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PubMedDate not supplied

Finding ways to create connections among communities: partial results of an ethnography of urban public health nurses.

The purpose of this ethnographic study was to describe the culture of public health nurses (PHNs) in a large, Midwestern urban health department. Data collection methods, data management, and analyses followed ethnographic procedures and resulted in the development of categories, domains, and cultural themes. The general study participants were PHNs, clients, supervisors, and administrators. The primary cultural theme that emerged was that public health nursing is finding ways to create connections among communities. Three interacting communities were identified: the local communities, communities created by individuals and families, and communities of resources. This article describes one of the three subthemes that emerged, processes used to help clients create connections, and describes how caring is shown uniquely in public health nursing. As a result of the study, implications for nursing practice, education, and research were developed. The results of the study supported a position that public health nursing is a unique nursing specialty. It reinforced also the applicability of an ethnographic design and methodology to nursing research.

Adult↗
PubMed2006

Parental attitudes towards the uptake of smoking by children.

ISSUE ADDRESSED: Factors related to parental smoking and parenting practice have a big effect on adolescent smoking. More in-depth information about these relationships can be used to inform interventions. This study investigated Maori, Pacific Islander, New Zealand European and Asian parent attitudes and practices in relation to smoking uptake in children. METHODS: Parents of children aged 8-15 years, recruited through the researchers' community networks and the media, participated in focus groups or interviews run by ethnically matched facilitators. Areas addressed included parents' beliefs about children smoking, their actions, and their suggestions for tobacco control activities. The data were analysed thematically. RESULTS: Parents believed that parental smoking, peer pressure and smoking role models in the media influenced smoking uptake in children. They said they would be disappointed if their children started smoking, but their confidence in influencing them varied. Many talked to their children about the health consequences of smoking, including their own negative perceptions of smoking and smokers. Most had smoke-free homes. The parents who smoked tried to avoid smoking around children. There was a good deal of commonality across the different ethnic groups. Important differences related to the provision of interventions. CONCLUSIONS: Parents believed in the value of a smoke-free lifestyle and wanted to protect their children from smoking. Important strategies to prevent smoking in children may include supporting parents to quit, informing them that discouraging children of any age from smoking can be effective, and providing culturally appropriate education and resources to facilitate parent/child communication about smoking.

Adolescent↗
PubMed2001

Social work and health restructuring in Canada and Finland.

The health care systems in Canada and Finland are currently in the process of restructuring. Responsibility for care has increasingly shifted to ill persons themselves and to their families and friends. Reduced hospital stays, service privatization and user fees have been implemented to some degree in both countries. These changes are reverberating throughout Finnish and Canadian societies, affecting not only users of health care but also the labour force in health workplaces. Health social workers, at the front line with clients, have experienced new issues which have impacted on their practice with ill persons and their families. In an environment of health care restructuring, they have needed to draw upon their repertoires of knowledge, skills and community networks in order to respond. At the same time, social workers noted that there is a leaner package of health and social service benefits to support patients and families. Social workers have tried to adapt and find new opportunities to practice social work in the changed environment. This small study, initially conducted as a pilot for a larger study, compared the experiences of social workers in Canada and Finland and the perceived impacts of health restructuring on their clients. The findings, seen within the context of changing societal and institutional environments, can help us to better understand some of the impacts of health restructuring on social work and social workers in hospitals and local health centres. Indirectly and directly, these changes also affect clients in the health care system, those whose needs remain uppermost in the delivery of social work services.

Canada↗
PubMed2005

Condom use in African adolescents: the role of individual and group factors.

This study set out to assess the ability of the Theory of Planned Behaviour (TPB) to predict and explain condom use in a traditional African context and in particular to assess the relative contributions of individual and normative constructs. A questionnaire survey was administered to 152 young adults (48% male, 52% female) at two points in time. Key constructs contained within the TPB were measured at Time 1. A short follow-up set of items was administered one week later at Time 2, thereby allowing for the measurement of actual behaviour. The results not only provide strong support for the predictive power of the TPB, since 67% of the variance in intention was explained, but also highlight the extent to which sexual behaviour in a rural location is governed by family/social influences. Subjective norm not only proved to be one of the most significant elements of the TPB model, together with self-efficacy (neither attitude nor perceived control were significantly involved), but 'my family' emerged as the most significant other. As such, the findings offer empirical evidence to support interventions that penetrate community networks.

Adolescent↗
PubMedDate not supplied

Participatory research strategies in nuclear risk management for native communities.

The Nuclear Risk Management for Native Communities (NRMNC) project is a collaborative academic, community-based, tribal project, which conducts the three essential elements of participatory research: research, education, and community action, named here as "community-based hazards management." This article describes the goals and outcomes of this effort in assisting Native American communities in Nevada, Utah, and Southern California affected by nuclear fallout from U.S. weapons testing in the 1950s and 1960s. The NRMNC project sought to create new models for dealing with health research and risk communication needs in an environmental justice setting. The following results of this four-year project are discussed: (1) building a community-based environmental health infrastructure, (2) building community capacities through workshops and educational materials, (3) conducting both technical and community research, and (4) facilitating community-based hazards management planning. We describe such positive outcomes as the improvements in the scientific database through participatory research activities, the development of equitable relationships between scientists and community members, and the creation of a sustaining program intervention for long-term community needs. The project's outcomes are presented as an expansion to limited scientific risk management outcomes in the environmental health field that often are solely quantitative and lack relevance to community concerns about environmental health impacts from contamination.

California↗
PubMed2004

Social capital, participation and the perpetuation of health inequalities: obstacles to African-Caribbean participation in 'partnerships' to improve mental health.

OBJECTIVES: There has recently been much emphasis on the role of 'partnerships' between local community 'stakeholders' in strategies to redress health inequalities. This paper examines obstacles to participation in such partnerships by African-Caribbean lay people in local initiatives to improve mental health in a town in southern England. We present a 'social psychology of participation' which we use to interpret our data. Our work seeks to illustrate some of the micro-social mechanisms through which social inequalities are perpetuated, using Bourdieu's conceptualization of the role played by various forms of capital (economic, social, cultural and symbolic) in perpetuating social inequalities. DESIGN: Our empirical research consists of a qualitative case study of attitudes to participation in mental-health-related partnerships in a deprived community. In-depth interviews and focus groups were conducted with 30 local community 'stakeholders', drawn from the statutory, voluntary, user and lay sectors. RESULTS: While interviewees expressed enthusiasm about the principles of participation, severe obstacles to its effective implementation were evident. These included severe distrust between statutory and community sectors, and reported disillusionment and disempowerment within the African-Caribbean community, as well as low levels of community capacity. Moreover, divergent understandings of the meaning of 'partnership' suggested that it would be difficult to satisfy both community and statutory sectors at once. CONCLUSIONS: We suggest that disadvantaged and socially excluded communities are often deprived of the social resources which would provide a solid basis for their participation in partnerships with state health services. In the absence of efforts to remove such obstacles, and to generate the necessary resources for participation, partnerships may be 'set up to fail', leaving social inequalities to prevail.

Adolescent↗
PubMed2004

A partnership approach to health promotion: a case study from Northern Ireland.

In recent years there has been a renewal of interest in community development and partnership approaches in the delivery of health and social services in Northern Ireland. The general thrust of these approaches is that local communities can be organized to address health and social needs and to work with government agencies, voluntary bodies and local authorities in delivering services and local solutions to problems. Since the Ottawa Charter was launched in 1986, government in Northern Ireland has stressed that community development should no longer simply be added on to key aspects of Health and Social Services, but should instead be at the core of their work. There is increasing consensus that traditional approaches to improving health and well-being, which have focused on the individual, are paternalistic and have failed to tackle inequalities effectively. Partnerships within a community development setting have been heralded as a means to facilitate participation and empowerment. This paper outlines the policy background to community development approaches in health promotion and delivery in Northern Ireland. Drawing on evidence from a case study of a community health project it highlights the benefits and difficulties with this approach. The findings suggest that partnerships can positively influence a community's health status, but in order to be effective they require effective planning and long-term commitment from both the state and the local community.

Community Health Planning↗
PubMed2004

Organizational capacity for community development in regional health authorities: a conceptual model.

The value of community development (CD) practices is well documented in the health promotion literature; it is a foundational strategy outlined in the Ottawa Charter for Health Promotion. Despite the importance of collaborative action with communities to enhance individual and community health and well-being, there exists a major gap between the evidence for CD and the actual extent to which CD is carried out by health organizations. In this paper it is argued that the gap exists because we have failed to turn the evaluative gaze inward-to examine the capacity of health organizations themselves to facilitate CD processes. This study was designed to explicate key elements that contribute to organizational capacity for community development (OC-CD). Twenty-two front-line CD workers and managers responsible for CD initiatives from five regional health authorities in Alberta, Canada, were interviewed. Based on the study findings, a multidimensional model for conceptualizing OC-CD is presented. Central to the model are four inter-related dimensions: (i) organizational commitment to CD, rooted in particular values and beliefs, leadership and shared understanding of CD; (ii) supportive structures and systems, such as job design, flexible planning processes, evaluation mechanisms and collaborative processes; (iii) allocation of resources for CD; and (iv) working relationships and processes that model CD within the health organization. These four dimensions contribute to successful CD practice in numerous ways, but perhaps most importantly by supporting the empowerment and autonomy of the pivotal organizational player in health promotion practice: the front-line worker.

Canada↗
PubMed2004

The Eat Well SA project: an evaluation-based case study in building capacity for promoting healthy eating.

The term 'capacity building' is used in the health promotion literature to mean investing in communities, organizations and structures to enhance access to knowledge, skills and resources needed to conduct effective health programs. The Eat Well SA project aimed to increase consumption of healthy food by children, young people and their families in South Australia. The project evaluation demonstrated that awareness about healthy eating among stakeholders across a range of sectors, coalitions and partnerships to promote healthy eating and sustainable programs had been developed. The project achievements were analysed further using a capacity-building framework. This analysis showed that partnership development was a key strategy for success, leading to increased problem-solving capacity among key stakeholders and workers from education, child care, health, transport and food industry sectors. It was also a strategy that required concerted effort and review. New and ongoing programs were initiated and institutionalized within other sectors, notably the child care, vocational education and transport sectors. A model for planning and evaluating nutrition health promotion work is described.

Adolescent↗
PubMed2006

What makes for sustainable Healthy Cities initiatives?--A review of the evidence from Noarlunga, Australia after 18 years.

This paper examines the factors that have enabled the Healthy Cities Noarlunga (HCN) initiative to be sustainable over 18 years (1987-2005). Sustainability related to the ability of the initiative to continue to operate continuously in a manner that indicated its existence was accorded value by the community and local service providers. The analysis is based on a narrative review of 29 documents related to HCN, including a number of evaluations. Nine factors emerged as important to ensuring sustainability: strong social health vision; inspirational leadership; a model that can adapt to local conditions; ability to juggle competing demands; strongly supported community involvement that represents genuine engagement; recognition by a broad range of players that Healthy Cities is a relatively neutral space in which to achieve goals; effective and sustainable links with a local university; an outward focus open to international links and outside perspectives; and, most crucial, the initiative makes the transition from a project to an approach and a way of working. These sustainability factors are likely to be relevant to a range of complex, community-based initiatives.

Community Health Planning↗
PubMed2006

Determinants of health promotion action: comparative analysis of local voluntary associations in four municipalities in Finland.

The World Health Organization makes a case for the importance of voluntary organizations in promoting health at local levels. The purpose of this paper is to contribute to understanding which factors explain local voluntary associations (LVAs) participation in health promotion in local contexts. It does so through (i) identifying indicators that represent determinants of health promotion action which were reported by LVAs and by (ii) comparing their actions with these determinants. The data reported are from a questionnaire survey of all registered LVAs in four municipalities in Finland. Principal component analysis revealed four determinants of health promotion action. Four factors in the final multivariate model explained over half of the variance of LVAs engagement in health promotion action: competence, values 'healthy' and also opportunities and municipality. There is some evidence to support a model of health promotion action which has not been tested empirically in relation to these types of organization. More detailed studies of determinants of health promotion action are needed to shape strategies in local communities.

Community Health Planning↗
PubMed2003

Broadening participation in community problem solving: a multidisciplinary model to support collaborative practice and research.

Over the last 40 years, thousands of communities-in the United States and internationally-have been working to broaden the involvement of people and organizations in addressing community-level problems related to health and other areas. Yet, in spite of this experience, many communities are having substantial difficulty achieving their collaborative objective, and many funders of community partnerships and participation initiatives are looking for ways to get more out of their investment. One of the reasons we are in this predicament is that the practitioners and researchers who are interested in community collaboration come from a variety of contexts, initiatives, and academic disciplines, and few of them have integrated their work with experiences or literatures beyond their own domain. In this article, we seek to overcome some of this fragmentation of effort by presenting a multidisciplinary model that lays out the pathways by which broadly participatory processes lead to more effective community problem solving and to improvements in community health. The model, which builds on a broad array of practical experience as well as conceptual and empirical work in multiple fields, is an outgrowth of a joint-learning work group that was organized to support nine communities in the Turning Point initiative. Following a detailed explication of the model, the article focuses on the implications of the model for research, practice, and policy. It describes how the model can help researchers answer the fundamental effectiveness and "how-to" questions related to community collaboration. In addition, the article explores differences between the model and current practice, suggesting strategies that can help the participants in, and funders of, community collaborations strengthen their efforts.

Community Health Planning↗
PubMed2005

A qualitative exploration of alternative strategies for building community health partnerships: collaboration- versus issue-oriented approaches.

Broad-based community partnerships are seen as an effective way of addressing many community health issues, but the partnership approach has had relatively limited success in producing measurable improvements in long-term health outcomes. One potential reason, among many, for this lack of success is a mismatch between the goals of the partnership and its structure/membership. This article reports on an exploratory empirical analysis relating the structure of partnerships to the types of issues they address. A qualitative analysis of 34 "successful" community health partnerships, produced two relatively clear patterns relating partnership goals to structure/membership: (1) "collaboration-oriented" partnerships that included substantial resident involvement and focused on broader determinants of health with interventions aimed at producing immediate, concrete community improvements; and (2) "issue-oriented" partnerships that focused on a single, typically health-related issue with multilevel interventions that included a focus on higher-level systems and policy change. Issue-oriented partnerships tended to have larger organizations governing the partnership with resident input obtained in other ways. The implication of these results, if confirmed by further research, is that funders and organizers of community health partnerships may need to pay closer attention to the alignment between the membership/structure of a community partnership and its goals, particularly with respect to the involvement of community residents.

Community Networks↗
PubMed2000

Inequalities in health: approaches by health authorities in an English health region.

BACKGROUND: In 1995 the Department of Health published Variations in health: what can the Department of Health do? This recommended that health authorities should have a comprehensive plan for identifying and tackling variations in health. We investigated how health authorities in the South and West Region were taking forward this work. METHODS: Semi-structured interviews and reviews of documentation were conducted in all health authorities in the South and West Region of England. RESULTS: All health authorities viewed tackling inequalities in health as important; however, explicit strategies did not exist and Health of the Nation targets were a vehicle for determining priorities of inequalities. Explicit corporate commitment was often weak. Analyses were being conducted to determine the magnitude of local health inequalities and to assist in designing appropriate interventions. The importance of alliance working was highlighted; much work was being done although success was variable. CONCLUSIONS: Efforts are being made throughout the South and West region to tackle inequalities in health. Although strategic vision at the corporate level was often lacking, there was evidence of commitment to taking the inequalities agenda forward within public health directorates. Strengthening of primary care and alliance working roles is essential. Recent national strategy documents, forthcoming legislation, and a review of health inequalities recognize the health effects of inequalities and require health authorities to collaborate with local partners to tackle these, and will offer opportunities to improve corporate commitment and alliance working. Uptake and success of these opportunities will have a major influence on progress in tackling health inequalities.

Community Health Planning↗
PubMed2002

Showing results in community organization.

This article describes a community organization program and its tangible results in a stigmatized neighborhood in the center of Israel. The program lasted six years; its central goal was the autonomy of the community, the empowerment of its residents, and collaboration among the human services workers and between them and the resident leaders. The results, measured objectively and quantitatively, included a large increase in the number of community activists; strong and statistically significant increases of self-esteem and mastery of surroundings; increase in family, service delivery, and community empowerment among the activists, and the participation of residents and outsiders in a project to build their own homes in the neighborhood.

Community Networks↗
PubMed1999

Caring for the community: the role of partnerships.

While many members of the public are deeply interested in and supportive of the three traditional missions of academic medicine--education, research, and clinical care, they also want to know what academic health centers (AHCs) are doing to improve the overall health of their communities. Much is already being done toward this goal, but improving communities' health in a measurable way requires a far broader agenda. AHCs must bring together the approaches of medicine and public health, and need to partner with many other players. This agenda must proceed despite all the other challenges that AHCs are currently facing. The author reviews illustrative and emerging national, state, and local efforts, public and private, in both medicine and public health, in partnerships with individuals and institutions in the larger community. He also highlights the physician's role in assisting stakeholders' efforts to deal with health threats from the environment, and offers advice about how such efforts should proceed. He closes by emphasizing the importance of community-based research to learn about the health statuses, problems, and resources of particular communities, and presents a set of principles for such community-based research.

Academic Medical Centers↗