Identifying diabetes knowledge network nodes as sites for a diabetes prevention program

This paper reports on the methods used and results of a study that identified specific places within a community that have the potential to be sites for a diabetes prevention program. These sites, termed diabetes knowledge network nodes (DKNNs), are based on the concept of socio-spatial knowledge networks (SSKNs), the web of social relationships within which people obtain knowledge about type 2 diabetes. The target population for the study was working poor African Americans, Latinos, and European Americans of both sexes in a small rural southern town who had not been diagnosed with diabetes. Information was collected from a sample of 121 respondents on the places they visited in carrying out their daily activities. Data on number of visits to specific sites, degree of familiarity with these sites, and ratings of sites as places to receive diabetes information were used to develop three categories of DKNNs for six subgroups based on ethnicity and sex. Primary potential sites of importance to one or more subgroups included churches, grocery stores, drugstores, the local library, a beauty salon, laundromats, a community service agency, and a branch of the County Health Department. Secondary potential sites included gas stations, restaurants, banks, and post offices. Latent potential sites included three medical facilities. Most of the DKNNs were located either in the downtown area or in one of two shopping areas along the most used highway that passed through the town. The procedures used in this study can be generalized to other communities and prevention programs for other chronic diseases.     

Health literacy in relation to cancer: addressing the silence about and absence of cancer discussion among Aboriginal people,communities and health services

Cancer outcomes for Aboriginal Australians are poorer when compared with cancer outcomes for non‐Aboriginal Australians despite overall improvements in cancer outcomes. One concept used to examine inequities in health outcomes between groups is health literacy. Recent research and advocacy have pointed to the importance of increasing health literacy as it relates to cancer among Aboriginal people. This study examined individual, social and cultural aspects of health literacy relevant to cancer among Aboriginal patients, carers and their health workers in New South Wales. Qualitative interviews were conducted with 22 Aboriginal people who had been diagnosed with cancer, 18 people who were carers of Aboriginal people with cancer and 16 healthcare workers (eight Aboriginal and eight non‐Aboriginal health workers). Awareness, knowledge and experience of cancer were largely absent from people's lives and experiences until they were diagnosed, illustrating the need for cancer awareness raising among Aboriginal people, communities and services. Some beliefs about cancer (particularly equating cancer to death) differed from mainstream Western biomedical views of the body and cancer and this served to silence discussion on cancer. As such, these beliefs can be used to inform communication and help illuminate how beliefs can shape responses to cancer. Participants proposed some practical strategies that could work to fill absences in knowledge and build on beliefs about cancer. These results were characterised by a silence about cancer, an absence of discussions of cancer and an acknowledgement of an already full health agenda for Aboriginal communities. To promote health literacy in relation to cancer would require a multi‐layered programme of work involving grass‐roots community education, workers and Board members of Aboriginal community‐controlled health organisations and speciality cancer services, with a particular focus on programmes to bridge community‐based primary care and tertiary level cancer services.     

某省社区居民高血压知识知晓率和管理治疗情况监测分析

目的通过对某省社区居民高血压知识知晓率和高血压治疗情况的研究,评估社区慢性病管理情况。方法采用SPSS软件对数据进行统计学分析,应用例数和百分比进行描述性统计。结果某省10个项目点共调查了6 376人,调查对象中男性为3 052人,女性为3 324人,男女比例为0.91∶1。高血压相关知识知晓率为47.83%,高血压治疗率为70.95%,高血压控制率为9.37%。结论提高居民的知识知晓率,帮助社区居民养成良好的饮食习惯和健康的生活观念,从而降低社区慢病患者的患病率;加强基层医生的慢性病防治能力,以基本公共卫生服务项目为抓手,切实提高社区慢性病患者管理水平,是社区卫生工作的首要任务。     

Our lives were healthier before: focus groups with African American, American Indian, Hispanic/Latino, and Hmong people with diabetes

Focus groups were conducted to explore health-related beliefs and experiences of African American, Hispanic/Latino, American Indian, and Hmong people with diabetes and engage community members in improving diabetes care and education for these populations. Eighty participants attended 12 focus groups, 3 per population. Major themes were loss of health attributed to modern American lifestyles, lack of confidence in the medical system, and the importance of spirituality. Participants recommended improvements in the areas of health care, diabetes education, social support, and community action. Their recommendations emphasize the importance of respectful, knowledgeable health care providers; culturally responsive diabetes education for people with diabetes and their families; and broad-based community action. These recommendations align with current public health priorities and medical knowledge. It is proposed that healthy traditions from diverse populations can be leveraged to improve the health of all people with diabetes.     

心脑血管病社区干预效果及人群依从性分析

目的：了解城市社区人群在心脑血管病防治上的需求和社区人群对干预措施的依从性。方法：从北京上海和长沙三城市社区年龄在３５岁以上的人群中随机抽取了３１８８名调查对象,采用面对面的问卷方法调查。结果：在３１８８名被调查者中,６１．９２％的被调查者关心医学保健知识。５５％以上的被调查者从宣传单中、３６％以上的被调查者从黑板报中获取心脑血管病、高血压和糖尿病防治知识。９０％以上的被调查者受到社区内开展的健康     

“I Want to Walk with My Moko.” The Application of Social Cognitive Theory in the Creation of a Diabetes Prevention Documentary with New Zealand Māori

Type 2 diabetes is almost three times more prevalent in the indigenous people of New Zealand (Māori) than non-Māori. Despite the high rate of diabetes there is a low level of diabetes knowledge and awareness in the Māori community. Several studies of Māori health identify a need for new health communication approaches to diabetes prevention in order to reduce the gap between Māori and non-Māori disease rates. We applied a Community-Based Participatory Research (CBPR) framework and behavioral theory to create a culturally appropriate documentary for Māori at risk for type 2 diabetes. We discuss how we utilized Bandura’s social cognitive theory to provide a culturally sensitive theoretical basis for behavior change messaging. We outline why social cognitive theory was a culturally appropriate foundation and describe the role of the community in shaping the documentary messaging. A culture-centered approach utilizing participatory methodologies and culturally sensitive behavioral change theory might serve as a model for creating health communication resources in collaboration with other indigenous communities.     

Positive community responses to an arts–health program designed to tackle diabetes and kidney disease in remote Aboriginal communities in Australia: a qualitative study

Objective : The Western Desert Kidney Health Project (WDKHP) is an innovative clinical screening, arts–health and community development program, staffed by Aboriginal health workers. The WDKHP is aimed at prevention and early detection, improving the chance of better management of kidney disease among people in 10 predominantly Aboriginal communities in rural Western Australia. This paper aimed to understand community responses to the WDKHP in three of these communities. Methods : Interviews were undertaken with 26 Aboriginal people living in three remote communities. Community responses were analysed with attention to the social organisation of participants in each community and a focus on the perspectives of key groups, identified here as ‘Community Leaders’, ‘Homelanders’, ‘Refuge Seekers’ and ‘Dislocated’. Results : Participants from all groups reported that the WDKHP was highly acceptable, and an effective means of drawing attention to the need for prevention, early detection and management of diabetes and kidney disease. The integration of Aboriginal health workers to explain the project contributed to the high rates of participation in clinical screening. Conclusions : Outreach clinical services can be an appropriate method of engaging people in remote communities in addressing diabetes and kidney disease. Implications : The remote community setting can act as an ‘enabler’ of healthy lifestyle for Aboriginal people, particularly when augmented by well‐designed outreach programs.     

Aboriginal perspectives of diabetes in a remote community in the Northern Territory

This study explores the knowledge and beliefs of diabetes in a group of Aboriginal people from a remote community in the Northern Territory. Information was gathered from participants through a combination of group discussions, semi-structured interviews and informal conversations. The four themes of explanation of diabetes were: worry, food, family and infections. The most common means of preventing or treating diabetes were stopping worry and changing one's diet. Significantly, few of the participants believed that medication was effective, and weight loss and exercise were not mentioned.
The results highlight the miscommunication about diabetes that has occurred in this population. For effective communication and management of diabetes, health information must incorporate the contemporary health beliefs of the clients.     

Maternity waiting areas – serving all women? Barriers and enablers of an equity-oriented maternal health intervention in Jimma Zone,Ethiopia

ABSTRACT

In Ethiopia, maternal waiting areas (MWAs) – residential areas near health facilities where women can stay while waiting to give birth – are community-based, equity-oriented interventions to improve maternal outcomes among rural populations. In this qualitative study we sought to explore the barriers and enablers that Health Extension Workers (HEWs) encounter when engaging with communities about MWAs. We conducted semi-structured interviews with HEWs across rural sites in Jimma Zone, Ethiopia. Drawing from an ecological model of social determinants of maternal and child health, we analysed data using thematic coding methods. HEWs reported a variety of factors that determined MWA use, including the number of children at home, previous childbirth experiences, community support networks, decision making practices within families, the availability and acceptability of health services, geographical access, and health beliefs. HEWs worked to increase the use of MWAs by engaging with husbands and communities, raising awareness in target groups of women, and managing community participation. Policies and practices that support enhanced training for HEWs, increased resources for communities, and greater opportunities for HEWs to liaise with decision makers at various levels of influence are possible ways forward to improve MWA use, specifically, and maternal and neonatal/child health outcomes more generally.     

北京市东城区慢性病防治研究结果与策略

慢性病 ,特别是循环系统慢性病以其高患病率、高死亡率、缺乏特效疗法等特点 ,形成了对社区居民健康的重要威胁。为探索慢性病的发展规律及防治方法 ,提高居民总体健康水平 ,我们从 1981～1997年进行了循环系统慢性病防治研究。在基线调查的基础上 ,在实验区开展了健康教育、限盐、戒烟、控酒 ,提倡合理膳食及开展健身运动等一系列干预措施 ,取得了较好效果 ,居民和高血压病人在慢性病防治知识掌握率、降低吸烟、饮酒率、减少食盐摄入等方面 ,以及高血压病人的症状改善、血压下降等方面 ,实验区都优于对照区 ,差异有非常显著性。在 16年防治工作的基础上 ,我们提出了当前城市社区居民循环系统慢性病防治策略的建议 ,以促进慢性病防治的进一步开展。     

The strategic network position: a feasible model for implementing a decentralized psychiatry

The Norwegian psychiatric health system is sectorized, decentralizedand mainly in the public domain. This paper examines the theoreticaland empirical foundation for community psychiatry with the responsibilityfor dealing with all mental disorders within the confines ofa community, both current and potential cases. Some resultsfrom a comprehensive epidemiological research project in a catchmentarea—Lofoten in Northern Norway—are presented. Thepaper describes a model— the strategic network position—andits application in the same area. A main requirement for themodel is a small catchment area (25—35 000 inhabitants)with geographical and personal proximity of psychiatric specialists,primary health services and other resources for mental healthin a community. The model aims at reaching in an optimal waythe people and the networks which influence the present andfuture mental health of the given communities. The model alsofocuses on various preventive and mental health promoting approacheswhich are feasible in the Norwegian social system. The recognizedstrategic networks consist of the most demanding patients, peoplewith explicit responsibility for treatment and care of definedpsychiatric patients, persons often in contact with people ina position to influence attitudes or with possibilities forobserving a great number of people, persons setting the frameworkand priorities for health and social services and people withspecial influence on the social function of the local communities.The attention and collaboration take place in the normal dayto day working situation, in offering support in crisis situationsand in establishing priorities when there is a need of psychiatrichelp. The model, so far, contributes in a promising way, bothto psychiatric treatment and implementation of mental healthpromotion in the community.     

蚌埠市社区慢病防治综合干预试点基线调查

目的研究蚌埠市城市社区居民存在的与慢性病的发生密切相关的主要不良行为和生活方式现况，为制定针对性较强的切合蚌埠地区社区居民的慢性病防治综合干预措施提供依据。方法在试点社区随机抽取206人，采用《社区居民营养与慢性病调查问卷》进行调查。结果蚌埠市试点社区人群慢病防治的知识、行为水平较低，分别为47．03％、54．77％。结论加强社区健康教育工作十分必要，且具有可行性。     

Knowledge and health information communication in Tanzania

OBJECTIVE: To explore and identify gaps in knowledge and information communication at all levels of health delivery system in Tanzania. METHODS: In-depth interviews and twelve Focus Group Discussions were conducted to capture information on the community knowledge on different health problems and the health information communication process. Interviews and discussions were also held with primary schoolchildren, traditional healers, health facility workers and district health management team members. Documentary review and inventory of the available health education materials at community, health facility and district levels, was made. RESULTS: Major community health and health-related problems included diseases (61.6%), lack of potable water (36.5%), frequent famine (26.9%) and lack of health facility services (253%). Malaria, HIV/AIDS and diarrhoeal diseases were the leading causes of morbidity and mortality. Most of the health communication packages covered communicable diseases and their prevention. Health care facility was the main (91.6%) source of health information for most communities. Public meetings, radio and print materials were the most frequently used channels of health information communication. Major constraints in adopting health education messages included poverty, inappropriate health education, ignorance and local beliefs. CONCLUSION: This study has identified gaps in health knowledge and information communication in Tanzania. There is lack of adequate knowledge and information exchange capacities among the health providers and the ability to share that information with the targeted community. Moreover, although the information gets to the community, most of them are not able to utilize it properly because they lack the necessary background knowledge.     

沈阳市大东区2013年主要慢性病及其危险因素现况调查

目的 为了尽快完善沈阳市大东区慢性病综合防治体系,推动社区卫生服务与慢性病防治相结合的综合防治工作,为制定大东区慢性病防治对策提供参考依据.方法 采取多阶段分层整群随机抽样方法,随机抽取大东区28个社区2 449名18岁以上居民进行慢性病患病率及相关危险因素调查.结果 大东区居民高血压患病率为17.35％,糖尿病患病率为4.12％,男女性慢性病患病率均随着年龄的增长而上升;吸烟、饮酒、缺乏运动和超重等因素是社区慢性病的主要危险因素.结论 大东区高血压和糖尿病发病处于中等水平,随着年龄的增加患病率明显上升.因此,针对居民中的吸烟、有害饮酒及活动量不足等慢性病主要危险因素采取干预措施,加强健康教育,提高居民的健康知识水平、控制危险因素的技能和居民的生活质量,已经成为当前公共卫生面临的重大问题,也是疾病预防控制工作的重要内容.     

What Is Community? An Evidence-Based Definition for Participatory Public Health

Increased emphasis on community collaboration indicates the need for consensus regarding the definition of community within public health. This study examined whether members of diverse US communities described community in similar ways. To identify strategies to support community collaboration in HIV vaccine trials, qualitative interviews were conducted with 25 African Americans in Durham, NC; 26 gay men in San Francisco, Calif; 25 injection drug users in Philadelphia, Pa; and 42 HIV vaccine researchers across the United States. Verbatim responses to the question "What does the word community mean to you?" were analyzed. Cluster analysis was used to identify similarities in the way community was described. A common definition of community emerged as a group of people with diverse characteristics who are linked by social ties, share common perspectives, and engage in joint action in geographical locations or settings. The participants differed in the emphasis they placed on particular elements of the definition. Community was defined similarly but experienced differently by people with diverse backgrounds. These results parallel similar social science findings and confirm the viability of a common definition for participatory public health.     

The treatment gap and primary health care for people with epilepsy in rural Gambia

OBJECTIVE: To study primary-level management for people with epilepsy in rural Gambia by means of community surveys. METHODS: After population screening was carried out, visits were made by a physician who described the epidemiology of epilepsy and its management. Gaps between required management and applied management were investigated by conducting interviews and discussions with people with epilepsy and their communities. FINDINGS: The lifetime prevalence of epilepsy was 4.9/1000 and the continuous treatment rate was less than 10%. The choice of treatment was shaped by beliefs in an external spiritual cause of epilepsy and was commonly expected to be curative but not preventive. Treatment rarely led to the control of seizures, although when control was achieved, the level of community acceptance of people with epilepsy increased. Every person with epilepsy had sought traditional treatment. Of the 69 people with active epilepsy, 42 (61%) said they would like to receive preventive biomedical treatment if it were available in their local community. Key programme factors included the local provision of effective treatment and community information with, in parallel, clarification of the use of preventive treatment and genuine integration with current traditional sources of treatment and advice. CONCLUSION: Primary-level management of epilepsy could be integrated into a chronic disease programme covering hypertension, diabetes, asthma and mental health. Initial diagnosis and prescribing could take place away from the periphery but recurrent dispensing would be conducted locally. Probable epilepsy etiologies suggest that there is scope for primary prevention through the strengthening of maternal and child health services.     

Community health workers: social justice and policy advocates for community health and well-being

Community health workers are resources to their communities and to the advocacy and policy world on several levels. Community health workers can connect people to health care and collect information relevant to policy. They are natural researchers who, as a result of direct interaction with the populations they serve, can recount the realities of exclusion and propose remedies for it. As natural researchers, they contribute to best practices while informing public policy with the information they can share. In this light, community health workers may also be advocates for social justice.     

‘Your wealth is your health’: the fundamental causes of inequalities in diabetes management outcomes: a qualitative analysis

Fundamental Cause Theory (FCT) is among the most influential explanations for health inequalities. The theory posits that the social gradient in health persists because higher-socioeconomic status (SES) groups are systematically more able to take advantage of new medical innovations and health-enhancing knowledge due to their greater access to resources. Taking the life histories of people with diabetes (PwD) (N = 17) in the Republic of Ireland as a case study, this paper aims to elucidate the behaviours and agencies underlying 'fundamental causality' through examining how PwD of contrasting SES respond to disease management information. Findings highlight how the most common barriers to effective diabetes control were chronic psychological distress, combined with the cultural significance of alcohol consumption, which was central to both the social and economic subsistence of male participants in particular. However, higher-SES groups were more likely to experience a 'turnabout' in their life, whereby they could remove themselves from the conditions giving rise to their distress and move into a social space where more health-enhancing behaviours were possible. It concludes with a discussion of potential mechanisms that may explain why such turnabouts were more likely to occur in the case of higher-SES groups and the implications for FCT.     

HDHL-INTIMIC: A European Knowledge Platform on Food,Diet, Intestinal Microbiomics,and Human Health

Studies indicate that the intestinal microbiota influences general metabolic processes in humans, thereby modulating the risk of chronic diseases such as type 2 diabetes, allergy, cardiovascular disease, and colorectal cancer (CRC). Dietary factors are also directly related to chronic disease risk, and they affect the composition and function of the gut microbiota. Still, detailed knowledge on the relation between diet, the microbiota, and chronic disease risk is limited. The overarching aim of the HDHL-INTIMIC (INtesTInal MICrobiomics) knowledge platform is to foster studies on the microbiota, nutrition, and health by assembling available knowledge of the microbiota and of the other aspects (e.g., food science and metabolomics) that are relevant in the context of microbiome research. The goal is to make this information findable, accessible, interoperable, and reusable (FAIR) to the scientific community, and to share information with the various stakeholders. Through these efforts a network of transnational and multidisciplinary collaboration has emerged, which has contributed to further develop and increase the impact of microbiome research in human health. The roles of microbiota in early infancy, during ageing, and in subclinical and clinically manifested disease are identified as urgent areas of research in this knowledge platform.