Community health services Research Papers (original) (raw)

Purpose. Conduct a social network analysis of the health and non–health related organizations that participate in Bogotá's Ciclovía Recreativa (Ciclovía). Design. Cross-sectional study. Setting. Ciclovía is a multisectoral community-based mass program in which streets are temporarily closed to motorized transport, allowing exclusive access to individuals for leisure activities and physical activity. Subjects. Twenty-five organizations that participate in the Ciclovía. Measures. Seven variables were examined by using network analytic methods: relationship, link attributes (integration, contact, and importance), and node attributes (leadership, years in the program, and the sector of the organization). Analysis. The network analytic methods were based on a visual descriptive analysis and an exponential random graph model. Results. Analysis shows that the most central organizations in the network were outside of the Health sector and include Sports and Recreation, Government, and S...

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- Health Promotion, Colombia, Stochastic processes, Theoretical Models

Background: Children of substance-abusing parents are at risk for developing psychosocial development problems. In Germany it is estimated that approx. 2.65 million children are affected by parental substance abuse or dependence. Only ten percent of them receive treatment when parents are treated. To date, no evaluated programme for children from substance-affected families exists in Germany. The study described in this protocol is designed to test the effectiveness of the group programme TRAMPOLINE for children aged 8-12 years with at least one substance-abusing or-dependent caregiver. The intervention is specifically geared to issues and needs of children from substance-affected families. Methods/Design: The effectiveness of the manualised nine-session group programme TRAMPOLINE is tested among N = 218 children from substance-affected families in a multicentre randomised controlled trial. Outpatient counselling facilities across the nation from different settings (rural/urban, Northern/Southern/Eastern/Western regions of the country) will deliver the interventions, as they hold the primary access to the target group in Germany. The control condition is a group programme with the same duration that is not addiction-specific. We expect that participants in the intervention condition will show a significant improvement in the use of adaptive coping strategies (in general and within the family) compared to the control condition as a direct result of the intervention. Data is collected shortly before and after as well as six months after the intervention. Discussion: In Germany, the study presented here is the first to develop and evaluate a programme for children of substance-abusing parents. Limitations and strengths are discussed with a special focus on recruitment challenges as they appear to be the most potent threat to feasibility in the difficult-to-access target group at hand (Trial registration: ISRCTN81470784).

- by Sonja Bröning
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- Program Evaluation, Research Design, Adolescent, Family Practice

OBJECTIVES To assess the birth preparedness and utilisation of services in an urban union council where only the private sector provided any healthcare. METHODS Descriptive study design was adopted which had two components: 1) a cross-sectional community survey on birth preparedness and utilisation of services and 2) a provider survey with census of all eligible healthcare facilities. Door to door survey was conducted by visiting every tenth household. All allopathic healthcare facilities in the selected union council were visited for collecting information about the available services and amenities. RESULTS Knowledge regarding danger signs during pregnancy and delivery was low. Sixty four percent women received some antenatal care while 45% deliveries were conducted at home. Among those having to seek emergency care during pregnancy, delivery or postpartum, 39% approached a health facility. Lack of preparation in terms of transport was reported in 83% cases. Two of the health facil...

- by Zaeem Haq
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- Pakistan, Medicine, Pregnancy, Young Adult

Implementation fidelity, a critical aspect of clinical trials research that establishes adequate delivery of the treatment as prescribed in treatment manuals and protocols, is also essential to the successful implementation of effective programs into new practice settings. Although infrequently studied in the drug abuse field, stronger implementation fidelity has been linked to better outcomes in practice but appears to be more difficult to achieve with greater distance from model developers. In the INternational CAnnabis Need for Treatment (INCANT) multinational randomized clinical trial, investigators tested the effectiveness of Multidimensional Family Therapy (MDFT) in comparison to individual psychotherapy (IP) in Brussels, Berlin, Paris, The Hague, and Geneva with 450 adolescents with a cannabis use disorder and their parents. This study reports on the implementation fidelity of MDFT across these five Western European sites in terms of treatment adherence, dose and program differentiation, and discusses possible implications for international implementation efforts.

- by Kees Mos
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- Psychology, Family Therapy, Psychotherapy, Adolescent

Educating nursing students for entry level practice in complex health care settings is a concern in Canada and many other countries. National groups have called for improved practice education to better prepare students for actual practice. The purposes of this paper are identification and critical analysis of current practice education models. Ten basic model types were identified in the literature: faculty-supervised practicum, preceptorship, education unit, joint appointment, secondment, affiliate position, internship, cooperative education, work-study and undergraduate nurse employment. Key features, benefits and limitations of each model are discussed. Emerging developments in practice education are increased inter-professional and community-based practice education, and new partnerships among academic and practice organizations. These developments are intended to alleviate model limitations, ease pressures from organizational contexts and respond to large integrated health care systems. Evidence-based research for practice education is beginning to be apparent. Further research is needed that compares models and examines learning, patient care outcomes and costs.

- by Lucia Gamroth
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- Nursing, Medicine, Canada, Nursing Education

 RESEARCH AND PRACTICE  Objectives. We determined the prevalence of asthma and estimated baseline asthma symptoms and asthma management strategies among children aged 0-12 years in Central Harlem. Methods. The Harlem Children's Zone Asthma Initiative is a longitudinal, community-based intervention designed for poor children with asthma. Children aged 0-12 years who live or go to school in the Harlem Children's Zone Project or who participate in any Harlem Children's Zone, Inc, program were screened for asthma. Children with asthma or asthma-like symptoms were invited to participate in an intensive intervention. Results. Of the 1982 children currently screened, 28.5% have been told by a doctor or nurse that they have asthma, and 30.3% have asthma or asthma-like symptoms. To date, 229 children are enrolled in the Harlem Children's Zone Asthma Initiative; at baseline, 24.0% had missed school in the last 14 days because of asthma. Conclusion. The high prevalence of asthma among children in the Harlem Children's Zone Project is consistent with reports from other poor urban communities. Intensive efforts are under way to reduce children's asthma symptoms and improve their asthma management strategies.

- by roger vaughan
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- Poverty, Asthma, Medicine, Crisis

Quantitative evaluations might be insufficient for measuring the impact of interventions promoting the right to health, particularly in their ability to contribute to a greater understanding of processes at the individual, community, and larger population level through which certain results are obtained. This paper discusses the application of a qualitative approach, the "most significant change" (MSC) methodology, in the Philippines, Palestine, the Democratic Republic of the Congo, and El Salvador between 2010 and 2013 by Third World Health Aid and its partner organizations. MSC is based on storytelling through which the central question--what changes occurred?--is developed in terms of, "who did what, when, why, and why was it important?" The approach focuses on personal stories that reflect on experiences of change for individuals over time. MSC implementation over several years allowed the organizations to observe significant change, as well as evolving types...

- by Ranin Darkhawaja and +1
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- Health Promotion, Human Rights, Palestine, Philippines

Work stress is widely thought to be a significant problem in the health and community services sector. We reviewed evidence from a range of different data sources that confirms this belief. High levels of psychosocial risk factors, psychological health problems and workers compensation claims for stress are found in the sector. We propose a multilevel theoretical model of work stress to account for the results. Psychosocial safety climate (PSC) refers to a climate for psychological health and safety. It reflects the balance of concern by management about psychological healthv.productivity. By extending the health erosion and motivational paths of the Job Demands-Resources model, we propose that PSC within work organisations predicts work conditions and in turn psychological health and engagement. Over and above this, however, we expect that the external environment of the sector particularly government policies, driven by economic rationalist ideology, is increasing work pressure an...

Este artigo reflete sobre o acolhimento e a produção de cuidado destinados à população em situação de rua numa perspectiva socioantropológica, a partir de uma observação participante realizada junto a uma equipe de Consultório na Rua. Observou-se que essa população, historicamente visibilizada como marginal, dificilmente consegue acessar os serviços de saúde, tornando-se invisível ao próprio Sistema Único de Saúde. Embora a Política Nacional para a População em Situação de Rua pretenda assegurar acesso à saúde, o cuidado, no entanto, nem sempre é garantido porque serviços e profissionais de saúde têm pouca experiência para acolher pessoas em situação de rua e atender as suas necessidades. Conclui-se que o desafio é hipervisibilizar as linhas de cuidado para situações impostas pela vida na rua e a construção de vínculo terapêutico desconstrutor da prática estigmatizante.

- by Janaina Hallais
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- Medical Sociology, Health Promotion, Brazil, Social Support

Dengue is the most important mosquito-borne disease in the Philippines, especially in Metropolitan Manila where communities are socially and economically diverse, and city governments struggle to provide basic services such as continuously available, piped water supply to residents. We examined responses to introducing water container management to control dengue vectors in two diverse communities in Masagana City: Village A (gated community) and Village B (informal settlers community). The roll out of the intervention was carried out by the study team, dengue control personnel and local health workers (BHWs). A behavioural change framework was used to describe the community responses to the introduction of a new vector control intervention - household water container management. Although, the desired outcome was not achieved during the study's timeline, observation on processes of behaviour change underscored the importance of understanding the social nature of the urban commun...

- by Ferdinand Salazar
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- Health Behavior, Philippines, Urban Health, Dengue Virus

A community survey was conducted in Al awayda village, one of eight villages selected for study in the rural Gezira province of Sudan. The objective of the survey was to identify the main health, social and economic problems of people in... more

- by Omer Merghani
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- Nutrition, Research Methodology, Primary Health Care, Culture
- by Amare Deribew
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- Optometry, Ophthalmology, Ethiopia, Medicine
- by Errol Cocks
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- Focus Groups, Qualitative Research, Treatment Outcome, Clinical Sciences

The popularity of dual physician assistant/master of public health degree programs continues to increase within US physician assistant (PA) education. The advantages and disadvantages of pursuing dual degree training have not been fully explored in the PA literature. Potential advantages of dual training include broadening of the student's perspective on health and health care beyond the "one provider, one patient" medical model, increased training in evaluation and use of the medical literature, increased skill in assessing community factors that affect the health of patients, enhanced expertise in health care administration or policy, and improved prospects for future roles as PA faculty members. Potential drawbacks include increased duration and expense of PA/MPH education, student burnout due to prolonged training, and the lack of jobs that explicitly use both halves of the PA/MPH training.

- by Tamara Ritsema
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- Primary Health Care, Curriculum, United States, Cost Benefit Analysis

Community pharmacies play a vital role in promoting, maintaining and improving the health of the local community. This study explored community pharmacists' activities and attitudes towards the provision of sexual health services (SHS) in North East Scotland, as well as their needs with regard to the delivery of current and future SHS. North East Scotland. A questionnaire was conducted of community pharmacists working in community pharmacies in Grampian (n = 128). Self-reported provision of sexual health services; attitudes towards current and future sexual health services; previous training and perceived training needs; respondent demographics. In total, 73% (94/128) of community pharmacists responded. The average number of SHS/products per pharmacy was six out of a possible 13 (range: 4-10). Respondents expressed positive attitudes towards the provision of current and future SHS. However, they also reported that they had received little or no sexual health training but that th...

- by Margaret Watson
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- Health Promotion, Contraception, Sexual Health, Clinical Pharmacy
- by Gary Bess
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- Sociology, Program Evaluation, Psychology, Research Methodology

Despite the high prevalence of mental disorders in Mexico, minimal mental health services are available and there are large gaps in mental health treatment. Community-based primary care settings are often the first contact between patients and the health system and thus could serve as important settings for assessing and treating mental disorders. However, no formal assessment has been undertaken regarding the feasibility of implementing these services in Mexico. Before tools are developed to undertake such an assessment, a more nuanced understanding of the microprocesses affecting mental health service delivery must be acquired. A qualitative study used semistructured interviews to gather information from 25 staff in 19 community-based primary care clinics in Mexico City. Semistructured interviews were analyzed by using the meaning categorization method. In a second phase of coding, emerging themes were compared with an established typology of barriers to health care access. Primar...

- by Shoshana Berenzon
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- Primary Health Care, Qualitative Research, Mexico, Mental health services

The limited access to oral health care in developing countries can be greatly improved by integrating oral health into the Primary Health Care (PHC) system. This study was designed to assess the views of PHC workers on integrating oral health care into the PHC system. A self-administered questionnaire survey was conducted in two selected local government areas of Lagos State. The instrument contained three sections assessing sociodemographic features, knowledge of common oral diseases and views on integration of oral health into PHC respectively. The mean knowledge score was 7.75 (SD=±1.81), while 60.4% of the respondents had average knowledge scores. Educational status (P=0.018) and designation (P=0.033) were significantly related to the mean knowledge scores. There was no significant difference in the oral health knowledge of the various cadres (P=0.393). Majority (85.4%) of the respondents were willing to include oral health education in their job schedule and 82% believed they n...

- by Jill Torrie
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- Dentistry, Health Promotion, Primary Health Care, Global Health

Background: Primary care physicians' ability to provide effective health behavior change advice might be leveraged by linking to available community resources. This study evaluates tools to facilitate such a link. Design: A mixed methods... more

- by Elizabeth Gordon
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- Primary Care, Education, Health Promotion, Primary Health Care

Objective: This study examines the levels of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) related stigma among the Iranian population and the factors that contribute to the formation of stigma within the study population. Design: A quantitative research design was used in this research whereby participants completed a self-administrated questionnaire. A sample of 236 adults aged 20–65 were collected using non-probability sampling techniques. Setting: The study was carried out in the Sydney (Australia) metropolitan area and data were collected in 2007. Method: To obtain a desirable sample size, multivariate techniques including snowball were used. Herek’s (1986) functional approach to attitudes was used to analyze HIV/AIDS stigma in the study population. Results: The findings illustrate that HIV/AIDS-related stigma was dominant among the study population. Overall, participants had negative feelings toward people with HIV/AIDS (PWHA); they were in favou...

This study examined perceived satisfaction among Hispanic/Latino individuals who participated in a baseline examination for the Hispanic Community Health Study/Study of Latinos (HCHS/SOL), a large cohort study of 16,415 adults living in four selected communities. An estimated 22% (n= 3,584) of participants completed a questionnaire regarding satisfaction with staff attention, the overall experience during the study examination, and the influence of the informed consent digital video disc (DVD). The majority of participants who completed the questionnaire expressed overall satisfaction with the study. Most participants reported that staff were friendly, courteous and respectful and study test procedures were clearly explained. Participants who preferred to complete the interview in Spanish felt that the informed consent DVD positively influenced their ability to make an informed decision to enroll in the study. Participants who preferred to complete the interview in English tended to...

- by Ana Talavera
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- Cultural Competency, Public Health, Patient Satisfaction, Risk factors

Aphasia is a chronic communication disability and the communication, information and psychosocial support needs of individuals and families impacted by aphasia change across time (Hilton et al., 2014; Lyon & Shadden, 2001). This is particularly so following discharge from formal inpatient and outpatient rehabilitation services, when with a newly acquired chronic communication disability, PWA face the large challenge of readjustment to work, family and community life (Howe,

- by Miranda Rose
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- Cognitive Science, Speech Language Pathology, Aphasia, Australia
- by Phoebe Pollitt
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- Health Promotion, Community Health, Health Equity, Public Health

Background: Pre-eclampsia is a complication of pregnancy responsible for high rates of morbidity and mortality, particularly in sub-Saharan Africa. When undetected or poorly managed, it may progress to eclampsia which further worsens the prognosis. While most studies examining pre-eclampsia have used a bio-medical model, this study recognizes the role of the socio-cultural environment, in order to understand perceptions of pre-eclampsia within the community. Methods: The study was conducted in Ogun State, Nigeria in 2011-2012. Data were obtained through twenty-eight focus group discussions; seven with pregnant women (N = 80), eight with new mothers (N = 95), three with male decision-makers (N = 35), six with community leaders (N = 68), and three with traditional birth attendants (N = 36). Interviews were also conducted with the heads of the local traditional birth attendants (N = 4) and with community leaders (N = 5). Data were transcribed verbatim and analysed in NVivo 10 software. Results: There was no terminology reportedly used for pre-eclampsia in the native language-Yoruba; however, hypertension has several terms independent of pregnancy status. Generally, 'gìrì âlábôyún' describes seizures specific to pregnancy. The cause of hypertension in pregnancy was thought to be due to depressive thoughts as a result of marital conflict and financial worries, while seizures in pregnancy were perceived to result from prolonged exposure to cold. There seemed to be no traditional treatment for hypertension. However for seizures the use of herbs, concoctions, incisions, and topical application of black soap were widespread. Conclusion: This study illustrates that knowledge of pre-eclampsia and eclampsia are limited amongst communities of Ogun State, Nigeria. Findings reveal that pre-eclampsia was perceived as a stress-induced condition, while eclampsia was perceived as a product of prolonged exposure to cold. Thus, heat-related local medicines and herbal concoctions were the treatment options. Perceptions anchored on cultural values and lack of adequate and focused public health awareness is a major constraint to knowledge of the aetiology and treatment of the conditions. A holistic approach is recommended for sensitization at the community level and the need to change the community perceptions of pre-eclampsia remains a challenge. Trial Registration: NCT01911494.

- by Cassimo Bique
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- Perception, Mozambique, Qualitative Research, Midwifery
- by Gail Reed
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- Health Policy, Family Practice, Medicine, Cuba

Purpose: To identify and analyse tools and methods that have been reported in the literature for the monitoring and evaluation of community-based rehabilitation (CBR) programmes. Method: A literature review and descriptive analysis were carried out to scope CBR monitoring and evaluation methods and tools. A search was conducted using PubMed and Google Scholar databases, hand searches and reference lists. Reports were retrieved, screened and information was extracted and analysed against research questions. Results: There were 34 reports which met the inclusion criteria. Analysis of the 34 reports showed that most reports used demographic and programme data. A range of methods were used: interviews, focus groups and questionnaires being the most common. Apart from this, no common standardised procedures or tools were identified and there was not a standard approach to the inclusion of people with disabilities or other CBR stakeholders. Conclusions: The findings suggest that there would be value in creating resources such as guidelines, common processes and checklists for monitoring and evaluation of CBR, to facilitate efficient and comparable practices and more comparable data. This needs to be done in partnership with people with disabilities, CBR providers, partners and researchers to ensure that all stakeholders' needs are understood and met. ä Implications for Rehabilitation While there is broad scope and complexity of CBR programmes, there needs to be consistency and a valid approach in the monitoring and evaluation methods and tools used by CBR programmes. The principles of CBR and CRPD require that monitoring and evaluation involve people with disabilities, CBR managers and staff not only as informants but also in the design and execution of monitoring and evaluation activities. The consistent use of appropriate and valid monitoring and evaluation methods and tools will contribute to developing a stronger evidence base on the efficacy and effectiveness of CBR.

- by Sally Hartley
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- Program Evaluation, Rehabilitation, Focus Groups, Evaluation

In 2011, the Bangladesh Government introduced the National Nutrition Services (NNS) by leveraging the existing health infrastructure to deliver nutrition services to pregnant woman and children. This study examined the quality of nutrition services provided during antenatal care (ANC) and management of sick children younger than five years. Service delivery quality was assessed across three dimensions; structural readiness, process and outcome. Structural readiness was assessed by observing the presence of equipment, guidelines and register/reporting forms in ANC rooms and consulting areas for sick children at 37 primary healthcare facilities in 12 sub-districts. In addition, the training and knowledge relevant to nutrition service delivery of 95 healthcare providers was determined. The process of nutrition service delivery was assessed by observing 381 ANC visits and 826 sick children consultations. Satisfaction with the service was the outcome and was determined by interviewing 54...

- by Ashfaqul Haq Chowdhury
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- Bangladesh, Adolescent, Multidisciplinary, Child

Resumen En este trabajo, aspectos como la construcción social de la salud y la enfermedad, la contribución de factores sociales y otros factores a la salud, así como las teorías sistémicas, se toman en consideración para conceptualizar la fisioterapia comunitaria. El papel del fisioterapeuta en la comunidad puede incluir un número amplio de estrategias, desde intervenciones terapéuticas con grupos en la comunidad, hasta prevención y procesos de educación para la salud. En cualquier caso, trabajar con comunidades debería dirigir al profesional a un proceso reflexivo, en el que se analicen las condiciones insaludables en que vive la gente y animar a la comunidad a hacer cambios globales e intersectoriales para incrementar los índices de salud de las personas.

- by Berta Paz-Lourido
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- Philosophy, Health Education, Physical Therapy, System Theory

BACKGROUND-Hepatitis B (HBV) induced hepatocellular carcinoma (HCC) is the greatest cancer health disparity affecting Asian Americans, but the prevalence of screening to detect HBV is suboptimal. AIMS-Our aims were to determine the effectiveness of electronic health record (EHR) prompts to increase ordering of HBV tests among primary care providers (PCPs) within an academic health system. METHODS-We conducted a randomized, controlled trial between April and June 2011 among 76 PCPs caring for 175 outpatient adults with Chinese or Vietnamese surnames, with appointments with providers and no history of HBV testing. Providers were randomized to either receive an EHR prompt for HBV testing prior to patients' appointments or usual care. Primary outcomes were the proportion of patients 1) whose physician ordered a HBsAg test and 2) who completed testing. Secondary outcomes were A) test results and B) whether the physicians followed-upon the results. RESULTS-HBsAg tests were ordered for 36/88 (40.9%) of the intervention patients and 1/87 (1.1%) of the control patients [χ 2 (df=1) =41.48, p<0.001]. Thirty intervention patients (34.1%) and no control patients completed the HBsAg test [χ 2 (df=1) =35.80, p<0.001]. Four (13.3%) of the completed tests were HBsAb positive, 14 (46.7%) were immune and 12 (40%) were unprotected from HBV. Two HBsAg positive patients were referred to specialists, and 3 unprotected patients were vaccinated for HBV. CONCLUSIONS-EHR-based provider prompts significantly increased HBV testing in Chinese and Vietnamese patients when compared to "usual care." EHR prompts are a promising intervention that could significantly increase screening for HBV.

- by tram nguyen
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- Electronic Health Records, Adolescent, Medicine, California

The risk of fire in the hospital is included in the highest ranking compared to other places, the risk of fire that can occur in the hospital can potentially be classified as mild or on a large scale, this is because the activities in the hospital use large electrical power, using tubes high pressure gases and chemicals that are flammable and explosive. The approach of the of this research is to analyze hospital preparadness in the fire disaster management efforts at Haji Hospital, South Sulawesi Province. The research design used in this study is descriptive qualitative. 2 key informan and 6 closest/supporting informants representing the head of the hospital unit team and the deputy director of the hospital as data verifiers. Data collection techniques using in-depth interviews. The result of this study indicate that the hospital already has policies or management related to fire management such as fire extinguishers, emergency stairs, evacuation routes, gathering points, fire fighting teams, training and outreach, and periodic testing. It is recommended to the hospital to complete active and passive protection systems, provide training to the disaster management team, and maintain regular testing of active protection facilities in the Haji Hospital, South Sulawesi Province.

- by mangindara mangin and +1
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- Human Resource Management, Quality of Healthcare Services, Hospital administration, Hospitality Marketing

Background To achieve the United Nations Millennium Development Goals, particularly reduction in child mortality (Millennium Development Goal 4), effective interventions to address severe and moderate acute malnutrition (SAM and MAM) among children under 5 years of age must be implemented and brought to scale alongside preventive measures. Bangladesh has an estimated 600,000 children with SAM, for a prevalence of 4%, while 1.8 million children suffer from MAM. Objective To assess the feasibility and constraints of community-based management of acute malnutrition (CMAM), a relatively new approach, in managing SAM and MAM among children in Bangladesh. Methods The methodology involved desk reviews of documents by searching through PubMed and other databases for published literature on CMAM in Bangladesh. We also did a hand search of policy and program documents, including the draft National Nutrition Policy 2013; the Health, Nutrition, Population Sector Development Program document of ...

- by Arish Syed
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- Nutrition and Dietetics, Health Behavior, United Nations, Health Policy

Bangladesh is one among the few countries of the world that provides free medical services at the community level through various public health facilities. It is now evident that, clients' perceived quality of services and their expectations of service standards affect health service utilization to a great extent. The aim of the study was to develop and validate the measures for perception and satisfaction of primary health care quality in Bangladesh context and to identify their aspects on the utilization status of the Community Clinic (CC) services. This mixed method cross sectional survey was conducted from January to June 2012, in the catchment area of 12 Community Clinics (CCs). Since most of the outcome indicators focus mainly on women and children, women having children less than two years of age were randomly assigned and interviewed for the study purpose. Data for the development of perceived service quality and satisfaction tools were collected through Focus Group Disc...

- by SHAIKH ABDULLAH
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- Focus Groups, Health Services Research, Bangladesh, Infant

Analyzing complex health programs by their components and sub-components serves design, documentation, evaluation, research, and gap identification and prioritization. In 2012, we developed a rapid methodology to characterize integrated community case management (iCCM) programs, by assessing benchmarks for eight health system components in three program phases. OBJECTIVE. To assess iCCM benchmarks in Ethiopia three years after scale-up commenced, and to compare the benchmarks across the geographical region. METHODS. Six national iCCM experts scored each of 70 benchmarks (no, partial, or yes) and then were facilitated to reach consensus. RESULTS. Overall, iCCM benchmark achievement in Ethiopia was high (87.3%), highest for pre-introduction (93.0%), followed by introduction (87.9%) and scale-up (78.1%) phases. Achievement by system component was highest for coordination and policy (94.2%) and lowest for costing and finance (70.3%). Six regional, countries benchmark assessments, includ...

- by Agazi Ameha
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- Ethiopia, Benchmarking, Case Management, Community Based Mental Health Services

This study sought to determine the level of satisfaction of patients with the healthcare services at Federal Medical Centre, Bida (FMCB) Nigeria and the factors associated with patients' satisfaction. The study utilized exit interview of 480 patients, sampled at the 9 service points of the Centre. The questions covered socio-demographic factors and the 3 core elements of healthcare service delivery namely quality, access and interpersonal issues. The evaluation of satisfaction on the 5 point Likert scale were categorized into dissatisfied {very dissatisfied, dissatisfied and Neutral} and satisfied {satisfied and very satisfied}, setting the threshold for satisfaction at a relatively higher level. On the overall, 78.5% of them were satisfied with the hospital services and 78.3% had their expectations met. Satisfaction was lowest (72.7%) at the revenue section and highest (96.1%) at the maternity section. Nine of every 10 respondents (91.7%) would recommend the facility to a frien...

- by Kay Wotton
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- Program Evaluation, Uganda, Community Health Workers, Prospective studies

Background: More than 450 newborns die every hour worldwide, before they reach the age of four weeks (neonatal period) and over 500,000 women die from complications related to childbirth. The major direct causes of neonatal death are infections (36%), Prematurity (28%) and Asphyxia (23%). Pakistan has one of the highest perinatal and neonatal mortality rates in the region and contributes significantly to global neonatal mortality. The high mortality rates are partially attributable to scarcity of trained skilled birth attendants and paucity of resources. Empowerment of health care providers with adequate knowledge and skills can serve as instrument of change. Methods: We carried out training needs assessment analysis in the public health sector of Pakistan to recognize gaps in the processes and quality of MNCH care provided. An assessment of Knowledge, Attitude, and Practices of Health Care Providers on key aspects was evaluated through a standardized pragmatic approach. Meticulously designed tools were tested on three tiers of health care personnel providing MNCH in the community and across the public health care system. The Lady Health Workers (LHWs) form the first tier of trained cadre that provides MNCH at primary care level (BHU) and in the community. The Lady Health Visitor (LHVs), Nurses, midwives) cadre follow next and provide facility based MNCH care at secondary and tertiary level (RHCs, Taluka/Tehsil, and DHQ Hospitals). The physician/doctor is the specialized cadre that forms the third tier of health care providers positioned in secondary and tertiary care hospitals (Taluka/Tehsil and DHQ Hospitals). The evaluation tools were designed to provide quantitative estimates across various domains of knowledge and skills. A priori thresholds were established for performance rating. Results: The performance of LHWs in knowledge of MNCH was good with 30% scoring more than 70%. The Medical officers (MOs), in comparison, performed poorly in their knowledge of MNCH with only 6% scoring more than 70%. All three cadres of health care providers performed poorly in the resuscitation skill and only 50% were able to demonstrate steps of immediate newborn care. The MOs performed far better in counselling skills compare to the LHWs. Only 50 per cent of LHWs could secure competency scale in this critical component of skills assessment. Conclusions: All three cadres of health care providers performed well below competency levels for MNCH knowledge and skills. Standardized training and counselling modules, tailored to the needs and resources at district level need to be developed and implemented. This evaluation highlighted the need for periodic assessment of health worker training and skills to address gaps and develop targeted continuing education modules. To achieve MDG4 and 5 goals, it is imperative that such deficiencies are identified and addressed.

- by Zulfi Bhutta
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- Health Care, Midwifery, CONTINUING EDUCATION, Maternal Mortality

Background: The integral Model of Family and Community Health care is based on three essential principles: patient centered care, comprehensive care and continuity of care. Aim: To know the perception of primary care clinic users about the elements that should be considered in a patient centered integrated health care. Material and Methods: Ten males and 31 females aged 18 to 78 years, users of two public family primary care centers participated in focus groups, which were recorded. A qualitative descriptive research design based on content analysis according to Krippendorf was done. Results: Seven issues emerged from the description of patients' experiences: professional-patient relationship, fragmentation of care, continued care with the same professional, promotion and prevention, availability of services and patient records. Conclusions: There are difficulties to install an integral model of family and community health care. The concerns raised by participants should be considered in order to modify the design of these models.

- by Aixa .Contreras
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- Perception, Public Opinion, Primary Health Care, Focus Groups

Currently, the engagement of local communities in Health Impact Assessment is becoming more and more important. A scoping review was performed to take stock of visions, methods and experiences in this field. A combined Scopus and Medline search yielded 100 articles in scientific journals. The final selection consisted of 43 papers, including case studies, evaluation studies, reviews, and opinion papers. After analysis, consultation of four experts was performed to check preliminary study outcomes. A grey literature web search was performed to check and complement the results. Results show that community participation is generally considered a core element in HIA. Views as expressed in the papers concern, firstly, the need for and value of local knowledge, secondly, the adherence to or application of democratic values and, thirdly, empowerment of communities. Three categories of methods are used in relation to community participation, often in combination: methods to facilitate knowledge elicitation, to ensure the inclusion of communities in the HIA process, and to build community capacity to participate in policy development. However, the theoretical or practical underpinning of the choice for specific methods is mostly not presented. The experiences described in the papers mainly focus on the access to local knowledge and its usability as a source of evidence in the HIA process. Described effects of community participation are (improved) relations between communities and local agencies, policy makers and professionals and the empowerment of community members. Although these effects are ascribed to community participation, many papers do not provide support for this conclusion beyond the retrospective perception of participants. Expert consultation and additional analysis of the grey literature supported the results derived from the scientific literature and provided more in-depth knowledge. In the grey literature theoretical frameworks, methods and tools for community participation in HIA were more extensively reported as compared to the scientific literature. We conclude that the visions, methods and experiences concerning community participation show that a participative approach may contribute to better, context specific knowledge. It appears that participative HIA has health promotion potential as it helps develop responsive policies. To accomplish this, HIA should, firstly, be better embedded in broader health promotion programmes. Secondly, the methods and approaches for community participation applied in HIA should be theory-informed and well described. The grey literature offers entry points. Finally, more robust and systematic evaluation and research is needed to assess the impact of HIAs on communities and policies.

- by Annemarie Wagemakers
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- Health Promotion, Research Design, Environmental Impact Assessment, Health

Background: NHS England's Five Year Forward View (NHS England, Five Year Forward View, 2014) formally introduced a strategy for new models of care driven by simultaneous pressures to contain costs, improve care and deliver services closer to home through integrated models. This synthesis focuses on a multispecialty community provider (MCP) model. This new model of care seeks to overcome the limitations in current models of care, often based around single condition-focused pathways, in contrast to patient-focused delivery (Royal College of General Practitioners, The 2022 GP: compendium of evidence, 2012) which offers greater continuity of care in recognition of complex needs and multimorbidity. Methods: The synthesis, an innovative combination of best fit framework synthesis and realist synthesis, will develop a "blueprint" which articulates how and why MCP models work, to inform design of future iterations of the MCP model. A systematic search will be conducted to identify research and practice-derived evidence to achieve a balance that captures the historical legacy of MCP models but focuses on contemporary evidence. Sources will include bibliographic databases including MEDLINE, PreMEDLINE, CINAHL, Embase, HMIC and Cochrane Library; and grey literature sources. The Best Fit synthesis methodology will be combined with a synthesis following realist principles which are particularly suited to exploring what works, when, for whom and in what circumstances. Discussion: The aim of this synthesis is to provide decision makers in health and social care with a practical evidence base relating to the multispecialty community provider (MCP) model of care. Systematic review registration: PROSPERO CRD42016039552.

- by Andrew Booth
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- Evidence Based Medicine, Medicine, England, Systematic Reviews
- by Glenn Laverack
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- Demography, Nutrition and Dietetics, Health Promotion, Social Networks

To examine the adoption of feeding recommendations among caregivers of children recuperating from malnutrition and assess the determinants of growth of children attending a nutrition rehabilitation centre (NRC) in Accra, Ghana. Longitudinal study in which attendance and maternal programme participation were recorded daily and children's anthropometry and dietary intake were measured at four time points (admission, interim, exit, post-exit) at the NRC and participants' homes. NRCs at four polyclinics and participants' homes in Accra, Ghana. One hundred and eight caregivers and their 116 children referred to an NRC between November 1999 and July 2000. Most caregivers attended the NRC sporadically (effective length of stay was 1.4+/-0.1 months). Use of NRC-promoted foods in the home after discharge was low due to inaccessibility of the food items, lack of preparation knowledge or money, child preferences and the common practice of purchasing ready-to-eat foods. Although the...

- by owusu michael
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- Behavior, Child Development, Anthropometry, Child Welfare

Background and Objectives: Dengue is an important public health problem in Yogyakarta city, Indonesia. The aim of this study was to build an innovative community-centered dengue-ecosystem management intervention in the city and to assess the process and results. Methods: For describing the baseline situation, entomological surveys and household surveys were carried out in six randomly selected neighborhoods in Yogyakarta city, documents were analyzed and different stakeholders involved in dengue control and environmental management were interviewed. Then a community-centered dengue-ecosystem management intervention was built up in two of the neighborhoods (Demangan and Giwangan) whereas two neighborhoods served as controls with no intervention (Tahunan and Bener). Six months after the intervention follow up surveys (household interviews and entomological) were conducted as well as focus group discussions and key informant interviews. FIindings: The intervention results included: better community knowledge, attitude and practices in dengue prevention; increased household and community participation; improved partnership including a variety of stakeholders with prospects for sustainability; vector control efforts refocused on environmental and health issues; increased community ownership of dengue vector management including broader community development activities such as solid waste management and recycling. Conclusion: The community-centred approach needs a lot of effort at the beginning but has better prospects for sustainability than the vertical ''top-down'' approach.

- by Susilowati Tana
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- Entomology, Health Behavior, Community Development, Environmental Management

Background While maternal, infant and under-five child mortality rates in developing countries have declined significantly in the past two to three decades, newborn mortality rates have reduced much more slowly. While it is recognised that almost half of the newborn deaths can be prevented by scaling up evidence-based available interventions such as tetanus toxoid immunisation to mothers; clean and skilled care at delivery; newborn resuscitation; exclusive breastfeeding; clean umbilical cord care; management of infections in newborns, many require facility based and outreach services. It has also been stated that a significant proportion of these mortalities and morbidities could also be potentially addressed by developing community-based packages interventions which should also be supplemented by developing and strengthening linkages with the local health systems. Some of the recent community-based studies of interventions targeting women of reproductive age have shown variable impacts on maternal outcomes and hence it is uncertain if these strategies have consistent benefit across the continuum of maternal and newborn care. Objectives To assess the effectiveness of community-based intervention packages in reducing maternal and neonatal morbidity and mortality; and improving neonatal outcomes.

- by Zohra Lassi
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- Maternal Mortality, Pregnancy, Protocols, Infant
- by Maria da Gloria Miotto Wright
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- Community Development, Social Support, Health, Medicine

One of fıve options for the new required Medical College of Wisconsin Pathways program, the Urban and Community Health Pathway (UCHP), links training with community needs and assets to prepare students with the knowledge, skills, and attitudes to provide effective care in urban, underserved settings; promote community health; and reduce health disparities. Students spend at least 10 hours per month on pathway activities: 4 hours of core material delivered through readings, didactics, case discussions, and site visits; and at least 6 hours of experiential noncore activities applying core competencies, guided by an Individualized Learning Plan and faculty advisor. Noncore activities include community-engaged research, service-learning activities or other relevant experiences, and submission of a synthesis paper addressing pathway competencies. The fırst cohort of students began their pathways in January 2010. Of 560 participating students, 95 (of which 48 were fırst-year, 21 second-year, and 26 third-year students) selected UCHP. Core sessions focused on public health, social determinants, cultural humility, poverty, the local healthcare system, and safety net. During noncore time, students engaged in projects addressing homelessness, obesity, advocacy, Hmong and Latino health, HIV, asthma, and violence prevention. Students enjoyed working with peers across classes and favored interactive, community-based sessions over didactics in the classroom. Students' papers reflected a range of service and scholarly activities and a deepened appreciation of social and economic influences on health. The UCHP enriches the traditional curriculum with individualized, community-based experiences to build knowledge about health determinants and skills in partnering with communities to improve health.

- by Ileen Gilbert
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- Education, Medical Education, Service Learning, Health Disparities

The prevalence of malnutrition in Cambodia is among the highest in Southeast Asia. Until recently, there has been a consensus that the treatment and rehabilitation of acutely severely malnourished children should take place in hospitals; however, limited local health resources often place constraints upon the inpatient management of these children. This study reviews the outcomes of a community nutrition program designed to rehabilitate children under the age of 5 years with moderate or severe acute malnutrition living in a poor urban community in Phnom Penh, Cambodia. Clinical records of the program participants during the period from January 1999 to November 2006 were reviewed. Attainment of recovery weight-for-height z-scores, the length of time taken to achieve this recovery, rates of weight gain, mortality rate, and rate of default were determined from the data. One hundred fifty-nine children aged 4 years or younger with a mean admission weight-for-height z-score of -3.3 were ...

- by Susan Jack
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- Nutrition and Dietetics, Cambodia, Urban Health, Malnutrition

Hospitals can cause disease and environmental pollution if the waste from the activities in it is disposed of without prior management. The first thing to do in waste management is to separate medical and non-medical solid waste. The purpose of this study was to determine the factors that influence nurse compliance with medical and non-medical solid waste segregation in the nursing room of Syekh Yusuf Hospital, Gowa. The type of research used is quantitative analysis method with a cross sectional study approach. The sampling technique to be studied is total sampling, where the number of samples is the same as the total population, namely 118 respondents. The data obtained were analyzed using the SPSS application and a chi square test was performed. The results showed that the knowledge of nurses with a value of p = 0.037, policies with a value of p = 0.015, and supervision of the head of the room with a value of p = 0.021 were factors that influenced nurses' compliance with the sorting of medical and non-medical solid waste in the nursing room of RSUD Syekh Yusuf, Gowa Regency. While the attitude of nurses with a value of p = 0.061, the availability of facilities with a value of p = 0.061, and the motivation of nurses with a value of p = 0.071 did not affect the compliance of nurses on the separation of medical and non-medical solid waste. It is recommended to the hospital to increase the availability of facilities, especially in the provision of infectious and non-infectious waste bins in all nursing rooms, as well as for nurses to maintain or increase compliance in the sorting of medical and non-medical solid waste.

This paper reviews fluoride varnish (FV) literature to develop a community-based protocol for people with special needs or those w h o are caries susceptible. Safety, personnel and cost issues are discussed and existing NIH, CDC and WHO recommendations are presented. FV studies are assessed with respect to type of FV to use and frequency of application. FV is compared with studies using other caries preventive agents: 0.2% NaF mouthrinse, acidulated phosphate fluoride (APF) gel, dental sealants, water fluoridation and chlorhexidine. Because there are few FV studies among special need populations, conclusions are based on available literature and public health principles. If personnel are available, FV use is preferred to APF gel and may be preferable to 0.2% NaF mouthrinse. FV is more effective in optimally fluoridated communities. If many occlusal surfaces are at risk, sealants should be applied. Additional combinations and frequencies of preventive agents should be tested, especially for people with special needs and high caries risk adults.

- by Jane Weintraub
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- Dentistry, Child, Dental Caries, Risk factors

The Barangay Nutrition Scholars (BNS) Project was created in 1977 to provide an effective means of disseminating nutrition information and providing nutrition services to the barangays through a trained community worker. The BNS project was pilot tested in 1977 in 13 municipalities and by the end of 1979, 5220 BNS had been trained and deployed in their communities. BNS must have certain personal and leadership qualifications, and are chosen by the barangay captain or the barangay nutrition committee. The nutrition program is based upon 4 intervention schemes: food production, food assistance, health protection, and information, education, and communication. The BNS is the nutrition program's instrument for implementing these intervention schemes. The BNS on return from training makes a spot map of the community and measures and weighs preschool children to screen for malnutrition. The BNS also conducts mothers' classes which dispense information on nutrition and health and distributes seeds and supplementary food packets for preschoolers to target families. Support to the BNS is provided by a van equipped with a communication worker and a video playback unit. An assessment of the BNS program indicated that about 80% of the BNS surveyed were effective implementors of their programs. Program officials expect most of the problems encountered to be solved with more effort by the BNS and increased financial and logistical support from the national and local governments.

- by Raymond Torres
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- Education, Primary Health Care, Health Education, Health Planning