An Integrated Framework for Assessing the Value of Community-Based Prevention (2012) / Chapter Skim
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3 Community-Based Prevention: More Than the Sum of Its Parts
3 Community-Based Prevention: More Than the Sum of Its Parts
Pages 61-88
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From page 61... ...
and illustrative elements within each domain are discussed, as are issues in valuing resources and costs of community-based prevention. As discussed in Chapter 2, community-based prevention interventions cover a broad spectrum of types, from those directed at a specific health condition (e.g., high blood pressure or diabetes)
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From page 62... ...
; intervention and applied research efforts such as community-based participatory research; the dissemination and implementation research supported by the NIH National Heart, Lung, and Blood Institute and the Office of Behavioral and Social Sciences Research; and cross-sector and multidisciplinary interventions, such as the CDC Communities Putting Prevention to Work program and the Healthy Kids Healthy Communities program (BSSR/NIH, 2012; CDC, 2012a,b; Horowitz et al., 2009; NHLBI/NIH, 2012; RWJF, 2012)
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From page 63... ...
Furthermore, systems science can help further elucidate • the pathways through which policy, system, and environmental changes operate to affect population health. • important ingredients that are needed to implement effective c ommunity-based prevention interventions as well as the imple mentation fidelity and "dose" of these activities (Carroll et al., 2007; Glasgow et al., 1999; Linnan and Steckler, 2002)
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From page 64... ...
VALUING COMMUNITY-BASED PREVENTION: DOMAINS AND ELEMENTS Policy makers, funders, and relevant stakeholders make decisions about the value of community-based interventions. Traditional approaches to assess value tend to focus solely on health impacts, to value interventions in isolation, to overlook community processes, and to fail to monitor
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From page 65... ...
To assess the true value of community-based prevention, therefore, decision makers, funders, and stakeholders would benefit from an approach that looks not just at health impacts, but at other impacts as well. A major task facing the committee, then, was determining what domains should be included in a framework to value community-based prevention interventions.
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the committee deliberately decided to identify community process as a specific area of valued outcomes for community-based prevention. Elements in the community process domain inherently affect outcomes upstream (e.g., civic participation)
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From page 67... ...
For example, some efforts that improve population health in the aggregate may increase health inequalities between groups, for example, a campaign to improve prenatal care that primarily reaches middle to higher income women and is not effective among lower income women may well increase health disparities. Reasonable people may disagree about when to give priority to one goal over the other.
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From page 68... ...
. Access to -- or even the presence of -- green space is associated with increased physical activity, better perceived general health, mitigation of the effects of stressful life events, and lower prevalence of some illnesses (Ellaway, 2005; Maas et al., 2006, 2009; Ulrich, 1984; Van Den Berg et al., 2010)
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From page 69... ...
found that commuting to work by light rail was associated with a reduction in body mass index and reduced odds of becoming obese. Active travel, such as walking and cycling, along with increasing physical activity can also lead to a decrease in vehicle emissions, thereby improving air quality (de Nazelle, 2011)
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From page 70... ...
. Numerous research studies have shown the relationship of social support and social networks to both physical and mental health (Berkman and Glass, 2000; Berkman and Kawachi, 2000; Cohen et al., 2000; Cornwell and Waite, 2009; Kawachi and Berkman, 2003; Marmot and Wilkinson, 1999; Maulik et al., 2009; Stansfeld et al., 1999)
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From page 71... ...
Community processes refer to several elements that have a distinctive influence on community participation in the decision making as well as in the design and implementation associated with community-based interventions. These elements include civic engagement, local leadership development, community participation, trust, skill building, transparency, and inclusiveness.
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From page 72... ...
137) , in a study of how sense of community and social capital work with leadership to encourage change, found that "community leaders assisted in developing important relationships, establishing communication and imparting community direction, thereby providing the needed link between variables." Skill-building The skills related to community processes include those associated with the process of community organizing.
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From page 73... ...
. Equity Equity is an important element of community process.
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The following section explores the issue of assessing the resource use or costs of a community-based prevention intervention. VALUING RESOURCES AND COSTS FOR COMMUNITY-BASED PREVENTION Community-based prevention is a collaborative effort among three sets of actors: funders, community partners, and participants.
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Funders may consider only their program costs, while community partners may want to consider only the costs that they bear. However, a comprehensive perspective considers the costs of all of the resources expended, including those of the participants.
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From page 76... ...
For example, a community health workers program that helps residents with chronic health conditions improve their self-care and medication use could result in lower emergency room use and rates of preventable hospitalizations. This lowers the residents' hospital care costs, thus generating savings for them and their health plans.
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From page 77... ...
This is particularly true of prevention interventions where the costs accrue immediately but the benefits accrue much later. In theory this could lead to an undervaluation of the long-term benefits relative to the short-term costs.
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From page 78... ...
Identifying measures and sources of information for community wellbeing and community process elements is even more challenging than collecting such information about health. Table 3-2 lists elements and indicators that could be used in the three domains of interest: health, community well-being, and community process.
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Rates of suicides Community Built environment Built environment Well-Being 1.
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Natural physical environment Natural physical environment Green space Parks, preserved open spaces, beauty Social and economic environments Social and economic environments 1. Social support and social 1.
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2000. Social integration, social networks, social support, and health.
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2009. Neigh borhood social cohesion and youth participation in physical activity in Chicago.
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Paper read at Annual Meeting of the Transportation Research Board, January 22-26, Washington, DC. http://rits.rutgers.edu/files/discountrate_lifecycle.pdf.
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2010. The effect of light rail transit on body mass index and physical activity.
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Individual and community health effects of bonding social capital. Social Science and Medicine 63(1)
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2005. Does the built environment influence physical activity?
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2010. Community-based participatory research contributions to intervention research: The intersection of science and practice to improve health equity.
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