Apha2003 110903 Fina Lalm
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A short slideshow on the use of social capital in one of the Puerto Rican Cultural Center's programs at the American Public Health Association Conference in 2003
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Apha2003 110903 Fina Lalm
- 1. 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)
Editor's Notes
- 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?