In another e-mail list-serv on Health Promotion (called just that and
operated out of Karolinska Institute in Sweden by Bo Haglund & Brian Flay)
there has been a recent discussion on the theoretical basis and origins of
'the settings approach' in health promotion (healthy schools, workplaces,
cities/communities, environments).  The discussion, ideas and references
have been far-ranging and have had contributions from all parts fo the
world.  Although there has been discussion of case studies, stories and
critical analyses of the "healthy settings" approaches, there does not
appear to be much discussion [yet!] from practitioners about working in
different settings  whether theory comes out in practice, and if theory or
models should direct community action or be shaped by it.

I receive many calls and requests for information from community health
organizations and practitioners across Ontario, usually seeking ideas and
examples of how their work can be done effectively, what has worked in
different places and what has *not*, and how they can learn about community
development in health.  Recently I had two calls from two public health
units who wanted to look at some of the models that are being suggested for
health promotion programming.  They wanted to know whether there had been
any critiques, analysis and evaluations or comparisons of these models of
community health promotion. In particular they were asking about:

* the use of the PRECEDE/PROCEED model developed by Lawrence Green &
Marshall Kreuter in community-wide programs

* the PATCH model (Planned Approach to Community Health) coordinated and
promoted by the CDC in Atlanta in the late '80s;  and

* using mass media and point of purchase communications to influence
peoples' attitudes, and behaviours who are in the precontemplation 'stages
of change'

Although I am quite familiar with the PRECEDE and PROCEED models, I have not
seen analyses of these models in practice or evaluation of application of
the models for community-wide health promotion programming.  Can someone
suggest reviews or references that might be helpful?
Regarding the PATCH model, there were two Ontario projects in the early
1990s that adapted the U.S. state-wide PATCH model and reported on how
applicable this approach was for regional areas with multicultural
communities. As well, there was a qualitative review of the application of
three PATCH model  programs to three CCDPP (Community Chronic Diseasse
Prevention Programs) in Maine reported in the American J Health Promotion
 v.7 #3 1993 that provided a useful comparison.  In a commentary of that
article, Green & Kreuter made an important point for all community health
practitioners:
"Is community organization and participation a tool of public health, or
should we view the more technical, linear, public health methods as specific
tools of community organization?"

I suggest the latter may be more appropriate, that health promotion methods
and theoretical models can be used to support community mobilization,
organization and development,  Are there studies, examples, and references
that take this approach?

Alison Stirling,
health promotion consultant <[log in to unmask]>
Ontario Prevention Clearinghouse <http://www.opc.on.ca>
Toronto, ON, M5B 2E7
tel: 416-408-2121 fax 416-408-2122