Health education quarterly最新文献

In the last decade, a revolution has been occurring in the field of health promotion. Guided to a large extent by position papers disseminated by the World Health Organization (WHO) Europe Health Promotion Office, and furthered by the Ottawa Charter, the Epp Report in Canada, the Healthy Cities project, as well as by other efforts, this new health promotion movement has introduced new ideas, new language, and new concepts about what constitutes health and how health promotion efforts should be configured to achieve health. Punctuated by the terms like empowerment and community participation, this movement has generated a whole new discourse about the theory and practice of health promotion. This paper explores the multiple meanings that surround these terms, and the implications for practice, by addressing questions like: What does health mean in this new context? What is empowerment? What does participation look like? Has the tyranny of the professional been replaced by the tyranny of the community? Has anything changed about the practice of health promotion other than the language? Finally, it is argued that an acknowledgment of the multidimensionality of these concepts may facilitate their translation from rhetoric into health promotion practice.

Freire used very specific materials in culture circles to support an empowering process that allowed learners to define the content and outcome of their own learning. However, the materials themselves were carefully crafted and developed by Freire and his co-workers. This article focuses on an extension of Freire's problem-posing educational methods to include participant involvement in the development and production of their own learning materials. Four linked case examples, one in literacy and three in health education, illustrate the process of participatory materials development and we discuss some issues for facilitators and learners. The production process can be an empowering experience and the product stands as testimony to the participants as self-conscious agents and critical thinkers capable of transforming their world. The resultant materials, geared to a particular locale and reflective of the people and language in the community, can provide a powerful model for those who may not have been involved in the process, but who can identify with the friends and neighbors who developed the materials. Participatory materials development is suggested as a supplement to problem-posing educational experiences and is particularly well suited for community programs.

This article presents two case studies highlighting the role of community conflict in the process of community empowerment. A graduate program for community health nurses (CHNs) in a large Midwestern city formed a partnership with a diverse, integrated neighborhood for the dual purposes of enhancing the community's capacity to improve its own health and teaching CHNs community organizing as a means to improve health. Central to the partnership are a broad definition of health, trust developed through long-term involvement, a commitment to reciprocity, social justice, and Freire's model of adult learning. Two initiatives that gave rise to major conflicts between community groups are analyzed. Conflicts, external and internal to the community, proved to be both powerful catalysts and potential barriers to the use of Freirian themes in community organization. Both university and community participants report needing better skills in the early recognition and management of conflict. We conclude that conflict management theory must be integrated with empowerment education theory, particularly when empowerment education is applied in a diverse community.

The Healthy Cities process uses action research to empower communities to take action for health. Five concepts that link community empowerment and action research are: focus on community, citizen participation, information and problem solving, sharing of power, and quality of life. Two city examples from Healthy Cities Indiana, a pilot program of CITYNET Healthy Cities, provide illustrations of these concepts. The dynamics of community participation in action research and the successes and barriers to community participation are presented. Outcomes that empowered the community are suggested: the extent to which Healthy City projects are initiated, their progress monitored, continued action in health supported, resources obtained, and policies promoted that contribute equity in health.

If political dynamics are included in the definition of community, health promotion programs have a greater potential to recognize that assisting people to empower their communities is as important as assisting them to improve their health. This paper reports on the evaluation methods employed for a health promotion program in a rural poor county of the Mississippi Delta that chose to define community in this way. The evaluation took an action research approach so that the methods would not contradict or interfere with the program's empowerment agenda. The methods required a close and collaborative working relationship among evaluators and local service providers, community leaders, and program staff who defined and operationalized eight dimensions of community competence, determined the units of analysis, and developed the data collection protocol. Emphasis was placed on using the data to engage the program and three communities in a dialogue on how to confront a system with the difficult issues they faced. The findings revealed that after 1 year of implementation, community competence moved from social interactions internal to communities to those more externally focused on mediating with outside institutions and officials. At the same time, measures of self-other awareness and conflict containment showed a decrease or virtual nonexistence.

Process evaluation complements outcome evaluation by providing data to describe how a program was implemented, how well the activities delivered fit the original design, to whom services were delivered, the extent to which the target population was reached, and factors external to the program that may compete with the program effects. The process evaluation system used in the Child and Adolescent Trial for Cardiovascular Health (CATCH) is presented in this paper. The conceptual model underlying the CATCH process evaluation system is described, and process measures and data collection protocols are reviewed. Functions of process evaluation data in the trial include: (1) describing the implementation of the program, (2) quality control and monitoring, and (3) explaining program effects. The importance of incorporating process evaluation into final outcome analyses and assessments of program impact is emphasized.

Relatively few health education interventions directed at preventive health behaviors and management of chronic illness among Native Americans have been reported in the literature. This article provides a selective review of health education interventions among Native Americans that address the prevention and management of chronic illnesses/conditions as well as preventive health behaviors. For each intervention included in the review, a description of its cultural relevance, sample, design, and evaluation is provided. Limitations are noted, as well as implications for research and practice.