Community-wide Health Promotion Research Articles

Reach and Capacity of Black Protestant Health Ministries as Sites of Community-Wide Health Promotion: A Qualitative Social Ecological Model Examination.

Black communities in the Southeast United States experience a disproportionate burden of illness and disease. To address this inequity, public health practitioners are partnering with Black Protestant churches to deliver health promotion interventions. Yet, the reach of these programs beyond the organizational level of the Social Ecological Model (SEM) is not well defined. Thus, the aim of this study is to understand Black Protestant church leaders' and members' perceptions about the capacity of their ministries to reach into their communities, beyond their congregations, as providers or hosts of health education or promotion interventions. From 20 Black Protestant churches in Atlanta, GA, 92 church leaders and members participated in semi-structured interviews. Grounded theory guided data analysis and a diverse team coded the interviews. Most participating churches had health ministries. Participants saw the boundaries between their churches at the organizational level of the SEM and the broader Black community to be porous. Those who described their "community" as being broader than their congregation also tended to describe community-wide health promotion their church engaged in. They described church-based health fairs as a strategy to promote engagement in their communities. Some participants, particularly those in a health-related profession, discussed visions of how to utilize their church as a site for community-wide health promotion. We suggest these participants may be boundary leaders who can build relationships between public health professionals, pastors, and congregants. Based on the findings, we suggest that church-based health fairs may be effective sites of community-wide health promotion.

A community-wide approach to reducing risky drinking cultures in young people in rural Australia.

This study evaluated the impact of a multi-faceted, harm minimisation program addressing youth alcohol change and risky drinking behaviours in rural Australia. The role and influence of a multi-tiered community approach to changing alcohol cultures is examined. An alcohol culture change project for young people (12-18 years) was implemented in rural Victoria. It was informed by the Alcohol Cultures Framework, comprising community-wide events and youth-focused activities, co-designed with young people. The approach aimed at maximising engagement and reducing alcohol-related harm by targeting the shared activities and drinking practices of young people, parents and the community. Participants (n=446) provided feedback specific to three key program activities for promoting alcohol change. Mixed methods: Feedback sheets were collected, and interviews and focus groups were conducted with program participants. Participants indicated that the program had informed their understanding of the way people in their region drink, and the social norms and practices around alcohol that encourage risky drinking. It influenced their short- and medium-term reactions, learnings and activities relating to alcohol consumption. The impact of the program was greatest in adults than young people although reflective learning and some behaviour change were evident across all age groups and community clusters. Community-wide health promotion events offer participants a deeper understanding of the ways in which dominant alcohol cultures inform the practices and activities of young people within a broader community context. Ensuring health promotion programs within a whole-of-community approach are established longer term, is recommended.

Evidence-Based Ethical Practice: Role of Health Promotion

This review article discusses the various ethical standards on which community health practice is founded. From autonomy, justice, privacy, paternalism and beneficence, the practice of health promotion is strongly underpinned by ethics. From private practice to community-wide health promotion, this article reminds practitioners of their obligation to uphold ethics in their evidence-based ethical practice. Finally, the article highlights common ethical dilemmas that are common in community health practice and how practitioners can navigate these situations. Keywords: Ethics, Empowerment, Health Promotion

Talking about health: Community ambassadors as a health promotion strategy to increase breast and bowel cancer screening in regional Australia.

In Australia, cancer is the leading contributor to disease burden, with breast and bowel cancer among the most commonly diagnosed cancers. Despite the presence of community-wide health promotion activities and screening programs, people living in regional and rural locations experience a number of factors that reduce breast and bowel cancer survival outcomes. This study investigates the ways that high-risk community members in a regional area of Australia interact with health messaging about breast and bowel cancer screening. A qualitative research method was used to conduct 31 in-depth one-on-one interviews with community members, leaders and essential service providers. A thematic approach was used to analyse data. Findings provided insight to the ways that health is spoken about within the community, what prompts discussion of health, trustworthy sources of health information and the significance of peer-to-peer communication. Existing community communication lines can be used to assist in delivering public health messages among high-risk and vulnerable population groups. Utilising community ambassadors is identified as a health promotion method for hard-to-reach populations. SO WHAT?: Conversations about health and screening amongst community members, and led by community members, play a key role in shaping engagement with cancer screening programs and represent an important site for health promotion activities. These findings have implications for future public health initiatives amongst high-risk groups in regional locations.

Gender Roles and One Health Risk Factors at the Human-Livestock-Wildlife Interface, Mpumalanga Province, South Africa.

Gender sensitivity in health promotion has been widely recommended, yet attention to gender roles and gender-disaggregated studies is often lacking in disease research and public health intervention planning. In the rural Mnisi community of Mpumalanga, South Africa, where zoonotic pathogens are known to contribute to acute febrile illness, community and household tasks may increase an individual's risk of exposure, and these tasks are likely to be influenced by gender. This study described the roles and responsibilities of community residents, specifically those that have been identified as critical control points for infectious pathogen exposure, by gender. Male gender-typed tasks included those associated with livestock and poultry husbandry, hunting and slaughtering wildlife, and rodent control. Female gender-typed tasks included animal-sourced food preparation, domestic cleaning and maintenance, and caregiving to children and ill family members. Given the gender-specific nature of these tasks, potential pathogen exposure and transmission patterns of infectious diseases may be also gender specific. These data can inform the development and revision of health promotion strategies, such as the community-based One Health Training and Leadership program, prioritizing outcomes for male and female participants alike. Gender-disaggregated analysis is recommended for effective risk mitigation and community-wide health promotion using a One Health approach.

Home Visit Intervention Promotes Lifestyle Changes: Results of an RCT in Mexican Americans

Hispanic populations are less likely that other ethnicities to meet physical activity guidelines. Community health worker (CHW) outreach is an effective delivery method for behavior change messages owing to shared culture, language, and life experience. This study examined the efficacy of a CHW-delivered intervention, Tu Salud ¡Si Cuenta! (Your Health Matters!) at Home Intervention, to promote physical activity among Mexican Americans. RCT. Mexican Americans living along the Texas-Mexico border from June 2010 to April 2013. Eligible adults were randomized into intervention (n=250) or standard care (n=250). Intervention participants received 6 monthly CHW visits that included education, motivation, and support for lifestyle changes. Standard care was potentially exposed to a community-wide health promotion campaign. Data were collected at baseline and 6- and 12-month follow-ups. Meeting physical activity guidelines was defined as ≥600 MET-adjusted minutes of moderate and vigorous exercise. Intervention participants were more likely to meet physical activity guidelines at 6 months (AOR=2.02, 95% CI=1.25, 3.26) than standard care, but the significance was not maintained at 12 months (AOR=1.53, 95% CI=0.92, 2.53). The results were similar in the as-treated and obesity-stratified analyses. The secondary analysis corroborated the primary results. This study shows increases in physical activity among those exposed to a CHW intervention, including participants with obesity. It also indicates that the removal of CHW contact tapers the effect at 12 months. NCT01168765.

Racial/ethnic and educational differences in perceptions and use of a new urban trail

ABSTRACT Objectives: Obesity and its associated health risks are on the rise throughout the US due, in part, to an overall decline in physical activity. Although public green spaces, and in particular trails, show promise as population-level interventions to promote physical activity among adults, these amenities may have disparate impacts across racial/ethnic and socioeconomic groups within a community. Design: This cross-sectional study employed an intercept survey of users of a newly opened $95 million rail-to-trail development in Chicago, IL, immediately after its opening and one year later to examine differences by race/ethnicity and educational attainment in trail use behaviors, motivations for trail use, safety concerns, and change in physical activity attributed to the trail. Results: Although the overall impact of the trail was positive, Latino users were more likely to report frequent use (4+ times/week), health motivations for using the trail, and increased physical activity attributed to the trail. However, Latino users were also more likely to indicate safety concerns and less likely to use areas of the trail in predominately white communities, even after controlling for community of residence. The least educated trail users frequented fewer trail areas and were less likely to indicate health motivations for trail use. Conclusions: Although urban trails represent an opportunity for cost-effective community-wide health promotion, they may not benefit all groups equally. Urban trails may have particularly promising benefits for Latino users, but safety concerns and the possibility of community racial segregation being replicated on trails should be addressed to maximize and sustain these benefits. Less educated residents in particular may not benefit from such projects as intended.

Role of information technology in nursing

Abstract. Nursing information system development such as the impact on the workload, planning and working methods of communicating between multiple jobs care organizations to meet the challenges associated with it. This study aimed to investigate nurses' experiences of their impact on the performance of nursing is nursing information. Most nurses effect on speeding up information systems in nursing, having more time for patient care, easy exchange of information between parts had experienced. They believed that when clinical information into the computer at the same time they cannot care and there was duplication in data entry. Between some demographic characteristics of computer literacy and experience of nurses and there was a significant relationship. Information and communication technologies along with community-wide health promotion, due to a change in the quality of health care has become. The main field of application is remote care information technology, based on developments within health systems, and changing attitudes of health-oriented perspective, and a community-oriented and based on the quality of health services. Despite the widespread penetration of advanced technologies in the field of health, ranging from diagnosis and treatment - treatment and medical education ict because of the challenges facing not been able to find its place fully in this area. It seems that the complexity of science and technology in medicine, there is reasons ashtray performance information technology in the health care setting is difficult. The rapid growth and development of technology in all aspects of life affected areas, followed by a wave of changes that a large change in the leading countries in the field of public health and its use has created. Although many countries have the technology opportunities and benefits, but also its effects and damage that neglect of these issues in the field of health, sometimes it can be dangerous and irreversible.

Ngāti and healthy: translating diabetes prevention evidence into community action

Introduction: Type 2 diabetes mellitus (T2DM) is a major health issue in New Zealand Māori. Clinical trials have demonstrated potential for the prevention of T2DM, but whether community public health programmes aiming to prevent diabetes are effective is untested. Objective: To describe the planning and design of an intervention aiming to translate T2DM prevention clinical trial evidence into a community-wide population health intervention in a high risk predominantly Māori community. Approach: Community concerns about the diabetes burden were heard by the local diabetes nurse, herself a tribal member, and discussed with a locally raised academic. Project planning ensued. The intervention and its evaluation were designed using a participatory community development model. The planned intervention had three components: community-wide health promotion initiatives conveying healthy lifestyle messages, community education and monitoring for identified high-risk individuals and their extended families, and a structural strategy aimed at adapting local environments to support lifestyle changes. The evaluation plan involved interrupted time series surveys coupled with formative and process evaluations rather than a randomised control trial design. Discussion: Consulting communities, validating community concerns and prioritising cultural and ethical issues were key steps. Time spent developing good relationships amongst the health provider and academic research team members at the outset proved invaluable, as the team were united in addressing the project planning and implementation challenges, such as funding obstacles that arose because of our ethically and culturally appropriate non-randomised control trial evaluation design. The pre-intervention survey demonstrated high rates of diabetes (13%), insulin resistance (33%) and risk factors, and provided evidence for positive, as opposed to negative, lifestyle intervention messages. Conclusion: Community-wide lifestyle interventions have the potential to reduce rates of type 2 diabetes and other chronic diseases in high-risk communities, but require a high level of commitment from the health sector and buy-in from the community. Adequate commitment, leadership, planning and resources are essential.

Changing the Hearts and Minds of Policy Makers: An Exploratory Study Associated with the West Virginia Walks Campaign

To pilot test whether West Virginia Walks changed local policy makers' awareness of walking-related issues. A quasi-experimental design with preintervention and postintervention mail surveys. Morgantown, WV (intervention community), and Huntington, WV (comparison community). One hundred thirty-three and 134 public officials in Morgantown and 120 and 116 public officials in Huntington at baseline and at follow-up, respectively. An 8-week mass media social ecological campaign designed to encourage moderate-intensity walking among insufficiently active persons aged 40 to 65 years. Policy makers listed three problems they believed needed to be addressed in their community. They then rated the severity of several problems that many communities face using a Likert scale, with 1 representing "not a problem" and 5 representing "an extremely important problem." Independent sample t-tests were used to examine differences in mean responses at baseline and at follow-up. Statistically significant increases in the perceived importance of walking-related issues were observed among policy makers in Morgantown but not in the comparison community. Integrated communitywide health promotion campaigns designed to influence the public can also affect the perceptions of policy makers. Future research should examine this linkage and determine whether resource allocation and policy changes follow such interventions.

The Psychology of Social Influence and Healthy Public Policy

Social–psychological research has led to effective health interventions based on social influence processes. For example, school-based substance abuse prevention programs using the social influences model consistently produce better results than programs emphasizing only health information. Other areas of application have been prevention of AIDS, marketing social action programs, community-wide health promotion, anti-predjudice intervention, aggression control, crime and injury prevention, and resource conservation. Yet another area for application is the emerging field of health promotion, which seeks to cross traditional boundaries to build healthy public policies in all sectors of society. A comprehensive social influences approach is needed because education alone is not likely to change fundamental ideas about where the responsibility for health rests. Current assignment of responsibility to the health sector and victim-blaming will be difficult to defeat. Positive changes at the required levels will depend on better understanding of how to instill health promotion values in policy arenas beyond the health care sector and better understanding of the dynamics of policy-making behaviors and related social influence processes. Social psychologists can and should assist the health promotion field to meet these challeges by conducting descriptive and intervention research on the psychology of social influence processes in public policy-making arenas.

Developing methodologies for evaluating community-wide health promotion

SUMMARY There has been growing recognition that health promotion programs which target whole communities are more likely to be effective in changing health behaviour. However, studies evaluating the impact of communitywide health promotion programs rarely use adequate methodology. Randomised control trials where multiple whole communities are randomly assigned to control and intervention groups are optimum if evaluators hope to validly attribute changes in health behaviour to the intervention. However, such trials present a number of difficulties including cost and feasibility limitations and the evolving nature of statistical techniques. This paper proposes applying a fairly well-accepted phased evaluation approach to the evaluation of community participation programs, using three defined phases. Phase 1 consists of small-scale studies to develop the measures and assess acceptability and feasibility of the intervention; Phase 2 consists of studies in a small number of communities designed to trial the intervention in the real world; Phase 3 studies use an appropriate number of entire communities to provide valid evidence of efficacy of the intervention. It is suggested that criteria be resolved to identify adequate studies at each stage and that advantages and limitations of Phase 1 and 2 studies be clearly identified. The paper describes the major design, sampling and analysis considerations for a Phase 3 study.

WHO Healthy Cities and the US family support movements: a marriage made in heaven or estranged bed fellows?

The family support movement in the US emerged at about the same time that the WHO Healthy Cities project was gaining momentum in Europe and the underlying principles and ecologic frameworks of the two have much in common. However while many Healthy Cities in Europe have included activities that benefit families this has not been made a major focus. There seems to be little awareness of experience gained in the US in terms of establishing programs with limited or no government funding using volunteers and developing social marketing and advocacy strategies sustain long term viability. Similarly cities and states in the US are struggling to develop networks of family support programs and they appear to be doing this without the benefit of experience gained in Healthy Cities projects on how to engage political leadership develop public policies establish intersectoral councils fund a coordinator position mobilize neighborhoods and evaluate community wide health promotion programs. The purpose of this paper is to examine how these two movements might join forces and learn from each other. (authors)

Community intervention trials: reflections on the Stanford Five-City Project Experience.

In the past two decades several community intervention studies designed to lower the risk of cardiovascular disease in populations have been completed. These trials shared the rationale that the community approach was the best way to address the large population attributable risk of mild elevations of multiple risk factors, the interrelation of several health behaviors, and the potential efficiency of large-scale interventions not limited to the medical care system. These trials also shared several threats to internal validity, especially the small number of intervention units (usually cities) that could be studied. The purpose of this paper is to reflect on the lessons learned in one of the studies, the Stanford Five-City Project, which began in 1978. The anticipated advantages were observed, including the generalizability of the intervention components, the potential for amplification of interventions through diffusion in the community, and the efficiency of the mass media and other community programs for reaching the entire population. Numerous components of the intervention proved effective when evaluated individually, as was true in other community studies. However, the design limitations proved difficult to overcome, especially in the face of unexpectedly large, favorable risk factor changes in control sites. As a result, definitive conclusions about the overall effectiveness of the communitywide efforts were not always possible. Nevertheless, in aggregate, these studies support the effectiveness of communitywide health promotion, and investigators in the field should turn to different questions. The authors have learned how little they know of the determinants of population-level change and the characteristics that separate communities that change quickly in response to general health information from those that do not. Future studies in communities must elucidate these characteristics, while improving the effectiveness of educational interventions and expanding the role of environmental and health policy components of health promotion.

Health interventions for African American and Latino youth: the potential role of mass media.

Children in Latino and African American families are far more likely to live in urban, high-poverty settings that greatly increase risks to healthy development. During adolescence, these settings are particularly hazardous for their role in the social transmission of risk behavior. Community-wide health promotion using local mass media can counteract these influences by reaching preadolescents and adolescents, their parents, and other adults in urban communities with safe-behavior messages. These messages can be designed to make safer behavior more acceptable and normative in the community, to increase awareness of community resources for adolescents, and to reverse the stereotyping and disregard that characterize media content about impoverished communities. Evidence is reviewed that, despite their poverty status, African American and Latino communities have considerable social resources to which community-wide health promotion can appeal, including strong family bonds, religious attachment, and concern about the community. The influence of these resources is exemplified by relatively low rates of adolescent drug use. Health promotion conducted regularly through local mass media could be an effective strategy to improve the health of adolescents in urban communities.

Community-wide youth nutrition education: long-term outcomes of the Minnesota Heart Health Program.

The Class of 1989 was part of the Minnesota Heart Health Program, a research and demonstration project designed to reduce cardiovascular disease in three intervention communities. This paper describes the long-term outcomes of a school- and community-based intervention on healthy eating behaviors in one intervention and matched reference community. Beginning in the sixth grade (1983), seven annual waves of behavioral measurements were taken from both communities (baseline N = 2376). Self-reported data were collected at each time period including measures of knowledge and preferences for certain foods, and food salting behavior. Data were analyzed using an ANCOVA model adjusting for baseline dependent variable differences, with the school as the unit of analysis. Knowledge, healthy food choices and restraint in food salting behavior variables were significantly higher throughout most of the follow-up period in the intervention community for females. Males also indicated greater knowledge of healthier choices in the intervention community and greater restraint in salting behavior but results are less conclusive for healthy food choices. These results suggest that multiple intervention components such as behavioral education in schools coupled with community-wide health promotion strategies can produce modest but lasting improvement in adolescent knowledge and choices of heart healthy foods and less frequent food salting practices, and that this improvement is most notable among females.

Obstacles to and future goals of ten comprehensive community health promotion projects

Over 100 project staff, community coalition members, and other representatives from 10 comprehensive community health promotion projects in the western United States were surveyed two years into a three year funding cycle about: (1) the problems or obstacles they judged as preventing successful completion of their current goals and objectives, and (2) future goals and objectives they envisioned for their projects. The key issues confronting respondents were diverse, although issues around the process of implementing community health promotion programs were cited more frequently than issues related to the content of health promotion. When respondents were asked to prioritize Future Goals in the second survey, consensus across communities was obtained despite broad differences in the type of community surveyed and the health problem targeted. This study identifies the common organizational and community development problems faced by newly emerging community health promotion programs and has implications for other communities involved in designing, implementing, and evaluating community-wide health promotion programs.

Regulatory influences on health-related behaviours: The case of workplace smoking-bans

Recent community-wide health-promotion campaigns in Australia and other industrialised countries have been concerned with reducing cardiovascular disease and cancer risk, and have focused on such b...

Nutrition education in supermarkets: the Lifestyle 2000 experience

A 15-week supermarket-based nutrition education program was conducted as part of a larger multiple-strategy community-wide health promotion project. The program consisted of point-of-purchase materials displayed in the supermarkets and was supported by a mass media campaign and promotional activities such as competitions, taste testing and cooking demonstrations. The objective of the program was to promote the selection and purchase of low-fat foods, specifically low-fat dairy products, fresh fruit and vegetables, bread and cereal products. Awareness of the promotion was high, with some self-reported behaviour change. Supermarkets are potential sites for public health nutrition education and recommendations are made for improving the effectiveness of point-of-purchase promotions.