A critique of contemporary community health promotion approaches: based on a qualitative review of six programs in Maine.
OBJECTIVE
This article reports on a process evaluation of three Planned Approach to Community Health (PATCH) projects and three Community Chronic Disease Prevention Programs (CCDPP) that operated in the State of Maine.  PATCH and CCDPP are similar approaches to community health promotion developed and disseminated by the Centers for Disease Control.  The evaluators studied how the Planned Approach to Community Health and the Community Chronic Disease Prevention Program models worked as community health strategies across the six field sites. RESEARCH METHODS USED:  Qualitative methods were used in a cross-case comparison of the six field sites.  In studying each site, the evaluators focused on six stages common to both the Planned Approach to Community Health and the Community Chronic Disease Prevention program models:  Stage 1:  conducting a community needs assessment; Stage 2:  analyzing needs assessment data; Stage 3: setting priorities for the project based on the data; Stage 4: implementing activities; Stage 5:  producing process outcomes; and Stage 6:  institutionalizing the project.  The analysis focused on how each of the six communities traversed these stages.


RESULTS
Eight recommendations for refining Planned Approach to Community Health and Community Chronic Disease Prevention strategies resulted from the study:  1) do a community capacity assessment prior to initiating a community needs assessment; 2) do not overly rely on Behavioral Risk Factor Surveys; 3) analyze needs assessment data rapidly for community consumption; 4) allow flexibility and community input in determining priority health objectives; 5) provide technical assistance throughout a project, not just in the beginning; 6) fund at least one full-time local coordinator and extensive capacity building; 7) emphasize multiple interventions around one chronic condition at a time; and 8) emphasize program institutionalization.


CONCLUSIONS
Community development approaches like Planned Approach to Community Health and Community Chronic Disease Prevention are promising health promotion strategies.  To be optimally effective, however, these strategies need refinement based on systematic study in field settings.  Because this study was limited to six sites in Maine, some of these findings may have limited generalizability.
Department of Health Promotion and Education, School of Public Health, University of South Carolina, Columbia.
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Goodman
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Steckler
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Hoover
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Schwartz
D002908:Chronic Disease; D003153:Community Health Services; D015438:Health Behavior; D006293:Health Promotion / Q000379:methods / Q000458:organization & administration*; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D006801:Humans; D008281:Maine; D008962:Models, Theoretical; D011315:Preventive Medicine / Q000379:methods / Q000458:organization & administration*; D015397:Program Evaluation; D012307:Risk Factors