1. Community Level Models; Participatory Research and Challenges
Alexandra Varga
H571

2. Public Health
Public health is “the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals.”
Winslow, C.E. (1920). The untilled fields of public health. Science, 51(1306),

4. CDC: Colorectal Cancer Control Program (CRCCP)
Social Ecological Model
Centers for Disease Control and Prevention. (2013). Colorectal Cancer Control Program; Social Ecological Model. Retrieved from

5. Community Level Models
Strategies for a variety of settings
Address individual, group, institutional, and community issues
Community: “a group of people with diverse characteristics who are linked by social ties, share common perspectives, and engage in joint action in geographical locations or settings.”
aMacQueen, K.M. et al. (2001). What is community? An evidenced- based definition for participatory public health. American Journal of Public Health, 91 (12),

6. Strategies for Community Level Intervention
Community organization and other participatory models
Diffusion of innovations theory
Communications theory

7. Community Organization
Seeks to expand participants sense of self interest (i.e. from the individual to neighborhood to state, etc.)
Communities are helped to identify, assess, and solve a problem
PH professionals may use methods that reflect community priorities and initiate the program
More likely to succeed with community’s priorities (as opposed to external agenda)

8. 3 General Types of Community Organizing
Orientation
Goal
Community development
process oriented
aim of developing group identity
Social planning
task oriented
goal of problem solving
*Social action
process and task oriented; grassroots based; conflict oriented
increase community capacity and solve problems; concrete change to social injustice (policy change)

9. 6 Common Elements of Community Organization that are key to achieving and measuring change
Definition
Empowerment
Social action process though which people gain confidence and skills to improve quality of life
Community Capacity
Characteristics of a community that allow it to identify and address problems
Participation in organizing process
Engagement of community members
Relevance
Participants identify issues that are important to them
Issue Selection
Problems are dissected into solvable pieces
Critical Consciousness
Awareness of social, political and economic factors contributing to social problems

10. Media Advocacy An essential tactic in community organizing
Definition: “the strategic use of mass media and community advocacy to advance environmental change or a public policy initiative”
Purpose: Advocate for the goals of safe, healthy and prosperous communities; identify barriers to strategic policy implementation; and share current research through
Centers for Disease Control and Prevention. Media Advocacy. Designing and Implementing an Effective Tobacco Counter Marketing Campaign. Retrieved from

12. Participatory Action Research (PAR)
People who are being studied take an active role in the research
Beneficiaries take a lead role
“One clear result … was successful mobilization and organization of communities around an externally defined public health objective. All the communities were successful in developing an organizational structure and using that structure to accomplish a defined set of objectives contained in the COMMIT protocol”

13. Disparities in health status due to: Exposures Health care access
Social experience/support
Community level interventions must address these issues to address health disparities

14. Challenges to PAR Competing institutional demands
Time requirements for other parts of job
Volunteers vs paid participants
Risks associated with tenure and promotion
Based on grants and publication
Time involved in building relationship within community and collaborating in all steps (longer time to publication)

15. Expectations and demands of funding institution
Harder to obtain funding
Non traditional study design
Different outcomes (not causal/association based)
Community based research takes longer
Requires longer grant period and maybe more resources
Political and social dynamics within the community
Deterrents to change
inequitable distribution of power
history of discrimination

16. Facilitating Factors Factors for successful PAR
Top level support from organizations involved
Allow participants to devote necessary time
Rewarding participation
Effect change when indicated
Incentives
Compensation for all participants
Provision of training
Public events recognizing contributions

17. Support for Community-based Research
Universities more supportive
Efforts to change tenure policy
Journals devote theme issues to community approach
Funding initiatives
Foundations allow more time and resources for planning and partnership building
Foundations may leverage government funding

18. Diffusion of Innovations Theory
“ the process by which an innovation is communicated through certain channels over time among the members of a social system”
How “new” ideas, products and social practices spread
Used to study adoption of PH programs and health behaviors
Programs must be disseminated to be effective

19. What Affects Diffusion?
Key factors
Advantage- better than current
Compatibility- fit with intended audience
Complexity- easy to use
Trialability- can it be tested
Observability- measurable results
Communication channels and setting
Formal and informal
mass media and interpersonal
Social network