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