Carolyn and the list, read this information regarding Citizen participation
and the theory of Arnstein. My question is should this information be taken
in the context of health care education?
I am a nurse case manager in the United States and have seen that patients
need accurate information. Most people, even the most educated are very
99999999999999 when they become sick and want information that they can
understand and then put into practice to "get better". I don't think that
the average person, can self managed him/herself without accurate
information from professionals. On the other hand, once patients are taught
and understand the disease process and have the tools to handle their
diagnosis themselves, many do self managed and do well with regular visits
to the doctors. This is the basis of Disease Management and the goal and
mission of those who practice in the field of Case/Care Management in
various venues where high risk/cost patient are identified and "managed" via
a nurse, mental health professional, etc to cope with their chronic or
catastrophic illness or injury.
Thanks for this information and looking forward to your replies re this.
----- Original Message -----
From: Carolyn Frohmader <[log in to unmask]>
To: <[log in to unmask]>
Sent: Tuesday, July 25, 2000 3:32 AM
Subject: Re: IMPACT of Community Participation
> Hi Jim
> One of the oldest, but still widely used measures of citizen participation
> comes from Arnstein (ref: Arnstein, S. (1969); 'A Ladder of Citizen
> Participation in the USA'; Journal of the American Institute of Planners,
> July.) (I've also included below some references which may be of use to
> you).
>
> Here's a bit of a synopsis of Arnstein's approach:
>
> Arnstein (1969) in discussing the confusion around the concept 'citizen
> participation' stated: 'the heated controversy over 'citizen
participation'
> has been waged largely in terms of exacerbated rhetoric and misleading
> euphemisms.' In aiming to 'encourage a more enlightened dialogue', she
> developed a typology of citizen participation, which was arranged in a
> ladder pattern with each rung corresponding to the extent of citizen's
power
> in determining plans and/or programs. The bottom rungs of the ladder,
> 'manipulation' and 'therapy', she describes as levels of 'non
> participation.' She sees 'manipulation' as 'the distortion of
participation
> into a public relations vehicle by power holders', and gives examples of
> people placed on advisory committees for the express purpose of
engineering
> their support. She sees group 'therapy' that is masked as community
> participation, as often being about power holders wishing to 'cure' or
> educate the participants. The next rungs of the ladder progress to what
she
> calls 'degrees of tokenism', such as 'informing', 'consultation' and
> 'placation'. Although she acknowledges that informing people of their
> rights and options can be a step towards community participation, all too
> often the emphasis is placed on a one way flow of information from
officials
> to consumers. 'Consultation' - that is, inviting peoples opinions, is
seen
> by Arnstein as being a 'sham' unless it is combined with other modes of
> participation. Examples of consultation include the use of attitude
> surveys, and public meetings. An example of 'placation' strategy is,
> according to Arnstein, placing a 'few hand-picked worthy 'poor' on boards
of
> community organisations.' She sees that if these people are not
accountable
> to a constituency in the community, and if the 'traditional power elite'
> hold the majority of seats, the "have nots" can easily be manipulated.
>
> Further up the ladder are the degrees of citizen power - which Arnstein
sees
> as partnership, delegated power and citizen control. She discusses
> 'partnership' as being the redistribution of power through negotiation
> between people and the power holders. Arnstein suggests that partnership
> works most effectively when there is an organised power base in the
> community to which the people's leaders are accountable. At the level of
> 'delegated power', people achieve the dominant decision making authority
> over particular plans and/or programs. Although Arnstein recognises that
no
> one can have absolute control, the final rung of the ladder - citizen
> control - refers to where citizens obtain the majority of decision making
or
> full managerial power.
>
> Other References:
>
> Arnstein, S. (1969); 'A Ladder of Citizen Participation in the USA';
Journal
> of the American Institute of Planners, July.
>
> Bracht, N. & Tsouros, A. (1990); 'Principles and Strategies of Effective
> Community Participation', Health Promotion International, Vol 5, No 3.
>
> Brown, I. (1994); 'Community and Participation for General Practice:
> Perceptions of General Practitioners and Community Nurses', Journal of
> Social Science and Medicine, Vol 39, No 3.
>
> Dixon, J. (1989); 'The Limits and Potential of Community Development for
> Personal and Social Change', Community Health Studies, Vol 13, No 1.
>
> Dwyer, J. (1989); 'The Politics of Participation', Community Health
Studies,
> Vol 13, No 1.
>
> Freyens, P. et al, (1993); 'How do health workers see community
> participation?', World Health Forum, Vol 14.
>
> Hamilton-Smith, E. (1975); 'Issues in the Measurement of 'Community Need',
> Australian Journal of Social Issues, Vol 10, No 1.
>
> Hunt, S. (1990) 'Building Alliances: Professional and Political Issues in
> Community Participation - Examples from a Health and Community Development
> Project', Health Promotion International, Vol 5, No 3.
>
> Labonte, R. (1989); ' Community and Professional Empowerment', The
Canadian
> Nurse, March.
>
> Labonte, R. (1990); ''Empowerment: Notes on Professional and Community
> Dimensions', Canadian Review of Social Policy, Issue 26, pp.64-75.
>
> Freire, P. (1972); 'Pedagogy of the Oppressed', Penguin Books, London.
>
> Tumwine, J. (1989); 'Community Participation as Myth or Reality: A
Personal
> Experience from Zimbabwe', Health Policy and Planning, Vol 4, No 2.
>
> Woelk, G. (1992); 'Cultural and Structural Influences in the Creation of
and
> Participation in Community Health Programmes', Journal of Social Science
and
> Medicine, Vol 35, No 4.
>
>
> Carolyn Frohmader
> Executive Director
> Women With Disabilities Australia (WWDA)
> PO Box 229, Dickson, ACT 2602
> Ph: +61 2 62421310 Fax: +61 2 62421314
> email: [log in to unmask]
> email: [log in to unmask]
> Web: http://www.wwda.org.au
>
>
> ----- Original Message -----
> From: jim <[log in to unmask]>
> To: <[log in to unmask]>
> Sent: Tuesday, July 25, 2000 8:31 AM
> Subject: IMPACT of Community Participation
>
>
> > Hello:
> >
> > We are presently engaged in a study of "citizen" (also called lay,
> > public or community) participation in health reform. We are looking for
> > tools and methods for assessing the IMPACT of citizen participation on
> > decision-making and decisions made. More specifically, we are interested
> > in answering the often-asked question "does citizen participation make a
> > difference?
> >
> > I would greatly appreciate receiving any information you might have
> > regarding the measurement of IMPACT of citizen participation.
> >
> > Best regards Jim
> >
> > Dr. C. James Frankish, BC Health Research Scholar
> > Acting Director, Institute of Health Promotion Research
> > Assistant Professor, Division of Preventive Medicine & Health Promotion
> > Department of Health Care & Epidemiology, Faculty of Medicine
> > University of British Columbia
> > Room 308, LPC Building, 2206 East Mall Vancouver BC V6T 1Z3
> > Ph:604-822-9205 Fax:604-822-9210 E-mail: [log in to unmask]
> > Web Site http://www.ihpr.ubc.ca
> >
>
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