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PubMed1995

The implementation of health promotion: a new structural perspective.

Although health promotion has become a critical concept in public health, both research and practical projects in this area are almost devoid of theory. The present article uses a theory of complexity and structure to organize the different elements of health promotion in a new perspective. This perspective involves (1) new ways for looking at patterns of behavioral risk factors and health-related lifestyles. It (2) relates health promotion to policy making. In particular, it (3) focuses on a comprehensive model of the implementation process, revealing the true interrelationship of relevant elements to the concept of health promotion. In this context, it (4) becomes obvious that the reflexivity and recursiveness of scientific analyses are an integral part of the structure of health promotion. Thus, the professional role of the social scientist with regards to the implementation and utilization of scientific knowledge in the field of public health policy will be discussed. Finally, the role of appropriate theory is emphasized as a strategy for improving the practice of health promotion and to further the development of a new public health.

Forecasting↗
PubMed1998

Preparing for communities of care for child and family mental health for the twenty-first century.

In a period of unprecedented change in the American health care system, a strong reform movement for child and family mental health services has developed in the last two decades that provides blueprints and models for the development of communities of care to provide individualized, strength-based services tailored to the needs of each child and family. To bring the spirit and substance of this reform into the twenty-first century, a two-pronged strategy is proposed, focusing on the broad implementation of value-based outcome measures and the development of skilled clinician leaders to ensure the effectiveness of the new delivery system.

Child↗
PubMed2006

Development and implementation of a food store-based intervention to improve diet in the Republic of the Marshall Islands.

Effective approaches for the prevention and reduction of obesity and obesity-related chronic diseases are urgently needed. Food store-centered programs represent one approach that may be both effective and sustainable. The authors developed a food store-based intervention in the Marshall Islands using qualitative and quantitative formative research methods, including a store usage survey (n = 184) and in-depth interviews with large-store managers (n = 13), small-store managers (n = 7), customers (n = 10), and community leaders (n = 4). This process was followed up by development and piloting of specific intervention components and workshops to finalize materials. The final intervention combined mass media (newspaper articles, video, radio announcements) and in-store components (shelf labels, cooking demonstrations, posters, recipe cards) and had high store-owner support and participation. High levels of exposure to the intervention were achieved during the 10-week period of implementation. This model for developing food store-based interventions is applicable to other settings.

Feeding Behavior↗
PubMed1997

Linking substance abuse services with general medical care: integrated, brief interventions with hospitalized patients.

This paper presents the results of implementing on-site alcohol or drug (AOD) brief intervention services across several medical, surgical, and psychiatric services in a county hospital. These integrated brief interventions (IBI) included patient substance abuse assessment, feedback to patient, and referral/recommendations. Three hundred sixty-three patients were referred by hospital staff to these services and 95% of these patients were subsequently confirmed by chemical dependency specialists as having diagnoses of psychoactive substance abuse or dependence. Seventy-nine percent of chemically dependent patients were without current substance abuse treatment, even though 54% were partially motivated and 20% were fully motivated for getting treatment. Of patients contacted at follow-up, 35% reported involvement in some kind of substance abuse treatment or 12-step meetings. Implications for implementing integrated brief intervention services are discussed in light of recent trends in publicly funded treatment availability and brief intervention outcome studies.

Adult↗
PubMed2006

Strategies to implement tobacco control policy and advocacy initiatives.

Critical care nursing organizations and individual critical care nurses can have an important impact on tobacco-related health policies. This article reviews the importance of critical care nursing involvement in policy efforts to achieve tobacco control goals, barriers to such involvement, and strategies to implement successful tobacco control policy initiatives. The involvement of the Association of Critical-Care Nurses and other nursing organizations in the Nursing Leadership in Tobacco Control Task Force is described.

Critical Care↗
PubMed2002

Roots, shoots, but too little fruit: assessing the contribution of COPC in South Africa.

Community-oriented primary care (COPC) originated in South Africa during the 1940s and 1950s, where it served to inform local church-based and nongovernmental organization-based initiatives during the apartheid years. During the 1990s, COPC played an inspirational role in the process of national health policy formulation. Yet COPC's contribution to current health practice remains more symbolic than substantive. Despite a policy framework that favors the widespread introduction of COPC, various political, structural, managerial, and human resource obstacles constrain its effective implementation. Notwithstanding a rapidly changing health care environment and well-established health transition from infections and nutritional disorders to non-communicable diseases and injury, COPC and its variants remain abidingly relevant to South Africa's-and Africa's-health care reality.

Community Health Centers↗
PubMed2001

Care management and the care programme approach: towards integration in old age mental health services.

OBJECTIVE: To examine the relationship between care management arrangements and the Care Programme Approach (CPA) in the context of old age mental health services and, particularly, dementia services. METHOD: The information reported is from a national study of care management arrangements, funded by the Department of Health. A response rate of 77% was obtained from local authority social services departments. RESULTS: In old age mental health services over half of the respondents reported joint screening arrangements for health and social care, almost four-fifths reported both joint criteria for the allocation of key workers and a clear definition of monitoring responsibilities. Of the latter over two-fifths were reported as being the same in care management and the CPA. Forty-six per cent of respondents provided a specialist service for people with dementia. Three-fifths of respondents reported that they did not apply CPA to people with dementia who were in receipt of care management or did so in less than 20% of cases. Where the CPA was applied it was more likely that a priority would be accorded to care management. A quarter of respondents reported the shared use of assessment documentation for people with dementia. DISCUSSION: The findings are set in the context of service developments to date and the implementation of the two systems of community based coordinated care for older people with mental health problems. Inter-authority variations are noted and the potential for greater service integration within the current legislative framework assessed.

Aged↗
PubMed1998

Assessing public health capacity to support community-based heart health promotion: the Canadian Heart Health Initiative, Ontario Project (CHHIOP).

This paper presents initial findings of the Canadian Heart Health Initiative, Ontario Project (CHHIOP). CHHIOP has two primary objectives. The programmatic objective is to coordinate and refine a system for supporting effective, sustained community-based heart health activities. This paper addresses the scientific objective: to develop knowledge of factors that influence the development of predisposition and capacity to undertake community-based heart health activities in public health departments. A systems theory framework for an ecological approach to health promotion informs the conceptualization of the key constructs, measured using a two-stage longitudinal design which combines quantitative and qualitative methods. This paper reports the results of the first round of quantitative survey data collected from all health departments in Ontario (N = 42) and individuals within each health department involved in heart health promotion (n = 262). Results indicate low levels of implementation of heart health activities, both overall and for particular risk factors and settings. Levels of capacity are also generally low, yet predisposition to undertake heart health promotion activities is reportedly high. Analyses show that implementation is positively related to capacity but not predisposition, while predisposition and capacity are positively related. Overall, results suggest predisposition is a necessary but not sufficient condition for implementation to occur; capacity-related factors appear to be the primary constraint. These findings are used to inform strategies to address CHHIOP's programmatic objective.

Causality↗
PubMed2002

Implementing a geriatric resource nurse model.

The aging of the American population and its effects on healthcare centers require strategies and programs to ensure best practices for older patients. The authors describe an educational program, modification of a Geriatric Resource Nurse Model, and the use of a Geriatric Nurse Practitioner in implementing and integrating the clinical, psychosocial, and financial aspects that influence care needed by elderly patients and their families.

Aged↗
PubMedDate not supplied

What factors influence provider knowledge of a congestive heart failure guideline in a national health care system?

Provider knowledge is a potential barrier to adherence to clinical guidelines. The purpose of this study is to assess the impact of organizational, provider, and guideline factors on provider knowledge of a congestive heart failure (CHF) clinical practice guideline (CPG) in the Veterans Health Administration (VHA) health care system. We developed a survey to investigate institution-level factors influencing the effectiveness of guideline implementation, including characteristics of the guideline, providers, hospital culture and structure, and regional network. Survey participants were quality managers, primary care administrators, and other individuals involved in primary care CPG implementation at 143 VHA hospitals with ambulatory care clinics. Potential explanatory variables were grouped into 11 factors. Multivariate regression models assessed the association between these factors and reported levels of provider knowledge regarding the CHF guideline at the hospital level. Two hundred forty surveys from 126 of 143 (88%) VHA hospitals were returned. Provider knowledge of the CHF guideline was estimated as "great" or "very great" by 58% of respondents. Three predictor factors (dissemination approaches, use of technology in guideline implementation, and hospital culture) were independently associated (P < or = .05) with provider knowledge. Specific variables within these categories that were related to greater knowledge included physician belief that guidelines were applicable to their practice, distribution of guideline summaries, use of guideline storyboards in clinic areas, the use of technology (eg, electronic patient records) in CPG implementation, and establishment of implementation checkpoints and deadlines. Provider knowledge of guidelines is affected by factors at various organizational levels: dissemination approaches, use of technology, and hospital culture. Guideline implementation efforts that target multiple organizational levels may increase provider knowledge.

Ambulatory Care Facilities↗
PubMed2006

Transitioning from a pen-and-paper health risk appraisal to an online health risk appraisal at a petroleum company.

Chevron Texaco's Health and Medical Services Department made the decision to use existing technology and transition from a paper health risk appraisal (HRA) to an online questionnaire. A cross-functional team was formed and a year was spent researching online tools to find a vendor who could supply a product best suited to Chevron Texaco's employee workforce. The purpose of this article is to describe the evolution of a paper-based HRA to an online tool as well as describe the project scope and strategy that a team of employees used in selecting the vendor. The article also describes implementation successes, challenges, and lessons learned in using the online tool with an industrial workforce. The strategy that was followed in deploying the Web site along with initial participation rates for this group of industrial employees are described.

Adult↗
PubMedDate not supplied

Building community-based service systems for children with special needs: the Michigan Locally Based Services program.

The philosophy of the Michigan Department of Public Health, Division of Children's Special Health Care Services (DCSHCS) program holds that children with special health care needs have a right to every opportunity for self-support and self-fulfillment. To assist families, the program historically has provided support with medical care and treatment payments. Likewise, local health departments have shared in the process of supporting families of children with special health care needs. A growing awareness that these families experience a variety of other needs not directly attended to by these mechanisms led the Division to respond further to those needs. The response was aimed toward increasing the capacity to locate clients and provide family assessments, and, where necessary, case management services at the local community level. The implementation, on-going program development, stabilization, and future trends of the Locally Based Services program are described from the varying perspectives of the state and a local health department.

Child↗
PubMed1997

From electronic medical record to personal health record.

In this paper we attempt to provide a definition and purpose for the electronic patient record, point out the benefits of its use and outline the major challenges in wider implementation that are encountered world-wide. Finally, some trends are highlighted that are believed to play an important role in the future development and use of the electronic patient record.

Computer Communication Networks↗
PubMed1996

Fluoridation in South Africa.

The issues on fluoridation, fluorosis and fluorides in South Africa have been reported for the last 50 years. Efforts to implement water fluoridation between 1960 and 1980 failed partly due to lack of government action and a strong anti-fluoride lobby. The political change in South Africa since 1994 has given new support from the Ministry of Health for enabling legislation to implement water fluoridation in metropolitan areas where the technical support and some 55 per cent of the population reside. Fluoridation also addresses the equitable distribution of resources and access to a known benefit.

Adolescent↗
PubMed1998

Community orientation in health services organizations: the concept and its implementation.

The management of community health needs has become a focal point in the drive to contain health care costs, enhance service quality, and improve access to care. This article presents a concept of community orientation that health services organizations can use to provide community-focused care. It also discusses the organizational antecedents and consequences of community orientation in health services organizations and develops research propositions.

Community Health Planning↗
PubMedDate not supplied

Mobilizing communities to reduce substance abuse in Indian country.

The impact of substance abuse is notable on Indian reservations in the United States and in the border communities surrounding them. One Indian country community, McKinley County, New Mexico, developed and implemented a series of alcohol policy and programmatic reforms beginning in 1989 which have reduced the impact of substance abuse on this community. Learning from the McKinley County experience, Fremont County in Wyoming, home of the Wind River Indian Reservation, has implemented similar reforms. This article introduces the substance abuse reduction efforts and delineates specific innovations implemented in these communities. The influence that these two communities have had on changes in substance abuse policy and programming statewide in New Mexico and Wyoming is also reviewed.

Accidents, Traffic↗
PubMed2003

Long-term implementation of the CATCH physical education program.

To test the effectiveness of the Child and Adolescent Trial for Cardiovascular Health (CATCH) program, a randomized trial was conducted in 96 elementary schools in four regions of the United States. Results from the original trial indicated a significant positive effect on the delivery of physical education (PE). All 56 former intervention schools (FI), 20 randomly selected former control schools (FC), and 12 newly selected unexposed control schools (UC) were assessed 5 years postintervention. Results indicate a strong secular trend of increasing moderate to vigorous physical activity (MVPA) in PE classes among both FC and UC schools. The FI schools surpassed the Healthy People 2010 goal for MVPA during PE lesson time (i.e., 50%), whereas the FC and UC schools came close to it. Barriers to implementing CATCH PE included insufficient training and lower importance of PE compared to other academic areas and indicate the need for in-service training.

Cardiovascular Diseases↗
PubMedDate not supplied

Health policy and its implementation in small island developing states in the British West Indies.

Health policy and its implementation in small island developing states (SIDS) is a neglected area of study, and, seemingly, of little interest. The existing literature is generally characterized by descriptions of failure or incompetence, with little attempt to understand the nature and workings of the policy process in these small, yet complex, societies. The research undertaken in this article was carried out over 6 years in Anguilla (pop. 9000) and the British Virgin Islands (pop. 20 000), two British Overseas Territories in the North East Caribbean. The purpose of the research was to determine to what extent policy theory and the tools of policy analysis could be used to explain the nature and the outcomes of the health policy and implementation process. In trying to analyse and understand the policy process in these small islands it was necessary to understand their socio-politic character. In addition, the development of a model of the public policy and public administration system in the English-speaking Caribbean was an essential part of this process. It was found that the conduct and outcome of the policy and implementation process in these islands varied significantly. It is postulated that the variations are anchored in the nature of the local context, the working practices and ideologies of politicians, senior public servants and the local policy elite.

Attitude of Health Personnel↗