Obstacles to community health promotion

The health transition ushered into the world in this century calls for a reorientation of traditional health services to manage the new causes of morbidity and mortality, renewing interest in disease prevention and health promotion. Community-based health promotion emphasizes prevention and community participation with people's empowerment to overturn current inequities and increase control over their health. Encouraged worldwide by the World Health Organization for the last two decades, some community health promotion programs have been implemented and lessons learned. However, the shift in focus required means nothing less than a paradigm change demanding not only a reorientation of professional training, but also a reorganization of social structures in communities. This article discusses nine of the interrelated obstacles that must be overcome to further develop community health promotion.     

Advocacy oral history: a research methodology for social activism in nursing

The reinstatement of social activism as a central feature of nursing practice has been advocated by nursing scholars and is consistent with contemporary conceptualizations of primary health care and health promotion that are rooted in critical social theory's concept of empowerment. Advocacy oral history from a feminist postmodern perspective offers a method of research that has the potential and purpose to empower participants to transform their political and social realities and may, therefore, be considered social activism. A recent study of public health nurses who had experienced significant distress through the reduction and redirection of their practice is provided as an exemplar of advocacy oral history. Philosophies underpinning the research method and characteristics of feminist postmodern research are reviewed and implications for the use of this methodology for social activism in nursing are drawn.     

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.     

An HIV/AIDS prevention project for Mexican homosexual men: an empowerment approach

In this intervention, participants design and implement an HIV/AIDS prevention project for Mexican homosexual men. The intervention is consistent with, and contributes to, empowerment theory because it enhances collective action, provides opportunities to develop knowledge and skills, creates needed resources, and includes shared control with professional and among participants. The intervention described provides an illustration of an empowering process and distinguishes itself from empowerment outcomes. An evaluation of the project is also described, but the outcomes were HIV/AIDS-related behaviors rather than psychological empowerment of the participants. The results suggest that the participants' HIV/AIDS knowledge and preventive behavior improved when compared to individuals who did not participate in the intervention. In addition, the intervention generated community change initiated by participants. Implications for designing interventions using an empowerment approach are discussed.     

Characterization of the Pac25I restriction-modification genes isolated from the endogenous pRA2 plasmid of Pseudomonas alcaligenes NCIB 9867

The recent attempts to implement the 1990 Americans with Disabilities Act underscore the necessity for promoting good health in adolescents with disabilities. This article addresses the reasons why this concern has not been recognized and explores the concepts of good health, habilitation, and the effects of assistance in encouraging independence for youths with developmental disabilities. The article discusses how mobility, education, family adjustment, social relationships and sexuality, and emotional adjustment to adolescence influence health adjustment. Social work implications suggest a holistic approach emphasizing the concepts of youth and family empowerment and quality of life as the key professional endeavors in practice with youths with disabilities.     

Empowerment in mainstream psychology: Legitimacy, obstacles, and possibilities.

Argues that if the concept of empowerment is to expand beyond the field of community psychology into more traditional areas of psychology (e.g., social, personality, clinical, and school psychology), its moral and psychological foundations should be more clearly articulated. To advance this proposition, an integrative conceptual model of empowerment is presented. Within this framework, ethical and therapeutic legitimacy of empowering practices, obstacles for their inclusion in mainstream psychology, and possibilities for their future development are explored. Some of the benefits to be derived from the adoption of the concept of empowerment in academic and applied psychology are outlined. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Roles of perceived sexist events and perceived social support in the mental health of women seeking counseling.

The authors of the present study contribute to research on the role of sexist events in women's mental health by examining the sexism-distress relation (a) with a sample of women who are seeking mental health services and (b) in the context of the additional roles of perceived social support in positive self-appraisal (i.e., empowerment and self-esteem) and psychological distress. A path analysis was conducted with data from 157 women who were seeking counseling services. Results supported the generalizability of previously observed links between the frequency of perceived sexist events and psychological distress. Results also indicated that the sexism-distress link was significant in the context of an additional significant indirect relation of perceived social support with psychological distress, which was mediated through empowerment but not through self-esteem. Implications for future research and practice are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Just another look at delegation

Twenty-first century health care is a given. Delegation to and by the professional nurse may well be one empowering tool that will strengthen the scope of 21st century professional practice. Nurses as leaders can make it happen.     

Modeling in anesthesia

Technological advances and economic, social, and cultural conditions have created a climate of change in health care. New roles and approaches are developing in relation to the holistic health movement. Within the holistic nursing community, three concepts of holistic practice have emerged. Differentiations among (a) certified holistic nurses, (b) practitioners of a healing modality, and (c) healers are presented to promote future discussion. As new roles must match a social need and become institutionalized to secure a professional role, speculations on possible directions for the certification in holistic nursing are presented.     

Perceived social support and community adaptation in schizophrenia

Prompted by the continuing transition to community care, mental health nurses are considering the role of social support in community adaptation. This article demonstrates the importance of distinguishing between kinds of social support and presents findings from the first round data of a longitudinal study of community adaptation in 156 people with schizophrenia conducted in Brisbane, Australia. All clients were interviewed using the relevant subscales of the Diagnostic Interview Schedule to confirm a primary diagnosis of schizophrenia. The study set out to investigate the relationship between community adaptation and social support. Community adaptation was measured with the Brief Psychiatric Rating Scale (BPRS), the Life Skills Profile (LSP) and measures of dissatisfaction with life and problems in daily living developed by the authors. Social support was measured with the Arizona Social Support Interview Schedule (ASSIS). The BPRS and ASSIS were incorporated into a client interview conducted by trained interviewers. The LSP was completed on each client by an informal carer (parent, relative or friend) or a professional carer (case manager or other health professional) nominated by the client. Hierarchical regression analysis was used to examine the relationship between community adaptation and four sets of social support variables. Given the order in which variables were entered in regression equations, a set of perceived social support variables was found to account for the largest unique variance of four measures of community adaptation in 96 people with schizophrenia for whom complete data are available from the first round of the three-wave longitudinal study. A set of the subjective experiences of the clients accounted for the largest unique variance in measures of symptomatology, life skills, dissatisfaction with life, and problems in daily living. Sets of community support, household support and functional variables accounted for less variance. Implications for mental health nursing practice are considered.     

The process of empowerment: A model for use in research and practice.

In this article, we propose a model of the process of empowerment. The notion of empowerment is compelling and much employed across many subfields inside and outside of psychology, but the lack of consistency in the ways prior literature has defined it is an obstacle to meaningful synthesis of findings and consistent application in practice. Our empowerment process model builds on prior work in taking the following steps: articulating empowerment as an iterative process, identifying core elements of that process, and defining the process in a way that is practically useful to both researchers and practitioners with terms that are easily communicated and applied. The components of the model are personally meaningful and power-oriented goals, self-efficacy, knowledge, competence, action, and impact. Individuals move through the process with respect to particular goals, doubling back repeatedly as experience promotes reflection. We make specific recommendations for research and practice and discuss applications to social justice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Shifting the paradigm in community mental health: Towards empowerment and community.

Reviews the book, Shifting the paradigm in community mental health: Towards empowerment and community by Geoffrey Nelson, John Lord, and Joanna Ochocka (2001). This book, as it combines theory, practice, and research (a case study) about the processes of empowerment and integration of consumers of mental health care in a Canadian setting, delineates strategies and approaches that can be factors in fulfilling this important aim. Shifting the Paradigm in Community Mental Health is a welcome contribution to the literature on the implementation of consumer empowerment and involvement in mental health treatment and care. The authors offer an approach enabling the reader to see the dimensions for empowerment and community integration termed the empowerment-community integration paradigm. The book will be useful for a wide audience, including consumers, professionals, stakeholders, researchers, and policy makers, and should be in the libraries of all institutions, formal and informal, that deliver mental health care. The overall clarity of the writing and all the approaches will be very much appreciated by all those who work or receive services in mental health. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Evaluating quality and effectiveness in the promotion of health: approaches and methods of public health and social sciences

Health promotion and health education have often been limited to evaluation of the effectiveness of actions and programmes. However, since 1996 with the Third European Conference on Health Promotion and Education Effectiveness, many researchers have become interested in "quality assessment" and new ways of thinking have emerged. Quality assurance is a concept and activity developed in industry with the objective of increasing production efficiency. There are two distinct approaches: External Standard Inspection (ESI) and Continuous Quality Improvement (CQI). ESI involves establishing criteria of quality, evaluating them and improving whatever needs improvement. CQI views the activity or service as a process and includes the quality assessment as part of the process. This article attempts to answer the questions of whether these methods are sufficient and suitable for operationalising the concepts of evaluation, effectiveness and quality in health promotion and education, whether it is necessary to complement them with other methods, and whether the ESI approach is appropriate. The first section of the article explains that health promotion is based on various paradigms from epidemiology to psychology and anthropology. Many authors warn against the exclusive use of public health disciplines for understanding, implementing and evaluating health promotion. The author argues that in practice, health promotion: -integrates preventive actions with those aiming to maintain and improve health, a characteristic which widens the actions of health promotion from those of classic public health which include essentially an epidemiological or "risk" focus; -aims to replace vertical approaches to prevention with a global approach based on educational sciences; -involves a community approach which includes the individual in a "central position of power" as much in the definition of needs as in the evaluation of services; -includes the participation and socio-political actions which necessitate the use of varied and specific instruments for action and evaluation. With the choice of health promotion ideology, there exist corresponding theories, concepts of quality, and therefore methods and techniques that differ from those used until now. The educational sciences have led to a widening of the definition of process to include both "throughput and input", which has meant that the methods of needs analysis, objective and priority setting and project development in health promotion have become objects of quality assessment. Also, the modes of action and interaction among actors are included, which has led to evaluation of ethical and ideological aspects of projects. The second section of the article discusses quality assessment versus evaluation of effectiveness. Different paradigms of evaluation such as the public health approach based on the measurement of (epidemiological) effectiveness, social marketing and communication, and the anthropological approach are briefly discussed, pointing out that there are many approaches which can both complement and contradict one another. The author explains the difference between impact (the intermediate effects, direct or indirect, planned or not planned, changes in practical or theoretical knowledge, perceptions, and attitudes) and results (final effects of mid to long term changes such as changes in morbidity, mortality, or access to services or cost of health care). He argues that by being too concerned with results of programmes, we have often ignored the issue of impact. Also, by limiting ourselves to evaluating effectiveness (i.e. that the expected effects were obtained), we ignore other possible unexpected, unplanned and positive and negative secondary effects. There are therefore many reasons to: -evaluate all possible effects rather than only those lined to objectives; -evaluate the entire process rather than only the resources, procedures and costs; -evaluate the impact rather than results; -evalu     

The connection between clinical health promotion and health status: A critical overview.

Argues that the clinical practice of health promotion is based on at least 4 assumptions: (a) behaviors increase the risk of certain chronic diseases; (b) changes in behaviors can reduce the probability of risk of certain diseases; (c) behavior can be easily changed; and (d) behavioral interventions are cost-effective. Although data support most of these assumptions, the strength of the support is shown to be much weaker than is assumed by many psychologists. Thus, the expected health benefits from behavioral programs may not match the enthusiasm espoused by some health psychologists. A major problem in this field is that outcomes are frequently not conceptualized in relation to health. Health status is therefore suggested as the focal point for conceptualizations of health psychology. (83 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Group psychotherapy specialty practice.

Group psychotherapy (mental health treatment-focused interventions based in social psychological research on group dynamics) is a growing specialization within psychology, not yet fully recognized by the public and the professional community. This article aims to inform the reader about the multiple components of training, practice, and research. Many graduate programs are teaching fewer group courses than ever before despite the fact that groups are being utilized increasingly in many settings. As defined, group specialty practice covers small, medium, and large groups led by expert leaders or coleaders specifically trained in group intervention skills, which are based on a rich history. Group typologies range from prevention and education to growth, counseling, or psychotherapy (although some controversy exists regarding definitions). Still, a consensus exists that it has more to do with who the members are and in what settings groups occur. Group practice is well-established given the extant evidence-based research, the depth and breadth of its utilization, and professional organizations--such as the Council of Specialties and the American Board of Professional Psychology--that officially recognize group practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Financing and payment reform for primary health care and substance abuse treatment

One of the most controversial areas for health care reform concerns the treatment of alcohol and other drug problems, which account for some of the most rapidly rising costs in the health care sector. There is arguably no other set of conditions that show such variation in accessibility to treatment on the basis of insurance status, present the same degree of difficulty in providing comprehensive care, or challenge as many public and professional assumptions about behavioral, social and economic determinants. The purpose of this article is to discuss some of the financing and coverage barriers to comprehensive treatment for alcohol and other drug abuse; to discuss some innovative mechanisms for providing and financing comprehensive services; and to suggest some directions for public policy to support the development of new practice models that emphasize cost-effectiveness and efficiency of care.     

Primary care psychologists in the Netherlands: 30 years of experience.

The primary care psychologist (PCP) in the Netherlands has 30 years of experience. The PCP is a generalist who, in close cooperation with the family physician and other providers of primary health care, has a mindset and manner of working that is largely determined by the context in which the PCP works. The specific attitudes and role of the PCP are described. The PCP provides services for a clearly delimited geographic region and is responsible for the provision of brief psychological help from a biopsychosocial perspective. In addition to psychological assessment and the provision of stepped care, the PCP also devotes considerable attention to prevention and health promotion. An orientation toward the community and the empowerment of clients stands central. The various tasks of the PCP are described in detail, and an educational curriculum for the specific 1-year training of the PCP is outlined. Lessons for other European countries and the United States are deduced from the Dutch experience. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Nursing science research to support nursing care practice

It is stated in this article that nursing is a professional science the goal being to utilize the nursing practice. New theories are formed or existing theoretical hypotheses are tested by nursing research. The difference between these two approaches is introduced. Nursing research for health promotion, prevention from illness and rehabilitation is discussed. The subject is viewed by the basic concepts of nursing: person, environment, health, nursing interventions. It seems to be essential to develop nursing theory for practise. It means to accept the point of view in which clinical nurses are theorists like academic researches.     

The indigenous paraprofessional and involuntary civil commitment: A return to community values.

Notes that many community mental health centers in North America have on their staff paraprofessionals (PPs) who are indigenous to the community. Sharing the same cultural background as the community, they can often bridge the wide cultural barriers between the professional and the population served. Despite this, PPs have traditionally held a relatively subservient role in relation to their professional colleagues, with the more crucial decisions left to the professionals—specifically, the involuntary commitment of the potentially dangerous person. Because of their understanding of the community culture, PPs' involvement in civil commitment procedures would seem critical. Although medical-psychological training is adequate for assessing dispositional traits, the very nature of such training prohibits an emphasis on cultural–contextual variables. The use of indigenous PPs in the commitment process would reduce this methodological dilemma and would also attenuate the potential misuse of mental health facilities as agents of social control. (French abstract) (2 p ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Community analysis for health planning: strategies for primary care practitioners

Primary care practitioners have an important role in planning for the health of individuals and selected target populations. Community analysis and needs assessment are the first steps in health planning. Community analysis involves identifying health issues within a community; gathering data about the community, the target group, and the health concern; analyzing data; and assessing community needs. Community needs assessment involves identifying both existing and potential health problems as well as health promotion needs. By using appropriate skills in carrying out needs assessments, primary care practitioners become active contributors in planning for the health of individuals, groups, and the nation as a whole. This article provides strategies for identifying, analyzing, and evaluating the health needs of a community.