In my last post, I illustrated the different types of outcomes that have been reported in research that examined the link between community power and health. It was based on the 12 articles that were classified as high-quality of the 93 that we found in our review. That leaves me 81 to summarize.
To be honest, I cannot think of anything more boring than me listing all of the outcomes from the 45 articles classified as medium quality and the 36 articles classified as low. That’s not to say that the findings aren’t interesting, only that listing them wouldn’t make a very engaging read. Those of you keen for the details, however, can read our full report online (see pages 113 to 118).
In this post, I’ll focus on the things that stood out.
One of the curious things about the research was that, although it was about community power and health, only five articles measured how much power a community had and whether it changed. Four showed that it increased (Cheadle, 2008; Harkins, 2012; Itzhaky, 2002; Massaro, 2001) with one being explicit that it occurred through an increase in the number of community activists (Itzhaky, 2002). One, however, found no impact on levels of community mobilization (Cheadle, 2001).
But what do we mean by community power? In my previous post, I mentioned that the process of building it led to outcomes in and between the community members involved, such as changes in their skills and perceptions and changes in the social fabric between them. That’s all very well but how does that lead to power, the ability to act in order to produce an effect? One article suggested it came down to the community members gaining new knowledge and ideas, developing local expertise and leadership, and enhancing their ability to focus on, and progress towards, goals (Johnso, 2006).
I mentioned in my second post that some researchers have warned that building community power can lead to an increase in distress and ill-health because there is only so much communities can do in the face of political, socioeconomic and cultural forces. Four articles spoke to this.
One illustrated that improvements to confidence, self-esteem and social networks were offset by the structural challenges involved in trying to take power (Bolam, 2006). Another described how communities felt restricted by the system (Chessie, 2009). And two studies in sex workers illustrated how their mobilization and empowerment were limited by their subordinated and exploited social positions (Asthana, 1996; Campbell, 2001).
The term ‘community power’ tends to conjure up images of residents coming together to take on oppressive organizations and systems, whether public or private. While that is certainly one form, two articles described how it occurred through the strengthening of civil society associations and greater participation in local government (Binka, 1995; Boussinesq, 1998).
A recurring theme in the research was the level of frustration amongst community members with the process of the work, and the general disappointment with the results (Blades, 2016; Chessie, 2009; Clift, 2008; D’Agostino, 2011; Environics Research, 2015; Franceschini, 2015; Haigh, 2008; Lamie, 2010; Resources for Change, 2016). This speaks to the above warning that building community power could increase distress and ill-health. That said, it’s likely that the frustration could be lessened if the process was better. Across the research, we identified some of the characteristics of successful strategies, such as:
- including communities from the start
- proactively seeking to overcome barriers to participation
- having clear and transparent operations
- being authentic about sharing power
- creating content tailored to people’s levels of education and cultural values
- being led by local opinion leaders with a strong commitment to equitable participation
- having skilled facilitation
- and having a clear understanding of local geography and its possible impact on the work
The above list reminds me of my previous attempt to improve how the health sector works with communities, which I called the 12 Principles (see the report in which we describe them and the tool we created to help implement them). Also, the final bullet point above reminds me of when I spoke to the Nebraska Hospital Association in October last year. In preparing for that talk, I realized how little I understood about rural environments and how much of my advice was probably prone to ‘structural urbanism’, a term explained in this excellent report (see page 12).
Remember that in this post I have focused on the things that stood out from the 81 articles classified as medium- or low-quality. The rest of their results fell into the six categories that I mentioned in my previous post. If you want to see the full list of outcomes, see pages 113 to 118 of our report.
In my next post, I’ll relate the findings from the research to Whitehead and colleagues’ synthesis of the many theories linking community power to health.
Until next time.
Pritpal S Tamber
Below I have tried to link to the full text of the articles. Sometimes that required linking to a PDF. Where the full text was not available, I’ve linked to the PubMed entry. Two of the articles are not online.
- Asthana, S., Oostvogels, R., 1996. Community participation in HIV prevention: problems and prospects for community-based strategies among female sex workers in Madras. Social Science & Medicine, 43(2):133–148. [link]
- Binka, F., Nazzar, A., Phillips, J., 1995. The Navrongo community health and family planning project. Studies in Family Planning, 26:121–139. [link]
- Blades, R., France, J., Ahmed, H., Diep, M., Jackson, O., 2016. Active Communities Evaluation – Final Report. London: ECORYS UK. [PDF]
- Bolam, B., McLean, C., Pennington, A., Gillies P., 2006. Using new media to build social capital for health: a qualitative process evaluation study of participation in the CityNet project. J Health Psychol 11:297–308. [link]
- Boussinesq, M., Hougard, J., 1998. The campaign against onchocerciasis in Africa: update. Med Trop (Mars), Medecine Tropicale: Revue du Corps de Sante Colonial, 58(285–296). [link]
- Campbell, C., Mzaidume, Z., 2001. Grassroots participation, peer education, and HIV prevention by sex workers in South Africa. American Journal of Public Health, 91(12):1978–1986. [link]
- Cheadle, A., Wagner, E., Walls, M., Diehr, P., Bell, M., Anderman, C., et al., 2001. The effect of neighborhood-based community organizing: results from the Seattle Minority Youth Health Project. Health Serv Res 36:671–89. [link]
- Cheadle, A., Hsu, C., Schwartz, P.M., Pearson, D., Greenwald, H.P., Beery, W.L., et al., 2008. Involving local health departments in community health partnerships: evaluation results from the partnership for the public’s health initiative. J. Urban Health 85 (2), 162–177. [link]
- Chessie, K., 2009. Health system regionalization in Canada’s provincial and territorial health systems: do citizen governance boards represent, engage, and empower? Int. J. Health Serv. 39 (4), 705–724. [link]
- Clift, S., 2008. Governance, community participation and urban regeneration: a new role for third sector partners? Middlesex: Middlesex University. [link]
- D’Agostino, M.J., Kloby, K., 2011. Building Community Capacity to Engage Government: Reflections of Nonprofit Leaders on Post-Katrina New Orleans. Administration & Society, 43: 749-769. [not online]
- Environics Research, 2015. Participatory Budgeting Pilot Evaluation – Evaluation report [Final]. Toronto: Environics Research Group Ltd. [PDF]
- Franceschini, S., Marletto, G., 2015. Assessing the benefits and the shortcomings of participation – findings from a test in Bari (Italy). Journal of Transport Geography, 44: 33-42.Haigh, 2008. [link]
- Haigh, F.A., Scott-Samuel, A., 2008. Engaging communities to tackle anti-social behaviour: a health impact assessment of a citizens’ jury. Public Health, 122: 1191-1198. [link]
- Harkins, C., Egan, J., 2012. The Role of Participatory Budgeting in Promoting Localism and Mobilising Community Assets – But where next for Participatory Budgeting in Scotland? Learning from the Govanhill Equally Well test site. Glasgow: Glasgow Centre for Population Health. [PDF]
- Itzhaky, H., York, A., 2002. Showing results in community organization. Social Work. 47(2):125-131. [link]
- Johnso, H.H., Bobbitt-Cooke, M., Schwarz, M., White, D., 2006. Creative partnerships for community health improvement: a qualitative evaluation of the Healthy Carolinians community micro-grant project. Health Promot. Pract. 7 (2), 162–169. [link]
- Lamie, J., Ball, R., 2010: Evaluation of Partnership Working within a Community Planning Context. Local Government Studies, 36: 109-127.Massaro, 2001 Resources for Change, 2016. [link]
- Massaro, E., Claiborne, N., 2001. Effective strategies for reaching high-risk minorities with diabetes. Diabetes Education, 27(6):820–828. [link]
- Resources for Change, 2016. Research into the Impact of Big Local: Impacts Found. May 2016. Crickhowell, Wales: Resources for Change. [not online]
- This week’s photo was taken by Marjan Blan, a designer and photographer based in Kiev, Ukraine. I don’t know Marjan. I just found his work on Unsplash. But it seems to me that it’s odd to send a newsletter about people power when a group of people in my home continent have just entered war and were powerless to stop it. I express no opinion on the rights or wrongs of the actors, only concern for the residents of the places being attacked.
- The research being described in this season of posts was in partnership with the Insight Center for Community Economic Development, and I thank Brad Caftel of the Center for overseeing the administrative details involved.