Community-based Health Initiatives Research Articles

IJCM_249A: Assessment of availability of drugs & logistics on Village Health Sanitation and Nutrition Day (VHSND) sessions of Raipur district, CG- A cross-sectional observational study

Background: Maternal and Child health remains one highly pervasive and damaging condition in low-middle-income countries. To improve the situation Govt. of India in 2007 initiated VHSND, as an effective platform for delivering healthcare services at the doorsteps of the unserved and underserved village population, improving awareness and access of the community for health services thereby leading to improvement in the health indicators.,(VHSND) are community-based health initiatives designed to bring essential healthcare services to the doorsteps of rural populations. These sessions serve as a crucial platform for promoting health, hygiene, and nutrition awareness within villages. Organized regularly, VHSNDs aim to address a spectrum of health issues, ranging from maternal and child health to sanitation and nutrition. The success of VHSNDs relies heavily on community participation. These sessions not only offer immediate health services but also empower communities by fostering a sense of ownership over their well-being. By engaging with local residents, VHSNDs contribute to the overall improvement of health indicators and the quality of life in rural areas. In summary, VHSNDs play a vital role in bridging the healthcare gap in rural communities, emphasizing preventive healthcare, and promoting a holistic approach to well-being. They embody the collaborative efforts of health professionals, community leaders, and residents to create healthier and more resilient villages. Objective: 1. To assess the status of logistic availability on VHSND sessions of Raipur District Methodology: A cross-sectional study was conducted to assess the status of logistic availability on 30 VHSND sessions of Raipur district during March- July 2023 in Chhattisgarh by observation and pre-tested pre-designed semi- structured questionnaires. Results: It was observed that out of 30 VHSND sessions site, 77 % were held as per the micro plan and from those 90% ANM, 97% ASHA, 84% Anganwadi workers, 57% Anganwadi helpers, and only 10% PRI members were present at the site of the session. Only 56% of session sites were supervised by supervisors, 28 (93.33%) session sites had drinking water facilities, 21 (70%) sites had toilet facilities, and only 25(83.33%) sites had electricity connectivity. BP Instrument, Stethoscope, Weighing scale, Hemoglobinometer, Glucometer, Disposable syringe 5ml, Disposable syringe 0.5 ml, Disposable syringe 0.1, MCP card, Examination table, were above (90%) present in most of the VHSND sessions. Out of 30 Sessions Stadiometer (19) Fetal Doppler (15), Curtains (21), Stepping stool for climbing on the examination table (17), and Referral slip (5) are present in the VHSND sessions. Nischaya kit, VDRL, HIV, and RDK for malaria kit were present in 74%,43%,97%, and 93% respectively. Iodized salt testing is not available in any sessions. All vaccines were available 100% except BCG, DPT, and Td, which were present in 87%,93%, and 90% sessions. AEFI Kit was available in 80% of sessions. Condom, OCPs, and Centchroman were present most of the site of the sessions but Inj. MPA, IUCD, and emergency contraceptive pills were available only in 14%,37%, and 14% of sessions respectively, 7.23 (77%) of the session sites have Information displayed about the day, time, and site of the VHSND session, Conclusion: Most of the session sites were held as per the micro plan, there is some lacuna in the availability of logistics although a majority of essential items were found at session sites special focus needs to be given to fetal doppler, HIV kit cold-chain maintenance, Iodized salt kit, Cotrimoxazole, Anti-malaria drugs, Td, and BCG vaccine. Satisfactory maternal and child health services were provided in many sessions.

Engaging underrepresented groups in community physical activity initiatives: a qualitative study of parkrun in the UK

BackgroundUnderrepresented groups, including racial/ethnic minority groups and individuals with low socioeconomic status face complex barriers to engaging in community-based health initiatives. This research uses parkrun, an outdoor, mass-participation, weekly physical activity and volunteering initiative, to explore the engagement strategies (‘outreach activities’) that have been used to promote the inclusivity and diversity of parkrun events.MethodsTen adult parkrun Ambassadors who fulfilled volunteer roles that involved promoting parkrun to underrepresented groups in the UK were interviewed. Interviews took place via telephone or video call in April-July 2021. Interview transcripts were analysed thematically.ResultsEngagement strategies implemented by Ambassadors varied from opportunistic promotion within communities to strategic negotiations at higher decision-making levels. Approaches were characterised by a community-centred focus that ensured community networks and assets were utilised. Stories were considered valuable indicators of successful outreach. A common challenge to outreach for Ambassadors was limited personal and organisational capacity that impeded the widescale scope, reach and scalability of parkrun’s engagement attempts.ConclusionsParkrun Ambassadors have used a wide range of outreach activities at different levels of influence. A number of challenges to doing sustainable and effective outreach have been highlighted that need to be addressed. Working with and alongside communities where community-based health initiatives events take place to understand how to address inclusivity issues could contribute to greater participation by underrepresented groups.

A Community Initiative to Help Children Who Are Homeless.

Children experiencing homelessness (CEH) have several health-related needs. It is necessary to address barriers posed by homelessness to improve health outcomes. Our objectives were to (1) conduct a health-related needs assessment and (2) determine acceptability/feasibility of the community-based initiative designed to identify and address health-related needs for CEH. The initiative involved a mobile care center, a health-focused education series for CEH, and resource provision, which included establishing connections with a stable source of health care. The needs assessment included standardized screening questions assessing health-related needs. We surveyed guardians of CEH who attended Summer360 between June and July 2022. Guardians were invited to evaluate our intervention via survey. We used descriptive statistics to characterize health-related needs. A needs assessment was completed on 36 of 100 children (42% white persons, 64% male), with 94% reporting at least 1 health-related need, and 61% with ≥3 needs. The most common needs identified were dental health and food insecurity. Twenty-four (24%) campers participated in a mobile health clinic that included hearing and vision screening, fluoride application, and vaccinations. The education series included dental hygiene, nutrition, and mental health. All families who desired assistance (73%) were connected to resources, and 91% of guardians agreed that the initiative helped meet their children’s health-related needs and provided helpful resources. Implementation required planning with contributors including dental partners, mobile clinic operators, and school leadership. A community-based health initiative may serve as a unique opportunity to identify and address health-related needs for CEH.

Determinants of body weight changes during Ramadan fasting in India amid COVID-19: A cross-sectional study.

Ramadan intermittent fasting (RIF) presents unique challenges and opportunities for public health and clinical practice, especially in populations with a high prevalence of non-communicable diseases. This study aims to investigate the impact of RIF on weight change among Indian Muslims and explore the associated demographic, dietary, and behavioral factors. A cross-sectional survey was conducted with a sample of Indian Muslim adults who observed RIF. Participants were asked to report their demographic information, family and personal health history, and dietary and lifestyle behaviors before and during Ramadan month. The primary outcome was body weight change, with secondary outcomes including changes in dietary patterns, physical activity, and other health-related lifestyle behaviors. The study found that during Ramadan, nearly half of the participants (48.5%) self-reported a retained initial weight, while a significant fraction (30.9%) self-reported a modest weight reduction between 0.5 to 2.5 kg at the end of Ramadan. Additionally, self-reported eating practices demonstrated moderately altered by about half (48.4%) of the study participants, with 32.2% reporting minor changes and 8.2% indicating substantial changes. An urban residence was associated with a higher likelihood of weight gain, where urban residents showed 3 times the odds of increased weight compared to rural inhabitants. Employment status emerged as a significant determinant for weight fluctuation, influencing both weight gain and loss. During Ramadan, there was a significant rise in snacking frequency, increasing from 21.7% to 32.6% in comparison with pre-Ramadan. The consumption of large quantities of food more frequently grew from 14.9% to 36%, and the incidence of eating despite not being hungry went up from 17.4% to 33.2%. The study demonstrates that RIF is associated with variable changes in body weight among adult Indian Muslims, influenced by urbanization, employment status, and dietary changes. The findings suggest that clinicians should provide tailored advice about body weight regulation during Ramadan and consider integrating community-based health initiatives within religious settings to improve health outcomes.

Manajemen Organisasi terhadap Efektivitas Kinerja Ponkesdes

One of the community-based health initiatives (UKBM) that actively incorporates the community in the construction of healthcare facilities is Ponkesdes. According to evaluation data from the Kediri City Health Service (Dinkes), the Ponkesdes program encountered a number of technical difficulties and a lack of coverage of targets. Analytical descriptive research was used in the study, which was carried out in Kediri City and Bondowoso Regency. The cross-sectional approach is the methodology employed. These include organizational structure, work schedule, work program, goal setting, coaching and supervision, and evaluation, all of which are based on organizational aspects found in this research. The analysis's findings indicate that the program variable (α=0.032) and assessment variable (α=0.003) of the health center are the organizational characteristics associated with how well its performance is carried out. Meanwhile, organizational variables (α=0.517), work schedule (α=0.383), compensation system (α=0.101), goal setting (α=0.618), supervision and coaching (α=0.837), and organizational structure variables (α=0.517) are unrelated to the village health center's efficacy. This is due to the fact that, although occasionally ignoring the established organizational structure and work schedules, the Islamic boarding school officers take seriously the need to carry out the programs at the school in order to meet predetermined targets.

Is Laughter Really the Best Medicine? Reflecting on a Mental Health Initiative Using Pragmatic Collaborative Autoethnography

This article relates to the potential of applied laughter in social science. Here, we explore the “Laughie Challenge Australia.” This community-based mental health initiative aims to get Australians laughing. We invite its instigator to discuss it, using a pragmatic qualitative research approach, Invited Collaborative Autoethnography (ICAE). Our purpose is to gain insight into the rationale and practicalities of using laughter to alleviate community mental health issues. Thus, we use ICAE instrumentally as a discourse platform to build understanding through joint narrative with a view of facilitating laughter community-science research collaborations. We recount the “story” of the Laughie Challenge, and the meeting of two academics and a community laughter leader, with a shared interest in the healing power of laughter and “real-world” laughter applications. ICAE enabled transparent, in-depth discourse. It has resulted in citizen science research to further advance knowledge in this area.

Group boundary salience and nonaccommodation between healthcare workers and community members in Ghana

Over the past decades, public health policy and initiatives have shifted away from individual interventions to focus more broadly on community-based and social determinants of health. Community-based health initiatives are health programs developed to be implemented at the community level, especially amongst poor rural populations and urban slums that may be excluded from traditional healthcare models. However, evidence regarding the success of community-based health initiatives remains mixed, perhaps due to lack of research focused on the social identity and communication experiences of community members and healthcare workers. Mobilizing communication accommodation theory, the current study analyzes healthcare discourses in the context of Ghana's Community-Based Health Planning and Service initiative. Critical discourse analysis of forty-four focus group interviews revealed significant tensions regarding patient-practitioner roles and expectations, organizational role constraints experienced by healthcare workers, and ethnolinguistic group boundaries. As a result, community members frequently express feelings of nonaccommodation from healthcare workers, leading to poor evaluations of healthcare workers' communication accommodation competence. Theoretical and practical implications of the findings are discussed.

Revitalizing a village for mental health in watershed area in Central Kalimantan, Indonesia

Most of the inhabitants in Central Kalimantan live in a residential area which is located close to the watershed (DAS). The geography of the watershed is a challenge for affordable health services, particularly in mental health services. Patients with mental disorders who do not get health care services will have a high risk of experiencing recurrence due to withdrawal of medication. There are needs to be solved by various parties to overcome this problem. Mental healthcare delivery in this area is more likely to be effective and sustainable if supported by the secondary level of care in particular the local Health Department. This photo essay pictures our effort to revitalize a village for mental health in watershed area in Central Kalimantan, Indonesia. The concept of "Desa Siaga Sehat Jiwa” (Healthy Village) focuses on empowering communities and local health authorities to work together to improve mental health. A community-based mental health initiative has been conducted in cooperation with mental health nurses raising awareness of mental health. Nurse educators at the Health Polytechnic Palangka Raya have an important role to play in raising awareness of mental health in village communities. We delivered and facilitated a discussion session to revitalize the village in order to increase their awareness to mental health. For the collaboration, to the meeting, we invite the village local stakeholders including the community leaders, health providers from the Primary Health Care, soldiers, police, and community representatives. To sustainably continue the forming of "Desa Siaga Sehat Jiwa”, a mutual agreement was signed by the stakeholders as a commitment to work together to create a healthy community in improving mental health in the villages.

Provision of injectable contraceptives by community health workers in sub-Saharan Africa: a systematic review of safety, acceptability and effectiveness

BackgroundInjectable contraceptives are the most popular method of contraception in sub-Saharan Africa (SSA), but their availability in clinical settings has been severely limited, despite the scarcity of health care providers and limited access to health facilities. WHO and USAID have endorsed the community-based distribution of injectable contraceptives as a promising option for improving access to family planning services and expanding the method mix for women who want to limit the number of births. Studies have shown that community health workers (CHWs) can provide women with injectable contraceptives that meet acceptable quality standards. The goal of this study is to identify, evaluate and synthesize evidence supporting the use of community-based administration of injectable contraceptives in SSA. MethodsThis review's guidance was based on a previously developed protocol. Nine international electronic databases and the websites of organizations known to support community-based reproductive health initiatives in SSA were searched systemically. Experts in this area were also contacted for the identification of unpublished literature and ongoing studies. The reference lists of eligible studies were reviewed. The Effective Public Practice Project tool was used to assess the quality and risk of bias in eligible studies. Data were extracted and analysed using a custom data extraction form and a narrative synthesis. ResultsThe search strategy identified a total of 1358 studies with 12 studies meeting the inclusion criteria. One unpublished study was provided by an expert making a total of 13 studies. The results showed that irrespective of the study designs, well-trained CHWs can competently administer injectable contraceptives safely and community-based delivery of injectable contraceptives is acceptable in SSA. Also, the use of community health workers in the provision of depot-medroxyprogesterone acetate expanded access to inhabitants of hard-to-reach areas and led to an overall uptake of injectable contraceptives as well as family planning. Studies that compared CHWs to clinic-based providers revealed equivalent or higher levels of performance in favour of CHWs. ConclusionsThe CHWs can competently provide injectable contraceptives within SSA communities if appropriately trained and supervised. Hence, SSA policymakers should give this initiative due consideration as a way of improving access to family planning services.

Residential Area Socioeconomic Deprivation is Associated with Physical Dependency and Polypharmacy in Community-Dwelling Older Adults: An Analysis of Health Administrative Data in Ireland.

IntroductionSocioeconomic disadvantage is associated with multiple adverse health outcomes in ageing. Whether this negative impact persists in populations of more advanced age and dependency is less clear. We aimed to determine the association between residential area deprivation and pre-specified health characteristics among community-dwelling dependent older adults.MethodsWe conducted a cross-sectional analysis of data from 1591 community-dwelling adults aged 65 years and older of mean age 83.9 ± 7.1 years and in receipt of state home support in Ireland. The HP Pobal Deprivation Index was used to categorize residential areas by socioeconomic deprivation. Health variables analysed included physical dependency (Barthel Index), polypharmacy (≥5 medications), previous acute hospital admission, cognitive impairment, and mental health diagnoses. Associations between residential area deprivation and prespecified health outcomes were explored in multivariable logistic regression analysis.ResultsIn socioeconomically disadvantaged areas, high physical dependency was twice that observed in affluent areas (16.2% vs 6.9%, p = 0.009). Similarly, acute hospitalization, as the trigger for increased dependency, was more common in deprived settings (41.6% v 29.1%, p < 0.001). Polypharmacy was common in this population (67.6%), but significantly higher in deprived vs affluent settings (74.7% v 64.5%, p = 0.030). The findings persisted in multivariable analyses when adjusted for age and gender. While all participants were accessing home support, those in deprived areas were on average 6.5 years younger than in affluent areas. Associations between residential deprivation and mental health conditions or cognitive impairment, however, were not observed in this study.ConclusionCommunity-dwelling older adults living in socioeconomically disadvantaged areas experienced greater polypharmacy, high physical dependency, hospitalization-associated dependency, and a 6.5-year earlier need for state home support than in affluent settings. The findings suggest that health inequality persists in populations of more advanced age and dependency and highlight a need for further research as well as community-based health and social care initiatives.

Public librarians and public health: How do partners perceive them?

Public libraries are increasingly recognized as community partners that improve the reach of health promotion organizations. The capacity of libraries to support community-based health initiatives has previously been studied through case studies in particular communities. Few national studies have considered how and why public libraries are perceived as part of the community health environment. With the aim of understanding how libraries are perceived in the context of promoting healthy eating and active living, this article examines the characteristics of successful community partnerships involving public libraries. This article uses data from interviews with librarians and their partners in 18 communities in 16 states across the United States. Case studies selection utilized a sentinel community approach to identify public libraries that self-identify as actively involved in community based health initiatives. Findings indicate that libraries are seen as trusted connectors, community experts, and organizations that share goals with health promotion organizations. Nevertheless, the strength of these partnerships is diminished by several factors. Improving and codifying community collaborations involving public libraries is identified as an opportunity to address this trend. The discussion focuses on how increased understanding of this trend both within the public health and within the public library profession would contribute to better including public libraries and public librarians in the promotion of community health.

Supporting community-based mental health initiatives: insights from a multi-country programme and recommendations for funders.

Community-based mental health initiatives are uniquely positioned to understand the mental health needs of their local population and provide relevant, culturally appropriate and sustainable responses. However, at the grassroots level, mental health initiatives in low- and middle-income countries face key challenges, such as inadequate funding, barriers to demonstrating impact and difficulty engaging with stakeholders. The Ember Mental Health programme establishes 12-month partnerships with community-based mental health initiatives in low- and middle-income countries to support them to address these challenges, grow and achieve sustainability. This paper outlines a longitudinal qualitative study conducted to evaluate the 2020-2021 Ember Mental Health programme. Data were collected from March 2020 to March 2021 through semistructured interviews conducted with 11 initiatives at various time points throughout their Ember Mental Health partnership. A framework approach was used to analyse all data in its original language. Findings indicated that initiatives particularly benefited from provision of side-by-side mentorship; opportunities for skills strengthening and strategic thinking; occasions to network with other like-minded initiatives and/or experts in global mental health; and support on team empowerment and well-being. Based on these findings, we put forward various recommendations for funders and other stakeholders working to support community-based mental health initiatives in low- and middle-income countries. Through establishing collaborative partnerships that challenge more top-down, traditional funder–grantee relationships, it is possible to support the rich ecosystem of initiatives working to address the mental health needs of communities.

Blending Participatory Action Synthesis and Meta-Ethnography: An Innovative Approach to Evaluating Complex Community Health Transformation

Community health improvement processes are diverse and complex, and evaluation methods to gain generalizable knowledge across community settings are limited by available data, and the need for deep contextual knowledge. This article describes an innovative participatory approach to evaluation of a transformation initiative involving up to eighteen communities nationwide. The approach blends two qualitative research synthesis methods: participatory action synthesis and meta-ethnography and applies them to the pragmatic evaluation of a program in real-life settings. In this article, we present the justification for and details about the evaluation process. The approach presented here will be useful to both researchers and practitioners interested in evaluating community-based health and well-being initiatives and other complex interventions conducted in complex settings.

Shifting Power in Maine: Findings From a Six-Year Community-Based Health Initiative

Between 2013 and 2019, a Maine Health Access Foundation community-based initiative provided place-based funding to communities to address system gaps and inefficiencies that impede the ability of Maine’s most vulnerable individuals to obtain essential services and supports. To rebalance power between the funder and grantees, the foundation introduced grantmaking practices such as long-term, flexible funding and new ways of relating to and supporting grantees. The theory of change guiding the initiative was that systems change is more effective and sustainable when communities develop cross-sector partnerships and engage community members in planning. The foundation guided the evaluation team to conduct a developmental, participatory, and adaptive approach focused on systems change rather than on individual health outcomes.

Do Right! Relax and Restore: An African American Community-Based Holistic Health Initiative

Examine the effectiveness of a holistic stress management program in a community-based setting. Post-session evaluations utilized to examine participant health knowledge and behaviors attained as a result of programming. Following items were examined: (1) participant perception of program delivery and (2) new health knowledge/skills gained. Post-session evaluations showed substantial knowledge/skill attainment in the following areas: (1) types of stress, (2) mindfulness, (3) stress and nutrition, (4) creative expression, and (5) holistic health and (6) relationship management. Program outcomes show relax and restore to be an effective community-based model in delivering holistic health stress management education.

Reducing smoking in Australia: how to include Aboriginal and Torres Strait Islander people

Issue addressed: Australia has succeeded in lowering the overall prevalence of tobacco smoking in the last four decades and has enjoyed a worldwide reputation for innovative policy. However, this success has not extended to Indigenous Australians.&#x0D; Method: Narrative review and critique of literature from government, public health, health promotion, marketing and communication on smoking cessation in Australia.&#x0D; Main points: We first consider the history of government anti-smoking measures including legislation and communication initiatives including advertising and sponsorship bans, health warnings and ‘no smoking’ rules affecting anti-smoking norms, culminating in the banning of branding and the advent of tobacco plain packaging. We also review the effects of excise increases and smoking cessation aids such as quit lines and nicotine replacement therapy. For each type of intervention, both population-wide and those specifically directed at Indigenous people, we consider the probable reasons for the failure to reach Aboriginal and Torres Strait Islander people or alter their smoking patterns, and make suggestions for improvements in interventions and their evaluation.&#x0D; Conclusion: The history of anti-smoking initiatives in Australia suggests that community-based health initiatives are likely to be more effective in addressing Indigenous people and helping smokers to quit.&#x0D;

The Community Access to Child Health (CATCH) Program: A 25-Year Retrospective.

For 25 years, the American Academy of Pediatrics (AAP) Community Access to Child Health (CATCH) program has supported pediatricians in collaborating within their communities to advance the health of all children. CATCH grants support pediatric residents and pediatricians in planning or implementing community-based child health initiatives. The CATCH program has provided almost 10 million dollars through 842 planning, 585 resident, and 305 implementation grants to >1700 pediatricians. Urban, rural, suburban, and tribal communities in every state as well as the District of Columbia and Puerto Rico have benefited from CATCH-funded projects. Collaborations with community partners such as schools, homeless shelters, and mental health centers have led to programs serving children and families, especially those living in poverty and in minority groups. The most recent program data reveal that 87.5% of the projects are operating 2 years after funding. Many CATCH projects have not only sustained themselves but have grown into larger programs with funding from other sources. CATCH has influenced pediatricians' careers by providing important skills, networking opportunities, career legitimacy, mentoring opportunities, and increased engagement with the AAP. More than 350 pediatricians have served the AAP as CATCH facilitators, the network of physicians that provides technical assistance to applicants and reviews grant applications. Responding to changing trends, CATCH leaders have looked at other funding models and recently launched the CATCH-On initiative. CATCH-On creates and provides templates from successful CATCH projects to busy pediatricians who can then implement the project in their communities with minimal funding.

Management challenges in mHealth: failures of a mobile community health worker surveillance programme in rural Nepal

Community health workers form the backbone of healthcare systems globally. The rapid expansion of mobile communications systems represents an opportunity to improve the productivity of community health workers in rural...

Exploring How Knowledge Translation Can Improve Sustainability of Community‐based Health Initiatives for People with Intellectual/Developmental Disabilities

Community-based health initiatives (CBHI) play an important role in maintaining the health, function and participation of people with intellectual/developmental disabilities (I/DD) living in the community. However, implementation and long-term sustainability of CBHI ischallenging. The Promoting Action on Research Implementation in Health Services (PARiHS) is a knowledge translation (KT) framework that is particularly relevant to intellectual/developmental disabilities research as it identifies the barriers and facilitators of implementation and action plans. This framework provides a foundation for understanding how KT can be used to aid the implementation and sustainability of CBHI for people with intellectual/developmental disabilities. The following study explores how KT - specifically the PARiHS framework - can be used to help sustain CBHI for people with intellectual/developmental disabilities.

A global framework for integrating community-based maternal, newborn, and child health strategies into existing health systems: revaluing the role of international non-governmental organizations

This study aims to: demonstrate that international non-governmental organizations (INGOs) play a strategic role in the large-scale impact of community-based maternal newborn and child health (MNCH) initiatives; introduce a novel conceptual framework that depicts three primary pathways through which INGOs catalyze the integration of community-based approaches to improving MNCH at the district national and global levels; illustrate the practical application of these three pathways through six case studies from multiple INGOs; and deduce the primary drivers that were found to be critical for successful INGO integration. (Excerpts]