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
Surveys
Secondary Data
Is this data representative?
Validity
Sampling
Design
What will be done with the info?
Know what will be done with it
Why include questions that won’t be used
Run it by an expert
Pilot the survey
Think in reverse. You must be ready to write the findings before doing the survey. This allows better design!
Secondary Data
Preventive and Societal/Community Med Help
State Offices
Advanced Techniques
Ethnography
Community Oriented PC
Asset-Based Approaches
The Missiological Model
Ethnographic Techniques
Participant-Observation
Interviews
Focus Groups
Data Collection
Field Notes
Use of standard questions, prompts
Transcripts
Observations/Impressions
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
Focus becomes negatives/deficiencies
Creates need for outside intervention to "rescue"
Contributes to hopelessness
Hard to succeed because
Funding ends if problem fixed
Agencies must therefore keep finding problems
ASSET-BASED APPROACH
McKnight and others
Focus is on:
Releasing individual capacities
Releasing the power of local associations
Capturing local institutions for building
Rebuilding the economy
Mobilizing entire community
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
Identify what needs to be changed
Change a minimum number of core values
Identify views of leaders, work with them
Prioritize work in groups (people movements)
Be patient and disciplined
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
Review basic concepts of Christianity
Facilitate an encounter with Christ
Post Retreat
Weekly Reunion Groups, Accountability, Personal Mission
Monthly Ultreya gatherings for support, mentoring, worship, all within the existing church
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
Enthusiasm most helpful
Active not passive
Keep in contact with contact
Email us if effort slowed
Think report, report, report
Great to do a lot of work
Work is wasted if not passed on
Don’t get paid w/o 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