Assessing Community Readiness Research Articles

What Are the Odds? Community Readiness for Smoke-Free Bingos in First Nation Communities

Community members have identified second-hand smoke exposure among young women and children within First Nations communities as a concern. As part of a community-based research project, we analyzed experiences related to establishing smoke-free public spaces and the challenges related to smoking and bingo. The purpose of this study was to a) describe and compare community smoking at bingo in First Nations communities, and b) draw implications for assessing and supporting community readiness for comprehensive tobacco control policies (TCPs). Data were collected using individual interviews, group discussions, and observations in the community. The establishment of smoke-free public spaces in communities evolved out of concern by people traditionally responsible for the well-being of the community. Despite close proximity and similar socioeconomic contexts, readiness to extend these successes to bingos held in community halls was influenced by three main factors: a) economic drivers, b) the smoking majority, and c) grassroots support. Although models for assessing community readiness provide a useful starting point for understanding local TCP development and implementation in First Nations communities, other factors also need to be considered. Using a comprehensive approach to assessing community readiness has the potential to increase success in extending TCPs and practices in First Nations communities in ways that are culturally relevant, address local conditions, and build on existing efforts.

Using the Community Readiness Model as an Approach to Formative Evaluation

This article presents an adapted version of an established model for assessing community readiness along with an illustrative case example from the evaluation of Positive Action, a school-based social and character development intervention, implemented as part of a randomized controlled trial in Chicago Public Schools from 2004 through 2010. Community readiness is an emerging assessment approach that can be used to gauge the level of understanding, desire, and ownership that community members have regarding a community problem and/or intervention. This approach is useful in engaging the community and leveraging particular aspects of readiness that the community may exhibit in order to maximize an intervention's successful implementation. The article concludes with a discussion of ways in which a community readiness model may be useful in health promotion practice, both in schools and in other community settings.

Using Community Readiness Assessment to Inform Environmental Intervention Development in the Children's Healthy Living (CHL) Program in Remote Underserved Minority Populations of the Pacific

The prevalence of early childhood obesity among Native Hawaiians, Pacific Islanders and Alaska Natives is disproportionately high compared to other US population groups. Sustainable, multi‐strategy, community‐based approaches, rather than individually targeted approaches, are increasingly recognized as effective strategies to obesity prevention. Previous studies, however, have not examined community readiness (CR) as an important facet to obesity prevention interventions. We present results of CR assessments completed in the Children's Healthy Living (CHL) Program that will inform development and implementation of a community‐based intervention to modify the food and physical activity environment to prevent child obesity in 5 jurisdictions: Alaska (AK), American Samoa (AS), Commonwealth of the Northern Mariana Islands (CNMI), Guam (GM) and Hawaii (HI). A survey assessing 6 dimensions of CR was administered to key informants in 4 target communities per jurisdiction. Possible dimension CR scores range from 1 (No Awareness) to 9 (High Level of Community Ownership). Jurisdiction scores ranged from 3 – 4 in AK (n = 23) and CNMI (n = 22), 4 – 5 in HI (n = 24), 5 – 6 in GM (n = 34), and 6 – 7 in AS (n = 39). Results will be used to tailor CHL's community‐based environmental intervention to match each community's level of readiness.Grant Funding Source: Agriculture and Food Research Initiative Grant no. 2011–68001‐30335 from the USDA National Institute of Food and Agricultural Science Enhancement Coordinated Agricultural Program

Dimensions of Community and Organizational Readiness for Change

Readiness can influence whether health interventions are implemented in, and ultimately integrated into, communities. Although there is significant research interest in readiness and capacity for change, the measurement of these constructs is still in its infancy. The purpose of this review was to integrate existing assessment models of community and organizational readiness. The database PubMed was searched for articles; articles, book chapters, and practitioner guides identified as references cited in the list of core articles. Studies were included if they met the following criteria: (1) Empirical research, (2) identified community or organizational readiness for innovative health programming in the study's title, purpose, research questions, or hypotheses, and (3) identified methods to measure these constructs. Duplicate articles were deleted and measures published before 1995 were excluded. The search yielded 150 studies; 13 met all criteria. This article presents the results of a critical review of 13 community and organizational readiness assessment models, stemming from articles, chapters, and practitioner's guides focusing on assessing, developing, and sustaining community and organizational readiness for innovative public health programs. Readiness is multidimensional and different models place emphasis on different components of readiness, such as (1) community and organizational climate that facilitates change, (2) attitudes and current efforts toward prevention, (3) commitment to change, and (4) capacity to implement change. When initiating the program planning process, it is essential to assess these four domains of readiness to determine how they apply to the nuances across different communities. Thus, community-based participatory research (CBPR) partnerships, in efforts to focus on public health problems, may consider using readiness assessments as a tool for tailoring intervention efforts to the needs of the community.

A Short Online Community Readiness Survey for Smoke-Free Policy

Rural residents in the United States are more likely to use tobacco, have less access to tobacco control resources and efforts, and are more highly exposed to secondhand smoke than their urban counterparts. The purpose was to design and pilot test a shortened, self-administered online survey (Community Readiness Survey-Short form [CRS-S]) to assess community readiness for smoke-free policy in rural communities. The Community Readiness Survey-Long form (CRS-L) is a 30- to 90-min telephone-administered survey. The Community Readiness Model can guide the design of programs and policy interventions to reduce health risks. 160 key informants from Wave 3 of a 5-year community-based randomized controlled trial set in Kentucky completed the CRS-L; 61 of approximately 140-284 items were significantly related to the relevant readiness dimension subscores and selected for inclusion. The online CRS-S was created with these items using Qualtrics software; 43 smoke-free advocates who had completed the CRS-L during Wave 4 were invited to participate. Correlations between the CRS-S and the CRS-L on overall readiness and the dimension scores were calculated. Readiness scores were correlated with existence of public policy and voluntary smoke-free policies to assess convergent validity. The correlation between the overall CRS-S and CRS-L scores was relatively strong (.82), and there is evidence to support convergent validity. Most respondents completed the CRS-S in less than 15 min and preferred this format. The CRS-S is a valid and less time- and resource-intensive method to assess readiness for smoke-free policy in rural communities.

Seeking to Bridge Two Cultures: The Wisconsin Hmong Cancer Experience

Compared to white non-Hispanics, Hmong report higher incidence rates of certain cancers and present at an advanced stage. Using a community-based participatory research approach, Hmong leaders partnered with academic researchers to assess the Wisconsin Hmong population's readiness to address cancer. Using the Colorado Tri-Ethnic Center's Community Readiness Assessment, face-to-face interviews were conducted with eight Hmong leaders. The stage of readiness to address cancer was "Vague Awareness". Six thematic areas provided insight into this stage and recommendations for effective intervention. Results emphasize the need for a bridge between Hmong and mainstream communities to provide basic, culturally appropriate education on the US healthcare system and cancer.

An assessment of community readiness for HIV/AIDS preventive interventions in rural Bangladesh

Efforts to prevent HIV from becoming widespread among the youth population 15-24 years in Bangladesh are in the early stages. However, conservative religious and cultural norms may curtail the dissemination of needed information about sexuality and condoms. The community-readiness stages model was adopted as a framework for assessing the level of preparedness of community leaders to facilitate planned HIV prevention efforts. Six focus group discussions with three professional groups (teachers, businessmen, drugshop vendors) in Hobiganj district were conducted in late 2005, and a single multi-professional group made up of teachers, imams, and drugshop vendors was convened in early 2007 to assess changes. The audio recordings in Bangla were coded as were English translations. Everyone had heard of AIDS and regarded it as a potential catastrophe for the health, economy and social fabric of Bangladesh. Remarks concerning Stage 1-Vulnerability indicated that most did not believe their community to be at risk, though Bangladesh was. Remarks at Stage 2-Knowledge of Transmission were mostly vague but accurately identified sex, blood and needles as the main means of spread; however sex with sex workers was also mentioned in each group. Remarks at Stage 3-Prevention showed strong opposition to condoms for unmarried males and a preference for current means of forbidding sex outside of marriage. A few in each group recognized the importance of condoms for wayward youth. Stage 4-Planning discussions centered on raising awareness and fear, and a desire for government and media to take the lead. By 2007 participants articulated more realistic strategies that they themselves could, and had, implemented, but also raised barriers that authorities should help them overcome. The findings provide formative information on the constraints and opportunities of community groups as partners in HIV preventive interventions and strategies to help them move to a higher stage of readiness.

Enabling volunteer health planning capacity: a rural Canadian case study

PurposeThe purpose of this paper is to determine opportunities, resources, and capacity building supports that enable volunteer capacity to participate in localized health planning processes.Design/methodology/approachA case study methodology is employed in this study. A range of qualitative research methods including focus groups, individual interviews, observation and document analysis is used to gather detailed data about the experience of the health volunteers. They engage in an in‐depth analysis of this experience. A thematic analysis of volunteer accounts informs the explanation of the case and the study findings.FindingsThe development of partnerships between health systems and communities is advocated as a means of enhancing overall community capacity to address priority health concerns, and to reduce escalating health care costs and inequities. The process of building health partnerships is complex, requiring extensive assessment of both health system and community readiness. Health volunteers have many capacities well suited to collaborative activity; these are more likely to find expression when barriers are minimized and facilitative conditions are maximized. The study finds that dialogue is a key mechanism for assessing community and system readiness, and for building trust and mutual understanding in such health partnerships. This case study introduces facilitated dialogue as a mechanism for assessing volunteer readiness and timely capacity building resources and supports, in line with the developmental needs of volunteers. Assessing health system readiness involves consideration of health system goals and definitions of participation, and overall commitment to developing and resourcing this kind of system‐wide change where the outcomes are longer term in nature. This commitment entails training of health professionals in the relevant health promotion knowledge and skills. This extends to mobilizing, nurturing, and supporting volunteer capacity to work with the health system to make informed decisions about the health needs of their community.Research limitations/implicationsA health system perspective on this question should be explored to identify other complex challenges associated with managing this kind of system‐wide change.Practical implicationsThe paper provides detailed insights into the experience of health volunteers in a health planning context. These insights potentially inform concrete strategies for assessing community strengths and readiness, and for minimizing barriers to volunteer participation, particularly in a rural context.Originality/valueThe paper provides insights about how health system structure and environmental processes can be adapted to create an environment conducive to community participation.

Community Readiness Assessment: The Scoring Process Revisited

The Community Readiness Model is an innovative and widely embraced approach to determining a community's stage of readiness to address a particular community issue and match that stage with an appropriate intervention. The current study used this approach in five communities experiencing cancer health disparities. In each community, leaders were interviewed and their qualitative data scored to determine the community's stage of readiness. Two methods of triangulation, investigator and interdisciplinary, were used to increase the scoring process's rigor. In order to gain a deeper understanding of the consensus portion of the scoring process, these meetings were content analyzed. The results have important implications for scoring team composition, provide insight into consensus reaching strategies, and offer recommendations for addressing potential challenges.

Suicide prevention as a community development process: understanding circumpolar youth suicide prevention through community level outcomes

Objectives. Community-based models have become increasingly prominent in prevention, and have special relevance for suicide prevention in circumpolar Indigenous communities. It follows that outcomes from circumpolar suicide prevention programs might be more completely understood at the community level. We present here a methodology for analysis at this level. This paper seeks to understand a cultural prevention program for rural Yup’ik youth in Alaska targeting suicide and co-occurring alcohol abuse as a community development process through changes at the community level.Study Design. Quasi-experimental design with assessment at pre-and post-intervention or at 4 time points. The community development process for this project began in October 2004. The first program baseline assessment began in November 2006, prior to prevention activities with youth and parents, and the post-intervention assessment concluded in March 2008.Methods. Five key informants pre-and post-intervention completed a community readiness assessment, which is a structured procedure assessing a community’s awareness of suicide as an issue and its organizational readiness for prevention programming. Forty-three adult caregivers or sponsors of youth in the prevention program completed an assessment of behaviours that contributed to community protective factors from youth suicide and alcohol abuse at 4 time points before, during and after the intervention. The 54 youth who participated in the prevention program completed an assessment of community protective factors, also at 4 time points before, during and after the intervention. The community protective factors from suicide that were assessed included safety, enforcement of alcohol prohibitions, role models, support and opportunities for youth.Results. Community readiness for the prevention efforts increased to new developmental stages of readiness post-intervention, and a trend in the data suggested community protective factors increased in the amount of protective behaviours performed by adults (slope estimate=0.0162, 95% CI-0.0028–0.0351, d=.55) and in the perceptions of youth (slope estimate=0.0148, 95% CI-0.0004–0.0291, d=.45), in a dose response relationship to the number of prevention program sessions attended by adults and youth.Conclusions. Using data from a feasibility study, this paper demonstrates the feasibility and potential utility of methodological approaches that use community-level variables beyond individual level outcomes in circumpolar suicide prevention research.

Foundation Readiness for Community Transformation: Learning in Real Time

Introduction Foundations sponsoring community change initiatives typically devote considerable time to assessing community readiness as they consider how to select communities that are most ready to take advantage of the resources and opportunities that the initiative will afford. What are the existing assets and momentum on which to build? Is there sufficient nonprofit capacity and community leadership? Are markets, politics, and regional forces sufficiently aligned to suggest a promising fit with the foundation’s approach to community change?

Assessing Community Readiness for Change in the Nashville Hispanic Community Through Participatory Research

Assessing Community Readiness for Change in the Nashville Hispanic Community Through Participatory Research

Assessing Community Readiness for Change in the Nashville Hispanic Community Through Participatory Research

"New-growth communities" with rapidly growing Hispanic populations often have little experience with addressing the needs of this population. "Community readiness for change" is the degree to which a community is prepared to take action on an issue. This study assessed the stage of community readiness for change in the area of Hispanic health in Nashville, using the community readiness model (CRM) and a community-based participatory research (CBPR) approach, through a partnership between an academic research center and a nonprofit, grassroots, Hispanic organization. Qualitative and quantitative data were collected by trained community interviewers and the academic researcher using a semistructured questionnaire based on the CRM. The sample of key informants included (1) a purposive sample of 18 organizations, and (2) a convenience sample of 50 Hispanic community members. The organizations were at a higher stage (stage 5, preparation) than the Hispanic community members were (stage 4, preplanning), particularly in the dimensions of Leadership, Resources, and Knowledge of Efforts. The community members were also aware of fewer local efforts focused on Hispanic health than the organizations (average of 4.5 vs. 7.6). Recommendations were made for stageappropriate, community-level interventions. The assessment results are being used by Nashville Latino Health Coalition (NLHC) to plan collaborative initiatives to address Hispanic health needs in Nashville. This study demonstrates the utility of the CRM as a model for assessing a community's stage of readiness to take action, and the feasibility of applying it using a CBPR approach in a "new-growth" Hispanic community.

Changing community readiness to prevent the abuse of inhalants and other harmful legal products in Alaska.

This paper presents results from an application of the Community Readiness Model (CRM) as part of a multi-stage community mobilization strategy to engage community leaders, retailers, parents, and school personnel in preventing youth use of inhalants and other harmful legal products in rural Alaska. The CRM is designed to assess readiness to address a single social problem, based on a limited set of key informant interviews. In this study, researchers conducted 32 baseline and 34 post-intervention community readiness assessment interviews in four rural Alaskan communities. These interviews with key informants from the communities were coded and analyzed using CRM methods to yield readiness scores for each community. The aggregate results were analyzed using hierarchical linear modeling (HLM), and the individual community scores were analyzed in the context of the overall study. Significant positive changes in community readiness were found across six readiness dimensions as well as for the overall readiness score. Variation in the degree of changes in readiness across the four communities is attributed to differences in the intervention's implementation. The implications of these results include the potential for CRM assessments to serve as an integral component of a community mobilization strategy and also to offer meaningful feedback to communities participating in prevention research.

COMMUNITY READINESS AS A MULTIDIMENSIONAL CONSTRUCT.

Both the organizational studies literature and the community psychology literature discuss the importance of readiness when implementing change. Although each area emphasizes different characteristics, several common themes are present within the literature. The current study integrates and applies organizational and community psychology literature in evaluating community readiness in the context of a school-community-university collaborative prevention model. Results demonstrate (a) that there is substantial agreement between members of community prevention teams on the level of readiness of a community; (b) that readiness is a cohesive, but multidimensional, construct related to hypothesized community and individual characteristics; and (c) that there is small to moderate agreement between members of prevention teams and their "agency directors." These results support the notion that clear "theories of change" need to be formulated before deciding how to assess community readiness, as assessments will vary due to several factors: the type of respondent, the level in which analyses are conducted, and the specific community domain (i.e., school, workplace collaboration, collaboration experience) investigated.

Developing locally relevant outreach programs for same sex attracted youth in regional areas

This paper reports on the process evaluation of the Same Sky project,1 which was aimed at developing regional community support programs for same sex attracted youth (SSAY) and their families in four regional sites in Western Australia. A multi-faceted approach modelled on successful urban outreach programs was used to build professional capacity and develop peer-based support programs in the community. A triangulated mixed methods evaluation design was implemented to capture various outputs and outcomes of the intervention strategies. Data were collected via interviews and questionnaires and by assessing community readiness through community participation and involvement in the programs and through demand for printed resources. There was increased community awareness of same sex attraction issues and professional capacity to help SSAY regionally following training and distribution of printed resources. Improved alliances between regional and metropolitan service providers were also evident. Not all of the planned peer support interventions could be implemented. Drop-in centres and peer support groups proved particularly problematic to establish. Basing the project officer in one of the rural sites was notable in improving project progress. Some aspects of the urban outreach models for SSAY were transportable to rural areas, others were not. Some specific problems identified were a lack of community readiness, a distrust of 'outsiders' to the community, significant differences between the needs of SSAY across regional demonstration sites, and difficulties in engaging locally based volunteers and agencies to develop and run rural outreach services.

Disparities in Community Readiness for HIV/AIDS Prevention

HIV and AIDS as a community issue have not been dealt with extensively in the literature. One model that offers promise for development of effective prevention and intervention efforts is the Community Readiness Model, a nine-stage model that assesses the level of readiness of a community to develop and implement prevention programming. Data are presented from a Community Readiness assessment of 30 rural U.S. communities: 10 African American, 10 Mexican American, and 10 White non-Mexican American. Four to five key respondent interviews were conducted via telephone in each community using the Community Readiness Assessment protocol during 1999–2000. Limitations of the study and implications for prevention are discussed. This study was funded by the National Institute on Drug Abuse.

The concept of community readiness for preventive action

Community readiness is defined as the extent to which a community is adequately prepared to develop and implement preventive interventions. The concept makes it possible to provide theoretically and scientifically grounded explanations of inconsistent effectiveness of prevention programs implemented in different communities. The article outlines the history of the community readiness model, its basic components (dimensions and stages) and practical implications - how to assess community readiness, and strategies to improve it.

Readiness for Drug Use Prevention in Rural Minority Communities

An assessment of community readiness for drug use prevention in rural communities indicated that most rural communities are at relatively low stages of readiness. Minority communities were particularly low in readiness, with only 2% having functioning drug prevention programs. Rural communities at different levels of readiness require different types of programs to increase readiness, i.e., communities at the no awareness stage require analysis of the historical and cultural issues that support tolerance of drug use, those at the denial and vague awareness stages need specific information about local problems, and communities at the preplanning and preparation stages need information about effective programs, help in identifying resources, and assistance with staff training. In addition, building and maintaining effective programs requires continued evolution of readiness through the stages of initiation, stabilization, confirmation and expansion, and professionalization. Revised and updated scales and methods for assessing community readiness are provided. [Translations are provided in the International s Section of this issue.]

Use of Qualitative Methodology in Community Nutrition Assessment

LEARNING OUTCOME: To compare qualitative methods for use in assessment of community nutrition needs Qualitative assessment of nutrition needs within a community is a crucial step in planning effective nutrition interventions for that community. Assessment of perceptions of nutrition and health problems by community leaders and members can guide planning, build support for later interventions, assess community readiness for change, and identify helps and barriers to change. Researchers evaluated qualitative methodologies in planning a community assessment for the Delta Nutrition Intervention Research Initiative (Delta-NIRI), a collaborative initiative targeting poor nutrition and health in the Lower Mississippi Delta region, an area characterized by extreme poverty. The key informant personal interview was compared with focus group methodology on the basis of the following considerations: meeting study objectives, respondent burden, data analysis, interviewee expectations and freedom to express opinion, group dynamics, bias, and researcher control. Personal interviews with key informants using a structured questionnaire are held at the convenience of the key informant and thus yield high response rates; key informants can express personal opinions without fear of disclosure or political ramifications; individual interviews can aid “buy-in” to a program or initiative at an early stage; data can be compared across communities and community sectors. Individual interviews may be more costly than focus groups and key informants may have bias associated with their roles in the community. Focus groups are generally easy, quick, and less expensive to conduct than individual interviews; they use group interaction to produce data that individuals might not generate independently; group interaction can lead to greater emphasis on the participant's point of view, but less control by the researcher over data generated; focus group participants should be homogeneous in order for comparisons to be made across groups in data analysis. Dietitians should consider use of qualitative methods in assessing community nutrition needs prior to planning nutrition interventions. (Supported by USDA-Agricultural Research Service)