Abstract
Broad-based community partnerships are seen as an effective way of addressing many community, health issues, but the partnership approach has had relatively limited success in producing measurable improvements in long-term health outcomes. One potential reason, among many, for this lack of success is a mismatch between the goals of the partnership, and its structure/membership. This article reports on an exploratory, empirical analysis relating the structure of partnerships to the types of issues they address. A qualitative analysis of 34 “successful” community health partnerships, produced two relatively clear patterns relating partnership goals to structurel membership: (1) “collaboration-oriented” partnerships that included substantial resident involvement and focused on broader determinants of health with interventions aimed at producing immediate, concrete community improvements; and (2) “issueoriented” partnerships that focused on a single, typically health-related issue with multilevel interventions that included a focus on higher-level systems and policy change. Issue-oriented partnerships tended to have larger organizations governing the partnership with resident input obtained in other ways. The implication of these results, if confirmed by further research, is that funders and organizers of community health partnerships may need to pay closer attention to the alignment between, the membership/structure of a community partnership and its goals particularly with respect to the involvement of community residents.
Keywords: Collaboration, Community health partnerships, Community-based health promotion, Resident involvement
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References
- 1.Alter C, Hage J. Organizations Working Together. Newbury Park, CA: Sage Publications; 1993. [Google Scholar]
- 2.Butterfoss FD, Goodman RM, Wandersman A. Community coalitions for prevention and health promotion. Health Educ Res. 1993;8:315–330. doi: 10.1093/her/8.3.315. [DOI] [PubMed] [Google Scholar]
- 3.Chavis DM. The paradoxes and promise of community coalitions. Am J Community Psychol. 2001;29:309–320. doi: 10.1023/A:1010343100379. [DOI] [PubMed] [Google Scholar]
- 4.Lasker RD. Medicine and Public Health: The Power of Collaboration. Chicago, IL: Health Administration Press; 1997. Committee on Medicine and Public Health. [Google Scholar]
- 5.Fawcett SB, Paine-Andrews A, Francisco VT, et al. Using empowerment theory in collaborative partnerships for community health and development. Am J Community Psychol. 1995;23:677–697. doi: 10.1007/BF02506987. [DOI] [PubMed] [Google Scholar]
- 6.Florin PR, Wandersman A. Cognitive social learning and participation in community development. Am J Community Psychol. 1984;12:689–708. doi: 10.1007/BF00922619. [DOI] [Google Scholar]
- 7.Labonte R. Community empowerment: the need for political analysis. Can J Public Health. 1989;80:87–88. [PubMed] [Google Scholar]
- 8.Bracht N, Tsouros N. Principles and strategies of effective community participation. Health Promot Int. 1990;5:199–208. [Google Scholar]
- 9.Bradshaw C, Soifer S, Gutierrez L. Toward a hybrid model for effective organizing in communities of colot. J Community Pract. 1994;1:25–41. doi: 10.1300/J125v01n01_03. [DOI] [Google Scholar]
- 10.Residents Engaged in Strengthening Families and Neighborhoods. Baltimore, MD: Annie E1. Casey Foundation; 2003. [Google Scholar]
- 11.Minkler M. Community organizing, among the elderly poor in the United States: a case study. Int J Health Serv. 1992;22:303–316. doi: 10.2190/6KFL-N1WY-NPDG-RXP5. [DOI] [PubMed] [Google Scholar]
- 12.Eng E, Young R. Lay health advisors as community change agents. J Fam Community Health. 1992;15:24–40. [Google Scholar]
- 13.Hanson P. Citizen involvement in community health promotion: a role application of CDC’s PATCH model. Int Q Community Health Educ. 1988;9:177–186. doi: 10.2190/FMWL-59TW-T3CL-VJ16. [DOI] [PubMed] [Google Scholar]
- 14.Israel BA, Schulz AJ, Parker EA, Becker AB. Review of community-based research: assessing partnership approaches to improve public health. Ann Rev Public Health. 1998;19:173–202. doi: 10.1146/annurev.publhealth.19.1.173. [DOI] [PubMed] [Google Scholar]
- 15.Pilisuk M, Mcallister J, Rothman J. Social change professionals and grassroots organizing. In: Minkler M, editor. Community Organizing and Community Building for Health. New Brunswick, NJ: Rutgers University Press; 1997. pp. 103–119. [Google Scholar]
- 16.Stoecker R. Are academics irrelevant?: roles for scholars in participatory research. Am Behav Sci. 1999;42:840–854. doi: 10.1177/00027649921954561. [DOI] [Google Scholar]
- 17.Lasker RD, Weiss ES. Broadening participation in community problem solving: a multidisciplinary model to support collaborative practice and research. J Urban Health. 2003;80:14–60. doi: 10.1093/jurban/jtg014. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 18.Eisen A. Survey of neighborhood-based, comprehensive community empowerment initiatives. Health Educ Q. 1994;21:235–252. doi: 10.1177/109019819402100208. [DOI] [PubMed] [Google Scholar]
- 19.Minkler M, Wallerstein N. Improving health through community organization and community building. In: Glanz K, Lewis FM, Rimer BK, editors. Health Behavior and Health Education: Theory, Research and Practice. 2nd ed. San Francisco, CA: Jossey-Bass; 1997. pp. 241–269. [Google Scholar]
- 20.Merzel C, D’Afflitti JD. Reconsidering community-based health promotion: promise, performance, and potential. Am J Public Health. 2003;93:557–574. doi: 10.2105/ajph.93.4.557. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 21.Kreuter M, Lezin NL, Young LA. Evaluating community-based mechanisms: implications for practitioners. Health Promot Pract. 2000;1:49–63. doi: 10.1177/152483990000100109. [DOI] [Google Scholar]
- 22.Hallfors D, Cho H, Livert D, Kadushin C. Fighting back against substance abuse: are community coalitions winning? Am J Prev Med. 2002;23:237–245. doi: 10.1016/S0749-3797(02)00511-1. [DOI] [PubMed] [Google Scholar]
- 23.Koepsell TD, Martin DM, Diehr PK, et al. Data analysis and sample size issues in evaluation of community-based health promotion and disease prevention programs: a mixed-model analysis of variance approach. J Clin Epidemiology. 1991;44:701–713. doi: 10.1016/0895-4356(91)90030-D. [DOI] [PubMed] [Google Scholar]
- 24.Koepsell TD, Wagner EH, Cheadle AC, et al. Selected methodological issues in evaluating community-based health promotion and disease prevention programs. Ann Rev Public Health. 1992;13:31–57. doi: 10.1146/annurev.pu.13.050192.000335. [DOI] [PubMed] [Google Scholar]
- 25.Mattesich PW, Murray-Close M, Monsey BR. Collaboration: What Makes It Work. 2nd ed. St. Paul: Amherst H. Wilder Foundation; 2001. [Google Scholar]
- 26.Hatch J, Eng E. Community participation and control: or control of community participation. In: Sidel Sidel., editor. Reforming Medicine: Lessons of the Last Quarter Century. New York, NY: Pantheon; 1984. pp. 223–245. [Google Scholar]
- 27.Puska P, Nissinen A, Tuomilehto J, et al. The community-based strategy to prevent coronary heart, disease: conclusions from the ten years of the North Karelia project. Ann Rev Public Health. 1985;6:147–193. doi: 10.1146/annurev.pu.06.050185.001051. [DOI] [PubMed] [Google Scholar]
- 28.Wagner EH, Wickizer TM, Cheadle A, et al. The community health promotion grants program in the West II: changes in attitudes, environments and behaviors. Health Serv Res. 2000;35:561–589. [PMC free article] [PubMed] [Google Scholar]
- 29.Farquar JW, Fortman SP, Flora JA, et al. Effects of community-wide education on cardiovascular disease risk factors: the Stanford five-city project. JAMA. 1990;264:359–365. doi: 10.1001/jama.264.3.359. [DOI] [PubMed] [Google Scholar]
- 30.Commit Research Group Community Intervention Trial for Smoking Cessation (COM-MIT): I. Cohort results from a four-year community intervention. Am. J Public Health. 1995;85:183–192. doi: 10.2105/AJPH.85.2.183. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 31.Proceedings of the Enhancing Community Capacity: California Healthy Cities and Communities Annual, Conference, April 26–28, 2000. San Diego, CA: Center for Civic Partnerships; 2000. [Google Scholar]
- 32.Wallerstein N. Power between evaluator and community research relationships within New Mexico’s Healthier Communities. Soc Sci Med. 1999;49:39–53. doi: 10.1016/S0277-9536(99)00073-8. [DOI] [PubMed] [Google Scholar]
- 33.Kaye G. Grassroots involvement. Am J. Community Psychol. 2001;29:269–275. doi: 10.1023/A:1010382714491. [DOI] [PubMed] [Google Scholar]
- 34.Steps to a healthier US initiative [homepage on the Internet]. The, power of prevention: steps to a healthier US-a program and policy perspective. Maryland, MD: US Department of Health and Human Services. Available at: http://www.healthierus.gov/steps. Accessed September 15, 2005.
- 35.Minkler M, Frantz S, Wechsler R. Social support and social action organizing in a “grey ghetto”: the Tenderloin experience. Int Q Community Health Educ. 1982;3:3–15. doi: 10.2190/5Q74-0DEQ-CYN7-GR5C. [DOI] [PubMed] [Google Scholar]
- 36.Baker EA, Brownson CA. Defining characteristics of community-based health promotion programs. J Public Health Manage Pract. 1998;4:1–9. doi: 10.1097/00124784-199803000-00003. [DOI] [PubMed] [Google Scholar]
- 37.Building Local Community-Based Public Health Systems: Midpoint Lessons Learned, and Policy Recommendations from the partnership for the Public’s Health. Oakland, CA: Public Health Institute; 2004. [Google Scholar]
- 38.Berkman LF, Glass T. Social integration, social networks, social support and health. In: Berkman LF, editor. Social Epidemiology. New York, NY: Oxford Press; 2000. pp. 137–173. [Google Scholar]