Capacity Assessment Tool Research Articles

Preference for Treatment Decision Making among Greek MedicalPatients

Dear Editor, In contemporary clinical practice of medicine and psychiatry patients’ involvement in decision-making procedure prior to treatment initiation is important. We investigated Greek medical inpatients’ (n =78, mean age 61.8 years) preference (Deegan & Drake 2006) on decision making procedure. Those patients had been admitted to the internal medicine ward of the General Hospital of Arta, north-west Greece, during a two-month period and provided consent for being interviewed. Patients were asked directly about their wish to participate in treatment decision procedure. The question was if they prefer physicians to decide on treatment, if they favor shared decision-making, or if they prefer themselves solely to take such decisions. The vast majority of patients (77%) stated their preference for physician’s treatment decision-making, and only 21.8% favored shared decision-making. This suggests that medical patients in Greece may not be familiar with the concept of shared treatment decision-making, and raises questions about patients’ autonomy in medical wards in our country. Additionally, we inquired for the level of treatment decision-making capacity of those patients with the use of the Greek version of the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) (Bilanakis, Vratsista, Kalampokis et al., 2013), which is a valid and widely used tool for capacity assessment (Grisso, Appelbaum, & Hill-Fotouni, 1997). Treating physicians’ estimation on patients’ capacity was also inquired for. Interestingly, treating physicians identified as incompetent of receiving valid treatment decisions less (8.9% vs. 15.4%), and importantly, different patients than those rated as such by the investigators (Bilanakis, Vratsista, Athanasiou et al., 2014) with the use of the Greek version of the MacCAT-T. This means that treating physicians perceived as capable for participation in the treatment decision-making process patients who were not, and vice versa. These findings underline the need to inform patients about their rights and to educate physicians on accurate recognition of incapable patients. From the dimensions of the MacCAT-T only reasoning appeared to be associated with physicians’ impression of patients’ capacity. Reasoning refers to the way patients are thinking through treatment decision, and use the information provided by clinicians in a decision-making process. It seems that physicians have difficulties in recognizing patients’ poor reasoning abilities through their interaction with them, and they perceive the way patients think about treatment as reliable in cases where this is not. Interestingly, recent research has shown that poor reasoning has been associated with treatment decision incapacity in medical patients (Owen, Szmukler, Richardson et al., 2013). Conceivably, efforts should be made to educate physicians on better evaluation of patients’ reasoning process. The generalizability of these findings may be limited. Our study involved a mixed urban/rural, mostly elderly population hospitalized in a general hospital of a city of 40000 inhabitants. It is unknown whether younger patients in large cities are more familiar with the concept of shared decision-making. Physicians’ abilities to identify incapable patients are referred to a single ward and may not be the case of other medical wards in Greece, although we believe that the sample of physicians (n =5) is representative, in terms of experience and expertise. More studies in different medical settings in Greece are needed to clarify these issues. Despite these limitations we believe that our study has some implications. There are several types of interventions which are used to foster patients’ informed decision, including interpersonal counseling, tailored and untailored print materials, videotapes, audiotapes, scripted telephone counseling, computer programs, Web sites, and decision boards (Rimer, Briss, Zeller et al., 2004). Regular use of such interventions in medical settings would facilitate patients’ informed decision making and would promote patients’ autonomy.

Evaluation of a New Screening Tool: Lucidity in Mental Capacity (LIMCap) Assessment Tool

Aim: The Lucidity In Mental Capacity (LIMCap) Assessment Tool was designed to provide untrained doctors with a flexible tool to assess decision making capacity (DMC) in different scenarios and to screen for patients who require further in-depth specialist capacity assessments. Methods: This prospective validation study compares the assessment of DMC between untrained doctors using this tool on various inpatient decisions with trained consultants’ independent assessment and assesses the tool’s user-friendliness.55 tertiary hospital in-patients were selected by their respective consultants and assessed on a single decision and re-interviewed with the tool by registrars. Our exclusion criteria included on-going delirium, depression or psychosis. Their average age was 85 years with 32.73% male. Results: Patients were assessed on decisions regarding discharge planning, resuscitation, financial planning, electing enduring power of attorney(s), medical choices or driving. The LIM Cap was 0.53 sensitive and 0.7 specific, the Cohen’s kappa was 0.3 and the tool took 10.5 minutes (mean) to administer. The feedback demonstrated satisfaction with the instructions (85.73%), method of scoring (85.73%), deciding on DMC (71.43%) and improvement in confidence in assessing DMC (92.86%). However, some registrars (14.29%) struggled with constructing the questions to suit their assessment and assessing for depression and psychosis. Conclusions: The LIM Cap is a versatile tool that was quick and easy to use by untrained doctors to assess DMC in different scenarios. There was fair correlation between the results of the consultants and registrars, and the test detects patients with capacity with good specificity but appears less sensitive in diagnosing patients without capacity.

Capacity to consent in mental health care bill 2013: A critique

Mental capacity refers to the ability of an individual to make one's own decisions. Decision-making capacity has been described as the “key to autonomy” and an important ingredient of informed consent. Limited or impaired mental capacity embarks on a minefield of ethical and legal issues, which doctors need to be aware of while dealing with a particular patient. The objective of this article is to critically analyze the provisions of “capacity to consent” in Mental Health Care Bill (MHC Bill 2013), under the framework of the United Nations Convention on the Rights of Person with Disabilities (UNCRPD 2006). This article also attempts to offer a practical legal framework and some concrete suggestions, for psychiatrists operating in an ethically and legally challenging area of mental capacity. Some of the highlights include attempts to translate aspirations of the UNCRPD into MHC Bill 2013, which were out of context given the available resources, the family structure of our society, and inadequate research inputs. However, there is a need to introduce the capacity to consent to the MHC Bill 2013 after comprehensive research and to study the impact of such a revolutionary idea on the family aspects of our society. There is an urgent need to formulate and validate a capacity assessment tool for our population. The MHC Bill needs to consider the repercussion and impact of capacity to consent, thereby making room for the compulsory community treatment order empowering affected family members in providing much needed treatment for persons with mental illness.

Assessment of Age-Related Differences in Functional Capacity Using the Virtual Reality Functional Capacity Assessment Tool (VRFCAT).

Clinical trials for primary prevention and early intervention in preclinical AD require measures of functional capacity with improved sensitivity to deficits in healthier, non-demented individuals. To this end, the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) was developed as a direct performance-based assessment of functional capacity that is sensitive to changes in function across multiple populations. Using a realistic virtual reality environment, the VRFCAT assesses a subject's ability to complete instrumental activities associated with a shopping trip. The present investigation represents an initial evaluation of the VRFCAT as a potential co-primary measure of functional capacity in healthy aging and preclinical MCI/AD by examining test-retest reliability and associations with cognitive performance in healthy young and older adults. The VRFCAT was compared and contrasted with the UPSA-2-VIM, a traditional performance-based assessment utilizing physical props. Results demonstrated strong age-related differences in performance on each VRFCAT outcome measure, including total completion time, total errors, and total forced progressions. VRFCAT performance showed strong correlations with cognitive performance across both age groups. VRFCAT Total Time demonstrated good test-retest reliability (ICC=.80 in young adults; ICC=.64 in older adults) and insignificant practice effects, indicating the measure is suitable for repeated testing in healthy populations. Taken together, these results provide preliminary support for the VRFCAT as a potential measure of functionally relevant change in primary prevention and preclinical AD/MCI trials.

Development and testing of a disease-specific health literacy measure in kidney transplant patients.

Health literacy affects a patient's ability to navigate through the system of care for late-stage kidney disease, including evaluation, waiting, and recovering from kidney transplant. To develop and provide a preliminary evaluation of a knowledge and decision-making capacity tool, which is a component of health literacy. Cross-sectional design with purposive sampling. Vascular access, dialysis, and outpatient transplant clinics. A Decision-Making Capacity Assessment Tool (DMCAT) was developed and administered to 127 adults at different stages in the kidney care process. The DMCAT tool is positively and significantly correlated to the other 2 previously validated instruments and accounts for more variance than the other 2 tools in the regression models. We found significant differences in patients' health literacy and decision-making capacity related to their stage of care. Decision-making capacity appeared to be an important component of health literacy and should be considered as health care providers tailor care to meet patients' needs.

HIV Communication Capacity Strengthening

HIV communication is most effective and sustainable when it is designed and implemented locally and tailored to the local context. This requires capacity strengthening at national, subnational, and community levels. Through a review of the published and selected "grey" literature, we examine HIV communication capacity strengthening: definitions, measurements, implementation, and effects. We found limited documentation of HIV communication capacity needs or systematic approaches to address them. Most HIV communication capacity strengthening to date has focused on building individual competencies to design and manage social and behavior change communication programs through training courses, often coupled with networking opportunities for participants, post-training mentoring, and technical assistance. A few of these efforts have been evaluated through pre- and post-training tests and qualitative interviews with participants and have shown potential for improvement in individual skills and knowledge. Health communication capacity assessment tools that measure individual and organizational competencies exist, but they have most often been used to identify capacity building needs, not for evaluating capacity strengthening efforts. A new definition of capacity strengthening, grown out of recent efforts to improve effectiveness of international health and development programs, focuses on improving organizational and societal systems that support performance and individual competencies. We propose a holistic model for HIV communication capacity strengthening and call for rigorous documentation and evaluation to determine and scale-up optimal capacity building interventions for strengthening social and behavior change communication for HIV prevention, care, and treatment in developing countries.

Institutional capacity for health systems research in East and Central African schools of public health: experiences with a capacity assessment tool.

BackgroundDespite significant investments in health systems research (HSR) capacity development, there is a dearth of information regarding how to assess HSR capacity. An alliance of schools of public health (SPHs) in East and Central Africa developed a tool for the self-assessment of HSR capacity with the aim of producing institutional capacity development plans.MethodsBetween June and November 2011, seven SPHs across the Democratic Republic of Congo, Ethiopia, Kenya, Rwanda, Tanzania, and Uganda implemented this co-created tool. The objectives of the institutional assessments were to assess existing capacities for HSR and to develop capacity development plans to address prioritized gaps. A mixed-method approach was employed consisting of document analysis, self-assessment questionnaires, in-depth interviews, and institutional dialogues aimed at capturing individual perceptions of institutional leadership, collective HSR skills, knowledge translation, and faculty incentives to engage in HSR. Implementation strategies for the capacity assessment varied across the SPHs. This paper reports findings from semi-structured interviews with focal persons from each SPH, to reflect on the process used at each SPH to execute the institutional assessments as well as the perceived strengths and weaknesses of the assessment process.ResultsThe assessment tool was robust enough to be utilized in its entirety across all seven SPHs resulting in a thorough HSR capacity assessment and a capacity development plan for each SPH. Successful implementation of the capacity assessment exercises depended on four factors: (i) support from senior leadership and collaborators, (ii) a common understanding of HSR, (iii) adequate human and financial resources for the exercise, and (iv) availability of data. Methods of extracting information from the results of the assessments, however, were tailored to the unique objectives of each SPH.ConclusionsThis institutional HSR capacity assessment tool and the process for its utilization may be valuable for any SPH. The self-assessments, as well as interviews with external stakeholders, provided diverse sources of input and galvanized interest around HSR at multiple levels.

Development of a virtual reality assessment of everyday living skills.

Cognitive impairments affect the majority of patients with schizophrenia and these impairments predict poor long term psychosocial outcomes. Treatment studies aimed at cognitive impairment in patients with schizophrenia not only require demonstration of improvements on cognitive tests, but also evidence that any cognitive changes lead to clinically meaningful improvements. Measures of “functional capacity” index the extent to which individuals have the potential to perform skills required for real world functioning. Current data do not support the recommendation of any single instrument for measurement of functional capacity. The Virtual Reality Functional Capacity Assessment Tool (VRFCAT) is a novel, interactive gaming based measure of functional capacity that uses a realistic simulated environment to recreate routine activities of daily living. Studies are currently underway to evaluate and establish the VRFCAT’s sensitivity, reliability, validity, and practicality. This new measure of functional capacity is practical, relevant, easy to use, and has several features that improve validity and sensitivity of measurement of function in clinical trials of patients with CNS disorders.

Development of a Virtual Reality Assessment of Everyday Living Skills

Cognitive impairments affect the majority of patients with schizophrenia and these impairments predict poor long term psychosocial outcomes. Treatment studies aimed at cognitive impairment in patients with schizophrenia not only require demonstration of improvements on cognitive tests, but also evidence that any cognitive changes lead to clinically meaningful improvements. Measures of “functional capacity” index the extent to which individuals have the potential to perform skills required for real world functioning. Current data do not support the recommendation of any single instrument for measurement of functional capacity. The Virtual Reality Functional Capacity Assessment Tool (VRFCAT) is a novel, interactive gaming based measure of functional capacity that uses a realistic simulated environment to recreate routine activities of daily living. Studies are currently underway to evaluate and establish the VRFCAT’s sensitivity, reliability, validity, and practicality. This new measure of functional capacity is practical, relevant, easy to use, and has several features that improve validity and sensitivity of measurement of function in clinical trials of patients with CNS disorders.

Virtual reality functional capacity assessment in schizophrenia: Preliminary data regarding feasibility and correlations with cognitive and functional capacity performance

IntroductionAssessment of functional capacity is an intrinsic part of determining the functional relevance of response to treatment of cognitive impairment in schizophrenia. Existing methods are highly and consistently correlated with performance on neuropsychological tests, but most current assessments of functional capacity are still paper and pencil simulations. We developed a computerized virtual reality assessment that contains all of the components of a shopping trip. MethodsWe administered the Virtual Reality Functional Capacity Assessment Tool (VRFCAT) to 54 healthy controls and to 51 people with schizophrenia to test its feasibility. Dependent variables for the VRFCAT included time to completion and errors on 12 objectives and the number of times that an individual failed to complete an objective. The MATRICS Consensus Cognitive Battery (MCCB) and a standard functional capacity measure, the UCSD Performance-Based Skills Assessment-Brief (UPSA-B), were administered to the patients with schizophrenia. ResultsPatients with schizophrenia performed more poorly than healthy controls on 10/11 of the time variables, as well as 2/12 error scores and 2/12 failed objectives. Pearson correlations for 7 of 15 VRFCAT variables with MCCB composite scores were statistically significant. ConclusionThese results provide support for the possibility of computerized functional capacity assessment, but more substantial studies are required.

The 6-min walk test: an independent correlate of elevated tricuspid regurgitant jet velocity in children and young adult sickle cell patients

Elevation of echocardiography-determined tricuspid regurgitant jet velocity (TRV) predicts high systolic pulmonary artery pressure. The present study tested the hypotheses that elevated tricuspid regurgitant jet velocity is associated with both hemolysis and hypoxia and abnormal 6-min walk test (6MWT) results. This study aims to correlate elevated TRV with different clinical laboratory findings and 6MWT and to find the independent predictors of increased TRV. A prospective study of 80 patients aged 5-25years old with sickle cell disease (SCD) under basal conditions and 40 matched controls was conducted. Hemolytic analysis was assessed by the levels of lactate dehydrogenase, serum bilirubin, and reticulocyte count. Oxygen saturation determination using pulse oximeter and 6MWT were done. The overall prevalence of elevated TRV (≥2.5m/s) was 28.75%. Associated risk factors were older age (r = 0.28, p = 0.01), longer duration of disease (r = 0.25, p = 0.025), higher reticulocytic count (r = 0.344, p = 0.002), lower O2 saturation (r = -0.574, p = 0.0001), and shorter walked distance in 6MWT (r = -0.75, p = 0.0001). By multivariate logistic analysis, only the distance walked during 6MWT was the independent correlate of elevated TRV (odds ratio = 0.85; 95% CI = 0.74 to 0.98 p = 0.033). The study provides evidence for independent association of TRV with abnormal 6MWT results. The 6-min walk test can be used as noninvasive adjuvant tool for functional capacity assessment of SCD patients with elevated TRV.

Status of Ophthalmic Education and the Eye Health Workforce in South Asian Association for Regional Cooperation Countries.

This study aimed to assess the capacity for ophthalmic education in the 8 South Asian Association for Regional Cooperation (SAARC) countries and to determine the need and future projections of eye health professionals in the region. This was a retrospective study and comprised desk review and Web-based questionnaire. Developed in the Asia Pacific region, the Capacity Assessment Tool for SAARC Eye Care Education, a Web-based survey mechanism derived from a 12-point framework, was used to collect data on the number of ophthalmologists and other eye care personnel, training institutions, and capacity for training in each SAARC country. There are an estimated 17,568 practicing ophthalmologists and 4086 ophthalmic subspecialists in the SAARC region. The population per ophthalmologist is approximately 92,270. Allied eye health professionals constitute an important element of the eye health workforce and have a population per allied eye health professional of approximately 99,852; the ophthalmologist to doctor (physician) ratio is 1:61. There are more than 510 centers providing ophthalmology training and more than 32 centers providing subspecialty training; ophthalmic subspecialty training varies from a 3-month observership to a 12-month hands-on training. In the SAARC region, the challenge is to sustain and increase the eye health workforce to meet the needs of a growing and aging population. The demographic transitions, improved child survival and life expectancy rates, and emerging noncommunicable disease trends require training of ophthalmic subspecialists and supporting eye care teams to meet the service delivery demands of changing eye health paradigms.

P4.130 Strengthening the Capacity of Community Based Organisations to Provide Care and Support to Vulnerable Children in Southern Nigeria

BackgroundFamilies act as ‘safety nets’ for vulnerable children. The phenomenal increase of orphans and vulnerable children (OVC) has weakened the traditional system, paving way for Community Based Organizations (CBOs) to...

Assessing patient capacity to consent to treatment: an integrative review of instruments and tools

To provide a narrative synthesis of research findings on instruments or tools designed to aid assessment of patient capacity to consent to treatment. Capacity assessment is of significant priority within health care as a finding of incapacity is a vehicle for the removal of many of an individual's fundamental rights. Despite there being many instruments and tools available to aid health professionals in the assessment of patient capacity, there are no standardised guidelines from professional bodies that inform the assessment of mental capacity. Integrative review. Primary studies of instruments or tools concerning assessment of patient capacity to consent to treatment, published in English in peer-reviewed journals between January 2005-December 2010, were included in the review. Review papers of capacity assessment instruments were included for years including and prior to 2006. Nineteen instruments were found which assess patient capacity to consent. Key themes were identified in terms of capacity domains assessed, psychometric properties, instrument implementation, patient populations studied and instrument versus clinician judgement. Despite a plethora of capacity assessment instruments and tools available, only a small number of instruments were found to have demonstrated both reliability and validity. Further research is required to improve the validity of existing capacity assessment instruments. Increased attention to patient rights and autonomy arguably places a considerable burden on healthcare professionals to facilitate capacity assessments across a continuum of health care. Despite a plethora of capacity assessment instruments and tools being available to healthcare professionals, a comprehensive assessment requires time and is often difficult in the acute care setting. A strictly formulaic approach to the assessment of capacity is unlikely to capture specific individual nuances; therefore, capacity assessment instruments should support, but not replace, experienced clinical judgement.

A patient with dementia: Decision-making capacity and surrogate decision makers

Medical decision-making capacity encompasses a patient's ability to comprehend diagnostic and/or therapeutic options, evaluate the context within which those options are presented, choose an option that is in keeping with his or her value system, and communicate that choice to the appropriate provider.1 According to a recent meta-analysis of medical decision-making capacity assessment tools, approximately 3% of healthy elderly adults lack medical decision-making capacity, as judged in most cases by a comprehensive evaluation by a psychiatrist.

Managing Plan Implementation in the Asante Akyem South District Assembly: Capacity Issues and Challenges

After years of implementation of the new decentralised planning system in Ghana, problems of plan implementation still persist. This paper uses a case study approach to appraise the capacity of the Asante Akyem South District Assembly (AASDA) in managing the implementation of its development plans. Using questionnaires and Organisational Capacity Assessment Tool (OCAT), the paper examines the capacity of the district assembly to implement its plans in six areas. The extent of implementation of a medium term development plan (2002-2005) was also reviewed. Finally the paper draws on the capacity situation of the district assembly and concludes that the assembly requires capacity upgrading to leverage its full potential in grassroots development. Keywords: Capacity, Plan Implementation, Management, District Assemblies

A tool for assessing management capacity at the decentralized level in a fragile state

Fragile states need assessment of decentralized management capabilities, not just of the central level, to design capacity-building efforts focused on improving management. Improving the management capacity of health departments at the provincial or district level is just as critical as strengthening the central ministry in fragile states if a health system that effectively addresses the real health needs of the population is to be formed. This paper describes a management capacity assessment tool developed for use in fragile states. It uses a framework that describes six critical management areas: oversight and coordination; human resources; resource management; health financing; community involvement; and health information management. These core areas of health system management are assessed with regard to capacity in three core management functions: the capacity to plan, to implement, and to monitor and evaluate. The tool was applied to assess the management capacity of six counties in Liberia. The results helped differentiate the level of capacity of the different counties and clarify the actions required to strengthen the health system in the periphery. The assessment also allowed the prioritizing of county health offices with regard to the level of capacity building required to improve management. The tool also identified successes that can inform the design of future health programs in other county health offices. The tool can be applied to other challenging country situations to assess management capacity, which will help focus technical assistance to the health sector in fragile states.

Gender Budgeting in the Education Sector: Implications for the Girl Child Education in Nigeria

More than any other time in the Nigerian history, women education is now considered a priority because it has become a major factor in the development equation, and in particular, a key to gender equity, justice and poverty reduction; improved skills and technological knowledge acquisition; improved nutrition; reproductive health; and general socio-economic development of a nation. Yet, the challenges of gender issues in education still remain mostly unabated. The cultural barriers which the girl child faces concerning her roles at home and in the society still inhibit her ability to go to school. Gender stereotypes still exist in learning materials and too often, teachers’ different expectations of boys and girls result in negative biases against girls’ education. Despite government policy interventions and programs, empirical evidences continue show gender disparity in enrolment, attrition, and retention at all levels – primary, secondary, and tertiary. Although the current National Gender Policy addresses gender imbalance in the education sector, the extent to which the country is able to achieve gender parity in the sector depends on how skillful are policy makers in the use gender mainstreaming (GM) tools and strategies, one of such is being able to adopt ‘a gender budgeting’ framework in the sector. This paper addresses the technical knowledge in gender mainstreaming and gender budgeting in the education sector, and the extent to which budgets in the sector now address identified gender gaps in the sector. This paper argues that beyond government rhetoric in policy documents, evidence of political will and government commitment to the girl child education are dependent on the extent to which the sector has become sensitive to gender issues, including adoption of a gender sensitive budgeting framework. Using ‘organizational capacity assessment tool (OCAT), the paper assesses the current technical capacity in gender mainstreaming and gender budgeting in the sector, while also using budgeting figures to establish the extent to which the sector allocates money to gender issues in the sector. Empirical findings show that the skills and capacities for gender mainstreaming and gender budgeting in the public sector (especially the education sector) are still very low, while government spending in the education sector is still skewed in favor of men. One clear way of supporting the ‘girl child’ education is to make the education sector responsive to ‘gender budgeting’ in line with democratic ethos.

A model of community capacity building for sustainable dengue problem solution in Southern Thailand

Dengue community capacity (DCC) is important for developing a sustainable approach to over-coming the problem of dengue. The objectives were 1) to develop and 2) evaluate a dengue community capacity building model for the leader and non-leader group in three communities selected by purposive technique. A mixed method research design was used employing both qualitative and quantitative methods with qualitative studies conducted for community capacity building model: assessment, planning, implementation, and evaluation. DCC level was assessed by the Dengue Community Capacity Assessment Tool (DCCAT) including larval indices, and morbidity and mortality rate. To analyze the differences of the leader and non-leader’s DCC levels both pre and post-interventions in each model, the Mann-Whitney and Independent T-test were used and to analyze the difference of the DCC level among the three models (Ban Mon, Ban Nangpraya and Ban Kang), the Kruskal-Wallis Test, ANOVA, and ANCOVA were used. The findings showed that there were some differences among the three models in dengue community capacity building in terms model. The participants consisted of leader (n = 26, 24 and 28) and non-leader groups (n = 200, 215 and 176 respectively). The DCC levels of both leader and non-leader groups increased post-intervention in each model (p < 0.001) and in all three models, showing a statistically significant difference between pre and post-intervention (p < 0.001). Ban Kang model demonstrated the highest DCC levels of leader and non-leader groups, the lowest larval indices (HI, BI, and CI), and no dengue morbidity. In contrast, Ban Mon and Ban Nangpraya model showed low DCC level in both leader and non-leader groups, a high rate of larval indices and high dengue morbidity rate. However, there was no mortality rate in three areas. The conclusion indicates that the model with a high DCC level showed low risk on the dengue index both entomological and epidemiology index. The model of dengue community capacity building for dengue solution was sustainability not only needs to be maintained DCC levels but also increased dependent upon the contexts of each community.

Community capacity for sustainable community-based dengue prevention and control: study of a sub–district in Southern Thailand

Objective To assess the level of community capacity for dengue prevention and control and to study household environments and larval indices in southern Thailand. Methods A cross-sectional survey was designed for the study, enrolling two communities with higher dengue incidence rate than the standard over the past five years. Data gathering was conducted by the dengue leader group (DLG), including 15 leaders and 15 non-leaders trained by the research team. The dengue community capacity assessment tool (DCCAT) for leaders (115 items, 14 domains) and non-leaders (83 items, 11 domains). Participants were selected by the DLG based on their communities' dengue risk. In the low-dengue incidence (LDI) community, 32 leaders and 177 non-leaders were selected; while in the high-dengue incidence (HDI) community, 31 leaders and 199 non-leaders were chosen. Results The leaders from the LDI and the HDI communities demonstrated high levels of dengue community-capacity (360.47±58.82, 416.22±57.72). Non-leaders in the LDI community demonstrated a moderate level of dengue community capacity competence (205.90±60.76), while the non-leaders in the HDI community had a high level (254.78±50.34). Conclusions These initial levels of dengue community capacity serves as a baseline for diagnosing each community. For a community that needed to improve its capacity, the DCCAT is essential tool to conduct a pre-post intervention assessment or a serial assessment. A participatory approach is taken to enable local communities to carry out anti-dengue efforts on their own, rather than have intervention by an outsider.