The service-education linkage: implications for family practice residency programs and community and migrant health centers

INTRODUCTION: Access to quality primary health care for our country's underserved populations is a challenge for both the government and physicians. The Division of Medicine, through funding priorities and other initiatives, is encouraging family practice educators to train residents and students for work in community and migrant health centers (C/MHCs) in underserved areas. The objective of this research was to study linkages between family practice residency programs and C/MHCs and determine the reasons for affiliation, disadvantages and advantages, predictors of successful linkages, and common errors in the linkage agreement. METHODS: We conducted in-depth telephone interviews with the directors of 13 of the 19 family practice residency programs identified as having linkages with C/MHCs. RESULTS: All interviewees at residency programs indicated that their programs had a mission to serve underserved patients. The most commonly cited constraining factor cited by both residency programs and C/MHCs was financial support for residents, on-site faculty, and support staff. Many programs reported that residents training at the C/MHC were able to gain a community health perspective and practice community-oriented primary care. Finally, financing the relationship involved many different approaches, ranging from the residency paying all of the salaries, to a sharing of salaries by the residency, state, and/or hospital, to C/MHC paying the salaries either through its own funds or through grant support. DISCUSSION: These data provide an assessment of the current issues that family practice residencies must address to implement service-education linkages. They provide an empirical basis to outline the steps involved in forming a linkage between a residency and a C/MHC.     

Differences between African American and Caucasian men participating in a community-based prostate cancer screening program

Prostate cancer is a major contributor to morbidity and mortality in the male population, but public awareness of the cancer has been reported as minimal. We evaluated the effectiveness of an educational prostate cancer screening program on 944 men in a midwest urban community. Digital rectal examinations and PSA blood tests were provided at no charge to participants with a grant from the Michigan Department of Community Health. An educational intervention that stressed the importance of prostate cancer early detection and treatment was conducted before screenings. A brief questionnaire administered before and after the videotape and screenings, targeted both knowledge and attitudes concerning prostate cancer. Pre-test results revealed that African American men were significantly (t = 3.7, P = .00) less likely then white men to correctly identify early symptoms of prostate cancer and the basic components of a prostate checkup. Following program involvement, scores significantly improved in all areas and differences were no longer significant between the races. Racial differences were also found for screening preferences and modes of reaching men to participate in screening. African American men were twice as likely as white men to choose private appointments over mass screening (OR = 2.2, P = .00). Radio reached the most African Americans (25%) while newspaper reached the most Caucasians (34%). The decreased level of knowledge among African Americans regarding prostate etiology and clinical factors highlights the need for educational programs to target minority populations. The need for discretion also applies by providing minority-favored access with screening through private appointments.     

Reaching out to the African American community through innovative strategies

PURPOSE/OBJECTIVES: To describe the University of Pittsburgh Cancer Institute's African American Cancer Program, including innovative strategies that were used, barriers that were encountered, an evaluation of each component, and future directions and implications. DATA SOURCES: Published articles, references from bibliographies, census data, personal contact, unpublished data. DATA SYNTHESIS: Cancer morbidity and mortality is higher among African Americans than Caucasians. The University of Pittsburgh Cancer Institute pilot-tested four interventions to increase awareness, provide education and early detection opportunities, and overcome barriers to cancer care among African Americans. CONCLUSION: Constant presence, cultural sensitivity, and repetition are necessary to overcome the barriers to increased awareness and behavioral changes in the African American community. A more formalized evaluation component is necessary to draw definitive conclusions. IMPLICATIONS FOR NURSING PRACTICE: To develop cancer prevention and education programs that meet the unique needs of African Americans, nurses must be aware of barriers and cultural differences.     

Erratum to Glenwick.

Reports an error in the original article by David S. Glenwick (American Psychologist, 1979[June], 34[6], p.559), a misplaced line occurred in the first paragraph, third column. The paragraph should read: I share Goodstein and Sandler's (1978, p. 891) opinion that "community psychology cannot prosper within the community mental health movement" (my emphasis). Nonetheless, there are some aspects of the community mental health movement (e.g., consultation, crisis intervention, use of paraprofessionals, community education, administration of the community mental health center as an organizational system) that can prosper within community psychology, that are consonant with a community psychology orientation and can lead to mutually productive collaborative undertakings. To prevent the baby from being thrown out with the bathwater, it is these aspects of community mental health that can legitimately be embraced by community psychology without comprising its ideological integrity. (The following abstract appears in record 1990-58513-001.) Comments on L. D. Goodstein and I. Sandler's (see record 1979-22507-001) conceptual analysis of community psychology (CP), focusing on program evaluation, multidisciplinary knowledge, and the community mental health movement (CMHM). There are aspects of the CMHM that can prosper within CP, that are consonant with a CP orientation, and that can lead to mutually productive collaborative undertakings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Community empowerment paradigm drift and the primary prevention of HIV/AIDS

Long discussed in the public health arena, the concept of empowerment has only recently entered the discourse on the primary prevention of HIV/AIDS in the United States. Despite its broad appeal, empowerment has not been systematically incorporated into theory-based interventions, which may reflect a lack of consensus on the meaning of empowerment, how to measure it, and the intervention strategies it implies. The purpose of this paper is to consider the relevance of empowerment to community interventions for persons at risk for HIV, particularly women. The origins of empowerment are reviewed; community empowerment as an intervention framework is described and its core assumptions defined. There is some evidence of the growing influence of empowerment and related concepts in recent HIV-related policy, research, and programs funded through the Centers for Disease Control and Prevention. However, adoption of an empowerment framework for HIV prevention will require further theory and measurement development, as well as changes in how public health researchers and practitioners work with the communities they serve.     

Late-stage breast cancer in Connecticut's three largest cities

Among 1,559 breast cancer patients diagnosed in 1984-89 in residents of Connecticut's three largest cities (Bridgeport, Hartford, and New Haven), the proportion of late- (ie, regional or distant) stage cancers increased with increasing poverty level in the census tract of residence. Many census tracts with the highest proportions of late-stage breast cancers were located near a federally-qualified community health center or a hospital. Changing the stage distribution of breast cancer through increased screening by mammography and clinical breast examination may require greater collaboration among community health centers, local hospitals, mammography facilities, and mobile mammography vans, along with continuing medical education programs for primary care physicians in these cities.     

Rural hospital health promotion: programs, methods, resource limitations

Most hospitals provide health promotion programs for community residents. There is little information concerning the specific types of services offered by rural hospitals. A questionnaire was sent to every acute care hospital in Iowa (N = 124), including 99 rural hospitals and 25 urban hospitals. Surveys were returned from 95 rural hospitals (96%) and 20 urban hospitals (80%). Results indicated that 98.9% of rural hospitals offered health promotion services to community residents. These services provided on average 7.5 programs on a regular basis, while using only 1.2 full-time equivalent (FTE) employees. Urban hospitals provided 9.5 regular programs with 2.4 FTE. The most common types of rural promotion programs were blood pressure screening, cholesterol screening, safety and protection programs, diet/nutrition programs, prenatal/maternal health, and breast cancer screening. Over 40% of rural respondents stated that other less common programs, including substance abuse prevention and mental health promotion, were needed but could not be offered because of resource limitations; these types of services were offered more commonly in urban hospitals. Rural hospital health promotion programs are attempting to meet a wide variety of programming needs with limited resources, and attention may be well directed towards finding how best to provide various programs with limited resources to maximize their impact on community health.     

Neighbors for a smoke free north side: evaluation of a community organization approach to promoting smoking cessation among African Americans

OBJECTIVES: This study evaluated a community organization approach that emphasized involvement of audiences in program planning and implementation in promoting nonsmoking among African American residents of low-income neighborhoods. METHODS: The quasi-experimental design involved a 24-month intervention in 3 low-income, predominantly African American neighborhoods in St. Louis. Intervention neighborhoods were compared with comparable, untreated neighborhoods in Kansas City. RESULTS: The program was successful in engaging audience members in its governance and in instigating numerous and diverse neighborhood activities to promote nonsmoking. The prevalence of smoking declined from 34% to 27% in program neighborhoods but only from 34% to 33% in comparison neighborhoods. This difference was apparent within all demographically defined subsamples, indicating that observed changes were consistent and not attributable to confounding by demographic characteristics. CONCLUSIONS: A community organization approach emphasizing local authority for program decisions and involvement of informal networks may have an appreciable impact on smoking among residents of low-income, African American neighborhoods.     

Rapid early action for coronary treatment: rationale, design, and baseline characteristics. REACT Research Group

OBJECTIVE: Early reperfusion for acute myocardial infarction (AMI) can reduce morbidity and mortality, yet there is often delay in accessing medical care after symptom onset. This report describes the design and baseline characteristics of the Rapid Early Action for Coronary Treatment (REACT) community trial, which is testing community intervention to reduce delay. METHODS: Twenty U.S. communities were pair-matched and randomly assigned within pairs to intervention or comparison. Four months of baseline data collection was followed by an 18-month intervention of community organization and public, patient, and health professional education. Primary cases were community residents seen in the ED with chest pain, admitted with suspected acute cardiac ischemia, and discharged with a diagnosis related to coronary heart disease. The primary outcome was delay time from symptom onset to ED arrival. Secondary outcomes included delay time in patients with MI/unstable angina, hospital case-fatality rate and length of stay, receipt of reperfusion, and ED/emergency medical services utilization. Impact on public and patient knowledge, attitudes, and intentions was measured by telephone interviews. Characteristics of communities and cases and comparability of paired communities at baseline were assessed. RESULTS: Baseline cases are 46% female, 14% minorities, and 73% aged > or =55 years, and paired communities have similar demographics characteristics. Median delay time (available for 72% of cases) is 2.3 hours and does not vary between treatment conditions (p > 0.86). CONCLUSIONS: REACT communities approximate the demographic distribution of the United States and there is baseline comparability between the intervention and comparison groups. The REACT trial will provide valuable information for community educational programs to reduce patient delay for AMI symptoms.     

The Latino Health Advocacy Program: a collaborative lay health advisor approach

There have been numerous calls in the literature for health educators to develop programs to improve access to and utilization of health and human services by traditionally underserved communities, including Latinos. While the literature suggests several principles that can guide the development of these programs, it is important to address the needs, and build on the strengths, of the specific community of interest. It is, therefore, important to use collaborative approaches in which community members take an active role in the initiation, design, implementation, and evaluation of program activities. Lay health advisor programs are particularly well suited to this approach as they are designed to build on the strength of already existing community relationships to improve community health. This article describes a collaborative, culturally appropriate, holistic, and ecological lay health advisor program--the Latino Health Advocacy Program. Lessons learned and implications for future program development are discussed.     

Parent involvement in health concerns for youth: the issue of adolescent immunization

Parents play a primary role in the health and health education of their children. In particular, parent involvement in planning and promoting adolescent immunization campaigns is critical to successful efforts. Parents serve as their children's primary educators on health issues, but where can they get accurate health information? To help guide local PTA units in their programmatic efforts, the National PTA maintains positions and policy statements on multiple health issues: alcohol and other drug abuse; emergency preparedness; environmental issues; family life education; firearm safety; HIV prevention; health screenings; immunization (measles, mumps, rubella, and hepatitis B); lead poisoning; nutrition; protective helmet use; sexual assault prevention; TB testing; tobacco use and access; violence prevention; and youth suicide prevention. Likewise, the school-home partnership is key to promoting the health of adolescents. Comprehensive school health programs and integrated services are necessary to support parent and community efforts to promote adolescent health issues, including immunization programs. Techniques for effective parent involvement, based on the National Standards for Family/Parent Involvement issued by the National PTA January 1997, are discussed.     

Effects of a long-term hypertension control program on stroke incidence and prevalence in a rural community in northeastern Japan

BACKGROUND AND PURPOSE: Although randomized clinical trials have demonstrated the benefit of antihypertensive treatment in preventing stroke, the effectiveness of community-based programs is largely unknown. We investigated long-term community-based prevention activities. METHODS: In rural northeastern Japan, people aged > or = 30 years numbered 3219 in the full intervention community and 1468 in the minimal intervention community in 1965. Systematic blood pressure screening and health education began in 1963. Stroke was registered through 1987. RESULTS: More than 80% of people aged 40 to 69 years were screened in both communities in the 1960s. One community charged for screening services after 1968, whereas the other community intensified intervention; subsequently, screening rates and the follow-up of hypertensive individuals declined in the minimal intervention community, especially in men. In men, stroke incidence declined more (P < 0.001) in the full intervention (42% in the period 1970 to 1975, 53% in the period 1976 to 1981, and 75% in the period 1982 to 1987) than in the minimal intervention community (5% increase, 20% decrease, and 29% decrease, respectively); in women, the stroke incidence declined about 45% to 65% in both communities. Changes in stroke prevalence paralleled those in stroke incidence. Trends in systolic blood pressure levels tend to explain the differential stroke rates in men. CONCLUSIONS: Delivery of hypertension control services through intensive, free, community-wide screening and health education was effective in prevention of stroke for men in a community.     

Role orientation in novice home healthcare nurses

The focus of healthcare delivery continues to shift from hospital-based nursing practice to care in the community, which includes home health care. Many basic nursing education programs provide home healthcare clinical experiences for students. However, this may not be enough to assist nurses in achieving home health nursing competency. Most nurses recruited into home health care worked exclusively in hospitals. Many nurses are employed in a practice environment for which they lack the necessary education and skills. As the practice environment for the nurse changes, so does the role of the nurse. Nurses are having difficulty adjusting to changing roles and responsibilities. This cross-sectional research study was conducted to evaluate the extent that new home healthcare nurses understand their role. This study reveals that nurses employed in home health care for 24 months or less continue to have only a moderate degree of understanding of their new role. These data suggest that educators critically evaluate the effectiveness of orientation programs for novice home healthcare nurses.     

Isotopic ventriculography in healthy young volunteers. Their response to different types of stress

BACKGROUND AND OBJECTIVES: This study determined the perceived characteristics of family practice residency training programs that produce a high percentage of graduates who provide maternity care. METHODS: We surveyed a Delphi panel of 28 family practice maternity care experts. RESULTS: Consensus was reached after the third survey. The characteristics of the family medicine faculty and teaching service were rated as most important. Other essential characteristics were an adequate obstetrical training volume; mutual respect between obstetric and family medicine faculty and residents; support for family practice maternity care from obstetricians, administration, and nursing staff; and family physicians being accepted in the community as maternity care providers. CONCLUSIONS: Family practice residency programs that produce a high percentage of graduates who provide maternity care have a unique, family practice maternity care-friendly environment. Residency programs wishing to increase the percentage of their graduates who provide maternity care should ensure that their faculty support family practice maternity care, are competent in maternity care, and model maternity care in their own practices. They should strive to ensure an adequate volume of obstetrical cases for resident education and work toward educating patients and local obstetricians, nursing staff, and hospital administration regarding family practice maternity care.     

Plasma lipid changes in the normal population following behavioral treatment.

Compared the effectiveness of 3 intervention programs, diet booklet only, nutrition education, and behavioral intervention with nutrition education, for reducing plasma cholesterol and triglyceride in individuals living in the community whose lipid levels fell within the average range for the American population. Results with 183 Ss (volunteers over 18 yrs of age solicited through newspaper articles and food demonstration workshops) show that Ss who received the behavioral intervention with nutrition education had a significantly greater reduction in cholesterol than those in the other 2 conditions at 6 mo. Both nutrition education and behavioral intervention groups had small but statistically significant cholesterol reduction at 12 mo. Triglyceride decreases were also small but statistically significant for both the nutrition education and behavioral intervention groups at 12 mo. Although Ss could lower their lipid levels for 6 mo, they did not maintain their decreases. Implications for the role of behavior modification in public health programs are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Changes in the activities, functions, and roles of public health educators

Accounts of early activities of public health educators, statements of the American Public Health Association on the qualifications and functions of these educators, and studies concerned with their responsbiliities, functions, work, or roles are reviewed. These point up the three major foci in public health education over time in the U.S., viz, dissemination of information, community organization, and health behavior and program planning. Functions of public health educators in emerging settings for practice are presented and the implications of this movement (i.e., movement of health educators into non-traditional settings) for public health education profession are discussed.     

Implementation of the Henry J. Kaiser Family Foundation's Community Health Promotion Grant Program: a process evaluation

The Community Health Promotion Grants Program, sponsored by the Henry J. Kaiser Family Foundation, represents a major health initiative that established 11 community health promotion projects. Successful implementation was characterized by several critical factors: (1) intervention activities; (2) community activation; (3) success in obtaining external funding; and (4) institutionalization. Analysis of the program was based on data from several sources: program reports, key informant surveys, and a community coalition survey. Results indicate that school-based programs focusing on adolescent health problems were the most successful in reaching the populations they were targeting. The majority of the programs were able to attract external funding, thereby adding to their initial resource base. The programs were less successful in generating health promotion activities and in achieving meaningful institutionalization in their communities.     

The impact of a mobile dental system on a school community. Part II--Responses of recipients and providers of care

This paper is concerned with the impact of a Mobile Dental System (MDS) on the providers and recipients of oral health care. It focuses more specifically on children as patients of the MDS and MDS personnel as clinicians and oral health educators. Data, which were quantitative and qualitative in nature were collected from children and MDS members by means of questionnaires and interviews. Results indicate that the children had acquired some oral health information from the MDS, but many were fearful of clinical procedures. MDS personnel were gratified that they were able to provide a service to an otherwise underserved community, but also considered themselves inadequate child managers and oral health educators. The lack of a permanent career structure created feelings of insecurity amongst MDS staff. Recommendations arising from this investigation are the need for permanent and comprehensive services for all members of the community, and improved working conditions and continuing education courses for MDS personnel.     

New insights and interventions: churches uniting to reach the African American community with health information

Effective church-based community health programs must take a holistic approach when dealing with health problems among African Americans. Such an approach emphasizes the relationship between the physiological, psychological, and spiritual selves. These programs must also ensure the complete involvement of clergy and church members, who can participate in programs by providing a certain level of skill, thereby engendering a sense of partnership in the process. Also necessary is an emphasis on healthy living instead of a fear of dying. Rather than framing health issues in mortality statistics, church-based programs need to stress ways to improve the quality of life, in keeping with the messages conveyed by the church. By taking these approaches, health organizations will find a religious community more willing to accept health messages.     

Longitudinal impact of two universal preventive interventions in first grade on educational outcomes in high school.

This study examined the longitudinal effects of 2 first-grade universal preventive interventions on academic outcomes (e.g., achievement, special education service use, graduation, postsecondary education) through age 19 in a sample of 678 urban, primarily African American children. The classroom-centered intervention combined the Good Behavior Game (H. H. Barrish, Saunders, & Wolfe, 1969) with an enhanced academic curriculum, whereas a second intervention, the Family–School Partnership, focused on promoting parental involvement in educational activities and bolstering parents’ behavior management strategies. Both programs aimed to address the proximal targets of aggressive behavior and poor academic achievement. Although the effects varied by gender, the classroom-centered intervention was associated with higher scores on standardized achievement tests, greater odds of high school graduation and college attendance, and reduced odds of special education service use. The intervention effects of the Family–School Partnership were in the expected direction; however, only 1 effect reached statistical significance. The findings of this randomized controlled trial illustrate the long-term educational impact of preventive interventions in early elementary school. (PsycINFO Database Record (c) 2010 APA, all rights reserved)