Barriers to the Development of a Public Health Initiative with a Coalition of Community and Neighborhood Resources Using Community-Based Participation

Influence of social determinants of health on health is essential to reducing health disparities.  Each community strives to improve public health. Imparting change takes many years.  The Patient Protection and Affordable Care Act includes the removal of barriers to providing home and community-based services¹.  The World Health Organization’s Commission on Social Determinants of Health has acknowledged, “measuring the problem” as one of three principles of action to achieve health equity².  In order to recognize inequities in a community, it is necessary to approach the disparities from multiple perspectives.  Barriers to the development of a healthy neighborhood initiative are described.

           The process of improving the health of a community has many positive outcomes.  The white paper “Healthy People, Healthy Lives”, stressed “the importance of local innovation to reduce inequalities and improve health at key stages in people’s lives.” This included “the empowerment of local government and communities to shape their environments and tackle local problems” ³.   Community-based participation includes reflection of the community’s values, beliefs, and vision.  This practice empowers the community members.  Empowerment is a viable public health strategy to improve the health of the residents⁴.  Using a bottom-up approach enabled the residents to have more control over and improve their health^4,5.  Empowering the residents to participate in the assessment and development of a public health initiative remained an essential component of the project.

           Community participation is a key to empowerment. There are several barriers to community participation that are established in the literature.  These barriers are a lack of community skills, dominance of professional culture, lack of organizational abilities, and local political dynamics⁶. Lack of community leadership supporting collaborative partnerships with involvement from outside support organizations, the influence of a neighborhood leader, and the community perception of local government involvement impacted the overall success of the initiative⁷ . 

           There are many challenges to using a community-based participation approach.  In developing the coalition, a group of interested persons took a giant step backward to become unaffiliated with the group.  In the individual meetings with the local pastors, this topic was discussed. The shifting of power from the leaders and professional partners was uncomfortable to the group members. No singular reason was cited as a cause for lack of participation.  Instead of looking at the 46808 community as a whole, focus groups were held within each faith congregation to solicit specific health issues to address in smaller groups.  The pastors were amenable and offer to share resources.  A rippling effect was expected. 

            The barriers identified in the literature rang true with the development of this initiative.  Barriers included lack of community skills, dominance of professionals, lack of organizational abilities, and the state of local political dynamics.  A community member could not be forced to become empowered to take action regarding the health of their community.  There was a disconnect between the goals of community leaders and residents.  The social determinants of health remained unclear for this community.

            The impact of acknowledging the barriers to a healthy neighborhood initiative could resurrect its momentum.  Evaluating the perspective of each set of participants, the community and organizational partners, and the residents, was instrumental in maintaining forward progress.  Using evidence-based practice was foundational in the development of a healthy neighborhood initiative.  Comprehending principles that influence social change was paramount to effectively anticipate and reduce barriers.  Levels of understanding, intimidation, and previous experiences all contributed to the influence on community participation. The ability to go back and clarify, revisit goals and barriers that arise, tenacity, and patience were useful lessons to take forward as new projects are written as part of implementation of the Patient Protection and Affordable Care Act.

 1.     The Patient Protection and Affordable Care Act, Pub. L. 111-148 § 2402 et seq. (U. S.

         Congress 2010). Retrieved from the United States Government Printing Office:

         http://www.gpo.gov/fdsys/pkg/BILLS-111hr3590enr/pdf/BILLS-111hr3590enr.pdf.

2.     National Association of County & City Health Officials (NACCHO). (2009). The use public health informatics to identify and address inequities [Issue Brief]. 

        Retrieved from NACCHO website: https://eweb.naccho.org

3.     Department of Health (England). (2010). Healthy lives, healthy people [White Paper].

        Retrieved from United Kingdom Department of Health website:  http://www.dh.gov.uk

4.     Cameron, C., Ghosh, S., & Eaton, S. (2011). Facilitating communities in designing and using their own community health impact assessment tool.

        Environmental Impact Assessment Review, 31, 433-437. doi:10.1016/j.eiar.2010.03.001

5.     Rodwell, C. M. (1996). An analysis of the concept of empowerment. Journal of Advanced

        Nursing, 23, 305-313. http://dx.doi.org/10.1111/1365-2648.ep8542315

6.     Kearney, M. (2004). Walking the walk?  Community participation in HIA a qualitative

        interview study. Environmental Impact Assessment Review, 24, 214-229.

        http://dx.doi.org/10.1016/j.eiar.2003.10.012

7.     Fawcett, S. B., Fisher, J. L., Paine-Andrews, A., Francisco, V. T., Schultz, J. A., Richter, K. P., & Berkley, J. Y. (1995). Using empowerment theory in collaborative

        partnerships for community health and development. American Journal of Community Psychology, 23, 677-

        697. doi:10.1007/BF02506987