Community nutrition in Canada: an overview.

This paper provides an overview of the scope and diversity of community nutrition in Canada today and illustrates the many community organizations that include a nutrition component. The relationship of public health nutrition to the broader field of community nutrition is outlined, and health promotion concepts and strategies are described as a basis for community nutrition programs. Strategies such as education, mass communication/social marketing, advocacy, self-help/mutual aid, community organization, economic support, policy development/legislation, and environmental change are identified with some examples from programs in Canadian communities. Future directions are proposed as research, better surveillance and monitoring, more effective program evaluation, and a forum for the exchange of community nutrition information.     

Management academy for public health: creating entrepreneurial managers

The Management Academy for Public Health develops public health managers' management skills. Ultimately, the program aims to develop civic entrepreneurs who can improve the efficiency and the effectiveness of their organizations. With help from a coach, teams write public health business plans to meet needs in their communities. An external evaluation found that 119 teams trained during the first 3 years of the program generated more than $6 million in enhanced revenue-including grants, contracts, and fees through their business plans--from $2 million in program funding. Approximately 38% of the teams expected to generate revenue from an academy business plan or a spin-off plan. Action-learning methods can help midcareer managers transfer their training to the workplace and build entrepreneurial skills.     

Developing research capacity building for Aboriginal & Torres Strait Islander health workers in health service settings

INTRODUCTION: Aboriginal and Torres Strait Islander health workers (hereafter called health workers) can play a major role in facilitating culturally appropriate health care delivery and program development through the acquisition of improved skills in the planning, monitoring and evaluation of these programs (RCB). However, many Aboriginal and Torres Strait Islander people and communities remain concerned about research and related activities. Health workers are well placed to assist communities to not only embrace research, but to be active players and promoters of relevant, appropriate and acceptable research. One means of achieving the twin goals of RCB and community acceptance and involvement in research, is through health workers undertaking research of health priority issues and evaluation of activities, such as program delivery, that are of direct relevance to their community's aim of improving or enhancing service delivery. This article outlines the development and content of a community-based RCB framework for health workers. The focus is on the major issues that enhance a proactive service delivery model using culturally appropriate research methods. Development process: The RCB framework described here was developed, over a period of time, through community workshops and consultations aimed at deriving general consensus on the key issues and components of a culturally-appropriate, community-based training process. The framework has subsequently been reviewed by Aboriginal and Torres Strait Islander community representatives from across Australia. The overall aim of the framework is to supplement current (institutionally-based) education and training resources for health workers with community-based research training modules. These modules can be tailored to provide research and evaluation skills relevant to health workers taking a more proactive role in facilitating health and wellbeing programs in their own communities. The use of collaborative consultation and participatory methods are intended to be a two-way education process. Course content: A visual pathway is used that encompasses the impact of health and practice in the community for health workers at a grass-roots level. This enables elements of the RCB process to be divided into a series of connected modules. These are: (i 'assessing' Existing Services; (ii) methods and measures for Identifying Need at various levels; (iii) important issues in Program Development; (iv) how the former contributes to Service Improvement; (v) resultant Outcomes that will impact on community and service provision; and (vi) Evaluation Methods and applying findings to service delivery. Conclusions: Active participation by the Aboriginal and Torres Strait Islander community is fundamental for effective research practices and outcomes. The aim is to provide health workers and community members with a working knowledge of research ethics and methods so that they can assist, monitor and steer the development of culturally appropriate research activities that will lead to provision of the highest quality services 'back' to the community. This RCB framework will enable health workers to be more proactive, self-reliant and self-sufficient within their community and healthcare settings.     

Alcohol and Drug Abuse Prevention in Wisconsin Public Schools

This survey assessed the status of Wisconsin public school district programs designed to prevent alcohol and other drug related problems among students. The assessment involved surveying prevention program directors of 102 school districts that received grants for prevention initiatives since 1981. Most districts (70%) implemented programs at the elementary, middle, and senior high school levels. Typical program strategies involved combining information dissemination with refusal skill and self-concept development. School programs predominantly were school-based and did not systematically involve community members or agencies. The greatest obstacles to providing effective prevention services include high rates of alcohol and other drug use in homes and communities, denial of alcohol and other drug related problems among students, parents, and community members, and lack of staff time for prevention activities. Project directors indicated a need for schools to initiate greater involvement of parents, nonschool alcohol and drug abuse prevention agencies, and other community organizations in school efforts.     

Strategies for Ensuring Use of Needs Assessment Findings: Experiences of a Community Substance Abuse Prevention Program

This article offers specific strategies for ensuring utilization of needs assessment findings. It is designed to help prevention specialists, community planners, program evaluators, and involved citizens maximize their efforts in developing community services by tying those services closely to community needs. Program evaluators who completed a broad-based community needs assessment commissioned by their organization, found that the organization had gone ahead in developing programs and saw the needs assessment findings as unrelated to their ongoing activities. Far from being unique, this situation is common in organizations where participants feel an urgency to get programs under way to address widespread community problems.     

Process evaluation of a three-year community-based peer education intervention for HIV prevention among Yemeni young people

This community process evaluation highlights key enabling factors that facilitated the implementation of a community peer education program for youth HIV prevention in four poor and vulnerable areas of Aden, Yemen. It also explains the implementation process and provides a deeper understanding of the impact evaluation outcomes, which revealed improved HIV knowledge and risk perception and decreased stigma and risky behavior. This process evaluation was based on qualitative methodologies, where five focus group discussions and 15 in-depth interviews were conducted among 52 participants: community peer educators, community focal points, targeted young people, and local councils. The results revealed that contributing factors to implementing the peer education program had been community participation, mobilization of targeted communities, and capacity building of all those included in the intervention. Existing community-based organizations like the Social Service Centre played a key role in building trust with the targeted communities and linking HIV peer education intervention to other existing community services. This process evaluation could provide lessons learned for replicating similar youth peer education programs in conservative communities.     

Community Organization and School Liaisons: How to Get Programs Started

This paper briefly reviews four intervention models, Rothman's community organization, Green's system-centered education, Rogers' innovation-decision process, and Watzlawick's planned change, for their applicability to help initiate community-based programs for drug abuse prevention and health promotion in youth. An expanded model is described, including preprogram assessment of the target population, community, and drug use problem, and continuous evaluation of program process and product. School liaisons are emphasized as a key factor in early adoption and demonstration of a community-based program for youth. The expanded model, including school liaisons, is applied to a comprehensive community drug abuse prevention project being implemented in the Greater Kansas City area. The model--and the project--suggest methods for organizing communities for long-term drug prevention, initially at the level of school and school district, and later to the family, mass media, and community organizations in a proximal-to-distal sequence of programming.     

Promising community-level indicators for evaluating cardiovascular health-promotion programs

Rigorous evaluation of community-based programs can be costly, particularly when a representative sample of all members of the community are surveyed in order to assess the impact of a program on individual health behavior. Community-level indicators (CLIs), which are based on observations of aspects of the community other than those associated with individuals, may serve to supplement individual-level measures in the evaluation of community-based programs or in some cases provide a lower-cost alternative to individual-level measures. Because they are often based on observations of the community environment, CLIs also provide a way of measuring environmental changes--often an intermediate goal of community-based programs. The Centers for Disease Control and Prevention convened a panel of experts knowledgeable about community-based program evaluation and cardiovascular disease (CVD) prevention to develop a list of CLIs, and rate their feasibility, reliability and validity. The indicators developed by the panel covered tobacco use, physical activity, diet and a fourth group that were considered 'cross-cutting' because they related to all three behaviors. The indicators were subdivided into policy and regulation, information, environmental change, and behavioral outcome. For example, policy and regulation indicators included laws and ordinances on tobacco use, policies on physical education, and guidelines for menu and food preparation. These indicators provide a good starting point for communities interested in tracking CVD-related outcomes at the community level.     

Increasing the involvement of national and regional racial and ethnic minority organizations in HIV information and education.

Responding to the facts that (a) the AIDS epidemic is occurring among black and Hispanic populations disproportionately to their percentage of the U.S. population and (b) effective human immunodeficiency virus (HIV) prevention programs are racially, ethnically, and culturally relevant and sensitive, CDC in 1988 initiated a 5-year grant program for HIV prevention efforts by national racial and ethnic minority organizations and regional consortia of racial and ethnic minority organizations. A total of 33 organizations received first-year funds. Of the 32 grants that are ongoing, 15 primarily target blacks, 12 Hispanics, 4 Native Americans and Alaskan Natives, and 1 Asian Americans and Pacific Islanders. Some grants are for more than one racial or ethnic population. Programs may be categorized as (a) education programs within national non-AIDS organizations and their respective affiliate networks to increase their understanding, support, and community out-reach for HIV prevention; for example, National Urban League, Inc.; (b) programs providing specific HIV prevention expertise and technical assistance to community-based and other organizations; for example, National Minority AIDS Council; (c) HIV prevention programs emphasizing communications and media; for example, Hispanic Designers, Inc; and (d) prevention programs targeted to a specific racial or ethnic group within a geographic area; for example, Midwest Hispanic AIDS Coalition. As a result of these grants, substantial resources are being invested in prevention programs developed by and for racial and ethnic minorities. Other overall benefits include an expanded foundation of organizations to address AIDS and other health problems affecting these populations, strengthened interrelationships among HIV-focused and broader-based minority organizations, and extensive collaboration of private sector organizations with Federal and State public health and education agencies.     

Processes of sharing issues among participating groups in the form of a food and nutrition education network: the case of the "S Network"

OBJECTIVE: To review processes of sharing issues among participating groups in the form of a food and nutrition education network and elucidate how organizations develop commitment and how individuals change their attitudes. METHODS: (1) Process regarding the form of a food and nutrition education network: After discussions by administrative public health nutritionists at public health centers and meetings with faculty members at J University, we encouraged three groups to participate in a network to share information on food and nutrition issues and gave them opportunities to interact with each other. Group A primarily provided food and nutrition information, group B primarily provided foods, and group C provided both. Specifically, these activities included two open community programs and eight volunteer activities. In the first open community program, they identified capacity to be developed through food and nutrition education and volunteers explored possible cooperation among organizations on the basis of the categorization and classification of issues. To provide feedback on the results, a workshop was held during the second open program. (2) Analysis of the process: We documented organizations involved in the form of a food and nutrition education network from 2003 through 2006, the processes and details of their activities, and activities and remarks by participants. These documents were classified by issue, broken down into categories, and listed chronologically with titles for characteristic entries, thereby reviewing the processes. On the basis of these results, we asked participants who were involved in the entire process of the construction of the food and nutrition education network to review their own activities, and we then investigated the changes in their attitudes. RESULTS: (1) A total of 63 persons in 34 organizations participated in open community programs. Local food issues included changing dietary behaviors along with diversification of lifestyle; problems with cooking, eating, and continuation of tradition because of the lack of nutritional knowledge and experience; and the uncontrolled flood of information. Participating organizations were found to engage in different activities to address nutritional issues. In addition, insufficient or low efficiency activities were identified, indicating the need for cooperation. (2) Issue-sharing processes consisted of the following three steps: identification of local nutritional issues, characterization of group activities to address food and nutritional problems, and exploration of possible cooperation among groups. Analysis of attitudes of three persons participating in the entire process of network construction revealed their interest in other organization activities and sympathy with other organizations. DISCUSSION: Factors for promotion of sharing issue include (1) our support to allow them to share food and nutrition issues in the early stages and thereafter, and (2) repeated deliberations within open community programs involving information and feedback from prior identification and analysis of problems, as well as selection of activities.     

Multi-level rural community engagement in health

Community participation in health is consistent with notions of democracy. A systems perspective of engagement can see consumers engaged to legitimise government agendas. Often community participation is via consultation instead of partnership or delegation. A community development approach to engagement can empower communities to take responsibility for their own health care. Understanding rural place facilitates alignment between health programs and community, assists in incorporating community resources into health care and provides information about health needs. Rural communities, health services and other community organisations need skills in working together to develop effective partnerships that transfer some power from health systems. Rural engagement with national/state agendas is a challenge. Community engagement takes time and resources, but can be expected to lead to better health outcomes for rural residents.     

Volunteers’ Experiences Delivering a Community-University Chronic Disease Health Awareness Program for South Asian Older Adults

Volunteers and voluntary organizations can connect preventative health care programs to communities and may play an important role in addressing the health needs of older adults. Despite this, tensions may exist in the structures that drive volunteers and voluntary organizations representing immigrant communities to provide unpaid labour to augment and supplement health care services. Furthermore, organizational challenges may exist for community agencies relying on volunteers to sustain a health screening and education program. The intervention program was led by one voluntary agency specifically for South Asian communities in partnership with the university and five local organizations. This paper draws on volunteer surveys (n?=?22) and key informant interviews (n?=?12) to detail volunteer experiences providing this intervention. Volunteers were university students and other community volunteers. A total of 810 adults participated in the intervention within the Greater Toronto Area, Ontario, Canada between October 2014 and June 2016. We found that volunteers often used their experience as a ‘stepping stone’ position to other education or work. They also gained from the knowledge and used it to educate themselves and their family members and friends. This paper provides a critical reflection on the role of volunteers in a preventative and educational healthcare intervention program for older adults from the South Asian community. Tensions exist when relying on volunteer labour for the implementation of preventative community health care programming and must be explored to ensure program sustainability as well as equity within the health care system.     

Community-Level Successes and Challenges to Implementing Adolescent Sex Education Programs

Best practices for adolescent sex education recommend science-based approaches. However, little is known about the capacity and needs of organizations who implement sex education programs on the local level. The purpose of this research was to describe successes and challenges of community organizations in implementing science-based sex education. Using qualitative methods, we interviewed program directors and educators in 17 state-funded adolescent pregnancy prevention/sex education programs as part of a larger mixed methods evaluation. Semi-structured interviews focused on success and challenges faced in implementing science-based approaches to program design, implementation and evaluation. Interviews were audio-recorded, transcribed and analyzed using a thematic approach. Grantees included a range of programs, from short programs on puberty and HIV for late elementary students, to skills-based curricular sex education programs for high schools, to year-long youth development programs. Key aspects of curricular choice included meeting the needs of the population, and working within time constraints of schools and other community partners. Populations presenting specific challenges included rural youth, youth in juvenile justice facilities, and working with Indiana’s growing Latino population. Programs self-developing curricula described challenges related to assessment and evaluation of impact. Programs using commercial curricula described challenges related to curricular selection and adaptation, in particularly shortening curricula, and adapting to different cultural or social groups. A remarkable degree of innovation was observed. The use of qualitative methods permitted the identification of key challenges and successes in a state-sponsored small grants program. Information can be used to enhance program capacity and quality.     

Impact of a community health promotion program on existing organizations: the Minnesota Heart Health Program.

A community organization strategy was used in the delivery of health education programs by the Minnesota Heart Health Program (MHHP). The effectiveness of the approach was evaluated to determine whether an enhanced health promotion delivery system had developed in MHHP communities by the end of the intervention period or whether the intervention had suppressed community efforts. 'Social connectedness' among providers, as measured by health promotion network size, also was expected to be higher in intervention communities. Six Midwestern communities were studied: the MHHP communities of Mankato, MN and Fargo, ND--Moorhead, MN with two matched comparison communities for each (Winona, MN, St Cloud, MN and Eau Claire, WI, Sioux Falls, SD). Nine areas of health promotion were assessed, including the five heart disease risk factor areas where education campaigns had been implemented (smoking cessation, weight loss, eating patterns, exercise, and heart disease education and screening) and four other areas where community programs are common (chemical dependency; home, personal and drivers' safety; stress management; and cancer education and screening). Indicators of the health promotion delivery system were developed (program options and program participation), and data were collected in separate surveys of 438 community organization providers and 320 larger worksites in the six communities. Results showed no suppression of health promotion delivery systems in MHHP communities. Instead, the survey of larger worksites showed that there was greater participation in heart disease health promotion and greater 'social connectedness' among worksites in both intervention communities. Also, there were more heart disease health promotion programs in the larger intervention community of Fargo-Moorhead. In the community organization survey, results favored the larger intervention community over its comparison communities in heart disease health promotion program options and in 'social connectedness' but not in program participation. However, survey results favored one of the comparison communities (Winona) over the smaller intervention community (Mankato) on all indicators in this survey. The greater impact of the MHHP intervention at worksites suggests that institutionalization may be more likely in stable organizations whose current needs and interests fit the goals of the intervention activity.     

Resources and interest among faith based organizations for influenza vaccination programs

In the United States, annual influenza vaccination rates are suboptimal and are well below the national health objectives. Project VIVA mobilized community members and organizations to implement an influenza vaccination program in Harlem by administering vaccines in “non-traditional” venues, such as community-based organizations, pharmacies, and faith-based organizations (FBOs). FBOs have been recognized as important venues for health promotion initiatives within medically underserved communities. However, data regarding the extent of resources and interest in health promotion programs among FBOs are sparse. We conducted a telephone survey among 115 FBOs in three New York City neighborhoods with histories of low influenza immunization rates to identify the congregation’s health concerns, interest in serving as a community-based venue for influenza vaccinations, and existing resources for health programming. Twenty-six percent of the FBOs had an established health ministry, while 45 % expressed interest in developing one. Seven percent included nurses among their health activities and 16.5 % had contact with the local health department. Most FBOs expressed interest in common health promotions programs; 60 % expressed interest in providing on-site influenza vaccination programs within their organization. Health programs within FBOs can be a point of access that may improve the health of their congregants as well as the larger community.     

Primary Prevention of Sexually Transmitted HIV Infections: Transferring Behavioral Research Technology to Community Programs

Behavioral research to prevent the spread of human immunodeficiency virus (HIV) infection has made significant progress over the past decade. Most importantly, studies have repeatedly shown that theory-based prevention interventions that build self-efficacy through self-management and communication skills training successfully reduce HIV risk behaviors. Simultaneously, communities have mobilized to develop programs that assist persons in reducing their risk for HIV infection. The degree to which behavioral sciences have contributed to community-based HIV prevention programming is examined in this paper through a systematic assessment of technology transfer in the area of sexual risk behavior reduction. We analyzed the content of twelve community-based HIV risk-reduction programs targeting gay and bisexual men developed by seven of the nation's largest AIDS service organizations. Telephone interviews were conducted with community program developers to determine the source of their programs and whether they had been influenced by behavioral sciences. Evidence was mixed with respect to the degree to which behavioral sciences have contributed to the development of community-based programs. Program elements often reflected research-based models but with questionable fidelity. Evidence for diffusion of research-based information occurred most often when community organizations received direct consultation from behavioral scientists. We suggest that technology transfer in HIV prevention requires behavioral scientists working in communities to serve as translators of theoretical constructs for practical applications. Preventing the spread of HIV could therefore be improved through partnerships between behavioral researchers and communities.     

Using Academy Standards of Excellence in Nutrition and Dietetics for Organization Self-Assessment and Quality Improvement

Standards of Excellence in Nutrition and Dietetics for an Organization is a self-assessment tool to measure and evaluate an organization's program, services, and initiatives that identify and distinguish the Registered Dietitian Nutritionist (RDN) brand as the professional expert in food and nutrition. The Standards of Excellence will serve as a road map to recognize RDNs as leaders and collaborators. Standards of Excellence criteria apply to all practice segments of nutrition and dietetics: health care, education and research, business and industry, and community nutrition and public health. Given the membership's call to action to be recognized for their professional expertise, the Academy of Nutrition and Dietetics Quality Management Committee developed four Standards of Excellence in Nutrition and Dietetics for Organizations: Quality of Leadership, Quality of Organization, Quality of Practice, and Quality of Outcomes. Within each standard, specific indicators provide strategies for an organization to demonstrate excellence. The Academy will develop a self-evaluation scoring tool to assist the organization in applying and implementing one or more of the strategies in the Standards of Excellence indicators. The organization can use the self-assessment tool to establish itself as a Center of Excellence in Nutrition and Dietetics. The role examples illustrate initiatives RDNs and organizations can take to identify themselves as a Center of Excellence in Nutrition and Dietetics. Achieving the Excellence level is an important collaborative initiative between nutrition and dietetics organizations and the Academy to provide increased autonomy, supportive management, respect within peers and community, opportunities for professional development, support for further education, and compensation for the RDN. For purposes of the Standards, “organization” means workplace or practice setting.     

School-based programs: lessons learned from CATCH, Planet Health, and Not-On-Tobacco

Establishing healthy habits in youth can help prevent many chronic health problems later in life that are attributable to unhealthy eating, sedentary lifestyle, and overweight. For this reason, many public health professionals are interested in working with school systems to reach children in school settings. However, a lack of familiarity with how schools operate can be a substantial impediment to developing effective partnerships with schools. We describe lessons learned from three successful school health promotion programs that were developed and disseminated through collaborations between public health professionals, academic institutions, and school personnel. The programs include two focused on physical activity and good nutrition for elementary and middle school children--Coordinated Approach to Child Health (CATCH) and Planet Health--and one focused on smoking cessation among adolescents--Not-On-Tobacco (N-O-T). Important features of these school health programs include 1) identification of staff and resources required for program implementation and dissemination; 2) involvement of stakeholders (e.g., teachers, students, other school personnel, parents, nonprofit organizations, professional organizations) during all phases of program development and dissemination; 3) planning for dissemination of programs early in the development and testing process; and 4) rigorous evaluation of interventions to determine their effectiveness. The authors provide advice based on lessons learned from these programs to those who wish to work with young people in schools.     

Community ownership and program continuation following a health demonstration project

Community ownership and maintenance of heart health programs was a major study goal of the Minnesota Heart Health Program (MHHP), a community-based National Heart, Blood and Lung Institute (NIH)-funded demonstration project. A partnership between the University of Minnesota and three Upper Midwest intervention communities was initiated in 1981. Local citizen boards were instrumental in planning, implementing and incorporating programs. Through an 8 year process of community organization, training and volunteer involvement, MHHP educational program responsibility was transferred to existing community-based groups and organizations. In 1989, when federal funding was withdrawn, 70% of all heart health intervention programs initiated by MHHP were being continued by local sponsors and supported by local funds. By 1992, maintenance of programs had decreased to an average 60%. Differential results of program incorporation among the three intervention communities are presented including findings on community sectors that most frequently sponsored programs. Factors that facilitate or impede local ownership are discussed. Research on longer-term maintenance of heart health programs in the three communities continues.     

Position of the American Dietetic Association: local support for nutrition integrity in schools

It is the position of The American Dietetic Association that the school and community have a shared responsibility to provide all students with access to high-quality foods and nutrition services as an integral part of the total education program. Educational goals, including the nutrition goals of the National School Lunch Program and the School Breakfast Program, should be supported and extended through school district policies that create an overall school environment with learning experiences that enable students to develop lifelong, healthful eating habits. Local school policy, developed through a collaborative process that responds to community needs and priorities, should include the integration of the school nutrition program with education. Nutrition integrity policy provides a framework for the integration and coordination of all aspects of the school nutrition program. Nutrition integrity is defined as “a guaranteed level of performance that ensures that all foods available and consumed by children in schools are consistent with the Recommended Dietary Allowances and the Dietary Guidelines for Americans, and contribute to the development of lifelong, healthy eating habits.” Achieving nutrition integrity means taking a comprehensive approach to program planning, management, operations, and integration of nutrition into the total education program of the school. The community is a valuable resource for this effort. Collaboration between key school- and community-based constituents, including children and other stakeholders, will result in the most effective and relevant plans for local school nutrition programs. However, competing and profit-making food and beverage sales may create a conflicting environment and can contradict lessons taught in health and nutrition education. This position provides direction for the dietetics profession for addressing this issue along with providing a suggested action plan for local schools and their communities. J Am Diet Assoc. 2000;100:108-111.