Review by Jennifer W. Purcell
Kennesaw State University
This volume is the product of a five-year collaborative study on the impact of community leadership development programs spanning six states. The book is the third volume of the Rural Studies Series sponsored by the Rural Sociological Society, and the research presented was funded in part by the U.S. Department of Agriculture’s National Institute of Food and Agriculture. The purpose of the book is to engender thoughtful theory and evidence-driven design and redesign of community leadership development programs.
Organization and Content
The book’s nine chapters are organized into two parts. In Part I, the authors dedicate six chapters to the presentation of their analysis of data collected on community leadership development. In Chapter One, the authors provide a historical context of community leadership development (CLD). They define community-based programs as those that are (1) focused on community issues and needs; (2) organized and managed locally or by a community group; and (3) sponsored by local resources. Although CLD programs are diverse in their target audience, curriculum, delivery, and specific community-level outcomes, the authors contend the common element across programs is their goal to “increase local leaders’ capacity to improve the community’s well-being” (p. 21). The authors suggest investment in leadership development and capacity-building responds to observed deficits in the community. They contend current and future community leaders in smaller, rural communities have inadequate preparation to address the complexity of social factors impacting their communities. In closing Chapter One, the authors propose two significant reconsiderations for CLD. First, they suggest CLD program sponsors and practitioners examine evaluation strategies for how program outcomes for individual participants, organizations, and communities are achieved. Identifying how CLD achieves outcomes at various levels is critical to evaluating and improving programs. Second, the authors call for a conceptualization of leadership that moves beyond individual roles and talents to one that recognizes the collaboration and interaction through which leadership and leaders manifest. This conceptual view of leadership as a social process informs the learning intervention that is CLD and is the premise on which the study is built.
Chapter Two details the impact of CLD on individual participants. The key finding related to individual participants informed by data collected in 24 communities with CLD programs, or “treatment sites,” was respondents who participated in CLD programs had significant learning when compared to respondents who lived in counties without programs. CLD participation yields learning that is associated with measureable increased levels of civic engagement and enhanced social capital within communities. Chapter Three expands upon the impact of CLD on social capital by illustrating how involvement in community organizations is broadened and intensified among CLD participants. In Chapter Four, the authors utilize a modified application of Flora, Flora, and Fey’s (2003) community capitals framework to demonstrate the positive impacts of CLD on community development.
Chapter Five addresses participant diversity, curriculum design, and community effects. The authors present data related to the six individual-level outcomes of CLD identified in the study (Personal Growth and Efficacy, Community Commitment, Shared Future and Purpose, Community Knowledge, Civic Engagement, and Social Cohesion). In Chapter Six, the authors press the core idea of the book: community leadership is about community change (p. 119). Their intent is to reveal strategies for CLD program improvement through empirical evidence. Chapter Six concludes Part I with a series of questions for practitioners and sponsors to consider as they design or redesign CLD offerings.
Part II includes three chapters that address the implications of the research for practitioners and future research. In this section, the authors detail a conceptual framework for community leadership development that integrates existing literature and findings from their research. The authors first emphasize the individual motivations for developing community leadership capacities and the myriad expressions of civic engagement (Chapter Seven). The authors suggest civic engagement leverages individual capacities for leadership and builds upon networked, relational leadership within a community in order to influence positive change (Chapter Eight). Hence, developing individual leadership capacity is elemental to promoting civic engagement; however, such individual-level development is merely a first step in CLD.
As demonstrated through the study, effective CLD interventions include curriculum that addresses individual, organizational, and community-level outcomes. Absence of any one of the three curricular outcomes is a missed opportunity to influence change and impact the community. The authors conclude with a discussion of a model of CLD informed by their research through which participants first attain and/or demonstrate (1) improved human capital self-efficacy and governance skills, (2) increased community commitment, (3) shared future and purpose, and (4) increased political knowledge (political capital). Based on the model, CLD participants then demonstrate increased social cohesion and ability to bridge networks and increased civic engagement. These CLD participant behaviors then result in enhanced civic infrastructure and community capacity that yield community-level awareness of responsiveness
to social needs and the inevitable changing conditions experienced in communities.
The book is tailored for CLD practitioners, sponsors, and evaluators through its accessible theoretical literature, study design, and data analysis. The volume is valuable for researchers who will be impressed with the breadth of relevant citations and integration of multiple disciplinary literature bases. Additionally, the authors provide five sets of study questions throughout the text that would be helpful for structuring independent or group learning exercises for graduate students or as a means of professional development for community leadership development practitioners.
Community effects of leadership development education: Citizen empowerment for civic engagement is an essential read for anyone responsible for the design and evaluation of community leadership development programs. Although targeted program evaluations and assessment of participant learning exist, there is a dearth of empirical research on CLD effects on communities and the interplay between individual, organizational, and community-level outcomes. This much anticipated volume heralds a new era of scholarship and practice that engages interdisciplinary literature and empirical research to more critically and precisely explore the benefits of the vast investment in CLD. The authors are frank in their discussion of the research’s limitations; the factors influencing CLD outcomes are numerable and controls are challenging. Despite the acknowledged limitations of the research, this volume is a significant contribution to CLD. The research presented provides an unprecedented synthesis of literature and empirically based insights into the recruitment practices, curriculum design, and evaluation strategies of CLD. Furthermore, the volume is a welcomed summons for scholars and practitioners to build upon the recommendations contained therein and advance the design of community leadership development programs and the ways in which such programs’ outcomes and impacts are measured.
The volume will also appeal to community engagement practitioners and community-engaged scholars who support and participate in university-community partnerships. University-sponsored community engagement activities, including community-engaged scholarship, are championed for their positive impact on communities;
however, comprehensive monitoring and measuring the varied impacts of these activities remains a challenge. Pigg and his colleagues challenge us to reconsider the design of programs intended to support leadership and community development. While the emphasis of their research addresses community leadership development specifically, there are implications for the diverse array of university-community partnerships. For example, the authors address multiple program design elements: primary and secondary outcomes, sponsorship mobilization, collaborative learning, the political and value-laden nature of community-engaged efforts, and diversity among participants among others.
The text may also encourage university leaders to reflect on the ways in which academic, co-curricular, and outreach programs meet their communities’ leadership development education needs. As representatives of anchor institutions that contribute to their communities’ sustainability and advancement, university leaders must carefully consider how and to what extent myriad initiatives individually and collectively impact participants and communities. Through this rigorous investigation, universities may more holistically illustrate their significance and demonstrate appropriate stewardship of the vast public and private investment in higher education.
The authors provide substantial insight into the effects of community leadership development programs; however, even they acknowledge their contribution falls short in providing a general
theory of community leadership. Pigg and his colleagues provide a model of the effects of community leadership development programs on individuals and communities that, although limited, presents a more comprehensive conceptual framework for leadership development education. Their model synthesizes multiple disciplinary literatures related to civic leadership capacity and demonstrates the interconnectivity and complexity of community leadership development. Community effects of leadership development education: Citizen empowerment for civic engagement is crucial addition to the literature on community leadership development, civic engagement, and community capacity building that will advance the influence of citizen leaders in their communities. The volume is also a valuable resource for university leaders who advocate for campus-community partnerships and those whose work directly impacts such collaborations that are designed to have positive impacts on communities.
The editorial team of the Journal of Community Engagement and Scholarship would like to acknowledge and thank the West Virginia University Press for providing copies of the book for this review.
About the Reviewer
Jennifer W. Purcell is an assistant professor of Leadership Studies and faculty consultant for community engagement at Kennesaw State University.
Review by Sarah Stanlick
Higher education has become increasingly technology-centric with massive open online courses (MOOCs), hybrid courses, and classroom technologies pushing us to reconsider how knowledge is shared, how identities develop, and how learners are reached. With this shift, there are both challenges and opportunities for the field of service-learning and civic engagement to consider. At the recent Pathways to Achieving Civic Engagement Conference hosted by North Carolina Campus Compact, a clear theme emerged with regard to technology’s impact on the future of service-learning and civic engagement. Some spoke with trepidation, and others with bold hope for innovations that could make service-learning even more accessible in the online format.
As educators, if we seek to develop the civic knowledge, skills, and values/attitudes of our students, that practice can take place in many different forms and formats. Harnessing technology’s power to support that diverse sharing of ideas, connections to modes of communication across boundaries, and scaffolding of critical reflection and growth are all domains in which the experience of service-learning and civic engagement can be deepened. However, not all are hopeful for technology’s role in education or society. Psychologist and MIT Professor Sherry Turkle (2012) has done extensive work on the divisive nature of technology and its capacity to push people further apart and encourage less “human” interactions. Clearly, there is much to be learned and new horizons to explore if we are to meaningfully and effectively implement technology in the service-learning and civic engagement field.
Editors Jean Strait and Katherine Nordyke are ahead of the curve in this respect, having published a volume that delves into the many expressions, benefits, and potential pitfalls of engaging in the online world. In their work eService-Learning: Creating Experiential Learning and Civic Engagement Through Online and Hybrid Courses, the editors bring together a diverse collection of author experience to speak to the future of service-learning in an online capacity. Divided into three main sections, the book provides a scaffold for readers to think through the ways in which experiential learning and civic engagement can take place in online and hybrid courses.
Moving from essentials to models to future directions, the book clearly scaffolds the knowledge about e-service-learning for the reader to both learn new frameworks and imagine the possibilities for their own practice. In the opening chapter, the editors—joined by Jane Turk—provide a comprehensive review that sets up many of the issues and implications of service-learning, both digitally and analog. They identify civic knowledge, skills, and values/attitudes as the ultimate goal of the pedagogy that is service-learning, and thus posit the question of how technology helps us to realize those goals. Leora Waldner provides a critical understanding of the components of e-service-learning and, further, what the values of a high-quality experience should encompass. In chapter 3, Nordyke explores the ways in which service-learning at large can be realized in a course, and then asks us to think about the appropriate usage when technology is involved. Whether it be direct or indirect service, integrated or standalone, there are many options for what service-learning can look like in the digital realm, and it is incumbent upon the curriculum designer to make intentional choices about that delivery. Finally, Strait rounds out this section of chapters by exploring the role of technology as a support system for service-learning, and specifically e-service-learning models.
In the next set of chapters, models for e-service-learning across disciplines and geographic areas are explored. Each provides a specific context for e-service-learning, from university adoption at-large to an online business course to the assessment of experiences in an established service-learning office. One of the chapters that focuses on exemplars is a case study on service-learning after Hurricane Katrina. Striking a parallel between today’s political landscape and the intense focus on the Syrian refugee crisis, one can look at this chapter as especially salient. A spike in attention and awareness can lead to a situation that susceptible to largely technocratic or unsustainable engagement. In the chapter on post-Katrina efforts, the example of the Each One, Teach One program provides evidence of a successful model that integrated hybrid online, in-person experiences for sustainable engagement and community partner relationship development. This section reminds us that we must think critically and carefully about the way in which service-learning and civic engagement is being implemented in truly meaningful, high-quality ways regardless of the realm—online or in-person.
Moving into the final section of the book, the focus shifts to the future. The penultimate chapter is a call from John Hamerlinck to leverage technology and community engagement to make higher education more purposeful and impactful. Trends in neoliberalism and internationalization in higher education—coupled with an increased focus on providing asynchronous experiences—have driven the growth and development of MOOCs and hybrid courses. Hamerlinck cites a number of examples from domains of cost, student success, and debt that point toward the need to rethinking the purpose and usefulness of higher education. Within the space constraints of a chapter, it is impossible to exhaust all of the issues facing the wicked problem of higher education delivery and transformation. However, there is one notable absence: the issue of access. I can envision an opportunity for a critical examination of these issues of access and equity in future works, especially as the opportunities for e-service-learning continues to grow and concern about the digital divide remains very real. That being said, the exciting opportunity that he highlights is the ability re-imagine higher education, leverage technology to create community, and highlight one’s work in service-learning and civic engagement to shift the expectations and models of higher education. In his vision, social media can be a tool to promote civic ideals, the openness of online courses can disseminate knowledge across stakeholders, and the creative, collaborative capacity of joint projects can be ever-expanded across geographies. Community-engaged teaching with technology, connectivism, and the decentralization of knowledge bases can have implications for the field, while strengthening values of community and public purpose for all of higher education.
Strait and Nordyke have put together a timely and useful resource for imagining and reconsidering the role of technology as a support, facilitator, and space for service-learning and civic engagement to take place. As a scholar-practitioner with significant experience in using technology in the classroom, I found this book to be an immensely helpful tool for those at any level of technology adoption. The contributors give us a catalyst to spark creative thinking about the delivery of service-learning education while retaining a focus on the values and quality of community engagement. Whether you look toward this brave new world of technology to expand your practice or deepen its impact, this volume is an essential resource.
Turkle, S. (2012). Alone together: Why we expect more from technology and less from each other. New York: Basic Books.
The editorial team of the Journal of Community Engagement and Scholarship would like to acknowledge and thank Stylus Publishing for providing copies of the book for this review.
About the Reviewer
Sarah Stanlick is director of the Center
for Community Engagement and professor
of practice in sociology and anthropology at
Review by Paul H. Matthews
University of Georgia
Is social entrepreneurship education just a kind of service-learning found in business schools? Or is it grounded in such different history, assumptions, and practice that its commonalities with community-based pedagogy are only superficial at best? The field of social entrepreneurship—an “innovative, social value-creating activity” (Wei-Skillern, Austin, Leonard, & Stevenson, 2007, p. 4)—is sometimes construed as analogous to service-learning, but on many campuses the two fields seem to occupy disparate and non-overlapping spaces. Sandra Enos’s brief volume (84 pages in four chapters, plus prefix, one appendix, and references), published in 2015 as part of the Community Engagement in Higher Education series (Palgrave Macmillan), seeks to change that, and to illustrate some of the ways in which these pedagogies of service-learning and social entrepreneurship can, do, and do not intersect on college campuses.
In the first chapter (“The Landscape of Social Change Education”), Enos—a sociology professor with experience in both service-learning and social entrepreneurship—sets the context with a sketch of some recent discussions of university engagement’s place in higher education, and contends that both fields focused on in this volume should be considered a subset of “social change education.” She provides evidence for the growing institutionalization of each, for instance through journals and professional associations, and draws parallels specifically between the existence of overarching organizations that encourage campus involvement in both movements (e.g., between Campus Compact and Ashoka U). Next, she summarizes prior work presenting these two fields’ commonalities (e.g., these are social-change oriented movements seeking greater campus reach; entail community-based partnerships; and provide opportunities for real-world applications of knowledge) as well as differences (e.g., a stronger focus on student learning in service-learning, versus on community/societal change in social entrepreneurship; a stronger orientation toward “disruption” of existing structures and practices in the latter; and differing language as well as desired learning outcomes). While Enos also contends that “[S]ocial entrepreneurship prizes the founding of new organizations” (p. 18), other researchers have noted the growth and value of social “intrepreneurship”—i.e., working to implement change within existing structures and organizations (Bornstein, 2007; Bornstein & Davis, 2010)—a construct not included in Enos’s overview.
Her second chapter (“Organizing for Engagement”) comprises the bulk of the book’s research contribution, an attempt to determine how these two pedagogies are organized and interrelate on campuses that offer both. Enos reports on website analyses and interviews she conducted with staff at the 10 campuses currently recognized with both Carnegie’s community engagement classification and the “Changemaker Campus” designation by Ashoka U. She contends that these “exemplars of service-learning and of social entrepreneurship education” (p. 23) should offer a view into the current status of institutionalization and potential relationships between these subfields of community engagement on U.S. campuses. As such, she investigates whether there are “patterns in the organization of these programs, whether there are typical disciplinary homes for service-learning and social entrepreneurship courses, …and how programs that offer [them] are related to each other” (p. 27). However, Enos reports that little consistency was found; instead, “what we see are individual profiles, tied to institutional size, history, culture and leadership” (pp. 32–33). While she summarizes information about each campus in a table, its content reads more like field notes than an analysis. As might be expected from a range of institutional sizes, types, and locations, she found that the colleges and universities studied had varying amounts of coursework, centralization, and support structures, and used different terminology in talking about their initiatives.
In chapter three, “Challenges for Service-Learning and Social Entrepreneurship,” Enos iterates several of the criticisms that have been extended toward these two sets of practice, including (for service-learning) a lack of “deliberate and intentional incorporation of civic skills” (p. 45), as well as issues of privilege, social justice, and the problematization of “service” (pp. 47–48). For social entrepreneurship, Enos notes that this field sometimes uses different terms (e.g. “social enterprise”) implying different foci; that innovations may struggle in being implemented at scale; and that the “celebratory nature of innovations in the social entrepreneurship space makes it difficult to mount a critical review of these practices” (p. 55). She also summarizes concerns that social entrepreneurship may tend to “paint the state, unions, public employees and other existing nonprofits as the enemy” (pp. 56–57), undermining rather than enhancing existing efforts, which may contrast with service-learning’s focus. In terms of social entrepreneurship education, Enos notes that existing courses have been criticized for a lack of emphasis on complex problem-solving, and for mismatches between desired competencies identified in course syllabi and those recommended by practitioners in the field. While interesting, and a good overview of some of the critiques offered for each field, this chapter does not contribute much new to the discussion beyond summarizing.
In the book’s final chapter, “Educating for Engagement: A Turning Point,” Enos renews her recommendations that, as two subsets of campus/community engagement, service-learning and social entrepreneurship should become better integrated institutionally. She provides examples from her own and other universities as demonstrations of how these two fields may fit into a broader conceptualization of civic engagement, as well as how particular disciplines might implement both. After repeating her calls for more cross-fertilization, Enos suggests the need “to challenge each other on what works—in teaching and research—and certainly on what strategies get us closer to working with community partners in problem-solving reciprocal ways” (p. 83). Finally, the book’s appendix provides a list of campus representatives for Chapter 3’s interviews.
Several aspects of this book raise issues worthy of contemplation for those in the community engagement field. The explicit comparison and contrasting between the two sets of philosophies and practices illuminates several interesting points. For instance, Enos contends:
Among the most important differences between service-learning and social entrepreneurship include the former’s focus on groups and collaboration vs. the latter’s on individualism, and vocabulary borrowed from the nonprofit sector vs. vocabulary taken from the business world. Other points that differentiate these fields are skepticism about market-based approaches to social problems on part of the service-learning community compared to an embrace of market-based solutions in the social entrepreneurship field. The service-learning field aims to educate students for civic engagement and democracy while some versions of social entrepreneurship work at solving problems outside of or independent of politics (pp. 16–17).
Likewise, a careful consideration of what each field might offer the other is a valuable exercise. Could some of the tools and concepts used in social entrepreneurship—e.g., the double/triple bottom line for determining return on investment—be helpful for assessing service-learning programs’ impacts? Could service-learning’s established expertise in reflection and in highlighting the importance of reciprocity with community partner organizations bolster the success of social entrepreneurship education and application?
In several areas, the book could be stronger. For instance, while couched at times in the language of research, this volume’s findings from campus interviews do not seem to follow many standards of qualitative methodology (e.g., thick description, coding, etc.), and as such fall somewhat short. Likewise, while the author includes a solid listing of prior articles that relate to this work’s guiding questions, Enos’s style of reviewing literature often seems more focused on enumerating a list of each author’s points, rather than synthesizing them as a whole. While in two separate chapters Enos offers other authors’ definitions for “social entrepreneurship,” she does not ever clarify how, specifically, she is using the term; and, while she notes that “the practice of social entrepreneurship is distinct from social entrepreneurship education” (p. 11), that distinction is not consistently apparent in the volume.
Several chapters enumerate details about certain journals, organizations and initiatives, yet omit others of similar potential interest and merit without explanation. For instance, for service-learning and community engagement, she lists several journals (JCES; the Michigan Journal of Community Service Learning) and conferences and organizations (IARSLCE; Campus Compact), while other equally relevant resources (e.g., the Journal of Higher Education Outreach and Engagement; the Engagement Scholarship Consortium) are omitted. On the social entrepreneurship side, Enos provides a strong focus on both the Skoll Foundation and Ashoka, but does not acknowledge other important resources and players such as the Acumen Fund, the Schwab Foundation for Social Entrepreneurship, or Echoing Green (Bornstein & Davis, 2010). Likewise, her “short history of social entrepreneurship” seems to lay the founding of this field at the feet of Jeffrey Skoll and Bill Drayton, with no mention of key international “pioneers” (Bornstein & Davis, 2010, p. 13) such as Muhammad Yunus (Grameen Bank) and Fazle Abed (Bangladesh Rural Advancement Committee). Finally, frequent typos and minor errors (e.g., in names of national organizations, journals, and funders, or in referring to the “2012 [sic] Carnegie round of applications” [p. 29]) also distract somewhat from the book’s content.
In the end, Enos defends and extends her thesis statement: “Some may believe that service-learning and social entrepreneurship models of educating students for community engagement are incompatible but I am going to argue that they are not” (p. 70); however, as her own research shows, even on campuses considered exemplary in each area, at present these two fields tend not to converge in practice. For readers interested in how these two branches of engaged pedagogy might interweave more productively, Service-Learning and Social Entrepreneurship in Higher Education may be a good starting point, from either side of the equation.
The JCES editorial team would like to acknowledge and thank Palgrave Macmillan for providing an electronic copy of the book for this review.
Bornstein, D. (2007). How to change the world: Social entrepreneurs and the power of new ideas (updated edition). New York, NY: Oxford University Press.
Bornstein, D., & Davis, S. (2010). Social entrepreneurship: What everyone needs to know. New York, NY: Oxford University Press.
Wei-Skillern, J., Austin, J.E., Leonard, H., & Stevenson, H. (2007). Entrepreneurship in the social sector. Thousand Oaks, CA: Sage Publishing.
About the Reviewer
Paul H. Matthews is associate director of the University of Georgia Office of Service-Learning.
Dr. Andrew J. Pearl
I am honored to have been asked to serve as the new Book Review Editor for the Journal of Community Engagement and Scholarship. Not only do I view this as a great opportunity to serve in the advancement of higher education community-engaged scholarship, but also as an opportunity for me to learn from authors, scholars, and community partners from across the country and around the globe.
I am currently director of Academic Engagement at the University of North Georgia, where my overarching responsibility is to institutionalize community-engaged scholarship across our five campuses. Among the ways that we accomplish this is to engage with and develop faculty members, work with students and let them know about the educational opportunities available to them, and develop mutually beneficial community partnerships.
I am a relatively recent graduate of the University of Georgia’s Institute of Higher Education, and my scholarly agenda includes faculty member motivations related to the scholarship of engagement, student motivations and outcomes related to service-learning experiences, and institutional and public policies that affect community engagement in higher education. In my research, I utilize the complementary strengths of both quantitative and qualitative analytic methods to fully explore scholarly questions, often through interdisciplinary collaborations. I am also interested in exploring how graduate students are socialized for and participate in community engagement, as well as strategies for integrating engagement into the STEM fields.
My goal with the book reviews in JCES will be to introduce readers to literature that advances knowledge, provides practical advice, disseminates best practices, and encourages conversation and dialogue. Book reviewers will not only provide summaries of recently published titles relevant to our field, but will also critically analyze and examine the works through the lens of community engagement.
I invite faculty members, administrators, staff members, students, and community partners to offer their interpretations of the literature. From its beginning, JCES has always intentionally been a “different kind of journal,” which helps to establish a niche among scholarly publication outlets. In addition to providing established scholars and researchers with a platform to disseminate their work, we also seek to hear from all of the people who work to make these multi-faceted community-campus partnerships work. In the true spirit of community engagement, we encourage authorship from first-time authors, students at all levels, and community partners.
To paraphrase Ernest Boyer, higher education has the potential, and I might even say the responsibility, to advance both intellectual and civic life, and I believe that JCES plays an important role in this process. I gratefully look forward to the opportunity to work with the rest of the JCES editorial and publishing team as we continue to build on the wonderful foundation already in place.
Eric Conrad, Meghan Shewmake, Courtney Shows, and Jen Nickelson
Sustainable community partnerships require more than good intentions, necessitating the facilitation of true collaboration to be successful (Blouin & Perry, 2009). McLean and Behringer (2008) assert that for a truly equitable partnership to exist, each party involved must both contribute to, and receive benefits from, the relationship. These contributions from students, campus partners, and communities provide meaningful experiences that result in reciprocal benefits among all partners. Practices that enable equitable collaborations include the establishment of personal relationships, reciprocity, flexibility in adapting to unexpected outcomes, and collaboration to overcome barriers (King, Williams, Howard, Proffitt, Belcher, & McLean, 2004). Fostering these practices result in increased sustainability with the potential to expand collaborative efforts.
The Holt Health Fair is a community event with the goal of providing health screenings and information dissemination to the community of Holt, Alabama. The inception of this annual event was developed through the formation of a collaborative between The University of Alabama (UA) students within the Delta Xi Chapter of the Eta Sigma Gamma (ESG) National Health Education Honorary, and members of the Holt community. Through the maturation of this partnership, stakeholder capacity has increased through mutual support and empowerment. This evolution is the direct result of a partnership that strongly values community voice and input. The following is a student perspective illustrating pertinent community engagement principles, as adapted from McLean and Behringer (2008), and their application in the development of the Holt Health Fair and community partnership.
Partnerships Thrive on Personal Connections
Two commonly asserted theoretical approaches to community change are that of “cultural invasion” and “cultural synthesis.” Cultural invasion occurs when external institutions or academics impose values and agendas with brazen disregard for community voice. Cultural synthesis necessitates those same external forces support and supplement community efforts to collaboratively solve community need (Green & Kreuter, 2005). The primary distinction between these theoretical approaches is in the formation of personal connections within the community. Development and fostering of these relationships demonstrate an investment in the community’s well-being that extends beyond the cessation of singular research projects and funding.
In 2008, a collective of concerned citizens established the Holt Community Partnership (HCP) in an effort to develop initiatives within Holt that “transform lives through opportunity, education, unity, and safety” (HCP, 2010). The HCP was comprised of Holt community members, local law enforcement, religious leaders, board of education affiliates, as well as faculty and staff from UA. This partnership established a foundation in which personal connections between UA and the Holt community could be fostered through cultural synthesis.
The establishment and cultivation of this relationship led to the inclusion of UA student associations, such as the ESG health organization. Since the integration of ESG and Holt, students have been afforded the opportunity to foster relationships within the community through interaction and participation at HCP meetings as well as through additional community collaboratives and initiatives. This community immersion is a transformative process in which programs and initiatives are no longer simple extracurricular activities, but vested experiences in which tangible change can result within the community where these relationships are formed.
Participation and Communication Requires Reciprocity
A true collaborative is one that includes an empowering and power-sharing dynamic that promotes an equitable partnership (Israel, Schulz, Parker, Becker, Allen, & Guzman, 2008). This dynamic may be challenging for academics due to the relinquishment of power or the perceived threat to validity, but is necessary to ensure cultural synthesis and capitalize on community expertise to enhance initiatives and improve outcomes. Support for this synergistic relationship can be achieved through the mobilization and utilization of university resources to supplement community efforts. The reciprocal nature of an equitable partnership ensures community collaborators have input in the development and implementation of programs that can be tailored to meet the diverse needs of the community (Ahmed & Palermo, 2010).
Prior to the inception of the health fair, the HCP and UA collaborators established a community festival within Holt. Over time, attendance and participation in the festival waned, necessitating a reevaluation of the initiative which ultimately resulted in the conclusion that the festival was no longer feasible and meeting the needs of the community. Collaborators began an iterative process to develop a new initiative within Holt to maximize the collective capacity of UA stakeholders and the community. Consistent with the theoretical approach of cultural synthesis, this cyclical method emphasized concerns created by community members and the capacity of stakeholders to address this need. The outcome of this reciprocal dynamic was a community proposal for the establishment of a Holt Health Fair and the creation of processes to support the initiative. Critical to this process was the explicit attention to the knowledge and expertise of community members and emphasis on empowerment inclusive of information sharing, decision-making power, resources, and support within the partnership.
The importance of reciprocity does not diminish following the approval of the initiative, but must be maintained throughout its entirety. As a health education organization, ESG was enthusiastic regarding the community initiated proposal for a health fair within Holt. While well intentioned, unbridled enthusiasm may result in an overzealousness that neglects or excludes community input and precipitates cultural invasion. Eta Sigma Gamma student and faculty representatives perpetuated an equitable dynamic through attendance at HCP sessions to ensure continued communication that emphasized community-initiated development, implementation, and evaluation. Respect for the unique perspective and expertise of Holt collaborators produced a reciprocal transfer of knowledge, skills, and resources that enhanced the capacity of all stakeholders.
Communication and Cooperation Overcome
Partnerships sustained through personal relationships that prioritize reciprocal communication and power facilitate leveraging of collective capacity to overcome project barriers (Green & Kreuter, 2005). A significant challenge following the decision to develop a health fair was creating a suitable event on an abbreviated timeline. Previously established relationships with the HCP facilitated efficient role delineation, allowing for the attainment of resources and services necessary for event implementation. Following the initial implementation of the Holt Health Fair, a stakeholder evaluation identified further barriers that adversely affected project outcomes. Promotion efforts in year one were primarily managed by ESG students which utilized radio and television broadcasts, as well as flyer distribution, yet intended reach was lower than expected. Year two of the initiative improved these processes through increased community involvement in the dissemination, utilizing the cultural influence of local church networks and businesses. Collaborations with Holt High School teachers and coaches resulted in presentations from high school students as well as performances by the dance team and band. The expansion of entertainment activities and the addition of childcare were incorporated to increase event appeal and facilitate easier access to services for community participants with children. Auxiliary barriers that were also addressed included the improvement of issues in regards to venue, transportation, as well as the expansion of vendors and services. Addressing and reducing barriers throughout the evolution of the health fair was expedited through cooperative mechanisms that prioritized continual communication and assessment between ESG, the HCP, as well as UA and community organizations.
Progress Necessitates Increased Capacity
The readiness of the partnership to be adaptable and amenable to increase contributions to the program strengthens the collaborative and improves program success (Sandy & Holland, 2006). Compared to the health fair, the Holt Festival required less resources and investment from each collaborator in the partnership. During the initial conception of the Holt Health Fair, the partnership determined current stakeholders needed to expand their capacity to accomplish the successful implementation of the initiative. The UA stakeholders increased capacity through incorporation of ESG student members and the expansion of university collaborators able to provide resources and health services. Barriers identified served as the impetus for increased community contributions resulting in systematized processes to increase promotion and engagement. Maintaining the equitable relationship through this expansion necessitated that each collaborator augment their contribution to improve the initiative and preserve reciprocity.
Expanding capacity to increase contributions of the partnership should also result in increased benefits to all stakeholders (King et al., 2004). Through the development and improvement of the Holt Health Fair, offerings were expanded from each collaborator which in turn increased the benefits each party received. University students within ESG and other collaborating organizations were provided the opportunity for experiential learning in their respective disciplines. Through application of classroom content, students benefit from deeper understanding of course material and are afforded the opportunity to strengthen cultural competency, leadership attributes, and self-efficacy (Powell & Conrad, 2015). Community members gained the expertise of UA students and faculty, access to health services through the university and external organizations, as well as media coverage and publicity. The benefits resulting from increased capacity were cultivated through relationships that foster trust and reliance in the collaborative process. The increased contribution and capacity can then be extended and utilized in other community partnerships.
Successful Partnerships Breed Successful Partnerships
The principles and benefits of equitable partnerships are transferable regardless of initiative, event, or program (Rhodes, Malow, & Jolly, 2010). The same practices of fostering and sustaining partnerships of reciprocity through cultural synthesis serve to reinforce relationships facilitating initiative success. Partnerships capable of overcoming project barriers promote capacity building through multidirectional learning on an individual or community level. Cultivating improved competence and proficiency through existing partnerships result in increased knowledge, skills, and expertise that enhance diverse community initiatives.
In addition to being active partners of the Holt Health Fair, ESG is also involved in additional health related initiatives within the Holt community. One such coalition is the Holt afterschool program in which ESG members educate elementary students regarding health topics in collaboration with the community organization Tuscaloosa’s One Place. An additional initiative is the Holt Health Lab in which UA and Holt collaborators aim to empower the community to meet health needs through screening, education, and policy. Similar to the Holt Health Fair, these initiatives incorporate processes to ensure community voice and reciprocity to enhance program success. Lessons learned in each initiative may serve to build on successful aspects and avoid barriers that other projects may have encountered. In this way, the expertise and capacity of each partnership is extended beyond itself to ultimately benefit the community through pervasive processes.
Partnership Length Increases Success
Successful partnerships that provide meaningful contributions and benefits to the community and university is a long-term process that requires commitment from both parties (Israel et al., 2008). Cultural synthesis asserts that the establishment and maintenance of trust and rapport among communities necessitate that commitments extend beyond single projects or funding. This prioritization on relationships over outcomes mediate an equitable power-sharing dynamic in which the partnership can more efficiently overcome barriers and increase capacity to achieve goals. These approaches allow for the development of an infrastructure that promotes longevity and sustainability which increases partnership and project success.
The successes of the Holt Health Fair and other community initiatives are direct results of an equitable partnership facilitated through cultural synthesis. Utilizing this approach, UA collaborators prioritized people over processes to develop and strengthen relationships among the Holt community. Through this genuine engagement and interaction within Holt, ESG student perspectives were altered from a mentality that prioritized a tangible product to a mindset that strongly desired an increase in community wellness, well-being, and empowerment. This vested interest fostered reciprocity among ESG students, UA faculty, and Holt community partners through the establishment of processes that respected community voice and perspective. Utilizing the collective strengths of the partnership, event deficiencies were identified and barriers were surmounted as each stakeholder evaluated and subsequently expanded contributions to the initiative, increasing student and community capacity. Lessons learned from the development, implementation, and evaluation of the Holt Health Fair can be applied in diverse community initiatives to further transform lives through opportunity, education, unity, and safety. Establishing an equitable partnership within Holt did not deny differences among multiple perspectives, but embraced diversity by affirming undeniable support through cultural synthesis to create improved outcomes in community engagement.
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About the Authors
Eric Conrad is a doctoral student, Meghan Shewmake is working on a master’s degree, Courtney Shows is an undergraduate student, and Dr. Jen Nickelson is an associate professor, all in the Department of Health Science at the University of Alabama.
Yawah Awolowo, Debra Clark, and Darlene Robinson
Project UNITED is a federally funded grant that addresses obesity issues in the Alabama Black Belt. The Black Belt represents some of the poorest counties in the United States and is plagued with chronic health conditions—obesity, diabetes, high blood pressure, cancer—which are predominantly found in African Americans. Community leaders from the Black Belt Community Foundation, a 501(c)3 nonprofit corporation whose purpose is to help improve the quality of life of residents in the Alabama Black Belt, participated in the project as community health scholars. Project UNITED partnered community health scholars and academic scholars to develop proposals that addressed obesity issues in rural communities. A team of three community health scholars and three academic scholars collaborated and formed, Home Sweet Home, a two-year, $50,000, multigenerational obesity intervention in Greene and Sumter counties. This paper provides reflections from the three community health scholars regarding their experience in a community based participatory research (CBPR) project.
The paper is presented as first person testimonials describing the experiences of each participant.
Darlene Robinson, Greene County
Being one who is always looking for ways to improve myself and my community, I took a step of faith in response to the invitation I received to become a community health scholar with Project UNITED. I also believed I would acquire knowledge that would help my community. In the community my mission is to improve everyday life of parents and their children. Even though my plate was already full, I felt it would be an opportunity to find ways to improve myself and my community.
The Project UNITED journey introduced us to individuals from around the state who also wanted to improve themselves and their communities. I could tell the training was well thought out, as we visited a small garden at a rural school where the youth were being introduced to growing their own foods. This was the Project UNITED pilot project. Educating our community about healthy lifestyle changes is very important and we learned ways to take it home. Project UNITED brought professors from the University of Alabama and community people together as a learning tool that showed that we all share the same passion of making Alabama a healthier place to live.
The circle was complete when our team formed. We had three members from the community and three members from academia, with a mission of curtailing obesity by educating ourselves. As a group we merged our thoughts, hashed out our ideas, made a plan, found an audience—the preschoolers and their parents—and formed a roadmap to get us where we wanted to go. We named our program “Home Sweet Home.” Our mission was to introduce and teach a new way of thinking about eating. We sought to change current statistics that says we are an obese society.
If you’re busy, think you have that all you can handle, feel you know all you need to know, then CBPR is probably for you, because it takes all you’re doing and all you can handle and turns it into a mission that you’ve been on all the time but gives you directions to get to a better place. Then it will not just be your idea of what the community needs, but the community will be able to tell you what they want.
Debra Clark, Sumter County
In 2013, I was chosen by the Black Belt Community Foundation to be a community health scholar. This was because of my health-related awareness work at the Health and Wellness Education Center (HWEC) Disease Management Program. At the first meeting my first thought was “Why am I here?” realizing that I did’t have time to take on an additional project. But my second thought was “how can I not participate?” considering the impact this project could have on my community. Certainty, it is through strong community partnerships with local agencies that has made HWEC successful. The agency has made great strides to implement initiatives to address obesity, diabetes, cardiovascular disease, and other chronic illnesses to improve the health of local residents.
As a result of this project, I
1. Was invited to present a paper entitled “Fighting Obesity for the Health of It” at the Rural Health Conference in Tuscaloosa in 2013.
2. Received the Rural Heroes Award from the UA College of Community Health Sciences.
3. Was able to expand the Jump To It (what is it?) program for additional communities.
4. Produced a simple handout on the traffic light diet to promote healthy eating for distribution at health fairs and community events.
5. Have witnessed the greatest impact within my own family. My 5-year old grandson was never introduced to yogurt, but now eats yogurt and encourages his mom to “add stuff” to make it good.
Although this fight has been tedious and time consuming, I must admit that rewards have been greater than the struggle. The program has helped build capacity and strengthen my agency by connecting me with a team of experts with genuine concern and interest, which correlates with the agency’s mission of promoting healthier lifestyles through education and prevention.
Yawah Awolowo, Sumter County
As a community health scholar participating in Project UNITED, I have enjoyed adding to what I already knew about health-related issues and unhealthy eating. I nurtured my family in an organic, self-sufficient, natural homebirth/home schooled permaculture environment and have sustained five seriously committed years of organic farming on a 66-acre, family-owned farm. My journey with CBPR and the development of a partnership with academic researchers not only expands my baseline knowledge, but the collaborative process has also allowed me to continue to put into practice my knowledge in a way to benefit my community. I have learned that while academic researchers are very knowledgeable about health and treatment, I also bring a great deal of knowledge about nutrition and health. Additionally, I have expertise about the rural community where I live, which I know is valuable for eliminating obesity in this community.
My participation in Project UNITED enlightened my interest in heart disease and obesity, major health concerns in my family. My mother, who was 90 years young developed heart disease. She had no hypertension, diabetes, no medicines for her entire life. The doctors informed the family that there was a blockage in one of her heart valves; surgery was necessary to remove the blockage. One of the major reasons I chose to be involved as a community health scholar in Project UNITED was because I watched my 90-year-old mother go through heart surgery and witnessed her spectacular recovery as she completely changed her eating habits. The other reason for my interest is because there are so many people in my family who have serious health conditions. My sister had surgery two weeks prior to my mother and my daughter has also had medical issues. For these reasons, my desire has been fueled to establish alternative eating habits as a means to prevent disease, especially with kids at an early age. I believe this can be done by letting them be involved with the purchase, preparation, cooking, and serving of good healthy foods.
Project United was the right program for my personal and community needs to learn more about prevention of this disease in our community. I realized that the cultural normality of food intake always consists of some type of animal products on a daily basis that cause blockages and slow down the process of the heart pumping blood and oxygen.
Involvement in Home Sweet Home Project
As a community health scholar I have been able to work with a team of people who share my interest of eliminating diseases through education and awareness. We met as a group utilizing a tool called speed dating to develop a professional relationship/marriage that has grown into a big happy family. Consider the three-legged stool; one cannot stand without the other. Each of us brings so much to table that I wonder how we could have been so close without ever crossing paths. Nevertheless, we have bonded and now look for ways to improve our efforts by enhancing our writing skills and seeking additional resources to promote sustainability to enhance our community for a better future. Community health scholars: What better name can you give to such individuals who are a community’s first choice when it comes to health care. We are the movers and shakers in our community.
Home Sweet Home is our project. We named it, we designed the program, we listened to the community, we respected the community, we educated ourselves, and we educated the community. The program was not handed to us; it was made by us for us with the mission in mind of changing lifestyles by teaching our families how to spend time together, talk to each other, share with others, cook with love, train our children how to prepare a dish and making home truly Home Sweet Home. The mission of introducing new ways of cooking to our parents was well received. The preschoolers enjoyed the experience and the parents appreciated the information because our eating habits have led to many health improvements. The traffic light playing cards (red light = foods to avoid; eat; yellow = sometimes foods; green = go foods) were designed as a way for families to learn what foods to stop eating, for example cautiously eating the yellow foods and eating lots of all the green foods. Each family received a deck of Home Sweet Home cards designed by the team.
The program was introduced in the communities represented by the community health scholars. The team was glued together by a passion to make a difference, and we believe it is the start of great things to come. Our coming together was not by accident; it was time for academia and the community to unite on a mission of bringing the idea of healthy eating to the community.
Project United has been a perfect learning catalyst. One of the major goals of the project was to partner community leaders with academic researchers to develop and pilot test an obesity intervention program. We spent the year getting to know each other’s interests and personalities with an emphasis on building trust and working toward sustaining a lasting relationship. This was important to me because I have had several business encounters where I have shared ideas and people have either ignored or taken my ideas. These experiences have made me wary to trust experts sometimes. Therefore, any emphasis on building trust and sustainability are going to be important for me and my community.
I eventually ended up working with a team of six. We talked about potential projects based on our interests where we would be competitive for funding internally. We also evaluated the best approaches to write the grant using all our strengths. As a member of the team, I also earned my IRB certificate, which builds on the training I received in medical ethics and research. We titled our submission: Home Sweet Home, with a focus on home food environment. This project addresses obesity in the age group 2 to 5 years (pre-k). Our primary goal was to get 2-5-year-old children, along with their parents, to learn how to choose good, healthy produce, prepare food in a clean area, practice safety measures, make it a child friendly environment, create their own recipes using the things they like to eat, and spark their interest in healthy eating habits from an early age.
Thankfully, our collaborative proposal received funding for one year through a competitive internal grant process.
As I reflect on the past year of my role as a Community health scholar and the value that CBPR has added to my life, I believe that the time invested in the program will save lives in my community. And that is time well spent. As the program began its journey into the community, the best began to happen with children and the parents. We prepared familiar food with new twist, collards greens with no meat; to make home-cooked foods with fresh herbs and olive oil; the children preparing salads, constructing parfaits and serving their parents and grandparents; providing chef hats and aprons and gifts for families to continue their healthy journeys.
About the Authors
Yawah Awolowo is an organic farmer and chef at Mahalah Farms in Cuba (Sumter County), Alabama.
Debra Clark is founder and executive director of the Health and Wellness Education Center in Livingston (Sumter County), Alabama.
Darlene Robinson is founder of Imagine Me Youth Development Program in Greene County, Alabama.
Lola Baydala, Fay Fletcher, Melissa Tremblay, Natasha Rabbit, Jennilee Louis, Kisikaw Ksay-yin, and Caitlin Sinclair
In response to high rates of substance abuse in their communities, members of the Maskwacis four Nations invited university researchers to partner in culturally adapting, implementing, and evaluating an evidence-based substance abuse and violence prevention program, the Life Skills Training program (Botvin & Griffin, 2014). This project used a community-based participatory research (Israel, Schulz, Parker, & Becker, 1998; Minkler & Wallerstein, 2003) approach, and was carried out by university and First Nation community partners. To evaluate the impact of the adapted program, students completed pre and post questionnaires, and community members participated in focus groups. The adapted Maskwacis Life Skills Training program was delivered in schools for three years. Students’ knowledge increased significantly during program delivery, and strong support was documented from community members. This project demonstrates the impact that can be facilitated by culturally adapting and delivering a prevention program, and by forming a community-university partnership.
The Maskwacis First Nations, located in central Alberta, Canada, include four communities: LouisBull, Montana, Samson, and Ermineskin. These neighboring Plains Cree Nations have a combined population of approximately 15,000 with roughly 53% of the population aged 17 or under (Grekul & Sanderson, 2011). The Nations are governed by independent chief and councils, and have separate education directors and schools.
National media attention has focused on high rates of crime and gang violence in Maskwacis, largely ignoring the rich and vibrant Cree culture that threads the four Nations together. In Maskwacis, Cree history, culture, and language are featured prominently in traditional community ceremonies and cultural events that regularly take place. Community Elders view their culture and language as a means to combat the social and public health problems that face Maskwacis community members as a result of the destructive impact of colonization, residential schools, and forced assimilation. Research evidence supports this perspective, demonstrating that a positive cultural identity can be a protective factor against substance abuse and violence for Indigenous
children and youth (French, Kim, & Pillado, 2006; Gazis, Connor, & Ho, 2009; Kulis, Napoli, & Marsiglia, 2002).
The current project stemmed from a previous pilot project led by a partnership between university researchers and Alexis Nakota Sioux Nation members (Baydala, Fletcher, Worrell, Kajner, Letendre, & Rasmussen, 2014). Alexis community members sought to address the root causes of fetal alcohol spectrum disorder, and invited university researchers to partner with them in working toward substance abuse prevention. This pilot project involved the cultural adaptation, delivery, and evaluation of a substance abuse and violence prevention program in the Alexis community. The Botvin Life Skills Training (LST) program (Botvin, Baker, Renick, Filazzola, & Botvin, 1984; Botvin & Griffin, 2014) was chosen for the project, based on the results of a literature review that identified the program as having extensive, high-quality evidence to support its effectiveness, including multiple randomized control trials (National Registry of Evidence-based Programs and Practices, 2008). The three-year LST program has three levels, each including between 8 and 14 one-hour modules, and begins in either elementary or junior high school (see Table 1).
In 2010, a Maskwacis community member attended a presentation delivered by university researchers and Alexis community members. Following this presentation, Maskwacis community members invited university researchers to partner in introducing and adapting the LST program in their own community.
The partners identified three broad objectives for the current project: (1) culturally adapt the LST program to reflect the language, culture, and visual images of the Maskwacis community; (2) deliver the adapted program in Maskwacis schools; and (3) evaluate the impact of the adapted program. Given the established effectiveness of the LST program in reducing substance abuse and violence and increasing skills related to prevention, the aim of the current project was to deliver the culturally adapted program with fidelity to the original curriculum, and to document the impact of the adapted program.
Research has demonstrated the importance of programming for Indigenous children to reflect Indigenous worldviews and culture (Hare, 2011). Further, the cultural content of programming has been correlated with enhanced learning for Indigenous children (Tsethlikai & Rogoff, 2013). A recent policy report also declared that the representation of Indigenous cultures, languages, and traditions in school classrooms is essential for promoting the academic success of Canadian Indigenous children and youth (Toulouse, 2008). For minority populations in general, culturally adapted evidence-based programs have been shown to be more effective than standard programs (Kumpfer, Magalhaes, & Xie, 2012).
The LST program is a generic program proven highly effective with students from different geographic regions, socioeconomic circumstances, and racial-ethnic backgrounds (Botvin, Griffin, Diaz, & Ifill-Williams, 2001). However, because the LST program does not incorporate Cree values, language, culture, and identity, Maskwacis community members and Elders decided to culturally adapt the program. In keeping with the principles of knowledge to action research (Graham, Logan, Harrison, Straus, Tetroe, Caswell, & Robinson, 2006), adaptations to the LST program, and the corresponding creation of the Maskwacis Life Skills Training (MLST) program, began in the first year of the project.
During the first year, a six-member adaptation committee was formed consisting of Elders from each of the Maskwacis four Nations. This committee met weekly to complete adaptations to the first level of manuals. Adaptations to the second and third levels were completed by a rotating group of Elders. During adaptation meetings, over 30 different Elders from all four communities reviewed the original LST curriculum and provided recommendations for adaptations, consisting of Cree language and syllabics, Elders’ teachings, and personal life stories. Following committee meetings, community and university partners worked together to adapt the manuals. Additionally, a community member created visual images for the manuals that reflected the Maskwacis culture and community. After adaptations were completed, Elders reviewed and provided approval for the adapted manuals.
Throughout the adaptation process, Elders were instrumental in ensuring that the adapted program accurately reflected the Cree culture. For example, one of the modules in the original LST curriculum focused on the harmful effects of tobacco use. However, Elders shared the importance of distinguishing between “poison tobacco” and “sacred tobacco” (i.e., kistemaw). In Maskwacis, kistemaw has important spiritual, cultural, and ceremonial purposes, such as being offered to communicate gratitude in advance of a request. Accordingly, the original LST module on smoking was adapted to focus on both the detrimental effects of poison tobacco as well as the healthy traditional use of kistemaw. Additionally, in order to reinforce program adaptations, MLST staff created digital stories to accompany each program module; these were guided and narrated by community Elders.
As Figure 1 shows, the adaptation process resulted in a program that incorporated both Western and Indigenous foundations of substance abuse and violence prevention. Rather than infusing Indigenous pillars of effective substance abuse prevention into an existing Western framework, the integrity of the lessons from each worldview was maintained.
Community-Based Participatory Research
This project used a community-based participatory research (CBPR) approach (Israel, Schulz, Parker, & Becker, 1998; Minkler & Wallerstein, 2003). With an emphasis on tangible benefits for communities, co-learning, equitable involvement, and respect for multiple forms of knowledge, CBPR can contribute to leveling power imbalances between community and university partners.
Because Indigenous peoples are calling for research to be done with and for Indigenous communities rather than on Indigenous communities, CBPR has been recognized as particularly suitable for research involving Indigenous peoples (Castleden, Morgan, & Lamb, 2012; Koster, Baccar, & Lemelin, 2012; Smith,1999). The partners in this project applied the principles of CBPR in multiple ways. In particular, academic team members traveled to the community each week to engage in team meetings; meetings began with smudging and a prayer conducted in the local Cree language; a consensus-based decision-making model was followed with contributions from all team members; program evaluation was participatory, with input and guidance from all partners; and all reports and program materials were created collaboratively and approved by all partners. The project was approved by the research ethics board at the partner university and by the Maskwacis First Nations through a Band Council Resolution (the authority mechanism by which elected representatives in First Nation communities support and authorize an action).
A total of 25 focus groups were held over the course of the three-year project with 42 school personnel, 102 students, 18 Elders, four parents, and 12 MLST facilitators. With the exception of student focus groups, which were held with classes of approximately 20 students, focus groups included between six and eight participants to enable effective information sharing (Kreuger & Casey, 2015). Focus groups took place at the end of each of the three program years, and were held separately with school personnel from each school, students from each school, Elders, parents, and facilitators. The length of focus groups was between one and two hours.
Using purposive sampling, university partners recruited MLST facilitators, school personnel, and students to participate in focus groups, while community partners recruited Elders and parents. Community and university partners worked together to gather consent for participation. Although university partners facilitated all focus groups, community partners were present during Elder focus groups to translate from Cree to English where necessary. University research team members who conducted focus groups had graduate-level training in research methods and focus group facilitation as well as specific experience working with Indigenous communities.
Different focus group guides were developed for school personnel, students, Elders, parents, and MLST facilitators. Questions focused on participants’ experiences with the program adaptation and delivery, program impact on students, schools, and the community, unanticipated successes and challenges, and suggestions for improvement. Focus groups were conducted using a conversational style whereby participants were invited to speak to one another rather than directly to the facilitator, disagreements were encouraged, and participants were guided to express their thoughts in their own words and on their own terms (Kitzinger, 2005).
With participants’ permission, focus groups were audio recorded and transcribed verbatim. Data were managed with ATLAS.ti software, and analyses were completed using content analysis. Data were grouped according to common content, and a preliminary coding scheme was developed. The coding scheme was refined during discussions among partners, and themes were subsequently identified. Transcripts and preliminary data analyses were presented to participants as a means of member checking.
To evaluate learning of program content, questionnaires were distributed to students before and after each year of program delivery. The LST questionnaire (National Health Promotion Associates, 2011a; 2011b) and Piers-Harris Self-Concept Scale, Second Edition (Piers & Herzberg, 2002) were distributed to students. The wording of LST questionnaires was adjusted to accommodate students’ reading levels. The elementary school version of the LST questionnaire included items regarding knowledge and attitudes toward smoking and drinking, as well as social and personal self-management skills. The junior high version of the LST questionnaire included similar content with an added focus on drug refusal skills. Additionally, LST questionnaires were adapted to include a cultural knowledge scale consisting of items created by community members and Elders. From the initial stages of the project, community partners emphasized the importance of using a strengths-based approach. Accordingly, questionnaire items that directly questioned frequency of substance use were eliminated. Instead, questionnaire items
focused on constructs that are highly related to decreased substance use (i.e., knowledge, attitudes, self-management, refusal, and social skills).
Children who provided verbal assent and whose parents provided written consent for participation completed questionnaires before and after each year of program delivery (see Table 2). Where assent and/ or consent was not provided, children still received the MLST program but did not complete questionnaires.
A sequential longitudinal cohort design was used, and a linear mixed model was used to analyze the questionnaire data. The linear mixed model has advantages over repeated measures ANOVA for working with repeated measures data (Kreuger & Tian, 2004). Primarily, a linear mixed model gives structure to the error term by adding additional random-effect terms. This is important to properly account for error that can arise due to correlations between data points within the same subject (intra-subject correlation). Also, the linear mixed effects model can accommodate missing data points, and is less likely to lead to spurious results (both Type I and Type II error) with categorical data.
Focus group findings were grouped into three overarching themes, consisting of (i) program impact; (ii) factors that contributed to the program’s success; and (iii) suggestions for improvement.
Program impact. Focus group participants described the impact of the MLST program in a number of areas. School impact was a particular
area of focus. Participants described how the program allowed for traditional Elders’ teachings to be brought in to the schools; that the program facilitated both student and teacher learning about Cree culture and the Maskwacis community; and how the program had resulted in positive classroom changes. As one teacher commented, “there’s a more positive environment in the classroom…we’re all communicating and we’re talking and there’s no yelling.”
Student impact was also described. Participants not only discussed how students had demonstrated learning of program content; they also described how the program had contributed to
elevating students’ self-esteem, respectful attitudes, and listening skills. According to one student, “I learned to like myself for who I am.” Similarly, as a school staff member stated, “I noticed their self-esteem was brought up…I noticed with their attitudes, they’ve been more respectful…to the class teacher and they’ve learned to respect themselves and their fellow peers…” Additionally, focus group participants reported that the MLST program had contributed to students’ enhanced sense of pride in their identity. One teacher described how the program had “opened up a lot of doors for them to try and realize that being who they are is okay.” Similarly, Elders reported an increase in youth attendance at cultural events in the community.
Focus group participants also described Elder impact. Elders recounted how the program had facilitated their own learning by reminding them about ancestral teachings shared by other Elders. Elders also felt that their participation in the program allowed them to contribute to their community in meaningful ways, resulting in positive personal impact. As one Elder described, “it warmed my heart to make me feel wanted.”
Similarly, facilitator impact was described. Facilitators felt that they had benefited from being immersed in cultural teachings, and described bringing traditional teachings into their own homes for their children and grandchildren to learn: “I had pride in what I was teaching. And for my personal life…I’m raising my grandson, and he gets to have a bulk of what I teach.” Additionally,
facilitators were impacted by the opportunity to build strong relationships with Elders, and also described feeling proud to make a difference in their community.
Factors contributing to program success. Among the multiple contributors to the MLST program’s success, participants described the focus on cultural teachings as paramount. According to participants, it was critical for facilitators and Elders to teach students about the importance of respect, honoring the Creator, speaking Cree, learning Maskwacis history, and developing cultural pride. These teachings were fundamental to student engagement and overall program acceptability. One teacher described how,
This content would not have worked had it not been presented culturally…we prayed before every class, we burned sweet grass…and the Elder led them in prayer and that just locked them in, they knew they were home once they did that.
In order to enrich the program’s cultural content, Elder involvement was also critical. Facilitators felt that Elders’ guidance and knowledge made program adaptations successful, while students, facilitators, and school personnel appreciated Elders’ presence in the classroom. As one facilitator described, “it seems like the more we bring the Elders in, the more the children benefit.”
Additionally, focus group participants commended the program’s community relevance.
Because the program was adapted specifically for the Maskwacis community by Maskwacis Elders and community members, the program incorporated community relevant language and visual images as well as local knowledge. Additionally, because MLST facilitators were community members, they were familiar to many students; even where facilitators and students did not have pre-existing relationships, focus group participants reported that students could easily identify with facilitators from their own community.
Facilitator skills were also important for the program’s success. Equipping facilitators with the necessary skills was a challenge in the first year of the program, with school personnel noting steady improvements in the second year of implementation, and providing exclusively positive feedback in the third year. The most important facilitator skills described by focus group participants were sincerity, confidence, the ability to engage students, the flexibility to accommodate students’ learning and reading levels, and classroom management competence. One teacher noted that, “it was really great that [the facilitator] was so enthusiastic about the program…it got the kids engaged, and they could sense that she really cared.”
Although it was important for facilitators to possess skills in leading students through program teachings and activities, teacher involvement was also described as essential. Facilitators noted that when teachers supported and contributed to MLST classes, students demonstrated increased engagement. It was helpful for teachers to assist with classroom management, to provide feedback to facilitators, and to supplement facilitators’ teachings with their own knowledge and experience. By the third year of implementation, all facilitators and school personnel reported strong relationships.
Finally, it was important for the MLST program to demonstrate compatibility with the school’s core curriculum. According to school personnel, the MLST program complemented students’ regular social studies curriculum, and was a suitable replacement for regularly scheduled health classes. This simplified the task of fitting MLST classes into busy classroom schedules. Even when classroom schedules were hectic, however, teachers were willing to prioritize the program: “They’re life skills, they’re things that are literally going to get them into their adulthood, so maybe math can wait a little while.”
Suggestions for improvement. Focus group participants made a number of suggestions for program improvement related to program delivery. In the first year of implementation, it was strongly suggested that facilitators take part in additional training to enhance their teaching and classroom management skills. This was addressed during the second and third years of implementation. In addition, focus group participants communicated that the program should be delivered for the full school year rather than for only four months of the year. One teacher felt that, “In order to really get the full benefit of the program, it needs to be reinforced all year long…so they are always reminded and supported.”
Suggestions for improvement were also made related to program content. During the first year of implementation, a recommendation was made to increase the involvement of Elders in program delivery, to incorporate more cultural teachings, and to improve the readability of manuals. Each of these suggestions were addressed by setting a goal to bring Elders into each MLST class, and by adapting manuals to include stronger cultural elements and lower reading levels. Suggestions were also made to add modules related to grieving and gender roles, as well as to implement a parent component. Finally, focus group participants strongly suggested that the program include more hands-on activities: “When we would do activities, it was amazing, it was the most interaction I would get out of my kids all year.”
Questionnaire results are summarized below, with scores at baseline and at the final data collection point (i.e., year 3 post) depicted. Tables 3 and 4 show LST questionnaire scores for elementary and junior high students respectively. Analyses demonstrated statistically significant increases in scores for elementary students on all LST questionnaire scales. For elementary students, the Overall Knowledge scale included items relevant to anti-smoking knowledge (i.e., the harmful effects of smoking) and life skills knowledge (i.e., communication, decision-making, advertising, self-esteem, dealing with stress, and assertiveness). Items relevant to cultural content (e.g., Cree words and cultural protocol) were included in the Cultural Knowledge scale. The Attitude scale included items relevant to anti-smoking and anti-drinking attitudes. Finally, the Life Skills scale included the same content as the life skills knowledge items, but inquired about behaviors related to these content areas rather than inquiring about knowledge.
Statistically significant differences between baseline and the end of year 3 were also demonstrated for junior high students on all LST questionnaire scales with the exception of relaxation skills. For junior high students, Overall Knowledge included anti-drinking knowledge and life skills knowledge. The Cultural Knowledge scale included items with the same content as that of the elementary questionnaire. Also similar to elementary students, the Attitude scale included anti-smoking and anti-drinking attitude content. Finally, the Life Skills scale included items relevant to drug refusal skills, assertiveness skills, relaxation skills, and self-control skills.
Table 5 depicts elementary and junior high students’ scores for the Piers-Harris Children’s Self-Concept Scale-2. There were no statistically
significant differences between baseline and the end of year 3 for elementary or junior high students on the Piers-Harris-2.
The current project demonstrates the meaningful impact that can be achieved by culturally adapting and delivering an evidence-based prevention program in a First Nations community. Quantitative results obtained from pre and post LST questionnaires showed significant positive increases in knowledge, skills, and attitudes between baseline and the end of year three. Findings reflect that students not only retained the knowledge communicated to them through the MLST program, but that students learned progressively more from the program each year. Further, because students’ scores increased related to both original program content and additional cultural content, these results demonstrate that students improved their knowledge, skills, and attitudes related to substance abuse from both Euro-Western and Indigenous perspectives.
With regard to the Piers-Harris questionnaire, there were no statistically significant differences between scores at baseline and the end of year three. This may be due in part to students’ scores being average at baseline (i.e., t scores approximated 50). It may not be realistic to expect mean self-concept scores to increase beyond an average range. Further, like other social-emotional measurement tools, the Piers-Harris-2 was validated using a U.S. sample of primarily Caucasian children (Piers & Herzberg, 2002), and its applicability to Indigenous children has not been established. Moving forward, it will be important to establish and utilize pre and post measurement tools that reflect the unique realities of Indigenous children.
In addition to pre and post questionnaires, focus groups were implemented to provide insight regarding program impact, factors contributing to program success, and suggestions for improvement. Conducting focus groups after each year of program delivery allowed for suggestions to be addressed continually, contributing to growing community support. Overall, focus group participants communicated strong support for and investment in the program as a promising means to address substance abuse and violence and to enhance traditional culture in Maskwacis. Focus groups provided information regarding the widespread impact of the program on schools, Elders, facilitators, and students.
Key to program impact was the utilization of a community-based participatory approach that incorporated Western and Indigenous pillars of knowledge. In this way, the MLST program honored the concept of “two-eyed seeing” (Figure 2), developed by Mi’kmaw Elders Albert and Mudena Marshall. “Two-eyed seeing” recognizes multiple diverse perspectives as valid without privileging one viewpoint over another. Enacting this principle also means acknowledging that multiple perspectives can lead to a richer understanding of health issues than one perspective alone. By acknowledging the value of Western and Indigenous substance abuse prevention models, our community-university partnership provided an example of how Indigenous and Western research paradigms can co-exist in a space that honors both worldviews. Focus groups revealed that this was critical to the success of the project. In particular, schools and community members identified the central importance of cultural adaptations to the program’s acceptance by students, schools, and the wider community. Focus group participants also reported that adaptations elevated the program’s potential to reach and engage students by presenting content in a way that was relevant to their community and cultural context. Similarly, adaptation of MLST questionnaires was important to honor community partners’ perspectives regarding the importance of capturing the program’s impact on students’ cultural knowledge.
The current project also suggests that CBPR can act as a catalyst for community change. However, although pre and post questionnaires and focus groups provided the opportunity to obtain important community feedback on the MLST program, our research team identified a number of unanticipated and peripheral community impacts that were not accounted for by the use of our
conventional evaluation methods. For example, community partners took on leadership roles in the program and formed a non-profit society to sustain the MLST program beyond the terms of our original research grant. In order to more fully understand these additional impacts, we supplemented the current evaluation methods with Outcome Mapping (Earl, Carden, & Smutylo, 2001; Tremblay, Baydala, Rabbit, Louis, & Ksay-yin, submitted for publication). Outcome Mapping is a tool that is sensitive to community change and development, and that emphasizes the significant process of culturally adapting and implementing programs in the context of a CBPR partnership.
Finally, a potential limitation of this study should be acknowledged; namely, the current study does not include a control group. In order to engage all four Nations in this project, it was necessary to deliver the MLST program in all Maskwacis schools. An intervention group and control group were initially defined; however, because these groups came from the same schools, it was not possible to maintain the integrity of the control group. In particular, students often switched back and forth between control group and intervention group classrooms, and teachers indicated that students were sharing MLST teachings with students in the control group. Consistent with our experience, recent literature indicates that treating complex community change initiatives as controlled experiments may be inappropriate, particularly in the context of CBPR (Kelly, 2010). In addition, we intentionally selected an evidence-based program with extensive research to support its effectiveness. As a result, it was not necessary to once again prove the effectiveness of the program; rather the aim of this project was to deliver the culturally adapted program with fidelity to the original curriculum, and to document the impact of the adapted program.
Maskwacis community members and Elders established a partnership with University of Alberta researchers to culturally adapt, implement, and evaluate an evidence-based substance abuse and violence prevention program. Students’ overall knowledge increased significantly during the three years of program implementation, and strong support was documented from schools, Elders, students, and other community members. This project demonstrates the considerable impact that can be facilitated by culturally adapting and delivering a prevention program, and by forming and maintaining a strong community-university partnership.
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About the Authors
Lola Baydala is an associate professor in the Department of Pediatrics at the University of Alberta.
Fay Fletcher is professor and associate dean academic, Faculty of Extension, the University of Alberta.
Melissa Tremblay is a program evaluator in the Department of Pediatrics at the University of Alberta.
Natasha Rabbit is the executive director of the Nehiyaw Kakeskewina Learning Society in Maskwacis, Alberta.
Jennilee Louis is a research assistant for the Nehiyaw Kakeskewina Learning Society in Maskwacis, Alberta.
Kisikaw Ksay-yin is an Elder in the Nehiyaw Kakeskewina Learning Society, Maskwacis, Alberta.
Caitlin Sinclair is research coordinator, Department of Pediatrics, University of Alberta.