People workers: a local health department's experience with health education aides

A randomized study of the impact of home health aides on diabetic control and utilization patterns

Home health aides were offered to half of a group of 227 low-income diabetic clinic patients; in the group offered aides, fasting blood sugar (FBS) declined when compared to control group (10.1 mg/dl vs an increase of 5.1 mg/dl), and missed clinic appointments and emergency room use also decreased. The group of 44, who, upon offer of an aide actually accepted one, showed a significant increase in eye clinic appointments as well as the greatest decline in FBS (13.9 mg/dl).

Waterborne giardiasis at a mountain resort: evidence for acquired immunity

In November 1981, an outbreak of waterborne giardiasis occurred at a popular ski resort in Colorado. Stratification of illness by consumption of municipal tap water showed a striking dose-response, with an attack rate of 42 per cent among persons who drank six or more glasses of water per day. Filtered water samples revealed Giardia cysts in specimens both before and after treatment, and several deficiencies were found in the water treatment facility. Residents who had lived in the area greater than 2 years had a lower attack rate for illness than short-term residents.

Outreach in urban clinics: a descriptive study

Outreach services were initially conceived as important elements of neighborhood health centers, but they have not been shown to be effective in outcome evaluations. This study examines the outreach programs in 11 community clinics in Seattle. Interviews were conducted with the program directors and outreach workers of these clinics. Outreach programs have failed to provide an adequate number of jobs and career opportunities for the poor. Workers have not been carefully selected and trained, and goals and objectives of the program have been vague. Unstable funding of outreach has affected the quality as well as the size of the programs. Reasons for the inadequate implementation of the concept of outreach are discussed, and suggestions are made for future programs.

The role of the health facilitator in community health education

A community health education program has been established by the Department of Community Health Sciences of Duke University Medical Center in two target areas of Durham County, North Carolina. The program trains unpaid lay people, "health facilitators", to whom others already turn for help, to increase their competency for advising and referring community residents to appropriate community resources. Several methods for identifying potential health facilitators have been developed. Evaluation of the role of health facilitators hinges upon designing measures to demonstrate their existence in the community and the impact that they make. To be successful, the training of health facilitators should result in improving the quality of the advice they give their fellows. It is also important to assess the cultural acceptability of the facilitators' advice and to ensure that their helping role in the community is not disturbed by the possible professionalization of their role due to the training program.

Chattanooga's experience with reorganization for delivery of health services

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