Community development and health education: I. Community organization as a health tactic.
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Attitude of Health Personnel↗
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Organizational capacity for community development in regional health authorities: a conceptual model.
The value of community development (CD) practices is well documented in the health promotion literature; it is a foundational strategy outlined in the Ottawa Charter for Health Promotion. Despite the importance of collaborative action with communities to enhance individual and community health and well-being, there exists a major gap between the evidence for CD and the actual extent to which CD is carried out by health organizations. In this paper it is argued that the gap exists because we have failed to turn the evaluative gaze inward-to examine the capacity of health organizations themselves to facilitate CD processes. This study was designed to explicate key elements that contribute to organizational capacity for community development (OC-CD). Twenty-two front-line CD workers and managers responsible for CD initiatives from five regional health authorities in Alberta, Canada, were interviewed. Based on the study findings, a multidimensional model for conceptualizing OC-CD is presented. Central to the model are four inter-related dimensions: (i) organizational commitment to CD, rooted in particular values and beliefs, leadership and shared understanding of CD; (ii) supportive structures and systems, such as job design, flexible planning processes, evaluation mechanisms and collaborative processes; (iii) allocation of resources for CD; and (iv) working relationships and processes that model CD within the health organization. These four dimensions contribute to successful CD practice in numerous ways, but perhaps most importantly by supporting the empowerment and autonomy of the pivotal organizational player in health promotion practice: the front-line worker.
Canada↗
Disturbance, biological legacies and community development in stream mesocosms.
Disturbances reduce the biota in stream ecosystems, and leave biological legacies, including remnant species, which potentially influence post-disturbance community development but are poorly understood. We investigated whether three remnant species, the snail Radix peregra, the mayfly Serratella ignita and the freshwater shrimp Gammarus pulex, affected community development in mesocosms that mimicked disturbed habitat patches in streams. Following 21 days of colonisation, we found that the occurrence of legacy effects depended on the identity of the remnant species. Radix had the strongest effect. By bulldozing epilithon, the snails acted as ecological engineers that promoted settlement of filter feeders (Simuliidae) and invertebrate predators (especially Pentaneura and Aphelocheirus) and strongly deterred settlement of non-predatory chironomids (e.g. Heterotrissocladius and Microtendipes). Gammarus increased in density (by 665%) where remnant, probably through rapid reproduction. Baetis and Pentaneura were scarce, and Asellus absent, in remnant Gammarus treatments, as a consequence of interference and/or predation by the amphipods. In contrast, Serratella tolerated the colonisation of immigrant species and did not affect the structure of the developing benthic community. Despite the observed effects on the presence and abundance of benthos, remnant fauna had no significant effect on assemblage taxon richness, or that of any specific trophic group. The contrasting effects of remnant species on immigrant colonisation echoed differences in their life-history traits and foraging behaviours. Our results indicate that biota can generate spatial patchiness of epilithon and benthic invertebrates in stream ecosystems.
Amphipoda↗
Case-control study of severe life threatening asthma (SLTA) in a developing community.
BACKGROUND: Distinct risk factors for asthma death have not been identified in developing communities. This study was conducted to distinguish risk factors for severe life threatening asthma (SLTA), a proxy for asthma death, in a developing country. METHODS: A case-control study was performed at a University Hospital serving developing communities in the Western Cape Province, South Africa, over the period October 1997 to April 2000. Thirty consecutive patients with SLTA admitted to the intensive care unit (ICU) were compared with 60 chronic asthmatic patients, without a history of SLTA, who had attended the hospital outpatient respiratory clinic over the same period. RESULTS: The risk of SLTA in comparison with controls increased with female sex (odds ratio (OR) 3.3, 95% CI 1.2 to 9.6, p = 0.02), rural residence (OR 8.1, 95% CI 2.6 to 25.3, p = 0.0005), and absence of a formal income (OR 5.7, 95% CI 2 to 16.6, p = 0.002). Cases were more likely to have had more than one hospital admission in the previous year (OR 8, 95% CI 2.5 to 25.2, p = 0.0009) and more than one emergency room visit in the previous year (OR 4.4, 95% CI 1.19 to 16.4, p = 0.04). Patients with SLTA were less likely to use inhaled corticosteroids (OR 5.6, 95% CI 1.9 to 16.5, p = 0.003) and more likely to use inhaled fenoterol (OR 6, 95% CI 2.2 to 16.2, p = 0.0004). Patients with SLTA also had lower mean (SE) forced expiratory volume in 1 second (FEV(1)) measurements (66.9 (9.5)% predicted v 82.5 (4.0)% predicted; p = 0.03) and lower FEV1/FVC ratios (60.7 (4.1)% predicted v 69.6 (1.9)% predicted; p = 0.05) documented before the episode of SLTA. CONCLUSIONS: Risk factors for SLTA that are mainly analogous to those distinguished in other environments have been identified in a geographical area characterised by a third world socioeconomic context. Rural residence and poverty may increase the risk of SLTA.
Adult↗
Family, friend or foe? Critical reflections on the relevance and role of social capital in health promotion and community development.
Social capital has been the focus of considerable academic and policy interest in recent years. Despite this interest, the concept remains undertheorized: there is an urgent need for a critical engagement with this literature that goes beyond summary. This paper lays a foundation for a critical dialogue between social capital and health promotion, by examining problematics in the conceptualization and practice of social capital building and linking these to models of community development, a cornerstone health promotion strategy. In so doing, the paper contributes to the existing literature by providing a theoretical exposition and critique of various threads in social capital discourse, and linking these threads explicitly to community development practice. Distinctions between communitarian, institutional and critical approaches to social capital are elaborated, and the relationships between these three approaches and three models of community development-social planning, locality development, and social action-are discussed. The existing social capital literature is then critically examined in relation to three key themes common to both literatures: community integration, public participation, and power relations. This examination suggests that social capital cannot be conceived in isolation from economic and political structures, since social connections are contingent on, and structured by, access to material resources. This runs counter to many current policy discourses, which focus on the importance of connection and cohesion without addressing fundamental inequities in access to resources. This paper posits that approaches to community development and social capital should emphasise the importance of a conscious concern with social justice. A construction of social capital which explicitly endorses the importance of transformative social engagement, while at the same time recognising the potential negative consequences of social capital development, could help community organizers build communities in ways that truly promote health.
Canada↗
Community development: a critical review of approaches to evaluation.
With the growing interest in community-based initiatives, this discussion paper focuses upon the evaluation of community development. It reviews three areas and highlights the complex and contentious nature of evaluation in this field. Commencing with approaches to evaluation, it critically reviews proposed methods and suggests that, rather than provide clarity and guidance, the competing designs are confusing for the potential researcher. Second, the discussion moves to evaluative terms that are applied to community development, suggesting that there is a mismatch between professional and lay interpretations with an ultimate impact upon the validity of their measurement. It uses the terms community and empowerment to make these differences more explicit. Finally, the paper argues that, although the aim of community-based initiatives is to bring about community health gain, gauging the pervasiveness of discreet project work is testing. It concludes by suggesting that a move away from an evaluative model based upon empowerment towards one which considers health and social capital may be a way forward.
Community Health Nursing↗
A qualitative study of the attitudes of members of a developing community towards their dogs and veterinary services.
A university-based hospital serving mainly a developing community readily appreciated that its clientele was from a very different sociological and cultural background than that of the professional staff and that developed and developing communities and their pets exhibit different patterns in their health status, with most diseases being predominantly related to socio-economic predicament. The need for a community-orientated service was recognised. From 1987 to 1988, the small animal outpatient clinic was used for an informal, unstructured sociological observation and interview-based study of the clientele and their pets. During this period, an informal educational programme was implemented to teach basic pet health care, and the efficacy of this programme was empirically gauged by comparing the knowledge and attitudes of first-time clients with those of regular clients. Regular clients appeared to become increasingly concerned about the health and management of their pets and the condition of their animals appeared to improve, with a corresponding decline in the degree of parasitism. The majority of clients however, still regarded the main reason for keeping dogs as the provision of some form of security. It also appeared as if improved attitudes towards household pets paralleled improvements in socio-economic status.
Animals↗
Defining our terms: community development and public health.
The HVA's community development interest group was launched to provide a forum for health visitors working, or wishing to develop their work, in this specialist area of practice. Ian Brown reflects on the discussions and issues raised at a study day organised by the group in March this year.
Community Health Nursing↗
A quantitative study of the attitudes of members of a black developing community towards their dogs and veterinary services.
To further the study of human-companion animal interactions in black developing communities, the clients (n = 94) of a university-based animal hospital, serving primarily a developing community, were interviewed. The interviews covered demographics, socio-economic aspects, perceptions, values and attitudes of clients towards their dogs. Regular and new clients were compared. A profile of the hospital's black clientele was also constructed. The study showed that the majority of black clients value their dogs for the sake of security and protection. Attitudes towards pets parallelled improvements in socio-economic status. Most clients felt positive towards existing veterinary services. The results of this study support and highlight the value of a previous observational study and could prove to be invaluable in designing, implementing and planning socially relevant animal health services.
Black or African American↗
Bacterial vaginosis and lower genital tract infections in women attending out-patient clinics at a tertiary institution serving a developing community.
The prevalence of bacterial vaginosis and other lower genital tract infections were determined in women from a developing community. Patients were recruited from four out-patient clinics of a large urban tertiary referral hospital serving the indigent Black population of KwaZulu/Natal, South Africa. A total of 208 women attending the sexually transmitted diseases (STD) (n = 51), colposcopy (n =50), family planning (n = 52) and antenatal (n = 55) clinics were investigated. Endocervical and vaginal specimens were collected for microbiological investigation of recognised sexually transmitted pathogens. Estimation of vaginal pH, amine test and wet smear microscopy were performed at the bedside. Peripheral venous blood was obtained for serological tests for syphilis, hepatitis B surface antigen and antibody to the human immunodeficiency virus (HIV). Vaginal infections were detected in a total of 50% (104) of women, endocervical infections alone in 9% (18) and concurrent vagino-endocervical infections in 20% (41). Bacterial vaginosis (BV) was diagnosed in 35% (73) and its prevalence amongst different clinic populations ranged from 25% to 41% with no significant differences between any groups. Trichomoniasis was detected significantly more often in women attending the STD and antenatal clinics. Endocervical infections were found mainly in women attending the STD clinic, though the prevalence of Chlamydia trachomatis amongst the other clinic attenders ranged from 13% to 20%. Micro-organisms such as Gardnerella vaginalis, Mycoplasma hominis, anaerobes and curved Gram-negative rods were found in significantly higher number of women with BV. This study confirms the high prevalence of vaginal, endocervical and mixed vagino-endocervical infections in women from developing communities. The high prevalence of bacterial vaginosis as a single infection and its association with other recognised sexually transmitted pathogens in a large proportion of women, is of significance since such infections not only predispose to ascending upper genital tract infections but are also associated with complications in pregnancy such as premature rupture of membranes, preterm labour and endometritis.
Journal Article↗
Issues of participation, ownership and empowerment in a community development programme: tackling smoking in a low-income area in Scotland.
Founded on community development principles and practice, the 'Breathing Space' initiative aimed to produce a significant shift in community norms towards non-toleration and non-practice of smoking in a low-income area in Edinburgh, Scotland. The effectiveness of Breathing Space was evaluated using a quasi-experimental design, which incorporated a process evaluation in order to provide a description of the development and implementation of the intervention. Drawing on qualitative data from the process evaluation, this paper explores the varied and sometimes competing understandings of the endeavour held by those implementing the intervention. The paper examines the principles that underpin health promotion in the community setting, particularly the concepts of ownership, empowerment and participation, and their differential interpretation and employment by participants. The data illustrate how these varied understandings had implications for the joint planning and implementation of Breathing Space objectives. In addition, the different understandings raise questions about the appropriateness and viability of utilizing community development approaches in this context.
Community Participation↗
Applying a basic development needs approach for sustainable and integrated community development in less-developed areas: report of ongoing Iranian experience.
INTRODUCTION: Despite considerable achievements in the provision of basic developmental facilities in terms of drinking water, access to primary healthcare services, high-quality and nutritious food, social services, and proper housing facilities, there are many rural and slum communities in Iran where these essential needs remain unfulfilled. Lack of equity is prominent, as large differences exist in underprivileged provinces. New policies developed in the past two decades have resulted in substantial achievements in meeting population needs and reducing the socio-economic gap; nevertheless, poverty levels, unemployment due to a large increase in the birth rate in the early 1980s, and lack of community participation are matters yet to be addressed. To overcome these deficiencies, a basic development needs approach was adopted to promote the concept of community self-help and self-reliance through intersectoral collaboration, creating an environment where people could take an active part in the development process, with the Iranian government providing the necessary support to achieve the desired level of development. DESCRIPTION OF THE PROJECT: Following firm commitment from the Iranian government and technical support from the World Health Organization Regional Office, basic development needs was assigned a high priority in health and health-related sectors, reflected in the third National Masterplan (2001-2005). A comprehensive intersectoral plan was designed, and pilot projects were commenced in three villages. Each village elected a representative, and committee clusters were formed to run and monitor projects identified by a process of local needs assessment and priority assignment. In each region, a variety of needs were elicited from these assessments, which were actively supported by local authorities. LESSON LEARNED: A basic development needs approach was found to be a reliable discipline to improve community participation, needs-led resource allocation and intersectoral co-operation in community development, particularly in underprivileged areas. Iran's initial experience of basic development needs has gained widespread public support but will require periodical evaluation as it is introduced into other rural and urban regions across the country.
Community Participation↗
Primary Care Trusts involving the community: is community development the way forward?
Patient and user involvement is central to current government thinking on the NHS. More comprehensive approaches to organised community participation and community development have received less support and examples of effective and genuine participation in key areas such as primary care decision-making are rare. The initiative described in this paper was established in Newcastle upon Tyne in 1995 to promote community participation in decision-making about local health services. It has particular relevance to current concerns about addressing social exclusion and tackling health inequalities since it operates in an area of social disadvantage with a significant black and ethnic minority population (6 percent). This case study is based on an independent evaluation which used multiple research methods, including interviews, questionnaire surveys and direct observation, to assess the project's practice and impact. Describes a community development approach to public participation. An emphasis on inclusive practices has facilitated meaningful involvement of minority groups such as ethnic minority residents and those with disabilities who tend to be marginalised in public debate. Argues that the project has made a significant impact on the ways in which local health services are planned and delivered
Community Participation↗
Managing water supply and sanitation services to developing communities: key success factors.
A number of key success factors in the management of organisations responsible for the provision of water supply and sanitation services to developing communities have been identified as critical to the sustained success of such organisations. These factors have to receive specific and sustained attention from management. They should form the focus of management attention in addition to the many other important factors requiring management input. The key success factors which are critical to ensure a sustained water supply and the provision of sanitation services to developing communities centre around two main areas, i.e. the credibility of the organisation with the community it serves and the creation of an organisation culture of focusing on service to the community, on income generation and on minimising of losses.
Developing Countries↗
Women and energy: household energy for developing communities, South African experience. Sustainability energy development.
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Africa↗
The association between sexually transmitted pathogens and cervical intra-epithelial neoplasia in a developing community.
OBJECTIVE--To determine the association of sexually transmitted pathogens in women with cervical intra-epithelial neoplasia (CIN). SETTING--An urban tertiary referral hospital serving a large indigent developing community. PARTICIPANTS--48 women attending a colposcopy clinic and 49 women attending a family planning clinic. METHODS--Vaginal, endocervical, rectal swab specimens and sera were collected for the detection of sexually transmitted pathogens. Cervical cytology was performed on all patients. Women attending the colposcopy clinic had confirmation of abnormal cervical cytology by colposcopic directed biopsy. RESULTS--The mean age of women with CIN (33 years) was significantly greater than that of the women without CIN (28 years) and that of the family planning group (26 years). There was a high prevalence of sexually transmitted pathogens in all women. A significantly higher prevalence of bacterial vaginosis was found in women with CIN compared to those without (50% vs 20%; p = 0.034). The human papilloma virus (HPV) was detected in 46% of women with CIN and 65% of those without CIN. Chlamydia trachomatis (21%) and Trichomonas vaginalis (39%) were detected frequently in women with CIN. C. trachomatis (14%-21%) was detected more frequently than Neisseria gonorrhoeae (3-5%) in all asymptomatic women studied. CONCLUSION--This study demonstrates a high prevalence of sexually transmitted pathogens in women with and without CIN as well as family planning clinic attenders. Bacterial vaginosis was a significant finding in women with CIN. C. trachomatis was detected in a high proportion of all women studied and found more commonly than N. gonorrhoeae. We therefore recommend that all women attending gynaecological services in a developing community be investigated and treated for sexually transmitted diseases.
Adult↗
Public participation and marginalized groups: the community development model.
OBJECTIVES: To develop ways of reaching house-bound people and enabling them to give their views in planning and monitoring health and social care. STRATEGY: HealthLINK - a project based in a community health council - explored ways of involving older house-bound people in the London Borough of Camden, in planning and monitoring health and social care using community development techniques. RESULTS: HealthLINK set up an infrastructure to enable house-bound people to have access to information and to enable them to give their views. This resulted in access for health and local authorities to the views of house-bound older people and increased the self esteem and quality of life of those who became involved. CONCLUSIONS: Community development approaches that enable an infrastructure to be established may be an effective way of reaching marginalized communities. However, there are tensions in this approach between the different requirements for public involvement of statutory bodies and of users, and between representation of groups and listening to individual voices.
Journal Article↗
Ecotourism and community development: case studies from Hainan, China.
The connections between people, parks, and tourism have received significant attention in recent years, recognizing the potential for mutually beneficial relationships. Ecotourism has been promoted and widely adopted as a strategy for funding conservation initiatives, while at the same time contributing to the socioeconomic development of host communities and providing for quality tourism experiences. Parks are among the most common ecotourism destinations. Employing interviews, observations and secondary sources, this study assesses the current status of ecotourism at two protected areas in Hainan, China, where it is being promoted as a strategy for balancing regional economic growth and conservation objectives. Through an evaluation of the existing tourism-park-community relationships, opportunities and constraints are identified. Ecotourism development was found to be at an early stage at both study sites. Socioeconomic benefits for the local communities have been limited and tourism activity has not contributed revenues towards conservation to date. Community residents, nevertheless, generally support conservation and are optimistic that tourism growth will yield benefits. In light of the study findings and the salient literature, planning direction is offered with the intention of enhancing the capacity of ecotourism to generate benefits for both communities and the parks, and thus contribute to the sustainable development of the region more generally. Lessons derived have broad applicability for ecotourism destinations elsewhere.
China↗