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UBC Theses and Dissertations

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


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 community-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 how coupling FPAR with critical theorizing can inform CBHP (Kesby, 2005; Poland, 1998). Exploring CBHP projects across this length of time and at this depth is rare, but doing so importantly explicates inclusion, participation, exclusion, and marginalization as contestable concepts that must be critically examined if they are to be useful. In the end, I offer an 'Inclusion Tool' designed to cultivate critical dialogues amongst CBHP participants, practitioners, and researchers who seek to embrace and utilize the complexity inherent within inclusion processes.

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