Community organization to enhance the delivery of preventive health services.

Preventive health services are most effective when provided to large groups, but health care professionals often are limited to provision to individuals or small groups. As recent studies show, the effects of preventive services can be enhanced through the use of community organization, which mobilizes a community's energies and resources to define and address a problem in a way that promotes local ownership and generates increasing effects over time. We pragmatically adapt community organization for health care practitioners. There are three guiding principles: (1) the community of interest must be clearly defined; (2) existing community structures should be used to reach and stimulate community members; and (3) the organizer's role is temporary. We discuss four tactics of community organization: (1) use of community analysis to understand the community; (2) stimulation of community activity; (3) provision of concrete assistance to accomplish community change; and (4) reinforcement of structures that will remain to carry on the programs. Use of these community organization tactics will allow delivery of preventive health services in a way that promotes widespread and lasting effects.

Improving collaboration between researchers and communities.

Active collaboration between communities and researchers is critical to developing appropriate public health research strategies that address community concerns. To capture the perspectives of inner-city Seattle communities about issues in community-researcher partnerships, Seattle Partners for Healthy Communities conducted interviews with community members from the ethnically diverse neighborhoods of Central and Southeast Seattle. The results suggest that effective community-researcher collaborations require a paradigm shift from traditional practices to an approach that involves: acknowledging community contributions, recruiting and training minority people to participate in research teams, improving communication, sharing power, and valuing respect and diversity.

Researcher and researched--community perspectives: toward bridging the gap.

In the process of initiating a new community-based research project, the authors wanted to understand the experiences of community members and researchers in community-based research projects and to develop guidelines to improve future projects. They conducted qualitative, key informant interviews with 41 people involved at all levels of community-based research projects in Seattle. Respondents were identified using a snowball sampling technique. More problems than successes were discussed by informants, including dissatisfaction with the focus of research, which some said is marked by a lack of cultural appropriateness and relevance. Power imbalances, lack of trust, and communication difficulties impeded collaboration. According to respondents, many problems could be avoided if the community were involved from the beginning in setting research priorities and developing and implementing interventions. Meaningful collaboration between communities and researchers is characterized by early involvement of communities, power sharing, mutual respect, community benefit, and cultural sensitivity.

Health promotion in cervical cancer prevention among the Yakama Indian women of the Wa'Shat Longhouse.

The purpose of this 3-year study was to gain a greater understanding of the importance of the Wa'Shat Longhouse religion to the design of a culturally appropriate health promotion (cervical cancer prevention) program with the Yakama Indian people of eastern Washington. This descriptive study involved interviews with 10 Wa'Shat members, observations, and participant observations of 30 community ceremonial activities. The framework of health promotion planning guided the investigation. We found that (a) program goals needed to be holistic and wellness oriented, (b) teaching methods needed to include circular symbols, and (c) intervention strategies needed to be linked to the natural patterns of communication of the Wa'Shat Longhouse and to involve elders. Storytelling, talking circles, and use of role models were all found to be important teaching methods. We confirm previous perspectives on the importance of religion, provide greater depth in this understanding and outline implications for transcultural nursing practice.

Exploring the doctor-patient relationship: a sociocultural pilot study in a family practice residency.

Family physicians' growing attention to the nature of their patients' live should include the social and cultural factors that influence patient health and illness behavior. Patient visits to a family practice residency program were found to be influenced by the patients' beliefs about symptoms and the beliefs of their significant others, and symptom interference with valued activities. Data from physician-patient encounters suggest that physician attention to such sociocultural information as occupation and family structure may have positively influenced rapport. Results from this pilot study confirm the feasibility of observational research by physician-behavioral scientist teams in a primary care setting.

The health seeking process: an approach to the natural history of illness.

Anthropological research on health-related behaviors in the United States has tended to emphasize folk illnesses among particular subcultural groups, obscuring the heterogeneity of popular culture health beliefs and practices in the lay health system. The development of theoretical models for this complex society will require research that stresses similarity as well as diversity within and between population groups. The health seeking process is proposed in this paper as a means to document natural histories of illness in any subculture. Concepts from medical anthropology and medical sociology are related to five components of health seeking -- symptom definition, illness-related shifts in role behavior, lay consultation and referral, treatment actions, and adherence. Illustrative propositions to guide further research are proposed.

Walking the journey of womanhood: Yakama Indian women and Papanicolaou (Pap) test screening.

Cervical cancer is the second leading cancer among Alaska Native, American Indian women, who have a high incidence of cervical cancer and low survival rates (Boss, 1991; Michalek & Mahoney, 1990; Page & Asire, 1985). The purpose of this Grounded Theory study was to gain a greater understanding of the meaning of the papanicolaou (Pap) test to the Yakama Indian women of eastern Washington to support the Tribe in the design of effective screening interventions. Data from 15 interviews, focus groups, and participant observation were included in the data analysis. The major theme was: Walking the Journey of Womanhood. Four phases of the journey were identified: (a) Starting the Journey, (b) Blooming, (c) Heading the Household, and (d) Becoming an Elder. In this study we found that interventions to influence Pap test screening among the Yakama women must address structures of care, provider-patient communications, and education for the women. Women heading the households and elders were identified as priority populations for education because they have negative attitudes from previous experiences and have a great influence on the younger women. Messages need to be wellness oriented and traditional methods of education, such as the talking circle, role model, and storytelling, need to be used.