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Flórez KR, Payán DD, Palar K, Williams MV, Katic B, Derose KP. Church-based interventions to address obesity among African Americans and Latinos in the United States: a systematic review. Nutr Rev 2020; 78:304-322. [PMID: 31539069 PMCID: PMC8453621 DOI: 10.1093/nutrit/nuz046] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
CONTEXT Multilevel church-based interventions may help address racial/ethnic disparities in obesity in the United States since churches are often trusted institutions in vulnerable communities. These types of interventions affect at least two levels of socio-ecological influence which could mean an intervention that targets individual congregants as well as the congregation as a whole. However, the extent to which such interventions are developed using a collaborative partnership approach and are effective with diverse racial/ethnic populations is unclear, and these crucial features of well-designed community-based interventions. OBJECTIVE The present systematic literature review of church-based interventions was conducted to assess their efficacy for addressing obesity across different racial/ethnic groups (eg, African Americans, Latinos). DATA SOURCES AND EXTRACTION In total, 43 relevant articles were identified using systematic review methods developed by the Center for Disease Control and Prevention (CDC)'s Task Force on Community Preventive Services. The extent to which each intervention was developed using community-based participatory research principles, was tailored to the particular community in question, and involved the church in the study development and implementation were also assessed. DATA ANALYSIS Although 81% of the studies reported significant results for between- or within-group differences according to the study design, effect sizes were reported or could only be calculated in 56% of cases, and most were small. There was also a lack of diversity among samples (eg, few studies involved Latinos, men, young adults, or children), which limits knowledge about the ability of church-based interventions to reduce the burden of obesity more broadly among vulnerable communities of color. Further, few interventions were multilevel in nature, or incorporated strategies at the church or community level. CONCLUSIONS Church-based interventions to address obesity will have greater impact if they consider the diversity among populations burdened by this condition and develop programs that are tailored to these different populations (eg, men of color, Latinos). Programs could also benefit from employing multilevel approaches to move the field away from behavioral modifications at the individual level and into a more systems-based framework. However, effect sizes will likely remain small, especially since individuals only spend a limited amount of time in this particular setting.
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Affiliation(s)
- Karen R Flórez
- CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
| | - Denise D Payán
- Department of Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, California, USA
- RAND Corporation, Santa Monica, California, USA
| | - Kartika Palar
- Department of Medicine, University of California, San Francisco, San Francisco, California, USA
| | | | - Bozena Katic
- CUNY Graduate School of Public Health and Health Policy, New York, New York, USA
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Derose KP, Williams MV, Flórez KR, Ann Griffin B, Payán DD, Seelam R, Branch CA, Hawes-Dawson J, Mata MA, Whitley MD, Wong EC. Eat, Pray, Move: A Pilot Cluster Randomized Controlled Trial of a Multilevel Church-Based Intervention to Address Obesity Among African Americans and Latinos. Am J Health Promot 2019; 33:586-596. [PMID: 30474376 PMCID: PMC7171715 DOI: 10.1177/0890117118813333] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE To implement a multilevel, church-based intervention with diverse disparity populations using community-based participatory research and evaluate feasibility, acceptability, and preliminary effectiveness in improving obesity-related outcomes. DESIGN Cluster randomized controlled trial (pilot). SETTING Two midsized (∼200 adults) African American baptist and 2 very large (∼2000) Latino Catholic churches in South Los Angeles, California. PARTICIPANTS Adult (18+ years) congregants (n = 268 enrolled at baseline, ranging from 45 to 99 per church). INTERVENTION Various components were implemented over 5 months and included 2 sermons by pastor, educational handouts, church vegetable and fruit gardens, cooking and nutrition classes, daily mobile messaging, community mapping of food and physical activity environments, and identification of congregational policy changes to increase healthy meals. MEASURES Outcomes included objectively measured body weight, body mass index (BMI), and systolic and diastolic blood pressure (BP), plus self-reported overall healthiness of diet and usual minutes spent in physical activity each week; control variables include sex, age, race-ethnicity, English proficiency, education, household income, and (for physical activity outcome) self-reported health status. ANALYSIS Multivariate linear regression models estimated the average effect size of the intervention, controlling for pair fixed effects, a main effect of the intervention, and baseline values of the outcomes. RESULTS Among those completing follow-up (68%), the intervention resulted in statistically significantly less weight gain and greater weight loss (-0.05 effect sizes; 95% confidence interval [CI] = -0.06 to -0.04), lower BMI (-0.08; 95% CI = -0.11 to -0.05), and healthier diet (-0.09; 95% CI = -0.17 to -0.00). There was no evidence of an intervention impact on BP or physical activity minutes per week. CONCLUSION Implementing a multilevel intervention across diverse congregations resulted in small improvements in obesity outcomes. A longer time line is needed to fully implement and assess effects of community and congregation environmental strategies and to allow for potential larger impacts of the intervention.
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Affiliation(s)
| | | | - Karen R. Flórez
- City University of New York (CUNY) Graduate School of Public Health and Health Policy, New York City, NY, USA
| | | | - Denise D. Payán
- RAND Corporation, Santa Monica, CA, USA
- University of California, Merced, Merced, CA, USA
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Hills MD, Carroll S, O'Neill M. Vers un modèle d'évaluation de l'efficacité des interventions communautaires en promotion de la santé : compte-rendu de quelques développements Nord-américains récents1. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/10253823040110010105] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Marcia D. Hills
- University of Victoria Human and Social Development
PO Box 3060 STN CSC Victoria BC V8W 3R4 Canada,
| | - Simon Carroll
- University of Victoria Human and Social Development
PO Box 3060 STN CSC Victoria BC V8W 3R4 Canada
| | - Michel O'Neill
- Faculté des Sciences infirmières 4108-J Pavillon Paul-Comtois,
Université Laval Québec, Qc, Canada, G1K 7P4
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Martini A, Morris JN, Preen D. Impact of non-clinical community-based promotional campaigns on bowel cancer screening engagement: An integrative literature review. PATIENT EDUCATION AND COUNSELING 2016; 99:1549-57. [PMID: 27270183 DOI: 10.1016/j.pec.2016.05.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 04/25/2016] [Accepted: 05/14/2016] [Indexed: 05/15/2023]
Abstract
OBJECTIVE This paper reviewed the relationship between non-clinical, client-oriented promotional campaigns to raise bowel cancer awareness and screening engagement. METHOD An integrative literature review using predefined search terms was conducted to summarise the accumulated knowledge. Data was analysed by coding and categorising, then synthesized through development of themes. RESULTS Eighteen of 116 studies met inclusion criteria. Promotional campaigns had varying impact on screening uptake for bowel cancer. Mass media was found to moderately increase screening, predominately amongst "worried well". Small media used in conjunction with other promotional activities, thus its effect on screening behaviours was unclear. One-on-one education was less effective and less feasible than group education in increasing intention to screen. Financial support was ineffective in increasing screening rates when compared to other promotional activities. Screening engagement increased because of special events and celebrity endorsement. CONCLUSION Non-clinical promotional campaigns did impact uptake of bowel cancer screening engagement. However, little is evident on the effect of single types of promotion and most research is based on clinician-directed campaigns. PRACTICE IMPLICATIONS Cancer awareness and screening promotions should be implemented at community and clinical level to maximize effectiveness. Such an approach will ensure promotional activities are targeting consumers, thus strengthening screening engagement.
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Affiliation(s)
- Angelita Martini
- Center for Health Services Research, School of Population Health, The University of Western Australia, 35 Stirling Hwy, Crawley 6009, Western Australia, Australia.
| | - Julia N Morris
- Center for Health Services Research, School of Population Health, The University of Western Australia, 35 Stirling Hwy, Crawley 6009, Western Australia, Australia.
| | - David Preen
- School of Population Health, The University of Western Australia, 35 Stirling Hwy, Crawley 6009, Western Australia, Australia.
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Lytvyak E, Olstad DL, Schopflocher DP, Plotnikoff RC, Storey KE, Nykiforuk CIJ, Raine KD. Impact of a 3-year multi-centre community-based intervention on risk factors for chronic disease and obesity among free-living adults: the Healthy Alberta Communities study. BMC Public Health 2016; 16:344. [PMID: 27090293 PMCID: PMC4835846 DOI: 10.1186/s12889-016-3021-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 04/10/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Healthy Alberta Communities (HAC) was a 3-year community-based intervention to reduce lifestyle-related risk factors for chronic disease and obesity at a population-level. The current paper examines changes in blood pressure (BP) and anthropometric indicators within HAC communities compared to secular trends. METHODS Between 2006 and 2009, this community-academic partnership sought to create environments supportive of healthier dietary and physical activity behaviours within four diverse communities in Alberta, Canada. Height, weight, waist and hip circumference and BP were measured among 1554 and 1808 community residents at baseline (2006) and follow-up (2009), respectively. A comparison sample was drawn from a representative national survey. Samples were stratified by age and change between pre- and post-intervention was assessed using t-tests. Changes in parameters over time between groups were compared using meta-analysis. The net difference in change in outcomes (change in intervention communities minus change in comparison group) represented the effect of the intervention. RESULTS Adjusted systolic (SBP) and diastolic (DBP) BP declined within most age groups in HAC communities from pre- to post-intervention. The net decline in SBP was 1 mmHg in 20-39 year olds (p = 0.006) and 2 mmHg in 40-59 year olds (p = 0.001), while the net decline in DBP was 3 mmHg in 20-39 year olds (p < 0.001), 2 mmHg in 40-59 year olds (p < 0.001) and 3 mmHg in 60-79 year olds (p < 0.001). The net increase in the proportion of individuals with normal BP was 5.9 % (p < 0.001), while the net decline in the proportion of individuals with stage 1 hypertension was 4.5 % (p < 0.001). BMI and body weight were unchanged. There was a significant net increase in waist and hip circumference among 20-39 year olds within intervention communities. CONCLUSIONS Findings suggest HAC succeeded in shifting the population distribution of BP in a leftward direction. By contrast, anthropometric parameters remained unchanged or worsened within intervention communities. Therefore, while improvements in some clinical risk factors can be achieved through relatively diffuse and shorter-term community-level environmental changes, improvements in others may require interventions of greater intensity and duration. Evaluating the success of community-based interventions based on their efficacy in changing individual-level clinical indicators may, however, underestimate their potential.
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Affiliation(s)
- Ellina Lytvyak
- />School of Public Health, University of Alberta, 3-300 ECHA, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Dana Lee Olstad
- />School of Public Health, University of Alberta, 3-300 ECHA, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
- />Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - Donald P. Schopflocher
- />School of Public Health, University of Alberta, 3-300 ECHA, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Ronald C. Plotnikoff
- />School of Public Health, University of Alberta, 3-300 ECHA, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
- />Priority Research Centre in Physical Activity and Nutrition, The University of Newcastle Callaghan, Callaghan, NSW 2308 Australia
| | - Kate E. Storey
- />School of Public Health, University of Alberta, 3-300 ECHA, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Candace I. J. Nykiforuk
- />School of Public Health, University of Alberta, 3-300 ECHA, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
| | - Kim D. Raine
- />School of Public Health, University of Alberta, 3-300 ECHA, 11405 87 Ave, Edmonton, AB T6G 1C9 Canada
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Nulu S. Neglected chronic disease: The WHO framework on non-communicable diseases and implications for the global poor. Glob Public Health 2016; 12:396-415. [PMID: 26948138 DOI: 10.1080/17441692.2016.1154584] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The current global framework on noncommunicable disease (NCD), as exemplified by the WHO Action Plan of 2012, neglects the needs of the global poor. The current framework is rooted in an outdated pseudo-evolutionary theory of epidemiologic transition, which weds NCDs to modernity, and relies on global aggregate data. It is oriented around a simplistic causal model of behaviour, risk and disease, which implicitly locates 'risk' within individuals, conveniently drawing attention away from important global drivers of the NCD epidemic. In fact, the epidemiologic realities of the bottom billion reveal a burden of neglected chronic diseases that are associated with 'alternative' environmental and infectious risks that are largely structurally determined. In addition, the vertical orientation of the framework fails to centralise health systems and delivery issues that are essential to chronic disease prevention and treatment. A new framework oriented around a global health equity perspective would be able to correct some of the failures of the current model by bringing the needs of the global poor to the forefront, and centralising health systems and delivery. In addition, core social science concepts such as Bordieu's habitus may be useful to re-conceptualising strategies that may address both behavioural and structural determinants of health.
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Affiliation(s)
- Shanti Nulu
- a Department of Medicine , Yale University , New Haven , CT , USA
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7
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A Media and Clinic Intervention to Increase Colorectal Cancer Screening in Ohio Appalachia. BIOMED RESEARCH INTERNATIONAL 2015; 2015:943152. [PMID: 26509172 PMCID: PMC4609808 DOI: 10.1155/2015/943152] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 06/29/2015] [Accepted: 08/16/2015] [Indexed: 12/25/2022]
Abstract
Objective. To test the effectiveness of a colorectal cancer (CRC) screening intervention among adults living in Ohio Appalachia. Methods. We conducted a group-randomized trial of a county-level intervention among adults living in 12 Ohio Appalachian counties who received a media campaign and clinic intervention focused on either CRC screening or fruits and vegetables. Participants' percentage within CRC screening guidelines was assessed with cross-sectional surveys conducted annually for four years, and validated with medical record review of screening. Results. On average, screening data were obtained on 564 intervention and 559 comparison participants per year. There was no difference in the Wave 4 CRC screening rates of intervention and comparison counties (35.2% versus 31.4%). Multivariate analyses found that high perceived risk of CRC, willingness to have a CRC test if recommended by a doctor, doctor recommendation of a CRC screening test, and patient-physician communication about changes in bowel habits, family history of CRC, and eating fruits and vegetables were significant (p < 0.05) predictors of being within CRC screening guidelines. Conclusions. The intervention was not effective in increasing CRC rates among Ohio Appalachian adults. Future research should determine how media and clinic-based interventions can be modified to improve CRC screening rates among this underserved population.
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McIntosh B, Daly A, Mâsse LC, Collet JP, Higgins JW, Naylor PJ, Amed S. Sustainable childhood obesity prevention through community engagement (SCOPE) program: evaluation of the implementation phase. Biochem Cell Biol 2015; 93:472-8. [PMID: 25974751 DOI: 10.1139/bcb-2014-0127] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Childhood obesity rates are steadily rising. Sustainable Childhood Obesity Prevention Through Community Engagement (SCOPE) is a community-based participatory action research (PAR) program aimed at preventing childhood obesity. This study aimed to describe community perspectives on, and elicit feedback about, SCOPE's first phase of implementation in two pilot cities in British Columbia, Canada. A case study was implemented using interviews and questionnaires to obtain feedback about SCOPE from two groups: SCOPE coordinators and stakeholders (i.e., individuals and organizations that were a member of the community and engaged with SCOPE coordinators). Participants were recruited via email and (or) by telephone. Coordinators completed a telephone interview. Stakeholders completed a questionnaire and (or) a telephone interview. Thematic analysis was conducted. Participants included 2 coordinators and 15 stakeholders. Participants similarly interpreted SCOPE as a program focused on raising awareness about childhood obesity prevention, while engaging multiple community sectors. Overall, participants valued the program's role in facilitating networking and partnership development, providing evidence-based resources, technical expertise, and contributing funding. Participants felt that SCOPE is sustainable. However, participants felt that barriers to achieving healthy weights among children included those related to the built environment, and social, behavioral, and economic obstacles. Perspectives on factors that facilitated and acted as barriers to SCOPE's first phase of implementation were obtained from the SCOPE communities and may be used to enhance the sustainability of SCOPE and its applicability to other BC communities.
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Affiliation(s)
- Bonnie McIntosh
- a University of British Columbia, Department of Pediatrics, K4-213, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
| | - Amelia Daly
- a University of British Columbia, Department of Pediatrics, K4-213, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
| | - Louise C Mâsse
- b University of British Columbia, School of Population and Public Health, F508-4480 Oak Street, Vancouver, BC V6H 3V4, Canada
| | - Jean-Paul Collet
- a University of British Columbia, Department of Pediatrics, K4-213, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
| | - Joan Wharf Higgins
- c University of Victoria, School of Exercise Science, Physical and Health Education, PO Box 1700 STN CSC Victoria, BC V8W 2Y2, Canada
| | - Patti-Jean Naylor
- c University of Victoria, School of Exercise Science, Physical and Health Education, PO Box 1700 STN CSC Victoria, BC V8W 2Y2, Canada
| | - Shazhan Amed
- a University of British Columbia, Department of Pediatrics, K4-213, 4480 Oak Street, Vancouver, BC V6H 3V4, Canada
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Abstract
This paper reviews the magnitude and empirical findings of social epidemiological neighborhood effects research. An electronic keyword literature search identified 1369 empirical and methodological neighborhood effects papers published in 112 relevant journals between 1990 and 2014. Analyses of temporal trends were conducted by focus, journal type (e.g., epidemiology, public health, or social science), and specific epidemiologic journal. Select papers were then critically reviewed. Results show an ever-increasing number of papers published, notably since the year 2000, with the majority published in public health journals. The variety of health outcomes analyzed is extensive, ranging from infectious disease to obesity to criminal behavior. Papers relying on data from experimental designs are thought to yield the most credible results, but such studies are few and findings are inconsistent. Papers relying on data from observational designs and multilevel models typically show small statistically significant effects, but most fail to appreciate fundamental identification problems. Ultimately, of the 1170 empirically focused neighborhood effects papers published in the last 24 years, only a handful have clearly advanced our understanding of the phenomena. The independent impact of neighborhood contexts on health remains unclear. It is time to expand the social epidemiological imagination.
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Abstract
Complexity-resulting from interactions among many component parts-is a property of both the intervention and the context (or system) into which it is placed. Complexity increases the unpredictability of effects. Complexity invites new approaches to logic modeling, definitions of integrity and means of standardization, and evaluation. New metaphors and terminology are needed to capture the recognition that knowledge generation comes from the hands of practitioners/implementers as much as it comes from those usually playing the role of intervention researcher. Failure to acknowledge this may blind us to the very mechanisms we seek to understand. Researchers in clinical settings are documenting health improvement gains made as a consequence of complex systems thinking. Improvement science in clinical settings has much to offer researchers in population health.
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Affiliation(s)
- Penelope Hawe
- Menzies Center for Health Policy, University of Sydney, New South Wales, 2006, Australia; and The Australian Prevention Partnership Center;
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Magzamen S, Brandt SJ, Tager IB. Examining household asthma management behavior through a microeconomic framework. HEALTH EDUCATION & BEHAVIOR 2014; 41:651-62. [PMID: 24799127 DOI: 10.1177/1090198114532288] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
National guidelines on the effective management of pediatric asthma have been promoted for over 20 years, yet asthma-related morbidity among low-income children remains disproportionately high. To date, household and clinical interventions designed to remediate these differences have been informed largely by a health behavior framework. However, these programs have not resulted in consistent sustained improvements in targeted populations. The continued funding and implementation of programs based on the health behavior framework leads us to question if traditional behavioral models are sufficient to understand and promote adaptation of positive health management behaviors. We introduce the application of the microeconomic framework to investigate potential mechanisms that can lead to positive management behaviors to improve asthma-related morbidity. We provide examples from the literature on health production, preferences, trade-offs and time horizons to illustrate how economic constructs can potentially add to understanding of disease management. The economic framework, which can be empirically observed, tested, and quantified, can explicate the engagement in household-level activities that would affect health and well-being. The inclusion of a microeconomic perspective in intervention research may lead to identification of mechanisms that lead to household decisions with regard to asthma management strategies and behavior. The inclusion of the microeconomic framework to understand the production of health may provide a novel theoretical framework to investigate the underlying causal behavioral mechanisms related to asthma management and control. Adaptation of an economic perspective may provide new insight into the design and implementation of interventions to improve asthma-related morbidity in susceptible populations.
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Affiliation(s)
- Sheryl Magzamen
- University of California, Berkeley, Berkeley, CA, USA University of Wisconsin-Madison, Madison, USA
| | | | - Ira B Tager
- University of California, Berkeley, Berkeley, CA, USA
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12
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Oakes JM. Commentary: Identification, neighbourhoods and families. Int J Epidemiol 2013; 42:1067-9. [DOI: 10.1093/ije/dyt145] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ekberg J, Timpka T, Angbratt M, Frank L, Norén AM, Hedin L, Andersen E, Gursky EA, Gäre BA. Design of an online health-promoting community: negotiating user community needs with public health goals and service capabilities. BMC Health Serv Res 2013; 13:258. [PMID: 23826944 PMCID: PMC3708753 DOI: 10.1186/1472-6963-13-258] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2012] [Accepted: 06/28/2013] [Indexed: 11/10/2022] Open
Abstract
Background An online health-promoting community (OHPC) has the potential to promote health and advance new means of dialogue between public health representatives and the general public. The aim of this study was to examine what aspects of an OHPC that are critical for satisfying the needs of the user community and public health goals and service capabilities. Methods Community-based participatory research methods were used for data collection and analysis, and participatory design principles to develop a case study OHPC for adolescents. Qualitative data from adolescents on health appraisals and perspectives on health information were collected in a Swedish health service region and classified into categories of user health information exchange needs. A composite design rationale for the OHPC was completed by linking the identified user needs, user-derived requirements, and technical and organizational systems solutions. Conflicts between end-user requirements and organizational goals and resources were identified. Results The most prominent health information needs were associated to food, exercise, and well-being. The assessment of the design rationale document and prototype in light of the regional public health goals and service capabilities showed that compromises were needed to resolve conflicts involving the management of organizational resources and responsibilities. The users wanted to discuss health issues with health experts having little time to set aside to the OHPC and it was unclear who should set the norms for the online discussions. Conclusions OHPCs can be designed to satisfy both the needs of user communities and public health goals and service capabilities. Compromises are needed to resolve conflicts between users’ needs to discuss health issues with domain experts and the management of resources and responsibilities in public health organizations.
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Affiliation(s)
- Joakim Ekberg
- Department of Medical and Health Sciences, Linköping University, SE-581 83, Linköping, Sweden.
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Kaczorowski J, Del Grande C, Nadeau-Grenier V. Community-Based Programs to Improve Prevention and Management of Hypertension: Recent Canadian Experiences, Challenges, and Opportunities. Can J Cardiol 2013; 29:571-8. [DOI: 10.1016/j.cjca.2013.02.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 02/14/2013] [Accepted: 02/14/2013] [Indexed: 01/11/2023] Open
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Abstract
Implementation science studies the use of strategies to adapt and use evidence-based interventions in targeted settings (e.g., schools, workplaces, health care facilities, public health departments) to sustain improvements to population health. This nascent field of research is in the early stages of developing theories of implementation and evaluating the properties of measures. Stakeholder engagement, effectiveness studies, research synthesis, and mathematical modeling are some of the methods used by implementation scientists to identify strategies to embed evidence-based interventions in clinical and public health programs. However, for implementation science to reach its full potential to improve population health the existing paradigm for how scientists create evidence, prioritize publications, and synthesize research needs to shift toward greater stakeholder input and improved reporting on external validity. This shift will improve the relevance of the research that is produced and provide information that will help guide decision makers in their selection of research-tested interventions.
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Affiliation(s)
- Rebecca Lobb
- Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis, St. Louis, Missouri 63110, USA.
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Pīrāgs V, El Damassy H, Dąbrowski M, Gönen MS, Račická E, Martinka E, Giaconia J, Stefanski A. Low risk of severe hypoglycaemia in patients with type 2 diabetes mellitus starting insulin therapy with premixed insulin analogues BID in outpatient settings. Int J Clin Pract 2012; 66:1033-41. [PMID: 23067027 DOI: 10.1111/j.1742-1241.2012.03001.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIMS The choice of insulin at initiation in type 2 diabetes remains controversial. The aim of this study was to assess the occurrence of self-reported severe hypoglycaemia associated with premixed insulin analogues in routine clinical care. METHODS A 12-month, prospective, observational, multicentre study in patients starting a commonly prescribed premixed insulin analogue (either insulin lispro 25/75 or biphasic insulin aspart 30/70, twice daily) after suboptimal glycaemic control on oral antidiabetic agents. Treatment decisions were made solely in the course of usual practice. RESULTS Study follow-up was completed by 991 (85.5%) of the 1150 patients enrolled. At baseline, mean (SD) age was 57.9 (10.1) years; mean diabetes duration was 9.2 (5.9) years; mean haemoglobin A(1c) (HbA(1c)) was 9.9 (1.8) % and the rate of severe hypoglycaemia was 0.03 episode/patient-year. At 12 months, the rate of severe hypoglycaemia was 0.04 episode/patient-year (95% CI 0.023, 0.055 episode/patient-year) and mean insulin dose was 41.5 (19.4) units. Changes from baseline to 12 months for mean fasting plasma glucose and HbA(1c) were -5.1 mmol/l and -2.5%, respectively. CONCLUSIONS After initiation of premixed insulin analogues in patients with type 2 diabetes in real-world settings, the incidence of severe hypoglycaemia was lower than expected from previously reported studies.
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Affiliation(s)
- V Pīrāgs
- Faculty of Medicine, University of Latvia, Riga, Latvia Ain Shams University, Cairo, Egypt
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Maibach EW, Maxfield A, Ladin K, Slater M. Translating health psychology into effective health communication: the american healthstyles audience segmentation project. J Health Psychol 2012; 1:261-77. [PMID: 22011991 DOI: 10.1177/135910539600100302] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This article presents a health lifestyle audience segmentation analysis based primarily on social cognitive theory. Two linked mail surveys were conducted among a representative group of US adults (N = 2967). Segmentation variables included data on five health behaviors (smoking, alcohol consumption, physical activity, nutrition and weight control), internal personal and social/ environmental variables associated with each of the health behaviors, as well as health value, sensation- seeking, life satisfaction and age. K-means classification analysis was employed; seven health lifestyles were identified. The majority of the health lifestyles are reliable, and as a whole, all demonstrate both discriminative, construct and predictive validity. The health-lifestyle audience segments are briefly profiled, and an argument is made that health- lifestyle segmentation, more than demographic or behavioral segmentation alone, can advance the goals of public health communication.
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From Framingham to North Karelia to U.S. Community-Based Prevention Programs: Negotiating Research Agenda for Coronary Heart Disease in the Second Half of the 20th Century. Public Health Rev 2011. [DOI: 10.1007/bf03391646] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Richard L, Gauvin L, Raine K. Ecological models revisited: their uses and evolution in health promotion over two decades. Annu Rev Public Health 2011; 32:307-26. [PMID: 21219155 DOI: 10.1146/annurev-publhealth-031210-101141] [Citation(s) in RCA: 270] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Since the 1980s, ecological models of health promotion have generated a great deal of enthusiasm among researchers and interventionists. These models emerged from conceptual developments in other fields, and only selected elements of the ecological approach have been integrated into them. In this article, we describe the tenets of the ecological approach and highlight those aspects that have been integrated into ecological models used in health promotion. We also analyze how ecological models have been applied to the study of two important public health issues, namely physical activity promotion and the increased consumption of fruits and vegetables, by conducting an archival study of published research. Finally, we make a statement regarding the usefulness of ecological models for research and practice and propose recommendations for future research, program planning, and evaluation.
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Affiliation(s)
- Lucie Richard
- Faculty of Nursing, Université de Montréal, Québec, Canada.
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Schildmann EK, Higginson IJ. Evaluating psycho-educational interventions for informal carers of patients receiving cancer care or palliative care: strengths and limitations of different study designs. Palliat Med 2011; 25:345-56. [PMID: 21228098 DOI: 10.1177/0269216310389223] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Despite evidence of negative psychological sequelae and unmet needs, there are few evaluated interventions for informal caregivers in cancer and palliative care. The aim of this article is to debate the strengths and limitations of randomized controlled trials (RCTs) and other designs that can be used to evaluate the effectiveness of these interventions. Psycho-educational interventions are used as example for this debate article, as a number of studies of various designs evaluating this type of intervention have been published. Systematic searching in Medline and the bibliography of a relevant systematic review identified five RCTs, one pre-test/post-test study with a control group and six one-group pre-test/post-test studies of psycho-educational interventions for caregivers. The methodological strengths and weaknesses were assessed. RCTs are seen as the gold standard, but can have important limitations in the context of carer intervention research, including biased recruitment and low generalizability, problems with blinding and attrition. Pre-test/post-test studies with a control group may be more feasible and more generalizable. Their crucial limitation is selection bias. Before-after studies are compromised by additional specific biases and therefore are the weakest of all discussed designs. After analysing the strengths and weaknesses of the mentioned study designs, this paper presents strategies to address the limitations of RCTs evaluating psycho-educational interventions for carers in cancer or palliative care.
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Affiliation(s)
- Eva K Schildmann
- Department of Haematology, Oncology and Tumour Immunology, Helios Klinikum Berlin-Buch, Berlin, Germany.
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Wu Z, Viisainen K, Wang Y, Hemminki E. Evaluation of a community-based randomized controlled prenatal care trial in rural China. BMC Health Serv Res 2011; 11:92. [PMID: 21542939 PMCID: PMC3096903 DOI: 10.1186/1472-6963-11-92] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2010] [Accepted: 05/04/2011] [Indexed: 11/10/2022] Open
Abstract
Background A community-based randomized control prenatal care trial was performed in a rural county of China during 2000-2003. The purpose of this paper is to describe the trial implementation and the impact of the trial on the utilization of prenatal care and perinatal outcomes. Materials and methods In the study county, 10 townships (from a total of 55) were each paired with a control (20 study townships in total), with the criteria for pairing being the township's socioeconomic development, perinatal health, and maternal care utilization and provision. One of each township pair was randomly allocated to the intervention or control groups. The trial interventions were: 1) training township hospital midwives and instructing them in how to provide systematic maternal care, 2) informing women in the community of the importance of prenatal care, 3) if needed, providing basic medical instruments to the hospitals. A variety of data sources were used to describe the trial implementation (observations, group discussions, field notes, survey to women). The data on pregnancy and perinatal outcomes were from the original hand-written work-records in the village family planning centers of the study townships. Results Implementation of the intervention was deficient. The factors hindering the trial implementation included poor coordination between midwives and family planning officers, broader policy changes implemented by the provincial government during the trial, the decentralization of county governance, and the lack of government funding for maternal care. There was only little difference in the use of maternal care, in women's opinions related to maternal care or content of prenatal care, and no difference in the perinatal outcomes between the intervention and control townships. Conclusions A community based randomized controlled trial could not be fully carried out in rural China as planned due to the changing political landscape, the complexity of the socio-economic situation and a lengthy planning stage. The study could not answer if perinatal outcomes could be improved by increased use of prenatal care. Trial registration NCT 01054235
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Affiliation(s)
- Zhuochun Wu
- School of Public Health, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, China.
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Haines VA, Godley J, Hawe P. Understanding interdisciplinary collaborations as social networks. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2011; 47:1-11. [PMID: 21063766 DOI: 10.1007/s10464-010-9374-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The dynamics of interdisciplinary collaboration invite further investigation if we are to make this endeavour more rewarding and productive. We are using social network analysis to track the development of a new interdisciplinary collaboration on complex interventions to improve population health. It involves nineteen scholars across four countries. We report the Baseline network of formal relationships among the scholars, along with the impact of the collaboration on these relationships in the first 18 months. We observed statistically significant increases in the density of six types of relationship networks: citing publications by other members of the collaboration, email contact, meeting with each other (outside of the formal annual meeting), visiting one another's institution, submitting research grants together and working on research projects together. The initial strategic role in the network of key 'gate keepers' has not altered substantially (betweenness centralization of the networks), but reciprocity has increased, that is, people are more likely to cite those who have cited them and work together. Increased collaboration is also reflected in the rise in number of subgroups over time and the increase in the average number of subgroup memberships. Use of social network analysis to understand the dynamics of interdisciplinary collaborations is a relatively new field. It invites reflection about what the optimal network structures for interdisciplinary collaborations would look like.
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Cherniack M, Henning R, Merchant JA, Punnett L, Sorensen GR, Wagner G. Statement on national worklife priorities. Am J Ind Med 2011; 54:10-20. [PMID: 20949545 PMCID: PMC5860803 DOI: 10.1002/ajim.20900] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The National Institute for Occupational Safety and Health (NIOSH) WorkLife Initiative (WLI) [http://www.cdc.gov/niosh/worklife] seeks to promote workplace programs, policies, and practices that result in healthier, more productive employees through a focus simultaneously on disease prevention, health promotion, and accommodations to age, family, and life stage. The Initiative incorporates the Institute's foundational commitment to workplaces free of recognized hazards into broader consideration of the factors that affect worker health and wellbeing. Workplace hazards, such as physical demands, chemical exposures, and work organization, often interact with non-work factors such as family demands and health behaviors to increase health and safety risks. New workplace interventions being tested by the first three NIOSH WLI Centers of WorkLife Excellence are exploring innovative models for employee health programs to reduce the human, social, and economic costs of compromised health and quality of life. Many parties in industry, labor, and government share the goals of improving employee health while controlling health care costs. NIOSH convened a workshop in 2008 with representatives of the three Centers of Excellence to develop a comprehensive, long-range strategy for advancing the WorkLife Initiative. The recommendations below fall into three areas: practice, research, and policy. Responding to these recommendations would permit the WorkLife Center system to establish a new infrastructure for workplace prevention programs by compiling and disseminating the innovative practices being developed and tested at the Centers, and elsewhere. The WLI would also extend the customary scope of NIOSH by engaging with multiple NIH Institutes that are already generating research-to-practice programs involving the working-age population, in areas such as chronic disease prevention and management. Research to Practice (r2p) is a concept focused on the translation of research findings, technologies, and information into evidence-based prevention practices and products that are adopted in the workplace or other "real-world" settings. NIOSH's goal is to overcome the translational issues that now prevent state-of-the-art occupational health, health promotion, and chronic disease research findings from benefiting working age populations immediately, regardless of workplace size, work sector, or region of the country.
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Affiliation(s)
- Martin Cherniack
- Center to Promote Health in the New England Workplace (CPH-NEW)
- Ergonomics Technology Center, University of Connecticut Health Center, Farmington, Connecticut
| | - Rob Henning
- Center to Promote Health in the New England Workplace (CPH-NEW)
- Department of Psychology, University of Connecticut, Storrs, Connecticut
| | - James A. Merchant
- Department of Occupational and Environmental Health and Healthier Workforce Center for Excellence, University of Iowa, Iowa City, Iowa
| | - Laura Punnett
- Center to Promote Health in the New England Workplace (CPH-NEW)
- Department of Work Environment and Center for Women and Work, University of Massachusetts, Lowell, Lowell, Massachusetts
| | - Glorian R. Sorensen
- Center for Work, Health and Wellbeing, Harvard School of Public Health, and Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Gregory Wagner
- Harvard School of Public Health, Boston, Massachusetts
- National Institute for Occupational Safety and Health, Washington, District of Columbia
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Latkin C, Weeks MR, Glasman L, Galletly C, Albarracin D. A dynamic social systems model for considering structural factors in HIV prevention and detection. AIDS Behav 2010. [PMID: 20838871 DOI: 10.1007/s10461-010-9804-y.a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
We present a model for HIV-related behaviors that emphasizes the dynamic and social nature of the structural factors that influence HIV prevention and detection. Key structural dimensions of the model include resources, science and technology, formal social control, informal social influences and control, social interconnectedness, and settings. These six dimensions can be conceptualized on macro, meso, and micro levels. Given the inherent complexity of structural factors and their interrelatedness, HIV prevention interventions may focus on different levels and dimensions. We employ a systems perspective to describe the interconnected and dynamic processes of change among social systems and their components. The topics of HIV testing and safer injection facilities (SIFs) are analyzed using this structural framework. Finally, we discuss methodological issues in the development and evaluation of structural interventions for HIV prevention and detection.
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Affiliation(s)
- Carl Latkin
- Department of Health, Behavior and Society, The Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA.
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25
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A dynamic social systems model for considering structural factors in HIV prevention and detection. AIDS Behav 2010; 14:222-38. [PMID: 20838871 DOI: 10.1007/s10461-010-9804-y] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We present a model for HIV-related behaviors that emphasizes the dynamic and social nature of the structural factors that influence HIV prevention and detection. Key structural dimensions of the model include resources, science and technology, formal social control, informal social influences and control, social interconnectedness, and settings. These six dimensions can be conceptualized on macro, meso, and micro levels. Given the inherent complexity of structural factors and their interrelatedness, HIV prevention interventions may focus on different levels and dimensions. We employ a systems perspective to describe the interconnected and dynamic processes of change among social systems and their components. The topics of HIV testing and safer injection facilities (SIFs) are analyzed using this structural framework. Finally, we discuss methodological issues in the development and evaluation of structural interventions for HIV prevention and detection.
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Krishnan A, Ekowati R, Baridalyne N, Kusumawardani N, Kapoor SK, Leowski J. Evaluation of community-based interventions for non-communicable diseases: experiences from India and Indonesia. Health Promot Int 2010; 26:276-89. [PMID: 21071458 DOI: 10.1093/heapro/daq067] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A Krishnan
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi 110029, India.
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Hull PC, Canedo JR, Reece MC, Lira I, Reyes F, Garcia E, Juarez P, Williams E, Husaini BA. Using a participatory research process to address disproportionate Hispanic cancer burden. J Health Care Poor Underserved 2010; 21:95-113. [PMID: 20173287 DOI: 10.1353/hpu.0.0271] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Community-based participatory research (CBPR) offers great potential for increasing the impact of research on reducing cancer health disparities. This article reports how the Community Outreach Core (COC) of the Meharry-Vanderbilt-Tennessee State University (TSU) Cancer Partnership has collaborated with community partners to develop and implement CBPR. The COC, Progreso Community Center, and Nashville Latino Health Coalition jointly developed and conducted the 2007 Hispanic Health in Nashville Survey as a participatory needs assessment to guide planning for subsequent CBPR projects and community health initiatives. Trained community and student interviewers surveyed 500 Hispanic adults in the Nashville area, using a convenience sampling method. In light of the survey results, NLHC decided to focus in the area of cancer on the primary prevention of cervical cancer. The survey led to a subsequent formative CBPR research project to develop an intervention, then to funding of a CBPR pilot intervention study to test the intervention.
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Affiliation(s)
- Pamela C Hull
- Center for Health Research, Tennessee State University (TSU), Nashville, TN, USA.
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28
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Reducing the take-home pathway of pesticide exposure: behavioral outcomes from the Para Niños Saludables study. J Occup Environ Med 2009; 51:922-33. [PMID: 19620892 DOI: 10.1097/jom.0b013e3181ad4995] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the effectiveness of a community intervention in promoting adoption of behaviors to reduce the take-home pathway of pesticide exposure in farmworker households. METHODS Using two cross-sectional samples of farmworker households in 11 intervention and 12 comparison communities in Washington State, we examined whether differences over time in reported pesticide safety practices varied by community intervention status. RESULTS Pesticide safety practices increased in both intervention and comparison communities over time. Changes were significantly greater in intervention communities for removing work shoes before entering the home (P = 0.003) and marginally significantly greater for changing out of work clothes within 1 hour of arriving home (P = 0.05). CONCLUSIONS The intervention was associated with modest effects in certain behaviors among farmworkers. Further research is needed to identify successful strategies for reducing the take-home pathway of pesticide exposure.
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Riley T, Hawe P. A typology of practice narratives during the implementation of a preventive, community intervention trial. Implement Sci 2009; 4:80. [PMID: 20003399 PMCID: PMC2803442 DOI: 10.1186/1748-5908-4-80] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Accepted: 12/14/2009] [Indexed: 11/18/2022] Open
Abstract
Background Traditional methods of process evaluation encompass what components were delivered, but rarely uncover how practitioners position themselves and act relative to an intervention being tested. This could be crucial for expanding our understanding of implementation and its contribution to intervention effectiveness. Methods We undertook a narrative analysis of in-depth, unstructured field diaries kept by nine community development practitioners for two years. The practitioners were responsible for implementing a multi-component, preventive, community-level intervention for mothers of new babies in eight communities, as part of a cluster randomised community intervention trial. We constructed a narrative typology of approaches to practice, drawing on the phenomenology of Alfred Schutz and Max Weber's Ideal Type theory. Results Five types of practice emerged, from a highly 'technology-based' type that was faithful to intervention specifications, through to a 'romantic' type that held relationships to be central to daily operations, with intact relationships being the final arbiter of intervention success. The five types also differed in terms of how others involved in the intervention were characterized, the narrative form (e.g., tragedy, satire) and where and how transformative change in communities was best created. This meant that different types traded-off or managed the priorities of the intervention differently, according to the deeply held values of their type. Conclusions The data set constructed for this analysis is unique. It revealed that practitioners not only exercise their agency within interventions, they do so systematically, that is, according to a pattern. The typology is the first of its kind and, if verified through replication, may have value for anticipating intervention dynamics and explaining implementation variation in community interventions.
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Affiliation(s)
- Therese Riley
- Centre for Health and Society, Melbourne School of Population Health, The University of Melbourne, Level 4, 207 Bouverie St, Carlton, Victoria, 3010, Australia.
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Kelishadi R, Sarrafzadegan N, Sadri GH, Pashmi R, Mohammadifard N, Tavasoli AA, Amani A, Rabiei K, Khosravi A, Bahonar A. Short-term results of a community-based program on promoting healthy lifestyle for prevention and control of chronic diseases in a developing country setting: Isfahan Healthy Heart Program. Asia Pac J Public Health 2009; 23:518-33. [PMID: 19825842 DOI: 10.1177/1010539509348241] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The objective of the study is to investigate the effect of a comprehensive community trial on behavioral modification after 2 years of intervention. The interventions of this 6-year, comprehensive community-based study target the whole population, of nearly 2 180 000, living in 2 cities in Iran and are compared with another Iranian city considered as reference. Educational, environmental, and legislative interventions are being conducted at the population level. From the baseline to the second year of evaluation of this study, the consumption of hydrogenated fat decreased significantly in the intervention community, but it remained nearly constant in the reference area. Meanwhile, the consumption of liquid oil increased in the intervention community, whereas it decreased in the reference area. The prevalence of current smoking and attempt to smoke decreased, respectively, in men and youths living in the intervention area but increased or remained constant in the reference area; however, no favorable change was seen for smoking among women. Leisure time physical activity increased in women and declined in men of both communities; the slopes of these changes were greater in the intervention area. Although the consumption of salty/fat snacks slightly decreased in the school students of the intervention area, it had a sharp increase in the reference area. This program succeeded in improving some aspects of lifestyle in its different target groups. The authors suggest that the synergy of activities intensified the dose of interventions and led to this improvement.
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Affiliation(s)
- Roya Kelishadi
- Pediatric Preventive Cardiology Department, Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
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31
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Murray DM. On developing and evaluating lifestyle interventions. Prev Med 2009; 49:19-20. [PMID: 19501116 DOI: 10.1016/j.ypmed.2009.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 05/28/2009] [Accepted: 05/30/2009] [Indexed: 11/29/2022]
Affiliation(s)
- David M Murray
- College of Public Health, The Ohio State University, B222 Starling-Loving Hall, 320 West 10th Avenue, Columbus, Ohio 43210, USA.
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From pills to programs: lessons from medicine for developing effective lifestyle interventions. Prev Med 2009; 49:12-8. [PMID: 19289142 DOI: 10.1016/j.ypmed.2009.03.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2008] [Revised: 03/04/2009] [Accepted: 03/07/2009] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To propose a scheme for comprehensive development and evaluation of lifestyle interventions. METHODS We adapted the four-phase system used in drug development, the engine of progress in medicine for decades, to construct a system for developing lifestyle intervention programs. RESULTS Phase I: The intervention is constructed and tested with a small number of individuals. Acceptability and feasibility are assessed. Evaluation is primarily qualitative. Phase II: Effectiveness on intermediate endpoints (e.g. behavior) is tested in a real field setting, with a limited number of individuals, using a before-and-after design. An iterative process of testing and refinement may be necessary. Phase III: The effectiveness of the intervention on health-related outcomes is tested, using, where possible, a randomized design. Phase IV: Large-scale implementation and penetration are assessed in other populations. Process variables and local and national health indicators are studied. The development and evaluation of our hygiene intervention, which took place in Jerusalem from 1999 to 2001, is presented as a case study. CONCLUSIONS Adaptation of the phased system of drug development to lifestyle interventions is a conceptually simple approach to building effective, sustainable programs for community-based public health.
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Hawe P, Shiell A, Riley T. Theorising interventions as events in systems. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2009; 43:267-76. [PMID: 19390961 DOI: 10.1007/s10464-009-9229-9] [Citation(s) in RCA: 568] [Impact Index Per Article: 37.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Conventional thinking about preventive interventions focuses over simplistically on the "package" of activities and/or their educational messages. An alternative is to focus on the dynamic properties of the context into which the intervention is introduced. Schools, communities and worksites can be thought of as complex ecological systems. They can be theorised on three dimensions: (1) their constituent activity settings (e.g., clubs, festivals, assemblies, classrooms); (2) the social networks that connect the people and the settings; and (3) time. An intervention may then be seen as a critical event in the history of a system, leading to the evolution of new structures of interaction and new shared meanings. Interventions impact on evolving networks of person-time-place interaction, changing relationships, displacing existing activities and redistributing and transforming resources. This alternative view has significant implications for how interventions should be evaluated and how they could be made more effective. We explore this idea, drawing on social network analysis and complex systems theory.
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Affiliation(s)
- Penelope Hawe
- Population Health Intervention Research Centre, University of Calgary, 3330 Hospital Drive NW, Calgary, AB T2N 4N1, Canada.
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34
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Collins CB. Evidence based interventions for preventing HIV transmission: commentary on Rotheram-Borus et al. (2009). AIDS Behav 2009; 13:414-9; discussion 420-3. [PMID: 19160035 DOI: 10.1007/s10461-008-9517-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2008] [Accepted: 12/15/2008] [Indexed: 12/17/2022]
Affiliation(s)
- Charles B Collins
- Capacity Building Branch, Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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35
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Bowen DJ, Sorensen G, Weiner BJ, Campbell M, Emmons K, Melvin C. Dissemination research in cancer control: where are we and where should we go? Cancer Causes Control 2009; 20:473-85. [PMID: 19224380 PMCID: PMC2915900 DOI: 10.1007/s10552-009-9308-0] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Accepted: 01/30/2009] [Indexed: 10/21/2022]
Abstract
Dissemination of evidence-based programs and policies is a critical final step in reducing the burden of cancer in the general public. Yet, we have not been fully successful to date in improving clinical or public health practice by disseminating programs found to be effective in research. Therefore, research is needed into the dissemination process and outcomes to enable better efforts in the future. This paper explores the definitions and models used for dissemination, the designs of dissemination studies, and possible research questions in dissemination research, all focused on cancer prevention and control. We hope that this paper will encourage dissemination research in our field.
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Affiliation(s)
- Deborah J Bowen
- Social and Behavioral Sciences Department, School of Public Health, Boston University, 715 Albany Street T2 W, Boston, MA 02118, USA.
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36
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Hawe P, Potvin L. What is population health intervention research? Canadian Journal of Public Health 2009. [PMID: 19263977 DOI: 10.1007/bf03405503] [Citation(s) in RCA: 190] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Population-level health interventions are policies or programs that shift the distribution of health risk by addressing the underlying social, economic and environmental conditions. These interventions might be programs or policies designed and developed in the health sector, but they are more likely to be in sectors elsewhere, such as education, housing or employment. Population health intervention research attempts to capture the value and differential effect of these interventions, the processes by which they bring about change and the contexts within which they work best. In health research, unhelpful distinctions maintained in the past between research and evaluation have retarded the development of knowledge and led to patchy evidence about policies and programs. Myths about what can and cannot be achieved within community-level intervention research have similarly held the field back. The pathway forward integrates systematic inquiry approaches from a variety of disciplines.
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Affiliation(s)
- Penelope Hawe
- Population Health Intervention Research Centre, University of Calgary, G012, 3330 Hospital Drive NW, Calgary, AB T2N 4N1.
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37
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Casagrande SS, Whitt-Glover MC, Lancaster KJ, Odoms-Young AM, Gary TL. Built environment and health behaviors among African Americans: a systematic review. Am J Prev Med 2009; 36:174-81. [PMID: 19135908 DOI: 10.1016/j.amepre.2008.09.037] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Revised: 08/28/2008] [Accepted: 09/25/2008] [Indexed: 10/21/2022]
Abstract
CONTEXT An overall understanding of environmental factors that affect weight-related behaviors and outcomes in African American adults is limited. This article presents a summarization of the literature on the built environment and its association with physical activity, diet, and obesity among African Americans. EVIDENCE ACQUISITION A systematic review was conducted by searching the PubMed electronic database from inception to July 31, 2007, reviewing bibliographies of eligible articles, and searching authors' personal databases using various search terms for the built environment, physical activity, diet, and obesity. Eligible articles were observational studies that included a study population >or=90% African American (or subgroup analysis), adults (>or=18 yrs), and were published in English; final article data abstraction occurred from October 2007 through February 2008. EVIDENCE SYNTHESIS A total of 2797 titles were identified from the initial search, and 90 were deemed eligible for abstract review. Of these, 17 articles were eligible for full review and ten met all eligibility criteria. The median sample size was 761 (234 to 10,623), and half of the articles included only African Americans. Light traffic, the presence of sidewalks, and safety from crime were more often positively associated with physical activity, although associations were not consistent (OR range = 0.53-2.43). Additionally, perceived barriers to physical activity were associated with obesity. The presence of supermarkets and specialty stores was consistently positively associated with meeting fruit and vegetable guidelines. CONCLUSIONS With relatively few studies in the literature focused on African Americans, more research is needed to draw conclusions on features of the built environment that are associated with physical activity, diet, and obesity.
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Affiliation(s)
- Sarah Stark Casagrande
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, Baltimore, Maryland, USA
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Hawe P, Potvin L. What is population health intervention research? CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2009; 100:Suppl I8-14. [PMID: 19263977 PMCID: PMC6973897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Population-level health interventions are policies or programs that shift the distribution of health risk by addressing the underlying social, economic and environmental conditions. These interventions might be programs or policies designed and developed in the health sector, but they are more likely to be in sectors elsewhere, such as education, housing or employment. Population health intervention research attempts to capture the value and differential effect of these interventions, the processes by which they bring about change and the contexts within which they work best. In health research, unhelpful distinctions maintained in the past between research and evaluation have retarded the development of knowledge and led to patchy evidence about policies and programs. Myths about what can and cannot be achieved within community-level intervention research have similarly held the field back. The pathway forward integrates systematic inquiry approaches from a variety of disciplines.
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Affiliation(s)
- Penelope Hawe
- Population Health Intervention Research Centre, University of Calgary, G012, 3330 Hospital Drive NW, Calgary, AB T2N 4N1.
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Baldwin SA, Stice E, Rohde P. Statistical analysis of group-administered intervention data: reanalysis of two randomized trials. Psychother Res 2008; 18:365-76. [PMID: 18815989 DOI: 10.1080/10503300701796992] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Group-administered interventions often create statistical dependencies, which, if ignored, increase the rate of Type I errors. The authors analyzed data from two randomized trials involving group interventions to document the impact of statistical dependency on tests of intervention effects and to provide estimates of statistical dependency. Intraclass correlations ranged from .02 to .12. Adjusting for dependencies increased p values for the tests of intervention effects. The increase in the p values depended on the magnitude of the statistical dependence and available degrees of freedom. Results suggest that the literature may overstate the efficacy of group interventions and imply that it will be important to study why groups create dependencies. The authors discuss how dependencies impact statistical power and how researchers can address this concern.
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Affiliation(s)
- Scott A Baldwin
- Department of Psychology, Brigham Young University, Provo, Utah 84602, USA.
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Allen JD, Stoddard AM, Sorensen G. Do social network characteristics predict mammography screening practices? HEALTH EDUCATION & BEHAVIOR 2008; 35:763-76. [PMID: 17620665 PMCID: PMC2859725 DOI: 10.1177/1090198107303251] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Many breast cancer outreach programs assume that dissemination of information through social networks and provision of social support will promote screening. The authors prospectively examined the relationship between social network characteristics and adherence to screening guidelines. METHOD Employed women age 40 years and older completed baseline and 2-year follow-up assessments (N=1,475) as part of an intervention trial. The authors modeled screening adherence at follow-up as a function of social network characteristics at baseline. RESULTS Baseline adherence explained most of the variation in adherence at follow-up. For women age 40 to 51 years, having a mammogram at follow-up was predicted by encouragement by family and/or friends and subjective norms at baseline (odds ratio=2.20 and 1.18, respectively). For women age 52 years and older, the perception that screening was normative was related to adherence at follow-up (odds ratio=1.46). CONCLUSIONS Previous mammography use is strongly predictive of future screening. Social network characteristics have a modest impact on screening. Outreach efforts should focus on those who have previously underutilized mammography.
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Can social capital be intentionally generated? A randomized trial from rural South Africa. Soc Sci Med 2008; 67:1559-70. [DOI: 10.1016/j.socscimed.2008.07.022] [Citation(s) in RCA: 152] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2007] [Indexed: 11/23/2022]
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Hamilton WL, Biener L, Brennan RT. Do local tobacco regulations influence perceived smoking norms? Evidence from adult and youth surveys in Massachusetts. HEALTH EDUCATION RESEARCH 2008; 23:709-722. [PMID: 17947246 PMCID: PMC2733799 DOI: 10.1093/her/cym054] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2007] [Accepted: 07/09/2007] [Indexed: 05/25/2023]
Abstract
Smoking behavior has been shown to be influenced by individuals' perceptions of social norms about smoking. This study examines whether local regulations regarding clean indoor air and youth access to tobacco are associated with residents' subsequent perceptions of smoking norms. Data came from Massachusetts surveys of adults and youths and from records of local tobacco control policies. Indices of perceived smoking norms were based on perceived smoking prevalence and perceived community acceptance of smoking. Multilevel models tested the association between perceived norms and the presence of strong local regulations in four policy domains (restaurant smoking bans, smoking restrictions in other venues, enforcement of laws prohibiting sales to youths and youth-oriented marketing restrictions). The model controlled for town voting results on a tobacco tax referendum, which served as a measure of antismoking sentiment pre-dating the regulations. Results showed that youths perceived community norms to be significantly more 'antismoking' if they lived in a town that had strong regulations in at least three of the four domains. For adults, having strong regulations in as few as one to two domains was associated with perceiving community norms to be significantly more antismoking. Implementing and publicizing local regulations may help shape perceptions of community smoking norms.
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Affiliation(s)
| | - Lois Biener
- Center for Survey Research, University of Massachusetts, Boston, MA 02125, USA
| | - Robert T. Brennan
- Department of Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA 02115
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The importance of context in understanding behavior and promoting health. Ann Behav Med 2008; 35:3-18. [PMID: 18347900 DOI: 10.1007/s12160-007-9001-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2007] [Indexed: 10/17/2022] Open
Abstract
Behavior, the roles of behavior in health, health promotion, health, quality of life, and death are all context-dependent. This paper begins with a review of behavioral and ecological models, emphasizing their shared emphasis on context. It then turns to genetics and the importance of contexts in understanding genetic influences. Jumping from genes to geography, it examines how spatial analysis provides both a model and framework for considering contextual influence. Continuing with analytic models, it returns to genetics, and considers how it provide models for integrating our understanding of broad social and community influences. The paper extends this thinking through multilevel analysis and proposes "analytic multilevel designs" as a way of studying "context focused interventions" (as opposed to context independent interventions for which conventional experimental designs are often well-suited). It closes with reflections on ways in which we cultivate and extend our knowledge base and on the intellectual contexts of positivism and postmodernism that surround behavioral and ecological thinking.
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Abstract
Well evaluated complex interventions are still needed
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Rogers EM, Peterson JC. Diffusion of clean indoor air ordinances in the southwestern United States. HEALTH EDUCATION & BEHAVIOR 2007; 35:683-97. [PMID: 17456855 DOI: 10.1177/1090198106296767] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors investigate the process through which clean indoor air ordinances were considered in 10 communities in the southwestern United States and key factors that influenced diffusion and adoption. Clean indoor air ordinances, which ban smoking in public places, were adopted in approximately 1,409 U.S. communities from 1986 to April 2004. The authors gathered data from 10 communities in New Mexico and Texas by means of face-to-face interview, e-mail, and telephone interviews and by analyzing archival materials. Important influences on the adoption or rejection of clean indoor air ordinances were (a) personal experiences of policy champions, (b) local framing of the ordinance as a public health issue versus as an economic/ business or an individual rights issue, and (c) interpersonal networks connecting a community to previously adopting communities. The policies that were adopted ranged in comprehensiveness, with each community of study reinventing model policies obtained from other communities.
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Affiliation(s)
- Everett M Rogers
- Department of Communication and Journalism, University of New Mexico, Albuquerque, USA
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Thompson B, Coronado G, Chen L, Islas I. Celebremos la salud! a community randomized trial of cancer prevention (United States). Cancer Causes Control 2006; 17:733-46. [PMID: 16633921 DOI: 10.1007/s10552-006-0006-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2005] [Accepted: 01/12/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Compared to non-Hispanic whites, Hispanics in the United States are at higher risk for certain types of cancer. METHODS In a randomized controlled trial of 20 communities, we examined whether a comprehensive intervention influenced cancer screening behaviors and lifestyle practices in rural communities in Eastern Washington State. Cross-sectional surveys at baseline and post-intervention included interviews with a random sample of approximately 100 households per community. The interview included questions on ever use and recent use of Pap test, mammogram, and fecal occult blood test (FOBT) and sigmoidoscopy/colonoscopy, fruit and vegetable consumption and smoking practices. RESULTS We found few significant changes in use of screening services for cervical (Pap test), breast (mammogram) or colorectal cancer (fecal occult blood test (FOBT) or sigmoidoscopy/colonoscopy) between intervention and control communities. We found no significant differences in fruit and vegetable consumption nor in smoking prevalence between the two groups. We found more awareness of and participation in intervention activities in the treatment communities than the control communities. CONCLUSIONS Our null findings might be attributable to the low dose of the intervention, a cohort effect, or contamination of the effect in non-intervention communities. Further research to identify effective strategies to improve cancer prevention lifestyle behaviors and screening practices are needed.
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Affiliation(s)
- Beti Thompson
- Cancer Prevention Research Program, Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N; M3-B232, P.O. Box 19024, Seattle, WA 98109, USA.
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Ebrahim S, Beswick A, Burke M, Davey Smith G. Multiple risk factor interventions for primary prevention of coronary heart disease. Cochrane Database Syst Rev 2006:CD001561. [PMID: 17054138 PMCID: PMC4160097 DOI: 10.1002/14651858.cd001561.pub2] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND Primary prevention programmes in many countries attempt to reduce mortality and morbidity due to coronary heart disease (CHD) through risk factor modification. It is widely believed that multiple risk factor intervention using counselling and educational methods is efficacious and cost-effective and should be expanded. Recent trials examining risk factor changes have cast considerable doubt on the effectiveness of these multiple risk factor interventions. OBJECTIVES To assess the effects of multiple risk factor intervention for reducing cardiovascular risk factors, total mortality, and mortality from CHD among adults without clinical evidence of established cardiovascular disease. SEARCH STRATEGY MEDLINE was searched for the original review to 1995. This was updated by searching the Cochrane Central Register of Controlled Trials on The Cochrane Library Issue 3 2001, MEDLINE (2000 to September 2001) and EMBASE (1998 to September 2001). SELECTION CRITERIA Intervention studies using counselling or education to modify more than one cardiovascular risk factor in adults from general populations, occupational groups, or high risk groups. Trials of less than 6 months duration were excluded. DATA COLLECTION AND ANALYSIS Data were extracted by two reviewers independently. Investigators were contacted to obtain missing information. MAIN RESULTS A total of 39 trials were found of which ten reported clinical event data. In the ten trials with clinical event end-points, the pooled odds ratios for total and CHD mortality were 0.96 (95% confidence intervals (CI) 0.92 to 1.01) and 0.96 (95% CI 0.89 to 1.04) respectively. Net changes in systolic and diastolic blood pressure, and blood cholesterol were (weighted mean differences) -3.6 mmHg (95% CI -3.9 to -3.3 mmHg), -2.8 mmHg (95% CI -2.9 to -2.6 mmHg) and -0.07 mMol/l (95% CI -0.8 to -0.06 mMol/l) respectively. Odds of reduction in smoking prevalence was 20% (95% CI 8% to 31%). Statistical heterogeneity between the studies with respect to mortality and risk factor changes was due to trials focusing on hypertensive participants and those using considerable amounts of drug treatment. AUTHORS' CONCLUSIONS The pooled effects suggest multiple risk factor intervention has no effect on mortality. However, a small, but potentially important, benefit of treatment (about a 10% reduction in CHD mortality) may have been missed. Risk factor changes were relatively modest, were related to the amount of pharmacological treatment used, and in some cases may have been over-estimated because of regression to the mean effects, lack of intention to treat analyses, habituation to blood pressure measurement, and use of self-reports of smoking. Interventions using personal or family counselling and education with or without pharmacological treatments appear to be more effective at achieving risk factor reduction and consequent reductions in mortality in high risk hypertensive populations. The evidence suggests that such interventions have limited utility in the general population.
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Affiliation(s)
- S Ebrahim
- London School of Hygiene & Tropical Medicine, Department of Epidemiology & Population Health, Keppel Street, London, UK.
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Abstract
AIM This paper outlines the difficulties in defining and evaluating a complex intervention and a number of currently available models for assisting this process are discussed. BACKGROUND Interventions aimed at producing change in the delivery and organization of healthcare services require rigorous evaluation to demonstrate their effectiveness. Evaluation poses difficulties, however, because these interventions are usually very complex. METHODS A framework developed by the United Kingdom Medical Research Council to evaluate complex interventions is described. The use of this framework in designing and evaluating a nurse-led intervention in intensive care for weaning patients from mechanical ventilation is discussed. Semi-structured interviews, a questionnaire survey and observational work were undertaken to define the components of the intervention, which was subsequently evaluated in an exploratory trial using a quasi-experimental design. CONCLUSION The framework was a useful tool and can be easily applied in developing and evaluating complex nursing interventions. Three key challenges emerge from this experience: (i) relevant research evidence should be used systematically in developing the components of the intervention, (ii) the definition and measurement of complex intervention outcomes needs to be improved and (iii) appropriate research designs must be used when evaluating complex interventions.
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Oakes JM. Commentary: advancing neighbourhood-effects research--selection, inferential support, and structural confounding. Int J Epidemiol 2006; 35:643-7. [PMID: 16556642 DOI: 10.1093/ije/dyl054] [Citation(s) in RCA: 82] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Michael Oakes
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN, USA.
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Glass TA, McAtee MJ. Behavioral science at the crossroads in public health: extending horizons, envisioning the future. Soc Sci Med 2005; 62:1650-71. [PMID: 16198467 DOI: 10.1016/j.socscimed.2005.08.044] [Citation(s) in RCA: 454] [Impact Index Per Article: 23.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2004] [Accepted: 08/11/2005] [Indexed: 12/26/2022]
Abstract
The social and behavioral sciences are at a crossroads in public health. In this paper, we attempt to describe a path toward the further integration of the natural and behavioral sciences with respect to the study of behavior and health. Three innovations are proposed. First, we extend and modify the "stream of causation" metaphor along two axes: time, and levels of nested systems of social and biological organization. Second, we address the question of whether 'upstream' features of social context are causes of disease, fundamental or otherwise. Finally, we propose the concept of a risk regulator to advance the study of behavior and health in populations. To illustrate the potential of these innovations, we develop a multilevel framework for the study of health behaviors and obesity in social and biological context.
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Affiliation(s)
- Thomas A Glass
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
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