Health trajectories in regeneration areas in England: the impact of the New Deal for Communities intervention

PubMed Central

Walthery, Pierre; Stafford, Mai; Nazroo, James; Whitehead, Margaret; Dibben, Christopher; Halliday, Emma; Povall, Sue; Popay, Jennie

2015-01-01

Background A large body of evidence documents the adverse relationship between concentrated deprivation and health. Among the evaluations of regeneration initiatives to tackle these spatial inequalities, few have traced the trajectories of individuals over time and fewer still have employed counterfactual comparison. We investigate the impact of one such initiative in England, the New Deal for Communities (NDC), which ran from 1999 to 2011, on socioeconomic inequalities in health trajectories. Methods Latent Growth Curve modelling of within-person changes in self-rated health, mental health and life satisfaction between 2002 and 2008 of an analytical cohort of residents of 39 disadvantaged areas of England in which the NDC was implemented, compared with residents of comparator, non-intervention areas, focusing on: (1) whether differences over time in outcomes can be detected between NDC and comparator areas and (2) whether interventions may have altered socioeconomic differences in outcomes. Results No evidence was found for an overall improvement in the three outcomes, or for significant differences in changes in health between respondents in NDC versus comparator areas. However, we found a weakly significant gap in life satisfaction and mental health between high and low socioeconomic status individuals in comparator areas which widened over time to a greater extent than in NDC areas. Change over time in the three outcomes was non-linear: individual improvements among NDC residents were largest before 2006. Conclusions There is limited evidence that the NDC moderated the impact of socioeconomic factors on mental health and life satisfaction trajectories. Furthermore, any NDC impact was strongest in the first 6 years of the programmes. PMID:26085649

Enhancing Themes and Strengths Assessment: Leveraging Academic-Led Qualitative Inquiry in Community Health Assessment to Uncover Roots of Community Health Inequities.

PubMed

Hebert-Beirne, Jennifer; Felner, Jennifer K; Castañeda, Yvette; Cohen, Sheri

Rigorous qualitative research can enhance local health departments' efforts to gain a deeper insight into residents' perceived community health inequities necessary for productive community health assessments (CHAs) and community health improvement plans (CHIPs). The Chicago Department of Public Health and the Partnership for Healthy Chicago used the National Association of County & City Health Officials' Mobilizing for Action through Planning and Partnerships (MAPP) model to conduct its CHA/CHIP, Healthy Chicago 2.0 (HC 2.0). Public health graduate students conducted qualitative research for part of the Community Themes and Strengths Assessment (CTSA), one of the 4 MAPP assessments. Using a health equity lens, this qualitative component included focus groups and oral histories with residents in Chicago Community Areas with the highest social and economic hardship to better understand how residents perceive health inequities in their respective neighborhoods. Community-based organizations in 6 Chicago neighborhoods with the highest quartile of social and economic hardship. Forty-eight Chicago residents from 5 community areas participated in focus groups, and 6 residents of a Mexican ethnic enclave shared oral histories. Residents' perceptions of community needs and assets. Needs identified include inaccessible resources and opportunities, economic instability, and safety. Assets include the efficacy and agency of resilient residents, as well as faith and spirituality. Systemic and institutional discrimination was identified at the roots of community health inequities. Through qualitative inquiry, the more nuanced understanding of how residents perceive health inequities better positioned HC 2.0 to develop upstream strategies in line with advanced health equity practice. Engaging qualitative academic researchers in CTSA brings academic expertise to enrich the CHA while providing real-time learning experiences to prepare future public health practitioners to work on

Influence of community-based education on undergraduate health professions students' decision to work in underserved areas in Uganda.

PubMed

Kizito, Samuel; Baingana, Rhona; Mugagga, Kintu; Akera, Peter; Sewankambo, Nelson K

2017-12-08

Uganda is beset by a shortage of health workers and the few available are mal-distributed. Providing rural exposure through community-based education could positively influence students' perspectives towards work in rural areas. We aimed to assess the impact of Community-Based Education and Research (COBERS) on health professions students' attitudes towards working in rural areas. This was a before-and-after study among 525 students of 4 medical universities in Uganda. Data was collected using self-administered paper-based questionnaires. Logistic regression and Poisson regression respectively were used to assess intention and intended number of years of work in rural areas. Before COBERS, 228/518 (44.0%) students indicated that they intended to work in rural areas as compared to 245/506 (48.4%) after the COBERS placement. Before the COBERS placement, the factors that were associated with students considering to work in a rural area were: extra allowance (OR = 0.2; 95% CI 0.1-0.6), and availability of social amenities (OR = 0.2; 95% CI 0.1-0.7). After their COBERS placement, the factors were: access to long distance courses (OR = 2.0; 95% CI 1.0-3.7) and being posted to a facility in a rural area (OR = 15.0; 95% CI 6.5-35.5). Before the COBERS placement the factors that influenced how long students thought they would be willing to work in a rural environment were: reliable electricity (IRR = 0.6; 95% CI 0.3-1.0) and Internet (IRR = 1.5; 95% CI 1.0-2.3), high salary (IRR = 0.4; 95% CI 0.3-0.7), and having skills to practice in rural settings (IRR = 2.0; 95% CI 1.3-3.1). Reliable electricity (IRR = 0.5; 95% CI 0.3-0.8) and long distance courses (IRR = 2.1; 95% CI 1.4-3.1) were significant motivators after having undergone the COBERS placement. The majority of health professions students do not intend to work in rural areas after they graduate. Improving the welfare of health professionals working in rural areas could attract more health

Health care in rural areas.

PubMed

Nath, L M

1994-02-01

In India, although the health care system infrastructure is extensive, the people often regard government facilities as family planning (FP) centers instead of primary health care centers. This problem has been compounded by the separation of health care and FP at all stages, even down to the storage of the same medication in two different locations depending upon whether it is to be used for "health" or for "FP." In rural areas where the government centers are particularly desolate, the community has chosen to erect its own health care system of private practitioners of all sorts and qualifications. Even in rural areas where a comprehensive health service is provided, with each household visited regularly by health workers, and where this service has resulted in a lowering of the crude death rate from 14.6 to 7 and the maternal mortality rate from 4.7 to 0.5/1000, people depend upon practitioners of various types. Upon analysis, it was discovered that the reason for using this multiplicity of practitioners had nothing to do with the level of satisfaction with the government service or with the accessibility of the services. Rather, when ill, the people make a diagnosis and then go to the proper place for treatment. If, for instance, they believe their malady was caused by the evil eye, they consult a magico-religious practitioner. These various types of practitioners flourish in areas with the best primary health care because they fulfill a need not met by the primary health care staff. If government agencies work with the local practitioners and afford them the proper respect, their skills can be upgraded in selected areas and the whole community will benefit.

Health trajectories in regeneration areas in England: the impact of the New Deal for Communities intervention.

PubMed

Walthery, Pierre; Stafford, Mai; Nazroo, James; Whitehead, Margaret; Dibben, Christopher; Halliday, Emma; Povall, Sue; Popay, Jennie

2015-08-01

A large body of evidence documents the adverse relationship between concentrated deprivation and health. Among the evaluations of regeneration initiatives to tackle these spatial inequalities, few have traced the trajectories of individuals over time and fewer still have employed counterfactual comparison. We investigate the impact of one such initiative in England, the New Deal for Communities (NDC), which ran from 1999 to 2011, on socioeconomic inequalities in health trajectories. Latent Growth Curve modelling of within-person changes in self-rated health, mental health and life satisfaction between 2002 and 2008 of an analytical cohort of residents of 39 disadvantaged areas of England in which the NDC was implemented, compared with residents of comparator, non-intervention areas, focusing on: (1) whether differences over time in outcomes can be detected between NDC and comparator areas and (2) whether interventions may have altered socioeconomic differences in outcomes. No evidence was found for an overall improvement in the three outcomes, or for significant differences in changes in health between respondents in NDC versus comparator areas. However, we found a weakly significant gap in life satisfaction and mental health between high and low socioeconomic status individuals in comparator areas which widened over time to a greater extent than in NDC areas. Change over time in the three outcomes was non-linear: individual improvements among NDC residents were largest before 2006. There is limited evidence that the NDC moderated the impact of socioeconomic factors on mental health and life satisfaction trajectories. Furthermore, any NDC impact was strongest in the first 6 years of the programmes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Place Matters in Non-Traditional Migration Areas: Exploring Barriers to Healthcare for Latino Immigrants by Region, Neighborhood, and Community Health Center.

PubMed

Topmiller, Michael; Zhen-Duan, Jenny; Jacquez, Farrah J; Vaughn, Lisa M

2017-12-01

This paper identifies differences in adult Latino immigrant barriers to healthcare in the Cincinnati area in Hamilton County, OH, on three levels: by region, by neighborhood, and by community health center. Secondary data analysis was performed on 439 surveys. Respondents were aggregated by the geographic regions and neighborhoods where they live and by two community health centers where they receive care. Outcome measures included pragmatic and skill barrier indices adapted from the Barriers to Care Questionnaire (BCQ); the pragmatics index consists logistical barriers, including transportation and cost; the skills index is made up of items related to navigating the healthcare system, including communicating with physicians and completing paperwork. The results indicate that immigrant Latinos living in western Cincinnati and northern Hamilton County face significantly higher pragmatic barriers to care, while Latino immigrants going to a community health center in western Cincinnati have significantly fewer pragmatic and skill barriers than immigrants utilizing a nearby community health center. Because healthcare options for undocumented immigrants do not improve with the Affordable Care Act, community health centers will continue to serve as their primary source of care. This is particularly true in non-traditional migration areas, where immigrants tend to be isolated and lack resources. Efforts to improve access to healthcare for immigrant Latinos require place-based approaches that allow for targeted resources to improve care in these locations. This study helps to fill that need by identifying variation in barriers to care on multiple levels and offering strategies to alleviate these barriers.

Involving local health departments in community health partnerships: evaluation results from the partnership for the public's health initiative.

PubMed

Cheadle, Allen; Hsu, Clarissa; Schwartz, Pamela M; Pearson, David; Greenwald, Howard P; Beery, William L; Flores, George; Casey, Maria Campbell

2008-03-01

Improving community health "from the ground up" entails a comprehensive ecological approach, deep involvement of community-based entities, and addressing social determinants of population health status. Although the Centers for Disease Control and Prevention, the Office of the Surgeon General, and other authorities have called for public health to be an "inter-sector" enterprise, few models have surfaced that feature local health departments as a key part of the collaborative model for effecting community-level change. This paper presents evaluation findings and lessons learned from the Partnership for the Public's Health (PPH), a comprehensive community initiative that featured a central role for local health departments with their community partners. Funded by The California Endowment, PPH provided technical and financial resources to 39 community partnerships in 14 local health department jurisdictions in California to promote community and health department capacity building and community-level policy and systems change designed to produce long-term improvements in population health. The evaluation used multiple data sources to create progress ratings for each partnership in five goal areas related to capacity building, community health improvement programs, and policy and systems change. Overall results were generally positive; in particular, of the 37 partnerships funded continuously throughout the 5 years of the initiative, between 25% and 40% were able to make a high level of progress in each of the Initiative's five goal areas. Factors associated with partnership success were also identified by local evaluators. These results showed that health departments able to work effectively with community groups had strong, committed leaders who used creative financing mechanisms, inclusive planning processes, organizational changes, and open communication to promote collaboration with the communities they served.

Evaluating community-based public health leadership training.

PubMed

Ceraso, Marion; Gruebling, Kirsten; Layde, Peter; Remington, Patrick; Hill, Barbara; Morzinski, Jeffrey; Ore, Peggy

2011-01-01

Addressing the nation's increasingly complex public health challenges will require more effective multisector collaboration and stronger public health leadership. In 2005, the Healthy Wisconsin Leadership Institute launched an annual, year-long intensive "community teams" program. The goal of this program is to develop collaborative leadership and public health skills among Wisconsin-based multisectoral teams mobilizing their communities to improve public health. To measure the scope of participation and program impacts on individual learning and practice, including application of new knowledge and collective achievements of teams on coalition and short-term community outcomes. End-of-year participant program evaluations and follow-up telephone interviews with participants 20 months after program completion. Community-based public health leadership training program. Sixty-eight participants in the Community Teams Program during the years 2006 to 2007 and 2007 to 2008. Professional diversity of program participants; individual learning and practice, including application of new knowledge; and collective achievements of teams, including coalition and short-term community outcomes. Participants in the Community Teams Program represent a diversity of sectors, including nonprofit, governmental, academic, business, and local public health. Participation increased knowledge across all public health and leadership competency areas covered in the program. Participating teams reported outcomes, including increased engagement of community leadership, expansion of preventive services, increased media coverage, strengthened community coalitions, and increased grant funding. Evaluation of this community-based approach to public health leadership training has shown it to be a promising model for building collaborative and public health leadership skills and initiating sustained community change for health improvement.

Economic Shocks and Public Health Protections in US Metropolitan Areas

PubMed Central

Hogg, Rachel A.

2015-01-01

Objectives. We examined public health system responses to economic shocks using longitudinal observations of public health activities implemented in US metropolitan areas from 1998 to 2012. Methods. The National Longitudinal Survey of Public Health Systems collected data on the implementation of 20 core public health activities in a nationally representative cohort of 280 metropolitan areas in 1998, 2006, and 2012. We used generalized estimating equations to estimate how local economic shocks relate to the scope of activities implemented in communities, the mix of organizations performing them, and perceptions of the effectiveness of activities. Results. Public health activities fell by nearly 5% in the average community between 2006 and 2012, with the bottom quintile of communities losing nearly 25% of their activities. Local public health delivery fell most sharply among communities experiencing the largest increases in unemployment and the largest reductions in governmental public health spending. Conclusions. Federal resources and private sector contributions failed to avert reductions in local public health protections during the recession. New financing mechanisms may be necessary to ensure equitable public health protections during economic downturns. PMID:25689201

Differences in Health Care, Family, and Community Factors Associated with Mental, Behavioral, and Developmental Disorders Among Children Aged 2-8 Years in Rural and Urban Areas - United States, 2011-2012.

PubMed

Robinson, Lara R; Holbrook, Joseph R; Bitsko, Rebecca H; Hartwig, Sophie A; Kaminski, Jennifer W; Ghandour, Reem M; Peacock, Georgina; Heggs, Akilah; Boyle, Coleen A

2017-03-17

Mental, behavioral, and developmental disorders (MBDDs) begin in early childhood and often affect lifelong health and well-being. Persons who live in rural areas report more health-related disparities than those in urban areas, including poorer health, more health risk behaviors, and less access to health resources. 2011-2012. The National Survey of Children's Health (NSCH) is a cross-sectional, random-digit-dial telephone survey of parents or guardians that collects information on noninstitutionalized children aged <18 years in the United States. Interviews included indicators of health and well-being, health care access, and family and community characteristics. Using data from the 2011-2012 NSCH, this report examines variations in health care, family, and community factors among children aged 2-8 years with and without MBDDs in rural and urban settings. Restricting the data to U.S. children aged 2-8 years with valid responses for child age and sex, each MBDD, and zip code resulted in an analytic sample of 34,535 children; MBDD diagnosis was determined by parent report and was not validated with health care providers or medical records. A higher percentage of all children in small rural and large rural areas compared with all children in urban areas had parents who reported experiencing financial difficulties (i.e., difficulties meeting basic needs such as food and housing). Children in all rural areas more often lacked amenities and lived in a neighborhood in poor condition. However, a lower percentage of children in small rural and isolated areas had parents who reported living in an unsafe neighborhood, and children in isolated areas less often lived in a neighborhood lacking social support, less often lacked a medical home, and less often had a parent with fair or poor mental health. Across rural subtypes, approximately one in six young children had a parent-reported MBDD diagnosis. A higher prevalence was found among children in small rural areas (18

The influence of community and individual health literacy on self-reported health status.

PubMed

Sentell, Tetine; Zhang, Wei; Davis, James; Baker, Kathleen Kromer; Braun, Kathryn L

2014-02-01

Individual health literacy is an established predictor of individual health outcomes. Community-level health literacy may also impact individual health, yet limited research has simultaneously considered the influence of individual and community health literacy on individual health. The study goal was to determine if community health literacy had an independent relationship with individual self-reported health beyond individual health literacy. We used data from the 2008 and 2010 Hawai'i Health Survey, a representative statewide telephone survey. Multilevel models predicted individual self-reported health by both individual and community health literacy, controlling for relevant individual-level (education, race/ethnicity, gender, poverty, insurance status, age, and marital status) and community-level variables (community poverty and community education). The sample included 11,779 individuals within 37 communities. Individual health literacy was defined by validated self-reported measurement. Communities were defined by zip code combinations. Community health literacy was defined as the percentage of individuals within a community reporting low health literacy. Census data by ZIP Code Tabulation Areas provided community-level variables. In descriptive results, 18.2 % self-reported low health literacy, and 14.7 % reported self-reported poor health. Community-level low health literacy ranged from 5.37 % to 35.99 %. In final, multilevel models, both individual (OR: 2.00; 95 % CI: 1.63-2.44) and community low health literacy (OR: 1.02; 95 % CI: 1.00-1.03) were significantly positively associated with self-reported poor health status. Each percentage increase of average low health literacy within a community was associated with an approximately 2 % increase in poor self-reported health for individuals in that community. Also associated with poorer health were lower educational attainment, older age, poverty, and non-White race. Both individual and community health

[Health vulnerability mapping in the Community of Madrid (Spain)].

PubMed

Ramasco-Gutiérrez, Milagros; Heras-Mosteiro, Julio; Garabato-González, Sonsoles; Aránguez-Ruiz, Emiliano; Aguirre Martín-Gil, Ramón

The Public Health General Directorate of Madrid has developed a health vulnerability mapping methodology to assist regional social health teams in health planning, prioritisation and intervention based on a model of social determinants of health and an equity approach. This process began with the selection of areas with the worst social indicators in health vulnerability. Then, key stakeholders of the region jointly identified priority areas of intervention and developed a consensual plan of action. We present the outcomes of this experience and its connection with theoretical models of asset-based community development, health-integrated georeferencing systems and community health interventions. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

[Community health in primary health care teams: a management objective].

PubMed

Nebot Adell, Carme; Pasarin Rua, Maribel; Canela Soler, Jaume; Sala Alvarez, Clara; Escosa Farga, Alex

2016-12-01

To describe the process of development of community health in a territory where the Primary Health Care board decided to include it in its roadmap as a strategic line. Evaluative research using qualitative techniques, including SWOT analysis on community health. Two-steps study. Primary care teams (PCT) of the Catalan Health Institute in Barcelona city. The 24 PCT belonging to the Muntanya-Dreta Primary Care Service in Barcelona city, with 904 professionals serving 557,430 inhabitants. Application of qualitative methodology using SWOT analysis in two steps (two-step study). Step 1: Setting up a core group consisting of local PCT professionals; collecting the community projects across the territory; SWOT analysis. Step 2: From the needs identified in the previous phase, a plan was developed, including a set of training activities in community health: basic, advanced, and a workshop to exchange experiences from the PCTs. A total of 80 team professionals received specific training in the 4 workshops held, one of them an advanced level. Two workshops were held to exchange experiences with 165 representatives from the local teams, and 22 PCTs presenting their practices. In 2013, 6 out of 24 PCTs have had a community diagnosis performed. Community health has achieved a good level of development in some areas, but this is not the general situation in the health care system. Its progression depends on the management support they have, the local community dynamics, and the scope of the Primary Health Care. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.

Building a community-academic partnership to improve health outcomes in an underserved community.

PubMed

McCann, Eileen

2010-01-01

East Garfield Park, IL, is an impoverished community with 59.7% of residents falling below twice the poverty level and 42.6% of its children in poverty. In 2001, the leading causes of hospitalizations were heart disease (10.3%), diabetes (2%), and asthma (3.9%), all of which occur at frequencies 33% greater than the Chicago average. Finally, a review of the health care facilities in the community suggests that there is a need for accessible primary health care services in the area. The purpose of this project was to improve health outcomes in an impoverished, underserved community with documented health care needs and lack of adequate health care services by creating a community-academic partnership to provide on-site, interdisciplinary, health care services within an established and trusted community-based social service agency, Marillac House. The short-term objectives for this project included creating a community-academic partnership between Marillac House and Colleges of Nursing, Medicine, and Health Sciences; providing comprehensive health care services; and developing an innovative clinical education model for interdisciplinary care across specialties. Long-term objectives included providing preventative services; evidenced-based management of acute and chronic illness; evaluating client's health outcomes; and creating a sustainability plan for the long-term success of the health center.

A Measure of the Potential Impact of Hospital Community Health Activities on Population Health and Equity.

PubMed

Begun, James W; Kahn, Linda M; Cunningham, Brooke A; Malcolm, Jan K; Potthoff, Sandra

2017-12-13

Many hospitals in the United States are exploring greater investment in community health activities that address upstream causes of poor health. Develop and apply a measure to categorize and estimate the potential impact of hospitals' community health activities on population health and equity. We propose a scale of potential impact on population health and equity, based on the cliff analogy developed by Jones and colleagues. The scale is applied to the 317 activities reported in the community health needs assessment implementation plan reports of 23 health care organizations in the Minneapolis-St Paul, Minnesota metropolitan area in 2015. Using a 5-point ordinal scale, we assigned a score of potential impact on population health and equity to each community health activity. A majority (50.2%) of health care organizations' community health activities are classified as addressing social determinants of health (level 4 on the 5-point scale), though very few (5.4%) address structural causes of health equity (level 5 on the 5-point scale). Activities that score highest on potential impact fall into the topic categories of "community health and connectedness" and "healthy lifestyles and wellness." Lower-scoring activities focus on sick or at-risk individuals, such as the topic category of "chronic disease prevention, management, and screening." Health care organizations in the Minneapolis-St Paul metropolitan area vary substantially in the potential impact of their aggregated community health activities. Hospitals can be significant contributors to investment in upstream community health programs. This article provides a scale that can be used not only by hospitals but by other health care and public health organizations to better align their community health strategies, investments, and partnerships with programming and policies that address the foundational causes of population health and equity within the communities they serve.

Perceptions of health, health care and community-oriented health interventions in poor urban communities of Kinshasa, Democratic Republic of Congo.

PubMed

Maketa, Vivi; Vuna, Mimy; Baloji, Sylvain; Lubanza, Symphorien; Hendrickx, David; Inocêncio da Luz, Raquel Andrea; Boelaert, Marleen; Lutumba, Pascal

2013-01-01

In Democratic Republic of Congo access to health care is limited because of many geographical and financial barriers, while quality of care is often low. Global health donors assist the country with a number of community-oriented interventions such as free distribution of bednets, antihelminthic drugs, vitamin A supplementation and vaccination campaigns, but uptake of these interventions is not always optimal. The aim of this study was to explore the perceptions of poor urban communities of the capital Kinshasa with regard to health issues in general as well as their experiences and expectations concerning facility-based health services and community-oriented health interventions. Applying an approach rooted in the grounded theory framework, focus group discussions were conducted in eight neighborhoods of poor urban areas in the city of Kinshasa in July 2011. Study participants were easily able to evoke the city's major health problems, with the notable exceptions of malnutrition and HIV/AIDS. They perceive the high out-of-pocket cost of health services as the major obstacle when seeking access to quality care. Knowledge of ongoing community-oriented health interventions seems good. Still, while the study participants agree that those interventions are beneficial; their acceptability seems to be problematic. This is chiefly put down to a lack of information and government communication about the programs and their interventions. Furthermore, the study participants referred to rumors and the deterring effect of stories about alleged harmful consequences of those interventions. Along with improving the provision and quality of general health care, the government and international actors must improve their efforts in informing the communities about disease control programs, their rationale and benefit/risk ratio. Directly engaging community members in a dialogue might be beneficial in terms of improving acceptability and overall access to health services and

Community health workers and home-based care programs for HIV clients.

PubMed Central

Johnson, Becky A.; Khanna, Sunil K.

2004-01-01

In Nyanza Province, Kenya, estimated HIV prevalence is 22%. Given that more than 80% of the population resides in rural areas, the majority of individuals in Nyanza Province do not have access to medical facilities on a regular basis. In response to the growing demands the HIV epidemic has placed on the people and communities in this region, hundreds of lay individuals have been trained as community health workers to provide home-based care to sick or dying HIV/AIDS clients in rural areas. This paper discusses the role and impact of these community health workers in Nyanza Province, Kenya. It outlines the collaborative relationship between community health workers and the Ministry of Health, examining community health workers' use of extant biomedical structures at the district level to provide services that government-run health facilities lack the monetary resources or personnel to provide. Finally, it explores the role played by community health workers in providing HIV/AIDS education to individuals in an attempt to prevent further infections. PMID:15101670

Implementing Community-based Health Planning and Services in impoverished urban communities: health workers' perspective.

PubMed

Nwameme, Adanna Uloaku; Tabong, Philip Teg-Nefaah; Adongo, Philip Baba

2018-03-20

Three-quarters of sub-Saharan Africa's urban population currently live under slum conditions making them susceptible to ill health and diseases. Ghana characterizes the situation in many developing countries where the urban poor have become a group much afflicted by complex health problems associated with their living conditions, and the intra-city inequity between them and the more privileged urban dwellers with respect to health care accessibility. Adopting Ghana's rural Community-Based Health Planning and Service (CHPS) programme in urban areas is challenging due to the differences in social networks and health challenges thus making modifications necessary. The Community Health Officers (CHOs) and their supervisors are the frontline providers of health in the community and there is a need to analyze and document the health sector response to urban CHPS. The study was solely qualitative and 19 in-depth interviews were conducted with all the CHOs and key health sector individuals in supervisory/coordinating positions working in urban CHPS zones to elicit relevant issues concerning urban CHPS implementation. Thematic content data analysis was done using the NVivo 7 software. Findings from this appraisal suggest that the implementation of this urban concept of the CHPS programme has been well undertaken by the health personnel involved in the process despite the challenges that they face in executing their duties. Several issues came to light including the lack of first aid drugs, as well as the need for the Integrated Management of Neonatal and Childhood Illnesses (IMNCI) programme and more indepth training for CHOs. In addition, the need to provide incentives for the volunteers and Community Health Committee members to sustain their motivation and the CHOs' apprehensions with regards to furthering their education and progression in their careers were key concerns raised. The establishment of the CHPS concept in the urban environment albeit challenging has been

Rural Community as Context and Teacher for Health Professions Education

PubMed Central

Baral, Kedar; Allison, Jill; Upadhyay, Shambu; Bhandary, Shital; Shrestha, Shrijana

2016-01-01

Nepal is a low-income, landlocked country located on the Indian subcontinent between China and India. The challenge of finding human resources for rural community health care settings is not unique to Nepal. In spite of the challenges, the health sector has made significant improvement in national health indices over the past half century. However, in terms of access to and quality of health services and impact, there remains a gross urban-rural disparity. The Patan Academy of Health Sciences (PAHS) has adopted a community-based education model, termed “community based learning and education" (CBLE), as one of the principal strategies and pedagogic methods. This method is linked to the PAHS mission of improving rural health in Nepal by training medical students through real-life experience in rural areas and developing a positive attitude among its graduates towards working in rural areas. This article outlines the PAHS approach of ruralizing the academy, which aligns with the concept of community engagement in health professional education. We describe how PAHS has embedded medical education in rural community settings, encouraging the learning context to be rural, fostering opportunities for community and peripheral health workers to participate in teaching-learning as well as evaluation of medical students, and involving community people in curriculum design and implementation. PMID:27980887

Service functions of private community health stations in China: A comparison analysis with government-sponsored community health stations.

PubMed

Hou, Wanli; Fan, Hong; Xu, Jing; Wang, Fang; Chai, Yun; Xu, Hancheng; Li, Yongbin; Liu, Liqun; Wang, Bin; Jin, Jianqiang; Lu, Zuxun

2012-04-01

In China, with the restructuring of health care system moving forward, private community health facilities have been playing a complementary but increasingly important role in providing public health and basic medical care services in urban areas. However, only limited evidence is available concerning the service functions of private community health facilities in China. The aim of this study was to explore the functions of private community health stations (PCHSs) to provide evidence-based recommendations for policy-making and practice in the development of urban community health services systems. A total of 818 PCHSs and 4320 government-sponsored community health stations (GCHSs) located in 28 cities of China were investigated in 2008. The percentages of stations that provided health services and the annual workload per community health worker (CHW) were compared between the two types of institutions. The results showed that the percentages of PCHSs providing public health services were significantly higher than those of GCHSs (P<0.05); but no significant differences were found in the percentages of basic medical services providing between PCHSs and GCHSs (P>0.05). The annual workloads of all the public health services and basic medical services per CHW in PCHSs were lighter than those in GCHSs (P<0.05), except for resident health records establishment and health education materials distribution (P>0.05). At present, the GCHSs are still the mainstream in urban China, which will last for a long period in future. However, our findings showed that the annual workloads of CHWs in PCHSs were no heavier than those in GCHSs, and the PCHSs were willing to provide public health services. In view of current inadequacy of health resources in China, it is feasible to further develop PCHSs under the guidance of the government, given that PCHSs can perform the basic functions of community health services, which is useful for the formation of public-private partnerships (PPP

Workforce insights on how health promotion is practised in an Aboriginal Community Controlled Health Service.

PubMed

McFarlane, Kathryn; Devine, Sue; Judd, Jenni; Nichols, Nina; Watt, Kerrianne

2017-07-01

Aboriginal Community Controlled Health Services deliver holistic and culturally appropriate primary health care to over 150 communities in Australia. Health promotion is a core function of comprehensive primary health care; however, little has been published on what enables or challenges health promotion practice in an Aboriginal Community Controlled Health Service. Apunipima Cape York Health Council (Apunipima) delivers primary health care to 11 remote north Queensland communities. The workforce includes medical, allied health, Aboriginal and Torres Strait Islander health workers and health practitioners and corporate support staff. This study aimed to identify current health promotion practices at Apunipima, and the enablers and challenges identified by the workforce, which support or hinder health promotion practice. Sixty-three staff from across this workforce completed an online survey in February 2015 (42% response rate). Key findings were: (1) health promotion is delivered across a continuum of one-on-one approaches through to population advocacy and policy change efforts; (2) the attitude towards health promotion was very positive; and (3) health promotion capacity can be enhanced at both individual and organisational levels. Workforce insights have identified areas for continued support and areas that, now identified, can be targeted to strengthen the health promotion capacity of Apunipima.

The Ife South Breastfeeding Project: training community health extension workers to promote and manage breastfeeding in rural communities.

PubMed

Davies-Adetugbo, A A; Adebawa, H A

1997-01-01

Reported are the results of a project to promote exclusive breastfeeding in rural communities through the training of community health extension workers in rural Nigeria. A workshop for the trainers was organized for health workers in the study area; subsequently, these trainers ran district-level training workshops. In the study area perinatal facilities, early initiation of breastfeeding has increased compared with those in the control area (P < 0.001). Also, the trained health workers had significantly better knowledge about breastfeeding than their untrained colleagues in both the study (P < 0.001) and control areas (P < 0.001), and more often recommended timely initiation and exclusive breastfeeding than the controls (P < 0.001). A multivariate analysis showed that the training programme and the study area were the only significant variables that were predictors of breastfeeding knowledge (P < 0.001). Appropriate education of health extension workers can therefore contribute significantly to the promotion of breastfeeding in rural communities.

Community Health

EPA Pesticide Factsheets

The Environmental Health Resources for Community Members site provides tools and information to help local leaders and members of the community protect public health by understanding and addressing environmental conditions.

An experiment with community health funds in Afghanistan.

PubMed

Rao, Krishna D; Waters, Hugh; Steinhardt, Laura; Alam, Sahibullah; Hansen, Peter; Naeem, Ahmad Jan

2009-07-01

As Afghanistan rebuilds its health system, it faces key challenges in financing health services. To reduce dependence on donor funds, it is important to develop sustainable local financing mechanisms. A second challenge is to reduce high levels of out-of-pocket payments. Community-based health insurance (CBHI) schemes offer the possibility of raising revenues from communities and at the same time providing financial protection. This paper describes the performance of one type of CBHI scheme, the Community Health Fund (CHF), which was piloted for the first time in five provinces of Afghanistan between June 2005 and October 2006. The performance of the CHF programme demonstrates that complex community-based health financing schemes can be implemented in post-conflict settings like Afghanistan, except in areas of high insecurity. The funds raised from the community, via premiums and user fees, enabled the pilot facilities to overcome temporary shortages of drugs and supplies, and to conduct outreach services via mobile clinics. However, enrolment and cost-recovery were modest. The median enrolment rate for premium-paying households was 6% of eligible households in the catchment areas of the clinics. Cost recovery rates ranged up to 16% of total operating costs and 32% of non-salary operating costs. No evidence of reduced out-of-pocket health expenditures was observed at the community level, though CHF members had markedly higher utilization of health services. The main reasons among non-members for not enrolling were being unaware of the programme; high premiums; and perceived low quality of services at the CHF clinics. The performance of Afghanistan's CHF was similar to other CHF-type programmes operating at the primary care level internationally. The solution to building local capacity to finance health services lies in a combination of financing sources rather than any single mechanism. In this context, it is critical that international assistance for Afghanistan

Community-based health and schools of nursing: supporting health promotion and research.

PubMed

Shannon, Crystal

2014-01-01

This article examines the role of community-based schools of nursing in the promotion of public health and research in poverty-stricken areas. This was a three-phase study (questionnaire and key-informants' interviews) that surveyed representatives of prelicensure associate and baccalaureate nursing schools (n=17), nursing-school key informants (n=6) and community leaders (n=10). A 13-question web-based survey and semi-structured interview of key informants elicited data on demographics, nursing program design, exposure of faculty and students to various research and health promotion methods, and beliefs about student involvement. Nursing schools participated minimally in community-based health promotion (CBHP) and community-based participatory research saw reduced need for student involvement in such activities, cited multiple barriers to active community collaboration, and reported restricted community partnerships. CBHP was recognized to be a valuable element of health care and student education, but is obstructed by many barriers. This study suggests that nursing schools are not taking full advantage of relationships with community leaders. Recommendations for action are given. © 2013 Wiley Periodicals, Inc.

The contribution of community health workers to the control of Buruli ulcer in the Ngoantet area, Cameroon.

PubMed

Vouking, Marius Zambou; Takougang, Innocent; Mbam, Léonard Mbam; Mbuagbaw, Lawrence; Tadenfok, Carine Nouboudem; Tamo, Claire Violette

2013-01-01

Buruli ulcer (BU) is a skin disease caused by Mycobacterium ulcerans. It is the third most common mycobacterial infection after tuberculosis and leprosy. Community Health Workers (CHWs) hold the potential to support patients and their families at the community level. We conducted a cross-sectional descriptive study to assess the participation of CHWs in the early diagnosis and treatment of BU in Ngoantet, Cameroon. The CHWs performance was measured using: the number of cases referred to the Ngoantet Health Centre, the percentage of accomplished referrals, the percentage of cases referred by CHWs confirmed by the staff of Ngoantet Health Centre. Data was analyzed using Epi-info version 3.4.1. and Microsoft Office Excel 2003. The study focused on 51 CHWs in the Ngoantet health area. The referral rate was 95.0%. Most of the suspicious cases (91.5%) referred were confirmed by health workers. Most CHWs (78.4%) declared that they had identified at least one presumptive case of BU infection. We conclude that the CHWs can play a key role in scaling up BU control activities using a referral system. This study confirms the role of home visits and inspections in the early detection and treatment of BU.

Community beliefs about causes and risks for mental disorders: a mental health literacy survey in a rural area of Maharashtra, India.

PubMed

Kermode, Michelle; Bowen, Kathryn; Arole, Shoba; Joag, Kaustubh; Jorm, Anthony F

2010-11-01

Explanations for mental disorders in India can be influenced by biomedicine, systems of traditional medicine and supernatural beliefs. Community beliefs about causes of mental distress influence help-seeking behaviours. This study aimed to assess local knowledge and understanding of causes and risks for mental disorders in a rural area of Maharashtra, and to assess the prevalence of possible common mental disorders. A cross-sectional mental health literacy survey was undertaken in late 2007. A questionnaire was administered to 240 systematically sampled community members and 60 village health workers (VHWs). Participants were presented with two vignettes describing people experiencing symptoms of mental disorders (depression, psychosis); they were asked about the causes of the problems and the vulnerabilities of community sub-groups. Additionally, the General Health Questionnaire (GHQ12) was administered to assess prevalence of possible common mental disorders. The most commonly acknowledged causes of the problems were a range of socioeconomic factors. Supernatural and biological explanations were not widely endorsed. Women, the unemployed and the poor were judged as more likely to develop mental disorders, while both young and older people were perceived to be less vulnerable. Results of the GHQ12 indicated that 27% had a possible common mental disorder and that the elderly were at increased risk, contrary to community perceptions. Enhancing mental health literacy of both VHWs and community members using approaches that are sensitive to local conceptualizations of mental health and illness will contribute to improved treatment and care for people with mental disorders. Further investigation of mental health among the elderly in this community is indicated.

Health and health-related indicators in slum, rural, and urban communities: a comparative analysis.

PubMed

Mberu, Blessing U; Haregu, Tilahun Nigatu; Kyobutungi, Catherine; Ezeh, Alex C

2016-01-01

It is generally assumed that urban slum residents have worse health status when compared with other urban populations, but better health status than their rural counterparts. This belief/assumption is often because of their physical proximity and assumed better access to health care services in urban areas. However, a few recent studies have cast doubt on this belief. Whether slum dwellers are better off, similar to, or worse off as compared with rural and other urban populations remain poorly understood as indicators for slum dwellers are generally hidden in urban averages. The aim of this study was to compare health and health-related indicators among slum, rural, and other urban populations in four countries where specific efforts have been made to generate health indicators specific to slum populations. We conducted a comparative analysis of health indicators among slums, non-slums, and all urban and rural populations as well as national averages in Bangladesh, Kenya, Egypt, and India. We triangulated data from demographic and health surveys, urban health surveys, and special cross-sectional slum surveys in these countries to assess differences in health indicators across the residential domains. We focused the comparisons on child health, maternal health, reproductive health, access to health services, and HIV/AIDS indicators. Within each country, we compared indicators for slums with non-slum, city/urban averages, rural, and national indicators. Between-country differences were also highlighted. In all the countries, except India, slum children had much poorer health outcomes than children in all other residential domains, including those in rural areas. Childhood illnesses and malnutrition were higher among children living in slum communities compared to those living elsewhere. Although treatment seeking was better among slum children as compared with those in rural areas, this did not translate to better mortality outcomes. They bear a disproportionately

Geography of community health information organization activity in the United States: Implications for the effectiveness of health information exchange.

PubMed

Vest, Joshua R

The United States has invested nearly a billion dollars in creating community health information organizations (HIOs) to foster health information exchange. Community HIOs provide exchange services to health care organizations within a distinct geographic area. While geography is a key organizing principle for community HIOs, it is unclear if geography is an effective method for organization or what challenges are created by a geography-based approach to health information exchange. This study describes the extent of reported community HIO coverage in the United States and explores the practical and policy implications of overlaps and gaps in HIO service areas. Furthermore, because self-reported service areas may not accurately reflect the true extent of HIOs activities, this study maps the actual markets for health services included in each HIO. An inventory of operational community HIOs that included self-reported geographic markets and participating organizations was face-validated using a crowd-sourcing approach. Aggregation of the participating hospitals' individual health care markets provided the total geographic market served by each community HIO. Mapping and overlay analyses using geographic information system methods described the extent of community HIO activity in the United States. Evidence suggests that community HIOs may be inefficiently distributed. Parts of the United States have multiple, overlapping HIOs, while others do not have any providing health information exchange services. In markets served by multiple community HIOs, 45% of hospitals were participants of only one HIO. The current geography of community HIO activity does not provide comprehensive patient information to providers, nor community-wide information for public health agencies. The discord between the self-reported and market geography of community HIOs raises concerns about the potential effectiveness of health information exchange, illustrates the limitations of geography as

The effect of a community mental health training program for multidisciplinary staff.

PubMed

Yang, Bing Xiang; Stone, Teresa E; Davis, Scott A

2018-06-01

Primary health workers play a critical role in providing health education to people with mental disorders. In China community health workers working with people with mental health problems lack experience and training in this area. Additionally, coordination between hospital and community staff is not well established. The aim of this study was to provide an interdisciplinary community mental health training program and to evaluate the effect of the training on staff knowledge about mental health and confidence in their roles. A three-day community mental health training program was offered specifically for interdisciplinary mental health professionals. Using a one-group pre-test post-test design, participants completed a self-assessment of mental health concepts and program evaluation which included asking participants to rate their satisfaction using a five-point Likert scale and to respond to open-ended questions. Forty-eight participants including health professionals from colleges, hospital and community health centers were recruited. Only 8.7% of participants had ever received community mental health training. Post-test evaluation demonstrated improvements in knowledge, and most participants were very satisfied with the program. The findings indicate that this brief interdisciplinary training program had a positive effect in improving knowledge about community mental health concepts and confidence in dealing with people with mental health disorders for multidisciplinary staff working in primary health care areas. Copyright © 2017 Elsevier Inc. All rights reserved.

Creating Meaningful Partnerships Between Communities and Environmental Health Researchers

PubMed Central

De Souza, Rachael; Aguilar, Genevieve C.; de Castro, A. B.

2014-01-01

Community engagement is a necessary, although challenging, element of environmental health research in communities. To facilitate the engagement process, direct action community organizing agencies can be useful in bringing together communities and researchers. This article describes the preliminary activities that one direct action community organizing agency used in partnership with researchers to improve community engagement in the first 6 months of an environmental health study conducted in a major U.S. city. Activities included developing communication strategies, creating opportunities for researcher–community interaction, and sustaining project momentum. To conduct environmental research that is both scientifically rigorous and relevant to communities, collaborating partners had to develop professional skills and strategies outside of their areas of expertise. PMID:23875568

Differences in Health Care, Family, and Community Factors Associated with Mental, Behavioral, and Developmental Disorders Among Children Aged 2–8 Years in Rural and Urban Areas — United States, 2011–2012

PubMed Central

Holbrook, Joseph R.; Bitsko, Rebecca H.; Hartwig, Sophie A.; Kaminski, Jennifer W.; Ghandour, Reem M.; Peacock, Georgina; Heggs, Akilah; Boyle, Coleen A.

2017-01-01

Problem/Condition Mental, behavioral, and developmental disorders (MBDDs) begin in early childhood and often affect lifelong health and well-being. Persons who live in rural areas report more health-related disparities than those in urban areas, including poorer health, more health risk behaviors, and less access to health resources. Reporting Period 2011–2012. Description of System The National Survey of Children’s Health (NSCH) is a cross-sectional, random-digit–dial telephone survey of parents or guardians that collects information on noninstitutionalized children aged <18 years in the United States. Interviews included indicators of health and well-being, health care access, and family and community characteristics. Using data from the 2011–2012 NSCH, this report examines variations in health care, family, and community factors among children aged 2–8 years with and without MBDDs in rural and urban settings. Restricting the data to U.S. children aged 2–8 years with valid responses for child age and sex, each MBDD, and zip code resulted in an analytic sample of 34,535 children; MBDD diagnosis was determined by parent report and was not validated with health care providers or medical records. Results A higher percentage of all children in small rural and large rural areas compared with all children in urban areas had parents who reported experiencing financial difficulties (i.e., difficulties meeting basic needs such as food and housing). Children in all rural areas more often lacked amenities and lived in a neighborhood in poor condition. However, a lower percentage of children in small rural and isolated areas had parents who reported living in an unsafe neighborhood, and children in isolated areas less often lived in a neighborhood lacking social support, less often lacked a medical home, and less often had a parent with fair or poor mental health. Across rural subtypes, approximately one in six young children had a parent-reported MBDD diagnosis

Health and health-related indicators in slum, rural, and urban communities: a comparative analysis

PubMed Central

Mberu, Blessing U.; Haregu, Tilahun Nigatu; Kyobutungi, Catherine; Ezeh, Alex C.

2016-01-01

Background It is generally assumed that urban slum residents have worse health status when compared with other urban populations, but better health status than their rural counterparts. This belief/assumption is often because of their physical proximity and assumed better access to health care services in urban areas. However, a few recent studies have cast doubt on this belief. Whether slum dwellers are better off, similar to, or worse off as compared with rural and other urban populations remain poorly understood as indicators for slum dwellers are generally hidden in urban averages. Objective The aim of this study was to compare health and health-related indicators among slum, rural, and other urban populations in four countries where specific efforts have been made to generate health indicators specific to slum populations. Design We conducted a comparative analysis of health indicators among slums, non-slums, and all urban and rural populations as well as national averages in Bangladesh, Kenya, Egypt, and India. We triangulated data from demographic and health surveys, urban health surveys, and special cross-sectional slum surveys in these countries to assess differences in health indicators across the residential domains. We focused the comparisons on child health, maternal health, reproductive health, access to health services, and HIV/AIDS indicators. Within each country, we compared indicators for slums with non-slum, city/urban averages, rural, and national indicators. Between-country differences were also highlighted. Results In all the countries, except India, slum children had much poorer health outcomes than children in all other residential domains, including those in rural areas. Childhood illnesses and malnutrition were higher among children living in slum communities compared to those living elsewhere. Although treatment seeking was better among slum children as compared with those in rural areas, this did not translate to better mortality

Health knowledge and health practices in Makeni, Sierra Leone: a community-based household survey.

PubMed

Abdelmalak, Mena J; Ahmed, Bilaal S; Mehta, Khanjan

2016-05-01

We characterize health knowledge and practices in urban and rural Makeni, Sierra Leone, drawing comparisons between areas served by community health workers (CHWs) with those that are not. We also inquire about causes of infant and maternal mortality and how they are understood in the local context. Our objective was to provide a baseline understanding of health knowledge and practices in Makeni during the implementation of a CHW program. We conducted 100 household interviews in Makeni City and rural villages in the surrounding area. We compared data between urban and rural areas to identify differences in health knowledge and practices. Our sample size covered 855 individuals. Insecticide treated bednet ownership was lower in urban settings compared to rural populations (58% vs 94%; p<.001). With regards to maternal mortality, most respondents indicated 'no clinic' (lack of clinical care or skipped antenatal care visits) as the primary cause (n=35), followed by bleeding (n=17), 'lack of blood' (anemia) (n=11) and 'will of God' (n=11). This initial survey of health knowledge and practices in rural and urban Makeni, Sierra Leone, highlights some simple opportunities for community health promotion, health education programming and behavioral interventions. Findings will inform future iterations of a CHW training module for community health education. © The Author 2015. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

RACIAL AND ETHNIC APPROACHES TO COMMUNITY HEALTH (REACH)

EPA Science Inventory

Racial and Ethnic Approaches to Community Health (REACH) 2010 is the cornerstone of CDC's efforts to eliminate racial and ethnic disparities in health. Launched in 1999, REACH 2010 is designed to eliminate disparities in the following six priority areas: cardiovascular disease, i...

Community participation for transformative action on women's, children's and adolescents' health.

PubMed

Marston, Cicely; Hinton, Rachael; Kean, Stuart; Baral, Sushil; Ahuja, Arti; Costello, Anthony; Portela, Anayda

2016-05-01

The Global strategy for women's, children's and adolescents' health (2016-2030) recognizes that people have a central role in improving their own health. We propose that community participation, particularly communities working together with health services (co-production in health care), will be central for achieving the objectives of the global strategy. Community participation specifically addresses the third of the key objectives: to transform societies so that women, children and adolescents can realize their rights to the highest attainable standards of health and well-being. In this paper, we examine what this implies in practice. We discuss three interdependent areas for action towards greater participation of the public in health: improving capabilities for individual and group participation; developing and sustaining people-centred health services; and social accountability. We outline challenges for implementation, and provide policy-makers, programme managers and practitioners with illustrative examples of the types of participatory approaches needed in each area to help achieve the health and development goals.

Financing geriatric programs in community health centers.

PubMed Central

Yeatts, D E; Ray, S; List, N; Duggar, B

1991-01-01

There are approximately 600 Community and Migrant Health Centers (C/MHCs) providing preventive and primary health care services principally to medically underserved rural and urban areas across the United States. The need to develop geriatric programs within C/MHCs is clear. Less clear is how and under what circumstances a comprehensive geriatric program can be adequately financed. The Health Resources and Services Administration of the Public Health Service contracted with La Jolla Management Corporation and Duke University Center on Aging to identify successful techniques for obtaining funding by examining 10 "good practice" C/MHC geriatric programs. The results from this study indicated that effective techniques included using a variety of funding sources, maintaining accurate cost-per-user information, developing a marketing strategy and user incentives, collaborating with the area agency on aging and other community organizations, and developing special services for the elderly. Developing cost-per-user information allowed for identifying appropriate "drawing card" services, negotiating sound reimbursement rates and contracts with other providers, and assessing the financial impact of changing service mixes. A marketing strategy was used to enhance the ability of the centers to provide a comprehensive package of services. Collaboration with the area agency on aging and other community organizations and volunteers in the aging network was found to help establish referral networks and subsequently increase the number of elderly patients served. Finally, development of special services for the elderly, such as adult day care, case management, and health education, was found to increase program visibility, opportunities to work with the network of services for the aging, and clinical utilization. PMID:1908588

Impact of m-health application used by community health volunteers on improving utilisation of maternal, new-born and child health care services in a rural area of Uttar Pradesh, India.

PubMed

Prinja, Shankar; Nimesh, Ruby; Gupta, Aditi; Bahuguna, Pankaj; Gupta, Madhu; Thakur, Jarnail Singh

2017-07-01

To raise the quality of counselling by community health volunteers resulting in improved uptake of maternal, neonatal and child health services (MNCH), an m-health application was introduced under a project named 'Reducing Maternal and Newborn Deaths (ReMiND)' in district Kaushambi in India. We report the impact of this project on coverage of key MNCH services. A pre- and post-quasi-experimental design was undertaken to assess the impact of intervention. This project was introduced in two community development blocks in Kaushambi district in 2012. Two other blocks from the same district were selected as controls after matching for coverage of two indicators at baseline - antenatal care and institutional deliveries. The Annual Health Survey conducted by the Ministry of Health and Family Welfare in 2011 served as pre-intervention data, whereas a household survey in four blocks of Kaushambi district in 2015 provided post-intervention coverage of key services. Propensity score matched samples from intervention and control areas in pre-intervention and post-intervention periods were analysed using difference-in-difference method to estimate the impact of ReMiND project. We found a statistically significant increase in coverage of iron-folic acid supplementation (12.58%), self-reporting of complication during pregnancy (13.11%) and after delivery (19.6%) in the intervention area. The coverage of three or more antenatal care visits, tetanus toxoid vaccination, full antenatal care and ambulance usage increased in intervention area by 10.3%, 4.28%, 1.1% and 2.06%, respectively; however, the changes were statistically insignificant. Three of eight services which were targeted for improvement under ReMiND project registered a significant improvement as result of m-health intervention. © 2017 John Wiley & Sons Ltd.

DEFINING THE "COMMUNITY" FOR A COMMUNITY-BASED PUBLIC HEALTH INTERVENTION ADDRESSING LATINO IMMIGRANT HEALTH DISPARITIES: AN APPLICATION OF ETHNOGRAPHIC METHODS.

PubMed

Edberg, Mark; Cleary, Sean; Simmons, Lauren B; Cubilla-Batista, Idalina; Andrade, Elizabeth L; Gudger, Glencora

2015-01-01

Although Latino and other immigrant populations are the driving force behind population increases in the U.S., there are significant gaps in knowledge and practice on addressing health disparities in these populations. The Avance Center for the Advancement of Immigrant/Refugee Health, a health disparities research center in the Washington, DC area, includes as part of its mission a multi-level, participatory community intervention (called Adelante) to address the co-occurrence of substance abuse, violence and sex risk among Latino immigrant youth and young adults. Research staff and community partners knew that the intervention community had grown beyond its Census-designated place (CDP) boundaries, and that connection and attachment to community were relevant to an intervention. Thus, in order to understand current geographic and social boundaries of the community for sampling, data collection, intervention design and implementation, the research team conducted an ethnographic study to identify self-defined community boundaries, both geographic and social. Beginning with preliminary data from a pilot intervention and the original CDP map, the research included: geo-mapping de-identified addresses of service clients from a major community organization; key informant interviews; and observation and intercept interviews in the community. The results provided an expanded community boundary profile and important information about community identity.

Community participation in health service reform: the development of an innovative remote Aboriginal primary health-care service.

PubMed

Reeve, Carole; Humphreys, John; Wakerman, John; Carroll, Vicki; Carter, Maureen; O'Brien, Tim; Erlank, Carol; Mansour, Rafik; Smith, Bec

2015-01-01

The aim of this study was to describe the reorientation of a remote primary health-care service, in the Kimberley region of Australia, its impact on access to services and the factors instrumental in bringing about change. A unique community-initiated health service partnership was developed between a community-controlled Aboriginal health organisation, a government hospital and a population health unit, in order to overcome the challenges of delivering primary health care to a dispersed, highly disadvantaged Aboriginal population in a very remote area. The shared goals and clear delineation of responsibilities achieved through the partnership reoriented an essentially acute hospital-based service to a prevention-focussed comprehensive primary health-care service, with a focus on systematic screening for chronic disease, interdisciplinary follow up, health promotion, community advocacy and primary prevention. This formal partnership enabled the primary health-care service to meet the major challenges of providing a sustainable, prevention-focussed service in a very remote and socially disadvantaged area.

Australian rural, remote and urban community nurses' health promotion role and function.

PubMed

Roden, Janet; Jarvis, Lynda; Campbell-Crofts, Sandra; Whitehead, Dean

2016-09-01

Community nurses have often been 'touted' as potential major contributors to health promotion. Critical literature, however, often states that this has not been the case. Furthermore, most studies examining nurses' role and function have occurred mainly in hospital settings. This is a sequential mixed-methods study of two groups of community nurses from a Sydney urban area (n = 100) and from rural and remote areas (n = 49) within New South Wales, Australia. A piloted questionnaire survey was developed based on the five action areas of the Ottawa Charter for Health Promotion. Following this, 10 qualitative interviews were conducted for both groups, plus a focus group to support or refute survey results. Findings showed that rural and remote nurses had more positive attitudes towards health promotion and its clinical implementation. Survey and interview data confirmed that urban community nurses had a narrower focus on caring for individuals rather than groups, agreeing that time constraints impacted on their limited health promotion role. There was agreement about lack of resources (material and people) to update health promotion knowledge and skills. Rural and remote nurses were more likely to have limited educational opportunities. All nurses undertook more development of personal skills (DPS, health education) than any other action area. The findings highlight the need for more education and resources for community nurses to assist their understanding of health promotion concepts. It is hoped that community nurse leaders will collectively become more effective health promoters and contribute to healthy reform in primary health care sectors. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Project TEACH: A Capacity-Building Training Program for Community-Based Organizations and Public Health Agencies.

PubMed

Sauaia, Angela; Tuitt, Nicole R; Kaufman, Carol E; Hunt, Cerise; Ledezma-Amorosi, Mariana; Byers, Tim

2016-01-01

Project TEACH (Teaching Equity to Advance Community Health) is a capacity-building training program to empower community-based organizations and regional public health agencies to develop data-driven, evidence-based, outcomes-focused public health interventions. TEACH delivers training modules on topics such as logic models, health data, social determinants of health, evidence-based interventions, and program evaluation. Cohorts of 7 to 12 community-based organizations and regional public health agencies in each of the 6 Colorado Area Health Education Centers service areas participate in a 2-day training program tailored to their specific needs. From July 2008 to December 2011, TEACH trained 94 organizations and agencies across Colorado. Training modules were well received and resulted in significant improvement in knowledge in core content areas, as well as accomplishment of self-proposed organizational goals, grant applications/awards, and several community-academic partnerships.

Community beliefs about treatments and outcomes of mental disorders: a mental health literacy survey in a rural area of Maharashtra, India.

PubMed

Kermode, M; Bowen, K; Arole, S; Joag, K; Jorm, A F

2009-07-01

Mental health remains a neglected issue in most developing countries, especially in rural areas where access to effective mental health services is limited. The integration of mental health into primary health care is being promoted as a strategy to address this problem. Consequently, there is an urgent need to enhance mental health awareness among communities, and to provide mental health training for primary healthcare staff. In order to do this effectively, it is important to understand and take account of local views on mental health and illness. As such, a mental health literacy (MHL) assessment was undertaken in a poor, rural area of Maharashtra, India to inform the development of a mental health training programme. A cross-sectional MHL survey was undertaken in late 2007. Data were collected from 240 systematically sampled community members and 60 purposively sampled village health workers (VHWs) using an interviewer-administered questionnaire. Participants were presented with two vignettes describing people experiencing symptoms of mental disorders (depression, psychosis), and were asked to name the problems, and to identify the treatments and people that were most likely to be helpful (or otherwise), and the likely outcomes for people with such problems. Most participants recognized that the people in the vignettes were experiencing a mental health problem. 'Depression' was the most common label for the problems experienced in the depression vignette, and 'a mind/brain problem' was the most common label in the case of the psychosis vignette. Socio-economic interventions provided by family, friends and neighbours were considered to be most helpful. Local VHWs and doctors were also viewed as potentially helpful, but psychiatrists less so. Approximately half of the sample thought that dealing with the problem alone would be helpful. Special diets, tonics, appetite stimulants and sleeping pills were also strongly endorsed, but awareness of psychiatric

Community Determinants of Latinos’ Use of Mental Health Services

PubMed Central

Aguilera, Adrian; Regeser López, Steven

2014-01-01

Objective This study examined the role of community in understanding Latino adults’ (18–64 years of age) use of community mental health services. Methods Service utilization data from the Los Angeles County Department of Mental Health were analyzed from 2003 in two service provider areas. Demographic data, including foreign-born status, language, education, and income for the Latino population, were obtained from the 2000 U.S. Census. The study sample consisted of 4,133 consumers of mental health services in 413 census tracts from an established immigrant community and 4,156 consumers of mental health services in 204 census tracts from a recent immigrant community. Negative binomial regression analyses were conducted to examine associations between locales, community characteristics, and use of services. Results Community of residence and foreign-born status were significantly associated with Latinos’ service use. Latinos from the established immigrant community were more likely to use services than Latinos from the recent immigrant community. Across both communities, census tracts with a higher percentage of foreign-born noncitizen residents showed lower service use. Within the established immigrant community, as income levels increased there was little change in utilization. In contrast, in the recent immigrant community, as income levels increased utilization rates increased as well (β=.001, p<.001). Conclusions The findings point out the importance of locale and community determinants in understanding Latinos’ use of public mental health services. PMID:18378840

Adolescent health-risk behavior and community disorder.

PubMed

Wiehe, Sarah E; Kwan, Mei-Po; Wilson, Jeff; Fortenberry, J Dennis

2013-01-01

Various forms of community disorder are associated with health outcomes but little is known about how dynamic context where an adolescent spends time relates to her health-related behaviors. Assess whether exposure to contexts associated with crime (as a marker of community disorder) correlates with self-reported health-related behaviors among adolescent girls. Girls (N = 52), aged 14-17, were recruited from a single geographic urban area and monitored for 1 week using a GPS-enabled cell phone. Adolescents completed an audio computer-assisted self-administered interview survey on substance use (cigarette, alcohol, or marijuana use) and sexual intercourse in the last 30 days. In addition to recorded home and school address, phones transmitted location data every 5 minutes (path points). Using ArcGIS, we defined community disorder as aggregated point-level Unified Crime Report data within a 200-meter Euclidian buffer from home, school and each path point. Using Stata, we analyzed how exposures to areas of higher crime prevalence differed among girls who reported each behavior or not. Participants lived and spent time in areas with variable crime prevalence within 200 meters of their home, school and path points. Significant differences in exposure occurred based on home location among girls who reported any substance use or not (p 0.04) and sexual intercourse or not (p 0.01). Differences in exposure by school and path points were only significant among girls reporting any substance use or not (p 0.03 and 0.02, respectively). Exposure also varied by school/non-school day as well as time of day. Adolescent travel patterns are not random. Furthermore, the crime context where an adolescent spends time relates to her health-related behavior. These data may guide policy relating to crime control and inform time- and space-specific interventions to improve adolescent health.

Community Health Warriors: Marshallese Community Health Workers' Perceptions and Experiences with CBPR and Community Engagement.

PubMed

Purvis, Rachel S; Bing, Williamina Ioanna; Jacob, Christopher J; Lang, Sharlynn; Mamis, Sammie; Ritok, Mandy; Rubon-Chutaro, Jellesen; McElfish, Pearl Anna

2017-01-01

Our manuscript highlights the viewpoints and reflections of the native Marshallese community health workers (CHWs) engaged in research with the local Marshallese community in Northwest Arkansas. In particular, this paper documents the vital role Marshallese CHWs play in the success of programs and research efforts. The negative health effects of nuclear testing in the Marshall Islands has been passed down through many generations, along with unfavorable attitudes toward the U.S. government and researchers. However, the community-based participatory research (CBPR) approach used by the University of Arkansas for Medical Sciences (UAMS) has allowed the native Marshallese CHWs to become advocates for the Marshallese community. The use of native CHWs has also leveled the power dynamics that can be a barrier to community-based research, and has strengthened trust with community stakeholders. Our paper shows how using Marshallese CHWs can produce positive health outcomes for the Marshallese community.

African American community breast health education: a pilot project.

PubMed

Robertson, Ethel M; Franklin, Anett Wakefield; Flores, AnnMarie; Wherry, Shari; Buford, Juanita

2006-01-01

This paper reports the results of a project designed to examine the effectiveness of a Train the Trainer breast health education and screening program for African American, elderly and underserved women residing in the greater Nashville area. The project aimed to identify a cadre of women from the community willing to serve as leaders advocated and peer breast health educators. Data collected from the community leaders and the women from the local community during the course of the project suggest that the Train the Trainer model was well suited to provide education, support and breast cancer resource referral to women residing within this rural Tennessee community.

Promoting Community Health and Eliminating Health Disparities Through Community-Based Participatory Research.

PubMed

Xia, Ruiping; Stone, John R; Hoffman, Julie E; Klappa, Susan G

2016-03-01

In physical therapy, there is increasing focus on the need at the community level to promote health, eliminate disparities in health status, and ameliorate risk factors among underserved minorities. Community-based participatory research (CBPR) is the most promising paradigm for pursuing these goals. Community-based participatory research stresses equitable partnering of the community and investigators in light of local social, structural, and cultural elements. Throughout the research process, the CBPR model emphasizes coalition and team building that joins partners with diverse skills/expertise, knowledge, and sensitivities. This article presents core concepts and principles of CBPR and the rationale for its application in the management of health issues at the community level. Community-based participatory research is now commonly used to address public health issues. A literature review identified limited reports of its use in physical therapy research and services. A published study is used to illustrate features of CBPR for physical therapy. The purpose of this article is to promote an understanding of how physical therapists could use CBPR as a promising way to advance the profession's goals of community health and elimination of health care disparities, and social responsibility. Funding opportunities for the support of CBPR are noted. © 2016 American Physical Therapy Association.

Implementing lung cancer screening: baseline results from a community-based 'Lung Health Check' pilot in deprived areas of Manchester.

PubMed

Crosbie, Phil A; Balata, Haval; Evison, Matthew; Atack, Melanie; Bayliss-Brideaux, Val; Colligan, Denis; Duerden, Rebecca; Eaglesfield, Josephine; Edwards, Timothy; Elton, Peter; Foster, Julie; Greaves, Melanie; Hayler, Graham; Higgins, Coral; Howells, John; Irion, Klaus; Karunaratne, Devinda; Kelly, Jodie; King, Zoe; Manson, Sarah; Mellor, Stuart; Miller, Donna; Myerscough, Amanda; Newton, Tom; O'Leary, Michelle; Pearson, Rachel; Pickford, Julie; Sawyer, Richard; Screaton, Nick J; Sharman, Anna; Simmons, Maggi; Smith, Elaine; Taylor, Ben; Taylor, Sarah; Walsham, Anna; Watts, Angela; Whittaker, James; Yarnell, Laura; Threlfall, Anthony; Barber, Phil V; Tonge, Janet; Booton, Richard

2018-02-13

We report baseline results of a community-based, targeted, low-dose CT (LDCT) lung cancer screening pilot in deprived areas of Manchester. Ever smokers, aged 55-74 years, were invited to 'lung health checks' (LHCs) next to local shopping centres, with immediate access to LDCT for those at high risk (6-year risk ≥1.51%, PLCO M2012 calculator). 75% of attendees (n=1893/2541) were ranked in the lowest deprivation quintile; 56% were high risk and of 1384 individuals screened, 3% (95% CI 2.3% to 4.1%) had lung cancer (80% early stage) of whom 65% had surgical resection. Taking lung cancer screening into communities, with an LHC approach, is effective and engages populations in deprived areas. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Association of Acculturation and Health Literacy with Prevalent Dysglycemia and Diabetes Control Among Latinos in the Boston Area Community Health (BACH) Survey.

PubMed

López, Lenny; Grant, Richard W; Marceau, Lisa; Piccolo, Rebecca; McKinlay, John B; Meigs, James B

2016-12-01

This study assessed the effect of acculturation on type 2 diabetes and whether health literacy may mediate this association. The Boston Area Community Health cohort is a multi-stage stratified random sample of adults from Boston including 744 Latinos. We defined dysglycemia as a HbA1c ≥5.7 %. Multivariable analyses examined the associations between acculturation and health literacy adjusting for demographic and clinical variables. Similar analyses were performed among participants with HbA1c ≥7.0 % to assess the association between acculturation and diabetes control. Among an insured primarily foreign born Spanish speaking Latino population, with a long residence period in the US and good healthcare utilization, higher levels of acculturation were not associated with dysglycemia. Lower levels of acculturation were associated with worse diabetes control. Health literacy level did not modify these associations. Elucidating the components of heterogeneity among Latinos will be essential for understanding the influence of acculturation on diabetes.

Indigenous community based participatory research and health impact assessment: A Canadian example

DOE Office of Scientific and Technical Information (OSTI.GOV)

Kwiatkowski, Roy E., E-mail: roy_kwiatkowski@hc-sc.gc.c

The Environmental Health Research Division (EHRD) of the First Nations and Inuit Health Branch, Health Canada conducts science-based activities and research with Canadian Indigenous communities in areas such as climate change adaptation, environmental contaminants, water quality, biomonitoring, risk assessment, health impact assessment, and food safety and nutrition. EHRD's research activities have been specifically designed to not only inform Health Canada's policy decision-makers but as well, Indigenous community decision-makers. This paper will discuss the reasons why Indigenous community engagement is important, what are some of the barriers preventing community engagement; and the efforts by EHRD to carry out community-based participatory researchmore » activities with Indigenous peoples.« less

Problems and Issues in Rural Community Mental Health: A Review.

ERIC Educational Resources Information Center

Solomon, Gary

After years of neglect, rural community mental health is becoming a legitimate area of specialization. Although the number of problems readily visible in rural mental health may appear to be inordinate, probabilities are that the difficulties found in rural locales are quantitatively no different than those found in non-rural areas. The…

[Community diagnosis using qualitative techniques of expectations and experiences in a health area in need of social transformation].

PubMed

Ramos Ruiz, Juan Andrés; Pérez Milena, Alejandro; Enguix Martínez, Natalia; Alvarez Nieto, Carmen; Martínez Fernández, M Luz

2013-01-01

To know the views, experiences and expectations of care provided by the Andalusian Public Health System (SSPA) of users of an urban area in need of social transformation (ZNTS). Qualitative methodology (exploratory study). Urban basic health zone (16,000 inhabitants, 40% ZNTS). Purposive sampling of users of SSPA and community leaders. Homogeneity criteria: age. Heterogeneity criteria: sex, frequency, active/pensioner, level cultural/economic. Conversational techniques recorded by videotape and moderated by a sociologist (user dicussion groups and in-depth interviews for community leaders). transcription of speeches, coding, categories triangulation and final outcome. Seven groups (43 participants, 58% ZNTS) and 6 leaders. They want continuity of care and choice of professionals, but not the medical change without information and attention's discontinuity primary care/hospital. There's bad physical accesibility by the urban environment in the ZNTS and is criticized admission services and paperwork; the programmed appointment and the electronic prescriptions are improvements but asking more hospital referrals and reviews. There's good appreciation of the professionals (primary care-closer, hospital-greater technical capacity). It needs to improve nursing education and speed of emergency assistance. There's a lack of leadership in the system organization, very fragmented. They know a range of services focusing on the demand for care; other health activities not spread to the users. The SSPA should incorporate the views and expectations of communities in social risk to a real improvement in the quality of care. Copyright © 2012 Elsevier España, S.L. All rights reserved.

Community Response to a Public Health Threat-VEE

ERIC Educational Resources Information Center

McDonald, John L.; Vuturo, Anthony F.

1975-01-01

After identifying the mosquito as the Venezuelan equine encephalitis vector, health officials worked with the community to eliminate mosquito breeding sites. By educating the public first, cooperation was received in opening drainage areas and stocking water collection areas with mosquito eating fish to interrupt the host-vector-recipient cycle.…

Assessing Community Leadership: Understanding Community Capacity for Health Improvement.

PubMed

Castle, Billie; Wendel, Monica; Kelly Pryor, Brandy N; Ingram, Monique

The purpose of this study was to pilot a quantitative instrument to measure aspects of community leadership within an assessment framework. The instrument includes 14 Likert-type questions asking residents how they perceive leaders within 5 sectors: Louisville Metro Council/Mayor's Office, the faith community, education, business, and the civic sector. Louisville/Jefferson County, Kentucky, has a population of about 743 000 residents. Respondents were asked to examine leadership within West Louisville, an economically deprived area of the city made up of 9 contiguous neighborhoods. This area is predominantly African American (78% compared with 22% in Louisville Metro), with an overall poverty rate of 43% (compared with 18% in Louisville Metro), and unemployment rate of 23% (compared with 8% in Louisville Metro). Residents of West Louisville are looking to leadership to address many of the inequities. Twenty-seven participants representing 7 community sectors completed the survey, of whom 90% work in West Louisville. The instrument measured local perceptions of leadership strength, effectiveness, trust, communication, community building, and leadership development. The majority of respondents agree that strong leadership exists across the 5 sectors, with variation regarding perceptions of the quality of that leadership. City leadership within the Mayor's Office and Metro Council is largely viewed positively, while the growing tensions within the education sector were reflected in the survey results. The perception of community leadership is important to understanding local community capacity to improve health and also inclusivity of community voice in the assessment and community improvement processes. Results from such assessments can offer useful information for strengthening community capacity and sustaining relationships needed to enact progressive and equitable solutions to address local issues. Leaders in a variety of settings can utilize this instrument to

Fifteen years of community organization for health in Panama: an assessment of current progress and problems.

PubMed

La Forgia, G M

1985-01-01

Since the late 1970s the WHO and other international agencies have placed much emphasis on strategies of community organization in order to improve preventive health services and facilities in rural areas. Many countries have recently set out to reform their rural health systems by means of a community-based approach. Panama's 15 years of experience in 'community health' provide insight into the constraints to program continuity at the national level and to maintenance of participatory mechanisms (health committees) at the village level. This paper focuses on the present status of the Community Health Program and level of activity of the health committees. This study is based on in-depth interviewing of key program participants at three contexts: central ministry, district/regional health institutions and rural communities. It sought to discover how interactions among and within these contexts affected program services and community participation. Inconsistent outcomes are evident. In some areas the Community Health Program thrives and the health committees are active, while in most areas the program functions at a minimal level and most health committees are inactive. Several factors are identified which affect a 'successful' or 'unsuccessful' program environment. These include: degree of support from medical directors of district and regional health centers, existence of 'federations of health committees', the extent of political interference, the presence of a functional 'technical health team' and degree of community confidence in health committee officers.

Mano a Mano: Improving health in impoverished Bolivian communities through community-based participatory research.

PubMed

Velasquez, Joan; Knatterud-Hubinger, Nate; Narr, Dan; Mendenhall, Tai; Solheim, Catherine

2011-12-01

Mano a Mano (Spanish translation: "Hand to Hand") is a nonprofit organization that is working in partnership with underserved Bolivian communities to cocreate medical infrastructures and to improve health. Using community-based participatory research (CBPR) methods, Mano a Mano engages local government and community leaders, health care providers, educators, and ordinary citizens in a manner that taps local strengths and resources to allow all participants to work together to realize this mission. After describing Bolivia's call for improved access to high quality care in its poor and underserved rural areas, we outline the Mano a Mano's CBPR approach and sequence to answer this call, the culmination of its efforts to date (including the establishment of 119 health care facilities), lessons learned, and next steps in the formal evaluation and extension of this collaborative work.

Adolescent health: a rural community's approach.

PubMed

Groft, Jean N; Hagen, Brad; Miller, Nancy K; Cooper, Natalie; Brown, Sharon

2005-01-01

Significant health problems encountered in adulthood often have their roots in health behaviours initiated during adolescence. In order to reverse this trend, school and health personnel, as well as parents and other community members working with high school students, need to be aware of the health-related beliefs and choices that guide the behaviours of teenagers. Although a wide variety of research has been conducted on this topic among urban adolescents, less is known about the health beliefs and behaviors of adolescents residing in rural areas, particularly in Canada. In general, rural Canadians are less healthy than their urban counterparts. Building on the knowledge and understanding of their own community, key stakeholders were invited to engage in the design and implementation of a participatory action research project aimed at understanding and improving the health of rural adolescents. A group of parents, teachers, students, school administrators and public health nurses engaged in a participatory action research project to better understand determinants of the health of rural adolescents at a high school in Western Canada. Group members developed and administered a health survey to 288 students from a small rural high school, in an effort to identify areas of concern and interest regarding health practices and beliefs of rural adolescents, and to take action on these identified concerns. Results indicated some interesting but potentially worrying trends in this population. For example, while frequent involvement in a physical activity was noted by 75.9% of participants, close to half of the females (48%) described their body image as 'a little overweight' or 'definitely overweight', and approximately 25.8% of respondents noted that they skipped meals most of the time. Differences between the genders were apparent in several categories. For example, more girls smoked (16.2%) than boys (12.3%), and more males (55.0%) than females (41%) had tried illegal

Community outreach: rural mobile health unit.

PubMed

Alexy, B B; Elnitsky, C A

1996-12-01

With the increased emphasis on cost containment, hospital administrators are investigating community outreach projects to remain economically viable. The authors describe the planning and implementation of a mobile health unit for rural elderly residents. This project represents an alternative model of healthcare delivery in a rural area with limited resources and healthcare providers.

Designing a community-based lay health advisor training curriculum to address cancer health disparities.

PubMed

Gwede, Clement K; Ashley, Atalie A; McGinnis, Kara; Montiel-Ishino, F Alejandro; Standifer, Maisha; Baldwin, Julie; Williams, Coni; Sneed, Kevin B; Wathington, Deanna; Dash-Pitts, Lolita; Green, B Lee

2013-05-01

Racial and ethnic minorities have disproportionately higher cancer incidence and mortality than their White counterparts. In response to this inequity in cancer prevention and care, community-based lay health advisors (LHAs) may be suited to deliver effective, culturally relevant, quality cancer education, prevention/screening, and early detection services for underserved populations. APPROACH AND STRATEGIES: Consistent with key tenets of community-based participatory research (CBPR), this project engaged community partners to develop and implement a unique LHA training curriculum to address cancer health disparities among medically underserved communities in a tricounty area. Seven phases of curriculum development went into designing a final seven-module LHA curriculum. In keeping with principles of CBPR and community engagement, academic-community partners and LHAs themselves were involved at all phases to ensure the needs of academic and community partners were mutually addressed in development and implementation of the LHA program. Community-based LHA programs for outreach, education, and promotion of cancer screening and early detection, are ideal for addressing cancer health disparities in access and quality care. When community-based LHAs are appropriately recruited, trained, and located in communities, they provide unique opportunities to link, bridge, and facilitate quality cancer education, services, and research.

Intermediate outcomes of a tribal community public health infrastructure assessment.

PubMed

English, Kevin C; Wallerstein, Nina; Chino, Michelle; Finster, Carolyn E; Rafelito, Alvin; Adeky, Sarah; Kennedy, Marianna

2004-01-01

The purpose of this collaborative participatory project was to assess the strengths and needs of a tribal community as part of a larger public health capacity building program. Key project partners included: the Ramah Band of Navajo Indians, the Albuquerque Area Indian Health Board, the University of New Mexico Masters in Public Health Program, and the University of Nevada, Las Vegas, American Indian Research and Education Center. Principal intervention steps entailed: 1) relationship-building activities among tribal programs and between the Tribe and the scientific community; 2) an orientation to public health; 3) a comprehensive public health infrastructure assessment, utilizing a standardized CDC instrument; and 4) a prioritization of identified needs. The direct outcome was the development and beginning implementation of a community specific public health strategic action plan. Broader results included: 1) increased comprehension of public health within the Tribe; 2) the creation of a community public health task force; 3) the design of a tribally applicable assessment instrument; and 4) improved collaboration between the Tribe and the scientific community. This project demonstrated that public health assessment in tribal communities is feasible and valuable. Further, the development of a tribally applicable instrument highlights a significant tribal contribution to research and assessment.

Strategic partnering to improve community health worker programming and performance: features of a community-health system integrated approach.

PubMed

Naimoli, Joseph F; Perry, Henry B; Townsend, John W; Frymus, Diana E; McCaffery, James A

2015-09-01

There is robust evidence that community health workers (CHWs) in low- and middle-income (LMIC) countries can improve their clients' health and well-being. The evidence on proven strategies to enhance and sustain CHW performance at scale, however, is limited. Nevertheless, CHW stakeholders need guidance and new ideas, which can emerge from the recognition that CHWs function at the intersection of two dynamic, overlapping systems - the formal health system and the community. Although each typically supports CHWs, their support is not necessarily strategic, collaborative or coordinated. We explore a strategic community health system partnership as one approach to improving CHW programming and performance in countries with or intending to mount large-scale CHW programmes. To identify the components of the approach, we drew on a year-long evidence synthesis exercise on CHW performance, synthesis records, author consultations, documentation on large-scale CHW programmes published after the synthesis and other relevant literature. We also established inclusion and exclusion criteria for the components we considered. We examined as well the challenges and opportunities associated with implementing each component. We identified a minimum package of four strategies that provide opportunities for increased cooperation between communities and health systems and address traditional weaknesses in large-scale CHW programmes, and for which implementation is feasible at sub-national levels over large geographic areas and among vulnerable populations in the greatest need of care. We postulate that the CHW performance benefits resulting from the simultaneous implementation of all four strategies could outweigh those that either the health system or community could produce independently. The strategies are (1) joint ownership and design of CHW programmes, (2) collaborative supervision and constructive feedback, (3) a balanced package of incentives, and (4) a practical monitoring

Community Bioethics: The Health Decisions Community Council.

ERIC Educational Resources Information Center

Gallegos, Tom; Mrgudic, Kate

1993-01-01

Sees health care decision making posing variety of complex issues for individuals, families, and providers. Describes Health Decisions Community Council (HDCC), community-based bioethics committee established to offer noninstitutional forum for discussion of health care dilemmas. Notes that social work skills and values for autonomy and…

From Community to Meta-Community Mental Health Care.

PubMed

Bouras, Nick; Ikkos, George; Craig, Thomas

2018-04-20

Since the 1960s, we have witnessed the development and growth of community mental health care that continues to dominate mental health policy and practice. Several high-income countries have implemented community mental health care programmes but for many others, including mostly low- and middle-income countries, it remains an aspiration. Although community mental health care has been positive for many service users, it has also had severe shortcomings. Expectations that it would lead to fuller social integration have not been fulfilled and many service users remain secluded in sheltered or custodial environments with limited social contacts and no prospect of work. Others receive little or no service at all. In today’s complex landscape of increasingly specialised services for people with mental health problems, the number of possible interfaces between services is increasing. Together with existing uneven financing systems and a context of constant change, these interfaces are challenging us to develop effective care pathways adjusted to the needs of service users and their carers. This discussion paper reviews the developments in community mental health care over the recent years and puts forward the concept of “Meta-Community Mental Health Care”. “Meta-Community Mental Health Care” embraces pluralism in understanding and treating psychiatric disorders, acknowledges the complexities of community provision, and reflects the realities and needs of the current era of care.

From Community to Meta-Community Mental Health Care

PubMed Central

Bouras, Nick; Ikkos, George; Craig, Thomas

2018-01-01

Since the 1960s, we have witnessed the development and growth of community mental health care that continues to dominate mental health policy and practice. Several high-income countries have implemented community mental health care programmes but for many others, including mostly low- and middle-income countries, it remains an aspiration. Although community mental health care has been positive for many service users, it has also had severe shortcomings. Expectations that it would lead to fuller social integration have not been fulfilled and many service users remain secluded in sheltered or custodial environments with limited social contacts and no prospect of work. Others receive little or no service at all. In today’s complex landscape of increasingly specialised services for people with mental health problems, the number of possible interfaces between services is increasing. Together with existing uneven financing systems and a context of constant change, these interfaces are challenging us to develop effective care pathways adjusted to the needs of service users and their carers. This discussion paper reviews the developments in community mental health care over the recent years and puts forward the concept of “Meta-Community Mental Health Care”. “Meta-Community Mental Health Care” embraces pluralism in understanding and treating psychiatric disorders, acknowledges the complexities of community provision, and reflects the realities and needs of the current era of care. PMID:29677100

Community Support as a Moderator of Postdisaster Mental Health Symptoms in Urban and Nonurban Communities

PubMed Central

West, Jenny S.; Price, Matthew; Gros, Kirstin Stauffacher; Ruggiero, Kenneth J.

2014-01-01

Objective We examined the association between disaster exposure, community support, and mental health outcomes in urban and nonurban participants of Galveston and Chambers counties after Hurricane Ike. The moderating effect of community support was evaluated as a protective factor relative to postdisaster mental health. Methods A representative population-based sample of 157 urban and 714 nonurban adults were interviewed 12 to 17 months after the hurricane about their mental health functioning, disaster exposure, and perceptions of community support. A series of multiple regressions demonstrated that disaster exposure was associated with mental health outcomes for both groups. The strength of the association varied across population samples. Results Community support moderated the association between interpersonal effects of the disaster and posttraumatic stress disorder (PTSD) and depression outcomes in nonurban participants and the association between property damage and PTSD in urban participants. Conclusions Community support played a larger role in reducing PTSD and depression symptoms associated with the interpersonal effects of a disaster in the nonurban sample only. Communities may play a more beneficial role in the recovery process in nonurban areas that have elevated levels of injury or death attributed to a disaster. PMID:24274123

[Relationship between fruit and vegetable gardening and health-related factors: male community gardeners aged 50-74 years living in a suburban area of Japan].

PubMed

Machida, Daisuke; Yoshida, Tohru

2017-01-01

Objectives　The aims of the study were as follows: 1) to investigate the relationship between community fruit and vegetable (FV) gardening and perceived changes in health-related factors by utilizing community gardens and 2) to determine the relationship of community FV gardening and other types of gardening on health-related factors among men aged 50-74 years living in a suburban area of Japan.Methods　In this cross-sectional study, we targeted men aged 50-74 years living in a city in Gunma Prefecture. A survey solicited demographic characteristics, FV gardening information, and health-related factors [BMI, self-rated health status, FV intake, physical activity (PA), and perceived neighborhood social cohesion (PNSC)]. The participants were divided into three groups: community gardeners, other types of gardeners, and non-gardeners. Items related to community gardening and perceived changes in health-related factors were presented only to community gardeners. The relationship between community gardening and perceived changes in health-related factors were analyzed by computing correlation coefficients. The relationships between FV gardening and specific health-related factors were analyzed by logistic regression modeling.Results　Significant positive correlations were observed between community FV gardening (the frequency of community gardening, the product of community gardening time and frequency of community gardening) and perceived changes in health-related factors (frequency of FV intake, amount of FV intake, and PA). The logistic regression models showed that 1) the number of participants with ≥23 METs h/week of PA was significantly greater among community gardeners than among non-gardeners; 2) the number of participants whose frequency of total vegetable intake, total vegetable intake (excluding juice), and total FV intake (excluding juice) was ≥5 times/day was significantly greater among other types of gardeners than non-gardeners; 3) participants

Area Community College and Area Vocational School Construction.

ERIC Educational Resources Information Center

Iowa State Dept. of Public Instruction, Des Moines.

The purpose of this guideline is to assist in the planning process, to encourage good school plant design, and to serve as criteria in the evaluation of area community college and area vocational school plans. It is divided into the following five sections--(1) area plant planning, (2) area sites, (3) physical facilities, (4) service systems, and…

Aging & Community Health: A University-Community Partnership Project

ERIC Educational Resources Information Center

Robinson-Dooley, Vanessa; Dumont, Kelly; Riapos, Jennifer A.

2018-01-01

The purpose of this paper is to discuss how university-community partnerships can be utilized to provide affordable and accessible health care for the elderly at community health clinics. A review of community health clinics, usage data from 2013 to 2014 by a sample of aging individuals will be described along with faculty perspectives about the…

Geographic Access to Specialty Mental Health Care Across High- and Low-Income US Communities.

PubMed

Cummings, Janet R; Allen, Lindsay; Clennon, Julie; Ji, Xu; Druss, Benjamin G

2017-05-01

With the future of the Affordable Care Act and Medicaid program unclear, it is critical to examine the geographic availability of specialty mental health treatment resources that serve low-income populations across local communities. To examine the geographic availability of community-based specialty mental health treatment resources and how these resources are distributed by community socioeconomic status. Measures of the availability of specialty mental health treatment resources were derived using national data for 31 836 zip code tabulation areas from 2013 to 2015. Analyses examined the association between community socioeconomic status (assessed by median household income quartiles) and resource availability using logistic regressions. Models controlled for zip code tabulation area-level demographic characteristics and state indicators. Dichotomous indicators for whether a zip code tabulation area had any (1) outpatient mental health treatment facility (more than nine-tenths of which offer payment arrangements for low-income populations), (2) office-based practice of mental health specialist physician(s), (3) office-based practice of nonphysician mental health professionals (eg, therapists), and (4) mental health facility or office-based practice (ie, any community-based resource). Of the 31 836 zip code tabulation areas in the study, more than four-tenths (3382 of 7959 [42.5%]) of communities in the highest income quartile (mean income, $81 207) had any community-based mental health treatment resource vs 23.1% of communities (1841 of 7959) in the lowest income quartile (mean income, $30 534) (adjusted odds ratio, 1.74; 95% CI, 1.50-2.03). When examining the distribution of mental health professionals, 25.3% of the communities (2014 of 7959) in the highest income quartile had a mental health specialist physician practice vs 8.0% (637 of 7959) of those in the lowest income quartile (adjusted odds ratio, 3.04; 95% CI, 2.53-3.66). Similarly, 35.1% of the

Effectiveness of a primary health care program on urban and rural community disaster preparedness, Islamic Republic of Iran: a community intervention trial.

PubMed

Ardalan, Ali; Mowafi, Hani; Malekafzali Ardakani, Hossein; Abolhasanai, Farid; Zanganeh, Ali-Mohammad; Safizadeh, Hossein; Salari, Sirous; Zonoobi, Vahid

2013-10-01

To evaluate the effectiveness of a capacity-building intervention administered through a primary health care (PHC) system on community disaster preparedness in Iran. A controlled community intervention trial with pre- and postassessments was conducted in 2011 in 3 provinces of Iran. In each province, 2 areas were chosen and randomly selected as an intervention or control group. A total of 9200 households were in the intervention area and 10 010 were in the control area. In each study group in each province 250 households were sampled for pre- and postassessment surveys. Community health volunteers led by PHC staff administered an educational intervention covering elements of hazard awareness and preparedness, with a focus on earthquakes and floods. Relative changes for awareness and readiness scores were assessed to demonstrate changes in outcome variables from pre- to postassessments in intervention and control groups. An effectiveness test of significance was based on interaction between time and area. Households in intervention communities exhibited improved disaster awareness and readiness with respect to all outcome measures. Relative changes in awareness in intervention and control areas were 2.94 and -0.08, respectively (P < .001). Relative changes for readiness scores were 5.52 in intervention areas and 0.56 in control areas (P < .001). Relative changes for awareness and readiness were significantly correlated with a community's baseline risk perception and previous experience with natural disasters (P < .001). An educational intervention administered through the PHC system effectively improved disaster awareness and readiness at a community level. For sustainability, community disaster reduction programs must be integrated into routine public health service delivery.

Community health development: a strategy for reinventing America's health care system one community at a time.

PubMed

Felix, Michael R J; Burdine, James N; Wendel, Monica L; Alaniz, Angie

2010-04-01

The purpose of this article is to propose a set of ideas for reinventing America's health care system, one community at a time. Community health development is proposed as a strategy and approach to population health improvement, the ultimate goal of health care reform. The practice of community health development, particularly the partnership approach, provides guidance about how this approach might be employed as a national health care reform strategy. Examples of two communities successfully using the partnership approach illustrate the methods described. Six specific recommendations for policy makers and public administrators in the new administration resulting from our experience with community health development are presented. First, adopt and apply community health development (CHD) as the American approach for facilitating population health improvement and building community capacity. Second, the partnership approach should be promoted as a model for communities to use in implementing CHD. Third, make the community-level the focus for planning, implementing, evaluating, and sustaining a full continuum of health and human services. Fourth, formally recognize the social determinants of health as a key component of a new population/community health status model and as a public policy driver for health care reform, marketplace issues, and population health status improvement at all levels of society. Fifth is a call for a national strategy for the recruitment, training, education, and support of individuals to facilitate this community movement. Sixth, Congress and the Obama Administration adopt and apply CHD as a national strategy and utilize American community-based experiences to bring about a national plan.

Community perspectives on post-Katrina mental health recovery in New Orleans.

PubMed

Meyers, Diana; Allien, Charles E; Dunn, Donisha; Wennerstrom, Ashley; Springgate, Benjamin F

2011-01-01

Disaster-affected communities may face prolonged challenges to community-wide mental health recovery due to limitations in local resources, infrastructure, and leadership. REACH NOLA, an umbrella non-profit organization comprising academic institutions and community-based agencies, sought to promote community recovery, increase mental health service delivery capacity, and develop local leadership in post-Katrina New Orleans through its Mental Health infrastructure and Training Project (MHIT). The project offered local health service providers training and follow-up support for implementing evidence-based and new approaches to mental health service delivery. This commentary shares the perspectives of three community leaders who co-directed MHIT. They describe the genesis of MHIT, the experience of each agency in adopting leadership roles in addressing post-disaster needs, challenges and growth opportunities, and then overarching lessons learned concerning leadership in a prolonged crisis. These lessons may be relevant to community agencies addressing hurricane recovery in other areas of the Gulf States as well as to inform long-term disaster recovery efforts elsewhere.

Primary care quality: community health center and health maintenance organization.

PubMed

Shi, Leiyu; Starfield, Barbara; Xu, Jiahong; Politzer, Robert; Regan, Jerrilyn

2003-08-01

This study compares the primary health care quality of community health centers (CHCs) and health maintenance organizations (HMOs) in South Carolina to elucidate the quality of CHC performance relative to mainstream settings such as the HMO. Mail surveys were used to obtain data from 350 randomly selected HMO users. Surveys with follow-up interviews were conducted to obtain data from 540 randomly selected CHC users. A validated adult primary care assessment tool was used in both surveys. Multivariate analyses were performed to assess the association of health care setting (HMO versus CHC) with primary care quality while controlling for sociodemographic and health care characteristics. After controlling for sociodemographic and health care use measures, CHC patients demonstrated higher scores in several primary care domains (ongoing care, coordination of service, comprehensiveness, and community orientation) as well as total primary care performance. Users of CHC are more likely than HMO users to rate their primary health care provider as good, except in the area of ease of first contact. The positive rating of the CHC is particularly impressive after taking into account that many CHC users have characteristics associated with poorer ratings of care.

Canadian community health centres and the Internet: exploring the challenges and solutions.

PubMed

Jamieson, R

1997-01-01

Community Health Centres (CHCs) across Canada are providing essential health and social services to many communities, and this function is becoming more vital as provinces concentrate on cutting costs and developing more economic and efficient solutions to the current healthcare system. More than 300 of these community-based organizations currently serve upwards to 13% of the Canadian population, providing a wide range of services in an attempt to promote total wellness in their communities. Over one half of all CHCs are located in rural or remote areas. However, despite the apparent need for, and success of, CHCs, they are among the most underserved health provision groups in the country. Many CHCs lack critical funding and resources, particularly in the area of technology. In this Information Age, the health sector is realizing the importance of using information technologies to increase efficiency, improve services, and maintain viability. Community Health Centres, however, often do not have money for even the most basic technologies such as fax machines, let alone computers and Internet access. Community Health Centres in Canada need to be given the tools they need in order to continue providing quality health care to their communities. This article provides an overview of the current situation of CHCs in Canada vis(-)à-vis the Internet and other information technologies. Some of the practical and organizational challenges facing CHCs in this area will be discussed, as well as potential solutions that could and are being developed to overcome these barriers. It is an objective of this article to facilitate information and resource-sharing and the creation of links between CHCs across Canada. Community Health Centres may benefit from better understanding of the implications of these new technologies, discovering ways in which their peers are using the Internet, and communicating with one another in order to begin basic planning and needs assessments. As part of

Mercury vapor in residential building common areas in communities where mercury is used for cultural purposes versus a reference community

PubMed Central

Garetano, Gary; Stern, Alan H.; Robson, Mark; Gochfeld, Michael

2015-01-01

Background Exposure to elemental mercury (Hg0) in residential buildings can occur from accidental spills, broken objects (thermometers, fluorescent fixtures, thermostats), and deliberate introduction, one mode of which involves cultural practices by individuals who believe dispersal of mercury in a residence will bring luck, enhance health or ward off harm. Objectives To determine whether mercury vapor levels in common areas of residential buildings is higher in a community where cultural uses are likely (study areas S1, S2) than in a reference community (C1) where cultural use is unlikely, and whether levels can serve as a signal of significant cultural mercury use. Methods We monitored Hg0 vapor with a portable spectrophotometer in the three communities. We randomly selected sites in S1 and C1 community, and also include sites in S2 specified by local health officials who suspected cultural mercury use. We evaluated 122 multifamily buildings and 116 outdoor locations. Findings We found >25 ng/m3 Hg0 in 14% of buildings in study areas compared to only one reference building. In the latter we identified an accidental mercury spill from a bottle that had been brought into the building. Both the mean and maximum indoor mercury vapor levels were greater in the study communities than in the reference community. In all communities, we observed mean indoor Hg0 vapor concentration greater than outdoors, although in two-thirds of buildings, indoor levels did not exceed the area-specific outdoor upper-limit concentration. Conclusion After controlling for factors that might influence Hg0 vapor levels, the most plausible explanation for greater Hg0 levels in the study area is a relationship to cultural use of mercury. None of the measured levels exceeded the ATSDR minimum risk level for residences of 200 ng/m3 Hg0 although levels in living quarters might be greater than those in the common areas. PMID:18406445

Stroke survivors’ levels of community reintegration, quality of life, satisfaction with the physiotherapy services and the level of caregiver strain at community health centres within the Johannesburg area

PubMed Central

Kusambiza-Kiingi, Adrian; Maleka, Douglas

2017-01-01

Background Stroke survivors are discharged home before they are functionally independent and return home with activity limitations that would not be manageable without a caregiver. Aim To determine stroke survivors’ levels of community reintegration, quality of life (QOL), satisfaction with the physiotherapy services and the level of caregiver strain at community health centres within the Johannesburg area. Method This was a cross-sectional study using the following outcome measures: Maleka Stroke Community Reintegration Measure, Stroke-specific quality of life scale, Caregiver strain index and Physical therapy patient satisfaction questionnaire. Results A total of 108 stroke survivors and 45 caregivers participated in this study. The average age of the stroke survivors was 54 years (standard deviation = 12.73) and 58% (n = 62) had moderate to full community reintegration. They were happy with physiotherapy services but not with parking availability and cost of services. The QOL was poor with the lowest scores for energy and highest scores for vision and language domains. Twenty five (55%) caregivers were strained. A positive correlation was found between community reintegration and satisfaction with services (r = 0.27, p < 0.0001) and QOL (r = 0.51, p < 0.0001). A negative correlation was found between community reintegration and caregiver strain (r = -0.37, p < 0.0001). Conclusion Most stroke survivors are reintegrated into their communities except in the areas of work and education and have poor QOL and most of their caregivers are strained; however, they are satisfied with physiotherapy services. PMID:28730068

Stroke survivors' levels of community reintegration, quality of life, satisfaction with the physiotherapy services and the level of caregiver strain at community health centres within the Johannesburg area.

PubMed

Kusambiza-Kiingi, Adrian; Maleka, Douglas; Ntsiea, Veronica

2017-01-01

Stroke survivors are discharged home before they are functionally independent and return home with activity limitations that would not be manageable without a caregiver. To determine stroke survivors' levels of community reintegration, quality of life (QOL), satisfaction with the physiotherapy services and the level of caregiver strain at community health centres within the Johannesburg area. This was a cross-sectional study using the following outcome measures: Maleka Stroke Community Reintegration Measure, Stroke-specific quality of life scale, Caregiver strain index and Physical therapy patient satisfaction questionnaire. A total of 108 stroke survivors and 45 caregivers participated in this study. The average age of the stroke survivors was 54 years (standard deviation = 12.73) and 58% ( n = 62) had moderate to full community reintegration. They were happy with physiotherapy services but not with parking availability and cost of services. The QOL was poor with the lowest scores for energy and highest scores for vision and language domains. Twenty five (55%) caregivers were strained. A positive correlation was found between community reintegration and satisfaction with services ( r = 0.27, p < 0.0001) and QOL ( r = 0.51, p < 0.0001). A negative correlation was found between community reintegration and caregiver strain ( r = -0.37, p < 0.0001). Most stroke survivors are reintegrated into their communities except in the areas of work and education and have poor QOL and most of their caregivers are strained; however, they are satisfied with physiotherapy services.

Beyond SARS: ethnic community organization's role in public health -- a Toronto experience.

PubMed

Weizhen Dong

2008-12-01

The SARS outbreak in Toronto was a public health crisis. It was particularly frightening to the Chinese-Canadians, because of the origin of the deadly disease. The Chinese-Canadian community organizations launched various activities to help the Chinese-Canadians as well as other Asian-Canadian communities to fight against SARS and its social side-effects. From launching the SARS Supporting Line, distributing health promotional material, disseminating SARS related information, paying tribute to frontline health workers, and promoting local business, to fundraising for SARS related research; they played an active role in easing the public's anxiety, especially for the Chinese-Canadians in the great Toronto area. The culturally diverse population brought problems as well as solutions. Ethnic groups have expertise in almost all areas, including people with leadership skills. The Toronto Chinese community's experience in combating SARS is a good example. The Chinese-Canadian community organizations' activities during the SARS outbreak demonstrate that ethnic minority organizations can play an important role in public health, especially in a public health crisis, and beyond.

A community health report card: comprehensive assessment for tracking community health (CATCH).

PubMed

Studnicki, J; Steverson, B; Myers, B; Hevner, A R; Berndt, D J

1997-01-01

A systematic method for assessing the health status of communities has been under development at the University of South Florida since 1991. The system, known as CATCH, draws 226 indicators from multiple sources and uses an innovative comparative framework and weighted evaluation criteria to produce a rank-ordered community problem list. The CATCH results from II Floridian counties have focused attention on high priority health problems and provided a framework for measuring the impact of health expenditures on community health status outcomes. The method and plans to create an automated data warehouse to support its expansion and enrichment are described.

Community Characteristics and Qualified Health Plan Selection during the First Open Enrollment Period.

PubMed

Boudreaux, Michel; Blewett, Lynn A; Fried, Brett; Hempstead, Katherine; Karaca-Mandic, Pinar

2017-06-01

To examine state and community factors that contributed to geographic variation in qualified health plan selection during the first open enrollment period. Administrative data on qualified health plan selections at the ZIP code area merged with survey estimates from the American Community Survey. Descriptive and regression analyses. Data were generated by healthcare.gov and from a household survey. Thirty-one percent of the variation in qualified health plan selection ratios resulted from between-state differences, and the rest was driven by local area differences. Education, language, age, gender, and the ethnic composition of communities contributed to disparate levels of plan selection. Medicaid expansion states had a qualified health plan selection ratio that was 4.4 points lower than non-Medicaid expansion states, controlling for covariates. Our results suggest community-level differences in the intensity or receptiveness to outreach and enrollment activities during the first open enrollment period. © Health Research and Educational Trust.

Mental Health Services in a Rural Area: The Integrated Relationship between State Hospital and Community Mental Health Centers. Notes from the Field.

ERIC Educational Resources Information Center

Bittle, Ronald G.

1988-01-01

Describes "linkage agreement" system between Illinois community mental health centers and Anna Mental Health and Developmental Center serving 28 rural counties. Agreements specify responsibilities of community centers and hospital staff regarding referrals, client treatment, and discharge. Describes improvements over previous…

Designing a Community-Based Lay Health Advisor Training Curriculum to Address Cancer Health Disparities

PubMed Central

Gwede, Clement K.; Ashley, Atalie A.; McGinnis, Kara; Montiel-Ishino, F. Alejandro; Standifer, Maisha; Baldwin, Julie; Williams, Coni; Sneed, Kevin B.; Wathington, Deanna; Dash-Pitts, Lolita; Green, B. Lee

2012-01-01

Introduction Racial and ethnic minorities have disproportionately higher cancer incidence and mortality than their White counterparts. In response to this inequity in cancer prevention and care, community-based lay health advisors (LHAs) may be suited to deliver effective, culturally relevant, quality cancer education, prevention/screening, and early detection services for underserved populations. Approach and Strategies Consistent with key tenets of community-based participatory research (CBPR), this project engaged community partners to develop and implement a unique LHA training curriculum to address cancer health disparities among medically underserved communities in a tricounty area. Seven phases of curriculum development went into designing a final seven-module LHA curriculum. In keeping with principles of CBPR and community engagement, academic–community partners and LHAs themselves were involved at all phases to ensure the needs of academic and community partners were mutually addressed in development and implementation of the LHA program. Discussion and Conclusions Community-based LHA programs for outreach, education, and promotion of cancer screening and early detection, are ideal for addressing cancer health disparities in access and quality care. When community-based LHAs are appropriately recruited, trained, and located in communities, they provide unique opportunities to link, bridge, and facilitate quality cancer education, services, and research. PMID:22982709

Canadian community pharmacists' use of digital health technologies in practice.

PubMed

Leung, Valerie; Tharmalingam, Sukirtha; Cooper, Janet; Charlebois, Maureen

2016-01-01

In 2010, a pan-Canadian study on the current state and benefits of provincial drug information systems (DIS) found that substantial benefits were being realized and that pharmacists perceived DIS to be a valuable tool in the evolving models of pharmacy practice. To understand changes in digital health and the impact on practice since that time, a survey of community pharmacists in Canada was conducted. In 2014, Canada Health Infoway (Infoway) and the Canadian Pharmacists Association (CPhA) invited community pharmacists to participate in a Web-based survey to understand their use and perceived benefits of digital health in practice. The survey was open from April 15 to May 12, 2014. Of the 447 survey responses, almost all used some form of digital health in practice. Those with access to DIS and provincial laboratory information systems (LIS) reported increased productivity and better quality of care. Those without access to these systems would overwhelmingly like access. There have been significant advances in digital health and community pharmacy practice over the past several years. In addition to digital health benefits in the areas of productivity and quality of care, pharmacists are also experiencing substantial benefits in areas related to recently expanded scope of practice activities such as ordering lab tests. Community pharmacists frequently use digital health in practice and recognize the benefits of these technologies. Digital health is, and will continue to be, a key enabler for practice transformation and improved quality of care. Can Pharm J (Ott) 2016;149:xx-xx.

Performance of female volunteer community health workers in Dhaka urban slums.

PubMed

Alam, Khurshid; Tasneem, Sakiba; Oliveras, Elizabeth

2012-08-01

Volunteer community health workers (CHWs) are one approach to addressing the health workforce crisis in developing countries. BRAC, a large Bangladeshi NGO, a pioneer in this area, uses female volunteer CHWs as core workers in its health programs. After 25 years of implementing the CHW model in rural areas, BRAC has begun using female CHWs in urban slums through its community-based mother, newborn and child health interventions. However, the program experienced suboptimal performance among CHWs, with a high percentage of them remaining in their positions but becoming "inactive", not truly participating in daily community health activities. This suggests a need to better understand the relative importance of factors affecting their active participation and to recommend strategies for improving their participation. This mixed-method study included a descriptive correlational design to assess factors relating to level of activity of CHWs and focus group discussions to explore solutions to these problems. A sample of 542 current female CHWs from project areas participated in the survey. Financial incentives were the main factor linked to the activity of CHWs. CHWs who thought that running their families would be difficult without CHW income had more than three times greater odds to become active. In addition, social prestige and positive community feedback to the CHWs were important non-financial factors associated with level of activity. In order to improve volunteer CHWs' performance, a combination of financial and non-financial incentives should be used. Copyright © 2012 Elsevier Ltd. All rights reserved.

Factors influencing the development of area health education centers with Texas-Mexico border populations.

PubMed

Fowkes, V K; Fowkes, W C; Walters, E G; Gamel, N

1990-12-01

Area Health Education Centers (AHECs) have been viewed as an appropriate vehicle for implementing new initiatives for training health professionals who will work along the U.S.-Mexico border. Perceptions about this program in Texas were evaluated from July 1988 to June 1989 to identify problems and formulate suggestions that might be of use to academic health science centers (HSCs)--and in particular medical schools--working with Hispanic populations. Interviews were conducted with 116 people: the presidents and/or deans of all eight Texas HSCs and/or medical schools, other deans and faculty, community leaders in five border counties, and state officials. The school and community perspectives about past and present AHEC activities were compared. Some of the barriers were: insufficient components of the health care delivery system to support medical education in severely underserved areas; differing school and community priorities; cultural differences between the school faculty and the community; and feeling among community physicians and dentists that AHECs were a source of competition. The school and community respondents agreed that the AHEC program needs more cooperative planning and training that emphasizes public health education for future AHEC-like activities with border populations.

Reliability of community health worker collected data for planning and policy in a peri-urban area of Kisumu, Kenya.

PubMed

Otieno, C F; Kaseje, D; Ochieng', B M; Githae, M N

2012-02-01

A general introduction of this article is as follows: Reliable and timely health information is an essential foundation of public health action and health systems strengthening, both nationally and internationally (Aqil et al. in Health Policy Plan 24(3): 217-228, 2009; Bradshaw et al. in initial burden of disease estimates for South Africa, 2000. South African Medical Research Council, Cape Town, 2003). The need for sound information is especially urgent in the case of emergent diseases and other acute health threats, where rapid awareness, investigation and response can save lives and prevent broader national outbreaks and even global pandemics (Aqil et al. in Health Policy Plan 24(3): 217-228, 2009). The government of Kenya, through the ministry of public health and sanitation has rolled out the community health strategy as a way of improving health care at the household level. This involves community health workers collecting health status data at the household level, which is then used for dialogue at all the levels to inform decisions and actions towards improvement in health status. A lot of health interventions have involved the community health workers in reaching out to the community, hence successfully implementing these health interventions. Large scale involvement of community health workers in government initiatives and most especially to collect health data for use in the health systems has been minimal due to the assumption that the data may not be useful to the government, because its quality is uncertain. It was therefore necessary that the validity and reliability of the data collected by community health workers be determined, and whether this kind of data can be used for planning and policy formulation for the communities from which it is collected. This would go a long way to settle speculation on whether the data collected by these workers is valid and reliable for use in determining the health status, its causes and distribution, of a

Indian Health Service: Community Health

MedlinePlus

... Community Health Representatives (CHRs) Office of Environmental Health & Engineering (OEHE) Environmental Health Support Center Training (EHSCT) IHS ... Contracting Tribes - 08E17 Office of Environmental Health and Engineering - 10N14C Office of Finance and Accounting - 10E54 Office ...

Burden experienced by community health volunteers in Taiwan: a survey

PubMed Central

2013-01-01

Background Volunteers in Taiwan complement the delivery of health services by paid health professionals. However, in doing so, community health volunteers experience burdens associated with their activities. The reasons for these burdens and degree to which they are experienced are explored in this paper. Our study adds to international research regarding the burden experienced by volunteers. This project is the first to assess how community health volunteers in Taiwan experience burden. Methods The 20 item Burden on Community Health Volunteer (BCHV) instrument, specifically designed for this project, was administered to 435 volunteers attached to Community Health Promotion Development Centres in northern Taiwan. Results The overall burden experienced by volunteers is relatively low. However, a multivariate adjusted regression analysis revealed significant differences in volunteer burden depending on the number of people each volunteer served on average per week, as well as the volunteer’s marital status and their perceptions about personal health. Volunteers who served many people and who perceived their own health as poor experienced a higher level of burden. Those who were a widow or a widower felt less burdened than others. Conclusions The results of the study identify areas where burden is high and where strategies can be developed to reduce the level of burden experienced by community health volunteers in Taiwan. Community health volunteers in Taiwan complement the role of nurses and other health care providers so their retention is important to ongoing service delivery. PMID:23687966

Quality of community basic medical service utilization in urban and suburban areas in Shanghai from 2009 to 2014.

PubMed

Guo, Lijun; Bao, Yong; Ma, Jun; Li, Shujun; Cai, Yuyang; Sun, Wei; Liu, Qiaohong

2018-01-01

Urban areas usually display better health care services than rural areas, but data about suburban areas in China are lacking. Hence, this cross-sectional study compared the utilization of community basic medical services in Shanghai urban and suburban areas between 2009 and 2014. These data were used to improve the efficiency of community health service utilization and to provide a reference for solving the main health problems of the residents in urban and suburban areas of Shanghai. Using a two-stage random sampling method, questionnaires were completed by 73 community health service centers that were randomly selected from six districts that were also randomly selected from 17 counties in Shanghai. Descriptive statistics, principal component analysis, and forecast analysis were used to complete a gap analysis of basic health services utilization quality between urban and suburban areas. During the 6-year study period, there was an increasing trend toward greater efficiency of basic medical service provision, benefits of basic medical service provision, effectiveness of common chronic disease management, overall satisfaction of community residents, and two-way referral effects. In addition to the implementation effect of hypertension management and two-way referral, the remaining indicators showed a superior effect in urban areas compared with the suburbs (P<0.001). In addition, among the seven principal components, four principal component scores were better in urban areas than in suburban areas (P = <0.001, 0.004, 0.036, and 0.022). The urban comprehensive score also exceeded that of the suburbs (P<0.001). In summary, over the 6-year period, there was a rapidly increasing trend in basic medical service utilization. Comprehensive satisfaction clearly improved as well. Nevertheless, there was an imbalance in health service utilization between urban and suburban areas. There is a need for the health administrative department to address this imbalance between urban

Quality of community basic medical service utilization in urban and suburban areas in Shanghai from 2009 to 2014

PubMed Central

Ma, Jun; Li, Shujun; Cai, Yuyang; Sun, Wei; Liu, Qiaohong

2018-01-01

Urban areas usually display better health care services than rural areas, but data about suburban areas in China are lacking. Hence, this cross-sectional study compared the utilization of community basic medical services in Shanghai urban and suburban areas between 2009 and 2014. These data were used to improve the efficiency of community health service utilization and to provide a reference for solving the main health problems of the residents in urban and suburban areas of Shanghai. Using a two-stage random sampling method, questionnaires were completed by 73 community health service centers that were randomly selected from six districts that were also randomly selected from 17 counties in Shanghai. Descriptive statistics, principal component analysis, and forecast analysis were used to complete a gap analysis of basic health services utilization quality between urban and suburban areas. During the 6-year study period, there was an increasing trend toward greater efficiency of basic medical service provision, benefits of basic medical service provision, effectiveness of common chronic disease management, overall satisfaction of community residents, and two-way referral effects. In addition to the implementation effect of hypertension management and two-way referral, the remaining indicators showed a superior effect in urban areas compared with the suburbs (P<0.001). In addition, among the seven principal components, four principal component scores were better in urban areas than in suburban areas (P = <0.001, 0.004, 0.036, and 0.022). The urban comprehensive score also exceeded that of the suburbs (P<0.001). In summary, over the 6-year period, there was a rapidly increasing trend in basic medical service utilization. Comprehensive satisfaction clearly improved as well. Nevertheless, there was an imbalance in health service utilization between urban and suburban areas. There is a need for the health administrative department to address this imbalance between urban

Task force report: the macroenvironment and community mental health.

PubMed

Monahan, J; Vaux, A

1980-01-01

The U.S. President's Commission on Mental Health (1978) has called for a broader conception of mental health and the factors that influence it. The "macro"-social environment is emerging as one area of concern. The influence of two macroenvironmental domains, the physical and economic, on several areas of human functioning is documented in this article. Topics in the physical domain include noise and crowding; and in the economic domain, socio-economic status, unemployment, and economic change. The implications of this research for community mental health practice is described.

Reading Area Community College Community Needs Assessment Telephone Survey.

ERIC Educational Resources Information Center

Reading Area Community Coll., PA.

A telephone survey was conducted in 1981 at Reading Area Community College (RACC) to determine the educational needs of the community, particularly those of prospective students and employers. More specifically, the study sought to determine how the Berks County community perceived the quality of education provided at RACC and to ascertain the…

Community health information sources--a survey in three disparate communities.

PubMed

Dart, Jared; Gallois, Cindy; Yellowlees, Peter

2008-02-01

To determine the current utilisation, importance, trust and future preference for contemporary sources of health information in three different socioeconomic groups. A pilot study including key informant interviews and direct observation was conducted in a low socioeconomic community. From this work a survey questionnaire was designed and implemented across three different communities. Semi-structured key informant interviews and focus groups capturing 52 respondents. Paper-based surveys were left in community organisations and local health practices in a low socioeconomic (LSE) community on the outskirts of Ipswich, Queensland, a mid-high socioeconomic (MSE) community in the western suburbs of Brisbane, and at a local university. Rank of current and preferred future sources of health information, importance and trustworthiness of health information sources. Across all three communities the local doctor was the most currently used, important, trusted and preferred future source of health information. The most striking difference between the three communities related to the current use and preferred future use of the internet. The internet was a more currently used source of health information and more important source in the university population than the LSE or MSE populations. It was also a less preferred source of future health information in the LSE population than the MSE or university populations. Importantly, currently used sources of health information did not reflect community members' preferred sources of health information. People in different socioeconomic communities obtain health information from various sources. This may reflect access issues, education and awareness of the internet as a source of health information, less health information seeking as well as a reluctance by the e-health community to address the specific needs of this group.

Place, health, and community attachment: Is community capacity associated with self-rated health at the individual level?

PubMed

Lovell, Sarah A; Gray, Andrew R; Boucher, Sara E

2017-12-01

Community-level interventions dominate contemporary public health responses to health inequalities as a lack of political will has discouraged action at a structural level. Health promoters commonly leverage community capacity to achieve programme goals, yet the health implications of low community capacity are unknown. In this study, we analyse perceptions of community capacity at the individual-level to explore how place-based understandings of identity and connectedness are associated with self-rated health. We examine associations between individual community capacity, self-rated health and income using a cross-sectional survey that was disseminated to 303 residents of four small (populations 1500-2000) New Zealand towns. Evidence indicating a relationship between individual community capacity and self-reported health was unconvincing once the effects of income were incorporated. That is, people who rated their community's capacity higher did not have better self-rated health. Much stronger evidence supported the relationship between income and both higher individual community capacity and higher self-rated health. We conclude that individual community capacity may mediate the positive association between income and health, however, overall we find no evidence suggesting that intervening to enhance individual community capacity is likely to improve health outcomes.

Community health centers and community development financial institutions: joining forces to address determinants of health.

PubMed

Kotelchuck, Ronda; Lowenstein, Daniel; Tobin, Jonathan N

2011-11-01

Community health centers and community development financial institutions share similar origins and missions and are increasingly working together to meet community needs. Addressing the social and economic determinants of health is a common focus. The availability of new federal grants and tax credits has led these financial institutions to invest in the creation and expansion of community health centers. This article reviews the most recent trends in these two sectors and explores opportunities for further collaboration to transform the health and well-being of the nation's low-income communities.

Perceptions of cardiovascular health in underserved communities.

PubMed

Bryant, Lucinda L; Chin, Nancy P; Cottrell, Lesley A; Duckles, Joyce M; Fernandez, I Diana; Garces, D Marcela; Keyserling, Thomas C; McMilin, Colleen R; Peters, Karen E; Samuel-Hodge, Carmen D; Tu, Shin-Ping; Vu, Maihan B; Fitzpatrick, Annette L

2010-03-01

Cardiovascular disease is the leading cause of deaths and illnesses in US adults, and the prevalence is disproportionately high in underserved populations. In this study, we assessed respondents' understanding of context-specific differences in knowledge and perceptions of disease, risk, and prevention in 6 underserved communities, with the longer-term goal of developing appropriate interventions. Thirty-nine small-group sessions and 14 interviews yielded data from 318 adults. Each site's researchers coded, analyzed, and extracted key themes from local data. Investigators from all sites synthesized results and identified common themes and differences. Themes clustered in 3 areas (barriers to cardiovascular health, constraints related to multiple roles, and suggestions for effective communications and programs). Barriers spanned individual, social and cultural, and environmental levels; women in particular cited multiple roles (eg, competing demands, lack of self-care). Programmatic suggestions included the following: personal, interactive, social context; information in language that people use; activities built around cultural values and interests; and community orientation. In addition, respondents preferred health-related information from trusted groups (eg, AARP), health care providers (but with noticeable differences of opinion), family and friends, and printed materials. Interventions to decrease barriers to cardiovascular health are needed; these strategies should include family and community context, small groups, interactive methods, culturally sensitive materials, and trusted information sources. New-immigrant communities need culturally and linguistically tailored education before receiving more substantive interventions.

Effects of Hurricane Hugo: Mental Health Workers and Community Members.

ERIC Educational Resources Information Center

Muzekari, Louis H.; And Others

This paper reports the effects of Hurricane Hugo on mental health workers and indigenous community members. The response and perceptions of mental health staff from the South Carolina Department of Mental Health (Go Teams) from areas unaffected by the hurricane were compared and contrasted with those of a subsequent Hugo Outreach Support Team…

Conducting a Hispanic Health Needs Assessment in rural Kansas: building the foundation for community action.

PubMed

Bopp, Melissa; Fallon, Elizabeth A; Bolton, Debra J; Kaczynski, Andrew T; Lukwago, Susan; Brooks, Alicia

2012-11-01

Healthy People 2020 states ethnic health disparities are a priority for the US. Although considerable national statistics document ethnic-related health disparities, information specific to rural areas is scarce and does not provide direction for implementing chronic disease prevention programming. Therefore, the purpose of our project was to use the Hispanic Health Needs Assessment (HHNA), a tool designed by the National Alliance for Hispanic Health (NAHH), in culturally diverse, rural Southwest Kansas. Our focus areas included: access to healthcare, heart disease, diabetes, overweight, nutrition, and physical activity. The assessment followed six steps: (1) developing the assessment team, (2) data gathering using community member surveys, existing statistics and community leader interviews, (3) assembling the findings, (4) formulating recommendations for action at individual, institutional, community and policy levels, (5) sharing findings and program planning, and (6) sharing findings with NAHH. We identified several challenges collecting health related data in rural communities, but overall, the HHNA was a comprehensive and useful tool for guiding a community level health assessment. This process has provided our community partners with locally relevant statistics regarding the current status of health, health behaviors, and perceived community needs to inform resource allocation, program planning and applications for new funding initiatives. Copyright © 2012 Elsevier Ltd. All rights reserved.

Community vulnerability to health impacts of wildland fire ...

EPA Pesticide Factsheets

Identifying communities vulnerable to adverse health effects from exposure to wildfire smoke may help prepare responses, increase the resilience to smoke and improve public health outcomes during smoke days. We developed a Community Health-Vulnerability Index (CHVI) based on factors known to increase the risks of health effects from air pollution and wildfire smoke exposures. These factors included county prevalence rates for asthma in children and adults, chronic obstructive pulmonary disease, hypertension, diabetes, obesity, percent of population 65 years of age and older, and indicators of socioeconomic status including poverty, education, income and unemployment. Using air quality simulated for the period between 2008 and 2012 over the continental U.S. we also characterized the population size at risk with respect to the level and duration of exposure to fire-originated fine particulate matter (fire-PM2.5) and CHVI. We estimate that 10% of the population (30.5 million) lived in the areas where the contribution of fire-PM2.5 to annual average ambient PM2.5 was high (>1.5 µg m3) and that 10.3 million individuals experienced unhealthy air quality levels for more than 10 days due to smoke. Using CHVI we identified the most vulnerable counties and determined that these communities experience more smoke exposures in comparison to less vulnerable communities. We describe the development of an index of community vulnerability for the health effects of smoke based o

Corporate Philanthropy Toward Community Health Improvement in Manufacturing Communities.

PubMed

McHugh, Megan; Farley, Diane; Maechling, Claude R; Dunlop, Dorothy D; French, Dustin D; Holl, Jane L

2018-06-01

Virtually all large employers engage in corporate philanthropy, but little is known about the extent to which it is directed toward improving community health. We conducted in-depth interviews with leaders of corporate philanthropy from 13 of the largest manufacturing companies in the US to understand how giving decisions were made, the extent to which funding was directed towards improving community health, and whether companies coordinate with local public health agencies. We found that corporate giving was sizable and directed towards communities in which the manufacturers have a large presence. Giving was aligned with the social determinants of health (i.e., aimed at improving economic stability, the neighborhood and physical environment, education, food security and nutrition, the community and social context, and the health care system). However, improving public health was not often cited as a goal of corporate giving, and coordination with public health agencies was limited. Our results suggest that there may be opportunities for public health agencies to help guide corporate philanthropy, particularly by sharing community-level data and offering their measurement and evaluation expertise.

Amplifying Health Through Community Gardens: A Framework for Advancing Multicomponent, Behaviorally Based Neighborhood Interventions.

PubMed

Alaimo, Katherine; Beavers, Alyssa W; Crawford, Caroline; Snyder, Elizabeth Hodges; Litt, Jill S

2016-09-01

The article presents a framework for understanding the relationship between community garden participation, and the myriad ways gardens and participation lead to emotional, social, and health impacts. Existing empirical research relating community gardens to health behaviors, such as physical activity and diet, and longer-term chronic disease-related outcomes is summarized. The research areas discussed include the effects of community garden participation on individual, social, emotional, and environmental processes; health behaviors including diet and physical activity; and health outcomes such as self-rated health, obesity, and mental health. Other mechanisms through which community gardens may affect population health are described. Applying a multitheoretical lens to explore associations between community garden participation and health enables us to delineate key aspects of gardening that elicit positive health behaviors and multifactorial health assets that could be applied to designing other types of health interventions.

Approaches to dog health education programs in Australian rural and remote Indigenous communities: four case studies.

PubMed

Constable, S E; Dixon, R M; Dixon, R J; Toribio, J-A

2013-09-01

Dog health in rural and remote Australian Indigenous communities is below urban averages in numerous respects. Many Indigenous communities have called for knowledge sharing in this area. However, dog health education programs are in their infancy, and lack data on effective practices. Without this core knowledge, health promotion efforts cannot progress effectively. This paper discusses a strategy that draws from successful approaches in human health and indigenous education, such as dadirri, and culturally respectful community engagement and development. Negotiating an appropriate education program is explored in its practical application through four case studies. Though each case was unique, the comparison of the four illustrated the importance of listening (community consultation), developing and maintaining relationships, community involvement and employment. The most successful case studies were those that could fully implement all four areas. Outcomes included improved local dog health capacity, local employment and engagement with the program and significantly improved dog health.

Beacon communities' public health initiatives: a case study analysis.

PubMed

Massoudi, Barbara L; Marcial, Laura H; Haque, Saira; Bailey, Robert; Chester, Kelley; Cunningham, Shellery; Riley, Amanda; Soper, Paula

2014-01-01

The Beacon Communities for Public Health (BCPH) project was launched in 2011 to gain a better understanding of the range of activities currently being conducted in population- and public health by the Beacon Communities. The project highlighted the successes and challenges of these efforts with the aim of sharing this information broadly among the public health community. The Beacon Community Program, designed to showcase technology-enabled, community-based initiatives to improve outcomes, focused on: building and strengthening health information technology (IT) infrastructure and exchange capabilities; translating investments in health IT to measureable improvements in cost, quality, and population health; and, developing innovative approaches to performance measurement, technology, and care delivery. Four multimethod case studies were conducted based on a modified sociotechnical framework to learn more about public health initiative implementation and use in the Beacon Communities. Our methodological approach included using document review and semistructured key informant interviews. NACCHO Model Practice Program criteria were used to select the public health initiatives included in the case studies. Despite differences among the case studies, common barriers and facilitators were found to be present in all areas of the sociotechnical framework application including structure, people, technology, tasks, overarching considerations, and sustainability. Overall, there were many more facilitators (range = 7-14) present for each Beacon compared to barriers (range = 4-6). Four influential promising practices were identified through the work: forging strong and sustainable partnerships; ensuring a good task-technology fit and a flexible and iterative design; fostering technology acceptance; and, providing education and demonstrating value. A common weakness was the lack of a framework or model for the Beacon Communities evaluation work. Sharing a framework or approach

Building community and public health nursing capacity: a synthesis report of the National Community Health Nursing Study.

PubMed

Underwood, Jane M; Mowat, David L; Meagher-Stewart, Donna M; Deber, Raisa B; Baumann, Andrea O; MacDonald, Mary B; Akhtar-Danesh, Noori; Schoenfeld, Bonnie M; Ciliska, Donna K; Blythe, Jennifer M; Lavoie-Tremblay, Mélanie; Ehrlich, Anne S; Knibbs, Kristin M; Munroe, Valerie J

2009-01-01

1) To describe the community health nursing workforce in Canada; 2) To compare, across political jurisdictions and community health sectors, what helps and hinders community nurses to work effectively; 3) To identify organizational attributes that support one community subsector--public health nurses--to practise the full scope of their competencies. Our study included an analysis of the Canadian Institute for Health Information nursing databases (1996-2007), a survey of over 13,000 community health nurses across Canada and 23 focus groups of public health policy-makers and front-line public health nurses. Over 53,000 registered and licensed practical nurses worked in community health in Canada in 2007, about 16% of the nursing workforce. Community nurses were older on average than the rest of their profession. Typical practice settings for community nurses included community health centres, home care and public health units/departments. To practise effectively, community nurses need professional confidence, good team relationships, supportive workplaces and community support. Most community nurses felt confident in their practice and relationships with other nurses and professionals, though less often with physicians. Their feelings about salary and job security were mixed, and most community nurses would like more learning opportunities, policy and practice information and chances to debrief about work. They needed their communities to do more to address social determinants of health and provide good quality resources. Public health nursing needs a combination of factors to succeed: sound government policy, supportive organizational culture and good management practices. Organizational attributes identified as supports for optimal practice include: flexibility in funding, program design and job descriptions; clear organizational vision driven by shared values and community needs; coordinated public health planning across jurisdictions; and strong leadership that

Enviromental Health Risks on Community in Coastal Area As a Results The Presence of Pb in Sea Water and Drinking Water.

NASA Astrophysics Data System (ADS)

Malem Indirawati, Sri; Pandia, Setiaty; Mawengkang, Herman; Hasan, Wirsal

2018-01-01

The burden of pollution due to industrial waste, ports, community activities and marine intrusion further exacerbate environmental quality. This pollution causes drinking water sources polluted. This study aims to analyze Pb contamination in marine, and drinking water from wellbores and measure the magnitude of health risks. This is cross sectional study and quantitative research that analyzes Pb concentrations in marine and drinking water. The sample are 250 people who live in coastal area and drink water from wellbores. Water samples were examined in certified laboratories by using Atomic Absorbstion Spectrophotometer method, health risk was analyzed by the environmental health risk (EHRA) method. Pb concentrations average in marine is 52 μgl-1 . Pb concentration from 92 samples of drinking water average is 4.5 μgl-1 and range 5.4 - 26.2 μgl-1. The amount of health risk RQ <1, which means that it has not shown risk yet. Pb exceeded the environmental quality standard in marine, There are 14.7% of people consuming Pb contaminated drinking water. Community complaints found at the study sites were diarrhea 22.8% and dizziness 17.2% and skin disease 17.2%, upper respiratory tract infection, rheumatism and hypertension.

Perceptions of newly admitted undergraduate medical students on experiential training on community placements and working in rural areas of Uganda.

PubMed

Kaye, Dan K; Mwanika, Andrew; Sekimpi, Patrick; Tugumisirize, Joshua; Sewankambo, Nelson

2010-06-23

Uganda has an acute problem of inadequate human resources partly due to health professionals' unwillingness to work in a rural environment. One strategy to address this problem is to arrange health professional training in rural environments through community placements. Makerere University College of Health Sciences changed training of medical students from the traditional curriculum to a problem-based learning (PBL) curriculum in 2003. This curriculum is based on the SPICES model (student-centered, problem-based, integrated, community-based and services oriented). During their first academic year, students undergo orientation on key areas of community-based education, after which they are sent in interdisciplinary teams for community placements. The objective was to assess first year students' perceptions on experiential training through community placements and factors that might influence their willingness to work in rural health facilities after completion of their training. The survey was conducted among 107 newly admitted first year students on the medical, nursing, pharmacy and medical radiography program students, using in-depth interview and open-ended self-administered questionnaires on their first day at the college, from October 28-30, 2008. Data was collected on socio-demographic characteristics, motivation for choosing a medical career, prior exposure to rural health facilities, willingness to have part of their training in rural areas and factors that would influence the decision to work in rural areas. Over 75% completed their high school from urban areas. The majority had minimal exposure to rural health facilities, yet this is where most of them will eventually have to work. Over 75% of the newly admitted students were willing to have their training from a rural area. Perceived factors that might influence retention in rural areas include the local context of work environment, support from family and friends, availability of continuing

Air Pollution Affects Community Health

ERIC Educational Resources Information Center

Shy, Carl M.; Finklea, John F.

1973-01-01

Community Health and Environmental Surveillance System (CHESS), a nationwide program relating community health to environmental quality, is designed to evaluate existing environmental standards, obtain health intelligence for new standards, and document health benefits of air pollution control. (BL)

A Bold Goal: More Healthy Days Through Improved Community Health.

PubMed

Cordier, Tristan; Song, Yongjia; Cambon, Jesse; Haugh, Gil S; Steffen, Mark; Hardy, Patty; Staehly, Marnie; Hagan, Angela; Gopal, Vipin; Tye, Pattie Dale; Renda, Andrew

2017-11-10

Humana, a large health care company, has set a goal of 20% improvement in health in the communities it serves by 2020. The metric chosen for the Bold Goal initiative was the HRQOL-4 version of the Centers for Disease Control and Prevention (CDC) Healthy Days survey. This paper presents the methods for measuring progress, reports results for the first year of tracking, and describes Humana's community-based interventions. Across 7 specially designated "Bold Goal" communities, mean unhealthy days declined from 10.98 in 2015 to 10.64 in 2016, which represented a 3.1% relative, or 0.34 absolute, decline. This compares with a 0.17 absolute unhealthy days decline in Humana's national population overall. The paper also describes how additional work identifying associations between social determinants of health (SDOH) and Healthy Days is influencing Humana's strategy. Lastly, a strategy of community engagement is illustrated through 2 case examples: San Antonio and Knoxville. In the San Antonio area, the community in which Humana has been involved the longest, unhealthy days dropped by 9.0% (-0.95 absolute) from a mean 10.52 to 9.57 unhealthy days. In Knoxville, one of the newer areas of engagement, mean unhealthy days declined by 4.8% (-0.61 absolute), representing declines in both physically and mentally unhealthy days. Overall, results are encouraging, and Humana expects declines to accelerate over time as initiatives are launched and scaled in Bold Goal communities.

A Bold Goal: More Healthy Days Through Improved Community Health

PubMed Central

Cordier, Tristan; Song, Yongjia; Cambon, Jesse; Haugh, Gil S.; Steffen, Mark; Hardy, Patty; Staehly, Marnie; Hagan, Angela; Gopal, Vipin; Tye, Pattie Dale

2018-01-01

Abstract Humana, a large health care company, has set a goal of 20% improvement in health in the communities it serves by 2020. The metric chosen for the Bold Goal initiative was the HRQOL-4 version of the Centers for Disease Control and Prevention (CDC) Healthy Days survey. This paper presents the methods for measuring progress, reports results for the first year of tracking, and describes Humana's community-based interventions. Across 7 specially designated “Bold Goal” communities, mean unhealthy days declined from 10.98 in 2015 to 10.64 in 2016, which represented a 3.1% relative, or 0.34 absolute, decline. This compares with a 0.17 absolute unhealthy days decline in Humana's national population overall. The paper also describes how additional work identifying associations between social determinants of health (SDOH) and Healthy Days is influencing Humana's strategy. Lastly, a strategy of community engagement is illustrated through 2 case examples: San Antonio and Knoxville. In the San Antonio area, the community in which Humana has been involved the longest, unhealthy days dropped by 9.0% (−0.95 absolute) from a mean 10.52 to 9.57 unhealthy days. In Knoxville, one of the newer areas of engagement, mean unhealthy days declined by 4.8% (−0.61 absolute), representing declines in both physically and mentally unhealthy days. Overall, results are encouraging, and Humana expects declines to accelerate over time as initiatives are launched and scaled in Bold Goal communities. PMID:29125796

Education resources in remote Australian Indigenous community dog health programs: a comparison of community and extra-community-produced resources.

PubMed

Constable, Sophie Elizabeth; Dixon, Roselyn May; Dixon, Robert John

2013-09-01

Commercial dog health programs in Australian Indigenous communities are a relatively recent occurrence. Health promotion for these programs is an even more recent development, and lacks data on effective practices. This paper analyses 38 resources created by veterinary-community partnerships in Indigenous communities, to 71 resources available through local veterinary service providers. On average, community-produced resources used significantly more of the resource area as image, more imagery as communicative rather than decorative images, larger fonts and smaller segments of text and used images of people with a range of skin tones. As well as informal registers of Standard Australian English, community-produced resources used Aboriginal English and/or Creole languages in their text, while extra-community (EC)-produced resources did not. The text of EC resources had Flesh-Kincaid reading grade levels that excluded a large proportion of community recipients. Also, they did not cover some topics of importance in communities, used academic, formal and technical language, and did not depict people of a representative range of skin tones. As such, community-produced resources were more relevant to the unique situations in remote communities, while EC resources were often inappropriate and in some cases could even distance recipients by using inappropriate language, formats and imagery.

Report of a Resident Health-Medical Care Survey. Southwest New Mexico Community Health Education Systems.

ERIC Educational Resources Information Center

Poulsen, Roger L.

This survey was conducted to provide informational inputs for planning and establishing a community health education system in southwest New Mexico. Information was gathered concerning the opinions of typical area residents regarding needed health-medical care facilities, personnel training needs, services, personnel requisite to their well-being,…

Health education and community participation in the control of urinary schistosomiasis in Ghana.

PubMed

Aryeetey, M E; Aholu, C; Wagatsuma, Y; Bentil, G; Nkrumah, F K; Kojima, S

1999-06-01

To study the role of health education and community participation for the provision of facilities necessary for the control of urinary schistosomiasis in southern Ghana. Health education facilitates community participation in the provision of facilities for the control of bilharzia. Three rural communities drained by the Densu river in southern Ghana. Individuals aged 14 years and above formed groups of 10-12 persons by age, sex, ethnic and educational background; 15-16 groups were formed. Based on existing structures, one community received active, another passive health education and the third had no education. All three communities received chemotherapy. Study was carried out in three phases: pre-intervention phase--during which baseline data on residents' knowledge, attitude, beliefs and perception about bilharzia were collected using focus group discussions (FGD) prior to the second phase, intervention. Another FGD was held after 18 months to evaluate the intervention--third phase. This study suggests that most community members were aware of schistosomiasis but not as a disease. Before the health education, some residents believed bilharzia was a sign of manhood while others attributed the red colour of the urine to the red colour of a variety of sugar cane eaten in the area. After the health education, residents in the three areas constructed hand-dug wells. In addition, those who received active health education constructed two toilets for the schools and weeded the banks of the rivers. Residents also associated the disease with the water snail. Health education was useful in changing community perception on bilharzia.

Health literacy in a community with low levels of education: findings from Chakaria, a rural area of Bangladesh.

PubMed

Das, Susmita; Mia, Mohammad Nahid; Hanifi, Syed Manzoor Ahmed; Hoque, Shahidul; Bhuiya, Abbas

2017-02-16

Health literacy (HL) helps individuals to make effective use of available health services. In low-income countries such as Bangladesh, the less than optimum use of services could be due to low levels of HL. Bangladesh's health service delivery is pluralistic with a mix of public, private and informally trained healthcare providers. Emphasis on HL has been inadequate. Thus, it is important to assess the levels of HL and service utilization patterns. The findings from this study aim to bridge the knowledge gap. The data for this study came from a cross-sectional survey carried out in September 2014, in Chakaria, a rural area in Bangladesh. A total of 1500 respondents were randomly selected from the population of 80,000 living in the Chakaria study area of icddr, b (International Centre for Diarrhoeal Disease Research, Bangladesh). HL was assessed in terms of knowledge of existing health facilities and sources of information on health care, immunization, diabetes and hypertension. Descriptive and cross-tabular analyses were carried out. Chambers of the rural practitioners of allopathic medicine, commonly known as 'village doctors', were mentioned by 86% of the respondents as a known health service facility in their area, followed by two public sector community clinics (54.6%) and Union Health and Family Welfare Centres (28.6%). Major sources of information on childhood immunization were government health workers. Almost all of the respondents had heard about diabetes and hypertension (97.4% and 95.4%, respectively). The top three sources of information for diabetes were neighbours (85.7%), followed by relatives (27.9%) and MBBS (Bachelor of Medicine and Bachelor of Surgery) doctors (20.4%). For hypertension, the sources were neighbours (78.0%), followed by village doctors (38.2%), MBBS doctors (23.2%) and relatives (15%). The proportions of respondents who knew diabetes and hypertension control measures were 40.9% and 28.0%, respectively. More females knew about the

Health surveillance assistants as intermediates between the community and health sector in Malawi: exploring how relationships influence performance.

PubMed

Kok, Maryse C; Namakhoma, Ireen; Nyirenda, Lot; Chikaphupha, Kingsley; Broerse, Jacqueline E W; Dieleman, Marjolein; Taegtmeyer, Miriam; Theobald, Sally

2016-05-03

There is increasing global interest in how best to support the role of community health workers (CHWs) in building bridges between communities and the health sector. CHWs' intermediary position means that interpersonal relationships are an important factor shaping CHW performance. This study aimed to obtain in-depth insight into the facilitators of and barriers to interpersonal relationships between health surveillance assistants (HSAs) and actors in the community and health sector in hard-to-reach settings in two districts in Malawi, in order to inform policy and practice on optimizing HSA performance. The study followed a qualitative design. Forty-four semi-structured interviews and 16 focus group discussions were conducted with HSAs, different community members and managers in Mchinji and Salima districts. Data were recorded, transcribed, translated, coded and thematically analysed. HSAs had relatively strong interpersonal relationships with traditional leaders and volunteers, who were generally supportive of their work. From the health sector side, HSAs linked to health professionals and managers, but found them less supportive. Accountability structures at the community level were not well-established and those within the health sector were executed irregularly. Mistrust from the community, volunteers or HSAs regarding incentives and expectations that could not be met by "higher levels" undermined support structures and led to demotivation and hampered performance. Supervision and training were sometimes a source of mistrust and demotivation for HSAs, because of the perceived disinterest of supervisors, uncoordinated supervision and favouritism in selection of training participants. Rural HSAs were seen as more disadvantaged than HSAs in urban areas. HSAs' intermediary position necessitates trusting relationships between them and all actors within the community and the health sector. There is a need to improve support and accountability structures that

New Mexico Community Health Councils: Documenting Contributions to Systems Changes.

PubMed

Sánchez, Victoria; Andrews, Mark L; Carrillo, Christina; Hale, Ron

2015-01-01

Coalition research has shifted from delineating structures and processes to identifying intermediate, systems changes (e.g., changes in policies) that contribute to longterm community health improvement. The University of New Mexico, the New Mexico Department of Health, and community health councils entered a multiyear participatory evaluation process to answer: What actions did health councils take that led to improving health through intermediate, systems changes? The evaluation system was created over several phases through an iterative, participatory process. Data were collected for councils' health priority areas (e.g., substance abuse) from 2009 to 2011. Twenty-three community health councils participated. Intermediate systems changes were measured: 1) networking and partnering, 2) joint planning of strategies, programs, and services, 3) leveraging resources, and 4) policy initiatives. Health councils reported data for each intermediate outcome by health priority area. Data showed councils identified local public health priorities and addressed those priorities through strengthening networks and partnerships, which lead to the creation and enhancement of strategies, services, and programs. Data also showed councils influenced policies in several ways (e.g., developing policy, identifying new policy, or sponsoring informational forums). Additionally, data showed councils leveraged $1.10 for every dollar invested by the state. When funding was suspended in July 2010, data showed dramatic decreases in activity levels from 2010 to 2011. The data demonstrate the feasibility and utility of an Internet-based system designed to gather intermediate systems changes evaluation data. This process is a model for similar efforts to capture common outcomes across diverse coalitions and partnerships.

Technology for community health alliances.

PubMed

Luce, Peggy; Phillips, Jill; Benjamin, Regina; Wasson, John H

2004-01-01

A community health alliance brings together divergent interests within a community for the betterment of personal and population health. In this report we describe how a community responsive strategy in Chicago is facilitating the improvement of healthcare by providing local information of what needs to be done, supporting change at the practice level to meet these needs, and initiating community-wide approaches to manage prevalent and important needs without waiting for direct involvement of health professionals.

Health journalists' perceptions of their communities and implications for the delivery of health information in the news.

PubMed

Friedman, Daniela B; Tanner, Andrea; Rose, India D

2014-04-01

Journalists have a unique opportunity to educate the community about public health and health care. In order for health communication messages to be effective, characteristics of the intended audience must be considered. Limited attention has been given to health journalists' perceptions of their target communities and little is known about how journalists' perceptions may impact the delivery of health information in the news. Fifteen in-depth telephone interviews were conducted with health journalists from varying geographic regions and media market sizes. Interview questions examined health journalists' perceptions of their target communities, the content and delivery of their health-related stories, and the current state of health journalism. Interviews were audio-recorded for transcription and thematic analysis. Health journalists perceived their audiences to be primarily mothers and adults with limited education. Participants reported they often used personal stories and strong headlines to engage their communities. They also stated that their news stories were quite technical and may not have been written at an appropriate reading level for their audience. When asked about the current state of health journalism, participants reported that there were areas for improvement. Journalists stated that increased collaborations with public health practitioners would improve their own understanding of health and medical information and allow them to develop health news content that was more appropriate for their target communities.

Changing community health service delivery in economically less-developed rural areas in China: impact on service use and satisfaction

PubMed Central

Liu, Yong; Yuan, Zhaokang; Liu, Yuxi; Jayasinghe, Upali W; Harris, Mark F

2014-01-01

Objective To evaluate the impact of a model of rural community health service (CHS) on the use and acceptability of primary healthcare services. Design Quasi-experimental. Setting Two adjacent rural counties in China. Participants 5842 residents in 2009 and 3807 in 2010 from 980 households in 7 intervention townships and 49 villages; 2232 residents in 2009 and 2315 in 2010 from 628 households in 3 comparison townships and 9 villages. All residents were approached to participate, with no significant differences in age or sex between groups. Intervention Multilevel intervention in 2009 including training rural practitioners, encouraging clinic improvements, providing clinical guidelines, standards and subsidies. Data collection Surveys of community members from randomly sampled households in 2009 and 2010. Primary outcome measures Satisfaction with and utilisation of outpatient and public health services. Analysis Factor analysis confirmed two components of satisfaction. Univariate and multilevel analysis was used. Results Satisfaction scores for intervention county respondents increased from 21.4 (95% CI 21.1 to 21.7) to 22.1 (95% CI 21.7 to 22.4) with no change in comparison area. In multilevel analysis, satisfaction with patient-centred care was associated with chronic disease, shorter waiting times and county. Satisfaction with clinic environment and cost was associated with female gender, shorter waiting times but not county. The proportion of children receiving immunisation in intervention village clinics increased from 42.5% (95% CI 27.9% to 47.1%) to 59.2% (95% CI 53.8% to 64.6%) whereas this decreased in comparison villages (16.5%; 95% CI 10.3% to 22.7% to 6.0%; 95% CI 1.3% to 10.7%). Antenatal visits increased in intervention villages (from 69.0%, 95% CI 65.8% to 73.1% to 75.8%, 95% CI 72.2% to 79.4%) with no change in comparison villages. Conclusions Introduction of a CHS model adapted to economically less-developed rural areas was associated with some

The ECHI project: health indicators for the European Community.

PubMed

Kramers, Pieter G N

2003-09-01

Within the EU Health Monitoring Programme (HMP), the ECHI project has proposed a comprehensive list of 'European Community Health Indicators'. In the design of the indicator set, a set of explicit criteria was applied. These included: i) be comprehensive and coherent, i.e. cover all domains of the public health field; ii) take account of earlier work, especially that by WHO-Europe, OECD and Eurostat; and iii) cover the priority areas that Member States and Community health policies currently pursue. Flexibility is an important characteristic of the present proposal. In ECHI, this has been emphasized by the definition of 'user-windows'. These are subsets from the overall indicator list, each of which should reflect a specific user's requirement or interest. The proposed indicators are, in most cases, defined as generic indicators, i.e. their actual operational definitions have not yet been attempted. This work has been, and is being carried out to a large part by other projects financed under the HMP, which cover specific areas of public health or areas of data collection. Apart from indicators covered by regularly available data, indicators (or issues) have been proposed for which data are currently difficult to collect but which from a policy point of view would be needed. All this points to the fact that establishing an indicator list which is actually used by Member States is a continuously developing process. This process is now continued by the first strand of the new EU Public Health Action Programme.

Community mental health accreditation: a pilot study.

PubMed

Dorgan, R E; Gerhard, R J; Kennard, E D

1977-01-01

The Balanced Services System is the conceptual framework for the newly initiated community mental health accreditation program sponsored by the Joint Commission on Accreditation of Hospitals (JCAH). The program design and performance of CMH systems are reviewed and judged according to a series of evaluation criteria that prescribe the desired operating state for each functional area in the center.

Cost-effectiveness of the community-based management of severe acute malnutrition by community health workers in southern Bangladesh.

PubMed

Puett, Chloe; Sadler, Kate; Alderman, Harold; Coates, Jennifer; Fiedler, John L; Myatt, Mark

2013-07-01

This study assessed the cost-effectiveness of adding the community-based management of severe acute malnutrition (CMAM) to a community-based health and nutrition programme delivered by community health workers (CHWs) in southern Bangladesh. The cost-effectiveness of this model of treatment for severe acute malnutrition (SAM) was compared with the cost-effectiveness of the 'standard of care' for SAM (i.e. inpatient treatment), augmented with community surveillance by CHWs to detect cases, in a neighbouring area. An activity-based cost model was used, and a societal perspective taken, to include all costs incurred in the programme by providers and participants for the management of SAM in both areas. Cost data were coupled with programme effectiveness data. The community-based strategy cost US$26 per disability-adjusted life year (DALY) averted, compared with US$1344 per DALY averted for inpatient treatment. The average cost to participant households for their child to recover from SAM in community treatment was one-sixth that of inpatient treatment. These results suggest that this model of treatment for SAM is highly cost-effective and that CHWs, given adequate supervision and training, can be employed effectively to expand access to treatment for SAM in Bangladesh.

Traffic-related air pollution and sleep in the Boston Area Community Health Survey.

PubMed

Fang, Shona C; Schwartz, Joel; Yang, May; Yaggi, H Klar; Bliwise, Donald L; Araujo, Andre B

2015-01-01

Little is known about environmental determinants of sleep. We investigated the association between black carbon (BC), a marker of traffic-related air pollution, and sleep measures among participants of the Boston Area Community Health Survey. We also sought to assess the impact of sociodemographic factors, health conditions, and season on associations. Residential 24-h BC was estimated from a validated land-use regression model for 3821 participants and averaged over 1-6 months and 1 year. Sleep measures included questionnaire-assessed sleep duration, sleep latency, and sleep apnea. Linear and logistic regression models controlling for confounders estimated the association between sleep measures and BC. Effect modification was tested with interaction terms. Main effects were not observed between BC and sleep measures. However, in stratified models, males experienced 0.23 h less sleep (95% CI: -0.42, -0.03) and those with low SES 0.25 h less sleep (95% CI: -0.48, -0.01) per IQR increase in annual BC (0.21 μg/m(3)). In blacks, sleep duration increased with annual BC (β=0.34 per IQR; 95% CI: 0.12, 0.57). Similar findings were observed for short sleep (≤5 h). BC was not associated with sleep apnea or sleep latency, however, long-term exposure may be associated with shorter sleep duration, particularly in men and those with low SES, and longer sleep duration in blacks.

Translating the Birmingham Neighborhood Leaders Survey into Innovative Action through the Community Health Innovation Awards.

PubMed

Allen, Shauntice; Pineda, Alaina; Hood, Anthony C; Wakelee, Jessica F

2017-01-01

The Carnegie Foundation for the Advancement of Teaching describes community engagement as the collaboration between higher education institutions and their larger communities (local, regional/state, national, global) for the mutually beneficial exchange of knowledge and resources in a context of partnership. This article describes the development, implementation and outcomes of a community-engaged grant-making program, the Community Health Innovation Awards (CHIA). The CHIA program was the by-product of a qualitative study jointly led by researchers at the University of Alabama at Birmingham and neighborhood leaders from the surrounding communities in Birmingham, AL. The competitive program provided funding to area organizations that proposed creative solutions to on-the-ground health challenges. Since its inception, CHIA has awarded $356,500 to 26 innovative projects between 2012 and 2017. These awards have supported novel programs that have connected academic and community partners in addressing health disparities and improving overall community well-being in the greater Birmingham area.

Listening to Community Health Workers: How Ethnographic Research Can Inform Positive Relationships Among Community Health Workers, Health Institutions, and Communities

PubMed Central

Closser, Svea; Kalofonos, Ippolytos

2014-01-01

Many actors in global health are concerned with improving community health worker (CHW) policy and practice to achieve universal health care. Ethnographic research can play an important role in providing information critical to the formation of effective CHW programs, by elucidating the life histories that shape CHWs’ desires for alleviation of their own and others’ economic and health challenges, and by addressing the working relationships that exist among CHWs, intended beneficiaries, and health officials. We briefly discuss ethnographic research with 3 groups of CHWs: volunteers involved in HIV/AIDS care and treatment support in Ethiopia and Mozambique and Lady Health Workers in Pakistan. We call for a broader application of ethnographic research to inform working relationships among CHWs, communities, and health institutions. PMID:24625167

Listening to community health workers: how ethnographic research can inform positive relationships among community health workers, health institutions, and communities.

PubMed

Maes, Kenneth; Closser, Svea; Kalofonos, Ippolytos

2014-05-01

Many actors in global health are concerned with improving community health worker (CHW) policy and practice to achieve universal health care. Ethnographic research can play an important role in providing information critical to the formation of effective CHW programs, by elucidating the life histories that shape CHWs' desires for alleviation of their own and others' economic and health challenges, and by addressing the working relationships that exist among CHWs, intended beneficiaries, and health officials. We briefly discuss ethnographic research with 3 groups of CHWs: volunteers involved in HIV/AIDS care and treatment support in Ethiopia and Mozambique and Lady Health Workers in Pakistan. We call for a broader application of ethnographic research to inform working relationships among CHWs, communities, and health institutions.

Perspectives on utilization of community based health information systems in Western Kenya.

PubMed

Flora, Otieno Careena; Margaret, Kaseje; Dan, Kaseje

2017-01-01

Health information systems (HIS) are considered fundamental for the efficient delivery of high quality health care. However, a large number of legal and practical constraints influence the design and introduction of such systems. The inability to quantify and analyse situations with credible data and to use data in planning and managing service delivery plagues Africa. Establishing effective information systems and using this data for planning efficient health service delivery is essential to district health systems' performance improvement. Community Health Units in Kenya are central points for community data collection, analysis, dissemination and use. In Kenya, data tend to be collected for reporting purposes and not for decision-making at the point of collection. This paper describes the perspectives of local users on information use in various socio-economic contexts in Kenya. Information for this study was gathered through semi-structured interviews. The interviewees were purposefully selected from various community health units and public health facilities in the study area. The data were organized and analysed manually, grouping them into themes and categories. Information needs of the community included service utilization and health status information. Dialogue was the main way of information utilization in the community. However, health systems and personal challenges impeded proper collection and use of information. The challenges experienced in health information utilization may be overcome by linkages and coordination between the community and the health facilities. The personal challenges can be remedied using a motivational package that includes training of the Community Health Workers.

Community Involvement and Adolescent Mental Health: Moderating Effects of Race/Ethnicity and Neighborhood Disadvantage

ERIC Educational Resources Information Center

Hull, Pamela; Kilbourne, Barbara; Reece, Michelle; Husaini, Baqar

2008-01-01

Social development and stress process theories suggest that participation in one's community can function as a protective factor for mental health, especially for youth from socioeconomically disadvantaged areas. However, the effects of community involvement on adolescent mental health could vary across racial/ethnic groups and levels of…

Relations between retired agricultural land, water quality, and aquatic-community health, Minnesota River Basin

USGS Publications Warehouse

Christensen, Victoria G.; Lee, Kathy E.; McLees, James M.; Niemela, Scott L.

2012-01-01

The relative importance of agricultural land retirement on water quality and aquatic-community health was investigated in the Minnesota River Basin. Eighty-two sites, with drainage areas ranging from 4.3 to 2200 km2, were examined for nutrient concentrations, measures of aquatic-community health (e.g., fish index of biotic integrity [IBI] scores), and environmental factors (e.g., drainage area and amount of agricultural land retirement). The relation of proximity of agricultural land retirement to the stream was determined by calculating the land retirement percent in various riparian zones. Spearman's rho results indicated that IBI score was not correlated to the percentage of agricultural land retirement at the basin scale (p = 0.070); however, IBI score was correlated to retired land percentage in the 50- to 400-m riparian zones surrounding the streams (p < 0.05), indicating that riparian agricultural land retirement may have more influence on aquatic-community health than does agricultural land retirement in upland areas. Multivariate analysis of covariance and analysis of covariance models indicated that other environmental factors (such as drainage area and lacustrine and palustrine features) commonly were correlated to aquatic-community health measures, as were in-stream factors (standard deviation of water depth and substrate type). These results indicate that although agricultural land retirement is significantly related to fish communities as measured by the IBI scores, a combination of basin, riparian, and in-stream factors act together to influence IBI scores.

Factors influencing motivation and job satisfaction among supervisors of community health workers in marginalized communities in South Africa.

PubMed

Akintola, Olagoke; Chikoko, Gamuchirai

2016-09-06

Management and supervision of community health workers are factors that are critical to the success of community health worker programmes. Yet few studies have explored the perspectives of supervisors in these programmes. This study explored factors influencing motivations of supervisors in community health worker programmes. We conducted qualitative interviews with 26 programme staff providing supervision to community health workers in eight community-based organizations in marginalized communities in the greater Durban area of South Africa from July 2010 to September 2011. Findings show that all the supervisors had previous experience working in the health or social services sectors and most started out as unpaid community health workers. Most of the participants were poor women from marginalized communities. Supervisors' activities include the management and supply of material resources, mentoring and training of community health workers, record keeping and report writing. Supervisors were motivated by intrinsic factors like making a difference and community appreciation and non-monetary incentives such as promotion to supervisory positions; acquisition of management skills; participation in capacity building and the development of programmes; and support for educational advancement like salary, bonuses and medical benefits. Hygiene factors that serve to prevent dissatisfaction are salaries and financial, medical and educational benefits attached to the supervisory position. Demotivating factors identified are patients' non-adherence to health advice and alienation from decision-making. Dissatisfiers include working in crime-prevalent communities, remuneration for community health workers (CHWs), problems with material and logistical resources, job insecurity, work-related stressors and navigating the interface between CHWs and management. While participants were dissatisfied with their low remuneration, they were not demotivated but continued to be motivated

[Health-related images and concepts among adolescents living in rural areas of Brazil].

PubMed

Costa, Anny Giselly Milhome da; Vieira, Neiva Francenely Cunha; Gubert, Fabiane do Amaral; Ferreira, Adriana Gomes Nogueira; Scopacasa, Lígia Fernandes; Pinheiro, Patrícia Neyva da Costa

2013-08-01

The objective of this study was to describe health-related images and concepts among adolescents living in rural areas of Brazil, using photography. This was a qualitative community-based participatory study that used the photovoice method for data collection with groups of teenagers. Over a four-month period, 26 participants identified health problems in the rural community, took photographs, and reflected critically on the local reality. The adolescents presented pictures and stories that they organized into research themes and categories, representing inadequate living conditions for appropriate socioeconomic and cultural development and limiting the opportunities for change in this community. The study proved to be a positive health education strategy, involving young people in the community's health and maximizing the voice of teenagers as protagonists in their own history.

Context matters: Community social cohesion and health behaviors in two South African areas.

PubMed

Lippman, Sheri A; Leslie, Hannah H; Neilands, Torsten B; Twine, Rhian; Grignon, Jessica S; MacPhail, Catherine; Morris, Jessica; Rebombo, Dumisani; Sesane, Malebo; El Ayadi, Alison M; Pettifor, Audrey; Kahn, Kathleen

2018-03-01

Understanding how social contexts shape HIV risk will facilitate development of effective prevention responses. Social cohesion, the trust and connectedness experienced in communities, has been associated with improved sexual health and HIV-related outcomes, but little research has been conducted in high prevalence settings. We conducted population-based surveys with adults 18-49 in high HIV prevalence districts in Mpumalanga (n = 2057) and North West Province (n = 1044), South Africa. Community social cohesion scores were calculated among the 70 clusters. We used multilevel logistic regression stratified by gender to assess individual- and group-level associations between social cohesion and HIV-related behaviors: recent HIV testing, heavy alcohol use, and concurrent sexual partnerships. Group-level cohesion was protective in Mpumalanga, where perceived social cohesion was higher. For each unit increase in group cohesion, the odds of heavy drinking among men were reduced by 40% (95%CI 0.25, 0.65); the odds of women reporting concurrent sexual partnerships were reduced by 45% (95%CI 0.19, 1.04; p = 0.06); and the odds of reporting recent HIV testing were 1.6 and 1.9 times higher in men and women, respectively. We identified potential health benefits of cohesion across three HIV-related health behaviors in one region with higher overall evidence of group cohesion. There may be a minimum level of cohesion required to yield positive health effects. Copyright © 2018 Elsevier Ltd. All rights reserved.

House Parties: An Innovative Model for Outreach and Community-Based Health Education.

PubMed

Anderson-Reeves, Timika; Goodman, Jacqueline; Bragg, Brian; Leruth, Chelsey

2017-12-01

Purpose To connect low resource communities to innovative services that address gaps in health access and knowledge. Description We describe the house party model, as a community-based workshop approach to health education developed by the Westside Healthy Start program (WHS) in Chicago, Illinois. Key elements of the WHS house party model include use of community health workers as facilitators, collaboration with participants and community-based organizations, referrals to health care and social services, and engagement strategies such as interactive activities, personal stories, and discussion. Assessment In 2014 and 2015, WHS completed 23 house parties with 271 participants, delivering education on relevant maternal and child health (MCH) topics. Participants demonstrated improvements in knowledge of several health-related areas. About half of participants were able to identify causes or signs of preterm labor prior to the house party, compared to over 80% after. In addition, 94% of participants rated the house party workshops "excellent" or "good". Conclusion House parties are a promising strategy for increasing knowledge about MCH topics and linking hard-to-reach populations to resources in the community.

Building community participatory research coalitions from the ground up: the Philadelphia area research community coalition.

PubMed

Johnson, Jerry C; Hayden, U Tara; Thomas, Nicole; Groce-Martin, Jennine; Henry, Thomas; Guerra, Terry; Walker, Alia; West, William; Barnett, Marina; Kumanyika, Shiriki

2009-01-01

A coalition of formal, large organizations and informal, grassroots organizations, recruited through an open process, contrasts with the usual practice of developing a community-based participatory research (CBPR) coalition with a small number of well-developed organizations. This paper describes the process, developmental challenges, and accomplishments of the Philadelphia Area Research Community Coalition (PARCC). The University of Pennsylvania-Cheyney University of Pennsylvania EXPORT Center established the PARCC, an academic-community research partnership of twenty-two diverse organizations of variable size and with variable experience in health research. The EXPORT Center provided the infrastructure and staff support needed to engage in sustained, face-to-face community outreach and to nurture, coordinate, and facilitate the 2.5-year developmental process. The start-up process, governing principles, activities, challenges, and lessons learned are described. Since its inception, PARCC established core work groups, a governance structure, operating principles, research training activities, community health education projects, and several PARCC-affiliated research projects. Organizations across the spectrum of developmental capacity were major contributors to PARCC. The success of PARCC was based on committed and trusted leadership, preexisting relationships, trust among members from the community and academia, research training, extensive time commitment of members to the coalition's work, and rapid development of work group activities. Building a CBPR coalition from the ground up involving organizations of diverse size and at various stages of development presents unique challenges that can be overcome with committed leadership, clear governance principles, and appropriate infrastructure. Engagement in community-based research during the early stages, while still developing trust, structure, and governance procedures can be accomplished as long as training of

Reactions of community members regarding community health workers' activities as a measure of the impact of a training program in Amazonas, Brazil.

PubMed

Kawasaki, Ryoko; Sadamori, Toru; Ferreira de Almeida, Terezinha; Akiyoshi, Megumi; Nishihara, Mika; Yoshimura, Toshiro; Ohnishi, Mayumi

2015-01-01

The aim of this study was to evaluate the impact of community health worker (CHW) training on recognition and satisfaction regarding the performance of CHWs among members of the community in Amazonas, Brazil, which is a resource-poor area underserved with regard to medical health-care accessibility. Baseline and endline surveys concerning recognition and satisfaction with respect to CHW performance among members of the community were conducted by interview using a questionnaire before and after implementation of a program to strengthen community health projects in Manicoré, Amazonas, Brazil. One of the components of the project was CHW refresher training, which focused on facilitating adequate use of health-care services and providing primary health care, including health guidance. The baseline survey was performed in February 2004 at the beginning of the project, and the endline survey was performed in February 2006 at the end of the project. There were 82 and 120 CHWs working in Manicoré at the times of the baseline and endline surveys, respectively. Statistical analysis was performed to determine the significance of changes in experience with CHW activities, expected functions of CHWs, and satisfaction regarding the performance of CHWs between the baseline and endline surveys. In addition, qualitative analysis was conducted to evaluate the acceptability, feasibility, and sustainability of CHW refresher training. Overall recognition and level of satisfaction regarding CHW performance among members of the community were improved from the baseline to the endline survey, regardless of type of residential area, such as town and/or remote area. Members of the community came to not expect CHWs to "provide strong medicine" (P < 0.001) and "provide injections" (P < 0.001), and came to appreciate "go to hospital with a sick person" (P = 0.031) as a function and role of CHWs. The results of the present study indicated that steady approaches to motivate and support CHWs

Is there any role for community involvement in the community-based health planning and services skilled delivery program in rural Ghana?

PubMed

Sakeah, Evelyn; McCloskey, Lois; Bernstein, Judith; Yeboah-Antwi, Kojo; Mills, Samuel; Doctor, Henry V

2014-08-11

In Ghana, between 1,400 and 3,900 women and girls die annually due to pregnancy related complications and an estimated two-thirds of these deaths occur in late pregnancy through to 48 hours after delivery. The Ghana Health Service piloted a strategy that involved training Community Health Officers (CHOs) as midwives to address the gap in skilled attendance in rural Upper East Region (UER). CHO-midwives collaborated with community members to provide skilled delivery services in rural areas. This paper presents findings from a study designed to assess the extent to which community residents and leaders participated in the skilled delivery program and the specific roles they played in its implementation and effectiveness. We employed an intrinsic case study design with a qualitative methodology. We conducted 29 in-depth interviews with health professionals and community stakeholders. We used a random sampling technique to select the CHO-midwives in three Community-based Health Planning and Services (CHPS) zones for the interviews and a purposive sampling technique to identify and interview District Directors of Health Services from the three districts, the Regional Coordinator of the CHPS program and community stakeholders. Community members play a significant role in promoting skilled delivery care in CHPS zones in Ghana. We found that community health volunteers and traditional birth attendants (TBAs) helped to provide health education on skilled delivery care, and they also referred or accompanied their clients for skilled attendants at birth. The political authorities, traditional leaders, and community members provide resources to promote the skilled delivery program. Both volunteers and TBAs are given financial and non-financial incentives for referring their clients for skilled delivery. However, inadequate transportation, infrequent supply of drugs, attitude of nurses remains as challenges, hindering women accessing maternity services in rural areas. Mutual

[A valid quality system for mental health care: from accountability and control in institutionalised settings to co-creation in small areas and a focus on community vital signs].

PubMed

van Os, J; Delespaul, P H

In a given year, around 25% of the Dutch population may experience significant mental health problems, much more than the mental health service can attend to, given a maximum capacity of 6% of the population per year. Due to the lack of a public mental health system, there is fierce competition over who gets to receive care from mental health services and little control over how the level of needs can be matched with the appropriate intensity of care. As a result, resources are being wasted and both overtreatment and undertreatment are prevalent.
AIM: To propose a valid quality system that benefits the mental health of the entire population and does not simply attend to the symptoms of a strategically selected group.
METHOD: Literature review from an epidemiological and public mental health perspective.
RESULTS: In our view, a valid quality system for mental health care needs to focus on two distinct areas. The first area involves the analysis of about 20 quantitative population parameters or 'Community Vital Signs' (care consumption, pharmaco-epidemiological indicators, mortality, somatic morbidity, social care, housing, work, benefits, involuntary admissions). This analysis will reveal regional variation in the mental health of the entire population rather than in the relatively small, selected group receiving mental health care. The second area to which attention needs to be directed comprises a system of simple qualitative visits to mental health care institutions based on 10 quality parameters that currently remain invisible; these parameters will measure the impact at local community level. The focus of these will be on a transition from accountability and control in large institutions to provision of care in small areas that was co-designed with users and other stakeholders.
CONCLUSION: A valid quality system for mental health care is within reach, provided it is combined with a novel system of public mental health and transition of care

Cross-sectional study of area-level disadvantage and glycaemic-related risk in community health service users in the Southern.IML Research (SIMLR) cohort.

PubMed

Cross, Roger; Bonney, Andrew; Mayne, Darren J; Weston, Kathryn M

2017-09-19

Objectives The aim of the present study was to determine the association between area-level socioeconomic disadvantage and glycaemic-related risk in health service users in the Illawarra-Shoalhaven region of New South Wales, Australia. Methods HbA1c values recorded between 2010 and 2012 for non-pregnant individuals aged ≥18 years were extracted from the Southern.IML Research (SIMLR) database. Individuals were assigned quintiles of the Socioeconomic Indices for Australia (SEIFA) Index of Relative Socioeconomic Disadvantage (IRSD) according to their Statistical Area 1 of residence. Glycaemic risk categories were defined as HbA1c 5.0-5.99% (lowest risk), 6.0-7.49% (intermediate risk) and ≥7.5% (highest risk). Logistic regression models were fit with glycaemic risk category as the outcome variable and IRSD as the study variable, adjusting for age and sex. Results Data from 29064 individuals were analysed. Higher disadvantage was associated with belonging to a higher glycaemic risk category in the fully adjusted model (most disadvantaged vs least disadvantaged quintile; odds ratio 1.74, 95% confidence interval 1.58, 1.93; P<0.001). Conclusion In this geocoded clinical dataset, area-level socioeconomic disadvantage was a significant correlate of increased glycaemic-related risk. Geocoded clinical data can inform more targeted use of health service resources, with the potential for improved health care equity and cost-effectiveness. What is known about the topic? The rapid increase in the prevalence of Type 2 diabetes (T2D), both globally and nationally within Australia, is a major concern for the community and public health agencies. Individual socioeconomic disadvantage is a known risk factor for abnormal glucose metabolism (AGM), including T2D. Although small-area-level socioeconomic disadvantage is a known correlate of AGM in Australia, less is known of the association of area-level disadvantage and glycaemic-related risk in individuals with AGM. What does this

Oral health interventions in Australian Aboriginal communities: a review of the literature.

PubMed

Patel, J; Durey, A; Hearn, L; Slack-Smith, L M

2017-09-01

Aboriginal Australians experience significant disparities in oral health with even poorer outcomes reported in rural and remote areas. The high rates of preventable dental disease in Aboriginal communities are a serious concern from a social standpoint and in terms of service provision and health care expenditure. In this review, primary research literature was comprehensively reviewed. Papers were selected if they reported designing or implementing an intervention or oral health programme specific to the needs of Aboriginal communities. Twenty-one publications fulfilled the inclusion criteria with 19 different interventions being described. Interventions were categorized using a classification adapted from the work of Whitehead (2002). The review identified interventions that aimed to reduce early childhood caries, increase services to remote communities, develop the role of Aboriginal health workers, improve oral health literacy, establish water fluoridation and provide periodontal therapy. Implementing successful oral health interventions in Aboriginal communities is a challenge that is compounded by the complex interplay between psychosocial and cultural determinants. Even interventions that follow a rigorous and consultative design have a high failure rate in Aboriginal communities if upstream determinants of health are not adequately understood and addressed. © 2016 Australian Dental Association.

Rural Oregon community perspectives: introducing community-based participatory research into a community health coalition.

PubMed

Young-Lorion, Julia; Davis, Melinda M; Kirks, Nancy; Hsu, Anna; Slater, Jana Kay; Rollins, Nancy; Aromaa, Susan; McGinnis, Paul

2013-01-01

The Community Health Improvement Partnership (CHIP) model has supported community health development in more than 100 communities nationally. In 2011, four rural Oregon CHIPs collaborated with investigators from the Oregon Rural Practice-based Research Network (ORPRN), a component of the Oregon Clinical and Translational Research Institute (OCTRI), to obtain training on research methods, develop and implement pilot research studies on childhood obesity, and explore matches with academic partners. This article summarizes the experiences of the Lincoln County CHIP, established in 2003, as it transitioned from CHIP to Community Health Improvement and Research Partnership (CHIRP). Our story and lessons learned may inform rural community-based health coalitions and academicians who are engaged in or considering Community-based participatory research (CBPR) partnerships. Utilizing existing infrastructure and relationships in community and academic settings provides an ideal starting point for rural, bidirectional research partnerships.

Perspectives on utilization of community based health information systems in Western Kenya

PubMed Central

Flora, Otieno Careena; Margaret, Kaseje; Dan, Kaseje

2017-01-01

Introduction Health information systems (HIS) are considered fundamental for the efficient delivery of high quality health care. However, a large number of legal and practical constraints influence the design and introduction of such systems. The inability to quantify and analyse situations with credible data and to use data in planning and managing service delivery plagues Africa. Establishing effective information systems and using this data for planning efficient health service delivery is essential to district health systems' performance improvement. Community Health Units in Kenya are central points for community data collection, analysis, dissemination and use. In Kenya, data tend to be collected for reporting purposes and not for decision-making at the point of collection. This paper describes the perspectives of local users on information use in various socio-economic contexts in Kenya. Methods Information for this study was gathered through semi-structured interviews. The interviewees were purposefully selected from various community health units and public health facilities in the study area. The data were organized and analysed manually, grouping them into themes and categories. Results Information needs of the community included service utilization and health status information. Dialogue was the main way of information utilization in the community. However, health systems and personal challenges impeded proper collection and use of information. Conclusion The challenges experienced in health information utilization may be overcome by linkages and coordination between the community and the health facilities. The personal challenges can be remedied using a motivational package that includes training of the Community Health Workers. PMID:28904707

Deaf community analysis for health education priorities.

PubMed

Jones, Elaine G; Renger, Ralph; Firestone, Rob

2005-01-01

Deaf persons' access to health-related information is limited by barriers to spoken or written language: they cannot overhear information; they have limited access to television, radio, and other channels for public information; and the average reading level of Deaf adults is at a 3rd to 4th grade level. However, literature searches revealed no published reports of community analysis focusing specifically on health education priorities for Deaf communities. A seven-step community analysis was conducted to learn the health education priorities in Arizona Deaf communities and to inform development of culturally relevant health education interventions in Deaf communities. The word "Deaf" is capitalized to reflect the cultural perspective of the Deaf community. A 14-member Deaf Health Committee collected data using multimethods that included review of state census data, review of national health priorities, key informant interviews, discussions with key community groups, a mail survey (n = 20), and semistructured interviews conducted in sign language with 111 Deaf adults. The community diagnosis with highest priority for health education was vulnerability to cardiovascular disease (CVD). Following completion of the community analysis, a heart-health education intervention (The Deaf Heart Health Intervention) was developed using a train-the-trainer, community health worker model. If this model proves to be effective in addressing vulnerability to CVD, then a similar protocol could be employed to address other health concerns identified in the Deaf community analysis.

Evaluation of health resource utilization efficiency in community health centers of Jiangsu Province, China.

PubMed

Xu, Xinglong; Zhou, Lulin; Antwi, Henry Asante; Chen, Xi

2018-02-20

While the demand for health services keep escalating at the grass roots or rural areas of China, a substantial portion of healthcare resources remain stagnant in the more developed cities and this has entrenched health inequity in many parts of China. At its conception, China's Deepen Medical Reform started in 2012 was intended to flush out possible disparities and promote a more equitable and efficient distribution of healthcare resources. Nearly half a decade of this reform, there are uncertainties as to whether the attainment of the objectives of the reform is in sight. Using a hybrid of panel data analysis and an augmented data envelopment analysis (DEA), we model human resources, material, finance to determine their technical and scale efficiency to comprehensively evaluate the transverse and longitudinal allocation efficiency of community health resources in Jiangsu Province. We observed that the Deepen Medical Reform in China has led to an increase concern to ensure efficient allocation of community health resources by health policy makers in the province. This has led to greater efficiency in health resource allocation in Jiangsu in general but serious regional or municipal disparities still exist. Using the DEA model, we note that the output from the Community Health Centers does not commensurate with the substantial resources (human resources, materials, and financial) invested in them. We further observe that the case is worst in less-developed Northern parts of Jiangsu Province. The government of Jiangsu Province could improve the efficiency of health resource allocation by improving the community health service system, rationalizing the allocation of health personnel, optimizing the allocation of material resources, and enhancing the level of health of financial resource allocation.

Providing animal health services to the poor in Northern Ghana: rethinking the role of community animal health workers?

PubMed

Mockshell, Jonathan; Ilukor, John; Birner, Regina

2014-02-01

The Community Animal Health Workers (CAHWs) system has been promoted as an alternative solution to providing animal health services in marginal areas. Yet, access to quality animal health services still remains a fundamental problem for livestock dependent communities. This paper uses the concepts of accessibility, affordability, and transaction costs to examine the perceptions of livestock keepers about the various animal health service providers. The empirical analysis is based on a survey of 120 livestock-keeping households in the Tolon-Kumbungu and Savelugu-Nanton districts in the Northern Region of Ghana. A multinomial logit model was used to determine the factors that influence households' choice of alternative animal health service providers. The results show that the government para-vets are the most preferred type of animal health service providers while CAHWs are the least preferred. Reasons for this observation include high transaction costs and low performance resulting from limited training. In areas with few or no government para-vets, farmers have resorted to self-treatment or to selling sick animals for consumption, which has undesirable health implications. These practices also result in significant financial losses for farmers. This paper finds that the CAHWs' system is insufficient for providing quality animal health services to the rural poor in marginal areas. Therefore, market-smart alternative solutions requiring strong public sector engagement to support livestock farmers in marginal areas and setting minimum training standards for animal health service providers merit policy consideration.

Sustainability and factors affecting the success of community-based reproductive health programs in rural northwest Ethiopia.

PubMed

Argaw, Daniel; Fanthahun, Mesganaw; Berhane, Yemane

2007-08-01

arious Community-Based Reproductive Health interventions were initiated in many developing countries but their effectiveness has not been evaluated as much as needed. A comparative cross sectional study was carried out in February 2002 among women who participated in community based reproductive health interventions in South Gondar zone, Ethiopia. The study was conducted in eight kebeles taking successful and weak program areas for comparison. Both quantitative and qualitative methods were used for data collection. The qualitative method included key informants interview, and Focus Group Discussions with Community-based reproductive health agents (CBRHAs). A multistage sampling technique was employed to select 792 study subjects for the quantitative part of the study. Awareness of the presence of the CBRHA in the locality, participation in selection of the agents, acceptance of the agent, and evertalking to CBRHA about reproductive health issues were significantly higher in successful than in weak program areas [OR(95% CI) = 2.32 (1.74, 3.08), 3.28 (1.22, 9.27), 6.65 (3.59, 12.43), and 5.05 (3.22, 7.96), respectively]. In multiple logistic regression analysis awareness of presence of CBRHA in the village, acceptance of the CBRHA, and having had discussion with CBRHA maintained significant associations with type of community-based reproductive health program (successful/weak). Focus Group Discussions and Key Informant Interviews revealed better involvement of community leaders and health workers in the process of selecting and supervising CBRHA in successful areas compared to weak areas. The sustainability score of the Community-Based Reproductive Health Program (CBRHP) graded by the program coordinators was 2.92 out of 5. Acceptance of the CBRHAs, communication of the agents with community members, level of Support to the agents, better involvement of community representatives in the selection process were found to be the major factors affecting CBRHP. Overall

Residual Barriers for Utilization of Maternal and Child Health Services: Community Perceptions From Rural Pakistan

PubMed Central

Memon, Zahid; Zaidi, Shehla; Riaz, Atif

2016-01-01

Low utilization of maternal and child care services in rural areas has constrained Pakistan from meeting targets of Millennium Development Goals (MDGs) 4 and 5. This study explores community barriers in accessing Maternal and Child Health (MCH) services in ten remote rural districts of Pakistan. It further presents how the barriers differ across a range of MCH services, and also whether the presence of Community Health Workers (CHWs) reduces client barriers. Qualitative methods were used involving altogether sixty focus group discussions with mothers, their spouses and community health workers. Low awareness, formidable distances, expense, and poorly functional services were the main barriers reported, while cultural and religious restrictions were lesser reported. For preventive services including antenatal care (ANC), facility deliveries, postnatal care (PNC), childhood immunization and family planning, the main barrier was low awareness. Conversely, formidable distances and poorly functional services were the main reported constraints in the event of maternal complications and acute child illnesses. The study also found that clients residing in areas served by CHWs had better awareness only of ANC and family planning, while other MCH services were overlooked by the health worker program. The paper highlights that traditional policy emphasis on health facility infrastructure expansion is not likely to address poor utilization rates in remote rural areas. Preventive MCH services require concerted attention to building community awareness, task shifting from facility to community for services provision, and re-energization of CHW program. For maternal and child emergencies there is strong community demand to utilize health facilities, but this will require catalytic support for transport networks and functional health care centers. PMID:26925902

CommunityRx: A Population Health Improvement Innovation That Connects Clinics To Communities.

PubMed

Lindau, Stacy T; Makelarski, Jennifer; Abramsohn, Emily; Beiser, David G; Escamilla, Veronica; Jerome, Jessica; Johnson, Daniel; Kho, Abel N; Lee, Karen K; Long, Timothy; Miller, Doriane C

2016-11-01

The CommunityRx system, a population health innovation, combined an e-prescribing model and community engagement to strengthen links between clinics and community resources for basic, wellness, and disease self-management needs in Chicago. The components of CommunityRx were a youth workforce, whose members identified 19,589 public-serving entities in the 106-square-mile implementation region between 2012 and 2014; community health information specialists, who used the workforce's findings to generate an inventory of 14,914 health-promoting resources; and a health information technology (IT) platform that was integrated with three electronic health record systems at thirty-three clinical sites. By mapping thirty-seven prevalent social and medical conditions to community resources, CommunityRx generated 253,479 personalized HealtheRx prescriptions for more than 113,000 participants. Eighty-three percent of the recipients found the HealtheRx very useful, and 19 percent went to a place they learned about from the HealtheRx. All but one organization continued using the CommunityRx system after the study period ended. This study demonstrates the feasibility of using health IT and workforce innovation to bridge the gap between clinical and other health-promoting sectors. Project HOPE—The People-to-People Health Foundation, Inc.

Faith communities and their assets for health promotion: the views from health professionals and faith leaders in Dundee, in Scotland.

PubMed

Fagan, Donna M; Kiger, Alice; van Teijlingen, Edwin

2012-06-01

Within the European Union, as well as in Canada and the United States (US), health promoters employ a number of strategies to encourage community-based health improvements. This involves the creation of innovative health promotion partnerships to support and enable people to choose and engage in healthy living practices. Compared to the US, in other Western countries, such as the United Kingdom, faith communities have largely been ignored in health promotion partnerships. This study established existing evidence about health promotion in faith communities in Scotland by examining the perceptions and attitudes concerning health promotion among faith leaders and health promotion professionals. We conducted 33 semi-structured interviews with health promotion professionals (n = 9) and representatives of Christian and non-Christian faith communities (n = 24). The majority of participants expressed an interest in the concept of health promotion in a faith community and could readily envision its application in their area of work. Both groups identified multiple physical assets, as well as social supports within faith communities that could be directed towards healthy living activities. Faith groups and church organisations may constitute potential partners and new settings to increase community capacity for health promotion. Further research and funding for demonstration projects may be particularly helpful to provide evidence of the strengths and limitations of faith-based health promotion in Scotland, which in turn could inform health promotion practice and policy.

Developing a student-led health and wellbeing clinic in an underserved community: collaborative learning, health outcomes and cost savings.

PubMed

Stuhlmiller, Cynthia M; Tolchard, Barry

2015-01-01

The University of New England (UNE), Australia decided to develop innovative placement opportunities for its increasing numbers of nursing students. Extensive community and stakeholder consultation determined that a community centre in rural New South Wales was the welcomed site of the student-led clinic because it fit the goals of the project-to increase access to health care services in an underserved area while providing service learning for students. Supported by a grant from Health Workforce Australia and in partnership with several community organisations, UNE established a student-led clinic in a disadvantaged community using an engaged scholarship approach which joins academic service learning with community based action research. The clinic was managed and run by the students, who were supervised by university staff and worked in collaboration with residents and local health and community services. Local families, many of whom were Indigenous Australians, received increased access to culturally appropriate health services. In the first year, the clinic increased from a one day per week to a three day per week service and offered over 1000 occasions of care and involved 1500 additional community members in health promotion activities. This has led to improved health outcomes for the community and cost savings to the health service estimated to be $430,000. The students learned from members of the community and community members learned from the students, in a collaborative process. Community members benefited from access to drop in help that was self-determined. The model of developing student-led community health and wellbeing clinics in underserved communities not only fulfils the local, State Government, Federal Government and international health reform agenda but it also represents good value for money. It offers free health services in a disadvantaged community, thereby improving overall health and wellbeing. The student-led clinic is an invaluable

Trialing the Community-Based Collaborative Action Research Framework: Supporting Rural Health Through a Community Health Needs Assessment.

PubMed

Van Gelderen, Stacey A; Krumwiede, Kelly A; Krumwiede, Norma K; Fenske, Candace

2018-01-01

To describe the application of the Community-Based Collaborative Action Research (CBCAR) framework to uplift rural community voices while conducting a community health needs assessment (CHNA) by formulating a partnership between a critical access hospital, public health agency, school of nursing, and community members to improve societal health of this rural community. This prospective explorative study used the CBCAR framework in the design, collection, and analysis of the data. The framework phases include: Partnership, dialogue, pattern recognition, dialogue on meaning of pattern, insight into action, and reflecting on evolving pattern. Hospital and public health agency leaders learned how to use the CBCAR framework when conducting a CHNA to meet Affordable Care Act federal requirements. Closing the community engagement gap helped ensure all voices were heard, maximized intellectual capital, synergized efforts, improved communication by establishing trust, aligned resources with initiatives, and diminished power struggles regarding rural health. The CBCAR framework facilitated community engagement and promoted critical dialogue where community voices were heard. A sustainable community-based collaborative was formed. The project increased the critical access hospital's capacity to conduct a CHNA. The collaborative's decision-making capacity was challenged and ultimately strengthened as efforts continue to be made to address rural health.

Patient satisfaction with primary health care rendered by community midwives in the area of Poznań.

PubMed

Niewiadomski, Tomasz; Biskupska, Maria; Wysocki, Jacek

2014-01-01

The main objective of this study was to examine the level of patient satisfaction with the care rendered by community midwives in the area of Poznań. A patient survey was distributed using face-to-face recruitment and with mail collection. Eight hundred new mothers were asked to participate in the study by filling out the questionnaire after eight weeks of the postpartum period. One hundred seventy seven (22.12%) returned completed questionnaires which were then analyzed. This paper provides information on the high level of patient satisfaction with the services provided by community midwives and the important role community midwives play in caring for and supporting women in the post partum period. The results of this study indicate that women in the area of Poznań, are satisfied with the care they receive from midwives. They also indicate a lack of association of patient satisfaction scores between groups of patients based on demographic data and reason for using community midwife services. It was also found that the overall patient satisfaction score depends most heavily on the time frame of receiving community midwife services.

Associations of Community Water Fluoridation with Caries Prevalence and Oral Health Inequality in Children

PubMed Central

Kim, Han-Na; Kim, Jeong-Hee; Kim, Se-Yeon; Kim, Jin-Bom

2017-01-01

This study aimed to confirm the association between the community water fluoridation (CWF) programme and dental caries prevention on permanent teeth, comparing to a control area, neighbouring population without the programme, and verifying whether the programme can reduce the socio-economic inequality related to the oral health of children in Korea. Evaluation surveys were conducted among 6-, 8-, and 11-year-old children living in Okcheon (CWF) and neighbouring Yeongdong (non-CWF, control area) towns in South Korea. Data on monthly family income, caregiver educational level, and Family Affluence Scale scores were evaluated using questionnaires that were distributed to the parents. The effectiveness of CWF in caries reduction was calculated based on the differences in decayed, missing, and filled teeth and decayed, missing, and filled tooth surfaces indices between the two towns. The data were analysed using logistic regression and univariate analysis of variance. Both 8- and 11-year-old children living in the CWF area had lower dental caries prevalence than those living in the non-CWF community. Differences in dental caries prevalence based on educational level were found in the control area but not in the CWF area. Socio-economic factor-related inequality in oral health were observed in the non-CWF community. Additionally, 8- and 11-year-old children living in the CWF area displayed lower dental caries prevalence in the pit-and-fissure and smooth surfaces than those living in the non-CWF community. These results suggest that CWF programmes are effective in the prevention of caries on permanent teeth and can reduce oral health inequalities among children. The implementation of CWF programmes should be sustained to overcome oral health inequalities due to socio-economic factors and improve children’s overall oral health. PMID:28608827

Associations of Community Water Fluoridation with Caries Prevalence and Oral Health Inequality in Children.

PubMed

Kim, Han-Na; Kim, Jeong-Hee; Kim, Se-Yeon; Kim, Jin-Bom

2017-06-13

This study aimed to confirm the association between the community water fluoridation (CWF) programme and dental caries prevention on permanent teeth, comparing to a control area, neighbouring population without the programme, and verifying whether the programme can reduce the socio-economic inequality related to the oral health of children in Korea. Evaluation surveys were conducted among 6-, 8-, and 11-year-old children living in Okcheon (CWF) and neighbouring Yeongdong (non-CWF, control area) towns in South Korea. Data on monthly family income, caregiver educational level, and Family Affluence Scale scores were evaluated using questionnaires that were distributed to the parents. The effectiveness of CWF in caries reduction was calculated based on the differences in decayed, missing, and filled teeth and decayed, missing, and filled tooth surfaces indices between the two towns. The data were analysed using logistic regression and univariate analysis of variance. Both 8- and 11-year-old children living in the CWF area had lower dental caries prevalence than those living in the non-CWF community. Differences in dental caries prevalence based on educational level were found in the control area but not in the CWF area. Socio-economic factor-related inequality in oral health were observed in the non-CWF community. Additionally, 8- and 11-year-old children living in the CWF area displayed lower dental caries prevalence in the pit-and-fissure and smooth surfaces than those living in the non-CWF community. These results suggest that CWF programmes are effective in the prevention of caries on permanent teeth and can reduce oral health inequalities among children. The implementation of CWF programmes should be sustained to overcome oral health inequalities due to socio-economic factors and improve children's overall oral health.

The Natural Area: Teaching Tool and Community Catalyst

ERIC Educational Resources Information Center

Davis, Roger M.; Grimm, Floyd M., III

1973-01-01

Discusses the properties desirable in a natural area to be used as a teaching tool in college courses such as general biology, botany, zoology, entomology, and ecology. Describes the use of a natural area at Harford Community College, Maryland, and outlines the community involvement in planning and utilizing the area. (JR)

Health and Taxes: Hospitals, Community Health and the IRS.

PubMed

Crossley, Mary

2016-01-01

The Affordable Care Act created new conditions of federal tax exemption for nonprofit hospitals, including a requirement that hospitals conduct a community health needs assessment (CHNA) every three years to identify significant health needs in their communities and then develop and implement a strategy responding to those needs. As a result, hospitals must now do more than provide charity care to their patients in exchange for the benefits of tax exemption. The CHNA requirement has the potential both to prompt a radical change in hospitals' relationship to their communities and to enlist hospitals as meaningful contributors to community health improvement initiatives. Final regulations issued in December 2014 clarify hospitals' obligations under the CHNA requirement, but could do more to facilitate hospitals' engagement in collaborative community health projects. The Internal Revenue Service (IRS) has a rich opportunity, while hospitals are still learning to conduct CHNAs, to develop guidance establishing clear but flexible expectations for how providers should assess and address community needs. This Article urges the IRS to seize that opportunity by refining its regulatory framework for the CHNA requirement. Specifically, the IRS should more robustly promote transparency, accountability, community engagement, and collaboration while simultaneously leaving hospitals a good degree of flexibility. By promoting alignment between hospitals' regulatory compliance activities and broader community health improvement initiatives, the IRS could play a meaningful role in efforts to reorient our system towards promoting health and not simply treating illness.

[Community-based health promotion--a challenge for the evaluation].

PubMed

Loss, J; Eichhorn, C; Gehlert, J; Donhauser, J; Wise, M; Nagel, E

2007-02-01

Community-based health promotion (CBHP) aims at mobilising citizens for health-related issues in their environment, and at implementing health-promoting projects on the community level. Whereas recent political decisions support this approach, scientific studies dealing with theories and consequences of CBHP are scarce in Germany. Evaluation of CBHP could help identify (in)effective factors and elements of community programmes and thus improve future planning. In Germany, however, there is a deficit in systematic concepts and recommendations for the evaluation of CBHP. This work outlines basic ideas and core principles of CBHP and deduces implications for the assessment of health-promoting community projects. Based on different international models and studies and on discussions with health promotion professionals, we developed a framework for the evaluation of CBHP. The proposed framework includes a guideline for CBHP programme planning. Its strategic and operational criteria can serve as a basis for a strategy evaluation. In terms of process evaluation, indicators for the dimensions (1) programme implementation and service delivery, (2) capacity building, and (3) reach of and acceptability in the target group were developed. In addition, we present different areas of OUTCOME EVALUATION; it is advisable to distinguish between measurement on the individual and on the community level. The framework further proposes strategies for the evaluation of the core principles empowerment and participation. The presented framework can serve as a basis for the development of flexible and individual instruments for the evaluation of CBHP, which should not ignore the perspective of the citizens, or complex aspects like changes on the community level. Some aspects, e.g., the potential evaluation of further targets of CBHP (improvement of quality of life, reduction of social and health inequalities), the responsibility of evaluation or the effects of financial constraints, are

The Assessment of a Community's Mental Health Needs.

ERIC Educational Resources Information Center

Zautra, Alex; Simons, Lynn Stanley

In this study social indicators and survey measures were used to predict three-year service utilization rates at a community mental health center on a geographic basis. Ten social indicators were selected from available census tract statistics and seven survey measures were taken from an epidemiological survey of the catchment area of the mental…

Community health workers in Lesotho: Experiences of health promotion activities.

PubMed

Seutloali, Thato; Napoles, Lizeka; Bam, Nomonde

2018-02-27

Lesotho adopted primary health care in 1979, and community health workers (CHWs) were included in the programme to focus on health promotion, particularly to reach people in underserved rural areas. Although the CHW programme has been successful, the heavy burden of disease because of HIV and/or AIDS and tuberculosis shifted resources from health promotion to home-based care. The study explored the lived experience of CHWs in conducting health promotion activities in Lesotho. The study was conducted in four health centres in Berea district, Lesotho. A qualitative study was conducted using an interviewer guide translated from English into Sesotho for four CHW focus group discussions, four individual interviews of key informants and four semi-structured interviews with the health centre nurses. The roles of CHWs in health promotion ranged from offering basic first aid and home-based care to increasing access to health care services by taking patients to the facilities and promoting behaviour change through health education. Their perceived successes included increased access to health care services and reduced mortality rates. CHW challenges involved their demotivation to carry out their work because of lack of or inconsistent financial incentives and supplies, work overload which compromises quality of their work and limited community involvement. This study concludes that CHWs are beneficial to health promotion and its various activities. They had a clear understanding of their roles and responsibilities, although they did not fully comprehend that what they were describing was, in fact, health promotion. When it came to advocacy, CHWs did not fully understand it, nor did they consider it as part of their roles, although they acknowledged its importance. Their role of increasing access to health care services by accompanying patients to the facilities has increased considerably because of changes in disease burden. This is affecting their ability to practise other

Oral Health in Rural Communities

MedlinePlus

... Toolkits Economic Impact Analysis Tool Community Health Gateway Sustainability Planning Tools Testing New Approaches Rural Health IT ... community water supplies than large ones. This paper report that it is six times more costly per ...

Exploring perceptions of community health policy in Kenya and identifying implications for policy change.

PubMed

McCollum, Rosalind; Otiso, Lilian; Mireku, Maryline; Theobald, Sally; de Koning, Korrie; Hussein, Salim; Taegtmeyer, Miriam

2016-02-01

Global interest and investment in close-to-community health services is increasing. Kenya is currently revising its community health strategy (CHS) alongside political devolution, which will result in revisioning of responsibility for local services. This article aims to explore drivers of policy change from key informant perspectives and to study perceptions of current community health services from community and sub-county levels, including perceptions of what is and what is not working well. It highlights implications for managing policy change. We conducted 40 in-depth interviews and 10 focus group discussions with a range of participants to capture plural perspectives, including those who will influence or be influenced by CHS policy change in Kenya (policymakers, sub-county health management teams, facility managers, community health extension worker (CHEW), community health workers (CHWs), clients and community members) in two purposively selected counties: Nairobi and Kitui. Qualitative data were digitally recorded, transcribed, translated and coded before framework analysis. There is widespread community appreciation for the existing strategy. High attrition, lack of accountability for voluntary CHWs and lack of funds to pay CHW salaries, combined with high CHEW workload were seen as main drivers for strategy change. Areas for change identified include: lack of clear supervisory structure including provision of adequate travel resources, current uneven coverage and equity of community health services, limited community knowledge about the strategy revision and demand for home-based HIV testing and counselling. This in-depth analysis which captures multiple perspectives results in robust recommendations for strategy revision informed by the Five Wonders of Change Framework. These recommendations point towards a more people-centred health system for improved equity and effectiveness and indicate priority areas for action if success of policy change through

Cove Area Community Involvement Plan

EPA Pesticide Factsheets

This Community Involvement Plan (CIP) outlines opportunities for individual participation and meaningful information sharing regarding EPA’s activities in the Cove Area Abandoned Uranium Mine Region.

Community-based organizations in the health sector: A scoping review

PubMed Central

2012-01-01

Community-based organizations are important health system stakeholders as they provide numerous, often highly valued programs and services to the members of their community. However, community-based organizations are described using diverse terminology and concepts from across a range of disciplines. To better understand the literature related to community-based organizations in the health sector (i.e., those working in health systems or more broadly to address population or public health issues), we conducted a scoping review by using an iterative process to identify existing literature, conceptually map it, and identify gaps and areas for future inquiry. We searched 18 databases and conducted citation searches using 15 articles to identify relevant literature. All search results were reviewed in duplicate and were included if they addressed the key characteristics of community-based organizations or networks of community-based organizations. We then coded all included articles based on the country focus, type of literature, source of literature, academic discipline, disease sector, terminology used to describe organizations and topics discussed. We identified 186 articles addressing topics related to the key characteristics of community-based organizations and/or networks of community-based organizations. The literature is largely focused on high-income countries and on mental health and addictions, HIV/AIDS or general/unspecified populations. A large number of different terms have been used in the literature to describe community-based organizations and the literature addresses a range of topics about them (mandate, structure, revenue sources and type and skills or skill mix of staff), the involvement of community members in organizations, how organizations contribute to community organizing and development and how they function in networks with each other and with government (e.g., in policy networks). Given the range of terms used to describe community

Community-based organizations in the health sector: a scoping review.

PubMed

Wilson, Michael G; Lavis, John N; Guta, Adrian

2012-11-21

Community-based organizations are important health system stakeholders as they provide numerous, often highly valued programs and services to the members of their community. However, community-based organizations are described using diverse terminology and concepts from across a range of disciplines. To better understand the literature related to community-based organizations in the health sector (i.e., those working in health systems or more broadly to address population or public health issues), we conducted a scoping review by using an iterative process to identify existing literature, conceptually map it, and identify gaps and areas for future inquiry.We searched 18 databases and conducted citation searches using 15 articles to identify relevant literature. All search results were reviewed in duplicate and were included if they addressed the key characteristics of community-based organizations or networks of community-based organizations. We then coded all included articles based on the country focus, type of literature, source of literature, academic discipline, disease sector, terminology used to describe organizations and topics discussed. We identified 186 articles addressing topics related to the key characteristics of community-based organizations and/or networks of community-based organizations. The literature is largely focused on high-income countries and on mental health and addictions, HIV/AIDS or general/unspecified populations. A large number of different terms have been used in the literature to describe community-based organizations and the literature addresses a range of topics about them (mandate, structure, revenue sources and type and skills or skill mix of staff), the involvement of community members in organizations, how organizations contribute to community organizing and development and how they function in networks with each other and with government (e.g., in policy networks).Given the range of terms used to describe community

Partnering with community institutions to increase access to healthful foods across municipalities.

PubMed

Jaskiewicz, Lara; Dombrowski, Rachael D; Drummond, Heather M; Barnett, Gina Massuda; Mason, Maryann; Welter, Christina

2013-10-03

Low-income and minority communities have higher rates of nutrition-related chronic diseases than do high-income and nonminority communities and often have reduced availability to healthful foods. Corner store initiatives have been proposed as a strategy to improve access to healthful foods in these communities, yet few studies evaluating these initiatives have been published. Suburban Cook County, Illinois, encompasses 125 municipalities with a population of more than 2 million. From 2000 through 2009, the percentage of low-income suburban Cook County residents increased 41%; African-American populations increased 20%, and Hispanic populations increased 44%. A 2012 report found that access to stores selling healthful foods was low in several areas of the county. Beginning in March 2011, the Cook County Department of Public Health recruited community institutions (ie, local governments, nonprofit organizations, faith-based institutions) who recruited corner stores to participate in the initiative. Corner stores were asked to add new, healthful foods (May-June 2011) to become eligible to receive new equipment, marketing materials, and enhanced community outreach (July 2011-February 2012). Nine community institutions participated. Of the 53 corner stores approached, 25 (47%) participated in the trial phase, which included offering 6 healthful foods in their stores. Of those, 21 (84%) completed the conversion phase, which included expansion of healthful foods through additional equipment and marketing and promotional activities. Community institutions can play a key role in identifying and engaging corner stores across jurisdictions that are willing and able to implement a retail environment initiative to improve access to healthful foods in their communities.

Public Health Spending and Medicare Resource Use: A Longitudinal Analysis of U.S. Communities.

PubMed

Mays, Glen P; Mamaril, Cezar B

2017-12-01

To examine whether local expenditures for public health activities influence area-level medical spending for Medicare beneficiaries. Six census surveys of the nation's 2,900 local public health agencies were conducted between 1993 and 2013, linked with contemporaneous information on population demographics, socioeconomic characteristics, and area-level Medicare spending estimates from the Dartmouth Atlas of Health Care. Measures derive from agency survey data and aggregated Medicare claims. A longitudinal cohort design follows the geographic areas served by local public health agencies. Multivariate, fixed-effects, and instrumental-variables regression models estimate how area-level Medicare spending changes in response to shifts in local public health spending, controlling for observed and unmeasured confounders. A 10 percent increase in local public health spending per capita was associated with 0.8 percent reduction in adjusted Medicare expenditures per person after 1 year (p < .01) and a 1.1 percent reduction after 5 years (p < .05). Estimated Medicare spending offsets were larger in communities with higher rates of poverty, lower health insurance coverage, and health professional shortages. Expanded financing for public health activities may provide an effective way of constraining Medicare spending, particularly in low-resource communities. © Health Research and Educational Trust.

HealthPartners adopts community business model to deepen focus on nonclinical factors of health outcomes.

PubMed

Isham, George J; Zimmerman, Donna J; Kindig, David A; Hornseth, Gary W

2013-08-01

Clinical care contributes only 20 percent to overall health outcomes, according to a population health model developed at the University of Wisconsin. Factors contributing to the remainder include lifestyle behaviors, the physical environment, and social and economic forces--all generally considered outside the realm of care. In 2010 Minnesota-based HealthPartners decided to target nonclinical community health factors as a formal part of its strategic business plan to improve public health in the Twin Cities area. The strategy included creating partnerships with businesses and institutions that are generally unaccustomed to working together or considering how their actions could help improve community health. This article describes efforts to promote healthy eating in schools, reduce the stigma of mental illness, improve end-of-life decision making, and strengthen an inner-city neighborhood. Although still in their early stages, the partnerships can serve as encouragement for organizations inside and outside health care that are considering undertaking similar efforts in their markets.

Exploration Into the Business Priorities Related to Corporate Engagement in Community Health Improvement Partnerships.

PubMed

Pronk, Nicolaas P; Baase, Catherine; May, Jeanette; Terry, Paul; Moseley, Karen

2017-11-01

To explore factors that matter to business in making decisions regarding engagement in community health improvement efforts. Using qualitative methods, domains of interest were identified through literature reviews and expert interviews. Relevance of the domains in terms of potential priorities for action was tested through employer and community stakeholder interviews. Factors that employers considered important to sustained community collaboration as a business priority included (1) credibility of the convener, (2) broad representation of the community, (3) strong mission and goals, (4) individual commitment to health, (5) organizational commitment to health, and (6) demonstrated commitment from leadership. Priorities have been identified for engaging business in community health efforts. Implications for research, practice, and policy include the need for measurement, transparency in reporting, and agreement on principles for public-private partnership in this area.

Process and impact evaluation of a legal assistance and health care community partnership.

PubMed

Teufel, James A; Brown, Stephen L; Thorne, Woody; Goffinet, Diane M; Clemons, Latesha

2009-07-01

Community health partnerships have increased in popularity, but their effectiveness is often not evaluated. Through secondary data analysis, this study evaluates a program that offered access to legal services to address health-related issues, such as Medicaid reimbursement, Social Security benefits, medication coverage, and divorce. Based on the analysis reimbursements to expenditures, the health and law program appears to be cost-effective and thereby economically sustainable. The cost-effectiveness of this program increases the likelihood that it will be institutionalized and/or expanded. This program evaluation is used to exemplify how community stakeholders could partner to leverage resources to establish a sustainable community health and law program to address the needs of people living in medically underserved areas.

Building research infrastructure in community health centers: a Community Health Applied Research Network (CHARN) report.

PubMed

Likumahuwa, Sonja; Song, Hui; Singal, Robbie; Weir, Rosy Chang; Crane, Heidi; Muench, John; Sim, Shao-Chee; DeVoe, Jennifer E

2013-01-01

This article introduces the Community Health Applied Research Network (CHARN), a practice-based research network of community health centers (CHCs). Established by the Health Resources and Services Administration in 2010, CHARN is a network of 4 community research nodes, each with multiple affiliated CHCs and an academic center. The four nodes (18 individual CHCs and 4 academic partners in 9 states) are supported by a data coordinating center. Here we provide case studies detailing how CHARN is building research infrastructure and capacity in CHCs, with a particular focus on how community practice-academic partnerships were facilitated by the CHARN structure. The examples provided by the CHARN nodes include many of the building blocks of research capacity: communication capacity and "matchmaking" between providers and researchers; technology transfer; research methods tailored to community practice settings; and community institutional review board infrastructure to enable community oversight. We draw lessons learned from these case studies that we hope will serve as examples for other networks, with special relevance for community-based networks seeking to build research infrastructure in primary care settings.

Building Research Infrastructure in Community Health Centers: A Community Health Applied Research Network (CHARN) Report

PubMed Central

Likumahuwa, Sonja; Song, Hui; Singal, Robbie; Weir, Rosy Chang; Crane, Heidi; Muench, John; Sim, Shao-Chee; DeVoe, Jennifer E.

2015-01-01

This article introduces the Community Health Applied Research Network (CHARN), a practice-based research network of community health centers (CHCs). Established by the Health Resources and Services Administration in 2010, CHARN is a network of 4 community research nodes, each with multiple affiliated CHCs and an academic center. The four nodes (18 individual CHCs and 4 academic partners in 9 states) are supported by a data coordinating center. Here we provide case studies detailing how CHARN is building research infrastructure and capacity in CHCs, with a particular focus on how community practice-academic partnerships were facilitated by the CHARN structure. The examples provided by the CHARN nodes include many of the building blocks of research capacity: communication capacity and “matchmaking” between providers and researchers; technology transfer; research methods tailored to community practice settings; and community institutional review board infrastructure to enable community oversight. We draw lessons learned from these case studies that we hope will serve as examples for other networks, with special relevance for community-based networks seeking to build research infrastructure in primary care settings. PMID:24004710

Comparison of high- versus low-intensity community health worker intervention to promote newborn and child health in Northern Nigeria

PubMed Central

Findley, Sally E; Uwemedimo, Omolara T; Doctor, Henry V; Green, Cathy; Adamu, Fatima; Afenyadu, Godwin Y

2013-01-01

coverage during pregnancy increased from 69.2% at baseline to 85.7% at follow-up in the intervention areas. Breastfeeding within 24 hours increased from 42.9% to 59.0% in the intervention areas, and more newborns were checked by health workers within 48 hours (from 16.8% at baseline to 26.8% at follow-up in the intervention areas). Newborns were more likely to be checked by trained health personnel, and they received more comprehensive newborn care. Compared to the control communities, more than twice as many women in intervention communities knew to watch for specific newborn danger signs. Compared to the control and low-intensity intervention communities, more mothers in the high-intensity communities learned about the care of sick children from CHWs, with a corresponding decline those seeking advice from family or friends or traditional birth attendants. Significantly fewer mothers did nothing when their child was sick. High-intensity intervention communities experienced the most decline. Those who did nothing for children with fever or cough declined from 35% to 30%, and with diarrhea from 40% to 31%. Use of medications, both traditional and modern, increased from baseline to follow-up, with no differentiation in use by intervention area. Conclusion The community-based approach to promoting improved newborn and sick child care through community volunteers and CHWs resulted in improved newborn and sick child care. The low-intensity approach with community volunteers appears to have been as effective as the higher-intensity CBSD approach with CHWs for several of the key newborn and sick child care indicators, particularly in the provision of appropriate home care for children with fever or cough. PMID:24194649

Comparison of high- versus low-intensity community health worker intervention to promote newborn and child health in Northern Nigeria.

PubMed

Findley, Sally E; Uwemedimo, Omolara T; Doctor, Henry V; Green, Cathy; Adamu, Fatima; Afenyadu, Godwin Y

2013-01-01

increased from 69.2% at baseline to 85.7% at follow-up in the intervention areas. Breastfeeding within 24 hours increased from 42.9% to 59.0% in the intervention areas, and more newborns were checked by health workers within 48 hours (from 16.8% at baseline to 26.8% at follow-up in the intervention areas). Newborns were more likely to be checked by trained health personnel, and they received more comprehensive newborn care. Compared to the control communities, more than twice as many women in intervention communities knew to watch for specific newborn danger signs. Compared to the control and low-intensity intervention communities, more mothers in the high-intensity communities learned about the care of sick children from CHWs, with a corresponding decline those seeking advice from family or friends or traditional birth attendants. Significantly fewer mothers did nothing when their child was sick. High-intensity intervention communities experienced the most decline. Those who did nothing for children with fever or cough declined from 35% to 30%, and with diarrhea from 40% to 31%. Use of medications, both traditional and modern, increased from baseline to follow-up, with no differentiation in use by intervention area. The community-based approach to promoting improved newborn and sick child care through community volunteers and CHWs resulted in improved newborn and sick child care. The low-intensity approach with community volunteers appears to have been as effective as the higher-intensity CBSD approach with CHWs for several of the key newborn and sick child care indicators, particularly in the provision of appropriate home care for children with fever or cough.

Community-based prevention marketing: organizing a community for health behavior intervention.

PubMed

Bryant, Carol A; Brown, Kelli R McCormack; McDermott, Robert J; Forthofer, Melinda S; Bumpus, Elizabeth C; Calkins, Susan A; Zapata, Lauren B

2007-04-01

This article describes the application and refinement of community-based prevention marketing (CBPM), an example of community-based participatory research that blends social marketing theories and techniques and community organization principles to guide voluntary health behavior change. The Florida Prevention Research Center has worked with a community coalition in Sarasota County, Florida to define locally important health problems and issues and to develop responsive health-promotion interventions. The CBPM framework has evolved as academic and community-based researchers have gained experience applying it. Community boards can use marketing principles to design evidence-based strategies for addressing local public health concerns. Based on 6 years of experience with the "Believe in All Your Possibilities" program, lessons learned that have led to revision and improvement of the CBPM framework are described.

Differences in the Community Built Environment Influence Poor Perceived Health among Persons with Spinal Cord Injury

PubMed Central

Botticello, Amanda L.; Rohrbach, Tanya; Cobbold, Nicolette

2015-01-01

Objectives To assess the association between characteristics of the built environment and differences in perceived health among persons with spinal cord injury (SCI) using objective measures of the local community derived from Geographic Information Systems (GIS) data. Design Secondary analysis of cross-sectional survey data. Setting Community. Participants 503 persons with chronic SCI enrolled in the Spinal Cord Injury Model Systems (SCIMS) database. All cases were residents of New Jersey, completed an interview during the years 2000–2012, had a complete residential address, and were community living at the time of follow-up. Intervention Not applicable. Main Outcome Measure Perceived health. Results Bivariate tests indicated that persons with SCI residing in communities with more (versus less) mixed land use and small (versus large) amounts of open space were more likely to report poor perceived health. No associations were found between perceived health and differences in the residential or destination density of the community. Adjusting for variation in demographic, impairment, quality of life, and community socioeconomic characteristics accounted for the gap in the odds of reporting poor health between persons living in areas with large versus small amounts of open space (OR 0.54; 95% CI 0.28–1.02). However, even after accounting for individual background differences, persons living in communities characterized by more heterogeneous land use were twice as likely to report poor health compared to persons living in less mixed areas (OR 2.14; 95% CI 1.12–4.08). Conclusions Differences in the built characteristics of communities may be important to the long-term health and well-being of persons with SCI who may have greater exposure to the features of their local area due to limited mobility. The results of this study suggest living in a community with more heterogeneous land use was not beneficial to the perceived health of persons with chronic SCI living

Differences in the Community Built Environment Influence Poor Perceived Health Among Persons With Spinal Cord Injury.

PubMed

Botticello, Amanda L; Rohrbach, Tanya; Cobbold, Nicolette

2015-09-01

To assess the association between characteristics of the built environment and differences in perceived health among persons with spinal cord injury (SCI) using objective measures of the local community derived from Geographic Information Systems data. Secondary analysis of cross-sectional survey data. Community. Persons with chronic SCI enrolled in the Spinal Cord Injury Model Systems database (N=503). All cases were residents of New Jersey, completed an interview during the years 2000 through 2012, had a complete residential address, and were community living at the time of follow-up. Not applicable. Perceived health. Bivariate tests indicated that persons with SCI residing in communities with more (vs less) mixed land use and small (vs large) amounts of open space were more likely to report poor perceived health. No associations were found between perceived health and differences in the residential or destination density of the community. Adjusting for variation in demographic, impairment, quality of life, and community socioeconomic characteristics accounted for the gap in the odds of reporting poor health between persons living in areas with large versus small amounts of open space (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.28-1.02). However, even after accounting for individual background differences, persons living in communities characterized by more heterogeneous land use were twice as likely to report poor health compared with persons living in less mixed areas (OR, 2.14; 95% CI, 1.12-4.08). Differences in the built characteristics of communities may be important to the long-term health and well-being of persons with SCI who may have greater exposure to the features of their local area because of limited mobility. The results of this study suggest living in a community with more heterogeneous land use was not beneficial to the perceived health of persons with chronic SCI living in New Jersey. Further investigation is needed to assess if the

Community-Based Health Education and Communication Model Development for Opisthorchiasis Prevention in a High Risk Area, Khon Kaen Province, Thailand.

PubMed

Promthet, Paitoon; Kessomboon, Pattapong; Promthet, Supannee

2015-01-01

This study aimed to evaluate the impact of a community-based health education and communication programme on reducing liver fluke infections caused by the consumption of uncooked fish among people in a high-risk area of Thailand. The study was quasi-experimental in nature, with three-stages. Stage 1 involved a situational and capacity analysis of designated communities in Khon Kaen province. This was followed by the development of a model for community-based health education and communication to prevent liver fluke infections among high-risk people, and, lastly, implementation and evaluation of the model were performed. Data were collected using both qualitative and quantitative methods. In total, 390 people were surveyed, and quasi-experimental and comparison groups, each with 90 people, were assessed between May 2011 and April 2012. Analysis was using statistical OR, 95 % CI, the Willcoxon matched pairs signed ranks test, the chi-square test, and the Mann-Whitney U test. The findings showed that most respondents had a high level of knowledge and understanding of liver fluke disease (89.5%, 95% CI:86.0-92.4), and positive attitudes toward the prevention of the disease (94.4%, 95% CI:91.6-96.4). However, with regard to changes in consumption of uncooked fish, most respondents were still in the pre-contemplation phase (55.1%, 95% CI:50.0-60.1), followed by the contemplation phase, 22.6%. Furthermore, four factors were found to be associated with the consumption of uncooked fish--the consumption of alcohol (OR 4.16, 95% CI:1.79-9.65), gender (OR 3.17 , 95% CI:1.53-6.54), smoking (OR 3.03, 95% CI:1.31-7.05), and age 40 years and above (OR 2.68, 95% CI:1.02-7.05). After nine months of the health education and communication programme using local media based on local wisdom, culture and persons, the results showed that, compared to the control group, members of the experimental group had a higher level of knowledge, a better attitude and lower levels of ill- advised

Reactions of community members regarding community health workers’ activities as a measure of the impact of a training program in Amazonas, Brazil

PubMed Central

Kawasaki, Ryoko; Sadamori, Toru; Ferreira de Almeida, Terezinha; Akiyoshi, Megumi; Nishihara, Mika; Yoshimura, Toshiro; Ohnishi, Mayumi

2014-01-01

Objectives: The aim of this study was to evaluate the impact of community health worker (CHW) training on recognition and satisfaction regarding the performance of CHWs among members of the community in Amazonas, Brazil, which is a resource-poor area underserved with regard to medical health-care accessibility. Methods: Baseline and endline surveys concerning recognition and satisfaction with respect to CHW performance among members of the community were conducted by interview using a questionnaire before and after implementation of a program to strengthen community health projects in Manicoré, Amazonas, Brazil. One of the components of the project was CHW refresher training, which focused on facilitating adequate use of health-care services and providing primary health care, including health guidance. The baseline survey was performed in February 2004 at the beginning of the project, and the endline survey was performed in February 2006 at the end of the project. There were 82 and 120 CHWs working in Manicoré at the times of the baseline and endline surveys, respectively. Statistical analysis was performed to determine the significance of changes in experience with CHW activities, expected functions of CHWs, and satisfaction regarding the performance of CHWs between the baseline and endline surveys. In addition, qualitative analysis was conducted to evaluate the acceptability, feasibility, and sustainability of CHW refresher training. Results: Overall recognition and level of satisfaction regarding CHW performance among members of the community were improved from the baseline to the endline survey, regardless of type of residential area, such as town and/or remote area. Members of the community came to not expect CHWs to “provide strong medicine” (P < 0.001) and “provide injections” (P < 0.001), and came to appreciate “go to hospital with a sick person” (P = 0.031) as a function and role of CHWs. Conclusions: The results of the present study

The role of non-governmental organizations in the mental health area: differences in understanding.

PubMed

Zupančič, Vesna; Pahor, Majda

2016-12-01

The contribution's aim is highlighting the differences in understanding non-governmental organizations' (NGOs) role in the mental health area within the public support network for patients with mental health problems from various viewpoints, in order to achieve progress in supporting patients with mental health problems in local communities. Qualitative data gathered as a part of a cross-sectional study of NGOs in the support network for patients with mental health problems in two Slovenian health regions (56 local communities), carried out in 2013 and 2014, were used. Qualitative analysis of interviews, focus groups and answers to an open survey question was performed. There are differences in understanding NGOs' role in the support network for patients with mental health problems, which stem from the roles of stakeholders (local community officials, experts, care providers, and patients) within this system and their experience. The actual differences need to be addressed and overcome in order to provide integrated community care. The importance of knowing the current state of NGOs in their life cycle and the socio-chronological context of the local community support network is evident.

Health Care Marketing: Role Evolution of the Community Health Educator.

ERIC Educational Resources Information Center

Syre, Thomas R.; Wilson, Richard W.

1990-01-01

This article discusses role delineation in the health education profession, defines and presents principles of health care marketing, describes marketing plan development, and examines major ethical issues associated with health care marketing when utilized by community health educators. A marketing plan format for community health education is…

Asian Community Mental Health Services at 35: a pioneering ethnic organization (1973-2008).

PubMed

Vu, Catherine M; Schwartz, Sara L; Austin, Michael J

2011-01-01

Asian Community Mental Health Services is a nonprofit organization that delivers mental health services to primarily Asian and Pacific Islander communities. From its early beginnings and over its 35-year history, the agency has had to overcome numerous challenges, including gaining legitimacy as a culturally specific nonprofit, combating stigma surrounding mental health issues within the Asian Pacific Islander community, building resources to fund service delivery, and developing an educated and culturally sensitive workforce. The history of the organization highlights the multiple challenges and rewards of developing a culturally specific nonprofit in an urban area as well as the important role that internal operations play in relation to nonprofit expansion and growth.

Unlocking community capability through promotion of self-help for health: experience from Chakaria, Bangladesh.

PubMed

Bhuiya, Abbas; Hanifi, Syed Manzoor Ahmed; Hoque, Shahidul

2016-11-15

People's participation in health, enshrined in the 1978 Alma Ata declaration, seeks to tap into community capability for better health and empowerment. One mechanism to promote participation in health is through participatory action research (PAR) methods. Beginning in 1994, the Bangladeshi research organization ICDDR,B implemented a project "self-help for health," to work with existing rural self-help organizations (SHOs). SHOs are organizations formed by villagers for their well-being through their own initiatives without external material help. This paper describes the project's implementation, impact, and reflective learnings. Following a self-help conceptual framework and PAR, the project focused on building the capacity of SHOs and their members through training on organizational issues, imparting health literacy, and supporting participatory planning and monitoring. Quarterly activity reports and process documentation were the main sources of qualitative data used for this paper, enabling documentation of changes in organizational issues, as well as the number and nature of initiatives taken by the SHOs in the intervention area. Health and demographic surveillance system (HDSS) data from intervention and comparison areas since 1999 allowed assessment of changes in health indicators over time. Villagers and members of the SHOs actively participated in the self-help activities. SHO functionality increased in the intervention area, in terms of improved organizational processes and planned health activities. These included most notably in convening more regular meetings, identifying community needs, developing and implementing action plans, and monitoring progress and impact. Between 1999 and 2015, while decreases in infant mortality and increases in utilization of at least one antenatal care visit occurred similarly in intervention and comparison areas, increases in immunization, skilled birth attendance, facility deliveries and sanitary latrines were

Service Learning Trips Abroad Benefit Both Communities and Seasoned Health Educators.

PubMed

Gan, Jody C

2018-05-01

Service learning experiences abroad provide an excellent opportunity for seasoned health educators to share their skills with underresourced communities in other parts of the world while enriching their own professional development. Health educators have not traditionally participated in short-term medical service trips, which have become a popular humanitarian effort, yet their contributions can expand the scope of these efforts. With our responsibilities often focused on assessing needs, planning, implementing, and evaluation, seasoned health educators can provide guidance for new initiatives and share health promotion materials and other resources with communities in other parts of the world. In this commentary, I detail my experience as the first health educator to volunteer with a medical brigade that has served a rural community in Honduras for nearly two decades, and describe my added contribution of a brief intervention to address teen pregnancy during the brigade's annual, medically oriented visit. I also reflect on the benefits to my professional growth from this opportunity to immerse myself in four very familiar areas of responsibility for health education in a new and unknown setting.

Building Community Resilience to Disasters: A Way Forward to Enhance National Health Security.

PubMed

Chandra, Anita; Acosta, Joie; Howard, Stefanie; Uscher-Pines, Lori; Williams, Malcolm; Yeung, Douglas; Garnett, Jeffrey; Meredith, Lisa S

2011-01-01

Community resilience, or the sustained ability of a community to withstand and recover from adversity, has become a key policy issue at federal, state, and local levels, including in the National Health Security Strategy. Because resources are limited in the wake of an emergency, it is increasingly recognized that resilience is critical to a community's ability to reduce long recovery periods after an emergency. This article shares details of a report that provides a roadmap for federal, state, and local leaders who are developing plans to enhance community resilience for health security threats and describes options for building community resilience in key areas. Based on findings from a literature review and a series of community and regional focus groups, the authors provide a definition of community resilience in the context of national health security and a set of eight levers and five core components for building resilience. They then describe suggested activities that communities are pursuing and may want to strengthen for community resilience, and they identify challenges to implementation.

Small-area estimation of health insurance coverage for California legislative districts.

PubMed

Yu, Hongjian; Meng, Ying-Ying; Mendez-Luck, Carolyn A; Jhawar, Mona; Wallace, Steven P

2007-04-01

To aid state and local policymakers, program planners, and community advocates, we created estimates of the percentage of the population lacking health insurance in small geographic areas of California. Finally, calibration ensured the consistency and stability of the estimates when they were aggregated. Health insurance coverage among nonelderly persons varied widely across assembly districts, from 10% to 44%. The utility of local-level estimates was most apparent when the variations in subcounty uninsured rates in Los Angeles County (19%-44%) were examined. Stable and useful estimates of health insurance rates for small areas such as legislative districts can be created through use of multiple sources of publicly available data.

Community-Clinical Linkages With Community Health Workers in the United States: A Scoping Review.

PubMed

Lohr, Abby M; Ingram, Maia; Nuñez, Annabelle V; Reinschmidt, Kerstin M; Carvajal, Scott C

2018-05-01

Despite the proliferation of community-clinical linkage (CCL) interventions with community health workers (CHWs), little is known about the components of these programs or how linkages are realized. In this scoping review, we synthesize evidence concerning the role of CHWs in creating and sustaining CCLs aimed at improving individual health outcomes. Our inclusion criteria included peer-reviewed articles that described a CHW intervention in the United States that used a CCL model. A total of 2,776 titles and/or abstracts were screened and 47 articles underwent full text review. Two independent reviewers rated the screened articles based on additional criteria including the CHW connection to community and evidence of linkage follow up rather than simple referral. For the 11 peer-reviewed articles included in the final review, we describe the CHW's relationship to the community, training, and role within the intervention, linkage, and outcomes. We used a standardized framework to determine commonalities in CHW roles across the interventions. CCLs with CHWs positively affect the delivery of both clinical care and community resources across a range of disease areas in a variety of contexts. To identify effective CCL models, additional information on CHW training, CCL follow-up methods, and the CHW role in CCLs is recommended.

Community desires for an online health information strategy.

PubMed

Dart, Jared M; Gallois, Cindy

2010-11-01

To determine whether the community's attitudes to components of a community eHealth strategy differ across three different socioeconomic groups. A survey questionnaire was designed and implemented across three different communities. Paper-based surveys were left in community organisations and local health practices in a low socioeconomic community on the outskirts of Ipswich, Queensland (n = 262), a mid-high socioeconomic community in the western suburbs of Brisbane (n = 256) and at a local university (n = 200). Ascribed importance and comfort with proposed components of a community eHealth strategy. A community-oriented health website was perceived as useful in getting access to relevant health information. Those who were most comfortable with accessing online health information were those who were: experienced, had home internet access and were frequent internet users. The most important types of health information for the website were: information about the treatment of conditions, how to manage a chronic illness, how to stay healthy and patient clinical pathways. The low socioeconomic community had different information priorities – all categories were considered more important, particularly information about how the public system operates, local health support groups, and the roles of health professionals. Different communities have different information demands but there is a strong demand for information which empowers community members to take control of their own health and become active participants in their health care. Tools such as a community health portal and patient clinical pathways should become more available.

The community health worker cultural mentoring project: preparing professional students for team work with health workers from urban communities.

PubMed

Sherwen, Laurie N; Schwolsky-Fitch, Elena; Rodriquez, Romelia; Horta, Greg; Lopez, Ivanna

2007-01-01

Community Health Workers or CHWs (also known by a variety of alternative titles) are health workers drawn from communities to provide access to care for members of their communities. CHWs have been documented as effective in delivering a variety of services in a culturally-sensitive manner, and in providing a bridge between health professionals and underserved or minority communities. Yet, CHWs have not been well incorporated into interdisciplinary health care teams. The majority of health professionals are not even aware of the possible role and skills of CHWs. Believing that the best time to educate professionals about this valuable health worker and ensure that CHWs become part of interdisciplinary health care teams is during the student years, the Hunter College Schools of the Health Professions, and the Community Health Worker Network of New York City developed a pilot project, the Community Health Worker Cultural Mentoring Project. Community Health Workers, who were members of the Network, served as "community mentors" for health professions students drawn from the programs of community health education, nursing, and nutrition. CHWs worked with faculty of selected courses in each of the professional programs, and served as panelists in these courses, presenting information about health beliefs and alternative health practices of diverse cultural groups in communities of New York City. Class sessions were first held in the fall of 2004; subsequent sessions were held in following semesters. Approximately 40 students participated in 7 classes, with 6 CHWs serving as mentors - two per class. At the end of the classroom presentations, students wrote reflections relating to their understanding of the CHW role and relevance for their future interdisciplinary practice. The majority of reflections met the goal of increasing professional students' understanding of the CHW role and skills. At this point, quantitative and qualitative data will need to be collected to

Communities defining environmental health: examples from the Colorado (U.S.A.) Healthy Communities Initiative.

PubMed

Conner, R F; Tanjasiri, S P

2000-01-01

Communities are increasingly defining 'health' for themselves, then becoming the main actors in actions to improve their health and well being. These community members work from a broad and inclusive definition of 'health' that often incorporates environmental health as a key aspect. They also assume an ecological, or systems, viewpoint that integrates many aspects of the community that affect health and well being, including housing, health, economy, education, transportation, youth and family issues, as well as health and illness care. This paper describes a program that involves 28 large and small, urban and rural communities in the United States state of Colorado that undertook this type of community-based health improvement project. The Colorado Healthy Communities Initiative (CHCI) was designed to bring together citizens in Colorado to work collaboratively to make their communities healthier. This paper describes the program's background, including its principles, processes, and participants, then focuses on the particular aspects of environmental health that communities included in their definitions of a 'healthy community'.

[Morbidity observed in a health area: Impact on professionals and funding].

PubMed

de Miguel, Pablo; Caballero, Isabel; Rivas, Francisco Javier; Manera, Jaime; de Vicente, María Auxiliadora; Gómez, Ángel

2015-05-01

To analyze morbidity, in the context of a health area, and broken down by health centre, of patients who made contact with healthcare services, in order to propose an adjustment to finance the payment per capita. A descriptive study of morbidity observed in citizens assigned a health area during year 2010. SITE: Health Area 9. Autonomous Community of Madrid. Formed by the municipalities of Fuenlabrada, Humanes, and Moraleja de Enmedio. All levels of health care included. All citizens with health card assigned to a health center in the area who has maintained contact with the public health service's own area. Coded contact of patients are grouped using the Population Grouping Clinical Risk 3M TM Software (CRG). Each patient is included in a homogeneous and exclusive group with a numerical morbidity and clinical sense. Through the health card is known primary care centre, physician, age and sex. The distribution of morbidity is obtained by primary care centre, primary care physician, age and sex analyzing differences and combinations. It was found that the average values of the population morbidity are different in each primary care centre. In order to maintain the principle of equity in health care, it is suggested that an adjustment is made to the per capita payment based on the morbidity rate of the population. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

Keys to Successful Community Health Worker Supervision

ERIC Educational Resources Information Center

Duthie, Patricia; Hahn, Janet S.; Philippi, Evelyn; Sanchez, Celeste

2012-01-01

For many years community health workers (CHW) have been important to the implementation of many of our health system's community health interventions. Through this experience, we have recognized some unique challenges in community health worker supervision and have highlighted what we have learned in order to help other organizations effectively…

Choropleth map legend design for visualizing community health disparities.

PubMed

Cromley, Robert G; Cromley, Ellen K

2009-09-24

Disparities in health outcomes across communities are a central concern in public health and epidemiology. Health disparities research often links differences in health outcomes to other social factors like income. Choropleth maps of health outcome rates show the geographical distribution of health outcomes. This paper illustrates the use of cumulative frequency map legends for visualizing how the health events are distributed in relation to social characteristics of community populations. The approach uses two graphs in the cumulative frequency legend to highlight the difference between the raw count of the health events and the raw count of the social characteristic like low income in the geographical areas of the map. The approach is applied to mapping publicly available data on low birth weight by town in Connecticut and Lyme disease incidence by town in Connecticut in relation to income. The steps involved in creating these legends are described in detail so that health analysts can adopt this approach. The different health problems, low birth weight and Lyme disease, have different cumulative frequency signatures. Graphing poverty population on the cumulative frequency legends revealed that the poverty population is distributed differently with respect to the two different health problems mapped here. Cumulative frequency legends can be useful supplements for choropleth maps. These legends can be constructed using readily available software. They contain all of the information found in standard choropleth map legends, and they can be used with any choropleth map classification scheme. Cumulative frequency legends effectively communicate the proportion of areas, the proportion of health events, and/or the proportion of the denominator population in which the health events occurred that falls within each class interval. They illuminate the context of disease through graphing associations with other variables.

Trust of community health workers influences the acceptance of community-based maternal and child health services.

PubMed

Grant, Merridy; Wilford, Aurene; Haskins, Lyn; Phakathi, Sifiso; Mntambo, Ntokozo; Horwood, Christiane M

2017-05-29

Community health workers (CHWs) are a component of the health system in many countries, providing effective community-based services to mothers and infants. However, implementation of CHW programmes at scale has been challenging in many settings. To explore the acceptability of CHWs conducting household visits to mothers and infants during pregnancy and after delivery, from the perspective of community members, professional nurses and CHWs themselves. Primary health care clinics in five rural districts in KwaZulu-Natal, South Africa. A qualitative exploratory study was conducted where participants were purposively selected to participate in 19 focus group discussions based on their experience with CHWs or child rearing. Poor confidentiality and trust emerged as key barriers to CHW acceptability in delivering maternal and child health services in the home. Most community members felt that CHWs could not be trusted because of their lack of professionalism and inability to maintain confidentiality. Familiarity and the complex relationships between household members and CHWs caused difficulties in developing and maintaining a relationship of trust, particularly in high HIV prevalence settings. Professional staff at the clinic were crucial in supporting the CHW's role; if they appeared to question the CHW's competency or trustworthiness, this seriously undermined CHW credibility in the eyes of the community. Understanding the complex contextual challenges faced by CHWs and community members can strengthen community-based interventions. CHWs require training, support and supervision to develop competencies navigating complex relationships within the community and the health system to provide effective care in communities.

Using community-based evidence for decentralized health planning: insights from Maharashtra, India.

PubMed

Shukla, Abhay; Khanna, Renu; Jadhav, Nitin

2018-01-01

Health planning is generally considered a technical subject, primarily the domain of health officials with minimal involvement of community representatives. The National Rural Health Mission launched in India in 2005 recognized this gap and mandated mechanisms for decentralized health planning. However, since planning develops in the context of highly unequal power relations, formal spaces for participation are necessary but not sufficient. Hence a project on capacity building for decentralized health planning was implemented in selected districts of Maharashtra, India during 2010-13. This process developed on the platform of officially supported community-based monitoring and planning, a process for community feedback and participation towards health system change. A specific project on capacity building for decentralized planning included a structured learning course and workshops for major stakeholders. An evaluation of the project, including in-depth interviews of various participants and analysis of change in local health planning processes, revealed positive changes in intervention areas, including increased capacity of key stakeholders leading to preparation of evidence-based, innovative planning proposals, significant community oriented changes in utilization of health facility funds, and inclusion of community-based proposals in village, health facility-based block and district plans. Transparency related to planning increased along with responsiveness of health providers to community suggestions. A key lesson is that active facilitation of decentralized health planning and influencing the health system to expand participation, are essential to ensure changes in planning. Effective strategies included: identifying people's health service related priorities through community-based monitoring, capacity building of diverse stakeholders regarding local health planning, and advocacy to enable participation of community-based actors in the planning process. This

Conversations on telemental health: listening to remote and rural First Nations communities.

PubMed

Gibson, Kerri L; Coulson, Heather; Miles, Roseanne; Kakekakekung, Christal; Daniels, Elizabeth; O'Donnell, Susan

2011-01-01

Telemental health involves technologies such as videoconferencing to deliver mental health services and education, and to connect individuals and communities for healing and health. In remote and rural First Nations communities there are often challenges to obtaining mental healthcare in the community and to working with external mental health workers. Telemental health is a service approach and tool that can address some of these challenges and potentially support First Nations communities in their goal of improving mental health and wellbeing. Community members' perspectives on the usefulness and appropriateness of telemental health can greatly influence the level of engagement with the service. It appears that no research or literature exists on First Nations community members' perspectives on telemental health, or even on community perspectives on the broader area of technologies for mental health services. Therefore, this article explores the perspectives on telemental health of community members living in two rural and remote First Nations communities in Ontario, Canada. METHODS; This study was part of the VideoCom project, a collaborative research project exploring how remote and rural First Nations communities are using ICTs. This current exploration was conducted with the support of Keewaytinook Okimakanak (KO), our partner in Northwestern Ontario. With the full collaboration of the communities' leadership, a team involving KO staff and VideoCom researchers visited the two communities in the spring of 2010. Using a participatory research design, we interviewed 59 community members, asking about their experiences with and thoughts on using technologies and their attitudes toward telemental health, specifically. A thematic analysis of this qualitative data and a descriptive quantitative analysis of the information revealed the diversity of attitudes among community members. Finally, based on a discussion with the community telehealth staff, a 'ways forward

Community Health Advisor Programs. An Issue Paper.

ERIC Educational Resources Information Center

National Rural Health Association, Kansas City, MO.

Third World countries have used community health advisors (CHAs) for many years to deliver health services, health education, and linkages to isolated and underserved communities. In 1998 the National Community Health Advisor Study estimated there were at least 600 such programs in the United States using about 12,500 CHAs. Program activities and…

Rural-Urban Differences in Consumer Governance at Community Health Centers

PubMed Central

Wright, David Bradley

2017-01-01

Context Community health centers (CHCs) are primary care clinics that serve mostly low-income patients in rural and urban areas. They are required to be governed by a consumer majority. What little is known about the structure and function of these boards in practice, suggests that CHC boards in rural areas may look and act differently than CHC boards in urban areas. Purpose To identify differences in the structure and function of consumer governance at CHCs in rural and urban areas. Methods Semi-structured telephone interviews were conducted with 30 CHC board members from 14 different states. Questions focused on board members’ perceptions of board composition and the role of consumers on the board. Findings CHCs in rural areas are more likely to have representative boards, are better able to convey confidence in the organization, and are better able to assess community needs than CHCs in urban areas. However, CHCs in rural areas often have problems achieving objective decision-making, and may have fewer means for objectively evaluating quality of care due to the lack of patient board member anonymity. Conclusions Consumer governance is implemented differently in rural and urban communities, and the advantages and disadvantages in each setting are unique. PMID:23551642

On the front line of primary health care: the profile of community health workers in rural Quechua communities in Peru.

PubMed

Brown, Angela; Malca, Rosa; Zumaran, Adriana; Miranda, J Jaime

2006-05-17

To describe the profile of community health workers--health promoters, traditional birth attendants and traditional healers--in rural Quechua communities from Ayacucho, Peru. Basic quantitative and qualitative information was gathered as part of a community health project implemented between 1997 and 2002 in 40 Andean communities with information from questionnaires, personal interviews and group discussions. The majority of current community health workers are men with limited education who are primarily Quechua speakers undertaking their work on a voluntary basis. Health promoters are mostly young, male, high school graduates. There exists a high drop-out rate among these workers. In contrast, traditional healers and traditional birth attendants possess an almost diametrically opposite profile in terms of age, education and drop-out rates, though males still predominate. At the community level the health promoters are the most visible community health workers. It is very important to consider and to be aware of the profile of community health workers in order to provide appropriate alternatives when working with these groups as well as with the indigenous population, particularly in terms of culture, language and gender issues.

Racism, health status, and birth outcomes: results of a participatory community-based intervention and health survey.

PubMed

Carty, Denise C; Kruger, Daniel J; Turner, Tonya M; Campbell, Bettina; DeLoney, E Hill; Lewis, E Yvonne

2011-02-01

Many community-based participatory research (CBPR) partnerships address social determinants of health as a central consideration. However, research studies that explicitly address racism are scarce in the CBPR literature, and there is a dearth of available community-generated data to empirically examine how racism influences health disparities at the local level. In this paper, we provide results of a cross-sectional, population-based health survey conducted in the urban areas of Genesee and Saginaw Counties in Michigan to assess how a sustained community intervention to reduce racism and infant mortality influenced knowledge, beliefs, and experiences of racism and to explore how perceived racism is associated with self-rated health and birth outcomes. We used ANOVA and regression models to compare the responses of intervention participants and non-participants as well as African Americans and European Americans (N = 629). We found that intervention participants reported greater acknowledgment of the enduring and differential impact of racism in comparison to the non-intervention participants. Moreover, survey analyses revealed that racism was associated with health in the following ways: (1) experiences of racial discrimination predicted self-rated physical health, mental health, and smoking status; (2) perceived racism against one's racial group predicted lower self-rated physical health; and (3) emotional responses to racism-related experiences were marginally associated with lower birth-weight births in the study sample. Our study bolsters the published findings on perceived racism and health outcomes and highlights the usefulness of CBPR and community surveys to empirically investigate racism as a social determinant of health.

A Mixed-Methods Approach to Understanding Community Participation in Community Health Needs Assessments.

PubMed

Pennel, Cara L; McLeroy, Kenneth R; Burdine, James N; Matarrita-Cascante, David; Wang, Jia

Nonprofit hospitals are exempt from paying taxes. To maintain this status, they must provide benefit to the community they serve. In an attempt to improve accountability to these communities and the federal government, the Patient Protection and Affordable Care Act of 2010 includes a provision that requires all nonprofit hospitals to conduct a community health needs assessment (CHNA) and implement strategies to address identified health priorities every 3 years. This Act's provision, operationalized by a regulation developed and enforced by the Internal Revenue Service, mandates the involvement of public health agencies and other community stakeholders in the completion of the CHNA. To better understand community participation in nonprofit hospital-directed community health assessment and health improvement planning activities. Using a 2-phased, mixed-methods study design, we (1) conducted content analysis of 95 CHNA/implementation plan reports and (2) interviewed hospital and health system key informants, consultants, and community stakeholders involved in CHNA and planning processes. Community participation was assessed in terms of types of stakeholders involved and the depth of their involvement. Our findings suggest that many hospitals engaged and involved community stakeholders in certain aspects of the assessment process, but very few engaged a broad array of community stakeholder and community members in meaningful participation throughout the CHNA and health improvement planning process. Vast improvements in community participation and collaborative assessment and planning can be made in future CHNAs. On the basis of the findings, recommendations are made for further research. Practice implications include expanding community engagement and participation by stakeholder and activity type and using a common community health improvement model that better aligns hospital CHNA processes and implementation strategies with other organizations and agencies.

Survey of community pharmacy residents' perceptions of transgender health management.

PubMed

Leach, Caitlin; Layson-Wolf, Cherokee

2016-01-01

1) To measure the general perceptions and attitudes of community pharmacy residents toward transgender patients and health; 2) to identify gaps in didactic education regarding transgender health care among residents; and 3) to evaluate residents' level of support for pharmacists receiving education in transgender health care. This study was a cross-sectional survey delivered online. Community residency directors were e-mailed a cover letter and a 34-question online survey. The directors were asked to forward the survey to their residents for completion within 4 weeks. Responses were anonymous with no identifiers collected on the survey. Survey responses used a combination of open-response, multiple-choice, and Likert-scale questions aimed at gathering respondents' demographic information, perceptions of managing transgender patients and the need for receiving additional education in transgender health care. Overall, the results of the survey indicated that community pharmacy residents support integrating transgender health management into pharmacy education and recognize that the overwhelming barriers to care for these patients include discrimination and lack of provider knowledge. Significant findings include: 82.7% of community residents think that community pharmacists play an important role in providing care for transgender patients; 98.2% think that they have a responsibility to treat transgender patients; and 71.4% were not educated about transgender patient issues in pharmacy school. Only 36.2% of community residents felt confident in their ability to treat transgender patients. Community pharmacy residents list discrimination and lack of provider knowledge as the major barriers to care for transgender patients. Residents do not feel confident in their ability to treat and manage transgender patients. The majority of residents were not educated about transgender patient issues while in pharmacy school and think that community pharmacists need more education

The voluntary community health movement in India: a strengths, weaknesses, opportunities, and threats (SWOT) analysis.

PubMed

Sharma, M; Bhatia, G

1996-12-01

There has been a prolific growth of voluntary organizations in India since independence in 1947. One of the major areas of this growth has been in the field of community health. The purpose of this article is to historically trace the voluntary movement in community health in India, analyze the current status, and predict future trends of voluntary efforts. A review of the literature in the form of a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis was the method of this study. Some of the key trends which emerged as the priority areas for progress and for strengthening voluntary organizations in the future were enhancing linkages between health and development; building upon collective force; greater utilization of participatory training; establishing egalitarian and effectual linkages for decision making at the international level; developing self-reliant community-based models; and the need for attaining holistic empowerment at individual, organizational, and community levels through "duty consciousness" as opposed to merely asking for rights.

Toward a Healthy Community (Organizing Events for Community Health Promotion).

ERIC Educational Resources Information Center

Public Health Service (DHHS), Rockville, MD. Office of Disease Prevention and Health Promotion.

This booklet suggests the first steps communities can take in assessing their needs and resources and mobilizing public interest and support for health promotion. It is based on an approach to health education and community organization that recognizes the value of a highly visible, time-limited event, such as a health fair, a marathon, or an…

Female Health Workers at the Doorstep: A Pilot of Community-Based Maternal, Newborn, and Child Health Service Delivery in Northern Nigeria

PubMed Central

Uzondu, Charles A; Doctor, Henry V; Findley, Sally E; Afenyadu, Godwin Y; Ager, Alastair

2015-01-01

ABSTRACT Introduction: Nigeria has one of the highest maternal mortality ratios in the world. Poor health outcomes are linked to weak health infrastructure, barriers to service access, and consequent low rates of service utilization. In the northern state of Jigawa, a pilot study was conducted to explore the feasibility of deploying resident female Community Health Extension Workers (CHEWs) to rural areas to provide essential maternal, newborn, and child health services. Methods: Between February and August 2011, a quasi-experimental design compared service utilization in the pilot community of Kadawawa, which deployed female resident CHEWs to provide health post services, 24/7 emergency access, and home visits, with the control community of Kafin Baka. In addition, we analyzed data from the preceding year in Kadawawa, and also compared service utilization data in Kadawawa from 2008–2010 (before introduction of the pilot) with data from 2011–2013 (during and after the pilot) to gauge sustainability of the model. Results: Following deployment of female CHEWs to Kadawawa in 2011, there was more than a 500% increase in rates of health post visits compared with 2010, from about 1.5 monthly visits per 100 population to about 8 monthly visits per 100. Health post visit rates were between 1.4 and 5.5 times higher in the intervention community than in the control community. Monthly antenatal care coverage in Kadawawa during the pilot period ranged from 11.9% to 21.3%, up from 0.9% to 5.8% in the preceding year. Coverage in Kafin Baka ranged from 0% to 3%. Facility-based deliveries by a skilled birth attendant more than doubled in Kadawawa compared with the preceding year (105 vs. 43 deliveries total, respectively). There was evidence of sustainability of these changes over the 2 subsequent years. Conclusion: Community-based service delivery through a resident female community health worker can increase health service utilization in rural, hard-to-reach areas. PMID

Monitoring of Selected Health Indicators in Children Living in a Copper Mine Development Area in Northwestern Zambia

PubMed Central

Knoblauch, Astrid M.; Divall, Mark J.; Owuor, Milka; Archer, Colleen; Nduna, Kennedy; Ng’uni, Harrison; Musunka, Gertrude; Pascall, Anna; Utzinger, Jürg; Winkler, Mirko S.

2017-01-01

The epidemiology of malaria, anaemia and malnutrition in children is potentially altered in mining development areas. In a copper extraction project in northwestern Zambia, a health impact assessment (HIA) was commissioned to predict, manage and monitor health impacts. Two cross-sectional surveys were conducted: at baseline prior to project development (2011) and at four years into development (2015). Prevalence of Plasmodium falciparum, anaemia and stunting were assessed in under-five-year-old children, while hookworm infection was assessed in children aged 9–14 years in communities impacted and comparison communities not impacted by the project. P. falciparum prevalence was significantly higher in 2015 compared to 2011 in both impacted and comparison communities (odds ratio (OR) = 2.51 and OR = 6.97, respectively). Stunting was significantly lower in 2015 in impacted communities only (OR = 0.63). Anaemia was slightly lower in 2015 compared to baseline in both impacted and comparison communities. Resettlement due to the project and migration background (i.e., moving into the area within the past five years) were generally associated with better health outcomes in 2015. We conclude that repeated cross-sectional surveys to monitor health in communities impacted by projects should become an integral part of HIA to deepen the understanding of changing patterns of health and support implementation of setting-specific public health measures. PMID:28335490

Monitoring of Selected Health Indicators in Children Living in a Copper Mine Development Area in Northwestern Zambia.

PubMed

Knoblauch, Astrid M; Divall, Mark J; Owuor, Milka; Archer, Colleen; Nduna, Kennedy; Ng'uni, Harrison; Musunka, Gertrude; Pascall, Anna; Utzinger, Jürg; Winkler, Mirko S

2017-03-19

The epidemiology of malaria, anaemia and malnutrition in children is potentially altered in mining development areas. In a copper extraction project in northwestern Zambia, a health impact assessment (HIA) was commissioned to predict, manage and monitor health impacts. Two cross-sectional surveys were conducted: at baseline prior to project development (2011) and at four years into development (2015). Prevalence of Plasmodium falciparum , anaemia and stunting were assessed in under-five-year-old children, while hookworm infection was assessed in children aged 9-14 years in communities impacted and comparison communities not impacted by the project. P . falciparum prevalence was significantly higher in 2015 compared to 2011 in both impacted and comparison communities (odds ratio (OR) = 2.51 and OR = 6.97, respectively). Stunting was significantly lower in 2015 in impacted communities only (OR = 0.63). Anaemia was slightly lower in 2015 compared to baseline in both impacted and comparison communities. Resettlement due to the project and migration background (i.e., moving into the area within the past five years) were generally associated with better health outcomes in 2015. We conclude that repeated cross-sectional surveys to monitor health in communities impacted by projects should become an integral part of HIA to deepen the understanding of changing patterns of health and support implementation of setting-specific public health measures.

Area-Level Socioeconomic Gradients in Overweight and Obesity in a Community-Derived Cohort of Health Service Users - A Cross-Sectional Study.

PubMed

Bonney, Andrew; Mayne, Darren J; Jones, Bryan D; Bott, Lawrence; Andersen, Stephen E J; Caputi, Peter; Weston, Kathryn M; Iverson, Don C

2015-01-01

Overweight and obesity lead to higher probability of individuals accessing primary care but adiposity estimates are rarely available at regional levels to inform health service planning. This paper analyses a large, community-derived clinical database of objectively measured body mass index (BMI) to explore relationships with area-level socioeconomic disadvantage for informing regional level planning activities. The study included 91776 adults who had BMI objectively measured between 1 July 2009 and 30 June 2011 by a single pathology provider. Demographic data and BMI were extracted and matched to 2006 national census socioeconomic data using geocoding. Adjusted odds-ratios for overweight and obesity were calculated using sex-stratified logistic regression models with socioeconomic disadvantage of census collection district of residence as the independent variable. The prevalence of overweight or obesity was 79.2% (males) and 65.8% (females); increased with age to 74 years; and was higher in rural (74%) versus urban areas (71.4%) (p<0.001). Increasing socioeconomic disadvantage was associated with increasing prevalence of overweight (p<0.0001), obesity (p<0.0001) and overweight or obesity (p<0.0001) in women and obesity (p<0.0001) in men. Socioeconomic disadvantage was unrelated to overweight (p = 0.2024) and overweight or obesity (p = 0.4896) in males. It is feasible to link routinely-collected clinical data, representative of a discrete population, with geographic distribution of disadvantage, and to obtain meaningful area-level information useful for targeting interventions to improve population health. Our results demonstrate novel area-level socioeconomic gradients in overweight and obesity relevant to regional health service planning.

Highlighting the Way Forward: A Review of Community Mental Health Research and Practice Published in AJCP and JCP.

PubMed

Townley, Greg; Terry, Rachel

2018-03-01

Articles published in the two most prominent journals of community psychology in North America, the American Journal of Community Psychology (AJCP) and Journal of Community Psychology (JCP), provide a clear indicator of trends in community research and practice. An examination of community psychology's history and scholarship suggests that the field has reduced its emphasis on promoting mental health, well-being, and liberation of individuals with serious mental illnesses over the past several decades. To further investigate this claim, the current review presents an analysis of articles relevant to community mental health (N = 307) published in the American Journal of Community Psychology (AJCP) and Journal of Community Psychology (JCP) from 1973 to 2015. The review focuses on article characteristics (e.g., type of article and methods employed), author characteristics, topic areas, and theoretical frameworks. Results document a downward trend in published articles from the mid-1980s to mid-2000s, with a substantial increase in published work between 2006 and 2015. A majority of articles were empirical and employed quantitative methods. The most frequent topic area was community mental health centers and services (n = 49), but the past three decades demonstrate a clear shift away from mental health service provision to address pressing social issues that impact community mental health, particularly homelessness (n = 42) and community integration of adults with serious mental illnesses (n = 40). Findings reflect both the past and present state of community psychology and suggest promising directions for re-engaging with community mental health and fostering well-being, inclusion, and liberation of adults experiencing serious mental health challenges. © Society for Community Research and Action 2017.

Curriculum for Community Health Workers.

ERIC Educational Resources Information Center

Southwick, Paula S.

The Community Outreach Curriculum described in this paper is designed to prepare community health aides employed through the Outreach Department of Pima County (Arizona) Indian Health Inc., (PCIHI), which consists of two medical clinics on two separate reservations. The first sections of the paper describe PCIHI, provide a rationale for the…

The Evolution of an Innovative Community-Engaged Health Navigator Program to Address Social Determinants of Health.

PubMed

Page-Reeves, Janet; Moffett, Maurice L; Steimel, Leah; Smith, Daryl T

Health navigators and other types of community health workers (CHWs) have become recognized as essential components of quality care, and key for addressing health disparities owing to the complex health care services landscape presents almost insurmountable challenges for vulnerable individuals. Bernalillo County, New Mexico, has high rates of uninsurance, poverty, and food insecurity. The design of the Pathways to a Healthy Bernalillo County Program (BP) has evolved innovations that are unique in terms of program stability and security, expansive reach, and community capacity across six domains: sustainable public mechanism for program funding, involvement of community organizations in designing the program, expanded focus to address the broader social determinants of health with targeted outreach, an integrated, community-based implementation structure, an outcomes-based payment structure, and using an adaptive program design that actively incorporates navigators in the process. In 2008, the Pathways to a Healthy Bernalillo County Program (BP), located in the Albuquerque metropolitan area in central New Mexico, was established to provide navigation and support for the most vulnerable county residents. BP is funded through a 1% carve out of county mill levy funds. The pathways model is an outcome-based approach for health and social services coordination that uses culturally competent CHW as "navigators" trained to connect at-risk individuals to needed health and social services. One of the important innovations of the pathways approach is a shift in focus from merely providing discrete services to confirming healthy outcomes for the individual patient.

Dimensions of Leadership among Community College Health Career Program Department Chairs and Implications for Leadership Development

ERIC Educational Resources Information Center

Platz-Wiechert, Lynn Marie

2010-01-01

Given the growth in community colleges, the projected need for health career workers, and the central position of the department chair in higher education, this study explored dimensions of leadership as identified by health career department chairs in five Illinois community colleges. Areas of study included: (a) professional profiles of health…

Community-Based Health Programmes: Role Perceptions and Experiences of Female Peer Facilitators in Mumbai's Urban Slums

ERIC Educational Resources Information Center

Alcock, Glyn A.; More, Neena Shah; Patil, Sarita; Porel, Maya; Vaidya, Leena; Osrin, David

2009-01-01

Community-based initiatives have become a popular approach to addressing the health needs of underserved populations, in both low- and higher-income countries. This article presents findings from a study of female peer facilitators involved in a community-based maternal and newborn health intervention in urban slum areas of Mumbai. Using…

Women and stress: a community prevention and health promotion program.

PubMed

Adam, D

1989-12-01

The past few decades have witnessed the launching of many health education and promotion programs for women, including Odyssée, Nouveaux départs and Women and Stress (Stress au féminin). Women and Stress was developed jointly by the Union culturelle des Franco-ontariennes, mental health professionals and representatives of the target audience. Its purpose is to help women take charge of their own health and their own bodies. This 15-hour group program, intended for French-speaking women in Ontario, includes six workshops that identify the symptoms and sources of stress and teach effective stress management strategies. The program is original in that it was designed primarily to be delivered by non-professionals in the community. According to the results of an evaluation by 360 participants, the program was an immediate success: it attained its health education and promotion objectives, and fostered community control in the area of prevention and health promotion.

Using an academic-community partnership model and blended learning to advance community health nursing pedagogy.

PubMed

Ezeonwu, Mabel; Berkowitz, Bobbie; Vlasses, Frances R

2014-01-01

This article describes a model of teaching community health nursing that evolved from a long-term partnership with a community with limited existing health programs. The partnership supported RN-BSN students' integration in the community and resulted in reciprocal gains for faculty, students and community members. Community clients accessed public health services as a result of the partnership. A blended learning approach that combines face-to-face interactions, service learning and online activities was utilized to enhance students' learning. Following classroom sessions, students actively participated in community-based educational process through comprehensive health needs assessments, planning and implementation of disease prevention and health promotion activities for community clients. Such active involvement in an underserved community deepened students' awareness of the fundamentals of community health practice. Students were challenged to view public health from a broader perspective while analyzing the impacts of social determinants of health on underserved populations. Through asynchronous online interactions, students synthesized classroom and community activities through critical thinking. This paper describes a model for teaching community health nursing that informs students' learning through blended learning, and meets the demands for community health nursing services delivery. © 2013 Wiley Periodicals, Inc.

On the front line of primary health care: the profile of community health workers in rural Quechua communities in Peru

PubMed Central

Brown, Angela; Malca, Rosa; Zumaran, Adriana; Miranda, J Jaime

2006-01-01

Objective To describe the profile of community health workers – health promoters, traditional birth attendants and traditional healers – in rural Quechua communities from Ayacucho, Peru. Methods Basic quantitative and qualitative information was gathered as part of a community health project implemented between 1997 and 2002 in 40 Andean communities with information from questionnaires, personal interviews and group discussions. Results The majority of current community health workers are men with limited education who are primarily Quechua speakers undertaking their work on a voluntary basis. Health promoters are mostly young, male, high school graduates. There exists a high drop-out rate among these workers. In contrast, traditional healers and traditional birth attendants possess an almost diametrically opposite profile in terms of age, education and drop-out rates, though males still predominate. At the community level the health promoters are the most visible community health workers. Conclusion It is very important to consider and to be aware of the profile of community health workers in order to provide appropriate alternatives when working with these groups as well as with the indigenous population, particularly in terms of culture, language and gender issues. PMID:16707010

Community Management That Works: How to Build and Sustain a Thriving Online Health Community

PubMed Central

2013-01-01

Health care professionals, patients, caregivers, family, friends, and other supporters are increasingly joining online health communities to share information and find support. But social Web (Web 2.0) technology alone does not create a successful online community. Building and sustaining a successful community requires an enabler and strategic community management. Community management is more than moderation. The developmental life cycle of a community has four stages: inception, establishment, maturity, and mitosis. Each stage presents distinct characteristics and management needs. This paper describes the community management strategies, resources, and expertise needed to build and maintain a thriving online health community; introduces some of the challenges; and provides a guide for health organizations considering this undertaking. The paper draws on insights from an ongoing study and observation of online communities as well as experience managing and consulting a variety of online health communities. Discussion includes effective community building practices relevant to each stage, such as outreach and relationship building, data collection, content creation, and other proven techniques that ensure the survival and steady growth of an online health community. PMID:23759312

Rush Health Systems and Meridian Community College: People Serving People

ERIC Educational Resources Information Center

Willis, Jean H.

2007-01-01

Meridian Community College and Rush Health Systems are partners in delivering training focused on Rush's mission statement of hospital-wide commitment to "excellence in service management." Rush and MCC have delivered customized classes in the following areas: medical billing, leadership management, computer training, admissions clerk,…

Training community health students to develop community-requested social marketing campaigns: an innovative partnership.

PubMed

Lindsey, Billie J; Hawk, Carol Wetherill

2013-01-01

This paper describes a sustained partnership between a university community health program and local and regional community health agencies. As a key component of the Health Communication and Social Marketing course, the partnership involves undergraduate community health students working for and with community agencies and community members to design social marketing campaigns based on community-identified health needs. The goals of the course are to (1) provide students with the opportunity to work within the community to apply their skills in program planning, evaluation, and communication and (2) provide community agencies with a tailored campaign that can be implemented in their communities. Throughout the 10-week quarter, teams of students follow the principles of community participation in planning a social marketing campaign. These include (1) audience segmentation and formative assessment with the intended audience to determine campaign content and strategies and (2) pretesting and revisions of campaign messages and materials based on community feedback. This partnership contributes to the promotion of health in the local community and it builds the skills and competencies of future health educators. It demonstrates a successful and sustainable combination of community-based participatory research and experiential learning. From 2005 to 2011, 35 campaigns have been developed, many which have been implemented.

Using public health and community partnerships to reduce density of alcohol outlets.

PubMed

Jernigan, David H; Sparks, Michael; Yang, Evelyn; Schwartz, Randy

2013-04-11

Excessive alcohol use causes approximately 80,000 deaths in the United States each year. The Guide to Community Preventive Services recommends reducing the density of alcohol outlets - the number of physical locations in which alcoholic beverages are available for purchase either per area or per population - through the use of regulatory authority as an effective strategy for reducing excessive alcohol consumption and related harms. We briefly review the research on density of alcohol outlets and public health and describe the powers localities have to influence alcohol outlet density. We summarize Regulating Alcohol Outlet Density: An Action Guide, which describes steps that local communities can take to reduce outlet density and the key competencies and resources of state and local health departments. These include expertise in public health surveillance and evaluation methods, identification and tracking of outcome measures, geographic information systems (GIS) mapping, community planning and development of multisector efforts, and education of community leaders and policy makers. We illustrate the potential for partnerships between public health agencies and local communities by presenting a contemporary case study from Omaha, Nebraska. Public health agencies have a vital and necessary role to play in efforts to reduce alcohol outlet density. They are often unaware of the potential of this strategy and have strong potential partners in the thousands of community coalitions nationwide that are focused on reducing alcohol-related problems.

Using Public Health and Community Partnerships to Reduce Density of Alcohol Outlets

PubMed Central

Sparks, Michael; Yang, Evelyn; Schwartz, Randy

2013-01-01

Excessive alcohol use causes approximately 80,000 deaths in the United States each year. The Guide to Community Preventive Services recommends reducing the density of alcohol outlets — the number of physical locations in which alcoholic beverages are available for purchase either per area or per population — through the use of regulatory authority as an effective strategy for reducing excessive alcohol consumption and related harms. We briefly review the research on density of alcohol outlets and public health and describe the powers localities have to influence alcohol outlet density. We summarize Regulating Alcohol Outlet Density: An Action Guide, which describes steps that local communities can take to reduce outlet density and the key competencies and resources of state and local health departments. These include expertise in public health surveillance and evaluation methods, identification and tracking of outcome measures, geographic information systems (GIS) mapping, community planning and development of multisector efforts, and education of community leaders and policy makers. We illustrate the potential for partnerships between public health agencies and local communities by presenting a contemporary case study from Omaha, Nebraska. Public health agencies have a vital and necessary role to play in efforts to reduce alcohol outlet density. They are often unaware of the potential of this strategy and have strong potential partners in the thousands of community coalitions nationwide that are focused on reducing alcohol-related problems. PMID:23578401

Improving maternal and newborn health: effectiveness of a community health worker program in rural Kenya.

PubMed

Adam, Mary B; Dillmann, Maria; Chen, Mei-kuang; Mbugua, Simon; Ndung'u, Joram; Mumbi, Priscilla; Waweru, Eunice; Meissner, Peter

2014-01-01

Volunteer community health workers (CHWs) form an important element of many health systems, and in Kenya these volunteers are the foundation for promoting behavior change through health education, earlier case identification, and timely referral to trained health care providers. This study examines the effectiveness of a community health worker project conducted in rural Kenya that sought to promote improved knowledge of maternal newborn health and to increase deliveries under skilled attendance. The study utilized a quasi-experimental nonequivalent design that examined relevant demographic items and knowledge about maternal and newborn health combined with a comprehensive retrospective birth history of women's children using oral interviews of women who were exposed to health messages delivered by CHWs and those who were not exposed. The project trained CHWs in three geographically distinct areas. Mean knowledge scores were higher in those women who reported being exposed to the health messages from CHWs, Eburru 32.3 versus 29.2, Kinale 21.8 vs 20.7, Nyakio 26.6 vs 23.8. The number of women delivering under skilled attendance was higher for those mothers who reported exposure to one or more health messages, compared to those who did not. The percentage of facility deliveries for women exposed to health messages by CHWs versus non-exposed was: Eburru 46% versus 19%; Kinale 94% versus 73%: and Nyakio 80% versus 78%. The delivery of health messages by CHWs increased knowledge of maternal and newborn care among women in the local community and encouraged deliveries under skilled attendance.

Improving Maternal and Newborn Health: Effectiveness of a Community Health Worker Program in Rural Kenya

PubMed Central

Adam, Mary B.; Dillmann, Maria; Chen, Mei-kuang; Mbugua, Simon; Ndung’u, Joram; Mumbi, Priscilla; Waweru, Eunice; Meissner, Peter

2014-01-01

Background Volunteer community health workers (CHWs) form an important element of many health systems, and in Kenya these volunteers are the foundation for promoting behavior change through health education, earlier case identification, and timely referral to trained health care providers. This study examines the effectiveness of a community health worker project conducted in rural Kenya that sought to promote improved knowledge of maternal newborn health and to increase deliveries under skilled attendance. Methods The study utilized a quasi-experimental nonequivalent design that examined relevant demographic items and knowledge about maternal and newborn health combined with a comprehensive retrospective birth history of women’s children using oral interviews of women who were exposed to health messages delivered by CHWs and those who were not exposed. The project trained CHWs in three geographically distinct areas. Results Mean knowledge scores were higher in those women who reported being exposed to the health messages from CHWs, Eburru 32.3 versus 29.2, Kinale 21.8 vs 20.7, Nyakio 26.6 vs 23.8. The number of women delivering under skilled attendance was higher for those mothers who reported exposure to one or more health messages, compared to those who did not. The percentage of facility deliveries for women exposed to health messages by CHWs versus non-exposed was: Eburru 46% versus 19%; Kinale 94% versus 73%: and Nyakio 80% versus 78%. Conclusion The delivery of health messages by CHWs increased knowledge of maternal and newborn care among women in the local community and encouraged deliveries under skilled attendance. PMID:25090111

Racial ethnic differences in type 2 diabetes treatment patterns and glycaemic control in the Boston Area Community Health Survey

PubMed Central

Goonesekera, Sunali D; Yang, May H; Hall, Susan A; Fang, Shona C; Piccolo, Rebecca S; McKinlay, John B

2015-01-01

Objectives Numerous studies continue to report poorer glycaemic control, and a higher incidence of diabetes-related complications among African–Americans and Hispanic–Americans as compared with non-Hispanic Caucasians with type 2 diabetes. We examined racial/ethnic differences in receipt of hypoglycaemic medications and glycaemic control in a highly insured Massachusetts community sample of individuals with type 2 diabetes. Setting Community-based sample from Boston, Massachusetts, USA. Participants 682 patients with physician-diagnosed diabetes from the third wave of the Boston Area Community Health Survey (2010–2012). The study included approximately equal proportions of African–Americans, Hispanics and Caucasians. Methods We examined racial/ethnic disparities in diabetes treatment by comparing proportions of individuals on mutually exclusive diabetes treatment regimens across racial/ethnic subgroups. Using multivariable linear and logistic regression, we also examined associations between race/ethnicity and glycaemic control in the overall population, and within treatment regimens, adjusting for age, gender, income, education, health insurance, health literacy, disease duration, diet and physical activity. Results Among those treated (82%), the most commonly prescribed antidiabetic regimens were biguanides only (31%), insulin only (23%), and biguanides and insulin (16%). No overall racial/ethnic differences in treatment or glycaemic control (per cent difference for African–Americans: 6.18, 95% CI −1.00 to 13.88; for Hispanic–Americans: 1.01, 95% CI −10.42 to 12.75) were observed. Within regimens, we did not observe poorer glycaemic control for African–Americans prescribed biguanides only, insulin only or biguanides combined with insulin/sulfonylureas. However, African–Americans prescribed miscellaneous regimens had higher risk of poorer glycaemic control (per cent difference=23.37, 95% CI 7.25 to 43.33). There were no associations between

John C. Lincoln Health Network recognized for community service. Phoenix institution wins prestigious Foster G. Mcgaw Prize.

PubMed

Rees, Tom

2003-01-01

John C. Lincoln Health Network, Phoenix, was awarded the Foster G. McGaw Prize for excellence in community service, one of the healthcare field's most prestigious honors. The network serves a broad geographic area and nearly a dozen communities. Those communities most challenged by poverty, hunger, poor housing and crime are the focus of most of the health network's efforts.

Training of Community Health Agents in health hearing children: current perspectives.

PubMed

Castro, Taís Teixeira de Oliveira; Zucki, Fernanda

2015-01-01

To characterize the training of Community Health Workers in the field of child hearing health. A systematic literature review on Biblioteca Virtual em Saúde (BVS) and Biblioteca Digital de Teses e Dissertações of USP databases was performed. The search strategy was oriented by the specific question: "How have the Community Health Workers been trained to work in the field of child hearing health?" The study selection criteria involved consistency with the proposed theme, belonging to the category of scientific papers, dissertation or thesis, and publication in Brazilian Portuguese. A total of 2,687 studies were found. After analyzing the title and abstract, eight studies were chosen for full reading, however, only four of them met the proposed criteria and were included in the review. The studies indicated live and virtual classes with the use of video conferencing or CD-ROM as training strategies for Community Health Workers. Trainings were effective. Only one questionnaire about hearing and language monitoring was described. Different possibilities for the activities of Community Health Workers were identified. Different learning methodologies have been used for training the Community Health Worker in the field of child hearing health, and all of have proven effective for knowledge acquisition. Community Health Workers play an important role in promoting and monitoring child hearing health.

Multilevel analysis of the physical health perception of employees: community and individual factors.

PubMed

Sathyanarayanan, Sudhakar; Brooks, Ambyr J; Hagen, Susan E; Edington, Dee W

2012-01-01

To investigate whether the communities where employees reside are associated with employee perception of overall physical health after adjusting for individual factors. Retrospective cross-sectional. Active employees from a large manufacturing company representing 157 zip code tabulation areas (ZCTAs) in Michigan. 22,012 active employees who completed at least one voluntary health risk appraisal (HRA) during 1999-2001. Community deprivation and racial segregation at the ZCTA level were obtained using indices created from 2000 U.S. Census data. Demographics and HRA-related data (health-related behaviors, medical history, and quality of life indicators) at the individual level were used as independent variables. A two-level logistic regression model (employees nested in ZCTA) was used to model the probability of better self-rated health perception (SRH) (better health: 89.1% versus poor health: 10.9%). Relative to those living in highly deprived communities, employees residing in less-deprived communities showed 2.06 (95% confidence interval [CI], 1.57-2.72) and those living in moderately deprived communities showed 1.83 (95% CI, 1.42-2.35) increased odds of better SRH. After adjusting for individual-level variables, employees living in less-deprived communities had increased odds (1.31 [95% CI, 1.07-1.60]) and those living in moderately deprived communities had increased odds (1.33 [95% CI, 1.11-1.59]) of better SRH compared with individuals from highly deprived communities. The association of racial segregation with employees' SRH was mediated after adjusting for other variables. Individual-level variables showed significant statistical associations with SRH. Communities do have a modest association with SRH of the employees living there. After adjusting for individual-level and demographic variables, employees living in less/moderately deprived communities are more likely to perceive better physical health relative to those who live in highly deprived communities.

A health-promoting community dental service in Melbourne, Victoria, Australia: protocol for the North Richmond model of oral health care.

PubMed

Hall, Martin; Christian, Bradley

2017-10-01

Despite the best efforts and commitment of oral health programs, there is no evidence that the current surgical output-based model of oral health care is delivering better oral health outcomes to the community. In fact, Australian evidence indicates the oral health of the community could be getting worse. It is now well-understood that this traditional surgical model of oral health care will never successfully manage the disease itself. It is proposed that a health-promoting, minimally invasive oral disease management model of care may lead to a sustainable benefit to the oral health status of the individual and community groups. The aim of this paper is to describe such a model of oral health care (MoC) currently being implemented by the North Richmond Community Health Oral Health (NRCH-OH) program in Melbourne, Victoria, Australia; this model may serve as a template for other services to re-orient their healthcare delivery towards health promotion and prevention. The paper describes the guiding principles and theories for the model and also its operational components, which are: pre-engagement while on the waitlist; client engagement at the reception area; the assessment phase; oral health education (high-risk clients only); disease management; and reviews and recall.

High Prevalence of Overweight Among Pediatric Users of Community Health Centers

PubMed Central

Stettler, Nicolas; Elliott, Michael R.; Kallan, Michael J.; Auerbach, Steven B.; Kumanyika, Shiriki K.

2005-01-01

Objective With the increasing prevalence of pediatric obesity, it is important to identify high-risk populations of children to direct limited resources for prevention and treatment to those who are most vulnerable. The objectives of this study were to determine the prevalence of overweight in children who are clients of community health centers in medically underserved areas of the Health Resources and Service Administration regions II and III (Mid-Atlantic and Puerto Rico), compare this prevalence to nationally representative data, and contrast prevalence data between geographic areas and racial/ethnic groups. Methods The charts from a representative sample of 2474 children using 30 community health centers in 2001 were abstracted to collect clinically measured weight and height. Overweight was defined as a body mass index of ≥95th percentile of a reference population. To generate an unbiased estimate of overweight, multiple imputations were used for missing data. These data were compared with the 1999–2002 National Health and Nutrition Examination Survey. Results The prevalence of overweight was elevated in this sample of children aged 2 to 5 years (21.8%; 95% confidence interval [CI]: 19.1–24.8) and 6 to 11 years (23.8%; 95% CI: 16.9–27.7) compared with the 1999–2002 National Health and Nutrition Examination Survey (10.3% and 15.8%, respectively). No significant differences in prevalence were observed between Asian American (18.2%; 95% CI: 11.2–28.3), Hispanic (24.6%; 95% CI: 21.3–28.2), non-Hispanic black (25.6%; 95% CI: 20.8–30.9), and non-Hispanic white (22.8%; 95% CI: 19.0–27.0) children. Furthermore, no differences in prevalence were observed between children using community health centers in continental urban (23.7%; 95% CI: 20.6–27.2), suburban (24.0%; 95% CI: 20.0–28.5), or rural (22.9%; 95% CI: 19.3–26.9) areas. Conclusions The present study identified a population of children at particularly high risk for obesity based on the

Personalized Health Monitoring System for Managing Well-Being in Rural Areas.

PubMed

Nedungadi, Prema; Jayakumar, Akshay; Raman, Raghu

2017-12-14

Rural India lacks easy access to health practitioners and medical centers, depending instead on community health workers. In these areas, common ailments that are easy to manage with medicines, often lead to medical escalations and even fatalities due to lack of awareness and delayed diagnosis. The introduction of wearable health devices has made it easier to monitor health conditions and to connect doctors and patients in urban areas. However, existing initiatives have not succeeded in providing adequate health monitoring to rural and low-literate patients, as current methods are expensive, require consistent connectivity and expect literate users. Our design considerations address these concerns by providing low-cost medical devices connected to a low-cost health platform, along with personalized guidance based on patient physiological parameters in local languages, and alerts to medical practitioners in case of emergencies. This patient-centric integrated healthcare system is designed to manage the overall health of villagers with real-time health monitoring of patients, to offer guidance on preventive care, and to increase health awareness and self-monitoring at an affordable price. This personalized health monitoring system addresses the health-related needs in remote and rural areas by (1) empowering health workers in monitoring of basic health conditions for rural patients in order to prevent escalations, (2) personalized feedback regarding nutrition, exercise, diet, preventive Ayurveda care and yoga postures based on vital parameters and (3) reporting of patient data to the patient's health center with emergency alerts to doctor and patient. The system supports community health workers in the diagnostic procedure, management, and reporting of rural patients, and functions well even with only intermittent access to Internet.

Social capital and health: civic engagement, community size, and recall of health messages.

PubMed

Viswanath, Kasisomayajula; Randolph Steele, Whitney; Finnegan, John R

2006-08-01

We explored the effects of community integration and pluralism on recall of cardiovascular disease health information messages. With 1980-1983 data from the Minnesota Heart Health Program, we examined whether ties to community groups were associated with recall of health messages, and whether this relation was modified by size and degree of differentiation of the community. A higher level of civic engagement through ties to community groups was associated with better recall of health messages. Ties to community groups independently contributed to better message recall even after control for gender, education, and other variables. The moderating role of community size was non-significant but intriguing. Community group membership could increase exposure to health messages, providing a critical pathway for social capital to influence health promotion and, thus, public health outcomes.

Fluoride and health hazards: community perception in a fluorotic area of central Rajasthan (India): an arid environment.

PubMed

Hussain, J; Hussain, I; Sharma, K C

2010-03-01

India is among the 23 nations around the globe where health problems occur due to excess ingestion of fluoride (>1.5 mg/l) by drinking water. In Rajasthan, 18 out of 32 districts are fluorotic and 11 million of the populations are at risk. An exploratory qualitative survey was conducted to describe perception of the community regarding fluoride and related health problems in Central Rajasthan. A study on distribution and health hazards by fluoride contaminate in groundwater was performed in 1,030 villages of Bhilwara district of Central Rajasthan. One thousand thirty water samples were collected and analyzed for fluoride concentration. Fluoride concentration in these villages varies from 0.2 to 13.0 mg/l. Seven hundred fifty-six (73.4%) villages have fluoride concentration above 1.0 mg/l. Sixty (5.83%) villages have fluoride concentration above 5.0 mg/l with maximum numbers (24, 19.5%) from Shahpura tehsil. A detailed fluorosis study was carried out in 41 villages out of 60 villages having fluoride above 5.0 mg/l in the study age, sex, and occupation data were also collected. Four thousand, two hundred fifty-two individuals above 5 years age were examined for the evidence of dental fluorosis, while 1998 individuals above 21 years were examined for the evidence of skeletal fluorosis. The overall prevalence of dental and skeletal fluorosis was found to be 3,270/4,252 (76.9%) and 949/1,998 (47.5%), respectively. Maximum of 23.9% (1,016) individuals have mild grade of Dean's classification. Three hundred seventy-four (8.8%) individuals have severe type of dental fluorosis. The Dean's Community Fluorosis Index for the studied area in total is 1.62. Maximum CFI 3.0 was recorded from Surajpura of Banera Tehsil. Five hundred sixty-six (28.3%) individuals have Grade I type of skeletal fluorosis while only 0.6% (12) individuals have Grade III skeletal fluorosis. In conclusion, the prevalence and severity of fluorosis increased with increasing fluoride concentration. It was

Reinvigorating health systems and community-based services to improve maternal health outcomes: case study from northern Nigeria.

PubMed

Findley, Sally E; Doctor, Henry V; Ashir, Garba M; Kana, Musa A; Mani, Abu S; Green, Cathy; Afenyadu, Godwin Y

2015-04-01

Maternal health outcomes in Nigeria, the most populous African nation, are among the worst in the world, and urgent efforts to improve the situation are critical as the deadline (2015) for achieving the Millennium Development Goals draws near. To evaluate the results of an integrated maternal, newborn, and child health (MNCH) program to improve maternal health outcomes in Northern Nigeria. The intervention model integrated critical health system and community-based improvements aimed at encouraging sustainable MNCH behavior change. Control Local Government Areas received less intense statewide policy changes. We assessed the impact of the intervention on maternal health outcomes in 3 northern Nigerian states by comparing data from 2360 women in 2009 and 4628 women in 2013 who had a birth or pregnancy in the 5 years prior to the survey. From 2009 to 2013, women with standing permission from their husband to go to the health center doubled (from 40.2% to 82.7%), and health care utilization increased. The proportions of women who delivered with a skilled birth attendant increased from 11.2% to 23.9%, and the proportion of women having at least 1 antenatal care (ANC) visit doubled from 24.9% to 48.8%. ANC was increasingly provided by trained community health extension workers at the primary health center, who provided ANC to 34% of all women with recent pregnancies in 2013. In 2013, 22% of women knew at least 4 maternal danger signs compared with 10% in 2009. Improvements were significantly greater in the intervention communities that received the additional demand-side interventions. The improvements between 2009 and 2013 demonstrate the measurable impact on maternal health outcomes of the program through local communities and primary health care services. The significant improvements in communities with the complete intervention show the importance of an integrated approach blending supply- and demand-side interventions. © The Author(s) 2014.

Community Gardens as Environmental Health Interventions: Benefits Versus Potential Risks.

PubMed

Al-Delaimy, W K; Webb, M

2017-06-01

The purpose of this paper was to summarize current findings on community gardens relevant to three specific areas of interest as follows: (1) health benefits, (2) garden interventions in developing versus developed countries, and (3) the concerns and risks of community gardening. Community gardens are a reemerging phenomenon in many low- and high-income urban neighborhoods to address the common risk factors of modern lifestyle. Community gardens are not limited to developed countries. They also exist in developing low-income countries but usually serve a different purpose of food security. Despite their benefits, community gardens can become a source of environmental toxicants from the soil of mostly empty lands that might have been contaminated by toxicants in the past. Therefore, caution should be taken about gardening practices and the types of foods to be grown on such soil if there was evidence of contamination. We present community gardens as additional solutions to the epidemic of chronic diseases in low-income urban communities and how it can have a positive physical, mental and social impact among participants. On balance, the benefits of engaging in community gardens are likely to outweigh the potential risk that can be remedied. Quantitative population studies are needed to provide evidence of the benefits and health impacts versus potential harms from community gardens.

Developing Responsive Indicators of Indigenous Community Health

PubMed Central

Donatuto, Jamie; Campbell, Larry; Gregory, Robin

2016-01-01

How health is defined and assessed is a priority concern for Indigenous peoples due to considerable health risks faced from environmental impacts to homelands, and because what is “at risk” is often determined without their input or approval. Many health assessments by government agencies, industry, and researchers from outside the communities fail to include Indigenous definitions of health and omit basic methodological guidance on how to evaluate Indigenous health, thus compromising the quality and consistency of results. Native Coast Salish communities (Washington State, USA) developed and pilot-tested a set of Indigenous Health Indicators (IHI) that reflect non-physiological aspects of health (community connection, natural resources security, cultural use, education, self-determination, resilience) on a community scale, using constructed measures that allow for concerns and priorities to be clearly articulated without releasing proprietary knowledge. Based on initial results from pilot-tests of the IHI with the Swinomish Indian Tribal Community (Washington State, USA), we argue that incorporation of IHIs into health assessments will provide a more comprehensive understanding of Indigenous health concerns, and assist Indigenous peoples to control their own health evaluations. PMID:27618086

Missing and accounted for: gaps and areas of wealth in the public health review literature

PubMed Central

2011-01-01

Background High-quality review evidence is useful for informing and influencing public health policy and practice decisions. However, certain topic areas lack representation in terms of the quantity and quality of review literature available. The objectives of this paper are to identify the quantity, as well as quality, of review-level evidence available on the effectiveness of public health interventions for public health decision makers. Methods Searches conducted on http://www.health-evidence.ca produced an inventory of public health review literature in 21 topic areas. Gaps and areas of wealth in the review literature, as well as the proportion of reviews rated methodologically strong, moderate, or weak were identified. The top 10 topic areas of interest for registered users and visitors of http://www.health-evidence.ca were extracted from user profile data and Google Analytics. Results Registered users' top three interests included: 1) healthy communities, 2) chronic diseases, and 3) nutrition. The top three preferences for visitors included: 1) chronic diseases, 2) physical activity, and 3) addiction/substance use. All of the topic areas with many (301+) available reviews were of interest to registered users and/or visitors (mental health, physical activity, addiction/substance use, adolescent health, child health, nutrition, adult health, and chronic diseases). Conversely, the majority of registered users and/or visitors did not have preference for topic areas with few (≤ 150) available reviews (food safety and inspection, dental health, environmental health) with the exception of social determinants of health and healthy communities. Across registered users' and visitors' topic areas of preference, 80.2% of the reviews were of well-done methodological quality, with 43.5% of reviews having a strong quality rating and 36.7% a moderate review quality rating. Conclusions In topic areas in which many reviews are available, higher level syntheses are needed to

Community perceptions of mental illness in rural Uganda: An analysis of existing challenges facing the Bwindi Mental Health Programme.

PubMed

Shah, Arya; Wheeler, Lydia; Sessions, Kristen; Kuule, Yusufu; Agaba, Edwin; Merry, Stephen P

2017-10-11

To assess community perceptions of mental illness in the Bwindi Community Hospital (BCH) catchment area: to recognise beliefs about the causes and the treatments for mental illness. To provide community data to staff at BCH as they work to develop more effective community mental health programmes. A shortage of mental health providers in Uganda has prompted research into community-based task-sharing models for the provision of mental health services in underserved communities. Six focus group discussions, with a total of 54 community members (50% male, n = 27; mean age + s.d. [39.9 + 10.9 years]) from the BCH catchment area, were conducted to assess community member and stakeholder perceptions of mental illness and belief in the feasibility of community-based programming. Qualitative study of data through thematic analysis was conducted to assess the presence of commonly occurring perceptions. Qualitative thematic analysis revealed two major themes: (1) belief that any given patient's metal illness results from either an intrinsic or an extrinsic cause and (2) belief in a need to determine treatment of mental illness based on the believed cause. As BCH designs community-based mental health services, our findings provide support for the need for further education of community members and training of community health workers to address and integrate the above-stated beliefs regarding mental illness.

Community perceptions of mental illness in rural Uganda: An analysis of existing challenges facing the Bwindi Mental Health Programme

PubMed Central

2017-01-01

Objectives To assess community perceptions of mental illness in the Bwindi Community Hospital (BCH) catchment area: to recognise beliefs about the causes and the treatments for mental illness. To provide community data to staff at BCH as they work to develop more effective community mental health programmes. Background A shortage of mental health providers in Uganda has prompted research into community-based task-sharing models for the provision of mental health services in underserved communities. Methods Six focus group discussions, with a total of 54 community members (50% male, n = 27; mean age + s.d. [39.9 + 10.9 years]) from the BCH catchment area, were conducted to assess community member and stakeholder perceptions of mental illness and belief in the feasibility of community-based programming. Qualitative study of data through thematic analysis was conducted to assess the presence of commonly occurring perceptions. Results Qualitative thematic analysis revealed two major themes: (1) belief that any given patient’s metal illness results from either an intrinsic or an extrinsic cause and (2) belief in a need to determine treatment of mental illness based on the believed cause. Conclusion As BCH designs community-based mental health services, our findings provide support for the need for further education of community members and training of community health workers to address and integrate the above-stated beliefs regarding mental illness. PMID:29041798

Using Community Health Assessment to Teach and Explore Health Status Disparities

ERIC Educational Resources Information Center

Sullivan, Marianne; Levine, Jack

2014-01-01

Introduction: Community health assessment (CHA) is a useful tool for identifying health status disparities at the community level. Developing the skills of master's level public health students to conduct CHA addresses a number of the Association of Schools of Public Health Core competencies for graduate public health education. Teaching…

Strategies To Empower Communities To Reduce Health Disparities.

PubMed

Thompson, Beti; Molina, Yamile; Viswanath, Kasisomayajula; Warnecke, Richard; Prelip, Michael L

2016-08-01

Community-based participatory research is a promising approach to reducing health disparities. It empowers individuals and communities to become the major players in solving their own health problems. We discuss the use of community-based participatory research and other strategies to enhance empowerment. We also discuss projects from the Centers for Population Health and Health Disparities that have empowered communities to achieve positive health outcomes aimed at reducing disparities. We offer recommendations to policy makers for involving residents in efforts to achieve health equity. Project HOPE—The People-to-People Health Foundation, Inc.

Factors influencing community nursing roles and health service provision in rural areas: a review of literature.

PubMed

Barrett, Annette; Terry, Daniel R; Lê, Quynh; Hoang, Ha

2016-02-01

This review sought to better understand the issues and challenges experienced by community nurses working in rural areas and how these factors shape their role. Databases were searched to identify relevant studies, published between 1990 and 2015, that focussed on issues and challenges experienced by rural community nurses. Generic and grey literature relating to the subject was also searched. The search was systematically conducted multiple times to assure accuracy. A total of 14 articles met the inclusion criteria. This critical review identified common issues impacting community nursing and included role definition, organisational change, human resource, workplace and geographic challenges. Community nurses are flexible, autonomous, able to adapt care to the service delivery setting, and have a diversity of knowledge and skills. Considerably more research is essential to identify factors that impact rural community nursing practice. In addition, greater advocacy is required to develop the role.

Health in my community: conducting and evaluating PhotoVoice as a tool to promote environmental health and leadership among Latino/a youth.

PubMed

Madrigal, Daniel Santiago; Salvatore, Alicia; Casillas, Gardenia; Casillas, Crystal; Vera, Irene; Eskenazi, Brenda; Minkler, Meredith

2014-01-01

The PhotoVoice method has shown substantial promise for work with youth in metropolitan areas, yet its potential for use with Latino youth from agricultural areas has not been well documented. This project was designed to teach environmental health to 15 high school youth while building their individual and community capacity for studying and addressing shared environmental concerns. The project also aimed to test the utility of PhotoVoice with Latino agricultural youth. Fifteen members of the Youth Community Council (YCC), part of a 15-year project with farmworker families in Salinas, CA, took part in a 12-week PhotoVoice project. Their pictures captured the assets and strengths of their community related to environmental health, and were then analyzed by participants. A multi-pronged evaluation was conducted. YCC members identified concerns such as poor access to affordable, healthy foods and lack of safe physical spaces in which to play, as well as assets, including caring adults and organizations, and open spaces in surrounding areas. Participants presented their findings on radio, television, at local community events, and to key policy makers. The youth also developed two action plans, a successful 5K run/walk and a school recycling project, still in progress. Evaluation results included significant changes in such areas as perceived ability to make presentations, leadership, and self-confidence, as well as challenges including transportation, group dynamics, and gaining access to people in power. The PhotoVoice method shows promise for environmental health education and youth development in farmworker communities.

Community mental health care in India.

PubMed

Padmavati, R

2005-04-01

Recent times are witnessing methods in the various forms of community care for the mentally ill in India. Non-governmental organizations (NGO) play a pivotal role in filling the gap in the existing mental health services in India and the substantial need for these services. Various strategies that have been employed in community care have attempted to utilize existing community resources for implementation. Informal manpower resources incorporated with specialist psychiatric care and integrated with existing health care facilities have been general strategies. While the feasibility and cost-effectiveness of the NGO operated community outreach programs for the mentally ill have been demonstrated, various factors are seen to influence the planning and execution of such programs. This paper elucidates some critical factors that would need to be considered in community mental health care in India.

Health care for all: effective, community supported, healthcare with innovative use of telemedicine technology.

PubMed

Shah, Tariq Kazim; Tariq, Tasneem; Phillips, Roger; Davison, Steve; Hoare, Adam; Hasan, Syed Shahzad; Babar, Zaheer-Ud-Din

2018-01-01

Almost half of the world's total population reside in rural and remote areas and a large number of these people remain deprived of most basic facilities like healthcare and education. It is deemed impossible for government with scarce resources in developing countries to open and run a health facility in every remote community using conventional means. One increasingly popular unconventional mean is the use of existing technology to improve exchange of medical information for the purpose of improving health of underprivileged communities. Telemedicine implies the use of information and communication technology to provide health care remotely from a distance. With the induction of telemedicine, patients who live in rural and remote areas can have increased access to medical services. In many developing countries, use of telemedicine however has been limited mainly to teleconferencing between primary and secondary/tertiary care facilities for diagnosis and management of patients. This system still requires patients from remote communities to travel, often long and arduous journeys to the centre where telecom and medical facilities are available. Health Care 4 All International, a not for profit registered charity is providing primary care to patients by taking telemedicine into their homes in remote communities, thus obviating the need and hardships of travel for patient.

Community health nursing vision for 2020: shaping the future.

PubMed

Schofield, Ruth; Ganann, Rebecca; Brooks, Sandy; McGugan, Jennifer; Dalla Bona, Kim; Betker, Claire; Dilworth, Katie; Parton, Laurie; Reid-Haughian, Cheryl; Slepkov, Marlene; Watson, Cori

2011-12-01

As health care is shifting from hospital to community, community health nurses (CHNs) are directly affected. This descriptive qualitative study sought to understand priority issues currently facing CHNs, explore development of a national vision for community health nursing, and develop recommendations to shape the future of the profession moving toward the year 2020. Focus groups and key informant interviews were conducted across Canada. Five key themes were identified: community health nursing in crisis now, a flawed health care system, responding to the public, vision for the future, and CHNs as solution makers. Key recommendations include developing a common definition and vision of community health nursing, collaborating on an aggressive plan to shift to a primary health care system, developing a comprehensive social marketing strategy, refocusing basic baccalaureate education, enhancing the capacity of community health researchers and knowledge in community health nursing, and establishing a community health nursing center of excellence.

Social Capital and Health: Civic Engagement, Community Size, and Recall of Health Messages

PubMed Central

Viswanath, Kasisomayajula; Randolph Steele, Whitney; Finnegan, John R.

2006-01-01

Objectives. We explored the effects of community integration and pluralism on recall of cardiovascular disease health information messages. Methods. With 1980–1983 data from the Minnesota Heart Health Program, we examined whether ties to community groups were associated with recall of health messages, and whether this relation was modified by size and degree of differentiation of the community. Results. A higher level of civic engagement through ties to community groups was associated with better recall of health messages. Ties to community groups independently contributed to better message recall even after control for gender, education, and other variables. The moderating role of community size was non-significant but intriguing. Conclusions. Community group membership could increase exposure to health messages, providing a critical pathway for social capital to influence health promotion and, thus, public health outcomes. PMID:16809608

Contextual variations in costs for a community health strategy implemented in rural, peri-urban and nomadic sites in Kenya.

PubMed

Wafula, Charles Ouma; Edwards, Nancy; Kaseje, Dan C O

2017-02-28

Many low and middle income countries have developed community health strategies involving lay health workers, to complement and strengthen public health services. This study explores variations in costing parameters pertinent to deployment of community health volunteers across different contexts outlining considerations for costing program scale-up. The study used quasi experimental study design and employed both quantitative and qualitative methods to explore community health unit implementation activities and costs and compare costs across purposively selected sites that differed socially, economically and ecologically. Data were collected from November 2010 to December 2013 through key informant interviews and focus group discussions. We interviewed 16 key informants (eight District community health strategy focal persons, eight frontline field officers), and eight focus group discussions (four with community health volunteers and four with community health committee) and 560 sets of monthly cost data. Cost data were tabulated using Microsoft Excel. Qualitative data were transcribed and coded using a content analysis framework. Four critical elements: attrition rates for community health volunteers, geography and population density, livelihood opportunity costs and benefits, and social opportunity benefits, drove cost variations across the three sites. Attrition rate was highest in peri-urban site where population is highly mobile and lowest in nomadic site. More households were covered by community health workers in the peri-urban area making per capita costs considerably less than in the nomadic settings where long distances had to be covered to reach sparsely distributed households. Livelihood opportunity costs for Community Health Volunteers were highest in nomadic setting, while peri-urban ones reported substantial employability benefits resulting from training. Social opportunity benefits were highest in rural site. Results show that costs of implementing

An ethnography of clinic "noise" in a community-based, promotora-centered mental health intervention.

PubMed

Getrich, Christina; Heying, Shirley; Willging, Cathleen; Waitzkin, Howard

2007-07-01

Community-based health interventions have emerged as a growing focus for anthropological research. The application of ethnographic approaches in clinical practice settings reveals that community-based interventions must grapple with "noise," or unanticipated factors such as patients' own perceptions of illness and treatment, primary care providers' non-adherence to guidelines-based treatment, the social dynamics of the clinic site itself, and incomplete understanding and acceptance of an intervention by a clinic's staff members. Such noise can influence the implementation and quality of treatment. Thus, identifying clinic-based noise is critical in assessments of fidelity to intervention protocols as well as outcomes of community-based interventions. This paper highlights findings from an evaluation of a mental health intervention focusing on the role of promotoras (briefly trained, non-professional community health workers) as mental health practitioners in two urban New Mexico, USA, community health centers. Our research identified three areas of clinic-based noise: the clinics' physical ability to "absorb" the intervention, the challenges of co-worker instability and interpersonal relationships, and balancing extra workplace demands. The findings demonstrate the value of ethnographic approaches in community-based intervention research.

Perceptions of the community on the pricing of community mental health services.

PubMed

Ogden, J R; Ogden, D T

1992-01-01

In the past few years there has been a decrease in governmental support of Community Mental Health centers. Because of this, there has been some concern, on the part of Community Mental Health professionals, as to the overall impact of this decreased governmental support. Research has been conducted that speculates on how best to handle this mini-crisis. One article suggests moving to an overall marketing approach to help combat this dollar support decline (Day and Ford 1988). Others provide methods for surveying Community Mental Health users (Ludke, Curry & Saywell 1983). William Winston (1988) suggests an overall psychographic segmentation approach to developing market targets. There has also been research detailing promotional methods for expanded marketing coverage (Moldenhauer 1988), however little has been written defining the pricing impact on Community Mental Health services. This study addresses the perceptions of Community Mental Health Center users toward the price variable of the marketing mix.

Community Vulnerability to Health Impacts of Wildland Fire Smoke Exposure.

PubMed

Rappold, Ana G; Reyes, Jeanette; Pouliot, George; Cascio, Wayne E; Diaz-Sanchez, David

2017-06-20

Identifying communities vulnerable to adverse health effects from exposure to wildfire smoke may help prepare responses, increase the resilience to smoke and improve public health outcomes during smoke days. We developed a Community Health-Vulnerability Index (CHVI) based on factors known to increase the risks of health effects from air pollution and wildfire smoke exposures. These factors included county prevalence rates for asthma in children and adults, chronic obstructive pulmonary disease, hypertension, diabetes, obesity, percent of population 65 years of age and older, and indicators of socioeconomic status including poverty, education, income and unemployment. Using air quality simulated for the period between 2008 and 2012 over the continental U.S. we also characterized the population size at risk with respect to the level and duration of exposure to fire-originated fine particulate matter (fire-PM 2.5 ) and CHVI. We estimate that 10% of the population (30.5 million) lived in the areas where the contribution of fire-PM 2.5 to annual average ambient PM 2.5 was high (>1.5 μg/m 3 ) and that 10.3 million individuals experienced unhealthy air quality levels for more than 10 days due to smoke. Using CHVI we identified the most vulnerable counties and determined that these communities experience more smoke exposures in comparison to less vulnerable communities.

Witness for Wellness: preliminary findings from a community-academic participatory research mental health initiative.

PubMed

Bluthenthal, Ricky N; Jones, Loretta; Fackler-Lowrie, Nicole; Ellison, Marcia; Booker, Theodore; Jones, Felica; McDaniel, Sharon; Moini, Moraya; Williams, Kamau R; Klap, Ruth; Koegel, Paul; Wells, Kenneth B

2006-01-01

Quality improvement programs promoting depression screening and appropriate treatment can significantly reduce racial and ethnic disparities in mental-health care and outcomes. However, promoting the adoption of quality-improvement strategies requires more than the simple knowledge of their potential benefits. To better understand depression issues in racial and ethnic minority communities and to discover, refine, and promote the adoption of evidence-based interventions in these communities, a collaborative academic-community participatory partnership was developed and introduced through a community-based depression conference. This partnership was based on the community-influenced model used by Healthy African-American Families, a community-based agency in south Los Angeles, and the Partners in Care model developed at the UCLA/RAND NIMH Health Services Research Center. The integrated model is described in this paper as well as the activities and preliminary results based on multimethod program evaluation techniques. We found that combining the two models was feasible. Significant improvements in depression identification, knowledge about treatment options, and availability of treatment providers were observed among conference participants. In addition, the conference reinforced in the participants the importance of community mobilization for addressing depression and mental health issues in the community. Although the project is relatively new and ongoing, already substantial gains in community activities in the area of depression have been observed. In addition, new applications of this integrated model are underway in the areas of diabetes and substance abuse. Continued monitoring of this project should help refine the model as well as assist in the identification of process and outcome measures for such efforts.

A Statewide Approach to Health Care Personnel Maldistribution—The California Area Health Education Center System

PubMed Central

Crowder, John E.; Schnepper, James E.; Gessert, Charles

1984-01-01

An Area Health Education Center (AHEC) system has been established in California to address the maldistribution of physicians and other health care professionals. The AHEC program uses educational incentives to recruit and retain health care personnel in underserved areas by linking the academic resources of university health science centers with local educational and clinical facilities. The medical schools, working in partnership with urban or rural AHECs throughout the state, are implementing educational programs to attract trainees and licensed professionals to work in underserved communities. The California AHEC project entered its fifth year in October of 1983 with the participation of all eight medical schools and the Charles Drew Postgraduate School of Medicine, 35 other health professions schools, 17 independent AHECs and more than 400 clinical training sites. Educational programs are reaching more than 22,000 students and practicing health professionals throughout California. We review the current status of the California AHEC system and use the AHEC programs at Loma Linda University to illustrate the effect this intervention is having. PMID:6730500

Aboriginal community controlled health services: leading the way in primary care.

PubMed

Panaretto, Kathryn S; Wenitong, Mark; Button, Selwyn; Ring, Ian T

2014-06-16

The national Closing the Gap framework commits to reducing persisting disadvantage in the health of Aboriginal and Torres Strait Islander people in Australia, with cross-government-sector initiatives and investment. Central to efforts to build healthier communities is the Aboriginal community controlled health service (ACCHS) sector; its focus on prevention, early intervention and comprehensive care has reduced barriers to access and unintentional racism, progressively improving individual health outcomes for Aboriginal people. There is now a broad range of primary health care data that provides a sound evidence base for comparing the health outcomes for Indigenous people in ACCHSs with the outcomes achieved through mainstream services, and these data show: models of comprehensive primary health care consistent with the patient-centred medical home model; coverage of the Aboriginal population higher than 60% outside major metropolitan centres; consistently improving performance in key performance on best-practice care indicators; and superior performance to mainstream general practice. ACCHSs play a significant role in training the medical workforce and employing Aboriginal people. ACCHSs have risen to the challenge of delivering best-practice care and there is a case for expanding ACCHSs into new areas. To achieve the best returns, the current mainstream Closing the Gap investment should be shifted to the community controlled health sector.

An Analysis of Community Health Nurses Documentation: The Best Approach to Computerization

PubMed Central

Chalmers, M.

1988-01-01

The study explored and analyzed the actual patient-related documentation performed by a sample of community health nurses working in voluntary home health agencies. The outcome of the study was a system flow chart of that documentation and included: common components of the documentation, where in the existing systems they are recorded, when they are recorded by the nurse and why they are used by the nurses and administrative personnel in the agencies. The flow chart is suitable for use as a prototype for the development of a computer software package for the computerization of the patient-related documentation by community health nurses. General System and communication theories were used as a framework for this study. A thorough analysis of the documenation resulted in a complete and exhaustive explication of the documentation by community health nurses, as well as the identification of what parts of that documentation lend themselves most readily to computerization and what areas, if any, may not readily adapt to computerization.

Child health inequities in developing countries: differences across urban and rural areas.

PubMed

Fotso, Jean-Christophe

2006-07-11

To document and compare the magnitude of inequities in child malnutrition across urban and rural areas, and to investigate the extent to which within-urban disparities in child malnutrition are accounted for by the characteristics of communities, households and individuals. The most recent data sets available from the Demographic and Health Surveys (DHS) of 15 countries in sub-Saharan Africa (SSA) are used. The selection criteria were set to ensure that the number of countries, their geographical spread across Western/Central and Eastern/Southern Africa, and their socioeconomic diversities, constitute a good yardstick for the region and allow us to draw some generalizations. A household wealth index is constructed in each country and area (urban, rural), and the odds ratio between its uppermost and lowermost category, derived from multilevel logistic models, is used as a measure of socioeconomic inequalities. Control variables include mother's and father's education, community socioeconomic status (SES) designed to represent the broad socio-economic ecology of the neighborhoods in which families live, and relevant mother- and child-level covariates. Across countries in SSA, though socioeconomic inequalities in stunting do exist in both urban and rural areas, they are significantly larger in urban areas. Intra-urban differences in child malnutrition are larger than overall urban-rural differentials in child malnutrition, and there seem to be no visible relationships between within-urban inequities in child health on the one hand, and urban population growth, urban malnutrition, or overall rural-urban differentials in malnutrition, on the other. Finally, maternal and father's education, community SES and other measurable covariates at the mother and child levels only explain a slight part of the within-urban differences in child malnutrition. The urban advantage in health masks enormous disparities between the poor and the non-poor in urban areas of SSA. Specific

Rural Religious Leaders' Perspectives on their Communities' Health Priorities and Health.

PubMed

Schoenberg, Nancy E; Swanson, Mark

2017-07-01

In traditionally underserved communities, faith-based interventions have been shown to be effective for health promotion. Religious leaders-generally the major partner in such interventions-however, are seldom are consulted about community health priorities and health promotion preferences. These insights are critical to ensure productive partnerships, effective programming, and sustainability. Mixed-methods surveys were administered in one of the nation's most under-resourced regions: rural Appalachia. A sample of 60 religious leaders, representing the main denominations in central Appalachia, participated. Measures included closed- and open-ended survey questions on health priorities and recommendations for health promotion. Descriptive statistics were used for closed-ended survey items and conventional qualitative content analysis was used for open-ended responses. Substance abuse, diabetes mellitus, suboptimal dietary intake and obesity/overweight, and cardiovascular and respiratory illnesses constitute major health concerns. Addressing these challenging conditions requires realistically acknowledging sparse community resources (particularly healthcare provider shortages); building in accountability; and leveraging local assets and traditions such as testimonials, intergenerational support, and witnessing. With their extensive reach within the community and their accurate understanding of community health threats, practitioners and researchers may find religious leaders to be natural allies in health-promotion and disease-prevention activities.

Barriers to Providing Health Education During Primary Care Visits at Community Health Centers: Clinical Staff Insights.

PubMed

Alicea-Planas, Jessica; Pose, Alix; Smith, Linda

2016-04-01

The rapid increase of diverse patients living in the US has created a different set of needs in healthcare, with the persistence of health disparities continuing to challenge the current system. Chronic disease management has been discussed as a way to improve health outcomes, with quality patient education being a key component. Using a community based participatory research framework, this study utilized a web-based survey and explored clinical staff perceptions of barriers to providing patient education during primary care visits. With a response rate of nearly 42 %, appointment time allotment seemed to be one of the most critical factors related to the delivery of health education and should be considered key. The importance of team-based care and staff training were also significant. Various suggestions were made in order to improve the delivery of quality patient education at community health centers located in underserved areas.

A gender-informed model to train community health workers in maternal mental health.

PubMed

Smith, Megan V; Kruse-Austin, Anna

2015-08-01

The New Haven Mental Health Outreach for MotherS (MOMS) Partnership is a community-academic partnership that works to develop public health approaches to ensure that pregnant and parenting women living in the City of New Haven achieve the highest possible level of mental health. The MOMS Partnership developed a training model for community health workers specializing in maternal mental health. Six community health workers (termed Community Mental Health Ambassadors or CMHAs) were trained on key topics in this gender-informed maternal mental health curriculum. Pre- and post-test questionnaires assessed changes in attitudes, perceived self-efficacy and control using standardized scales. The results indicated preliminary acceptability of the training curriculum in transforming knowledge and attitudes about maternal mental health among community health workers. Copyright © 2014. Published by Elsevier Ltd.

Community-Based Nursing versus Community Health Nursing: What Does It All Mean?

ERIC Educational Resources Information Center

Zotti, Marianne E.; And Others

1996-01-01

Offers practice models for community-based nursing and community health nursing that demonstrate the different roles, philosophies, and activities of the two approaches. Points to curriculum changes that are needed to prepare students to practice in an increasingly community-oriented health care industry. (Author)

Improving local health through community health workers in Cambodia: challenges and solutions.

PubMed

Ozano, Kim; Simkhada, Padam; Thann, Khem; Khatri, Rose

2018-01-06

Volunteer community health workers (CHWs) are an important link between the public health system and the community. The 'Community Participation Policy for Health' in Cambodia identifies CHWs as key to local health promotion and as a critical link between district health centres and the community. However, research on the challenges CHWs face and identifying what is required to optimise their performance is limited in the Cambodian context. This research explores the views of CHWs in rural Cambodia, on the challenges they face when implementing health initiatives. Qualitative methodology was used to capture the experiences of CHWs in Kratie and Mondulkiri provinces. Two participatory focus groups with CHWs in Mondulkiri and ten semi-structured interviews in Kratie were conducted. Results from both studies were used to identify common themes. Participants were CHWs, male and female, from rural Khmer and Muslim communities and linked with seven different district health centres. Findings identify that CHWs regularly deliver health promotion to communities. However, systemic, personal and community engagement challenges hinder their ability to function effectively. These include minimal leadership and support from local government, irregular training which focuses on verticalised health programmes, inadequate resources, a lack of professional identity and challenges to achieving behaviour change of community members. In addition, the CHW programme is delivered in a fragmented way that is largely influenced by external aid objectives. When consulted, however, CHWs demonstrate their ability to develop realistic practical solutions to challenges and barriers. The fragmented delivery of the CHW programme in Cambodia means that government ownership is minimal. This, coupled with the lack of defined core training programme or adequate resources, prevents CHWs from reaching their potential. CHWs have positive and realistic ideas on how to improve their role and, subsequently

The Health and Well-Being of Children in Rural Areas: A Portrait of the Nation 2007. The National Survey of Children's Health

ERIC Educational Resources Information Center

US Department of Health and Human Services, 2011

2011-01-01

The National Survey of Children's Health (NSCH) provides a unique resource with which to analyze the health status, health care use, activities, and family and community environments experienced by children in rural and urban areas. The NSCH was designed to measure the health and well-being of children from birth through age 17 in the United…

Community Mental Health Systems Generate New Chronics: The Study of a Pure Case.

ERIC Educational Resources Information Center

Lieberman, Harvey J.; And Others

1988-01-01

Study indicated that, although well-integrated comprehensive community mental health system (CMHS) dramatically reduces utilization of long-stay inpatient beds compared to traditional health care systems, it does not banish appearance of "new chronic" patients from a catchment area. CMHS new chronic patients were younger, mostly male,…

ENGAGING THE COMMUNITY IN HEALTH RESEARCH IN INDIA

PubMed Central

Wells, Kristen J.; Preuss, Charles; Pathak, Yashwant; Kosambiya, J. K.; Kumar, Ambuj

2013-01-01

Community-engaged research approaches involve members of the community in various aspects of a research endeavor to improve the health of populations. Engaging the community in research is important in the development, dissemination, and evaluation of new interventions, technologies, and other medical advancements to improve population health globally. A review of published community-engaged research studies conducted in India was performed. Fifteen published studies were identified and reviewed to evaluate the state of community-engaged research in India. The review indicated that community-engaged research in India is limited. Most published community-engaged research focused on health promotion, especially in the prevention or management of HIV/AIDS and other STIs. Community members were involved in a variety of aspects of the research, but there was not one published article indicating that community members had defined the disease of focus. Community-engaged research often led to valuable insights into the views, experiences, and behaviors of community members and also led to increased community participation in health initiatives. It is anticipated that future community-engaged research will lead to improvements in global health through increased empowerment of communities and a better ability to implement new and innovative medical advances, technologies, and interventions. PMID:24353757

Preserving community in health care.

PubMed

Emanuel, E J; Emanuel, L L

1997-02-01

There are two prominent trends in health care today: first, increasing demands for accountabilty, and second, increasing provision of care through managed care organizations. These trends promote the question: What form of account-ability is appropriate to managed care plans? Accountability is the process by which a party justifies its actions and policies. Components of accountability include parties that can be held or hold others accountable, domains and content areas being assessed, and procedures of assessment. Traditionally, the professional model of accountability has operated in medical care. In this model, physicians establish the standards of accountability and hold each other accountable through professional organizations. This form of accountability seems outdated and inapplicable to managed care plans. The alternatives are the economic and the political models of accountability. In the economic model, medicine becomes more like a commodity, and "exit" (consumers changing providers for reasons of cost and quality) is the dominant procedure of accountability. In the political model, medicine becomes more like a community good, and "voice" (citizens communicating their views in public forums or on policy committees, or in elections for representatives) is the dominant procedure of accountability. The economic model's advantages affirm American individualism, make minimal demands on consumers, and use a powerful incentive, money. Its disadvantages undermine health care as a nonmarket good, undermine individual autonomy, undermine good medical practice, impose significant demands on consumers to be informed, sustain differentials of power, and use indirect procedures of accountability. The political model's advantages affirm health care as a matter of justice, permit selecting domains other than price and quality for accountability, reinforce good medical practice, and equalize power between patients and physicians. Its disadvantages include inefficiency in

The Impact of Integrating Community Advocacy Into Community Health Worker Roles on Health-Focused Organizations and Community Health Workers in Southern Arizona.

PubMed

Reinschmidt, Kerstin M; Ingram, Maia; Schachter, Kenneth; Sabo, Samantha; Verdugo, Lorena; Carvajal, Scott

2015-01-01

Organizational environments may encourage community health workers (CHWs) to engage community members in improving their communities. We conducted open-ended interviews and focus groups to explore how participation in the Acción intervention, which trained CHWs in community advocacy, affected organizational capacity to support their CHWs. Supervisors described improved organizational recognition and trust of CHWs. Organizational leaders reported organizational benefits and increased appreciation of CHW leadership. Both expressed increased interest in future advocacy trainings. Limiting factors included organizational mission, CHW position descriptions, and funding. Findings indicate that, with training and funding, CHW community advocacy can be integrated into organizations with congruent missions.

Work of community health agents in the Family Health Strategy: meta-synthesis

PubMed Central

Alonso, Carolina Maria do Carmo; Béguin, Pascal Daniel; Duarte, Francisco José de Castro Moura

2018-01-01

ABSTRACT OBJECTIVE To systematize and analyze the evidence from qualitative studies that address the perception of Brazilian Community Health Agents about their work. METHODS This is a systematic review of the meta-synthesis type on the work of community health agents, carried out from the Virtual Health Library using the descriptors “Agente Comunitário de Saúde” and “Trabalho”, in Portuguese. The strategy was constructed by crossing descriptors, using the Boolean operator “AND”, and filtering Brazilian articles, published from 2004 to 2014, which resulted in 129 identified articles. We removed quantitative or quanti-qualitative research articles, essays, debates, literature reviews, reports of experiences, and research that did not include Brazilian Community Health Agents as subjects. Using these criteria, we selected and analyzed 33 studies that allowed us to identify common subjects and differences between them, to group the main conclusions, to classify subjects, and to interpret the content. RESULTS The analysis resulted in three thematic units: characteristics of the work of community health agents, problems related to the work of community health agents, and positive aspects of the work of community health agents. On the characteristics, we could see that the work of the community health agents is permeated by the political and social dimensions of the health work with predominant use of light technologies. The main input is the knowledge that this professional obtains with the contact with families, which is developed with home visits. On the problems in the work of community health agents, we could identify the lack of limits in their attributions, poor conditions, obstacles in the relationship with the community and teams, weak professional training, and bureaucracy. The positive aspects we identified were the recognition of the work by families, resolution, bonding, work with peers, and work close to home. CONCLUSIONS This review provided

Work of community health agents in the Family Health Strategy: meta-synthesis.

PubMed

Alonso, Carolina Maria do Carmo; Béguin, Pascal Daniel; Duarte, Francisco José de Castro Moura

2018-01-01

OBJECTIVE To systematize and analyze the evidence from qualitative studies that address the perception of Brazilian Community Health Agents about their work. METHODS This is a systematic review of the meta-synthesis type on the work of community health agents, carried out from the Virtual Health Library using the descriptors "Agente Comunitário de Saúde" and "Trabalho", in Portuguese. The strategy was constructed by crossing descriptors, using the Boolean operator "AND", and filtering Brazilian articles, published from 2004 to 2014, which resulted in 129 identified articles. We removed quantitative or quanti-qualitative research articles, essays, debates, literature reviews, reports of experiences, and research that did not include Brazilian Community Health Agents as subjects. Using these criteria, we selected and analyzed 33 studies that allowed us to identify common subjects and differences between them, to group the main conclusions, to classify subjects, and to interpret the content. RESULTS The analysis resulted in three thematic units: characteristics of the work of community health agents, problems related to the work of community health agents, and positive aspects of the work of community health agents. On the characteristics, we could see that the work of the community health agents is permeated by the political and social dimensions of the health work with predominant use of light technologies. The main input is the knowledge that this professional obtains with the contact with families, which is developed with home visits. On the problems in the work of community health agents, we could identify the lack of limits in their attributions, poor conditions, obstacles in the relationship with the community and teams, weak professional training, and bureaucracy. The positive aspects we identified were the recognition of the work by families, resolution, bonding, work with peers, and work close to home. CONCLUSIONS This review provided an overview of the

Accelerated Adoption of Advanced Health Information Technology in Beacon Community Health Centers.

PubMed

Jones, Emily; Wittie, Michael

2015-01-01

To complement national and state-level HITECH Act programs, 17 Beacon communities were funded to fuel community-wide use of health information technology to improve quality. Health centers in Beacon communities received supplemental funding. This article explores the association between participation in the Beacon program and the adoption of electronic health records. Using the 2010-2012 Uniform Data System, trends in health information technology adoption among health centers located within and outside of Beacon communities were explored using differences in mean t tests and multivariate logistic regression. Electronic health record adoption was widespread and rapidly growing in all health centers, especially quality improvement functionalities: structured data capture, order and results management, and clinical decision support. Adoption lagged for functionalities supporting patient engagement, performance measurement, care coordination, and public health. The use of advanced functionalities such as care coordination grew faster in Beacon health centers, and Beacon health centers had 1.7 times higher odds of adopting health records with basic safety and quality functionalities in 2010-2012. Three factors likely underlie these findings: technical assistance, community-wide activation supporting health information exchange, and the layering of financial incentives. Additional technical assistance and community-wide activation is needed to support the use of functionalities that are currently lagging. © Copyright 2015 by the American Board of Family Medicine.

Climate change and health research: has it served rural communities?

PubMed

Bell, Erica J

2013-01-01

the health sciences. 'Rural' and 'Aboriginal' concepts have increased by 1% across both discipline areas, since 2011 for the 'rural' concept and since 2004 for the 'Aboriginal' concept. 'Health' concepts in the health sciences and 'economic' concepts in the social sciences, as well as 'urban' concepts, are referred to more positively than either the 'rural' or 'Aboriginal' concepts. While care needs to be taken in interpreting the results of this study too negatively for rural and Aboriginal communities, they suggest that a disease focus dominates climate and health research typically unconnected to wider socio-economic and human system factors. This finding needs to be considered in light of the accumulating evidence of the importance of such contextual systemic factors in understanding climate and health effects and responses. The study adds some support to the view that a key priority is bringing the learnings of applied community-based researchers, from those in rural health to those in the social sciences, to climate research. There is a need to build confidence, including in the rural health sector which has arguably been slow to participate in programs of climate change research, that community-based research could make a difference to rural health in a climate-changing world.

From theory to practice: community health nursing in a public health neighborhood team.

PubMed

Westbrook, L O; Schultz, P R

2000-12-01

An interdisciplinary team in a local public health district tested its ability to implement the core public health functions of assessment, policy development, and assurance by changing its practice to a community-driven model of building partnerships for health with groups and communities in a designated locale. Evaluation of this innovation revealed that the public health nurse members of the team enacted their community health nursing knowledge to strengthen agency to cocreate health. Interdisciplinary collaboration was essential to the team's community mobilization efforts. Additional findings suggested that this organizational innovation was associated with developing a more participatory organizational climate, increasing system effectiveness, and building community capacity.

Teaching Health Center Graduate Medical Education Locations Predominantly Located in Federally Designated Underserved Areas.

PubMed

Barclift, Songhai C; Brown, Elizabeth J; Finnegan, Sean C; Cohen, Elena R; Klink, Kathleen

2016-05-01

Background The Teaching Health Center Graduate Medical Education (THCGME) program is an Affordable Care Act funding initiative designed to expand primary care residency training in community-based ambulatory settings. Statute suggests, but does not require, training in underserved settings. Residents who train in underserved settings are more likely to go on to practice in similar settings, and graduates more often than not practice near where they have trained. Objective The objective of this study was to describe and quantify federally designated clinical continuity training sites of the THCGME program. Methods Geographic locations of the training sites were collected and characterized as Health Professional Shortage Area, Medically Underserved Area, Population, or rural areas, and were compared with the distribution of Centers for Medicare and Medicaid Services (CMS)-funded training positions. Results More than half of the teaching health centers (57%) are located in states that are in the 4 quintiles with the lowest CMS-funded resident-to-population ratio. Of the 109 training sites identified, more than 70% are located in federally designated high-need areas. Conclusions The THCGME program is a model that funds residency training in community-based ambulatory settings. Statute suggests, but does not explicitly require, that training take place in underserved settings. Because the majority of the 109 clinical training sites of the 60 funded programs in 2014-2015 are located in federally designated underserved locations, the THCGME program deserves further study as a model to improve primary care distribution into high-need communities.

Health in My Community: Conducting and evaluating photovoice as a tool to promote environmental health and leadership among Latino/a youth

PubMed Central

Madrigal, Daniel; Salvatore, Alicia; Casillas, Gardenia; Casillas, Crystal; Vera, Irene; Eskenazi, Brenda; Minkler, Meredith

2015-01-01

Background The photovoice method has shown substantial promise for work with youth in metropolitan areas, yet its potential for use with youth from farmworker families has not been documented. Objectives This project was designed to teach environmental health to 15 high school youth while building their individual and community capacity for studying and addressing shared environmental concerns. The project also aimed to test the utility of photovoice with Latino agricultural youth. Methods Fifteen members of the Youth Community Council (YCC), part of a 15-year project with farmworker families in Salinas, CA, took part in a 12-week photovoice project. Their pictures captured the assets and strengths of their community related to environmental health, and were then analyzed by participants. A multi-pronged evaluation was conducted. Results YCC members identified concerns such as poor access to affordable, healthy foods and lack of safe physical spaces in which to play, as well as assets, including caring adults and organizations, and open spaces in surrounding areas. Participants presented their findings on radio, television, at local community events, and to key policy makers. The youth also developed and implemented two action plans, a successful 5K run/walk and a school recycling project, still in progress. Evaluation results included significant changes or trends in such areas as perceived ability to make presentations, leadership, and self-confidence, as well as challenges including transportation, group dynamics, and gaining access to people in power. Conclusion The photovoice method shows promise for environmental health education and youth development in farmworker communities. PMID:25435558

Species area relationships in mediterranean-climate plant communities

USGS Publications Warehouse

Keeley, Jon E.; Fotheringham, C.J.

2003-01-01

Aim To determine the best-fit model of species–area relationships for Mediterranean-type plant communities and evaluate how community structure affects these species–area models.Location Data were collected from California shrublands and woodlands and compared with literature reports for other Mediterranean-climate regions.Methods The number of species was recorded from 1, 100 and 1000 m2 nested plots. Best fit to the power model or exponential model was determined by comparing adjusted r2 values from the least squares regression, pattern of residuals, homoscedasticity across scales, and semi-log slopes at 1–100 m2 and 100–1000 m2. Dominance–diversity curves were tested for fit to the lognormal model, MacArthur's broken stick model, and the geometric and harmonic series.Results Early successional Western Australia and California shrublands represented the extremes and provide an interesting contrast as the exponential model was the best fit for the former, and the power model for the latter, despite similar total species richness. We hypothesize that structural differences in these communities account for the different species–area curves and are tied to patterns of dominance, equitability and life form distribution. Dominance–diversity relationships for Western Australian heathlands exhibited a close fit to MacArthur's broken stick model, indicating more equitable distribution of species. In contrast, Californian shrublands, both postfire and mature stands, were best fit by the geometric model indicating strong dominance and many minor subordinate species. These regions differ in life form distribution, with annuals being a major component of diversity in early successional Californian shrublands although they are largely lacking in mature stands. Both young and old Australian heathlands are dominated by perennials, and annuals are largely absent. Inherent in all of these ecosystems is cyclical disequilibrium caused by periodic fires. The

The Human Gut Phage Community and Its Implications for Health and Disease.

PubMed

Manrique, Pilar; Dills, Michael; Young, Mark J

2017-06-08

In this review, we assess our current understanding of the role of bacteriophages infecting the human gut bacterial community in health and disease. In general, bacteriophages contribute to the structure of their microbial communities by driving host and viral diversification, bacterial evolution, and by expanding the functional diversity of ecosystems. Gut bacteriophages are an ensemble of unique and shared phages in individuals, which encompass temperate phages found predominately as prophage in gut bacteria (prophage reservoir) and lytic phages. In healthy individuals, only a small fraction of the prophage reservoir is activated and found as extracellular phages. Phage community dysbiosis is characterized by a shift in the activated prophage community or an increase of lytic phages, and has been correlated with disease, suggesting that a proper balance between lysis and lysogeny is needed to maintain health. Consequently, the concept of microbial dysbiosis might be extended to the phage component of the microbiome as well. Understanding the dynamics and mechanisms to restore balance after dysbiosis is an active area of research. The use of phage transplants to re-establish health suggests that phages can be used as disease treatment. Such advances represent milestones in our understanding of gut phages in human health and should fuel research on their role in health and disease.

A Community Health Education System to meet the health needs of Indo-Chinese women.

PubMed

Ratnaike, R N; Chinner, T L

1992-04-01

This paper presents a Community Health Education System which is cost-effective, sustainable, strongly community-based, and directed at improving the health status of rural women in Indo-china (Kampuchea, Laos and Vietnam). The system is developed through a series of steps which are concerned with the education of Community Health Education Units (in national ministries of health) and, at the village level, among community health workers, women's groups, and other women. The ultimate aim is the establishment of a community health education program in Indochinese villages.

Community Arts for Health: An Evaluation of a District Programme