The effectiveness of community development in health is enhanced by partnerships between health and other sectors such as education, housing, arts or sport, or in programs such as community building and neighborhood renewal. Community development approaches to health promotion are generally poorly identified in planning and practice. Concepts such as empowerment, community engagement and participation are commonly referred to as either processes or out- comes, but often given token effort and paid only lip service. Community development is not a single track in health promotion programs. Health promotion practice entails the planning and implementation of interventions which may take many forms. Evidence about the effectiveness of health promotion demonstrates that one-off programs at a single level of intervention have little value, and that multi-level approaches delivered intensively over longer periods of time are much more likely to create sustainable change. The Framework for Health Promotion Action (Murphy, 2004) illustrates the different levels of health pro- motion interventions and shows where community/health development is situated in relation to other interventions.
Community participation, engagement, empowerment and action Consumer participation in health service development has been built into the planning of health services for at least 20 years, and there is a substantial body of literature about strategies which are designed to improve health services through consumer participation. There are many excellent resources such as kits, fact sheets and reviews to assist health services with community participation strategies and consultation processes. However, there are challenges in achieving effective consumer participation strategies. Token or symbolic community representation on advisory groups can allow health services to 'tick the box' those consumers have been consulted, based on the erroneous belief that one or two selected (rather than elected) people can genuinely represent the diversity and complexity of consumers in any community.
Further, organizations are not usually provided with adequate resources to undertake consultation with the communities they are supposed to represent. Genuine participation actually involves more than token consultation with one, or even a few, people from the community. Another criticism of consumer participation is that its strategies are much more likely to give voice to people who are already empowered by education and who are in relatively comfortable circumstances. There also appears to be very little evaluation available of consumer participation activities or strategies.
Health Promotion Strategies Related to "Income and Social Status"
Consumer engagement is a term that is somewhat more in its infancy (Bush, 2002) than consumer participation. Consumer engagement is emerging in relation to health promotion as a strategy to improve the use of, and access to, services. In this context, consumer engagement seeks to increase the uptake of health services by a more diverse range of consumers, particularly vulnerable population groups including those experiencing disadvantage and/or social exclusion.
The processes and philosophy of consumer engagement include the enhancement of services so that they are more likely to be used or taken up by those consumers. Through engagement with consumers and their subsequent participation, enhancement and quality improvement of services is more likely to occur. Thus community engagement is also about issues of reach as well as shared power and shared decision-making.
A theory of motivation that may be used to change behaviors towards health promotion actions related to "Income and Social status"
When members of a community are engaged with an issue of concern to them-that is, an issue that they have defined as being a determinant of their health-more effective engagement with the processes of community action are likely to result. For example, communities feeling threatened by plans to locate a facility that will have a negative impact on their locale (e.g. A toxic waste facility) often show remarkable capacities to organize and resource themselves in order to mount a campaign to oppose the planning scheme. They will often demonstrate a sophisticated understanding of the problem-for example that a toxic waste facility needs to be located away from sensitive environmental areas, from waterways and agricultural land because contamination will pose threats to the health of people or native habitat that may come into contact with toxic waste. Such communities become empowered by this theory of motivation.
Brief Overview of the Theory
A different example is when a health practitioner has developed a program that he/she then attempts to implement in a community setting. For example, a diabetes / healthy lifestyles education program that has been developed on the basis of staff, consumer and key service provider consultation will have limited appeal to marginalized groups.
Explain Your Rationale for Choosing This Theory
The program will have greater success in reaching people whose first language is English, who have access to transport, and who are...
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