Ahmadian Maryam, Samah Asnarulkhadi Abu
Department of Social and Development Sciences, Faculty of Human Ecology, Universiti Putra Malaysia, UPM Serdang, Selangor, Malaysia.
Asian Pac J Cancer Prev. 2012;13(5):2419-23. doi: 10.7314/apjcp.2012.13.5.2419.
Genuine community participation does not denote taking part in an action planned by health care professionals in a medical or top-down approach. Further, community participation and health education on breast cancer prevention are not similar to other activities incorporated in primary health care services in Iran.
To propose a model that provides a methodological tool to increase women's participation in the decision making process towards breast cancer prevention. To address this, an evaluation framework was developed that includes a typology of community participation approaches (models) in health, as well as five levels of participation in health programs proposed by Rifkin (1985 and 1991).
This model explains the community participation approaches in breast cancer prevention in Iran. In a 'medical approach', participation occurs in the form of women's adherence to mammography recommendations. As a 'health services approach', women get the benefits of a health project or participate in the available program activities related to breast cancer prevention. The model provides the five levels of participation in health programs along with the 'health services approach' and explains how to implement those levels for women's participation in available breast cancer prevention programs at the local level.
It is hoped that a focus on the 'medical approach' (top-down) and the 'health services approach' (top-down) will bring sustainable changes in breast cancer prevention and will consequently produce the 'community development approach' (bottom-up). This could be achieved using a comprehensive approach to breast cancer prevention by combining the individual and community strategies in designing an intervention program for breast cancer prevention.
真正的社区参与并非指以医学或自上而下的方式参与医护人员所规划的行动。此外，社区参与和乳腺癌预防健康教育与伊朗初级卫生保健服务中纳入的其他活动并不相同。
提出一个模型，提供一种方法工具，以增加女性在乳腺癌预防决策过程中的参与度。为此，开发了一个评估框架，其中包括健康领域社区参与方法（模式）的类型学，以及里夫金（1985年和1991年）提出的健康项目参与的五个层次。
该模型解释了伊朗乳腺癌预防中的社区参与方法。在“医学方法”中，参与表现为女性遵守乳房X光检查建议的形式。作为“卫生服务方法”，女性可从健康项目中受益或参与与乳腺癌预防相关的现有项目活动。该模型提供了健康项目参与的五个层次以及“卫生服务方法”，并解释了如何在地方层面将这些层次应用于女性参与现有的乳腺癌预防项目。
希望关注“医学方法”（自上而下）和“卫生服务方法”（自上而下）能给乳腺癌预防带来可持续的变化，并因此产生“社区发展方法”（自下而上）。这可以通过在设计乳腺癌预防干预项目时结合个人和社区策略，采用综合的乳腺癌预防方法来实现。
