November 19, 1999
Comprehensive community health projects often include a variety of organizations working together to achieve a common goal. Making sure these organizations plan and implement the projects effectively is the aim of Robert Goodman, Usdin Family Professor of Community Health Sciences in the School of Public Health and Tropical Medicine.
"When different constituencies get together to work on improving a community, even though they're concerned about the same issue, they have different reasons for coming to the table," Goodman says. Sometimes those differences can cause conflict. Goodman has developed a system named FORECAST (Formative Evaluation, Consultation and Systems Technique) to help groups develop, plan and implement programs designed to improve public health.
He is using the technique to help the organizations involved in the National Diabetes Prevention Center in Gallop, N.M. The project, which aims to prevent and treat diabetes in Native Americans, is composed of groups including the Centers for Disease Control (CDC) and Prevention, the Indian Health Service, the University of New Mexico, Dini College, the Zuni Pueblo tribe, the Navaho Nation, the Zuni Public Health Service Hospital and the Gallop Indian Medical Center.
The diabetes prevention program focuses on educating New Mexicos Native American community members about the risk factors associated with diabetes, improving their access to medical care and assuring the quality of care they receive.
The FORECAST technique is meant to involve community stakeholders from the beginning, developing consensus through negotiation and compromise-building the partnership at the same time the program is being built, Goodman says. "It's a very big challenge to bring all of the groups together, to have the approaches we take be culturally sensitive and culturally appropriate and to have consensus among all of these groups."
To ensure that the project achieves its goals, Goodman starts by distilling the technical, wordy proposals that funded the program to a one-page diagram that serves as a road map of the project from the first steps of organization to measuring the outcomes.
He then develops markers, which serve as milestones in the project, and includes a list of measures to show whether project leaders have reached these markers. He ends by interpreting the project's success, what he calls meaning.
"It's not an evaluation in the traditional sense of the word," he says. "I don't believe in evaluations that look at good or bad or right or wrong. My approach is to act as a mirror that reflects back what I see so that the stakeholders can use the assessment to improve their approach."
Goodman, who has applied this technique to a variety of projects, including numerous alcohol-, tobacco- and drug-use prevention programs in South Carolina, says the FORECAST system helps identify areas early in the planning process that may lead to problems once the project is under way. In the diabetes prevention program, Goodman's analysis indicated a potential for duplication of educational services among the Indian Health Service, the University of New Mexico and the CDC. When these groups got together, they addressed this issue head on.
"The way to deal with it is to be forthright," he says. "You put it on the table with all the people present and discuss it. We look for ways of dividing up the tasks, and, where there might be potential overlap, look at how that overlap can be cooperative instead of competitive."
Goodman stresses that his role in the New Mexico project is a small part of the entire endeavor and that the credit for the project's effectiveness belongs with the various groups involved. He adds that it's important to remember the ultimate goal of this massive project: to improve the lives of members of the Native American community.
One of the local grassroots workers related a story of a Navaho woman who lives on the reservation and had her leg amputated because of diabetes. She now hops to the outhouse because she has no running water, he says. "Designing and implementing the best program possible means a better life for this woman and the entire community," Goodman says.
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