Robert M. Goodman

Identifying and Defining the Dimensions of Community Capacity to Provide a Basis for Measurement

Although community capacity is a central concern of community development experts, the concept requires clarification. Because of the potential importance of community capacity to health promotion, the Division of Chronic Disease Control and Community Intervention, Centers for Disease Control and Prevention (CDC), convened a symposium in December 1995 with the hope that a consensus might emerge regarding the dimensions that are integral to community capacity. This article describes the dimensions that the symposium participants suggested as central to the construct, including participation and leadership, skills, resources, social and interorganizational networks, sense of community, understanding of community history, community power, community values, and critical reflection. The dimensions are not exhaustive but may serve as a point of departure to extend and refine the construct and to operationalize ways to assess capacity in communities.

Community Coalitions for Prevention and Health Promotion: Factors Predicting Satisfaction, Participation, and Planning

Coalitions currently are a popular tool for promoting community-based solutions to health problems, such as alcohol, tobacco, and other drug (ATOD) abuse. Private foundations, granting agencies, and other public health organizations assume that participation of community members in health promotion coalitions will increase the likelihood of program success. This article examines whether key characteristics of coalitions are related to effectiveness as measured by member satisfaction, commitment to the coalition, and the quality of planning efforts. Member survey data from the first year evaluation of an ATOD coalition were analyzed using factor analysis, chi-square, and multiple regression techniques at both the individual and group levels. The results suggest that community leadership, shared decision making, linkages with other organizations, and a positive organizational climate were key determinants of member satisfaction and participation. These same factors were not related to the quality of coalition plans. However, the significance of coalitions for community empowerment and health promotion is discussed.

Measuring the Diffusion of Innovative Health Promotion Programs

Once a health promotion program has proven to be effective in one or two initial settings, attempts may be made to transfer the program to new settings. One way to conceptualize the transference of health promotion programs from one locale to another is by considering the programs to be innovations that are being diffused. In this way, diffusion of innovation theory can be applied to guide the process of program transference. This article reports on the development of six questionnaires to measure the extent to which health promotion programs are successfully disseminated: Organizational Climate, Awareness-Concern, Rogerss Adoption Variables, Level of Use, Level of Success, and Level of Institutionalization. The instruments are being successfully used in a study of the diffusion of health promotion/tobacco prevention curricula to junior high schools in North Carolina. The instruments, which measure the four steps of the diffusion process, have construct validity since they were develóped within existing theories and are derived from the work of previous researchers. No previous research has attempted to use instruments like these to measure sequentially the stages of the diffusion process.

How to institutionalize health promotion programs.

This article presents six implications for practice that suggest how to optimize the institutionalization of health promotion programs. These six implications were derived from a study of ten health promotion programs funded by the Virginia State Health Department and operated by local schools- and community health agencies. Institutionalization refers to the long-term survival of health promotion programs, i.e., survival well beyond an initial grant funding period. To generate the implications for practice, a multiple case design for cross-case comparisons was applied to the ten health promotion programs. In brief, the six practice implications are: 1) cultivating a “program champion”; 2) favoring organizations with mature “subsystems”; 3) favoring organizations in which health promotion “fits” with the organizations mission; 4) avoiding brokering relationships; 5) altering lengths of funding periods; and 6) funding existing worthy programs. The significance of these practice implications for both funding and implementing agencies is briefly discussed.

A critique of contemporary community health promotion approaches: based on a qualitative review of six programs in Maine

Purpose. This article reports on a process evaluation of three Planned Approach to Community Health (PATCH) projects and three Community Chronic Disease Prevention Programs (CCDPP) that operated in the State of Maine. PATCH and CCDPP are similar approaches to community health promotion developed and disseminated by the Centers for Disease Control. The evaluators studied how the Planned Approach to Community Health and the Community Chronic Disease Prevention Program models worked as community health strategies across the six field sites. Research Methods Used. Qualitative methods were used in a cross-case comparison of the six field sites. In studying each site, the evaluators focused on six stages common to both the Planned Approach to Community Health and the Community Chronic Disease Prevention Program models: Stage 1: conducting a community needs assessment; Stage 2: analyzing needs assessment data; Stage 3: setting priorities for the project based on the data; Stage 4: implementing activities; Stage 5: producing process outcomes; and Stage 6: institutionalizing the project. The analysis focused on how each of the six communities traversed these stages. Summary of Findings. Eight recommendations for refining Planned Approach to Community Health and Community Chronic Disease Prevention strategies resulted from the study: 1) do a community capacity assessment prior to initiating a community needs assessment; 2) do not overly rely on Behavioral Risk Factor Surveys; 3) analyze needs assessment data rapidly for community consumption; 4) allow flexibility and community input in determining priority health objectives; 5) provide technical assistance throughout a project, not just in the beginning; 6) fund at least one full-time local coordinator and extensive capacity building; 7) emphasize multiple interventions around one chronic condition at a time; and 8) emphasize program institutionalization. Conclusions. Community development approaches like Planned Approach to Community Health and Community Chronic Disease Prevention are promising health promotion strategies. To be optimally effective, however, these strategies need refinement based on systematic study in field settings. Because this study was limited to six sites in Maine, some of these findings may have limited generalizability.

Principals and tools for evaluating community-based prevention and health promotion programs.

This article is an overview and practical guide for the evaluation of community-based disease prevention and health promotion programs. The article first offers a rationale for evaluating community-based programs, then enumerates five selected principles that are contemporary to community evaluation. The principles are as follows: (1) evaluation of community programs should include an assessment of program theory; (2) evaluation instruments that are used to measure community programs must be contoured to each individual community; (3) evaluation approaches used should be guided by the questions asked and often require both a quantitative and qualitative orientation; (4) evaluation should be informed by social ecology and social system concepts; and (5) community evaluation should involve local stakeholders in meaningful ways. At the end of each principle, an annotated reference list is provided that contains tools for applying the principle to community evaluation.

Health Education Intervention Strategies: Recommendations for Future Research

While the ultimate goal of health education interventions is to positively influence health status, more proximal indicators of success are changes in intermediate outcomes, or impact. Because health education interventions work through intermediate outcomes, the linkage to health status is often assumed to be at a conceptual or theoretical level. The term health education intervention strategy is a heuristic device used to conceptualize and organize a large variety of activities. There is a wide range of studies and reports in the literature that either test specific intervention strategies or report on larger health education efforts combining several strategies. This article organizes the discussion to focus on individual-, community-, and policy-level interventions. Mass communications are also considered, and the authors comment on program planning issues that cut across specific interventions at the individual, community, and policy levels. Eleven recommendations are offered for future health education intervention research.

Toward a Social Ecology of Community Coalitions

This article is guided by several premises. First, community coalitions fit with a social ecology perspective of health promotion because they work with multiple domains and promote community change. Second, the community context affects the functioning of coalitions. Third, key leaders are an important part of the social fabric of a community and influence the social ecology of a community; therefore a coalition should include key leaders and influence them and their organizations. The purpose of this article is to advance an understanding of the social ecology of coalitions by describing concepts, variables and results from two national studies and by providing anecdotal evidence and a measure of key leaders from our own work. After briefly defining and describing community coalitions, we: (1) review literature on contextual variables and community coalitions, (2) provide examples of contextual variables influencing community coalition development, and (3) discuss the relationship of key leaders in multiple domains and community coalitions. The article concludes with a discussion of the need for a framework of contextual variables and a promising next step.

A framework for assessing program institutionalization

This article presents a framework for assessing the institutionalization of programmatic innovations in nonprofit community agencies and in schools. Institutionalization is the attainment of long-term viability and integration of innovations in organizations. Institutionalization is often characterized as the final stage in an innovation diffusion process.The framework was derived from a qualitative study of ten health promotion programs that were innovations in their host organizations. The framework is a two dimensional matrix: one dimension consists of organizational subsystems; the other consists of levels of institutionalization termed passages, routines, and niche saturation. The cells of the matrix are the basis for assessing program institutionalization.

The perceptions of costs and benefits of high active versus low active groups in community coalitions at different stages in coalition development

Over 200 community volunteers who belong to different committees of an alcohol, tobacco, and other drug abuse prevention coalition completed a comprehensive survey designed to measure specific variables associated with coalition functioning including costs and benefits of participation. Community volunteers are one of the coalition’s greatest resources, and benefits and costs may mediate member participation throughout the different stages of coalition functioning. The survey was completed first at the formation stage (Time l), and then eight to ten months later at the implementation stage (Time 2) of the coalition’s development. Contrary to most previous research, a principal component analysis of the benefit and cost items yielded only one benefit component and one cost component. Also, the authors found that benefits and costs distinguished between the members of “High” and “Low” attendance groups only at Time 2. We consider the implications for coalition functioning, empowerment theory, and “incentive/cost management.” We also describe how we provided the partnerships with information in order to assist them to implement the incentivefcost management process. Community coalitions are frequently being used to address serious public health concerns. For example, the Center for Substance Abuse Prevention (CSAP) currently funds 245 communities across the country to create community partnerships in order to mobilize individuals and organizations to address the alcohol, tobacco, and other drug abuse (ATODA) problems at a local level. CSAP partnerships form coalitions involving youth and parent volunteers, in addition to volunteers from business, the criminal justice system, the media, health services, the religious community, as well as community and school-based personnel to develop and implement a comprehensive plan for reducing ATODA within their community. The coalition studied in this research is one of the 245 CSAP partnerships. Maximizing volunteer participation is important because the coalition depends heavily on the efforts of these volunteers to do much of the coalition’s work. Gaining an understanding of the benefits and the costs that volunteer coalition members experience from their participation is the first step in this process. Participation, benefit, and cost variables are related in various volunteer organizations (Prestby, Wandersman, Florin, Rich, & Chavis, 1990), political parties (Clarke, Price, Stewart, & Krause, 1978), and business groups (Knoke & Adams, 1987). Since this relationship is robust and useful across several different types of organizations, this study will examine the relationship between participation, benefits, and costs in volunteer coalitions. Researchers have previously studied individuals’ perceptions of benefits and costs (Chavis, Florin, Rich, & Wandersman, 1987; Prestby & Wandersman, 1985; Wandersman & Alderman, 1993; Wan