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E63694.Pdf (‎5.127Mb) FIRST SECTION Experiences of the Lahti project Marja Holmila Introduction The Lahti Project is a multi component community action programme aimed at the prevention of alcohol related harms. The project site is the city of Lahti in Finland. The project relies to a great extent on the work of local professionals. It includes work in developing local alcohol policy discussion, education and information, health care intervention for heavy drinkers, youth work, support for family members and server training. Formative, process and outcome evaluation research are being conducted in order to assess the impact of the project (Holmila 1992; 1995). The programme is an experimental one, and its purpose is to obtain information about the feasibility and possibilities of local prevention. For that reason research has an important role in the project. The programme started during the autumn of 1992, and was mostly finished by the end of 1994, even if some parts are still being continued. The final report is currently being written, and will contain description of the processes, research results of the community's life- styles, responses to alcohol use and evaluation of the project (Holmila 1996). This paper will not be a comprehensive presentation of the Lahti project. The paper gives a short summary of the project’s main features, and discusses in more detail some issues related to the process of working and the relations between research and action. Starting the project The initiative to start Lahti project came from several sources simultaneously. When the wish to start such action had developed independently both in the city of Lahti, among alcohol educators and among researchers, the project began without difficulties. A suggestion to formulate Lahti’s alcohol policy programme was made in the city council already at the end of the 1980's. This initiative was, however, not supported by the local decision makers, and the matter was left to rest. Two years later the same suggestion was made again and supported by the professionals in the city. This time a working group was set to write the programme. Lahti was the second city in Finland to make such a plan, the first one had been Tampere. A permanent drug and alcohol policy working group, which consists of civil servants and representatives of some citizens’ organizations was nominated in 1992. The working group’s tasks are to monitor the changes in drug and alcohol use and to make suggestions for the city government for prevention and treatment of drug problems. The researchers’ involvement started also gradually. A study on community social response to 1 alcohol problems collected its data in Lahti during the years 1988 - 1990 (Holmila, Ahtola and Stenius 1989; Simpura 1991; Säilä 1991). Even if this study did not look at prevention, it provided useful information for the prevention project. Many civil servants, treatment personnel and citizens of Lahti became familiar with the researchers and vice versa. This influenced the choice of Lahti as the location of the community prevention project. Interest in carrying out community based programmes had grown among health promoters, too. As a result, a pilot study on organizing a library based education campaign in Salo was started (Montonen 1992). This campaign was then repeated in Lahti. Community action studies from other countries, international symposiums on community action were important sources for inspiration. WHO:s European Office’s Alcohol Action Plan which includes community action as one of its action areas, has been an important support in gaining and maintaining the interest of national and local actors. A lengthy process had thus preceded the beginning of the project. By the time the researchers were ready to start the project in Lahti, we were very welcome. The city’s involvement was ensured by negotiations with the city leaders. The project was supported by the mayor in Lahti. All the chiefs in the city’s administration were also involved, even if individuals differed as to how actively they backed the project. An opening seminar in the autumn of 1992 marked the beginning of the project. The goals of the project The goals of the experimental community action organized in Lahti can be listed as follows. It is possible to make this list now, after the project has matured and developed into its full shape. There was no clear programme when the project started, only the general idea and gradually different areas of work were specified. 1. Influencing the knowledge, attitudes and use of alcohol among the inhabitants of Lahti 2. Influencing the knowledge and attitudes among the key persons in the locality 3. Developing the social response to alcohol problems in the city’s welfare services as well as in the citizens’ organizations. Social response means here both the supply of services and the overall willingness and ability to approach the alcohol problems from a preventive point of view. 4. Activating local alcohol policy discussion and planning. Action in the project was divided into independent working modules. The most important modules were interviews of key persons, alcohol policy processes at the local level, education and information, health care intervention of heavy drinkers, youth work, heavy drinkers and self-help, influencing the alcohol supply and server responsibility, and family. The researchers acted as promoters of the action during its first stages. In doing this, their role was of two kinds. Some of us had a prevention idea, a method and a ”package”. This was the case in the Library Weeks and the heavy drinkers intervention in the primary health care centres. Some of us had a pure research idea, as was the case in the interviews of the local influences (which 2 however then later also had an intervention impact). For myself and Kari Haavisto the method of working was that of an interpreter, listener, summarizer, and on the basis of that, also an active initiator of meetings and action. There were lots of meetings and discussions, and it was natural to the researchers to use their skills in collecting and organizing speech texts, interpreting it and writing it up. In that capacity, the researchers actively directed the action in the locality. The local actors then usually developed the actual prevention methods. As the process developed, the local activists took a stronger and stronger hold of planning and carrying out all action whilst the researchers started to pull out back to their desks. All activities were from the beginning based on previous work and resources in the locality. The organization of the project itself has been very light. There was no separate budget, and the funds came from the normal budgets of the different cooperating partners. The planning and information was coordinated by a project group, which consisted of the local coordinator Sirkka- Liisa Mäkelä, principal coordinator Marja Holmila, Leena Warsell and Pekka Olkkonen from the State Alcohol Monopoly’s information and education unit and all the researchers. The research work was funded by the Social Research Institute of Alcohol Studies and the Biomedical Research Centre in Oy Alko Ab and the Finnish Foundation of Alcohol Studies. The core of the actors in Lahti were the welfare professionals in the city. They are permanently engaged in responding to social problems, and formed the ”support-network” for the volunteer organizations and individuals in the project. Research The research in Lahti project is clearly a case study. Case studies can be defined as empirical inquiries that investigate contemporary phenomena within their real-life contexts, especially when the boundaries between the phenomenon studied and the context are not clearly evident (Yin 1994, 13). In other words, one would use the case study method when one deliberately wanted to cover contextual conditions - believing that they might be highly pertinent to the phenomenon of study. Important here is that in the Lahti project the action - the prevention project - and the context - the cultural and social structure of the community - are not to be clearly separated. The context of the action and the action itself are studied at the same time. Case studies allow the use of qualitative data, which in the present study has been an important element, for instance in interpreting the thoughts and actions of the local people and by describing the preventive action alive in the context of everyday life and more than just a list of good intentions, plans and protocols. Action research Action research differs from other types of social studies in two basic ways. First, it takes an active approach to change. Action research aims at changing the social group or the society, at producing innovations. Secondly, the relationship between the researcher and those studied is different in action research than in other types of research. Traditional academic research stresses the 3 distinction between the researcher and those studied. The researcher avoids influencing the studied persons or groups in order to obtain as objective results as possible. Action research, on the contrary, tries to break down the barriers between science and the world outside it, to make research a part of a process and to build good communication networks between different actors. The distinctive element in action research is the way it understands the process of knowledge formation. Action research basis its knowledge on the group’s or system’s characteristics on acts. It ”checks” the interpretations of the system in a straight-forward manner, by engaging in action with it. It is this special dialogical and practical way of obtaining knowledge of the studied case that distinguishes action research from other kinds of studies. The group has to agree in open and dialogical atmosphere about the action, its goals and main methods.
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