Public health in community settings: An introduction
Public health in community settings: An introduction

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Public health in community settings: An introduction

1.2 Getting to know the community, both formally and informally

If communities are to be able to participate in the decision-making processes and achieve partnership ways of working, then public health practitioners need to work with the community and understand and value their needs and perspectives. This can take time and patience as well as a great deal of tact and diplomacy. Thus, the public health worker needs to be aware of the cultural and political sensitivities of the area. Burman et al. (2004) have, for example, shown how ‘culture’ can be a barrier in the delivery of domestic violence services.

‘Networking’ is a term frequently heard in community work. Basically, it is about making contacts, building trust, developing alliances, tapping into local knowledge and listening and learning from as wide a range of people within the community as possible. The following ideas have been suggested for building good networks:

  1. Walk, don’t ride. Always try to walk from A to B, and ensure that you visit areas that are unfamiliar to you
  2. Never pass up the opportunity to make or renew a contact (unless you are fairly sure that to do so at that point will damage another area of work)
  3. Learn how to listen and notice
  4. In order to get you must give. People are prepared to give best when it is clear that they will get something in return.
(Source: Twelvetrees, 1982, quoted in Thornley, 2002, p. 72)
Figure 1 A health visitor networks with a young mother at a Sure Start centre in Powys, Wales

‘Snowballing’ is a useful technique in building networks. Essentially, this is about using existing contacts to suggest others who might also be contacted, who in turn are asked to suggest yet others. One of the drawbacks of this technique is that one could end up with only one real network based on the original person contacted. To avoid this, it is best to initiate more than one snowball. Community workers who are very unfamiliar with an area will need to immerse themselves in the community by frequenting local shopping centres, sitting in cafes or pubs and generally talking informally to as many people as possible.

Making both formal and informal contacts will allow the community worker the opportunity to talk and, more importantly, to listen to people who live and work in the community about what they think constitutes a ‘healthy’ person and community; what the particular health needs of their area are; whether they think that these are being met and, if not, what they think might be the solution to them; and whether they might want to be involved with future developments. In order to do this, the community worker can use a range of methods, such as one-to-one discussion, questionnaires, workshops, focus groups and public meetings.

Activity 2 Dilemmas in community development

30 minutes

This activity asks you to think about the practical and ethical problems that might arise in the approaches discussed above. Consider the following issues and suggest what problem you might face in:

  • Working with a forceful group of community leaders
  • Trying to mobilise local residents who feel their views have been ignored
  • Identifying and responding to what you see as a long-standing problem

Answer

The process of networking and building up community contacts can raise a number of dilemmas in terms of who can be said to represent the community’s views and interests. At a practical level, community leaders or representatives will be able to give a particular perspective or overall view, but they may not be representative of the whole community. The skill of the community worker is to recognise and understand this and to seek as many views as is practically possible. They also need to be aware of the community’s existing organisational structures; and to clarify what local residents see as the boundary to their community, which may be different from the geographical one based on the electoral ward.

Other issues that may emerge are those related to what can be achieved and how this is to be done, particularly if any proposed local action is an ‘intervention’ based on a time-limited project. Local residents and/or community groups may have low expectations as to what may be achieved, particularly if they have had little or no resources in the past or, in their view, statutory agencies have ‘failed to deliver’.

‘Unrealistic’ expectations of what is achievable could eventually lead to demoralisation if timescales and outcomes do not match those expectations. However, low expectations are a more common problem. For various reasons (such as lack of self-confidence, the inaccessibility of an organisation, or institutional racism), local people may feel unable to raise with the appropriate agency the issues they feel strongly about.

In such situations the community worker would need to act as a conduit or communication channel to enable those voices to be heard and the issues put on the relevant agenda. They would also need to work with local people to develop their skills and confidence. This process of empowerment is crucial if local people are to be able to determine how they want to take action to get their needs met. The worker’s role would be to enable them to develop appropriate ways of taking action, such as campaigning and lobbying, or developing activities to suit their needs. Local people would start to take action to set the agenda rather than having it set for them.

The role of the community worker is to build on initial research and contact with people living and working in the community, so that the needs identified can be expanded upon and solutions developed. The worker’s overall role would be to support and facilitate that process, particularly in terms of existing organisational structures and the creation of new ones.

The next section addresses more specifically these aspects of engaging with a community.

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