Cross Cultural Health Care Conference Community Collaborations and Interventions: Models of Community Engagement October 8, 2011 Angela Sy, DrPH Assistant Professor Office of Public Health Studies UH John A. Burns School of Medicine

Background and Rationale Community members have an extensive set of skills, strengths, and resources which can be harnessed to address the social determinants of health 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 ” 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 ”

Concepts of Community Engagement Culture: Kieffer, 2007 Community organizing: Minkler, 1990 Community participation: Butterfoss, 2006; Wandersman et al, 1987 Capacity building: Eng et al., 1994 Community empowerment: Maton, 2008 Coalition 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

Frameworks Models and Frameworks Social Ecological Model: Stokols, 1996 CDC, 2007

Frameworks Models and Frameworks Social Ecological Model: Stokols, 1996 Constructing Social, 2009

Frameworks Models and Frameworks Association of Alaska School Boards

Frameworks Models and Frameworks International Association of Public Participation

Frameworks Models and Frameworks International Association of Public Participation

Frameworks Models and Frameworks Foster-Fishman & Watson, 2011 ABLe Change Framework – Engaging Community Toward Systems Changes

Community-Based Participatory Research Brings together researchers and communities  Share power  Address community identified needs  Foster co-learning Cultural humility  Vis 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 Co-OptionComplianceConsultationCooperationCo-Learning Collective Action Parkes, 2001 ONFORFOR/WITH WITH WITH/BY (CPPR) BY Community sets research agenda and mobilizes with or without outside facilitation Frameworks Models and Frameworks

Ripple Model for Growing Effective CPP Researchers Multicultura l exposure Community connection Adequate resources (funding/ time) Research er Cultural humility Cultural safety training Immersion in community culture Effective communication & trust Personal transformation Strengthening communities on community’s terms Open- mindedness Commitment to social justice Frameworks Models and Frameworks Burke, 2011

Routes of Transformation Multicultu ral exposure Community connection Adequate resources (funding/ time) Researcher Cultural humility Cultural safety training Open- mindedness Commitm ent to social justice Burke, 2011 Frameworks Models and Frameworks

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 trust, work with the formal and informal leadership, and seek commitment from community organizations and leaders to create processes for mobilizing the community. Remember and accept that community self- determination is the responsibility and right of all people who comprise a community. No external entity should assume it can bestow on a community the power to act in its own self-interest. Partnering with the community is necessary to create change and improve health. Principles of Community Engagement (CDC,2011)

All aspects of community engagement must recognize and respect community diversity. Awareness of the various cultures of a community and other factors of diversity must be paramount in designing and implementing community engagement approaches. Community engagement can only be sustained by identifying and mobilizing community assets, and by developing capacities and resources for community 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