Community Organizing (Building & Health Promotion Programming)

Community Organizing/Building & Health Promotion Programming 1. Introduction a. Evidence based practice i. When community & public health workers systematically find, appraise, & use evidence as the basis for decision making related to community organizing/building & health promotion programming ii. Evidence- the body of data that can be used to make decisions 1. objective→ derived from science 2. subjective→ personal experiences & observations b. Socio-ecological approach i. Behavior has multiple levels of influence ii. Health behavior of individuals is shaped in party by social context in which they live 2. Community Organizing/Building a. The process by which community groups are helped to identify common problems or change targets, mobilize resources, & develop & implement strategies for reaching their collective goals b. Assumptions of Community Organizing i. Communities of people can develop the capacity to deal with their own problems ii. People want to change & can change iii. People should participate in making, adjusting, or controlling the major changes taking place within their communities iv. Changes in community living that are self-imposed or selfdeveloped have a meaning & permanence that imposed changes do not have A “holistic approach” can successfully address with which a “fragmented approach” cannot cope vi. Democracy requires cooperative participation & action in the affairs of the community & people must learn the skills that make this possible vii. Frequently, communities of people need help in organizing to deal with their needs, just as many individuals require help in coping with their individual problems c. Community Organizing Methods i. Locality development→ planning & policy practice 1. Data 2. Health care workers generate persuasive rationales that lead toward proposing & enacting particular solutions ii. Social planning→ community capacity development 1. Based on empowering those impacted by a problem with knowledge & skills to understand the problem & then work to cooperatively deal with it 2. Group consensus & social solidarity iii. Social action→ social advocacy 1. Used to address a problem through the implication of pressure such as confrontation on those who have created the problem or stand as a barrier to a solution to the problem 2. Creates conflict 3. The Process of Community Organizing/Building a. Recognizing the Issue i. Grassroots- citizen initiated or organized from the bottom up ii. Top-down organization→ individuals from outside the community initiate community organization b. Gaining Entry into the Community v. i. ii. iii. iv. Gatekeepers 1. Individuals who control both formally & informally the “political climate” of the community 2. Know their community, how it functions, & how to accomplish tasks within it Organizers need to know: 1. Who is causing the violence & why 2. How the problem has been addressed in the past 3. Who supports & who opposes the idea of addressing the problem 4. Who could provide more insight into the problem Organizing the People 1. “Executive participants” will become the backbone of the workforce & will end up doing the majority of the work 2. From among the core group a leader or coordinator must be identified 3. When expanding constituencies organizers should be sure to: a. Identify people who are affected by the problem that they are trying to solve b. Provide “perks” for volunteers c. Keep volunteer time short d. Match volunteer assignments with the abilities & expertise of the volunteers e. Consider providing appropriate training to make sure volunteers are comfortable with their tasks 4. Task force- self-contained group of doers that is not ongoing 5. Coalition- formal alliance of organizations that come together to work for a common goal Assessing the Community 1. Community building a. An orientation to practice focused on v. community rather than a strategic framework or approach & on building capacities not fixing problems b. Assessment focuses on the assets & capabilities of the community 2. Needs assess→ process by which data about the issue of concern are collected & analyzed 3. Mapping community capacity a. Process of identifying community assets not concerns or problems b. Primary building blocks i. Most accessible assets & capabilities ii. Located in the neighborhood & are controlled by those who live there c. Secondary building blocks i. Next most accessible assets & capabilities ii. Located in the neighborhood but largely controlled by people outside d. Potential building blocks i. Least accessible assets ii. Resources originating outside the neighborhood & controlled by people outside Determining the Priorities and Setting Goals 1. Prioritization is best achieved through general agreement or consensus 2. Miller identified 5 criteria: a. Must be winnable, ensuring working on it does not simple reinforce fatalistic attitudes & beliefs that things cannot be improved b. Must be simple & specific so that any member of the organizing group can explain it clearly in a sentence or two c. Must unite members of the organizing group & involve them in a meaningful way in achieving resolution of the issue d. Should affect many people & build up the community e. Should be a part of a larger plan or strategy to enhance the community vi. Arriving at a Solution and Selecting Intervention Strategies 1. turfism→ protection oof subgroups within the larger group vii. The Final Steps in the Community Organizing/Building Process 1. Implementing: a. Intervention strategy & Activities that were selected b. Identifying & collecting necessary resources for implementation & creating appropriate time line 2. Evaluation: a. Of the outcome of the plans of action b. Often involves comparing the long-term health & social outcomes of the process to the goals that were set 3. Maintaining: a. The outcomes over time (most difficult step) b. Organizers seriously need to consider need for a long-term capacity for problem solving 4. Looping Back to modify or restructure the work plan 4. Health Promotion Programming a. Basic Understanding of Program Planning i. Two relationships must be presented: 1. Relationship between health education & health promotion 2. Relationship between program planning & community organizing/building ii. Health education- any combination of planned learning experiences using evidence based practice or sound theories that provide the opportunity to acquire knowledge, attitudes, & skills needed to maintain health behaviors iii. Health promotion- any planned combination of educational, political, environmental, regulatory, or organizational mechanisms that support actions & conditions of living conductive to the health of individuals, groups, & communities iv. Program planning- process in which an intervention is planned to help meet the specific needs of a specific group of people 5. Creating a Health Promotion Program a. Priority population (audience)- those whom the health promotion program is intended to serve b. Steps: i. Assessing the Needs of the Priority Population 1. Needs assessment- the process of identifying, analyzing, & prioritizing the needs of a priority population 2. Community analysis, diagnosis, assessment 3. Determining the Purpose & Scope of the Needs Assessment a. What’s the goal? b. What does it hope to gain? c. How extensive is it? d. What kind of resources will be available? 4. Gathering Data a. Primary data- collected specifically for the use of the project b. Secondary data- has already been collected for some other purpose 5. Analyzing Data a. Formal analysis→ statistical ii. b. Informal analysis→ “eyeballing data” c. Prioritizing list of problems: i. Importance of the need ii. How changeable the need is iii. Whether adequate resources are available to address the problem 6. Identifying the Risk Factors Linked to the Health Problem a. What genetic, behavioral, & environmental conditions are known risk factors (CHD) 7. Identifying the Program Focus 8. Validating the Prioritized Need a. Double check or to confirm b. Who is the priority population? c. What are the needs of the priority population? d. Which subgroups within the priority population have the greatest needs? e. Where are the subgroups located geographically? f. What is currently being done to resolve the identified needs? g. How well have the identified needs been addressed in the past? h. What is the capacity of the community to deal with the needs? i. What are the assets in a community on which a program can be built? Setting Appropriate Goals and Objectives 1. Foundation of the program & for evaluation 2. Goals a. Future event word which a committed endeavor is directed b. Easy to write & include two components: i. Who will be affected ii. What will change because of the iii. iv. v. program 3. Objective a. Steps taken in pursuit of goal b. More precises c. SMART→ specific, measurable, achievable, realist, & time phased Creating an Intervention that Considers the Peculiarities of the Setting 1. Intervention- treatment, planned actions designed to prevent disease or injury or promote health in the priority population 2. Multiplicity- number of components or activities that make up the intervention 3. Dose- the number of program units delivered 4. Best practice- recommendations for an intervention, based on critical review of multiple research & evaluation studies that substantiate the efficacy of the intervention in the populations & the circumstances in which the studies were done 5. Best experience- intervention strategies are those of prior or existing programs that have not gone through the critical research & evaluation studies 6. Best Processes- intervention strategies are original interventions that the planners create based on their knowledge & skills of good planning processes Implementing the Intervention 1. Implementation- actual carrying out or putting into practice the activities that make up the intervention 2. Pilot test- trial run (any problems?) 3. Phasing- step-by-step implementation in which the intervention is introduced 1st to smaller groups instead of the entire population Evaluating the Results 1. Evaluation- process in which planners determine the value or with of the object of interest by comparing it to a standard acceptability 2. Formative evaluation- improve/refine program 3. Summative evaluation- begins with the development of goals & objectives & is conducted after implementation of the intervention to determine the program’s effect on the priority population 4. Impact evaluation- immediate observable effects of the program 5. Outcome evaluation- focuses on the end result of the program & is generally measured by improvements in morbidity & mortality 6. Steps: a. Engage stakeholders i. Those involved in the creation & delivery of the program ii. Those in the priority population iii. Those that will be the primary users of the evaluation results b. Describe the program c. Focus the evaluation design i. Stating purpose of evaluation ii. Formulating the questions to be answered by evaluation d. Gather credible data e. Justify conclusions f. Ensure use & share lessons learned