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Is Your Community Ready to Support Comprehensive Prevention Programming?—Part 2

Defining Community and Community Readiness


Part 1 in this #PreventionNuggets series addressed the challenging issue of having a culture of prevention in the community as the platform for developing, supporting, and sustaining comprehensive prevention programming over time. In this Nugget, we are looking at definitions of the term ‘community’ as we consider the means for building community readiness as part of culture.



Definitions of Community

As usual here in the U.S., we often start with the Merriam-Webster Dictionary, where community is defined as:

“a unified body of individuals: such as, the people with common interests living in a particular area broadly; the area itself.

In a qualitative study (MacQueen et al., 2001) asked 118 diverse people “What does the word community mean to you”. The authors state that “a common definition of community emerged as a group of people with diverse characteristics who are linked by social ties, share common perspectives, and engage in joint action in geographical locations or settings”.

A review article by Cobigo and colleagues (2016) identified the following seven components of definitions of community found in the research:


a. physical proximity,

b. shared,

c. group,

d. bounded,

e. interaction,

f. belonging, and,

g. support


In general then, for purposes of implementing prevention programming, a community can be viewed as a geographically defined area and the population that lives or works within its boundaries OR a subgroup of people within that geographic area that share some common characteristic, for example, being parents, injecting drug users, a specific ethnic group, workers in restaurants.


How Ready Is the Community for Prevention?

For purposes of developing a comprehensive prevention service system, it is important to clearly identify and define what your community is and who within that community will benefit from these services. The next question to be addressed then is, how ready is the community for these prevention services?


Castenada et al. (2012) suggest that ‘readiness’ is multidimensional and include components such as

a. community and organizational climate that facilitates change,

b. attitudes and current efforts toward prevention,

c. commitment to change, and

d. capacity to implement change.


We have long recognized the importance of involving the community in identifying needs and required services to address these needs. Many efforts have been made around the world to involve the community in some way to address health needs. Good examples of these efforts in the U.S. are the Stanford Three Community Study conducted by Stanford University from 1979 through 1990 and the Midwestern Prevention Project conducted by the University of Southern California during the 1980s.


The Stanford Three Community Study (Fortmann et al., 1993) used a community education campaign to address cardiovascular disease through changing dietary practices and reducing smoking among the general population. The Midwestern Prevention Project (Pentz et al., 1989) addressed substance use in Kansas City, Missouri using mass media programming, a school-based educational program, parent education programs, community organization that included business leaders, and health policy components that are introduced sequentially into communities during a 6-year period. These studies showed how multiple interventions within a defined geographic area could have an impact on health-related behaviors.


Based on this history, in the late 1990s the Center for Substance Abuse Prevention funded the community partnerships, and the Robert Wood Johnson Foundation funded the Fighting Back Community Coalitions. However, evaluations of these two coalition efforts found that both failed to bring about changes in youth AOD use (Hallfors et al., 2002; Yin et al., 1997). WHY? The evaluations indicated that the coalitions involved in these projects lacked guidance as to how to enact prevention strategies, varied widely in the nature and amount of prevention services provided, and largely relied on locally created prevention strategies that had not been previously evaluated for effectiveness in reducing AOD use. So, for the most part, they were not using evidence-based interventions—recognized today as a critical component of effective prevention programming.


These studies suggest that the mere presence of an active, well-intentioned coalition is not enough to prevent AOD use. A coalition is not an intervention itself but is a structure developed to guide, support, and sustain effective prevention interventions and policies. Instead, the evidence suggests that in order to be successful, coalitions must ensure:


a. They have clearly defined, focused, and manageable goals;

b. They have adequate planning time;

c. Prevention decisions must be based on empirical data about what needs to change in the community and on evidence from scientifically valid studies of what has worked to address those needs.


They must implement prevention policies, practices, and programs that have been tested and shown to be effective; and they must carefully monitor prevention activities to ensure implementation quality and fidelity.


Each community varies in terms of its human, service, and funding resources; coalition structures will vary across communities and may change over time. The coalition model should build on the competencies and leadership abilities that exist within the communities. Coalition structure is important and should include clear guidelines on leadership, decision-making, membership roles, and fiscal responsibilities along with on-going assessments to determine gaps in knowledge and expertise of coalition members along with training to address these gaps. Finally, not all communities are ready to form a coalition or partnership.


Measuring Readiness

What is community readiness and how do we know when our community is ready to support a coalition to address prevention services? The Tri-Ethnic Center for Prevention Research at Colorado State University has developed a model that identifies dimensions and levels of community readiness. The model also comprises an instrument for determining community readiness that can be easily used and scored by community members. We’ll include the url for the readiness instrument and instructions for scoring it in the “How to” part of this #PreventionNuggets.

Dimensions of readiness are key factors that influence your community’s preparedness to take action on an issue; so all of these dimensions will relate to the particular issue you are trying to address. The six dimensions are:

  1. Community efforts. To what extent are there existing efforts, programs, and policies that address the issue?

  2. Community knowledge of the efforts. To what extent do community members know about existing local efforts and their effectiveness? Are the efforts accessible to all segments of the community?

  3. Leadership. To what extent are appointed leaders and influential community members supportive of the issue?

  4. Community climate. What is the prevailing attitude of the community toward the issue? Is it one of helplessness or one of responsibility and empowerment?

  5. Community knowledge about the issue. To what extent do community members know about the causes of the problem, consequences, and how it impacts your community?

  6. Resources related to the issue. To what extent are local resources – people, time, money, space, etc. – available to support efforts?

Your community’s status with respect to each of the dimensions forms the basis of the overall level of community readiness. The levels of readiness describe just how prepared your community is to tackle the issue in question.


So, what are the levels of community readiness defined by these 6 dimensions?

a. No awareness. The issue is not generally recognized by the community or leaders as a problem.

b. Denial/ resistance. At least some community members recognize that it is a concern, but there is little recognition that it might be occurring locally.

c. Vague awareness. Most feel that there is a local concern, but there is no immediate motivation to do anything about it.

d. Preplanning. There is clear recognition that something must be done, and there may even be a group addressing it. However, efforts are not focused or detailed.

e. Preparation. Active leaders begin planning in earnest. The community offers modest support of their efforts.

f. Initiation. Enough information is available to justify efforts. Activities are underway.

g. Stabilization. Activities are supported by administrators or community decision-makers. Staff are trained and experienced.

h. Confirmation/ expansion. Efforts are in place. Community members feel comfortable using services, and they support expansions. Local data are regularly obtained.

i. High level of community ownership. Detailed and sophisticated knowledge exists about prevalence, causes, and consequences. Effective evaluation guides new directions. The model is applied to other issues


Readiness is often linked to Social Capital. Social capital is the practice of developing and maintaining relationships that form social networks willing to help each other. The level of trust, frequency of cooperative exchanges, group cohesion and social support are factors that make community relationships and networks viable. These networks can further the level of readiness of a community to implement preventive interventions. When thinking about creating an environment supportive of prevention, approaching and engaging individuals and groups with existing social capital in the community can be key (Bourdieu, 1983; Woolcock & Narayan, 2000). There are three kinds of social capital: bonding social capital, bridging social capital and linking social capital. Basically, social capital refers to the ability to bond with like-minded persons, bridging to dissimilar people, through a shared sense of identity, shared norms and values that include trust, cooperation and reciprocity, and linking with people outside one’s community to leverage resources that are not readily available.


How to Assess the Readiness of Your Community?

The manual for conducting a Community Readiness assessment is available at https://communityreadiness.org/. The National Center for Community and Organizational Readiness (NCCOR; https://nccr.colostate.edu/) was established at Colorado State University in an effort to help communities address the health and quality of life of their members. The NCCOR has a special emphasis on under-served and multiethnic populations to build their capacity to better engage with their health and social services through capacity building assistance, training, and research efforts. Guidelines for moving your community forward along the continuum of ‘readiness’ can be found at https://tec.colostate.edu/wp-content/uploads/2018/04/CR_Handbook_8-3-15.pdf.


 

References

Bourdieu, P. (1983). “The Forms of Capital‟, translated by Richard Nice, http://www9.georgetown.edu/faculty/irvinem/theory/Bourdieu-Forms_of_Capital.html. Originally published as „Ökonomisches Kapital, kulturelles Kapital, soziales Kapital‟, in Soziale Ungleichheiten (Soziale Welt, Sonderheft 2), edited by Goettingen, R.K., & Schartz, O. pp. 183-98.


Woolcock, M., & Narayan, D. (2000) “Social Capital: Implications for Development Theory, Research, and Policy”. World Bank Research Observer, 15(2): 225-250.

Castañeda SF, Holscher J, Mumman MK, Salgado H, Keir KB, Foster-Fishman PG, Talavera GA. Dimensions of community and organizational readiness for change. Prog Community Health Partnership. 2012 Summer;6(2):219-26. doi: 10.1353/cpr.2012.0016. PMID: 22820232; PMCID: PMC4169887.


Cobigo, V., Martin, L., & Mcheimech, R. (2016).Understanding Community. Canadian Journal of Disability Studies, 5(4), 181-203. DOI: 10.15353/cjds.v5i4.318.


Drug Strategies. (2001). Assessing Community Coalitions. www.drugstrategies.org


Fagan, A.A., Hawkins, J.D., & Catalano, R.F. (2011). Engaging Communities to Prevent Underage Drinking. Alcohol Research & Health, 34(2), 167-174.


Fortmann, S.F., Taylor, C.B., Flora, J.A., & Jatulis, D.E. (1993). Changes in Adult Cigarette Smoking Prevalence After 5 Years of Community Health Education: The Stanford Five-City Project. American Journal of Epidemiology, 137(1): 82-96.


Hallfors, D., Cho, H., Livert, D., & Kadushin, C. (2002). Fighting back against substance abuse: Are community coalitions winning? American Journal of Preventive Medicine, (23)4, 237-245.


Kadushin C, Reber E, Saxe L, Livert D. (1998). The substance use system: social and neighborhood environments associated with substance use and misuse. Substance Use and Misuse, 33(8),1681-1710. doi: 10.3109/10826089809058950. PMID: 9680088.


Pentz, M.A., Dwyer, J.H., MacKinnon, D.P., Flay, B.R., Hansen, W.B., Wang, E.Y.I., & Johnson, C.A.. (1989). A Multicommunity Trial for Primary Prevention of Adolescent Drug Abuse Effects on Drug Use Prevalence. Journal of the American Medical Association, 261(22):3259-3266.


Slater, M.D., Edwards, R.W., Plested, B.A., Thurman, P.J., Kelly, K.J., Comello, M.L., & Keefe, T.J. (2005). Using community readiness key informant assessments in a randomized group prevention trial: impact of a participatory community-media intervention. Journal of Community Health, 30(1), 39-53. doi: 10.1007/s10900-004-6094-1. PMID: 15751598.

Yin, R.K., Kaftarian, S.J., Yu, P., & Jansen, M.A. (1997). Outcomes from CSAP's community partnership program: Findings from the national cross-site evaluation, Evaluation and Program Planning, 20(3), 345-355.


Articles on the Community Readiness Model


Donnermeyer, J. F., Oetting, E. R., Plested, B. A., Edwards, R. W., Jumper-Thurman, P., & Littlethunder, L. (1997). Community readiness and prevention programs. Journal of Community Development, 28(1), 65-83.


Edwards, R. W., Jumper-Thurman. P., Plested, B. A., Oetting, E. R., & Swanson, L. (2000). The community readiness model: Research to practice. Journal of Community Psychology, 28(3), 291-307.


Jumper-Thurman, P. & Plested, B. A. (2000, Summer). Community readiness: A model for healing in a rural Alaskan community. The Family Psychologist, 8-9.


Jumper-Thurman, P., Edwards, R. W., Plested, B. A., & Oetting, E. R. (2003). Honoring the differences: Using community readiness to create culturally valid community interventions. In G. Bernal, J. Trimble, K. Burlew, & F. Leong (Eds.), Handbook of Racial & Ethnic Minority Psychology (pp. 591-607). Thousand Oaks, CA: Sage Publications.


Jumper-Thurman, P., Plested, B. A., Edwards, R. W., Foley, R., & Burnside, M. (2003). Community readiness: The journey to community healing. Journal of Psychoactive Drugs, 35(1), 27-31.


Jumper-Thurman, P., Plested, B. A., Edwards, R. W., Helm, H. M., & Oetting, E. R. (2001). Using the community readiness model in Native communities. Health Promotion and Substance Abuse Prevention Among American Indian and Alaska Native Communities: Issues in Cultural Competence, CSAP 9, 129-158.


Jumper-Thurman, P., Plested, B. A., Edwards, R. W., Helm, H. M., & Oetting, E. R. (2000). Community readiness: A promising model for community healing. In D. Bigfoot-Subia (Ed.), Native American Topic-specific Monograph Series. Oklahoma City, OK: The University of Oklahoma Health Sciences Center, Office for Victims of Crime, Department of Justice.


Kelly, K., Edwards, R., Comello, M. L. G., Plested, B.A., Jumper-Thurman, P., & Slater, M. (2003). The community readiness model: A complementary approach to social marketing. Marketing Theory, 3(4), 411-425.


Oetting, E. R., Donnermeyer, J. F., Plested, B. A., Edwards, R. W., Kelly, K., & Beauvais, F. (1995). Assessing community readiness for prevention. The International Journal of the Addictions, 30(6), 659-683.


Oetting, E. R., Jumper-Thurman, P., Plested, B. A., & Edwards, R. W. (2001). Community Readiness and Health Services, 36(6 & 7), 825-843.


Plested, B. A., Smitham, D. M., Jumper-Thurman, P., Oetting, E. R., & Edwards, R. W. (1999). Readiness for drug use prevention in rural minority communities. Substance Use and Misuse, 34(4 & 5), 521-544.

Plested, B.A., Jumper-Thurman, P., Edwards, R. W., & Oetting, E. R. (1998). Community readiness: A tool for effective community-based prevention. Prevention Researcher, 5(2), 5-7.


Slater, M. D., Kelly, K., & Edwards, R. W. (2000). Integrating social marketing, community readiness and media advocacy in community-based prevention efforts. Social Marketing Quarterly, VI(3), 125-137.



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