Assessing local capacity for health intervention

Because of their location within the practice realm, participatory, community-based public health coalitions offer many lessons about implementing and sustaining local interventions. This paper presents a case study of capacity assessment at the local level. Capacity evaluation methods are presented, with emphasis on the theoretical framework used to guide the evaluation. The capacity evaluation framework presented herein was theoretically based and designed to generate practical information to facilitate the adoption of a locally tailored youth obesity prevention program, VERB Summer Scorecard (VSS). Using multiple methods, four aspects of community capacity were assessed, including community, knowledge and skills, resources, and power. Within each category, factors that facilitated or impeded program implementation were distinguished. The evaluation protocol was designed to generate information increasing community capacity to sustain a community-based obesity prevention program. Capacity tables were used as a program-planning tool and as a system for sharing implementation and sustainability requirements with potential adopters. This case study also explores how to use capacity assessment results to empower coalitions to serve as catalysts for development of local programs in other communities.     

A theoretical framework for comparisons of social movement participation

This article attempts to draft a framework for the comparison of movement participation. The standards of comparison I developed at the movement level were the magnitude of mobilization potentials, the composition of multiorganizational fields, organizational characteristics, and action orientation. Utilizing this framework, I compared mobilization campaigns for three different types of activities conducted by three different movements: a campaign conducted by a labor union for, possibly, a strike, a campaign of the Dutch peace movement in a local community for a national demonstration, and campaigns by women's groups in a community for a variety of activities. I explain differences in motivational dynamics and levels of participation in terms of differing movement characteristics. Finally, I discuss the advantages of comparative work on social movements.     

Women and work in rural Taiwan: building a contextual model linking employment and health

This paper is based on ethnographic research in a rural Taiwanese village in which married women with children are a major source of labor for local industry. Responsibility for job and home exposes these women to repeated stressors that can increase their susceptibility to illness. Existing explanatory models linking employment and women's health, however, do not explain adequately the women's response to their wage labor and the consequences of the social aspects of their work on their health. This paper describes women's work and its meaning, and discusses the way in which micro phenomena such as meanings and health states are linked to macro phenomena such as national political-economic processes and the world capitalist system.     

The role of community context in planning and implementing community-based health promotion projects

The current study examines how community context affected collaborative planning and implementation in eight sites participating in a healthy cities and communities initiative in California. Data are from 23 focus groups conducted with coalition members, and 76 semi-structured interviews with local coordinators and community leaders. Multiple case study methods were used to identify major themes related to how five contextual domains influenced collaborative planning and implementation. Results showed that history of collaboration can influence resources and interpersonal and organizational connections available for planning and implementation, as well as priorities selected for action. Community politics and history can affect which segments of the community participate in a planning process and what issues are prioritized, as well as the pool of partners willing to aid in implementation. Some community norms and values bring people together and others appear to limit involvement from certain groups. Community demographics and economic conditions may shape outreach strategies for planning and implementation, and may also shape priorities. Geography can play a role in assessment methods, priority selection, partners available to aid in implementation, and participation in activities and events. Results suggest that community context plays a substantive role in shaping how community-based health promotion projects unfold.     

Locating the Community Field: A Study of Interorganizational Network Structure and Capacity for Community Action*

Abstract I examine the concept of the community field to identify the structures, elements, and processes that generate improved capacity for community action. I conduct analysis of interlocking leadership among local organizations and recent community action in three Midwestern communities to determine the structure and attributes of the community field. I use findings from community power research to anticipate and guide interpretation of the different network structures found in each community. A community field is identified in the communities with pyramidal and coalitional structures. Inclusive, coordinating networks, institutions with stockpiled resources, and the existence of local planning processes are some of the community field‐like structures and processes I identify. The findings have implications for future rural community research and practice, including support for increased use of network analysis as a diagnostic tool for community development.     

Child health and parental paid work

We ask how the paid work of Canadian married mothers and fathers is affected when a child has a physical/mental condition or health problem that leads to restrictions in daily activities. Using the Statistics Canada National Longitudinal Survey of Children and Youth, we find that married mothers of children with disabilities are less likely to engage in paid work and/or work fewer paid hours per week. No statistically significant changes in paid work participation or hours are apparent for fathers of the same children. We find, moreover, evidence that the degree of specialization within families increases when there is a child with a disability. These responses are consistent with traditional gender roles within families, and may make sense as a ‘household’ coping strategy. However, such a division of labor may generate economic vulnerability for mothers compared to fathers.     

Part-time work and hurried adolescence: the links among work intensity, social activities, health behaviors, and substance use

The present study examines adolescents' part-time work intensity and its relation to participation in various activities as well as substance use. We consider mechanisms articulated in two theoretical perspectives on how high work intensity is associated with substance use: (1) the "time trade-off perspective," and (2) "the precocious development perspective." Nationally representative data were drawn from the "Monitoring the Future" project from 8th, 10th and 12th grade students (overall N approximately 380,000) to address our research questions. Work intensity was found to be linked to more time spent on unstructured social activities, but to less time spent engaged in sports, health behaviors, and school-related activities. Social time use and health behaviors were found to partially mediate the relationship between work hours and substance use. Overall, results provide evidence for a combination of both perspectives.     

Local policy networks in the programme Social City—a case in point for new forms of governance in the field of local social work and urban planning1 Lokale Politiknetzwerke im Programm Soziale Stadt—ein Beispielfall für neue Formen von governance im Bereich lokaler Sozialer Arbeit und Stadtplanung

The federal programme Social City represents a concept that is different from traditional urban planning, social work and local economic development as well as planning concepts in various ways. The developmental processes to be set into motion on the level of city districts:

• should make cooperation between various sectors and actors a key issue;

• should encourage them to invest into this cooperation and use the resources to be brought about by their participation and

• furthermore, the participation of various groups of the local population is foreseen.

Building up the respective institutional premises for this kind of networking and participation is part of the programme. Thereby urban planning and policies in social work and social services are to be brought into cooperation. The paper is based on an evaluative study of such local policy networks as they take place in one of the Länder, Hessen. Central results of the analysis will be presented, and suggestions for the programme's further development as a new concept of governance at the local level include some reflections on its potential for legitimising social work in community building.     

Gender, aging, poverty and health: Survival strategies of older men and women in Nairobi slums

This paper is based on data from focus group discussions and in-depth individual interviews carried out in two slum areas, Korogocho and Viwandani in Nairobi, Kenya. It discusses how the division between domestic sphere and public sphere impacts on survival during, and adaptation to old age. Although this paper adopts some of the tenets of the life course approach, it posits that women's participation in the domestic sphere may sometimes give them a ‘gender advantage’ over men in terms of health and adaptation to old age. The paper also discusses the impact of gender roles on the cultivation of social networks and how these networks in turn impact on health and social adjustment as people grow older. It investigates how older people are adjusting and coping with the new challenges they face as a result of high morbidity and mortality among adults in the reproductive age groups.     

Women's work, cohort change, and health

Rapid changes in women's labor force participation, access to good jobs, and changing work-family pressures have altered the landscape of work and family life. We use logit negative binomial hurdle models to examine whether these countervailing trends have affected the physical health of women across four birth cohorts. Longitudinal data are used to compare successive cohorts of U.S. women when they are between the ages 44 and 50. While the health of women overall did not change across cohorts, we find an increase in health problems among employed women, explained by increases in the ability of women with physical limitations to become and remain employed. Health problems among housewives decline across cohorts, resulting in better health among housewives than among employed women in the most recent cohort. These findings provide further evidence of the importance of selection processes in understanding health effects of roles, and they highlight the need for greater attention to the health effects of unpaid work.     

A comparative study of social network models: Network evolution models and nodal attribute models

This paper reviews, classifies and compares recent models for social networks that have mainly been published within the physics-oriented complex networks literature. The models fall into two categories: those in which the addition of new links is dependent on the (typically local) network structure (network evolution models, NEMs), and those in which links are generated based only on nodal attributes (nodal attribute models, NAMs). An exponential random graph model (ERGM) with structural dependencies is included for comparison. We fit models from each of these categories to two empirical acquaintance networks with respect to basic network properties. We compare higher order structures in the resulting networks with those in the data, with the aim of determining which models produce the most realistic network structure with respect to degree distributions, assortativity, clustering spectra, geodesic path distributions, and community structure (subgroups with dense internal connections). We find that the nodal attribute models successfully produce assortative networks and very clear community structure. However, they generate unrealistic clustering spectra and peaked degree distributions that do not match empirical data on large social networks. On the other hand, many of the network evolution models produce degree distributions and clustering spectra that agree more closely with data. They also generate assortative networks and community structure, although often not to the same extent as in the data. The ERGM model, which turned out to be near-degenerate in the parameter region best fitting our data, produces the weakest community structure.     

Migration and health

Investigation of migration and health often forces us to acknowledge that the types of migration (international, internal, and residential) interact with each other as well as other population parameters such as the age/sex structure, sexual activity, fertility, mortality, and family structure. Research on migration is often obscured by these interactions. In fact, the adoption of a health perspective in the design of migration research represents a substantial improvement over traditional approaches that are based on distinctions among the various types of population movement. This is because a health perspective treats population movement as a dynamic process by which individuals are related to specific locations by reason of their participation in human networks. In other words, migration is regarded as a human process rather than a discrete event, and accordingly, it becomes less important to describe the individual's involvement with human networks and the institutions sustaining them. The use of a health perspective in migration research often calls our attention to the ways in which the types of migration are interconnected. For example, a migrant from Mexico might exhibit considerable internal mobility and may circulate between Mexico might exhibit considerable internal mobility and may circulate between Mexico and the US over several years until he develops enough contacts in the US to settle in a particular community in which his personal contact with human networks and place-specific institutions are conducive to settlement. Through him, family members may attach to the community. In the process, they all encounter health risks, make demands on the health care system, change the demographic/health characteristics of both sending and receiving places, sometimes act as transmitting agents of disease to those with whom they interact and, undergo changes in their levels of personal development and well-being. A research perspective that investigates these processes will consider all of the types of movement and characterize them as dynamic processes rather than as discrete events. The articles in this issue all touch on the ways in which migration can affect the health of migrants, and show the circle range of ways migration and health are interrelated. A special introductory note also suggests Acquired Immunodeficiency Syndrome (AIDS) should receive special attention in the study of this interrelationship. The uneven distribution of AIDS is heightening concern about the health implications for receiving countries.     

Community orientation of services for persons with a psychiatric disability. Comparison between Estonia,Hungary and the Netherlands

This article explores the way mental health services and social services are orientated on assisting people with a psychiatric disability to participate in different areas of community life. A large research project about community participation in three different countries (Estonia, Hungary and the Netherlands) confirms the findings of other studies that – regardless of geographical location – people with a psychiatric disability have difficulty fulfilling social roles in the community. They are often faced with fewer opportunities than other citizens, due to their health problems, stigma, discrimination and poverty [World Health Organisation. (2011). World report on disability. Geneva: WHO]. An important objective of social work is to help people find their way in society. Surprisingly enough, in all three countries, most social workers are mainly focused on solving individual problems, and not on community participation. Shifting the focus starts by having a clear awareness of the notion of community participation. Social workers have to work both on supporting individuals to find their way in the community (individual support), and on supporting social networks in the community to accommodate persons with a disability on the basis of equal and valued citizenship (community support).     

Scissors, Surveys, And Psycho-Prophylactics: Prenatal Health Care Campaigns And State Building In China, 1949–1954

This paper examines how the Chinese state's prenatal health care campaigns of the early 1950s attempted to redefine women's social and political roles. The replacement of local midwifing practices with a uniform birthing method in order to radically reduce infant and mother mortality entailed complex ramifications regarding the relationship of women vis-a-vis the state. Campaigns involved demonizing "traditional" midwifing, promoting a statistical vision of female reproductivity and children as national resources, and the isolation of individual mothers as directly responsible to the state for managing reproduction for the national interest. In sum, a physiological definition of gender was used to open women's bodies to state management. Utopic visions of painless childbirth and of the socialist nation as a giant new family were used to promote participation in grassroots campaigns, but the sources also point to forms of local resistance to the micro-level reorganization of power these campaigns intended.     

Willing but unable? Extending theory to investigate community capacity to participate in Ghana’s community-based health planning and service implementation

While primary health care programmes based on community participation are widely implemented in low- and middle- income settings, empirical evidence on whether and to what extent local people have the capacity to participate, support and drive such programmes scale up is scant in these countries. This paper assessed the level of community capacity to participate in one such programme – the Community-Based Health Planning and Service (CHPS) in Ghana. The capacity assessments were drawn from Chaskin’s (2001) theorised indicators of community capacity with modifications to include: sense of community; community members commitment; community leadership commitment; problem solving mechanisms; and access to resources. These capacity measures guided the design of an interview guide used to collect data from community informants, frontline health providers (FLP) and district health managers. Key qualitative themes were built into a questionnaire administered to households selected through systematic sampling approach. Findings showed that growing individualism, low trust in neighbours and apathetic behaviours undermined the capacity of mutual support for CHPS. The capacity to support CHPS was high for local leadership and community social mobilisation groups who often dedicated time to working with FLP to promote maternal and reproductive health service use, and in advocating broader support for CHPS. Within the wider community, commitment to voluntarism was low as members perceived CHPS to be owned by, and run on government funds and resources. Poor voluntarism was compounded by poverty that crippled the capacity to provide needed resource support for CHPS. Findings have great implications for building strong capable communities for participation in community oriented health programmes.     

Socioeconomic, medical care, and public health contexts affecting infant mortality: a study of community-level differentials in Peru

Socioeconomic, medical care, and public health contexts are examined in Peruvian communities for their relationship to infant mortality. A deviant case analysis is used to uncover characteristics important in the social structure of Peruvian communities. Results from fieldwork in two "deviant" communities suggest that economic diversity, income disparity, social class fluidity, and women's autonomy, along with refined measures of medical care and public health resources, are important in understanding differentials in mortality. Attention is drawn to the community context and to the interplay of socioeconomic determinants affecting infant mortality.     

Understanding the Juggling Act: Gendered Preferences and Social Structural Constraints

In this paper we use longitudinal data to test the strength of individual preferences and structural variables as explanations for married women's labor force participation. Data drawn from a subset of the Career Development Study are used to compare gendered preferences measured toward the end of adolescence vs. work and family structural variables as predictors of the actual number of hours married women work for pay. Family structures that push women out of the labor force and pull them into family work prove to be the strongest predictor of married women's employment hours, with work structures (e.g., aspects of good jobs) and the subjective definition of paid work as a career also being substantively important for explaining hours in the labor force. Our findings also indicate that attitudes formed before and during early adolescence do have a weak but statistically significant effect on married women's labor force participation, at least for baby boom women.     

The rejuvenation of community studies? Neighbours,networks and policy

Why have community studies in Britain undergone such a decline? Several reasons are suggested for the decrease in popularity of this type of research since the mid-1960s, but several signs of possible resurgence are detected. Sociologists may also have something to learn from applied work in this area. The definition of the field is shifting from the geographical community to the study of primary group relations among neighbours, friends and kin. An effective methodological strategy which avoids hypostatising geographical space is social network analysis. Current theoretical issues are exemplified from Philip Abrams's work. There is revival too in the study of local-level political action.     

A mixed-methods evaluation using effectiveness perception surveys,social network analysis,and county-level health statistics: A pilot study of eight rural Indiana community health coalitions

Community health coalitions (CHCs) are a promising approach for addressing disparities in rural health statistics. However, their effectiveness has been variable, and evaluation methods have been insufficient and inconsistent. Thus, we propose a mixed-methods evaluation framework and discuss pilot study findings. CHCs in our pilot study partnered with Purdue Extension. Extension links communities and land grant universities, providing programming and support for community-engaged research. We conducted social network analysis and effectiveness perception surveys in CHCs in 8 rural Indiana counties during summer 2017 and accessed county-level health statistics from 2015-16. We compared calculated variables (i.e., effectiveness survey k-means clusters, network measures, health status/outcomes) using Pearson’s correlations. CHC members’ positive perceptions of their leadership and functioning correlated with interconnectedness in their partnership networks, while more centralized partnership networks correlated with CHC members reporting problems in their coalitions. CHCs with highly rated leadership and functioning developed in counties with poor infant/maternal health and opioid outcomes. Likewise, CHCs reporting fewer problems for participation developed in counties with poor infant/maternal health, poor opioid outcomes, and more people without healthcare coverage. This pilot study provides a framework for iterative CHC evaluation. As the evidence grows, we will make recommendations for best practices that optimize CHC partnerships to improve local health in rural areas.