The theory of community based health and safety programs: a critical examination.
This paper examines the theoretical underpinning of the community based approach to health and safety programs. Drawing upon the literature, a theory is constructed by elucidating assumptions of community based programs. The theory is then put to test by analyzing the extent to which the assumptions are supported by empirical evidence and the extent to which the assumptions have been applied in community based injury prevention practice. Seven principles representing key assumptions of the community based approach to health and safety programs are identified. The analysis suggests that some of the principles may have important shortcomings. Programs overwhelmingly define geographical or geopolitical units as communities, which is problematic considering that these entities can be heterogeneous and characterized by a weak sense of community. This may yield insufficient community mobilization and inadequate program reach. At the same time, none of the principles identified as most plausible appears to be widely or fully applied in program practice. The implication is that many community based health and safety programs do not function at an optimum level, which could explain some of the difficulties in demonstrating effectiveness seen with many of these programs.
Nilsen
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Department of Health and Society, Division of Social Medicine and Public Health Science, Linköping University, SE-58183 Linköping, Sweden. nilsen@uptown.se
D003153:Community Health Services / Q000458:organization & administration*; D006293:Health Promotion / Q000379:methods / Q000458:organization & administration*; D006801:Humans; D008962:Models, Theoretical; D011314:Preventive Health Services / Q000458:organization & administration*; D015397:Program Evaluation; D014947:Wounds and Injuries / Q000517:prevention & control*