Jacqueline L. Fisher

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.

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.

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.

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.

Are Parents in Favor or against School-Based Sexuality Education? A Report from the Midwest

A telephone survey was conducted in a midsized city in the Midwest to assess community members’ opinions about sexuality education being taught in school. Out of 566 people who were called, 350 completed the survey (61% response rate). The results showed that community members were supportive (91%) of sexuality education being taught in school. Other findings suggest that community members were helpful to the researchers by identifying the most appropriate time when sexuality education should begin and in which class sexuality education should be taught. The information from this survey has important implications that help health educators design age-appropriate sex education curriculum that fit community needs.

Some Experiential Lessons in Supporting and Evaluating Community-Based Initiatives for Preventing Adolescent Pregnancy

This article describes some experiential lessons and recommendations regarding supporting and evaluating comprehensive, multicomponent school and community-based initiatives for prevention of adolescent pregnancy. The lessons and associated recommendations were generated during small group retreats and individual meetings among initiative, university, and foundation staff, and during semistructured interviews with community-based staff and volunteers. This article outlines 15 recommendations associated with implementing, supporting, evaluating, and sustaining multicomponent school and community-based initiatives for prevention of adolescent pregnancy. These recommendations, if modified to fit community contexts, could help strengthen community efforts to prevent adolescent pregnancy. Given the controversial nature of teen pregnancy prevention programs, it is important to have insight, draw on the experiences of others, and avoid pitfalls associated with this work.