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PubMed1999

Teaching community diagnosis: integrating community experience with meeting graduate standards for health educators.

In 1996, the American Association for Health Education and the Society for Public Health Education developed new Standards for the Preparation of Graduate Level Health Educators. Learning to work effectively with communities is an essential part of graduate level health education. This article provides an overview of the community diagnosis (CD) class, a component of the Master's in Public Health program in the Department of Health Behavior and Health Education, School of Public Health, University of North Carolina. CD is a required two-semester class in which student teams work with preceptors to define a client community, assess its needs and strengths, and establish a foundation of quantitative and qualitative data for future community action. This experience provides a strong foundation for development of graduate level competencies and fosters an appreciation for the complexity of partnerships with communities.

Community Health Planning↗
PubMed1997

The challenge of developing community profiles for use in community health assessment: lessons from Michigan's experience.

In Michigan, a number of steps have been undertaken to revitalize a key public health function--community health assessment. This article reports on the activities of these initiatives, focusing on the beginning stage of the community health assessment process--the development of community health profiles. The findings and lessons learned from Michigan's experience, although state specific, appear to have broad applicability to the entire local public health community. It is hoped their publication will stimulate replication of this process among this community in other states.

Community Health Planning↗
PubMed2003

Community care networks: linking vision to outcomes for community health improvement.

This article examines the relationship between progress toward the Community Care Network (CCN) vision and "intermediate outcomes" of 25 community-based health partnerships (CCNs). Specific components of the CCN vision were community accountability, community health focus, creation of a seamless service continuum, and managing under limited resources. Four community outcome dimensions were evaluated: access, cost, health, and quality of service delivery integration. Overall progress toward the CCN vision was significantly positively related to average intermediate outcome score and most highly correlated with two dimensions: access and quality of service integration. Qualitative analysis suggests that CCN sites accomplished the most along two dimensions--access and health--noting that intermediate health outcomes generally were in health assessment and information rather than actual health status improvement. Keys to outcome achievement appear to be (1) clearly focused intervention; (2) explicit, ongoing outcome measurement; and (3) strong integration of separate intervention components.

Community Health Services↗
PubMed2005

Community-building versus career-building research: the challenges, risks, and responsibilities of conducting research with Aboriginal and Native American communities.

BACKGROUND: The Aboriginal Women's Cancer Care Project used a participatory research model guided by an Aboriginal advisory group. METHODS: The researchers attempted to conduct cancer research with 5 culturally and geographically different communities in North America. RESULTS: We discuss the challenges of conducting ethical research in keeping with the emergent research principles of community ownership and control of the research process and products. CONCLUSIONS: Although there are many perils for researchers and communities in conducting participatory research, clearer practice guidelines will ensure that research in Aboriginal communities will increasingly prioritize community- versus career-building outcomes.

Biomedical Research↗
PubMedDate not supplied

Tools for community-oriented primary care: a process for linking practice and community data.

BACKGROUND: Community-oriented primary care (COPC) is an increasingly attractive paradigm for primary care delivery. Further work is needed, however, to implement COPC in busy practice settings. This study reports a feasible method for linking practice and community health data for use in COPC. METHODS: Using one practice and its community as an example of the process, we sought data related to five common cancers. Data from readily accessible community sources were combined with practice morbidity data using commonly available computer hardware and software. RESULTS: We developed a user-friendly database and maps showing rates and distribution of the example diseases. We also developed strategies to obtain complete case identification and to address confidentiality and proprietary concerns. CONCLUSIONS: Understanding patterns of disease expression in the practice and the community is critical to the COPC process. Rapid, inexpensive methods for displaying these patterns, such as the database and maps described, must be accessible to clinicians if COPC is to move from theory into practice. Partnerships between health care providers and institutions can also help get this capability into the hands of clinicians.

Community Health Services↗
PubMed1999

Organizational change towards the empowerment-community integration paradigm in community mental health.

As a part of a larger study of change towards the values of an empowerment-community integration paradigm in community mental health, we examined changes in 3 mental health organizations in 1 community. Using qualitative methods, we focused on: (a) change pathways, (b) organizational change outcomes, and (c) the factors which helped and hindered change outcomes. We found evidence of a paradigm shift in the values and related practices within the organizations. Our results and themes are discussed and aimed at understanding and integrating knowledge about organizational change and the empowerment-community integration paradigm in community mental health.

Community Mental Health Services↗
PubMedDate not supplied

The community need index. A new tool pinpoints health care disparities in communities throughout the nation.

Catholic Healthcare West, San Francisco (CHW), has developed a national Community Need Index (CNI) in partnership with Solucient, an information products company, to help health care organizations, not-for-profits, and policymakers identify and address barriers to health care access in their communities. The CNI aggregates five socioeconomic indicators long known to contribute to health disparity--income, culture/language, education, housing status, and insurance coverage--and applies them to every zip code in the United States. Each zip code is then given a score ranging from 1.0 (low need) to 5.0 (high need). Residents of communities with the highest CNI scores were shown to be twice as likely to experience preventable hospitalization for manageable conditions--such as ear infections, pneumonia or congestive heart failure--as communities with the lowest CNI scores. The CNI provides compelling evidence for addressing socioeconomic barriers when considering health policy and local health planning. The tool highlights health care disparities between geographic regions and illustrates the acute needs of several notable geographies, including inner city and rural areas.Further, it should enable health care providers, policymakers, and others to allocate resources where they are most needed, using a standardized, quantitative tool. The CNI provides CHW with an important means to strategically allocate resources where it will be most effective in maintaining a healthy community.

Community Health Planning↗
PubMedDate not supplied

The hospital staff and community benefit. An Iowa facility works to involve busy employees in community benefit reporting.

Mercy Medical Center-North Iowa (MMC), Mason City, IA, has done much over the years to support the poor and underserved of its community. However, in recent years, the facilities leaders came to see that much of its community benefit activity went unreported. They decided to launch an initiative to improve this reporting. They began, in the summer of 2002, with a campaign to educate staff members about the facility's sponsor, the Sisters of Mercy, and that congregation's foundress, Mother Catherine McAuley. In December, MMC adopted a biannual reporting cycle for community benefit activities. Such reporting was facilitated by putting it online. More recently, MMC has begun publicizing its community benefit activities. As a result, both the facility's staff and the community have gained a clearer idea of the services that MMC provides in north Iowa.

Catholicism↗
PubMed2006

Rural community leaders' perceptions of environmental health risks: improving community health.

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.

Attitude to Health↗
PubMed1997

Community partnership primary care case study: Abbottsford Community Health Center.

Welfare reform and the movement of Medicaid to managed care have set the stage for great risk and potential reward for low-income communities and their health care providers. Nurse practitioners are responding to current opportunities by opening up nurse practitioner-directed practices to offer a range of care to targeted high-risk patients and communities. Nursing practices and the communities they serve will be greatly strengthened by democratic collaboration and partnership. The beginnings of Abbottsford Community Health Center are described as an example of community partnership primary care.

Community Health Centers↗
PubMed1977

Comprehensive community mental health center- business community relationship: a reexamination.

In this paper the belief that nonprofit service organizations and profit-motivated organizations should function separately from each other is questioned. Several of the advantages inherent from a cooperative relationship between comprehensive community mental health centers and the business community for the worker, mental health professional, comprehensive community mental health center, and business are discussed. Possible negative emotional responses against this new alliance are presented and dispelled. A joint effort between comprehensive community mental health centers and the business community is anticipated to develop with the common goal being the promotion of mental health.

Attitude of Health Personnel↗
PubMed1994

Community and participation for general practice: perceptions of general practitioners and community nurses.

A central theme of health policy has concerned the public's participation in primary health care services, both as individual consumers and collectively as communities. In the U.K. primary care increasingly centres on general practice. This paper reports an exploratory study undertaken with practice teams in inner city Sheffield about community participation. The study design was influenced by a grounded theory approach to data collection and analysis. The main data collected was from interviews of 23 general practitioners, 20 practice nurses, 11 health visitors and 7 district nurses. Concepts of community and participation were explored by interview with these primary care workers. Typologies of community and participation for general practice are presented in the findings, along with associated strategic positions and political tensions. The discussion highlights a number of tensions and issues concerning community participation when primary care is organized around general practice.

Attitude of Health Personnel↗
PubMedDate not supplied

Community-based participatory research with Latino community members: horizonte Latino.

As the demographic makeup of the United States undergoes rapid transformation, the importance of studying ethnic and cultural variations between and within population subgroups becomes increasingly clear. Researchers must challenge themselves to move beyond simply matching their methodology to the research question at hand and seek out methods that are compatible with the culture, language, traditions, and particular life circumstances of the cultural group under study. Community-based participatory research is collaborative and includes community members as participants in the research process, which ensures the cultural and community specificity of the research. This article demonstrates how experiential learning of community members as research participants provided culturally grounded insights used in grant writing. The experiences and involvement of the community researchers shaped the research questions and provided the major conceptual basis in response to a National Institutes of Health Request for Applications.

Adult↗
PubMed2006

Community-associated methicillin-resistant Staphylococcus aureus skin infections in a religious community.

In September 2004, an outbreak of community-associated methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTI) was reported among members of a religious community. We conducted a retrospective cohort study on all 175 community members; performed a nasal carriage survey, and environmental swab testing. We identified 24 MRSA cases (attack rate 14%). In multivariate analysis, sauna use [odds ratio (OR) 19.1, 95% confidence interval (CI) 2.7-206.1] and antimicrobial use within 12 months before infection (OR 11.7, 95% CI 2.9-47.6) were risk factors for infection. MRSA nasal carriage rate was 0.6% (1/174). Nine of 10 clinical isolates and an isolate from an administrative office within the community had the pulsed-field gel electrophoresis type USA300. Targeted hygiene improvement, wound care, and environmental cleaning were implemented. We describe the first reported outbreak of MRSA SSTI in a religious community. Adherence to appropriate personal and environmental hygiene might be critical factors in controlling transmission.

Adolescent↗
PubMed2004

Simulated patients in the community pharmacy setting. Using simulated patients to measure practice in the community pharmacy setting.

BACKGROUND: Performance measurement and quality of care in community pharmacy settings is problematic because of the lack of formal patient registration and the resultant risk of selection bias. Although simulated patients have been used for teaching and education purposes, particularly in medical settings, their use as a research tool requires exploration in other health settings. The purpose of this paper is to describe how we used simulated patients to measure professional performance of community pharmacy staff. METHOD: Sixty pharmacies participated in a randomised controlled trial (RCT) to evaluate the effectiveness and efficiency of two guideline implementation strategies in the community pharmacy setting. The primary outcome measure for the study was derived from assessment forms completed by simulated patients following covert visits to participating pharmacies. RESULTS: Of the 420 simulated patient visits scheduled, 384 (91%) were completed. Nine visits were reported by pharmacy staff using reply-paid postcards, four of which concurred with known SP visits. Each detected visit was made by a different SP. In a post-intervention survey, 26 (52%) pharmacists stated they had been apprehensive about the use of simulated patients as part of the study, however, 41 (82%) pharmacists agreed that SP visits were an acceptable research method to use in a community pharmacy setting. DISCUSSION: Simulated patients are a feasible method of assessing professional performance in community pharmacy settings and overcome the methodological problems of other measurement methods. Further research is needed to assess the reliability and validity of simulated patients.

Adult↗
PubMed1996

Decision making in community nursing: an analysis of the stages of decision making as they relate to community nursing assessment practice.

This paper considers the nature of decisions made in the context of community nursing practice, in the light of the stages of decision making distilled by Carroll & Johnson from the work of various theorists, and explores the relevance of each stage to community nurses' decision making. Illustrative examples of specific theoretical perspectives are included throughout the paper. The discussion forms part of the literature review for research currently being undertaken by the authors into patient assessment by community nurses. As decision making is a key element of community nurses' assessment practice, the paper argues that decision making theory forms a useful conceptual framework for investigating this aspect of community nursing.

Community Health Nursing↗
PubMed2006

AAC and community partnerships: the participation path to community inclusion.

The Life Needs Model (LNM) of service delivery emphasizes the importance of community participation in children's development and quality of life. This article is a case illustration of two community partnership programs based on the LNM. StoryTime and Dress Up and Drama provide participation opportunities in the community for children who use Augmentative and Alternative Communication (AAC). The authors describe the development and implementation of both programs. Regardless of level of functioning, each child who participated in the programs did so by communicating, interacting socially, and controlling the environment. Multiple benefits for children, parents/caregivers, community partners, and AAC clinicians are highlighted. The authors hope that this article will assist others in developing partnerships and implementing inclusive practices within their communities.

Child↗
PubMedDate not supplied

Project Dil: a co-ordinated Primary Care and Community Health Promotion Programme for reducing risk factors of coronary heart disease amongst the South Asian community of Leicester--experiences and evaluation of the project.

OBJECTIVES: To improve the effectiveness of primary and secondary prevention of coronary heart disease (CHD) in volunteer Leicestershire general practices with a high percentage of South Asian patients. To increase the awareness of lifestyle risk factors amongst the South Asian community with means of reducing CHD. DESIGN: Development and implementation of: A CHD training and awareness programme for health care professionals. Organizational change to ensure adoption of an effective secondary prevention programme for general practice. A public awareness campaign including a peer education programme for the South Asian community of Leicestershire. Interim evaluation using participation data, user satisfaction and organizational development of primary care is reported. RESULTS: A multi-disciplinary training programme accessed by 88% of staff from 23 volunteer practices has been developed and implemented. Organizational development in practices including CHD registers, action planning and establishing CHD clinics has taken place at a much faster pace than comparable non-Project Dil practices. An externally accredited peer education programme has been completed by 45 community volunteers. Within 6 months of completion, a total of 54 peer education sessions accessed by over 2,000 people from the Asian community had taken place. Project Dil, although initially funded only for 2 years, has now been adopted by Leicestershire Health Services (via a Primary Care Trust) as a mainstream programme. CONCLUSION: Project Dil has made considerable progress in engaging and driving changes in general practices to facilitate improvement in CHD management. In parallel, the project has developed a community education programme, including the use of peer education. The project is now hosted by a Primary Care Trust on behalf of Leicestershire Health Services. External evaluation of the peer education programme has commenced.

Adolescent↗