**4.1 Survey of actors concerning capacity building in the neighborhood**

With the help of a survey tool developed by the project, central actors from the health and social sector were asked about capacity building in the district. Capacity building has barely been used as a concept in Germany thus far. Nevertheless, capacity building has been explicitly listed for several years as a benefit dimension and intermediate target parameter for prevention and health promotion. This relatively new indicator – which is still defined to differing degrees of broadness in the literature – essentially refers to:


The first pilot study was conducted in June 2006. In addition to the assessment of the current situation (T1), a retrospective assessment of the situation was also to be made before the introduction of individual health promotion offers in May 2001 (T0). In addition to the level of approval, qualitative information was also requested to explain why the statements were judged to be of more or less relevance. Based on a list that was drawn up together with our practice partners, we called on 48 professional actors from the health and social sector (including district development, community work, education, and upbringing) from the area surrounding the Lenzsiedlung to participate in the survey. After sending or handing over the survey documents, only 27 questionnaires were actually evaluated (56% response rate) due to subsequent cancelations and/or short-term unavailability. The attempt to include socially engaged residents in the quantitative study with the same questionnaire was impractical

#### *Participation as a Core Principle of Community Health Promotion: General Account… DOI: http://dx.doi.org/10.5772/intechopen.111930*

because of the low level of participation; however, we have organized the residents' participation in this issue with different approaches (− > 4.2).

In the following, the results for the five dimensions of capacity development at 3 points in time are summarized in a spider diagram (see **Figure 1**). The average scores are shown per dimension in 2001 and 2006, as well as for the T2 survey in 2008, and, in each case, they can range from 1 to 5 (= best score). The overall positive results for district development and health promotion in the district are to be emphasized: we attribute these, above all, to the general climate of engagement for the neighborhood as well as to the strong commitment and perseverance of individual actors from the health and social sector. There are also positive developments in the field of public involvement – understood as participating or sharing in the community life of the Lenz settlement (e.g., attending information events or neighborhood festivals, using public services). Many respondents attribute this to the more open "climate" in the district, which has been fostered most notably by the use of various activation techniques (e.g., resident surveys, information afternoons), as well as awards and accolades for the district management and the population. However, only partial progress is noted in self-selected initiatives and the assumption of more personal responsibility (primarily in the low-threshold area, such as childcare/fixed preparation).

However, the T2 survey in June 2008, still shows a certain growth or consistency of the values on the spider diagram, which means that, after the seven-year activity phase, stable capacity building and sustainable capacity development in the Lenz estate could be assumed.

All changes T0–T1 and T0–T2 are very pronounced (ES ≥ 0.8) and highly significant (p < 0.001). From T1 to T2, no statistically significant improvements can be detected, but only tendential ones.

*Originally called "(Supporting residents through) health care services".*

Representation as a spider diagram proved to be particularly suitable for visualizing the results and discussing them with the inhabitants.

However, it must be pointed out that the extent of capacity building is assessed here by the responsible actors themselves, and, so, there is a risk of subjective

#### **Figure 1.**

*An overview of the capacity development dimensions (mean values: 1 = worst, 5 = best value) (own illustration).*

distortion. For this reason, we also consulted the residents about capacity development, with the aim of validating the expert results.

## **4.2 Two approaches to the resident survey about capacity development in the neighborhood**

In a pretest in the winter of 2010/2011, *focus groups* were carried out to involve the population. The objectives were:


The focus groups consisted of several engaged residents of the Lenzsiedlung who had been selected and who initially worked through a discussion guide as an introduction. In a later step, individual items from the KEQ questionnaire were then discussed.

In addition to the focus groups a *citizen survey (n = 157)* was carried out in the Lenzsiedlung in autumn 2009. This was carried out not by us, but in collaboration with us by the provider of children's and youth services "Lenzsiedlung e.V.," and we were able to introduce some of the same items in the survey as in the KEQ questionnaire and compare them with the results from the focus groups.

It was interesting that the results of the focus groups and the quantitative survey of the population by Lenzsiedlung e.V. were sometimes almost identical. In general, the two surveys of the residents were not completely consistent with the expert judgments, and also differed from each other in some respects.

However, the most important aspect of all three approaches to measuring capacity development was reporting the results. On the one hand, this element of participation was implemented as part of events that were announced and held in the district. On the other hand – more importantly – the results were introduced and discussed at the "Lenzgesund" round table meetings in order to further develop individual fields of action or drive forward strategic planning for the program as a whole.

#### **4.3 Involve and activate residents through a resident survey**

The aim of the activating resident survey conducted by our project at the beginning of 2006 was to determine how citizens perceive, use and assess ongoing health promotion and prevention activities in the district, as well as which activities they could possibly participate in themselves or which they could reinitiate themselves. In addition, starting points for future projects were to be identified, and direct participation was sought. We, therefore, once again applied a classic tool in civic involvement, the activating survey.

Two-thirds of the interviews were conducted by means of surveying passers-by. In order to reach migrants with insufficient knowledge of German, about a third of the interviews were conducted by committed residents of the Lenzsiedlung, who

#### *Participation as a Core Principle of Community Health Promotion: General Account… DOI: http://dx.doi.org/10.5772/intechopen.111930*

interviewed their friends, relatives, and neighbors. Some of these interviews were conducted in Turkish, Farsi, or Urdu. A total of 157 people between the ages of 14 and 58 were interviewed. Due to the survey method, the survey is not representative but provides relevant insights into the views of the population. Selected results of the survey will be presented in brief below.

The existing services were relatively well-known to the respondents; on average, each resident was familiar with about five of the 15 services. The ratings were almost consistently "good" to "very good" (90%). Only for a few services was there a greater number of "moderate" or "bad" reviews.

In addition to the acceptance of the services, the barriers to use perceived by the residents were also of interest. As shown in **Figure 2**, it was deficient information that was most often assumed to be a barrier (40%). Disinterest and a lack of motivation were conjectured by almost a third (31%) of residents and a lack of time by another fifth (19%). An uncertain environment or lack of a sense of belonging playing a role was reported by 12% of respondents. Answers such as "Isolation," "Mistrust" or "Is not the best area" went into this category. Language was conjectured as a barrier by 6%, while lack of money and poor (spatial) accessibility both played a subordinate role, with only two mentions each.

In order to determine what wishes the residents have for health promotion in the district, they were first asked which services they would like to see set up next. The most desired offers were "cooking courses for healthy eating," "addiction counseling," and "smoking cessation" as well as "psychological counseling" (44–37% of respondents).

Another question dealt with the willingness of the respondents to participate, which was answered by 144 of the 157 respondents. Of these, 40% stated that they could imagine actively participating in health-promoting offers. The latter clearly showed that there is great interest among the residents in getting involved and in cocreation. However, the actual participation (even at the presentation of the results) lagged significantly behind the expressed interest.

**Figure 2.** *Barriers to the use of the services (n = 157; multiple responses possible).*

#### **4.4 "Lenzgesund" round table participation structure**

Round table – this is a metaphor intended to make it clear that no one can sit at the head of the table. Nobody is in charge. Decisions are made together. The "Lenzgesund" round table was held for the first time in autumn 2003 at the initiative of the Eimsbüttel health office in the Lenzsiedlung. It serves as an interface between the actors and the population and aims to establish health promotion and prevention with participation as an area of activity within the district development. Further overarching objectives of the health-promoting activities of the "Lenzgesund" round table are described in detail [16]:


At its first meetings, the round table more often organized small groups for special tasks, but there were no long-term working groups that were also active between the plenary sessions. Measures and projects were organized by and between individual institutions – in particular, the health office and the Lenzsiedlung Association.

The participation of the residents was envisaged in this initial conception of the round table. However, it became clear that the sessions were not interesting for them, as a collaboration between actors and institutions with regard to the implementation of health promotion and prevention services was becoming more and more important. Therefore, the development of professional concepts and professional decisionmaking processes mainly determined the discussion at the round table. In addition to the function of ensuring information exchange, the round table thus increasingly had the function of an advisory body.

The adoption of the Lenzgesund prevention program in January 2005 strengthened the structure of the round table as a result of the determination of objectives or fields of action and the establishment of permanent working groups. In June 2011, 10 to 12 institutions with 14 to 18 representatives formed the fixed core of the round table; others were only present occasionally (see **Figure 3**).

The "Lenzgesund" round table has significantly promoted networking among actors and their areas of activity, and thus the implementation of the prevention program. However, from the point of view of our practice partner, the Hamburg-Eimsbüttel Health Office, it cannot be expected to provide permanent and continuous monitoring and implementation for the program. It is more of an instrument of ideation and activation.

The experience of recent years shows that it is possible to activate a relatively large number of institutions and their representatives to exchange information and ideas. However, for many participants, this purpose was not sufficient for a permanent, regular engagement. Even so, there was a smaller group that was continuously involved. In addition, communication at the round table has developed into a series of sustainable working relationships in everyday life.

*Participation as a Core Principle of Community Health Promotion: General Account… DOI: http://dx.doi.org/10.5772/intechopen.111930*

**Figure 3.** *Facilities at the "Lenzgesund" round table.* 

For the health office as the organizer of the "Lenzgesund" prevention program, this meant that, in addition to the networking committee, the "Lenzgesund" round table, it needed stable working alliances with other individual institutions. Such alliances developed with the "Lenzsiedlung" Association and in approaches with the "Rauhen Haus", a further free provider of active social work in the district. The aim was also to strengthen collaborations with schools in the area surrounding the Lenzsiedlung.

Interesting information on the performance of the task and the role of the round table is gained from a survey of the participants. According to the respondents, the round table particularly fulfills the tasks of exchanging information, identifying problem areas, and developing goals, as well as the general management and further development of the prevention program (values 3.8–4.0 on a five-point scale, with the best value being 5).

In addition, the district diagnoses published as part of the research projects are considered important for the implementation of prevention and health promotion in the Lenzsiedlung [16, 17] and were made available and discussed at the round table, as they can be used to "provide better and targeted support."

The importance of the round table was also assessed in the context of a further survey in the autumn of 2008, with the instrument for measuring KEQ already presented. Here, too, it can be seen that, compared to other networking structures in and around the district, the importance of the "Lenzgesund" round table in the area is evaluated as important to very important, i.e., it holds an outstanding position.

From our point of view, it can be said that the "Lenzgesund" round table, with its continuous and regular work, played an informative, orienting, motivating, moderating, and coordinating role. Unfortunately, the original intention to involve the residents directly in the meetings of the round table could not be realized because there were not enough interested residents to take part continuously.

The participatory approaches and project experiences presented in the community-based health promotion activities show the diverse possibilities of setting-related involvement and activation of actors and residents [18] using the example of the Lenzsiedlung.
