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The effectiveness of community-based animal health workers, for the poor, for communities and for public safety.

The development of community animal health (CAH) is an invaluable tool for addressing a series of challenges, particularly for the policy-maker, whose prime concern is public welfare. This paper examines three of the major challenges which confront governments, particularly the governments of less-developed countries, namely, the collapse of government services, the crucial issue of poverty reduction and the misuse of animal drugs. Although CAH is a potentially powerful tool for approaching all of these problems, the authors argue that CAH can only be fully exploited on a macroscopic level by developing strong institutions to support and regulate such community initiatives. In some countries, developing such institutions depends upon accepting the more fundamental and controversial principle of legalising non-professional animal health service providers who work within the private sector. In Section 1, the authors outline the three principal challenges which face governments, particularly in developing countries, and to which CAH offers a potential solution. Sections 2 to 4 investigate the evidence relating to each of these challenges in turn. Section 5 briefly draws on the lessons that have been generated by field experiences over the years, to propose how governments may develop CAH systems to their best advantage.

Animal Welfare↗

A pilot study of death competency amongst health workers in the Uthukela District in Kwazulu-Natal.

AIM: The aim of this study was to investigate the registered nurses abilities to cope with the death of their clients and to determine if there was any improvement after attending a workshop designed to address this issue. NULL HYPOTHESIS: Using the Coping with Death Scale by Bugen (1980--1981) cited in Neimeyer (1994), respondents' pre-test scores are equal to their post-test scores. METHODOLOGY: An exploratory survey was used to investigate the registered nurses' death competencies before and after the scheduled workshops. Although these workshops were initially planned for registered nurses, a great variety of health workers (nurses, pharmacists, oral hygienists, physiotherapists and HIV community workers) expressed interest and were thus accommodated in the workshops. Data were collected from the Death Education Workshops held at three sites, and fifty-one respondents completed the questionnaire before the workshop and fifty-six on completion of the workshop. The tool that was used in this research was Bugen's (1980--1981) Coping with Death Scale, cited in Neimeyer (1994). This scale consists of 30 items assessing the participant's sense of competence in handling death and their concrete knowledge concerning preparation for death. FINDINGS: Analysis of the pre and post tests revealed a move from a neutral stance to one where the respondents tended to have a more definite opinion about the statement. This was usually towards agreeing with the statement. Applying the two sampled T-Test to compare the scores of the two related groups (that is the pre-workshop and post-workshop variables), the results yielded were t =0.00, 95% confidence level. Thus there was a significant difference between the two groups, and the null hypothesis is therefore rejected.

Adaptation, Psychological↗

Por La Vida model intervention enhances use of cancer screening tests among Latinas.

OBJECTIVE: To describe the short-term impact of the intervention known as Por La Vida (PLV) on cancer screening for Latinas in San Diego, California. METHODS: Thirty-six lay community workers (consejeras) were recruited and trained to conduct educational group sessions. Each consejera recruited approximately 14 peers from the community to participate in the program. The consejeras were randomly assigned to either a twelve-week cancer screening intervention group or a control group in which they participated in an equally engaging program entitled "Community Living Skills." Pre- and post-intervention self-report information was obtained from project participants on the use of cancer screening examinations. Outcome measures were changes in the percentages of women who had breast and cervical cancer screening test within the past year before and after the intervention occurred. Experimental and control groups were compared using t-tests. Analyses were conducted using both consejeras and participants as the unit of analysis. RESULTS: The increase in the use of the cancer screening test was higher in the PLV cancer intervention group in comparison to women in the community living skills control group. CONCLUSIONS: Key to the PLV intervention model is the identification of natural helpers in the Latino community and their subsequent training in intervention based on social learning theory using culturally appropriate educational materials. The model is an effective and viable approach for increasing the use of cancer screening tests in Latinas of low socioeconomic level and low level of acculturation.

Adult↗

Costs and effectiveness of community postnatal support workers: randomised controlled trial.

OBJECTIVES: To establish the relative cost effectiveness of postnatal support in the community in addition to the usual care provided by community midwives. DESIGN: Randomised controlled trial with six month follow up. SETTING: Recruitment in a university teaching hospital and care provided in women's homes. PARTICIPANTS: 623 postnatal women allocated at random to intervention (311) or control (312) group. INTERVENTION: Up to 10 home visits in the first postnatal month of up to three hours duration by a community postnatal support worker. MAIN OUTCOME MEASURE: General health status as measured by the SF-36 and risk of postnatal depression. Breast feeding rates, satisfaction with care, use of services, and personal costs. RESULTS: At six weeks there was no significant improvement in health status among the women in the intervention group. At six weeks the mean total NHS costs were pound 635 for the intervention group and pound 456 for the control group (P=0.001). At six months figures were pound 815 and pound 639 (P=0.001). There were no differences between the groups in use of social services or personal costs. The women in the intervention group were very satisfied with the support worker visits. CONCLUSIONS: There was no health benefit of additional home visits by community postnatal support workers compared with traditional community midwifery visiting as measured by the SF-36. There were no savings to the NHS over six months after the introduction of the community postnatal support worker service.

Adolescent↗

Community-based health workers: head start or false start towards health for all?

Health service delivery programs using minimally-trained community-based health workers (CHWs) have been established in many developing countries in recent years. These programs are expected to improve the cost-effectiveness of health care systems by reaching large numbers of previously underserved people with high-impact basic services at low cost. The reported experience with these programs has been mixed, raising questions about whether the community health worker is an optimal vehicle for extending primary health care. This review of six large-scale community-based worker programs suggests that they have succeeded in some of their objectives but not in others. CHWs increase the coverage and equity of service delivery at low cost compared with alternative modes of service organization. However, they do not consistently provide services likely to have substantial health impact and the quality of services they provide is sometimes poor. Large-scale CHW systems require substantial increases in support for training, management, supervision, and logistics. The evidence suggests that, in general, their potential has not been achieved in large routine programs. Further development of these programs is needed to reinforce their successes and assure that they are adequately supported as an integral component of the basic health system.

Asia↗

[Community-based health workers: building the identity of this hybrid, polyphonic character].

This article analyzes the identity-building process for community-based health workers in the context of their role in the Health Family Program team and their interaction with the residents of communities where they work. Based on this analysis we specifically emphasize conflicts of interpretation, power relationships between both sides of identity-building for community-based health workers from three perspectives: that included in the official training of these workers, that produced by workers concerning themselves, and that transmitted by the community. The fact that community-based health workers live the reality of health practices in the neighborhoods where they live and work and are trained with biomedical references makes them actors that convey both the contradictions and the possibility for a deep dialogue between these two forms of knowledge and practice.

Communication↗

Community Partners for Healthy Farming Intervention Research.

The purpose of the Community Partners for Healthy Farming Intervention Research (CPHF-IR) program is to implement and evaluate existing or new interventions for reduction of agriculture-related injuries, hazards, and illnesses. Objectives include the development of active partnerships between experienced researchers, communities, workers, managers, agricultural organizations, agribusinesses, and other stakeholders. Specific intervention projects were selected by the competitive review process in response to a request for proposals. The second series of projects (funded 2000-2003) targeted: improved ergonomics for handling grapes (CA) and for small-scale berry growers (WI, IA, MI, MN), engineering controls (KY, VA, SC) and training (IN) related to tractors, private-sector financial incentives for safety (IA, NE), and reducing eye injuries in Latino farmworkers (IL, MI, FL). Partners have provided their unique resources for accessing the target population, planning, implementation, dissemination, and evaluation. They have produced useful engineering controls, educational and motivational tools, and helped build infrastructure for promoting agricultural health as essential to sustainable agriculture. Additional outcomes have included: increased interest among participants in collaborating in further research, the feasibility of Latino lay health advisors as active partners in research, and the value of process evaluation of a partnership to enhance intervention sustainability. NIOSH is utilizing the model created for Simple Solutions: Ergonomics for Farm Workers, a document related to earlier CPHF-IR projects, for a comparable document for construction in both English and Spanish. This program has confirmed that such partnerships can produce not only sustainable interventions but also products and models with the potential to expand farther geographically than originally anticipated and even into other sectors, e.g., for primary prevention among healthcare workers and adolescents, and to introduce public health in social studies and language classes.

Agricultural Workers' Diseases↗

Five-year stability of job characteristics scale scores among a Japanese working population.

BACKGROUND: The job characteristics scale of job strain, which combines high job demands and low decision latitude based on Karasek's model, has been applied to studies on health care and cardiovascular disease. However, little is known about the long-term stability of this scale with exposure of workers to job. We investigated the 5-year intraindividual variation in job characteristics scores among healthy community workers. METHODS: Subjects of the study were 458 community dwelling persons forming part of the Jichi Medical School Cohort Study at Yamato (currently, Minami-Uonuma city), Niigata prefecture. The Japanese version of the World Health Organization Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (WHO-MONICA) Psychosocial Study Questionnaire was implemented twice (from 1992 through 1995, and in 1999) to measure job demands and decision latitude levels. Intraclass correlation coefficients were computed to evaluate stability of scores of the questionnaire. RESULTS: Intraclass correlation coefficient of the decision latitude scores was 0.629 (95% confidence interval: 0.564-0.686) and that of the job demands scores was 0.551 (0.476-0.617). Subgroup analyses by age, sex, education level, years since first employment, number of co-workers, and job category and status at baseline revealed similar results. In contrast, subjects who experienced position changes within the same enterprise or changed jobs showed lower correlation coefficients of both decision latitude and job demands scores compared to those who experienced no change in job contents. CONCLUSION: The Japanese version of the WHO-MONICA Psychosocial Study Questionnaire showed statistically significant long-term stability and could be to some extent responsive to change in job strain levels.

Adult↗

Community competence: a positive approach to needs assessment.

A procedure was developed for assessing residents' perceptions of community functioning. A questionnaire, derived from Cottrell's work in the area of community competence and elaborated upon by community workers and researchers, was constructed and field tested in five rural communities. In a telephone interview, 433 residents were surveyed. Responses were analyzed to determine which items discriminated among the communities and to what extent they represented Cottrell's original model. Representing six of Cottrell's eight conditions of competence, 14 items were judged to discriminate among the communities (analysis of variance, F-test, maximum p = .008). A factor analysis of the 14 items revealed four factors that were labeled Democratic Participation Style, Crime, Resource Adequacy and Use, and Decision-Making Interactions. The factors are consistent with Cottrell's model and explain 35% of the variance. These findings are discussed in relation to current community research and methodological constraints.

Community Participation↗

Tuberculosis outbreak among healthcare workers in a community hospital.

Twenty-nine healthcare workers (HCW) were exposed to an active case of unrecognized drug-susceptible pulmonary tuberculosis in a community hospital for as long as 2 h in the emergency room and 10 h in a medical intensive care unit. Twelve of the 29 exposed HCW could not be evaluated for tuberculosis infection because 10 of them had a previously positive tuberculin skin test and two were lost to follow-up. Of the remaining 17 tuberculin skin test negative HCW, 13 (76%) either converted their skin test to positive (10 HCW) or developed active disease (three HCW) after exposure to the index case. The Mycobacterium tuberculosis isolates from the three HCW had identical DNA restriction fragment length polymorphism (RFLP) patterns when studied by pulsed field gel electrophoresis. This case of drug-susceptible tuberculosis was associated with unusually high rates of tuberculosis infection and disease in HCW. Prevention of similar occurrences in HCW may be difficult because of the short exposure time required for transmission of tuberculosis and the absence of consensus on optimal respiratory protective measures.

Adult↗

The role of community mental health workers.

This article compares the work and skills of mental health social workers with those of community psychiatric nurses, through a review of the literature in the field. The literature reveals a mixed picture of the work of the two groups, describing subjective experiences of the work of each, often from the point of view of other professionals, particularly doctors.

Community Health Nursing↗

Monitoring the worker and the community for chemical exposure and disease: legal and ethical considerations in the US.

Biomonitoring of workers and communities raises important legal and ethical concerns, but the two contexts are different. Monitoring workers is usually done by, or at the instigation of, the employer who, in law, is responsible for their health and safety. Whenever worker monitoring leads to the removal of workers, difficult issues emerge affecting labor-management relations, labor law, and discrimination law. Resulting legal and ethical questions are usually framed with the context of the employment contract or labor relationship. In contrast, public health or environmental officials may be the driving force behind biomonitoring of the community. No employer-employee relationship exists, and the doctor-patient relationship may be tenuous. The community may often request biomonitoring, but the situation is no less contentious. On the basis of an historical view of monitoring events within the US, mechanisms are suggested to promote positive interactions between employers and workers and among agencies, individuals, and groups in the monitoring of chemically contaminated communities.

Environmental Monitoring↗

[Training of community health aides by means of a self-instruction "package"].

This paper describes the results of a teaching experiment carried out in the state of Querétaro, Mexico, in which a self-teaching "package" was used to train community workers in basic concepts of health education. This teaching method was used as a practical educational device that offered training which, while rapid, was based on principles of educational technology. It was shown that the system was useful for the acquisition of information applicable to primary health care activities and could also find application in other areas of public health.

Community Health Workers↗

Children can't fly: a program to prevent childhood morbidity and mortality from window falls.

"Children Can't Fly" is a health education program developed by the New York City Department of Health to combat the high incidence of child mortality and morbidity due to falls from windows. The success of the program, begun in 1972, in drastically reducing death and injury persuaded the New York City Board of Health to amend the Health Code in 1976 to require that landlords provide window guards in apartments where children ten years old and younger reside. The law is the first and only one of its kind in the nation. The program has four major components: 1) reporting of falls by hospital emergency rooms and police precincts, followed up by counseling, referral, and data collecting by public health nurses; 2) a media campaign to inform the public and elevate their awareness of the hazards; 3) community education for prevention through door-to-door hazard identification, counseling by outreach workers, community organization efforts with schools, tenant groups, clinics, churches, health care providers, etc; 4) provision of free, easily installed window guards to families with young children living in high-risk areas. Significant reduction in falls resulted, particularly in the Bronx, where reported falls declined 50 percent from 1973 to 1975. The program is one solution to an urgent urban problem which other cities might consider to avert the loss of life and limb, and the corollary financial burden for hospitalization, rehabilitation, and maintenance of the injured and permanently disabled.

Accidents, Home↗

Behind the mud walls: the role and practice of lady health visitors in Pakistan.

Lady health visitors (LHVs), as a specific cadre of health care provider, have existed in Pakistan since 1951. They provide a variety of services to urban and rural communities, including basic nursing care, maternal child health services, and training of community workers. Our purpose in conducting this study was to provide a broad description of LHVs and their practice in Pakistan. A descriptive exploratory design using the qualitative technique of interviewing was considered the most appropriate choice for the study given the lack of literature related to LHVs. A purposive sample of 52 LHVs were interviewed located in both rural and urban areas of the four provinces in Pakistan along with the Northern Areas. The major theme emerging from this study was that of "marginalization." LHVs aligned their practice with medicine yet were originally registered with the Pakistan Nursing Council and had 1 year of midwifery training. LHVs also differentiated their practice from nursing by clearly demarcating the role of registered nurses (RNs) to the hospital, whereas they as LHVs served the community. Confidence that they were making an impact within the communities was apparent. However, frustration at the lack of career mobility was evident along with the desire for strengthening their basic 2-year LHV education.

Adult↗

Teen Club: a nursing intervention for reducing risk-taking behavior and improving well-being in female African American adolescents.

This article describes a nursing intervention called Teen Club that was designed to reduce risk-taking behavior and improve well-being in female African American adolescents. Participants were referred to Teen Club by their nurse practitioners, physicians, and a community health nurse who were working at an urban neighborhood health center's teen clinic. Referrals were based on factors such as parental substance abuse, lack of social and family support, and other characteristics thought to increase vulnerability to risk-taking behavior. The 2-year intervention included weekly group meetings co-led by a European American female community health nurse and a Latino American male community worker, supplemented by case management and home visits by both these persons. Findings from a retrospective group interview conducted with 11 of the 12 original participants are presented. This is the first step in a series of pilot studies designed to refine the Teen Club intervention in anticipation of a future prospective, randomized investigation of this health promotion and disease prevention model of nursing care.

Adolescent↗

HIV/AIDS knowledge among female migrant farm workers in the midwest.

The rate of HIV infection in the migrant farm worker community is 10 times the national average. A survey was conducted of 106 female migrant farm workers in rural Northwest Ohio to assess HIV knowledge. The average participant's age was 28.7 years, 78 spoke Spanish, and 47 had an < or =8th- grade education. Fifty-six women received their information on HIV/AIDS from television. Eighty-seven women identified sexual contact as the major source of HIV transmission and 54 women identified the combination of sex, use of needles, and blood contact as the important routes. Sixty-nine women identified both homosexual and heterosexual intercourse as risk factors. Only 58 women identified perinatal infection as a route of HIV transmission and 59 women knew that treatment was available to prevent perinatal transmission. Although the majority of women had a good general knowledge of HIV transmission, further prevention education on perinatal transmission is needed among this population.

Adolescent↗