HEALTH PROGRAMS

MAKING THEM WORK SUSTAINABLY

Phase One

Community Assessment
During this phase, community members determine priority health problems, the risk factors that contribute to the health problems, and the influences on risk factors in their community. Community leaders and community resources are identified. Community Health agencies will have already completed substantial steps in this phase through the community assessment portion of their planning process. However, special applications or refinements may be useful for program planning for health promotion.

1- Define the Community.

The term "community" has multiple meanings. In order to complete a community assessment and determine the health of a community, decisions must be made about the following questions:

How large is it? (A neighbourhood, a city, or a town?)

What are its major social institutions or sectors? (Education, health, recreation, business, faith, media, civic organizations, government, etc. What are the patterns of social interaction? (Clubs and networks)

Where is the social control? (Influence groups, key decision-makers, power structures)
Involving Community Leaders Identifying Opinion Leaders Who constitutes the community? (Special populations as high percentage of teens or elderly)

2- Collect or Review Data that will help identify key community health problems related to chronic diseases. Examples of the types of data to be collected could include morbidity and mortality data, key demographic data and health status data. Community Health Check

3- Identify the risk factors that contribute to chronic diseases and their prevalence in the community. The state-wide behavioural risk factor survey data can be helpful. Some communities may choose to conduct a community-wide behavioural risk factor survey of their own. This takes a significant amount of time to conduct properly, but can be accomplished with technical assistance.

4- Examine other factors in the community that influence risk factor behaviour. For example, such things as the availability of exercise facilities; location, accessibility and number of cigarette machines; and number of grocery stores with a low fat meat labelling program all influence an individual's behaviours. Involving Community Leaders Finding Resources

5- Begin a public awareness campaign.

The use of the media throughout this process is critical to the success of the effort. The purpose of this initial campaign is to generate awareness and understanding of the planned effort in the community. It will raise the awareness of local leaders to the issues of health in the community and "set the stage" for recruiting volunteers for the program. Working With the Media

6- Conduct a Community Opinion Survey and/or a Consultation .

A community opinion survey helps determine what is perceived to be the major community health problems. The procedure includes interviews with identified community leaders. These interviews are "tools" for analysing the community, identifying community leaders, and is one of the first steps in the community organisation process. They are also the introduction of the project to important community leaders and begin to build support for later program activities.

7- Analyse the collected data.

Collect as much community specific data as possible. Organising and summarising data into charts and graphs that are easily viewed and understood by others is important.

8- Formulate Initial Goal Statements.

Using all the data, begin to formulate ideas for potential goals for the project. These goals will be presented, along with supporting data, to the core group and/or community coalition for further discussion and development.

Phase Two Community Organisation Community Organisation: various methods of intervention whereby individuals, groups, and organisations engage in planned collective action to deal with social concerns.

Community awareness and participation are critical to the success of community-based health promotion efforts. Community organisation is the vehicle that informs and involves people in the project. The community is mobilised through ever-increasing involvement of its leaders and citizens.

1- Assemble a Core Planning Group This group consists of a local coordinator and at least three to six people willing to participate in long term planning. The core group may be assembled before and participate in the data collection or it may be assembled after data collection is completed. The core group assists the coordinator in the planning and administration of the project, helps identify resources necessary to accomplish the objectives, and assists in recruiting coalition members.

The coordinator serves as a catalyst in the process of identifying what needs to be done and recruits core group and coalition members to use their collective strength to solve the health problems of the community. The coordinator will be the organiser, the communicator and the person through whom all paperwork will flow. Some communities use the core group to collect data and participate in conducting the surveys. This necessitates training core group members but has the advantages of involving them from the beginning and in sharing the work load.

2- Present and discuss data with the core group. Discussions need to produce agreement on the health problems or needs of the community and achieve a consensus on the goals and priorities for action.

3- Identify target populations and likely successful interventions. Based on data and the collective wisdom of the core group, target populations and possible interventions are discussed. For example, Comprehensive Community Health Promotion
Channels Schools, grades 4-6 Strategies/Interventions Strengthening health education in school curriculum including parents in school health education activities

Media

Involving media personnel in local health activities

Grocers

Promoting availability of healthy food choices

Workers

Worksite cardiovascular screening and education

4- Write measurable objectives/develop a work plan. These objectives define the work of the coalition, are time-limited, specific, and stated in measurable terms.

5- Identify potential coalition members. Representation of all major community "institutional" sectors is important. The coalition members should represent all the sectors of the community, including commercial, volunteer, political, religious, recreational, medical, public health, and media. For example, a coalition may include representatives from the following groups:

School Hospital Newspaper/Radio/TV Health Organisation Banking

Community College Industry Vocational School Primary Care Clinic Faith Community Government

There may already be an appropriate interested group in the community. If so, this group may want to expand its responsibilities or be involved in the organisation of the coalition in some way. If such a group exists, it is imperative that its leadership is informed/involved in some way to avoid competition and other obstacles that might arise.

6- Recruit Coalition Members.

Initially, several leading citizens with a stated interest or known commitment to the project are solicited for membership. They are asked to suggest names of others they think might be helpful to the program. These names will probably be similar to those mentioned in the community opinion survey or community resources inventory. Invitations are issued both to heads of organisation and individuals identified as community leaders.

Recruit representatives from all segments of the community. Members must be enthusiastic and excited about the goals and believe that the objectives can and will be accomplished if people work together. Recruit positive thinkers who will look for opportunities, strengths, and multiple solution-people who enjoy a challenge. There should be a balance between community leaders, and those members who will be the "doers".

7- Clarify the coalition mission and each of the members roles within the mission.

Clear roles and expectations for coalition members Without a clear mission. Common goal and should be able to describe the goal of the coalition and their role in its work in a few short words. Define individual coalition member's jobs. Job descriptions or agreements include such things as the length of the commitment, training opportunities, support from staff, personal expectations, and financial commitment.

8- Work to build involvement, ownership and consensus. Active involvement by coalition members is critical. However, it may take 6-10 months to build mutual respect and program ownership. Members need training and sufficient time to "digest" this type of broad public health program. Devoting a portion of each meeting to training yields long-term benefits.

Group consensus is the most effective method for decision-making. For this to occur, the coalition must take time to resolve member concerns and periodically determine who is not in accord and why. It is important to hear from all memberssilence does not necessarily mean that they agree. Members who may be opposed to an idea, but not skilled at airing their views, can later block implementation. In effective decision-making, all members volunteer or are asked to share their views before a decision is made.