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PubMed2002

Mental health promotion and illness prevention in Western Australia: a study of service capacity.

While considerable evidence exists regarding the effectiveness of specific kinds of interventions for mental illness prevention and to a lesser extent mental health promotion, mental health promotion and illness prevention (MHPIP) remain underdeveloped in Western Australia. The aim of this study was to explore the current state of MHPIP in Western Australia and to highlight some of the structural and systemic issues that need to be addressed if MHPIP services are to be progressed further in this state. For this purpose, the study examined the capacity for delivery of MHPIP services. Opportunities and barriers to the further development of MHPIP were also identified. Thirty-four key stakeholders representing a cross-section of local services, central government agencies and universities were interviewed using a semi-structured interview schedule. The interviews were conducted over a 6-week period. The interview schedule included questions on the workforce, agency liaison and project implementation, and priority areas and issues with respect to research and policy setting in MHPIP. In developing the focus of MHPIP services, critical factors that constitute capacity building were identified. These included readiness to participate in MHPIP, service infrastructure development, workforce development, resource allocation, networks and evaluation of programmes.

Delivery of Health Care↗

PubMed2004

The European Health Promoting Hospitals (HPH) project: how far on?

Back in 1986, the World Health Organization (WHO) produced the Ottawa Charter for Health Promotion. The intention of the charter was to create a framework that conveyed the notions of capacity building into a structured process for health promotion action in specific settings. This charter subsequently provided the vehicle from which the Health Promoting Hospital (HPH) initiative was launched, culminating in the Budapest Declaration of Health Promoting Hospitals (WHO, 1991). The aim of this paper is to investigate the nature and progress of the European HPH movement. Despite the fact that 'pockets' of concerted and progressive activity and evaluation have emerged from the HPH initiative, the majority of the available literature demonstrates a more limited impact than perhaps the WHO might have anticipated for its efforts over the last 15 years or so. Indications are that many of the member European HPH states have struggled to move beyond the 'project' phases of their planned programmes. This is not to detract from the considerable efforts that have been made to establish HPH networks or the continuing attempts to recruit further members/institutions into the movement. Nevertheless, this account concludes that a more concerted evaluation of European HPH progress is needed to accurately measure its impact and progress. If the situation remains unchanged, perhaps a fundamental review of the strategy is worth considering.

Community-Institutional Relations↗

PubMed2005

Implementation of promotion and prevention activities in decentralized health systems: comparative case studies from Chile and Brazil.

The policies for restructuring health systems in Latin America during the 1990s have included an emphasis on changing in the model of health care delivery to one that incorporates prevention and promotion activities. At the same time, health systems have been decentralized in their management, allowing room for greater variation in local interpretation and implementation of policy directives. Despite rhetoric and policy debate, there is no documentation or evaluation of actual experiences of prevention and promotion within decentralized health systems in Latin America. This paper explores the ways in which the national structure of a health system influences the implementation of activities for prevention and promotion through a comparison of the experiences in four local health systems in each of Brazil and Chile. These experiences in Brazil and Chile are presented by key themes of national health system structure, local health system structure, partnership and intersectorality, human resources and introducing a family health approach. Five clear factors emerge as operating at the national level that influence prevention and promotion activities in local health systems: vertical (Chile) versus horizontal (Brazil) structure of health system; greater awareness of prevention and promotion issues in Chile; greater urban bias in Chile compared with Brazil; strategies to attract human resources to primary care and rural areas; importance of local capacity building especially in rural areas. This account of case study experiences in Brazil and Chile provides a series of examples of arrangements and strategies that can facilitate implementation and usefully highlights a number of issues that policy-makers and health system managers need explicitly to consider. As such, the paper hopes to provoke debate about the structures and strategies for supporting the implementation of prevention and promotion programmes in Latin America and further health systems research in this field.

Brazil↗

PubMed2006

Implementation of the Healthy Cities' principles and strategies: an evaluation of the Israel Healthy Cities network.

The Israel network of Healthy Cities has been operating since 1990, and the first evaluation of its performance was carried out in 2004. The objectives were to evaluate the level of implementation of the 'Healthy Cities' principles and strategies in each network city and to assess the contribution of the network to its member cities. Coordinators of 18 active healthy cities participated in the study by completing a questionnaire with the aid of key informants in the municipality. The survey covered six dimensions of Healthy Cities' principles and strategies, and each was analyzed as a sum of scores of separate components and measures, converted to a 0-10 scale. Cities were found to differ in their performances. The dimension of intersectoral collaboration received the highest mean score (8.0 +/- 1.6), while the environmental protection dimension received the lowest one (4.5 +/- 2.2). Time investment by the coordinator of > 20 h a week is significantly associated with a higher score on the management dimension (7.8 versus 4.4 where the coordinator invests 20 h a week or less, P < 0.001). Previous work experience in either public health or community work was associated with higher scores of the community participation and intersectoral partnership dimensions (6.9 versus 5.2 and 8.5 versus 6.8, respectively, P < 0.05). Political support was associated with the city equity policy dimension (8.1 versus 4.8 in cities with high versus low political support, P < 0.01). Coordinator's participation in the network's activities is associated with better scores on all the dimensions except for environmental protection. It appears that political commitment and support is a significant enabling condition, which, together with the capacity building of the coordinator, may lead to better implementation of Healthy Cities' policy. Environmental issues should be incorporated into training sessions to enhance the environmental protection dimension.

Adult↗

PubMed2006

WHO Health Promotion Glossary: new terms.

The WHO Health Promotion Glossary was written to facilitate understanding, communication and cooperation among those engaged in health promotion at the local, regional, national and global levels. Two editions of the Glossary have been released, the first in 1986 and the second in 1998, and continued revision of the document is necessary to promote consensus regarding meanings and to take account of developments in thinking and practice. In this update 10 new terms that are to be included in the Glossary are presented. Criteria for the inclusion of terms in the Glossary are that they differentiate health promotion from other health concepts, or have a specific application or meaning when used in relation to health promotion. The terms defined here are: burden of disease; capacity building; evidence-based health promotion; global health; health impact assessment; needs assessment; self-efficacy; social marketing; sustainable health promotion strategies, and; wellness. WHO will continue to periodically update the Health Promotion Glossary to ensure its relevance to the international health promotion community.

Cost of Illness↗

PubMed1997

The impact of the National Cancer Institute's Data-based Intervention Research program on state health agencies.

To assist state health agencies adopt a new role in cancer prevention and control, the National Cancer Institute (NCI) initiated the Data-based Intervention Research (DBIR) program. The goal of DBIR was to stimulate data-driven activities and to build capacity for ongoing programs within state health agencies to ensure the translation of cancer prevention and control science into practice across the US. Each state funded under the DBIR program was required to conduct four phases of activity: identifying and analyzing relevant data, using these data to develop a state cancer control plan, and implementing and evaluating prevention and control interventions at the local level. This paper presents the results of survey of the 22 states that participated in the DBIR program. The survey is intended as a supplement to the case study also reported in this issue of Health Education Research. Results indicated that states were able to implement the DBIR model and they show the process to be useful to their cancer prevention efforts. DBIR had a major impact on how states will use data in future planning for cancer prevention and control. States had a number of recommendations for how NCI could improve its working relationships with state health agencies.

National Institutes of Health (U.S.)↗

PubMed1998

Planning for the sustainability of community-based health programs: conceptual frameworks and future directions for research, practice and policy.

Attention to the sustainability of health intervention programs both in the US and abroad is increasing, but little consensus exists on the conceptual and operational definitions of sustainability. Moreover, an empirical knowledge base about the determinants of sustainability is still at an early stage. Planning for sustainability requires, first, a clear understanding of the concept of sustainability and operational indicators that may be used in monitoring sustainability over time. Important categories of indicators include: (1) maintenance of health benefits achieved through an initial program, (2) level of institutionalization of a program within an organization and (3) measures of capacity building in the recipient community. Second, planning for sustainability requires the use of programmatic approaches and strategies that favor long-term program maintenance. We suggest that the potential influences on sustainability may derive from three major groups of factors: (1) project design and implementation factors, (2) factors within the organizational setting, and (3) factors in the broader community environment. Future efforts to develop sustainable health intervention programs in communities can build on the concepts and strategies proposed here.

Community Health Services↗

PubMed2006

Implementation of a school environment intervention to increase physical activity in high school girls.

Physical activity levels begin to decline in childhood and continue falling throughout adolescence, with girls being at greatest risk for inactivity. Schools are ideal settings for helping girls develop and maintain a physically active lifestyle. This paper describes the design and implementation of 'Lifestyle Education for Activity Program', or LEAP. LEAP used a health team approach with participatory strategies to provide training and support, instructional capacity building and opportunities to adapt school instructional program and environmental supports to local needs. The social-ecological model, based on social cognitive theory, served as the organizing framework for the LEAP intervention and elements of the coordinated school health program model as intervention channels. For the 12 intervention schools, LEAP staff documented 191 visits and interactions with 850 individuals over the 2-year period. Teachers reported successful implementation of most components of the intervention and demonstrated optimism for sustainability. These results indicate that a facilitative approach to intervention implementation can be used successfully to engage school personnel, and to change instructional programs and school environments to increase the physical activity level of high school girls.

Adolescent↗

PubMed2026

Nosocomial Outbreak of Lassa Fever in Conakry, Guinea, 2022.

BACKGROUND: Lassa fever is endemic in Guinea, with high seroprevalence in the forest region. However, clinical cases have been only anecdotally reported. In August 2022, a nosocomial outbreak occurred at a private clinic in the capital, Conakry, an area previously considered low risk. METHODS: Suspected cases were confirmed by real-time reverse-transcription polymerase chain reaction within 24 hours. Viremia was monitored during hospitalization, and whole-genome sequencing was performed in-country within 13 days of outbreak detection. Outbreak investigation involved rodent testing in the home village of the suspected primary case. RESULTS: Six cases were laboratory-confirmed, 5 of which were healthcare workers of the clinic. The case fatality rate was 16.7%. Viral RNA remained detectable in blood of survivors for a median of 26 days (interquartile range, 24-41 days) post-disease onset. Epidemiological investigations identified a suspected primary case, who had died of a febrile disease compatible with Lassa fever, had contact with all secondary cases, and had a travel history from Kissidougou area. Three near-complete and 1 partial Lassa virus genomes were recovered from the secondary cases, which phylogenetically clustered with genomes from central Guinea. Consistent with a common transmission source, the 4 genomes were almost identical. Rodent testing revealed a new reservoir area in eastern-central Guinea. CONCLUSIONS: This outbreak highlights the vulnerability of healthcare settings in low-prevalence areas of West Africa to nosocomial Lassa virus transmission due to human mobility. Facilitated by capacity-building programs for viral hemorrhagic fevers, rapid diagnosis, genomic analysis, and ecological assessment enabled an efficient outbreak response and control.

Lassa Fever↗

PubMed2000

Status of a health care quality review programme in South Africa.

This paper provides an overview of an accreditation programme for health care facilities in South Africa. It traces the origin of COHSASA (The Council for Health Service Accreditation of Southern Africa) which began as a pilot programme in 1992, to its current status as the only accreditation body in the country. There are brief descriptions of its structure, how it is governed, and how standards were developed and organized. The authors sketch a background of the unique sociopolitical context and legal developments within which the programme operates in South Africa and how the programme is contributing towards the new government's intention to provide equitable and quality health care to all its citizens. There is an outline of the principles on which the COHSASA programme is based and the structure and process of the programme. The programme incorporates an integrated, multi-disciplinary, continuous quality improvement approach with special emphasis on capacity building of hospital staff when necessary. The paper refers to groundbreaking research in Kwa-Zulu Natal where the impact of accreditation is being measured in a randomized control trial. It points to the benefits of accreditation being perceived in both public and private sectors of health care in South Africa and outlines some of the results of the program's implementation.

Accreditation↗

PubMed2003

Integrated program enhancements increased utilization of Farmers' Market Nutrition Program.

Three New York State agencies undertook a state-wide initiative in 2001 to enhance the effectiveness of the Special Supplemental Program for Women, Infants, and Children (WIC) Farmers' Market Nutrition Program (FMNP) for both families and farmers. The program enhancements included four components intended to influence market and consumer behavior: hiring a state-wide Cornell Cooperative Extension staff member to initiate and coordinate FMNP promotion efforts; increased collaboration among state-level agencies; local-level community capacity-building; and dissemination of newly developed nutrition education resources. Because components were overlapping and potentially synergistic, the total effect was considered. To test the hypothesis that the enhancements increased Program utilization as measured by redemption rates, a time-series, quasi-experimental design was employed in which observed 2001 redemption was tested for departure from earlier trends. Linear regression showed FMNP coupon redemption rates from 1996 through 2000 decreased 2.36% annually (P = 0.002). This trend was interrupted in 2001 when actual redemption exceeded predicted redemption by >2.2% (P < 0.055). Alternate explanations for this shift were deemed improbable. These findings show that FMNP goals were advanced through a coordinated, collaborative initiative with activities at state and local levels, resulting in increased utilization of FMNP benefits by WIC participants and increased income to local farmers.

Agriculture↗

PubMedDate not supplied

Reducing diabetes health disparities through community-based participatory action research: the Chicago Southeast Diabetes Community Action Coalition.

To address disproportionately high rates of diabetes morbidity and mortality in some of Chicago's medically underserved minority neighborhoods, a group of community residents, medical and social service providers, and a local university founded the Chicago Southeast Diabetes Community Action Coalition, a Centers for Disease Control and Prevention REACH 2010 Initiative. A community-based participatory action research model guided coalition activities from conceptualization through implementation. Capacity building activities included training on: diabetes, coalition building, research methods, and action planning. Other activities sought to increase coalition members' understanding of the social causes and potential solutions for health disparities related to diabetes. Trained coalition members conducted epidemiologic analyses, focus groups, a telephone survey, and a community inventory. All coalition members participated in decisions. The participatory process led to increased awareness of the complexities of diabetes in the community and to a state of readiness for social action. Data documented disparities in diabetes. The participatory action research approach (a) encouraged key stakeholders outside of the health care sector to participate (e.g., business sector, church groups); (b) permitted an examination of the sociopolitical context affecting the health of the community; (c) provided an opportunity to focus on preventing the onset of diabetes and its complications; (d) increased understanding of the importance of community research in catalyzing social action aimed at community and systems change and change among change agents.

Chicago↗

PubMedDate not supplied

Cross-cultural considerations in the conduct of community-based participatory research.

This article explores cross-cultural challenges that arise when university and community members collaborate in community-based participatory research. As part of a project for primary prevention of human immunodeficiency virus (HIV) infection, researchers trained community leaders to jointly develop a research question and conduct a pilot qualitative study in a Puerto Rican community in Massachusetts. Different priorities of the community and university members about HIV as a research topic underscored the need to continuously reflect on developing a research question in community-based participatory research. Recognizing the cultural assumptions of both university and community members is an important component of capacity building among collaborative research teams.

Community-Institutional Relations↗

PubMedDate not supplied

The contingencies of organizational learning in long-term care: factors that affect innovation adoption.

We apply the theoretical frameworks of knowledge transfer and organizational learning, and findings from studies of clinical practice guideline (CPG) implementation in health care, to develop a contingency model of innovation adoption in long-term care (LTC) facilities. Our focus is on a particular type of innovation, CPGs designed to improve the quality of LTC. Our interest in this area is founded on the premise that the ability of LTC organizations to adopt and sustain the use of innovations like CPGs is contingent on the initial capacity these institutions have to learn about them, and on the presence of factors that contribute to capacity building at each stage of innovation adoption. Based on our review of relevant theory, we develop a set of fifteen testable propositions that relate factors operating at the guideline, individual, organizational, and environmental levels in LTC institutions to stages of guideline adoption/transfer. Our model offers insights into the complexities of adopting and sustaining innovations in LTC facilities particularly, in health care organizations specifically, and in service organizations generally.

Diffusion of Innovation↗

PubMedDate not supplied

Management tools for Medicaid and State Children's Health Insurance Program (SCHIP).

Medicaid and the State Children's Health Insurance Program need analytic tools to manage their programs. Drawing upon extensive discussions with experts in states, this article describes the state of the art in tool use, making several observations: (1) Several states have linked Medicaid/State Children's Health Insurance Program administrative data to other data (eg, birth and death records) to measure access to care. (2) Several states use managed care encounter data to set payment rates. (3) The analysis of pharmacy claims data appears widespread. The article also describes "lessons learned" regarding building capacity and improving data to support the implementation of management tools.

Child Health Services↗

PubMed1997

Typology of local health departments based on maternal and child health core functions.

A survey of Missouri local health departments (LHDs) was conducted to measure core public health functions within maternal and child health (MCH). Measurement was based on a prior key informant study that defined each core function as a set of specific MCH activities, programs, and services. The 59 items in the survey operationalized these activities and enabled the creation of summary scores for assessment, policy development, and assurance. Participation included 93 of the 112 Missouri LHDs (83%) in 1995. Reliability coefficients for the summary scores ranged from .83 to .92. Cluster analysis produced six types of LHDs with differing core function patterns. By matching efforts to improve core function practice to LHD type, more efficient use of capacity building resources may result.

Female↗

PubMed1997

Developing injury prevention capacity in New York City: the role of a local health department in fostering collaborations.

Injuries have long been a leading cause of mortality in urban areas such as New York City. While efforts to address injuries were undertaken by the New York City Department of Health (NYCDOH) starting in the 1940s, it was not until the department received a Capacity Building Grant from the Centers for Disease Control and Prevention (CDC) in 1989 that a more comprehensive program could be developed. The NYCDOH launched several collaborative projects with a variety of organizations and institutions. These efforts indicate that through collaborations, local health departments can increase their effectiveness and better promote their approach to injury prevention.

Community Networks↗

PubMed1997

Reinventing injury prevention in California: a model for reinventing local public health programs.

The evolution of state injury control programs, like the evolution of public health itself, involves many jurisdictions and disciplines outside the health domain and requires the cooperation and coordination of many sectors. Perhaps most important is that it requires involvement by the states to assure success. In California, the federal investment of less than $2 million in capacity building spread over five years has produced more than $8 million in injury control programming in the subsequent four years.

California↗