Examining Resident Power Building in a Place-Based Initiative

Abstract

Rates of diseases and disabilities that are otherwise preventable are higher in low-income communities and communities of color. These disparities are attributed, in large part, to a power imbalance between residents and decision makers, and restoring resident power is necessary to improve health outcomes. A key strategy in many health promotion programs, resident power building is a process by which residents gain necessary skills to improve social conditions through their involvement in community change work. This study is part of a larger evaluation of Building Healthy Communities, a ground-breaking 10-year, $1 billion place-based initiative funded by The California Endowment designed to reverse the historical impact of racial and economic discrimination by advancing statewide policy, changing the narrative around health, and transforming underserved communities to achieve health equity. This article presents the resident power framework and identifies five domains that contributed to resident power building: continuity, culture, context, concrete action, and capacity. Continuity and culture mattered most to residents’ ability to organize and to their ability to exercise their voice, respectively. While this study examined resident power building within the context of a large-scale place-based initiative, the domains that the authors identified are salient across health promotion programs that use power building as a key strategy to achieve program outcomes. The domains serve as opportunities to modify power-building strategies and allow program staff to allocate resources to specific activities to achieve program outcomes.

Keywords

resident power power building community capacity building community capacity community empowerment community mobilization place-based evaluation local evaluation

Rates of diseases and disabilities that are otherwise preventable are higher in low-income communities and communities of color. This results in gaps in health status between the rich and the poor, and between racial/ethnic minorities and non-Hispanic Whites. Disparities in health outcomes are attributed, in large part, to decisions made by people in positions of power. These decisions often reflect corporate and governmental interests and are made without community input, resulting in structural racialization, or the cumulative, durable, and race-based inequalities (LaVeist et al., 2011) that contribute to disparities in health outcomes. For example, the disproportionate number of waste facilities in low-income communities and communities of color results in increased exposure to environmental pollutants (Ludwig et al., 2012), and limited access to healthy food and green space has been associated with chronic conditions such as diabetes and cardiovascular disease (Astell-Burt et al., 2014; Malambo et al., 2016) and with higher all-cause mortality (Gascon et al., 2016).

Place matters in health and well-being, such that one’s zip code is as important as one’s genetic code, because it determines access to healthy foods, green space, quality schools, economically-viable jobs, and other resources associated with health and economic outcomes. Strategies to improve health outcomes are moving beyond traditional public health approaches that focus on changing individual-level factors to place-based initiatives that aim to make systems-level changes. Included in this approach is a focus on resident power building, which is based on the recognition that neighborhood disinvestment results from a power imbalance between residents and decision makers. Place-based initiatives aim to improve health outcomes by engaging residents in decision-making processes to address the social inequities that are at the root of health disparities (Israel et al., 2010; Labonte, 1994; Malqvist, 2018; Pastor et al., 2018; Thompson et al., 2016; Wallerstein & Duran, 2006).

Building resident power is a key strategy in achieving health equity. We define resident power building as the process by which residents gain knowledge and skills through their community involvement. We view resident power building as a bottom-up, asset-based approach to empower residents in low-income communities and communities of color. This approach recognizes a community’s strengths and resiliency and empowers residents to tap into these community assets to challenge systems of oppression. Resident power is related to community capacity (Goodman et al., 1998), community competence (Eng & Parker, 1994), community cohesiveness (Geyer, 1997), and social capital (Putnam, 1995), but it is most closely related to community empowerment, which has gained the most prominence in health promotion, as it recognizes an individual’s ability to organize and mobilize as critical to the change process (Wallerstein & Duran, 2006). This study examined resident power building within the context of a large-scale place-based initiative to identify the domains connected to resident power that may be salient across health promotion programs that use power building as a key strategy to achieve program outcomes.

Building Healthy Communities Long Beach

Building power is the cornerstone of Building Healthy Communities (BHC), a ground-breaking, 10-year, $1 billion place-based initiative funded by The California Endowment (TCE) designed to reverse the historical impact of racial and economic discrimination by advancing statewide policy, changing the narrative around health, and transforming underserved communities to achieve health equity. TCE selected Central/West Long Beach as one of 14 communities to implement the BHC initiative based on key health and socioeconomic indicators that show gross disparities in health outcomes. Additional background on these indicators can be found in the Supplemental Material.

Launched in 2010, BHC Long Beach has since grown into a collaborative of more than 50 partner organizations working together to improve community health. BHC prioritizes increasing social and political power among residents to change policy and systems. Residents involved in BHC Long Beach gain knowledge and skills in the resident leadership pathway (RLP), a structured approach to power building that consists of a series of workshops and training programs facilitated by community leaders and organizers with expertise in specific issue areas, such as housing, air quality, and food access. Workshops and training programs within the RLP are hosted by BHC Long Beach partner organizations and are designed to increase knowledge of decision-making processes and the skills needed to challenge or reverse the impact of these decisions. Outside of the RLP, residents gain knowledge and skills in unstructured spaces, such as through volunteer work on campaigns within BHC Long Beach.

Resident Power Building

The resident power framework emerged from an evaluation study designed to identify BHC Long Beach activities that contribute to power building. Identifying these activities serve several programmatic purposes. One, the identification of specific domains connected to resident power helps evaluate the effectiveness of power-building activities, thereby allowing programs to be more easily replicated in new settings. Two, a better understanding of the activities associated with power building is key in ensuring effective programming, as resources can be allocated to specific activities to achieve different goals. Finally, the ability to measure the effect of program activities on power building is of particular interest to funders who want to know whether funding community organizing, advocacy, and other power-building activities lead to increased community capacity to engage in social change.

Methodology

Resident Power Survey

As the learning and evaluation team for BHC Long Beach, we are composed of public health researchers and senior staff at a community-based organization that serves as the hub for the BHC Long Beach collaborative. We developed the Resident Power Survey in 2012 to examine resident power building as part of the evaluation of BHC Long Beach. To develop the Resident Power Survey, we conducted an extensive literature review of relevant social science theories and previous efforts to measure resident power or similar concepts (e.g., community empowerment, community mobilization, community capacity building). We identified three elements as having the most relevance to resident power-building activities. They include (1) engagement (the perceived level of involvement, satisfaction, value of contribution, and connectedness), (2) leadership (the ability to access and utilize information, challenge authority, engage in strategic thinking and planning, and knowledge of and access to leaders and decision makers), and (3) influence (the perceived level of influence on the decision-making process, successful campaigns, and life improvements).

Community engagement was key in our understanding of resident power. We engaged the community by holding community forums to present the three elements of resident power to partner organizations that engage in power building to solicit feedback on the relevancy of these elements to their idea of resident power. We also presented the elements of resident power to BHC Long Beach staff and to TCE leadership in smaller meetings. Finally, we submitted a draft survey to an advisory board that consisted of community leaders within the BHC Long Beach collaborative for review and feedback, and pilot tested the survey with a small group of residents. Reflecting the primary languages of Long Beach residents, the final survey contained 128 items and was available in English, Spanish, and Khmer.

To recruit survey participants, we compiled a list of BHC Long Beach workgroups, coalitions, and partner organizations with resident volunteers. We contacted group and organizational leaders via email and/or telephone to explain the purpose of the survey and to ask for assistance in recruiting participants. Survey eligibility criteria in 2013 were (1) age 14 years or more, (2) resident of Central/West Long Beach, and (3) direct involvement with BHC Long Beach through workgroups and coalitions, or indirect involvement through volunteer work with a partner organization.

The first wave of data collection took place between July and October 2013. A large majority of participants completed surveys online using home computers or handheld tablets that the evaluation team provided. Participants completed surveys individually or in a group setting at an organizational partner meeting with interpretation, if language assistance was needed. During group data collection, we asked participants to refrain from discussing survey items among each other and to sit at least 3 feet away from the nearest individual to protect confidentiality. The survey took approximately 45 to 60 minutes to complete, depending on the number of questions that applied to each respondent. Residents received a $10 Target gift card as an incentive for completing the survey.

Challenges with participant recruitment and survey completion in 2013 resulted in several changes. We shortened the survey by removing items that produced redundant data, changed age eligibility to 18 years and older to avoid overburdening youth who were already involved in a study on youth leadership, and increased the incentive to a $20 gift card. The final survey consisted of 70 items and took approximately 30 to 45 minutes to complete. The second and third wave of data collection took place between July and November 2015 and August and December 2018, respectively.

Data Analysis

Using SPSS Version 19, we conducted univariate descriptive analysis on all survey items to examine frequency distribution. As the surveys were completed anonymously, there was a possibility of repeated respondents across the three waves of data collection. However, preliminary data analysis did not reveal statistically significant differences in length of involvement in BHC Long Beach between respondents from the three waves of data collection. This gave us confidence that each wave of data collection captured new residents, so we combined the samples into one large sample for further analyses.

Operationalizing Resident Power

We operationalized the three elements of resident power (i.e., engagement, leadership, and influence) by grouping together individual survey items into five composite variables. We measured engagement with one composite variable titled Residents’ Involvement in Community Decision Making (“resident involvement’—12 items); leadership with three composite variables Residents’ Ability to Exercise Voice (“exercise voice”—three items), Residents’ Ability to Use Information for Community Improvement (“use of information”—eight items), and Residents’ Ability to Organize and Advocate for Community Improvements (“organize and advocate”—11 items); and influence with one composite variable Residents’ Perceptions of BHC Long Beach Contributions (“BHC Long Beach contributions”—four items). We then performed a factor analysis to assess internal consistency for each composite variable; Cronbach’s alpha ranged from .81 to .90. Table 1 presents sample survey items within each composite variable.

Table 1
Five Composite Variables and Sample Survey Items

Resident involvement Voice Use information Organize and advocate BHCLB contributions

I have been successful in influencing decisions that affect my community. I am comfortable stating my opinion publicly when it is different from that of systems leaders. I am able to get information related to issues that are important to me and/or my community. I am able to organize a group to work toward changes that would benefit my community. My community is improving because of the work being done through BHCLB.

Contributions by residents are valued by BHCLB. I am able to ask questions of nongovernment organizational leaders. My skills in collecting, organizing, and analyzing information relating to community issues have improved since my involvement with BHCLB. I am comfortable making public presentations on community issues that are important to me. BHCLB has helped strengthen our network of individuals and organizations so that we have the ability to respond to community needs.

There are enough residents involved in BHCLB. I am comfortable stating my opinion publicly when it is different from that of nongovernment organizational leaders. If I do not understand information I receive at a meeting or presentation, I know how to get help in understanding it. I suggest solutions when there are differences of opinion. My quality of life has improved since my involvement in BHCLB.

Note. BHCLB = Building Healthy Communities Long Beach.

The mean scores for the composite variables ranged from 3.94 to 4.04. While the distribution of the scores within each composite variable reflected an underlying normal tendency, we found that the structure of the scales resulted in a right-skewed curve. To address this, we calculated a z score for each composite variable to create values more amenable to statistical analyses that require an assumption of normality.

Construction and Deployment of Resident Power

We took several steps to identify the domains connected to the five composite variables of resident power and to examine their level of influence to each variable. First, we performed a factor analysis to identify variables that predict each of the five composite variables, excluding variables that were used in their initial construction. Second, we grouped variables that were shown to have importance across all five composite variables, resulting in the five domains of resident power (Figure 1). Third, we performed an analysis of variance to determine the distribution of the proportion of variance for each domain and to examine its level of influence on the five composite variables.

Figure 1
Five Domains of Resident Power and Variables of Importance

We identified five domains as contributing to resident power building. These domains include (1) continuity, (2) culture, (3) context, (4) concrete action, and (5) capacity. We view continuity as level of engagement; culture as the individual, social, and environmental factors, and lived experiences that shape residents’ knowledge, attitudes, beliefs, and behavior; context as the socio-environmental factors that are associated with power building; concrete action as skill-building activities that achieve program goals; and capacity as the availability of knowledge, critical skills, and necessary resources among residents to advocate for community change. These domains are evident in the process of interaction between residents, organizations, and systems, and as illustrated by the resident power framework (Figure 2), they serve as a means to modify power-building activities in order to attain different program goals.

Figure 2
Resident Power Framework

Results

Sample Characteristics

A total of 443 residents completed the Resident Power Survey across three waves of data collection, 77 in 2013, 211 in 2015, and 155 in 2018. Sample characteristics are presented in Table 2. Almost three quarters of the sample was female (74.2%). The largest age-group was individuals between 25 and 44 years (37.2%), followed by individuals between 45 and 64 years (31.8%). The largest racial/ethnic group was Hispanic/Latino at more than half of the sample (55.2%), followed by Asian/Pacific Islanders and African American/Black at 26.3% and 11.8%, respectively. Almost 20% of the respondents did not identify as being directly involved with BHC Long Beach, but rather with a partner organization that is part of the BHC Long Beach collaborative. Of those who identified as being involved with the initiative, 29.3% have been involved for 2 years or longer.

Table 2
Sample Characteristics, N = 423

Characteristic n (%)

Gender n = 388^a

Female 288 (74.2)

Male 97 (25.0)

Gender nonconforming 3 (0.8)

Age-group (years) n = 422^a

<24 70 (16.6)

25–44 157 (37.2)

45–64 134 (31.8)

65+ 61 (14.4)

Race/ethnicity n = 422^a

American Indian/Alaskan Native 3 (0.7)

Asian/Pacific Islanders 111 (26.3)

African American/Black 50 (11.8)

Hispanic/Latino 233 (55.2)

White 13 (3.1)

Other/multiracial 12 (2.8)

Length of involvement in BHC Long Beach n = 423^a

Not involved in BHC Long Beach^b 78 (18.4)

Less than 6 months 94 (22.2)

6 months to 1 year 68 (16.1)

More than 1 year, but less than 2 years 59 (13.9)

2 or more years 124 (29.3)

Note. BHC = Building Healthy Communities.

a
Number of residents who responded to survey item. ^bResident identified as a member of a BHC Long Beach partner organization.

Deployment Domains and the Elements of Resident Power

Figure 3 presents the proportion of variance explained by each domain across the five composite variables. Culture explained the largest proportion of variance of the composite variable for residents’ ability to exercise their voice (37.8%), followed by ability to use information (22.1%), and ability to organize (16.5%). We observed statistically significant between-group differences in respondents’ level of agreement to survey items, such that Cambodian respondents were less likely to select strongly agree or strongly disagree when compared with other racial/ethnic groups, further corroborating the association between culture and residents’ ability or willingness to voice disagreement. Continuity explained the largest proportion of the variance for residents’ ability to organize (31.2%), followed by ability to use information (19.7%) and involvement in BHC Long Beach (19.24%). Context explained the largest proportion of variance for residents’ perception of the contribution of BHC Long Beach to individual and social improvements (28.07%), followed closely by community involvement (25.7%) and ability to use information (25.2%). The proportion of variance explained by concrete action was relatively equally distributed across the five composite variables at approximately 20%. The proportion of the variance explained by capacity was equally distributed between resident involvement in BHC Long Beach (22.0%) and their ability to exercise their voice (22.1%) and was slightly lower for their ability to use information (20.8%).

Figure 3
Proportion of Variance Explained by Each Domain of Resident Power

Discussion

The study revealed considerable differences in how the domains are associated with resident power. Culture mattered the most in participants’ perceived ability to exercise their voice. Only 3.4% of Cambodian respondents strongly agreed that they are able to ask questions of systems leaders, and 6.3% strongly agreed that they are comfortable stating a different opinion from that of systems leaders, compared with 26% and 27.4%, respectively, for persons of other racial/ethnic groups combined. Due to the extreme trauma that Cambodian refugees experienced during the Khmer Rouge genocide, many still hold a deep fear of government authority and are thereby reluctant to challenge people in positions of power. Therefore, power-building strategies must take into account how lived experiences can influence residents’ ability to organize and advocate for social change. For example, creating safe spaces that recognize a group’s history of trauma can improve resident engagement when working with vulnerable communities.

In our study, continuity played the largest role in residents’ ability to organize. Within this domain are variables related to length of involvement and level of engagement. These variables are inextricably associated with the amount of training and mentorship residents receive, such that those who have been involved with a program or initiative longer have more time to gain leadership skills compared with residents who may have recently joined. In our study, we found that 70% of respondents who have been involved in BHC Long Beach for 2 or more years reported increased leadership skills compared with 30% of respondents who have been involved for less than 2 years. This finding indicates that programs need to allocate more time and resources on resident engagement and retention activities if the goal is to increase leadership and advocacy skills.

Interestingly, context played the smallest role for residents’ ability to exercise their voice, explaining only 9.36% of the variance. This may be due to several reasons in the context of BHC Long Beach. One, there may be minimal variability in power-building activities across different campaigns. Two, several campaigns existed prior to BHC Long Beach, and residents may have already developed leadership skills before joining the initiative. Finally, it is not uncommon for residents to be involved in multiple campaigns, thereby making it difficult to contribute resident power building to any one campaign. Nevertheless, context is important in skill-building activities, as our study showed that this domain explained 22.1% of the variance in residents’ ability to use information. We believe that this finding is useful for informing curriculum design for training programs that aim to increase residents’ ability to find, synthesize, and utilize information for social change.

The availability of knowledge, critical skills, and resources, and participation in skill-building activities, operationalized as capacity and concrete action, respectively, had relatively equal importance across the five composite variables, each explaining approximately 20% of the variance of each of the five composite variables. This finding is not at all unexpected, as skill-building activities are necessary to increase knowledge and leadership skills. Programs that provide opportunities for residents to take on meaningful roles with increased responsibilities will continually build power by influencing the other domains of power building. Meaningful resident engagement increases both length and level of program involvement (i.e., continuity), which we have found to matter the most to an individual’s ability to organize and advocate for community change, accounting for more than 30% of the variance in this composite variable.

Strengths and Limitations

This study is one of the few that connects power-building activities to the construction and deployment of power within a place-based initiative. It explored how resident involvement in a large-scale health initiative affects leadership skills and the ability to effect change. An additional strength is that it is one of the few studies that examined leadership and power building from residents’ perspectives. This study has limitations related to its design and sampling methodology. First, the study was exploratory in nature, and the elements and domains of resident power have not been validated. Second, we used convenience sampling to reach residents who were actively involved in the initiative and who regularly attended partner organization meetings. Therefore, we cannot generalize survey results to all residents in BHC Long Beach. Finally, because we did not design the Resident Power Survey to be a longitudinal study, we were not able to examine changes in resident power over time.

Implications for Practice and Research

To our knowledge, this study is the first to examine power building in a place-based initiative that aims to increase resident power to engage in social change. While we present study findings within the context of the BHC Long Beach initiative, the resident power framework can be used in other health promotion programs that engage residents to address the place-based factors that affect health. The finding that not all residents in our study equally demonstrated leadership skills indicates that program activities must be designed to meet residents’ specific needs. Additionally, the finding that Cambodian residents in our study were less likely to challenge authority indicates that more research is needed to examine the role that culture and the other domains of power building play in leadership development for specific groups.

This study found that socioenvironmental factors associated with power building played the smallest role in residents’ ability to exercise their voice. Nevertheless, it is important to consider context in resident power building, particularly when engaging residents in multiple campaigns, as each will provide different skill-building activities. These serve as opportunities for program staff to modify activities to develop different leadership skills among residents to respond to changes in the political landscape or to work on new issues as they arise. While this study fills a gap in knowledge of resident power building, more research is needed to examine the mechanism by which individual-level power building leads to the collective action needed to achieve campaign goals.

Conclusion

Restoring the balance of power between residents and decision makers is the first step in addressing health and social inequities. Empowered residents become the decision makers for their own community by having the knowledge and skills to identify and challenge harmful projects to ensure that all residents live in a healthy environment regardless of their zip code. The resident power framework is a tool that can be adapted for use in health promotion programs that engage residents for social change. It can be used in its entirety or as subscales to more effectively build resident power, which is key to addressing health and social inequities.

Supplemental Material

sj-docx-1-hpp-10.1177_1524839906289376 – Supplemental material for Examining Resident Power Building in a Place-Based Initiative

Supplemental material, sj-docx-1-hpp-10.1177_1524839906289376 for Examining Resident Power Building in a Place-Based Initiative by Parichart Sabado, Laura D’Anna, Gisele Fong, Christine Petit and Jefferson Wood in Health Promotion Practice

Resident involvement	Voice	Use information	Organize and advocate	BHCLB contributions
I have been successful in influencing decisions that affect my community.	I am comfortable stating my opinion publicly when it is different from that of systems leaders.	I am able to get information related to issues that are important to me and/or my community.	I am able to organize a group to work toward changes that would benefit my community.	My community is improving because of the work being done through BHCLB.
Contributions by residents are valued by BHCLB.	I am able to ask questions of nongovernment organizational leaders.	My skills in collecting, organizing, and analyzing information relating to community issues have improved since my involvement with BHCLB.	I am comfortable making public presentations on community issues that are important to me.	BHCLB has helped strengthen our network of individuals and organizations so that we have the ability to respond to community needs.
There are enough residents involved in BHCLB.	I am comfortable stating my opinion publicly when it is different from that of nongovernment organizational leaders.	If I do not understand information I receive at a meeting or presentation, I know how to get help in understanding it.	I suggest solutions when there are differences of opinion.	My quality of life has improved since my involvement in BHCLB.

Characteristic	n (%)
Gender	n = 388^a
Female	288 (74.2)
Male	97 (25.0)
Gender nonconforming	3 (0.8)
Age-group (years)	n = 422^a
<24	70 (16.6)
25–44	157 (37.2)
45–64	134 (31.8)
65+	61 (14.4)
Race/ethnicity	n = 422^a
American Indian/Alaskan Native	3 (0.7)
Asian/Pacific Islanders	111 (26.3)
African American/Black	50 (11.8)
Hispanic/Latino	233 (55.2)
White	13 (3.1)
Other/multiracial	12 (2.8)
Length of involvement in BHC Long Beach	n = 423^a
Not involved in BHC Long Beach^b	78 (18.4)
Less than 6 months	94 (22.2)
6 months to 1 year	68 (16.1)
More than 1 year, but less than 2 years	59 (13.9)
2 or more years	124 (29.3)

Footnotes

Authors’ Note:

The authors would like to thank organizational staff who helped with participant recruitment and data collection and all residents who completed the Resident Power Survey. This study is part of a larger evaluation of the Building Healthy Communities Long Beach initiative and is supported by a learning and evaluation grant from The California Endowment.

ORCID iD

Parichart Sabado

Supplemental Material

Supplemental material for this article is available online at .

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