4cipc barcelona community readiness
DESCRIPTION
This study uses the concept of readiness to intervention for evaluating and improving primary health care. The concept of community readiness examines the interaction between community context and program design and implementation. The main idea is that effectiveness of social intervention depends on the preparation of the community for social change. The original model (Edwards et al., 2000) proposes nine different stages of readiness for implementing programs, from “no awareness” to “professionalization”. However, we could interpret readiness also as a continuum and identify different profiles or types (Chazdon & Lott, 2011; Holgado & Maya Jariego, 2012; Maya Jariego et al., 2010). In this paper we present a classification of primary health centres in Andalusia (Spain) according to three dimensions of community readiness. The research was based in three different strategies. First, 81 social workers from primary health care centres in Andalusia were interviewed and completed a 18 items scale on social participation, community adjustment and professional implication in health centres. Second, 40 health centres were observed, taking information on the professional role of social workers and organizational issues, as well as applying a survey both to compare the view of social workers and other health professionals. Finally, 10 case studies were deployed examining through in-depth interviews the interaction between the organizational and the community contexts in health care programs’ implementation. Three levels of community readiness were identified, conducing respectively to sensitization activities, community organizing strategies and application of evidence-based programs. Cluster analysis allowed the identification of three different profiles of community readiness in primary health care centres in Andalusia: reactive, technical-aid and community approach. The interaction between organization and community processes is discussed.TRANSCRIPT
Health-Illness Care
Community Readiness for Primary Health Care
Isidro Maya-Jariego, Daniel Holgado & Ignacio Ramos
Departamento de Psicología Social(Universidad de Sevilla)
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"Community readiness is the relative level of acceptance of a program, action or other form of decision-making that is locality-based” (Donnermeyer, Plested, Edwards, Oetting & Littlethunder, 1997)
"[...] unless a community was ready, initiation of a prevention program was unlikely, and if a program was started despite the fact that the community was not ready, initiation was likely to lead only to failure." (Edwards, Jumper-Thurman, Plested, Oetting & Swanson, 2000)
Theoretical contextThe Three-Ethnic Experience
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Community readiness refers to the disposition to change contingent to social intervention in a community context.◦So it is defined as the extent to which a
community is adequately prepared to the implementation of an intervention,
◦And evaluates the capacity to change.
Theoretical contextDefinition
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Community readiness as barrier between science and practice (Morrisey et al. 1997):
1. Differing theoretical orientations and training.
2. Funding priorities.3. Resources constraints.4. System-level barriers.5. Lack of community readiness.
Theoretical contextBarriers
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9 stages (Oetting et al., 1995)
1. No awareness2. Denial3. Vague awareness4. Preplanning5. Preparation6. Initiation7. Stabilization8. Confirmation/expansion9. Professionalization
Theoretical contextStages of community readiness
Theoretical contextThree levels of community readiness
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Dimensions of community readiness (Oetting et al., 1995):
1. Community efforts and community knowledge of efforts.
2. Leadership.3. Community climate.4. Knowledge about the issue.5. Resources for prevention efforts.
Theoretical contextDimensions
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Building typologies of contexts based in organizational and community dimensions to evaluate community readiness.
Social workers incorporation into primary health care teams.
ObjectivesTypologies of communities
Community readiness in PHC
Organization and professional practice
Community intervention for health in PHC
Survey to social workers
81 interviews to social workers in PHC centres
Evaluation of community readiness in health contexts
Profiles of the contexts for community intervention
Capabilities and potential
Method
Overview of the study
Visits to PHC centres
Direct observation of 40 PHC centres
Interviews to 80 health professionals
Role of social workers in PHC
Professional practice and organizational context in PHC
Community readiness in PHC
Organization and professional practice
Community intervention for health in PHC
Method
Overview of the study
Case studies
Interviews and case studies of 10 social workers in PHC centres.
Discourse network analysis.
Interaction between community and organizational contexts and program implementation.
Community readiness in PHC
Organization and professional practice
Community intervention for health in PHC
Method
Overview of the study
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Key informants: 81 social workers in PHC centres
Community Readiness Scale◦18 items, agreement 1-10, α= .886◦Perception of community problems,
engagement of health professionals, social participation, community adjustment of social interventions.
Survey with questions on social worker role, social climate, activities of the PHC centres and demographics.
MethodInstruments and participants
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MethodInstruments and participants
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MethodInstruments and participants
15
ResultsThree clusters of community readiness
16
Community Mobilization PHC Center Engagement Community Adjustment0
1
2
3
4
5
6
7
8
6.42
7.25
5.255.23
6.73
7.42
3.09 3.26
4.77 Cluster 1
Cluster 2
Cluster 3
ResultsThree clusters of community readiness
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From barriers to disposition:◦Interaction between intervention and
context.◦Potential for change or “zone of proximal
development”.From levels to profiles:
◦Evaluation of multiple dimensions.◦Effectiveness depends on the contingency
intervention/context.Key role of the interaction between
organizational and community dynamics.
ConclusionsProfiles of community readiness
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Laboratorio de Redes Personales y Comunidades
http://personal.us.es/isidromj
Isidro Maya Jariego <[email protected]>Ignacio Ramos <
[email protected]>Daniel Holgado <[email protected]>