Community Health in Rural America During the Mid-20th Century.

The Council on Rural Health (1945-1975) of the American Medical Association (AMA) collaborated with domestic health care organizations in the mid-20th century to improve access to health care in rural areas. This council promoted health and farm safety education, public health measures, insurance plans, and construction of health facilities. It also lobbied state and county medical societies to form rural health committees. AMA archive materials document these activities and demonstrate physicians' involvement and investment in the communities they served.

Chelsea, Pimlico and Belgravia District Nursing Association 1930-1939: A case study.

The case study explores how the expansion of the health services during the interwar period impacted upon the status of district nursing and examines how being a voluntary service shaped district nursing associations. A range of primary sources were used; the Association Annual Reports, the Medical Officer for Health Annual Reports for the Borough of Chelsea, the Ministry of Health records, the archives of the Queen's Nursing Institute (QNI) and the Borough of Chelsea Council Minutes. The Medical Officer for Health Reports and the Council minutes identify efforts to improve environmental factors that impacted upon health. These primary sources briefly note the contribution of the Association suggesting that it was integral to the health care provision but considered a constant. The impact of changes to the 1932 Sunday Entertainments Act provide an interesting juxtaposition between the acknowledged value of district nursing and the constant struggle to fundraise in order to provide home nursing. Throughout the 1930s the Association experienced staff shortages and challenges regarding recruitment. The complexities of payment for municipal health services following the 1929 Local Government Act contributed to the staffing challenges. The move to a block grant in 1938 provided increased stability with regards to income. The case study identifies a contradiction regarding the esteem and value placed upon district nursing associations providing home nursing and the constant challenge of resources. District nursing services face similar challenges and this is the 130th anniversary of the Queen's Nursing Institute.

Award for Distinguished Senior Career Contributions to Psychology in the Public Interest: Faye Z. Belgrave.

The APA Awards for Distinguished Contributions to Psychology in the Public Interest recognize persons who have advanced psychology as a science and/or profession by a single extraordinary achievement or a lifetime of outstanding contributions in the public interest. The 2016 recipient of the Award for Distinguished Senior Career Contributions to Psychology in the Public Interest is Faye Z. Belgrave. She was selected for her "extensive service contributions to her profession, her university, and the community," evidenced in her "focused research agenda that informs and shapes her teaching, her mentoring, and the community programs, workshops, and trainings she has designed." Dr. Belgrave's award citation, biography, and a selected bibliography are presented here. (PsycINFO Database Record

Improving care delivery at the community level: an examination of the AF4Q legacy.

OBJECTIVE: Aligning Forces for Quality (AF4Q) was the Robert Wood Johnson Foundation's nearly 10-year, multicomponent initiative to create meaningful and sustainable change in 16 communities. Our purpose was to describe the likely legacy of the care delivery component of AF4Q among participating communities and the factors that influenced the legacy. METHODS: We used a multiple-case study approach. Our analysis relied on 3 key documents for each community, based on key informant interviews conducted between 2006 and 2015: (1) a summary of the community's care delivery activities under AF4Q, (2) a summary of the community's experience in the AF4Q program, and (3) a summary of the characteristics of each community and the multi-stakeholder alliance that led local efforts under AF4Q. We used a team-based consensual approach to analysis. RESULTS: We identified 3 types of legacies: (1) in 3 communities, there appear to be sustained infrastructures or wide-reaching activities attributable to AF4Q; (2) in 5 communities, AF4Q participation was used to advance preexisting activities; and (3) in 8 communities, the care delivery legacy is likely to be limited, because the local alliance focused on performance measurement instead of care delivery or the care delivery activities had limited reach and sustainability. Community contextual factors (eg, availability of other grant support) and alliance characteristics (eg, areas of expertise) greatly influenced the AF4Q care delivery legacy. CONCLUSION: AF4Q appears to have created meaningful and sustained change in care delivery in half of the participating communities. Among the other communities, the considerable financial support and technical assistance provided by RWJF was not enough to overcome some of the contextual barriers that often hamper quality-improvement efforts.

Psicología comunitaria: apuntes para no olvidar / Community psychology: notes to not forget

En este artículo abordaremos un tema que, aunque ha sido muy estudiado, necesita ser analizado desde un punto de vista más crítico en nuestro país. Por ende, se realizará una búsqueda bibliográfica, que dará cuenta de los aportes a la teoría y la puesta en práctica en Colombia de la Psicología Comunitaria. Este campo de estudio, es una de las ramas más recientes de la psicología, ya que se consolidó en Estados Unidos en el año de 1965, y en Latinoamérica a mediados de los años 70; pero su desarrollo no ha cesado, y se ha pensado desde la interdisciplinaridad. Ahora bien, nos sumergiremos en el mundo del tema que nos convoca en esta ocasión, buscando las razones que llevan a un área de estudio, tan importante en nuestro contexto, a dar a entender el por qué, el cómo, el dónde, el para qué y quiénes han contribuido, con el fin de hacer un avistamiento de los fundamentos y desarrollos que han adquirido los profesionales, en el transcurso de la investigación y la práctica de esta área en el país. Este artículo de reflexión planteará, en tres subtítulos, la lectura que, desde la perspectiva de tres estudiantes en formación de un pregrado de psicología, se han pensado, desde una perspectiva propositiva y apreciativa, sobre el cómo este enfoque contribuye a generar en las comunidades, agenciamientos desde la posibilidad, la resiliencia y el trabajo comunitario en red.

In this article we will approach a topic that, although it has been very studied, needs to be analyzed from a more critical point of view in our country. Therefore, a bibliographic search, which will account for the contributions to the theory and implementation in Colombia of Community Psychology. This field of study is one of the branches psychology, since it was consolidated in the United States in the year of 1965, and in Latin America in the mid-70s; but its development has not stopped, and It has been thought from the interdisciplinarity. Now, we will immerse ourselves in the world of the topic that summons us on this occasion, looking for the reasons that lead to an area of study, so important in our context, to make us understand why, how, where, for what and who have contributed, in order to make a sighting of the fundamentals and developments that professionals have acquired during the course of research and practice of this area in the country. This article of reflection will pose, in three subtitles, reading that, from the perspective of three fit students of a psychology undergraduate, have been thought, from a propositive perspective and appreciative, on how this approach contributes to generate in the communities, agencies from the possibility, resilience and community work in network.

Reforming the community research program: from Community Clinical Oncology Program to the National Cancer Institute Community Oncology Research Program.

Community research has been an integral and influential component of the National Research Program since the late 1970s. Institutionalization of community research in the Community Clinical Oncology Program (CCOP) has resulted in successful collaborations, meaningful accrual, achievement of quality standards, and translation of research into clinical practice. Although the national clinical trial system is undergoing modernization and improvement, the success of the CCOP and minority-based CCOP in cancer treatment, prevention, and control research is being extended to include cancer care delivery research in the newly created National Cancer Institute (NCI) Community Oncology Research Program. This article briefly presents a historic perspective of community involvement in federally sponsored clinical trials and introduces the continued involvement in the newly created NCI program.

Cultivating constituencies: the story of the East Harlem Nursing and Health Service, 1928-1941.

I examine the history of the East Harlem Nursing and Health Service in New York City from its beginnings as a demonstration project in 1922 to its closing in 1941. I explore the less tangible goals, needs, and ambitions of the many different constituents that paid for, delivered, and received health care services. I place these goals, needs, and ambitions as critically important drivers of ultimate success or failure. The East Harlem Nursing and Health Service gained international fame among public health leaders for its innovative and independent nursing practice and teaching. However, it ultimately failed because its commitment was to a particular disciplinary mission that did not meet the needs of the constituent communities it served. From 1928 to 1941, the service focused more on the educational advancement of public health nursing and less on addressing the real health care needs of those in East Harlem.

Modernization and rural health in Mexico: the case of the Tepalcatepec Commission.

Mexican policymakers instituted community-based health programs in the 1940s and 1950s to encourage rural participation in state-sponsored health and economic development initiatives. The Tepalcatepec Commission (1947-1961) united previously independent government programs into a multi-tiered collaboration that addressed regional development through national, state, and local networks. While national policymakers and state officials designed plans to improve agricultural production, promote industrialization, utilize the area's natural resources, and expand communication channels, health workers established unprecedented relationships with indigenous community members by introducing the Commission's projects in culturally relevant ways. They used their on-the-ground experiences to learn local languages, customs, and beliefs, and incorporated these factors into their health education and disease treatment campaigns. The result serves as an example of short-term cooperative relationships between healthcare workers and indigenous groups that not only reduced the major health risks in the area, but also paved the way for collective economic development.

Navigating the AIDS industry: being poor and positive in Tanzania.

This article shows how poor people living with HIV/AIDS in Tanzania navigate a myriad of actors, agencies and organizations to obtain the aid they need to survive. It focuses on community-based organizations which establish networks of care through which people obtain care, treatment and financial support. A case study of a roadside town in Tanzania illustrates that these community-based networks of care ­ essential to the survival of many ­ are partly the product of the AIDS industry, which encourages the establishment of community-based organizations and voluntary service delivery rather than more formalized systems of care. Community-based organizations, however, are so poorly supported that they often deploy self-destructive strategies. The need to strategically navigate the AIDS industry creates tension and even conflict among HIV-positive activists, the people they represent and the wider community, which undermines rather than strengthens community-based interventions. Whilst the AIDS industry promises inclusion of HIV-positive people in the response to HIV/AIDS, it succeeds only partially, with the result that it may potentially do more harm than good.

Social capital and women's reduced vulnerability to HIV infection in rural Zimbabwe.

Social capital­especially through its "network" dimension (high levels of participation in local community groups)­is thought to be an important determinant of health in many contexts. We investigate its effect on HIV prevention, using prospective data from a general population cohort in eastern Zimbabwe spanning a period of extensive behavior change (1998­2003). Almost half of the initially uninfected women interviewed were members of at least one community group. In an analysis of 88 communities, individuals with higher levels of community group participation had lower incidence of new HIV infections and more of them had adopted safer behaviors, although these effects were largely accounted for by differences in socio-demographic composition. Individual women in community groups had lower HIV incidence and more extensive behavior change, even after controlling for confounding factors. Community group membership was not associated with lower HIV incidence in men, possibly refecting a propensity among men to participate in groups that allow them to develop and demonstrate their masculine identities­often at the expense of their health. Support for women's community groups could be an effective HIV prevention strategy in countries with large-scale HIV epidemics.

Comparative efficiency assessment of primary care service delivery models using data envelopment analysis.

This paper compares the relative productive efficiencies of four models of primary care service delivery using the data envelopment analysis method on 130 primary care practices in Ontario, Canada. A quality-controlled measure of output and two input scenarios are employed: one with full-time-equivalent labour inputs and the other with total expenditures. Regression analysis controls for the mix of patients in the practice population. Overall, we find that community health centres fare the worst when it comes to relative efficiency scores.

Feeding the family during times of stress: experience and determinants of food insecurity in an Inuit community.

This paper uses a mixed methods approach to characterise the experience of food insecurity among Inuit community members in Igloolik, Nunavut, and examine the conditions and processes that constrain access, availability, and quality of food. We conducted semi-structured interviews (n= 66) and focus groups (n= 10) with community members, and key informant interviews with local and territorial health professionals and policymakers (n= 19). The study indicates widespread experience of food insecurity. Even individuals and households who were food secure at the time of the research had experienced food insecurity in the recent past, with food insecurity largely transitory in nature. Multiple determinants of food insecurity operating over different spatial-temporal scales are identified, including food affordability and budgeting, food knowledge and preferences, food quality and availability, environmental stress, declining hunting activity, and the cost of harvesting. These determinants are operating in the context of changing livelihoods and climate change, which in many cases are exacerbating food insecurity, although high-order manifestations of food insecurity (that is, starvation) are no longer experienced.

Parallel realities: exploring poverty dynamics using mixed methods in rural Bangladesh.

This paper explores the implications of using two methodological approaches to study poverty dynamics in rural Bangladesh. Using data from a unique longitudinal study, we show how different methods lead to very different assessments of socio-economic mobility. We suggest five ways of reconciling these differences: considering assets in addition to expenditures, proximity to the poverty line, other aspects of well-being, household division, and qualitative recall errors. Considering assets and proximity to the poverty line along with expenditures resolves three-fifths of the qualitative and quantitative differences. Use of such integrated mixed-methods can therefore improve the reliability of poverty dynamics research.

An evaluation of the policy on community health organizations in China: will the priority of new healthcare reform in China be a success?

OBJECTIVES: The objective of this paper is to assess historical and recent health reform efforts in China. We provide a brief history of the Chinese healthcare system since 1949 as context for the current healthcare; examine the factors that led to recent efforts to reestablish community-based care in China; and identify the challenges associated with attaining a sustainable and quality community healthcare system. METHODS: Based on literature review and publicly available data in China, the paper will present a historical case study analysis of health policy change of CHOs in China and provide policy evaluation, and the paper provided policy suggestions. RESULTS: We find that the government's recent efforts to emphasize the significance of community healthcare services in China have started to change patterns of healthcare use, but many problems still inhibit the development of CHOs, including unsustainable governmental roles, issues of human resource inadequacy and laggard GP practice, poorly designed payment schemes, patient's trust crisis and continue to inhibit the development of community-based primary care. CONCLUSIONS: Additional policy efforts to help CHOs' development are needed. Recent government investments in public health and primary care alone are not sufficient and could not be sustainable. It will not until long-term self-sustaining mechanisms to relieve an omnipotent government are established, including competent community doctors (GP) system, supportive social insurance reimbursement, appropriate financial incentives to providers, better transparency and accountability, as well as a more regulated referral system, a legitimate, sustainable and quality community health system could be attained.

[Community health and social action in the epidemiologic control of infantile trachoma, Spain (1932-1939)]. / Salud comunitaria y acción social en el control epidemiologíco del tracoma infantil, España (1932-1939).

Within the context of the endemic trachoma that affected different regions of Spain until the 1960s, this paper analyses the epidemiological determinants of child trachoma and its treatment, based on a preventive care model which incorporated the concept of community health that took shape during the interwar period. Early detection of cases, together with preventive measures, education, therapy and inspections, such as those carried out by visiting nurses, all helped to control the disease. Our results reaffirm the validity of the horizontal intervention strategies used for improving the sanitary conditions and environmental factors responsible for this prevalence of trachoma.

Lessons from the evolution of a CBR programme for people affected by leprosy in Northern Nigeria.

OBJECTIVE: This paper reviews the 13-year evolution of the social economic activities in Northern Nigeria from a welfare-oriented to a community-centred programme for people affected by leprosy. DESIGN: The review relied on the analysis of policy and strategy documents, programme guidelines and statistical and evaluation reports. RESULTS: Findings revealed that the transformation among other things, demanded formulation of new programme policies and guidelines; and staff training in CBR principles and practice. Findings also showed that adopting CBR principles and community development projects can stimulate improvements in living conditions, self-esteem and acceptance of people affected by leprosy into the community. Regardless of becoming a more inclusive and participatory programme wherein people affected by leprosy contribute to programme implementation and evaluation; groups affected by leprosy remain economically dependent on the programme and partnership mobilisation is weak. This explains why the priorities for sustaining the processes and impacts generated through CBR in northern Nigeria include: i) empowering groups to access mainline services; ii) working through partners to implement CBR and attract extra funding/ownership of interventions, and iii) promoting human rights of people affected by leprosy and working for a barrier free environment. CONCLUSIONS: In the absence of an agreeable understanding and method of assessing sustainability in CBR, we recommend the field-testing of a proposal for evaluating sustainability, to determine its utility in different contexts. Such field-tests have the potential of influencing policy and practice in the future.