Adrienne Paine-Andrews

Using empowerment theory in collaborative partnerships for community health and development

Models of community empowerment help us understand the process of gaining influence over conditions that matter to people who share neighborhoods, workplaces, experiences, or concerns. Such frameworks can help improve collaborative partnerships for community health and development. First, we outline an interactive model of community empowerment that describes reciprocal influences between personal or group factors and environmental factors in an empowerment process. Second, we describe an iterative framework for the process of empowerment in community partnerships that includes collaborative planning, community action, community change, capacity building, and outcomes, and adaptation, renewal, and institutionalization. Third, we outline activities that are used by community leadership and support organizations to facilitate the process of community empowerment. Fourth, we present case stories of collaborative partnerships for prevention of substance abuse among adolescents to illustrate selected enabling activities. We conclude with a discussion of the challenges and opportunities of facilitating empowerment with collaborative partnerships for community health and development.

A contextual-behavioral model of empowerment: case studies involving people with physical disabilities.

When people with disabilities, ethnic minorities, older adults, women, and others lack power, they usually experience adverse conditions disproportionate to other members of society. Emproverment—the process by which people gain some control over valued events, outcomes, and resources—is an important construct for understanding and improving the lives of people of marginal status. This manuscript presents a contextual-behavioral model of empowerment and its application in collaborative research with people with physical disabilities. The eight case studies illustrate 18 tactics for promoting empowerment that flow from the model. The case studies show the use of different combinations of empowerment tactics in a variety of contexts: (a) setting improvement agendas from the perspective of people with disabilities, (b) enforcing ordinances that preserve access to parking spaces designated for people with disabilities, (c) enabling access to homes through housing modifications, (d) enhancing support available through mutual-aid groups, (e) developing skills for recruiting mentors, (f) promoting self-directed behavior hange with personal and health concerns, (g) enhancing skills for personal self-advocacy, and (h) building the capacities of groups of people with disabilities for systems advocacy. Finally, we discuss issues that may contribute to research and action related to empowerment.

Evaluating Community Coalitions for Prevention of Substance Abuse: The Case of Project Freedom

In the United States alone, there are more than 2,000 community coalitions to address local concerns about abuse of alcohol, tobacco, and other drugs. This article describes an evaluation system used to examine the process, outcome, and impact of coalitions for the prevention of substance abuse. The evaluation addresses five key questions: (a) Was the community mobilized to address substance abuse (Process)? (b) What changes in the community resulted from the coalition (Outcome)? (c) Is there a change in reported use of alcohol and other substances by youths (Outcome)? (d) Does the coalition have a community-level impact on substance abuse (Impact)? and (e) Is community-level impact related to changes facilitated by the coalition (Impact)? To address these and other questions, using eight core measurement instruments, the evaluation system collects 15 distinct measures. This evaluation system is illustrated with a multiyear study of Project Freedom, a substance abuse coalition in a large midwestem city.

Effects of a replication of a multicomponent model for preventing adolescent pregnancy in three Kansas communities

CONTEXT A significant amount of attention has been devoted to the complex issue of teenage pregnancy and to programs for reducing pregnancy among adolescents. Careful evaluations of such programs are needed to ascertain what strategies will be most effective at reducing teenage pregnancy. METHODS A pretest-posttest comparison group design was used to analyze the effects of a comprehensive multicomponent school and community intervention on estimated pregnancy rates and birthrates among young people in three Kansas communities: Geary County, Franklin County and selected neighborhoods of Wichita. RESULTS There were high levels of program activity in all three communities during the intervention period, including teacher training and sexuality education for students. Survey respondents rated highly such project interventions as the extension of school-linked clinic hours to accommodate student schedules and support groups established in middle schools. Between 1994 and 1997, the proportions of adolescents reporting that they had ever had sex decreased significantly among all ninth and 10th graders in Geary County, from 51% to 38% among females and from 63% to 43% among males. In Franklin County, more males in grades 11 and 12 reported using condoms in 1996 (55%) than had done so in 1994 (39%). Age at first intercourse remained relatively stable in Franklin and Geary counties during the intervention period. The estimated pregnancy rate among adolescents aged 14-17 decreased between 1994 and 1997 in Geary Country, while it increased in comparison areas. The estimated pregnancy rates among 14-17-year-olds decreased in both Franklin County and its comparison communities. The birthrate declined both in one target area of Wichita and in its comparison area from 1991-1993 to 1994-1996. Over the same time period, the birthrate increased in a second target area of Wichita, while it decreased in the comparison community. CONCLUSIONS This evaluation of a comprehensive multicomponent program for adolescent pregnancy prevention contributes to our understanding of this model and its replicability in diverse communities. Ongoing program evaluation is important for developing initiatives and for refining strategies so they respond to local conditions.

Reducing Elementary School Children's Risks for Chronic Diseases through School Lunch Modifications, Nutrition Education, and Physical Activity Interventions

Abstract Many behaviors, such as physical inactivity or a poor diet, that put adults at risk for chronic diseases are established in childhood. This manuscript describes the outcomes of a comprehensive school health project, the Kansas LEAN School Intervention Project. The Kansas LEAN School Intervention Project in Salina and Dighton had four components, three of which were school based: (a) modified school lunches, (b) enhanced nutrition education, and (c) increased opportunities for physical activity. The fourth component, actions taken by a community partnership, is described elsewhere. Data from two case studies were used to address three primary evaluation questions: (a) did changes in the school lunch menu reduce the fat content yet maintain calories in meals served? ( b) did nutrition knowledge, skills, and attitudes of students improve? and (c) did students’ physical fitness improve? The findings suggest that the project was successful in reducing the fat content in school lunches in both communities from baseline levels of approximately 38% calories from fat to the target goal of 30% calories from fat during the 1993–94 school year. The schools also maintained adequate calories for students in this age group. Students’ knowledge, skills, and behaviors related to nutrition as well as their physical fitness improved in both Kansas communities. The strengths and limitations of this strategy of making healthy choices easy choices through school-based intervention are discussed.

Promoting Sustainability of Community Health Initiatives: An Empirical Case Study

Community health initiatives are a prominent strategy for health promotion and disease prevention. This article describes an empirical study of strategies used to promote sustainability of six community health initiatives that began in 1993 and received funding for 4 years. The study, conducted 1 year after funding ceased, examined how each initiative approached sustainability. First, the context for the work is described. Second, we describe the methodology used to gather information about sustainability. Third, we describe the current status of sustainability for each initiative. Fourth, we discuss the strategies for sustainability we observed, the context for sustaining the efforts, and the factors that may have affected sustainability. We end with recommendations for practice.

Evaluating a statewide partnership for reducing risks for chronic diseases.

We describe a case study evaluation of Kansas LEAN, a statewide partnership with the mission of reducing risks for chronic diseases through dietary and exercise modification. We used a case study design to examine five primary questions related to process and outcome: (a) were the goals of the partnership important to constituents? (process), (b) were constituents satisfied with the partnership (process), (c) were community or systems changes (new or modified programs, policies, or practices) facilitated by partnership efforts (outcome)?, (d) were these changes important to the partnerships mission (outcome)?, and (e) what critical events helped facilitate community changes (outcome)? Several measurement instruments—a monitoring and feedback system, constituent surveys, and semistructured interviews—were used to address key evaluation questions. Kansas LEAN is a strong statewide partnership with involvement from key representatives throughout Kansas. It is an ongoing, comprehensive health promotion program that plans and implements multiple components, in a variety of settings, to create awareness, behavior change, and a supportive environment. Kansas LEAN has facilitated several important community or systems changes related to its mission. We conclude with a discussion of the challenges of evaluating partnerships that seek to reduce risks for chronic diseases.

Analyzing the Contribution of Community Change to Population Health Outcomes in an Adolescent Pregnancy Prevention Initiative

Few evaluations of community initiatives have established a link between intermediate outcomes, such as community or systems change, and more distant population-level health outcomes (e.g., estimated rates of employment or adolescent pregnancy). This article describes an analysis of the contribution of community changes facilitated by a community health initiative to prevent adolescent pregnancy to the population-level outcome of birth rates for teens. The authors examine a hypothesis that this link might be expected when community changes are of greater amount, intensity, duration, and exposure. The results showed reductions in birth rates in Target Area A, where there was a greater concentration of community changes and a slight increase where there were far fewer changes. This report provides a method for describing empirically the contribution of environmental change to more distant population-level outcomes.

Replicating a community initiative for preventing adolescent pregnancy: from South Carolina to Kansas.

The School/Community Sexual Risk Reduction Model is a comprehensive community-wide strategy for preventing adolescent pregnancy. It was first implemented in two communities in South Carolina. This paper describes the models replication in several communities in Kansas. The School/Community Models history major program components evaluation results and the conceptual framework for the Kansas replication are described. The authors then consider the School/Community Sexual Risk Reduction Replication Initiative including the collaborators early implementation strategies for grantmaking contexts and sites technical assistance and evaluation and reinvention of the model. A discussion of the challenges and opportunities of replicating broad-scale community initiatives for preventing adolescent pregnancy concludes the paper.

Community Partnerships: Review of Selected Models and Evaluation of Two Case Studies

Abstract Risks for cardiovascular diseases (CVDs) are established early in life with behavior patterns associated with diet and physical activity. Establishing healthy behavior patterns among children, and providing the environmental supports necessary to maintain them, has the potential to reduce future risks for chronic diseases. This paper reviews the literature on collaborative partnerships formed to address similar issues.The authors describe the evaluation of school and community partnerships facilitated by the Kansas LEAN School Intervention Project, which had the mission of reducing risks for chronic diseases, including CVDs and some cancers, among children. A multiple case study design was used with collaborative partnerships in two communities in Kansas.The results suggest that the partnerships facilitated important changes in the schools and communities. We discuss challenges and opportunities in the evaluation of school and community partnerships for health.