Expert answer:answer six question on chapter 9

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1- why is it that communities are the primary sittings for public health/health
promotion interventions?
2- how is a virtual community similar or dissimilar to a geographic or placebased community for purpose of health promotion?
3- What is the difference between a community intervention and an
intervention in a community?
4- What kinds of community politics might you encounter? What theoretical
approaches could you use to address some of these political situations?
5- Explain what it means to tailor an intervention to a community or
population.
6- How can you keep an intervention going? What does sustainability refer to in
health promotion?
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.
…
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