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1.
BMC Public Health ; 19(1): 1699, 2019 Dec 18.
Artículo en Inglés | MEDLINE | ID: mdl-31852528

RESUMEN

BACKGROUND: In Australia, around 67% of adults and 25% of children (5-17 years) are currently overweight or obese (Australian Bureau of Statistics, 4364.0.55.001 - National Health Survey: First Results, 2017-18, 2018). The Campbelltown - Changing our Future study will translate 'a whole of system' approach, previously trialed in rural communities in Victoria and the Australian Capital Territoty, to Campbelltown Local Government Area (LGA), a socioeconomically and ethnically diverse urban community in south western Sydney, NSW. METHODS: The study intervention will use a five-step approach; 1 - set up a childhood obesity monitoring system by collecting baseline data from children in primary schools across Campbelltown LGA to give a local context to the community when developing the systems map; 2 - key stakeholders develop systems maps which inform the development of the interventions; 3 - key stakeholders and community groups identify priority areas for action and form working groups; 4 - implementation of the interventions; 5 - evaluation of the interventions. The study will adopt a longitudinal pre/post design with repeated measures at baseline, 2 years and 4 years. Both qualitative and quantitative methods will be used to collect and analyse the data. DISCUSSION: Addressing childhood overweight and obesity is complex and requires a multifaceted intervention. This approach has the capacity to impact a range of factors that influence childhood overweight and obesity utilising existing capacity of multiple partners with broad community reach. Findings will develop local responses which capture the complexity of obesity at a community level and further our understanding of the interrelationships and relative importance of local factors impacting childhood overweight and obesity. This study aims to provide evidence for systems methods and approaches suitable for adaption and scaling and may provide evidence of successful community intervention elements.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Grupos Étnicos/educación , Grupos Étnicos/estadística & datos numéricos , Promoción de la Salud/métodos , Obesidad Pediátrica/epidemiología , Obesidad Pediátrica/prevención & control , Australia/epidemiología , Niño , Preescolar , Femenino , Humanos , Estudios Longitudinales , Masculino , Población Rural/estadística & datos numéricos , Instituciones Académicas/estadística & datos numéricos
2.
Artículo en Inglés | MEDLINE | ID: mdl-31847468

RESUMEN

Elucidating the perceptions of residents regarding medical group practice (GP) among rural communities (GP-R) in Japan will be useful for establishing this system in such communities. A survey by questionnaire, as made by experts in rural health, was conducted in 2017. The self-administered questionnaire inquired about the perceptions of residents for accepting the GP-R into the community's healthcare using seven major elements of GP-R. The questionnaire was randomly distributed to 400 adult residents who lived in rural communities with a recently launched GP and had access to clinics within the communities. Among the 321 respondents, comparisons were made between younger (≤sixties) and older (≥seventies) residents, and a stepwise multiple regression analysis was performed to extract the factors influencing acceptance of the GP-R system. The results showed that older residents had a greater disapprove of being treated by different physicians daily or weekly in clinics (p < 0.001) and the use of telemedicine (p < 0.001) compared with younger residents. Younger residents showed a greater disapproval of clinics closing on weekdays than older residents (p = 0.007). Among all respondents, regardless of age groups, over half of residents approved of the involvement of nurse practitioners in the GP-R. Living with family and children was also extracted as an independent factor influencing a positive perception of the GP-R. These data suggest that the promotion of GP-R should consider generation gaps in the approach to medical practice as well as the family structures of residents. The involvement of nurse practitioners can also encourage the acceptance of GP-R in Japan.


Asunto(s)
Práctica de Grupo , Servicios de Salud Rural/organización & administración , Población Rural , Adulto , Anciano , Servicios de Salud Comunitaria/organización & administración , Femenino , Humanos , Japón , Masculino , Persona de Mediana Edad , Percepción , Salud Rural , Encuestas y Cuestionarios , Adulto Joven
3.
BMC Health Serv Res ; 19(1): 986, 2019 Dec 21.
Artículo en Inglés | MEDLINE | ID: mdl-31864354

RESUMEN

BACKGROUND: The family doctor system has developed rapidly all over the world, and in the past few years, China has actively explored family doctor-type contracted services. This study aimed to explore the related factors of Contracted Family Doctors Services (CFDS) from the perspectives of medical staff and consumers, and to provide a stronger basis for the development and promotion of CFDS. METHODS: A combination of quantitative and qualitative methods were used in this study. A self-reported questionnaire was designed through a literature analysis, group discussions, expert consultations and a pre-investigation, and conducted among community health service providers in 12 community health service centres across four provinces of China. A total of 389 participants participated, and 320 valid questionnaires were obtained, with an effective response rate of 82.3%. A total of 36 consumers participated in in-depth interviews, and the effective rate was 100.0%. An exploratory factor analysis, a confirmatory factor analysis, inductive methods, and expert consultations were used to analyse the related factors of CFDS. RESULTS: The related factors of CFDS from the perspectives of medical staff were divided into four dimensions, with the following weighting coefficients: national government factors (31.9%), community health service agency factors (24.7%), consumer-related factors (22.6%), and contracted doctor-related factors (20.8%). The related factors of CFDS from the perspectives of consumers were divided into four dimensions, with the following frequency sequence: national government factors, contract doctor-related factors, community health service agency factors, and consumers-related factors. National government factors played an important role in CFDS from the perspectives of medical staff and consumers. CONCLUSIONS: The related factors of CFDS were the same from the perspective of medical staff and consumers, but the weight of each factor was different. The development of CFDS is inseparable from the support of policies. It is suggested that the government should strengthen the publicity of CFDS, expand the coverage, introduce personalised contract programs that meet the needs of different groups, and promote the rapid development of CFDS.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Servicios Contratados/estadística & datos numéricos , Médicos de Familia , Adulto , Actitud del Personal de Salud , Actitud Frente a la Salud , China , Estudios Transversales , Análisis Factorial , Femenino , Humanos , Masculino , Cuerpo Médico/psicología , Persona de Mediana Edad , Pacientes/psicología , Investigación Cualitativa
4.
BMC Health Serv Res ; 19(1): 799, 2019 Nov 05.
Artículo en Inglés | MEDLINE | ID: mdl-31690299

RESUMEN

INTRODUCTION: Female Sex workers (FSW) and their clients accounted for 18% of the new HIV infections in 2015/2016. Special community-based HIV testing service delivery models (static facilities, outreaches, and peer to peer mechanism) were designed in 2012 under the Most At Risk Populations Frame work and implemented to increase access and utilization of HIV care services for key populations like female sex workers. However, to date there is no study that has been done to access the preference and uptake of different community-based HIV testing service delivery models used to reach FSW. We assessed preference and uptake of the current community-based HIV testing services delivery models that are used to reach FSW and identified challenges faced during the implementation of the models. METHODS: We conducted a cross-sectional study design using quantitative (interview with the health workers in facilities providing services to female sex workers and interviews with FSWs) and qualitative (interviews with Ministry of Health staff, health workers, district health team members, program staff at different levels involved in delivery of HIV care services, FSWs and political leaders to assess for the enabling environment created to deliver the different community-based HIV testing services to FSWs along the Malaba-Kampala highway. Malaba - Kampala high way is one of the major high ways with many different hot spots where the actual buying and selling of sex takes place. We defined FSWs as any female, who undertakes sexual activity after consenting with a man for money or other items/benefits as an occupation or as a primary source of livelihood irrespective of site of operation within the past six months. We assessed the preference and uptake of different community based HIV testing services delivery model among FSWs based on two indicators, i.e., the proportion of FSWs who had an HIV Counseling and Testing (HCT) in the last 12 months and the proportion of FSWs who were positive and linked to care. RESULTS: Overall, 86% (390/456) of the FSWs had taken an HIV test in the last 12 months. Of the 390 FSWs, 72% (279/390) had used static facilities, 25% (98/390) had used outreaches, and 3.3% (13/390) used peer to peer mechanisms to have an HIV test. Overall, 35% (159/390) of the FSWs who had taken an HIV test were HIV positive. Of the 159, 83% (132/159) were successfully linked into care. Ninety one percent (120/132) reported to have been linked into care by static facilities. Challenges experienced included; lack of trust in the results given during outreaches, failure to offer other testing services including hepatitis B and syphilis during outreaches, inconsistent supply of testing kits, condoms, STI drugs, and unfriendly health services due to the infrastructure and non-trained health workers delivering KP HIV testing services. CONCLUSIONS: Most of the FSWs had HCT services and were linked to care through static facilities. Community-based HIV testing service delivery models are challenged with inconsistent supply of HIV testing commodities and unfriendly services.. We recommended strengthening of all HIV testing community-based HIV testing service deliverymodels by ensuring constant supply of HIV testing/AIDS care commoditiesoffering FSW friendly services, and provision of comprehensive HIV/AIDS health care package.


Asunto(s)
Infecciones por VIH/diagnóstico , Tamizaje Masivo/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Prioridad del Paciente/estadística & datos numéricos , Trabajadores Sexuales/psicología , Adolescente , Adulto , Servicios de Salud Comunitaria/organización & administración , Estudios Transversales , Femenino , Investigación sobre Servicios de Salud , Humanos , Trabajadores Sexuales/estadística & datos numéricos , Uganda , Adulto Joven
5.
Nihon Koshu Eisei Zasshi ; 66(11): 712-722, 2019.
Artículo en Japonés | MEDLINE | ID: mdl-31776313

RESUMEN

Objective Various types of health promotion organizations exist in Japan, including volunteer organizations that promote healthy diets, health improvement, and maternal and child health. Health promotion volunteers, trained and recruited by municipalities, provide counseling and education on various health concerns to community members. A previous study on the effect of these activities and the organizational challenges demonstrated a decrease in the number of volunteer members. The present study aimed to identify the organizational characteristics and challenges of health promotion volunteer work in Japan to gain insight into volunteer recruitment and organizational management.Methods A questionnaire was sent to 1,873 Japanese municipalities via e-mail or postal mail (excluding Tokyo's 23 wards). For cities of cabinet order, a questionnaire was sent to each borough in the municipality. Data were collected from February to March 2017. The survey was used to collect data on four types of health promotion volunteer organizations: healthy diet (organizations of volunteers who were shokuseikatsu kaizen suishinin), health improvement (organizations of volunteers who were kenkozukuri suishinin), and two types promoting maternal and child health (organizations of volunteers who were boshihoken suishinin and aiikuhan). We asked about the presence or absence of the organization type, year of establishment, number of members, the largest age group, recruitment methods, etc. Twelve organizational challenges were measured with a six-item Likert scale (from 1="strongly agree" to 6="strongly disagree"). Proportions of active members in the volunteer organization ranged from 0% to 10%.Results Eight hundred eight municipalities responded to the survey (valid responses: 805, valid response rate: 43.1%). The presence or absence of the four types of volunteer organizations differed among the municipalities. The most common type was organizations of volunteers who were shokuseikatsu kaizen suishinin (84.7% municipalities), followed by kenkozukuri suishinin (64.3%), boshihoken suishinin (26.4%), and aiikuhan (10.1%). The total ratio of responses of "strongly agree," "agree," and "somewhat agree" about the organizational challenges, including "The organization cannot find new members easily" and "The participants are always the same people," was commonly more than 50% for the four types of volunteer organizations. The challenges, including "Many do not enjoy what they do," "For many volunteers, participation is limited due to work and family obligations," and "The goal of the activities is not widely shared among volunteers," were significantly correlated to the proportion of active members in the volunteer organization for all four types of organizations.Conclusion This study revealed that organizational characteristics differed among the four types of health promotion volunteer organizations; however, many of the organizational challenges were found to be common throughout Japanese municipalities.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Promoción de la Salud/organización & administración , Salud Pública , Encuestas y Cuestionarios , Voluntarios/psicología , Adulto , Anciano , Anciano de 80 o más Años , Ciudades , Femenino , Humanos , Japón , Masculino , Persona de Mediana Edad
6.
BMC Health Serv Res ; 19(1): 843, 2019 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-31730457

RESUMEN

BACKGROUND: Patients with multiple chronic conditions represent a growing segment for healthcare. The Chronic Care Model (CCM) supports leveraging community programs to support patients and their caregivers overwhelmed by their treatment plans, but this component has lagged behind the adoption of other model elements. Community Care Teams (CCTs) leverage partnerships between healthcare delivery systems and existing community programs to address this deficiency. There remains a gap in moving CCTs from pilot phase to sustainable full-scale programs. Therefore, the purpose of this study was to identify the cognitive and structural needs of clinicians, social workers, and nurse care coordinators to effectively refer appropriate patients to the CCT and the value these stakeholders derived from referring to and receiving feedback from the CCT. We then sought to translate this knowledge into an implementation toolkit to bridge implementation gaps. METHODS: Our research process was guided by the Assess, Innovate, Develop, Engage, and Devolve (AIDED) implementation science framework. During the Assess process we conducted chart reviews, interviews, and observations and in Innovate and Develop phases, we worked with stakeholders to develop an implementation toolkit. The Engage and Devolve phases disseminate the toolkit through social networks of clinical champions and are ongoing. RESULTS: We completed 14 chart reviews, 11 interviews, and 2 observations. From these, facilitators and barriers to CCT referrals and patient re-integration into primary care were identified. These insights informed the development of a toolkit with seven components to address implementation gaps identified by the researchers and stakeholders. CONCLUSION: We identified implementation gaps to sustaining the CCT program, a community-healthcare partnership, and used this information to build an implementation toolkit. We established liaisons with clinical champions to diffuse this information. The AIDED Model, not previously used in high-income countries' primary care settings, proved adaptable and useful.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Prestación de Atención de Salud/organización & administración , Afecciones Crónicas Múltiples/terapia , Anciano , Femenino , Humanos , Masculino , Evaluación de Necesidades , Grupo de Atención al Paciente/organización & administración , Atención Primaria de Salud/organización & administración , Evaluación de Programas y Proyectos de Salud
7.
BMC Health Serv Res ; 19(1): 878, 2019 Nov 21.
Artículo en Inglés | MEDLINE | ID: mdl-31752869

RESUMEN

BACKGROUND: Community Health Workers (CHWs) are critical to providing healthcare services in countries such as India which face a severe shortage of skilled healthcare personnel especially in rural areas. The aim of this study is to understand the work flow of CHWs in a rural Community Mental Health Project (CMHP) in India and identify inefficiencies which impede their service delivery. This will aid in formulating a targeted policy approach, improving efficiency and supporting appropriate work allocation as the roles and responsibilities of the CHWs evolve. METHODS: A continuous observation Time Motion study was conducted on Community Health Workers selected through purposive sampling. The CHWs were observed for the duration of an entire working day (9 am- 3 pm) for 5 days each, staggered during a period of 1 month. The 14 different activities performed by the CHWs were identified and the time duration was recorded. Activities were then classified as value added, non-value added but necessary and non-value-added to determine their time allocation. RESULTS: Home visits occupied the CHWs for the maximum number of hours followed by Documentation, and Traveling. Documentation, Administrative work and Review of work process are the non-value-added but necessary activities which consumed a significant proportion of their time. The CHWs spent approximately 40% of their time on value added, 58.5% of their time on non-value added but necessary and 1.5% of their time on non-value added activities. The CHWs worked for 0.7 h beyond the stipulated time daily. CONCLUSION: The CHW's are "dedicated" mental health workers as opposed to being "generalists" and their activities involve a significant investment of their time due to the specialized nature of the services offered such as counselling, screening and home visits. The CHWs are stretched beyond their standard work hours. Non-value added but necessary activities consumed a significant proportion of their time at the expense of value-added activities. Work flow redesign and implementation of Health Management Information Systems (HMIS) can mitigate inefficiencies.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Agentes Comunitarios de Salud , Servicios de Atención de Salud a Domicilio/organización & administración , Servicios de Salud Mental/organización & administración , Estudios de Tiempo y Movimiento , Visita Domiciliaria/estadística & datos numéricos , Humanos , India , Servicios de Salud Rural/organización & administración , Flujo de Trabajo
8.
Cochrane Database Syst Rev ; 2019(11)2019 11 05.
Artículo en Inglés | MEDLINE | ID: mdl-31686427

RESUMEN

BACKGROUND: In low- and middle-income countries (LMICs), health services are under-utilised, and several studies have reported improvements in neonatal outcomes following health education imparted to mothers in homes, at health units, or in hospitals. However, evaluating health educational strategy to deliver newborn care, such as one-to-one counselling or group counselling via peer or support groups, or delivered by health professionals, requires rigorous assessment of methodological design and quality, as well as assessment of cost-effectiveness, affordability, sustainability, and reproducibility in diverse health systems. OBJECTIVES: To compare a community health educational strategy versus no strategy or the existing approach to health education on maternal and newborn care in LMICs, as imparted to mothers or their family members specifically in community settings during the antenatal and/or postnatal period, in terms of effectiveness for improving neonatal health and survival (i.e. neonatal mortality, neonatal morbidity, access to health care, and cost). SEARCH METHODS: We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL; 2017, Issue 4), in the Cochrane Library, MEDLINE via PubMed (1966 to 2 May 2017), Embase (1980 to 2 May 2017), and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to 2 May 2017). We also searched clinical trials databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials and quasi-randomised trials. SELECTION CRITERIA: Community-based randomised controlled, cluster-randomised, or quasi-randomised controlled trials. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial quality and extracted the data. We assessed the quality of evidence using the GRADE method and prepared 'Summary of findings' tables. MAIN RESULTS: We included in this review 33 original trials (reported in 62 separate articles), which were conducted across Africa and Central and South America, with most reported from Asia, specifically India, Pakistan, and Bangladesh. Of the 33 community educational interventions provided, 16 included family members in educational counselling, most frequently the mother-in-law or the expectant father. Most studies (n = 14) required one-to-one counselling between a healthcare worker and a mother, and 12 interventions involved group counselling for mothers and occasionally family members; the remaining seven incorporated components of both counselling methods. Our analyses show that community health educational interventions had a significant impact on reducing overall neonatal mortality (risk ratio (RR) 0.87, 95% confidence interval (CI) 0.78 to 0.96; random-effects model; 26 studies; n = 553,111; I² = 88%; very low-quality evidence), early neonatal mortality (RR 0.74, 95% CI 0.66 to 0.84; random-effects model; 15 studies that included 3 subsets from 3 studies; n = 321,588; I² = 86%; very low-quality evidence), late neonatal mortality (RR 0.54, 95% CI 0.40 to 0.74; random-effects model; 11 studies; n = 186,643; I² = 88%; very low-quality evidence), and perinatal mortality (RR 0.83, 95% CI 0.75 to 0.91; random-effects model; 15 studies; n = 262,613; I² = 81%; very low-quality evidence). Moreover, community health educational interventions increased utilisation of any antenatal care (RR 1.16, 95% CI 1.11 to 1.22; random-effects model; 18 studies; n = 307,528; I² = 96%) and initiation of breastfeeding (RR 1.56, 95% CI 1.37 to 1.77; random-effects model; 19 studies; n = 126,375; I² = 99%). In contrast, community health educational interventions were found to have a non-significant impact on use of modern contraceptives (RR 1.10, 95% CI 0.86 to 1.41; random-effects model; 3 studies; n = 22,237; I² = 80%); presence of skilled birth attendance at birth (RR 1.09, 95% CI 0.94 to 1.25; random-effects model; 10 studies; n = 117,870; I² = 97%); utilisation of clean delivery kits (RR 4.44, 95% CI 0.71 to 27.76; random-effects model; 2 studies; n = 17,087; I² = 98%); and care-seeking (RR 1.11, 95% CI 0.97 to 1.27; random-effects model; 7 studies; n = 46,154; I² = 93%). Cost-effectiveness analysis conducted in seven studies demonstrated that the cost-effectiveness for intervention packages ranged between USD 910 and USD 11,975 for newborn lives saved and newborn deaths averted. For averted disability-adjusted life-year, costs ranged from USD 79 to USD 146, depending on the intervention strategy; for cost per year of lost lives averted, the most effective strategy was peer counsellors, and the cost was USD 33. AUTHORS' CONCLUSIONS: This review offers encouraging evidence on the value of integrating packages of interventions with educational components delivered by a range of community workers in group settings in LMICs, with groups consisting of mothers, and additional education for family members, for improved neonatal survival, especially early and late neonatal survival.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Consejo/métodos , Mortalidad Infantil , Madres/educación , Mortalidad Perinatal , Países en Desarrollo , Femenino , Educación en Salud , Humanos , Lactante , Salud del Lactante , Recién Nacido , Servicios de Salud Materna/organización & administración , Embarazo , Ensayos Clínicos Controlados Aleatorios como Asunto
9.
J Glob Health ; 9(2): 020414, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31662849

RESUMEN

Background: Mass drug administration (MDA) programmes for neglected tropical diseases (NTDs) depend on voluntary community drug distributors (CDDs) to deliver drugs, and these volunteer schemes need regular training and supervision. NTD policy now includes integration of multiple disease programmes, but we are unsure if there is clarity in what is currently expected of CDDs and how they are managed. We therefore analysed World Health Organization (WHO) policy, strategy and implementation guidance, and select national NTD programme implementation plans. Methods: Included are a) WHO global and WHO-Regional Office for Africa guidelines, strategies, operational manuals and meeting reports published between January 2007 to February 2018 that included policy and plans for CDDs; and b) national NTD programme master plans for Cameroon, Ghana, Liberia and Nigeria. For both review components, we examined the CDD responsibilities through a framework developed iteratively against the documents and prepared a narrative synthesis. Results: Twenty WHO policy documents met the inclusion criteria. In the twelve global and eight regional documents, the CDD role was not explicitly or comprehensively defined. Three documents mentioned CDDs will distribute drugs; some mentioned health promotion, data handling and engagement in clinical care. Four WHO documents noted a need for CDD training or management, eight detailed some aspect of this, and one regional document provided a comprehensive overview. In the national plans, additional responsibilities included case management in two countries and transmission control in two countries. Every plan included training and supervision, but this was not always explicit, and details of the purpose and frequency varied. In all national plans, CDD motivation was identified as a challenge but not comprehensively addressed, although one document mentioned provision of bicycles. Conclusions: WHO and national policies and plans assume CDDs will implement NTD programmes. However, there is almost no clear delineation of responsibilities, nor is there up-to-date practical guidance to guide managers. This ambiguity, in relation to the lack of explicit policies or programmatic guidance, probably impairs the effectiveness of NTD programmes.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Administración Masiva de Medicamentos , Enfermedades Desatendidas/tratamiento farmacológico , Camerún , Ghana , Humanos , Liberia , Nigeria , Políticas , Evaluación de Programas y Proyectos de Salud
10.
Cien Saude Colet ; 24(10): 3815-3824, 2019.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31577012

RESUMEN

This article analyses the knowledge, attitudes and practices of community health agents (CHAs) regarding tuberculosis in Recife, a municipality with a high incidence of tuberculosis and high treatment dropout rates in Brazil. The cross-sectional study was conducted with a representative sample of CHAs and a standardized questionnaire. The frequencies of the variables related to knowledge, attitudes and practices were described, and the association between satisfactory knowledge and appropriate practices of CHAs was analysed. Of the 401 eligible CHAs, 385 (96.0%) were interviewed. The majority were women (87.5%) aged ≥ 40 years (66.0%) and had been on the job for more than nine years (74.5%). A large percentage (61.7%) had satisfactory knowledge about tuberculosis, and this knowledge (75.8%) was associated with appropriate practices (p = 0.008). Regarding attitudes, 97.1% of CHAs were believed to be at risk of contracting tuberculosis, and 53.2% attributed this risk to their job. The results suggest the need for investment in training actions that may help improve tuberculosis indicators in the municipality.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/estadística & datos numéricos , Tuberculosis Pulmonar/terapia , Adolescente , Adulto , Brasil , Estudios Transversales , Femenino , Personal de Salud/normas , Humanos , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Tuberculosis Pulmonar/epidemiología , Adulto Joven
11.
Aust N Z J Public Health ; 43(6): 532-537, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31577862

RESUMEN

OBJECTIVE: This paper provides a case study of the responses to alcohol of an Aboriginal Community Controlled Health Service (The Service), and investigates the implementation of comprehensive primary health care and how it challenges the logic of colonial approaches. METHODS: Data were drawn from a larger comprehensive primary health care study. Data on actions on alcohol were collected from: a) six-monthly service reports of activities; b) 29 interviews with staff and board members; c) six interviews with advocacy partners; and d) community assessment workshops with 13 service users. RESULTS: The Service engaged in rehabilitative, curative, preventive and promotive work targeting alcohol, including advocacy and collaborative action on social determinants of health. It challenged other government approaches by increasing Aboriginal people's control, providing culturally safe services, addressing racism, and advocating to government and industry. CONCLUSIONS: This case study provides an example of implementation of the full continuum of comprehensive primary health care activities. It shows how community control can challenge colonialism and ongoing power imbalances to promote evidence-based policy and practice that support self-determination as a positive determinant for health. Implications for public health: Aboriginal Community Controlled Health Services are a good model for comprehensive primary health care approaches to alcohol control.


Asunto(s)
Trastornos Relacionados con Alcohol/terapia , Servicios de Salud Comunitaria/organización & administración , Servicios de Salud del Indígena/organización & administración , Atención Primaria de Salud/métodos , Trastornos Relacionados con Alcohol/etnología , Colonialismo , Humanos , Grupo de Ascendencia Oceánica , Racismo , Determinantes Sociales de la Salud
12.
Artículo en Inglés | MEDLINE | ID: mdl-31640288

RESUMEN

The sustainability of community-based programs represents a major focus of the literature on community-based interventions in the last few decades. However, without sustainable host organizations to effectively implement them, many are prone to failure. This paper analyzes the influence of the sustainability factors of healthcare community-based programs on the host organization's sustainability. Based on a sample of 11 community-based healthcare programs and 401 respondents and using structural equation modeling, the study investigated if program specific, organization specific, and community specific factors are indeed measures of community-based programs' sustainability, if social and economic dimensions are measures of host organization sustainability, and if the sustainability of the community-based program influences thee host organization's sustainability. The results confirmed all three research hypothesis. The main contribution of the paper is to demonstrate a direct relationship between the sustainability of community-based programs and the overall sustainability of the organizations implementing them.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Evaluación de Programas y Proyectos de Salud , Humanos , Análisis de Clases Latentes , Organizaciones
13.
BMC Public Health ; 19(1): 1326, 2019 Oct 22.
Artículo en Inglés | MEDLINE | ID: mdl-31640639

RESUMEN

BACKGROUND: It is well documented that Egypt has the highest prevalence of hepatitis C virus (HCV) infection in the world. The recent development of highly effective direct acting antiviral drugs (DAAs), has opened the possibility of treating and curing HCV infection in the Egyptian population on a large scale. METHODS: A screening demonstration project was implemented in southern Egypt in and around the city of Luxor. Free screening and if indicated, treatment, was offered to those 16 years or older for anti-HCV antibodies (anti-HCV) and hepatitis B surface antigen (HBsAg) using third generation enzyme immunoassays (Enzygnost® Anti-HCV and HbsAg). Statistical methods included estimation of odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: There was a large turnout of 67,042 persons who were screened in a 12-month period starting in June 2016. Thirty-one thousand nine hundred sixty-four males (47.7%) and 35,074 females (52.3%) were screened with a mean age of 43.6 ± 14.3 years. Nine thousand seven hundred one patients (14.5%) were positive for anti-HCV and 2950 (4.4%) for HBsAg. Prevalence of anti-HCV was significantly higher in males than females (19.67% vs.9.73% OR = 2.27; CI 2.2 to 2.4; p < 0.001) and the same for HBsAg (6.2% vs. 2.8% OR = 2.3; CI 2.2 to 2.5; p < 0.001). The prevalence of anti-HCV was significantly associated with age (p < 0.001), ranging from between 1 and 4% in individuals below the age of 40 years, then increased steadily to 42% at age 60 followed by a precipitous decline in age specific prevalence. CONCLUSIONS: The results showed unanticipated patterns in the Luxor area of anti-HCV and HBsAg by age and gender in contrast to previous reports on this unique HCV epidemic in Egypt. Moreover, the level and rate of turnout, cost, and other logistical issues, provided essential information for effective planning, design, and evaluation methods for larger national mass screening and treatment programs.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Hepatitis B/diagnóstico , Hepatitis C/diagnóstico , Tamizaje Masivo/estadística & datos numéricos , Adolescente , Adulto , Egipto/epidemiología , Femenino , Hepacivirus/aislamiento & purificación , Hepatitis B/epidemiología , Antígenos de Superficie de la Hepatitis B/sangre , Hepatitis C/epidemiología , Anticuerpos contra la Hepatitis C/sangre , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Seroepidemiológicos
14.
J Youth Adolesc ; 48(12): 2418-2431, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31606828

RESUMEN

LGBTQ youth are at greater risk for compromised health, yet large-scale health promotion programs for LGBTQ young people have been slow to develop. LGBTQ community-based organizations-which provide LGBTQ-focused support and services-have existed for decades, but have not been a focus of the LGBTQ youth health literature. The current study used a contemporary sample of LGBTQ youth (age 15-21; M = 18.81; n = 1045) to examine who participates in LGBTQ community-based organizations, and the association between participation and self-reported mental health and substance use. Youth who participated in LGBTQ community-based organizations were more likely to be assigned male at birth, transgender, youth of color, and accessing free-or-reduced lunch. Participation was associated with concurrent and longitudinal reports of mental health and substance use. LGBTQ community-based organizations may be an underutilized resource for promoting LGBTQ youth health.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Promoción de la Salud/organización & administración , Minorías Sexuales y de Género/estadística & datos numéricos , Adolescente , Investigación Participativa Basada en la Comunidad , Femenino , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Masculino , Personas Transgénero/estadística & datos numéricos , Adulto Joven
15.
BMC Health Serv Res ; 19(1): 693, 2019 Oct 15.
Artículo en Inglés | MEDLINE | ID: mdl-31615529

RESUMEN

BACKGROUND: Hypertension, itself a cardiovascular condition, is a significant risk factor for other cardiovascular diseases. Hypertension is recognized as a major public health challenge in Ghana. Beginning in 2014, a collaborative team launched the community-based hypertension improvement program (ComHIP) in one health district in Ghana. The ComHIP project, a public-private partnership, tests a community-based model that engages the private sector and utilizes information and communication technology (ICT) to control hypertension. This paper, focuses on the various challenges associated with managing hypertension in Ghana, as reported by ComHIP stakeholders. METHODS: A total of 55 informants - comprising patients, health care professionals, licensed chemical sellers (LCS), national and sub-national policymakers - were purposively selected for interview and focus group discussions (FGDs). Interviews were audio-recorded and transcribed verbatim. Where applicable, transcriptions were translated directly from local language to English. The data were then analysed using two-step thematic analysis. The protocol was approved by the two ethics review committees based in Ghana and the third, based in the United Kingdom. All participants were interviewed after giving informed consent. RESULTS: Our data have implications for the on-going implementation of ComHIP, especially the importance of policy maker buy-in, and the benefits, as well as drawbacks, of the program to different stakeholders. While our data show that the ComHIP initiative is acceptable to patients and healthcare providers - increasing providers' knowledge on hypertension and patients' awareness of same- there were implementation challenges identified by both patients and providers. Policy level challenges relate to task-sharing bottlenecks, which precluded nurses from prescribing or dispensing antihypertensives, and LCS from stocking same. Medication adherence and the phenomenon of medical pluralism in Ghana were identified challenges. The perspectives from the national level stakeholders enable elucidation of whole of health system challenges to ComHIP and similarly designed programmes. CONCLUSIONS: This paper sheds important light on the patient/individual, and system level challenges to hypertension and related non-communicable disease prevention and treatment in Ghana. The data show that although the ComHIP initiative is acceptable to patients and healthcare providers, policy level task-sharing bottlenecks preclude optimal implementation of ComHIP.


Asunto(s)
Hipertensión/prevención & control , Enfermedades no Transmisibles/prevención & control , Personal Administrativo , Adulto , Concienciación , Servicios de Salud Comunitaria/organización & administración , Femenino , Grupos Focales , Ghana , Programas de Gobierno , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud , Política de Salud , Hospitales , Humanos , Masculino , Asistencia Médica , Sector Privado , Salud Pública , Sector Público , Asociación entre el Sector Público-Privado , Investigación Cualitativa , Factores de Riesgo
16.
Int J Equity Health ; 18(1): 146, 2019 09 18.
Artículo en Inglés | MEDLINE | ID: mdl-31533741

RESUMEN

BACKGROUND: In 2012, the WHO described the quality of health care as the route to equity and dignity for women and children. AIM OF THE WORK: To provide community based support and empowerment to women in childbearing period to seek optimal prenatal, natal and postnatal healthcare. Achieving this is anticipated to decrease maternal morbidity and mortality in Egypt. SUBJECTS AND METHODS: An interventional study was conducted among women in childbearing period in the poorest two governorates of Upper Egypt. The study passed through three stages over three and a half years; pre-interventional assessment of awareness (n = 1000), educational interventions targeting the health providers and all women in childbearing period in their communities (n = 20,494), and post-intervention evaluation of change in awareness of their rights for prenatal, natal and postnatal care (no = 1150). RESULTS: The studied indicators relating to receiving care in pregnancy, labor, and puerperium have changed dramatically as a result of the study interventions. Results of the study showed that before interventions, the surveyed women had inaccurate knowledge regarding most of the items related to their rights. The percentages of women aware of their right to have pregnancy card increased and those who possessed a pregnancy card were doubled with a significant percent change of more than 25%. Some indicators showed more than 75% improvement, including; percent of surveyed women who knew that it's their right to follow up their pregnancy and to deliver with a specialized doctor, a trained nurse or at an equipped health facility, and those who knew their right to have at least two home preparations necessary for safe delivery at home. CONCLUSION AND RECOMMENDATIONS: More work is needed in order to achieve the targeted reduction of maternal mortality. This could be achieved by ensuring accessible and high quality care provided by the governmental health facilities together with increasing the awareness of women regarding their rights in receiving such care.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Derechos Sexuales y Reproductivos , Derechos de la Mujer , Egipto/epidemiología , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Mortalidad Materna , Aceptación de la Atención de Salud/estadística & datos numéricos , Atención Posnatal/estadística & datos numéricos , Embarazo , Atención Prenatal/estadística & datos numéricos
17.
Asia Pac J Public Health ; 31(6): 522-535, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31523988

RESUMEN

As the prevalence of chronic diseases is continuously increasing, the socioeconomic cost of those conditions in Korea is also rising. In order to effectively manage chronic diseases, the "Community-Based Primary Care Project" was implemented from 2014 to 2016 and focused on primary medical care and physician-led chronic disease management. The purpose of this study is evaluating the effects of the project through the DID (difference in difference) model. The project's database and the National Health Insurance claims database were both used to compare the project and control groups (n = 6092 vs 24 368). Results of the analysis show that medication adherence was increased more in the project group compared with the control group. Hospitalization days, outpatient days, and number of primary medical clinic visits increased more in the participant group than the control group. As the project showed an improvement in treatment persistence, it will be necessary to monitor for a longer period of time.


Asunto(s)
Servicios de Salud Comunitaria/organización & administración , Diabetes Mellitus/terapia , Hipertensión/terapia , Atención Primaria de Salud/organización & administración , Anciano , Enfermedad Crónica , Bases de Datos Factuales , Diabetes Mellitus/epidemiología , Femenino , Humanos , Hipertensión/epidemiología , Revisión de Utilización de Seguros , Masculino , Cumplimiento de la Medicación/estadística & datos numéricos , Persona de Mediana Edad , Programas Nacionales de Salud , República de Corea/epidemiología
18.
Middle East Afr J Ophthalmol ; 26(2): 83-88, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31543665

RESUMEN

PURPOSE: The purpose of this study is to describe the methodology and to assess the effectiveness of a community-based rehabilitation (CBR) program to identify and refer children with blinding cataract for the management and surgery to reduce the burden of childhood blindness due to cataract in Kinshasa. METHODS: Church-based volunteers were trained to identify children with presumed eye disorders in their localities and households and to refer them for cataract identification by an ophthalmic nurse during parishes' visits. Volunteers were parishioners living in the quartiers where identification took place and worked as community workers with the CBR program. Nurses used a lamp-torch to rule out cataract. Selected children were referred to the tertiary eye health facility at St Joseph Hospital for diagnosis and management. RESULTS: Identification took place in 31 out of 165 parishes in the Archdioceses of Kinshasa from 2000 to 2016 and 11,106 children aged <16 years were screened. Among them, 1277 children (11.5%) were presumed to have cataract. Ninety-two children among them died before surgery; 107 children were lost to further follow-up and did not report to the CBR center for referral. Reasons given were change of home address, moving in their lieu of origin, death, and refusal of treatment by the parents. Finally, only 1078 children were referred to the pediatric ophthalmologist and 705 children (65.4%) were definitively diagnosed to have treatable cataract, while in 373 children (34.6%), cataract surgery was not indicated for several reasons. There was a positive history of familial cataract in 36 children (2.8%). CONCLUSION: Using church-based volunteers and ophthalmic nurses during community screening proved efficient in the identification and referral of pediatric cataract. Keeping regular identification activities in the community and maintaining high-quality and accessible pediatric cataract surgery services can help to clear up the backlog of cataract blind children.


Asunto(s)
Extracción de Catarata , Catarata/diagnóstico , Servicios de Salud Comunitaria/organización & administración , Organizaciones Religiosas/organización & administración , Derivación y Consulta/organización & administración , Adolescente , Ceguera/prevención & control , Catarata/terapia , Niño , Preescolar , Estudios Transversales , República Democrática del Congo , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Pediatría , Voluntarios
19.
Afr J Prim Health Care Fam Med ; 11(1): e1-e12, 2019 Aug 29.
Artículo en Inglés | MEDLINE | ID: mdl-31478747

RESUMEN

BACKGROUND: One of the most important primary health challenges currently affecting older people in South Africa (SA) is the increasing prevalence of non-communicable disease (NCD). Research is needed to investigate the current state of care and self-management support available to older diabetic patients in SA and the potential for interventions promoting self-management and community involvement. AIM: This study aimed to review current policies, programmes and any other interventions as they relate to older people with diabetes with a view to assess the potential for the development of a self-management programme for older persons attending public sector primary health care services in Cape Town, South Africa. SETTING: Eighteen community health centres (CHCs) formed the sampling frame for the study. METHODS: This study aimed to review current policies and programmes as they relate to older people with diabetes. It involved a documentary review and qualitative individual interviews with key informants in the health services and Department of Health. RESULTS: Several national initiatives have sought to advance the health of older people, but they have only been partially successful. There are however multiple efforts to re-orientate the health-care system to focus more effectively on NCDs, which benefit older patients with diabetes. The establishment of community-based services to provide self-management support, promote health and ease access to medicine helps overcome many of the commonly cited barriers to care experienced by older patients. What may be equally important is that practitioners gain the communication skills and educational resources to effectively educate and counsel patients on lifestyle behaviour change and self-care management. CONCLUSION: This article alerts policy-makers and clinicians to some of the specific issues considered to be pertinent and important in the care and management of older diabetic patients. Many of these would also be applicable to older patients with other chronic conditions.


Asunto(s)
Servicios de Salud Comunitaria/legislación & jurisprudencia , Diabetes Mellitus , Política de Salud , Servicios de Salud para Ancianos/legislación & jurisprudencia , Atención Primaria de Salud/legislación & jurisprudencia , Anciano , Anciano de 80 o más Años , Servicios de Salud Comunitaria/organización & administración , Femenino , Servicios de Salud para Ancianos/organización & administración , Humanos , Masculino , Persona de Mediana Edad , Atención Primaria de Salud/organización & administración , Evaluación de Programas y Proyectos de Salud , Sistemas de Apoyo Psicosocial , Investigación Cualitativa , Automanejo , Sudáfrica
20.
Prim Health Care Res Dev ; 20: e129, 2019 09 10.
Artículo en Inglés | MEDLINE | ID: mdl-31500680

RESUMEN

Community and public participation and involvement is an underpinning principle of primary health care, an essential component of a social justice-orientated approach to health care and a vehicle to improving health outcomes for patients, public and communities. However, influenced by history and context, there are intrinsic issues surrounding power imbalance and other barriers to partnerships between communities, public, policy makers and researchers. It is important to acknowledge these issues, and through doing so share experiences and learn from those working within very different settings.In South Africa, community participation is seen as a route to decolonisation. It is also integral to the core functions of South African Higher Education Institutes, alongside teaching and research. In the UK, there has also been a history of participation and involvement as part of a social rights movement, but notably public involvement has become embedded in publicly funded health research as a policy imperative.In this paper, we draw on our respective programmes of work in public and community participation and involvement. These include a South African community engagement project to reduce teenage pregnancy and HIV infection working through a partnership between teachers, students and university academics, and a national evaluation in England of public involvement in applied health research. We begin by highlighting the lack of clarity and terms used interchangeably to describe participation, engagement and involvement. Frameworks for partnership working with relevance to South Africa and the UK are then analysed, suggesting key themes of relationships, working together, and evaluation and monitoring. The South African project and examples of public involvement in English primary and community care research are examined through these themes. We conclude the paper by mapping out common enablers and barriers to partnership working within these very different contexts.


Asunto(s)
Investigación Biomédica/organización & administración , Servicios de Salud Comunitaria/organización & administración , Participación de la Comunidad , Personal de Salud/psicología , Colaboración Intersectorial , Atención Primaria de Salud/organización & administración , Investigadores/psicología , Adulto , Conducta Cooperativa , Femenino , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Sudáfrica , Reino Unido
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