Public health in community settings: An introduction

2.1 Recognising, realising and responding to the potential of communities

There are no simple answers to what works in facilitating community engagement, but the local context is of central importance. A variety of techniques, methods and support has to be adopted to ensure optimal conditions for community engagement. However, as you have already read, much has been written on the skills and practices which seem generally effective in facilitating community engagement for health. Effective practices fall under the following main headings:

• identify local circumstances that may present barriers to effective community involvement (e.g. lack of transport infrastructure) and act on these
• acknowledge the diversity of local communities and develop both targeted and universal strategies to reach all members of the local community, including traditionally ‘hard-to-reach? groups such as women, young people, people with a disability and members of minority ethnic groups
• budget and plan for community development, training and capacity building from the start, ideally involving the local residents in the planning process
• provide a variety of opportunities for training and support for local people and professionals
• use regular evaluation as a tool to identify barriers to community involvement and actions to address these
• establish effective ways of partnership working between statutory and non-statutory agencies and the local community.

Figure 2 is an illustration of one particular strategy used by Be Active Stay Active (BASA), a community-based mental health project in Scotland, to reach and engage with communities.

The public health practitioner at a community level has a developmental role in the process of bringing together a group of people who share a common need or interest, in order to realise their hopes of taking the appropriate action to meet that need or follow that interest. Task groups or subgroups, such as a Health Action Group, can be set up to work on particular issues. Within this structure, focus groups could be organised to enable more in-depth research of the needs and solutions identified. These methods may include either a participatory action research approach or community-based participatory research, both of which favour rapid participatory appraisal techniques. This involves communities identifying and challenging their own health-related needs utilising rapid information gathering. Here, the community role is seen as critical to the development of rapid appraisal originating in the social/ community tradition. It is this feature which distinguishes this approach from the rapid epidemiological approach (which uses epidemiological and statistical methods alone for a rapid assessment) (Rifkin, 1992). Either or both of these groups could, through the composition of their membership, provide the foundations for developing a partnership between the local residents and statutory, non-statutory, voluntary and community organisations.

The setting up and development of a group to address an identified public health issue, whether it be to deal with a single issue or a variety of issues, requires the public health worker to have a range of skills to enable the group both to develop, as a cohesive force with a shared vision and common identity, and to achieve its objectives. Community development workers often seem like the glue that keeps people working together.

Realising the potential of communities calls for good organisational skills, along with the ability to manage both people and budgets. Skills in fundraising and marketing are especially useful in consolidating, sustaining and mainstreaming projects or interventions. Both community and professional members will bring different skills and experiences, together with their different commitments outside the group process. This can raise some important questions in terms of ownership and control, the development of an equitable partnership and the commitment expected from each member. This will be the case particularly for an inter-agency group, because its members may have differing expectations, as well as competing needs, interests and priorities. The group may also have a naturally limited lifespan because:

• it has a particular task to achieve
• it is part of a time-limited project for which the funding ceases
• there is no longer a perceived need for this particular type of group and something else might replace it.