Lecture 4 Community Action Research PDF

Lecture 4: Community Action Research ------------------------------------ **Introduction: what and why community action research** **Health education** encompasses the informing and influencing of *individual* receivers. When using **community action**, you get a **broader** perspective of health...

Lecture 4: Community Action Research ------------------------------------ **Introduction: what and why community action research** **Health education** encompasses the informing and influencing of *individual* receivers. When using **community action**, you get a **broader** perspective of health promotion, it is more focused on the community and is mostly used in settings where people live, work and play; the start from peoples everyday lives. This way is focused on actual change through action. So, **community action research** is research using the principles of the community action. This type of research uses collective efforts, directed towards increasing community control over the determinants of health, thereby improving health. It requires **participation** of the 'target' population, and involves developing and implementing **multiple** coherent interventions, focusing simultaneously on individual and community as a whole (so on **different levels**). It is in need for **collaboration** of different princiles, and different sectors. Why would you use community approach? - The impact of health problems and interventions are often **highly complex**, so using knowledge to translate it into behavioral change. - **Disadvantaged areas and groups** can be difficult to reach. A community approach is more effective and thereby can reduce socioeconomic health differences. - It will strengthen the community as a whole. Participation and cooperation contribute to increased **social capital of community**. In research, there is a **demand gap** (between a problem and research) and **implementation gap** (between research and implementation). This is due to a lack of collaboration between society and researchers. To decrease the demand gap, we need to **listen better**. To decrease the implementation gap, we need to **explain better**. It is not only a lack of communication, but it is also important to collaborate with all the different actors that pay a role around a problem. **Transdisciplinary research** is a new form of learning and problem solving involving cooperation among different parts of society and academia in order to meet complex challenges of society. A community is often defined as a **geographical area**; a group of people living in one place, district, country etc. However, this may give some problems. It is better to look at the group as they have a **shared characteristic**, such as sharing the same values, needs or culture. Social organizations (**setting**) such as schools, shops, business and churches should also be included. Communities are **dynamic** instead of static. **Self-identification** is key in defining a community. Communities can also be virtual. So communities are groups of people who identify themselves by their group membership, sharing a common interest, common social institutions and common social control components. **Community participation** The principles of community participation are that there is **active involvement** of individual community members. Maybe not all, but a broad representation. In **all phases** they should be involved, like problem analysis, needs assessment, priority setting and development, implementation and evaluation of interventions. It is a process of **interaction and feedback**. The community will be taking part in decision making at all levels of the research. The Arnstein's Ladder of citizen participation and Pretty's Typology of participation show a visualization of this process. There are multiple methods for action research: - Integration of research methods, both being qualitative and quantitative via narrative and semi-structured **interviews** and **focus groups** - Qualitative data collection via **questionnaires** provides room **for interaction**. - Joint analysis and feedback are done via **dialogue meetings** **Social network approach** A social network is a web of social interactions around a community member. There are certain characteristics visible in each community: - **Nature of relationships**: the type and quality of conncetions between individuals - **Reciprocity**: refers to the mutual exchange of interactions or support between individuals in an network - **Intensity**: Refers to the strength or depth of relationships within a network - **Complexity**: refers to the number of different roles a person may be and the various types of interactions that may occur - **Size**: the number of individuals or nodes in a social network - **Homogeneity:** refers to the similarity among individuals within a network in terms of characteristics as age, gender, ethnicity etc. When using a social network approach, it will strengthen existing relationships, develop new network functions and create new social networks, such as support groups, self-help groups or a buddy system. This increases the ability for **collective action.** **Intersectoral collaboration** Health is a collective responsibility of different sectors. There is a guided principle adopted from the WHO in its Primary Health Care strategy; "A recognized relationshop **between (parts of) different sectors of society**, which has been formed to take action on an issue to achieve outcomes in a way which is more effective or sustainable than might be achieved by the health sector alone." this leads to the improvement of determinants of health, creating **better health** overall. **Challenges in community action** **Tension** between community members, researchers and health professionals because they can all have different perspectives: - *People* express needs beyond those behaviors targeted by most health professionals more **holistic perspective** - *Scientific knowledge* is considered **more valuable** than experiential knowledge scientifically validated - *Professionals* often disregard needs and knowledge of community members **reductionist tradition** - Focus may be on **symptoms** of ill health instead of on their **causes** (e.g. unemployment, poor housing, insecurity) Organizations and sectors will have different **'frames'**. Organizations may be highly specialized, and all have their own philosophy, culture, value and norm system, maybe even rituals. This leads to various types of uncertainties in collaboration. Community action often implies a different way of thinking and working for those involved. This requires new competences of not only scientists, but all those involved. However this is not easy, and can cause a **paradigm shift** (fundamental change) in underlying assumptions, values and practices in communities. Community action is increasingly practiced due to effectiveness when facing these complex problems.