Vincent T. Francisco

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.

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.

Evaluating Community Partnerships and Coalitions with Practitioners in Mind

Evaluation plays a key role in developing and sustaining community partnerships and coalitions. We recommend focusing on three levels of coalition evaluation that measure (a) processes that sustain and renew coalition infrastructure and function; (b) programs intended to meet target activities, or those that work directly toward the partnership’s goals; and (c) changes in health status or the community. A tendency to focus on quick wins and short-term effects of programs may explain why some coalitions are not able to achieve systems and/or health outcomes change. Although measuring community-level or system changes (e.g., improving environmental quality or changing insurance coverage policies) is much more difficult than evaluating program outcomes, it is essential. This article presents challenges that coalition practitioners and evaluators face and concludes with practical resources for evaluation.

Building Capacity for Participatory Evaluation Within Community Initiatives

Abstract Participatory evaluation is the process by which those doing the work contribute to understanding and improving it. In the context of community initiatives, this often involves co-production of knowledgelocal people and outside evaluators sharing responsibility for gathering data and interpreting its meaning. We outline a six-component framework for participatory evaluation: (a) Naming and framing the problem/goal to be addressed, (b) Developing a logic model (or theory of practice) for how to achieve success, (c) Identifying evaluation questions and appropriate methods, (d) Documenting the intervention and its effects, (e) Making sense of the data, and (f) Using the information to celebrate and make adjustments. Incorporating examples from different community initiatives, we examine how to support and build capacity for participatory evaluation. To help guide the collaborative work of participatory evaluation among community members and outside evaluators, we outline orienting questions (e.g., what are we seeing?) and core activities (e.g., characterizing the data) for each component, and describe Internet-based supports to help reflect and act on what we see. Finally, we discuss challenges, benefits, and opportunities in this approach to supporting and building capacity for participatory evaluation within community initiatives for health and development.

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.

Stakeholder Participation in Evaluation

C ollaboration is a value that most public health practitioners generally accept. However, practitioners may also feel overwhelmed with the various approaches to involving stakeholders in the evaluation process. Overall, stakeholder participation and collaboration is viewed positively and is generally accepted by the evaluation community. Evidence indicates that stakeholder participation will improve the quality of evaluation results, but the particular circumstances and conditions must be carefully considered. In this issue, we will describe the different ways that stakeholders can be involved in evaluation, how it can be most useful, and how it is actually accomplished. Moreover, we would like to make the case that collaborative evaluation should be seen as a viable option in your evaluation toolbox.

Social Validation of Goals, Procedures, and Effects in Public Health

By relying solely on tests of statistical significance as the measure of success for interventions in public health, and in community-based participatory research, we can miss important social dimensions of the project. These dimensions include how our interventions might affect the lives of participants (social validity) and the lives of people more broadly (clinical or public health significance). Social validation procedures were originally developed to assess the acceptability of procedures and effects of behavioral interventions among clients and consumers. This article describes the methods used to obtain social validity data for goals, procedures, and effects of interventions in health settings. The challenges in using these procedures are also discussed, and suggestions are offered for future research and practice in this area.

A Review of Social Host Policies Focused on Underage Drinking Parties: Suggestions for Future Research:

Underage drinking continues to be a public health concern, partially due to the ease in which adolescents obtain alcohol and consume it in private locations. States and municipalities have implemented strategies to counteract this, including adopting public policies called social host policies, despite limited evidence of effectiveness. Traditionally, these laws have held adults accountable for furnishing alcohol to underage drinkers. However, states and communities are using another policy, also called social host, to deter underage drinking parties where easy access to alcohol and high-risk use occurs. These innovative laws hold individuals who control the property accountable for underage drinking that occurs there, regardless of alcohol source. We conducted a critical analysis of social host policies focused on hosting underage drinking parties and constructed a conceptual model to understand their targeted factors. Future research recommendations are discussed.

Conflict Transformation, Stigma, and HIV-Preventive Structural Change

Over the prior decade, structural change efforts have become an important component of community-based HIV prevention initiatives. However, these efforts may not succeed when structural change initiatives encounter political resistance or invoke conflicting values, which may be likely when changes are intended to benefit a stigmatized population. The current study sought to examine the impact of target population stigma on the ability of 13 community coalitions to achieve structural change objectives. Results indicated that coalitions working on behalf of highly stigmatized populations had to abandon objectives more often than did coalitions working for less stigmatized populations because of external opposition to coalition objectives and resultant internal conflict over goals. Those coalitions that were most successful in meeting external challenges used opposition and conflict as transformative occasions by targeting conflicts directly and attempting to neutralize oppositional groups or turn them into strategic allies; less successful coalitions working on behalf of stigmatized groups struggled to determine an appropriate response to opposition. The role of conflict transformation as a success strategy for working on behalf of stigmatized groups is discussed.

The community tool box: using the Internet to support the work of community health and development

SUMMARY Despite limited preparation through formal and non-formal education, local people throughout the world are engaged in the common work of building healthier communities. Some core competencies-including community assessment, planning, mobilization, and evaluation-are needed to address the variety of issues that matter to local communities. This report describes an Internet-based support system for community work known as the Community Tool Box (CTB) [http://ctb.lsi.ukans.edu/]. We examine the idea and origins of the CTB and its core content, access features, and applications. We review evidence for its use, implementation and dissemination strategies, and discuss core values that guide this internet-based work.