Pilot Communities Research Articles

84 Context Analysis for Scaling-Up a Community-Based Physical Activity Promotion Approach: a Comparative Case Study of 10 German Pilot Communities

84 Context Analysis for Scaling-Up a Community-Based Physical Activity Promotion Approach: a Comparative Case Study of 10 German Pilot Communities

O.5.3-4 Key components in the implementation of a co-produced framework for community-based physical activity promotion: a comparative case study of six diverse pilot communities

Abstract Purpose As part of the project KOMBINE, we co-produced a framework with nine key components for community-based physical activity promotion (c-PAP) focusing on health equity together with stakeholders from policy, practice and research. We then implemented the framework in six diverse pilot communities (PC). The aim of this study is to analyse process and output of the participatory implementation. Methods The framework includes six phases: (1) preparation, (2) assessment, (3) setting up cooperative planning groups including steering committees (4) organization of the planning process, (5) development and (6) implementation of measures. We used an online questionnaire and meeting minutes to evaluate the process by means of qualitative content analysis. We then compared the PC regarding the four key components intersectoral collaboration, participation, political support and resources. For the output evaluation, we conducted a document analysis of the action plans from phase 5. Results Each PC established a cooperative planning group with intersectoral collaboration. The participation of people with social disadvantages proved to be challenging, but was more successful in rural compared to urban PC. Further, some PC had to invest many resources to ensure political support and had difficulties involving high-ranking political stakeholders, while in others political support was a given throughout the entire process. Personnel resources were a highly relevant topic in all PC, while financial resources played a bigger role in rural and socioeconomically deprived PC. The output was a broad range of measures (personal skills (n = 28), infrastructure (n = 70), policy action (n = 11), and community action (n = 3)) relevant to the specific needs of each PC. Conclusions Through the analysis, we shed light on the interplay between context, process and output and the role of key components for the successful implementation of sustainable and equitable c-PAP in different contexts. Next steps are the evaluation of outcome and impact to inform the effective scale up of this approach. Funding Source This work was supported by the Federal Centre of Health Education (BZgA) on behalf of and with funds from the statutory health insurances according to § 20a SGB V in the context of the GKV Alliance for Health (https://www.gkv-buendnis.de).

O.5.3-5 Existing structures for physical activity promotion: the role of resources, political support, intersectoral collaboration, and participation in six pilot communities - a comparative case study-

Abstract Purpose The German Recommendations for Physical Activity (PA) and PA Promotion recommend community-based PA promotion (c-PAP) with focus on health equity. As communities are complex systems with dynamic relationships and interactions, a deeper understanding of the community’s structures is crucial for implementation. Therefore, the aim of this study is to analyse the initial structures in six diverse pilot communities (PC). Methods A framework for c-PAP was co-produced and implemented in six PC, which varied in terms of type (urban, rural), region, readiness, and socioeconomic deprivation. Using a comparative case study design, we conducted qualitative interviews with key stakeholders from each PC including political stakeholders, experts, representatives of the administration, “door-openers” with contact to people with social disadvantages, and community facilitators. The development of a semi-structured interview guideline was based on the co-produced nine KC. With a qualitative content analysis, we compared similarities and differences in the initial structures of the six PC along the following four KC: “resources”, “political support”, “intersectoral collaboration”, and “participation”. Results 32 interviews revealed differences in the four analysed KC according to the community type, the socioeconomic deprivation as well as the readiness. “Intersectoral collaboration” was stronger in most urban-PC. The KC “participation” varied according to previous experiences in participatory approaches. Although urban PC have had more experiences, these were not necessarily positive and sometimes lead to reservation about new approaches. “Political support” seemed to be higher in rural-PC. Available resources differed according to the socioeconomic deprivation and rural-PC in general had fewer financial and personnel resources at disposal. Conclusions A thorough analysis of the initial community structures will contribute to a better understanding of how the structures influence process, output, and outcome of community-based PA promotion. Finally, it will support an enhanced exploration of the impact regarding sustainable and equitable structural change for PA promotion at community level. Funding Source This work was supported by the Federal Centre of Health Education (BZgA) on behalf of and with funds from the statutory health insurances according to § 20a SGB V in the context of the GKV Alliance for Health (www.gkv-buendnis.de).

Validation of a methodological model to incubate successful agribusinesses in marginalized areas from South Mexico

Given the situation of poverty and marginalization in which most of the communities in the rural areas of the Mexican South Southeast are found, a situation that affects 17 million people classified as in a situation of extreme poverty, agribusiness is an alternative under these conditions for it. An operational and practical methodology is required that allows a good identification and implementation of initiatives according to the situation and the environment. The objective of this work was to validate an operational methodological model called model for the competitiveness of small farmers in extreme poverty based on agribusiness. The validation project was developed in four pilot communities in the Mexican South Southeast considered to be highly marginalized and poor: San Andrés Tuxtla, Veracruz; Tahdziu, Yucatan; Ocotepec, Chiapas and San Jerónimo Taviche, Oaxaca. The applied model consists of four stages, diagnosis, incubation, development and maturity. The diagnosis considered in turn two sub-stages, one on the description of the environment and the actors and the second on the definition of the portfolio of opportunities. The incubation considered the sub-stages of prioritization through a qualification criteria and the business plan itself according to the conditions of the actors and the environment. The development stage is nothing more than the start-up and consolidation of the business with a view to continuous improvement. The results obtained were four agribusinesses in progress, one for each pilot community, with profitability indicators such as the Internal Rate of Return (IRR) of 35.0%, 100.0%, 41.0% and 45.9% for jam production in San Andrés Tuxtla Veracruz, Stevia production and marketing in Tadhziu Yucatán, Hass avocado production and marketing in San Pablo Huacanó Chiapas and tomato production and marketing in greenhouses in San Jerónimo Taviche Oaxaca, respectively. The operational methodological model to identify and develop agribusiness in poor and marginalized communities was successfully validated. It is concluded that it is possible to develop profitable and competitive agribusiness in conditions of extreme poverty and marginalization.

Perceived impacts of COVID-19 and bushfires on the implementation of an obesity prevention trial in Northeast Victoria, Australia.

Calls for the adoption of a systems approach to chronic disease prevention date back at least ten years because of the potential to empower communities to identify and address the complex causes of overnutrition, undernutrition and climate change. Australia, like many countries, has high levels of obesity and extreme climate events. The Reflexive Evidence and Systems interventions to Prevent Obesity and Non-communicable Disease (RESPOND) trial aims to prevent unhealthy weight gain in children in 10 intervention and two pilot communities in north-east Victoria, Australia using community-based participatory approaches informed by systems science. Intervention activities co-designed in 2019 were disrupted by COVID-19 and bushfires. This paper explores the impacts of these 'shocks' on the local prevention workforce to implement actions within communities. A case study design involving one-hour online focus groups and an on-line survey (November 2021-February 2022). Purposive sampling was used to achieve diverse representation from RESPOND stakeholders including local council, health services, primary care partnerships and department of health. The focus group interview schedule and survey questions were based on Durlak and DuPre's implementation factors. Twenty-nine participants from seven different communities participated in at least one of nine focus groups to discuss the impacts of COVID-19 and bushfires on localised implementation. Twenty-eight participants (97% of focus group sample) also completed the on-line survey. Implementation of RESPOND stalled or stopped in most communities due to bushfires and/or COVID-19. These shocks resulted in organisational priorities changing, loss of momentum for implementation, redeployment of human resources, culminating in fatigue and exhaustion. Participants reported adaptation of RESPOND, but implementation was slowed due to limited resources. Further research is needed to advance risk management strategies and protect resources within health promotion. System shocks such as bushfires and COVID-19 are inevitable, and despite multiple adaptation opportunities, this intervention approach was not 'shock proof'.

Increasing women’s participation in wildlife governance in Zambia

Community-based natural resource management bodies, including Community Resource Boards (CRBs) and Community Scouts, are responsible for governance and wildlife law enforcement in Zambia’s Game Management Areas (GMA), community lands that buffer the National Parks. Despite commitments to inclusive governance and benefit sharing, men dominate the wildlife and natural resource sectors in Zambia; they make up the vast majority of wildlife scouts who patrol the GMAs and hold most positions on the CRBs who allocate benefits and decide on management priorities. Gender blind structures within community governance institutions during the recruitment and training process and social and gender norms that see leadership roles as men’s domain act as barriers to women’s participation in the sector. In response, the United States Agency for International Development (USAID) invested in a comprehensive package of activities to increase women’s effective participation in wildlife governance and law enforcement, including gender-responsive CRB elections, empowerment training for newly elected women candidates, revised community scout training curriculum, and capacity building support for organizations that support scouts and CRBs. The intervention helped increase women’s representation in CRBs from four percent to 25 percent in pilot communities. It also supported the Department of National Parks and Wildlife (DNPW) to recruit the first gender balanced cohort of community scout recruits and field an all-women patrol unit in Lower Zambezi National Park.

Determinants of clean cooking fuels utilization in three peri-urban communities in Ghana: key lessons to inform national policy

Use of polluting fuels has negative effect on human health and the environment. Use of clean cooking fuels (liquefied petroleum gas (LPG) can address this burden but in Ghana adoption is low with accessibility, convenience and safety concerns being potential barriers to LPG use. In order to address these issues, the Ghanaian government launched a new LPG distribution model through cylinder recirculation in 2019 on a pilot basis As part of the CLEAN-Air (Africa) project, we collaborated with National Petroleum Authority implementing the CRM to conduct face-to-face surveys of randomly selected households on household cooking fuels preferences and use in three peri-urban CRM pilot communities in Ghana. To analyse determinants of adoption and sustained use of LPG for cooking, individual, household and wider community characteristics were entered as covariates into logistic regression models as potential predictors. A total of 5,008 respondents completed the questionnaires across the three communities (Obuasi; 1,987 (40.0%), Kwaebibirem; 1,731 (34.9%) and Hohoe; 1,248 (25.1%)). A total of 48.6% (Obuasi (50.1%); Kwaebibirem (44.4%); Hohoe (52.2%)) households reported currently using LPG as the main cooking fuel. Being head of the household, increased household size, home ownership, an indoor cooking area, increased educational status and an increased number of LPG burners were associated with household’s choice of using LPG as a primary fuel. Households using an LPG stove with three or more-burners, were 68% [OR:1.68 (95%CI: 1.32, 2.14), 001] more likely to use LPG as a primary fuel than those using a single burner on top of the cylinder. Given the importance of the CRM, understanding household level characteristics for adoption are important. Better education and awareness raising of benefits will be important in scaling adoption of LPG as a clean fuel for cooking at the household level. Keywords: clean cooking fuels, LPG, Cylinder Recirculation Model, primary fuel use

A roadmap to becoming a smart village: Experiences from living labs in rural Bavaria

This paper illustrates the measures and digital integrations being made in the course of digitalization, using the example of existing rural pilot communities in Bavaria, Germany. The participating communities were selected as part of the government-funded project "Digitales Dorf" (Engl. digital village). Since 2016, digital solutions as well as complementary actions have been identified and implemented to make everyday life in the community equal to that in the city: the main intention is to push digitalization to create equivalent living conditions to urban areas. This paper is intended to provide an overview of the requirements and steps that need to be taken in digital transformation, in order to develop a generalized blueprint for other communities. Furthermore, it introduces the pilot projects, provides an insight into best practices to promote digitalization in traditional rural areas, and focuses on the transformation process rather than on digital solutions.

What motivates communities to participate in forest conservation? A study of REDD+ pilot sites in Cross River, Nigeria

Market-based forest governance mechanisms such as reducing emissions from deforestation and degradation (REDD+) are implemented in many forests rich countries to conserve biodiversity and mitigate against global climate change. The assumption is that communities will be better motivated to participate in forest conservation if monetary payments are provided to compensate for past efforts or future improvements against pre-defined carbon reference levels. In this paper, I utilized Q methodology to identify discourses of forest values and motivations for forest conservation in selected REDD+ pilot communities in Cross River State, Nigeria. Data from interviews and focus group discussions are also used to support the analysis. The aim is to examine communities' motivations for practicing conservation initiatives and the extent to which such motivations are shaping their participation in the REDD+ program. The analysis uncovers five main discourses namely: forest for survival, forest is beautiful, no pay no care, conservation volunteers, and we care but pay us. I discussed these discourses around three themes: livelihoods dependence, financial incentives, and place attachment and social norms. Results indicate that the reasons why communities practice conservation are complex and subjective, and payment of monetary incentives or lack thereof will not necessarily motivate them to participate in the REDD+ program. I suggest that values such as place attachment, nature connectedness and social norms matter in the success of REDD+ particularly in communities that have long history of practicing voluntary conservation initiatives.

Feasibility and acceptability of a video library tool to support community health worker counseling in rural Afghan districts: a cross-sectional assessment

BackgroundRural Afghan populations have low skilled birth attendance rates and high maternal and infant mortality. Insecurity and armed conflict, geographic barriers, and cultural norms often hinder women’s access to facility-based reproductive, maternal, newborn, and child health (RMNCH) services. Community health workers (CHWs) are critical agents for behavioral change in this and similarly fragile settings, where RMNCH information exposure is limited by low literacy and mass media access. We assessed the feasibility and acceptability of a computer tablet-based health video library (HVL) to enhance CHW counseling on RMNCH topics in three rural Afghan districts.MethodsThe HVL was introduced by trained CHWs in 10 pilot communities within one rural district in each of Balkh, Herat, and Kandahar provinces. We used a mixed-methods study design to assess exposure to and perception of the HVL 6 months post-introduction. We surveyed married women (n = 473) and men (n = 468) with at least one child under 5 years and conducted in-depth interviews with CHWs and community leaders (shuras and Family Health Action groups) within pilot communities (n = 80). Program improvement needs were summarized using quantitative and qualitative data.ResultsHigher proportions of women in Balkh (60.3%) and Herat (67.3%) reported viewing at least one HVL video compared to women in Kandahar (15%), while male HVL exposure was low (8–17%) across all districts. Most HVL-exposed clients (85–93% of women and 74–92% of men) reported post-video counseling by CHWs. Nearly all (94–96% of women and 85–92% of men) were very interested in watching videos on other health topics in the future. Participants recommended increasing the number of videos and range of topics, using tablets with larger screens, and translating videos into additional local languages to improve the HVL program.ConclusionThe HVL was a highly acceptable tool for relaying health information, but coverage of female audiences in Kandahar and male audiences broadly was low. The HVL should better engage men and other key influencers to engineer local solutions that directly facilitate male HVL exposure, indirectly improve women’s HVL access, and support collaborative spousal health decision-making. A larger efficacy trial is warranted to measure the HVL’s effect on knowledge and health-related behavioral outcomes.

Early integration of palliative care in a long-term care home: A telemedicine feasibility pilot study.

Palliative care plays an essential role in enhancing the quality of life and quality of death for residents in long-term care homes (LTCHs). Access to palliative care specialists is one barrier to providing palliative care to LTCHs. This project focused on palliative telemedicine, specifically evaluating whether integration of early palliative care specialist consultation into an LTCH would be feasible through the implementation of videoconferencing during routine interdisciplinary care conferences. This was a mixed-methods evaluation of a pilot program implementation over 6 months, to integrate early palliative care into an LTCH. There were two pilot communities with a total of 61 residents. Resident demographics were collected by a chart review, and palliative telemedicine feasibility was evaluated using staff and family member surveys. For the 61 residents, the average age of the residents was 87 years, with 61% being female and 69% having dementia as the primary diagnosis. The mean CHESS (Change in Health, End-Stage Disease, Signs, and Symptoms) and ADL (Activities of Daily Living) scores were 0.8 and 4.0, respectively, with 54% having a Palliative Performance Scale score of 40. Seventeen clinical staff surveys on palliative teleconferences were completed with the majority rating their experience as high. Ten out of the 20 family members completed the palliative teleconference surveys, and the majority were generally satisfied with the experience and were willing to use it again. Clinical staff confidence in delivering palliative care through telemedicine significantly increased (P = 0.0021). The results support the feasibility of videoconferencing as a means of palliative care provision. Despite technical issues, most clinical staff and families were satisfied with the videoconference and were willing to use it again. Early integration of palliative care specialist services into an LTCH through videoconferencing also led to improved self-rated confidence in the palliative approach to care by clinical staff.

Carbon emissions under different domestic waste treatment modes induced by garbage classification: Case study in pilot communities in Shanghai, China

The GHGs contributions (tally by carbon emissions) during treatment of domestic food waste and residual waste from pilot communities (contained 2365 families) in Shanghai, China, under different Modes induced by garbage classification were investigated. It was found that under the present condition of garbage classification in Shanghai, 51.8% of the food waste could be separated finally. With garbage classification, the load of landfill was saved by 17.3% (Mode 2) and 16.5% (Mode 3), the moisture of garbage for incineration was reduced by 13.6%, and the lower heating value (LHV) of garbage was increased by 16.2%. Applying the life-cycle assessment (LCA) methodology and Life Cycle Inventory (LCI) with material flows, net carbon emissions during the treatment of garbage were found to be in the following order: Mode 3 (1.60 × 10−3 kg CE/kg waste) < Mode 2 (4.85 × 10−3 kg CE/kg waste) < Mode 1 (4.94 × 10−3 kg CE/kg waste) < landfill (1.49 × 10−2 kg CE/kg waste). Mode 2 and Mode 3 were replaceable patterns of Mode 1, and anaerobic digestion was the recommendable strategy to recover energy from food waste. Especially, there was no obvious benefit of increasing the separation proportion of food waste to 60% (or above) for reducing net carbon emissions in the following treatment processes.

Local early warning systems for drought – Could they add value to nationally disseminated seasonal climate forecasts?

Limited application and use of forecast information restrict smallholder farmers’ ability to deal with drought in proactive ways. This paper explores the barriers that impede use and uptake of seasonal climate forecasts (SCF) in two pilot communities in Limpopo Province. Current interpretation, translation and mediation of national SCF to the local context is weak. A local early warning system (EWS) was developed that incorporated hydrological modelled information based on national SCF, locally monitored rainfall and soil moisture by a wireless sensor network, and signs from indigenous climate indicators. We assessed to what degree this local EWS could improve interpretation of SCF and increase understanding and uptake by farmers. Local extension staff and champion farmers were found to play important knowledge brokering roles that could be strengthened to increase trust of SCF. The local EWS provided added value to national SCF by involving community members in local monitoring, enacting knowledge interplay with indigenous knowledge and simplifying and tailoring SCF and hydrological information to the local context. It also helped farmers mentally prepare for upcoming conditions even if many do not currently have the adaptive mindsets, economic resources or pre-conditions to positively respond to SCF information.

A four-step process for building sustainable access to diagnosis and treatment of Chagas disease.

ABSTRACTThe vast majority of people with Chagas disease (CD) are undiagnosed and untreated. Improving access to diagnosis and treatment for CD involves confronting a wide range of barriers. This report discusses a collaborative approach to eliminate barriers and increase the availability of CD testing and treatment. Potential areas for intervention are selected based on burden of disease, support of local champions, and commitment from national and local authorities. A 4D approach (diagnose, design, deliver, and demonstrate impact) is then implemented. The diagnose step involves gathering key stakeholders at a seminar to collaboratively identify important barriers and propose solutions. The design step creates a specific plan to act upon the seminar’s conclusions with consensus on core indicators. The deliver step entails implementing the plan at pilot locations, while simultaneously strengthening health system capacity for CD testing and treatment. Lastly, the demonstrate impact step compares baseline data with annual post-implementation data to measure progress. In Colombia, this approach has helped simplify testing procedures and increase CD testing and treatment access in pilot communities, though challenges remain. The 4D approach represents one of several pathways toward ensuring that the best therapeutic and diagnostic products reach people affected by neglected tropical diseases.

Addressing social determinants of NCDs through community mobilisation: comparative research for effectiveness assessment

An introduction: Since 2014, Swiss Red Cross has been running a “Community Action for Health” project in Belarus. Directly implemented by the Belarus Red Cross, the project is aimed at improving knowledge, changing attitudes and behaviour of the local population on such determinants of NCDs as physical activity and healthy nutrition via establishing Initiative Groups IGs in the communities. To identify effectiveness of the community mobilisation approach, a project end-line survey was done in March-July 2017. Theory/Methods: Community mobilisation was implemented in selected geographical areas of 5 pilot districts. Base-line data on NCD related knowledge, attitudes and behaviour of people living in the pilot districts was collected in 2014. The end-line data collection was organised using quasi-experimental method. 1866 respondents were organised in three target groups TGs: 417 IGs members and volunteers with full coverage; a sample of 385 systematic random sampling from 76,500 people in pilot communities covered by the IGs’ work; a sample of 1,067 people not covered by the IGs’ work multistage samplings with district stratification at the first stage, rural/urban stratification at the second stage from 208,411 people living in the pilot districts. First two groups were considered as experimental, the third one – as a control group. The end-line results were also compared with the base-line data. Results: Not only people directly involved in the IGs – members and volunteers, - but also people “covered” by the IGs’ work are more physically active ride a bicycle every day/few times a week 31.9% of “covered” population versus 19.2% of general population; go for a walk 71.4% versus 58.5% respectively. The IGs members/volunteers and the “covered” population reported switching to healthier diet 53.3% and 41.5% respectively and weight loss 29.2% and 20.1%. Discussions: How does the research - assess “spill over” effect of targeted interventions; - eliminates role of “external environmental factors” increased state attention to the NCD prevention over the recent years; - foster programme sustainability and development. Conclusions: The research showed a high degree of effectiveness of the community mobilization approach in improve both the health status and life quality improving subjective well-being, increasing communication of the population covered by the project activities. Survey results: broadly used for advocacy, played an important role in further geographical expansion of and stronger involvement of the state health institutions in community mobilization for NCD prevention. Lessons learned: Comparative analysis experimental and control groups made a stronger policy influence; Distribution of the information on the IGs work during interviews with the “non-covered” population target group 3 was a good strategy of involving new people/communities in NCD prevention. Limitations: Questions on subjective assessment of health and wellbeing change within the project time-frame were used only for the experimental groups. Difficulties in defining “covered” population target group 2 in the urban areas. Suggestions for future research Longitude survey, based on the existing questionnaire could be used to monitor longer-term impact of community mobilisation for NCD prevention.

Supporting Indigenous families in the Cree territory: lessons from the  Mashkûpímâtsît Awash initiative.

We describe the adaptation of an early childcare and development program to the Indigenous context of the Cree territory in Québec. We also share lessons on the challenging implementation of home visits by Indigenous family support workers (FSWs), which is a critical component of the intervention. Â Mashkûpímâtsît Awash (AMA) aims to enhance the health and well-being of pregnant mothers, young children, and their families by providing intensive interdisciplinary care and follow-up. Indigenous female FSWs from the community are the key frontline workers and cornerstone of the program. AMA is implemented as part of the multidisciplinary services provided by the Community Miyupimaatisiiun Centres (primary health care centres) in three pilot communities of Eeyou Istchee. AMA builds on family centredness and cultural safety, integration of services, and creation of family-friendly communities. It emphasizes the role of female local Indigenous FSWs in providing culturally safe outreach services in the form of home visits. The main challenge was conducting home visits. FSWs' view of the pertinence of home visits, as well as their personal stories, seemed to influence their motivation to conduct home visits. Their level of experience appeared to facilitate home visits. Encouraging creativity, fostering autonomy, ensuring a step-by-step implementation, and promoting communication were found to create a supporting environment to facilitate home visits. Hiring local Indigenous workers is necessary to ensure that early childhood development programs are culturally safe. Success of such programs relies on team management, provision of culturally adapted training, and quality of the ongoing emotional support provided to the FSWs.

Intervention effect assessment of response to heatwave in communities of four cities, China

Objective: To evaluate the intervention effects of response to heatwave in communities of four cities, China. Methods: Baseline survey on heatwave and climate change related knowledge, attitude and practice (KAP) was conducted in the pilot communities in Harbin, Nanjing, Shenzhen and Chongqing, using face-to-face questionnaire interview in November, 2011 to November, 2013. Finally, 1 604 residents were interviewed. Intervention measures were implemented in summers of 2013 and 2014, including delivering early warning information of heatwave health risk and launching health education and promotion. The second survey was conducted in same communities using the same questionnaire and sampling method as baseline survey in November, 2014, and 1 640 residents were interviewed. The Chi-square test was used to compare the demographic characteristics and KAP of community residents between before and after intervention, and the factors that affected the intervention effect were selected by logistic multiple stepwise regression model. Results: The age of the residents interviewed before and after intervention was (46.4 ± 15.5) years and (45.0 ± 15.9) years, respectively. Overall, the residents' awareness rates of heatwave before and after intervention were 70.5% (1 131/1 604) and 82.9% (1 359/1 640) (χ2=69.40, P<0.001). The rate of residents who had wished to receive early warning information increased 6.3% (χ2=41.11, P<0.001), which reached 94.6% (1 551/1 604) after intervention from 88.3% (1 416/1 604) in baseline survey. Both heatwave health risk early warning and health education had big impacts to residents. There were 92.7% (1 105 residents) among the 1 192 residents who had received the early warning information arrange work and rest time according to the early warning information and 93.0% (1 231 residents) among the 1 323 residents who knew about health education activities being conducted in community thought that the community health education activities had made active role in protecting health from heatwaves. After a series of intervention, male had a effect on attitude about hot wave than female in Nanjing and Chongqing, OR (95%CI) were 1.48(1.02-2.16) and 1.45 (1.18-2.05) , respectively; compared with subjects below primary school education, people with college degree or above had higer KAP in all cities (ORs range from 1.18 to 2.05), P<0.05; regular physical exercise (ORs range from 1.39 to 2.70) also had profound impacts on KAP in all cities (P<0.05). Conclusion: s Early warning and health education were effective measures to enhance residents' response capacity to climate change.

Status and influencing factors of contracting and renewing on family doctor service in pilot areas in Guangzhou

Objective To learn the current status of family doctor service at pilot communities in Guangzhou, and discover existing problems and influencing factors by investigating the residents who have contracted such service, those have not and the family doctors. Methods This study chose typical community health centers of six communities in Guangzhou in January 2016. In random sampling, residents who visited doctors during the survey and all the family doctors were surveyed. EpiData was used to doubly input data, with SPSS 20.0 for statistical analysis. Results 66.0% of those residents who have not contracted the service are willing to contract a family doctor. According to the binary logistic regression analysis after eliminating the interference factors, there are two factors affecting their willingness: gender and whether needing a family doctor for themselves and their family for health management. According to the binary logistic regression analysis after eliminating the interference factors, the influencing factors of renewing contract are overall satisfaction and necessity for signing family doctors. Conclusions The smooth development of the family doctor service is faced with many bottlenecks, while improving willingness to contract and renew contract to family doctors are the cornerstone for sustainability of the family doctor system. Key words: Family doctor; Willingness to sign; Willingness to renew; Influencing factors; Investigation

Non-communicable diseases prevention through community mobilization

An introduction : Non-communicable diseases (NCD) are a serious macro-economic burden for Belarus. About 90% of all deaths in the country are due to NCDs (63% – cardiovascular diseases). Behavior change is an important element of NCD prevention. Practice change implemented. In order to reduce the impact of NCDs on individuals and society BRC implemented the project “Community action for Health” supported by SRC. The project is aimed at behavior change of individual community members through introducing a change from “non-organized” members of community to community volunteer groups (CVGs) with extension of the “effect” to wider circle of people in community. Aim and theory of change. The aim is engaging people and communities in and empowering for healthier life style through setting up CVGs, united around key community needs/priorities in the area of healthy life style. Key stages: - Training for volunteers on NCD prevention, - public events for public awareness and engaging more community members, - thematic mini-initiatives, - peer-support in individual behavior change. Target population: - 14 CVGs with more than 250 members aged between 9 and 85 years in 12 pilot districts (with population about 185 thousand of people). - Around 10,000 people involved in CVGs activities. - More than 500 volunteers trained in NCD prevention. Main stakeholders – BRC, health, educational, social, sport and culture institutions, local authorities. Innovation/ impact and outcomes : Important element of community mobilization is developing and implementing mini-initiatives that address the health related priorities identified by the communities. It doesn’t only establish supporting environment for behavior change, but shapes community and works as an advocacy tool. There is also a “spill-over” effect to other communities/districts of the pilot regions. Within peer-support process, trained volunteers help community members (maximum 3 persons per one volunteer) setting a goal, personal motivation, make up a clear plan, arrange supporting environment. Monitoring of changing process is carried out by collecting personal stories. At the end of the project it is planned to get more quantitative results of behavior change based on the quasi-experimental method (comparing knowledge, skills and practices in the pilot communities with those communities that were not covered by any health related projects). Sustainability of CVGs is ensured by signed partnership agreements with the local state organizations providing organizational and financial support to the CVGs. Transferability : BRC has 100% coverage of the country with regional and district branches: CVGs experience is transferred within the organization, as well as by partner state organisations and local authorities. Conclusions : Community mobilization via CVGs work is new, but effective mechanism of NCDs prevention in Belarus. Discussions : How feasible it is to build-in community-led NCD prevention into the state primary prevention system including Lessons learned : - There are two “types” of CVGs: uniting active members of community in their individual capacity and built around representatives of the local institutions interested in addressing NCDs. - Individual peer-support is effective method of behavior change: needs to be better described and further developed.

Community safety, social cohesion and embedded autonomy: a case from south-west Dublin

The article provides a case of community safety based upon an evaluative study of an community safety intervention in the south-west Dublin suburb of Tallaght. Characteristic of the Irish context for crime prevention and community safety has been the ad hoc nature of policy formation and the underdeveloped structures for urban security. The case is based primarily upon qualitative data from interviews and focus groups with key stakeholders, together with some additional observations from a household survey. The key themes centre on the way safety manifests from issues related to social integration in the pilot communities; the impact, capacity and potential of the local authority as an agent for urban security; the creative tension between evidence-based approaches and practical problem-solving; and the role of community safety workers’ local knowledge and autonomous action within the local authority structures.