Community Health Promotion Interventions Research Articles

A Socio-Ecological Approach to A Community-Based Health Promotion Intervention on the U.S.-Mexico Border: Insights and Lessons Learned During the COVID-19 Pandemic

The Healthy Families Healthy Kids Initiative (HFHKI) is a community-based initiative developed based on the socio-ecological model to address preventive health care needs in El Paso County, Texas, one of the most economically and health-challenged border communities in the United States. HFHKI’s three main goals are to increase access to experiential learning and health education, service delivery, and sustainable systems/linkages of care. These were accomplished through seven critical activities. We present the rationale, background, setting, and conceptual framework for the initiative, followed by the methods used to develop and assess the success of the activities and results of our project outcomes. We end with a discussion of lessons learned and future directions. We also share insights gained from our community health promotion intervention during the COVID-19 pandemic, which will enrich current conversations among applied social scientists. Overall, our project served 2,347 participants of all age ranges during our first year of project implementation across all 7 activities. We recommend the use of the socio-ecological model in designing, implementing, and improving health interventions aimed at enhancing family and community health, with each intervention tailored to the needs of different segments of the community. While the need to contain the COVID-19 virus amid the pandemic has created challenges in health promotion efforts, the need to help affected communities regain control of their health cannot be stressed enough. Our project can serve as an implementation framework for community-based projects on the U.S.-Mexico border.

Prevalence and knowledge of modifiable cardiovascular diseases risk factors among vulnerable population in Central Tanzania

BackgroundCardiovascular diseases (CVDs) are the global public health problem which has been associated with increasing prevalence of modifiable CVDs risk factors. This study aimed to describe the prevalence and knowledge of modifiable CVDs risk factors among vulnerable population of Central Tanzania.MethodsA community-based cross-sectional study design was employed. A total of 749 participants were interviewed. The socio-demographic information and modifiable CVDs risk factors (behavioral and biological) were measured using a modified World Health Organization (WHO) STEPwise approach for chronic disease risk factor surveillance. Knowledge of modifiable CVDs risk factors was measured by comprehensive heart disease knowledge questionnaire. Descriptive statistics were used to describe the knowledge and prevalence of modifiable CVDs risk factors. Logistic regression analysis was used to determine the factors associated with adequate knowledge of CVDs risk factors.ResultsThe prevalence of béhavioral risk factors were; current smokers and alcohol consumers were 4.4% and 18.0% respectively, use of raw salt was 43.7%, consumption of fruit/vegetables < 5 days per week was 56.9%. The prevalence of Biological CVDs risk factors was as follows: Overall, 63.5% (33.3% overweight and 29.9% obese) were overweight or obese, 4.5% were diabetic and 43.4% were hypertensive. Only 35.4% of participants had adequate knowledge of CVDs risk factors. Being a male (AOR = 1.44, 95%CI = 1.01–2.06, p < .05), having primary education (AOR = 6.43, 95%CI = 2.39–17.36, p < .0001), being employed (AOR = 1.59, 95%CI = 1.00-2.52, p < .05), ever checked blood pressure (AOR = 0.59, 95%CI = 0.42–0.84, p < .001), family history of hypertension (AOR = 0.38, 95%CI = 0.25–0.57, p < .0001) determined adequate knowledge of CVDs risk factors.ConclusionsThis study has revealed a high prevalence of modifiable CVDs risk factors and low knowledge of CVDs risk factors. Community health promotion interventions to increase population knowledge of CVDs risk factors are recommended for the efficacious reduction of CVDs in the country.

Current anxiety problems and organized activity participation among U.S. adolescents.

The study objectives were to examine the relationships between healthcare provider-confirmed current anxiety problems and organized activity participation including sports, clubs/organizations, and other activities. We used data from the 2018–2019 National Survey of Children’s Health including 24,356 adolescents 12–17 years old. Poisson and logistic regression analyses were conducted. About 13% of adolescents had current anxiety problems. Poisson regression results indicated that adolescents with anxiety problems were less likely to participate in a higher total number of organized activities compared to children without anxiety problems. Similarly, logistic regression results indicated that adolescents with anxiety problems were at reduced odds of participating in at least one organized activity compared to adolescents without anxiety problems. Specific to activity type, adolescents with anxiety problems were at reduced odds of participating in sports and clubs/organizations. Study findings should be considered when creating and implementing community health promotion and education prevention programs and interventions for adolescents.

Indices and Indicators Developed to Evaluate the "Strengthening Community Actions" Mechanism of the Ottawa Charter for Health Promotion: A Scoping Review.

To determine 1) the indexes/indicators used for evaluating the "strengthening community actions" mechanism of the Ottawa Charter for Health Promotion and 2) to extract the characteristics and key components of the indexes/indicators using a scoping review.Data Source:In May 2020, the search was conducted across three databases: Medline (via PubMed), Embase, and Scopus.Inclusion and Exclusion Criteria: All primary studies relating to development, identification, and measurement of health promotion indices/indicators associated to the "strengthening community actions" were included. The review articles were excluded. The data were extracted to a data-charting form that was developed by the research team. Two authors reviewed the extracted data. To summarize and report the data, a descriptive numerical analysis and a narrative descriptive synthesizing approach were used. In total, 93 study articles were included. A majority of studies (82%) were conducted in developed countries. Different types of recognized indices were categorized into seven groups: social cohesion (n = 3), community capacity (n = 1), community participation (n = 7), social capital (n = 6), social network (n = 3), social support (n = 1), and others (n = 5). Having a collection of "strengthening community actions" indices/indicators in hand, health policymakers and health promotion specialists might be able to do their best in considering, selecting, and applying the most appropriate indices/indicators while evaluating community health promotion interventions in different settings.

Functional Mobility, Aging, and People With Mental Illness: Issues and Challenges

People with serious mental illness (SMI) are more likely to experience chronic health conditions at younger ages, which increases the risk of premature death. Co-morbid health conditions and risk for premature death are well-studied in the population, however less is understood about the impact of aging and SMI on functional ability. Research suggests that the population walk less and may have lower fitness levels than other populations (Gill et al., 2016). Specific data exploring functional age of people with SMI is sparse. The authors compared published standardized geriatric functional fitness values for people over 65 to baseline values of a community sample of people living with SMI who participated in a community health promotion intervention. The average age of the sample was 50 (SD=11). Three physical functioning measures were used in the comparison to measure physical functioning; the Sit to Stand Test, 6 Minute Walk, and Single Legged Stance. Results indicated significant differences in mean physical functioning values between the sample and standardized geriatric values. The sample performed at levels 20-30 years older than their chronological age. This finding suggests that mental health and aging services may need to adjust interventions, services and methods to improve physical functioning in middle-aged and older adults living with SMI. Premature functional decline impacts community living skills, independent living, housing choice, vocational options, and may impede personal goal attainment. Recommendations for interventions will be offered, as will suggestions for policies targeting services that cross aging and mental health silos.

La teoría del cambio: una herramienta para la planificación y la evaluación participativa en salud comunitaria

There is a growing interest in finding innovative approaches to the evaluation of complex interventions in public health. This methodological note presents the theory of change as a useful tool to facilitate both the planning and the evaluation of community health promotion interventions. A theory of change is a visual representation of how a programme or intervention works, in which its different components can be identified, together with how they relate to each other: what its objectives are, its expected results and through which actions they are expected to be achieved. It can be an applied research tool, developed using participatory approaches together with all relevant stakeholders, who can identify and jointly decide what to evaluate and how to.

Changing Social Norms: the Importance of \u201cOrganized Diffusion\u201d for Scaling Up Community Health Promotion and Women Empowerment Interventions

Some harmful practices are sustained by social norms—collective beliefs about what people expect from each other. Practitioners and researchers alike have been investigating the potential of social norms theory to inform the design of effective interventions addressing these practices in low- and middle-income countries. One approach commonly used to facilitate social norms change is community-based dialogs and trainings. This approach has often been criticized for not being cost-effective, as it usually includes a relatively small number of direct participants and does not allow for scaling-up strategies. In spite of some evidence (as for instance, the SASA! Program) that community dialogs can achieve social norms change, little exists in the literature about how exactly participants in community dialogs engage others in their networks to achieve change. In this paper, we look at the potential of “organized diffusion” as a cost-effective strategy to expand the positive effects of community-based interventions to participants’ networks, achieving sustainable normative shifts. We provide quantitative evidence from three case studies—Community Empowerment Program in Mali, Change Starts at Home in Nepal, and Voices for Change in Nigeria—showing that participants in community-based interventions can be effectively empowered to share their new knowledge and understandings systematically with others in their networks, eventually facilitating social norms change. Future community-based interventions intending to achieve social norms change would benefit from integrating ways to help participants engage others in their network in transformative conversations. Doing so has the potential to generate additional impact with little additional investment.

Improving access and provision of pre-travel healthcare for travellers visiting friends and relatives: a review of the evidence.

Travellers visiting friends and relatives (VFR travellers) in their country of origin are at increased risk of a range of preventable infections. Risks are broadly related to circumstances of travel, risk misconceptions and access to health services. Despite nearly two decades of literature highlighting these increased risks little impact has been made on their risk disparity. This review draws on evidence from travel medicine literature, supplemented by evidence from the broader field of immigrant health, and is structured to include strategies that aim to reduce barriers at the patient, provider and health system level. For the travel medicine provider, tailored risk communication that is cognisant of the unique health beliefs and barriers to travel health for VFR travellers is needed, including enhanced communication through the use of interpreters and supplementary written communication. Primary care providers are uniquely placed to identify future travel plans among immigrant patients, however, greater awareness of VFR traveller risks and training in travel medicine are required. Community health promotion interventions that are culturally appropriate, translated into multiple languages and takes into account the cumulative risk of multiple return visits are key to normalizing travel healthcare seeking behaviours and improving awareness of VFR travel risks. Currently, there are few examples of novel strategies to engage migrant communities in travel health with no formal evaluations of their effectiveness. Best practice includes the use of community-consulted approaches in collaboration with government, primary care and travel medicine. Multifactorial barriers related to health beliefs and access to health services require a range of strategies and interventions in both reaching and providing advice to VFR travellers. To improve the evidence base, future research should focus on the evaluation of novel strategies that address these barriers and improve access and provision of pre-travel healthcare to VFR travellers.

Learning from communities in the USA and England to promote equity and address the social determinants of health.

This commentary contextualises and documents the process of a twinning learning exchange between the US Racial and Ethnic Approaches to Community Health initiative and the Communities for Health initiative in England to enable the transfer and adaptation of ideas for similar community-focused initiatives in various contexts globally. The multi-partner twinning exchange built on and shared knowledge around community health promotion interventions, targeting 'marginalised' populations and focused on addressing the social determinants of health to effectively reduce health inequalities. This commentary presents the methodology of the exchange; provides key themes, outcomes and lessons learnt that arose from discussions and the experience; and provides insights, considerations and recommendations for adaptation. Finally, it highlights the importance of such exchanges in the current global context and the need for their replication and adaptation. These experiences contribute to building the evidence base on successful interventions and identifying strategies that work for improving health outcomes and reducing health inequalities. They strengthen the need for all governments to address the social determinants of health as a priority whilst providing insights to inform successful policy.

An investigation into the partnership process of community-based health promotion for men

Working in partnership offers service providers an opportunity to support one another and to maximise their collective resources. Effective partnerships underpin effective interventions whereby the efforts of the whole group outweigh the sum of the efforts of individual partners. Partnership work is essential in the area of community-based health promotion for men; vulnerable men are a particularly challenging group to engage and sustain in community health promotion interventions, and traditionally sparse resources have been targeted at this cohort. Using qualitative research techniques, this study examined how one men's community health promotion partnership operated over a 15-month period. Findings demonstrate that consensus among the partners with respect to the purpose of the partnership was essential. The positive group dynamic was based upon an informed and democratic decision-making process, the use of planning (Reach Effectiveness Adoption Implementation Maintenance – REAIM) and implementation tools (operational plan), ongoing evaluation of practice as well as the adoption of a ‘hands on approach’ to the work. Group membership was carefully considered; consultation with the target group was ongoing and it was agreed that training was required before men could participate at the partnership meetings. The specific challenges faced by the partnership were the lack of resources available for men's health work and the difficulty of initially engaging and then sustaining men's engagement with their health. The findings from this study may be adopted as guidelines to support others working in partnership in this challenging area.

Effects of Anti-diabetic Agents on Major Depressive Disorder in Type 2 Diabetic Patients

for community unwillingness to have type 2 diabetes screening and to create health promotion interventions for high-risk diabetes people. Methods: A participatory action research (PAR) was performed during November 2009 until June 2010 in Watsamakkee community, Maha Sarakham Province. PAR were divided into two phases Phase 1: focus group discussion to promote community participation in diabetes screening for people aged R35 years in the community and Phase 2: focus group to create and implement 1-month health promotion interventions for risk people by the community themselves. Four outcomes for risk people on diabetes were the better in 1) clinical outcomes 2) health behaviors 3) diabetes knowledge 4) health attitude. Outcomes on before and after activities were compared by using Wilcoxon Signed ranks tests. Results: After a focus group discussion with people in community, the causes of unwillingness to receive diabetes screening and resolution were found, Phase 1, we found 71 from 242 people (29.3%) came to screen and 33 (46.5%) were the risk diabetes persons. Phase 2, people proposed three health promotion activities that willing to participate, 1) home visits by community pharmacist, 2) providing posters of diabetes symptoms and giving symptom check every week by health volunteers, and 3) broadcasting diabetes songs via local radio every morning by community leaders. After 3 activities, the highrisk people showed the increasing scores on diabetes knowledge (1.85 1.28 score, p!0.001), more suitable behavior (p!0.05), decreased Fasting Blood Sugar from pre-test (4.87 10.03 mg/dl, p1⁄40.009), decreased systolic blood pressure (7.58 18.85mmHg, p1⁄40.028). Moreover, they were satisfied in health promotion activities, had more concern and good attitude on their health. Conclusion: When people have more participated in community health promotion intervention, they have more concern on their own health.

Effects of Community Participation and Health Promotion Interventions on Type 2 Diabetes Screening and High-risk Diabetes People's Outcomes

Effects of Community Participation and Health Promotion Interventions on Type 2 Diabetes Screening and High-risk Diabetes People's Outcomes

Current status of and factors associated with social isolation in the elderly living in a rapidly aging housing estate community

The aim of this study was to examine social isolation development among elderly persons living in a rapidly aging housing estate community in terms of the frequency of activities of daily living outside the home and social contact with neighbors and to identify associated factors. A self-administered questionnaire survey was conducted in 2007 (102 subjects) and 2010 (104 subjects) involving elderly residents living on a suburban housing estate. The data collected on the 87 subjects who responded to both surveys were analyzed. The survey investigated physical, psychological, and social factors regarded as being associated with social isolation. The subjects were divided into four social types according to the frequency of activities of daily living outside the home and social contact with neighbors. Multiple logistic regression analysis involved would-be-isolated and non-isolated groups as dependent variables and each factor as an independent variable. Isolated group subjects increased from 2.3 to 7.0% during the study period, with the would-be-isolated group accounting for 33.7% of the study population in both years. Factors strongly associated with the would-be-isolated group were a low subjective sense of well-being and socioeconomic status were identified in 2007, and an older age, low subjective sense of socioeconomic status, and no provision of emotional support in 2010. The health condition and social well-being of the elderly on a rapidly aging housing estate community tended to decline, revealing that the number of isolated and would-be-isolated subjects is increasing. Taking preventive action against social isolation among the elderly population is essential, suggesting the need to combine community health promotion and social communication interventions and to develop programs aimed at providing opportunities for elderly persons to be emotional support providers.

Assessing Readiness for Establishing a Farmers’ Market at a Community Health Center

Farmers' markets are community health promotion interventions that increase access to fresh fruits and vegetables. As farmers' markets continue to develop, it is important to strategically locate them in settings that are accessible to populations disparately affected by health disparities. One potential setting is a community health center. The goal of this analysis is to extend existing research on community readiness to identify indicators of preparedness among community health centers for establishing onsite farmers' markets. The sampling frame for the readiness assessment included all community health centers in South Carolina (N=20) representing 163 practice sites. Data collection included two brief online surveys, in-depth key informant interviews, and secondary analysis of contextual data. Five themes related to readiness for establishing a farmers market at a community health center were identified: capacity, social capital, awareness of health problems and solutions, logistical factors, and sustainability. Findings from this study provide guidance to researchers and community health center staff as they explore the development of environmental interventions focused on reducing diet-related health conditions by improving access to healthy foods.

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.

Using Service-Learning to Teach Community Health: The Morehouse School of Medicine Community Health Course

Medical education is evolving to include more community-based training opportunities. Most frequently, third- and fourth-year medical students have access to these opportunities. However, introducing community-based learning to medical students earlier in their training may provide a more formative experience that guides their perspectives as they enter clinical clerkships. Few known courses of this type exist for first-year medical students. Since 1998, the Morehouse School of Medicine (MSM) has required first-year students to take a yearlong Community Health Course (CHC) that entails conducting a community health needs assessment and developing, implementing, and evaluating a community health promotion intervention. In teams, students conduct health needs assessments in the fall, and in the spring they develop interventions in response to the problems they identified through the needs assessments. At the end of each semester, students present their findings, outcomes, and policy recommendations at a session attended by other students, course faculty, and community stakeholders.The authors describe the course and offer data from the course's past 11 years. Data include the types of collaborating community sites, the community health issues addressed, and the interventions implemented and evaluated. The MSM CHC has provided students with an opportunity to obtain hands-on experience in collaborating with diverse communities to address community health. Students gain insight into how health promotion interventions and community partnerships can improve health disparities. The MSM CHC is a model that other medical schools across the country can use to train students.

Community-Based Organizational Capacity Building as a Strategy to Reduce Racial Health Disparities

One of the biggest challenges facing racial health disparities research is identifying how and where to implement effective, sustainable interventions. Community-based organizations (CBOs) and community-academic partnerships are frequently utilized as vehicles to conduct community health promotion interventions without attending to the viability and sustainability of CBOs or capacity inequities among partners. Utilizing organizational empowerment theory, this paper describes an intervention designed to increase the capacity of CBOs and community-academic partnerships to implement strategies to improve community health. The Capacity Building project illustrates how capacity building interventions can help to identify community health needs, promote community empowerment, and reduce health disparities.

Outcome evaluation of community health promotion intervention within a donor funded project climate in Papua New Guinea

The Australian Agency for International Development (AusAID) funded Women and Children's Health Project sought to improve the health of women and children throughout Papua New Guinea between 1998 and 2004. The project utilised education, community development and health promotion interventions aimed to increase community support for the health of women and children. An outcome evaluation in 2006 investigated the long-term impact of the project using a multi-methods approach and covering 10 selectively sampled provinces, 19 districts and 93 communities. Qualitative data were collected from 175 interviews (national to village level) and 77 community discussions. Quantitative data from national, provincial and district levels were examined to attempt to validate findings. The evaluation found new-health-knowledge initiated changes to lifestyle practices and improved physical health and social and economic well-being in villages where volunteers and staff had been trained. Factors influencing success were a health-motivated person acting as a catalyst for change, empowered leadership through new community governance structures, effective visual tools and village health volunteers linking community and rural health workers. Failure was attributed to poor understanding of community development, limited information sharing, a 'top down' approach to community development and weak community leadership. The project's community health interventions improved the interaction between the community and health system, and influenced improved use of maternal and child health services. Evaluation suggests sustainable improvements in health can be achieved through community led and maintained activity.

A retrospective analysis of a community-based health program in Papua New Guinea

The Women and Children's Health Project was a large Australian funded aid Project that sought to improve the health of women and children in Papua New Guinea between 1998 and 2004. Community development and health promotion interventions aimed to increase community support for attended birth and children's health. Green and Kreuter's [Green, L. W. and Kreuter, M. W. (2005) Health Program Planning: An Educational and Ecological Approach, 4th edition. McGraw-Hill, New York] precede-proceed model of health program planning was applied retrospectively to critique the design, implementation and evaluation of the Project. An outcome evaluation (2006) provided data for this analysis and investigated long-term impact using a multi-methods approach. Application of the precede-proceed model was useful, but the model fails to sufficiently well identify 'inhibiting factors' as part of the educational and ecological assessment during the planning phase. Pre-defined objectives and contractually obligated outputs in a donor funded business model negatively influenced Project activity and outcomes. Despite this and the challenging context for implementation, Project interventions improved interaction between the community and health systems, and improved use of maternal child health services.

Identifying psychosocial mediators of health amongst Indigenous Australians for the Heart Health Project

Objective. The Heart Health Project is an ongoing community-directed health promotion programme encompassing the collection of health-related data and interventions promoting cardiovascular health. Following research which has emphasised the importance of psychological factors including mastery, or personal control, in mitigating cardiovascular health outcomes, this qualitative study explored whether such constructs were relevant from Indigenous perspectives, or whether there were other, more meaningful and relevant psychosocial factors identified by participants that should be incorporated into models of Indigenous health and which could be effective targets for change. Design. The study fits within the broader participatory action research design of the Heart Health Project. Data comprised 30 in-depth interviews with members of a rural Aboriginal community in south-eastern Australia to identify psychosocial factors relevant to their health. Interviews were semi-structured and carried out by two interviewers, one Aboriginal and one non-Aboriginal. Qualitative analysis using QN6 software resulted in a number of salient themes and sub-themes. These are summarised using extracts from the data. Results/Conclusions. Five major themes and 15 sub-themes emerged from data analysis. The findings indicated that while a sense of control may be one factor impacting on health and health behaviours, there were other factors that participants spoke about more readily that have specific relevance to the social and cultural context of Indigenous health. These included history, relationship with mainstream and connectedness. These may be worthy of further empirical investigation and are likely to assist in the design of community health promotion interventions for Aboriginal people.