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7 Cases Exhibiting Hybrid Framework Characteristics

Examples From Public Health

hy public health? Keeping a population healthy requires a considerable amount of involvement on the part of communities and providers of services. Consider what happened in the United States in getting its citizens to voluntarily be inoculated against polio.

When the author was in his 20s, Sabin and Salk developed vaccines to prevent polio. It is germane to note that almost everyone in my age range went to school with classmates who had minor to major crippling from the disease. Stopping it was a huge breakthrough. In earlier generations, its effects were devastating. B. R. Witkin, my first coauthor on needs assessment, passed away of complications from the disease that recycled years after childhood.

I did not receive my vaccination from a doctor or a minute clinic (now in retail pharmacies and other outlets), as the latter was a long time away. Rather, cities and metropolitan areas mounted vast public awareness campaigns and recruited different locations within them to offer shots or oral delivery of the vaccine. There were public service ads in the media that encouraged individuals to come in for treatment. Indeed, I went to a small Catholic church near where I lived for the vaccination.

Public health would be a fertile context for using the framework, and many examples should come from that field. The first step to locate cases was to conduct literature searches starting with broad terms, then narrowing them more to the concept of joint needs assessment and asset/capacity building. The strategy was modified as materials were found and reviewed. Community-based participatory research approaches, as well as community needs assessments, were explored when that phraseology came up. The time frame was mostly from the late 1990s until the present. That was based on the fact that the Kretzmann and McKnight book appeared in 1993, and hybrid usages would need a period to appear.

Articles and reports were examined in regard to characteristics fitting the criteria of hybrid thinking. How would one know if enough of needs assessment and asset/capacity building in a complementary fashion was truly there? The question is important because, as noted in Chapter 6, it was unlikely that much in the way of comprehensive or full implementation would be taking place.

With that proviso, here are some of the major considerations that governed selection:

• Assets and resources were investigated in the article or report. • Needs were being determined, examined, or taken into account. • The two approaches were there even when one may have predominated. • Mixed methods were being used. • Needs were identified usually but not entirely via existing quantitative data. • The voice of the community or organization was in evidence, especially in the way that data were

collected (often qualitative in nature) and in data interpretation and decision making. • The needs and assets were played off of each other to a degree as a possible path for improvement. • It was acknowledged, if only tacitly, that there were two ways to approach development or

improvement, and there was a sense of the contrasting philosophies.

Judgment was exercised as to whether a situation satisfied enough of these criteria to warrant inclusion. Another factor was that community members or key personnel from an organization would be the driving force behind the endeavor. It was not to be controlled or driven by external individuals or consultants. That involvement was OK, but they were not to be the ones who determined directions in the focus of a study and

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the vision of where things might be going. This very important factor was sometimes not so apparent. The German Village example (Exhibit 3.1 in Chapter 3) is closer to the ideal on this dimension. As time passes and doing simultaneous needs assessments and asset/capacity-building efforts becomes more common, we may see more clarity on this point. Lastly, titles of articles or reports are not as informative as desired. What was termed needs assessment may actually be nearer to the hybrid. The picture was not always fully clear.

OVERVIEW OF PUBLIC HEALTH CASES

In Table 7.1 on page 158, three exemplars from public health are overviewed. It includes their authors, the year in which the study was conducted, and some of the aspects of hybrid work being demonstrated with a rating of their strength. For the latter, + would be that it was there minimally and +++ that it was an extremely strong part of what was done. It would be desirable to see many plusses. Comments are in the last column.

CASE 1. RAPID NEEDS APPRAISAL IN THE MODERN NATIONAL HEALTH SERVICE: POTENTIAL AND DILEMMAS—THE UK STUDY

With a needs assessment title, is this study appropriate? Ordinarily not, but it was more of a hybrid.

Structure of the Project It was done in four localities in the West Cumbria area of the United Kingdom and had numerous

activities that firmly embedded it in the book context. The purposes were to seek involvement across sectors in communities, have direct participation of community members in the investigation, use many different methods iteratively, and build upon what was learned to improve. The work was carried out by a team of external university researchers to see if services available through health service organizations were based on identified needs in the local environment. This says needs assessment, not asset/capacity building, so why is it here?

Table 7.1 Overview of Cases From Public Health in Regard to the Hybrid Framework

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Reading further, all of a sudden the authors veer into a perspective that a capacity-building approach was what they wanted to do—not to emphasize deficit or needs thinking. That revelation moves the study into the hybrid mode. And beyond that, needs were in the broader social and community sense—in other words they had a more encompassing understanding or perspective of needs. Exhibit 7.1 contains a description of what they did.

Exhibit 7.1 Activities Incorporated Into the Rapid Needs Appraisal (and Asset/Capacity Building)

Formation of a working group of health service providers Providers were in charge of meetings. Emphasis was on the providers being active in the process. One of the provider roles was in decision making and direction setting. Independent studies were to be done in four communities. The working group was to be involved continuously, not just one time.

Due to difficulties in convening, the group used a Delphi-type survey; worded questions in asset and action terms; avoided needs or deficit type of statements; provided Delphi feedback to the group; and conducted some interviews.

Finding out what was already known (needs) Public health studies

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Public health information Assembling local heath profiles Reports of various organizations Unemployment data Scanning of newspaper articles Demographics Epidemiology data

Collecting local data Neighborhood forum meetings Police/community liaison meeting School reports

From data collected, the research team created identities for the communities: Tangible dimensions Demographics Levels of service And so on Symbolic dimensions Networks Social capacity And so on

A list of specific assets and capacities for each of the communities was created mostly from information collected above (asset/capacity building).

Needs-type and asset/capacity data and information were provided to each community.

Some Delphi survey work in one of the communities was also used.

Mixed patterns of data collection occurred per locality.

Many of the principles and strategies in the hybrid framework were employed in this case, and it received high marks in Table 7.1 for the presence of asset/capacity building (A/CB) and needs assessment (NA), for the use of mixed methods, for seeing the A/CB and NA approaches as complementary, and most importantly for the joint philosophy category. In the words of the authors, it clearly reflects the hybrid wavelength.

Our own view was that a capacity building model rather than a deficit model of need would most closely reflect the aims of the Health Action Zone and we also recommend a broad definition of need encompassing social and community needs. (Balogh, Whitelaw, & Thompson, 2008, p. 234)

For What Aspects of the Checklist Was There Evidence? Only Section 1 of the checklist will be used to assess what was done. This is based on the fact that in a 12-

page journal article extensive summarization is required, and therefore not all details will be provided. In rating items in the checklist, reading between the lines and interpretation admittedly were there.

Other considerations from the study come into play. The authors often cite time pressures and unrealistic expectations of the working group, the decision makers. In hybrid activities, along with action plans for improvement and moving forward, it simply may not be meaningful to have goals for the short term or to assume that things will change in that time span. Throw in the complication that this is being carried out in four distinct communities, and complexity escalates like trying to turn around a huge oceangoing ship on a dime. It just doesn’t happen. If the ocean has many high whitecaps, turning becomes even harder.

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Table 7.2 on page 162 contains the first section of the checklist with a few items deleted, but most have been retained as they fit a case like this. Ratings are estimates about the presence of an item. The other sections of the checklist are not included due to article length, and not all items within them would occur in any local study. Even with full documentation, only a portion of them would likely be there, but still some comments (see discussion of the case) are possible. The study authors provided invaluable insights to explain the subtle features of working with communities and trying to involve all parties as much as they could.

Discussion of the Case First, Balogh et al. (2008) pointed out that the policy makers expected too much to be done too fast. There

is a human imperative to act, want to get going, and not waste time in identifying needs and assets and considering options for putting them to good use. Implementing the hybrid framework is like the adage in carpentry—measure twice and cut once. Be careful before you do something. The problem these policy makers encountered is one that needs assessors also face, the rush to judgment. In doing needs assessments, asset/capacity-building efforts, or combinations of them, it may be necessary to inform decision-making parties about the nature of the work. Given the amount of data collected, interpreted, and framed into a meaningful whole for informing choices, the scope is well beyond a short-term, quick fix—an assessment of this type is not a panacea.

Table 7.2 Application of the First Part of the Evaluative Checklist to Assess the Degree of Fit for Case 1 With the Hybrid Framework (ratings in bold)

Second, it was observed that the capacity for new initiatives was variable depending on the circumstances and experiences of each community. Some had done more in the past and were better able to move to action.

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It was as though there were existing infrastructures and a community learning mien that were utilitarian and important. In fact, in one of the four locations a prior investigation had been good enough that the project team questioned whether the community would benefit from looking at needs or assets at all.

Third, the investigators suggested that engaging local providers in a fully functioning cohesive working group was difficult given the demands of their ongoing duties and responsibilities. That was underscored by the fact that they as outsiders were asked to do the study as opposed to greater involvement of the organizations that were participating. Despite the best intentions of the researchers to enhance capacity by leaving behind a base of community expertise, it just did not happen. The issue of locus of control and how to get and maintain a feeling of community and organizational investiture is a complex undertaking.

Fourth, two different types of needs emerged as the project progressed. There was a number-based, harder, quantitative one that was more absolute in appearance. It was the traditional deficit need. There was another coming from qualitative data and input that related more to solutions or thinking of ways to tie needs and assets together. This led to an interesting table in which the authors compared deficit needs to the other needs coming from the asset perspective. It was a unique way to present findings and one that could engender a spirited conversation about options to be pursued. As the authors stressed, it could even result in more innovative responses to the situation.

Fifth, the study probed a series of subtle issues. What might it take to get better commitment of the agencies that were part of this project? This becomes more complex when a range of groups and individuals are included in an investigation. It was noted that it takes a lot more time to sensitively dig into needs and assets and eventually arrive at a deep-seated understanding of capacity. Lastly, the authors stressed that each local community, while similar to others, has its own egocentric constitution.

Sixth, a conclusion that might be drawn from Table 7.2 is that the other sections of the checklist have no relevance and are more of an academic license. That view contains some truth but not entirely. In the article, there were brief mentions of meetings or taking data and findings to broader groups for interpretation and input. Also, from the start, the rapid needs appraisal was highly iterative, and although not all dimensions of this were described, they were alluded to as were repeated interactions and meetings with various parties.

The hybrid framework demands that kind of activity. The suspicion is that to a degree it was being implemented beyond the first section of the checklist, and if the members of the group conducting the study were not limited by journal requirements, other sections and items would have been observed as operational. Certainly, scoping was done in depth, and without it the framework does not have the legs it needs. This particular case was exceptionally strong in this regard.

CASE 2. MODELING THE PRINCIPLES OF COMMUNITY-BASED PARTICIPATORY RESEARCH IN A COMMUNITY HEALTH ASSESSMENT CONDUCTED BY A HEALTH FOUNDATION

Three models of community-based participatory research (CBPR) were studied in the context of community health mobilization. The emphasis was not stated as needs or asset/resource assessments, but features of both were apparent. Three related approaches (models) were examined as to which was best. In the write-up, the authors cover such events as local analysis of quantitative and qualitative data, the use of mixed methods, asset mapping, participatory approaches, and epidemiology—all aligned with the hybrid framework.

Structure of the Project This endeavor was part of the Healthy Neighborhood Initiatives of the Episcopal Diocese of Texas. It was

the culmination of associated studies implemented and modified over a 10-plus-year period. The three models have overlapping aspects with varying amounts of intensity. While one model stood out, the authors provide a clear and insightful discussion of issues in all three and the difficulties encountered in this kind of work. Their perceptions generalize to many different settings and environments.

Exhibit 7.2 is a summary of the key dimensions of the models and what it takes to put them into play. A significant difference between Models A and B in contrast to C is that when the latter was done, the initiator was the community collaborative as opposed to an external party for the first two. Table 7.3 on page 167 is an analysis of the case for the scoping section of the checklist.

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Exhibit 7.2 Models and Activities Incorporated Into the Community-Based Participatory Research Case in Community Health

Premises Collaborative approach involving multiple partners All applications beginning with a topic of importance to the community (perhaps a need) Learning and empowering environment Inclusion of all partners Knowledge and information distributed to all of them Builds off of work done for urban research centers funded by the Centers for Disease Control and Prevention Partly comes from participatory rural appraisal Role reversal with the community becoming the teachers and the researchers, the learners

Model A—Pertinent Aspects

Get a numerical picture of local community-based statistics and an assortment of data-based sources and reports. Quantitative profiles developed Qualitative data from key informants and focus groups May include questions about strengths as well as needs Community asset mapping

Model B—Pertinent Aspects

Get more depth of understanding. Phase 1 Conduct a deeper qualitative study using participatory rural appraisal techniques Train 10 community members

They then participated in all facets of the effort including data collection, discussions, and analysis. Led nine small community group discussions Examined health issues In groups, suggested root causes and consequences of health issues Developed visual trees of the above Presented results to the community in a community event

Phase 2 Rapid epidemiological survey à la World Health Organization Rapid cluster sampling Determination of prevalence of health issues and verification of what was found in Phase 1 Assisting local agencies to learn the above technique

Community members were trained to conduct relevant interviews and then employed as interviewers (218 interviews were done).

They developed a community health collaborative.

Model C—Pertinent Aspects Model B was seen as better than Model A. Costs were high, so that was a concern. Some of the aspects of Models A and B were incorporated.

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Quantitative data was used. Community asset mapping was done. Community-trained interviewers were used, but far less so. The community event was retained from one of the models. New activities were included. Reliance was on an existing community coalition. Community members were added to the collaborative cited under Model B.

Discussion of the Case It is no surprise to anyone looking at this case that the costs were high, and the first issue the authors raise

is what is required to do similar studies and that researchers should be alert to numerous unexpected expenditures that arise. This is like the earlier example in the text about the “Westington” school project. Unless an effort is small, it goes without saying that more resources will be needed even when volunteers are included and community members are trained to stand in for expensive formal interviewers. The authors point to little nuances that eat at finances such as the costs for community members and maintaining communication with all players. They mention that the interviewers were invaluable and helpful but were not funded adequately.

Table 7.3 Application of the First Part of the Evaluative Checklist to Assess the Degree of Fit of Case 2 With the Hybrid Framework (ratings in bold)

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Second, another concern was time, a precious commodity. The authors did not note this, but projects always take more than anticipated. This repeats what was cited for Case 1. Building trust across many partners and within communities is intensive not only to establish a program but also in the considerable energy devoted to keeping it alive and viable.

Third, communications were a problem since it was necessary to have Spanish speakers and translators. This may not pertain to other cases, but some aspects of communication they observed were problems that cut across settings. One was in getting on crowded schedules of administrators. Another was having clear channels for parents and communicating with different constituencies. By analogy, the author was part of a national study where different wording (vernacular, frame of reference) on surveys for principals and teachers had to be used to ensure that ideas and concepts were clear to all individuals and groups (Altschuld & White, 2010; Altschuld & Witkin, 2000). Communications necessitate diligence.

Fourth, the three models are very much along the lines of the hybrid framework. Indeed, Williams, Bray, Shapiro-Mendoza, Reisz, and Peranteau (2009) affirm the value of one of its tenets—the inclusion of a community or an organization firmly throughout the entire process. This was a serious message in the three models, particularly Model C.

Fifth, a rich set of methods was utilized, and the authors suggest that by combining tools, the community- based participatory research was greatly enhanced. Further, a neat feature related to community meetings (community celebration events). Visuals were employed to help facilitate sessions. Causal trees and

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consequences were displayed, as were photo collages. This, in conjunction with sizable community-generated information, proved to be wonderful input into local community deliberation and reflection.

Sixth, an outgrowth of Point 5 is that there was improved interpretation of quantitative data. This is the result of having many sources of data coming from multiple methods and having a lot of eyes (including community ones) reviewing and assigning meaning.

Seventh, communication has a very positive side. It led to better exchanges and understandings across agencies, community health providers, and community members. The celebratory events were an excellent way for people to get to know each other. Interestingly, photovoice is now being added to the toolbox of CBPR as a method that would fit well with community involvement, especially for interpreting findings and getting discussions going.

Eighth, noticeable in this case and others is the flexibility that is required. The pieces and parts in each of the three models, the collection and analysis of data, using what has been learned, and working with varied constituencies all point to the fact that everyone involved has to be adaptable and patient and accept progress as well as setbacks. Go back to the first point about when unanticipated costs and expenditures arose and had to be resolved. Whether it is a small group or an individual leading the effort, be ready for snags and difficulties.

Flexibility has advantages and disadvantages for the staff from providers of services that are involved. It enhances interactions with stakeholders, but at the same time it could underscore an imbalance of power favoring providers and may lead to the collection of distorted or biased data. The devil is in the details as to how CBPR is implemented and varies from context to context.

This brings to the fore the perplexing issue of whether CBPR is predicated on an asset/resource stance, a needs assessment one, or the hybrid framework. It cuts across them well except for one factor. Where is the impetus for it coming from—what is the major motivation? Is it under the aegis of the community or more the agencies and providers? In a purist sense and given the possible imbalance of power, the study may conflict with the idea that the community is in control of setting its own destiny via project decisions. If that is even partially accurate and if it generalizes to CBPR types of studies, it goes back to the dependency concern identified in arguments for the asset/resource side of the equation.

The world is not pure, pristine, or antiseptic, but septic, and just doesn’t operate in an ideal fashion. The voice of the consumer (the community) was there, did affect what was done, and was valued, but is it as paramount as asset/capacity builders would want? Maybe yes, maybe no. Every circumstance has its own vagaries that affect implementation and that lead to a high or low community locus of direction. It is an ultimate goal that may be difficult to fully achieve.

Ninth, going beyond Table 7.3, what about the rest of the sections in the checklist? Other information supplied in the summarized article includes that over $400,000 of funding was gained for projects in the local area based on project efforts. Although not in full detail, the overview of the celebratory outreach event was helpful. Moreover, attention was directed to gaining and keeping meaningful (not superficial) community involvement. Comprehensive documentation of all events would have led to positive findings for other parts of hybrid framework usage.

CASE 3. UNDERSTANDING COMMUNITY PERCEPTION OF HEALTH AND SOCIAL NEEDS IN A RURAL BALINESE VILLAGE: RESULTS OF A RAPID PARTICIPATORY APPRAISAL

At initial glance, this case too may appear not to be suited for the book. However, its focus is on assets/resources and needs assessment with heavy community involvement.

Structure of the Project The abstract for the project described it as implementing rapid participatory appraisal and community-

based action research for asset-based community development (Pepall, Earnest, & James, 2006). It was done for a community radio station in Bali with a low literacy population.

Rapid participatory appraisal was viewed as a good way to collect community input and perspectives without excessive expenditures. It would not take much time and would provide valuable information. It was

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an iterative type of methodology, thus fitting with the hybrid framework. It would go through what is called an asset-focused rapid participatory appraisal (RPA) cycle, a process of collecting information, followed by analysis and planning/acting on what has been learned, and then going back through the cycle.

A model (the Health Information Pyramid) was the basis for generating interview questions. Data were obtained from key informant interviews, observations in the field, and review of existing documents. While the focus was on assets, the authors acknowledged needs and problems but stressed that this could not be the sole basis for moving forward. They felt that their approach enabled them to combine both problems and solutions. A summary of the project is given in Exhibit 7.3 and the checklist evaluation in Table 7.4 on page 171.

Exhibit 7.3 Activities Incorporated Into Case 3

Phase 1 Communicating with stakeholders Planning, collecting, and analyzing information about assets Planning, collecting, and analyzing information about needs Data primarily from key informants

Phase 2 Further discussions with community participants Verification of what has been collected and learned about assets Verification of what has been collected and learned about needs Sharing in the discussions about issues and possible improvement strategies Generally from key stakeholders

Other methodological features Field observations Informal individual and group discussions Collation of existing secondary data (needs information) Semistructured questionnaires that guided the interviews Questions reviewed for cultural sensitivity Questions revised as appropriate as the process was ongoing

Table 7.4 Application of the First Part of the Evaluative Checklist to Assess the Degree of Fit of Case 3 With the Hybrid Framework (ratings in bold)

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Discussion of the Case First, the team that did this study commented on the need for a group representing multiple sectors to

carry out the endeavor. Several individuals were included who knew the local customs and were fluent in Bahasa Indonesia (Indonesian language). They were instrumental in obtaining local leadership approval. In cultural efforts like this, that was absolutely essential. The researchers were from Australia, so sensitivity was imperative. (See Hung, Altschuld, & Lee, 2008, for a research study in Taiwan where cultural and language issues arose from a team consisting of two Taiwanese and an American with different perspectives that had to be attended to and resolved.)

A second feature was that despite the fact that the 57 key informants were not randomly sampled, the authors felt that they did obtain the views of the community without large expenditures. Triangulation of sources added to the validity of findings. In other words, a degree of rigor was realized. This would be a strong point of such endeavors where methods are implemented as best they can be in field settings. Procedures are not perfect, but when multiple methods complement each other, a corroborative strength emerges.

Third, the value of formal and informal discussions with individuals and groups was underscored in terms of what it produced for the locality. The investigators exercised care in sampling to ensure that poorer community members were included and their voice was heard. To enhance participation, small token gifts were provided.

Fourth, on the needs assessment side, the investigators found sources of census information from the local government. Regional health authorities provided more in the form of health service utilization statistics.

Fifth, the researchers conducted field observations of the community. This, in conjunction with the interviews and discussions, led to an asset map of the community.

Sixth, detailed notes for each day of the project were examined for recurring or interrelated themes. This took place across all sources. Where discrepancies were encountered as they normally would be, new or other data were sought for clarification.

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Seventh, the study generated a lot of insightful results. They dealt with needs to work on the overall economic situation of the community, areas in which health service promotion and provision should be improved, concerns about child labor (the community was poor), causes of health problems, considerations for how the radio station could do a better job of benefiting its community, and local assets.

Three main strategies for changing and enhancing the community came from what was learned. Two of the strategies were not in the health emphasis of the project, and although not intended it was meaningful input for another area, should be duly noted, and should if important enough be pursued.

Eighth, there is great value in community involvement as it builds the base for action. Community members began to develop ownership in what came from the study and what could change because of it. Since a radio station was a key element, the idea arose that it might feature more local voices in broadcasts— something that could be implemented with little cost and with the potential of a big payoff, especially as it showed that the voice of the people was really being taken into account.

Ninth, how well did this effort match the hybrid framework? Like the two other cases, it fits the general parameters of the framework. Needs assessment and asset/capacity building were prominent, and one cannot overstate the concern for community participation and sensitivity to it. Reading into the article, mention comes up about multiple meetings with the community and how what was gathered through them and the other procedures contributed to in-depth perspectives of health issues and others affecting community life. If the full checklist had been applied, there would be ratings for other facets of the hybrid. The study led to concrete suggestions for new/enhanced activities for the community. It definitely is consistent with the tenets of hybrid thinking.

ACROSS THE THREE CASES

An analysis across the three studies in terms of features in the framework would be useful. Before offering it, note that there were several other publications considered for inclusion. One was a needs assessment but with a twist conducted by Iutcovich in 1993. The concept was to do the assessment with the heavy involvement of the community so that it would be empowered to change and be an integral part of improvement. It had components of the hybrid including a needs assessment committee (NAC) that went beyond an advisory role. The NAC did much work vital to the assessment such as determining what questions should be asked and designing a draft of the survey. This effort was not included due to its date and that it might be loading more on needs assessment. It also was not very specific on the concept of identifying assets and resources.

The second possibility was called common needs assessment, or CNA (Garfield, Blake, Chatainger, & Walton-Ellery, 2011) as prescribed for humanitarian action. It is a needs assessment that is carried out across multiple sectors and stakeholders to collect and analyze information about discrepancies and capabilities and subsequently inform decisions about needs (vulnerabilities) in communities. What results would inform decisions and early recovery responses? As the authors point out, “working together to design the assessment can foster collaboration, making possible a shared understanding of priorities and improving coordination across agencies” (Garfield et al., 2011, p. 3). Other reasons for CNA are efficiency, timeliness, shared learning, coordination across agencies that are working together, and efficiency. This process overlaps with needs assessment/asset capacity building, and it has numerous useful ideas and procedures. It is a good reference but was not included in this text because its focus leans more toward needs than the full balance of criteria employed for selection.

Another thing to mention is that many techniques have elements in them that relate well to the hybrid framework. Consider the description of community-based participatory research, rapid participatory appraisal, and what is in the synthesized needs assessment and asset/capacity-building framework in Chapter 2. This is positive, and implementers should be aware of such overlaps as they conduct investigations to promote positive change and growth.

All three of the cases in the chapter required a lot of work to collect volumes of data, write and interpret findings, establish and maintain community involvement, seek community insights into what the data mean, and so forth. By the same token, some features may not fully resonate with what a hybrid should have. Table 7.5 is a summary of main elements of the hybrid and how they present collectively for the cases.

Table 7.5 Summary of Some Main Features of the Hybrid Framework in the Three Cases

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Table 7.5 (Continued)

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HIGHLIGHTS OF CHAPTER 7

1. A rationale was provided as to why cases from health were chosen for the chapter. 2. General parameters for searching the literature were explained, as were features that influenced the

interpretation of the findings. 3. An overview of three cases from health coming from the United Kingdom, the United States, and Bali

was given, and each was looked at in depth followed by analysis and rating of its key aspects. 4. Before looking across the three cases, a somewhat older needs assessment study not chosen (date of

publication, primary focus on needs) was briefly described. Common needs assessment (CNA) was similarly mentioned.

5. Table 7.5 contained an analysis across the three cases. As expected, because of selection, they were strong in terms of hybrid features (see Tables 7.1, 7.2, 7.3, and 7.4).

6. One aspect that did not present well was the locus of control. The voice of the community was noticeable in the cases, but it did not seem to be the driving force or the impetus, which is less than desirable from the asset/capacity-building side of the equation.

DISCUSSION QUESTIONS

6/2/2018 Bookshelf Online: Bridging the Gap Between Asset/Capacity Building and Needs Assessment: Concepts and Practical Applic

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1. In the three cases, a great deal of effort and time was expended. Qualitative and quantitative data were collected; sincere outreach to the community was commendable, well intentioned, and extended over time; needs and assets were major foci; and so forth. What are your perceptions about expenditures to do the work, who should the funders be, and could they introduce bias into the process?

2. In one investigation, the researchers noted that several communities had prior pertinent experience and therefore were more responsive to participation. Change could more readily take place in such settings. This variable may have major bearing on these types of ventures—what should we look for, and what kinds of questions could be asked that would alert researchers to this characteristic?

3. Each case was evaluated on the first part (scoping) of the checklist. That may be due to published articles being examined instead of comprehensive reports, or it could be that the checklist is over the top. Go back to the checklist. What might be the main things to emphasize, and what could be deemphasized?

4. Time frames are not totally clear, but undoubtedly the cases required a fair investment of that commodity. The time in Bali was considerably shorter, but it had an intense period of activity guided by an external research team. What about time in such investigations? How long should they take, and if a lot of time is required, how would motivation and involvement be maintained?

5. The external impetus versus the internal one is a bone of contention—visibly or sitting under the surface. Consider and discuss the following questions: Could any of the three cases have been successful without external support, guidance, or even direction? What biases could be introduced? Can an endeavor of sizable scope be done without an external group being there and doing a majority of the activities? What are the roles of all parties, and what are the best ways of organizing? How do we keep the community meaningfully involved over time, and what might this take in terms of coordination and resources?

6. There are a myriad of issues and things to think about when conducting hybrid studies, and research done about such projects would be informative. Speculate about research questions that could be raised. What procedures could be used to learn about them? Have you read or seen any of these studies, and if so, what were their findings? The three cases cited were exceptionally good, but certainly there are others that did not work well. How could we investigate them in order to not repeat mistakes?

7. The examples were exemplary in using quantitative and qualitative data and in obtaining information from many sources. In one case and probably in others the data did not always agree and necessitated additional fieldwork. What do we do when data and findings are not complementary, and how do we resolve such problems?

8. Lastly, what the three cases did is demanding. Deciding on direction, designing techniques for collecting data, utilizing many sources of data, involving multiple constituencies so that they have ownership in what has been learned and suggested for improvement, and interpreting from observations, surveys, interviews, and databases are complex entities by themselves, let alone occurring in consort in a comprehensive community-based investigation. With that in mind, think about concerns such as the following: How could the investigations be streamlined in method or data collection while at the same time collecting enough data to move the community forward? If some things were done to a lesser degree or not at all, what would be lost, and what would the disadvantages be?