Gem 201 Flashcards
What is a community?
Why is community health so important?
A community can be described as a group of people who share some or all of the following: geographic boundaries; a sense of membership;
Culture and language;
common norms, interests, or valucs; and common health risks or conditions (IOM, 1995; Jewkes and Murcott, 1996;
Ruderman, 2000; Ricketts, 2001).
Community health is important because:
Health is a “fundamental resource to the individual, the community and to society* (Kickbusch, 1989: 13).
• When people are healthy, they are better able to work, leam, build a good life, and contribute to society.
State the four constituents of a community
Individual health is influenced by what things?
State six characteristics of a healthy community
Constituents:
Individuals
Families
Organizations
Associations
Organizations are usually more formal, with clear structures, rules, and goals (e.g., to deliver services, make profit, or solve a problem).
• Associations are more about membership and unity over a common interest, often voluntary and for advocacy, networking, or professional development.
Term Meaning Example
Organization: A structured group of people working together to achieve specific goals. A hospital, school, NGO, company, ministry
Association :A group of people who come together based on shared interests or purpose. Medical Association, Teachers’ Association
About the individual:
From the 15th century and earlier, and also today within the fields of statistics and metaphysics, individual meant indivisible, typically describing any numerically singular thing. but sometimes meaning a person,
• From the 17th century on, individual indicates separateness that’s seeks unique personal identity
• Even though the individuals make up the family and society, the need of the individual varies with the need of the family and society
• The individual health is influenced by a number of factors that are within that person age, sex, knowledge, behavior and lifestyle etc.) and outside that person (Family practices, love and care, socialization, environmental halth, family economy etc.)
Characteristics of a healthy community
What is a healthy community?
• Leadership
• Public health and social infrastructure and policies on health
• Essential public health services
• values Communication and collaborations
•considers and addresses the determinants of health
• Individuals make informed positive choices
These characteristics are the key pillars of a healthy community because they ensure overall well-being by addressing health at multiple levels:
1. Leadership → Guides decision-making, sets policies, and drives health initiatives and assesses community resources and needs
2. Public Health & Social Infrastructure → Provides essential services like hospitals, sanitation, and policies that promote health.
3. Essential Public Health Services → Ensures disease prevention, health promotion, and emergency preparedness.
4. Values, Communication & Collaboration → Strengthens trust, encourages teamwork, and promotes collective action for health improvement.
5. Determinants of Health → Recognizes that health is influenced by social, economic, and environmental factors such as income, education and environment.
6. Informed Choices → Empowers individuals to take responsibility for their health through education and access to resources.
Together, these aspects create an environment where people can thrive physically, mentally, and socially, making them essential characteristics of a healthy community.
State three features of the community
use them to define what a community is
Location:
• This means a specific geographical location.
• The health of the community is affected by the location, including the placement of the service, the geographical features
• Population:
diverse people who live with in the boundary of the community.
• Social system
Various entities (conomic, educational, cultural etc.) that interact to form a relational system
It looks like you were trying to explain the key features of a community, but the wording might have made it unclear. Here’s a clearer way to structure what you meant:
Features of a Community
1. Location → A community exists in a specific geographical area. The health of the community depends on factors like service availability, environmental conditions, and infrastructure.
2. Population → The people who live within the community’s boundaries. They may be diverse in terms of age, culture, and socioeconomic status.
3. Social System → The different institutions and interactions (e.g., economy, education, healthcare, culture) that help the community function as a connected system.
Definition of Community
You can define a community based on:
• Geographical boundaries (e.g., a town, neighborhood, or country).
• Shared interests or identity (e.g., religious groups, professional groups).
• Social connections (e.g., online communities, cultural groups).
You were likely trying to emphasize that a community is defined by its location, people, and systems, and that these factors shape its overall well-being. Let me know if you want it reworded further!
What is the human development index?
State the three human development index (HDI) indicators and dimensions and dimensions indexes
Dimensions:
Long and healthy life
Knowledge
A decent standard of living
Respective indicators:
Life expectancy at birth
Expected years of schooling and mean years of schooling
GNI per capita income(PPP$)
Respective dimensions indexes:
Life expectancy index
Education index
GNI index
Human Development Index (HDI)
The HDI is a measure used by the United Nations Development Programme (UNDP) to assess and compare human development across countries. It considers three key dimensions:
1. Health – Measured by life expectancy at birth (how long people are expected to live).
2. Education – Measured by mean years of schooling (average years of education received) and expected years of schooling (how many years a child entering school is expected to complete).
3. Standard of Living – Measured by Gross National Income (GNI) per capita (average income per person).
The HDI gives a score between 0 and 1, where:
• Closer to 1 → High human development
• Closer to 0 → Low human development
Ghana’s HDI score of 0.613 indicates medium human development. In the African context, Ghana ranks 14th, with countries like Seychelles (0.802), Mauritius (0.796), and Algeria (0.746) leading the continent in HDI rankings. 
It’s important to note that while the HDI provides a snapshot of a country’s development, it doesn’t capture all aspects of human well-being, such as inequality, poverty, and security. For a more comprehensive understanding, other indices like the Inequality-adjusted Human Development Index (IHDI) and the Gender Development Index (GDI) can be considered.
Think of it like this:
• Dimensions are the big ideas or categories you want to measure.
• Example: If you’re measuring health, dimensions could be “nutrition,” “fitness,” and “mental well-being.”
• Indicators are the specific things you look at to measure those dimensions.
• Example: For “nutrition,” an indicator could be “daily fruit and vegetable intake.”
• Indexes are scores that summarize multiple indicators into one number.
• Example: A “Health Index” might combine scores from nutrition, fitness, and mental well-being to give an overall health score.
GNI is gross National income
What are the 8 WHO identified health priorities
WHO identified health priorities
• Inadequate health education
• Inadequate food supply and poor nutrition
• Unsafe water and inadequate basic sanitation
• Inadequate maternal and child health
• Inadequate family planning
• Incomplete immunizations
• Uncontrolled endemic diseases
• Scarcity of essential drugs
How can you learn about a community
• Learn custom and language
• Study reports on the area
• Observe how people live
• Ask about the community
• Listen to people talk
• Visit families and places
• Join local celebrations
One of the constituents of the community is family.
State the factors that affect the health of the family
What is community influence?
State the three things that influence the community
In human context, a family(Latin is familia) is a group of people affiliated by consanguinity, affinity or co residence. In a human context, a family refers to a group of people connected by:
1. Consanguinity → Blood relations (e.g., parents, children, siblings).
2. Affinity → Relationships through marriage or legal bonds (e.g., spouses, in-laws).
3. Co-residence → People living together as a household, even if not related by blood or marriage (e.g., adopted children, long-term caregivers).
The word “familia” comes from Latin and originally referred to a household, including relatives and even servants. Over time, the concept of family has evolved to include nuclear families, extended families, and even chosen families based on emotional bonds.
In most societies it is the principal institution for the socialization of children.
• Even though families make up the communities, the need of the family and that of the communities varies in many aspects.
• The health of the family is affected by many factors that are within the family (family practices, gene and heredity, family income, intrafamily relationship etc.) and
outside the family (environmental sanitation of the surrounding. social relations, socio cultural practices, availability of health services, natural disasters, availability of market, educational facilities etc.j.
Community influence:
Social
Economic
Environmental and physical risks
Community Influence refers to how a community impacts the lives of its members in different ways:
1. Social Influence → The community shapes values, behaviors, and relationships through culture, traditions, and social networks (e.g., education, support systems, crime rates).
2. Economic Influence → Economic conditions affect job opportunities, income levels, and access to resources like healthcare and education. A wealthy community offers more opportunities, while a poor one may struggle with unemployment and low wages.
3. Environmental & Physical Risks → The physical environment affects health and safety. Risks include pollution, poor sanitation, natural disasters, and lack of infrastructure (e.g., unsafe water, air pollution, or flood-prone areas).
These factors together determine the well-being and development of a community.
Note: 80% of the worlds population resided in developing country where people suffer and die from preventable and easily treatable illnesses.
o For improvement to occur, the problem and their causes must be identified and appropriate solutions formulated
and implementeu
0 Community assessment involves identifying problems at the community level which adversely affect health:
What are community health practices
State the elements of community health practice and explain how they relate
Part of larger public health efforts that focuses on health and well-being of the community as a whole.
Basic clements
• health promotion
• Prevention of health prolems
• Treatment of disorders
• rehabilitation
Evaluation
Research
Determinants of health
Elements of Community Health Practice & Their Relationship
1. Health Promotion → Encourages healthy behaviors and lifestyles (e.g., education on nutrition, exercise, and hygiene).
• Related to: Prevention of health problems, determinants of health.
2. Prevention of Health Problems → Focuses on reducing disease risks through primary (vaccination), secondary (screening), and tertiary (disease management) prevention.
• Related to: Health promotion, treatment, rehabilitation.
3. Treatment of Disorders → Provides medical care to manage illnesses and improve health outcomes.
• Related to: Prevention (to stop complications), rehabilitation (for recovery).
4. Rehabilitation → Helps individuals recover and regain function after illness or injury (e.g., physiotherapy, counseling).
• Related to: Treatment, evaluation.
5. Evaluation → Assesses the effectiveness of health programs and interventions to improve future efforts.
• Related to: Research, determinants of health.
6. Research → Studies health trends, risk factors, and interventions to improve community health.
• Related to: Evaluation, prevention, treatment.
7. Determinants of Health → The factors that influence health, including social, economic, environmental, and genetic factors.
• Related to: Every other element, as they all aim to address or improve these determinants.
All these elements work together to improve and sustain community health, from preventing diseases to treating, rehabilitating, and evaluating health strategies.
State seven aims of community health diagnosis
Aims
• Describe the socio-cconomic characteristics of the community
• Describe the health status of the population in the community
• Determine factors that contribute to health status
• Identify assets and resources that can be mobilized
• Conduct micro health projects following need prioritization
• Develop comprehensive community health profile and
• develop an epidemiological baseline for follow up.
State the five Components of community health diagnosis
Components of community health diagnosis
• A description of the demographics of the population
• Sociocultural and behavioral aspects of the community
• A general description of health problems by different strata of the population
• Availability of heaith resources in the community and the
patter of delivery and utilization
• Non-health resources and their role in future improvement
Explain community health assessment or diagnosis as a process
Explain it as a product
Community health diagnosis
• Community health assessment/diagnosis is both a process and a product.
As a process:
• Gathering and interpreting information
• Prioritizing needs and developing strategies
• Conducting and evaluating the MHP
Preparing the further strategies
• As a product:
• Community diagnosis report: A Community Assessment Report is the final product of a community health assessment. It summarizes health needs, resources, and recommendations for action. The report is data-driven, structured, action-oriented, and used by stakeholders to guide policies and health programs. It helps drive evidence based decision making to improve community health
• Further/future intervention plan
Conducting and Evaluating the MHP (Maternal Health Program) as Part of Community Health Assessment
Community Health Assessment (CHA) is a process used to identify health needs, develop interventions, and measure their impact. One key aspect is conducting and evaluating the Maternal Health Program (MHP) to ensure maternal and child well-being.
1. Conducting the MHP → This involves implementing programs that support maternal health, such as:
• Prenatal and postnatal care services.
• Nutrition and vaccination programs for mothers and infants.
• Education on safe pregnancy and childbirth.
2. Evaluating the MHP → After implementation, the program is assessed to determine:
• Effectiveness in improving maternal and child health outcomes.
• Accessibility and quality of services.
• Challenges and areas for improvement.
How This Fits into the Community Health Assessment Process
• Identifies maternal health issues (e.g., high maternal mortality rates, poor prenatal care).
• Develops targeted interventions (e.g., training midwives, improving healthcare access).
• Measures program success through data collection, surveys, and health indicators.
• Improves future programs based on findings from the evaluation.
This process helps ensure that maternal health programs are effective, sustainable, and responsive to community needs.
State the steps in community health diagnosis
Steps in community health diagnosis
• Developing the operational definition of the community
•Collecting background information of various communities
• Selecting a target community
• developing tools and techniques
• Entry to the community and Rapport Building
• information collection
• Data entry, processing and analysis
•Need identification
• Community Presentation
• prioritizing needs with community people
• Conducting Micro-Health Project
• final community presentation and departure from the community
Follow up
Steps in Community Health Diagnosis
1. Developing the Operational Definition of the Community → Clearly define the community by location, population, or social structure.
2. Collecting Background Information → Gather existing data on demographics, health status, and resources.
3. Selecting a Target Community → Choose the specific community for assessment based on needs and feasibility.
4. Developing Tools & Techniques → Create surveys, interviews, and observational checklists for data collection.
5. Entry & Rapport Building → Gain community trust through meetings and discussions.
6. Information Collection → Conduct surveys, interviews, and focus groups to gather primary data.
7. Data Entry, Processing & Analysis → Organize and analyze collected data to identify trends and health issues.
8. Need Identification → Determine priority health needs based on data.
9. Community Presentation → Share findings with the community for validation.
10. Prioritizing Needs → Work with the community to rank health concerns based on severity and impact.
11. Conducting a Micro-Health Project → Implement a small-scale intervention to address a key health issue.
12. Final Community Presentation & Departure → Present project outcomes and handover responsibilities to the community.
13. Follow-up → Monitor progress and provide support to ensure sustainability.
Each step ensures an inclusive, data-driven approach to improving community health.
Explain the differences between clinical diagnosis and community diagnosis
Community diagnosis:
Community
• Focus is on Community
• Survey team goes to the community
• take individual as well as houschold information in details (socio economic, cultural,
environmental, behavioral)
• Socio economics, behavioral, educational and environmental interventions (c.g. micro-health project)
• Researchers (might) go to the community to measure the effect of interventions
clinical
• Focus is on
Individual/ patient
• Patient decides to consult
doctor
• Take symptoms, history, as well as laboratory details
• Usually drug treatment and
advice afterwards
• Patient comes for follow up
What is community health diagnosis
State five purposes of community health diagnosis
A means of examining aggregate and social statistics in addition to the knowledge of the local situation, in order to determine the health needs of the community”
Or This means analyzing broad health data (like disease rates and life expectancy of a group) alongside social factors (like income and living conditions) to understand what a community needs to improve its health.
• The purpose of community health diagnosis is to:
Analyze the health status of the community
• Evaluate the health resources, services, and systems of care
within the communities
• Assess attitudes toward community health services and issues
•identify priorities, establish goals, and determine courses of action to improve the health status of the community
• Establish an epidemiologic baseline for measuring improvement over time.
State the four main models of community health diagnosis
Models of community health diagnosis
• There are a number of models that serve as the conceptual frameworks for community health diagnosis
• The common models that are widely used are
• Community-as-partner model
• Ecological mode!
• Health behavior model
• Heaith belief model
Each model provides a framework to make sense of the data collected during community health diagnosis. So these models help you use the data to identify the problems in the community and their probable causes and what the community needs to stay healthy.
Here’s how they help:
1. Community-as-Partner Model → If data shows high malnutrition rates, this model helps analyze whether it’s due to economic issues (poverty), lack of education, or poor healthcare access.
2. Ecological Model → If pollution levels are high and many people have respiratory diseases, this model looks at how the environment (factories, poor waste disposal) is affecting health.
3. Health Behavior Model → If data shows high obesity rates, this model helps find out whether it’s because of unhealthy eating habits, lack of exercise, or poor awareness of nutrition.
4. Health Belief Model → If vaccination rates are low, this model helps understand whether people are avoiding vaccines due to fear, mistrust, or cultural beliefs.
So, these models help interpret health data by focusing on different aspects of a community’s health problems.
The Community-as-Partner Model looks at how different factors in a community interact to affect health.
For example, if many children in a community are malnourished, this model helps identify the causes. It examines:
• Economic factors → Are families too poor to afford nutritious food?
• Education → Do parents understand what a balanced diet is?
• Healthcare access → Are there enough clinics or nutrition programs?
This model helps figure out which of these factors (or a combination) is the real issue so that the right solution can be applied.
This model aligns with the earlier definition of community health diagnosis because it emphasizes analyzing broad health data and social factors with the community, rather than for them. It recognizes that effective health solutions come from understanding local needs directly from the people affected. Instead of just relying on statistics, this approach integrates community input to identify health problems and create sustainable solutions.
Which model of community health diagnosis focuses on the community as target of the needs assessment and says the community is considered capable of determining its own needs ?
Community-Partner Model of community health diagnosis
• It was first termed as “community as client” model
• The model focuses on the community as target of and partner in needs assessment
• The community is considered capable of determining its own needs
• External people only have to empower the community people to make them able to identify their own health
issues and develop their strategies
• Model focuses on establishing a partnership between service providers and the community to accurately assess, plan, implement, and evaluate any health services
Which model of community health diagnosis says that Health and wellness are affected by multiple levels of environmental influences that occur at individual, interpersonal, organizational, community and public policy levels?
This model is assessed in two ways or aspects, state them.
Ecological Model
• Health and wellness are affected by multiple levels of environmental influences that occur at individual, interpersonal, organizational, community and public policy levels
The assessment is done of two aspects:
• Influence of environment on health and wellness behavior
• Influence of these behaviors on the environment
The Ecological Model of Community Health Diagnosis looks at how the environment and human behavior affect each other in two ways:
1. How the Environment Affects Health Behaviors
• The physical environment (e.g., air pollution, access to clean water) can make people sick or influence their health choices.
• The social and economic environment (e.g., poverty, education, cultural beliefs) can shape behaviors like diet, exercise, and seeking medical care.
2. How Health Behaviors Affect the Environment
• The way people live and behave can impact their surroundings.
• For example, littering and improper waste disposal can cause pollution, and smoking in public places can harm others’ health.
Why Is This Important?
By understanding these interactions, health programs can target both environmental factors and behavior changes to improve community health effectively.
This approach helps identify root causes of health issues and guides interventions for sustainable health improvements.
Which model of community health diagnosis says that “Consumers use of health services is determined by their perception of threats to health and benefits of using services, plus triggers that cause them to seck services”
Health behaviour Model
• The underlying principle of this model is:
• “Consumers use of health services is determined by their perception of threats to health and benefits of using services, plus triggers that cause them to seck services or what makes them do what they do
• This model is useful in predicting existing health services, examine health knowledge, psychomotor capacities and self management skills
Health Behavior Model
This model explains how people decide whether to use health services. The key idea is that people seek healthcare based on their perception of risk and the benefits of taking action.
1. Perceived Threat to Health → If a person believes they are at risk of illness (e.g., feeling symptoms or knowing a disease is common), they are more likely to seek healthcare.
2. Perceived Benefits of Seeking Care → If they believe treatment will be effective and accessible, they are more likely to use health services.
3. Triggers (Cues to Action) → Events like illness, health campaigns, or recommendations from others can push someone to seek care.
Why Is This Important?
This model helps in predicting healthcare usage, understanding health knowledge, and improving self-management skills to encourage better health decisions.
Usefulness of the Health Behavior Model
This model is useful because it helps predict and improve how people use health services by identifying what influences their decisions.
1. Predicting Health Service Use → It helps health workers understand why some people seek care while others don’t. For example, if people don’t feel at risk, they may ignore check-ups.
2. Improving Health Education → It helps assess health knowledge and identify gaps. If people don’t understand a disease, they may not take preventive actions like vaccination or screenings.
3. Enhancing Self-Management → The model helps in designing interventions that improve how people manage their health, such as teaching patients how to control diabetes or hypertension.
Why It Matters
By understanding what motivates or discourages people from seeking healthcare, policies and programs can be designed to increase health service use and improve community health.
Psychomotor Capacities in the Health Behavior Model
Psychomotor capacities refer to a person’s physical ability to perform health-related tasks. The model considers this because even if someone understands their health risk and wants to seek care, they must also have the skills to take action.
Usefulness in Health Services:
1. Self-Management Skills → People with chronic diseases (e.g., diabetes) need motor skills to check their blood sugar or administer insulin properly.
2. Treatment Adherence → If a person lacks the ability to follow treatments (e.g., elderly patients struggling to take medication correctly), interventions should provide support or training.
3. Health Education Design → Programs should not only provide knowledge but also teach practical skills (e.g., proper handwashing, CPR, or using medical devices).
Why It Matters
Even if people understand health risks and benefits, they must also have the physical ability and skills to act on them. This ensures that health services and education are accessible and effective for all.
Which model of community health diagnosis Focuses on consumer’s belief on efficacy of health behaviors and practices, and their relationship to the use of health services
Health belief model
• Focus is on consumer’s belief on efficacy of health behaviors and practices, and their relationship to the use of health services or mindsets they have that will affect the way they do what they do
• Often used to explain and predict primary health behaviors for the prevention of illness, disease and other health conditions
• Useful in guiding the development of programs that provide incentives for consumers to use health services
Health Belief Model (HBM)
This model focuses on how a person’s beliefs about health behaviors influence their decisions to use health services.
1. Belief in Effectiveness → People are more likely to adopt health behaviors if they believe they will prevent illness (e.g., getting vaccinated to avoid disease).
2. Predicting Preventive Behaviors → Helps explain why people do or don’t engage in prevention (e.g., screenings, vaccinations, healthy eating).
3. Guiding Health Programs → Useful for designing programs that motivate people by addressing their concerns and providing incentives (e.g., free screenings or health campaigns).
Why It Matters → It helps in shaping public health policies and interventions to encourage better health choices.
What is community entry procedures?
Process of establishing contact with leadership structure in a community
Community entry is a Process of initiating, nurturing and sustaining a desirable relationship with the purpose of securing and sustaining the
community’s interest in all aspects of a programme
Involves recognizing the community, its leadership and people and adopting the most appropriate process in meeting, interacting and working with them
• Involves principles and techniques of community mobilisation and participation.
What are the preparations before entering a community (you can go over Dr Taylor’s slides on community entry)
State six interest groups and personalities in the community
who can serve as contact persons
Preparations before entry into a community
1. form a reconnaissance team which is a team which
Spy
2. read about the community (read annual report from the DHMT, District Assembly or special report, disease durance report, news papers health journals)
3. collect informal information about the community (this is done through interview with individuals, through focus groups discussion, through mapping, contact opinion leaders, through house to house census)
4. transect walk and observation
Interest groups and personalities in the community
who can serve as contact persons
• Prominent head of families
• Heads of schools/teachers
• Religious leaders/catechists
• District assembly members
• Unity committee members
• Yout’ leaders
• Women group leaders
• The water and sanitation committee
• Disease surveillance volunteers
• Health workers
HOW DO WE INITIATE COMMUNITY ENTRY
HOW DO WE INITIATE COMMUNITY ENTRY
• Start off with a transparent community selection process and share results
• Map community priorities and identify community leaders through community assessments
• Hold preliminary meetings with community leaders and enlist their support to mobilize community participation
• Hold community assembly meetings to elect local representation to coordinate program activities
• Allow communities to prioritize and select quir a impact projects to solidify support and galvanize local participation
PCD is a framework. What does it include
It includes the improvement of people lives in terms of:
• economic,
• social,
• political,
• environmental,
• spiritual/personal and
• cultural aspects
P means participation
C means community development or so
What is participation in the PCD framework
Paul (1987) also refers participation as the shift and a self-transformational process and learning by practice.
According to Oakely (1991) the term participation refers to:
harnessing the existing physical, economic and social resources of rural people in order to attain the objectives of community development programs and projects.
Refers to the involvement of the community in the decision making process of implementation of development projects (Maser, 1997).
What did Dennis 1977 say about community development
State the five values that the concept of development encompasses
What did Lau Tse say about the participatory approach to community development
What is community development
Community development
Is the new paradigm of development that focuses on participatory methodologies and ensures the involvement of the community in the decision making process.
It also encourages the use of practical and generalist skills, on locally derived revenues
(Maser, 1997; Abott, 1995; Hawken, 1983)
Community development
“Go and meet your people, live and stay with them, love them, work with them.
Begin with what they have, plan and develop from what they know, and in the end, when the work is over, they will say: “we did it ourselves” (Dennis, 1977).
The concept development is very broad and encompasses values such as:
capacity building, equity, sustainability, self-reliance and empowerment.
Chinese Philosopher Lau Tse embodies the essence of the participatory approach to community development in the following poem.
Lao Tse (Laozi), the ancient Chinese philosopher, captured the essence of participatory community development in a well-known poem:
Go to the people, Live with them, Love them, Learn from them, Start with what they know, Build with what they have, But with the best leaders, When the work is done, The people will say, “We have done this ourselves.”
Explanation
This poem emphasizes empowerment, inclusion, and collaboration in community development:
• “Go to the people, live with them” → Engage with the community directly.
• “Start with what they know, build with what they have” → Use existing knowledge and resources.
• “When the work is done, the people will say, ‘We have done this ourselves.’” → True leadership enables people to take ownership of their development.
This reflects the participatory approach, where communities actively contribute to their own progress rather than having solutions imposed on them.
What is participatory development
The key concept of participatory development includes what two things?
An active involvement of people in making decisions about implementation of processes, programs and projects that affect them
(Slocum, Wichhart, Rocheleau, & Thomas-
Slayter, 1995).
The key concept of participatory development includes:
• the collaborative effort of people,
• taking initiatives by themselves in terms of their own thinking and deliberations
(Rahman, 1993; Oakley, 1991).
What is capacity building
What is empowerment
An approach to community development that raises people’s knowledge, awareness and skills to use their own capacity and, using available support systems, to resolve the more underlying causes of underdevelopment
(Schuftan, 1996)
empowerment
• A process in which a person or community gives or gets power from another.
• Empowerment is also termed as gaining of strength, confidence and vision to work for positive changes (Eade, 1997).
Maybe true or not but:
Yes! PCD often stands for Participation, Capacity Building, and Community Development in community health and development contexts.
Breakdown of PCD:
• Participation (P): Engaging the community in planning and decision-making.
• Capacity Building (C): Strengthening skills, knowledge, and resources to empower individuals and organizations.
• Community Development (D): Improving living conditions and well-being through sustainable projects.
Why It Matters:
PCD ensures that communities take ownership of their development, making solutions more effective and long-lasting.
Concerning participatory theories, ´People-Centered Development’ and the view that ordinary people have the capacity to manage their own development.
This theory encourages the involvement of all stakeholders in the process of development.
• Freire’s model and participatory models in general proposed a human-centered approach that
• valued the importance of interpersonal channels of communication in decision-making processes at the community level
People-Centered Development (PCD) & Participatory Models
This approach believes ordinary people can manage their own development and emphasizes inclusive participation.
• Stakeholder Involvement → Development should include community members, leaders, and organizations.
• Freire’s Model → Focuses on dialogue, empowerment, and critical thinking, ensuring people actively shape their future.
• Participatory Models → Use interpersonal communication to involve communities in decision-making for sustainable change.
Why It Matters: Empowers communities to take ownership of their growth, leading to lasting and meaningful development.
Which people is the Participatory development approach for?
Participatory development approaches view the term “participation” as?
Participatory development approach
• For participatory theorists and practitioners, development required sensitivity to cultural diversity
• Participatory development approaches view the term “participation” as:
• the exercise of people’s power in thinking, acting, and controlling their action in a collaborative framework
State the 8 principles of the participatory approach as argued by Lau Tse
The principles of the participatory approach
Lau Tse, argues that the principles of the participatory approach includes (Dennis, 1997):
• Inclusion - of all people, or representatives of all groups who will be affected by the results of a decision or a process - for example a development project
• Equal partnership - recognizing that every person has skill, ability and initiative and has an equal right to participate in the process, regardless of their status.
Transparency - all participants must help to create a climate conducive to open communication and building dialogue.
Cooperation - is very important; sharing everybody’s strength reduces everybody’s weakness
the principles of the participatory approach
• Lau Tse, argues that the principles of the participatory approach includes (Dennis, 1997):
• Sharing power - authority and power must be balanced evenly between all stakeholders to avoid the domination of one party.
• Sharing responsibility - similarly, all stakeholders have equal responsibility for decisions that are made, and each should have clear responsibilities within each process.
• Empowerment - participants with special skills should be encouraged to take responsibility for tasks within their specialty, but should also encourage others to also be involved to promote mutual learning and empowerment.
• Cooperation -is very important; sharing everybody’s strength reduces everybody’s weaknesses
Think of sharing power and sharing responsibility like running a group project.
Sharing Power:
• Everyone has an equal say in decisions.
• No one person or group controls everything.
• Example: In a school project, all group members decide together on the topic and how to approach it.
Sharing Responsibility:
• Everyone has a specific role to play.
• The work is divided so that all contribute.
• Example: In the same school project, one person researches, another writes, and another presents.
How Do You Share Power Equally?
1. Let everyone be part of decisions (not just leaders).
2. Use voting or consensus so no one dominates.
3. Ensure equal access to information so all can contribute meaningfully.
Key Difference:
• Sharing power = Equal decision-making rights
• Sharing responsibility = Equal workload distribution
Would you like a real-world example?
Note: Values of development.
Participation : engagement of people on the in involvement of the community decision making process.
Capacity building
Community development
Equality means each individual or group of people is given the same resources or opportunities. Equity recognizes that each person has different circumstances and allocates the exact resources and opportunities needed to reach an equal outcome. Equality means each individual or group of people is given the same resources or opportunities. Equity recognizes that each person has different circumstances and allocates the exact resources and opportunities needed to reach an equal outcome.
State and explain the two basic participatory tools
Basic Participatory Tools
1. PRA (Participatory Rural Appraisal)
• A method used to help rural communities analyze their own situation and find solutions.
• Uses tools like mapping, ranking, and focus group discussions to gather local knowledge.
• Encourages community-led decision-making.
2. PAR (Participatory Action Research)
• A research method where community members and researchers work together to identify problems and take action.
• Focuses on empowering people by involving them in research and decision-making.
• Leads to practical solutions and real changes.
Key Difference:
• PRA focuses on understanding community issues.
• PAR focuses on solving community issues through action.
What is a culture and state five domains that culture operates in
• Set of rules or standards
• Shared by members of a society
• When acted produces behaviours
Culture health behavior and health
• Cultural behaviors have important implications for human health.
• Culture, a socially transmitted system of shared knowledge, beliefs and/or practices that varies across groups, and individuals within those groups,
• Socioeconomic status, gender, religion and moral values all play into how individuals:
• experience, conceptualize and react to their world, and
• Therefore, general understandings of cultural groups are insufficient for grasping a patient’s unique experience with health and illnesses
Domains culture operate
• The family
• Social groups beyond the actor’s family
• Individual growth and development
• Communication
• Religion
• Art
• Music
• Politics and law
• The economy
How does culture influence health
Culture and health dynamics
• Culture is a determinant of health
• It relates to health behaviors.
• It is a determinant of people’s perception of illness
• It influences people’s use health services
• Different cultures have different practices concerning health and medical treatment
Selected examples of cultural explanations of disease
Body balances:
•Temperature
• Energy
・Blood
•Dislocation
•Problems with organs
•Incompatibility of horoscopes
Emotional:
•Fright
•Sorrow
•Envy
•Stress
Supernatural:
•Bewitching
•Demons
•Spirit possession
•Evil eye
•Offending god or gods
•Soul loss
Sexual
•Sex with forbidden person
•Overindulgence in sex
Kleinman and Benson’s approach to conducting a ‘mini-ethnography’ with every patient in order to best incorporate a patient’s culture into treatment plans [3]
The six Steps for performing a mini-ethnography Description
Why should medical students be concerned about culture?
• It will equip medical professionals with the context, skills and empathy necessary for
• HCs can improve individual outcomes by thoroughly factoring in life experiences
-The use of a ‘mini-ethnography’ can help
HCPs understand how identity, interpretation of illness and the moral values of patients factor into building a trusting relationship that considers the patient’s life experiences into treatment plans
Kleinman and Benson’s approach to conducting a ‘mini-ethnography’ with every patient in order to best incorporate a patient’s culture into treatment plans [3]
Steps for performing a mini-ethnography Description
Step 1: How does ethnicity factor into your patient’s identity?
Not all individual’s identify with their ethnicity. Ask your patient how they identify with theirs and the importance their ethnicity plays in their life.
Step 2: What is at stake for your patient and their loved ones?
illnesses can jeopardize aspects of patients’ lives in ways that may not be immediately visible.
Ask your patient what is at stake in having this illness.
Step 3: How does your patient conceptu-alize their illness?
Individuals may conceptualize their illness differently than healthcare pro-viders. Ask your patient what they call their illness, what they believe the cause of their illness may be, what they believe potential treatments are, and what they fear most about treatment.
Step 4: What social stresses is your patient experiencing because of their illness?
Ask your patient what additional stressors they may be experiencing because of their illness. These can include financial, familial and professional stressors that may impact their treatment plan.
Step 5: How does the clinical setting influence your relationship with your patient?
your patient?
Determine and acknowledge the extent to which the clinical setting may influence your patient. How does the culture of biomedicine influence your patient’s ability to seek and receive treatment for their illness?
Step 6: Is this intervention appropriate for your patients?
Determine what clinical interventions would be appropriate for your patient,
not necessarily for the illness. This should factor in the information you’ve gathered from the previous steps.
Examples of health providers
Examples of health providers
Indigenous
• Midwifes
•Shamans
•Curers
•Spiritualists
• Witches
•Sorcerers
•Priests
•Diviners
•Herbalist
•Bonesetters
Western biomedical
•Pharmacists
• Nurse-midwives
• Nurses
• Nurse-practitioners
• Physicians
•Dentists
Other medical systems
•Chinese medical system
•Chemist/herbalist
•Acupuncturists
• Ayuervedic practitioners
Give this info
Working with groups in the community
Why work in Groups
Community Participatory Models
Problem solving with community groups
Introduction to ethics
Approaches to being ethical
Introduction to Survey Methodologies
Concepts of Biostatistics and its applications in Health
Recommended Reading List (Please feel free to refer to
other literature)
Aschengrau, A. and Seage III, G.R. (2009) Essentials of Epidemiology in Public Health Jones and Bartlett Publishers Boston USA
King, F.S and Burgess, A (2000). Nutrition for developing
Working with Groups in the Community
Why Work in Groups?
• Encourages collaboration and shared decision-making.
• Increases community participation and empowerment.
• Helps solve problems more efficiently through collective effort.
• Strengthens social support and trust within the community.
Community Participatory Models
1. Participatory Rural Appraisal (PRA) → Uses local knowledge to assess community needs.
2. Participatory Action Research (PAR) → Engages communities in research and action.
3. Freire’s Model → Focuses on empowerment through dialogue and critical thinking.
Problem-Solving with Community Groups
• Identify key issues and prioritize them.
• Use brainstorming, discussions, and participatory tools to find solutions.
• Ensure inclusiveness and transparency in decision-making.
• Implement and evaluate solutions with community involvement.
Introduction to Ethics
• Ethics deals with moral principles that guide human behavior.
• In community work, ethics ensures fairness, respect, and accountability.
• Protects the rights and dignity of individuals.
Approaches to Being Ethical
1. Utilitarian Approach → Actions should benefit the greatest number of people.
2. Rights-Based Approach → Respects the individual rights of all community members.
3. Fairness & Justice Approach → Ensures equal treatment for all.
4. Virtue-Based Approach → Focuses on integrity, honesty, and compassion.
Introduction to Survey Methodologies
• Surveys help collect data on community health and social issues.
• Types: Questionnaires, interviews, focus groups, and online surveys.
• Used for needs assessment, program evaluation, and policy-making.
Concepts of Biostatistics & Its Applications in Health
• Biostatistics applies statistical methods to analyze health data.
• Helps in disease tracking, health program evaluation, and medical research.
• Key concepts: Sampling, probability, data analysis, and interpretation.
Recommended Reading List
1. Aschengrau, A. & Seage III, G.R. (2009) – Essentials of Epidemiology in Public Health, Jones and Bartlett Publishers, Boston, USA.
2. King, F.S. & Burgess, A. (2000) – Nutrition for Developing Countries.
Would you like more details on any section?
EBM
Apply the rules of public presentation for various topics and audience.
Obtain articles through literature search on Medline data base, Cochrane etc.
Use the five step model of EBM to answer clinical questions.
Make a sound clinical decision for a given clinical scenario.
Reference:
Akobeng AK. Principles of evidence based medicine.
Arch Dis Child 2005; 90:837-840.
Pai M, et al. Systematic reviews and meta-analyses: An illustrated, step-by-step guide. Natl Med J India 2004;
17:86.95.
Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions. 2008.
Lee D.S, et al. Predicting Mortality Among Patients Hospitalized for Heart Failure:
Derivation and
Validation of a Clinical Model. JAMA; Nov 19, 2003;
290, 19; Proquest Medical Library pg. 2581
Applying the principles of evidence-based medicine (EBM) involves integrating clinical expertise with the best available research evidence and patient values to make informed healthcare decisions. The following steps outline this process:
- Applying Rules of Public Presentation for Various Topics and Audiences
When presenting medical information, it’s essential to tailor the content to the audience’s level of understanding and interest. For healthcare professionals, presentations should focus on detailed methodologies, statistical analyses, and clinical implications. For patients or the general public, the emphasis should be on practical information, outcomes, and how the evidence affects their health choices.
- Obtaining Articles Through Literature Search on Databases like Medline and Cochrane
Efficient literature searching is crucial for sourcing high-quality evidence:
• Medline: Accessed via PubMed, Medline offers a comprehensive database of biomedical literature. Utilizing specific search strategies, such as Medical Subject Headings (MeSH) terms, can enhance the retrieval of relevant articles.
• Cochrane Library: This resource provides systematic reviews and meta-analyses on various healthcare interventions, offering high-quality evidence to inform clinical practice.
- Using the Five-Step Model of EBM to Answer Clinical Questions
The five-step model of EBM guides clinicians in integrating research evidence into practice:
1. Formulate an Answerable Question: Use the PICO framework (Population, Intervention, Comparison, Outcome) to define the clinical query.
2. Search for the Best Evidence: Identify relevant studies and reviews using systematic search strategies.
3. Critically Appraise the Evidence: Evaluate the validity, impact, and applicability of the findings.
4. Apply the Evidence: Integrate the evidence with clinical expertise and patient preferences to make informed decisions.
5. Evaluate Performance: Assess the outcomes of the decision and seek ways to improve.
- Making Sound Clinical Decisions for Given Clinical Scenarios
Incorporate the EBM process to make informed clinical decisions:
• Assess the Patient: Gather comprehensive clinical data.
• Ask: Formulate a clear clinical question based on the patient’s problem.
• Acquire: Search for relevant evidence.
• Appraise: Critically evaluate the evidence’s quality and relevance.
• Apply: Combine the evidence with clinical expertise and patient preferences to determine the best course of action.
References
• Akobeng AK. Principles of Evidence-Based Medicine. Arch Dis Child 2005;90:837-840.
This article provides an overview of EBM principles, emphasizing the integration of clinical expertise with the best available evidence.
• Pai M, et al. Systematic Reviews and Meta-Analyses: An Illustrated, Step-by-Step Guide. Natl Med J India 2004;17:86-95.
This guide offers a detailed walkthrough of conducting systematic reviews and meta-analyses, essential components of EBM.
• Higgins J, Green S. Cochrane Handbook for Systematic Reviews of Interventions. 2008.
The Cochrane Handbook is a comprehensive resource on conducting systematic reviews, a cornerstone of EBM.
• Lee DS, et al. Predicting Mortality Among Patients Hospitalized for Heart Failure: Derivation and Validation of a Clinical Model. JAMA 2003;290:2581-2587.
This study exemplifies the application of EBM principles in developing a clinical prediction model for patient outcomes.
By adhering to EBM principles, healthcare professionals can enhance patient care through informed and effective clinical decision-making.
