CHAPTER 9

COMMUNITIES AND POPULATIONS AS THE FOCUS FOR HEALTH PROMOTION PROGRAMS

COMMUNITY INTERVENTION OR INTERVENTION IN A COMMUNITY?

• Typically, you will be addressing health issues WITHIN A COMMUNITY

• In which a particular set of – Individuals– social group– cultures and norms– economic patterns– politics – resources

• all interact to help create a unique situation.

COMMUNITY DEFINED

• “A collective body of individuals identified by common characteristics such as geography, interests, experiences, concerns or values”– A group of people who have common characteristics

• Can be defined by location, race, ethnicity, age, occupation, interest in particular problems or outcomes, or common bonds

• Virtual communities including online interaction

Community Intervention vs.

Intervention in a community

COMMUNITY INTERVENTION

• Broader interventions • Community interventions tend to result in

smaller changes, but over a large number of people

• Example: a community mass media intervention resulted in a 3% decrease in smoking– Consider 3% over the whole community– May be hundreds or thousands of individuals

INTERVENTION IN A COMMUNITY

• More targeted interventions within a community

• Focus on a segment of the community that is highly affected by a health problem.

• Example: an HIV/AIDS intervention might focus on intravenous drug users, high risk population involved in transmitting infection through shared equipment– 32% of this segment may stop sharing used

needles– Big change over a small subset of the community

CDC’s Five Strategies to eliminate Health Disparities

1. Capacity building• Empowerment; community coalition actions to reduce

disparities• Community characteristics affecting its ability to

identify, mobilize and address problems

2. Targeted actions• Intervention activities believed to bring about a

desired effect

CDC’s Five Strategies to eliminate Health Disparities

3. Community/systems change• Changes to the community environment and to

the knowledge, attitudes, beliefs, and behaviors of influential individuals and groups

• Gatekeepers - the leaders of the community who control, both formally and informally the political climate of the community; helps to gain entry into a community

CDC’s Five Strategies to eliminate Health Disparities

4. Widespread risk/protective behavior change• Changes in rates of risk reduction behaviors

among significant percentage of community members

5. Health disparity reduction• Narrowing gaps in health status

Trends in Adult/Adolescent Reported HIV Diagnoses by Race/Ethnicity in Montgomery County, 1985-2012, Reported through 12/31/2012 (MD DHMH, 2013)

Maryland Department of Health and Mental Hygiene. (2013). Montgomery County HIV/AIDS Epidemiological Profile. [Data file]. Retrieved April 10, 2015, from http://phpa.dhmh.maryland.gov/OIDEOR/CHSE/Shared%20Documents/Montgomery%20County%20HIV%20AIDS%20Epidemiological%20Profile%2012-2011.pdf

INTERVENTIONS AND THE COMPLEXITY OF COMMUNITIES

• Whether large or targeted, the intervention itself is almost always just part of the picture.

• Because a community is involved, the following will inevitably play a role in some way:– Interests– Needs– Politics– resources, and – social structures of the community

POLITICS OF SELECTING THE TARGET POPULATION AND HEALTH ISSUE

• In any community, there could be a number of health issues that are important, including: – Cancer– Cardiovascular health– Alcohol abuse– Mine safety/occupational health

• HOW do you choose which to focus on?

POLITICS OF SELECTING THE TARGET POPULATION AND HEALTH ISSUE

• Any health issue may have a Political dimension to it– Advocacy groups or particular interests within

the community may be trying to increase the attention and resources directed to their issue.

• The health issue you focus on may be dictated by the source of funds.– funds that you have may be limited in a way

that clashes with strong community interests.

COALITIONS AND COMMUNITY STRUCTURES OF POWER

• The implementation of a community intervention may require collaboration with community structures, including, for example:– Government agencies or a specific leader

(e.g., mayor)– Task forces formed by the government– Community coalitions and organizations– Grassroots community organizations– Professional groups

COALITIONS AND COMMUNITY STRUCTURES OF POWER

• These groups may have their own motives related to the:– politics of the community– preserving or enhancing their position in the

community– gaining control over a particular heath issue,

etc.

COALITIONS AND COMMUNITY STRUCTURES OF POWER

• Also, they may have internal conflicts. • The community context means a

recognition that multiple social and political forces may intersect with a health issue.

COMMUNITIES AS EXPERTS• There is no better expertise on the community

than expertise from the community itself and the diverse groups within it. – People who know community habits and

customs, knowledge and attitudes, social groups, where things happen, and much more.

• An increasing number of health promotion and related research efforts require the integration and participation of the community.– E.g., Gaining entry to the community through

gatekeepers

POPULATION-BASED HEALTH PROMOTION

• Public Health focuses on addressing the health of populations or population aggregates.

• CAUTION: Over-emphasizing shared characteristics of a specific group can be dangerous (stigmatizing, stereotyping).

POPULATION-BASED HEALTH PROMOTION

• To develop a health promotion approach towards a population/group, it is best to – gain familiarity with the population and its

environment, dynamics, social structures, patterns of behavior, and other factors

TAILORING COMMUNITY HEALTH PROMOTION INTERVENTIONS

• Tailoring involves development of programs or adapting an existing program to a new situation, community, or population.– Develop based on an assessment and

understanding of the health problem of a specific population

– Use language and materials appropriate for the audience

– Refer to situations, people, and issues relevant to the target community/population

– Schedule activities so that members of the target population can participate

TAILORING: STEPS TO FOLLOW

• Assessment of the problem (as in PRECEDE-PROCEDE or similar assessment).

• Formative research and identifying any existing evidence-based programs or strategies.

• Ongoing evaluation and assessment to track how well the program is going during implementation.

SUSTAINABILITY

• Funding that is available for a community program is for a relatively short period of time.

• Plan for this when you are developing or implementing a program.

• If the program funding ends in three years, add in steps along the way that help build community capacity to run the program when funding is finished and to link with other source of funding.

SUSTAINABILITY

• Some steps may be:– Train and hire members of the

community to operate the program. – Involve community stakeholders.– Write grant applications or letters

seeking other funding sources.– Help link the program to others like it

and practitioners in the field.