Models of change

A change in the drinking culture can only happen with grass-roots support for activities, whether they focus on achieving better compliance with the law, parents’ programmes, policy issues or promoting healthier lifestyles.

The value of communities

‘Community’ is a term used to identify a group of people with common interests. Often a community is defined by the fact that its members reside in a particular geographic location. But it may also be that a community is defined by some other characteristic they share for example their ethnicity, sexual orientation or age. Any geographical community will include many smaller communities or groups with a range of common interests. These interests often include community service and could potentially include an interest in reducing alcohol-related harm.

People contribute to the wellbeing of their communities and the nation, both as paid workers and as volunteers. Through a wide range of organisations and groups they provide essential social, environmental and cultural services. Tapping into this vast resource offers many opportunities for influencing New Zealand’s drinking culture – from influencing the way a community group manages its own alcohol use to engaging these groups as champions of change within their wider communities.

Engaging with communities

Effective community engagement relies on ensuring the community is at the heart of a programme. Without community buy-in and involvement, it is hard to gain traction and achieve positive outcomes. The following models present a range of commonly used approaches to engaging with communities.

Community development

Community development is a process where people discover how to manage and change their environment by working together, setting their own goals and achieving them.

A community development approach should bring people together, increase their knowledge and skills and facilitate change that the community owns and drives.

Community development generally has a board aim of community empowerment. It does not start by trying to address a specific health or social goal but rather supports a community in managing and changing its environment by setting its own goals and working to achieve them.

Community development is about process; engaging the community by giving it access to resources and information and community ownership of the issues.

Community development can happen by:

• people becoming aware of an issue that concerns them and starting to look for more information
• people contacting others to see how concerned they are and to gather that additional information
• interested people getting together to discuss the issue, exchange information and identify the skills needed to tackle the issue
• a committee or working group being formed
• if further training or information is required, the committee/working group approaching organisations able to pass these on
• the spokespeople for the committee/working group publicising its actions to increase support
• the committee/working group initiating action leading to a change

Community action

Community action is a process where health professionals and/or other agencies or individuals:

• define the public health issue
• involve community members and groups in developing strategies to address it
• help solve the issue
• work toward transferring responsibility for ongoing programme ownership to the community.

Community action is about mobilising communities. It draws on existing human and material resources in the community to strengthen public participation in public health and social issues.

Community action stimulates environmental change in the systems and structures that support individual lifestyle choices. Change is likely to be successful and maintained when people it affects are involved in initiating and promoting it.

Community action usually relies on the community’s underlying support, even though many members will not have the time to be directly involved in the programme itself.

It is important to recognise that effective community action is built over time, has periods of high and low activity and uses a combination of approaches. A one-off campaign will not generally achieve long-term benefits to the community. The aim is to improve the way organisations in the community work together to achieve positive health outcomes.

Social marketing

Social marketing evolved as a tool to influence social attitudes and behaviours in the 1970s. It has a strong community focus and requires a good understanding of the target population to deliver appropriately targeted strategies. It is strong on needs analysis, communications and product development and testing. It differs from traditional marketing in that it seeks to benefit the target population rather than the marketer. Its product is social change.

Social marketing is about influencing what people think and, ultimately, how they behave. It does this by:

• offering benefits people want
• reducing barriers people face
• using persuasion, not just information.

Social marketing applies commercial marketing techniques to analysing, planning, executing and evaluating programmes designed to influence target audiences’ voluntary or involuntary behaviour in order to improve the welfare of individuals and society (Donovan & Henley, 2003). It also seeks to facilitate environmental change within social structures that will support individuals in their behaviour change (Hastings at al, 2000).

Social marketing has much in common with other health promotion models:

• it is based around the transtheoretical model of change
• it attempts to educate and motivate communities
• it values evidence-based strategies
• it demands a multi-strategy approach to social change.

The media are a crucial component of social marketing and public health campaigns, as information is a key factor in influencing attitudes and behaviours. Media are used to:

• raise awareness of the issue or product (social change)
• raise awareness of the product’s benefits
• raise awareness of where or how the product can be bought
• motivate people to seek further information or trial the product.

A campaign that aims to promote health through behaviour change must be based on much more than information and mass media. Marketers within the alcohol industry and broader commercial environment employ a four-fold strategy in implementing their programmes. Social marketing goes one step further with a five-fold approach that recognises the importance of policy in the marketing mix. These elements are often referred to as the Five Ps: product, price, place, promotion and policy.

Community readiness

Communities vary in their readiness to adopt programmes of change. This readiness plays a considerable part in a programme’s success and the community’s willingness to support it.

The ‘community readiness’ model provides a way of identifying a community’s willingness to develop and implement a public health programme. It is important in emphasising the range of, and the changing needs for, interventions within any given population. It illustrates the need to tailor programmes to the real needs of a community, rather than assuming one programme or approach will suit all.

 Community readiness is loosely based on the transtheoretical model of change (Prochaska & Diclemente, 1984). This model describes and explains the different stages of change that appear common to most individuals. It suggests that, as with individuals, community change is a process rather than an event, and acknowledges that communities have varying levels of motivation to change.

Assessing the level of community readiness requires gathering information from the community itself. This can be done using a range of methods.

Having ascertained the level of community readiness, the aim is to move the community to the next stage. While specific answers to the problems need to come from the community itself, the following strategies are general examples of effective approaches. Nine basic stages of change have been identified:

Stage 1. No awareness

The community or its leaders do not generally recognise the issue as a problem. The community may unknowingly encourage the behaviour, although the behaviour may be expected of one group and not another based on gender, class, race, age, etc.

Goal: Raise awareness of the issue

• Visit community leaders and members individually.
• Meet existing and established groups to inform them of the issues.
• Rally potential allies and supporters.

Stage 2. Denial

There is little or no recognition of a local problem, although some community members may acknowledge some issues but feel there is little that can be done about them or that they are others’ problems.

Goal: Raise awareness that the issue exists in the community

• Continue face-to-face visits and enlist support from these people.
• Discuss local incidents related to the issue.
• Point out media articles that describe critical local incidents.
• Use existing networks and community organisations to distribute information.
• Present information to community groups.

Stage 3. Vague awareness

Some members of the community feel there is a local problem and that something needs to be done about it, but have no motivation to address it. No leadership has emerged around the problem, and if it has, the community climate does not serve to motivate leaders.

Goal: Raise awareness that the community can do something

• Present information at local community events and to unrelated community groups.
• Post fliers, posters and billboards.
• Initiate your own events to present information on the issue.
• Conduct informal local surveys/interviews within the community.
• Use the media to tell the community of a local problem.

Stage 4. Pre-planning

There is clear recognition of a local problem and the need to do something about it. There are identifiable leaders and maybe even a committee, but efforts are not focused or detailed. There is discussion but no real planning.

Goal: Raise awareness with concrete ideas to combat issues

• Introduce information about the issues through presentations and media.
• Visit and gain support from community leaders.
• Review existing efforts in the community to determine their success.
• Conduct local focus groups to discuss issues and develop strategies.
• Increase media exposure.

Stage 5. Preparation

Information exists about local problems and the pros and cons of prevention activities, but it may not be based on formally collected data. Leadership is active and energetic, resources are being sought and committed to the programme. The community offers at least moderate support for efforts.

Goal: Gather existing information to help plan strategies

• Conduct community surveys.
• Present in-depth local statistics.
• Determine and publicise the costs of the problem in the community.
• Conduct public forums to develop strategies.
• Use key leaders and influential people to speak to groups and participate in local radio and television shows.

Stage 6. Initiation

Information is available to justify a programme and it is newly underway. Leadership is enthusiastic as limitations and problems have not yet been experienced. The community climate can vary, but there is usually no active resistance and often modest involvement from the community.

Goal: Provide community-specific information

• Plan publicity efforts associated with the launch of the programme or activity.
• Attend meetings to provide updates on the programme’s progress.
• Identify service gaps and improve existing services.
• Begin searching for resources and/or funding. 

Stage 7. Stabilisation

One or two programmes are running, supported by decision-makers, and these appear stable. There is little perceived need for change or expansion and no in-depth evaluation of effectiveness. The community generally supports what is happening.

Goal: Stabilise efforts/programme

• Plan community events to maintain support for the issue.
• Provide training for community professionals and community members.
• Hold quarterly meetings to review progress and modify strategies.
• Publicly recognise the efforts of local supporters and volunteers.
• Use media to detail progress and outline future plans.
• Begin networking between service providers and community systems.

Stage 8. Confirmation/ Expansion

Decision-makers support expanding or improving the current efforts. The original efforts have been evaluated and modified and new efforts are being planned or tried to reach new/more members of the community. Resources for new efforts are being sought or committed. Data is regularly collected on the extent of local problems. The community may challenge specific efforts, but is fundamentally supportive.

Goal: Expand and enhance service

• Begin to initiate local policy change.
• Strengthen and expand community networks.
• Use media to inform the community of local statistical trends. 

Stage 9. Professionalisation

There is a detailed and sophisticated knowledge of the problem’s prevalence, risk factors and causes. Some efforts may be targeted at the general population while others focus on high-risk factors and groups. Community involvement is high and leaders are supportive of programmes. Effective evaluation is used to test and modify efforts. The community is fundamentally supportive although community members should continue to hold programmes accountable.

Goal: Maintain momentum and continue growth

• Diversify funding sources.
• Continue reassessing issues and progress.
• Use external evaluation and feedback for programme modification.
• Continue more advanced training of professionals.