Alcohol and other drug (AOD) abuse is a major Public Health challenge... how can communities be involved in finding solutions?
Problems and Purpose
Alcohol and other drug (AOD) abuse is a major public health challenge disproportionately affecting marginalised communities. Involving communities in the development of responses can contribute to acceptable solutions.
Origins and Development
This research was based on the premise that involving affected communities in the development of responses to complex public health issues can contribute to acceptable, sustainable, equity-oriented responses. While community participation is a key issue on national and international agendas, the concept remains poorly understood, especially at operational levels and communities grappling with AOD are rarely engaged in the development of responses. Similarly, while research and intervention development are well-informed through processes involving researchers, professionals, and community members in problem definition, design, and analysis, AOD often is dealt with scientifically by quantitative methodology, where participation is not usually called for.
Participant Recruitment and Selection
PAR was progressed with 48 community stakeholders across three rural villages in the MRC/Wits Agincourt Health and Socio Demographic Surveillance System (HDSS) in Mpumalanga, South Africa. A series of workshops explored community-nominated topics, systematised lived experience into shared accounts and considered actions to address problems identified. Photovoice was also used to generate visual evidence. Narrative and visual data were thematically analysed, situated within practice frameworks, and learning and adaption elicited.
How it Works: Process, Interaction, and Decision-Making
AOD abuse was identified as a topic of high priority. It was understood as an entrenched social problem with destructive effects. Biopsychosocial impacts were mapped and related to unemployment, poverty, stress, peer pressure, criminal activity, corruption, and a proliferating number of taverns. Integrated action agendas were developed focussed on demand, supply, and harm reduction underpinned by shared responsibility among community, state, and non-state actors. Community stakeholders appreciated systematising and sharing knowledge, taking active roles, developing new skills in planning and public speaking, and progressing shared accountability processes. Expectations required sensitive management, however.
Influence, Outcomes, and Effects
There is significant willingness and capacity among community stakeholders to work in partnership with authorities to address priority health concerns. As a process, participation can help to raise and frame issues, which may help to better inform action and encourage shared responsibility. Broader understandings of participation require reference to, and ultimately transfer of power towards, those most directly affected, developing community voice as continuous processes within social and political environments.
Analysis and Lessons Learned
In terms of learning, adapting, and building the process, flexible and inclusive spaces can build confidence and capacity among those most directly affected as a basis from which to raise and frame issues, which may help to inform action to enhance service delivery and, more generally, encourage shared responsibility for health with decision-makers and other stakeholders. More generally, broader understandings of participation require explicit reference to, and ultimately transfer of power towards, those most directly affected. Our learning and adaptation prioritise flexible and inclusive processes, developing community voice as continuous processes within social and political environments.
© 2020 Oladeiende et al. https://doi.org/10.1080/16549716.2020.1726722 Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.