Community Demonstration Project Research Articles

Multi-Criteria Evaluation of Site Selection for Smart Community Demonstration Projects

Definition and imagination of an ideal city can be traced back to the origin of garden city in UK about 100 years ago. Since then, many different names and topics have been proposed and smart city is the one most recently proposed. Starting from 2000, more and more countries have developed various demonstration projects for the promotion of smart city in order to provide total solution for the promotion of sustainable development and social welfare. In fact, some of them have been successfully carried out. Some researchers in Taiwan argue that the current mechanism by which government subsidies are allocated for smart city demonstration projects warrants improvement. A comprehensive literature review determined that the development potential of smart cities should be prioritized in site selection for such demonstration projects. This study developed an evaluation framework on the basis of multi-criteria evaluation methods to enable the identification of suitable smart city demonstration sites. Evaluation criteria were first identified through the Delphi method. Next, the weights of each criterion were derived through the analytic hierarchy process. Furthermore, the capability of the proposed evaluation model was determined through simulation testing. Four demonstration sites are simulated, they are: Taipower Smart Community, Yinlin Technology University campus, Taichung Creative Cultural Park, and Asian New Bay Area in Kaohsiung, It is expected that the research findings in this thesis can be helpful to the future decision for the demo site selection of smart city.

Implementation of a community-based hypertension control program in Matanzas, Cuba.

Increased blood pressure is a leading risk factor for death worldwide, and improving the control of hypertension is a major health goal to reduce non-communicable disease. Thus, in 2016, as part of a regional effort between the Pan American Health Organization and Cuban Ministry of Public Health to reduce cardiovascular risk and disease, a community demonstration project was implemented to enhance hypertension control. The intervention project was in a population of 25868 people served by the Carlos Verdugo Martínez Polyclinic in Matanzas, Cuba. The project implemented interventions currently recommended in the World Health Organization HEARTS modules, including a standardized clinical training program with certification for blood pressure measurement, routine screening for hypertension in clinics and in the community, a simple directive pharmacologic treatment algorithm, and a registry with performance reporting and feedback. Qualitative and quantitative program monitoring and evaluation was established. In a 2010 national survey, the prevalence of hypertension and the rate of hypertension control were estimated to be 31% and 36%, respectively. Following less than one year of the full implementation of the program, the prevalence of hypertension, proportion of the hypertensive population registered as having hypertension, proportion of those drug-treated who were controlled, and estimated population rate of control were 30%, 90%, 68%, and 58%, respectively. Based on these positive results, the program has been expanded to include another demonstration program initiated in a second region. In addition, preliminary efforts to disseminate and scale-up aspects of the program to the full Cuban population have started.

Demand response of customers in Kitakyushu smart community project to critical peak pricing of electricity

Dynamic pricing is an effective way to induce the customers to change their electricity usage patterns, critical peak pricing (CPP) event shows a great potential to reduce the peak demand and enhance the grid reliability. This paper investigates performances of the CPP experiment across aggregated group-level of electricity customers covering 16 commercial, 15 office and 50 residential objectives in the Kitakyushu Smart Community demonstration project. A data-based approach to the comparisons of electricity demand curves and distributions among time of use (TOU) and CPP events. Result confirms the differences in price-based responsiveness across types of customer, there is demand shaping effect during the CPP event period by adjusting the electricity price at 30-min interval. The power saving effects were obviously confirmed in residential and commercial sectors under CPP event program. A multiple linear regression model is used to examine the response effectiveness and weigh the influencing factors of the fixed time for the dynamic pricing scheme. For the no-residential part, the electricity consumption strongly depends on the variations in temperature, commercial consumer tends to respond more to the changes of electricity price than office sector. The residential customer shows a promising potential for load reduction corresponding the increasing electricity price. However, the effects depend on the preferences of residential customers to change their power usage pattern at real time of the CPP event period.

Outcomes of Integrated Behavioral Health with Primary Care.

Integrating behavioral health and primary care is beneficial to patients and health systems. However, for integration to be widely adopted, studies demonstrating its benefits in community practices are needed. The objective of this study was to evaluate effect of integrated care, adapted to local contexts, on depression severity and patients' experience of care. This study used a convergent mixed-methods design, merging findings from a quasi-experimental study with patient interviews conducted as part of Advancing Care Together, a community demonstration project that created an innovation incubator for practices implementing evidence-based integration strategies. The study included 475 patients with a 9-item Patient Health Questionnaire (PHQ-9) score ≥10 at baseline, from 5 practices. Statistically significant reductions in mean PHQ-9 scores were observed in all practices, ranging from 2.72 to 6.46 points. Clinically, 50% of patients had a ≥5-point reduction in PHQ-9 score and 32% had a ≥50% reduction. This finding was corroborated by patient interviews that demonstrated positive experiences with behavioral health clinicians and acquiring new skills to cope with adverse situations at work and home. Integrating behavioral health and primary care, when adapted to fit into community practices, reduced depression severity and enhanced patients' experience of care. Integration is a worthwhile investment; clinical leaders, policymakers, and payers should support integration in their communities.

Lessons Learned From Dissemination of Evidence-Based Interventions for HIV Prevention.

In 1999, IOM issued a report that recommended that the Centers for Disease Control and Prevention should disseminate evidence-based HIV prevention interventions (EBIs) to be implemented by health departments, community-based organizations, drug treatment centers, and clinics. Based on these recommendations, the Diffusion of Effective Behavioral Interventions Project was initiated in 2000 and began disseminating interventions into public health practice. For 15 years, the Centers for Disease Control and Prevention has disseminated 29 EBIs to more than 11,300 agencies. Lessons were identified during the 15 years of implementation regarding successful methods of dissemination of EBIs. Lessons around selecting interventions for dissemination, developing a dissemination infrastructure including a resource website (https://effectiveinterventions.cdc.gov), and engagement with stakeholders are discussed. A continuous development approach ensured that intervention implementation materials, instructions, and technical assistance were all tailored to the needs of end users, focus populations, and agency capacities. Six follow-up studies demonstrated that adopters of EBIs were able to obtain comparable outcomes to those of the original efficacy research. The Diffusion of Effective Behavioral Interventions Project may offer guidance for other large, national, evidence-based public health dissemination projects.

Partnership and community capacity characteristics in 49 sites implementing healthy eating and active living interventions.

One component of the Evaluation of Healthy Kids, Healthy Communities, funded by the Robert Wood Johnson Foundation, was to assess partnership and community capacity characteristics of 49 cross-sector, multidisciplinary community demonstration projects to increase healthy eating and active living as well as to prevent and reduce childhood obesity. From December 2012 to December 2013, an 82-item partnership and community capacity survey instrument assessed perspectives of community partnership members and community representatives from 48 of the 49 communities on the structure and function of their partnerships and the capacity of the community to create change. Through factor analysis and descriptive statistics, the evaluators described common characteristics of the partnerships, their leadership, and their relationships to the broader communities. A total of 603 individuals responded from 48 of the 49 partnerships. Evaluators identified 15 components, or factors that were broken into a themes, including leadership, partnership structure, relationship with partners, partnership capacity, political influence of partnership, and perceptions of partnership's involvement with the community and community members. Survey respondents perceived the Healthy Kids, Healthy Communities partnerships to have the capacity to ensure the partnerships' effectiveness in forming and growing their structures and functions, collaborating to implement policy and environmental change, and planning for sustainability.

P6.018 Participatory Action Research, Evidence-Based Public Health, and Cooperative Agreements: Adverse Effects

<h3>Background</h3> Racial and Ethnic Approaches to Community Health (REACH) 2010 was an ambitious multi-sector, multilevel, multicenter, and multi-phased community demonstration project designed to reduce health disparities in the United States. Requirements for a cooperative agreement with the Centers for Disease Control and Prevention were enumerated in Program Announcement 99064. Applicants had to represent coalitions of predominantly minority community members that would propose community action plans (CAPs) to address one or more serious health problems affecting one or more minority populations. The Broward Coalition to Eliminate Disparities in HIV Disease was one of 32 (out of 206) eligible applicants to receive a competitive award in Fiscal Year 2000 to develop a CAP. The CAP was one of 24 to be approved by CDC for implementation in Fiscal Year 2001. The primary goal was to eliminate disparities in new HIV infections reported among Black and Hispanic residents of Broward County by 2010. <h3>Methods</h3> A case study to illustrate how competing models of disease prevention can inhibit successful outcomes in public health. <h3>Results</h3> The participatory action research (PAR) programme designed, developed, and implemented by the Broward Coalition contained four interventions chosen by members after systematically working through the PRECEDE Health Promotion Planning Model. From 1999 through 2006, rates of new HIV infections among non-Hispanic Black residents of Broward declined from 193/100,000 to 81/100,000. On April 5, 2005, CDC site visitors informed the Coalition that funding for Broward would be cut in half in Fiscal Year 2006. They urged that only interventions recommended by CDC experts as “high impact” be continued. Subsequently, educational outreach efforts considered essential by local community members were curtailed and rates of new HIV infections among Blacks in Broward began to rise. <h3>Conclusion</h3> Project shortcomings were linked to the decrement of resources and reinterpretation of PAR interventions by evidence-based criteria.

Challenges in Green Innovation Policy after the Fukushima Nuclear Accident

This paper examines Japan’s Science and Technology (S&T) Basic Plans in accordance with its S&T Basic Law. The Basic Plans promote two major innovation (Green Innovation and Life Innovation) towards the creation of new markets and jobs, specifically under the Fourth S&T Basic Plan enacted on August 2011. Successful smart community demonstration projects at four urban localities were launched under plans to promote Green Innovation research and development of renewable energy technologies. However, the expectation that renewable energy such as solar or wind power can replace nuclear power is not backed by sufficient evidence. Furthermore, the electricity produced by these sources is expensive and unstable owing to its reliance on weather conditions. The Fukushima nuclear power plant accident on March 2011 has also seriously affected Japan’s future energy plans. According to a government estimate, electricity charges would double if nuclear power generation were abandoned, imposing a heavy burden on the Japanese economy. Japan is in need of energy policies designed on the basis of more far-sighted initiatives.

Reducing potentially preventable complications at the multi hospital level

BackgroundThis study describes the continuation of a program to constrain health care costs by limiting inpatient hospital programs among the hospitals of Syracuse, New York. Through a community demonstration project, it identified components of individual hospital programs for reduction of complications and their impact on the frequency and rates of these outcomes.FindingsThis study involved the implementation of interventions by three hospitals using the Potentially Preventable Complications System developed by 3M™ Health Information Systems. The program is noteworthy because it included competing hospitals in the same community working together to reduce adverse patient outcomes and related costs.The study data identified statistically significant reductions in the frequency of high and low volume complications during the three year period at two of the hospitals. At both of these hospitals, aggregate complication rates also declined. At these hospitals, the differences between actual complication rates and severity adjusted complication rates were also reduced.At the third hospital, specific and aggregate complication rates remained the same or increased slightly. Differences between these rates and those of severity adjusted comparison population also remained the same or increased.ConclusionsResults of the study suggested that, in one community health care system, the progress of reducing complications involved different experiences. At two hospitals with relatively higher rates at the beginning of the study, management by administrative and clinical staff outside quality assurance produced significant reductions in complication rates, while at a hospital with lower rates, management by quality assurance staff had little effect on reducing the rate of PPCs.

Mixed Communities: A New Approach to Spatially Concentrated Poverty in England

AbstractThis article examines the adoption, by the New Labour government, of a mixed communities approach to the renewal of disadvantaged neighbourhoods in England. It argues that while there are continuities with previous policy, the new approach represents a more neoliberal policy turn in three respects: its identification of concentrated poverty as the problem; its faith in market‐led regeneration; and its alignment with a new urban policy agenda in which cities are gentrified and remodelled as sites for capital accumulation through entrepreneurial local governance. The article then draws on evidence from the early phases of the evaluation of the mixed community demonstration projects to explore how the new policy approach is playing out at a local level, where it is layered upon existing policies, politics and institutional relationships. Tensions between neighbourhood and strategic interests, community and capital are evident as the local projects attempt neighbourhood transformation, while seeking to protect the rights and interests of existing residents. Extensive community consultation efforts run parallel with emergent governance structures, in which local state and capital interests combine and communities may effectively be disempowered. Policies and structures are still evolving and it is not yet entirely clear how these tensions will be resolved, especially in the light of a collapsing housing market, increased poverty and demand for affordable housing, and a shortage of private investment.Résumé Le gouvernement New Labour a adopté une démarche de mixité des communautés dans le cadre de la rénovation des quartiers défavorisés anglais. Si certains aspects de la politique antérieure persistent, la nouvelle approche prend une tournure plus néolibérale à trois titres: en identifiant les concentrations de pauvreté comme étant le problème, en se fiant à une régénération par le marché, et en s'associant à un nouveau programme de politiques urbaines dans lequel les villes sont ‘gentrifiées’ et remodelées en tant que lieux d'accumulation de capital à travers une gouvernance locale de type entrepreneurial. En s'appuyant sur les premières phases d’évaluation de ces projets de démonstration sur la mixité, il est possible d’étudier l'exécution de la nouvelle approche à un niveau local, où elle s'ajoute aux actions, politiques et relations institutionnelles existantes. Des tensions entre intérêts des quartiers et intérêts stratégiques, entre communauté et capital, sont manifestes, tandis que les projets locaux s'efforcent de transformer les quartiers tout en cherchant à protéger les droits et intérêts des résidents en place. D'importants efforts de consultation des communautés se déroulent pendant qu'apparaissent les structures de gouvernance dans lesquelles les intérêts du capital et des autorités territoriales se combinent et où les communautés risquent bien de perdre toute capacité. Actions publiques et structures continuant d’évoluer, on ne peut pas encore voir comment ces tensions vont être réglées, compte tenu notamment d'un effondrement du marché du logement, d'une progression de la pauvreté, d'un accroissement de la demande d'habitations accessibles financièrement, et d'un manque d'investissement privé.

Coalition Contract Management as a Systems Change Strategy for HIV Prevention

Racial and Ethnic Approaches to Community Health (REACH) 2010 provided a unique opportunity for minority community-based organizations (CBOs) to work together to eliminate disparities in HIV disease. A coalition was formed in Broward County to respond to the REACH 2010 program announcement, a university was chosen to coordinate efforts, and contracts were negotiated with CBO partners to develop, implement, and evaluate a community action plan. Contract management provided stability, focus, and a mechanism for coalition partners to measure progress toward achieving project objectives. By emphasizing documentation as well as the delivery of services, however, contract conditions also placed a heavy burden on educational outreach workers, restricted the reimbursable activities of member organizations, and created friction between minority agencies and university staff. Although the coalition met many of its objectives, the introduction and enforcement of a mutually agreed on set of rules and obligations as a way of promoting systems change in Broward County failed to make a lasting impact among community partners. CBOs continued to compete with one another for HIV prevention project funding and stopped collaborating as closely with another when federal support for our REACH 2010 community demonstration project ran out.

Low-cost flexible sigmoidoscopy screening: a community demonstration and education project.

The purpose of this project was to demonstrate that a low-cost, community-based screening and education approach (for both patients and physicians), as has been used with mammography, can be successful with flexible sigmoidoscopy. One hundred appointments over four days were made available via a targeted mailing to 12,000 health-interested community members if they were asymptomatic, 50 years old or older, and had never before been screened by flexible sigmoidoscopy. The cost for the procedure was set at $50. Professional education was accomplished by having local physicians interested in gaining greater experience with flexible sigmoidoscopy provide the screenings under supervision. All 100 patient appointments and seven physician-training slots were quickly filled. Ninety-five procedures were performed by seven local physicians, averaging 10 minutes per procedure, with an average insertion depth of 31 cm and a 4.2% premalignant-polyp detection rate. The patients were also given education and counseling about colorectal cancer screening and prevention, and were evaluated by pre- and post-testing, and satisfaction questionnaires. The patients demonstrated markedly significant knowledge gains about colorectal cancer prevention and early detection, with 99% agreeable to having the procedure repeated in the future. This project demonstrated a high level of both public and professional willingness to participate in a flexible sigmoidoscopy screening program. The project method is presented in detail to encourage future such programs.

Older Adults Seeking Mental Health Counseling in a NORC

The authors used the Andersen model to compare older adults’ help seeking from clergy to help seeking from other sources of formal mental health services. Data were from the Naturally Occurring Retirement Community Demonstration Project. Multinomial logistic regression was used to compare sources from which help was sought.The results indicate that older adults sought help from clergy more frequently than from other formal sources. Increased stress levels, higher intrinsic religiosity, and being younger were related to seeking help from clergy. Greater stress and attendance at religious services were related to help seeking from other sources. Only greater frequency of attending religious services was associated with a greater likelihood of seeking help from clergy versus other formal providers.The increasing elderly population and the attendant crisis in mental health services might best be addressed through public-private partnerships in which mental health professionals assist clergy in identifying problems and making appropriate referrals.

Older Drivers Retiring From the Road: An Application of the Selection, Optimization, and Compensation Model

Purpose: This study uses the selection, optimization, and compensation (SOC) model to compare older adults who have given up driving, those who still drive, and those who drive less to identify differences in the three groups. Design and Methods: This cross-sectional study of 281 older adults is part of the Naturally Occurring Retirement Community Demonstration Project. Study participants completed interviews that included questions on demographics, health and functioning, mental health, social support, and current levels of engagement in activities including current driving status. Results: Data suggest that driving retirement is a process and that a substantial number of people are in the transitional stage, where they are less functional than those who still drive and more similar to those who have retired from the road. Implications: Given the similarity of those who drive less to those who have given up driving, front-line professionals and policy makers must work together to ease the transition to driving retirement for those without adequate ability to effectively compensate for their inability to continue to drive safely.

Clergy as mental health service providers to older adults

Older adults tend to seek help for emotional problems from clergy at greater rates than they do from other sources. However, their help-seeking from clergy is largely understudied. We used data from the Naturally Occurring Retirement Community (NORC) Demonstration Project to examine older adults’ patterns of help-seeking from clergy. We studied a sample of adults aged 65 or older (n = 317) to determine which factors were related to help-seeking from a religious leader. This study was framed within the Behavioral Model of Health Services Utilization. Results of hierarchical logistic regression analyses indicated that having less social support and greater frequency of attendance at religious services was related to help-seeking from clergy for this sample, while other predisposing, enabling, need and religiosity variables were not found to be related to help-seeking from clergy. Discussion focuses on the need for mental health workers to be aware of the important role that clergy play in service provision and to find ways to leverage knowledge and skills to enhance provider–clergy relationships in order to improve services that older adults receive.

HIV interventions affect behavior indirectly: results from the AIDS Community Demonstration Projects

Behavioral theory informs HIV prevention programs by identifying important predictors of the relevant behavior. Changes in those predictors brought about by program messages should theoretically translate into behavior change. Program evaluation, however, may examine only whether message exposure is associated with behavior change, assuming that if people changed their behavior, the intervention must have effectively changed the determinants. This practice obscures how intervention programs work in the field. We use data from the AIDS Community Demonstration Projects (ACDP) to illustrate this important idea. Earlier research found that the ACDP moved at-risk communities to more consistent condom use with both main and non-main partners. This study demonstrates that these behavioral effects are explained by the ACDP's ability to improve intention and self-efficacy for condom use with both main and non-main partners. We conclude that to understand how HIV prevention programs work, program evaluations need to assess how the intervention affected what it was designed to change: one or more critical behavioral determinants.

The New Caring

Increasing longevity and the growing proportion of the aged in the population in most countries have served to focus on the question of how governments and older people can finance living, health, and care options in retirement. Prudent management of income and assets is an increasingly complex and important aspect of aging as assets and expectations of self-financing increase. Although many informal caregivers act as asset managers and/or substitute decision-makers for older people, little attention has been paid to this increasingly important aspect of care. This paper summaries key findings of a broad research program exploring family involvement in the management of older people's assets and the practices that constitute good practice as well as financial mismanagement and abuse. It identifies multi-level and multi-strategy responses needed to address the issues raised by the research and outlines an innovative community demonstration project aimed at improving financial management practices in relation to older people's assets.

The relationship of religiosity to older adults’ mental health service use

This article uses data from the Naturally Occurring Retirement Community (NORC) Demonstration Project (N = 326) to examine older adults’ utilization of mental health services. This study is guided by the behavioral model of health service utilization and helps to fill gaps in the literature by including religious affiliation, religiosity, and interaction terms as variables in regression models. These variables are important, as religion is more important in the lives of older adults than in the lives of their younger counterparts. This study found the rate of use of mental health services during the previous six months to be 19.0%, and those with higher levels of private religious activity and higher levels of intrinsic religiosity are more likely to have accessed some form of mental health service. However, frequency of attendance at religious services is not associated with the use or non-use of services. Information from this study suggests that more research is needed to specify the manner in which religious affiliation and religiosity work to affect the use of mental health services, and future studies must include religious variables in order for models of service use to be complete.

Reductions in Transmission Risk Behaviors in HIV–Positive Clients Receiving Prevention Case Management Services: Findings from a Community Demonstration Project

Prevention case management (PCM) for HIV-infected persons is an HIV risk reduction intervention designed to assist clients who are aware of their HIV infection and who continue to engage in risk transmission behaviors. PCM combines individual risk reduction counseling with case management to address the psychosocial factors affecting HIV transmission. More than 350 HIV-positive clients participated in PCM in Wisconsin between 2000 and 2003, and 109 completed both baseline and follow-up risk assessments. The percentage of clients reporting risk transmission behaviors, specifically unprotected vaginal intercourse, insertive anal intercourse, or needle sharing with partners of negative or unknown HIV status, declined from 41.3% at baseline to 29.4% at follow-up (p = 0.04). Furthermore, clients showed progression (p < or =.05) through stages of change using Prochaska and DiClemente's transtheoretical model on seven domains related to HIV transmission risk, including personalizing risk of HIV transmission and sexual risk behavior.

Sustainable libraries: teaching environmental responsibility to communities

This article defines sustainability to include community, economy, and the buildings made in service to those considerations. As gateways for knowledge, libraries are particularly well‐suited as demonstration vehicles. Beneficiaries are determined so that potential sources of funding can be identified. The case study (Oak Park Library, Ventura, California) integrates state‐of‐the‐art energy‐conserving design into a new joint‐use public and high school library. Client review, public presentations, computer modeling, and environmental specifications research led to a design that was awarded nearly $250,000 in construction funding and “buydowns”. Computer‐modeled analyses of the energy‐conserving elements of the Oak Park Library showed reductions in heating, cooling, and electricity consumption when those strategies were implemented. The strategies illustrated include techniques in lighting design, cooling/heating, and construction that can be replicated in new and existing projects to maximize efficiency in high‐visibility community demonstration projects. A listing of additional resources is also included.