Improving collaboration between researchers and communities

Active collaboration between communities and researchers is critical to developing appropriate public health research strategies that address community concerns. To capture the perspectives of inner-city Seattle communities about issues in community-researcher partnerships, Seattle Partners for Healthy Communities conducted interviews with community members from the ethnically diverse neighborhoods of Central and Southeast Seattle. The results suggest that effective community-researcher collaborations require a paradigm shift from traditional practices to an approach that involves: acknowledging community contributions, recruiting and training minority people to participate in research teams, improving communication, sharing power, and valuing respect and diversity.     

The Health Action Fund: a community-based approach to enhancing health

This article is based on a program that was developed by the Center for Healthy Communities (CHC), a community-academic partnership in Dayton, Ohio, that continues to act as a force for change in health professions' education and health delivery, stressing the philosophy of "doing with" instead of "doing for" or "doing to." The Health Action Fund is a grassroots health communications and social marketing program that targets community groups who are involved often in health promotion activities developed by large agencies. However, rather than taking the traditional approach to health promotion and prevention where program development and implementation is left to professionals, a different approach was taken that encourages members of neighborhoods, a community group, or a church to identify a problem and then develop a way to address that problem for their group. The program focuses on neighbors helping neighbors where communities take the lead in health promotion and prevention activities. We discuss in detail the project's innovation, challenges and how they have been addressed, qualitative and quantitative improvements made to the program, and how the program serves as a model for other communities.     

Paradigm shifters, professionals, and community sentinels: immigrant community institutions' roles in shaping places and implications for stigmatized public health initiatives

Immigrant community institutions are strategically positioned to facilitate or impede public health efforts in their neighborhoods and communities because of their influence over discourse regarding values and tradition. Their authority may be particularly relevant when stigmatized or sensitive issues, such as HIV or reproductive health, are addressed. Using qualitative and quantitative methods to analyze data collected from 22 Chinese and South Asian immigrant institutions in New York City, we examine attitudes about HIV, social change and tradition to delineate the different structural roles that Asian immigrant community institutions play in relation to the preservation of traditional values and culture in their neighborhoods and communities. Implications are explored for working with immigrant community institutions to conduct HIV-related work and other stigmatized public health initiatives in immigrant neighborhoods.     

Local services and amenities, neighborhood social capital, and health

Recent work on health and place has examined the impact of the environment on health. At the local level, research has followed several strands, such as contextual effects of neighborhoods, the impact of differential access to services and amenities, effects of a neighborhood's collective efficacy, and the relationship between social capital and health. Of these four approaches, social capital has generated the most debate; some scholars discuss social capital as a key epidemiological variable, while others discount or dismiss its utility. We undertook this research to assess whether the concept of social capital could increase our understanding of the impact of neighborhoods on residents' health. We utilized key informant interviews and focus groups to understand ways in which residents of diverse neighborhoods in one large California city perceived that their local communities were affecting health. We argue in this paper that using the term "social capital" to discuss social resources and their mobilization in a particular neighborhood highlights the ways in which social resources can vary in relation to economic resources, and that residents of neighborhoods with differing levels of services and amenities face different issues when mobilizing to improve their neighborhoods. Additionally, the projects that people invest in vary by neighborhood socioeconomic status. We draw on the paired concepts of "bridging" and "bonding" social capital, and discuss that while stores of bonding social capital may be more uniform across neighborhoods of varying SES, bridging social capital tends to be found in greater amounts in neighborhoods of higher SES which allows them greater success when mobilizing to improve their neighborhoods.     

Environmental public health research: engaging communities

Environmental public health research is a multi-disciplinary and multi-institutional field of endeavor that is changing. New and innovative approaches are vital to researchers and communities. Partnerships and collaborations also are part of the equation. Thus, engaging communities is a necessary component for successful environmental public health research. The federal government has a fiduciary and a moral responsibility to provide ethical research in communities with the same integrity as required for individuals. There is an inherent distrust by many communities, especially minority communities, in light of past public health research failures. Communities targeted by public health researchers may be aware of the need to improve the community's environmental health and quality of life but are unsure of the methods and benefits. This in turn requires competent and attentive collaborations between the community and the researcher(s). Communities are indeed more astute to their physical surroundings, but may still not understand the nature and intent of the research process. Therefore, the collaboration and partnership should start as early in the design, planning, and execution of the project as possible. Future challenges in genetic screening and research will only increase the need for communities to be engaged in public health research.     

The governance and management of effective community health partnerships: a typology for research, policy, and practice

Community health partnerships (CHPs) are voluntary collaborations of diverse community organizations that have joined forces in order to pursue a shared interest in improving community health. Although these cross-sectoral collaborations represent a way to address social determinants of health and disease in society, they suffer from governance and management problems associated with interorganizational relationships in general and health care challenges specifically. A typology of effective governance and management characteristics provides a systematic, theoretically based way of addressing dimensions of governance and management and serves as a guide in constructing, maintaining, and measuring successful partnerships. It offers a multidisciplinary perspective for classifying important organizational issues, identifying barriers to successful development and sustainability, and facilitating the attainment of goals.     

Peri-urbanization and in-home environmental health risks: the side effects of planned and unplanned growth

Urbanization is occurring at an explosive rate, and many cities, especially in low-income countries, are struggling to control growth and stop the development of unplanned communities. This research investigates the in-home environmental health risks associated with planned and unplanned growth in peri-urban communities (neighborhoods) of a rapidly growing city in Northern Mexico. Surveys were conducted during home visits to 98 households in a planned community and 202 households in unplanned communities of comparable, though slightly higher, socio-economic status. To assess the differences for the two types of communities, multiple risk factors were measured and compared. Results showed that households in both planned and unplanned communities were vulnerable to poor environmental health conditions, but more risk factors and negative health outcomes were associated with unplanned communities. Some of the obvious benefits of living in a planned community included better-constructed homes and water and sewer connections. Other study results indicated that households in the planned community reported fewer cases of respiratory problems (P = 0.039) and dizziness (P = 0.009). They were also less likely to store insecticides and other chemicals inappropriately in their home (P < 0.001). Providing adequate housing infrastructure appears to provide a number of important benefits to health and behavior beyond the simple provision of additional amenities in the home.     

How the health and community development sectors are combining forces to improve health and well-being

The root causes of poor health experienced by many who live in low-income neighborhoods-such as the lack of access to health care, limited food choices, and exposure to environmental hazards-are well documented, but often go beyond the scope of the health care delivery system. But that is beginning to change. The health sector has begun to collaborate with the community development sector, which for decades has been working in low-income neighborhoods. Encouraging local and national examples of these new partnerships abound. They include an effort in Seattle, Washington, to reduce exposure to allergens and irritants among low-income asthmatic children, and a $500?million federal program to finance the operation of grocery stores in what have previously been urban "food deserts." To nurture such efforts, the Robert Wood Johnson Foundation, the Federal Reserve System, and others have sponsored a series of "healthy community" forums in US cities. In this article we explore the growing partnerships between the health and community development sectors as well as the challenges they face, and we offer policy recommendations that might help them succeed.     

The missing voice: Impacts of health system change on low-income communities

Unique problems in obtaining adequate health care face poor urban communities. These include the rising number of uninsured, abuses in the managed-care system, the unwillingness of private providers to deliver health care for either Medicaid recipients or the uninsured, and an insufficient supply of primary care physicians in minority neighborhoods. If the managed-care system is to bring decent health care to poor urban communities, it must avoid the mistakes of the past. The health care system must be community based, oriented toward primary care, sufficiently funded, and universally accessible. There needs to be better coordination between medical schools and community health requirements and better support for public health facilities. Without adequate health care for the poor, urban living will eventually become more onerous for all.     

Boundary crossers, communities, and health: exploring the role of rural health professionals

Boundary crossers understand the culture and language of community and health service domains and have the trust of both. Rural health professionals living within the communities they serve are ideally placed to harness community capacity so as to influence community-level determinants of health. We analyse five case studies of rural health professionals acting as boundary crossers against indicators of capacity for communities and external agents such as health services working in partnership. A more explicit evidence base for inclusion of community health development in the jobs of rural health professionals is needed.     

Community-based health workers: building the identity of this hybrid,polyphonic character

This article analyzes the identity-building process for community-based health workers in the context of their role in the Health Family Program team and their interaction with the residents of communities where they work. Based on this analysis we specifically emphasize conflicts of interpretation, power relationships between both sides of identity-building for community-based health workers from three perspectives: that included in the official training of these workers, that produced by workers concerning themselves, and that transmitted by the community. The fact that community-based health workers live the reality of health practices in the neighborhoods where they live and work and are trained with biomedical references makes them actors that convey both the contradictions and the possibility for a deep dialogue between these two forms of knowledge and practice.     

Environmental health training of promotoras in colonias along the Texas-Mexico border

Poverty, overpopulation, and a lack of environmental controls have combined with cultural and linguistic division to produce a looming public health threat in unincorporated communities on the US-Mexico border. These rapidly multiplying colonias, from a Spanish term for neighborhoods, are settlements of varying size located along the border. Along the American side of the Texas-Mexico border alone, there are approximately 1800 colonias--the largest number of any border state--most of which lack basic water and sewer systems, paved roads, and safe and sanitary housing. Promotoras, from a Spanish term for lay community educators, are community leaders who live in the colonias and build important bridges between residents and the federal and state bureaucracies. These women have been trained to introduce their neighbors to state "systems" of government, education, and medical and social services that otherwise may lie out of reach. Promotoras are able to "translate" this training into culturally meaningful instruction that empowers community self-development. When neighbors teach neighbors, the message is received with greater trust and readiness to act.     

上海市闸北区域卫生信息化建设及发展

介绍了上海市闸北区卫生信息化建设的发展阶段、构架、系统功能、建设成效和发展方向.闸北区已经开发应用了服务环节中多位点采集,实时动态更新的标准化居民健康档案;构建了区域医疗卫生服务信息共享与协同服务平台,实现了社区卫生服务中心与二级医院双向转诊、检验检查信息互认;通过开发研制居民健康钥匙,探索了居民利用电子档案开展健康自我管理的模式.     

When being alone might be better: neighborhood poverty,social capital,and child mental health

Public health researchers have provided a growing body of evidence on the salutary effects of social capital for individual well being. The importance of these findings for social epidemiology, however, may have precluded so far a full examination of the complex association between neighborhood social processes and the well being of individual residents, including the often acknowledged potential "downside" of social capital. In this study, we examine the association between attachment to community, an indicator of social capital, in a sample of African American parents, and the presence of behavior problems in their preschool children. Participants were recruited from a socioeconomically diverse set of neighborhoods. Attachment to community was assessed using a multi-item scale comprised of two subscales, general sense of community and how well one knew one's neighbors. Results indicated that the association between how well a parent knew her neighbors and the presence of child behavior problems differed depending on the degree of economic impoverishment of the neighborhood. In wealthy neighborhoods, children whose parent reported knowing few of the neighbors had higher levels of internalizing problems such as anxiety and depression compared to those who knew many of their neighbors. In contrast, in poor neighborhoods, children whose parent reported knowing few of the neighbors had lower levels of internalizing problems compared to those who knew many of their neighbors. These results are discussed in terms of furthering the study of the contextual nature of the social capital in explaining community inequalities in mental health among children.     

Community resilience, quality childcare, and preschoolers' mental health: a three-city comparison

Many studies suggest that quality childcare can positively influence children's outcomes in a wide range of domains, including mental health. While an extensive literature on the effects of childcare on individual children exists, how quality childcare programs contribute to trends at the population-level is yet to be established. In this study, we examine community differences in the quality of childcare and the mental health of children attending childcare centres in three communities in British Columbia, Canada. Previous research on Kindergarten children conducted in these communities indicated that two exhibited expected outcomes (based on socioeconomic criteria, these communities were classified as "better off" and "worse off"), and one exhibited better than expected outcomes and was therefore labeled "resilient." We hypothesized that the better than expected child outcomes in the resilient community were due to better quality childcare in this community. To test this hypothesis, we assessed 621 children and their 24 respective childcare centres, and conducted extensive observations of the three study communities. As expected, teachers (but not parents) from the resilient community reported fewer children's mental health problems and childcare quality was found to be higher in the resilient community than in the comparison communities. However, city differences were lost in the hierarchical linear regressions suggesting that the community effects were mediated through childcare quality. To interpret these findings we turned to our observations that indicated that the resilient community was markedly different from the other two in terms of the social capital and developmental assets that it possessed.     

Toward a policy-relevant analysis of geographic and racial/ethnic disparities in child health

Extreme racial/ethnic disparities exist in children's access to "opportunity neighborhoods." These disparities arise from high levels of residential segregation and have implications for health and well-being in childhood and throughout the life course. The fact that health disparities are rooted in social factors, such as residential segregation and an unequal geography of opportunity, should not have a paralyzing effect on the public health community. However, we need to move beyond conventional public health and health care approaches to consider policies to improve access to opportunity-rich neighborhoods through enhanced housing mobility, and to increase the opportunities for healthy living in disadvantaged neighborhoods.     

社区健康教育效果评价

目的：评价以健康讲座为手段、社区居民为对象的社区健康教育效果,探讨健康教育方式。方法：采用完全随机抽样方法,从杭州市上城区6个街道54个社区范围中随机抽取10场健康讲座及受众居民为研究对象,采用自身前后对照来评价效果。结果：不同社区不同人数参与的不同内容的10场健康讲座共涉及253位社区居民,253人讲座后知识水平均有提高（P〈0．05）。结论：在社区开展以健康讲座为主要形式的健康教育,效果较明显。     

Community interdisciplinary education to promote partnerships in family violence prevention

Family violence is a major social and health problem in the United States. Educational approaches are needed that help professionals and communities develop more effective skills to work with families and communities. This article describes a statewide, interdisciplinary, community-based educational program for professionals and paraprofessionals and a 6-month post-evaluation. Participants reported knowledge and skill development in assessment and interventions, improved use of violence prevention data for planning and interventions, and increased community partnerships and collaborations. Recommendations address violence prevention leadership, funding, infrastructure, interdisciplinary professional education, greater community awareness, and policy development.     

Community health report cards. Results of a national survey.

INTRODUCTION: The purpose of this research is to examine the state-of-the-art in community health report card development and use in order to increase their effective integration into community health improvement efforts. METHODS: A mailed survey was sent to 115 "report card" communities nationwide. This list was generated through multiple key informants at the national, regional, and state levels. Seventy-four percent (85/115) were eligible for the study. The report cards returned were inventoried for: quality of their data, comprehensiveness, presentation, appropriateness to target audiences, purpose and sponsorship, relevance to policy development, community involvement, comparability, replicability, and other factors. RESULTS: Of the 85 eligible projects, 65 responded. The report cards varied significantly in all areas. Only one half of communities used pre-existing formats or the experience of others to guide this resource-intensive development process. Data collection was the greatest challenge encountered in development. Local health departments, hospitals, and non-profit civic groups were the community groups most likely to be involved in development. CONCLUSION: There is need for infrastructure, technical assistance, and improved, easy-to-use tools to facilitate the report card development process and the sharing of expertise and experience among involved communities. Greater systematization of the process would enhance the reasonableness and sustainability of the effort. Broad community involvement, including support of the local health department, other community agencies, as well as the local business community, may be key to their success.