4cipc Barcelona Community Readiness
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4cipc Barcelona Community Readiness

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This study uses the concept of readiness to intervention for evaluating and improving primary health care. The concept of community readiness examines the interaction between community context and ...

This study uses the concept of readiness to intervention for evaluating and improving primary health care. The concept of community readiness examines the interaction between community context and program design and implementation. The main idea is that effectiveness of social intervention depends on the preparation of the community for social change. The original model (Edwards et al., 2000) proposes nine different stages of readiness for implementing programs, from “no awareness” to “professionalization”. However, we could interpret readiness also as a continuum and identify different profiles or types (Chazdon & Lott, 2011; Holgado & Maya Jariego, 2012; Maya Jariego et al., 2010). In this paper we present a classification of primary health centres in Andalusia (Spain) according to three dimensions of community readiness.
The research was based in three different strategies. First, 81 social workers from primary health care centres in Andalusia were interviewed and completed a 18 items scale on social participation, community adjustment and professional implication in health centres. Second, 40 health centres were observed, taking information on the professional role of social workers and organizational issues, as well as applying a survey both to compare the view of social workers and other health professionals. Finally, 10 case studies were deployed examining through in-depth interviews the interaction between the organizational and the community contexts in health care programs’ implementation.
Three levels of community readiness were identified, conducing respectively to sensitization activities, community organizing strategies and application of evidence-based programs. Cluster analysis allowed the identification of three different profiles of community readiness in primary health care centres in Andalusia: reactive, technical-aid and community approach. The interaction between organization and community processes is discussed.

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    4cipc Barcelona Community Readiness 4cipc Barcelona Community Readiness Presentation Transcript

    • Health-Illness CareCommunity Readiness for Primary Health Care Isidro Maya-Jariego, Daniel Holgado & Ignacio Ramos Departamento de Psicología Social (Universidad de Sevilla)
    • Theoretical contextThe Three-Ethnic Experience "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 4cipc BCN-2012 2
    • Theoretical contextDefinition 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. 4cipc BCN-2012 3
    • Theoretical contextBarriers 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. 4cipc BCN-2012 4
    • Theoretical contextStages of community readiness9 stages (Oetting et al., 1995)1. No awareness2. Denial3. Vague awareness4. Preplanning5. Preparation6. Initiation7. Stabilization8. Confirmation/expansion9. Professionalization 4cipc BCN-2012 5
    • Theoretical contextThree levels of communityreadiness
    • Theoretical contextDimensions 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. 4cipc BCN-2012 7
    • ObjectivesTypologies of communities Building typologies of contexts based in organizational and community dimensions to evaluate community readiness. Social workers incorporation into primary health care teams. 4cipc BCN-2012 8
    • MethodOverview of the study Survey to social workersCommunity readiness in PHC  81 interviews to social workers in PHC centresOrganization and  Evaluation of communityprofessional practice readiness in health contextsCommunity intervention for  Profiles of the contexts forhealth in PHC community intervention  Capabilities and potential
    • MethodOverview of the study Visits to PHC centresCommunity readiness in PHC  Direct observation of 40 PHC centresOrganization andprofessional practice  Interviews to 80 health professionalsCommunity intervention forhealth in PHC  Role of social workers in PHC  Professional practice and organizational context in PHC
    • MethodOverview of the study Case studiesCommunity readiness in PHC  Interviews and case studies of 10 social workers in PHCOrganization and centres.professional practice  Discourse network analysis.Community intervention forhealth in PHC  Interaction between community and organizational contexts and program implementation.
    • MethodInstruments and participants 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 4cipc BCN-2012 12
    • MethodInstruments and participants 4cipc BCN-2012 13
    • MethodInstruments and participants 4cipc BCN-2012 14
    • ResultsThree clusters of communityreadiness 15
    • ResultsThree clusters of communityreadiness 8 7.25 7.42 7 6.73 6.42 6 5.23 5.25 Cluster 1 5 4.77 4 Cluster 2 3.09 3.26 3 Cluster 3 2 1 0 Community Mobilization PHC Center Engagement Community Adjustment 16
    • ConclusionsProfiles of community readiness 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. 4cipc BCN-2012 18
    • 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> 4cipc BCN-2012 19