Chapter 15 Community Approaches Within Health Psychology

Chapter 15Community Approaches Within Health Psychology HEALTH PSYCHOLOGY 3rd Edition Marks  Murray  Evans  Estacio

Chapter 15Community Approaches Within Health Psychology • Social Values for Community Psychology • Community Health Psychology • Community Health Actions • Community-level Approaches to Sexual Health • Critique of Community-level Theories and Models • Arts and Community Action • Future Research • Summary

Social Values for Community Psychology (Prilleltensky & Nelson, 2004) • An awareness of the political dimensions of human problems and a concern to promote an empowerment approach that emphasizes self-determination, democratic participation and power sharing. • A commitment to participation in broader social movements for social action and social injustice. • An emotional commitment to social change through adopting a ‘preferential option’ for the poor and depressed. • A concern with promoting health and preventing disease and distress. • Respect for diversity.

Community Health Psychology • Over the past decade there has emerged an increasing interest in developing a community health psychology. • As with community psychology there are different orientations: • A more accommodationist approach focuses on processes within the community; • The more critical approaches aim to connect intra-community processes with the broader socio-political context.

Community Health Psychology (continued) • McLeroy, Norton, Kelger, Burdine & Sumaya (2003) distinguish between four different forms of community-based health promotion: • Community as setting; • Community as target; • Community as agent; • Community as resource.

Dimensions of Community • Community is often considered in terms of location such as that those people who live in a particular defined location are considered as being members of a community. • However, people who live in the same locality often have different interests and affiliations. • Howarth (2001), deriving her ideas from social representation theory, defines community in terms of four dimensions: 1) A source of social knowledge; 2) As a basis for common ideas; 3) As a means of marginalization and social exclusion; 4) As a resource for empowerment.

Community Participation • Much of the concern of community health psychology focuses on the process of working with community to promote social change. • Many community residents are apprehensive about participating in community health actions. Stephens (2007) identifies three primary approaches to understanding community participation: 1) A focus on the immediate problems and successes and how the problem can be overcome – this approach considers all forms of participation positive and does not critique the nature of participation. 2) A concern with different forms and complexities of participation. Although this approach is popular it lacks a clear understanding of the meaning of participation and why some people do not want to participate. 3) The more social psychological approach starts with re-emphasizing the importance of social identity in participation. It is not simply the physical location but rather the extent to which the members identify with the community.

Community Health ActionsPromoting Health Behaviour Change • The traditional focus of health psychology has been on promoting individual behaviour change. • There have been various attempts to explore more community-based strategies. • Community health psychology attempts to work with groups or communities to identify how they see the issue and to explore opportunities for change. • A sustained example of this approach is the work of Catherine Campbell in South Africa where she has been involved in several projects designed to reduce the HIV infection.

Promoting Health Behaviour Change (continued) • She used peer educators who: • take a leading role in educating residents; • engage in participatory learning through games, drama and role-playing for example. • The participants are then active participants in the learning. • Despite considerable resources being expanded in the development of such community interventions Campbell (2006) did not encounter sustained success. • Her research highlights the importance of connecting community health interventions with attempts to promote economic empowerment of the residents.

Promoting Health Behaviour Change (continued) • Her subsequent work aims to promote AIDS-competent communities. Six factors to promote such communities have been identified which also have broader relevance in other contexts: • Building knowledge and basic skills; • Creating social spaces for dialogue and critical thinking; • Promoting a sense of local ownership of the problem and incentives for action; • Emphasizing community strengths and resources; • Mobilizing existing formal and informal networks; • Building partnerships between marginalized communities and more powerful outside actors.

Promoting Social Well-Being • The growth of interest in the connection between social interaction and health status has contributed to a more expansive definition of health including the extent and character of people’s everyday social relationships. • Social capital: • Characterized by Putnam (2001) as the character of civic participation, trust in others and reciprocity; • However, initial confusion about this concept – confusion over its definition and it’s lack of connection with broader political processes – led researchers to consider other more specific concepts.

Promoting Social Well-Being (continued) • Risk society: • Another concept is drawn from Beck’s idea of risk society and the extent to which this explains the extent of youth engagement or alienation from society; • According to this theory one of the consequences of modernization is the breakdown of established certainties which has a particular impact on young people who have no clear identity maps.

Community Approaches to Combating Health Inequalities • A more critical community health psychology attempts at all times to connect local action with broader social change. • While community action projects can enthuse the participants they are often apprehensive about taking larger social action. • The magnitude of the task is apparent in the various community projects that have sought to challenge social inequalities in health. • However researchers have concluded that their projects have shown ‘that it is possible to establish a rallying point, or catalyst, for work towards a more social or communitarian model of health improvement’.

Community-level Approaches to Sexual Health • Community-level approaches to sexual health mobilize skills and resources from communities who themselves can see that changes are necessary and who can develop strategies for making those changes. • These approaches are characterized as ‘grass roots’ and ‘bottom-up’ because the issues for change and change strategies are identified and applied by people themselves. • The community approach is highly flexible and adapted from place to place according to particular community issues and needs.

Adolescent Sexual Health in Peru • Ramella and de la Cruz (2000) describe an adolescent sexual health promotion project in Peru called ‘SaRA’: • Goal – to encourage positive changes in adolescent sexual health by working with relevant social actors and social networks; • Through – networks or ‘Clubs’ which were given access to video cameras etc. and encouraged to generate accounts of their activities (e.g. football match, salsa party).. • These stories open up opportunities for adolescents to talk about pressing issues felt by them and created a means of expression which can feedback into the adolescents’ reflections and understandings of themselves.

Adolescent Sexual Health in Peru (continued) Outcomes of the project: • In all but four of these communities, the Clubs established themselves as key social players by becoming a social centre for local adolescents. • Increased use by adolescent Club members of locally available health services and products. • A substantial decrease (90%) in the level of unintended pregnancies among adolescent girls in SaRA.

Confronting HIV/AIDS and Alcohol in Cambodia • Lubeck (2005) presents the Hybrid Capacity Building Model (HCBM) as an example of a community-level HIV intervention. • The context is that of attempting to reduce, not the stigma of HIV/AIDS, but of its actual transmission. • In rural Cambodia, where non-literacy rates are as high as 75%, female workers face health and safety risks selling international beer brands in restaurants. • These so-called ‘beer girls’ are underpaid by about 50%, 20% are HIV-steropositive, quickly die and are replaced by younger girls.

Confronting HIV/AIDS and Alcohol in Cambodia (continued) • The Siem Reap Citizens for Health, Educational and Social Issues (SiRCHESI, 2008) organization, which embodies the HCBM, has confronted the issues involved. • SiRCHESI uses a multi-sectional Participatory Action Research (PAR) approach which: • Emphasizes empowerment of local women and others increasingly at risk; • Emphasizes the development of a culturally and gender sensitive health intervention/research programme, which may eventually be self-sustaining. • This approach succeeds best by facilitating collaboration between grass root organizations and local and international corporate industries.

Critique of Community-level Theories and Models • Lack of evaluation • Lack of detailed description • Empowerment – who empowers whom? • Victim blaming • Unexpected consequences

Arts and Community Action • A particularly popular means of mobilizing groups and communities is through a range of arts activities. • The arts have the power to both communicate ideas and promote community health action. • However there is the possibility that work in community arts can be compromised to serve the interests of the state more so than that of the community. • Different forms of performance should be considered central to community research practice.

Photovoice • Photovoice is a particular art form that has attracted widespread adoption in community health action projects. • Wang (1999) describes the aims of photovoive as threefold: 1. To enable people to record and reflect on both their own and their community’s strengths and concerns through taking photographs; 2. To promote critical dialogue and review the participants’ lives through discussion around the photographs; 3. To deliberately connect with policy makers and decision makers through public forums and around exhibitions of the photographs.

Photovoice (continued) • This approach has drawn inspiration from Freire’s critical literacy and also from feminist theory and work on documentary photography. It emphasizes how within community health work the aim is to shift control over image-making from the professional to those with little power and influence. • With the rapid growth of the Internet and the availability of relatively cheap still and video cameras this approach has become extremely popular as a means of engaging communities. Unfortunately, through the process known as ‘happy slapping’ a version of it has attracted negative connotations through the process of exposing people to ridicule and threats. • This illustrates the conflicting use of technology to further both health and injury to both individuals and communities.

Future Research • There is an ongoing need to clarify the processes that contribute to promoting community participation. • Different approaches to community engagement need to be explored. • The growth of the Internet opens up new types of community and of community participation. • Different art forms not only provide means of community participation but also of community research.

Summary • Community is a concept that has a long history. • The concept is used by people with different political interests. • Community psychology is an approach to encouraging involvement of people at a local level. It can have both radical and accommodationist approaches. • Community health psychology is concerned with promoting health through various forms of community action. • The arts are a popular means of involving people in community health action. • Community health psychology needs to consider the broader socio-political context within which it operates.

Chapter 15 Community Approaches Within Health Psychology