Community-Based Participatory Action: Impact on a Neighborhood Level Community Health Improvement Process

CHIP is more than a means of identifying, prioritizing, and addressing local health needs. At its heart, CHIP is a method by which neighborhoods can self-actualize and attain locally recognized health goals. The process begins with the development of a local coalition that designs and implements health improvement services.1 The definition of the coalition and the processes involved in recruiting, maintaining, and sustaining the group may vary, depending on the size of the jurisdiction in question. In a smaller community or in neighborhoods, the implementation processes of community health improvement may be determined primarily by local constituents who can more closely scrutinize the process and by so doing are more likely to benefit from its results.

Beginning in 2003, RHI, a group of local organizational partners and neighbors interested in health, established a coalition and began to address the need for neighborhood health improvement. Initial coalition partners included local social service agencies, local public schools, a minority health organization, a local medical clinic, a large health system, two academic partners, a university's nursing faculty and its community nursing center, neighborhood residents, and local media. Meetings were open and the coalition grew over time. After meeting for about a year, the coalition used community-based models of action^2–5 to expand partnerships, assess the community's health, and begin working toward improved health outcomes. Coached by its academic partners, RHI applied principles of CBPA to implement CHIP¹ as a model for facilitating health improvement. For example, RHI members recognized the need for a community health assessment that went beyond readily available epidemiologic data and included social, behavioral, and environmental information.

In this report, the issues the coalition addressed and the processes used to implement the CHIP are described at the level of a local, very urban neighborhood including almost 7,000 households in six census tracts. The community partners found that neighborhood-derived health priorities are more specific than those of larger jurisdictions. CHIP provided local data that helped practitioners to target scarce resources to the specific health concerns of the community.

Theoretical Framework

RHI was designed to establish a stronger ecological link between the Riverwest community and local health services than previously existed. The partners initially came together, and after several round table discussions about their individual agency's missions, found that they all shared common beliefs in primary health care, social justice, and a goal for health improvement. Two theoretical models informed this initiative. The first was derived from the World Health Organization's (WHO) definition of primary health care to which the RHI members subscribed. This is a health promotion model that includes social and environmental determinants of health, community participation, and delivered where people live and work.⁶

The second model, CBPA, was introduced by the academic partners and provided a means for the RHI coalition to express locally WHO's global ideals. CBPA is an ecological framework grounded in social justice.^7,8 For this reason, it is particularly well-suited to public health and has been described widely in the community/public health literature over the past 10 years.^9-17 CBPA supports a democratic model of research that provides for a distribution of power that includes community members in the process. From a research standpoint, principles of CBPA include "casting a wide net in recruiting participants and involving them in every step, including project design, implementation, analysis, and dissemination of results."¹⁸

From a public health perspective, the principles include (1) recognizing the community as a unit of identity, (2) building on strengths and resources within the community, (3) facilitating collaborative partnerships in all phases, (4) committing to integrating knowledge, and (5) acting for mutual benefit of all partners.¹³ Throughout, CBPA promotes a co-learning and empowering process that attends to social inequalities. Having been influenced by Brazilian educator Paulo Freire,¹⁹ CBPA is an iterative process that includes the broad determinants of health and ensures that the knowledge gained is understandable, respectful, and shared.¹³ Together these two models grounded the...