Multi-level rural community engagement in health

Community participation in health is consistent with notions of democracy. A systems perspective of engagement can see consumers engaged to legitimise government agendas. Often community participation is via consultation instead of partnership or delegation. A community development approach to engagement can empower communities to take responsibility for their own health care. Understanding rural place facilitates alignment between health programs and community, assists in incorporating community resources into health care and provides information about health needs. Rural communities, health services and other community organisations need skills in working together to develop effective partnerships that transfer some power from health systems. Rural engagement with national/state agendas is a challenge. Community engagement takes time and resources, but can be expected to lead to better health outcomes for rural residents.     

Boundary crossers, communities, and health: exploring the role of rural health professionals

Boundary crossers understand the culture and language of community and health service domains and have the trust of both. Rural health professionals living within the communities they serve are ideally placed to harness community capacity so as to influence community-level determinants of health. We analyse five case studies of rural health professionals acting as boundary crossers against indicators of capacity for communities and external agents such as health services working in partnership. A more explicit evidence base for inclusion of community health development in the jobs of rural health professionals is needed.     

Skill improvement among coalition members in the California Healthy Cities and Communities Program

Community-driven, collaborative approaches to health promotion have the potential to enhance skills among community members and, in turn, increase community capacity. This study uses data from an evaluation of the California Healthy Cities and Communities (CHCC) Program to examine whether, and how, community problem-solving and collaboration skills are improved among coalition members and local coordinators in 20 participating communities. Methods include semi-structured interviews with coordinators and mailed surveys with coalition members (n=330 in planning phase and n=243 in implementation phase). The largest number of coordinators reported skill improvement in defining health broadly and assessing needs and assets. Similarly, coalition members reported greatest skill improvement for defining health broadly, assessing needs and assets and setting priorities and developing action plans. Modest correlations were observed between number of roles played in the local healthy cities and communities project and each skill area assessed. Time committed to the local CHCC coalition and its activities was not meaningfully correlated with any of the skills. Types of skill-building opportunities may be more important than number of hours devoted to meetings and activities in strengthening community problem-solving and collaboration skills among coalition members.     

Specialist public health capacity in England: working in the new primary care organizations

OBJECTIVES: To determine the capacity and development needs, in relation to key areas of competency and skills, of the specialist public health workforce based in primary care organizations following the 2001 restructuring of the UK National Health Service. STUDY DESIGN: Questionnaire survey to all consultants and specialists in public health (including directors of public health) based in primary care trusts (PCTs) and strategic health authorities (SHAs) in England. RESULTS: Participants reported a high degree of competency. However, skill gaps were evident in some areas of public health practice, most notably "developing quality and risk management" and in relation to media communication, computing, management and leadership. In general, medically qualified individuals were weaker on community development than non-medically qualified specialists, and non-medically qualified specialists were less able to perform tasks that require epidemiological or clinical expertise than medically qualified specialists. Less than 50% of specialists felt that their links to external organizations, including public health networks, were strong. Twenty-nine percent of respondents felt professionally isolated and 22% reported inadequate team working within their PCT or SHA. Approximately 21% of respondents expressed concerns that they did not have access to enough expertise to fulfil their tasks and that their skills were not being adequately utilized. CONCLUSIONS: Some important skill gaps are evident among the specialist public health workforce although, in general, a high degree of competency was reported. This suggests that the capacity deficit is a problem of numbers of specialists rather than an overall lack of appropriate skills. Professional isolation must be addressed by encouraging greater partnership working across teams.     

Youth violence prevention curriculum evaluation: outcomes of a Cook County, Illinois community based partnership

The John H. Stroger, Jr. Hospital Departments of Trauma and Emergency created a youth violence prevention curriculum for healthcare providers and staff with a community partnership of practitioners and professionals. A participatory, train-the-trainer approach was used to develop and present the curriculum. Participants were offered voluntary participation in the anonymous evaluation survey to determine their interests, work experience, expectations, knowledge, and skill development, use of, and improvement for the curriculum. Responses from 49 complete surveys were qualitatively analyzed with a response rate of 42% (49/116). The activity, and efforts of professionals and community members to engage and educate themselves through this violence prevention partnership, are an example of how healthcare providers can deploy resources to benefit communities as well as to respond to the needs of individual patients, particularly in the compelling area of youth violence prevention.     

Collaboration among community members,local health service providers,and researchers in an urban research center in Harlem,New York

The Urban Research Center at the Center for Urban Epidemiologic Studies brings together community members and researchers working in Harlem, New York. A Community Advisory Board (CAB) composed of community members, service providers, public health professionals, and researchers was formed to assist the Center's research and interventions and to guide community partnerships. Through a collaborative process, the CAB identified three public health problems-substance use, infectious diseases, and asthma-as action priorities. To deal with substance use, the Center created a Web-based resource guide for service providers and a "survival guide" for substance users, designed to improve access to community services. To deal with infectious diseases, the Center is collaborating with local community-based organizations on an intervention that trains injection drug users to serve as peer mentors to motivate behavior change among other injection drug users. To deal with asthma, the Center is collaborating with community child care providers on an educational intervention to increase asthma awareness among day care teaching staff, enhance communication between staff and families, and improve the self-management skills of children with asthma. The Center's experience has demonstrated that active communities and responsive researchers can establish partnerships that improve community health.     

Community participation in organising rural general practice: Is it sustainable?

OBJECTIVE: We analysed community participation in organising rural general medical practice in order to suggest ways to extend and sustain it. DESIGN: A multisite, embedded case-study design collecting data through semistructured interviews, non-participation observation and a document analysis. SETTING: One remote and two rural communities in Australia. PARTICIPANTS: Community members, GPs, health professionals, government officers and rural medical workforce consultants. RESULTS: High levels of community participation in recruiting and retaining GPs, organising the business model, and contributing to practice infrastructure were evident. Community participation in designing health care was uncommon. Participation was primarily to ensure viable general practice services necessary to strengthen the social and economic fabric of the community. There were factors about the decision-making and partnership processes in each of the communities that threatened the viability of community participation. CONCLUSIONS: We recommend that a concept of community development and explicit facilitation of the processes involved is necessary to strengthen participation, create effective partnerships and ensure inclusive decision-making.     

Beyond tribal self determination: a community health initiative.

The Gila River Indian Community is a 583-square mile community located 45 miles south of Phoenix, Arizona, home to 11,257 residents and 16,985 enrolled tribal members. The community is in the midst of significant change, primarily due to determination to prosper and ensure a healthier life for all tribal members and residents. The authors describe the evolution of the Gila River Indian Community Turning Point Initiative from its emphasis on development of a tribal health department through its growth and change into a community partnership.     

Rural professionals’ perceptions of interprofessional continuing education in mental health

We describe the impact of an interprofessional education programme in mental health for professionals in six rural Canadian communities. The 10‐session programme, offered primarily via videoconference, focussed on eight domains of mental health practice. One hundred and twenty‐five professionals, representing 15 professions, attended at least some sessions, although attendance was variable. Data were collected between September 2006 and December 2007. The programme was evaluated using a mixed methods approach. Participants reported high levels of satisfaction for all topics and all aspects of the presentations: they were most satisfied with the opportunity to interact with other professionals and least satisfied with the videoconference technology. Professionals’ confidence (n = 49) with mental health interventions, issues and populations was measured pre‐ and post‐programme. There was a significant increase in confidence for seven of the eight mental health interventions and four of the six mental health issues that had been taught in the programme. Participants reported developing a more reflective mental health practice, becoming more aware of mental health issues, integrating new knowledge and skills into their work and they expressed a desire for further mental health training. They noted that interprofessional referrals, inter‐agency linkages and collaborations had increased. Conditions that appeared to underpin the programme’s success included: scheduling the programme over an extended time period, a positive relationship between the facilitator and participants, experiential learning format and community co‐ordinators as liaisons. Participants’ dissatisfaction with the videoconference technology was mitigated by the strong connection between the facilitator and participants. One challenge was designing a curriculum that met the needs of professionals with varied expertise and work demands. The programme seemed to benefit most of those professionals who had a mental health background. This programme has the potential to be of use in rural communities where professionals often do not have access to professional development in mental health.     

One size fits all partnerships? What explains community partnership leadership skills?

The authors evaluated W. K. Kellogg-funded Community Partnerships (CPs) between academic, health service, and community partners in South Africa. Stakeholders (N = 668 respondents) completed questionnaires to explore the operational, functional and organisational factors that contribute to members' perceptions of the skills of their CPs' leadership. Ten factors accounted for 53% of leadership skills across five participating CPs and six stakeholder groups. Each CP displayed its unique footprint of factors that accounted for its leadership levels. Similarly, each stakeholder group had its unique signature of factors that were associated with its leadership. Two factors (communication mechanisms and operational understanding) accounted for more than 25% of leadership skills; management capabilities and participation benefits accounted for 4% and 3%; and effectiveness, benefits to difficulties ratio of being a member, engagement in education, flow of information and sense of ownership accounted for 2% to 3% each. Attention to these and other factors is warranted.     

Achieving cardiovascular health through continuing interprofessional development

In order to achieve cardiovascular health for all Canadians, the ACHIC (Achieving Cardiovascular Health in Canada) partnership advocates that health promotion for healthy lifestyles be incorporated into practice, and that the consistent messages and professional skills required to motivate patients and the public be acquired through interprofessional education and development. Professional education specialists are essential members of health care promotion teams with expertise to develop educational interventions that impact behaviours of health professionals and subsequent patient outcomes. Continuing medical education (CME) is in evolution to continuing professional development (CPD), and then to continuing inter-professional development (CID). Providers of health promotion, public health, and health care can work with health educators to complete the cascade of learning, change in practice, and improvement in patient outcomes. The Canadian health care system can empower Canadians to achieve cardiovascular health, the most important health challenge in the 21st century.     

Expanding Environmental Health Literacy—A Focus on Water Quality and Tribal Lands.

Environmental health literacy (EHL), an evolving concept, has potential for significant public health impact. However, complex skills are needed to access and use information, to study and document hazards, to link findings to health outcomes, and to understand the complexities of regulations and laws needed to take efficacious action. Because water issues are creating headlines world-wide, we draw from several water-related cases on American Indian tribal lands to examine some of the complexities associated with building needed skills, obtaining accessible information, and navigating the layers of laws and regulations that enable or inhibit efficacious action. Each case highlights the importance of partnerships, skill building, and collaborative action to redress environmental assaults. For our analysis, we draw from and expand upon Nutbeam’s typology of health literacy which includes functional, interactive, and critical stages to derive lessons from each of the EHL cases. Community partnerships engaging in EHL efforts still face many challenges, including enhancing skills for community members as well as professionals, clarifying scientific processes and findings, articulating and respecting cultural practices and needs, and translating policies and laws for community accessibility and collaborative action.     

The contribution of community health surveys to Aboriginal health in the 1990s

Community health surveys take place in many Aboriginal communities. We considered these surveys to determine their potential to contribute to Aboriginal health in the 1990s. Community health surveys-also known as health audits, community health screenings or check-ups-usually consist of a team of health professionals travelling to an Aboriginal community to measure a wide variety of parameters on as many of the people in the community as possible. For the individual participant, community health surveys represent a sporadic screening program which should meet the World Health Organization's criteria for screening. From the population health perspective, these surveys represent prevalence surveys which may contribute little new knowledge regarding Aboriginal health and do not, of themselves, change the urgent need for preventive health programs. Community health surveys should meet minimum scientific standards (i.e. have a clearly stated aim and use valid measurements and statistical techniques) and should incorporate practically feasible protocols and services for the follow-up of individuals with screen-detected abnormalities. They must have ethical and community approval and incorporate genuine consultation and feedback of results to the Aboriginal communities involved, in order for them to be justified.     

Community health screening programs for African-Americans and the medical anthropologist

Community health screening programs were originally designed: to stimulate change in family and community knowledge and behavior relating to the prevention of disease; to inform the use of available health resources; and to improve the environmental, economic, and educational factors related to health. Since their inception, however, community health screening programs have primarily used conventional approaches to health improvement for the African-American community. That is, the need is not merely for the provision of more preventative and curative health services or the distribution of services to passive recipients, but for the active involvement of local populations in ways which will preserve or repattern their knowledge, attitudes and motivation concerning major health care issues. Health care professionals such as the clinicians need to expand their biopsychosocial model to include specific sociocultural data concerning African-American health care seeking pattern. Collaborative efforts of this type will therefore enable health care professionals to design future community health screening programs for the African-American community that are practical and culturally-oriented.     

Potential of pharmacists to help reduce the burden of poorly managed cardiovascular risk

Introduction: Rural areas require better use of existing health professionals to ensure capacity to deliver improved cardiovascular outcomes. Community pharmacists (CPs) are accessible to most communities and can potentially undertake expanded roles in prevention of cardiovascular disease (CVD). Objective: This study aims to establish frequency of contact with general practitioners (GPs) and CPs by patients at high risk of CVD or with inadequately controlled CVD risk factors. Design, setting and participants: Population survey using randomly selected individuals from the Wimmera region electoral roll and incorporating a physical health check and self‐administered health questionnaire. Overall, 1500 were invited to participate. Results: The participation rate was 51% when ineligible individuals were excluded. Nine out of 10 participants visited one or both types of practitioner in the previous 12 months. Substantially more participants visited GPs compared with CPs (88.5% versus 66.8%). With the exception of excess alcohol intake, the median number of opportunities to intervene for every inadequately controlled CVD risk factor and among high risk patient groups at least doubled for the professions combined when compared with GP visits alone. Conclusion: Opportunities exist to intervene more frequently with target groups by engaging CPs more effectively but would require a significant attitude shift towards CPs. Mechanisms for greater pharmacist integration into primary care teams should be investigated.     

Community interdisciplinary education to promote partnerships in family violence prevention

Family violence is a major social and health problem in the United States. Educational approaches are needed that help professionals and communities develop more effective skills to work with families and communities. This article describes a statewide, interdisciplinary, community-based educational program for professionals and paraprofessionals and a 6-month post-evaluation. Participants reported knowledge and skill development in assessment and interventions, improved use of violence prevention data for planning and interventions, and increased community partnerships and collaborations. Recommendations address violence prevention leadership, funding, infrastructure, interdisciplinary professional education, greater community awareness, and policy development.     

Community Priorities for Healthy Eating in Older Adults

Community planners such as policymakers and health care and nutrition service providers can create an “age-friendly” environment to support healthy eating in older residents by addressing the highest priorities that enable older adults to improve their dietary intake through different food-related community settings. To identify and prioritize these factors that facilitate behavioral change (enablers) and behavioral settings important for older adult nutrition based on the social ecological model, nutrition and aging professionals (n?=?30) from two rural (West Virginia, Iowa) and two urban (Massachusetts, New York) city/county regions (communities) participated in an online or live focus group discussion and completed an analytic hierarchy process survey online. Overall, the most important perceived enablers were accessibility and cost, followed by transportation and social support, but their relative importance varied by community. Participants from all communities considered congregate meal sites and food banks among the most important behavioral settings. Participants from most communities considered food stores to be important and also highlighted other settings unique to the area, such as senior housing, neighborhood, and farmers’ markets. By targeting interventions to address the most notable enablers and behavioral settings specific to their community, planning groups can enhance their older residents’ ability to achieve optimal nutritional health.     

Promoting participatory research by family physicians

In the past, researchers have inadvertently caused stigmatization of various populations, first by not involving community members and then through publishing negative findings. In contrast, participatory research, which is based on a partnership between researchers and those affected by the issue being studied, promotes the voice of those being researched. This essay highlights key principles, processes, complexities, and challenges of participatory research and outlines when participatory research is not appropriate. It also reflects on the training and skills of family physicians that make them especially suited to participatory research. Family physicians have established clinical partnerships with their patients and sometimes entire communities, are trained in patient-centered care-a good basis for community centered research-and are accustomed to working with uncertainty. In addition, they are frequently pragmatic, interested in questions arising from their patients and communities, and likely to respond well to community requests. The main challenges to participatory research are lack of funding, expertise, and time, which may improve as more funding agencies and universities support this approach to research.     

The Feasibility of a Web Intervention for Military and Veteran Spouses Concerned About Their Partner’s Alcohol Misuse

Concerned partners (CPs) of military service members and veterans with alcohol misuse face significant help-seeking barriers. We adapted the Community Reinforcement and Family Training (CRAFT) intervention into a 4-session web-based intervention (WBI) called Partners Connect. The program aims to help the CP increase their own well-being, teach the CP how to manage his/her behavior (e.g., communication) toward their partner, and identify ways the CP can help their partner reduce drinking and seek treatment. We recruited CPs through social media, and then tested the feasibility and acceptance of the WBI by conducting qualitative interviews and post-WBI session surveys after their WBI sessions. CPs (n?=?12) spontaneously reported improvements in communication and more effective management of their partner’s drinking due to skills learned. They discussed how the online approach can help overcome barriers to seeking in-person help. This WBI fills an important gap in clinical services for military and veteran CPs and CPs in the general population who may not otherwise seek in-person counseling.