cross cultural health care conference community collaborations and interventions: models of...
TRANSCRIPT
Cross Cultural Health Care Conference
Community Collaborations and Interventions: Models of Community Engagement
October 8, 2011
Angela Sy, DrPHAssistant Professor
Office of Public Health StudiesUH John A. Burns School of Medicine
Background and Rationale
Community members have an extensive set of Community members have an extensive set of skills, strengths, and resources which can be skills, strengths, and resources which can be harnessed to address the social determinants of harnessed to address the social determinants of health and to promote good healthhealth and to promote good health
Complex health and social problems ill-suited to “outside experts”
Enhance the effectiveness of public health interventions
Tailored to the concerns and cultures Include participants in all aspects of intervention
design, implementation & evaluation Holistic focus on broader social & structural
determinants of health
Background and Rationale
“It is a powerful vehicle for bringing about environmental and behavioral changes that will improve the health of the community and its members” (CDC, 1997)
Background and Rationale
Definition of Community Engagement
CDC, 1997: “The process of working collaboratively with and through groups of people affiliated by geographic proximity, special interest, or similar situations to address issues affecting the well-being of those people.”
Definition of “Community”Definition of “Community”
A group of people:
Linked by social ties
Sharing common perspectives or interests
Who may or may not share a geographic location
Common designations:
Culture or ethnic heritage
Where we live
Similar age
Speak the same language
Religion
Definition of “Community”Definition of “Community”
Concepts of Community Engagement
Culture: Kieffer, 2007 Community organizing: Minkler, 1990Community participation: Butterfoss, 2006; Wandersman et al , 1987 Capacity building: Eng et al., 1994Community empowerment: Maton, 2008Coalition building: Cohen, 2002
Benefits of Community Engagement
Agenda
Implementation design, delivery and change:– Relevance– Feasibility– Sustainability
Community involvement and goodwill:– Competence– Capital– Capacity
Benefits of Community Engagement
Co-learning:
– Academic– Community organizations– Research participants– Community members– General public
Models and FrameworksFrameworks
Social Ecological Model: Stokols, 1996
CDC, 2007
Models and FrameworksFrameworks
Social Ecological Model: Stokols, 1996
Constructing Social, 2009
Models and FrameworksFrameworks
Association of Alaska School Boards
Models and FrameworksFrameworks
International Association of Public Participation
Models and FrameworksFrameworks
International Association of Public Participation
Models and FrameworksFrameworks
Foster-Fishman & Watson, 2011
ABLe Change Framework – Engaging Community Toward Systems Changes
Community-Based Participatory Research
Brings together researchers and communitiesBrings together researchers and communities Share powerShare power Address community identified needsAddress community identified needs Foster co-learningFoster co-learning
Cultural humility Vis a vis cultural competenceVis a vis cultural competence Professionals cannot master another’s culture
What it is and isn’t An approach involving empowerment, social justice values
—health disparities Applied to influence equitable change in community health,
norms, systems, programs, policies
CBPR Trajectory
Parkes, 2001
ON FOR FOR/WITH WITH WITH/BY(CPPR)
BY
Community sets research agenda and
mobilizes with or without outside
facilitation
Models and FrameworksFrameworks
Ripple Model for Growing Effective CPP Researchers
Multicultural
exposure
Community connection
Adequate
resources
(funding/
time)
Researcher
Cultu
ral
hum
ility
Cultural safety
training
Immersion in community culture Effective
communication
& trust
Perso
nal
transfo
rmati
on
Strengthening communities
on community’s
terms
Open-
mindedness
Com
mitm
ent
to so
cial
justi
ce
Models and FrameworksFrameworks
Burke, 2011
Routes of Transformation
Multicultu
ral
exposure
Community connection
Adequate resources
(funding/ time)
ResearcherCu
ltura
l hu
mili
tyCultural safety
training
Open-
mindedness
Com
mitm
ent t
o so
cial
justi
ce
Burke, 2011
Models and FrameworksFrameworks
Models and FrameworksFrameworks
Minkler et al., 2008
CBPR Conceptual Model
Principles of Community Engagement (CDC,2011)
Be clear about the purposes or goals of the engagement effort, and the populations and/or communities you want to engage.
Become knowledgeable about the community in terms of its economic conditions, political structures, norms and values, demographic trends, history, and experience with engagement efforts. Learn about the community’s perceptions of those initiating the engagement activities.
Go into the community, establish relationships, build Go into the community, establish relationships, build trust, work with the formal and informal leadership, and trust, work with the formal and informal leadership, and seek commitment from community organizations and seek commitment from community organizations and leaders to create processes for mobilizing the community.leaders to create processes for mobilizing the community.
Remember and accept that community self-determination Remember and accept that community self-determination is the responsibility and right of all people who comprise is the responsibility and right of all people who comprise a community. No external entity should assume it can a community. No external entity should assume it can bestow on a community the power to act in its own self-bestow on a community the power to act in its own self-interest.interest.
Partnering with the community is necessary to create Partnering with the community is necessary to create change and improve health.change and improve health.
Principles of Community Engagement (CDC,2011)
All aspects of community engagement must All aspects of community engagement must recognize and respect community diversity. recognize and respect community diversity. Awareness of the various cultures of a community Awareness of the various cultures of a community and other factors of diversity must be paramount in and other factors of diversity must be paramount in designing and implementing community engagement designing and implementing community engagement approaches. approaches.
Community engagement can only be sustained by Community engagement can only be sustained by identifying and mobilizing community assets, and by identifying and mobilizing community assets, and by developing capacities and resources for community developing capacities and resources for community health decisions and action.health decisions and action.
Principles of Community Engagement (CDC,2011)
An engaging organization or individual change agent must be prepared to release control of actions or interventions to the community, and be flexible enough to meet the changing needs of the community.
Community collaboration requires long-term commitment by the engaging organization and its partners.
Principles of Community Engagement (CDC,2011)
Questions?
Examples of Community
Engagement and Culture
in the Clinic:Drs. Susana Helm, Dale Fryxell, Bradley Chun,
Darryl Salvador