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To prepare for this assignment:

  • Analyse the different levels of community-based interaction in health programs; use Laverack’s  ladder to help with your thinking on this complex subject.
  • Analyse the different theories and models of health promotion practice.
  • Critique the link between capacity building and empowerment.

Address the following:

Part 1: Identify a preventable health concern in which you are interested, such as dengue fever or type 2 diabetes. Using Laverack’s ladder of community-based interaction as a guide, describe three key strategies that you might use to engage with a community to implement a program to address this health concern (Module 1).

Part 2: Discuss how you could use the core domains of capacity-building identified by Liberato et al (2011) to support the journey to community empowerment and ownership of a prevention program for your chosen health concern.

Part 3: Describe the models and approaches of health promotion (such as the health belief model or the education approach) that you would use to motivate and educate the community about your chosen health concern, and discuss the advantages and disadvantages of each model/approach.

Identifying a Preventable Health Concern

The primary objective of the paper is to identify a preventable health concern as well as analyze the different levels of community-based interaction in the health programs by using Laverack's ladder. It will describe key strategies that could be used to implement a program in order to address the chosen health concern. Moreover, the paper will also discuss the ways to use core domains of capacity building that support the community empowerment as well as ownership. Besides this, the models and approaches to health promotion will be provided to motivate as well as educate the community regarding the selected health issue.

Identification of health concern

Tuberculosis is identified as the preventable health concern caused due to several social, environmental and behavioral factors. The factors like under nutrition, lack of empowerment, abuse of alcohol, poverty, indoor air pollution, overcrowded living conditions and diabetes increase the risk of tuberculosis among the health of the population. According to the Laverack's ladder of community based interaction, community empowerment is crucial for the interaction of community in the health programs (Herens & Wagemakers, 2017). It offers a link between the social factors and control capacity of the individuals. It is considered that leadership is a significant component in the community-based interaction in the health programs because it led to the possibility of community empowerment. It is essential for the government to understand that the communities are required to be motivated to participate in the health programs so that the programs would be more efficient.

In order to prevent tuberculosis, three key strategies are described below that would be used to engage the community in the implementation of the program:

Policy making – It is the first strategy used to encourage the community to participate in the health programs in order to prevent the major health issue. Tuberculosis is both curable and preventable, and thus, it needs to be addressed by the community. Policy-making is the step in which the policy makers join together and provide policies for the community. It is seen that the interest of the policy makers has a great influence on the policy made for addressing the health issue. The international bodies such as World Health Organization and United Nation Organization are the policy makers that made health care policies in order to motivate the participation of the community and leadership for empowering the whole community (Nickel & von dem Knesebeck, 2019).

Strategies for Engaging the Community in Implementing the Program

Leadership building – It is the second strategy used to implement an effective health program to prevent health concern. Leadership is recognized as the vital element in the interaction of community in the health programs as well as empowering the people. Development of leadership is critical to empower the community to participate in the health program that needs to implement to overcome tuberculosis (Wallerstein, Minkler, Carter-Edwards, Avila & Sanchez, 2015). An effective leader is a must for focusing on community participation along with empowerment. Leadership enable the team to address the requirements of the community and monitor the reason for not participating in the health programs. Through the creation of leadership, the community is encouraged to participate in the programs and address the factors of tuberculosis.

Community development program – It is the third strategy used by the leaders or policy makers to address the health problem in order to maintain a healthy community. The community development program is useful for developing and encouraging the participation of the community (Garney et al., 2017). With the help of this strategy, the members of the community come together to take collective actions and produce solutions to prevent tuberculosis. The community development strategy enables the leaders to encourage the people, make them aware of the issues, change thinking ability and bring equality (Archibald, Sharrock, Buckley & Cook, 2016). The main aim of this strategy is to support the communities to take an active part in health programs and improve the health of the entire community.

The use of the core domains of capacity building identified by (Liberato et al., 2011) to support community development

The different domains of the capacity identified can be recognized as “learning opportunities along with the development of skills”, “leaderships”, “participatory and the decision-making procedures”, “approaches based on assets”, “sense of the community”, “communicational techniques” and the “development pathway” (Wu et al., 2017).  The primary use of these domains helps in providing support to the various prevention programs for tuberculosis. One of the preventive program used for tuberculosis is Isoniazid preventive therapy, which is presently recommended for curing patients of latent tuberculosis infection. It helps in treating people living with HIV and have children under five years of age.  It also includes diseases like Multi-drug-resistant tuberculosis. One of the domains mentioned above that can be used for supporting the preventive programs is ‘sense of community’ and ‘learning opportunities’. The ‘sense of community’ domain will help in making the community aware of reading the preventive measures from this disease. Isoniazid is one of the widely used drugs, which prevents latent TB from increasing towards the active TB. One the other hand, National TB control program is efficiently integrated with the primary health care system (PHC) that was implemented the concerned district health authorities to provide the desired support to the provincial TB control programs (PTPs) (Zenner et al., 2017). The use of “communication” domain could be used to support the preventive programs by enhancing the verbal and non-verbal means of communicational techniques.  The utilization of the effective communicational approaches will help in clearing out the exact points to the concerned community as well as to the patient regarding the steps that need to be followed to get prevented from tuberculosis. The awareness can be created among the patients regarding the symptoms and the services, which will be offered to them under the preventive tuberculosis program, and in this way, the “communication and learning” domain could be used to support it.

Using Core Domains of Capacity Building to Support Empowerment and Ownership

Moreover, the public awareness programs and the idea of social mobilization could also be used for supporting the preventive programs for tuberculosis. Another domain is the “development pathway” which will reflect the desired pathway as well as the directions, which are needed to get cured of tuberculosis. The government and regular can adopt offering and launching of several commodities authorises to make people free from this disease (Kaufmann, Weiner & von Reyn, 2017).  

The “leadership” domain plays a vital role in supporting the preventive programs as it helps the concerned leaders such as the managers as well as the various other health care professionals to take effective measures for controlling and curing people of tuberculosis. The leadership qualities are required by the mangers and health care professionals during the various stages of the partnership (Jansen & Rhee, 2017).  The TB control manger could be hired as the “technical manager” which plays an important role in establishing a partnership with various other organizations, which are working for the welfare and development of the community’s health. These partnerships help in supporting the programs, which are developed to make people free from TB.  The leadership domain also helps the concerned mangers to collect and gather money and resources that can be used for treating people tuberculosis (Yoon, Dowdy, Esmail, MacPherson & Schumacher, 2019). The use of another domain “decision-making procedures” will help in taking the desired decisions considering the financial resources that will be required to facilitate the tuberculosis preventive programs.

Models and approaches of health promotion

The model utilized for health promotion is the Health belief model (HBM) which is determined to be the widely used and oldest model to demonstrate health behavior. This particular model is used to describe the impact of attitudes and beliefs determining the protective health behaviors like acquiring chest x-rays and immunization for tuberculosis (Jones et al., 2015). It can be applied to most of the health-related areas that involve health promotional behaviors. It educates the community to gain an understanding regarding the uptake of tuberculosis X-ray screening. This particular model helps in creating an educational program through educational interventions by facilitating practical and theoretical basis for evidence-based health education related to tuberculosis. This may help in creating a better level of understanding and awareness among communities. This model helps community members to differentiate between credible sources and information related to tuberculosis.

While the approach used for health promotion model is the education approach whose aim is to provide information and knowledge to enhance the significant skills so that individuals can make an informed choice regarding their health behaviors, it is a set of assumptions regarding the relationship between behavior and knowledge related to tuberculosis. This helps the community to understand the impact of tuberculosis on their health. However, the target groups are individuals and groups from the community (Mirtskhulava et al., 2015). Health education for the TB patients within the community will include providing advice to different educational issues, adhere to the full course of their treatment and cover their mouth at the time of coughing. This will not only help them to take care of themselves but also prevent the entire community from getting infected.

Models and Approaches for Health Promotion


The health belief model helps in developing programs that help communities to understand the effect of tuberculosis on their health. It enhances the significant relationship between health behaviors and beliefs. While education approach provides information with the help of one-to-one advice, visual advice, booklets and leaflets (Tarkang & Zotor, 2015). It helps in enhancing the decision-making skills of the communities after gaining appropriate data based on tuberculosis.


Health belief model dies not considers determinants, beliefs and attitudes of individuals that demonstrate the acceptance of the individual to health behavior. It ignores economic and environmental factors that might prohibit the suggested action that is highly required to overcome tuberculosis (Craig, Daftary, Engel, O'Driscoll & Ioannaki, 2017). On the other hand, the education approach is less focused towards an existing understanding of communities, whereas, it is more focused towards providing appropriate and inappropriate information. It ignores the economic and social factors that are related to tuberculosis that leads to behavior change, whereas health-related decisions can be critical.

In this manner, the research that is related to various aspects of communities with tuberculosis is supported and treated from informal sources that make the research holistic and significant research within the domains of human rights (Lakhani & Sundaram, 2017). The policy communication that is used within the research strengthens the higher level of empowerment and leadership among individuals. Analysis and research are determined to be the significant aspects of research support the government to develop a complete understanding of the topic and create better policies. The example of analysis and research includes the collection of appropriate data on tuberculosis. The aspects of empowerment can be enhanced only when awareness, leadership and capacity are increased. In the study, the comparison is related to the understanding of tuberculosis infection rate and awareness level prior to and after the awareness program (Lewallen, Hunt, Potts‐Datema, Zaza & Giles, 2015). This may help in analyzing the efficiency of the awareness program within the community. Moreover, self-efficacy is determined to be the major element in the health belief model that can be utilized to create a stronger community.


The paper demonstrated an understanding of tuberculosis, which is a major health issue within the community. The key strategies that are used to implement a program are leadership building, community development program and policymaking. The paper also provided a brief description of major domains of capacity building that helps in promoting awareness regarding tuberculosis. It demonstrated the utilization of different empowerment and participation programs for the community members. It discussed regarding health belief model and education program that is regarded as a part of health promotion, which helps the community to provide an understanding and knowledge regarding the effects of tuberculosis.


Archibald, T., Sharrock, G., Buckley, J., & Cook, N. (2016). Assumptions, conjectures, and other miracles: The application of evaluative thinking to theory of change models in community development. Evaluation and program planning, 59, 119-127.

Craig, G. M., Daftary, A., Engel, N., O'Driscoll, S., & Ioannaki, A. (2017). Tuberculosis stigma as a social determinant of health: a systematic mapping review of research in low incidence countries. International Journal of Infectious Diseases, 56, 90-100.

Garney, W. R., Wendel, M., McLeroy, K., Alaniz, A., Cunningham, G., Castle, B., ... & Burdine, J. (2017). Using a community health development framework to increase community capacity: a multiple case study. Family & community health, 40(1), 18-23.

Herens, M., & Wagemakers, A. (2017). Assessing participants' perceptions on group-based principles for action in community-based health enhancing physical activity programmes: the APEF tool. Evaluation and program planning, 65, 54-68.

Jansen, R. S., & Rhee, K. Y. (2017). Emerging approaches to tuberculosis drug development: at home in the metabolome. Trends in pharmacological sciences, 38(4), 393-405.

Jones, C. L., Jensen, J. D., Scherr, C. L., Brown, N. R., Christy, K., & Weaver, J. (2015). The health belief model as an explanatory framework in communication research: Exploring parallel, serial, and moderated mediation. Health communication, 30(6), 566-576.

Kaufmann, S. H., Weiner, J., & von Reyn, C. F. (2017). Novel approaches to tuberculosis vaccine development. International Journal of Infectious Diseases, 56, 263-267.

Lakhani, P., & Sundaram, B. (2017). Deep learning at chest radiography: automated classification of pulmonary tuberculosis by using convolutional neural networks. Radiology, 284(2), 574-582.

Lewallen, T. C., Hunt, H., Potts‐Datema, W., Zaza, S., & Giles, W. (2015). The whole school, whole community, whole child model: A new approach for improving educational attainment and healthy development for students. Journal of School Health, 85(11), 729-739.

Mirtskhulava, V., Whitaker, J. A., Kipiani, M., Harris, D. A., Tabagari, N., Owen-Smith, A. A., ... & Blumberg, H. M. (2015). Determinants of tuberculosis infection control–related behaviors among healthcare workers in the country of Georgia. infection control & hospital epidemiology, 36(5), 522-528.

Nickel, S., & von dem Knesebeck, O. (2019). Effectiveness of Community-Based Health Promotion Interventions in Urban Areas: A Systematic Review. Journal of community health, 1-16.

Tarkang, E. E., & Zotor, F. B. (2015). Application of the Health Belief Model (HBM) in HIV prevention: a literature review. Central African Journal of Public Health, 1(1), 1-8.

Wallerstein, N., Minkler, M., Carter-Edwards, L., Avila, M., & Sanchez, V. (2015). Improving health through community engagement, community organization, and community building. Health behavior. Theory, research and practice. 5th ed. Hoboken, NJ: Jossey-Bass, 277-300.

Wu, Y., Hu, K., Li, D., Bai, L., Yang, S., Jastrab, J. B., ... & Wang, T. (2017). Mycobacterium tuberculosis proteasomal ATPase Mpa has a β‐grasp domain that hinders docking with the proteasome core protease. Molecular microbiology, 105(2), 227-241.

Yoon, C., Dowdy, D. W., Esmail, H., MacPherson, P., & Schumacher, S. G. (2019). Screening for tuberculosis: time to move beyond symptoms. The Lancet Respiratory Medicine, 7(3), 202-204.

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