Implementation Of Community-based Interventions Research Articles

Social Capital and Community Development

Purpose: This study sought to investigate the concept of social capital and its role in promoting community development and resilience, with a focus on practical interventions and policy implications. Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library. Findings: The findings reveal that there exists a contextual and methodological gap relating to social capital and community development. In this study on social capital and community development, while all authors contribute to the overarching theme, one author stands out for discussing a slightly different topic. Specifically, the author who emphasizes the economic advantages of robust social capital within a community diverges somewhat from the others. While the study as a whole examines various aspects of community development, including economic prosperity, social cohesion, and resilience, this particular author delves deeper into the specific mechanisms through which social capital enhances economic opportunities, such as access to resources, markets, and employment. Therefore, this author's focus on the economic dimension of social capital provides a unique perspective within the broader context of community development discussed by the other authors. Unique Contribution to Theory, Practice and Policy: The Social Capital theory, Community Empowerment theory and Structural Functionalism theory may be used to anchor future studies on the concept of social capital and its role in promoting community development and resilience. The study made several recommendations that contributed to theory, practice, and policy in the field. It suggested further exploration of the mechanisms linking social capital to community development outcomes, integration of social capital considerations into policy frameworks, and implementation of community-based interventions. Additionally, the study emphasized the importance of capacity-building efforts, collaborative partnerships among stakeholders, and robust monitoring and evaluation mechanisms. By investing in these recommendations, stakeholders aimed to foster resilient, inclusive, and thriving communities, leveraging social capital as a catalyst for positive social change.

The influence of community factors in the implementation of community-based interventions to improve antenatal care: a qualitative study based on the IMCHA programme in Tanzania

BackgroundEfforts to improve antenatal care have been heightened to reduce global maternal deaths. In resource-limited settings, community-based interventions play a pivotal role in improving antenatal care services. However, effective implementation of community-based interventions is influenced by prevailing community-related factors. Drawing from the community-based interventions implemented in Iringa Region in Tanzania, this paper underscores how community factors influence implementation and ultimate improvement of antenatal care services.MethodsA qualitative case study design was employed using in-depth interviews, focus group discussions and document reviews. Data was collected in Kilolo and Mufindi districts in Iringa Region where community-based interventions were implemented. A total of one hundred and forty-six (146) participants were involved in the study. Eighty-six (86) participants were interviewed and sixty (n = 60) participated in focus group discussions. Data were analysed thematically and manually by categorizing and coding emerging issues to facilitate analysis and interpretation.ResultsKey factors that influenced the implementation of the community-based interventions were the community readiness to adopt the interventions and effective local administrative systems. Stakeholders’ engagement and local health system support were also pivotal for improving antenatal care services. However, the physical environment, bullying of implementers of interventions and family-related challenges constrained the implementation of the interventions.ConclusionThis study has shown that the performance of community-based interventions is highly influenced by community-related factors. More specifically, inadequate community engagement may lead to community members’ reluctance to adopt implemented interventions. Therefore, in-depth understanding and adequate management of community engagement are important during the planning, development and implementation of community-based interventions.

Simulation-Based Estimation of SARS-CoV-2 Infections Associated With School Closures and Community-Based Nonpharmaceutical Interventions in Ontario, Canada

Resurgent COVID-19 cases have resulted in the reinstitution of nonpharmaceutical interventions, including school closures, which can have adverse effects on families. Understanding the associations of school closures with the number of incident and cumulative COVID-19 cases is critical for decision-making. To estimate the association of schools being open or closed with the number of COVID-19 cases compared with community-based nonpharmaceutical interventions. This decision analytical modelling study developed an agent-based transmission model using a synthetic population of 1 000 000 individuals based on the characteristics of the population of Ontario, Canada. Members of the synthetic population were clustered into households, neighborhoods, or rural districts, cities or rural regions, day care facilities, classrooms (ie, primary, elementary, or high school), colleges or universities, and workplaces. Data were analyzed between May 5, 2020, and October 20, 2020. School reopening on September 15, 2020, vs schools remaining closed under different scenarios for nonpharmaceutical interventions. Incident and cumulative COVID-19 cases between September 1, 2020, and October 31, 2020. Among 1 000 000 simulated individuals, the percentage of infections among students and teachers acquired within schools was less than 5% across modeled scenarios. Incident COVID-19 case numbers on October 31, 2020, were 4414 (95% credible interval [CrI], 3491-5382) cases in the scenario with schools remaining closed and 4740 (95% CrI, 3863-5691) cases in the scenario for schools reopening, with no other community-based nonpharmaceutical intervention. In scenarios with community-based nonpharmaceutical interventions implemented, the incident case numbers on October 31 were 714 (95% CrI, 568-908) cases for schools remaining closed and 780 (95% CrI, 580-993) cases for schools reopening. When scenarios applied the case numbers observed in early October in Ontario, the cumulative case numbers were 777 (95% CrI, 621-993) cases for schools remaining closed and 803 (95% CrI, 617-990) cases for schools reopening. In scenarios with implementation of community-based interventions vs no community-based interventions, there was a mean difference of 39 355 cumulative COVID-19 cases by October 31, 2020, while keeping schools closed vs reopening them yielded a mean difference of 2040 cases. This decision analytical modeling study of a synthetic population of individuals in Ontario, Canada, found that most COVID-19 cases in schools were due to acquisition in the community rather than transmission within schools and that the changes in COVID-19 case numbers associated with school reopenings were relatively small compared with the changes associated with community-based nonpharmaceutical interventions.

A system dynamic perspective of stop-start prevention interventions in Australia.

Time-limited prevention initiatives are frequently used to address complex and persisting public health issues, such as non-communicable diseases. This often creates issues in terms of achieving sustainable change. In this study, we use a system dynamic perspective to explore the effects of stop-start funding over system behaviour in two community-based initiatives designed to prevent chronic diseases and obesity. We conducted a qualitative exploratory study using complexity theory as an analytical lens of two Healthy Together Communities (HTCs) initiatives in Victoria, Australia. Data were generated from 20 semi-structured interviews with health promotion practitioners and managers, from community health and local government organizations. Template analysis based on properties of complex systems informed the inductive identification of system behaviour narratives across the stop-start life-course of HTCs. A central narrative of system behaviour emerged around relationships. Within it, we identified pre-existing contextual conditions and intervention design elements that influenced non-linearity of system self-organization and adaptation, and emergence of outcomes. Examples include cynicism, personal relationships and trust, and history of collaboration. Feedback loops operated between HTCs and these conditions, in a way that could influence long-term system behaviour. Taking a dynamic life-course view of system behaviour helps understand the pre-existing contextual factors, design and implementation influences, and feedback loops which shape the long-term legacy of short-lived interventions aimed at solving complex issues. In turn, greater awareness of such interactions can inform better design and implementation of community-based interventions.

Determinants of adverse neonatal outcomes among postnatal women in Dar es Salaam -Tanzania.

Neanatal comploications are the commonest problems facing babies in Tanzania. An attempt has been made to investigate determinants of neonatal outcomes among postnatal women. Using a case-contrrol study design, 165 women were selected from 3 health facilities, where they had had antenatal care (ANC), labour, delivery and post natal care. Chi- square test revealed that gestational age (p-value, 0.01), HIV status (p-value, 0.000) and malaria (p-value, 0.001<0.05) were significantly associated with adverse neonatal outcomes. The study concluded that implementation of community-based intervention is needed to ensure survival of newborns.

Diabetes care: Comparison of patients' and healthcare professionals' assessment using the PACIC instrument.

Whereas the Patient Assessment of Chronic Illness Care (PACIC) instrument measures the extent to which care received by patients is congruent with the Chronic Care Model, the 5As model emphasizes self-management and community resources, 2 key components of the Chronic Care Model. We aimed at comparing evaluation of diabetes care, as reported by patients with diabetes and healthcare professionals (HCPs), using these instruments. Two independent samples, patients with diabetes (n=395) and HCPs (including primary and secondary care physicians and nurses; n=287), responded to the 20-item PACIC and the six 5As model questions. The PACIC-5A (questions scored on a 5-point scale, 1=never to 5=always) was adapted for HCPs (modified-PACIC-5A). In both samples, means and standard deviations for each question as well as proportions of responses to each response modality were computed, and an overall score was calculated for the 20-item PACIC. Patients' and HCPs' overall scores were 2.6 (SD 0.9) and 3.6 (SD 0.5), respectively, with HCPs reporting higher scores for all questions except 1. Patients' education and self-management, referral/follow-up and participation in community programs were rated as low by patients and HCPs. Healthcare professionals, particularly diabetes specialists, tended to report better PACIC scores than patients, suggesting that care was not reported similarly when received or provided. Evaluation differences might be reduced by a closer collaboration between patients and HCPs, as well as the implementation of community-based interventions considering more patients' perspectives such as patients' education and self-management.

Changing epidemiology of maternal mortality in rural India: time to reset strategies for MDG‐5

To understand changes in epidemiology of maternal mortality in rural India in the context of increasing institutional deliveries and implementation of community-based interventions that can inform policies to reach MDG-5. This study is a secondary analysis of prospectively collected community-based data of every pregnancy and its outcomes from 2002 to 2011 in a rural, tribal area of Gujarat, India as part of safe-motherhood programme implemented by voluntary organisation, SEWA Rural. The programme consisted of community-based interventions supported by a first referral unit, and promotion of institutional deliveries. For every maternal death, a verbal autopsy was conducted. The incidence rates for maternal mortality according to place, cause and timing of maternal deaths in relation to pregnancy were computed. Annual incidence rate ratios (IRR) and 95% confidence intervals, adjusted for caste and maternal education, were estimated using Poisson regression to test for linear trend in reduction in mortality during the study period. Thirty-two thousand eight hundred and ninety-three pregnancies, 29,817 live births and 80 maternal deaths were recorded. Maternal mortality ratio improved from 607 (19 deaths) in 2002-2003 to 161 (five deaths) in 2010-2011. The institutional delivery rate increased from 23% to 65%. The trend of falling maternal deaths was significant over time, with an annual reduction of 17% (adjusted IRR 0.83 CI 0.75-0.91, P-value <0.001). There were significant reductions in adjusted incidence rate of maternal deaths due to direct causes, during intrapartum and post-partum periods, and those which occurred at home. However, reductions in incidence of maternal deaths due to indirect causes, at hospital and during antepartum period were not statistically significant. Most maternal deaths are now occurring at hospitals and due to indirect causes. Gains in institutional deliveries and community-based interventions resulting in fewer maternal deaths due to direct causes should be maintained. However, it would be essential to now prioritize management of indirect causes of maternal mortality during pregnancy at community and hospitals for further reduction in maternal deaths to achieve MDG-5.

Race, Culture, and Ethnicity: Implications for a Community Intervention

We present an overview of research on African American families and emphasize in this discussion limitations of approaches used in the past to study African American families. We also discuss and identify challenges for designing and implementing community, family-based programs targeting competence-promoting behaviors in African American families. In addition, we attempt to accomplish the following objectives: (1) identify themes in studies of African American families, including bias in prior research; (2) discuss ways in which prior approaches and conceptual models guiding studies of African Americans have created challenges for the development and implementation of community-based intervention and research programs; and (3) present the Parents Matter! Program as an example of a community-based prevention effort that attempted to overcome many of the challenges created by prior research efforts.

PSOC in community context: Multi‐Level correlates of a measure of psychological sense of community in low‐income, urban neighborhoods

Recent years have seen a steady increase in attention to communities as a source of both risk and protective factors for various individual outcomes. Psychological sense of community (PSOC) is one concept which can be important in describing the ways in which real and perceived aspects of community might mediate both individual and community outcomes. To understand the setting-specific interaction of individual and community, it is necessary to examine how individual and community level factors are simultaneously associated with psychological sense of community. As part of a larger study of community influence on health, we conducted a random household survey in three geographically defined low-income communities in Baltimore City. Nine hundred fourteen individuals were surveyed with a questionnaire that included a measure of psychological sense of community. This article describes the variability of PSOC in these communities and identifies individual- and community-level characteristics associated with varying levels of PSOC. Statistical methods of multi-level analysis were employed. Individuals in low-income communities showed heterogeneity for PSOC that is partially explained by variation in individual- and community-level characteristics. We suggest that this variability, as well as the promotion of positive PSOC within low-income communities, has implications for the development and implementation of community-based interventions.

Systems theory perspective and community psychology

This article explores some implications of recent epistemological revisions in community psychology, beginning with the developments of the community perspective and proceeding through its subsequent transformations. The changes produced from the shift from cybernetic models to dialogical models generated a serious review of our understanding of community change processes. The major unanticipated questions resulting from these changes have generated many uncertainties in the field that are likely to alter our conceptions, our scientific methods, and our ability to impact community processes. These uncertainties create possibilities for new metaphors that may open up new ways to think about the design and implementation of community-based intervention. Some consequences of recent epistemological changes in the multidisciplinary field referred to as “community psychology” are explored in this article. In general, this field incorporates the perspectives of many social sciences that share an interest in the interconnections between “subjectiveness” and “social.” In its development, community psychology has spread beyond disciplinary boundaries, thus promoting the exploration of new conceptual metaphors, methods, and techniques. These explorations have yielded epistemological and theoretical changes as well as alterations in how one thinks about practice. In the systems theory perspective, the movement from “first order cybernetic” models to a “dialogical” position has significantly changed how one plans actions, how one thinks about the role of professionals in the context of community work, and how one defines genuine cooperation. The goal of the article is to examine the consequences of this ongoing process, which has yielded uncertainty and a range of unanticipated possibilities. Some steps which have already been taken will be explored and new steps which might be taken will be recommended. Naturally, some unanswered questions will, hopefully, engage readers in the examination of these issues. © 1998 John Wiley & Sons, Inc.