PHLT 8450 Week 10 Stakeholder Critique Example

Reading the Draft From Three Chairs: A Stakeholder Critique of the Colonia Health Assessment by a Founding Cooperative Family, a Returning Farmworker Household and the Hospital's Community Benefit Manager

Student Name

Walden University

PHLT 8450: Community Health Assessment

Instructor Name

Month Day, Year

Reading the Draft From Three Chairs: A Stakeholder Critique of the Colonia Health Assessment by a Founding Cooperative Family, a Returning Farmworker Household and the Hospital's Community Benefit Manager

Three Chairs, Chosen First

A draft assessment can be accurate and still fail the people it describes. This critique reads the draft report from three positions, chosen before the draft was opened so that the readers were not picked to confirm faults already suspected. The first is a family that bought one of the first lots in the largest colonia and helped found its water cooperative. The second is a farmworker household that lives in a colonia for most of the year and follows the harvest north each summer. The third is the regional hospital's community benefit manager, who must turn the assessment into an implementation strategy. The positions were selected to cover long residence, seasonal residence and institutional responsibility, the three relationships to the assessment that the steering group identified. The readings are composites built from steering group discussion, listening session notes and the manager's published job duties, not interviews with real individuals.

Fact, Framing or Commitment

Each flagged passage is sorted into one of three kinds of problem, because each calls for a different fix. A fact problem is a statement that is wrong or unsupported; the fix is to correct or source it. A framing problem is a statement that may be accurate but describes people in a way they would reject; the fix is to rewrite it with the finding intact, as in the Week 6 critiques. A commitment problem is a statement that implies someone has promised something they have not; the fix is to state exactly who has agreed to what.

Table 1

Flagged Passages by Reader and Kind

Note. Composite readings of a composite draft.

When the Settlement Began

The draft dates the colonias to the 1990s, apparently from the year the county began tracking them. The founding family remembers buying their lot in 1979 through a contract for deed, a common arrangement in which the seller keeps title until the last payment. The error is more than a date. Placing the colonias' origin in the 1990s erases two decades in which families built homes, dug wells and organized without public water or paved roads, and it makes the current lack of services look recent rather than long-standing. The fix is to cite county plat records for the date and to add a sentence on how long residents have waited for services. Mier et al. (2008) describe colonia residents' health in the context of this long history of infrastructure neglect, and the report should do the same.

Returning, Not Transient

The second reader objects to "transient." The household has lived at the same address for fourteen years and leaves for about ten weeks each summer to work the harvest in other states. "Transient" suggests people with no stake in the place, which is the opposite of the truth and could weaken their claim on county services. The finding behind the word, that a share of households is away in summer, matters for planning and should stay. The household also raises a fact problem with consequences: the assessment's door-to-door survey ran in July, when these households were gone. Their absence means the survey undercounts families who move for seasonal work, the families most likely to lack coverage. The report should state this gap and, if possible, add fall interviews.

A Van Nobody Promised

The community benefit manager reads the draft for what it commits the hospital and its partners to do. Two sentences overstate. The draft says the clinic van will serve all seven colonias, but the clinic has only said it is considering new stops. It says the hospital will fund a drainage study, but that is a resident request, not a decision. The manager's concern is legitimate: a report that announces commitments no one made sets up residents for disappointment and puts the hospital in a position of appearing to break promises it never gave. Pennel et al. (2015) note that hospital assessments vary widely in how clearly they connect findings to action, and precision about who has agreed to what is part of that connection. The fix is to separate, in a clearly labeled section, actions that are decided, actions that are requested and actions that are being considered.

What the Three Readings Share

The three readers want different things, but all of their objections concern the same quality, trust. The founding family wants their history acknowledged; the returning household wants not to be described as outsiders; the manager wants commitments stated accurately. Lucero et al. (2020) found that trust between partners is associated with the outcomes of community-engaged research, and a report that gets history, people or promises wrong damages trust with the very partners it needs.

Where Readers Disagree

On one point the readers conflict. The founding family wants the report to name the county's long failure to provide services; the manager worries that blunt language will make county officials defensive. The critique does not resolve this for the steering group. It recommends that the report state the facts of the service gap plainly, with dates, and leave characterization to residents' quoted words, consistent with the weight Wallerstein and Duran (2006) give to communities defining their own problems.

Recommended Revisions

The critique recommends six revisions: correct the founding date with a source; replace the claim that residents lack water organization with a description of the cooperative; replace "transient"; disclose that the summer survey missed returning households and add fall interviews; restate the van and drainage statements as considerations and requests; and add a section separating decided, requested and considered actions. Each revision keeps the draft's findings while removing a reason for a reader to stop trusting it.

References

Lucero, J. E., Boursaw, B., Eder, M. M., Greene-Moton, E., Wallerstein, N., & Oetzel, J. G. (2020). Engage for equity: The role of trust and synergy in community-based participatory research. Health Education & Behavior, 47(3), 372-379. https://doi.org/10.1177/1090198120918838

Mier, N., Ory, M. G., Zhan, D., Conkling, M., Sharkey, J. R., & Burdine, J. N. (2008). Health-related quality of life among Mexican Americans living in colonias at the Texas-Mexico border. Social Science & Medicine, 66(8), 1760-1771. https://doi.org/10.1016/j.socscimed.2007.12.017

Pennel, C. L., McLeroy, K. R., Burdine, J. N., & Matarrita-Cascante, D. (2015). Nonprofit hospitals' approach to community health needs assessment. American Journal of Public Health, 105(3), e103-e113. https://doi.org/10.2105/AJPH.2014.302286

Wallerstein, N. B., & Duran, B. (2006). Using community-based participatory research to address health disparities. Health Promotion Practice, 7(3), 312-323. https://doi.org/10.1177/1524839906289376