Community capacity building eschews a focus on

Community capacity building eschews a focus on deficits and considers concepts of place through residents’ sense of GW788388 Supplier (Jung & Viswanath, 2013), and perceived collective efficacy. Consistent with Ellaway et al.’s (2001) findings that perceived problems within a community were associated with worse health, the final two dimensions of the community capacity scale consider the potential of a community to resolve problems. ‘Problem assessment’ captures whether residents communicate to identify problems and take action e.g. “If there was a serious problem, people here could get together and solve it”, “I frequently discuss community issues with my friends and neighbours.” ‘Leadership’ addresses residents’ confidence in, perceived accessibility and responsiveness of local leaders e.g. “The most important issues affecting [my town] are being addressed”, “If I share my ideas and opinions with local leaders they will listen.” Putnam\'s early work in Italy, found a clear relationship between indicators of civic participation and effective governance or “the hallmarks of a successful region” (Putnam, 1995). In measuring collective efficacy and leadership, we extend the current literature on health and community by capturing these neglected, political dimensions of place. Community capacity building is commonly used as a tool by health promoters tasked with implementing community-level interventions and is considered the mainstay of public health. Given the paucity of evidence addressing the health impacts of community capacity building, we sought to interrogate community capacity as a predictor of self-rated health. Previous research demonstrating associations between income inequality and health at the ecological level has highlighted the possible mediating role of social capital in this relationship (Kawachi, Kennedy, Lochner, & Prothrow-Stith, 1997; Veenstra, 2002). This work had us questioning whether community capacity could play a mediating role in the income-health nexus. We explore these issues by testing the following hypotheses:
Methods
Results Of the 175 respondents providing their self-rated health, the most common response (36%) was ‘very good’ (see Table 3) with a further 21% rating their health as ‘excellent’. This pattern was consistent across the four settings with the median response dipping into ‘good’ in two towns (Milton and Riverton). A community capacity score was calculated for each town based on the aggregated response of individual residents; median scores ranged from 4.96 in Mataura to 5.45 in Riverton; the overall median score was 5.13. The instrument\'s subscales were developed to identify the unique strengths of each community. High scores were observed in the ‘participation’ subscale across the four communities but, when examining the remaining dimensions of community capacity, residents’ ‘sense of place’ emerged as a particular strength for Mataura and Riverton whereas positive ‘community attitudes’ was weaker in Mataura compared to other towns (see Table 3). Income was positively associated with health in a dose-response manner both before and following adjustment in the individual-level analyses using three levels of income and including clustering at the town-level (linear trend p=0.009), see Table 4 (unadjusted results were very similar to the adjusted results with linear trend p=0.002). Associations between self-rated health and the instrument\'s subscales were investigated (shown in Table 4). Among the subscales, participating in one\'s community demonstrated the strongest relationship and was associated with health in a positive direction both before and after adjustment for non-modifiable factors. The participation measure captured apolitical elements of civic engagement, such as support for community groups, and corresponds with a Canadian study that found social participation was positively associated with self-rated health (whereas civic participation was not) (Veenstra, 2000). In the partially adjusted models, total individual community capacity, sense of place, community attitudes, and problem assessment variables were all statistically significantly positively associated with health. For the non-significant associations, we note that all of these associations were also in the positive direction providing an overall consistency to these models.