Community-Based Interventions

The article Reconsidering Community-Based Health Promotion: Promise, Performance, and Potential by Merzel and D’Afflitti1 in this issue of the Journal makes a valuable contribution to the literature on community approaches to health promotion. The breadth of studies covered in this review article, combined with the prominence the Journal is giving to the subject in this issue, suggests how far the field has come in its understanding of the links between public health and communities. The authors summarize many of the community-based studies since 1980 and draw useful conclusions for strengthening community-based efforts at improving the health of the US population. Moreover, by drawing from the lessons learned from human immunodeficiency virus (HIV)prevention programs, they provide significant recommendations for improving the potential of community-based strategies. However, we would like to draw the readers’ attention to some of the substantive issues involved in reviewing such a diverse literature, including a number raised by Merzel and D’Afflitti. The term community-based has a wide range of meanings. In this editorial we focus on 4 categories of community-based projects based on implicit constructions of community employed by investigators: community as setting, community as target, community as agent, and community as resource. This typology (many typologies of community approaches have been proposed in the literature, the most frequently used of which is Rothman’s Strategies of Community Intervention2; we chose not to use Rothman’s categories explicitly, although some of his ideas are included in the discussion) is used to illustrate the difficulties in summarizing results across the array of community-based projects (of course we recognize that projects rarely fit our categories neatly and that any one project may have characteristics borrowed from each of the categories). This brief discussion of “types” of projects is followed by a discussion of the importance of community capacity; the use of social ecology as a framework for community interventions; the use of a theory of community change; and the role of public health values.