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INTRODUCTION: The goal of integrating a Public Health Certificate (PHC) into the medical school curriculum is meant to provide basic public health skills and knowledge to all future physicians, ultimately broadening the health workforce's capacity to address community health needs. The faculty at the University of New Mexico's (UNM) School of Medicine (SOM), in collaboration with multiple community stakeholders, created a PHC equivalent to 15 graduate level units. The PHC will be required of all medical students matriculating in 2010. METHODS: The authors, community leaders, university administrators, faculty, staff, and students met to address the many tasks required of such broad curricular and policy change. The tasks required piloting innovations in curriculum design and implementation, working within the bureaucratic structure, fostering collaboration, nurturing leadership skills, marketing the new ideas, and designing credible evaluation strategies. RESULTS: We have engaged the stakeholders; surveyed our resources; produced and implemented ongoing evaluation; examined implementation strategies; developed, implemented and pilot tested the PHC courses; and engaged faculty from the Department of Family & Community Medicine in faculty development seminars. CONCLUSION: Introduction of a PHC for all students is feasible with planning tools such as the Logic Model.

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In 1986, the Ottawa Charter identified community empowerment as being a central theme of health promotion discourse. Community empowerment became a topical issue in the health promotion literature soon afterwards, though its roots also come from earlier literature in community psychology, community organizing and liberation education. Subsequent international conferences to address health promotion in Sundsvall, Adelaide and Jakarta have acted to reinforce this concept. It is as relevant today as it was more than a decade ago. The literature surrounding health promotion has since moved onto other overlapping theoretical perspectives, such as community capacity and social capital. And yet the critical issue of making community empowerment operational in a programme context remains thorny and elusive. Community empowerment is still difficult to measure and implement as a part of health promotion. This article offers a fresh look at key theoretical and practical questions in regard to the measurement of community empowerment. The theoretical questions help to unpack community empowerment in an attempt to clarify how the application of this concept can be best approached. The practical questions address the basic design characteristics for methodologies to measure community empowerment within the context of international health promotion programming. The purpose of this article is to allow researchers and practitioners to address again the important issue of making community empowerment operational.

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Participatory evaluation models that invite community coalitions to take an active role in developing evaluations of their programs are a natural fit with Healthy Communities initiatives. The author describes the development of a participatory evaluation model for New Mexico's Healthier Communities program. She describes evaluation principles, research questions, and baseline findings. The evaluation model shows the links between process, community-level system impacts, and population health changes.

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This article reports on the process evaluation of the training of facilitators for the Adolescent Social Action Program, a health education program in Albuquerque, New Mexico that trained college students and adult volunteers to work with middle school students. From the process evaluation data collected throughout a four-year period (1995-1998), data relevant to training are described: facilitator characteristics, facilitator training, curriculum implementation, and use of the program's model designed to promote critical thinking and dialogue. Results indicated that, though most facilitators reported the training was sufficient to enable them to implement the curriculum, they did not completely do so, especially as groups reached their final sessions. Facilitators covered the core curriculum content, but often failed to follow through with the more abstract activities. The need to perform and report the process evaluation in time to provide ample opportunity for trainers and curriculum designers to make appropriate adjustments is discussed.

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The relationship between evaluators and communities has been changing in the last two decades to a model of research 'with' the community, instead of research 'on' the community. This shift has paralleled increasing community demands for accountability and authority as community participation rhetoric has given way to words such as partnership, collaboration and community empowerment. Despite the rhetoric, there has been little reflection on the problematic and contradictory relationships between communities and researchers, specifically as related to their differing positions of power. This article provides a reflective examination of the contested power dynamics of the research relationship within a participatory evaluation process of the Healthier Communities initiative in New Mexico. An in-depth literature review of the philosophical principles and the complex realities of evaluations based on participatory, community-driven and post-modern inquiry precedes the case study. Without ongoing consideration of power issues, the article argues that evaluation design, implementation and utilization of findings will be compromised.

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Although community capacity is a central concern of community development experts, the concept requires clarification. Because of the potential importance of community capacity to health promotion, the Division of Chronic Disease Control and Community Intervention, Centers for Disease Control and Prevention (CDC), convened a symposium in December 1995 with the hope that a consensus might emerge regarding the dimensions that are integral to community capacity. This article describes the dimensions that the symposium participants suggested as central to the construct, including participation and leadership, skills, resources, social and interorganizational networks, sense of community, understanding of community history, community power, community values, and critical reflection. The dimensions are not exhaustive but may serve as a point of departure to extend and refine the construct and to operationalize ways to assess capacity in communities.

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The dominant theoretical models used in health education today are based in social psychology. While these theories have increasingly acknowledged the role of larger social and cultural influences in health behavior, they have many limitations. Theories seek to explain the causes of health problems, whereas principles of practice, which are derived from practical experience, assist intervenors to achieve their objectives. By elucidating the relationships between theory and practice principles, it may be possible to develop more coherent and effective interventions. The key research agenda for health education is to link theories at different levels of analysis and to create theory-driven models that can be used to plan more effective interventions in the complex environments in which health educators work.

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PURPOSE: To analyze the organizational development and implementation of an interdisciplinary health promotion project at the University of New Mexico. The effort involved three academic units in a 3-year externally funded project to institutionalize health promotion curricula in the respective schools and to develop a wellness-oriented service for students, faculty, and staff. METHODS: The open systems theory was used as a framework to analyze the organizational and role issues that emerged from the data collected through interviews, staff surveys, and document review. The analysis is summarized by five thematic questions: (1) How did the project's vision affect its development? (2) How was leadership enacted, and with what effect? (3) What were the organizational issues for the staff? (4) What were the interdisciplinary dilemmas? (5) What was instituted or changed as a result of the project? RESULTS: The analysis uncovered a series of interpersonal and organizational dilemmas involving the nature of the organizational environment, the character of interdisciplinary work, leadership, boundaries of group membership, and the structuring of a unified vision. CONCLUSIONS: Future projects should consider the strength and stability of the boundary spanners, the resource context, and the role of a unified vision for new and organizationally linked units as key issues in facilitating and sustaining change.

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This study illustrates how a union education center successfully integrated adult empowerment education principles into the teaching methods and curriculum of a health and safety training program. The 12-month follow-up phone survey involved 481 local union respondents each representing a separate plant site and a group of 50 manager trainees. The evaluation shows that the training manual continued to be used by more than 70% of respondents, more than 70% taught coworkers, more than 50% of union trainees went on to train their managers, and more than 90% identified problems at work and sought and obtained changes in programs, training, or equipment. More than 20% reported that major spills had occurred following training. The majority stated that the handling of the spills improved. More than 80% stated that the training better prepared them for their health and safety duties. The managers' data substantially supported union members' reports.

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Labor health and safety programs encourage workers to take an active part in making the workplace safe. The authors describe the growing need for preparing workers to participate in prevention efforts, the role of training in addressing this need, educational principles and traditions that contribute to empowerment education, and a step-by-step process that is required to achieve the goals of worker involvement and empowerment.

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This article illustrates how Paulo Freire's social change theory can be integrated with a cognitive and behavior change theory to develop a comprehensive health education program directed at both individual- and community-level change. Through discussion of ASAP, an alcohol and substance abuse prevention program for youth from high-risk communities in New Mexico, this article presents an interweaving of Freirian theory and protection-motivation cognitive change theory. Qualitative research data are provided on the processes of change, the interplay of personal and societal factors, and the potential outcomes as a result of using this integrated approach. Programmatic and evaluation implications for health education programs are discussed.

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This article introduces a special issue of the American Journal of Industrial Medicine dedicated to innovative approaches to worker education in health and safety. Contributors to this issue describe applications of an "empowerment approach" in a wide variety of institutions and settings throughout the United States and Canada. In this article, empowerment education is presented and contrasted with other training methodologies. The article offers suggestions on how to implement this approach discusses evaluation issues, and summarizes the articles contained in this issue. Explored are preliminary outcomes of using this methodology and implications for developing educational programs in the future.

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Low literacy and limited English proficiency have become a growing concern for health and safety educators. With one-fifth of the workforce reading below an eighth-grade level and possibly another tenth having limited English skills, health and safety educators and unions have increasingly become aware that current training programs often surpass the language and literacy abilities of workers being trained. This article describes the dilemmas facing health and safety professionals in incorporating knowledge about language and literacy skill levels. It documents creative strategies and new programs, largely based on participatory and popular education approaches, to provide training that simultaneously matches worker needs and leads to worker empowerment.

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