COMMUNITY-BASED HEALTH PROMOTION

1. COMMUNITY-BASED HEALTH PROMOTION Kaia Gallagher, Ph.D. Douglas Easterling, Ph.D. Dora Lodwick, Ph.D.

2. SESSON OBJECTIVES • Define the various roles of the community in C-B health promotion • Provide concrete examples of how C-B health promotion projects can be organized, implemented and evaluated • Summarize a continuum of outcomes from C-B health promotion efforts

3. BACKGROUND • Project examples are derived from 7 initiatives funded by The Colorado Trust during the 1990s • More detailed summaries of these initiatives are provided in the book PROMOTING HEALTH AT THE COMMUNITY LEVEL • Purpose of this session is to synthesize the broader cross-site findings from these initiatives

4. WHAT IS COMMUNITY-BASED HEALTH PROMOTION? • The defining feature of community-based health promotion lies in the role given to community residents and their representatives in planning, implementing and evaluating health promotion initiatives.

5. RANGE OF C-B INITIATIVES EXAMINED

6. COMMON ELEMENTS ACROSS THE INITIATIVES • Overall purpose was to enhance health promotion at the community level • Communities were given a role to increase the effectiveness and relevance of the strategies adopted. • An expected secondary benefit was that the grantees and communities would increase their capacity to address health-related problems.

7. CONTINUUM OF ROLES FOR THE COMMUNITY • Community-defined, community-controlled health interventions • Health interventions monitored by community-based stakeholder groups • Agency-based health interventions utilizing community advisory boards • Agency-based health interventions seeking ways to become more community-responsive

8. STRUCTURAL IMPLICATIONS OF COMMUNITY INVOLVEMENT • C-B interventions are located in “community” settings. • C-B interventions are sponsored by non- traditional organizations and community-based agencies. • Community stakeholders assume a broader leadership role.

9. FUNCTIONAL IMPLICATIONS OF COMMUNITY INVOLVEMENT • “Health” becomes more defined beyond the absence of disease. • Non-health related contextual factors assume greater prominence. • Scope of interventions becomes encompasses “community health’ in its broadest terms.

10. HOW CAN THE SUCCESS OF THESE C-B INITIATIVES BE JUDGED? • Case examples describe scope of efforts and level of effort. • Assessments of outcomes include consideration of community capacity. • Evaluations of C-B health promotion should include both direct and contextual measures of success.

11. OPTIONAL MEASURES OF COMMUNITY CAPACITY • Knowledge and skills • Leadership • Collective efficacy • Social capital

12. BENEFITS OF INCREASED COMMUNITY CAPACITY • Communities will have an increased ability to respond to health issues. • C-B responses are likely to be more responsive to community needs and thereby more effective in community terms. • Increases in social capital will have more generalized benefits in terms of health improvements.

13. CHALLENGES • Providing mechanisms for authentic community participation on the part of the larger community. • Developing “effective” health promotion strategies that are community-based • Sharing decision-making • Providing appropriate technical assistance • Clarifying expectations

14. TAKE-AWAY LESSONS • C-B health promotion efforts can take many forms, but offer promise in being responsive and effective vis-à-vis community needs. • The value of C-B health promotion extends beyond the immediate outcomes of the initiatives. • More needs to be learned about how to implement and evaluate C-B health promotion efforts.