Title: Community Capacity for Health Improvement James Burdine Ken McLeroy Texas A & M School of Rural Public Health July 10-11, 2006
1Community Capacity for Health Improvement
James Burdine Ken McLeroyTexas A M School of
Rural Public Health July 10-11, 2006
- Texas Public Health Training Center
- Summer Institute
2Community Capacity Defined
Described as a process ...the cultivation and
use of transferable knowledge, skills, systems
and resources that effect community and
individual-level changes... (Rogers,
Howard-Pitney Lee, 1995) and as a set of
characteristics a set of dynamic community
traits, resources, and associational patterns
that can be brought to bear for community
building and community health improvement
(Norton, McLeroy at el., 2002) the interaction
of human capital, organization resources, and
social capital existing within a given community
that can be leveraged to solve collective
problems and improve or maintain well-being of
the community (Chaskin et al., 2001)
3Comparing Community Capacity
- Empowerment
- Conditions in which individuals and organizations
use their skills and resources to meet their
needs and where there are opportunities for
citizens to interact with others and be
meaningfully involved with decision-making and to
influence the larger social system (Israel,
Checkoway, Schulz, and Zimmerman, 1994)
4Comparing Community Capacity
- Social Capital
- Shared values, transmitted through networks of
social exchange, based upon trust and norms of
reciprocal obligation (Putnam, 2000)
5Dimensions of Community Capacity
- Connectedness and Social Support
- Participation
- Leadership
- Skills and Resources
- Power and Influence
6Dimensions of Community Capacity
- Sense of Community
- Reflexivity
- Values
- History and Information
- Structures mechanisms for community dialogue
7Connectedness and Social Support
- Inter-organizational Linkages
- Collaborative activities
- Formal and informal communication channels
- Formal relationships, including cooperative
agreements, contracts, etc. - Organizational relationships across community
sectors - Shared resources
- Strong lead agencies
- Vertical Integration
8Connectedness (contd.)
- Connections Outside the Community
- Access to external resources
- Connections across informal social networks
- Shared membership
- Boundary spanners
- Weak ties
9Connectedness (contd.)
- Social support Flows Across Network Ties
- Information
- Instrumental assistance
- Access to new social contacts and social roles
- Affective support
- Social identity
10Participation
- Opportunities for Participation
- Mediating Structures (churches, social clubs,
voluntary associations) - Policies That Encourage Participation Directly
(e.g., citizen advisory boards) - Quality of Participation
- Diversity
- Extent of Participation
11Participation (contd.)
- Levels of Participation
- Informal networks
- Neighborhoods
- Mediating structures
- Community organizations by sector (business,
education, religious, health, media, social
services) - Participation in the policy process
12Leadership
- Quality of Leadership
- Representativeness
- Diversity
- Commitment to the community
- Commitment to democratic principles
- Vision
- Ties Among Community Leaders
- Characteristics of network ties (density, etc)
- Extent of ties outside the community (localite
vs. cosmopolitan)
13Skills and Resources
- Skills
- Problem solving
- Group process
- Conflict resolution
- Ability to mobilize resources
- Planning, implementation, evaluation
- Intervention
14Skills and Resources (contd.)
- Resources
- Social capital
- Trust
- Organizational and informal network ties
- Volunteerism
- Leadership
- Professionals
- Capital
- Goods and Services
- Financial
- Technology
- Facilities
15Power and Influence
- Power and Influence
- Distribution
- Legitimacy
- Accessibility
- Empowerment
- Policies
- Organizations
- Practices
16Sense of Community
- Psychological Sense of Community
- Sense of Identity (family, networks,
neighborhoods, organizations, larger community) - Shared Values and Norms
17Reflexivity
- Critical Reflexivity Ability to analyze and
identify problems and solutions - Ability to identify
- Root causes
- Key stakeholders and actors
- Areas of conflict
- Flexibility
- Tolerance of ambiguity
- Ability to identify successes and failiures and
to change direction
18Reflexivity (contd.)
- Reconstructing definitions
- Identify strengths and weaknesses
- Develop strength-based models
19Values
- Values and Principles
- Democratic
- Social Justice
- Diversity
- Trust
- Inclusiveness
- Equity vs. efficacy
20History and Information
- History of the Community
- Critical events
- Developmental history
- Inter-group relations and conflict
- Cooperation
- Interorganizational relationships (collaboration,
conflict, outcomes) - Results of previous efforts
- Knowledge about community history
21History (contd.)
- Information about the Community
- Awareness of community standing, including
information on other communities - Information for Planning and Action
- Health-related information
- Planning data
22Structures for Community Dialogue
- Public Spaces
- Meeting Places
- Traditions
23Selected Approaches to Measuring Community
Capacity Dimensions
- Key leader survey
- Network analysis
- Ethnography
- Inter-organizational surveys
- Review of existing documents
- Population surveys e.g., civic participation,
sense of community - Focus groups
- Organizational culture surveys
- Resource inventories
- Content analysis of media
24Community Capacity Outcomes
Healthy Communities Intervention using capacity-bu
ilding processes
Community Capacity Reserves
New or Improved Health Promotion Technology
New or More Health Responsive Structures
Community Capacity Roles In Community Health
Interventions
Behavior Change
B.L. Norton SOPHE Mid-Year Conference, 2000
25Community Capacity as Pre-Condition
- Function
- Provides for initial coalescing
- Provides initial set of individual, organization
community resources - Establishes infrastructure for collaboration
community problem-solving - Importance
- Contributes to likelihood of intervention success
- Strengthens sustainability of programs
26Community Capacity (Building) as Process
- Function
- Establishes an over-arching goal, complementary
to the health intervention - Operates as a parallel set of intervention
strategies - Identifies key leverage points
- Informs the evaluation process
- Importance
- Contributes to likelihood of intervention success
and to secondary outcomes - Strengthens sustainability of programs
27Continuum of Community Capacity-Building Practice
PURPOSE Community-building Improved outcomes
renewal for health well-being RELEVANCE As
an outcome, As a tool in assessing
readiness in of itself or as an
intervention strategy ROLE OF Creates community
Produces more effective service PRACTICE
reduces disparities delivery system EMPHASIS Se
lf-diagnosis or Design implementation of
health self-renewal improvement
interventions IMPORTANT Civic dialogue Skill-b
uilding DIMENSIONS Public spaces Information
resources Social networks Inter-organizational
networks Catalytic organizations Sponsoring
agencies Diverse participation
leadership Diverse participation
leadership Shared purpose public
norms Community/preventive values
28Continuum of Capacity-Building Practice, cont
LEVERAGE Opportunities for social
interaction Skills, data POINTS Mechanisms for
community conversation Civic participation
opportunities Leadership cultivation
education Leadership development
training Accessible welcoming
spaces Structures for collaboration Face-to-face
community organizing Resource
leveraging EVIDENCE Subjective measures related
to Objective measures related to changes in OF
SUCCESS community well-being health status or
behavioral risks over time LEVEL OF Network
community Individual, aggregated ANALYSIS
SECONDARY Improvements in health Enhanced
community ties OUTCOMES well-being
processes
29Community Capacity as Intermediate or Ultimate
Outcome
- Function
- Within theory-based intervention model, can
provide short-term impact measures, related to
ultimate long-term outcomes, which then serve as
a basis for judging intervention success - Health-enhancing since community
capacity-building is responsive to who we are as
a social creatures and is manifest in our
physical and psychological well-being - Importance
- Lack of detectable change in desired outcome
measures, given traditional timeframes, requiring
other measures of effect - Emphasis on outcomes affecting the community and
broader systems
30Socio-Political Culture
Community
Organizational
Interpersonal
Intrapersonal
Social Ecological Model for Considering Public
Health Interventions
31Healthy Cities Communities
- Healthy Cities Movement
- started in 1986 when WHO developed a pilot
initiative in 11 European cities. - over 1000 participating cities worldwide
- in U.S. A few statewide initiatives countless
individual cities participate - California Healthy Cities and Communities
- program of the Public Health Institutes Center
for Civic Partnerships, starting in 1988 and
initially focusing upon city-led projects - expanded to small and modest-sized communities
in which a CBO would be eligible to serve as the
sponsoring agency and lead convener in 1998 with
the advent of a California Endowment grant. By
the beginning of 2002 a total of 20 CA
communities will have completed their
participated in this community health improvement
initiative.
32Healthy Cities Communities Model
- Goal improve health status and overall quality
of life - Emphasizes a broad definition of health
- Seeks a high level of diversity on community
decision-making - Strengthens the civic infrastructure by fostering
the communitys ability to work collaboratively
to solve problems - Utilizes a community development approach to
community health improvement
33California Healthy Cities Communities Theory
of Change
Healthier Communities
HC/C Intermediate Outcomes
National and State
CHCC Grant Technical Support
Enhanced Community Safety and Amenities Healthy
Public Policies Health Promotion Preventive
Programs Leadership Development Civic
Engagement Social Support Systems Organizational
Development Inter-organizational
Partnerships Cultural Bridges Increased
Financial In-Kind Resources For Health
Promotion Healthy Community Norms
Practices Learning Opportunities Practices
Social/Cultural System
Political System
Economic System
Community Contextual Factors
Local HC/C Communities Sponsoring Organization
HC/C Health Impacts
CHCC INTERVENTION PRINCIPLES Broad definition of
health Broad community representation Systems
change Collaborative partnerships Developing a
shared vision using local assets resources to
build capacity Measuring progress HC/C
INTERVENTION PROCESS Action Planning
Implementation of Health Promotion Activities
Improvements in Risk/Protective Behaviors Improv
ed Health Status
Local Healthy Communities Collaborative/Steering
Committee
B.L. Norton Sierra Health Conference, 2002
34CHCC Outcomes Evaluation (Five Ecological Levels)
- Individual
- -Level
- Change
- Knowledge
- skills
- Broad
- understanding
- of health
- determinants
- Changes in
- Civic
- Participation
- INTERNAL
- Participation
- Leadership
- Trust
- EXTERNAL
- Civic involvement
- Civic leadership
- opportunities
- Organizational
- -Level
- Change
- Organizational
- policies practices
- Programs services
- Resources for
- health promotion
- Inter-
- Organizational
- Intersectoral
- Change
- Partnerships
- Engagement of
- broad community to
- promote health
- External linkages
- Community
- -Level
- Change
- Public policies
- Community norms
- Social capital
- sense of community
- Physical
- environment
Community Capacity Outcomes Being Tracked All
items in yellow-framed boxes or highlighted in
yellow font Data Collection Techniques Documents
, Participant Survey, Observation, Interviews,
Focus Groups
M.C. Kegler et al., 1999
35What Are the Implications of Community Capacity
Theory?
- For funding organizations
- For program staff
- For evaluators researchers
36Implications of Community Capacity Theory
- Funding organizations
- Start where the community (or collaborative) is
- Readiness/capacity assessment adapting grant
type and/or intervention design, accordingly - Attentiveness to context in tailoring technical
support expectations - Flexibility in use of funding to invest in
infrastructure capacity-building - Flexibility in intervention timetable, especially
when it involves community mobilization
planning - Provide sufficient and appropriate support
- Internal resources for on-site coaching,
technical support for organizational resource
development, and capacity-building asst - Reasonable funding levels over a longer period,
esp. when capacity-building is a major goal - Generous opportunities for reflective learning
and networking with others engaged with similar
endeavors
37Implications of Community Capacity Theory
- Program staff
- Assess organizational community capacity prior
to funding applications - Integrate community capacity- building strategies
into logic model and programmatic action plan - Consciously plan to capitalize on community
capacity strengths and to remedy (or neutralize
potential effects from) community capacity
weaknesses - Maintain monitoring systems to provide early
warning signals about capacity deficits that may
jeopardize success or sustainability of otherwise
effective programs
38Implications of Community Capacity Theory
- Evaluators researchers
- Go beyond process-impact-outcome evaluation
paradigm include community context evaluation
as well - Target improvements in community capacity as
intermediate outcomes - Integrate community capacity elements into
formative feedback for local program improvement - Develop measures of community capacity
- Investigate contextual factors that influence
level of community capacity and mix of capacity
elements needed to achieve community health
improvement goals
39Remaining Questions
- What are the consequences of pre-intervention
judgments of low community capacity?
Similarly, for post-intervention outcome
assessments of failure? - How does a community (or intervention planners)
determine where, on the practice continuum, to
optimally engage strategies of community
capacity-building? - How can we build more resources into our
personal, organizational lives for learning
about, investing in and celebrating dimensions of
community capacity?