Howell E M, Devaney B, McCormick M, Raykovich K T
Harvard University, USA.
J Health Polit Policy Law. 1998 Apr;23(2):291-317. doi: 10.1215/03616878-23-2-291.
This article discusses how community involvement is incorporated into Healthy Start, a major initiative to reduce infant mortality in selected communities with disproportionately high levels of infant mortality. Based on site visits to each of the fifteen original Healthy Start project areas, we discovered that two main community involvement strategies were used: a service consortium model and a community empowerment model. In the service consortium model, the community is involved primarily through a consortium of local providers, other professionals, and some governmental representatives who help to plan services. The community empowerment model involves the community by engaging neighborhood-based groups, contracting with community-based organizations, employing community residents as lay workers in the Healthy Start program, and creating other economic development initiatives. Important lessons drawn from this study are that the purpose and commitment to community involvement is not always clear; that it is difficult to involve community residents; that efforts to involve the community are extremely labor intensive; that given monetary incentives, it is easier to involve community providers than residents; that community involvement may conflict with efficient program operations; that increased community involvement may create program goals that differ from the program's original goals; and that community involvement may slow program development.
本文讨论了社区参与是如何融入“健康开端”计划的，该计划是一项旨在降低某些婴儿死亡率过高社区的婴儿死亡率的重大举措。基于对最初的15个“健康开端”项目地区的实地考察，我们发现主要采用了两种社区参与策略：服务联盟模式和社区赋权模式。在服务联盟模式中，社区主要通过当地服务提供者、其他专业人员和一些政府代表组成的联盟参与进来，这些人帮助规划服务。社区赋权模式通过让邻里团体参与、与社区组织签约、在“健康开端”计划中雇佣社区居民作为非专业工作人员以及开展其他经济发展举措来使社区参与其中。从这项研究中得出的重要经验教训包括：社区参与的目的和承诺并不总是明确的；让社区居民参与很困难；让社区参与的努力极其耗费人力；在有金钱激励的情况下，让社区服务提供者参与比让居民参与更容易；社区参与可能与高效的项目运作相冲突；增加社区参与可能会产生与项目最初目标不同的项目目标；并且社区参与可能会减缓项目发展。
