Level of research support: Based on sound theory
What is it?
A framework for community health involves a continuous process by which the community develops and implements a comprehensive strategy to nurture its own wellbeing. This involves more than simply focusing on the health of individuals. It requires attention to developing healthy institutions and healthy relationships. This process is sometimes called community development.
Community development is a cyclical exercise that involves thinking about what you want to do (reflection), working out how you are going to do it (planning), doing it (action), measuirng how you are doing (evaluation), and then reflecting once again.
This approach allows you to continuously review what you are doing and respond if something is not working out as well as anticipated. You may have to repeat the cycle several times before you see significant improvements in the outcomes you are trying to achieve. This is because your community is ever-changing and will continue to be so as you move from reflection to doing and back to reflection.
A community development process builds a structure based on shared vision, principles, values and beliefs. This foundation helps individuals and groups continuously reflect on the factors in their community that promote or detract from health, develop decentralized initiatives across multiple sectors, and build and sustain capacity by mapping and tapping the whole range of accessible resources within the community.
Why do it?
A thoughtful and intentional community development process is more likely to produce positive results than a haphazard approach. And, participatory processes are likely to be more effective than top-down methods (Larsen et al., 2009). Research suggests community participation in tasks such as developing activities and outcomes is critical to achieving long-term results (Merzel & D’Afflitti, 2003; Kreuter et al., 2000). What is more, the planning process itself promotes engagement, connectedness and inclusiveness among different community groups. This builds mutual respect and trust that increases community capacity and sustainability of initiatives (Larsen et al., 2009).
A community development process that involves reflection, planning, action and evaluation helps ensure activities are based on sound theory and, where possible, have evidence of effectiveness. It also allows for various inter-related factors to be addressed at multiple intervention points through the participation of a cross-section of the community (Larsen et al., 2009). Research shows that the best responses to ensure healthy and long-lasting outcomes for all individuals and groups within a community include a mix of interventions that address individual, social and environmental factors (Kreuter et al., 2000; Merzel & D’Afflitti, 2003; Thom & Bayley, 2007). This is especially true when it comes to issues involving alcohol and other drug use.
Who is it for?
Who can facilitate it?
How can we implement it?
Before making any decisions about initiatives or activities, invite participation from diverse groups within the community and spend some time thinking about factors that detract or contribute to community health and wellbeing, and ways you might strengthen community assets. Having a conversation about what it means to be healthy and live in a healthy community helps foster in citizens and institutions a sense of unity and commitment to work together.
Effective efforts to enhance community health will be based on a realistic assessment of your community's current relationship with substance use. For example, you may want to consider the specific drug-related harms people in your community experience. Or you may want to look into which segments of the population experience the most harm.
The next layer contains the factors that influence or contribute to the observable signs of visible community health and wellbeing. Drug use and drug-related harms are all influenced by individual factors (e.g., knowledge, attitudes, skills), social factors (e.g., family attitudes, cultural values, community norms), and environmental factors (e.g., public policy, institutions). Having a sense of the factors present in your community is important when designing initiatives to promote community health.
Beneath the second layer sits the community itself—the values, beliefs and resources of its citizens and institutions. Communities are complex, often involving a diverse mix of embedded communities and groups. While it is true that communities are often diverse, they also have something that defines them. This "something" is usually more than geographical boundaries or the purpose for which the community was established. It is about how members of the community are valued and engaged. These qualities can either promote or detract from healthy forms of connectedness.
While a long-term goal and series of logical steps to get there may emerge naturally during the reflection stage, you still need to draft a plan in order to effectively work toward a long-term desired outcome. The following planning steps and a simple logic model (see Tools below) can help guide this process.
There is no "one way" or single strategy to achieve community health and wellbeing. Multiple strategies and approaches are needed to ensure healthy and long-lasting outcomes for all individuals and groups within a community.
Taking action begins with filling in details of your plan: the who, what, where, when and how of the activities you identified as key to reaching your goal. Without hammering out the details of your plan, you run the risk of losing focus, losing connectedness or spinning your wheels through the misuse of time, energy and resources. (As the proverb says, "People don't plan to fail. Instead they fail to plan.")
Working out the details of your actions will help you
The process will also help you build capacity and sustainability, both of which are critical for the long-term success of any initiative and therefore worthy of consideration in the early planning and action stages.
One way to build and sustain an activity is to get individuals and groups to take on different parts of it. Seattle-based activist Jim Diers offers this simple advice to get people involved:
Tip: Translating your plans into action is both a science and an art. The science of implementation suggests that you benefit from these basic elements: community capacity, adequate resources, participation of a range of community partners, a system for collaborative problem solving and a process for measuring and reporting progress. But the art of implementation suggests that carrying out these tasks requires leadership, communication and adaptability.
The community development cycle begins and ends (and begins again) with the evaluation process. Therefore, evaluation is something that a community must think about early in the planning process, rather than after implementation.
Evaluation helps you
When planning for evaluation, it is important to strive for balance. (Evaluations that are based too heavily on accountability to funders will naturally push you toward making your case as positive as possible.) While accountability to funders should be part of your plan, your long-term goal is likely better served by creating an evaluation that supports evidence-informed adaptation. This way, you can stay focused on identifying ways to improve effectiveness or efficiency in promoting community health within the changing circumstances of your community.
Sources and related material