PubMed · 9687757
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C Perry. Parallel lines converge.. https://pubmed.ncbi.nlm.nih.gov/9687757/
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Type 2 diabetes mellitus is a major cause of morbidity and mortality among First Nations in Canada. We used multiple research methods to develop an integrated multi-institutional diabetes prevention program based on the successful Sandy Lake Health and Diabetes Project and Apache Healthy Stores programs. In-depth interviews, a structured survey, demonstration and feedback sessions, group activities, and meetings with key stakeholders were used to generate knowledge about the needs and resources for each community, and to obtain feedback on SLHDP interventions. First Nations communities were eager to address the increasing epidemic of diabetes. Educating children through a school prevention program was the most popular proposed intervention. Remote communities had poorer access to healthy foods and more on-reserve media and services than the smaller semi-remote reserves. While the reserves shared similar risk factors for diabetes, variations in health beliefs and attitudes and environmental conditions required tailoring of programs to each reserve. In addition, it was necessary to balance community input with proven health promotion strategies. This study demonstrates the importance of formative research in developing integrated health promotion programs for multiple communities based on previously evaluated studies.
PURPOSE: To establish whether the effect of improved glaucoma detection in the community suggested by an intervention study is maintained when intervention is extended to include all optometrists in the area. METHODS: Optometrists' in the Ealing, Hammersmith, and Hounslow area were invited to ongoing training sessions following completion of an intervention study. The number of optometrist initiated referrals to Ealing Hospital Eye Clinic (EHEC) for suspect glaucoma was assessed over a 12-month period. The positive predictive value (PPV) of those referrals was calculated and a historical comparison made with the results of the original study. RESULTS: A total of 376 new referrals for suspected glaucoma were assessed at EHEC during the 12-month period of data collection. This represents an increase in the number of referrals of 58% compared with an equivalent 12-month period during the initial intervention trial (376 vs. 238). The PPV was maintained at 0.45 (95% CI 0.41-0.51). CONCLUSION: The rising number of new referrals for glaucoma together with maintenance of the PPV suggests an impact on the number of new cases of glaucoma detected in the community. The increase in referral numbers was limited to glaucoma when compared with new referrals for cataract. This implies a targeted effect of the intervention in terms of glaucoma detection. We believe the next step is to perform the study in an alternative location to see if the effect is repeatable elsewhere. If proven to be the case, there is a coherent argument for widespread adoption of this strategy to improve glaucoma case finding.
Coordination and collaboration between organizations interested in promoting the health of the populations they serve can potentially help to ensure that key services are provided as well as augment the efforts beyond that which could be accomplished by each organization alone. Understanding the perspectives of each organization can facilitate development of health promotion initiatives that will be of mutual benefit. In Maryland, when a Medicaid managed care program was initiated, Memoranda of Understanding were signed between each managed care organization (MCO) and each of the 24 local health departments; many stipulated that the parties will coordinate on community health issues. This report describes a telephone survey of the health departments that was performed by one MCO to better understand the interests and expectations of the health departments and discusses a process for developing a community health promotion agenda for an MCO.