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PubMed2003

Community perspectives on advance care planning: report from the Community Ethics Program.

The objectives of the Community Ethics Program are to increase community awareness about advance care planning to address patient preferences concerning future care, and to improve hospital-community collaboration around care at end of life in diverse communities. As part of this educational program, community forums and focus groups were held with African-American, Korean-American, and Latino communities in Philadelphia between 2000 and 2001. In this paper, we discuss concerns related to end of life and advance care planning specific to each community, as well as themes that cut across communities. Increasing our understanding of community views and perspectives on potential barriers to advance care planning, particularly through a hospital-community partnership, is an important step toward enhancing the quality of end of life care for all patients.

Advance Care Planning↗
PubMed1979

The Mayo Three-Community Hypertension Control Program. II. Outcome of intervention in entire communities.

A pronounced decline in blood pressure levels of hypertensive patients occurred in each of three rural Minnesota communities 1 to 2 years after the inception of community programs to control high blood pressure in these populations. An experimental hypertension clinic was established in one community to integrate a nurse practitioner into a physician-supervised program of long-term patient management. In the community with this innovative, partially subsidized practice arrangement, we observed declines in diastolic pressures of hypertensives. However, comparable degrees of blood pressure reduction occurred in the two other communities, with traditional solo or small group practice arrangements, where intervention was limited to detection and referral alone or was supplemented with continuing education of physicians in the management of hypertension. The evaluation of these three community programs suggests, among other conclusions, that this innovative community model for hypertension control, based on the recommendations of the Inter-Society Commission for Heart Disease Resources, contributed to favorable short-term blood pressure outcomes for the community. The observation of similar overall outcomes as measured by blood pressure reduction in all three communities was unexpected; the clinic's impact appears to have been matched by the effectiveness of screening and referral, alone or with continuing education, in the two other communities.

Adult↗
PubMed1997

[Home care and nursing administration in community health nursing--the integration of individual health care with community health care].

There has been a paradigm shift in community health nursing. In 1992, visiting nursing stations were first introduced. In 1994, the Community Health Act came into force and in recent years public health care insurance has become a major issue. In this paradigm shift, one of the roles of nursing in the community is to train people to become more autonomous as consumers of health care services, and to design and implement a system that enhances community members' health and provides support when they are ill. In 1990 and 1996, the national nursing curriculum was revised to reflect changes in the age of the population. Community health nursing now faces the challenge of developing a new nursing model that is in tune with Japanese cultural values. Dr. Katsunuma (1996) proposed two alternative approaches to health care services: the public health approach and the clinical approach. In this paper, it is suggested that home care offers a third alternative, which integrates the clinical approach with the public health approach. This third approach provides a paradigm for community health nursing that integrates individual health care with community health care. New roles and specialties for public health nurses include care management, care planning, community health nursing administration, and supervision. Community-based nursing centers that cooperate with schools of nursing will provide a setting and a concept for community health nursing.

Case Management↗
PubMed2006

Governance and management structures for community partnerships: experiences from the Robert Wood Johnson Foundation's Community Partnerships for Older Adults Program.

PURPOSE: This article describes early efforts of four community partnerships in Boston, El Paso, Houston, and Milwaukee to address governance and management structures in ways that promote the sustainability of innovative community-based long-term care system improvements. The four communities are grantees of the Community Partnerships for Older Adults Program, a national initiative of the Robert Wood Johnson Foundation that fosters local partnerships to improve long-term care and supportive-services systems in order to meet the current and future needs of older adults. DESIGN AND METHODS: We examined community partnership approaches to governance and management, as well as evidence of the partnerships' influence in their communities, by using the conceptual framework of the community health partnerships typology developed by Shannon M. Mitchell and Stephen Shortell. RESULTS: Addressing governance and management issues was critical to the early evolution of community partnerships for older adults. Early partnership experiences, particularly with regard to local funders and media, provide evidence of emerging centrality (importance and influence in the community), which forecasts sustainability. Observation over a longer period is needed in order to see whether early successes will be sustained, particularly once original grant funding ends. IMPLICATIONS: Community partnerships for older adults can become influential positive forces but must invest in adequate governance and management structures early on.

Aged↗
PubMed2004

Legitimizing diabetes as a community health issue: a case analysis of an Aboriginal community in Canada.

The Kahnawake Schools Diabetes Prevention Project (KSDPP) is an ongoing participatory research and intervention project aimed at the primary prevention of type 2 diabetes. Formally initiated in 1994 with strong community support, KSDPP provides a fertile opportunity to learn about how a community came to identify the need for preventive action on a health problem such as diabetes. The purpose of our study was to describe the various conditions in the community of Kahnawake, which gave rise to its mobilization for the prevention of type 2 diabetes. Qualitative data consisted of 12 individual interviews and one focus group with key community members and health professionals living and/or working in the community of Kahnawake, along with historically relevant documents. The data collection and analysis procedures of the grounded theory method were applied. Results describe a preceding phase to formal KSDPP implementation, triggered by returning research results on the community prevalence of type 2 diabetes. This phase of 'legitimizing diabetes as a community health issue' is characterized by a shift in the perceived preventability of diabetes among community members; from a problem that was to be lived with to a problem that was to be prevented. The shift in perceptions was facilitated by the context in the community, described by structural developments, cognitive and relational elements. In addition to reaffirming the critical importance of utilizing lay knowledge during the planning of a health promotion intervention, our study has uncovered some of the key conditions through which individuals in the community came to participate in the identification and planning of a diabetes prevention project.

Canada↗
PubMed2006

From physician-centered to community-oriented perspectives on health care: assessing the efficacy of community-based training.

PURPOSE: To understand the influence of a community-based child advocacy block rotation on the perspectives of first-year pediatric residents and whether this influence persists. METHOD: The authors conducted semistructured interviews to assess the impact of the training program on pediatrics residents' perspectives regarding child advocacy and their understanding of the role of the community members and community-based assets in child advocacy. Three cohorts of first-year residents at the University of California, Davis, participated in the two-week community collaborative rotation from 2000 03. Two cohorts of 23 first-year residents were interviewed. In 2003, the first cohort of nine third-year residents was re-interviewed to assess long-term impact. Interviews were conducted before and after residents' experiences with community collaboratives. Transcripts of interviews were reviewed using an iterative process, and a coding system was applied using a qualitative software program. RESULTS: Comparison of pre- and postrotation interview data showed that residents' conceptions of advocacy shifted from ideas about being a pediatrician for the community to being a pediatrician in the community. This change in definition reflected a view of the pediatrician as facilitator, a community asset, rather than as a central administrator of child health affairs. This shift persisted through the completion of residency. CONCLUSIONS: These findings suggest that substantive interaction in a community collaborative can provide a starting point for residents to reconceptualize their role as pediatrician, for understanding the diverse contexts characteristic of children's circumstances, and for identifying and using community-based assets for improving child health. Definition changes persisted through residency and may influence residents' future behavior in clinical practice.

Adult↗
PubMed2006

Comparison of outcomes of a community-based education programme executed with and without active community involvement.

OBJECTIVE: The aim of this study was to evaluate the applicability of a previously designed set of generic objectives for community-based education (CBE) emphasising community involvement. METHODS: The study was designed as a non-blinded, randomised trial. Experimental and conventional groups of students following CBE programmes either closely or weakly matching the set of generic objectives were compared. Student groups were subjected to passive participatory observation. Students evaluated their programmes through questionnaires. The impact of student interventions was assessed by community compliance. Community perception of the programmes was evaluated through structured interviews with community representatives. RESULTS: Students in experimental groups appreciated their programme more than students in conventional groups. High compliance and appreciation were recorded in communities hosting the modified programme. Most students in conventional groups judged their posting negatively, largely because of the high number of households to be visited. Health interventions performed by conventional groups lacked co-operation between students and the community. Communities hosting conventional groups felt their health needs were scarcely discussed and addressed. CONCLUSIONS: The modification of an existing CBE programme to better match a set of generic CBE objectives emphasising community involvement had a positive effect on programme outcomes and levels of appreciation by both students and hosting communities. However, some confounding variables could not be controlled. Colleagues planning comparable studies may take advantage of the lessons we learned while performing this study.

Attitude of Health Personnel↗
PubMed1998

Community based intervention on adolescent risk taking: using research for community action.

OBJECTIVES: To use research on adolescent risk taking behaviour as an impetus for a community to develop locally based injury prevention strategies. DESIGN: Case study, based on a community action model and formative evaluation. This involved: a community profile on adolescent risk taking behaviour; interviews with service providers; dissemination of research findings to local policy makers; development and implementation of a community action plan to address adolescent risk taking; and assessment of its impact. SETTING: A rural town with a population of 10,195 situated in the North Island of New Zealand. SUBJECTS: School aged adolescents and the safety policies and practices of community organisations involved with adolescents. RESULTS: Risk taking behaviours identified by the community profile included: drink-driving, substance abuse, carrying of weapons with intent to harm, and suicidal ideation. Community members identified that risk taking behaviour associated with alcohol in relation to: (1) violence (self directed and assault) and (2) road related injuries should be the focus of their activities. The strategies identified focused on advocacy, education, legal/regulatory change, and environmental modification. Evaluation conducted six months after intervention identified increased community awareness of the adverse effects of adolescent risk taking and some changes in policies and practice related to adolescent safety. CONCLUSIONS: Providing a community with local information that has high relevance for its members may act as a stimulus for the development of injury prevention initiatives. While this case study illustrated that a comprehensive approach focusing on adolescent risk taking behaviour, rather than on isolated injury problems, may be an appropriate way to highlight escalating adolescent injury rates, it also demonstrates the limitations of a short time frame for a community development project.

Adolescent↗
PubMed2004

Using community indicators to assess nutrition in Arizona-Mexico border communities.

INTRODUCTION: Community indicators are used to measure and monitor factors that affect the well-being of a community or region. Community indicators can be used to assess nutrition. Evaluating nutrition in communities along the Arizona-Mexico border is important because nutrition is related to an individual's risk of overweight or obesity; obesity is a risk factor for developing type 2 diabetes. METHODS: Local grocery store purchases were selected as a community indicator for nutrition. A structured 26-question interview was developed and administered to grocery store managers in communities along the Arizona-Mexico border that were targeted by the Border Health Strategic Initiative, a program implemented by community groups and the University of Arizona. In addition, data from milk distributors serving the border communities were collected. RESULTS: Residents of these communities favor food items with a higher fat and higher caloric content. This trend held across several food categories. Major barriers to customer acceptance of healthier food items include lack of knowledge concerning healthy foods and their prices. CONCLUSION: The demand for healthy food items is relatively low along the Arizona-Mexico border. Interventions should continue to target this population with the aim of changing dietary patterns as one method of improving the health of the community and preventing and controlling diabetes.

Arizona↗
PubMed1989

Community organization and development for health promotion within an urban black community: a conceptual model.

The community organization and development process is not new and has its roots in social action ideology from the 1960s. The difference between the 1960s and the 1990s is in bringing together of target community consumers with representatives of private and public sector resources (with consumers in the majority), to form a community coalition board. This community coalition board must make policy decisions. Combining these community organizers and development techniques with the mission of health promotion is a viable methodology for addressing the needs of medically underserved and unserved communities. The approach is a multifactorial one, as illustrated in Figure 1. The Health Promotion Resource Center at Morehouse School of Medicine seeks to combine the ideology of community organization and development with culturally sensitive and linguistically appropriate health promotion curriculum materials and intervention strategies. Within the HPRC lies the Statewide Coordinating Center for Georgia which has been funded by the Henry J. Kaiser Family Foundation. Its mandate is to assist minority and poor communities in Georgia in developing community-based health promotion initiatives which address the areas of cancer, cardiovascular disease, adolescent pregnancy, substance abuse, and violence and unintentional injury. Our strategy in carrying out this mandate is the community organization and development model described in this article.

Black or African American↗
PubMed1987

The effectiveness of three sets of school-based instructional materials and community training on the acquisition and generalization of community laundry skills by students with severe handicaps.

This study examined the effectiveness of three sets of school-based instructional materials and community training on acquisition and generalization of a community laundry skill by nine students with severe handicaps. School-based instruction involved artificial materials (pictures), simulated materials (cardboard replica of a community washing machine), and natural materials (modified home model washing machine). Generalization assessments were conducted at two different community laundromats, on two machines represented fully by the school-based instructional materials and two machines not represented fully by these materials. After three phases of school-based instruction, the students were provided ten community training trials in one laundromat setting and a final assessment was conducted in both the trained and untrained community settings. A multiple probe design across students was used to evaluate the effectiveness of the three types of school instruction and community training. After systematic training, most of the students increased their laundry performance with all three sets of school-based materials; however, generalization of these acquired skills was limited in the two community settings. Direct training in one of the community settings resulted in more efficient acquisition of the laundry skills and enhanced generalization to the untrained laundromat setting for most of the students. Results of this study are discussed in regard to the issue of school versus community-based instruction and recommendations are made for future research in this area.

Educational Measurement↗
PubMed1998

Community Intervention Trial for Smoking Cessation (COMMIT): changes in community attitudes toward cigarette smoking.

The success of the Community Intervention Trial for Smoking Cessation (COMMIT) in changing smoking attitudes is examined by testing two primary hypotheses: (1) the priority of smoking as a public health problem increased more in the intervention communities than in the comparison communities, and (2) norms and values that support non-smoking increased more in the intervention than in the comparison communities. One community within each of 11 matched pairs was randomly assigned to receive a 4-year (1989-92) community-based smoking control intervention. Community attitudes towards smoking were measured primarily by cross-sectional surveys in 1989 (n = 9875) and 1993 (n = 14117) but a cohort (n = 5450) also provided attitude information. The main trial effect was on heavy smokers in the intervention communities who showed significantly more change in their beliefs about smoking as a public health problem. Despite the absence of an intervention-comparison difference, the magnitude of change in community-wide norms and values was related to the level of smoking control activities. In the cohort, light-to-moderate smokers in the intervention communities came to have stronger beliefs about smoking as a serious public health problem. COMMIT's impact on the beliefs of heavy smokers about the seriousness of smoking as a public health problem has important public health implications.

Adult↗
PubMed2005

Overseas-trained doctors in Australia: community integration and their intention to stay in a rural community.

OBJECTIVE: The aim of this study was to identify the factors that influence foreign doctors' community integration and examine how these affect their intention to stay in the rural community. DESIGN: Qualitative study using life-history perspective. SETTING: Rural communities throughout Victoria. PARTICIPANTS: Fifty-seven overseas-trained doctors (OTDs) working throughout rural Victoria, Australia. MAIN OUTCOME MEASURES: Key factors of community integration influencing OTDs' decision to stay in or leave a rural community. RESULTS: Maintaining cultural and religious values, as well as relationships to their respective ethnic communities is important to OTDs. While they do not expect excessive support from the community they appreciated the cultures of welcoming or 'embracing differences'. Supportive communication and supervisory support positively influence OTDs' appreciation of what the rural community can offer them and how they might overcome any difficulties that they face with their rural practice and life. CONCLUSION: As well as ensuring that OTDs' professional needs are met, the importance of a supportive environment within the clinic and community awareness of the OTDs' needs should not be underestimated as influences on an OTD's retention in a rural community.

Acculturation↗
PubMed1991

Photosynthetic carbon incorporation and turnover in antarctic cryptoendolithic microbial communities: are they the slowest-growing communities on Earth?

The main forms of terrestrial life in the cold, desolate Ross Desert of Antarctica are lichen-dominated or cyanobacterium-dominated cryptoendolithic (hidden in rock) microbial communities. Though microbial community biomass (as measured by extractable lipid phosphate) was well within the range of values determined for other microbial communities, community lipid carbon turnover times (calculated from community lipid biomass, rates of community photosynthetic carbon incorporation into lipids versus temperature, and the in situ temperature record) were among the longest on Earth (ca. 20,000 years). When the temperature is above freezing and moisture is present, moderate rates of photosynthesis can be measured. Lichen communities had a psychrophilic temperature response (maximal rate of 4.5 ng of C h m at 10 degrees C) while cyanobacteria communities had maximal rates at 20 to 30 degrees C (3 ng of C h m). These extraordinarily slowly growing communities were not nutrient limited. No significant changes in photosynthetic metabolism were observed upon additions of 100 nM to 1 mM nitrate, ammonium, phosphate, and manganese. These simple, tenacious microbial communities demonstrate strategies of survival under conditions normally considered too extreme for life.

Journal Article↗
PubMed2002

Assessment of personal and community-level exposures to particulate matter among children with asthma in Detroit, Michigan, as part of Community Action Against Asthma (CAAA).

We report on the research conducted by the Community Action Against Asthma (CAAA) in Detroit, Michigan, to evaluate personal and community-level exposures to particulate matter (PM) among children with asthma living in an urban environment. CAAA is a community-based participatory research collaboration among academia, health agencies, and community-based organizations. CAAA investigates the effects of environmental exposures on the residents of Detroit through a participatory process that engages participants from the affected communities in all aspects of the design and conduct of the research; disseminates the results to all parties involved; and uses the research results to design, in collaboration with all partners, interventions to reduce the identified environmental exposures. The CAAA PM exposure assessment includes four seasonal measurement campaigns each year that are conducted for a 2-week duration each season. In each seasonal measurement period, daily ambient measurements of PM2.5 and PM10 (particulate matter with a mass median aerodynamic diameter less than 2.5 microm and 10 microm, respectively) are collected at two elementary schools in the eastside and southwest communities of Detroit. Concurrently, indoor measurements of PM2.5 and PM10 are made at the schools as well as inside the homes of a subset of 20 children with asthma. Daily personal exposure measurements of PM10 are also collected for these 20 children with asthma. Results from the first five seasonal assessment periods reveal that mean personal PM10 (68.4 39.2 microg/m(3)) and indoor home PM10 (52.2 30.6 microg/m(3)) exposures are significantly greater (p < 0.05) than the outdoor PM10 concentrations (25.8 11.8 microg/m(3)). The same was also found for PM2.5 (indoor PM2.5 = 34.4 21.7 microg/m(3); outdoor PM2.5 = 15.6 8.2 microg/m(3)). In addition, significant differences (p < 0.05) in community-level exposure to both PM10 and PM2.5 are observed between the two Detroit communities (southwest PM10 = 28.9 14.4 microg/m(3)), PM2.5 = 17.0 9.3 microg/m(3); eastside PM10 = 23.8 12.1 microg/m(3), PM2.5 = 15.5 9.0 microg/m(3). The increased levels in the southwest Detroit community are likely due to the proximity to heavy industrial pollutant point sources and interstate motorways. Trace element characterization of filter samples collected over the 2-year period will allow a more complete assessment of the PM components. When combined with other project measures, including concurrent seasonal twice-daily peak expiratory flow and forced expiratory volume at 1 sec and daily asthma symptom and medication dairies for 300 children with asthma living in the two Detroit communities, these data will allow not only investigations into the sources of PM in the Detroit airshed with regard to PM exposure assessment but also the role of air pollutants in exacerbation of childhood asthma.

Adolescent↗
PubMed2005

Teaching community pediatrics to pediatric residents: strategic approaches and successful models for education in community health and child advocacy.

To improve child health at a community level, pediatricians require knowledge and skills that have not been traditionally included in residency training. Recent policy statements from the American Academy of Pediatrics and requirements from Accreditation Council for Graduate Medical Education Residency Review committees emphasizing the importance of community pediatrics training have provided additional incentive for pediatric residency programs to actively explore methods of teaching the principles and promoting the practice of community pediatrics to resident trainees. With a growing number of diverse educational models in various stages of practice or development, common themes and approaches to promote successful teaching of community health and child advocacy can be described. This article defines strategies for 2 critical elements of community pediatrics training, engaging residents and building strong community partnerships, then highlights a number of educational models that illustrate key curricular components and methods. Published results from evaluations of some programs suggest that community pediatrics training of this caliber will cultivate a cadre of pediatricians (academic and community based, generalists and subspecialists, researchers and practitioners) who understand child health in the context of community and have the leadership and collaborative skills to improve the health of children in their communities.

Child↗
PubMed2006

Population and community resilience in multitrophic communities.

Diversity-stability relationships have long been a topic of controversy in ecology, but one whose importance has been re-highlighted by increasing large-scale threats to global biodiversity. The ability of a community to recover from a perturbation (or resilience) is a common measure of stability that has received a large amount of theoretical attention. Yet, general expectations regarding diversity-resilience relations remain elusive. Moreover, the effects of productivity and its interaction with diversity on resilience are equally unclear. We examined the effects of species diversity, species composition, and productivity on population-and community-level resilience in experimental aquatic food webs composed of bacteria, algae, heterotrophic protozoa, and rotifers. Productivity manipulations were crossed with manipulations of the number of species and species compositions within trophic groups. Resilience was measured by perturbing communities with a nonselective, density-independent, mortality event and comparing responses over time between perturbed communities and controls. We found evidence that species diversity can enhance resilience at the community level (i.e., total community biomass), though this effect was more strongly expressed in low-productivity treatments. Diversity effects on resilience were driven by a sampling/selection effect, with resilient communities showing rapid response and dominance by a minority of species (primarily unicellular algae). In contrast, diversity had no effect on mean population-level resilience. Instead, the ability of a community's populations to recover from perturbations was dependent on species composition. We found no evidence of an effect of productivity, either positive or negative, on community- or population-level resilience. Our results indicate that the role of diversity as an insurer of stability may depend on the level of biological organization at which stability is measured, with effects emerging only when focusing on aggregate community properties.

Ecosystem↗
PubMed1998

Use of 16S rDNA community fingerprints to study cricket hindgut microbial communities.

A nucleic acid-based method was evaluated in the course of a study of microbial community structure in the cricket hindgut. Genomic DNA was extracted from the hindgut microbial community of Acheta domesticus and used as a template in the polymerase chain reaction (PCR) method, using primers that align to well conserved regions of the 16S rRNA gene. The rDNA-PCR product was used as a community probe to generate restriction fragment length polymorphisms (RFLPs) of hindgut bacterial isolates and gut microbial communities of insects fed different diets. Fingerprints of the bacterial isolates consisted of several bands suggesting multiple rRNA operons. In contrast with soil communities, hindgut community RFLP contained distinguishable band patterns. However, community rDNA fingerprints were complex and varied among insects fed similar diets, suggesting considerable intrinsic variability in the hindgut microbial community structure between crickets regardless of dietary regime. These results suggest that community RFLP methods using broad-specific phylogenetic probes do not have the resolution or specificity required to ascertain the effect of diet on the cricket hindgut microbial community structure.

Journal Article↗