CONSUMER SATISFACTION IN TWO SMALL RURAL COMMUNITIES: A QUICK METHODOLOGY TO EMPOWER RURAL COMMUNITIES TO ASSESS THEIR OWN HEALTHCARE NEEDS

ABSTRACT: This study was designed to develop a quick methodology to assess the healthcare needs of a rural community and to determine what factors make these communities 'happy' or 'unhappy' with respect to medical service provision. Two rural shires of approximately 4000 people each were chosen from different health regions of Western Australia. The methodology consisted of interviews with healthcare providers and key community informants as well as a community questionnaire. The interviewing process showed that key community informants offered no new information in addition to that already provided by the healthcare providers. Furthermore, all key points would have been covered by interviewing approximately 60% of all healthcare providers in each community. Hand delivery of the community questionnaire yielded the highest response rate. The level of community satisfaction with general practitioner (GP) and hospital services determines whether a community is medically 'happy' or 'unhappy'.     

A regional health care system partnership with local communities to impact chronic disease

Regional health care systems have significant opportunities to adopt community-oriented approaches that impact the incidence and burden of chronic disease. In 1998, a vertically integrated, regional health care system established a community health institute to identify, understand, and respond to health needs from a community perspective. The project was implemented in four communities (two rural counties, a rural/urban transitional county, and an inner-city community) using five steps: 1) support or form a local community coalition; 2) hire and support a local coordinator; 3) prepare a formal community assessment; 4) fund locally designed interventions; and 5) evaluate each project. In four narrative case studies, we present the steps, challenges, and common principles faced at the local level by Carolinas Community Health Institute. The case studies were prepared using three data sources: reviews of written documents, interviews with the seven-member steering committee, and interviews with six key informants from each county. Data were coded and analyzed using standard qualitative software to identify common themes and sources of variance between cases. The project model was generally well accepted. Local autonomy and domain disputes were challenges in all four sites. Funding for local projects was the most frequently cited benefit. The project was successful in increasing local capacity and supporting well-designed interventions to prevent chronic disease. This approach can be used by large health care systems and by other organizations to better support local health initiatives.     

Durability of tobacco control efforts in the 22 Community Intervention Trial for Smoking Cessation (COMMIT) communities 2 years after the end of intervention

Funding organizations increasingly want to know that successful interventions are continued after the end of a research project. Assessments of durability are rare and where done do not include the comparison communities. In this study we ascertain what tobacco control activities continued in intervention communities involved in the Community Intervention Trial for Smoking Cessation (COMMIT), a randomized, controlled community trial aimed at adult smokers, and also assessed level of tobacco control activities in the comparison communities. A mailed survey of key informants including paid staff and community volunteers in the 22 COMMIT communities was conducted. Approximately 79% of key informants responded to the survey. Although there was evidence that tobacco control activities were continuing in the intervention communities, there was an equal amount of tobacco control effort in the comparison communities. Within the specific tobacco control intervention areas, only the youth area showed more activity in intervention communities than comparison communities. We conclude that despite a positive trial outcome, differential durability was not achieved. More work needs to be done to assist communities in maintaining proven intervention activities. More study of methods to measure durability is also needed.     

关键知情人对河南省社区卫生服务机构反应性的评价研究

目的:了解河南省社区卫生服务机构反应性水平。方法:采用制定的《河南省社区卫生反应性调查表(关键知情人)》问卷,调查社区卫生服务机构关键知情人。采用多输入优序图列法确定河南省社区卫生服务机构反应性各维度权重,采用模糊综合评价法评价反应性水平,采用反应性不平等指数测量反应性分布。结果:共调查有效关键知情人431位。问卷各维度Cronbachα系数均大于0.623,总量表Cronbachα系数为0.850;重测信度的各维度相关系数均大于0.907。反应性水平与分布指数分别为8.33和0.2744,各维度重要性排序为:及时关注尊严基础设施交流保密性社会支持选择性自主性。关键知情人认为脆弱人群在社区卫生机构有时或经常受到不公平对待的比例约为50%。结论:关键知情人认为河南省社区卫生服务机构的反应性水平总体较高,反应性分布比较均衡。但认为在基础设施、对患者的隐私保护、与患者的交流沟通等方面存在很大不足。     

Activating communities for health promotion: a process evaluation method.

OBJECTIVES. To date, evaluations of community-based prevention programs have focused on assessing outcomes, not the process of organizing communities for health promotion. An approach was developed to analyze community organization efforts aimed at advancing community health objectives. These organizational processes are referred to as community activation. METHODS. Information was gathered from 762 informants through a key informant survey conducted in 28 western communities. The data collected included informant ratings of community activation and information about interorganizational activities analyzed through network analytic techniques. RESULTS. Activation levels, as measured by informant ratings, varied across communities. Program coordination, as measured by network analysis, occurred, on average, approximately 30% of the time. Higher income communities tended to be more activated than lower income communities. CONCLUSIONS. There is a widely recognized need for improved information about health-related community organization activities. It appears possible to gather such information through key informant surveys and to develop measures of community organization status that can be used in the evaluation of community health promotion programs.     

PEER REVIEWED: A Regional Health Care System Partnership With Local Communities to Impact Chronic Disease

Regional health care systems have significant opportunities to adopt community-oriented approaches that impact the incidence and burden of chronic disease. In 1998, a vertically integrated, regional health care system established a community health institute to identify, understand, and respond to health needs from a community perspective. The project was implemented in four communities (two rural counties, a rural/urban transitional county, and an inner-city community) using five steps: 1) support or form a local community coalition; 2) hire and support a local coordinator; 3) prepare a formal community assessment; 4) fund locally designed interventions; and 5) evaluate each project.

In four narrative case studies, we present the steps, challenges, and common principles faced at the local level by Carolinas Community Health Institute. The case studies were prepared using three data sources: reviews of written documents, interviews with the seven-member steering committee, and interviews with six key informants from each county. Data were coded and analyzed using standard qualitative software to identify common themes and sources of variance between cases.

The project model was generally well accepted. Local autonomy and domain disputes were challenges in all four sites. Funding for local projects was the most frequently cited benefit. The project was successful in increasing local capacity and supporting well-designed interventions to prevent chronic disease. This approach can be used by large health care systems and by other organizations to better support local health initiatives.

     

Community activation and health promotion: identification of key organizations

PURPOSE. The purpose of this study is to identify the kinds of community organizations community leaders consider important for community health promotion efforts. DESIGN. Key informants were identified by reputational sampling of organizations relevant to community health promotion. Key informants were asked to list organizations they considered important for community health promotion. Differences in identified organizations were compared across informants from seven urban, five suburban, seven rural, and three Native American communities, with significance evaluated by chi-square tests. SETTING. This survey was conducted in 22 Western U.S. communities comprising the intervention and control communities of the Community Health Promotion Grants Program of the Henry J. Kaiser Family Foundation. SUBJECTS. Key informants (N = 184) from community organizations, identified using a reputational sampling technique beginning with the health department, were interviewed by telephone. MEASURES. Key informants listed organizations considered important for community health promotion in five areas: adolescent pregnancy, substance abuse, tobacco use, cancer, and cardiovascular disease. RESULTS. Informants frequently identified the health department (mentioned by 78% of informants overall), schools (72%), governmental agencies (55%), hospitals (47%), health clinics (42%), churches (33%), and newspapers (32%) as important. Organizations more prominent in urban and suburban areas than in rural and Native American areas included television stations, health-related private nonprofit organizations, substance abuse treatment centers, and colleges. Private physicians were frequently identified in rural areas (44% of informants).(ABSTRACT TRUNCATED AT 250 WORDS)     

Changing Community Readiness to Prevent the Abuse of Inhalants and Other Harmful Legal Products in Alaska

This paper presents results from an application of the Community Readiness Model (CRM) as part of a multi-stage community mobilization strategy to engage community leaders, retailers, parents, and school personnel in preventing youth use of inhalants and other harmful legal products in rural Alaska. The CRM is designed to assess readiness to address a single social problem, based on a limited set of key informant interviews. In this study, researchers conducted 32 baseline and 34 post-intervention community readiness assessment interviews in four rural Alaskan communities. These interviews with key informants from the communities were coded and analyzed using CRM methods to yield readiness scores for each community. The aggregate results were analyzed using hierarchical linear modeling (HLM), and the individual community scores were analyzed in the context of the overall study. Significant positive changes in community readiness were found across six readiness dimensions as well as for the overall readiness score. Variation in the degree of changes in readiness across the four communities is attributed to differences in the intervention's implementation. The implications of these results include the potential for CRM assessments to serve as an integral component of a community mobilization strategy and also to offer meaningful feedback to communities participating in prevention research.     

Community participation in the control of Aedes aegypti: opinions of the population in one section of Havana, Cuba]

OBJECTIVE: To analyze opinions on community participation held by residents of one section of the city of Havana, Cuba, in order to identify key criteria to use in preparing a participatory strategy for controlling the Aedes aegypti mosquito. METHODS: The study was conducted from September to October 1999 in Playa, one of the 15 municipios (districts) that make up the city of Havana, Cuba. In the first phase of the study, interviews were carried out with key informants, including health brigade members and sanitation activists, who had lived in Playa for more than five years. The key informants were selected randomly from the nine health areas that the Playa municipio has. Qualitative content analysis was used to identify terms, common expressions, and key concepts related to community participation in the area. In the study's second phase a questionnaire using a Likert scale was prepared for application with a population sample from Playa. Based on the answers from the respondents, a point score with a confidence interval was calculated for each of the 30 statements on the questionnaire. The point scores for those statements were used to identify the population's most relevant criteria, that is, the statements producing the strongest agreement and the ones producing the strongest disagreement. RESULTS: In the first phase, from the interviews with key informants, the three most important variables to explore were identified as: (1) community participation in environmental cleanup, (2) the role and image of community leaders and of community organizations, and (3) community participation, in a general sense, in solving any problem in the community. In the second phase, the population survey indicated that the members of the community recognized the usefulness of community participation in solving local problems, especially for controlling A. aegypti. Among the statements on the questionnaire that had the highest levels of agreement were ones dealing with the value of working together as a team, the knowledge that local authorities had of community problems, and recognition of the obligation that citizens have to take part in developing the community. The statements that had the lowest level of agreement had to do with the need to reward-with more than just words of thanks-residents who regularly serve the community and with the view that the majority of community leaders were more concerned with their personal well-being than with the problems of the community. CONCLUSIONS: The opinions on community participation identified among the population in Playa served as the basis for designing new strategies for controlling A. aegypti. The methodology utilized in this study could be used to plan local participatory processes, both in Cuba and in other countries, and could be applied to other problems whose solution requires community participation.     

A study of a rural community's readiness for telehealth

A qualitative approach was used to explore the readiness of a rural community for the implementation of telehealth services. There were four domains of interest: patient, practitioner, public and organization. Sixteen semistructured telephone interviews (three to five in each domain) were carried out with key informants and recorded on audio-tape. Two community awareness sessions were held, which were followed by five audio-taped focus groups (with five to eight people in each) in the practitioner, patient and public domains. In addition, two in-depth interviews were conducted with community physicians. Analysis of the data suggested that there were four types of community readiness: core, engagement, structural and non-readiness. The level of readiness varied across domains. There were six main themes: core readiness; structural readiness; projection of benefits; assessment of risk; awareness and education; and intra-group and inter-group dynamics. The results of the study can be used to investigate the readiness of rural and remote communities for telehealth, which should improve the chance of successful implementation.     

Caregiver and community insights on coping strategies used by adolescents living in conflict-affected communities

The aim of this qualitative study was to provide a context-specific understanding of adolescent (10–15 years of age) exposure and coping with trauma from the perspective of mothers/female caregivers and key informants in rural conflict-affected villages. Focus groups were conducted with mothers/female caregivers (4 groups with total participants n?=?26) and interviews were conducted with key informants (n?=?9) in four villages in the Walungu Territory, Eastern Democratic Republic of Congo. Focus group and interview guides were designed to elicit responses by participants on adolescent exposures to trauma and coping strategies. A grounded theory approach was used to identify emergent themes. Mothers/female caregivers and key informants reported use of both cognitive and behavioural coping strategies by adolescents. Cognitive coping strategies included avoidance and trying to forget. Behavioural strategies included self-imposed isolation, risk-taking and social-support-seeking behaviours. Findings indicated community social support was a critical resource for adolescents, particularly for adolescents that did not have adequate support from their family. Supporting positive peer, family and community relationships can help prevent risk-taking behaviours and teach positive coping strategies to break a cycle of violence reported in these communities. Recommendations for gender-specific intervention programming are highlighted.

Abbreviations: DRC: Democratic Republic of Congo; PAIDEK: Programme d’Appui aux Initiatives Economiques; PFP: Pigs for Peace; RFR: Rabbits for Resilience     

Use of postpartum health services in rural uganda: knowledge, attitudes and barriers

The purpose of this study was to explore the knowledge, attitudes and barriers to use of postpartum care service among rural communities in Uganda. Study was a part of a larger reproductive health evaluation project, and was cross-sectional in nature utilizing qualitative research methods using the narrative inquiry. Two matched rural communities were used in this study; Semuto in Luwero district, and Lwamaggwa in Rakai district. Fifty key informants who were purposefully selected from each study site were interviewed. They included community leaders, political leaders, health care providers, women leaders and community members. One-on-one interviews were conducted with key community informants using an interview guide. The purpose of the interview was explained to each participant, and written informed consent was obtained before the start of the interview. Respondents were allowed to express their views, opinions and observations on several health issues including postpartum health care services. There was a low level of knowledge about postpartum care services among the respondents of the two communities. There was lack of awareness about postpartum care and it’s benefits. The main barriers to use of services were; misconceptions regarding the importance of postpartum care, distance to health facilities, poverty, and health system factors notably; poor facilities, lack of essential drugs, and poor attitudes of health workers. In the effort to improve reproductive health care services, there is an urgent need to improve postpartum services, and make them more accessible and user friendly. The training of providers at all levels is essential, in addition to educating families on the importance of postpartum care services.Sarah K. Nabukera is Senior Lecturer Community Health, (currently on study leave at the University of Alabama at Birmingham); Charles Muchunguzi, Lecturer Development Studies; Francis Bajunirwe; Vincent K. Batwala; and Edgar M. Mulogo, Lecturers Community Health, all at Mbarara University of Science and Technology, Mbarara, Uganda. Souleymane Barry was Chief of Party DISH II Project, Kampala, Uganda.Kim Witte is Senior Program Evaluation Officer, Center for Communication Programs, Johns Hopkins University, Baltimore, Maryland; Celeste Farr, Assistant Professor Department of Communications, North Carolina State University, Raleigh, North Carolina; and Hamisu M Salihu Associate Professor Maternal and Child Health, University of Alabama at Birmingham, USA.This project was funded by USAID # 617-A-00-00-00-0000-00.     

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.     

A comparison of efficacy of the key informant and community survey methods in the identification of childhood disability in Jamaica.

A comparison of the efficacy of the key informant and the community survey methods for identifying children with disability was carried out in the Jamaican component of an international epidemiological study of childhood disability. Approximately 130 key informants were exposed to a 2-day workshop giving information on signs of disability, aspects of the project, and available services. Questionnaires were given to enable the informants to refer children and they were reminded 6 months later. In the survey method, eight community workers completed a house-to-house survey of all families and administered the 10-question screen with probes on 5475 children, 2 to 9 years old. Seventeen referrals were made by the key informants; of these, two were found to have disabilities. Of the 821 children who tested positive on the 10-question screen in the house-to-house survey, 193 had disabilities. We concluded that the key informant method would not be a satisfactory way of identifying cases of childhood disability.     

Exploring key informants’ perceptions of Covid-19 vaccine hesitancy in a disadvantaged urban community in Ireland: Emergence of a ‘4Cs’ model

AimThe aim of this study was to explore key informants’ views on and experiences with Covid-19 vaccine hesitancy in a Dublin community with a high concentration of economic and social disadvantage and to identify feasible, community-centred solutions for improving vaccination acceptance and uptake.MethodsQualitative, semi-structured interviews were carried out at a local community-centre and a central hair salon. Twelve key informants from the target community were selected based on their professional experience with vulnerable population groups: the unemployed, adults in recovery from addiction, the elderly, and Irish Travellers. Inductive thematic framework analysis was conducted to identify emergent themes and sub-themes.ResultsDrivers of vaccine hesitancy identified by key informants largely fell under the WHO ‘3Cs’ model of hesitancy: lack of confidence in the vaccine and its providers, complacency towards the health risks of Covid-19, and inconvenient access conditions. Covid-19 Communications emerged as a fourth ‘C’ whereby unclear and negative messages, confusing public health measures, and unmet expectations of the vaccine’s effectiveness exacerbated anti-authority sentiments and vaccine scepticism during the pandemic. Community-specific solutions involve the provision of accurate and accessible information, collaborating with community-based organizations to build trust in the vaccine through relationship building and ongoing dialogue, and ensuring acceptable access conditions.ConclusionsThe proposed Confidence, Complacency, Convenience, Covid-19 Communications (‘4Cs’) model provides a tool for considering vaccine hesitancy in disadvantaged urban communities reacting to the rapid development and distribution of a novel vaccine. The model and in-depth key informants’ perspectives can be used to compliment equitable vaccination efforts currently underway by public health agencies and non-governmental organizations.     

'Alukura ... for my daughters and their daughters and their daughters'. A review of Congress Alukura

OBJECTIVE: To describe the process, findings and limitations of a review of Congress Alukura commissioned in 1998. METHODS: Analysis of documents and reports, service use and perinatal data from Alukura and the Northern Territory Midwives Collection; interviews with staff of Congress Alukura, of Central Australian Aboriginal Congress, of Aboriginal community organisations in Alice Springs and remote communities, of health care providers and other key informants in Alice Springs; community consultations through women's meetings or group discussions in local and remote communities. Interviews were coded for thematic and content analysis. RESULTS: Client visits increased by 42% from 1995/96 (2130) to 1997/98. The proportion of women having a first trimester antenatal visit increased from 23% (1986-88) to 38% (1993-95). Mean birthweight of Aboriginal infants in the Alice Springs urban area was 3168 g in 1986-90, 3271 g in 1991-95, and 3268 g in 1996-99. Other primary and maternity care providers perceived the quality of care to be high and saw Alukura playing a key role through transport, liaison, screening and follow-up. Alukura was much less successful in its role as a place for birth. Expectations of additional outreach by local and remote communities were high. DISCUSSION: The review's limitations included: a lack of direct input from young women, the main users of Alukura; a timeframe that precluded the detailed discussion necessary for seeking access to medical records, and the need for interpreters in community settings. Current and former staff who participated in the review often had other important community roles. Developments since the review are discussed briefly.     

Researcher and researched--community perspectives: toward bridging the gap.

In the process of initiating a new community-based research project, the authors wanted to understand the experiences of community members and researchers in community-based research projects and to develop guidelines to improve future projects. They conducted qualitative, key informant interviews with 41 people involved at all levels of community-based research projects in Seattle. Respondents were identified using a snowball sampling technique. More problems than successes were discussed by informants, including dissatisfaction with the focus of research, which some said is marked by a lack of cultural appropriateness and relevance. Power imbalances, lack of trust, and communication difficulties impeded collaboration. According to respondents, many problems could be avoided if the community were involved from the beginning in setting research priorities and developing and implementing interventions. Meaningful collaboration between communities and researchers is characterized by early involvement of communities, power sharing, mutual respect, community benefit, and cultural sensitivity.     

Community perceptions of mental distress in a post-conflict setting: A qualitative study in Burundi

There is scant documentation of the mental health characteristics of low-income communities recovering from armed conflict. To prepare for quantitative health surveys and health service planning in Burundi, we implemented a qualitative study to explore concepts related to mental distress and coping among adults. Mental distress was defined as problems related to feelings, thinking, behaviour and physical stress. Using free listing and key informant interviews with a range of community members, we triangulated data to identify salient issues. Thirty-eight free list respondents and 23 key informants were interviewed in 5 rural communities in Burundi using 2 interview guides from the WHO Toolkit for Mental Health Assessment in Humanitarian Settings. Based on these interviews, we identified four locally defined idioms/terms relating to mental distress: ihahamuka (anxiety spectrum illnesses), ukutiyemera (a mix of depression and anxiety-like syndrome), akabonge (depression/grief-like syndrome) and kwamana ubwoba burengeje (anxiety-like syndrome). Mental distress terms were perceived as important problems impacting community development. Affected individuals sought help from several sources within the community, including community leaders and traditional healers. We discuss how local expressions of distress can be used to tailor health research and service integration from the bottom up.     

The development of measures of community capacity for community-based funding programs in Canada

Improving community capacity for influencing actions on the determinants of health is an immediate outcome of many Public Health Agency of Canada-funding community-based programs. Despite the importance of this outcome, it has been difficult to measure and describe the contribution of funding programs to improving community capacity. This paper reports on a study conducted to develop and establish the psychometric properties of scales that measure community capacity to address health issues in the context of federally funded community-based programs. A literature review and national think tank with 21 experts informed the development of the first draft of the scales that outlined nine key domains of community capacity. Two focus groups with community practitioners provided information on the face and content validity and general usability of this draft instrument. The revised instrument was sent for pilot testing to 114 community organizations. Qualitative and quantitative analyses were performed to assess the validity, reliability and usability of the instrument. Twenty-nine organizations returned a completed instrument (25% response rate). Principal Component Analysis confirmed scale unidimensionality for eight multi-item scales: all of the component loadings were considered good with all scales loading between 0.60 and 0.92. Scale internal consistency was also considered high with alphas between 0.72 and 0.86 for six of these eight scales. Spearman's correlations were significant for the remaining two multi-item scales (composed of two items each), indicating that the two items for each scale were significantly correlated to each other. One scale could not be analyzed quantitatively, as it contained only a single item. Triangulation of qualitative and quantitative results found consistency in interpretations of scale response sets. Feedback on the instrument indicated interest in using it for project planning and evaluation. Psychometric analyses and triangulation provided evidence of the construct validity and reliability of the instrument. The final instrument covers 9 domains and has a total of 26 items, each with a four-point rating scale and a section for qualitative contextual comments. The instrument provides quantitative and qualitative information on community capacity within the context and scope of community-based funding programs.