Community-based Intervention Model Research Articles

Design and methods of a translational, community-based, lifestyle weight management pilot intervention trial in breast cancer survivors with overweight or obesity

BackgroundBreast cancer survivors (BCS) with overweight or obesity are at heightened risk of cancer recurrence, cardiometabolic disease, and compromised quality of life. Given the prevalence of significant weight gain during and following breast cancer treatment, there is growing recognition of the need to develop efficacious, widely-accessible, weight management programs for BCS. Unfortunately, access to evidence-based weight management resources for BCS remains limited and little is known of the optimal theoretical basis, program components, and mode of delivery for community-based interventions. The primary aim of the Healthy New Albany Breast Cancer (HNABC) pilot trial was to determine the safety, feasibility, and preliminary efficacy of delivering a translational, evidence-based, and theory-driven lifestyle weight management intervention to BCS with overweight or obesity in the community setting. MethodsHNABC was a single-arm, pilot trial evaluating a 24-week, multi-component intervention leveraging exercise, dietary modification, and group-mediated cognitive behavioral (GMCB) counseling components designed to facilitate lifestyle behavior change and promote sustained independent adherence. Assessments of various objectively-determined and patient-reported outcomes and theory-derived determinants of behavioral adoption and maintenance were obtained at baseline, 3- and 6-month follow-up. Measures of trial feasibility were calculated prospectively throughout the study. ConclusionFindings from the HNABC pilot trial will provide evidence demonstrating the feasibility and preliminary efficacy of a multi-component, community-based, GMCB lifestyle weight management intervention for BCS. Results will inform the design of a future, large-scale, randomized controlled efficacy trial. If successful, this approach could offer a widely accessible, community-based intervention model for weight management programs in BCS.

Mindfulness-Based Stress Reduction and Hope in Women Participating in Alternative Sentencing Programs

Purpose: Alternative sentencing programs for women with nonviolent drug offenses may provide opportunities to change the life trajectories of women and their families. The primary purpose of this study was to assess whether a mindfulness-based stress reduction (MBSR) intervention could improve levels of hope following treatment. A second objective was to assess whether MBSR intervention could influence perceived stress, self-compassion, and mindfulness. Methods: Participants attended a 6-week mindfulness class, with outcomes measured using pretest–posttest survey comparison. Results: Paired sample t tests showed improvements in hope, stress, self-compassion, and mindfulness following treatment. Discussion: Community-based intervention models, such as MBSR therapy in alternative sentencing programs, may alleviate negative psychological impacts experienced by female offenders. These results align with previous research that suggests participants may see improved ability to regulate emotions following MBSR therapy. This research indicates that MBSR therapy, for women in alternative sentencing programs, may promote hope as a learned psychological skill.

Feasibility and acceptability of a novel community-based mental health intervention delivered by community volunteers in Maharashtra, India: the Atmiyata programme

BackgroundMany community-based intervention models for mental health and wellbeing have undergone robust experimental evaluation; however, there are limited accounts of the implementation of these evidence-based interventions in practice. Atmiyata piloted the implementation of a community-led intervention to identify and understand the challenges of delivering such an intervention. The goal of the pilot evaluation is to identify factors important for larger-scale implementation across an entire district in India. This paper presents the results of a feasibility and acceptability study of the Atmiyata intervention piloted in Nashik district, Maharashtra, India between 2013 and 2015.MethodsA mixed methods approach was used to evaluate the Atmiyata intervention. First, a pre-post survey conducted with 215 cases identified with a GHQ cut-off 6 using a 3-month interval. Cases enrolled into the study in one randomly selected month (May–June 2015). Secondly, a quasi-experimental, pre-post design was used to conduct a population-based survey in the intervention and control areas. A randomly selected sample (panel) of 827 women and 843 men age between 18 to 65 years were interviewed to assess the impact of the Atmiyata intervention on common mental disorders. Finally, using qualitative methods, 16 Champions interviewed to understand an implementation processes, barriers and facilitators.ResultsOf the 215 participants identified by the Champions as being distressed or having a common mental disorder (CMD), n = 202 (94.4%) had a GHQ score at either sub-threshold level for CMD or above at baseline. Champions accurately identified people with emotional distress and in need of psychological support. After a 6-session counselling provided by the Champions, the percentage of participants with a case-level GHQ score dropped from 63.8 to 36.8%. The second sub-intervention consisted of showing films on Champions’ mobile phones to raise community awareness regarding mental health. Films consisted of short scenario-based depictions of problems commonly experienced in villages (alcohol use and domestic violence). Champions facilitated access to social benefits for people with disability. Retention of Atmiyata Champions was high; 90.7% of the initial selected champions continued to work till the end of the project. Champions stated that they enjoyed their work and found it fulfilling to help others. This made them willing to work voluntarily, without pay. The semi-structured interviews with champions indicated that persons in the community experienced reduced symptoms and improved social, occupational and family functioning for problems such as depression, domestic violence, alcohol use, and severe mental illness.ConclusionsThis study shows that community-led interventions using volunteers from rural neighbourhoods can serve as a locally feasible and acceptable approach to facilitating access social welfare benefits, as well as reducing distress and symptoms of depression and anxiety in a low and middle-income country context. The intervention draws upon social capital in a community to engage and empower community members to address mental health problems. A robust evaluation methodology is needed to test the efficacy of such a model when it is implemented at scale.

Evaluation of two intervention models on contraceptive attitudes and behaviors among nulliparous women in Shanghai, China: a clustered randomized controlled trial

BackgroundWith increasing acceptance of premarital sex among young Chinese women, the rates of unintended pregnancies and induced abortions are becoming alarmingly high, suggesting the needs of educating women with adequate contraceptive knowledge and providing them with accessible contraceptive services. Previous studies have shown that knowledge and attitudes towards contraception could be modified through intervention strategies. This study aimed to evaluate the effects of two community intervention models on modifying contraceptive attitudes and behaviors among nulliparous women.MethodsIn this clustered randomized controlled trial, nulliparous women aged 18–40 years from 18 communities were enrolled and randomized to either the traditional community intervention model (TC model) or the more comprehensive new community-based intervention model (NC model) with a ratio of 1:2. Contraceptive attitudes and behaviors were assessed before and after the interventions.ResultsA total of 901 nulliparous women were followed. The most common contraceptive method in both groups was condom (approximately 80%) before or after interventions. The rates of using effective contraceptive methods were very low (<5%) even after the intervention. Comparing the NC with TC group, the adjusted ORs and 95% CIs regarding natural family planning, emergency contraceptive usage and short-acting OCPs were1.53 (95% CI: 1.11–2.13), 2.87 (95% CI: 2.05–4.02), and 2.71 (95% CI: 1.65–4.47), respectively; while the ORs and 95%CIs of gynecological examination and contraceptive use were 2.31 (95% CI: 1.63–3.27) and 2.89 (95% CI: 1.98–4.23), respectively. No statistical significant difference was found for the use of effective contraceptive methods at post-intervention among the two models.ConclusionsHigh proportions of nulliparous women held negative attitudes and behaviors towards effective contraceptive methods. The NC model, integrating existing health resources, had more positive influence than the TC model on the favorable contraceptive attitudes and behaviors towards the use of any contraceptive methods, but had limited impact on the use of effective contraceptive methods. Our study suggested the feasibility of applying the NC model in Shanghai. Interventions on contraceptive attitudes and behaviors should base on the existing health service system, synthesize resources and selectively apply to populations with distinct characteristics.

From Family Research to Practice: Argentine Families Coping with the Challenges of Religious Intensification

This intergenerational, qualitative study of Jewish families in Argentina (N = 10 mother/daughter dyads) coping with the religious intensification of their daughters exemplifies cultural change in one or more of their subsystems. We found challenges to family cohesion related to food and television limitations, daughters' lack of acceptance of siblings' partners, and parents' concerns about the way their grandchildren were being raised. Relationships reportedly were not adversely affected by the daughters' religious intensification. The grandparent-grandchild relationship served as a bridge between cultures and generations with grandchildren being regarded as socializing agents. Results were interpreted in terms of strengths, ecological, and interactionist role theories. A community-based intervention model that derives from this research is suggested.

An examination of social work interventions for use with displaced Iraqi households in Jordan

The purpose of this paper is to identify and examine how models of social work intervention are being used with displaced Iraqi households in Jordan. The review of the situation of displaced Iraqis in Jordan identifies the size, characteristics and experiences of this group, Jordanian government policies towards them, and the role of IGOs and NGOs dealing with them. The literature review of social work interventions with refugees internationally identifies a range of psycho-social and community-based intervention models that are contextual, some of which include spiritual dimensions. The paper reviews social work interventions in use with Iraqi households in Jordan and concludes that these need to be focused at the individual, household and community levels using an inter-professional, holistic approach that includes spiritual dimensions, and that coordination between agencies is essential.

TOWARDS A SELF-CHANGE-FRIENDLY TREATMENT AND POLICY FOR ADDICTIVE BEHAVIOURS

Dr Klingemann and his colleagues reviewed a substantial literature on the current state-of-the-art in natural recovery research, and concluded that natural recoveries from substance use disorders not only occur but are a major pathway to recovery 1. The results of self-change research have given rise to basic questions about the effectiveness of mainstream treatment modalities and drug policies on demand reduction. However, research shows that, like other chronic diseases, drug addiction can be treated effectively and managed over its course. In addition, addiction treatment has also been shown to be an effective way to prevent the spread of diseases, such as human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) and hepatitis 2. This means that, contrary to the conclusions of Dr Klingemann, we believe recovery is happening in communities, families, hospitals, recovery centres, therapeutic communities, clinics, faith-based programmes and self-help groups in every corner of the world. Effective treatment occurs in a variety of settings, in many different forms and for different lengths of time 3. We think the arguments about the methodology, subjects and conclusions in self-change and treatment research will continue for a long time. Dialectic philosophy holds that ‘external causes are the condition of change and internal causes are the basis of change, and that external causes become operative through internal causes’4. From this viewpoint, it is not whether or not self-change exists, or whether therapy is effective. What we really need is to try to develop treatment approaches and policy that create a good environment to facilitate maturity and change for drug use patients. In fact, recovery from addiction is an established reality, achieved through a variety of treatment modalities when they are matched to the needs of individual patients. Numerous studies have shown that addiction treatments are comparable in effectiveness to treatments for other chronic illnesses 2. In our independent evaluation for the ‘Drug-free Community’ project in Furong District, Changsha, China, we found that in 662 government registered patients with drug use (86.9% were heroin use) history in Furong District, 57.4% of patients had negative drug test results (those who refused to be interviewed or take a drug test were considered as positive), in which the 5-year abstinence rate was 16.6%. The reported reason for abstinence can be divided into two categories: external and internal. External reasons included pressure and help from family (27.2%), economic burden (24.8%) and help from community leaders and policemen (16.3%). Internal reasons included concern about health (16.1%), concern about working and life (11.7%), concern about being caught by the police and ‘change was done to me’ (5.7%). Two conclusions come from the survey: (i) it is not ‘once drug, always drug’, as circulated both in public and professional circles in China, and (ii) change can take place from the inside with external help 5. In the past 30 years drug abuse, along with prostitution and gambling, has been referred to as an ‘ugly social phenomenon in China’. Both lay people and professionals think punishment should be an important component of drug abuse treatment. Professionals who work with drug-dependent people often focus upon interventions for acute conditions in treatment facilities and neglect interventions in the community; and we lack an effective mechanism for integration of different resources from government sectors, such as public security, justice and health sectors in the intervention of drug abuse 6. The concept of self-change has rarely been accepted as a method for stopping drug use. For this reason, we have begun to develop a community-based intervention model, in which we are trying to mobilize the resources in communities and integrate efforts from government sectors, and develop a seamless intervention for patients in five communities in the cities of Changsha, Shanghai and Kunming. The preliminary results of the ongoing project show that the community-based and integrated approach not only reduces drug use and related crime but also increases employment and quality of life. In conclusion, much work needs to be undertaken to understand internal factors if self-change takes place, and what external factors, such as treatment and policy, facilitate the initiation and maintenance of self-change. Given the present evidence base regarding self-change, community-based interventions should be prioritized and tested as a means of encouraging attempts at self-change. Such strategies would also be predicted to increase treatment uptake. The author is supported by Key Projects in the National Science & Technology Program during the 11th five-year Plan Period (2007BAI07B01). None.

Community-based model for preventing tobacco use among disadvantaged adolescents in urban slums of India

Tobacco consumption in multiple forms presents an emerging, significant and growing threat to the health of Indian adolescents, especially those from low socio-economic communities. Research in two phases was undertaken among economically disadvantaged adolescents in two urban slums of Delhi. In phase I, qualitative research methods such as focus group discussions and in-depth interviews were used to explore and understand the determinants influencing tobacco use among these adolescents. Prevalence of tobacco use was higher among boys than girls. Adolescents reported using tobacco in multiple forms, chewing tobacco being the most popular. Peer pressure, easy availability and affordability were important reasons associated with tobacco initiation and continued use. Though they had some knowledge about the harmful effects of tobacco, this was not sufficient to motivate them to abstain or quit. The community-based intervention model developed on the basis of the results of phase I was evaluated in phase II in a demonstration study with two slum communities. One was treated as the intervention and the other as control. A significant difference in current use of tobacco was observed between the study groups (p = 0.048), with the intervention group showing a reduction in use, compared with an increase in use among the control group. Post-intervention, the intervention group reported significantly lower fresh uptake (0.3%) of tobacco use compared with the control group (1.7%). No significant change was found for quit rate (p = 0.282) in the two groups. Community-based interventions can be effective in preventing adolescents from initiating tobacco use in a low-resource setting such as India.

Physiotherapy Program through Home Visits for Community-Dwelling Elderly Japanese Women with Mild Knee Pain

Knee pain is extremely common among the elderly, particularly women. Hence, there is an urgent need for applicable community-based intervention models for halting the progression of knee pain and related disabilities in elderly women. We aimed to assess the efficacy of home-visit physiotherapy as a new intervention model. This non-randomized 5-month-long controlled trial enrolled elderly community-dwelling women (aged 60-83 years) with mild knee pain. The intervention consisted of two home visits by a physiotherapist, with instructions on routinely performing muscle-strengthening exercises at home and implementing simple environmental modifications when necessary. Outcome measures were assessed at baseline and 5 months later. The primary outcomes were measured as the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and a newly devised seiza-style sitting score. People in Japan, especially elderly women, are accustomed to seiza-style sitting that involves kneeling on one's lower legs while resting the buttocks on the heels. The secondary outcomes included quadriceps isometric strength, knee alignment in the frontal and sagittal planes, and passive knee extension range. Forty-two subjects (20 in the intervention group and 22 in the control group) completed the study. At baseline, characteristics and the primary outcomes did not significantly differ between the 2 groups. At 5 months, the primary outcomes improved significantly in the intervention group. Estimated differences in the change from baseline for each outcome between the 2 groups were computed, adjusting for outcome variables imbalanced at baseline. Even after the adjustment, the home-visit physiotherapy regimen provides favorable improvement in the seiza-style sitting score.

Las comunidades seguras: una sinopsis

The "Safe Community" is a community-based intervention model by the World Health Organization (WHO) for control and prevention of injuries and violence. The program is directed towards the prevention of all types of injuries and to all age groups, environments and situations. In this model, the community identifies its organizational needs, defines interest areas with participation by everybody, designs and implements interventions by means of inter-sector work using local, low cost solutions, and guarantees the sustainability of the programs by means of governmental commitment and alliances among different organizations. This model has demonstrated its effectiveness in different contexts, including developing countries. In Latin America, a "Safe Community" has been certified in Chile, an example to be followed for facing the problem of injuries and violence in the region.

Preventing Alcohol and Drug Exposed Births in Washington State: Intervention Findings From Three Parent-Child Assistance Program Sites

Home visitation interventions show promise for helping at-risk mothers, yet few programs have been developed and evaluated specifically for alcohol and drug-abusing pregnant women. This study examines outcomes among 216 women enrolled in the Washington State Parent-Child Assistance Program, a three-year intervention program for women who abuse alcohol and drugs during an index pregnancy. Pretest-posttest comparison was made across three sites: the original demonstration (1991–1995), and the Seattle and Tacoma replications (1996–2003). In the original demonstration, the client group performed significantly better than controls. Compared to the original demonstration, outcomes at replication sites were maintained (for regular use of contraception and use of reliable method; and number of subsequent deliveries), or improved (for alcohol/drug treatment completed; alcohol/drug abstinence; subsequent delivery unexposed to alcohol/drugs). Improved outcomes at replication sites are not attributable to enrolling lower-risk women. Public policies and programs initiated over the study period may have had a positive effect on outcomes. Study findings suggest that this community-based intervention model is effective over time and across venues.

Early Communication Intervention within a Community-based Intervention Model in South Africa

Infants and toddlers with special needs within the developing context in South Africa are not currently receiving adequate early communication intervention services. The development of a model for service delivery to this population is imperative for the successful implementation of early communication intervention in the developing context in South Africa. The basic model of early intervention service delivery provides a theoretical basis for early intervention service delivery but has certain limitations when applied to the developing context in South Africa. Community-based intervention is proposed as an avenue for the delivery of health care services within primary health care although constraints in the application of community-based intervention exist. An integrated model of early communication intervention service delivery within community-based intervention is proposed and illustrated by presenting a case example.

Community-Based Intervention to Reduce Demand for Drugs in Northern Thai Tribal Villages

This is an evaluation study of a community-based intervention model used in a project designed to reduce the demand for and use of opium, heroin, and other drugs among 85 tribal villages located in Northern Thailand. The Integrated Drug Abuse Prevention (IDAP) Project was conducted from 1995 to 1997 and used a community-based approach which included innovative methods such as multimedia awareness raising campaigns, networking between villages and local government agencies, and village-based drug detoxification and treatment to assist villages in solving their drug problems. The intervention model was successfully implemented in most villages and demonstrated very good results in improving awareness, decreasing the number of active drug users living in the villages, and preventing new cases of addiction. However, a follow-up study at 6 months after project termination indicated problems with sustainability of demand reduction activities and outcomes. These problems were attributed in part to a lack of empowerment among village leaders to continue activities without assistance from project staff. Also, village leaders expressed problems in resisting drug dealers who returned to the area, which suggested that support from law enforcement is critical to the viability of drug demand reduction programs.

Use of Peer Role Models to Increase Pap Smear and Mammogram Screening in Mexican-American and Black Women

We evaluated the use of a community-based intervention model to increase Pap smear and mammogram screening in minority women. The community programs were based on the A Su Salud (To Your Health) model, which includes the presentation of positive role models in the media and positive social reinforcement by community volunteers. Mexican-American women 40-70 years of age in Corpus Christi, Texas, and black women 40-70 years of age in Galveston, Texas, were targeted. Role models from the target community told their personal stories about cancer screening through local media (television, radio, and newspapers). Volunteers reinforced media messages among the target audience by distributing newsletters. Preintervention and postintervention cross-sectional surveys among the target group measured relative increases in knowledge, attitude, and practice. Pap smear use (past two years) was not substantially improved. Mammogram use (past two years) increased 57% among Mexican-American women (prevalence rate ratio [PRR] = 1.57; 90% confidence interval [CI] = 1.19, 2.08) and 30% among black women (PRR = 1.30; 90% CI = 1.04, 1.63). We demonstrated the feasibility of implementing a peer role model intervention at the local health department level. The improvement in mammogram use among high-risk women is encouraging, but further controlled research is needed to test the effectiveness and cost-efficiency of this approach.