PURPOSE

To describe a public health nursing (PHN) model of community assessment (CA) based on community participatory and ethnographic approaches

To discuss the importance of community participation and local knowledge in development of culturally relevant preventive interventions

WHY COMMUNITY ASSESSMENT? To collect information required to initiate individual, community, and population level change

To assess health-promoting and health-negating conditions or community health status

To empower community members

To increase sustainable interventions

To inform development of a substance use prevention program in a rural southern county

Community Assessment

Model of CBPR

and Ethnographic Orientation

Teen/Parent Photovoice

Teen/Parent Group

Discussions

Ethnographically Informed

Community Assessment and

Mapping

Community

Leader

Interviews

Community Partnership Approach (CPRT)

Community Drug Prevention and Program

Manual for Rural Youths and Parents

Community Core and History

Physical Environment

Idea Systems

Social systems

Behavioral Patterns

(Adapted from Aronson

and colleagues, 2007)

COMMUNITY ASSESSMENT (CA):

Core function of public health

Integral to interprofessional public health research and practice

Useful in community-based participatory research (CBPR) and population-focused practice

Primary aim of our VFHY project

Partnering with Rural Youth and Parents to Design and Test

a Tobacco, Alcohol, and Drug Use Prevention Program Model

Funded by VFHY July 1, 2009 - June 30, 2012

BACKGROUND: Evolution of CA

Community diagnosis – a “keystone of public health practice” Ecologic approach: man-environment interaction and social needs, basic to accurate assessment of the health of a community Requires multidisciplinary skills Based on community’s health status, capability, and action potential People and environmental factors, institutional and human resources, beliefs and behaviors, political systems, habits of action (Freeman, 1970)

BACKGROUND: Evolution of CA

Community health nurses (CHNs) work with a “community as the patient” to gather pertinent community data about: The physical community, its people, the environment, communication channels, vital statistics, health and related resources, and CHN services and programs (Tinkham & Voorhies, 1972)

Community as client – the focus is on the health of the total population Personal and physical data to formulate a total picture of the community’s wants and needs (Archer & Fleshman, 1975)

BACKGROUND: Evolution of Participation

C o m m u n i t y a s C l i e n t

Community-Target of change

Community health – Goal of change

Partnership-Means of change

Involve Community Members

Define their needs

Set realistic priorities

Determine/control acceptable solutions

Evaluate progress

(Goeppinger, Lassiter, & Wilcox, 1982; Goeppinger, 1984; Cook [PhD], Goeppinger [PhD, RN],

Brunk [MSN, RN], Price [PhD], Whitehead [PhD Anthro.], & Sauter [MD], 1988)

BACKGROUND: Evolution of Methods

I n t e g r a t i o n o f C A D a t a A n d M e t h o d s :

Ethnographic and qualitative methods Epidemiologic data

from secondary sources Holistic assessment

of the health of a community (Project GENESIS, Glittenberg, 1982)

Informant interviews Participant observation Windshield survey Secondary analysis Surveys Interpretation to identify

community capabilities and problems (Goeppinger, 1984)

BACKGROUND: CA Revisited Theoretical orientations of a CA model for PHN

Community participatory approach Ethnographically informed

A participatory approach provides philosophical and theoretical basis for community partnerships. This orientation also provides the basis for collaboration with the community (Chiu, 2003; Minkler & Wallerstein, 2003).

An ethnographic orientation emphasizes “ways of life” of people; providing a social scientific description and cultural basis for understanding people in interaction (Patton, 2002).

A Multi Method

Community Assessment Model

Stakeholders

Photovoice

Individual and/or Group

Interviews

Processes

Ethnographically Informed

Community Assessment and

Geographic Systems Information

(GIS) Mapping

Existing Data

Census

Geographic

Vital and Health

Statistics

Community and Population Outcomes

Community, Practitioner, and/or Researcher Partnership

Identification of Strengths and Weaknesses

Foundation for Program Planning

CA Domains Community Core and History

Physical Environment

Idea Systems

Social systems

Behavioral Patterns

COMMUNITY HEALTH

Determined by multiple community and population levels Economic, physical, and psycho-social environments Interacting with intrapersonal/interpersonal level factors

Community participation and ethnographic approaches Ecological, community, and environmental assessment Photovoice and GIS mapping methods

Foster understanding of socio-cultural contexts, systems, and meaning through a collaborative research or practice process.

CA DOMAINS: Ethnographic Perspective

Five relevant domains

Community core and history

Physical environment

Social systems

Idea systems

Behavior patterns

(Aronson, Wallis, O’Campo,

Whitehead, & Schafer, 2007)

C O M M U N I T Y

D ATA P R O F I L E S

Geographic

Demographic

Economic

Health Status

Housing

Infrastructure

Historical

C O M M U N I T Y

A S S E S S M E N T W H E E L

Community Core

Physical Environment

Health and Social Services

Economy

Transportation and Safety

Politics and Government

Communication

Education

Recreation

Perceptions – Subjective and Objective

Anthropology

(Whitehead, 2004, 2009) Nursing

(Anderson & McFarlane, 2011)

LOCAL KNOWLEDGE Provides rich understanding of ecological

and contextual dimensions, and health attitudes and behaviors

Informs and empowers community and public health research or practice teams To select and customize culturally relevant

interventions to increase capacity of a community to promote healthy lifestyles.

MULTI METHOD CA MODEL

An ethnographic and participatory model is grounded in epistemology and critical theories

Fosters understanding of socio-cultural contexts, systems, and meaning through a collaborative research or practice process.

Provides the basis for true collaboration and community partnerships

REFERENCES Archer, S. E. & Fleshman, R. (1975). Community health nursing: Patterns and practice. No. Scituate,

MA: Duxbury Press.

Aronson, R.E., Wallis, Anne B., O’Campo, P.J. & Schafer, P. (2007). Neighborhood mapping and evaluation: A methodology for participatory community health initiatives. Maternal Child Health Journal, 11, 373 – 383.

Aronson, R.E., Wallis, A.B., O’Campo, P.J., Whitehead, T.L., & Schafer, P. (2007). Ethnographically informed community evaluation: A framework and approach for evaluating community-based initiatives. Matern Child Health J, 11, 97-109.

Chiu, L.F. (2003). Transformational potential of focus group practice in participatory action research. Action Research, 1(2), 165-183.

Freeman, R. (1970). Community health nursing practice. Philadelphia PA: W. B Saunders Co.

Goeppinger, J. (1894). Community as client: Using the nursing process to promote health. In M. Stanhope & J. Lancaster (eds.) Community Health Nursing: Process and practice of promoting health. St. Louis, MO: The C.V. Mosby Co.

Minkler, M. & Wallerstein, N. (eds) (2003). Community-Based Participatory Research for Health. San Francisco, CA: John Wiley & Sons, Inc.

Patton, M. (2002) Qualitative Research and Evaluative Methods. Third Edition. Thousand Oaks, CA: Sage Publications.

Tinkham, C.W. & Voohries, E.F. (1972). Community health nursing : Evolution and process. NY: Appleton-Century-Crofts.

Wang, CC and MA Burris, “Empowerment through Photovoice: Portraits of participation.” Health Education Quarterly ,Vol. 21(2): 171-186. 1994.