David G. Altman
The Wake Forest University School of Medicine
Robert M. Goodman
Tulane University School of Public Health and Tropical Medicine
This chapter reviews community interventions to promote health and prevent disease. Community interventions typically emanate from a health promotion perspective, with health promotion defined as education, organizational, economic, environmental, and advocacy efforts that foster healthful behaviors and settings. The goals of community interventions can be quite diverse, ranging from decreasing morbidity or mortality, to increasing the practice of a healthy behavior, to securing passage of health policies. Community interventions typically employ an array of programmatic approaches. These include those steeped in informational, behavioral, organizational, community development, environmental, and policy perspectives. A distinction is sometimes made between community interventions (i.e., interventions that attempt to achieve small but widespread changes) and interventions in communities (i.e., interventions that seek large changes among targeted groups; Green & Kreuter, 1991). Issues surrounding both types of intervention are covered.
Because most community interventions employ a wide array of intervention approaches, from those focused on changing individual behavior to those that target policies that facilitate or impede individual behavior, the line between community interventions and individual interventions is drawn artificially. Instead, community interventions are viewed as a set of approaches that utilize a vast array of change strategies. As noted throughout this chapter, however, a community intervention does have features that distinguish it from interventions that only target individuals or small groups.
There is a long history of community intervention in the field of public health (Rosen, 1993). Contemporary approaches to community health promotion can be traced to the late 1800s (Minkler, 1990; Nyswander, 1967). Over the years, community interventionists have drawn on a variety of theoretical perspectives to guide community intervention, including those from psychology (Farquhar, Fortmann, Wood, & Haskell, 1983; Iscoe & Harris, 1984; Levine, Toro, & Perkins, 1993; Maccoby & Altman, 1988; Shea & Basch, 1990), health education, community development (Bracht & Kingsbury, 1990; Kinne, Thompson, Chrisman, & Hanley, 1989), social ecology (Binder, Stokols, & Catalano, 1975; Stokols, 1992), and policy (Bennis, Benne, & Chin, 1969; Elder, Schmid, Dower, & Hedlund, 1993; Freudenberg, 1984–1985; McAlister, 1991; M&night, 1987; Milio, 1981; Sarason, 1983; Steckler, 1989).
Although public health professionals have utilized community interventions for many years, psychology has played a less prominent role in recent years, although the theoretical underpinnings of health education and health promotion were articulated by Lewin (195 1; field theory) and Rosenstock (1974; Health Belief Model), to name two. As noted throughout this chapter, however, the knowledge, skills, and perspectives of modern-day psychology, especially community psychology, have great potential for contributing to this domain of work (Iscoe, 1982; Revenson & Schiaffino, 2000; Winett, King, & D. G. Aitman, 1989).
The following case illustration of a partnership approach serves as an example of community interventions that are informed