Committed, ambivalent, concealed, or distanced: community organisations’ perceptions of their role in local prevention systems

ABSTRACT

Prevention of chronic diseases happens within systems of action across whole communities. In local communities, organisations play important roles that influence health, but many are in non-health sectors where health or ‘prevention’ is not their main remit. In this paper, we explore how organisations in communities perceive their role as part of a local system of chronic disease prevention. We use interview data from ‘Prevention Tracker’, an investigation undertaken with Australian communities that aimed to describe how local prevention systems are organised. Four communities participated – one regional, one remote, and two urban. In each, local advisory groups identified key informants for semi-structured interviews (n = 80). We applied the Ottawa Charter for Health Promotion as a sensitising framework to categorise responses; and undertook inductive thematic analysis to generate deeper insights into organisations’ orientation to prevention. While some respondents clearly recognised and articulated linkages between their organisation’s activities and prevention, sometimes drawing from health promotion principles to do so, many did not and were prompted by the interview to consider their contributions. A proportion explicitly distanced themselves from prevention despite their work directly addressing the social determinants that underscore health. For some, this distancing reflects a tactical decision to reduce competition and promote partnership between organisations, and to engage clients. This study demonstrates that diverse organisations make contributions to prevention – often outside of ‘core business’ – whether or not the organisations themselves realise, relate to and/or self-identify as playing this role.

KEYWORDS:

• Prevention
• health promotion
• systems thinking
• community organisations

Acknowledgements

We wish to thank the communities, participants, and partners of the Prevention Tracker project. Preliminary results for this paper were presented at the International Union of Health Promotion Educators conference in Rotorua, April 2019. We thank the attendees for the useful discussion and feedback which were incorporated into this draft as well as Drs Janya McCalman and Luca Conte for their feedback. We also thank Rose Ryan and Nick Roberts for their work on the Prevention Tracker pilot, conducting the initial interviews. Finally, we gratefully acknowledge and memorialise our departed colleague Sonia Wutzke, whose bold leadership and innovation established Prevention Tracker.

Disclosure statement

The authors have no conflicts of interest to disclose.

Data availability statement

The datasets generated and/or analysed during the current study are not publicly available due to information that could compromise research participant consent and privacy.

Author contributions

KC conceptualised the research questions for and led this analysis. TJR with KC co-analysed the data and co-developed the first draft of the manuscript. KC, LH, and TR conducted the interviews in three communities. LH, TR, and MG established Prevention Tracker and led the project under TR’s guidance and conducted extensive fieldwork throughout the project. All authors participated in the interpretation of the analysis, have read and approved the final version of this manuscript.

Supplementary material

Supplemental data for this article can be accessed here.

Notes

1. In the context of COVID-19, which began after this research was completed, our findings take on a heightened salience as the serious consequences of fragmented prevention systems across the world are emerging. The COVID-19 pandemic has exposed severe inefficiencies in cross-sector coordination that are contributing to deaths and major disparities in health consequences (Metzl et al., 2020). If community organisations continue to be unaware of their roles in health and prevention, or unable to fully or formally embrace them, it will be impossible to build comprehensive health systems.

Additional information

Funding

This research was supported by The Australian Prevention Partnership Centre through the NHMRC partnership centre grant scheme [Grant ID: GNT9100001] with the Australian Government Department of Health, NSW Ministry of Health, ACT Health, Hospital Contribution Fund (HCF) of Australia, and the HCF Research Foundation.