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Abstract
This article presents the evolution of a comprehensive participatory coalition evaluation model and a workbook that emerged from a 6-year Healthier Communities initiative in New Mexico. Despite the explosion of interest in a new paradigm for coalition evaluation, few models in the literature encompass coalition effectiveness, capacity and health outcomes, and a dynamic process of community participation. The New Mexico model features a participatory evaluation process that emphasizes community system changes and population health changes. Several community case stories illustrate the difficulties and potentials of using the participatory evaluation model. Lessons learned include the need for guiding principles so that issues such as power relationships and collaborative decision making are “above board,” understanding the complexity of coalition evaluation, the need to clarify evaluator roles to enhance buy-in, the use of a logic model to clarify a common vision of change, and the importance of using community-friendly, jargon-free language.
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Affiliation(s)
- Nina Wallerstein
- Department of Family and Community Medicine at the University of New Mexico School of Medicine in Albuquerque
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2
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Lea CS, Rose C, May CL, Winterbauer N, Miller E, Fitzgerald TL. Patient scenario identifies gaps in breast cancer services in a rural region. J Community Health Nurs 2013; 30:129-42. [PMID: 23879579 DOI: 10.1080/07370016.2013.806692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Studies have demonstrated that community-based cancer coalitions can effectively address cancer disparities in rural areas. Scenario plots have been used to assess community needs in health care and public health. The social and medical context of a woman with undetected breast cancer was developed as a patient scenario implemented at a rural cancer coalition meeting to rapidly identify gaps in services. Transportation, fragmentation of cancer care, access to insurance coverage, patient navigation, and survivorship services were identified as gaps in ensuring patient compliance across the continuum of breast cancer care throughout the region. Results will be used to shape coalition priorities.
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Affiliation(s)
- C Suzanne Lea
- Department of Public Health, Brody School of Medicine, East Carolina University, Greenville, NC 27834, USA.
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3
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Rhodes SD, Hergenrather KC, Zometa C, Lindstrom K, Montano J. Characteristics of Immigrant Latino Men Who Utilize Formal Healthcare Services: Baseline Findings from the HoMBReS Study. J Natl Med Assoc 2008; 100:1177-85. [DOI: 10.1016/s0027-9684(15)31476-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Cashman SB, Adeky S, Allen AJ, Corburn J, Israel BA, Montaño J, Rafelito A, Rhodes SD, Swanston S, Wallerstein N, Eng E. The power and the promise: working with communities to analyze data, interpret findings, and get to outcomes. Am J Public Health 2008; 98:1407-17. [PMID: 18556617 DOI: 10.2105/ajph.2007.113571] [Citation(s) in RCA: 186] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Although the intent of community-based participatory research (CBPR) is to include community voices in all phases of a research initiative, community partners appear less frequently engaged in data analysis and interpretation than in other research phases. Using 4 brief case studies, each with a different data collection methodology, we provide examples of how community members participated in data analysis, interpretation, or both, thereby strengthening community capacity and providing unique insight. The roles and skills of the community and academic partners were different from but complementary to each other. We suggest that including community partners in data analysis and interpretation, while lengthening project time, enriches insights and findings and consequently should be a focus of the next generation of CBPR initiatives.
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Affiliation(s)
- Suzanne B Cashman
- Department of Family Medicine and Community Health, A3-150 Benedict Bldg, University of Massachusetts Medical School, Worcester, MA 01655, USA.
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Abstract
This paper examines the theoretical underpinning of the community based approach to health and safety programs. Drawing upon the literature, a theory is constructed by elucidating assumptions of community based programs. The theory is then put to test by analyzing the extent to which the assumptions are supported by empirical evidence and the extent to which the assumptions have been applied in community based injury prevention practice. Seven principles representing key assumptions of the community based approach to health and safety programs are identified. The analysis suggests that some of the principles may have important shortcomings. Programs overwhelmingly define geographical or geopolitical units as communities, which is problematic considering that these entities can be heterogeneous and characterized by a weak sense of community. This may yield insufficient community mobilization and inadequate program reach. At the same time, none of the principles identified as most plausible appears to be widely or fully applied in program practice. The implication is that many community based health and safety programs do not function at an optimum level, which could explain some of the difficulties in demonstrating effectiveness seen with many of these programs.
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Affiliation(s)
- P Nilsen
- Department of Health and Society, Division of Social Medicine and Public Health Science, Linköping University, SE-58183 Linköping, Sweden.
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7
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Rhodes SD, Hergenrather KC, Montaño J, Remnitz IM, Arceo R, Bloom FR, Leichliter JS, Bowden WP. Using community-based participatory research to develop an intervention to reduce HIV and STD infections among Latino men. AIDS Educ Prev 2006; 18:375-89. [PMID: 17067250 DOI: 10.1521/aeap.2006.18.5.375] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Although the Latino community living in the United States has been disproportionately affected by the intersecting epidemics of HIV and sexually transmitted diseases (STDs), the development, implementation, and evaluation of HIV and STD prevention interventions designed to reduce infection among Latinos lags behind prevention efforts targeting other communities. HoMBReS: Hombres Manteniendo Bienestar y Relaciones Saludables is a sexual risk reduction intervention designed to reduce HIV and STD infection among recently arrived, non-English-speaking Latino men who are members of a multicounty Latino soccer league in central North Carolina, a region of the United States with both the fastest growing Latino population and disproportionate HIV and STD infection rates. HoMBReS was developed in partnership with the local Latino community using community-based participatory research (CBPR). We describe (a) the CBPR partnership history and further expansion; (b) the development of the intervention through the integration of collected formative data, theoretical considerations, and findings from the scientific literature; and (c) lessons learned while using a CBPR approach to develop HoMBReS.
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Affiliation(s)
- Scott D Rhodes
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1063, USA.
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Zakocs RC, Edwards EM. What explains community coalition effectiveness?: a review of the literature. Am J Prev Med 2006; 30:351-61. [PMID: 16530624 DOI: 10.1016/j.amepre.2005.12.004] [Citation(s) in RCA: 166] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2005] [Revised: 12/15/2005] [Accepted: 12/16/2005] [Indexed: 11/29/2022]
Abstract
Community coalitions have become popular vehicles for promoting health. Which factors make coalitions effective, however, is unclear. The study's aim was to identify coalition-building factors related to indicators of coalition effectiveness through a review of the empirical literature. Published articles from 1980 to 2004 that empirically examined the relationships among coalition-building factors and indicators of coalition effectiveness were reviewed. Two indicators of coalition effectiveness were examined: coalition functioning and community-wide changes. A two-phase strategy was employed to identify articles by reviewing citations from previous literature reviews and then searching electronic reference databases. A total of 1168 non-mutually exclusive citations were identified, their abstracts reviewed, and 145 unique full articles were retrieved. The review yielded 26 studies that met the selection criteria. Collectively, these studies assessed 26 indicators of coalition effectiveness, with 19 indicators (73%) measuring coalition functioning, and only two indicators (7%) measuring changes in rates of community-wide health behaviors. The 26 studies identified 55 coalition-building factors that were associated with indicators of coalition effectiveness. Six coalition-building factors were found to be associated with indicators of effectiveness in five or more studies: formalization of rules/procedures, leadership style, member participation, membership diversity, agency collaboration, and group cohesion. However, caution is warranted when drawing conclusions about these associations due to the wide variations in indicators of coalition effectiveness and coalition-building factors examined across relatively few studies, discrepancies in how these variables were measured, and the studies' reliance on cross-sectional designs.
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Affiliation(s)
- Ronda C Zakocs
- Department of Social and Behavioral Sciences, Boston University School of Public Health, Boston, Massachusetts 02118, USA.
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Lewis TC, Robins TG, Joseph CLM, Parker EA, Israel BA, Rowe Z, Edgren KK, Salinas MA, Martinez ME, Brown RW. Identification of gaps in the diagnosis and treatment of childhood asthma using a community-based participatory research approach. J Urban Health 2004; 81:472-88. [PMID: 15273269 PMCID: PMC3455945 DOI: 10.1093/jurban/jth131] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
The goal of this investigation was to use a community-based participatory research approach to develop, pilot test, and administer an asthma screening questionnaire to identify children with asthma and asthma symptoms in a community setting. This study was conducted as the recruitment effort for Community Action Against Asthma, a randomized trial of a household intervention to reduce exposure to environmental triggers of asthma and was not designed as a classic prevalence study. An asthma screening questionnaire was mailed and/or hand delivered to parents of 9,627 children, aged 5 to 11 years, in two geographic areas of Detroit, Michigan, with predominantly African American and Hispanic populations. Additional questionnaires were distributed via community networking. Measurements included parent report of their child's frequency of respiratory symptoms, presence of physician diagnosis of asthma, and frequency of doctor-prescribed asthma medication usage. Among the 3,067 completed questionnaires, 1,570 (51.2% of returned surveys, 16.3% of eligible population) were consistent with asthma of any severity and 398 (12.9% of returned surveys, 4.1% of eligible population) met criteria for moderate-to-severe asthma. Among those meeting criteria for moderate-to-severe asthma, over 30% had not been diagnosed by a physician, over one half were not taking daily asthma medication, and one quarter had not taken any physician-prescribed asthma medication in the past year. Screening surveys conducted within the context of a community-based participatory research partnership can identify large numbers of children with undiagnosed and/or undertreated moderate-to-severe asthma. These children are likely to benefit from interventions to reduce morbidity and improve quality of life.
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Affiliation(s)
- Toby C Lewis
- Department of Pediatrics and Communicable Diseases, University of Michigan School of Medicine, Ann Arbor, MI, USA.
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Affiliation(s)
- Ross C Brownson
- Department of Community Health and Prevention Research Center, Saint Louis University School of Public Health, St. Louis, MO 63104, USA.
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11
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Abstract
Food insufficiency is a major public health problem that has been linked to poor nutritional intake, poor diabetes management, poor cognitive development in children, and other adverse health outcomes. Since the 1960s, antihunger advocacy organizations (AHAOs) have fought to alleviate hunger at the local, state, and federal levels. Few studies have investigated the organizational structure, programs, advocacy activities, and outcomes of these organizations, although many organizations have been instrumental in advocating for state and federal food policy, creating measurements for hunger, and conducting research. Four state-level AHAOs were studied by using multiple case study methodology and grounded theory for analysis to assess organizational effectiveness. The findings highlight a conceptual framework that identified 19 important organizational characteristics that reflect organizational capacity, performance, achievement, and effectiveness. The conceptual framework may be useful in assessing effectiveness of public health organizations and coalitions.
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Affiliation(s)
- Barbara A Laraia
- Department of Nutrition, School of Public Health and Carolina Population Center, CB 8120, University of North Carolina at Chapel Hill 27599, USA.
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Metzler MM, Higgins DL, Beeker CG, Freudenberg N, Lantz PM, Senturia KD, Eisinger AA, Viruell-Fuentes EA, Gheisar B, Palermo AG, Softley D. Addressing urban health in Detroit, New York City, and Seattle through community-based participatory research partnerships. Am J Public Health 2003; 93:803-11. [PMID: 12721148 PMCID: PMC1447843 DOI: 10.2105/ajph.93.5.803] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE This study describes key activities integral to the development of 3 community-based participatory research (CBPR) partnerships. METHODS We compared findings from individual case studies conducted at 3 urban research centers (URCs) to identify crosscutting adaptations of a CBPR approach in the first 4 years of the partnerships' development. RESULTS Activities critical in partnership development include sharing decision-making, defining principles of collaboration, establishing research priorities, and securing funding. Intermediate outcomes were sustained CBPR partnerships, trust within the partnerships, public health research programs, and increased capacity to conduct CBPR. Challenges included the time needed for meaningful collaboration, concerns regarding sustainable funding, and issues related to institutional racism. CONCLUSIONS The URC experiences suggest that CBPR can be successfully implemented in diverse settings.
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Affiliation(s)
- Marilyn M Metzler
- Centers for Disease Control and Prevention, Mail Stop K67, 4770 Buford Highway NE, Atlanta, GA 30341-3717, USA.
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Abstract
Contemporary public health emphasizes a community-based approach to health promotion and disease prevention. The evidence from the past 20 years indicates, however, that many community-based programs have had only modest impact, with the notable exception of a number of HIV prevention programs. To better understand the reasons for these outcomes, we conducted a systematic literature review of 32 community-based prevention programs. Reasons for poor performance include methodological challenges to study design and evaluation, concurrent secular trends, smaller-than-expected effect sizes, limitations of the interventions, and limitations of theories used. The effectiveness of HIV programs appears to be related in part to extensive formative research and an emphasis on changing social norms.
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Affiliation(s)
- Cheryl Merzel
- Center for Applied Public Health, Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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Parker E, Margolis LH, Eng E, Henríquez-Roldán C. Assessing the capacity of health departments to engage in community-based participatory public health. Am J Public Health 2003; 93:472-6. [PMID: 12604498 PMCID: PMC1447766 DOI: 10.2105/ajph.93.3.472] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We created indicators of local public health agency capacity to engage in community-based participatory public health. METHODS We sent a survey of 27 items reflecting aspects of community-based participatory public health to 429 employees in 4 local health departments. Two thirds (n = 282) responded. We performed a factor analysis to identify components of community-based participatory practice. RESULTS We identified 4 factors: (1) the agency's and (2) the individual employee's skills in working with community groups and minority populations, (3) the extent and frequency of agency networking, and (4) community participation in health department planning. CONCLUSIONS Our findings suggest that it is possible to measure the competencies needed by health department staff to engage in community-based participatory public health.
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Affiliation(s)
- Edith Parker
- Department of Health Behavior and Health Education, University of Michigan, School of Public Health, Ann Arbor 48109-2029, USA.
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Abstract
The treatment of pregnant women addicted to drugs provides an especially important and illustrative example of how political and popular demands can successfully challenge professional ethical norms associated with clinical medicine — norms such as confidentiality, patient autonomy, and the right to consent to and to refuse treatment. One increasingly popular policy approach is to limit patient autonomy by coercing women in an attempt to change their behavior, either by involuntary civil commitment or by imprisoning them for drug abuse or child neglect. Thirty-five states have criminally prosecuted women for substance abuse or alcohol use during pregnancy. Other states aggressively use involuntary civil commitment as a means to protect the yet-to-be-born from harm during pregnancy. Medical professionals have been forced to participate in these programs by mandatory reporting requirements.
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Affiliation(s)
- Philip H Jos
- College of Charleston, Charleston, South Carolina, USA
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Krieger J, Allen C, Cheadle A, Ciske S, Schier JK, Senturia K, Sullivan M. Using community-based participatory research to address social determinants of health: lessons learned from Seattle Partners for Healthy Communities. Health Educ Behav 2002; 29:361-82. [PMID: 12038744 DOI: 10.1177/109019810202900307] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Seattle Partners for Healthy Communities (SPHC) is a multidisciplinary collaboration of community agencies, community activists, public health professionals, academics, and health providers who conduct research aimed at improving the health of urban, socioeconomically marginalized Seattle communities. SPHC uses a community-based participatory research approach to address social factors that affect the health of these communities. This article describes three SPHC projects that focus on social determinants of health, particularly the development of social support and improving housing quality. The characteristics of community participation in each of these projects are discussed and show a spectrum of participation. Although projects successfully addressed proximal social factors affecting health, influencing more distal underlying factors was more difficult. Implications for researchers using a community-based participatory research approach and public health practitioners seeking to engage communities in addressing social determinants of health are presented.
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Abstract
Collaborative partnerships (people and organizations from multiple sectors working together in common purpose) are a prominent strategy for community health improvement. This review examines evidence about the effects of collaborative partnerships on (a) community and systems change (environmental changes), (b) community-wide behavior change, and (c) more distant population-level health outcomes. We also consider the conditions and factors that may determine whether collaborative partnerships are effective. The review concludes with specific recommendations designed to enhance research and practice and to set conditions for promoting community health.
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Fielding JE, Lamirault I, Nolan B, Bobrowsky J. Changing the paradigm: planning for ambulatory care expansion in Los Angeles County using a community-based and evidence-based model. J Ambul Care Manage 2000; 23:19-27. [PMID: 11010227 DOI: 10.1097/00004479-200007000-00003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In 1998, Los Angeles County's Department of Health Services (DHS) embarked on a planning process to expand ambulatory care services for the county's 2.7 million uninsured and otherwise medically indigent residents. This planning process was novel in two ways. First, it used a quantitative, needs-based approach for resource allocation to ensure an equitable distribution of safety-net ambulatory care services across the county. Second, it used a new community-based planning paradigm that took into consideration the specific needs of each of the county's eight geographic service planning areas. Together, the evidence-based approach to planning and the community-based decision-making will ensure that DHS can more equitably provide for the needs of Los Angeles County's medically indigent residents.
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Affiliation(s)
- J E Fielding
- Los Angeles County Department of Health Services, California, USA
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Kreuter MW, Sabol BJ, O'Donovan A, Donovan J, Klein L, Green LW, Vliet M, Bradley T, Campuzano MK, Tarlov AR. Commentaries from grantmakers on Fawcett et al.'s proposed memorandum of collaboration. Public Health Rep 2000; 115:180-90. [PMID: 10968752 PMCID: PMC1308709 DOI: 10.1093/phr/115.2.180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M W Kreuter
- Div. of Adult and Community Health, National Center for Chronic Disease Prevention and Health Promotion, US Centers for Disease Control and Prevention, Atlanta, GA 30341, USA.
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Maciak BJ, Guzman R, Santiago A, Villalobos G, Israel BA. Establishing LA VIDA: a community-based partnership to prevent intimate violence against Latina women. Health Educ Behav 1999; 26:821-40. [PMID: 10608573 DOI: 10.1177/109019819902600606] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LA VIDA--the Southwest Detroit Partnership to Prevent Intimate Violence Against Latina Women--evolved in response to community concern about the problem of intimate partner violence (IPV) and the lack of culturally competent preventive and support services for Latino women and men in southwest Detroit. Since 1997, diverse organizations have mobilized as a community-academic partnership to ensure the availability, accessibility, and utilization of IPV services. This article describes and analyzes the evolution of LA VIDA within a community-based participatory research framework using a case study approach that draws on multiple data sources including group and individual interviews and field notes. The challenges and lessons learned in addressing a complex multifaceted problem such as IPV in an ethnic minority community are highlighted in an examination of the process of mobilizing diverse organizations, conducting community diagnosis and needs assessment activities, establishing goals and objectives within a social ecological framework, and integrating evaluation during the development phase.
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Affiliation(s)
- B J Maciak
- Urban Research Centers, Centers for Disease Control and Prevention, School of Public Health, University of Michigan, Ann Arbor 48109-2029, USA.
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Abstract
The relationship between evaluators and communities has been changing in the last two decades to a model of research 'with' the community, instead of research 'on' the community. This shift has paralleled increasing community demands for accountability and authority as community participation rhetoric has given way to words such as partnership, collaboration and community empowerment. Despite the rhetoric, there has been little reflection on the problematic and contradictory relationships between communities and researchers, specifically as related to their differing positions of power. This article provides a reflective examination of the contested power dynamics of the research relationship within a participatory evaluation process of the Healthier Communities initiative in New Mexico. An in-depth literature review of the philosophical principles and the complex realities of evaluations based on participatory, community-driven and post-modern inquiry precedes the case study. Without ongoing consideration of power issues, the article argues that evaluation design, implementation and utilization of findings will be compromised.
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Affiliation(s)
- N Wallerstein
- Department of Family and Community Medicine, University of New Mexico, Albuquerque 87131, USA.
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Parker EA, Eng E, Schulz AJ, Israel BA. Evaluating community-based health programs that seek to increase community capacity. ACTA ACUST UNITED AC 1999. [DOI: 10.1002/ev.1144] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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