Laura H. Downey

Dialogue to Deliberation: Expanding the Empowerment Education Model

OBJECTIVE To explore the importance of a theoretical framework, the Empowerment education model (EEM), that can be used in participatory research. A deliberative project in one community in eastern Kentucky exemplifies the use of the EEM in participatory research. METHODS Research techniques include surveys, focus groups, community forums, and photovoice. RESULTS This project presents preliminary evidence that participatory projects might benefit if the dialogue phase of the EEM is followed by a deliberative phase. CONCLUSION The theoretical underpinnings of the EEM could be expanded to include dialogue and deliberation in participatory efforts.

The Use of Photovoice as a Method of Facilitating Deliberation

Efforts have been made in one rural Appalachian county to broaden local participation in a community health assessment. Through a series of community forums and a photovoice project, residents named community health needs and assets, framed potential solutions, and selected possible action steps to improve the local health status. Photographs and narratives from the photovoice project supplemented information from preliminary health forums to devise a framework of possible solutions to the identified health problems. Analysis of forum transcripts suggests that participants who used an issue guide that used photovoice images and stories were able to transition from broad approaches of change to specific action steps more than participants in other forums who used a more traditional forum issue guide. Community members are more easily able to identify solutions to local health issues when forum discussions are informed by local images and narratives.

Examining the diet of post-migrant Hispanic males using the precede-proceed model: predisposing, reinforcing, and enabling dietary factors.

OBJECTIVE To examine socio-environmental, behavioral, and predisposing, reinforcing, and enabling (PRE) factors contributing to post-migration dietary behavior change among a sample of traditional Hispanic males. DESIGN In this descriptive study, semistructured interviews, a group interview, and photovoice, followed by group interviews, were used to examine dietary change and contributing factors. The behavioral, environmental, organizational, and educational assessment phases of the PRECEDE-PROCEED model guided the organization of dietary contributing factors for development of a nutrition intervention. SETTING The southern region of Mississippi. PARTICIPANTS Traditional Hispanic males (n = 19) were identified from 35 Hispanic males who participated in a larger study. The traditional Hispanic males were identified by the Acculturation Rating Scale for Mexican Americans-II and the Marginality Scale. ANALYSIS Using the Grounded Theory approach to data analysis, themes and core categories relating to dietary behavior were identified and defined during the analysis process. The constant comparison method was used to identify key themes among coders. RESULTS Cultural gender role and living structure, as socio-environmental factors, influenced the PRE dietary factors. CONCLUSIONS AND IMPLICATIONS Multiple factors influence dietary behavior in the target population. The identified socio-environmental factors underlie the PRE factors and, therefore, must first be addressed in nutrition interventions.

Capacity Building for Health Through Community-Based Participatory Nutrition Intervention Research in Rural Communities

Since its inception, capacity building has been a stated goal of the Delta Nutrition Intervention Research Initiative, a tri-state collaboration in the Lower Mississippi Delta to address high rates of chronic disease. Textual analysis of project documents identifies and describes strategies carried out to foster capacity building. Strategies to build community capacity include fostering participation, cultivating leadership opportunities, training community members as co-researchers, securing community resources, and implementing the intervention together. Incorporating capacity-building approaches in health promotion and nutrition-intervention programming in rural communities provides a means to enhance potential for sustainability of health outcomes and developed effectiveness.

Turning the Tide on Poverty: Documenting impacts through Ripple Effect Mapping

Abstract As practitioners expand their efforts to promote civic engagement and action through the use of dialog, one of the nagging concerns is how to effectively and successfully measure and document the outcomes associated with these local activities. The organic nature of citizen-led initiatives makes this a particularly challenging area in which to guage results. One promising method, Ripple Effect Mapping (REM), is an effective, easy-to-use, and cost-efficient method of evaluating participatory programs. Evaluators used REM to document the impact of Turning the Tide on Poverty in the southern US. Additionally, the method visually mapped the capacity-building work of communities participating in Tide. Representatives from each community that participated in REM were able to identify multiple accomplishments that resulted from Tide. These accomplishments were categorized using the Community Capitals Framework. REM was a useful evaluation method that documented how the Tide initiative affected the participating communities’ capitals.

Farmers’ Concerns: A Qualitative Assessment to Plan Rural Medical Education

CONTEXT Limited research suggests that translational approaches are needed to decrease the distance, physical and cultural, between farmers and health care. PURPOSE This study seeks to identify special concerns of farmers in Alabama and explore the need for a medical education program tailored to prepare physicians to address those concerns. METHODS We conducted 2 focus groups with 20 farmers from diverse communities, backgrounds, and farming operations. The sessions were audio-recorded, transcribed, coded, and analyzed for determined patterns. FINDINGS The following categories were developed as areas of importance to farmers: the need for physicians to understand the culture of farming, occupational exposures in farming, and recommendations for improving the health of farmers. CONCLUSION Findings suggest that to adequately serve farmers, medical students interested in entering practice in rural areas should have or develop a relevant and adequate understanding of farming practices.

Perceptions of community-based participatory research in the Delta Nutrition Intervention Research Initiative: an academic perspective.

Lower Mississippi Delta Nutrition Intervention Research Initiative (Delta NIRI) is an academic–community partnership between seven academic institutions and three communities in Mississippi, Arkansas, and Louisiana. A range of community-based participatory methods have been used to develop sustainable nutrition intervention strategies. Focus groups were conducted with 22 faculty and staff members from the academic partners on the project to document their perceptions of community-based participatory processes in a federally funded, multi-academic–community partnership spanning a decade. Focus groups were conducted to glean insights or lessons from the experiences of academic personnel. Focus groups were transcribed and analyzed using the constant comparative method. Two researchers analyzed each transcript independently and reached consensus on the consistent themes. Participants candidly shared their experiences of working with community members to devise research plans, implement programs, and evaluate outcomes. The majority of faculty and staff members were attracted to this project by an excitement for conducting a more egalitarian and potentially more successful type of research. Yet each academic partner voiced that there was an underlying disconnect between community practices and research procedures during the project. Additional barriers to collaboration and action, located in communities and academic institutions, were described. Academic partners stressed the importance of open and ongoing communication, collective decision-making strategies, and techniques that support power sharing between all parties involved in the project. Findings from this research can inform academic–community partnerships and hopefully improve the community-based participatory research process implemented by academic institutions and communities.

Examining Social Connections as a Link Between Religious Participation and Well-being Among Older Adults

Social connections provided through religious participation are associated with subjective well-being in older populations. This study investigated how much of this association can be explained by other social connections, and whether these associations vary by age. A cross-sectional random-sample telephone survey was completed by 1,025 individuals over 55 years of age. The contribution of religious participation was examined using hierarchical multiple regression and ANCOVA analyses for the entire sample and for four age-specific groups: (1) 55–64, (2) 65–74, (3) 75–84, and (4) 85+. Religious participation was found to be a significant predictor of subjective well-being for the oldest and youngest groups.

The Relationship Between Local Public Health Agency Characteristics and Performance of Partnership-Related Essential Public Health Services

Objective. The relationships between characteristics of local public health agencies and their self-reported scores on partnership-related indicators of the Ten Essential Public Health Services were examined. Design. A retrospective cross-sectional study using secondary data from the National Public Health Performance Standards Program (NPHPSP) and the 2005 Profile of Local Public Health Agencies from the National Association of City and County Health Organizations (NACCHO) was completed. Participants. Local public health systems that participated in both the NPHPSP and the NACCHO surveys. Main outcome measures. Partnership-related elements from the NPHPSP data set were used as dependent variables, whereas combined focused elements from the NPHPSP and the NACCHO surveys served as independent variables. Results. Local public health agencies’ increase in partnerships over the preceding 3 years and involvement in a community health improvement process were significantly related to numerous partnership performance scores—more so than other agency characteristics. Involvement in the Mobilizing Action through Planning and Partnerships process was inversely related to some partnership performance scores. Conclusions. Future research must continue to identify and explore additional community- and agency-level predictors of partnership performance.

Turning the Tide on Poverty: The role of the Cooperative Extension Service in the initiative

Abstract Cooperative Extension Services (CES) played a critical role in the Turning the Tide on Poverty (Tide) project in the southern US. In an effort to explore how CES professionals perceived their role in the initiative, data were collected from CES leaders and agents. Focus groups were held at the beginning (N  =  11) and conclusion (N  =  12) of the first year with Extension leadership to discuss their thoughts on CES’ role in civic engagement activities. Survey data were collected from Extension agents (N = 17) to gauge attitudes and beliefs during the course of Tide. Leadership and agents noted potential to expand and strengthen outreach through Tide but also expressed concerns about constraints. Implications are that Tide provided a way to enhance the mission of CES and that community development efforts implemented through Tide could be replicated by other CES.