Community-based health interventions

objectives Further scale-up of antiretroviral therapy (ART) to those in need while supporting the growing patient cohort on ART requires continuous adaptation of healthcare delivery models. We describe several approaches to manage stable patients on ART developed by M edecins Sans Fronti eres together with Ministries of Health in four countries in sub-Saharan Africa.

Background: Exercise is an important and effective approach to preventing falls in older people, but adherence to exercise participation remains a persistent problem. A unique purpose-built exercise park was designed to provide a fun but physically challenging environment to support exercise in a community setting. This project is a randomised controlled trial designed to evaluate the effectiveness of an exercise intervention using an exercise park specifically designed for older people in reducing the risk of falls. Methods/Design: This study will be a parallel randomised control trial with pre and post intervention design. One hundred and twenty people aged between 60 and 90 years old will be recruited from Melbourne suburbs and will be randomly allocated to either an exercise park intervention group (EPIG) or a control group (CG). The CG will receive social activities and an educational booklet on falls prevention. The BOOMER balance test will be used as the primary outcome measure. Secondary outcome measures will include hand grip strength, two minute walk test, lower limb strength test, spatio-temporal walking parameters, health related quality of life, feasibility, adherence, safety, and a number of other psychosocial measures. Outcome assessment will be conducted at baseline and at 18 and 26 weeks after intervention commencement. Participants will inform their falls and physical activity history for a 12-month period via monthly calendars. Mixed linear modelling incorporating intervention and control groups at the baseline and two follow up time points (18 weeks and 26 weeks after intervention commencement) will be used to assess outcomes.

Objectives: Implementation of a large-scale, child weight management program in low-income, ethnically diverse communities provided an important opportunity to evaluate its effectiveness under service level conditions (i.e. provision as a primary care child weight management service). Methods: MEND 7–13 is a community-based, multicomponent, childhood obesity intervention designed to improve dietary, physical activity and sedentary behaviors. It comprises twice weekly sessions for 10 consecutive weeks (35 contact hours) and is delivered to groups of children and accompanying parents/caregivers. The evaluation used an uncontrolled, repeated measures design. 3,782 children with overweight or obesity attended 415 MEND 7–13 programs in eight US states. 2,482 children (65.6%) had complete data for change in zBMI. The intervention targeted low-income, ethnically diverse families. Changes in anthropometric, cardiovascular fitness and psychological outcomes were evaluated. A longitudinal multivariate imputation model was used to impute missing data. Peer effects analysis was conducted using the instrumental variables approach and group fixed effects. Results: Mean changes in BMI and zBMI at 10 weeks were -0.49 kg/m 2 (95%CI: -0.67, -0.31) and -0.06 (95%CI: -0.08, -0.05) respectively. Benefits were observed for cardiovascular fitness and psychological outcomes. Mean peer reduction in zBMI was associated with a reduction in participant zBMI in the instrumental variables model (B=0.78, p=0.04, 95%CI: 0.03, 1.53). Mean program attendance and retention were 73.9% and 88.5% respectively. Conclusion: Implementing MEND 7–13 under service level conditions was associated with short-term improvements in anthropometric, fitness and psychological indices in a large sample of low-income, ethnically diverse children with overweight and obesity. A peer effect was quantified showing that benefits for an individual child were enhanced, if peers in the same group also performed well. To our knowledge, this is the first US study to evaluate outcomes of an up-scaled community-based, child weight management program and to show positive peer effects associated with participation in the intervention.

Abstract

The use of community health workers to administer prompt treatments is gaining popularity in most sub-Saharan African countries. Their performance is a key challenge because it varies considerably, depending on the context, while being closely associated with the effectiveness of case management strategies. What determines community health workers' performance is still under debate. Based on a realist perspective, a systematic review recently hypothesized that several mechanisms are associated with good performance and successful community interventions. In order to empirically investigate this hypothesis and confront it with the reality, we conducted a study in Burkina Faso, where in 2010 health authorities have implemented a national program introducing community case management of malaria. The objective was to assess the presence of the mechanisms in community health workers, and explore the influence of contextual factors. In 2012, we conducted semi-structured interviews with 35 community health workers from a study area established in two similar health districts (Kaya and Zorgho). Results suggest that they perceive most of the mechanisms, except the sense of being valued by the health system and accountability to village members. Analysis shows that drug stock-outs and past experiences of community health workers simultaneously influence the presence of several mechanisms. The lack of integration between governmental and non-governmental interventions and the overall socio-economic deprivation, were also identified as influencing the mechanisms' presence. By focusing on community health workers' agency, this study puts the influence of the context back at the core of the performance debate and raises the question of their ability to perform well in scaled-up anti-malaria programs.

USA Leadership networks Evidence-based interventions Social network analysis Faith-based organizations a b s t r a c t Through two case studies of Catholic parishes in Massachusetts, this study explores the implications of leader-centered versus distributed leadership in Catholic parishes for the implementation of evidencebased health interventions. The two parishes involved in the study differ from each other in several ways. In the first, parishioners are less engaged in leadership activities at the decision-making level in the parish. A small group of lay volunteers work with the parish priest and other ordained leaders on parish activities. In the second parish, a large and active lay volunteer leadership have forged an organizational structure that allows more independence from the pastor's direct oversight. In this parish, lay volunteer leaders are the prime drivers of organizational programs and events. In 2012e2013, three types of networks were assessed at each parish: discussion, collaboration, and outside-of-parish ties. The contrasts between each parish include differences in density of collaboration, in frequency of discussion, and network centrality of the respective parish priests. We further identified key actors in the network structures at each parish. We discuss the implications of these findings for understanding organizational capacity in the context of health program implementation.

Innovative projects to reduce disparities in cancer treatment and research include partnerships between academic and community cancer centers, patient navigation programs and strategies to promote community awareness, education and engagement. A 4 h training program about cancer clinical trials was developed through a needs assessment and in collaboration with community health workers who served as consultants and a larger advisory board comprised of community health workers, educators and clinical trialists. This program was delivered first as a collaboration between a phsycian who is experienced in the conduct of clinical research and two community health workers, and subsequently by the community health workers alone. We report on four workshops attended by a total of 61 community health workers recruited from Boston-area hospitals, community health centers and outreach programs. Support for and knowledge of clinical trials was measured in a pretest and post-test, which also included a satisfaction rating. Participants had a range of prior experience with clinical trials in the context of their personal and professional experience. Mean accuracy of knowledge about clinical trials increased from 72 to 84%, support for clinical trials improved considerably, and satisfaction with the training experience was high. Knowledge gaps and low levels of support for cancer clinical trials among community health workers can be improved with a short training program delivered by other community health workers. Further research is needed to identify the impact of this training on accrual to cancer clinical trials.

Reported by: SW Nicholas, MD, VE Hutchinson, MD, B Ortiz, MD, S Klihr-Beall, MA, Dept of Pediatrics, Harlem Hospital Center; B Jean-Louis, PhD, K Shoemaker, MPP, C Singleton, MSW, J Credell, R Swaner, MPA, Harlem Children's Zone, Inc.; RD Vaughan, DrPH, ME Northridge, PhD, LF Cushman, PhD, E Polley, C Golembeski, Harlem Health Promotion Center, Columbia Univ, New York.

Since 1980, asthma prevalence, hospitalization, and mortality have been increasing in the United States (1). Because of concern about asthma-related morbidity among children in Central Harlem, New York City (NYC), the Harlem Children's Zone Asthma Initiative (HCZAI) was established in 2001 to reduce asthma-related morbidity through improved surveillance, health-care use, and health-care service delivery for children aged <12 years living in a 60-block radius of Central Harlem known as the Harlem Children's Zone Project*. Families of children with asthma or asthma-like signs† or physical findings consistent with asthma are invited to participate in the program. This report summarizes preliminary data collected during 2001--2004 on the effectiveness of the program in reducing asthma-related morbidity; data indicate decreased parental/guardian reports of school absences among children enrolled in the program, both for any reason and because of asthma. In addition, emergency department and unscheduled physician office visits for treatment of asthma decreased from 35% to 8% after 18 months of the program, indicating improved asthma management and appropriate use of health-care services by program enrollees. The effectiveness of HCZAI underscores the utility of community-based public health programs in reducing asthma morbidity.

Interventionists usually blame cultural factors and traditional attitudes for non-compliance of target populations, a framework Didier Fassin terms as culturalism. Despite their efforts, what the Roll Back Malaria employees find in southeastern Nigeria is a 'troubling' nonchalance towards the programme because target populations' perceptions of malaria differ from the donor/programme perspective. The RBM employees cast the local attitude as culturalism, accordingly framing their exhortations in terms of this discourse. How the Roll Back Malaria employees deployed culturalism to fit with the neoliberal individualizing framework of current international health practices is one more nuanced analytical perspective the article brings to intervention literature.

Fundamental conceptual tensions underlie current debates regarding the implementation of psychosocial interventions with war-affected populations. Three particular tensions structuring current discourse concern the generalisability versus uniqueness of relevant knowledge, the valuing of technical versus indigenous understandings, and the planning of targeted versus community-based intervention. The implications of working out these tensions in the implementation of programmes are explored, leading to the proposal of a model of phased response to psychosocial needs. This distinguishes four discrete phases of potential response: 1 minimal disruption of intact protective influences; 2 re-establishment of protective influences; 3 provision of compensatory support; and 4 targeted therapeutic intervention.

This supplement provides a comprehensive and indepth
examination of proven clinical-community
health strategies employed by the Alliance to Reduce
Disparities in Diabetes, across five sites located in
diverse geographic regions of the United States,
including a tribal community. Alliance projects in
these communities focused on African Americans,
Hispanics/Latinos, and American Indians as priority
populations. Each project was implemented with an
understanding that there are cultural norms, community
characteristics, and health care system challenges
that require sustained multicomponent
approaches to ameliorate factors that exacerbate poor
disease management and health outcomes. The articles
increase understanding of what is required to
implement evidence-based approaches shaped by
local experiences in order to meet the needs of diverse
communities affected by diabetes. Lessons learned
have generic elements that can be used in other priority
populations and settings.

Theatre-based interventions have been used in health promotion with young people to address HIV and sexual health. In this study, we explored the experience of undergraduate student performers participating in a theatre-based HIV prevention and sexual health education intervention for high school students in the USA.
Undergraduate students enrolled in a credit-bearing course to learn about HIV and sexual health, participatory theatre and health education techniques. We analysed students’ reflective essays written throughout the semester to identify any changes and the intervention processes that promoted these changes. Students experienced five interrelated forms of transformation: (1) increased knowledge about HIV and sexual health; (2) changes in attitudes and communication about sex; (3) artistic growth; (4)
emotional growth; and (5) clarification of career goals and future plans. Intervention processes that contributed to these transformations included improvisation, guided writing exercises, the creation of a close-knit cohesive group and interactions with
a group of HIV-positive speakers. Theatre-based, peer-led sexual health programmes can provide a transformative experience for undergraduate student performers. These transformative effects are linked to specific activities and processes of the intervention
and require examination in future research.

Background: This study was conducted to gauge how the demographic profile of smokeless tobacco (SLT) users from Gujarat and Andhra Pradesh, India, differs from that of smokers. It also addresses how factors associated with the initiation and continuation of smokeless tobacco vary by age, gender, and education.
Materials and Methods: We analyzed 2011 cross-sectional survey data collected from 4,759 respondents (smokers/SLT users/non-users) in both states. Chi-square analysis was used to make comparisons between the demographic profiles of smokers and SLT users. Multivariable logistic regression analysis was used to obtain the odds ratios (ORs) for initiation and continuation factors regressed on socio-demographic variables (age, gender, education).
Results: Initiation-women were less likely than men to report “peer pressure”, “fashion statement”, and “stress/coping” as
relevant factors for SLT use (OR: 0.45 CI: 0.30-0.70; OR: 0.42 CI: 0.24-0.74; OR: 2.47, CI: 1.47-4.15). Older age groups had lower odds of choosing “peer pressure” than the 15-24 year olds. Respondents with 11 or more years of education were more likely to report “stress/coping” than those with no education (OR: 2.82, CI: 1.06-7.48).
Continuation-women were less likely than men to choose “relaxation”, and “distance from family” as important continuation factors (OR: 0.50, CI:0.32-0.80; OR: 0.20, CI: 0.06-0.65). All age groups were less likely to choose “stimulation” as a factor than the youngest group. Conclusions: Along with confirming and expanding upon previous literature, the findings of this study should encourage further SLT research in women and younger age groups (15-24 and 24-44). They also confirm the need for SLT prevention and cessation interventions in India in other community-based settings, besides schools.

BACKGROUND: Community-based health programs (CBHPs) with participatory approaches has been recognized as an important tool in health promotion. The goal of this study was to understand the nature of participation practice in CBHP and to use the data to advocate for more participation-friendly policies in the community, academy and funding organizations.METHODS: In this qualitative study, 13 CBHPs, which were active for last 5 years have been assessed using semi-structural in-depth interviews with programs principal and managers and focus group discussions with volunteers and service users. Data analysis was based on the deductive-inductive content analysis considering the participatory approaches in these programs.RESULTS: The results show that, the main category of participation was divided to community participation and intersectional collaboration. The community participation level was very different from "main," "advisory" or "supporting" level. The process of recruitment of volunteers by the governmental organization was centralized and in non-governmental organizations was quite different. According to respondents opinion, financial and spiritual incentives especially tangible rewards, e.g., learning skills or capacity building were useful for engaging and maintaining volunteers' participation. For intersectional collaboration, strong and dedicated partners, supportive policy environment are critical.CONCLUSIONS: It seems that maintaining partnership in CBHP takes considerable time, financial support, knowledge development and capacity building.

This In Brief reports on a multiday workshop on HIV
that was held in Manokwari, West Papua province,
Indonesia, from 27–29 November 2014. The workshop,
called Developing an HIV Prevention and Control
Strategy for Papuans in Tanah Papua,1 represented the
culmination of over a year of preparatory work, and
something new in Tanah Papua’s HIV response: the
mobilisation of a broad base of community and provincial-
level actors committed to responding to epidemic
levels of HIV among indigenous Papuans.2 Based on
comparative data obtained from the World Health
Organization, Tanah Papua faces the fastest growing
HIV epidemic in the world, and one of the highest
HIV prevalence rates in the world outside of Africa.

Background and Objectives: Based on different studies, substance use is one of the health problems in the Iranian society. The prevalence of substance use is on a growing trend; moreover, the age of the onset of substance use has declined to early adolescence and even lower. Regarding this, the present study aimed to develop a family-based early-onset substance use prevention program in children (i.e., My Family-Study) by using intervention mapping approach. Materials and Methods: This study descirbes the research protocol during which the intervention mapping approach was used as a framework to develop My Family-Study. In this study, six steps of intervention mapping were completed. Interviews with experts and literature review fulfilled the need assessment. In the second step, the change objectivs were rewritten based on the intersection of the performance objectives and the determinants associated in the matrices. After designing the program and planning the implementation of the intervention, the evaluation plan of the program was accomplished. Results: The use of intervention mapping approach facilitated the develop-pment of a systematic as well as theory-and evidence-based program. Moreover, this approach was helful in the determination of outcomes, performance and change objectives, change of determinants, theoretical methods, practical application, intervention, dissemination, and evaluation program. Conclusions: As the findings of this study indicated, the intervention mapping provided a systematic as well as theory-and evidence-based approach to develop a quality continuing health promotion program.

Globally, the population is ageing, which has serious consequences for businesses. The prosperity of companies is crucially dependent on the ability to effectively manage their employees, including older workers. Best practice in age management is defined as those measures that combat age barriers and/or promote age diversity. These measures may entail specific initiatives aimed at particular dimensions of age management; they may also include more general employment or human resources policies that help to create an environment in which individual employees can achieve their potential without being disadvantaged by their age (Walker, 1999).
Promoting early retirement is generally not encouraged. Companies now have to encourage longer working lives. Much needs to be done to ensure that work remains a positive experience for workers throughout their career trajectories, and it does not damage their health. It has been found by studies that health is significantly related to retirement timing (both planned and unplanned) (Goyer, 2013, Adams et al., 2014), influences work performance (Merrill et al., 2012; Ilmarinen, 2009), and health-related organisational policies can positively influence employee retention (Towers, 2005). The major contemporary challenges to health at work are those associated with the way work, and work organisations are designed and managed. This is especially true for older workers. A comprehensive and effective approach towards age management can be very beneficial for them. How should companies implement age management? Some possible ways are set out in this policy brief below, which focuses on best practices in age management regarding ergonomic aspects and health interventions for older workers at an organisational level. The intention is to discuss the current situation and to illustrate some organisational techniques in selected countries. This policy brief can serve as an inspiration for, among others, companies and policymakers. Recommendations for successful practice are included. In total, this policy brief covers 8 COST  member countries (the Czech Republic, Finland, Germany, the Netherlands, Slovenia, Spain, Sweden and the United Kingdom) to give a glimpse of the current situation of best practice in age management and show how companies in various states deal with ergonomic aspects, health interventions and the ageing of their labour force.

Here is presented a retrospective review of the Charis Project's Family Engagement Program (FEN) as it existed in 2014-2017. FEN was a program of women's health education, nutrition supplements, and family visitation. The education program consisted of a 12-week course on nutrition, maternity, and sex education taught individually and in groups, focusing on pregnant Burmese migrant labourers, but including approximately 20% male participation. The nutrition supplements consisted of 5 kilograms of fresh vegetables and 12 eggs weekly to pregnant mothers, from course onset to about six months after childbirth depending on family needs. Family visitation took place during food deliveries, and focused on individual counselling and family stability. The program served 39 families from 2014-2017. FEN did not reduce neonatal mortality (due to a miscarriage and severe congenital birth defect), but resulted in all surviving infants being born normal weight and surviving to the end of 2019, representing a significant improvement over the 25.6% low birth weights reported for Kayin State, Myanmar (Ministry of Health and Sports, Myanmanr (2016)

This case study is about Master A. A, a 4 year old boy with sickle cell disease who was diagnosed of osteomyelitis with pathological fracture of the right humerus. Patient has been hospitalised before for dactylitis on the 7 th July, 2015, was treated and discharged home on the 16 th July, 2015. He was however readmitted via Children Outpatient Department of Oni and Son Memorial Hospital, Ibadan, Nigeria on the 21 st July, 2015 on account of history of fever of 6 days duration and swelling of the distal 2/3 third of the left forearm, there was also swelling of the right upper hand which was associated with pain and loss of function. A provisional diagnosis of osteomyelitis with pathological fracture of the right humerus was made by the doctor in charge. He was later reviewed by the paediatric team and was admitted into Ward I for further investigations and proper management. Afterwards, Master A, A had cast applied on the right humerus due to the fracture as confirmed by the X-ray report. Nursing management was carried out by adopting Quality Care Model which was proposed by Duffy J. R (2005).