Health Promotion International, Vol. 18, No. 4, 339-350, December 2003
© Oxford University Press 2003 All rights reserved
Working with Toronto neighbourhoods toward developing indicators of community capacity
Centre for Health Promotion, Department of Public Health Sciences, University of Toronto, 100 College Street, Suite 207, Toronto, Ontario, M5G 1L5, Canada
Address for correspondence: Suzanne F. Jackson, Centre for Health Promotion, University of Toronto, 100 College St., Suite 207, Toronto, Ontario M5G 1L5, E-mail:
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SUMMARY |
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Often the goal of health and social development agencies is to assess communities and work with them to improve community capacity. Particularly for health promoters working in community settings and to ensure consistency in the definition of health promotion, the evaluation of health promotion programmes should be based on strengths and assets, yet existing information for planning and evaluation purposes usually focuses on problems and deficits. A model and definition of community capacity, grounded in community experience and focusing on strengths and assets, was developed following a 4-year, multi-site, qualitative, action research project in four Toronto neighbourhoods. There was significant community involvement in the four Community Advisory Committees, one for each study site. Semi-structured, open-ended interviews and focus groups were conducted with 161 residents and agency workers identified by the Community Advisory Committees. The data were analyzed with the assistance of NUDIST software. Thematic analysis was undertaken in two stages: (i) within each site and (ii) across sites, with the latter serving as the basis for the development of indicators of community capacity. This paper presents a summary of the research, the model and the proposed indicators. The model locates talents and skills of community members in a larger context of socioenvironmental conditions, both inside and outside the community, which can act to enable or constrain the expression of these talents and skills. The significance of the indicators of community capacity proposed in the study is that they focus on identifying and measuring the facilitating and constraining socioenvironmental conditions.
Key words: action research; community capacity; health promotion; indicators
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INTRODUCTION |
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TOPSUMMARYINTRODUCTIONMETHODSRESULTSDISCUSSIONCONCLUSIONREFERENCES |
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Health promotion practitioners operate based upon a definition of health promotion as ‘... a process of enabling people to increase control over their health’ [World Health Organization (WHO), 1986
]. This means working with communities by building upon their existing strengths and abilities. However, the traditional planning information available to community workers, public health practitioners and health promoters is problem- or deficit-based, incorporating factors such as death or disease rates, income levels or crime statistics. The resulting labels can be disabling when: (i) community members internalize such information and describe themselves in negative or problem-based terms; (ii) community workers and agencies come into communities to ‘fix’ problems that workers have identified and offer training to community members on how to fix problems; and (iii) communities are denied opportunities for growth and development because of how labels lead others to perceive their communities. This paper reports on research that contributes to the development of positive information about communities.
To date, work has been done on how to build community capacities, and wide-ranging discussions of concepts and definitions have been held (Kretzman and McKnight, 1993; Eng and Parker, 1994; Freudenberg et al., 1995; Goodman et al., 1998). However, there are few instances in which these concepts have been operationalized in measurable terms based on empirical research.
In this study, preliminary community capacity indicators were developed through a collaborative research process involving university researchers, community residents and workers in four community sites in Toronto. These four sites have been labelled by others in Toronto as ‘problem areas’. This research started with the basic belief that people in these communities have many talents and skills and accomplish many things together. Researchers talked with residents and community-based workers about how they describe their community, what events and activities they have done together, what their talents and skills are, and what have facilitated or acted as barriers to the events and activities the community has undertaken.
The purpose of this study was to develop a model of community capacity and explore how one might measure community capacity based upon community experience. The communities were interested in this research as a means to provide a countervailing view of themselves to the outside world (especially the media) and to facilitate work according to their own agendas. Both the conceptual model of community capacity and the associated basis for measurement could be used by community organizations as well as planning agencies, public health departments and community health centres who plan for health promotion. These agencies could use such ‘health asset’ indicators to counterbalance the traditional mortality, morbidity and lifestyle statistics utilized to describe communities in terms of health deficits.
Terms and definitions
The body of literature relevant to the term ‘capacity’ refers to a range of terms, concepts and models drawn from health, sociology, psychology and political science. Definitions of capacity tend to focus on abilities or skills to effect action. One of the ironies inherent in this approach is that enhancing ‘capacity’ involves training in ‘needs assessment’, by which community deficits might be systematically identified. These terms also tend to point to community capacity as an aggregate of individual abilities, which may miss aspects of group dynamics and community that accrue from collective action (i.e. not reducible to individuals).
In December 1995, the Centers for Disease Control and Prevention (CDC) convened a symposium on community capacity to find a basis for measurement. Their working definition was:
(i) The characteristics of communities that affect their ability to identify, mobilize and address social and public health problems; and (ii) the cultivation and use of transferable knowledge, skills, systems and resources that affect community- and individual-level changes consistent with public health-related goals and objectives. (Goodman et al., 1998
These dimensions overlap in many ways with the indicator domains identified in our research. One of the major differences is that our research focused on barriers and facilitating conditions for community action, in addition to skills and other dimensions listed by Goodman and colleagues (Goodman et al., 1998). It is important to acknowledge that government and organization policies and practices may play just as large a role in the development and application of community capacity as the existence or absence of skills and resources among residents.
There are several terms related to ‘capacity’ in the literature. Some include the word ‘capacity’ [such as ‘capacity building’ (Kwapong and Lesser, 1990)], while others use the word ‘capacity’ in the text of definitions that are conceptually similar {e.g. ‘empowerment’ and ‘community competence’ [Beigel (1984), quoted in (Israel et al., 1994)]}. In our research, community capacity was conceptualized as a combination of (i) talents and capabilities, and (ii) the socioenvironmental conditions originating inside and outside the neighbourhood that enable or disable the expression of the existing talents in community activities. This conceptualization is similar to earlier revisions to models of health promotion that sought to move beyond ‘blaming the victim’ to include socioenvironmental conditions.
Our review of the literature suggests that the search for conceptual clarity about what constitutes community capacity is an ongoing struggle, and illustrates the complexities and highly inter-related nature of the terms. The paucity of literature on models of community capacity and practical indicators is noteworthy.
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METHODS |
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TOPSUMMARYINTRODUCTIONMETHODSRESULTSDISCUSSIONCONCLUSIONREFERENCES |
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The objectives of our research were: (i) to work with residents, community agency workers and members of communities of interest in the Regent Park, Parkdale and Jane-Finch areas of Toronto; (ii) to describe their talents and capabilities, and the socioenvironmental conditions that enabled these capabilities or constituted barriers to their expression; (iii) to develop a model of community capacity; and (iv) to develop indicators of community capacities.
From the outset the research team developed links with the Communities Against Neighbourhoodism Coalition (CAN), representing residents and agency workers from seven neighbourhoods across Toronto. CAN was formed by workers and residents from these neighbourhoods who felt they were unfairly labelled as ‘bad’, with the aim of educating one another and the news media about ‘neighbourhoodism’ (labelling people based on where they live). Three members of CAN volunteered their support to begin work in their neighbourhoods as sites for our research. Investigators met with individuals familiar with each site to seek guidance about how to approach their neighbourhood (data collection design) and who to contact. CAN members welcomed the research because it focused on the positive aspects of their communities, and they felt the results could be useful to them in their own work.
In each research site we took advice from local residents and key informants on how to proceed with the research. In Regent Park (the oldest and one of the largest public housing projects in Canada), we focused on reaching some of the major language and cultural groupings within the site, such as Vietnamese-, Cantonese-, Spanish-, Somalian-, Tamil- and English-speaking groups (the latter including youth, seniors and West Indians). In Parkdale, we cast our net widely to capture the social diversity present (homeless people, single parents, business associations, tenants' and ratepayers' associations, intercultural associations, etc.). In Jane-Finch, we worked with two different public housing complexes, one with many agency services and the other with fewer services. As the research proceeded, it became clear that these two sites in Jane-Finch saw themselves as distinct. Although they were considered to be one site initially in the research design, they became separate sites during the analysis.
Community Advisory Committees (CACs) were set up for each site. These comprised residents as well as community agency workers. The CACs identified subcommunities and community-based organizations in their area, identified contacts and individuals, and gave advice on who would be more appropriate for interviews as opposed to focus groups. The criteria they were given included reaching as many residents who belonged to the full range of subcommunities in the site as possible, representatives of community-based groups, and the least vocal or most disenfranchised parts as well as the organized and articulate. Table 1 lists the subcommunities from whom the individuals who participated in interviews and focus groups were selected. Three focus groups in Regent Park had community translators present.
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Focus groups or semi-structured open-ended interviews were conducted with 161 residents and agency workers (89% were residents of their respective sites, while the remaining 11% of participants were non-resident agency workers with long-standing relationships in their neighbourhoods). Respondents were asked to describe their community, describe the talents, skills, abilities and strengths of their communities, identify the events and activities the community has done together, and then identify the factors that helped or hindered the community in working together.
The coding framework was developed by the investigators based on data from a 1-year pilot phase, and revised over several meetings to accommodate the emerging data in the main phase of the project and to allow for some flexibility at the site level within overall common categories across all sites. All transcripts were coded by either an investigator or the project coordinator using the coding framework. Consistent coding between the different coders was ensured by: (i) dividing the coding framework into large categories with clear descriptions attached; and (ii) developing the framework over several meetings with all investigators participating in trial coding.
Thematic analysis was undertaken in two stages: (i) within each site, and (ii) across sites, with the latter serving as the basis for the development of indicators of community capacity. With the assistance of NUDIST software, themes and potential indicators for each site were developed by each site team based on a review of the site-specific coded sections. The factors that facilitated and hindered community action in all sites were reviewed by the investigative team for common themes, which were recorded in a separate document. The original model of community capacity was reviewed and refined, the definitions were clarified, and the themes were examined for those suited to indicator development. The criteria used to select themes for indicator development were: (i) appearance in more than one site; and (ii) the ability to be stated in clear and unambiguous outcome terms, with some possibility of developing specific measures. A document describing the model of community capacity, the definition of terms, and the proposed indicators and measures was prepared and circulated to members of the CACs for discussion and input. A final report was prepared in a plain language format for use by community groups, and the results were presented as a display at community meetings, summer festivals and fairs.
In keeping with the research values of community action research and capacity building, the relationship between the university-based researchers and the community members was carefully built and maintained. The investigative team maintained a relationship with CAN through attending meetings with editorial boards at the Globe and Mail and the Toronto Star at the request of CAN, through conducting a study of neighbourhood reporting by those two papers, by presenting at locally organized conferences and workshops, and by supporting CAN press conferences and other meetings. Throughout the study, the project coordinator maintained relationships with community leaders in all four sites through attending special meetings and events at the community's request, accommodating individual timing needs (meeting in the evening and at weekends), and approaching each community site and its individuals according to the advice of the CAC members. After the analysis was completed, the information available for each site and the overall indicators and model were discussed with individuals on the CACs. Particular attention was paid to ensuring that the project generated products usable by the community sites (e.g. the Community Report).
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RESULTS |
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TOPSUMMARYINTRODUCTIONMETHODSRESULTSDISCUSSIONCONCLUSIONREFERENCES |
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Respondents for all four sites gave mixed descriptions of their neighbourhoods, including both positive and negative descriptors. Table 2 presents a brief description of each site from the point of view of the study participants.
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There were many similarities in the talents and strengths listed by respondents in each of the four sites (see Table 3). This study did not attempt to develop measures of the talent present in communities because other studies have done this (Kretzmann and McKnight, 1993
). Instead the focus was to acknowledge the presence of talents, skills and abilities, and to illustrate the key role of the facilitating and disabling conditions. It was also evident that there were major activities and events held in each of these communities throughout the year which stand as public testimonies to the presence of community organizing skills, the ability to work together, and the ability to effect change.
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All sites held community-wide fairs and festivals, and organized some activities specifically for children, youth and seniors. In Tobermory, residents lobbied for a special contract with the Metro Toronto Housing Authority unlike any other in Toronto and banded together to get rid of the drug dealers in their lobby. In Firgrove, residents were active in the fight against privatization of public housing and they lobbied for improvements in property maintenance issues. In Regent Park, residents instigated the building of a new Community Health Centre, they changed the way policing was done in their community, and they succeeded in getting the Board of Education to change the attitude of the teachers towards the children in Regent Park. In Parkdale, residents set up an internationally recognized Community Watch programme, they lobbied City councillors to improve the street lighting, they have a community street beautification programme, and they built Redwood Shelter for abused women and children. Both Regent Park and Parkdale have longer lists of lobbying activities and events they have organized than could be included here (Jackson et al., 1999
). Key factors that supported community action in all sites included: first, a positive social environment (e.g. caring neighbours, strong sense of community, celebratory events); and secondly, the ability to work together, link to one another and participate. Key factors that hindered their individual and collective work included: (i) a negative public image of the community; (ii) high levels of individual stress trying to meet basic needs; and (iii) policies and regulations set by agencies, institutions and governments. Four factors that presented both supportive and hindering dimensions (depending on context) were diversity, the physical built environment, community infrastructure and agency characteristics.
Key facilitators and barriers to community action were separated into those that originated from within and those that were external to each community. According to our model (see next section), increasing community capacity means not only improving the skills of community residents, but also creating the conditions inside and outside the community that maximize the potential for these to develop and find full expression. It is barriers such as the negative image that teachers have about the community or the work it requires to get simple property maintenance issues addressed that could be removed by agencies and governments truly interested in increasing community capacity. Building healthy public policy and creating supportive environments are key health promotion strategies towards improving community capacity (WHO, 1986).
Specific indicators were developed from the factors identified by residents that affected their ability as communities to work towards and achieve their goals. The proposed overall indicators of community capacity are listed in Table 4, with examples of suggested measures. Proposed indicators related specifically to the facilitators and barriers to community capacity are listed in Table 5. Specific measures would need to be developed by each community who wanted to use these indicators.
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Model of community capacity
Our definition of community capacity is: the potential of a community to build on its strengths in order to work towards and achieve its goals and dreams, given both facilitating and barrier conditions coming from inside and outside the community. Community is defined in this study as a group of individuals living and/or working within the same geographic area. This geographical definition of community was essential to understand how capacity is linked to the ability of a community to include and deal with the variety of conflicting factions that co-exist within the same geographic area. Each site in this study contained several subcommunities of self-identified shared interests (e.g. spoke same language, concerned about housing), yet community action required that the subcommunities work together.
Figure 1 is an illustration of the model of community capacity developed by this study. The talents, skills and abilities of the community are at the centre. These talents and skills are facilitated or hindered by the presence of facilitators and barriers originating within (inside) the community, and by the presence of facilitators and barriers that originate outside the community. Factors originating inside the community were the physical and social aspects described within the community's physical and social boundaries. Factors originating outside the community were seen as the attitudes and policies of larger institutions, governments and agencies that affected the community, or the attitudes of the people living outside the physical boundaries of the community. This inside/outside distinction was problematic when referring to the role of community-based agencies. Some agencies are based only in a particular community (e.g. Regent Park Community Health Centre) and others are large institutions with local offices (e.g. United Church). Thus, agencies as a group can have both ‘insider’ and ‘outsider’ characteristics depending on the community. The lines separating the talents and skills from the community site and the community site from the external environment are dotted to indicate the permeability between what is considered ‘inside’ and ‘outside’ the community.
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Talents, strengths, skills and abilities are present in all of the individual community members as well as at the community level. Individual skills might for example include caring for others, hospitality and running a meeting, whereas community-level skills could include residents, agencies, organizations, businesses and politicians who are well linked and who work together. These strengths form the basis upon which the community in all of its diversity can develop its visions and act to achieve them.
‘Inside facilitators’ are the enabling conditions created by the community that help the community to work towards achieving its desires (such as meeting space and provision of child care during community meetings and events). If agencies are instrumental in creating enabling conditions locally (such as meeting space or child care), then they are considered ‘inside facilitators’.
‘Inside barriers’ are the conditions and factors generated by the community and its members that act as barriers to the community working towards and achieving its goals. Examples of such barriers are community factions that actively exclude others from their activities and stick to themselves, or meeting spaces that feel unsafe or are not accessible.
‘Outside facilitators’ are conditions external to the community that help the community work towards and achieve its desires. Examples of such facilitators include: (i) agency policies that foster stable, long-term relationships between its staff and the community; and (ii) convenient access to green space, services, amenities and programmes.
‘Outside barriers’ are conditions external to the community that create barriers to the community working towards and achieving its goals. Examples of such barriers include: (i) a negative image of the community and its residents by the media or others who do not live in the community; and (ii) government policies that specifically increase the challenge of daily living.
Community capacity builds over time. It was clear from interviews with long-term residents that as communities developed their ability to provide some of the inside facilitators and lobby against the outside barriers, their initial successes led to more involvement, more utilization of existing talents, and further successes. One should also note that to have the greatest impact, outside groups (government, agencies, institutions, funders) in these communities need to play a role in removing the external barriers and conditions. It is the position of this study that such actions could contribute a great deal to the evolution of community capacity through creating the conditions for existing talent and capabilities to be expressed.
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DISCUSSION |
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TOPSUMMARYINTRODUCTIONMETHODSRESULTSDISCUSSIONCONCLUSIONREFERENCES |
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In this study, community capacity represents the potential of a community to act in its best interests. The model underlines the importance of the conditions and factors that enable or constrain the community. Our approach moves away from the traditional focus on improving the skills and knowledge base of community members, which often carries the implicit assumption that such capabilities do not already exist. Instead, our approach was to assume that the ‘problem’ of community capacity is not located so much in the community members as in the facilitating and constraining conditions.
In much of the literature, capacity is presented as something that needs to be added or built. For example, ‘capacity-building’ is described as building skills, knowledge and institutions (Kwapong and Lesser, 1990), and ensuring that projects have skilled personnel, adequate funds and access to information to perform effectively (WHO, 1992). In coalitions, ‘capacity building’ refers to building knowledge, attitudes and skills among members, and establishing linkages with community organizations (Florin et al., 1993). Bennett and McCoshan (Bennett and McCoshan, 1993) indicate that the processes of local capacity building include enterprise, education and training, that ‘capacity depends on developing a means of responding to challenges and changes’, and that capacity, at its best, implies leadership in social change efforts, and not merely responding to changes initiated from outside. Our work suggests that communities are not the only architects of their current state and that there is much agencies and institutions could do to remove policy barriers to community capacity in addition to their traditional education efforts.
Kretzmann and McKnight (Kretzmann and McKnight, 1993) refer to individual capacities and present a mapping exercise to create an inventory of ‘skills information’, ‘community skills’ and ‘enterprising interests and experience’. Several projects in Canada and the United States are guided by Kretzmann and McKnight's work. Our empirical investigations can be seen to extend this work in two ways: (i) we sought to involve community members in defining their own capacities, rather than imposing pre-existing typologies; and (ii) we examined the role of facilitating factors and barriers in the expression of community capabilities as community capacity (see conceptual model).
This study also differs from that of Eng and Parker (Eng and Parker, 1994) in that: (i) we used qualitative methods rather than quantitative scaling techniques to elicit dimensions of community capacity, which we believe are more suited to collaborative work that seeks to ‘give voice’ to community perspectives; and (ii) we did not seek to make community input ‘conform’ to pre-existing scales found in the literature (whereas Eng and Parker use Cottrell's eight dimensions as a primary filter through which community responses are both elicited and analysed). The current study differs from that of Goodman and colleagues (Goodman et al., 1998) in that we conducted empirical research directly with community residents and workers, rather than primarily conducting a synthesis of existing literature and concepts.
‘Community resilience’ is another concept with some features that are very similar to the model of community capacity developed in this study. The Atlantic Health Promotion Research Unit (AHPRU, 1999) proposed a framework of resilience that outlined social, environmental and behavioural community risk factors (somewhat similar to the inside and outside barriers to community capacity in our study) plus community protective factors (social support, empowerment and communal coping, somewhat overlapping the facilitators of community capacity), resulting in community resilient outcomes (physical environment, residents' health and social relations). One of the key differences between the work described in the AHPRU study and our own is that resilience refers to the community's ability to survive challenges, whereas capacity recognizes the challenges as part of the community's action plan to address barriers and explicitly incorporates the concept that the community can be proactive towards achieving its goals (i.e. community agency).
Our study was carried out in so-called ‘marginalized’ communities, and the implications for community and agency actions are complex. Although the communities who participated in our study were anxious to demonstrate that there were many positive aspects at work in their communities, it is also true that they had many problems. These communities face ‘extra’ barriers because they are labelled as ‘bad’ areas. Study participants pointed out that using positive indicators that show their strengths and capacity could act against their best interests by giving politicians an excuse to justify reductions in direct service provision or cuts in community funding. On the other hand, it is also important to recognize and build on community strengths, identify and address barriers, and measure/evaluate positive change.
There was much discussion in each CAC about specific measures that could be linked to the proposed overall indicators of—and the facilitators and barriers to—community capacity (examples of which were provided in Tables 4 and 5). Finding common indicators across four different geographical communities has given us cautious optimism that these results may be applicable in other similar large urban settings. The applicability of our findings in rural and other cultural settings requires further study. Whether this model and set of indicators can be useful for evaluating community capacity building interventions also needs to be explored. Evaluation would require that each community (or community programme) develop specific measures of success in each indicator area in consultation with the community, thereby fostering community participation, and enabling the framework to be adapted to the uniqueness of each community or situation.
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CONCLUSION |
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TOPSUMMARYINTRODUCTIONMETHODSRESULTSDISCUSSIONCONCLUSIONREFERENCES |
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There is a need for indicators of community-based health promotion programmes that can measure progress in positive directions. Such indicators have to be measurable, positive and yet responsive to individual community uniqueness. We have made a modest contribution in this direction.
In addition, the model of community capacity developed in this study presents ways for governments, institutions and agencies to understand their role in increasing or reducing community capacity via their policies, attitudes and activities. We argue that agency recognition and the removal of the barriers they create can go a long way towards improving the capacity of communities to take community action.
Further research is required to explore the application of this model and set of indicators to non-marginalized communities, rural settings and other countries. In addition, further research is needed to assess the application of this model in the evaluation of community-based programmes.
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ACKNOWLEDGEMENTS |
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We wish to acknowledge the participation of the following residents and individuals on the Community Advisory Committees: Don Wackley, Gilmar Militar, Deany Peters, Debra Dineen, Diane MacLean, Barry Reider, Rose Bowen, Kathleen Blair, Janice Ross, Clayton Keupfer, Dorothea Sutton, Carol Kniff, Amanjeet Singh and Farida Basania. The following people also contributed to the research process at various stages of the project: Dr Michael Goodstadt, Joanna Reesor-McDowell, Dalton Jantzi, Lisa Salsberg, Sandra Spurling, Celio Ruben Amaya, Dr Ruth Morris, Wanda McNevin and Ralph Allerstein.
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