Empowering the Community to Identify and Prioritize Neighborhood Development Needs: A Qualitative Study

authors:

avatar Hosein Malekafzali 1 , avatar Parisa Shojaei ORCID 2 , avatar Salime Zare Abdollahi ORCID 3 , avatar Mohammad Hasan Lotfi ORCID 4 , *

Department of Biostatistics and Epidemiology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Department of Community and Preventive Medicine, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
Social Determinants of Health Research Center, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Department of Biostatistics and Epidemiology, Faculty of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran

how to cite: Malekafzali H, Shojaei P, Zare Abdollahi S, Lotfi M H. Empowering the Community to Identify and Prioritize Neighborhood Development Needs: A Qualitative Study. Jundishapur J Health Sci. 2022;14(2):e122089. https://doi.org/10.5812/jjhs-122089.

Abstract

Background:

The present study aimed to empower the community to identify and prioritize the needs for the health development of the Eskan neighborhood in Yazd province, Iran.

Methods:

This community-based participatory research (CBPR) was conducted in the Eskan neighborhood, Yazd. The project ‘neighborhood health improvement plan (Tabasom)’ was conducted, which included five steps (i.e., area identification, organization, empowerment, needs assessment and prioritization, and intervention and action). In the present paper, two steps, namely empowerment and needs assessment, are described.

Results:

The results revealed 10 high-priority problems in the Eskan neighborhood. The first problem with the highest priority was associated with waste management.

Conclusions:

According to the findings, empowering and educating individuals to detect the neighborhood problems led to the better identification of the problems, resulting in the further development of the neighborhood and the provision of more effective solutions by the authorities with the community participation.

1. Background

Although the inclusion of community participation in health programs is not a new phenomenon, it has received worldwide attention after being discussed by the World Health Organization (WHO) at a conference in Almaty (formerly Alma-Ata) in September 2016. Since then, it has spread across the globe and is being considered one of the fundamental principles of primary health care (PHC) (1). In Iran, regarding the problems with informal settlements in metropolises and even the middle cities, different approaches to problem-solving have been considered. In some cases, evacuation and demolition policies have even been observed in some metropolises. The Eskan neighborhood, with a population of above 16,000 persons, is located on the western border of Yazd, Iran. Following the implementation of the Health Transformation Plan by the 11th government, the Comprehensive Health Services Center of the region was founded in 2016 to provide a variety of health services to the residents. Considering the potentials of the neighborhood, including a dynamic and popular non-governmental organization, the place was nominated for the implementation of the neighborhood empowerment and optimal health development program (Tabasom Project). The Neighborhood Health Improvement aimed at organizing the community, empowering the residents, supporting individuals to use their capabilities and potential to identify and solve neighborhood problems, and encouraging community self-reliance.

2. Objectives

This project aimed to provide a model for community organization and empowerment to identify and prioritize needs in line with the development of the Eskan neighborhood in Yazd.

3. Methods

This community-based participatory research (CBPR) aimed at the development of the Eskan neighborhood, Yazd. The neighborhood health improvement plan (Tabasom) was implemented in five steps, including area identification, organization, empowerment, needs assessment and prioritization, intervention and action. This article describes the empowerment and needs assessment steps.

In the area identification and organization steps, according to the censuses and the neighborhood map, the neighborhood population was divided into some clusters to facilitate working. In the concerned clusters, among those who were volunteers, provided more dialogue, justification, and consideration, literate (at least in the first grade of high school), could understand the subject more easily, and transferred information to the cluster members more successfully, were selected as the cluster heads. The population of the region, volunteers, and cluster heads were named as the neighborhood health club. In the empowerment phase, the club was trained. They were first taught about qualitative research, needs assessment, and prioritization. In other words, when they surveyed the problems of a cluster, they adopted the qualitative research method. To this end, some university professors were invited to teach the club, and qualitative research was explained to those individuals using a simple language. Such training meetings were held because they were supposed to refer to their clusters and, with the help of people and other volunteers, find the priorities of each cluster via group discussions. Accordingly, the cluster heads should have been fully prepared to guarantee the success of the needs assessment in the neighborhood.

Another issue was the discussion of prioritization. That is, when we found the needs of a cluster, we had to identify ten priority needs among those needs according to the scientific procedures. This implied that two types of training materials were necessary for the club members: Qualitative research and prioritization.

Since it was not possible to train the whole population of the region, the volunteered cluster heads were trained and empowered in each cluster to train the other members. The following steps were adopted to empower all clubs, including the head clusters, trustees, the health team, and club representatives: (1) Holding a workshop on qualitative research and how to conduct interviews and group discussions for the selected head clusters (diploma holders or individuals with higher levels of education); (2) cascade training for other head clusters in small groups; (3) training on how to identify and prioritize problems; (4) training on negotiation techniques, litigation, and others; (5) organizing orientation and training sessions for interdepartmental authorities; (6) organizing empowerment sessions for the health team members; (7) holding a workshop on empowering needy job seekers (marketing, proposal writing); and (8) holding basic and environmental health education classes for the region residents.

3.1. Community Needs Assessment (Identifying and Prioritizing Problems)

In this step, the following measures were adopted: (1) Conducting at least two group discussions in each cluster and identifying problems (Given the significance of the native culture, women had at least one group discussion with the neighborhood ladies, and men held one session with the neighborhood men); (2) prioritizing and determining ten high priority problems in each cluster; (3) integrating clusters’ priorities; (4) extracting the top ten priorities of the neighborhood; (5) submitting high priority problems to the neighborhood health club; (6) sending high priority problems from the neighborhood health club to the board of directors; and (7) creating workgroups to solve priority problems (10 workgroups).

3.2. Needs Assessment Method

(1) Forming small group discussions by the cluster heads in each clusters; (2) typing down all group discussions; (3) having a quantitative content analysis of the reported problems; (4) identifying the problems; and (5) listing all problems in a form.

3.3. Group Discussion Questions

We intend to hear the region’s health problems from you and the neighborhood community so that, with your participation, we can determined the main ones and plan together.

- In your opinion, what are the problems in your neighborhood?

- What cultural problems are there in your region?

- What health-related problems are there in your region?

- What are the social problems in your region?

- What are the economic problems in your region?

It is essential to obtain the participants’ consent in group discussions (written consent). Moreover, if agreed by the participants, the sessions need to be recorded. This will help transcribe the discussions.

3.4. Prioritizing the Problems

3.4.1. Criteria for a High Priority Problem

(1) Magnitude

(2) Emergency

(3) Feasibility

(4) Consequences

To prioritize the problems, a meeting was held by the cluster heads and the representative of the board of directors of the neighborhood health association, who had been trained in prioritizing problems. The problems were prioritized using the Hanlon method for prioritization. Accordingly, each problem extracted from the community was scored by each participant in terms of magnitude, consequences, feasibility, and emergency in separate tables with scores ranging from 10 (highest) to 1 (lowest). The mean score of each problem was estimated, and finally, the total mean score for each problem was calculated. Given the final scores, the top ten priorities were ranked on an ordinal scale, as reported in the table of problem prioritization. These ten problems must have been proposed and approved by the Neighborhood Health Association as the high-priority problems of the region.

Ethical approval was provided by the Iran Research Ethics Committee of the Shahid Sadoughi University of Medical Sciences and Health Services, Yazd, Iran [Code: Ir.ssu.rec.1396.212]

4. Results

Table 1 shows the demographic information of the cluster heads. One hundred two focus group discussions were conducted, each lasting 30 - 110 minutes, from April to October 2018. In general, 1224 individuals participated in the group discussions. Discussions were recorded and transcribed, and the cluster heads spared their efforts to take important notes during the discussions. Table 2 presents the problems of the Eskan neighborhood in priority (38 clusters). Using the Neighborhood Needs Assessment in a qualitative study (focus group discussions - FGD), the extracted codes were classified into some subcategories, categories, and themes (Table 3), according to which the first ten priority problems of the Eskan neighborhood were extracted (Table 4).

Table 1.

Cluster Heads’ Demographic Information in Eskan Neighborhood

Variables No. (%)
Gender
Female59 (61.46)
Male37 (38.54)
Age (y)
18 - 29.919 (25.95)
30 - 5077 (37.08)
Level of education
Elementary 22 (22.91)
High school 23 (23.96)
Academic51 (53.13)
Occupation
Self-employed14 (14.58)
Retired 3 (3.13)
Officer13 (13.54)
University student8 (8.33)
Worker7 (7.29)
Housewife51 (53.13)
Table 2.

Prioritized Problems of Eskan Neighborhood (48 Clusters)

No.PriorityConsidering Min. Score
Mean (SD)Median
1Waste16.2 (5.9)19.5
2No asphalt/broken asphalt15.6 (5.4)17.0
3No parking lot15.3 (5.6)17.0
4No educational space15.0 (5.1)16.5
5No green space14.7 (5.5)16.0
6No middle school and high schools14.1 (5.3)16.0
7No house deed13.9 (5.5)13.5
8No bus station, canopy, and seats 13.9 (5.8)14.5
9No bank13.9 (5.4)15.0
10Unused lands and ruins13.7 (5.3)15.0
11No urban bus13.6 (5.8)13.5
12No pharmacy13.6 (5.7)15.5
13Unpaved sidewalk13.5 (5.7)13.5
14Lack of primary school13.3 (5.4)15.5
15Insecurity 13.3 (6.1)10.5
16No library12.8 (4.9)13.0
17Cats and dogs12.7 (5.1)8.0
18Afghan nationality12.5 (5.0)10.0
19No sanitation of alleys12.4 (5.4)8.0
20No visit by authorities 12.3 (5.3)8.0
21House toll/tax11.8 (4.9)8.0
22Poor internet network11.8 (4.9)8.0
23No footbridge11.5 (5.2)8.0
24Beautification of Eskan entrance11.5 (5.2)8.0
25No trash cans on streets11.5 (5.3)8.0
26Addicts11.4 (5.2)8.0
27Presence of factories in the neighborhood11.2 (4.4)8.0
28No religious facilities11.2 (4.9)8.0
29Absence of cell phone coverage 11.0 (4.7)8.0
30Speed breakers11.0 (5.0)8.0
31Breach of covenant10.9 (5.0)8.0
32Traffic in Sanaat Sq.10.8 (4.8)8.0
33Landlords: Renting to refugees and Afghan evacuees10.6 (4.5)8.0
34Concern about house demolition order10.5 (4.5)8.0
35No institute for the intellectual development10.5 (4.0)8.0
36No language institute10.3 (4.0)8.0
37No laboratory equipment10.3 (4.7)8.0
38No dentistry10.3 (4.1)8.0
39Addiction prevention training courses10.2 (4.3)8.0
40Traffic10.0 (4.5)8.0
41Dirty walls of alleys and streets10.0 (3.6)8.0
42No celebration hall9.9 (4.1)8.0
43No injection services9.9 (4.7)8.0
44No technical & vocational training institute9.9 (3.8)8.0
45Poor street lighting9.8 (4.2)8.0
46Failure to repair hussainiyas9.3 (3.2)8.0
47Sports club discount9.3 (3.8)8.0
48No gym9.3 (3.5)8.0
49Employment8.9 (3.3)8.0
50No specialized clinic8.9 (3.0)8.0
51No training institute8.8 (2.7)8.0
52Construction waste collection8.8 (3.0)8.0
53Arman underpass bridge8.7 (2.9)8.0
54No sports space for women8.7 (2.9)8.0
55Existence of mice and snakes8.6 (2.4)8.0
56No footbridge8.6 (2.3)8.0
57Poor individual culture8.5 (2.1)8.0
58Heavy vehicle traffic8.5 (2.0)8.0
59Water and power distribution costs8.5 (2.3)8.0
60Residents’ lack of cooperation8.4 (2.2)8.0
61No waste collection vehicle8.4 (2.3)8.0
62No sewerage system8.4 (2.1)8.0
63No police station8.4 (2.0)8.0
64Heavy vehicle traffic8.4 (1.9)8.0
65Shortage of parking space8.3 (1.6)8.0
66Inappropriate street numbering8.3 (1.6)8.0
67Poverty8.3 (2.0)8.0
68No shopping center8.3 (1.4)8.0
69Pay fines to the municipality for utilities8.3 (2.0)8.0
70No police station8.3 (1.8)8.0
71Lack of women’s employment8.3 (1.3)8.0
72No lending fund8.2 (1.7)8.0
73No gas station8.2 (1.2)8.0
74Pigeon keeping8.2 (1.7)8.0
75No supervision of the real estate agencies8.2 (1.7)8.0
76High expenses of kindergarten8.2 (1.4)8.0
77No water dispensers8.2 (1.4)8.0
78Existence of flies and mosquitoes8.2 (1.3)8.0
79Costly commuting to schools 8.2 (1.3)8.0
80Lack of skilled teachers at schools8.2 (1.3)8.0
81No bakery8.2 (1.1)8.0
82No Basij site8.2 (1.1)8.0
83Deed fraud 8.2 (1.1)8.0
84Absence of facilities at the neighborhood’s endpoint8.2 (1.1)8.0
85No trees in streets8.1 (1.0)8.0
86No soccer school8.1 (1.0)8.0
87No hospital8.1 (0.8)8.0
88Excavated lands8.1 (0.8)8.0
89Bachelor pads8.1 (0.8)8.0
90Workshop camera inconvenience8.1 (0.8)8.0
91Workshop inconvenience8.1 (0.8)8.0
92Security cameras in alleys8.1 (0.7)8.0
93The youth’s leisure time8.1 (0.4)8.0
94Tree planting/lighting/30m St.8.0 (0.0)8.0
95Asphalt in street No. 8 8.0 (0.0)8.0
96Absence of police patrol8.0 (0.0)8.0
97Poor quality bread8.0 (0.0)8.0
98No telephone landline in the streets8.0 (0.0)8.0
99High rental costs8.0 (0.0)8.0
100No summer school8.0 (0.0)8.0
101Occupational loans8.0 (0.0)8.0
102Religious mourning group8.0 (0.0)8.0
103Traffic line/guide sign8.0 (0.0)8.0
104House number plate8.0 (0.0)8.0
Table 3.

Categories of Problems in Eskan Neighborhood

ThemeCategorySubcategory
SocialCulture and education House rental to Afghan nationals
Addicts
No religious mourning group
Poor individual culture, lack of cooperation and participation of residents
Pigeon keeping and causing inconvenience
EducationShortage of skilled teachers at schools
No addiction prevention training courses
Well-being and sportNo celebration hall
Need for sports club discount
The youth’s leisure time
Construction and developmentInfrastructurePoor internet network, absence of cell phone coverage, no telephone landline in the streets
Arman underpass bridge
Unpaved alleys and broken asphalt, unpaved sidewalks, asphalt on alley No. 8
Well-being and sportNo gas station, lack of facilities at the neighborhood’s endpoint
No bakery, no shopping center
No Basij site
No gym, no sports space for women, no soccer school
Urban spaceNo park, no green space, no trees in streets, Tree planting and lighting/30m St.
Beautification of Eskan entrance, Dirty walls of alleys and streets
CultureNo library
No religious facilities, failure to repair hussainiyas
No middle school and high school, lack of primary schools, no technical & vocational training institute
No educational space, no language institute, no Institute for intellectual development
Health and clinical affairsNo laboratory equipment, No injection services
No pharmacy, no dentistry
No hospital, no specialized clinic
Transportation No urban bus, no bus station, canopy, and seats
No footbridge, speed breakers, poor street lighting, traffic line/guide sign
Traffic, traffic in Sanaat Sq., heavy vehicle traffic
shortage of parking space
Management and securityManagement Authorities’ breach of covenant, no visit by authorities, No supervision on the real estate agencies
Security Workshop camera inconvenience, unused lands and ruins, presence of factories in the neighborhood, insecurity, security cameras in alleys
Migrants and nationals problems, Afghan nationals, bachelor pads
No police station, absence of police patrol
HousingHousingNo house deed, deed fraud, concerns about house demolition order, excavated lands
Lack of registration plates for houses, inappropriate street numbering
Health Environment Waste collection and disposal, no large trash cans in alleys, no sewerage system, existence of cats and dogs, mice and snakes, flies, and mosquitoes, construction waste collection, no waste collection vehicle, no sanitation of alleys
Service Poor quality of bread
Economic House tax, pay fines to the municipality for utilities, water and power distribution costs, high rental costs
Employment, lack of women’s employment
Poverty
No bank, lending fund, and occupation loan
High expenses of kindergartens
Costly commuting to schools
Table 4.

Ten High Priority Problems of Eskan Neighborhood

RankPriority TitleMeanMedianS.D.
1Waste16.219.55.9
2Unpaved alleys and broken asphalt15.617.05.4
3Lack of parking lots15.317.05.6
4Shortage of educational space15.016.55.1
5No green space14.716.05.5
6No middle school and high school14.116.05.3
7No house deeds13.913.55.5
8No bus station, canopy, and seats13.914.55.8
9No bank13.915.05.4
10Unused lands and ruins13.715.05.3

5. Discussion

The prioritization process by selecting high priority problems leads to implementing an intervention project in the community, resulting in the development of the Eskan neighborhood. This study aimed to promote participation and enhance social interaction to solve the problems in the Eskan neighborhood and ultimately develop the region. In this study, the top 10 priorities were extracted. Focus group discussion is a social research method performed as a structured discussion, which involves sharing and clarifying participants’ views and ideas. The method is mainly used for analyzing issues leading to different opinions or complicated issues requiring careful examination. This method has resulted in sharing different perspectives and experiences on the topics under discussion and allows for a precise assessment of different actors’ positions regarding each problem (2-4). In this study, 104 problems in the community assessment process were identified, which were classified into six dimensions: Social, development and civil, management and security, housing, health, and economics. Comparing the results of this study with similar studies conducted in the Azarbayjan neighborhood in Tehran (5), the Chahestani neighborhood in Bandar Abbas (6) the Mehdi Abad and Bastam neighborhood in Shahroud, (7) Gonabad (8), Alani village in Meshkinshahr, one Rural region in Nigeria (9), Tulsa (USA) (10), and one of the neighborhoods of Buenos Aires (11) indicated that although the problems in these societies are more or less similar in general dimensions (namely social, development and civil, management and security, housing, health, economic, and others), the problems in each field are different in these communities as a result of differences in social, economic and cultural variables of different societies. This evidently justifies the necessity of the needs assessment and the identification of problems in each society by individuals in the same society.

Different analyses by various experts indicate the importance of the prioritization process. In this regard, Kamuzora et al. stated that community participation in prioritization in developing countries, characterized by weak democratic institutions and poor public awareness, requires the effective mobilization of communities and health systems (12). Moreover, this study confirmed that community participation is one of the main factors empowering health systems. The findings also indicated the significance of external support and facilitation in empowering health professionals and community representatives to reach efficiency (12). Developed prioritized decisions improve the quality of service delivery and stakeholders’ satisfaction and reduce complaints leading to increased trust and appropriate allocation of resources (13). Some studies have documented the success of these structures in terms of community participation. For example, they have noted that communities have identified and interpreted their problems and, using the existing administrative structures, have discovered resources to implement what they consider as relevant projects (14). Aristeidou et al. explained that we needed to categorize the levels of engagement across different types of community participation and consider group members in interaction profiles according to their behavior patterns (15). The findings illustrate the need for a different design approach regarding citizens’ participation in community and individual profiles (15).

5.1. Conclusions

The benefits of community participation in the decision-making process vary depending on the type of public services.

Acknowledgements

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