Advancing the Science of Community-Level Interventions

Department of Psychology, University of Illinois at Chicago, USA.
American Journal of Public Health (Impact Factor: 4.55). 06/2011; 101(8):1410-9. DOI: 10.2105/AJPH.2010.300113
Source: PubMed


Community interventions are complex social processes that need to move beyond single interventions and outcomes at individual levels of short-term change. A scientific paradigm is emerging that supports collaborative, multilevel, culturally situated community interventions aimed at creating sustainable community-level impact. This paradigm is rooted in a deep history of ecological and collaborative thinking across public health, psychology, anthropology, and other fields of social science. The new paradigm makes a number of primary assertions that affect conceptualization of health issues, intervention design, and intervention evaluation. To elaborate the paradigm and advance the science of community intervention, we offer suggestions for promoting a scientific agenda, developing collaborations among professionals and communities, and examining the culture of science.

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    • "Our model understands culture as a constitutive social practice based on shared ideologies, beliefs, values, norms, and meanings that act as a probabilistic causal force in shaping health outcomes (Patterson, 2014: 7). Second , CBPR emphasizes extreme contextualism but overlooks " the effects that more macro-level forces, such as state and national policies and ideologies, have on relevant aspects of community life " (Trickett et al., 2011: 1413). Our framework not only illuminates how structural forces enable or constrain people's choices, but also that individuals have the potential to effect structural and cultural changes. "
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    ABSTRACT: Although a substantial literature examines the relationship between culture and health in myriad individual contexts, a lack of comparative data across settings has resulted in disparate and imprecise conceptualizations of the concept for scholars and practitioners alike. This article examines scholars and practitioners' understandings of culture in relation to health interventions. Drawing on 169 interviews with officials from three different nongovernmental organizations working on health issues in multiple countries-Partners in Health, Oxfam America, and Sesame Workshop-we examine how these respondents' interpretations of culture converge or diverge with recent developments in the study of the concept, as well as how these understandings influence health interventions at three different stages-design, implementation, and evaluation-of a project. Based on these analyses, a tripartite definition of culture is built-as knowledge, practice, and change-and these distinct conceptualizations are linked to the success or failure of a project at each stage of an intervention. In so doing, the study provides a descriptive and analytical starting point for scholars interested in understanding the theoretical and empirical relevance of culture for health interventions, and sets forth concrete recommendations for practitioners working to achieve robust improvements in health outcomes.
    Full-text · Article · Sep 2015 · Social Science [?] Medicine
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    • "Although community-based programs have generally been more successful than standalone interventions targeting only children, even these programs have had difficulty showing sustained improvements in children's behaviour and health outcomes (Towns, Cooke, Rysdale, & Wilk, 2014). Considering the relatively high degree of control that First Nations have had in implementing these large scale programs in their communities, the diverse and fragmented nature of urban communities and the health systems that serve them suggests that engaging the system as a whole through inter-sectoral collaboration (Midgley, 2006; Trickett, Deutsch, et al., 2011) is necessary in an urban context. "

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    • "The collection of articles in this Special Section helps to address this by bringing together multiple strategies and demonstrating their strength in addressing research questions with small samples. Small sample research issues also arise in multi-level, group-based, or community-level intervention research (Trickett et al. 2011). An example of this is a study that uses a media campaign and compares the efficacy of that campaign across communities. "
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    ABSTRACT: Small sample research presents a challenge to current standards of design and analytic approaches and the underlying notions of what constitutes good prevention science. Yet, small sample research is critically important as the research questions posed in small samples often represent serious health concerns in vulnerable and underrepresented populations. This commentary considers the Special Section on small sample research and also highlights additional challenges that arise in small sample research not considered in the Special Section, including generalizability, determining what constitutes knowledge, and ensuring that research designs match community desires. It also points to opportunities afforded by small sample research, such as a focus on and increased understanding of context and the emphasis it may place on alternatives to the randomized clinical trial. The commentary urges the development and adoption of innovative strategies to conduct research with small samples.
    Full-text · Article · Aug 2015 · Prevention Science
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