Mapeo de activos en salud en dos barrios vulnerables y su dinamización en una intervención comunitaria participativa

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2017
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12-09-2017
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Tittle: Mapping of health assets in two vulnerable neighbourhoods and their dynamization in a participatory community intervention Abstract Objectives: 1) This study describes the process and results of the elaboration of health assets maps in two neighbourhoods in a situation of high social vulnerability in which a participatory community intervention in health promotion is carried out 2) Describe the process and results of dynamizing the asset map of each of the neighbourhoods in a proposal for community health intervention Methods: A descriptive study was conducted using semi-structured individual and group interviews and participatory dynamics. The study was developed in “El Raval” and “L'Alquerieta” neighborhoods in Alzira (Valencia) in 2010-2011 and 2012-2013, respectively. Citizens (Spanish, Roma and Maghreb Spanish women, mostly) and professionals from public services of the administration (public health, health care, social services and education, mainly) were participated. Results: Health assets were identified according to six categories (people, groups and associations, institutions and services, infrastructures and physical spaces and culture) and their territorial location (neighbourhood, rest of town, district and other places). Citizens identified more health assets than the staff of the public services of the administration. The most frequent health assets were, in both neighborhoods, people and institutions and services. The less frequent health assets were groups and associations (low number of associations in neighborhoods, lack of knowledge of the town and existence of bonding social capital) and physical spaces and infrastructures (few green spaces and sports facilities and degraded public space in neighborhoods). The research team developed two health asset maps. Citizens of the second neighbourhood graphically represented health assets using Google Earth ®. This tool contributed to the digital literacy of the citizens and to the visualization of the map by politicians and decisors of services but it wasn't useful for the dynamization of heath assets. Connections were made between assets of different types and territories with an equity approach (most vulnerable age groups, gender and cultural origin or ethnicity). The proposals for action were related with training (the most numerous), physical and sports activity, coexistence between the neighborhood and solidarity networks and mutual support. Two community actions were designed based on the dynamization of assets taking according the felt needs of the study population. In the neighbourhood of El Raval, the research team designed an intervention project to support students in the neighbourhood to complete Secondary Education ("Barri-Escola" project). In the neighbourhood of L'Alquerieta, citizens, staff and the research team designed a gymkhana to promote the cleaning of public space and physical activity in the neighbourhood. Both actions were carried out later. The main limitations of the study were: the small number of participants, the majority presence of female health workers, the professional profiles of staff and the lack of policy makers. These issues may have influenced in identified health assets and in their connections. Also, the evaluation of process and results of identifying health assets and establishing connections between them was not considered in the study. Conclusions: Neighbourhoods in situation of high vulnerability also have health assets that can be connected to improve the health of the population. The research techniques used to develop the asset maps and their dynamization were valid to work in these environments. The classification of assets in paper according to typology and location was very productive in the dynamization of the maps. Citizens in situations of high vulnerability and professionals worked together in the dynamization of maps (the level of co-production is reached in the scale of participation). Intersectoral workspaces were generated to identify assets and design actions according to needs. Assets are linked to the social determinants of health and to actions. It established relations that tend to the recognition and trust between different social groups and the professionals of public services (bridging and linking social capital). The incorporation of the health assets approach in the design of community health and health promotion projects as well as their evaluation are future lines of research in which progress is needed.
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