Identification of gaps in the diagnosis and treatment of childhood asthma using a community-based participatory research approach

The goal of this investigation was to use a community-based participatory research approach to develop, pilot test, and administer an asthma screening questionnaire to identify children with asthma and asthma symptoms in a community setting. This study was conducted as the recruitment effort for Community Action Against Asthma, a randomized trial of a household intervention to reduce exposure to environmental triggers of asthma and was not designed as a classic prevalence study. An asthma screening questionnaire was mailed and/or hand delivered to parents of 9,627 children, aged 5 to 11 years, in two geographic areas of Detroit, Michigan, with predominantly African American and Hispanic populations. Additional questionnaires were distributed via community networking. Measurements included parent report of their child's frequency of respiratory symptoms, presence of physician diagnosis of asthma, and frequency of doctor-prescribed asthma medication usage. Among the 3,067 completed questionnaires, 1,570 (51.2% of returned surveys, 16.3% of eligible population) were consistent with asthma of any severity and 398 (12.9% of returned surveys, 4.1% of eligible population) met criteria, for moderate-to-severe asthma. Among those meeting criteria for moderate-to-severe asthma, over 30% had not been diagnosed by a physician, over one half were not taking daily asthma medication, and one quarter had not taken any physician-prescribed asthma medication in the past year. Screening surveys conducted within the context of a community-based participatory research partnership can identify large numbers of children with undiagnosed and/or undertreated moderate-to-severe asthma. These children are likely to benefit from interventions to reduce morbidity and improve quality of life.     

A community-based evaluation of disability resources and inclusion practices in rural Botswana

BackgroundCommunity-based approaches to enhance the inclusion of persons with disabilities have proven effective; however, not much is known about cultural and contextual factors that influence the capacity of policy implementation and inclusion practices in rural Botswana.ObjectiveThe study evaluated local disability education and health resources in rural Botswana to develop a deeper understanding of cultural and contextual factors impacting inclusion practices.MethodResearchers used socio-demographic and qualitative research methods to conduct a comprehensive community-based needs assessment. Sampling techniques included maximum variation and snowball sampling. Thirty-two individuals participated in the study. Data were collected between June and August of 2019 through participant observation, in-depth interviews, and focus group discussions. An inductive thematic analysis was conducted by examining participants’ attitudes, perceptions, and experiences of community members with disabilities.ResultsFour primary themes emerged identifying factors that affect people living with disabilities in the rural community: (1) culture of vulnerability, (2) determinants of disability, (3) educational resources for persons with disabilities, and (4) effective systems integration. Findings suggested that while policies associated with disability at the government level are in place, disparities among rural communities’ hindered local responses to managing the needs of persons with disabilities.ConclusionsSocial, environmental, and physical barriers prevent the full implementation of policies that advocate for the rights of persons with disabilities in Botswana's rural settings. Increasing awareness of cultural and contextual factors may help community stakeholders facilitate inclusive practices in Botswana.     

Physical Activity Space Methodology for Assessment and Prioritization (PASMAP): Combining systematic observations with community perceptions to identify community physical activity resource priorities

Despite benefits of physical activity (PA), most Americans are not regularly active, with notable disparities for residents of low-income communities. PA is positively correlated with resource availability and quality, which can be measured and quantified by PA resource assessment tools. However, community members’ perceptions are often not considered. This study incorporates community perceptions with systematic environmental observations to identify community PA resource priorities. The PA Space Methodology for Assessment and Prioritization (PASMAP) includes three phases. Phase 1: Promotora-researchers completed 57 PA Resource Assessments (PARAs) in colonias along the Texas-Mexico border assessing quantity and quality of features, amenities, and incivilities. Characteristics were ranked using average PARA scores from all PA spaces. Phase 2: community advisory board (CAB) members (n = 36 from 3 CABs) ranked the importance of each feature, amenity, and incivility respectively; rankings were averaged and ordered. Phase 3: differences between phases 1 and 2 were calculated. Large differences indicated high discordance between systematic observations and perceived importance. Phase 1: highest ranked PARA characteristics were sidewalks, non-street lighting, and noise. Phase 2: CAB members ranked trails/paths, sidewalks, play equipment, bathrooms, drinking fountains, substance abuse evidence, and litter most important. Phase 3: multiple characteristics had high discordance: trails/paths, fenced-in open fields (features), drinking fountains (amenity), and litter (incivility); low quantity/poor quality yet perceived as highly important. Discordant characteristics identified through PASMAP provide evidence-based, community-valued recommendations on PA resource priorities for planning and advocacy. Future work should incorporate perceptions from additional community members and apply PASMAP methods to other environmental assessments.     

社区早期婴幼儿教育与服务对婴儿智能发育的影响

目的评价在社区开展的早期婴幼儿教育和服务对婴儿智能发育的影响。方法采用社区干预研究的方法，将359名新生儿及其家庭作为项目对象。在婴儿满月时进行基线调查，干预组随之接受以婴幼儿养育和智力开发为主要内容的干预活动。在婴儿6月龄和12月龄时进行随访调查。婴儿智力测量采用“0～6岁发育筛查测验”量表。结果两组婴儿的性别和出生过程中的情况差异没有统计学意义。干预组和对照组婴儿基线调查时智力指数（MI）得分分别为98.26分和101．79分，发育商（DQ）得分分别为94．50和99．36分。干预组婴儿6月龄和12月龄随访MI得分较基线的增值分别为6．07和8．86分，高于对照组的增值（-2．46分和1．05分）；干预组6月龄和12月龄随访DQ得分较基线的增值分别为12.94和11．24分，高于对照组的增值（-0．18和0．34分）。MI及DQ得分6月龄及12月龄的组别×时间的交互项（干预作用），均高于基线。结论社区早期教育和服务促进了婴儿的智力发育。     

Complexities of holistic community-based participatory research for a low income, multi-ethnic population exposed to multiple built-environment stressors in Worcester, Massachusetts

Low income, multi-ethnic communities in Main South/Piedmont neighborhoods of Worcester, Massachusetts are exposed to cumulative, chronic built-environment stressors, and have limited capacity to respond, magnifying their vulnerability to adverse health outcomes. “Neighborhood STRENGTH”, our community-based participatory research (CBPR) project, comprised four partners: a youth center; an environmental non-profit; a community-based health center; and a university. Unlike most CBPR projects that are single topic-focused, our ‘holistic’, systems-based project targeted five priorities. The three research-focused/action-oriented components were: (1) participatory monitoring of indoor and outdoor pollution; (2) learning about health needs and concerns of residents through community-based listening sessions; (3) engaging in collaborative survey work, including a household vulnerability survey and an asthma prevalence survey for schoolchildren. The two action-focused/research-informed components were: (4) tackling persistent street trash and illegal dumping strategically; and (5) educating and empowering youth to promote environmental justice. We used a coupled CBPR-capacity building approach to design, vulnerability theory to frame, and mixed methods: quantitative environmental testing and qualitative surveys. Process and outcomes yielded important lessons: vulnerability theory helps frame issues holistically; having several topic-based projects yielded useful information, but was hard to manage and articulate to the public; access to, and engagement with, the target population was very difficult and would have benefited greatly from having representative residents who were paid at the partners’ table. Engagement with residents and conflict burden varied highly across components. Notwithstanding, we built enabling capacity, strengthened our understanding of vulnerability, and are able to share valuable experiential knowledge.     

Opening doors and building capacity: Employing a community-based approach to surveying

Although many community-based initiatives employ community residents to undertake door-to-door surveys as a form of community mobilization or for purposes of needs assessment or evaluation, very little has been published on the strengths and weaknesses of this approach. This article discusses our experience in undertaking such a survey in collaboration with a coalition of community-based organizations (CBOs) in the South Bronx, New York. Although resource constraints limited the already-strained capacity of the CBOs to provide supervision, the CBOs and community surveyors helped us gain access to neighborhood buildings and to individuals who might otherwise have been inaccessible. The survey process also contributed to the coalition’s community outreach efforts and helped to link the CBO leadership and staff more closely to the coalition and its mission. Many of the surveyors enhanced their knowledge and skills in ways that have since benefited them or the coalition directly. The participating CBOs continue to be deeply engaged in the coalitions’ work, and many of the surveyors are active as community health advocates and have taken leadership roles within the coalition.     

Improving the prevention and control of hazardous substance exposures: a randomized controlled trial in manufacturing worksites

BACKGROUND: New measures of exposure prevention (EP) activity were used to evaluate the effectiveness of a 16-month management-focused intervention addressing hazardous substance exposures in manufacturing work settings. METHODS: EP efforts were assessed using a rating scheme developed for this study. The rating scheme yields a set of measures of exposure potential and protection, which are combined into an overall EP summary rating. A randomized, controlled design was used to assess intervention effectiveness. Fifteen large manufacturing worksites completed the 16-month intervention and follow-up assessments. Analyses were conducted on the 107 production processes assessed at both baseline and final. RESULTS: Patterns of improvement within the intervention condition were consistent with the intervention emphasis on upstream or source-focused intervention; whereas patterns in controls were consistent with prevalent practice (more downstream, worker-focused). A mixed model analysis of variance showed greater improvement in EP ratings in intervention versus controls, but the difference in improvement was moderate and statistically non-significant. CONCLUSIONS: This study has demonstrated that EP efforts in the manufacturing sector can be systematically assessed across the full range of hazardous substances in use, and that such assessments can serve both needs assessment and effectiveness evaluation functions. Findings suggest that more sustained or intense management-focused intervention would significantly improve EP activity in manufacturing settings.     

Sex differences in the impact of a community-based program for non-communicable disease prevention: The Isfahan Healthy Heart Program (IHHP)

Aims  To study the feasibility and impact of a comprehensive, integrated, community-based program directed towards reducing modifiable risk factors for cardiovascular disease. In this study, we reported the differences in the impacts of IHHP on physical activity, smoking and nutritional behaviors of a study population based on sex. Subjects and methods  Using multi-stage cluster sampling on people aged ≥19 years of both intervention and reference areas, 12,514 individuals in 2001, 5,891 in 2002, 4,793 in 2003 and 6,097 in 2004 as well as a sample of 3,011 participants from the intervention area in 2005 were enrolled. Women made up 50.8 percent of participants, with similar proportions from 2001 to 2005 and comparable distribution between intervention and reference areas. Eight distinct component interventional projects were designed separately for both sexes to improve modifiable risk factors in the intervention area. The WHO STEPwise risk factor surveillance questionnaires were used to conduct the annual cross-sectional surveys for behavioral changes. Estimates of intervention effect ratio were conducted based on annual changes in the behavioral modifiable risk factors for both men and women. Results  Intervention activities positively affected the total and leisure-time physical activities in men, but not women. Dietary choice of both sexes showed modest degrees of improvement. Smoking status of men improved in the study period (except 2004), while the effect on women was not significant. Conclusions  Further interventions to improve physical activity in women should be regarded as a health priority in Iran. Sex differences should be considered in implementing any health promotion activity. Grant no. HQ/03/873531, WHO Department of Chronic Disease and Health Promotion     

Can communities and academia work together on public health research? Evaluation results from a community-based participatory research partnershipin detroit

This article reports the results of a formative evaluation of the first 4 years of the Detroit Community-Academic Urban Research Center (URC), a community-based participatory research partnership that was founded in 1995 with core funding from the Centers for Disease Control and Prevention (CDC). Several organizations are members of this partnership, including a university, six community-based organizations, a city health department, a health care system, and CDC. The Detroit URC is a strong partnership that has accomplished many of its goals, including the receipt of over $11 million in funding for 12 community-based participatory research projects during its initial 4 years. Detroit URC Board members identified a number of facilitating factors for their growth and achievements, such as (1) developing a sound infrastructure and set of processes for making decisions and working together, (2) building trust among partners, (3) garnering committed and active leadership from community partners, and (4) receiving support from CDC. Board members also identified a number of ongoing challenges, including organizational constraints, time pressures, and balancing community interests in interventions and academic research needs. Overall, the Detroit URC represents a partnership approach to identifying community health concerns and implementing potential solutions.     

环境污染暴露评估的研究进展

环境污染暴露评估研究是环境健康研究的重要组成部分,充分分析环境污染物暴露的研究前沿对把握环境污染暴露研究的发展方向及准确评价健康风险具有重要作用。该文从环境污染的外暴露、内暴露、复合暴露及暴露组学几个方面入手,充分分析区域尺度暴露评估模型、大范围生物连续监测、内分泌干扰物内暴露水平、污染内暴露技术及复合暴露和暴露组学等前沿问题的国内外研究现状,最后对我国环境污染暴露评估的研究方向进行了展望。     

Workshop summary: connecting social and environmental factors to measure and track environmental health disparities

On May 24-25, 2005 in Ann Arbor, Michigan, the US Environmental Protection Agency, the National Institute of Environmental Health Sciences, and the University of Michigan sponsored a technical workshop on the topic of connecting social and environmental factors to measure and track environmental health disparities. The workshop was designed to develop a transdisciplinary scientific foundation for exploring the conceptual issues, data needs, and policy applications associated with social and environmental factors used to measure and track racial, ethnic, and class disparities in environmental health. Papers, presentations, and discussions focused on the use of multilevel analysis to study environmental health disparities, the development of an organizing framework for evaluating health disparities, the development of indicators, and the generation of community-based participatory approaches for indicator development and use. Group exercises were conducted to identify preliminary lists of priority health outcomes and potential indicators and to discuss policy implications and next steps. Three critical issues that stem from the workshop were: (a) stronger funding support is needed for community-based participatory research in environmental health disparities, (b) race/ethnicity and socioeconomic position need to be included in environmental health surveillance and research, and (c) models to elucidate the interrelations between social, physical, and built environments should continue to be developed and empirically tested.     

严格评价两项在非洲开展的HIV/AIDS社区干预项目

采用循证医学中严格评价的方法，在介绍严格评价相关概念的基础上，对在非洲开展的两项HIV／AIDS社区干预的随机对照试验进行评价，并提出讨论。     

Variation in the interpretation of scientific integrity in community-based participatory health research

Community-based participatory research (CBPR) has become essential in health disparities and environmental justice research; however, the scientific integrity of CBPR projects has become a concern. Some concerns, such as appropriate research training, lack of access to resources and finances, have been discussed as possibly limiting the scientific integrity of a project. Prior to understanding what threatens scientific integrity in CBPR, it is vital to understand what scientific integrity means for the professional and community investigators who are involved in CBPR.This analysis explores the interpretation of scientific integrity in CBPR among 74 professional and community research team members from of 25 CBPR projects in nine states in the southeastern United States in 2012. It describes the basic definition for scientific integrity and then explores variations in the interpretation of scientific integrity in CBPR. Variations in the interpretations were associated with team member identity as professional or community investigators. Professional investigators understood scientific integrity in CBPR as either conceptually or logistically flexible, as challenging to balance with community needs, or no different than traditional scientific integrity. Community investigators interpret other factors as important in scientific integrity, such as trust, accountability, and overall benefit to the community. This research demonstrates that the variations in the interpretation of scientific integrity in CBPR call for a new definition of scientific integrity in CBPR that takes into account the understanding and needs of all investigators.     

Feasibility of conducting a randomized trial to promote healthy eating,active play and sustainability awareness in early childhood curricula

We sought to evaluate the feasibility of conducting a randomized trial to evaluate the efficacy of a preschool/kindergarten curriculum intervention designed to increase 4-year-old children's knowledge of healthy eating, active play and the sustainability consequences of their food and toy choices. Ninety intervention and 65 control parent/child dyads were recruited. We assessed the study feasibility by examining recruitment and participation, completion of data collection, realization of the intervention and early childhood educators’ experiences of implementing the study protocol; our findings suggest the intervention was feasible to deliver. In addition, children's sustainability awareness of non-compostable and recyclable items increased. Children in the intervention group significantly reduced their sugary drink consumption and increased their vegetable intake at follow-up compared to control. We conclude with recommendations for revisions to the child interview and parent questionnaire delivery to ensure the roll out of the randomized trial is conducted efficiently and rigorously.     

Participatory research in Northwest Atlanta's Proctor Creek Watershed: Using photovoice to explore environmental health risks at the water's edge

In this study we used a participatory research method, photovoice, to explore community perceptions about environmental health risks, community assets, and strengths in and around an urban, degraded watershed in Northwest Atlanta, Georgia. This watershed, formed by Proctor Creek, is a focal point for redevelopment and infrastructure investments for years to come. Using a community-based participatory research approach, 10 Proctor Creek residents (watershed researchers), and a university partner, engaged in data collection; participatory data analysis; internal discussions; translation of research findings into watershed restoration, community revitalization, remedial action, and policy solutions; and dissemination of results to fellow watershed residents, stakeholders, and decision makers. We present a conceptual model linking the watershed researchers' understanding of urban policies and practice in the Proctor Creek Watershed to environmental, neighborhood and housing conditions and their influence on health outcomes and quality of life. Engaging community members in defining their own community environmental health challenges and assets yielded the following primary themes: 1) threats to the natural environment, 2) built environment stressors that influence health, 3) blight and divestment of public resources, and 4) hope for the future. Residents’ vision for the future of the watershed - a restored creek, revitalized neighborhoods, and restored people - is fueled by a strong connection to history, memory, and sense of place. We demonstrate the value of local knowledge in identifying previously unaddressed environmental health risks in the Proctor Creek Watershed as well as solutions to reduce or eliminate them.     

高血压社区防治中共同学习方法的应用探讨

目的在社区卫生服务中引入“共同学习”方法，探讨其在高血压社区防治中的效果。方法在四川成都和青海西宁各选取社区卫生服务机构10个（干预组、对照组各5个）。采用方便抽样方法在每个社区卫生服务机构辖区内选取60岁及以上老年人200名左右，比较引入“共同学习”方法前后，居民血压控制率及高血压患者的管理覆盖率变化，干预时间为一年。结果西宁市干预组与对照组结局血压控制率分别为50．3％和34．2％，高于基线的43．6％和25．4％，干预组结局的血压控制率高于对照组，经x^2检验，有统计学差异（P〈0．05）。成都市武侯区干预组结局高血压患者的管理覆盖率为8．2％，高于基线5．4％，对照组结局高血压患者的管理覆盖率为2.8％，低于基线3．4％；西宁市干预组、对照组结局高血压患者的管理覆盖率分别为2．8％和1．5％，高于基线的1．6％和0．5％，两地的干预组结局高血压患者的管理覆盖率均高于对照组，经x^2检验，均有统计学差异（P〈0．05）。结论“共同学习”方法在高血压社区防治中具有一定效果。     

Description of YESHealth: A consumer-directed intervention in a randomized trial of methods to improve quality of care for persons with disability

Background

Persons leading their own evaluations of care quality offers the promise of generating maximally meaningful information to ensure person-centered care.

The effect of a community-based coronary risk reduction: the Rockford CHIP

OBJECTIVE: The aim of this study was to assess the clinical effects of a community-based lifestyle intervention program in reducing coronary risk, especially in a high risk group. METHOD: The 40-hour educational curriculum of the Coronary Health Improvement Project (CHIP) delivered over a 30-day period with clinical and nutritional assessments before and after was offered in the spring and fall of 2000 to 2002 through the Center for Complementary Medicine of the Swedish American Health System in Rockford, Illinois to its employees and the general public. The participants were instructed to optimize their diet, quit smoking and exercise daily (walking 30 min/day). RESULTS: The data of the 5 CHIP programs were pooled and analyzed. 544 men and 973 women (almost all Caucasian; mean age 55 years) were eligible for analysis. At the end of the 30-day intervention period, stratified analyses of total cholesterol, LDL, triglycerides, blood glucose, blood pressure and weight showed highly significant reductions with the greatest improvements among those at highest risk. CONCLUSION: Well-designed community-based intervention programs can improve lifestyle choices and health habits. They can also markedly and rather quickly reduce the level of coronary risk factors in a non-randomized population.