Trusted messengers and trusted messages: The role for community-based organizations in promoting COVID-19 and routine immunizations

We sought to explore the trust and influence community-based organizations have within the communities they serve to inform public health strategies in tailoring vaccine and other health messages.A qualitative study was conducted between March 15 – April 12, 2021 of key informants in community-based organizations serving communities in and around Philadelphia, Pennsylvania. These organizations serve communities with high Social Vulnerability Index scores. We explored four key questions including: (1) What was and continues to be the impact of COVID-19 on communities; (2) How have trust and influence been cultivated in the community; (3) Who are trusted sources of information and health messengers; and (4) What are the community’s perceptions about vaccines, vaccinations, and intent to vaccinate in the context of the COVID-19 pandemic.Fifteen key informants from nine community-based organizations who serve vulnerable populations (e.g., mental health, homeless, substance use, medically complex, food insecurity) were interviewed. Five key findings include: (1) The pandemic has exacerbated disparities in existing social determinants of health for individuals and families and have created new concerns for these communities; (2) components of how to build the trust and influence (e.g., demonstrate empathy, create a safe space, deliver on results)resonated with key informants; (3) regardless of the source, presenting health information in a respectful and understandable manner is key to effective delivery; (4) trust and influence can be transferred by association to a secondary messenger connected to or introduced by the primary trusted source; and (5) increased awareness about vaccines and vaccinations offers opportunities to think differently, changing previously held beliefs or attitudes, as many individuals are now more cognizant of risks associated with vaccine-preventable diseases and the importance of vaccines.Community-based organizations offer unique opportunities to address population-level health disparities as trusted vaccine messengers to deliver public health messages.     

Perceptions of community participation and health gain in a community project for the South Asian population: a qualitative study

BACKGROUND: The new public health rejects old individualist attempts at improving health and embraces community-based approaches in reducing health inequalities. Primary Care Trusts in England face the challenge of converting community participation in health into reality. This study explores differences in perception of participation between lay and professional stakeholders of a community health project for a South Asian population in Greater Manchester. METHODS: In-depth interviews and focus groups were used to explore the views of professional and lay stakeholders. All data were audio-taped, transcribed and analysed for emerging themes using a qualitative framework. RESULTS: Professionals talked of working in partnership with the community but lay stakeholders did not feel that they had control over the project. There were problems in engaging the community and local health professionals in the project. Lack of cultural awareness hampered participation in the project. There was agreement that the project improved the self-confidence of participants and created a more informed population. However, there was little support for claims of improvements in social cohesion and changes in lifestyle directly as a result of the project. CONCLUSION: Converting the rhetoric of community participation in health into reality is a greater challenge than was envisaged by policy makers. Marginalized communities may not be willing participants and issues of language and cultural sensitivity are important. Project outcomes need to be agreed to ensure projects are evaluated appropriately. Projects with South Asian communities should not be seen to be dealing with all 'ethnic health' issues without addressing changes in statutory organizations and other wider social determinants of health.     

Community Organization and School Liaisons: How to Get Programs Started

This paper briefly reviews four intervention models, Rothman's community organization, Green's system-centered education, Rogers' innovation-decision process, and Watzlawick's planned change, for their applicability to help initiate community-based programs for drug abuse prevention and health promotion in youth. An expanded model is described, including preprogram assessment of the target population, community, and drug use problem, and continuous evaluation of program process and product. School liaisons are emphasized as a key factor in early adoption and demonstration of a community-based program for youth. The expanded model, including school liaisons, is applied to a comprehensive community drug abuse prevention project being implemented in the Greater Kansas City area. The model--and the project--suggest methods for organizing communities for long-term drug prevention, initially at the level of school and school district, and later to the family, mass media, and community organizations in a proximal-to-distal sequence of programming.     

Meeting the health promotion needs of Hispanic communities. Policy and Research, National Coalition of Hispanic Health and Human Services Organizations (COSSMHO)

This paper conducts a review of the demographic and health status data for Hispanic communities and relates them to the role of culture in health care. The author's recommend that promotion programs for Hispanic communities should focus on specific community data (morbidity rather than mortality), understand the impact of culture and language (cultural competency training and staffing), develop strong outreach components (establish community advisory boards, identify credible community spokespersons and incorporate community residents as health educators), and work in partnership (sharing funds and resources) with community-based organizations.     

Health promotion: private voluntary organisations in action

Since the country's independence in 1947, India has come a long way in its efforts to improve health services. One initiative taken by the Government is the involvement of private voluntary organizations (PVOs) in the health promotion activity. Several grant-in-aid schemes have been initiated, whereby PVOs obtain government funding for the provision of services and the promotion of health and family welfare activities. The US Agency for International Development has supported the government in this endeavor. Keeping these in mind, Tamil Nadu Voluntary Health Association, a state-level association of voluntary health organizations such as hospitals, dispensaries and community-based health organizations, worked out a proposal for support and collaboration with the Government of India. This association aims to promote health through networking and coordinating with voluntary organizations, strengthening of nongovernmental organization activities, collection and dissemination of relevant information, lobbying, campaigning and liaisoning for health issues. This article highlights the experience of the Association in conceiving and carrying out its proposal/project. In particular, it describes the planning and implementation of the Integrated Project for Development of Primary Health Care and Women's Welfare in Tamil Nadu as well as the achievements of the project. The main goal of this project is to coordinate with various levels of health services to improve the health status of rural Tamil Nadu.     

Myth and Reality in the Rural Health Service Crisis: Facing Up to Community Responsibilities

Rural communities, rural advocacy organizations, and policy makers persist in perpetuating two serious but related misconceptions, namely: (1) The continuing deterioration of health services in most rural communities is primarily the result of forces and factors outside of the communities themselves, and (2) the solution to reverse this deterioration will come mainly from changes in reimbursement and other types of public policy initiatives. Overemphasis on the role of external factors has created a serious imbalance in programs, resources, and policy efforts, including those supported by the NRHA, resulting in inadequate national efforts and resources to foster community-based solutions. Suggested solutions include: (1) application by communities of a proven set of principles for organizing and developing local health services, and (2) creation of a national network to promote such community-based solutions.     

Resources and interest among faith based organizations for influenza vaccination programs

In the United States, annual influenza vaccination rates are suboptimal and are well below the national health objectives. Project VIVA mobilized community members and organizations to implement an influenza vaccination program in Harlem by administering vaccines in “non-traditional” venues, such as community-based organizations, pharmacies, and faith-based organizations (FBOs). FBOs have been recognized as important venues for health promotion initiatives within medically underserved communities. However, data regarding the extent of resources and interest in health promotion programs among FBOs are sparse. We conducted a telephone survey among 115 FBOs in three New York City neighborhoods with histories of low influenza immunization rates to identify the congregation’s health concerns, interest in serving as a community-based venue for influenza vaccinations, and existing resources for health programming. Twenty-six percent of the FBOs had an established health ministry, while 45 % expressed interest in developing one. Seven percent included nurses among their health activities and 16.5 % had contact with the local health department. Most FBOs expressed interest in common health promotions programs; 60 % expressed interest in providing on-site influenza vaccination programs within their organization. Health programs within FBOs can be a point of access that may improve the health of their congregants as well as the larger community.     

Macro-intervention to support health behavior: some theoretical perspectives and practical reflections

Large-scale, integrated programs--as distinct from multiple and widespread replications of small-scale programs--require for their planning, implementation and evaluation a qualitatively different set of concepts, methods, and procedures. They are not merely the sum of the parts making up numerous applications of the same health education messages and objectives in various organizations or communities. This review of theory, research and the experience of national and community-based studies in mass media and community development for health, family planning and cardiovascular risk reduction identifies some distinctions between micro- and macrointerventions, as well as between the uses of mass media in commercial marketing and those in health promotion.     

Community organizing among the elderly poor in the United States: a case study.

This case study demonstrates the role of community organizing as a vehicle for enhancing individual and community-level empowerment. Building on social support theory, Freire's "education for critical consciousness," and the principles and strategies of community organization practice, the 12-year-old Tenderloin Senior Organizing Project reflects the World Health Organization definition of health promotion as a means of helping individuals and communities to take increasing control over the factors influencing their health. Through the Project, low-income elders have successfully identified and addressed shared problems in such areas as crime and safety, undernutrition, and tenants rights. They further have developed ongoing tenants' associations and other community-based organizations that have provided continuity over time and contributed to the development of a "competent community." Problems in areas such as funding, evaluation, and volunteer burnout are discussed, as are the potentials for project replication in other settings.     

Empowered women from rural areas of Bolivia promote community development

Abstract: The United States Agency for Development in Bolivia (USAID/Bolivia) created in 2002 PROSALUD- Partners for Development Project (PfD) with the aim of improving the population's well-being. The project used three components: small grant scheme, technical assistance and database system management. Through the small grants scheme, the PfD supported a Community Participation Strategy (CPS) project over a three year period. The project involved the rural areas of six Bolivian departments and suburban areas of three Bolivian cities. The main objective was to increase health service utilization with a particular emphasis on empowerment of women, strengthening of local organizations and increasing the demand for health services. Women from both the urban and rural areas, and from different indigenous groups, were trained in project management, health promotion, reproductive health and family planning, advocacy and community participation. Participatory methodologies have allowed empowering women in decision making and capacity building throughout the entire project process. The experience shows that it is important to work with formally established grass-root community organizations and strengthen leadership within them. Additionally, the sub-projects demonstrated that interventions are more successful when promoters speak and write native languages, women are more motivated and empowered, projects are designed to be responsive to daily necessities identified by the communities and health services are culturally suitable. A preliminary evaluation, in both quantitative and qualitative terms, shows an overall improvement in health knowledge and practice, and utilization of health services.     

Benefits of standardized diabetes and hypertension screening forms at community screening events

The objectives of this project were to (a) assess hypertension and diabetes screening data collection practices and guidelines and (b) develop and test standardized screening forms for use at minority community- and faith-based screening events. Project Phase I involved resource assessment and the development of a set of screening forms and guidelines containing a core data set for both hypertension and diabetes. These were then tested during Phase II at predetermined community based screening events throughout the United States. Community- and faith-based health screening programs are important in reaching and informing individuals in selected communities about their health and health risks. This study demonstrated the development of a standard tool that was effective in conducting African American community-based screening programs for hypertension and diabetes by community-based organizations. These activities are effective to obtain standardized information on individuals within the communities served.     

Community ownership and program continuation following a health demonstration project

Community ownership and maintenance of heart health programs was a major study goal of the Minnesota Heart Health Program (MHHP), a community-based National Heart, Blood and Lung Institute (NIH)-funded demonstration project. A partnership between the University of Minnesota and three Upper Midwest intervention communities was initiated in 1981. Local citizen boards were instrumental in planning, implementing and incorporating programs. Through an 8 year process of community organization, training and volunteer involvement, MHHP educational program responsibility was transferred to existing community-based groups and organizations. In 1989, when federal funding was withdrawn, 70% of all heart health intervention programs initiated by MHHP were being continued by local sponsors and supported by local funds. By 1992, maintenance of programs had decreased to an average 60%. Differential results of program incorporation among the three intervention communities are presented including findings on community sectors that most frequently sponsored programs. Factors that facilitate or impede local ownership are discussed. Research on longer-term maintenance of heart health programs in the three communities continues.     

Gemeindenahe Gesundheitsförderung für ältere Menschen

Background

Health promotion for the elderly is a central challenge for society as a whole and for every single member. Demographic change is taking place in very different ways in each municipality and even in different parts of a single community. This makes development of specific solutions for each area necessary. Target groups of the socially disadvantaged could especially profit from this kind of approach; however, the mainstream prevention programs do not reach them.

Aims

After existing prevention strategies of communities and health insurance companies are analyzed, effective prevention strategies for the socially disadvantaged should be discussed, along with their long-term effects. The health promotion sector should embark on a strategy based on intensive participation of the target groups; the key players are the target groups themselves. The main aim of this analysis was to define a theoretical basis and framework for effective community-based prevention for the elderly.

Results

This article defines the settings approach as a theoretical basis of community-based prevention strategies for the socially disadvantaged. Intersectoral cooperation of the local health care system and organizations caring for the elderly is of great importance. A central and pivotal point of effective prevention is a high participation level of the target groups. This article illustrates the theoretical framework with examples from the project“Modern Aging in the City.” Using this practice model, effective participation and prevention programs for the elderly were realized in a midsize town.     

Seeds of HOPE: a model for addressing social and economic determinants of health in a women's obesity prevention project in two rural communities

Socioeconomic status (SES) and income disparity are strong predictors of health, and health promotion interventions that address them are more likely to be meaningful to participants and to sustain positive effects. Seeds of HOPE is an innovative project that is the result of a long-standing collaboration between the University of North Carolina (UNC) Center for Health Promotion and Disease Prevention, a Centers for Disease Control and Prevention (CDC) Prevention Research Center, and communities in rural North Carolina. Initial formative work, including key informant interviews, community surveys, and focus groups, strengthened our understanding of the link between hope and health and the importance of addressing social and economic issues as part of our health promotion interventions. A Seeds of HOPE strategic plan was developed using a community-based participatory process and led to the idea to start Threads of HOPE, an enterprise that will serve as a business laboratory where women will produce and market a unique product and also learn business skills. Threads of HOPE will be a health-enhancing business and will serve as a training program for a new cadre of women entrepreneurs in two rural communities.     

Aboriginal Community-Centered Injury Surveillance: A Community-Based Participatory Process Evaluation

While injuries are a leading health concern for Aboriginal populations, injury rates and types vary substantially across bands. The uniqueness of Aboriginal communities highlights the importance of collecting community-level injury surveillance data to assist with identifying local injury patterns, setting priorities for action and evaluating programs. Secwepemc First Nations communities in British Columbia, Canada, implemented the Injury Surveillance Project using the Aboriginal Community-Centered Injury Surveillance System. This paper presents findings from a community-based participatory process evaluation of the Injury Surveillance Project. Qualitative data collection methods were informed by OCAP (Ownership, Control, Access, and Possession) principles and included focus groups, interviews and document review. Results focused on lessons learned through the planning, implementation and management of the Injury Surveillance Project identifying lessons related to: project leadership and staff, training, project funding, initial project outcomes, and community readiness. Key findings included the central importance of a community-based and paced approach guided by OCAP principles, the key role of leadership and project champions, and the strongly collaborative relationships between the project communities. Findings may assist with successful implementation of community-based health surveillance in other settings and with other health issues and illustrate another path to self-determination for Aboriginal communities. The evaluation methods represent an example of a collaborative community-driven approach guided by OCAP principles necessary for work with Aboriginal communities.     

Community-based participatory research: lessons learned from the Centers for Children's Environmental Health and Disease Prevention Research

Over the past several decades there has been growing evidence of the increase in incidence rates, morbidity, and mortality for a number of health problems experienced by children. The causation and aggravation of these problems are complex and multifactorial. The burden of these health problems and environmental exposures is borne disproportionately by children from low-income communities and communities of color. Researchers and funding institutions have called for increased attention to the complex issues that affect the health of children living in marginalized communities--and communities more broadly--and have suggested greater community involvement in processes that shape research and intervention approaches, for example, through community-based participatory research (CBPR) partnerships among academic, health services, public health, and community-based organizations. Centers for Children's Environmental Health and Disease Prevention Research (Children's Centers) funded by the National Institute of Environmental Health Sciences and U.S. Environmental Protection Agency were required to include a CBPR project. The purpose of this article is to provide a definition and set of CBPR principles, to describe the rationale for and major benefits of using this approach, to draw on the experiences of six of the Children's Centers in using CBPR, and to provide lessons learned and recommendations for how to successfully establish and maintain CBPR partnerships aimed at enhancing our understanding and addressing the multiple determinants of children's health.     

Promoting health and innovative health promotion practice through a community arts centre

The salubrious effects of participation in and exposure to the arts are well documented. This paper describes the development of a unique arts centre established in a disadvantaged urban school setting as part of a larger community-based health promotion research project. The discussion highlights how community-based arts programming may impact health not only through positive effects on "upstream" non-medical health determinants, particularly aspects of social support, but also through its ability to facilitate the more traditional health-promotion initiatives of the larger parent project. Also discussed is this centre's potential to act as a catalyst to achieve the overarching project goal of enhanced community health by building constitutive capacity around positive aspects of the community, rather than focusing on capacity only as an instrumental resource to solve social or health problems. Greater incorporation of the arts within health-promotion projects offers potential to enhance both health promotion practice and outcomes.     

Multi-agency, multi-professional work: experiences from a drug prevention project

Policy documents at local, national and international level continue to call for greater multi-agency and multi-professional working. These calls are based on three arguments: (1) health and illness are created and influenced by multiple factors outside of health service policy, (2) health improvement requires collaboration between statutory, voluntary and private sector organizations, and (3) efficiency and effectiveness are aided when duplication of effect is avoided and service transition is as seamless as possible. However, there remains limited process-orientated research that has explored the difficulties and challenges faced during multi-agency and multi-professional work. This study employed qualitative methods (interviews, participant observation and documentary analysis) to understand the social construction of a multi-agency and multi-professional health promotion project orientated toward the prevention of drug-related harm. The findings illustrate the ways in which the processes involved in securing funding led to multiple and competing project aims, how changes in personnel and the internal (re)organization of agencies created disjunctions in project membership and shared understandings of key priorities, and how the social need to keep group members 'onside' and committed, competed with the imperatives of prioritization and addressing issues surrounding differentials in power between members and between agencies.     

Evaluation of health policy intervention on the community level--the "Neighborhood Coordination of Health and Social Care" Model Project in North Rhine-Westphalia

Between October 1995 and December 1998 the pilot project 'Local Coordination of Health and Social Care' was conducted in 28 communities of the state of North Rhine-Westphalia. The project has been evaluated by two university research teams. The aim of the project was basically to establish new structures of health planning and coordination at the community level, in order to improve health reporting and health care as well as health promotion. To realize this aim round tables, working groups and project-offices were implemented in the communities. The evaluation was focused on the following question: What were the conditions (structures) and processes that influenced the project outcomes? Qualitative and quantitative methods were applied (interviews, standardised self-administered questionnaires, analyses of documents) to this end. Evaluation of structures showed that most communities succeeded in integrating relevant health policy actors into the newly created round tables and working groups. Working climate and achievements were evaluated favourably by most of the involved actors. All communities succeeded in developing and enacting recommendations for programmes, and about 40% of these programmes were implemented during the project. The probability of programme implementation was particularly high if the programme was based on reliable local data and if execution was effected only on the community level. The possibly beneficial effects on health care and welfare produced by the new programmes could not be assessed within the short project period. The paper concludes with a brief discussion of practical consequences for future health policy at community level.