I am very pleased to be here today with Bob Goodman and our academic partners. I am most grateful that my friend, and community partner, Alejandro Molina, is here to co-present. Before we start, I would like to acknowledge Dr. Noel Chavez, Dr. Rise Jones, and Marilyn Willis as co-investigators on this project. I am very pleased to have masters student Dr. Swapna Sarwardekar and doctoral student Jeannie Concha here today because they joined the study in the analysis phase; they are knowledgeable about the community and have contributed greatly to the ideas presented here. And most importantly, we have a study participant here, Lolita Lopez, who decided to enroll in our MPH program. Because of time constraints, we wont read every slide aloud but will comment on them instead.
Social capital is considered as potentially important for designing collaborative community- based solutions to reduce health disparities. In the 3 rd objective, we see that we have much to learn from the perspectives and resources that communities have developed; and from their experiences about particular health issues. In this regard, we never “start from scratch” when designing interventions. We start with an understanding of community processes and assets and work to build them into interventions, and enhance them, at the direction of the community.
There is a paucity of literature relating social capital to community- based health promotion; and specifically to community context. Dr. Marshall Kreuter, formerly of CDC, offers a brief definition on your right. The full reference is on the cream colored handout. Programs that emerge out of community SC are likely to be participatory, foster democratized inquiry, and build on current community resources and skills. So, Social Capital is regarded as a social protective factor in health. It can influence ecologically valid program design, implementation and sustainability.
Within the community, we focused on the role of community- based organizations because collaborative partnerships to improve community health typically involve one or more organizations. We recognize this term is used broadly and so we mean “community- based” not just “community -placed”. The CBO’s function as an expression of the will of the community; they are mediating structures- connecting local social and organizations networks within the community and to the broader society; they have moral authority by virtue of their history and record on improving the quality of life with consistency and integrity in the process- reflecting the voice and experience of the community. They are vehicles for mobilization and for dissemination and clarification of information and ideas. We rarely talk about the affective component of CBHP or health behavior change, and people’s emotional response to a health issue can either facilitate or hinder their readiness to take action. Some population- based health approaches to health promotion might be seen as de-personalized and de-contextualized, inadvertently keeping away the very people who need programs. However, if programs and organizations are ecologically valid, i.e.,reflecting themes in the daily experiences of the community, they will be experienced as authentic and people will be drawn to them. Alejandro will illustrate these ideas when he presents our findings.
We had community involvement through conceptualization and analysis. Another unique feature is that we provided manuals with the study questions and methods, not only for the interviewers but also for the interviewees. We respected the community’s ability to think for itself and to ask US questions. We practiced a reciprocal learning model, meaning that everyone learns from each other. In this slide, we did the usual activities for a qualitative case study- but the participatory process involved much more than that. One of the challenges of doing this engaged research, is that the efforts to make the study truly participatory are not fully funded, if funded at all. Yet we believe we could not get the quality of information we have without full participation. So not only is democratized inquiry the right thing to do, but it improves science.
Note: discuss eco-identity Our process of analysis for this case study is based on assumptions about how knowledge is created. In this study, we drew upon a phenomenological approach to inquiry, i.e. an independent subjective meaning that is ascribed to life experiences that is not immediately apparent to the outside observer. The iterative process of going back and forth to the community for obtaining additional data and clarifying meaning is a traditional part of participatory, qualitative inquiry (also called Member Checking). We found that it is difficult to understand social capital without considering local culture AND without directly experiencing it. Therefore, additional data from community ethnography was incorporated into the current project using grounded theory approach. I looked at the intervdiiw data in the light of other sources of information from the ethnography (during a summer workshop at the International Institute for Qualitative Research at the U of alberta)and realized that we have a core concept: projecting a postive cultural identity. I also realized that social capital ais mediated through cultural capital. One has to look at the broader comuty conetxt in which social capital processes evolve and operate on the social environment. REFER TO DIAGRAM ON HANDOUT A consequence of the self reflective process inherent in this work is taking on an “eco identity”
HIV continues to be a critical public health issue among the Puerto Rican population in the U.S. and on the Island. As a health promotion initiative of PRCC, Vida/Sida Health prevention programs are targeted toward life experiences of community sub-groups. The following slides will show how elements of social capital, informed by cultural capital, allow for the creation, success, and sustainability of Vida/SIDA. I will now talk about what we encountered through the interviews and through Michele’s ethnography.
UIC qualitative research found that Vida/SIDA was a community -driven organization. It comes out of collective action and community participation. It began as a volunteer project with the PRCC alternative high school students as a community project and later became institutionalized within the community, and was funded by CDC.
When we talk about cultural competency, these organizational characteristics represent a sense of ecological validity to the extent that the organization can establish trust and express caring and concern for the community and its related issues. A critical element of this ecological validity is reflecting back meaningful themes in the lives of the people of the community with some precision. This is also important for cultural competency in programs, and it is far less common than we might hope.
Under the domain of community characteristics, the UIC researchers were able to capture how our community establishes a unique identity, with members expressing a sense of belonging and participation. The expression of multiculturalism with a sense of unity across cultures also contributes to the broader sense of community, social responsibility and is seen as vital for the program. A community- driven agency, unlike an outside organization, has the community’s interests as its center.
Since it’s inception, the PRCC has understood trust and shared identity as being essential for making an impact in the community. The first quote speaks to the sense of shared community and the concept of fluid boundaries in terms of work vs. community roles. The complexity and flexibility, and tension inherent in these roles, provides a sense of trust and belonging. Furthermore, people in these dual roles also experience sense of authentic contribution to the welfare of the community at the macro-level.
Taking collective action for the greater good and the formation of alliances and partnerships also exemplifies social capital in the community. The democratic value expressed in these quotes represents how the social norms and expectancies contribute to increased community action.
Michele first approaching us with the idea for this study prove to be an enlightening experience for her. She thought that we might not be familiar with the concept of SC, yet in a very short time, both the Executive Director, and the head of the community development association clarified, in a very succinct manner, the matter for her. Jose, the ED, said, “That’s like saying when Columbus landed here, there was nothing.” And Enrique said, “That (SC) is how we do so much with no money.” This slide and the following one summarize some key aspects of Social Capital in our community. For a better idea of the process under discussion, see the cream-colored handout.
It is important to recognize limitations in our research. Because of the nature of our inquiry we did not focus on quantifiable aspects of social capital, e.g. assessing the prevalence of social trust or assessing social and organizational networks, or counting the number of social settings for community discourse and interaction. A complementary quantitative study would greatly add to our knowledge of social capital. Similarly, a longitudinal study about how the community organization and program developed over time would yield a deeper level of understanding of the role of social capital. Although we have some limitations there are advantages as well. As a student Swapna has developed a practicum in the community and we are all working on developing interventions across the life span for “a community of wellness” concept that the PRCC is developing.
READ THIS SLIDE Do you have anything to add Michele?
Apha2003 110903 Fina Lalm
Social Capital and HIV Prevention In a Puerto Rican Community: A Participatory Assessment of the Vida/SIDA Project University of Illinois at Chicago School of Public Health Maternal and Child Health Program, Health Research and Policy Centers & the Puerto Rican Cultural Center Funded by the Centers for Disease Control and Prevention (rev.110903)
<ul><li>Project Goal </li></ul><ul><li>To describe a community-driven response to the HIV/AIDS crisis using social capital terms and concepts. </li></ul><ul><li>Objectives </li></ul><ul><li>To understand community definitions of social capital. </li></ul><ul><li>To describe the role of a CBO and it’s programs in fostering </li></ul><ul><li>and enhancing social capital. </li></ul><ul><li>To consider the processes by which CBO’s employ </li></ul><ul><li>elements of social capital in organized efforts to improve </li></ul><ul><li>community health e.g. HIV/AIDS. </li></ul><ul><li>To understand how the participatory methods impacted </li></ul><ul><li>the science as well as the researchers and community. </li></ul>
What is Social Capital? <ul><li>A multi-dimensional construct usually applied to describe </li></ul><ul><li>communities and the relations among people who live there </li></ul><ul><li>… those specific processes among people & organizations, working collaboratively in an atmosphere of trust, that lead to accomplishing a goal of mutual social benefit. (Kreuter et. al., 2001 ) </li></ul>
Role of Community-Based Organizations <ul><li>Expression of the local ecology </li></ul><ul><ul><li>Not just “community-placed” </li></ul></ul><ul><li>Level where issues are identified/framed </li></ul><ul><ul><li>Engaged in ongoing “struggle” </li></ul></ul><ul><li>Strategies (programs or social action) are developed as a response to issues </li></ul><ul><li>Space for social interaction </li></ul><ul><ul><ul><ul><ul><li>Encourage community discourse about critical issues </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Intersection of disparate social networks </li></ul></ul></ul></ul></ul><ul><ul><ul><ul><ul><li>Mechanisms created for shared awareness among community members </li></ul></ul></ul></ul></ul><ul><li>Linkages to the broader society </li></ul>
Procedures <ul><li>Formation of Community Advisory Board </li></ul><ul><ul><li>Case study criteria & nominated organizations </li></ul></ul><ul><ul><li>Develop instruments and interview manuals </li></ul></ul><ul><li>CBO and community background information </li></ul><ul><li>Data collection </li></ul><ul><ul><li>Discuss research ethics and methods; informed consent </li></ul></ul><ul><ul><li>Semi- Structured Interviews with CBO affiliates </li></ul></ul><ul><ul><li>Had manuals for leaders being interviewed </li></ul></ul><ul><ul><li>Tapes transcribed and translated </li></ul></ul><ul><ul><li>Data entry </li></ul></ul><ul><ul><li>-Text entered into Atlas.ti </li></ul></ul><ul><ul><li>-Coded at two levels within “families”; codebook created </li></ul></ul><ul><ul><li>-3 way reliability </li></ul></ul>
Process of Analysis <ul><li>Five broad domains ( organizational characteristics, community characteristics, organizational impact, community participation, action for change ) </li></ul><ul><li>Collaborative, negotiated process </li></ul><ul><li>Triangulation of data </li></ul><ul><ul><li>Community epidemiological data & organizational data </li></ul></ul><ul><ul><li>Semi-structured interview data </li></ul></ul><ul><ul><li>Ethnographic data (Puerto Rican community) </li></ul></ul><ul><li>Iterative process with member checking </li></ul><ul><li>Researcher self-reflection </li></ul><ul><li>Co-creation of knowledge </li></ul><ul><ul><li>Sharing methodology through community workshop </li></ul></ul><ul><ul><li>Discovery and validation of indigenous theories </li></ul></ul>
Vida SIDA: A Program of the Puerto Rican Cultural Center (PRCC) <ul><li>PRCC is an umbrella organization, founded to improve the quality of life and to promote the culture of the Puerto Rican people. </li></ul><ul><li>Vida SIDA is a community-driven response to HIV crisis </li></ul><ul><li>Has culturally tailored health education and testing services </li></ul><ul><ul><li>Testing, peer education, outreach, condom distribution, advocacy, referrals </li></ul></ul><ul><li>Creates positive social norms about preventing and living with HIV: </li></ul><ul><li>“ Vivir y ayudar a vivir” </li></ul><ul><li>“ To live and to help to live” </li></ul>Puerto Rican Cultural Center
<ul><li>Involvement: </li></ul><ul><li>“… It [VS] is a space that was created by the students of our high school.” </li></ul><ul><li>P2:11 (96:98) </li></ul>Efforts/Framing Participation: “…we always have youth involvement, when… we’re writing grants, or we’re creating murals, or… we’re doing posters. …we usually always meet with them and say ‘Does this work for you?’…like when we’re developing outreach forms.” P6:76 (1582:1588) Community Participation Project Humboldt Park Performing Vida SIDA Facade
Organizational Characteristics <ul><li>Quality </li></ul><ul><li>“… a good CBO, just like a good political program, just like a good scientific undertaking, must ultimately be premised on some social reality that people are articulating and in that process that we learn from that, and then from that … we give back (with clarity).” </li></ul><ul><li>P 2:39 (828:833) </li></ul><ul><li>“ How do you capture the essence of a CBO... I were to only assume that it’s heart is the community . You know, and how, how do you quantify that?” </li></ul><ul><li>P5:100 (2161:2183) </li></ul>Volunteer Neighborhood Cleanup World AIDS Day Vigil
Community Characteristics <ul><li>Resident Attribute: </li></ul><ul><li>“… I think that’s the case for a lot of people where it’s really being a part of the community. Knowing more than just your neighbors but really taking the hand and cleaning it and helping others out some way or another. Being a familiar face.” </li></ul><ul><li>P5:17 (368:373) </li></ul><ul><li>Resident Attribute, Assets: </li></ul><ul><li>“ I guess we just, you know, we know that as Puerto Ricans we’re strong but as Puerto Ricans and Mexicans we’re stronger.” </li></ul><ul><li>P6:46 (1003:1006) </li></ul>West Entrance to Paseo Boricua Community Demonstration
Organization Impact <ul><li>Trust: </li></ul><ul><li>“… the community knows that [VS] has been here for a long time, and they know the faces [of] the workers. They know that although…I work at [VS], that I’m also in the neighborhood , that whether I’m working or I’m not working that I still say hello to them, I still ask them, ‘how are you doing?’ </li></ul><ul><li>… So I think that makes a big difference,…if someone knows that if they walk in at 6:00pm ….and I say I’m leaving and they say ‘can I get some condoms before you leave?’ I’m not going to leave. They know that I’ll open the door up and give them the condoms. And that’s the difference between this agency and any other agency that would be like ‘Oh, sorry it’s 6:00pm we’re closed.’ </li></ul><ul><li>P6:26 (693:713) </li></ul>
Action for Change <ul><li>Defining Issues, Partnership, Advocacy: </li></ul><ul><li>“… And for instance in the Parade…we’re going to have the gay flag and … we’ve always invited other Latino gay organizations to be a part of it. …we’ve had obviously lots of people who have been a part of the Center who are gay or lesbian and being an intrinsic part of it. … being visible and equal in the whole democratic process but trying also to make the community see that …it’s also people in those other organizations are also willing to be seen in the community.” </li></ul><ul><li>P5:89 (1961:1976) </li></ul>Annual Puerto Rican Peoples’ Parade Governor Calderon and Congressman Gutierrez
¿Qué significa “Capital Social”? “What does “Social Capital” mean? <ul><li>La comunidad siempre ha entendido. </li></ul><ul><li>The community has always understood </li></ul><ul><li>Social capital is mediated through a community’s cultural capital. </li></ul><ul><li>Both social and cultural capital are useful to understand how a locally driven health program was created and maintained. </li></ul><ul><li>Social capital can ensure that the local ecology is reflected in program content. </li></ul>
¿Qué significa “Capital Social”? “What does “Social Capital” mean? <ul><li>Community self-concsiousness is a primay attribute for employing social capital for commuity developemnt and health improvement. </li></ul><ul><li>The shared history and cultural capital foster trustworthy relationships amont people and organizations. </li></ul><ul><li>Community- based organizations act as authentic agents of change by reflecting lived experience in the community and by consistently clarifying and validating the social realitites of the people. </li></ul>
Limitations <ul><li>1 case study </li></ul><ul><li>Researcher-Community relationship </li></ul><ul><li>Perspective of consumers and residents </li></ul><ul><li>Cross-sectional look at organizational processes </li></ul><ul><li>Categories constructed with ties to outside influence. National project limited flexibility in constructing local study domains. </li></ul><ul><li>Limitations partially minimized by intensifying researcher and community participation </li></ul>
Conclusion <ul><li>An understanding of local social capital concepts of trust, social connections, relationships & the role of CBOs requires an understanding of community history and culture. </li></ul><ul><li>Organizational qualities and community cultural characteristics were especially important to understand how social capital can be used to address critical health issues in the community, while contributing to community development. </li></ul><ul><li>CBO’s created from social capital processes can clarify health and other social issues in the community. This local asset is necessary for effective community-based health promotion. </li></ul>