Download - Wright lemmen levels of participation
Levels of Participation inHIV Prevention
2nd Conference on Quality in HIV Prevention in the European Region23-24 April 2012, Berlin
Prof. Dr. Michael T. Wright, LICSW, MSInstitute for Social Health
Catholic University of Applied Sciences Berlin (KHSB)
Dipl.-Psych. Karl LemmenDeutsche AIDS-Hilfe
Berlin
Wright & Lemmen, Workshop PQ, 23.04.12, Berlin
What is Participation?
• More than just being there!• The power to affect change in areas important for one’s life and
the life of one’s community• This includes the power to define the issues regarding health
and well-being and to influence the measures taken to address these issues
• The more influence one has on decision-making processes affecting these issues, the larger his/her participation
Why Participation?
According to the WHO Ottawa Charter (1986), self-determination is at the core of health promotion
International community development has shown that lasting positive change is dependent on active citizen participation
The science and practice of public health has shown that community-based approaches are most promising for improving the living situation of people most affected by health issues
Wright & Lemmen, Workshop PQ, 23.04.12, Berlin
What Does Participation Look Like?
How do we know that participation is actually taking place? What criteria can we use to judge whether we have been
successful in enabling participation?
Wright & Lemmen, Workshop PQ, 23.04.12, Berlin
“The idea of citizen participation is a littlelike eating spinach: no one is against it in principlebecause it is good for you.”
“There is a critical difference between going through theempty ritual of participation and having the real power
needed to affect the outcome of the process.”
Sherry Arnstein (1969) A Ladder of Citizen Participation. Journal of the American Institute of Planners, No. 4: 216-224.
Wright & Lemmen, Workshop PQ, 23.04.12, Berlin
Participatory HIV Prevention
Means a Change in Perspective
Wright & Lemmen, Workshop PQ, 23.04.12, Berlin
Conventional Prevention Programs
Participatory Prevention Programs
Beneficiary as client
(person in need of help)
Beneficiary as consumer of services and as partner
Prevention worker as expert who defines and solves health problems
Prevention worker as catalyst who supports beneficiaries in defining and solving health problems
Prevention work consists of counseling, treating, and conditioning the beneficiary
Prevention work is an activating, supportive activity promoting agency
Services are delivered in a formal setting
Services are provided on an outreach basis
Prevention is about communicating accepted social norms regarding a healthy lifestyle
Prevention is about helping beneficiaries find their own language and approaches which fit their life situation
The goal of prevention is getting people to adapt “healthy behaviors”
The goal of prevention is empowering people so that they can take action on health issues
Wright & Lemmen, Workshop PQ, 23.04.12, Berlin
Participation is a Developmental Process
Participation is not an either/or proposition, but rather a developmental process for all concerned
Critical reflexivity and a successful cooperation between stakeholders promote participatory processes
Participation depends on both the abilities and experience of the stakeholders as well as various contextual factors faced by professionals and beneficiaries
The task is to strive for the level of participation which can be reached under the current conditions and to identify what needs to change in order to increase participation
Wright & Lemmen, Workshop PQ, 23.04.12, Berlin
Levels of Participation Level 9
Community-Owned Initiatives
Goes beyond participation
Level 8
Decision-making Authority
Participation
Level 7
Partial Delegation of Decision-making Authority
Level 6
Shared Decision-Making
Level 5
Inclusion
Preliminary Stages of Participation
Level 4
Consultation
Level 3
Information
Level 2
Instruction
Non-Participation
Level 1
Instrumentalization
Wright & Lemmen, Workshop PQ, 23.04.12, Berlin
Non-ParticipationThe perspective of the beneficiaries is not taken into account
Level 1: Instrumentalization– The concerns of the beneficiaries are disregarded – Decisions are made apart from the beneficiaries– The interests of the decision-makers are primary– Beneficiaries as “decoration”
Level 2: Instruction– The situation of the group is given attention– The health problem is defined from the perspective of the decision-makers
(professionals)– The opinions of the beneficiaries are not taken into account– The communication is one-way and directive
Wright & Lemmen, Workshop PQ, 23.04.12, Berlin
Preliminary Stages of Participation Beneficiaries are increasingly included in planning and implementation but without any direct influence on the decision-making process
Level 3: Information– Decision-makers (professionals) tell the beneficiaries what problems they have
and what help they need– Various behaviors and actions are recommended by the professionals– The professionals explain their actions– The perspective of the beneficiaries is taken into account in order to maximize
the acceptance of the messages developed by the professionals
Level 4: Consultation– The professionals take an active interest in the perspectives of the beneficiaries– Beneficiaries are passively consulted (for example, by way of questionnaires)
Level 5: Inclusion– The professionals seek active consultation on the part of the beneficiaries (for
example by entering a dialogue with certain people from the beneficiary group)
Wright & Lemmen, Workshop PQ, 23.04.12, Berlin
Participation A formale, binding role for beneficiaries in decision-making processes
Level 6: Shared Decision-Making– The professionals routinely consult with beneficiaries– Decisions are made in terms of negotiating solutions between professionals and
beneficiaries– Beneficiaries have a formal right to be heard in decision-making processes
Level 7: Partial Delegation of Decision-Making Authority
– Beneficiaries have a formal role in decision-making processes, meaning they can also block decisions being made
– This role is limited to specific aspects of planning or implentation
Level 8: Decision-Making Authority– All major aspects of planning and implementation are decided by the
beneficiaries themselves– There exisits a partnership between all stakeholders (including the
beneficiaries)– Beneficiares receive active support from professionals for their actions
Wright & Lemmen, Workshop PQ, 23.04.12, Berlin
Beyond ParticipationAll actions planned and implemented under the direction of the beneficiaries
Level 9: Community-Owned Initiatives– The responsiblity for planning and implementation lies exclusively in the hands
of the beneficiaries
Wright & Lemmen, Workshop PQ, 23.04.12, Berlin
less participatory potential
Recording the Requests and Concerns of the
Beneficiaries
Observation
Service User Advisory Committee
Rapid Assessment
Open Space
Focus Group
Guided Working Group
more participatory potential
Methods for Participatory Quality Development
Wright & Lemmen, Workshop PQ, 23.04.12, Berlin
Summary
Participation is a core principle of health promotion – and of HIV prevention
Participation is not an either/or proposition, but rather a developmental process for all concerned
Participation can be concretely described and can be implemented gradually, step-by-step over time
Wright & Lemmen, Workshop PQ, 23.04.12, Berlin