Citizen deliberation in setting health-care priorities.

BACKGROUND: Citizen deliberation is a prominent theme in health policy literature. It is believed that citizens who deliberate may influence the setting of public health-care priorities. Currently, in some jurisdictions, citizens are members of community health boards, and thus have a forum to articulate and share values that could affect the reduction of health inequalities within their communities. However, there is little conceptual clarity on the character of citizen deliberation, or, more specifically, how citizens may articulate and share values. OBJECTIVES: This paper reviews the literature on citizen deliberation in setting health-care priorities; discusses potential challenges for citizens in setting health-care priorities; outlines a developing theory of citizen deliberation; describes how citizens may articulate and share values that ground their health-care priorities and outlines implications of a developing theory of citizen deliberation, its relevance to UK study findings, and to community health boards in setting health-care priorities. CONCLUSIONS: As members of community health boards, citizens can evaluate their subjective experiences. In reasoning about embedded values, citizens may gain insight into the kind of community they aspire to be, and, in that process, examine their intentions, including whether to serve self or other(s). Citizens who articulate and share values such as respect, generosity or equity may justify health-care priorities that create opportunities for all community members to gain mastery over their lives.     

Community action and reflective practice in health promotion research

While health promotion practitioners are engaging increasingly in research, there has been little examination of the practical dilemmas they may face in negotiating and collaborating with academics and community members in action research projects. This paper analyses how the practice of health promotion can interact with action research, and considers issues that arise for organizationally based health promotion practitioners and professional researchers. The first section charts types of action research along three dimensions (power, goals/values, resources). The second section examines some of the issues and practical dilemmas which arise in negotiating and researching collaborative projects in community health promotion. The discussion includes the differing perspectives of: practitioners (managerial and frontline), community members and academic researchers. The final section outlines a hybrid model of action research, developed in our work with community members, organizationally based health promoters and academy-based researchers. It combines the reflective practice of practice-based action research with the community participation and control of participatory research. The model is called community reflective action research.     

Strengthening access to restorative places: findings from a participatory study on engaging with nature in the promotion of health

In this paper, we examine selected research findings from a community-based study on engaging with nature to promote health. Combining participatory photographic research methods with an iterative process of dialectical analysis, we explored nature-based health promotion with community citizens, practitioners, and decision-makers from various sectors to examine the complexities of connecting with natural outdoor places in local contexts. Participants identified an array of barriers to and opportunities for everyday access to restorative outdoor places. The findings suggest that inter-sectoral governance with active citizen engagement in research, decision-making, and action may be essential to develop the ecological citizenship and communal norms and strategies that promote the health of people and their shared restorative places.     

Health promotion: an ethical analysis

Thinking and practising ethically requires reasoning systematically about the right thing to do. Health promotion ethics – a form of applied ethics – includes analysis of health promotion practice and how this can be ethically justified. Existing frameworks can assist in such evaluation. These acknowledge the moral value of delivering benefits. But benefits need to be weighed against burdens, harms or wrongs, and these should be minimised: they include invading privacy, breaking confidentiality, restraining liberty, undermining self‐determination or people's own values, or perpetuating injustice. Thinking about the ethics of health promotion also means recognising health promotion as a normative ideal: a vision of the good society. This ideal society values health, sees citizens as active and includes them in decisions that affect them, and makes the state responsible for providing all of its citizens, no matter how advantaged or disadvantaged, with the conditions and resources they need to be healthy. Ethicists writing about health promotion have focused on this relationship between the citizen and the state. Comparing existing frameworks, theories and the expressed values of practitioners themselves, we can see common patterns. All oppose pursuing an instrumental, individualistic, health‐at‐all‐costs vision of health promotion. And all defend the moral significance of just processes: those that engage with citizens in a transparent, inclusive and open way. In recent years, some Australian governments have sought to delegitimise health promotion, defining it as extraneous to the role of the state. Good evidence is not enough to counter this trend, because it is founded in competing visions of a good society. For this reason, the most pressing agenda for health promotion ethics is to engage with communities, in a procedurally just way, about the role and responsibilities of the citizen and the state in promoting and maintaining good health.     

深圳市流塘社区老人健康状况调查分析及护理干预

目的了解深圳市宝安区流塘社区老年人群的健康状况,为社区老人的健康促进及护理干预提供指导。方法按10%抽样比采取双重抽样方法随机抽取371名60岁以上老年人进行上门问卷调查、健康档案查阅和血压测量。结果两周患病率为49.4%,女性组显著高于男性组（χ2=11.736,P〈0.001）,并随着年龄的增长而升高（χ2=52.087,P〈0.001）。慢性病患病率达73.5%。71.5%的老年人视力有不同程度下降,24.0%的老年人有不同程度的听力受损,其中中度以上受损达8.5%。有5.2%的老年人经常出现情绪低落或忧郁。结论老年人群慢性病患病率较高,随着年龄的增长,两周患病率逐渐升高,日常生活能力逐渐减退。应积极开展以加强慢性病防治、提供老年社区护理为主的社区卫生服务工作,以促进老年人的身心健康,提高社区老年人的生活质量。     

An integrative framework for community partnering to translate theory into effective health promotion strategy

INTRODUCTION: Although there is general agreement about the complex interplay among individual-, family-, organizational-, and community-level factors as they influence health outcomes, there is still a gap between health promotion research and practice. The authors suggest that a disjuncture exists between the multiple theories and models of health promotion and the practitioner's need for a more unified set of guidelines for comprehensive planning of programs. Therefore, we put forward in this paper an idea toward closing the gap between research and practice, a case for developing an overarching framework--with several health promotion models that could integrate existing theories--and applying it to comprehensive health promotion strategy. AN INTEGRATIVE FRAMEWORK: We outline a theoretical foundation for future health promotion research and practice that integrates four models: the social ecology; the Life Course Health Development; the Predisposing, Reinforcing, and Enabling Constructs in Educational/Environmental Diagnosis and Evaluation-Policy, Regulatory and Organizational Constructs in Educational and Environmental Development; and the community partnering models. The first three models are well developed and complementary. There is little consensus on the latter model, community partnering. However, we suggest that such a model is a vital part of an overall framework, and we present an approach to reconciling theoretical tensions among researchers and practitioners involved in community health promotion. INTEGRATING THE MODELS: THE NEED FOR SYSTEMS THEORY AND THINKING: Systems theory has been relatively ignored both by the health promotion field and, more generally, by the health services. We make a case for greater use of systems theory in the development of an overall framework, both to improve integration and to incorporate key concepts from the diverse systems literatures of other disciplines. VISION FOR HEALTHY COMMUNITIES: (1) Researchers and practitioners understand the complex interplay among individual-, family-, organizational-, and community-level factors as they influence population health; (2) health promotion researchers and practitioners collaborate effectively with others in the community to create integrated strategies that work as a system to address a wide array of health-related factors; (3) The Healthy People Objectives for the Nation includes balanced indicators to reflect health promotion realities and research-measures effects on all levels; (4) the gap between community health promotion "best practices" guidelines and the way things work in the everyday world of health promotion practice has been substantially closed. CONCLUSIONS AND RECOMMENDATIONS: We suggest critical next steps toward closing the gap between health promotion research and practice: investing in networks that promote, support, and sustain ongoing dialogue and sharing of experience; finding common ground in an approach to community partnering; and gaining consensus on the proposed integrating framework.     

上海市基层健康促进队伍健康促进能力调查

采用普查和随机抽样调查,对上海市健康城市建设的基层健康促进队伍结构及其个人健康促进能力分析显示:年龄偏大、学历偏低、缺乏医学专业背景;个人健康促进能力总体良好,个人资源偏低。因此,建议构建老中青结合的年轻化结构,鼓励健康促进专业技能培训,开拓健康促进资源,提高健康促进能力。     

Health promotion in different medical settings: women's health, community health and private practice

This paper describes the health promotion role of doctors in two medical practice settings: women's and community health centres, and fee-for-service practice. It proposes the establishment of divisions of primary health care in Australia which would be multi-disciplinary and focus on community-wide health issues. The paper is based on data from an interview survey of medical practitioners who had worked in metropolitan Adelaide women's and community health centres and from a questionnaire survey of GPs in private practice. The types of health promotion activity by the doctors in the different settings are discussed. It is concluded that private practice GPs are involved primarily in providing health education advice to individual patients. Doctors within women's and community health centres are more likely to report involvement in group health promotion activity and broader community development initiatives. The study concludes that health promotion which focuses on the health of the local community is best conducted within multi-disciplinary health centres. GPs in private practice are limited by the structure of their setting (particularly the fee-for-service basis and reliance on a single discipline) to health promotion which focuses on the needs of individual patients.     

北京市怀柔区健康促进社区(农村)工作可持续发展模式探讨

目的探讨怀柔区健康促进社区(农村)工作可持续发展模式。方法 2009年在怀柔区14个镇乡、2个街道共计70个健康促进示范社区(农村)中,以建立健康教育组织机构和网络、培训专(兼)职健康教育工作者、建立健康促进工作制度、经费投入和综合信息传播等为干预措施。调查干预前健康相关知识行为的改变情况。结果健康知识平均知晓率由干预前的51.6%提高到干预后的74.5%;健康行为形成率由干预前的56.5%提高到干预后的71.8%,各项指标干预前后差异均具有统计学意义(P0.05)。结论通过上述干预措施证明,"政府规划,社区动员,群众参与,信息传播,目标管理"是怀柔区健康促进社区(农村)工作可持续发展的模式。     

上海市金山区张堰镇居民健康素养调查结果

目的了解上海市金山区城乡接合部张堰镇城镇居民与农村居民健康素养水平是否有差异。方法采用分层随机抽样的原则,使用卫生部统一设计《中国公民健康素养——基本知识与技能》调查问卷,对张堰镇167名城镇居民和300名农村居民进行问卷调查。结果张堰镇城镇居民具备健康素养的比例为35．93％,农村居民具备健康素养的比例为8．67％。城镇居民的3个维度健康素养水平和5类健康问题素养水平高于农村居民,其差异具有统计学意义（P〈0．01）。结论张堰镇城镇居民与农村居民健康素养水平存在差异,城镇居民健康素养水平高于农村居民,农村居民健康素养促进工作亟待加强。     

The APHA criteria for development of health promotion programs applied to four Healthy Community projects in British Columbia

The British Columbia Healthy Communities projects are intersectoralhealth promotion programs emphasizing local policy developmentto put the vision of the World Health Organization's and Canadianfederal initiatives of Achieving Health for All into practicalcommunity action and organization. They attempt to convert theOttawa Charter for Health Promotion into practical communityaction projects, including operationalizing the concepts ofparticipation, empowerment and ownership. The American PublicHealth Association's (APHA) criteria for the development ofhealth promotion and education programs (American Journal ofPublic Health, 77, 89–92, 1987) offer five standards bywhich to guide program design and implementation. As a testof the compatibility of these two models, we present case analysesof four Healthy Community projects in relation to the APHA criteria.At this early stage of the projects we can only speculate asto the results likely to be attained by these municipalities.We conclude that the APHA criteria would disqualify most ofthe Healthy Community projects as worthy health promotion programs,mainly on the APHA criteria requiring projects to have a modifiablerisk-factor target of known epidemiological importance to healthoutcomes, having interventions that will clearly and effectivelyreduce a targeted risk factor and having built-in evaluation.We weigh the relative merits of the Canadian community projectsaround the APHA criteria, concluding that different criteriamight apply to different types of health promotion policiesand programming.     

Understanding public health informatics competencies for mid-tier public health practitioners: a web-based survey

The literature suggests that there is a need for measuring public health informatics (PHI) competency to further understand whether current educational modules and modalities meet the needs of PHI practitioners and researchers to perform their jobs more effectively, particularly for mid-tier practitioners that constitute the majority of public health workers in the USA. The present study seeks to update current knowledge of the perceptions and experiences of PHI competencies proposed by the U.S. Council on Linkage in Public Health specifically for mid-tier PH practitioners and researchers. The results were collected and analyzed by using a Web-based survey (WBS) method administered among both practitioners and researchers. Researchers first compiled a draft list of candidate competency set by incorporating existing competency areas provided by: 1) the Council on Linkage; and by 2) those proposed by the USA's Centers for Disease Control CDC Public Health Informatics Work Group. Nine sets of competency statements with 120 competency items and demographic information of respondents were included in the WBS. The online survey instruments were pilot-tested accordingly to incorporate feedback from respondents of the pilot. Fifty-six subjects were recruited from PH experts who were: 1) members of the Health Informatics Information Technology (HIIT) group of American Public Health Association; and, 2) members from the Community of Science (COS) Website who were the first authors published in the PHI field from PubMed. The sample included diverse backgrounds of PHI workers. They expressed an increased need for training to improve their PHI competencies. Respondents agreed that four competency sets should be adequately represented, including Leadership and System Thinking Skills (82%), followed by Financial Planning and Management Skills (79%), Community Dimensions of Practice Skills (77%), and Policy Development/Program Planning Skills (63%). The findings parallel current literature indicating that there exists an expressed need for clarification of the public health practitioner's job-specific informatics competency. Findings of expressed needs for basic computer literacy training and community-based practice were consistent with those of the literature. Additional training and resources should be allocated to address the competency of leadership, management, community-based practice and policy advocacy skills for mid-tier public health practitioners to perform their jobs more effectively. Only when healthcare organizations properly identify PHI competency needs will public health practitioners likely improve their overall informatics skills while improving diversification for contribution across multiple settings.     

北京市社区常见疾病转诊现状及指征需求调查

目的了解北京市社区卫生服务机构转诊现状、存在的问题及转诊指征的需求情况,为相关政策及转诊标准的制定提供参考。方法对2009年3月参加全科医生培训的199名北京市各区、县社区医生实施问卷调查;使用Epidata3.02数据库进行数据双录入,SPSS13.0软件进行频数及卡方检验分析。结果 76.6%的医生认为双向转诊运行情况一般或较差;86.0%的被调查者曾向上级医院转诊过病人,42.5%的医生曾接收上级医院转下来的病人;转诊存在转上不转下(64.8%)、病人盲目要求转诊(60.1%)等问题;47.2%的全科医生对疾病转诊把握度不高;转诊依据主要为依靠有关诊断资料和信息(53.9%)及自我决定(48.2%);全科医生认为最需要的转诊症状是气短和胸痛(88.6%);最需要转诊的疾病是慢性阻塞性肺病(85.5%)。结论北京市社区卫生服务机构转诊现状不容乐观,社区医生对双向转诊的了解情况不尽如人意,对转诊指征或标准需求迫切。应加强社区卫生建设及全科医师培训,扩大宣传,提高双向转诊的知晓率,制定完善的转诊标准及转诊规范,增加医疗机构间的沟通交流。     

Characteristics of hospitals providing preventive services: does delivery system integration make a difference?

OBJECTIVE: As health care organizations consolidate into integrated delivery systems, increased delivery of preventive services is expected. The study objective was to evaluate the impact of hospitals' participation in multiorganizational arrangements and managed care on their delivery of preventive services. METHOD: The study is a secondary data analysis of data in the American Hospital Association 1993 Annual Survey of Hospitals Data Base. Two primary prevention variables (health promotion services to patients and to community members), and one secondary prevention variable (screening mammography) were included. Hospital characteristics included ownership, bed-size, and integration-participation in a multiorganizational arrangement and having managed care (HMO and PPO) contracts. RESULT: The 5,387 general medical and surgical hospitals responding to the 1993 survey were included in the analysis. Proportions of hospitals reporting delivery of health promotion services to patients, and to community members, and screening mammography services were respectively 90%, 83%, and 88%. Hospitals reporting participation in multiorganizational arrangements were more likely to report delivery of preventive services after adjusting for bed-size. The bed-adjusted odds ratios for providing health promotion services to inpatients, and to members of the community, and screening mammography services in hospitals with managed care contracts versus those without managed care contracts were respectively: 2.72 (95% CI: 1.65, 2.50), 2.03 (1.63, 2.53), and 1.51 (1.26, 1.81). CONCLUSION: Preliminary findings from this secondary data analysis support the expectation that current changes in the health care delivery system may expand the delivery of preventive services.     

IMPROVING THE QUALITY OF COMMUNITY HEALTH SURVEYS AND COMMUNITY HEALTH PROMOTION CAMPAIGNS BY FEEDBACK FROM THE COMMUNITY: EXPERIENCE FROM THE WALLSEND COMMUNITY AND HEALTH PROJECT

A lifestyle and health risk survey was conducted in two socially disadvantaged Collector's Districts, as the basis for a health promotion intervention in one of the Districts. After community input into the planning, and local advance publicity, 395 people responded to the survey (a response rate of 39%). Three sources of community feedback were used: (i) reasons for refusal to participate; (ii) written comments solicited at a two-month follow-up; (iii) later, in-depth interviews with a subset of respondents. The data from this feedback related both to the process and outcomes of the survey; the latter included increased personal and community awareness of health, as well as lifestyle changes. The data are discussed in terms of their representativeness and the factors influencing participation, the implications of the low response rate, the stages of health behaviour change, and the potential conflict between scientific and human value-systems in community research.     

Citizen science in the community: Gaining insight in community and participant health in four deprived neighbourhoods in the Netherlands

The aim of this study was to examine if citizen science contributes to gaining insight into community health and to the health of the citizen scientists themselves. Therefore, thirteen citizens in four deprived neighbourhoods were trained as citizen scientists to conduct research in their own communities. Results showed that the citizen scientists identified forty (health related) themes in their communities. The citizen scientists reported an increase in their overall self-perceived health which, however, was not significantly demonstrated in the prequestionnaire and postquestionnaire.     

Community based health education: general practitioners' perceptions of their role and willingness to participate

Abstract: This study aimed to: 1. determine general practitioners' perceptions of their appropriateness to conduct community based health education; 2. assess the proportion of general practitioners who had undertaken group health education in the previous 12 months, and identify the factors that discourage and encourage this activity; and 3. identify appropriate health areas and the community groups that general practitioners would be prepared to address if provided with educational packages on the topic. A random sample of 181 general practitioners (66.5 per cent response rate) completed a mailed questionnaire. General practitioners rated health promotion officers (32.6 per cent) and general practitioners (30.9 per cent) as the most appropriate health care providers to undertake community based health education activities. Of the general practitioners, 38 per cent had undertaken community health education in the previous 12 months, with lack of time, lack of earnings while away from the practice, and lack of confidence in public speaking being the main reasons for not undertaking this activity. Being specifically invited to address groups, being provided with an information package on the topic, and being paid for their time were the three factors most likely to encourage this activity. Skin, cervical and breast cancer, blood pressure and cholesterol, and asthma were the topics general practitioners were most willing to speak on. Although this survey suggests that general practitioners would be willing to undertake this community health education, research is needed on whether they are the most appropriate and effective group for this.     

“A good spot”: Health promotion discourse,healthy cities and heterogeneity in contemporary Denmark

Health promotion at a community level has gained popularity in recent decades within and outside academic environments. The health promotion discourse is part of a wider political discourse, aimed at empowering individuals to take control of their own lives and enabling them to be engaged, responsible and active citizens in their own communities. Key values of the discourse, deriving from a democratic and individualistic culture, are evident in how local authorities develop and implement policies aimed at promoting population health and wellbeing. In this article, we draw on data from a relatively poor multicultural Danish community incorporated in the WHO Healthy Cities Programme. We explore how key terms of the health promoting discourse are constructed, operationalized and resisted by different subgroups. The contradictions that emerge challenge how we comprehend communities in relation to safety and harmony, and how people within defined communities are involved in common community life.     

Survey of health needs and concerns of rural Pennsylvanians

INTRODUCTION: This survey was undertaken to determine the most important health and safety needs of farmers and rural citizens of Pennsylvania. METHODS: In June of 2004, a one-page questionnaire was distributed by mail to 32,700 members of the Pennsylvania Farm Bureau as an attachment to their monthly newsletter. RESULTS: The lack of affordable health care insurance was overwhelmingly cited as the most important unmet health care need (73%). No other issue was chosen by more than 10 percent of respondents. This lack of affordable health insurance was also cited as the most important health or safety problem to be addressed in the respondent's communities (71%). When asked the most important health or safety problem affecting them as individuals or their community, the respondents chose "no major problem or need" as the most frequent response (46%). The issue of affordable health insurance was not an option for this question. The predominant concern regarding the lack of affordable health insurance was consistent across all regions of the Commonwealth and for farmers as well as residents of all community sizes sampled. DISCUSSION: This study would indicate that the lack of affordable health insurance is the preeminent health and safety issue for many Pennsylvania farmers and rural citizens.