Chronic Disease Prevention Programs Research Articles

Path Analysis on the Effectiveness of Chronic Disease Prevention Program using Health Belief Model

Background: Chronic disease prevention program is a proactive health service system on chronic diseases which can affect hypertension control. This study aimed to determine the effect of the chronic disease prevention program and the construction of the Health Belief Model (HBM) on the prevention of elderly hypertension with path analysis method. Subjects dan Method: This study used observational analytical study with retrospective cohort study approach. This study was conducted in four community health centers in Ngawi Regency, East Java, in April-May 2019. The total sample of 200 elderly aged 60-74 years was divided into2 groups, such as group which participated in chronic disease prevention program(case) and the group which did not participate in chronic disease prevention program(control) based on fixed exposure sampling. The dependent variable of this study was hypertension control. The independent variables in this study were participants in a chronic disease prevention program, perceived vulnerability, perceived seriousness, perceived benefits, perceived barriers, cues to action, and self-efficacy. Variable data collection used questionnaires and analyzed using path analysis. Results: Hypertension control was directly and positively affected by chronic disease prevention program(b= ­­2.85­; ­95%CI= 0.48 to 5.22; p= 0.018), perceived vulnerability (b= 1.35; 95%CI= 0.16 hingga 2.53; p= 0.025), perceived seriousness (b= 0.83; 95%CI= 0.04 to 1.62; p= 0.039), and self-efficacy (b= 0.99; 95%CI= 0.14 to 1.85; p= 0.023). Hypertension control was indirectly affected by perceived benefits, perceived barriers, and cues to action. Conclusion: Hypertension control in the elderly is directly and positively affected by participation in chronic disease prevention program, perceived vulnerability, perceived seriousness, and self-efficacy. Hypertension control is indirectly affected by perceived benefits, perceived barriers, and cues to action. Keywords : Hypertension, chronic disease, prevention, Health Belief Model, path analysis Correspondence : Nafi’ah Aprilia. Masters Program in Public Health, Universitas Sebelas Maret. Jl. Ir. Sutami 36A, Surakarta 57126, Central Java. Email: nafiahlia@gmail.com. Mobile: 082230766393 Journal of Health Promotion and Behavior (2019), 4(2): 85-97 https://doi.org/10.26911/thejhpb.2019.04.02.01

Primary health care services for patients with chronic disease in Newfoundland and Labrador: a descriptive analysis.

Newfoundland and Labrador has a rapidly aging population, much of which is rural, with poor health behaviours and high rates of chronic disease. These factors contribute to a unique challenge in health care delivery. Our aim was to describe the availability of publicly funded primary health care programs and services delivered by regional health authorities across the province. We performed a descriptive analysis using data from a cross-sectional provincial primary health care survey deployed across Newfoundland and Labrador. Survey data included location, disease-specific chronic disease prevention programming, types of routine primary care, allied health prevention and promotion, chronic disease prevention and management services, and team-based care. The mode of service delivery was identified for most programs and services. Surveys were returned by 153 sites (99.4% response rate). Family physician services were available at 66% of sites (95/145) and nurse practitioner services were available at 51% (74/144) of sites. Many sites offered screening for cervical (60%, 86/144), colon (42%, 59/142) and prostate cancers (43%, 60/141), in addition to various self-management and education services. Allied health services, such as clinical nutrition counselling (47%, 68/46) and occupational therapy (46%, 68/147), were available at many sites. Available health care services were most often offered by on-site staff, and few sites provided primary health care services through telehealth. Overall, rural sites offered a greater variety of services than urban sites. Considerable variability exists in the range of primary health care services available across Newfoundland and Labrador, with limited delivery of some programs and services. Future research should examine how availability of programs and services affects health outcomes and costs.

Satisfaction with Financial Incentives for Chronic Disease Prevention.

ObjectiveWe examined Medicaid enrollees' experiences and satisfaction with financial incentives-based chronic disease prevention programs in 10 states. MethodsThis cross-site study of the Medicaid Incentives for Prevention of Chronic Diseases model used a mixed-methods approach to assess Medicaid enrollees' experiences and satisfaction with the incentive programs. We conducted 31 in-person focus groups with 212 program participants, followed by a mail survey in English and Spanish (N = 2274). We used both the qualitative focus group data and the quantitative survey data to examine participant satisfaction with the incentives, along with differences by program and incentive characteristics. ResultsOverall, focus group and survey findings aligned, with participants reporting satisfaction with program incentives. Participants felt that the incentives helped them make positive changes to improve their health. Nevertheless, satisfaction varied considerably depending on characteristics of the program, such as the form and magnitude of the incentive, health focus of the program, and program delivery method. ConclusionsProgram and incentive characteristics play key roles in participants' satisfaction and experience with incentive-based, chronic disease prevention programs. Further research is required to examine the optimal design of incentive programs to support sustained behavior change.

Participant Satisfaction and Perceptions About Program Impact in the Medicaid Incentives for Prevention of Chronic Disease Pilot Program.

Evaluate the Centers for Medicare & Medicaid Incentives for Prevention of Chronic Diseases (MIPCD) program in terms of participant satisfaction and self-reported program impact. Participant survey (mail/telephone follow-up), English and Spanish (N = 2274). Ten states in MIPCD program. Medicaid beneficiaries. Incentive-based health promotion programs targeting diabetes prevention and management, smoking cessation, and weight, hypertension, and cholesterol management. Dependent measures are (1) overall program satisfaction and (2) self-reported program impact, operationalized as whether program helped with understanding health issues, learning ways to take care of health, and encouraging healthy lifestyle changes. Multilevel multivariable ordinal logistic regression models to identify predictors of overall program satisfaction and program impact. Sixty-seven percent were very satisfied with the program, and 76% strongly agreed the program encouraged healthy lifestyle changes. Age (59+ vs <45 years) and being female predicted overall program satisfaction. Satisfaction with specific aspects of the program including communication with staff, accessibility, and incentives predicted higher overall satisfaction. Age (45-52 vs <45 years) and being black or Hispanic predicted higher program impact. Points redeemable for rewards performed worse than money-valued incentives in terms of encouraging lifestyle changes (odds ratio [OR], 0.30; 95% confidence interval [CI], 0.11-0.82). Participants receiving incentives valued at $25 to <$100 were more likely to report higher agreement that the program helped them learn ways to care for their health (OR, 1.72; 95% CI, 1.21-2.44) and encouraged lifestyle changes (OR, 1.46; 95% CI, 1.02-2.10), compared to participants receiving incentives valued at $0 to <$25. Incentives valued at $100 to <$400 predicted higher agreement that the program helped with understanding of health issues (OR, 1.62; 95% CI, 1.13-2.33), compared to incentives valued at $0 to <$25. Effective chronic disease prevention programs are needed for Medicaid populations. Study findings highlight important considerations for incentive-based programs.

Management Practices to Build Evidence-Based Decision-Making Capacity for Chronic Disease Prevention in Georgia: A Case Study.

BackgroundResearch shows that training can improve skills needed for evidence-based decision making, but less is known about instituting organizational supports to build capacity for evidence-based chronic disease prevention.Community ContextThe objectives of this case study were to assess facilitators and challenges of applying management practices to support evidence-based decision making in chronic disease prevention programs in the public health system in Georgia through key informant interviews and quantitatively test for changes in perceived management practices and skills through a pre–post survey.MethodsLeadership of the chronic disease prevention section hosted a multiday training, provided regular supplemental training, restructured the section and staff meetings, led and oversaw technical assistance with partners, instituted transparent performance-based contracting, and made other changes. A 65-item online survey measured perceived importance of skills and the availability of skilled staff, organizational supports, and use of research evidence at baseline (2014) and in 2016 (after training). A structured interview guide asked about management practices, context, internal and external facilitators and barriers, and recommendations.Capacity-Building Activities and Survey FindingsSeventy-four staff members and partners completed both surveys (70.5% response). Eleven participants also completed a 1-hour telephone interview. Interview participants deemed leadership support and implementation of multiple concurrent management practices key facilitators to increase capacity. Main challenges included competing priorities, lack of political will, and receipt of requests counter to evidence-based approaches. At posttest, health department staff had significantly reduced gaps in skills overall (10-item sum) and in 4 of 10 individual skills, and increased use of research evidence to justify interventions. Use of research evidence for evaluation, but not skills, increased among partners.InterpretationThe commitment of leaders with authority to establish multiple management practices to help staff members learn and apply evidence-based decision-making processes is key to increased use of evidence-based chronic disease prevention to improve population health.

Navigating the evidentiary turn in public health: Sensemaking strategies to integrate genomics into state-level chronic disease prevention programs

In the past decade, healthcare delivery has faced two major disruptions: the mapping of the human genome and the rise of evidence-based practice. Sociologists have documented the paradigmatic shift towards evidence-based practice in medicine, but have yet to examine its effect on other health professions or the broader healthcare arena. This article shows how evidence-based practice is transforming public health in the United States. We present an in-depth qualitative analysis of interview, ethnographic, and archival data to show how Michigan's state public health agency has navigated the turn to evidence-based practice, as they have integrated scientific advances in genomics into their chronic disease prevention programming. Drawing on organizational theory, we demonstrate how they managed ambiguity through a combination of sensegiving and sensemaking activities. Specifically, they linked novel developments in genomics to a long-accepted public health planning model, the Core Public Health Functions. This made cutting edge advances in genomics more familiar to their peers in the state health agency. They also marshaled state-specific surveillance data to illustrate the public health burden of hereditary cancers in Michigan, and to make expert panel recommendations for genetic screening more locally relevant. Finally, they mobilized expertise to help their internal colleagues and external partners modernize conventional public health activities in chronic disease prevention. Our findings show that tools and concepts from organizational sociology can help medical sociologists understand how evidence-based practice is shaping institutions and interprofessional relations in the healthcare arena.

What are the effective elements in patient-centered and multimorbidity care? A scoping review

BackgroundInterventions to improve patient-centered care for persons with multimorbidity are in constant growth. To date, the emphasis has been on two separate kinds of interventions, those based on a patient-centered care approach with persons with chronic disease and the other ones created specifically for persons with multimorbidity. Their effectiveness in primary healthcare is well documented. Currently, none of these interventions have synthesized a patient-centered care approach for care for multimorbidity. The objective of this project is to determine the particular elements of patient-centered interventions and interventions for persons with multimorbidity that are associated with positive health-related outcomes for patients.MethodA scoping review was conducted as the method supports the rapid mapping of the key concepts underpinning a research area and the main sources and types of evidence available. A five-stage approach was adopted: (1) identifying the research question; (2) identifying relevant studies; (3) selecting studies; (4) charting the data; and (5) collating, summarizing and reporting results. We searched for interventions for persons with multimorbidity or patient-centered care in primary care. Relevant studies were identified in four systematic reviews (Smith et al. (2012;2016), De Bruin et al. (2012), and Dwamena et al. (2012)). Inductive analysis was performed.ResultsFour systematic reviews and 98 original studies were reviewed and analysed. Elements of interventions can be grouped into three main types and clustered into seven categories of interventions: 1) Supporting decision process and evidence-based practice; 2) Providing patient-centered approaches; 3) Supporting patient self-management; 4) Providing case/care management; 5) Enhancing interdisciplinary team approach; 6) Developing training for healthcare providers; and 7) Integrating information technology. Providing patient-oriented approaches, self-management support interventions and developing training for healthcare providers were the most frequent categories of interventions with the potential to result in positive impact for patients with chronic diseases.ConclusionThis scoping review provides evidence for the adaption of patient-centered interventions for patients with multimorbidity. Findings from this scoping review will inform the development of a toolkit to assist chronic disease prevention and management programs in reorienting patient care.

Study on the effectiveness of implementation: the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases

Objective: To assess the implementation and impact of programs carried out by the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases. Methods: Both sociological and epidemiological methods were used to collect qualitative and quantitative data in November and December, 2016 in order to conduct on process and outcome evaluation of the above mentioned objective. In the meantime, case study was also conducted. Results: All the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases were found well implemented across the country, with health education and health promotion, surveillance and safeguard measures in particular. A government-led and inter-sector coordination and communication mechanism had been well established, with more than 16 non-health departments actively involved. 28.7% of the residents living in the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases were aware of the key messages related to chronic diseases. Among the residents, 72.1% of them consumed vegetables and 53.6% consumed fruits daily, with another 86.9% walked at least 10 minutes per day. Over 70% of the patients with hypertension or diabetes reported that they were taken care of by the Community Health Centers, and above 50% of them were under standardized management. Residents, living in the National Demonstration Areas under higher ranking of implementation scores, were more likely to be aware of relevant knowledge on chronic disease control and prevention (OR=6.591, 95%CI: 5.188-8.373), salt reduction (OR=1.352, 95%CI: 1.151-1.589), oil reduction (OR=1.477, 95%CI: 1.249-1.746) and recommendation on physical activities (OR=1.975, 95%CI: 1.623- 2.403). Conclusion: The implementation of programs carried out by the National Demonstration Areas for Comprehensive Prevention and Control of Non-communicable Diseases had served a local platform for the control and prevention of non-communicable diseases, and thus become an important 'carrier' for chronic disease prevention and control programs in China.

Amharic based Knowledge-Based System for Diagnosis and Treatment of Chronic Kidney Disease using Machine Learning

Chronic kidney disease is an important challenge for health systems around the world and consuming a huge proportion of health care finances. Around 85% of the world populations live in developing country of the world, where chronic kidney disease prevention programs are undeveloped. Treatment options for chronic kidney disease are not readily available for most countries in sub-Saharan Africa including Ethiopia. Many rural and urban communities in Ethiopia have extremely limited access to medical advice where medical experts are not readily available. To address such a problem, a medical knowledge-based system can play a significant role. Therefore, the aim of this research was developing a self- learning knowledge based system for diagnosis and treatment of the first three stages of kidney disease that can update the knowledge without the involvement of knowledge engineer. In the development of this system, the following procedures are followed: Knowledge Engineering research design was used to develop the prototype system. Purposive sampling strategies were utilized to choose specialists. The information was acquired by using both structured and unstructured interviews and all knowledge’s are represented by using production rule. The represented production rule was modeled by using decision tree modeling approach. Implementation was employed by using pro-log tools. Testing and evolution was performed through test case and user acceptance methods. Finally, we extensively evaluate the prototype system through visual interactions and test cases. Finally, the results show that our approach is better than the current ones.

The effects of resistance exercise on insulin sensitivity in adolescents

Background: An escalating incidence of type 2 diabetes among adolescents is causing concern. This is thought to be sparked by rising population-wide prevalence of insulin resistance. Resistance exercise has been shown to reduce insulin resistance, however only immediate, post-intervention effects have been demonstrated. The use of resistance exercise by adolescents in managing insulin resistance in the long-term has not been evaluated. Purpose: To assess the effects, up to six months, of a physiotherapist-supervised, resistance exercise program on insulin sensitivity, cardiorespiratory fitness, muscle strength, physical activity levels, and anthropometric measures among adolescents with insulin resistance. Methods: Participants with insulin resistance were recruited from a database of patients from a pediatric chronic disease prevention program. They completed a supervised 10-week resistance exercise program, 60-minutes, three times per week. A body positive approach was used focusing on health behaviours. Using a repeated-measures design, participants were assessed during an observational run-in control period then at pre, post, and 6-month follow-up assessments. The primary outcome was insulin sensitivity, measured by the oral glucose tolerance test. Secondary outcomes included cardiorespiratory fitness, muscle strength, physical activity level, and anthropometric measures. Results: Thirteen participants (14.16±1.19 years old; 8 males, 5 females) completed the intervention. Improvements in insulin sensitivity were found, observed as reduced fasting insulin [F(₂,₂₂)=7.54,p=0.003,ηp²=0.41], fasting glucose [F(₂,₂₂)=3.58,p=0.045,ηp²=0.25], and HOMA-IR [F(₂,₂₂)=7.60,p=0.003,ηp²=0.41], which were maintained at follow-up. Cardiorespiratory fitness, waist circumference, and waist-to-hip ratio also significantly improved at post and follow-up. Daily physical activity levels improved but not significantly. Upper and lower body muscle strength significantly increased post-intervention but returned to pre-assessment values at follow-up. Conclusion: The findings suggest that a supervised 10-week resistance exercise program (60-minute, three times per week) improves insulin sensitivity, cardiorespiratory fitness, waist circumference, and waist-to-hip ratio in adolescents who are at high risk of developing type 2 diabetes. Importantly, these benefits are maintained up to six months. Supervised, resistance exercise adds significant long-term benefit in the management of insulin resistance in adolescents.

Self-Reported Screen Time is Independently Associated with Cardiometabolic Disease Risk Factors in Young Adults

Research has shown that self-reported screen time is linked to cardiometabolic disease risk factors in children. Whether this association extends to young adults has not been investigated. PURPOSE: To determine the associations between self-reported screen time and individual cardiometabolic disease risk factors in young adults. METHODS: Sixty-six young adults volunteered for the study (mean±SD: age 20.6±1.4 y; BMI 24.3±3.6 kg/m2; body fat 22.7±8.8%; peak oxygen consumption [VO2peak] 45.7±7.7 ml/kg/min). Sedentary behavior and screen time (television viewing, video games and computer games) were self-reported using the Sedentary Behavior Questionnaire. Moderate-to-vigorous physical activity (MVPA) was objectively measured by 7 d of accelerometer wear. Cardiometabolic disease risk factors were measured using standard procedures and included waist circumference, blood pressure, glucose, triglycerides (TG), high-density lipoprotein cholesterol (HDL) and low-density lipoprotein cholesterol (LDL). Body composition was estimated by BOD POD and VO2peak was measured by indirect calorimetry using an incremental treadmill test to exhaustion. Multiple regression was used to analyze the independent associations between screen time and individual cardiometabolic disease risk factors with sedentary behavior, MVPA, age, and sex used as covariates in the models. RESULTS: On average, screen time (14.8±11.6 h/week) accounted for 25% of total sedentary behavior (59.0±25.8 h/week). Screen time was positively associated with BMI (R2=0.19, β=0.35, p=0.02), waist circumference (R2=0.19, β=0.43, p<0.01), fat mass (R2=0.39, β=0.34, p=0.01), and TG (R2=0.24, β=0.43, p<0.01), and negatively associated with VO2peak (R2=0.66, β=-0.39, p<0.01). These associations were independent of total sedentary behavior, MVPA, age and sex. Screen time was not associated with blood pressure, glucose, HDL or LDL (p>0.05). CONCLUSIONS: Our findings suggest that screen time is related to individual cardiometabolic disease risk factors in young adults. Screen time accounted for 25% of sedentary time and may be an important area to target for chronic disease prevention programs in young adults. Funded by CTR-IN NIH NIGMS #1U54GM104944-01A1

Programa de prevención de la enfermedad renal crónica basado en redes integradas de servicios en Colombia

Chronic Kidney Disease (CKD) prevention programs allow to control morbidity and/or delay renal replacement therapy. The design of a CKD prevention program is described, including highlights on how the primary and secondary levels of care interact with each other through the characterization of the population admitted for secondary prevention. The description of the program was based on a literature review. Descriptive statistics were used to characterize the patients participating in the program. The design and implementation of the prevention program was based on the integration of service networks and care levels. The main activities for the program were detailed according to the care level in which they performed. 3 487 patients in total were admitted for control at the second care level due to an estimated glomerular filtration rate of <60 mil/min; 87.81% of the patients were admitted with CKD stage 3 and a median glomerular filtration rate of 46.21mil/min. The main causes of CKD were hypertension and diabetes. On admission, 2 129 patients (61.05 %) had systolic blood pressure <140 mmHg and 3 091 (88.64 %) had diastolic blood pressure <90 mmHg; 357 (57.58 %), out of 620, diabetic patients with glycosylated hemoglobin presented values <7.5 %. A prevention program was designed and implemented to allow the integration of care levels oriented to a multidisciplinary intervention, which ultimately managed to recognize patients and to give continuity to care provision for a better control of CKD.

Burden of end-stage kidney disease: North Africa.

Geographical, ecological, and genetic factors result in many similarities among the six main countries of the African Sahara, including the epidemiology of kidney disease. With an average incidence of 182 and prevalence of 522 patients with end-stage kidney disease (ESKD) per million population, North Africa (NA) spends $650 million on dialysis and transplantation despite an estimated annual loss of 600,000 life years. The health burden of ESKD is not limited to its directly-related morbidity and mortality but affects even more significantly other body systems, particularly the cardiovascular system. In addition, dialysis units are reservoirs for infectious agents, such as hepatitis-C (HCV) and -B (HBV) viruses, and methicillin-resistant staphylococci (MRSA), which threaten the health of the community. Shortage of financial resources eventually creates inequity of health care at large since only the rich are able to find their way around the limited public services. ESKD is no exception; inequity being even further augmented by the trade of organs, particularly in Egypt. This is attributed to high demand in the absence of a deceased donor program and in the presence of a pool of young, healthy, unemployed potential donors who have no access to any social security plans. Many attempts to face the challenge of accommodating ESKD management in NA are underway, including relevant legislations, promoting deceased donor transplants, chronic kidney disease (CKD) prevention and early detection programs, and generating nontraditionally directed financial resources.

Integration of chronic disease prevention and management services into primary care: a pragmatic randomized controlled trial (PR1MaC).

Chronic disease prevention and management programs are usually single-disease oriented. Our objective was to evaluate an intervention that targeted multiple chronic conditions and risk factors. We conducted a pragmatic randomized controlled trial involving patients aged 18-75 years with at least 1 of the targeted chronic conditions or risk factors from 8 primary care practices in the Saguenay region of Quebec, Canada, to evaluate an intervention that included self-management support and patient-centred motivational approaches. Self-management (primary outcome) was evaluated using the Health Education Impact Questionnaire (heiQ). Secondary outcomes included self-efficacy, health-related quality of life, psychological distress and health behaviours. Three hundred thirty-two patients were recruited and randomly assigned (n = 166 for both intervention and control groups) and evaluated after 3 months. The intervention group showed improvement in 6 of the 8 heiQ domains: health-directed behaviour (relative risk [RR] 1.71, 95% confidence interval [CI] 1.13 to 2.59), emotional well-being (RR 1.73, 95% CI 1.07 to 2.79), self-monitoring and insight (RR 2.40, 95% CI 1.19 to 4.86), constructive attitudes and approaches (RR 2.40, 95% CI 1.37 to 4.21), skill and technique acquisition (RR 1.70, 95% CI 1.14 to 2.53), and health service navigation (RR 1.93, 95% CI 1.08 to 3.47). Improvement was also observed in the Physical Component Summary (p = 0.017) and the Single Index (p = 0.041) of the 12-Item Short Form Health Survey (version 2). The intervention group improved in fruit and vegetable consumption (odds ratio [OR] 2.36, 95% CI 1.41 to 3.95) and physical activity (OR 3.81, 95% CI 1.65 to 8.76). One-year improvement was maintained in the intervention group for several outcomes. It is possible to implement an intervention integrating chronic disease prevention and management services into primary care settings. We obtained positive and promising results using this intervention. Trial registration: ClinicalTrials.gov, no.: NCT01319656.

Speculating on health: public health meets finance in 'health impact bonds'.

Where modern public health developed techniques to calculate probability, potentiality, risk and uncertainty, contemporary finance introduces instruments that redeploy these. This article traces possibilities for interrogating the connection between health and financialisation as it is arising in one particular example - the health impact bond. It locates the development of this very recent financial innovation in an account of public health's role within governance strategies over the 20th century to the present. We examine how social impact bonds for chronic disease prevention programmes bring two previously distinct ways of thinking about and addressing risk into the same domain. Exploring the derivative-type properties of health impact bonds elucidates the financial processes of exchange, hedging, bundling and leveraging. As tools for speculation, the functions of health impact bonds can be delinked from any particular outcome for participants in health interventions. How public health techniques for knowing and acting on risks to population health will contest, rework or be subsumed within finance's speculative response to risk, is to be seen.

Barriers to Recruiting Men Into Chronic Disease Prevention and Management Programs in Rural Areas

Chronic disease is becoming increasingly prevalent in Canada. Many of these diseases could be prevented by adoption of healthy lifestyle habits including physical activity and healthy eating. Men, especially those in rural areas, are disproportionately affected by chronic disease. However, men are often underrepresented in community-based chronic disease prevention and management (CDPM) programs, including those that focus on physical activity and/or healthy eating. The purpose of this study was to explore the experiences and perceptions of program delivery staff regarding the challenges in recruitment and participation of men in physical activity and healthy eating programs in rural communities, and suggestions for improvement. Semistructured interviews were conducted by telephone with 10 CDPM program delivery staff from rural communities in Southwest Ontario, Canada. Time and travel constraints, relying on spouses, and lack of male program leaders were cited as barriers that contributed to low participation levels by men in CDPM programs. Hiring qualified male instructors and engaging spouses were offered as strategies to increase men's participation. The results of this study highlight many of the current issues faced by rural health organizations when offering CDPM programming to men. Health care organizations and program delivery staff can use the recommendations in this report to improve male participation levels.

Engaging Men in Chronic Disease Prevention and Management Programs: A Scoping Review.

Chronic disease has become one of the largest health burdens facing the developed world. Men are at a higher risk of being diagnosed with chronic disease than women. Although lifestyle interventions have been shown to reduce the risk of chronic disease in participants, men are often underrepresented in such programs. The purpose of this study was to explore the individual-level and program-specific factors that affect male participation rates in chronic disease prevention and management (CDPM) programs. A scoping review methodology was selected, and 25 studies met the criteria for inclusion in the review. Results showed that traditional group-based programs that focused on topics such as nutrition and physical activity were often seen by men as inherently feminine, which served as a barrier for participation. Program-specific factors that attracted men to participate in interventions included a group component with like-minded men, the use of humor in the delivery of health information, the inclusion of both nutrition and physical activity components, and the presence of some manner of competition. A past negative health event, personal concern for health status, and motivation to improve physical appearance were cited by men as facilitators to CDPM program participation. Gaps in the research are identified, and results of this study can be used to inform the development of CDPM programs that will improve the engagement and participation of men.

Factors Driving Local Health Departments' Partnerships With Other Organizations in Maternal and Child Health, Communicable Disease Prevention, and Chronic Disease Control.

To describe levels of partnership between local health departments (LHDs) and other community organizations in maternal and child health (MCH), communicable disease prevention, and chronic disease control and to assess LHD organizational characteristics and community factors that contribute to partnerships. Data were drawn from the National Association of County & City Health Officials' 2013 National Profile Study (Profile Study) and the Area Health Resources File. LHDs that received module 1 of the Profile Study were asked to describe the level of partnership in MCH, communicable disease prevention, and chronic disease control. Levels of partnership included "not involved," "networking," "coordinating," "cooperating," and "collaborating," with "collaborating" as the highest level of partnership. Covariates included both LHD organizational and community factors. Data analyses were conducted using Stata 13 SVY procedures to account for the Profile Study's survey design. About 82%, 92%, and 80% of LHDs partnered with other organizations in MCH, communicable disease prevention, and chronic disease control programs, respectively. LHDs having a public health physician on staff were more likely to partner in chronic disease control programs (adjusted odds ratio [AOR] = 2.33; 95% confidence interval [CI], 1.03-5.25). Larger per capita expenditure was also associated with partnerships in MCH (AOR = 2.43; 95% CI, 1.22-4.86) and chronic disease prevention programs (AOR = 1.76; 95% CI, 1.09-2.86). Completion of a community health assessment was associated with partnership in MCH (AOR = 7.26; 95% CI, 2.90-18.18), and chronic disease prevention (AOR = 5.10; 95% CI, 2.28-11.39). About 1 in 5 LHDs did not have any partnerships in chronic disease control. LHD partnerships should be promoted to improve care coordination and utilization of limited health care resources. Factors that might promote LHDs' partnerships include having a public health physician on staff, higher per capita expenditure, and completion of a community health assessment. Community context likely influences types and levels of partnerships. A better understanding of these contextual factors may lead to more complete and effective LHD partnerships.

Community Interagency Connections for Immigrant Worker Health Interventions, King County, Washington State, 2012–2013

IntroductionCross-sector community partnerships are a potentially powerful strategy to address population health problems, including health disparities. US immigrants — commonly employed in low-wage jobs that pose high risks to their health — experience such disparities because of hazardous exposures in the workplace. Hazardous exposures contribute to chronic health problems and complicate disease management. Moreover, prevention strategies such as worksite wellness programs are not effective for low-wage immigrant groups. The purpose of this article was to describe an innovative application of social network analysis to characterize interagency connections and knowledge needed to design and deliver a comprehensive community-based chronic disease prevention program for immigrant workers.MethodsUsing iterative sample expansion, we identified 42 agencies representing diverse community sectors (service agencies, faith-based organizations, unions, nonprofits, government agencies) pertinent to the health of Chinese immigrant workers. To capture data on shared information, resources, and services as well as organizational characteristics, we jointly interviewed 2 representatives from each agency. We used social network analysis to describe interagency network structure and the positions of agencies within the networks.ResultsAgency interconnections were established primarily for information sharing. In the overall interagency network, a few service-oriented agencies held central or gatekeeper positions. Strong interconnectedness occurred predominately across service, public, and nonprofit sectors. The Chinese and Pan-Asian service sectors showed the strongest interconnectedness.ConclusionNetwork analysis yields critical understanding of community structural links and assets needed to inform decisions about actual and potential community collaborations. Alternative intervention strategies may be needed to address health disparities among immigrant workers.

A Customizable Model for Chronic Disease Coordination: Lessons Learned From the Coordinated Chronic Disease Program.

In 2012, the Centers for Disease Control and Prevention provided funding and technical assistance to all states and territories to implement the Coordinated Chronic Disease Program, marking the first time that all state health departments had federal resources to coordinate chronic disease prevention and control programs. This article describes lessons learned from this initiative and identifies key elements of a coordinated approach. We analyzed 80 programmatic documents from 21 states and conducted semistructured interviews with 7 chronic disease directors. Six overarching themes emerged: 1) focused agenda, 2) identification of functions, 3) comprehensive planning, 4) collaborative leadership and expertise, 5) managed resources, and 6) relationship building. These elements supported 4 essential activities: 1) evidence-based interventions, 2) strategic use of staff, 3) consistent communication, and 4) strong program infrastructure. On the basis of these elements and activities, we propose a conceptual model that frames overarching concepts, skills, and strategies needed to coordinate state chronic disease prevention and control programs.