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PubMed1993

A strategy to enhance skills. Developing intravenous therapy skills for community nursing.

1. Information abounds on teaching clients, partners and relatives about home i.v. therapy, but there is a lack of training for community nurses in this area. 2. Training for IV therapy has been difficult to develop in community settings, but must involve managers, specialists, and practitioners. 3. Community-led IV therapy training requires resources across acute and community sectors, with skills development through contract learning and focusing skills to specific practice contexts. 4. Training and experience in managing central venous access developed by community nurses are transferable to all clients and to other colleagues.

Community Health Nursing↗
PubMed2006

Guidelines for conducting rapid participatory appraisals of community health needs in developing countries: experience from Tulikup, Bali.

The use of rapid participatory appraisal (RPA) methodology to assess community health needs in developing countries is widely supported. Despite this, there are few recently published practical guidelines or recommendations advising researchers on how best to plan, implement and communicate such an activity. Having recently conducted a successful RPA of community health and social needs in the traditional rural village of Tulikup, Bali, the authors discuss lessons to be learned and suggest practical guidelines for others wishing to conduct similar community focused RPAs.

Community Health Services↗
PubMed2006

Community nutrition programmes, globalization and sustainable development.

On an international scale, the last seventy-five years have been a period of deep social, economic and political transformation for the developing countries. They have been especially influenced by the international phenomenon of globalization, the benefits of which have been unequally distributed among countries. In this context, the strategies used to improve the general nutritional health of the population of developing countries include broad approaches integrating nutritional interventions in a context of sustainable community development, while valuing the existing relations between fields as diverse as agriculture, education, sociology, economy, health, environment, hygiene and nutrition. The community nutrition programmes are emblematic of these initiatives. Nevertheless, in spite of the increasing evidence of the potential possibilities offered by these programmes to improve the nutritional status and contribute to the development and the self-sufficiency of the community, their success is relatively limited, due to the inappropriate planning, implementation and evaluation of the programmes. In the present article, I attempt to emphasie the importance of community participation of the population of developing countries in the community nutrition programmes within the context of globalization. This process is not only an ethical imperative, but a pragmatic one. It is a crucial step in the process of liberation, democratization and equality that will lead to true sustainable development.

Community Networks↗
PubMed1985

Mid-arm and chest circumferences at birth as predictors of low birth weight and neonatal mortality in the community.

In developing countries, where about three quarters of births occur at home or in the community, logistic problems prevent the weighing of every newborn child. A study was performed to see whether other simpler measurements could be substituted for weight to identify neonates of low birth weight and those at risk. A study of 520 hospital births showed a strong correlation (p less than 0.001) between other anthropometric variables and birth weight, but the correlation was maximum for chest circumference (r = 0.8696) and mid-arm circumference (r = 0.8110). A mid-arm circumference of less than or equal to 8.7 cm and a chest circumference of less than or equal to 30 cm had the best sensitivity and specificity for identifying neonates with a birth weight of 2500 g or less. Measurements on 501 consecutive live births in the community were recorded and the infants followed up at specified ages. Mid-arm circumference was again significantly correlated to birth weight (r = 0.6918). Neonatal mortality showed an inverse relation but postneonatal mortality an inconsistent relation with mid-arm circumference. A mid-arm circumference of less than or equal to 8.7 cm and a birth weight of less than or equal to 2500 g were equally useful in predicting neonatal outcome. Mid-arm and chest circumferences are simple, practicable, quick, and reliable indicators for predicting low birth weight and neonatal outcome in the community and can be easily measured by paramedical workers in developing nations.

Abdomen↗
PubMed1983

[Concept of the therapeutic community].

The historic development of therapeutic communities is discussed, and it is shown that the term has been neither conceptualized not operationalized. Their unclear aims are considered to be utopian, and the author stresses that previous studies on such communities have been too superficial. The following problems have not hitherto received attention: 1. micro- and macrosocial relationships, 2. the role of the supervisor (authority problems), 3. norms and valuation systems, 4. discipline and sanctions, 5. the problem of roles, 6. questions of indicants and efficacy. The introduction of therapeutic communities is superfluous as a means of improving the socialist health services: it is sufficient to implement the principles of socialist democracy by means of appropriate training programmes.

Anomie↗
PubMed2004

Development of a community-based medical rehabilitation programme in the Kivalliq Region of Nunavut, Canada.

OBJECTIVE: In 2000, the University of Manitoba and the Department of Health and Social Services of Nunavut, Canada, jointly embarked upon the development of a community-based medical rehabilitation programme in the Kivalliq Region of Canada's central Arctic. Two main objectives were identified in moving forward with the implementation of a rehabilitation programme. Firstly, to conduct a region wide community needs assessment for rehabilitation services for all age groups of all residents of the Kivalliq Region of Nunavut. Secondly, to provide information from which a community-based rehabilitation therapy programme could be developed. METHODS: A community needs assessment of the Kivalliq Region was carried out to guide the implementation of physiotherapy, occupational therapy and speech language pathology services. RESULTS: There are now two physiotherapists, one occupational therapist, and one speech language pathologist providing rehabilitation services to the residents of the Kivalliq Region of Nunavut. The results of this needs assessment, the challenges and successes of this medical rehabilitation programme are discussed. CONCLUSION: The total population of the service area is approximately 8,000 people, the significant majority of whom self-report as Inuit, and are widely dispersed over eight communities. Despite the challenges in terms of culture, geography and recruitment of introducing a rehabilitation program in Canada's north, the residents of the Kivalliq Region now have a viable model of receiving rehabilitative intervention in their home communities.

Community Health Services↗
PubMed1976

Impact of intensive newborn care on neonatal mortality in a community hospital.

Development of a Perinatal Center delivering Level 3 intensive care in a community hospital is described. The inborn neonatal mortality at the hospital in which the Center is located, as well as that of the 13 surrounding counties, has diminished more rapidly than the state neonatal mortality. This has coincided with an almost constant delivery rate, increased proportion of staff patients, relatively constant rate of low birth weight, and declining total perinatal mortality. Our experience suggests that appropriately trained and motivated people, not equipment or geographic location, represent the key factor in the development of such a center.

Child Health Services↗
PubMed2001

Developing a rural community-based disability service: (I) service framework and implementation strategy.

In response to widely recognised dilemmas associated with rehabilitation and disability service provision in remote and rural areas of Australia, a community-based, participatory approach to service development was adapted for a disability service project in central Queensland. The service framework, known as Community Based Rehabilitation (CBR), fosters the involvement of community members in disability service provision. Although this framework has been described previously, few guidelines exist regarding appropriate implementation of such an approach. Consequently, the implementation strategy known as Participatory Rural Appraisal (PRA) was adopted. Participatory Rural Appraisal has been reported to foster the participation and decision-making of community members in community projects. The present article describes the application of this implementation strategy to disability service provision in a relatively under-resourced rural shire. The rationale, framework and process of the pilot are described. A subsequent publication will document the service component, detail evaluation findings and describe the long-term outcomes of this research.

Community Health Planning↗
PubMed2003

The structural reform of mental health services.

During past decades many countries have initiated extensive mental health care system reforms, and the main goal of these reforms has been the transfer of treatment of the mentally ill from psychiatric hospitals to the community. For example, assessment of the results of these reforms in Italy and Austria demonstrates considerable reduction in the number of psychiatric beds, higher quality and more available community services, and increased total expenditure for mental health services. However, because sufficient data is not yet available, many questions regarding how these reforms impact improvement in patient clinical parameters remain unanswered. Some of the answers to these questions can be gleaned from the results of research carried out in the United States and Canada in the 1980s. This research evaluated transfer of psychiatric treatment from a hospital setting to a community service setting. The results demonstrated that community treatment models were more effective than a hospital treatment model in reducing the number of hospitalizations and shortening length of stay. Patient monitoring also demonstrated good integration into the community. However, alongside the research supporting these reforms, there is some research that demonstrates a number of possible disadvantages: an increase in the number of homeless and in the mortality rate among psychiatric patients, and an increase in rehospitalization rates of chronically ill patients," referred to as the "Revolving Door Syndrome." To avoid the disadvantages that could possibly accompany the reform, particular attention needs to be given to planning and funding, so that development of community services and reduction in psychiatric hospital system correspond. Care must be taken to ensure that the number and the geographic location of these services meets the need of the population at risk, and that staff is available and well trained. A monitoring system should be set in place to monitor the patients according to the clinical standards agreed upon, and at the same time guidelines should be set up to evaluate the functioning of community services. The structural reform is progressing and should be completed at the end of 2005. However, development of community services is not progressing at the desired rate. In January 2003, the Israeli government made a decision to transfer the responsibility for medical insurance for the mentally ill from the government to the Sick Funds. However, an agreement between the Ministry of Health, the Ministry of the Treasury and the Sick Funds has yet to be signed and the government's decision has yet to be realized. This has caused development of community services to come to a halt, and neither the government nor the Sick Funds are investing in community development. We can only hope that the transfer of responsibility for health insurance for the mentally ill from the State to the Sick Funds will be completed soon and that development of community service for the mentally ill will then move forward quickly.

Health Care Reform↗
PubMed1998

Development of a community-based diabetes and hypertension preventive program.

The purpose of this project was to develop rapport with a Chinese Community Association and then establish preventive diabetic and hypertension programs with the Chinese in Chinatown, Hawaii. Subjects were recruited from this Chinese Community Association. Two hundred Chinese responded to the invitation. Among these, 75 individuals had either Type 2 diabetes, hypertension or both. Thirty-six males and 39 females ranging in age from 51 years old to 96 years old (Mean = 71.76, SD = 9.58) participated. Surveys and educational programs were carried out in Chinese. Results were described in terms of quantitative measures (family support and health outcomes) and qualitative experiences (case studies). Eighty percent of participants had decreased their diastolic blood pressure from above 95 mmHg to below 90 mmHg and systolic blood pressure from above 155 mmHg to below 140 mmHg. Ninety-five (n = 71) percent of participants had maintained their glucose level within the 90 mg/dL to 150 mg/dL range with a mean reduction of 57.86 mg/dL in one year. The hardest thing for families was the glucose self-monitoring. Case studies suggested that open-minded active listening and persistence formed the basis for developing a culturally sensitive community-based self management program for chronic diseases. Collaboration among the community, public health nurses, and diabetes nurse educators facilitated the process of community education and health promotion.

Aged↗
PubMed1980

Community medicine: future imperfect?

The development of community medicine is seen in historical perspective and found to be a redirection of preceding trends rather than the development of new concepts. The current problems of the specialty are reviewed and found to be due to erroneous perceptions of its role by many doctors, to the specialty's present preoccupation with its academic purity, and to the failure to provide within the National Health Service the resources that were vital to the functions it was asked to perform. It is argued that the essential skill of community physicians is epidemiology, which must be applied within the management process of the National Health Service to enable it to adapt itself to the needs of changing disease patterns. It must also be applied to the prevention of disease and this will necessarily involve the community physician in much wider social problems than the provision of medical care services. This second responsibility may well prove to be the more crucial in the longer term.

Community Medicine↗
PubMedDate not supplied

Development of a community-based diabetes management program for Pacific Islanders.

PURPOSE: This study examined the perception of diabetes among a sample of Pacific Islanders in Honolulu, Hawaii. All 23 participants were diagnosed with type 2 diabetes, ranged in age from 21 to 70 years, and had glycosylated hemoglobin levels of 5.8% to 13.9%. METHODS: Four focus groups were held in English and audiotaped. Outreach workers served as translators and comoderators. The content of transcripts was analyzed with Ethnograph software by investigators. The priority issues were confirmed by the comoderators and participants. RESULTS: Participants perceived diabetes as full of complications, emotions, symptoms, and behavior changes. Responses to hyperglycemia were fear, frustration, and uncertainty. Barriers to staying on the prescribed diet were habit, cultural ritual, ideal body image, and limited budget. CONCLUSIONS: Participants suggested that helpful activities would include walking/support group, cooking class, community healthy food store, translated material, and family participation. A community-based diabetes program has been developing as a result of the focus group findings.

Adult↗
PubMed2006

Developing an academic-community partnership for research in prostate cancer.

Community-based participatory research (CBPR) is an important strategy for reducing racial disparities in health outcomes. Academic-community partnerships are central to CBPR; however, there are few examples of how to develop these partnerships for prostate cancer research. This report describes the methods used to develop an academic-community partnership between investigators at the University of Pennsylvania and members of the Philadelphia chapter of the National Black Leadership Initiative on Cancer for CBPR on quality of life following prostate cancer diagnosis. Our experiences demonstrate that a significant investment of time is needed to identify a community partner for prostate cancer research and develop an effective partnership.

Academic Medical Centers↗
PubMed1990

Identification of community leadership in the development of public health education programs.

This paper deals with the identification of community leadership within the context of a community cancer prevention education program. An unusually high age-adjusted black/white mortality ratio exists for cervical cancer in Forsyth County, North Carolina. In response to this problem, a comprehensive public education program dealing with cervical cancer prevention was developed and currently is being implemented. Black community leaders have played an important role in planning for the program and in providing assistance for program implementation. Leaders were identified by means of a modified snowball technique in which ten recognized leaders in the black community initially were contacted and asked to name at least five other leaders in areas of leadership that included social/civic, political, religious, business, and less visible leaders. This process continued until no new names were generated. Interviews were conducted with 103 persons, and 589 leaders were identified. A cohort of 54 top-ranked leaders were identified, and the characteristics of these leaders are presented. The value of the leadership identification process is discussed in terms of (a) the identification process itself, (b) the generation of a list of key individuals who can serve as sources of advice for development and implementation of the program and as the beginning point for dissemination of new information on the project, and (c) a mechanism for development of a sense of community ownership of the project.

Black or African American↗
PubMedDate not supplied

Community participation in health and development.

BACKGROUND: This paper critically appraises the importance of community participation in health and development and the methods of involving them. It also emphasizes the role of every stakeholder in health and development. METHODS: These involved the review of some literature on this subject and examination of issues arising from the review. RESULTS: Community participation in health offers various advantages in health care and development among which are helping communities to develop problem solving skills, making them to take responsibility for their health and welfare, ensuring that the need and problems of the community are adequately addressed, ensuring that the strategies and methods used are culturally and socially appropriate or acceptable and finally it enhances sustainability. It is the responsibility of the government at various level, non-governmental organizations, international health agencies and health care programme planners and providers to help the community to organize themselves and be involved in their health care and development. Them should be well established or institutionalized framework of making sure that people are consulted, persuaded, and given responsibility in decision making under technical and professional guidance of health care professionals. CONCLUSION: Plans must not be imposed or policies formulated without involving the community in all matters concerning health and development.

Community Health Planning↗