Lessons from community participation in health programmes

Although primary health care emphasizes community participationand many health care programmes attempt to develop participation,good analysis of these developments is still rare. This paper,based on a review of about 200 case studies, examines some ofthe lessons for planners which are emerging from experiencesof the last decade. These lessons focus on the problems of definingthe term ‘community participation’, of gaining andsustaining broad-based community participation, of failing torecognize the political implications of the concept and of attemptingto develop a management model of community participation forhealth. Based on these lessons, a planning framework is suggestedthat seeks individual programme answers to three questions:‘Why participation?’, ‘Who participates?’,‘How do they participate?’. The answers to thesequestions will help to define a programme's objectives and tomonitor and evaluate its development.     

Guthrie house: a rural community organizing for wellness

This paper is interested in the issue of community participation and empowerment in health care provision and decision-making. In Canada, the present scope for public involvement in planning or managing the state's health and social services system is limited. This poses a particular problem for rural communities--places where the provision of health care services has historically been limited when compared to urban locations. These rural communities are now facing a double burden as public policy moves increasingly towards a retrenchment of the welfare state. This paper examines one rural community's response to this double burden. The village of Elgin in rural Ontario recently established Guthrie House, a community-based resource center for health and wellness services. Community participation in this case involved a level of control whereby local citizens together defined the health and social care services that they saw as best meeting the needs of their community. This form of community participation is considerably different from the forms of public involvement in the established medical system and represents a critical link to 'empowering' the local community as partners in health care. Through an examination of Guthrie House, the paper presents a review of some critical 'characteristics' which mark successful community self-help organizations and concludes with a discussion of the policy implications for greater community participation. It is argued that such community participation in health care is a policy option which government should be paying particular attention to in these times of fiscal constraint, increasing health care needs and increasing consumer dissatisfaction with government service provision mechanisms.     

The first community health centers: a model of enduring value

Community health centers in the United States, first launched as a federal initiative in 1965, were rooted in models from South Africa, the American civil rights struggle, and a national commitment to address poverty. The first 2 centers, one serving a rural population in the Mississippi Delta and another a public housing project in Boston, incorporated such core principles as provision of primary care to a defined area or population; public health interventions addressing social determinants of health; emphasis on community participation; community empowerment leading to control of the new institutions; epidemiologic methods to identify problems and guide decisions; new combinations of clinical and public health personnel; and reduction of disparities in health and healthcare of the poor and minorities. The continuing relevance of these principles in today's greatly expanded health center network is reviewed.     

Perceptions of community participation and health gain in a community project for the South Asian population: a qualitative study

BACKGROUND: The new public health rejects old individualist attempts at improving health and embraces community-based approaches in reducing health inequalities. Primary Care Trusts in England face the challenge of converting community participation in health into reality. This study explores differences in perception of participation between lay and professional stakeholders of a community health project for a South Asian population in Greater Manchester. METHODS: In-depth interviews and focus groups were used to explore the views of professional and lay stakeholders. All data were audio-taped, transcribed and analysed for emerging themes using a qualitative framework. RESULTS: Professionals talked of working in partnership with the community but lay stakeholders did not feel that they had control over the project. There were problems in engaging the community and local health professionals in the project. Lack of cultural awareness hampered participation in the project. There was agreement that the project improved the self-confidence of participants and created a more informed population. However, there was little support for claims of improvements in social cohesion and changes in lifestyle directly as a result of the project. CONCLUSION: Converting the rhetoric of community participation in health into reality is a greater challenge than was envisaged by policy makers. Marginalized communities may not be willing participants and issues of language and cultural sensitivity are important. Project outcomes need to be agreed to ensure projects are evaluated appropriately. Projects with South Asian communities should not be seen to be dealing with all 'ethnic health' issues without addressing changes in statutory organizations and other wider social determinants of health.     

Broadening participation in community problem solving: A multidisciplinary model to support collaborative practice and research

Over the last 40 years, thousands of communities—in the United States and internationally—have been working to broaden the involvement of people and organizations in addressing community-level problems related to health and other areas. Yet, in spite of, this experience, many communities are having substantial difficulty achieving their collaborative objective, and many funders of community partnerships and participation initiatives are looking for ways to get more out of their investment. One of the reasons we are in this predicament is that the practitioners and researchers who are interested in community collaboration come from a variety of contexts, initiatives, and academic disciplines, and few of them have integrated their work with experiences or literatures beyond their own domain. In this article, we seek to overcome some of this fragmentation of effort by presenting a multidisciplinary model that lays out the pathways by which broadly participatory processes lead to more effective community problem solving and to improvements in community health. The model, which builds on a broad array of practical experience as well as conceptual and empirical work in multiple fields, is an outgrowth of a joint-learning work group that was organized to support nine communities in the Turning Point initiative. Following a detailed explication of the model, the article focuses on the implications of the model for research, practice, and policy. It describes how the model can help researchers answer the fundamental effectiveness and “how-to” questions related to community collaboration. In addition, the article explores differences between the model and current practice, suggesting strategies that can help the participants in, and funders of, community collaborations strengthen their efforts.     

Implementation and evaluation of public relations activity in a community health program]

OBJECTIVE: This study evaluated public relations activity in a community health program in order to develop effective strategies to attract the public attention for the program. METHODS: An intervention study was conducted on public relations for "Nutrition Seminar for Citizens," sponsored by the Health Department of Machida City, Tokyo, in October, 1999. One ward in the city was selected as an intervention area, and another ward which had similar demographic and geographic characteristics was chosen as a control area. Two target populations were defined; one was women in their 20s to 60s (#1) and the other was those who had previously never utilized community health programs sponsored by the city (#2). Handbills were used as the medium for public relations for the seminar. These announced the time, place and content of the nutrition seminar and were designed by authors with special attention to catchphrases, colors and fonts. Handbills were distributed in the intervention area through elementary schools, local voluntary organizations and local health volunteers. In addition, the authors directly handed them out to people in front of two supermarkets in the town. The sources of seminar information were requested from the participants of the Nutrition Seminar with a self-administered questionnaire. RESULTS: 1. The percentage of participants who received the seminar information from handbills was higher than that of those who used monthly newsletters from the city as a source of information. 2. The percentage of participants from the intervention area was higher than that from the control area. 3. Regarding target populations #1 and #2, there were no differences in participation rates between the intervention and control area. 4. Among the four distribution routes, the local voluntary organization route was the most effective for attracting participants. CONCLUSIONS: The results show that handbills can be an effective medium for pubic relations to increase the number of participants in community health programs. Also, local voluntary organizations can play a crucial role in information transfer in the community because of their high credibility. On the other hand, we could not reach specified target populations with the medium. Further surveys are needed to establish optimal media and routes to reach appropriate target populations in health programs.     

Revisiting community participation

Community participation in health is a complex entity that has been examined extensively in the literature and continues to be of great interest among community health workers. The genesis of the idea and its conceptual development are primarily attributed to large multinational health institutions, particularly the World Health Organization. However, the implementation of community participation is the ultimate responsibility of local health programme initiators. It is therefore at the local level where day to day realities of incorporating community participation into health service delivery are confronted. This paper reviews the value of community participation in health and provides a detailed examination of the challenges facing its implementation and sustainability. In 1978, the World Health Organization placed community participation squarely at the centre of their strategy to achieve Health For All By The Year 2000. As the year 2000 nears, it is time to critically re-examine the notion of community participation and the most pressing challenges to its viability.      

Implementing community participation through legislative reform: a study of the policy framework for community participation in the Western Cape province of South Africa

ABSTRACT: BACKGROUND: Amidst an evolving post-apartheid policy framework for health, policymakers have sought to institutionalize community participation in Primary Health Care, recognizing participation as integral to realizing South Africa's constitutional commitment to the right to health. With evolving South African legislation supporting community involvement in the health system, early policy developments focused on Community Health Committees (HCs) as the principal institutions of community participation. Formally recognized in the National Health Act of 2003, the National Health Act deferred to provincial governments in establishing the specific roles and functions of HCs. As a result, stakeholders developed a Draft Policy Framework for Community Participation in Health (Draft Policy) to formalize participatory institutions in the Western Cape province. METHODS: With the Draft Policy as a frame of analysis, the researchers conducted documentary policy analysis and semi-structured interviews on the evolution of South African community participation policy. Moving beyond the specific and unique circumstances of the Western Cape, this study analyzes generalizable themes for rights-based community participation in the health system. RESULTS: Framing institutions for the establishment, appointment, and functioning of community participation, the Draft Policy proposed a formal network of communication -- from local HCs to the health system. However, this participation structure has struggled to establish itself and function effectively as a result of limitations in community representation, administrative support, capacity building, and policy commitment. Without legislative support for community participation, the enactment of superseding legislation is likely to bring an end to HC structures in the Western Cape. CONCLUSIONS: Attempts to realize community participation have not adequately addressed the underlying factors crucial to promoting effective participation, with policy reforms necessary: to codify clearly defined roles and functions of community representation; to outline how communities engage with government through effective and accountable channels for participation; and to ensure extensive training and capacity building of community representatives. Given the public health importance of structured and effective policies for community participation, and the normative importance of participation in realizing a rights-based approach to health, this analysis informs researchers on the challenges to institutionalizing participation in health systems policy and provides practitioners with a research base to frame future policy reforms.     

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     

Health, human development and the community ecosystem: three ecological models

Health, as both an expres and a component of human development,has to be seen in an ecological way as ‘the pattern thatconnects’ and the radical and subversive nature of anecological approach needs to be recognized. Three ecologicalmodels are presented, that of health, the links between health,environment and economy (or between ‘health for all’and sustainable development); and the social, environmentaland eco nomic dimensions of a healthy and sustainable com munity. The ‘Mandala of Health’, as a model of the humanecosystem, presents the determinants of health as a set of nestedinfluences, ranging from the biological and personal to theecological and planetary, including the social and political The health-environment-economy model shows the crucial linksbetween health (or social wellbeing) and environmental and economicwellbeing with a particular focus on two key public health principles—equityand sustainabilizy. The final model applies these concepts atthe community level, introducing such issues viability, convivialityand liveabilily. These models could be used to better understand health, to definekey criteria for hea Ithier public policies and to define somekey action areas for healthy city projects. It is in their applicationthat their value—and their ‘subversiveness’—willbe tested.     

Increasing community participation in an Aboriginal health service

Objective: To increase Aboriginal participation with mainstream health professionals in an Aboriginal health and well‐being centre. Design: Participatory Action Research using Aboriginal traditional symbolism to depict aspects of the research process, interview surveys and a document review. Setting: A regional town with 629 Aboriginal and Torres Strait Islander residents and a newly established Aboriginal health and well‐being centre (Nunyara). Participants: Thirty Aboriginal community members were interviewed about their involvement with Nunyara and their health issues. Participants were selected through purposive ‘pass‐me‐around’ sampling to ensure that all family groups were included. Results: The results are presented in two areas: the structure of the Aboriginal community that affects participation and community views about health issues. Aboriginal people living in the town come from 10 or more different language groups and relate almost exclusively within their own groups. Activities at Nunyara were seen as individual family group events and not for everyone. Aboriginal community participants had a broad view of health as they reported problems that included smoking and alcohol use. Almost all would like more involvement in health issues through Nunyara. Conclusion: Aboriginal community members are willing to get involved in health issues in collaboration with Nunyara. However, fundamental to increasing participation is to bring people together from different family groups and increase social cohesion. This can be done through developing relationships with groups enabling different points of view to be heard and valued.     

Young people’s perceptions of substance use norms and attitudes in the LGBT community

Objectives : Sexual minority young people (SMYP) show higher levels of substance use than their heterosexual counterparts. This study aims to test potential LGBT community‐specific reasons assumed to affect substance use and their relationships to LGBT community participation/connectedness and substance use behaviour. Methods : Eight LGBT community‐specific reasons for substance use were tested in an online survey with 1,556 SMYP. Results : Respondents agreed that the LGBT community had liberal attitudes towards substance use (80.5%, n=1,079) and that the media portrayed substance use as a part of the community culture (66.5%, n=904). Participants disagreed that excessive partying is a part of the community (34.7%, n=470). Significant but weak correlations between reasons and community participation/connectedness or personal substance use behaviour were found. Subgroup analyses indicated male and gay/lesbian participants showed differential agreement levels to some of the reasons. Conclusion : Young people’s perceptions of substance use within the LGBT community are not associated with community participation/connectedness or personal substance use. Implications for public health : Further research is needed to better understand what factors lead to elevated levels of substance use in SMYP. This may assist in the development of adequate public health responses. Targeting problematic beliefs may have little impact on substance use in SMYP.     

The relationships of social participation and community ratings to health and health behaviors in areas with high and low population density

Previous studies have linked social participation and community levels of trust with improved health status. We examined the associations between levels of community participation, self-reported community ratings (trust), and health within a public health surveillance survey conducted in Kansas (N=4601). Independent variables were individual ratings of their communities (excellent, very good, good/ fair, poor), and their involvement in community groups or organizations in the last 5 years (yes/no). Dependent variables were self-rated health status, depressive symptoms, physical activity, smoking, obesity, and binge drinking. After controlling for age, gender, race/ethnicity, education, and having a medical doctor, self-rated health status (p<0.001) and physical activity (PA) (p<0.001) were positively, and smoking (p<0.001) and depressive symptoms (p<0.001) were negatively associated with community ratings. Only PA (p<0.001) remained associated with community involvement in a multivariate analyses. Multilevel analysis using county-level data showed no significant interactions between population density and dependent variables. Individuals from rural areas had the highest community involvement but relatively low levels of community ratings. Our findings suggest that individuals in rural areas, especially in densely settled rural areas, may face increased risks of poor health.     

Improving cervical screening in a remote Aboriginal community

Improved cervical screening has been identified as a priority in reducing the incidence of cervical cancer among Aboriginal women. This paper discusses the cervical screening recommendations of a women's health project developed by Nganampa Health Council (NHC), the Aboriginal-controlled medical service meeting the health needs of the people of the Anangu Pitjantjatjara (AP) Lands. A community participation public health model was used in program development. A process including community and staff consultation, literature review and prioritisation informed the program development, ensuring strategies thereby derived were culturally acceptable as well as practical and scientifically valid. The epidemiology of cervical cancer and screening in this community is discussed. Strategies aimed at maximising patient participation, improving patient satisfaction, running an effective call and recall system, improving quality of cervical smears, improving management of women with abnormal smears and evaluating the program are suggested. The involvement of the community in a scientifically sound, public health approach may increase the likelihood that the strategies suggested will be effective in this community. Both the model of program development and the cervical screening strategies derived are likely to be of relevance for other Aboriginal communities.     

社区居民心理健康预警及干预机制探讨

心理卫生问题已成为公共卫生问题和突出的社会问题.社区居民心理健康预警及干预机制,是应对社区居民心理健康问题的有效机制.建议:重视并建立社区心理服务机构,完善社区心理卫生服务机构及职能,建立有效的社区心理健康卫生服务预警及治疗机制,加强健康教育、健康促进及心理卫生知识宣传工作,贯彻心理卫生工作的三级预防及三级功能方针.由此,预防社区居民心理疾病的产生,提高社区居民心理健康水平,促进我国社区精神卫生服务的建设及发展.     

社区居民心理健康预警及干预机制探讨

心理卫生问题已成为公共卫生问题和突出的社会问题.社区居民心理健康预警及干预机制,是应对社区居民心理健康问题的有效机制.建议:重视并建立社区心理服务机构,完善社区心理卫生服务机构及职能,建立有效的社区心理健康卫生服务预警及治疗机制,加强健康教育、健康促进及心理卫生知识宣传工作,贯彻心理卫生工作的三级预防及三级功能方针.由此,预防社区居民心理疾病的产生,提高社区居民心理健康水平,促进我国社区精神卫生服务的建设及发展.     

社区居民心理健康预警及干预机制探讨

心理卫生问题已成为公共卫生问题和突出的社会问题.社区居民心理健康预警及干预机制,是应对社区居民心理健康问题的有效机制.建议:重视并建立社区心理服务机构,完善社区心理卫生服务机构及职能,建立有效的社区心理健康卫生服务预警及治疗机制,加强健康教育、健康促进及心理卫生知识宣传工作,贯彻心理卫生工作的三级预防及三级功能方针.由此,预防社区居民心理疾病的产生,提高社区居民心理健康水平,促进我国社区精神卫生服务的建设及发展.     

社区居民心理健康预警及干预机制探讨

心理卫生问题已成为公共卫生问题和突出的社会问题.社区居民心理健康预警及干预机制,是应对社区居民心理健康问题的有效机制.建议:重视并建立社区心理服务机构,完善社区心理卫生服务机构及职能,建立有效的社区心理健康卫生服务预警及治疗机制,加强健康教育、健康促进及心理卫生知识宣传工作,贯彻心理卫生工作的三级预防及三级功能方针.由此,预防社区居民心理疾病的产生,提高社区居民心理健康水平,促进我国社区精神卫生服务的建设及发展.     

社区居民心理健康预警及干预机制探讨

心理卫生问题已成为公共卫生问题和突出的社会问题.社区居民心理健康预警及干预机制,是应对社区居民心理健康问题的有效机制.建议:重视并建立社区心理服务机构,完善社区心理卫生服务机构及职能,建立有效的社区心理健康卫生服务预警及治疗机制,加强健康教育、健康促进及心理卫生知识宣传工作,贯彻心理卫生工作的三级预防及三级功能方针.由此,预防社区居民心理疾病的产生,提高社区居民心理健康水平,促进我国社区精神卫生服务的建设及发展.     

社区居民心理健康预警及干预机制探讨

心理卫生问题已成为公共卫生问题和突出的社会问题.社区居民心理健康预警及干预机制,是应对社区居民心理健康问题的有效机制.建议:重视并建立社区心理服务机构,完善社区心理卫生服务机构及职能,建立有效的社区心理健康卫生服务预警及治疗机制,加强健康教育、健康促进及心理卫生知识宣传工作,贯彻心理卫生工作的三级预防及三级功能方针.由此,预防社区居民心理疾病的产生,提高社区居民心理健康水平,促进我国社区精神卫生服务的建设及发展.