Organizational capacity for community development in regional health authorities: a conceptual model

The value of community development (CD) practices is well documented in the health promotion literature; it is a foundational strategy outlined in the Ottawa Charter for Health Promotion. Despite the importance of collaborative action with communities to enhance individual and community health and well-being, there exists a major gap between the evidence for CD and the actual extent to which CD is carried out by health organizations. In this paper it is argued that the gap exists because we have failed to turn the evaluative gaze inward-to examine the capacity of health organizations themselves to facilitate CD processes. This study was designed to explicate key elements that contribute to organizational capacity for community development (OC-CD). Twenty-two front-line CD workers and managers responsible for CD initiatives from five regional health authorities in Alberta, Canada, were interviewed. Based on the study findings, a multidimensional model for conceptualizing OC-CD is presented. Central to the model are four inter-related dimensions: (i) organizational commitment to CD, rooted in particular values and beliefs, leadership and shared understanding of CD; (ii) supportive structures and systems, such as job design, flexible planning processes, evaluation mechanisms and collaborative processes; (iii) allocation of resources for CD; and (iv) working relationships and processes that model CD within the health organization. These four dimensions contribute to successful CD practice in numerous ways, but perhaps most importantly by supporting the empowerment and autonomy of the pivotal organizational player in health promotion practice: the front-line worker.     

Community organization and development for health promotion within an urban black community: a conceptual model

The community organization and development process is not new and has its roots in social action ideology from the 1960s. The difference between the 1960s and the 1990s is in bringing together of target community consumers with representatives of private and public sector resources (with consumers in the majority), to form a community coalition board. This community coalition board must make policy decisions. Combining these community organizers and development techniques with the mission of health promotion is a viable methodology for addressing the needs of medically underserved and unserved communities. The approach is a multifactorial one, as illustrated in Figure 1. The Health Promotion Resource Center at Morehouse School of Medicine seeks to combine the ideology of community organization and development with culturally sensitive and linguistically appropriate health promotion curriculum materials and intervention strategies. Within the HPRC lies the Statewide Coordinating Center for Georgia which has been funded by the Henry J. Kaiser Family Foundation. Its mandate is to assist minority and poor communities in Georgia in developing community-based health promotion initiatives which address the areas of cancer, cardiovascular disease, adolescent pregnancy, substance abuse, and violence and unintentional injury. Our strategy in carrying out this mandate is the community organization and development model described in this article.     

Voluntary involvement in community health promotion: the Pawtucket Heart Health Program

The Pawtucket Heart Health Program employs a community activationapproach aimed at reducing cardiovascular morbidity and mortality.This approach is put into operation through the recruitmentof lay volunteers from the community to assist in planning,implementing, evaluating and managing various components ofthe Program. This unique approach of voluntary delivery of programmesis presented in this report. Strategies for the recruitment,interview and placement, training, maintenance and evaluationof volunteers are discussed. The characteristics of people whohave volunteered for specific administrative and service deliveryjobs with the Pawtucket Heart Health Program are also described.The volunteer delivery focus of the Program provides a modelfor adaptation by other public health projects.     

Health promotion for community patients--and health care

There is a basic attitude in using terms like 'sick' or 'healthy' referring to a client. This attitude determines the nursing and therapeutic measures. The provision of health care is an inevitable part of the community nursing services. The relation to the population is given on the basis of personal contact in every-day matters. Communal or visiting nursing organisations can not handle large projects by themselves but are definitely in the position to participate. Continuing further education is a necessity for nurses as well as for the employers. Community nursing is in addition dependent on the support and co-operation of advanced thinking specialists groups.     

Assessing public health capacity to support community-based heart health promotion: the Canadian Heart Health Initiative, Ontario Project (CHHIOP).

This paper presents initial findings of the Canadian Heart Health Initiative, Ontario Project (CHHIOP). CHHIOP has two primary objectives. The programmatic objective is to coordinate and refine a system for supporting effective, sustained community-based heart health activities. This paper addresses the scientific objective: to develop knowledge of factors that influence the development of predisposition and capacity to undertake community-based heart health activities in public health departments. A systems theory framework for an ecological approach to health promotion informs the conceptualization of the key constructs, measured using a two-stage longitudinal design which combines quantitative and qualitative methods. This paper reports the results of the first round of quantitative survey data collected from all health departments in Ontario (N = 42) and individuals within each health department involved in heart health promotion (n = 262). Results indicate low levels of implementation of heart health activities, both overall and for particular risk factors and settings. Levels of capacity are also generally low, yet predisposition to undertake heart health promotion activities is reportedly high. Analyses show that implementation is positively related to capacity but not predisposition, while predisposition and capacity are positively related. Overall, results suggest predisposition is a necessary but not sufficient condition for implementation to occur; capacity-related factors appear to be the primary constraint. These findings are used to inform strategies to address CHHIOP's programmatic objective.     

Baseline assessment of organizational capacity for health promotion within regional health authorities in Alberta, Canada

This paper provides a baseline profile of organizational capacity for (heart) health promotion in Alberta's regional health authorities (RHAs); and examines differences in perceived organizational health promotion capacity specific to modifiable risk factors across three levels of staff and across capacity levels. Baseline data were collected from a purposive sample of 144 board members, senior/middle managers and service providers from 17 RHAs participating in a five-year time-series repeated survey design assessing RHA capacity for (heart) health promotion. Results indicate low levels of capacity to take health promotion action on the broader determinants of health and risk conditions like poverty and social support. In contrast, capacity for health promotion action specific to physiological and behavioural risk factors is considerably higher. Organizational "will" to do health promotion is noticeably more present than is both infrastructure and leadership. Both position held within an organization as well as overall level of organizational capacity appear to influence perceptions of organizational capacity. Overall, results suggest that organizational "will", while necessary, is inadequate on its own for health promotion implementation to occur, especially in regard to addressing the broader determinants of health. A combination of low infrastructure and limited leadership may help explain a lack of health promotion action.     

A conceptual meta-paradigm for the study of health behaviour and health promotion

It is the position of this article that our understanding andresearch of health behaviour and health promotion will be considerablyadvanced when it is conceptualized, conducted and interpretedwithin the frame of reference of a person—environmentdynamic interaction model, thereby taking into account the continuousprocess of change that characterizes all behaviour. By no meansis the present author the first to call attention to the meritsof the person - environment or ecological approach to the understandingof health behaviour, but few systematic attempts at formulatinga meta-theory and research within this framework have been producedto date. The recent work by psychologist Norman S.Endler ofYork University is one notable endeavour to stimulate work inthe study of personality and health behaviour. The present articleis intended to provide a conceptual framework for further heuristicand systematic efforts in health behaviour and health promotionwork.     

Integrating worksite health protection and health promotion: A conceptual model for intervention and research

There is increasing recognition of the value added by integrating traditionally separate efforts to protect and promote worker safety and health. This paper presents an innovative conceptual model to guide research on determinants of worker safety and health and to inform the design, implementation and evaluation of integrated approaches to promoting and protecting worker health. This model is rooted in multiple theories and the premise that the conditions of work are important determinants of individual safety and health outcomes and behaviors, and outcomes important to enterprises such as absence and turnover. Integrated policies, programs and practices simultaneously address multiple conditions of work, including the physical work environment and the organization of work (e.g., psychosocial factors, job tasks and demands). Findings from two recent studies conducted in Boston and Minnesota (2009–2015) illustrate the application of this model to guide social epidemiological research. This paper focuses particular attention on the relationships of the conditions of work to worker health-related behaviors, musculoskeletal symptoms, and occupational injury; and to the design of integrated interventions in response to specific settings and conditions of work of small and medium size manufacturing businesses, based on a systematic assessment of priorities, needs, and resources within an organization. This model provides an organizing framework for both research and practice by specifying the causal pathways through which work may influence health outcomes, and for designing and testing interventions to improve worker safety and health that are meaningful for workers and employers, and responsive to that setting's conditions of work.     

Health promotion community development and the tyranny of individualism

Economic evaluation of health promotion poses few major difficulties when the theoretical approach of the programme and the evaluation of cost and benefits are confined within the context of the individual. Methodological individualism has a long history in economics and the techniques of microeconomics are well suited to the examination of individually focused behaviour change programmes. However, new developments in community health promotion pose special challenges. These programmes have the community, not the individual, as the focus of programme theory and ‘community’ means something completely different from the sum of individuals. Community empowerment and promotion of the community's capacity to deal with health issues are the goals of such programmes. To reflect these notions, sense of community and community competence should be considered as ‘functionings’, an extra-welfarist constituent of well-being. Their inclusion as outcomes of community health promotion requires a shift from individualist utilitarian economics into a communitarian framework which respects the programme's notion of community. If health economics fails to develop new constructs to deal with these new approaches in health promotion, the application of existing techniques to community programmes will mislead health decision makers about their value and potential.     

Impact of a community health promotion program on existing organizations: the Minnesota Heart Health Program.

A community organization strategy was used in the delivery of health education programs by the Minnesota Heart Health Program (MHHP). The effectiveness of the approach was evaluated to determine whether an enhanced health promotion delivery system had developed in MHHP communities by the end of the intervention period or whether the intervention had suppressed community efforts. 'Social connectedness' among providers, as measured by health promotion network size, also was expected to be higher in intervention communities. Six Midwestern communities were studied: the MHHP communities of Mankato, MN and Fargo, ND--Moorhead, MN with two matched comparison communities for each (Winona, MN, St Cloud, MN and Eau Claire, WI, Sioux Falls, SD). Nine areas of health promotion were assessed, including the five heart disease risk factor areas where education campaigns had been implemented (smoking cessation, weight loss, eating patterns, exercise, and heart disease education and screening) and four other areas where community programs are common (chemical dependency; home, personal and drivers' safety; stress management; and cancer education and screening). Indicators of the health promotion delivery system were developed (program options and program participation), and data were collected in separate surveys of 438 community organization providers and 320 larger worksites in the six communities. Results showed no suppression of health promotion delivery systems in MHHP communities. Instead, the survey of larger worksites showed that there was greater participation in heart disease health promotion and greater 'social connectedness' among worksites in both intervention communities. Also, there were more heart disease health promotion programs in the larger intervention community of Fargo-Moorhead. In the community organization survey, results favored the larger intervention community over its comparison communities in heart disease health promotion program options and in 'social connectedness' but not in program participation. However, survey results favored one of the comparison communities (Winona) over the smaller intervention community (Mankato) on all indicators in this survey. The greater impact of the MHHP intervention at worksites suggests that institutionalization may be more likely in stable organizations whose current needs and interests fit the goals of the intervention activity.     

A survey of community gardens in upstate New York: implications for health promotion and community development

Twenty community garden programs in upstate New York (representing 63 gardens) were surveyed to identify characteristics that may be useful to facilitate neighborhood development and health promotion. The most commonly expressed reasons for participating in gardens were access to fresh foods, to enjoy nature, and health benefits. Gardens in low-income neighborhoods (46%) were four times as likely as non low-income gardens to lead to other issues in the neighborhood being addressed; reportedly due to organizing facilitated through the community gardens. Additional research on community gardening can improve our understanding of the interaction of social and physical environments and community health, and effective strategies for empowerment, development, and health promotion.     

Health promotion, advocacy and health inequalities: a conceptual framework

Advocacy has often been described as a key strategy for theachievement of health promotion aims, but multiple and conflictingdefinitions and usages exist. The concept itself may be unnecessarilyintimidating. Advocacy work can take place at the level of both‘cases’ and ‘causes’. Two main goalsunderpin health advocacy—protection of the vulnerable(representational advocacy) and empowerment of the disadvantaged(facilitational advocacy). This paper attempts to integrateexisting models and definitions into a conceptual frameworkfor considering the role of advocacy in addressing health inequalities.It argues that we need to pay some attention to the diversityof values and goals of health promotion if we are to understandwhich models and approaches to health advocacy apply and inwhat context. This paper concludes that advocacy for healthfulfils two functions: as a form of practice and as a usefulstrategy for a discipline which has to be self-promoting aswell as health-promoting in order to survive in the competitivepolitical environment of contemporary health work.     

School-based community development as a health promotion strategy for children

In this paper we discuss our experience of engaging 9–10-year-oldchildren in grade 4 in a community development process to dealwith community health problems they consider important. Withguidance from a facilitator, young children can work cooperativelyto identify problems, set priorities, and design and implementactivities to address a community health issue. They can reflectupon their actions and the process within which they have workedand can realize that the process can be applied to the resolutionof other community problems. However, children's levels of cognitiveand social maturity and their position in society present specialissues for the use of community development as a health educationstrategy     

Project Salsa: development and institutionalization of a nutritional health promotion project in a Latino community

PURPOSE: Project Salsa was a community-based effort seeking to promote health through nutritional behavior change in a Latino community of San Diego, California. The purpose of this article is to report on program factors related to long-term institutionalization of Project Salsa interventions. DESIGN: Project Salsa was a demonstration rather than an experimental project. To ensure maximum sensitivity to the needs and values of the community, Project Salsa began with an extensive health needs assessment, including development of an advisory council, telephone survey, archival research, and key informant interviews. SETTING: Project Salsa interventions took place in San Ysidro, California, located near the U.S.-Mexico border adjacent to Tijuana from 1987 to 1992. SUBJECTS: The intervention community had 14,500 residents, of which nearly 83% were Latino. INTERVENTIONS: Interventions included coronary heart disease risk factor screenings, meal preparation classes, newspaper columns, point-of-purchase education, school health and cafeteria programs, and breast-feeding promotion. MEASURES: Institutionalization of intervention components. RESULTS: Two of the interventions, the risk factor screenings and school health programs, are still in operation 4 years after the end of project funding. CONCLUSIONS: Four factors common to institutionalized components are presented in the paper.