Docent tour: A human-centered method for exploring the role of environment in community-based programs

Introduction: Public health conceptualizations of “place”, such as social ecology models, suggest there are multiple, interacting levels of environmental influences on health behaviors (including individual, physical, community, policy). What remains unclear however is how to apply social-ecological determinants into public health services delivery. This issue is particularly salient for community-based programs, which exist in unique and diverse ecological settings. The current study aimed to develop a new, participatory research method to explore with community members how environments shape health/illness, and to illustrate how study findings based on this method can inform public health practice.

Methods: The docent tour is an in-depth, participant-led walking interview that incorporates ethnographic and community-based participatory research methods. This method was used with formerly homeless women who use drugs/alcohol (N=20) who led me on walking interviews of San Francisco's Tenderloin neighborhood. As we walked, we recorded (using audio, photographs, notes) and discussed the docents' experiences with substance use, community-based treatment, housing, and recovery. Interview data were transcribed verbatim and analyzed in Atlas.ti using the grounded theory method.

Results: Three place-based themes related to the social ecology of substance use will be described: 1) informal and formal surveillance, 2) recovery situated in risk, and 3) the unique role of social support in the Tenderloin.

Discussion: Human-centered methods should be part of community-based health service delivery and evaluation. The docent tour method can be used to illuminate the social ecology of drug and alcohol use in San Francisco in ways relevant to community-based public health efforts.