Community-based Health Education Research Articles

Oral health status of children and adults in the Republic of Niger, Africa

The present study was undertaken in order to describe the oral health status of children and adults in the Republic of Niger and to provide baseline data for the organisation and evaluation of systematic oral health promotion programmes in the country. The WHO pathfinder sampling procedures were applied to obtain representative samples of the following age groups: 6 years (n = 373); 12 years (n = 400); 18 years (n = 300) and 35-44 years (n = 400). Data were collected in 1997 according to the WHO methods, including information on dental caries and CPITN. In 6-year-olds, 56 per cent had caries and a mean score of 1.3 DMFT was observed among the 12-year-olds; the 35-44-year-olds had an average score of 5.7 DMFT. Differences in dental caries prevalence were found according to sex, province and urbanisation. Ninety-nine per cent of individuals at age 18, and 87 per cent at age 35-44 had maximum CPITN score 2 (calculus). Where 6- and 35-44-year-olds are concerned, the data may indicate increasing levels of dental caries. The implementation of primary prevention and community-based oral health education is therefore a matter of urgency.

Sexualities as Social Roles Among Asian- and Pacific Islander American Gay, Lesbian, Bisexual, and Transgender Individuals: Implications for Community-Based Health Education and Prevention

Purpose: The aims of this paper are (a) to examine sexualities (especially homosexuality, bisexuality, and transgenderism) and their correlates among Asian- and Pacific Islander (API) Americans, and (b) to explore their implications for community-based health education and prevention targeting API gay, lesbian, bisexual, and transgender (GLBT) individuals. Study selection: Derived from the literature of human sexuality, sex-roles socialization, and cross-cultural psychology, a framework was developed to examine sexualities as social roles among APIs. Data synthesis: There are three major sections to this article. The first section is a sociohistorical analysis about the diversity of the API communities, followed by a brief review of health beliefs and practices among APIs. The second section examines the framework used to study sexualities among APIs. In the last section, implications for API community-based health education and prevention targeting GLBT individuals are examined in light of a case study. Conclusions: Sexualities among APIs are discussed using a sexualities-as-social-role paradigm. This paradigm emphasizes the powerful influences of cultural forces in articulating social roles or scripts on sexualities. Sexual expression(s) and its correlates (e.g., identity) among API GLBT individuals are the product of a “relational” rather than a “linear” process—a premise that differentiates it from the “sexual script theory.” A fact-based case study was used to illustrate the various concepts of the paradigm.

Breast cancer screening adherence in African-American women

African Americans suffer a disproportionate burden of illness. Afrocentric, community-based health education programs that create permanent health resources within the community offer a viable means to reduce morbidity and mortality. This feasibility study randomized African-American cosmetologists into two groups of peer health educators and trained them to pass along health information to their clients. Cosmetologists in one arm were trained to become actively involved peer health educators, whereas, in the other arm, they were trained to be informed generally about the information they were passing along to their clients. An African-American ancestral storyteller refined the cosmetologists' storytelling skills to facilitate inclusion of key health facts and their repetition to others. Cosmetologists and their clients reported high acceptance of the cosmetologists as peer health educators. Cosmetologists preferred the active involvement in health education over the more passive role and reported no negative consequences to their business. Reported adherence to screening guidelines exceeded the Year 2000 goals for mammograms. Although the reported awareness of and training for breast self examination (BSE) were high, neither the cosmetologists' nor their clients' initial BSE skills suggested that prior teaching had occurred to the point of mastery. Clients reported their willingness to share their health-promotion information with other women. Although difficulties recruiting and retaining women to this research study were reduced by this Afrocentric model, they were not resolved entirely. Overall, this health-promotion model offers considerable promise as a way to reach African-American women with health-promotion information, whereas the feasibility study identified design modifications that will be necessary prior to project expansion. Cancer 1998;83:1836-1839. © 1998 American Cancer Society.

Promoting Opportunities for Community Based Health Education in Managed Care

The recent transformation to managed care in this country has not only changed the financing of health care, but has also placed a premium on health education in several ways. The Health Resources and Services Administration (HRSA), an agency of the U.S. Department of Health and Human Services, is working with community-based health care organizations to take advantage of opportunities for health education offered by managed care. HRSA has developed a workbook to help Federally Qualified Health Centers, which receive funding from HRSA, to provide primary health care to underserved populations, and to develop culturally and linguistically appropriate programs for educating their clients about how to effectively access and utilize health services under Medic-aid managed care. This article discusses health education principles highlighted in the workbook and describes how these principles are applicable to other managed care health education programs, using an asthma intervention program at a HRSA-funded community health center as an example.

Appraising and Funding Participatory Research in Health Promotion

Participatory action research combines research, education and social action. Each of these elements reflects health education research and practice. Indeed, health education, health promotion and participatory research have converged in these respects. Participatory research is well suited to the philosophies and theories underpinning community-based health education and health promotion. The nature of participatory research is such that funding agencies, especially those awarding research funds, tend to be challenged in their attempts to assess proposals. This is true at least for those agencies operating under traditional criteria for reviewing standards, which may not be appropriate for participatory research. As well, it may reflect a broader lack of common understanding about the processes and expectations, the apparent untidiness of projects (comparing with traditional research) which by their nature offer no standard methods, deadlines, procedures or predetermined outcome measures. The Study of Participatory Research in Health Promotion [1], commissioned by the Royal Society of Canada, attempted to clarify the topic by providing a working definition and a set of guidelines for use by funding agencies when appraising projects purporting to be participatory research. The guidelines emphasize how the normal ways of conducting health research in populations need to adapt to meet the educational and policy expectations of participatory research. The study also examined current practical examples of participatory research in the field of health promotion in Canada. This summary of the results of the project provides detailed guidelines flowing from a review of experience in the field and consultation with groups engaged in participatory research.

Community-based health education for urban populations: an overview.

Community-based health education for urban populations: an overview.

自記式食事歴法質問票を用いた簡単な個別栄養指導が栄養素等摂取量の改善に及ぼす効果 地域における軽症高コレステロール血症者を対象とした健康教室の例

Cardiovascular disease, which progresses by many risk factors with their interactions, has different causes at an individual level. The strategy required against it is also different among the subjects. An assessment of a patient's lifestyle in detail and strategy focused on the specific problems should, therefors, be performed. However, the methods to assess lifestyle in detail and to use the results for patient education have not yet fully been established for the health education programs carred out in Japan. A health education program against hypercholesterolemia, which is one of the cardiovascular risk factors, also has the same problem. A self-administered diet history questionnaire (DHQ) was used to assess dietary habits, especialy nutrient intake, at an individual level and the results applied for brief dietar ycounselling, in addition to conventional group-education during a 4 -month health education program performed in Hikone city, Shiga prefecture, Japan. A control group with only con-ventional group-education was established for comparison. After the program had been completed, statistically significant favorable changes in the intake level of saturated fatty acids, P/S rati, and Keys score were apparent for only the case group. The cholesterol intake level also declined, although no statistically significant difference was apparent between the groups. There was no significant change in any other nutrients in both groups. The results indicate that an individual dietary assessment and brief counselling based on DHQ might be effective for dietary modification with a community-based health education program in which group-education has normally been used.

Degos' disease

<h3>ABSTRACT</h3> <h3>Background:</h3> Over 43% of children living in low- and middle-income countries are at risk for developmental delays; however, access to protective interventions in these settings is limited. We evaluated the effect of maternal participation in Chamas for Change (Chamas)—a community-based women9s health education program during pregnancy and postpartum—and risk of developmental delay among their children in rural Kenya. <h3>Methods:</h3> We analyzed developmental screening questionnaire (DSQ) data from a cluster randomized controlled trial in Trans Nzoia County, Kenya (ClinicalTrials.gov, NCT03187873). Intervention clusters (Chamas) participated in community health volunteer-led, group-based health lessons twice a month during pregnancy and postpartum; controls had monthly home visits (standard of care). We screened all children born during the trial who were alive at 1-year follow-up. We labeled children with any positive item on the DSQ as “at-risk development.” We analyzed data using descriptive statistics and multilevel regression models (α=.05); analyses were intention-to-treat using individual-level data. <h3>Results:</h3> Between November 2017 and March 2018, we enrolled 1,920 pregnant women to participate in the parent trial. At 1-year follow-up, we screened 1,273 (689 intervention, 584 control) children born during the trial with the DSQ. Intervention mothers had lower education levels and higher poverty likelihood scores than controls (<i>P</i>&lt;.001 and <i>P</i>=.007, respectively). The overall rate of at-risk development was 3.5%. Children in Chamas clusters demonstrated significantly lower rates of at-risk development than controls (2.5% vs. 4.8%, <i>P</i>=.025). Adjusted analyses revealed lower odds for at-risk development in the intervention arm (OR=0.50; 95% confidence interval=0.27, 0.94). <h3>Conclusions:</h3> Maternal participation in a community-based women9s health education program was associated with lower rates of at-risk development compared to the standard of care. Overall, rates of at-risk development were lower than expected for this population, warranting further investigation. Chamas may help protect children from developmental delay in rural Kenya and other resource-limited settings.

A Program to Reduce Cardiovascular and Cerebrovascular Disease in the Czech Republic: Design and Methods of the Healthy Dubec Project

Cardiovascular Disease (CVD) morbidity and mortality rates in the Czech Republic are among the highest in the industrialized world. Due to the substantial burden CVD plays on the health and well being of the Czech society, a variety of health promotion/disease management strategies to reduce CVD risk need to be designed and implemented. A project that combined community-based health education programs designed to address pervasive perceptions and cultural traditions that influence lifestyle factors, with secondary and tertiary prevention clinical strategies to aggressively treat high-risk individuals was recently conducted in Dubec, a small Czech community. This article describes the methods used in this project (i.e., the Healthy Dubec Project) which took American-based technology and experiences in community risk reduction methods and clinical management strategies for high risk patients and adapted them to fit the Czech people and their attitudes about CVD risk behaviors.

Community based health education: general practitioners' perceptions of their role and willingness to participate.

This study aimed to: 1. determine general practitioners' perceptions of their appropriateness to conduct community based health education; 2. assess the proportion of general practitioners who had undertaken group health education in the previous 12 months, and identify the factors that discourage and encourage this activity; and 3. identify appropriate health areas and the community groups that general practitioners would be prepared to address if provided with educational packages on the topic. A random sample of 181 general practitioners (66.5 per cent response rate) completed a mailed questionnaire. General practitioners rated health promotion officers (32.6 per cent) and general practitioners (30.9 per cent) as the most appropriate health care providers to undertake community based health education activities. Of the general practitioners, 38 per cent had undertaken community health education in the previous 12 months, with lack of time, lack of earnings while away from the practice, and lack of confidence in public speaking being the main reasons for not undertaking this activity. Being specifically invited to address groups, being provided with an information package on the topic, and being paid for their time were the three factors most likely to encourage this activity. Skin, cervical and breast cancer, blood pressure and cholesterol, and asthma were the topics general practitioners were most willing to speak on. Although this survey suggests that general practitioners would be willing to undertake this community health education, research is needed on whether they are the most appropriate and effective group for this.

Helping Schoolchildren with Asthma Breathe Easier: Partnerships in Community-Based Environmental Health Education

Hospitalizations and deaths attributed to asthma are increasing, and the disease has disproportionate impacts on children and minority populations, particularly African-Americans. Because asthma hospitalizations and deaths are viewed by many experts as preventable events, and because asthma's toll is so significant in economic terms, increased efforts to reverse these trends, particularly among the most affected groups, are warranted. Reducing exposures to airborne pollutants known to trigger asthma in both indoor and outdoor environments is one important preventive strategy. The public-private partnership effort to implement the Open Airways for Schools asthma management curriculum in urban elementary schools, with its emphasis on pollution prevention, is an example of a community-based effort that may help decrease the toll asthma takes on society.

Helping schoolchildren with asthma breathe easier: partnerships in community-based environmental health education.

Hospitalizations and deaths attributed to asthma are increasing, and the disease has disproportionate impacts on children and minority populations, particularly African-Americans. Because asthma hospitalizations and deaths are viewed by many experts as preventable events, and because asthma's toll is so significant in economic terms, increased efforts to reverse these trends, particularly among the most affected groups, are warranted. Reducing exposures to airborne pollutants known to trigger asthma in both indoor and outdoor environments is one important preventive strategy. The public-private partnership effort to implement the Open Airways for Schools asthma management curriculum in urban elementary schools, with its emphasis on pollution prevention, is an example of a community-based effort that may help decrease the toll asthma takes on society.

An analysis of the relationship among functional fitness tests, life style and bone density of the elderly in O town, Fukuoka Prefecture

A functional fitness test, which is composed of four tests-standing up, walking, hand working, and rope working, was applied to thirty-four elderly women (62.9 +/- 5.2 y.o.) living in O town, Fukuoka Prefecture. The functional fitness level was lower among obese women, and higher among women who were doing more physical activities, as well as those who have more subjects of pleasure in their daily life. Furthermore, there was a positive correlation between the bone density and functional fitness level. The functional fitness test has several favorable characteristics for use in the community based health education for the elderly. For example, 1) it is very easy to conduct and does not require any special pre-test training, 2) it is very safe, 3) as results directly correspond to daily activities, it is rather easy to give concrete advise regarding health promotion in daily life.

HIV/AIDS prevention among female sexual partners of injection drug users in Ciudad Juarez, Mexico.

A participatory community project in the US-Mexico border town of Ciudad Juarez, aimed at helping women who are sex partners of male injection drug users to reduce behaviours which increase their risk for HIV infection, is described and evaluated. The design and implementation of the project were influenced by Paulo Freire's pedagogy in the Latin American tradition of 'popular' education, by Bandura's self-efficacy concepts, and by David Warner's 'barefoot doctor' community health care methodology. Using these approaches the participants were directly involved in the development of teaching materials, and curriculum content and implementation of the project. The programme was evaluated quantitatively using NIDA's AIDS Intake and Follow-up Assessment (AIA/AFA) questionnaires, and qualitatively using open ended interviews. While the AIA/AFA questionnaires detected small changes in the frequency of condom use among the participants, ethnographic interviews detected significant changes in the nature of the behaviours which were placing the women at risk. The changes seem to stem from an increase in the degree of self-esteem, self-efficacy and awareness of the social, economic, and political constraints of their lives. These results demonstrate the need for qualitative measures to be incorporated in the evaluation of community based health education programmes. A series of recommendations is presented to facilitate further development and replication of the programme in similar populations.

An assessment of the cardiovascular health education program in primary health care

Primary health care is an effective means of improving health for all while at the same time containing rising health care costs. In an effort to improve the health of one community, the Cardiovascular Health Education Program (CHEP) was implemented in a study of 44 eighth-grade adolescents. The purpose of this study was to assess the influence of the CHEP on adolescents' cardiovascular health knowledge. It was found that participants' knowledge improved significantly, whereas a control group showed no comparable improvement. This study showed that community-based health education programs for targeted populations can influence health knowledge.

The design of a community-based health education intervention for the control of Aedes aegypti.

This report describes the process used to develop locally appropriate educational materials and to implement the education component of a community-based Aedes aegypti control program in Merida, Yucatan, Mexico. The process is broken into five stages: formative research, developing recommendations for behavior change, development of educational messages, development and production of educational materials, and distribution of the materials. Appropriate terminology and taxonomies for dengue were obtained from open in-depth interviews; baseline data from a knowledge, beliefs, and practices questionnaire served to confirm this information. A larval survey of house lots was carried out to identify the Ae. aegypti larval production sites found on individual house lots. This enabled the program to target the most important larval habitats. Community groups were organized to work on the development of messages and production of the educational materials to be used. The education intervention was successful in stimulating changes in both knowledge and behavior, which were measured in the evaluations of the intervention. To be successful, community-based strategies must be flexible and adapted to the local setting because of ecologic, cultural, and social differences between localities.

The Forsyth County Cervical Cancer Prevention Project--I. Cervical cancer screening for black women.

The Forsyth County Cervical Cancer Prevention Project was a 5 year National Cancer Institute-funded community-based public health education program implemented to address the problem of excess mortality from cervical cancer among black women in Forsyth County, North Carolina. The intervention was a community-based public health education program that included mass media, direct education workshops, and provision of education on cervical cancer and screening to health care providers. The intervention was implemented from November 1988 to September 1991. Evaluation of the community intervention used a quasi-experimental design, with Forsyth County, North Carolina, receiving the program and Durham County, North Carolina, serving as the control. Comparison of pre- and post-intervention telephone survey data revealed that, overall, awareness of cervical cancer and the Pap smear increased. Knowledge, attitudes and behaviors showed little change, considering those interviewed in aggregate. Among women defined as high-risk (elderly, low socioeconomic status, public health clinic patients and/or those who do not receive regular care), a significant trend toward greater participation in screening was detected for the 6 month period following the intervention. These results suggest that awareness of cervical cancer can be increased by public health education, but that the additional attention coming to patients through the actions of health care providers and health care delivery systems may supply the additional input needed to produce behavior change.

Academic detailing: A model for in-office CME

The National Cancer Institute (NCI), in its goal to reduce cancer mortality by 50% by the year 2000, has placed a special emphasis on prevention and early detection, especially in underserved populations. Check-Up On Health is a community based health education program being carried out by Fox Chase Cancer Center in three inner city Philadelphia neighborhoods, to improve the provision of appropriate cancer screening and prevention services to older, blue-collar adults by their primary care physicians. Primary care physicians in the chosen neighborhoods were targeted to receive a brief cancer prevention educational message delivered by project staff and patterned on the model of drug detailing developed by the pharmaceutical industry. This study represents an attempt to evaluate the feasibility and acceptability of such an approach aimed at improving cancer prevention promotion in the health care system. Primary care physicians were identified by community residents who attended one of 67 Check-Up On Health education presentations about cancer prevention at churches, social clubs, and senior-citizen centers within the targeted neighborhoods. An attempt was then made by project staff to visit each identified physician in his/her office or clinic, during office hours, both to conduct a brief survey and to deliver an educational message about either cancer screening guidelines or counseling for smoking cessation. The physicians were also provided with educational materials for themselves as well as their patients. Twelve months after the visit, a follow-up phone call to the physicians assessed the impact of the visit and solicited suggestions for future outreach efforts.(ABSTRACT TRUNCATED AT 250 WORDS)

Determinants of night blindness in Bangladesh.

A cross-sectional study was conducted to evaluate the effect of a community-based health education intervention programme and to study the determinants of night blindness in Bangladesh. The intervention programme was implemented to reduce the morbidity of nutritional blindness (night blindness) in the northern part of Bangladesh (Ranjpure district) during 1986-1989. A baseline study in 1986 covered 2010 households with a total population of 11,600, and the evaluation study in 1989 covered 2011 households with a total population of 10,456. Prevalence of night blindness was studied among children aged < 9 years in these households. The prevalence of night blindness per 1000 children was reduced significantly during the intervention period from 50.7 in 1986 to 26.7 in 1989. However, the post-intervention prevalence varied significantly between areas. Multivariate analyses showed that consumption of fish, meat, milk or eggs, dark green leaf vegetables, yellow fruits and vitamin A capsules were significant predictors of night blindness. In addition, family income, mother's literacy, family size and area of residence exhibited strong and statistically significant associations with night blindness in the 1989 cross-sectional study. The prevalence of night blindness was highest among 4-6 year old girls and 7-8 year old boys. The sex difference was, however, not statistically significant.

Implementation of mass media community health education: the Forsyth County Cervical Cancer Prevention Project.

The Forsyth County Cervical Cancer Prevention Project (FCP) is a community-based health education project funded by the National Cancer Institute. The target population includes around 25 000 black women age 18 and older who reside in Forsyth County, North Carolina. The overall goal of the program is to prevent mortality from cervical cancer by promoting Pap smears and return for follow-up care when needed. Based on the principles of social marketing, a plan to reach the target population with mass media educational messages through electronic and print channels was developed. Guided by marketing objectives, the target population was divided into relatively discrete segments. The segments included church attenders, patients in waiting rooms of public and selected health providers, female students at local colleges, shoppers, viewers of radio and television, newspaper readers, and business owners and managers. Introduction of the program was based on strategies developed for reaching the target population in each segment with television, radio and print mass media messages. Qualitative assessment of the mass media developed by the program indicated that all forms of communication helped to increase awareness of the program.