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PubMed2001

Disentangling measures of individual perceptions of community social dynamics: results of a community survey.

This study examined how different measures of individual perceptions of community social dynamics relate to each other and how these measures relate to self-reported general health and depressive symptoms. Results of a principal components analysis conducted to investigate the interrelationships between these individual measures suggest that these measures measure separate phenomena. In addition, in results of multiple-regression analyses conducted to examine associations between the various measures of individual perceptions of community social dynamics and the dependent variables of self-reported general health and depressive symptoms, sense of community, perceived neighborhood control, and neighborhood participation were all associated with the outcome variables in separate regression models. In a regression model with these three variables added to control variables, only sense of community was significantly, albeit modestly, associated with depressive symptoms and self-reported general health.

Adolescent↗

PubMed2004

Effects of community factors on access to ambulatory care for lower-income adults in large urban communities.

This study examines the effects of community-level and individual-level factors on access to ambulatory care for lower-income adults in 54 urban metropolitan statistical areas in the United States. Drawing on a conceptual behavioral and structural framework of access, the authors developed multivariate models for insured and uninsured lower-income adults to assess the adjusted effects of community- and individual-level factors on two indicators of access: having a usual source of care, and having at least one physician visit in the past year. Several community factors influenced access, but they did so differently for insured and uninsured adults and for the two measures of access used. The findings of this sttudy confirm that public policies and community environment have measurable and substantial impacts on access to care, and that expanded public resources, such as Medicaid payments and safety-net clinics, can lead to measurable improvements in access for vulnerable populations residing in large urban areas.

Adult↗

PubMed1997

Community screening for rheumatic disorder: cross cultural adaptation and screening characteristics of the COPCORD Core Questionnaire in Brazil, Chile, and Mexico. The PANLAR-COPCORD Working Group. Pan American League of Associations for Rheumatology. Community Oriented Programme for the Control of Rheumatic Disease.

OBJECTIVE: (1) To adapt the Community Oriented Programme for the Control of Rheumatic Disease (COPCORD) Core Questionnaire (CCQ) for use as a rheumatic disease screening instrument in Spanish and Portuguese communities in Brazil, Chile, and Mexico, including translation and back translation, and assessment of cross cultural equivalence and reliability. (2) To determine the screening characteristics of the CCQ, specifically the sensitivity and specificity of Spanish and Portuguese versions for detecting cases of rheumatic disorder compared with a full clinical examination by a rheumatologist. (3) To determine the number of clinical examinations that could be avoided in population studies by applying the CCQ followed by a clinical examination in positive CCQ screenees. METHODS: Translation and assessment of cross cultural equivalence were conducted by practising rheumatologists in Brazil, Chile, and Mexico using standardized methods. Back translation was done by an independent rheumatologist (Brazil), a radiologist (Chile), and a general physician (Mexico). Interviewer agreement was assessed in all sites in a convenience sample. Sensitivity and specificity were assessed by independently administering the CCQ and a full clinical examination to a sample of 200 persons aged 15 years or older, randomly selected from communities in Sao Paulo, Brazil (n = 200), Temuco, Chile (n = 200), and Mexico City, Mexico (n = 200). RESULTS: (1) Cross cultural equivalence and back translation of the modified questionnaire were satisfactory. Interviewer agreement was acceptable. (2) In groups from Brazil, Chile, and Mexico, respectively, the overall prevalence of rheumatic disease based on clinical examination was 33.3, 45.1, and 46.3%. The sensitivity and specificity of 2 definitions of a positive CCQ screening for the presence of rheumatic disorder were: Definition 1 (no trauma, present pain, tenderness, swelling or stiffness in bones, joints or muscles): sensitivity, 91.8, 96.0, 84.0; specificity, 70.0, 35.5, 61.0; Definition 2 (Definition 1 plus pain intensity > or = 4 and 11 point category rating scale): sensitivity, 66.2, 86.3, 42.7; specificity, 82.3, 41.9, 80.0. (3) In groups from Brazil, Chile, and Mexico, respectively, positive screening by Definition 1 followed by a clinical examination avoids 499, 213, and 403 clinical examination per 1000 respondents screened and yields an overall prevalence of rheumatic disorder of 30, 43, and 40%. The addition of pain intensity (Definition 2) increased the total number of examinations avoided, but reduced the prevalence estimate compared to Definition 1 (22.0, 39.0, and 20.0%). CONCLUSION: The CCQ appears promising as a screening tool to detect rheumatic disorder in Spanish and Portuguese speaking communities in a developing country. The findings suggest that the CCQ followed by a full clinical examination in positive respondents can provide an acceptable estimate of prevalence of rheumatic disorder. The total number of clinical examinations that must be administered in population based prevalence surveys can be reduced by using the CCQ, while maintaining satisfactory accuracy. Our findings need to be confirmed in further applications of the CCQ.

Adolescent↗

PubMed1980

Evaluating community awareness of a community mental health center.

To assess community awareness of a community mental health center, a telephone survey was conducted, using a random stratified sample. In order to provide comparative analyses, two other mental health agencies were included in the study. Five specific issues were addressed: (a) the percentage of the population that was aware of the agencies, (b) inter-agency comparisons, (c) heterogeneity of awareness levels among geographic areas, (d) the relative merit of different sources of information, and (e) the relationship between awareness and demographic factors. The results indicated relatively high levels of awareness for the three agencies (X = 57%). There were, however, significant differences in awareness levels between agencies and between geographic areas. The source of information cited most often by respondents was the newspaper; in addition, there was an effect for the primary agency's storefront office. Sex, education, and family size had significant but weak correlations with the amount of accurate information a respondent possessed. The results provided substantive answers to the agency's concerns as well as methodological guidelines for future evaluations of community awareness.

Awareness↗

PubMed2003

What is true community-acquired urinary tract infection? Comparison of pathogens identified in urine from routine outpatient specimens and from community clinics in a prospective study.

In order to identify the true nature of community-acquired urinary tract infections, the uropathogens isolated from 100 patients with urinary tract infection included in a prospective study conducted in community clinics were compared to 244 isolates from outpatient urine specimens routinely submitted to the laboratory. Significant differences in both the spectrum of bacteria and their antibiograms were found between the two groups. Laboratory data analysis of uropathogens from outpatient urine specimens may not reflect the true bacteriology of urinary tract infections acquired in the community. Hence, surveys based on laboratory data alone may overestimate resistance rates, leading to misinformed choices being made when treatment is empirical.

Anti-Bacterial Agents↗

PubMed2006

Utilizing program evaluation as a strategy to promote community change: evaluation of a comprehensive, community-based, family violence initiative.

This paper describes the authors' work in a community that received Federal funding for an integrated system of care to reduce the impact and incidence of exposure to violence for children less than six years of age. The paper includes a review of the conceptual framework that guided the work of the authors and provides a brief overview of the issue of family violence, the impact of this violence on young children, and the Federal response to this issue. In addition, a description of the Initiative and the community in which it was based is provided along with some aspects of the evaluation plan. Finally, the authors discuss how their work with this Initiative depicts an approach to facilitating change within communities.

Community Health Planning↗

PubMedDate not supplied

Community assessment: a church community and the parish nurse.

In central Massachusetts a large urban parish asked the University of Massachusetts, Amherst School of Nursing to conduct a community assessment for the church and newly employed parish nurse. The aims of the assessment were: to determine the health status of parishioners, identify their perceived health needs and perceived barriers in meeting those needs, and to assist the church and parish nurse in developing a health program for their faith community. Findings of the assessment are based on questionnaire and focus group data. Four hundred and twenty-one questionnaires were completed, and six focus groups were held to validate the data. Results showed most parishioners felt they were in good health (93%), believed faith and spiritual beliefs were important in maintaining health and well-being (91%), and thought that the church should play a role in helping parishioners meet their health needs (70%). In addition, focus group discussions revealed a need for respite care for primary caretakers of the ill and elderly, and health education programs for their teen and elderly populations. In conclusion, parishioners were positive and articulated support of the parish nurse and activities designed to address the physical, emotional, and spiritual needs of their community.

Catholicism↗

PubMedDate not supplied

Community nursing and rehabilitation nursing using community agencies.

A course of study is proposed for nursing students studying rehabilitation nursing that would use community health settings as clinical sites for the practice of rehabilitation nursing rather than the traditional rehabilitation setting. Suggested community agencies range from a typical community health agency to a shelter for homeless women.

Community Health Centers↗

PubMed2001

Use of innovative technologies in the evaluation of Nashville's REACH 2010 community action plan: reducing disparities in cardiovascular disease and diabetes in the African American community.

Ethnic minorities in the United States suffer disproportionately from chronic diseases such as cancer, heart disease, AIDS, and diabetes. A nationally-funded initiative known as Racial and Ethnic Approaches to Community Health (REACH) has designated 26 communities to implement demonstration projects to reduce health disparities in targeted minority populations. This article presents two methods of integrating innovative technologies into the program's evaluation plan: (1) a Web-based data entry system for recording project activity and (2) geographic information systems (GISs) for developing visual maps of project targets. These technologies can assist other programs in managing and measuring community-based public health initiatives.

Black or African American↗

PubMed1991

A community pre-registration year: the continuation of a community-oriented medical school curriculum.

A voluntary community-based preregistration year (internship) was created for graduates of a community-oriented medical school in Beersheva, Israel. Graduates were placed in community clinics which had been upgraded to meet the needs of the programme through provision of on-site laboratory facilities and specialist consultation, and placement of social workers and health education personnel in the clinics. The graduates participated in a weekly postgraduate education programme directed to their specific needs. There was a high degree of satisfaction with the programme among the trainees, the clinic team members and the patients. Relatively few of the trainees indicated a desire to pursue careers entirely devoted to primary care, despite their positive evaluation of the pre-registration experience. Though this might have been explained by problems encountered in the programme, such as the lack of adequate on-site supervision and lack of support from the health service providers, external factors such as a general move of graduates towards more lucrative subspecialties and the relative lack of status of family practice were probably the more significant reasons. Increasing focus on the internship year, in addition to the undergraduate and residency periods, is needed to help direct medical education to ambulatory settings.

Attitude of Health Personnel↗

PubMed1999

Linking community-based blood pressure measurement to clinical care: a randomized controlled trial of outreach and tracking by community health workers.

OBJECTIVES: This study assessed the effectiveness of enhanced tracking and follow-up services provided by community health workers in promoting medical follow-up of persons whose elevated blood pressures were detected during blood pressure measurement at urban community sites. METHODS: In a randomized controlled trial, 421 participants received either enhanced or usual referrals to care. Participants were 18 years or older, were either Black or White, and had blood pressure greater than or equal to 140/90 mm Hg and income equal to or less than 200% of poverty. The primary outcome measure was completion of a medical follow-up visit within 90 days of referral. RESULTS: The enhanced intervention increased follow-up by 39.4% (95% confidence interval [CI] = 14%, 71%; P = .001) relative to usual care. Follow-up visits were completed by 65.1% of participants in the intervention group, compared with 46.7% of those in the usual-care group. The number needed to treat was 5 clients (95% CI = 3, 13) per additional follow-up visit realized. CONCLUSIONS: Enhanced tracking and outreach increased the proportion of persons with elevated blood pressure detected during community measurement who followed up with medical care.

Adolescent↗

PubMed1995

Community-based research: a tool for community empowerment and student learning.

Teaching Nursing Research is most often done close to the end of the student's educational experience. This article describes Northeastern University College of Nursing's experience using community-based research projects as a method of teaching nursing concepts and skills to beginning nursing students. By using Paulo Freire's model of Community Empowerment, a group of inner-city teens developed a drug awareness manual that is used to teach elementary school students about drugs and drug use. Through this model, students also learn that healthcare is a partnership among individuals, communities and professionals.

Adolescent↗

PubMedDate not supplied

Focus on Trent--community. A seamless service for community care.

In an era of rapid change and development related to community care, Trent Health has been rethinking the region's approach to community nursing services. A task group set up to examine the issues led to the circulation of a consultative document: the responses revealed widespread support for the concept of a joint single service specification as the key to a 'seamless service' within the community. Work continues in Trent to clarify how nurses can contribute to achieving an effective seamless service.

Community Health Nursing↗

PubMedDate not supplied

A hospital and community in partnership: "case management coordinated care model in a community setting.".

Eighteen months ago, a small Ontario community hospital teamed up with Home Care to develop and implement a system of care delivery that would provide quality care within existing financial obligations and constraints. This article describes why the model, "Case Management Coordinated Care Model in a Community Setting," was chosen, how it works and how it is evaluated. Readers are encouraged to examine the successful implementation of this new collaborative concept of care, given today's limited funds and mandate to improve the use of community and hospital resources.

Community-Institutional Relations↗

PubMed2001

Reflections on building community: a different perspective on academic-community partnerships using the integration matrix.

Implementation of interdisciplinary rehabilitation services and clinical training in community settings is a complex process. Documented methods for analyzing, evaluating and monitoring the process within federally funded grant projects are limited. This paper reports on the use of one proposed method, the Integration Matrix of Konrad, as a framework for formative assessment and analysis of project operations. Based upon ongoing experiences implementing a Health Resources and Services Administration (HRSA) funded clinical training program in a community setting, a revision of the Integration Matrix is proposed to better reflect a community-centered, pervasive communication approach to program operations and analysis.

Academic Medical Centers↗

PubMed1997

The Ife South Breastfeeding Project: training community health extension workers to promote and manage breastfeeding in rural communities.

Reported are the results of a project to promote exclusive breastfeeding in rural communities through the training of community health extension workers in rural Nigeria. A workshop for the trainers was organized for health workers in the study area; subsequently, these trainers ran district-level training workshops. In the study area perinatal facilities, early initiation of breastfeeding has increased compared with those in the control area (P < 0.001). Also, the trained health workers had significantly better knowledge about breastfeeding than their untrained colleagues in both the study (P < 0.001) and control areas (P < 0.001), and more often recommended timely initiation and exclusive breastfeeding than the controls (P < 0.001). A multivariate analysis showed that the training programme and the study area were the only significant variables that were predictors of breastfeeding knowledge (P < 0.001). Appropriate education of health extension workers can therefore contribute significantly to the promotion of breastfeeding in rural communities.

Adult↗

PubMed1998

[A method for quality assurance in a community mental health center. Community psychiatry in Copenhagen].

The purpose was to describe a method for quality assurance in community mental health centres. Three psychiatrists and a multiprofessional treatment team conceived the method. The community mental health center--which was the basis for the work--was the Copenhagen centre for the sectors Vesterbro and Kongens Enghave. The target group for the centre is people with serious mental illness. The work is done according to the principles for clinical case managers. Data are registered in a national database in combination with the centre's own registration system. Eleven indicators for process quality and eight for outcome quality were selected. Measurement parameters for there indicators were defined. Criteria and standard were defined according to existing knowledge and the author's clinical experience. The necessary programs for calculating the value of the chosen standards are constructed. With the use of existing data and a limited extra registration it was possible to evolve a method for quality assurance in a community mental health centre.

Case Management↗

PubMedDate not supplied

Patients and community together. A family medicine community-oriented primary care project in an urban private practice.

BACKGROUND: There has been considerable discussion in the literature regarding the value and feasibility of community-oriented primary care (COPC), but relatively few published real-world examples. OBJECTIVE: To examine the effect of a practice-based COPC project on rates of preventive health interventions within an inner-city family medicine practice. METHODS: A newly created community advisory board called Patients and Community Together (PACT) and the medical director of the practice in Rochester, NY, collaborated on all phases of the COPC project. Papanicolaou smear and mammography screening, childhood immunizations, diabetes control, and smoking cessation were targeted for intervention. A practice/community awareness campaign was instituted and individual and group incentives were developed. Progress was monitored through a computerized medical record that included all active patients in the practice. RESULTS: Rates of annual Papanicolaou smears increased from 46% to 71%; annual mammography for women older than age 50 years, from 56% to 86%; completed childhood immunizations when younger than 6 years, from 78% to 97%; and performance of semiannual glycosylated hemoglobin, from 85% to 92%. Rates of patients with glycosylated hemoglobin values under 10% improved from 56% to 77%. There were 5 smokers who successfully quit. CONCLUSION: This project illustrates how practice-based COPC can be successfully implemented within a private practice setting. It also shows how COPC principles can be used to achieve the goals for Healthy People 2000 within inner-city practices.

Adult↗