First Published in 2003. Routledge is an imprint of Taylor & Francis, an informa company.
Setha Low is Professor of Anthropology and Environmental Psychology at the CUNY Graduate Center. She is the ...author or editor of numerous books, including Theorizing the City: The New Urban Anthropology Reader ; Housing, Culture, and Design ; Cultural Spaces ; and Place Attachment.
"Provocative and disturbing, this much-needed book holds up an unsparing mirror to an unsettling sign of our times." - The New York Times
Context: Co-creation—collaborative knowledge generation by academics working alongside other stakeholders—reflects a "Mode 2" relationship (knowledge production rather than knowledge translation) ...between universities and society. Co-creation is widely believed to increase research impact. Methods: We undertook a narrative review of different models of co-creation relevant to community-based health services. We contrasted their diverse disciplinary roots and highlighted their common philosophical assumptions, principles of success, and explanations for failures. We applied these to an empirical case study of a community-based research-service partnership led by the Centre of Research Excellence in Quality and Safety in Integrated Primary-Secondary Care at the University of Queensland, Australia. Findings: Co-creation emerged independently in several fields, including business studies ("value co-creation"), design science ("experience-based co-design"), computer science ("technology co-design"), and community development ("participatory research"). These diverse models share some common features, which were also evident in the case study. Key success principles included (1) a systems perspective (assuming emergence, local adaptation, and nonlinearity); (2) the framing of research as a creative enterprise with human experience at its core; and (3) an emphasis on process (the framing of the program, the nature of relationships, and governance and facilitation arrangements, especially the style of leadership and how conflict is managed). In both the literature review and the case study, co-creation "failures" could often be tracked back to abandoning (or never adopting) these principles. All co-creation models made strong claims for significant and sustainable societal impacts as a result of the adaptive and developmental research process; these were illustrated in the case study. Conclusions: Co-creation models have high potential for societal impact but depend critically on key success principles. To capture the nonlinear chains of causation in the co-creation pathway, impact metrics must reflect the dynamic nature and complex interdependencies of health research systems and address processes as well as outcomes.
The Morehouse Model Braithwaite, Ronald L; Akintobi, Tabia Henry; Blumenthal, Daniel S ...
2020, 2020-06-16
eBook
Among the 154 medical schools in the United States, Morehouse School of Medicine stands out for its formidable success in improving its surrounding communities. Over its history, Morehouse has become ...known as an institution committed to community engagement with an interest in closing the health equity gap between people of color and the white majority population. In The Morehouse Model, Ronald L. Braithwaite and his coauthors reveal the lessons learned over the decades since the school's founding—lessons that other medical schools and health systems will be eager to learn in the hope of replicating Morehouse's success.
Describing the philosophical, cultural, and contextual grounding of the Morehouse Model, they give concrete examples of it in action before explaining how to foster the collaboration between community-based organizations and university faculty that is essential to making this model of care and research work. Arguing that establishing ongoing collaborative projects requires genuineness, transparency, and trust from everyone involved, the authors offer a theory of citizen participation as a critical element for facilitating behavioral change. Drawing on case studies, exploratory research, surveys, interventions, and secondary analysis, they extrapolate lessons to advance the field of community-based participatory research alongside community health.
Written by well-respected leaders in the effort to reduce health inequities, The Morehouse Model is rooted in social action and social justice constructs. It will be a touchstone for anyone conducting community-based participatory research, as well as any institution that wants to have a positive effect on its local community.
Community-based participatory research has a long-term commitment to principles of equity and justice with decades of research showcasing the added value of power-sharing and participatory ...involvement of community members for achieving health, community capacity, policy, and social justice outcomes. Missing, however, has been a clear articulation of how power operates within partnership practices and the impact of these practices on outcomes. The National Institutes of Health–funded Research for Improved Health study (2009-2013), having surveyed 200 partnerships, then conducted seven in-depth case studies to better understand which partnership practices can best build from community histories of organizing to address inequities. The diverse case studies represented multiple ethnic–racial and other marginalized populations, health issues, and urban and rural areas and regions. Cross-cutting analyses of the qualitative results focus on how oppressive and emancipatory forms of power operate within partnerships in response to oppressive conditions or emancipatory histories of advocacy within communities. The analysis of power was conducted within each of the four domains of the community-based participatory research conceptual model, starting from how contexts shape partnering processes to impact short-term intervention and research outputs, and contribute to outcomes. Similarities and differences in how partnerships leveraged and addressed their unique contexts and histories are presented, with both structural and relational practices that intentionally addressed power relations. These results demonstrate how community members draw from their resilience and strengths to combat histories of injustice and oppression, using partnership principles and practices toward multilevel outcomes that honor community knowledge and leadership, and seek shared power, policy, and community transformation changes, thereby advancing health equity.
Everyday ethics Brodwin, Paul
2013., 20121202, 2013, 2013-01-01
eBook
This book explores the moral lives of mental health clinicians serving the most marginalized individuals in the US healthcare system. Drawing on years of fieldwork in a community psychiatry outreach ...team, Brodwin traces the ethical dilemmas and everyday struggles of front line providers. On the street, in staff room debates, or in private confessions, these psychiatrists and social workers confront ongoing challenges to their self-image as competent and compassionate advocates. At times they openly question the coercion and forced-dependency built into the current system of care. At other times they justify their use of extreme power in the face of loud opposition from clients. This in-depth study exposes the fault lines in today's community psychiatry. It shows how people working deep inside the system struggle to maintain their ideals and manage a chronic sense of futility. Their commentaries about the obligatory and the forbidden also suggest ways to bridge formal bioethics and the realities of mental health practice. The experiences of these clinicians pose a single overarching question: how should we bear responsibility for the most vulnerable among us?
For scholars seeking to undertake consequential research in service-learning and community engagement (SLCE) at a time when there is widening interest in and increasing acceptance of research in this ...field as a primary area of scholarship, this book provides accounts by preeminent scholars about the trajectories of their research, their methodologies, lessons learned along the way, as well as their views about the future direction of the field.The contributors to this volume represent a range of disciplines and fields including education, history, organizational leadership, political science, philanthropic studies, psychology, and public health, as well as both qualitative and quantitative traditions, and offer models of scholarly learning that contribute to a knowledge base that can guide practice and further the broader public purposes of the academy.They articulate how they view their research on SLCE as having broader purposes that matter to them personally as well as professionally and illustrate how the "why" and "to what end" of their research can evolve as a program of research develops and matures across time. They identify key choices they made in terms of inquiry and methodology, describe both successes and challenges in establishing and navigating a SLCE research agenda across their careers, and share lessons learned from their research journey to advance the field both domestically and abroad. Emerging from these narratives is a theme of practical wisdom that arises through the learning of researchers, students and communities as they engage with complex social contexts.
Many studies indicate that participation and sense of community (SoC) are associated factors enhancing community development. However, research has almost completely ignored the magnitude of the ...association between the two and the stability of this relationship across contexts, populations and different forms of community participation. A meta-analysis was conducted to assess the following: (a) the strength and stability of the SoC-participation relationship; (b) variations in this relationship associated with different forms of participation (i.e., civic and political); and (c) the influence of population characteristics on the SoC-participation relationship. The results showed that the SoC-participation relationship is significant, positive and moderately strong for forms of participation in the adult population and specific cultural contexts. Implications for theory and applications are discussed.
This is the ninth paper in our series, "Community Health Workers at the Dawn of a New Era". Community health workers (CHWs) are in an intermediary position between the health system and the ...community. While this position provides CHWs with a good platform to improve community health, a major challenge in large-scale CHW programmes is the need for CHWs to establish and maintain beneficial relationships with both sets of actors, who may have different expectations and needs. This paper focuses on the quality of CHW relationships with actors at the local level of the national health system and with communities.
The authors conducted a selective review of journal articles and the grey literature, including case study findings in the 2020 book Health for the People: National CHW Programs from Afghanistan to Zimbabwe. They also drew upon their experience working with CHW programmes.
The space where CHWs form relationships with the health system and the community has various inherent strengths and tensions that can enable or constrain the quality of these relationships. Important elements are role clarity for all actors, working referral systems, and functioning supply chains. CHWs need good interpersonal communication skills, good community engagement skills, and the opportunity to participate in community-based organizations. Communities need to have a realistic understanding of the CHW programme, to be involved in a transparent process for selecting CHWs, and to have the opportunity to participate in the CHW programme. Support and interaction between CHWs and other health workers are essential, as is positive engagement with community members, groups, and leaders.
To be successful, large-scale CHW programmes need well-designed, effective support from the health system, productive interactions between CHWs and health system staff, and support and engagement of the community. This requires health sector leadership from national to local levels, support from local government, and partnerships with community organizations. Large-scale CHW programmes should be designed to enable local flexibility in adjusting to the local community context.
As part of its strategy, the Community Engagement Centre (CEC) – a joint venture of Indus Health Network’s Global Health Directorate and Interactive Research and Development, Pakistan – collects ...communities’ stories from program catchment populations. These include challenging, life-changing incidents and narratives of agency which offer valuable insights into organic systems and barriers as well as the nuances of power and access.Nine stories were analysed to reveal a ‘catalyst’; these stories included a person or group holding the trust of community members, that demonstrated agency to act either for themselves or their communities. These catalysts may or may not have been successful in achieving the desired change, but studying these narratives revealed the lived experiences, mechanisms of trust and dynamics of power in communities: how healthcare workers, individuals, and communities interact, utilise their agency to own positions in society, and build trust to enable change – within themselves or the larger collective. We investigated the levels at which low-resourced communities experienced challenges while aspiring towards change and whether certain social categories enabled more agency than others. To examine the stories, we developed and applied an intersectional framework that was able to dissect the stories down to their elements.Findings yielded that classism and sexism were significant barriers for communities and individuals, while trust was a powerful facilitator for agency and action. The analysis demonstrates that conducting an intersectional analysis on these stories aids in dispelling the ‘symptomised’ perspective of poor communities as non-agentic and helpless in the face of difficulties. Furthermore, by understanding communities’ organic responses to collective problems and health concerns, programs can integrate with existing local systems for long-term solutions.
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