Health Intervention Model Research Articles

Effects of a new community-based reproductive health intervention on knowledge of and attitudes and behaviors toward stress urinary incontinence among young women in Shanghai: a cluster-randomized controlled trial.

This study aimed to evaluate the prevalence of stress urinary incontinence (SUI) and to introduce a new community-based reproductive health intervention. We then evaluated the effectiveness of this intervention. In this cluster-randomized trial, 2100 participants aged 18-40 years were divided randomly into an intervention group (IG, 1400 women) and a control group (CG, 700 women). The CG received traditional community intervention, cmprising limited reproductive information and education; the IG received the new community-based reproductive health intervention model, comprising self-designed handbooks, health lectures, and free medical consultations, in addition to the traditional community intervention. All participants were surveyed face to face using a self-designed questionnaire before and after the 6-month intervention. In Shanghai, the prevalence rate of SUI was 14.3 %. No difference was observed between groups regarding mean knowledge, attitudes, and practices (KAPs) about SUI and the total score at baseline (P > 0.05). The IG scored significantly higher than the CG on the KAP questions at follow-up, and a significant improvement was observed in the IG after the intervention. Total scores increased with age, educational level, income, and time spent working in Shanghai per year but decreased with gravidity and the number of abortions. Native respondents scored higher than did migrants. The prevalence of SUI is high in Shanghai, and the new community-based reproductive health intervention model is both effective and easily implemented. This intervention should focus on women with a low income, women with low education levels, young women, migrant women, and women who have had multiple abortions or pregnancies.

Implementing Firearms Restriction for Preventing U.S. Army Suicide

Suicide among U.S. Army soldiers remains a significant concern for both population health and personnel readiness, with firearms constituting the majority of soldier suicides. Means restriction, or removing an at-risk soldier’s access to lethal means, is a well-established procedure for reducing suicides. Nonetheless, various cultural, legal, and practical concerns may encumber firearms restriction implementation in the U.S. Army. This article reviews policy relevant to firearms restriction, including federal laws, Department of Defense directives, and U.S. Army regulations. Recommendations are provided for providers and commanders that balance the rights of soldiers with the need to ensure safety. In particular, installation restriction, field settings, enlisting supportive others, unit engagement, and off-installation storage are discussed. These approaches span the public health intervention model, providing numerous potential avenues to a balanced approach for firearms restriction in preventing suicide.

The model of comprehensive prevention and control on hypertension and diabetes in community residents in Guangdong Province

Objective To study the model of comprehensive prevention and control on hypertension and diabetes in community residents.Methods A community in Guangdong Province from January 2009 to December 2012 was randomly selected by random cluster sampling method.Residents in the community were followed up and investigated by the method of prospective health intervention.The status of community residents and patients with high blood pressure,diabetes was followed up before and after intervention.Results The survey participants included 5293 community residents in Guangdong province,and 4967 cases were followed up,with the follow-up rate of 93.84％.Prevalence rate of community residents was similar before and after intervention (24.32％ vs.22.59％,P ＞ 0.05).After intervention awareness rate of knowledge about hypertension,diabetes in community residents were significantly higher than those before intervention,with statistically significant differences (P ＜ 0.001).Proportion of health behavior such as regular blood pressure measurement,regular blood sugar measurement,low salt diet and regular exercise after intervention in community residents were obviously higher than those before intervention,with statistically significant differences (P ＜ 0.001); and the proportion of bad behavior such as smoking,alcohol consumption and highfat diet were significantly lower than those before intervention,with statistically significant differences (P ＜ 0.001).After intervention,rates of treatment,rational drugs use and disease control were significantly better than those before intervention,with statistically significant differences (P ＜ 0.001); rates of complications,disability and mortality in patients with high blood pressure,diabetes after intervention were significantly lower than those before intervention,with statistically significant differences (P ＜ 0.001).Conclusion Chronic diseases' prevention and control depends on working together of government,society,residents and families,and community health intervention model is an effective way of prevention and control of chronic diseases. Key words: Community residents; Hypertension; Diabetes; Prevention; Control

Sustained impact of community-based physical activity interventions: key elements for success

BackgroundCompelling evidence supports the cost effectiveness and potential impact of physical activity on chronic disease prevention and health promotion. Quality of evidence is one piece, but certainly not the sole determinant of whether public health interventions, physical activity focused or otherwise, achieve their full potential for impact. Health promotion at both population and community levels must progress beyond health intervention models that isolate individuals from social, environmental, and political systems of influence.We offer a critical evaluation of lessons learned from two successful research initiatives to provide insights as to how health promotion research contributes to sustained impact. We highlight factors key to success including the theoretical and methodological integration of: i) a social ecological approach; ii) participatory action research (PAR) methods; and iii) an interdisciplinary team.MethodsTo identify and illustrate the key elements of our success we layered an evaluation of steps taken atop a review of relevant literature.ResultsIn the school-based case study (Action Schools! BC), the success of our approach included early and sustained engagement with a broad cross-section of stakeholders, establishing partnerships across sectors and at different levels of government, and team members across multiple disciplines. In the neighbourhood built environment case study, the three domains guided our approach through study design and team development, and the integration of older adults’ perspectives into greenway design plans. In each case study we describe how elements of the domains serve as a guide for our work.ConclusionTo sustain and maximize the impact of community-based public health interventions we propose the integration of elements from three domains of research that acknowledge the interplay between social, environmental and poilitical systems of influence. We emphasize that a number of key factors determine whether evidence from public health interventions in school and built environment settings is applied in practice and policy sectors. These include relationship building at individual, community, and societal levels of the social ecological model, using participatory action research methods, and involving an engaged and committed interdisciplinary team.

Costs of a Public Health Model to Increase Receipt of Hepatitis-Related Services for Persons With Mental Illness

This study examined the costs and impact on receipt of hepatitis and HIV testing and hepatitis immunization services of a public health intervention model that was designed for use by persons with serious mental illness and co-occurring substance use disorders. Between 2006 and 2008, a random sample of 202 nonelderly, predominantly African-American males with a psychotic or major depressive disorder and a co-occurring substance use disorder was recruited at four community mental health outpatient programs in a large metropolitan area. Participants were randomly assigned at each site to enhanced treatment as usual (N=97), including education about blood-borne diseases and referrals for testing and vaccinations, or to an experimental intervention (N=105) that provided on-site infectious disease education, screening of risk level, pretest counseling, testing for HIV and hepatitis B and C, vaccination for hepatitis A and B, and personalized risk-reduction counseling. The authors compared the two study groups to assess the average costs of improving hepatitis and HIV testing and hepatitis A and B vaccination in this population. The average cost per participant was $423 for the intervention and $24 for the comparison condition (t=52.7, df=201, p<.001). The costs per additional person tested was $706 for hepatitis C, $776 for hepatitis B, and $3,630 for HIV, and the cost per additional person vaccinated for hepatitis was $561. Delivery of hepatitis and HIV public health services to persons with serious mental illness in outpatient mental health settings can be as cost-effective as similar interventions for other at-risk populations.

The Ergonomic Program Implementation Continuum (EPIC): Integration of health and safety - A process evaluation in the healthcare sector

IntroductionThis article presents a health and safety intervention model and the use of process evaluation to assess a participatory ergonomic intervention. MethodThe effectiveness of the Ergonomic Program Implementation Continuum (EPIC) was assessed at six healthcare pilot sites in Ontario, Canada. The model provided a framework to demonstrate evaluation findings. ResultsParticipants reported that EPIC was thorough and identified improvements related to its use. Participants believed the program contributed to advancing an organizational culture of safety (COS). Main barriers to program uptake included resistance to change and need for adequate funding and resources. The dedication of organizational leaders and consultant coaches was identified as essential to the program's success. Impact on IndustryIn terms of impact on industry, findings contribute to the evidence-based knowledge of health and safety interventions and support use of the framework for creating a robust infrastructure to advance organizational COS and link staff safety and wellness with patient safety in healthcare.

Modeling inhalational tularemia: deliberate release and public health response.

Two epidemic modeling studies of inhalational tularemia were identified in the published literature, both demonstrating the high number of potential casualties that could result from a deliberate aerosolized release of the causative agent in an urban setting. However, neither study analyzed the natural history of inhalational tularemia nor modeled the relative merits of different mitigation strategies. We first analyzed publicly available human/primate experimental data and reports of naturally acquired inhalational tularemia cases to better understand the epidemiology of the disease. We then simulated an aerosolized release of the causative agent, using airborne dispersion modeling to demonstrate the potential number of casualties and the extent of their spatial distribution. Finally, we developed a public health intervention model that compares 2 mitigation strategies: targeting antibiotics at symptomatic individuals with or without mass distribution of antibiotics to potentially infected individuals. An antibiotic stockpile that is sufficient to capture all areas where symptomatic individuals were infected is likely to save more lives than treating symptomatic individuals alone, providing antibiotics can be distributed rapidly and their uptake is high. However, with smaller stockpiles, a strategy of treating symptomatic individuals alone is likely to save many more lives than additional mass distribution of antibiotics to potentially infected individuals. The spatial distribution of symptomatic individuals is unlikely to coincide exactly with the path of the dispersion cloud if such individuals are infected near their work locations but then seek treatment close to their homes. The optimal mitigation strategy will depend critically on the size of the release relative to the stockpile level and the effectiveness of treatment relative to the speed at which antibiotics can be distributed.

Community-based practice program in a rural medical school: Benefits and challenges

Background: Community-based education is a component of many medical curricula and may contribute to the solution of inequity in health services.Aims: This article evaluates a Community-based practice program (CBPP) conducted at Gippsland Medical School, Monash University. Students gain exposure to the community and conduct a community-based research project. The principal objective of the CBPP is to provide students with an opportunity to develop an interprofessional perspective on the application of social equity, justice and models of health interventions in the community.Methods: Students and representatives from community organisations (community educators) evaluated the CBPP using questionnaires, focus groups and interviews.Results: Students agree that participating in the CBPP improves understanding of community services, barriers and social determinants of health and the roles of health professionals. Community educators view the CBPP as a valuable platform for mutual learning for all parties involved, with students gaining real life experience. Challenges in the CBPP include formulating and conducting a research project and contextualisation of didactic material at community sites.Conclusion: From this evaluation, based as it is on 1 year and limited data, we cannot unequivocally claim that the program fully meets its overall objective; however, there are positive outcomes and pointers to success.

Addressing Obesity and Diabetes Among African American Men: Examination of a Community-Based Model of Prevention

The Save Our Sons study is a community-based, culturally responsive, and gender-specific intervention aimed at reducing obesity and diabetes among a small sample (n = 42) of African American men. The goals of the study were to: (1) test the feasibility of implementing a group health education and intervention model to reduce the incidence of diabetes and obesity among African American men; (2) improve regular access to and utilization of health care services and community supportive resources to promote healthy lifestyles among African American men; and (3) build community networks and capacity for advocacy and addressing some of the health needs of African American men residing in Lorain County, Ohio. Trained community health workers facilitated activities to achieve program aims. Following the 6-week intervention, results indicated that participant's had greater knowledge about strategies for prevention and management of obesity and diabetes; increased engagement in exercise and fitness activities; decreased blood pressure, weight, and body mass index levels; and visited a primary care doctor more frequently. Also, local residents elevated African American men's health and identified it as a priority in their community. This model of prevention appears to be a substantial, robust, and replicable approach for improving the health and wellbeing of African American men.

Public Health Intervention Model: Impact on Australian Community and Mental Health Nursing Students' Practice

Recent Australian health care reform in all jurisdictions of government, have attempted to address the need to curtail the burden of chronic disease by adopting and or referring to a primary health care (PHC) approach. In this way, community health nurses are challenged to demonstrate their understanding and capacity to practice according to primary health care principles. Evaluated in this paper is the impact a community health nursing curriculum adaptation of the Public Health Intervention Model (PHIM) has had on students' understanding and application of PHC to community nursing practice. A thematic analysis was utilized to review student assessment tasks. Generated themes support the PHIM adaptation, as a means to facilitate students' cognitive learning of community nursing practice interventions 'greater than treating the wound', and thus this model is particularly pertinent to future Bachelor of Nursing curriculum development and Australian Community Health Nursing.

What We have Learned from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) Study

&lt;p&gt;The first publications from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) began to appear in 2003. STEP-BD was conceived in response to an initiative by the National Institutes for Mental Health (NIMB) seeking a public health intervention model that could generate externally valid answers to questions related to bipolar disorder. The study uses a hybrid design to collect longitudinal data for a patient’s transition between naturalistic studies and randomized clinical trials. About 4,360 patients were admitted to the STEP-BD program, receiving a systematic assessment battery at entry and treated by a range of psychiatrists trained to deliver care and measure outcomes in bipolar patients. A registry of all bipolar patients of every subtype = / &gt; 15 was maintained. A report of the first 1,000 patients enrolled in this study found that the sample was 92.6% white and 58.6% female, less racially diverse than the national population, with higher than average education but also higher than average unemployment and lower than average income. &lt;/p&gt; &lt;h4&gt;ABOUT THE AUTHOR&lt;/h4&gt; &lt;p&gt;Jan Fawcett, MD, is Editor of &lt;cite&gt;Psychiatric Annals&lt;/cite&gt;, and is Professor, Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque. &lt;/p&gt; &lt;p&gt;Address correspondence to: Jan Fawcett, MD, &lt;a href="mailto:jan.fawcett@comcast.net"&gt;jan.fawcett@comcast.net&lt;/a&gt;. &lt;/p&gt; &lt;p&gt;Dr. Fawcett has disclosed the following relevant financial relationships: Eli Lilly &amp; Co.: Member of Speakers’ Bureau; and Abbott Laboratories: Member of Medical Advisory Board.&lt;/p&gt; &lt;h4&gt;EDUCATIONAL OBJECTIVES&lt;/h4&gt; &lt;ol&gt;&lt;li&gt; Describe the findings of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study.&lt;/li&gt; &lt;li&gt;Discuss how the course and treatment of bipolar disorder and the difficulties in treating and preventing recurrences of bipolar depression.&lt;/li&gt; &lt;li&gt;Demonstrate the difficulties of successfully treating bipolar disorder and its comorbidities.&lt;/li&gt;&lt;/ol&gt;

Engaging communities in health intervention research/practice

Asking communities to participate in heath intervention is an increasingly popular strategy in public health and health promotion. The Community Health Educator Model, developed through a series of Participatory Action Research (PAR) projects in cancer screening in the UK during the 1990s, is a participatory health intervention model that emphasises community engagement. Although the model has been adopted by many health districts in the UK, little is known about the effectiveness of its appropriation; crucially, how researchers/practitioners engage with communities has seldom been reported. This paper presents the author's reflection on her experience in developing a set of community organising tools to respond to the diversity found in communities in practice. It suggests that engagement can be enhanced if the contingent and constructed nature of the concepts of ‘ethnicity’ and ‘community’ in the real world can be better understood. Researchers and practitioners need to cultivate a tolerance to difference and ambiguity so as to negotiate the ever-shifting boundary of engagement.

Social factors influencing adolsecents\' susceptibility to hiv/aids/stis infection in Oyo State, Nigeria.

No group stands to be as affected and infected by HIV as adolescents. The need to consider objective social factors with respect to the growing HIV/AIDS epidemic has been recognized by AIDS researchers in Africa as well as by the designers of health intervention models world wide. This study, therefore, investigated the social factors influencing adolescents\' susceptibility to HIV/AIDS/STIs infection in order to effectively plan and develop preventative educational strategies for adolescents in such a way that they can be more assertive and thus less vulnerable to STIs/HIV/AIDS infection. The research adopted a descriptive survey research design. A total of two hundred (N=200) randomly selected school-going secondary school adolescents supplied data for this study. One hundred of the participants were males while one hundred were females. Multiple regression analysis was adopted to answer the two research questions raised in the study. The analysis showed that four social variables of environment, poverty, peer pressure and family factors were significant predictors of the adolescent susceptibility to HIV/AIDS infection. The need for counseling services in schools for adolescents and parents by way of parental education are strongly recommended. More importantly, poverty alleviation programmes of government should be strengthened as poverty seems to be the pivot on which other factors revolve.International Journal of emotiaonl psychology and sport ethics Vol. 9 2007: pp. 89-98

The development and evaluation of the intervention model for the Florida Infant Mental Health Pilot Program.

The focus of this paper is on the development and evaluation of an intervention model for Florida's Infant and Young Child Mental Health Pilot Program, designed to identify families with children at risk for abuse and neglect, and to provide clinical evaluation and treatment services. The evaluation model, intervention strategies, and results presented in this paper are all part of the Florida pilot project developed as a response to the recommendations of the state's Strategic Plan for Infant Mental Health. Funded by the Florida legislature, the 3-year, multisite pilot was designed to provide earlier identification, better evaluation, and more effective treatment services for high-risk children under the age of three. The target population was children either at risk for out-of-home placement due to abuse and neglect, or those already in the child welfare system or adjudicated dependent by the state. The goals of the pilot project were: 1) to reduce the occurrence and re-occurrence of abuse and neglect; 2) to enhance the child's developmental functioning; 3) to improve the parent-child relationship; 4) to increase expeditious permanency placements; 5) to develop a model for intervention and treatment that could potentially be replicated in different sites; and 6) to document the components of a quality infant mental health intervention model and evaluate its effectiveness.

First Responders: Mental Health Consequences of Natural and Human-Made Disasters for Public Health and Public Safety Workers

First responders, including military health care workers, public health service workers, and state, local, and volunteer first responders serve an important role in protecting our nation's citizenry in the aftermath of disaster. Protecting our nation's health is a vital part of preserving national security and the continuity of critical national functions. However, public health and public safety workers experience a broad range of health and mental health consequences as a result of work-related exposures to natural or man-made disasters. This chapter reviews recent epidemiologic studies that broaden our understanding of the range of health and mental health consequences for first responders. Evidence-based psychopharmacologic and psychotherapeutic interventions for posttraumatic distress reactions and psychiatric disorders are outlined. Finally, the application of public health intervention models for the assessment and management of distress responses and mental disorders in first-responder communities is discussed.

Evaluation of an osteoporosis and fall risk intervention program for community-dwelling elderly. A quasi-experimental study of behavioral modifications

Osteoporosis and fall fractures are increasing problems amongst the elderly. The aim of this study was to explore whether combined population-based and individual interventions directed at risk factors for osteoporosis and falls result in behavioral changes in an elderly population. A quasi-experimental design was used for the study. Persons aged >or=65 years were randomly selected in the intervention and control community. An intervention program was managed from the primary health care center and delivered to the community. Health education was designed to increase awareness of risk factors for the development of osteoporosis and falling. Questionnaires about lifestyle, health, previous fractures, safety behavior and physical activity level were distributed at baseline in 1989 and at the follow-ups in 1992 and 1994 in both communities. There was a difference of 17.7% between the dual intervention (receiving both population-based and individual interventions) and the control samples regarding the self-reported use of shoe/cane spikes, and a difference of 20.5% regarding the reported "moderate level" of physical activity in 1994. There was an increase in the number of participants in the dual intervention sample who, at baseline, had not reported equipping their homes with non-slip mats and removing loose rugs but who did report these changes in 1994. The increase in the reported use of shoe/cane spikes in the dual intervention sample was observed mainly for the period 1992-1994. A public health intervention model, including both population-based and individual interventions, can contribute to behavioral changes in the prevention of falls and changed physical activity patterns amongst elderly people.

A Big Night Out in Melbourne: Drinking as an Enactment of Class and Gender

Alcohol is a ubiquitous substance in Western cultures but knowledge about contemporary drinking cultures and consumption contexts is relatively sparse. Examining the ways in which drink choice and drinking settings are differentiated opens up new areas for analysis and health intervention. Drinking is not simply shaped by variables such as class and gender but is an enactment and expression of these social divisions. What, where, and how a person drinks is a simultaneous enactment of class and gender. This argument is based on research of drinking practices in pubs and clubs in Melbourne, Australia. The project used a qualitative methodology which involved a series of 30 field observations in 10 licensed premises. In addition 35 patrons (15 females and 20 males) aged 18–30 were recruited from the venues and participated in qualitative interviews about their drinking practices. Understanding drinking as an expression of social location has implications for models of alcohol research and health interventions.

The Health of Children in Foster Care

This qualitative study of school nurses describes what the nurses want to do for school children in foster care, what they are actually doing, and how the school organization affects the provision of care. The study looked at the nurses' practice through the lens of the Social Ecological Model of Health, identified interventions using the Minnesota Public Health Intervention Model, and analyzed the school organization using the Bolman-Deal Model (Bolman & Deal, 1997). A purposive sample of nurses was chosen to participate in interviews, and observations of their work and a survey on the frequency of their interventions was implemented. Interviews were analyzed using a phenomenological approach. Four themes derived from the data included structural barriers to client access, nonrecognition of the broad determinants of health, isolationism, and lack of political power. School nurses are aware of foster children's increased health care needs, yet increased services are not provided as a result of a lack of organizational support.

The clinical significance of change in trauma-related symptoms following a pilot group intervention for coping with HIV-AIDS and childhood sexual trauma.

The association between sexual abuse and HIV risk is well documented, yet little empirical data exists on treatment approaches integrating the psychological impact of sexual abuse and HIV disease. This study examined the clinical significance of change on sexual-trauma-related stress following a coping group intervention study among 28 women and men with HIV-AIDS and a history of childhood sexual abuse. More than 75% of participants showed improvement on 1 or more subscales of the Trauma Symptom Inventory, with the majority of improvements within domains related to trauma symptoms and behavioral difficulties. Most observed gains were modest, but are considered meaningful in the context of stressors encountered by this disenfranchised sample, which was diverse with respect to race, sexual orientation, and psychiatric comorbidity. These preliminary findings support the need for the conduct of research trials to identify mental health and secondary prevention intervention models that can assist those with HIV-AIDS who have experienced childhood sexual abuse.

Population-based public health interventions: innovations in practice, teaching, and management. Part II.

The Intervention Wheel is a population-based practice model that encompasses three levels of practice (community, systems, and individual/family) and 17 public health interventions. Each intervention and practice level contributes to improving population health. The Intervention Wheel, previously known as the Public Health Intervention Model, was originally introduced in 1998 by the Minnesota Department of Health, Section of Public Health Nursing (PHN). The model has been widely disseminated and used throughout the United States since that time. The evidence supporting the Intervention Wheel was recently subjected to a rigorous critique by regional and national experts. This critical process, which involved hundreds of public health nurses, resulted in a more robust Intervention Wheel and established the validity of the model. The critique also produced basic steps and best practices for each of the 17 interventions. Part I describes the Intervention Wheel, defines population-based practice, and details the recommended modifications and validation process. Part II provides examples of the innovative ways that the Intervention Wheel is being used in public health/PHN practice, education, and administration. The two articles provide a foundation and vision for population-based PHN practice and direction for improving population health.