Community Health Promotion Initiatives Research Articles

Design and Implementation of the Diabetes Impact Project: A Multisector Partnership to Reduce Diabetes Burden in Indianapolis Communities.

Community-level health disparities have not arisen suddenly but are the result of long-term systemic inequities. This article describes the design and implementation of a community-engaged multisector partnership to address health disparities by reducing the diabetes burden in 3 Indianapolis communities through the implementation of evidence-based strategies across the prevention continuum. The project has 5 foundational design principles: engage partners from multiple sectors to address community health, focus on geographic communities most affected by the health disparity, practice authentic community engagement, commit for the long term, and utilize a holistic approach spanning the prevention continuum. The design principles are incorporated into the following project components in each community: (1) health system community health workers (hCHWs), (2) neighborhood CHWs (nCHWs), (3) community health promotion initiatives, and (4) resident steering committees, as well as a backbone organization responsible for overall coordination, project communication, evaluation, and partnership coordination. This complex multilevel intervention is being evaluated using data sources and methodologies suited to each project component and its purpose overall. Each component is being evaluated independently and included holistically to measure the impact of the project on the health and culture of health in the communities. Key Performance Indicators were established upon project initiation as our common metrics for the partnership. Because complex interventions aiming at population-level change take time, we evaluate Diabetes Impact Project-Indianapolis Neighborhoods (DIP-IN), assuming its impact will take many years to achieve. Health disparities such as the diabetes prevalence in project communities have not arisen suddenly but are the result of long-term systemic inequities. This complex issue requires a complex holistic solution with long-term commitment, trusted partnerships, and investment from diverse sectors as seen in this project. Implications for policy and practice include the need to identify stable funding mechanisms to support these types of holistic approaches.

Community intervention for cardiovascular disease risk factors in Kalutara, Sri Lanka

BackgroundThe effectiveness of a 2015–17 community intervention to reduce cardiovascular disease (CVD) and type 2 diabetes (T2DM) risk factors is assessed in a Sri Lanka adult population, using a before-and-after study design.MethodsFour contiguous Public Health Midwife (PHM) areas in Kalutara district (Western Province) were exposed to a Sri Lankan designed community health promotion initiatives (without screening) to lower CVD and T2DM risk factors. Pre- and post-intervention surveys (2014, n=1,019; 2017, n=908) were of 25–64 year males (M) and females (F) from dissimilar randomly selected clusters (villages or settlements) from PHMs, with probability of selection proportional to population size, followed by household sampling, then individual selection to yield equal-probability samples. Differences in resting blood pressure (BP), fasting plasma glucose (FPG), total cholesterol, body mass index and tobacco smoking, adjusting for cluster sampling, age and socio-economic differences, were examined.ResultsHypertension prevalence declined from 25% to 16% (F) (p<.0001), and 21% to 17% (M). Both mean systolic and diastolic BP declined. T2DM declined from 18% to 13% (F), and 18% to 15% (M), as did mean fasting plasma glucose. Elevated total cholesterol declined from 21% to 15% in women (p=0.003) and mean cholesterol declined. Frequency distributions, medians and means of these continuous CVD risk factors shifted to lower levels, and were mostly statistically significant (p< 0.05).ConclusionsCommunity health promotion can lower key CVD and T2DM risk factors. Lowering tobacco consumption in males and obesity remain challenges in Sri Lanka.

Engaging Residents in Planning a Community Garden: A Strategy for Enhancing Participation Through Relevant Messaging

Understanding residents’ perceptions and preferences regarding health promotion and community development strategies is vital. Community gardens, often collaborative community-engaged projects, are designed to be healthy places where neighbors gather; however, they have the potential to be much more. The purpose of the study was to gauge public support for a community garden in South Omaha and prioritize messaging strategies regarding the potential benefits of a garden. To that end, a bilingual online survey that assessed interest in, perceived benefits of, purposes for, and functional attributes to co-locate in a community garden was conducted. Through this process, we learned about the value of developing local data, importance of using an asset-based framework, understanding community perceptions about potential benefits, balancing community research endeavors, and developing partnerships to expand the reach of a project. Developing community research strategies and appropriate messaging in collaboration with community members and partners is critical to the success of community health promotion initiatives.

A Conceptual Sustainability Strategy for a Rurally-Based Community Health Promotion Initiative

Sustaining grant-funded rural community health promotion initiatives following expiration of active funding cycles is usually challenging. Rural communities are described as periphery to cities and somewhat isolated with all larger communities located more than 30 miles away and are perceived as lacking in essential resources that create and nurture businesses [1,2]. Statistics show that rural residents are comparatively poorer than urban and metropolitan residents. For instance in 2005, 17% of rural residents lived below poverty line whereas in metropolitan areas it was 13% [3]. Furthermore, as funding sources and grant making agencies limit, restrict, prioritize, and restructure funding because of current national economic downturn, it is imperative that rurally-based community healthcare promotion projects become familiar with a locally-dependent strategy that fosters sustenance of life-saving community health initiatives. This article describes a practical strategy for securing local resources to sustain rurally-based grant-funded community health promotion programs. It provides a step by step guide for identifying, recruiting, and engaging suitable local collaborators to secure resources that continue to meet goals and objectives of funded programs following expiration of external funding thereby ensuring that rural residents continue to receive benefits of useful health promotion initiatives. During these times of severe national economic hardship, program administrators will find this strategy very informative and helpful. However, there is need for further testing to properly evaluate the usefulness of this sustainability strategy.

Evaluation of changes in individual community-related empowerment in community health promotion interventions in Estonia.

This study assessed changes in community members’ ratings of the dimensions of individual community related empowerment (ICRE) before and two years after the implementation of an empowerment expansion framework in three community health promotion initiatives within the Estonian context. We employed a self-administered questionnaire, the adapted mobilisation scale–individual. As the first step, we investigated the multidimensional nature of the ICRE construct and explored the validity and reliability (internal consistency) of the ICRE scale. Two datasets were used. The first dataset comprised a cross-sectional random sample of 1,000 inhabitants of Rapla County selected in 2003 from the National Population Register, which was used to confirm the composition of the dimensions of the scale and to examine the reliability of the dimensions. The second dataset comprised two waves of data: 120 participants from three health promotion programs in 2003 (pre-test) and 115 participants in 2005 (post-test), and the dataset was used to compare participants’ pre-test and post-test ratings of their levels of empowerment. The content validity ratio, determined using Lawshe’s formula, was high (0.98). Five dimensions of ICRE, self-efficacy, intention, participation, motivation and critical awareness, emerged from the factor analysis. The internal consistency (α) of the total empowerment scale was 0.86 (subscales self-efficacy α = 0.88, intention α = 0.83, participation α = 0.81 and motivation α = 0.69; critical awareness comprised only one item). The levels of ICRE dimensions measured after the application of the empowerment expansion framework were significantly more favourable for the dimensions self-efficacy, participation, intention and motivation to participate. We conclude that for Rapla community workgroups and networks, their ICRE was rendered more favourable after the implementation of the empowerment expansion framework.

The use of Goal Attainment Scaling in a community health promotion initiative with seniors.

BackgroundEvaluating collaborative community health promotion initiatives presents unique challenges, including engaging community members and other stakeholders in the evaluation process, and measuring the attainment of goals at the collective community level. Goal Attainment Scaling (GAS) is a versatile, under-utilized evaluation tool adaptable to a wide range of situations. GAS actively involves all partners in the evaluation process and has many benefits when used in community health settings.MethodsThe purpose of this paper is to describe the use of GAS as a potential means of measuring progress and outcomes in community health promotion and community development projects. GAS methodology was used in a local community of seniors (n = 2500; mean age = 76 ± 8.06 SD; 77% female, 23% male) to a) collaboratively set health promotion and community partnership goals and b) objectively measure the degree of achievement, over- or under-achievement of the established health promotion goals. Goal attainment was measured in a variety of areas including operationalizing a health promotion centre in a local mall, developing a sustainable mechanism for recruiting and training volunteers to operate the health promotion centre, and developing and implementing community health education programs. Goal attainment was evaluated at 3 monthly intervals for one year, then re-evaluated again at year 2.ResultsGAS was found to be a feasible and responsive method of measuring community health promotion and community development progress. All project goals were achieved at one year or sooner. The overall GAS score for the total health promotion project increased from 16.02 at baseline (sum of scale scores = -30, average scale score = -2) to 54.53 at one year (sum of scale scores = +4, average scale score = +0.27) showing project goals were achieved above the expected level. With GAS methodology an amalgamated score of 50 represents the achievement of goals at the expected level.ConclusionGAS provides a "participatory", flexible evaluation approach that involves community members, research partners and other stakeholders in the evaluation process. GAS was found to be "user-friendly" and readily understandable by seniors and other community partners not familiar with program evaluation.

Evaluating Australian Indigenous community health promotion initiatives: a selective review

Effective health promotion interventions are critical to addressing the health needs of Indigenous people. We reviewed published and unpublished evaluation reports between 2000 and 2005 to identify practice issues pertinent to evaluators of Aboriginal and Torres Strait Islander health promotion initiatives. While the review of the literature was not systematic it was sufficiently comprehensive to provide a snapshot of evaluation practice currently in place within the Australian context. We found that published evaluation literature infrequently referred to the utilisation of guidelines for ethical research with Aboriginal and Torres Strait Islander peoples. The implications of this are that the importance and relevance of the guidelines for evaluative research are not being widely promoted or disseminated to evaluation practitioners and the role of the guidelines for improving evaluation practice remain unclear. While many innovative health promotion programs appear to have been highly regarded and well received by communities, the evaluation studies were not always able to report conclusively on the impact and health outcomes of these interventions or programs. This was due mainly to limitations in evaluation design that in some cases were insufficiently robust to measure the complex and multifaceted interventions described. To enhance rigour, evaluators of community health promotion initiatives could utilise mixed method approaches overtly informed by appropriate ethical guidelines, together with a broader range of qualitative methods aided by critical appraisal tools to assist in the design of evaluation studies.

Reorienting health services through community health promotion in Kwaio, Solomon Islands

When ethnic minorities adhere to cultural practices which mark them as unique, structural impediments within health services can deny access and significantly add to the burden of disease. This is particularly pertinent if the development of health services is not done in partnership with all population groups in the area. This is the case at Atoifi Hospital, which structure prevents certain Kwaio people (Solomon Islands) from receiving benefits of hospital services and maintaining cultural beliefs at the same time. A Participatory Action Research process was used to collaboratively work with health service providers and community groups to review the situation, design and build a health facility with both medically and culturally appropriate policies and procedures. The Participatory Action Research process of collectively looking, thinking, planning and acting towards reorienting health services to become more culturally appropriate at Atoifi was the first time leaders, from both the community and hospital, had collectively sat together in a mutually respectful way to discuss community health promotion initiatives. The project was complete in 2006 with collaboration and dialogue between both groups proving vital to its success. Numerous indicators are present that the culturally appropriate health facility is making a difference, not only in terms of the hospital usage by all, but also for the feeling of "community ownership."

An Interview with Dr. Laura Leviton, Leader in the Field of Evaluating Community Health Promotion Initiatives

This article summarizes a recent interview with Dr. Laura Leviton, Senior Program Officer in Re-search and Evaluation for the Robert Wood Johnson Foundation. Dr. Leviton is also the immediate past president of the American Evaluation Association. With a wealth of experience in working with community health promotion initiatives, Dr. Leviton provides important insights, recommendations, and dreams for the future of the field. The authors’ questions are in italics, followed by Dr. Leviton’s responses.

Determining Nutrition Needs and Wants Using a Community Needs Assessment Model: A Pilot Project

Nutrition education is fundamental component of community health promotion initiatives. Nutrition professionals can better plan community-based programs if they understand the needs and wants of the target population. A comprehensive community needs assessment (CNA) can clarify these needs and wants, and serve as a foundation for planning and evaluating nutrition education programs. We conducted a pilot CNA in a population of U.S. Army soldiers to determine the feasibility and effectiveness of a multi-component CNA model. Components of the CNA included a review of the literature, secondary data analysis of the target population (health risk appraisal data), consumer feedback (focus groups), and key informant interviews (health professionals and military leaders). We examined the information from these diverse sources, looking for convergence of issues. Results indicate that soldiers are interested in nutrition issues, particularly in learning how to: make healthy food choices, use supplements, and maintain a healthy weight. Results also highlight an opportunity to educate leaders about the importance of nutrition in overall health. Although time intensive, we found the CNA project to be both feasible arid effective in identifying the key nutrition issues. This multifaceted approach to nutrition needs assessment in a community provided relevant, diverse, and detailed information to assist program planning, and served to heighten nutrition interest among participants.

Community-based substance abuse prevention: a multicultural perspective.

Communities represent complex organizational entities which frequently are comprised of varying racial, ethnic, and sociocultural subgroups. This diversity, which is often underestimated and at times overlooked, presents a formidable challenge to substance abuse prevention efforts. The different lifestyles exhibited by various subgroups within a community represent a range of target behaviors that must be addressed if community health promotion initiatives are to be effective. This paper describes the barriers to achieving the goals of community-based substance abuse prevention that can arise from failing to recognize socioculturally-defined subgroups. An intervention planning model, which addresses the barriers from the perspective of a communication-behavior change (CBC) theoretical framework, is presented.