Community development in health promotion: empowerment or regulation?

"Without social there is no health": Social work perspectives in multidisciplinary healthcare

The pandemic has not just affected the health sphere: strong social effects of the emergency have added to the health risk, stressing on social relations and the deterioration of people's living conditions, and making those who are already fragile more fragile. Notwithstanding, during the emergency following the COVID-19 pandemic the attention was focused, indeed understandably, on the health aspects, widening the already existing misalignment between the health interventions and the social ones. Emergency oriented efforts and resources more toward a clinical care approach (cure) than toward support for the social and the inclusion aspects (care). Reflecting on the specific area of health care that interacts with social care (and vice versa), shows how the medicalization in managing the emergency have undermined or, at least, weakened the global approach to the person and to vulnerability profiles that should inspire the socio-healthcare integration. The aim of this review is describing the relationship between the health and social systems and the effects of the COVID-19 pandemic on it: a review of studies on the role played by social work in the health sector before and during COVID-19 pandemic emergency shows how much potential there is still to be developed for social work in the health sector that acts together with the personal health services; a care that looks at the person within his or her relationships, community resources and environmental aspects requires an investment toward integration between hospital care, social services and local communities.

Communities in charge of alcohol (CICA): a protocol for a stepped-wedge randomised control trial of an alcohol health champions programme

BACKGROUND

Communities In Charge of Alcohol (CICA) takes an Asset Based Community Development (ABCD) approach to reducing alcohol harm. Through a cascade training model, supported by a designated local co-ordinator, local volunteers are trained to become accredited 'Alcohol Health Champions' to provide brief opportunistic advice at an individual level and mobilise action on alcohol availability at a community level. The CICA programme is the first time that a devolved UK region has attempted to coordinate an approach to building health champion capacity, presenting an opportunity to investigate its implementation and impact at scale. This paper describes the protocol for a stepped wedge randomised controlled trial of an Alcohol Health Champions programme in Greater Manchester which aims to strengthen the evidence base of ABCD approaches for health improvement and reducing alcohol-related harm.

METHODS

A natural experiment that will examine the effect of CICA on area level alcohol-related hospital admissions, Accident and Emergency attendances, ambulance call outs, street-level crime and anti-social behaviour data. Using a stepped wedged randomised design (whereby the intervention is rolled out sequentially in a randomly assigned order), potential changes in health and criminal justice primary outcomes are analysed using mixed-effects log-rate models, differences-in-differences models and Bayesian structured time series models. An economic evaluation identifies the set-up and running costs of CICA using HM Treasury approved standardised methods and resolves cost-consequences by sector. A process evaluation explores the context, implementation and response to the intervention. Qualitative analyses utilise the Framework method to identify underlying themes.

DISCUSSION

We will investigate: whether training lay people to offer brief advice and take action on licensing decisions has an impact on alcohol-related harm in local areas; the cost-consequences for health and criminal justice sectors, and; mechanisms that influence intervention outcomes. As well as providing evidence for the effectiveness of this intervention to reduce the harm from alcohol, this evaluation will contribute to broader understanding of asset based approaches to improve public health.

TRIAL REGISTRATION

ISRCTN 81942890 , date of registration 12/09/2017.

Nuestro Futuro saludable: connecting public health research and community development in partnership to build a healthy environment

Caribbean Latinos are the largest Latino group in Boston, primarily located in the Jamaica Plain (JP) neighborhood. There are various macro-level public health issues that result from the built environment in JP, factors which can create and sustain health disparities. Caribbean Latino youth are a priority group in JP, and it is important to address the causes of disparities early in life to promote good health. Presented here is an integrated research-and-action model to engage community stakeholders and researchers in designing an intervention to mitigate the negative health effects of the built environment and maximize community assets. The approach operates from a community empowerment model that allows public health practitioners, policy makers, researchers and residents to take an up-stream approach to improve health by focusing on the built environment, which is integral to community development.

Tobacco control advocacy in Australia: reflections on 30 years of progress

Australia has one of the world's most successful records on tobacco control. The role of public health advocacy in securing public and political support for tobacco control legislation and policy and program support is widely acknowledged and enshrined in World Health Organization policy documents yet is seldom the subject of analysis in the public health policy research literature. Australian public health advocates tend to not work in settings where evaluation and systematic planning are valued. However, their day-to-day strategies reveal considerable method and grounding in framing theory. The nature of media advocacy is explored, with differences between the conceptualization of routine "programmatic" public health interventions and the modus operandi of media advocacy highlighted. Two case studies on securing smoke-free indoor air and banning all tobacco advertising are used to illustrate advocacy strategies that have been used in Australia. Finally, the argument that advocacy should emanate from communities and be driven by them is considered.

Disadvantaged persons' participation in health promotion projects: some structural dimensions

A structural perspective was used in studying community participation of disadvantaged groups (poor women, street youth, and disabled persons) in health promotion projects. Five community projects in the Canadian Health Promotion Contribution Program were examined in a comparative case study utilizing in-depth interviews, documents, and secondary sources. Analysis revealed relatively low numbers and restricted range of participants, difficulties in recruiting and maintaining participants, declining rates of active participation over time, and limited target group influence and power. This paper reports on the relationship between various dimensions of structure (social-cultural, organizational, political-legal-economic) and the community participation process. Participation was influenced by structural factors such as bureaucratic rules and regulators, perceived minority group rights and relations, agency reputations and responsibilities, available resources, and organizational roles. Control of projects by target group members, rather than by service agencies, was an important overall organizational structural factor which allowed community members to achieve influence in projects. The study concludes that a conceptual model based on structural factors is useful in explaining how key factors from federal and local levels can restrict or facilitate the community participation process.

Watson's philosophy, science, and theory of human caring as a conceptual framework for guiding community health nursing practice

Criticisms of existing nursing theories in relation to community health nursing practice are that they focus on individuals and have been developed primarily for practice within the context of infirmity and disease, making them inadequate to guide community health nursing practice. Despite being developed for individuals, Watson's theory is proposed as a nursing framework that is philosophically congruent with contemporary global approaches to community health and health promotion. An overview of her theory identifies the centrality of caring, holism, and ecology in the theory as it has evolved over the past 20 years. Concepts developed for individual-nurse interactions are extrapolated to the community in a discussion of the suitability of the theory to guide community health nursing practice. A community assessment tool based on Watson's theory is provided.

Community development: a critical review of approaches to evaluation

With the growing interest in community-based initiatives, this discussion paper focuses upon the evaluation of community development. It reviews three areas and highlights the complex and contentious nature of evaluation in this field. Commencing with approaches to evaluation, it critically reviews proposed methods and suggests that, rather than provide clarity and guidance, the competing designs are confusing for the potential researcher. Second, the discussion moves to evaluative terms that are applied to community development, suggesting that there is a mismatch between professional and lay interpretations with an ultimate impact upon the validity of their measurement. It uses the terms community and empowerment to make these differences more explicit. Finally, the paper argues that, although the aim of community-based initiatives is to bring about community health gain, gauging the pervasiveness of discreet project work is testing. It concludes by suggesting that a move away from an evaluative model based upon empowerment towards one which considers health and social capital may be a way forward.

The politics of health promotion: influences on public health promoting nursing practice in Ontario, Canada from Nightingale to the nineties

The marked and significant differences in the various meanings ascribed to health promotion in professional literature provide evidence of the concept's evolution over the last half of the 20th century and testify both to the powerful influences of dominant ideologies and the invisibility of others. The "new public health" marks a return to a conceptualization of health that is consistent with a nursing paradigm and thus potentially useful in supporting nursing health promotion practice. To take full advantage of this knowledge, however, it is critical that nurses reclaim their legacy in health promotion, critically appraise outside influences that threaten to undermine their work, and educate the public and other disciplines about nursing's unique focus on health promotion.

The 60 and Better Program: a primary health care program for the aged

The emergence of community-based primary health care programs is considered to be one way of improving the health of the community, including the older population. While community-based programs are considered to provide worthwhile resources to a range of individuals, regular evaluation of these services is required to ensure the services are meeting the needs of the community. This paper discusses 'The 60 and Better Program' as a means of improving the health of the older population. It is argued that as the program aims to empower the older population and to promote equity and access, the program is meeting the major principles of primary health care, and thus working towards improving and maintaining the health of the target group of the older population. It is further argued that the nurse has a major role in encouraging older members of our community to become active in programs such as "The 60 and Better Program'.

Building community networks: a road trauma education and training program for rural areas

The work of the Road Trauma Support Team highlights the ongoing impact of road trauma on rural communities. Small population size and close social networks mean that road trauma can have a negative effect on social relations across the whole community. Much of the 'flow-on' effect of road trauma, in the form of community distress, can be alleviated by increased skills, information about responding to road trauma, and the establishment of supportive community networks. This paper reports on the implementation and evaluation of a project that addressed knowledge, skills and awareness of road trauma in rural communities. Funded by the Rural Health Support Education and Training (RHSET) program and conducted by the Road Trauma Support Team, the project focused on the impact of traumatic events in small communities and strategies to maximise effective participation of community members and health workers in response to trauma. Piloted in six rural communities in northern Tasmania, the project has developed an educational resource package.

Who's prepared for advocacy? Another inverse law

OBJECTIVES

To examine the characteristics of parents responding to a petition calling for greater efforts to ensure the safety of children as pedestrians and to contrast factors predictive of advocacy with risk factors for child pedestrian injury.

SETTING

The Auckland region of New Zealand.

METHODS

Parents participating in the Auckland Child Pedestrian Injury Study, a community based case-control study, were invited to support a series of recommendations based on the study results, by signing and returning a petition that was to be delivered to the New Zealand Minister for Transport. Characteristics of petitioners were determined by linking their petition responses to the study questionnaires using an unique identifier. The characteristics of petitioners and nonpetitioners were summarised using odds ratios.

RESULTS

31% of parents signed and returned the petition; 19% were parents of cases and 36% were parents of controls. The sociodemographic groups whose children were at the lowest risk of pedestrian injury were the most likely to return the petition. Children in the most disadvantaged socioeconomic group and children of Pacific Island parents were at greatest risk of injury but the parents of these children were the least likely to respond to the petition.

CONCLUSIONS

The frequency with which parents advocate for child safety varies inversely with the need for it. Models of health promotion based on community ownership and empowerment alone are unlikely to address the steep socioeconomic gradients in childhood injury mortality.