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[A prerequisite to the development of community health: the mobilization of professionals and residents in Saint-Herblain].

In 1990-1991, the city of Saint-Herblain (Loire-Atlantique) has been involved in a method of a social development of the area. As part of it, an health project has been made in order to associate the residents. Through a question: "what is health as for you?", residents and professionals have expressed themselves about the neighbourhood sources before identifying the problems and difficulties. This "positive" method has let a dynamics to be carried out and professionals and inhabitants go on participating in it.

Attitude of Health Personnel↗

Women's impetus in community and health development.

Women in Indonesia are playing an increasingly large part in economic activity and community development. Moreover, they are making a significant beneficial impact on the nation's health, most notably, perhaps, by helping to secure financial resources. The present article describes some of the ways in which women are working to improve the well-being of the Indonesian people.

Community Health Services↗

A training pack. Field programme management: food and nutrition.

One of the main barriers to development is the lack of adequately trained field staff. It is now widely recognized that the field worker plays a crucial role in implementing community development programmes. National development plans may look promising on paper but without the staff in the field, capable of managing the programmes, there is little chance for substantial gain from development efforts. To help address the problem of training for field workers, the Food Policy and Nutrition Division has produced the Training Pack. Its aim is to help field workers develop simple management skills which can be used in their daily work. The material in the Pack stresses those management techniques required by all field workers, whether their primary responsibility is agriculture, health, nutrition or community development. The Pack uses aspects of food and nutrition to illustrate the basic management skills, without attempting to turn the field workers into nutritionists. The emphasis of the Course is on the planning, implementation and evaluation of community activities. The practical approach advocated by these training materials is described in detail here.

Community Health Workers↗

Assertive community treatment: development of the team, selection of clients, and impact on length of hospital stay.

Mental health services have been criticized for the lack of focus and response to people suffering from a serious mental illness (SMI). Assertive community treatment (ACT) offers the potential for greater partnership working between the user and provider of mental health services. The author describes one approach in developing ACT in the UK. Four criteria were developed to identify the most appropriate service users for ACT: those with SMI, illness instability, illness disability and risk to self or others. Fifty-five clients were identified using these criteria and tracked for their length of hospital stay and frequency of admission 2 years before acceptance to an ACT team and for 12 months after. Duration of hospital stay was unchanged although both the frequency and total numbers of bed days were reduced.

Adult↗

Development of community practice teaching in Swindon.

Jenny Jardine and Janet Asherson describe how they introduced group work into their community practice teaching. They found the advantages of this approach, for both students and teachers, far outweighed any disadvantages.

Community Health Nursing↗

King's College's Graduate Program in Health Care Administration helps to achieve community wellness: a case study.

Graduate programs in health care administration can become catalysts in the community wellness initiatives that the Institute of Medicine and the Centers for Disease Control and Prevention have identified as being critical to the improvement of public health among the U.S population. This paper examines the results of such a program at King's College, Wilkes-Barre, Pennsylvania, which developed community wellness programs through the establishment of a center for health promotion, assisted in the establishment of a city health department, developed a peer leader tobacco education program for elementary school students, and produced a 30-minute video on adolescent high-risk behavior. The program's goal is to facilitate coalition building among health agencies and to produce graduates equipped with administrative skills and a thorough knowledge of the value of well-developed community wellness programs. Healthy communities will require the emergence of leaders who can gather information about high-risk health behaviors and work with communities to implement solutions. Health care administration programs have a tremendous opportunity to become catalysts in the development and implementation of educational programs that may improve a community's overall health and reduce health care costs.

Community Health Planning↗

From local concern to randomized trial: the Watcombe Housing Project.

BACKGROUND: A randomized study of the effect on people's health of improving their housing is underway in Torbay. The link between poor health, particularly respiratory health, and poor housing conditions has been recognized for a long time, but there have been few intervention studies to demonstrate that improving housing can improve health. In 1994, South and West Devon Health Authority set up a community development project in a deprived area of Torbay, in response to the concerns of local primary health-care workers. A community development worker helped local residents survey their homes for dampness and record their respiratory symptoms. The survey reported high levels of condensation/dampness and respiratory illness and the Council agreed to direct the majority of their housing improvement funds to the estate over the next 3 years. The Health Authority, University of Plymouth and Torbay Council were successful in obtaining funding to evaluate the housing improvements from the NHS R & D programme. PARTICIPANTS AND METHODS: Of 119 houses eligible for the study, 50 were chosen at random and improved in the first year. The rest were improved the following year. Questionnaires screening for health problems were sent to all 580 residents and baseline surveys of the indoor environment were also carried out. More detailed health surveys were completed by community nurses visiting residents in their homes. All adults were asked to complete SF-36 and GHQ 12 questionnaires, as well as disease-specific questionnaires if appropriate. PROGRESS: All houses in the study have now been improved, including insulation, double-glazing, re-roofing, heating, ventilation and electrical rewiring. Follow-up surveys are underway.

Community Health Planning↗

A simplified guide to practising community-based/community development initiatives.

The Simplified Guide to Practising Community-Based/Community Development Initiatives is tool for professionals who are beginning to embrace the principles of community development and empowerment into their philosophy of practice. The tool can be used to prepare for the initiative, to assist with the process, or afterwards to evaluate and formulate recommendations. The role of the professional is highlighted. One retrospective descriptive case analysis is presented to demonstrate the tool as an evaluation technique and to demonstrate the role of the practitioner in community development.

Community Health Nursing↗

Looking out for family caregivers.

Nurses are regularly advised to become involved in community development initiatives, but what exactly does this entail and what are the precautions that should be considered? A 10-week, government sponsored, community-development program for family caregivers allowed nurses to offer education and support to six under-serviced areas of B.C. They offer a critique of the program and recommendations for the future.

Caregivers↗

Health educaton in developing countries.

Health education is of great relevance in developing communities as it is a means of improving the health level which is an integral part of the overall socioeconomic development. It must be undertaken in conjunction with health services which should involve consumer participation at an early stage. Its focus is on changing behavior in respect to healthful living both at the individual and community levels. Health education subjects in developing communities include maternal and child health (MCH), nutrition, family planning and infectious diseases. Every member in the health team must be a health educator. Personal methods, especially when used by indigenous community health workers, are best suited to induce health behavior change in developing communities. Mass media as a rule is less suited for this, although radio can inform large segments of the population.

Adult↗

Potential development of community oriented HIV outreach among drug injectors in the UK.

Given the current epidemiological and behavioural risk profile of HIV infection among injecting drug users in the UK, the main strategic task continues to be to develop interventions to prevent the spread of HIV infection. Outreach to drug injectors is an important part of the wider UK HIV prevention strategy. This paper reviews critically and reassesses practically the role of outreach interventions among drug injectors in the UK. It is argued that despite the development of innovative outreach activity, the full potential of outreach has not been realized due to its theoretical orientation and in-built structural limitations. Outreach has predominantly operated with an 'individual' orientation, aiming to work with individual clients to help them to change their behaviour, gain access to services, or to become better users of services. The main thesis of this paper is that current outreach provision needs to be complemented by 'community change' models which seek to engender changes in the social etiquette of drug use within communities of drug injectors. The paper argues that the social networks through which HIV may be transmitted are the same social networks that may be coopted for HIV prevention. Future outreach services must turn to these networks as a way of targeting and encouraging changes among broad populations of drug injectors. Such models might use indigenous advocates, working within social networks, supported by community outreach facilitators.

Community Health Services↗