Broad Definition Of Health Research Articles

Health-related Quality of Life among Type 2 Diabetes Patients in Southern Province of Saudi Arabia using WHOQOL-BREF: A Cross-section Study.

Quality of life has become a more important health outcome with advancements in medical therapies and disease management, leading to better lives for people in general, particularly those living with chronic diseases. Diabetes has a direct impact on the physical, psychological, and social aspects of personal health. This study aimed to determine healthrelated quality of life (HRQOL) and its predictors in patients with type 2 diabetes. A cross-sectional study was carried out on 420 patients with type 2 diabetes who presented to primary healthcare centers in Samtah Town, Saudi Arabia, from March 2017 to February 2018. The HRQOL of the study participants was determined using the World Health Organization Quality of Life-BREF. Multi-level linear regression was employed to ascertain the factors associated with HRQOL among patients with type 2 diabetes. Female sex was significantly associated with higher HbA1c, anxiety, depression, and stress scores and a lower HRQL in the physical, psychological, and environmental health subscales than males (P<0.001). All subscales of HRQOL were significantly lower in the > 50 years age group. When compared to those with low levels of education (illiterate, primary, or elementary school), patients with secondary and bachelor's degrees had significantly higher HRQOL in all subscales (P<0.001). In addition, there were significant differences in glycemic control and HRQL with a longer duration of diabetes, the presence of one or more diabetes complications, and the presence of comorbid hypertension (P<0.001). However, no significant differences in the Depression Anxiety and Stress Scale (DASS) index were observed with a longer duration of diabetes and the presence of comorbid hypertension. Patients with diabetes on combined therapy and healthy diet and exercise showed significantly higher HRQOL on physical functioning (P<0.001). Type 2 diabetes was significantly associated with impaired health-related quality of life and mental health among study participants. Females appeared to have worse quality of life and mental health than males. Age, duration of diabetes, comorbid hypertension, diabetes complications, and level of education were significantly associated with lower HRQOL and mental health scores. Healthy diet and exercise, when combined with hypoglycemic and insulin therapy, were found to improve HRQOL and mental health among patients with diabetes. Scales based on a broad definition of health, such as the WHOQOL-BREF, are appropriate for use in primary care settings and can enhance patient management and care.

5610614 ASSESSING PHYSICAL, SOCIAL AND EMOTIONAL IMPACT OF SICKLE CELL DISEASE IN PORTUGUESE PATIENTS: AN OBSERVATIONAL, MULTICENTER STUDY (ASCEND)

Background: Sickle cell disease (SCD) is a chronic, multisystem autosomal recessive blood disorder that is characterized by painful episodes caused by vaso-occlusion. SCD patients can face social, economic and academic challenges, as well as barriers to accessing quality heath care. Evidence about the impact of SCD and related treatments on the lives of patients is lacking, with a broad definition of health as a combination of physical, mental and social well-being. The purpose of this observational study is to characterize the physical, social and emotional impact of SCD on adult patients with confirmed diagnosis and to characterize patient pathway in the healthcare system. Objectives: The primary objective of ASCEND is to characterize the physical impact of SCD on patients, through collection of PROs that will assess the impact of pain and disease complications in patients’ QoL. As secondary objectives the study aims to characterize SCD patients’ demographics and clinical history, as well as to describe the social and emotional impact of SCD on patients; to describe SCD patient pathway in the healthcare system. In this abstract the authors intend to describe the results obtained for QoL assessment through PRO questionnaires Methods: ASCEND is non-interventional cross-sectional study of 2 cohorts of SCD adult patients with SCD. The study sample is 200 (recruited by hospital sites) + 50 patients (recruited by patient association). PRO questionnaires include both EQ-5D-5L and ASCQ-Me (Pain Episodes Frequency and Severity). Portuguese patients and Social Studies investigators participated in the validation process. Results: Study recruitment is terminating in the current week as 194 have been included already. We expect to have QoL results evaluated through EQ-5D-5L and ASQC-Me for 200 patients by mid September 2022, in due time to be presented in ASCAT. Conclusions: Conclusions will be elaborated upon data analyses

The healthscaping approach: Toward a global history of early public health

This article presents a modular, multidisciplinary methodology for tracing how different communities in the deeper past adapted their behaviors and shaped their environments to address the health risks they faced, a process also known as “healthscaping.” Historians have made major strides in reconstructing preventative health programs across the pre- or non-industrial world, thereby challenging a common view of public health as a product of Euro-American modernity and biomedicine. However, these studies’ general focus on cities and their reliance on archival and other documents that are more readily available in Euro-American contexts, limit the intervention’s potential for rethinking the earlier history of public health comparatively, transregionally and on a global scale. A broader definition of health, additional sources and alternative methodologies allow us to expand research in and especially beyond urban Europe, promoting a global turn in health historiography that operates outside the seductive teleology of modernization, colonialism and imperialism.

Establishing patient-partner priorities within the primary and integrated health care innovations network in Canada.

Background: Many experienced primary care researchers have seen the benefits of meaningful engagement with patients and community members in their research, elevating them to a research partner status. The research questions and agendas, however, are often initiated and determined by the researchers. Increasingly, research teams, organizations and networks actively engage with patient-partners to better understand what their research priorities would look like, bringing patient-partners into the research process much earlier. Among many other initiatives within the Strategy for Patient Oriented Research program, a Primary and Integrated Health Care Innovations Network (PIHCIN) was established in Canada, which includes 11 geographically distributed research networks. As part of PIHCIN, a Pan-Canadian Patient Council (the Council) was established with representatives from each provincial site. To ensure their voices were being heard, the Council decided to establish their own research priorities for consideration by the PIHCI network. Objective: To establish patient-partner priorities in the Canadian primary health care context Methods: The main goal of the Council was to submit research priorities to identify what was important from a patient-partner perspective. Through consensus building and prioritization voting, the Council developed and presented a draft of their research priorities to the PIHCI Network Leadership Council. In a second step, the Council decided that the process was missing from the document. Subsequently, with the use of the SMART goal framework, the Council engaged in a process to establish how research priorities could be accomplished. Results: The initial research priorities comprised 11 items, including priorities concerning patient's access to data, integrated health teams, patient initiated collaborative research, virtual care, broader definition of health, etc. The initial priorities eventually evolved into a set of principles, strategic operating goals, and finalized research priorities. Conclusion: Through an iterative process, the Council was able to lead, initiate and differentiate strategic operating goals from the research priorities. This process and results can provide insight for developing critical input from patient-partners for primary health care research.

Social Isolation of Older Adults in Long Term Care as a Result of COVID-19 Mitigation Measures During the COVID-19 Pandemic

Social Isolation of Older Adults in Long Term Care as a Result of COVID-19 Mitigation Measures During the COVID-19 Pandemic

Human Nature

The research-based Danish therapy garden Nacadia, which opened in 2011, can be viewed as a holistically oriented realization of the World Health Organization’s (WHO) broad definition of health from 1948: health is not just the absence of disease, but a state of both physical, mental and social well-being in which individuals may develop their abilities, deal with everyday challenges and stress, as well as socialize with other people. Nacadia’s raison d’être and relevance are indisputable. But the questions this article addresses are what perception of nature the therapy forest garden promotes and what social diagnosis it springs from and reproduces. Nacadia’s interdisciplinary research team provides no explanation, but these questions inform my analysis. Based on Nacadia’s concept manual and the therapy garden itself, as well as some literary accounts of engaging with nature, I develop two answers: First, that the researchers behind Nacadia operate with both a discourse and a physical-aesthetic presentation of nature as a peaceful and accessible place for both self-immersion and connection with ‘something greater’. Secondly, the implementation of such a sanctuary encourages romantically tinted modes of experience which certainly seem invigorating but may also evoke an element of alienation for people in a modern society.

The essential role of law in achieving the health-related Sustainable Development Goals

In this article, we examine the essential role of law in achieving the health-related Sustainable Development Goals (SDGs). Following the World Health Organization’s broad definition of health, all SDGs can be seen to impact on human health and hence the health goal (SDG3) should be right at the centre of the entire 2030 Agenda for Sustainable Development. We note recent research on the contribution of law, including international human rights law, to achieving health for all and discuss the role of law in addressing seven emerging health challenges. Law can and should play an important role in achieving all health-related SDGs, by respecting, protecting and fulfilling the right to health, ensuring that no one is left behind.

The Dutch Public Health Foresight Study 2018: an example of a comprehensive foresight exercise.

The use of foresight studies is common in some policy fields, but not in public health. Interest in such studies is growing. This paper gives a general overview of the Dutch Public Health Foresight Study (PHFS) 2018, providing insight into what performing a broad scenario exercise in the field of public health entails and its societal impacts. The aim of the PHFS-2018 was: (a) to show how public health and healthcare in the Netherlands will develop over the next 25 years if we pursue our current course and detect 'new' developments; (b) to give options for dealing with the major future societal challenges. Part a was addressed by means of a quantitative business-as-usual scenario exercise complemented with qualitative thematic studies, and part b by elaborating courses of action for three key challenges, based on stakeholder consultation. Typical aspects of the PHFS methods are a multidisciplinary, participatory and conceptual approach and using a broad definition of health. The PHFS-2018 is the basis for the upcoming National Health Policy Memorandum and the Trend Scenario is the baseline for the National Prevention Agreement. Unexpectedly, the findings about increasing mental pressure in young people received most attention. There still is room for expanding use of the study to its full potential. Long-term thinking could be stimulated by using back casting techniques and stronger involvement of policy-makers in the elaboration of options for action. Lessons learned from developing intersectoral policy at the local level could be applied at the national level.

Healthcare Service in Hong Kong and its Challenges

The Hong Kong Special Administrative Region combines a British colonial history within a Chinese cultural context and offers its population a dual system with a comprehensive and efficient public health care system in tandem with private hospitals and practitioners. Multiple challenges are looming: increasing demand for health services due to an aging population, staff shortages at all levels, and an underdeveloped primary healthcare system. Health is determined by multiple factors and is defined as a state of complete physical, mental, and social well-being. In recent years, the medical model of health focusing on pathology and disease has been considered insufficient, and a social model of health has been proposed, relying on a more holistic and broad definition of health. Rather than focusing on individual responsibility for health, the social model emphasises collective responsibility for health. This paper analyses the challenges facing Hong Kong in view of the social model of health. The discussion provides some reflections on medical dominance, the reasons behind limited primary care services, and what steps could be recommended to deliver healthcare services in Hong Kong in line with a more holistic view of health.

Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard-LSHTM Independent Panel on the Global Response to Ebola

© 2015 Elsevier Ltd. The west African Ebola epidemic that began in 2013 exposed deep inadequacies in the national and international institutions responsible for protecting the public from the far-reaching human, social, economic, and political consequences of infectious disease outbreaks. The Ebola epidemic raised a crucial question: what reforms are needed to mend the fragile global system for outbreak prevention and response, rebuild confidence, and prevent future disasters? To address this question, the Harvard Global Health Institute and the London School of Hygiene & Tropical Medicine jointly launched the Independent Panel on the Global Response to Ebola. Panel members from academia, think tanks, and civil society have collectively reviewed the worldwide response to the Ebola outbreak. After difficult and lengthy deliberation, we concluded that major reforms are both warranted and feasible. The Panel's conclusions off er a roadmap of ten interrelated recommendations across four thematic areas: 1 Preventing major disease outbreaks All countries need a minimum level of core capacity to detect, report, and respond rapidly to outbreaks. The shortage of such capacities in Guinea, Liberia, and Sierra Leone enabled Ebola to develop into a national, and worldwide, crisis. Recommendation 1: The global community must agree on a clear strategy to ensure that governments invest domestically in building such capacities and mobilise adequate external support to supplement eff orts in poorer countries. This plan must be supported by a transparent central system for tracking and monitoring the results of these resource flows. Additionally, all governments must agree to regular, independent, external assessment of their core capacities. Recommendation 2: WHO should promote early reporting of outbreaks by commending countries that rapidly and publicly share information, while publishing lists of countries that delay reporting. Funders should create economic incentives for early reporting by committing to disburse emergency funds rapidly to assist countries when outbreaks strike and compensating for economic losses that might result. Additionally, WHO must confront governments that implement trade and travel restrictions without scientific justification, while developing industry-wide cooperation frameworks to ensure private firms such as airlines and shipping companies continue to provide crucial services during emergencies. 2 Responding to major disease outbreaks When preventive measures do not succeed, outbreaks can cross borders and surpass national capacities. Ebola exposed WHO as unable to meet its responsibility for responding to such situations and alerting the global community. Recommendation 3: A dedicated centre for outbreak response with strong technical capacity, a protected budget, and clear lines of accountability should be created at WHO, governed by a separate Board. Recommendation 4: A transparent and politically protected WHO Standing Emergency Committee should be delegated with the responsibility for declaring public health emergencies. Recommendation 5: An independent UN Accountability Commission should be created to do systemwide assessments of worldwide responses to major disease outbreaks. 3 Research: production and sharing of data, knowledge, and technology Rapid knowledge production and dissemination are essential for outbreak prevention and response, but reliable systems for sharing epidemiological, genomic, and clinical data were not established during the Ebola outbreak. Recommendation 6: Governments, the scientific research community, industry, and non-governmental organisations must begin to develop a framework of norms and rules operating both during and between outbreaks to enable and accelerate research, govern the conduct of research, and ensure access to the benefits of research. Recommendation 7: Additionally, research funders should establish a worldwide research and development financing facility for outbreak-relevant drugs, vaccines, diagnostics, and non-pharmaceutical supplies (such as personal protective equipment) when commercial incentives are not appropriate.

Drama to promote social and personal well-being in six- and seven-year-olds with communication difficulties: the Speech Bubbles project

This paper focuses on an innovative intersection between education, health and arts. Taking a broad definition of health it examines some social and psychological well-being impacts of extended collaborations between a theatre company and children with communication difficulties. It seeks to test aspects of Fredrickson's(1) broaden-and-build theory of positive emotions in a primary school curriculum context. The researcher participated in a project called Speech Bubbles. The programme was devised by theatre practitioners and aimed at six- and seven-year-olds with difficulties in speech, language and communication. Sessions were observed, videoed and analysed for levels of child well-being using an established scale. In addition, responses regarding perceived improvements in speech, language and communication were gathered from school records and teachers, teaching assistants, practitioners and parents. Data were captured using still images and videos, children's recorded commentaries, conversations, written feedback and observation. Using grounded research methods, themes and categories arose directly from the collected data. Fluency, vocabulary, inventiveness and concentration were enhanced in the large majority of referred children. The research also found significant positive developments in motivation and confidence. Teachers and their assistants credited the drama intervention with notable improvements in attitude, behaviour and relationships over the year. Aspects of many children's psychological well-being also showed marked signs of progress when measured against original reasons for referral and normal expectations over a year. An unexpected outcome was evidence of heightened well-being of the teaching assistants involved. Findings compared well with expectations based upon Fredrickson's theory and also the theatre company's view that theatre-making promotes emotional awareness and empathy. Improvements in both children's well-being and communication were at least in part related to the sustained and playful emphases on the processes and practice of drama, clear values and an inclusive environment.

The essential elements of health impact assessment and healthy public policy: a qualitative study of practitioner perspectives

ObjectivesThis study uses critical realist methodology to identify the essential and contingent elements of Health Impact Assessment (HIA) and Healthy Public Policy (HPP) as operationalised by practitioners.DesignData collection—qualitative interviews and...

Collaboration and “Visibility” of Health Research in the Western Pacific Region

Using more than 3.5 million bibliographic references in Thomson ISI Web of Science (health-related articles, notes, and reviews) and a broad definition of health (covering related social, medical, environmental, and physical sciences) research production, collaboration patterns and "visibility" of that production for largest producers in the Western Pacific Region of the World Health Organization are estimated for the 1992-2001 period. Two findings are of particular interest in relation to the production of relevant knowledge on health topics and equity in the access to this knowledge. The first is that intra-regional collaboration is low and that large regional producers of research (ie, Japan, Australia, China, etc) collaborate more with high-income countries from other regions than among themselves within the region, or with smaller regional research producers. The second one is that "visibility" of health research in the region is relatively low, even for high-income countries. High "visibility" research is mostly done with the involvement, through collaboration, of extra-region high-income countries. Collaboration between low-income or middle-income countries is mostly in low "visibility" research.

Aging and Mental Health*

SUMMARY This report presents an overview of mental health and aging in Canada. It does so by providing some figures about various aspects of health, revealing the difference between physical disease and mental well-being. While our physical health declines as we age and we are more likely to suffer from various diseases including dementia, a disease of our cognitive abilities, the same pattern is not evident for mental health, mental illness, or subjective notions of our health. Normal aging does not include significant changes in cognition (memory and intelligence); mental illnesses such as depression are not more prevalent in old age than in the younger years; and seniors evidence equal and oftentimes better mental health than those younger (measured in terms such as happiness, life satisfaction, and sense of coherence). Perceptions of their health are overwhelmingly positive. The discordance in findings, depending on the types of health being examined, exposes the importance of a broad definition of health, including psychological and social elements in addition to biomedical aspects. It also supports a broad health promotion perspective for health care workers. After presenting a brief critique of Canada's provincial and territorial health care systems, the report discusses the advantages of a health promotion, population health approach and the important role social workers have to play. Incorporating such an approach into social work requires an empowering approach to clients through individual interaction as well as programs and policies.

Social Capital and Health

This article aims at contributing to the discussion on the features of public health systems consistent with the broader definition of health - broader than the strictly bio-medical one - which is currently accepted in the related literature. The questions it raises are on how social capital influences well-being, and on whether and how it can be recognized and cultivated as a basic resource for health, and integrated into the health systems. In the first part, research literature on the ways health conditions are correlated with both poverty and social capital is briefly discussed. In the second part, several cases on health prevention and rehabilitation programs are analysed in some detail, as they appear to improve the health conditions of a community by investing in its 'social capital'. The main insights are on how to combine social protection with individual agency.

Bridging disciplines: an introduction to the special issue on public health and pediatric psychology.

Public health reflects a broad variety of activities, with the ultimate goal of reducing disease mortality and morbidity and promoting health of the population as a whole. In the past, population health was measured by a relative absence of diseases, and the focus of public health research and practice was on the control of such diseases (especially communicable and infectious ones). However, more recently, a broader definition of health has been recognized. The World Health Organization views health as not just an absence of something, namely disease, but as a resource for realizing higher aspirations, satisfying needs, and coping with changes in the environment (Young, 1998). With this conceptualization being more widely adopted, the focus of population health has broadened to include social, environmental, and behavioral factors that may jeopardize health, placing individuals at risk for disease. Consequently, there is increased interest in including behavioral science and theory in the dialogue of public health research (Muehrer et al., 2002). Public health efforts aimed at pediatric populations have focused on either preventing problematic health outcomes in children (e.g., injury, childhood obesity, social/emotional problems) or preventing health risk behaviors associated with adult-onset chronic diseases (e.g., smoking prevention to reduce cancer or heart disease). Public health and population-based research and practice have not traditionally been the focus of pediatric psychology. Few articles submitted or published in the Journal have taken a public health focus (Kazak, 2002; La Greca, 1997; Roberts, 1992). However, recent surveys of pediatric psychologists and commentaries on the state of the field of pediatric psychology suggest the field is evolving and expanding. For instance, pediatric psychologists view primary prevention of poor health outcomes and the promotion of optimal physical and mental health in children to be of high priority (Brown & Roberts, 2000; Roberts, 1992). These sentiments are not germane solely to the pediatric psychology community; they are echoed by national health organization priorities and leaders in prevention science research calling for primary prevention and health promotion efforts to begin early in life and to include children, their families, schools, and communities (Perry, 2000; Stokols, 1996). Given the recent importance assigned to prevention of poor health outcomes and health promotion in pediatric psychology and the broader scientific community, this seems a fitting time to highlight current pediatric public health research. In the solicitation of articles for this special issue, we sought articles in the area of pediatric psychology that are related to disease prevention, including primary and secondary prevention efforts. We also were interested in receiving articles that included studies of surveillance that pertain to pediatric populations, issues related to pediatric psychology in rural settings, delivery of and access to care in pediatric populations, economic implications of pediatric psychological services, and health disparities in pediatric populations, as well as articles addressing policy regarding the interface between pediatric psychology and public health. A broad net was cast to attract submissions from individuals of different disciplines, including pediatric psychologists, epidemiologists, health service researchers, and prevention scientists. We received a set of high-quality manuscripts, and include in this special issue articles related to injury prevention and dissemination/diffusion efforts directed at substanceabuse and obesity prevention.

Accessing Population Health Information through Interactive Systems: Lessons Learned and Future Directions

In the mid-1990s, several state and county public health departments implemented interactive software systems that provided easy access to public health-related data for local boards of health, other public health agencies, health care providers, community groups, and other interested members of the public. Based on their experiences with two well-established state interactive systems and one well-established county system, the authors summarize lessons that could prove useful to state and local public health agencies interested in developing new interactive systems or adapting existing ones. The article addresses issues such as: basing interactive systems on a broad definition of health, designing systems to incorporate user preferences, moving from data warehouses to information warehouses, and fostering prevention communities. Finally, the article provides recommendations to assist federal, state, and local public health agencies in developing the next generation of interactive data access systems.

Understandings of Health

The purpose of the study was to discover what the concept of health means to the participants and to determine how an organization can assist its members in developing and maintaining their notion of health. The participants for this study were drawn from the employees at a post secondary educational institution. Tape recorded interviews were transcribed by the researcher, and the transcripts were analyzed for common topics and predominant themes. Imbedded in the data were four themes that provided an over arching conceptual framework from which to view health and health promoting activities: well being as a broad definition of health; the concept of balance as a prime contributor to health; the notion of self efficacy in determining one's health, and the value of caring as a significant determinant of health. Findings of the study have significance for individual health, organizations and health, health promoters, and further research.

Community Health Initiatives Are Widespread, Challenging Our Sense of Civic Obligation

Bob Sigmond's assertion that community coordination is a key missing ingredient in achieving more effective health systems at the local level is worth our full attention. He brings to this issue a wealth of relevant experience in the financing and delivery of health services and as a pioneer in health planning at the community level. Having had a modest exposure to community initiatives through, most recently, a program in Calhoun County, Michigan, I support Sigmond's basic point, although with a few elaborations that I will mention later. Coordination Is on the Move Despite pervasive changes in health systems across the country, from my perspective, the public in general and, specifically, buyers and providers of care in many communities are frustrated with fragmentation of care, rising costs, uneven access, shortages of primary care, inadequate information, and a lack of consumer input or feedback. Whereas there are few successes to point to, many communities are beginning to address these and other issues through community studies and the development of overarching coordination programs. Over 2,000 persons attended a meeting last year in Anaheim to discuss Healthier Communities(1). Greater coordination was a key topic; the pot is beginning to boil, fired by a mixture of social and economic pressures. The theme of coordination is being addressed among national associations as well. Recently, the American Hospital Association, with the Hospital Research and Educational Trust (HRET), has published a vision entitled, Community Care Networks (1994), which called for collaborative networks of hospitals, physicians, other health providers, and social agencies to work in a coordinated fashion for a fixed annual payment--with their success being measured not only by overall costs but by impact on health status. In October 1994, HRET received a $6 million grant from the W. K. Kellogg Foundation to monitor and guide local community initiatives and to coordinate a concept of community benefit standards. It is important to note that the AHA guidelines supplementing the vision stress such key concepts as: childhood immunization, mammograms, and other preventive efforts; the need to promote primary care and improve environmental conditions; and the need to control costs through an attack on root causes--for example, teenage pregnancy, lack of prenatal care, alcoholism, substance abuse, preventable accidents, and poor nutrition. Communities are being urged not only to coordinate health programs but to broaden their definition of health as well. What has prompted establishment of such guidelines among AHA leaders remains speculative, but one suspects that the realization has grown that a broader definition of health that includes new local initiatives is the most effective route to value, and for some, only on such a path can hospitals and allied health institutions lay legitimate claim to being accountable and thus deserving of special tax status. Employers and health plans are also beginning to look at performance indicators from an increasingly broad-based community perspective. The guidelines of the Health Employers Data Information Set (HEDIS) seek to apply preventive and patient satisfaction-oriented performance criteria when comparing health plans. Health plans themselves are becoming increasingly focused on these issues as they seek accreditation through the National Committee on Quality Assurance. The Jury Is Still Out, but the Reasons for Coordination Are Compelling It is true that we have little evidence yet regarding how local initiatives that are built on a concept of coordination have succeeded in improving access, reducing fragmentation, improving quality of care, or moderating cost increases. We appear embarked on a new cycle of social medicine, but the jury is still out. On the other hand, before opting one way or another, we should remind ourselves that a significant amount of medicine is practiced without outcome validation, and some of it seems to do some good. …

Building community for health: lessons from a seven-year-old neighborhood/university partnership.

This article presents two case studies highlighting the role of community conflict in the process of community empowerment. A graduate program for community health nurses (CHNs) in a large Midwestern city formed a partnership with a diverse, integrated neighborhood for the dual purposes of enhancing the community's capacity to improve its own health and teaching CHNs community organizing as a means to improve health. Central to the partnership are a broad definition of health, trust developed through long-term involvement, a commitment to reciprocity, social justice, and Freire's model of adult learning. Two initiatives that gave rise to major conflicts between community groups are analyzed. Conflicts, external and internal to the community, proved to be both powerful catalysts and potential barriers to the use of Freirian themes in community organization. Both university and community participants report needing better skills in the early recognition and management of conflict. We conclude that conflict management theory must be integrated with empowerment education theory, particularly when empowerment education is applied in a diverse community.