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PubMed2006

Using participatory rural appraisal (PRA) in the identification of children with disabilities in rural Kilifi, Kenya.

INTRODUCTION: Cross-sectional surveys have been used widely for identifying children with disabilities, but they have several disadvantages. The surveys concentrate on identifying impairments and do not encourage the participation and ownership of the community. Participatory rural appraisal (PRA) provides a cost-effective and efficient method that reflects the local perceptions of disability and involves local people. These factors are important for sustainability in resource-poor countries. PURPOSE: To evaluate the application of PRA to identifying children with disabilities in a rural setting. METHODS: PRA was used to identify children with disabilities in two rural sub-locations in Kilifi, Kenya. Data were collected through 12 focus group discussions and 12 social mapping activities. A purposive convenience sample of teachers, village leaders and women groups participated in the PRA. The perceptions of disability were established before identification of the children. The categories of identification were based on these local perceptions. The qualitative data were analyzed thematically and validation was performed through triangulation. RESULTS: Disability was perceived locally as the existence of impairments, activity limitations and participation restrictions. Disabilities were associated with traditional beliefs including witchcraft, evil spirits and punishments from God. In some cases these categories were mutually exclusive and in others they were concurrent. Children who had lost their parents and were not being cared for by relatives (disadvantaged orphans) were also perceived as disabled children by teachers and local women, but not by community leaders. CONCLUSION: The results suggest that PRA is an efficient and cost-effective method of identifying children with disabilities according to local perceptions, and it may be useful in community-based rehabilitation as an alternative to surveys.

Adolescent↗
PubMed1990

[Suicide and social policy in Quebec].

Starting from three documents published by organizations set up by the Québec government, the author examines how the government intends to give direction to and build a framework for social intervention in the area of suicide. The article looks at the fate that social policies could and, according to the author, should reserve for suicide. The author argues for an approach that fully recognizes the social dimension of suicide and that emphasizes primary prevention as well as government support for an autonomous community network that would have equal footing with the public network.

Health Policy↗
PubMed1989

[Transgenerational solidarity: treatment and prevention in an expanded context].

This article searches for a common denominator for the requirements of that which therapy and prevention address in their broadest terms: 1. Genuine criteria of autonomous individuation in the context of real relationship that have to be sorted out vis-à-vis random internal relations that inform the private epistemologies of each partner's idiosyncratic goals. 2. The dialogue of mutual self-definition anchored in the balance of inherent commitments to mutual self-validation through fair give and take--the basis of relational ethics, i.e., responsibility for consequences to others. 3. The systemic regulation of behavioral patterns of marriages, parent-child relationships, nuclear and extended families, and larger community networks. 4. An intrinsic tribunal of transgenerational solidarity as the basis of prevention and as the manifestation of human species survival, e.g., concern about environmental health. 5. Negentropy as the "locomotive" of biological evolution and via ethics of receiving through giving to posterity, the guardian of both parent-child and peer relationships in a progressively automated world.

Adolescent↗
PubMed1989

Social characteristics and oral health behaviour of families in Riverlea.

Planning of community health programmes requires a comprehensive "community diagnosis" as its basis, taking into account a complex range of health related factors. The family and particularly the mother play a crucial role in oral health. Thus, the social context, the source and extent of health information, as well as their oral health behaviour, can determine the mothers' function in promoting oral health. This study examined the social characteristics and oral health behaviour of families in Riverlea. One hundred and fifty seven mothers were interviewed in their homes using a structured questionnaire. The results reveal a picture where the percentage of 'broken' or single mother families is high. There is overcrowding in the homes combined with a low level of education and employment in mainly non-skilled, low-paid jobs. The utilisation of existing dental services was poor despite the fact that 43 per cent of the families are members of medical aid schemes. Almost one third of the mothers were edentulous. Although cost and other factors were cited as barriers for not 'going to the dentist', most of the respondents have a symptomatic approach to oral health which might be responsible for poor utilisation. The 'lay referral system' for obtaining information was common and teachers played a role in this process. The study identified various factors that adversely affect the process of development of good oral health and related behaviour in the home environment. Schools and supportive community networks as well as outside organizations could be enlisted to take part in the efforts to overcome the barriers identified and improve the situation.

Dental Health Surveys↗
PubMed1988

The National High Blood Pressure Education Program: measuring progress and assessing its impact.

The National High Blood Pressure Education Program has been designed to translate the results of basic and clinical research to medical practice through a program of education for the public, patients, and health professionals. It has continuously used health-education principals of media development, patient education, social networking, community organizations, theories of social change, and program evaluation and measurement to reach its objectives. After 15 years, public knowledge regarding blood pressure and its sequelae has improved dramatically.

Health Education↗
PubMed1988

Developing trauma care systems: a nursing perspective.

Emergency medical services (EMS)/trauma care systems offer unique opportunities for nurse administrators in community hospitals and medical centers to encourage a professional practice model for the department of nursing. The development of local and regional EMS/trauma services involves nurse administrators and their staffs in the legislative process; community networking; program planning, operation, and evaluation; and clinical research. This, the first in a series of articles, reviews the history of trauma care in America, explains the process of regionalization and designation as provided for in the proposed federal legislation, discusses appropriate roles and responsibilities for nurse leaders in trauma care systems, and outlines planning and operational functions for nursing departments in designated trauma care facilities.

Administrative Personnel↗
PubMed1996

A model of community mobilization for the prevention of HIV in women and infants. Prevention of HIV in Women and Infants Demonstration Projects.

The prevention of HIV in Women and Infants Demonstration Projects use a conceptual model for maximizing broad community participation for HIV prevention called the Community Mobilization Framework. The projects' comprehensive approach attempts to bring about changes on a community level using a model which encourages community-wide participation of persons with various roles and relationships in the community. The Community Mobilization Framework is one way to systematically conceptualize the organization of the community for the purpose of mobilizing the maximum number of community members around a common health initiative. A community becomes mobilized around an issue by endorsing health-enhancing attitudes, behaviors, and projects supporting positive health outcomes. This mobilization is expressed through the promotion, support, and delivery of motivational and informational health messages which convey consistent ideas, themes, and images. There are two fundamental bases of the Community Mobilization Framework. The first is its characterization of the variety of individual, social, and organizational roles and relationships in the community that might be used in a concerted campaign for HIV prevention for women. The second basis of the model is the description of the nature and extent of the involvement, which includes a continuum of involvement, ranging from simple endorsement to building active coalitions around a health initiative. The paper discusses practical methods of applying these principles, with the Women and Infants Demonstration Projects providing concrete examples.

Acquired Immunodeficiency Syndrome↗
PubMed1996

Organizing Asian Pacific Islanders in an urban community to reduce HIV risk: a case study.

We present a case study of community organization efforts within the Asian Pacific Islander communities of San Diego County to reduce the risk of HIV transmission. We utilized a five-phase process to implement the strategies of locality development, social planning, and social action: community analysis, program design and initiation, program implementation, program maintenance and consolidation, and program reassessment. An evaluation of the process indicates that there were increases over time in the project's activities as well as in the levels of interagency connectedness. This is one of the few reported efforts to organize Asian Pacific Islander groups to address HIV transmission. Key elements that led to the successful organization of the original project into a tax-exempt nonprofit entity (the Asian Pacific Islander Community AIDS Project) were emphasis on community ownership, reliance on group consensus, use of "gatekeepers" to access communities, simultaneous multilevel programming, and service to the community as a "coordinating" entity.

Acquired Immunodeficiency Syndrome↗
PubMed1997

Barriers to cervical screening: women's and health workers' perceptions.

Cancer of the cervix is the most common cause of cancer mortality among Black South African women. Mortality can be reduced by an effective screening programme. Such a programme is being considered for implementation in South Africa. It is important that the implementation of a national screening programme be based on solid understanding of the current situation as well as the anticipated barriers to the effectiveness of the programme. This qualitative study was done at three rural sites in order to explore the barriers to effective utilisation of cervical screening from the perspectives of women and health workers. The aim was to inform the local service organisers as well as the policy process when planning the new screening programme. There were interesting similarities and differences between the barriers that were identified by the health workers and those by the women. Those identified by the health workers included several structural problems associated with the service such as busy clinics and problems of access including lack of transport, the mobility of the people and opposition from men. None of the women spoke of these service and access factors. Women emphasised issues surrounding the actual procedures which were based on their experiences and information they had gained from friends and other community networks. The barriers identified by women are amenable to change through careful attention to health education and the circumstances of the test. If the new screening policy is to be implemented nationally and be successful in recruiting cervical cancer cases, nurses will have a key role in identifying and overcoming barriers to smear uptake at a local level. This study has shown the importance of listening to patients in this process.

Adult↗
PubMed1997

[Secondary prevention of drug abuse: problems and examples].

Since 1992, the Federal Office of Public Health (FOPH) has been promoting an innovative approach of secondary drug use prevention. Our main purpose is to present this approach. For the FOPH, the objective of the measures in this field includes the development of concepts and means to detect, at an early stage, young people at risk, or whose drug consumption is recent or occasional, in order to help them. The basic principle of the strategy is to strengthen the protective role of the community network of the young people at risk. To illustrate this strategy, we briefly describe different projects supported by the FOPH; some of them are immediately launched on a national or regional scale, while others are innovative local or regional projects. Finally, we identify situations which are a priori more favourable to funding or support by the FOPH.

Adolescent↗
PubMed1997

The Medicare mall. Will Washington like what it built?

"Shopping spree" doesn't begin to describe it. Next year, 38 million seniors will begin choosing their health care coverage from a menu crammed with options. Medicare Plus Choice means just that: HMOs, provider-sponsored plans, private-pay options, medical savings accounts, and more. It also means a bevy of new rules--and risks--for everyone.

Aged↗
PubMed1997

Promoting oral health in South Africa: public perceptions of water fluoridation.

Public knowledge of water fluoridation (WF), sources of information, purpose of WF and the level of support for the implementation of WF was assessed in South Africa. Of the 2229 respondents interviewed, 23 per cent had heard or read about WF. Almost a third said they obtained their information from schools or community networks while 60 per cent mentioned either radio, newspapers/magazines, or television. About 25 per cent correctly recognized the protection of teeth as the purpose of fluoridation, while two-fifths believed the purpose of WF is to purify water. More than sixty per cent of respondents were in favour of WF, with almost a quarter of the sample feeling uncertain. This study demonstrates that a considerable amount of educational and political action is required for water fluoridation to be implemented in South Africa.

Adolescent↗
PubMed1998

[Effects of establishment of community psychiatry in Aalborg].

The aim of the present study was to illustrate the effects of community-based psychiatry. The catchment area was divided into three homogeneous districts, East, North and West. Teams were established on 1.9. 1990, 1.10.91 and 1.5.1992, respectively. Social, diagnostic and treatment related data were gathered from two cross-sectional investigations (I: February 1992 and II: February 1993) and from in-patients and out-patients files. In cross-section I a majority of long-term ward patients and hospital-based employment offers was found in the district where the community district team had not yet been established. In the district where the first community district team was established most primary target patients were treated. In cross-section II the hospital-based psychiatric service were more homogeneously distributed between the districts. The establishment of community-based psychiatric teams resulted in new referrals, and increasing numbers of patients becoming attached to the psychiatric teams, but crowding and use of compulsory measures in hospital also increased.

Adult↗