What is risk reduction? What are protective factors?
You know your group wants to work on preventing a particular health problem in your community. Many effective prevention efforts work both to reduce risk factors and strengthen protective factors. But what's risk reduction? And what are protective factors?
Risk reduction means identifying the factors and conditions that increase the likelihood of the problem you're trying to prevent and then working to reduce or change those factors. For example, if you're working to prevent lung cancer, reducing tobacco use and exposure to tobacco smoke may be important parts of your strategy.
Protective factors are strengths, resources, relationships, conditions, and experiences that can reduce risk or support positive outcomes. For instance, if you work with a coalition to reduce cardiovascular disease, protective factors might include access to nutritious food, opportunities for physical activity, supportive social relationships, and high-quality preventive health care. Protective factors can help reduce the effects of risk factors and create conditions that support health and well-being. To demonstrate this, let's look at an example adapted from the work of researchers Hawkins and Catalano on risk and protective factors.
Example: Risk and protective factors for substance use among young people
Risk factors:
- Economic hardship and limited access to resources
- Community instability or limited social connection
- Frequent transitions and mobility
- Availability of alcohol and other substances
- Community norms that normalize or encourage substance use
- Family history of substance use disorders or problematic substance use
- Limited family support, communication, or consistent expectations
- Academic difficulties or school disengagement
- Persistent behavioral challenges or involvement in harmful behavior
- Peers who use substances
Protective factors:
- Strong family, peer, school, and community connections
- Social, emotional, decision-making, and coping skills
- Clear and supportive expectations around substance use
- Stable employment and economic opportunity
- Availability of substance-free activities and opportunities for young people
- Supportive role models and mentors
By looking at the above lists, you should be able to identify several risk and protective factors that relate to one another. Clear and supportive expectations around substance use may help counter community norms that normalize substance use, for example. Strong relationships and community connections may also provide stability and support during periods of transition.
As you might have guessed by now, once you've figured out what the risk and protective factors are for the issue you're dealing with, the next step is to develop ways to reduce risk and strengthen protective factors. It's not enough simply to say, "Okay, we need to reduce sexual activity without adequate protection against STIs and unintended pregnancy among 18-to-24-year-olds." You'll need to develop strategies that address the factors contributing to that risk and specific tactics for carrying out those strategies.
Who should be involved in selection of risk reduction strategies?
Deciding on risk reduction strategies is something you shouldn't do completely on your own. While your organization may come up with some strong ideas, it's important to bring community members into the process, including people most affected by the issue and people who can contribute knowledge, relationships, resources, services, or decision-making authority. A community-wide approach works best in many cases.
Including members of the community in this process is advised because:
- It can help shape community norms and conditions that are connected to risk and protective factors. For example, HIV and STI prevention efforts may involve community members in promoting safer sexual practices, consent, access to condoms and testing, accurate health information, and supportive norms around sexual health.
- It creates a wider base of support for positive change. Involving people from a variety of groups, organizations, programs, and community networks can broaden participation and strengthen the effort.
- It can give you a better understanding of the strengths and resources available in the community. No single organization knows everything about community resources. Involving people from community organizations, government, social services, businesses, schools, health systems, neighborhood groups, and other sectors can help identify existing assets, relationships, and opportunities.
- It can help build broader community support for your initiative. When community members participate meaningfully in planning and decision-making, they are more likely to see the effort as something they helped shape and may share information and support through their own networks.
- It is more likely to support long-term change. Strategies developed through strong community partnerships can become integrated into organizations, relationships, policies, and community systems in ways that support sustainability.
Who are good people and groups to think about including?
- Local law enforcement and other public safety partners, when relevant
- Faith and spiritual leaders
- Local government officials and public agencies
- School administrators, teachers, students, parents and caregivers, school board members, and other education partners, especially when the effort involves young people
- Health and human service organizations
- Local media and communications organizations
- Young people, parents, caregivers, and families
- Local business owners, employers, and workers
- Community members representing a range of neighborhoods, backgrounds, experiences, and perspectives
You should also include people who are most directly affected by the issue in the process. Why is their participation important?
Including people most directly affected is important because:
- Meaningful participation can help establish and strengthen trust. Some communities have understandable reasons for mistrusting public health organizations or other institutions because of past or ongoing discrimination, exclusion, or mistreatment. Historical abuses such as the U.S. Public Health Service Syphilis Study at Tuskegee illustrate why transparency, accountability, respect, and meaningful community involvement are essential.
- People most affected by an issue bring essential strengths, knowledge, relationships, and lived experience. Community members often understand local conditions, barriers, assets, and possible solutions in ways that outside organizations may not. Their leadership can make an initiative more relevant and effective.
- It can give your group a better understanding of community priorities and what is likely to work. People with lived experience can identify barriers, strengths, unintended consequences, and opportunities that may not be apparent to planners or service providers.
- It can also increase community awareness of your organization and effort. Ongoing communication and participation can help community members understand what the initiative is doing and provide feedback as the work develops.
How to select risk reduction strategies
Now you have identified the risk and protective factors for your coalition, you have people together, and you're ready to start coming up with strategies and tactics. Where do you begin?
Take advantage of existing information.
First of all, you don't want to reinvent the wheel. There's a great deal of existing information that community health coalitions can use. Know your community's history. Has this initiative or something similar been tried here before? Even an effort that didn't achieve its goals may offer valuable lessons. Take advantage of existing knowledge on risk reduction and protective factors before developing strategies and tactics from scratch. Here are some ways you can do this:
Research to find out what other groups with missions similar to your own have done. A library search, credible online sources, research databases, program evaluations, and conversations with other organizations can yield a wealth of information. For example, a successful healthy food access program in another community might provide useful ideas for your own effort. Exchanging information with people doing similar work can benefit everyone involved.
Network, network, network. Get to know people who work with groups like yours. Conferences, workshops, professional networks, and community learning opportunities can connect you with people who have useful experience. Establish relationships with your peers so that you can exchange information, stories, lessons, and suggestions. Here are a few ways you can connect with people doing similar work:
- Attend conferences, workshops, webinars, and community learning events
- Get involved in regional and national coalitions or professional networks
- Join relevant email groups, online communities, professional associations, or other networks for people working on similar issues
A word of caution, however - don't assume that what has worked in other communities will necessarily work in your own. When you examine a possible strategy that has been used elsewhere, consider how well it fits your community's culture, laws, resources, priorities, history, and existing services. A syringe services program, for example, may require different outreach, partnerships, and implementation strategies in different communities.
Finally, conduct your own research and see what original strategies you can develop with community members and partners. A little ingenuity goes a long way. While many strong strategies can be adapted from other sources, don't be afraid to modify them when needed or develop new approaches based on local knowledge and experience.
Characteristics of effective risk reduction strategies
Here are some things that are usually present in an effective risk reduction strategy:
- First and foremost, an effective risk reduction strategy also works to strengthen protective factors. Focusing on strengths, resources, relationships, and supportive conditions can help avoid stigmatizing people based on risk factors or behaviors.
- The goals, methods to be used for data collection, evaluation, and feedback, and specific roles and duties of staff, volunteers, community partners, and other participants should be clearly defined. Outlining these things ahead of time can reduce confusion later in the process.
- The strategy approaches risk reduction in a way that's appropriate and responsive to the people and communities involved. Consider age, developmental stage, culture, language, accessibility, lived experience, community priorities, and the level and type of risk involved. For example, peer education can be effective with young people because peers may bring credibility, shared experience, and ways of communicating that complement information provided by adults and professionals.
- Many effective risk reduction strategies include early prevention and support. For example, providing people with access to nutritious food, health care, and other supports before and during pregnancy can promote healthy outcomes. Likewise, age-appropriate education about healthy relationships, consent, contraception, and STI prevention can help young people make informed decisions before problems arise.
- The strategy makes thoughtful and realistic use of available resources, including funding, staff time, partnerships, materials, facilities, and community capacity. If an approach cannot be sustained with available resources, consider adapting it or working with partners who can contribute additional support.
- If addressing more than one risk factor, it's usually helpful to use more than one strategy. Complex issues rarely have a single cause or solution. Domestic violence, for example, may be addressed through a combination of survivor-centered services, prevention education, economic and housing supports, programs that promote healthy relationships, accountability for people who cause harm, and policies and community norms that support safety and respect.
Questions to ask when evaluating prevention strategies you're considering:
- Does the strategy address important and well-supported risk factors?
- How will the strategy reduce risk and/or strengthen protective factors and community assets?
- Is the strategy likely to reach and meaningfully engage the people and communities it is intended to benefit?
- Is the strategy designed in a way that allows its implementation and effectiveness to be evaluated?
Common types of risk reduction strategies
Risk reduction strategies are often grouped into approaches that support individual behavior and approaches that change organizational, community, environmental, or policy conditions. Effective efforts often use both.
Strategies related to supporting individual behavior include:
- Incentives or disincentives - changing the costs, benefits, or supports associated with particular behaviors (for example, tobacco taxes that discourage tobacco use or free and low-cost cessation supports that make quitting more accessible)
- Increasing or reducing the time, effort, or other barriers associated with desired actions
- Providing support, such as peer education, coaching, counseling, navigation, or other forms of assistance
- Developing mentoring and supportive relationship programs
- Enhancing resources - raising funds, improving materials, strengthening connections with other programs and services, and increasing awareness of resources that are available
- Changing programs or services to reduce barriers and make them more accessible and responsive to the people using them
- Changing policies by creating, modifying, or ending policies as appropriate
- Providing information through approaches such as communication campaigns, community outreach, peer education, and counseling
- Modeling positive behaviors, relationships, or practices, including through peer education and mentoring
- Building skills through education, peer learning, coaching, counseling, practice, and other approaches
- Providing feedback on progress and opportunities for participants to reflect on and adjust their goals
Strategies related to organizational and community development include:
- Public awareness and communication campaigns, using tactics such as information campaigns, community outreach, peer education, and other appropriate communication methods
- Community assessment, learning, and monitoring
- Building coalitions and partnerships with other community groups
- Changing access to products and services, such as reducing youth access to tobacco products or expanding access to preventive health services
- Developing resources that strengthen family, peer, and community support
- Implementing and enforcing existing policies and laws fairly and consistently
- Advocacy and nonviolent civic action, including public education, community organizing, and other forms of collective participation
- Changing policies and laws through appropriate advocacy, outreach, public participation, and decision-making processes
Common tactics used in risk reduction
There are many tactics that can be used in risk reduction. Here are a few of the most common - but remember that the tactics you use should fit your goals, community, resources, and the people you hope to engage.
- Information and communication campaigns - This is one of the most commonly used tactics in risk reduction. Campaigns can help people understand health risks, protective factors, available resources, and actions they can take. Communication methods might include social media, websites, advertisements, posters, brochures, community newsletters, radio or television messages, speakers, text messaging, and informational hotlines.
- Street and place-based outreach - Outreach workers or peer outreach specialists connect directly with people in neighborhoods and other places where community members spend time. Activities might include conversations, canvassing, information tables, distributing supplies, harm-reduction resources, referrals, and connections to services. Consistent outreach can help build trust and make information and resources more accessible.
- Community outreach - Community outreach often takes place through workshops, presentations, listening sessions, community events, or other group settings. These activities can share information, build relationships, gather community input, and connect people with resources. They are often most effective when combined with other ongoing strategies.
- Peer education - Peer education involves people with shared experiences, identities, or community connections providing information, support, and opportunities for learning. Peer educators may bring credibility and lived experience that help make communication more relevant and accessible. They can participate in one-on-one conversations, group education, outreach, mentoring, navigation, or other activities.
- Risk reduction counseling - Risk reduction counseling is collaborative, nonjudgmental support for people who may experience increased risk. A counselor, peer specialist, health worker, or other trained person works with participants to understand their goals, identify risks and protective factors, explore realistic options, and develop skills and strategies that support safer and healthier choices. Counseling may take place one-on-one or in small groups.
- Direct action - Direct action refers to organized public actions intended to draw attention to an issue or advocate for change. Examples may include demonstrations, symbolic actions, public events, sit-ins, boycotts, or other forms of nonviolent civic participation. Because these tactics may attract significant public attention or involve legal, safety, and accessibility considerations, organizations should plan carefully and consider how the action fits within their broader goals and strategy. If using direct action tactics, think through the purpose, participants, safety, communication, and possible consequences in advance.
In Summary
This section provides an understanding of how you can design strategies and tactics to reduce risk and strengthen protective factors and community assets. Pay close attention to evidence and lessons from other communities, particularly those that share relevant characteristics with your own, while recognizing that strategies may need to be adapted to local strengths, priorities, resources, and circumstances. Community members - especially people most directly affected by the issue - should help shape those adaptations. You may find that a combination of locally developed ideas and approaches adapted from other sources works best for your community.