Chapter 1. Community Engagement: Definitions and Organizing Concepts from the Literature
Donna Jo McCloskey, RN, PhD, (Chair), Mary Anne McDonald, DrPH, MA, Jennifer Cook, MPH, Suzanne HeurtinRoberts, PhD, MSW, Stephen Updegrove, MD, MPH, Dana Sampson, MS, MBA, Sheila Gutter, PhD, Milton (Mickey) Eder, PhD
Over the last two decades, research and practice in health promotion have increasingly employed community engagement, defined as “the process of working collaboratively with and through groups of people affiliated by geographic proximity, special interest, or similar situations to address issues affecting the well-being of those people” (Centers for Disease Control and Prevention [CDC], 1997, p. 9). In general, the goals of community engagement are to build trust, enlist new resources and allies, create better communication, and improve overall health outcomes as successful projects evolve into lasting collaborations (CDC, 1997; Shore, 2006; Wallerstein, 2002).
The rationale for community-engaged health promotion, policy making, and research is largely rooted in the recognition that lifestyles, behaviors, and the incidence of illness are all shaped by social and physical environments (Hanson, 1988; Institute of Medicine, 1988). This “ecological” view is consistent with the idea that health inequalities have their roots in larger socioeconomic conditions (Iton, 2009). If health is socially determined, then health issues are best addressed by engaging community partners who can bring their own perspectives and understandings of community life and health issues to a project. And if health inequalities are rooted in larger socioeconomic inequalities, then approaches to health improvement must take into account the concerns of communities and be able to benefit diverse populations.
The growing commitment to community engagement is reflected in a number of major federal initiatives, including the Clinical and Translational Science Awards (CTSA) program and the Research Centers in Minority Institutions program of the National Institutes of Health (NIH), CDC’s Prevention Research Centers, and the practice based research networks of the Agency for Healthcare Research and Quality (AHRQ). In addition, new work by AHRQ highlights the potential benefits of engaging patients and families in the redesign of medical care (Scholle et al., 2010). Healthy People 2020, which lays out our national health objectives, emphasizes collaboration among diverse groups as a strategy to improve health.
This emphasis on community engagement has encouraged health professionals, community leaders, and policy makers to imagine new opportunities as they face new challenges (Doll et al., 2008). This initial chapter addresses concepts, models, and frameworks that can be used to guide and inspire efforts to meet those challenges. It does not pretend to cover all the available and relevant social science and public health literature, but it provides an overview of some of the critical organizing concepts that shed light on the idea of community and the practice of community engagement. Sociology, political science, cultural anthropology, organizational development, psychology, social work, and other disciplines have all contributed to the development and practice of community engagement (Minkler et al., 2009). Moreover, community engagement is grounded in the principles of community organization: fairness, justice, empowerment, participation, and self-determination (Alinsky, 1962; Chávez et al., 2007; Freire, 1970; Wallerstein et al., 2006). The interdisciplinary background offered in this chapter provides a rich array of concepts for stakeholders, such as public health agencies, practice-based researchers (in clinics, agencies, after-school programs, and nursing homes), policy makers, and community organizations, to draw from when developing partnerships in community engagement.
This chapter is more extensive than the corresponding chapter in the first edition, reflecting growth in the literature and the increased collective experience in community engagement.