Expert answer:Comparing CBPR with Health Planning

Expert answer:Community-Based Participatory Research is often used as part of a particular form of health research called Community Health Assessment (CHA). CHA is research into the health-related conditions of a “community.” The community may be a neighborhood or city, or even a state or country, but it may also be a community of health workers in a hospital or a community of students in a school. The term community is very flexible! A CHA may be undertaken by a health department or a hospital to fulfill a legislative mandate, by a university or funding agency to understand a selected issue better, or by the community itself in response to an emerging health-related problem.There are basically two different approaches to community health assessment: the “health planning approach” and the “community development approach.” These two approaches differ in who takes the lead when making decisions. The traditional health planning approach is considered more “top down,” in that professional experts make the key decisions. The community-development approach—of which CBPR is one—takes a more “bottom up” approach, in which community stakeholders make the key decisions regarding the research and development of health programs that will affect them directly.For this week’s Assignment, you will start thinking about your Final Project—the design of a Community Health Assessment using CBPR. For this preparatory step towards your Final Project, consider how CBPR is a bottom-up “community organizing” approach to community health research and how it differs from the traditional top-down “health planning” form of health research.To prepare:Review Bracht (1999), “Assessing Community Needs, Resources, and Readiness.”Review Minkler and Wallerstein (2008), “Critical Issues in Developing and Following CBPR Principles.”Submit a 3-page account of how CBPR differs from traditional forms of community health research. Include:Five elements of CBPR that differ from traditional approaches to health research in communities and an explanation of how they differ.At least one example of how these five elements of CBPR can be applied.https://archive.org/stream/communitybasedpa00mink#… (Minkler book)
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CHAPTER
3
Assessing Community Needs,
Resources, and Readiness
Building on Strengths
CHRIS RISSEL
NEIL BRACHT
Assessing the Community
Community analysis is the process of assessing and defining needs, possible barriers and opportunities, and resources involved in initiating community health action programs. This process is
variously referred to in the literature as “community diagnosis,” “community needs assessment,”
“health education planning,” and “mapping.” Analysis is a critical first step not only in shaping
the design of project interventions but also in adapting implementation plans to unique community
characteristics. It should define community strengths as well as potential problem areas. The
product of community analysis is a dynamic community profile, blending quantitative health and
illness statistics and demographic indicators with information on political and sociocultural factors.
The profile includes a community’s image of itself and its goals; its past history and recent civic
changes; and its current resources, readiness, and capacity for health promotion activities. A review
of previous (if any) community analyses and needs assessments is also important.
The process of completing a comprehensive analysis of the community can also provide a
unique opportunity for citizen involvement in a community health project. In genuinely empowering and participatory health projects, analysis is not done on the community but with the
community. Through involvement in the study process, citizens and organizations can develop
awareness and “ownership” of the program and build commitment to local action. Studies of
communities can rarely be completed if local citizens do not cooperate. The level of interest in a
new project can be an early indicator of community readiness.
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ADVANCES IN THEORY AND PRACTICE
Many communities may already have conducted some form of community analysis or
general needs assessment. Typically, these broad community analyses do not provide all the
planning information needed for a specific project. Original data will need to be collected. New
projects can therefore be seen to contribute to the broad understanding of a community. Sustainability of programs (see Chapter 7) is more likely if these programs build on existing efforts. Also,
focused needs assessments can be an efficient approach to collecting relevant and timely information for program planning and engaging those people most likely to be interested in or affected by
an innovative program.
In addition to its planning function, the process of conducting a community analysis is
intended to lead to citizen activation and participation in a designated sustainable health intervention. In this chapter, we begin with a brief discussion on the meamng of community and then review
the traditions and approaches that have influenced current community assessment and diagnostic
models. This is followed by the presentation of methods for data collection, including suggestions
for special studies to increase information about selected social groups in a community.
What Is Community?
In beginning a community analysis, one of the first questions asked is, What is a community? How
is it defined? No single definition or concept of community serves all fields of investigation or
professional intervention. Community has multiple meanings and has been studied from varying
perspectives by sociologists, geographers, medical specialists, anthropologists, urbanologists, and
social workers. However, as early as 1955 and after studying 94 definitions of community, Hillery
( 1955) found that 73% of definitions agreed that “social interaction, area, and a common tie or
ties” (p. 118) were commonly found features of a community. Some define community as a
psychological bond or relationship that unites individuals in a common goal or experience. Others
use the term in the geographic or physical sense, as a space with political or economic boundaries.
Yet space alone does not tell us all we need to know about community membership. The Internet
and “virtual” communities can make physical, geographic boundaries obsolete.
Many characteristics of community structure and interaction have been identified in the
writings of sociologists, including such useful concepts as community complexity, horizontal and
vertical linkage among institutions, centralization of authority, regional autonomy, community
identitication, and social integration of the population. Theoretical underpinnings for this chapter
rely principally on Warren’s classic ( 1969) social systems view of the community, which focuses
assessment on four important features-space or boundaries, social institutions, social interaction,
and social control-and Chavis and Wanders man’s ( 1990) view that communities can be identified
by arbitrary geographical boundaries, by their social relationships, or through the exercise of
collective political power. Sometimes these dimensions overlap, such as in isolated rural towns.
For other communities, only one dimension may be present, such ac; m the case of a national
coalition representing state-based grassroots organizations lobbying government for a single issue.
The type of problem or intervention being planned and how community is defined will determine
the nature of analysis required (see Chapter 2, pp. 31-32, for additional discussion).
Assessing Community Needs, Resources, and Readiness
61
In any analysis of a community, the geographical boundaries (or their absence) must be
specified and should approximate the view held by most local residents or community members.
Often, government health agencies have responsibilities for populations living or working in
arbitrary geographical areas. Once boundaries are determined, an assessment of social institutions
(education, health, recreation, business and labor, religious, communications and media, government, and so on) is undertaken to understand which organizations currently take responsibility for
providing programs and services. Service directories may well list services provided, but a more
thorough assessment also allows for the estimation of the possibilities for coordinating community wide programs of health action. Social interaction patterns should also be studied for what they
can reveal about community cleavages (for example, discriminatory practices), coalitions and
influence networks, and sources of social support for individuals and groups (Heaney & Israel,
1997; House, Umberson, & Landis, 1988). An examination of social control mechanisms and
norms is also useful. Social control is a function of many community institutions (church, school,
police, and so on) and is based on values, norms, and customs. Any ethical concerns raised about
a proposed community health intervention should be noted. How political power or the collective
power of community members is used should be understood, as should local regulations and
enforcement policies (e.g., concerning the sale of cigarettes to minors). Interviews with a variety
of organizational and political representattves or key informants can provide most of this kind of
assessment information.
Assessment Traditions
Before describing the various components of analysis, we briefly review the background of various
assessment traditions. The terms community analysis and community diagnosis are used interchangeably in the literature, although analysis, strictly speaking, precedes diagnosis. The term
community diagnosis surfaced in the 1950s (Morris, 1975) and was introduced to the health
planning tield in the mid-1960s. The content of community diagnosis was later reformulated by
Bennett ( 1979). Green, Kreuter, Deeds, and Partridge’s (1980) pioneering work “Health Education
Planning: A diagnostic approach” added a broader social diagnostic framework to this applied
discipline. They have extended this framework further to mclude environmental, policy, and
legislative perspectives (Green & Kreuter, 1991). The World Health Organit.ation (1982) has
published a handbook for community health workers in the developing countries based on the
community diagnosis concept. Haglund ( 1988) has written about community diagnosis within the
Swedish context, and Hawe, Degeling, and Hall (1990) have described community needs assessment in the Australian context within a planning and evaluation framework. Other guides include
Blum’s (1981) Planning for Health and Dignan and Carr’s (1986) Program Planning for Health
Education and Health Promotion. Suggestions for how to approach community needs assessments
can also be derived from major theories of personal and community behavior described in texts
such as Glanz, Lewis, and Rimer’s ( 1997).
Community analysis has evolved independently from two basic traditions that follow
different paradigms that can broadly be termed the health planning approach and the community
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ADVANCES IN THEORY AND PRACTICE
development approach. Some refer to them as “trickle down” or “bubble up” approaches. Elements
from these two approaches can be found in assessment practice today, and the approaches can
overlap.
The medical or health planning approach equates health with the absence of disease and
health improvement<; with the application of medical science and technology to the community. The medical concept of community analysis in Sweden, for example. dates to the 18th century, when the Swedish Collegium Medicum requested that district medical officers record patterns of epidemic and endemic diseases each year and encouraged them to describe important factors that influenced these disease patterns in terms of demography, environmental health hazards, and living habits. This use of routinely collected public health data is a relatively common government approach to identifying health needs and priorities and could be seen as a minimal form of community analysis. In parts of Australia (R1ssel, Winchester, Ward, & Sainsbury, 1995), routinely collected health data have been aggregated and presented according to national goals and targets frameworks. This allows ready identification of regional priorities. The health plann1ng approach to community analysis can lack direct cit1zen involvement or consultation and tends to rely on diagnosis by experts. The Canadian Lalonde report (Epp, 1986), using this approach, started a worldwide chain of national reportc; addressed to disease prevention. Other countries have similar approaches to national health goals and targets, such as reports of the Better Health Commission in Australia in 1986 and national goals and targets reported in the document Better Health Outcomes for Australians (Commonwealth Department of Human Services and Health, 1994). New Zealand ha<; developed a strategic public health framework for improving health (Public Health Commission, I 994), as has England (Department of Health, I 992). In the United States, Promoting Health and Preventing Disease: Objectives for the Nation (U.S. Department of Health and Human Services, I 980), the surgeon general's report, Healthy People 2000: National Health Promotion and Disease Prevention Objectives (U.S. Department of Health and Human Services, 199 I) reflect the health planning influence. Priority areas for new health interventions are often determined by indtvidual health providers or the community. Efforts to develop a planning process, however, usually follow a needs assessment model adapted from community social service planning. Health promot1on planning 1s often isolated from other social service planning (especially in U.S. communities) and is often separate from major primary health care providers. This fragmentation 1n planning between health and social service areas IS common and requires new approaches and solutions, by policy and legislative leaders, that are in the best interests of communities. For a further discussion of new partnership structures in health promotion planning and implementation, see Chapter 4. Lack of coordination of services may never completely disappear, but often improvements can be made. For example, some states 1n Australia have created regiOnal area health services that have a legislated responsibility to prevent ill health and to protect and promote the health of the people living and working in that area (New South Wales Department of Health, 1986). Each area has its own budget and is responsible for primary, secondary, and tertiary prevention and treatment services, from youth drop-10 centers and community health staff to high-technology operating rooms. Services and programs can be matched to the needs of the community. The community development approach views health m the broader context of social and economic improvement and views individual and communtty empowerment a<; vital to improve- Assessing Community Needs, Resources, and Readiness 63 ment in health status. Better health, in large part, is seen as the result of tmprovements in social and educational levels and involves tmproved quality of life as well a~ access to and control of medical and preventive programs and services. Community members are encouraged to take greater responsibility for and control of thetr own health. Community development emphasizes communrty cooperation. Advocates of this approach include Freire ( 1970), Nix ( 1978), Biddle and Biddle ( 1985), Bracht (1988), Rifkin ( 1988), and Minkler and Wallerstein ( 1997). One example of the community development approach is the A Su Salud program, a community health program implemented in the low-income community of Eagle Pass, on the Mexican American border (Amezcua, McAlister, Ramirez, & Espinoza, 1990). A special feature of this program was its focus on interpersonal communication in cuing: providing feedback on and reinforcing the acquisition of health behaviors and attitudes that were promoted in mass media messages. An extensive network of"lay leaders" and volunteers parttcipated in training programs to enhance communication within their soctal networks to promote and retnforce positive health behaviors. Volunteers served as role models in media campaigns or tdentified role models from their social networks across seven categories of sites: neighborhoods, business settings, government, social clubs, health care providers, education settings, and religious organizations. The community development (or community organization) approach emphasizes direct citizen participation in the community analysis process and encourages a grassroots or "bottom-up" dectsion-making process rather than a "top-down" health-planning approach in which "experts" determine the community's health promotion agenda and new initiatives. Minkler and Wallerstein (1997) provtde a good overview of thts approach and present several U.S. examples. Other examples can be found in most countries in the world (Community Development in Health Project, 1988). More recently, coalitions of organizations have developed as major vehicles for collaboration (Butterfoss, Goodman, & Wandersman, 1993) and participation to achieve shared goals (ASSIST Project, NCI, United States, 1989-1998). The old adage that there is strength in numbers remains true, especially in policy and advocacy interventions (for example, smoking bans in public areas). In an attempt to formalize the key processes of community organization, the U.S.-bascd COMMIT project required participating communities to engage in 12 specific activities to support tis mobtlizatton efforts (U.S. Department of Health and Human Servtces, 1995). Among these activtties were the establishment of a community planning group, plannmg for a program office and staff recruitment, the first community board meeting, the creation of a task force member ltst and recruitment of members, writing of by-laws and organizational rules, development of a field site management plan, the preparation of a smoking control plan, annual action plans for each of the 4 years of the project, and the development of a transition plan for the postfunding period. To begin with, COMMIT researchers prepared a community profile for all communities in the trial using quantitative and qualitative information. Intervention communit1cs also had more detailed assessment prepared to identify key stakeholders and relevant resources to avoid duplicating or replacmg ex•shng services. Communities where intervention staff were involved in this process found the commumty profile and analyses most useful. Thompson, Corbett, Bracht, and Pehacek (1993) have reported on the successful mobilization process of local community boards in the COMMIT project. Health promo6on planners following the community development paradigm view the communtty as both the context in which a health promotion program operates and the vehicle 64 ADVANCES IN THEORY AND PRACTICE through which mstitutional changes in attitudes, practices. and policies can be effected. The information gathered for community analysis can facilitate partnerships among organizations, civic leaders, and groups that play an important intervention role as channels of program dissemination. Overlap of the two approaches can be found in programs such as PATCH (Planned Approach to Community Health) (Centers for Disease Control, 1992). ... Purchase answer to see full attachment

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