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3.
PLoS One ; 15(1): e0227332, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31945073

RESUMO

BACKGROUND: Iron and Folic Acid Supplementation (IFAS) is recommended by World Health Organization as part of antenatal care to prevent anaemia in pregnancy. In 2010, Kenya adopted this recommendation and the current policy is to provide one combined IFAS tablet for daily use throughout pregnancy, free of charge, in all public health facilities. However, adherence remains low over the years though anaemia in pregnancy remains high. Integration of IFAS into community-based interventions has been recommended because of its excellent outcome. Using Community Health Volunteers (CHVs) to distribute IFAS has not been implemented in Kenya before. METHODS: Following an intervention study implementing a community-based approach for IFAS in five public health facilities in Lari Sub-County, 19 interviews were conducted among CHVs, nurses and pregnant women participating to describe their experiences. Thematic analysis of data was done using NVivo and findings described, with use of quotes. FINDINGS: The nurses, CHVs and pregnant women were all positive and supportive of community-based approach for IFAS. They reported increased access and utilization of both IFAS and antenatal services leading to perceived reduction in anaemia and better pregnancy outcomes. Counselling provided by CHVs improved IFAS knowledge among pregnant women and consequent adherence. The increased IFAS utilization led to main challenge experienced being IFAS stock-outs. All participants recommended complementing antenatal IFAS distribution approach with community-based approach for IFAS. CONCLUSION: Using CHVs to implement a community-based approach for IFAS was successful and increased supplement awareness and utilization. However, the role of CHVs in IFAS programme implementation is not clearly defined in current policy and their potential in IFAS education and distribution is not fully utilized. All participants endorsed integration of community-based approach for IFAS into the antenatal approach to enhance IFAS coverage and adherence among pregnant women for better pregnancy outcomes.


Assuntos
Anemia Ferropriva/prevenção & controle , Serviços de Saúde Comunitária/métodos , Suplementos Nutricionais , Ácido Fólico/administração & dosagem , Ferro/administração & dosagem , Complicações na Gravidez/prevenção & controle , Educação Pré-Natal/métodos , Combinação de Medicamentos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Quênia , Cooperação do Paciente , Gravidez , Resultado da Gravidez , Pesquisa Qualitativa , População Rural , Comprimidos
4.
PLoS One ; 15(1): e0226237, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31914165

RESUMO

INTRODUCTION: Approximately two-thirds of HIV-infected individuals reside in sub-Saharan Africa. The region accounts for 68% of the new HIV infections occurring worldwide with almost one-half of these infections being among young adults aged 12-24 years. Cowan and colleagues conducted a community-based, multi-component HIV intervention aimed at youth in rural Zimbabwe. Despite some changes in knowledge and attitudes, the community-based intervention did not affect the prevalence of HIV or HSV-2. We selected this frequently cited study for replication since it incorporates individual-, community-, and structural- level intervention components that are often considered in global HIV/AIDS prevention programs. Additionally, the intervention could be easily scaled-up, which is especially important in the context of limited resources. Although this study indicated no intervention effects in reducing HIV, the authors acknowledged some key methodological challenges. Our replication analysis provided important insights regarding the impact of these challenges to the interpretation of the results of this study. METHODS: Our replication study focused on replicating Cowan's findings and assessing the robustness of Cowan's results to alternative analytical models based on their study design. We determined how out-migration occurring during Cowan's study may have affected the population characteristics, the intervention exposure level, and the study findings. While the original intervention targeted knowledge and attitudes as a mechanism to decrease HIV/HSV-2, the Cowan study evaluated the intervention effects on knowledge, attitudes, and prevalence of HIV or HSV-2 separately. To better identify the pathway describing the interrelationship among the intervention and knowledge, attitudes, and prevalence of HIV or HSV-2, we assessed whether increases in knowledge or attitudes were associated with decreased HIV or HSV-2 prevalence. RESULTS: We replicated the original findings with minor discrepancies during the pure replication. Our additional analyses revealed that the study population characteristics changed over time in ways that may have affected outcomes. These changes also affected the levels of intervention exposure, with 48.7% males and 75.5% females of the intervention group receiving low-level exposure. Both genders with higher level intervention exposure experienced higher increments in multiple knowledge, attitude, and sexual risk behavior outcomes. Unfortunately, these did not translate to a significant reduction in HIV or HSV-2 regardless of the level and combination of knowledge and attitude domains. However, males receiving high-level intervention exposure compared to control indicated significantly lower odds of having HIV or HSV-2 under a Bayesian modeling paradigm. CONCLUSIONS: Our findings suggest a more robust conclusion on the study intervention effects. Further study based on a design that more consistently maximizes the exposure level of the intervention is necessary and should ideally be an evaluated goal in similar studies. Evaluation of the intervention impact for key subgroups of the target population is important and would better advise the use and scale-up of the evaluated interventions in various contexts. Our observation of a consistent lack of relationship between knowledge/attitudes and HIV/HSV-2 suggests a need to explore and include relevant additional and or complementary interventions, e.g., promoting effective skills in reducing risky sexual behaviors and addressing cultural and structural bottlenecks that may reduce HIV/HSV-2 risk among youth.


Assuntos
Serviços de Saúde Comunitária/métodos , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Herpes Genital/prevenção & controle , Educação de Pacientes como Assunto , Adolescente , Adulto , Teorema de Bayes , Feminino , HIV/isolamento & purificação , Infecções por HIV/transmissão , Infecções por HIV/virologia , Herpes Genital/transmissão , Herpes Genital/virologia , Herpesvirus Humano 2/isolamento & purificação , Humanos , Masculino , Comportamento de Redução do Risco , Adulto Jovem , Zimbábue
5.
Neurology ; 94(4): 165-175, 2020 01 28.
Artigo em Inglês | MEDLINE | ID: mdl-31919114

RESUMO

OBJECTIVE: To review systematically community-based primary care interventions for epilepsy in low- and middle-income countries to rationalize approaches and outcome measures in relation to epilepsy care in these countries. METHODS: A systematic search of PubMed, EMBASE, Global Index Medicus, CINAHL, and Web of Science was undertaken to identify trials and implementation of provision of antiseizure medications, adherence reinforcement, and/or health care provider or community education in community-based samples of epilepsy. Data on populations addressed, interventions, and outcomes were extracted from eligible articles. RESULTS: The 24 reports identified comprise mostly care programs addressing active convulsive epilepsy. Phenobarbital has been used most frequently, although other conventional antiseizure medications (ASMs) have also been used, but none of the newer. Tolerability rates in these studies are high, but overall attrition is considerable. Other approaches include updating primary health care providers, reinforcing treatment adherence in clinics, and raising community awareness. In these programs, the coverage of existing treatment gap in the community, epilepsy-related mortality, and comorbidity burden are only fleetingly addressed. None, however, explicitly describe sustainability plans. CONCLUSIONS: Cost-free provision, mostly of phenobarbital, has resulted in short-term seizure freedom in roughly half of the people with epilepsy in low- and middle-income countries. Future programs should include a range of ASMs. These should cover apart from seizure control and treatment adherence, primary health care provider education, community awareness, and referral protocols for specialist care. Programs should incorporate impact assessment at the local level. Sustainability in the long term as much as resilience and scalability should be addressed in future initiatives.


Assuntos
Serviços de Saúde Comunitária/métodos , Países em Desenvolvimento , Epilepsia/terapia , Atenção Primária à Saúde/métodos , Humanos
7.
Nihon Koshu Eisei Zasshi ; 66(11): 681-689, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31776310

RESUMO

Objectives The aim of this study was to investigate the effect of mail-based intervention using the TAKE10! Program to improve dietary habits in cases where direct intervention is not possible.Methods Subjects aged 70-91 years (77.6±5.0) were randomly assigned to two groups: 72 in the intervention group and 71 in the control group. The intervention group received monthly mail, which included self-check sheets (TAKE10! Check sheet and TAKE10! Calendar) and a letter with feedback and comments for 5 months. The outcome measures were changes in the intake frequency of 10 food groups, Dietary Variety Score (DVS), and Food Frequency Score (FFS).Results Compared to baseline, the post-intervention intake frequencies for 9 of 10 food groups, DVS, and FFS significantly increased in the intervention group. No significant differences were observed between baseline and post-intervention in the control group. In the subgroup analysis of the intervention group, post-intervention DVS and FFS of both subjects who cooked their own food and those who did not showed significant increases compared to baseline.Conclusion The mail-based TAKE10! Program resulted in improved dietary habits and could be shared with families in addition to direct interventions and could also be used in regions with inadequate transportation systems or frequent poor weather conditions.


Assuntos
Serviços de Saúde Comunitária/métodos , Demência/prevenção & controle , Dieta , Comportamento Alimentar , Vida Independente , Desnutrição/prevenção & controle , Serviços Postais , Serviços Preventivos de Saúde/métodos , Neve , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Japão , Masculino , Estado Nutricional , Inquéritos e Questionários , Transportes
8.
BMC Health Serv Res ; 19(1): 699, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615484

RESUMO

BACKGROUND: Dengue is an emerging vector disease with frequent outbreaks in Nepal that pose a major threat to public health. Dengue control activities are mostly outbreak driven, and still lack systematic interventions while most people have poor health-related knowledge and practices. Mobile Short Message Service (SMS) represents a low-cost health promotion intervention that can enhance the dengue prevention knowledge and practices of the affected communities. This study aimed to explore the acceptability, appropriateness, and effectiveness of mobile SMS intervention in improving dengue control practices. METHODS: This study was an implementation research that used mixed-methods design with intervention. A total of 300 households were divided into three groups, i.e. one control group, one dengue prevention leaflet (DPL) only intervention group and one DPL with mobile SMS intervention group (DPL + SMS). We used a structured questionnaire to collect information regarding participants' knowledge and practice of dengue prevention. We conducted in-depth interviews with key informants to measure acceptability and appropriateness of intervention. Mean difference with standard deviation (SD), one-way ANOVA, paired t-test and regression analyses were used to assess the effectiveness of the interventions. Thematic analysis was used to assess the acceptability, and appropriateness as well as barriers and enablers of the intervention. RESULTS: The DPL + SMS intervention produced significantly higher mean knowledge difference (32.7 ± 13.7 SD vs. 13.3 ± 8.8 SD) and mean practice difference (27.9 ± 11.4 SD vs 4.9 ± 5.4 SD) compared to the DPL only group (p = 0.000). Multivariate analysis showed that the DPL + SMS intervention was effective to increase knowledge by 28.6 points and practice by 28.1 points compared to the control group. The intervention was perceived as acceptable and appropriate by the study participants and key stakeholders. Perceived barriers included reaching private network users and poor network in geographically remote areas, while enabling factors included mobile phone penetration, low cost, and shared responsibility. CONCLUSIONS: Mobile SMS is an effective, acceptable and appropriate health intervention to improve dengue prevention practices in communities. This intervention can be adopted as a promising tool for health education against dengue and other diseases.


Assuntos
Telefone Celular/estatística & dados numéricos , Dengue/prevenção & controle , Promoção da Saúde/métodos , Adulto , Análise de Variância , Serviços de Saúde Comunitária/métodos , Serviços de Saúde Comunitária/normas , Feminino , Nível de Saúde , Humanos , Masculino , Nepal , Projetos Piloto , Inquéritos e Questionários , Envio de Mensagens de Texto/estatística & dados numéricos
10.
Sex Reprod Health Matters ; 27(1): 1571324, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31533562

RESUMO

Roma health mediators are part of a government funded, community-led health intervention. One of the programme's central aims is to improve access to reproductive care for Roma women, often said to be one of the most disadvantaged population groups in Europe. This paper is a critical analysis of mediation in Romania, focusing on how social determinants shape access to family planning and how mediators are employed to address inequalities. It is based on ethnographic observations of mediators at work, as well as in-depth interviews with community members, health professionals, and mediators. Health professionals tended to see Roma families as wanting and having an unreasonably large number of children and tried to curtail this through the promotion of contraception. This contrasted with the perspective of community members, who appeared not to choose having many children but who instead struggled to access contraception for financial reasons. Roma health mediators generally seemed aware of multiple and intersecting pressures that women were facing, but ultimately tended to frame family planning as a matter of choice, culture, and knowledge. I set these perspectives against the background of anti-Roma racism and eugenic sentiments, reflected in popular discourses about Roma reproduction. I explore how an intervention that nominally aims to promote the emancipation of Roma communities, in fact entrenches some of the racially fused assumptions that are connected to inequalities of access to reproductive health care in the first place. The discussion has implications for Roma reproductive health interventions across Europe, and for participatory interventions more globally.


Assuntos
Serviços de Saúde Comunitária/métodos , Comportamento Contraceptivo/etnologia , Características da Família/etnologia , Serviços de Planejamento Familiar , Racismo/psicologia , Roma/psicologia , Antropologia Cultural , Anticoncepção , Comportamento Contraceptivo/psicologia , Acesso aos Serviços de Saúde , Humanos , Entrevistas como Assunto , Negociação , Romênia
11.
Bull World Health Organ ; 97(9): 597-604, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31474772

RESUMO

Objective: To improve the low coverage and performance of a programme on community-based management of acute malnutrition, implemented between October 2015 and April 2018 in Kupang district in rural Indonesia. Methods: To investigate why the coverage and performance were low in the first year of the programme, we conducted a semiquantitative evaluation between August and September 2016. We used the results from the evaluation to inform programme improvement, by developing and modifying community mobilization strategies. We employed a multipronged approach to improve community awareness on acute malnutrition and on community-based services for such condition. This approach involved workshops, focus discussion groups in the community and sensitization events at health posts that had issues with community engagement. Community health workers increased their efforts in active case finding by visiting households with children who had missed the community health post sessions. We measured the performance using three Sphere minimum standard performance indicators: proportion of children recovering (> 75%); defaulting (< 15%); and dying (<10%). Results: The community mobilization efforts increased the screening rate from 17% (564/3278) in October 2015 to 66% (6793/10 251) in March 2018. In 2017, the programme met the three performance indicators: 79% (256/326) of children recovered; 10% (34/326) defaulted; and less than 1% (2/326) died. Conclusion: In Indonesia, community mobilization is central for addressing severe acute malnutrition in children younger than five years. This strategy includes securing political leadership and effective messaging alongside locally tailored strategies and continuous ground-level support.


Assuntos
Serviços de Saúde Comunitária/métodos , Promoção da Saúde/métodos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Desnutrição Aguda Grave/diagnóstico , Desnutrição Aguda Grave/epidemiologia , Pré-Escolar , Feminino , Humanos , Indonésia/epidemiologia , Lactente , Masculino , Avaliação de Programas e Projetos de Saúde , Melhoria de Qualidade , Pesquisa , População Rural
12.
Int J Health Plann Manage ; 34(3): 960-974, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31368128

RESUMO

BACKGROUND: Preventive interventions of hypertension and health care activities are often performed in the community and at home. Studies have shown that self-management plays an indispensable role in the management of chronic diseases. This study aimed to explore an innovative community-based hypertension self-management model and to evaluate its effects. METHODS: The study involved qualitative and quantitative research methods. A community-based hypertension self-management model was developed using consultation with experts and qualitative interviews. The intervention was executed in the communities of Pudong New Area in Shanghai, China. We enrolled 1080 patients with hypertension in the intervention group and 588 similar patients in the control group. A questionnaire was administered before and after the intervention to collect information on patients' health status, self-management skills, and disease management abilities. Analyses were conducted to evaluate changes in the health-related outcomes. RESULTS: There was a significant difference in general health and health literacy after the intervention for the intervention patients group (P < .05). Furthermore, the proportion of health literacy was higher in the intervention group than in the control group (71.6% vs 59.6%). The significant differences were demonstrated in the comparison of the disease management ability data between the intervention and control group, especially in drug compliance, physical activity, regulate diet, and smoking. In addition, there is other evidence of the successful applicability and effectiveness of the community-based hypertension self-management program in 2007-2013, such as self-management teams formation and blood pressure control rate. CONCLUSIONS: The community-based self-management hypertension model, which involved the participation of general practitioners, is suitable for the management of hypertension disease in Pudong of Shanghai and could provide a reference for its large-scale promotion and application.


Assuntos
Serviços de Saúde Comunitária/métodos , Clínicos Gerais/organização & administração , Hipertensão/terapia , Autocuidado/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Serviços de Saúde Comunitária/organização & administração , Letramento em Saúde , Nível de Saúde , Humanos , Pessoa de Meia-Idade , Modelos Organizacionais , Cooperação do Paciente , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários
13.
Int J Health Plann Manage ; 34(3): 986-997, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31368129

RESUMO

With the high prevalence of diabetes, its long-term treatment, and many complications, there is a need for a new diabetes self-management model in developing countries. Therefore, this study aimed to assess the implementation and effect of a new diabetes self-management model, known as the healthcare cloud information platform, in Shanghai, China. The implementation of the new model was evaluated in terms of the equipment coverage in community health service centres and the services provided. The effect was assessed according to the treatment rate and control rate from 2012 to 2017. Their correlations with the self-management rate were analysed using Spearman's test. It was found that the Shanghai healthcare cloud information platform had covered a total of 237 community health service centres in all of the 16 administrative districts, equipping them with 2489 health stations, by 2017. An average of 8966 people uploaded data to the healthcare cloud information platform every day, with the accumulated service up to 12 043 508 person-times and an average daily increase of 13 227.9. The treatment rate of diabetes patients in Shanghai increased from 42.9% in 2012 to 78.0% in 2017, and the control rate increased to 72% in 2017, compared with 63% in 2012. Furthermore, there was a significant correlation between the treatment rate, control rate, and self-management rate. The findings indicate that it is feasible to implement the new healthcare cloud information platform for diabetes self-management and that it is effective.


Assuntos
Computação em Nuvem , Diabetes Mellitus/terapia , Autocuidado/métodos , Adulto , China/epidemiologia , Serviços de Saúde Comunitária/métodos , Diabetes Mellitus/epidemiologia , Humanos , Avaliação de Programas e Projetos de Saúde
14.
Int J Health Plann Manage ; 34(3): 975-985, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31368135

RESUMO

AIM: To assess the results of a type 2 diabetes electronic clinical pathway using an empirical study. METHODS: A literature review and expert meetings were used to formulate a community-based clinical pathway document for type 2 diabetes, and an electronic clinical pathway platform was developed. An intervention study method was adopted in which the electronic clinical pathway management intervention was applied in type 2 diabetes patients from the Weifang Community Health Service Center. The patients were randomly divided into the clinical pathway group (electronic clinical pathway management) or the control group (routine blood glucose control treatment), and the study lasted 1 year. The results of the electronic clinical pathway management for type 2 diabetes was assessed through a comparative analysis of three factors, namely, metabolic markers, standardised management rate, and blood glucose control rate. RESULTS: The overall cohort comprised 264 patients. The postintervention blood glucose and blood lipid levels were significantly different between the clinical pathway (n = 132) and control groups (n = 132) (P < .0001). In addition, the fasting blood glucose levels, glycated haemoglobin levels, and blood lipid levels of the clinical pathway group were significantly lower than those in the control group. CONCLUSION: The type 2 diabetes electronic clinical pathway can effectively improve the diabetes management levels and improve the degree of standardisation and levels of diagnosis and treatment during administration by family doctors. The application of the electronic clinical pathway can be further improved and expanded in community health service centres.


Assuntos
Serviços de Saúde Comunitária/métodos , Procedimentos Clínicos , Diabetes Mellitus Tipo 2/terapia , Idoso , Glicemia/análise , Feminino , Humanos , Lipídeos/sangue , Masculino , Pessoa de Meia-Idade
15.
Support Care Cancer ; 27(12): 4435-4450, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31418074

RESUMO

PURPOSE: Based on randomized controlled trials, exercise is an efficacious strategy to improve quality of life (QOL) among cancer survivors. However, the effectiveness of exercise programs to improve QOL in real-world settings is unknown, as are factors related to external validity. This hinders dissemination and scalability. This scoping review synthesized published research on community-based exercise programs for cancer survivors and reported on the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM). METHODS: A systematic literature search identified community-based exercise programs for adult cancer survivors (1980-March 2018), that met the following inclusion criteria: at least one face-to-face exercise session, the primary aim of program evaluation (i.e., feasibility/effectiveness), and pre/post measure of QOL. Data were coded using the RE-AIM framework. The effect size was calculated for overall QOL. RESULTS: Electronic database search yielded 553 articles; 31 studies describing unique programs were included for review. All studies described at least one element of implementation and most (80.6%) reported a significant (p < .05) improvement in at least one subscale, or total QOL. Few studies reported on indicators of reach (16.1%), adoption (6.5%), individual (16.1%), or system-level maintenance (32.3%). CONCLUSIONS: Community-based exercise programs are effective for improving QOL in adult cancer survivors. Recommendations are provided to improve reporting across RE-AIM dimensions, which is an important step to enhance the scalability of programs and thus, the potential for exercise to be fully integrated into system-level standard care for cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: Community-based exercise programs are a resource to improve QOL for adult cancer survivors.


Assuntos
Sobreviventes de Câncer , Terapia por Exercício/métodos , Neoplasias/reabilitação , Serviços de Saúde Comunitária/métodos , Serviços de Saúde Comunitária/organização & administração , Medicina Baseada em Evidências , Exercício Físico/fisiologia , Terapia por Exercício/organização & administração , Humanos , Avaliação de Programas e Projetos de Saúde , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto
16.
Artigo em Inglês | MEDLINE | ID: mdl-31366047

RESUMO

Social networks have the potential to enhance Type 2 Diabetes Mellitus (T2DM) self-management. We used qualitative methods to study if and how mobile application (app) functions that mobilize social resources to improve T2DM management would be desired in a low-income African American community. Data were collected through community discussions and in-depth interviews with 78 participants in 2016-2018. Participants included individuals with self-reported pre-diabetes, T2DM, close family members or friends of a T2DM patient, and healthcare providers. Open-ended questions solicited information about challenges with T2DM management and gathered ideas on features of a mobile app that could address them. Data were transcribed and thematically coded by two coders using Atlas-ti. Regarding types of app functions, main themes included: (1) the importance of having support in diabetes self-care; (2) using informal networks to help to each other; and (3) monitoring one another through an app. Suggested app features included reminders for and transportation to medical visits, sharing information and exercise companionship, and providing opportunities for monitoring by friends/family members, especially in case of emergencies. Participants viewed an app as a potential vehicle for reinforcing accomplishments in T2DM self-management. Future research should implement and test an app with these features in this or similar communities.


Assuntos
Serviços de Saúde Comunitária/métodos , Diabetes Mellitus Tipo 2/terapia , Aplicativos Móveis , Pobreza , Autocuidado/métodos , Rede Social , Afro-Americanos , Família , Feminino , Pessoal de Saúde , Humanos , Masculino , Smartphone
17.
Qual Health Res ; 29(11): 1535-1548, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31274060

RESUMO

Task shifting from trained clinicians to community health workers (CHWs) is a central, primary health care strategy advocated by global health policy planners in resource-poor settings where trained health professionals are scarce. The evidence base for the efficacy of these programs, however, is limited-in particular, research that identifies their potential unintended consequences. Based on sustained ethnographic study of CHWs working for AIDS projects in South Africa at the height of the country's AIDS epidemic, this article identifies how structural and local factors produced unintended consequences for CHW programs. These consequences were (a) CHWs moonlighting for multiple organizations, (b) CHWs freelancing in communities without regulation, and (c) adverse patient outcomes resulting from uncoordinated care. These consequences stemmed from structural elements of a bureaucratically weak health system and from local grassroots dynamics that jeopardized long-term CHW program sustainability and eroded national health goals.


Assuntos
Agentes Comunitários de Saúde , Síndrome de Imunodeficiência Adquirida/terapia , Antropologia Cultural , Serviços de Saúde Comunitária/métodos , Serviços de Saúde Comunitária/organização & administração , Agentes Comunitários de Saúde/organização & administração , Humanos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde , África do Sul
18.
BMC Health Serv Res ; 19(1): 453, 2019 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-31277640

RESUMO

BACKGROUND: Control of obesity is an important priority to reduce the burden of chronic disease. Clinical guidelines focus on the role of primary healthcare in obesity prevention. The purpose of this scoping review is to examine what the published literature indicates about the role of hospital and community based health services in adult obesity prevention in order to map the evidence and identify gaps in existing research. METHODS: Databases were searched for articles published in English between 2006 and 2016 and screened against inclusion and exclusion criteria. Further papers were highlighted through a manual search of the reference lists. Included papers evaluated interventions aimed at preventing overweight and obesity in adults that were implemented within and/or by hospital and community health services; were an empirical description of obesity prevention within a health setting or reported health staff perceptions of obesity and obesity prevention. RESULTS: The evidence supports screening for obesity of all healthcare patients, combined with referral to appropriate intervention services but indicates that health professionals do not typically adopt this practice. As well as practical issues such as time and resourcing, implementation is impacted by health professionals' views about the causes of obesity and doubts about the benefits of the health sector intervening once someone is already obese. As well as lacking confidence or knowledge about how to integrate prevention into clinical care, health professional judgements about who might benefit from prevention and negative views about effectiveness of prevention hinder the implementation of practice guidelines. This is compounded by an often prevailing view that preventing obesity is a matter of personal responsibility and choice. CONCLUSIONS: This review highlights that whilst a population health approach is important to address the complexity of obesity, it is important that the remit of health services is extended beyond medical treatment to incorporate obesity prevention through screening and referral. Further research into the role of health services in obesity prevention should take a systems approach to examine how health service structures, policy and practice interrelationships, and service delivery boundaries, processes and perspectives impact on changing models of care.


Assuntos
Serviços de Saúde Comunitária , Promoção da Saúde , Obesidade/prevenção & controle , Adulto , Serviços de Saúde Comunitária/métodos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Atenção Primária à Saúde
19.
Trop Doct ; 49(4): 298-300, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31333059

RESUMO

Community mobilisation is an essential part of cervical cancer screening programmes to increase demand for screening services. While there are different methods of community mobilisation, in Ethiopia community conversations during traditional coffee ceremonies appear to be a context appropriate and effective method. Linkage of community mobilisation with existing community networks can increase uptake of cervical cancer screening and improve continuous support and care among community members.


Assuntos
Café , Serviços de Saúde Comunitária/métodos , Redes Comunitárias/organização & administração , Detecção Precoce de Câncer/métodos , Neoplasias do Colo do Útero/diagnóstico , Adulto , Serviços de Saúde Comunitária/organização & administração , Etiópia/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/prevenção & controle
20.
PLoS Med ; 16(6): e1002830, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31199792

RESUMO

BACKGROUND: Although there is mounting evidence demonstrating beneficial effects of community health workers (CHWs), few studies have examined the impact of CHW programs focused on preventing infectious diseases in children through behavior changes. We assessed the preventive effects of community health volunteers (CHVs), who receive no financial incentive, on child diarrhea and fever prevalence in Ghana. METHODS AND FINDINGS: We conducted a cluster-randomized controlled trial in 40 communities in the Volta Region, Ghana. Twenty communities were randomly allocated to the intervention arm, and 20 to the control arm, using a computer-generated block randomization list. In the intervention arm, CHVs were deployed in their own community with the key task of conducting home visits for health education and community mobilization. The primary outcomes of the trial were diarrhea and fever prevalence at 6 and 12 months among under-5 children based on caregivers' recall. Secondary outcomes included oral rehydration treatment and rapid diagnostic testing for malaria among under-5 children, and family planning practices of caregivers. Generalized estimating equations (GEEs) with a log link and exchangeable correlation matrix were used to determine the relative risk (RR) and 95% confidence intervals (CIs) for diarrhea, fever, and secondary outcomes adjusted for clustering and stratification. Between April 18 and May 4, 2015, 1,956 children were recruited and followed up until September 20, 2016. At 6 and 12 months post-randomization, 1,660 (85%) and 1,609 (82%) participants, respectively, had outcomes assessed. CHVs' home visits had no statistically significant effect on diarrhea or fever prevalence at either time point. After a follow-up of 12 months, the prevalence of diarrhea and fever was 7.0% (55/784) and 18.4% (144/784), respectively, in the control communities and 4.5% (37/825) and 14.7% (121/825), respectively, in the intervention communities (12-month RR adjusted for clustering and stratification: diarrhea, RR 0.73, 95% CI 0.37-1.45, p = 0.37; fever, RR 0.76, 95% CI 0.51-1.14, p = 0.20). However, the following were observed: improved hand hygiene practices, increased utilization of insecticide-treated bed nets, and greater participation in community outreach programs (p-values < 0.05) in the intervention group. In a post hoc subgroup analysis, the prevalence of diarrhea and fever at 6 months was 3.2% (2/62) and 17.7% (11/62), respectively, in the intervention communities with ≥70% coverage and a ≥30-minute visit duration, and 14.4% (116/806) and 30.2% (243/806) in the control communities (RR adjusted for clustering, stratification, baseline prevalence, and covariates: diarrhea, RR 0.23, 95% CI 0.09-0.60, p = 0.003; fever, RR 0.69, 95% CI 0.52-0.92, p = 0.01). The main limitations were the following: We were unable to investigate the longer-term effects of CHVs; the trial may have been underpowered to detect small to moderate effects due to the large decline in diarrheal and fever prevalence in both the intervention and control group; and caregivers' practices were based on self-report, and the possibility of caregivers providing socially desirable responses cannot be excluded. CONCLUSIONS: We found no effect of CHVs' home visits on the prevalence of child diarrhea or fever. However, CHV programs with high community coverage and regular household contacts of effective duration may reduce childhood infectious disease prevalence. TRIAL REGISTRATION: International Standard Randomised Controlled Trial Registry, ISRCTN49236178.


Assuntos
Serviços de Saúde Comunitária/normas , Agentes Comunitários de Saúde/normas , Diarreia/epidemiologia , Febre/epidemiologia , Visita Domiciliar , Adulto , Criança , Pré-Escolar , Análise por Conglomerados , Serviços de Saúde Comunitária/métodos , Diarreia/prevenção & controle , Feminino , Febre/prevenção & controle , Seguimentos , Gana/epidemiologia , Humanos , Masculino
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