Community-based Care Program Research Articles

A time series analysis of disruptions to maternal and child health care in northern Togo during the COVID-19 pandemic in the context of an integrated primary care program

There are significant concerns that COVID-19-related disruptions in routine health care will reverse the gains made over the past 2 decades in reducing maternal and under-5 mortality in low- and middle-income countries. The objective of this study was to examine the extent of disruptions in community-based maternal and child health services and explore community perceptions and experiences with health care use in the year following the start of the COVID-19 pandemic in one district in northern Togo, West Africa. This study included analysis of multiple types of data including: (1) routine health management information system data from 18 public sector health centers, (2) programmatic data collected through an integrated health center- and community-based primary care program at 5 health centers, and (3) semi-structured interviews with health center managers, community health workers (CHWs), and community members at those 5 health centers. We found only short-term declines in service utilization coinciding with the COVID-19 pandemic and no decline in the delivery of community-based care by CHWs. Qualitative data were consistent with the quantitative results, reporting sustained use of health-care services. Multilevel factors related to the continued provision of care during the COVID-19 pandemic included regular and clear communication from CHWs as trusted community sources, risk minimization at the health-center level, continued provision of community-based care by CHWs, and collaboration between community leaders and health-care workers to limit COVID-19 transmission. Findings demonstrate resiliency of an integrated primary care system when equipped with an adequately trained, supervised, and supplied health workforce, implementation of infection prevention and control measures, communication by trusted community sources, and adaptations to health-care delivery that enable the continued provision of care.

Addressing Disparities in Vision Health and Eye Care in the US

Health disparities are a prevalent issue that continues to affect health outcomes. In ophthalmology, these disparities affect eye care utilization increasing the burden of eye care disorders and vision impairment/loss. Various factors contribute to disparities in vision care. They include age, gender, socioeconomic status, geographic location, and race and ethnicity. These factors make it difficult for people affected by eye conditions to access care. Addressing these disparities can help to increase eye care utilization and improve patient outcomes. Some measures that can address these disparities and increase utilization are providing patient education, increasing insurance coverage, implementing community-based eye care programs, using teleophthalmology, providing transport services, providing reminder alerts, and creating community centres that are federally funded among others. This review seeks to identify measures that can help to address disparities in vision and eye care in the US. The review also identifies drivers of health disparities in vision health and how they affect the ability to access care.

Addressing Disparities in Vision Health and Eye Care in the US

Health disparities are a prevalent issue that continues to affect health outcomes. In ophthalmology, these disparities affect eye care utilization increasing the burden of eye care disorders and vision impairment/loss. Various factors contribute to disparities in vision care. They include age, gender, socioeconomic status, geographic location, and race and ethnicity. These factors make it difficult for people affected by eye conditions to access care. Addressing these disparities can help to increase eye care utilization and improve patient outcomes. Some measures that can address these disparities and increase utilization are providing patient education, increasing insurance coverage, implementing community-based eye care programs, using teleophthalmology, providing transport services, providing reminder alerts, and creating community centres that are federally funded among others. This review seeks to identify measures that can help to address disparities in vision and eye care in the US. The review also identifies drivers of health disparities in vision health and how they affect the ability to access care. Keywords: eye disorders, disparities, vision health, eye care, utilization

Nature and Impact of Family Care in the Life of Elderly People: A Study in Dhaka City

Family care is an important issue that plays a significant role in the life of elderly people since the number of elderly people is increasing and the role of the families is also changing. The family structure reduces the number of caregivers in the family, and it has a crucial implication on the healthy life of older people. The objective of this study is to explore the nature and impact of family care in the life of elderly people in Dhaka city. This study is mainly qualitative in nature and the case study method was followed to understand the in-depth situation of family caregiving. Through a purposive sampling technique, 20 families were selected as cases from the Dhaka South City Corporation area. In-depth interviews were conducted to collect some qualitative data. The study findings indicated that the majority of elderly people get care from spouses and children to perform the basic activities necessary for daily life where women play a vital role. Family members provide both daily living and instrumental support to the elderly people. Moreover, this study found that lack of family attachment, busy urban life, professional stress, involvement of women in the labor market, migration of youth, individualism, limited formal and non-formal caregivers, lack of proper health and disease related information and knowledge, and apathetic attitude are the major challenges for getting adequate and effective elderly care. The findings suggest home-based and community-based care program is needed to support family caregivers and older people to stay in their homes and communities.

A retrospective cohort study of a community-based primary care program's effects on pharmacotherapy quality in low-income Peruvians with type 2 diabetes and hypertension.

Little is known about the effects of the Chronic Care Model (CCM) and community health workers (CHWs) on pharmacotherapy of type 2 diabetes and hypertension in resource-poor settings. This retrospective cohort implementation study evaluated the effects of a community-based program consisting of CCM, CHWs, guidelines-based treatment protocols, and inexpensive freely accessible medications on type 2 diabetes and hypertension pharmacotherapy quality. A door-to-door household survey identified 856 adults 35 years of age and older living in a low-income Peruvian community, of whom 83% participated in screening for diabetes and hypertension. Patients with confirmed type 2 diabetes and/or hypertension participated in the program's weekly to monthly visits for < = 27 months. The program was implemented as two care periods employed sequentially. During home care, CHWs made weekly home visits and a physician made treatment decisions remotely. During subsequent clinic care, a physician attended patients in a centralized clinic. The study compared the effects of program (pre- versus post-) (N = 262 observations), and home versus clinic care periods (N = 211 observations) on standards of treatment with hypoglycemic and antihypertensive agents, angiotensin converting enzyme inhibitors, and low-dose aspirin. During the program, 80% and 50% achieved hypoglycemic and antihypertensive standards, respectively, compared to 35% and 8% prior to the program, RRs 2.29 (1.72-3.04, p <0.001) and 6.64 (3.17-13.9, p<0.001). Achievement of treatment standards was not improved by clinic compared to home care (RRs 1.0 +/- 0.08). In both care periods, longer retention in care (>50% of allowable time) was associated with achievement of all treatment standards. 85% compared to 56% achieved the hypoglycemic treatment standard with longer and shorter retention, respectively, RR 1.52 (1.13-2.06, p<0.001); 56% compared to 27% achieved the antihypertensive standard, RR 2.11 (1.29-3.45, p<0.001). In a dose-dependent manner, the community-based program was associated with improved guidelines-based pharmacotherapy of type 2 diabetes and hypertension.

Planning, implementing, and evaluating Hepatitis C virus elimination via collaborative community-based care cascade: age–period–cohort model for estimating demand from antecedent anti-HCV survey

BackgroundEstimating the demand for HCV care cascade plays an important role in planning, monitoring, and assessing the performance of introducing a new community-based hepatitis C virus (HCV) elimination program but such an analytic and systematic approach has been barley addressed.MethodsA new collaborative care program for HCV elimination in the Changhua Community of Taiwan has been offered to a total of 895,353 residents since 2018. To grasp the variation of demand for HCV care cascade across demographic and geographic features in the planning stage, we applied the age–period–cohort spatial model to the antecedent anti-HCV survey enrolling 123,617 participants aged 30 years or older between 2005 and 2018. Based on this precise denominator, we then employed a “before-and-after” study design to routinely evaluate whether the WHO criteria of 90% RNA positive diagnosis and 80% successful treatments could be reached.ResultsThe overall demand for HCV care cascade was 4.28% (HCV infection) of the underlying population but a declining trend was noted. The early cohort had a higher demand, whereas the demand of the young cohort decreased with each passing year. The demand also differed by township. The demand, allowing for these variations, for antiviral treatment was 22,362, yielding the WHO target of 12,880 for achieving HCV elimination. With 11,844 successful treatments, the effectiveness of elimination has already reached 92% (11,844/12,880) by the end of 2022.ConclusionsThe demand for HCV care cascade allows health care decision-makers to timely and properly assess the performance of a novel community-based collaborative care program in achieving HCV elimination.

Community-Based Wound Care Programs for Unhoused Individuals.

Wound care management for unhoused individuals is challenging due to the lack of healthcare infrastructure to handle the unique needs of this population. Therefore, we aimed to obtain insights for best practices and to establish a care clinic that is low threshold, community-based and meets the needs of unhoused people. We employed two approaches: (1) conduct a targeted narrative review of the literature of existing or proposed community-based program models that can address the wound care needs of unhoused individuals, and (2) assess cost-effectiveness and describe the results of a survey administered to unhoused clients and their health care providers at a community-based wound care program in Honolulu, Hawai'i. The literature search and screening yielded 11 articles relevant to the topic. Per the literature, existing community-based healthcare programs were successful when: (1) wound care services were incorporated into a broader social/health program, (2) cost-effective, and (3) comprehensive services were provided. Survey results in Honolulu found that the wound care program matched the needs of the targeted population and was cost-effective. Difficulty in following clients until wound closure and the sustainability of the program, particularly the lack of insurance reimbursement for street-based services, were perceived challenges. Additionally, the lack of insurance reimbursement for street-based wound care services continues to impact sustainability. Community-based programs can be successful in addressing the wound care needs of unhoused individuals if they address complex fundamental issues. This paper highlights existing gaps in logistics and policies that must be addressed to meet the specific medical needs of these vulnerable individuals.

Evaluation of the Behavioral Determinants of Infant Oral Hygiene Practices in a Rural Area.

Background Dental caries is one of the most common oral health diseases in children. Early childhood caries (ECC) in children can lead to delayed overall growth in the future. This can be prevented by early initiation of infant oral hygiene practices (IOHP). As mothers are the primary caregivers, assessing their behavioral factors that play a significant role in IOHPcan help design a customized health prevention plan for appropriate infant oral hygiene practices. Methodology A questionnaire based-study was carried out in an Anganwadi(rural child care center in India) of Nagpur region,Central India, for two months. Parents of young children were interviewed about the oral health care of children. The study was planned to evaluate the various methods used by parents to perform IOHP and to identify various behavioral determinants that affect IOHP. An integrative model of behavior change was used to evaluate factors determining the behavioral determinants in performing oral hygiene. Results Out of 144 parents, 105 (72.92%) initiated IOHP immediately after birth. Most of them (76, 52.78%) used a moist cloth to clean the oral cavity. The other methods used were the parent's finger, water, etc. Most of the parents were unaware of commercially available oral wipes.Out of the various factors of behavioral determinants of integrative theory, oral health beliefs, emotional reactions, self-standard, and skills played a significant role in modifying parents' intention to maintain the oral hygiene of young children. There was a direct correlation between the educational qualification of the mother and oral hygiene practices. Conclusion The results of this study reveal an integrative structure that includes factors like oral health beliefs, emotional reactions, self-standard, external support, social norms, and skills that are responsible for the behavior of parents towards oral health care. These factors vary from individual to individual. Modifying these specific behavioral determinants in parents could improve the oral hygiene practices of infants and toddlers. Community-based oral health care programs should be tailormade to target these specific barriers.

Equity in maternal healthcare utilisation in Ghana: Do community-based primaryhealth care programmes matter?

Improving equity in the use of maternal health services in rural and remote communities is critical to meeting the Sustainable Development Goals targets on maternal and child health. This study examines the effect of a community-based primary healthcare strengthening programme on improving the utilisation of antenatal care (ANC4+), skilled delivery and health facility delivery. Baseline and endline survey data of women of reproductive age for intervention and comparison districts were used to examine the equity impact of the Ghana Essential Health Interventions Programme (GEHIP) on antenatal care visits, skilled delivery and health facility delivery. The Wagstaff extension of the concentration index and regression models are used to assess equity effects of the programme on the utilisation of these services by wealth index and educational attainment. Coverage rates increased for both intervention and comparison districts, but were generally higher in intervention districts than comparison districts at endline (90% vs. 88% for ANC4+, 88% vs. 84% for skilled delivery and 93% vs. 88% for health facility delivery). Only ANC4+ showed a statistically significant positive treatment effect of the intervention (Dif-in-Dif = 0.071, p-value = 0.010). Equity analysis showed a mixed picture with intervention districts achieving significant equity improvement for skilled delivery for both wealth index and maternal education but only education equity for health facility delivery, while comparison districts achieved both wealth and education equity improvements for two indicators (health facility delivery and skilled delivery). No significant equity/inequity effects were found for ANC4+. Efforts to improve community-based healthcare access have been associated with improved coverage of maternal health services; however, the effect on improving equity in service coverage is mixed. Results indicate a need to extend community-based primary health care development beyond general improvements in access to ensure equity in the coverage of maternal and child health services that such programmes provide.

Social deprivation, the Area Deprivation Index, and emergency department utilization within a community-based primary and preventive care program at a Florida medical school

Social deprivation, the Area Deprivation Index, and emergency department utilization within a community-based primary and preventive care program at a Florida medical school

Co-designing implementation strategies to promote remote physical activity programs in frail older community-dwellers.

The "AGIL Barcelona (AGILBcn)" community-based integrated care program is a multicomponent healthy aging intervention for frail older adults. In this context, the present study aimed to identify implementation strategies to optimize the accessibility, acceptability, and adaptability of mobile health (mhealth) interventions to enhance physical activity in frail older adults, and to prioritize action points according to their importance and feasibility, through a co-design process. A mixed methods approach was used. In the qualitative phase, a method adapted from the World Café was applied in 6 virtual groups to identify strategies to facilitate the virtual physical activity program. In the quantitative phase, prioritization and feasibility of the strategies was analyzed through surveys. Strategies were ranked based on priority vs. feasibility, revealing if strategies should either be: implemented first; if possible; taken into account for future consideration; or directly disregarded. The convenience sample included older adults (n = 7), community professionals (n = 9) and health professionals (n = 13). Qualitative data were analyzed by summative content analysis and quantitative data by nonparametric descriptive analyses. A total of 27 strategies were identified and grouped into four categories: general strategies for reducing barriers; specific strategies for facilitating the use of a digital application; specific strategies for facilitating participation in virtual exercise groups; and specific strategies for facilitating external support. According to the ranking of strategies, the first ones to be implemented included: digital literacy, digital capability assessment, family technology support, weekly telephone follow-up by professionals, personalizing exercises, and virtual exercises in small groups. The active participation of all stakeholders enabled us to identify potential strategies for implementing person-oriented technology in physical activity programs and for engaging older adults.

Palliative care management committees: a model of collaborative governance for primary health care.

The community-based primary palliative care programme in Kerala, India, has received international acclaim. Programme functioning is supported through Palliative Care Management Committees (PMCs) at the local government (LG) level. To study the functioning of the PMCs within the decentralised governance space to identify achievements, gaps and notable innovations. This qualitative study included seven key informant interviews (KIIs), 28 in-depth interviews and a review of relevant publicly available policies and documents. Major themes were recognised from the KII transcripts. Codes emerging from the document review and in-depth interview transcripts were mapped into the identified thematic areas. Successful PMCs raised resources like money, human resource, equipment, had good skilled care options for symptom relief and facilitated reduced out-of-pocket expenditure by providing home care and free medicines, and improved access to interventions that addressed the social determinants of suffering like poverty. PMCs had varying managerial and technical capacities. In some LGs, the programme was weak and mostly limited to the supply of medicines, basic aids and appliances to patients' homes. Despite varied implementation patterns, PMCs in Kerala are examples of state-supported, community-owned care initiatives, that can potentially address medical and social determinants of suffering.

Health and social care of home-dwelling frail older adults in Switzerland: a mixed methods study

BackgroundHome-dwelling frail older adults are often faced with multimorbidity and complex care needs, requiring health and social care systems that support frail older adults to age in place. The objective of this paper was to investigate the types of formal health and social care as well as informal care and social support used by home-dwelling frail older adults; whether they perceive their support as sufficient; and their experience with and preferences for care and support.MethodsUsing an explanatory sequential mixed methods design, we first conducted a secondary analysis of a subset of cross-sectional data from the ImplemeNtation of a community-baSed care Program for home dwelling senIoR citizEns (INSPIRE) population survey using descriptive analysis. Subsequently, we analyzed existing data from interviews in the parent study to help explain the survey results using applied thematic analysis. Results were organized according to adapted domains and concepts of the SELFIE framework and integrated via a joint display table.ResultsOf the parent population survey respondents, 2314 older adults indicating frailty were included in the quantitative arm of this study. Interview data was included from 7 older adults who indicated frailty. Support from health and social, formal and informal caregivers is diverse and anticipated to increase (e.g., for ‘care and assistance at home’ and ‘meal services’). Informal caregivers fulfilled various roles and while some older adults strongly relied on them for support, others feared burdening them. Most participants (93.5%) perceived their overall support to meet their needs; however, findings suggest areas (e.g., assessment of overall needs) which merit attention to optimize future care.ConclusionsGiven the anticipated demand for future care and support, we recommend efforts to prevent fragmentation between health and social as well as formal and informal care.

An evaluation of a community-based vision care programme for the elderly

BackgroundThis study evaluated the real-world effectiveness and potential cost-effectiveness of a community-based vision care programme for the elderly population aged 60 years or above.MethodsData from a total of 8899 subjects participating in a community-based comprehensive vision care programme from 2015 to 2019 were analysed to evaluate the effectiveness of the programme in terms of the prevalence of distance visual impairment (VI), the change in the prevalence of distance VI after refractive error correction, and the types of ocular disorders suspected. Distance VI was defined as a) visual acuity (VA) worse than 6/18 in any eye (worse eye) and b) VA worse than 6/18 in the better eye. The cost-effectiveness from the funder’s perspective was also estimated in terms of cost per distance VI avoided.ResultsBased on the presenting vision of the worse eye, the prevalence of distance VI was 39.1% (3482/8899, 95% CI: 38.1%-40.1%) and reduced to 13.8% (1227/8899, 95% CI: 13.1%-14.5%) based on best-corrected VA. Referenced to the presenting vision of the better eye, the prevalence of distance VI was 17.3% (1539/8899, 95% CI: 16.5%-18.1%) and decreased to 4.2% (373/8899, 95% CI: 3.8%-4.6%) with best optical correction. Uncorrected refractive error was the major cause of presenting distance VI. From the funder’s perspective, the cost per distance VI case prevented was HK$1921 based on VA in the worse eye and HK$3715 based on the better eye.ConclusionThis community-based programme identified distance VI in the best eye of 17 out of every 100 subjects. With appropriate new or updated distance optical corrections, distance VI was reduced to about 4 in 100 subjects. Visual impairment in the elderly is common even in a relatively affluent city. A model of care which could minimise avoidable distance VI would bring benefits at individual and societal levels.

Exploring community-based HIV/AIDS awareness creation among the Gusii people of Kenya

The study purposed to investigate the exploring community-based HIV/AIDS awareness creation among the gusii people of Kenya. The study used a case study design. The target population was 300,000 people affected and infected by HIV and AIDS epidemic within Kisii Municipality. From an accessible population of 500 people, a sample size of 239 was purposively selected, out of which 128 PLWHAS were support group members, whereas 74 were not, and 25 were family caregivers. Data were collected using questionnaires. The reliability of the instruments was confirmed. The questionnaires yielded a reliability coefficient of 0.7 15. SPSS version 12.5 for windows) was used to analyse d a. The t-tests were employed to establish whether there were any differences between support group attendances, gender and stress levels of PLW AS. On the other hand, the Chi-square test was employed to establish whether there was any association between Mwanyagetinge Community-Based Care and awareness and prevention of HIV/A DS. The study established that the Mwanyagetinge community-based care programme had significantly contributed to raising their level of awareness and mobilising PLWHAS to be agents of prevention rather than spread. With the adverse effects of HIV in our society and schools, counselling curricula in the universities should include an in-depth and mandatory study on the PLWHAS.

Gendered stress levels and support group attendance among persons with HIV in Kenya

The study purposed to determine the difference in stress levels of PLWHAS based on gender and support group attendance in Kisii municipality. The study used a case study design. The target population was 300,000 people affected and infected by HIV and AIDS epidemic within Kisii Municipality. From an accessible population of 500 people, a sample size of 239 was purposively selected, out of which 128 PLWHAS were support group members, whereas 74 were not, and 25 were family caregivers. Data were collected using questionnaires. The reliability of the tools was checked through a pilot study. The questionnaires yielded a reliability coefficient of 0.7815. SPSS version 12.5 for windows was used to analyse data. The t-tests were employed to establish whether there were any differences between support group attendances, gender and stress levels of PLWHAS. A t-test for equality of means to establish the difference between stress levels by gender yielded a two-tailed - level of 0.051, which is not significant at a 0.05 level of significance. The study concluded that there is no difference in stress levels by gender. Both men and women go through stress; therefore, it is important for them to undergo counselling. This can be done through empowering community-based care programmes. Mass education and campaign using media, barazas and churches should be carried out on the rights and privileges of PLWHAS as a first step to recognise PLWHAS as human beings deserving respect and dignity.

Community health workers' non-technical skills for delivering primary healthcare in low-income areas.

To overcome the poor conditions of low-income areas in developing countries like Brazil, Community Health Workers (CHWs) are required to exceed the regular set of formal skills they are used to employ. In this study, we aim at identifying the non-technical skills CHWs must develop to cope with the extraordinary situations that occur in vulnerable communities. 41 CHWs based in two primary healthcare clinics in Brazil underwent two rounds of in-depth interviews. The analysis was carried out using the Analytical Hierarchy Process, resulting in the prioritization of social skills according to their calculated importance to house calls. Among the ten higher-scored skills, we find communication and advocacy skills being of high importance. Civility was found to be the most important attribute, confirming that community action relies strongly on the relationship between health professionals and the community. The results of our study contribute primarily to the improvement of community-based primary care programs as it helps to identify major skills required for community action.

Community Primary Care-Based Hypertension and Diabetes Management Program in Korea: Evaluation of Participating Patients and Doctors.

Background:This study was conducted to examine the effectiveness of a community-based primary care program focused on hypertension and diabetes in Korea.Methods:We selected patients and doctors who participated in the community-based primary care program as study subjects from Aug 2015 to Jan 2016. Patients and physicians completed a survey, and medical records were reviewed to obtain information regarding clinical variables. Change in the baseline recognition of diseases, motivation for changing health behavior, medical services utilization, doctor-patient relationship were assessed after participation in the program.Results:Both patients and physicians indicated there was improvement in recognition of disease, motivation for changing health behavior, medical services utilization, and doctor-patient relationship (All of recognition scores were above the median point). Patient health behavior such as exercise, smoking, drinking and diet and clinical variables (blood pressure and blood glucose and cholesterol level) also showed significant improvement.Conclusion:The community-based primary care program was found to be helpful in improving hypertension and diabetes patients’ overall outcomes and their healthcare providers’ behavior.

Self and professional treatment of skin and soft tissue infections among women who inject drugs: Implications for wound care provision to prevent endocarditis

BackgroundSkin and soft tissue infections (SSTI) are common among people who inject drugs and can result in severe health consequences, including infective endocarditis. Numerous barriers to accessing care often prevent people who inject drugs from seeking healthcare including past negative healthcare experiences, transportation, and shame around drug use. These barriers can lead some people who inject drugs to self-care instead of seeking formal treatment. MethodsWe explored the prevalence of SSTIs and associated treatment behaviors among women who inject drugs and sell sex (N = 114). Women reported their drug use and SSTI histories. Those who experienced an SSTI reported if they self-treated their SSTIs and/or sought formal treatment. ResultsHalf (50.0%) experienced at least one SSTI in the past 6 months. SSTIs were more common among those who injected painkillers (24.6% vs 8.8%, p = 0.02) and who had ever been treated for endocarditis (28.1% vs 10.5%, p = 0.02). SSTIs were less common among those who injected multiple times per day (17.9% vs 38.6%, p = 0.01) and always injected with a sterile syringe (19.3% vs 42.1%, p = 0.01). Among those who experienced an SSTI, most (85.7%) reported self-treating, and half (52.6%) sought formal care. The emergency room was the most common source of care (73.3%). ConclusionsWhen experiencing SSTIs, women often opted to self-treat rather than seek formal healthcare. A lack of formal care can lead to infections progressing to serious conditions, like endocarditis. Self-treatment with non-prescribed antibiotics may further result in antibiotic-resistant infections. Low threshold, stigma free, community-based wound care programs are warranted.

Classification of Program Types and Cost Prediction of Integrated Care for the Elderly.

This paper analyzes the types of community-based integrated care programs based on the needs of consumers and estimates future costs through data on consumer-oriented integrated care for the elderly in the local community operated by Korea, which is experiencing rapid aging. By analyzing the types of programs and the composition of budget items, we check the composition of the program from the consumer side of the integrated care program in the local community and predict the national budget for each item to operate it. Through this, policy implications for business operation and implications for sustainable financial management are derived.