This study uses the concept of readiness to intervention for evaluating and improving primary health care. The concept of community readiness examines the interaction between community context and program design and implementation. The main idea is that effectiveness of social intervention depends on the preparation of the community for social change. The original model (Edwards et al., 2000) proposes nine different stages of readiness for implementing programs, from “no awareness” to “professionalization”. However, we could interpret readiness also as a continuum and identify different profiles or types (Chazdon & Lott, 2011; Holgado & Maya Jariego, 2012; Maya Jariego et al., 2010). In this paper we present a classification of primary health centres in Andalusia (Spain) according to three dimensions of community readiness. The research was based in three different strategies. First, 81 social workers from primary health care centres in Andalusia were interviewed and completed a 18 items scale on social participation, community adjustment and professional implication in health centres. Second, 40 health centres were observed, taking information on the professional role of social workers and organizational issues, as well as applying a survey both to compare the view of social workers and other health professionals. Finally, 10 case studies were deployed examining through in-depth interviews the interaction between the organizational and the community contexts in health care programs’ implementation. Three levels of community readiness were identified, conducing respectively to sensitization activities, community organizing strategies and application of evidence-based programs. Cluster analysis allowed the identification of three different profiles of community readiness in primary health care centres in Andalusia: reactive, technical-aid and community approach. The interaction between organization and community processes is discussed.

1. Health-Illness Care
Community Readiness for
Primary Health Care
Isidro Maya-Jariego, Daniel Holgado & Ignacio
Ramos
Departamento de Psicología Social
(Universidad de Sevilla)

2. Theoretical context
The Three-Ethnic Experience
 "Community readiness is the relative level
of acceptance of a program, action or other
form of decision-making that is locality-
based”
(Donnermeyer, Plested, Edwards, Oetting &
Littlethunder, 1997)
 "[...] unless a community was
ready, initiation of a prevention program
was unlikely, and if a program was started
despite the fact that the community was not
ready, initiation was likely to lead only to
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3. Theoretical context
Definition
 Community readiness refers to the
disposition to change contingent to social
intervention in a community context.
◦ So it is defined as the extent to which a
community is adequately prepared to the
implementation of an intervention,
◦ And evaluates the capacity to change.
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4. Theoretical context
Barriers
 Community readiness as barrier
between science and practice (Morrisey
et al. 1997):
1. Differing theoretical orientations and
training.
2. Funding priorities.
3. Resources constraints.
4. System-level barriers.
5. Lack of community readiness.
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5. Theoretical context
Stages of community readiness
9 stages (Oetting et al., 1995)
1. No awareness
2. Denial
3. Vague awareness
4. Preplanning
5. Preparation
6. Initiation
7. Stabilization
8. Confirmation/expansion
9. Professionalization
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6. Theoretical context
Three levels of community
readiness

7. Theoretical context
Dimensions
 Dimensions of community readiness
(Oetting et al., 1995):
1. Community efforts and community
knowledge of efforts.
2. Leadership.
3. Community climate.
4. Knowledge about the issue.
5. Resources for prevention efforts.
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8. Objectives
Typologies of communities
 Building typologies of contexts based in
organizational and community
dimensions to evaluate community
readiness.
 Social workers incorporation into primary
health care teams.
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9. Method
Overview of the study
Survey to social workers
Community readiness in PHC  81 interviews to social workers
in PHC centres
Organization and
 Evaluation of community
professional practice
readiness in health contexts
Community intervention for  Profiles of the contexts for
health in PHC community intervention
 Capabilities and potential

10. Method
Overview of the study
Visits to PHC centres
Community readiness in PHC  Direct observation of 40 PHC
centres
Organization and
professional practice  Interviews to 80 health
professionals
Community intervention for
health in PHC  Role of social workers in PHC
 Professional practice and
organizational context in PHC

11. Method
Overview of the study
Case studies
Community readiness in PHC  Interviews and case studies of
10 social workers in PHC
Organization and centres.
professional practice
 Discourse network analysis.
Community intervention for
health in PHC  Interaction between
community and organizational
contexts and program
implementation.

12. Method
Instruments and participants
 Key informants: 81 social workers in
PHC centres
 Community Readiness Scale
◦ 18 items, agreement 1-10, α= .886
◦ Perception of community
problems, engagement of health
professionals, social
participation, community adjustment of social
interventions.
 Survey with questions on social worker
role, social climate, activities of the PHC
4cipc BCN-2012 12

13. Method
Instruments and participants
4cipc BCN-2012 13

14. Method
Instruments and participants
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15. Results
Three clusters of community
readiness
15

16. Results
Three clusters of community
readiness
8
7.25 7.42
7 6.73
6.42
6
5.23 5.25 Cluster 1
5 4.77
4
Cluster 2
3.09 3.26
3
Cluster 3
2
1
0
Community Mobilization PHC Center Engagement Community Adjustment
16

18. Conclusions
Profiles of community readiness
 From barriers to disposition:
◦ Interaction between intervention and context.
◦ Potential for change or “zone of proximal
development”.
 From levels to profiles:
◦ Evaluation of multiple dimensions.
◦ Effectiveness depends on the contingency
intervention/context.
 Key role of the interaction between
organizational and community dynamics.
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19. Laboratorio de Redes Personales y
Comunidades
http://personal.us.es/isidromj
Isidro Maya Jariego <isidromj@us.es>
Ignacio Ramos <ignacioramosvidal@hotmail.com>
Daniel Holgado <daniel.holgado@gmail.com>
4cipc BCN-2012 19