The Wellness Guide: towards a new model for community participation in health promotion

This paper describes how community participation came to playa central role in developing the Wellness Guide Project, a majornew health promotion initiative of the State of California.The Guide itself was to be a simple document that would giveinformation on how to stay well and where to find help on health-relatedtopics. It was to be sensitive to the needs of people of allethnic and social backgrounds, and suitable for distributionto all households in the State (10 million). The metamorphosisof the Guide is described, from early drafts, prepared by healthand welfare specialists and covering traditional behavioralrisk factors, to the final product, a large-format, illustrated80-page book, written with diverse community involvement, andaddressing a wide range of personal and social topics. Telephonecompanies and information and referral services participatedin developing a cross-referral system from the Guide to new‘Community Services’ listings in phone directoriesthroughout the State. The community also participated in preparinga Spanish adaptation of the Guide. The project outcomes—aunique health education document, a novel referral system, andthe beginnings of a new model for community participation inhealth promotion—are discussed.     

Gascoyne Growers Market: a sustainable health promotion activity developed in partnership with the community

OBJECTIVE: To explore the social, health and economic impact of a farmers' market on a small rural community in the north of Western Australia. DESIGN: Qualitative and quantitative research using a random structured intercept survey, and focus group interviews around four domains of social capital: economic impact, governance and capacity building, healthy public places and social and civic participation. SETTING: The Gascoyne Growers Markets in Carnarvon. SUBJECTS: One hundred consumers and 28 market stallholders. RESULTS: Consumers demonstrated community pride and an increase in fruit and vegetable consumption since they commenced shopping at the markets. The stallholders appear to have gained economically, professionally and socially from the market experience. CONCLUSIONS: The Gascoyne Growers Markets demonstrate a sustainable health promotion activity developed in partnership with the community. It has contributed to the local economy, providing local quality fruit and vegetables directly to the community while also increasing social capital and creating a healthy public space.     

Effective community health participation strategies: a Cuban example

Since the decade of the 1970s health promotion has been an integral part of most primary health care strategies. This article examines some community participation strategies adopted in the health promotion in Cuba and the policies which enable such strategies. This is done in the context of health promotion theory and also examines the concept of direct involvement by the political directorate in health promotion. The article is written from a reflexive perspective following the author's visit to Cuba as member of a health study tour in March 2002.     

Scientific rigor and community participation in health promotion research: are they compatible?

An important challenge for those conducting health promotionresearch is to reconcile the competing demands of scientificrigor and community participation. To develop further the theoreticaland empirical basis for health promotion, research needs tobe scientifically rigorous in every aspect of conceptualization,design, implementation, analysis and interpretation. Anotherwidely held perspective in health promotion research is thatit should be based on widespread community participation invarious stages of the process. These two compelling forces arecompeting to the extent that they create questions about controlof the research questions, methods used and relevance. The natureof this dilemma is discussed in this paper, along with an exampleof how one community-based research unit is dealing with theseissues     

Factors related to preference for participation and degree of commitment in community activities among older adults in Japanese depopulated areas

To address the rapid increase in the ageing population, Japan implemented the Long‐Term Care Insurance System (LTCS) in 2000. Additionally, a community‐based integrated community care system was released in 2012. The purpose of these policies was to help older people who need care or support to continue to live their preferred lifestyles in their own communities. According to this paradigm, older residents are themselves considered members of the community caregiving team and expected to participate in volunteer activities to help the neighbourhood. One such activity is social participation including community activities. Many factors influencing social participation have been found in previous literature. However, knowledge of specific factors about community activities is limited, even though these kinds of activities have attracted policy attention. Our study examined factors related to thoughts about community activities among people aged >40 years. We conducted random sampling in two depopulated areas in Japan and used an anonymous mail survey method. Our survey consisted of three parts: social demographics, health and life, and medical/long‐term care. A total of 2,466 individuals participated in the study (response rate 52.2%), whose average age was 64.2 (SD = 10.3) and 46.5% (n = 1,146) were female. Items including talking with neighbours frequently (social demographics), higher self‐rated health (health and life), the need for health consultations and the desire to take care of family members when they need help (medical/long‐term care) were significantly related to both preference for participation and degree of commitment in community activities. To encourage participation in community activities among older citizens, we recommend interventions related to health literacy and family ties.     

Influence of health promotion bureaucracy on community participation: a Canadian case study

The purpose of this paper is to illustrate, through a Canadian case study, the bureaucratic support and obstacles for community participation in health promotion. The paper begins with a brief history of the development of a participatory health promotion programme in Canada. The role of bureaucracies on participation of communities is highlighted. Secondly, the paper describes how a variety of bureaucratic factors affected grassroots community participation efforts of local projects in one province. Finally, discussion focuses on how community participation is constrained in a bureau-cratically mediated activity such as health promotion.     

Service providers' views of community participation at six Australian primary healthcare services: scope for empowerment and challenges to implementation

Community participation is a key principle of comprehensive primary health care (PHC). There is little literature on how community participation is implemented at Australian PHC services. As part of a wider study conducted in partnership with five South Australian PHC services, and one Aboriginal community controlled health service in the Northern Territory, 68 staff, manager, regional health executives, and departmental funders were interviewed about community participation, perceived benefits, and factors that influenced implementation. Additional data were collected through analysis of policy documents, service reports on activity, and a web‐based survey completed by 130 staff. A variety of community participation strategies was reported, ranging from consultation and participation as a means to improve service quality and acceptability, to substantive and structural participation strategies with an emphasis on empowerment. The Aboriginal community controlled health service in our study reported the most comprehensive community participation. Respondents from all services were positive about the benefits of participation but reported that efforts to involve service users had to compete with a centrally directed model of care emphasising individual treatment services, particularly at state‐managed services. More empowering substantive and structural participation strategies were less common than consultation or participation used to achieve prescribed goals. The most commonly reported barriers to community participation were budget and lack of flexibility in service delivery. The current central control of the state‐managed services needs to be replaced with more local management decision making if empowering community participation is to be strengthened and embedded more effectively in the culture of services. Copyright © 2014 John Wiley & Sons, Ltd.     

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.     

A new approach to community participation assessment

It is important to investigate the processes which influenceparticipation in a community-wide intervenlion programme, tosee if the programme actually evolved from an idea to reality.A method for assessing community participation in health programmeshas been developed and so far niainly applied in developingcountries. The method uses five indicators that strongly influencethe community participation process. These are: needs assessment,leadership, organization, resource mobilization and management.This method was used to analyse the community development processin a community intervention programme aimed at preventing accidents,in Sollentuna municipality, Stockholm County. An asses.snrentof the participation process was made for years 2 and 4, indicatingthat participation had expanded. The method was of value fordescribing and understanding the participation process and wasalso found to be relevant in an accident prevention programmein an industrialized country. The method was also found robea valuable educational tool when used as a process indicatorfor the programme, and important for understanding change.     

Building alliances: professional and political issues in community participation. Examples from a health and community development project

The notion of community participation in health finds favourin many circles, since, lacking close definition, it can beinterpreted in such a way as to be acceptable to all politicalpersuasions. This paper explores some of the consequences of these multipleinterpretations and gives examples from a community developmentand health promotion project in Scotland. Professional attitudes and behaviour and bureaucratic structuresare seen as significant barriers to public participation inhealth. Fundamental changes in the state of the public healthare blocked by a medical model which emphasizes individual responsibilityand treatment. It is argued that the public must retain ‘ownership’of the problems they define and the solutions to those problems.Professionals need to share their skills, rather than imposethem, and learn, in their turn, about the world inhabited bydisadvantaged groups.     

Toward an institutional perspective on social capital health interventions: lay community health workers as social capital builders

This article argues that social capital health research should move beyond a mere focus on social cohesion and network perspectives to integrate an institutional approach into the development of social capital health interventions. An institutional perspective, which is unique in its emphasis on linking social capital in addition to the bonding and bridging forms, contextualises social capital, allowing researchers to confront the complexity of social relationships. This perspective allows for the construction of interventions that draw on the resources of diverse actors, particularly the state. One intervention strategy with the potential to create community linkages involves lay community health workers (LCHWs), individuals who are trained to perform a variety of health-related functions but lack a formal professional health education. This article begins with a review of the institutional social capital-building literature. It then goes on to briefly review the social capital and health literature and discuss the state of intervention research. Thereafter, it describes LCHWs and discusses studies that have utilised LCHWs to tackle community health problems. In doing so, this article presents an institutional-based systematic framework for how LCHWs can build social capital, including a discussion of the ways in which LCHWs can successfully promote bonding, bridging and linking social capital.     

Community participation in road safety: barriers and enablers

The objectives of the paper were to identify barriers to community participation in road safety activities and to recommend strategies to reduce those barriers. Information was obtained from: a review of relevant literature, from the authors' extensive community-based experiences, from undertaking community-based research, and from interviews with key stakeholders in road safety in Western Australia. Ten significant barriers to community participation were identified. These are classified into two groups: personnel and planning issues. The former includes: reasons why people are often reluctant to become involved in projects in their communities, a lack of leadership, and a lack of skills. The latter includes: inappropriate program foci, inappropriate program evaluation, lack of resources, and a lack of sustainability. It was concluded that the barriers to community involvement in road safety initiatives are similar in many parts of Australia and overseas and apply to a wide range of health promotion interventions besides road safety. Awareness of the barriers and knowledge of their solutions can ensure that appropriate steps are taken to maximise the likelihood of community participation.     

Preliminary development and validation of an Australian community participation questionnaire: types of participation and associations with distress in a coastal community

Participating in the social and civic life of communities is protectively associated with the onset and course of physical and mental disorders, and is considered important in achieving health promotion goals. Despite its importance in health research, there is no systematically developed measure of community participation. Our aim was to undertake the preliminary development of a community participation questionnaire, including validating it against an external reference, general psychological distress. Participants were 963 randomly selected community members, aged 19-97, from coastal New South Wales, Australia, who completed an anonymous postal survey. There were 14 types of community participation, most of which were characterised by personal involvement, initiative and effort. Frequency of participation varied across types and between women and men. Based on multiple linear regression analyses, controlling for socio-demographic factors, nine types of participation were independently and significantly associated with general psychological distress. Unexpectedly, for two of these, "expressing opinions publicly" and "political protest", higher levels of participation were associated with higher levels of distress. The other seven were: contact with immediate household, extended family, friends, and neighbours; participating in organised community activities; taking an active interest in current affairs; and religious observance. We called these the "Big 7". Higher levels of participation in the Big 7 were associated with lower levels of distress. Participating in an increasing number of the Big 7 types of participation was strongly associated in linear fashion with decreasing distress.     

Building community capacity for end of life: an investigation of community capacity and its implications for health-promoting palliative care in the Australian Capital Territory

This study identified and examined community-based activities around death, dying and end-of-life care which might reflect a health-promoting palliative care (HPPC) philosophy. This approach is argued to restore community ownership of, and agency in, dying and death through the building of community capacity. However, the enactment of the HPPC approach has not been extensively examined in Australia. Current understandings of community capacity-building relating to end of life are orientated toward service provision. A qualitative interpretive approach was used to engage with local community groups in the Australian Capital Territory with an interest in death, dying and end-of-life care. Data were collected from ten in-depth, semi-structured interviews and thematically analysed. The themes of Practical Support, Respect and Responsiveness and Connection and Empowerment were identified, reflecting community activities initiated in response to the experience of life-limiting illness. Building community capacity offers to restore community agency in end-of-life concerns, while potentially enhancing health service provision through collaborative partnerships. This study indicates an existing community capacity, demonstrated by activities that promote socialisation, peer support and normalisation of death and dying. However, as these activities occur primarily in response to illness, proactive and preparatory interventions in HPPC are a priority.     

Strengthening community mental health competence—A realist informed case study from Dehradun,North India

Few accounts exist of programmes in low‐ and middle‐income countries seeking to strengthen community knowledge and skills in mental health. This case study uses a realist lens to explore how a mental health project in a context with few mental health services, strengthened community mental health competence by increasing community knowledge, creating safer social spaces and engaging partnerships for action. We used predominantly qualitative methods to explore relationships between context, interventions, mechanisms and outcomes in the “natural setting” of a community‐based mental health project in Dehradun district, Uttarakhand, North India. Qualitative data came from focus group discussions, participant observation and document reviews of community teams' monthly reports on changes in behaviour, attitudes and relationships among stakeholder groups. Data analysis initially involved thematic analysis of three domains: knowledge, safe social spaces and partnerships for action. By exploring patterns within the identified themes for each domain, we were able to infer the mechanisms and contextual elements contributing to observed outcomes. Community knowledge was effectively increased by allowing communities to absorb new understanding into pre‐existing social and cultural constructs. Non‐hierarchical informal community conversations allowed “organic” integration of unfamiliar biomedical knowledge into local explanatory frameworks. People with psycho‐social disability and caregivers found increased social support and inclusion by participating in groups. Building skills in respectful communication through role plays and reflexive discussion increased the receptivity of social environments to people with psycho‐social disabilities participation, thereby creating safe social spaces. Facilitating social networks through groups increases women's capacity for collective action to promote mental health. In summary, locally appropriate methods contribute most to learning, stigma reduction and help‐seeking. The complex social change progress was patchy and often slow. This study demonstrates a participatory, iterative, reflexive project design which is generating evidence indicating substantial improvements in community mental health competence.     

Multicultural social policy and community participation in health: new opportunities and challenges for indigenous people

Community participation in local health has assumed a central role in the reforms of public healthcare, being increasingly associated with the issue of decentralization of the health system. The aim of this paper is to raise questions regarding the structural approaches to multicultural social policy in Chile and to analyze the results of its implementation. The article analyzes the case study of Makewe Hospital, one of the pioneering experiences of intercultural health initiative in Chile. The Makewe Hospital, which involves the indigenous community of the Mapuche, provides interesting insights to understand the dynamics of multicultural social policy and presents an example of a successful initiative that has succeeded in involving local communities in multicultural health policy. This case study discusses the effectiveness of grassroots participation in multicultural healthcare provision and presents the main strengths and challenges for the replicability of this experience in other settings.     

Capacity building and social marketing promotes healthy lifestyle behaviour in an Australian Aboriginal community

Objective

We explored the effectiveness of a project targeting an Australian Aboriginal community.

Design

A collaborative approach included stakeholder interviews, an intercept survey, observations and Facebook insights.

Setting

Gippsland encompasses 41 557 km² of Victoria and has an Aboriginal population of around 4000.

Participants

Five stakeholders from local Aboriginal health/sports organisations were interviewed at 6 and 18 months. A total of 49 Aboriginal persons aged 16 years or more, who lived in Gippsland, were surveyed at a community event. Facebook engagement involved 933 people over a 4‐week period.

Main outcome measures

Reach was assessed at 6 and 18 months using Facebook likes and video views. Survey measures addressed campaign awareness, recall and attitudinal and behavioural change.

Results

The project provides organisations with skills development, social media production and online resources promoting sports and community events. Stakeholders and survey respondents valued local content, positive stories and awareness‐raising elements. Two campaigns developed by state and regional organisations were adapted using locally developed social media with campaign messages. After 18 months, there were 2592 video views and 1738 likes. Forty‐seven (69%) of the eligible attendees at the community event completed the survey. Thirty‐three (70%) had seen the campaign; 20 (61%) subsequently thought about changing their behaviour and 13 (39%) changed their behaviour.

Conclusion

The model was mutually beneficial. Partner organisations enabled project access to local events and project staff supported organisational development and event promotion. Social marketing engaged the community and prompted positive behaviour change. Formative work that is undertaken centrally might be useful for organisations to adapt for local campaigns.

     

Policy, competence and participation: empirical evidence for a multilevel health promotion model

This paper uses data from a European health promotion evaluationstudy (MAREPS) to empirically test some fundamental assumptionsof health promotion theory. Analysis shows that both the competenceof individual actors and the opportunities provided for by health-promotingpolicies are significant predictors of participation in healthpromotion action. It also demonstrates effects of health promotionvalues on such action. Moreover, people's perception of theirown political efficacy, e.g. their influence on community decisionsthat effect their health, turns out to be a significant predictorof self-rated health. In conclusion, the paper encourages furtherresearch to investigate the effectiveness of health-promotingpolicy strategies within a multilevel health promotion framework.As the present results indicate, effective health-promotingpolicies may create opportunities that enable individuals andcommunities to increase control over the determinants of health,and thereby improve their health.     

Fear and Shame: using theatre to destigmatise mental illness in an Australian Macedonian community

In the article entitled ‘Fear and Shame: using theatre to destigmatise mental illness in an Australian Macedonian community’ by Blignault et al., an incorrect year was used. Page 124, col. 2, para 3, line 3 should read: When asked who they would contact for help if someone they knew was showing signs of mental illness, 84% of the overall sample nominated health workers or services in 2009 compared to 60% in 2003 (see Table 5).