Building capacity in disadvantaged communities: Development of the Community Advocacy and Leadership Program

Abstract

Background.

Successful community groups have the capacity to mobilize community assets to address needs. Capacity building education is integral to building competent communities.

Objectives.

A community-university team developed and pilot tested an education program for community advocates from disadvantaged neighborhoods with high chronic disease burden.

Methods.

The Community Advocacy and Leadership Program (CALP) included eight monthly workshops, a mini-grant opportunity and technical assistance. A nominal group with community health practitioners, focus group with community advocates and a literature search comprised a triangulated educational needs assessment. A participating pretest with thirty-five community health practitioners guided curriculum refinement. Seven representatives from three community groups in a medically underserved South Carolina county participated in pilot implementation and evaluation. Qualitative and quantitative data informed the process and impact evaluation.

Conclusions.

The mean knowledge score at one month post-program was 77% (range=52% to 96%). The mean score on post-program self-assessment of skills improvement was 3.8 out of a possible 4.0 (range=3.6 to 4.0). Two groups submitted successful community mini-grant applications for playground improvements, and the third group successfully advocated for public funding of neighborhood park improvements. Participants reported favorable impressions and both personal and community benefits from participation. A community-university partnership successfully conducted a local educational needs assessment and developed and pilot-tested a capacity development program within a CBPR partnership. Successes, challenges and lessons learned will guide program refinement, replication and dissemination.

Community coalitions, community-based organizations and neighborhood associations are essential partners in community-based, participatory research (CBPR). Successful communities have the skills to mobilize human and community resources to address community needs,¹ therefore, building community members’ capacities is integral to the CBPR goal of nurturing a “competent community.”² Community capacity is a means to improving health and an endpoint of community health initiatives.^3,4

Definitions of community capacity and characteristics of effective partnerships have been described;^1,3,5–10 however, there is no consensus on a knowledge and skill set, necessitating an educational assessment to identify learning objectives and tailor a curriculum to the local community’s educational needs.¹⁰ The purpose of this paper is to describe the development, implementation and pilot testing of a capacity-building program tailored to community advocates in disadvantaged neighborhoods.

The Partnership

A community-based organization (CBO) and university research center (Prevention Research Center (PRC)) were engaged in a CBPR partnership since 1998, focused on creating an active community environment,¹¹ both county-wide and in disadvantaged neighborhoods with high chronic disease risk and low access to resources. As part of priority-setting sessions, advocates from six disadvantaged neighborhoods, who served on the CBO’s Accessibility and Outreach Committee, had identified community concerns related to physical activity, health and quality of life (Table 1). The community advocates endorsed the need for education to enhance their capacities, thus CALP was developed within the existing CBPR relationship to meet the needs of community advocates from community groups in underserved communities. As the key actors in the CBPR partnership’s goal of addressing health disparities, the Accessibility and Outreach Committee members focused on advocating for changes in underserved communities in the county, supporting networking among local community groups, and building community capacity. The goal of the CALP project was to develop and pilot test an educational, capacity-building program that enabled community advocates to assess existing human and community assets and apply new knowledge and skills to address community health issues, both within the CBPR partnership and on their own.

Table 1.

Community advocates’ concerns

Community-level

Crime: vandalism, drug activity

Run-down buildings

Inadequately maintained public and private properties

Stray animals, need for animal control

Lack of safe places to walk

Few or no safe recreation and play areas

Lack of amenities in existing parks: No restrooms, water fountains, trash cans, benches

Inadequate lighting

Individual and family level

Obesity

Diabetes

Insufficient physical activity

The community partners and university researchers developed and pilot tested the Community Advocacy and Leadership Program (CALP). Community representatives from the existing CBPR partnership (i.e., the community advocates) and community health practitioners participated in the educational needs assessment, pilot implementation and evaluation. The community partner (CBO) participated in a conference abstract submission to the American Public Health Association annual meeting and in preparation of this manuscript. See Figure 1 for a depiction of the partnership.

Figure 1.

A community-university partnership as the context for development of CALP

Note: Shaded boxes represent the CALP program partners.

Methods

Recruitment and Enrollment of Participants

Participation in the 2010 CALP pilot project was open to representatives from the six community groups in economically disadvantaged areas of a South Carolina county that were participants in the ongoing CBPR partnership on the coordinating CBO’s Accessibility and Outreach Committee. All six groups had previously received community mini-grants through the CBPR partnership to enhance environmental supports for physical activity; however, their existing capacities and experience varied. Participation was open to members of the six groups nominated by their group’s governing board, regardless of prior participation in the CBPR activities. Nominees submitted an application that responded to questions about themselves and their community’s projects, strengths, experience, and skills; plans to involve the community group in a mini-grant project; commitment and availability. A CBO-university team comprising the CBO’s Executive Director and her Executive Assistant and two university PRC staff persons (CALP workshop facilitator and CALP evaluator) reviewed applications, interviewed applicants and completed a nominee rating form. They presented their ratings and impressions to CALP’s principal investigator, and the group reached consensus on participants.

Educational Needs Assessment

To obtain community, academic and health promotion practice perspectives, a triangulated assessment process used a nominal group with a practitioner advisory group, a focus group with community advocates and a literature search. Triangulation uses multiple information sources to provide a more thorough description of educational needs than a single source can provide.^12–14

Nominal group process with community health practitioners

The project’s lead researcher and two staff persons facilitated a nominal group¹⁵ with practitioners using the following steps: verbally generate a list of topics (i.e., knowledge and skill areas); clarify the meaning of the topics; organize/categorize the topics; and individually, select top choices and rank order them. Participants rank ordered their top 15 topic choices. Rankings were summed and ordered from highest to lowest.

Focus group with community representatives

A focus group with CALP participants prior to the start of the workshops identified their perceived educational needs and preferred learning methods. The 90-minute focus group was audiotaped with verbal consent, and staff observers took notes. Workshop topics and learning preferences were extracted. The university’s CALP project full-time workshop facilitator facilitated the focus group, while the CALP’s evaluation staff person and the CBO’s Executive Director observed the focus group, took notes and audiotaped the discussion.

Literature search

The literature search employed scientific and general search engines with terms such as community health advocacy, community advocacy training, community capacity building, coalition building, and leadership training. The search yielded a list of knowledge and skills, which was synthesized. The search was broad but cannot be considered a systematic review of all relevant literature.

Institutional Review

The university’s Institutional Review Board deemed the project exempt, therefore written informed consent was not required. Participants received written descriptions of the expectations for participation. Group discussions were audiotaped with unanimous verbal consent

Workshop Curriculum Development and Pretesting

The CBO and the university team applied the educational assessment results to lesson plan development. Health promotion practitioners participated in mock workshops and provided a critique at the end. Table 2 shows the steps in curriculum development.

Table 2.

Steps in the Community Advocacy and Leadership Program Curriculum Development

• Community and university team conducted a triangulated educational needs assessment.

• Focus group with community advocates from the CBPR partnership

• Nominal group process with practitioner advisory group, including the community partner organization’s director

• Literature search

• Generated lists of knowledge and skills-related topics from the educational needs   assessment and identify commonalities to create a combined list of topics.

• Searched the published and gray literature for relevant learning materials of appropriate   educational level and content. Determined copyright status of potential materials.

• Put topics in logical order. Collapsed, expanded and combined topics to fit the time   frame of the half-day workshops.

• Created draft lesson plans with learning objectives and experiential learning activities.   Incorporate examples from community advocates’ past work to illustrate concepts.

• Circulated draft lesson plans among the community-university team for critique and   revision.

• Conducted a participating pretest with mock workshops with practitioners from public   health, social work and non-profit service agencies experienced in community advocacy.

• Audiotaped pretest session discussions to identify strengths and weaknesses.

• Summarized, discussed and incorporated practitioners’ suggestions.

• Revised lesson plans and re-circulated among the team for review.

• Implemented the pilot workshop curriculum among community advocates.

• Conducted process and impact evaluation.

• Summarized strengths, limitations and lessons learned.

The Mini-grant Component

Community mini-grants for underserved communities had been part of the ongoing CBPR partnership. The PRC used its CDC funding for past mini-grants and for the CALP mini-grant component. A committee member of the CBO had previously provided a mini-grant application and reviewer’s rating tool used from a community grants program of the health department, which the CBO and university team used as a template, slightly modified to fit the focus on active community environments. Previous mini-grant recipients (prior to CALP) had provided feedback through evaluation interviews on the strengths and limitations of the application and procedures. Based on these experiences, and through review of other examples of memoranda of agreement (MOUs) for CBPR, the CBO’s Executive Director and the university PRC’s staff created procedures and a MOU form, which included requirements for progress report. Early in the project year (by the third workshop), prospective applicants were required to meet with their community groups to agree on a project idea.

One CALP workshop session addressed grant writing and an in-depth explanation of the application and requirements. Requirements were the following: at least one representative present at ≥80% of workshops; ≤$5000 budget; $1250 in matching funds or in-kind contribution; project supports a physically active community; product (e.g., a walking track or playground) accessible to the entire community or service area and not on private property; and letters of support to document partnerships and matching fund commitments. Awardees had 12 months to complete their project and submit a final report. Progress reports and documentation of expenditures were required.

Technical Assistance

Project staff provided technical assistance as requested during the year of CALP workshops and the subsequent year (i.e., during mini-grant project implementation). A staff person helped the groups create action-oriented objectives to further their mission. The date, topic, action items, observations and progress toward objectives were recorded for each technical assistance contact. Project staff and the lead researcher met monthly to discuss the technical assistance activities, solve problems and identify resources or referrals.

Evaluation Plan

An overview of the CALP evaluation, including examples of questions and other data collection methods, is shown in Table 3. As part of the process evaluation, the university staff used simple databases to document CALP processes related to recruitment, community engagement (meetings and other contacts), technical assistance, workshop attendance, and mini-grant activities. Rating forms were used to evaluate mini-grant applications. Qualitative discussion guides were used in the curriculum pretesting, in a phone interview to assess satisfaction with technical assistance and in a focus group conducted one month after the last workshop to discuss participants’ impressions of CALP. Progress report forms documented mini-grant project implementation. At the end of each workshop, participants completed an anonymous satisfaction questionnaire.

Table 3.

Community Advocacy and Leadership Program Evaluation

Process	Method	Time
Workshop pretesting	a) Mock workshop pretest, discussion with interview guide; notes and audiotape Examples of questions	2–3 weeks before each workshop
	• Think about the workshop contents. Are the     contents appropriate for a grassroots leadership     training? If so, how? … what specific activities     make the workshop appropriate for this audience?     If not, what could we change to make the workshop     more appropriate?   • … As I name each [learning activity], please tell     me: a) How well did this activity convey the lesson     content? b) What was good about the activity? c)     What improvements or changes might be needed? …     which ones, if any, made you feel bored? Got you     excited? Seemed unclear?   • Additional questions regarding workshop flow,     comprehension, facilitator’s delivery, quality of     visuals, readability of handouts. b) Database describing pretest participants: Gender, race/ethnicity, role/profession c) Readability statistics of educational materials used in workshops (Flesch-Kincaid, SMOG)
Satisfaction with workshop content and delivery	Self-administered satisfaction questionnaire with 7 yes/no questions with space to explain the answer (“Please explain.”) and 2 open-ended questions	The end of each workshop
	• Was the information presented in a way that kept my     attention? Yes/No   • Was the workshop easy to follow and “user     friendly? Yes/No   • Was there two-way communication between me and     the workshop facilitator/participants? Yes/No   • Did I get a chance to take part and share my     thoughts and opinions with others? Yes/No   • Was the workshop put together in a way that made     sense and flowed? Yes/No   • Did I learn new information or skills I can apply in     my community? Yes/No   • Did attending this workshop advance my abilities as     a community advocate? Yes/No Open-ended questions   • What was the best part of today’s workshop?   • What aspect of today’s workshop could be     improved?
Document and describe - a) Community meetings, events and outreach b) CALP workshops & attendance c) Site visits d) Community contacts (recruitment, inquiries, applicants) e) Technical assistance tracking form	Excel databases to track activities of community engagement and technical assistance Date, Community group, Type and description of activity, Notes Topic, date, location, facilitators, notes Participant names and dates of workshops attended Date, community group, activity, notes Name, title, organization/agency,contact information, notes Date, time, location, attendance, purpose of meeting, items discussed, materials provided, follow-up action items	Ongoing throughout the project period
Impressions of CALP program, perceptions of individual and community benefits	Focus group with CALP participants; notes and audio-tape Examples of questions   • Please tell us overall what your experience in CALP     has been like. We are especially interested in any     experiences you have had inside or outside the     workshops. Let’s go around the table and make     sure everyone has a chance to tell their story.   • What was your group’s greatest challenge while     participating in CALP?   • What would you consider your community group’s     greatest success as a result of your participation in     CALP?   • How has the Community Advocacy and Leadership     Program affected you, if at all, in your community     advocacy activities?   • Going forward, what aspects of the CALP     experience will have the greatest impact on your     community group’s success, if anything? PROBE:     Give examples of how what you’ve learned will be     applied to your group’s work.   • Tell us what you think about the content of the     CALP. PROBES: Describe which workshops were     most helpful and least helpful. What did you think     about the number of workshops? Was there a topic     that we did not cover that you wished we had?	One month after workshop 8
Satisfaction with technical assistance	Structured telephone interview with questionnaire Examples of questions   • Describe the technical assistance you received.   • Please tell us what you thought about the technical     assistance you received.   • How do you plan to use the skills or information     learned?   • Any other comments or suggestions.	One month after workshop 8
Community’s documentation of CALP activities	Community scrapbook (one per community group) to include   • photos of the mini-grant project;   • agendas, attendance sheets and minutes;   • documentation of newspaper/media coverage;   • other documents related to mini-grant project such     as fliers of letters; community contact lists;   • community activity logs (key actions taken). Review of scrapbook - Audit tool   • Completeness of the scrapbook compared to the     requested content. Rated as low (1) – none of the     requested documents included, medium (2) – some     of the requested documents included, or high (3)–     all of the requested documents included; and   • Quality of the documents. Rated as poor (1),     acceptable (2) or good/very good (3).	Ongoing throughout project year Scrapbooks reviewed after Workshop 7
Knowledge achieved from workshops	23 item knowledge posttest Multiple choice and matching items assessed knowledge concerning   • characteristics of an effective and ineffective leader   • member recruitment strategies   • team-building strategies   • components of a grant proposal   • types of grant funder   • community health development   • needs-based and strengths-based approaches   • methods to gather community information   • ineffective/effective listening   • conflict resolution   • meeting facilitation   • talking points   • press releases and letter writing in community     advocacy   • components of strategic plan   • vision statement   • cultural competence   • types of electronic/social media.	One month post- workshop 8
Perceptions of skills achieved	22-item participant impact assessment questionnaire Please rate how much you think your skills have improved since workshop. 1 of CALP. 1-no improvement, 2-little improvement, 3-medium improvement, 4-much improvement, 9-uncertain [No participants chose “uncertain.”]	One month post- workshop 8
	Understanding of community needs and assets, resources available, how a group operates effectively Skills/abilities regarding   • conducting community assessment   • obtaining support from other organizations   • writing grant proposals   • solving problems   • influencing local policies through media advocacy     and political/policy advocacy   • designing and implementing a strategic plan   • writing measurable goals and objectives   • conducting meetings   • communicating effectively   • resolving group conflicts   • helping a group achieve its goals   • leadership ability   • building consensus   • creating a meeting agenda   • writing meeting minutes   • recruiting new members   • involving diverse members   • identifying and using community members’ talents Open-ended item: What is the greatest impact that CALP has had on you as an individual?

To encourage CALP participants to document their community advocacy and improvement activities and successes, each community group received a “scrapbook” in which to save documentation of their work and their mini-grant project or other community improvement projects. Items saved included photos, agenda, meeting minutes, community assets inventories and contacts, newspaper clippings. The team of the CBO’s executive director, the CALP workshop facilitator and CALP evaluation staff person used a brief rating tool to evaluate the completeness and quality of the scrapbook.

To assess program impacts, a meeting was held one month after the last CALP workshop. This evaluation included a guided discussion of CALP processes and individual and community-level benefits, a knowledge posttest and a skills and knowledge self-assessment questionnaire. The CBO’s executive director facilitated the post-workshops discussion group to encourage a candid critique of the CALP without university staff persons present, which could have introduced a positive bias.

The 23-item multiple-choice and matching knowledge test addressed the main points of each workshop. After the data collection, the CALP workshop facilitator reviewed questions and answers with the participants. The self-assessment questionnaire addressed perceived improvements in 22 types of knowledge and skills as a result of CALP participation. Both the knowledge test and the self-assessment were unannounced and anonymous. Administering the posttest and self-assessment questionnaire one month after the end of the workshops provided a more conservative and realistic indication of the CALP’s overall impact on knowledge and perceived skill attainment, as immediate posttests after each workshop would have been affected by short-term recall of one CALP workshop’s content and would include only participants present on the day of administration.

Results

Setting and CALP Participants

The setting was a medically underserved¹⁶ South Carolina county with a population of 107,456 residents (48.2% White, 46.9% Black/African American, 4.9% all other races or more than one race). Thirty-nine percent of the population is rural, and 15.5% percent of families have below poverty-level income.¹⁷

Six community groups were eligible to participate in the CALP pilot project. Of these, three chose to participate and nominated a combined total of nine representatives. The three participant groups were located in the county seat (100% urban), a nearby suburban community (78% urban) ) and a rural community (100% rural). The census tracts that circumscribe the three communities are home to large proportions of African American residents (49.6%, 64.4%% and 78.3%, respectively).¹⁷

Scores for the nine nominees on the rating form ranged from 14–38 (possible range, 9–39). Seven nominees were invited to be CALP representatives (6 African American women and (1 African American man) and one African American woman was invited as an alternate. One nominee could not perform the duties and did not participate.

Educational Needs Assessment Results

Nominal group process with community health practitioners

The six nominal group participants (4 White women, 1 African American woman, 1 White man) were community health practitioners from two universities’ community programs, the state and regional health department offices and a community-based organization, all of whom were experienced in community capacity development. The nominal group process initially generated 40 topics, then categorized them into 29 topics and ranked them. Ranks were summed and ordered from highest to lowest, producing a list of 17 topics. An additional topic, cultural sensitivity and inclusivity, had been agreed upon in advance of the rankings by consensus, making a total of 18 topics (Table 4) .

Table 4.

Capacity-building topics identified through the educational needs assessment

Nominal group process (practitioners)	Literature search	Focus group (community)
Team building	Team-centered approach Stakeholder control	Team building/effective team
Communication skills	Communication skills	Communication skills
Community mapping (community assessment)	Community/problem assessment	Learn what resources are already available
Grant writing	Grant writing	Grant writing/finding funding
Group/meeting facilitation	Group process skills, including conflict resolution
Community development/Community organizing	Community development/ Community organizing
Effective leadership skills	Effective/collaborative leadership
Strategic planning	Strategic planning and evaluation
Relationship between chronic disease and community environment	‘Asking Why?’ (root causes of health and social problems, inequities); Broad understanding of community problems
Media relations	Media advocacy / linkages to media
Action planning2	Program design, implementation and evaluation
Using technology (computer skills)	Using electronic resources (computer skills, technology)
Sustainability1	Sustainability / institutionalization
Building a volunteer base	Recruiting and retaining volunteers
Legislative/policy advocacy	Advocacy
	Networking (equitable linkages) and collaboration	Networking
	Community participation and involvement	Participation / how to get more community involvement
	Resource mobilization	Resource mobilization
Inclusivity and cultural competence	Inclusivity/diversity
	Data management
Local government organizations (Note: Topic was combined with Policy/Political Advocacy)
Organizational self-assessment1		Board training

¹Note: Topic was combined with Strategic Planning workshop.

²Note: Topic was covered in the Strategic Planning and Grant Writing workshops.

Focus group results with community representatives

Focus group participants were six of the seven community representatives selected to participant in the CALP. They participated in the needs educational assessment focus group as a first step prior to the workshops. The needs assessment focus group identified eight workshop topic areas (Table 4) and provided guidance regarding preferred learning styles. Participants requested “slides” and handouts, interaction between facilitator and participants, open discussion, active learning, “hearing and seeing,” and time to “think through” the information. They named role play; field trips; “energetic, stimulating, creative approaches;” a mixture of methods; and a casual, relaxed atmosphere. As dislikes they named “a lot of reading or writing” during workshops, being read to and “round robin” discussions.

Literature search results

The literature search yielded 22 topics. The three lists of topics from the nominal group, literature and focus group are shown in Table 4. Similar or overlapping topics were combined in the process of creating the workshop curriculum. Nineteen topics appeared in at least two of the lists, which were incorporated into workshop curriculum.

Mock Workshop Pretest Results

Thirty-five professionals from health, social services, community and faith-based settings who served communities similar to the CALP communities participated in the pretest sessions (five to twelve participants per workshop). Participants were 71% women, 71% African American and 29% White. The CALP workshop facilitator led the pretest sessions and subsequent discussion. She elicited general and specific suggestions. In addition to positive feedback on the workshops’ content, format and learning activities, suggestions for revision addressed increased participation in learning, improved clarity of some concepts and better transitioning in specific sections, re-ordering topics and re-prioritization of time devoted to some content areas.

Curriculum and Format

There were ten half-day sessions: an overview, eight workshops, and a final meeting that was an evaluation session and “graduation” ceremony. Table 5 shows an overview of each lesson plan and a list of learning strategies employed across workshops. Two skilled facilitators led the workshops. Each participant received $75 for attendance. Most workshops concluded with a community assignment to apply new knowledge, with experience described at the next month’s workshop.

Table 5.

Overview of the Community Advocacy and Leadership Program Workshops

Learning Strategies Lecture/discussion with audiovisuals: flipchart, videos, websites, printed handouts Role play with feedback and reinforcement Guest speakers Brainstorming Worksheets - In-class group practice Small group discussion Informational sheets, resource guides and CDs Community scrapbook	Questionnaires, self-assessments Community storytelling Problem-solving exercises Reflection/ Community group evaluation Discovery/Information search Visioning activities Guided group practice of new skills Questions and answers Community assignments - Skills practice
ORIENTATION MEETING  CONTENT • Introductions • Educational Assessment Focus Group Community Assignment: • Call a community meeting to agree on mini-grant project. • Identify partnerships with associations/organizations.	WORKSHOP 1: INTRODUCTION & LEADERSHIP Objectives: Participants will be able to Name two chronic diseases. Define how much physical activity is needed for health benefits. Describe how physical activity affects health. Define grassroots leadership. Identify three characteristics of an effective leader. Identify three characteristics of an ineffective leader. Assess personal leadership skills. Identify two community leaders to interview. CONTENT • CALP Program and Workshop Overview • Understanding My Role in Creating an Active Community Environment • Chronic Disease   - Moderate and Vigorous Physical Activity   - Preventable Causes of Death • Leadership   - Grassroots Leadership Defined   - Characteristics of an Effective Leader and an Ineffective Leader Community Assignment: • Assessing Needs and Assets: Interview Community Leaders.
WORKSHOP 2: TEAM BUILDING AND EFFECTIVE GROUPS Objectives: Participants will be able to Describe characteristics of a team. List four team-building strategies. Assess their group’s organizational characteristics using a Community Group Self-Assessment tool. Recognize the potential advantages and disadvantages of community groups working as a team. List four methods of recruiting new members. CONTENT • Team Building Strategies • Disadvantages and Advantages of Working Together as a Team • Characteristics of an Effectively Functioning Community Group • Methods of Recruiting New Community Members • Optimal Group Size Community Assignment: • Begin recruiting new community members using the methods described in class • Read mini-grant application and bring questions to next workshop	WORKSHOP 3: GRANT WRITING Objectives: Participants will be able to Identify typical components of a grant proposal. Write a goal, measurable objective, and activities. Describe elements of a budget and budget justification. Describe tips for an effective grant proposal. Identify at least two grant funding resources. CONTENT • Determining If You Should Apply for a Grant • Typical Components of a Grant Proposal • How to Write Goals and Objectives • Ways to Increase Chances of Being Funded • Finding Funding resources • Detailed Overview of CALP Mini-grant application with examples Community Assignment: • Begin CALP mini-grant application
WORKSHOP 4: COMMUNITY HEALTH DEVELOPMENT AND ORGANIZING Objectives: Participants will be able to Define community health development. Define community assessment. Describe two approaches to community assessment. Describe and give examples of three community assessment techniques. Describe at least three community health development strategies. CONTENT • Community Health Development/Organizing • Defining Community • Community Health Development Process • Community Assessment • Community Assessment Techniques: Overview • Community Interviews • Community Inventory • Networking • Policy Advocacy • Media Advocacy Community Assignment: • Conduct a Human Assets Inventory • Conduct a Community Assets Inventory	WORKSHOP 5: BASIC COMMUNICATION SKILLS, CONFLICT RESOLUTION, CHAIRING A MEETING & CULTURAL SENSITIVITY/INCLUSIVITY Objectives: Participants will be able to Define communication. List the two skills of an effective communicator. List two components of effective speaking. List four steps to active listening. Define assertive communication. Describe four components of assertive communication. Define conflict List three advantages/disadvantages of conflict. Describe five approaches to conflict. Define conflict resolution. Identify the three steps of conflict resolution. List the four values that a facilitator should foster in a meeting. List and describe the general duties of a facilitator in a meeting. Describe three techniques for building consensus. Apply the S. O. S. strategy in meeting facilitation. Describe strategies for managing difficult behaviors in a meeting. Define culture. Identify your own culture. Incorporate appreciation of others’ cultural background into community health development and advocacy. CONTENT • Active Listening • Effective Speaking • Assertive Communication • Conflict Resolution • Causes of Conflict • Steps to Resolve Conflict • How to Chair a Meeting • Duties of a Meeting Facilitator • Steps to Building Consensus • Building Relationships with People of Other Cultures Community Assignment: • Observe and Critique a Community Meeting in the Community
WORKSHOP 6: POLICY/POLITICAL ADVOCACY & MEDIA ADVOCACY Objectives: Participants will be able to Define policy advocacy. Describe policy advocacy activities. Define and use talking points. Describe components of a letter to an elected official. Define media advocacy. List four media advocacy channels. Describe three qualities of a letter to the editor. CONTENT • Community Health Advocacy Strategies • Policy Advocacy Potential Audiences • Policy Advocacy Strategies • Working with Elected Officials • Media Advocacy • Media Advocacy Channels • Preparing a Press Release • Writing a Letter to the Editor • Creating a Media Contact List • Guest Speakers: Tips on Effective Advocacy (e.g., mayor’s office, newspaper, radio, city and county council, law enforcement) Community Assignment: • Who Represents Me? Identify local, state and national elected officials.	WORKSHOP 7: STRATEGIC PLANNING Objectives: Participants will be able to Define strategic planning. Lists the benefits of strategic planning. Describe the characteristics of a good strategic plan. List the components of a strategic plan. Recognize and label a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis matrix. CONTENT • Definition of Strategic Planning • Benefits of Strategic Planning • Preparing for Strategic Planning • Characteristics of a Good Strategic Plan • Components of a Strategic Plan • Vision Statement • Mission Statement • Core Value Statements • Setting Priorities • SWOT Analysis (Strengths, Weaknesses, Opportunities, Threats) • Goals, Objectives and Activities • Writing a Strategic Plan Community Assignment: • Assessing Readiness for Strategic Planning • Bring Community Scrapbook
WORKSHOP 8: COMMUNITY RESOURCES & TECHNOLOGY Objectives: Participants will be able to Identify sources for grant funding. Identify three local computer technology training sites. Define social media and uses. List at least three social media sites. Describe at least two considerations when interacting with people living with a disability. CONTENT • Grant Resources • Finding Socio-demographic Data & Health Data • Nonprofit Training Opportunities • Nonprofit Resources • Social Media • Inclusivity continued from Workshop 5: • Guest Speakers: Interacting with people living with disabilities.   Community Assignment: • None	EVALUATION AND GRADUATION CELEBRATION MEETING • Knowledge Quiz • Participant Impact Assessment • Guided Group Discussion • Graduation   Photos, Certificates, Lapel pins

Workshop Process Evaluation

Readability

Readability was targeted to laypersons with high school education. Reading grade level computations vary across methods, so two commonly used methods, Flesch-Kincaid Grade Level Readability Formula²⁰ and the SMOG Readability Formula,²¹ were used to estimate reading levels for all printed educational materials that could be evaluated, such as handouts for in-session learning activities and community assignments.. Across 40 documents, the Flesch-Kincaid level ranged from 2.6 to 14.8 (mean=8.0). The SMOG level ranged from 5.8 to 14.8 (mean= 10.5). See detailed information about readability formulas at http://www.readabilityformulas.com/.

Attendance and satisfaction

Community representatives attended four to ten meetings (mean=8). Seven post-workshop satisfaction items were positively endorsed by all respondents after all eight workshops. Positive comments included facilitators’ skills; quality and practicality of materials; interactive, participatory nature; “upbeat,” comfortable environment; ease of understanding; confidence built to apply knowledge gained; content organization; and value of experiential learning activities. Negative comments addressed the setting, such as the room temperature.

Post-workshops focus group with participants

The main perceived benefits were empowerment to be more active in the communities, including interaction with decision-makers; enhanced advocacy through increased awareness of community needs; skills for increasing community involvement; skills applicable in other settings (e.g., church); and excitement about community improvement potential. Participants reported they learned skills to help them grow their groups and accomplish goals. Participants stated that [Community members] “ … are always asking about us [in CALP] and what’s happening,” and “ … more people are interested in being a part of our group after hearing our story.” Sources of pride included the community mini-grant project, large accomplishments by small groups, and greater group cohesion.

Community scrapbook audit

Three university reviewers (CALP workshop facilitator, CALP evaluation staff person, CALP principal investigator) rated the scrapbooks for completeness and quality of entries. The mean completeness scores by group were 11.0, 9.3 and 15.0 (grand mean=11.8) out of 18. The mean quality scores were 8.0, 7.3 and 13.7 (grand mean=9.7) out of 18. Strengths included community photos and community news coverage documentation. Weaknesses were incomplete or missing documents and extraneous materials.

Impact Evaluation Results

Perception of knowledge and skills achieved

Seven participants rated their improvement from 1 (no improvement) to 4 (much improvement) and responded to one open-ended question on a one-month post-workshops questionnaire (see Table 3 for items). The mean score was 3.8 (range=3.6–4.0). The perceived impacts of CALP were the following: proposal writing (n=2); how to get things done/work with the community (n=3); effective communication (n=1); insights and resources (n=1); materials being used in community meetings (n=2); improved overall skills (n=2); strengthened connections with community group (n=2).

Knowledge posttest

Seven participants completed the 23-item unannounced posttest one month after the last workshop (see Table 3 for items). The mean percent correct was 77% (SD=15.4, range=52% to 96%).

Mini-grant projects

Group submitted letters of intent and received feedback and approval to proceed with an application. A team of the CBO’s Executive Director and university’s CALP staff and principal investigator reviewed the applications using a rating tool adapted from previous community grant procedures, compared their scores and discussed strengths and weaknesses of the applications. Two groups were funded at $5000 each, which they combined with the required matching funds and in-kind contributions to install playground equipment in their communities. The third group’s application was not approved; however, this group was successful in advocating for and receiving park enhancements from the city valued at more than $31,000. Awardees submitted progress reports with receipts for expenditures and photos of completed projects. While an impact evaluation was not required of the grantees, park usage was monitored using the System for Observing Play and Recreation in Communities (SOPARC) protocol¹⁸ as part of a related study.¹⁹

Technical Assistance

Technical assistance contacts ranged from 1 to 29 per group. Requests focused on strategic planning, procuring funds, and developing ideas for community programs. Specific topics discussed were grant funding opportunities; review of grant applications in progress; review of strategic plans; revision of vision and mission statements, goals and objectives; referral for programmatic and skills-building information (e.g., school gardens, grants training); website content updates; and creation of a fundraising sponsorship packet.

Discussion

Despite the recognition that community capacity and leadership training are essential, few materials for laypersons exist. This paper describes the development of a community advocacy and leadership training program for use with lay community advocates. A systematic, triangulated approach used scientific literature, practitioners’ expertise, and community members’ perceptions. The curriculum was pretested, revised, and evaluated in a pilot program with participants from disadvantaged communities already in a community-university partnership. Participants reported favorable impressions and benefits from participation. Posttests showed satisfactory knowledge and attitudes.

The existing community CBO-university relationship contributed knowledge about community contextual factors and skill sets. Participants began the program enthusiastically with some experience in community advocacy, but initial capacity was uneven and low overall. Because we invited groups from a pre-existing partnership, an important next step is to replicate the program in a different location with a different coordinating CBO. A “train the trainer” approach would contain program costs, and CALP graduates could become role-model participants in future workshops.

Table 6 summarizes the primary lessons learned. Features that contributed to success included the pretesting sessions, experienced facilitators, guest panelists with real-world media and policy advocacy experiences, community-based assignments, mini-grant opportunity, and inclusion of orientation and evaluation/celebration sessions.

Table 6.

Successes, Limitations and Lessons Learned

Successes	Limitations and Lessons Learned
The mini-grant process provided practice of grant-writing and an opportunity for quick success. The requirement to obtain matching funds was a confidence-building component.	Weak writing skills and intra-group challenges can lead to a disappointing mini-grant application. Requiring a letter of intent may have helped participants avoid procrastination and encouraged better conceptualization of the project idea. Discussing an example of a completed mini-grant application during the workshops may be useful; however, any tendency to mimic an example too closely should be discouraged. The position of the grant-writing workshop in Session 3 was driven by the project’s funding cycle to allow for applications, review and award letters within the given time frame. In future provision of CALP, participants may benefit from later placement of this material. Other means besides writing grants for obtaining financial support was encouraged (e.g., advocacy to obtain infusion of public funds, partnering with larger organizations, finding volunteer helpers). This may be especially important for inexperienced community advocates without strong writing skills. The position of the grant-writing workshop in Session 3 was driving by the project’s funding cycle. In future provision of CALP, participants may benefit from later placement of this material
Guest panelists provided real examples of media and policy advocacy and were well received.	Workshops held on Saturday, at participants’ request, presented an obstacle to guest panelists’ participation. At least one evening session for the guest panelists may be useful.
Community assignments enhanced participants’ engagement with community leaders and provided hands-on learning.	Although reading levels of all materials were at high school level and below, reading and writing deficiencies in some participants presented a challenge to completing in-workshop activities and community assignments (e.g., taking notes during an interview, creating an inventory of community assets). Learning activities during workshops that involved writing were facilitated to allow verbal sharing and thus avoid revealing reading or writing weaknesses.
The network among participants for information sharing was strengthened through the workshops.
Presence of two experienced co-facilitators led to a smooth, organized workshop experience.	When participants bond with facilitators, they seem unwilling to give any constructive criticism on post-workshop evaluation forms. The value of constructive criticism and the lack of negative ramifications for staff persons should be emphasized. The CALP staff did not facilitate the final evaluation focus group. To encourage candid responses, the CBO’s executive director, a community member herself, facilitated.
The stipend provided at the end of each workshop was appreciated, especially as some participants had to travel a considerable distance.	The stipend was provided to lend an atmosphere of professionalism and convey respect for the many hours of uncompensated volunteer time devoted to community advocacy. Guidelines stated that late arrival or early departure (more than 15 minutes) would result in no stipend for that workshop. Though agreed upon in advance, and intended to create fairness among participants, this nevertheless created awkwardness for the workshop facilitator when a late arrival of one hour occurred. This component needs to be revisited for future offerings of CALP. One participant had poor attendance. Tardiness was a challenge for another, which can be disruptive to the group process. Time at the beginning of each workshop to discuss the past month’s community assignment experience reduced the amount of new material that latecomers missed.
The orientation and evaluation/celebration meetings were valuable in setting the context for learning and recognizing successful engagement.
	Conveniently located, reliably available meeting space with Internet access was not readily available in this community. Not all workshops were held in the same location, leading to occasional confusion about location even though changes were communicated.
Pretesting of workshop content and activities with community health practitioners enhanced the curriculum content and format and provided practice to facilitators.	Some lesson plans contained too much information for the time available and/or included redundant information. The order of presentation was not optimal and would benefit from re-ordering. A pilot implementation period such as that employed in this study, with time for revisions, is essential prior to replication and dissemination.
Low or no computer skills among some participants presented a challenge in advancing their skills as community advocates.	Accommodations were made for participants without email accounts or Internet access, and Workshop 8 included information about technology resources; however, additional hands-on practice in accessing websites and online videos would have enhanced the learning experience. Some participants remained resistant to learning computer technology, while one enrolled in a free, basic computer course at a local community college. Linking community advocates to computer-literate community volunteers may be a viable option.

Challenges need to be addressed in replication and dissemination efforts. Building capacity in disadvantaged communities is CALP’s goal; however, modifications are warranted to assist laypersons with limited writing skills. Providing an example of a successful grant proposal may be useful for those with little experience. Emphasizing the importance of other forms of fund raising and collaboration with other non-profit groups may be necessary for participants who find proposal-writing particularly daunting. Reading and writing challenges can interfere with workshop activities and community-based assignments. Facilitators must be discrete in making adaptations so that participants’ experiences are meaningful without revealing reading or writing weaknesses to the group. For example, reading instructions for learning activities aloud to the group and allowing participants to verbally supply their ideas while the facilitator records them on a flip chart or projects them onto a screen may be preferable to activities requiring writing. Having participants team up to do community assignments may be helpful as well by pairing greater and lesser skilled participants to complete activities.

A related challenge was the lack of computer skills. Some of the participants were not comfortable with or interested in using computers, which presents a challenge in advancing advocacy skills. Some, but not all, participants were open to increasing computer skills. Inclusion of adequate hands-on computer training may be beyond the scope of a community capacity training program. Linking advocates to other computer training options and to computer-literate community volunteers may be a viable option to address this challenge.

Careful consideration of logistical issues is important. For example, CALP participants wanted Saturday sessions and guest speakers, but guest speakers were usually not available on Saturdays. Convenient community meeting spaces did not always provide needed resources such as Internet access, so meeting locations changed over time, which created some confusion.

The provision of stipends needs to be revisited for future offerings of CALP. Stipends help to instill an atmosphere of professionalism and convey respect for uncompensated volunteer time. Participants agreed upon a contingency of reasonable on-time arrival (no more than 15 minutes late) and workshop completion to receive the day’s stipend, but facilitators found its application awkward when a significantly late arriver or early departer expected the full stipend. Significant tardiness or early departures were the exception, but when habitual they may interfere with group dynamics and learning.

Finally, when CBPR partners in control of funds (both university staff and CBO staff) review mini-grant applications from community advocates who are laypersons, there is a risk of damage to the relationship when applications do not meet the basic requirements and are not approved for funding. Regardless of the applicants’ failure to follow basic application guidelines, and the reviewers’ leniency in applying the review criteria, laypersons may assume that all applications will be funded because of the positive existing relationship. During the CALP pilot, we were on a short timeline to get the applications reviewed. While there was no serious negative impact on the partnership between the university, the CBO and the unfunded community applicant, we recommend avoiding the risk by using an external review panel of CBPR researchers and practitioners, including some from the community when possible, as we had done in previous initiatives. Finally, providing guidance on how to revise the unfunded proposal and locate other funding sources is an important part of technical assistance.

The CBPR literature describes the importance of effective partnerships and the various aspects of community capacity, however rarely are the specific steps taken to conduct a thorough educational needs assessment and apply the findings to curriculum development described. Our contribution is the description of specific steps to conduct a careful triangulated needs assessment of lay community advocates, community health practitioners and the CBPR literature; synthesize the findings to develop a curriculum, conduct the pilot implementation and evaluation process; and identify lessons learned, all within an existing CBPR partnership. Future work will focus on the application of lessons learned, replication and evaluation with new partners in preparation for dissemination of the CALP curriculum through a train-the-trainer approach. These steps from CALP are adaptable to a range of settings, topics and community-based initiatives that include a training component for lay community advocates.