Developing a health promoting PHO
HEALTH PROMOTION - DEVELOPING A HEALTH-PROMOTING PHO PLACING COMMUNITY AT THE CENTRE:
Developing a health-promoting PHO: placing community at the centre
Abstract
This research explored how a ‘mainstream’ New Zealand primary health organisation (PHO), Manaia PHO, can become a ‘health-promoting PHO’. A health promotion ‘model’ was proposed that focused on community development and the concept of community as partner. The first stage suggested establishing community action groups within various communities of Whangarei. The second stage proposed a community coalition group formed from representatives of these community action groups. The third and final stage envisaged a partnership between the PHO and the community coalition group.
Participatory action research principles guided the research approach. Following a process of purposive sampling, semi-structured interviews were held with six people selected from various Whangarei communities, and seven people with various roles within Manaia PHO. The interviews identified health and wellbeing issues and potential actions, at the community and Whangarei district level, and discussed participant views about the proposed health promotion ‘model’. A general inductive approach to data analysis was undertaken for each group of participants, at three levels, micro, meso and macro. Following this, a meeting was held with community participants to present the findings for validation, comment and discussion on how to proceed. Three macro themes were identified. Two common to both participant groups and one identified solely for community participants. The first common macro theme was the importance of people which identified that people are central to the concept of community; people who connect, belong and contribute are valued in the community; active participation is required; and getting the right mix of people with a range of roles, being inclusive of the diversity of people in the community, and working with existing people active within the community are useful implementation strategies. The second common macro theme was support for the proposed health promotion model and a community development approach. Of note was the endorsement of community development from PHO participants. The third macro theme, action, was only identified for community participants. Five key meanings were attributed to this theme: the importance of ‘action’ to empowerment; the valuing of action as outcomes; respect for community autonomy; the need for inclusive community activities; and the link between identifying needs and taking action. In summary, the findings endorsed the approach suggested within this health promotion model, particularly a focus on people, action and community development. The challenges will be implementing the model with the resources available and holding true to the principles of community development. A working definition of a health-promoting PHO is proposed:
A health-promoting PHO acknowledges that the greatest strength and resource within our community is people. This requires the PHO to adopt a community-as-partner approach, based on the principle of empowerment, that prioritises, provides resources, and takes action to address community identified health and wellbeing issues.
A fuller report on this research is available here
One of the recommendations arising from the research was to implement the model by seeking to establish community action groups in the various communities. The following is a summary of the action taken to date.
Otangarei
We continue to support and work alongside Te Puawaitanga o Otangarei.
We have also become involved, through the Northland Intersectoral Forum, in the Housing New Zealand (HNZ) led Community Renewal Project in Otangarei. A project sponsorship group and a project steering group made up of representatives from HNZ, Ministry of Social Development, the Whangarei District Council and Manaia Health PHO has been formed to progress this project. HNZ has employed a community development advisor to lead the project. This person is based in Otangarei and is working closely with Te Roopu Whakahaere o Otangarei, a group of Otangarei residents working to improve their community.
Raumanga
In 2007 we supported, through funding and participation, the Raumanga Community Development Group, a community development project initiated in 2002. Monthly meetings of the group are held at The Pulse and community projects discussed. In May and June we supported a ‘healthy cooking on a budget’ course held at The Pulse. This group ceased at the end of 2007. Links with Raumanga community are being maintained through The Pulse.
Pipiwai
Early discussions have been held with the community at the local marae to discuss support and activities for children / young people. This will be progressed as the Community Hub project is implemented (link here)
Tikipunga
The PHO has a Memorandum of Understanding with Pehiaweri Marae and accordingly our focus in Tikipunga starts with our relationship with Pehiaweri Marae. Various ‘healthy eating and healthy action’ projects occurred at the Marae in 2007.
Hikurangi - Healthy Hikurangi.
Whangaruru
We are in discussion with Ki a Ora Ngatiwai, the Maori health provider covering the area of Whangaruru, as how best to proceed.
Community Hub Project
With the Northland Sport and Physical Activity Strategy (NSPAS) facilitator we have developed a Northland wide proposal, based on the research and the Healthy Hikurangi project, which aims to establish community action groups in rural communities of Northland. The proposal has been approved by the NSPAS steering group which has representation from Sport Northland, the Northland District Health Board, Tai Tokerau MAPO, the three Northland district councils and the Northland Regional Council. Funding has been received from the Northland District Health Board and the Ministry of Healthy, Healthy Eating Healthy Action evaluation fund. This project commenced in September 2008. For more detail on this project see (insert link)
NURM Community Development Programme
As part of our commitment to community development, social justice and the building of capacity within the community sector we were involved in the co-facilitation of the Northland Urban Rural Mission community development training programme in 2007. This programme involved five full days of training for 11 community workers. This group will continue to meet to provide peer supervision and mentoring as well as exploring potential collaborative community projects.
Developing a health-promoting PHO:
In 2007 a small research project was completed Health which explored how a ‘mainstream’ New Zealand primary health organisation (PHO), Manaia PHO, can become a ‘health-promoting PHO’. A health promotion ‘model’ was proposed that focused on community development and the concept of community as partner. The first stage suggested establishing community action groups within various communities of Whangarei. The second stage proposed a community coalition group formed from representatives of these community action groups. The third and final stage envisaged a partnership between the PHO and the community coalition group.
Participatory action research principles guided the research approach. Following a process of purposive sampling, semi-structured interviews were held with six people selected from various Whangarei communities, and seven people with various roles within Manaia PHO. The interviews identified health and wellbeing issues and potential actions, at the community and Whangarei district level, and discussed participant views about the proposed health promotion ‘model’. A general inductive approach to data analysis was undertaken for each group of participants, at three levels, micro, meso and macro. Following this, a meeting was held with community participants to present the findings for validation, comment and discussion on how to proceed. Three macro themes were identified.
Two common to both participant groups and one identified solely for community participants. The first common macro theme was the importance of people which identified that people are central to the concept of community; people who connect, belong and contribute are valued in the community; active participation is required; and getting the right mix of people with a range of roles, being inclusive of the diversity of people in the community, and working with existing people active within the community are useful implementation strategies. The second common macro theme was support for the proposed health promotion model and a community development approach. Of note was the endorsement of community development from PHO participants. The third macro theme, action, was only identified for community participants.
Five key meanings were attributed to this theme: the importance of ‘action’ to empowerment; the valuing of action as outcomes; respect for community autonomy; the need for inclusive community activities; and the link between identifying needs and taking action.
In summary, the findings endorsed the approach suggested within this health promotion model, particularly a focus on people, action and community development.
The challenges will be implementing the model with the resources available and holding true to the principles of community development. A working definition of a health-promoting PHO is proposed:
A health-promoting PHO acknowledges that the greatest strength and resource within our community is people. This requires the PHO to adopt a community-as-partner approach, based on the principle of empowerment, that prioritises, provides resources, and takes action to address community identified health and wellbeing issues.
