Community health development: what is it?

The Department of Health in Taiwan initiated community health development (CHD), a new approach to national community health care. Community-based research and evaluation approaches have recently been shifting from 'traditional' research to 'participatory' research. However, there is vagueness about the theoretical foundation of CHD and the appropriateness of using participatory action research (PAR) to evaluate CHD. This article explores theoretical concepts of CHD and discusses the compatibility of PAR and CHD in the theoretical and philosophical foundations. Community health development is a developing and changing process that involves both the social and the health contexts. It operates on the basis of three approaches to care: primary care, health promotion and community development. Partnership and empowerment between community health nurses and the community are concurrently involved in the entire process of CHD practice. The fundamental tenet of PAR focuses on the development of knowledge through partnership and empowerment between the researcher and the community, and the creation of critical consciousness leading to necessary action and effective change. Unlike empirical community-based research, PAR is flexible enough to capture an understanding of the complex social and health phenomena in the CHD framework. Furthermore, utilizing the PAR approach is appropriate not only for the methodological framework of the CHD evaluation, but also for the enhancement of the CHD actualization.