Community development

社区发展
  • 文章类型: Journal Article
    不可否认,新冠肺炎大流行影响了人口健康和社区组织的几个方面,包括服务提供和社会凝聚力。部门间协作和公平,社区复原力的两个关键维度,事实证明,这对于有效和公平地应对这一流行病至关重要。然而,在这种紧急和不确定的时期,促使或限制社区制定部门间合作和注重公平的行动的能力的因素仍然知之甚少。这项描述性定性研究旨在(1)描述在第一波COVID-19期间部门间合作和注重公平的行动的过程,以及(2)确定促成和限制这些过程的因素。我们对35名政府代表进行了半定向采访,机构,以及来自埃斯特里地区四个市县的公共和第三部门(魁北克,加拿大)。我们按照码本主题分析方法对详细的访谈笔记进行了编码。我们确定了部署部门间合作和注重公平的行动的三个过程:(1)联网;(2)适应,创造和创新;(3)以人为本的行动。支持这些流程部署的杠杆示例包括利用预先存在的网络,适应实践和服务,并投资于团结和互助。我们描述的影响因素代表了韧性建设行动的具体目标。尽管专注于COVID-19大流行,我们的发现与其他类型的健康有关,社会,环境或经济危机,并可以指导健康促进和社区发展从业人员采取更有效的社区复原力建设对策。
    The COVID-19 pandemic undeniably impacted population health and several aspects of community organization, including service delivery and social cohesion. Intersectoral collaboration and equity, two key dimensions of community resilience, proved central to an effective and equitable response to the pandemic. Yet the factors that enabled or constrained communities\' capacity to enact intersectoral collaboration and equity-focused action in such times of urgency and uncertainty remain poorly understood. This descriptive qualitative study aimed to (1) describe the processes through which intersectoral collaboration and equity-focused action were deployed during the first wave of COVID-19 and (2) identify factors enabling and constraining these processes. We conducted semi-directed interviews with 35 representatives of the governmental, institutional, and public and third sectors from four municipal regional counties of the Estrie region (Québec, Canada). We coded detailed interview notes following a codebook thematic analysis approach. We identified three processes through which intersectoral collaboration and equity-focused action were deployed: (1) networking; (2) adaptation, creation and innovation; and (3) human-centred action. Examples of levers which supported the deployment of these processes included capitalizing on pre-existing networks, adapting practices and services, and investing in solidarity and mutual aid. The influencing factors we describe represent concrete targets for resilience-building action. Although focused on the COVID-19 pandemic, our findings are relevant to other types of health, social, environmental or economic crises, and may guide health promotion and community development practitioners towards more effective community resilience-building responses.
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  • 文章类型: Journal Article
    研究表明,普遍基本收入(UBI)有能力在全国范围内对整个人口产生实质性的健康益处。最近已对多种影响途径进行了理论化,并呼吁进行试验以凭经验探索这些途径。然而,在地方层面进行了非常有限的研究,以探索潜在的特定环境影响,或者这些影响如何在经济中发挥作用,社会,和行为变化。为了检查这些影响并思考潜在的问题和意想不到的后果,我们在Jarrow召集了公民参与团体,南泰恩赛德,在英格兰东北部,探索当地人对UBI政策制定的期望和立场,并在实施之前进行试点。我们发现,人们对UBI对其社区的潜在有益健康影响的期望强烈地映射到学术理论影响途径上。他们还以有意义的方式扩展了对这些途径的理解。我们的发现增加了关于UBI和健康的文献,并为实证的未来发展提供了重要的见解,注重健康,UBI研究。
    Studies have suggested that universal basic income (UBI) has the capacity to have substantial health benefits across the population at national level. Multiple impact pathways have recently been theorized and there are calls for trials to explore these pathways empirically. However, very limited research has taken place at local levels to explore potential context-specific effects, or how these effects could play out in economic, social, and behavioral changes. In order to examine these effects and to think through potential issues and unintended consequences, we brought together citizen engagement groups in Jarrow, South Tyneside, in the northeast of England to explore local people\'s expectations and positions on the development of UBI policies and pilots prior to their implementation. We found that people\'s expectations regarding the potential beneficial health impacts of UBI on their communities mapped strongly onto academically theorized impact pathways. They also extended understanding of these pathways in meaningful ways. Our findings add to the literature about UBI and health and provide important insights for the future development of empirical, health focused, UBI research.
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  • 文章类型: Journal Article
    物理治疗师应该能够筛查患者影响健康的社会决定因素,并酌情参考社区资源。为了进行适当的转介,理疗师必须具备将患者和客户与各自机构外的社区资源联系起来的技能,从在物理治疗师教育计划中发展这些实践开始。经验丰富的社区建设者建议社区发展方法,居民可以发起并同意决定,外部利益相关者作为合作伙伴来提升社区。应支持社区以增强公平性的方式确定期望的结果,inclusion,和社会正义。社区在健康结果中发挥着重要作用。研究表明,一个人85%的健康与社区和经济资源有关,只有15%受到医疗干预的影响。互联社区是增强健康的有力工具。连接社区是居民培育邻里关系的地方,使他们能够共同努力,创造良好的生活,支持他们的集体福祉。社区建设者的方法使人们及其社区成为基本的卫生领导者;机构可以利用其资源通过将权力重新安置回社区来提升社区。社区的资产和资源基本上没有得到承认,断开连接,而不是由居民动员。机构有能力支持公民及其协会发现,连接,动员这些资产。这种以资产为基础的社区发展(ABCD)方法侧重于5个原则:以地方为基础,公民主导,关系导向,基于资产的,以包容为中心。本文将描述机构可以提升社区的方式;社区发展实践在物理治疗师教育计划中的好处;并探索社区伙伴关系和最佳实践的示例,以与社区居民建立公平的联盟。
    结论:一个人的健康很大一部分与一个人的生活地点直接相关。物理治疗师和物理治疗师助理可以通过社区发展参与当地社区,在改善社会健康方面发挥至关重要的作用。社区发展是一种实践,社区成员和外部利益相关者,比如物理治疗师,走到一起,以满足社区的需求。
    Physical therapists should be able to screen patients for social determinants that impact health and refer to community resources as appropriate. To make appropriate referrals, physical therapists must equip themselves with skills to connect patients and clients to community resources outside the walls of their respective institutions, starting with developing these practices in physical therapist education programs.Experienced community builders recommend a community development approach where residents initiate and agree upon decisions, and outside stakeholders work as partners to elevate the community. The community should be supported to determine the desired outcomes in ways that enhance equity, inclusion, and social justice. Communities play a substantial role in health outcomes. Studies indicate that 85% of one\'s health is connected to community and economic resources, while only 15% is affected by medical interventions. Connected communities are potent tools to enhance health. Connected communities are places where residents nurture neighborhood relationships that enable them to work together to create a good life supporting their collective well-being.The community-builder approach recenters people and their communities as fundamental health leaders; institutions can use their resources to elevate communities by relocating authority back to communities. Communities have assets and resources largely unrecognized, disconnected, and not mobilized by residents. Institutions are positioned to support citizens and their associations in discovering, connecting, and mobilizing these assets. This asset-based community development (ABCD) approach focuses on 5 principles: place-based, citizen-led, relationship-oriented, asset-based, and inclusion-focused.This perspective paper will describe ways institutions can elevate communities; the benefits of community development practices in physical therapist education programs; and explore examples of community partnerships and best practices to develop equitable alliances with residents in the community.
    CONCLUSIONS: A large part of one\'s health is directly related to where one lives. Physical therapists and physical therapist assistants can play a vital role in improving the health of society by engaging in their local communities through community development. Community development is a practice where community members and outside stakeholders, such as physical therapists, come together to meet the needs of a community.
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  • 文章类型: Journal Article
    社交媒体平台,比如Instagram,为边缘化群体提供联系空间,学习和表达自己,培养社区。跨拉丁裔,暴力和歧视的群体目标,通过社交媒体表达自己和建立社区来抵制。作为顺性研究人员,我们探索了transLatinas如何在Instagram上使用#translatina作为共享空间来展示自己和他们的身份,在我们的领域中利用这些知识。我们分析了2020年2月和3月的134个帖子,采用基本和解释性内容分析,同时考虑了Goffman的自我呈现理论。结果表明,跨性别的拉丁裔大多通过在相机附近拍摄的自拍照单独呈现,使用直线摄像机角度,站立,不笑,和眼神交流。大多数用户化妆,造型的头发,和配件。分析书面标题和照片,构建了四个主题,以了解跨性别拉丁裔如何表现出他们的身份并与他人联系:(1)美丽和女性气质的表达,(2)培育社区,(3)商业或工作,(4)感觉良好和自信。这些结果对心理健康和健康促进实践有影响,因为社交媒体可以作为跨性别拉丁裔的确认空间来加强他们的自决权,保持自我意识,并建立社区。
    Social media platforms, such as Instagram, provide space for marginalized groups to connect, learn about and express themselves, and cultivate community. Trans Latinas, a group target of violence and discrimination, resist by expressing themselves and building community through social media. As cisgender researchers, we explored how trans Latinas use #translatina on Instagram as a shared space to present themselves and their identities, to leverage this knowledge in our fields. We analyzed 134 posts in February and March of 2020 employing basic and interpretive content analyses while considering Goffman\'s theory of presentation of self. Results showed that trans Latinas mostly presented individually through posed selfies taken near the camera, using a straight camera angle, standing, not smiling, and making eye contact. Most users wore makeup, styled hair, and accessories. Analyzing written captions and photos, four themes were constructed to understand how trans Latinas presented their identities and connected with others: (1) expressions of beauty and femininity, (2) fostering community, (3) commercial or work, and (4) feeling good and confident. These results have implications for mental health and health promotion practices, as social media could serve as affirming spaces for trans Latinas to reinforce their self-determination, maintain a sense of self, and build community.
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  • 文章类型: Journal Article
    目的:本文探讨了\'place\'作为生态,健康和福祉的社会和文化决定因素,重点关注澳大利亚农村和偏远生活的好处和挑战。
    背景:卫生系统,包括健康促进,可以积极为创造支持性环境和场所做出贡献,以促进居住在农村和偏远地区的个人的健康和福祉。对于第一民族人民,生活在乡村,关心国家和人民,是土著世界观的核心,以及促进土著和托雷斯海峡岛民的健康和福祉。他们被迫从祖传土地上移走是灾难性的。对所有人来说,生活在农村和偏远地区可以提供丰富的元素,有助于“宜居”社区,包括呼吸新鲜空气,绿色和蓝色的空间,农业就业,紧密联系的社区,一种归属感和认同感,和社会资本。然而,远程生活也会限制就业机会,干净的水,负担得起的食物,可靠的运输,社会基础设施,社交网络和预防保健服务。\'place\'是维持健康生活的关键推动者。然而,目前的趋势导致当地服务和资源减少,增加了对气候变化影响的暴露。
    方法:本评论提出了一些想法和策略,通过这些想法和策略,农村和偏远地区的人们可以增强宜居性,他们社区的韧性和认同,并重新获得基本保健和健康促进服务和资源。
    结论:推荐的策略包括在线获取教育,就业和远程医疗;灵活提供社会基础设施;以及有意义和反应迅速的大学卫生服务伙伴关系。
    OBJECTIVE: This article explores the crucial role of \'place\' as an ecological, social and cultural determinant of health and well-being, with a focus on the benefits and challenges of living rurally and remotely in Australia.
    BACKGROUND: The health system, including health promotion, can contribute actively to creating supportive environments and places that foster health and well-being among individuals residing in rural and remote locations. For First Nations peoples, living on Country, and caring for Country and its people, are core to Indigenous worldviews, and the promotion of Aboriginal and Torres Strait Islander health and well-being. Their forced removal from ancestral lands has been catastrophic. For all people, living in rural and remote areas can deliver an abundance of the elements that contribute to a \'liveable\' community, including access to fresh air, green and blue space, agricultural employment, tight-knit communities, a sense of belonging and identity, and social capital. However, living remotely also can limit access to employment opportunities, clean water, affordable food, reliable transport, social infrastructure, social networks and preventive health services. \'Place\' is a critical enabler of maintaining a healthy life. However, current trends have led to a reduction in local services and resources, and increased exposure to the impacts of climate change.
    METHODS: This commentary suggests ideas and strategies through which people in rural and remote locations can strengthen the liveability, resilience and identity of their communities, and regain access to essential health care and health promotion services and resources.
    CONCLUSIONS: Recommended strategies include online access to education, employment and telehealth; flexible provision of social infrastructure; and meaningful and responsive university-health service partnerships.
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  • 文章类型: Journal Article
    背景:英国的图书馆已经从传统的图书借阅机构发展成为充满活力的社区中心,本研究旨在探索图书馆作为社区中心的潜力,以促进社区成年人的身心健康和福祉。借鉴英国图书馆用户和图书馆工作人员的见解。
    方法:混合方法,使用在线调查和对社区居住的成年人和图书馆工作人员的访谈进行横断面研究。
    方法:我们使用14项电子调查和对图书馆用户和工作人员的访谈来收集数据,以衡量看法。描述性统计和主题分析用于确定关键趋势和紧急主题。
    结果:我们纳入了605名调查对象,并采访了12名图书馆用户和工作人员。图书馆仍然很受欢迎,被社区成员认为是安全的地方,无论他们使用服务的频率,无论他们是否是服务的频繁用户。然而,图书馆用户对面向社区的服务缺乏认识,可能成为改善社区健康和福祉的障碍。需要有针对性地与居民接触,以提高对图书馆服务的认识,包括社区干预措施,以帮助解决数字和健康素养中的孤独和不平等。图书馆工作人员通常不参与重要的决策。各种障碍,确定了驱动因素和实用建议,以利用图书馆作为促进社区健康和福祉的中心。
    结论:图书馆已经提供了各种直接或间接支持社区成年人和年轻人的健康和福祉的资源。然而,公众对这些服务的认识有限。当我们驾驭大流行后的复苏时,图书馆可以作为社区参与的平台,培养韧性,心理健康支持和减少社会孤立。认识到图书馆未开发的潜力可以带来更健康的社区和改善的福祉。
    BACKGROUND: Libraries in the UK have evolved from traditional book-lending institutions into dynamic community hubs, This study aims to explore the potential of libraries to act as community hubs to promote mental and physical health and wellbeing of community-dwelling adults, drawing on insights from both library users and library staff in England.
    METHODS: A mixed-method, cross-sectional study using online survey and interviews with community-dwelling adults and library staff.
    METHODS: We collected data using a 14-item electronic survey and interviews with library users and staff to gauge perceptions. Descriptive statistics and thematic analysis were used to identify key trends and emergent themes.
    RESULTS: We included 605 respondents from the survey and interviewed 12 library users and staff. Libraries remain popular and are considered a \'safe place by members of the community, regardless of their frequency of service usage irrespective of whether they are frequent users of services. However, a lack of awareness among library users about community-facing services could act as a hurdle to improving community health and wellbeing. Targeted engagement with residents is needed to increase awareness of libraries\' services, including community interventions to help tackle loneliness and inequalities in digital and health literacy. Library staff often did not feel involved in important decision-making. Various barriers, drivers and practical recommendations were identified to leverage libraries as hubs to promote community health and wellbeing.
    CONCLUSIONS: Libraries already offer a variety of resources that directly or indirectly support the health and wellbeing of community-dwelling adults and young people. However, public awareness of these services is limited. As we navigate post-pandemic recovery, libraries can serve as platforms for community engagement, fostering resilience, mental health support and reducing social isolation. Recognising libraries\' untapped potential can lead to healthier communities and improved wellbeing.
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  • 文章类型: Journal Article
    近年来,国际(护理)运动有所增加,这些运动优先考虑以社区为中心的倡议,例如对年龄友好的社区,富有同情心的社区或综合社区护理。虽然这些运动有不同的焦点,它们具有共同的特点:寻求解决(护理)服务中的系统性故障,重视最终用户的参与,专注于未满足的(护理)需求,通过一个地方,以邻里为导向的方法。在佛兰德和布鲁塞尔地区,尤其是“关爱社区”的概念正在快速增长。
    本研究的目的是审查佛兰德斯和布鲁塞尔(比利时)35个关爱邻里倡议的制定和实施情况,以探索此类项目的附加值,以及创建关爱社区的关键因素。
    通过与项目协调员的五次焦点小组访谈(n=34)和与邻里居民的五次焦点小组访谈(n=27),检查了35个关怀邻里项目。使用参与者生成的照片启发。
    录制了焦点小组会议,使用归纳分析框架转录和标记数据,遵循反身主题分析的步骤。
    对35个关爱社区的分析表明,培养联系是建立关爱社区的关键:居民之间的联系,居民与护理和支持服务之间以及护理服务本身之间的联系。联系人们的三种主要方式是通过活动,地方和人。此外,关怀邻里协调员的作用被强调为关键,它应该专注于编织现有资源,促进和指导,而不是组织。总之,这些项目为参与者的生活带来了意义和价值,提高整体生活满意度和幸福感,强调身体和心理社会护理和支持。
    通过批判性地反思我们的结果和其他研究,我们呼吁研究人员更多地关注以社区为中心的死亡护理计划的研究,死亡和悲伤,公平和社会正义,以及冷暖团结的需要。
    UNASSIGNED: In recent years, there has been a rise in international (care) movements that prioritise community-centred initiatives such as age-friendly communities, compassionate communities or integrated community care. Although these movements have different focal points, they share common features: seeking to address systemic failures in (care) services, value the participation of end-users, focus on unmet (care) needs, through a local, neighbourhood-oriented approach. In the Flemish and Brussels regions notably the concept of Caring Neighbourhoods is experiencing rapid growth.
    UNASSIGNED: The objective of the present study is to examine the development and implementation of 35 Caring Neighbourhood initiatives in Flanders and Brussels (Belgium) to explore the added value of such projects, as well as the crucial elements for creating Caring Neighbourhoods.
    UNASSIGNED: Thirty-five caring neighbourhood projects were examined by means of five focus group interviews with project coordinators (n = 34) and five focus group interviews with neighbourhood residents (n = 27), using participant-generated photo elicitation.
    UNASSIGNED: The focus group sessions were recorded, transcribed and data were labelled using an inductive analytical framework, following the steps of reflexive thematic analysis.
    UNASSIGNED: The analysis of the 35 Caring Neighbourhoods showed that fostering connections was key in building Caring Neighbourhoods: connections among residents, connections between residents and care and support services and among care services themselves. The three primary ways to connect people were through activities, places and people. Also, the role of the Caring Neighbourhood coordinator is highlighted as key, which should focus on weaving existing resources, facilitating and coaching instead of organising. Altogether, the projects brought meaning and value to participants\' lives, enhancing overall life satisfaction and well-being, with an emphasis on physical and psychosocial care and support.
    UNASSIGNED: Through critically reflecting on our results and other research, we call on researchers to pay increased attention in research on community-centred care initiatives to death, dying and grief, equity and social justice and the need for both warm and cold solidarity.
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  • 文章类型: Journal Article
    在香港,专业社会工作者在大流行最严重的时候提供各种服务时,感受到了他们的存在。当其他类型的社会服务的可用性和可及性受到严重阻碍时,从事社区发展项目或采用社区工作方法的社会工作者已成为主要的服务提供者。本文报告了一项定性研究,旨在研究(1)社区社会工作者如何计划和实施服务,(2)他们使用信息和通信技术(ICT),(3)解决灾害管理工作中不公正的想法。
    In Hong Kong, professional social workers made their presence felt when they delivered a variety of services at the height of the pandemic. Social workers who were working in community development projects or who had adopted community work approaches have become the major service providers when the availability and accessibility of other types of social services have been seriously impeded. This article reports on a qualitative research study conducted to examine (1) how community social workers have planned and implemented services, (2) their use of information and communication technologies (ICTs), and (3) ideas for addressing injustices in disaster management work.
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  • 文章类型: Systematic Review
    背景:基于资产的方法(ABAs)通过赋予更弱势社区的人们权力来解决健康不平等问题,或目标人群,更好地利用现有的本地社区资源。利用现有资源支持个人更好地管理自己的健康及其决定因素,潜在的低成本。针对与传统服务提供方法脱节的个人,可以进一步节省有意义的成本。因为这些人通常需要昂贵的护理。因此,加强预防,和管理,这些群体的健康状况不佳可能会产生相当大的成本影响。
    目标:为了系统地审查当前成本和经济证据对ABAs的影响程度,以及开发它的方法。
    方法:搜索策略术语包括:i)成本计算;ii)干预细节;iii)地区。搜索的数据库:Medline,CENTRALandWedofScience.研究人员筛选了9116篇文章。使用关键评估技能计划(CASP)工具评估偏差风险。叙事综合总结了研究结果。
    结果:12篇论文符合纳入标准,代表11个不同的ABAs。在研究中,方法多种多样,不仅在设计和比较方面,但也包括成本和结果措施。研究表明经济效率,但是缺乏合适的比较器使更明确的结论变得困难。
    结论:围绕ABAs的经济证据有限。ABA可能是一种有希望的方式,可以让服务不足或少数群体参与进来,与替代健康和福祉改善方法相比,这可能具有更低的净成本。ABAs,嵌入式服务的一个例子,在经济评估的背景下受苦,它们通常认为服务是相互排斥的替代品。周围服务的经济学,信息共享机制,和合作是资产和ABA成功的基础。经济证据,和总体评估,将受益于更多的背景和细节,以帮助确保对ABA的经济学有更细致入微的理解。需要进一步的证据来得出关于ABAs成本效益的结论。
    BACKGROUND: Asset-based approaches (ABAs) tackle health inequalities by empowering people in more disadvantaged communities, or targeted populations, to better utilise pre-existing local community-based resources. Using existing resources supports individuals to better manage their own health and its determinants, potentially at low cost. Targeting individuals disengaged with traditional service delivery methods offers further potential for meaningful cost-savings, since these people often require costly care. Thus, improving prevention, and management, of ill-health in these groups may have considerable cost implications.
    OBJECTIVE: To systematically review the extent of current cost and economic evidence on ABAs, and methods used to develop it.
    METHODS: Search strategy terms encompassed: i) costing; ii) intervention detail; and iii) locality. Databases searched: Medline, CENTRAL and Wed of Science. Researchers screened 9,116 articles. Risk of bias was assessed using the Critical Appraisal Skills Programme (CASP) tool. Narrative synthesis summarised findings.
    RESULTS: Twelve papers met inclusion criteria, representing eleven different ABAs. Within studies, methods varied widely, not only in design and comparators, but also in terms of included costs and outcome measures. Studies suggested economic efficiency, but lack of suitable comparators made more definitive conclusions difficult.
    CONCLUSIONS: Economic evidence around ABAs is limited. ABAs may be a promising way to engage underserved or minority groups, that may have lower net costs compared to alternative health and wellbeing improvement approaches. ABAs, an example of embedded services, suffer in the context of economic evaluation, which typically consider services as mutually exclusive alternatives. Economics of the surrounding services, mechanisms of information sharing, and collaboration underpin the success of assets and ABAs. The economic evidence, and evaluations in general, would benefit from increased context and detail to help ensure more nuanced and sophisticated understanding of the economics of ABAs. Further evidence is needed to reach conclusions about cost-effectiveness of ABAs.
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  • 文章类型: Journal Article
    要了解基于赋权的社区卫生工作者(CHW)培训计划的核心方面,我们研究了Jamkhed农村综合卫生项目(CRHP)的模型,印度-一个以促进妇女作为乡村卫生工作者(VHW)和社区变革推动者而闻名的组织。我们将赋权定义为个人获得健康和发展相关技能和知识的一种手段,以促进其生活和社区内的积极变化。使用VHW培训观察和对卫生工作者和高级培训师的半结构化访谈,制定了6个主题,并在4个焦点小组会议中应用了18个由CRHP培训的多代VHW。成绩单在6个主题选择下进行了定性分析,基线训练,继续教育和支持,社区参与,社区赋权,承诺和长寿。VHW的授权被认为是一个有意的过程,涉及创建安全和支持性的环境,有利于与促进和指导的专业人员进行长期参与性和体验式学习。通过在现场和培训中心进行的计划-VHW互动和知识强化,维持了基线培训的影响。重要的是,这些互动加强了VHWs在所服务社区的可信度和信心。从选择阶段开始,社区参与被认为至关重要。用于选择的方法,培训和持续支持对于培养有能力的干部至关重要,有效和积极的VHW,以及培养持久的自我发展和领导技能。通过诸如获得安全分娩、儿童营养不良率下降,高疫苗接种率以及减少对疾病的污名化和种姓歧视。
    To understand the core aspects of an empowerment-based Community Health Worker (CHW) training program, we studied the model of the Comprehensive Rural Health Project (CRHP) in Jamkhed, India-an organization known for facilitating empowerment of women as Village Health Workers (VHWs) and agents of community change. We define empowerment as a means by which individuals gain health and development-related skills and knowledge to facilitate positive change within their lives and communities. Using VHW training observations and semi-structured interviews with health workers and senior trainers, 6 themes were developed and applied in 4 focus group sessions with 18 multigenerational VHWs trained by the CRHP. Transcripts were qualitatively analyzed under 6 themes-selection, baseline training, continuing education and support, community participation, community empowerment, and commitment and longevity. Empowerment of VHWs was found to be an intentional process involving the creation of safe and supportive environments conducive to long-term participatory and experiential learning with professionals who facilitate and mentor. The impact of the baseline training is maintained through ongoing program-VHW interactions and knowledge reinforcement in both the field and training center. Importantly, these interactions reinforce VHWs\' credibility and confidence in communities served. Community participation was found to be of key importance starting at the selection phase. The methods used for selection, training and ongoing support are critical to developing a cadre of competent, effective and motivated VHWs as well as fostering long-lasting self-development and leadership skills. Downstream effectiveness of community empowerment on health outcomes is demonstrated through indicators such as access to safe deliveries, declining child malnutrition rates, high vaccination rates as well as reductions in stigmatization of illness and caste discrimination.
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