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PubMed2004

A partnership approach to health promotion: a case study from Northern Ireland.

In recent years there has been a renewal of interest in community development and partnership approaches in the delivery of health and social services in Northern Ireland. The general thrust of these approaches is that local communities can be organized to address health and social needs and to work with government agencies, voluntary bodies and local authorities in delivering services and local solutions to problems. Since the Ottawa Charter was launched in 1986, government in Northern Ireland has stressed that community development should no longer simply be added on to key aspects of Health and Social Services, but should instead be at the core of their work. There is increasing consensus that traditional approaches to improving health and well-being, which have focused on the individual, are paternalistic and have failed to tackle inequalities effectively. Partnerships within a community development setting have been heralded as a means to facilitate participation and empowerment. This paper outlines the policy background to community development approaches in health promotion and delivery in Northern Ireland. Drawing on evidence from a case study of a community health project it highlights the benefits and difficulties with this approach. The findings suggest that partnerships can positively influence a community's health status, but in order to be effective they require effective planning and long-term commitment from both the state and the local community.

Community Health Planning↗
PubMed2006

E-learning for healthcare students: developing the communities of practice framework.

AIM: This paper presents research considering whether healthcare students were able to develop characteristics of communities of practice when engaged in an online module. BACKGROUND: Little is known about whether the communities of practice framework can be applied to online learning, with no previous consideration of its potential use within healthcare education. METHODS: Using a case study approach the research, completed in 2004, had two phases. A questionnaire was administered to a group of 109 healthcare students to gain information on which to base sampling for the subsequent phase. Phase 2 employed three strands of data collection: five students completed an online diary, the online interactions of seven students were captured on a discussion board and three students were interviewed. Data were analysed using a form of pattern matching. FINDINGS: Students were able to develop essential elements of communities of practice: mutual engagement, joint enterprise and shared repertoire, though this was not uniformly seen. Particular issues emerged for the online community, including enabling access to the online environment to support mutual engagement. The development of trust was also threatened by difficulties of presenting identities online. Joint enterprise was hampered by the online situation, although the virtual classroom proved essential for supporting endeavour. Not all students were committed to their groups. There was some evidence of group members developing shared repertoire, as routines of group working emerged. Professional understanding and computer skills were also enhanced. CONCLUSION: The framework can be applied to supporting online learning internationally amongst students and has applicability to professional groups. Those intending to employ the framework should ensure that students can gain access to the community and have the computer skills to engage. Course design should be considered to ensure support for developing the essential components of communities of practice.

Adult↗
PubMed1991

Addressing the contradictions: health promotion and community health action in the United Kingdom.

Within mainstream health education/promotion in the United Kingdom, the last few years have witnessed an upsurge of interest in community development, sometimes coupled with an undermining of the fundamental principles of this approach. This article addresses some of the contradictions and dilemmas that this development has presented for the community health movement. Current trends in health promotion policy and practice are examined in relation to broader health and welfare policy of the 1980s, the history of community development in health, and the background to the World Health Organization's "Health for All by the Year 2000" and health promotion initiatives. The possibilities and limitations of utilizing the rhetoric, to support community health action, are explored with reference to recent attempts by the community health movement to "reclaim" Health for All.

Community Health Services↗
PubMedDate not supplied

Developing a community nursing center.

With the move to community-based nursing education, schools of nursing are seeking ways to implement high-quality clinical experiences for undergraduate and graduate students in partnership with the community. The author presents ten tips for the development of a community nursing center that accomplishes this goal.

Community Health Centers↗
PubMed1995

Using empowerment theory in collaborative partnerships for community health and development.

Models of community empowerment help us understand the process of gaining influence over conditions that matter to people who share neighborhoods, workplaces, experiences, or concerns. Such frameworks can help improve collaborative partnerships for community health and development. First, we outline an interactive model of community empowerment that describes reciprocal influences between personal or group factors and environmental factors in an empowerment process. Second, we describe an iterative framework for the process of empowerment in community partnerships that includes collaborative planning, community action, community change, capacity building, and outcomes, and adaptation, renewal, and institutionalization. Third, we outline activities that are used by community leadership and support organizations to facilitate the process of community empowerment. Fourth, we present case stories of collaborative partnerships for prevention of substance abuse among adolescents to illustrate selected enabling activities. We conclude with a discussion of the challenges and opportunities of facilitating empowerment with collaborative partnerships for community health and development.

Adolescent↗
PubMed2003

The process and impact of implementing injury prevention projects in smaller communities in New Zealand.

It has been argued that developing community projects is an effective means by which to reduce injury. Two pilot community injury prevention projects (CIPPs) were established in small communities in New Zealand based on the World Health Organization (WHO) Safe Community model. The process and impact of the implementation of these CIPPs was monitored over 3 years. The setting was two small New Zealand communities with populations of <10 000. An external process and impact evaluation was conducted, with data gathered from written documentation, informant interviews and observation. The WHO Safe Community criteria formed the basis of the evaluation framework used. Other essential factors included were identified through the literature and the projects themselves. Findings from each CIPP were considered independently, followed by an examination of the differences observed. The findings from the evaluation of the implementation of these CIPPs are reported in relation to the themes identified in the evaluation framework, namely: community context, ownership and participation, focus and planning, data collection, leadership, management, sustainability and external links. Despite the different contexts, a common conclusion was that if the CIPPs' success was dependent on achieving a meaningful reduction of injury, they were unlikely to succeed. There were, however, a number of strategies and outputs for achieving change that could contribute to increasing safety for the population of interest. These were closely linked to community development strategies and needed greater acknowledgement in the evolution of the CIPPs. Critical to the development of the CIPPs were community capacity and the context in which the projects were operating. These conclusions are likely to apply to other projects in such settings, irrespective of the health outcomes sought.

Accident Prevention↗
PubMed2001

The role of AIDS volunteers in developing community-based care for people with AIDS in Thailand.

The present study analyses the effectiveness of AIDS volunteers in mitigating the stigma attached to People With AIDS (PWAs) within the context of developing community-based care (CBC) in Thailand. A total of 86 trained village health volunteers (T-VHVs) and 99 non-trained village health volunteers (N-VHVs) were enrolled in the study. In addition, 58 villagers in the T-VHV's intervention area and 72 villagers in the non-intervention area were also enrolled. Both T-VHVs and N-VHVs as well as villagers were assessed to determine their level of knowledge with respect to HIV/AIDS and attitudes toward PWAs. Furthermore, we also determined the village health volunteers' level of activity in distributing knowledge of HIV/AIDS in order to prevent and reduce stigma in the community. Although T-VHVs showed a greater depth of knowledge of HIV/AIDS than N-VHVs (p < 0.05), positive attitudes toward PWAs and the level of practice of village health volunteers did not differ significantly between T-VHVs and N-VHVs. While the level of health knowledge of villagers did not differ significantly between the T-VHV's intervention and control areas, a significant difference was observed between the two areas in terms of the villagers' attitudes towards PWAs (p < 0.01). Villagers in the intervention area attached less stigma to PWAs; therefore, T-VHVs played a role in providing basic information on AIDS to the villagers and in mitigating the stigma attached to PWAs. However, these volunteers need to undergo further training through a well-organized training programme in order to obtain a greater depth of knowledge. This is essential for the development of community-based care for PWAs.

Acquired Immunodeficiency Syndrome↗
PubMed1997

In pursuit of a better quality of life through the Basic Minimum Needs Programme: the Afghan experience.

This paper reports the outcome of work on integrated community development carried out in two villages in the Behsood district of Nangarhar province, Afghanistan, where the Basic Development Needs (BMN) model of community development was introduced in the last quarter of 1995. It describes the conceptual framework and the socio-political constraint under which the BMN development process evolved and was pursued. It also provides a detailed account of the methodology adopted, the results of the BMN survey, the socio-economic profile of the villages and the underlying causes of the problems. The paper gives an exposé of the set of potential interventions and solutions chosen by the community to solve their problems.

Adolescent↗
PubMed1998

Program fidelity in assertive community treatment: development and use of a measure.

Assertive community treatment (ACT) is a complex community-based service approach to helping people with severe mental disorders live successfully in the community. Effective replication of the model and research on critical elements require explicit criteria and measurement. A measure of program fidelity to ACT and the results of its application to fifty diverse programs are presented.

Community Mental Health Services↗
PubMed2005

Contested ground: how should qualitative evidence inform the conduct of a community intervention trial?

This paper presents issues which arose in the conduct of qualitative evaluation research within a cluster-randomized, community-level, preventive intervention trial. The research involved the collection of narratives of practice regarding the intervention by community development officers working in eight communities over a two-year period. The community development officers were largely responsible for implementing the intervention. We discuss the challenges associated with the collection of data as the intervention unfolded, in particular, the disputes over cues to revise and adjust the intervention (i.e. to use the early data formatively). We explore the ethical uncertainties that arise when multiple parties have different views on the legitimacy of types of knowledge and the appropriate role of research and theory in various trial stages. These issues are discussed drawing on the fields of ethnography, community psychology, epidemiology, qualitative methodology and notions of research reflexivity. We conclude by arguing that, in addition to the usual practice of having an outcome data-monitoring committee, community intervention trials also require a process data-monitoring committee as a forum for debate and decision-making. Without such a forum, the relevance, ethics and position of qualitative evaluation research within randomized controlled trials are destined to be a point of contention rather than a source of insight.

Cluster Analysis↗
PubMed2006

Targeting evaluations of youth development-oriented community partnerships.

Community-based partnerships (CBPs) focused on youth development (YD) have the potential to improve public health outcomes. These partnerships also present opportunities for the design and implementation of innovative, community-level change strategies, which ultimately may result in new capacities for positive YD. Evaluation-driven learning and improvement frameworks facilitate the achievement of these partnership-related benefits. Partnerships are complex because they embody multiple levels of intervention (eg, youth-serving programs, youth participation as partners or evaluators, network development for collaborative projects and resource sharing, YD-oriented organizational or community policy change). This inherent complexity transfers to evaluations of CBPs. This article provides resources for meeting evaluation-related challenges. It includes a framework for articulating relevant evaluation questions for YD-oriented CBPs, a summary of relevant types of evaluation studies, and practical solutions to common evaluation problems using targeted evaluation studies. Concrete examples of relevant, small-scale evaluation studies are provided throughout.

Adolescent↗
PubMed2005

Collaborating with an urban community to develop an HIV and AIDS prevention program for black youth and families.

This article describes a collaboration between academic researchers and residents of a low-income, inner-city community to develop and deliver an HIV and AIDS prevention program for Black youth. The Chicago HIV Prevention and Adolescent Mental Health Project (CHAMP) Program was developed and implemented to decrease HIV and AIDS risk exposure among youth living in a community that has been dramatically affected by HIV and AIDS. The article outlines (a) phases in the collaborative process to develop the program; (b) strategies used to embed contextually relevant themes and activities that address individual and systemic factors influencing HIV and AIDS risk; (c) a process model, based on the CHAMP experience, that can be replicated to develop programs for other youth problems; (d) descriptions of the CHAMP preadolescent and early adolescent curricula; (e) and how university- and community-based facilitators were trained to collaborate as a team to implement the CHAMP Program. Information is also provided about delivering the program in a distressed urban setting.

Acquired Immunodeficiency Syndrome↗
PubMed1994

The development of community orientated recommendations for diabetes care in south Auckland. South Auckland Community Diabetes Planning Group.

Growing numbers and costs associated with diabetes and its tissue damage are of increasing concern. We describe the development of community orientated recommendations aimed at primary and secondary prevention of diabetes in an area with a high proportion of Maori and Pacific Islands people. Preliminary results from structured face-to-face interviews with patients (n = 555), general practitioners (n = 163) and other health professionals were discussed by a core group of elected or selected community and health professional representatives. Twelve meetings and one full day workshop were held over a 7 month period. Formal and informal consultation occurred among community and health groups between meetings. The 68 recommendations included the need to: empower communities and diabetic patients; improve coordination and standardisation of care and the importance of the general practitioner in this process; improve access to care by removing transport, cultural and language barriers to care; subsidize preventative treatment costs; improve foot and eye services; improve monitoring of those with past diabetes in pregnancy or impaired glucose tolerance; improve detection of diabetes by increased high risk screening linked to ongoing diabetes care programmes. Implementation requires quality information systems and a cooperative partnership approach between hospital, general practitioner and the community, particularly local Maori and Pacific Islands communities.

Community Health Services↗
PubMed2002

Enhancing rural economic development: crafting a health care revolving loan fund.

Community development efforts in economically depressed rural areas are often hampered by poor access to health care. One barrier to rural provider availability is the difficulty of obtaining capital for rural health care infrastructure development. Commercial lending institutions are limited in their ability to respond to these needs due to traditional lending criteria--creditworthiness, equity, experience, management ability, and profits or cash flow. This paper describes a rural health care revolving loan fund crafted to address these needs for capital while addressing the goal of improving health care access in rural Arkansas. The Arkansas Rural Health Revolving Loan Fund is a model for other states interested in two processes that work synergistically: (1) increasing access to capital to strengthen the rural primary health care infrastructure and (2) making health care more economically viable by integrating the fund's efforts with those of other community development initiatives.

Arkansas↗
PubMed1993

Factors controlling the spread of HIV in heterosexual communities in developing countries: patterns of mixing between different age and sexual activity classes.

The paper describes the development and analysis of a mathematical model of the spread and demographic impact of HIV in heterosexual communities in developing countries. The model extends previous work in this area by the representation of patterns of mixing between and within different age and sexual activity classes in a two sex structure. Summary parameters are derived to represent different mixing patterns, ranging from assortative via random to disassortative, as are methods to ensure that particular mixing patterns between different age and sexual classes (stratified on the basis of rates of sexual partner change) meet constraints that balance the supply and demand for sexual partners as AIDS induced mortality influences the demographic structure of a population. Analyses of model behaviour rely on numerical methods due to the complexity of the mathematical framework, and sensitivity analyses are conducted to assess the significance of different assumptions and different parameter assignments. Simulated patterns of HIV spread across the two sexes and various age classes are compared with observed patterns in Uganda. The principle conclusion of the study is that the pattern of mixing between age and sexual activity classes, combined with the assumptions made to balance supply and demand between the sexes have a very major influence on the predicted pattern of HIV spread and the demographic impact of AIDS. The paper ends with a discussion of future needs in model development and data acquisition.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Safety culture assessment in community pharmacy: development, face validity, and feasibility of the Manchester Patient Safety Assessment Framework.

OBJECTIVE: To develop a framework that could be used by community pharmacies to self-assess their current level of safety culture maturity, which has high face validity and is both acceptable and feasible for use in this setting. DESIGN: An iterative review process in which the framework was developed and evaluated through a series of 10 focus groups with a purposive sample of 67 community pharmacists and support staff in the UK. MAIN OUTCOME MEASURES: Development of the framework and qualitative process feedback on its acceptability, face validity, and feasibility for use in community pharmacies. RESULTS: Using this process, a version of the Manchester Patient Safety Assessment Framework (MaPSAF) was developed that is suitable for application to community pharmacies. The participants were able to understand the concepts, recognised differences between the five stages of safety culture maturity, and concurred with the descriptions from personal experience. They also indicated that they would be willing to use the framework but recognised that staff would require protected time in order to complete the assessment. CONCLUSIONS: In practice the MaPSAF is likely to have a number of uses including raising awareness about patient safety and illustrating any differences in perception between staff, stimulating discussion about the strengths and weaknesses of patient safety culture within the pharmacy, identifying areas for improvement, and evaluating patient safety interventions and tracking changes over time. This will support the development of a mature safety culture in community pharmacies.

England↗