Culture Counts: A Guide to Best Practices for Developing Health Promotion Initiatives in Mental Health and Substance Use with Ethnocultural Communities

If one or more agencies or individuals responds positively to your invitation, arrange to meet with them to further discuss issues of concern. Ideally, meet them at their location to get a better idea of their resources and the amount of support they have from community members.

During your first meetings, you and your partners should:

• define the goals of the partnership
• make a commitment to work towards those goals
• state what each will give to the partnership (staff, office space, training, and so on)
• define who will do what
• have effective processes for communicating among themselves and informing community members about partnership activities
• figure out how decisions will be made
• figure out how disagreements or conflicts will be resolved
• determine how each partner will share in the benefits of the partnership
• make a work plan and agree to follow it
• agree to evaluate the results of partnership activities as you go and make changes to the work plan if needed.

Take time to build trust and respect among partners

Whenever people get together to work on a project, there are always going to be some disagreements and misunderstandings along the way. When those people have different cultural, religious and linguistic backgrounds, the risk of misunderstandings rises. But as long as people respect and trust each other, they can usually work out these differences and work towards their common goals.

Trust takes time to develop. Partners from ethnocultural communities may have had unhappy experiences with other mainstream organizations or even your own organization in the past. These experiences may lead them to be unsure about you and your organization’s intentions at first. Partners in the Culture Counts project described some sources of frustration they experienced in past involvements with mainstream organizations:

• not being consulted about health promotion initiatives aimed at their community

• lack of trust in or respect for their knowledge, experience and skills
• being used in research projects without any direct benefit to the community

• having their time wasted through poor organization

• not being treated as equal partners.

Some ways you can ensure that these types of experiences aren't repeated:

• Initiate contact with communities before making decisions about health promotion initiatives aimed at them.
• Sincerely treat your work with a community as an exchange of knowledge among equals, rather than as a one-sided “gift” of your expertise or your organization’s resources.
• Make sure all partners will share in the benefits of the initiative.

• Learn about the community agency’s resources and ways of working and adapt to them.
• Be organized and do what you said you would do.
• Keep communication open. Be sure partners receive copies of all memos and reports and are informed of any events that may affect the joint project.

Make a work plan

Once you have agreed to work together, you and your partners should plan the work in more detail. Taking the time now to make a detailed work plan can save time, money and effort in the long run. Even on small, informal projects, partners should create a work plan together and put it down on paper. This way, everyone will be clear on what they’ve agreed to do, which should lower the risk of misunderstandings. Also, having it in print for all to see increases people’s commitment to doing what they said they would do and keeping to the schedule.

A work plan should include:

• clearly stated, measurable goals
• clearly stated steps needed to reach the goals
• who will be responsible for getting the steps done
• a schedule showing the start and end dates for each step
• resources needed for doing steps
• who will approve and report on steps
• timetable for meetings to review progress and alter schedules as needed
• processes for collecting information for feedback to the partners and the community, as well as for evaluations
• processes for making sure steps get done correctly and on time
• a schedule and methods for reporting information about the project’s progress and achievements.

To learn more about work/action planning:
CIVICUS (World Alliance for Citizen Participation): "Action planning." (South Africa)

Look for capacity-building opportunities

As you and your partners work out what you can do with the resources you have, keep community-capacity-building in mind. Creating the health promotion initiative may be the main purpose of your project, but the process of working with the community to create the initiative also offers opportunities to build community capacity. Look for these opportunities in your work plan.

For example, you and your partners find that, due to funding cuts, various community self-help groups for people with mental health and substance use problems can no longer use the local school as a meeting place. You and your partners may decide to run a training session for members of the affected groups on how to lobby the local and provincial governments to reinstate the funding needed to make school facilities available for their meetings. These skills may not only help the groups get their meeting rooms back but also can be put to use to pressure the government in other areas affecting the community.

Keep records of the partnership’s activities

Keeping accurate records of the partnership’s activities is important for:

• getting feedback on the development and running of the initiative
• providing information for internal and external reports
• evaluations
• resolving misunderstandings and disagreements.

Partners should decide together what will be recorded, who will record it and how it will be recorded. Think about who needs information about the activities, what type of information they need and a suitable way to record that information. For example, those who provided funds for the project need to know how the money is being spent, so from the outset you need a system for keeping track of expenses. Spreadsheets are suitable for recording financial information.

Examples of items that should be recorded:

• meetings, e.g., progress review meetings, community meetings
• work plans and changes to plans
• activities run during the project and their results, e.g., focus groups
• events during the project that affect it, e.g., key staff person left before his or her work is done
• numbers of people taking part in activities
• evaluation information, such as statistical data.

Writing information down is the most common way of recording activities but there are other ways that may be better or at least can add to the effect of words: photographing, video and audio recording, even drawing.

Before recording anything in any fashion, always discuss with those taking part in the activity what method they would prefer and how the results are going to be used. You may also want to get written consent from participants to use their images and/or words.

To learn more about running effective meetings:

• EffectiveMeetings.com: “Meeting Basics” (USA)
• Community Tool Box: “Capturing What People Say: Tips for Recording a Meeting” (USA)
• International Association of Facilitators. Basic Facilitation Skills. PDF. (USA)

Expect conflicts and plan to deal with them

Whenever a group of people tries to do something together, there will be disagreements and conflicts about how to go about it.

Different people approach conflicts in different ways. These differences may be based on their culture or may be simply the result of an individual’s personality or experiences.

Miscommunication and misunderstanding can cause disagreements and conflicts. By having well organized and effective communication processes, these can be avoided.

Working to keep conflicts from happening does not mean partners should avoid dealing with disagreements in hopes they will somehow go away. Even small disagreements can grow into major problems if they are ignored. By admitting that everyone may not always agree, partners can feel freer to talk about points of disagreement and work at resolving them or finding compromises that all can accept.

When the partners first gather to decide how they will work together, discussion should include plans for what will happen when conflicts occur and discussions get heated. These may come down to stated rules about how people will be expected to act if they disagree about something. For example, one rule might be that each person will be allowed to speak without interruption for five minutes. If the conflict is between individuals, perhaps there could be a rule that a third person would meet with the individuals to act as a go-between to help them resolve the problem.

In the event a conflict becomes serious enough to possibly shut down the partnership, you and your partners may plan to bring in a mediator or facilitator from outside the partnership to help resolve the conflict.

Conflict can be challenging to deal with, but partners that can work through conflicts on their own usually come through them with a stronger commitment to each other and their goals.

Source: E. Franklin Dukes and Madeleine Solomon. Reaching Higher Ground: A Guide for Preventing, Preparing for, and Transforming Conflict for Tobacco Control Coalitions. (PDF) Tobacco Technical Assistance Consortium, no date.

To learn more about dealing with conflict:

• Association for Conflict Resolution: “Transformative Tools: A tool kit for Transformative Mediation.”

Make an evaluation plan

Evaluation is the process of measuring the value of something. In the case of developing and running a health promotion initiative, you would want to measure the value of your partnership’s work: the results of the initiative and lessons learned along the way. This is called an “outcome evaluation.”

You and your partners probably do not want to wait until your initiative is done to find out if it was effective or not. To catch any problems before they affect the success of your initiative, you do a “process evaluation.”

Process evaluation

Process evaluations compare what was supposed to happen with what is actually happening in a project. For the purpose of the development phase of the project, process evaluations ask and answer these questions:

• Are all the steps in the work plan being done?
• Are people doing what they agreed to do?
• Are the steps being completed according to the planned timetable?
• Is the project within its budget?

If the answer to any of these questions is “no,” then you and your partners need to figure out why. Then you have to decide what changes need to be made to get a “yes” answer to all the questions.

When you and your partners are putting together your work plan, include process evaluations. Figure out:

• what information you want to include in the process evaluation
• how you will collect this information
• how often you will do process evaluations
• who will create the process evaluation reports.

Process evaluation should not only be about finding out what’s not working. It should also be an opportunity to celebrate achievements and recognize efforts.

Outcome evaluation

Although outcome evaluation is done at the end of a project, it has to be planned for at the beginning of the project. Information for the outcome evaluation has to be collected before, during and after the initiative.

In order to figure out what information to collect along the way, you and your partners need to think about what questions your outcome evaluation will answer. Some examples:

• Did we achieve our goal(s)? If not, why not?
• What changes occurred because of our initiative?
• Do community members feel the initiative was useful?
• What lessons did we learn?
• Did staff, volunteers or community members learn new skills?
• Are the outcomes of the initiative worth the amount of time, money and effort put into it?
• What did the initiative do to address barriers to health care and health promotion faced by the community?
• Did our approach follow health promotion principles outlined in the Ottawa Charter?

Thinking about these questions not only helps you and your partners plan for the outcome evaluation, but also helps you think about what you need to include in your work plan.

To learn more about evaluation:

• Framework for Program Evaluation in Public Health (USA)
• Atlantic Centre of Excellence for Women’s Health: “EVAL--Evaluation made Very easy, Accessible, and Logical” (Canada)
• The Health Communications Unit (THCU) of the Centre for Health Promotion at the University of Toronto: “Evaluating Health Promotion Programs” (Canada)
• Center for Substance Use Prevention (CSAP): “Evaluation for the Unevaluated: Program Evaluation 101” (USA)
• Community Tool Box: “Introduction to Evaluation” (USA)
• Evaluation Tools for Racial Equity (USA)

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