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PubMed2006

Application of qualitative methods in program planning for health promotion interventions.

The use of qualitative methods can provide an in-depth understanding of the issues and barriers related to community health and can help to inform the planning of health promotion programs and interventions. Although there are many examples in the literature that describe the application of quantitative data to program planning, few articles explicitly describe the application of qualitative data, such as data gathered using focus groups, in-depth interviews, and windshield tours, in program planning. Using the East Side Village Health Worker Partnership in Detroit, Michigan, as a case study example, this article explains the methods of incorporating qualitative data into each stage of program planning and development, including community assessment, development of goals and objectives, implementation of activities, and program evaluation.

Child↗
PubMed2000

Preliminary report from the Kansas Hartford Geriatrics Project: a model of community university collaboration in geriatric medicine faculty development.

OBJECTIVES: This paper describes the development, implementation, and participant satisfaction of a faculty development program for community-based clinician educators with competencies in geriatric medicine. DESIGN: One group, ongoing trial. SETTING: University of Kansas School of Medicine, Kansas City, Kansas. PARTICIPANTS: Family physicians and general internists from throughout the state of Kansas (n = 30). INTERVENTION: This is an integrated faculty development curriculum of clinical geriatrics and educational process offered in nine sessions over 3 years. MEASUREMENTS: Project retention, session attendance, and participant satisfaction are the measures of program success. MAIN RESULTS: Project retention at 18 months, the midpoint of this project, has been 87%, with 91% of the retained participants attending all of the sessions to date. More than 95% of the participants have rated each of the first five sessions as highly satisfactory or excellent in meeting their needs as a clinician educator. Satisfaction for on-site and interactive televideo participation has been equally high. CONCLUSIONS: Our preliminary results indicate the Kansas Hartford Geriatrics Project model of community-university collaboration in geriatric faculty development is successful in recruitment and satisfaction of participants. The curriculum is highly attractive and rewarding to faculty. Interactive televideo provides a successful innovation in aging-oriented faculty development.

Community Networks↗
PubMed1993

Impact of community-based instruction on the development of adaptive behavior of secondary-level students with mental retardation.

The impact of community-based instruction on the development of adaptive behavior in 34 high school students with moderate to profound mental retardation was examined. Results were: (a) Students made statistically significant gains in three of four domains of the Scales of Independent Behavior; (b) student IQ, level of student ambulation, and presence of behavior problems were not significant predictors of the amount of community-based instruction students received; and (c) the amount of community-based instruction was a more powerful predictor of gains in these domains than were IQ, level of student ambulation, and the presence of behavior problems. Results were discussed in terms of implications for the design and implementation of secondary programs for students with mental retardation.

Adolescent↗
PubMed1979

[An example of the application of factorial analysis of correspondences to infant mortality and its prevention in a rural area of West Africa].

A retrospective study through questionnaire was made among over 800 women of a Pre-Sahel region of Mali. It confirmed the very high infant and child mortality in this population: over 250% mortality under 1 year of age and over 400% under 6 years of age. The factorial analysis of correspondences proved adequate to determine the main characteristics of the local mortality pattern. In chronological order, the most important causes are obstetrical factors (1st day of life), umbilical tetanus (1 week to 1 month of age), malaria (1 month to 1 year of age), pneumopathies (including pertussis and lung complications of measles), toxicoses and nutritional syndromes (over 1 year of age). Preventive measures at various levels are proposed on the basis of these findings. They belong to three broad groups: -Overall socioeconomic development with effective participation of the rural communities concerned. -Development of an appropriate primary health care structure, with a primary health care team in each village. -Strengthening of the programmes of control of the most important communicable diseases. Such simple and cheap actions should, given a clear political will of the national authorities and a modicum of trust in the future on the part of local leaders, be rapidly implementable even in the most underprivileged countries and bring a significant amount of progress in the rural areas.

Child, Preschool↗
PubMed2006

Prevention programmes of progressive renal disease in developing nations.

Development of strategies for the early detection and prevention of non-communicable diseases, including kidney disease, is the only realistic strategy to avert an imminent global health and economic crisis and enhance equity in health care worldwide. In this article, we briefly examine the burden of non-communicable diseases, including diabetes, hypertension, cardiovascular disease and how chronic kidney disease (CKD) represents a key integrated element in the setting, even in developing countries. A possible explanation of the increasing number of people who have or are at risk to develop CKD in poor countries is also given. A survey of major screening and intervention programmes performed or ongoing globally is then presented, highlighting differences and hurdles of projects planned in developed or developing nations as well as in unprivileged communities in developed countries. Finally, some recommendations on future steps to implement prevention programmes in emerging worlds are provided.

Developing Countries↗
PubMed2004

Factors related to alcohol use among 6th through 10th graders: the Sarasota County Demonstration Project.

Alcohol consumption by youth can produce negative health outcomes. This study identified correlates of lifetime alcohol use, recent alcohol use, and binge drinking among youth in sixth through 10th grade (n = 2,004) in Sarasota County, Fla. Results from a closed-ended, quantitative survey acknowledged a range of personal, social, and environmental influences. Breadth of these influences supports a need for multifaceted, community-based interventions for effective prevention of youth alcohol use. This study was unique because it represents population-specific research in which community partners are using the findings to develop community-specific social marketing interventions to prevent underage drinking and promote alternative behaviors.

Adolescent↗
PubMedDate not supplied

Cigarette use in 6th through 10th grade: the Sarasota County Demonstration Project.

OBJECTIVES: To identify factors associated with cigarette smoking in the 6th-grade through 10th-grade youth population of Sarasota County, Florida. METHODS: A closed-ended, quantitative survey was completed by 2004 youth and used to extract population-specific data on the correlates of cigarette use. RESULTS: A range of factors influence cigarette use including self-efficacy to refuse offers of cigarettes, perceived emotional benefits, and perceived maternal disapproval of smoking. CONCLUSIONS: Results underscore the need for multiple-component interventions. This study is unique in that it represents population-specific research in which community partners are using the findings to develop community-specific prevention marketing interventions.

Adolescent↗
PubMed1983

California's approach to hypertension control: an overview.

California's Department of Health Services, recognizing the serious community health problem presented by uncontrolled hypertension, developed community-based programs of early detection and referral, follow-up and education. Special consideration was given to underserved populations at high risk. A statewide probability household survey was conducted and showed an improvement in control status during the past decade for definite and critical hypertension, but not for mild hypertension. With diminishing public resources, future efforts must be cost effective, focus on care for persons known to have hypertension and encourage maximum coordination between private and public agencies.

Adolescent↗
PubMed1994

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↗
PubMed1999

The development and testing of information system for community nursing.

The paper presents the development and testing of information system (IS) for community nursing (CN). The goal of IS is to support CN practice and to encourage research and development in the field. The development was based on analysis of CN process. Principal functions of CN were analysed. The logical data model and corresponding user interface were designed. A special emphasis in the development process was put on testing in practice and users' training. The developed IS will: increase work efficiency, introduce process-oriented nursing doctrine, support integrated treatment of the subjects and enable data comparison and exchange. An important subsidary goal of the IS development and usage is the harmonisation of concepts and terminology used in Slovenia with those used in the EU. In this framework International Classification of Nursing Practice (ICNP) which was translated into Slovene was introduced and tested.

Community Health Nursing↗
PubMed2006

Using community-based participatory research to develop an intervention to reduce HIV and STD infections among Latino men.

Although the Latino community living in the United States has been disproportionately affected by the intersecting epidemics of HIV and sexually transmitted diseases (STDs), the development, implementation, and evaluation of HIV and STD prevention interventions designed to reduce infection among Latinos lags behind prevention efforts targeting other communities. HoMBReS: Hombres Manteniendo Bienestar y Relaciones Saludables is a sexual risk reduction intervention designed to reduce HIV and STD infection among recently arrived, non-English-speaking Latino men who are members of a multicounty Latino soccer league in central North Carolina, a region of the United States with both the fastest growing Latino population and disproportionate HIV and STD infection rates. HoMBReS was developed in partnership with the local Latino community using community-based participatory research (CBPR). We describe (a) the CBPR partnership history and further expansion; (b) the development of the intervention through the integration of collected formative data, theoretical considerations, and findings from the scientific literature; and (c) lessons learned while using a CBPR approach to develop HoMBReS.

Community Participation↗
PubMedDate not supplied

Promoting science-based prevention in communities.

In the past decade, prevention science has emerged as a discipline built on the integration of life course development research, community epidemiology, and preventive intervention trials [Am. Psychol. 48 (1993) 1013; Am. J. Community Psychol. 27 (1999) 463; Kellam, S. G., & Rebok, G. W. (1992). Building developmental and etiological theory through epidemiologically based preventive intervention trials. In J. McCord & R. E. Tremblay (Eds.), Preventing antisocial behavior: interventions from birth through adolescence (pp. 162-195). New York: Guilford Press.]. Prevention science is based on the premise that empirically verifiable precursors (risk and protective factors) predict the likelihood of undesired health outcomes including substance abuse and dependence. Prevention science postulates that negative health outcomes like alcohol abuse and dependence can be prevented by reducing or eliminating risk factors and enhancing protective factors in individuals and their environments during the course of development. A growing number of interventions have been found to be effective in preventing adolescent tobacco, alcohol, and other drug abuse, delinquency, violence, and related health risk behaviors by reducing risk and enhancing protection. During the same decade, comprehensive community-based interventions to prevent adolescent health and behavior problems have been widely implemented in the U.S. with federal and foundation support. Despite the advances in the science base for effective preventive interventions and the investments in community-wide preventive interventions, many communities continue to invest in prevention strategies with limited evidence of effectiveness [Am. J. Public Health 84 (1994) 1394; J. Res. Crime Delinq. 39 (2002) 3; J. Community Psychol. 28 (2000) 237; J. Community Psychol. 28 (2000) 237; J. Consult. Clin. Psychol. 67 (1999) 590; Eval. Program Plann. 20 (1997) 367.]. Translating prevention science into community prevention systems has emerged as a priority for prevention research [J. Community Psychol. 28 (2000) 363; J. Appl. Behav. Anal. 28 (1995) 479.]. The Communities That Care (CTC) prevention operating system is a field-tested strategy for activating communities to use prevention science to plan and implement community prevention systems. CTC provides tools that assist communities to use local data on risk and protective factors to identify elevated risks and depressed protective factors in geographic areas where levels of risk are high and levels of protection are low and then to implement tested, effective preventive interventions that reduce the identified risks and enhance protection in these [Developmental Research and Programs. (1997). Communities That Care: a comprehensive prevention program. Seattle, WA: Author; Developmental Research and Programs. (2000a). Communities That Care: a comprehensive prevention program. Seattle: Author; Hawkins, J. D., Catalano, R. F., et al. (1992). Communities That Care: action for drug abuse prevention (1st ed.). A joint publication of the Jossey-Bass social and behavioral science series and the Jossey-Bass education series. San Francisco: Jossey-Bass]. The CTC system is widely implemented, and process evaluations of CTC suggest that it can assist communities to develop more effective prevention systems. This paper describes the background and use of the CTC operating system and results of evaluations of implementation of the system.

Adolescent↗
PubMed1998

[Compulsory referral to institutionalised psychiatric care and its organizational structure].

Nation-wide German Counseling Review regarding psychiatry in 1975 yielded a reasonable reform of psychiatric care in Germany. Especially outpatient and complementary caring concepts promoted the integration of psychiatric patients in their communities. However, this development was paralled by an increase of involuntary hospitalisations in Northrine-Westphalia. Within ten years involuntary hospitalisations doubled in some communities. These findings contrast with recent concepts of a complex community psychiatry with improved caring according to humanitarian principles and those of non-violence. These specific settings must be taken into consideration in developing community psychiatry. The report presents the activity of the working group concerning community psychiatry in Northrine-Westphalia. During its annual meetings a standardised and valid documentation concerning hospitalisation procedures in the communities as a means of quality control was discussed repeatedly. Taking into consideration the data of this survey the complex mechanisms leading to an increase of involuntary hospitalisations becomes understandable. Health reporting on a community level on the topic of involuntary hospitalisations is an important tool for discussion of its complex psychosocial and administrative mechanisms. Discussion about standard procedures in psychiatric emergency care service will thus be enabled.

Commitment of Persons with Psychiatric Disorders↗
PubMed2002

Can historical and functional risk factors be used to predict fractures in community-dwelling older adults? development and validation of a clinical tool.

The objectives of the study were: (1) to evaluate the contribution of impaired functional status, cognition and medication to fracture risk; (2) to determine whether risk factor profiles differ between regionally and socially diverse populations; and (3) to develop and validate a simple fracture prediction instrument for use in older adults using easily obtainable clinical information. A prospective population-based cohort study with 6-10 years of follow-up was carried out: the Duke and Iowa Established Populations for the Epidemiologic Study of the Elderly (EPESE), with in-person interviews in North Carolina and Iowa. The participants were community-dwelling men and women aged 65 years or over without a history of previous fracture at the baseline interview ( n = 7654). The measurements were potential risk factors for osteoporosis and falls including: demographic factors, co-morbidities, medications, functional status measures, and physical measures. These were examined for association with self-reported subsequent hip fractures and fractures at any site using survival analysis. The resulting multivariable model was simplified and validated in a separate cohort. Test operating characteristics at 3 years were estimated using logistic regression. There were a total of 842 fractures in both cohorts including 382 hip fractures. Significant risk factors for all subsequent fractures and/or hip fracture in the developmental cohort included female sex (relative hazard 1.9-2.3), lowest quartile of body mass index (1.3), Caucasian race (2.1-2.8), one or more Rosow-Breslau physical function impairments (1.8-2.1), age over 75 years (2.1), history of stroke (1.9), cognitive impairment (2.2), one or more impairments in the activities of daily living (1.5) and anti-seizure medication use (2.0). Three predicitive models were highly significantly correlated with subsequent fractures with c-statistics in the developmental cohort at 3 and 6 years of 0.640-0.789. A simple count of risk factors had similar discriminative ability to the full model with a linear 35-65% increase in hazard of all fractures and hip fracture for each additional risk factor. In the validation cohort, the above variables were less potent predictors of fracture with only sex, body mass index and Rosow-Breslau impairment achieving significance. The predictive models including risk factor count remained significant in the validation set although the discriminative ability of the model was poor, with c-statistics of 0.574-0.749. Although there is no cut-point where fracture risk dramatically increases, patients can be counselled that there is a linear 77% increase in risk of hip fracture, and 29% increase in any fracture risk, with each additional risk factor they possess. Functional status impairment is an important predictor of fracture in older community-dwelling adults. The contribution of risk factors to fracture risk may differ between distinct populations.

Accidental Falls↗
PubMedDate not supplied

Acute inpatient psychiatry in England: an old problem and a new priority.

With the development of community care, the number of National Health Service psychiatric beds in England has been reduced to between one-fifth and one-quarter of those provided in the mid-1950s. Psychiatric bed numbers are close to the irreducible minimum if they have not already reached it. The problems facing today's acute psychiatric admission wards include: poor design, maintenance and ambience; a lack of therapeutic and leisure activities for patients leading to inactivity and boredom; frequent incidents of aggression and low-level violence and problems with staffing. It is suggested that there are a number of underlying causes: First, there has been failure to plan inpatient services, or to define their role, as attention has focused on new developments in community care. Second, the reduction in bed numbers has led to a change in the casemix of inpatients with a concentration on admission wards of a more challenging group of patients. Third, admission ward environments are permeable to the adverse effects of local street life, including drug taking. After years of neglect, acute inpatient psychiatric services in England are now high on the UK Government agenda. The paper lists a number of national initiatives designed to improve their quality and safety. A recent review of qualitative research suggests that acute psychiatric wards in other countries face similar problems to those reported in England. It is suggested that there might be a need for joint action which might take the form either of international research about acute inpatient care or the development of international standards and a common quality improvement system.

Acute Disease↗
PubMed1985

Community-oriented health services education: a strategy for international cooperation.

This paper describes the approach of the Department of Community Medicine of the Mount Sinai School of Medicine in the education of local and foreign physicians and their participation in the development of community oriented health care systems. It also presents the first steps taken by this medical school to create an international program whose aims are to develop long-term partnership agreements with foreign universities by bringing together and integrating medical education with the development of community-oriented health care services.

Community Health Services↗