Social movement strategies to engage and mobilize communities have been effective at reducing HIV transmission. Community-based interventions have made significant advancements in HIV prevention, including:

• decreasing discrimination against those who are HIV positive;
• raising the levels of HIV testing and counseling amongst young adults;
• improving access to program and service quality; and
• increasing the uptake of antiretroviral treatment to prevent transmission to non-infected partners.

Engaging and mobilizing communities – including members of stakeholder groups and civil society agencies – has been critical in taking collective action towards the goal of preventing HIV transmission. To be effective, communities were found to need the following three key components:

1. empowerment through elements, such as leadership, resources, program management and the support of external partners
2. development of having a collective or shared identity as a community
3. capacity in health promotion, including the development of knowledge and skills, available resources, civic engagement, values for change and a learning culture

The Kahnawake Schools Diabetes Prevention Project (ksdpp.org) in the First Nations reserve of the Mohawks of the Kahnawake in Quebec, Canada aims to prevent type 2 diabetes in Kahnawake by empowering community members to care for their health. Project leaders were informed at the outset by evidence that demonstrated a two-fold higher risk of diabetes and diabetes-related complications in adults (Tremblay et al., 2018). 

To be meaningful for community members, the change was rooted in the values and traditions of Kanien’kehá:ka beliefs, incorporating a holistic approach of spiritual, emotional, physical and mental dimensions that reflect wellbeing. The project’s focus aligned with the value of protecting and promoting the health of future generations. By linking the change in values, families and other community members were more invested in the cause.

Advocacy for humane death and dying care practices led to the valuing and realization of hospice and palliative care services in South Australia in the 1990s (Elsey, 1998). Early hospice and palliative care advocates pressed for comprehensive community services provided by knowledgeable, humane and compassionate care providers who understood and supported the need for an alternative to medical practices in this area.

Advocates also recognized the need for funding, legislation, support of relevant volunteer organizations, and capacity-building in health professionals to ensure effective delivery of hospice and palliative care services.

RNAO uses social media campaigns to increase public visibility and raise awareness of issues. One example: RNAO’s call on the Ontario government to mandate recommendations set out in its Nursing Home Basic Care Guarantee. The campaign incorporated the hashtags #LTC #BasicCareGuarantee and #4Hours4Seniors to raise awareness of the staffing crisis in long-term care (LTC) and to encourage the public, health professionals, the government, LTC residents and their families to mobilize change.

As the campaign evolved, so did the visuals and the messaging. The three examples below show the stages of the campaign as it gained attention and momentum – from “good” through “better” to “best.”

Good example

RNAO developed an Action Alert (AA) to mobilize collective action to advocate for nursing home residents. The link to the AA, the graphic, the messaging and the hashtag #4Hours4Seniors were all shared on social media to urge others to sign and share the AA. People were also encouraged to use the hashtag to contribute to the dialogue about the LTC crisis.

The social media campaign aimed to support the goal set out in the AA – encourage as many people as possible to add their signatures to urge action from key political leaders.

This is a good example of a social media campaign, incorporating a graphic, supportive messaging, a call-to-action (the link to the AA) and a specific hashtag.  

Better example

In this example, RNAO staff members are holding signs identifying why #4Hours4Seniors matters to them. The hashtag is used consistently and individual reasons for supporting the cause are illustrated.

This is a better example of a social media campaign – it brings a personal touch to the campaign and allows supporters to share why they want to join the conversation. It also brought life to the hashtag and to the purpose of the campaign. 

Best example

Image

In this example, RNAO collaborated with F.J. Davey Home in Sudbury, Ontario, Canada to encourage residents to share their “why” for wanting #4Hours4Seniors. Building on the same idea as the “better” example given above, this example truly brought a face to the reason for the campaign in the first place. RNAO shared the photos and quotes from residents on its social media feeds (Instagram, Facebook and Twitter) alongside the hashtag #4Hours4Seniors.

For example, M. Doan, a senior living at the F.J. Davey Home, shared: “I am a very independent person, but my wife on the other hand isn’t and she means the world to me. With four hours of care, it doesn’t need to be rushed. And who wouldn’t want to see her beautiful smile for four hours!" (https://twitter.com/RNAO/status/1336781022780928000).

The photos are powerful as they show a real-life married couple living in a LTC home – two of the many residents RNAO advocated for through its AA and its ongoing call for a Nursing Home Basic Care Guarantee. The posters held by the couple express their personal values of dignity and comfort.

In 2014, RNAO, Wound Care Canada, and other supporters organized a coalition and advocated for diabetes-related foot ulcers care from the provincial government in Ontario, Canada. The coalition used evidence, political pressure to demand an integrated system of care with universal access to improve health outcomes, including reduced ulcers and amputations and reduced costs for pressure-alleviating devices. Members of the coalition participated in many activities, including:

• attending and participating in stakeholder meetings
• writing a media release and lead article in RNJ
• meeting with members of provincial parliament (MPPs) at RNAO’s annual Queen’s Park Day (Grinspun et al., 2018a)

The result of these advocacy efforts and changes in health outcomes are also described in an RNAO Evidence Booster measuring the impact of offloading devices for people living with diabetes and foot ulcers (https://rnao.ca/bpg/resources/evidence-booster-assessment-and-management-foot-ulcers-people-diabetes).

A community coalition in Los Angeles, California took collective action to advocate for the rights of Deaf children in accessing child abuse prevention and treatment services. The coalition took multiple steps to increase visibility, spread awareness and gain support. Some examples:

• one of the member organizations wrote an article published in a magazine for the Deaf community advocating for the protection of Deaf children.
• A presentation by coalition members was made at a local synagogue that included members of the Deaf community.
• A local social event included a focus on the collective actions of the coalition and how attendees could financially support their efforts.

These activities drew further attention to the collective action being taken and the urgency for change (Embry and Grossman, 2006).   

The Health as a Social Movement project for the National Health Services (NHS) developed the Programme Theory of Change to create system-level changes in health care in the United Kingdom.

The project used this theoretical model to provide impetus for change by defining goals for the change. These goals included connecting individuals, groups and organizations acting as change agents with the health system to mobilize local action for health.

Momentum played a pivotal role in achieving system change and transformation. Indicators of momentum included:

• an increase in social connectedness of individuals, groups and/or organizations 
• higher levels of control, resourcefulness and resilience in the community
• an increase in change agents’ confidence and influence over the health system

The sustained momentum arising from the individual and collective action aimed to support a preventable and sustainable health system, characterized as having:

• improvements in local services
• an integration of determinants of health into service provision
• higher levels of health and well-being (Arnold et al., 2018).  

To keep the momentum as a Best Practice Spotlight Organization® (BPSO®) implementing, evaluating and sustaining RNAO best practice guidelines (BPGs), Unity Health Toronto: St. Michael’s Hospital, https://rnao.ca/bpg/bpso/st-michaels-hospital, an acute care facility in Toronto, Ontario, Canada engaged their Professional Practice team as change leaders. Strategies the Professional Practice team have used to maintain momentum include:

1. profiling the activities, leadership and achievements of their champions and other change agents
2. using newsletters, posters and pins to promote BPSO and increase its visibility
3. participating in poster galleries and nursing rounds
4. publishing multiple articles in scholarly and professional journals to highlight key accomplishments and deliverables
5. creating and using an intranet site to update staff on BPSO activities (Ferris, Jeffs, Krock, & Skiffington, 2018).  ​​​​​

Launched in 2002, the RNAO Best Practice Champions Network® supports the active engagement of volunteer peer Best Practice Champions in knowledge exchange amongst one another, and between them and RNAO. Through this international network, more than 100,000 champions access tools and strategies such as workshops, webinars and online modules (Grinspun, 2018).   

In Quebec, Canada, community groups and researchers participated in a network using social movement approaches for the Kahnawake Schools Diabetes Prevention Project. In the early phase of the social movement, the network supported capacity building and collaboration of the community members. As the movement evolved, the network strengthened alliances among the community members and their shared decision-making. It also supported the program’s expansion to more children. At the conclusion of the project, the network supported the emerging leadership of the community partners (Tremblay et al., 2018).