For Engagement to Succeed…
The American Heritage Dictionary defines partnership as “a relationship between individuals or groups that is characterized by mutual cooperation and responsibility, as for the achievement of a specified goal.” Many of the organizing concepts, models, and frameworks highlighted in Chapter 1, such as social ecology, community participation, and community organization, speak to the relationship between community partnerships and positive change. Indeed, community-based participatory research and current approaches to translational research explicitly recognize that community engagement significantly enhances the potential for research to lead to improved health by improving participation in the research, its implementation, and dissemination of its findings. Community engagement based on improving health takes place in the context of and must respond to economic, social, and political trends that affect health and health disparities. Furthermore, as the literature on community empowerment contends, equitable community partnerships and transparent discussions of power are more likely to lead to desired outcomes (see Principle 4). The individuals and groups involved in a partnership must identify opportunities for co-learning and feel that they each have something meaningful to contribute to the pursuit of improved health, while at the same time seeing something to gain. Every party in such a relationship also holds important responsibility for the final outcome of an effort.
Diversity may be related to economic, educational, employment, or health status as well as differences in culture, language, race, ethnicity, age, gender, mobility, literacy, or personal interests. These elements of diversity may affect individuals’ and communities’ access to health care delivery, their health status, and their response to community engagement efforts. For example, as indicated in Chapter 1, the processes, strategies, and techniques used to engage the community must be respectful of and complement cultural traditions. The systems perspective suggests attention to another element of community diversity: the diversity of roles that different people and organizations play in the functioning of a community. Engaging these diverse populations will require the use of multiple engagement strategies.
Community assets include the interests, skills, and experiences of individuals and local organizations as well as the networks of relationships that connect them. Individual and institutional resources such as facilities, materials, skills, and economic power all can be mobilized for community health decision making and action. In brief, community members and institutions should be viewed as resources to bring about change and take action. The discussion of community participation in Chapter 1 highlights the need to offer an exchange of resources to ensure com-munity participation. Of course, depending on the “trigger” for the engagement process (e.g., a funded mandate vs. a more grassroots effort), resources are likely to be quite varied.
Although it is essential to begin by using existing resources, the literature on capacity building and coalitions stresses that engagement is more likely to be sustained when new resources and capacities are developed. Engaging the community in making decisions about health and taking action in that arena may involve the provision of experts and resources to help communities develop the necessary capacities (e.g., through leadership training) and infrastructure to analyze situations, make decisions, and take action.
Engaging the community is ultimately about facilitating community-driven action (see discussions under community empowerment and community organization in Chapter 1). Community action should include the many elements of a community that are needed for the action to be sustained while still creating a manageable process. Community engagement will create changes in relationships and in the way institutions and individuals demonstrate their capacity and strength to act on specific issues. In environments characterized by dynamism and constant change, coalitions, networks, and new alliances are likely to emerge. Efforts made to engage communities will affect the nature of public and private programs, policies, and resource allocation. Those implementing efforts to engage a community must be prepared to anticipate and respond to these changes.
Communities and community collaborations differ in their stage of development (see the active community engagement continuum and diffusion of innovation in Chapter 1). As noted earlier, community engagement sometimes occurs around a specific, time-limited initiative. More commonly, however, community participation and mobilization need nurturing over the long term. Moreover, long-term partnerships have the greatest capacity for making a difference in the health of the population. Not surprisingly, building trust and helping communities develop the capacity and infrastructure for successful community action takes time. Before individuals and organizations can gain influence and become players and partners in decision making and action steps taken by communities relative to their health, they may need additional resources, knowledge, and skills. For example, partners might need long-term technical assistance and training related to developing an organization, securing resources, organizing constituencies to work for change, participating in partnerships and coalitions, resolving conflict, and other technical knowledge necessary to address issues of concern. Furthermore, strategies must be developed for sustaining efforts. The probability of sustained engagement and effective programming increases when community participants are active partners in the process.