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PubMed2006

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

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.

Adolescent↗
PubMed1991

Community health nursing and the AIDS pandemic: case report of one community's response.

The World Health Organization (WHO) currently projects that there may be a cumulative total of 30 million cases of Acquired Immune Deficiency Syndrome (AIDS) worldwide by the year 2000 ("WHO Predicts," 1991). Community health nurses (CHNs), particularly those employed by local and state health departments, have a major role to play in the worldwide public health effort being mounted in response to the AIDS pandemic. CHN roles may include: direct caregiver, advocate, case manager, health educator, program planner, program coordinator, and policy advocate. How CHNs contribute to the effort against AIDS in various CHN roles is illustrated through a case report of a Midwestern U.S. suburban community's response to AIDS. The community's response was fostered and an AIDS program developed and implemented by CHNs employed by the community's health department. In addition to enabling this community to respond to AIDS in a humane and caring manner, the CHN initiatives have resulted in positive community feelings about the health department, and enhanced the image of CHNs as innovators and facilitators of change.

Acquired Immunodeficiency Syndrome↗
PubMed2002

Community-based education and problem solving: the Community Health Scholars Program at the University of Florida.

BACKGROUND: Although many medical schools understand and support the need for community service as part of educational training, this goal has been difficult to operationalize. DESCRIPTION: The Community Health Scholars program, a joint effort between the Area Health Education Center and the University of Florida, places 1st-year medical students in clinical settings with underserved populations, both rural and urban. The stated goal of the experience is to solve a problem identified by the communities as well as provide exposure to community practice and environment. EVALUATION: The program provided notable services to many communities. More than 80% of participating students believed it was a good or excellent learning experience; more than 90% believed that the program affected their career choice; and 100% believed that the program should be continued. Although this is a 1st-year program, students were not surveyed until their last year, suggesting that the program may have a lasting effect. CONCLUSIONS: This collaborative program successfully provided a service-learning experience for students while promoting solutions to problems in underserved communities.

Community Health Planning↗
PubMed2002

Community integration and statewide systems change: qualitative evaluation research in community life and disability.

As the disability field moves to the next generation of community life, this article describes the findings of a qualitative state policy research study on deinstitutionalization and community integration. New Hampshire was selected as a leading national example in the United States based, in part, upon the closure of its only public institution showing community leadership in the field of mental retardation and developmental disabilities. Drawing on the disciplines of politicial science, sociology, psychology and rehabilitation (Majchrzak, 1980), the research design uses a multi-case, multi-site study approach (Yin, 1989), and on-site, semi-structured interviewing of key informants using a research field guide (Taylor & Bogdan, 1984/1998). The qualitative research reflects an indepth version of state formative evaluation research studies on community integration (e.g, Taylor, Racino, & Rothenberg, 1988), and the use of coded data and multiple analytic techniques (e.g., Glaser & Strauss, 1967) congruent with the emerging support and empowerment paradigm (Racino, 1992). The article highlights four sets of research findings (i.e., state characteristics and community integration practices, thematic case studies of change, comparative roles in the change process, and a theoretical framework for understanding change) which form the basis for further statewide study of change toward community life in the United States.

Community Mental Health Services↗
PubMed2004

Targeting community-dwelling urinary incontinence sufferers: a multi-disciplinary community based model for conservative continence services.

This paper presents an argument that there is a need to provide services that target community-dwelling incontinence sufferers, and presents a demonstration case study of a multi-disciplinary, community-based conservative model of service delivery: The Waterworx Model. Rationale for approaches taken, implementation of the model, evaluation and lessons learned are discussed. In this paper community-dwelling sufferers of urinary incontinence are identified as an underserved group, and useful information is provided for those wishing to establish services for them. The Waterworx Model of continence service delivery incorporates three interrelated approaches. Firstly, client access is achieved by using community-based services via clinic and home visits, creating referral pathways and active promotion of services. Secondly, multi-disciplinary client care is provided by targeting a specific client group, multi-disciplinary assessment, promoting client self-management and developing client knowledge and health literacy. Finally, interdisciplinary collaboration and linkages is facilitated by developing multidisciplinary assessment tools, using interdisciplinary referrals, staff development, multi-disciplinary management and providing professional education. Implementation of the model achieved greater client access, improvement in urinary incontinence and client satisfaction. Our experiences suggest that those suffering urinary incontinence and living in the community are an underserved group and that continence services should be community focussed, multi-disciplinary, generalist in nature.

Adult↗
PubMed1979

The Mayo Three-Community Hypertension Control Program. III. Outcome in a community-based hypertension clinic.

As part of a broader community program to evaluate approaches to hypertension control, a Community Hypertension Clinic, staffed by two nurse practitioners, was set up in a rural community. Hypertensive persons were identified either by an initial central blood pressure screening or by a subsequent home screening. Slightly more than half of the hypertensive patients at initial screening, or 256 persons, elected to go to the Community Hypertension Clinic for second-stage screening, whereas the remainder elected to see their physicians or to do neither. After secondary screening at the Clinic, 120 patients eventually came under care and were managed by the nurse practitioners. After 2 years of follow-up, 57% of the Clinic patients had office-recorded diastolic blood pressures of less than 90 mm Hg. The Community Hypertension Clinic dropout rate was only 5% after 30 months of operation, for participants whose duration of follow-up ranged from 12 to 27 months (median 16 months), when a repeat home blood pressure screening examination was performed. Comparison of outcomes was thus possible between persons who attended the Community Hypertension Clinic and those who were referred to their physicians' offices. Persons with more severe hypertension most often elected to go to the Clinic, whereas patients with milder degrees of hypertension tended to go to their private physicians for follow-up or failed to make the recommended second-stage screening contact altogether. Greater declines in blood pressure were observed in the Clinic group.

Adult↗
PubMed1982

The demand for human resources by the community: the implications of a community participation approach.

The author states that community participation needs to be designed at the national level and executed at the local level, which therefore places greater demands on the organizational efficiency and communication skills of national agencies. The ramifications of a community participation approach reach all aspects of national planning, including budget procedures and allocations of responsibility. Above all, the approach requires that authority, responsibility, and procedures be clearly spelled out and understood by all involved. Only when national strategies have been set for numbers of communities to be served, level of service, and degree of community involvement, can the specific implications for manpower needs, training, and national support services be discussed, evaluated, and quantified. Given a clear indication of national policy directions for community participation, sector planners can begin discussions with their regional offices, other agencies, and community leaders on how to implement it. This article reviews some of the major issues about human resources that need to be addressed in the planning process.

Community Participation↗
PubMedDate not supplied

Community diagnosis: its uses in the training of community health workers and in primary health care in East Africa.

Over the last 20 years, medical schools in Uganda, Kenya and Tanzania have been developing teaching programs in community health which have placed increasing emphasis on community diagnosis. This process, which involves students, health workers and the community, is a team effort to obtain a wide variety of information using epidemiologic methods and to establish priorities for health action. The programs which are developed following community diagnosis often rely on primary health workers and small health centers for their execution. Experience in community diagnosis is an important element in the training of health workers. Such experience is also an excellent means of teaching the management skills that are essential for operating primary health care programs. This paper traces the evolution of the methods of community diagnosis used in East Africa.

Africa, Eastern↗
PubMed1994

Health education and community empowerment: conceptualizing and measuring perceptions of individual, organizational, and community control.

The prevailing emphasis in health education is on understanding and changing life-style choices and individual health behaviors related to health status. Although such approaches are appropriate for some health problems, they often ignore the association between increased morbidity and mortality and social, structural, and physical factors in the environment, such as inadequate housing, poor sanitation, unemployment, exposure to toxic chemicals, occupational stress, minority status, powerlessness or alienation, and the lack of supportive interpersonal relationships. A conceptual model of the stress process incorporates the relationships among these environmental factors, powerlessness (or conversely empowerment), social support, and health status. The concept of empowerment has been examined in diverse academic disciplines and professional fields. However, there is still a lack of clarity on the conceptualization of empowerment at different levels of practice, including its measurement, relationship to health, and application to health education. The purpose of this article is to address these issues as they relate to the concept of community empowerment. It provides a definition of community empowerment that includes individual, organizational, and community levels of analysis; describes how empowerment fits within a broader conceptual model of stress and its relationship to health status; and examines a series of scales that measure perceptions of individual, organizational, community, and multiple levels of control. The article concludes with broad guidelines for and barriers to a community empowerment approach for health education practice.

Adaptation, Psychological↗
PubMed1998

Person-time analysis of paired community intervention trials when the number of communities is small.

Community intervention trials involve randomization of communities to either an intervention or control arm. The objective of this paper is to evaluate person-time methods of analysis of paired community intervention trials when the number of community pairs is small. We consider several test procedures and evaluate their performance by simulation. Naive methods that ignore intracluster correlation, such as standard Mantel-Haenszel type statistics, can be misleading. The performance of the paired t-test depends on the distribution of the random community effects. Permutation tests perform well for the ranges of situations considered. However, there can be considerable loss of power with permutation methods compared to standard Mantel-Haenszel methods if in fact there is no intracluster correlation when the number of pairs is small. We consider methods to account for individual level covariates. Motivation for this work came from recent randomized community intervention trials in Africa to prevent transmission of the human immunodeficiency virus (HIV).

Africa↗
PubMed1990

Community treatment for the seriously mentally ill: is this community psychology?

Reviewed the study by Bond et al. (1990) on assertive community treatment (ACT) for the seriously mentally ill and raised questions as to why community psychologists have not been more involved in this research area. The relevance of ACT to community psychology was described in 6 areas: ecological approach, advocacy orientation, promotion of competence, prevention of psychopathology, integration of services, and systems theory. Three other areas were identified as critical for ACT and as domains in which community psychologists could provide future expertise: empowerment, research design, and community context effects. Community psychologists were challenged to reach out to the seriously mentally ill and demonstrate the relevance of this discipline to all disenfranchised persons.

Assertiveness↗
PubMed1998

Willingness to pay for community-based ivermectin distribution: a study of three onchocerciasis-endemic communities in Nigeria.

OBJECTIVE: To determine the willingness to pay (WTP) for local ivermectin distribution in a community financing framework. METHOD: Contingent valuation in three communities in Nigeria, using randomly selected household heads. WTP was elicited using a bidding game, and for collecting information on the households' socio-economic status, level of knowledge, priority ranking and perception of risk of contracting the disease, structured questionnaires were used. Ordinary least squares (OLS) multiple regression analysis was used to analyse factors associated with WTP. RESULTS: Between 92.1% and 93.3 % of respondents were willing to pay amounts ranging from 5 Naira (US$ 0.06) to 100 Naira (US$ 1.25) (median: 20 Naira, US$ 0.25) in the three communities, more than three times the modelled unit direct cost of distributing ivermectin by the communities themselves. Occupation of the respondent, marital status, average monthly expenditure on health care, manifestations of onchocerciasis, the type of savings scheme embarked on by the respondent, age-group, level of education and type of property were statistically significant (P < 0.05) variables affecting WTP. CONCLUSION: This study shows that there is WTP for local ivermectin distribution in the three study communities, and that it should be assessed before instituting community-directed treatment with ivermectin.

Adult↗
PubMed1994

Program evaluation strategies for community-based health promotion programs: perspectives from the cardiovascular disease community research and demonstration studies.

Community-based programs are being widely adopted in the struggle to prevent chronic disease. Program evaluation of community-based programs involves a particular set of problems stemming from the variety of activities being undertaken simultaneously, the multiple intermediate goals of the programs and the rapidity with which the programs evolve. An analysis of the experience of four large community-based cardiovascular disease research and demonstration studies (Stanford Five-City Project, Minnesota Heart Health Program, Pawtucket Heart Health Program and the German Cardiovascular Prevention Project) provides valuable models, methodologies and strategies for planning and conducting evaluations of public health programs or community studies. By comparing and combining their experiences, the four programs have identified eight categories of evaluation for community studies, including formative evaluation, quality assurance, assessment of delivered dose, assessment of received dose, component program impact, intermediate outcomes, community impact and cost analysis. This paper presents information on the strategies by which each of the four programs addressed these evaluation categories.

Cardiovascular Diseases↗
PubMed2002

Linking cultural competency and community service: a partnership between students, faculty, and the community.

OBJECTIVE: The purpose of the migrant health initiative is to give medical students the opportunity to provide clinical services, at appropriate levels of training, to a population that reflects a different ethnic and economic background than medical students typically see in the clinical setting. This initiative integrates concepts of cultural competency with experiential learning. DESCRIPTION: The migrant health initiative provides an infrastructure for a cultural competency educational program in the first two years of medical school within an essentials of clinical medicine course (ECM). The ECM course emphasizes the impacts of family, society, and community on the delivery of patient health care. Experience in the provision of clinical care to migrant workers provides an exceptional opportunity to expose students to a medically underserved, diverse group of people and to provide care to persons with a different language. The program was developed from grass-roots initiatives of students and the region's Area Health Education Center (AHEC). Historically, migrant workers provide the majority of the labor for harvesting onions in southeast Georgia. In April 2000, the regional AHEC organized a one-day clinic for migrant workers, staffed by one local physician and allied health students. Care was provided to over 400 laborers. As a result of the response by the migrant workforce, the AHEC developed a partnership with the local community to expand the health care services to this underserved group. Five medical students, working with the school's associate dean for curriculum and local AHEC, had observed a migrant health clinic organized by the AHEC and were seeking ongoing community service opportunities. Based on the interest and enthusiasm of the students, a faculty-supervised migrant health elective was developed for first- and second-year students. The number of students who wanted to take the elective exceeded the available opportunities. The ECM course will be enhanced with an integrated and longitudinal curriculum that focuses on migrant health care; the revised ECM course will provide students with the knowledge, skills, attitudes, and behaviors to care for individuals from different cultures. First-year students will be able to volunteer to work in the program. Second-year students will participate in at least one migrant health clinic, traveling only three hours but providing a different world with medical care. In addition, the opportunities for medical students to participate in a community health initiative and to work with nursing and allied health students will enhance their public health knowledge and their team and leadership skills. DISCUSSION: The partnership between students, faculty, and the community provides the mechanism to thoughtfully develop and integrate cultural issues and experiences into the curriculum. Students have recently received a Caring for Community five-year grant from the Association of American Medical Colleges. Program expansions will continue into the third-year medicine clerkship and include a senior elective. The program expansions will result in a migrant health initiative that will be coordinated; comprehensive; and expand student knowledge, skills, and experiences in cultural health care.

Community Health Services↗
PubMed2001

Ethics and community-based education: balancing respect for the community with professional preparation.

Community-based education and service learning are becoming increasingly common in health and human services education. As students enter the community, several ethical dilemmas arise regarding the university's interaction with the community. This article explores clinical, agency, and community placements in terms of the relationships they engender between the university and the community. The article then outlines some ethical obligations of universities and faculty members and ethical dilemmas that arise in different placements. Finally, a fundamental ethical framework that may guide universities and faculty members in planning community-based educational experiences is proposed.

Clinical Clerkship↗
PubMed2004

Assessing interorganizational networks as a dimension of community capacity: illustrations from a community intervention to prevent lead poisoning.

Network analysis is often cited as a method for assessing collaboration among organizations as an indicator of community capacity. The purpose of this study was to (1) document patterns of collaboration in organizational networks related to lead poisoning prevention in a Native American community and (2) examine measurement issues in using organizational network analysis to assess community capacity. Interviews were conducted with representatives from 22 tribes, government agencies, schools, and community-based organizations in northeastern Oklahoma. Intensity, density, and reliability were assessed for several stages of collaboration. Intensity and density were greater for similar types of organizations than for the network as a whole and decreased as stage of collaboration increased. Network data were more reliable when responses were dichotomized than when intensities were compared. Mean reliability scores across two respondents from the same organization ranged from 60% to 90%. Results from network studies may help communities learn how to strengthen organizational networks to enhance community capacity.

Community Networks↗
PubMed2006

The community barometer: a breast health needs assessment tool for community-based organizations.

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.

Adult↗
PubMed2005

Community involvement in the conduct of a health education intervention and research project: Community Action Against Asthma.

There is a need for more guidance on how to implement community-based participatory research, particularly on the roles of community members, throughout the process. This article focuses on how a Steering Committee, composed of representatives from community-based organizations, a local health department, an integrated health care system, and academia from the University of Michigan, participated in the design and implementation of a children's asthma study in Detroit, Michigan: Community Action Against Asthma. In addition, this article focuses on the role of community members as data collectors, examining a variety of sophisticated data collection roles. A description and analysis of how community members shaped and participated in the project, the lessons learned, and recommendations for practitioners are also presented.

Asthma↗