文章基本信息

标题：Advancing the Science of Community-Level Interventions
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作者：Edison J. Trickett ; Sarah Beehler ; Charles Deutsch 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2011
卷号：101
期号：8
页码：1410-1419
DOI：10.2105/AJPH.2010.300113
语种：English
出版社：American Public Health Association
摘要：Community interventions are complex social processes that need to move beyond single interventions and outcomes at individual levels of short-term change. A scientific paradigm is emerging that supports collaborative, multilevel, culturally situated community interventions aimed at creating sustainable community-level impact. This paradigm is rooted in a deep history of ecological and collaborative thinking across public health, psychology, anthropology, and other fields of social science. The new paradigm makes a number of primary assertions that affect conceptualization of health issues, intervention design, and intervention evaluation. To elaborate the paradigm and advance the science of community intervention, we offer suggestions for promoting a scientific agenda, developing collaborations among professionals and communities, and examining the culture of science. Each year millions of dollars are spent on community interventions intended—if not always strategically designed, effectively implemented, or adequately funded—to improve health equity across socioeconomically and socioculturally diverse communities. Much has been accomplished through such projects, producing evidence-based programs that provide ways to improve such important outcomes as unsafe sexual behavior,^{1 , 2} HIV/AIDS prevention in adolescents,³ access to screening and treatment of underserved populations,⁴ reductions in smoking,⁵ and improvements in dietary practices.⁶ Subsequent work synthesizing evidence across research and evaluations has generated more evidence about community interventions. As this evidence and experience have accumulated, so too have calls to further emphasize the creation of community interventions that reflect the complex, multicausal nature of health inequalities^{7 – 10} and to work in partnership with communities and their representatives.^{11 – 17} These goals reflect research-based and community-based concerns about the ecological validity of community interventions (i.e., the extent to which research conditions approximate in vivo conditions) and the critical role of local knowledge, hopes, and involvement in the community intervention process. In October 2009, a conference held in Chicago, Illinois, convened a wide range of researchers, community representatives, policymakers, journal editors, and funders to take stock of current movements and issues in community intervention research. The conference goals were to (1) elaborate tensions in the science of community intervention in terms of conceptual frameworks, implementation, and evaluation of their effects; (2) surface conceptual frameworks and key concepts, such as collaboration, related to achieving sustainable community-level impact; and (3) develop ideas for how to promote alternative ways of thinking about community interventions that are responsive to concerns raised in the extant scholarly literature and by community members. Emphasis was also placed on how to create sustainable community-level interventions with community-level impact designed to eliminate health inequalities. An interdisciplinary planning committee worked over the course of a year to develop the 2-day conference, which was designed to promote discussions of key issues among participants in small-group sessions, as well as more traditional plenary and breakout sessions (conference materials available at http://www.phirnet.ca/en/index.aspx?sortcode=2.0.4.5.5 ). Conference participants were selected to reflect the broad scope of those engaged in and affected by community intervention processes. Thus, the participant group was interdisciplinary and multisectoral, including researchers from public health, anthropology, sociology, economics, and community psychology, as well as community members, funders, and journal editors. We briefly describe developments that emerged from the conference and that make up the contours of a scientific paradigm supporting community intervention. This collaborative, multilevel, culturally situated paradigm is intended to create sustainable community-level impact. Together, these elements constitute an ecological perspective on community intervention.^{8 , 18 – 23}