The second step of CCB is to identify and understand the underlying causes and challenges to improving the issue you want to focus on in your community. Understanding the causes contributing to the issue of concern will help you to identify some of the potential challenges to improving the issue [2][4][5]. Other potential challenges may include the availability of services; location (i.e., if remote or rural); and barriers such as financial, technology, and language [4].
Below are a few ways to gather information about underlying causes and challenges to improvements in your issue of interest.
- Local/Community-Based Information
- Have conversations with service providers.
- Have conversations with community members.
- Reach out to provincial organizations to find relevant resources.
- Attend public events/fairs to network, build relationships, and get information.
- Partner with existing groups, service providers, and individuals who are working towards the same goal.
- Learn from previous or similar project experiences within or outside your community.
- Provincial/Federal Information
- Seek public reports produced by health bodies (e.g., Saskatchewan Health Authority, Saskatchewan Ministry of Health, Health Canada).
- Seek public reports produced by non-profit organizations such as Saskatchewan Prevention Institute.
- Research
- Look for current best-evidence research studies, if available, for example, literature reviews that include multiple studies are preferable to single studies. These can be found through Google scholar, university libraries and some local libraries through their inter-library loan system. Some employers and/or community partners may also have a subscription to access research articles, e.g., Saskatchewan Health Information Resources Program (SHIRP).
- Conduct focus groups, interviews, and/or surveys with community members and/or service providers and analyze their responses.
The list above provides just a few suggestions for places you may look for information. You can also partner with other organizations working towards the same goal. These might be local, provincial, or federal organizations.
Step 2 – Identify and Understand Underlying Causes and Challenges Example
- To further understand and identify the underlying causes of FASD and challenges to FASD prevention, community members visit the Saskatchewan Prevention Institute website and connect with the FASD Prevention Coordinator. This organization provides current evidence-based information on various health issues that affect children.
- The community team also gathers more information that is available on local, provincial, or federal health websites.
- Through their research, the community team learns that alcohol is a psychoactive substance that is legal and acceptable in North America making it an integral part of our society [9]. Alcohol’s acceptance in society leads to relaxed attitudes about drinking; therefore, people are less likely to look at their own drinking patterns or pay attention to alcohol’s possible negative outcomes.
- The above research reflects the information that was gathered from the community in Step 1. That is, alcohol use is a norm in the community and is present at most community and personal gatherings resulting in feelings of stigma if a person does not drink, and social isolation for those who avoid events [10][11]. Some of this pressure is because there are confusing messages about alcohol use during pregnancy [12].
- Through reviewing reports and research, the community team learns about other factors that can influence why a pregnant person may drink alcohol. They learned that consuming alcohol could be an individual’s choice and/or it could be influenced by their circumstances; however, when an individual conceives, whether intentionally or unintentionally, their circumstances do not change overnight. For instance, if they are experiencing an unhealthy relationship, stress, mental health challenges, addiction, or sexual violence and use alcohol and/or other substances as a coping mechanism, their circumstances do not change when they become pregnant [10][13][14]. Rather than receiving the support they need, they are usually shamed by others and considered unfit to give birth and raise their child [15][16]. This stigma makes it difficult to ask for the support they need.
- Of the many factors contributing to alcohol use among women, trauma and stigma are talked about and understood the least; however, they found research that showed that trauma and stigma are huge barriers that need to be addressed to prevent FASD in our communities [13].
- The community also determined that there are a lot of places where people who are pregnant can get support in the community as well as socialize, e.g., a recreational walking group that meets at the high school’s track on Saturday mornings. These opportunities are not well known by members of the community and do not target pregnant people specifically.