Using community development theory

The community development approach empowers communities. It has been defined as a process of ‘working with people as they define their own goals, mobilise resources, and develop action plans for addressing problems they collectively have identified’ (Minkler 1991: 261).

The terms ‘community development’ and ‘community organisation’ are both defined variously and often overlap in their definition. While Minkler’s definition (1991) refers to community organisation, it actually describes community development. Rothman and Tropman (1987) described community development as one form of community organisation. Egger et al (2005: 134) have described the difference between the two terms as one of ‘directiveness’, because they regard community organisation as being a process more directed by workers, while community development is more directed by members of the community.

Working at the level of the community, and community development in particular, has become popular in the health field since the Declaration of Alma-Ata highlighted community development and community participation as important strategies for promoting health. Before that, many health workers were unfamiliar with the concept of community development, although it had been used in other fields and by health workers in Majority countries for many years.

An essential component of the Primary Health Care approach to health promotion is the recognition that it is necessary to change the structures that influence people’s lives in order to improve their health. There is also recognition that the people who are affected most need to be integral to that process. A key challenge in health promotion work is to put these ideas into practice by encouraging and supporting community-led and community-controlled activities, rather than only those activities that are led and controlled by health workers or the health system.

The fundamental principle that underpins community development work centres on people’s entitlement to have control over issues that affect their lives, and the worker’s role is to support these rights, on the basis of equity and social justice principles.

In Chapter 2 we noted that the term ‘community’ has different meanings. In community development, emphasis is placed on community as a social system, bound by geographical location or common interest, recognising that community is ‘a “living” organism with interactive webs of ties among organisations, neighbourhoods, families, and friends’ (Eng et al 1992: 1). Definitions of community commonly encompass elements of geography, culture and social stratification (Naidoo & Wills 2000). These three factors are viewed as bringing together people into a positive and desirable common entity (Naidoo & Wills 2000). However we also noted in Chapter 2 that communities are not necessarily homogenous entities; they often include groups with conflicting interests, and that this fact is often hidden behind the romantic connotations of the term ‘community’.

The notion of a ‘sense of community’ was also discussed in Chapter 2. This feeling is an ideal state in which everyone affected by the life of the community participates in community life. The community as a whole takes responsibility for its members and respect for the individuality of the members is maintained (Daly & Cobb 1989: 172). There is a ‘sense of solidarity and a sense of significance’ (Clark 1973: 409). This sense of community can be an important component of people feeling as though they belong to a community, and it also has implications for the process of community development (Falk & Kilpatrick 2000). Two further points are worth making here. Firstly, we need to take care not to oversimplify the consequences of human beings living in communities. Secondly, we must be careful not to assume that this sense of community is an ideal state for everyone, because some people may not choose living in a community as their ideal. These issues are of particular importance in considering community development, as these aspects of community may really come to the fore in the community development process. Indeed, workers using the community development process may have to regularly consider the implications of these issues in their work. Box 5.1 provides some ideals to work toward. Ife and Tesoriero (2006: 100) suggest that community is a subjective experience that means different things to different people; that communities evolve over time with ongoing dialogue, consciousness-raising and action.

Community development is the process by which health workers are most able to work with communities. The aim in community development is for communities to be in control of decisions that affect them and gain control over the determinants of their health. The task for the health promotion worker is to assist the decision-making process. The role is complex because it involves facilitating community members’ access to the conditions and resources that will enable them to exercise control and set their own directions. When health promotion workers function in this way their work is defined as community development.

Manipulating people, through co-opting them to take a predetermined action, or working in a way that does not encourage true community control, is a thoughtless and manipulative use of power and is likely to create distrust among community members. This is not community development.

As we have said, community development and community organisation are two of three theories that are commonly discussed in health promotion: identifying key approaches by organisations and workers to bring about change in local communities (community organisation); and enabling communities to be central in decisions about their futures (community building) (Nutbeam & Harris 2004). There are many similarities within these approaches and we draw primarily from community development in this chapter; however, it is useful to outline the diffusion of innovation theory given the expectation that one of the roles of the community development worker is that of change agent.

Using diffusion of innovation theory

The diffusion of innovation theory provides us with a way of understanding how new ideas are taken up (or not); that is, how change takes place in a community (Rogers 1995). Diffusion is defined as the process by which an innovation is communicated through certain channels over time among members of a social system. An innovation is defined as an idea, practice, or object perceived as new by an individual or other unit of adoption (Rogers 1995). The process works in a group as clarity to a few, then gradual and later rapid uptake by the rest of the group. Five general factors that influence the speed and success with which new ideas are taken up have been identified: relative advantage; compatibility; complexity; trialability; and observability (Rogers 1995).

There are several kinds of adopters: innovators, change agents, transformers, mainstreamers, unwilling laggards, reactionaries; there are also iconoclasts, spiritual recluses and curmudgeons (Rogers 1995; AtKisson 1999 in Verrinder 2005). Innovators are the progenitors of new ideas; they may be considered ‘fringe’, eccentric or unpredictable by the rest of the community and so may not be trusted. Change agents are the ‘ideas brokers’ for the innovator. Transformers or early adopters in the mainstream are open to new ideas and want to promote change. Mainstreamers can be persuaded that the innovation is a good idea and will change when they see the majority changing, but unwilling laggards (who are the late majority and who constitute about the same number as the mainstreamers) are the sceptics who need to be convinced of the benefits before they adopt a change. Reactionaries have a vested interest in keeping things as they are. Iconoclasts highlight problems but do not generate ideas; they are often silent partners of innovators. Spiritual recluses may proffer the philosophical underpinning and influence the atmosphere for change, while curmudgeons see change efforts as useless (Rogers 1995; AtKisson 1999 in Verrinder 2005). As we have said, we propose that community development workers are agents of change for community-led ideas. Understanding the change role played by different community members will facilitate effective community decision-making and long-term social change.

In theory the success or otherwise of innovation depends on how it is seen by various groups — whether the innovation is seen as compatible with the established culture, for example, or the perceived relative advantage of the innovation. The simplicity and flexibility of innovation together with its reversibility and the perceived risk of its adoption will affect the extent to which innovation is taken up by the community. Finally, the observability of results will influence whether others take up the change (Rogers 1995). An in-depth study of these factors and other theories may provide useful information for agents of change. The important thing is to know the community and what is likely to influence its response. Insight 5.1 demonstrates how this theory has been used to understand and track change in one community.

If we are to work with community development realistically and optimistically, we need to recognise its limits as well as its potential. There has been a tendency to expect a great deal from community development processes. It is important to recognise that while community development processes can have some impact on power relationships and equity at a local level, these processes will not shift power relationships on a broad scale without a vision and a plan to create a social movement. Even with the best intentions in the world, these processes at the local level will not change widespread social, economic and political conditions that are creating inequality and ill health.

The community development continuum

Jackson et al (1989) outlined a community development continuum as a way of conceptualising the various practice modes or ‘ways of working’ in community development. They emphasised that community development is a ‘philosophical belief’ which underpins the way a worker engages with the community, whether it be working to support an individual at a time of crisis, or being active in a social movement across a wider community. The philosophical belief is centred on people’s entitlement to have control over issues that affect their lives, and the worker’s role is to support these rights, on the basis of equity and social justice principles. Jackson et al argued that (1989: 67):

People in times of crisis will have different needs for support than those who feel strong enough to take on policy-makers to bring about social change; therefore the role of the worker will differ accordingly. The continuum in Figure 5.1 gives some guidance to the role most suitable at the time.

FIGURE 5.1 The community development continuum

(Source: Adapted from Jackson T, Mitchell S, Wright M 1989 Community Health Studies, 13(1):66–73)

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