Tools for Community Work     Robert C. Bowman, M.D.

See powerpoint presentation in member section, Community Tools and other presentations

This community study lends support to the belief that the ability of a community to attract physicians is closely related to the ability of that community to confront problems and take necessary actions - Tom Bruce in Improving Rural Health 1984 p 66

Common Tools

Is this data representative?

What will be done with the info?

Think in reverse. You must be ready to write the findings before doing the survey. This allows better design!

 

Secondary Data

Advanced Techniques

Ethnographic Techniques


Participant-Observation
Interviews
Focus Groups

Data Collection

Ethnographic Techniques

Compile Data then Analysis often in Groups

Ethnography leads to a better asking of the real questions with better understanding and communication, but needs group participation and time and resources

Community-Oriented Primary Care - COPC
A Step by Step Process

A person or Group works to:

1. Identify concerns
2. Collect information
3. Define the problem
4. Design an intervention
5. Implement the intervention
6. Evaluate the impact
7. Re-design & start again

COPC still focuses on problems rather than finding the real questions.

One problem with typical approaches is the development of DEPENDENCY

Problems with Dependency

Hard to succeed because

ASSET-BASED APPROACH
McKnight and others

Focus is on:

Priority on working with associations of associations such as the Chamber, ministerial alliance, task forces, etc.

 

There are models with lots of experience in changing cultures……

 

The Missiological Model (Halvorsen, FamMed May 98)
the study of the mission of the Christian Church

To be effective at change you must

Change individuals
Transform cultures

Key Concepts

 

Similar model is known as Social Marketing

Diffusion Theory

                                                                    Laggards

                                                        Late majority

                                            Early majority

 

                                Opinion leaders

 

            Early adopters

Innovators

 

Concept of Relative Advantage   or more important, relative advantage

Divisibility - put it in limited quantities rather than biting off big chunks

Complexity - keep it simple!

Compatibility - with culture, etc.

 

Stages of Adoption - 

1. Awareness     can be bad or good

2. Interest    is it personal, relative, credible sources

3. Trial     make as pleasant as possible   

4. Decision    

5.  Adoption

 

 

 

Example within the church - the Cursillo Movement - Arose in the Aftermath of the Spanish Civil War to impact on leaders at all levels of the Catholic Church.

Cursillo is now in multiple denominations throughout the world, in prisons, colleges, at high school level, etc.

Retreat - 3-4 days

Post Retreat

A Critique of the Missiological Model – often the changes were severe and governmentally imposed, i.e. the work done with Tribal Reservations

This work was sometimes done out of a paternalistic tradition that is not a part of God’s plan that all are His children. The consequences of these attempts are apparent in many cultures around the world. Often the most successful missionaries find out what parts of the culture are most like the Christian Model. Paul was a master of becoming a part of the local culture to lead others to Christ. The focus was on saving souls, not changing the laws and traditions. 1CO 9:19 Though I am free and belong to no man, I make myself a slave to everyone, to win as many as possible. 20 To the Jews I became like a Jew, to win the Jews. To those under the law I became like one under the law (though I myself am not under the law), so as to win those under the law. 21 To those not having the law I became like one not having the law (though I am not free from God's law but am under Christ's law), so as to win those not having the law. 22 To the weak I became weak, to win the weak. I have become all things to all men so that by all possible means I might save some. 23 I do all this for the sake of the gospel, that I may share in its blessings.

 

Summary of Community Process

Some findings

Think report, report, report

I will ask you to integrate the above with what you know from your experience and what you will learn about those you work with.

You will be entering communities, often as a stranger. You will need to respect their wishes. You will have to adjust to them. Each is different in acceptance, cooperation, experience in problem solving at the community level, etc.

Typically the projects are a three year process before the groundwork is laid for significant projects and progress.

Turnover of community leaders inhibits this process.

Focus on health care leaders (hospital administrators and providers) also is limiting as they are busy and can be less willing to share power/communicate with community.

Try to work with groups.

Work in multiple dimensions (see chart).

Working with Rural Communities and networks http://www.ruralresource.org/index.shtml

Title 
Fostering the health of communities: a unifying mission for the University of New Mexico Health Sciences Center. 
Author 
Kaufman A; Galbraith P; Alfero C; Urbina C; Derksen D; Wiese W; Contreras R; Kalishman N 
Address 
Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque 87131, USA. [email protected] 
Source 
Acad Med, 71(5):432-40 1996 May 
Abstract 
Fostering the health of communities can serve as a unifying mission of the academic health center (AHC), which can set the AHC apart from other health
providers in the community. To achieve this mission, the University of New Mexico's AHC is increasingly focusing education, research, and service upon the
identified health and service needs of communities in its state. Since major health problems in our society have social, behavioral, and economic roots, New
Mexico's AHC has tapped into the broad expertise of its different components as well as that of its state and community partners to adequately address health
problems in the community. Its hospitals offer financing and management resources, its colleges offer innovative approaches to community-based education,
and the state department of health offers expertise in health policy development. To adequately respond to the complexity of community health needs, the
different colleges and departments at New Mexico's AHC are increasingly merging into integrated governance units. Measures of community outreach success
include evidence of strengthened community development, increased health care access, and improved indices of community health. New Mexico's AHC
formed an interdisciplinary rural outreach task force, which has demonstrated its ability to form partnerships with state and local agencies and to mobilize
institutional resources in education, research, and service from the AHC's different departments, colleges, and hospitals to respond promptly to unique
community health needs. Evidence shows that such an integrated, coordinated AHC intervention can generate strong and lasting AHC-community alliances,
improve the quality and economic viability of community health systems, and enhance the financial resources of the AHC. 
Language 
Eng 
Unique Identifier 
97269960 



MESH Headings 
Academic Medical Centers *OG ; Community Health Centers *OG ; Community-Institutional Relations */EC ; Education, Medical, Undergraduate OG ;
New Mexico ; Rural Health ; Support, Non-U.S. Gov't