Example #1 - Preventing Suicide in Native Alaskan Communities
After hearing about the model at a conference, a Native Alaskan woman came to the Center seeking help. In her village of 600 people, there had been 18 suicides in the previous six months. She requested that the team go to her community and help them to use the Community Readiness Model. Because of the urgency of the situation, and with the financial support of the Colorado Injury Control Research Center at Colorado State University, Tri-Ethnic Center staff members traveled to the remote village. The staff were expecting no more than 15-20 people from the village to attend, but were very moved when they were greeted by almost 100 Native people, young and old, from six different villages. Many people had overcome great challenges to come to the meeting. Between villages, there are no roads, and the only way in is by flying in small airplanes or by barging down the river if it isn’t frozen. Once visitors arrive, there are no hotels, so visitors must find a family that is willing to take them in. Despite these difficulties, people found a way to be there.
Initially, community members spoke of their grief and helplessness in the face of the pain of their losses. The model was presented, and participants divided into village groups. The members of each group used the model to assess their village’s stage of readiness and to identify their strengths and resources. An outsider might think that these small villages had very little in the way of resources (no clinics, shelters, etc.). But the village groups recognized many resources – human resources to cultural resources. They later talked about how grateful they were to rediscover those strengths because they had forgotten them in their grief, or because they hadn’t really recognized them as strengths.
Community members offered their time, their creativity, and their knowledge of the culture. The youth formed their own group to develop strategies to offer support to friends in school. Elders lined the outer walls of the community center. Most couldn’t hear what was going on and some were blind, yet they stayed from eight in the morning until eleven at night to offer their support. At the conclusion, the groups from each village summarized the strategies they had developed. Finally, the entire group formed a circle and again, using the model, worked together to brainstorm an action plan to maintain inter-village communication and support.
They indicated that for the first time in a long time, the communities felt hope and empowerment. A woman from the state office who had attended the gathering was so impressed by the efforts that she offered each of the six villages $2,000 to begin working on their strategies. Another woman donated her 80 acres of allotment land for a treatment center. The group was so motivated that they were able to move from a lower to a higher stage of readiness in only two days. The villages continue to work toward their goals, and their strategies have been remarkably successful. From having experienced 18 suicides in a six-month period before the training, they did not lose a single person to suicide in the three years following the training and the suicide rate has continued to be very low.
Example #2 - Tai Chi in the Parks
This section was developed by combining portions of participatory evaluation materials provided by the Area of Sustainable Development and Environmental Health of the Pan American Health Organization.
Background
The “Tai Chi in the Parks” initiative was implemented in the 1990s as a public health strategy in the municipality of Miraflores in Lima, Peru. Today, the “Tai Chi in the Parks” Association is responsible for the maintenance, improvement and advancement of the initiative along with Tai Chi Clubs and more than 20,000 elderly people who practice Tai Chi in the municipality.
The mission of the “Tai Chi in the Parks” program was to transform Miraflores into the municipality with the healthiest and most active elderly population in Peru, thereby, promoting healthy aging of the population.
The initiative’s main objectives were to:
- Incorporate the practice of Tai Chi and its philosophy as a daily, voluntary and accessible habit in the life of Miraflores’ elderly population.
- Achieve physical, psychological, social and spiritual development of Miraflores’ elderly population through the practice of Tai Chi.
To reach its objectives, the program aimed to achieve the following goals:
- Increase the number of elders practicing Tai Chi up to 25,000.
- Multiply the effects of the initiative in other parks and share the experience with other municipalities.
- Maintain support by the Ministry of Health and the Peruvian Sports Institute.
- Secure financing to expand the program to Lima’s underserved communities.
- Disseminate program results among health workers to improve collaboration in the construction of a primary care system for the elderly based on health promotion.
Activities of the Tai Chi in the Parks initiative include:
- Tai Chi classes offered weekdays in various parks in Miraflores.
- Support the formation of Tai Chi clubs, which are informal Tai Chi groups, and the development of a “Tai Chi in the Parks” network.
- Organize gatherings such as the “Tai Chi Convention” organized by the Peruvian Sports Institute.
- Promote community activities such as festivals, Tai Chi championships, conferences, etc., jointly organized by the Miraflores municipality and the Peruvian Sports Institute.
- Train community elderly to become Tai Chi instructors and therefore increase human resources necessary to expand the program.
- Hold capacity-building workshops with other municipalities to share the experience.
- Prepare and publish promotional material.
Preparation
After years of implementing the Tai Chi in the Parks Initiative, partners decided it was time to engage in a participatory evaluation process. An Evaluation Subcommittee was formed with 15 members that represented the following sectors and institutions
- Tai Chi in the Parks Association
- Tai Chi in the Parks Network
- Peruvian Federation of Kung Fu
- Peruvian Sports Institute
- Miraflores’ Health Department
- Local universities
- Mayor’s office
- Miraflores’ Elderly Program
- Ministry of Health and Ministry of Women and Social Development
- NGO EsSalud
- Tai Chi Clubs formed by elderly who practice Tai Chi
- PAHO/WHO
- Network of groups working on elderly health in Miraflores
By engaging in the preparation process, the group was able to identify potential problems for their joint work, as well as facilitating factors.
Potential barriers included:
- Different interests and agendas from each of the institutions and sectors represented.
- Lack of coordination of sectors and activities
- Lack of public policies geared toward the elderly
Among the factors facilitating the group’s work, the following were identified:
- Existence of a “House of the Elderly” that belongs to the municipality and that offered its premises for the meetings of the group.
- The presence of representatives from the program’s users.
- Commitment to community participation by local authorities.
- Presence of Tai Chi instructors that enjoyed great acceptability by the community.
Defining Evaluation Questions in Miraflores
The main interest of the Evaluation Subcommittee was to understand what influence the initiative had on the wellbeing of Miraflores’ elderly population. This interest was based on the fact that the Tai Chi in the Parks Program had a positive unexpected outcome: it had become one of the most popular physical exercise and social interaction programs in the municipality and, as a result, it had been implemented in another 15 municipalities through the Peruvian Sports Institute. After discussion, the Evaluation Subcommittee came up with the following evaluation questions:
- What has been the contribution of each stakeholder sector
- What factors have facilitated or hindered the participation of each sector (i.e. competing interests; creation of Tai Chi clubs managed by program users, etc.)?
- What is the impact of the Tai Chi in the Parks program on:
- Promoting social integration of the elderly?
- Improving the health of the elderly population?
Evaluation Questions selected in Miraflores
The Miraflores’ Evaluation Subcommittee decided to focus its efforts on answering the following evaluation questions:
What is the impact of the Tai Chi in the Parks program on:
- Promoting social integration of the elderly?
- Improving the health of the elderly population?
Documenting Information
To document health improvements among those participating in the Tai Chi in the Parks program, the Evaluation Subcommittee will use various sources of information. For example, it will interview participants (participants are the source of this information) and review program attendance sheets (sheets are the source of information).
- Qualitative information helps to understand the meaning of an initiative and its effects from the community’s standpoint (i.e. the community feels that the initiative is improving its quality of life).
- Qualitative information can provide rich descriptions about activities, context and behaviors and are usually collected by reviewing documents, observations, and interviews.
- It can also be expressed in numbers or quantified. For example, interview responses can be added up to report how many people responded in a certain way, for example, how many participants reported feeling healthier after enrolling in the Tai Chi program.
- Similarly, an observer can report how many people out of a group engaged in a particular behavior, for example, how many people who were present at the Tai Chi classes actually performed the exercises as opposed to just observing his or her classmates doing the exercises.
- Quantitative information is measured and expressed with amounts or quantities (i.e. attendance records of elderly participating in Tai Chi classes, number of participants who were trained to be Tai Chi instructors, etc.)
Interpret Results
The Evaluation Subcommittee wanted to know if the elderly population of Miraflores had been empowered through participation in the Tai Chi in the Parks Program. In order to find out, they interviewed program participants, their family members, Tai Chi instructors, and members of the municipality’s Elderly Program. They also observed the Tai Chi classes and meetings of the Miraflores Elderly Program.
The results showed that:
- A large number of elderly people, who had a low level of physical activity before the program, reported they are now exercising and are physically active.
- Many are actively involved in Tai Chi clubs and are in training to become Tai Chi instructors themselves.
- Family members report the elderly are more assertive and less dependent on them to care for their daily needs.
- Some program participants have joined committees that implement programs for the elderly in Miraflores.
- However, even though they are physically present at the meetings of the Miraflores Elderly Program they rarely participate or express their opinions.
Questions Asked Based on Results
- What do these results mean?
- How can the Evaluation Subcommittee interpret this data?
- What do these results say about goal of ‘empowering elderly people’ through the practice of Tai Chi?
Defining Audiences
The Evaluation Subcommittee decided that the results demonstrating the benefits of the Tai Chi in the Parks Program should be disseminated to various groups in order to encourage more elderly to join the Program and bring new partners into the process. Audiences included the elderly, with a focus on men and low-income groups; their family members, neighbourhood networks and associations; Tai Chi instructors; health professionals; municipal staff; NGOs and funders.
Defining key messages to target audiences
One of the target audiences for the evaluation results was the elderly population of Miraflores. The goal of sharing the evaluation results with this group was to promote the idea of Tai Chi as a health promotion strategy and to encourage more people to participate in the program, particularly men and those with low-income.
Some of the key messages developed for this communication strategy included:
- Tai Chi is the exercise most practiced by Lima’s elderly population.
- The practice of Tai Chi can help you better manage your blood pressure, prevent depression and improve your health in general.
- (for men) Tai Chi is closely related to martial arts and is a very popular sport among Asian men.
- (for low-income populations) Tai Chi can be practiced by everyone since it does not require special equipment and it does not cost anything.
The results of the evaluation were presented, and the focus was put on the evaluation committee collaboration: what it achieved, how it worked, what were the constraints and the possibilities of such strategy, etc.
Action Based on Evaluation Results
Evaluation question: What is the impact of the Tai Chi in the Parks Program in improving the health of Miraflores’ elderly population?
Information collected: The information collected shows that the practice of Tai Chi could improve health: participants showed lower blood pressure and decreased levels of depression after one year of practice. However, the majority of the participants were women from mid to high income levels.
Interpretation: The initiative was successful in improving health in the elderly population, however it reached more women and those in the mid to higher-income sections of the population.
Recommendation: Expand the initiative but review efforts to encourage men and low-income people to join the program. Action:
- Schedule a meeting of the evaluation committee and organizations working in low-income areas of the municipality to discuss how to better promote the initiative.
- Incorporate Kung Fu and other martial arts demonstrations into presentations given by the Tai Chi clubs to encourage more men to join the program.
- Prepare and distribute a report to health centers, NGOs and institutions working on issues related to elderly health.