Social Protection and Health: Experiences in Uganda

There is an interesting and continuing debate on the nature and role of social protection in poverty reduction. Within the health sector, discussion has focussed on the drawbacks associated with fee exemption schemes and community‐based health insurance, with much less attention paid to the policy option of abolishing user fees. This paper reviews empirical evidence on the impact of the Government of Uganda's decision in 2001 to abolish user fees for health services. The paper finds that this policy intervention has had a significant positive impact on health‐seeking behaviour in Uganda and concludes that this policy measure can make an important contribution towards a more ‘promotional’ policy approach to social protection.     

Application of mixed-methods design in community-engaged research: Lessons learned from an evidence-based intervention for Latinos with chronic illness and minor depression

The purpose of this paper is to share lessons learned from a collaborative, community-informed mixed-methods approach to adapting an evidence-based intervention to meet the needs of Latinos with chronic disease and minor depression and their family members. Mixed-methods informed by community-based participatory research (CBPR) were employed to triangulate multiple stakeholders’ perceptions of facilitators and barriers of implementing the adapted intervention in community settings. Community partners provided an insider perspective to overcome methodological challenges. The study’s community informed mixed-methods: research approach offered advantages to a single research methodology by expanding or confirming research findings and engaging multiple stakeholders in data collection. This approach also allowed community partners to collaborate with academic partners in key research decisions.     

Exploring the unmet needs for creating an enabling environment for nurturing care to promote migrant child health in Bishkek,Kyrgyzstan: A theory-guided community-based participatory action research

Empirical evidence on community-driven child health promotion programs in disadvantaged migrant populations is limited despite various promotional strategies. Therefore, we implemented a developmental process to shape child health interventions using theory-guided community-based participatory action research (CBPAR) in a migrant community in Bishkek, Kyrgyzstan between 2015 and 2019.The collaborative and iterative CBPAR process was conducted through participatory workshops and focus group discussions with support from trusting and collegial partnerships between community members and the research team. The goal and scope of the intervention was guided by enabling environments for nurturing care, including the four domains of caregivers’ capabilities, empowered communities, supportive services, and enabling policies. Diverse interests and needs identified by community members were aggregated in the theoretical model and reflected in the intervention.Community-driven intervention is perceived as a culturally acceptable, sustainable, sensitive and relevant approach to solve problems. There are several challenges in conducting the CBPAR, such as the effort and time spent on building partnerships, co-learning and mutual understanding, and the power equilibrium involved. Despite this, the success of the CBPAR process provided opportunities for community mobilization, empowerment and sustainability of the intervention. Evaluation of the process and outcomes of the intervention provided community health researchers and practitioners with evidence of the theory-guided community participatory approach.     

Using theory of change as a framework for examining community context and philanthropic impact

As part of the process of examining their theory of change (TOC) and reflecting on grant making activity, one Midwestern foundation employed a multipronged strategy to assess 209 community-based mental health grants across seven years of funding. This article details the evaluation approach, which comprised these areas of the TOC: grantees’ use of evidence-based interventions, cultural competency, quality improvement, community collaboration, and use of integrated care. Inductive analyses identified grantees’ use of innovative practices, trauma-informed care, and use of validated instruments. In an iterative exercise spanning multiple years, the foundation and researchers found ways to gather information about community capacity and impact while simultaneously minimizing grantee data collection/reporting burden. Findings revealed that community agencies were improving in their uptake of evidence-based interventions and use of validated instruments. Community grantee use of trauma informed care also improved over the study period. Grantee desire to collaborate and coordinate services within the community was also strong. The research also revealed that in multiple domains (such as technology and non-profit operating costs) grantees needed support in building agency capacity. These findings shed light on which aspects of the foundation’s TOC were being addressed through funding, and which areas of the community needed additional support.     

Effective targeted and community HIV/STD prevention programs

Community interventions and interventions targeting specific groups at risk of STDs/HIV have demonstrated significant impacts on sexual behavior, particularly condom use and safer sex. The scientific evidence suggests the factors that make these interventions particularly effective include the establishment of community, including business and CBO partnerships; maintainance of the intervention post-research funding; and buy-in by the community or target group. The modification of risky normative beliefs through the use of opinion leaders and role models, and through intervention delivery by peer educators, is an important facet of such interventions. Interventions delivered by health professionals, absent a community base, appear to be unsuccessful. Where cultures or subcultures are targeted, the close involvement of such groups in the design and delivery of messages is critical to their success. Diffusion of interventions through existing social networks further extends the intervention into the community and acts to reinforce and maintain changes in peer norms toward safer sexual behavior. The available data confirm that community or medical infrastructure-based interventions are effective in changing sexual behavior and can reach a wider range of the population than face-to-face programs if they incorporate peer educators as role models in modifying norms, and if diffusion of the intervention is integral to the design.     

Mental health interventions for children in foster care: A systematic review

Children in foster care have high rates of adverse childhood experiences and are at risk for mental health problems. These problems can be difficult to ameliorate, creating a need for rigorous intervention research. Previous research suggests that intervening with children in foster care can be challenging for several reasons, including the severity and complexity of their mental health problems, and challenges engaging this often transitory population in mental health services. The goal of this article was to systematically review the intervention research that has been conducted with children in foster care, and to identify future research directions. This review was conducted on mental health interventions for children, ages 0 to 12, in foster care, using ERIC, CINAHL, PsycINFO, PubMed, ProQuest's Dissertation and Theses Database, Social Services Abstracts, and Social Work Abstracts. It was restricted to interventions that are at least “possibly efficacious” (i.e., supported by evidence from at least one randomized controlled trial). Studies were evaluated for risk of bias. Ten interventions were identified, with diverse outcomes, including mental health and physiological. Six interventions were developed for children in foster care. Interventions not developed for children in foster care were typically adapted to the foster context. Most interventions have yet to be rigorously evaluated in community-based settings with children in foster care. Little research has been conducted on child and family engagement within these interventions, and there is a need for more research on moderators of intervention outcomes and subgroups that benefit most from these interventions. In addition, there is no consensus regarding how to adapt interventions to this population. Future research should focus on developing and testing more interventions with this population, rigorously evaluating their effectiveness in community-based settings, determining necessary adaptations, and identifying which interventions work best for whom.     

Tobacco Control and Smoking Cessation Efforts in an Inner-City African American Community

This paper describes the conceptual framework that guided the development and implementation of a large-scale, community-based health initiative to lower the prevalence of smoking in an urban African American community. This project developed culturally-sensitive approaches to reducing smoking in the community and to promoting tobacco control efforts developed and implemented by community members. A randomized clinical-trial methodology was used to test the efficacy of the culturally-sensitivey community-developed smoking cessation interventions in lowering smoking rates as compared with a self-help approach. Two theoretical models guided the intervention strategies: a macro-level model applicable to the community as a whole, and a psychological process model applicable to individuals. The community model was based on community systems theory and incorporated the Readiness for Change Model which was applied in both the individual and organizational models. In addition, culturally-sensitive data collection methods were developed to improve the reliability and validity of project data, especially in determining the smoking prevalence rates and smoking behaviors of hard-to-reach, inner-city African Americans. Since the health of individuals is related to the health of their communities, smoking cessation and tobacco control activities that are integrated into the framework of the community (Le., churches, city-council, housing developments, community organizations), and incorporate culturally-relevant and specific interventions can be effective methods for achieving behavioral and societal change.     

Care for left-behind children in rural China: A realist evaluation of a community-based intervention

In many countries, large numbers of left-behind children (LBC) grow up experiencing prolonged separation from their migrant worker parents. These children are known to be vulnerable to psychological and developmental problems. Drawing on qualitative interview data as well as ethnographic observations, a realist approach was applied in this study to evaluate the feasibility, acceptance, preliminary outcomes and potential sustainability of a community-based intervention to provide care and support to LBC, in a migrant-sending area of rural China. The intervention program comprised “Children's Clubs” in local communities, in which LBC participate in play and educational activities under the care and supervision of local volunteers. Twelve Clubs in 12 different villages were evaluated for the study. In each village, semi-structured interviews were conducted with three community stakeholders, and children and primary caregivers from two families, to examine their perceptions and experiences with regard to the intervention. Our findings indicated that most Clubs adapted the initial program theory and implementation plan to specific community contexts, particularly the socio-economic situation and the support from village leadership and other community members. Program implementation mechanisms consisted of integrating available resources, engaging local volunteers, and delivering various Club activities. Preliminary outcomes indicated the success in establishing a community care platform to benefit the emotional and behavioral wellbeing of LBC, and to enhance the community support networks. To ensure program sustainability, the Children's Clubs should explore new funding schemes, expand the pool of qualified volunteers, and improve the curricular and activities at the Clubs.     

Building resilience to environmental problems in Kenya: lessons for aid organizations from three successful community-based processes

Vulnerable communities are disproportionately affected by environmental changes and problems. Developing interventions that aim to foster resilience by utilizing existing local strengths can support these communities. This study explored experiences of community resilience to environmental problems in Kenya. This article offers 3 successful processes of mutual support: culturally appropriate charity, community-based micro financing, and community-based fundraising. Lessons learned are offered, which can be supported by aid organizations to increase impact and reach.     

Tobacco control and smoking cessation efforts in an inner-city African American community

This paper describes the conceptual framework that guided the development and implementation of a large-scale, community-based health initiative to lower the prevalence of smoking in an urban African American community. This project developed culturally-sensitive approaches to reducing smoking in the community and to promoting tobacco control efforts developed and implemented by community members. A randomized clinical-trial methodology was used to test the efficacy of the culturally-sensitive, community-developed smoking cessation interventions in lowering smoking rates as compared with a self-help approach. Two theoretical models guided the intervention strategies: a macro-level model applicable to the community as a whole, and a psychological process model applicable to individuals. The community model was based on community systems theory and incorporated the Readiness for Change Model, which was applied in both the individual and organizational models. In addition, culturally-sensitive data collection methods were developed to improve the reliability and validity of project data, especially in determining the smoking prevalence rates and smoking behaviors of hard-to-reach, inner-city African Americans. Since the health of individuals is related to the health of their communities, smoking cessation and tobacco control activities that are integrated into the framework of the community (i.e., churches, city-council, housing developments, community organizations), and incorporate culturally-relevant and specific interventions can be effective methods for achieving behavioral and societal change.     

Mentoring Improves Acceptance of a Community Intervention For Court-Referred Male Persons in Need of Supervision (PINS)

Despite excellent community-based interventions for court-referred adolescent boys, low rates of retention in the initial phase of treatment often lower overall effectiveness. This study assessed the contribution of mentoring towards improving compliance with a community-based intervention for court-referred adolescent male Persons in Need of Supervision (PINS). Charts on 79 court-referred adolescent boys (mean age=14.28; SD=1.37) admitted to a community based intervention in a large metropolitan area were systematically reviewed for patterns of service utilization (mentoring and group treatment), familial history, and substance use and psychopathology. Male adolescent PINS who utilized mentoring were ten times more likely to remain in the community-based intervention during the initial 6 months. Following the initial 6 months period, utilization of group treatment, but not mentoring, was associated with retention in the community-based intervention and positive outcome. Community-based intervention for court-referred adolescents might include mentoring during the initial 6 months of treatment to improve compliance.     

Developing a community-level anti-HIV/AIDS stigma and homophobia intervention in new York city: The project CHHANGE model

HIV/AIDS stigma and homophobia are associated with significant negative health and social outcomes among people living with HIV/AIDS (PLWHA) and those at risk of infection. Interventions to decrease HIV stigma have focused on providing information and education, changing attitudes and values, and increasing contact with people living with HIV/AIDS (PLWHA), activities that act to reduce stereotyped beliefs and prejudice, as well as acts of discrimination. Most anti-homophobia interventions have focused on bullying reduction and have been implemented at the secondary and post-secondary education levels. Few interventions address HIV stigma and homophobia and operate at the community level. Project CHHANGE, Challenge HIV Stigma and Homophobia and Gain Empowerment, was a community-level, multi-component anti-HIV/AIDS stigma and homophobia intervention designed to reduce HIV stigma and homophobia thus increasing access to HIV prevention and treatment access. The theory-based intervention included three primary components: workshops and trainings with local residents, businesses and community-based organizations (CBO); space-based events at a CBO-partner drop-in storefront and “pop-up” street-based events and outreach; and a bus shelter ad campaign. This paper describes the intervention design process, resultant intervention and the study team’s experiences working with the community. We conclude that CHHANGE was feasible and acceptable to the community. Promoting the labeling of gay and/or HIV-related “space” as a non-stigmatized, community resource, as well as providing opportunities for residents to have contact with targeted groups and to understand how HIV stigma and homophobia relate to HIV/AIDS prevalence in their neighborhood may be crucial components of successful anti-stigma and discrimination programming.     

LGBTQ + community organizations under neoliberalism in Ontario,Canada: Contradictions and disconnects

Abstract

This study examines the impact of neoliberal policy—which introduces competition for funding and pressure to professionalize and bureaucratize—on the working conditions and precarity of a purposive sample of southern Ontario (Canada) organizations dealing with LGBTQ?+?health. Findings from semi-structured, in-depth interviews with 20 community-based organization stakeholders and government bureaucrats confirmed that neoliberal policy pressures these organizations to professionalize and bureaucratize, while restricting political advocacy. Queer Liberation Theory’s three central tenets of anti-assimilationism, solidarity across movements, and the political economy of queer health are used to understand the situation and possible futures for third-sector organizations within the LGBTQ?+?movement.     

Primary healthcare planning,bottleneck analysis and performance improvement: An evaluation of processes and outcomes in a Nigerian context

Operational planning of interventions defines roadmaps, timelines and resources necessary for translating policies into expected health outcomes along the evidence-policy-implementation continuum. However, bottlenecks often hinder the attainment of objectives and the timely delivery of intervention packages leading to sub-optimal performance of health systems. Bottleneck identification, analysis and removal approaches to planning, which requires key stakeholders’ participation, have been recommended to improve health system outcomes in LMICs. This study demonstrates how integration of participatory action research (PAR) within a quality improvement model can help navigate the complexities of health system bottleneck analyses, planning and performance improvement in a Nigerian sub-national context.The study is based on data collected between June 2016 and June 2017, from Chikun LGA in Kaduna State Nigeria. PAR was integrated into a quality improvement model called DIVA (Diagnose-Intervene-Verify-Adjust) applied across selected interventions (eMTCT, Antenatal care, skilled birth attendance, immunization and Integrated Management of Childhood Illnesses). PAR was used to identify and analyse health system bottlenecks, as well as develop, monitor implementation and follow-up on action plans to address them. Evaluations were conducted involving 2 cycles of DIVA. The outputs (bottleneck analysis charts, driver diagrams, operational plans, M/E reports, etc.) from each cycle of the DIVA process were collated and analysed. Bottlenecks identified include availability of human resources for health, availability of health commodities as well as geographical accessibility. These had implications on acceptability and quality of services. Mean Improvements recorded were 20.4%, 14.0% and 10.8% and 11.2%, 7.5%; 5.5% (across eMTCT, maternal health and child health interventions) in the 1 st and 2nd DIVA cycles respectively. This study highlights processes and outcomes of integrating PAR in quality improvement design and operations in health intervention programmes with a focus on health systems strengthening in a Nigerian context. Implementing the DIVA model using a PAR approach may be considered an effective strategy for planning and implementing health interventions in comparable settings.     

Experiments in evaluation capacity building: Enhancing brain disorders research impact in Ontario

This paper is the introductory paper on a forum on evaluation capacity building for enhancing impacts of research on brain disorders. It describes challenges and opportunities of building evaluation capacity among community-based organizations in Ontario involved in enhancing brain health and supporting people living with a brain disorder. Using an example of a capacity building program called the “Evaluation Support Program”, which is run by the Ontario Brain Institute, this forum discusses multiple themes including evaluation capacity building, evaluation culture and evaluation methodologies appropriate for evaluating complex community interventions. The goal of the Evaluation Support Program is to help community-based organizations build the capacity to demonstrate the value that they offer in order to improve, sustain, and spread their programs and activities. One of the features of this forum is that perspectives on the Evaluation Support Program are provided by multiple stakeholders, including the community-based organizations, evaluation team members involved in capacity building, thought leaders in the fields of evaluation capacity building and evaluation culture, and the funders.     

A measure of community members’ perceptions of the impacts of research partnerships in health and social services

Currently, there are no psychometrically sound outcome measures by which to assess the impacts of research partnerships. This article describes the development of a 33-item, survey questionnaire measuring community members’ perceptions of the impact of research partnerships addressing health or social issues. The Community Impacts of Research Oriented Partnerships (CIROP) was developed using information from the literatures on health promotion, community development, research utilization, and community-based participatory research, and from focus groups involving 29 key informants. Data from 174 community members were used to determine the factor structure, internal consistency, and test–retest reliability of the four CIROP scales, and to provide evidence of construct validity. The CIROP informs research partnerships about the extent of their impact in the areas of Personal Knowledge Development, Personal Research Skill Development, Organizational/Group Access To and Use of Information, and Community and Organizational Development, allowing them to demonstrate accountability to funding bodies. As well, the CIROP can be used as a research tool to assess the effectiveness of knowledge sharing approaches, determine the most influential activities of research partnerships, and determine structural characteristics of partnerships associated with various types of impact. The CIROP provides a better understanding of community members’ perspectives and expectations of research partnerships, with important implications for knowledge transfer and uptake.     

Full-service community schools: a strategy--not a program

The concept that drives the emerging full-service community school movement is this: Schools cannot address all the problems and needs of disadvantaged children, youth, and families. Community schools are operated jointly by school systems and community agencies, are open extended hours, and may provide the site for after-school programs, primary-care health services, mental health counseling, parent education and involvement, and community development. No two community schools are alike. They grow out of a planning process that involves all stakeholders, school personnel, community-based organizations, city and county government, parents, and students. The Quitman Street Community School in Newark, New Jersey, exemplifies this approach.     

A Participant-Informed Model for Preventing Teen Pregnancy in a Rural Latino Community

Recognizing the need for health prevention efforts that are tailored to the needs of Latinos in rural communities, the researchers utilized focus groups to ascertain the perspectives of Latino children and their parents who participated in a teen pregnancy prevention program. This article presents a Latino-driven conceptual design of an evidence-informed comprehensive, community-based, and culturally sensitive teen-pregnancy prevention program. The new model, called the Family-Festival Prevention Model, (1) used culturally relevant and experiential learning activities, (2) promoted community connections, (3) incorporated strategies that engaged fathers, and (4) engaged important faith-based and community stakeholders to involve the whole community in prevention efforts.     

A theory based evaluation of an intervention to promote positive health behaviors and reduce social isolation in people experiencing homelessness

ABSTRACT

Homelessness adversely affects an individual's ability to access healthcare, opportunities for social interaction and recreational activities such as physical activity. This study aimed to evaluate the impact of a community-based physical activity and peer support intervention on the health and wellbeing of homeless participants. This study employed semi-structured interviews to investigate the perceived impact of the Street Fit Scotland intervention on the health and wellbeing of 10 homeless adults. Interviews were audio recorded and transcribed verbatim. A thematic analysis was conducted. Participants reported that their health and wellbeing had improved since attending the intervention. This was attributed to improvements in self-esteem, social interaction and mental wellbeing. Participants generally felt that their physical activity had increased since attending Street Fit Scotland, and a number of individuals reported that they were making healthier choices with regards to health behaviors. A theory of change logic model was developed that demonstrated how each component of the intervention influences the observed and intended outcomes. Attendance of Street Fit Scotland had positive effects on participant's health and wellbeing, particularly concerning self-esteem, health behaviors, social interaction, and physical activity. More efforts should be made to evaluate small-scale interventions that are reaching vulnerable population groups.