Community participation: continuing the momentum.
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Adolescent↗
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Folk healers as associate therapists.
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Community Health Workers↗
[Attitude toward retirement of employed workers in 5 Dutch communities; a research report].
Most studies on retirement in the Netherlands concern workers of one specific industrial branch or company. This puts restrictions on the generalization of research outcomes. We selected 553 male workers, aged 64 (N = 376) and 60 (N = 177) via the population registers of five northern municipalities, who were on the pay-roll for at least eight hours a week. The mean total of working hours per week, however, was 41,5. From a pilot study with other, although similar respondents 35 items relating to retirement were generated. These could be reduced in the main study to four, a priori hypothesized dimensions: the attitude toward retirement, the perception of retirement and life after retirement, the attitude toward loss of social work contacts and the actualization of self after retirement. The data from the longitudinal research project, that are reported in this article, are gathered in the period 1973-74. We estimate that in the population of those aged 64, 15-25% had a negative attitude toward retirement, 16-26% a negative perception of retirement, 45-55% a negative attitude toward the loss of social work contacts and 61-70% a negative perception of self-actualization after retirement. For those aged 60 we estimate these intervals at respectively 8-22%, 13-27%, 45-59% and 62-76%.
Attitude↗
Socio-economic differences and health seeking behaviour for the diagnosis and treatment of malaria: a case study of four local government areas operating the Bamako initiative programme in south-east Nigeria.
BACKGROUND: Malaria is one of the leading causes of mortality and morbidity in Nigeria. It is not known how user fees introduced under the Bamako Initiative (BI) system affect healthcare seeking among different socio-economic groups in Nigeria for diagnosis and treatment of malaria. Reliable information is needed to initiate new policy thrusts to protect the poor from the adverse effect of user fees. METHODS: Structured questionnaires were used to collect information from 1594 female household primary care givers or household head on their socio-economic and demographic status and use of malaria diagnosis and treatment services. Principal components analysis was used to create a socio-economic status index which was decomposed into quartiles and chi-square for trends was used to calculate for any statistical difference. RESULTS: The study showed that self diagnosis was the commonest form of diagnosis by the respondents. This was followed by diagnosis through laboratory tests, community health workers, family members and traditional healers. The initial choice of care for malaria was a visit to the patent medicine dealers for most respondents. This was followed by visit to the government hospitals, the BI health centres, traditional medicine healers, private clinics, community health workers and does nothing at home. Furthermore, the private health facilities were the initial choice of treatment for the majority with a decline among those choosing them as a second source of care and an increase in the utilization of public health facilities as a second choice of care. Self diagnosis was practiced more by the poorer households while the least poor used the patent medicine dealers and community health workers less often for diagnosis of malaria. The least poor groups had a higher probability of seeking treatment at the BI health centres (creating equity problem in BI), hospitals, and private clinics and in using laboratory procedures. The least poor also used the patent medicine dealers and community health workers less often for the treatment of malaria. The richer households complained more about poor staff attitude and lack of drugs as their reasons for not attending the BI health centres. The factors that encourage people to use services in BI health centres were availability of good services, proximity of the centres to the homes and polite health workers. CONCLUSIONS: Factors deterring people from using BI centres should be eliminated. The use of laboratory services for the diagnosis of malaria by the poor should be encouraged through appropriate information, education and communication which at the long run will be more cost effective and cost saving for them while devising means of reducing the equity gap created. This could be done by granting a properly worked out and implemented fee exemptions to the poor or completely abolishing user fees for the diagnosis and treatment of malaria in BI health centres.
Journal Article↗
Enterprise-based sheltered workshops in Nanjing. A new model for the community rehabilitation of mentally ill workers.
This paper describes the development of community mental health services in Nanjing and reports on a retrospective study that compared the two-year outcome for 78 schizophrenic patients who attended four enterprise-based sheltered workshops (experimental group) with that of 78 schizophrenic patients who attended an out-patient clinic (control group). Despite having a longer course of illness and more prior hospital admissions than patients in the control group, at the end of the two years patients treated in enterprise-based sheltered workshops had significantly less psychosocial dysfunction (mean Social Dysfunction Screening Schedule score 3.4 (s.d. 0.2) v. 7.4 (s.d. 0.7), t = 49.2, d.f. 154, P < 0.001) and less severe psychiatric symptomatology (mean Brief Psychiatric Rating Scale score 33.1 (s.d. 2.7) v. 54.1 (s.d. 2.9), t = 47.0, d.f. 154, P < 0.001). Moreover, compared with the control group, over the two year period a smaller proportion of the experimental group experienced a clinical relapse (14.1% v. 38.5%, chi 2 = 5.10, d.f. 1, P < 0.05) or hospital readmission (7.7% v. 21.8%, chi 2 = 10.7, d.f. 1, P < 0.01). We conclude that the organisation of on-site sheltered workshops for mentally ill factory workers is an effective model for promoting community mental health that merits widespread application in China.
Adult↗
Client violence toward social workers: the role of management in community mental health programs.
With the shift in mental health treatment from psychiatric hospitals to community agencies, mental health workers provide outreach interventions to clientele with increasingly acute psychiatric disorders in their neighborhoods and residences. This article examines job-related, client-perpetrated threats or physical violence against social workers in general, and community outreach mental health professionals in particular. The article highlights the critical role of supervisors and administrators in community mental health programs in developing proactive prevention and postincident response policies and procedures that create an organizational climate of safety awareness, training, and psychological support to traumatized worker-victims. Recommendations for macro-level intervention are proposed, and implications for social work education and the profession are addressed.
Allied Health Personnel↗
Primary health care networks in the Islamic Republic of Iran.
The progress towards achieving health for all in the Islamic Republic of Iran is reported in this paper with particular reference to primary health care networks. The establishment of the networks is outlined and the vital elements within the system described, such as the community health workers (behvarz) and the health information system. Areas of achievement are reviewed.
Community Health Workers↗
Health care auxiliaries in the detection and prevention of oral cancer.
Oral cancer is one among the few human cancers with a vast potential for prevention. One of the operational strategies considered to translate preventive measures into practice in developing countries has been the use of community health workers and other health auxiliaries of the primary health care system to disseminate anti-tobacco health education messages and to provide mouth examinations in high-risk individuals during their routine home visits and community meetings. Studies conducted in India and Sri Lanka to address the role of the above approach indicate that it is feasible to train community health workers and other health auxiliaries in primary prevention and early detection of oral cancer and precancerous lesions. However, no evidence of the efficacy of such an approach in reducing the incidence and mortality from oral cancer is yet available. Sufficient evidence in terms of efficacy and cost effectiveness is needed to justifiably convince health administrators for the inclusion of non-communicable disease control in general and oral cancer screening in particular as part of the primary health care delivery by community health workers and other health auxiliaries especially when considering the burden of already existing work responsibilities. The need for studies in this direction is very obvious. However, the opportunities for 'case-finding' and health education should be utilised when encountering high-risk subjects both in primary medical and health care.
Community Health Workers↗
Feeling the heat: displaced tobacco workers in North Carolina.
Tobacco control is a successful public health movement, but little attention is being paid to what this success means for workers and communities who are economically dependent on tobacco. The social context of job loss for these workers remains largely unstudied. We conducted a case study of a cigarette manufacturing facility closure in Reidsville, North Carolina and report on the effects of the closure for workers and the community. Results suggest the need for: 1) worker education directed toward developing skills for jobs that pay family-supporting wages, and 2) community-driven strategies to attract new businesses that offer such jobs. Public health organizations, labor unions, community development groups, business representatives, civic leaders, academic institutions, and others should unite in efforts to assist tobacco-dependent workers and communities to transition to other economic bases. These efforts should be funded by the tobacco industry.
Journal Article↗
[The paradox of community participation in primary health care in Zaire].
The classic approach fails from the very beginning when District Medical Officers and other health professionals are chosen to manage primary health care programmes. Their attempts to convince the communities of the necessity of following their advice are often far too overbearing, and thus reinforce the "expert to ignorant" situation to a point where maintaining a true partnership becomes difficult, even impossible. It often happens as well that the community representatives in PHC programmes adopt aspects of the overbearing, "expert-like" behaviour. When this happens, they alienate themselves from the community or, in the least, lose any influence toward initiating action. As for the health professionals, they most likely direct any influence they may have towards clinically-oriented health measures. The preceding tendencies result in programmes which are quite far from the community's true concerns for achieving well-being and development. The PHC's problems such as lack of medicine and care facilities are generally overtaken by the more pressing priorities such as lack of good roads, energy, safe water, diminishing crops, etc. Dr. Ngo Bebe's article describes an initiative wherein the traditional primary health care approach is replaced by an integrated, community-centered programme. The health center remains the physical point for coordination, and its personnel participates in a variety of activities already taking place in the community. A health aspect is included, but does not overpower the activity which was formerly underway. A community development worker is integrated into the health center team. This provides the opportunity for growth and exchange, thus rendering the various activities truly interdisciplinary. Although this community mobilisation process has been underway in certain villages in Zaire for the past two years, and seems to have a positive impact on community development and the health status of the villagers, it is still early to proclaim the initiative an entire success. Only an assessment of the long term benefits will indicate the strengths and weaknesses of the project.
Community Health Workers↗
Morale and job perception of community mental health professionals in Berlin and London.
INTRODUCTION: Morale and job perception of staff in community mental health care may influence feasibility and quality of care, and some research has suggested particularly high burnout of staff in the community. The aims of this study were to: a) assess morale, i. e. team identity, job satisfaction and burnout, in psychiatrists, community psychiatric nurses and social workers in community mental health care in Berlin and London; b) compare findings between the groups and test whether personal characteristics, place of working and professional group predict morale; and c) explore what tasks, obstacles, skills, enjoyable and stressful aspects interviewees perceived as important in their jobs. METHODS: In all, 189 mental health professionals (a minimum of 30 in each of the six groups) responded to a postal survey and reported activities per week using pre-formed categories. Perception of professional role was assessed on the Team Identity Scale, job satisfaction on the Minnesota Job Satisfaction Scale, and burnout on the Maslach Burnout Inventory. Seven simple open questions were used to elicit the main tasks, skills that staff did and did not feel competent in, aspects that they did and did not enjoy in their job, and obstacles and factors that caused pressure. Answers were subjected to content analysis using a posteriori formed categories. RESULTS: Weekly activities and morale varied between sites and professional groups. Some mean scores for groups in London exceeded the threshold for a burnout syndrome, and are particularly less favourable for social workers. Working in London predicted higher burnout, lower job satisfaction and lower team identity. Being a psychiatrist predicted higher team identity, whilst being a social worker was associated with higher burnout and lower job satisfaction. Male gender predicted lower burnout and higher team identity. However, professional group and site interacted in predicting burnout and job satisfaction. Psychiatrists in London had much more favourable scores than the other two groups, whilst this did not hold true in Berlin. Answers to open questions revealed universal aspects, such as enjoying direct patient contact and disliking bureaucracy, but also various views that were specific to a site or professional group or both. CONCLUSIONS: Burnout remains a problem for some, but not all, professional groups in community mental health care, and social workers in London appear to be a group with particularly low morale. Differences between professional groups depend on the location, and it remains unclear to what extent job-related and general factors impact on the morale of mental health professionals. Answers to open questions reveal general as well as specific aspects of the job perception of the professional groups, some of which may be relevant for service development, training and supervision. More conceptual and methodological work and more extensive studies are required to develop a better understanding of how community mental health professionals perceive their job and how morale may be improved.
Adult↗
Part time female sex workers in a suburban community in Kenya: a vulnerable hidden population.
BACKGROUND: In sub-Saharan Africa, female sex workers (FSWs) are a vulnerable high risk group for the acquisition and transmission of sexually transmitted infections (STI) and HIV. OBJECTIVES: To study parameters of sexual behaviour and knowledge of STI and HIV, to describe health seeking behaviour related to STI, and to measure the prevalence of gonorrhoea, chlamydia, syphilis, and HIV-1, to provide baseline data for targeted STI and HIV prevention interventions. METHODS: In a cross sectional survey with snowballing recruitment, between February and March 2000, 503 self identified FSWs in a suburb in Mombasa, Kenya, were interviewed with a structured questionnaire and screened for gonorrhoea, chlamydia, syphilis, and HIV-1. RESULTS: The mean number of sexual partners in the previous week was 2.8 (SD 1.6). The mean number of non-regular clients and regular clients in the previous week was 1.5 (1.0) and 1.0 (0.9) respectively. The median weekly income from sex work was $US15. A total of 337 (67%) women had an alternative income in the informal sector. 146 (29%) and 145 (45%) never used a condom with a client and non-paying partner respectively. The prevalence of gonorrhoea, chlamydia, and syphilis was 1.8%, 4.2%, and 2.0% respectively. The overall HIV-1 seroprevalence was 30.6%. CONCLUSIONS: There is a large need for intensive STI and HIV prevention interventions in part time FSW.
Acquired Immunodeficiency Syndrome↗
Child passenger safety for inner-city Latinos: new approaches from the community.
OBJECTIVE: Motor vehicle crashes injuries, the leading cause of death for Latino children in the United States, can be reduced by the correct use of child safety seats. This study evaluated the ability of a community health worker education program to improve proper child safety seat usage in urban low income Latino families. METHODS: At a series of check events, proper child safety seat usage in families who had received an education intervention was compared with similar families who had not. The education intervention, provided by Latino community health workers trained as child passenger safety technicians, used videos and an office demonstrator. Members of the target community initiated the study and participated in its subsequent design and implementation. RESULTS: The families that participated in the study were primarily Mexican with low income, education, and acculturation levels. Forty six rear facing and 44 forward facing child safety seats were checked. Families exposed to the intervention were more likely to have their child's seat within the manufacturer's recommended weight/height range, their child facing the correct direction, the harness straps positioned properly, to have not been in a crash, the harness straps snug, the harness retainer clip used correctly, the seat belt routed correctly, and the seat belt locked. CONCLUSIONS: Exposure to an educational intervention provided by community health workers trained as child passenger safety technicians was associated with child safety seats being used more properly than seats of families not exposed to the intervention in an urban low income Latino community.
Adolescent↗
Breastfeeding knowledge among health workers in rural South Africa.
The aim of the study was to conduct a rapid assessment of breastfeeding knowledge amongst health workers in an area of high HIV prevalence. A cross-sectional survey using semi-structured questionnaires and problem-based scenarios was carried out. Responses were compared to those recommended in the World Health Organization (WHO) Breastfeeding Counselling Course. The setting was a rural area of KwaZulu Natal, with a population of 220 000 people. At the time of the study approximately 36 per cent of pregnant women were HIV-infected and no programme to prevent mother-to-child transmission was in place. A convenient sample of 71 healthcare workers (14 doctors, 25 professional nurses, 16 staff nurses, and 16 community health workers) were included in the study. Over 50% of respondents had given breastfeeding advice to clients over the previous month. However, there were significant discrepancies in breastfeeding knowledge compared to WHO recommendations. Ninety-three per cent (n = 13) of doctors knew that breastfeeding should be initiated within 30 min of delivery, but 71 per cent (n = 10) would recommend water, and 50 per cent (n = 7) solids to breastfed infants under 6 months of age. Fifty-seven per cent (n = 8) considered glucose water necessary for neonatal jaundice, constipation, and for infants immediately after delivery. Only 44 per cent (n = 7) of staff nurses and 56 per cent (n = 14) of professional nurses knew that breastfeeding should be on demand. The majority would recommend water, formula milk, and solids to breastfed infants under 6 months of age, and glucose water for neonatal jaundice and immediately after delivery. Knowledge of community health workers differed most from WHO recommendations: only 37 per cent (n = 6) knew that breastfeeding should be initiated within 30 min of delivery, 68 per cent (n = 11) thought breastfeeding should be on schedule and not on demand, and the majority would recommend supplements to infants under 6 months of age. Few respondents suggested taking a feeding history or observing a breastfeed in response to the problem scenarios. The most commonly given responses to problems of babies who were perceived to be thirsty, unsatisfied, or crying after feeds was to supplement with other fluids or feeds. There is a need for systematic and ongoing training in breastfeeding and infant feeding counselling in the context of HIV, so that breastfeeding is not undermined by the current HIV pandemic, and exclusive breastfeeding continues to be promoted for all HIV-uninfected women, women of unknown status, and HIV-infected women who choose to breastfeed.
Attitude of Health Personnel↗
[Severe personality disorders associated with addictive behavior].
After demonstrating the failure of a one dimensional approach to treating addictive behavior coupled with severe personality disorders, the authors suggest an organization of services based on the systemic approach. They recommend a personalized program with both external and internal services. With this in mind, the authors present a program developed by professionals involved in the fields of mental health and addictive behavior. Co-ordinated by a multidisciplinary team, it requires a specific contribution from all members of the team who are involved in different aspects of the person's life. To locate potential users of the program, brochures are sent to CLSCs (community health centres), hospitals, public and private resources, AIDS programs, social workers, and community health workers. Once in treatment, the patient goes through various treatment zones. The first, labelled the reception zone is designated with the initial contact between client and the program. In many instances, a significant other who is close to the client is contacted to take part in the program and help. In the zone of clarification, the client must come to terms with the program and indicate a serious determination to see the program through. The development zone centers on an active reflection of self and the development of new abilities for interpersonal relations, assisting the individual to function autonomously. The goal is for clients to attain a level of self-criticism of their own addiction. The zone of consolidation is optimally reached after about one year in the program. Clients are able to integrate everything learned in the development zone and apply it to their daily life. Community organizations are involved at this stage. The authors conclude that a multidimensional approach, a concerted commitment and a recognition of the contribution of all team members involved in the treatment, are essential elements for tangible results.
Humans↗
Communication of epidemiology study results by industry: the Dow Chemical Company approach.
Communicating epidemiology study results to subjects, affected workers, and community members is an important part of compliance and alignment with our company's policies, industry's Responsible Care Principles, and the doctrines of Good Epidemiology Practices. It is the responsibility of the investigators to interpret their research appropriately for each audience, and to assure that all who have a need or right to know get information in a form meaningful to them. We discuss study communication with examples from a recent evaluation of communication efforts within Dow and our experience with occupational and community studies on dioxin. We also discuss how we currently structure worker and community communication based on this experience. Since each Dow protocol must include a communication plan, when we agree to undertake a study, we are also agreeing to communicate study results. Depending upon the nature and type of the study, there may also be some prestudy communication. We encourage all investigators to share the results of their studies more broadly than just scientific publication and plan for the study communication before the study is initiated.
Chemical Industry↗
Paradigms lost: toward a new understanding of community participation in health programmes.
Community participation has been a critical part of health programmes, particularly since the acceptance of primary health care as the health policy of the member states of the World Health Organisation. However, it has rarely met the expectations of health planners/professionals. This paper argues that the reason for this failure is that community participation has been conceived in a paradigm which views community participation as a magic bullet to solve problems rooted both in health and political power. For this reason, it is necessary to use a different paradigm which views community participation as an iterative learning process allowing for a more eclectic approach to be taken. Viewing community participation in this way will enable more realistic expectations to be made. Community participation in disease control programmes focusing on community health workers is used as an example to show the limitations of the old paradigm. Participatory rapid appraisal is used to illustrate the new.
Community Health Planning↗
Therapeutic group programme for women with postnatal depression in rural Victoria: a pilot study.
OBJECTIVE: The aim of this study was to examine the effectiveness of a therapeutic group programme, provided by community health workers, in reducing anxiety and depressive symptoms associated with postnatal depression (PND) among women living in a rural setting. METHOD: A prospective repeated measures design was used. Women reporting difficulties in the postnatal period were recruited through community health services. Training was provided to community health workers, who then facilitated a 9 week group programme (cognitive-behavioural strategies) for women with PND. The Edinburgh Postnatal Depression Scale and the Hospital Anxiety and Depression Scale measured depressive and anxiety symptoms before starting the group programme, at the completion of the programme and at two follow-up times. RESULTS: Fourteen women completed the group programme at two sites in rural Victoria. Comparison of mean anxiety and depressive symptom scores revealed a significant reduction in scores from pre- to post-programme. For those women who also completed the follow-up symptom measurement, this reduction in symptoms was maintained. CONCLUSIONS: The results show that therapeutic group work is an effective intervention that can be applied by community health workers in a rural setting. Challenges for clinicians working with women experiencing PND in rural areas and implications for future research are discussed.
Adult↗