A planning framework for community empowerment goals within health promotion

Abstract

Health promotion often comprises a tension between 'bottom-up' and 'top-down' programming. The former, more associated with concepts of community empowerment, begins on issues of concern to particular groups or individuals, and regards some improvement in their overall power or capacity as the important health outcome. The latter, more associated with disease prevention efforts, begins by seeking to involve particular groups or individuals in issues and activities largely defined by health agencies, and regards improvement in particular behaviours as the important health outcome. Community empowerment is viewed more instrumentally as a means to the end of health behaviour change. The tension between these two approaches is not unresolvable, but this requires a different orientation on the part of those responsible for planning more conventional, top-down programmes. This article presents a framework intended to assist planners, implementers and evaluators to systematically consider community empowerment goals within top-down health promotion programming. The framework 'unpacks' the tensions in health promotion at each stage of the more conventional, top-down programme cycle, by presenting a parallel 'empowerment' track. The framework also presents a new technology for the assessment and strategic planning of nine identified 'domains' that represent the organizational influences on the process of community empowerment. Future papers analyze the design of this assessment and planning methodology, and discuss the findings of its field-testing in rural communities in Fiji.

Messung, Bewertung und strategische Weiterentwicklung von Gemeindekapazität und -empowerment: Vorstellen eines qualitativen Instruments

“…Hierf ü r kann es sinnvoll sein, ein Instrument zu verwenden, das hilft, die gemeindebezogene Kapazit ä t und Empowerment zu dokumentieren und abzubilden, die sich innerhalb eines Programmkontexts entwickelt haben. Dieses partizipative Instrument, das auf die genannten neun Bereiche zur ü ckgreift, wurde entwickelt, um gemeinsam mit dem System des " parallel-tracking " [9] eingesetzt werden zu k ö nnen (s. a. Laverack G, " Ber ü cksichtigung des Empowerment in der Programmplanung von Gesundheitsf ö rderung " in dieser Ausgabe, S. 736). Das Anstreben von Capacity Building in einer Gemeinde bedeutet nicht, dass das Erreichen von Gemeindekapazit ä t einen Ersatz f ü r inhaltliche Programmziele darstellt.…”

Participatie en empowerment in de gezondheidsbevordering: Professionals in de knel tussen ideaal en praktijk?

“…5 Bovendien gaat het in het nieuwe paradigma niet alleen om toerusting van personen, maar ook om toerusting van de omgeving door belangenbehartiging en sociale actie gericht op beïnvloeding van het beleid en praktijk van de gezondheidsbevordering. Gezondheid komt hier in het perspectief te staan van een mens-en rechtvaardig bestaan (Laverack & Labonte 2000).…”

Parallel-tracking bottom-up approaches within chronic disease prevention programmes

“…Bottom-up programmes are fewer in design and address the concerns of the beneficiaries based on discussions with them prior to implementation. The concerns are prioritised and then developed into a form that makes sense to all the programme stakeholders (Laverack and Labonte 2000).…”

“…Rather than viewing the issue as a bottom-up versus topdown tension, accommodating both can be better viewed as a 'parallel track'. The tensions between the two then occur at each stage of the programme cycle making their resolution much easier to achieve (Laverack 2004). The main purpose of the programme remains unchanged with a focus on the more conventional top-down issues and so fits within the expectations of, and is therefore acceptable to, funding agencies but still has a clearly defined role to address community needs and to build capacity.…”