Chapter 5: Community Organizing / Building and Health Promotion Programming

Two tools that community and public health workers master:

the skills to organize/build a community and to plan a health promotion program

cultural competence

they must be aware of the cultural differences within a community and effectively work with the cultural context of the community

secondary data

those that ave been collected by someone else and are available for use by the planners ex. health insurance claims

gatekeepers

those who control, both formally and informally, the political climate of the community - they know their community, how it functions, and how to accomplish tasks within it, they can be a representative of an intermediary organization that has direct contact to your priority population. ex. politicians, leaders of activist groups, business and education leaders, and clergy etc.

priority population

those whom a program is intended to serve This means that we are getting involved in the early stages of the health promotion program planning process.

horizontal relationship

when the resources can be found within the community (the interaction of local units with one another)

Three sources of guidance for selecting intervention strategies:

- Best practices, best experiences, and best processes

Determining the Priorities and Setting Goals

- Resources needed to solve all identified problems are not available. Therefore, the problems that have been identified MUST be prioritized

Best practices

- recommendations for interventions based in critical reviews of multiple research and evaluation studies that substantiate the efficacy of the intervention. Example The Community Guide

community organization and community building typology

- separates and categorizes the various methods of community organizing and building - Consensus strategy (whether needs based or strengthens based) use collaboration strategies. Conflict approaches use advocacy strategy

Community Organizing/Building

- small and simple problems that are local require a few people and can be solved with the effort of small group of people and minimal amount of organization - large and complex problems with whole communities need significant skills and resources - For larger problems, community organization effort is needed.

leader in the core group

- they must be identified later they will build a group cohesion

task force

A temporary group that is brought together for dealing with a specific problem. Who the core group has been expanded to include other volunteers. It is convened for a narrow purpose over a defined timeframe at the request of another body or committee.

examples of health promotion programs

PRECEDE/PROCEED MODEL, MAPP, INTERVENTION MAPPING, CDCynergy, and SMART

Setting Appropriate Goals and Objectives

The goals and objectives should be thought as the foundation of the program and for the evaluation. Intervention development, implementation, and evaluation will be designed to achieve the goals by meeting objectives.

multiplicity

The number of components or activities that make up the interaction. Ex. If intervention has two acitivites like a workshop and pamphlet

Creating a intervention

What needs to change and where isn't the change needed? (Answer from needs assessment and goals and objectivites) At what level of prevention will the program be aimed? (Primary secondary and tertiary) At what level of influence will the intervention be focused? (Interpersonal etc these levels allow a framework from which to think about how they will will attack needs of the priority population. Has an effective intervention strategy to deal with the focus of The problem already been created? - is the intervention an appropriate fit for the priority population? (does the plan intervention meet the specific characteristics of the priority population such as education level, developmental stages, or the specific cultural characteristics of the people being served?) - Are the resources available to implement the intervention selected? - Would it be better to use an intervention that consists of single strategy or multiple strategies?

Need for Organizing Communities

With advances in electronics and communications, household upgrades, and increased mobility it has created a loss of a sense of community. More independent. Because of these changes in community social structure, it takes special skills to organize a community to act together for a collective good.

Assumptions of Community Organizing

- Communities can develop the capacity to deal with their own problems - People want to change and can change - People should participate in making, adjusting, or controlling changes taking place in their community - Self-imposed and self-developed change have more permanence and meaning that imposed changes do not have - "Holistic" is preferred over "fragmented" approach because it can successfully address problems - Democracy requires cooperative participation and action in the affairs of the community and people must learn the skills to make this possible - Communities of people need help with problems just like individuals do

assessments in community building and community organizing

- Community organizing: the assessment is focused on the needs of the community - Community building: the assessment focuses on the assets and capabilities of the community

Step five: justify conclusions

- Data must be analyze and interpreted. Evaluator will compare the collected data against he standards of acceptability to determine effectiveness and the value of program. - The evaluator must make every effort to increase objectivity and decrease subjectivity.

Assessing Needs of the Priority Population

- Must determine the needs and wants of the priority population (needs assessment). Important part because identifies and priorities health problems and makes a baseline for evaluating program impact. - Six step approach that can be used to conduct needs assessment

Organizing the People

- Obtaining support of the community members to deal with the problem. Best to organize with those who are already interested in seeing the problem solved. - Important to recruit people from the subpopulation who are most affected by the problem (old people, teens)

Recognizing the Issue

- Process begins when someone recognizes that a problem exists in a community and decides to do something about it. (person is referred to as initial organizer). They get things started but they may not be the primary organizer. People can be from the community or outside the community

Step six: ensure use and shared lessons learned

- The evaluation report should be written. Decisions must be made regarding who should write the report, who should receive the report, and what form it should be distributed, and when it should be distributed. - Then it must be decided how they would been used. It is important that the results be useful for reaching a constructive end. This is a time when a decision can be made to modify, continue, or discontinue the intervention based on the evaluation data.

Formative evaluation

- The evaluation that is conducted during the planning and implementing processes to improve or refine the program. - Ex validating the needs assessment and pilot testing

Conclusion: four standards for the framework for program evaluation

- Utility (needs of the stakeholders are met) - Feasibility (the evaluation is viable and pragmatic) - Propriety (The evaluation is ethical) - Accuracy (evaluation findings are correct)

Pilot test

- a trial run of an intervention. Presented to a few people who are from the priority population or similar to that population - To determine whether there are any problems with it. If minor flaws are detected and corrected, intervention is ready for full implementation. If not, intervention goes through pilot test again - Process is needed to collect feedback from those in the pilot group.

Process objectives

- activities presented and task completed - number of session held, exposure, attendance, participation, staff performance, materials, resources, task on schedule ex. During the next 6months, a breast cancer brochure will be distributed to all female customers over the age of 18 at the grocery store.

potential building blocks

- are the least accessible assets - are resources originating outside the neighborhood and controlled by people outside (welfare expenditures and public information)

secondary building blocks

- assets located in the neighborhood but are largely controlled by people outside (social services, schools etc).

Inherent in the community organizing/building health promotion programming is

- behavior change - in order for efforts to be successful people must change their behavior

Learning objectives

- change in awareness, knowledge, attitudes, and skills - increase in awareness, knowledge, attitudes, and skill development - ex. When asked in class 50% of the students will b bee to list four principles of CV conditioning

Behavioral objectives

- change in behavior - current behavior modified -- ex. telephone interview 35% of residents report that they cholesterol was checked in the last 6 months

Outcome objectives

- change in quality of life, health status, or risk and social benefits - morbidity data and mortality data, measure of risk, quality of life - ex. Year 2020 infant mortality rates will be reduced to no more than 7 per 1,000

Environmental objectives

- change in the environment - measures associated with economic, service, physical, social, psychological, or political environment; protection added or barriers removed -ex. by the end of the year, all seniors who requested transportation to the congregate meals will have received it

Step 3: Analyzing the Data

- data can be analyzed informally or formally - Formal analysis: consists of some type of statistical analysis - Informal analysis: "eyeballing the data", program planners look for the obvious differences between health status or condition of the priority population and the health behaviors and programs and services TO close the gap - Analysis should yield the list of problems that exist - Final part of the needs assessment is prioritizing the list of problems/ Must take place because all needs are important and there is seldom enough resources available to deal with all the problems identified.

Step four :gather credible data

- deciding what type of data needs to be collected, how to collect the data, determining who will collect them, pilot testing the procedures, and performing the actual data collection

maintaining or sustaining the outcomes

- difficult step - organizers need to cinder the need for a long term capacity for problem solving

Summative evaluation

- evaluation that determines the effect of a program on the priority population - Begins with the development of goals and objectives and is conducted after implementation of the intervention - Separated into two categories impact and outcome evaluation

Impact evaluation

- evaluation that focuses on immediate observable effects of a program - Like changes in awareness, knowledge, attitude skills and varmint to surroundings and behavior of those in the priority population

Outcome evaluation

- evaluation that focuses on the end result of the program - Measured by improvements in morbidity, mortality, or vital measures of symptoms signs or psychological indicators

what are the two reasons why people do not volunteer?

- families where both husband and wife work - single parent households

Step 2: Gathering Data

- gathering data helps identify the true needs of the priority population (primary and secondary)

once the problem has been prioritized

- goals need to be identified and written to serve as guides for problem solving - practice of consensus building should be employed during the setting of the goals - keep goals lists long

Arriving at a Solution and Selecting Intervention Strategies

- groups should examine the alternatives in terms of probate outcomes, acceptability to the community, probable long and short term effects on the community, and the cost of resources to solve the problem - group must for toward consensus through compromise

CDC framework for program evaluation

- has developed a framework for program evaluation that includes six steps - 1) engage stakeholders - 2) describe the program - 3) focus the evaluation design - 4) gather credible data - 5) justify conclusions - 6) ensure use and share lessons learned - It should be determined who will conduct evaluation an internal evaluator (one who already is involved in the program) or an external evaluator (one from outside the program)

Step two: describe the program

- have a well written goals and objectives in a well conceive intervention - A clear program description helps to clarify program components and the intended outcomes - Helps to focus the evaluation on the central and important questions to be answered

planning and policy practice

- heart of this strategy are data - By using data, community public health workers generate persuasive rationales that lead toward proposing and enacting particular solutions

Phasing in

- implementation of an intervention with a series of small groups instead of the entire population. - It is advisable that the intervention be implemented gradually rather than all at once because a large priority population means that there is a lot at stake with the implementation - Criteria used to select participants groups for the phasing in = participant ability, number of participants, and program location - Ex. Planners divide the priority population by residence location. Smoking cessation class on the south side.

Best experiences

- intervention strategies used in prior or existing programs that have not gone through the critical research and evaluation studies and thus fall short of best practices. Example often found by networking with others professionals and by reviewing literature

labels of level of influence

- intrapersonal - interpersonal - institutional or organizational - community - public policy - physical environment - culture

example of socio-ecoclogical approach

- intrapersonal: individual level, adults know that exercise is good but hard to start or maintain a program - interpersonal: encouraged by people around them (get active on their own or doing a fitness exercise program) - institutional: employers developing worksite health promotion with incentives - community: town, cities, counties passed ordinances to create bicycle lanes - public policy: government spending money on public service announcement and advertising - physical environment: number of communities have built new structures like walking paths - culture level: focus on wetting and reinforcing regular exercise as the cultural norm

Gaining Entry into the Community

- may or may no be needed depending if problem was identified by someone within the community or outside - If identified by someone outside the is a critical step. Could be the most crucial step! - important to negotiate entry into a community through the individuals who controls political climate - could enter the community through a religious organization

Community Organizing Methods

- multiple community organization methods - Earlier, social workers emphasized the use of consensus and cooperation to deal with community problems - three methods of community organizing: locality development, social planning, and social action (now called planning and policy practice, community capacity development, and social advocacy)

Best processes

- original intervention strategies that the planners create based in their knowledge and skills of good planning processes including the involvement of those in the priority population and the use of theories and models

Evaluating the results

- planning evaluation occur during the first stages of program development or just the end because the purpose is to improve the quality of programs and to measure their effectiveness

Evaluation

- process in which planners determine the value of worth of the object of interest (comparing to standard of acceptability)

Hierarchy of Objectives and Examples of Each

- process objectives - impact objectives: learning, behavioral, and environmental - Outcome objectives - shows that it takes less time and resources to increase awareness in the priority population than to improve the health status

Implementing Information Implementation

- putting a planned intervention into action. The act of converting planning goals and objectives into action through administrative structure, management activities, policies, procedures, regulations and organizational actions of new programs

Step one: engage stakeholders

- stakeholders include those involved in the creation and delivery of the program, those in the priority population or affected by the program in some other way, and those that will be the primary users of the evaluation result. - These individuals must be engaged to ensure that their perspectives are understood and that the evaluation results meet their expectations.

step three: focus the evaluation design

- stating the purpose of the evaluation (improving the quality of the program or assessing its affects or both) and formulating the questions to be answered by the evaluation - Once your are done a Evaluation design(qualitative or quantitative) and the type of data analysis can be determined

community capacity development

- strategy based on empowering those impacted by a problem with knowledge and skills to understand the problem and then work cooperatively together to deal with this problem - group consensus and social solidarity are important components

Evidence

- the body of data that can be used to make decisions - can be objective (higher quality, systematic reviews of research) or it can be subjective (personal experience)

primary building blocks

- the most accessible assets and capacities - located in the neighborhood and are controlled by those who live in the neighborhood - can be organized into assists and capacities of individuals (skills talent) and those of organization or associations (citizen organization)

social advocacy

- used to address a problem through the application of pressure, including confrontation, on those who have created the problem or stand as a barrier to a solution to the problem - creates conflict

top-down organization

- when individuals from outside the community initiate community organization - ex. can be a judge who presides over cases involving violence, state social worker, politically active group - great care must be taken when notifying people in the community

Creating a Health Promotion Program

-Involves a series of steps -Success depends on many factors -Experienced planners use models to guide work. Planning models are the means by which structure and organization are given both planning process.

Intervention Strategies and Example Activities

1. Health Communication strategies: mass media, booklets etc 2. Health education: lectures, discussions, labs etc 3. Health policy/enforcement: laws, orders, policies 4. Environmental change: strategies that are designed to change the structure of services, system, building health promotion services 5. Health related community services: clinical screenings, immunization clinics 6. behavior modification activities: modifying behavior 7. Community advocacy: social action planning 8. Organizational culture activities: activities that work to change the norm and traditions of an organization 9. Incentives and disincentives: items tat can either encourage or discourage people to behave in certain ways 10. social intervention activities: support groups, social activities, and social networks 11. technology-delievered actions: educating or informing people by using technology

Health professionals must possess specific skills and knowledge

1. Identify Problems 2. Develop a plan to attack the problem 3. Gather resources needed to carry out that plan 4. Implement the plan 5. Evaluate the results to determine the degree of progress that has been achieved

The Process of Community Organizing/Building generic steps of community organizing and building

1. Recognizing the issue 2. Gaining entry into the community 3. organizing the people 4. assessing the community 5. determining the priorities and setting goals 6. arriving at a solution and selecting intervention strategies 7. implementing the plan 8. evaluating the outcomes of the plan of action 9. maintaining the outcomes in the community 10. looping back

The Generalized Model for program planning

1. assessing needs 2. setting goals and objectives 3. developing an intervention 4. implementing the intervention 5. evaluating the results

Terms Associated with Community Organizing/Building

1. community capacity: community characteristics affecting its ability to identify, mobilize, and address problems 2. empowerment: social action process for people to gain mastery over their lives and lives of their communities 3. grassroots participation: efforts of people taking collective actions on their own behalf, and involve the use of a sopshicated blend of confrontation and cooperation to achieve their ends 4. macro practice: methods of professional change that deal with issues beyond the individual, family, and small group level 5. participation and relevance: community organizing should start where people are and engage community members as equals 6. social capital: processes and conditions among people and organizations that lead to accomplish a goal of mutual social benefit (constructs of trust, cooperation, civic engagement, and reciprocity, reinforced by networking)

When organizers are expanding their constituencies they should be sure to:

1. identify people who are affected by the problem that they are trying to solve 2. provide perks for or otherwise reward volunteers 3. keep volunteer time short 4. match volunteer assignments with the abilities and expertise of the volunteers 5. consider providing training to make sure they are comfortable

five criteria needed when considering to select a priority issue or problem

1. must be winnable (working on it does not reinforce fatalistic attitudes and beliefs that things cannot be improved) 2. must be simple and specific (any member of the group can explain it) 3. must unite members of the organizing group and must involve them in a meaningful way in achieving a resolution of the issue or problem 4. should affect many people and build up the community 5. should be a part of a larger plan or strategy to inhale the community

Goal

A future event toward which a committed endeavor is directed. They are expectations that provide the overall direction for the program, more general, do not have a specific deadline, take longer to complete, and often not measured in exact terms. Two components: who will be affected and what will change because of the program ex. To reduce the number of teenage pregnancies in the community

program planning

A process by which an intervention is planned to help meet the needs of a priority population - may involve community organizing.building effort

grassroots

A process that begins with those who are affected by the problem/concern. Members of the community that initiates the community organization. Organized from the bottom up. - Community groups are built from scratch and leadership is developed where non existed. - ex. could be teachers, police officers, concerned citizens

Creating an Intervention That Considers the Peculiarities of the Setting Intervention

An activity or activities designed to create chane in people. Created to help the priority population meets objectives and achieve program goals. The planned actions designed to prevent disease or injury or promote health in the priority population. Multiple activities are often better than a single activity. Hitting the priority population from servers angles or through multiple channels should increase making an impact.

Assessing the Community community building

An orientation to practice focused on community, rather that a strategic framework or approach, and on building capacities, not fixing problems.

Program planning committee

Committee with representation from various subgroups of the workforce. Helps ensure that all segments of the priority population will b ended in the planning process.

evaluation of the process

Comparing the long term health and social outcomes of the process to the goals that were set in an earlier step. - not easy to carry out because of limitations

executive participants

Core group of community members who will become the backbone of the workforce and will do the majority of the work. ex. victims of the problem etc.

Step 6: Validating the Prioritized Need

Double check or to confirm that the identified need and resulting program focus indeed need to be addressed in the priority population. Make sure they identified a true need and all work should be double checked. should be able to answer: who is the priority population, what are the needs of the priority population, which subgroups need the greatest need, where are subgroups located, what is currently being done, how well have identified needs been addressed in the past, what is the capacity of the community to deal with the needs, and what are the assets in a community on which program can be built

coalition

Formal alliance of organizations that come together to work for a common goal. Larger group with more resources, people, and energy.

implementation of the intervention

Identifying and collecting the resources for implementation and creating the appropriate time line for implementation.

The Final Steps in the Community Organizing/Building Process: Implementing, evaluating, maintaining, and looping back

Implementing the intervention strategy and activities that were selected in the previous step and evaluating the outcomes of the plans of actions, maintaining the outcomes over time, and if need be going back to the previous step (looping back) to modify or restructure the work plan to organize the community.

Health Promotion Programming

In the 1979 US Surgeon General's report on health promotion and disease prevention (Health People), set a new course for community and public health. Away from curing disease and toward preventing diseases and promoting health.

socio-ecological approach (ecological perspective)

Individuals influence and are influenced by their families, social networks, the organizations in which they participate (workplaces, schools, religious organizations), the communities of which they are apart of, and the society in which they live - Health behavior of individuals is shaped in part by their social context in which they live in. Takes multi-level intervention to achieve changes in health behavior

before approaching to important individuals in the community...

Need to make sure you study the community. Organizers need to know where the power lies, the community power dynamics, what type of politics must be used to solve a problem, and whether the particular problems they wish to solve has ever been dealt with before in the community. - They need to be cultural sensitive and work toward cultural competence.

formation of core group

One of their tasks is to recruit more members of the community to the cause. Step can take place through networking process (when organizers make personal contacts with others who might be interested). The core group can spread out the workload and generate additional resources to deal with the problem.

Step 4: Identifying the Risk Factors Linked to the Health Problem

Planers need to identify and prioritize the risk factors that are associated with the health problem.

Step 5: Identifying the Program Focus

Planners need to identify those predisposing, enabling, and reinforcing factors that seem to have a direct impact on the risk factors. They then need to be prioritized. - predisposing: having knowledge and skills to begin an exercise program - enabling: having access to recreational facilities - reinforcing: having people around you

needs assessment

Process by which data about issues of concern are collected and analyzed. From the analyze data, problem emerge and are prioritized so that strategies can be created to tackle them. ex. Written questionnaires or interviewing people in the community. ex. Used participatory data collection process: get people from the data and use them to collect and help with data collection. ex. Photovoice and video voice members are given cameras and skills training and then they use the cameras to convey their own images of community problems and strengths. They then use this to stimulate change

pre-planning

Step prior to undertaking the first step in the generalized model. Is a quad-step that allows program planners to gather insert to key questions which will help understand the community and engage the priority population. Finding out as much as possible about the priority population and the environment in which it exits.

Dose

The number of program units delivered as part of the intervention. Ex the number of times each of the acitivites is presented

process of community organizing/building

The process by which individuals, groups, and organizations engage in planned action to influence social problems.

Objectives

The steps taken in pursuit of a goal (to achieve the program goals). More precise. The more complex a program the greater number of objectives.

thee strategies

They can be combined (3x3 matrix). They revolve around a common theme with is the work and resources of many have a much better chance of solving a problem that the work and resources of a few.

no matter what community organizing/building approach is used

They include strengthens-based approaches, principle of relevance or starting where the people are, the principle of participatory issue selection and choice of actions, and the importance of creating environments in which individuals and communities can become empowered as they increase their community capacity or problem solving ability.

SMART objectives

Those that are specific, measurable, achievable, realistic, and time-phased. Answers The Who, what, when, and how much.

Step 1: Determining the Purpose and Scope of the Needs Assessment

What is the goal of the needs assessment? What does the planning committee hope to gain from the needs assessment? How extensive will the assessment be? What kind of resources will be available to conduct the needs assessment?

Standard of acceptability

a comparative mandate, value, norm, or group (comparison/control group)

community organizing

a process by which community groups are helped to identify common problems or change targets, mobilize resources, and develop and implement strategies for reaching their collective goals - First coined by American social workers to describe their efforts to coordinate services for immigrants and the poor. Refers to various methods of interventions to deal with social problems.

mapping community capacity

a process of identifying community assets

health education (joint committee)

any combination of planned learning experiences using evidence based practices and/or sound theories that provide the opportunity to acquire knowledge attitudes, and skills needed to adopt or maintain health behaviors - - health education is only a part of health promotion

health promotion (joint committee)

any planned combination of educational, political, environmental, regulatory, or organizational mechanisms that support actions and conditions of living conducive to the health of individuals, groups, and communities - term is more encompassing

prioritization is best achieved through

general agreement or consensus of those who have been organized so that ownership can take hold; need to fell like they own the problem and want to see it solved

two reasons for completing an assessment:

information is. needed for change and also needed from empowerment

Basic Understanding of Program Planning

need to understand the relationship between health education and health promotion and program planning and community organizing/building

cultural humility

openness to other's culture

by knowing th needs, assets, and capacities

organizers can work to identify the true concerns or problems of the community and use the assets of the community as a foundation for dealing with concerns or problems

primary data

original data collected by the planners ex. have the priority population complex a needs assessment questionnaire about their health behavior

when prioritizing

planners need to consider the importance of the need, how changeable the need is, and whether adequate resources are available to address the problem

Three different group of assets and capacities based on availability to community

primary, secondary, and potential building blocks

vertical relationships

resources obtained from units located outside the community (local units interact with extracommmunity system are needed)

evidence-based practice

systematically finding, appraising, and using evidence as the basis for decision making - (when community and public health workers)

needs assessment

the process of identifying, analyzing, and prioritizing the needs of a priority population - other terms used to describe the process of determining the needs: community analysis, community diagnosis and community assessment

loop back

the process to rethink or rework before proceeding onward in their plan