What comes to mind when you think of the word “community”?
What comes to mind when you think of the word “community”? Take a moment to reflect over public health meetings you’ve attended over the last year. Make a list of the key words that have been a part of your public health task force, coalition, network or collaborative meetings. Odds are the word “community” would be high on the list.
Here are a few questions to ask yourself when engaging communities in your work. The Socio-Ecological Model is a common public health model that considers the interplay between individual, interpersonal, organizational, community and societal factors that affect health. As you are using this model in your work and engaging community, consider the following questions:
- To what extent do the engaged organizations employ/engage people that directly experience the issues within public health?
- Are there people with lived experience within the leadership of these organizations to ensure that their input is central to the recommendations/interventions developed?
- How do we support and uplift solutions that are designed by people with lived experience? How do we support people with lived experience to mobilize and create Community-Based Organizations that can play the central role in determining the appropriate interventions for the communities that are most impacted? How can we support them in becoming effective advocates for their communities?
- How can we modify the SEM to ensure that the model explicitly encourages public health practitioners to seek out and center the people with a lived experience in their planning and strategy?
The Socio-Ecological Model and Community Engagement Overview
With an increasing focus on health equity, stakeholders have become more focused on engaging the community as interventions are developed. This intervention support is often informed by public health models that encourage program planning with the communities served. These models guide public health thinking and help to determine what and how interventions are implemented. Before applying any framework, it’s important to have a common understanding of how the community is defined and understood.
One of the common models in the field of public health is the Socio-Ecological Model (See figure 1) where the best outcomes are achieved with interventions that target at least 2 levels of the model. Research has shown that multi-level interventions are necessary to produce the highest amount of change when we target the individual, interpersonal, community, and the societal (policy) levels.
How could community engagement play out when we use the SEM?
In some versions of the SEM, community is defined as the relationships between organizations that advocate on behalf of or directly serve individuals and families that reside within the community. With this definition, connecting with organization leaders can lead to believing that this is the same as engaging the community. This approach often leads to the exclusion of individuals with the lived experience from the engagement. The SEM definition of “community” may hinder authentic communication and collaboration between grassroot community members and public health practitioners. For practitioners who are working on building long-lasting partnerships and ensuring that the voice of those with lived-experience is central to our approaches, the SEM may limit engagement of these individuals.
From the SEM model perspective, an assumption is made that those who have lived experience are within these organizations’ leadership. While that may sometimes be the case, individuals who are most negatively impacted by the social determinants of health can also face systemic barriers that prevent them from joining and moving to leadership positions with community organizations. These individuals with the lived experience may be in crisis mode which is a state of high alertness, fear and anxiety due to difficult life circumstances and thus only able to attend to immediate and essential needs which would not include joining community-based organizations. This means that their experiences which are vital in shaping interventions and recommendations are likely to be left out of the conversation. Furthermore, due to the recent Covid-19 pandemic, public health workers are also in crisis mode as they work to address the various public health demands that are posed by the pandemic. This would negatively affect their ability to take the time to equitably engage the community.
Defining Community
There are various ways in which community is described and each way provides insight on how we engage community.
Some concepts of community include a system perspective, a social perspective, a virtual perspective, and an individual perspective (ATSDR, 2015). With a system perspective, a community comprises of different parts with specialized functions that operate within specific boundaries to meet community needs (ATSDR, 2015). A social perspective views the community as social and political networks that link individuals, community organizations, and leaders. A virtual perspective recognizes virtual communities where people rely on computer mediated communication (ATSDR, 2015). An individual perspective on community recognizes the individual’s sense of community membership that is derived from one’s self-identity and also how others see or think about the individual (ATSDR, 2015).
Other definitions of community:
- “A form of social and often spatial, organization centered on common interests and/or a locale” (Oxford University Press, 2022)
- A feeling of fellowship with others, as a result of sharing common attitudes, interests, and goal (Oxford Lexico, 2022)
- A person with the lived experience of maternal health inequities
Engaging Community
Community engagement is a critical part of any public health initiative. Community engagement includes public health entities working hand-in-hand with organizations, informal groups or individuals in mutually beneficial relationships to improve outcomes for the community. Practitioners should be mindful of how they are defining community engagement when using the SEM. Consider changing our definition of “community” to include people with lived experience and decide if we will engage organizations, informal groups, individuals, or a combination in our work. A combination of engaging organizations and individuals will provide more diverse experiences that can be drawn upon to design interventions that are culturally responsive at each level of the SEM.
References
- Agency for Toxic Substances and Disease Registry (ATSDR). 2015. Concepts of Community. ATSDR. Retrieved from https://www.atsdr.cdc.gov/communityengagement/pce_concepts.html
- Oxford Lexico. 2022. Community. Oxford Powered by Lexico. Retrieved from https://www.lexico.com/definition/community