Advancing the Science of Community Intervention - Society for ...

“Advancing the Science of
Community Intervention,”
Chicago 2009:
Report and Discussion
Moderator:
Michael Fagen (University of Illinois at Chicago)
Panelists:
Chuck Conner (West Virginia University PRC)
Charles Deutsch (Harvard University PRC)
Alicia N. Heim (CDC PRC Program)
Ken McLeroy (Texas A&M Health Science Center PRC)

Outline
• Reason for the Conference
• Planning Committee and Sponsors
• Conference Themes
• Implications for Stakeholders,
Practitioners, and Researchers
• Systems
• Policy
• Practice

Reason for the Conference
• Proposal submitted to CDC: conference on
strengthening research designs and assessing
impact of intervention research conducted in
real-world settings
• Follow-up conference to one held in 2007
• Sponsored by National Institutes of Health (NIH), Agency for Health
Research and Quality (AHRQ), and International Collaborative on
Complex Interventions (ICCI)
• Trade-offs between randomized and non-randomized designs for
complex community interventions
• Published in four articles in American Journal of Preventive Medicine
August 2007, Volume 33, Issue 2: Pages 137-168

Planning Committee and Sponsors
• Co-Organizers
• Edison Trickett, Community Psychology Professor, UIC
• Eduardo Simoes, Director, CDC PRC Program
• Planning Committee
• Representation from CDC PRC Program office, CDC-funded PRCs,
Canada, ICCI members
• Members: Sarah Beehler, Charles Deutsch, Barbara Gray, Larry
Green, Penny Hawe, Alicia Heim, Ken McLeroy, Robin Miller, Bruce
Rapkin, Jay Schensul, Amy Schulz, Jean Smith, Joe Trimble
• Sponsors
• CDC
• Centers for Research Development in Population Health (Canadian
Institutes of Health Research)
• Award given to Dr. Penny Hawe and colleagues to catalyze
international collaboration on complex interventions (ICCI)

Conference Themes
• Conceptualizing communities and
interventions as dynamic systems with
multiple levels
• Nature of evidence
• What types of evidence are valued and not
valued
• Developments in both domestic and global
health
• Alternative rigorous research and
evaluation methods

Policy Implications
• Primacy of context over theory and
evidence
• Theories used by academics are most
often derived from exotic and controlled
trials
• Such trials treat most of the complexity of
the real world as noise

Systems Implications

Cottrell, 1976
(community competence)
Goodman et al., 1998 (community
capacity)
Easterling et al., 1998 (community
capacity)
Chaskin et al., 2001 (community capacity)
Laverack, 2001
(community capacity)
Articulateness
Skills
SKILLS & RESOURCES
Management of relations with the larger
society
Resources (financial, technological, other
material, etc.)
Skills and knowledge
Access to resources
Ability to mobilize internal resources and
access external resources
Commitment
Sense of community
Trusting relationships and norms of
reciprocity
Commitment among community members
Links with others
NATURE OF SOCIAL RELATIONS
Conflict containment & accommodation
Social capital/ trust (listed as type of
“resource”
Sense of efficacy and confidence among
residence
Sense of community
Role of outside agents (facilitators/
organizers, consultants)
Communication
Social and inter-organizational networks
Organizational (mediating) structures
STRUCTURES & MECHANISMS FOR
COMMUNITY DIALOGUE
Machinery for facilitating participant
interaction and decision-making
Mechanisms for communication across the
community and for citizen input (listed as
type of “resource”)
Mechanisms of problem solving
Program management (includes community
control)
LEADERSHIP Leadership Leadership Strong leadership
Participation
Participation
CIVIC PARTICIPATION
Participation
Community power (distribution)
Problem assessment (identification of
problems and action to resolve are carried
out by the community; self-determination)
VALUE SYSTEM
Community values
LEARNING CULTURE
Self-other awareness and clarity of
situational definitions
Understanding of community history
Culture of learning
“Asking why”
Critical reflection

Characteristics of Systems Models
• Interconnectedness (relational perspective)
• Non-reductionist approach
• Focus on context
• Idea of embedded systems
• Problematic concept of causality
• Non-linear relationships
• Feedback loops
• Stocks and flows
• Progressive approximation of models

Characteristics of Systems Models
(continued)
• Dynamic nature of systems across time
• Importance of boundaries
• Subjective nature of relationships between
observer and observed
• Importance of multidisciplinary approaches
• Emergent properties
• Chaos and complexity
• Autopoesis

Community Activist Perspective
• Defining community
• CBPR is a strategy for social change: developed, informed, guided,
and implemented with the community as a partner
Partnership Challenges
• Community-based versus Community-engaged
• Concept of science taking place in “real life settings” and
encompassing the “noise, messiness, and unpredictability” of those
complex adaptive systems.
• Is this what CBPR does or is it more than that?
• Academia may see their connection as distant….possibly to maintain
objectivity

Community Activist Perspective
• Need to value both local knowledge and academic knowledge
• Taking time in the community to build relationships is critical to
building trust within the partnership
• Traditionally, ownership of research process, findings, and final
product is held by corporation or institution – no shared ownership
• Community partners are under-funded and lack resources for
capacity building and sustainability
• Unpaid and/or unrecognized labor both in the community and within
academia
• Why don’t we examine deeply imbedded determinants? Are they
off-limits? Do they create offense? Are they politically incorrect?

Community Activist Perspective
• Do we as community understand the challenges facing CBPR
researchers within academia? (tenure, CBPR values)
• How much scientific literacy does a community need? How much
scientific literacy do they want?
• The concept of “complex community interventions” is not
well understood by the community.
• What do communities need to know about systems concepts
when they are included as a part of research?
• There will always be researchers who are skeptical of the process as
it doesn’t fit everyone’s professional views or needs
• We are building a history of success and numbers of people that are
involved, committed, and sold on the process

Practitioner Implications
• How can practitioners find and interpret
evidence for interventions? Does practice-based
evidence have the same merit and value as
evidence-based practice?
• How best for practitioners to evaluate (or
contract with others to evaluate)? Is
aggregating individual outcomes as the primary
measure of success enough? How to account for
broader-level measures?

Next Steps
• This conference discussion
• Posting conference materials (presenters’ slides,
program book) at http://preventionresearch.dal.ca
• Commentary for the American Journal of Public
Health, written by planning committee members
• Community-authored papers for various journals

Presenter Contact Information
Michael Fagen
mfagen1@uic.edu
(312) 355-0647
Chuck Conner
cconner@wvrhep.org
(304) 927-8182
Charles Deutsch
cdeutsch@hsph.harvard.edu
(617) 432-3936
Alicia Heim
aheim@cdc.gov
(770) 488-8523
Ken McLeroy
kmcleroy@srph.tamhsc.edu
(979) 862-3152