Lessons Learned from HIV Prevention Initiatives: Implications for Community Anti-Drug Coalitions

By Evelyn Yang,M.A.Part of the nature of community-based health initiatives, such as community anti-drug coalitions, is the importance of community participation. It is standard practice to create community collaborative groups that direct planning, implementation and evaluation of community-based prevention efforts. However, research has not yet demonstrated that collaboration and interventions targeting community participation can effectively move the needle on behavioral/health outcomes. Why has this been the case?

• Researchers and community members do not agree in their “goals and priorities.”

• Difficulty in reaching agreement on program objectives.

• Confusion around stakeholders’ roles and responsibilities.

• Externally driven time constraints may not allow communities enough time to gather a group of stakeholders together that can collaboratively drive a process resulting in population level change.

• Lack of sufficient funding, technical assistance and resources to sustain community initiatives.

• Community consensus-based models may not address the power differences and conflicts that exist in the community.

• Researchers may be using inappropriate methods/tools to adequately evaluate the complex interconnectedness of the various programs,policies and practices implemented by a coalition.

While community-based health initiatives have become popular vehicles to support health promotion and disease prevention, evaluations of many of these efforts have shown only a limited impact in changing behaviors at the population level. Outcomes have not lived up to the promise of these comprehensive, community-change oriented models. However, while other health prevention initiatives show little to no effects, HIV prevention initiatives have demonstrated greater success. What are the lessons to be learned from the HIV prevention field?

Lessons from HIV Prevention Initiatives

• Emphasis on Modifying Social Norms – Programs, practices and policies target modifying the social norms around risky behaviors, focusing on increasing the social desirability of avoiding risky behavior.

• Use of Formative Research – Research was conducted to specifically tailor interventions to a targeted population.

• Use of Trusted Community Peer Volunteers – Community member volunteers help ensure that interventions/programs are provided in ways that are appropriate to the context of the environment and the people they are reaching.

• Understanding the Nature of Risk and Communities – Since HIV is easily communicable through relatively few engagements in risky behavior, successful interventions target changing just a few risky behaviors. Also, the target population is easily identified and relatively homogeneous, which helps in program adaptation. This is very different from coalitions that engage in multi-level/multi-strategic efforts targeted at the general community.

Implications for Community Anti-Drug Coalitions

From the current body of research on coalition effectiveness and from the lessons learned from the HIV prevention field, there are new directions for community anti-drug coalitions to move towards as they work on addressing their local substance abuse issues:

• Need to better understand how to best evaluate community-based health initiatives, including the scale and time frame needed to have a detectable impact on health outcomes.

• Need to be concrete and think through what are realistic and valid outcomes. If a coalition’s focus is on changing individual behavior, then expecting population level change may be unrealistic.

• Need for new evaluation tools and methods to fully understand the rich, synergistic coalition process.

• Need to focus on community-level change, including policies and norms, and energizing community members and organizations.

• Critical to use programs, policies and practices that specifically target high-risk behaviors and also have strategies focused on the population as a whole. Use a mix of universal, selected and indicated approaches.

• Community readiness and capacity issues must be addressed – need a thorough understanding of the community before programs, policies and practices can be tailored and implemented.

For more information, please read: Merzel, C. & D’Affitti, J. (2003). Reconsidering Community-based Health Promotion: Promise, Performance, and Potential. American Journal of Public Health, 93, 557-574.

Evelyn Yang is the Manager of Evaluation and Research for CADCA’s National Coalition Institute. You may contact her at eyangcadca.org.

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