Effectiveness Of Community Interventions Research Articles

Partnered implementation of the veteran sponsorship initiative: protocol for a randomized hybrid type 2 effectiveness—implementation trial

BackgroundThe USA is undergoing a suicide epidemic for its youngest Veterans (18-to-34-years-old) as their suicide rate has almost doubled since 2001. Veterans are at the highest risk during their first-year post-discharge, thus creating a “deadly gap.” In response, the nation has developed strategies that emphasize a preventive, universal, and public health approach and embrace the value of community interventions. The three-step theory of suicide suggests that community interventions that reduce reintegration difficulties and promote connectedness for Veterans as they transition to civilian life have the greatest likelihood of reducing suicide. Recent research shows that the effectiveness of community interventions can be enhanced when augmented by volunteer and certified sponsors (1-on-1) who actively engage with Veterans, as part of the Veteran Sponsorship Initiative (VSI).Method/designThe purpose of this randomized hybrid type 2 effectiveness-implementation trial is to evaluate the implementation of the VSI in six cities in Texas in collaboration with the US Departments of Defense, Labor and Veterans Affairs, Texas government, and local stakeholders. Texas is an optimal location for this large-scale implementation as it has the second largest population of these young Veterans and is home to the largest US military installation, Fort Hood. The first aim is to determine the effectiveness of the VSI, as evidenced by measures of reintegration difficulties, health/psychological distress, VA healthcare utilization, connectedness, and suicidal risk. The second aim is to determine the feasibility and potential utility of a stakeholder-engaged plan for implementing the VSI in Texas with the intent of future expansion in more states. The evaluators will use a stepped wedge design with a sequential roll-out to participating cities over time. Participants (n=630) will be enrolled on military installations six months prior to discharge. Implementation efforts will draw upon a bundled implementation strategy that includes strategies such as ongoing training, implementation facilitation, and audit and feedback. Formative and summative evaluations will be guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework and will include interviews with participants and periodic reflections with key stakeholders to longitudinally identify barriers and facilitators to implementation.DiscussionThis evaluation will have important implications for the national implementation of community interventions that address the epidemic of Veteran suicide. Aligned with the Evidence Act, it is the first large-scale implementation of an evidence-based practice that conducts a thorough assessment of TSMVs during the “deadly gap.”Trial registrationClinicalTrials.gov ID number: NCT05224440. Registered on 04 February 2022.

DEPRESSION AND EFFECTIVENESS OF COMMUNITY-BASED DEPRESSION INTERVENTION PROGRAMME FOR ELDERLY IN QUANG NGAI CITY

Introduction: With the growing elderly population in Vietnam and the increasing impact of mental health problems, the prevention of these disorders should be emphasized and support programs in the community are needed. Objectives: 1. To determine the prevalence of depression using the GDS-30 scale; 2. To evaluate the effectiveness of community intervention in preventing depression. Methods: A quasi-experimental survey with pretest/posttest design was adopted. A cross-sectional survey of 1572 elderly people to determine the prevalence and factors related to depression. The next step was to implement a community intervention program on 402 people (intervention group) and 384 people (control group). Results: The prevalence of depression in the elderly population was 18.8% (mild: 12.1%, moderate: 6.5%; and severe: 0.2%). Finding from posttest of intervention, the prevalence of depression in intervention group and control group was 12.4% (mild 7.7%, moderate 4.7%), 19.5% (mild 13.8%; moderate 5.5%), respectively. The effectiveness of the intervention program was reported to reduce the prevalence of depression compared to baseline by 34.0% and to control group by 31.3%. Conclusion: the finding indicates that depression among elderly people is prevalent in the community, accounting for 18.8%. The community intervention program to reduce the risk of depression has proven to be effective and it is necessary to recommend the health department to disseminate this model locally. " Key words: Effective; community intervention; Depression of the elderly; Quang Ngai city

A community intervention to reduce alcohol consumption and drunkenness among adolescents in Sweden: a quasi-experiment

BackgroundSeveral studies have examined the effect of community interventions on youth alcohol consumption, and the results have often been mixed. The aim of this study is to evaluate the effectiveness of a community intervention known as the Öckerö Method on adolescent alcohol consumption and perceived parental attitudes towards adolescent drinking.MethodThe study is based on a quasi-experimental design, using matched controls. Self-report studies were conducted among adolescents in grades 7–9 of compulsory education in four control and four intervention communities in the south of Sweden in 2016–2018. Baseline measures were collected in autumn 2016 before the intervention was implemented in the intervention communities. Outcomes were the adolescents’ alcohol consumption, past-year drunkenness, past-month drunkenness and perceived parental attitudes towards alcohol.ResultsEstimating Difference-in-Difference models using Linear Probability Models, we found no empirical evidence that the intervention has any effect on adolescents’ drinking habits, or on their perceptions of their parents’ attitudes towards adolescent drinking.ConclusionThis is the first evaluation of this method, and we found no evidence that the intervention had any effect on the level of either young people’s alcohol consumption or their past-year or past-month drunkenness, nor on their parents’ perceived attitudes toward adolescent drinking. A further improvement would be to employ a follow-up period that is longer than the three-year period employed in this study.Trial registrationISRCTN registry: Study ID: 51635778, 31th March 2021 (Retrospectively registered).

Community interventions in Low-And Middle-Income Countries to inform COVID-19 control implementation decisions in Kenya: A rapid systematic review.

Globally, public health measures like face masks, hand hygiene and maintaining social distancing have been implemented to delay and reduce local transmission of COVID-19. To date there is emerging evidence to provide effectiveness and compliance to intervention measures on COVID-19 due to rapid spread of the disease. We synthesized evidence of community interventions and innovative practices to mitigate COVID-19 as well as previous respiratory outbreak infections which may share some aspects of transmission dynamics with COVID-19. In the study, we systematically searched the literature on community interventions to mitigate COVID-19, SARS (severe acute respiratory syndrome), H1N1 Influenza and MERS (middle east respiratory syndrome) epidemics in PubMed, Google Scholar, World Health Organization (WHO), MEDRXIV and Google from their inception until May 30, 2020 for up-to-date published and grey resources. We screened records, extracted data, and assessed risk of bias in duplicates. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO (CRD42020183064). Of 41,138 papers found, 17 studies met the inclusion criteria in various settings in Low- and Middle-Income Countries (LMICs). One of the papers from LMICs originated from Africa (Madagascar) with the rest from Asia 9 (China 5, Bangladesh 2, Thailand 2); South America 5 (Mexico 3, Peru 2) and Europe 2 (Serbia and Romania). Following five studies on the use of face masks, the risk of contracting SARS and Influenza was reduced OR 0.78 and 95% CI = 0.36-1.67. Equally, six studies on hand hygiene practices reported a reduced risk of contracting SARS and Influenza OR 0.95 and 95% CI = 0.83-1.08. Further two studies that looked at combined use of face masks and hand hygiene interventions showed the effectiveness in controlling the transmission of influenza OR 0.94 and 95% CI = 0.58-1.54. Nine studies on social distancing intervention demonstrated the importance of physical distance through closure of learning institutions on the transmission dynamics of disease. The evidence confirms the use of face masks, good hand hygiene and social distancing as community interventions are effective to control the spread of SARS and influenza in LMICs. However, the effectiveness of community interventions in LMICs should be informed by adherence of the mitigation measures and contextual factors taking into account the best practices. The study has shown gaps in adherence/compliance of the interventions, hence a need for robust intervention studies to better inform the evidence on compliance of the interventions. Nevertheless, this rapid review of currently best available evidence might inform interim guidance on similar respiratory infectious diseases like Covid-19 in Kenya and similar LMIC context.

Intersectionality and gender: community practice with low-income migrant women

AbstractEchoing the call to incorporate the intersectionality framework into studies of gender structure, this paper applied the framework to re-analyse the quantitative and qualitative findings of an evaluation study on a women empowerment community project in Hong Kong. This effort revealed the importance of the gender structure’s dimension of sexual division of labour and the intersectional effects of gender, race and class in explaining the mixed traditional and progressive views in different items within a domain and across different domains of the gender division of labour, specifically the marital, parental, employment, social activities and education domains. The low-income migrant women have upheld different traditional ideas in these domains. However, in contrast with the richer and local women who also shared these traditional views, low-income migrant women in this study questioned some prevailing ideas in these domains, due to their need to survive the conditions defined by the intersection of gender, race and class. The findings of this study, despite being preliminary and limited, demonstrate the significance and feasibility of studying gender structure adopting the perspective of intersectionality. Arguably, this lack of understanding of the intersectional effects diminishes the effectiveness of community intervention. In light of the paucity of research adopting the intersectionality framework in the community development field in general, and a similar deficit in the feminist and community development fields in Hong Kong in particular, the failure to adopt the intersectionality framework by the community project under consideration is understandable. It is likely that as this framework becomes more prominent in the future, given its potential to offer deeper insight into the dynamics of gender structure, community interventions for women of different identities could be strengthened.

Systematic review of community participation interventions to improve maternal health outcomes in rural South Asia

BackgroundThis is a systematic review on the effectiveness of community interventions in improving maternal health care outcomes in South Asia.MethodsWe searched electronic databases to June 2017. Randomised or cluster randomised studies in communities within rural/remote areas of Nepal, Bangladesh, India and Pakistan were included. Data were analysed as risk ratios (RR) or odds ratios (OR), and effects were adjusted for clustering. Meta-analyses were performed using random-effects and evidence quality was assessed.ResultsEleven randomised trials were included from 5440 citations. Meta-analysis of all community interventions combined compared with control showed a small improvement in the number of women attending at least one antenatal care visit (RR 1.19, 95% CI 1.06 to 1.33). Two community mobilisation sub groups: home care using both male and female mobilisers, and education by community mobilisers, improved the number of women attending at least one antenatal visit. There was no difference in the number of women attending at least one antenatal visit for any other subgroup. There was no difference in the number of women attending 3 or more antenatal visits for all community interventions combined, or any community subgroup. Likewise, there was no difference in attendance at birth between all community interventions combined and control. Health care facility births were modestly increased in women’s education groups (adjusted RR (1.15, 95% CI 1.11 to 1.20; 2 studies)). Risk of maternal deaths after 2 years (RR 0.63, 95% CI 0.24 to 1.64; 5 studies), and 3 years (RR 1.11, 95% CI 0.52 to 2.36; 2 studies), were no different between women’s education groups and control. Community level mobilisation rather than health care messages at district level improved the numbers of women giving birth at health care facilities (RR1.09 (95%CI 1.06 to 1.13; 1 study)). Maternal health care knowledge scores improved in two community-based interventions, one involving education of male community members.ConclusionWomen’s education interventions may improve the number of women seeking birth at a health care facility, but the evidence is of low quality. No impact on maternal mortality was observed Future research should explore the effectiveness of including male mobilisers.Trial registrationThis systematic review is registered with PROSPERO CRD42016033201.

Effects of community intervention on quality of life in women with gynecological cancers

Effects of community intervention on quality of life in women with gynecological cancers

Understanding the mechanisms through which women's group community participatory intervention improved maternal health outcomes in rural Malawi: was the use of contraceptives the pathway?

BackgroundWomen's group intervention is a community based initiative through which rural women form groups, meet regularly to discuss maternal health issues affecting them, and come up with locally available solutions. This intervention has been associated with reduced maternal and neonatal mortality in limited resource settings. Nevertheless, the mechanisms through which women's groups influence maternal health outcomes are uncertain. Because contraception reduces the risk of maternal mortality and women's groups also tackled this issue, we speculated that contraceptive use might be the pathway. Consequently, this study investigated whether participation in women's groups was associated with contraceptive use in Malawi.DesignWe examined the use of contraceptives between women who participated in women's groups and those who did not through a community-based cross-sectional study in Mchinji, Malawi. The study involved 3,435 women of reproductive age (15–49 years) who were recruited using a multistage sampling approach. Members (treated) and non-members (control) of women's groups were matched on observed covariates using propensity scores and the counterfactual for the treated individuals was estimated.ResultsCrude analysis revealed that women's groups improved uptake of contraceptives by 26% (odds ratio (OR)=1.26; 95% confidence interval (CI)=1.03–1.56; p=0.024). However, using the matched data, uptake of contraceptives was almost the same among members and non-members of women's groups. More precisely, the likelihood of using contraceptives was not significantly different between the members and non-members of women's groups (OR=1.00; 95% CI=0.81–1.24; p=0.991).ConclusionsThere is insufficient evidence of an association between participation in women's groups and contraceptive use among rural Malawian women. The implication is that contraception was not the mechanism through which women's groups contributed to reduced maternal mortality in Malawi. Because the effects of community interventions are usually comprehensive and sometimes difficult to demonstrate, ethnographic studies should be considered in the evaluation of women's groups and other related interventions.

Community preventive interventions for children of parents with serious mental illness: a commentary on the evidence base

Improving the lives of children of parents with serious mental illnesses (SMI) such as schizophrenia, major depression and bipolar disorder is of urgent political and public health concern. Parental SMI is associated with increased risk of multiple adverse child outcomes including poorer short-term mental and physical health, behavioural, social and educational difficulties, maltreatment and neglect (Goodman et al., 2011; Royal College of Psychiatrists [RCPsych], 2011). Longer term outcomes can extend into adulthood and include increased risk of psychiatric morbidity, socio-occupational dysfunction, alcohol or substance misuse and premature death (Goodman et al., 2011; RCPsych, 2011; Weissman, Warner, Wickramaratne, Moreau, & Olfson, 1997). This commentary discusses the existing evidence base for community-based interventions in maintaining or improving health and well-being in the children of parents with SMI, based on the findings of a recent systematic review.National initiatives such as the Australian children of parents with mental illness (COPMI) programme aim to promote better mental health outcomes for the COPMI. The rationale for such initiatives is attracting international support, with contemporary health and social-care policies in countries such as the UK similarly asking for enhanced service provision and family support (Diggins, 2011). The key challenge we are left with is in knowing when and how best to intervene. With increasing emphasis on evidence-based practice, there is a pressing need to demonstrate the clinical effectiveness and cost-effectiveness of interventions for children and families living with parental mental illness.A recent systematic review, funded by the UK National Institute for Health Research, has evaluated the international evidence base for the clinical and cost-effectiveness of community-based interventions for enhancing or maintaining quality of life (QoL) in children living with parents with serious mental illness (Bee et al., 2014). This commissioned review is the largest and most comprehensive review of the international evidence for preventative interventions for families living with SMI to date, and the first and only review focussed on maintaining children's QoL.Our review confirms that the existing evidence for community interventions to enhance the QoL of children of parents with SMI is severely lacking and, in its current form, cannot provide an adequate rationale on which to base practice or service development. Despite thorough and comprehensive searches, we were only able to identify three randomized controlled trials, all conducted in the USA more than two decades previously. All three trials evaluated interventions for maternal psychosis and were heavily targeted towards group-based models seeking to enhance parenting behaviours in the mothers of children aged less than 12 years old. No validated measures of children's QoL or emotional well-being were reported and secondary outcomes were focused on observer ratings of child behaviour and cognitive function. The relevance of these data to current healthcare systems is unclear. Service configuration models and the interface between adult psychiatric services, children's services and social care will vary considerably, both between countries and over time. Equally, children's own QoL judgements are likely to be influenced by the cultural and temporal contexts in which they occur. Doubt therefore exists as to the generalizability of this evidence to contemporary children living with serious parental mental illness.In our review, contemporary evidence of the effectiveness of community interventions to enhance life quality in the children of parents with severe mental illness was limited to a small number of non-randomized studies, traditionally considered lower quality evidence than well-conducted randomized trials capable of demonstrating cause and effect. Four non-randomized trials were eligible for inclusion in our review, three of which were Australian studies published within the last 4 years (i. …

African stakeholders' views of research options to improve nutritional status in sub-Saharan Africa.

Setting research priorities for improving nutrition in Africa is currently ad hoc and there is a need to shift the status quo in the light of slow progress in reducing malnutrition. This study explored African stakeholders' views on research priorities in the context of environmental and socio-demographic changes that will impact on nutritional status in Africa in the coming years. Using Multi-Criteria Mapping, quantitative and qualitative data were gathered from 91 stakeholders representing 6 stakeholder groups (health professionals, food Industry, government, civil society, academics and research funders) in Benin, Mozambique, South Africa, Tanzania, Togo and Uganda. Stakeholders appraised six research options (ecological nutrition, nutritional epidemiology, community nutrition interventions, behavioural nutrition, clinical nutrition and molecular nutrition) for how well they could address malnutrition in Africa. Impact (28.3%), research efficacy (23.6%) and social acceptability (22.4%) were the criteria chosen the most to evaluate the performance of research options. Research on the effectiveness of community interventions was seen as a priority by stakeholders because they were perceived as likely to have an impact relatively quickly, were inexpensive and cost-effective, involved communities and provided direct evidence of what works. Behavioural nutrition research was also highly appraised. Many stakeholders, particularly academics and government were optimistic about the value of ecological nutrition research (the impact of environmental change on nutritional status). Research funders did not share this enthusiasm. Molecular nutrition was least preferred, considered expensive, slow to have an impact and requiring infrastructure. South Africa ranked clinical and molecular nutrition the highest of all countries. Research funders should redirect research funds in Africa towards the priorities identified by giving precedence to develop the evidence for effective community nutrition interventions. Expanding research funding in behavioural and ecological nutrition was also valued and require multi-disciplinary collaborations between nutritionists, social scientists, agricultural and climate change scientists.

Effect of community interventions on social-communicative abilities of preschoolers with autism spectrum disorder

Purpose: To evaluate the effect that different intervention methods have on the social-communicative abilities of children with autism spectrum disorder (ASD) in community settings. Methods: Intervention based on applied behaviour analysis was compared with a more specific intervention programme targeting imitation and joint attention (JA) and with treatment as usual in a sample of 85 children with ASD. Objective measures for imitation, JA, pretend play, language, autism severity and parent report measures were used to assess the effect of six months of intervention. Results: Results revealed no differences between the intervention methods. There was, however, great individual variability in outcome within each treatment method. Conclusion: These results suggest that it is important to focus on “What works for whom” instead of trying to find a one-size-fits-all-treatment for children with ASD.

Effect of community intervention on recovery of patients with lumbar degenerative disease

Objective To discuss the effect of community intervention on visual analogue scale （ VAS ） , Oswestry disability index （ ODI ） and frequency of drug use in patients with lumbar degenerative disease （ LDD） .Methods Forty-one patients with LDD were applied with 3 months of community intervention , self-made DV on health guide and handbook on rehabilitation training were handed out , community lecture was carried out and telephone interview was conducted .VAS and ODI were used to evaluate patients ’ pain and function of lumbar vertebra , and the frequency of drug use was collected 3 months before and after the intervention.Results The correct rate of training on lumbar posture and dorsal muscles was 92.68% after the intervention, higher than 17.07% before the intervention, and the difference was statistically significant （χ2 =47.33,P〈0.001）.The score of VAS on lumbar and VAS on lower limbs , the frequency of drug use and the score of ODI was respectively （2.65 ±0.82）,（2.60 ±1.01）,（1.51 ±0.71）,（10.95 ±4.52） before intervention, and （2.05 ±0.69）,（1.94 ±0.87）,（0.98 ±0.57）,（8.46 ±3.49）after the intervention, with statistically significant differences （t=6.82,7.07,6.81,9.87, respectively; P 〈0.00）.Conclusions Community intervention can promote the improvement of symptoms and recovery of body function for patients with LDD . Key words: Lumbar degenerative disease; Functional exercise; Community intervention; Rehabilitation

Effect of community intervention on symptoms and quality of life in patients with chronic obstructive pulmonary disease and bronchiectasis

Objective To investigate the effect of community intervention on symptoms and quality of life in patients with moderate or severe chronic obstructive pulmonary disease and bronchiectasis.Methods Sixty-three cases of stable patients with moderate or severe chronic obstructive pulmonary disease and bronchiectasis were chosen and randomly divided into the observation group (n =32) and the control group (n =31).The observation group was given periodical home visits and telephone follow-up for 6 months,while the control group only received health education on discharge.Patients' symptoms and quality of life were compared between two groups.Results Intervention in the first two groups,there was no statistically significant different (P ＞ 0.05) ; The scores of cough,sputum volume and dyspnea were (0.67 ± 0.44),(0.69 ± 0.32) and (1.04 ± 0.53) in the observation group,and its annual number of hospitalization was (0.85 ± 0.64).The scores of cough,sputum volume and dyspnea were (1.04 ± 0.31),(0.94 ± 0.53) and (1.52 ± 1.04) in the control group,and its annual number of hospitalization was (1.61 ± 0.82).The differences were statistically significant (t =3.85,2.28,2.32,4.11,respectively ; P ＜ 0.05).The score of life quality was (39.84 ± 11.42) for respiratory symptoms,(40.68 ± 11.23) for activity limitation,(32.19 ± 9.50) for disease impact and (34.09 ± 11.26) in total in the observation group.And the score of life quality was (55.64 ± 17.37) for respiratory symptoms,(49.07 ± 10.35) for activity limitation,(39.45 ± 12.51) for disease impact and (45.98 ± 12.77) in total in the control group.The differences were statistically significant (t =4.26,3.05,2.60,3.92,respectively; P ＜ 0.05).Conclusions Community intervention has significant effect on patients with chronic obstructive pulmonary disease and bronchiectasis,which can improve patients' respiratory symptoms,comfort level and quality of life as well as reduce re-hospitalization rate. Key words: Pulmonary disease, chronic obstructive; Bronchiectasis ; Quality of life; Community intervention

Effectiveness of Community Intervention in Improving Bone Health Behaviors in Older Adults

An 8-week, bone-health community program addressed risks/lifestyle changes within the Health Belief Model and Theory of Reasoned Action frameworks in a randomized format (treatment group n = 35; control group n = 34). Median week 1 values for calcium (control, 963 mg; treatment, 1023 mg) and vitamin D (81 IU both groups) were below recommendations, increasing throughout the program for both control (1023 mg calcium, 128 IU vitamin D) and treatment (1005 mg calcium, 122 IU vitamin D) groups. There was limited response to the exercise outcome variables, with many not participating in that section of the program. Psychosocial variables were positive for both control and treatment groups at week 1, with no significant difference at postintervention. Regression analysis indicated that those with a positive attitude about calcium intake and belief that they could choose calcium-fortified foods were more likely to have higher calcium intake. Intention to exercise was modified by peer and family support. Community-based programs can translate and use clinical trial key topics and outcomes, but participation bias makes impact results difficult to interpret the effectiveness of the program.

The Effect of Community Interventions on Alcohol-related Assault in Geelong, Australia

Alcohol has consistently been demonstrated to increase levels of aggression and violence, particularly in late night licensed venues. Since 2005, the City of Geelong in Australia has implemented a substantial number of interventions to reduce alcohol related violence, including a liquor accord, increased police surveillance, ID scanners, CCTV, a radio network and an alcohol industry sponsored social marketing campaign. The aim of the current study is to assess the indi- vidual and collective impact of community interventions on indicators of alcohol-related assaults in the Geelong region. This paper reports stage one findings from the Dealing with Alcohol-related problems in the Night-time Economy project (DANTE) and specifically examines assault rate data from both emergency department presentations, ICD-10 classifica- tion codes, and police records of assaults. None of the interventions were associated with reductions in alcohol-related as- sault or intoxication in Geelong, either individually or when combined. However, the alcohol industry sponsored social marketing campaign 'Just Think' was associated with an increase in assault rates. Community level interventions ap- peared to have had little effect on assault rates during high alcohol times. It is also possible that social marketing cam- paigns without practical strategies are associated with increased assault rates. The findings also raise questions about whether interventions should be targeted at reducing whole-of-community alcohol consumption.

The effect of community intervention on pulmonary function of elderly patients with COPD after quitting smoking in stability period

Objective To explorer the effect of community intervention on pulmonary function of elderly patients with COPD after quitting smoking in stability period,raise the rate of smoking cessation and promote the rehabilitation of this disease.Methods A total of 60 elderly male patients with COPD were selected and divided into two groups.The 30 patients in observation group received full health guidance of smoking cessation and follow - up visits regularly.And other patients received general the guidance of smoking cessation.The change of pulmonary function was compared between two groups after 6 months.Results There were significant differences statistically in comparing the change of pulmonary function between two groups.Conclusions Community intervention in the overall process can improve effectively pulmonary function of elderly patients with COPD after quitting smoking in stability period. Key words: Chronic obstructive pulmonary disease; Smoking cessation; Pulmonary function; Community intervention

The IDEFICS community-oriented intervention programme: a new model for childhood obesity prevention in Europe?

The European Union-as well as other parts of the world-faces a major challenge of increasing incidence of overweight/obesity. In particular, the increase in childhood obesity gives rise to a strong imperative for immediate action. Yet, little is known about the effectiveness of community interventions, and further research in this field is needed. There is, however, a growing consensus that such research should start from the paradigm that the current living environments tend to counteract healthy lifestyles. Questioning these environments thoroughly can help to develop new pathways for sustainable health-promoting communities. Against this background, the IDEFICS (Identification and prevention of dietary- and lifestyle-induced health effects in children and infants) study developed and implemented innovative community-oriented intervention programmes for obesity prevention and healthy lifestyle primarily in children aged 2-10 years in eight European countries: Sweden, Estonia, Germany, Belgium, Hungary, Italy, Spain and Cyprus. The IDEFICS community-oriented intervention study mobilised an integrated set of interventional efforts at different levels of society, with the aim of facilitating the adoption of a healthy obesity-preventing lifestyle. The overall programme has been composed of 10 modules: three at community level, six at school level and one for parents. The main focus was on diet, physical activity and stress-coping capacity. The sphere of action encompassed both children and their (grand) parents, schools, local public authorities and influential stakeholders in the community. All materials for the interventions were centrally developed and culturally adapted. So far, the following has been achieved: focus group research, literature review and expert consultations were done in an early phase as a basis for the development of the intervention modules. The intervention mapping protocol was followed as guide for structuring the intervention research. The overall intervention programme's duration was 2 years, but a longer-term follow-up programme is under development. This large-scale European effort is expected to contribute significantly to the understanding of this major public health challenge.

The effect of community interventions in reducing burns and scalds in children

ObjectiveThis paper reviews the effect of a variety of community-based interventions in preventing burns and scalds in children. It also highlights how clinical research can be used to improve public...

Feria de Salud: implementation and evaluation of a communitywide health fair.

Evaluating the effectiveness of community interventions is a major responsibility for community health nurses (CHNs). Without evidence of the effectiveness of interventions, their impact on the health status of populations or communities cannot be determined. This article presents the planning, implementation, and evaluation processes of a communitywide health fair. This fair was held in a suburban community of approximately 12,000 individuals, located 20 kilometers outside of Mexico City. The health fair was one component of a collaborative project aimed at addressing the overall health needs of the community. Emphasis is on the development and utilization of measurable objectives in evaluating both processes and outcomes of the health fair. Green and Kreuter's (1991) PRECEDE-PROCEED program planning model provided direction for program planning and evaluation. The findings of process, impact, and outcome evaluation are described, providing both qualitative and quantitative measures of program effectiveness. These findings provide direction for program replication and modification. Recommendations address the utility of theory-based assessment, program planning, and evaluation, the importance of formative evaluation, and the need for cultural sensitivity in community health program planning.

The value of interrupted time-series experiments for community intervention research.

Greater use of interrupted time-series experiments is advocated for community intervention research. Time-series designs enable the development of knowledge about the effects of community interventions and policies in circumstances in which randomized controlled trials are too expensive, premature, or simply impractical. The multiple baseline time-series design typically involves two or more communities that are repeatedly assessed, with the intervention introduced into one community at a time. It is particularly well suited to initial evaluations of community interventions and the refinement of those interventions. This paper describes the main features of multiple baseline designs and related repeated-measures time-series experiments, discusses the threats to internal validity in multiple baseline designs, and outlines techniques for statistical analyses of time-series data. Examples are given of the use of multiple baseline designs in evaluating community interventions and policy changes.