Study Rationale and Background
Community participation in public health promotion activities is a fundamental precept in public health, and the ability to mount successful community initiatives is predicated largely on a local organization's capacity to be strategic in taking action.1–8 Desired community outcomes may go unrealized without a precise recognition of which capacities are of the greatest strategic importance.9,10 This article reports on a qualitative study that explores what aspects of capacity are most relevant to grassroots public health initiatives spearheaded by local organizations in minority communities. The study was conducted because attempts at better understanding capacity are pertinent to producing more effective community betterment efforts.
Several definitions of community capacity have been proffered in recent years. A report from the Institute of Medicine considers community capacity to be a social protective factor or a “…condition that can mitigate social ills.”11(p89) The report suggests that social protective factors may be health protective in the face of social inequalities like poverty, racial disparities, limited employment options, and other social determinants of health that contribute to public health risk. As with the Institute of Medicine report,12 The Colorado Trust13 and other researchers in community-based public health10 reflect similar dimensions that highlight the direct relationship between the capacity of community initiatives and population health.
Goodman et al4 and Chaskin et al14 subsume social capital within community capacity, inferring that the latter is a more encompassing construct. Goodman et al4 define community capacity as “the characteristics of communities that affect their ability to identify, mobilize, and address social and public health problems,”4(p259) and they delineate 10 dimensions of capacity: leadership, citizen participation, skills, networks, resources, sense of community, community power, understanding community history, values, and critical reflection. The dimensions underscore relationships across multiple social levels and can be applied to both geographic communities and communities of shared identity. By way of comparison, Putnam15 characterizes social capital as composed of four dimensions: (1) trust, (2) civic involvement, (3) social engagement, and (4) reciprocity or exchange that informs an initial attempt at the measurement of community health initiatives. The works of Putnam and Goodman et al overlap. Citizen participation for Goodman et al is equivalent to Putnam's civic involvement, and reciprocity for Putnam is similar to networks for Goodman et al. But the construct for community capacity seems to contain as many as six additional dimensions that are not included in the construct for social capital. Similarly, Chaskin et al14 add that capacity derives from “the interaction of human capital, organizational resources, and social capital existing within a given community that can be leveraged to solve collective problems and improve or maintain the well-being of a given community.”(p395)
Although there is little question that concepts such as community capacity and social capital require clarification, especially in how one may be distinguished from the other, clarifying such distinctions is not the main purpose of this article. It is to provide a conceptual lens that complements social capital and offers a construct for the capacities that are necessary for community public health initiatives to optimize the likelihood that they achieve desired outcomes.
Study Methods and Design
This study used qualitative approaches to establish a construct for the capacities necessary in operationalizing successful community-based public health initiatives.16,17 The premise of the research holds that the initiatives with the highest evidence of organizational capacity have the greatest likelihood of realizing their goals. Eight community-based initiatives in a large southern city agreed to participate in the study. To recruit the eight, an array of recognized community leaders suggested possible initiatives to study. From a list of 30 initiatives generated, eight were selected by a university research team in conjunction with a community advisory board that was constituted for the study. Of the eight initiatives selected, four were successful in achieving their goals and four were challenged in doing so. Successful initiatives were defined as those that reached at least 80 percent of their established goals, and unsuccessful initiatives were those defined as those that reached less than 20 percent of their established goals. The selected initiatives focused on working to improve the physical and social environments in specific geographic communities; confronting industrial and other forms of pollution and waste; working on specific health-related topics such as HIV/AIDS, quality housing, and violence; and concentrating on overall community development. These organizations—a combination of faith-based, well-established community-based organizations, and grassroots voluntary groups—were included because they represented a wide range of experiences in terms of accomplishing goals and facing challenges; they were recommended for being interviewed by community leaders and had established productive working relationships with the research team.
Group interviews were conducted with core members of each community initiative. Each initiative was interviewed individually; thus, no interviews mixed the members from different initiatives. An open-ended interview protocol was developed, which focused on the successes and challenges faced by each community initiative in trying to achieve its goals. Each group interview lasted about 2 hours, was tape recorded, and then transcribed to have an accurate record for data analysis. Informed consent was obtained from each interview participant before initiating the interview.
The transcribed interviews were formatted into Atlas-ti, a software application designed for qualitative analysis.18 The interviews were coded to parallel the interview questions (eg, Is a capacity factor that contributed to desired project outcomes? Is a capacity factor that was absent when desired project outcomes did not result?). First, a content analysis was conducted on each interview by coding the text whenever one of the blanks could be filled with examples from the interview text. Following Spradley,19 similar codes were aggregated into taxonomies. This process of coding and aggregating was repeated for each case interview so that the resulting taxonomies were unique to each case.19 The results were presented to seven of the eight groups for a verification of accuracy (the eighth group was not actively functioning when approached for verification). All seven groups verified that the results were accurate renditions of the group interviews.
Once community validation was ensured, a cross-site analysis was performed to ascertain how constructs for capacity were patterned across the eight cases. The procedures for a multiple case analysis were taken from Miles and Huberman,20 who organized matrix arrays of case data. Each case was represented by a column in the matrix, with the rows containing the elements of the capacity taxonomy for comparison across cases.9,20,21
The cross-site analysis also contrasted sites according to the degree of challenge they reported facing in their efforts. Capacities that were most often emphasized as contributing to success by the sites reporting major success, but not emphasized, not mentioned, or mentioned as lacking by sites when describing their disappointments and challenges served to confirm the importance of a dimension for the emergent construct for capacity. Similarly, when sites emphasized factors that contributed to challenges or led to disappointments but were not mentioned in connection to goals that they achieved, this pattern confirmed a dimension as important to the emergent construct for capacity. For example, when respondents from the successful initiatives emphasized the importance of clear processes and procedures for reducing conflict and respondents from challenged initiatives emphasized how arguing and personal conflicts detracted from success with no means in place for resolving differences, then the researchers determined that processes and procedures for preventing or effectively engaging in conflict were important aspects of community capacity.
Construct for capacity
Figure 1 depicts three of the dominant dimensions of capacity-–leadership, organizing, and activism. This section describes each of the dimensions and suggests how capacity contributes to the outcomes desired by the community. It further elaborates on how outside forces (ie, social, economic, and political) can debilitate a community initiative regardless of its level of capacity. Citations from respondent interviews are included selectively as evidence in support of the Figure 1 construct.
All of the eight initiatives were formed by or with local leaders. In all cases, the leaders responded to perceived community needs and organized to address them. For instance, AIDS activists formed a highly effective initiative when they perceived a gap in services. Also, local leaders organized an initiative to fight environmental pollution from a local industry, but, in this case, the initiative experienced difficulty in achieving its aims. Thus, the mere involvement of leadership did not seem to be enough to guarantee success. On the other hand, specific characteristics of leadership distinguished the initiatives that were successful in reaching their goals versus those that were not. Leadership disposition was foremost as a distinguishing factor. The dispositions most often connected with goal attainment were characterized as visionary, selfless, persuasive, fearless, and respected as opposed to overloaded, overwhelmed, unresponsive, self-interested, and passive that dominated the four more challenged initiatives. The following quotations characterize the difference between groups with effective and ineffective leadership, with the former emphasizing the importance of coupling commitment with vision:
It took a while for me to really decide that I wanted to give up what I had in the private sector to take on this challenge—and it was a challenge. I knew, since I was the (organization's) founder, the steps needed. I saw the vision. I put a plan together.
An example from another successful case of positive dispositional attributes included leaders who refused to bow to mob pressure aimed at persuading the initiative to drop their reform candidate for state legislature out of the race. In yet another successful case, the leadership was described as “…not easily intimidated by the pressures and the hard knocks that come,” when confronting contractors, loan authorities, and land owners in developing high-quality, low-income housing.
These characterizations of leadership as active, visionary, and fearless stand in contrast to depictions of leadership most associated with the more challenged initiatives. For instance, respondents from one initiative attributed their difficulty in getting a response from local government as a consequence of a local leadership that was passive:
Other people are coming into this community and they get permits and things, and then we have our leadership who will sit back. They tell us in City Hall, “we don't know who is in the leadership.” … They say, “this isn't a leadership,” and they don't want to deal with any particular group, because if they did, say with [our] group, then this [other] group is going to get mad. They always say, “go back to the board and get yourselves together.”
Other characteristics of leadership in instances of limited success included corruption or favoritism in allocating governmental funds and jobs and burnout as illustrated in the following quote:
[the leader] had a beautiful vision, but its foundation wasn't as strong as his vision was, because he didn't know how to delegate—he wanted to put all this on his shoulder. So when [the leader] shut down, everything shut down.
Leadership decision-making style that was characterized as participatory and team-oriented also seemed to be more associated with goal achievement, as in the following description by one respondent, about the leadership team in his organization:
I'm not afraid to take the lead. I'm a brave leader, but I'm a better follower. Cal's not afraid to take the lead. He's a great follower as well. Sam's not afraid to take the lead. He's a great follower as well. We'll do any of the jobs. It doesn't matter what the task is, you see. There's no jealousy. It doesn't matter, you know, because we hash it out. Now, if I do something they don't like, they'll tell me about it, or if it's too far, they'll check you right in front of whoever else is there. That's the way we are, and each and every one of us is different.
In contrast, when decision making was characterized as top-down or passive, it seemed to lead more often to disappointments and challenges for the initiatives:
We had the sandblasting [of a local government building] totally demolish [residents'] houses. There was the money allocated for a chosen few leaders [to fix the problem]. They chose where they wanted this money to go to, and the rest of the people have to go out and get loans on a fixed income to bring these houses half-way up to standard. Through the years the government has been allocating money here, and this money never reached the poor, because I'm sitting to this table. I'm one of the poor. I can tell true facts that we have never received any money that was ever allocated here to us. … We have to try to find somebody that could provide the type of leadership that we're looking for. Then we have a problem with trying to get people.
Leadership ethos epitomized a dimension of capacity that was present in all eight cases. All were guided by a distinct set of leadership principles (ethos) that resonated with community members, thus fostering a base of community support for the initiative. Religious or spiritual expressions were one manifestation of ethos. Others included the leaders invoking principles such as the sanctity of community heritage and identity, the importance of neighborhood stability, and family orientation. Leadership values predicated on human dignity are typified in the quote below and can be generalized to all eight cases. The quote is from a discussion regarding the influence of leadership on community awareness. It suggests that the principles held by those in leadership positions connect to the innate sense of social rights and equity that reside within community members:
We could not be successful at anything we do, nor could any other nonprofit organization if you didn't have individuals in the community who were aware of the fact that they should have more rights than they have, or that they should receive more respect than they have, or that there is a better standard of living that they don't have access too. We don't just go out and make people know these things. Our job is to go out and find people who are already aware of the fact that there is a better side to this. And then we help them access it.
Collectively, the cases illustrate that when the ethos that underlies a community-based initiative is well articulated and resonates with community members, they become predisposed to participation in support of the initiatives' ideals. However, still more is needed to guide such a committed membership to successful outcomes. An initiative's capacity for organizing an operational base is pivotal in providing a framework for meaningful participation and helps explain why initiatives with similarly articulated principles can experience dramatically different outcomes.
In the four successful cases, the leadership's ability to develop functional structures and processes, including initiative infrastructure, planning, and oversight mechanisms, was most often associated with goal achievement. Success also seemed to be associated with initiative members' ability to cooperate, solve problems, resolve conflicts, and reflect critically on the impact of their efforts.
These distinguishing characteristics suggest that, for the leadership to translate principles into effective action, leaders must be painstaking about the following qualities:
* How they organize: “We have shown that [we] know how to mobilize the community, to get a community meeting successful and to handle a large funding base in terms of no audit exceptions.”
* How they plan: “We meet and we collaborate on projects. We discuss in a group setting as a team effort. … Everyone has input in the decision making, everyone has a say, and then ultimately all of that is put in, and then I will decide. It is a team approach that has ensured that we get the best from our potential. It's not a shotgun approach. … We look at our overall mission, we look at programs that we would like to see implemented and how funding will effect what needs to be done.”
* How to problem solve and resolve conflict: “We ran into a lot of brick walls. I had an 86-year-old [funder] who was stubborn and controlling his whole life. … I kept taking him back to reality by looking at the contract and what we had negotiated. That was the key. We not only structured our [funding] agreement, but also our agreement on how we were going to operate, and we agreed upon that in the very beginning before any ink dried on the [contract with the funder].”
By way of contrast, initiatives that were not successful perceived that intragroup and/or interpersonal conflict, coupled with no pathway for its constructive resolution or what one respondent epitomized as the spirit of confusion:
Every meeting I go to … you going to have as many different reasons and opinions about that issue. I like to believe that the table is round and that means that everybody has something to input, and after that happens we take a priority check. After a priority check, [we] just take a vote; but, everybody don't want to listen to [those chairing the meeting], so [participants] go on and bicker. I know that a spirit of confusion is determined to be in our meetings. … Some of us love to be a part of the problem. So other people get discouraged when those kinds of people are around and they say “Well, I'm not going to be bothered, leave me alone.”
Community action (activism)
Virtually all respondents from the eight initiatives characterized a sense of community as a motivating factor for their involvement. Thus, the sense of community is not a distinguishing characteristic for effectiveness. Rather, a strong organizational base seemed to be the distinguishing dimension in motivating involvement and effective action. That is, the degree to which an initiative's activities were organized and coordinated corresponded most with the level of community participation. Respondents from the initiatives that achieved their intended outcomes were more readily able to detail a set of well-organized and coordinated activities in which community members could participate. They reported less difficulty in mobilizing the community. In the following quote, members of one initiative compare themselves to what they have heard about another community that was still struggling to achieve major goals:
Respondent 1: What happened in this community, if you had rent problem, you never gave up supper.
Respondent 2: And the other thing, though, the [other community] didn't have the cultural togetherness. … (1) they don't have the skill to organize, (2) they don't understand racism—they don't understand that factor, and (3) people mistrust them, because they been out there so long and they ain't did nothing all these years.
In the above quote, the importance of both a sense of community and effective organizational processes is emphasized. One respondent supports this notion with an explanation of what leads to passivity in his community:
You see sometimes we are so passive, [and] when you are passive you get nothing done. … The radical people back here, why they get attention? Because they go down there, and harass, and fire up. But we say, “We going to wait for God.” God said, “Get up and go!” We going to have to do something to make them look at our neighborhood.
Again, the importance of organized activities with roles for a large number of community members is contrasted with a tendency to “wait for God” in explaining why some communities get attention and get people motivated and others do not.
Outcomes Produced by the Effective and Challenged Initiatives
The outcomes produced by the four effective cases were in line with initiative goals. To a lesser extent, goal attainment occurred in two of the cases with more challenges, with three cases depicting their efforts as leading to disappointment and dispiritedness. Examples of desired outcomes from the four effective cases include the development of affordable housing with full occupancy, improved and expanded health and social services, reduced community violence, defeat of an undesirable rezoning plan and unsupportive politicians, and increased legitimacy and influence with elected officials. In contrast, the more challenged cases did not recognize as many successes and were often dispirited and bitter. The following interaction at a group interview is emblematic of responses across the four challenged initiatives:
Question: Can we talk for a minute about any successes you had?
Respondent 1: I'm trying to think real hard.
Respondent 2: We haven't had any successes.
Respondent 3: I'm trying to think of successes. That's right none.
Respondent 4: We haven't had any successes.
Respondent 5: None. Absolutely.
The following quotation characterizes the sense of powerlessness that was felt by all four challenged groups:
…I have worked in other communities, … and their stories are quite different. … than [our] stories. These people had the same problems, but they have so much more hope. [In our community] hope is smothered. They don't have hope back here. That is what smothers this community, they know they been abandoned and nobody cares about them.…
The Effect of External Forces on Community Capacity
Although differences among initiatives in leadership, organizing, and activism capacities help explain differences in goal achievement, also important is the nature of the forces external-–economic, political, and social—to the community. As for outside political forces, some initiatives may simply confront a lack of interest on the part of governmental officials. For instance, when one group was asked “Why do you suspect that you are not seeing quicker action compared to other places?” the answer-–“We not top priority [by government agencies]”-–was typical of demoralized initiative members. Adverse outside economic factors were typical where members perceived power holders as purposefully blocking community action for personal gain as the following quotation typifies: “Some of the politicians have contracts, like the dumpsters. You know, they make money and so to get rid of (relocate) this community [living on a toxic waste dump] they would lose money.” Racism perceived by initiative members stands as an example of a negative social force. For instance, in one community where the initiative disbanded, members felt that they were victims of racism:
Something I noticed and I see it in this community is just like everywhere and that's the racial issues, and we haven't talked anything about racism at all and it ain't because I'm Black, but it's something we have to put on the table. One of the things that people don't acknowledge is the insidious racism that happens in this community. As I painted a picture of the different neighborhoods, this is a Black neighborhood … and the neighborhood that's gets everything last as far as representation. We get everything last.
To overcome what might be characterized as either passive or active opposition, communities need to understand the nature of the opposition and then develop strategies to overcome it. In the case of not being a priority, for example, communities may need to use their capacities to draw attention to themselves and their situation, in order to garner powerful support. In the case of explicit opposition, the solution—at least in the experiences of these eight organizations—becomes much less clear. To illustrate, in the challenged case where the community's residents lived on a toxic waste dump, the critical dimensions of capacity were present (committed leadership, organization, and activism). How then can the lack of initiative success for this case be explained in a manner consistent with the analysis so far? The explanation lay in the array of negative and powerful outside forces that forestalled effectiveness. The impact of outside power is summed up in the following quote from a community member: “…the people with the deep pockets are the ones who are strong against us.” In this case, community members were pitted against the federal government and a powerful oil industry, and although initiative members recounted intensive levels of activism and persistence in their struggle of more than 20 years to remove the homes and relocate the families, they were met with stiff opposition seemingly beyond their ken. Many members of the initiatives involved in this initiative also cited racism—individual and institutional-–as one, if not the root, cause of such external opposition. In almost all the group interviews, racism surfaced as an important social factor that impeded initiative outcomes: Question-–“Why didn't they move this community?” Answer—I'm Black. That's why. [Spelling] B-L-A-C-K, and they do not care what happens to me or my grandchildren.
Discussion and Conclusion
This article reports on the development of a construct for the capacity of community-based public health initiatives. The construct is empirically grounded in the experiences of eight cases. The study focuses on dimensions of capacity that are of greatest strategic import to a community initiative in realizing its goals. Moreover, if an initiative is strategic in maximizing capacity, it can then become socially protective in the face of adverse external conditions, that is, social determinants of health. That the study was conducted in communities that were poor and largely African American underscores the fact that the health disparities that many minority communities experience are inextricably linked to social determinants.
This study provides empirical grounding for many of the 10 capacity dimensions articulated by the aforementioned Centers for Disease Control and Prevention Symposium.4 In particular, capable leadership was sine qua non. The essential characteristics of high-capacity leadership are transformative in nature and are personified as visionary, risk-taking, inclusive, participatory, transparent, value-based, and reflective in problem solving.22 In a recently published quantitative study of community capacity, Lempa et al23 found that leadership capacity contributed to more than five times of the variance than all other factors and more to the total variance than all other factors combined. Organizing and activism were also key variables. Lasker and Weiss24 draw similar conclusions in their study of community initiatives funded by the Kellogg Foundation. That is, strategic activities tend to occur where the community initiative attends to organizational details.
On a pessimistic note, the study's finding that well-organized activities can be stymied when arrayed against powerful outside interests is not new.25 Although all initiatives in this study struggled to be heard by outside power holders, those initiatives that were able to persuade powerful outsiders of the importance of the initiatives' work seemed to reach more of their goals. From the data presented herein, it seems enormously difficult for initiatives to achieve their goals when the outside power holders are solidly opposed to those goals. In this regard, social capital is an essential ingredient for community capacity.
In conclusion, the study should be viewed in light of its weaknesses. First, the Figure 1 construct is based only on eight initiatives in one southern city. How well it generalizes to other places is an open question, and the one that will require additional investigation. Second, the case studies depended largely on group interviews. Although, they produced more than 1 000 pages of transcripts, such a monomethod approach has built-in limitations for developing construct richness. Third, the construct developed herein has limited generalizability beyond organized community efforts that are issue focused.
In sum, the most salient insight taken from this study concerns the pivotal role of high-capacity local leadership in the achievement of a community-based public health initiative's goals. Such leadership does not necessarily have to be structured into local social organizations but can be cultivated from grassroots citizenry. As noted above, highly capable local leadership is characterized by the ability to be committed to local concerns, to rally community members around them, to organize tasks that the members can engage in with vigor, and to link the actions in such a way that they sway influential politicians or other power brokers to act in accordance with the initiative's goals. Future studies may further this conclusion by randomizing community initiatives in which the treatment group is provided with intensive training in community leadership to increase the aforementioned leadership characteristics. Because leadership seems to be a most pivotal leverage point in influencing desired community outcomes, such an intervention, were it to prove significant, could be cost-effective and parsimonious to implement.
A second related insight concerns the limits of influence that even the most capable community initiatives face. Practically speaking, many at-risk communities have to fend for themselves in the face of outside pressure and, in many instances, such pressure is of sufficient force that even those influential politicians who may rally in support of a community may not have sufficient clout to make a difference. Nevertheless, in many instances, community capacity can influence the production of desired community outcomes, and if we believe in the principles of social equality, job access, and economic and personal security as highly desirable, then developing high levels of community capacity where it can produce the most strategic advantage can be a promising pathway for mitigating many, if not the most, pernicious antagonistic social factors.