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PubMed1999

Meanings of community in a community health center.

As health care organizations make communities the targets for their interventions, connections between "community" as theory for practice and community as setting for practice require examination. This study s purpose was to explore meanings given to community in a newly formed community health center, with particular emphasis on the relationship among women, community, and health. Using interpretive and emancipatory methodologies, interviews were conducted with clinic administrators and staff, and women who used the clinic. Data analysis revealed discrepancies in meanings of community. Clinic personnel referred to community as the target for their services, while clinic users spoke about community as the process that made feeling connected with others possible. Health center staff and administrators described the community they were serving as having limited economic, educational, physical, and psychological resources and saw little which could be labeled a community strength. Health center users however, spoke primarily of their abilities to support each other. These contradictory understandings of the meaning of community rendered different expectations regarding health care services. Meanings given to community may de-personalize, homogenize, and objectify, and ultimately distance nursing from those intended to be served.

Adolescent↗
PubMed2001

The evolution of community involvement in public health community-based efforts: a case study.

It is the opinion of many practitioners and analysts of public health efforts that community involvement is necessary to improve local health status. The nature of community involvement, however, can vary among projects, among sites in the same project and through time in the same site. Clear conceptions of community involvement assist in foreseeing the potential activities, outcomes and challenges of any particular community-based effort. Himmelman's concepts of community betterment and community empowerment offer a useful framework when community-involvement entails the direct participation of local organizations and constituencies. These two concepts are the ends of a continuum whereby in the movement from a community betterment to a community empowerment effort, there is an increase in community ownership and self-determination over all aspects of a project. This paper presents an empirical investigation of one community-based public health effort which instances a movement from community betterment to community empowerment.

Community Health Planning↗
PubMed1999

Can community leaders' preferences be used to proxy those of the community as a whole?

BACKGROUND: Community-based distribution of ivermectin and other drugs requires people in the endemic communities who are capable of distributing the drug. It is essential also to collect information on local people's views concerning different financing mechanisms and approaches to distributing ivermectin. However, studies at household level are resource-intensive. Eliciting the preferences of the community by interviewing a smaller number of community leaders offers an alternative strategy. METHODS: A comparison of information from community leaders and household heads on the financing and distribution of ivermectin through communities was conducted in three communities in Nigeria to determine whether rapidly collected information from key community leaders could represent broad community preferences. RESULTS: The preferences of community leaders and household heads were comparable in relation to the method of collecting payments, managing payments and making payments, who should set the level of payments and the drug distribution mechanisms. However, there were differences between community leaders' views and those of heads of households concerning how the scheme should be supervised. CONCLUSIONS: This study has shown that community leaders' views can only be used as a partial substitute for more laborious methods of data collection insofar as they have the attraction of being quicker and less costly to use. However, they should not be assumed to be identical with the views of the community as a whole.

Attitude to Health↗
PubMedDate not supplied

Lessons learned from community site administrators involved in pediatric community rotations.

OBJECTIVE: Prominent pediatric organizations agree that young physicians need to be trained for the role of patient advocate in the community. However, information on the community site administrators' perspective on such training is limited. Therefore, the objective of this study was to explore community site administrators' perceptions of the advantages and disadvantages to pediatric resident training at their centers. Understanding these perspectives may lead to better partnerships and experiences for both the residents and the community sites. METHODS: Twenty-eight community site administrators participating in 2 residency community rotations located in Ohio and Florida were surveyed with a semistructured questionnaire. A qualitative data analysis methodology was used to explore the entire set of responses. Research team members reviewed the responses, coded them for emerging themes, and generated three themes: 1) awareness, 2) knowledge exchange, and 3) organizational issues. RESULTS: Fifty-seven percent of site administrators responded. These administrators consistently indicated that they valued the opportunity to increase residents' awareness of the services their sites provided to the community. The administrators and families served by the agencies appeared to benefit from the medical knowledge exchange, and this was a significant advantage from the community site administrators' perspective. Finally, community sites identified organizational issues of complex scheduling as an area for improvement. CONCLUSIONS: These findings demonstrate the value community sites place on active, early involvement of pediatric residents with community agencies. We have also identified key points to improve the experiences for both community sites and residents during a community pediatric rotation.

Community Medicine↗
PubMed2005

A community coalition board creates a set of values for community-based research.

BACKGROUND: Researchers generally agree that communities should participate in the community-based research process, but neither a universally accepted approach to community participation nor a set of guiding principles exists. CONTEXT: The Morehouse School of Medicine Prevention Research Center was established in 1999 with the support of a grant from the Centers for Disease Control and Prevention. Its partners include a low-income, predominantly African American community, six public agencies, and two other academic institutions. A Community Coalition Board was established to represent the partners. The majority of the board is community members; it serves in a governance rather than an advisory capacity, with the community acting as the senior partner in interactions with the medical school, the agencies, and other academic institutions. METHODS: The Community Coalition Board developed a set of research priorities and a set of 10 community values, or principles, to guide research. A board committee reviews each protocol to ensure they uphold the values. CONSEQUENCES: The Community Coalition Board has been using the values since 1999, and in this article we describe its experience. After an initial period that included some disagreements between researchers and community members on the board, relationships have been good, and protocols have been approved with only minor changes. INTERPRETATION: Although the established community values reflect universally acknowledged principles of research ethics, they also address local concerns. An equal partnership between community members and researchers is most beneficial if the partners can agree on a set of values to govern research.

Black or African American↗
PubMed2002

Can we tell how a community was constructed? A comparison of five evenness indices for their ability to identify theoretical models of community construction.

Evenness indices provide a simple measure of community structure. It might therefore be possible to use them to identify the process by which a community has been assembled. To test whether this is practicable, we constructed simulated community samples using five stochastic models of community construction, proposed by Tokeshi. We then examined the ability of five evenness indices to identify the model under which the community samples were produced. Each model produced samples with a range of evenness values, but mean evenness differed between the models. The dominance decay (DD) model produced community samples with the greatest evenness, followed by MacArthur fraction (MF). Evenness was lowest under the dominance pre-emption (DP) model. The differences between models were quite consistent across indices and consistent between 5-species and 15-species communities. Samples produced under the DD and MF models varied least in evenness between 5-species and 15-species samples, and those produced under the random assortment (RA) model varied most, irrespective of the evenness index used. Evenness varied considerably between replicate samples, as expected with stochastic processes. In 5-species communities, the greatest robustness in evenness across replicates was seen using indices O or E'. In 15-species communities, O and E(Q) were the most robust. The index best able to identify the model which had generated the sample differed between models and with species richness. If the model of interest is not known in advance, the best index for identifying the generating model is E(var) for communities of more than 10 species for RF, RA and DP models and O for other communities. The number of samples required in a data set before it could be effectively identified was, for example, more than 30 for 5-species samples produced under the random fraction (RF) model, and 3 for 15-species RF samples. In contrast, a 5-species DD data set could be effectively identified when it contained 15 or more samples. We conclude that evenness can be used to identify the process by which the community has been constructed, out of the five models considered here. The best evenness index for doing this varies with the species richness and the evenness of the community but we can suggest the use of O without knowing the model because its the more stable one against species richness and the more robust and unbiased against simulated samples and it encompass a good discriminating power between the models in most of the cases studied.

Abstracting and Indexing↗
PubMed2006

Evaluation of a multi-component community tobacco intervention in three remote Australian Aboriginal communities.

OBJECTIVES: To assess the effect of community tobacco interventions in Aboriginal communities. METHODS: The study consisted of a pre- and post-study of the effect of a multi-component tobacco intervention conducted in six Aboriginal communities in the Northern Territory (NT). The intervention included sports sponsorship, health promotion campaigns, training health professionals in the delivery of smoking cessation advice, school education about tobacco, and policy on smoke-free public places. The study was conducted in three intervention communities and three matched control communities. Surveys were used to measure changes in prevalence of tobacco use, changes in knowledge, and attitudes to cessation in intervention communities. RESULTS: Tobacco consumption decreased in one intervention community compared with the matched control community; the trends of consumption (as measured by tobacco ordered through points of sale) in these communities were significantly different (t = -4.5, 95% CI -33.6 - (-12.5), p < or = 0.01). Community samples in intervention communities included 920 participants. There was no significant change in the prevalence of tobacco use, although knowledge of the health effects of tobacco and readiness to quit increased. CONCLUSIONS: Although it is difficult to demonstrate a reduction in tobacco consumption or in the prevalence of tobacco use as a result of multi-component community tobacco interventions delivered in Aboriginal communities, such interventions can increase awareness of the health effects of tobacco and increase reported readiness to cease tobacco use.

Adolescent↗
PubMed1983

Primary health care in Southeast Asia: attitudes about community participation in community health programmes.

Although community participation in health has become a major plank in WHO's Primary Health Care platform, comparatively little concrete programme data has been collected which helps to define its potentials and problems. In an effort to expand knowledge in this area, a study of three Church-related community health programmes in Southeast Asia was undertaken. All three programmes have the stated goal of 'having the community take responsibility for its own health care' and as a concrete step in this direction, have developed training programmes for community health workers (CHWs). Starting about the same time, 1973-1975, they provide data for comparative examination of the development of community participation. As part of the study, a questionnaire was designed to elicit information from three categories of programme participants (the medical professionals, the community development workers and the CHWs) in community health programmes. It sought to discover their attitudes about the objectives of community health programmes; impact and measurements of success of these programmes; the role of health services; the role of medical professionals and community development workers in community health programmes; the role and training of community health workers; and financing community health programmes. The hypothesis of the investigation was that all three categories of programme participants in one programme share attitudes distinct from participants in the other two programmes. Although, due to technical reasons, it was not possible to test this hypothesis, the survey produced other conclusions.(ABSTRACT TRUNCATED AT 250 WORDS)

Asia, Southeastern↗
PubMed2001

Can you do a community assessment without talking to the community?

Conventionally, it has been accepted that an accurate understanding of community views on health topics can only come directly from community members. Yet, even as the need for this data has been increased by managed care, the methods of gathering it from community members remain costly and impractical for most busy practices or communities. This case study was conducted to determine whether well-informed health professionals can accurately and less expensively convey community views on health topics. In a low-income urban community, using a standard set of open-ended questions, focus groups and telephone and mail surveys were used to gather qualitative data from community residents and patients. Extended interviews and key informant surveys were used to gather similar data from health professionals. Data obtained from both sets of respondents were compared for content and logistics of collection. Overall, responses from the two groups had similar content but differing emphases. Community residents tended to emphasize socioeconomic determinants of health and everyday life concerns, while health care workers tended to emphasize the process of care. However, these perspectives were shared across the groups, as was an emphasis on the need for education with regard to community health concerns. The most striking difference between the groups was the community resources each group identified. As expected, costs for the health care worker approaches were less expensive. Findings from this case study suggest limited situations in which health care workers can adequately convey community views. In other situations, the different perspectives of each group can be complementary. Regardless of their role in qualitative data gathering, there remain important roles for community members in planning and decision-making regarding their health care.

Adult↗
PubMed2000

Durability of tobacco control efforts in the 22 Community Intervention Trial for Smoking Cessation (COMMIT) communities 2 years after the end of intervention.

Funding organizations increasingly want to know that successful interventions are continued after the end of a research project. Assessments of durability are rare and where done do not include the comparison communities. In this study we ascertain what tobacco control activities continued in intervention communities involved in the Community Intervention Trial for Smoking Cessation (COMMIT), a randomized, controlled community trial aimed at adult smokers, and also assessed level of tobacco control activities in the comparison communities. A mailed survey of key informants including paid staff and community volunteers in the 22 COMMIT communities was conducted. Approximately 79% of key informants responded to the survey. Although there was evidence that tobacco control activities were continuing in the intervention communities, there was an equal amount of tobacco control effort in the comparison communities. Within the specific tobacco control intervention areas, only the youth area showed more activity in intervention communities than comparison communities. We conclude that despite a positive trial outcome, differential durability was not achieved. More work needs to be done to assist communities in maintaining proven intervention activities. More study of methods to measure durability is also needed.

Adult↗
PubMed2003

Balancing hospital and community treatment: effectiveness of an extended-hours community mental health team in a semi-rural region of australia.

OBJECTIVE: To examine the effectiveness of the introduction of a community mental health team on consumer psychosocial outcomes. DESIGN: Longitudinal panel design. SETTING: District general hospital in a semi-rural region of Australia. NUMBERS: Two matched groups (n = 37 in each group) MAIN OUTCOME MEASURE: These included: Brief Psychiatric Rating Scale (BPRS), Global Assessment Scale (GAS), Rosenberg Self-Esteem, Life Skills Profile as well as self-report. RESULTS: The study found that the introduction of the new service resulted in few significant differences in consumer outcomes. CONCLUSIONS: The paper argues that because the state was the only specialist mental health service provider and it was unable to offer assertive community treatment, hospital care remained central. Evidence that a substantial proportion of consumers and carers preferred hospital to community care is placed against this background. The paper argues that in regions like these, where community-based services are likely to remain underdeveloped, it may be best to maintain quality hospital services and to target community services more precisely on what is achievable rather than developing community services at the expense of hospital care. WHAT IS ALREADY KNOWN: Studies on the efficacy of assertive community treatment suggest that it can lead to improved consumer outcomes. However, these studies are usually in urban settings and involve experimental teams. In many rural and regional areas community treatment teams offer standard rather than assertive community care. It is therefore important to investigate the effectiveness of community treatment teams in rural and regional Australia. WHAT THIS STUDY ADDS: This study suggests that in rural and regional areas characterised by limited resources, it is too much to expect community treatment teams to have a measurable impact on consumer outcomes. In these settings hospital care remains at the heart of the service. This means that regions such as these need to focus their community services on what is achievable given the level of resources and social ecology. For example, they may need to consider offering either crisis intervention or rehabilitation services and to rely on innovations, such as telehealth or strategic alliances with other service providers to fill the gap.

Attitude to Health↗
PubMed2006

People Improving the Community's Health: community health workers as agents of change.

People Improving the Community's Health (PITCH) uses teams of community health workers to provide targeted outreach, to enroll those eligible in health coverage plans, to provide information and linkages to health and social support services, and to engage community members in community improvement activities. The initiative is based on the assumption that communities must work on the determinants of health and effectively mobilize all their assets to improve not only individual health, but also community health. Developed with support from the Kellogg Foundation's Community Voices Initiative, PITCH addresses intertwined public health concerns about access to health care and community health improvement. Outcomes of PITCH include increased enrollment in health coverage plans as well as increased participation in community improvement activities. The PITCH initiative helps community members work together to unleash the enormous power for change that emerges when people connect to one another, thereby tapping the knowledge, skills, and resources of community members and institutions alike.

Community Health Planning↗
PubMed2005

Community capacity building in CDC's Community Coalition Partnership Programs for the Prevention of Teen Pregnancy.

PURPOSE: To describe lessons learned from the Centers for Disease Control and Prevention's Community Coalition Partnership Program (CCPP) about building a community's capacity to prevent teen pregnancy through strengthening of partnerships, mobilization of community resources, and changes in the number and quality of community programs. METHODS: A multi-component post-test-only evaluation. In-person interviews (n = 364) were conducted with a sample of CCPP project staff, evaluators, and community and agency members from each of the 13 CCPP communities. RESULTS: All partnerships reported that new groups worked together to address teen pregnancy prevention; however, more time, effort, and resources than anticipated were spent engaging these groups and strengthening their partnerships. Respondents reported increases in community awareness of the problem of teen pregnancy and the willingness to discuss the issue. As a result of partnerships' activities, knowledge and skills related to addressing teen pregnancy improved among partnership members, but respondents were concerned that the broader community did not share these gains. To a lesser extent, respondents reported that partners worked together to reduce duplication and fill gaps in services either through increased collaboration and/or differentiation of activities. Respondents from most of the partnerships also reported new programs were developed as a result of the project; however, in several partnerships, only a few programs were developed in their community. Many respondents doubted whether the limited mobilization of resources during the program would translate into increased agency and community capacity. CONCLUSIONS: Overall, increased partner skills, program improvements, and new programs did not appear to be sufficient to affect community capacity. Research is needed to identify the pathways between changes in community capacity and in individual-level behavior that might result in the avoidance or reduction of teen pregnancy.

Adolescent↗
PubMed1996

The value of community health nursing: a phenomenological study of the perceptions of community health nurses.

This study explores and describes the value of community health nursing from the perspective of community health nurses. The phenomenological method as defined by Colaizzi (1978) guided this exploration. Eleven community health nurses from the health department of a large urban center were interviewed for the study. The data revealed five major themes: 1) the value of activities in community health nursing; 2) the value of the purposes of community health nursing; 3) the value of prerequisites for community health nursing; 4) the value of the visibility of community health nursing; and 5) the value of community health nursing as the way to the future in health care. The findings of this study are particularly important in light of recent government interest in community health. However, if community health nurses are to capitalize upon this window of opportunity, they must clearly and forcefully articulate and make visible their value. Further research, particularly from a qualitative perspectives, could help to advance this field of practice. Research that articulates the value of community health nursing in various settings and from the perspectives of various nurses, clients, and colleagues could also clarify and promote the collective and individual value of community health nursing.

Attitude of Health Personnel↗