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PubMed1999

Community-based disaster management during the 1997 Red River Flood in Canada.

This paper examines the relationship between community preparedness and response to natural disaster and their level and pattern of community development. This is done by investigating preparation and response to the 1997 Red River Flood by three rural communities in Manitoba, Canada. The communities were selected because of their different ethnic mix and associated level and pattern of community development. The hypothesis was supported that the level and pattern of community development affect community capacity to respond to flooding. Communities characterised by higher levels of physical, human and social capital were better prepared and more effective responders to the flood. However, where the pattern of community development was characterised by high levels of social capital, decision-making processes were complicated.

Community Networks↗
PubMed1995

Community partnership primary care: a new paradigm for primary care.

Primary care has become the focal point of health care reform. For too long primary care has been narrowly conceptualized as office-based care for common problems of individuals. In this article, a nurse practitioner describes a new model for primary care, community partnership primary care (CPPC), which moves beyond typical primary care practice to create what may be a new paradigm for primary care. This proposed new paradigm moves beyond older models of primary care into new dimensions of practice. The CPPC model emphasizes new roles for clinicians and a unique goal to foster the empowerment of individuals, families, and community. Innovative features of the CPPC model include blending a clinical role with a new area of practice called community practice. CPPC emphasizes new, innovative roles for nurse practitioners and nurses in community development and community empowerment activities. A 4-year funded project permitted the development and implementation of the CPPC model in an urban Hispanic community. This article provides an overview of the CPPC model and the initial steps of model implementation.

Community Health Services↗
PubMed1996

Incidence of hypertension and non-insulin dependent diabetes mellitus and associated risk factors in a rapidly developing Caribbean community: the St James survey, Trinidad.

OBJECTIVE: To compare the incidence rates of hypertension and non-insulin dependent diabetes mellitus in relation to ethnicity and other characteristics in a rapidly developing community. DESIGN: Prospective surveillance of a total community for five years. SUBJECTS: Cohort of 2491 men and women aged 35 to 69 years (79% response), of African, Indian and "other' (mainly Afro-European) descent. RESULTS: During surveillance, secular increases occurred in fasting blood glucose concentrations in both sexes and in body mass index (BMI) in men, with apparent secular reductions in systolic blood pressure in both sexes. Incidence rates of hypertension did not differ significantly with ethnicity, ranging between 33 and 41 per 1000 person-years in men and between 27 and 32 per 1000 person-years in women. In men, the incidence of diabetes (per 1000 person-years) in Indians (24) was significantly higher than in Africans (13) and others (11). In women, the diabetic incidence was similar to that for men in Indians (23) and Africans (14), but in others was twice that in men (21). In both sexes, weight gain was an important risk factor for hypertension, whereas risk of diabetes increased with BMI at baseline. The increased risk of diabetes in Indians among men was independent of baseline BMI and blood glucose. CONCLUSION: Apart from the increased risk of diabetes in Indians, ethnicity had no significant influence on incidence rates of hypertension and diabetes in Trinidad. Secular increases in blood glucose in both sexes and in BMI in men probably contributed to the concurrent increase in mortality from coronary heart disease in this community.

Adult↗
PubMed1994

[Mental health services in Japan: development of community care for mentally ill patients and their families].

Psychiatric care in Japan has received criticisms not only within Japan but from other parts of the world. In contrast, the services for the mentally ill in England are considered to be superior, despite serious criticisms. Psychiatric services in Japan and England are compared using government statistics. In Japan, the number of inpatients per 100,000 population has increased from the 1950s, while that of England has decreased since 1954. Since 1972 the prevalence of inpatients has been higher in Japan than in England. The history of psychiatric services in England where, after World War II, deinstitutionalization has been occurring is briefly described. For developing community care of the mentally ill in Japan, alternatives to inpatient care are thought to be important. These include primary care, day care and residential service in the community. Studies on families of mentally ill patients are crucial in community care and, among them, Expressed Emotion (EE) study is promising. Twenty cohort studies on EE and schizophrenic relapse, most of which successfully replicated the relationship between EE of the family and the course of the disease, are reviewed. Finally, some important aspects of EE study in Japan are discussed.

Adolescent↗
PubMed1996

Dynamics of participation in a community health project.

Although the term 'participation' is widely used in discussing community development strategies, there has been relatively little said about the characteristics of 'participatory relationships', i.e. the interactions between community developers and those who stand to benefit from community development initiatives. There is seen to be a need for case studies which attempt to understand the relational and communicative processes involved in participatory development. The paper presents an analysis of the participatory dynamics of a community health development project. The principal source of data is interviews conducted with thirteen selected participants in the project. Analysis of interview data using a structured hermeneutic method led to a description of the meaning of participation for each of the participants interviewed. Further interpretation led to the identification of a number of modes of participation in the project as a whole. For each mode of participation descriptions were developed of how it was perceived by others not participating from that mode. An attempt was made to understand the dynamics of the project in terms of the relationship between the different modes of participation and in terms of the discrepancies between how participants saw themselves and how others saw them. Finally, these problems were discussed at a general theoretical level and suggestions were made about how such problems might be alleviated.

Communication Barriers↗
PubMed1996

The development of community care policy for the elderly: a comparative perspective.

A comparison of the development of community care for the elderly in the province of Ontario, Canada, and in the State of Israel is presented in the light of the economic constraints currently challenging the expansion of welfare state services. The inquiry identified several common issues regarding the nature of the policy mandate for long-term care delivered in the home, the structure of the service delivery system and matters concerning funding arrangements for community care. Issues that emerged in both settings include the relationship between health and social services in the delivery of care at the local level; the separation of purchaser and provider functions; the question of needs-driven versus service-driven social care provisions; accessibility concerns and the aspiration for one-stop entry to the delivery system; the growing involvement of the private sector in the delivery of domiciliary-based personal care services; and the relative paucity of current efforts to address the needs of family caregivers.

Aged↗
PubMed1991

Addressing the contradictions: health promotion and community health action in the United Kingdom.

Within mainstream health education/promotion in the United Kingdom, the last few years have witnessed an upsurge of interest in community development, sometimes coupled with an undermining of the fundamental principles of this approach. This article addresses some of the contradictions and dilemmas that this development has presented for the community health movement. Current trends in health promotion policy and practice are examined in relation to broader health and welfare policy of the 1980s, the history of community development in health, and the background to the World Health Organization's "Health for All by the Year 2000" and health promotion initiatives. The possibilities and limitations of utilizing the rhetoric, to support community health action, are explored with reference to recent attempts by the community health movement to "reclaim" Health for All.

Community Health Services↗
PubMed1995

Using empowerment theory in collaborative partnerships for community health and development.

Models of community empowerment help us understand the process of gaining influence over conditions that matter to people who share neighborhoods, workplaces, experiences, or concerns. Such frameworks can help improve collaborative partnerships for community health and development. First, we outline an interactive model of community empowerment that describes reciprocal influences between personal or group factors and environmental factors in an empowerment process. Second, we describe an iterative framework for the process of empowerment in community partnerships that includes collaborative planning, community action, community change, capacity building, and outcomes, and adaptation, renewal, and institutionalization. Third, we outline activities that are used by community leadership and support organizations to facilitate the process of community empowerment. Fourth, we present case stories of collaborative partnerships for prevention of substance abuse among adolescents to illustrate selected enabling activities. We conclude with a discussion of the challenges and opportunities of facilitating empowerment with collaborative partnerships for community health and development.

Adolescent↗
PubMed1997

In pursuit of a better quality of life through the Basic Minimum Needs Programme: the Afghan experience.

This paper reports the outcome of work on integrated community development carried out in two villages in the Behsood district of Nangarhar province, Afghanistan, where the Basic Development Needs (BMN) model of community development was introduced in the last quarter of 1995. It describes the conceptual framework and the socio-political constraint under which the BMN development process evolved and was pursued. It also provides a detailed account of the methodology adopted, the results of the BMN survey, the socio-economic profile of the villages and the underlying causes of the problems. The paper gives an exposé of the set of potential interventions and solutions chosen by the community to solve their problems.

Adolescent↗
PubMed1998

Program fidelity in assertive community treatment: development and use of a measure.

Assertive community treatment (ACT) is a complex community-based service approach to helping people with severe mental disorders live successfully in the community. Effective replication of the model and research on critical elements require explicit criteria and measurement. A measure of program fidelity to ACT and the results of its application to fifty diverse programs are presented.

Community Mental Health Services↗
PubMed1994

The development of community orientated recommendations for diabetes care in south Auckland. South Auckland Community Diabetes Planning Group.

Growing numbers and costs associated with diabetes and its tissue damage are of increasing concern. We describe the development of community orientated recommendations aimed at primary and secondary prevention of diabetes in an area with a high proportion of Maori and Pacific Islands people. Preliminary results from structured face-to-face interviews with patients (n = 555), general practitioners (n = 163) and other health professionals were discussed by a core group of elected or selected community and health professional representatives. Twelve meetings and one full day workshop were held over a 7 month period. Formal and informal consultation occurred among community and health groups between meetings. The 68 recommendations included the need to: empower communities and diabetic patients; improve coordination and standardisation of care and the importance of the general practitioner in this process; improve access to care by removing transport, cultural and language barriers to care; subsidize preventative treatment costs; improve foot and eye services; improve monitoring of those with past diabetes in pregnancy or impaired glucose tolerance; improve detection of diabetes by increased high risk screening linked to ongoing diabetes care programmes. Implementation requires quality information systems and a cooperative partnership approach between hospital, general practitioner and the community, particularly local Maori and Pacific Islands communities.

Community Health Services↗
PubMed1993

Factors controlling the spread of HIV in heterosexual communities in developing countries: patterns of mixing between different age and sexual activity classes.

The paper describes the development and analysis of a mathematical model of the spread and demographic impact of HIV in heterosexual communities in developing countries. The model extends previous work in this area by the representation of patterns of mixing between and within different age and sexual activity classes in a two sex structure. Summary parameters are derived to represent different mixing patterns, ranging from assortative via random to disassortative, as are methods to ensure that particular mixing patterns between different age and sexual classes (stratified on the basis of rates of sexual partner change) meet constraints that balance the supply and demand for sexual partners as AIDS induced mortality influences the demographic structure of a population. Analyses of model behaviour rely on numerical methods due to the complexity of the mathematical framework, and sensitivity analyses are conducted to assess the significance of different assumptions and different parameter assignments. Simulated patterns of HIV spread across the two sexes and various age classes are compared with observed patterns in Uganda. The principle conclusion of the study is that the pattern of mixing between age and sexual activity classes, combined with the assumptions made to balance supply and demand between the sexes have a very major influence on the predicted pattern of HIV spread and the demographic impact of AIDS. The paper ends with a discussion of future needs in model development and data acquisition.

Acquired Immunodeficiency Syndrome↗
PubMed1994

[Work in community health is about to change].

Changes in Ontario's political, social and economic environments have necessitated an unprecedented transformation in the health care system. The change in focus from the individual to the community now includes core units such as families, groups and communities. Visiting nurses, public health nurses and community health nurses have worked in Community Health Centres (CHCs) since 1970. However, the role of nurses working in these centres has not been clearly defined in the literature. Nor is there is a general consensus on their title. Nurse practitioners, primary care nurses or community health nurses are all used. As well, there is no existing educational program in Ontario that trains this type of nurse. This article discusses and gives examples of nurses working in community health, whose primary clinical expertise is in using community based and community development program strategies to plan health programs. These programs are specifically developed to address the health needs of the communities they serve--in this case, Toronto's francophone community. Also demonstrated are new approaches to nursing care within a community setting. From health promotion to disease prevention, from community development to research, the practice of community health nursing is complex and exciting.

Community Health Nursing↗
PubMed1989

Toward a synergism of rural development and community psychology.

It is a common experience that all social intervention programs planned and executed for social amelioration have not met with success. The major thesis of this article is that parallel growth of two subfields: rural development and community psychology, may not be coincidental, and the recent trends in Indian psychology readily lead themselves to a union between the two. The attempts to intervene in two different communities (heterogeneous and homogeneous) have proved an eye-opener for future interventions.

Community Mental Health Services↗