13.9: Community Intervention Models
The social-ecological model identifies several potential areas for intervention and health promotion within a community at each different circle. Yet, just as individuals have varying levels of readiness to change behaviors, so do communities have varying levels of readiness for intervention (McKenzie et al., 2017). Due to group dynamics, physical environments, and political powers which are involved in every community, we cannot necessarily apply the same behavior change theories to a group that we might to an individual. Several researchers have described different approaches to community interventions, some which emphasize looking for deficits (needs-based) and others that emphasize identifying what is already working well (strengths-based). These different models work via social action, advocacy, capacity building, grassroots organizing, and leadership development in order to cause positive change (Seabert et al., 2021).
Community-based health promotion programs often take a holistic approach, in that they are not limited to a single location (like a hospital), they often have multiple, coordinated interventions, and may also focus on environmental and policy changes to support the desired behaviors (Merzel & D’Afflitti, 2003). There are four major models that most community-based interventions fall into according to McLeroy et al. (2003). Most successful community interventions are not only multi-faceted, they also utilize more than one of these models.
- Community as a setting . Sometimes the community is simply the geographical location in which the intervention takes place. Health promotion programming might take place at various locations within the community, such as city parks, community centers, churches or other faith-based organizations, hospitals, schools, worksites, or other non-profit organizations. Mass media (like billboards, paper flyers, radio, T.V., or Youtube advertisements, etc.) may be used to convey specific health messaging. When the community is the setting, the goal of the intervention is to elicit personal behavioral change. Therefore, any improvement in population health is the sum of all of the individual behaviors. This model may fail to address environmental, economic, or political influences of behavior and health.
- Community as a target . Interventions that target the community seek to make changes to the environment, programs, and/or policies available to community members. Instead of focusing on individual health behaviors as outcomes, these interventions might focus on other environmental or policy measures related to health, such as acreage of park-space per person, or the number of seniors participating in a free lunch program. The assumption is that if the community environment is changed, this will improve healthy behaviors and quality of life.
- Community as a resource . This approach seeks to utilize the people and resources within the community to either drive or at least contribute to health-promoting changes. A public health practitioner might bring a health priority to the community and seek input on intervention design as well as leveraging and supporting current resources, or they might ask the community members themselves to identify the highest priority for the community, and build an intervention from there.
- Community as an agent . This model assumes that the community already has the solutions and resources to its own health problems. It attempts to “meet people where they are” in supporting the community itself to identify needs, come up with solutions, and implement them. This model might fail to address disparities in social determinants of health that many communities face such as economics, environment, and policy.
Public health interventions are indelibly tied to current cultural perceptions and beliefs about society, and their success depends upon how well they are designed, received, and implemented. To what extent does the responsibility for health lie within each person (individualism) or within society (collectivism)? What role should the government play in protecting and promoting health? As McLeroy et al. (2003) states:
Public health is more than a body of theory and intervention methods. We cannot separate how we do public health from why we do public health. Whether we talk about changing behavior, changing community structures, or building community capacity, these changes cannot be separated from our ideals about what constitutes a good community or a good society.