My name is Beverly Triana-Tremain and I am the President & Owner of Public Health Consulting, LLC. I want to share with you one of my favorite quotes by Mark Twain, “A habit cannot be tossed out the window…it must be coaxed down the stairs one step at a time.” This quote is never more appropriate than in the organizational setting where public health advocates are trying to change awareness, attitudes, behaviors, and policy. Currently, I am working with Dr. David Fetterman using the empowerment model to help non-profits reduce tobacco exposure in Arkansas .
The situation: The community advocates sometimes meet with resistance as they set ambitious goals for change. For one community advocate, his goal was to “eliminate second hand smoke in apartment complex apartment complexes by 2011.” To his surprise, he could not even get people to fill out a survey, never mind help to eliminate second hand smoke. Many reasons were given including: the change in behavior was threatening, they liked to smoke, it was none of his business, and it would reduce business. The problem with this approach was that they wanted a win too quickly. In addition, the goal within the time frame listed was not realistic – that is a significant change in only one year, e.g. eliminate second hand smoke in apartment complexes in several counties. This true story will be the focus of this tip.
Hot Tip: Many grantees are overly ambitious and overpromise because they want to make real changes in the community. However, this approach can backfire if they expect too much change too quickly in their own communities.
Hot Tip: We recommended that they revise their goals and strategies and make them more realistic. Small wins are key. We recommended that they make their 5 year goal a perimeter law, but their first one to two years about relationship building and getting buy-in for the change. For example, meeting with the owner of the building, then the manager, and then seeking a meeting with the tenants.
Hot Tip: We have found that success is more likely when community advocates first build a relationship with the intended audience , show them the benefits of why that behavior is unhealthy in a slow and nonthreatening way, and then build upon that relationship to continue introducing new activities, strategies and methods for success in that community.
What are your thoughts and experiences in this area of community change and empowerment evaluation?
Rad Resource: Fetterman, D.M., Deitz, J., Gesundheit, N. (2010). Empowerment evaluation: A collaborative approach to evaluating and transforming a medical school curriculum. Academic Medicine, 85(5), p. 813.
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Hi Bev – very nice posting.
I like the example you selected from our empowerment evaluation work in Arkansas. A lot of folks think that evaluators engaged in our kind of work are unrealistic dreamers. We may be on a certain level – we have great hopes for social change, improvements in health and health care – but we are (and try to be) very realistic about setting goals and monitoring change because we know it must be at a reasonable pace if it is not going to disillusion folks.
Thanks for tempering the optimism we have with our tools to help people make their own changes in their own communities (but with realistic expectations when it comes to accomplishing the tasks that help them reach their dreams).
Take care.
– David