Community
Based Participatory Models in
Identifying
Barriers and Assets for Changes to Address Chronic Diseases
The intended outcomes are
twofold: (1) to describe what specific communities identify as the barriers and
assets for change in their communities relevant to chronic diseases and their
risk factors and (2) such models are designed to serve as a tool for programs
to utilize information tapped from communities to address change, as well as
tools for communities for leadership development and empowerment.
Focused group discussions
began in January 2004 with a Native Hawaiian community group, a Filipino
community group and a group from rural areas and
Environmental Change Initiation
The population of the State
of
The focus of this on-going
process is not just to do surveillance and describe the disease burden and
on-going disparities (e.g. “…counting the sick and the dead”, Finau, 2002), but to move further along to help diverse
communities identify the barriers, as well as strengths and assets that they
can use to focus on change (Cooperrider et al, 2003).
Public Health Agency Roles
Within the CHD, as a result
of many community based projects (and subsequent evaluations), there arose a
need to set standards around cultural competency and cultural appropriateness
for contractors. Subsequently, the CHD initiated several community based focus
groups to get input from communities on cultural competency. This is part of an
on-going process to address health disparities. In addition, as CHD programs
state they are working with disparate groups, there is an expectation that
there will be an engagement process that includes and involves these identified
groups who in turn can influence decisions about the program.
Major Partners
Existing CHD branch and
program contacts and links to community-based organizations, partners and
coalitions have all been part of this process and assist in wider based
community level contacts with key informants in targeted communities. Community
partners were also recruited from existing contacts within specific communities
(e.g. Filipino youth were recruited with the assistance of contacts at the
Official Support
Numerous public officials
have assisted by either participating or recruiting key community contacts.
There is no “official” sanction of this project; however, key CHD staff have played a key role in the Department of Health’s
on-going development of cultural competency guidelines.
Results from the Environmental Change
The current outcomes of this
process are still unfolding since it in progress and on-going. The feedback
from the communities themselves is the current outcome. Further, in such a
process, the communities themselves may be the driving force behind
articulating the outcomes or changes they want to envision.
Lessons Learned
The most important lessons we
are learning about this process is its utility for use among a wide variety of
groups and topic areas in chronic diseases. All chronic disease programs are
employing community-based outreach models, with varying degrees of community
participation. The level of participation depends on the disease or risk
factor, the length of time the program has developed committed relationships in
communities over time, as well as other factors we are still exploring.
Additional efforts in
community based-participatory models by the CHD include:
·
Outreach efforts
in cancer screening (Pobutsky, Pordell, Yamashita et
al, 2004).
·
Working to engage
Micronesian migrant communities and other stakeholders in
·
On-going
participation in a statewide obesity Task Force which developed a “White Paper”
on obesity which then led to numerous Legislative Bills and Resolutions in 2005
and 2006.
For more information, contact:
Barbara Yamashita, MSW
Chief, Community Health
Division
or
Chronic Disease
Epidemiologist
Community Health Division
Hawaii State Department of
Health
(808) 586-4126
(808) 586-4791 FAX
References
Centers for Disease Control and Prevention (1997). Principles of Community Engagement.
Cooperrider,
D.L., D. Whitney and J.M. Stavros (2003). Appreciative
inquiry handbook: Workbooks for leaders of change.
Davison, N, R. Workman, Y.G. Daida, R.
Novotny and D. Ching (2004). Health living in the
Fancher, E. and
J. Lipsher (2004). Using a community-based participatory research
model to gather information on Filipino-American knowledge, attitudes and
behaviors related to tobacco use on
Finau, Sitaleki A., Iris L. Wainiqolo
and Giuseppe Cuboni (2002). Health
Transition and Globalization in the Pacific: Vestiges of Colonialism?
Working Papers and Papers in Progress No. 2.
Pobutsky, A.M.,
P. Pordell, B. Yamashita, D. Wong-Tomiyasu, Wendy Ku’upio Nihoa. K. Kitagawa, et.al.
(2004). Community based participatory approaches to address health disparities
in
Pobutsky, Ann, Lee
Buenconsejo-Lum, Catherine Chow, Neal Papafox and
Gregory Maskerinc (2005). Micronesian Migrants in
Yamashita, B., A. Pobutsky,
D. Wong Tomiyasu, and L. Nakao. (2005) Public Health Villains or Good Guys: Do We Know the
Difference? Presentation at the 19th Annual National Conference On Chronic Disease Prevention and Control,