Assessment of capacity for cardiovascular disease control and prevention in Thailand: a qualitative study

The present study explored community members' knowledge and perceptions about cardiovascular disease (CVD), risk factors and prevention, and identified the current capacity of primary care providers to manage and control CVD at the provincial level. A qualitative study, including in-depth interviews and focus group discussions, was conducted in Suphan Buri Province, Thailand. Participants included community members, CVD patients and healthcare providers in health centers and hospitals. The results showed that community members had little knowledge about the symptoms and signs of heart attack or stroke. They perceived that existing health centers and community hospitals were not sufficiently equipped to treat CVD patients. Primary healthcare workers reported that they lacked skills to manage heart disease, particularly emergency care. Physicians said that they had too little time to educate patients and felt that medical schools should update their curricula, including practical training on CVD management in a low-resource setting. Nurses reported that they had inadequate training in health education for the prevention of CVD. There was a problem of inadequate feedback mechanisms in the existing referral system for continuing improvement. All of the health professionals agreed that more community participation and the involvement of non-health sectors and non-government organizations were needed in the national CVD control program. In conclusion, capacity building for strengthening CVD prevention and control at the primary care level should be implemented. The existing training and education systems have to be revised with an orientation towards health promotion and disease prevention. Publicity of CVD burden and preventive measures, and local programs, should be implemented with community participation.     

Randomized controlled study of a retiree health promotion program. The Bank of American Study.

The initial results of a 12-month controlled trial of a health promotion program in 5686 Bank of America retirees, randomized into full program, questionnaire only, and insurance claims only groups, were analyzed to determine whether the health promotion program was effective. Comparisons were between program and questionnaire only groups for self-reported health habit changes, health risk scores, medical care utilization, and days confined to home, and between all groups for insurance claims data. The intervention, or full program, included health habit questionnaires administered every 6 months, individualized time-oriented health risk appraisals, personal recommendation letters, self-management materials, and a health promotion book. Twelve-month changes in health habits, health status, and economic variables favored the full program group in 31 of 32 comparisons and were statistically significant at the .05 level in two-tailed tests in 19 comparisons and at the .01 level in two-tailed tests in 13 comparisons. Over 12 months, overall computed health risk scores decreased by 4.3% in the full program experimental group and increased by 7.2% in the questionnaire only control group. Total direct and indirect costs decreased by 11% in the experimental group and increased by 6.3% in the questionnaire only control group. Analysis of claims data confirmed these trends. A low-cost health promotion program for retirees was effective in changing health behaviors and has potential to decrease health care utilization.     

'Effect Typology' and Work Ability Index : Evaluating the Success of Health Promotion in Elder Workforce

Changes in work ability and work interest (meaning) after the participation in a health promotion program were perceived and evaluated. Drivers of the Munich Transport Authority (n=122) of an average age of 50 years participated in 20 health days during working time over 1 year. The evaluation instruments of the health promotion program were the Work Ability Index (WAI) developed by the Finnish Institute of Occupational Health (FIOH) and the Effect Typology developed by the Institute of Occupational Health Promotion (IBG Austria). No changes were found in the WAI score. The Effect Typology evaluated the optimal effect ''evolution,'' i.e., psychological and noetic (mental) changes, for 50% of the participants. A variance analysis of the WAI pre-post differences according to the effect classes of the Effect Typology showed significant differences, namely an increase in the WAI in the evolution group and a drop in the recovery group. The Effect Typology is suitable for the evaluation of occupational health promotion and for the further understanding and development of the WAI.     

Impact of education on knowledge, agricultural practices, and community actions for mosquito control and mosquito-borne disease prevention in rice ecosystems in Sri Lanka

Mosquito-borne diseases are a major public health threat in Sri Lanka. A 20-week pilot education program to improve community knowledge and mosquito control with participatory and non-chemical approaches was developed, implemented, and evaluated using pre-educational and post-educational surveys in two intervention and two comparison villages. Correlates of baseline knowledge were sex, number of family members, ratio of family members with malaria history, school education level, and availability of electricity at the residence. Participation in the educational program led to improved knowledge of mosquito ecology and disease epidemiology, changes in agricultural practices, and an increase in environmentally sound measures for mosquito control and disease prevention. The variety of actions at the post-educational stage were determined by improved knowledge, but not by sociodemographic characteristics. Such community-based educational interventions are effective in increasing understanding and active involvement in mosquito control and disease prevention in rice ecosystems regardless of sociodemographic characteristics.     

"Effect typology" and work ability index: evaluating the success of health promotion in elder workforce.

Changes in work ability and work interest (meaning) after the participation in a health promotion program were perceived and evaluated. Drivers of the Munich Transport Authority (n = 122) of an average age of 50 years participated in 20 health days during working time over 1 year. The evaluation instruments of the health promotion program were the Work Ability Index (WAI) developed by the Finnish Institute of Occupational Health (FIOH) and the Effect Typology developed by the Institute of Occupational Health Promotion (IBG Austria). No changes were found in the WAI score. The Effect Typology evaluated the optimal effect "evolution," i.e., psychological and noetic (mental) changes, for 50% of the participants. A variance analysis of the WAI pre-post differences according to the effect classes of the Effect Typology showed significant differences, namely an increase in the WAI in the evolution group and a drop in the recovery group. The Effect Typology is suitable for the evaluation of occupational health promotion and for the further understanding and development of the WAI.     

Implementation and effectiveness of a community-based health promotion program for older adults

BACKGROUND: Because preventing functional decline in older adults is a national priority and senior centers have been identified as potentially important venues for health-promotion activities, a trial of a multicomponent disability prevention program was conducted at a senior center. METHODS: One hundred older adults were recruited for a 6-month randomized clinical trial. All members of the experimental group received an exercise intervention, nutrition counseling, and a home safety assessment. Smoking and alcohol interventions were delivered to at-risk subjects. Outcome variables included the Medical Outcomes Study Short Form (SF-36) health survey, the CES-Depression scale, bed days, and restricted-activity days. RESULTS: A single study announcement resulted in a response sufficient to recruit 100 subjects. The exercise program was well received: 85% of intervention subjects completed the 6-month program and adherence was excellent, with over 90% attendance at exercise classes. After 6 months the intervention group had significantly better scores on 7 of 8 SF-36 subscales and fewer depressive symptoms than controls. CONCLUSIONS: Senior centers may be excellent sites for community-based health promotion interventions: participation and adherence rates may be acceptable, interventions can be designed that are feasible in this setting, and these interventions appear to affect health status positively. The study program improved physical and psychosocial functioning and is a promising model for preventing functional decline through activities based at senior centers.     

手足口病健康教育中同伴教育的应用对不良情绪产生的影响

目的探讨手足口病健康教育中同伴教育的应用对不良情绪产生的影响。方法选取2017年1月至2019年1月在本院进行手足口病治疗的98例患儿家属作为本研究对象,随机设为研究组与对照组。对照组采用常规健康宣教,研究组在对照组基础上实行同伴教育。比较两组的紧张情况、疾病总知晓率以及干预前后的不良情绪评分。结果研究组总紧张率低于对照组(P<0.05);研究组疾病知识总知晓率高于对照组(P<0.05);研究组干预后的不良情绪评分均低于对照组(P<0.05)。结论在对手足口病患儿家属进行健康教育的同时实行同伴教育,能够促使家属的参与度得到显著提升,更加有助于患儿家属对疾病相关知识进行准确了解,且有效缓解其紧张及抑郁等不良情绪,利于临床应用及推广。     

Older and wiser: a hospital-based comprehensive geriatric program

A survey of a sample of members and a 9-month study of all members were undertaken in 1988, four years after a hospital implemented a comprehensive geriatric program. It was found that surveyed members join this program for its reasonable cost but continue with it because of the good health care. Medical care and no claim forms or bills were the two services that surveyed members valued most and used more. Similarly, the entire membership used these two services more; however, it also lodged more complaints about and suggestions for improving medical care than any other service.     

Promoting mental health in rural elders: a pilot program

Objective: This paper reports on the development and trial of a mental health promotion program for older people in rural north‐east Victoria entitled Healthy & Wise. The objective of the program was to increase mental health literacy among older adults referred to Aged Psychiatry who were not diagnosed with a psychiatric disorder but who were experiencing difficulties in dealing with the stresses of later life. A further objective of the program was to assist older adults develop skills in adapting to these stresses. Method: Delivery of the program was in a small‐group format. Evaluation utilised both quantitative and qualitative assessment of outcomes. In this report the focus is on assessment based on the Geriatric Depression Scale self‐administered to participants before the program began, post program, and at a 6‐month follow‐up. Results: There was a significant reduction in GDS score over time (pre/post) which was maintained at follow up. The program was successful in attracting participants experiencing a number of risk factors associated with poorer mental health (e.g. chronic illness). Conclusion: Adoption of Healthy & Wise, a trialed and evaluated community mental health program for older adults, could extend the delivery of mental health services in rural areas in an economic and effective way. At a time when smaller rural communities are ageing more rapidly than Australia as a whole, and funding constraints continue, it is recommended as a valuable addition to current programming. Because the study does not include a control group and because participants self selected for the program, generalisation to other populations and settings needs to be cautious. However, because of the success of this trial, it is recommended that the program be tested with other populations. Target groups might include hostel residents and carers of people with dementia.     

Effective strategies for reaching high-risk minorities with diabetes

The NDOP goals of enhancing diabetes awareness by increasing screening activities within select African American neighborhoods and involving residents in health promotion activities were met during the course of the project. The coalition focused on principles suggested for diabetes programs directed at African American communities, including involving a target audience, providing a service, empowering people, and respecting cultural diversity. The focus group mechanism facilitated the input of community members into the program design prior to implementation and insured their involvement throughout the project. The screening and education program fostered empowerment by increasing community residents' control, focusing on their strengths, and identifying personal health goals. Funding support from the New York State Department of Health and the American Association of Diabetes Educators' Research Foundation were both essential in implementing the program. The program was well received. Most of the participant evaluations rated the program as excellent or very good. The program sites, although demographically situated within identified African American communities, produced a greater number of Caucasian and Hispanic participants than expected. Although the older group of African American women constituted 25% of the total population screened, it did not reach the desired number of 300 participants. Future programs need to target sites where older African American women are more likely to be found in greater numbers. Key to the program's success was building strong partnerships with community leaders who served as cultural spokespersons for the initiative to ensure participation from the community. Developing this partnership proved to be more challenging than originally anticipated and required a respectful, persevering approach. Yet once the coalition achieved cohesion, the volunteer members were invaluable in planning and implementing program events. Community members eventually took charge of the coalition and organized programs that have extended beyond the 2-year period of the grant. The coalition continues to expand; members have been added and education programs at churches and community meetings are ongoing. Addressing the problem of diabetes in African American communities requires programs that are innovative, culturally and educationally appropriate, and presented regularly. Such ongoing efforts can increase the knowledge in African American communities and ultimately enhance the health outcomes of community members.     

Factors associated with physiotherapy provision in a population of elderly nursing home residents; a cross sectional study

Background

Evaluating collaborative community health promotion initiatives presents unique challenges, including engaging community members and other stakeholders in the evaluation process, and measuring the attainment of goals at the collective community level. Goal Attainment Scaling (GAS) is a versatile, under-utilized evaluation tool adaptable to a wide range of situations. GAS actively involves all partners in the evaluation process and has many benefits when used in community health settings.

Methods

The purpose of this paper is to describe the use of GAS as a potential means of measuring progress and outcomes in community health promotion and community development projects. GAS methodology was used in a local community of seniors (n = 2500; mean age = 76 ± 8.06 SD; 77% female, 23% male) to a) collaboratively set health promotion and community partnership goals and b) objectively measure the degree of achievement, over- or under-achievement of the established health promotion goals. Goal attainment was measured in a variety of areas including operationalizing a health promotion centre in a local mall, developing a sustainable mechanism for recruiting and training volunteers to operate the health promotion centre, and developing and implementing community health education programs. Goal attainment was evaluated at 3 monthly intervals for one year, then re-evaluated again at year 2.

Results

GAS was found to be a feasible and responsive method of measuring community health promotion and community development progress. All project goals were achieved at one year or sooner. The overall GAS score for the total health promotion project increased from 16.02 at baseline (sum of scale scores = -30, average scale score = -2) to 54.53 at one year (sum of scale scores = +4, average scale score = +0.27) showing project goals were achieved above the expected level. With GAS methodology an amalgamated score of 50 represents the achievement of goals at the expected level.

Conclusion

GAS provides a "participatory", flexible evaluation approach that involves community members, research partners and other stakeholders in the evaluation process. GAS was found to be "user-friendly" and readily understandable by seniors and other community partners not familiar with program evaluation.     

中国结核病防治健康教育材料资源库使用情况评估

目的　评价《中国结核病防治健康教育材料资源库》的使用情况,为进一步完善资源库、指导各级正确使用资源库提供科学的依据。方法 收集2006年7月—2007年6月各级结防机构资源库内宣传材料的使用情况,采用问卷调查法进行相关内容收集。结果 资源库内宣传材料总体使用率较低,仅为28.6%,其中平面宣传材料使用率高于广播电视媒体宣传材料;在不同种类的平面宣传材料中黑白单片和彩色单片印制数量最多;另外,71.4%的电视媒体宣传材料和52.8%的广播媒体宣传材料在黄金时间播出。结论 为达到《结核病防治规划(2001—2010年)》2010年全民结核病防治知晓率80%的目标,各级应充分、合理的使用资源库内的宣传材料,同时资源库本身应不断得到完善和更新,以应对结核病防治工作中不断出现的新挑战。     

Innovative Business Approaches for Incenting Health Promotion in Sub-Saharan Africa: Progress and Persisting Challenges

Non-communicable chronic diseases related to behaviors such as tobacco use, overeating, excess alcohol intake and physical inactivity account for increasing morbidity and mortality in South Africa. Over the last 15 years, Discovery Health, the largest private health plan in South Africa, has developed a voluntary health promotion program called Vitality with over 1.5 million members. Vitality was designed with many applications drawn from the growing field of behavioral economics, including the use of incentives and rewards. Incentives offered on the program are aimed at lowering the financial barriers to activities such as visiting the gym, buying healthy food or receiving preventive screening. Members accrue points for engagement which translate into discounts on a range of goods and services. Although the full impact of the program cannot yet be quantified, engagement with the program is continually increasing and there is compelling evidence that this translates into better health and cost outcomes.     

Community-based health coaching, exercise, and health service utilization

OBJECTIVE: The outcomes of the California Public Employees Retirement System's Health Matters program, a replication of a health promotion and fitness program known as the Senior Wellness Program (SWP), are reported. METHOD: A randomized controlled design (n = 504) was used. Eligibility included one or more qualifying chronic health conditions, age 65 or older, member of a participating health plan, and owner of a CalPERS long-term care insurance policy. Disability risk factors were measured via questionnaires and included health status, pain, exercise, depression, and social activity. Activity was compiled in project records. RESULTS: At 12 months, Health Matters members were engaged in significantly more stretching and aerobic exercise than the controls. Depressive symptoms decreased among those with moderate or higher symptom scores. DISCUSSION: Health Matters extends the SWP model to younger, more active, and healthier individuals with improvements in duration of exercise and stretching; use of other health promotion activities was low.     

Reduction of hospital utilization in patients with chronic obstructive pulmonary disease: a disease-specific self-management intervention

BACKGROUND: Self-management interventions improve various outcomes for many chronic diseases. The definite place of self-management in the care of chronic obstructive pulmonary disease (COPD) has not been established. We evaluated the effect of a continuum of self-management, specific to COPD, on the use of hospital services and health status among patients with moderate to severe disease. METHODS: A multicenter, randomized clinical trial was carried out in 7 hospitals from February 1998 to July 1999. All patients had advanced COPD with at least 1 hospitalization for exacerbation in the previous year. Patients were assigned to a self-management program or to usual care. The intervention consisted of a comprehensive patient education program administered through weekly visits by trained health professionals over a 2-month period with monthly telephone follow-up. Over 12 months, data were collected regarding the primary outcome and number of hospitalizations; secondary outcomes included emergency visits and patient health status. RESULTS: Hospital admissions for exacerbation of COPD were reduced by 39.8% in the intervention group compared with the usual care group (P =.01), and admissions for other health problems were reduced by 57.1% (P =.01). Emergency department visits were reduced by 41.0% (P =.02) and unscheduled physician visits by 58.9% (P =.003). Greater improvements in the impact subscale and total quality-of-life scores were observed in the intervention group at 4 months, although some of the benefits were maintained only for the impact score at 12 months. CONCLUSIONS: A continuum of self-management for COPD patients provided by a trained health professional can significantly reduce the utilization of health care services and improve health status. This approach of care can be implemented within normal practice.     

Development of an Internet/Population-Based Weight Management Program for the U.S. Army

A significant number of Army soldiers are sufficiently overweight to exceed the maximum weight allowances defined by the Army weight control program (AR600-9). Also, the body weights of a substantial number of soldiers approach the maximum weight allowances. These soldiers should not gain additional weight if they are to meet Army weight allowances. The conventional approach to this overweight problem is assigning soldiers to remedial physical training and mandatory referral for nutrition counseling by a health care provider. An alternative to this conventional approach is to target the entire population of soldiers (population-based intervention) to promote weight loss in overweight soldiers and weight gain prevention in soldiers who are approaching overweight status. To accomplish this objective, the Healthy Eating, Activity, and Lifestyle Training Headquarters (H.E.A.L.T.H.) program was developed. This article describes the rationale for developing the program, the components of the program, and the utilization promotion strategies of the program. The H.E.A.L.T.H. program includes two primary components: (1) a Web site tailored to the standards established in Field Manual 21-20, Physical Fitness Training, Army physical fitness test, and AR600-9, the army weight control program, and (2) a health promotion program designed to promote awareness of the H.E.A.L.T.H. Web site and to facilitate use of the Web site by soldiers and their family members. The Web site is equipped with personalized planning tools and progress tracking over time related to fitness, caloric intake, and lifestyle behavior change goals. The health promotion program includes media advertisements and “ground roots” efforts to facilitate use by soldiers.     

Addressing the needs of Nicaraguan older adults living on the edge: A university–community partnership in international service-learning

ABSTRACT

Nicaragua is a very low-income country entering a period of rapid aging with limited geriatric training for health care professionals. To help build capacity and to enhance student learning, a short-term international service-learning program was implemented in 2004 in partnership with the Jessie F. Richardson Foundation and Nicaraguan community stakeholders. Graduate and undergraduate students at Portland State University complete coursework for one term in the United States then travel to Nicaragua for about two weeks to participate in educational, research, and service activities, primarily in group homes for older Nicaraguans. Students learn about global aging, gerontology, community development, service learning, and Nicaraguan history and culture, then apply their gerontology-related knowledge by training direct care staff, older adults and their family members, and students. The authors describe the impetus for and evolution of the program, students’ evaluation of the program, faculty observations on program benefits and challenges, lessons learned, and future plans.     

Health-promotion interventions enhance and maintain self-efficacy for adults at cardiometabolic risk: A randomized controlled trial

ObjectivesTo investigate whether a community-based intervention program, based on self-efficacy theory, might improve older adults’ self-care behaviors as well as health outcomes related to hypertension and dyslipidemia.MethodsThis randomized controlled trial was conducted in Taipei, Taiwan, From October 16, 2011 to July 31, 2014. Residents identified during community screening for the over 50 s were invited to participate if their blood pressure was 120–139/80–89 mmHg, high-density lipoprotein cholesterol was <40 mg/dL (men) or <50 mg/dL (women), or low-density lipoprotein cholesterol was 130–159 mg/dL. The intervention group participated in a special health promotion program; the control group received conventional health education. Participants’ demographic and anthropometric data were recorded, and each completed semi-structured questionnaires about hypertension and cholesterol management, and gave blood samples for biochemical analyses before the intervention and 6 months after it ended.ResultsFrom 90/98 eligible subjects who enrolled, 84 completed the study: 41/43 and 43/47 respectively in intervention and control groups. Body mass index, blood pressure, hyperglycemia, and high-density lipoprotein cholesterol in the intervention group improved significantly from baseline. The Self-Efficacy Scale (P = 0.020), Self-Care Activities Questionnaire (P = 0.014) and Perceived Therapeutic Efficacy Scale (P = 0.023) scores improved significantly.ConclusionThis health promotion intervention program enhanced self-efficacy among older adults, with sustained effect through 6-months’ follow-up. These findings are consistent with studies that evaluated the effect of a diabetes education program on self-efficacy. The beneficial effect on a population at high-risk for hypertension and hypercholesterolemia, may serve as a model for developing and implementing such interventions.     

Physical activity outcomes of CHAMPS II: a physical activity promotion program for older adults

BACKGROUND: Despite well-known benefits of physical activity for older adults, about two thirds are underactive. Community-based programs are needed to facilitate increased physical activity. We examine the effectiveness of CHAMPS II, an inclusive, choice-based physical activity promotion program to increase lifetime physical activity levels of seniors. CHAMPS guided participants to choose activities that took into account their health, preferences, and abilities. It offered information on ways for them to exercise safely, motivate themselves, overcome barriers, and develop a balanced exercise regimen. METHODS: A 1-year randomized controlled trial was conducted with physically underactive seniors in a multispecialty group practice. Changes in self-reported physical activity by group were evaluated using ANCOVA, controlling for age and sex. RESULTS: Of 173 randomized subjects, 164 (95%) completed the trial. Subjects were aged 65 to 90 years (M = 74, SD = 6); 66% were female. The intervention group increased estimated caloric expenditure by 487 calories/week in moderate (or greater) intensity activities (MET >/= 3.0; p <.001) and by 687 calories/week in physical activities of any intensity (p <.001). Control group changes were negligible. Between-group analyses found that the changes were significantly different in both measures (p values <.05). Overweight persons especially benefited from this program. The program was as effective for women, older adults (75+), and those who did not set aside time to exercise at baseline. CONCLUSIONS: The program led to meaningful physical activity increases. Individually tailored programs to encourage lifestyle changes in seniors may be effective and applicable to health care and community settings.