Community agency and empowerment : a need for new perspectives and deepened understanding

Background: In an increasingly globalized and interlinked world it becomes ever more important to find strategies to prevent, detect, and respond to emerging public health threats. Local communities have a central role in this effort and need to be empowered and strengthened to be able to meet the challenge, and local knowledge and participation are key. This paper outlines a theoretical framework for community intervention dynamics and explores perceptions, priorities, and perspectives of stakeholders involved in community interventions. Methods: A deductive discourse analysis was performed based on the proposed theoretical framework consisting of three levels: intervention design, intervention delivery, and community agency. The setting was a workshop on community preparedness at Uppsala Health Summit 2017. Thirty-eight participants representing government officials, international organizations, and researchers as well as community implementers underwent a value exercise and were asked to prioritize good practices, challenges, and needed solutions to empower communities to meet emerging health threats. Results: The value exercise revealed a large variation in basic values among participants. Discussions mainly focused on intervention delivery and choice of methods. Need and allocation of resources at any level was not an issue. Despite being probed to take a deeper look at contextual factors and the underlying drivers of community engagement, participants scarcely mentioned and problematized community agency mechanisms. Conclusion: There is a need for new perspectives and a deepened reflection among decision-makers and public health implementers engaging at the local level to strengthen communities to face public health threats. A greater understanding and focus on contextual factors is needed which necessitates stronger interdisciplinary approaches