Embracing complexity in community-based health promotion : inclusion, power, and women's health

Pamela Lynn Ponic
Inclusion is increasingly being positioned by health promoters as a way of alleviating exclusion and related health inequities experienced by marginalized women (Shookner, 2002; Reid, 2004). Yet assumptions about inclusion are rarely investigated, especially from the perspectives of the individuals it is meant to benefit. The purpose of this research was to critically examine inclusion as a health promotion strategy from the standpoints of 14 diverse women who were involved in a 5-year
more » ... -based health promotion (CBHP) project called Women Organizing Activities for Women (WOAW). This qualitative feminist participatory action research (FPAR) project developed from my 4-year stint as research manager of WOAW, which was designed to improve poor women's health through a community development approach to recreation (Frisby, Reid & Ponic, 2007). Participants reflected on their varied experiences through interviews, writing, and collaborative analysis. Through my critical feminist lens, the findings reveal that inclusion was a multifaceted and dynamic process produced by the interplay between individual, psychosocial, relational, local/organizational, and socio-political factors. Inclusion and exclusion existed in a fluid relationship that was shaped by contradictory and internalized understandings of power across axes of difference including gender, class, race/ethnicity, age, and (dis)ability. These tensions resulted in significant conflict through issues of leadership, sub-group loyalties, fear, and resistance. Amidst the inclusion-exclusion fluidity, participants' physical and mental health was both enhanced and hindered through psychosocial pathways. Their capacity, confidence, and sense of identity improved through participation, community connections, and consciousness-raising. Although the conflicts produced stress and anxiety, participants continually made health promoting choices to alleviate the effects. These findings do not measure health outcomes or inclusion processes; rather, they illustrate ho [...]
doi:10.14288/1.0077007 fatcat:wvbn3iu26zgrxhn2dfbkkcmimm