Chapman, Colin A; van Bavel, Bianca; Boodman, Carl; Ghai, Ria R; Gogarten, Jan F; Hartter, Joel; Mechak, Lauren E; Omeja, Patrick A; Poonawala, Sofia; Tuli, Dan; Goldberg, Tony L
Impoverished communities often turn to illegal extraction of resources from protected areas to alleviate economic pressures or to make monetary gains. Such practices can cause ecological damage and threaten animal populations. These communities also often face a high disease burden and typically do not have access to affordable health care. Here we argue that these two seemingly separate challenges may have a common solution. In particular, providing health care to communities adjacent to protected areas may be an efficient and effective way to reduce the disease burden while also improving local perceptions about protected areas, potentially reducing illegal extraction. We present a case study of a health centre on the edge of Kibale National Park, Uganda. The centre has provided care to c. 7,200 people since 2008 and its outreach programme extends to c. 4,500 schoolchildren each year. Contrasting the provision of health care to other means of improving community perceptions of protected areas suggests that health clinics have potential as a conservation tool in some situations and should be considered in future efforts to manage protected areas.
van Bavel, Bianca; Boodman, Carl; Ghai, Ria R.; Gogarten, Jan F.; Hartter, Joel; Mechak, Lauren E.; Omeja, Patrick A.; Poonawala, Sofia; Tuli, Dan; Goldberg, Tony L.
Impoverished communities often turn to illegal extraction of resources from protected areas to alleviate economic pressures or to make monetary gains. Such practices can cause ecological damage and threaten animal populations. These communities also often face a high disease burden and typically do not have access to affordable health care. Here we argue that these two seemingly separate challenges may have a common solution. In particular, providing health care to communities adjacent to protected areas may be an efficient and effective way to reduce the disease burden while also improving local perceptions about protected areas, potentially reducing illegal extraction. We present a case study of a health centre on the edge of Kibale National Park, Uganda. The centre has provided care to c. 7,200 people since 2008 and its outreach programme extends to c. 4,500 schoolchildren each year. Contrasting the provision of health care to other means of improving community perceptions of protected areas suggests that health clinics have potential as a conservation tool in some situations and should be considered in future efforts to manage protected areas. PMID:26456977
Piccolo, Rebecca S; Araujo, Andre B; Pearce, Neil; McKinlay, John B
The Boston Area Community Health (BACH) Survey is a community-based, random sample, epidemiologic cohort of n = 5502 Boston (MA) residents. The baseline BACH Survey (2002-05) was designed to explore the mechanisms conferring increased health risks on minority populations with a particular focus on urologic signs/symptoms and type 2 diabetes. To this end, the cohort was designed to include adequate numbers of US racial/ethnic minorities (Black, Hispanic, White), both men and women, across a broad age of distribution. Follow-up surveys were conducted ∼5 (BACH II, 2008) and 7 (BACH III, 2010) years later, which allows for both within- and between-person comparisons over time. The BACH Survey's measures were designed to cover the following seven broad categories: socio-demographics, health care access/utilization, lifestyles, psychosocial factors, health status, physical measures and biochemical parameters. The breadth of measures has allowed BACH researchers to identify disparities and quantify contributions to social disparities in a number of health conditions including urologic conditions (e.g. nocturia, lower urinary tract symptoms, prostatitis), type 2 diabetes, obesity, bone mineral content and density, and physical function. BACH I data are available through the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Central Repositories (www.niddkrepository.org). Further inquiries can be made through the New England Research Institutes Inc. website (www.neriscience.com/epidemiology).
Cromley, Ellen; Kleinman, Lawrence C.; Ramos, Michelle A.; Arniella, Guedy; Viswanathan, Nalini; Garel, Mischka; Horowitz, Carol R.
Background While neighborhood-based approaches to eliminate health disparities are on the rise, there is little guidance on how researchers may engage with community partners to select geographic areas for interventions to reduce health disparities. We aimed to identify a small geographic area to target interventions to improve diabetes-related outcomes. Objectives We describe lessons learned from a community-engaged approach to specify the geographic area of focus. Methods A community-academic partnership of more than 20 organizations collaborated to develop and employ a 5-stage process to specify a target area for diabetes preventions and control activities. Lessons Learned A coalition with local knowledge and ties to the community can develop criteria and direct a process leading to selection of a geographic area, increased research capacity, and strengthened relationships among partners. Conclusion A participatory approach can be effective in defining a geographic area for targeting interventions to reduce health disparities. PMID:22080778
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.
The provision of quality mental health services in rural areas continues to be an ongoing challenge for nurses and the patients they serve. The use of computer mediated communication to construct collaborative learning environments similar to those suggested in Wenger's community of practice framework has the potential to mitigate a number of the difficulties faced by rural health care providers. The author presents a brief discussion of social learning theories, the communities of practice framework, and related concepts. Examples of current online communities of practice used as a means for knowledge construction in various professional disciplines are presented in building the case for the fit between online communities of practice and the needs of nurses in rural mental health. Nurses providing mental health care in rural areas have documented needs for interdisciplinary teamwork, access to a collaborative learning environment, and ongoing contact with expert resources. The construction of online communities of practice could potentially address a multitude of concerns identified by nurses practicing mental health care in rural areas.
Lara, Maristela Oliveira; Brito, Maria José Menezes; Rezende, Lilian Cristina
The daily practice of Community Health Agents (CHAs) is permeated with educational interventions aimed at preventive care and health promotion. The sociocultural universe of these professionals can affect the dynamics of their practice within the community, particularly in rural areas, where there is evidence that the population expects to obtain information relative to their health and/or disease by means of cultural rites. Based on a case study, we sought to analyze the influence of the cultural practices of the agents working in a rural area in the interior of the state of Minas Gerais. The analysis revealed the presence of a strong connection between the culture and their activities. Religious beliefs and knowledge developed from the fusion of biomedical information and values based on family tradition regarding the health-disease process have a direct effect on their practices. It is emphasized that they have an important role as facilitators in the practice of health care, with a positive effect stemming from the similarity of their life experiences and inherited cultures with those of the clients, thus making it possible to develop effective interventions.
Walthery, Pierre; Stafford, Mai; Nazroo, James; Whitehead, Margaret; Dibben, Christopher; Halliday, Emma; Povall, Sue; Popay, Jennie
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
North Carolina has numerous low-income minority communities and tribal areas where basic public health amenities are lacking. Disparities in clean air, safe drinking water, and toxin-free soil create human exposures that result in poor health, depressed property value, and more contaminated environments than are present in higher income communities.
Fang, Shona C; Subramanian, S V; Piccolo, Rebecca; Yang, May; Yaggi, H Klar; Bliwise, Donald L; Araujo, Andre B
Background Sleep plays an important role in health and varies by social determinants. Little is known, however, about geographic variations in sleep and the role of individual-level and neighbourhood-level factors. Methods We used a multilevel modelling approach to quantify neighbourhood variation in self-reported sleep duration (very short <5 h; short 5–6.9 h; normative 7–8.9 h; long ≥9 h) among 3591 participants of the Boston Area Community Health Survey. We determined whether geographic variations persisted with control for individual-level demographic, socioeconomic status (SES) and lifestyle factors. We then determined the role of neighbourhood SES (nSES) in geographic variations. Additional models considered individual health factors. Results Between neighbourhood differences accounted for a substantial portion of total variability in sleep duration. Neighbourhood variation persisted with control for demographics, SES and lifestyle factors. These characteristics accounted for a portion (6–20%) of between-neighbourhood variance in very short, short and long sleep, while nSES accounted for the majority of the remaining between-neighbourhood variances. Low and medium nSES were associated with very short and short sleep (eg, very short sleep OR=2.08; 95% CI 1.38 to 3.14 for low vs high nSES), but not long sleep. Further inclusion of health factors did not appreciably increase the amount of between-neighbourhood variance explained nor did it alter associations. Conclusions Sleep duration varied by neighbourhood in a diverse urban setting in the northeastern USA. Individual-level demographics, SES and lifestyle factors explained some geographic variability, while nSES explained a substantial amount. Mechanisms associated with nSES should be examined in future studies to help understand and reduce geographic variations in sleep. PMID:25199880
Fang, Shona C; Schwartz, Joel; Yang, May; Yaggi, H Klar; Bliwise, Donald L; Araujo, Andre B
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.
Perales, Aurora Rodriguez
An experienced community health worker describes her experiences in the field as a basis for recommended guidelines for the role, philosophy, aims, and goals of community health workers. The role of the community health worker as a member of the health care team is explored, and the problem of recognition for community health workers is considered…
Asfaw, Abay; von Braun, Joachim
It has become clear that due to market failure, state failure, and other reasons, the conventional sources of finance alone could not solve the health problem of the rural population, particularly that of the socially excluded and disadvantaged groups. Community Based Health Insurance Schemes (CBHIS) are one of the most recently mentioned options to narrow the existing inequalities in access to basic health services. This study assesses the prospect of CBHIS in the rural areas of Ethiopia using a double bounded dichotomous contingent valuation method. The results show that even in one of the poorest countries of the world, there is a promising prospect to introduce CBHIS.
Gilbertson, M; Brophy, J
The rates of mortality, morbidity as hospitalizations, and congenital anomalies in the Windsor Area of Concern ranked among the highest of the 17 Areas of Concern on the Canadian side of the Great Lakes for selected end points that might be related to pollution in this relatively highly industrialized city. Mortality and morbidity rates from all causes were higher than in the rest of the province. Anomalously high rates of diseases included various cancers; endocrine, nutritional, metabolic, and immunity disorders; diseases of the blood and blood-forming organs, nervous system and sense organs, circulatory and respiratory systems, digestive system, genitourinary system, skin and subcutaneous tissue, musculoskeletal system and connective tissues; congenital anomalies, and infant mortality. Of particular concern was the early onset of the elevated rates of many of these diseases and conditions. Comparison of these incident rates with those in Hamilton, another industrial municipality in southern Ontario, suggested that in addition to a variety of local sources of industrial pollution from automobile manufacturing and use, transboundary air and water pollution from Detroit, Michigan, should be investigated as potentially important causes of these health outcomes in the Windsor Area of Concern. Some of the institutional and political trends of the past decade may need to be reversed before effective remedial programs are implemented for cleaning up contaminated sediments and for containment of leaking hazardous waste sites. This pilot project would seem to be a useful preliminary method of integrating human health concerns and of priority setting for the administration of the Great Lakes Water Quality Agreement and the Canada-United States Air Quality Agreement. PMID:11744501
Liu, Yong; Yuan, Zhaokang; Liu, Yuxi; Jayasinghe, Upali W; Harris, Mark F
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
Otieno, C F; Kaseje, D; Ochieng', B M; Githae, M N
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
SALEHI ZALANI, Gholamhossein; BAYAT, Mahboubeh; SHOKRI, Azad; MIRBAHAEDDIN, S. Elmira; RASI, Vahid; ALIREZAEI, Samira; MANAFI, Fatemeh
Background: This study aimed to use a mixed-method approach to investigate affecting factors on the performance of Community Health Workers (CHW) in Iran’s villages. Methods: This study was conducted during 2014–2015 with a mixed method in three phases of literature review, Delphi technique and developing a rich picture. Overall, in order to finalize the affecting factors and their relationships between qualitative content analysis, Delphi technique, AHP technique and Focus Group Discussion were used, respectively. Results: Affecting factors on CHW performance were divided into four main categories, 10 sub-themes and 35 contents. Increase in the level of people’s awareness, disease patterns, demographic structure and lifestyle were placed in four priorities respectively on the basis of importance. Conclusion: To the most extent CHW cannot face current needs of rural communities. It challenges equitable access to healthcare services and also conflicts with the primary philosophy of CHW presence in rural areas. CHW can be used in two forms; either as an assistant to rural family physicians or with the same previous functions. PMID:28032057
López, Lenny; Grant, Richard W.; Marceau, Lisa; Piccolo, Rebecca; McKinlay, John B.; Meigs, James B.
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. PMID:26898955
Shy, Carl M.; Finklea, John F.
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)
Topmiller, Michael; Zhen-Duan, Jenny; Jacquez, Farrah J; Vaughn, Lisa M
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.
Gates, Margaret A.; Hall, Susan A.; Chiu, Gretchen R.; Kupelian, Varant; FitzGerald, Mary P.; Link, Carol L.; McKinlay, John B.
There is evidence for a role of inflammation in the etiology of lower urinary tract symptoms (LUTS), raising the possibility that use of nonsteroidal antiinflammatory drugs (NSAIDs) may inhibit the development or progression of LUTS. The authors examined the association between use of prescription and over-the-counter NSAIDs and LUTS among 1,974 men and 2,661 women in the Boston Area Community Health Survey (2002–2005). Multivariable-adjusted logistic regression was used to estimate odds ratios and 95% confidence intervals for LUTS, voiding symptoms, storage symptoms, and nocturia. There was no clear association between use of prescription or over-the-counter NSAIDs (compared with no NSAID use) and overall LUTS, voiding symptoms, or nocturia in men or women. However, over-the-counter NSAID use was positively associated with storage symptoms in women (odds ratio = 1.37, 95% confidence interval: 1.03, 1.83), and there was a positive association between over-the-counter NSAID use and overall LUTS among women with a history of arthritis (odds ratio = 2.09, 95% confidence interval: 1.20, 3.64). These results do not provide strong support for an association between NSAIDs and LUTS. However, the associations between over-the-counter NSAID use and certain urologic symptoms, particularly among women with arthritis, and the potential mechanisms involved should be evaluated in future studies. PMID:21357657
Rosenberger, Joshua G; Schick, Vanessa; Schnarrs, Phillip; Novak, David S; Reece, Michael
Limited research has focused on the sexual behaviors of men who have sex with men (MSM) from rural communities. We examined the sexual and health-related behaviors of MSM living in rural areas of the United States in order to understand the sexual health repertoire of this population. A total of 5,357 participants living in rural settings were recruited online and completed an anonymous Internet-based survey that assessed sexual behaviors, condom use, and men's engagement with various community activities and events. These data provide a greater understanding of sexual health profiles that exist among rural MSM and will help inform the design of effective programs for men in these often underserved communities.
Gallegos, Tom; Mrgudic, Kate
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…
Health education and disease prevention programs are essential elements in every health care system. We normally envision community health programs in urban and rural settings across Canada. However, health education and disease prevention have also become a fundamental part of the health care system for refugee communities around the world.
Health is socio-demographic construct of population. In an urban area social, economic and political systems simultaneously operate within a geographically defined space in which the urban dwellers accommodate and act as key player. As such the physical and social factors virtually affect the community health as a consequence of disparity in accessing health. Health disparities in smaller towns of the developing world have drawn serious attention as they are poorly suffering from the problems of `urban penalty'. This paper deals with statistical clustering of neighbourhoods on the basis of quality of life, social deprivation and multiple suffering quantified as the variables derived from measurable parameters. Neighbourhoods inequality has been mapped as per the score received by each neighbourhood in respect to the above three variables. Principal Component Analysis (PCA) has also been employed for grouping the neighbourhoods in social terms. Then it has been tried to examine relationship between health attainment and social status of the neighbourhoods. The study shows that status of health does not merely depend on socio-demographic and political factors but availability of healthcare facilities, health related behaviour, health perception and awareness have played significant roles. The findings of the study may be helpful for setting planning strategies most important of which would be inclusion of local people in catering health services.
Paz-y-Miño, César; Muñoz, María José; Maldonado, Adolfo; Valladares, Carolina; Cumbal, Nadia; Herrera, Catalina; Robles, Paulo; Sánchez, María Eugenia; López-Cortés, Andrés
The northeastern Ecuadorian border has undergone aerial spraying with an herbicide mix that contains surfactants and adjuvants, executed by the Colombian Government. The purpose of this study was to diagnose social, health, and genetic aspects of the people affected by glyphosate. For this objective to be achieved, 144 people were interviewed, and 521 medical diagnoses and 182 peripheral blood samples were obtained. Genotyping of GSTP1 Ile105Val, GPX-1 Pro198Leu, and XRCC1 Arg399Gln polymorphisms were analyzed, using PCR-RFLP technique. The assessment of chromosomal aberrations was performed, obtaining 182 karyotypes. Malnutrition in children was 3%. Of the total population, 7.7% had children with malformations, and the percentage of abortions was 12.7%. Concerning genotyping, individuals with GSTP1 Val/Val obtained an odds ratio of 4.88 (p < 0.001), and Ile/Val individuals, together with Val/Val individuals, had an odds ratio of 2.6 (p < 0.05). In addition, GPX-1 Leu/Leu individuals presented an odds ratio (OR) of 8.5 (p < 0.05). Regarding karyotyping, the 182 individuals had normal karyotypes. In conclusion, the study population did not present significant chromosomal and DNA alterations. The most important social impact was fear. We recommend future prospective studies to assess the communities.
Bell, D.; Go, R.; Miguel, C.; Walker, J.; Cacal, L.; Saul, A.
OBJECTIVE: To compare the efficacies of remote symptom-based diagnosis of malaria, rapid diagnostic tests and microscopy in an area of low endemicity in the Philippines. METHODS: In Trial I, 350 symptomatic patients were tested within their villages using malaria Plasmodium falciparum (Pf)/Plasmodium vivax (Pv) immunochromatographic tests (ICT tests) and blood films stored and read under local conditions. The slides were later restained and read. In Trial II, unsupervised volunteer barangay health workers prepared ICT tests and slides after brief training. These slides were read at rural health units. Twenty-seven barangay health workers and 72 community members were later questioned about the three diagnostic strategies. FINDINGS: A history of fever alone was sensitive (95.4%) but poorly specific (16.5%) for predicting parasitaemia. The inclusion of other symptoms reduced the sensitivity to below 85%, while specificity remained low. The axillary temperature was poorly predictive. ICT tests achieved high sensitivity (97.9%) but many cases indicated as positive by ICT tests were negative by microscopy. Further analysis of these cases in Trial I indicated that ICT tests were detecting low-level parasitaemias missed by microscopy, and that local microscopy had poor accuracy. ICT tests were well accepted and accurately performed by barangay health workers. CONCLUSION: These tests meet a strong desire in the community for blood-based diagnosis and may increase the compliance and treatment-seeking behaviour of patients. PMID:11693975
Gundersen, Hilde; Magerøy, Nils; Moen, Bente E; Bråtveit, Magne
Vehicle traffic is increasing worldwide, and this is a major concern because traffic-related air pollution and noise may influence health. The aim of this study was to evaluate whether health-related quality of life (HRQoL) is associated with vehicle traffic density in area of residence. A total of 16,410 individuals, 40 to 45 years old, were asked to participate in this study (response rate: 55% for men, 66% for women). Using the 12-Item Short Form Health Survey (SF-12) questionnaire, both physical and mental HRQoL were investigated. Multiple linear regression analyses showed that women living in areas with high traffic density had significantly poorer physical HRQoL than women living in areas with moderate or low vehicle traffic density. There were no similar findings among men. Mental HRQoL was not associated with vehicle traffic density in the area of residence, neither for women nor for men. There is an association between high vehicle traffic density in residential area and reduced HRQoL in women.
Siribié, Mohamadou; Ajayi, IkeOluwapo O.; Nsungwa-Sabiiti, Jesca; Afonne, Chinenye; Balyeku, Andrew; Falade, Catherine O.; Gansane, Zakaria; Jegede, Ayodele S.; Ojanduru, Lillian; Oshiname, Frederick O.; Kabarungi, Vanessa; Kyaligonza, Josephine; Sanou, Armande K.; Sermé, Luc; Castellani, Joëlle; Singlovic, Jan; Gomes, Melba
Background. Use of community health workers (CHWs) to increase access to diagnosis and treatment of malaria is recommended by the World Health Organization. The present article reports on training and performance of CHWs in applying these recommendations. Methods. Two hundred seventy-nine CHWs were trained for 3–5 days in Burkina Faso, Nigeria, and Uganda, and 19 were certified to diagnose and treat only uncomplicated malaria and 235 to diagnose and treat both uncomplicated and severe malaria. Almost 1 year after training, 220 CHWs were assessed using standard checklists using facility staff responses as the reference standard. Results. Training models were slightly different in the 3 countries, but the same topics were covered. The main challenges noticed were the low level of education in rural areas and the involvement of health staff in the supervision process. Overall performance was 98% (with 99% in taking history, 95% in measuring temperature, 85% for measuring respiratory rates, 98% for diagnosis, 98% for classification, and 99% for prescribing treatment). Young, single, new CHWs performed better than their older, married, more experienced counterparts. Conclusions. Training CHWs for community-based diagnosis and treatment of uncomplicated and severe malaria is possible with basic and refresher training and close supervision of CHWs’ performance. Clinical Trials Registration. ISRCTRS13858170. PMID:27941103
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…
Jung, Hee-Won; Jang, Il-Young; Lee, Young Soo; Lee, Chang Ki; Cho, Eun-Il; Kang, Woo Young; Chae, Jeoung Hee; Lee, Eun Ju; Kim, Dae Hyun
Frailty has been previously studied in Western countries and the urban Korean population; however, the burden of frailty and geriatric conditions in the aging populations of rural Korean communities had not yet been determined. Thus, we established a population-based prospective study of adults aged ≥ 65 years residing in rural communities of Korea between October 2014 and December 2014. All participants underwent comprehensive geriatric assessment that encompassed the assessment of cognitive and physical function, depression, nutrition, and body composition using bioimpedance analysis. We determined the prevalence of frailty based on the Cardiovascular Health Study (CHS) and Korean version of FRAIL (K-FRAIL) criteria, as well as geriatric conditions. We recruited 382 adults (98% of eligible adults; mean age: 74 years; 56% women). Generally, sociodemographic characteristics were similar to those of the general rural Korean population. Common geriatric conditions included instrumental activity of daily living disability (39%), malnutrition risk (38%), cognitive dysfunction (33%), multimorbidity (32%), and sarcopenia (28%), while dismobility (8%), incontinence (8%), and polypharmacy (3%) were less common conditions. While more individuals were classified as frail according to the K-FRAIL criteria (27%) than the CHS criteria (17%), the CHS criteria were more strongly associated with prevalent geriatric conditions. Older Koreans living in rural communities have a significant burden of frailty and geriatric conditions that increase the risk of functional decline, poor quality of life, and mortality. The current study provides a basis to guide public health professionals and policy-makers in prioritizing certain areas of care and designing effective public health interventions to promote healthy aging of this vulnerable population.
Health Service Areas (HSAs) are a compromise between the 3000 counties and the 50 states. An HSA may be thought of as an area that is relatively self-contained with respect to hospital care and may cross over state boundries.
Hillemeier, Marianne M; Lynch, John; Harper, Sam; Casper, Michele
Objective To conceptualize and measure community contextual influences on population health and health disparities. Data Sources We use traditional and nontraditional secondary sources of data comprising a comprehensive array of community characteristics. Study Design Using a consultative process, we identify 12 overarching dimensions of contextual characteristics that may affect community health, as well as specific subcomponents relating to each dimension. Data Collection An extensive geocoded library of data indicators relating to each dimension and subcomponent for metropolitan areas in the United States is assembled. Principal Findings We describe the development of community contextual health profiles, present the rationale supporting each of the profile dimensions, and provide examples of relevant data sources. Conclusions Our conceptual framework for community contextual characteristics, including a specified set of dimensions and components, can provide practical ways to monitor health-related aspects of the economic, social, and physical environments in which people live. We suggest several guiding principles useful for understanding how aspects of contextual characteristics can affect health and health disparities. PMID:14727793
Effective Collaboration Among Health Care and Education Professionals: A Necessary Condition for Successful Early Intervention in Rural Areas. Making It Work in Rural Communities. A Rural Network Monograph.
Smith-Dickson, Bonnie, Ed.; Hutinger, Patricia, Ed.
Addressing the lack of cooperation between early intervention programs and the rural health community, this monograph presents eight papers by educators and health professionals who identify specific problems and offer solutions in the form of effective collaboration techniques and model programs. Papers by Susan Hastings and Stewart Gabel…
Goodman, Melody S.; Gonzalez, Maria; Gil, Sandra; Si, Xuemei; Pashoukos, Judith L.; Stafford, Jewel D.; Ford, Elsa; Pashoukos, Dennis A.
Background The Community Alliance for Research Empowering Social Change (CARES) is an academic–community research partnership designed to train community members on research methods and develop the infrastructure for community-based participatory research (CBPR) to examine and address racial/ethnic health disparities. The Brentwood Community Health Assessment (BCHA) was developed through a CBPR pilot project grant from CARES. Objectives The purpose of the BCHA is to assess health care utilization and identify existing barriers to health care access among a multi-ethnic community in the Hamlet of Brentwood, New York. Methods Using CBPR approaches, the community–academic research partnership develop the study design and survey instrument. Trained Bilingual (English/Spanish) data collectors verbally administered surveys door-to-door to residents of Brentwood from October 2010 to May 2011. Inclusion criteria required participants to be at least 18 years of age and speak either English or Spanish. Results Overall, 232 residents completed the BCHA; 49% were male, 66% Hispanic, 13% non-Hispanic White, 13% non-Hispanic Black, 29% had less than a high school education, and 33% were born in United States. The assessment results revealed that most residents are able to access health care when needed and the most significant barriers to health care access are insurance and cost. Conclusions We describe the community–academic partnered process used to develop and implement the BCHA and report assessment findings; the community-partnered approach improved data collection and allowed access into one of Suffolk County’s most vulnerable communities. PMID:24859100
Alexy, B B; Elnitsky, C A
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.
Woodrow, M; Wheat, R P
In order to encourage citizens to take a more active role in their health care management, a 464-bed community hospital presented a series of 12 health forums during a two-year period. A multidisciplinary panel of speakers was gathered to discuss specific health-related topics. The following article details the selection of forum topics, the general structure of the forums, use of publicity, audiovisual support, cost, and implications for planning further series.
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.
Community health education does more than educate communities about health. In the most basic form, community health education seeks to enable citizens to assume responsibility for their own and their community's health through an understanding of their community's health problems and the societal influences that act upon them. Many community…
Curtis, Denice C
This article evaluates the status of community health assessment in Kansas. It describes community characteristics associated with community health assessment completion, factors contributing to success, as well as barriers and limitations that prevented Kansas communities from initiating a community health assessment or completing the process. Survey findings show that certain community characteristics such as interagency cooperation, history of success at problem solving, and shared decision-making power are strongly associated with completion of a community health assessment. Results also indicate that factors such as lack of leadership, money, and time as well as poor functioning coalitions may hinder the completion of community health assessment.
Piccolo, Rebecca S.; Pearce, Neil; Araujo, Andre B.; McKinlay, John B.
Purpose Racial/ethnic disparities in the incidence of type 2 diabetes (T2DM) are well documented and many researchers have proposed that biogeographical ancestry (BGA) may play a role in these disparities. However, studies examining the role of BGA on T2DM have produced mixed results to date. Therefore, the objective of this research is to quantify the contribution of BGA to racial/ethnic disparities in T2DM incidence controlling for the mediating influences of socioeconomic factors. Methods We analyzed data from the Boston Area Community Health (BACH) Survey, a prospective cohort with approximately equal numbers of Black, Hispanic, and White participants. We used Ancestry Informative Markers to calculate the percentages of West African and Native American ancestry of participants. We used logistic regression with g-computation to analyze the contribution of BGA and socioeconomic factors to racial/ethnic disparities in T2DM incidence. Results We found that socioeconomic factors accounted for 44.7% of the total effect of T2DM attributed to Black race and 54.9% of the effect attributed to Hispanic ethnicity. We found that BGA had almost no direct association with T2DM and was almost entirely mediated by self-identified race/ethnicity and socioeconomic factors. Conclusions It is likely that non-genetic factors, specifically socioeconomic factors, account for much of the reported racial/ethnic disparities in T2DM incidence. PMID:25088753
Tewari, A; Gauba, K; Goyal, A
The knowledge about infant dental care (as a part of primary preventive programme) was delivered by the existing health team of CHC viz. medical doctors, multipurpose workers, health workers, Anganwadi workers (ICDS scheme), after due training from the dental experts, in the rural community of Raipur Rani (Haryana). The knowledge of community regarding infant dental care subsequent to intervention strategies when evaluated and compared to baseline values three years after intervention revealed that 72 percent of the community had the correct knowledge of prolonged breast/bottle feeding causing nursing bottle caries. 94 per cent had correct knowledge about harmful effects of thumb/finger sucking on teeth and jaw bones and 77 percent about harmful effects of mouth breathing. 98 percent of expecting mothers knew when to clean the gum pads and 62 percent how to clean the gum pads in an infant. 100 percent of the expecting mothers had the correct knowledge that pacifiers should not be used in small children.
Piccolo, Rebecca S; Duncan, Dustin T; Pearce, Neil; McKinlay, John B
Racial/ethnic disparities in the prevalence of type 2 diabetes mellitus (T2DM) are well documented and until recently, research has focused almost exclusively on individual-based determinants as potential contributors to these disparities (health behaviors, biological/genetic factors, and individual-level socio-demographics). Research on the role of neighborhood characteristics in relation to racial/ethnic disparities in T2DM is very limited. Therefore, the aim of this research is to identify and estimate the contribution of specific aspects of neighborhoods that may be associated with racial/ethnic disparities in T2DM. Data from the Boston Area Community Health III Survey (N = 2764) was used in this study, which is a community-based random-sample survey of adults in Boston, Massachusetts from three racial/ethnic groups (Black, Hispanic, and White). We applied two-level random intercepts logistic regression to assess the associations between race/ethnicity, neighborhood characteristics (census tract socioeconomic status, racial composition, property and violent crime, open space, geographic proximity to grocery stores, convenience stores, and fast food, and neighborhood disorder) and prevalent T2DM (fasting glucose > 125 mg/dL, HbA1c ≥ 6.5%, or self-report of a T2DM diagnosis). Black and Hispanic participants had 2.89 times and 1.48 times the odds of T2DM as White participants, respectively. Multilevel models indicated a significant between-neighborhood variance estimate of 0.943, providing evidence of neighborhood variation. Individual demographics (race/ethnicity, age and gender) explained 22.3% of the neighborhood variability in T2DM. The addition of neighborhood-level variables to the model had very little effect on the magnitude of the racial/ethnic disparities and on the between-neighborhood variability. For example, census tract poverty explained less than 1% and 6% of the excess odds of T2DM among Blacks and Hispanics and only 1.8% of the neighborhood
Piccolo, Rebecca S.; Duncan, Dustin T.; Pearce, Neil; McKinlay, John B.
Racial/ethnic disparities in the prevalence of type 2 diabetes mellitus (T2DM) are well documented and until recently, research has focused almost exclusively on individual-based determinants as potential contributors to these disparities (health behaviors, biological/genetic factors, and individual-level sociodemographics). Research on the role of neighborhood characteristics in relation to racial/ethnic disparities in T2DM is very limited. Therefore, the aim of this research is to identify and estimate the contribution of specific aspects of neighborhoods that may be associated with racial/ethnic disparities in T2DM. Data from the Boston Area Community Health III Survey (N = 2,764) was used in this study, which is a community-based random-sample survey of adults in Boston, Massachusetts from three racial/ethnic groups (Black, Hispanic, and White). We applied two-level random intercepts logistic regression to assess the associations between race/ethnicity, neighborhood characteristics (census tract socioeconomic status, racial composition, property and violent crime, open space, geographic proximity to grocery stores, convenience stores, and fast food, and neighborhood disorder) and prevalent T2DM (fasting glucose > 125 mg/dL, HbA1c ≥ 6.5%, or self-report of a T2DM diagnosis). Black and Hispanic participants had 2.89 times and 1.48 times the odds of T2DM as White participants, respectively. Multilevel models indicated a significant between-neighborhood variance estimate of 0.943, providing evidence of neighborhood variation. Individual demographics (race/ethnicity, age and gender) explained 22.3% of the neighborhood variability in T2DM. The addition of neighborhood-level variables to the model had very little effect on the magnitude of the racial/ethnic disparities and on the between-neighborhood variability. For example, census tract poverty explained less than 1% and 6% of the excess odds of T2DM among Blacks and Hispanics and only 1.8% of the neighborhood
EPA’s Community Public Health (CPH) project in the Office of Research and Development (ORD) produces high quality science and tools to understand and assess environmental risks and ecosystem goods and services (EGS) to decision-makers at all levels.
The topic of this article is program planning for K-12 school health programs collaborating with community agencies, businesses, colleges, and organizations. Community involvement was listed as one of the weakest areas of school health efforts in a national coordinated school health study . This article presents the 5-year results demonstrating the outcomes of K-12 schools program planning aimed at community involvement in the coordinated school health model. Directors of the Departments of Education and Health in South Dakota initiated training for school personnel in the coordinated school health model through development of councils in the schools starting in 2000. The expectations of the councils were to design a program plan to support the health of students and staff in their school. The short-term results of a 5-year evaluation indicated the greatest area of gain was in community health involvement to improve student and staff health.
... to urban (Urban, 38.4%, High Poverty Rural 51.3%, Other Rural, 45%). Counties with high rates ... for information about oral health programs in my area? The Association of State and Territorial Dental Directors ( ...
Duthie, Patricia; Hahn, Janet S.; Philippi, Evelyn; Sanchez, Celeste
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…
Anantaphruti, Malinee T; Waikagul, Jitra; Maipanich, Wanna; Nuamtanong, Supaporn; Pubampen, Somchit
The prevalence of soil-transmitted helminthic infections and health behaviors related to infections in schoolchildren and villagers of a community (4 hamlets) was studied in Hauy Kayeng subdistrict, Thong Pha Phum district, in the north of Kanchanaburi Province. The intestinal helminth infection rate of the schoolchildren was 15.6%. Hookworm infection was the most prominent (9.8%), followed by Trichuris trichiura (6.2%), and Ascaris lumbricoides (2.2%). The community showed higher prevalence rates and was infected with more types of intestinal helminths than the schoolchildren. Thirty-five point two percent (35.2%) of the residents were infected with soil-transmitted helminths, 30.5% with hookworm, 3.4% with A. lumbricoides and 2.2% with T. trichiura. Almost all hookworm cases (94.3%) were light intensity infections, while only 1.3% were heavy infections. Moreover, the hookworm infection rate in the community was found to be much higher when a stool culture method was used (39.1%). With this technique, 2.3% Strongyloides stercoralis infections were detected in the community population. Examination of the health behavior of the study samples showed that approximately 75% always defecated in a toilet. Schoolchildren who always wore shoes comprised 67%, which was lower than the community, at 85%.
Huh, Jina; McDonald, David W; Hartzler, Andrea; Pratt, Wanda
An increasing number of people visit online health communities to share experiences and seek health information. Although studies have enumerated reasons for patients' visits to online communities for health information from peers, we know little about how patients gain health information from the moderators in these communities. We qualitatively analyze 480 patient and moderator posts from six communities to understand how moderators fulfill patients' information needs. Our findings show that patients use the community as an integral part of their health management practices. Based on our results, we suggest enhancements to moderated online health communities for their unique role to support patient care.
Huh, Jina; McDonald, David W.; Hartzler, Andrea; Pratt, Wanda
An increasing number of people visit online health communities to share experiences and seek health information. Although studies have enumerated reasons for patients’ visits to online communities for health information from peers, we know little about how patients gain health information from the moderators in these communities. We qualitatively analyze 480 patient and moderator posts from six communities to understand how moderators fulfill patients’ information needs. Our findings show that patients use the community as an integral part of their health management practices. Based on our results, we suggest enhancements to moderated online health communities for their unique role to support patient care. PMID:24551364
Logan, M L
The setting up of a medical cooperative in a squatter community in Davao City, Philippines, and the training of women from the community to serve as paramedical health visitors and family planning workers, is described. The clinic charges each family a small fee and sells drugs at cost. The health visitor program was initiated by the poor families themselves to reach those who could not come to the clinic. The 1st groups trained chose the name Kaunaunahang Katiwala ng Kalusugan, or First Trustees of Health, and they are called katiwala for short. Since 1973 about 80 of these women, usually about 30 years of age, with home and family responsibilities, and of low educational background, have bee n trained. The dialogic method of Paolo Fraire of Brazil is used, which focuses on the native intelligence of the student and emphasizes a mutual learning process on the part of both teacher and student. Upon graduation the katiwala take care of minor ailments, refer major problems to the clinic, distribute family planning information, and encourage sanitation and good health practices. The barrios are divided into districts and 2 katiwala assigned to each. They receive some compensation. The program has proved it is possible to train persons with little education to be effective health workers and free physicians and nurses for more serious cases.
Lists several key concepts in developing successful interpretive programs for marine protected areas with community involvement. Identifies educational tools that help foster community involvement in conservation and management. Cites three model programs. Sets standards and goals for international success including leadership, education,…
Gazzinelli, Maria Flavia; Lobato, Lucas; Matoso, Leonardo; Avila, Renato; de Cassia Marques, Rita; Shah Brown, Ami; Correa-Oliveira, Rodrigo; Bethony, Jeffrey M.; Diemert, David J.
Background Obtaining informed consent for clinical trials is especially challenging when working in rural, resource-limited areas, where there are often high levels of illiteracy and lack of experience with clinical research. Such an area, a remote field site in the northeastern part of the state of Minas Gerais, Brazil, is currently being prepared for clinical trials of experimental hookworm vaccines. This study was conducted to assess whether special educational tools can be developed to increase the knowledge and comprehension of potential clinical trial participants and thereby enable them to make truly informed decisions to participate in such research. Methodology/Principal Findings An informational video was produced to explain the work of the research team and the first planned hookworm vaccine trial, using a pedagogical method based on analogies. Seventy-two adults living in a rural community of Minas Gerais were administered a structured questionnaire that assessed their knowledge of hookworm, of research and of the planned hookworm vaccine trial, as well as their attitudes and perceptions about the researchers and participation in future vaccine trials. The questionnaire was administered before being shown the educational video and two months after and the results compared. After viewing the video, significant improvements in knowledge related to hookworm infection and its health impact were observed: using a composite score combining related questions for which correct answers were assigned a value of 1 and incorrect answers a value of 0, participants had a mean score of 0.76 post-video compared to 0.68 pre-video (p = 0.0001). Similar improvements were seen in understanding the purpose of vaccination and the possible adverse effects of an experimental vaccine. Although 100% of participants expressed a positive opinion of the researchers even before viewing the film and over 90% said that they would participate in a hookworm vaccine trial, an
Four community colleges in Western Massachusetts--Berkshire Community College (BCC), Greenfield Community College (GCC), Holyoke Community College (HCC), and Springfield Technical Community College (STCC)--have created a collaborative Web site, at www.healthprograms.org, to present information on allied health associate degrees or certificate…
Syre, Thomas R.; Wilson, Richard W.
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…
Jones, Elaine G; Renger, Ralph; Firestone, Rob
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.
This study employed historical methodologies to explore the means through which the Maternity Care Coalition used grassroots activism to dismantle the power structures and other obstacles that contributed to high infant mortality rates in Philadelphia’s health districts 5 and 6 during the 1980s. Infant mortality within the black community has been a persistent phenomenon in the United States. Refusing to accept poverty as a major determinant of infant mortality within marginalized populations of women, activists during the 1980s harnessed momentum from a postcivil rights context and sought alternative methods toward change and improvement of infant mortality rates. PMID:24892861
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…
Minority communities face discrimination and abuse. The main health problems they face are those of severe and early chronic disease and poor well-being due to inequality in jobs, education and access to health care. The Sandwell community health network provides support workers to six major minority groups in Sandwell, providing information and access to skilled health services. Without securing health as a basic right for our minorities we perpetuate divisions in our society which cause mistrust, conflict and violence. The health system has a vital role to play in securing people's rights and campaigning for equality and justice for all our communities, to enhance community cohesion.
The professional mental health community, which had romanticized the concept of community control, is presently becoming disenchanted with it due to the lack of facility and skills for working with it. The task is to understand and evaluate community control and to alter only those aspects found destructive to community well-being. (DM)
Martinez, Linda Sprague; Rubin, Carolyn Leung; Russell, Beverley; Leslie, Laurel K.; Brugge, Doug
Objective This exploratory study set out to identify how communities in the Tufts University Clinical Translational Science Institute (CTSI) catchment area define health-related research priority areas. Methods Three focus groups comprised of community stakeholders were conducted in three communities. Participants were representatives from community-based organizations and health centers. A systematic content analysis was performed that involved the identification, labeling and categorization of data followed by thematic analysis. Results Participant conceptualizations of health and health priorities were not formulated in the context of specific disease conditions, such as diabetes, obesity, cardiovascular disease or asthma. Instead, participants described contextual factors including social, environmental, economic and political conditions that influence health and health behavior. Conclusions Respondents in the Tufts University CTSI catchment area, like many diverse urban communities, described multiple interconnected social determinants of health and wellbeing. As such, they were interested in research that focuses on “upstream” areas of intervention as opposed to disease prevention at the individual level. In addition, respondents were interested in research that would catalyze community change. PMID:21707945
Baral, Kedar; Allison, Jill; Upadhyay, Shambu; Bhandary, Shital; Shrestha, Shrijana
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
Baral, Kedar; Allison, Jill; Upadhyay, Shambu; Bhandary, Shital; Shrestha, Shrijana; Renouf, Tia
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.
Hou, Wanli; Fan, Hong; Xu, Jing; Wang, Fang; Chai, Yun; Xu, Hancheng; Li, Yongbin; Liu, Liqun; Wang, Bin; Jin, Jianqiang; Lu, Zuxun
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
Chiu, Gretchen R.; Lutfey, Karen E.; Litman, Heather J.; Link, Carol L.; Hall, Susan A.; McKinlay, John B.
Abuse is associated with a wide variety of health problems, yet comprehensive population-based data are scant. Existing literature focuses on a single type of abuse, population, or lifestage. Using a racially/ethnically diverse community-based sample, we document the prevalence of physical, emotional, and sexual abuse by lifestage and gender; assess variation in abuse by socio-demographics; establish overlap of abuses; and examine childhood abuse relationships with abuse in adulthood. Prevalence of abuse ranges from 15% to 27%; women report more adulthood emotional abuse and lifetime sexual abuse than men; reports of abuse can vary by race/ethnicity and poverty status, particularly in women; there is overlap between types of abuse; and a history of childhood abuse is associated with a greater risk of abuse as an adult. PMID:23862305
Lal, Sham; Ndyomugenyi, Richard; Magnussen, Pascal; Hansen, Kristian S.; Alexander, Neal D.; Paintain, Lucy; Chandramohan, Daniel; Clarke, Siân E.
Malaria-endemic countries have implemented community health worker (CHW) programs to provide malaria diagnosis and treatment to populations living beyond the reach of health systems. However, there is limited evidence describing the referral practices of CHWs. We examined the impact of malaria rapid diagnostic tests (mRDTs) on CHW referral in two cluster-randomized trials, one conducted in a moderate-to-high malaria transmission setting and one in a low-transmission setting in Uganda, between January 2010 and July 2012. All CHWs were trained to prescribe artemisinin-based combination therapy (ACT) for malaria and recognize signs and symptoms for referral to health centers. CHWs in the control arm used a presumptive diagnosis for malaria based on clinical symptoms, whereas intervention arm CHWs used mRDTs. CHWs recorded ACT prescriptions, mRDT results, and referral in patient registers. An intention-to-treat analysis was undertaken using multivariable logistic regression. Referral was more frequent in the intervention arm versus the control arm (moderate-to-high transmission, P < 0.001; low transmission, P < 0.001). Despite this increase, referral advice was not always given when ACTs or prereferral rectal artesunate were prescribed: 14% prescribed rectal artesunate in the moderate-to-high setting were not referred. In addition, CHWs considered factors alongside mRDTs when referring. Child visits during the weekends or the rainy season were less likely to be referred, whereas visits to CHWs more distant from health centers were more likely to be referred (low transmission only). CHWs using mRDTs and ACTs increased referral compared with CHWs using a presumptive diagnosis. To address these concerns, referral training should be emphasized in CHW programs as they are scaled-up. PMID:27799650
Quillian, J P
Community participation and utilization of community health workers (CHWs) are essential components of the primary health care model. The success of CHWs is dependent on their training and subsequent community support. Community-prepared nurses are ideal CHW educators. A training program for CHWs was implemented in Honduras emphasizing the principles of adult learning and problem-based learning. Following a 4-month program of training a primary health care clinic was opened and managed by CHWs for a population over 10,000. Approximately 80% of local health problems were managed by the CHWs proving that well-trained CHWs can have a significant impact on the delivery of health care.
Siegel, Wilma Bulkin; Bartley, Mary Anne
Staff at a nurse-managed urban health center conducted a series of art sessions to benefit the community. The authors believe the program's success clearly communicated the relationship between art and community health. As a result of the success of the sessions, plans are in the works to make art a permanent part of the health center's services.
Bender, Amy; Clune, Laurie; Guruge, Sepali
When a geographic location is assigned meaning, it becomes a place. The authors argue that place matters as both geographical location and lived experience. They extend the current conceptualization of nursing geography to encompass community health nursing and address intricacies of community nursing practice and research that often go unnoticed. They do so by exploring the notion of place in home and community, including the structural/spatial dimensions of the nurse-client relationship. The authors review the health geography literatures, then discuss the implications for practice and research in community health. They invite community health nurses to critically examine their practice and research with reference to such issues as the power of the nurse, marginalized places as determinants of health, and how best to care for clients living in diverse community settings.
Background: Community health promotion efforts involve communicating resource information to priority populations. Which communication strategies are most effective is largely unknown for specific populations. Objective: A random-dialed telephone survey was conducted to assess health resource comm...
Huh, Jina; Kwon, Bum Chul; Kim, Sung-Hee; Lee, Sukwon; Choo, Jaegul; Kim, Jihoon; Choi, Min-Je; Yi, Ji Soo
Many researchers and practitioners use online health communities (OHCs) to influence health behavior and provide patients with social support. One of the biggest challenges in this approach, however, is the rate of attrition. OHCs face similar problems as other social media platforms where user migration happens unless tailored content and appropriate socialization is supported. To provide tailored support for each OHC user, we developed personas in OHCs illustrating users' needs and requirements in OHC use. To develop OHC personas, we first interviewed 16 OHC users and administrators to qualitatively understand varying user needs in OHC. Based on their responses, we developed an online survey to systematically investigate OHC personas. We received 184 survey responses from OHC users, which informed their values and their OHC use patterns. We performed open coding analysis with the interview data and cluster analysis with the survey data and consolidated the analyses of the two datasets. Four personas emerged-Caretakers, Opportunists, Scientists, and Adventurers. The results inform users' interaction behavior and attitude patterns with OHCs. We discuss implications for how these personas inform OHCs in delivering personalized informational and emotional support.
McFarlane, Kathryn; Devine, Sue; Judd, Jenni; Nichols, Nina; Watt, Kerrianne
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.
Baffigo, Virginia; Albinagorta, Jorge; Nauca, Luis; Rojas, Percy; Alegre, Rossana; Hubbard, Brian; Sarisky, John
Peru's expanding population and rapid urbanization—a result of migration to its largest cities—have stressed the country's public services infrastructure and the provision of public health and environmental health services. In response, the Ministry of Health established the General Directorate of Environmental Health (DIGESA), the branch charged with assuring adequate environmental health services to populations in rural and urban areas. The magnitude of the environmental health problems in peri-urban settlements, however, has exceeded the capacity of DIGESA to respond. The Urban Environmental Health Project is an effort to develop the ability of local communities to address these problems PMID:11574311
The purpose and approach of community mental health in the urban ghetto is discussed. Mental health service is viewed as an alien institution by the deprived citizen and institutions of the Kennedy era were naive the approaches from 1963 on were only new in ideals but not practice. Each center is meant to offer its community consultation and…
Ferguson, W. J.; Lemay, C. A.; Hargraves, J. L.; Gorodetsky, T.; Calista, J.
We designed, implemented and evaluated a 48-hour training program for community health workers (CHWs) deployed to diabetes care teams in community health centers (CHCs). The curriculum included core knowledge/skills with diabetes content to assist CHWs in developing patient self-management goals. Our qualitative evaluation included…
Murray, Michael; Ziegler, Friederike
Community health psychology is an approach which promotes community mobilisation as a means of enhancing community capacity and well-being and challenging health inequalities. Much of the research on this approach has been at the more strategic and policy level with less reference to the everyday experiences of community workers who are actively involved in promoting various forms of community change. This article considers the narrative accounts of a sample of 12 community workers who were interviewed about their lives. Their accounts were analysed in terms of narrative content. This revealed the tensions in their everyday practice as they attempted to overcome community divisions and management demands for evidence. Common to all accounts was a commitment to social justice. These findings are discussed with reference to opportunities and challenges in the practice of community work.
Kim, Katherine K.; Rudin, Robert S.; Wilson, Machelle D.
Objectives National and state initiatives to spur adoption of electronic health record (EHR) use and health information exchange (HIE) among providers in rural and underserved communities have been in place for 15 years. Our goal was to systematically assess the impact of these initiatives by quantifying the level of adoption and key factors associated with adoption among community health centers (CHCs) in California. Study Design Cross-sectional statewide survey. Methods We conducted a telephone survey of all California primary care CHCs from August to September 2013. Multiple logistic regressions were fit to test for associations between various practice characteristics and adoption of EHRs, Meaningful Use (MU)–certified EHRs, and HIE. For the multivariable model, we included those variables which were significant at the P = .10 level in the univariate tests. Results We received responses from 194 CHCs (73.5% response rate). Adoption of any EHRs (80.3%) and MU–certified EHRs (94.6% of those with an EHR) was very high. Adoption of HIE is substantial (48.7%) and took place within a few years (mean = 2.61 years; SD = 2.01). More than half (54.7%) of CHCs are able to receive data into the EHR, indicating some level of interoperability. Patient engagement capacity is moderate, with 21.6% offering a personal health record, and 55.2% electronic visit summaries. Rural location and belonging to a multi-site clinic organization both increase the odds of adoption of EHRs, HIE, and electronic visit summary, with odds ratios ranging from 0.63 to 3.28 (all P values <.05). Conclusions Greater adoption of health information technology (IT) in rural areas may be the result of both federal and state investments. As CHCs lack access to capital for investments, continued support of technology infrastructure may be needed for them to further leverage health IT to improve healthcare. PMID:26760431
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.
Johnson, Barbara H; Hayes, Sandra C; Ekundayo, Olugbemiga T; Wheeler, Primus; Ford, D'Arcy M
The impact of community-based organizations on the delivery of health care knowledge is well documented. Little research has focused on the importance of health literacy in the dissemination of health care information by minority small business owners. This study sampled 38 business owners within a local business district to assess their level of health literacy. Although adequate health literacy is not required to serve as a community resource, it may be necessary to understand the health literacy level of local business owners as gatekeepers in order to develop appropriate training/educational programs. The results of this descriptive cross-sectional study indicate that for sample of business owners, health literacy levels are adequate. The findings suggest the feasibility of using local business owners as disseminators of health-related materials to the communities in which they operate their businesses.
McDonald, John L.; Vuturo, Anthony F.
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.…
Huh, Jina; Pratt, Wanda
Many patients visit online health communities to receive support. In face-to-face support groups, health professionals facilitate peer-patients exchanging experience while adding their clinical expertise when necessary. However, the large scale of online health communities makes it challenging for such health professional moderators' involvement to happen. To address this challenge of delivering clinical expertise to where patients need them, we explore the idea of semi-automatically providing clinical expertise in online health communities. We interviewed 14 clinicians showing them example peer-patient conversation threads. From the interviews, we examined the ideal practice of clinicians providing expertise to patients. The clinicians continuously assessed when peer-patients were providing appropriate support, what kinds of clinical help they could give online, and when to defer to patients' healthcare providers. The findings inform requirements for building a semi-automated system delivering clinical expertise in online health communities.
... contact your stateâ€™s board of health, nursing, or human services. Important Qualities Analytical skills. Health educators collect and analyze data ... and nutritionists are experts in the use of food and nutrition to promote health and manage disease. ... and causes of disease and injury in humans. They seek to reduce the risk and occurrence ...
Krantzler, Nora J.; Miner, Kathleen R.
The 10-volume "Health Facts" series is intended to supplement health education curricula and provide a handy reference for individuals who would like additional background information on particular health topics. The emphasis is placed on topics and examples relevant to youth of middle and high school age. This book is divided into two…
Hogg, Rachel A.
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
Oliveira, Jonas Welton Barros; Aquino, Jael Maria; Monteiro, Estela Maria Leite Meirelles
The objective of the study was to know how the Pankararu indigenous perceive their health situation and identify actions they prioritize as necessary to promote health in their community. Qualitative research, in which the declarations collected were subjected to the technique of analyzing the Collective Subject Discourse. It was identified that in the indigenous perception, as the health status of their community, there is a lack of general assistance, and a lack of professionals to assist them meeting their needs. In relation to actions that the Indigenous prioritize as necessary to promote the health of their community, it was highlighted provision of health unit with trained professionals and access to health education actions. It was, thus, proposed an overhaul of the organizations and establishments of the subsystems in promoting indigenous health.
Donatuto, Jamie; Campbell, Larry; Gregory, Robin
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
Flick, L H; Reese, C; Harris, A
Debate continues about the appropriateness of clinical experiences targeting aggregates in undergraduate community health nursing education. This paper describes a practical model to teach, through experience, the concepts of aggregate/community-centered practice at the baccalaureate level. As a voluntary alternative to the usual community assessment paper, groups of students worked in partnership with community groups to define health needs and to address one need. Sequential student groups focused the assessment and implemented a plan. The required time for each project varied. One project is described to illustrate the model. While independent community-centered practice is not expected of the B.S.N. graduate, the model described here develops comprehension of the concepts and process of such practice.
Cheadle, Allen; Hsu, Clarissa; Schwartz, Pamela M; Pearson, David; Greenwald, Howard P; Beery, William L; Flores, George; Casey, Maria Campbell
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.
Larsson, Laura S; Butterfield, Patricia; Christopher, Suzanne; Hill, Wade
Qualitative description was used to explore how rural community leaders frame, interpret, and give meaning to environmental health issues affecting their constituents and communities. Six rural community leaders discussed growth, vulnerable families, and the action avoidance strategies they use or see used in lieu of adopting health-promoting behaviors. Findings suggest intervention strategies should be economical, use common sense, be sensitive to regional identity, and use local case studies and "inside leadership." Occupational health nurses addressing the disparate environmental health risks in rural communities are encouraged to use agenda-neutral, scientifically based risk communication efforts and foster collaborative relationships among nurses, planners, industry, and other community leaders.
Closser, Svea; Kalofonos, Ippolytos
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
Cox, Gary B.; And Others
Describes an ongoing research project designed to develop a computer model capable of simulating the service delivery activities of community mental health care centers and human service agencies. The goal and methodology of the project are described. (NB)
To improve asthma health, it takes a variety of people working together to reduce triggers and provide safe and healthy environments for people with asthma. This includes parents and caregivers, community organizations, healthcare providers and schools.
Federally qualified health centers face numerous issues with regard to marketplace competition, staffing, and reimbursement streams that assure financial viability. Positioning the dental department of a health center to a high community profile strengthens the health center in professional educational development leading to a pipeline of workforce members, effective dental directors, and innovative fund-raising. A new dental team member developed by the American Dental Association can be utilized in health centers to make all traditional auxiliaries more productive.
Bers, Trudy H.; Head, Ronald B.
In this age of educational accountability, there is an increasing emphasis on assessment and institutional effectiveness, not only in the academic arena but also in other aspects of community college operation, such as fiscal health and stability, revenue generation, resource allocation, facilities, workforce development, and community enrichment…
dos Santos, Karina Tonini; Saliba, Nemre Adas; Moimaz, Suzely Adas Saliba; Arcieri, Renato Moreira; Carvalho, Maria de Lourdes
This study analyses the status and work reality of Community Health Agents, with the purpose of contributing to the improvement of the Brazilian Health System (SUS) in small cities. It was discussed aspects related to their participation in the team of the Family Health Program (PSF) and their interaction with the community. It was observed a lack of motivation and experience, which compromises the quality of Agents performance in the community. It is known that these findings are reflex and consequence of an established context. It is necessary the team rethink their practice, specially the managers, having always as a fundament the principles that guide the SUS and PSF.
Senellart, J M; Philippe, B
To provide adequate health care in many islands or atolls scattered on a surface equal to Europe, raises many problems. Physicians cannot have a full-time presence. Sanitary education given to the local population by auxiliaries born in the islands or living in, seems the recommendable way to improve the health situation. This on-the-spot basic action must associate Officers from various Departments (Health and Social Welfare, Fisheries, Agriculture, Education).
Rao, Krishna D; Waters, Hugh; Steinhardt, Laura; Alam, Sahibullah; Hansen, Peter; Naeem, Ahmad Jan
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
Pérez, Leda M; Martinez, Jacqueline
Community health workers are resources to their communities and to the advocacy and policy world on several levels. Community health workers can connect people to health care and collect information relevant to policy. They are natural researchers who, as a result of direct interaction with the populations they serve, can recount the realities of exclusion and propose remedies for it. As natural researchers, they contribute to best practices while informing public policy with the information they can share. In this light, community health workers may also be advocates for social justice.
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 for all is a people-based approach to health which considers the community as its focus. Community partnership is an important principle of health for all. This paper describes the many aspects of community partnership and gives examples of community partnerships initiatives in the World Health Organization Eastern Mediterranean Region, such as the basic development needs approach. The main agenda of community partnership for health for all is discussed and some opportunities conducive to community partnership in the Region are outlined.
Buxbaum, Carl B.
This critical review of the 1961 report of the Joint Commission on Mental Illness and Health concludes that the report and its adherents promised more than could be delivered and its claims regarding community mental health could not be supported by the available data. (Author)
In 1990, a telephone survey was conducted of health services offered by California's community colleges. Statewide, 42 of the 71 districts in California levied a health service fee, 18 districts offered services without charge, and 11 offered no service. Districts operating programs collected an average of $15.81 in student fees per credit average…
Kwiatkowski, Roy E.
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 research activities with Indigenous peoples.
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…
Pattison, E. Mansell
An ad hoc committee of the American Group Psychotherapy Association (AGPA) was charged to investigate the use of group methods in Community mental health centers (CMHC), to assess the conceptual basis for the use of various group methods, to relate the use of group methods to group psychotherapy, and to evaluate trends in this area of mental…
Purpose: The purpose of this paper is to present an evaluation of a community arts for health programme in the UK involving the delivery of three separate projects targeted at disadvantaged areas. Design/methodology/approach: Evaluation plans were drawn up for each project, which linked long-term goals, objectives, indicators of success and data…
Scott, Kathryn D.
This study examined the impact of childhood sexual abuse (CSA) on the mental health status of the Los Angeles Epidemiologic Catchment Area. A history of CSA was found to significantly increase an individual's odds of developing eight psychiatric disorders in adulthood. CSA's effect on the community level was also found to be substantial.…
Willis, Jean H.
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,…
Modi, Dhiren; Gopalan, Ravi; Shah, Shobha; Venkatraman, Sethuraman; Desai, Gayatri; Desai, Shrey; Shah, Pankaj
Background A new cadre of village-based frontline health workers, called Accredited Social Health Activists (ASHAs), was created in India. However, coverage of selected community-based maternal, newborn and child health (MNCH) services remains low. Objective This article describes the process of development and formative evaluation of a complex mHealth intervention (ImTeCHO) to increase the coverage of proven MNCH services in rural India by improving the performance of ASHAs. Design The Medical Research Council (MRC) framework for developing complex interventions was used. Gaps were identified in the usual care provided by ASHAs, based on a literature search, and SEWA Rural's1 three decades of grassroots experience. The components of the intervention (mHealth strategies) were designed to overcome the gaps in care. The intervention, in the form of the ImTeCHO mobile phone and web application, along with the delivery model, was developed to incorporate these mHealth strategies. The intervention was piloted through 45 ASHAs among 45 villages in Gujarat (population: 45,000) over 7 months in 2013 to assess the acceptability, feasibility, and usefulness of the intervention and to identify barriers to its delivery. Results Inadequate supervision and support to ASHAs were noted as a gap in usual care, resulting in low coverage of selected MNCH services and care received by complicated cases. Therefore, the ImTeCHO application was developed to integrate mHealth strategies in the form of job aid to ASHAs to assist with scheduling, behavior change communication, diagnosis, and patient management, along with supervision and support of ASHAs. During the pilot, the intervention and its delivery were found to be largely acceptable, feasible, and useful. A few changes were made to the intervention and its delivery, including 1) a new helpline for ASHAs, 2) further simplification of processes within the ImTeCHO incentive management system and 3) additional web-based features for
Modi, Dhiren; Gopalan, Ravi; Shah, Shobha; Venkatraman, Sethuraman; Desai, Gayatri; Desai, Shrey; Shah, Pankaj
Background A new cadre of village-based frontline health workers, called Accredited Social Health Activists (ASHAs), was created in India. However, coverage of selected community-based maternal, newborn and child health (MNCH) services remains low. Objective This article describes the process of development and formative evaluation of a complex mHealth intervention (ImTeCHO) to increase the coverage of proven MNCH services in rural India by improving the performance of ASHAs. Design The Medical Research Council (MRC) framework for developing complex interventions was used. Gaps were identified in the usual care provided by ASHAs, based on a literature search, and SEWA Rural's 1 three decades of grassroots experience. The components of the intervention (mHealth strategies) were designed to overcome the gaps in care. The intervention, in the form of the ImTeCHO mobile phone and web application, along with the delivery model, was developed to incorporate these mHealth strategies. The intervention was piloted through 45 ASHAs among 45 villages in Gujarat (population: 45,000) over 7 months in 2013 to assess the acceptability, feasibility, and usefulness of the intervention and to identify barriers to its delivery. Results Inadequate supervision and support to ASHAs were noted as a gap in usual care, resulting in low coverage of selected MNCH services and care received by complicated cases. Therefore, the ImTeCHO application was developed to integrate mHealth strategies in the form of job aid to ASHAs to assist with scheduling, behavior change communication, diagnosis, and patient management, along with supervision and support of ASHAs. During the pilot, the intervention and its delivery were found to be largely acceptable, feasible, and useful. A few changes were made to the intervention and its delivery, including 1) a new helpline for ASHAs, 2) further simplification of processes within the ImTeCHO incentive management system and 3) additional web-based features for
Smith, Selina A.; Blumenthal, Daniel S.
Ethical principles of community-based participatory research (CBPR)— specifically, community engagement, mutual learning, action-reflection, and commitment to sustainability—stem from the work of Kurt Lewin and Paulo Freire. These are particularly relevant in cancer disparities research because vulnerable populations are often construed to be powerless, supposedly benefiting from programs over which they have no control. The long history of exploiting minority individuals and communities for research purposes (the U.S. Public Health Service Tuskegee Syphilis Study being the most notorious) has left a legacy of mistrust of research and researchers. The purpose of this article is to examine experiences and lessons learned from community health workers (CHWs) in the 10-year translation of an educational intervention in the research-to-practice-to-community continuum. We conclude that the central role played by CHWs enabled the community to gain some degree of control over the intervention and its delivery, thus operationalizing the ethical principles of CBPR. PMID:23124502
Constable, Sophie Elizabeth; Dixon, Roselyn May; Dixon, Robert John
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.
Braithwaite, Ronald L.; And Others
A case study of the use of ethnographic approaches in community organization and development demonstrates their utility in achieving health empowerment among communities of color. The importance of citizen participation in community-based health initiatives is stressed. (SK)
Alaimo, Katherine; Beavers, Alyssa W; Crawford, Caroline; Snyder, Elizabeth Hodges; Litt, Jill S
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.
Griswold, Kim S; Lesko, Sarah E; Westfall, John M
Communities of solution (COSs) are the key principle for improving population health. The 1967 Folsom Report explains that the COS concept arose from the recognition that complex political and administrative structures often hinder problem solving by creating barriers to communication and compromise. A 2012 reexamination of the Folsom Report resurrects the idea of the COS and presents 13 grand challenges that define the critical links among community, public health, and primary care and call for ongoing demonstrations of COSs grounded in patient-centered care. In this issue, examples of COSs from around the country demonstrate core principles and propose visions of the future. Essential themes of each COS are the crossing of "jurisdictional boundaries," community-led or -oriented initiatives, measurement of outcomes, and creating durable connections with public health.
Studnicki, J; Steverson, B; Myers, B; Hevner, A R; Berndt, D J
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.
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
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
Soares, Neelkamal S; Hobson, Wendy L; Ruch-Ross, Holly; Finneran, Maureen; Varrasso, Denia A; Keller, David
The CATCH (Community Access to Child Health) Program, which supports pediatricians who engage with the community to improve child health, increase access to health care, and promote advocacy through small seed grants, was last evaluated in 1998. The objective was to describe the characteristics of CATCH grant recipients and projects and assess the community impact of funded projects. Prospective data was collected from CATCH applications (grantee characteristics, topic area and target population for projects funded from 2006-2012) and post-project 2-year follow-up survey (project outcomes, sustainability, and impact for projects funded from 2008 through 2010). From 2006 through 2012, the CATCH Program awarded 401 projects to grantees working mostly in general pediatrics. Eighty-five percent of projects targeted children covered by Medicaid, 33% targeted uninsured children, and 75% involved a Latino population. Main topic areas addressed were nutrition, access to health care, and medical home. Sixty-nine percent of grantees from 2008 to 2010 responded to the follow-up survey. Ninety percent reported completing their projects, and 86% of those projects continued to exist in some form. Grantees reported the development of community partnerships (77%) and enhanced recognition of child health issues in the community (73%) as the most frequent changes due to the projects. The CATCH Program funds community-based projects led by pediatricians that address the medical home and access to care. A majority of these projects and community partnerships are sustained beyond their original CATCH funding and, in many cases, are leveraged into additional financial or other community support.
Ezeonwu, Mabel C
The purpose of this article is to present an in-depth analysis of the concept of community health nursing (CHN) advocacy. Walker and Avant's (2010) 8-step concept analysis methodology was used. A broad inquiry into the literature between 1994 and 2014 resulted in the identification of the uses, defining attributes, empirical referents, antecedents, and consequences, as well as the articulation of an operational definition of CHN advocacy. Model and contrary cases were identified to demonstrate the concept's application and to clarify its meaning. This analysis contributes to the advancement of knowledge of CHN advocacy and provides nurse clinicians, educators, and researchers with some conceptual clarity to help improve community health outcomes.
A principal purpose of this article has been to examine the gap between research and practice in relation to community factors in child mental health. Two caveats were introduced in preparation for this assessment. First, it was pointed out that the definition of communities has been expanded by considering the organizing properties of social aggregates that are not simply a function of the race, ethnicity, or social class of individuals who compose them. Having these definitions grounded in theory substantially advances the needs of research and the design and goals of community-level interventions. The second caveat relates to the boundaries of the disciplines that cater to the needs of children. During the same era when child psychiatry is largely occupied with placing psychotropic medications at the center of clinical approaches, there is an important effort in child psychology and sociology to cut across their disciplinary confines to form more comprehensive designs that are sensitive to experiences and circumstances that emerge from specific aspects of community context. Research from the PHDCN was used as an example of this new interdisciplinary approach. Several community-based research projects were selected for review based on their clear implications to improve context-sensitive assessment of child mental health and design effective community-based interventions to improve child mental health. The Healthy Start and CATCH programs indicate that involving child professionals at the grassroots of community life requires skill and patience but that the effort is satisfying and potentially effective. Other examples, exemplified by North Carolina's Smart Start initiative and the program of developmental assets from the Search Institute, demonstrate coherent approaches that provide a foundation for long-term capacity building in assessment, local decision making, and the design and evaluation of interventions. Three conclusions are warranted from this
Davis, Roger M.; Grimm, Floyd M., III
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)
West, Jenny S.; Price, Matthew; Gros, Kirstin Stauffacher; Ruggiero, Kenneth J.
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
Roestam, K S
Women in Indonesia are playing an increasingly large part in economic activity and community development. Moreover, they are making a significant beneficial impact on the nation's health, most notably, perhaps, by helping to secure financial resources. The present article describes some of the ways in which women are working to improve the well-being of the Indonesian people.
Mberu, Blessing U.; Haregu, Tilahun Nigatu; Kyobutungi, Catherine; Ezeh, Alex C.
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
Leung, Valerie; Tharmalingam, Sukirtha; Cooper, Janet; Charlebois, Maureen
Background: 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. Methods: 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. Results: 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. Discussion: 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. Conclusion: 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. PMID:26798376
Schofield, Ruth; Ganann, Rebecca; Brooks, Sandy; McGugan, Jennifer; Dalla Bona, Kim; Betker, Claire; Dilworth, Katie; Parton, Laurie; Reid-Haughian, Cheryl; Slepkov, Marlene; Watson, Cori
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.
Ryan, Rob; Garlick, Robyn; Happell, Brenda
There is currently considerable discussion about the impact of the aging population on the demand for health care services, however there is considerably less attention paid to the impact of mental health issues on the needs of the aged population. Nurses comprise the largest professional group within the mental health workforce in Australia. The availability of a high quality mental health nursing workforce will therefore be crucial to meeting the health needs of aging clients in the future, accompanied by an increased pressure to increase the proportion of care delivered in the community. There is however, a paucity of literature on the role and contribution of community mental health nurses specialising in the aged care field. The aim of this paper is to present the findings of a project designed to examine the role of mental health nursing within aged persons' community mental health teams in Victoria, Australia, with particular emphasis on the biopsychosocial interventions used. Fifteen participants from three community mental health services in Victoria participated in a focus group interview to share their insights and experiences. Data analysis revealed two main themes, the role of the nurse, and the specific functions of the nurse. This data is presented as a beginning contribution to the paucity of literature currently available in this important area.
States, Rebecca A; Susman, William M; Riquelme, Luis F; Godwin, Ellen M; Greer, Ellen
To address disparities in access to health care information, we developed a model program of community-based, health education workshops to be delivered in English and Spanish to older urban adults from diverse ethnic, cultural, and language backgrounds. The workshops were created through an interdisciplinary collaboration among faculty from seven health care professions and focused on three healthcare topics identified in Healthy People 2010: dementia and depression, stress reduction, and physical activity. The development of workshop content and structure, including didactic and interactive components, an approach to interdisciplinary student involvement, and program evaluation by clients and community center staff, are presented as a model for other educators. The workshops presented at five senior centers were attended by 1110 mostly female clients with an average age of 74 yrs and with a large proportion self-identified as of minority background. One hundred seven students from seven healthcare programs helped deliver the workshops. Interviews and surveys of the clients demonstrated that most had a positive learning experience, whereas the evidence of intent to take action on health care issues was less definitive. Analysis of student essays demonstrated increased student understanding of older adults and of community services. A website, Geriatric Educational Resources for Instructors and Elders (www.GERIE.org), was created to provide access to the instructional and resource materials used for the workshops, including presentation materials in Spanish. This model program may help address the substantial health education needs of a growing population of older adults from diverse ethnic, cultural, and language minorities.
Health-care parameters for Natives living in isolated northern areas of Canada show rates of life expectancy, morbidity, and infant mortality far worse than the Canadian average. Improving access to medical facilities has not affected these statistics. Socioeconomic factors such as inadequate housing and lack of sewage systems are likely contributors to poor health, as is an attitude of hopelessness and impotence on the part of Native people. Health-care providers have recognized the need for health promotion as well as treatment, but have often instituted programs that blame the victim. An approach to health education that embodies community development, participation, and the fostering of a positive self-image is discussed. The implication of this approach is that when Native Canadian groups can identify their own health problems, have access to the information needed for their solution, and develop the confidence and assertiveness to act, change may occur at a community, as well as an individual, level. PMID:21253037
Tichy, N M; Taylor, J I
This article presents the case of Dr. Martin Luther King Jr. Health Center's unique community management system in which neighborhood workers have been developed to assume managerial responsibilities and are directing the Center. The Martin Luther King Center experience is instructive because the Center was able to achieve significant community control by focusing primarily on the internal dimension of control, namely, management, without experiencing destructive conflicts and the deterioration of health services.
Describes how Los Rios Community College District (LRCCD), California, the major provider of nursing graduates to the Sacramento area, addressed the issue of the nursing shortage crisis. LRCCD faced the dual issues of student/faculty ratio restrictions of 10/1 and funding that accommodated a 40/1 ratio. Describes LRCCD's new off-campus,…
... HUMAN SERVICES Indian Health Service Division of Nursing, Public Health Nursing Community Based Model of...), Community Based Model of Public Health Nursing Case Management Services. This program is authorized under... nursing programs for the IHS Area Offices and Service Units. The IHS PHN Program is a community...
The Bellevue Community College (BCC) Service Area 2000 Data Book includes the following demographic information on the BCC Service Area: total population; race and ethnicity descriptive statistics; Hispanic and Latino population demographics; age and gender distributions; household data; and the service area zip codes, areas, and school districts.…
Platz-Wiechert, Lynn Marie
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…
World Health Organization, Geneva (Switzerland).
Designed for trainers of community health workers, these guidelines are intended to help them instruct, in a practical way, those workers in how to improve nutrition in their areas. The book is divided into nine modules, each concerned with a different aspect of the community health worker's training. Each module first sets forth the learning…
Hull, Pamela; Kilbourne, Barbara; Reece, Michelle; Husaini, Baqar
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…
Constable, S E; Dixon, R M; Dixon, R J; Toribio, J-A
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.
Likumahuwa, Sonja; Song, Hui; Singal, Robbie; Weir, Rosy Chang; Crane, Heidi; Muench, John; Sim, Shao-Chee; DeVoe, Jennifer E.
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
Sarkar, Norma; Dallwig, Amber; Abbott, Patricia
Community Health Nursing (N456) is a required senior clinical course in the undergraduate nursing curriculum at the University of Michigan in which students learn to assess and address the health of populations and communities. In 2012, we began our efforts to internationalize the curriculum using a globally engaged nursing education framework. Our goal is for all students to have an intercultural learning experience understanding that all students are unable to travel internationally. Therefore, this intercultural learning was implemented through a range of experiences including actual immersion, virtual activities (videoconferencing) and interventions with local vulnerable populations. Grants were obtained to provide immersion experiences in Quito, Ecuador and New Delhi, India. Several technologies were initiated with partner nursing schools in Leogane, Haiti and New Delhi, India. Weekly videoconferencing utilizing BlueJeans software and exchange of knowledge through the Knowledge Gateway facilitated intercultural exchange of knowledge and culture. Local clinical groups work with a variety of vulnerable populations. A private blog was developed for all sections to share community assessment data from local and international communities. Qualitative evaluation data was collected for local and international students to begin to assess cultural competence and student learning. Analysis of data documented increased awareness of culture and identified the many positive benefits of interaction with a global partner.
Maketa, Vivi; Vuna, Mimy; Baloji, Sylvain; Lubanza, Symphorien; Hendrickx, David; Inocêncio da Luz, Raquel Andrea; Boelaert, Marleen; Lutumba, Pascal
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
Payne, Julianne; Razi, Sima; Emery, Kyle; Quattrone, Westleigh; Tardif-Douglin, Miriam
Health care organizations increasingly employ community health workers (CHWs) to help address growing provider shortages, improve patient outcomes, and increase access to culturally sensitive care among traditionally inaccessible or disenfranchised patient populations. Scholarly interest in CHWs has grown in recent decades, but researchers tend to focus on how CHWs affect patient outcomes rather than whether and how CHWs fit into the existing health care workforce. This paper focuses on the factors that facilitate and impede the integration of the CHWs into health care organizations, and strategies that organizations and their staff develop to overcome barriers to CHW integration. We use qualitative evaluation data from 13 awardees that received Health Care Innovation Awards from the Centers of Medicare and Medicaid Innovation to enhance the quality of health care, improve health outcomes, and reduce the cost of care using programs involving CHWs. We find that organizational capacity, support for CHWs, clarity about health care roles, and clinical workflow drive CHW integration. We conclude with practical recommendations for health care organizations interested in employing CHWs.
Christeson, Elisabeth P.
School nursing is based on a conceptual foundation of community health nursing. Using community health nursing as a reference point, this article describes a viewpoint of school nurses as the population of care. With this perspective, school nurses will better understand how to foster the health of their community. Developed on the basis of…
American Journal of Health Promotion, 1995
The paper reviews demographic and health status data for Hispanic communities and relates them to the role of culture in health care, recommending that health promotion programs focus on specific community data, understand the impact of culture and language, develop powerful outreach, and team up with community-based organizations. (SM)
Katz, Daniel Seth; Davison, Karen
This study explores community college student mental health by comparing the responses of California community college and traditional university students on the American College Health Association-National College Health Assessment II (ACHA-NCHA II). Using MANOVA, we compared community college and traditional university students, examining…
In 1999 the Victorian primary care and community support system began a process of substantial reform, involving purchasing reforms and a contested selection process between providers in large catchment areas across the State. The Liberal Government's electoral defeat in September 1999 led to a review of these reforms. This paper questions the reforms from a rural perspective. They were based on a generic template that did not consider rural-urban differences in health needs or other differences including socio-economic status, and may have reinforced if not aggravated rural-urban differences in the quality of and access to primary health care in Victoria.
Worley, N K; Lowery, B J
Directors of community mental health centers and superintendents of public mental health hospitals in one state were surveyed to gather data on interagency linkages. Implementation of affiliation agreements, exchange of staff training, and exchange of patient information were investigated. Affiliation agreements tended to be implemented with little difficulty and there was more interagency cooperation than that reported in earlier research. However, exchange of training and staff were still areas of minimal interaction. Geographic proximity was found to have a positive influence and competition a negative influence on cooperation. Further attempts at interagency linkages in the interest of continuity of patient care are recommended.
McAvoy, Peter V; Driscoll, Mary Beth; Gramling, Benjamin J
The Sixteenth Street Community Health Center (SSCHC) in Milwaukee, Wis, is making a difference in the livability of surrounding neighborhoods and the overall health of the families it serves. SSCHC is going beyond traditional health care provider models and working to link the environment, the economy, and community health through urban brownfield redevelopment and sustainable land-use planning. In 1997, SSCHC recognized that restoration of local air and water quality and other environmental conditions, coupled with restoring family-supporting jobs in the neighborhood, could have a substantial impact on the overall health of families. Recent events indicate that SSCHC's pursuit of smart growth strategies has begun to pay off.
Development Communication Report, 1977
The lead article discusses the results of a series of experiments in rural Alaska in which telemedicine was used to improve the delivery of health care to isolated populations. The author, Dennis Foote, also discusses the implications of these experiments for planning telemedicine systems in other areas. Satellite communication and a centralized…
Nonaka, Daisuke; Maazou, Abani; Yamagata, Shigeo; Oumarou, Issofou; Uchida, Takako; Yacouba, Honoré JG; Kobayashi, Jun; Takeuchi, Tsutomu; Mizoue, Tetsuya
In Niger, insecticide-treated bed nets (ITNs) have been distributed to the target group of households with young children and/or pregnant women at healthcare facilities in the course of antenatal/immunization clinics. With the aim of universal coverage, ITNs were additionally distributed to households through strengthened community health committees in 2009. This study assessed the impact of the community-based net distribution strategy involving community health committees in the ITN coverage in Boboye Health District, Niger. A cross-sectional survey was carried out on 1,034 households drawn from the intervention area (the co-existence of the community-based system together with the facility-based system) and the control area (the facility-based system alone). In the intervention area, 55.8% of households owned ITNs delivered through the community-based system, and 29.6% of households exclusively owned ITNs obtained through the community-based system. The community-based system not only reached households within the target group (54.6% ownership) but also those without (59.1% ownership). Overall, household ITN ownership was significantly higher in the intervention area than in the control area (82.5% vs. 60.7%). In combination, the community-based system and the facility-based system achieved a high ITN coverage. The community-based system contributed to reducing leakage in the facility-based system. PMID:23532450
Quality of life is widely used as a measure of individual well-being in developed countries. Social quality (SQ), however, describes how favorable the socioenvironmental components are that impact the life chance of an individual. Despite the associations between SQ, including institutional capacity and citizen capacity, and other community indicators, the impact of SQ on community health status has not been fully examined. This study investigated the interrelationships among institutional capacity, citizen capacity, and their associations with community-level health indicators such as mortality and suicide among 230 local governments in South Korea. Under the principles of conceptual suitability, clarity, reliability, consistency, changeability, and comparability, a total of 81 SQ indicators were collected, and 19 indicators of the 81 indicators were selected. The 19 indicators were transformed by the imputation of missing values, standardization, and geographic information system transformation. It was found that the health outcome of local government was superior as social welfare, political participation, and education were higher. According to the result of the regression analysis based on the regional type, social welfare had the most influence on the health level of local government in both metropolises and small-/medium-sized cities. In addition, education and political participation had a positive effect on the health indicator of local metropolis government. However, SQ indicators did not have any meaningful influence at the county level. Therefore, small- and medium-sized cities need to promote the collective health of the local government through improving social welfare, and metropolises need to consider the complex relationship among other indicators while increasing the level of social welfare and education. Meanwhile, counties need to develop health indicators that reflect aged population characteristics and social environment of rural areas
Friedman, Daniela B; Tanner, Andrea; Rose, India D
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.
Braithwaite, R L; Bianchi, C; Taylor, S E
The purpose of this article is to address pertinent issues relative to the association between community organization and health empowerment methods in ethnic communities of colour. It seeks to address these issues by utilizing ethnographic procedures for documenting community health concerns and by advocating for empowerment for people of colour and their participation in coalition partnerships. Increasingly the importance of citizen participation in the planning, assessment, and implementation of community-based health initiatives has been identified as essential for effective health promotion and disease prevention programs. This article argues for the utility of a community organization approach for achieving health empowerment, and subsequently decreasing the excess deaths in communities of colour. The interface of ethnographic procedures, community organization, and development of community-owned action plans for programming health interventions is discussed.
The Environmental Health Coalition (EHC) is a recipient of a CARE Level II cooperative agreement grant. The Clean Ports, Healthy Communities in San Diego targets the Barrio Logan and Old Town National City areas located along San Diego Bay.
Thompson, Beti; Molina, Yamile; Viswanath, Kasisomayajula; Warnecke, Richard; Prelip, Michael L
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.
Kickbusch, Ilona; Reddy, K Srikanth
Communities are characterized by common interests, common ecology, and common social system or structure. These characteristics, qualities, and processes involved in the community affect both health behaviors and health outcomes during disease outbreaks. Hence, health promotion theorists and practitioners emphasize working 'with' rather than 'on' communities. They believe health promotion, with all its experiences in community mobilization, empowerment, and health literacy programs, should be part of disease prevention and control efforts from the very beginning. Health promotion knowledge needs to be fully integrated into infectious disease control, especially in the context of outbreaks.
Kaseje, D C; Spencer, H C; Sempebwa, E K
A community-based health development programme in Saradidi, Kenya had 126 village health helpers (VHH's) for the 56 villages. These volunteer health workers lived in the community and served a total population of about 43,000 in an area of 225 km2. Each VHH served a maximum of 100 households averaging 4.0 persons. Conditions imposed by the community were that the VHH be perceived to be a mature person, to be compassionate and to have a desire to help people and to live in the village. Literacy or formal education were not requirements. VHH's were chosen and supported by the people who lived in their village. Characteristics of the 126 VHH's were that 96.8% were women, 99.2% were married, 75.4% were between 25 and 39 years of age, and 80.2% had at least five years of formal education (only 7.1% had none). The VHH's spent an average five to ten days each month on programme activities in addition to their other responsibilities which included preparing meals, cleaning their homes, carrying water and firewood from long distances, caring for their children and cultivating food for their family. Each VHH visited about 15 households per month, spending one to two hours on a visit. Problems experienced by a random sample of 36 VHH's included difficulties due to lack of transport, lack of medicines, slowness of the community to accept new ideas, distance from project clinic, lack of food in the village, weak village health committees, and no payment for services. The main support for the VHH's came from village women individually, women's groups, and the central programme committee. Village Health Committees did not provide effective support. Nevertheless, in four years only four of the 126 VHH's dropped out of the programme. The main reasons that 36 VHH's reported for continuing to volunteer were as follows: the continuous training they were given was beneficial (mentioned by all); they agreed to serve the villages and did not want to go back on their word (36.1%); they
Proser, Michelle; Bysshe, Tyler; Weaver, Donald; Yee, Ronald
ABSTRACT In response to increased demand for primary care services under the Affordable Care Act, the national network of community health centers (CHCs) will play an increasingly prominent role. CHCs have a broad staffing model that includes extensive use of physician assistants (PAs), nurse practitioners (NPs), and certified nurse midwives (CNMs). Between 2007 and 2012, the number of PAs, NPs, and CNMs at CHCs increased by 61%, compared with 31% for physicians. However, several policy and payment issues jeopardize CHCs' ability to expand their workforce and meet the current and rising demand for care. PMID:25802941
Story, Lachel; Mayfield-Johnson, Susan; Downey, Laura H; Anderson-Lewis, Charkarra; Young, Rebekah; Day, Pearlean
Health disparities along with insufficient numbers of healthcare providers and resources have created a need for effective and efficient grassroots approaches to improve community health. Community-based participatory research (CBPR), more specifically the utilization of community health advisors (CHAs), is one such strategy. The Getting on Target with Community Health Advisors (GOTCHA) project convened an interdisciplinary team to answer the call from 10 counties in the rural Mississippi Delta area of 'The Stroke Belt' to meet the region's identified health needs, and to impact the health of a disparaged state. This article explores this CBPR project including the community involvement strategies, innovative CHA training curriculum, evaluation plan, and implications to healthcare professionals, particularly nurses.
Fowkes, Virginia; Blossom, H John; Sandrock, Christian; Mitchell, Brenda; Brandstein, Kendra
Health professionals in community settings are generally unprepared for disasters. From 2006 to 2008 the California Statewide Area Health Education Center (AHEC) program conducted 90 table top exercises in community practice sites in 18 counties. The exercises arranged and facilitated by AHEC trained local coordinators and trainers were designed to assist health professionals in developing and applying their practice site emergency plans using simulated events about pandemic influenza or other emergencies. Of the 1,496 multidisciplinary health professionals and staff participating in the exercises, 1,176 (79%) completed learner evaluation forms with 92-98% of participants rating the training experiences as good to excellent. A few reported helpful effects when applying their training to a real time local disaster. Assessments of the status of clinic emergency plans using 15 criteria were conducted at three intervals: when the exercises were scheduled, immediately before the exercises, and for one-third of sites, three months after the exercise. All sites made improvements in their emergency plans with some or all of the plan criteria. Of the sites having follow up, most (N = 23) were community health centers that made statistically significant changes in two-thirds of the plan criteria (P = .001-.046). Following the exercises, after action reports were completed for 88 sites and noted strengths, weaknesses, and plans for improvements in their emergency plans Most sites (72-90%) showed improvements in how to activate their plans, the roles of their staff, and how to participate in a coordinated response. Challenges in scheduling exercises included time constraints and lack of resources among busy health professionals. Technical assistance and considerations of clinic schedules mitigated these issues. The multidisciplinary table top exercises proved to be an effective means to develop or improve clinic emergency plans and enhance the dialogue and coordination among
Blossom, H. John; Sandrock, Christian; Mitchell, Brenda; Brandstein, Kendra
Health professionals in community settings are generally unprepared for disasters. From 2006 to 2008 the California Statewide Area Health Education Center (AHEC) program conducted 90 table top exercises in community practice sites in 18 counties. The exercises arranged and facilitated by AHEC trained local coordinators and trainers were designed to assist health professionals in developing and applying their practice site emergency plans using simulated events about pandemic influenza or other emergencies. Of the 1,496 multidisciplinary health professionals and staff participating in the exercises, 1,176 (79%) completed learner evaluation forms with 92–98% of participants rating the training experiences as good to excellent. A few reported helpful effects when applying their training to a real time local disaster. Assessments of the status of clinic emergency plans using 15 criteria were conducted at three intervals: when the exercises were scheduled, immediately before the exercises, and for one-third of sites, three months after the exercise. All sites made improvements in their emergency plans with some or all of the plan criteria. Of the sites having follow up, most (N = 23) were community health centers that made statistically significant changes in two-thirds of the plan criteria (P = .001–.046). Following the exercises, after action reports were completed for 88 sites and noted strengths, weaknesses, and plans for improvements in their emergency plans Most sites (72–90%) showed improvements in how to activate their plans, the roles of their staff, and how to participate in a coordinated response. Challenges in scheduling exercises included time constraints and lack of resources among busy health professionals. Technical assistance and considerations of clinic schedules mitigated these issues. The multidisciplinary table top exercises proved to be an effective means to develop or improve clinic emergency plans and enhance the dialogue and
Cornwell, Lisa; Hawley, Suzanne R.; St. Romain, Theresa
Background: Coordinated school health programs (CSHPs) bring together educational and community resources in the school environment. This method is particularly important in rural areas like Kansas, where resources and trained health professionals are in short supply. Rural Stafford County, Kansas, struggles with health professional shortages and…
Cornish, Flora; Montenegro, Cristian; van Reisen, Kirsten; Zaka, Flavia; Sevitt, James
This article argues that community health psychology's core strategy of 'community mobilisation' is in need of renewal and proposes a new way of conceptualising community health action. Taking the Occupy movement as an example, we critique modernist understandings of community mobilisation, which are based on instrumental action in the service of a predetermined goal. Aiming to re-invigorate the 'process' tradition of community health psychology, we explore possibilities of an open-ended, anti-hierarchical and inclusive mode of community action, which we label 'trusting the process'. The gains to be made are unpredictable, but we suggest that the risk is worth taking.
Plescia, M; Koontz, S; Laurent, S
OBJECTIVES: In this report, the authors present a representative case of the implementation of community assessment and the subsequent application of findings by a large, vertically integrated health care system. METHODS: Geographic information systems technology was used to access and analyze secondary data for a geographically defined community. Primary data included a community survey and asset maps. RESULTS: In this case presentation, information has been collected on demographics, prevalent health problems, access to health care, citizens' perceptions, and community assets. The assessment has been used to plan services for a new health center and to engage community members in health promotion interventions. CONCLUSIONS: Geographically focused assessments help target specific community needs and promote community participation. This project provides a practical application for integrating aspects of medicine and public health. PMID:11344895
Bartoli, Claire; And Others
Describes the creation of a series of interactive video modules on dental hygiene at Luzerne County Community College. These modules are intended to supplement instruction in a community dentistry and health education course and to guide students in an assignment to develop and implement dental health projects in their community. (MBR)
Ezeonwu, Mabel; Berkowitz, Bobbie; Vlasses, Frances R
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.
Pérez Mendoza, S; Ascanio, S V
Action Community regarding health is but part of a long-term project started out back in the 1960. As far as Latin America was concerned the so-called experience did not work out; notwithstanding, it has become an Attention-Getter among the countries of the area once again. How so? Because of the Primary-Approach. Understood as an approach based on the global development of society, self-involvement lies at the cornerstone of the whole process. The health section gives full measure of the primary-approach theoretical framework and propose alternatives to get it of the ground. Professionals from the health section aim at "self-involvement" as activity performed willingly. Besides as it were, it should be supervised by experts. Nowadays the venezuelan government promotes action community claiming it will endorse the Primary-Approach on health granted the national health system bill is approved. Amid such context dentistry most meet the challenge of upcoming changes, so must fellow-dentists who, in the end, will dominate center stage. The process must narrow down to actions with will stem from its own dynamics along the way. Needless to say, these actions can not be easily foreseen, let alone do they guarantee success.
Horton, Graeme; Hanna, Liz; Kelly, Brian
Older Australians living in rural areas have long faced significant challenges in maintaining health. Their circumstances are shaped by the occupations, lifestyles, environments and remoteness which characterise the diversity of rural communities. Many rural regions face threats to future sustainability and greater proportions of the aged reside in these areas. The emerging changes in Australia's climate over the past decade may be considered indicative of future trends, and herald amplification of these familiar challenges for rural communities. Such climate changes are likely to exacerbate existing health risks and compromise community infrastructure in some instances. This paper discusses climate change-related health risks facing older people in rural areas, with an emphasis on the impact of heat, drought and drying on rural and remote regions. Adaptive health sector responses are identified to promote mitigation of this substantial emerging need as individuals and their communities experience the projected impact of climate change.
... 42 Public Health 1 2012-10-01 2012-10-01 false Health Service Delivery Areas. 136a.15 Section 136a.15 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH What Services Are Available and Who Is Eligible...
... 42 Public Health 1 2011-10-01 2011-10-01 false Health Service Delivery Areas. 136a.15 Section 136a.15 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH What Services Are Available and Who Is Eligible...
... 42 Public Health 1 2010-10-01 2010-10-01 false Health Service Delivery Areas. 136a.15 Section 136a.15 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH What Services Are Available and Who Is Eligible...
... 42 Public Health 1 2013-10-01 2013-10-01 false Health Service Delivery Areas. 136a.15 Section 136a.15 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH What Services Are Available and Who Is Eligible...
... 42 Public Health 1 2014-10-01 2014-10-01 false Health Service Delivery Areas. 136a.15 Section 136a.15 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES INDIAN HEALTH What Services Are Available and Who Is Eligible...
Lane, Sandra D; Cashman, Donna M; Keefe, Robert H; Narine, Lutchmie; Ducre, Bradford; Chesna, Sharon; Hall, Meghan; Oliver, David
The Affordable Care Act mandates that public health data be made available for community agency use. Having access to such data allows community agencies to tailor interventions, evaluations, and funding requests more effectively. This study, jointly undertaken by Syracuse University faculty and students with the New York State Perinatal Association, sought to understand community agencies' access to requests for governmental data, as well as to identify areas for improving data access. Results from this survey of administrators from 43 agencies in New York State found that only one-half of their requests for data were successful. Difficulties in obtaining access to needed data included fiscal and staffing constraints of the state-level agencies that house the data, as well as possible overinterpretation of confidentiality policies. In addition, some of community agency respondents reported that their staff lacked skills in data analysis and would benefit from training in epidemiology and quantitative evaluation.
Young, Rachel; Willis, Erin; Stemmle, John; Rodgers, Shelly
Newspaper health stories often originate with news releases from health organizations. Tailoring news releases to a particular mass media outlet increases the possibility that the release will result in a published story. This study describes a 2-year effort to promote coverage of health through dissemination of localized health news releases to newspapers. Each newspaper received stories tailored to that community. Localized elements of stories included local headlines and local data. Nearly half of newspapers in our study (48.2%) published at least one of our health news stories, and 541 health news stories were published as a result of the project. We also examined which types of newspapers were most likely to publish health news stories. Newspapers in rural versus suburban and urban areas were more likely to publish health news stories, as were midsized newspapers. In addition, rural newspapers were more likely than urban newspapers to publish stories about aging, specifically arthritis and heart disease. Our findings indicate that tailoring health news releases with local information and targeting releases to align with newspaper audience demographics could increase the quantity and quality of health-promoting information available to rural residents, who experience disparities in health care access and health outcomes.
This is a report on a national survey of community colleges conducted by the American Association of Community Colleges (AACC) in 2000. The survey was designed to identify various community health programs, centers, classes, and services related to HIV/AIDS that community colleges administered, partnered, or sponsored. The study surveyed 1,100…
Ahmad, Waqar I. U., Ed.; Atkin, Karl, Ed.
This collection offers a wide-ranging introduction to contemporary issues surrounding the health care needs of members of minority ethnic communities within the framework of community care in Britain. The following chapters consider state welfare, minority communities, family structures, and social change: (1) "'Race' and Community Care: An…
Roden, Janet; Jarvis, Lynda; Campbell-Crofts, Sandra; Whitehead, Dean
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.
Cameron, Colleen; Ghosh, Sebanti; Eaton, Susan L.
Reducing health inequities and improving the health of communities require an informed public that is aware of the social determinants of health and how policies and programs have an impact on the health of their communities. People Assessing Their Health (PATH) is a process that uses community-driven health impact assessment to build the capacity of people to become active participants in the decisions that affect the well-being of their community. The PATH process is both a health promotion and a community development approach that builds people's ability to bring critical analysis to a situation and to engage in effective social action to bring about desired change. Because it increases analytical skills and provides communities with their own unique tool to assess the potential impact of projects, programs or policies on the health and well-being of their community it is an empowering process. PATH was originally used in three communities in northeastern Nova Scotia, Canada in 1996 when the Canadian health care system was being restructured to a more decentralized system. Since then it has been used in other communities in Nova Scotia and India. This paper will describe the PATH process and the use of the community health impact assessment as well as the methodology used in the PATH process. The lessons learned from PATH's experiences of building capacity among the community in Canada and India will be presented.
Kaur, Manjit; Mayfield, James B.
Key factors of a model for training community health aides are (1) extended time for updating and reinforcing skills; (2) relevance to local situations; (3) group process and interpersonal communication training; (4) practical materials; and (5) participation of physicians, local health workers, and community leaders in rural health policy…
Williams, Carolyn A.
It is important that nurses, particularly those who consider themselves community health nursing specialists, assign a high priority to participation in the formation of health policy and broader public policy. To put subsequent remarks about policy into perspective, it is useful to consider the case for seeing community health nursing as…
Schoenberg, Nancy E.; Hatcher, Jennifer; Dignan, Mark B.
Context: Decades of behavioral research suggest that awareness of health threats is a necessary precursor to engage in health promotion and disease prevention, findings that can be extended to the community level. Purpose: We sought to better understand local perspectives on the main health concerns of rural Appalachian communities in order to…
Corbin, David E.; Leach, Marilyn M.
Community Health 360, a required class for community health educators and exercise science majors at University of Nebraska at Omaha, was developed to teach students the interrelatedness of health, music, art, language, history, and environment. The course and its evaluation by students and by peer review is described. (MT)
Collins, Jessica; Ward, Bernadette M.; Snow, Pamela; Kippen, Sandra; Judd, Fiona
There are disproportionately higher and inconsistently distributed rates of recorded suicides in rural areas. Patterns of rural suicide are well documented, but they remain poorly understood. Geographic variations in physical and mental health can be understood through the combination of compositional, contextual, and collective factors pertaining to particular places. The aim of this study was to explore the role of “place” contributing to suicide rates in rural communities. Seventeen mental health professionals participated in semi-structured in-depth interviews. Principles of grounded theory were used to guide the analysis. Compositional themes were demographics and perceived mental health issues; contextual themes were physical environment, employment, housing, and mental health services; and collective themes were town identity, community values, social cohesion, perceptions of safety, and attitudes to mental illness. It is proposed that connectedness may be the underlying mechanism by which compositional, contextual, and collective factors influence mental health and well-being in rural communities. PMID:26848083
Conger, Cynthia O'Neill; Baldwin, Joan H.; Abegglen, JoAnn; Callister, Lynn C.
Brigham Young University's nursing curriculum was revised to reflect the community-driven nature of primary health care. Curricular threads of inquiry, practice, stewardship, spirituality, and service are the framework for integrating community health nursing practice. (SK)
Sullivan, Marianne; Levine, Jack
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…
Information technology (IT) has the potential to assist disadvantaged communities in gaining access to mainstream resources, and to a new kind of community health-supporting infrastructure. Federal and state information technology policy will affect how and how well community institutions can reach their goals, collaborate with service agencies, and effectively advocate investing essential, health-supporting resources in their communities. The current information technology focus of the health professions is institution and provider-oriented. It should have a wider scope to include community-based organizations. Laborious efforts undertaken by community-based organizations (CBOs) with only a patchwork of resources and without policy support suggest their value to the public's health. Increasingly burdened public health organizations should examine the public health interest in closing the gap between IT-poor and IT-rich organizations and develop a strategy for building inclusive electronic webs with CBOs. PMID:8826628
Zotti, Marianne E.; And Others
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)
... Regulatory Use Areas and Community Governing Body that Recommends the Community Quota Entity 21 Table 21 to..., Table 21 Table 21 to Part 679—Eligible GOA Communities, Halibut IFQ Regulatory Use Areas and Community.... Whale Pass Whale Pass Community Association. Akhiok City of Akhiok. Chenega Bay Chenega IRA...
Yeh, Lily; Chen, Yi-Hsing
In the 21st century, many healthcare programs are delivered in community settings. As such, successfully recruiting target members of the community to participate in programs represents a key challenge for the nursing profession. Although the "community" is not a new concept, its meaning has changed over the past century or more of public healthcare, which has had a profound effect on community health nursing praxis. This article describes changes in community concepts through history in order to define the significance of community participation in today's community health nursing practice.
WestRasmus, Emma K; Pineda-Reyes, Fernando; Tamez, Montelle; Westfall, John M
For underserved and disenfranchised communities in the United States, affordable, effective health care can be nearly inaccessible, which often leads to the exclusion of these communities from relevant medical information and care. Barriers to care are especially salient in minority communities, where language, traditions and customs, socioeconomics, and access to education can serve as additional roadblocks to accessing health care information and services. These factors have contributed to a national health disparity crisis that unnecessarily places some communities in a vulnerable position without adequate prevention and treatment opportunities. One solution to the exclusion some communities face in the health care system may be the promotores de salud (PdS)/community health worker (CHW), an approach to culturally competent health care delivery whose popularity in the mainstream health care system has been steadily growing in recent decades. Known by a wide variety of names and broad in the spectrum of health issues they address, the PdS/CHW serves as cultural brokers between their own community and the formal health care system and can play a crucial role in promoting health and wellness within their community. This annotated bibliography was created to educate the reader about the history, definition, key features, utility, outcomes, and broad potential of the CHW approach in a variety of populations. Intended to serve as a reference point to a vast body of information on the CHW/PdS approach, this document is a resource for those wishing to effect change in the disparities within the health care system, and to improve the access to, quality, and cost of health care for underserved patients and their communities. Promotores de Salud is a Spanish term that translates to Health Promoter. A female health worker may be referred to as a Promotora, a male as a Promotor, and the plural of both is Promotores. For the purposes of this bibliography, the terms community
Wakefield, Sarah; Yeudall, Fiona; Taron, Carolin; Reynolds, Jennifer; Skinner, Ana
This article describes results from an investigation of the health impacts of community gardening, using Toronto, Ontario as a case study. According to community members and local service organizations, these gardens have a number of positive health benefits. However, few studies have explicitly focused on the health impacts of community gardens, and many of those did not ask community gardeners directly about their experiences in community gardening. This article sets out to fill this gap by describing the results of a community-based research project that collected data on the perceived health impacts of community gardening through participant observation, focus groups and in-depth interviews. Results suggest that community gardens were perceived by gardeners to provide numerous health benefits, including improved access to food, improved nutrition, increased physical activity and improved mental health. Community gardens were also seen to promote social health and community cohesion. These benefits were set against a backdrop of insecure land tenure and access, bureaucratic resistance, concerns about soil contamination and a lack of awareness and understanding by community members and decision-makers. Results also highlight the need for ongoing resources to support gardens in these many roles.
Background A 2.5-month diabetes education training for community health workers (CHWs) was developed, implemented, and evaluated. Methods Training methods used included case studies, role-playing, and lectures. Exams were used throughout the training for its evaluation. Teaching was delivered by different ways: a one day American Diabetes Association (ADA) course; a five day Diabetes Self-Management Program (DSMP); Conversation Maps; and a series of seven National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) diabetes education booklets. Results Qualitative and quantitative evaluative methods were used during and after the training. The CHWs’ diabetes knowledge was evaluated by a pre- and post-test Diabetes Knowledge Questionnaire (DKQ). The post-test was conducted one week after completing the training. The findings showed that the diabetes knowledge of the CHWs increased. Conclusions Diabetes competencies and evaluative tools need to be developed specific for CHWs as a way to standardize all CHW diabetes trainings. PMID:27110434
Klopp, Jonathon; Konrad, Shane; Yanofski, Jason
Identity theft is a serious problem in the United States, and persons with enduring mental illnesses may be particularly vulnerable to becoming victims of this crime. Victims of identity theft experience a variety of consequences that include financial loss and serious emotional distress. Little is known about the impact of identity theft on individuals with mental illnesses. The two cases from a community mental health center presented in this article demonstrate many of the facets that may be associated with an increased risk for becoming the victim of identity theft. A summary of preventive steps as well as steps involved in resolving the crime once one has become a victim are presented. PMID:20806029
Zhao, Jing; Ha, Sejin; Widdows, Richard
This study investigates consumers' use of online health communities (OHCs) for healthcare from a relationship building perspective based on the commitment-trust theory of relationships. The study proposes that perspective taking, empathic concern, self-efficacy, and network density affect the development of both cognitive and affective trust, which together determine OHC members' membership continuance intention (MCI) and knowledge contribution. Data collected from eight existing OHCs (N=255) were utilized to test the hypothesized model. Results show that perspective taking and self-efficacy can increase cognitive trust and affective trust, respectively. Network density contributes to cognitive and affective trust. Both cognitive trust and affective trust influence MCI, while only affective trust impacts members' knowledge contribution behaviors.
Mendoza, F S; Fuentes-Afflick, E
A majority of Latino children in the US live in poverty. However, unlike other poor children, Latino children do not seem to have a consistent association between poverty and poor health. Instead, many poor Latino children have unexpectedly good health outcomes. This has been labeled an epidemiologic paradox. This paper proposes a new model of health, the family-community health promotion model, to account for this paradox. The family-community health promotion model emphasizes the family-community milieu of the child, in contrast to traditional models of health. In addition, the family-community model expands the outcome measures from physical health to functional health status, and underscores the contribution of cultural factors to functional health outcomes. In this paper, we applied the family-community health promotion model to four health outcomes: low birthweight, infant mortality, chronic and acute illness, and perceived health status. The implications of this model for research and policy are discussed. PMID:10063394
This article originates in current research into community-based arts in health. Arts in health is now a diverse field of practice, and community-based arts in health interventions have extended the work beyond healthcare settings into public health. Examples of this work can now be found internationally in different health systems and cultural contexts. The paper argues that researchers need to understand the processes through which community-based arts in health projects evolve, and how they work holistically in their attempt to produce therapeutic and social benefits for both individuals and communities, and to connect with a cultural base in healthcare services themselves. A development model that might be adapted to assist in analysing this is the World Health Organisation Quality of Life Index (WHOQOL). Issues raised in the paper around community engagement, healthy choice and self-esteem are then illustrated in case examples of community-based arts in health practice in South Africa and England; namely the DramAide and Siyazama projects in KwaZulu-Natal, and Looking Well Healthy Living Centre in North Yorkshire. In South Africa there are arts and media projects attempting to raise awareness about HIV/AIDS through mass messaging, but they also recognize that they lack models of longer-term community engagement. Looking Well by contrast addresses health issues identified by the community itself in ways that are personal, empathic and domesticated. But there are also similarities among these projects in their aims to generate a range of social, educational and economic benefits within a community-health framework, and they are successfully regenerating traditional cultural forms to create public participation in health promotion. Process evaluation may provide a framework in which community-based arts in health projects, especially if they are networked together to share practice and thinking, can assess their ability to address health inequalities and focus
Isham, George J; Zimmerman, Donna J; Kindig, David A; Hornseth, Gary W
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.
Sunderland, Naomi; Beekhuyzen, Jenine; Kendall, Elizabeth; Wolski, Malcom
There is a need to enhance the effectiveness and reach of complex health promotion initiatives by providing opportunities for diverse health promotion practitioners and others to interact in online settings. This paper reviews the existing literature on how to take health promotion communities and networks into online settings. A scoping review of relevant bodies of literature and empirical evidence was undertaken to provide an interpretive synthesis of existing knowledge on the topic. Sixteen studies were identified between 1986 and 2007. Relatively little research has been conducted on the process of taking existing offline communities and networks into online settings. However, more research has focused on offline (i.e. not mediated via computer networks); 'virtual' (purely online with no offline interpersonal contact); and 'multiplex' communities (i.e. those that interact across both online and offline settings). Results are summarised under three themes: characteristics of communities in online and offline settings; issues in moving offline communities online, and designing online communities to match community needs. Existing health promotion initiatives can benefit from online platforms that promote community building and knowledge sharing. Online e-health promotion settings and communities can successfully integrate with existing offline settings and communities to form 'multiplex' communities (i.e. communities that operate fluently across both online and offline settings).
Willis, Erin; Royne, Marla B
This research uses content analysis (N = 1,960) to examine the computer-mediated communication within online health communities for evidence of chronic disease self-management behaviors, including the perceived benefits and perceived barriers to participating in such behaviors. Online health communities act as informal self-management programs led by peers with the same chronic disease through the exchange of health information. Online health communities provide opportunities for health behavior change messages to educate and persuade regarding chronic disease self-management behaviors.
Background Community assessment is a core function of public health. In such assessments, a commitment to community participation and empowerment is at the heart of the WHO European Healthy Cities Network, reflecting its origins in health for all and the Ottawa Charter for Health Promotion. This study employs a participation and empowerment plan in order to conduct community assessment. Methods The method of participatory action research (PAR) was used. The study was carried out in an area of high socio-economic deprivation in Ardabil, a city in the northwest of Iran, which is currently served by a branch of the Social Development Center (SDC). The steering committee of the project was formed by some university faculty members, health officials and delegates form Farhikhteh non-governmental organization and representatives from twelve blocks or districts of the community. Then, the representatives were trained and then conducted focus groups in their block. The focus group findings informed the development of the questionnaire. About six hundred households were surveyed and study questionnaires were completed either during face-to-face interviews by the research team (in case of illiteracy) or via self-completion. The primary question for the residents was: 'what is the most important health problem in your community? Each health problem identified by the community was weighted based on the frequency it was selected on the survey, and steering committee perception of the problem's seriousness, urgency, solvability, and financial load. Results The main problems of the area appeared to be the asphalt problem, lack of easy access to medical centers, addiction among relatives and unemployment of youth. High participation rates of community members in the steering committee and survey suggest that the PAR approach was greatly appreciated by the community and that problems identified through this research truly reflect community opinion. Conclusions Participatory action
Sierra, Isabel; Cabezas, Carmen; Brugulat, Pilar; Mompart, Anna
Through the Law 2/2004 on improving neighbourhoods, urban areas and towns requiring special attention, the Government of Catalonia set up a fund for financing projects prepared by town/city councils for the integral improvement of neighbourhoods. The Ministry of Health signed on to the strategy with The Neighbourhood Health Programme, which was a healthcare policy priority. Healthcare and municipal structures cooperate at neighbourhood level in all of the phases of the community intervention project (analysis and detection of needs, prioritisation of the problems detected, definition and distribution of actions). Techniques such as the nominal group are used. Four vulnerable groups have been identified with higher levels of illness, co-morbidity, situations of risk, etc. (the young, the elderly, women and recent immigrants). The actions of all the agents involved, among them those from the Ministry of Health itself, are then intensified and prioritised and a specific portfolio of public health services is prepared.
Rahbar, Mohammadreza; Ahmadi, Mina
Background: Many experts believe that the “health houses” of Iran have had major effects in increasing health status of Iranian rural community. One of the factors, which was critical to this success is the employment of young women and men from rural communities who serve as multipurpose health workers. They participate in a two-year task-oriented training course. Objectives: The purpose of this article was to describe the model of training behvarzes as the community health workers who deliver health services to the health houses of Iran. This description included the specific method of recruiting these CHWs, strategies and methods of their training which is different from general academic education. Materials and Methods: A descriptive study design was utilized for this analysis in six areas. These areas have been selected according to the expert opinions and experiences of the Center for Health Networks Management. Results: The results showed the specific method of student selection and clear objectives and standards of training related to the health needs of the community. Recruitment of native human resources, the relationship between training and performance are the characteristics, which have been made this system more efficient and responsive to the health system needs. Conclusions: Development of the job and task analysis to ensure providing the right training needs, applying more evidences through different studies for reforms, more decentralized equipped system with decision-making tools have been proposed for development. PMID:25838935
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
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.
Brenner, Barbara L.; Manice, Melissa P.
Community engagement strategies and skills can build trust and reduce historical mistrust between researchers, communities and populations being studied, as well as contribute to the quality of study designs, methods and dissemination of findings. This review paper discusses why community engagement is of increasing importance in children’s environmental health research, describes models and the continuum of methods that are used and discusses their challenges and benefits. Two case studies, representing different study designs and using different community engagement models and methods, and lessons learned from these cases are described. Community engagement methods are best understood on a continuum based on the degree to which community members or representatives of community populations are involved in research planning, decision making and dissemination. Methods along this continuum include community consultation, community based participatory research(CBPR) and community consent to research. Community engagement knowledge and skills are especially important in the conduct of children’s environmental health research with its emphasis on reducing environmental risks at the community level; the increasing focus on genetics and gene-environment interactions; and the importance placed on translation of scientific results into behaviors and policies that protect the community. Across study designs, whether qualitative survey research, an observational epidemiology study, or a randomized intervention trial, understanding community interests, norms and values is necessary to describe attitudes and behaviors of specific population groups, build evidence of cause and effect between environmental exposures and health and/or that demonstrate the effectiveness of interventions to reduce risks. PMID:21259265
Illingworth, R S
Three years' experience as a doctor taking two clinics a week in an area health authority child health clinic was reviewed. A wide range of clinical conditions was seen, including: problems associated with feeding in breast- and bottle-fed infants; minor developmental abnormalities (mental, behavioural, and physical); surgical and orthopaedic conditions requiring treatment; medical conditions, mainly respiratory and alimentary infections, skin conditions, and problems of over-treatment for minor ailments; and minor genetic abnormalities. Mothers asked for advice on a wide range of topics, risks and benefits of immunisation being the most common. The clinic doctor needs a wide experience in paediatrics to deal with such problems. It is suggested that all lecturers in child health and paediatric and senior registrars should take one clinic a week for six months, and all medical students should attend some clinics as part of their paediatric training. Health visitors have an important role in helping the clinic doctor, but their training should be more realistic and appropriate facilities should be provided to keep them up to date in their work. PMID:86374
Lebowitz, Barry D.; And Others
Examined coordination between community mental health centers (CMHCs) and Area Agencies on Aging (AAAs) through survey of 281 CMHCs. Found affiliation with AAA associated with more indirect services of all types; more sites where mental health programs were offered to elderly; and more provision of direct services, such as Alzheimer's disease…
Petrova, P G; Yakovleva, N P; Zakharova, F A
Health of a nation is a sensitive barometer of the environmental situation, especially in the North, where vulnerable nature cannot resist intensive industrial development. The geographical location and severe climatic conditions of the Republic of Sakha (Yakutia) significantly sharpen any negative impact of industrial activity on the state of the environment. The impact of ecological factors on the health of population has been studied in the case of a diamond province (Vilyuy region), where a complex of chemical pollutants from diamond mining, products of wood decay in places of flooding of the water reservoir for the Vilyuisk power station, highly mineralised underground waters and consequences of underground explosions have caused a substantial negative effect on the environment and people. Studies on the health of the population in the Vilyuy region has shown that sickness and morbidity rates of viral hepatitis, tuberculosis, pathologies during pregnancy and other diseases are higher in comparison to rates in the Republic as a whole, a feature which has been attributed to environmental degradation in the area.
Gale, J; Marshall-Lucette, S
Recovery-oriented practice, an approach aligned towards the service user perspective, has dominated the mental health care arena. Numerous studies have explored service users' accounts of the purpose, meaning and importance of 'recovery'; however, far less is known about healthcare staff confidence in its application to care delivery. A self-efficacy questionnaire and content analysis of nursing course documents were used to investigate a cohort of community mental health nurses' recovery-oriented practice and to determine the extent to which the current continuing professional development curriculum met their educational needs in this regard. Twenty-three community mental health nurses completed a self-efficacy questionnaire and 28 course documents were analysed. The findings revealed high levels of nurses' confidence in their understanding and ability to apply the recovery model and low levels of confidence were found in areas of social inclusion. The content analysis found only one course document that used the whole term 'recovery model'. The findings suggest a gap in the nurses' perceived ability and confidence in recovery-oriented practice with what is taught academically. Hence, nursing education needs to be more explicitly focused on the recovery model and its application to care delivery.
Twenty community garden programs in upstate New York (representing 63 gardens) were surveyed to identify characteristics that may be useful to facilitate neighborhood development and health promotion. The most commonly expressed reasons for participating in gardens were access to fresh foods, to enjoy nature, and health benefits. Gardens in low-income neighborhoods (46%) were four times as likely as non low-income gardens to lead to other issues in the neighborhood being addressed; reportedly due to organizing facilitated through the community gardens. Additional research on community gardening can improve our understanding of the interaction of social and physical environments and community health, and effective strategies for empowerment, development, and health promotion.
Presents a comparative analysis of changing ethnic residential distributions from 1940-1970 to identify recently evolved forms of ethnic settlement in the Detroit (Michigan) metropolitan area. Identifies and classifies contemporary types of ethnic communities to expand the knowledge of ethnic settlement. (MK)
Lopes, P M; Nichols, A W
The concept of a health service district, as a variation of the special tax district, is described and discussed. Tax districts have traditionally been used to support both capital construction (revenue bonds) and operational expenses of single-purpose governmental entities. The health service district, where authorized by state laws, may be used by local areas to subsidize the delivery of ambulatory health care. A particular case, the Ajo-Lukeville Health Service District in Arizona, illustrates what can be accomplished by this mechanism with the cooperation of local residents and outside agencies. Both the process of establishing such a district and the outcome of the Ajo-Lukeville experience is described. Reasons why health service districts may prove potentially attractive at this time are reviewed. Impediments to the development of more health service districts are also explored, including the lack of technical assistance, an inadequate awareness of the potential of health service districts, and the absence of a widespread orientation toward community financed and controlled health care. Movement in this direction should facilitate the development of additional health service districts.
Roy, Brita; Stanojevich, Joel; Stange, Paul; Jiwani, Nafisa; King, Raymond; Koo, Denise
Summary With the passage of the Patient Protection and Affordable Care Act, the requirements for hospitals to achieve tax-exempt status include performing a triennial community health needs assessment and developing a plan to address identified needs. To address community health needs, multisector collaborative efforts to improve both health care and non–health care determinants of health outcomes have been the most effective and sustainable. In 2015, CDC released the Community Health Improvement Navigator to facilitate the development of these efforts. This report describes the development of the database of interventions included in the Community Health Improvement Navigator. The database of interventions allows the user to easily search for multisector, collaborative, evidence-based interventions to address the underlying causes of the greatest morbidity and mortality in the United States: tobacco use and exposure, physical inactivity, unhealthy diet, high cholesterol, high blood pressure, diabetes, and obesity. PMID:26917110
Argan, Mehpare Tokay; Argan, Metin; Suher, Idil K.
Like in all areas, virtual communities make their presence felt in the area of healthcare too. Virtual communities play an important role in healthcare in terms of gathering information on healthcare, sharing of personal interests and providing social support. Virtual communities provide a way for a group of peers to communicate with each other.…
Sant'Anna, Cynthia Fontella; Cezar-Vaz, Marta Regina; Cardoso, Leticia Silveira; Erdmann, Alacoque Lorenzini; Soares, Jorgana Fernanda de Souza
The purpose of this study is to identify the Social Determinants of Health Care which emerge in nurses' statements as they characterize the community, analyzing its relation to the work carried out by them. It is an exploratory and descriptive study containing a qualitative analysis in the theoretical categories of the determinants. We used a semi-structured interview, recorded with the permission of the 65 nurses of the Family Health Care, members of the 3rd Regional Health Care Coordination of Rio Grande do Sul, Brazil. It has been shown the inter- and intra-relation in the health determinant factors, obtaining 104 citations for the anatomo-physiological features of the corresponding individuals/community to the proximal correspondents and in association, mainly, to the work carried out by the nurses. For intermediate determinants there were 27 citations and, for distals, 166, with predominant reference to the territorial localization of communities in rural areas and peripheries. The nurses have stated a narrow relation between the proximal features and the work carried out by them, as well as the connection with other determinants in the relation with the process of getting sick.
Butler, Karen L.; Dawkins, Phyllis W.
Learning communities in health and human performance are creative approaches to traditional academic outcomes. Learning communities are becoming increasingly widespread in a variety of contexts, and there is extensive evidence suggesting that effective learning communities have important benefits for students as well as faculty. In this article,…
Hutkin, Ronald M.; Holmberg, Mary Lou
This study sought to determine the extent of existing in-service education programs in health care available in northeast central Nebraska and to determine if there was a need for a Community Health Education Consortium (CHEC). Two questionnaires were developed for the study and were mailed to hospitals and nursing homes in a 22 county area; 86%…
Smith, Megan V; Kruse-Austin, Anna
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.
Asthma is a leading cause of school absenteeism in the United States, especially in poor and minority communities, where prevalence and hospitalization rates are significantly higher than average. A community health approach can help poorer school districts hire full-time nurses and access other health resources.
Catell, Grace Manion
Community health nursing curriculum components in a sample of baccalaureate nursing programs were investigated. Questionnaires were sent to a sample of 12 National League of Nursing (NLN) accredited, generic, baccalaureate nursing programs representative of the four NLN regions in the United States. Community health nursing content in theory…
Miller, Marilyn P.; Swanson, Elizabeth
Community health nursing students performed community assessments and proposed and implemented service learning projects that addressed adolescent smoking in middle schools, home safety for elderly persons, industrial worker health, and sexual abuse of teenaged girls. Students learned to apply epidemiological research methods, mobilize resources,…
This document describes services for the elderly provided by the Spokane Community Mental Health Center (CMHC) in Spokane, Washington. It begins by stating several reasons that the elderly are often unserved or underserved by health and social service agencies and by noting the need for community efforts to identify and locate the subpopulation of…
Katz, Arthur J., Ed.
Articles by social work educators on some of the critical issues in community mental health are presented. Examined are some conceptual and program developments related to coordination, continuity of care, and the use of teams in planning and service delivery for community mental health (Lawrence K. Berg). The issue of civil commitment to and…
A one-day conference in Washington brought together leaders of community health centers and worker advocates to discuss collaboration. They agreed that health centers could help protect vulnerable workers. They agreed on use of electronic medical records; access to workers compensation; Medical-Legal Partnerships; better understanding of work settings in their communities; and educating clinicians on work and jobs.
Brotman, Richard; Freedman, Alfred
The nature of the historical changes in the presumed stereo-types of drug users in the United States, and the associated policy changes, are described in this report which takes a community health viewpoint of drug use while concurrently dealing with the individual. Eight case histories illustrate the community mental health approach in action.…
Keeley, Jon E.; Fotheringham, C.J.
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
US Department of Health and Human Services, 2011
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…
In this paper, recent reviews of the World Health Organization, other review papers, and more recent literature on the human health effects of current air pollution trends in urban areas are reviewed and summarized as follows: Sulphur dioxide. Some studies, but not others, found associations between sulphur dioxide (SO2) exposure and daily mortality and morbidity. Single-pollutant correlations sometimes disappeared when other pollutants, especially suspended particulate matter (SPM), were included. Cross-sectional studies with asthmatics revealed significant, non-threshold relations between SO2 and decrements of the forced expiratory volume in 1 second (FEV1). Nitrogen dioxide. Weak associations between short-term nitrogen dioxide (NO2) exposure from gas cooking and respiratory symptoms and a decrement in lung function parameters were found in children, but not consistently in exposed women. With long-term exposure, children, but not adults, exhibit increased respiratory symptoms, decreased lung function, and increased incidences of chronic cough, bronchitis, and conjunctivitis. A causal relationship between NO2 exposure and adverse health effects has not yet been established. Carbon monoxide. Binding of CO in the lungs with hemoglobin in the blood forms carboxyhemoglobin (COHb), which impairs the transport of oxygen. The health effects of CO include hypoxia, neurological deficits and neurobehavioral changes, and increases in daily mortality and hospital admissions for cardiovascular diseases. The latter persists even at very low CO levels, indicating no threshold for the onset of these effects. Whether the relation between daily mortality and exposure to CO are causal or whether CO might act as a proxy for SPM is still an open question. Ambient CO may have even more serious health consequences than does COHb formation and at lower levels than that mediated through elevated COHb levels. Ozone. Short-term acute effects of O3 include pulmonary function decrements
Luckow, Peter W; Kenny, Avi; White, Emily; Ballard, Madeleine; Dorr, Lorenzo; Erlandson, Kirby; Grant, Benjamin; Johnson, Alice; Lorenzen, Breanna; Mukherjee, Subarna; Ly, E John; McDaniel, Abigail; Nowine, Netus; Sathananthan, Vidiya; Sechler, Gerald A; Kraemer, John D; Siedner, Mark J
Abstract Objective To assess changes in the use of essential maternal and child health services in Konobo, Liberia, after implementation of an enhanced community health worker (CHW) programme. Methods The Liberian Ministry of Health partnered with Last Mile Health, a nongovernmental organization, to implement a pilot CHW programme with enhanced recruitment, training, supervision and compensation. To assess changes in maternal and child health-care use, we conducted repeated cross-sectional cluster surveys before (2012) and after (2015) programme implementation. Findings Between 2012 and 2015, 54 CHWs, seven peer supervisors and three clinical supervisors were trained to serve a population of 12 127 people in 44 communities. The regression-adjusted percentage of children receiving care from formal care providers increased by 60.1 (95% confidence interval, CI: 51.6 to 68.7) percentage points for diarrhoea, by 30.6 (95% CI: 20.5 to 40.7) for fever and by 51.2 (95% CI: 37.9 to 64.5) for acute respiratory infection. Facility-based delivery increased by 28.2 points (95% CI: 20.3 to 36.1). Facility-based delivery and formal sector care for acute respiratory infection and diarrhoea increased more in agricultural than gold-mining communities. Receipt of one-or-more antenatal care sessions at a health facility and postnatal care within 24 hours of delivery did not change significantly. Conclusion We identified significant increases in uptake of child and maternal health-care services from formal providers during the pilot CHW programme in remote rural Liberia. Clinic-based services, such as postnatal care, and services in specific settings, such as mining areas, require additional interventions to achieve optimal outcomes. PMID:28250511
Johnson, Becky A.; Khanna, Sunil K.
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
Mkandawire, Wanangwa C; Muula, Adamson S
The main objective was to determine motivating factors for community care givers (CCGs), the services they provided to the community, and to identify sources of CCGs' material supplies. A cross sectional qualitative study was done using in-depth key informant interviews with community cares givers and traditional leaders. Analysis was based on themes utilizing content analysis. Most of the CCGs were housewives. Intrinsic motivating factors included feelings of empathy, altruism and religious convictions. Extrinsic motivators were rarely mentioned and these included expected opportunities for loans to start businesses, recognition by the community and eventual employment. The services that CCGs provided in their communities included; offering psycho-spiritual support, providing clothes, food and money to the under-privileged and paying school fees for orphans. In many instances the community care givers were spending from their own personal resources to help the under-privileged, while support from non-governmental organizations could only be sourced erratically. Mobilising resources from the local community through contributions was not seen a viable option. Intrinsic factors are an important motivator for community health volunteers CCGs in the peri-urban area of Blantyre. There is need for community groups to explore the feasibility of tapping from local material and financial resources.
Bernhard, M.C.; Evans, M.B.; Kent, S.T.; Johnson, E.; Threadgill, S.L.; Tyson, S.; Becker, S.M.; Gohlke, J.M.
Objectives Understanding and effectively addressing persistent health disparities in minority communities requires a clear picture of members’ concerns and priorities. This study was intended to engage residents in urban and rural communities in order to identify environmental health priorities. Specific emphasis was placed on how the communities defined the term environment, their perceptions of environmental exposures as affecting their health, specific priorities in their communities, and differences in urban versus rural populations. Study design A community-engaged approach was used to develop and implement focus groups and compare environmental health priorities in urban versus rural communities. Methods A total of eight focus groups were conducted: four in rural and four in urban communities. Topics included defining the term environment, how the environment may affect health, and environmental priorities within their communities, using both open discussion and a predefined list. Data were analysed both qualitatively and quantitatively to identify patterns and trends. Results There were important areas of overlap in priorities between urban and rural communities; both emphasized the importance of the social environment and shared a concern over air pollution from industrial sources. In contrast, for urban focus groups, abandoned houses and their social and physical sequelae were a high priority while concerns about adequate sewer and water services and road maintenance were high priorities in rural communities. Conclusions This study was able to identify environmental health priorities in urban versus rural minority communities. In contrast to some previous risk perception research, the results of this study suggest prioritization of tangible, known risks in everyday life instead of rare, disaster-related events, even in communities that have recently experienced devastating damage from tornadoes. The findings can help inform future efforts to study
The Hanford Site, Benton County, Washington, lies within the broad semi-arid shrub-steppe vegetation zone of the Columbia Basin. Thirteen different habitat types on the Hanford Site have been mapped in Habitat Types on the Hanford Site: Wildlife and Plant Species of Concern (Downs et al. 1993). In a broad sense, this classification is correct. On a smaller scale, however, finer delineations are possible. This study was conducted to determine the plant communities and estimate vegetation cover in and directly adjacent to the 100 and 200 Areas, primarily in relation to waste sites, as part of a comprehensive ecological study for the Compensation Environmental Response, Compensation, and Liability Act (CERCLA) characterization of the 100 and 200 Areas. During the summer of 1993, field surveys were conducted and a map of vegetation communities in each area, including dominant species associations, was produced. The field surveys consisted of qualitative community delineations. The community delineations described were made by field reconnaissance and are qualitative in nature. The delineations were made by visually determining the dominant plant species or vegetation types and were based on the species most apparent at the time of inspection. Additionally, 38 transects were run in these plant communities to try to obtain a more accurate representation of the community. Because habitat disturbances from construction/operations activities continue to occur in these areas, users of this information should be cautious in applying these maps without a current ground survey. This work will complement large-scale habitat maps of the Hanford Site.
The purpose of this article was to examine the development of community health nursing and public health nursing in Taiwan from an educational perspective. Key issues addressed include: teaching strategies and scopes of practice used in community health nursing in Taiwan between 1910 and the 1950s; the philosophical foundations for the concepts of "health for all" and "social justice" in Taiwan's community health nursing; the five "P"s of community health nursing teaching and practice (population, prevention, promotion, policy, and partnership); the core competencies and scope of practice of community health nursing proposed by the TWNA Community Health Nursing Committee; and the core competencies and the tiers of classification proposed by the Quad Council of Public Health Nursing Organizations. This article helps to elucidate the inseparable relationship between community health nursing education and practice at both the micro and macro level and examines possible future directions for community health nursing in Taiwan. The author proposes the following recommendations for future community health nursing education development in Taiwan: 1) implement competence classifications appropriate to each nursing education preparation level, 2) promote multidisciplinary cooperation among education, practice, and policy, and 3) promote collaboration and consensus among community health nursing and public health related associations.
Jinadu, M. K.; Adegbenro, C. A.; Esmai, A. O.; Ojo, A. A.; Oyeleye, B. A.
Objective: Community-based health promotion intervention for improving unhygienic disposal of children's faeces was conducted in a rural area of Nigeria. Setting: The study was conducted in Ife South Local Government area of Osun State, Nigeria. Design: The study was conducted in 10 randomly selected rural villages: five control and five active.…
Lottes, Christine R; Engstrom, Del; Engstrom, Lorri F
There is a need for spiritual health seminars at the work site and through hospital and other community venues. This article describes how the authors prepared for and conducted seminars in their community. The research demonstrates that religious commitment may play a beneficial role in an individual's health. Once the authors were armed with this research and a fundamentally sound and practical program, they were able to assist individuals in their community in designing and initiating their own individual spiritual health workouts, which may then influence their physical and mental health. In this way, the authors were able to apply holistic principles of spirit, mind, and body.
Elsom, Stephen; Happell, Brenda; Manias, Elizabeth
Significant changes to the delivery of mental health services have resulted in the expansion of the community mental health nursing role. This qualitative study was undertaken to explore the extent to which community mental health nurses are currently engaged in expanded forms of practice. Focus groups were undertaken with community mental health nurses (n = 27) from metropolitan and rural Victoria, Australia. Thematic analysis identified the following major themes: reported practice, consumers as beneficiaries of expanded practice, risk of harm and litigation, and barriers to expanded practice. The findings emphasize the need for significant changes in current legislation if expanded practice for nurses is to become a reality.
Brieger, W R; Ramakrishna, J; Akpovi, S U; Adeniyi, J D
Community health education strategies in guineaworm control can be applied at several intervention levels. Community development mobilizes local resources to provide safe water supplies such as wells. Mass education in schools and communities can teach personal protection measures such as filtering water. Training of volunteer community health workers produces front line staff, who by being culturally in tune with the community can demonstrate and promote the use of appropriate prevention and treatment measures. Advocacy assists community members to express their needs to government and ministry decision makers. All of these strategies have been applied in a community health education/primary health care program in Idere, Ibarapa District, Oyo State. Community development for well construction was found to be a long-term strategy that first must overcome problems of village organization and resource location. Mass education, to be effective, must have a simple and acceptable technology to promote. Trained village health workers must overcome traditional beliefs that inhibit use of preventive and treatment measures. Advocacy requires basic political education of community leaders. A variety of health education strategies is needed to address short- and long-term priorities as well as to overcome the different barriers to guineaworm control.
Roussy, Véronique; Livingstone, Charles
Until now, comprehensive service planning has been uncommon in the Victorian community health sector. Where it has occurred, it has primarily been undertaken by community health services embedded within larger, hospital-based health services. Reflections on the utility and efficacy of community health service planning are largely absent from the Australian peer-reviewed literature. Using a case study focussed on a specific centre in Melbourne's outer suburbs, this paper explores how community health service planning is shaped by the current policy context, the legal status of registered community health services, and the data and methodologies available to inform planning. It argues that regular and systematic service planning could support registered community health centres to better understand their unique position within the primary health-care landscape, having regard to their inherent opportunities and vulnerabilities. Furthermore, consistent and effective service planning is proposed to benefit agencies in establishing themselves as critical players in promoting local population health initiatives and driving improved health outcomes.
Sprague Martinez, Linda; Reisner, Ellin; Campbell, Maria; Brugge, Doug
Background: Conflicting interests, power imbalance and relationships characterized by distrust are just a few of the many challenges community-academic research partnerships face. In addition, the time it takes to build relationships is often overlooked, which further complicates matters and can leave well-intentioned individuals re-creating oppressive conditions through inauthentic partnerships. This paper presents a novel approach of using meeting minutes to explore partnership dynamics. The Community Assessment of Freeway Exposure and Health (CAFEH) partnership is used as an illustrative case study to identify how community academic partnerships overcome the challenges associated with community-based participatory research (CBPR). CAFEH is a study of ultrafine particle exposure (UFP) near highways in the Boston, MA area. Methods: Qualitative analysis was applied to meeting minutes and process evaluation reports from the first three years of the CAFEH study (n = 73 files). In addition, a group meeting was held with project partners in order to contextualize the findings from the document analysis. Results: The three most commonly referenced challenges included language barriers, the overall project structure and budgetary constraints. Meanwhile, a heavy emphasis on process and an approach steeped in participatory democracy facilitated CAFEH's ability to overcome these challenges, as well as sustain and augment strong partnership ties. Conclusions: This experience suggests that leadership that incorporates an organizing approach and a transformational style facilitates CBPR processes and helps teams surmount challenges.
Brown, Angela; Malca, Rosa; Zumaran, Adriana; Miranda, J Jaime
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
Cohen, Alison; Lopez, Andrea; Malloy, Nile; Morello-Frosch, Rachel
This study presents a health survey conducted by a community-based participatory research partnership between academic researchers and community organizers to consider environmental health and environmental justice issues in four neighborhoods of Richmond, California, a low-income community of color living along the fence line of a major oil…
public health needs that require attention (such as poor prenatal health, teen pregnancy , and sexually transmitted diseases) it is not difficult to...such as maternal and child health care or family planning education. One primary educational responsibility best accomplished with state and local...transformation in law enforcement is the concept of community policing. Community policing broadens the nature of police functions and makes better use
Menon, Sanjay T
This article presents a model of health empowerment from an individual psychological perspective. Building on Menon's (2001) model of psychological empowerment in organizations, psychological health empowerment is developed as a construct to capture the individual community member's feelings of empowerment with regard to health and health care. The context for health empowerment is first conceptualized as an interactive system of three elements, namely, the individual community member, health service providers, and the regulatory environment consisting of health policy and systems. The individual manages his or her own health on a daily basis, interacts with health service providers when in need of specialized medical assistance, and is affected by the 'health policy and systems' element. Perceived control, perceived competence, and goal internalization, the three facets of Menon's empowerment model, are then adapted to the health context. A scale for measuring psychological health empowerment is also proposed. The implications of this approach for health care in multicultural communities are then explored.
Mockshell, Jonathan; Ilukor, John; Birner, Regina
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.
Afulani, Patience A.; Awoonor-Williams, John K.; Opoku, Ernest C.; Asunka, Joseph
The Nutrition and Malaria Control for Child Survival Project is a community-based growth promotion project that utilizes Community Health Workers (CHWs), referred to as Community Child Growth Promoters (CCGPs), as the principal change agents. The purpose of this study was to identify perceptions of key stakeholders about the project and the role…
Building community capacity for health promotion in small rural communities is essential if health promotion research is to yield sustainable outcomes. Since its inception, capacity-building has been a stated goal of the Delta Nutrition Intervention Research Initiative, a tri-state collaboration in ...
Building community capacity for health promotion in small rural communities is essential if health promotion research is to yield sustainable outcomes. Since its inception, capacity-building has been a stated goal of the Delta Nutrition Intervention Research initiative, a tri-state collaboration in ...
Kline, Cathy C.; Godolphin, William J.; Chhina, Gagun S.; Towle, Angela
Communication between health care professionals and Aboriginal patients is complicated by cultural differences and the enduring effects of colonization. Health care providers need better training to meet the needs of Aboriginal patients and communities. We describe the development and outcomes of a community-driven service-learning program in…
Mellin, Camille; Aaron MacNeil, M; Cheal, Alistair J; Emslie, Michael J; Julian Caley, M
With marine biodiversity declining globally at accelerating rates, maximising the effectiveness of conservation has become a key goal for local, national and international regulators. Marine protected areas (MPAs) have been widely advocated for conserving and managing marine biodiversity yet, despite extensive research, their benefits for conserving non-target species and wider ecosystem functions remain unclear. Here, we demonstrate that MPAs can increase the resilience of coral reef communities to natural disturbances, including coral bleaching, coral diseases, Acanthaster planci outbreaks and storms. Using a 20-year time series from Australia's Great Barrier Reef, we show that within MPAs, (1) reef community composition was 21-38% more stable; (2) the magnitude of disturbance impacts was 30% lower and (3) subsequent recovery was 20% faster that in adjacent unprotected habitats. Our results demonstrate that MPAs can increase the resilience of marine communities to natural disturbance possibly through herbivory, trophic cascades and portfolio effects.
Bryant, Carol A; Brown, Kelli R McCormack; McDermott, Robert J; Forthofer, Melinda S; Bumpus, Elizabeth C; Calkins, Susan A; Zapata, Lauren B
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.
Background This project is a community-level study of equity of access to eye health services for Indigenous Australians. Methods The project used data on eye health services from multiple sources including Medicare Australia, inpatient and outpatient data and the National Indigenous Eye Health Survey. The analysis focused on the extent to which access to eye health services varied at an area level according to the proportion of the population that was Indigenous (very low = 0-1.0%, low = 1.1-3.0%, low medium = 3.1-6.0%, high medium = 6.1-10.0%, high = 10.1-20.0%, very high = 20 + %). The analysis of health service utilisation also took into account age, remoteness and the Socioeconomic Indices for Areas (SEIFA). Results The rate of eye exams provided in areas with very high Indigenous populations was two-thirds of the rate of eye exams for areas with very low indigenous populations. The cataract surgery rates in areas with high medium to very high Indigenous populations were less than half that reference areas. In over a third of communities with very high Indigenous populations the cataract surgery rate fell below the World Health Organization (WHO) guidelines compared to a cataract surgery rate of 3% in areas with very low Indigenous populations. Conclusions There remain serious disparities in access to eye health service in areas with high Indigenous populations. Addressing disparities requires a co-ordinated approach to improving Indigenous people’s access to eye health services. More extensive take-up of existing Medicare provisions is an important step in this process. Along with improving access to health services, community education concerning the importance of eye health and the effectiveness of treatment might reduce reluctance to seek help. PMID:22998612
Ogden, J R; Ogden, D T
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.
Cohen, Alison; Lopez, Andrea; Malloy, Nile; Morello-Frosch, Rachel
This study presents a health survey conducted by a community-based participatory research partnership between academic researchers and community organizers to consider environmental health and environmental justice issues in four neighborhoods of Richmond, California, a low-income community of color living along the fence line of a major oil refinery and near other industrial and mobile sources of pollution. The Richmond health survey aimed to assess local concerns and perceptions of neighborhood conditions, health problems, mobile and stationary hazards, access to health care, and other issues affecting residents of Richmond. Although respondents thought their neighborhoods were good places to live, they expressed concerns about neighborhood stressors and particular sources of pollution, and identified elevated asthma rates for children and long-time Richmond residents. The Richmond health survey offers a holistic, community-centered perspective to understanding local environmental health issues, and can inform future environmental health research and organizing efforts for community-university collaboratives.
Kinder, G; Cashman, S B; Seifer, S D; Inouye, A; Hagopian, A
To meet the demands of the evolving health care system, health professionals need skills that will allow them to anticipate and respond to the broader social determinants of health. To ensure that these skills are learned during their professional education and training, health professions institutions must look beyond the medical model of caring for communities. Models in Seattle and Roanoke demonstrate the curricular changes necessary to ensure that students in the health professions are adequately prepared to contribute to building Healthy Communities in the 21st century. In addition to these models, a number of resources are available to help promote the needed institutional changes. PMID:10968767
Aguilar-Gaxiola, Sergio; Ahmed, Syed; Franco, Zeno; Kissack, Anne; Gabriel, Davera; Hurd, Thelma; Ziegahn, Linda; Bates, Nancy J; Calhoun, Karen; Carter-Edwards, Lori; Corbie-Smith, Giselle; Eder, Milton Mickey; Ferrans, Carol; Hacker, Karen; Rumala, Bernice B; Strelnick, A Hal; Wallerstein, Nina
The Clinical and Translational Science Awards (CTSA) program represents a significant public investment. To realize its major goal of improving the public's health and reducing health disparities, the CTSA Consortium's Community Engagement Key Function Committee has undertaken the challenge of developing a taxonomy of community health indicators. The objective is to initiate a unified approach for monitoring progress in improving population health outcomes. Such outcomes include, importantly, the interests and priorities of community stakeholders, plus the multiple, overlapping interests of universities and of the public health and health care professions involved in the development and use of local health care indicators.The emerging taxonomy of community health indicators that the authors propose supports alignment of CTSA activities and facilitates comparative effectiveness research across CTSAs, thereby improving the health of communities and reducing health disparities. The proposed taxonomy starts at the broadest level, determinants of health; subsequently moves to more finite categories of community health indicators; and, finally, addresses specific quantifiable measures. To illustrate the taxonomy's application, the authors have synthesized 21 health indicator projects from the literature and categorized them into international, national, or local/special jurisdictions. They furthered categorized the projects within the taxonomy by ranking indicators with the greatest representation among projects and by ranking the frequency of specific measures. They intend for the taxonomy to provide common metrics for measuring changes to population health and, thus, extend the utility of the CTSA Community Engagement Logic Model. The input of community partners will ultimately improve population health.
Dade County Public Schools, Miami, FL.
GRADES OR AGES: Grade twlve. SUBJECT MATTER: The physical development and needs, as well as the psychological development and needs of the individual from infancy to old age. The health of the community is studied in terms of communicable diseases, immunology, resources available for the optimal health of any community (including health services…
Jutte, Douglas P; Miller, Jennifer L; Erickson, David J
Despite medical advances, childhood health and well-being have not been broadly achieved due to rising chronic diseases and conditions related to child poverty. Family and neighborhood living conditions can have lasting consequences for health, with community adversity affecting health outcomes in significant part through stress response and increased allostatic load. Exposure to this "toxic stress" influences gene expression and brain development with direct and indirect negative consequences for health. Ensuring healthy child development requires improving conditions in distressed, high-poverty neighborhoods by reducing children's exposure to neighborhood stressors and supporting good family and caregiver functioning. The community development industry invests more than $200 billion annually in low-income neighborhoods, with the goal of improving living conditions for residents. The most impactful investments have transformed neighborhoods by integrating across sectors to address both the built environment and the social and service environment. By addressing many facets of the social determinants of health at once, these efforts suggest substantial results for children, but health outcomes generally have not been considered or evaluated. Increased partnership between the health sector and community development can bring health outcomes explicitly into focus for community development investments, help optimize intervention strategies for health, and provide natural experiments to build the evidence base for holistic interventions for disadvantaged children. The problems and potential solutions are beyond the scope of practicing pediatricians, but the community development sector stands ready to engage in shared efforts to improve the health and development of our most at-risk children.
Gomez, Marisela B
Studies show that policing, when violent, and community fragmentation have a negative impact on health outcomes. This current study investigates the connection of policing and community fragmentation and public health. Using an embedded case study analysis, semi-structured interviews were conducted with 21 African-American female and male residents, ages 21-64 years of various neighborhoods of high arrest rates and health and socioeconomic depravation in Baltimore City, MD. Baltimore residents' perceptions of policing, stress, community fragmentation, and solutions are presented. Analysis of the perceptions of these factors suggests that violent policing increases community fragmentation and is a public health threat. Approaches to address this public health threat are discussed.
Lin, Ching-Ping; Black, Robert A.; LaPlante, Jay; Keppel, Gina A.; Tuzzio, Leah; Berg, Alfred O.; Whitener, Ron J.; Buchwald, Dedra S.; Baldwin, Laura-Mae; Fishman, Paul A.; Greene, Sarah M.; Gennari, John H.; Tarczy-Hornoch, Peter; Stephens, Kari A.
Health data sharing with and among practices is a method for engaging rural and underserved populations, often with strong histories of marginalization, in health research. The Institute of Translational Health Sciences, funded by a National Institutes of Health Clinical and Translational Science Award, is engaged in the LC Data QUEST project to build practice and community based research networks with the ability to share semantically aligned electronic health data. We visited ten practices and communities to assess the feasibility of and barriers to developing data sharing networks. We found that these sites had very different approaches and expectations for data sharing. In order to support practices and communities and foster the acceptance of data sharing in these settings, informaticists must take these diverse views into account. Based on these findings, we discuss system design implications and the need for flexibility in the development of community-based data sharing networks. PMID:21347138
Gary, Lawrence E., Ed.
In this anthology, fourteen articles on mental health and the black community are collected. Topics considered include family life, childhood environment, adolescence, work and adulthood, the black aged, functions of the social network, ecological influences, mental health services, public policy, the black mental health network force, and…
Blecke, Janalou; Hadden, Lisa
Describes the "Community Defined Health" (trademark) process developed by the Center for Health Professions, Saginaw, Michigan, to capture caring, citizen engagement, and the quality of relationships and assure that these intangible assets become as valuable as institutionally defined health indicators in curricula for the health…
Trieu, Sang Leng; Bratton, Sally; Marshak, Helen Hopp
Objective: To explore the sexual and reproductive health behaviors of students from 13 community college campuses in California. Participants: Heterosexual college students, ages 18 to 24, who have had sexual intercourse (N = 4,487). Methods: The American College Health Association's National College Health Assessment (ACHA-NCHA) survey was…
Spencer, Michael S.; Gunter, Kathryn E.; Palmisano, Gloria
Community health workers (CHWs) play a vital and unique role in linking diverse and underserved populations to health and social service systems. Despite their effectiveness, as documented by empirical studies across various disciplines including public health, nursing, and biomedicine, the value and potential role of CHWs in the social work…
10. Looking northwest at the "community" area at the center of the store, and beyond at the main sales counters along the west wall; metal sheathing to protect the wood floor from the former heating stove can be seen in the foreground, and a wooden drawer unit for seeds is beyond the chairs - Horsepasture Store, U.S. Route 58 & State Route 687, Horse Pasture, Henry County, VA
Alfonso, Moya L; Jackson, Gayle; Jackson, Alvin; Hardy, DeShannon; Gupta, Akrati
The overall purpose of this community needs assessment was to explore the perceptions of health and educational needs among youth residing in a rural Georgia community, document existing assets that could be utilized to meet those needs, and to identify socioeconomic barriers and facilitators in health education. A sequential mixed method design was used. Intercept surveys were conducted followed by individual, key informant interviews and a focus group. Survey data was entered into an Excel spreadsheet and SPSS for analysis and descriptive statistics including means and frequencies were calculated. For qualitative interviews, full transcripts were created from audio-recordings and uploaded into NVivo for content analysis. Several health issues were highlighted by the Willow Hill/Portal Georgia community members, including teachers, parents, youth and Willow Hill Heritage and Renaissance Center board members. Some of the health issues identified by youth in the community were low levels of physical activity, obesity, diabetes, lack of healthy food choices, and access to health care services. Including the issues identified by youth, the parents, teachers and board members identified additional health issues in the community such as asthma, hygiene and lack of dental and eye care facilities. Overall, there is a need for better infrastructure and awareness among community members. Utilizing identified assets, including active community leaders, involved faith-based organizations, commitment of community members, presence of land resources, and commitment to physical activity and sports, could modify the current community landscape.
Herce, Michael E; Chapman, Jacob A; Castro, Arachu; García-Salyano, Gabriel; Khoshnood, Kaveh
We conducted a qualitative study employing structured interviews with 38 community health workers, known as health promoters, from twelve rural municipalities of Chiapas, Mexico in order to characterize their work and identify aspects of their services that would be applicable to community-based tuberculosis (TB) control programs. Health promoters self-identify as being of Mayan Indian ethnicity. Most are bilingual, speaking Spanish and one of four indigenous Mayan languages native to Chiapas. They volunteer 11 h each week to conduct clinical and public health work in their communities. Over half (53%) work with a botiquín, a medicine cabinet stocked with essential medicines. Fifty-three percent identify TB as a major problem affecting the health of their communities, with one-fifth (21%) of promoters reporting experience caring for patients with known or suspected TB and 29% having attended to patients with hemoptysis. One-third of health promoters have access to antibiotics (32%) and one-half have experience with their administration; 55% complement their biomedical treatments with traditional Mayan medicinal plant therapies in caring for their patients. We describe how health promoters employ both traditional and allopathic medicine to treat the symptoms and diseases they encounter most frequently which include fever, diarrhea, and parasitic infections. We contend that given the complex sociopolitical climate in Chiapas and the state's unwavering TB epidemic and paucity of health care infrastructure in rural areas, efforts to implement comprehensive, community-based TB control would benefit from employing the services of health promoters.
Ingram, Maia; Schachter, Ken A; Sabo, Samantha J; Reinschmidt, Kerstin M; Gomez, Sofia; De Zapien, Jill Guernsey; Carvajal, Scott C
Public policy that seeks to achieve sustainable improvements in the social determinants of health, such as income, education, housing, food security and neighborhood conditions, can create positive and sustainable health effects. This paper describes preliminary results of Acción para la Salud, a public health intervention in which Community health workers (CHWs) from five health agencies engaged their community in the process of making positive systems and environmental changes. Academic-community partners trained Acción CHWs in community advocacy and provided ongoing technical assistance in developing strategic advocacy plans. The CHWs documented community advocacy activities through encounter forms in which they identified problems, formulated solutions, and described systems and policy change efforts. Strategy maps described the steps of the advocacy plans. Findings demonstrate that CHWs worked to initiate discussions about underlying social determinants and environment-related factors that impact health, and identified solutions to improve neighborhood conditions, create community opportunities, and increase access to services.
While nursing handovers are predominantly used in ward settings, this essential form of communication is also used by community mental health teams to promote continuity of care. A community mental health nursing handover form was developed to overcome poor communication of patient information. It is expected that the form will increase efficiency and reduce handover time by focusing on pertinent and current patient information. Implementation of a community mental health nursing handover form requires the willingness of staff to be proactive and embrace change. The involvement of nurse leaders is essential to implement successful change, overcome barriers and motivate staff.
This review examined the interactions between the correctional system and the health of urban populations. Cities have more poor people, more people of color, and higher crime rates than suburban and rural areas; thus, urban populations are overrepresented in the nation's jails and prisons. As a result, US incarceration policies and programs have a disproportionate impact on urban communities, especially black and Latino ones. Health conditions that are overrepresented in incarcerated populations include substance abuse, human immunodeficiency virus (HIV) and other infectious diseases, perpetration and victimization by violence, mental illness, chronic disease, and reproductive health problems. Correctional systems have direct and indirect effects on health. Indirectly, they influence family structure, economic opportunities, political participation, and normative community values on sex, drugs, and violence. Current correctional policies also divert resources from other social needs. Correctional systems can have a direct effect on the health of urban populations by offering health care and health promotion in jails and prisons, by linking inmates to community services after release, and by assisting in the process of community reintegration. Specific recommendations for action and research to reduce the adverse health and social consequences of current incarceration policies are offered.
Nath, Chinmoy; Huh, Jina; Adupa, Abhishek Kalyan
Background An increasing number of people visit online health communities to seek health information. In these communities, people share experiences and information with others, often complemented with links to different websites. Understanding how people share websites can help us understand patients’ needs in online health communities and improve how peer patients share health information online. Objective Our goal was to understand (1) what kinds of websites are shared, (2) information quality of the shared websites, (3) who shares websites, (4) community differences in website-sharing behavior, and (5) the contexts in which patients share websites. We aimed to find practical applications and implications of website-sharing practices in online health communities. Methods We used regular expressions to extract URLs from 10 WebMD online health communities. We then categorized the URLs based on their top-level domains. We counted the number of trust codes (eg, accredited agencies’ formal evaluation and PubMed authors’ institutions) for each website to assess information quality. We used descriptive statistics to determine website-sharing activities. To understand the context of the URL being discussed, we conducted a simple random selection of 5 threads that contained at least one post with URLs from each community. Gathering all other posts in these threads resulted in 387 posts for open coding analysis with the goal of understanding motivations and situations in which website sharing occurred. Results We extracted a total of 25,448 websites. The majority of the shared websites were .com (59.16%, 15,056/25,448) and WebMD internal (23.2%, 5905/25,448) websites; the least shared websites were social media websites (0.15%, 39/25,448). High-posting community members and moderators posted more websites with trust codes than low-posting community members did. The heart disease community had the highest percentage of websites containing trust codes compared to
Puett, Chloe; Sadler, Kate; Alderman, Harold; Coates, Jennifer; Fiedler, John L; Myatt, Mark
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.
Jopang, Yupin; Petchmark, Suthep; Jetsrisuparb, Arunee; Sanchaisuriya, Kanokwan; Sanchaisuriya, Pattara; Schelp, Frank Peter
The study was conducted to assess the achievement of a thalassemia screening program at a community level supported by village health volunteers (VHVs) of 2 subdistricts in the northeast of Thailand. One subdistrict served as the intervention and the other as the control area. A training program was organized for the village health volunteers from the intervention area. Essential information about the risk and danger of thalassemia was given to the participants who wanted to have children in the community as well. Of the 206 individuals who wanted to have children living in the intervention area, 190 (92.2%) agreed to undergo screening. Of the 196 individuals within the control area, only 26 (13.3%) voluntarily participated in the screening tests. Attitude toward prevention and knowledge about the disease improved significantly in both areas, but the differences between the scores were statistically significantly higher for individuals living in the intervention area.
Sprague Martinez, Linda; Reisner, Ellin; Campbell, Maria; Brugge, Doug
Background: Conflicting interests, power imbalance and relationships characterized by distrust are just a few of the many challenges community–academic research partnerships face. In addition, the time it takes to build relationships is often overlooked, which further complicates matters and can leave well-intentioned individuals re-creating oppressive conditions through inauthentic partnerships. This paper presents a novel approach of using meeting minutes to explore partnership dynamics. The Community Assessment of Freeway Exposure and Health (CAFEH) partnership is used as an illustrative case study to identify how community academic partnerships overcome the challenges associated with community-based participatory research (CBPR). CAFEH is a study of ultrafine particle exposure (UFP) near highways in the Boston, MA area. Methods: Qualitative analysis was applied to meeting minutes and process evaluation reports from the first three years of the CAFEH study (n = 73 files). In addition, a group meeting was held with project partners in order to contextualize the findings from the document analysis. Results: The three most commonly referenced challenges included language barriers, the overall project structure and budgetary constraints. Meanwhile, a heavy emphasis on process and an approach steeped in participatory democracy facilitated CAFEH’s ability to overcome these challenges, as well as sustain and augment strong partnership ties. Conclusions: This experience suggests that leadership that incorporates an organizing approach and a transformational style facilitates CBPR processes and helps teams surmount challenges. PMID:28165418
Begun last year with only six participants, the Massachusetts Consumer Health Educators Association, now 100 members strong, is in the business of sharing experiences to help alleviate its members' feelings of being alone. Meetings are held once a month, and authorities in the health education field are invited to speak. The Consumer Health Educators' first major project is the compilation of an index of hospital-based health education programs in the state.
Wallerstein, Nina B; Duran, Bonnie
Community-based participatory research (CBPR) has emerged in the past decades as an alternative research paradigm, which integrates education and social action to improve health and reduce health disparities. More than a set of research methods, CBPR is an orientation to research that focuses on relationships between academic and community partners, with principles of colearning, mutual benefit, and long-term commitment and incorporates community theories, participation, and practices into the research efforts. As CBPR matures, tensions have become recognized that challenge the mutuality of the research relationship, including issues of power, privilege, participation, community consent, racial and/or ethnic discrimination, and the role of research in social change. This article focuses on these challenges as a dynamic and ever-changing context of the researcher-community relationship, provides examples of these paradoxes from work in tribal communities, discusses the evidence that CBPR reduces disparities, and recommends transforming the culture of academia to strengthen collaborative research relationships.
Guion, W. Kent; Mishoe, Shelley C.; Taft, Arthur A.; Campbell, Carol A.
Context: Statewide studies indicate a continuing shortfall of personnel in several allied health disciplines in rural Georgia. National trends indicate lagging enrollment in allied health education programs, suggesting that the workforce shortages will worsen. Purpose: This article describes the efforts of the School of Allied Health Sciences at…
Christensen, Victoria G.; Lee, Kathy E.; McLees, James M.; Niemela, Scott L.
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.
Segall, Mary; McKay, Rose
Discusses the graduate program in community health nursing at the University of Colorado that is structured according to the aggregate/family and group model. Describes the development of the program and its evaluation. (JOW)
And Others; White, Caroline
Highlights of a survey of community health nursing agencies and faculty suggest the need for better planning and collaboration between service and education in preparing students for this field. Survey data tables are included. (CT)
... multiple chronic conditions better manage their health care. Definitions Residential care communities : Includes assisted-living facilities and ... a unit or wing that met the above definition and residents could be enumerated separately. The 2010 ...
This presentation, The MATCH Study (Metals Assessment Targeting Community Health), was given at the NIEHS/EPA Children's Centers 2015 Webinar Series: Historical Perspectives and Research Updates from Previously Funded Children's Centers held on 11/18/15.
Barnidge, Ellen; Baker, Elizabeth A.; Motton, Freda; Fitzgerald, Teresa; Rose, Frank
Health disparities are a major concern in the United States. Research suggests that inequitable distribution of money, power, and resources shape the circumstances for daily life and create and exacerbate health disparities. In rural communities, inequitable distribution of these structural factors seems to limit employment opportunities. The Sustainable Livelihoods framework, an economic development model, provides a conceptual framework to understand how distribution of these social, economic, and political structural factors affect employment opportunities and community health in rural America. This study uses photo-elicitation interviews, a qualitative, participatory method, to understand community members perceptions of how distribution of structural factors through creation and maintenance of institutional practices and policies, influence employment opportunities and, ultimately, community health for African Americans living in rural Missouri. PMID:21169478
Yuen, E; Anda, M; Mathew, K; Ho, G
Limited water resources exist in numerous remote indigenous settlements around Australia. Indigenous people in these communities are still living in rudimentary conditions while their urban counterparts have full amenities, large scale water supplies and behavioral practices which may not be appropriate for an arid continent but are supported by extensive infrastructure in higher rainfall coastal areas. As remote indigenous communities continue to develop, their water use will increase, and in some cases, costly solutions may have to be implemented to augment supplies. Water harvesting techniques have been applied in settlements on a small scale for domestic and municipal purposes, and in the large, broadacre farm setting for productive use of the water. The techniques discussed include swales, infiltration basins, infiltration trenches and "sand dam" basins. This paper reviews the applications of water harvesting relevant to small communities for land rehabilitation, landscaping and flood control. Landscaping is important in these communities as it provides shelter from the sun and wind, reduces soil erosion and hence reduced airborne dust, and in some cases provides food and nutrition. Case studies of water harvesting systems applied in the Pilbara Region, Western Australia for landscaping around single dwellings in Jigalong and Cheeditha, in a permaculture garden in Wittenoon and at a college and carpark in Karratha are described.
Long, A; Baxter, R
This paper reports the results of a study that was designed to explore and examine the perceptions of two groups of newly qualified community nurses about the factors they considered to be embedded within the concepts of health, health-enhancing behaviours at individual, family and community levels and their 'innermost self'. The research was exploratory in nature, and included two sample groups: group 1 comprised 16 newly qualified health visitors; group 2 comprised 16 newly qualified community mental health nurses. Purposive sampling was used and data were collected using semi-structured interviews. The group of health visitors perceived health in terms of physical fitness and functional states. At a global level they perceived the need to provide education on health matters. They gave generously to 'charities' and perceived the 'inner self' as 'that part that matters'. The group of community mental health nurses perceived health in terms of holism and being states. Their concept of health was related to listening to each individual's perception of what is 'right' and 'health-enhancing' for them. At a global level they considered the protection of the ozone layer and the promotion of a just and equitable society which focused on the reduction of poverty, to be key health-enhancing activities. They perceived their 'innermost self' to be 'that part of me that makes life worth living', and the soul. The findings have implications for developing new and creative approaches for teaching the holistic concept of health and healing. Educational activities could be designed which strive to ensure that nurses themselves have safe and health embracing opportunities for exploring all the elements that are embedded within the topic of health. Their role in facilitating holistic health promoting activities for all clients also needs to be addressed.
Nivet, Marc A; Berlin, Anne
While the levers for the social determinants of health reside largely outside institutional walls, this does not absolve health professional schools from exercising their influence to improve the communities in which they are located. Fulfilling this charge will require a departure from conventional thinking, particularly when it comes to educating future health professionals. We describe efforts within medical education to transform recruitment, admissions, and classroom environments to emphasize diversity and inclusion. The aim is to cultivate a workforce with the perspectives, aptitudes, and skills needed to fuel community-responsive health-care institutions.
Oddy, W H; Holman, C D; Corti, B; Donovan, R J
The paper is concerned with the use of epidemiological methods to measure the rates at which different strata of a defined population participate in community health promotion projects. The specific aim was to estimate the incidence rates of participation in projects sponsored by the Western Australian Health Promotion Foundation (Healthway), separately for sociodemographic and health-related behavioral subgroups. Data were drawn from Healthway sponsorship projects in 1992. Each sport, arts, and racing project was associated with promotion of a health message and creation of a health promoting environment. The study used a 2-stage sampling design. 13 of 57 large sponsorship projects and 30 of 129 small projects were selected. In the second stage, respondents were randomly surveyed from among project participants. A total of 4060 respondents at least 10 years old was sampled from the 43 selected projects. Population-based incident participation were estimated and were related to person-years at risk. The total participation rate was 4.01 per person-year in people or= 10 years old. The rate was very high at ages 10-14 years and thereafter declined with increasing age. Compared with the least socially disadvantaged 25% of the population, the participation rate fell by around 1/3 in the medium and high disadvantaged groups, but exceeded the baseline by a ratio of 1.85 (95% confidence interval: 1.57-2.18) in the most disadvantaged 10% of the population. The comparatively high rate of participation in the most disadvantaged group occurred only at ages 50 years and the effect was most pronounced at ages 10-19 years. Compared with the least disadvantaged 25%, the rate ratio in the most disadvantaged 10% of the population was 2.50 in the metropolitan area and 1.25 in the country regions of western Australia. Participation was higher in those who smoked, drank alcohol unsafely, reported sunburn, and reported low consumption of fruit and vegetables. Epidemiological methods
Lesh, Kathryn A.
Adoption and use of health information technology, the electronic health record (EHR) in particular, has the potential to help improve the quality of care, increase patient safety, and reduce health care costs. Unfortunately, adoption and use of health information technology has been slow, especially when compared to the adoption and use of…
Armenia, Joanne Elizabeth
Limited health literacy is a national public health problem contributing to adverse health outcomes and increasing healthcare costs. Both health and educational systems are intervention points for improvement; however, there is paucity in empirical research regarding the role of educational systems. This needs assessment study explored health…
Van Brunt, Deryk
To systematically improve population health in the United States, community health records (CHRs) must be defined, developed, and implemented. Like electronic and personal health records, CHRs have both unique and overlapping information. CHRs contain data about communities, including the social, physical, and lifestyle determinants of health. These records will serve to complement electronic and personal health records to provide a more complete view of population health, allowing stakeholders to target community health and quality-of-life interventions in a data-driven and evidence-based manner, establishing the basis from which organizations can develop a systematic approach to improving community health. This commentary calls on the United States to conduct a set of consensus activities to define and implement CHRs.
To systematically improve population health in the United States, community health records (CHRs) must be defined, developed, and implemented. Like electronic and personal health records, CHRs have both unique and overlapping information. CHRs contain data about communities, including the social, physical, and lifestyle determinants of health. These records will serve to complement electronic and personal health records to provide a more complete view of population health, allowing stakeholders to target community health and quality-of-life interventions in a data-driven and evidence-based manner, establishing the basis from which organizations can develop a systematic approach to improving community health. This commentary calls on the United States to conduct a set of consensus activities to define and implement CHRs. PMID:28103072
Bramson, Sharon; Merlino, Ann
Describes the phased development of a program in Blood Transfusion Technology at Staten Island Community College of the City University of New York. Presents a detailed outline of the instructional content of the course. (SL)
Context: Research on health disparities in Appalachia has rarely compared Appalachia to other geographic areas in such a way as to isolate possible Appalachian effects. Purpose: This study tests hypotheses that nonmetropolitan Appalachia will have higher levels of mental health professional shortage areas than other nonmetropolitan areas of the…
TAYLOR, KANARDY L.
THE ANNOATATED BIBLIOGRAPHY IS PREPARED ESPECIALLY FOR STATE AND LOCAL PUBLIC WELFARE AGENCIES RESPONSIBLE FOR COMMUNITY PLANNING. IT MAY ALSO BE OF ASSISTANCE TO OTHERS INTERESTED IN HEALTH, EDUCATION, AND WELFARE. THE SELECTED REFERENCES ON BASIC CONCEPTS AND APPROACHES IN COMMUNITY PLANNING AND RELATED SUBJECTS ARE GENERALLY AVAILABLE IN PUBLIC…
Nilson, Ralph; And Others
The Wellness Mobile transports medical supplies, equipment, informational materials, and staff to rural Saskatchewan communities to assist them in developing wellness programs that stress disease prevention. Staff from the Wellness Mobile offer health-risk screening and appraisal to community members and work with local practitioners and schools…
Though there are at least 12.4 million community college students, accounting for 44% of all undergraduates within the United States (Cohen & Brawer, 2008), little academic research has explored the mental health needs of community college students as a distinct population ( Floyd, 2003; Townsend & LaPaglia, 2000; Townsend, Donaldson,…
Signorello, Lisa B.; Hargreaves, Margaret K.; Blot, William J.
Summary Over 73,700 adults age 40–79, nearly 70% African American, were recruited at community health centers across 12 southeastern states; individual characteristics were recorded and biologic specimens collected at baseline for later follow-up. The Southern Community Cohort Study is a unique national resource for assessing determinants of racial/ethnic differentials in diseases. PMID:20173283
Garfield, Charles A.; And Others
Summarizes a national survey of the hospice community. Results indicated that the hospice community is attempting to meet the mental health training needs of its paid staff members and volunteers. However, more than half expressed a need for further training and a more systematic and comprehensive curriculum. (Author)
Zakus, J D
Great hope is accorded to community participation in health. A large number of potential benefits are attributed to participatory processes, including better addressing community needs through more locally adapted organizational processes and improvement in health outcomes. To this end, many governments around the world have adopted policies and programmes of community participation as part of their strategy to implement primary health care services. In Mexico this is, in great part, realized through the module programme of the Ministry of Health. A module is characterized by various village based health posts (casas de salud), each operated by a community volunteer and associated with a health committee, all of which are supervised by a nurse from a nearby health centre. The southern Mexican state of Oaxaca was chosen for a study of the module programme (during the period 1987-1992) to gain a better understanding of how organizational processes impact on the implementation and outcomes of community participation programmes in large institutions (i.e. the Ministry of Health). The resource dependency perspective formed the basis for the theoretical framework used. Some 75 towns and villages were visited and about 170 health related personnel from all over the state were interviewed to obtain data on the operation and impact of the module programme. As predicted by resource dependency theory, which postulates that organizations will react to pressures in their external environment to secure the resources needed for survival, the findings of this research led to the conclusion that the Ministry of Health had co-opted the resources of the communities it was involving in the module programme in order to meet its policy objectives, especially those related to expanding service coverage. Community participation in the module programme was found to have been implemented entirely for its utility in supplying resources and not for democratic or intrinsic values. This
American Coll. Health Association, Evanston, IL.
The basic premise of this document is that every community college should have a plan through which the health needs of students, faculty and staff can be met by health services which are available, accessible and of high quality. Services should be available in each of the following program areas: personal medical, mental health, and other direct…
Jeffery, Vivienne; Ervin, Kaye
A small rural health service undertook a major needs analysis in 2008 to identify gaps in service delivery and duplication of services. This exercise was intended to inform strategic direction but the result was consumer and community consultation and outcomes that far exceeded everyone's expectations. Organisations often pay lip service to the concept of community participation and consultation and the importance of consumer involvement. Turning this rhetoric into action is challenging and requires dedicated staff, organisational support and momentum for it to occur. The project described resulted in targeted, purposeful action regarding community engagement, and the findings and outcomes are reflective of this. The unexpected findings required an organisational shift, which was embraced by the health service and resulted in collaborative partnerships with consumers and organisations that are proving beneficial to the entire community and outlying areas. Few organisations would demonstrate the willingness to accommodate such change, or undertake a needs analysis that is chiefly community driven.
Since the decade of the 1970s health promotion has been an integral part of most primary health care strategies. This article examines some community participation strategies adopted in the health promotion in Cuba and the policies which enable such strategies. This is done in the context of health promotion theory and also examines the concept of direct involvement by the political directorate in health promotion. The article is written from a reflexive perspective following the author's visit to Cuba as member of a health study tour in March 2002.
de Groot, Esther; Endedijk, Maaike; Jaarsma, Debbie; van Beukelen, Peter; Simons, Robert-Jan
Critically reflective dialogues (CRD) are important for knowledge sharing and creating meaning in communities. CRD includes different aspects: being open about mistakes, critical opinion sharing, asking for and giving feedback, experimentation, challenging groupthink and research utilisation. In this article we explore whether CRD aspects change over time, through a study of two dialogues each from six different communities of veterinary health professionals. Change was studied from the perspective of observations, through analysing transcripts of dialogues, and from the perspective of community members' perceptions, through an evaluative discussion with members. The results showed that some communities became more open about mistakes, a finding that is related to an increase in trust. Other observed aspects of CRD seemed to be fairly stable over time. Community members perceived research utilisation and asking for and giving feedback to have been increased. From an analysis of perceptions of the community members it emerged that limited interaction could be associated with the epistemological conceptions of community members.
Thornicroft, Graham; Deb, Tanya; Henderson, Claire
This paper aims to give an overview of the key issues facing those who are in a position to influence the planning and provision of mental health systems, and who need to address questions of which staff, services and sectors to invest in, and for which patients. The paper considers in turn: a) definitions of community mental health care; b) a conceptual framework to use when evaluating the need for hospital and community mental health care; c) the potential for wider platforms, outside the health service, for mental health improvement, including schools and the workplace; d) data on how far community mental health services have been developed across different regions of the world; e) the need to develop in more detail models of community mental health services for low- and middle-income countries which are directly based upon evidence for those countries; f) how to incorporate mental health practice within integrated models to identify and treat people with comorbid long-term conditions; g) possible adverse effects of deinstitutionalization. We then present a series of ten recommendations for the future strengthening of health systems to support and treat people with mental illness.
Thornicroft, Graham; Deb, Tanya; Henderson, Claire
This paper aims to give an overview of the key issues facing those who are in a position to influence the planning and provision of mental health systems, and who need to address questions of which staff, services and sectors to invest in, and for which patients. The paper considers in turn: a) definitions of community mental health care; b) a conceptual framework to use when evaluating the need for hospital and community mental health care; c) the potential for wider platforms, outside the health service, for mental health improvement, including schools and the workplace; d) data on how far community mental health services have been developed across different regions of the world; e) the need to develop in more detail models of community mental health services for low‐ and middle‐income countries which are directly based upon evidence for those countries; f) how to incorporate mental health practice within integrated models to identify and treat people with comorbid long‐term conditions; g) possible adverse effects of deinstitutionalization. We then present a series of ten recommendations for the future strengthening of health systems to support and treat people with mental illness. PMID:27717265
Jackson, Richard; Shields, Kyra Naumoff
In society's effort to address and prepare for climate change, the health community itself must ensure that it is prepared. Health personnel will require flexible and iterative action plans to address climate change at the individual, hospital, local health department, state, and national levels. This requires that health workers analyze the impact of climate change with a view to human health, and then formulate robust policy and demonstrate authentic leadership. In this review, we summarize the status of the health community's preparation for climate change and provide specific recommendations for action at each level. Although preparation status and recommendations vary, our observation is that it is not enough for public health and medical care agencies and departments to develop policies and advocate change. They have a direct responsibility to demonstrate substantive leadership.
Sousa, Fábio Alexandre Melo do Rego; Goulart, Maria José Garcia; Braga, Antonieta Manuela dos Santos; Medeiros, Clara Maria Oliveira; Rego, Débora Cristina Martins; Vieira, Flávio Garcia; Pereira, Helder José Alves da Rocha; Tavares, Helena Margarida Correia Vicente; Loura, Marta Maria Puim
ABSTRACT OBJECTIVE To describe the methodology used in the process of setting health priorities for community intervention in a community of older adults. METHODS Based on the results of a health diagnosis related to active aging, a prioritization process was conceived to select the priority intervention problem. The process comprised four successive phases of problem analysis and classification: (1) grouping by level of similarity, (2) classification according to epidemiological criteria, (3) ordering by experts, and (4) application of the Hanlon method. These stages combined, in an integrated manner, the views of health team professionals, community nursing and gerontology experts, and the actual community. RESULTS The first stage grouped the identified problems by level of similarity, comprising a body of 19 issues for analysis. In the second stage these problems were classified by the health team members by epidemiological criteria (size, vulnerability, and transcendence). The nine most relevant problems resulting from the second stage of the process were submitted to expert analysis and the five most pertinent problems were selected. The last step identified the priority issue for intervention in this specific community with the participation of formal and informal community leaders: Low Social Interaction in Community Participation. CONCLUSIONS The prioritization process is a key step in health planning, enabling the identification of priority problems to intervene in a given community at a given time. There are no default formulas for selecting priority issues. It is up to each community intervention team to define its own process with different methods/techniques that allow the identification of and intervention in needs classified as priority by the community. PMID:28273229
The British Bangladeshi community is one of the youngest and fastest growing ethnic minority groups in the UK. Many report poor socio-economic and health profiles with the existence of substantial health inequalities, particularly in relation to type 2 diabetes. Although there is compelling evidence for the effectiveness of lifestyle interventions in the prevention of type 2 diabetes, there is little understanding of how best to tailor treatments to the needs of minority ethnic groups. Little is known about nutrition related lifestyle choices in the Bangladeshi community or the factors influencing such decisions. Only by exploring these factors will it be possible to design and tailor interventions appropriately. The Bangladeshi Initiative for the Prevention of Diabetes study explored lay beliefs and attitudes, religious teachings and professional perspectives in relation to diabetes prevention in the Bangladeshi community in Tower Hamlets, London. Contrary to the views of health professionals and previous research, poor knowledge was not the main barrier to healthy lifestyle choices. Rather the desire to comply with cultural norms, particularly those relating to hospitality, conflicted with efforts to implement healthy behaviours. Considerable support from Islamic teachings for diabetes prevention messages was provided by religious leaders, and faith may have an important role in supporting health promotion in this community. Some health professionals expressed outdated views on community attitudes and were concerned about their own limited cultural understanding. The potential for collaborative working between health educators and religious leaders should be explored further, and the cultural competence of health professionals addressed.
Heslop, Brett; Wynaden, Dianne; Tohotoa, Jenny; Heslop, Karen
Australian mental health policy is focused on providing mental health care in the community setting and community mental health teams provide services to clients in a shared model with primary care. The historical literature reports that community mental health nurses' experience high levels of stress and are often allocated the most complex and challenging clients managed by the team. Yet information on their specific roles remains limited. This paper reports on research conducted at one Australian public mental health service to identify the components of the community mental health nursing role and to quantify the time nurses spent in each component during the study period. Six focus groups were conducted with community mental health nurses to identify their perceived role within the team. Data analysis identified 18 components of which 10 were related to direct clinical contact with clients and eight covered administrative and care coordination activities. A data collection tool based on the findings of the focus groups was designed and nurses recorded workload data on the tool in 15-min intervals over a 4-week period. Seventeen nurses collected 1528 hours of data. Internal coordination of care was identified as the top workload item followed by clinical documentation and national data collection responsibilities supporting the complexity of the community mental health nursing role. The high rating attached to the internal coordination of care role demonstrates an important contribution that community mental health nurses make to the functioning of the team and the delivery of quality mental health care.
Mobile health (mHealth) is gaining widespread attention for its potential to engage patients in their health and health care in their daily lives. Emerging evidence suggests that mHealth interventions can be used effectively to support behavior change, but numerous challenges remain when implementing these programs at the community level. This paper provides an overview of considerations when implementing community-based mHealth initiatives, based on the experiences of three Beacon Communities across the United States that have launched text messaging (short message service, SMS) pilot programs aimed at diabetes risk reduction and disease management. The paper addresses lessons learned and suggests strategies to overcome challenges related to developing text message content, conducting marketing and outreach, enrolling participants, engaging providers, evaluating program effectiveness, and sustaining and scaling the programs. PMID:24128406
Abebe, Nebeyou A; Capozza, Korey L; Des Jardins, Terrisca R; Kulick, David A; Rein, Alison L; Schachter, Abigail A; Turske, Scott A
Mobile health (mHealth) is gaining widespread attention for its potential to engage patients in their health and health care in their daily lives. Emerging evidence suggests that mHealth interventions can be used effectively to support behavior change, but numerous challenges remain when implementing these programs at the community level. This paper provides an overview of considerations when implementing community-based mHealth initiatives, based on the experiences of three Beacon Communities across the United States that have launched text messaging (short message service, SMS) pilot programs aimed at diabetes risk reduction and disease management. The paper addresses lessons learned and suggests strategies to overcome challenges related to developing text message content, conducting marketing and outreach, enrolling participants, engaging providers, evaluating program effectiveness, and sustaining and scaling the programs.
Lavadenz, F; Schwab, N; Straatman, H
Health sector reform in Bolivia is based primarily on the principles of decentralization and equity, and with the objectives of improving quality and of expanding health services coverage in rural and low-income areas of the country. As an experiment in reform, the Bolivian Ministry of Health and Social Welfare, the department of La Paz, and the municipality of El Alto signed an agreement with a nongovernmental organization (NGO), transferring to the NGO the overall management of one of the health services networks in El Alto. The transfer was based on a management contract that had process and outcome indicators for the network. A year after implementation began, the preliminary results suggest that through the agreement the quality of management and services has improved, health services coverage has expanded, and the network's primary care services have been strengthened. Bed occupancy rates are generally very low in secondary hospitals in Bolivia, with that figure being just 43% in the department of La Paz in 1999. However, in the second 6 months of operation of the El Alto network the occupancy rate for the network's hospital reached 84%. Between the first 6 months of 1999 and the same period in 2000, outpatient consultations increased by 55% in the network (83% in the hospital and 18% in the network's primary care centers). Over that same period, institutional deliveries increased by 41% and the percentage of deliveries in the primary care centers grew from 5% of the total to 9%. A recent user survey found that 87% of the people receiving care in the network felt highly satisfied with the service they had received, and 75% of the persons surveyed said they would recommend the service to others. These are not typical data for health services in Bolivia. This pilot effort suggests that a change in the organization and management of a health services network, with a separation of the roles of purchaser and provider, combined with management based on results and
Harper, T D; Berg, R N
Of late, there have been several court decisions of significance in the United States in the health care area. In 1 case the Supreme Court was faced with the question of whether or not states were required to fund abortions under the Medicaid program. In a 2nd case, a lower court was required to determine whether a Professional Standards Review Organization (PSRO) was a federal agency subject to the disclosure requirements of the federal Freedom of Information Act. Both of these issues are discussed. The Supreme Court authoritatively and conclusively established that a woman has no constitutional right to a state or federally funded abortion and with this ruling resolved several contrary lower court decisions and extended Congressional power to limit the expenditure of federal funds. Congress has established by a funding exclusion commonly referred to as the "Hyde Amendment," a limitation upon the expenditure of federally appropriated funds provided pursuant to Title 19 of the Social Security Act (Medicaid). A United States District Court in Georgia held that this exclusion was not to affect a state's duty to fund abortions deemed to be "medically necessary." A United States District Court in New York held the Hyde Amendment to be unconstitutional for failing to require funding of abortions that were deemed medically necessary. Contrary to the Georgia Court's ruling, the Supreme Court determined that the Medicaid program provides no unilateral funding obligation for a state which chooses to participate in the system. Contrary to the New York Court's ruling, the Sumpreme Court concluded that the Hyde Amendment is not constitutionally deficient. The Supreme Court determined that the limitation of abortion funding does not constitute a violation of the Establishment Clause of the 1st Amendment and that the limitation upon funding does not constitute a violation of the Equal Protection Clause of the 14th Amendment. The District Court in the District of Columbia
Andrulis, D P
Urban communities continue to face formidable historic challenges to improving public health. However, reinvestment initiatives, changing demographics, and growth in urban areas are creating changes that offer new opportunities for improving health while requiring that health systems be adapted to residents' health needs. This commentary suggests that health care improvement in metropolitan areas will require setting local, state, and national agendas around 3 priorities. First, health care must reorient around powerful population dynamics, in particular, cultural diversity, growing numbers of elderly, those in welfare-workplace transition, and those unable to negotiate an increasingly complex health system. Second, communities and governments must assess the consequences of health professional shortages, safety net provider closures and conversions, and new marketplace pressures in terms of their effects on access to care for vulnerable urban populations; they must also weigh the potential value of emerging models for improving those populations' care. Finally, governments at all levels should use their influence through accreditation, standards, tobacco settlements, and other financing streams to educate and guide urban providers in directions that respond to urban communities' health care needs. PMID:10846501
Kramer, Kathryn D.; Geller, E. Scott
The article examines community dental health promotion for children in terms of factors impacting children's dental health (water fluoridation, dental health education, behavior change strategies, use of dental services, and dental phobias). Proposed is a large scale behavior change approach to public dental health which integrates applied…
Menon, Sanjay T.
The context for health empowerment includes individuals, health providers, and the regulatory environment. Psychological health empowerment consists of perceived control, perceived competence, and goal internalization. In multicultural communities, barriers to empowerment include locus of control, access to health care, and language and cultural…
Hernández, Alison; Hurtig, Anna-Karin; Dahlblom, Kjerstin; San Sebastián, Miguel
Background. The performance of midlevel health workers is a critical lever for strengthening health systems and redressing inequalities in underserved areas. Auxiliary nurses form the largest cadre of health workers in Guatemala. In rural settings, they provide essential services to vulnerable communities, and thus have great potential to address priority health needs. This paper examines auxiliary nurses' motivation and satisfaction, and the coping strategies they use to respond to challenges they confront in their practice. Methods. Semistructured interviews were conducted with 14 auxiliary nurses delivering health services in Alta Verapaz, Guatemala. Results. Community connectedness was central to motivation in this rural Guatemalan setting. Participants were from rural communities and conveyed a sense of connection to the people they were serving through shared culture and their own experiences of health needs. Satisfaction was derived through recognition from the community and a sense of valuing their work. Auxiliary nurses described challenges commonly faced in low-resource settings. Findings indicated they were actively confronting these challenges through their own initiative. Conclusions. Strategies to support the performance of midlevel health workers should focus on mechanisms to make training accessible to rural residents, support problem-solving in practice, and emphasize building relationships with communities served. PMID:23097715
Galiatsatos, Panagis; Sundar, Siddhi; Qureshi, Adil; Ooi, Gavyn; Teague, Paula; Daniel Hale, W
Promoting wellness and providing reliable health information in the community present serious challenges. Lay health educators, also known as community health workers, may offer a cost-effective solution to such challenges. This is a retrospective observational study of graduates from the Lay Health Educator Program (LHEP) at Johns Hopkins Bayview Medical Center from 2013 to 2014. Students were enrolled from the surrounding community congregations and from the hospital's accredited clinical pastoral education program. There were 50 events implemented by the lay health educators during the 2014-2015 time period, reaching a total of 2004 individuals. The mean time from date of graduation from the LHEP to implementation of their first health promotional event was 196 ± 76 days. A significant number of lay health educators implemented events within the first year after completing their training. Ongoing monitoring of their community activity and the clinical impact of their efforts should be a priority for future studies.
Carter, Melondie R; Kelly, Rebecca K; Montgomery, Michele; Cheshire, Michelle
The number of nurses working in community-based practices with a population focus is increasing rapidly, whereas the rate of employment for nurses in hospitals is expected to grow more slowly. The shift in health care toward primary health care and health promotion requires nurse educators to ensure that students learn to practice in collaborative partnerships in community settings. This article describes an innovative collaborative partnership with the Capstone College of Nursing and the Office of Health Promotion and Wellness at The University of Alabama. Through this partnership, community health nursing students provide health promotion for university employees in the University's wellness program. The program provides nursing students with a unique opportunity for interprofessional collaboration while improving their clinical and communication skills. This innovative collaborative approach serves as a useful model for nursing faculty members when delivering community health instruction.
Garrett, Nedra; Kriseman, Jeffrey; Crum, Melvin; Rafalski, Edward M.; Sweat, David; Frazier, Renee; Schearer, Sue; Cutts, Teresa
We present a framework for developing a community health record to bring stakeholders, information, and technology together to collectively improve the health of a community. It is both social and technical in nature and presents an iterative and participatory process for achieving multisector collaboration and information sharing. It proposes a methodology and infrastructure for bringing multisector stakeholders and their information together to inform, target, monitor, and evaluate community health initiatives. The community health record is defined as both the proposed framework and a tool or system for integrating and transforming multisector data into actionable information. It is informed by the electronic health record, personal health record, and County Health Ranking systems but differs in its social complexity, communal ownership, and provision of information to multisector partners at scales ranging from address to zip code. PMID:27609300
Apostle, Elisa P; O'Connell, Marykate E; Vezeau, Toni M
This article investigates how the health disparities of Appalachian coal miners and coal mining communities could be decreased through a partnership with occupational health nurses. On-site health clinics managed by occupational health nurses working in the coal mining industry are proposed as a means to improve health care outcomes. Health effects, economic considerations, environmental impacts, and U.S. coal mining legislation and regulation are examined. An epidemiological approach is presented to the unique health effects experienced by Appalachian coal miners and coal mining communities within the context of existent socioeconomic disparities. The long-standing health crisis in Appalachian coal mining communities requires a multidisciplinary approach led by occupational health nurses.
Bernheim, Ruth Gaare; Stefanak, Matthew; Brandenburg, Terry; Pannone, Aaron; Melnick, Alan
As public health departments around the country undergo accreditation using the Public Health Accreditation Board standards, the process provides a new opportunity to integrate ethics metrics into day-to-day public health practice. While the accreditation standards do not explicitly address ethics, ethical tools and considerations can enrich the accreditation process by helping health departments and their communities understand what ethical principles underlie the accreditation standards and how to use metrics based on these ethical principles to support decision making in public health practice. We provide a crosswalk between a public health essential service, Public Health Accreditation Board community engagement domain standards, and the relevant ethical principles in the Public Health Code of Ethics (Code). A case study illustrates how the accreditation standards and the ethical principles in the Code together can enhance the practice of engaging the community in decision making in the local health department.
García Pastor de Domínguez, E; Robles de Sandoval, A; Martínez Chopen, O
The authors describe in detail a self-tutorial system that has been used for some ten years in Guatemala to train auxiliary nursing personnel. This model addressed both training and service objectives, and it proved to be consistent with a health policy of integrating teaching and service which the country was implementing at the time. The system involved a national effort to develop self-tutorial units and materials on basic subjects such as nursing procedures, mother and child health, first aid, management, guided therapy, community development and health education. Materials were divided into three categories: for self-tutorial instruction, for recording, supervision and evaluation, and for coordination and feedback within the system. Lastly, greater detail is given on the functions and tasks performed at the different levels of staff involved in managing the system, and the mechanisms which were implemented in the country's health areas are described.
Kang, Changhyun; Shin, Jihyung; Matthews, Bob
Objectives The aim of this study is to ascertain and identify the effectiveness of area-based initiatives as a policy tool mediated by societal and individual factors in the five World Health Organization (WHO)-designated Safe Communities of Korea and the Health Action Zones of the United Kingdom (UK). Methods The Korean National Hospital discharge in-depth injury survey from the Korea Centers for Disease Control and Prevention and causes of death statistics by the Statistics Korea were used for all analyses. The trend and changes in injury rate and mortality by external causes were compared among the five WHO-designated Safe Communities in Korea. Results The injury incident rates decreased at a greater level in the Safe Communities compared with the national average. Similar results were shown for the changes in unintentional injury incident rates. In comparison of changes in mortality rate by external causes between 2005 and 2011, the rate increase in Safe Communities was higher than the national average except for Jeju, where the mortality rate by external causes decreased. Conclusion When the Healthy Action Zones of the UK and the WHO Safe Communities of Korea were examined, the outcomes were interpreted differently among the compared index, regions, and time periods. Therefore, qualitative outcomes, such as bringing the residents' attention to the safety of the communities and promoting participation and coordination of stakeholders, should also be considered as important impacts of the community-based initiatives. PMID:26981341
Aguirre-Molina, Marilyn, Ed.; Molina, Carlos W., Ed.; Zambrana, Ruth Enid, Ed.
This collection of papers includes 6 parts. Part 1, "Latino Populations in the United States," includes: (1) "Latino Health Policy: Beyond Demographic Determinism" (Angelo Falcon, Marilyn Aguirre-Molina, and Carlos W. Molina); (2) "Latino Health Status" (Olivia Carter-Pokras and Ruth Enid Zambrana); and (3)…
Memon, Zahid; Zaidi, Shehla; Riaz, Atif
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
Singh, Debra; Cumming, Robert; Negin, Joel
When trusted, Community Health Workers (CHWs) can contribute to improving maternal and newborn health outcomes in low- and middle-income countries through education. Issues of acceptability of CHWs by communities were explored through experiences gained in a qualitative study that is part of a cluster randomized trial in East Uganda. Initially,…
Background An online health-promoting community (OHPC) has the potential to promote health and advance new means of dialogue between public health representatives and the general public. The aim of this study was to examine what aspects of an OHPC that are critical for satisfying the needs of the user community and public health goals and service capabilities. Methods Community-based participatory research methods were used for data collection and analysis, and participatory design principles to develop a case study OHPC for adolescents. Qualitative data from adolescents on health appraisals and perspectives on health information were collected in a Swedish health service region and classified into categories of user health information exchange needs. A composite design rationale for the OHPC was completed by linking the identified user needs, user-derived requirements, and technical and organizational systems solutions. Conflicts between end-user requirements and organizational goals and resources were identified. Results The most prominent health information needs were associated to food, exercise, and well-being. The assessment of the design rationale document and prototype in light of the regional public health goals and service capabilities showed that compromises were needed to resolve conflicts involving the management of organizational resources and responsibilities. The users wanted to discuss health issues with health experts having little time to set aside to the OHPC and it was unclear who should set the norms for the online discussions. Conclusions OHPCs can be designed to satisfy both the needs of user communities and public health goals and service capabilities. Compromises are needed to resolve conflicts between users’ needs to discuss health issues with domain experts and the management of resources and responsibilities in public health organizations. PMID:23826944
Steiner, Beat D; Denham, Amy C; Ashkin, Evan; Newton, Warren P; Wroth, Thomas; Dobson, L Allen
The United States leads the world in health care costs but ranks far below many developed countries in health outcomes. Finding ways to narrow this gap remains elusive. This article describes the response of one state to establish community health networks to achieve quality, utilization, and cost objectives for the care of its Medicaid recipients. The program, known as Community Care of North Carolina, is an innovative effort organized and operated by practicing community physicians. In partnership with hospitals, health departments, and departments of social services, these community networks have improved quality and reduced cost since their inception a decade ago. The program is now saving the State of North Carolina at least $160 million annually. A description of this experience and the lessons learned from it can inform others seeking to implement effective systems of care for patients with chronic illness.
Barnidge, Ellen K.; Baker, Elizabeth A.; Motton, Freda; Fitzgerald, Teresa; Rose, Frank
Health disparities are a major concern in the United States. Research suggests that inequitable distribution of money, power, and resources shape the circumstances for daily life and create and exacerbate health disparities. In rural communities, inequitable distribution of these structural factors seems to limit employment opportunities. The…
Kraus, Marjorie B.; Morgan, Connie M.; Matteson, Peggy S.
In New Orleans, nursing faculty and students partnered with inner-city schools and churches to mobilize neighborhood assets and improve health care. Students learned community assessment skills and worked with empowered citizens who reclaimed their health resources. (Contains 28 references.) (SK)
Busky, Henry F.
Guidelines are presented for the development of educational materials for the Health Services Program at Prince George's Community College. This program, as part of the Human Development Department, serves three kinds of functions: remediation--the correction of health problems after they have arisen; prevention--the prior identification and…
Kriseman, Jeffrey Michael
This work involved the analysis of a public health system, and the design, development and deployment of enterprise informatics architecture, and sustainable community methods to address problems with the current public health system. Specifically, assessment of the Nationally Notifiable Disease Surveillance System (NNDSS) was instrumental in…
Challenor, Bernard; Onyeani, Loretta
Discusses the role legal services play in public health care delivery in disadvantaged communities in relation to such socio-medical problems as lead poisoning, child abuse, involuntary mental commitment, and housing code violations. Recommends a legal advocacy program to ensure adequate public health care. (Author/SF)
Houston, Charles A.; Sellers, Harry
Due to factors such as high enrollment demands, limited institutional space, and high program costs, certain admissions requirements in the guidance/selection of students for health technology programs at Virginia Western Community College (VWCC) have become necessary. A Health Technology Admissions Evaluation System was created to develop and…
The rapid increase in Colorado's population has created a huge demand for allied health care providers. This increase, coupled with the aging baby boomer population, has created a near-crisis situation in many Colorado communities. The U.S. Department of Labor predicts severe shortages of allied health care workers for the next several years. The…
Angner, Erik; Miller, Michael J.; Ray, Midge N.; Saag, Kenneth G.; Allison, Jeroan J.
The relationship between health literacy and happiness was explored using a cross-sectional survey of community-dwelling older primary-care patients. Health literacy status was estimated with the following previously validated question: "How confident are you in filling out medical forms by yourself?" Happiness was measured using an adapted…
Community mobilisation and health management committee strengthening to increase birth attendance by trained health workers in rural Makwanpur, Nepal: study protocol for a cluster randomised controlled trial
Background Birth attendance by trained health workers is low in rural Nepal. Local participation in improving health services and increased interaction between health systems and communities may stimulate demand for health services. Significant increases in birth attendance by trained health workers may be affected through community mobilisation by local women's groups and health management committee strengthening. We will test the effect of community mobilisation through women's groups, and health management committee strengthening, on institutional deliveries and home deliveries attended by trained health workers in Makwanpur District. Design Cluster randomised controlled trial involving 43 village development committee clusters. 21 clusters will receive the intervention and 22 clusters will serve as control areas. In intervention areas, Female Community Health Volunteers are supported in convening monthly women's groups. The groups work through an action research cycle in which they consider barriers to institutional delivery, plan and implement strategies to address these barriers with their communities, and evaluate their progress. Health management committees participate in three-day workshops that use appreciative inquiry methods to explore and plan ways to improve maternal and newborn health services. Follow-up meetings are conducted every three months to review progress. Primary outcomes are institutional deliveries and home deliveries conducted by trained health workers. Secondary outcome measures include uptake of antenatal and postnatal care, neonatal mortality and stillbirth rates, and maternal morbidity. Trial registration number ISRCTN99834806 PMID:21595902
Wagenfeld, Morton O.; Murray, J. Dennis; Mohatt, Dennis F.; DeBruyn, Jeanne C.
The rural community mental health center tends to serve a large geographic area, have decentralized service delivery, require its professionals to function as generalists, and coordinate closely with other agencies. The last decade has seen an increasing strain placed on this pattern. As block grant and fee-for-service shifts resulting from the…
Reynolds, John N.; And Others
Psychologists' roles are changing and expanding in many ways. In the next decade, psychologists will probably continue their involvement away from the clinic and into the community. Deinstitutionalization should create many new opportunities for psychologists, particularly in the areas of community support system coordination and service…
Mayer, K; Appelbaum, J; Rogers, T; Lo, W; Bradford, J; Boswell, S
Fenway Community Health was founded by community activists in 1971 in the Fenway neighborhood of Boston, Mass, and within a decade had rapidly expanded its medical services for gay men in response to the AIDS epidemic. Increased expertise and cultural competence in lesbian, gay, bisexual, and transgender (LGBT) care led to expansion of medical services to address broader community concerns, ranging from substance use to parenting issues to domestic and homophobic violence, as well as specialized programs for lesbians, bisexuals, and transgendered individuals. Fenway began as a grassroots neighborhood clinic. In 1975, the center recorded 5000 patient care visits; in 2000, Fenway's clinical departments recorded 50,850 visits by 8361 individuals, including more than 1100 individuals receiving HIV-associated care. The center now has more than 170 staff people responsible for clinical programs, community education, research, administration, planning, and development. Over the past few years, Fenway's annual budget has exceeded $10 million. Fenway has established standards for improved cultural competence about LGBT health issues for other health providers and has developed programs to educate the general community about specific LGBT health concerns. This health center may provide a model of comprehensive LGBT health services that have a local impact.
Kuntz, Sandra W; Frable, Pamela; Qureshi, Kristine; Strong, Linda L
The Association of Community Health Nursing Educators (ACHNE) has developed a number of documents designed to delineate the scope and function of community/public health nursing educators, researchers, and practitioners. In response to societal issues, increased emphasis on disaster preparedness in nursing and public health, and requests from partner organizations to contribute to curriculum development endeavors regarding disaster preparedness, the ACHNE Disaster Preparedness Task Force was appointed in spring 2007 for the purpose of developing this document. Task Force members developed a draft of the document in summer and fall 2007, input was solicited and received from ACHNE members in fall 2007, and the document was approved and published in January 2008. The members of ACHNE extend their appreciation to the members of the Emergency Preparedness Task Force for their efforts: Pam Frable, N.D., R.N.; Sandra Kuntz, Ph.D., C.N.S.-B.C. (Chair); Kristine Qureshi, D.N.Sc., C.E.N., R.N.; Linda Strong, Ed.D., R.N. This white paper is aimed at meeting the needs of community/public health nursing educators and clarifying issues for the nursing and public health communities. ACHNE is committed to promotion of the public's health through ensuring leadership and excellence in community and public health nursing education, research, and practice.
Haynes, Erin N.; Elam, Sarah; Burns, Roxanne; Spencer, Alonzo; Yancey, Elissa; Kuhnell, Pierce; Alden, Jody; Walton, Mike; Reynolds, Virgil; Newman, Nicholas; Wright, Robert O.; Parsons, Patrick J.; Praamsma, Meredith L.; Palmer, Christopher D.; Dietrich, Kim N.
Summary: Federal funding agencies increasingly support stakeholder participation in environmental health studies, and yet there is very little published research on engagement of community members in the development of data disclosure (DD) strategies. The Ohio Environmental Protection Agency reported airborne manganese (Mn) concentrations in East Liverpool, Ohio, 30 times higher than the reference concentration, which led to an academic–community research partnership to address community concern about Mn exposure, particularly among children. Children and their families were recruited to participate in a pilot study. Samples of blood and hair were collected from the children and analyzed for metals. DD mechanisms were developed using an iterative approach between community and academic partners. Individual DD letters were mailed to each participating family, and a community meeting was held. A post-meeting survey was administered to gauge community perception of the DD strategies. The purpose of this article is to demonstrate the effectiveness of engaging community partners in the conduct of environmental health research and in the development of DD strategies for individuals and the community at large. Scientists should include community partners in the development of DD strategies to enhance translation of the research findings and support the right of study participants to know their individual results. PMID:26829152
Haynes, Erin N; Elam, Sarah; Burns, Roxanne; Spencer, Alonzo; Yancey, Elissa; Kuhnell, Pierce; Alden, Jody; Walton, Mike; Reynolds, Virgil; Newman, Nicholas; Wright, Robert O; Parsons, Patrick J; Praamsma, Meredith L; Palmer, Christopher D; Dietrich, Kim N
Federal funding agencies increasingly support stakeholder participation in environmental health studies, and yet there is very little published research on engagement of community members in the development of data disclosure (DD) strategies. The Ohio Environmental Protection Agency reported airborne manganese (Mn) concentrations in East Liverpool, Ohio, 30 times higher than the reference concentration, which led to an academic–community research partnership to address community concern about Mn exposure, particularly among children. Children and their families were recruited to participate in a pilot study. Samples of blood and hair were collected from the children and analyzed for metals. DD mechanisms were developed using an iterative approach between community and academic partners. Individual DD letters were mailed to each participating family, and a community meeting was held. A post-meeting survey was administered to gauge community perception of the DD strategies. The purpose of this article is to demonstrate the effectiveness of engaging community partners in the conduct of environmental health research and in the development of DD strategies for individuals and the community at large. Scientists should include community partners in the development of DD strategies to enhance translation of the research findings and support the right of study participants to know their individual results.
Whitley, Elizabeth M; Everhart, Rachel M; Wright, Richard A
Community health workers (CHWs) are effective in improving access to health care, promoting client knowledge and behavior change, and contributing to improved health status of individuals. However, few outreach programs have evaluated the financial impact of CHWs on health care systems and policies. A longitudinal repeated measures design was used to assess the return on investment (ROI) of outreach by CHWs employed by Denver Health Community Voices. Service utilization, charges and reimbursements for 590 underserved men were analyzed 9 months before and after interaction with a CHW. Primary and specialty care visits increased and urgent care, inpatient, and outpatient behavioral health care utilization decreased, resulting in a reduction of monthly uncompensated costs by $14,244. Program costs were $6,229 per month and the ROI was 2.28:1.00, a savings of $95,941 annually. These data provide evidence of economic contributions that CHWs make to a public safety net system and inform policy making regarding program sustainability.
Flynn, B S
Development of community ownership is often identified as an important intermediate objective of community health education programs. Community ownership is assumed to be important to program effectiveness and long-term maintenance, but validated measures of this construct have not been available to test this proposition. A measure of community leaders' perceived ownership of health education programs was developed and tested. The Community Ownership Scale identified key functions within a program and asked community leaders to rate the amount of control the leaders themselves, the external sponsoring agency and the local program staff had in each area. The measure was tested with the volunteer leadership of three community health education programs. Predictions about scores were based on the conceptual framework from which the ownership construct was derived. Results of these tests were consistent with predictions, providing evidence for the validity of the measure. Subscale scores showed high levels of internal consistency reliability. This measure could be applied at different stages in the life of a program to monitor the success of efforts to foster community ownership, and to test the relationships between perceived ownership and program effectiveness and maintenance.
Meyers, Diana; Allien, Charles E; Dunn, Donisha; Wennerstrom, Ashley; Springgate, Benjamin F
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.
Jernigan, David H; Sparks, Michael; Yang, Evelyn; Schwartz, Randy
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.
McMurray, L. and W. Templin-Branner
Environmental health focus with training conducted as part of the United Negro College Fund Special Programs Corporation/National Library of Medicine HBCU ACCESS Project at Winston-Salem State University, NC on November 10, 2010.
Wurster, Cecil R.; Goodman, John D.
Various approaches to centralized support of computer applications in health care are described. The NIMH project to develop a prototype Management Information System (MIS) for community mental health centers is presented and discussed as a centralized development of an automated data processing system for multiple user organizations. The NIMH program is summarized, the prototype MIS is characterized, and steps taken to provide for the differing needs of the mental health centers are highlighted.
Abstract Introduction 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. Methods 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. Results 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. Discussion and conclusion 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. PMID:27703545
Marston, Cicely; Hinton, Rachael; Kean, Stuart; Baral, Sushil; Ahuja, Arti; Costello, Anthony
Abstract 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. PMID:27152056
Marston, Cicely; Hinton, Rachael; Kean, Stuart; Baral, Sushil; Ahuja, Arti; Costello, Anthony; Portela, Anayda
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.
Street, Jackie M.; Braunack‐Mayer, Annette J.; Facey, Karen; Ashcroft, Richard E.; Hiller, Janet E.
Abstract Background Community views, expressed in social impact assessments and collected through community consultation, should play an important role in health technology assessment (HTA). Yet HTA methodologists have been slow to include outcomes of these forms of inquiry in analyses, in part because collecting community views is time‐consuming and resource intensive. Objective To explore how community views sourced from published studies, grey literature and informal internet web pages can inform HTA. Methods A technology reviewed by Adelaide HTA in 2004 was selected: retinal photography for detection of diabetic retinopathy. Published literature, ‘grey’ literature and informal web pages were searched to examine the availability of evidence about service community and user community views with respect to this technology. Particular efforts were made to source evidence relating to rural, remote and Aboriginal populations. Results We found that journal articles, reports from the grey literature and informal internet web pages (including blogs and discussion forums) can provide valuable insight into community views. Although there was little empirical evidence relating to the experience of diabetes and diabetes management in rural, remote and Aboriginal communities, there were indications that some evidence may be transferable from other populations. Conclusions Community perspectives on selected health technologies can be gauged from available resources in published and grey literature and perspectives collected in this way can provide insight into whether the introduction of the technology would be acceptable to the community. The limitations of this approach are discussed. PMID:18430153
Brito, Suerde Miranda de Oliveira; Domingos Sobrinho, Moisés
The study aimed at identifying the social representation of health education built by communitarian health workers. It was developed with 119 communitarian health workers in the city of João Pessoa, Paraíba, Brazil. Data were collected by the test of free association of words, questionnaires and interviews and analyzed by different methods and techniques. The results show: guidance, prevention and care as the centerpiece of representations. The peripheral: important, be prepared to guide, conduct, guidelines, professional, among others. The social representation of health education is structured in two levels: one aimed at informing the general public, another for professional training.
Eyre, Rachel; Gauld, Robin
Since the mid-1980s, the New Zealand health sector has been in a state of continual change. The most radical changes were in the early-1990s, with the creation of an internal market system for public health care delivery. Rural health services, seen to be unviable, were given the option of establishing themselves as 'community trusts', owning and running their own services. Community trusts have since become a feature of rural health care in New Zealand. An expectation was that community trusts would facilitate community participation. This article reports on a study of participation in a rural community health trust. The 'pentagram model' of Rifkin and coworkers, with its five dimensions of participation-needs assessment, leadership, resource mobilization, management and organization-was applied. High levels of participation were found across each of these dimensions. The research revealed additional dimensions that could be added to the framework, including 'sustainability of participation', 'equity in participation' and 'the dynamic socio-political context'. In this regard, it supports recent theoretical work by Laverack (2001) and Laverack and Wallerstein (2001). Finally, the article comments on the future of rural health trusts in the current round of health sector restructuring.
Haar, Mindy; Scanlan, Craig
Over the last decade, there has been a substantial increase in online education in the health professions, as well as growing recognition that teamwork and collaboration are essential to success. While the impact of students' sense of community on factors such as course satisfaction and retention has been studied among college enrollees in general, there is little research exploring this concept among allied health students. To address this shortcoming, a convenience sample of students enrolled in a large northeastern school of health-related professions was surveyed to gather information on their demographics, curriculum and selected course attributes, perceived instructor teaching perspectives, and sense of community. Univariate analysis indicated that entry-level students experienced a greater sense of community than post-professional students. Multivariate analysis revealed that instructor-determined factors of encouraging discussion, encouraging expression of opinions, and specifying response times best predicted sense of community. With all other variables controlled, perceptions of community were significantly lower in online courses, among students for whom English was their second language, and in courses where instructors were perceived as focused primarily on content delivery. This study supports promoting selected course and instructor-related attributes associated with sense of community in allied health education, with a particular focus on both non-native English speakers and post-professional students. Enhancement of online courses with strategies that increase instructor presence, better engage students, and facilitate interaction also are warranted.
Wong, Yin-Ling Irene; Sands, Roberta G; Solomon, Phyllis L
In this article we describe a focus group study of the perspectives of diverse groups of mental health consumers on the concept of community. We identify the core domains that constitute the notion of community, and commonalities and differences in the perception of community along the lines of ethnicity and sexual orientation/gender identity. Seven focus groups were conducted with a total of 62 participants. Transcripts were analyzed using the grounded theory approach.Two domains-togetherness and community acceptance-emerged as common to four types of communities that were most frequently mentioned in the focus group discussion. Our findings show that identities other than those associated with mental illness and the role of service user are critical to the understanding of the psychological sense of community among persons with psychiatric disabilities. We suggest that mental health providers empower consumers to expand their "personal communities" beyond that of mental health clients using their diverse identities, and design interventions for addressing the stigma emanating from identities that are discriminated against by the wider society.
Wisener, Katherine; Shapka, Jennifer; Jarvis-Selinger, Sandra
Despite evidence supporting the ongoing provision of health education interventions in First Nations communities, there is a paucity of research that specifically addresses how these programs should be designed to ensure sustainability and long-term effects. Using a Community-Based Research approach, a collective case study was completed with three Canadian First Nations communities to address the following research question: What factors are related to sustainable health education programs, and how do they contribute to and/or inhibit program success in an Aboriginal context? Semi-structured interviews and a sharing circle were completed with 19 participants, including members of community leadership, external partners, and program staff and users. Seven factors were identified to either promote or inhibit program sustainability, including: 1) community uptake; 2) environmental factors; 3) stakeholder awareness and support; 4) presence of a champion; 5) availability of funding; 6) fit and flexibility; and 7) capacity and capacity building. Each factor is provided with a working definition, influential moderators, and key evaluation questions. This study is grounded in, and builds on existing research, and can be used by First Nations communities and universities to support effective sustainability planning for community-based health education interventions.
Charzyńska-Gula, Marianna; Sygit, Katarzyna; Sygit, Marian; Goździewska, Małgorzata; Dobrowolska, Beata; Gałęziowska, Edyta
Health promotion is aimed at the reduction of the differences in society's access to factors determining the frequency of occurrence of pro-health behaviours. This means the construction of health resources and increase in the level of egalitarianism in access to these resources. Health education carried out on a high level in rural schools provides actual possibilities for gaining these resources. Many examples of educational practices confirm that the establishment of health conditioning and health behaviours of schoolchildren, and the diagnosis of rural school on the background of the specificity of the community in which it functions. These are a basis for the construction of effective educational programmes, and not analysis of the differences between urban and rural children and adolescents. In Poland, the performance of health education in rural schools encounters many problems associated both with the lack of infrastructure for health promotion, insufficient perception of the importance of health education at school by the educational authorities, underestimation of primary health care, low activity of the local governments, and lack of qualified rural health promoters. Current health education in Polish rural schools deepens inequalities in access to health, and postpones the moment of providing equal opportunities for rural and urban schoolchildren with access to the resources which condition the maintenance or even an enhancement of health. The objective of the study is to present selected problems in the performance of health education in a Polish rural school in the light of international trends, experiences and discussions related with an optimum form of health promotion in the environment of rural a school and the community.
Sciammas, Charlie; Seto, Edmund; Bhatia, Rajiv; Rivard, Tom
Health impacts on neighborhood residents from transportation systems can be an environmental justice issue. To assess the effects of transportation planning decisions, including the construction of an intraurban freeway, on residents of the Excelsior neighborhood in southeast San Francisco, PODER (People Organizing to Demand Environmental and Economic Rights), a local grassroots environmental justice organization; the San Francisco Department of Public Health; and the University of California, Berkeley, collaborated on participatory research. We used our findings regarding traffic-related exposures and health hazards in the area to facilitate community education and action to address transportation-related health burdens on neighborhood residents. PMID:19890147
Swenson, Nathan G; Mi, Xiangcheng; Kress, W John; Thompson, Jill; Uriarte, María; Zimmerman, Jess K
The species-area relationship (SAR) has proven to be one of the few strong generalities in ecology. The temporal analog of the SAR, the species-time relationship (STR), has received considerably less attention. Recent work primarily from the temperate zone has aimed to merge the SAR and the STR into a synthetic and unified species-time-area relationship (STAR) as originally envisioned by Preston (1960). Here we test this framework using two tropical tree communities and extend it by deriving a phylogenetic-time-area relationship (PTAR). The work finds some support for Preston's prediction that diversity-time relationships, both species and phylogenetic, are sensitive to the spatial scale of the sampling. Contrary to the Preston's predictions we find a decoupling of diversity-area and diversity-time relationships in both forests as the time period used to quantify the diversity-area relationship changes. In particular, diversity-area and diversity-time relationships are positively correlated using the initial census to quantify the diversity-area relationship, but weakly or even negatively correlated when using the most recent census. Thus, diversity-area relationships could forecast the temporal accumulation of biodiversity of the forests, but they failed to “back-cast” the temporal accumulation of biodiversity suggesting a decoupling of space and time. PMID:23762505
Swenson, Nathan G; Mi, Xiangcheng; Kress, W John; Thompson, Jill; Uriarte, María; Zimmerman, Jess K
The species-area relationship (SAR) has proven to be one of the few strong generalities in ecology. The temporal analog of the SAR, the species-time relationship (STR), has received considerably less attention. Recent work primarily from the temperate zone has aimed to merge the SAR and the STR into a synthetic and unified species-time-area relationship (STAR) as originally envisioned by Preston (1960). Here we test this framework using two tropical tree communities and extend it by deriving a phylogenetic-time-area relationship (PTAR). The work finds some support for Preston's prediction that diversity-time relationships, both species and phylogenetic, are sensitive to the spatial scale of the sampling. Contrary to the Preston's predictions we find a decoupling of diversity-area and diversity-time relationships in both forests as the time period used to quantify the diversity-area relationship changes. In particular, diversity-area and diversity-time relationships are positively correlated using the initial census to quantify the diversity-area relationship, but weakly or even negatively correlated when using the most recent census. Thus, diversity-area relationships could forecast the temporal accumulation of biodiversity of the forests, but they failed to "back-cast" the temporal accumulation of biodiversity suggesting a decoupling of space and time.
Carty, Denise C; Kruger, Daniel J; Turner, Tonya M; Campbell, Bettina; DeLoney, E Hill; Lewis, E Yvonne
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.
Johnson, Diane; Saavedra, Patricia; Sun, Eugene; Stageman, Ann; Grovet, Dodie; Alfero, Charles; Maynes, Carmen; Skipper, Betty; Powell, Wayne; Kaufman, Arthur
We describe the impact of community health workers (CHWs) providing community-based support services to enrollees who are high consumers of health resources in a Medicaid managed care system. We conducted a retrospective study on a sample of 448 enrollees who were assigned to field-based CHWs in 11 of New Mexico's 33 counties. The CHWs provided patients education, advocacy and social support for a period up to 6 months. Data was collected on services provided, and community resources accessed. Utilization and payments in the emergency department, inpatient service, non-narcotic and narcotic prescriptions as well as outpatient primary care and specialty care were collected on each patient for a 6 month period before, for 6 months during and for 6 months after the intervention. For comparison, data was collected on another group of 448 enrollees who were also high consumers of health resources but who did not receive CHW intervention. For all measures, there was a significant reduction in both numbers of claims and payments after the community health worker intervention. Costs also declined in the non-CHW group on all measures, but to a more modest degree, with a greater reduction than in the CHW group in use of ambulatory services. The incorporation of field-based, community health workers as part of Medicaid managed care to provide supportive services to high resource-consuming enrollees can improve access to preventive and social services and may reduce resource utilization and cost.
Ahmed, Syed; Franco, Zeno; Kissack, Anne; Gabriel, Davera; Hurd, Thelma; Ziegahn, Linda; Bates, Nancy J.; Calhoun, Karen; Carter-Edwards, Lori; Corbie-Smith, Giselle; Eder, Milton “Mickey”; Ferrans, Carol; Hacker, Karen; Rumala, Bernice B.; Strelnick, A. Hal; Wallerstein, Nina
The Clinical and Translational Science Awards (CTSA) program represents a significant public investment. To realize its major goal of improving the public’s health and reducing health disparities, the CTSA Consortium’s Community Engagement Key Function Committee has undertaken the challenge of developing a taxonomy of community health indicators. The objective is to initiate a unified approach for monitoring progress in improving population health outcomes. Such outcomes include, importantly, the interests and priorities of community stakeholders, plus the multiple, overlapping interests of universities and of the public health and health care professions involved in the development and use of local health care indicators. The emerging taxonomy of community health indicators that the authors propose supports alignment of CTSA activities and facilitates comparative effectiveness research across CTSAs, thereby improving the health of communities and reducing health disparities. The proposed taxonomy starts at the broadest level, determinants of health; subsequently moves to more finite categories of community health indicators; and, finally, addresses specific quantifiable measures. To illustrate the taxonomy’s application, the authors have synthesized 21 health indicator projects from the literature and categorized them into international, national, or local/special jurisdictions. They furthered categorized the projects within the taxonomy by ranking indicators with the greatest representation among projects and by ranking the frequency of specific measures. They intend for the taxonomy to provide common metrics for measuring changes to population health and, thus, extend the utility of the CTSA Community Engagement Logic Model. The input of community partners will ultimately improve population health. PMID:24556775
Willie, Charles V., Ed.; And Others
These 15 essays by leading psychiatrists, sociologists, educators, demographers, and health administrators are organized into four parts: "Overview,""Clinical Context,""Social Context," and "Action Context." Part I includes: "Racism and Mental Health as a Field of Thought and Action," Bernard M.…
15. Photocopy of architectural drawing (from Albuquerque Area Indian Health Service, Division of Health Facilities, Albuquerque, New Mexico) Mayers, Murray, and Phillip, Architects, New York, NY, 1934 First Floor - plumbing - Taos Indian Health Center, 0.3 mile south-southwest of Pueblos Plaza, Taos Pueblo, Taos County, NM
14. Photocopy of architectural drawing (from Albuquerque Area Indian Health Service, Division of Health Facilities, Albuquerque, New Mexico) Mayers, Murray, and Phillip, Architects, New York, N&, 1934 Foundation Plan - Taos Indian Health Center, 0.3 mile south-southwest of Pueblos Plaza, Taos Pueblo, Taos County, NM
18. Photocopy of architectural drawing (from Albuquerque Area Indian Health Service, Division of Health Facilities, Albuquerque, New Mexico) Mayers, Murray, and Phillip, Architects, New York, NY, 1934 Detail sheet - Taos Indian Health Center, 0.3 mile south-southwest of Pueblos Plaza, Taos Pueblo, Taos County, NM
16 Photocopy of architectural drawing (from Albuquerque Area Indian Health Service, Division of Health Facilities, Albuquerque, New Mexico) Mayers Murray, and Phillip, Architects, New York, NY, 1934 first floor mechanical plan - heating - Taos Indian Health Center, 0.3 mile south-southwest of Pueblos Plaza, Taos Pueblo, Taos County, NM
17. Photocopy of architectural drawing (from Albuquerque Area Indian Health Service, Division of Health Facilities, Albuquerque, New Mexico) Mayers, Murray, and Phillip, Architects, New York, NY, 1934 Elevations - Taos Indian Health Center, 0.3 mile south-southwest of Pueblos Plaza, Taos Pueblo, Taos County, NM
Tomah, Kent; And Others
Based on health education needs of Navajo children as established by the Navajo Area health and physical education committees, this curriculum guideline for health and physical education is delineated into three phases reflecting emphasis of instructional techniques (introductory, exploration/extended learning, widened learning) and three levels…
Brooks, Beth A; Davis, Sheila; Kulbok, Pamela; Frank-Lightfoot, Loraine; Sgarlata, Lisa; Poree, Shawanda
In light of the fragmentation of health care services and the need for health promotion and disease prevention, it is time to consider the important role community health workers (CHWs) could play as part of the health care team. Globally, CHWs tend to focus on a single patient condition, resulting in fragmented, uncoordinated health care services. Polyvalent (or multimodal) CHWs can provide a comprehensive, patient-centric range of care coordination services with other members of the health care team, ultimately improving patient outcomes and decreasing the cost of care. The potential benefits of the polyvalent CHW to the health care team are not widely understood in the United States. To fill this knowledge gap, a toolkit for nurse leaders in mainstream health care settings was created. The toolkit outlines the key elements essential to a successful CHW program and offers strategies for navigating the various challenges involved when integrating this new role into existing models of care.
Wilson, Michael G; Lavis, John N; Guta, Adrian
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
Green, Donna; Minchin, Liz
Closing the gap between the health and well-being status of Indigenous people living in remote areas of northern Australia and non-Indigenous Australians has long been a major target of federal health policy. With climate projections suggesting large increases in hot spells in desert regions and more extremes in rainfall in other areas of the north, direct and indirect impacts resulting from these changes are likely to further entrench this health and well-being disparity. This paper argues that it is time to explicitly draw on Indigenous definitions of health, which directly address the need to connect individual and community health to the health of their country, in order to develop effective climate adaptation and health strategies. We detail how current health policies overlook this 'missing' dimension of Indigenous connection to country, and why that is likely to be detrimental to the health and well-being of people living in remote communities in a climate-changed future.
Hsu, Chiehwen Ed; Mas, Francisco Soto; Jacobson, Holly E; Harris, Ann Marie; Hunt, Victoria I; Nkhoma, Ella T
Meeting the needs of public health emergency and response presents a unique challenge for health practitioners with primary responsibilities for rural communities that are often very diverse. The present study assessed the language capabilities, confidence and training needs of Texas rural physicians in responding to public health emergencies. In the first half of year 2004, a cross-sectional, semistructured survey questionnaire was administered in northern, rural Texas. The study population consisted of 841 practicing or retired physicians in the targeted area. One-hundred-sixty-six physicians (30%) responded to the survey. The responses were geographically referenced in maps. Respondents reported seeing patients with diverse cultural backgrounds. They communicated in 16 different languages other than English in clinical practice or at home, with 40% speaking Spanish at work. Most were not confident in the diagnosis or treatment of public health emergency cases. Geographic information systems were found useful in identifying those jurisdictions with expressed training and cultural needs. Additional efforts should be extended to involve African-American/Hispanic physicians in preparedness plans for providing culturally and linguistically appropriate care in emergencies.
Dulin-Keita, Akilah; Hannon, Lonnie; Buys, David; Casazza, Krista; Clay, Olivio
Using a community-engaged participatory research approach, this study identified surrounding community residents’ expectations for how a HOPE VI housing initiative might affect their community and individual health and physical activity. Fifty-nine women and men engaged in concept mapping, which is a mixed methods approach, where participants generate, sort, and rate ideas. Participants generated 197 unique statements. Thirteen thematic clusters related to expected changes for the community, health and physical activity emerged. Residents’ rated ‘Increased Pride in the Neighborhood’ and ‘Increased Safety’ as the most important factors related to HOPE VI whereas ‘Drawbacks of HOPE VI’ was rated as least important. This research provides insight into the potential impacts of housing initiatives from the perspective of those most affected by such initiatives. The findings also highlight environmental changes as potential mechanisms that may improve residents’ perceptions of the community and encourage healthy lifestyles. PMID:27667912
Nutbeam, Don; McGill, Bronwyn; Premkumar, Pav
Governments around the world have adopted national policies and programs to improve health literacy. This paper examines progress in the development of evidence to support these policies from interventions to improve health literacy among community populations. Our review found only a limited number of studies (n=7) that met the criteria for inclusion, with many more influenced by the concept of health literacy but not using it in the design and evaluation. Those included were diverse in setting, population and intended outcomes. All included educational strategies to develop functional health literacy, and a majority designed to improve interactive or critical health literacy skills. Several papers were excluded because they described a protocol for an intervention, but not results, indicating that our review may be early in a cycle of activity in community intervention research. The review methodology may not have captured all relevant studies, but it provides a clear message that the academic interest and attractive rhetoric surrounding health literacy needs to be tested more systematically through intervention experimentation in a wide range of populations using valid and reliable measurement tools. The distinctive influence of the concept of health literacy on the purpose and methodologies of health education and communication is not reflected in many reported interventions at present. Evidence to support the implementation of national policies and programs, and the intervention tools required by community practitioners are not emerging as quickly as needed. This should be addressed as a matter of priority by research funding agencies.
Knoff, Howard M.
Three areas of reform have been under national scrutiny: school reform, community services reform, and health-care reform. Few have discussed how these three areas interface and can be organized toward more effective services for children and youth. Describes organizational and planning methodology that coordinates these three reform areas into a…
Schrader, Elizabeth L.; Schrader, David C.
This paper applies concepts from intercultural communication theory, adult learning theory, and traditional Native American medicine to a specific learning experience for Native Americans. The background is an educational opportunity offered by the Indian Health Services Bureau to tribe members to become employed on their reservations as Health…
McMurray, L.; R. Foster; and R. Womble
Training update with Environmental a health focus. Training conducted as part of the United Negro College Fund Special Programs Corporation/National Library of Medicine - HBCU ACCESS Project at the University of the District of Columbia, Washington, DC on November 2, 2010.
Sen. Feingold, Russell D. [D-WI
06/03/2009 Read twice and referred to the Committee on Health, Education, Labor, and Pensions. (text of measure as introduced: CR S6034-6035) (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:
Sen. Reed, Jack [D-RI
06/04/2009 Read twice and referred to the Committee on Health, Education, Labor, and Pensions. (text of measure as introduced: CR S6202-6204) (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:
Sen. Bingaman, Jeff [D-NM
01/26/2009 Read twice and referred to the Committee on Health, Education, Labor, and Pensions. (text of measure as introduced: CR S836-838) (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:
Lavery, James V; Tinadana, Paulina O; Scott, Thomas W; Harrington, Laura C; Ramsey, Janine M; Ytuarte-Nuñez, Claudia; James, Anthony A
New technologies for global public health are spurring critical evaluations of the role of communities in research and what they receive in exchange for their participation. Community engagement activities resulting from these evaluations are most challenging for novel scientific ventures, particularly those involving controversial strategies and those in which some risks are poorly understood or determined. Remarkably, there is no explicit body of community engagement knowledge to which researchers can turn for guidance about approaches that are most likely to be effective in different contexts, and why. We describe here a framework that provides a starting point for broader discussions of community engagement in global health research, particularly as it relates to the development, evaluation and application of new technologies.
Watts, Vanessa M.; Christopher, Suzanne; Streitz, Jana L.; McCormick, Alma Knows His Gun
Community-based participatory research directly involves community members and community-based service providers as partners in the research process. It is especially important in Native American communities, where egregious research practices have led some communities and individuals to be wary of researchers. Messengers for Health uses a lay…
Garner, James A; Ahmad, H Anwar; Dacus, Chad M
Soil productivity effects nutritive quality of food plants, growth of humans and animals, and reproductive health of domestic animals. Game-range surveys sometimes poorly explained variations in wildlife populations, but classification of survey data by major soil types improved effectiveness. Our study evaluates possible health effects of lower condition and reproductive rates for wild populations of Odocoileus virginianus Zimmerman (white-tailed deer) in some physiographic regions of Mississippi. We analyzed condition and reproductive data for 2400 female deer from the Mississippi Department of Wildlife, Fisheries, and Parks herd health evaluations from 1991-1998. We evaluated age, body mass (Mass), kidney mass, kidney fat mass, number of corpora lutea (CL) and fetuses, as well as fetal ages. Region affected kidney fat index (KFI), which is a body condition index, and numbers of fetuses of adults (P≤0.001). Region affected numbers of CL of adults (P≤0.002). Mass and conception date (CD) were affected (P≤0.001) by region which interacted significantly with age for Mass (P≤0.001) and CD (P<0.04). Soil region appears to be a major factor influencing physical characteristics of female deer.
Clithero, Amy; Ross, Simone Jacquelyn; Middleton, Lyn; Reeve, Carole; Neusy, Andre-Jacques
Health professionals providing health-care services must have the relevant competencies and clinical experiences needed to improve population health outcomes in different contexts. Current models of health profession education often fail to produce a fit-for-purpose workforce ready and willing to provide relevant, quality care to underserved communities. Evidence is emerging that community-engaged and socially accountable health workforce education, i.e., aligned with priority health needs, produces a workforce ready and willing to work in partnership with underserved regions. This model of education fosters greater affiliation between education and service delivery systems and requires institutions to measure graduate outcomes and institutional impact. The Training for Health Equity Network (THEnet), a partnership of socially accountable health workforce education institutions, has developed and tested a Social Accountability Framework for Health Workforce Education (the Framework) and toolkit to improve alignment of health workforce education with outcomes to assess how well education institutions meet the needs of the communities they serve. The Framework links education and service delivery creating a continuous quality improvement feedback loop to ensure that education addresses needs and maximizes impact on the quality of service delivery. The Framework also provides a unifying set of guidelines for health workforce policy and planning, accreditation, education, research, and service delivery. A key element to ensuring consistent high quality service delivery is an appropriately trained and equitably distributed workforce. An effective and comprehensive mechanism for evaluation is the method of CQI which links the design, implementation, accreditation, and evaluation of health workforce education with health service delivery and health outcomes measurement. PMID:28289678
Clithero, Amy; Ross, Simone Jacquelyn; Middleton, Lyn; Reeve, Carole; Neusy, Andre-Jacques
Health professionals providing health-care services must have the relevant competencies and clinical experiences needed to improve population health outcomes in different contexts. Current models of health profession education often fail to produce a fit-for-purpose workforce ready and willing to provide relevant, quality care to underserved communities. Evidence is emerging that community-engaged and socially accountable health workforce education, i.e., aligned with priority health needs, produces a workforce ready and willing to work in partnership with underserved regions. This model of education fosters greater affiliation between education and service delivery systems and requires institutions to measure graduate outcomes and institutional impact. The Training for Health Equity Network (THEnet), a partnership of socially accountable health workforce education institutions, has developed and tested a Social Accountability Framework for Health Workforce Education (the Framework) and toolkit to improve alignment of health workforce education with outcomes to assess how well education institutions meet the needs of the communities they serve. The Framework links education and service delivery creating a continuous quality improvement feedback loop to ensure that education addresses needs and maximizes impact on the quality of service delivery. The Framework also provides a unifying set of guidelines for health workforce policy and planning, accreditation, education, research, and service delivery. A key element to ensuring consistent high quality service delivery is an appropriately trained and equitably distributed workforce. An effective and comprehensive mechanism for evaluation is the method of CQI which links the design, implementation, accreditation, and evaluation of health workforce education with health service delivery and health outcomes measurement.
Holden, Kisha; Akintobi, Tabia; Hopkins, Jammie; Belton, Allyson; McGregor, Brian; Blanks, Starla; Wrenn, Glenda
Health is a human right. Equity in health implies that ideally everyone should have a fair opportunity to attain their full health potential and, more pragmatically, that no one should be disadvantaged from achieving this potential. Addressing the multi-faceted health needs of ethnically and culturally diverse individuals in the United States is a complex issue that requires inventive strategies to reduce risk factors and buttress protective factors to promote greater well-being among individuals, families, and communities. With growing diversity concerning various ethnicities and nationalities; and with significant changes in the constellation of multiple of risk factors that can influence health outcomes, it is imperative that we delineate strategic efforts that encourage better access to primary care, focused community-based programs, multi-disciplinary clinical and translational research methodologies, and health policy advocacy initiatives that may improve individuals’ longevity and quality of life. PMID:27713839
Nimgaonkar, Alok U; Menon, Shylaja Devi
Psychiatric disorders constitute a major source of disability across the globe. In India, individuals with mental disorders are diagnosed and treated inadequately, particularly in under-served rural areas. We implemented and evaluated a psychiatric 'task shifting' program for a rural, marginalized, impoverished South Indian tribal community. The program was added to a pre-existing medical program and utilized community workers to improve health care delivery. Following community wide discussions, health workers were trained to provide community education and to identify and refer individuals with psychiatric problems to a community hospital. Subsequently, they also followed up the psychiatric patients to improve treatment adherence. The program was evaluated through medical records and community surveys. Treated patients experienced significant improvement in daily function (p=0.01). Mean treatment adherence scores remained stable at the beginning and end of treatment, overall. The proportion of self-referrals increased from 27% to 57% over three years. Surveys conducted before and after program initiation also suggested improved knowledge, attitudes and acceptance of mental illness by the community. The annual per capita cost of the program was 122.53 Indian Rupees per person per annum (USD 1.61). In conclusion, the community-driven psychiatric task shifting program was implemented successfully. It was accompanied by positive changes in knowledge, attitudes and practice. Initial community consultations and integration with a pre-existing medical program increased acceptance by the community and reduced costs. We recommend a similar model with integrated medical and psychiatric health care in other resource-deficient communities.
The rise of the active health care consumer in the United Kingdom requires a reformulation not only of the traditional relationship between patients and doctors, but also of the macro-politics of health which reflect and service that relationship. Market and democratic themes have supplied an ideological impetus to the pressures for change. The well-publicised problems of medical self-regulation have given them practical political expression. However, the response from the policy community still reflects the dominant partners within it, medicine and the state. What neither partner has recognised is that the functionality of the policy community has been undermined by the different and issue-based challenges to the traditional patient-doctor relationship. As a result, the state is likely to remain the lead player in an increasingly unstable politics of health where consumerist issues are on the policy agenda, but patient groups are still excluded from the policy community.
Catania, Valentina; Sarà, Gianluca; Settanni, Luca; Quatrini, Paola
Biodiversity is crucial in preservation of ecosystems, and bacterial communities play an indispensable role for the functioning of marine ecosystems. The Mediterranean marine protected area (MPA) "Capo Gallo-Isola delle Femmine" was instituted to preserve marine biodiversity. The bacterial diversity associated with MPA sediment was compared with that from sediment of an adjacent harbour exposed to intense nautical traffic. The MPA sediment showed higher diversity with respect to the impacted site. A 16S rDNA clone library of the MPA sediment allowed the identification of 7 phyla: Proteobacteria (78%), Firmicutes (11%), Acidobacteria (3%), Actinobacteria (3%), Bacteroidetes (2%), Planctomycetes (2%), and Cyanobacteria (1%). Analysis of the hydrocarbon (HC)-degrading bacteria was performed using enrichment cultures. Most of the MPA sediment isolates were affiliated with Gram-positive G+C rich bacteria, whereas the majority of taxa in the harbour sediment clustered with Alpha- and Gammaproteobacteria; no Gram-positive HC degraders were isolated from the harbour sediment. Our results show that protection probably has an influence on bacterial diversity, and suggest the importance of monitoring the effects of protection at microbial level as well. This study creates a baseline of data that can be used to assess changes over time in bacterial communities associated with a Mediterranean MPA.
Hartwig, Kari A; Mason, Meghan
Refugees and new immigrants arriving in the United States (U.S.) often encounter a multitude of stressors adjusting to a new country and potentially coping with past traumas. Community gardens have been celebrated for their role in improving physical and emotional health, and in the Twin Cities of Minnesota, have been offered as a resource to immigrants and refugees. The purpose of this study is to present a mixed method evaluation of a refugee gardening project hosted by area churches serving primarily Karen and Bhutanese populations. Quantitative data were obtained from early and late season surveys (44 and 45 % response rates, respectively), and seven focus groups conducted at the end of the season provided qualitative data. Although few gardeners (4 %) identified food insecurity as a problem, 86 % indicated that they received some food subsidy, and 78 % reported vegetable intake increased between the early and late season surveys. Twelve percent of gardeners indicated possible depression using the PHQ-2 scale; in focus groups numerous respondents identified the gardens as a healing space for their depression or anxiety. Refugee gardeners expressed receiving physical and emotional benefits from gardening, including a sense of identity with their former selves. Gardens may serve as a meaningful health promotion intervention for refugees and immigrants adjusting to the complexity of their new lives in the U.S. and coping with past traumas.
The Community Assessment Tool (CAT) for Public Health Emergencies Including Pandemic Influenza (hereafter referred to as the CAT) was developed as a result of feedback received from several communities. These communities participated in workshops focused on influenza pandemic planning and response. The 2008 through 2011 workshops were sponsored by the Centers for Disease Control and Prevention (CDC). Feedback during those workshops indicated the need for a tool that a community can use to assess its readiness for a disaster—readiness from a total healthcare perspective, not just hospitals, but the whole healthcare system. The CAT intends to do just that—help strengthen existing preparedness plans by allowing the healthcare system and other agencies to work together during an influenza pandemic. It helps reveal each core agency partners' (sectors) capabilities and resources, and highlights cases of the same vendors being used for resource supplies (e.g., personal protective equipment [PPE] and oxygen) by the partners (e.g., public health departments, clinics, or hospitals). The CAT also addresses gaps in the community's capabilities or potential shortages in resources. While the purpose of the CAT is to further prepare the community for an influenza pandemic, its framework is an extension of the traditional all-hazards approach to planning and preparedness. As such, the information gathered by the tool is useful in preparation for most widespread public health emergencies. This tool is primarily intended for use by those involved in healthcare emergency preparedness (e.g., community planners, community disaster preparedness coordinators, 9-1-1 directors, hospital emergency preparedness coordinators). It is divided into sections based on the core agency partners, which may be involved in the community's influenza pandemic influenza response.
Lounsbury, David; Rapkin, Bruce; Marini, Lisa; Jansky, Elizabeth; Massie, Mary Jane
This article presents findings from the ACCESS Project focusing on the impact of an outreach initiative that used "data sharing" as a mechanism to establish a wide variety of academic-community partnerships for cancer awareness. The Community Barometer, a brief needs assessment tool developed for this purpose, was used to collect data from clients, and sometimes staff members, of a variety of community-based organizations in New York City. Over a 5-year period, Barometer data were collected from 1,001 women who were affiliated with 20 community-based organizations. Analysis of these data supported our hypothesis that community-based organizations are more likely than chance to serve women with similar needs and preferences for breast health education and screening and that customized or tailored programs were warranted. Four case studies are presented. Limitations of the instrument and its administration in community settings as well as future research objectives are discussed.
Luke, Nancy; Xu, Hongwei
Much research attention has been devoted to community context and health. Communities are often defined as residential spaces, such as neighborhoods, or as social groupings, such as caste in India. Using data from a group of tea estates in South India, we attempt to address important methodological challenges in the identification of neighborhood effects on child health. We find significant neighborhood effects for weight for age at age one, including a protective role for community-level women's education, but none for birth weight. In contrast to the usual pattern in rural India, caste disparities in child health are also eliminated in this setting. PMID:25484619
Blank, Martin J
BACKGROUND Growing health disparities have a negative impact on young people's educational achievement. Community schools that involve deep relationships with partners across multiple domains address these disparities by providing opportunities and services that promote healthy development of young people, and enable them to graduate from high school ready for college, technical school, on-the-job training, career, and citizenship. METHODS Results from Milwaukie High School, North Clackamas, OR; Oakland Unified School District, Oakland, CA; and Cincinnati Community Learning Centers, Cincinnati, OH were based on a review of local site documents, web-based information, interviews, and e-mail communication with key local actors. RESULTS The schools and districts with strong health partnerships reflecting community schools strategy have shown improvements in attendance, academic performance, and increased access to mental, dental, vision, and health supports for their students. CONCLUSIONS To build deep health-education partnerships and grow community schools, a working leadership and management infrastructure must be in place that uses quality data, focuses on results, and facilitates professional development across sectors. The leadership infrastructure of community school initiatives offers a prototype on which others can build. Moreover, as leaders build cross-sector relationships, a clear definition of what scaling up means is essential for subsequent long-term systemic change. PMID:26440823
Skerritt, Louise; Moore, Zena
This study aimed to establish the prevalence and aetiology of wounds, allowing an insight into the management of wound care, the use of dressings and the nursing time allocated to the provision of wound care in a community setting in Ireland. A cross-sectional survey was used, with data collected on all clients in the community who received treatment from public health nurses or community registered general nurses for wound care over a 1-week period in April 2013. A 98.9% response rate was realised, and 188 people were identified as having wounds, equating to a crude prevalence of 5% of the active community nursing caseload. A total of 60% (n=112) had leg ulcers, 22% (n=42) had pressure ulcers, 16% (n=30) had an acute wound (surgical or traumatic wounds), 1% (n=2) had a diabetic foot wound and a further 1% (n=2) had wounds of other aetiologies. The mean duration of wounds was 5.41 months. A total of 18% of wounds were identified as infected; however, 60% (n=112) of wounds had antimicrobial products in use as either a primary or secondary dressing. The study established that there is a significant prevalence of wounds in this community care area. There was absence of a clinical diagnosis in many cases, and evidence of inappropriate dressing use, risking an increase in costs and a decrease in good clinical outcomes. It also highlighted the importance of ongoing education and auditing in the provision of wound care.
Shin, Peter; Sharac, Jessica; Jacobs, Feygele
The objective of this study was to assess the use of telemedicine services at community health centers. A national survey was distributed to all federally qualified health centers to gather data on their use of health information technology, including telemedicine services. Over a third of responding health centers (37%) provided some type of telemedicine service while 63% provided no telemedicine services. A further analysis that employed ANOVA and chi-square tests to assess differences by the provision of telemedicine services (provided no telemedicine services, provided one telemedicine service, and provided two or more telemedicine services) found that the groups differed by Meaningful Use compliance, location, percentage of elderly patients, mid-level provider, medical, and mental health staffing ratios, the percentage of patients with diabetes with good blood sugar control, and state and local funds per patient and per uninsured patient. This article presents the first national estimate of the use of telemedicine services at community health centers. Further study is needed to determine how to address factors, such as reimbursement and provider shortages, that may serve as obstacles to further expansion of telemedicine services use by community health centers.
Campbell, Catherine; Cornish, Flora
This special issue celebrates and maps out the 'coming of age' of community health psychology, demonstrating its confident and productive expansion beyond its roots in the theory and practice of small-scale collective action in local settings. Articles demonstrate the field's engagement with the growing complexity of local and global inequalities, contemporary forms of collective social protest and developments in critical social science. These open up novel problem spaces for the application and extension of its theories and methods, deepening our understandings of power, identity, community, knowledge and social change - in the context of evolving understandings of the spatial, embodied, relational, collaborative and historical dimensions of health.
Easpaig, Bróna R Nic Giolla; Fryer, David M; Linn, Seònaid E; Humphrey, Rhianna H
Queer-theoretical resources offer ways of productively rethinking how central concepts such as 'person-context', 'identity' and 'difference' may be understood for community health psychologists. This would require going beyond consideration of the problems with which queer theory is popularly associated to cautiously engage with the aspects of this work relevant to the promotion of collective practice and engaging with processes of marginalisation. In this article, we will draw upon and illustrate the queer-theoretical concepts of 'performativity' and 'cultural intelligibility' before moving towards a preliminary mapping of what a queer-informed approach to community health psychology might involve.
ORAU's Oak Ridge Institute for Science Education
The Community Assessment Tool (CAT) for Public Health Emergencies Including Pandemic Influenza (hereafter referred to as the CAT) was developed as a result of feedback received from several communities. These communities participated in workshops focused on influenza pandemic planning and response. The 2008 through 2011 workshops were sponsored by the Centers for Disease Control and Prevention (CDC). Feedback during those workshops indicated the need for a tool that a community can use to assess its readiness for a disaster - readiness from a total healthcare perspective, not just hospitals, but the whole healthcare system. The CAT intends to do just that - help strengthen existing preparedness plans by allowing the healthcare system and other agencies to work together during an influenza pandemic. It helps reveal each core agency partners (sectors) capabilities and resources, and highlights cases of the same vendors being used for resource supplies (e.g., personal protective equipment [PPE] and oxygen) by the partners (e.g., public health departments, clinics, or hospitals). The CAT also addresses gaps in the community's capabilities or potential shortages in resources. This tool has been reviewed by a variety of key subject matter experts from federal, state, and local agencies and organizations. It also has been piloted with various communities that consist of different population sizes, to include large urban to small rural communities.
Yacoob, May; Brantly, Eugene; Whiteford, Linda
In October 1992, the Water and Sanitation for Health (WASH) Project held a workshop to explore how the U.S. Agency for International Development (USAID) could incorporate community participation as a core element in projects to improve water supply, sanitation, and other environmental conditions of peri-urban areas in developing countries. The…
Bacon, T J; Baden, D J; Coccodrilli, L D
The Area Health Education Center (AHEC) program was established in 1972 to improve the supply, distribution, retention and quality of primary care and other health practitioners in medically underserved areas. Through academic/community partnerships, regional AHECs offer a broad array of educational programs for students, residents and practicing health professionals. With primary care medical education a core part of AHEC programs, AHECs have been involved in decentralized residency training from the outset, with particular attention to family medicine. This paper provides an overview of the national AHEC program, its core components and its support for primary care residency training. Although AHECs have achieved considerable success in training primary care physicians for their respective states, continued refinements of programs are needed to address the needs of the most rural and underserved communities.
Berrian, Amanda M; van Rooyen, Jacques; Martínez-López, Beatriz; Knobel, Darryn; Simpson, Gregory J G; Wilkes, Michael S; Conrad, Patricia A
We used a community engagement approach to develop a One Health profile of an agro-pastoralist population at the interface of wildlife areas in eastern South Africa. Representatives from 262 randomly-selected households participated in an in-person, cross-sectional survey. Questions were designed to ascertain the participants' knowledge, attitudes, and practices with regard to human health, domestic animal health, and natural resources including wildlife and water. Surveys were conducted within four selected villages by a team of trained surveyors and translators over four weeks in July-August 2013. Questions were a combination of multiple choice (single answer), multiple selection, open-ended, and Likert scale. The study found that nearly three-quarters of all households surveyed reported owning at least one animal (55% owned chickens, 31% dogs, 25% cattle, 16% goats, 9% cats, and 5% pigs). Among the animal-owning respondents, health concerns identified included dissatisfaction with government-run cattle dip facilities (97%) and frequent morbidity and mortality of chickens that had clinical signs consistent with Newcastle disease (49%). Sixty-one percent of participants believed that diseases of animals could be transmitted to humans. Ninety-six percent of respondents desired greater knowledge about animal diseases. With regard to human health issues, the primary barrier to health care access was related to transportation to/from the community health clinics. Environmental health issues revealed by the survey included disparities by village in drinking water reliability and frequent domiciliary rodent sightings positively associated with increased household size and chicken ownership. Attitudes towards conservation were generally favorable; however, the community demonstrated a strong preference for a dichotomous approach to wildlife management, one that separated wildlife from humans. Due to the location of the community, which neighbors the Great Limpopo
Environmental Health Education (EHE) is most effective when it incorporates environmental science, risk education, and health education. When paired with the local knowledge of community members, EHE can promote health equity and community action, especially for socially disadvan...
Greeff, M; van der Walt, E; Strydom, C; Wessels, C; Schutte, P J
For several years the School of Nursing Science and the School of Psychosocial Behavioural Science, of a specific university, have been offering health care services in response to some of the health needs of a disadvantaged community as part of their students' experiential learning. However, these health care services were rendered independently by these two schools, implying that no feedback system existed to evaluate the worth and quality of these student-rendered health care services. The objectives of this research were to explore and describe the experiences of senior nursing and social work students, the experiences of health service delivery organisations concerned and the experiences of the disadvantaged community members receiving such health care services, as well as to investigate which communication models were apparent with regard to the major factors within health communication. An exploratory descriptive qualitative research design was used. Focus group discussions were held, interviews were conducted and field notes taken. Focus group discussions and interviews were transcribed and analysed by the research team to determine themes and sub-themes using the open coding technique. The results of the three groups showed similarities. The health service delivery organisations also identified a communication barrier, although the students were prepared to bridge it. The health service delivery organisations and the community felt positive towards the students and what they offered to the organisations and to the patients. A greater need for multi-disciplinary team work was recognised by al parties concerned. Recommendations focus on improved student accompaniment by lecturers; extending health care delivery to include a multi-disciplinary team approach by students; as well as improving the delivery of health care services.
Online peer support communities play an important part in many people’s experience of healthcare. They can be particularly significant in behavioral health/mental health due to the difficulties that people may experience in accessing face to face care for these conditions. There is considerable diversity of practice in service management, target group, and moderation practices of online peer support communities. People using the communities also appear to have diverse aims and experiences. This heterogeneity contributes to a relative lack of data about the value and effectiveness of online peer support in behavioral health, although there is significant research into some aspects of these communities. The digital behavioral health service Big White Wall was launched in the UK in 2007, and in the US in 2015, and is focused on delivering moderated peer support. There are considerable differences in health systems between the two countries, and this has been reflected in different experiences of implementation. The value of online peer support could be maximized if systemic challenges to implementation and adoption were addressed more effectively. PMID:28293613
Bulut, A; Uzel, N; Kutluay, T; Neyzi, O
A project aiming at creating a model for comprehensive maternal and child health care for urban underdeveloped areas was started in a new settlement area of migrants in the vicinity of Istanbul. The project had an impact on health care status, particularly among infants and children, but the results indicated that more effort was needed to reach the mothers. It was noted that building space and the appearance of the work place influenced the prestige of the team. Absentee problems could be partly surmounted by repeated home visits. Based on this experience, it was concluded that health services in underdeveloped areas need to be supported by non medical personnel to act as home visitors and as mediators between the community and the health team. It was also concluded that an established recording system to include both clinical data and attendance is needed to define the cases who need special care.
... Associated Areas Where a CQE Representing an Eligible Community May Be Permitted To Participate 21 Table 21 to Part 679 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND... ALASKA Pt. 679, Table 21 Table 21 to Part 679—Eligible Communities, Halibut IFQ Regulatory Area...
... Associated Areas Where a CQE Representing an Eligible Community May Be Permitted To Participate 21 Table 21 to Part 679 Wildlife and Fisheries FISHERY CONSERVATION AND MANAGEMENT, NATIONAL OCEANIC AND... ALASKA Pt. 679, Table 21 Table 21 to Part 679—Eligible Communities, Halibut IFQ Regulatory Area...
Baillie, Lynne; Broughton, Sandra; Bassett-Smith, Joan; Aasen, Wendy; Oostindie, Madeleine; Marino, Betty Anne; Hewitt, Ken
The Primary Prevention of Cancer Program at the British Columbia Cancer Agency Centre for the Southern Interior (BCCA-CSI), known as the Waddell Project, is now five years old and currently is in partnership with fourteen regional communities. Each of these communities has a range of community-developed programs currently in place. The driving…
Kudless, Mary W; White, Jane H
Community mental health nurses practice in a range of behavioral health care settings, including community mental health centers, detoxification centers, group homes for individuals with mental retardation or serious mental illnesses, and residential substance abuse treatment programs. As the population for whom they care grows and ages and with an increase in comorbid conditions, different skills may be needed or different roles may require emphasis. This can present challenges related to role competencies and nursing preparation and to the allocation of their time. The overall purposes of this project were to compare the competencies of basic and advanced practice nurses with accepted psychiatric-mental health nursing competencies and to assess the nurses' roles and division of work time among various roles. The findings support the need for changes related to nursing roles and job descriptions. Specific recommendations have been implemented based on the findings.
The following reflections on the author's management practice are based on the text of an address given by the author at the 1999 International Conference of the Royal Australasian College of Medical Administrators in Sydney. These reflections arise out of the author's experience for the past 5 years as manager of Nganampa Health Council, an Aboriginal community-controlled health organisation located in the remote north-west of South Australia. Nganampa Health Council is a large regional service with a national reputation for clinical and administrative excellence. It has several leading-edge health programs, which provide an exemplar for other remote health services across Australia. The author discusses three generic key management issues that remote health services managers typically encounter and argues that services are likely to be most effective when resources are applied in a focused and strategic manner and when management practices that are pragmatic and culturally appropriate are adopted.
Botvin, Judith D
A seafaring theme seems unusual for a system based in Sun City, Ariz., but Sun Health uses it to good advantage in its 2002 Report to the Community. The title, Stay the Course, refers to the fact the system plans to stay afloat after four consecutive years of operational losses. Now completing its 15th year, Sun Health tells readers how it hopes to navigate around the reefs and find clear waters.
... 42 Public Health 1 2010-10-01 2010-10-01 false Compliance alternative for community health centers, migrant health centers and certain National Health Service Corps sites. 124.515 Section 124.515 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH RESOURCES...
Vandebroek, Ina; Thomas, Evert; Sanca, Sabino; Van Damme, Patrick; Puyvelde, Luc Van; De Kimpe, Norbert
Background The objective of the present study was to reveal patterns in the treatment of health conditions in a Quechua-speaking community in the Bolivian Andes based on plant use data from traditional healers and patient data from a primary health care (PHC) service, and to demonstrate similarities and differences between the type of illnesses treated with traditional and biomedical health care, respectively. Methods A secondary analysis of plant use data from semi-structured interviews with eight healers was conducted and diagnostic data was collected from 324 patients in the community PHC service. Health conditions were ranked according to: (A) the percentage of patients in the PHC service diagnosed with these conditions; and (B) the citation frequency of plant use reports to treat these conditions by healers. Healers were also queried about the payment modalities they offer to their patients. Results Plant use reports from healers yielded 1166 responses about 181 medicinal plant species, which are used to treat 67 different health conditions, ranging from general symptoms (e.g. fever and body pain), to more specific ailments, such as arthritis, biliary colic and pneumonia. The results show that treatment offered by traditional medicine overlaps with biomedical health care in the case of respiratory infections, wounds and bruises, fever and biliary colic/cholecystitis. Furthermore, traditional health care appears to be complementary to biomedical health care for chronic illnesses, especially arthritis, and for folk illnesses that are particularly relevant within the local cultural context. Payment from patients to healers included flexible, outcome contingent and non-monetary options. Conclusion Traditional medicine in the study area is adaptive because it corresponds well with local patterns of morbidity, health care needs in relation to chronic illnesses, cultural perceptions of health conditions and socio-economic aspects of health care. The quantitative
Community-based health promotion is poorly theorised and lacks an agreed evidence-base. This paper examines characteristics of community-based health promotion and the challenges they present to evaluation. A review of health promotion evaluation leads to an exploration of more recent approaches, drawing on ideas from complexity theory and developmental evaluation. A reflexive analysis of three program evaluations previously undertaken as an evaluation consultant is used to develop a conceptual model to help in the design and conduct of health promotion evaluation. The model is further explored by applying it retrospectively to one evaluation. Findings suggest that the context-contingent nature of health promotion programs; turbulence in the community context and players; multiple stakeholders, goals and strategies; and uncertainty of outcomes all contribute to the complexity of interventions. Bringing together insights from developmental evaluation and complexity theory can help to address some evaluation challenges. The proposed model emphasises recognising and responding to changing contexts and emerging outcomes, providing rapid feedback and facilitating reflexive practice. This will enable the evaluator to gain a better understanding of the influence of context and other implementation factors in a complex setting. Use of the model should contribute to building cumulative evidence and knowledge in order to identify the principles of health promotion effectiveness that may be transferable to new situations.
Araújo, Maria Rizoneide Negreiros; Assunção, Raquel Silva
This article discusses practices developed by the community health agency in the Family Health Program of Divinópolis--MG reporting on practices in the fields of Health Promotion and Disease Prevention, taking as main reference the principles established at the 1st International Health Promotion Conference, which took place in Canada in 1986. Field research was carried out by questionnaire, direct observation of work and open interviews with community health agencies. A qualitative approach was chosen in which the concepts and statements of the subjects were dealt with in the light of historical and dialectical materialism, and the organization and analysis of the discourses according to the Discourse of the Collective Subject. We conclude that the community health agency performs actions recommended by the Ministry of Health, and that its health promoting actions are confined to the creation of environments favorable to health, actions in the home. It works more widely in disease prevention, in individual actions, health education for the community and for groups at risk, and controlling infectious disease and parasites such as dengue and worms. Its focus of attention is predominantly the individual and not the family.
Fulcher, Christopher L; Kaukinen, Catherine E
Given changes in the faces of AIDS over the last decade, it is crucial that disparities in health and access to healthcare are addressed. An Internet-based GIS was developed using ESRI's Arc Internet Map Server (Arc IMS) to provide users with a suite of tools to interact with geographic data and conduct spatial analyses related to the characteristics that promote or impede the provision of HIV-related services. Internet Mapping allows those engaged in local decision-making to: (1) geographically visualize information via the Internet; (2) Assess the relationship between the distribution of HIV services and spatially referenced socio-economic data; and (3) generate "what if" scenarios" that may direct the allocation of healthcare resources.
A resolution recognizing that access to hospitals and other health care providers for patients in rural areas of the United States is essential to the survival and success of communities in the United States.
Sen. Moran, Jerry [R-KS
02/07/2013 Referred to the Committee on Health, Education, Labor, and Pensions. (text of measure as introduced: CR S527) (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:
Chandra, Anita; Miller, Carolyn E; Acosta, Joie D; Weilant, Sarah; Trujillo, Matthew; Plough, Alonzo
Making health a shared value is central to building a culture of health, a new action framework intended to spur faster progress toward equitable health outcomes in the United States. Unlike in other US social movements, such as the environmental and civil rights movements, the necessary understanding of shared values has not yet been achieved for health. Discussions about values regarding health have primarily focused on health care instead of health or well-being. These discussions have not progressed to a clear focus on prioritizing values on health instead of simply health care. The evidence base for understanding health as a shared value is only now emerging. Making health a shared value is the first of four Action Areas in the Robert Wood Johnson Foundation's Culture of Health Action Framework. We assert that the achievement of this shared understanding of health as a cultural value will be enhanced through action in specific drivers: mindset and expectations, sense of community, and civic engagement. Building on a literature review and stakeholder engagement, this article examines the evidence base for these drivers and identifies where policy and research actions are needed to advance positive change on population health and well-being outcomes.
Aungst, Heide; Ruhe, Mary; Stange, Kurt C; Allan, Terry M; Borawski, Elaine A; Drummond, Colin K; Fischer, Robert L; Fry, Ronald; Kahana, Eva; Lalumandier, James A; Mehlman, Maxwell; Moore, Shirley M
Boundaries, which are essential for the healthy functioning of individuals and organisations, can become problematic when they limit creative thought and action. In this article, we present a framework for promoting health across boundaries and summarise preliminary insights from experience, conversations and reflection on how the process of boundary spanning may affect health. Boundary spanning requires specific individual qualities and skills. It can be facilitated or thwarted by organisational context. Boundary spanning often involves risk, but may reap abundant rewards. Boundary spanning is necessary to optimise health and health care. Exploring the process, the landscape and resources that enable boundary spanning may yield new opportunities for advancing health. We invite boundary spanners to join in a learning community to advance understanding and health.
Frounfelker, Rochelle; Mishra, Tej; Hussein, Aweis; Falzarano, Rita
Objectives. We sought to understand the problems, strengths, and help-seeking behaviors of Somali Bantu and Bhutanese refugees and determine local expressions of mental health problems among youths in both communities. Methods. We used qualitative research methods to develop community needs assessments and identify local terms for child mental health problems among Somali Bantu and Bhutanese refugees in Greater Boston and Springfield, Massachusetts, between 2011 and 2014. A total of 56 Somali Bantu and 93 Bhutanese refugees participated in free list and key informant interviews. Results. Financial and language barriers impeded the abilities of families to assist youths who were struggling academically and socially. Participants identified resources both within and outside the refugee community to help with these problems. Both communities identified areas of distress corresponding to Western concepts of conduct disorders, depression, and anxiety. Conclusions. There are numerous challenges faced by Somali Bantu and Bhutanese youths, as well as strengths and resources that promote resilience. Future steps include using culturally informed methods for identifying those in need of services and developing community-based prevention programs. PMID:25905818
Davis, Lwendo Moonzwe; Schensul, Stephen L.; Schensul, Jean J.; Verma, Ravi; Nastasi, Bonnie K.; Singh, Rajendra
This paper examines the relationship of empowerment to women's self-reported general health status and women's self-reported health during pregnancy in low-income communities in Mumbai. The data on which this paper is based were collected in three study communities located in a marginalized area of Mumbai. We draw on two data sources: in-depth qualitative interviews conducted with 66 married women and a survey sample of 260 married women. Our analysis shows that empowerment functions differently in relation to women's reproductive status. Non-pregnant women with higher levels of empowerment experience greater general health problems, while pregnant women with higher levels of empowerment are less likely to experience pregnancy related health problems. We explain this non-intuitive finding and suggest that a globally defined empowerment measure for women may be less useful that one that is contextually and situationally defined. PMID:24766149
Dulin, Mary Katherine; Olive, Kenneth E; Florence, Joseph A; Sliger, Carolyn
There has been little discussion in the literature regarding the financial value of the services provided to the participants in health fairs. This article examines the financial value of preventive services provided through a community health fair in an economically depressed area of southwest Virginia. Current Procedural Terminology codes were assigned to the services provided in order to estimate costs participants might incur for such services. An average 50-year-old man would have paid up to $320 to obtain commonly recommended preventive services available free at the fair. An average 50-year-old woman would have paid up to $495. Overall, over $58,000 in services were provided through the health fair. This community health fair provided preventive services that many participants otherwise might have found to be cost-prohibitive.
Mahaffey, Lisa; Burson, Kathrine A; Januszewski, Celeste; Pitts, Deborah B; Preissner, Katharine
Occupational therapists must be aware of professional and policy trends. More importantly, occupational therapists must be involved in efforts to influence policy both for the profession and for the people they serve (Bonder, 1987). Using the state of Illinois as an example, this article reviews the policies and initiatives that impact service decisions for persons with psychiatric disabilities as well as the rationale for including occupational therapy in community mental health service provision. Despite challenges in building a workforce of occupational therapists in the mental health system, this article makes the argument that the current climate of emerging policy and litigation combined with the supporting evidence provides the impetus to strengthen mental health as a primary area of practice. Implications for scholarship of practice related to occupational therapy services in community mental health programs for individuals with psychiatric disability are discussed.
Waters, William F; Gallegos, Carlos A
Middle-income countries like Ecuador are in the process of demographic and epidemiological transitions, and their populations are aging. The challenges associated with providing services to growing numbers of citizens who experience the inevitable deterioration associated with aging are mirrored by the manner in which aging is perceived in a culturally heterogeneous society. This paper presents the results of qualitative research conducted among older men and women in indigenous communities in the Ecuadorian highlands in order to investigate the perceptions regarding the ability of family and community networks to provide adequate and appropriate support for older persons in the context of their perceptions of health, health care, and aging. The principal findings are that: (i) perceptions of aging are shaped by chronic illness, fatigue, deteriorating sensory capacities, and vulnerability to accidents; (ii) barriers to health care are exacerbated among aging members of indigenous communities, although in some cases they can be addressed through traditional alternatives; (iii) the sense of identity shifts as aging people are increasingly unable to work the land and participate in community activities; and (iv) family and community support networks for older adults are not as strong as is generally thought. These findings represent the context within which issues related aging in a culturally heterogeneous society can be best understood and addressed.
Kwon, Bum Chul; Kim, Sung-Hee; Lee, Sukwon; Choo, Jaegul; Huh, Jina; Yi, Ji Soo
Through online health communities (OHCs), patients and caregivers exchange their illness experiences and strategies for overcoming the illness, and provide emotional support. To facilitate healthy and lively conversations in these communities, their members should be continuously monitored and nurtured by OHC administrators. The main challenge of OHC administrators' tasks lies in understanding the diverse dimensions of conversation threads that lead to productive discussions in their communities. In this paper, we present a design study in which three domain expert groups participated, an OHC researcher and two OHC administrators of online health communities, which was conducted to find with a visual analytic solution. Through our design study, we characterized the domain goals of OHC administrators and derived tasks to achieve these goals. As a result of this study, we propose a system called VisOHC, which visualizes individual OHC conversation threads as collapsed boxes-a visual metaphor of conversation threads. In addition, we augmented the posters' reply authorship network with marks and/or beams to show conversation dynamics within threads. We also developed unique measures tailored to the characteristics of OHCs, which can be encoded for thread visualizations at the users' requests. Our observation of the two administrators while using VisOHC showed that it supports their tasks and reveals interesting insights into online health communities. Finally, we share our methodological lessons on probing visual designs together with domain experts by allowing them to freely encode measurements into visual variables.
Kwon, Bum Chul; Kim, Sung-Hee; Lee, Sukwon; Choo, Jaegul; Huh, Jina; Yi, Ji Soo
Through online health communities (OHCs), patients and caregivers exchange their illness experiences and strategies for overcoming the illness, and provide emotional support. To facilitate healthy and lively conversations in these communities, their members should be continuously monitored and nurtured by OHC administrators. The main challenge of OHC administrators' tasks lies in understanding the diverse dimensions of conversation threads that lead to productive discussions in their communities. In this paper, we present a design study in which three domain expert groups participated, an OHC researcher and two OHC administrators of online health communities, which was conducted to find with a visual analytic solution. Through our design study, we characterized the domain goals of OHC administrators and derived tasks to achieve these goals. As a result of this study, we propose a system called VisOHC, which visualizes individual OHC conversation threads as collapsed boxes–a visual metaphor of conversation threads. In addition, we augmented the posters' reply authorship network with marks and/or beams to show conversation dynamics within threads. We also developed unique measures tailored to the characteristics of OHCs, which can be encoded for thread visualizations at the users' requests. Our observation of the two administrators while using VisOHC showed that it supports their tasks and reveals interesting insights into online health communities. Finally, we share our methodological lessons on probing visual designs together with domain experts by allowing them to freely encode measurements into visual variables. PMID:26529688
Tu Do, V.; de Montaudouin, Xavier; Lavesque, Nicolas; Blanchet, Hugues; Guyard, Hervé
This study provided evidence that Zostera noltii presence affects macrofauna community structure independently from median sediment grain-size and that the notion of ecosystem health is rather subjective: in the present case, we recorded "good health" in terms of seagrass development, "no impact" in terms of macrobenthic biotic indices and "negative effect" for a given key-population. The occurrence and development of a Z. noltii seagrass bed was surveyed at Banc d'Arguin, Arcachon Bay (France), to estimate the modification of the macrozoobenthic community and of the dynamics of a key-population for the local ecosystem, - the cockle Cerastoderma edule. Even though median grain-size of the sediment decreased only at the very end of the survey, i.e. when seagrass totally invaded the area, most of the macrofauna community characteristics (such as abundance and biomass) increased as soon as Z. noltii patches appeared. The structure of the macrofauna community also immediately diverged between sand and seagrass habitats, without however modifying the tested biotic indices (BENTIX, BOPA, AMBI). The health of the cockle population (growth, abundance, recruitment) was impacted by seagrass development. Related parasite communities slowly diverged between habitats, with more parasites in the cockles from seagrass areas. However, the number of parasites per cockle was always insufficient to alter cockle fitness.
Background The model of volunteer community health workers (CHWs) is a common approach to serving the poor communities in developing countries. BRAC, a large NGO in Bangladesh, is a pioneer in this area, has been using female CHWs as core workers in its community-based health programs since 1977. After 25 years of implementing of the CHW model in rural areas, BRAC has begun using female CHWs in urban slums through a community-based maternal health intervention. However, BRAC experiences high dropout rates among CHWs suggesting a need to better understand the impact of their dropout which would help to reduce dropout and increase program sustainability. The main objective of the study was to estimate impact of dropout of volunteer CHWs from both BRAC and community perspectives. Also, we estimated cost of possible strategies to reduce dropout and compared whether these costs were more or less than the costs borne by BRAC and the community. Methods We used the ‘ingredient approach’ to estimate the cost of recruiting and training of CHWs and the so-called ‘friction cost approach’ to estimate the cost of replacement of CHWs after adapting. Finally, we estimated forgone services in the community due to CHW dropout applying the concept of the friction period. Results In 2009, average cost per regular CHW was US$ 59.28 which was US$ 60.04 for an ad-hoc CHW if a CHW participated a three-week basic training, a one-day refresher training, one incentive day and worked for a month in the community after recruitment. One month absence of a CHW with standard performance in the community meant substantial forgone health services like health education, antenatal visits, deliveries, referrals of complicated cases, and distribution of drugs and health commodities. However, with an additional investment of US$ 121 yearly per CHW BRAC could save another US$ 60 invested an ad-hoc CHW plus forgone services in the community. Conclusion Although CHWs work as volunteers in Dhaka
National Inst. of Mental Health (DHEW), Rockville, MD. Center for Studies of Child and Family Mental Health.
The need to help the emotionally disturbed is discussed with a focus on community mental health centers. Psychiatric services described are diagnosis, inpatient care, day care, outpatient care, emergency care, continuity of care and services, and care adjusted to age groupings ranging from infancy to adolescence. Aspects of the community goal of…
Sakti, G M; Boldy, D P
This study assessed the usefulness and relevance of the information, which had been provided by the Ministry of Health for use in community health centers. Furthermore, this identified the needs of health professionals in terms of relevant information for providing health care to the elderly in the community health centers. A total of 105 questionnaires were administered to 35 doctors and 70 health care workers. The overall response rate of the 105 questionnaires sent out was 80%. Findings revealed that the overall opinion expressed by the health professionals was that the information leaflets, in general, were good. However, some gaps existed between the information provided by the Ministry of Health and the information needs perceived by health professionals working in community health centers for providing health care to the elderly. The majority commented that pertinent information on health problems related to hypertension, arthritis, and heart disease needed to be added. Furthermore, effective pre-testing of the prepared information materials with the target groups before their production and distribution may lessen such gaps or deficiencies. Recommendations to ensure appropriate information are also given and presented in this article.
Clancy, Gerard P; Duffy, F Daniel
Oklahoma's health status ranks among the lowest of the states', yet many Oklahomans oppose the best-known aspects of federal health reform legislation. To address this situation, the University of Oklahoma College of Medicine's School of Community Medicine in Tulsa adopted an "all-in," fully committed approach to transform the Tulsa region's health care delivery system and health care workforce teaching environment by leading community-wide initiatives that took advantage of lesser-known health reform provisions. Medical school leaders shared a vision of improved health for the region with a focus on equity in care for underserved populations. They engaged Tulsa stakeholders to implement health system changes to improve care access, quality, and efficiency. A partnership between payers, providers, and health systems transformed primary care practices into patient-centered medical homes (PCMHs) and instituted both community-wide care coordination and a regional health information exchange. To emphasize the importance of these new approaches to improving the health of an entire community, the medical school began to transform the teaching environment by adding several interdependent experiences. These included an annual interdisciplinary summer institute in which students and faculty from across the university could explore firsthand the social determinants of health as well as student-run PCMH clinics for the uninsured to teach systems-based practice, team-based learning, and health system improvement. The authors share lessons learned from these collaborations. They conclude that working across competitive boundaries and going all in are necessary to improve the health of a community.
Murphy, Andrea L.; Gardner, David M.; Martin-Misener, Ruth; Naylor, Ted; Kutcher, Stan P.
Background: Community pharmacists care for and support people with lived experience of mental illness in their communities. We developed a program called More Than Meds to facilitate enhancing capacity of community pharmacists’ roles in mental health care. Methods: We conducted a qualitative study and used a directed content analysis with application of the Theoretical Domains Framework as part of our underlying theory of behaviour change and our analytic framework. Results: Ten interviews (n = 6 pharmacists, n = 4 community members) were conducted with participants from the More Than Meds program. Three key themes were identified from the experiences of More Than Meds participants: networking and bridging, stigma, and expectations and permissions. The most frequently coded domains in the data from the Theoretical Domains Framework were social/professional role, skills, beliefs about capabilities, knowledge and environmental context and resources. Conclusions: The More than Meds Program enabled community pharmacists to increase their capabilities, opportunities and motivation in providing mental health care and support. Involving community pharmacists together with people with lived experience of mental illness was identified as an innovative component of the program. PMID:26600823
Kegler, Michelle C; Rigler, Jessica; Honeycutt, Sally
The current study examines how community context affected collaborative planning and implementation in eight sites participating in a healthy cities and communities initiative in California. Data are from 23 focus groups conducted with coalition members, and 76 semi-structured interviews with local coordinators and community leaders. Multiple case study methods were used to identify major themes related to how five contextual domains influenced collaborative planning and implementation. Results showed that history of collaboration can influence resources and interpersonal and organizational connections available for planning and implementation, as well as priorities selected for action. Community politics and history can affect which segments of the community participate in a planning process and what issues are prioritized, as well as the pool of partners willing to aid in implementation. Some community norms and values bring people together and others appear to limit involvement from certain groups. Community demographics and economic conditions may shape outreach strategies for planning and implementation, and may also shape priorities. Geography can play a role in assessment methods, priority selection, partners available to aid in implementation, and participation in activities and events. Results suggest that community context plays a substantive role in shaping how community-based health promotion projects unfold.
Empowerment as social action addresses lack of control by enhancing participation in community action. An alcohol and substance abuse prevention program for New Mexico adolescents used Freire's problem posing and critical thinking philosophy and methods to empower young people to change their health behavior. (SK)
Clarke, Pamela N.; And Others
According to responses from 23 of 52 doctoral nursing program directors and interviews with 16, newer programs tend to offer more general rather than specialized curricula. Only four identified community health nursing as a specialty, all in older, long-standing programs. (SK)
World Health Organization, Geneva (Switzerland).
This task-oriented manual for the training of community health workers in nutrition presents information and instructions in two parts. The first part consists of three chapters. The first chapter introduces the guidelines; the second deals with teaching skills and is intended to improve teaching. The third chapter presents some basic facts about…
Freadling, Amy H.; Foss-Kelly, Louisa L.
This phenomenological study explored 6 new counselors' experiences working in community mental health centers and their experiences of the Council for Accreditation of Counseling and Related Educational Programs-accredited training received in preparation for such work. Three themes from the interviews were identified to provide implications…
Nakamura, Naoki; Nakayama, Masaharu; Nakaya, Jun; Tominaga, Teiji; Suganuma, Takuo; Shiratori, Norio
After the Great East Japan Earthquake we constructed a community health care information network system. Focusing on the authentication server and portal server capable of SAML&ID-WSF, we proposed an audit trail management system to look over audit events in a comprehensive manner. Through implementation and experimentation, we verified the effectiveness of our proposed audit trail management system.
Blank, Martin J.
Background: Growing health disparities have a negative impact on young people's educational achievement. Community schools that involve deep relationships with partners across multiple domains address these disparities by providing opportunities and services that promote healthy development of young people, and enable them to graduate from high…
Farmer, Frank L.; Clarke, Leslie L.; Flocks, Joan D.; Bryant, Carol A.; Romund, Camilla S.; Albrecht, Stan L.
Two community-based projects employed social marketing to design and implement interventions to promote health. The Arkansas project involved key informant interviews, actuarial analysis, citizen and student surveys, and participant observation. The Florida approach included focus groups and provider, worker, and employer surveys. (Contains 25…
Bower, Wilma; And Others
Some children in American schools have known and unknown communicable diseases, including herpes, cytomegalovirus, AIDS, mononucleosis, pinworms, and hepatitis. This article examines major public health issues, school responsibility, preventative measures (like basic hygiene), and the need for more effective community education programs. A disease…
... Internal Revenue Service 26 CFR Parts 1 and 53 RIN 1545-BL30 Community Health Needs Assessments for Charitable Hospitals AGENCY: Internal Revenue Service (IRS), Treasury. ACTION: Notice of proposed rulemaking... hospital organizations. These regulations will affect charitable hospital organizations. DATES:...
Tanvatanakul, Vasuton; Amado, Joao; Saowakontha, Sastri
Object: To investigate channels for communication of health information to various groups in the community. Design: An exploratory cross sectional design was used, followed by focus groups of selected participants to confirm and clarify the findings. Setting: Five levels of sub-district administration organizations were selected from different…
Bartlett, Peter; Jenkins, Rachel; Kiima, David
The new United Nations Convention on the Rights of Persons with Disabilities creates a new paradigm for mental health law, moving from a focus on institutional care to a focus on community-based services and treatment. This article considers implementation of this approach in Africa.
Lando, Harry A.; And Others
The Minnesota Heart Health Program's Quit and Win smoking cessation contests occurred between 1982 and 1989. The contests used large prizes to encourage smokers to quit smoking. Evaluations indicated that the contests succeeded in recruiting relatively large proportions of smokers in entire communities, and abstinence outcomes were encouraging.…
For the last 2 decades, researchers and practitioners dedicated to improving the health of gay and bisexual men have largely focused their work on the need to reduce the incidence of HIV infection. This is certainly warranted given the intensity of this particular epidemic in the gay community and the challenges it has presented to the nation's…
Moran, Kristen; Bodenhorn, Nancy
Perceptions and experiences of elementary school counselors' collaborative efforts with community mental health providers are examined through this exploratory phenomenological study. Ten participants engaged in two in-depth interviews. Collaboration was considered an effective way to increase services to students and their families. Six themes…
Rugkåsa, Jorun; Canvin, Krysia
In this article we reflect on the recruitment of research participants to two related studies of experiences of mental health problems in Black and minority ethnic communities in the United Kingdom. A total of 65 people were recruited via three main strategies: the employment of bicultural recruiters, intensive information sharing about the studies, and work through local community groups. Three main issues seemed to affect recruitment: gatekeepers' attitudes, the (non)payment of participants, and reciprocal arrangements with local community groups. The type of strategy employed resulted in recruits with differing characteristics (although our sample was too small to draw generalizable conclusions). We conclude that to ensure that research participation is accessible to all, researchers must employ flexible recruitment methods that permit adaptation to specific needs arising out of health status, level of involvement with services, culture, and socioeconomic status. Systematic research into this part of the research process is needed.
Kushto-Reese, Kathryn; Maguire, Maureen C; Silbert-Flagg, Joanne; Immelt, Susan; Shaefer, Sarah J M
Community partnerships are central to educating nurses and providing much-needed services to underserved children in Baltimore City. Johns Hopkins University School of Nursing (JHUSON) collaborates with Head Start programs and a local elementary school for faculty practice and child-health clinical Service Learning experiences. At local Head Start programs, undergraduate nursing students annually screen > 1000 children for height, weight, hearing, vision, and blood pressure. Results are sent to parents with referral information if indicated. In addition, graduate and baccalaureate nursing students implement skills and knowledge learned in the classroom in a nurse-run clinic in a local elementary school, a faculty practice site. The Service Learning community partnerships benefit nursing students because they can apply principles of growth and development while providing important health screening to children in underserved populations. All students gain from practicing in the community and applying their classroom instruction to the care of children.
Smith, Aaron C T; Stewart, Bob
In this article we explore the social constructions, body perceptions, and health experiences of a serious recreational and competitive bodybuilder and powerlifter community. Data were obtained from a discussion forum appearing within an online community dedicated to muscular development. Forum postings for a period of 36 months were transposed to QSR NVivo, in which a narrative-based analytical method employing Gee's coding approach was employed. We used a priori codes based on Bourdieu's multipronged conceptual categories of social field, habitus, and capital accumulation as a theoretical frame. Our results expose an extreme social reality held by a devoted muscle-building community with a fanatical obsession with muscular hypertrophy and any accouterment helpful in its acquisition, from nutrition and supplements to training regimes and anabolic androgenic substances. Few health costs were considered too severe in this muscular meritocracy, where the strong commanded deference and the massive dominated the social field.
Merzel, Cheryl; D’Afflitti, Joanna
Contemporary public health emphasizes a community-based approach to health promotion and disease prevention. The evidence from the past 20 years indicates, however, that many community-based programs have had only modest impact, with the notable exception of a number of HIV prevention programs. To better understand the reasons for these outcomes, we conducted a systematic literature review of 32 community-based prevention programs. Reasons for poor performance include methodological challenges to study design and evaluation, concurrent secular trends, smaller-than-expected effect sizes, limitations of the interventions, and limitations of theories used. The effectiveness of HIV programs appears to be related in part to extensive formative research and an emphasis on changing social norms. PMID:12660197
Fu, Yu-Chen; Chen, Mei-Yen; Feng, Huang-Chih
Over the past three decades, chronic disease has replaced communicable disease as the leading collective cause of death in Taiwan. As a result, medical and public healthcare manpower and budgets dedicated to communicable diseases have been reduced. The 2003 outbreak of Severe Acute Respiratory Syndrome (SARS) changed government epidemic prevention policies and marked a renewed focus on preventing and controlling communicable diseases. This study introduces Taiwan's communicable disease control system and reforms, the domestic status of communicable diseases, the infection control policies of Japanese colonial authorities in the early 20th century, and national / community-level communicable disease control mechanisms in place before and after 2003. This paper further examines the actual health management conditions in a county in southern Taiwan to show how the public health system is rooted in communities, how infection control strategies are promoted, and how social organizations influence community life and mores.
Campbell, Megan Ann; Hunt, Jennifer; Scrimgeour, David J; Davey, Maureen; Jones, Victoria
Objective Aboriginal Community-Controlled Health Services (ACCHSs) deliver comprehensive, culturally appropriate primary health care to Aboriginal people and communities. The published literature acknowledging and supporting the roles of ACCHSs in improving Aboriginal health is limited. This paper seeks to collate and analyse the published evidence supporting the contribution of ACCHSs to improving the health of Aboriginal people.Methods A conceptual framework for exploring the contribution of ACCHSs was developed, drawing on the literature on the core functions of ACCHSs and the components of quality primary health care. This framework was used to structure the search strategy, inclusion criteria and analysis of the review.Results ACCHSs contribute to improving the health and well being of Aboriginal peoples through several pathways, including community controlled governance, providing employment and training, strengthening the broader health system and providing accessible, comprehensive primary health care.Conclusions ACCHSs make a range of important contributions to improving the health of Aboriginal peoples that are under-acknowledged. Consideration of the different ways ACCHSs contribute to improving Aboriginal health is of value in the design and evaluation of programs and policies that aim to improve the health of Aboriginal peoples.What is known about the topic? Aboriginal communities have long argued the vital role of ACCHSs in improving Aboriginal health.What does this paper add? This paper provides a comprehensive collation and analysis of the evidence supporting the contributions ACCHSs are making to improving Aboriginal health.What are the implications for practitioners? The conceptual framework and findings outlined in this paper illustrate that ACCHSs are making important contributions to improving Aboriginal health through several pathways. This information can be used to ensure actions to improve Aboriginal health are appropriate and effective
Sistrom, Maria Gilson; Hale, Patty J
Community and public health nurses (C/PHNs) may play a vital role in the investigation of disease outbreaks. C/PHNs possess skills in conducting interviews on sensitive subjects and in collaborating with communities. C/PHNs maintain key links to community providers, symptomatic clients, their families and associates, as well as community institutions where outbreaks occur. This combination of skills makes C/PHNs ideally suited to perform outbreak investigations. There are, however, pressing questions about whether C/PHNs are adequately prepared to contribute to investigation outcomes, to foster participation of affected communities, and to fully apply nursing skills to outbreak investigations to stop the spread of disease. Using one case study, the authors explore investigation outcomes, community participation issues, educational preparation, and public health funding and workforce policies required to achieve these ends successfully. One model of community participation in the steps of outbreak investigation and several Quad Council domains and competencies are proposed for use in practice. Questions regarding the use of emergency preparedness funding and employment of C/PHNs in epidemiology roles are raised.
Felland, Laurie E; Katz, Aaron; Liebhaber, Allison; Cohen, Genna R
Since Sept. 11, 2001, communities have responded to the federal call to enhance health care surge capacity--the space, supplies, staffing and management structure to care for many injured or ill people during a terrorist attack, natural disaster or infectious disease pandemic. Communities with varied experience handling emergencies are building broad surge capacity, including transportation, communication, hospital care and handling mass fatalities, according to a new study by the Center for Studying Health System Change (HSC). Communities rely on federal funding to help coordinate and plan across agencies and providers, conduct training and drills, recruit volunteers, and purchase equipment and stockpile supplies. The current federal focus on pandemic influenza has helped prepare for all types of emergencies, although at times communities struggle with fragmented and restrictive funding requirements. Despite progress, communities face an inherent tension in developing surge capacity. The need for surge capacity has increased at the same time that daily health care capacity has become strained, largely because of workforce shortages, reimbursement pressures and growing numbers of uninsured people. Payers do not subsidize hospitals to keep beds empty for an emergency, nor is it practical for trained staff to sit idle until a disaster hits. To compensate, communities are trying to develop surge capacity in a manner that supports day-to-day activities and stretches existing resources in an emergency. Many of these efforts--including integrating outpatient providers, expanding staff roles and adapting standards of care during a large-scale emergency--require greater coordination, guidance and policy support. As time passes since 9/11 and Hurricane Katrina, federal funding for surge capacity has waned, and communities are concerned about losing surge capacity they have built.
Freudenberg, Nicholas; Tsui, Emma
General job training programs, and separate disease prevention or health promotion programs, are usually viewed as two different strategies for reducing poverty and promoting community development. We propose that with better alignment of the strategies, new jobs with the potential to simultaneously improve population health, lower the cost of health care, and reduce unemployment could be created and filled. Initiatives for three types of entry-level positions-in the fields of community health, environmental remediation and protection, and food preparation-show particular promise as vehicles for health and economic improvement at the individual and community levels. Building on current federal programs, new pilot projects financed by federal funding should be created to test and refine such initiatives and their impact and assemble an evidence base for future policy action.
Farrar, Brandy; Morgan, Jennifer Craft; Chuang, Emmeline; Konrad, Thomas R
This article evaluates the implementation and impact of 5 workforce development programs aimed at achieving skills upgrades, educational advancement, and career development for community health workers (CHWs). Quantitative and qualitative case study data from the national evaluation of the Jobs to Careers: Transforming the Front Lines of Health Care initiative demonstrate that investing in CHWs can achieve measurable worker (eg, raises) and programmatic (eg, more skilled workers) outcomes. To achieve these outcomes, targeted changes were made to the structure, culture, and work processes of employing organizations. These findings have implications for other health care employers interested in developing their CHW workforce.
Ports, Katie A.; Ayers, Antoinette; Crocker, Wayne; Hart, Alton; Mosavel, Maghboeba; Rafie, Carlin
The purpose of this study was to understand factors that may affect the usage of a consumer health center located in a public library. More specifically, the authors wanted to know what health resources are of interest to the community, what patrons' perceptions of their experience at the center are, and finally, how staff can increase utilization of the center. In general, perceptions of the center were positive. The findings support that participants appreciate efforts to provide health information in the public library setting and that utilization could be improved through marketing and outreach. PMID:25552943
Scott, David M.; Strand, Mark; Undem, Teri; Anderson, Gabrielle; Clarens, Andrea; Liu, Xiyuan
Background: The profession of pharmacy is expanding its involvement in public health, but few studies have examined pharmacists’ delivery of public health services. Objective: To assess Iowa and North Dakota pharmacists’ practices, frequency of public health service delivery, level of involvement in achieving the essential services of public health, and barriers to expansion of public health services in rural and urban areas. Methods: This study implemented an on-line survey sent to all pharmacists currently practicing pharmacy in Iowa and North Dakota. Results: Overall, 602 valid responses were analyzed, 297 in rural areas and 305 in urban areas. Three practice settings (chain stores [169, 28.2%], independent community pharmacies [162, 27.0%], and hospital pharmacies [156, 26.0%]) comprised 81.2% of the sample. Both chain and independent community pharmacists were more commonly located in rural areas than in urban areas (P<0.05). For some public health services, pharmacists in rural areas reported higher frequency of delivery than did pharmacists in urban areas (P < .05) that included: medication therapy management, immunizations, tobacco counseling, and medication take-back programs. For some essential services, pharmacists (particularly independents) in rural areas reported more frequent delivery than did pharmacists in urban areas (P < .05), these included: evaluate the services the pharmacy provides, partner with the community to identify and help solve health problems, and conduct needs assessments to identify health risks in my community. Conclusion: Rural pharmacists more frequently deliver public health services than urban in both Iowa and North Dakota. These findings should be interpreted to be primarily due to differences in the role of the rural pharmacist and the quest for certain opportunities that rural pharmacists are seeking. PMID:28042356
Torres, Sara; Labonté, Ronald; Spitzer, Denise L.; Andrew, Caroline; Amaratunga, Carol
This article reports findings from an applied case study of collaboration between a community-based organization staffed by community health workers/multicultural health brokers (CHWs/MCHBs) serving immigrants and refugees and a local public health unit in Alberta, Canada. In this study, we explored the challenges, successes and unrealized potential of CHWs/MCHBs in facilitating culturally responsive access to healthcare and other social services for new immigrants and refugees. We suggest that health equity for marginalized populations such as new immigrants and refugees could be improved by increasing the role of CHWs in population health programs in Canada. Furthermore, we propose that recognition by health and social care agencies and institutions of CHWs/MCHBs, and the role they play in such programs, has the potential to transform the way we deliver healthcare services and address health equity challenges. Such recognition would also benefit CHWs and the populations they serve. PMID:25410697
Yanos, Philip T.; Stefancic, Ana; Tsemberis, Sam
Objective Housing programs for people with severe mental illnesses aim to maximize community integration. However, little is known about how the community integration of mental health consumers living in supported housing compares with that of other community residents in the socially disadvantaged communities where supported housing is often located. The purpose of this study was to examine predictors of objective community integration of mental health consumers living in supported housing and of other persons living in the same communities. Methods Participants were 124 adults (60 mental health consumers and 64 other community residents) residing in designated zip codes in the Bronx, New York. Participants were administered measures of psychiatric symptoms, substance use, physical community integration (participation in local activities), social integration (interactions with community members), and citizenship (political activism or volunteering). Results Mental health consumers living in supported independent housing had significantly lower scores on indicators of objective community integration than other community members. However, differences were relatively small. Among mental health consumers, African-American race, education, and length of time in current residence were associated with better community integration. Conclusions Findings suggest that mental health consumers living in supported housing may not achieve levels of objective community integration that are comparable with other community members; however, psychiatric factors did not account for this difference. Length of time in neighborhoods appears to be an important factor in facilitating social integration. PMID:22549530
Eskandari, Amir; Abolfazli, Nader; Lafzi, Ardeshir; Golmohammadi, Shima
Statement of the Problem: Prevention is the key factor in acquiring dental and oral health. Community health workers, as a part of health care networks in Iran, play an important role in delivering primary care and their knowledge and attitude directly affect the population whom they interact with in their service scope. Purpose: The aim of this research was to evaluate the knowledge and attitude level of community health workers regarding oral health. Materials and Method: This descriptive analytical study was carried out on 1170 community health workers who were employed in health offices in East Azerbaijan to evaluate their knowledge and attitude level about oral health. Data were acquired through filled out questionnaires and were analyzed by SPSS software. Results: There was no significant statistical relationship between knowledge and gender (p= 0.063), level of education (p= 0.08) and the period spent from the last continuing education course (p= 0.148).However, by increasing age (p= 0.016), work experience (p=0.083) and number of attended continuing education courses (p= 0.023), the knowledge scores were reduced. No statistically significant relationships were found between attitude and any of research variables. Conclusion: The level of knowledge and attitude of community health workers in East Azerbaijan regarding oral health was good. There was a reverse relationship between age, work experience, and frequency of participation in continuing education courses and knowledge scores which emphasizes the necessity of continuous training and revising the method of training in education of community health workers and other staffs of health care system. PMID:27942544
LaVeist, Thomas; Thorpe, Roland; Bowen-Reid, Terra; Jackson, John; Gary, Tiffany; Gaskin, Darrell; Browne, Dorothy
Progress in understanding the nature of health disparities requires data that are race-comparative while overcoming confounding between race, socioeconomic status, and segregation. The Exploring Health Disparities in Integrated Communities (EHDIC) study is a multisite cohort study that will address these confounders by examining the nature of health disparities within racially integrated communities without racial disparities in socioeconomic status. Data consisted of a structured questionnaire and blood pressure measurements collected from a sample of the adult population (age 18 and older) of two racially integrated contiguous census tracts. This manuscript reports on baseline results from the first EHDIC site, a low-income urban community in southwest Baltimore, Maryland (EHDIC-SWB). In the adjusted models, African Americans had lower rates of smoking and fair or poor self-rated health than whites, but no race differences in obesity, drinking, or physical inactivity. Our findings indicate that accounting for race differences in exposure to social conditions reduces or eliminates some health-related disparities. Moreover, these findings suggest that solutions to the seemingly intractable health disparities problem that target social determinants may be effective, especially those factors that are confounded with racial segregation. Future research in the area of health disparities should seek ways to account for confounding from SES and segregation.
Panaretto, Kathryn S; Wenitong, Mark; Button, Selwyn; Ring, Ian T
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.
Omohundro, Ellen; Boswell, Derrick; Evans, Dwayne; Ferranti, Lori B.
Community health assessment is a core function of public health departments, a standard for accreditation of public health departments, and a core competency for public health professionals. The Tennessee Department of Health developed a statewide initiative to improve the processes for engaging county health departments in assessing their community’s health status through the collection and analysis of secondary data. One aim of the Tennessee Department of Health was to position county public health departments as trusted leaders in providing population data and engaging community stakeholders in assessments. The Tennessee Department of Health’s Division of Policy, Planning, and Assessment conducted regional 2-day training workshops to explain and guide completion of computer spreadsheets on 12 health topics. Participants from 93 counties extracted data from multiple and diverse sources to quantify county demographics, health status, and resources and wrote problem statements based on the data examined. The workshops included additional staff development through integration of short lessons on data analysis, epidemiology, and social-behavior theory. Participants reported in post-workshop surveys higher degrees of comfort in interpreting data and writing about their findings on county health issues, and they shared their findings with health, hospital, school, and government leaders (including county health council members) in their counties. Completion of the assessments enabled counties and the Tennessee Department of Health to address performance-improvement goals and assist counties in preparing to meet public health accreditation prerequisites. The methods developed for using secondary data for community health assessment are Tennessee’s first-phase response to counties’ request for a statewide structure for conducting such assessments. PMID:24384302
Vanderbilt, Allison A; Dail, Michael D; Jaberi, Parham
Health disparities can negatively impact subsets of the population who have systematically experienced greater socioeconomic obstacles to health. Health disparities are pervasive across the United States and no single health care profession can tackle this national crisis alone. It is essential that all health care providers work collaboratively toward the overarching goal of systematically closing the health disparities gap. Interprofessional collaboration is the foundation needed for health care providers to support patient needs and reduce health disparities in public health. Let us reach across the silos we work within and collaborate with our colleagues. Stand up and begin thinking about our communities, our patients, and the future overall health status of the population for the United States. PMID:25960659
Schwartz, Brian S.; Parker, Cindy; Glass, Thomas A.; Hu, Howard
The debate about whether global environmental change is real is now over; in its wake is the realization that it is happening more rapidly than predicted. These changes constitute a profound challenge to human health, both as a direct threat and as a promoter of other risks. We call on health care providers to inform themselves about these issues and to become agents of change in their communities. It is our responsibility as clinicians to educate patients and their communities on the connections between regressive policies, unsustainable behaviors, global environmental changes, and threats to health and security. We call on professional organizations to assist in educating their members about these issues, in helping clinicians practice behavior change with their patients, and in adding their voices to this issue in our statehouses and Congress. We call for the development of carbon- and other environmental-labeling of consumer products so individuals can make informed choices; we also call for the rapid implementation of policies that provide tangible economic incentives for choosing environmentally sustainable products and services. We urge the environmental health community to take up the challenge of developing a global environmental health index that will incorporate human health into available “planetary health” metrics and that can be used as a policy tool to evaluate the impact of interventions and document spatial and temporal shifts in the healthfulness of local areas. Finally, we urge our political, business, public health, and academic leaders to heed these environmental warnings and quickly develop regulatory and policy solutions so that the health of populations and the integrity of their environments will be ensured for future generations. PMID:17185267
Vydiswaran, V G Vinod; Mei, Qiaozhu; Hanauer, David A; Zheng, Kai
Community-generated text corpora can be a valuable resource to extract consumer health vocabulary (CHV) and link them to professional terminologies and alternative variants. In this research, we propose a pattern-based text-mining approach to identify pairs of CHV and professional terms from Wikipedia, a large text corpus created and maintained by the community. A novel measure, leveraging the ratio of frequency of occurrence, was used to differentiate consumer terms from professional terms. We empirically evaluated the applicability of this approach using a large data sample consisting of MedLine abstracts and all posts from an online health forum, MedHelp. The results show that the proposed approach is able to identify synonymous pairs and label the terms as either consumer or professional term with high accuracy. We conclude that the proposed approach provides great potential to produce a high quality CHV to improve the performance of computational applications in processing consumer-generated health text.
Kunjan, Kislaya; Toscos, Tammy; Turkcan, Ayten; Doebbeling, Brad N.
Community health centers (CHCs) play a pivotal role in healthcare delivery to vulnerable populations, but have not yet benefited from a data warehouse that can support improvements in clinical and financial outcomes across the practice. We have developed a multidimensional clinic data warehouse (CDW) by working with 7 CHCs across the state of Indiana and integrating their operational, financial and electronic patient records to support ongoing delivery of care. We describe in detail the rationale for the project, the data architecture employed, the content of the data warehouse, along with a description of the challenges experienced and strategies used in the development of this repository that may help other researchers, managers and leaders in health informatics. The resulting multidimensional data warehouse is highly practical and is designed to provide a foundation for wide-ranging healthcare data analytics over time and across the community health research enterprise. PMID:26958297
Yang, Kyeongra; Woomer, Gail R; Matthews, Judith T
Teamwork can benefit students, enhancing their ability to think critically, solve problems creatively, and collaborate effectively. We piloted a collaborative learning project with undergraduate community health nursing students (N = 83) that entailed working in teams to explore epidemiologic data, synthesize the literature, and develop an evidence-based plan for nursing intervention and evaluation pertaining to a public health issue. Project evaluation consisted of pre- and post-project surveys by students, peer evaluation, and formative and summative evaluation by faculty. Having students work in teams, while challenging both for faculty and students, may be a viable strategy for preparing the next generation of nurses for inter- and intraprofessional collaboration. Our experience suggests that instituting a collaborative learning experience as part of an undergraduate course in community health nursing can be an effective way to expose students to constructive approaches to teamwork and prepare them for evidence-based nursing practice in the future.
Kunjan, Kislaya; Toscos, Tammy; Turkcan, Ayten; Doebbeling, Brad N
Community health centers (CHCs) play a pivotal role in healthcare delivery to vulnerable populations, but have not yet benefited from a data warehouse that can support improvements in clinical and financial outcomes across the practice. We have developed a multidimensional clinic data warehouse (CDW) by working with 7 CHCs across the state of Indiana and integrating their operational, financial and electronic patient records to support ongoing delivery of care. We describe in detail the rationale for the project, the data architecture employed, the content of the data warehouse, along with a description of the challenges experienced and strategies used in the development of this repository that may help other researchers, managers and leaders in health informatics. The resulting multidimensional data warehouse is highly practical and is designed to provide a foundation for wide-ranging healthcare data analytics over time and across the community health research enterprise.
Pettibone, Kristianna G; Parras, Juan; Croisant, Sharon Petronella; Drew, Christina H
The National Institute of Environmental Health Sciences' (NIEHS) Partnerships for Environmental Public Health (PEPH) program created the Evaluation Metrics Manual as a tool to help grantees understand how to map out their programs using a logic model, and to identify measures for documenting their achievements in environmental public health research. This article provides an overview of the manual, describing how grantees and community partners contributed to the manual, and how the basic components of a logic model can be used to identify metrics. We illustrate how the approach can be implemented, using a real-world case study from the University of Texas Medical Branch, where researchers worked with community partners to develop a network to address environmental justice issues.
Bressington, Daniel; Mui, Jolene; Wells, Harvey; Chien, Wai Tong; Lam, Claire; White, Jacquie; Gray, Richard
In the present qualitative, descriptive study, we explored Hong Kong community psychiatric nurses' (CPN) perceptions of using comprehensive physical health checks for service users diagnosed with severe mental illness (SMI). Research interviews were conducted with a purposive sample of 11 CPN in order to explore their perceptions about the use of the Health Improvement Profile (HIP) over a 1-year period. Interview data were analysed using inductive thematic analysis. The analysis revealed that the majority of CPN appreciated the comprehensive focus on the physical health of their clients and reported positive changes in their clinical practice. Many of them observed an increase in the motivation of their clients to improve their physical health, and also noted observable benefits in service users' well-being. The use of the HIP also helped the CPN identify implementation barriers, and highlighted areas of the tool that required modifications to suit the local cultural and clinical context. To our knowledge, this is the first study conducted in an Asian mental health service that explores nurses' views about using comprehensive health checks for people with SMI. The findings suggest that such approaches are viewed as being acceptable, feasible, and potentially beneficial in the community mental health setting.
Cianelli, Rosina; Ferrer, Lilian; Norr, Kathleen F.; McCreary, Linda; Irarrázabal, Lisette; Bernales, Margarita; Miner, Sarah
Purpose When healthcare workers have stigmatizing attitudes toward people living with HIV it may lead to discriminatory behavior that interferes with prevention, treatment, and care. This research examined the HIV-related stigmatizing attitudes reported by health workers in Santiago, Chile. Methods The study used focus group data from the first phase of a larger study to develop and test a HIV prevention intervention for Chilean health workers. Ten focus groups were conducted with Health workers in two communities in Santiago, Chile. Content analysis was used to analyze the data. Results Two central themes emerged: Societal stigma and discrimination towards people living with HIV and healthcare system’s policies related to HIV. Both inaccurate fears of transmission among the general public and Chilean Health workers and societal prejudices against homosexuals contributed to stigmatization and discrimination. Conclusions Health workers did not recognize their own stigmatizing attitudes or discriminatory behaviors, but their discussion indicated that these behaviors and attitudes did exist. Healthcare system issues identified included problems with confidentiality due to the desire to inform other health workers about client HIV status. Health workers must be sensitized to the current stigmatization and misinformation associated with HIV and its negative impacts on persons living with HIV and the general community. Implications All clinical and non-clinical workers at community clinics need mandatory education for HIV prevention that focuses on changing attitudes as well as sharing knowledge. Also, the Chilean law protecting people living with HIV and the confidentiality of their medical care needs to be publicized, along with guidelines for its enactment in clinics and other health facilities. PMID:21687824
Thiel, Daniel B; Platt, Tevah; Platt, Jodyn; King, Susan B; Kardia, Sharon L R
Biobanks raise challenges for developing ethically sound and practicable consent policies. Biobanks comprised of dried bloodspots (DBS) left over from newborn screening, maintained for long-term storage, and potential secondary research applications are no exception. Michigan has been a leader in transforming its DBS collection, marketing its biobank of de-identified samples for health research use. The Michigan BioTrust for Health includes approximately 4 million unconsented retrospective samples collected as early as 1984 and prospective samples added since the fall of 2010 with blanket parental consent. We engaged Michigan citizens to ascertain public attitudes, knowledge, and beliefs about the BioTrust and informed consent. A convenience sampling of 393 participants from communities around the state of Michigan (oversampling for minority populations) participated in meetings addressing newborn screening, the BioTrust and informed consent, yielding quantitative and qualitative survey and discussion data. Participants affirmed the principle of voluntary informed participation in research and advocated for greater public awareness of the existence of the BioTrust. Most expressed support for the use of DBS for research and a desire for greater involvement in granting permission for research use. Opinions varied as to which specific research uses were acceptable. Participants indicated a desire for greater engagement, public awareness, and more active decision making on the part of biobank participants and parents. Diversity of opinion over which research areas were deemed acceptable problematizes the blanket consent model that currently applies to the BioTrust's prospective DBS collection and that could become the new norm for research using de-identified data under proposed changes to the Common Rule.
Al-Nuaimi, Maha A.
Background: The recent events in Iraq following the 2003 war render Iraq as a country with a high level of all types of violence. Exposure to violence, as a witness or a victim, is related to a number of longer term emotional, behavioral and social problems. Objectives: To investigate the impact of witnessing and experiencing community violence and tragedy as a factor contributing to mental health disorders among Iraqi women in the city of Mosul. Methods: A population-based cross-sectional study of 500 women were selected by a multi-stage random sampling technique. Four catchment areas of primary health centers of Mosul city were selected. Community violence with nine commonly associated social, economic, emotional, physical and mental health symptoms were recorded by questionnaire. Results: The study revealed that all the participating women had a history of exposure to at least one type of community violence within the last twelve months. A mainstream consequence of exposure to community violence was transportation difficulties, loss of husband's job, and family displacement. More than half of the women were classified as having severe emotional disturbances that may evolve to mental health problems in future. Conclusion: Women are bearing the consequences of the violence in Iraq. National commitment and action needs to be taken to curb the violence which is hugely affecting the people of Iraq. Treatment programs targeted at promoting emotional resilience may be effective at preventing mental health problems. PMID:25003060
Center for Disease Control (DHEW/PHS), Atlanta, GA.
This book is primarily a guide and source directory to health education materials in 10 nationally recognized health risk areas: (1) stopping or reducing smoking; (2) improving nutrition; (3) controlling high blood pressure; (4) modifying alcohol intake or drinking habits; (5) increasing physical activity; (6) reducing stress; (7) detecting cancer…
Health promotion programs often lack a clearly specified theoretical foundation or are based on narrowly conceived conceptual models. For example, lifestyle modification programs typically emphasize individually focused behavior change strategies, while neglecting the environmental underpinnings of health and illness. This article compares three distinct, yet complementary, theoretical perspectives on health promotion: behavioral change, environmental enhancement, and social ecological models. Key strengths and limitations of each perspective are examined, and core principles of social ecological theory are used to derive practical guidelines for designing and evaluating community health promotion programs. Directions for future health promotion research are discussed, including studies examining the role of intermediaries (e.g., corporate decision-makers, legislators) in promoting the well-being of others, and those evaluating the duration and scope of intervention outcomes.
Kaiser, Michelle L
Food security and health are complex interrelated issues. Individual characteristics exist within the physical and built environments. Title IV of the Food, Conservation, and Energy Act of 2008 is analyzed in terms of how it addresses systemic food insecurity and the opportunities the policy has for improving public health by increasing support for the availability of affordable local produce to low-income households. Structural changes need to occur for programs to be equitable, efficient, and effective. Interdisciplinary leadership within government agencies, school systems, social service agencies, health care agencies, and nonprofit networks is necessary to ensure food security and health for all Americans. Social work and public health practitioners have the opportunity to change the status quo, encourage community-level interventions, advocate for producers and consumers, and encourage more equitable distribution of food to create a healthier low-income population.
Kearns, Ade; Mason, Phil
In the UK, recent regeneration programmes have aimed to improve the health of those who remain in their neighbourhood (Remainers) and those who are relocated (Outmovers); thus, as part of the 10-year GoWell study (2006-2015) of the effects of demolition, rebuilding and housing improvements on residents and communities, we examined associations of health behaviours with residential conditions and location status in deprived neighbourhoods of Glasgow. Better internal dwelling conditions were associated with several better health behaviours; in relation to neighbourhood conditions, the results were more mixed. Outmovers often exhibited worse health behaviours than Remainers, perhaps because environmental and social conditions were little altered by relocation, and because personal support mechanisms were missing. Health behaviours were relatively good among Remainers, indicating that in situ changes might stimulate life-changing improvements, but relocation less so.
Shahandeh, KH; Basseri, HR; Pakari, A; Riazi, A
Background: Use of bed-net continues to offer potential strategy for malaria prevention in endemic areas. Local communities are indispensable during design and implementation stages. Methods: A cross-sectional study of 192 randomly selected inhabitants was carried out in malarious zone, Siahoo direstrict, Hormozgan Province, southern Iran. In addition, we monitored human landing periodicity of main malaria vectors and as well as self-protection of inhabitant in the study area for a period of one transmission season between April to October 2006. Results The biting activities were seen throughout the whole night for three malaria vectors, Anopheles fluviatilis, An. stephensi and An. dthali, and An. fluviatilis exhibiting bimodal peaks, the first at midnight (0:00−1:00) and the other before dawn (5:00−6:00 am) but the maximum biting activity of An. stephensi was occurred at second quarter of night (11:00−12:00 pm). The majority of interviewers (83.3%) knew that malaria was transmitted by mosquitoes and 70.3% of them stated that bed-net is the best control measures. Most subjects (62%) did not have a mosquito net. Conclusion: Study subjects were aware of an association between mosquito bite and malaria transmission. Health workers at different levels of the health care delivery system should disseminate relevant information about self-protection to help community members to be involved more in malaria control. PMID:22808398
Wennerstrom, Ashley; Johnson, Liljana; Gibson, Kristina; Batta, Sarah E; Springgate, Benjamin F
Academic institutions and community organizations engaged community health workers (CHWs) in creating a community-appropriate CHW workforce capacity-building program in an area without a previously established CHW professional group. From 2009 to 2010, we solicited New Orleans-based CHWs' opinions about CHW professional development through a survey, a community conference, and workgroup meetings. Throughout 2011 and 2012, we created and implemented a responsive 80-h workforce development program that used popular education techniques. We interviewed CHWs 6 months post-training to assess impressions of the course and application of skills and knowledge to practice. CHWs requested training to develop nationally-recognized core competencies including community advocacy, addresses issues unique to New Orleans, and mitigate common professional challenges. Thirty-five people completed the course. Among 25 interviewees, common themes included positive impressions of the course, application of skills and community-specific information to practice, understanding of CHWs' historical roles as community advocates, and ongoing professional challenges. Engaging CHW participation in workforce development programs is possible in areas lacking organized CHW groups. CHW insight supports development of training that addresses unique local concerns. Trained CHWs require ongoing professional support.
Jung, Yuchul; Hur, Cinyoung; Jung, Dain
Background The volume of health-related user-created content, especially hospital-related questions and answers in online health communities, has rapidly increased. Patients and caregivers participate in online community activities to share their experiences, exchange information, and ask about recommended or discredited hospitals. However, there is little research on how to identify hospital service quality automatically from the online communities. In the past, in-depth analysis of hospitals has used random sampling surveys. However, such surveys are becoming impractical owing to the rapidly increasing volume of online data and the diverse analysis requirements of related stakeholders. Objective As a solution for utilizing large-scale health-related information, we propose a novel approach to identify hospital service quality factors and overtime trends automatically from online health communities, especially hospital-related questions and answers. Methods We defined social media–based key quality factors for hospitals. In addition, we developed text mining techniques to detect such factors that frequently occur in online health communities. After detecting these factors that represent qualitative aspects of hospitals, we applied a sentiment analysis to recognize the types of recommendations in messages posted within online health communities. Korea’s two biggest online portals were used to test the effectiveness of detection of social media–based key quality factors for hospitals. Results To evaluate the proposed text mining techniques, we performed manual evaluations on the extraction and classification results, such as hospital name, service quality factors, and recommendation types using a random sample of messages (ie, 5.44% (9450/173,748) of the total messages). Service quality factor detection and hospital name extraction achieved average F1 scores of 91% and 78%, respectively. In terms of recommendation classification, performance (ie, precision) is
Hall, Joanne M.; Stevens, Patricia E.
Graduate nursing education can be made more responsive to health care needs in several ways: reflection on the roles of nurse practitioners and others, advocacy for vulnerable groups, expertise in community-based practice and research, understanding of the broader environmental context of health, and commitment to making a difference in public…
DeSantis, L; Thomas, J T
Lack of information about health education from the perspective of immigrants was the basis of a descriptive survey of 30 Haitian mothers in southeast Florida. Subjects were interviewed regarding the value of health education received while seeking preventive health care for infants and preschool children in community health settings, their access to other sources of health education, and their perceptions of what community health care providers could do to assist them in improving child health. Ninety-seven percent took children for well-child care to medical facilities, and 66% received health education during the visits. Seventy percent had access to health-education programs through clinics or the media. Impediments to effective health education were lack of providers who speak Haitian Creole, need for more nurses, and long clinic waiting periods. Nurses were considered the best persons to do health teaching; radio and clinic lectures were the preferred media. Teaching was valuable if it was understandable and practical, reinforced parenting abilities, and allowed time for questions. Results are related to socioeconomic and political factors, traditional Haitian health culture, and cultural views of the cognitive development in children. Culture-specific strategies related to the modes and foci of health education are discussed.
Asuzu, Michael C.
Background Primary healthcare is established to ensure that people have access to health services through facilities located in their community. However, utilisation of health facilities in Nigeria remains low in many communities. Aim To assess the utilisation of community-based health facility (CBHF) amongst adults in Ibadan, Nigeria Settings A low-income community in Ibadan North West Local Government Area of Oyo State. Methods A cross-sectional survey was conducted using a simple random sampling technique to select one adult per household in all 586 houses in the community. A semi-structured interviewer-administered questionnaire was used to collect information on respondents' sociodemographic characteristics, knowledge and utilisation of the CBHF. Data analysis included descriptive statistics and association testing using the Chi-square test at p = 0.05. Results The mean age of the respondents was 46.5 ± 16.0 years; 46.0% were men and 81.0% married; 26% had no formal education and 38.0% had secondary-level education and above; traders constituted 52.0% of the sample; and 85.2% were of low socioeconomic standing; 90% had patronised the CBHF. The main reasons for non-utilisation were preference for general hospitals (13.8%) and self-medication (12.1%). Respondents who had secondary education and above, were in a higher socioeconomic class, who had good knowledge of the facility and were satisfied with care, utilised the CBHF three months significantly more than their counterparts prior to the study (p < 0.05). However, only satisfaction with care was found to be a significant predictor of utilisation of the CBHF. Conclusion The utilisation of the CBHF amongst adults in the study setting is high, driven mostly by satisfaction with the care received previously. Self-medication, promoted by uncontrolled access to drugs through pharmacies and patent medicine stores, threatens this high utilisation. PMID:26245600
El-Fadel, M; Massoud, M
The interest in the association between human health and air pollution has grown substantially in recent years. Based on epidemiological studies in several countries, there is conclusive evidence of a link between particulate air pollution and adverse health effects. Considering that particulate matter may be the most serious pollutant in urban areas and that pollution-related illness results in financial and non-financial welfare losses, the main objective of this study is to assess the economic benefits of reducing particulate air pollution in Lebanese urban areas. Accordingly, the extent and value of health benefits due to decreasing levels of particulate in the air are predicted. Health impacts are expressed in both physical and monetary terms for saved statistical lives, and productivity due to different types of morbidity endpoints. Finally, the study concludes with a range of policy options available to mitigate particulate air pollution in urban areas.
Dong, Xinqi; Li, Yawen; Chen, Ruijia; Chang, E-Shien; Simon, Melissa
Background: Health education is one of the proven ways to improve knowledge and change health attitudes and behaviors. This study is intended to assess the effectiveness of five health workshops in a Chinese community, focusing on depression, elder abuse, nutrition, breast cancer and stroke. Methods: A community-based participatory research…
Reader, Tom W; Gillespie, Alex; Mannell, Jenevieve
Despite the technological and organisational advances of 21st century health-care systems, care scandals and burgeoning complaints from patients have raised concerns about patient neglect in hospitals. This article reviews the concept of patient neglect and the role of community health psychology in understanding its occurrence. Patient neglect has previously been conceptualised as a problem associated with hospital staff attitudes and behaviours, with regulation and training cited as solutions. Yet, a community health psychology perspective shows that the wider symbolic, material and relational aspects of care are crucial for understanding why patient neglect occurs and for outlining new solutions to augment existing interventions.
George, Asha S.; Mehra, Vrinda; Scott, Kerry; Sriram, Veena
Background Community participation is a major principle of people centered health systems, with considerable research highlighting its intrinsic value and strategic importance. Existing reviews largely focus on the effectiveness of community participation with less attention to how community participation is supported in health systems intervention research. Objective To explore the extent, nature and quality of community participation in health systems intervention research in low- and middle-income countries. Methodology We searched for peer-reviewed, English language literature published between January 2000 and May 2012 through four electronic databases. Search terms combined the concepts of community, capability/participation, health systems research and low- and middle-income countries. The initial search yielded 3,092 articles, of which 260 articles with more than nominal community participation were identified and included. We further excluded 104 articles due to lower levels of community participation across the research cycle and poor description of the process of community participation. Out of the remaining 160 articles with rich community participation, we further examined 64 articles focused on service delivery and governance within health systems research. Results Most articles were led by authors in high income countries and many did not consistently list critical aspects of study quality. Articles were most likely to describe community participation in health promotion interventions (78%, 202/260), even though they were less participatory than other health systems areas. Community involvement in governance and supply chain management was less common (12%, 30/260 and 9%, 24/260 respectively), but more participatory. Articles cut across all health conditions and varied by scale and duration, with those that were implemented at national scale or over more than five years being mainstreamed by government. Most articles detailed improvements in service
Georgia Univ., Athens. Center for Continuing Education.
This report details the development of a comprehensive and coordinated continuing education program of mental health training for professional and paraprofessional workers engaged in the delivery of human services to clients who live in a special catchment area formerly known as the Model Cities areas of Savannah, Georgia. The thrust of the…
Cwikel, J G
The underlying purpose of all epidemiological research is ultimately to use inferences in order to prevent disease and promote health and well-being. Effective skills in translating results into appropriate policy, programs, and interventions are inherently tricky, and often politically controversial. Generally they are not taught to epidemiologists formally, even though they are a traditionally part of public health practice. To move from findings to policy change requires that the informed and committed epidemiologist should known how to: (1) organize affected parties to negotiate successfully with government and industry; (2) activate populations at risk to protect their health (3) communicate responsibly with lay persons about their health risks so as to encourage effective activism; (4) collaborate with other professionals to achieve disease prevention and health promotion goals. The paper presents and discusses four case studies to illustrate these strategies: (1) the grass-roots social action that was the response of the community to the environmental contamination at Love Canal, New York; (2) mobilization of recognized leaders within the gay community to disseminate HIV risk reduction techniques; (3) collaboration with an existing voluntary organization interested in community empowerment through health promotion in a Chicago slum by using existing hospital, emergency room admissions, and local motor vehicle accident data; (4) a self-help group, MADD (mothers against drunk driving) which fought to change public policy to limit and decrease drunk driving. In addition, the importance of multidisciplinary collaboration and responsible communication with the public is emphasized. Factors that limit the ability of the epidemiologist to move into public health action are discussed, including who owns the research findings, what is the degree of scientific uncertainty, and the cost-benefit balance of taking affirmative public action. Putting epidemiological
Martín-García, Manuel; Ponte-Mittelbrun, Carlos; Sánchez-Bayle, Marciano
The community participation in the health systems is a concept that develops from the health policy proposals that have led the World Health Organization and that they highlight the fundamental role of health promotion and of primary care to answer to the health challenges from the middle of the XXth century. Its development has encountered big obstacles that have become major from the increasing trend of introduction of healthcare marketing. This explains partly its scanty advance in the developed countries, though there exist very interesting experiences that are based especially on the effort of professionals and social organizations. The fundamental dilemma is one in the option among the assumption of the role like consumers or clients that it supports a relation subordinated of the patients with a major dependence of the consumption, or on the contrary to give voice and vote for the citizens incorporating them into the productive process and turning them into producers of health. There are analyzed also the existing practices of community participation in Spain and offers are realized for its impulse and development.