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Creating community health worker jobs in the public sector is a prominent goal in the global health development industry. According to industry leaders, Ethiopia's government has created community health worker jobs at a scale and in a way that other countries can look to as a model. Based on extensive document review and interviews with district, national, and international health officials, we show that narratives about saving lives, empowering women, and creating model citizens in a context of resource scarcity allow Ethiopia's ruling party to obtain international admiration for creating salaried community health worker jobs and to simultaneously avoid criticisms of its concurrent use of unpaid women's community health labor. Public sector community health worker investments in the twenty-first century reveal the layered narratives inherent in global development practices that entangle states, international donors, NGOs, and citizens. [ABSTRACT FROM AUTHOR]

Background: Community development is a health promotion approach identified as having great potential to improve Indigenous health, because of its potential for extensive community participation. There has been no systematic examination of the extent of community participation in community development projects and little analysis of their effectiveness. This systematic review aims to identify the extent of community participation in community development projects implemented in Australian Indigenous communities, critically appraise the qualitative and quantitative methods used in their evaluation, and summarise their outcomes.Methods: Ten electronic peer-reviewed databases and two electronic grey literature databases were searched for relevant studies published between 1990 and 2015. The level of community participation and the methodological quality of the qualitative and quantitative components of the studies were assessed against standardised criteria.Results: Thirty one evaluation studies of community development projects were identified. Community participation varied between different phases of project development, generally high during project implementation, but low during the evaluation phase. For the majority of studies, methodological quality was low and the methods were poorly described. Although positive qualitative or quantitative outcomes were reported in all studies, only two studies reported statistically significant outcomes.Discussion: Partnerships between researchers, community members and service providers have great potential to improve methodological quality and community participation when research skills and community knowledge are integrated to design, implement and evaluate community development projects.Conclusion: The methodological quality of studies evaluating Australian Indigenous community development projects is currently too weak to confidently determine the cost-effectiveness of community development projects in improving the health and wellbeing of Indigenous Australians. Higher quality studies evaluating community development projects would strengthen the evidence base. [ABSTRACT FROM AUTHOR]

Background: Community health initiatives often do not provide enough supports for people with disabilities to fully participate in healthy, active living opportunities. The purpose of this study was to design an instrument that focused on integrating disability-related items into a multi-level survey tool that assessed healthy, active living initiatives.Methods: The development and testing of the Community Health Inclusion Index (CHII) involved four components: (a) literature review of studies that examined barriers and facilitators to healthy, active living; (b) focus groups with persons with disabilities and professionals living in geographically diverse settings; (c) expert panel to establish a final set of critical items; and (d) field testing the CHII in 164 sites across 15 communities in 5 states to assess the instrument's reliability.Results: Results from initial analysis of these data indicated that the CHII has good reliability. Depending on the subscale, Cronbach's alpha ranged from 0.700 to 0.965. The CHII's inter-rater agreement showed that 14 of the 15 venues for physical activity or healthy eating throughout a community had strong agreement (0.81 - 1.00), while one venue had substantial agreement (0.61 - 0.80).Conclusion: The CHII is the first instrument to operationalize community health inclusion into a comprehensive assessment tool that can be used by public health professionals and community coalitions to examine the critical supports needed for improving healthy, active living among people with disabilities. [ABSTRACT FROM AUTHOR]

Although their numbers have declined over the last 10 years, younger (teenage) parents are still one of the most disadvantaged client groups and have significantly poorer health outcomes for both themselves and their children. This article describes the author's creation of a Health Visiting practice pathway for this specific client group. The pathway was planned to promote a standardisation of service from all the health visiting teams across the Humber Foundation Trust area, aiming towards equity of service for all clients in this group. This is particularly important in a Trust which has a very diverse client population covering approximately 930 square miles. The article explores young parents' health issues and summarises why we should invest health visitor resources in this small but very specific client group. As a result of the project work, challenges and opportunities for health visiting practice were identified. Recommendations for both current and future practice are discussed. [ABSTRACT FROM AUTHOR]

Information on a roundtable discussion on health-related issues in Great Britain in 2015 is presented. Issues discussed include the caseloads of health visitors, the need to motivate them and promote their well-being and the unequal distribution of caseloads amongst the team. The roundtable discussion featured several health professionals including Obi Amadi, Julie Millward and Christine Bidmead.

Background: An assessment of self-efficacy and social capital may have the potential to detect an effect of dynamic, complex and comprehensive collective actions in community-based health promotion. In 2003, a healthy village project was launched in Santa Cruz, Bolivia with technical assistance from the Japan International Cooperation Agency (JICA). The originally developed FORSA (Fortalecimiento de Redes de Salud) model accounted for participatory processes in which people could improve their health and well-being through individual behavioral changes and family/community-driven activities. This study aimed to examine the extent of self-efficacy and social capital obtained via project activities by a cross-sectional analysis. Methods: We randomly selected 340 subjects from the healthy village project site and 113 subjects from a control area. Both groups were interviewed using the same structured questionnaire. Self-efficacy was assessed with a General Self-Efficacy Scale (GSES), while social capital was measured as the frequency of formal group participation in community meetings during the past three months, perceived social solidarity, and general trust. Results: The study results showed that the participants in the project site had higher self-efficacy and social capital compared to those in the control site. The number of times a subject participated in the health committee activities was positively associated with the self-efficacy scale. Regarding social capital, females and lower-educated people were more likely to have had more frequent participation in formal groups; males and higher-educated participants showed less formal group participation, but more generosity to contribute money for the community. The main perceived benefit of participation in formal group activities varied among individuals. Conclusion: The findings suggest that people in the healthy village project site have higher self-efficacy, especially those with active participation in the health committee activities. To recruit more participants in future healthy village projects, we should consider the gender and level of education, and match the perceived benefits of participants accordingly. [ABSTRACT FROM AUTHOR]

Background: Dissemination and implementation (D&I) research seeks to understand and overcome barriers to adoption of behavioral interventions that address complex problems, specifically interventions that arise from multiple interacting influences crossing socio-ecological levels. It is often difficult for research to accurately represent and address the complexities of the real world, and traditional methodological approaches are generally inadequate for this task. Systems science methods, expressly designed to study complex systems, can be effectively employed for an improved understanding about dissemination and implementation of evidence-based interventions. Purpose: The aims of this study were to understand the complex factors influencing successful D&I of programs in community settings and to identify D&I challenges imposed by system complexity. Method: Case examples of three systems science methods-system dynamics modeling, agent-based modeling, and network analysis-are used to illustrate how each method can be used to address D&I challenges. Results: The case studies feature relevant behavioral topical areas: chronic disease prevention, community violence prevention, and educational intervention. To emphasize consistency with D&I priorities, the discussion of the value of each method is framed around the elements of the established Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework. Conclusion: Systems science methods can help researchers, public health decision makers, and program implementers to understand the complex factors influencing successful D&I of programs in community settings and to identify D&I challenges imposed by system complexity. [ABSTRACT FROM AUTHOR]

Purpose: China has experienced a rapid increase in cardiovascular diseases and related chronic conditions over the last 20 years, and there is now an urgent need for new approaches that can effectively reduce the progression of cardiovascular disease in high-risk individuals. This article reports on the evaluation of the implementation of the Dutch-China Cardiovascular Prevention Program. Methods: A screening questionnaire, based on the Dutch concept of Prevention- Consultation, was distributed among inhabitants in seven communities in Anhui Province, China. This tool categorizes individuals into being at low or high risk according to their responses to a number of self-administered questions. The 'high-risk' individuals were then invited to undergo further clinical and laboratory tests, before being offered lifestyle education and counseling. The program is delivered by primary care professionals from local community health service centers (CHSCs). An evaluation of the program's implementation was undertaken with both program participants and CHSC staff. Results: The screening questionnaire was completed by 9067 participants in seven demonstration communities. Thirty percent of these individuals were categorized as high risk according to their scores. About one third of these individuals returned for further clinical and laboratory tests. Almost half of those re-screened participated in lifestyle education classes. Program participants and community health staff provided mostly positive feedback about the program. Conclusions: While the program proved acceptable and feasible for delivery by CHSCs and by program participants, additional strategies are required to improve future uptake of both screening and subsequent lifestyle education by those at high risk. [ABSTRACT FROM AUTHOR]

Despite a large number of evidence-based health communication interventions tested in private, public, and community health settings, there is a dearth of research on successful secondary dissemination of these interventions to other audiences. This article presents the case study of “1-2-3 Pap,” a health communication intervention to improve human papillomavirus (HPV) vaccination uptake and Pap testing outcomes in Eastern Kentucky, and explores strategies used to disseminate this intervention to other populations in Kentucky, North Carolina, and West Virginia. Through this dissemination project, we identified several health communication intervention design considerations that facilitated our successful dissemination to these other audiences; these intervention design considerations include (a) developing strategies for reaching other potential audiences, (b) identifying intervention message adaptations that might be needed, and (c) determining the most appropriate means or channels by which to reach these potential future audiences. Using “1-2-3 Pap” as an illustrative case study, we describe how careful planning and partnership development early in the intervention development process can improve the potential success of enhancing the reach and effectiveness of an intervention to other audiences beyond the audience for whom the intervention messages were originally designed. [ABSTRACT FROM AUTHOR]

Aims and objectives To compare nurses' caring expectations with their caregiving experiences and to identify factors that could potentially be included in a preliminary conceptual model of job satisfaction and compassion fatigue. Background Nurses often report emotional reward and satisfaction in their profession from compassionately caring for sick and injured patients. However, being in close proximity to trauma can eventually deplete a nurse's compassion and empathy for the patients they care for. This loss of compassion is further exacerbated by demanding work environments that involve administrative duties, attending to patients' psychosocial needs and interacting with patients' families. To date, the literature has tended to focus on pathology of compassion fatigue, rather than identifying its contributing factors. Design A grounded theory approach was used to identify emerging themes in nurses' accounts of their caregiving roles. Methods Open-ended interviews were conducted with nurses ( n = 9) who were employed by a maritime district health authority for a minimum of five years. Interviews focused on beliefs of how to provide care, perceived caregiving responsibilities and perceived challenges in the provision of care. Results Emerging from the data is a proposed model of job satisfaction. The concepts of monitoring and patient advocacy appeared to be key components in reported satisfaction or alienation. Discrepancies were found between care expectations outlined by management and nurses' perceptions of care provision. Additionally, type of nursing education was related to nurses' confidence in applying nursing skills. Conclusions These findings have implications for training programmes, hospital management and quality of patient care. Relevance to clinical practice It is important to identify factors that could explain resilience to compassion fatigue because compassion fatigue has negative consequences not only for nurses themselves but for the patients in their care. [ABSTRACT FROM AUTHOR]

Introduction: A workplace orientation program is a core requirement of the National Safety and Quality Health Service (NSQHS) Standards in Australia. This is particularly important within healthcare as patient safety and the patient experience are at risk if the healthcare workforce is not supported with an effective orientation and induction program. Aim: This study aimed to review the literature and map the requirements of the NSQHS Standards in relation to orientation and induction. Method: This study utilised online databases to search for literature pertaining to orientation and induction within healthcare. Inclusion criteria included relevance to research questions, and originating in a country with a comparative health system to Australia. Results: The search identified a total of 202 articles of potential relevance with 42 articles meeting the inclusion criteria. Articles were ranked according to hierarchy of evidence criteria for both qualitative and quantitative studies. The importance of using orientation to detail safety and quality roles, the organisations' risk management system, governance structure, operational processes and procedures was highlighted. Patient-centred care, antimicrobial stewardship, clinical handover and mechanisms for escalation of care and emergency assistance should also be covered within the orientation process. Conclusion: There is a dearth of studies in relation to orientation and induction in the healthcare literature. Orientation content is now clearly prescribed, what is lacking within healthcare is a standardised framework. Concept mapping, educational theory and adult learning methods have been shown to enhance workforce problem solving and engagement with orientation, however further research is needed to enhance practice. [ABSTRACT FROM AUTHOR]

Background Deprived children constitute a large population with high levels of ill health, and difficulty with access to healthcare contributes to their poor health outcomes. There is debate on how best to engage deprived families and the literature on differential access to paediatric care based on deprivation is limited. Aims To demonstrate that community paediatrics can contribute to reduction of health inequalities by providing services that are accessible to and preferentially used by children whose health is likely to be affected by deprivation., To provide a template for others to improve and monitor equity in their services., Method Long-term service reconfiguration and health equity audit. We used routinely collected activity data and the Indices of Multiple Deprivation to construct equity profiles of the children using our service, and compared these with the profile of the population aged 0-16 years in the geographical area covered by the service. Results The new patient contact rate for the most deprived children in the population was more than three times that of the least deprived [odds ratio ( OR) 3.29, 95% confidence interval ( CI) 2.76-3.93]. Deprived children were more than twice as likely to require multi-agency meetings as part of their medical care ( OR 2.28, 95% CI 1.94-2.69). Seventy per cent (3693/5312) of our total contacts were with children in the two most deprived quintiles. There was a marked socio-economic gradient in all types of contact. Conclusions The model of care used by our community paediatric service successfully engages deprived families, thereby reducing health inequalities due to poor access. Key features are multi-agency working, removing barriers to access, raising staff awareness and use of health equity audit. Our findings provide support for tackling health inequalities via health services that are available to all, but capable of responding proportionately according to level of need, a model recently described as proportionate universalism. [ABSTRACT FROM AUTHOR]

Community-based organizations (CBOs) serving persons living with HIV or AIDS face the challenge of an aging population with more chronic diseases. This study assessed cancer programming needs of AIDS service organizations (ASOs) in New York, New Jersey, and Connecticut by conducting a community needs assessment. Sixty (58%) of 103 organizations completed the survey. ASOs conduct activities most related to early steps along the cancer care continuum, but they also express great interest in expanding cancer-focused programming into new areas. ASOs have resources or capacities in assisting HIV+ clients with mental health or substance abuse problems, but there exists a need for funding in undertaking or expanding cancer-focused programs. ASOs are receptive to collaborating with researchers on disseminating cancer prevention and control knowledge in their settings. Community-academic research partnerships enable resonant training and technical assistance methods to be explored that will enhance the abilities of ASOs to bring cancer-related programming to their clients. [ABSTRACT FROM AUTHOR]

Nursing faculty are confronted with the need to design community learning activities with vulnerable populations to prepare students for nursing practice. The creation of sustainable academic-community partnerships with agencies providing care to underserved populations meets this challenge. This article describes the development and implementation of a foot care clinic in a homeless shelter, created through a model of curricular integration, faculty engagement, and a long-term academic-community partnership. A transformative pedagogical approach based on service-learning was used to facilitate student understanding of social justice through activities that promote citizenship, develop advocacy skills, and increase knowledge and skills related to the role of the public health nurse in the community. The process of designing and developing a community clinical learning activity and the essential components for sustainability are discussed. Student outcomes are addressed. Recommendations for implementing a foot care clinic within an academic-community partnership are outlined. [ABSTRACT FROM AUTHOR]

The introduction of social enterprises into healthcare has brought about opportunities and challenges for providers and clinicians. Dudley Lymphoedema Service, a team originally of five staff members, has undergone radical changes. The team has successfully gone through the Department of Health's right to request programme to move from a primary care trust service to become a social enterprise, LymphCare UK, which is a community interest company. There are only approximately 40 NHS services throughout the country that have taken this option as part of government changes and plans to put clinicians at the helm of services. Becoming a social enterprise has led to the service becoming bespoke, more responsive, flexible and innovative. Stepping out of the NHS has not been an easy journey but is one that the team is confident will improve outcomes for the organisation and the patients it serves. INSETS: Box 1. LymphCare UK mission statement;Box 3. Patient satisfaction survey comments. [ABSTRACT FROM AUTHOR]

This article identifies key trends over the last 20 years in residential and community care for older people in England, Finland and Australia, investigating the extent of ‘de-institutionalisation’, ‘privatisation’ and ‘individualisation’. The concepts of collective and individual ‘voice’ and ‘choice’ are used to interrogate the roles of collective and individual actors, older people and carers, in influencing policy formulation. While these three processes have been pursued by policy-makers in each country, their implementation is illuminated by understanding how ‘voice’ and ‘choice’ have been operationalised – individually and collectively – in each context. In the reshaping of eldercare in the three states, the analysis identifies the greater influence of claims-making by family carers, who provide the informal bastion of formal care services in the push to de-institutionalisation, in comparison with the collective and individual voices of older people as ‘service users’. [ABSTRACT FROM PUBLISHER]

Participatory implementation in three community health programs is examined using a 17 point assessment tool organized within a participatory framework made up of three conceptual elements: stakeholder participation in the program, cultural and structural relationships, and partnership synergy. The study results suggest that horizontal cultural relationships between frontline program implementers and beneficiaries, could lead to beneficiary satisfaction and empowerment even when structural relationships are vertical and beneficiary participation is not as robust as in complete participatory programs. The study's findings also suggest that partnership synergy can affect the success of program implementation and the growth of community social capital. [ABSTRACT FROM AUTHOR]

For many decades, early access to prenatal care has been considered the gold standard for improving birth outcomes. In Contra Costa County, a diverse urban and suburban county of over one million people in the San Francisco Bay Area, the Family Maternal and Child Health Programs of Contra Costa Health Services (CCHS) have seen high rates of early entry into prenatal care since 2000. Yet despite our best efforts to increase access to quality prenatal care, our rates of low birth weight and infant mortality, especially among African Americans, continue to be high. When we were introduced to the Life Course Perspective in 2003 as an organizational framework for our programmatic activities, we recognized that emerging scientific evidence in the literature demonstrated the importance of social and environmental factors in determining health and health equity, and supported a general impression in the field that prenatal care was not enough to improve birth outcomes. The Life Course Perspective suggests that many of the risk and protective factors that influence health and wellbeing across the lifespan also play an important role in birth outcomes and in health and quality of life beyond the initial years. In this article, we describe the Life Course Perspective and how one local Maternal and Child Health Program adopted and adapted this paradigm by creating and launching a Life Course Initiative to guide our programs and services. The Life Course Initiative implemented by CCHS is designed to reduce inequities in birth outcomes, improve reproductive potential, and change the health of future generations by introducing a longitudinal, integrated, and ecological approach to implementing maternal and child health programs. [ABSTRACT FROM AUTHOR]

Background: Seniors frequently struggle during the transition home following an acute hospitalization resulting in frequent rehospitalizations. Studies consistently show a lack of comprehension of discharge instructions.Objectives: To determine the frequency of low cognition at hospital discharge among community dwelling seniors and the changes in cognition that occur one month following hospitalization.Design: Face-to-face surveys were performed at hospital discharge and one month later in the home of the subject. The Mini-Mental Status Examination (MMSE), Backward Digit Span, and 15 Word Immediate and Delayed Recall Tests were used to evaluate cognition. Low cognition was determined to be a score of less than 25 on the MMSE for subjects with high school education and less than 18 for subjects with less than high school education.Participants: Two hundred community-dwelling seniors ≥ 70 years, admitted to acute medicine services >24 hours, consenting to their own procedures, not having previously documented cognitive loss, and not admitted for cognitive changes.Results: Upon hospital discharge, 31.5% of subjects had previously unrecognized low cognition. One month later, 58% of these patients no longer had low cognition (p < 0.001). Of those subjects with low cognition, the MMSE improved by an average of 4 points one month post-discharge. Within the MMSE, subjects experienced significant improvements in the areas of orientation, registration, repetition, comprehension, naming, reading, writing, and calculation.Conclusion: Low cognition at discharge is common among elderly patients without dementia, and cognition often improves one month post-hospitalization. Seniors may not comprehend discharge instructions, and patient self-management may be better taught as an outpatient following discharge rather than at the time of hospital discharge. Discharge interventions should incorporate screening of seniors for low cognition prior to hospital discharge to provide optimal transitional care. [ABSTRACT FROM AUTHOR]

Objectives. We sought to determine whether a community-based initiative designed to reduce cancer disparities among Pacific Islanders in Southern California increased communications between community-based organizations and university researchers. Methods. We conducted network analysis among 11 community-based organizations (CBOs) and 5 universities by interviewing 91 and 56 members of these organizations, respectively, at 2 points in time. We estimated random effects probit regression and stochastic actor-oriented network dynamic models. Results. We found that, during the 2-year study period, CBOs increased their connectedness with one another (b=0.44; P<.05) and to the universities (b=0.46; P<.05), but that university researchers did not increase their connectedness to each other or to CBOs. Conclusions. Cancer awareness, cancer education, and access to cancer services are low among Pacific Island groups, and this study provides an initial attempt to reduce these disparities. Community-based initiatives can strengthen a CBO network, creating the potential for increased community-informed cancer research and improved community access to cancer research resources. [ABSTRACT FROM AUTHOR]

Background: The India AIDS Initiative (Avahan) project is involved in rapid scale-up of HIV-prevention interventions in high-risk populations. This study examines the cost variation of 107 non-governmental organisations (NGOs) implementing targeted interventions, over the start up (defined as period from project inception until services to the key population commenced) and first 2 years of intervention.Methods: The Avahan interventions for female and male sex workers and their clients, in 62 districts of four southern states were costed for the financial years 2004/2005 and 2005/2006 using standard costing techniques. Data sources include financial and economic costs from the lead implementing partners (LPs) and subcontracted local implementing NGOs retrospectively and prospectively collected from a provider perspective. Ingredients and step-down allocation processes were used. Outcomes were measured using routinely collected project data. The average costs were estimated and a regression analysis carried out to explore causes of cost variation. Costs were calculated in US$ 2006.Results: The total number of registered people was 134,391 at the end of 2 years, and 124,669 had used STI services during that period. The median average cost of Avahan programme for this period was $76 per person registered with the project. Sixty-one per cent of the cost variation could be explained by scale (positive association), number of NGOs per district (negative), number of LPs in the state (negative) and project maturity (positive) (p<0.0001).Conclusions: During rapid scale-up in the initial phase of the Avahan programme, a significant reduction in average costs was observed. As full scale-up had not yet been achieved, the average cost at scale is yet to be realised and the extent of the impact of scale on costs yet to be captured. Scale effects are important to quantify for planning resource requirements of large-scale interventions. The average cost after 2 years is within the range of global scale-up costs estimates and other studies in India. [ABSTRACT FROM AUTHOR]

Background: Documentation of the long-term impact of supportive supervision using a monitoring tool in STI intervention with sex workers, men who have sex with men and injection-drug users is limited. The authors report methods and results of continued quality monitoring in a large-scale STI services provided as a part of a broader HIV-prevention package in six Indian states under Avahan, the India AIDS Initiative.Methodology: Guidelines and standards for STI services, and a supportive supervisory tool to monitor the quality were developed for providing technical support to STI component of large-scale HIV-prevention intervention through 372 project-supported STI clinics. The tool contained 80 questions to track the quality of STI services provided on a five-point scoring scale in five performance areas: coverage, quality of clinic and services, referral networks, community involvement and technical support.Results: The tool was applied to different STI clinics during supportive supervision visits conducted once in every 3 months to assess quality, give immediate feedback and develop a quality score. A total of 292 clinics managed by seven lead implementing partners in six Indian states were covered in 15 quarters over 45 months. Overall quality indicators for the five performance areas showed a three- to sevenfold improvement over the period.Conclusion: It was possible to improve quality over the long-term in STI interventions for sex workers, men who have sex with men and injection-drug users using an interactive and comprehensive supportive supervision tool which gives on-the-spot feedback. However, such an effort is time-consuming and resource-intensive, and needs a structured approach. [ABSTRACT FROM AUTHOR]

Recent contributions to the policy implementation literature have applied Kingdon's model of ‘policy windows’ to the implementation of policy on health inequalities in the UK, and have identified the key role played by ‘policy entrepreneurs’ at local as well as national level. Despite this, the picture that emerges is of frustration of central policy intentions at the local level, alongside frustration of local aspirations by the centre. This article explores the relationship between central policy and local implementation in the context of a Lottery-funded initiative to develop community cancer care in the UK. We examine the relationships: between the BIG Lottery Fund and central government; between BIG and the cancer care projects it funded; and between the projects and their local economy of cancer care. We found evidence of success both in vertical cascading of policy and in local policy innovation; 83 per cent of projects succeeded in obtaining continuation funding at the end of their Lottery funding. We suggest that this was due, in part, to two features of Lottery funding and accountability that combined to differentiate it from the other policy initiatives studied. They meant that projects were ‘buffered’ not just from national policy churn, but also from competing local priorities. In the ‘protected space’ that was thus formed, ‘street-level policy entrepreneurs’ played a key role in developing cancer care innovations for adoption by mainstream funding agencies. [ABSTRACT FROM AUTHOR]

Chronic pain is a colossal health care problem that is devastating to the individual afflicted with unremitting pain and frustrating to the beleaguered health care provider attempting to adequately manage this multifaceted disease. The biopsychosocial model of pain management is a promising approach that emphasizes evidence-based medication management in conjunction with cognitive-behavioral therapy and a graded exercise program. The patient with chronic pain and concomitant mood and/or substance use disorders is exceptionally challenging. Effective pharmacologic management of pain and comorbid mood disorders, including the thoughtful use of opioids, can have a dramatic effect in improving the quality of life in patients with chronic pain. The high prevalence of chronic pain in our society and the scarcity of experienced pain medicine physicians necessitate the development of a community-based systems approach to this complex patient population. [ABSTRACT FROM AUTHOR]

Background: Concern Worldwide is an international humanitarian nongovernmental organization that piloted and is now implementing and researching community-based therapeutic care (CTC) approaches to managing acute malnutrition. Experience in several countries suggests that there are key issues to be addressed at the international, national, regional, and community levels for community-based treatment of acute malnutrition to be sustainable.National Level: At the national level there must be demonstrated commitment to a clear health policy and strategy to address outpatient treatment of acute malnutrition. In addition, locally available, affordable ready-to-use therapeutic food (RUTF) must be accessible.Regional Level: At the regional level a functional health system and appropriate capacity for service provision are required. Integration of outpatient services should be viewed as a process with different levels of inputs at different phases depending on the capacity of the Ministry of Health (MOH). There is a need for indicators to facilitate scale-up and scale-back for future emergency response.Community Level: Strong community participation and active screening linked to health service provision at the local level is paramount for sustainable assessment and referral of severe acute malnutrition. FUTURE CHALLENGES TO SUSTAIN COMMUNITY-BASED THERAPEUTIC CARE. Key challenges to the sustainable treatment of severe acute malnutrition include the development of locally produced RUTF, development of international standards on local RUTF production, the integration of outpatient treatment protocols into international health and nutrition guidelines, and further operational research into integration of community-based treatment of severe acute malnutrition into health systems in nonemergency contexts. [ABSTRACT FROM AUTHOR]

Community is a key construct in population health research and a major locus of health determinants study. In recent years in Canada, a new emphasis on such research has emerged in the form of community–university partnerships, supported by several of the major research granting agencies. The authors regard such partnerships as a special case of participatory action research (PAR), albeit one where greater emphasis is placed on the institutional nature of the university research partner. Drawing from the first three years’ experience of a local quality of life study, and the extant North American literature on community–university partnerships, this article explores how such partnerships are established and sustained. These processes are illustrated with critical reflections on some of the methods, actions and relational issues that arose during the authors’ quality of life project. The article concludes with a brief reflection on the potential benefits and costs of the growing Canadian trend to require such partnerships as a condition for research grants. [ABSTRACT FROM AUTHOR]

Little is published about step-by-step implementation of telephone counseling interventions to promote community-based health activities. This article describes the authors' experience of implementing a church-based telephone mammography counseling intervention with peer counselors representing three principal racial or ethnic groups: African American, Latino, and Anglo (White). Twenty-six women from 12 churches in the Los Angeles area were recruited and trained to deliver the counseling annually over a two-year period to 570 women participants who were recruited from participating churches (n = 15). The counseling sessions were conducted from church-based telephone centers in key geographic locations in our program area. Training and supervision proved challenging: most of the Latino counselors had fewer than seven years of education and spoke only Spanish, while most of the other counselors had at least some college and spoke only English. Culturally specific and small group interactions, role plays, and a more modular approach to training were the most effective ways to enhance counselors' skills. Latina participants' mammography adherence rates were lowest, and their barriers reflected their low socioeconomic status; as Latina counselors shared basic information about mammograms and where to obtain them at little or no cost, the counseling exchanges tended to be nonconflictive and supportive. Black and White participants were generally more knowledgeable and adherent with screening guidelines than Latinas. We found that it was possible to implement this intervention with diverse groups and conclude with lessons learned that may inform others considering such a strategy. [ABSTRACT FROM AUTHOR]

Objectives: Childhood asthma is a growing public health concern in low-income urban communities. Indoor exposure to asthma triggers has emerged as an important cause of asthma exacerbations. We describe indoor environmental conditions related to asthma triggers among a low-income urban population in Seattle/King County, Washington, as well as caregiver knowledge and resources related to control of these triggers.Methods: Data are obtained from in-person, structured, closed-end interviews with the caretakers of children aged 4-12 years with persistent asthma living in households with incomes less than 200% of poverty. Additional information is collected during a home inspection. The children and their caregivers are participants in the ongoing Seattle-King County Healthy Homes Project, a randomized controlled trial of an intervention to empower low-income families to reduce exposure to indoor asthma triggers. We report findings on the conditions of the homes prior to this intervention among the first 112 enrolled households.Results: A smoker was present in 37.5% of homes. Mold was visible in 26.8% of homes, water damage was present in 18.6% of homes, and damp conditions occurred in 64.8% of households, while 39.6% of caregivers were aware that excessive moisture can increase exposures to allergens. Dust-trapping reservoirs were common; 76.8% of children's bedrooms had carpeting. Cockroach infestation in the past 3 months was reported by 23.4% of caregivers, while 57.1% were unaware of the association of roaches and asthma. Only 19.8% of the children had allergy-control mattress covers.Conclusions: Many low-income urban children with asthma in King County live in indoor environments that place them at substantial risk of ongoing exposure to asthma triggers. Substandard housing and lack of resources often underlie these exposures. Initiatives involving health educators, outreach workers, medical providers, health care insurers, housing agencies, and elected officials are needed to reduce these exposures. [ABSTRACT FROM AUTHOR]

The article focuses on the effectiveness of community coalitions for prevention and health promotion. The concept of coalitions has evolved in the social sciences over the past three decades. In recent years, there is an increase in the development of coalitions of community agencies, institutions and concerned citizens to combat chronic health conditions. The U.S. Center for Substance Abuse Prevention, for instance, has funded over 250 community partnerships throughout the U.S. to reduce morbidity and mortality caused by alcohol and other drugs. Some of the benefits of coalitions explored here are that: coalitions can maximize the power of individuals and groups through joint action; they can minimize duplication of effort and services; and they can help mobilize more talents, resources and approaches to influence an issue than any single organization could achieve alone.

This article cites a study of leadership and team effectiveness in community coalitions for the prevention of alcohol and other drug (AOD) abuse. During the study, it was hypothesized that leadership style, member satisfaction and team self-efficacy influence team effectiveness. A total of 65 team members from ten teams were included in this study. These subjects were actively involved in one of ten teams charged with planning and establishing AOD abuse prevention programs. Based on this study, a model of coalition team effectiveness is developed here, which proposes that the leader's characteristics are critical to positive team outcomes. The style of leadership proposed to be most related to team efficacy in the first phases of coalition implementation and planning is an empowering style of leadership.

The article focuses on the development and operation of the Minnesota Statewide Association for Family Planning (SAFPLAN), a coalition of organizations and individuals that is aimed to address the problem of inadequate state-subsidized family planning funds. The SAFPLAN was established in 1990 when there was an steady need for subsidized family planning services in Minnesota. It is one of a number of statewide coalitions that have developed around family planning issues. The purpose of this article is to explore the key issues of recruitment of organizational members of such a coalition and establishing an effective division of labor among those members. For this purpose, data from the study of the SAFPLAN is used. Systematic data were collected on SAFPLAN through 31 in-person structured interviews of representatives of SAFPLAN member organizations and individuals.

This study examines the changing role of the trustee in public community hospitals as perceived by primary organizational participants. Results indicate that a growing concern by consumers of health care products and services and court decisions have produced a growth in responsibility for the trustee in hospital governance. Implications for future research are discussed. [ABSTRACT FROM AUTHOR]

This article focuses on the need for building community capacity to promote social and public health in the U.S., with identifying the challenges being faced by universities in this regard. To become sensitive and tactful participants in the community capacity-building movement, students, suggestively, must learn to perform several internal support functions in community action structures. A suggested solution to overcome the challenges of social and public health programs is to establish community capacity-building institutes. Many state agencies in health and social services are searching for ways to redirect staff and other agency resources to community development. The author suggests that universities can partner with these agencies by forming joint institutes that would: train agency staff to form and sustain community action structures; train students from relevant disciplines to provide support services to staff and lay leaders involved in community development; transfer theoretical knowledge and applied research to communities; and monitor and evaluate community health outcomes.

Background: Methods for translating evidence-based behavioral interventions into real-world settings seldom account for the special issues in reaching health disparity populations.Main Text: The objective of this article is to describe an innovative "transcreational" framework for designing and delivering interventions in communities to reduce health disparities. We define transcreation as the process of planning, delivering, and evaluating interventions so that they resonate with the community experiencing health disparities, while achieving intended health outcomes. The Transcreation Framework for Community-engaged Behavioral Interventions to Reduce Health Disparities comprises seven steps: 1) identify community infrastructure and engage partners; 2) specify theory; 3) identify multiple inputs for new program; 4) design intervention prototype; 5) design study, methods, and measures for community setting; 6) build community capacity for delivery; and 7) deliver transcreated intervention and evaluate implementation processes. Communities are engaged from the start and interventions are delivered by community-based interventionists and tested in community settings. The framework applies rigorous scientific methods for evaluating program effectiveness and implementation processes. It incorporates training and ongoing technical assistance to assure treatment fidelity and build community capacity.Conclusions: This framework expands the types of scientific evidence used and balances fidelity to evidence and fit to the community setting. It can guide researchers and communities in developing and testing behavioral interventions to reduce health disparities that are likely to be sustained because infrastructure development is embedded in the research. [ABSTRACT FROM AUTHOR]

Background: Information communication technology (ICT) is a critical enabler of integrated models of community-based primary health care; however, little is known about how existing technologies have been used to support new models of integrated care. To address this gap, we draw on data from an international study of integrated models, exploring how ICT is used to support activities of integrated care and the organizational and environmental barriers and enablers to its adoption.Methods: We take an embedded comparative multiple-case study approach using data from a study of implementation of nine models of integrated community-based primary health care, the Implementing Integrated Care for Older Adults with Complex Health Needs (iCOACH) study. Six cases from Canada, three each in Ontario and Quebec, and three in New Zealand, were studied. As part of the case studies, interviews were conducted with managers and front-line health care providers from February 2015 to March 2017. A qualitative descriptive approach was used to code data from 137 interviews and generate word tables to guide analysis.Results: Despite different models and contexts, we found strikingly similar accounts of the types of activities supported through ICT systems in each of the cases. ICT systems were used most frequently to support activities like care coordination by inter-professional teams through information sharing. However, providers were limited in their ability to efficiently share patient data due to data access issues across organizational and professional boundaries and due to system functionality limitations, such as a lack of interoperability.Conclusions: Even in innovative models of care, managers and providers in our cases mainly use technology to enable traditional ways of working. Technology limitations prevent more innovative uses of technology that could support disruption necessary to improve care delivery. We argue the barriers to more innovative use of technology are linked to three factors: (1) information access barriers, (2) limited functionality of available technology, and (3) organizational and provider inertia. [ABSTRACT FROM AUTHOR]

Background: Severe acute malnutrition (SAM) in children is the most serious form of malnutrition and is associated with very high rates of morbidity and mortality. For sustainable SAM management, United Nations recommends integration of community based management of acute malnutrition (CMAM) into the health system. The objective of the study was to assess the preparedness of the health system to implement CMAM in Bangladesh.Methods: The assessment was undertaken during January to May 2014 by conducting document review, key informant interviews, and direct observation. A total of 38 key informant interviews were conducted among government policy makers and program managers (n = 4), nutrition experts (n = 2), health and nutrition implementing partners (n = 2), development partner (n = 1), government health system staff (n = 5), government front line field workers (n = 22), and community members (n = 2). The assessment was based on: workforce, service delivery, financing, governance, information system, medical supplies, and the broad socio-political context.Results: The government of Bangladesh has developed inpatient and outpatient guidelines for the management of SAM. There are cadres of community health workers of government and non-government actors who can be adequately trained to conduct CMAM. Inpatient management of SAM is available in 288 facilities across the country. However, only 2.7% doctors and 3.3% auxiliary staff are trained on facility based management of SAM. In functional facilities, uninterrupted supply of medicines and therapeutic diet are not available. There is resistance and disagreement among nutrition stakeholders regarding import or local production of ready-to-use therapeutic food (RUTF). Nutrition coordination is fragile and there is no functional supra-ministerial coordination platform for multi-sectoral and multi-stakeholder nutrition.Conclusion: There is an enabling environment for CMAM intervention in Bangladesh although health system strengthening is needed considering the barriers that have been identified. Training of facility based health staff, government community workers, and ensuring uninterrupted supply of medicines and logistics to the functional facilities should be the immediate priorities. Availability of ready-to-use therapeutic food (RUTF) is a critical component of CMAM and government should promote in-country production of RUTF for effective integration of CMAM into the health system in Bangladesh. [ABSTRACT FROM AUTHOR]

Background: The provision of high-quality maternity services is a priority for reducing inequalities in health outcomes for mothers and infants. Best practice includes women having their initial antenatal appointment within the first trimester of pregnancy in order to provide screening and support for healthy lifestyles, well-being and self-care in pregnancy. Previous research has identified inequalities in access to antenatal care, yet there is little evidence on interventions to improve early initiation of antenatal care. The Community REACH trial will assess the effectiveness and cost-effectiveness of engaging communities in the co-production and delivery of an intervention that addresses this issue.Methods/design: The study design is a matched cluster randomised controlled trial with integrated process and economic evaluations. The unit of randomisation is electoral ward. The intervention will be delivered in 10 wards; 10 comparator wards will have normal practice. The primary outcome is the proportion of pregnant women attending their antenatal booking appointment by the 12th completed week of pregnancy. This and a number of secondary outcomes will be assessed for cohorts of women (n = approximately 1450 per arm) who give birth 2-7 and 8-13 months after intervention delivery completion in the included wards, using routinely collected maternity data. Eight hospitals commissioned to provide maternity services in six NHS trusts in north and east London and Essex have been recruited to the study. These trusts will provide anonymised routine data for randomisation and outcomes analysis. The process evaluation will examine intervention implementation, acceptability, reach and possible causal pathways. The economic evaluation will use a cost-consequences analysis and decision model to evaluate the intervention. Targeted community engagement in the research process was a priority.Discussion: Community REACH aims to increase early initiation of antenatal care using an intervention that is co-produced and delivered by local communities. This pragmatic cluster randomised controlled trial, with integrated process and economic evaluation, aims to rigorously assess the effectiveness of this public health intervention, which is particularly complex due to the required combination of standardisation with local flexibility. It will also answer questions about scalability and generalisability.Trial Registration: ISRCTN registry: registration number 63066975 . Registered on 18 August 2015. [ABSTRACT FROM AUTHOR]

Background: The New South Wales (NSW) HIV Strategy 2016-2020 aims for the virtual elimination of HIV transmission in NSW, Australia, by 2020. Despite high and increasing levels of HIV testing and treatment since 2012, the annual number of HIV diagnoses in NSW has remained generally unchanged. Pre-exposure prophylaxis (PrEP) is highly effective in preventing HIV infection among gay and bisexual men (GBM) when taken appropriately. However, there have been no population-level studies that evaluate the impact of rapid PrEP scale-up in high-risk GBM. Expanded PrEP Implementation in Communities in NSW (EPIC-NSW) is a population-level evaluation of the rapid, targeted roll-out of PrEP to high-risk individuals.Methods: EPIC-NSW, is an open-label, single-arm, multi-centre prospective observational study of PrEP implementation and impact. Over 20 public and private clinics across urban and regional areas in NSW have participated in the rapid roll-out of PrEP, supported by strong community mobilization and PrEP promotion. The study began on 1 March 2016, aiming to enroll at least 3700 HIV negative people at high risk of HIV. This estimate took into consideration criteria for PrEP prescription in people at high risk for acquiring HIV as defined in the NSW PrEP guidelines. Study participants receive once daily co-formulated tenofovir disoproxil fumarate and emtricitabine (TDF/FTC) and are followed for up to 24 months. Follow-up includes: testing for HIV at 1 month, HIV and other sexually transmissible infections three-monthly, HCV annually and monitoring of renal function six-monthly. Optional online behavioural surveys are conducted quarterly. The co-primary endpoints are (i) HIV diagnoses and incidence in the cohort and (ii) HIV diagnoses in NSW.Discussion: EPIC-NSW is a population-based PrEP implementation trial which targets the entire estimated population of GBM at high risk for HIV infection in NSW. It will provide a unique opportunity to evaluate the population impact of PrEP on a concentrated HIV epidemic.Trial Registration: https://clinicaltrials.gov/ (identifying number NCT02870790 ; registration date 14 August 2016), pre-results stage. [ABSTRACT FROM AUTHOR]

A response from the author of the article about anticipatory care of older patients in the December 2013 issue is presented.

The article focuses on the concerns of Unite and Unite/Community Practitioners and Health Visitors Association (CPHVA) regarding the changes made by the British government in the Health and Social Care Bill and its impact on the rest of the European countries. It states that the changes will affect the fragmentation of the health services. It mentions that despite the concern of privatisation relates England, other countries including Scotland, Northern Ireland, and Scotland will be affected.