Alhassanain(p) Network for Heritage and Islamic Thought

CASE STUDY:

THE TOHONO O'ODHAM COMMUNITY DEVELOPMENT PROGRAM

This case study will describe and evaluate the results of a program that was organized to stimulate development in the Tohono O'Odham Indian communities, located on the Gila Bend, San Xavier, and the Tohono O'Odham reservations in southern Arizona. The Tohono O'Odham Community Development Program began its operations in July of 1967 with the selection and training of the first workers.

Context of the Program

There are approximately eleven thousand Tohono O'Odhams, about half of whom live in the on-reservation villages that were the primary target of the program. The reservations are part of the Sonoran Desert, which forms a major portion of the southwestern United States.

The basic unit of settlement is the village, of which there are forty of various sizes. Traditionally, the Tohono O'Odham village's political deliberations have taken place in a village council, which can be characterized by its commitment to consensus-based democracy. The councils remain a vital force in many villages. However, it should be recognized that both the structural complexity and capacity for problem solving in individual villages is quite variable. The most thoroughly integrated communities may have the benefit of several specific organizations, such as stockmen's associations, water committees, and feast committees.

The community's organizational focal point is usually the village council, which deals with a range of problems. An important component of the village political organization are the individuals who link the village to higher-level Tohono O'Odham political organizations, such as the district and tribal councils. There was no formal pan-Tohono O'Odham political organization until the creation of the Tohono O'Odham Tribal Council in 1937, under the provisions of the Indian Reorganization Act of 1934. There are now district councilmen and tribal councilmen, who serve, in theory at least, to communicate the desires and decisions of the village people to the tribal and district councils. In addition, contemporary Tohono O'Odham communities may have the benefit of a number of special-purpose organizations made up of differing segments of the village population.

The current Tohono O'Odham economic adaptation consists of three major strata. The first stratum consists of residual elements of the traditional economic system, which was based on flash-flood farming of corn, beans, and squash; hunting of desert game such as whitetailed deer and javelina; gathering the edible portions of plants such as cholla, mesquite, and saguaro; and the production of craft items. The second stratum, derived from Spanish sources, consists of major augmentations to traditional farming, such as wheat and barley, and the use of various domestic animals, such as cattle and horses. The last stratum, associated with Anglo-American contact, includes increased monetization of Tohono O'Odham economic life through wage labor, welfare programs, cattle sales and, in some places, lease income payments. Currently, elements from all strata make up the Tohono O'Odham economic system. Individual Tohono O'Odhams are differentially committed to various parts of the system. The importance of the first stratum is limited.

Development Strategy

In response to conditions of need, and the opportunity afforded it by the federal government through its Office of Economic Opportunity, the Tohono O'Odham Tribal Council requested support for the community development program, which they thought would meet some of their developmental needs. The cutting edge of the program were to be multipurpose community-level workers selected by the communities within which they were to work. The program was to use the community development approach as its basic strategy. The program used the International Cooperation Administration's definition of community development in the initial training sessions. This definition was cited above.

The was to operate in terms of thefelt need concept . It was considered necessary to involve the people in the process of realizing their needs, and to develop a community-based strategy for achieving goals predicated on those needs. This was to be done with a minimum of reliance on resources from outside the community. Therefore, one of the program's responsibilities was to "encourage discussion in the villages and to focus on the real concerns of the people, define and rank the needs, develop the confidence and the will to work at these needs before aid is solicited and provided to them" ( Tohono O'Odham Community Action Program Staff 1966:2).

The program was to work within the context of existing Tohono O'Odham social organization. The workers were interested in "developing individual feelings of worth and dignity [as well as] community pride [while they were attempting to] significantly raise living standards within existing social organization" ( Tohono O'Odham Community Action Program Staff 1966:6). There was a realization that the existing organization might not be adequate for the new developments. Therefore, the project staff noted that development could be in terms of "community organization which may, or may not, already exist, or by helping to create that organization where it does not exist" ( Tohono O'Odham Community Action Program Staff 1966:2). It was realized that new needs would develop within the community, that a "whole series of problems may develop for which new mechanisms to provide for the economic and psychological needs now taken care of by family organization may have to be developed" ( Tohono O'Odham Community Action Program Staff 1966:2). There were no specific recommendations for the creation of new community organization.

One of the major concerns of the program was the stimulation of community independence. The concept of cooperative self-help was seen as basic to this concern. Communities engaged in development were to improve their competence in dealing with their own problems. "The possibilities envisioned are limitless but the self-help, working together, and awakening to the potential of a community are necessary attributes of the program. A learn by doing approach is a prerequisite to its success" ( Tohono O'Odham Community Action Program Staff 1966:6).

The planners were very much concerned that Tohono O'Odham communities learn how to make use of their own resources as well as resources from outside the community. One of the products of increased community independence was to be increased problem-solving ability. This was to come from increased cooperation, new organizations, new technology, and increased knowledge of available resources. The proposal states: "It is anticipated that the community development program . will make it possible to extend the range and scope of the problems with which communities can deal successfully" ( Tohono O'Odham Community Action Program Staff 1966:3).

The community development program was to serve as the connecting link between Tohono O'Odham communities and the other tribal programs. Through these linkages the chances for success of the other tribal programs--Head Start, parent and child centers, administration, and legal services--were expected to increase. The workers were to coordinate all programs of the Office of Economic Opportunity at the local level. The workers were also to increase the communication between all government programs and Tohono O'Odham communities.

There was a very strong commitment not to impose the program on the people. The communities were to choose voluntarily to participate. This is related to a desire not to disrupt the Tohono O'Odham way of life. Discussing technological innovation, the proposal notes that "many aspects of life in a Tohono O'Odham Community relate to customs, beliefs, ceremonies and rituals which may be affected in a fundamental way by the introduction of these new ideas and subsequent technical changes" ( Tohono O'Odham Community Action Program Staff 1966:1).

Goals of the Program

The thrust of the program was to be the achievement of the developmental goals of the traditional Tohono O'Odham villages. The planners disavowed direct planning of specific development projects for these villages, although the original program proposal indicates some of the potential areas of development. The most fundamental concern was with "basic living conditions," including a desire for improved basic technology rather than large-scale economic transformations. The planners also desired "that the Tohono O'Odham communities be stimulated or helped to adapt new techniques that will lead to greater economic productivity and provide them with better food, housing, health, education" ( Tohono O'Odham Community Action Program Staff 1966:2).

More specifically, there were aspects of Tohono O'Odham community life that the program staff regarded as "crucial gaps." These were to be the foci of concentrated effort. These foci included adult education, pre-school education, community recreation for all age groups, improved community sanitation programs, citizenship and leadership training, agricultural development, improved marketing techniques for livestock, stimulation of arts and crafts production, training in the building trades, improved house construction, and programs to preserve Tohono O'Odham culture.

Selection of Workers

The worker selection policy stressed community control. The communities were to select their own workers, with minimal guidance from the administrative staff. As a corollary to this, few job requirements were specified, except those stipulated by the Office of Economic Opportunity as conditions of the grant (i.e., all employees were to be at least twenty-one years old). The workers needed to be able to speak English and Tohono O'Odham.

The community development concept was not something with which Tohono O'Odham communities were conversant. Therefore, the program staff had to provide communities with information through the tribal political organization upon which a rational selection decision could be based.

The various administrators associated with the program did little to influence the selection process. The communities themselves established requisite qualifications for community development workers as the program matured. One requirement that was often insisted upon was the possession of a high school diploma. Another community-defined job requirement was the ability to cope with drinking.

The basic attributes of the community development workers selected are as follows: the median age was thirty-four, with a range from twenty-two to fiftytwo years. Only two of the workers were female, whereas fifteen were males. The median educational attainment was a relatively high ten years, although the range was from zero years to two years of college. All the workers were active in Tohono O'Odham religious life; fourteen were Roman Catholic, one was Sonoran Catholic, and two others were Protestant. Five workers were also traditional Tohono O'Odham religious practitioners. All but one worker spoke English; all spoke Tohono O'Odham. Many of the workers participated in a wide range of activities in their districts, communities, schools, and their places of employment.

The Tohono O'Odham Community Development Program was committed to a set of abstract goals, which are clearly stated in the original proposal and training plans. The staff attempted to execute policy and administer the program with these goals in mind. However, it remained the responsibility of the individual community-level worker to translate his or her understanding of the role as a Tohono O'Odham community development worker into daily actions that were appropriate for achieving program goals. The Tohono O'Odham Community Development Program workers were able to do this with varying success. Some were able effectively to stimulate development projects that were responsive to both concrete community-defined goals and the abstract goals of the program. Others tended to routinize the service component of their jobs and did not actively stimulate change.

The program did have some success in achieving certain development goals. In addition, it is possible to point to a certain number of goals that the program failed to attain. Furthermore, the program had effects that were largely unanticipated. We will discuss the effects of the program in terms of four areas. These are the effects on community facilities, the effects on the economy, the effects on sociopolitical milieu, and the effects on the bureaucratic context.

Effects on Community Facilities

One of the program's most significant successes was in terms of housing development. Virtually every community in direct contact with the program had some success in solving its housing problems. During the period of study the workers assisted in the construction of approximately 250 units (i.e., remodeled houses, expansions, and new construction). The housing constructed by the program was based on traditional housing concepts. The basic house was small and rectangular, made from adobe blocks. The improvements incorporated in program-constructed housing included concrete floors (instead of dirt), framedup plywood roofs (instead of desert-grown materials), and plastered external walls (instead of bare adobe).

In addition to housing development, the workers were successful in constructing or remodeling a number of community buildings, such as feast houses and meeting halls. This type of construction was a high priority in some communities. In addition, workers participated in the construction of community water systems, community sanitation systems, and community recreation facilities. As the program matured, there came to be development activities within the local cattle industry, such as pastures and community corrals.

Economic Effects

The program produced various economic effects; none of these could be construed as real economic growth. There may have been some flaws in the program strategy, but the major problem was lack of investment in economic growth at the village level. Where specific "job-creating" entrepreneurial projects were attempted, they failed. Among the villages directly participating in the program, only two initiated programs that were entrepreneurial in nature. One was an attempt to manufacture roof trusses with material, equipment, and technical assistance supplied by the Bureau of Indian Affairs. The project was abandoned after two preliminary planning meetings. The other project involved the manufacturing of burnt adobe bricks for local construction projects. This idea was abandoned after a few trips to a town in the adjacent Mexican state of Sonora to observe brick manufacturing techniques.

Virtually nothing was accomplished in the area of improving cattle and basketry marketing, because the economic exchange relations were strongly entrenched. There seemed to be little concern with the problem on the part of the community, and developments in this area would have affected only a portion of the community. In addition, there were other organizations that had established an interest in these areas.

One of the few planned economic effects that was realized was increased access by Tohono O'Odham villages to information concerning employment opportunities. This was based on the working relationship that was established between the Community Development Program and the Arizona State Employment Service. The relationship was encouraged by welfare eligibility policies that required that all applicants go to the State Employment Service to see if there was available work. Community development workers came to refer community members routinely to the employment service.

An unanticipated effect of the program was the increased participation of Tohono O'Odhams in various programs of government subsidy. There were increases in social security payments, Veteran's Administration benefits, and in various welfare programs. The most dramatic increases occurred in the Bureau of Indian Affairs General Assistance Program. The most important aspect of the bureau's general assistance payments is the Tribal Work Experience Program, in which an individual who is qualified for welfare accepts a job assignment in either his or her village or an agency. The grants are issued to him or her weekly on apro rata basis for time worked. There was a fivefold increase in the local BIA welfare case load.

The massive increase in general assistance was largely due to the efforts of the community development workers. Prior to the inception of the program, individual enrollees in the Tribal Work Experience Program were always placed in job training situations in government agencies. Individual community development workers successfully established community-based work crews subsidized by the General Assistance Program. Because these crews worked on community projects, such as housing improvement, there was a great deal of community support for participation in this program. In response to this support, community workers actively recruited program enrollees.

Sociopolitical Effects

The program had little effect on the quality of traditional community leadership, in spite of the fact that this was a major goal of the program. The ostensible cause of this shortfall was the lack of any useful strategy to fulfill the goal. Such a strategy would have been difficult to develop given the immense variation in leadership competence levels, and the animosity that sometimes existed between community-level workers and traditional leaders. In spite of this program shortfall, there were significant increases in the number of community organizations that would serve community needs.

One of the other planned goals was increasing the integration between the tribal administration and the villages. In general there was improved access to information concerning tribal administrative affairs. The communication link between the community development workers and staff paralleled and reinforced the link that existed between the tribal chairman and the tribal council representatives. This served to make the tribal council communicate to the villages more effectively. It made it more difficult to withhold information.

The integrative communication function of the Tohono O'Odham Community Development Program was not without its problems. The minor problems included unfair distribution of information, inaccuracy, and overly literals inter pretations of messages. In spite of the benefits of the communication, it was at times obvious that there was inconsistency between tribal government goals and village goals. Some Tohono O'Odham leaders assumed that community workers were to be regarded as extensions of the tribal administrators. Some tribal administrators assumed that there was a "line relationship" between the tribal administration and the village-level workers through the community development director. This would cause community workers temporarily to set aside community-defined, goal-oriented activities while tribal-administration-defined, goal-oriented activities were carried out. When this occurred it would delay the achievement of community goals as well as increase in the minds of community members the identification of community workers with the political establishment.

The program had unanticipated sociopolitical effects. These unanticipated effects included the formalization of regional intervillage alliances that focused on program activities. The focus of these alliances included the selection of the program workers, as well as specific development projects. Regional projects included a major pasture development and a community center construction project for a group of villages.

Another unanticipated effect was the tendency for communities to elect community workers to formal political roles in village, district, and tribal organizations. A primary function of the community development worker's role is communication. In this project, important sources of information included: community development worker meetings, training sessions, staff counseling, staff memoranda, tribal council meetings, district council meetings, and officials of tribal government. Information obtained from these sources was communicated to workers' communities through home visits, community meetings, district meetings, and meetings that the worker himself "put up." It is clear that in communities having a rather high dependence on extracommunity resources, information relating to resource exploitation is crucially important. In the Tohono O'Odham case, its importance was increased by the general lack of access to information resulting from the language barrier, illiteracy, the almost total absence of relevant mass media, such as newspapers and radio, and the lack of numerous parallel political communication links. The political power of community development workers increased because they had superior access to politically significant information, such as welfare program enrollment requirements, or deadlines for applying for BIA housing subsidies.

Ten of the original twelve community workers were nominated for political office, ranging from village chairman to vice-chairman of the tribal council. This phenomenon can best be explained as a community attempt to superimpose formal political roles on individuals who were acting out behavior appropriate to those roles.

Bureaucratic Effects

In the initial plans, coordination of existing tribal programs at the village level was stated as a program goal. Effects were rather mixed in this area. There was fairly successful coordination with that had limited field staff, such as legal services and the emergency food and medical services program. In the case of other tribal community-level worker programs, such as the Public Health Service-sponsored Community Health Representative program, there was a substantial amount of conflict and jealousy. In some cases workers from both programs invested time and effort in bad-mouthing their counterpart in the other program. In certain cases, the directors of both programs had to meet and establish "truces" between workers.

One of the program's goals that was more uniformly achieved was the increase of development resources available to the Tohono O'Odham villages. These resources included various programs and departments of the federal bureaucracies, such as the Domestic Water and Sanitation Program of the U.S. Public Health Service, and the Tribal Work Experience Program of the BIA. The various programs supported by charitable organizations, such as the Save the Children Federation Community Program, the Red Cross Emergency Relief Program, and the Saint Vincent de Paul Used Clothing Program, had a role to play in villagelevel development. In addition, there were numerous state, county, tribal, and village resource-providing institutions. These included the Arizona State Cooperative Extension Service, the Pima County Adult Education Program, and the Tohono O'Odham Tribal Well Maintenance Department, as well as Tohono O'Odham stockmen's associations.

In addition to increasing broadly the number and impact of resources provided to Tohono O'Odham communities, the workers often came to act as administrative extensions of some of those programs. This was particularly important in the BIA housing program and the water system development program of the Public Health Service.

SUMMARY

The depth and breadth of the use of community development as a development strategy is much more extensive than for any other approach treated in this text. The community development approach evolved with contributions from mass education, extension work, and social work, as well as anthropology. The use of the approach was very extensive in the immediate postwar period, with use being curtailed somewhat in the 1970s. With its more broadly based use, it is much more diverse than any of the other approaches considered here.

It is difficult to identify the factors that led to the reduction of its use. Some relevant factors include its strong commitment to local input in planning, and its heavy reliance on the use of local resources, which caused national-level politicians to lose control. The pendulum seems to have swung, however. Increasingly, the development literature is expressing disenchantment with big picture, top-down projects in which local initiative is ignored. Thus one would expect that community development experiences and ideas will be put to use again. The names may change, but the practices will remain the same. Many community development ideas will be useful in the context of the increased commitment to decentralization in development planning and the appropriate technology movement.

The approach seems to be more typically used by the development staff of private voluntary organizations rather than by government-sponsored international development agencies. These days, organizations such as the U.S. Agency for International Development seem to support community development work through private voluntary organizations. In this framework public-sector international development agencies express their residual grass roots tendencies. One problem with the grass roots approach to development is that development efforts tend to be too localized when viewed from the standpoint of host country governments and the politics of international public agencies. Local development efforts are hard to evaluate except on a case-by-case basis. They are often based on narrow views of needs, which tend to ignore large infrastructure development projects such as roads or irrigation systems.

The approach is useful in situations where there are existing, functioning communities that can benefit from improved integration with regional and national governments. Often the key task of development is to bring to bear culturally appropriate technical assistance and resources with local organizations and plans. The approach can be used to stimulate the development of local organizations so as to allow further self-sustained development or to provide a means of increasing national integration through development.

The important concepts are felt needs and the so-called process approach. The felt need idea is perhaps self-explanatory. The process idea is more cryptic. Process refers to the notion that both the means and ends of development must be considered. Ends are to be determined locally, and the means used for achieving them must be designed to increase community adaptability. This orientation is not inconsistent with the action anthropology and the research and development approaches. It should be noted that the means-ends conception found in action anthropology communicates a different but complementary idea.

FURTHER READING

Biddle William W., and Loureide J. Biddle. 1965.The Community Development Process: The Rediscovery of Local Initiative . New York: Holt, Rinehart and Winston.

Presents a classic account of the process-based approach. Many readers may react negatively to its naive politics, but if you can read through that, you will find some ideas that are in fact practical. The approach specified here is oriented toward rural America. The idea of class struggle and revolution is not part of the approach.

Brokensha David, and Peter Hodge. 1969.Community Development: An Interpretation . San Francisco: Chandler Publishing.

A useful, although dated, textbook on the topic.

Goodenough Ward H. 1963.Cooperation in Change: An Anthropological Approach to Community Development . New York: Russell Sage Foundation.

This comprehensive work can serve as a handbook for the community-focused development administrator. It offers a good review of effective change agent practice, as well as an extensive discussion of issues relating to cultural appropriateness. The ideology of the text is adjusted to conditions that do not exist any longer.

7 Advocacy Anthropology

Anthropologists such as Sol Tax and Allan Holmberg operated on unfamiliar ground when they developed research and development anthropology and action anthropology. They were operating under the limitations of an assumption of a value-free social science. Their approaches contrasted with existing patterns of application that did not include the role of change agent. The value-explicit nature of these new approaches allowed the anthropologist to become involved in producing change.

Community advocacy is a kind of value-explicit applied anthropology useful in certain types of communities. Like action anthropology, research and development anthropology, and community development, community advocacy anthropology is a values-in-action process. In advocacy anthropology there is a distinctive relationship between the anthropologist and the community.

Community advocacy anthropology is a value-explicit process by which the anthropologist as researcher acts to augment and facilitate indigenously designed and controlled social action or development programs by providing data and technical assistance in research, training, and communication to a community through its leadership. Although community advocacy is primarily a research activity, the anthropologist is also involved in change-producing action. The anthropologist serves not as a direct change agent but as an auxiliary to community leaders. This contrasts with the more direct involvement of anthropologists as change agents in both action anthropology and research and development anthropology. The community advocacy anthropologist does not work through an intervening agency. His or her relationship with the community is direct and intimate.

DEVELOPMENT OF ADVOCACY TECHNIQUES

A kind of community advocacy anthropology was developed by Stephen Schensul within the context of a community mental health in Chicago. The approach developed by Schensul emerged out of a community research unit that was a component of a mental health program. As an approach, it developed as an adaptation of the factors extant in this situation. These included the values of the researcher, the needs of the client community, and the nature of the initial sponsoring organization.

Program specifications indicated the research unit was to serve the direct informational needs of the program's administration and thereby, indirectly, the community. This proved unworkable. Research team members felt that the health program staff "were neither open to new information nor flexible in their ideas concerning program development and provision of services" ( Schensul 1973:107). It seemed inevitable to the team that "no matter how good" the data acquired was, it would not have a significant impact on the community. Members of the research team tended more and more to identify with the community rather than the clinical program.

"Thus," Schensul notes, "we began to withdraw from intensive involvement in the clinical activities of the program. We turned to a search for new situations in which our research data could make useful contributions to positive social action. We found those action situationsdirectly in the communities themselves" ( Schensul 1973:107). The research efforts developed most intensively in the Chicano barrio in Chicago, where the relationships between team and community developed quite intensively.

KEY CONCEPTS

The primary reference group of the community advocate anthropologist is the community. It is through an understanding of this relationship that we can best understand the nature of community advocacy anthropology. A key concept is collaboration: collaboration between anthropologists and community leadership focusing on the former's research skills and the latter's information needs. Community advocacy anthropology is an involved-in-the-action process. It is based on two fundamental assumptions. First, "Anthropological research should provide information to the population under study which contributes to the development of the community and the improvement of community life" ( Schensul 1973:111). The research effort is focused on

short-term research needs, with provisions for "direct, immediate and localized" feedback. Further, the research is not intended to make a contribution to the generalized pool of scientific knowledge, because the "pay-off" to the community from this type of research is limited.

A second basic assumption is that "programs for community development and improvement are most successful and effective when they are conceived and directed by knowledgeable community residents" ( Schensul 1973:111). This assumption indicates a belief that an anthropologist's potential for success in assisting a community to achieve its goals is enhanced by working in collaboration with the community rather than an external agency. Based on these assumptions, Schensul notes that "it should be the goal of our applied anthropological research unit to facilitate indigenous social action programs by supplying data and results which can make significant contributions to the effectiveness of their efforts" ( Schensul 1973:111).

The collaboration occurs in the relationships that develop between the researcher and community activists. The activists are those community members who are regularly involved in community planning and action. This group is a changing network of individuals with various degrees of commitment, areas of specialized knowledge, and ideological orientations. These people often exist as the natural leaders in a community. They are proficient at mobilizing members of the community.

The activist role calls for a very broad range of skills and a high level of commitment to the community. They must effectively communicate with the power structures of both the establishment and their own community. They must be able to mobilize their community to achieve community goals. Often their success produces as much criticism as praise. It is this group that forms the principal constituency of the community advocacy anthropologist. The activists' view of community needs shapes the content of the research process. Their importance in shaping the research effort is based on a number of factors. They have significant knowledge of the community and participate in situations that have potential for useful research activities. Further, they often serve as "gatekeepers" by controlling access into the community. Researcher-activist ties are often facilitated by the need for the activists to develop alliances with persons who will assist in their work for the community. However, it should be noted that the activist can serve as either facilitator or limiter of research.

The nature of the specific advocacy project grows out of the relationship developed with the activists. This relationship is multistranded and contingent upon many of the rapport-building skills characteristic of anthropological fieldwork. A substantial period of time is necessary to develop effective collaboration because of the need to develop trust and understanding in the context of complex political activities. A key to effective collaboration is the manifestation of commitment on the part of the researcher. The researcher has to be prepared to allocate a significant amount of time to the process. It is suggested that something more than a year is necessary. Collaboration is also facilitated by the residence of the anthropologist in the community, much like traditional fieldwork. Community residence may signify for the community the commitment of the researcher to the community. Additionally, it allows the researcher to develop intense knowledge of the community. This knowledge develops through the increased opportunity for participation.

There are real limits to the extent to which rapport can be developed in community. The limitations are most striking in complex, politicized urban situations. In these settings, the anthropologists may come to be affiliated with certain factions in the community. Neutrality is not aggressively maintained. Advocacy means being on someone's side and, of course, being in opposition. Although the anthropologist will inevitably become aligned with certain community factions, he or she must attempt to maintain an open and flexible stance for the purpose of maintaining contact with the whole community. The anthropologist should not actively participate in the internal conflict between community organizations. In fact, the advocacy anthropologist needs to maintain working relations with all parties to the development situation.

Community advocacy anthropologists are primarily researchers. They need to avoid displacing the activists as representatives of the community. Nor should they foster the role of the outside expert. Advocacy anthropologists need to avoid competition with community leaders. The activists must retain their positions as community organizers and leaders.

COMPONENTS OF SUCCESSFUL COLLABORATION

For successful collaboration to occur, a number of principles should be followed. The relationship between researcher and activist must be symmetrical and coequal. The activists must work as coinvestigators on advocacy research projects. Theprinciple of parity is based not so much on democratic values, but on the fact that the activist knows the community and its needs, which is essential for meaningful advocacy research. Further, it is through parity that the research and data utilization skills are most effectively conveyed. It is intended that through collaboration the activist becomes a better producer and consumer of research results.

Success in collaboration is also enhanced bycommunity control of research operations . Community representatives must determine if a specific research project and its related methods are appropriate to community needs. Community control implies an informed and involved constituency. Community control also implies a substantial amount of reformulation of the research effort during implementation.

The effectiveness of research collaboration is enhanced by wide sharing of the research effort. The sharing of effort helps insure that research will be useful to the community and its action plans. Sharing also increases the research skills of the community.

The recipients of research results are the activists and the community members. Dissemination of results through traditional academic channels is a secondary consideration. The primary function of the research effort in collaborative terms is the furtherance of the developmental and political goals of the community. Communication of research results outside the community can only be done if it is in the interests of the community. Review of research results by community activists prior to dissemination in public contexts is advisable.

A major factor relating to the success of the collaborative research effort is the extent to which the research is an expression of community goals. Thus, real collaboration is only possible where there is substantial ideological sharing and agreement between anthropologist and activist. The quality of the collaboration is evaluated through analysis of its positive impact on the community, not its impact on the discipline of anthropology.Community advocacy researchers are above all parsimonious. They must be able to identify research goals in such a way as to allow quick satisfaction of community informational needs. This means that research techniques must be time-effective. The community advocacy anthropologist should be a master of the "quick and dirty" study. This is not to disparage the approach, but it does recognize that theoretical elegance and justification back to the theoretical literature, which do not serve the goals of the community, are viewed as unproductive in community advocacy. Community advocacy research makes use of various techniques that contribute time economies. These include large research teams, highly focused research instruments, and clear conceptualizations of research purposes. Consistent with both time-effectiveness and the basic ideology of community advocacy is direct community participation in the research effort. In fact, most instructional activities in community advocacy relate to making community members into competent researchers. The developers of the community advocacy approach have clearly conceptualized the contrast between applied and theoretical research, and have through their efforts made a significant contribution to the development of anthropological methodology.

COMMUNITY ADVOCACY PROCESS In an article dealing with the Chicago project, Schensul identifies an idealized conception of the action research process. The article, entitled "Action Research: The Applied Anthropologist in a Community Mental Health Program" ( Schensul 1973), indicates nine steps that are thought to be part of the action research process. The following discussion is based on that article.

The Nine Steps

I.Development of Rapport and Credibility of Applied Research. The process is based on rather intimate involvement of the researcher in the life of the community. He or she is advised to live in the community and is thought to have greater potential for success if he or she works in close conjunction with community activists.

Traditional anthropological fieldwork approaches are very useful for developing working relationships and rapport. Fieldwork also serves to develop in the researcher an operational understanding of the total setting of a problem. Feedback of research results is important early in the process because this clarifies the researcher's role and "demonstrates to community people that the information gathered can be of value to their action programs" ( Schensul 1973:112).

II. The Identification of Significant, Indigenous, Action Programs. The participant-observer, anthropologist-as-advocate attempts to establish a preliminary understanding of community priorities as they are related to the organization of Existing and potential programs. This understanding will provide a basis for decisions that the anthropologist must make concerning involvement. The involvement process is, of course, based on some value-explicit decisions. Schensul notes:

Unlike the traditional fieldworker, the researcher's own value system plays an important part in the kind of action he will seek to facilitate. Rather than avoid this issue, the researcher must balance the values and attitudes of the people in the community with his own ways of looking at the world before he commits himself to any program ( Schensul 1973:113). In these settings it is often difficult to resist pressures. Because of this, the anthropologist may not be able to plan and control the nature of his or her involvement to any great extent. Pressures from the discipline are unimportant. As Schensul notes, "localized action has become the prime molder of our research operations and goals" (1973:113).

The Negotiation of Cooperative and Reciprocal Relationships between the Applied Researchers and the Action People.

This process is most successful when the potential contribution of research to the community is quite well understood. Associated with this is the need for a clear identification of the motives of the researcher. The researchers and activists must both participate in the negotiation process. This process is calculated to produce a clear indication of the communities research needs. Additionally, the process, which increases community sensitivity toward the utility of research, can result in increased access to information in the community on the part of the researchers.

Initial Participation in Specific Action Programs.

This step often results in the collection of case study material relevant to specific programs. The researcher should stress rapport development and program assessment in this period. Baseline data is also collected, which is useful for long-term program evaluation.

The Identification of Specific Informational Needs of the Action People.

Schensul makes a recommendation concerning this part of the process: "We have found that research results have a higher probability of being useful when people in the community who are involved in programs play an important role in the development of research concepts and strategies, and when community and program people help in the collection and analysis of data" ( Schensul 1973:114).

Meeting the Needs of Long-Range Research Plans.

In addition to meeting the short-term informational needs of the community, the community advocacy anthropologist should develop a set of long-term research goals. These goals are more closely identified with the type of operations typical of the theoretical anthropologist, yet these long-term operations are also important to the goals of the community. Through these efforts the researchers create a data base that may meet the short-term informational needs of the community. Short research projects often serve as practice for the long-term research projects. Formalized Research and Data Collection Operations. As the process continues less reliance is placed on the informal research strategies, such as participant-observation and key informant interviewing. As specific informational needs are identified, research operations become more structured and formal. As community members come to participate in the research effort, the process becomes more highly structured. Analysis of Data. Analysis techniques must be time-effective. This is a crucial attribute of the process. Schensul notes:

Unlike more academically based research, the time within which research results are produced is vitally related to their usefulness. The "involvement in the action" strategy requires the development of procedures for the rapid analysis of data utilizing simple and easily manipulated techniques. At the same time, more sophisticated techniques are used to serve less pressing action needs as well as the long-term research goals. ( 1973:116)

Data Dissemination, Evaluation, and Interpretation. The results of the research are rapidly disseminated. If the information is not effectively communicated, even the most "significant" results will not have significant impact on the situation. The researcher can increase communication effectiveness by increasing the number of media of presentation. Results suggest that the least effective means of communicating is the typical technical report. An anthropologist who is concerned with communicating with his clients should use a variety of presentation techniques. It is suggested that the anthropologist be an aggressive and innovative communicator. The dissemination process is thought to influence the outcome of the process significantly, in that "disseminating data to community groups allows criticism, evaluation and assessment of the results to be rapidly fed back to the researcher" ( Schensul 1973:116). The results of research, good or bad, are "exposed to scrutiny" in the community.

The two key components of the community advocacy process are research and communication. These two processes are used to achieve a number of objectives, which include:

Communicating community goals and understandings to persons and agencies outside the community.

Assisting community-oriented programs in being appropriate to the needs of the community.

Evaluating community-oriented service programs.

Evaluating community-run programs.

Decreasing divisiveness between community factions.

CASE STUDY:

THE COMMUNITY MENTAL HEALTH PROGRAM AND EL BARRIO

The Community Mental Health Program was developed to serve the needs of a large population of blacks, Mexicans, and Middle Europeans on the lower West Side of Chicago. The activities of the research team primarily focused on the Mexican portion of the population. The population resides in an east-west oriented corridor clearly marked by physical and ethnic boundaries. The corridor is characterized by substantial population movement. It extends six miles, east to west, and six to nine blocks, north to south.

The area served by the mental health program clearly manifests its culturally plural nature. This area, in the jargon of community mental health programs, is called the catchment area. The black portion of the population is segregated from the rest of the population by a railroad underpass. The Middle Europeans and the Mexicans live in close spatial association, each maintaining a distinctive physical presence in the community. The Middle Europeans are leaving the area, whereas the Mexican population is expanding. This shift commenced in the 1950s with the movement of Mexican families from other parts of Chicago. The flow of people into the corridor was augmented by immigrants from Mexico, who were largely concentrated in the eastern portion of the corridor. According to Schensul, this area "has taken on an overwhelming Mexican cultural orientation. Restaurants, taverns, groceries and supermarkets providing Mexican foods and services dominate the entrepreneurial activity" ( 1973:108). The intensity of Mexican residence makes it possible for persons to be employed in Spanishspeaking contexts. The resident Mexican population represents three types of individuals: immigrants from Mexico, and Tejanos, that is, Chicanos from Texas, as well as Chicago-born Chicanos.

The research team concentrated their efforts on the eastern section of the corridor, which had a higher concentration of individuals of Mexican origin.

Initial Program Context

The Community Mental Health Program was established to bring alternative mental health services to various portions of Chicago's population. Based on federal funds, the program was to provide psychiatric services to the ethnically diverse population of the catchment area. Program strategy was based on community "outpost" clinics in the black, Mexican, and Middle European neighborhoods. The clinics were to be staffed by a full complement of professionally trained staff, including psychiatrists, psychologists, psychiatric social workers, psychiatric nurses, and vocational counselors, who were to increase access of low-income populations to professional mental health care. From these centers patients were to be referred to the "parent" mental health center. The outposts were also intended to make available a wide range of community social services to people in the neighborhood. It was assumed that outpost staff would develop a more intense familiarity with the neighborhoods so that preventative programs could be more easily developed. Prior to the development of this communityfocused approach the local ethnic population had made little use of the services of the supporting hospital.

The professionals of the centers came from the hospital staff. At the new centers they were faced with a different assortment of mental health problems. This change was related to substantial staff turnover. The services actually offered in the program were far from being innovative, and there was a relatively small number of Mexican participants. The staff of the outposts seemed frustrated and the potential client population seemed apathetic. An anthropologist was brought in. The anthropologist was to be involved in the community and to systematically tell the "community's story" for the benefit of the various staff members. Initially, Schensul interpreted the role as an ethnographer. He was to collect data that would lead to improved program structures and new treatment styles, and to provide data about the community to program administrators.

The research team attempted to activate the more traditional role, but found that the community situation took them in another direction. Schensul found that it was possible to conceptualize the research task at hand, yet difficult to carry it out. One of the major difficulties seemed to be that program administrators had little understanding of what potential contribution the anthropologist would make to the program. As a result, no specific responsibilities were assigned. This situation was complicated by Schensul's lack of knowledge of the community itself. His previous research experience was among rural Minnesotans and Ugandans. Because of limited experiences, his initial inputs were limited to general statements about the nature of culture and cultural relativity. In addition, Schensul attempted to develop a set of research strategies that would serve the needs of the program. Schensul indicates that both research and instructional strategies were failures. He felt that new inputs did not provide the program staff with any useful or problem-solving information. The response was one of hostility. The staff, it should be noted, had had negative experiences with previous researchers.

Schensul felt that his efforts in activating the traditional role were consistently unsuccessful. He tried various strategies to improve his positive impact on the program, but nothing seemed to work.

The short-run adaptation to the situation was to spend more and more time in the community. The team's knowledge of the community increased as they had more time to follow their natural tendencies to discover the community. This both reduced stress and increased their skill and knowledge. Because their role was not well understood by the staff, their withdrawal from daily involvement in the program was not difficult. As their knowledge of the community increased, so did their "contacts." This tended to legitimize them in the eyes of program staff and they became increasingly free to participate in the affairs of the community.

The relationship between the community research unit and the community steadily improved. The unit was able to get involved in its first survey project, which involved identification of certain characteristics of the school population. The school project, which was developed in conjunction with school staff, was to provide information that would lead to improvements in parent-school communication. Specifically, the project intended to determine through parental interviews the nature of family social and economic life in a specific neighborhood and to discover the parents' attitudes toward the school. In addition, the research intended to determine the nature and attitudes of the teacher population in terms of teaching Mexican-American children, and to determine the basis of the students' responses toward the school situation. The research procedure used interviews, home visits, and student records applied to a random sample.

The research produced a number of interesting results that improved the researchers' understanding of the community. Through the survey they found that they had grossly underestimated the size of the Mexican-born population of the total Chicano population. The research indicated that the parents had strong preferences for bilingual and bicultural education. Although the research had little impact on school administrators, the researchers learned some lessons about effectively conveying data to program administrators.

The school survey was followed up with a similar study of a Catholic school that served the same neighborhood. The research found that the Catholic school families had lived in Chicago longer and were more bilingual. They also seemed better off socioeconomically and educationally. The Catholic school's administration offered the researchers greater opportunities to communicate to the parents. This included a session in which the researchers were allowed to address a meeting of the parents' association. The researchers used a number of different techniques, including hand-outs of summary tables, Spanish translation, overhead projections, and parental feedback. The parents were especially interested in the demographic aspects of the study.

For a number of reasons, the research did not have any significant impact on the community or the school. The researchers felt the schools were unresponsive to this type of research because of control from outside the community, nonindigenous staff, and little interest in orienting programs toward the community. The school research left the research team frustrated and dissatisfied.

The team's energies came to be directed at the research needs of a settlement house funded by the Presbyterian church that served one of the neighborhoods in the corridor. Preliminary research indicated that the settlement house played an important role in the community as a meeting place for various community groups. The research for the settlement house was to focus on the "block clubs" that the settlement house was attempting to develop in their service area. Relations with the settlement house were quite good, based on the interaction with persons at the center that occurred during the initial period of participant-observation. Without any specific goals in mind, the research team began negotiations with the staff of the settlement house to determine the nature of the research. The team was to interview residents and perform the necessary work to carry out a census survey. Significantly, the anthropologists were to be in contact with the block team leaders and residents in order to provide feedback of research results to decision makers.

The researchers assigned to each block were quickly drawn into the action of the block club development teams. The researchers assisted in getting community improvement petitions filled out, organizing community activities such as street dances and fiestas, and doing attitudinal research concerning community needs. The researchers also carefully documented residents' participation. The initial efforts improved researcher understanding of the community. This, coupled with the high-quality interpersonal relations that developed, did much to facilitate the application and development of the action research or community advocacy model.

As the research progressed there was a shift in emphasis from general, areawide research for the purpose of generating basic demographic data to problemfocused, block-specific research. There were a number of issues examined. One block was faced with a problem characteristic of many American neighborhoods, a zoning change. The research team assisted in the collection of data that was useful in the resistance process. The team worked to communicate the nature of the threat to the community. They also documented the nature of the participation, which was useful for further projects. They were able to give group leaders some idea of the identity of the most effective community members. They found, for example, that the Mexican portion of the area was more predisposed to continued participation in action programs. Initially, the group seemed successful in resisting the change. A large group attended the zoning commission meeting in which the key decision was to be made. Community opposition was strong and articulate, and the decision was deferred, temporarily. Unfortunately, the zoning change was approved at a meeting held by the zoning commission that was not announced in the community. Some months later the new construction took place. The anthropologists were somewhat disillusioned by this. In any case, it was a lesson in big-city politics.

The experience with the zoning project led to further decreases in the participation of the research team in the community mental health program. The team was no longer concerned about the utility of their efforts to the clinical staff. They were concerned with the research needs of community groups, and justified their approach in terms of the preventative component of the community mental health approach. At this point they "discovered" the advocacy anthropology approach. Although community mental health programming was intended primarily to provide mental health care directly to patients, a certain portion of resources could be allocated to alleviating community-based causes of mental health problems, such as bad schools or little economic opportunity.

The approach was successfully applied in a number of different contexts following the somewhat fortuitous "discovery" of the approach. A selection of these projects will be reviewed here. The projects selected were related to community needs and the developing data base of the research team. Additionally, the team came to be more and more tied to formally established community organizations. One of these organizations was ALAS (Alliance LatinoAmericano para Adelante Social), which was one of the first and most active community action groups. ALAS dealt with a number of crucial issues that faced Chicanos nationally and locally. More specifically, this meant increasing the quality of bilingual and bicultural programming in the Chicago school system. They were especially interested in augmenting the Teaching English as a Second Language (TESL) program. The action research team supported the efforts of ALAS in this and other realms.

Commando Anthropology

Initially, involvement in the bilingual education issue took the form of an ALAS-organized "commando raid" to assess the quality of TESL programs in the schools of the area. With no forewarning, eleven separate research teams entered the schools of the community at precisely eleven o'clock in the morning. Each team was equipped with a data collection schedule. The teams attempted to identify the extent and quality of the TESL programs. The investigators discovered that TESL classes were limited in time and were often not held. Additionally, TESL classes were often run by untrained substitutes or nonSpanish-speaking teachers. The space allocated to the program was determined to be of low quality. The general conclusion was that the TESL program did not meet program guidelines.

The data derived from the process of "commando research" was organized and used to support the filing of a suit with the Illinois Civil Rights Commission. The "raid" showed that it was possible to do good research under severe time constraints, if speed was planned into the research project.

The Community Research Unit and El Centro de la Causa

The staff of the Eighteenth Street settlement house in the barrio had become increasingly concerned with the quality of recreational, social, and educational services that they offered. The situation had become critical because of the physical deterioration of existing community facilities. To improve the situation the settlement house staff attempted to develop a new youth program to deal with what the other social service agencies called "hard-core kids." These individuals were simply not welcome at the existing social service programs. The situation called for an alternative kind of facility. This alternative was to take form under the name ofEl Centro de la Causa . The key organizer was a street-worker who developed a following among local gang members.

The group found an old parochial school that was not fully used. With a group of volunteers the building was cleaned and renovated. A recreation program was organized and soon a group of Chicano students were able to offer some classes on various Chicano topics. Various local businessmen were able to make contributions. Some clinical services were also offered at the center. The center drew a number of new participants. As participation increased, so did the services offered.

El Centro began its first fund-raisers in 1971 with a community fiesta and carnival. Three years later, El Centro had a $400,000 budget. The staff had been successful in acquiring funds from outside the community. Their fund-raising success was related to their skill as well as the changing relationship between Chicanos and the federal government. In the case of El Centro, these grants took the form of a drug treatment program and a mental health para-professional training program, as well as various other education, youth and other social service programs. Increasingly, El Centro became a focal point for the political activism that was to sweep the Chicago Chicano community.

It was in conjunction with the program at El Centro that the community advocacy was most effective. The research team's activities grew, expanded, and increased in complexity. Their relationship with El Centro was multifaceted in that it included a wide range of activities and responsibilities.

While the ultimate goals of community advocacy must be in the hands of the community leaders, the researcher has to be involved in all phases of the action. This implies that the community advocacy anthropologist activates a number of roles beyond that of researcher. El Centro project made use of the anthropologists' research skills very early, but soon these activities were supplemented. Members of the research team participated with activists in strategy planning and policy making. The team was also given the responsibility of providing historic documentation, and a major role in "facilitating communication with outside groups" ( Schensul 1974:205).

The team's involvement included "identifying potential sources of funding, participating in meetings with representatives of a number of institutions and funding agencies, using research data on health, mental health, drugs, drug use, youth organizations, community structure, and demography in reports and discussions in which the community 'case' was presented," and "collaborating with community activists in writing formal proposals for funds to private institutions and federal funding sources" ( Schensul 1974:206). Through the research team, El Centro was better able to present its case to relevant agencies. The developing data base of the center collected by the team was useful in preparing proposals, which served to legitimate the presence of the research team.

The data that proved useful was quite variable, including such things as ethnographic studies of Mexican folk medicine found in the literature, data relating to evaluation of local health care facilities, and information dealing with sources of additional grant funds. Although research skills are important, they can only be made useful through an ability to communicate. The researchers were the means by which the community could express its ideas and plans. "The applied researcher must demonstrate the ability not only to describe the research results, but also to write effectively and economically about program structures, treatment plans, training schedules and other components of community programs" ( Schensul 1974:206).

Increasingly, the team was drawn into all aspects of program operations and management. This related to a general tendency of the researchers and the activists to become more and more alike. The researchers were taught action skills in organization of the community and bureaucratic manipulation. The activists learned to be competent researchers. Ultimately, they could develop research protocols and analyze research data.

As the program at El Centro increased in complexity, the team was called upon to carry out more focused research. Often a staff member would communicate a specific research problem in conjunction with a program development need.

For example, the youth service staff decided that, before developing a program that would be based on their own preconceptions, they needed a survey of youth attitudes and behavior. Together, we constructed an extensive questionnaire that was eventually administered to over eight hundred youngsters (aged thirteen to fifteen) in the community. ( Schensul 1974:206)

Similar activities developed in association with a program of treatment for Chicano drug addicts. Research skills increased and the team developed a good workable understanding of the advocacy process. The team discovered that a key to research success was to negotiate research methodology with staff and activists. According to Schensul, negotiation "can increase the relevance of the information collected, make activists more receptive to the resulting data and create more sensitivity to the inevitable problems and delays in data collection" ( 1974:207). The team also attempted to carry out research both in terms of long-term and short-term needs so that each short-term project would result in an increase of their data base. The effectiveness of this approach increased as the team learned how to better predict future information needs. The team discovered that the well-designed, methodologically clean project often did not meet the needs of the situation. The results were often not available at the correct time. At times, in order to be effective, the researchers had to go into a "quick and dirty" mode.

As the relationship between the researchers and the El Centro activists improved, there came to be an increasing focus on internal research activities. This grew out of a need to institutionalize the research effort of El Centro. In response to this, an internal research unit was created. The unit engaged in a number of significant research problems.

The team continued to work through El Centro. Their efforts became directed at a wide range of increasingly concrete action programs. Each was addressed to specific needs identified within the Chicano community. These programs were diverse and included drug treatment, community education, and mental health training.

SUMMARY

Advocacy anthropology represents a set of anthropological activities that are well adapted to working in direct relationship with community organizations as opposed to working through an intervening agency. The role of the advocacy anthropologist is limited to the expressed needs of the community, usually expressed through its leadership. Usually this involves work as aa researcher, research trainer, and proposal writer. Advocacy relations do not usually call for the anthropologist to be directly involved in change-produciing decision making. The advocacy anthropologist is, as Schensul says, involved in the action, but as an auxiliary to community leadership. The advocacy portion of the name of this approach simply means using one's research skills to support the attainment of community goals.

This simple, but very useful idea can be expressed in many ways. The case presented here represents a good model of the advocacy role. It is clear that the advocacy anthropologist must be able to reduce somewhat his or her use of the discipline as a reference group. The reference group is the community. Professional achievement is measured in reference to the community's achievement of its goals. This is not an easy task, but when it occurs it can yield powerful satisfactions on the part of the anthropologist, while increasing community capabilities. Although there are a number of skills that are useful to the advocacy anthropologist, proposal writing often is crucial. This can both help achieve the goals of the community, and provide the means for the continued involvement of the anthropologist.

FURTHER READING

Stull Donald D., and Jean J. Schensul, eds. 1987.Collaborative Research and Social Change: Applied Anthropology in Action . Boulder, Colo.: Westview Press.

Contains good documentation on a number of advocacy projects.

Weber George H., and George J. McCall, eds. 1978.Social Scientists as Advocates: Views from the Applied Disciplines . Beverly Hills, Calif.: Sage Publications.

Contains chapters that discuss advocacy from the standpoint of social work, law, psychology, urban planning, sociology, and anthropology. The chapter on anthropology was written by Stephen L. Schensul and Jean J. Schensul. Their article includes reference to the Chicago work discussed here, and the use of the same technique in Hartford, Connecticut.

8 Cultural Brokerage

Hazel Weidman first described in 1973 (Weidman 1973) her conception of culture broker applied in the "health care context" ( Lefley and Bestman 1984:120). Her idea was based on a concept developed originally by Eric Wolf to account for those persons who served as links between two cultural systems (1956), but was modified and extended by Weidman to serve socially useful purposes.

Wolf's view of culture broker was conceptualized in the context of his research into the linkage between peasant communities and national life in Mexico. Wolf suggested that "we can achieve greater synthesis in the study of complex societies by focusing our attention on the relationships between different groups operating on different levels of the society, rather than on any one of its isolated segments" ( 1956:1074). The broker provides the individual link between sociocultural units. In the case of Mexico, the units are peasant communities and various national systems. Specifically, Wolf suggested that the study of brokers would be a useful first step in studying the integration of large-scale, culturally plural systems. Brokers are important because they stand guard over the crucial junctures or synapses of relationships which connect the local system to the larger whole. Their basic function is to relate community-oriented individuals who want to stabilize or improve their life chances, but who lack economic security and political connections, with nation-oriented individuals who operate primarily in terms of complex cultural forms standardized as national institutions, but whose success in these operations depends on the size and strength of their personal following. (Wolf 1956:1075-76)

It is this concept of role that forms the basis of the cultural brokerage model. The concept of the broker role is supplemented by other ideas that are essential to the approach. Cultural brokerage is an intervention strategy of research, training, and service that links persons of two or more coequal socio-cultural systems through an individual, with the primary goals of making community service programs more open and responsive to the needs of the community, and of improving the community's access to resources. While other types of intervention affect the community in substantial ways, cultural brokerage substantially affects the service providers. In other words the focus of change processes are the agencies themselves. The cultural brokerage approach to intervention is a way of restructuring cultural relationships not so much to resolve cross-cultural conflicts, but to prevent them.

DEVELOPMENT OF THE APPROACH

The development of the approach started with a research project focused on "health systems, beliefs and behavior" begun in 1971 by the Department of Psychiatry of a large, county-owned general hospital in Miami, Florida ( Lefley and Bestman 1984:120). Called the Health Ecology Project, this research made use of a variety of different data collection techniques, including in-depth interviewing, survey questionnaires, a symptoms and conditions list, values scale, and health calendar ( Lefley and Bestman 1984:121). These and other techniques were used in collecting data from a sample of five hundred families over a period of time. This data was supplemented by interviews with "folk healers and their patients from each ethnic group" ( Lefley and Bestman 1984:121). As a result of the research, the team thoroughly documented the health culture of a major segment of the service area of the hospital.

The hospital's service area was ethnically diverse. Within its area it was possible to find Cubans, Puerto Ricans, black Americans, Haitians, and Bahamians, as well as whites. In its massive scale and impersonal nature the hospital was similar to most large, public, and urban hospitals. Weidman notes: "Even if the services are provided in a sympathetic and compassionate manner, they are seldom appropriate in the cultural sense. Examined largely by white middleclass health professionals or professionals in training, the patients were evaluated and labeled according to white middle-class criteria, and treated with middleclass therapies" ( Sussex and Weidman 1975:307).

The psychiatric patients were often critically ill. This factor and the heavy case load caused the care providers to emphasize control of inappropriate behavior through drugs. Unresponsive patients were transferred to a state hospital for custodial care. Although the program was under review, no major improvements were forthcoming. It was thought that a major limitation to more effective service was lack of understanding of the cultural differences among the ethnic communities in Miami.

The research field staff had fostered good working relationships with community members as part of the community research effort. Through the efforts of community research assistants who were the same ethnic background community members, the demand for improved mental health care services increased. The practice of brokerage grew out of these relationships. Using ideas that developed out of the research and the interaction with community members, the cultural brokerage approach to mental health care delivery was formally implemented in the Miami Community Mental Health Program, funded in 1974 by the National Institute of Mental Health, under provisions of the Community Health Centers Act of 1963 ( Lefley and Bestman 1984:122).

KEY CONCEPTS

According to Weidman, there are five concepts that are essential to understanding the cultural brokerage approach ( 1975:312). These concepts are culture, health culture, coculture, culture broker, and culture mediation. The conceptualization used for culture is "the learned patterns of thought and behavior characteristic of a population or society--a society's repertory of behavioral, cognitive, and emotional patterns" ( Harris, in Weidman 1975:312). The project was very strongly committed to a cultural relativism position. The concepts used in the project provided a means by which project personnel could think about the cultural complexity in the community without necessarily engaging in an evaluative comparison of the alternative systems. This represents an important conceptual innovation that is an essential aspect of Weidman's transcultural perspective. This perspective places the anthropologist at the margins of the cultures of both the health care providers and the community ( Weidman 1982:203; 1979:86).

The project's conceptual structure is quite well developed and internally consistent, and rather more explicit than some of the other conceptual schemes discussed in this text. Importantly, the health care providers were able to respond well to these ideas because they made sense to them. Coupled with the culture concept is the health culture concept, which is defined as "all the phenomena associated with the maintenance of well-being and problems of sickness with which people cope in traditional ways within their own social networks" ( Weidman 1975:313). Health culture encompasses both "the cognitive and social-system aspects of folk therapies." Cognitively, this includes health values and beliefs, guides for health action and the relevant folk theories of "health maintenance, disease etiology, prevention, diagnosis, treatment and cure" ( Weidman 1975:313). The social component of the concept deals with the structural-functional aspects of health-related social statuses and roles.

An essential aspect of cultural brokerage is the concept ofcoculture . Coculture is a conceptual substitute for "subculture," though it is different in very important ways. Most importantly it stresses parity. Cocultures are equal in value to their participants. As expressed by Weidman, the concept of subculture implies that one group is subordinate to another. The role of the culture broker is introduced to accommodate the link between cocultures. The role concept is appropriate to the "parity of cultures" notion. To quote Weidman, "The label seems applicable whenever there is need to recognize the existence of separate cultural or subcultural systems and to acknowledge a particular person's role in establishing useful links between them" ( 1975:313). The parity idea, and the responsiveness, respect, and support that it produces, contributes to the acceptance of the approach to community members. Parity does not mean that the cultures are the same. As Weidman states, use of the concept results in the juxtaposition of cultural systems, which "provides the basis for comparison of congruent and noncongruent elements in them" (1982:210). This perspective is consistent with the comparative method of anthropology as a research science.

The concept, as noted above, developed out of research and teaching activities at the hospital and was ultimately expressed in project organization; that is, persons were hired as culture brokers. The culture broker's linkage activities occurred in two frameworks. The broker served to link the community health culture and the orthodox health care system so as to facilitate the provision of orthodox care that is "coculturally informed." The second arena for linkages was between the community and the "broader social, economic, and political system" ( Weidman 1975:314).

The process of linkage is labeledculture mediation . In practical terms this means the provision of culturally appropriate services. Effective mediation facilitates better interaction between representatives of the cocultures represented in a community. The basis for cultural mediation is the culture broker's knowledge of the involved cultures. This requires a strong commitment to synthesis of various health traditions as well as various scientific disciplines. The process of mediation will be discussed below.

THE CULTURE BROKER'S ROLE

The culture broker is to be viewed as an important player in the interactions between two parts of a larger cultural system. In the scientific literature on brokerage, the broker links traditional and modern, national and local, or European and "native" ( Fallers 1955; Wolf 1956; Geertz 1959). In the Miami project these distinctions were rejected to the extent that they implied cultural dominance.

The broker role as conceptualized by Wolf attributes a certain self-interested quality to the role. Wolf notes:

They must serve some of the interests of groups operating on both the community and national level, and they must cope with the conflicts raised by the collision of these interests. They cannot settle them, since by doing so they would abolish their own usefulness to others. Thus they often act as buffers between groups, maintaining the tensions which provide the dynamic of their actions. ( 1956:1076)

This component of meaning associated with Wolf's conception was not part of the use of the concept in the Miami project. Weidman and the others stressed the buffering and mediation that serves to facilitate harmony and equality between cocultures, while they recognized that their approach restructured community services. Their conception of the broker role included a purposive and intentional aspect that does not appear in the original conception ( Weidman 1985). The application of the cultural brokerage approach is motivated by the need to increase accessibility of basic medical care in the United States. There exists in every complex society a range of alternative health care systems that typically are in competition. Different viable health cultures are found throughout the world in isolated rural areas and in dense urban settlements. In one way or another, the therapeutic practices that are part of these health cultures are in competition with each other and with modern medicine.

The position of Western medicine in this competition is unique. As Weidman notes, "Since it emerged in the Western world, that social institution called 'scientific' or 'modern' medicine has been sanctioned internationally as being ultimately responsible for the health of national populations" ( 1979:85). In the total scope of human history this is a relatively recent event. Throughout the world much health maintenance behavior is based not on "scientific" medicine but on traditional health culture. According to Weidman, "Our field of inquiry is a culturally plural one. In every urban center in the world today we must recognize a 'pluriverse' of health cultures, one of which is our own or that of Western medicine, all of which are interacting or inhibiting from interacting on the basis of reciprocal images of each other" ( Weidman 1973:8).

In these settings the culture broker links alternative systems that are equivalent. This, of course, relates to the discussion of coculture indicated above. The relationship between the systems is thought to be symmetrical. The parity concept is what distinguishes the culture broker from the more common outreach worker. This more typical role is consistent with the view that Western medicine is dominant and the cultural alternatives are to be aided, displaced, or changed, because of their impotence. Typical outreach workers are usually agents for the dominant culture and often work in an inherently compromised political position.

Because the culture brokers are thought to operate between two systems at parity, the broker's function calls for substantial knowledge of the two systems involved. Therefore brokerage requires ongoing research. In the prototype project in Miami, there was an extensive research effort. The Health Ecology Research Project, briefly described above, attempted to obtain data on the health culture of the different ethnic groups of the area. Some of the areas researched included patterns of symptoms, categories of illness, folk etiologies, nature of self-care, health care use patterns, healer roles, referral patterns, value orientations, and world view ( Weidman 1982:209). It is important to remember that the research often compared the traditional and orthodox health cultures, and that it was ongoing.

PROCESS OF CULTURAL BROKERAGE

The process of cultural brokerage includes the establishment and maintenance of a system of interaction, mutual support, and communication between cocultures expressed through the culture broker's role. The process of mediation protects the cultural values of the involved ethnic groups. It is within this frame-

-129work that change occurs. Change is toward increased cultural appropriateness, access to resources, better health, and more compliance with medical regimens ( Weidman 1985). The potential for change goes much beyond health; social and economic conditions may also be positively influenced. The basic process can include a variety of strategies that benefit community members, including many of the strategies discussed in this section of the book, such as advocacy.

Phases of the Process

I. The compilation of research data on the health culture of all the cocultures in the community. This includes both the traditional and orthodox health systems.

II. The training of brokers in aspects of community life. Culture brokers are usually members of the ethnic group being related to, as well as being trained social scientists. The primary reference in the training is health culture. The training may involve participation in the initial research.

III. Early activation of the culture broker role usually involves collaboration with institutionally based health care personnel to assist in providing culturally more appropriate health care. In addition, the broker fosters referral relationships with traditional health practitioners and trains community people to assume broker roles. These activities are associated with continual involvement in research to increase the project's data base and support community action projects.

IV. The brokerage efforts cause change in both the community and the orthodox health care system. These include increased knowledge of the culture of the community on the part of the health care providers, and improvements in the community's resource base. Overall improvements in mental health levels occur.

Prior to implementation of a culture broker program, interactions between community members and the health care facility are based largely on decisions of the individual community member. There are no outreach or other efforts at linkage. The institution does not possess any significant knowledge about the patient's way of life. This way of life is conceptualized in subcultural terms, that is, inevitably changing to the pattern of the institutional or dominant culture. The little information that is gathered about patient subculture is obtained on a nonsystematic,ad hoc basis. Encounters between health care institutions and the community are almost always between therapist and "sick person." That is, the interactions are single-stranded.

In the early phase of implementation a new formal role is created, the culture broker, and the culture parity concept is asserted. The parity concept is an ideological commitment to be operationalized programmatically. Parity may not be manifested in the relationship between the two cocultures in the larger political realm. Later, the culture broker comes to be more throughly integrated into both cocultures, serving as a knowledge resource for both.

CASE STUDY:

THE MIAMI COMMUNITY MENTAL HEALTH PROGRAM

The Miami Community Mental Health Program was designed to serve the mental health needs of a large, ethnically diverse area of Miami ( Lefley and Bestman 1984:122). The service area, so-called catchment area IV, was a lowincome area inhabited by five major ethnic groups: Bahamians, Cubans, Haitians, Puerto Ricans, and American blacks. Ethnically diverse, this population exhibited many of the stresses typical of low-income, inner-city populations. The area had higher rates of crime and unemployment and much substandard housing. Program designers felt that the standard "medical model" approach would be inadequate for achieving mental health improvements. It was felt that the traditional approach would not produce culturally appropriate health care. The diversity of causes of ill health and the cultural complexities of the community would not yield to the orthodox treatments available in the hospital.

The Miami model, as suggested above, was built upon a thorough community research base provided by the research component of the Miami Health Ecology Project, which had been established earlier. The primary finding of the project was that each of the five ethnic groups had distinctive knowledge and behavior vis-à-vis mental health. The diverse conditions under which they lived produced culturally patterned health conditions, including "culture-bound syndromes not recognized by the orthodox medical profession" ( Lefley 1975:317). In the community, "alternative healing modalities were widely used, often in conjunction with orthodox medical treatment" ( Lefley and Bestman 1984:121). "Differential perceptions of causation and remediation of illness" were identified ( Lefley and Bestman 1984:121). The most fundamental and far-reaching conclusion from the research was that "culturally specific therapeutic interventions were needed to deal with ethnic variables in these diverse groups" ( Lefley 1975:317). Research results were documented in publications and "ethnic libraries" for use of the project ( Lefley and Bestman 1984:121).

Basing their approach on the existing mental health services of the hospital, the project attempted to develop a culturally appropriate approach. The countyowned hospital was a 1,250-bed general hospital serving an area of Dade County populated by 200,000 persons. This economically depressed area manifested significant numbers of mental health problems. Although the hospital seemed to be in the middle of things it was somewhat inaccessible to the residents of the catchment area. Public transportation, for example, was inadequate for getting patients to the clinic. The service was impersonal and culturally inappropriate. The diagnosis procedure was based on white, middle-class conceptions of symptoms. Patients tended to come to the hospital only when they were desperate-when "they have been stabbed or shot or otherwise injured, when they are critically ill, or when they are so behaviorally deranged that the police deliver them to our doorstep" ( Sussex and Weidman 1975:307).

The hospital's psychiatric service had operated as a disease-focused mental health service that viewed health in terms of the medical model ( Fabrega 1972). That is, care was based on the assumption that a given disease should be treated in a certain generally accepted way because it always has the same cause, . and always responds (or should respond) to a particular type of treatment. So the standard nomenclature is used, the usual signs and symptoms of the mental-status examination are duly elicited and recorded, and the customary therapeutic procedures are prescribed. ( Sussex and Weidman 1975:307)

The psychiatric service had a rather high case load, largely derived from a busy emergency service. The goal of the service was behavior control, mostly through the use of drugs. Patients who did not respond were typically sent to a state hospital. Case management was made more difficult by limitations in after-care treatment.

In 1974, the action component of the project was funded. The proposal emerged directly from the work of five field teams that were ethnically identical to the different communities. As is often the case with ethnographic fieldwork, the teams developed good rapport with community members. Although not necessarily intended, the teams' efforts resulted in increased sensitivity to the possibilities for improved mental health services for the community. As an outgrowth of this, there was increased demand for appropriate services. The funding for action allowed the placement of the five ethnically specific teams. The five teams were ultimately supplemented by teams that dealt with the substantial elderly Anglo-American and black populations. The efforts of each of the ethnically specific teams were supplemented by a community advisory board that assisted in defining program goals and team personnel recruitment. Each team was directed by a social scientist with training, in most cases, to the Ph.D. level. These directors were the culture brokers referred to as the key component of this approach.

One important role of the culture broker was to serve as a bridge between the community and the hospital. This effort included acting as liaison between community leaders and the hospital. There was to be a special effort at serving as a link between the different kinds of physicians and the community members who faced particular health problems. The broker was to serve as both a researcher and a teacher in the program. As teachers, the brokers were engaged in augmenting courses in various hospital training programs, instructing in community orientation classes for hospital staff, consulting on the health problems of individual patients, and assisting students on projects. Further, the culture brokers were to act as trainers of community representatives in various areas, as well as training various health professionals as culture brokers. For an excellent review of the development of the role of the anthropologist in clinical settings in Miami, one should read Weidman "Research Strategies, Structural Alterations and Clinically Applied Anthropology" ( 1982).

The other important aspect of the broker role developed in the community, where they organized community groups with social action goals. These efforts often started with assessments of community needs, which were used for community planning and proposal development. The brokers could be thought of as social change catalysts that acted primarily through their research. Research was done in support of many different goals that the community related to mental health problems. These included research in support of such things as day care centers, hot lunch programs, and changes in housing policy. These community involvements also included acting as resource specialists to bring consumers together with service providers in Miami. This helped community members to act when agencies were lacking or inadequate ( Lefley 1975:318).

Each ethnic community had its own pattern of program development, although each team provided "essential psychiatric services" ( Lefley and Bestman 1984:127). Much of the content of program activities was based on advice given by community advisory boards. Some of the early efforts included research done on behalf of community groups ( Lefley and Bestman 1984:127). It is important to remember that the teams functioned both in the hospital and community frameworks.

Teams at Work: Some Examples

The black American mental health unit worked in two communities within catchment area IV. These were Model City, with eighty thousand persons, and Overtown, described as a "transitional" community of fifteen thousand blacks. Each posed a different and complex set of problems. Overtown was fragmented by ill-planned urban renewal and freeway development, although it had a history of community life. The community had lost much of its organizational coherence. Overtown came to be the focus of the program efforts. The black American mental health unit attempted to achieve program objectives by "the creation of a comprehensive services center," and "the development of a dynamic communication network system for educating, informing and organizing the Overtown residents" ( Carroo 1975:321).

Based on needs assessment research carried out with a sample of community residents, the mental health unit focused upon housing, education, employment, mental problems, and after care ( Carroo 1975:321). The unit worked toward collaborating with existing social service agencies in order to create a comprehensive service center in the midst of the community. This cooperative effort came to be the focus of much of the unit's efforts. The center offered a range of important services, such as a mini-clinic that offered both clinical and social services. There was an emphasis on "the principles of self-help and collective action" ( Carroo 1975:322). The unit, in conjunction with a nearby community college, offered community workshops on aspects of social service. The clinic also was involved in "building and strengthening support systems for high-risk groups" ( Carroo 1975:322). This included work with the school system. The cultural specialist worked with school counselors in group therapy sessions, and also facilitated the development of a tutoring program to treat one of the causes of stress among students.

Housing problems were addressed through an arrangement with a tenant organization and a local poverty law group. In this context the mental health unit determined community sentiments through survey research, developed a community forum for review of the housing problem, and contacted individuals in the community who were having significant difficulty. In addition to these efforts, the mental health unit also served to coordinate and focus many of the diverse community groups. This took a special effort because of the diverse and transitional nature of the Overtown community.

The Cuban unit began operations in early 1974, in the Edison-Little River region of Miami. Initial mental health unit operations were research-focused. Over 620 families were interviewed to assess needs and to begin to determine action goals in Edison-Little River. The research indicated some of the needs of the low-income and elderly population. Out of this initial research certain preliminary goals were identified. These included a shopping assistance and hot lunch program for elderly residents. The need for day care and after-school care was also identified in the community. Shortly all these problem areas were addressed programmatically. Soon the mental health unit had geared up a shopping assistance program for elderly residents of Edison-Little River. Somewhat later, hot lunch and day care programs were established. Parallel to these action projects, the team offered social services to an increasing number of people.

During the early stages of the Edison-Little River work, the Cuban mental health unit went through substantial in-service training. This training was directed toward improving the team's knowledge of social research techniques, Cuban culture and its relevance to service delivery, social services available in the community, and basic techniques for dealing with mental health problems at an individual level.

The Edison-Little River project seemed to be good training for the work in the section of catchment area IV called Allapattah, with its very heavy concentration of Cubans. The southern half of Allapattah is about 68 percent Cuban ( Sandoval and Tozo 1975:329). The Allapattah community was marked by a very limited sense of identity.

The Allapattah Cuban community had very few appropriate programs available to meet its substantial social, health, and mental health needs. Many Cuban-focused services could only be obtained by going to nearby Little Havana. This included public schooling and Cubanclinicas for outpatient health care. According to Sandoval and Tozo, the Cuban population was characterized by substantial intergenerational conflict caused by the fact that the old and the young Cubans were raised in two different cultural settings. Further, it was also felt that the Cuban extended family had weakened ( Sandoval and Tozo 1975:329).

In Allapattah, the Cuban unit carried through a basic demographic census. This was coupled with an attempt to contact various leaders in the community. Through this procedure, the team came to be "aware of the lack of cohesiveness within the different ethnic groups in the community, the lack of power structure within the Cuban community, and the lack of communication between the various ethnic groups" ( Sandoval and Tozo 1975:330). The unit was also very much committed to improving the capacity of the community to assess its own needs. Much of the strategy was oriented toward increasing community awareness in Allapattah. This awareness was built upon the growing data base on the community that was developed by the members of the team.

This effort resulted in the development of a community social service agency called La Norguesera. The agency delivered a substantial range of services, including food stamps, legal counseling, and medical services. These general efforts were coupled with a specific program for mental health treatment that resulted in the establishment of a mini-clinic. This operation was similar to the project developed in Overtown. La Norguesera mini-clinic staff found cases and provided initial treatment and follow-up within a Cuban neighborhood. People in need of services could drop in for recreational, social, and therapeutic activities. All this was oriented toward rehabilitation in the community itself rather than outside ( Sandoval and Tozo 1975:331).

The mini-clinic's mental health services were designed to be culturally appropriate. All staff members were Cuban and, of course, the research team continually provided relevant data. Action was taken that accommodated Cuban culture at a number of different levels.

A somewhat different orientation was used by the Puerto Rican mental health unit ( Bryant 1975). The team focused its efforts on Wynwood, a section of the catchment area that had the highest concentration of the twenty thousand Puerto Ricans living in Dade County. It manifested many of the same difficulties and stresses characteristic of the other catchment areas: "low incomes, high rents, a plethora of health and mental health problems, and an underutilization of health, mental health and social-service agencies" ( Bryant 1975:333). The Puerto Rican team's approach was conceptually related to that of the other units. Led by an anthropologist, the team was committed to "building support networks" in the community, facilitating "indigenous social action and community development," and acting as "systems linkers or culture brokers between psychiatric personnel and Puerto Rican patients in the Psychiatric Institute" ( Bryant 1975:333). Further, the strategy called for participation in the hospital's training programs for mental health staff who were to work with the Puerto Rican community, and the provision of research data and other information about the community to social service agencies ( Bryant 1975:333).

The Puerto Rican mental health unit used the culture brokerage approach in two ways. The unit attempted to make significant use of community mental health resources such as the extended family, churches, clubs, and traditional curers (espiritistas ), thus bringing community resources directly to bear on specific patient needs. The brokerage efforts were also directed at creating new community organizations to help meet community needs. Often this meant initiation of an organizational effort and the subsequent reduction in involvement as community members took on the responsibility. These efforts included recreation and athletic programs, and activities more clearly related to mental health programs.

The cultural brokerage program started by dividing the Wynwood community into four areas, each with one or two neighborhood workers. Area workers were initially involved in researching the basic community characteristics and needs. The field staff continued to work as community information sources. As research questions came up, these workers collected appropriate information. The workers also did basic mental health assistance work with afflicted individuals in their neighborhoods. Bryant notes: "By working on a neighborhood basis in all activities--a consistent and comprehensive contact is maintained between community and [the] program" (1975:335).

The linkage effort was further served by having the workers regularly participate in community organizations. This linkage was replicated at the leadership level; the leader of the Puerto Rican mental health unit met with leaders of other programs regularly in order to facilitate coordination of program efforts. This led to the development of an incipient coalition between the program and community activists. The mental health unit served the community's leadership in three ways. The team provided community leaders with data on various community problems and the use of social services outside the community. One of the projects that illustrates this activity was a community survey that helped identify, in cooperation with a local community action group, housing needs and problems in the community. This information was used in dealing with the Department of Housing and Urban Development. The team also assisted community leaders in the proposal development that would lead to more community-based programs. In one case the mental health team member was able to facilitate the development of day care facilities in the community. The third aspect of the team's community collaboration strategy was the evaluation of existing community programs at the request of the community leadership. The Puerto Rican mental health unit also worked to assist agencies serving the community with their research needs. One agency was concerned about the perceived underutilization of their services by the Puerto Rican community.

SUMMARY

Cultural brokerage is a useful strategy for applying anthropological knowledge to a wide range of contexts. It, quite obviously, has had its utility demonstrated in health and medical programs. It has begun to be used in other settings as well. Its primary purpose is linking two culturally different groups with the intent of increasing cultural appropriateness of services and increasing the resource base of the community.

The ideological program of cultural brokerage is quite simple. It is the programmatic operationalization of intercultural parity. It does not have the elaborate values-in-action factor characteristic of research and development anthropology, nor does it have a strong concern for the bifurcated goals of scientific truth and community self-determination, as does action anthropology. Its conceptual structure provides an excellent means for providing culturally appropriate services.

The goals of cultural brokerage contrast significantly with some of the other value-explicit approaches. The others are largely up-front change programs, in which the anthropologist is actively seeking changes in the behavior of a target community. The goals of cultural brokerage are different. While change is an intended product of cultural brokerage, a primary target of the change-producing activities is the health care or other service-providing system. If that system changes so that it effectively deals with cultural pluralism, then the task of the broker is over. He or she will have worked him or herself out of a job. A health care system that was truly "transcultural" would have no use for the culture brokerage role. The care providers would be the brokers.

Cultural brokerage functions have long been a part of the applied anthropologist's role. It was not until more recent times that there emerged an entire strategy based on cultural brokerage.

Cultural brokerage could be used in many different kinds of situations. It seems especially useful when there is a need to link a service-providing organization with an ethnic community where there is a commitment to cultural pluralism. Commitments to cultural pluralism seem to be based upon emerging equality of power. In other words, the approach seems very well adjusted to contemporary American urban ethnic politics.

Further Reading

Lefley Harriet P., and Evalina W. Bestman. 1984. "Community Mental Health and Minorities: A Multi-Ethnic Approach." InThe Pluralistic Society: A Community Mental Health Perspective , Stanley Sue and Thom Moore, eds. New York: Human Sciences Press.

A recent, comprehensive account of the approach and its development.

Weidman Hazel H. 1982. "Research Strategies, Structural Alerations and Clinically Applied Anthropology." InClinically Applied Anthropology , N. J. Chrisman and T. W. Maretzki, eds. Dordrecht: D. Reidel Publishing Company.

Excellent discussion of aspects of the cultural brokerage role, with emphasis on the inhospital function. 1976. "In Praise of the Double-Bind Inherent in Anthropological Application." InDo Applied Anthropologists Apply Anthropology? , M. V. Angrosino, ed.Proceedings of the Southern Anthropological Society no. 10. Athens: University of Georgia Press.

Presents Weidman view of cultural brokerage as she contrasts it with other kinds of applied anthropology. Also discusses the key concepts of cultural brokerage.

9 Social Marketing

Social marketing is a social change strategy that combines commercial marketing techniques with applied social science to help people change to beneficial behaviors. Some examples of the issues targeted by social marketing are contraception ( Schellstede and Ciszewski 1984), blood cholesterol screening ( Lefebvre and Flora 1988), heart disease prevention ( Maccoby et al. 1977), safer sex ( BEBASHI 1990), high blood pressure reduction ( Ward 1984), oral rehydration therapy use ( Clift 1989), and smoking reduction ( Altman et al. 1987).

Used in both the developed and developing countries ( Manoff 1985:221), social marketing represents a synthesis of "marketing, mass communication, instructional design, health education, behavioral analysis, anthropology, and related social sciences" ( Academy for Educational Development 1987:67). While commercial marketing is an organizing concept in social marketing, as it "provides analytical techniques for segmenting market audiences, product development, pricing, testing, and distribution," the core of social marketing practice is "a commitment to understand consumer needs and to produce products, programs or practices to enable them to better solve their problems" ( Bryant and Lindenberger 1992: 1). Social change is promoted through culturally appropriate messages carried through mass media. These efforts are highly coordinated, working cooperatively with local agencies and community groups.

Social marketing requires skills and viewpoints that are part of being an anthropologist, and therefore increasingly we find anthropologists working in all stages of the social marketing process. The anthropologist's primary role in social marketing is research. Social marketing uses qualitative and quantitative research during all phases of planning, implementation, and administration. Good ethnographers bring many useful skills to the process, including the "creative interpretation of research into ingenious message design" ( Manoff 1988:4). The attitudes of social marketers about research are highly consistent with those of ethngraphers. Both have a strong commitment to the "native" viewpoint and skepticism about survey research.

In this chapter social marketing is illustrated by the BEST START project. Directed by anthropologist Carol A. Bryant, this project is directed at increasing the number of low-income women that breastfeed in the southeastern United States.

While social marketing draws heavily from commercial marketing, there are differences ( Academy for Educational Development 1987:70). First, the changes called for in commercial marketing are often less complex than those aspired to through social marketing. For example, it is less complicated to persuade people to switch cigarette brands than to stop smoking. Second, the new behavior or product may be more controversial. The promotion of safer sex practices is made difficult because of public modesty standards. Third, the new products or practices advocated in social marketing may be less satisfying to people. In the case of smoking, for example, present gratification is exchanged for future health improvements. Fourth, often the intended audience of social marketing has fewer resources and cannot easily act on their new information. Many times the target population is poor. Fifth, the politics of social marketing often require high levels of success. In the commercial realm a small increase in market share may justify substantial marketing investment, while in the public arena large, sustained increases are demanded.

DEVELOPMENT OF THE APPROACH

The use of the term social marketing dates from the late 1960s and grew out of discussions between Philip Kotler and Richard Manoff ( Kotler 1975; Manoff 1985). Kotler was a professor of marketing from Northwestern University and Manoff was director of a marketing firm that had begun to approach nutrition and health education as a marketing problem. The term social marketing was used to distinguish between marketing commercial products and marketing better health practices.

The early 1970s saw increased academic interest in the idea; there were more publications on it and, of course, considerable debate about the "but is it marketing" question. During that time social marketing approaches were used in many different areas, mostly relating to promoting ideas, practices, and products in health and nutrition.

KEY CONCEPTS

There are a number of concepts that are fundamental to understanding the process.Marketing involves those activities that result in the movement of goods and services from producer to consumer in response to consumer demand, satisfying consumer needs, and achieving the goals of the producer. Increasingly marketing is seen as a process of communicating ideas rather than the movement of goods and services. This may involve informing consumers of products and services or the discovery and communication of consumer needs by producers. The goal of commercial marketing is a profit or increase in market share. In social marketing the goal is societal improvement or social problem solving, a process that often involves creating demand for a socially beneficial product and developing products or programs to meet consumer needs.

The people to whom social marketing efforts are directed are referred to as thetarget audience . The primary audience is the people you wish would accept the new behavior. This group may be segmented in various ways. There may be a difference between rural and urban people, rich and poor, for example. The secondary audience is an audience that influences the decision making of the primary audience. For example, the mothers and husbands of potentially breastfeeding women are a good example of a secondary audience. The tertiary audience may be opinion leaders in the community or the general public. These are people whom others look up to, or who in other ways influence decision makers. Effective social marketing is often based on identification and targeting of a large number of audience segments. In a Brazilian breastfeeding promotion project, eight distinctive target audiences were identified. These were doctors, health services, hospitals, infant food industry, industry in general, community, government officials, and mothers ( Manoff 1985:48).

Communication channel refers to the media through which the message is communicated. Typically, mass media like radio and television are combined with print media and personal communication. An important task is the identification of available communication channels, or channel analysis. An important task in social marketing is to identify the most effective channels for communicating each message. In general, mass media are used to transmit short, persuasive, or informational messages and create a climate conducive for change. Print material is used for more lengthy, instructional messages, and personal communication is used for the more complex information that requires interaction and social support.

Resistance points are the constraints that prevent people from adopting a new behavior. Resistance points can be of "social, cultural, economic or religious origin, or the product of ignorance" ( Manoff 1985:107). These constraints will vary between audience segments. The resistance points are very important to identify and overcome. This is a very important aspect of the social marketing process.

Social marketing has various functions.Demand creation involves letting people know about the availability of a particular service or product. This requires more than simple publicity: the people need to know the relative advantage of a particular innovation and the community itself needs to be motivated to act on a particular situation.Appropriate use is a more complex goal ( Academy for Educational Development 1987:68), because often the new practices are complex and can be applied in a variety of ways.

SOCIAL MARKETING PROCESS

The social marketing process consists of a long-term program to produce sustainable changes in a clearly defined set of behaviors in a large population ( Academy for Educational Development 1987:75). There are various conceptions of the process in the literature on social marketing ( Manoff 1985; Kotler and Roberto 1989; Fine 1981). The following description is based on the discussion of process that was developed in the BEST START project ( Bryant and Lindenberger 1992).The social marketing process has five phases, according to Bryant and Lindenberger. These are formative research, strategy formation, program development, program implementation, and program monitoring and revision ( 1992). While there are five phases, in practice the different stages are repeated depending on the experience with the specific project. That is, if a part of the strategy is not working, the team will go through a phase of the process again. The process is iterative. You change what you do, based on what you learn.

Stages in Social Marketing

I. Formative Research

II.Strategy Formation

III.Program Development

IV.Program Implementation

V. Program Monitoring and Revision

The formative research stage starts with review of recent literature on the problem and examination of existing that deal with the problem. Often staff of exemplary programs are interviewed and materials produced by their program are reviewed. The formative stage includes the design of a research plan in which qualitative and quantitative data needs are specified, along with potential data sources and research objectives. Identification of program partners, including collaborating agencies, occurs in this phase. Research makes use of in-depth interviews, focus groups, and surveys of various types, creating a foundation for the project.

Formative research includes preliminary research on the community and agency context of the project. Social marketers need to know the nature of the organizations and persons with whom they will be working. These people need to achieve consensus on the nature of the problem. It is this consensus that makes things work. It is very important to identify the "real players" rather than the formal leadership as depicted in the organization chart. When the concerns of the cooperating professionals are not understood and addressed, projects fail.

Formative research identifies the target population's perception of the problem and the nature of resistance points. This research typically has a very large qualitative component, often based on the focus group technique. The strategy development stage also requires the identification of the primary, secondary, and tertiary target audiences, with the appropriate segmentations.

Staff identify media that are available for the project. It is important to find out what the target audience listens to, watches, and reads. In developed countries this information is often readily available; in less developed countries it may be necessary to research the question of media exposure. This information is necessary for the formulation of an effective media plan.

During this early phase the team carefully establishes network ties with organizations that may be interested in the project's problem. These can be private voluntary organizations, religious organizations, commercial organizations, and various governmental organizations. This collaboration will back up the media campaign. Organizational networking is done to multiply the impact of messages, to obtain feedback from stakeholders and to decrease interagency competition.

The second stage in the social marketing process, strategy formation, is done in planning sessions with staff and key advisors, who are often representative of stakeholders and program partners. The first step in strategy formation is to produce a definitive statement of the problem. Once the problem is defined, the social marketing team expresses it as project objectives. Objectives are described in measurable action terms that relate to the goals of the project. Objectives need to be measurable, expressed in terms of "required input, desired output, and a time frame" ( Manoff 1985:106). Manoff warns that they can be "too broad, too vague, too unrealistic, or 'off-target'" ( 1985:106). It is important to have measurable objectives so that evaluation of performance is possible.

The strategy formation stage is concluded with identification of the elements in the messages that will be included in the campaign. This includes selection of message content, spokespersons, and tone. These decisions create the basis of a marketing plan.

The third stage isprogram development , a stage often carried out with the help of an advertising agency. Program development includes message design and materials development. The entire program development stage is directed at producing a written media plan, which describes the formation of the project strategy. The plan includes the messages, the target audience and its segments, media to be used, the products, the research design for tracking the project, and the plan for integrating the project with other organizations. Media planning includes "preparation of draft or prototype materials; materials testing; final production and program inauguration" ( Manoff 1985:111). The actual media can be developed "in-house" or they can be purchased from advertising agencies. Prototype versions of public service announcements, pamphlets, instructional tapes, advertisements, and other messages are prepared, pretested, and revised. This pre-testing is to decide whether the developed messages are "comprehensible, culturally relevant, practical, capable of motivating the target audiences, emotionally appealing, memorable and free of negatives" ( Manoff 1988:3). Product development includes decisions about product names, packaging, price, and supportive promotion and sales materials. All this requires the technical skills of persons trained in media. The anthropologist will bring skills in research that will support the development of the product through research.

After pre-testing, the materials enter final production. The team makes presentations of the project to public officials and community groups for approval and guidance. The presentation will include supporting research results that can guide their decisions about the effects of the materials.

Also part of the development stage is identification of "primary, secondary and tertiary audiences and their component segments" ( Manoff 1988:3). As part of this process, resistance points that limit the potential for change in behavior are identified. Persons and institutions that can advocate the desired change need to be identified. The team looks for opinion leaders in the community or any person that would "enhance credibility" of the messages, thus increasing the chances for change in behavior. The last component of the strategy development stage is the determination of the media use patterns of the population.

Channel analysis continues as part of the program development phase. In channel analysis researchers identify the pathways through which messages, products, and services can be delivered to a population ( Lefebvre and Flora 1988:305), and how these pathways complement and compete with one another. In the social marketing framework this can include everything from electronic and print media to social networks and opinion leaders. It is necessary to inventory all the places where a person encounters messages; these in turn become possible channels to use in the marketing process. Lefebvre and Flora speak of the identification of "life path points," which they exemplify from an American urban setting as laundromats, groceries, restaurants, and bus stops. In channel analysis the researcher not only knows which channels the population is exposed to, but which ones are most influential and important. For example, for certain health behavior changes the mass media do not present credible information, while personal networks do.

The fourth stage isprogram implementation . This includes implementation of policy changes, training of professionals, and distribution of educational materials. Also the public information program may be launched.

The last phase of the social marketing process isprogram monitoring and revision . This has two components, formative and summative. The formative evaluation determines strengths and weaknesses of project components so that the project can be improved. The team introduces improvements in the process to increase effectiveness. Summative research finds out the actual impact of the project. Much of the summative research consists of studies to identify knowledge, attitudes, and practices of the project's products by potential consumers. These are repeated, with uniform measures and sampling, so that the results can be compared wave after wave to answer questions such as what the target audience knows and does because of the project. These may be supplemented with qualitative data collection to get at meanings that cannot be investigated with surveys.

SOCIAL MARKETING AND FOCUS GROUPS

A research technique often used in designing the social marketing plan is the focus group, or group depth interview. Sociologist Robert K. Merton developed the focus group technique while doing research on German propaganda films done during World War II. Merton wanted to provide an interpretive framework for quantitative data collected with propaganda film viewers to try to find out why they answered questions the way they did about their psychological responses to propaganda films ( Merton and Kendall 1946; Merton, Fiske, and Kendall 1990). Examples of use of focus group research in social marketing can be found in many areas, including social action programs ( Schearer 1981), family planning ( Folch-Lyon, Macorra, and Schearer 1981), vitamin supplement use ( Pollard 1987), and educational evaluation ( Hess 1991).

A focus group is a small group discussion guided by a moderator to develop understanding about the group participants' perceptions of a designated topic. While it can be argued that data collection efficiency is improved because you are increasing the number of interviewees being interviewed at one time, more important are the effects of the interaction of the participants being interviewed. Morgan states this clearly: "The hallmark of focus groups is the explicit use of the group interaction to produce data and insights that would be less accessible without the interaction found in a group" ( 1988:12). While the interaction deals with the content specified by the moderator, the interaction should be informal and lively. Morgan describes it as being like a conversation between neighbors or friends.

The composition of focus groups is carefully planned to produce representative information about the population. The difficulty and cost of recruiting participants can vary considerably with the nature of the research problem. When a highly specialized population is being researched it may be expensive to find qualified participants. The number of group participants is typically between six and eight, although sometimes the groups are larger ( Morgan 1988).

Smaller groups involve more interviewee participation and are more susceptible to the impact of domineering persons. Larger groups require more moderator participation. Unless you are investigating the life of a small organization it is unlikely that your research results will be statistically generalizable. It is best to overrecruit participants so that persons that are inappropriate can be easily replaced. The sessions usually do not last more than two hours.

It is important to be very aware of the problem of bias in participant selection. It is also important to screen the participants carefully so that you are sure they do share the relevant attributes. As Morgan states, "participants must feel able to talk to each other, and wide gaps in social background or life-style can defeat this" ( 1988:46). Gender, ethnicity, age, and class may influence willingness to discuss a topic. While participant similarity is important, it is better if the interviewees do not know each other.

The number of focus groups to be completed is an important consideration both methodologically and practically. The increase in the number of types of participants of course will lead to an increase in the number of groups. For example, if urban and rural differences are important you will need groups for each type.

An important part of quality data collection is the creation of a permissive, nonthreatening atmosphere, conducive to revelation and disclosure. Moderator skill and group homogeneity are important factors in establishing these conditions. Moderator involvement varies with the purpose of the research. As Morgan states, "if the goal is to learn something new from participants, then it is best to let them speak for themselves" ( 1988:49). High moderator involvement may be called for when it is necessary to get the discussion back on the topic, when the group loses energy, when minority positions are stifled, when domineering individuals need to be shut down, and when some participants need to be encouraged ( Morgan 1988:51).

Morgan encourages low moderator involvement through a process he calls group self-management. To a large extent this involves simply giving the focus group participants expectations for their own behavior through instructions that will lead them in the desired direction. For example you might tell them to expect that if they get off track a member of the group will pull them back. Other practitioners of the technique may more directly intervene. It is also possible to intervene more at the end of the session to help make sure that the ground is covered. In any case the interviewer "must develop the practice of continuously assessing the interview as it is in process" ( Merton Fiske, and Kendall 1990:11).

Like other techniques, focus group interviewing has both strengths and weaknesses. The technique is practical because it can be done quickly and easily. Morgan says that "when time and/or money are essential considerations, it is often possible to design focus group research when other methods would be prohibitive" ( 1988:20). A focus group-based research project does not require large teams of interviewers. Kumar estimates that a project based on ten to fifteen interview sessions can be carried out within six weeks under normal conditions ( 1987:6).

Focus groups are most useful for discovery, and less useful for hypothesis testing. When you are unfamiliar with the content or are potentially biased, focus groups offer real advantages. The approach may not work well on topics that are highly private, and it is sometimes difficult to get all persons in the group to participate equally. It is important to note that an important principle in ethical research practice is that the researcher does not share information obtained from one informant with another. While this is the essential feature of the focus group approach, people can choose not to talk. While this solves the ethical problem it raises considerable methodological issues. Privacy and confidentiality may go far to encourage talk.

CASE STUDY: BEST START--A BREASTFEEDING PROMOTION PROJECT

The BEST START project was a joint effort of public health agencies in eight southeastern states to promote breastfeeding among low-income women by developing effective promotional messages and a workable strategy for communicating them. The developed materials and strategies were made available for use to programs around the country through a nonprofit organization called BEST START, Inc.

A team led by anthropologist Carol A. Bryant planned the project. Doraine F. C. Bailey contributed to the research and planning and subsequently served as the coordinator of the Kentucky state project and the local project in Lexington, Kentucky. Jeannine Coreil contributed to the formative research and strategy formation phases of the project by conducting focus groups among audience members and health professionals. The project was a collaboration between local health departments and three national organizations--the Healthy Mothers, Healthy Babies Coalition, the National Center of Education in Maternal and Child Health, and the National Maternal and Child Health Clearinghouse.

Breastfeeding offers considerable advantages over bottle-feeding. Mothers benefit because it offers a quicker recovery from childbirth, stronger bonding with the infant, and an emotionally satisfying activity. The infants are better off because it offers the best nutrition for normal growth and development, protection against disease, especially ear infections and gastrointestinal illness, and decreased risk of allergies. There are significant societal benefits. Breastfeeding results in stronger family bonds, increased self-esteem of women, decreased cost of infant formula in food subsidy programs, and decreased health care costs for infants ( Bryant 1989:11).

Because of these advantages the U.S. Surgeon General, in his series of national health objectives for the year 2000 ( U. S. Public Health Service 1991:379), included the goal of increasing breastfeeding to 75 percent of mothers at hospital discharge, from 54 percent in 1988. Increasing breastfeeding is a matter of national policy in the United States.

In spite of the advantages of breastfeeding, and considerable investment in public health education programs, the rate of breastfeeding among low-income women remained low. The rate of breastfeeding has increased among middleand upper-income women.

The BEST START: Breastfeeding for Health Mothers, Healthy Babies Program is addressing these goals for a consortium of public health agencies in eight southeastern states, based on social marketing principles. Specifically BEST START's goal is to "enhance breastfeeding's image among economically disadvantaged women and the public at large" and "to motivate economically disadvantaged women, especially those participating in WIC [a federal mother and child food supplement program], to breastfeed" ( Bryant et al. 1989:15).

Bryant's team used the social marketing approach because the traditional clinic-based health education directed at low-income women did not work ( Bryant et al. 1989:642). Low-income women were not given the information they needed to make the decision to breastfeed. The messages used were culturally inappropriate. The clinical staff did not have the time for education activities. Further, the constraints faced by low-income women were poorly understood.

During the formative research phase, project staff completed forty focus group interviews with low-income women in Tennessee, Kentucky, Georgia, Florida, North Carolina, and South Carolina. Most of these women were recruited from public health programs. BEST START researchers conducted focus groups among black and white women, teenaged and older women, urban and rural women, and women that were bottle-feeding and breastfeeding. These interviews were conducted in health department conference rooms.

The location of the interviews was the place where the women usually received health services or their WIC support. Interviews involved from three to eight people, plus one or two moderators. The first moderator introduced topics and interjected questions and guided the discussion. The second person helped supervise audio or video recording and helped interpret questions. The interviews lasted from one to three hours. Often participants expressed satisfaction about participating in the process because it gave them positive feelings and they learned so much from their peers.

The analysis emulated Krueger's "chronological sequence of analysis" and made use of ideas expressed by various other researchers ( Krueger 1988; Agar and Hobbs 1985; Glaser and Straus 1967; Miles and Huberman 1984). After each session the moderators prepared short summary statements on various topics. Focusing on each participant, they identified any problems with the recruitment criteria and considered "level of enthusiasm, strength of infant feeding preference, consistency of comments and reported behavior" ( Bryant and Bailey 1991:30). Also identified were themes concerning breastfeeding constraints and motivational factors that might stimulate change. Differences between participants were noted. Researchers considered the way these women spoke about the topic; this information often influenced the questioning process in subsequent sessions. The moderator's techniques and the interview success were evaluated.

Researchers processed each interview with the help of a computer program called The Ethnograph ( Seidel et al. 1988). This program allows the coding, indexing, and subsequent retrieval of portions of the interview transcript. Codes reflected questions in the interview guide and were expanded as analysis proceeded. Retrieval with The Ethnograph is done in terms of subsets of the sample so that comparisons can be made by ethnicity, parity, respondent age, residence, and other variables. For example, the statements made by black teenagers on a particular topic can be retrieved from the data base and read and written about. This software allows the nesting and overlapping of codes. Some might assume that the use of this software makes analysis a mechanical exercise. The software serves only as a more efficient and complete means for shuffling through and reading all the field notes. It is still necessary to think it through and interpret the meaning.

Through the focus groups, the BEST START team learned factors that were attracting women to breastfeeding. An important component of attraction was the mother's aspirations. Like other mothers these women hoped for a special relationship with their children; they wanted a closeness with the baby that would endure beyond childhood. Mothers wanted to give their children a better life than they had when they were young. Especially they wanted health, happiness, and a good education for their children. Participants saw breastfeeding as a means for establishing an exclusive relationship between mother and child.

Teenage participants viewed motherhood as an opportunity to come of age, to gain positive attention from friends and family, and to establish a long-term relationship with their child. They also thought that breastfeeding can indicate maturity and responsibility and a certain adventurousness that can set her apart from her peers. These mothers were also concerned about their children becoming too attached to the people that often provide child care. They felt that breastfeeding can help prevent the child from becoming too attached to these other caregivers.

Most of the focus group participants were aware that breastfeeding offers significant health benefits to the child, such as protection from infection, fewer allergies, and better nutrition. Breastfeeding mothers expressed these ideas with pride and said they felt they were giving their children the best. Many bottlefeeding mothers accepted these claims, but questioned their significance. Some challenged these claims, citing their own observations, and a few believed bottlefeeding is superior.

The breastfeeding mothers regarded nursing as a special time that only a mother can enjoy with her children. They noted that it makes them feel relaxed; some even reported falling asleep. Many women cherished the experience as a memory that makes motherhood worthwhile.

The research team identified several barriers to breastfeeding. The most important constraint to starting and continuing breastfeeding was many women's lack of confidence in their ability to produce good milk in an adequate supply. These women often did not understand how milk is produced. Often, in response to their fears of milk inadequacy, they would use formula supplements, resulting in a real reduction in the supply. These women felt that breastfeeding is a more complex, difficult to learn skill than it really is. Their lack of confidence made them more easily discouraged when they heard of other women's negative experiences.

An important constraint was the embarrassment that women might feel about breastfeeding when others are present. There were significant differences between breastfeeding and bottle-feeding women in this regard. Some saw breasts sexual objects that would arouse men and make their husbands and boyfriends jealous. They thought breastfeeding would make other women jealous and that it might be viewed as disgusting. These women resented having to go and "hide" in a public rest room, their car, or the bedroom at home when they were breastfeeding. Others said they would feel comfortable in public if they could be discreet. Many said they feel comfortable breastfeeding in the presence of their husbands or boyfriends, mothers, sisters, or other female relatives or friends; others felt uncomfortable breastfeeding in the presence of these people. A small number of focus group participants felt that breastfeeding was not possible for them; for them breasts were strictly sexual and the idea of putting a baby's mouth on them was disgusting. Historically, promotional materials have used women who are unusually attractive or well-dressed as models, and have stressed the importance of being healthy and relaxed. These messages reinforced the poorer women's fears that they might not be able to meet their health and nutrition needs and follow the practices needed to breastfeed successfully.

The women expressed concern that breastfeeding would cause them to lose freedom. They saw breastfeeding as incompatible with an active social life. Younger women thought that it would prevent them from having time for themselves and their friends. Women expressed these ideas in various ways—breastfeeding will make it hard to leave the child with the babysitter, for example, and the breastfed child will cry when its mother is not nearby. These women tended not to know how to mix breastfeeding and formula use. Some thought the use of breast pumps was messy, painful, or a "hassle," and that school and work were constraints on starting and continuing breastfeeding. Some felt that they couldn't cope with breastfeeding while going to work.

The women were concerned about their ability to make life-style changes such as cessation of smoking tobacco and drinking alcohol. They also expressed concern about their ability to eat properly, to get enough sleep, and to be relaxed. Some women thought that breastfeeding might be more painful than they could tolerate and that breastfeeding would disfigure their breasts.

The formative research was used to formulate guidelines for design of messages and other aspects of the program. The development team concluded that the tone of the campaign should be strongly emotional, "to reflect the strong feelings women attach to their aspirations for their children and themselves as mothers" ( Bryant and Bailey 1991:32). The messages themselves were to be succinct and easy to understand, in order to "counteract the mistaken belief that breastfeeding is complicated or difficult" ( Bryant and Bailey 1991:32). The development team thought it was important that the women featured in the materials be of the same economic level, ethnic backgrounds, and ages as the targeted population. They concluded that images used in print and broadcast media should communicate modernity and confidence, and that celebrity spokespersons should be avoided.

The educational campaign was to emphasize that most women can produce enough good milk despite differences in diet, stress levels, and health status. The research showed there was a need for social marketing efforts that made use of various mutually supporting activities to change the image that lower income women had of breastfeeding, and to help these women in overcoming the barriers to this behavior. The project developed many educational materials based on the formative research that helped to overcome barriers to breastfeeding. These emphasized benefits identified in the focus groups as appealing to low-income women. Public information materials included five television public service announcements and seven radio public service announcements, in English and Spanish. Educational materials included videotapes featuring testimonials taken from focus group interviews with WIC food supplement recipients.

A pre-test of this tape revealed an interesting oversight that had to be corrected later. When pilot tested among clients, the tape was seen as highly motivational: women enjoyed seeing WIC clients discuss their fears and how they overcame them. The health professionals were less enthusiastic. They mistakenly believed that the WIC participants, who were more expressive and articulate in a focus group than a clinic setting, were actresses working from a script. Program designers had to revise the tape to explain that the women were, in fact, all WIC participants. This tape has also been produced using Spanish-speaking WIC participants.

Other educational materials included five posters, ten pamphlets in English, seven in Spanish, and ten pamphlets written for a low literacy population. For health professionals, a motivational videotape, training tape, and accompanying training manual have been produced to teach a new counseling approach. New and revised materials are being developed with proceeds from sales.

The team developed a counseling strategy for breastfeeding promotion based on what they discovered in the formative research. The team developed a threestep approach to breastfeeding promotion in order to "counteract the lack of confidence and lack of knowledge that are at the root of these women's fears and doubts" ( Bryant 1990). The counseling steps are 1) elicit client's concerns; 2) acknowledge her feelings; and 3) educate.

The experience of the focus groups revealed that women need assistance with sorting out their feelings. The first step in the counseling process, therefore, is an open-ended exploration. Clients are asked about their feelings about breastfeeding, as opposed to direct questions about whether they want to feed with a bottle or breast. A typical question is "what have you heard about breastfeeding?" ( Bryant 1990:C-4).

In addition to their feelings, the women's knowledge of breastfeeding is explored. Step one of the counseling process represents a kind of emotional and cognitive diagnosis that helps the counselor select materials to stress in further counseling. Inviting women to speak about their concerns validates these concerns and allows resolution. In step two the counselor acknowledges the women's feelings. The most consistent problem is that the client thinks her response is unusual. With acknowledgment, the client's comfort increases as the encounter feels safer, especially if she receives positive reinforcement. It is important to respect her. As Bryant expresses it, "by laying this foundation of trust, you also build her selfrespect and self-confidence, which is a prerequisite for successful breastfeeding" ( 1990:C-3).

The third step is education of the client with carefully targeted messages. The new information allows the woman to ignore misinformation that she has received in the past. Women tend not to understand the lactation process and therefore are easily influenced by fear-producing misinformation. The formula producers provide information about the quality of the product that is reassuring. Breast milk, on the other hand, does not come with an ingredient list.

It is important not to overload the women with new information, as the BEST START team found that can reinforce her fears. The counseling strategy can address women's lack of confidence, embarrassment, her concerns about loss of freedom, dietary and health practices, and the negative influence of family and friends. The counseling education strategy reflects the team's recognition that a major barrier to breastfeeding was lack of confidence, and that the foundation for the solution was listening to the women. Empowerment is very important.

The use of the focus group data was comprehensive. The whole fabric of the content of the campaign was based on these materials. In retrospect Bryant felt the educational materials should have been pretested with professional health educators. These people serve as gatekeepers, as they make the decisions about local program design and the purchase of media. It would have been very useful to know what their concerns were. It also would have been useful to have interviewed husbands and boyfriends.

The use of materials developed through this project is widespread. About thirty state programs are using the materials at one level or another. Ten of these programs have been funded by the Maternal and Child Health Bureau of the U.S. Department of Health and Human Services as part of an effort to build state-level programs. Evaluations have shown that the materials have a high impact: substantial increases in breastfeeding among low-income women have occurred at various sites.

SUMMARY

Social marketing is an approach to producing changes in people's behavior through the use of culturally appropriate education and advertising media, widely disseminated through communication channels, including mass media. Social marketing draws heavily from practices associated with commercial marketing although it is generally recognized that social marketing is more complex and difficult. The technique is most widely used in the area of public health and has had an impact on smoking, sexual behavior, and cardio-vascular problems, among other concerns.

The development of media with culturally appropriate content is an important part of social marketing. The media development process uses social science research to identify cultural and social constraints to behavioral change and to select communication channels that have the potential for high impact. Anthropological research skills are often used in social marketing because of the importance of understanding the viewpoint of members of the community.

Focus-group research techniques are an important data-collection technique in social marketing. Based on the work of sociologist Robert Merton, focus group technique involves a group interview process that is quite consistent with cultural anthropology research practice. A focus group's leader facilitates discussion among a small group of informants selected for their capacity to illuminate a particular marketing problem. The texts that document this discussion represent the primary product of focus-group technique. These materials are analyzed and help shape the research that is used to structure the media campaign.

FURTHER READING

Bryant Carol, and Doraine F. C. Bailey. 1991. "The Use of Focus Group Research in Program Development. " InSoundings: Rapid and Reliable Research Methods for Practicing Anthropologists . NAPA Bulletin no. 10, John van Willigen and Timothy J. Finan , eds. Washington, D.C.: American Anthropological Association. A detailed and concrete discussion of the formative research process in the BEST START project. It shows in remarkably clear terms how this process works.

Kotler Philip, and Eduardo L. Roberto. 1989.Social Marketing: Strategies for Changing Public Behavior . New York: Free Press. This comprehensive and straightforward guide shows how organizations can be more efficient using a social marketing approach.

Manoff Richard K. 1985.Social Marketing: New Imperative for Public Health . New York: Praeger. A readable, concrete account of the social marketing process.