Theory, Practice, and Community Development (Community Development Research and Practice Series)

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What is community work?

Each is discussed, and the relevance for community health nursing practice is critiqued. Finally, issues which may arise when community health nurses attempt to practice within a community development model are discussed. Issues are examined related to the structures of organizations in which nurses work, characteristics of nurses themselves, and the communities which nurses serve. The argument is advanced that despite the pitfalls and problems, this new role shows promise as an important mechanism for community health nurses to promote the community's health.

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However, much additional work will be needed to test out models for community development in actual practice. I think that we're seeing it come to light more now, with the hospitals now getting involved and seeing general community members come out who show an interest in volunteering. Although community organization is the most commonly used approach within networks and coalitions in these communities, often community-based approaches guide heart health programming and agency interaction outside of coalitions. Many agencies continue to work independently to plan and deliver their own programs.

It's certainly in its beginning stages, community liaison is starting to happen. But I don't think the big picture is ever a big enough picture. We all work on our own projects. There are no big frameworks, we all create our own structures and work within them. We contribute to each other's work but we don't work together on the program itself.

Community Development Policy and Practice M.A.

I don't think we've done a very good job of linking that part of it altogether. The positive atmosphere for collaboration in these two communities is based in different contexts. In Avondale, the recent success of the community in diversifying its economy in the face of industrial restructuring has resulted in a community with a unified sense of commitment to its future.

It has always been a very united community. I think we have a union kind of representation in our city, not in a negative sense at all but it is a very collective community. So when we put our minds to something, it is very successful and it plays a very strong role in promoting the community and the area. Alternatively, in Bayshore, the small, rural nature of the community has necessitated that agencies work closely to share resources and develop a common agenda in order to maintain the health services and opportunities they currently have. Thus they have made adaptations to community development approaches focus on organizations and agencies and amalgamated them with community organization principles.

From a logistics level there is no way you can go out and do this for everybody, everywhere. You have to hand it over to the community, you have to help them to see that there is a problem or that there is something that they could be doing to make the world a better place to be.

Then you go in and support them in the way they want to do it.

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So that is what I see community development as being. I don't see it as being a blank slate where you just go in and say OK what is your problem, because there are issues here that we know from the epidemiological data base are really important. In Bayshore, although a group of agencies intended to do community development, in reality the approach tended to focus more on agencies. The resulting approach was a combination of community development and community organization principles.

I think we're very much trying to do a community development model, but if I'm really being truthful, often times it looks more like community organization. And the reason why I'm saying that even though we have ownership of our agenda in this community, are we the board of directors true representatives, are we grassroots enough in the community, for the community to take ownership? I don't think we are. In summary, these findings suggest that a continuum of community approaches is employed across this set of communities with respect to heart health promotion Table III. It is further evident that most agencies make use of more than one community approach, the selection of which is dependent upon the issue and stakeholders involved.

Community approaches are thus not necessarily mutually exclusive and may be used in combination at different stages within a particular initiative. In addition, it is evident that communities do not all use the same combinations of community approaches; community context, including the characteristics of the population and the history of community events, form the backcloth against which community approaches to heart health promotion are played out.

Lack of understanding and capacity related to community development strongly influence implementation of such approaches. The variable use of community approaches both within and across communities can also be partly explained by the influence of other factors which either facilitate or impede collaboration at the local level.

These factors play out differently within diverse community contexts i. Hillview's highly urbanized, poor multi-cultural community versus Elsmere's middle-upper income, corporate business employment sector; Table I and influence collaboration between agencies to differing degrees depending on the strengths and resources within each community.

For example, resource constraints acted to stimulate increased sharing among partners within Fanford as it created a greater sense of common goals, while in Gleason limited resources left already stretched, small agencies with less time for external partnering and projects. Despite these differences, the data indicate a parsimonious set of common facilitators acting across communities Table IV.

The commitment of staff, volunteers and community members is overwhelmingly the key facilitating factor for inter-agency collaboration. In both smaller, rural populations such as Gleason and distinct urbanized communities such as Hillview, interpersonal links between agencies and community groups also function to bring agencies closer together. In several communities, such as Canton, Elsmere and Bayshore, a solid history of partnering and the existence of health networks provided a stable forum for maintaining linkages and building upon previous accomplishments.

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We have a community that is mobilized, we have a lot of organizations with volunteers, that are manned. We also have an awful lot of partner organizations that have been bought into heart health that were here 6 years ago, but they weren't talking about heart health. We have come some distance here. And so there is an energy that is ready to be applied, if its done in the right way. There is a lot of credible groundwork that has already been laid. For both those communities that have established collaborative initiatives e. Avondale , and those that are now beginning to explore coordination of services or programs among health organizations e.

Davisville , access to expertise, space and materials of other agencies, helps avoid reinventing the wheel and allows communities to maintain levels of service during times of cutbacks. Though we are certainly anti-smoking, we don't have the health promotion equipment here to do it, but then there's no reason for us to have it and to input money to it when someone else has such brilliant stuff and awesome visual equipment. So it's silly for us to input money into a programme when there are two very good programmes already out there and I don't have any hesitation in recommending people to go there.

We sent our clients there and share our services so they can get the same service without us having to spend more to meet those needs. Several barriers common across study communities also appear to influence the level of collaboration between health agencies Table IV. For example, lack of human resources and the negative political and economic climate that has been driving cutbacks to health and agency funding are the most prevalent impeding factors.

We are losing some of the key vehicles to get kids and families to think about health. From my perspective I don't have the time any more to go and sit on other committees. Next year when I am cut there won't be anyone from the Board of Ed to do that. From our perspective there is a real danger of health promotion and our connections to others collapsing. There just isn't the personnel to continue them.

In communities like Fanford with a large number of health-related organizations, it may be difficult to get consensus within an inter-agency group; they may not all see the same value in community participation or may not be comfortable giving up control. Therefore differences in organizational philosophies and perceptions of agency roles may interfere more with joint interaction in those communities that have not developed ways of negotiating differences.

Just difference of opinion, different focuses for the groups, different goals—it creates gaps in understanding. In any group you will have these dynamics to deal with.

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Whether it comes down to an individual personality, to the hidden agenda of a specific group coming to the table, or the need for control by another group, they all make it difficult to agree. While competition appears to be a barrier in several communities, the manner and degree to which it constitutes a barrier to collaboration differs. In one community, competition for fundraising between agencies may result in a refusal of particular groups to join inter-agency efforts, yet in another competition over issues of community profile may simply result in altering the design of promotional campaigns to reflect one unified image for the issue of heart health.

The interviews revealed that there are other more general factors which underlie the limited use of community development approaches in heart health promotion. I think the community development process takes a lot more time, and so that may be a factor in terms of funding, accountability, motivation for the people who are doing the work. I think its also a mode of work that a lot of people don't know how to do or what to expect in terms of results. Within some communities heart health is not perceived to be compatible with community development because of the a priori agenda focusing on heart health to the exclusion of community-identified issues.

I don't think they are compatible. And that doesn't mean that heart-health is not a necessary programme or not a good thing, but it's a contradiction to what community development means. In my understanding of community development the issues come from the community, heart health does not, so it cannot be a community development approach. But who knows, there could be something from the community that got identified in one of the lifestyle areas and it may be that we could tap into the heart-health programme and use some of their resources.

But heart health comes from a different end of the spectrum. In addition, heart health is often not considered a high priority in the community relative to other more immediate social and economic concerns. Given this public sentiment, heart health is unlikely to be identified as a priority issue. My sense is heart health is a model for other health and social issues in terms of how to go about organizing the community so that professionals working in the area of heart health are developing lots of skills that they could use in lots of different areas.

You don't want communities to be advising the health sector what to do, you want them to own the issue, you want them to be the ones that are creating and developing and designing the initiatives, strategies and plans that are going to be moved forward in your community. The research findings reveal a continuum of community approaches to heart health promotion.

Overlaid on this continuum is a trend towards increased collaboration and participation in all communities. Differences in heart health practice across communities are likely related to the complex of community contexts, levels and types of capacity, and the influence of particular facilitators and barriers.

In fact, it may not be realistic to advocate community development as a discrete strategy to be used in all community contexts. This in no way implies that community development is not a laudable goal toward which health promoters should strive; rather, the evidence presented in this paper underscores the need to address the context within which community approaches are used and in particular, the barriers affecting their use.

Goodman et al. The variable use of community development approaches is also based in the recognition that communities must meet their local needs. These contexts for community development include the atmosphere for partnering and history of inter-relations, which inherently shape the functioning of collaborative relationships, the basis of community development approaches. As these results indicate, in some communities the role of heart health programs forms an ongoing barrier to collaboration given that various issues e.

At the same time, other communities have used their heart health programs to galvanize collaborative relationships which developed around other important community issues. Community development approaches are adapted to community needs and altered to meet the realities of practice. The study participants perceived that inter-agency groups rarely come together without a predetermined issue or lead agency.

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