4cipc barcelona community readiness

Health-Illness Care

Community Readiness for Primary Health Care

Isidro Maya-Jariego, Daniel Holgado & Ignacio Ramos

Departamento de Psicología Social(Universidad de Sevilla)

24cipc BCN-2012

"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 <isidromj@us.es>Ignacio Ramos <

ignacioramosvidal@hotmail.com>Daniel Holgado <daniel.holgado@gmail.com>