The evolution of community involvement in public health community-based efforts: a case study

It is the opinion of many practitioners and analysts of public health efforts that community involvement is necessary to improve local health status. The nature of community involvement, however, can vary among projects, among sites in the same project and through time in the same site. Clear conceptions of community involvement assist in foreseeing the potential activities, outcomes and challenges of any particular community-based effort. Himmelman's concepts of community betterment and community empowerment offer a useful framework when community-involvement entails the direct participation of local organizations and constituencies. These two concepts are the ends of a continuum whereby in the movement from a community betterment to a community empowerment effort, there is an increase in community ownership and self-determination over all aspects of a project. This paper presents an empirical investigation of one community-based public health effort which instances a movement from community betterment to community empowerment.