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PubMed1977

Women's liberation groups as a primary preventive mental health strategy.

As a preventive mental health worker in a community mental health center, I considered it part of my role to explore the possible therapeutic value of women's liberation groups in the community. I was particularly concerned with countering the sense of isolation and powerlessness prevalent among female adults in our suburban catchment area. Subsequent investigation and participant observation of women's groups bore out my expectation that many of the goals, premises, and methods of preventive mental health were compatible with those of women's liberation groups. These groups provided a very effective framework for personal as well as interpersonal and sociocultrual change in the direction of psychological growth.

Adaptation, Psychological↗
PubMed1977

Based on cultural strengths, a school primary prevention program for Asian-American youth.

As Asian-American mental health workers in a community mental health center where there is very little being done to provide appropriate services to its Asian-American population, we felt a need to find effective mental health models for the unique cultural and linguistic characteristics of our people. The high-school primary prevention program described in this paper provides Filipino youth with a positive view of their cultural identity and a supportive place to examine how their cultural values and behavior differ from those of mainstream Americans. Recognizing that ethnic minorities need to rely on their own subculture for the kind of psychological and social support required for a positive mental health, the program is aimed at mobilizing the strengths and resources of that particular subculture. In this way, its members can more effectively cope with the larger culture.

Adolescent↗
PubMed2001

From competition to community: participatory learning and action among young, debt-bonded Vietnamese sex workers in Cambodia.

Community mobilisation strategies for HIV/AIDS prevention based on recognition of social vulnerability and concepts of empowerment have emerged at the forefront of international efforts to reduce the AIDS pandemic, increasingly replacing a focus on individual risk. This paper describes the start-up phase of a participatory learning and action project to create a sense of community identity as a first step towards collective action among some 300 young, debt-bonded, brothel-based migrant sex workers from Vietnam in Phnom Penh, Cambodia. The factors that make sex workers vulnerable to HIV also pose considerable barriers to mobilising them, due to competing interests between and among brothel owners and sex workers. Discussion and visual tools--e.g. a spider diagram of causes of unsafe sex and how to overcome these--are being used in group work to analyse concerns expressed by sex workers, along with survey questionnaires and in-depth interviews. In the second phase the project will address sensitive topics such as violence and unsafe sex in more depth, in hopes of protecting the emerging solidarity among sex workers and shifting the balance towards greater co-operation.

Adult↗
PubMed2003

The effectiveness of a community/academic health center partnership in decreasing the level of blood pressure in an urban African-American population.

This study investigated the effectiveness of a community-academic health center partnership, utilizing nurse-supervised indigenous community health workers, in decreasing the blood pressure in an urban African-American population. A four-year randomized clinical trial was conducted in the Sandtown-Winchester community, which has an excess prevalence of high blood pressure, in order to test the effectiveness of 2 different levels of intervention intensity on increasing the control of high blood pressure. Community health workers were trained and certified in blood pressure management, monitoring, education and counseling, social support mobilization, and community outreach and follow up. The primary results were a significant decrease in mean systolic and diastolic pressures after both levels of intervention, and a significant increase in the percentage of individuals with controlled high blood pressure. Surprisingly, no differences in results were observed between the 2 levels of intervention intensity. This study supports the use of community-based partnership efforts, and the utilization of indigenous health workers, to enhance the control of high blood pressure in a high-risk, African-American urban population.

Academic Medical Centers↗
PubMed2002

Assessment of a new approach to family planning services in rural Pakistan.

OBJECTIVES: In 1993, the government of Pakistan started a new approach to the delivery of contraceptive services by training literate married women to provide doorstep advice and supplies in their own and neighboring communities. This report assesses whether this community-based approach is starting to have an impact on contraceptive use in rural areas. METHODS: A clustered nationally representative survey was used to collect data on contraceptive use and access to services in each cluster. Two-level logistic regression was applied to assess the effects of service access, after potential confounders were taken into account. RESULTS: Married women living within 5 km of 2 community-based workers were significantly more likely to be using a modern, reversible method of contraception than those with no access (odds ratio = 1.74; 95% confidence interval = 1.11, 2.71). CONCLUSIONS: After decades of failure, the managers of the family planning program have designed a way of presenting modern contraceptives that is appropriate to the conditions of rural Pakistan. The new community-based approach should be steadily expanded.

Birth Rate↗
PubMed1999

Minority ethnic community participation in needs assessment and service development in primary care: perceptions of Pakistani and Bangladeshi people about psychological distress.

OBJECTIVES: To promote community participation in exploring perceptions of psychological distress amongst Pakistani and Bangladeshi people, in order to develop appropriate services. DESIGN: Training and facilitation of resident community members (as community project workers), to define and conduct qualitative research involving semistructured interviews in their own communities, informing primary care led commissioning and service decision making. Setting A socio-economically disadvantaged inner-city locality in the UK. Participants One-hundred and four South Asian people (49 of Pakistani and 55 of Bangladeshi origin), interviewed by 13 resident community members. RESULTS: All community project workers completed training leading to a National Vocational Qualification, and successfully executed the research. Most study respondents located their main sources of stress within pervasive experience of racism and socio-economic disadvantage. They were positive about 'talking' and neutral listening as helpful, but sought strategies beyond non-directive counselling services that embraced practical welfare advice and social support. The roles of primary health care professionals were believed to be restricted to physical ill health rather than personal distress. The importance of professionals' sex, age, ethnicity and social status were emphasized as affecting open communication. Practical recommendations for the re-orientation and provision of services were generated and implemented in response to the findings, through dialogue with a primary care commissioning group, Health and Local Authority, and voluntary agencies. CONCLUSIONS: The work illustrates the feasibility and value of a community participation approach to research and service development in addressing a challenging and neglected area of minority ethnic health need. It offers one model for generating responsive service change in the context of current health policy in the UK, whilst also imparting skills and empowering community members. The study findings emphasize the need to recognize the social contexts in which distress is experienced and have implications for effective responses.

Journal Article↗
PubMed2003

[Sociotherapy in German social law. Indication, contents, and aspects of public health].

In German mental health services, the ill-defined term "sociotherapy" has been used to designate nonmedical, social, and work-related components of the care process. Recently, a new component of outpatient/community mental health care called "sociotherapy" (according to Paragraph 37a of the Fifth German Social Code) which is funded by the public health insurance system has been introduced and is now in the process of being implemented. The paper describes (a) patients eligible for the service and (b) the aims and scope of this case management module. The key objectives are to motivate patients with schizophrenia to utilise mental health services and antipsychotic medication and to liaise with psychosocial services. Therefore, sociotherapy is distinct from (a) multidisciplinary inpatient care for people with severe mental illness, (b) assertive community treatment, (c) community care provided by social workers or community psychiatric nurses, and (d) family interventions. So far there has been little evaluation of sociotherapy.

Case Management↗
PubMedDate not supplied

Assets-oriented community assessment.

Determining how to promote community health requires that community health workers first assess where the community stands. The authors maintain that Healthy Communities initiatives are better served by assets-oriented assessment methods than by standard "problem-focused" or "needs-based" approaches. An assets orientation allows community members to identify, support, and mobilize existing community resources to create a shared vision of change, and encourages greater creativity when community members do address problems and obstacles.

Community Health Planning↗
PubMedDate not supplied

Evaluation of a program to promote diabetes care via existing agencies in African American communities.

Some African Americans with (or at risk for) diabetes underutilize health care services. We report short-term results of a "training of trainers" workshop designed to address this problem. The training program includes culturally sensitive educational materials, including materials developed for the ADA's African American Program (AAP). Workshops were presented to a) the 1996 national meeting of the predominantly black National Missionary Baptist Convention's Nurses Guilds, b) a minority-owned, TN based managed care organization's "community outreach workers," and c) other interested community organizations. Evaluations were based on program satisfaction and an "intention to change" procedure that assessed participants' actions and the obstacles they faced 6 months later. Sixty-four group representatives from 13 states participated. They completed a satisfaction questionnaire and were asked to complete a form that asked them to check any of 12 diabetes-related actions (distributing ADA risk tests, offering AAP classes, etc.) they intended their church/community group to take within six months. Activities not listed could be added. Follow-up contact information was solicited. Satisfaction surveys were positive. 39 (61%) returned checklists with complete contact information. Intentions included: arrange for congregation/community group to take risk test (71% of respondents), distribute diabetes materials at community health fairs or church services (67%), present AAP modules (59%), promote healthy foods at pot luck suppers (56%) and arrange cooking or exercise classes (38%). Respondents were contacted by telephone 6 months post-workshop and asked whether they had fulfilled their intentions. Contact information for 6 (15%) was no longer valid, and we were unable to reach 7 others despite repeated attempts. Approximately 30% of intentions were fulfilled by nurses guild members, but less than 10% by other groups. Half of all fulfilled intentions occurred in a community served by an active ADA AAP Coalition. Barriers to fulfilling intentions included lack of time/support, group not ready to act or doing other programs, and failure to collaborate with the ADA or others for mutual assistance. Existing agencies, especially churches with nurses guilds, offer a means for promoting diabetes screening and awareness in African American communities. A training workshop was well received and influenced some participant groups' self-reported actions. Participants appear more likely to fulfill intentions to conduct diabetes-related programs when they collaborate with other churches, agencies and/or the ADA.

Black or African American↗
PubMed2002

A social and demographic study of Tibetan refugees in India.

The social and demographic characteristics of approximately 65,000 Tibetan refugees in India were determined from data collected 1994-1996. Approximately 55,000 refugees were living in 37 settlements widely distributed around India. The remaining 10,000 refugees were monks living in monasteries associated with some of the settlements, mostly in the south of India. In the settlements, a community-based surveillance system was established and data were collected by trained community health workers in house to house visits. In the monasteries, data were collected by the community health workers in monthly interviews with a designated liaison monk at each monastery. These data indicated little immigration of new civilian refugees in the past 10 years into the settlements but a steady influx of new monks into the monasteries. The age distribution in the settlements showed a prominent mode in the 15-25 year age range, a declining birth rate, and an increasing proportion of elderly. In general, refugees born in India were educated through secondary school, while refugees born in Tibet were often illiterate. The principle occupations were education involving 27% (including students), farming, 16%. and sweater selling, 6.5%; another 6.5% were too young or too old for employment, and only 2.4% were unemployed. The overall crude birth rate was determined to be relatively low at 16.8/1000. although this may underestimate the true figure. Infant mortality varied from 20 to 35/1000 live births in the different regions. Child vaccination programs cover less than 50% of the population. The burden of illness in this society was mainly characterized by diarrhoea. skin infections, respiratory infections, fevers, and, among the elderly. joint pains and cardiovascular problems. Although calculated death rates were unrealistically low, due to under-reporting, causes of death, derived from "verbal autopsies", were mainly cancer, tuberculosis, accidents, cirrhosis and heart disease in order of decreasing frequency. Overall, the sociodemographic and health characteristics of this population appear to be in transition from those typical of the least developed countries to those typical of middle income and more affluent societies.

Adolescent↗
PubMed1997

"Popular" health and the state: dialectics of the peace process in El Salvador.

The poor performance of large-scale "vertical" rural health programs tied to state Ministries of Health in Third World countries has often been attributed to a lack of "political will". But that term tells little about the conditions that favor health reform and may obscure disparate power relations and struggles over development. This work explores such a struggle over community health that emerged as part of the peace process in a former war zone of El Salvador since the 1992 ceasefire. The formalized negotiations (and behind-the-scenes confrontations) over health in Chalatenango province took place between Ministry of Health administrators and proponents of a "popular" health system that has functioned in repopulated villages of rebel-controlled Chalatenango since 1987. The Ministry has set up its own national (U.S. AID-designed) community health worker program, and agreed in theory with the popular system's emphasis on village-based lay health promoters; however, in negotiations and efforts at collaboration in Chalatenango the Ministry has been unwilling to support the promoters in the popular system, to accommodate local participation in health decision-making, or to restructure its own physician-centered practices around the need for more comprehensive approaches to health.

Civil Disorders↗
PubMed1999

Changing women: the narrative construction of personal change through community health work among women in Mexico.

A major premise of health education is that people can and do change their lives. Personal changes and the events that precipitate them are often told in a form of narrative and are accompanied by a new sense of oneself. This research draws on the study of narratives and women's community activism to explore processes of personal change in women's activism as community health workers in Mexico. The research is a case study based on in-depth semistructured interviews. Two major categories of narratives of change emerged: change of the self and little or no change. Within these categories, changes are defined as development of the self, becoming a new and different person, actualization of the self, and little or no change. Although women experience significant changes, their changes are based on normative female identities. Implications for the study of narratives and personal change in health education are discussed.

Adult↗
PubMed2000

Can cultural competency reduce racial and ethnic health disparities? A review and conceptual model.

This article develops a conceptual model of cultural competency's potential to reduce racial and ethnic health disparities, using the cultural competency and disparities literature to lay the foundation for the model and inform assessments of its validity. The authors identify nine major cultural competency techniques: interpreter services, recruitment and retention policies, training, coordinating with traditional healers, use of community health workers, culturally competent health promotion, including family/community members, immersion into another culture, and administrative and organizational accommodations. The conceptual model shows how these techniques could theoretically improve the ability of health systems and their clinicians to deliver appropriate services to diverse populations, thereby improving outcomes and reducing disparities. The authors conclude that while there is substantial research evidence to suggest that cultural competency should in fact work, health systems have little evidence about which cultural competency techniques are effective and less evidence on when and how to implement them properly.

Acculturation↗
PubMed1994

Staff demographic influences on personnel preference of health service location.

Health service personnel maldistribution between rural and urban areas remains unresolved in health care organizations. Career preferences of health workers might be contributory to their maldistribution. The health workers preferences could relate to their demographic characteristics. Such characteristics as relevant to their career preferences would be useful for effective health personnel management. The crucial role of nurses and community health workers in the delivery of primary health care services led to their choice as study subjects among the health care team. Rural and urban health services were used as career preferences and the subjects' demographic characteristics were obtained with questionnaires. Analysis of the results showed that nurses and community health workers who preferred rural to urban health service were mainly males, had rural background and had previous rural health service experience. These findings were considered significant for trainee as well as employee recruitment for health services in order to improve the coverage of rural areas with needed manpower for primary health care.

Adolescent↗
PubMed1989

Intestinal parasitic infestation in rural communities: a focus for primary health care in Nigeria.

A study carried out in four villages in two local government areas of Oyo State in the southwestern part of Nigeria, revealed that intestinal helminthiasis is still very prevalent in Nigeria. Ascaris is the most common helminth encountered and multiple infestation is also quite common. Schoolchildren and pre-school children are the greatest sufferers of Ascaris, while students and farmers are the greatest target for hookworm. The usefulness of a community-based distribution programme of health services using trained traditional birth attendants and voluntary health workers for data collection and distribution of antihelminth drugs is discussed.

Adolescent↗
PubMed1993

Estimation of early childhood mortality using preceding birth technique in a community-based setting.

The preceding birth technique, an indirect method for estimating early childhood mortality based on ascertaining the survival of previous children, was applied in rural Ethiopia within a system of demographic surveillance. Trained community health workers acted as interviewers and transmission flow of the routine health information system was used for data reporting. Data were collected for a median 12 month period from 39 sampled villages of Ticho district in Arsi region. From 1064 mothers having at least a second birth, the proportion dead of the last birth was 0.138 (95% CI 0.117-0.150), corresponding approximately to the probability of dying between birth and age two. It approximates to an infant mortality rate of about 100 x 1000 live-births. From 974 mothers having at least a higher-order birth, the proportion dead of the second to last birth was 0.203 (95% CI 0.178-0.228), equivalent to the risk of dying between 0 and age 5. In spite of the progressive migration of the surveyed population, the process and the outcome of the study suggest that PBT may well be inserted into a primary health care information system run by trained community health workers.

Birth Order↗
PubMed1976

The Comprehensive Nutrition Action Program in Arizona.

Through the Comprehensive Nutrition Action Program for Arizona (funded by the Nutrition Program, Center for Disease Control, Atlanta), a nutrition care delivery system was developed. Four sub-systems-screening, referral, monitoring, and the development of community nutrition workers--allowed for the identification of problems, intervention, utilization of other agencies, and expansion of manpower with community nutrition/health workers. Improvement in nutritional status was demonstrated by this program. As a result, it has been expanded.

Adult↗