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Baker RM, Ahmed M, Bertotti M, Cassidy J, Chipuriro R, Clewett E, Donaldson C, Elders A, Fenge LA, Fox J, Galway K, Gildea A, McGuinness A, McLean J, Manoukian S, Mason H, Morgan A, Mulholland J, O'Hare L, Paterson A, Porter S, Rendall J, Roy MJ, Seaman P, Simpson M, Steiner A, Kelly MP. Common health assets protocol: a mixed-methods, realist evaluation and economic appraisal of how community-led organisations (CLOs) impact on the health and well-being of people living in deprived areas. BMJ Open 2023; 13:e069979. [PMID: 36927592 PMCID: PMC10030928 DOI: 10.1136/bmjopen-2022-069979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION This research investigates how community-led organisations' (CLOs') use of assets-based approaches improves health and well-being, and how that might be different in different contexts. Assets-based approaches involve 'doing with' rather than 'doing to' and bring people in communities together to achieve positive change using their own knowledge, skills and experience. Some studies have shown that such approaches can have a positive effect on health and well-being. However, research is limited, and we know little about which approaches lead to which outcomes and how different contexts might affect success. METHODS AND ANALYSIS Using a realist approach, we will work with 15 CLOs based in disadvantaged communities in England, Scotland and Northern Ireland. A realist synthesis of review papers, and a policy analysis in different contexts, precedes qualitative interviews and workshops with stakeholders, to find out how CLOs' programmes work and identify existing data. We will explore participants' experiences through: a Q methodology study; participatory photography workshops; qualitative interviews and measure outcomes using a longitudinal survey, with 225 CLO participants, to assess impact for people who connect with the CLOs. An economic analysis will estimate costs and benefits to participants, for different contexts and mechanisms. A 'Lived Experience Panel' of people connected with our CLOs as participants or volunteers, will ensure the appropriateness of the research, interpretation and reporting of findings. ETHICS AND DISSEMINATION This project, research tools and consent processes have been approved by the Glasgow Caledonian University School of Health and Life Sciences Ethics Committee, and affirmed by Ethics Committees at Bournemouth University, Queen's University Belfast and the University of East London. Common Health Assets does not involve any National Health Service sites, staff or patients.Findings will be presented through social media, project website, blogs, policy briefings, journal articles, conferences and visually in short digital stories, and photographic exhibitions.
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Affiliation(s)
- Rachel Mairi Baker
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | | | - Marcello Bertotti
- Institute for Connected Communities, University of East London, London, UK
| | - John Cassidy
- Scottish Communities for Health and Wellbeing, Glasgow, UK
| | - Rejoice Chipuriro
- Department of Social Sciences and Social Work, Bournemouth University, Poole, UK
| | - Emma Clewett
- Institute for Connected Communities, University of East London, London, UK
| | - Cam Donaldson
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Andrew Elders
- NMAHP Research Unit, Glasgow Caledonian University School of Health and Life Sciences, Glasgow, UK
| | - Lee Ann Fenge
- Department of Social Sciences and Social Work, Bournemouth University, Poole, UK
| | - Julie Fox
- Annexe Communities Glasgow, Glasgow, UK
| | - Karen Galway
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Aideen Gildea
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | | | - Sarkis Manoukian
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Antony Morgan
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Jill Mulholland
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Liam O'Hare
- Innovation Zones, School of Social Science, Education and Social Work, Queen's University Belfast, Belfast, UK
| | | | - Sam Porter
- Department of Social Sciences and Social Work, Bournemouth University, Poole, UK
| | - Jack Rendall
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Michael J Roy
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Peter Seaman
- Glasgow Centre for Population Health, Glasgow, UK
| | | | - Artur Steiner
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Michael P Kelly
- Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Wheat S, Gaughen S, Skeet J, Campbell L, Donatuto J, Schaeffer J, Sorensen C. Climate change and COVID-19: Assessing the vulnerability and resilience of U.S. Indigenous communities to syndemic crises. THE JOURNAL OF CLIMATE CHANGE AND HEALTH 2022; 8:100148. [PMID: 35722027 PMCID: PMC9197810 DOI: 10.1016/j.joclim.2022.100148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 06/06/2022] [Indexed: 06/15/2023]
Abstract
The rapid emergence of the COVID-19 pandemic and the insidiously evolving climate crisis represent two of the most pressing public health threats to Indigenous Peoples in the United States. Understanding the ways in which these syndemics uniquely impact Indigenous Peoples, given the existing health disparities for such communities, is essential if we are to address modifiable root causes of health vulnerability and devise effective and equitable strategies to protect and improve health in the evolving climate landscape. We explore the compounding burden of the COVID-19 pandemic and climate change on Indigenous Peoples' health, and present several case studies which outline novel Indigenous approaches and perspectives that address climate change, COVID-19 and future health threats.
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Affiliation(s)
- Stefan Wheat
- Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Shasta Gaughen
- Pala Environmental Department, Director and Tribal Historic Preservation Officer, Pala Band of Mission Indians, Pala, CA, USA
| | - James Skeet
- Covenant Pathways, Navajo Nation, Vanderwagen, NM, USA
| | - Larry Campbell
- Swinomish Community Environmental Health Program, Swinomish Indian Tribal Community, WA, USA
| | - Jamie Donatuto
- Swinomish Community Environmental Health Program, Swinomish Indian Tribal Community, WA, USA
| | - Jacqualine Schaeffer
- Community Environment and Health, Division of Environmental Health and Engineering, Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Cecilia Sorensen
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
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Santos ACPDO, Camargo CLD, Vargas MADO. Hospital structure elements demarcating (in)visibilities of institutional violence against children. Rev Bras Enferm 2022; 75:e20200785. [PMID: 35043933 DOI: 10.1590/0034-7167-2020-0785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/05/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to analyze the hospital structure elements that demarcate (in)visibilities of institutional violence in hospitalized children. METHODS this is a descriptive-exploratory qualitative study that used approaches with Foucault's thinking. Ten companions and 39 healthcare professionals from a university hospital in Salvador, Bahia participated. Data collection took place from November 2018 to June 2019 through semi-structured interviews. The discourse analysis method was used. The study was approved by the Institutional Review Board. RESULTS institutional violence was understood in the violations and invisibilities of the structure of health services through the problems: in infrastructure (physical structure, lack of human and material resources, scrapping of equipment); administrative and management; pilgrimage. FINAL CONSIDERATIONS it is necessary to realize the invisibilities of the infrastructure to act in confronting institutional violence to hospitalized children.
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Peters LER, Shannon G, Kelman I, Meriläinen E. Toward resourcefulness: pathways for community positive health. Glob Health Promot 2021; 29:5-13. [PMID: 34806465 DOI: 10.1177/17579759211051370] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Communities are powerful and necessary agents for defining and pursuing their health, but outside organizations often adopt community health promotion approaches that are patronizing and top-down. Conversely, bottom-up approaches that build on and mobilize community health assets are often critiqued for tasking the most vulnerable and marginalized communities to use their own limited resources without real opportunities for change. Taking into consideration these community health promotion shortcomings, this article asks how communities may be most effectively and appropriately supported in pursuing their health. This article reviews how community health is understood, moving from negative to positive conceptualizations; how it is determined, moving from a risk-factor orientation to social determination; and how it is promoted, moving from top-down to bottom-up approaches. Building on these understandings, we offer the concept of 'resourcefulness' as an approach to strengthen positive health for communities, and we discuss how it engages with three interrelated tensions in community health promotion: resources and sustainability, interdependence and autonomy, and community diversity and inclusion. We make practical suggestions for outside organizations to apply resourcefulness as a process-based, place-based, and relational approach to community health promotion, arguing that resourcefulness can forge new pathways to sustainable and self-sustaining community positive health.
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Affiliation(s)
- Laura E R Peters
- Institute for Risk and Disaster Reduction, University College London, London, UK.,Institute for Global Health, University College London, London, UK.,College of Earth, Ocean, and Atmospheric Sciences, Oregon State University, Corvallis, OR, USA.,Stema Health Systems, London, UK
| | - Geordan Shannon
- Institute for Global Health, University College London, London, UK
| | - Ilan Kelman
- Institute for Risk and Disaster Reduction, University College London, London, UK.,Institute for Global Health, University College London, London, UK.,University of Agder, Kristiansand, Norway
| | - Eija Meriläinen
- Institute for Risk and Disaster Reduction, University College London, London, UK.,Institute for Global Health, University College London, London, UK
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5
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Chen H, Gao J, Dai J, Mao Y, Wang Y, Chen S, Xiao Q, Jia Y, Zheng P, Fu H. Generalized anxiety disorder and resilience during the COVID-19 pandemic: evidence from China during the early rapid outbreak. BMC Public Health 2021; 21:1830. [PMID: 34627208 PMCID: PMC8502085 DOI: 10.1186/s12889-021-11877-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 09/28/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Generalized Anxiety Disorder (GAD) is a common but urgent mental health problem during disease outbreaks. Resilience buffers against the negative impacts of life stressors on common internalizing psychopathology such as GAD. This study assesses the prevalence of GAD and examines the protective or compensatory effect of resilience against worry factors during the COVID-19 outbreak. METHODS A cross-sectional online survey was conducted among Chinese citizens aged ≥18 years from January 31 to February 2, 2020. A total of 4827 participants across 31 provinces and autonomous regions of the mainland of China participated in this study. The Generalized Anxiety Disorder scale (GAD-7), the Connor-Davidson Resilience Scale (CD-RISC), and a self-designed worry questionnaire were used to asses anxiety disorder prevalence, resilience level, and anxiety risk factors. Multivariable logistic regression was used to identify the associations of resilience and worry factors with GAD prevalence after controlling for other covariates. RESULTS The prevalence of anxiety disorder was 22.6% across the 31 areas, and the highest prevalence was 35.4% in Hubei province. After controlling for covariates, the results suggested a higher GAD prevalence among participants who were worried about themselves or family members being infected with COVID-19 (adjusted odds ratio, AOR 3.40, 95%CI 2.43-4.75), worried about difficulty obtaining masks (AOR 1.92, 95%CI 1.47-2.50), worried about difficulty of distinguishing true information (AOR 1.65, 95%CI 1.36-2.02), worried about the prognosis of COVID-19 (AOR 2.41, 95%CI 1.75-3.33), worried about delays in working (AOR 1.71, 95%CI 1.27-.31), or worried about decreased income (AOR 1.45, 95%CI 1.14-1.85) compared with those without such worries. Additionally, those with a higher resilience level had a lower prevalence of GAD (AOR 0.59, 95%CI 0.51-0.70). Resilience also showed a mediating effect, with a negative influence on worry factors and thereby a negative association with GAD prevalence. CONCLUSION It may be beneficial to promote public mental health during the COVID-19 outbreak through enhancing resilience, which may buffer against adverse psychological effects from worry factors.
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Affiliation(s)
- Hao Chen
- Preventive Medicine and Health Education Department, School of Public Health, Fudan University, No.138 Yixueyuan Road, Shanghai, 200032, P.R. China
| | - Junling Gao
- Preventive Medicine and Health Education Department, School of Public Health, Fudan University, No.138 Yixueyuan Road, Shanghai, 200032, P.R. China
| | - Junming Dai
- Preventive Medicine and Health Education Department, School of Public Health, Fudan University, No.138 Yixueyuan Road, Shanghai, 200032, P.R. China
| | - Yimeng Mao
- Preventive Medicine and Health Education Department, School of Public Health, Fudan University, No.138 Yixueyuan Road, Shanghai, 200032, P.R. China
| | - Yi Wang
- Preventive Medicine and Health Education Department, School of Public Health, Fudan University, No.138 Yixueyuan Road, Shanghai, 200032, P.R. China
| | - Suhong Chen
- Preventive Medicine and Health Education Department, School of Public Health, Fudan University, No.138 Yixueyuan Road, Shanghai, 200032, P.R. China
| | - Qianyi Xiao
- Preventive Medicine and Health Education Department, School of Public Health, Fudan University, No.138 Yixueyuan Road, Shanghai, 200032, P.R. China
| | - Yingnan Jia
- Preventive Medicine and Health Education Department, School of Public Health, Fudan University, No.138 Yixueyuan Road, Shanghai, 200032, P.R. China
| | - Pinpin Zheng
- Preventive Medicine and Health Education Department, School of Public Health, Fudan University, No.138 Yixueyuan Road, Shanghai, 200032, P.R. China
| | - Hua Fu
- Preventive Medicine and Health Education Department, School of Public Health, Fudan University, No.138 Yixueyuan Road, Shanghai, 200032, P.R. China.
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Peters LER, Kelman I, Shannon G, Tan D. Synthesising the shifting terminology of community health: A critiquing review of agent-based approaches. Glob Public Health 2021; 17:1492-1506. [PMID: 34097587 DOI: 10.1080/17441692.2021.1938169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The field of community health promotion encompasses a wide range of approaches, including bottom-up approaches that recognise and build on the agency and strengths of communities to define and pursue their health goals. Momentum towards agent-based approaches to community health promotion has grown in recent years, and several related but distinct conceptual and methodological bodies of work have developed largely in isolation from each other. The lack of a cohesive collection of research, practice, and policy has made it difficult to learn from the innovations, best practices, and shortcomings of these approaches, which is exacerbated by the imprecise and inconsistent use of related terms. This article provides a review of three agent-based approaches to promoting community health: asset-based approaches, capacity building, and capabilities approaches, noting the theoretical origins and fundamental concepts, applications and methodologies, and limitations and critiques of each. This article discusses their commonalities and differences in terms of how they conceptualise and approach the promotion of community health, including a critical consideration of their limitations and where they may prove to be counterproductive. This article argues that agent-based approaches to community health must be met with meaningful opportunities to disengage from the structures that constrain their health.
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Affiliation(s)
- Laura E R Peters
- Institute for Risk and Disaster Reduction, University College London, London, UK.,Institute for Global Health, University College London, London, UK.,College of Earth, Ocean, and Atmospheric Sciences, Oregon State University, Corvallis, OR, USA.,Stema Health Systems, London, UK
| | - Ilan Kelman
- Institute for Risk and Disaster Reduction, University College London, London, UK.,Institute for Global Health, University College London, London, UK.,University of Agder, Kristiansand, Norway
| | - Geordan Shannon
- Institute for Global Health, University College London, London, UK.,Stema Health Systems, London, UK
| | - Des Tan
- Stema Health Systems, London, UK
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Lorne C, Coleman A, McDonald R, Walshe K. Assembling the Healthopolis: Competitive city-regionalism and policy boosterism pushing Greater Manchester further, faster. TRANSACTIONS (INSTITUTE OF BRITISH GEOGRAPHERS : 1965) 2021; 46:314-329. [PMID: 34262224 PMCID: PMC8252707 DOI: 10.1111/tran.12421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/10/2020] [Indexed: 06/13/2023]
Abstract
Health and care policy is increasingly promoted within visions of the competitive city-region. This paper examines the importance of policy boosterism within the political construction of city-regions in the context of English devolution. Based on a two-year case study of health and social care devolution in Greater Manchester, England, we trace the relational and territorial geographies of policy across and through new "devolved" city-regional arrangements. Contributing to geographical debates on policy assemblages and city-regionalism, we advance a conceptual framework linking crisis and opportunity, emulation and exceptionalism, and evidence and experimentation. The paper makes two key contributions. First, we argue health and care policy is increasingly drawn towards the logic of global competitiveness without being wholly defined by neoliberal political agendas. Fostering transnational policy networks helped embed global "best practice" policies while simultaneously hailing Greater Manchester as a place beyond compare. Second, we caution against positioning the city-region solely at the receiving end of devolutionary austerity. Rather, we illustrate how the urgency of devolution was conditioned by crisis, yet concomitantly framed as a unique opportunity by the local state harnessing policy to negotiate a more fluid politics of scale. In doing so, the paper demonstrates how attempts to resolve the "local problem" of governing health and care under austerity were rearticulated as a "global opportunity" to forge new connections between place, health, and economy. Consequently, we foreground the multiple tensions and contradictions accumulating through turning to health and care to push Greater Manchester further, faster. The paper concludes by asking what the present crisis might mean for city-regions in good health and turbulent times.
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Affiliation(s)
- Colin Lorne
- Geography, Faculty of Arts and Social SciencesThe Open UniversityMilton KeynesUK
| | - Anna Coleman
- Division of Population Health, Health Services Research and Primary CareUniversity of ManchesterManchesterUK
| | - Ruth McDonald
- Alliance Manchester Business SchoolUniversity of ManchesterManchesterUK
| | - Kieran Walshe
- Alliance Manchester Business SchoolUniversity of ManchesterManchesterUK
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Morrison J, Arjyal A. A funfair without the candy floss: engaging communities to prevent diabetes in Nepal. Public Health 2021; 193:23-25. [PMID: 33711779 PMCID: PMC8128096 DOI: 10.1016/j.puhe.2021.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 12/08/2020] [Accepted: 01/15/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The World Health Organization estimates that 422 million people have diabetes, three-quarters of whom live in low- and middle-income countries. Global action plans to address non-communicable diseases (NCDs) recognise the centrality of community engagement to create an enabling environment within which to address risk factors. STUDY DESIGN In this article, we describe and critically reflect on a cocreated community engagement approach to address type 2 diabetes in the southern plains of Nepal. We coproduced the engagement approach with 40 artists from the Janakpur Women's Development Centre to create an environment for dialogue about diabetes and NCD risk between artists and the general public. METHODS We used participatory action research to produce contextually relevant interactive methods and materials. Methods included artists' peer research to inform creative workshops, a drama performed in 19 villages and a two-day funfair in a public park. We used qualitative and participatory methods to analyse the effect of this engagement and reflect on lessons learned. RESULTS Around 2000 people saw the drama, and around 4000 people attended the funfair. Community dialogue about prevention of diabetes was facilitated by drama and through games and songs at the funfair. Artists grew confident to interact with their peers and drama audiences about the causes of diabetes and prevention strategies. Despite crowds at the funfair, it was difficult to reach women because the venue was often used by men and boys, and patriarchal norms prevent women from free movement. Village interactions were able to engage a more mixed audience. CONCLUSION Innovative, asset-based community engagement about diabetes and other NCDs at scale is possible through locating, building on and strengthening community resources to address local health issues. Engagement could be enhanced by considering the gendered nature of community engagement spaces and by increasing opportunities for interaction between artists and the general public through more intimate and large-scale events.
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Affiliation(s)
- J Morrison
- University College London, Institute of Global Health, London, UK.
| | - A Arjyal
- Herd International, Thapathali, Kathmandu, Nepal
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Abstract
Market incentives in capitalist economies and public health requirements are contradictory. In the COVID-19 pandemic, market-rewarded self-interested behavior has been exposed as a source of mortality and morbidity. Profit-motivated behaviors can keep people from accessing necessities for health thereby harming individuals and possibly damaging population health. The profit motive can also undermine healthcare system capacity by maldistributing goods that are inputs to healthcare. Furthermore, because profit-seeking is economically rational in capitalism, capitalist imperatives may be incompatible with public health. The ways markets misallocate resources provide a rationale for state responsibility for health, which is a public good.
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Affiliation(s)
- Jennifer Cohen
- Department of Global and Intercultural Studies, Miami University, Ezintsha, Wits Reproductive Health and HIV Institute, Faculty of Health Sciences, University of the Witwatersrand
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Estacio EV, Nathan L, Protheroe J. Celebrating the health literacy skills of parents: A photovoice study. J Health Psychol 2020. [PMID: 29534617 DOI: 10.1177/1359105318763494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Parents play a vital role in promoting children's health. The parental health literacy skills are important since the decisions they make can have an impact on other family members' health and well-being. Using an assets-based approach, this project aimed to explore the skills parents use to communicate health messages with their children and how they manage their family's health. Six adult parents of children aged 0-16 years old took part in this photovoice study. The thematic analysis suggests that tapping into the creativity of parents through the gamification of health messages and encouraging children's independence are effective ways to promote healthy behaviors. Trusting their instincts and developing good relationships with healthcare providers were also seen as important. However, there is still a need to improve confidence and skills, particularly on how to critically appraise information, especially in this digital age where sources of information are vast and conflicting messages could arise.
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Jatho A, Mugisha NM, Kafeero J, Holoya G, Okuku F, Niyonzima N. Mobile cancer prevention and early detection outreach in Uganda: Partnering with communities toward bridging the cancer health disparities through "asset-based community development model". Cancer Med 2020; 9:7317-7329. [PMID: 32810394 PMCID: PMC7541131 DOI: 10.1002/cam4.3387] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/26/2020] [Accepted: 07/27/2020] [Indexed: 12/28/2022] Open
Abstract
Background Communities in low‐income countries are characterized by limited access to cancer prevention and early detection services, even for the commonest types of cancer. Limited resources for cancer control are one of the contributors to cancer health disparities. We explored the feasibility and benefit of conducting outreaches in partnership with local communities using the “asset‐based community development (ABCD)” model. Methods We analyzed the quarterly Uganda cancer institute (UCI) community outreach cancer health education and screening output reported secondary data without individual identifiers from July 2016 to June 2019 to compare the UCI‐hospital‐based and community outreach cancer awareness and screening services based on the ABCD model. Results From July 2016 to June 2019, we worked with 107 local partners and conducted 151 outreaches. Of the total number of people who attended cancer health education sessions, 201 568 (77.9%) were reached through outreaches. Ninety‐two (95%) cancer awareness TVs and radio talk‐shows conducted were sponsored by local partners. Of the total people screened; 22 795 (63.0%) cervical, 22 014 (64.4%) breast, and 4904 (38.7%) prostate screening were reached through community outreach model. The screen‐positive rates were higher in hospital‐based screening except for Prostate screening; cervical, 8.8%, breast, 8.4%, prostate, 7.1% than in outreaches; cervical, 3.2%, breast, 2.2%, prostate, 8.2%. Of the screened positive clients who were eligible for precancer treatment like cryotherapy for treatment of precervical cancer lesions, thousands‐folds monetary value and productive life saved relative to the market cost of cancer treatment and survival rate in Uganda. When the total number of clients screened for cervical, breast, and prostate cancer are subjected to the incremental cost of specific screening, a greater portion (98.7%) of the outreach cost was absorbed through community partnership. Conclusions Outreaching and working in collaboration with communities as partners through asset‐based community development model are feasible and help in cost‐sharing and leverage for scarce resources to promote primary prevention and early detection of cancer. This could contribute to bridging the cancer health disparities in the target populations.
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Affiliation(s)
- Alfred Jatho
- National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea.,Uganda Cancer Institute, Kampala, Uganda
| | | | | | | | - Fred Okuku
- Uganda Cancer Institute, Kampala, Uganda
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Mackenzie M, Skivington K, Fergie G. "The state They're in": Unpicking fantasy paradigms of health improvement interventions as tools for addressing health inequalities. Soc Sci Med 2020; 256:113047. [PMID: 32460096 PMCID: PMC7306155 DOI: 10.1016/j.socscimed.2020.113047] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 11/24/2022]
Abstract
Globally, it is recognised that the fundamental causes of iniquitous health outcomes lie within unequal distributions of wealth and power. Internationally, however, policies and interventions persist in individualising the inequalities problem and targeting individual behaviours as the main solution. This approach has been argued to represent 'Fantasy Paradigms'. This paper explores one example of such 'Fantasy' intervention from the perspective of health practitioners. Further, it explores opportunities for deepening practitioner understandings of the socio-political determination of health. Data were collected through in-depth interviews with 47 professionals involved in delivering a social prescribing programme in poor areas of Glasgow, Scotland. Data were analysed thematically across and within transcripts. Narratives highlighted different explanatory types concerning how the intervention could tackle health inequalities including: firm commitment to individualised approaches; hopeful pessimism; the social-determinants-of-health as an unpoliticised and nondeterministic backdrop to poor health; and finally, incomplete understanding of the social gradient as a population concept. Disrupted narratives of the social determination of health were also evident. This paper contributes new insights to existing debates on health inequalities discourse. These are conceptually important and identify opportunities for sharpening practitioner understanding of the social determinants of health which could in turn contribute to better, non-stigmatising primary care. It argues that re-engaging communities of practice with what is meant by determination of health is necessary and that there is a need to de-couple the policy aim of reducing health inequalities from the delivery of structurally competent and equality-focused public services.
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Affiliation(s)
- Mhairi Mackenzie
- Urban Studies, School of Social & Political Sciences, University of Glasgow, 27 Bute Gardens, Glasgow, G12 8RS, Scotland, UK.
| | - Kathryn Skivington
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, UK
| | - Gillian Fergie
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, UK
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Agdal R, Midtgård IH, Meidell V. Can Asset-Based Community Development with Children and Youth Enhance the Level of Participation in Health Promotion Projects? A Qualitative Meta-Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16193778. [PMID: 31597340 PMCID: PMC6801434 DOI: 10.3390/ijerph16193778] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/13/2019] [Accepted: 09/25/2019] [Indexed: 11/16/2022]
Abstract
The asset-based community development (ABCD) approach have been widely used to map local assets and to ensure participation of local communities in public health promotion strategies. Participatory practices, such as ABCD, have been applied to shift public health strategies towards addressing health inequities. In this meta-synthesis, we ask if, and how, ABCD enhance the level of participation for children, youth and schools. Three thousand eight hundred eight titles and abstracts were identified in ten databases and transferred to the online program Rayyan. Through a blinded process we excluded texts that did not meet the inclusion criteria. The twelve included texts on ABCD for children, youth and schools are of varying quality. The research on ABCD for children, youth and schools have not been cumulative. Nevertheless, the texts show that ABCD provides strategies that enhance the participation of children, youth, and schools, in health promotion projects. The projects were categorized according to Robert Hart’s classical participation ladder, and we found that the projects with the highest level of adherence to ABCD principles also had the highest level of participation. The projects with high levels of participation were supported by adult facilitators that created learning environments where children and youth developed their participatory skills.
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Affiliation(s)
- Rita Agdal
- Western Norway University of Applied Sciences, 7030, 5020 Bergen, Norway.
| | | | - Vigdis Meidell
- Western Norway University of Applied Sciences, 7030, 5020 Bergen, Norway.
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Miranda DE, Garcia-Ramirez M, Balcazar FE, Suarez-Balcazar Y. A Community-Based Participatory Action Research for Roma Health Justice in a Deprived District in Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3722. [PMID: 31581695 PMCID: PMC6801624 DOI: 10.3390/ijerph16193722] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/28/2019] [Accepted: 09/30/2019] [Indexed: 11/29/2022]
Abstract
Addressing health disparities and promoting health equity for Roma has been a challenge. The Roma are the largest disadvantaged ethnic minority population in Europe and have been the victims of deep social and economic injustices, institutional discrimination, and structural antigypsyism over many centuries. This has resulted in a much worse health status than their non-Roma counterparts. Current strategies based on ameliorative and top-down approaches to service delivery have resulted in paradoxical effects that solidify health disparities, since they do not effectively address the problems of vulnerable Roma groups. Following a health justice approach, we present a community-based participatory action research case study generated by a community and university partnership intended to address power imbalances and build collaboration among local stakeholders. This case study involved a group of health providers, Roma residents, researchers, Roma community organizations, and other stakeholders in the Poligono Sur, a neighborhood of Seville, Spain. The case study comprises four phases: (1) identifying Roma health assets, (2) empowering Roma community through sociopolitical awareness, (3) promoting alliances between Roma and community resources/institutions, and (4) building a common agenda for promoting Roma health justice. We highlighted best practices for developing processes to influence Roma health equity in local health policy agendas.
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Affiliation(s)
- Daniela E Miranda
- CESPYD, Coalition for the Study of Health, Power and Diversity, Department of Social Psychology, Universidad de Sevilla, Seville 41018, Spain.
| | - Manuel Garcia-Ramirez
- CESPYD, Coalition for the Study of Health, Power and Diversity, Department of Social Psychology, Universidad de Sevilla, Seville 41018, Spain.
| | - Fabricio E Balcazar
- Department of Disability and Human Development, University of Illinois at Chicago, Chicago, IL 60608, USA.
| | - Yolanda Suarez-Balcazar
- Department of Occupational Therapy, University of Illinois at Chicago, Chicago, Il 60612, USA.
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Tomalin E, Sadgrove J, Summers R. Health, faith and therapeutic landscapes: Places of worship as Black, Asian and Minority Ethnic (BAME) public health settings in the United Kingdom. Soc Sci Med 2019; 230:57-65. [PMID: 30965184 DOI: 10.1016/j.socscimed.2019.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 02/17/2019] [Accepted: 03/05/2019] [Indexed: 11/29/2022]
Abstract
Within the United Kingdom, there is evidence that faith-based affiliations, ideas, actors and organisations play a role in public health (PH) that has been neither properly recognised nor integrated into mainstream health systems (November, 2014). Discourses on faith and improving health outcomes have been particularly focused on 'seldom heard' groups, including 'Black, Asian and Minority Ethnic' (BAME) communities (November, 2014; Jain, 2014; Burton et al., 2017; Muhammad, 2018). In this paper we first present findings from a qualitative scoping study carried out in the UK cities of Leeds and Bradford, between 2014 and 2015, which examined Places of Worship (PWs) as BAME PH settings. We carried out 19 semi-structured interviews with purposively selected respondents, and three focus groups. Second, we develop a theory that originates from one in the sub-discipline of 'health geography' concerned with 'therapeutic landscapes', applying it to our research findings on PWs as BAME PH settings. The paper argues for the recentring of religion and faith settings back into the therapeutic landscapes literature, reflecting evidence that faith-based affiliations, ideas, actors and organisations are relevant to the pursuit of health and wellbeing. We also contend that a therapeutic landscapes framework provides a way of making the health relevance of PWs visible to both health practitioners and to members of PWs. We argue that PWs act as therapeutic places (i.e. specific transformative sacred sites) as well as therapeutic spaces (i.e. settings that provide adjuncts to formal PH promotion services), and are often part of therapeutic networks included in 'kinship groups and networks of care provided by family, friends, therapists and other agents of support' (Smyth, 2005: 490). This approach allows us to see how influences on health behaviour are not just confined to biomedical settings, but that the 'healing process works itself out in places (or situations, locales, settings and milieus)' (Gesler, 1992: 743).
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Affiliation(s)
- Emma Tomalin
- School of Philosophy, Religion and History of Science, University of Leeds, Leeds, LS2 9JT, UK.
| | - Joanna Sadgrove
- School of Philosophy, Religion and History of Science, University of Leeds, Leeds, LS2 9JT, UK.
| | - Roxana Summers
- Former BME Health Improvement Specialist, The Office of the Director of Public Health, Leeds City Council, Technorth, 9 Harrogate Road, LS7 3NB, UK.
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Abstract
OBJECTIVE To provide an up-to-date overview of health assets in a global context both from a theoretical perspective and its practical applications to address health inequalities and achieve sustainable health. DESIGN A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. DATA SOURCES A comprehensive search, including 10 electronic bibliographic databases and hand searches, was undertaken to capture the wide range of terms associated with 'health assets' and 'asset-based approaches to health'. ELIGIBILITY CRITERIA Any peer-reviewed published and grey literature in English related to 'health assets' or 'assets' in a 'health' context was included without any date, country or study design restrictions and the quality of evidence was appraised according to the Oxford Level of Evidence. OUTCOMES A broad consideration of all outcome measures including clinical outcomes, patient-level, community-level and population-level impacts and costs, was adopted. RESULTS 478 publications were included. Health assets were researched in 40 countries, predominantly in the West such as the USA and the UK. A number of broad health assets were identified including community and individual assets. Even though research was conducted in a number of different settings, most occurred in the community, clinical, care or educational settings. A wide variety of interventions and approaches were implemented, most commonly related to education and/or training, asset mapping or asset approaches. CONCLUSIONS Globally, authors most often referred to general 'health assets', 'assets' or some form of 'community asset' in relation to health. Overall, the idea of health assets is framed within a positive paradigm focusing on health creation rather than curative approaches. The sustained credibility of the global 'health assets' literature depends on future research on definitional, theoretical and evaluative issues in order to convince policy-makers and service commissioners of its necessity and added value to the traditional deficit approach.
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Affiliation(s)
- Tine Van Bortel
- Institute for Health and Human Development, University of East London, London, UK
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Nuwan Darshana Wickramasinghe
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
- Department of Community Medicine, Rajarata University of Sri Lanka Faculty of Medicine and Allied Sciences, Saliyapura, Sri Lanka
| | - Antony Morgan
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, London, UK
| | - Steven Martin
- Institute for Health and Human Development, University of East London, London, UK
- Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK
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de Andrade M, Angelova N. Evaluating and evidencing asset-based approaches and co-production in health inequalities: measuring the unmeasurable? CRITICAL PUBLIC HEALTH 2018. [DOI: 10.1080/09581596.2018.1541229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Marisa de Andrade
- School of Health in Social Science, Counselling, Psychotherapy and Applied Social Sciences (CPASS), University of Edinburgh, Edinburgh, UK
- UK Centre for Tobacco and Alcohol Studies (UKCTAS), UK
- Group for Research on Inequalities and Tobacco (GRIT), University of Edinburgh, Edinburgh, UK
- Centre for Creative-Relational Inquiry (CCRI), University of Edinburgh, Edinburgh, UK
| | - Nikolina Angelova
- School of Health in Social Science, Counselling, Psychotherapy and Applied Social Sciences (CPASS), University of Edinburgh, Edinburgh, UK
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Social enterprises and public health improvement in England: a qualitative case study. Public Health 2018; 161:99-105. [PMID: 29940430 DOI: 10.1016/j.puhe.2018.04.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/29/2018] [Accepted: 04/30/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To explore the contribution of social enterprises to publicly commissioned public health improvement and assess the risks and benefits of their role. STUDY DESIGN Qualitative case study of four south London boroughs. METHODS Documentary research; in-depth interviews with 19 key informants. RESULTS This study identified 24 social enterprises that were currently commissioned to contribute to public health improvement. These organisations ranged in size, longevity, and structure. They were widely reported as flexible and able to rapidly develop services responsive to local community needs. Their work often addressed upstream health determinants. However, to capitalise on securing contracts, they had to bureaucratise and establish provider alliances, which risked losing the very characteristics that make them unique. Social enterprises bore the financial risk of innovative service developments. Emerging mixed economies of public health were fragmented, limiting commissioners' abilities to plan strategically and evaluate the impact. CONCLUSIONS Social enterprises have an increasing role in providing potential solutions to intractable health improvement challenges, contributing to a broader vision around upstream action for health. However, the fragmentation and growing outsourcing of public health has risks for coherent and equitable service planning.
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de Andrade M. Measuring Humanity: hip-hop as evidence for health inequalities. Lancet 2018; 391:1340-1341. [PMID: 29636261 DOI: 10.1016/s0140-6736(18)30575-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 02/26/2018] [Indexed: 01/13/2023]
Affiliation(s)
- Marisa de Andrade
- Centre for Creative-Relational Inquiry, School of Health in Social Science, Counselling, Psychotherapy and Applied Social Sciences, University of Edinburgh, Edinburgh EH8 9AG, UK.
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Theorising lifestyle drift in health promotion: explaining community and voluntary sector engagement practices in disadvantaged areas. CRITICAL PUBLIC HEALTH 2017. [DOI: 10.1080/09581596.2017.1356909] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Roy MJ, Baker R, Kerr S. Conceptualising the public health role of actors operating outside of formal health systems: The case of social enterprise. Soc Sci Med 2017; 172:144-152. [PMID: 27842999 PMCID: PMC5223783 DOI: 10.1016/j.socscimed.2016.11.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Revised: 09/14/2016] [Accepted: 11/07/2016] [Indexed: 10/31/2022]
Abstract
This paper focuses on the role of actors that operate outside formal health systems, but nevertheless have a vital, if often under-recognised, role in supporting public health. The specific example used is the 'social enterprise', an organisation that seeks, through trading, to maximise social returns, rather than the distribution of profits to shareholders or owners. In this paper we advance empirical and theoretical understanding of the causal pathways at work in social enterprises, by considering them as a particularly complex form of public health 'intervention'. Data were generated through qualitative, in depth, semi-structured interviews and a focus group discussion, with a purposive, maximum variation sample of social enterprise practitioners (n = 13) in an urban setting in the west of Scotland. A method of analysis inspired by critical realism - Causation Coding - enabled the identification of a range of explanatory mechanisms and potential pathways of causation between engagement in social enterprise-led activity and various outcomes, which have been grouped into physical health, mental health and social determinants. The findings then informed the construction of an empirically-informed conceptual model to act as a platform upon which to develop a future research agenda. The results of this work are considered to not only encourage a broader and more imaginative consideration of what actually constitutes a public health intervention, but also reinforces arguments that actors within the Third Sector have an important role to play in addressing contemporary and future public health challenges.
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Affiliation(s)
- Michael J Roy
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK; Glasgow School for Business and Society, Glasgow Caledonian University, Glasgow, UK.
| | - Rachel Baker
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Susan Kerr
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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