Presentation by Amy Paulson at the 2009 Virginia Health Equity Conference. Explores and explains the community-based participatory approach with focus on application of theory in “real communities with real people”. The use of coalitions in community-based participatory approaches will be discussed. Explains the challenges and benefits of coalition building was they relate to moving from theory to practice, as well as the impact of individual and community factors on coalition building.
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Community-Based Participatory Approaches: Coalition Building in Real Communities
1. Coalition Building In Real Communities Virginia Health Equity Conference, September 11, 2009 Amy Paulson Consortium for Infant & Child Health Eastern Virginia Medical School
69. (Retiring is not an option….) “ Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it's the only thing that ever has.” ~Margaret Mead
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Editor's Notes
Some of you are probably here because you have questions about the CBPA – some of you are probably here because you don’t know what direction to go in with your public health work …some of you are probably lost and in the wrong room…
It isn’t all about meetings or smiling people….you can’t call it community-based just because you manage to get a diverse group together.
It isn’t all about place although place is important
Community-based participatory approaches really is all about community – and giving them a voice along side of traditional researchers that lends to an active partnership role in community approaches to biomedical, behavioral, and public health research.
Sometimes community-based participatory approaches can include community organizing. Usually, it does involve some level of organizing whether it be mobilizing a group of respected community leaders to take part in a program or organizing a large population to action. Some community leader and researchers may not want their project to be “community-based” or “participatory” for a variety of reasons, the main usually being control – when you invite community participation you turn over a good deal of control to the community itself. If you aren’t prepared to follow their lead this may not be the right approach for you or your project.
Among the terms used to describe CBPR and its analogues are community action research , participatory action research , community-based action research , participatory rapid appraisal , and empowerment evaluation . Minkler (5) described CBPR as “a process that involves community members or recipients of interventions in all phases of the research process.” Green and Mercer (6) defined CBPR as “a systematic inquiry, with the collaboration of those affected by the issue being studied, for purposes of education and taking action or effecting change.” Sometimes the term is applied to community-based participatory efforts to implement health enhancement programs that do not include research components at all (7). CBPR is necessarily action research. For community members to invest in research, the process must have tangible results. For this reason, development of knowledge not linked to action, change, or advocacy does not fall into the realm of CBPR. Every partnership is unique. At the same time there are some common principles that many partnerships share. (Source: http://depts.washington.edu/ccph/pdf_files/ritas.pdf p5)
According to Barbara A. Israel, Department of Health Behavior and Health Education, School of Public Health – University of Michigan, CBPA is based on principles that include: Recognizing the community as a unit of identity Building on collective strengths and shared resources Facilitating partnership and capacity building throughout the process Disseminating pertinent information, data and other findings to all participants Involving a long-term process and commitment Seeking balance between research and action It is important to engage the most trusted members of the community, “gatekeepers,” right from the beginning of the project to ensure the promotion of an intervention. By empowering community leaders through the CBPA, the entire community can help steer the project towards goal achievement.
CBPA is really about helping everyone to understand that we all hold a piece of the puzzle and that only by working together do we truly understand problems and develop the best solutions.
The community must own at least some of the project, process or outcomes – this means the researcher or lead expert MUST relinquish control of the agenda and project to the community. This can be very hard for some people!
How is this different from other groups?
*Purpose is specific, yet inclusive – using immunization coalition as example, addressing specific aspects of immunization but keeping it broad enough so that there is still a variety of stakeholders *It’s about systems change – this is one of my own personal mantras. The coalition needs to mean something. This may be a good time to ask some preliminary leading questions about lifecycles – what is a lifecycle, how can a coalition have one, etc.
Coalitions aren’t perfect…there are some downsides which must be considered so that success is achieved that wouldn’t have been possible without the coalition, yet members aren’t disappointed with the “speed” of things and the actual work gets done… First, coalitions take more time…bottom line, no way around it…however, the sum of what the coalition usually ends up with is much more valuable compared to a fast solution developed by one or two people in a room by themselves. leadership is key, but remember that leadership often exists beyond the “formal” titles. So if your chairperson turns out to not have been the best choice, often the work still gets done because the informal leaders take charge… Lastly…member investment is critical. If your members don’t care and/or don’t contribute, you might as well go back to that little room with one or two people and get busy…
*Perhaps we could each share specific examples of how these three attributes have contributed to the success of our respective coalitions. Using coalitions to move community change works because of the investment made by community partners Partners can access a variety of resources that no one individual organization could access on their own The cumulative ideas of many are almost always better than the ideas of a few…
Coalitions are successful not because you have partners at the table – but because you have a “synergy” of the “right stuff” at the table. Part of it is convening the right structure and resources, and part is finding a topic that resonates with the community. A good topic that doesn’t have the right intervention isn’t going to excite the community and develop stakeholders interest. Critical success factors include: Commitment, Vision, having a strategic plan, realistic expectations and determination, winnable issues, broad enough to be relevant to a large enough support base, equitable, culturally sensitive, MEASURABLE Outcomes… Talk also about the “Bad” experiences people have had with coalitions – i.e., what DOESN’T work…
Negative Action Lack of Action Not enough Action
We’ll give people time to share here….
See model handout.
There are a variety of positions and leaders within coalitions – and sometimes whether a coalition has staff or not can partially define their “type”. In general, staffed coalitions have better outcomes. This means that in general there is someone whose job is in whole or part responsible for coordinating and facilitating the work of the coalition. Talk about drawbacks & benefits of staff Talk about leaders elected willing vs coerced! Talk about informal leaders pros and cons Need balance of “power” in order to have members feel their contribution is appropriate and appreciated.
Leaders are not always found…sometimes you have to develop them. Some words of wisdom Leading is more than showing up, Leaders have increased responsibility as a member in terms of attendance, task assignment, and setting an example, Leaders can be hard to find, Good leaders are even harder to find , Some leaders are informal leaders. Ask your members what would be helpful to them in terms of skill building to make them more productive members. CINCH EXAMPLE.
Organizations have a responsibility in regard to the experience of members Members also have a responsibly in regard to their participation in an organization – talk here about Member Rights and Organization rights which is in ToolKit. Members must participate in order to be of benefit, as well as to feel they are making an impact. Members who don’t feel included or useful will leave. Members should leave each meeting having contributed to the group Encourage members to follow basic etiquette in regards participation – i.e., do what you say you will do, respond to requests for information, be on time, etc. This creates trust in the group and reduces conflict between the doers and the talkers.. Participating includes taking personal responsible for the outcomes of the group - be willing to take on tasks and not just sit there talking. Personality counts…Refer to handout in toolkit. Member personalities play an important role within the “personality of the group” All members are important, regardless of their strengths and weaknesses Identifying your member “type” may help you to temper your more difficult attributes Find a group whose “personality” does not run contrary to your own – members who don’t do this will ultimately not stay anyway. Encourage members to “shake things up” if they feel nothing is being accomplished. Address group habits early, before a problem arises. Recognize why members stay and leave. They leave because: Don’t feel included, Disagree with leadership style, Group personality, Conflict with individuals within the group Why members stay: Feel included, Are making a contribution to the group, Feel comfortable with the group personality, leadership, and members, Feel the group is accomplishing goals, The group meets a personal need,
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Pass out “What kind of Member Are you” Handout….discuss….Have everyone self identify – place “card” on the table in front of them….
we ask the participants to “shout out” their top challenges and we’ll right them down. Hopefully, we’ll address most of them in the workshop. What not to do – get angry, stop attending, be rude… And no handcuffs, ear muffs, or duct tape allowed!
We are not just the sum of our parts – groups are exponentially powerful… However, to prompt change individuals must be willing to become parts of groups and to give over their individual power to the will of the collective community. Will you?
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