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PubMedDate not supplied

Community resiliency: the potential for community health nursing theory development.

There is insufficient theory development within community health nursing that addresses the community as a collective and not simply as groupings of aggregates. Conceptual clarification of nursing's domains is needed, however, before theory development can take place. In an attempt to rectify this situation, this article discusses the environment domain. Community resiliency, or the ability of a community to deal with adversity and in so doing reach a higher level of functioning, is presented as a useful framework to gain greater understanding of this particular domain. Findings from research that have resulted in a community resiliency model for describing the environment domain, within which rural-based community health nurses (CHNs) work, are presented. The relevance for community health nursing theory is included with recommendations for future research and subsequent theory development.

Canada↗
PubMedDate not supplied

Community risk perception and waste management: a comparison of three communities.

Three cross-sectional surveys were conducted in different regions of British Columbia, using a model of risk perception that divides the community into attitudinal and behavioral subgroups based on awareness and concern about waste management facilities. The three communities differed with respect to their levels of both awareness and concern about facilities, either planned for or situated in their region. Surprisingly, the most polarized community, which had nevertheless accepted a facility, rated this facility as more desirable than the other two communities. The unconcerned group in this community felt well informed, was more trusting of siting and operating agencies, and believed that the facility would generate benefits. The concerned group in this community also felt better informed, was more trusting of siting and operating agencies, and believed that its facility would generate benefits, compared with concerned groups in the other two communities. Longitudinal studies of the attitudes driving the siting process are needed to understand how these relationships evolve over time.

Adult↗
PubMed1997

Do local inhabitants want to participate in community injury prevention?: a focus on the significance of local identities for community participation.

During the 1980s the community became the object of new interest and enthusiasm among many health promotion practitioners and researchers, and the principle of community participation was put on the research agenda. However, recent evaluations of major community health promotion programs have questioned the value of community interventions. This paper argues that the community level need not be of less importance in future health promotion initiatives. It is discussed whether the cultural dimension and the significance of local identities, neglected in most community health promotion programs, should receive more attention when local inhabitants are invited to participate in health promotion or disease prevention activities. Results from a study of injury prevention projects in small Norwegian municipalities indicate that the inhabitants' identification with local spatial subarenas might play an important role when they decide to become involved in injury prevention. Contemporary sociological approaches to the community, focusing on developments of local identities in processes of globalization, have formed a theoretical frame of reference in this study.

Attitude to Health↗
PubMed2001

Can communities and academia work together on public health research? Evaluation results from a community-based participatory research partnership in Detroit.

This article reports the results of a formative evaluation of the first 4 years of the Detroit Community-Academic Urban Research Center (URC), a community-based participatory research partnership that was founded in 1995 with core funding from the Centers for Disease Control and Prevention (CDC). Several organizations are members of this partnership, including a university, six community-based organizations, a city health department, a health care system, and CDC. The Detroit URC is a strong partnership that has accomplished many of its goals, including the receipt of over $11 million in funding for 12 community-based participatory research projects during its initial 4 years. Detroit URC Board members identified a number of facilitating factors for their growth and achievements, such as (1) developing a sound infrastructure and set of processes for making decisions and working together, (2) building trust among partners, (3) garnering committed and active leadership from community partners, and (4) receiving support from CDC. Board members also identified a number of ongoing challenges, including organizational constraints, time pressures, and balancing community interests in interventions and academic research needs. Overall, the Detroit URC represents a partnership approach to identifying community health concerns and implementing potential solutions.

Centers for Disease Control and Prevention, U.S.↗
PubMed2004

A study of community guides: lessons for professionals practicing with and in communities.

A study of 35 nonprofessional helpers, identified as community "guides," focused on the contribution each made to helping marginalized individuals and families become a part of their communities. The lessons learned through these lay helpers can inform a postmodern social work practice that promotes the use of indigenous practice principles appropriate for work with and in culturally distinct communities. The practice wisdom of these guides demonstrates a need for professionals to reposition themselves in the associational life of a community, and to make their practice less visible. It is shown that an effective community-building practice that respects community solutions to individual and community problems requires permeable boundaries on the part of intervening professionals.

Community Participation↗
PubMedDate not supplied

Racial disparities in sense of community and health status: implications in community-based participatory interventions targeting chronic disease in African Americans.

This study examined the relation between sense of community (SOC), sociodemographic characteristics, and health status to inform community-based interventions designed to prevent and reduce chronic disease in African Americans. A telephone survey was conducted with 1463 randomly selected residents in Nashville, Tenn. Respondents were majority female (69%), African American (59%), and single (59%), with a mean age of 55 (+/-17.61 years). African Americans have lower overall SOC scores, or lower scores on the domains related to perceived influence over community and sharing of common community values compared to Whites. High rates of chronic disease and low SES, combined with a low SOC, can hinder efforts to reduce and eliminate disparities. The goal of community-based participatory initiatives is to create programs that are sustainable by the target community after the funding is gone. Thus, to maximize the success, uptake, and sustainability of disease-specific interventions, it is imperative to incorporate assessment of SOC, identify factors that depress SOC, and engage in community collaboration to develop a plan to improve SOC.

Adult↗
PubMed2000

Effectiveness of a community-directed 'healthy lifestyle' program in a remote Australian aboriginal community.

OBJECTIVE: To assess the sustainability and effectiveness of a community-directed program for primary and secondary prevention of obesity, diabetes and cardiovascular disease in an Aboriginal community in north-west Western Australia. METHOD: Evaluation of health outcomes (body mass index, glucose tolerance, and plasma insulin and triglyceride concentrations) in a cohort of high-risk individuals (n = 49, followed over two years) and cross-sectional community samples (n = 200 at baseline, 185 at two-year and 132 at four-year follow-ups), process (interventions and their implementation) and impact (diet and exercise behaviour). RESULTS: For the high-risk cohort, involvement in diet and/or exercise strategies was associated with protection from increases in plasma glucose and triglycerides seen in a comparison group; however, sustained weight loss was not achieved. At the community level, significant reductions were observed in fasting insulin concentration but no change in prevalence of diabetes, overweight or obesity. Weight gain remained a problem among younger people. Sustainable improvements were observed for dietary intake and level of physical activity. These changes were related to supportive policies implemented by the community council and store management. CONCLUSIONS: Community control and ownership enabled embedding and sustainability of program, in association with social environmental policy changes and long-term improvements in important risk factors for chronic disease. IMPLICATIONS: Developmental initiatives facilitating planning, implementation and ownership of interventions by community members and organisations can be a feasible and effective way to achieve sustainable improvements in health behaviours and selected health outcomes among Aboriginal people.

Adult↗
PubMed1997

Community mothers' programme: extension to the travelling community in Ireland.

STUDY OBJECTIVE: To see whether the community mothers' programme, using lay volunteer mothers to deliver a childhood development programme, could be extended successfully to the travelling community in Ireland. DESIGN: This was a prospective study of the travelling community; comparisons were made with results of a previous randomised trial of settled mothers. SETTING: A regional health authority in Ireland. PARTICIPANTS: These comprised 39 traveller and 127 settled intervention mother/ infant pairs (randomised controlled trial (RCT) intervention); settled community mothers; 105 settled control pairs (RCT control). All mothers received standard support; traveller and RCT intervention groups also received the services of a community mother. MAIN RESULTS: The travellers' sociodemographic profile differed significantly from the other groups. At the end of the study, traveller and intervention children were exposed to more cognitive games and nursery rhymes. There were significant differences in the proportions who received all three shots of their primary immunisation schedule before 12 months of age and who received "three in one" vaccination, with traveller children doing least well. The diet of traveller children surpassed that of RCT controls in all food groups except fruit; they were less likely to begin cows' milk before 26 weeks of age. Traveller mothers' diet was superior to that of RCT control and similar to RCT intervention mothers. Traveller and RCT intervention mothers were less likely to feel tired, feel miserable, and want to stay indoors than RCT control mothers. CONCLUSIONS: The results of the community mothers' programme in the travelling community are encouraging; poor immunisation uptake remains a challenge.

Accidents↗
PubMed2000

A new light on the community health fund--effective political support for a community essential drug project in Vietnam.

This report sheds new light on the development of a community health fund through the implementation of a community essential drug project, and its impact on the improvement of primary health care at the community level. The experience of community drug funds in Vietnam, supported by a strong government commitment, in which full delegation of authority on the management of drugs and finances is given to the community along with a measure for tax exemptions for drug fund revenues, provides a significant example of an autonomous community with active participation of people and effective resource mobilization, that is leading to the improvement of community health.

Community Health Services↗
PubMed1992

The role of community organizations in AIDS prevention in two Latino communities in New York City.

Black and Latino community organizations can play a major role in acquired immunodeficiency syndrome (AIDS) prevention. Their ongoing relationships with their constituents, knowledge of relevant cultural values and channels of communication, and commitment to safeguard the well-being of their neighborhoods are an important resource for AIDS prevention campaigns. In order to better understand the process by which community groups have taken on the issue of AIDS, investigators conducted in-depth interviews with a convenience sample of 47 neighborhood organizations in two primarily Latino communities in New York City. Researchers also attended community meetings, interviewed AIDS educators, and conducted focus groups with respondents. More than half the groups had already sponsored some AIDS prevention activities prior to the first interview. More active groups were more likely to have multiple missions, previous experience with the target population, and prior experience working with people with AIDS. Respondents reported a variety of obstacles to more active involvement in AIDS prevention at the community, organizational, and individual levels. To strengthen the role of community organizations in AIDS prevention, more resources should be provided to grass roots groups, AIDS should be linked to other urgent social problems facing black and Latino communities, and funders and AIDS organizations should respond more flexibly to the needs of neighborhood organizations.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Community-based rehabilitation: does it change community attitudes towards people with disability?

To achieve the goal of 'Health for All by the Year 2000' the World Health Organization (WHO) adopted an approach to rehabilitation described as community-based rehabilitation (CBR). A major objective of CBR is to develop positive community attitudes towards people with disabilities. To determine whether this objective can be achieved, post hoc measurement of attitudes towards people with disabilities was carried out in a community in which CBR had been established and in a control community. It is shown that both groups exhibited neutral attitudes. The community exposed to CBR obtained a mean attitude score significantly (p < 0.001) closer to the positive end of the scale than did the control community. It is concluded that communities in which CBR is being carried out develop more favourable attitudes towards people with disabilities than do those in which no such programme has been implemented.

Adult↗
PubMedDate not supplied

Developing personal and community learning in graduate nursing education through community engagement.

Community engagement through service-learning was introduced into a graduate program in nursing education to develop student leadership skills, interest in learning, and social responsibility. With faculty expertise and guidance, students worked in partnership with underserved community agencies. The goal of sustainability was accomplished by developing faculty expertise in service-learning as a method of instruction and integrating community engagement into academic assignments within existing courses. Opportunities to reflect on the benefits of the experiences were considered crucial to bridging service to learning in the community. Evaluation findings indicate that students gained insight into community needs and resources as they moved outside traditional health care settings. Graduates increased their understanding of their role as a resource to the community, and community agencies saw the value of a nurse educated at an advanced practice level.

Attitude of Health Personnel↗
PubMed1991

Community participation and attitudes of decision-makers towards community involvement in health development in Saudi Arabia.

National policies and government strategies in Saudi Arabia are adequate for the promotion of community involvement in health development (CIH). The system of government is decentralized and has ample scope for intersectorial cooperation. In Ha'il and Qasim regions active efforts are being made to realize intersectorial coordination through regional committees in which community leaders are involved; unfortunately, however, such mechanisms are lacking at the central level. Decision-makers and community leaders adequately recognized and interpreted the importance of CIH. Most of the respondents advocated community participation in planning and evaluation, while less than 50% thought that communities could participate in the implementation of health services. A survey in Ha'il and Qasim regions of 2417 residents indicated that community participation in health activities was in its infancy and that considerable effort is still needed at the central, regional, and peripheral levels to achieve meaningful community involvement in health.

Community Participation↗
PubMed1996

Academic-community linkages: community-based training for family physicians.

BACKGROUND: Community-based curricular experiences have been proposed to fulfill the graduate training needs of future family physicians. Are such experiences feasible? How can such experiences be started? What outcomes can be expected? METHODS: We describe 15 years' experience with community-based training in family practice graduate medical education at UMDNJ-Robert Wood Johnson Medical School. We also describe the process of creating academic-community linkages using stakeholder management and the resultant programs that evolved to fulfill specific training requirements. RESULTS: Five of the curricular programs designed are described, four of which were successful. Community-based training enhanced recruitment of students of minority background into the residency, and a high proportion of residency graduates have established practices in communities with underserved populations. CONCLUSIONS: Community-based training of family physicians is a feasible and effective means of addressing unmet health needs of communities served by graduate medical education programs and their related health care institutions.

Ambulatory Care↗
PubMedDate not supplied

Managing community and neighborhood partnerships in a community-based nursing curriculum.

A community-based undergraduate nursing program in a liberal arts college sought to establish partnerships with area neighborhoods to enhance the educational process of the program and the health of the neighborhoods. With the full financial and emotional support of the college administration, two unique positions were developed within the nursing department: community partnership coordinator (CPC) and neighborhood coordinator. The CPC works at the greater community level with involvement in area-wide community health ventures to provide a liaison to the community for the nursing department. The CPC coordinates area-wide student experiences, provides oversight to the community-based participatory research process, and expands scholarly opportunities for students and faculty. In addition, a neighborhood coordinator for each of the three underserved, ethnically diverse partnering neighborhoods provides an ongoing presence in the neighborhood, coordinating and teaching students as they have practicum experiences within the neighborhood. The neighborhood coordinator is also intimately involved in the neighborhood, maintaining professional relationships with neighborhood residents, leaders, agency representatives, and health care professionals. Discussion of how challenges of the roles were managed is included.

Clinical Competence↗
PubMed2002

Community-oriented primary care: a path to community development.

Although community development and social change are not explicit goals of community-oriented primary care (COPC), they are implicit in COPC's emphasis on community organization and local participation with health professionals in the assessment of health problems. These goals are also implicit in the shared understanding of health problems' social, physical, and economic causes and in the design of COPC interventions. In the mid-1960s, a community health center in the Mississippi Delta created programs designed to move beyond narrowly focused disease-specific interventions and address some of the root causes of community morbidity and mortality. Drawing on the skills of the community itself, a selfsustaining process of health-related social change was initiated. A key program involved the provision of educational opportunities.

Black or African American↗
PubMedDate not supplied

Systems collaborate for a healthier community. A Community Health Advisory Board focuses on immunization.

The Community Health Advisory Board (CHAB), Pierce County, WA, involves four healthcare systems--Franciscan Health System, MultiCare Medical Center, Group Health Cooperative of Puget Sound, and Good Samaritan Hospital--that have joined forces with other providers in an innovative attempt to better serve their community. An evaluation by representatives of New York University's Hospital Community Benefit Standard Program prompted St. Joseph Medical Center, Tacoma, WA, to bring major providers together in a coordinated effort that could reach community residents in need. At their first meeting in November 1992, CHAB members agreed on a purpose: to facilitate collaboration between healthcare providers throughout the county to develop programs and services that improve the health status of community residents. In January 1993 CHAB members selected a "quick success" project: a program aimed at increasing immunization levels to 90 percent for two-year-old children in the county. In February 1993 CHAB members committed the "best and brightest" to the Immunization Task Force, naming experts in planning, nursing, community health, education, and marketing. When the Immunization Task Force assessed the project, they realized that the "quick success" program would not be accomplished so quickly. CHAB has had to address underlying problems to make higher immunization levels sustainable. In March 1994 members will evaluate the immunization program's process, status, and structure; data on immunization levels; and the group's demonstrated ability to cooperate.

Child, Preschool↗
PubMed1999

Community Access to Child Health (CATCH) in the historical context of Community Pediatrics.

OBJECTIVES: As part of the evaluation of the American Academy of Pediatrics (AAP) Community Access to Child Health (CATCH), to 1) identify, retrospectively, the actual chronology of activities undertaken through CATCH, and 2) review its antecedents within the AAP, and its predecessor program-Healthy Children. METHODS: Key informant telephone interviews with 14 national leaders in CATCH were conducted. Relevant program and administrative files and other documents were reviewed. AAP staff assisted the authors in preparing a detailed chronology of Healthy Children and CATCH activities and events from spring 1988 through summer 1996. RESULTS AND CONCLUSIONS: A decade of change in the AAP, under the acronym CATCH began in the late 1980s. The formation of the AAP's Partnership for Children and the Access to Care for Children Initiative, combined with the decision by the Robert Wood Johnson Foundation to transfer the funding of Healthy Children to the AAP, underpinned the changes. The Foundation's decision provided the resources and stimulus for the expansion and increased recognition of Community Pediatrics at the national AAP office, culminating in the establishment of the Department of Community Pediatrics in mid-1994. A national program of pediatrician-led, community-based programs and supportive services was launched, other resources were attracted, and a philosophical shift in defining the role of the pediatrician was put forward. A responsibility toward all children within the community was included in the role of the pediatrician, as well as caring for the individual child within a community context.

Child↗