Culture Counts: A Guide to Best Practices for Developing Health Promotion Initiatives in Mental Health and substance Use with
Ethnocultural Communities
In chapter 3 - Gather and analyze information:
On this page:
You will need to gather information to develop and run your health promotion initiative effectively. You will also need to
gather information during the development process and the running of the initiative in order to do evaluations.
The first task in developing a health promotion initiative is to figure out what problem the initiative should focus on. There
are probably many issues of concern to the community, but your initiative can only address one, and it may only be able to
deal with one part of that problem. The process of figuring out what problem to address is called “needs assessment.”
Determining which issue to target also involves figuring out how prepared the community is to make changes. If you involve
the community in the needs assessment, it will become clear what issues the community is ready to address. If you have used
other sources for the needs assessment, such as statistical studies, you may need to try out your ideas on community members
to see whether they view the issue as urgent or as something that can be changed. The term for this is “community readiness.”
Needs assessment
A needs assessment asks:
- What problems does the community have?
- What problems are most urgent?
- What are the causes of the most urgent problem?
- What resources (e.g., people, services, funds) does the community already have to deal with the most urgent problem?
- How can a health promotion initiative use and add to community resources and strengths to make a positive change in the problem?
A variety of research tools can be used for needs assessment—for example, surveys, community meetings, interviews. More than
one tool should be used to make sure many points of view are included.
What are the community’s strengths?
Since the process of developing a health promotion initiative focuses on problems that the initiative could address, there
is a danger of losing sight of the positive aspects of the community. Taking time to consider and highlight a community’s
strengths is particularly important in ethnocultural communities because it can help to counterbalance their frequent exposure
to discrimination and prejudice.
The media, for instance, may only take notice of ethnocultural communities when there is a problem. Efforts to promote and
publicize the initiative should therefore be carefully arranged to include the community’s strengths as well as the issue
on which the initiative is focused.
To learn more about needs assessment:
Community readiness
Community readiness is the extent to which a community is prepared to implement a health promotion initiative. Is the community
ready to make a change? Evidence shows that a community’s level of readiness is an important factor in determining whether
an initiative will be effective and supported by the community.
Ethnocultural communities are at many different levels of readiness for starting health promotion initiatives in mental health
and substance use. Although you and your partner agencies may see a need for a change in some type of behaviour, community
members may not be ready to hear about it or may not believe change is possible.
“People sometimes are aware of problems such as HIV/AIDS and substance use but deny these problems exist in their own community.” --Dr. Krishanthy Shu, Vasantham (Tamil Seniors Wellness Centre) |
In some communities, such as those with many newly arrived refugees, people may be too busy with basic concerns, such as finding
work and housing, to think about broader health concerns. In these cases, an initiative aimed at changing behaviour, such
as alcohol use, will have little effect. A health initiative that helps a community move towards being ready to hear this
message may be more useful.
Communities where people see that there is a local problem and believe that something needs to be done about it are ready
to receive a message about changing behaviour. Research shows that the higher the level of readiness, the more successful
a health promotion initiative will be.
Example:
In the LRDG project, the Serbian community in Windsor seemed to be at a different stage of community readiness for this health
promotion initiative than the other communities. Participants in community focus groups stated that information about the
ways to avoid or reduce the risks of alcohol use as described in the LRDG brochure were not relevant to the Serbian community.
Drinking was seen as an established practice so deeply rooted in the Serbian tradition that it is “almost impossible” to change
in adults. “Drinking and driving is the only message getting through right now.” Instead of a Serbian version of the LRDG
brochure, a poster in Serbian warning against drinking and driving was produced and distributed.
“A recent immigrant, a 45-year-old woman, was very upset at the audacity of the government trying to tell people they couldn’t
drink and drive… She was angry about it. That is the mentality that they arrive with.”
--Key informant in Serbian community focus group |
To learn more about community readiness:
Center for the Application of Prevention Technologies: “Community Readiness Assessment Tools” (USA)
After assessing the community’s needs and level of readiness, you and your partners may have a list of problems the community
wishes to work on. You cannot work on all the problems at once, so your initiative would address the most urgent problem on
the list in some way.
To determine what type of initiative is likely to be effective, break the problem down into parts, and then figure out which
parts of the problem an initiative can work to change. Here is how the process might work:
1. State the problem, in general terms.
Example: Interviews with key informants, as well as referrals to the community-based agency indicate that the most urgent problem
is: “People in our community are drinking too much alcohol.”
2. Give specific examples of the problem.
Example: Discussions with the community and a search of back issues of the community newspaper for the past year show:
- Seven students were suspended from the local high school last month for drinking alcohol on school property.
- Four middle-aged men from the community have died in the past year due to alcohol-related health problems.
- Three months ago, two children were killed when they were hit by a car driven by a man who had been drinking.
3. Think of reasons for the problem.
Example: Have focus groups come up with lists of possible reasons:
- Maybe people don’t know the laws about legal drinking age and drinking and driving.
- Maybe people are using alcohol to cope with other problems, such as unemployment.
- Maybe people don’t know the risks of drinking alcohol.
4. Find the most probable reason.
Example: A survey is done to find out what community members know and think about alcohol use. The results show that
- 68% did not know what the legal drinking age was
- 87% knew that driving while drunk was illegal, but 47% admitted they had driven while drunk at least once in the past year
- 67% said the main health risk of drinking was falling down and hurting oneself when drunk
- reasons for drinking too much included to celebrate a special event, to feel better when sad or lonely and to enjoy oneself.
The results of this imaginary survey seem to show that the main reason for problems from alcohol use is that drinking is seen
as acceptable and there is not much concern or knowledge about the risks of drinking too much.
5. Identify ways to help fix the most probable reason for the problem.
Example: Focus groups with community members explore ways to make people in the community more aware of the risks of alcohol use.
- Put health warnings in the community’s language on alcohol containers.
- Produce a video showing what happens when you drink too much.
- Create a brochure in the community’s language about the risks of alcohol use and how to avoid them.
6. Choose the best approach that can be done with available resources.
Example: Look at each suggestion and consider positives and negatives:
- People would see the labels when they bought the alcohol but many community members drink home-made alcoholic beverages.
- A video could be shown on TV where a lot of people would see it and it would reach people who have difficulty reading, but
we don’t have the money for a video.
- A brochure may not be as useful for people who don’t or can’t read, but it would be a better fit for our budget and could
be given out at many community locations. Using lots of pictures and simple language may help people with reading difficulties.
This seems to be the best approach for us.
By going through the steps to break down the problem into its possible causes and solutions and using a few different information-gathering
methods, you and your partners should end up with a solid idea for your health promotion initiative.
* Source: Community Tool Box: “Analyzing Community Problems”
After doing careful research and talking with community members about health problems they wish to fix, you and your partners
should have now narrowed down the possibilities for your health promotion initiative. Before you start working on your initiative,
you may want to do a bit more thinking and research, however. Some questions you will want to answer include:
- What approaches have been tried before?
- Who will be the intended audience?
- How will we know when our initiative has reached its goal?
Research other approaches
- Look at what type of health promotion initiatives for mental health and substance use have been done in the community before.
What worked or didn’t work?
- Are there any initiatives still being run in the community that might “compete” with yours, or that your initiative might
join with to increase its impact?
- Now that you know the problem you want to focus on, are there initiatives that have been run elsewhere that might be adapted
for use with your intended audience?
Should the initiative aim at the whole community or parts of it?
Your research may have shown that a certain parts of the community are key in addressing the problem. For example, if the
community identified alcohol use by teenagers as a problem, your initiative might be most effective if it is aimed at teenagers.
Another group that you might aim at is parents of teenagers. Depending on your resources, your initiative might aim at both
or only one of these groups.
On the other hand, your research may show that the whole community is in need of information, so a more general approach may
be more effective. For example, if your research showed that a majority of community members did not know that drinking too
much alcohol could cause long-term health problems, your initiative might be aimed at informing the whole community about
the risks of drinking.
Some questions to ask about where to aim your initiative:
- Who is most affected by the problem?
- Who needs to be involved in dealing with the problem?
- Is there a certain part of the community your initiative should be aimed at, or does the problem affect everyone in the community?
To learn more abour defining audiences:
How will we know we have reached our goal?
When you and your partners are figuring out your initiative’s goal and how you will reach it, you will probably realize you
need some way of measuring when you have reached your goal. This means you have to be precise about expressing your goal.
It may mean breaking your goal down further into smaller goals or “objectives.”
For example, your goal might be “to raise awareness of the risks of alcohol use.” How will you know your initiative has done
this? During your research, you do a survey which shows that 67% of community members think the main health risk of drinking
is falling down and hurting oneself when drunk. One way to see if your initiative is working is to measure a change in that
statistic. You might create an objective based on this:
“In six months, 30% of adults over age 16 in the community will know that drinking alcohol during pregnancy raises the risk
of fetal alcohol syndrome.”
Then you might set an objective that builds on the first one:
“In one year 65% of adults over age 16 in the community will know that drinking alcohol during pregnancy raises the risk of
fetal alcohol syndrome.”
Your objectives should contain numbers and dates for reaching them. They should also be ones that your initiative is likely
to achieve, rather than ones you and your partners wish it could achieve. It can be difficult to find a balance between hope
and reality. By having clear numbers and dates, however, you can at least measure progress towards your initiative’s goals,
even if the targets you set are not reached.
To set objectives, you need to have a starting point, called “baseline data.” You need to gather information on which to base
your future measurements of change. Baseline data are usually gathered through surveys. They should be both qualitative and
quantitative.
To learn more about setting goals and objectives:
In chapter 2 there is a discussion about the need for an evaluation plan. One or more information-gathering methods described in the next
section may be used for both process and outcome evaluations. Your information-gathering activities can often serve more than
one purpose—for example, the baseline data you gather for developing your initiative’s goals and objectives can also be used
for your outcome evaluation.
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