This article is written by Venchele Saint Dic, founder of Mesfami Care Inc. and Pathway Coach Writing

When I decided to undertake a career in public health at the age of 20, I never thought it would land me in a job developing community programs in rural areas. I got my first exposure to community planning when I served as a volunteer in Senegal, West Africa.

This experience taught me first-hand the importance of ensuring communities are involved when implementing programs. This also helped me wise-up to a fact most health professionals encounter in their career: the need to have projects validated in the communities they serve.

The necessity of community buy-in is, unfortunately, often at odds with the realities of project planning. Projects are often challenged by funding constraints, political instability, lack of community engagement or a scarcity of resources that make it nearly impossible for health evaluators or organisations to achieve project milestones. In fact, the reality is that no matter how much time is spent on minute details of a project, there will always be elements that could be missed during the planning process.

The missing elements could be the lack of community engagement, project sponsorship or knowledge on conducting effective community health programs. Either way, health professionals and rural communities alike have much to gain from becoming comrades-in-arms to prioritise relevant health issues that can be addressed within a reasonable timeframe.

Additionally, health professionals who support projects in the field may sometimes underestimate the time dedicated to the planning process of community programs. But there are several ways health professionals can equip themselves to be efficient in developing health programs.

Data in health

First there is the question of being culturally competent to work with varying communities with cultural, ethnic backgrounds, gender, and/or religious differences.

Over the years, a combination of health models, such as the ecological models, the Precede-Proceed model or the public health pyramid, have been created to help health professionals understand the interconnectedness of public health.

For instance, the ecological model shows the influence of public/private structures, populations, families, programs and resources on the health of individuals. To increase the awareness of the role of culture in public health, we founded Mesfami Care, providing families who have lost loved ones access to behavioural health services in their neighbourhoods, using the principles of community integration, evidence-based research and community engagement.

We wanted to demonstrate how individuals can be impacted by factors in their immediate social and physical environment. To do that, we started by looking at a number of databases, including:

  • the US Department of Social and Health Services (DSHS)
  • Behavioral Risk Factor Surveillance System (BRFSS)
  • County Health Rankings and Roadmaps
  • Comprehensive Hospital Abstract Reporting System (CHARS)

These databases showcased best practices to advance the healing process of rural populations by improving their accessibility to health services. Thus, the health indicators on behavioural health such as availability of cross-training for the most common chronic medical and behavioural illnesses prevalent in the population, or if a program ensured availability of counselling sessions after hours to patients, provided insights on the contributing factors that could magnify the severity of health problems within Maryland.

Moreover, these databases showed trending patterns on lack of access to behavioural health in target communities comparable to state, national and local data measures for particular diseases.

The importance of community support

When health professionals do not take the time to gain community support, potential donors or funders may question the scope of the program and stall the planning of the project in terms of what it will cost, who will do the work, how the work will be done and what the benefits will be. As a result, this could lead to the recipe of having failed projects. Therefore, gaining community support is directly correlated to the longevity of programs.

The challenge of program planning can be solved if health professionals or evaluators focus on whether they have included community assets (i.e. churches, health care facilities, youth/playgrounds, parks and recreation facilities, community leaders, community services, schools, stakeholders, businesses/industries and cultural heritage) and taken topographical features such as rugged hills, damaged roads and lack of adequate infrastructure that make it challenging for individuals to access health services into account.

The establishment of evidence-based interventions does not always guarantee that a given health issue such as obesity is completely resolved

Causal theories that guide the identification, development and implementations linked to the precede-proceed model address this problem by supporting the premise of looking at program development using health systems thinking models. In practice, causal theories tend to justify the implementation of community programs. On the other hand, the establishment of evidence-based interventions does not always guarantee that a given health issue such as obesity is completely resolved. It takes years of applying health models over an extended period of time to observe tangible results.

For instance, the community assets mentioned above allow us to assess the current resources in communities so as not to duplicate program ideas and strain existing resources within the community. Identifying community assets highlights the relationships between existing interventions, policies, norms, structures and patterns that influence behavioural health outcomes. In general, the precede-proceed model aids health professionals and evaluators alike to evaluate intervention approaches for health priorities in various settings.

Applying a health systems thinking approach

The model facilitates the planning and evaluation process for evaluators who need context to explain health-related behaviours and social environments. This is achieved through the model’s criteria on social assessment (participatory planning and situation analysis), epidemiological diagnosis (health, behavioural and environmental assessment), and ecological and educational diagnosis.

In turn, the findings can lead to the design of interventions that influence health behaviours and environments. According to the academic information in the book Health program planning and evaluation: a practical, systematic approach for community health, the precede-proceed model has been tested and verified in more than 960 published studies and thousands of unpublished projects in communities.

The steps are further described below with examples accentuating the role played to implement behavioural interventions with the assistance of community mobilisation.

1. Apply a health systems thinking approach: The health systems thinking framework involves identifying internal and external stakeholders, evaluating benefits and blindspots of current policies and procedures, doing community mapping and identifying places within the system that can be modified or enhanced to address health problems within communities.

2. Precede-Proceed Model: a model that outlines a series of planning and evaluation steps to improve health outcomes pertaining to community health programs. Performing a community map allows for the retrieval of information on the benefits and limitations of interventions by geographic location, community demographics and magnitude of disease prevalence. Furthermore, community mapping places a pronounced focus on the assets of communities (i.e. churches, health care facilities, youth/playgrounds, parks and recreation, community leaders, community services, schools, stakeholders, businesses/industries and cultural heritage). Sequentially, community mapping could provide clarity on effectively engaging rural communities to oversee community programs.

3. Developing Causal Theory: The causal theory allows evaluators and health professionals to identify the path from disease causal factors, community/system interventions to the impact of programmatic interventions to alleviate roadblocks towards health. This theoretical model can also help uncover unintended consequences with proposed interventions far in advance. If the program interventions are implemented dismissing this crucial step, evaluators will have to highlight the roots of the programs’ failure.

Map the resources

Overall, health professionals and evaluators who intend to work with rural communities must take the time to map out the availability of resources, and clearly define the health priorities of target communities.

Once the health priorities are defined, causal theories can help evaluators discern appropriate evidence-based strategies to design effective programming with community support. In fact, there are several public health models used for community planning and evaluation.

However, a systems thinking lens can help health professionals hone in on interventions that can easily merge into existing public health systems’ societal structure. After all, developing future programs will not be achieved if the planning and evaluation processes are not fully vetted to amend unforeseen intervention shortcomings. — Venchele Saint Dic

(Picture Credit: Unsplash)