bureaucratin translating and mediating health promotion rhetoric intoaction. The Canadian Healthy Communities and Strengthening Communitiesprojects are used as examples in analyzing the opportunitiesand contradictions in building alliances.     

Development and evaluation of a breast cancer prevention decision aid for higher-risk women

Objective To develop and evaluate the effectiveness of a breast cancer prevention decision aid for women aged 50 and older at higher risk of breast cancer. Design Pre‐test–post‐test study using decision aid alone and in combination with counselling. Setting Breast Cancer Risk Assessment Clinic. Participants Twenty‐seven women aged 50–69 with 1.66% or higher 5‐year risk of breast cancer. Intervention Self‐administered breast cancer prevention decision aid. Main outcome measures Acceptability; decisional conflict; knowledge; realistic expectations; choice predisposition; intention to improve life‐style practices; psychological distress; and satisfaction with preparation for consultation. Results The decision aid alone, or in combination with counselling, decreased some dimensions of decisional conflict, increased knowledge (P < 0.01), and created more realistic expectations (P < 0.01). The aid in combination with counselling, significantly reduced decisional conflict (P < 0.01) and psychological distress (P < 0.02), helped the uncertain become certain (P < 0.02), and increased intentions to adopt healthier life‐style practices (P < 0.03). Women rated the aid as acceptable, and both women and practitioners were satisfied with the effect it had on the counselling session. Conclusion The decision aid shows promise as a useful decision support tool. Further research should compare the effect of the decision aid in combination with counselling to counselling alone.     

Social participation and life-style: A longitudinal and cohort study

This study focuses on changes occurring in one area of life-style, social participation during retirement. The population consisted of four cohorts, born in 1905–06, 1909–10, 1917–18, and 1921–22. In the longitudinal study the members of the oldest cohort were interviewed five times at the ages of 66, 70, 74, 78 and 82 years. In the cohort study the subjects were interviewed at the age of 66. Interests decreased after the age of 78 among men and women. Also, formal social participation declined with age among men and women. There were no cohort differences among men, but among women formal social participation was higher in the younger cohorts than in the older ones. In the longitudinal study education correlated positively with the interests index at almost all ages among both men and women. In the cohort study correlations between interests index and education were lower in the younger cohorts than in the older ones.Paper originally presented at the XIVth International Congress of Gerontology, Acapulo, Mexico 18–23 June 1989.     

The Effects of Incentives and Research Requirements on Participation Rates for a Community-Based Preventive Intervention Research Study

This investigation utilized prospective survey data to examine the influence of a research incentive ($100) and requirement (videotaping) on decisions to participate in prevention research. Individuals were significantly attracted by the incentive, and marginally deterred by the requirement. Interaction analyses revealed that the positive incentive effect was stronger among prospective participants with less education and who were otherwise less likely to participate. These findings indicate that monetary incentives can be useful for increasing participation rates, and may help reduce sampling bias by increasing rates most strongly among individuals who are typically less likely to take part in research projects.     

Midwives' practices and beliefs about discharging clients from their practice

Discharging a client from a practice is a choice clinicians may need to make when conflicts arise that cannot be resolved. The legal and ethical considerations before discharging a client are presented. This preliminary survey of 111 certified nurse-midwives was conducted to determine their practices and beliefs about discharging clients. Most (83.7%) participants had discharged five or fewer clients from their practice throughout their careers, including 36.9% who had never discharged a client from their practice. In contrast, 77.5% of participants said that midwives should definitely discharge clients from their practice under some circumstances. Antepartum care was the most frequent period during which clients were discharged, and 59% of those discharged were for noncompliance with the therapeutic regimen, obnoxious or abusive behavior as subjectively identified by the midwife and her colleagues, or failure to keep appointments. When asked why they might not discharge a client from their practice, 60% identified empathy or sympathy for the client as the reason. When asked why they did not discharge clients in the past, 23 (21%) respondents selected "colleagues disagreed" as the reason.     

What Motivates Participation and Dropout Among Low‐Income Urban Families of Color in a Prevention Intervention?*

Low‐income urban parents of color enrolled in a parent training study were interviewed to understand what motivated their participation and what led 30% of them to subsequently drop out. Most enrolled because they wanted to be better parents. Most dropped out because of time and schedule constraints. Retention was higher when parents' motivations for participation matched program goals. Program location and qualities of the recruiter were cited most often as important; financial compensation was cited least often as important.