Conceptual differences between prevention and health promotion: research implications for community health programs

We review recent publications on the concepts of health promotion and prevention. These concepts are based on various paradigms which are defined here. A brief history of the evolution in the meaning of health is presented. Attention is turned to the research implications of the new trend of public health programs which focus on health promotion. In Canada, Achieving Health for All: a framework for health promotion is under examination in order to establish objectives and strategies for the development of health promotion programs. However, a well-articulated research strategy is urgently needed to enhance health promotion activities in this country. Disease prevention and health promotion could continue as distinct entities only if clear operational criteria, characteristics and definitions exist for each of them.     

Falls-prevention programs for older ambulatory community dwellers: from public health research to health promotion policy

Summary Objectives:Falls result in significant morbidity and mortality among the elderly. The purpose was to review the public health research literature on falls prevention among community-dwelling older adults and derive evidence-based implications for health promotion policy.Methods:CINAHL, COCHRANE, EMBASE, MEDLINE, and PUBMED databases were used to search the research literature concerning falls epidemiology, injury mechanisms, and falls-prevention strategies published during 1966–2003.Results:Falls affect one in three older adults living in the community and result in significant fall-related injuries that constitute an important and costly public health problem. There are numerous, but potentially modifiable, determinants of falls. Several community falls-prevention programs have been shown to reduce the incidence of falls and fall-related injuries.Conclusions:The review suggests that there is compelling evidence from public health research to support health promotion policy for making societal investments in community falls-prevention programs.     

Disseminating effective health promotion programs from prevention research to community organizations.

Promising programs developed through health promotion and disease prevention research are not always disseminated to the agencies, organizations, and individuals that can benefit from them most. Systematic and practical approaches to dissemination are needed to ensure that effective programs more often reach end users in communities. This article describes six steps used in translation and dissemination of the ABC Immunization Calendar program to public health centers in St. Louis, Missouri. The authors discuss how one health center successfully adopted this program and provide recommendations for other researchers seeking to disseminate innovative, effective health promotion programs.     

Procuring incentives for community health promotion programs

Many community health promotion programs have used incentives to encourage partcipation and to reward health behavior change. To minimize expenses and to enhance a sense of shared responsibility, a number of projects have turned to community merchants as a source of incentives. This study investigated the relative effectiveness of solicitation methods used to procure incentives from local merchants for community health promotion programs. The effect of setting, i.e. level of urban development, and type of business were also analyzed in terms of procurement rates. Two hundred and eighteen merchants were solicited to gain incentives for two programs. Twenty-four incentives were procured at a total value of $480. Telemarketing and face-to-face contact had similar procurement rates, restaurants were by far the type of business most likely to donate, and rural merchants provided incentives significantly more often than urban merchants, while developing urban area merchants' donation rates were midway in between. Telemarketing was the solicitation method clearly most cost effective.Moshe Engelberg, M.A. is a specialist in health promotion at Healthwise, Inc. in Boise, Idaho. Nadia Hammond, M.P.H. is a research associate in health promotion at the Graduate School of Public Health as San Diego State University. John Elder, Ph.D. and Craig Molgaard, Ph.D. are Assistant Professors of Public Health at San Diego State University. Warren Boskin, Ed.D. is Associate Professor of Health Sciences at San Diego State University.     

Mental health promotion in public health: perspectives and strategies from positive psychology

Positive psychology is the study of what is "right" about people-their positive attributes, psychological assets, and strengths. Its aim is to understand and foster the factors that allow individuals, communities, and societies to thrive. Cross-sectional, experimental, and longitudinal research demonstrates that positive emotions are associated with numerous benefits related to health, work, family, and economic status. Growing biomedical research supports the view that positive emotions are not merely the opposite of negative emotions but may be independent dimensions of mental affect. The asset-based paradigms of positive psychology offer new approaches for bolstering psychological resilience and promoting mental health. Ultimately, greater synergy between positive psychology and public health might help promote mental health in innovative ways.     

Principals and tools for evaluating community-based prevention and health promotion programs.

This article is an overview and practical guide for the evaluation of community-based disease prevention and health promotion programs. The article first offers a rationale for evaluating community-based programs, then enumerates five selected principles that are contemporary to community evaluation. The principles are as follows: (1) evaluation of community programs should include an assessment of program theory; (2) evaluation instruments that are used to measure community programs must be contoured to each individual community; (3) evaluation approaches used should be guided by the questions asked and often require both a quantitative and qualitative orientation; (4) evaluation should be informed by social ecology and social system concepts; and (5) community evaluation should involve local stakeholders in meaningful ways. At the end of each principle, an annotated reference list is provided that contains tools for applying the principle to community evaluation.     

Recruitment strategies for school health promotion research

The initial step of a 4 year study of the diffusion of a school-basedtobacco prevention program was the recruitment of school districtsto participate in the data collection required by the study.The literature on recruitment almost without exception concernsrecruiting individual subjects not organizations into a study.Since no model for recruiting school districts existed, strategiesfrom both the clinical trials and survey research literaturewere used to design the recruitment plan for this study. Thispaper presents the methods used to recruit school districtsinto a 4 year study. The combined strategy of personal visitsand direct mailing with telephone follow-up was successful inrecruiting 132 out of the 166 districts (80%) that were targetedfor inclusion in the study. Recommendations for recruiting schooldistricts are discussed.     

Community demonstration programs for cardiovascular disease prevention: the Asia-Pacific experience.

Cardiovascular diseases are an important and increasing cause of death in many countries in the Asia-Pacific Region. Formal demonstration programs for the prevention of cardiovascular disease are few in number and not likely to be widely used in the future. Prevention programs focused on key risk factors are widely used in the Region and have been successful. Smoking prevention remains a high priority for all countries in the Region.     

Sampling for evaluation. Issues and strategies for community-based HIV prevention programs

Sampling methods are an important issue in the evaluation of community-based HIV prevention initiatives because it is through responsible sampling procedures that a valid model of the population is produced and reliable estimates of behavior change determined. This article provides an overview on sampling with particular focus on the needs of community-based organizations (CBOs). As these organizations continue to improve their capacity for sampling and program evaluation activities, comparisons across CBOs can become more rigorous, resulting in valuable information collectively regarding the effectiveness of particular HIV prevention initiatives. The author reviews several probability and non-probability sampling designs; discusses bias, cost, and feasibility factors in design selection; and presents six guidelines designed to encourage community organizations to consider these important sampling issues as they plan their program evaluations.     

A review of five major community-based cardiovascular disease prevention programs. Part II: Intervention strategies, evaluation methods, and results

Major community-based cardiovascular disease prevention programs have been conducted in North Karelia, Finland; the state of Minnesota; Pawtucket, Rhode Island; and in three communities and more recently in five cities near Stanford, California. The main hypothesis is that community intervention will reduce the prevalence of cardiovascular disease risk factors and consequently reduce cardiovascular disease incidence, morbidity, and mortality. Intervention strategies include community mobilization, social marketing, school-based health education, worksite health promotion, screening and referral of those at high risk, education of health professionals, direct education of adults, and modification of physical environments. Formative evaluation provides short-term feedback to program managers about immediate effects of intervention strategies. Outcome evaluation examines the effects of intervention on longitudinally sampled cohorts and compares cardiovascular risk status and morbidity and mortality in intervention and comparison communities. Results from North Karelia and the Stanford Three Community Study indicate that this model is efficacious and cost-effective. The National Heart, Lung, and Blood Institute biomedical research spectrum envisions research in knowledge transfer and innovation diffusion as the last link in the causal chain whereby research affects the health of the population, but research in this area remains undeveloped compared to other aspects of cardiovascular disease prevention. This is Part II of a two part article; Part I appeared in Volume 4, Number 3.     

Use of community-based mental health programs by HMOs: evidence from a Medicaid demonstration.

BACKGROUND. Proposals to enroll Medicaid beneficiaries in health maintenance organizations (HMOs) have raised concerns that community-based mental health treatment programs would be adversely affected. METHODS. In Hennepin County (Minnesota) 35% of Medicaid beneficiaries were randomly assigned to prepaid plans. Random samples of individuals with severe mental illness with selected from the prepaid enrollees and from beneficiaries remaining with traditional Medicaid. The two groups were compared with respect to their use of community treatment programs and the write-off (the proportion of patient charges for which payment was not received) experienced by those programs for members of the study sample. RESULTS. There was no strong evidence that Medicaid beneficiaries with severe mental illness who were randomly assigned to prepaid plans used community-based mental health treatment programs differently than did other Medicaid beneficiaries. However, write-offs were consistently higher for enrollees in prepaid plans. CONCLUSIONS. In the short run, the use of community-based mental health treatment programs need not be affected by enrollment of Medicaid beneficiaries in prepaid plans, providing that Medicaid program administrators take steps to minimize the disruption of ongoing treatment, offer beneficiaries a choice among prepaid plans, and encourage community treatment programs to contract with plans to serve beneficiaries.     

Researching the implementation of community mental health promotion programs

Understanding the process of program implementation plays a critical role in advancing research, practice and policy in mental health promotion. This paper focuses on the implementation of community mental health promotion and considers the challenges presented in implementing and evaluating complex, multifaceted interventions carried out in the context of dynamic community settings. The Rural Mental Health Project1–3 is presented as a case study to illustrate the practical and research challenges encountered in implementing and evaluating a community mental health promotion initiative. This case study highlights the factors that contributed to the successful implementation and evaluation of a community‐based intervention for rural communities on the border region in the Republic and Northern Ireland. Among the factors identified are: a partnership model of working; local co‐ordinating structures and consultation mechanisms; use of a structured planning model to guide program planning and implementation; mobilisation of cross‐community and inter‐agency support; and a comprehensive logic evaluation framework to assess the input, process, impact and outcomes of the project as it unfolded.     

The community health advisor program and the deep South network for cancer control: health promotion programs for volunteer community health advisors

The Community Health Advisor program is a proven, community-driven health promotion program that identifies and trains natural helpers who then seek to improve the health of individuals and their communities. This article details the basis of the Community Health Advisor model and describes early pilot programs in the Mississippi Delta. Also described is the formation of the Community Health Advisor Network, which provides technical assistance to Community Health Advisor programs and the proliferation of Community Health Advisor programs nationally. Specifically, details are presented of the modification of the model for the Deep South Network for Cancer Control and of early findings showing a decrease in health disparities in Alabama.     

Using a qualitative approach to develop an evaluation data set for community-based health promotion programs addressing racial and ethnic health disparities

Racial and ethnic disparities in health have increasingly become a central focus of health promotion efforts. At the community level, however, collecting data and evaluating these programs has been a challenge because of the diversity of populations, community contexts, and health issues as well as a range of capacities for conducting evaluation. This article outlines a qualitative research process used to develop a Web-based standard program performance data reporting system for programs funded by the U.S. Office of Minority Health (OMH), but generally applicable to community-based health promotion programs addressing health disparities. The "core-and-module" data set, known as the Uniform Data Set (UDS), is a Web-based system and is used as the programwide reporting system for OMH. The process for developing the UDS can be used by any agency, locality, or organization to develop a tailored data collection system allowing comparison across projects via an activity-based typology around which data reporting is structured. The UDS model enables the collection of grounded data reflecting community-level steps necessary to address disparities as well as a reporting structure that can guide data collection based on broader frameworks now emerging that specify criteria for measuring progress toward the elimination of health disparities.     

Building program participation: strategies for recruitment and retention in worksite health promotion programs

Building program participation is vital for all health promotion programs. There are a large variety of strategies that have been used to enhance recruitment and retention in worksite health promotion programs. Many of these strategies are examined and their significance in the design and operation of health promotion programs in worksite settings is reviewed.     

Designing effective health promotion and disease prevention programs

Numerous researchers stress the importance of health promotion and disease prevention programs as a means of helping people to foster positive health and lifestyle habits. Typically, health promotion and disease prevention programs strive to educate the public about risks involved in health abuses and the impact of lifestyle upon health status. Research, however, also reveals that health promotion and disease programs are often poorly designed. In response to the problem, a course model for teaching future health professionals how to strategically plan health promotion and disease prevention programs is presented.