Community-based Health Promotion Project Research Articles

Understanding community health workers’ activities in a community-based child health promotion project in Kyrgyzstan

BackgroundCommunity health workers (CHWs) have strong potential for conducting health initiatives in vulnerable countries. Their continuing activities are essential for positive outcomes. The purpose of this study is to understand CHW activities in Kyrgyzstan migrant villages and their impact on individuals and communities. MethodsThis study used a mixed-method design. All active CHWs were invited to participate in the survey and the first reflection note regarding their experience and satisfaction with CHW activities. Respondents who agreed to participate in the second reflection notes wrote additional reflection notes. Participatory observational CHW activity report meeting data was collected for additional qualitative analysis. Quantitative data were analyzed using descriptive statistics, and qualitative data were analyzed thematically. ResultsCHWs started their activities with altruistic and personal motives, such as social recognition and knowledge acquisition. Job-related satisfaction after the activity tended to be high. After performing home visits and resident participatory events, they experienced intrinsic motivation, resource mobilization efforts, increased autonomy, and social recognition. Although the material rewards were small as volunteers, they recognized their positive impact on individuals and communities and gained pride and happiness. ConclusionsCHWs participating in health promotion projects had training and CHW-nurse network activities and were gradually empowered in the process. When considering the sustainability of CHW activities, it is important to increase self-confidence and strengthen social recognition through empowerment.

Involving supermarkets in health promotion interventions in the Danish Project SoL. A practice-oriented qualitative study on the engagement of supermarket staff and managers

BackgroundSupermarkets have been suggested as relevant settings for environmental and educational initiatives encouraging healthier shopping and eating decisions, but in the literature, limited attention has been paid to the context, perspectives, and everyday practices of supermarket staff. The aim of this study was to examine the engagement of supermarket staff in a health promotion project from a practice-oriented perspective.MethodsThe study was based on qualitative data collected in the supermarket setting of Project SoL; a community-based health promotion project in Denmark. We conducted 26 in-depth interviews with store managers and other key staff members in seven participating supermarkets. In addition, we collected data on planning, implementation, and perceptions of supermarket staff of in-store interventions and other project-related activities. These field data included short telephone interviews, observational notes, photos, and audiotapes of meetings. Data were analysed from the perspective of practice theory.ResultsAlthough supermarket staff found community-based health promotion meaningful to engage in, the study observed that their engagement was challenged by a business mindset, practical routines and structural requirements favouring sales promotion over health promotion. Nevertheless, there were also examples of how health promotion activities and ways of thinking were successfully incorporated in everyday staff practices during and after Project SoL.ConclusionsOur findings point to both potentials and challenges for using supermarkets as settings for health promotion. The voluntary engagement of supermarket staff in community-based health projects cannot stand alone but should be supplemented by more long-lasting strategies and policies regulating this and other food environments. Context-sensitive and practice-oriented analyses in local food environments could inform such strategies and policies to make sure they target unwanted elements and practices and not just individual behavior.

Community-Based Strategies as Transformative Approaches for Health Promotion and Empowerment among Commercial Sex Workers in India

The current paper examines the utilization of community mobilization as a strategic health communication technique in an intervention to reduce human immunodeficiency virus (HIV) and sexually transmitted infections (STI) rates among marginalized and at-risk populations such as commercial female sex workers in a red-light district in India. The research documents the struggles of a historically exploited community in India to mitigate its marginalization through implementation of a multilayered strategy of capacity building and economic empowerment. Semi-structured interviews of 37 commercial female sex workers were conducted in a red-light district of India. Qualitative analysis of the interview transcripts showed the prevalence of three themes which demonstrated the different facets of the community mobilization framework within the context of a health communication intervention. The findings of this research delineate how STI risk reduction as well as participation and empowerment can be achieved through a community-based health promotion project targeted towards commercial female sex workers within the context of their lived realities of marginalization and oppression.

Participation in the Gyeongsangbuk-do Health Saemaeul Program and Health Behavior Improvement Effect

Objectives The purpose of this study was to determine association between participation degree and any changes in health behaviors in the Gyeongsangbuk-do Health Saemaeul Program, a community-based health promotion project. Methods The study used surveys of the Gyeongsangbuk-do Health Saemaeul Program, in 2016, 2018 and data from KOSIS. Results The multi-level linear regression analysis was completed with a total health behavior improvement score based on the six types of health behavior changes. People with temporal participation showed a higher total health behavior improvement score than the non-participants. Females showed a higher total health behavior improvement score than males and people with any chronic diseases showed a higher total health behavior improvement score than those without. None of the community-related variables showed any statistical significances. The results of the stratified analysis according to individual and community-related variables revealed that a group with the following community-related characteristics were more likely to have a higher total health behavior improvement score according to the participation degree; (1) a higher proportion of vulnerable subjects, (2) a higher financial self-reliance, and (3) a higher participation degree with willingness. No statistical significance was revealed with the individual characteristics. Conclusions In order to enhance health status of its residents in a community-level, designing an integrated health promotion program in considering the community characteristics would be more effective. In order to improve the quality of the Gyeongsangbuk-do Saemaeul Health Program and to expand its effects, an establishment of strategic plans is required at the level of selecting the target community. Key words: Participation of resident, Health behaviors, Health village, Health Saemaeul Program

A local-level evaluation of capacity for health promotion in Lima, Peru: Comas and Callao health center areas utilizing the WHO health promotion capacity profile

Capacity mapping for health promotion in Peru is said to have been done in 2001 and 2010 by the Pan American Health Organization/World Health Organization through a regional exercise, but no specific report is available to examine in detail. This paper reviews the role of what has come to be termed ‘capacity-mapping’ in health promotion in three health center service areas in Peru that are part of a community-based health promotion project partially financed by KOICA. One international capacity mapping tool was used to evaluate the situation of the mentioned services areas, specifically the Health Promotion Capacity Profile, developed by WHO in 2004. Local-level capacity for health promotion was analyzed, and limitations are highlighted. The results of the local-level exercise are discussed and suggestions are made on how to improve the identified components in Lima, Peru that are the most lacking; primarily, the areas of partnerships among public, nongovernmental and private organizations, professional development, and health promotion financing. Community-based interventions such as local health promotion programmes should be encouraged as they foster partnerships and support the strengthening of health promotion education for local staff. In addition, the introduction of an earmarked tobacco tax system could be a solution to the considerable financing issue that also affects local health centers, so that the development of effective and sustainable health promotion programmes can be attained.

Health Advocacy Project: Evaluating the Benefits of Service Learning to Nursing Students and Low Income Individuals Involved in a Community-Based Mental Health Promotion Project.

Poverty, along with other factors such as unemployment, work and life stressors, interpersonal violence, and lack of access to high quality health and/or social services all play a role in determining who develops a mental illness and for whom those symptoms persist or worsen. Senior nursing student preparing to enter the field and working in a service learning capacity may be able to influence early recovery and symptom abatement among those most vulnerable to mental illness. A consortium of community stakeholders and researchers collaboratively designed a 10-week mental health promotion project called the Health Advocacy Project (HAP). The project combines case management and system navigation support delivered by trained and highly supervised nursing students to individuals experiencing major depressive disorder (MDD) and/or post-traumatic stress disorder (PTSD). In this article, we present the findings of a qualitative fidelity evaluation that examines the effectiveness of nursing students in delivering the health advocacy intervention at the level and with the intensity originally intended. The findings demonstrate how the services of senior nursing students may be optimized to benefit our healthcare system and populations most at risk for developing MDD and PTSD.

Lay elderly volunteers as buddies for old subjects in a community-based health promotion project: nutrition optimisation, physical training and improvement of social support

Lay elderly volunteers as buddies for old subjects in a community-based health promotion project: nutrition optimisation, physical training and improvement of social support

OA53 "dementia friendly pharmacies" a community based health promotion project.

Inspired by the Ottawa Charter for Health Promotion, which is a major point of reference also for the "Compassionate Communities", we would like to propose that communities consolidate various settings like schools, workplaces, and health care organisations like community pharmacies, all of which might be included in a compassionate communities approach. We aim at enabling community pharmacies to offer informal consulting and support for people with dementia and their informal caregivers. Furthermore we want to support pharmacies to reach out in the community through various activities. By this means the project seeks to contribute to de-stigmatising dementia. The project is based on the approach "Participatory Health Research" (Hockley, Froggatt, Heimerl 2013; Wright et al . 2010). The core elements of the approach are participation, action and reflection. Approximately 40 staff (almost exclusively women) in 18 community pharmacies actively participates in the project, i.e. needs assessment, interactive workshops, practice projects and evaluation. People with dementia and their informal care givers are included in the needs assessment and in different steps of the programme. Community pharmacy staff raised several issues, closely related to communication, counselling and providing advice in a community pharmacy setting: They believe further development of professional practice to be important, since dementia care will become a more prominent issue for the community pharmacy. Moreover, a high frequency of contact with people living with dementia and their caregivers was reported by the majority of staff. Professional competencies related to dementia care are a key issue, and community pharmacy personnel viewed their practice with a critical eye: Communicating with disoriented persons poses some challenges, as does communicating with caregivers. In the still ongoing project the raised issues are being dealt with in practice projects that are performed by the pharmacies with the support of the project staff. Several projects reach out to the community through self-help groups, cinema performances, public presentations and discussions. Informal care givers have engaged in direct contact with the included pharmacies and become part of selected practice projects. People with dementia have been included in the needs assessment and the design of the project logo.

From Sociocultural Disintegration to Community Connectedness Dimensions of Local Community Concepts and Their Effects on Psychological Health of Its Residents

In a series of community mental health promotion studies in Lofoten, Norway, the concept of sociocultural integration is used to describe properties of a local community that are related to people's psychological health. Starting with Durkheim's description of a cohesive society, we compare different concepts that are related to sociocultural integration, for example, sense of community, social capital, and social cohesion. We then examine the relationship of various individual oriented social psychological concepts to sociocultural integration. These concepts often share theoretical and operational definitions. The concept of sociocultural integration in the Lofoten studies was proved to be very valuable in understanding how the properties of a community can affect people's mental health and their social psychological properties. It has also shown its value in the planning of mental health services and demonstrating its success in concrete community-based mental health promotion projects. Thus they could make important contributions to further studies and actions in local communities where the intersection between the individual, their social network, and their local community occurs.

Outcome of a Community-Based Oral Health Promotion Project on Primary Schoolchildren’s Oral Hygiene Habits

The aim of this study was to evaluate the effect of a school-based intervention project conducted in a mid-sized Finnish city, Laukaa on schoolchildren's oral health behavior. Material and Methods. In the intervention, all children received dental education and some of the 7–12-year-old schoolchildren received individual tooth brushing instructions by a dental nurse in 2009-2010. Parents were present at the instruction sessions. In 2009 and 2010, all the children answered a questionnaire or an oral hygienist on their oral health behavior without identification. Results. Tooth brushing frequency increased significantly among the schoolchildren between the years 2009 (61.2%) and 2010 (65%) (P < 0.05); more so among younger children (7–10-year-olds) compared to the older ones (11-12-year-olds). The 2010 results showed a slight trend of decreasing tooth brushing frequency by age both among girls and boys. Younger children got significantly more often parental help or reminding. The girls brushed their teeth significantly more frequently (71.9%) than boys (57.0%). Conclusions. Our findings indicate that oral health intervention can be beneficial on health behavior especially for children at low grades. All children, 11 to 12 years of age, especially boys, need continuous health promotion.

The Benefits of Youth Engagement in HIV-Preventive Structural Change Interventions

Youth are infrequently included in planning the health promotion projects designed to benefit them as many of the factors infringing upon youth's health and well-being also limit their engagement in community-based public health promotion projects. This article explores youth engagement in 13 coalitions implementing structural changes meant to reduce HIV transmission among adolescents. There was wide variation of youth membership and involvement across coalitions. Using analytic induction, the authors show that youth engagement was associated with the successful completion of structural change efforts. The authors also describe how youth engagement indirectly facilitated coalitions' success. The authors suggest that youth engagement in planning and conducting structural interventions is itself a valuable structural change.

Lay perspectives on lay health worker roles, boundaries and participation within three UK community-based health promotion projects

This paper examines lay interpretations of lay health worker roles within three UK community-based health promotion projects. It argues that understanding lay health worker roles requires critical analysis of the complex interrelationships between professionals, lay workers and the communities receiving a programme. Findings are presented that are drawn from a qualitative study of lay engagement in public health programme delivery where a key objective was to examine the perspectives of community members with the experience of receiving services delivered by lay health workers. Interviews and focus groups were conducted with 46 programme recipients from three case study projects; a breastfeeding peer support service, a walking for health scheme and a neighbourhood health project. The results show how participants interpreted the function and responsibilities of lay health workers and how those roles provided personalized support and facilitated engagement in group activities. Further insights into community participation processes are provided revealing the potential for active engagement in both formal and informal roles. The paper concludes that social relationships are core to understanding lay health worker programmes and therefore analysis needs to take account of the capacity for community members to move within a spectrum of participation defined by increasing responsibility for others.

The role of community context in planning and implementing community-based health promotion projects

The current study examines how community context affected collaborative planning and implementation in eight sites participating in a healthy cities and communities initiative in California. Data are from 23 focus groups conducted with coalition members, and 76 semi-structured interviews with local coordinators and community leaders. Multiple case study methods were used to identify major themes related to how five contextual domains influenced collaborative planning and implementation. Results showed that history of collaboration can influence resources and interpersonal and organizational connections available for planning and implementation, as well as priorities selected for action. Community politics and history can affect which segments of the community participate in a planning process and what issues are prioritized, as well as the pool of partners willing to aid in implementation. Some community norms and values bring people together and others appear to limit involvement from certain groups. Community demographics and economic conditions may shape outreach strategies for planning and implementation, and may also shape priorities. Geography can play a role in assessment methods, priority selection, partners available to aid in implementation, and participation in activities and events. Results suggest that community context plays a substantive role in shaping how community-based health promotion projects unfold.

Prospective, randomized controlled assessment of the short‐ and long‐term efficacy of a hearing conservation education program in Canadian elementary school children

To assess the efficacy of a hearing conservation program in changing acoustic risk-taking and hearing conservation behaviors in elementary school children. Prospective, randomized, mixed design controlled study. Participants were grade-six students from 16 Vancouver School Board schools. Differences between the intervention and control group responses on a behavioral questionnaire were measured at baseline, and then at 2 weeks and 6 months after administration of a hearing conservation program (Sound Sense™). The intervention resulted in significant interactions for improved earplug use at dances (P = .019), rock concerts (P = .001), with percussion musical instruments (P = .002), and electric guitars (P = .028) at 2 weeks postintervention relative to baseline. Improvements in children's earplug use at dances (P = .041), rock concerts (P = .0024), and with power lawn mowers (P = .043) at 6 months postintervention relative to baseline were also observed. Behavior in the intervention group compared to control group improved in earplug use with any "other noises" at 2 weeks (P = .001), and 6 months (P = .022) relative to baseline. There was a tendency in the intervention group to reduce the duration of use of personal music devices at 2 weeks and 6 months after the hearing conservation program, which was nonsignificant. The Sound Sense™ hearing conservation program improved earplug use practices in elementary school children in the short and long term. The development, implementation and evaluation of a community-based health promotion project around hearing loss can serve as a tremendous opportunity for students to develop their knowledge and skills in health advocacy.

Unpacking Assumptions About Inclusion in Community-Based Health Promotion: Perspectives of Women Living in Poverty

Community-based health promoters often aim to facilitate "inclusion" when working with marginalized women to address their exclusion and related health issues. Yet the notion of inclusion has not been critically interrogated within this field, resulting in the perpetuation of assumptions that oversimplify it. We provide qualitative evidence on inclusion as a health-promotion strategy from the perspectives of women living in poverty. We collected data with women engaged in a 6-year community-based health promotion and feminist participatory action research project. Participants' experiences illustrated that inclusion was a multidimensional process that involved a dynamic interplay between structural determinants and individual agency. The women named multiple elements of inclusion across psychosocial, relational, organizational, and participatory dimensions. This knowledge interrupts assumptions that inclusion is achievable and desirable for so-called recipients of such initiatives. We thus call for critical consideration of the complexities, limitations, and possibilities of facilitating inclusion as a health-promotion strategy.

Evaluating the Participatory Process in a Community-Based Health Promotion Project

This article presents and discusses the evaluation of the participatory process involved in the Local Plans for Health (LPH) of the Region Emilia-Romagna (North Italy). LPH are three-year plans of action that actively engage community members in collaborative decision making over health promotion interventions. The evaluation study conducted on the LPH 2001–2003 of Cesena, using a Participatory Action Research (PAR) approach, involved 34 community stakeholders, who took part in three focus groups. Themes discussed centered on the difficulties encountered in engaging all relevant community members, how to overcome such difficulties, and how to best communicate the results of the evaluation process to the population. Process evaluation was a central component of the planning of future plans.

The C-project: use of self-collection kits to screen for Chlamydia trachomatis in young people in a community-based health promotion project

The present study aimed to ascertain the acceptability to at-risk young people of self-collected urine samples as a means of testing for Chlamydia trachomatis (chlamydia); to determine the effectiveness of drop-off and outreach collection methods as a means of detecting and treating chlamydia; and to determine the rate of positive chlamydia tests in a sample of the target group. Participants requested postal testing kits from the project website, the NSW Sexual Health Infoline or at an outreach event and either returned urine samples at selected drop-off locations or directly to the researchers during active outreach events. A total of 413 kits were requested - 196 (47.5%) via email, 204 (49.4%) during outreach events and nine (2.2%) via the NSW Sexual Health Infoline. A total of 195 samples (47.2% of ordered kits) were returned. Participants were less likely to return samples if they had been requested by email (odds ratio = 9.6; 95% confidence interval: 6.0-15.0) or via telephone (odds ratio = 22.0; 95% confidence interval: 2.7-181.0) compared with directly obtaining a kit at an outreach event. The number of specimens positive for chlamydia in the targeted age range was 4, giving a 3.1% positive rate (95% confidence interval: 1.0-8.0). This study identified that free testing kits and online communication worked well as a means of engaging young people and raising awareness of sexual health. However, the requirement to drop-off urine samples at selected locations was not well accepted.

Integrating health planning and social planning: a case study in community-based partnerships for better health

This paper reports the findings of a study that investigated the processes through which health planning and social planning were integrated in practice, at the community level, through the active engagement of childcare centres in health promotion and community capacity building. A small-scale, retrospective study of Healthy Bodies Healthy Minds, a community-based health promotion project for early childhood environments, was conducted. Focusing on links between health and social planning, the study revealed crucial factors that led to integrated planning and action at the community level: opportunities for professional development, the strengthening of partnerships through interpersonal networks, reduced isolation of childcare staff in community contexts, and genuine engagement of childcare centre staff in a planning process. It also demonstrated how momentum for planning and action at the community level was created, and how a shift towards integrated health and social planning, stemming from an attitudinal shift by childcare staff towards planning and partnerships, emerged. Insights are gained on ways to build upon the social component of health promotion programs, so as to establish sustainable partnerships for integrating health and social planning in communities.

A Wellness Service-Learning Project Improves The Perception of Professional Empowerment in Physical Therapist Students

William A Romani, PT, PhD, SCS, ATC, and R Lance Holbert, PhD Background and Purpose. There is an increasing demand to train physical therapist students to effectively develop, promote, and deliver wellness and health promotion programs. The purpose of this study was to determine whether participating in a community-based wellness or health promotion project improved the student's sense of empowerment by increasing their confidence in their ability to independently plan and participate in a similar service-learning project in the future. Subjects. Participants were 32 students enrolled in the second year of a 3-year Doctor of Physical Therapy program. Methods. Students attended a lecture on health and wellness promotion (WP) based on the Guide to Physical Therapist Practice. Groups of 5-7 students were assigned to 1 of 5 prearranged WP activities throughout the second year of their curriculum. Each group planned and completed a WP, reflected on the project through written self assessment and peer feedback, and completed a pre and postproject questionnaire. A nonparametric Friedman test was used to analyze questionnaire data and determine whether or not students' perceptions of professional empowerment shifted across time. Results. After completing the WP, students felt significantly more empowered to complete a similar project in the future. Discussion and Conclusion. Participating in service-learning projects may increase physical therapist students' sense of professional empowerment to practically apply health and wellness promotion concepts learned in their curriculum and may make them more confident to participate in similar activities after graduation. Key Words: Community health, Health promotion, Educational outcomes, Student confidence. INTRODUCTION There is an increasing demand for allied health professionals to develop health and wellness programs to promote the health of their clients as well as advance their profession and create a market niche for their practices.1 In 2006 the Commission on Accreditation in Physical Therapy Education (CAPTE) accreditation guidelines included 6 criteria that addressed prevention, health promotion, and wellness.2 The increased demand and new CAPTE criteria have created a need for physical therapist education programs to provide students with the skills to independently develop, promote, and execute wellness outreach programs following graduation. The Guide to Physical Therapist Practice' describes the roles that physical therapists play in prevention, health promotion, and wellness and how these roles fit within the scope of physical therapist practice. Although the concepts presented in the Guide can be presented in the classroom setting, creating effective, practical experiences to successfully implement these principles and empower students to use them after graduation is more challenging. In acute care, rehabilitation, and outpatient practice settings, physical therapist students participate in clinical internships structured by the Clinical Performance Instrument (CPI)4 to objectively measure educational outcomes. Wellness and health promotion are components of the CPI, but students rarely have the opportunity to apply these concepts to all clinical settings; the subject often must be addressed in other parts of the physical therapist education curriculum. One option for students to practically apply wellness and health promotion is a structured service-learning model. Service-learning models have previously been used in nursing,5,6 medicine,7 occupational therapy,8 and physical therapy9-11 settings to teach clinical skills and improve the student's confidence in their own ability to competently perform these clinical skills. Improving self-esteem and confidence in the ability to apply knowledge and skills are consistent with previous definitions of empowerment 12-17 and have been shown to be indicators of a student's likelihood to use his or her learned skills after graduation from other health professional programs. …

Building capacity for health promotion—a case study from China

During the period 1997-2000 a technical assistance project to build capacity for community-based health promotion was implemented in seven cities and one province in China. The technical assistance project formed part of a much larger World Bank supported program to improve disease prevention capabilities in China, commonly known as Health VII. The technical assistance project was funded by the Australian Agency for International Development. It was designed to develop capacity within the Ministry of Health (MOH) and the cities and province in the management of community-based health promotion projects, as well as supporting institutional development and public health policy reform. There are some relatively unique features of this technical assistance which helped shape its implementation and impact. It sought to provide the Chinese MOH and the cities and province with an introduction to comprehensive health promotion strategies, in contrast to the more limited information, education and communication strategies. The project was provided on a continuing basis over 3 years through a single institution, rather than as a series of ad hoc consultancies by individuals. Teaching and learning processes were developmental, leading progressively to a greater degree of local Chinese input and management to ensure sustainability and maintenance of technical support for the project. Based on this experience, this paper presents a model for capacity building projects of this type. It describes the education, training and planning activities that were the key inputs to the project, as well as the limited available evidence on the impact of the project. It describes how the project evolved over time to meet the changing needs of the participants, specifically how the content of the project shifted from a risk-factor orientation to a settings-based focus, and the delivery of the project moved from an expert-led approach to a more participatory, problem based learning approach. In terms of impact, marked differences before and after the implementation of the training activities were identified in key areas for reform, in addition to the self reported positive change in knowledge, and a high level of participant satisfaction. Key lessons are summarized. Technical assistance projects of this kind benefit from continuity and a high level of coordination, the provision of culturally and linguistically appropriate teaching, and a clear understanding of the need to match workforce development with organizational/institutional development.