Inequities in birth outcomes are best understood as “wicked problems” affected by challenges at the individual, interpersonal, community, and societal levels. Community-driven, place-based interventions are a promising upstream approach to address the factors contributing to poor birth outcomes, and to transform communities into spaces where all people can live and thrive. The mechanisms of successfully applying a community-driven approach to place-based transformation have not been well articulated, however. The objective of this study was to create a model of these variables using group model building, a qualitative, participatory approach in the systems dynamics tradition. By creating this conceptual model of the mechanisms facilitating and challenging community-driven work, others seeking to implement this strategy can be grounded in a more comprehensive understanding of what it means to fully engage residents to transform communities.
The Best Babies Zone Initiative is a place-based, multi-sector initiative that operates in nine locations throughout the United States. Convenience sampling was used to identify and recruit individuals who were doing community-driven work in five of these Zones across the US. Participants (n=9) engaged in one two hour session in February 2018, which was audio recorded and transcribed. Participants’ duration of doing community-grounded work ranged from 4 years to 30 years (M = 10.9, SD = 8.4). A semi-structured script was used to guide participants through the model-building session. Participants began by defining what it means to do community-driven work, what makes this approach valuable, and what makes it challenging. Next, they identified factors associated with implementing a community-driven approach and drew connections among those factors. A conceptual model was collaboratively constructed in the session.
Group model building provided a useful methodology to learn from practitioners who are using a community-driven approach to develop and implement place-based initiatives. The model reflects the complexity of engaging in community-driven work and resulted in the identification of factors, and connections between them related to: organizational collaborations, the relationships between organizations and funders, direct work with community residents, and organizational best practices. A number of key leverage points were identified to facilitate community-driven work.
As the field of social work seeks to identify and implement effective strategies to achieve health equity, as articulated in the Social Work Grand Challenges, community-driven approaches must be prioritized. Findings from this study can be used to support practitioners doing this work by: (1) informing their understanding of the complexities of community-driven work, (2) helping them plan for potential challenges, and (3) leveraging opportunities for full, meaningful engagement. Further, this model can be used by researchers to better understand the nuances of doing community-driven work, which is an important component of measuring the effectiveness of this approach in working towards health equity.