Community participation in health initiatives for marginalized populations.
ABSTRACT Community-based participatory methods have emerged as a response to conventional approaches that have historically failed to make notable improvement in health status or reduce chronic disease among marginalized populations. The social-ecological model provides a framework to develop and implement strategies directed to affecting multiple levels (societal, community, organizational, and individual) of influence on health status. A systems approach can facilitate the identification of the complex interrelationships of factors at all levels that contribute to health disparities by making use of the unique knowledge, expertise, and resources of community partners. Community engagement in the planning, implementation, and evaluation of health initiatives builds community capacity to create sustainable changes at all levels to achieve and maintain optimal health for those who bear the greatest burden of disease.
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ABSTRACT: Engaging communities in authentic partnerships is increasingly accepted as best practice in both medicine and public health, despite the many barriers to doing so. New medical schools have an opportunity to incorporate community engagement into their very foundation. In rural northeast Pennsylvania, a new medical school used a regional health assessment to engage community partners across the 16 counties it serves. A community health advisory board guided the development and implementation of a key informant focus group methodology. Twenty-three focus groups were held. Themes were generated using content analysis involving 21 observers along with the principal investigators. A total of 221 representatives of 195 agencies from across the region participated. Twelve themes relating to needs were discussed in more than 75% of focus groups. The findings revealed barriers to improving health in the region, including lack of access to preventive services, to primary care and specialty providers, and to basic mental health services. Consistent themes related to strengths and expectations for the new medical school also emerged. Holding focus groups across the region allowed community service providers to connect to a new medical school, despite distances in the rural region. Partnerships with community agencies and providers are evolving. Findings from the study regarding needs and strengths in rural communities have been incorporated into the school's curriculum and research agenda. Dissemination efforts have focused on communicating findings to community partners in formats and venues that are useful for them.Family medicine 42(10):693-701. · 0.85 Impact Factor
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ABSTRACT: We examined how National Cancer Institute-funded Community Network Programs (CNPs) operationalized principles of community-based participatory research (CBPR). We reviewed the literature and extant CBPR measurement tools. On the basis of that review, we developed a 27-item questionnaire for CNPs to self-assess their operationalization of 9 CBPR principles. Our team comprised representatives of 9 of the National Cancer Institute's 25 CNPs. Of the 25 CNPs, 22 (88%) completed the questionnaire. Most scored well on CBPR principles of recognizing community as a unit of identity, building on community strengths, facilitating colearning, embracing iterative processes in developing community capacity, and achieving a balance between data generation and intervention. CNPs varied in the extent to which they employed CBPR principles of addressing determinants of health, sharing power among partners, engaging the community in research dissemination, and striving for sustainability. Although the development of assessment tools in this field is in its infancy, our findings suggest that fidelity to CBPR processes can be assessed in a variety of settings.American Journal of Public Health 11/2011; 102(6):1195-203. DOI:10.2105/AJPH.2011.300304 · 4.23 Impact Factor
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ABSTRACT: CONTEXT: Policymakers and practitioners continue to pursue initiatives designed to engage individuals in their health and health care despite discordant views and mixed evidence regarding the ability to cultivate greater individual engagement that improves Americans' health and well-being and helps manage health care costs. There is limited and mixed evidence regarding the value of different interventions. METHODS: Based on our involvement in evaluating various community-based consumer engagement initiatives and a targeted literature review of models of behavior change, we identified the need for a framework to classify the universe of consumer engagement initiatives toward advancing policymakers' and practitioners' knowledge of their value and fit in various contexts. We developed a framework that expanded our conceptualization of consumer engagement, building on elements of two common models, the individually focused transtheoretical model of behavior and the broader, multilevel social ecological model. Finally, we applied this framework to one community's existing consumer engagement program. FINDINGS: Consumer engagement in health and health care refers to the performance of specific behaviors ("engaged behaviors") and/or an individual's capacity and motivation to perform these behaviors ("activation"). These two dimensions are related but distinct and thus should be differentiated. The framework creates four classification schemas, by (1) targeted behavior types (self-management, health care encounter, shopping, and health behaviors) and by (2) individual, (3) group, and (4) community dimensions. Our example illustrates that the framework can systematically classify a variety of consumer engagement programs, and that this exercise and resulting characterization can provide a structured way to consider the program and how its components fit program goals both individually and collectively. CONCLUSIONS: Applying the framework could help advance the field by making policymakers and practitioners aware of the wide range of approaches, providing a structured way to organize and characterize interventions retrospectively, and helping them consider how they can meet the program's goals both individually and collectively.Milbank Quarterly 03/2013; 91(1):37-77. DOI:10.1111/milq.12002 · 5.06 Impact Factor