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Dr. Kimlin Tam Ashing, PhD

Professor and Director of the Center of Community Alliance for Research and Education (CCARE), City of Hope

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Capacity Building in the Hispanic Community: A Mission to Improve Health and Lives

08/29/2013 07:17AM | 9743 views

Capacity building refers to those activities that a non-profit engages in to achieve, improve upon and sustain its mission over time. These activities are usually focused on ways to engage and better address the needs of the community, as well as develop the infrastructure to support such activities and document the impact – which if successful means the ability to serve more and more members with greater benefit to the community.

For City of Hope, capacity building within the Hispanic community has become a major focus. At 50.5 million people as of 2012, Hispanics are the largest minority in the U.S. – 1 in 6 Americans is now of Hispanic origin and 65% are millennials (ages 22 to 35) – and their numbers continue to grow faster than any other group. Also in 2012, the number of U.S.-born Hispanics reached more than a million, and for the first time immigration was not the leading cause of growth.

Yet, according to a Pew Hispanic Center Report, at least 8 out of 10 Hispanics are still getting their health information from sources other than medical professionals – a fact of great concern to City of Hope, as its catchment area reaches nearly 8 million Hispanics, 16% of the total U.S. Hispanic population. As such, City of Hope is deeply committed to workforce development, and sponsored an exclusive Hispanic Leadership Program hosted by Rice University and The Jones Graduate School of Business in July. City of Hope is also sponsoring a five-city College Leadership Tour across America to recruit and educate Hispanic university students about careers in the healthcare industry.

As City of Hope sees it, there are 5 main components of capacity building: 1) relationship building and trust achieved via bidirectional communication and learning; 2) engaging community health leaders and members in the understanding, developing and implementing of strategies to address their unique healthcare needs; 3) providing technical resources and skills, as well as workforce development; 4) conducting appropriate research and applying the results and findings to improve and benefit the community; and last but not least 5) shared values and responsibility.

For the concept of capacity building to work, you must engage the community from within and learn to think the way that they do. This means respecting the community enough to earn their trust, so that you can begin to establish common goals that address their healthcare needs and empower them to take preventive action and engage in health promoting practices.

Capacity building also depends on having shared values with the community, and showing genuine care and concern for its members. Following through on promises made to the community is one – if not the most – important way to show that you really do care about them, and this will in turn enable you to begin earning their trust. At the same time, you must demonstrate a belief in the community and understand the cultural values and strengths they bring to the table, so they can begin to participate in and take control of their own healthcare. For example, Hispanics are brought up to consider the needs of family and others in the community as much as their own. If they don’t take care of their own health, they risk not only their own lives but the well-being of those who depend on them – quite possibly becoming a burden to those who need them most.

The first step in reaching out to the Hispanic or any community is to establish a presence. This can be anything from a meeting with community leaders to participation in a local health fair, seminar or workshop. Hence, the primary goal of your initial contacts with the community should be relationship building, followed by an assessment of the challenges they are facing and the unique strengths they possess that can be tapped to deal with these challenges. Following up with the community in this manner will show that you are genuinely invested in helping them – because you are taking the time to listen to them and understand what ails them.

Though it might seem easy to begin the engagement process, it’s important to follow through and keep the momentum going, especially with the Hispanic community. Many Hispanics are naturally skeptical – – due to turmoil in their mother countries and lower social status and challenging immigration policies they experience in this country. Thus, if you fail to follow through on your initial contact and relationship building, you will immediately begin to lose ground with the community and in fact may never be able to regain it or recover enough to earn their respect or trust.

Expanding community involvement as well as that of the organization should be your next goal. Bring together various people from the organization who can contribute in positive ways to an ongoing dialog with the community and continue meeting with them on a regular basis. Hispanics in particular are eager to share their hopes and dreams, so be equally eager to share what you can offer to help make dreams of a healthier community a reality.

Come prepared with a transparent approach and ensure all communication is clear as well. If you don’t do both well – prepare and communicate – you run the risk of appearing paternalistic and insincere. This means doing your research before getting too deep into your community engagement and benefits efforts. Start with the basics, the demographics of who lives and works in the neighborhood. Is it mostly Mexicans or Cubans? Puerto Ricans or Colombians? Some other group? Gather as much knowledge as you can beforehand, and if it’s a mix of different groups, understand their different customs as well as the similarities they share. At the same time, be open to letting the community inform you about who they are and what they think are their biggest health challenges. For example, cancer might be the leading cause of death in the Hispanic community, but that doesn’t necessarily mean they would recognize it as their primary health issue. Their health priorities may be quite different than what you expect, so don’t go into the community with any preconceptions based solely on facts and figures.

Instead, go in with the attitude that this is an opportunity for co-education. Listen with an open mind and learn what remedies they have tried in the past, what they think works for them and what doesn’t, and what they feel are their strengths and limitations. Only by learning where they are coming from can you begin to move forward together. From here, once you’ve begun to establish a foundation of trust, you can look around, beneath and beyond the obvious lifestyle risk factors (i.e., smoking, drinking and diet) to include cultural beliefs and practices and systemic barriers.

Listen to the storytellers in the neighborhood, they will know what’s going on in the community and will give you the best examples of people’s strengths as well as the challenges they are facing. They’re usually not too hard to find, as they will be well-known and respected throughout the community.

Don’t limit yourself to traditional community healthcare educators, such as those from the county health department. Although they are good sources of information, so are religious and spiritual leaders and untapped resources in local government. Parks & Recreation and other departments is where you will find community-minded people who are drawn to public service and community activism. But be aware that even public servants – especially Hispanics – may be offended if you just want to “talk shop.” Make it more personal, take them out for coffee or lunch, show that you truly do care about them and that you want to take the time to get to know them. What major trends will you find with the Hispanic community? Often you will find the thinking – especially with Latino men – that “if it ain’t broke, don’t fix it.” When it comes to their health, that translates into, “If I feel healthy, and don’t have any symptoms, then I don’t need a doctor’s check-up.” Yet, how many of those who don’t see the importance of preventative medicine would miss the opportunity to take their car in for a routine oil change and other preventative maintenance? They know it’s necessary to keep the car performing optimally, even when it seems to be running just fine.

Prevention matters, because if you wait too long, it may be too late. Most people know this on some level, and do care about their health, but when they are dealing with more immediate pressures and burdens in their lives, health often gets pushed down the list of things to worry about – especially in low income communities. For example, changing your diet and eating less meat are preventative actions that people can take to improve their health and lower their risk of disease. But newcomers to this country with historical financial and other hardships often start eating more meat and serving it to their families because it’s cheaper and so readily available in our society – especially in unhealthy fast-food portions.

These are the types of challenges that must be understood and addressed. A doctor’s warning will only go so far – but when reinforced with community voices, the message will be further validated and start to sink in. For this very reason, City of Hope is supporting a biomedical pipeline as well as partnering with community leaders and promoters to be health advocates.

Here are a few final pointers and things to remember about capacity building to get you started:

• Find out what the main healthcare event is in your catchment area, and make sure you attend and participate in the coming year. Make some initial contacts, and keep in touch after the event.

• In your follow-up encounters, get to know the rhythms of the community, the cultural values and strengths they bring to the table, and the tension points that are making healthcare more of a challenge for them.

• Don’t overcommit, as you can’t afford to make a bad first impression. But do make some initial commitments that you can follow through on, and then deliver on them as soon as possible. Finally, be thankful for small changes and incremental improvement. Capacity building takes time and effort, so jointly celebrate the small victories along the way.


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