Academic journal article International Public Health Journal

Community Wise: A Formative Evaluation of a Community-Based Health Intervention

Academic journal article International Public Health Journal

Community Wise: A Formative Evaluation of a Community-Based Health Intervention

Article excerpt

Introduction

Health disparities in the United States are well documented and result in a significant financial burden to the nation. For example, the per capita rate of new AIDS cases is 8 times higher for Blacks than it is for Whites (1). These differences, as identified by the National Healthcare Disparities Report, mandated by Congress, impose great financial and human costs. According to the Joint Center for Political and Economic Studies, health disparities cost the United States $1.24 trillion between 2003 and 2006 and this burden has only continued to grow (2). Disparities related to race and income are exacerbated in low-income African-American communities, where substance abuse and incarceration rates are high. Health indicators show that African-Americans suffer significantly harsher consequences of substance use than their White counterparts (e.g. higher rates of HIV/HCV infection), and yet, have less access to HIV and substance abuse interventions that could mitigate this disparity (3, 4).

For low-income African-Americans involved in the criminal justice system, incarceration has a significant impact on health and substance use, especially upon release. Few individuals receive substance abuse treatment and HIV/HCV prevention services while in prison and they often return to the same distressed communities in which they obtained and used drugs, engaged in related risk behaviors, and became exposed to the criminal justice system (5). Research has identified these issues as major obstacles in maintaining recovery (6, 7).

Despite increased efforts to reduce health disparities in distressed African American communities, few evidence-based interventions have been successfully adopted by these communities (8). Often substance abuse and community reentry programs focus solely on individual treatment even though community-based models have been shown to enhance effectiveness by addressing the environmental context in which problems occur (9).

This paper reports results of the formative evaluation of Community Wise, a community-based, manualized, multilevel health intervention designed to reduce substance use frequency, HIV/HCV risk behaviors, and reoffending among individuals with histories of substance abuse and incarceration residing in distressed communities in Newark, New Jersey. The long term goal of Community Wise is to reduce health disparities. Distressed communities are defined as geographic areas where rates of poverty, drug use and traffic, violence, and disease are higher than in neighboring areas (10).

Developing "Community wise"

Community based participatory research (CBPR) principles were used to develop and pilot-test Community Wise. CBPR requires that researchers and community members work together to identify community problems and solutions through the combination of scientific and experiential knowledge. The key purpose of CBPR is to help create knowledge that can be immediately used to help the community involved in the research (11,12).

Community Wise was developed by a team of community members, consumers (individuals with histories of incarceration and substance abuse and their families and friends), service providers, researchers, and government officials who compose the Newark Community Collaborative Board (NCCB). The NCCB has been working together using a CBPR framework since September 2010 to develop Community Wise. During phase 1 of the formative evaluation, the NCCB was formed; trained; and engaged in CBPR to conduct a needs assessment as well as an ethnographic study that informed the development of Community Wise. The NCCB also developed the first edition of the Community Wise manual (13-15). During phase 2 of the formative evaluation, Community Wise was implemented for the first time in the Spring of 2012 with 26 individuals at a community based agency to test the feasibility of the manual and develop the first evaluation procedures (16). The current paper reports findings from phase 3 of the formative evaluation, where the NCCB implemented the revised version of Community Wise's manual with 36 individuals at a community-based agency in Newark, NJ. …

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