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PubMed2003

Effectiveness of home-based food storage training: a community development approach.

A community-based home hygiene training initiative, funded by Merseyside Health Action Zone, was piloted in Dingle, a deprived area of Liverpool, UK, during Spring and early Summer 2000. The project actively involved the community, and home-based domestic hygiene training was delivered by community-based facilitators to households in Dingle, Liverpool. During the project the community-based facilitators visited 904 households on two separate occasions. During the first visit, the community-based facilitators completed a questionnaire and an 'action sheet' which had been designed to measure participants' prior knowledge and behaviour, in relation to a range of important food hygiene issues, and delivered the home-based food hygiene training. Within 8 weeks of the first visit, the community-based facilitators returned to the participating households and completed a second questionnaire and action sheet. Home-based training is effective in raising awareness, and community development approach has the advantage of facilitating access to households which otherwise would have been difficult to reach.

Adult↗
PubMed1994

Integrating a community development approach with mainstream health visiting.

Community development work is often seen as an activity separate from and working to different principles to traditional health visiting practice. Yvonne Dalziel describes how, required by management to take on a routine health visiting caseload, she is attempting to integrate the community development approach to her work with families and children.

Child↗
PubMedDate not supplied

Accessing community development research methodologies.

This paper is a perspective on the strengths and weaknesses of community development research offered to health promoters by a community development insider. The author provides her rationale for the opinion that no research paradigm other than the qualitative one satisfies the naturalistic context of either community development or health promotion, including inquiry into concepts such as community health, community wellbeing, community competence and community self-reliance. Attention is drawn to key aspects of the community development process with relevance to health promoters which are largely undertheorized, including clarity about the central issue of the nature of the interaction among learning, action and change. Finally, the paper specifies three implications of the naturalistic paradigm for either research or practice. These include academic prejudice against qualitative research from some quarters, the limitations of all research paradigms for some questions, and essential uncertainties of naturalistic inquiry.

Community Health Services↗
PubMed1997

Health and rural-to-urban migration in Thailand. The Population and Community Development Association's experience in rural development.

The Population and Community Development Association (PDA), a non-governmental organisation, has designed and implemented a new model of rural economic development in which health is considered to be the cornerstone of all development strategies. By attacking migration as the root cause of current threats to the population's health, PDA's Thai Business Initiative in Rural Development program provides economic opportunities to villagers in the poorest areas of the country. This structural approach to health enhancement includes specific components to address primary health care, family planning, and HIV/AIDS prevention, education and care.

Acquired Immunodeficiency Syndrome↗
PubMed2000

The practice of community development approaches in heart health promotion.

There has been a recent shift in public health policy towards population-based approaches to the reduction of cardiovascular disease. This shift has been accompanied by a re-examination of strategies appropriate to the goal. Often, community development approaches, designed to affect socio-environmental change, are suggested as the most appropriate strategy for affecting community-wide change. Despite the fact that community development approaches have been used by several of the major community-based heart health initiatives, evidence of their use and usefulness remains sparse. This paper presents the findings of a qualitative study of the factors (i.e. community context, facilitators, barriers) affecting the use of community development approaches to heart health promotion in Ontario, Canada. Key informant interviews (n = 30) were conducted with stake-holders representing voluntary agencies, community health providers, boards of education and local coalitions in eight of the 42 health unit areas across Ontario. The qualitative analysis reveals (1) that the use of comprehensive community development approaches is limited and (2) that community agencies typically employ elements of community development approaches (e.g. community organization, community-based), often in combination and adapted to suit local conditions. The resulting landscape of community development approaches is characterized by a continuum of collaborative practices indicating that no one type of community approach is appropriate for all initiatives and in all communities. Therefore, from a programmatic perspective, it may not be realistic to advocate community development as the goal to which all communities should strive.

Attitude to Health↗
PubMed2000

The policy context for community development practice in public health: a Canadian case study.

The Community Action in Public Health Study explored how public health managers, frontline staff, and community participants interpret, implement and receive policy guidelines urging collaboration with community groups in public health work. In-depth case studies of 6 public health units in Ontario, Canada focussed on 19 community development projects in 3 program areas (107 interviews). In the absence of formal policy guidelines on community development at provincial or local levels, informal policy predominated. Local senior management frequently set the tone, distinguishing health units in which community development was a basic philosophy underlying a broad spectrum of public health practice from those in which it was seen as only one among many possible strategies. Uncertainty and risk associated with informal policy lead many frontline staff to adopt strategies intended to preserve autonomy in community work, including "seeking forgiveness rather than permission" and maintaining relative "invisibility."

Community Health Planning↗
PubMed1989

Evaluating community development programs for health promotion: problems illustrated by a New Zealand example.

This paper illustrates problems in the evaluation of community development programs for health promotion. It is based on the authors' retrospective process evaluation of the Wanganui Community Alcohol Action Program (WCAAP), a recent example of a health promotion program directed at reducing alcohol-related problems in a small New Zealand town. Described by its designers as a community-based program, it included coordination of community organizations, education, publicity and increased enforcement of drinking laws. Discussion of the problems in the evaluation of such programs puts them within the context of the substantial body of previous social science research in both evaluation and community development. This, it is argued, is a body of knowledge with which health promotion researchers need to be conversant. Community development programs usually stem from a process of negotiation between interest groups with differing objectives. This results in a changing definition of both the problem to be solved and the nature of the solution, making evaluation difficult. Community development is also likely to be seen as a new solution providing a panacea for old problems. This can lead to such programs being too ambitious. From the point of view of experimental design these programs are likely to have a number of technical problems. This paper argues that these problems are so significant that it often unwise to attempt large scale evaluations of community development programs. Rather, attention should be concentrated on critically assessing the policy-making process and disseminating previous knowledge about such programs.

Alcoholism↗
PubMed1989

The limits and potential of community development for personal and social change.

Some health and welfare workers are making claims for community development which are both unrealistic and misleading. By tracing the history and public policy use of community development and by defining its characteristics, much of the mystique which surrounds this intervention is eliminated. Community development is revealed in this paper to have potential in the areas of personal and planned social change. However, community development's contribution to fundamental social change is circumscribed by the nature of government sponsorship and by its very process which emphasizes parochialism and the generation of self reliance.

Australia↗
PubMed1982

Incentives, reproductive behavior, and integrated community development in Asia.

Surveying experience with incentives, disincentives, and integrated community development approaches in selected Asian countries, this overview defines concepts, notes policy trends, and discusses ethical and legal constraints, psychosocial and socioeconomic aspects, and cultural-environmental influences on reproductive behavior. Major emphasis is on experience reported from China, India, Indonesia, Korea, Philippines, Singapore, and Thailand. Findings to date suggest that, to be successful, programs using incentives, disincentives, and integrated community development approaches will have to be formulated as consistent, clearly defined, and well-communicated policies, responsive to development needs and sensitive to local autonomy and values, with dynamic leadership to obtain and nurture continued policy backing.

Asia↗
PubMedDate not supplied

Health promotion community development and the tyranny of individualism.

Economic evaluation of health promotion poses few major difficulties when the theoretical approach of the programme and the evaluation of cost and benefits are confined within the context of the individual. Methodological individualism has a long history in economics and the techniques of microeconomics are well suited to the examination of individually focused behaviour change programmes. However, new developments in community health promotion pose special challenges. These programmes have the community, not the individual, as the focus of programme theory and "community' means something completely different from the sum of individuals. Community empowerment and promotion of the community's capacity to deal with health issues are the goals of such programmes. To reflect these notions, sense of community and community competence should be considered as "functionings', an extra-welfarist constituent of well-being. Their inclusion as outcomes of community health promotion requires a shift from individualist utilitarian economics into a communitarian framework which respects the programme's notion of community. If health economics fails to develop new constructs to deal with these new approaches in health promotion, the application of existing techniques to community programmes will mislead health decision makers about their value and potential.

Bias↗
PubMed1996

Evaluation of a pilot study for breast and cervical cancer screening with Bradford's minority ethnic women; a community development approach, 1991-93.

The objectives were: to provide information about breast and cervical cancer and related screening services to minority ethnic women, to enable them to make well informed decisions and choices; to adopt a health education strategy based on a community development approach, augmented by a local publicity campaign; and to evaluate both the direct and indirect effects of this project. To this end a community development intervention study was made over 18 months from October 1991 to March 1993 in Bradford, a multicultural city with 87,000 residents from minority ethnic groups. The subjects of the study were 1,628 women from minority ethnic groups in three geographical areas of Bradford. A stratified sample of 1,000 women (670 South Asian, 163 African-Caribbean, 96 Eastern European and 71 other) was interviewed at the beginning of the project and six months after the health promotion intervention. Two specifically trained Health Promotion Facilitators from minority ethnic groups undertook community development work within three neighbourhoods in Bradford with the largest minority ethnic populations. There were group sessions in both formal and informal settings, which included health education about breast and cervical cancer and the associated screening programmes. These sessions were in the women's preferred languages and audio-visual material and a specially designed teaching pack were used. There were significant differences in the baseline levels of knowledge about cervical cancer and breast cancer across the different minority ethnic groups. The South Asian women had the lowest levels of knowledge and also showed the most significant improvements. Significant increases in attendance for cervical smear and breast cancer screening were self-reported. These were confirmed by anecdotal views of local health professionals. In addition, a local self-help group for South Asian women was established; also the contacts with other related organisations and professionals has helped to raise the issues of ethnically sensitive services within the voluntary and statutory sectors. A community development approach to health promotion is particularly valuable in communities with low levels of knowledge about a diseases or health service provision. Community development approaches often produce outcomes that had not been predicted. There is a need to conduct a definitive study in this area of health promotion for minority ethnic populations with emphasis on evaluation, cost-benefit analysis and opportunity costs.

Adult↗
PubMed2002

Community development and health project: a 5-year (1995-1999) experience in Mozambique, Africa.

The Community Development and Health Project (1995-1999) in Mozambique, East Africa, was undertaken to help alleviate the dire circumstances of daily life following years of internal warfare. The project was supported by the International United Methodist Church and was administered by the Mozambique Conference of the United Methodist Church, Chicuque Rural Hospital and Cambine Health Center. The target population, whose daily survival depended on subsistence farming, lived throughout the country, in particular in rural areas, far from health care facilities. The Project Content included the following topics: basic education in personal and environmental hygiene; proper nutrition using locally available food products; methods of agriculture that would ensure the best use of the land for growing nutritious food; economic methods to guarantee a supply of safe drinking water; disease prevention/home treatment; maternal child health; self-esteem issues; and establishing a representatively inclusive community-development committee. Indigenous women, the 'promotoras/os', were selected from their communities, attended a 4-week training session and then returned to their homes as 'Promotoras/os of Community Development and Health'.

Health Education↗
PubMed1997

Community development for health and identity politics.

Community development for health (CD4H) is defined as the mobilization of communities actually or potentially suffering from a health problem to eliminate its causes or alleviate its consequences. This paper links this with questions of social identity, focusing on issues of ethnicity and 'race', in health promotion. When combined with notions of ethnicity and 'race'. CD4H is frequently a reaction to inequalities which are communally experienced and believed to increase risk of ill-health for the group. This paper theorizes the link between communal experience and activity to promote health, by drawing on sociological theory linking structure and agency. It examines how discourses of belonging and exclusion are enacted in struggles for health. Via examples from the Caribbean and the UK, instances of 'identity politics' in CD4H are identified, viewed as the use of essentialist, binary notions of self and other in the attempt to gain an advantage over the other. It is argued that such instances should not be considered in isolation, but should be viewed as responses to experience, particularly, in the UK context, the experience of racism in the Health Service.

Community Health Planning↗
PubMed1996

A community development and outreach program in geriatric mental health: four years' experience.

OBJECTIVES: To describe a geriatric mental health outreach program based on a community development model and to review 4 years of experience with this program. DESIGN: Program model and description of implementation experience. SETTINGS: A geriatric mental health outreach program of a regional psychiatric hospital, serving a primarily non-urban area, with offices in the community it serves. PARTICIPANTS: The program targets community-dwelling or institutionalized older persons with late-onset mental health problems and/or behavioral disturbances, persons with long-standing psychiatric disorders with age-related changes, and their caregivers. INTERVENTION: The program is a geriatric mental health outreach and consultation service that emphasizes community development and caregiver education. Program components include an interprofessional consultation team, a specialized information and resource service, educational service initiatives, and an ongoing role in planning and coordination activity in the local health care system. MEASUREMENTS: Program monitoring, including a patient database and a description of program activities. RESULTS: Cognitive impairment, behavioral disturbance, physical/medical problems and depression are the most common reasons for referral to the outreach program. Referred patients (mean age 78; 65% female) have usually (almost 90% of cases) been managed at a similar or lower level of care. Program activities have included focused educational initiatives in community and institutional settings and have emphasized the involvement and development of community caregivers and other local resources. CONCLUSION: The program is a multifaceted effort to make efficient use of scarce specialized resources in a manner that is sensitive and responsive to local circumstances and needs. Experience to date has shown evidence of the feasibility and potential benefits of a comprehensive approach to community development and outreach in geriatric mental health.

Aged↗