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Community‐based research requires the involvement of both the community and researchers to investigate the influence of existing political, social and structural factors…
Community‐based research requires the involvement of both the community and researchers to investigate the influence of existing political, social and structural factors on the health of individuals and communities. In the Bekaa Valley of Lebanon, a community‐based intervention is proposed, as part of an EU INCO DEV‐funded project that aims to assess reproductive health care among Bedouin in Lebanon and Jordan. This intervention intends to train Bedouin community health volunteers (CHVs) to spread reproductive and child health knowledge and awareness among the Bedouin community and link them to the existing primary health care centres. The challenges facing this intervention relate to the existing political atmosphere and the difficult process of building and maintaining a partnership between the research team and the Bedouin. Evidence from the data‐collection phase and the current implementation phase of the Bedouin project has shown that the positive outcomes that result from community‐based interventions can be outweighed by the burden of obstacles and challenges that arise. These have to be carefully anticipated and tackled to guarantee a successful intervention. This paper will explore these obstacles and highlight some recommendations for implementing a community‐based intervention on the basis of our experience with the Bedouin.
Population, community, and public health notions are addressed separately in the Patient Protection and Affordable Care Act (ACA), have different foci and stakeholders…
Population, community, and public health notions are addressed separately in the Patient Protection and Affordable Care Act (ACA), have different foci and stakeholders, build on different frameworks to achieve their aims, and apply different measures to determine the long-term impact of interventions. This paper attempts to clarify each concept and proposes a method of evaluating each of these sets of health-related activities based on the benefits that accrue to the respective stakeholders.
In addition to indicating how to affect change and improvements in health, the ecological model of health also provides insight into how the benefits from health-related activities may or may not flow back to the entities sponsoring health interventions. By clearly defining each of the concepts and examining the methods and metrics being used to select activities and measure benefits, a valuation model is developed that measures the financial impact on the targeted population as well as the sponsoring institution.
Defining, measuring, and evaluating are important to bring clarity to how individual organizations can contribute to the overall health of the population, as well as the limits of any single organization in doing so. Collective and upstream action will be required to improve the population’s health, but identifying and justifying the role of each participating organization is a challenge that still lacks an overarching vision that can be explained and measured to the satisfaction of all stakeholders.
Decision makers must justify how resources are committed in an era of scarcity and limited financial means. Moreover, methods must be in place to measure the impact of potential collaborations. The proposed valuation framework lays out the natural incentives, the responses to those incentives, and how to select initiatives that maximize value from the perspective of the various stakeholders.
Hartslag Limburg, a cardiovascular diseases (CVD) prevention programme, integrates a community strategy and a high‐risk strategy. The present paper presents the evaluation…
Hartslag Limburg, a cardiovascular diseases (CVD) prevention programme, integrates a community strategy and a high‐risk strategy. The present paper presents the evaluation design for, and baseline data from, the community intervention. The conceptual framework of the community intervention and its evaluation study were based on programme planning and evaluation models. Within this framework, community organization principles and methods and health education theories and methods were applied. Pre‐test/post‐test control group designs were used to study changes at the individual and the organizational level. The baseline results confirm the need to carry out a comprehensive CVD prevention community project, and the appropriateness of the conceptual model that is used for the development of interventions.
This study aims to explore the role of community health workers (promotoras) as a vehicle to identify and involve stakeholders in cleaning the environment in two community…
This study aims to explore the role of community health workers (promotoras) as a vehicle to identify and involve stakeholders in cleaning the environment in two community-based social marketing (CBSM) interventions.
This paper evaluates two CBSM interventions that used a promotora model to address city cleaning efforts; one in Puebla, Mexico and the other in San Luis, Arizona, USA. The qualitative methods included as follows: 25 in-depth and short interviews with managers, residents and promotoras and observational data on the sites with the cleanliness issues which were the focus of the interventions. Open-ended qualitative responses were analyzed for recurring themes.
This research advances in the area of CBSM by presenting the figure of the “promotora” as a key element that helped to involve diverse groups of stakeholders as active members in two CBSM interventions, and who also facilitated socialization, penetration and co-responsibility in the community in two cleaning interventions. Promotoras have the knowledge of community conditions and the skills necessary to engage community stakeholders in the objectives of a program with community level benefits.
This comparative analysis identifies that CBSM interventions that include promotoras can engage a diverse group of stakeholders achieving participation and co-responsibility in cleaning their environment.
As part of a tobacco farmer diversification randomized intervention study in 14 eastern North Carolina counties, a media content analysis of 16 local newspapers was…
As part of a tobacco farmer diversification randomized intervention study in 14 eastern North Carolina counties, a media content analysis of 16 local newspapers was conducted. All available issues of each of the newspapers from the period 1 November 1996, through 31 December 1999, were reviewed, and all relevant articles were clipped, coded, and entered into a database. Media coverage intensity was compared, qualitatively, with data from interviews with local civic, health, and religious leaders. There was, on average, only one tobacco diversification article in every 100 newspaper issues. The hypothesis that coverage of tobacco diversification and tobacco control would become more favorable in the intervention counties over time was not supported. Interview data showed that organizational leaders placed a higher priority on tobacco diversification policy issues than evidenced by media coverage.
The purpose of this study is to examine the involvement of communities – geographical or geopolitical units, which identifies culture, interest and ethnicity – in…
The purpose of this study is to examine the involvement of communities – geographical or geopolitical units, which identifies culture, interest and ethnicity – in construction health and safety (H&S) and the implications. This stems from the unexamined hence poorly understood roles of many stakeholders in the construction H&S management and regulatory regime in Nigeria.
Interviews with contractors and key informants and a survey of contractors were conducted. Descriptive and inferential statistics and thematic analysis were used.
There is evidences of community interventions: negotiating with contractors on H&S issues; strongly stipulating that H&S measures are adopted and implemented; and enforcing H&S through both violent and non-violent means. These have no legal backing. There is a relationship between the locations of the projects, urban area and rural area, and six community intervention variables. The study also reveals that among the implications of community interventions in H&S are contractors contextualising H&S in these communities and the tension between parties in construction projects. Again, there is a relationship between the location of the projects and six of the implications including the tension between communities and contractors and between contractors and clients.
In adequately addressing construction safety, health and environment issues in Nigeria, geographic location and socio-cultural consideration are pertinent, a point for policymakers, communities and contractors.
The study draws attention to the geographic location and socio-cultural explanations for the differences in the H&S management, performance and attitudes of contractors in Nigeria. This is the first study that examines the involvement of communities in H&S and the implications.
Purpose – A structured comparison, based on underlying social ecological constructs, provides the framework for this preliminary investigation of the commonalities and…
Purpose – A structured comparison, based on underlying social ecological constructs, provides the framework for this preliminary investigation of the commonalities and differences between three emerging approaches to health disparities: community-based participatory research (CBPR), community-focused health outreach (CFHO), and community health promotion programs (CHPP).
Methodology/approach – A conceptual review and preliminary analysis at the macrolevel of major community trends that focus on eliminating health disparity outcomes.
Findings – Each of the three community health approaches share similar purposes using community-focused collaborative efforts, but involve different change agents, levels of partnership, timeframes, social participation, and implementation methodologies.
Research limitations/implications – Additional in-depth literature reviews and meta-evaluations highlighting the contributions of each of the three approaches (CPBR, CFHO, and CHPP) are strongly recommended.
Practical implications – Interested community stakeholders can monitor results and impacts of each of the three approaches within their environments.
Originality/value of paper – Past reviews have concentrated on isolating individual contributing social causes of health disparities. This analysis introduces three emerging trends that currently function within community-based frameworks as potential mechanisms for helping the health disadvantaged.
Improving access and the quality of health services requires community health initiatives. However, in order for such efforts to be successful, there has to be some…
Improving access and the quality of health services requires community health initiatives. However, in order for such efforts to be successful, there has to be some agreement at the community level as to which community initiatives ought to be pursued. With diversity of population, health disparities, limited resources, and competing needs, agreement is unlikely; instead a negotiated consensus among key stakeholders (community advocates, agency leaders, service providers, and consumers) must be developed. A negotiated consensus takes into account differences and allows for some kind of resolution of these differences in order to achieve a given end. A negotiated consensus is necessary for the identification of common goals, prioritizing these goals, and either seeking funding or utilizing available funding for selected community initiatives. The chapter examines efforts by a regional health care system which fostered community initiatives in four diverse sites. We develop a framework which can guide other community initiatives in health care.
This commentary outlines the role and benefits of peer‐professional partnerships in developing and providing culturally competent health promotion services. There is…
This commentary outlines the role and benefits of peer‐professional partnerships in developing and providing culturally competent health promotion services. There is evidence that both paid and voluntary peer leaders can effectively work with public health professionals, to increase reach, access and positive outcomes through culturally tailored interventions. This paper outlines many of the advantages of these partnerships for public health practice, while acknowledging some limitations and calls for a greater application and evaluation of peer‐professional models in preventative health services.
A vehicle to reduce health inequalities and improve public health has been provided by programmes at a neighbourhood level. The purpose of this paper is to analyse the…
A vehicle to reduce health inequalities and improve public health has been provided by programmes at a neighbourhood level. The purpose of this paper is to analyse the development processes in four municipalities for achieving sustainable structures in area‐based development programmes during and after a formal partnership period.
A case‐study database was compiled based on the strategic and local work of four municipalities and four municipal housing companies who cooperated in the Partnership for Sustainable Welfare Development 2003‐2009. The case‐study database includes nine in‐depth studies with interviews (n=68), participant observations (n=125), a survey (n=1,160), and documents. The data are analysed using three theoretical concepts: political support, alliances, and citizen participation.
Political support, alliances, and citizen participation are important building blocks in neighbourhood development work. However, when the partnership ended there was little left that could function as a sustainable structure. Political support seems to be a means to reach the target, including ensuring a consistent approach and allocation of resources. However, the support must continue also after the intervention period, when the formal partnership collaboration ends, otherwise the established structure will soon decompose. Citizen participation is another precondition for a sustainable structure able to continue despite reduced municipal support. Alliances have the best chance of forming sustainable structures when they involve both the strategic and the operational level.
Even though many evaluations have been conducted to capture the process of interventions, little attention has been given to the challenges facing the outcomes of the intervention when it comes to making permanent the activities for reducing health inequalities. This paper is an attempt to deal with these challenges.