Angela Sy, DrPH Assistant Professor Office of Public Health Studies

1. Angela Sy, DrPH Assistant Professor Office of Public Health Studies UH John A. Burns School of Medicine Cross Cultural Health Care Conference Community Collaborations and Interventions: Models of Community EngagementOctober 8, 2011

2. Background and Rationale • Community members have an extensive set of skills, strengths, and resources which can be harnessed to address the social determinants of health and to promote good health • Complex health and social problems ill-suited to “outside experts”

3. Background and Rationale • Enhance the effectiveness of public health interventions • Tailored to the concerns and cultures • Include participants in all aspects of intervention design, implementation & evaluation • Holistic focus on broader social & structural determinants of health

4. Background and Rationale • “It is a powerful vehicle for bringing about environmental and behavioral changes that will improve the health of the community and its members” (CDC, 1997)

5. Definition of Community Engagement CDC, 1997: “The process of working collaboratively with and through groups of people affiliated by geographic proximity, special interest, or similar situations to address issues affecting the well-being of those people.”

6. Definition of “Community” A group of people: • Linked by social ties • Sharing common perspectives or interests • Who may or may not share a geographic location

7. Definition of “Community” Common designations: • Culture or ethnic heritage • Where we live • Similar age • Speak the same language • Religion

8. Concepts of Community Engagement • Culture: Kieffer, 2007 • Community organizing: Minkler, 1990 • Community participation: Butterfoss, 2006; Wandersman et al , 1987 • Capacity building: Eng et al., 1994 • Community empowerment: Maton, 2008 • Coalition building: Cohen, 2002

9. Benefits of Community Engagement • Agenda • Implementation design, delivery and change: • Relevance • Feasibility • Sustainability • Community involvement and goodwill: • Competence • Capital • Capacity

10. Benefits of Community Engagement • Co-learning: • Academic • Community organizations • Research participants • Community members • General public

11. Models and Frameworks Social Ecological Model: Stokols, 1996 CDC, 2007

12. Models and Frameworks Social Ecological Model: Stokols, 1996 Constructing Social, 2009

13. Models and Frameworks Association of Alaska School Boards

14. Models and Frameworks International Association of Public Participation

15. Models and Frameworks International Association of Public Participation

16. Models and Frameworks ABLe Change Framework – Engaging Community Toward Systems Changes Foster-Fishman & Watson, 2011

17. Community-Based Participatory Research • Brings together researchers and communities • Share power • Address community identified needs • Foster co-learning • Cultural humility • Vis a vis cultural competence • Professionals cannot master another’s culture • What it is and isn’t • An approach involving empowerment, social justice values—health disparities • Applied to influence equitable change in community health, norms, systems, programs, policies

18. CBPR Trajectory Models and Frameworks WITH ON FOR FOR/WITH WITH/BY (CPPR) BY Community sets research agenda and mobilizes with or without outside facilitation Parkes, 2001

19. Models and Frameworks Ripple Model for Growing Effective CPP Researchers community Immersion in culture Multicultural exposure Commitment to social justice Effective communication& trust Researcher Community connection Strengthening communities on community’s terms Cultural safety training Adequate resources (funding/ time) Personal transformation Cultural humility Open-mindedness Burke, 2011

20. Models and Frameworks Routes of Transformation Multicultural exposure Commitment to social justice Researcher Community connection Cultural safety training Adequate resources (funding/ time) Cultural humility Open-mindedness Burke, 2011

21. Models and Frameworks CBPR Conceptual Model Minkler et al., 2008

22. Principles of Community Engagement (CDC,2011) • Be clear about the purposes or goals of the engagement effort, and the populations and/or communities you want to engage. • Become knowledgeable about the community in terms of its economic conditions, political structures, norms and values, demographic trends, history, and experience with engagement efforts. Learn about the community’s perceptions of those initiating the engagement activities.

23. Principles of Community Engagement (CDC,2011) • Go into the community, establish relationships, build trust, work with the formal and informal leadership, and seek commitment from community organizations and leaders to create processes for mobilizing the community. • Remember and accept that community self-determination is the responsibility and right of all people who comprise a community. No external entity should assume it can bestow on a community the power to act in its own self-interest. • Partnering with the community is necessary to create change and improve health.

24. Principles of Community Engagement (CDC,2011) • All aspects of community engagement must recognize and respect community diversity. Awareness of the various cultures of a community and other factors of diversity must be paramount in designing and implementing community engagement approaches. • Community engagement can only be sustained by identifying and mobilizing community assets, and by developing capacities and resources for community health decisions and action.

25. Principles of Community Engagement (CDC,2011) • An engaging organization or individual change agent must be prepared to release control of actions or interventions to the community, and be flexible enough to meet the changing needs of the community. • Community collaboration requires long-term commitment by the engaging organization and its partners.

26. Questions?Examples of Community Engagement and Culture in the Clinic:Drs. Susana Helm, Dale Fryxell, Bradley Chun, Darryl Salvador