The Interventional Capacity of Community Health Volunteers for Screening and Linkages of Non-Communicable Diseases in Nyeri County, Kenya

Non-communicable diseases (NCDs) account for 63% of mortalities. Approximately 80% of these NCD-related deaths occur in LMICs. A quasi-experimental study utilizing a non-equivalent pre-and post-test was conducted from May 2022 to March 2023 with 370 study participants. Multistage cluster and random sampling were used to select ten community units, and therefore, 150 CHVs were chosen for the control unit, and 150 were used to form the interventional group. Data was collected from the KOBO app. Six (6) homogenous FGDs comprised ten members, and 10 KII were conducted across study sites. Quantitative data was analyzed using SPSS version 28.0, and qualitative data was audio-recorded, transcribed, and analyzed via N-Vivo 12. The study shows that 59.3% of respondents have minimal information, and 92.7% (n = 139) have no clear understanding of NCDs, with a pre-intervention capacity of 48.8%. Independent sample t-test showed a significant difference in capacity from a pre-intervention average of 48.75 (SD ± 5.7)%, which increased to 68.28 (SD ± 7.6)%, p < 0.001. A well-designed community interventional model plays a pivotal role in grassroots healthcare delivery but requires optimization for NCD management.

Challenges faced by community health nurses to achieve universal health coverage in Myanmar:A mixed methods study

Objective:This study aimed to identify the challenges of community health nurses(CHNs)in delivering effective community health care to achieve universal health coverage(UHC)in Myanmar.Methods:A total of 30 CHNs from township health centers in the northeastern,southern,and western parts of Myanmar were purposefully recruited for quantitative and qualitative interviews.Quantitative data were processed using Microsoft Excel software,and qualitative data were analyzed using thematic analysis.This study is registered with researchregistry6201.Results:Around the country,30 CHNs uncovered their hardships in implementing primary health care to achieve UHC.Over 90%of the participants agreed to the problem of inadequate health infrastructure,while half of them felt unmotivated when they encountered role conflicts among various cadres of healthcare providers and poor opportunities for career promotion.Major problems arose from the lack of standard professional education at the entry point to community settings because most CHNs did not achieve specialized training in providing public health services.Complications are incapable of evaluating health services for policy-making and the inability to conduct health research to develop evidencebased practices.Insecure work and living conditions,unsupportive community relationships,and undereducation in professional practices were supportive major themes explored by CHNs to achieve a deeper understanding of the barriers to UHC.Not only the health system itself but also the population and other geographical factors have contributed to many challenges to CHNs.Conclusion:Myanmar’s CHNs face many challenges in achieving UHC.These challenges are not confined to the health sector.Some situations,such as geographical barriers and transportation problems,remain persistent challenges for healthcare providers.This study highlights the fact that current health systems should be strengthened by qualified healthcare providers and sufficient infrastructure.Meanwhile,public empowerment plays a critical role in promoting health development.

Service Functions of Private Community Health Stations in China: A Comparison Analysis with Government-sponsored Community Health Stations

In China, with the restructuring of health care system moving forward, private community health facilities have been playing a complementary but increasingly important role in providing public health and basic medical care services in urban areas. However, only limited evidence is available con-cerning the service functions of private community health facilities in China. The aim of this study was to explore the functions of private community health stations (PCHSs) to provide evidence-based rec-ommendations for policy-making and practice in the development of urban community health services systems. A total of 818 PCHSs and 4320 government-sponsored community health stations (GCHSs) located in 28 cities of China were investigated in 2008. The percentages of stations that provided health services and the annual workload per community health worker (CHW) were compared between the two types of institutions. The results showed that the percentages of PCHSs providing public health services were significantly higher than those of GCHSs (P<0.05); but no significant differences were found in the percentages of basic medical services providing between PCHSs and GCHSs (P>0.05). The annual workloads of all the public health services and basic medical services per CHW in PCHSs were lighter than those in GCHSs (P<0.05), except for resident health records establishment and health education materials distribution (P>0.05). At present, the GCHSs are still the mainstream in urban China, which will last for a long period in future. However, our findings showed that the annual workloads of CHWs in PCHSs were no heavier than those in GCHSs, and the PCHSs were willing to provide public health services. In view of current inadequacy of health resources in China, it is feasible to further develop PCHSs under the guidance of the government, given that PCHSs can perform the basic functions of community health services, which is useful for the formation of public-private partnerships (PPP) and the improvement of community health services.

Factors Affecting Patient Satisfaction with Community Health Service under the Gatekeeper System:A Cross-sectional Study in Nanjing,China

The gatekeeper policy has been implemented for approximately ten years on a pilot population in China. It is necessary to assess the satisfaction of patients utilizing community health service（CHS） under the gatekeeper system. Our study showed that the cognition of gatekeeper policy was associated with four dimensions including doctor‐patient relationships, information and support, organization of care, and accessibility（P 〈 0.001）. One or more factors such as gender and self‐perceived health scores also affected their satisfaction. General practitioners must be prepared to focus on these aspects of information and support, organization of care, and accessibility as indicators of potential opportunities for improvement. Additionally, policymakers can improve patients＇ satisfaction with CHS by strengthening their awareness of the gatekeeper policy.

Role of Community Health Practitioners in National Development: The Nigeria Situation

This is a review paper that brings to focus, concepts of Community Health Practice that connect Community Health Practitioners’ Roles to National development in view of its composite index improvement measure of social welfare services provision among others for the citizens of a country over time, with particular emphasis on medical care component of such index aimed at reduction in diseases and poverty in the population. The objective of the review work is to determine the extent to which Community Health Practice, particularly by Community Health Practitioners is capable of ensuring National Development in democratic governance or otherwise, in the context of our country, Nigeria. The methodology applied was traditional review of published literatures concerning the subject and findings of operational research of programme implemented by Community Health Practitioners at the Primary Health Care facilities and household level in the communities. This paper emphasizes on Primary Health Care services delivery contribution to National Development, since it is the level where Community Health Practitioners are mainly commissioned to render their services. Home-Based Care Strategy for Integrated Maternal, Newborn and Child Health piloted in three (3) local government areas (Ahoada West, Etche and Oyigbo) in Rivers State, Nigeria, in 2012 and implemented by Community Health Practitioners, aimed at reducing maternal, newborn and child morbidity and mortality by 20% by 2015 in line with the United Nations (UN) Millennium Development Goals 4 and 5, had been shown to achieve an average of 26% improvement in utilization of maternal and newborn health services, an average of 27% overall reduction in maternal malnutrition status, an average of 14% overall improvement in under 5 years malnutrition status among others in 2013 on comparing with baseline indicators. Nigeria also attained 80% coverage in routine immunization in most vaccine preventable diseases except Tetanus Toxiod (TT) 2 (54%) in 2013 to achieve herd immunity of the community to prevent transmission of disease pathogen to cause a disease. Community Health Practitioners are the frontline Primary Health Care Professionals charged with the responsibility of implementation of immunization programmes in Nigeria and therefore contributing significantly to the prevention and control of targeted vaccine preventable diseases in Nigeria Health System. Our findings on factors militating against Community Health Practitioners’ Roles in National Development as elicited in this paper may form basis for empirical studies to determine the level of significance of each of these factors. In conclusion, it is when the Community Health parameters are adequately addressed that we can ensure sustainable National Development and we can say we have succeeded in our various strategic agenda of government at whatever level that makes up the complex whole. This brings to fore, the importance of the roles of Community Health Practitioners in health care delivery to National Development in the context of our country, Nigeria.

Roles of mutual help of local community networks in community health activities: Improvement for the quality of life of older people in Thailand

Objectives: This study aimed to describe work and activities of community networks focusing on the improvement of the quality of life (QOL) of older people in Thailand.The understanding of the work can help enhancing the community development and strengthening of local communities and their networks.Methods: Qualitative methods including in-depth interview,observation,and focus group discussion were employed to the study.64 participants participated to the study and were recruited from 4 key actors within the community.Content analysis was used to analyze the obtained data.This study was conducted in 6 local administrative organizations (LAOs) which selected from the outstanding areas of the project.Each LAO represents one sub-district of the regions of Thailand namely;(1) the upper north,(2) the lower north,(3)the upper eastern,(4) the lower eastern,(5) the central and (6) the south.Results: The findings of this study were categorized into three main themes: (1) Social capital including people in the community,social groups,and organizations,(2) Mutual help/collaboration activities composed of six sets of activities related to social capitals working on the improvement of QOL of older people,and (3) Impacts of the mutual help/collaboration activities on older people and local communities who help to improve of QOL of older people.Conclusion: The findings are important features for the community development.These themes should be recommended for community nurses,health related groups and organizations for the improvement of QOL of older people in the community.

Analysis of Inpatient Bed Allocation Equity and Utilization in the City Community Health Service Center of China

The objective of this study was to examine the inpatient bed （IB） allocation equity and utilization in Chinese city commtmity health service centers （CHSCs）. The data were derived from the Baseline Survey of National City Community Health Service System Building Project, which was conducted in 1917 CHSCs in 28 cities in 2007. The IB allocation was analyzed in terms oflB alloca- tion quantity and distribution equity, and the IB utilization was analyzed by the IB utilization rate and average length of stay of the CHSC inpatients. The results showed that 49.3% of the CHSCs were equipped with IB; averagely, there were 45 IBs per CHSC, 0.94 IBs per 1000 people, and 0.38 nurses and 0.57 doctors per IB; the IB Gini coefficient was 0.32; the IB utilization rate was 40.06%; and the average length of stay of inpatients was 12.24 days. The conclusions were that IB allocation among the population was equitable, but the number of nurse per IB was not up to the national standard; and the CHSC IB utilization was low as a whole, thus inpatient service was not the main health service for Chinese CHSCs.

Extension for Community Health Outcomes-hepatitis C:Small steps carve big footprints in the allocation of scarce resources for hepatitis C virus treatment to remote developing areas

Hepatitis C virus(HCV)infection is still a major health problem throughout the world.HCV patients living in rural areas are less fortunate than their counterparts residing in populous urbanized regions.The lack of medical resources and properly trained medical personnel in rural regions make it especially burdensome for HCV patients seeking treatment.Dr.Sanjeev Arora at the University of New Mexico Health Sciences Center took initiative to resolve the issue at hand by developing a model named Project Extension for Community Health Outcomes(ECHO).ECHO connects primary care providers(PCPs),usually family medicine physicians,in local communities with specialists.ECHO providers test the efficacy of treatment given using the ECHO model vs that at academic medical centers.The ECHO model has produced promising results such that the sustained virologic response rates for both types of sites were near-equivalent.Show Me ECHO was adapted from Project ECHO to train PCPs in Missouri and equip them with the tools and skills to properly treat and diagnose HCV in a timely manner.This healthcare model can be implemented for treating other common infections and chronic diseases.Telemedicine is the direction healthcare is headed for the next several decades.It has potential to be applied in developing countries to alleviate agony and despair resulting from limited resources and lack of access to expert medical care.

Family Medicine and Community Health期刊简介

宗旨和内容Family Medicine and Community Health(FMCH,《家庭医学和社区卫生》)(ISSN 2305-6983)是一本同行评议的开放性英文期刊(季刊),主要关注流行病、慢性病管理、社区卫生服务及家庭医学教育和培训。期刊旨在促进家庭医学领域知识和技能的即时沟通,以便为更好的医疗服务作指导。文章内容包括卫生政策、临床研究和实践、教育培训及社区卫生中心管理等。栏目包括但不限于,社论、原创研究、临床技能。

Quantitative Analysis on Economic Contribution of Community Health Service in China

In China, the implementation of community health service shows that the prevention is an essential and important part of our national health system and is helpful to decrease the medical expenditure gradually. According to the data from Health Statistic Information Center of Ministry of Health in China, we calculated that the total health expenditure of China would be decreased 8000.0 million yuan only in 2001, among which, 1188.3 million, 1953.9 million and 4833.0 million yuan were respectively saved for the government budget, the society and resident if implementing the policy of community health service powerfully. And every outpatient can save 15.46 yuan per time. By the quantitative analysis on the economic contribution of community health service, it can be proved that a great economic benefit could be gotten from the implementation of community health service.

Assessment of community health needs of Chongqing residents: a qualitative study

Objective: The aim of this preliminary qualitative study was to gain insight into community health needs in order to develop health program for community in Chongqing. Methods: Totally 40 participants were assigned into 6 focus group discussions. All groups were led by local language speakers, and their talking was recorded after gaining informed consent. Transcribed data were coded and subjected to thematic analysis. Results: The main obtained themes were that community health problems were chronic noncommunicable disease, main health service needs included regularly free check-up and health education, and perceived health risk factors were unhealthy lifestyle and behavior as well as environment problems. Conclusion: Our community health needs assessment (CHNA) with FGDs indicate that residents realize the importance of prevention of disease. Our study identifies that primarily community health promotion is one of the priorities of community health service needs, including reorienting health service, health education, guiding behavior or lifestyle, and creating healthy environments. The findings of this study can provide guidance to the development of more effective and pertinent health program in this community.

Family Medicine and Community Health 2016年2期目次选登

·An evaluation of a screening programme for immigrant women to Taiwan关于台湾移民妇女筛查项目的评价·Methodological challenges of cross-language qualitative research with South Asian communities living in the UK对生活在英国的南亚移民进行定性研究时在方法学上所遇到挑战·Process engineering for primary care:quality improvement

Role of community health nurse in the prevention of elderly dehydration:A mini-review

As dehydration is related to negative health outcomes in the elderly,including an increased risk of disability and death,prevention may help improve health,functional status,and quality of life.Dehydration diagnosis can be challenging in the elderly as the traditional physical indications of dehydration may be absent or ambiguous.Numerous etiologies place the elderly at an increased risk.The role of the community health nurse(CHN)derives from the responsibilities attached to her,and the Betty Neuman’s Systems Model of health care with three levels of protection is usually applied to the CHN.In this mini-review,we try to integrate the Betty Neuman’s Systems Model with the results of identified articles.This study includes a literature search of reputable international databases such as SpringerLink,PubMed,Embase,and Wanfang,particularly for the period 2005 to the present.Ten articles that met the qualifying criteria were included in this study.The findings of this study draw a picture of the role of CHN in preventing dehydration across the three levels of prevention as mentioned by Betty Neuman.

Boat Racing： The Cultural Creative for Community Health Promotion in Wiang Sa District, Nan Province, Thailand

This article identified values and creative culture for community health promotion through the use of boat racing in Wiang Sa district, Nan province, which is located in Northern Thailand as the case study. The author applied qualitative method to reveal the possibilities of community-based health care. The in-depth interview and participatory observation were adopted to investigate the context, problems, and current situation from the stakeholders during May to October 2013. The results showed that Wiang Sa district hold the traditional boat racing for more than 177 years. Before 1979, the boat racing was a traditional village collective activity, after that, the tradition has transformed into sports game in which the promotion of community health and tourism has been introduced. Values of boat racing of the people in the community included： （1） Aesthetic value--the unique characteristics of the regatta; （2） spiritual value--religious rites and relating rituals which was the source of the regatta; （3） social value--participation in various stages of racing from mutual thinking and practicing, and benefits among the group of villagers at various ages. Today, the regatta become a social symbol characterized by the community creative culture in many areas： promoting village cooperation, increasing social harmony, valuing the role of women, stimulating non-alcohol racing scheme, creating sharing collective activities for the youth and the elderly, etc. The health promotion, even though it only occurs in a short time of the racing course, especially among the rowers, it is considered as the beginning of building a positive attitude towards community health promotion through the use of the regatta as a social innovation.

Family Medicine and Community Health 2016年3期目次选登

·An evaluation of a screening programme for immigrant women to Taiwan关于台湾移民妇女筛查项目的评价·Methodological challenges of cross-language qualitative research with South Asian communities living in the UK对生活在英国的南亚移民进行定性研究时在方法学上所遇到挑战·Process engineering for primary care:quality improvement

Community health worker model for health care delivery and environment programs focused on initiatives in USA and India

Community health workers are equipped with the tools and resources necessary to bring about a change in the form of a rapid chain reaction.The community health workers model focuses on the practices,strategies,plans,and implementation techniques needed to organize a community health event based on diverse agendas:health,environment,and minorities.This model encompasses past experiences as a guide with tested strategies to assist future health interns with a ground framework and resources to showcase the importance of adopting healthy and environmentally friendly practices.The basic outline of the model is based on data collected from various community health events in Illinois(United States of America)and New Delhi(India).These events included back to school fairs,cleanliness drives,health camps,and educational events.As community health workers can help in implementing better practices in the masses through one-on-one interactions,this model of community health worker programs would outline event organization tips,predicted outcomes,targeted audience,and required material templates.The next phase of this model highlights utilizing the data and experience from these events to report to the health ministries of different countries for the incorporation of the proposed practices in their health agendas and policies.This model,if implemented unanimously,could bring about a revolution in the arena of health workers.They will be assisted at each step,will establish connections with health workers globally,and share their health and environment-based agendas to collaborate and organize important events.This model envisions a strong established network of community health workers,display of their agenda,and creation of a ripple effect throughout the society by the means of these programs.

Assessment of Knowledge and Practices of Community Health Nurses on Data Quality in the Ho Municipality of Ghana

Background: High data quality provides correct and up-to-date information which is critical to ensure, not only for the maintenance of health care at an optimal level, but also for the provision of high-quality clinical care, continuing health care, clinical and health service research, and planning and management of health systems. For the attainment of achievable improvements in the health sector, good data is core. Aim/Objective: To assess the level of knowledge and practices of Community Health Nurses on data quality in the Ho municipality, Ghana. Methods: A descriptive cross-sectional study was employed for the study, using a standard Likert scale questionnaire. A census was used to collect 77 Community Health Nurses’ information. The statistical software, Epi-Data 3.1 was used to enter the data and exported to STATA 12.0 for the analyses. Chi-square and logistic analyses were performed to establish associations between categorical variables and a p-value of less than 0.05 at 95% significance interval was considered statistically significant. Results: Out of the 77 Community Health Nurses studied, 49 (63.64%) had good knowledge on data accuracy, 51 (66.23%) out of the 77 Community Health Nurses studied had poor knowledge on data completeness, and 64 (83.12%) had poor knowledge on data timeliness out of the 77 studied. Also, 16 (20.78%) and 33 (42.86%) of the 77 Community Health Nurses responded there was no designated staff for data quality review and no feedback from the health directorate respectively. Out of the 16 health facilities studied for data quality practices, half (8, 50.00%) had missing values on copies of their previous months’ report forms. More so, 10 (62.50%) had no reminders (monthly data submission itineraries) at the facility level. Conclusion: Overall, the general level of knowledge of Community Health Nurses on data quality was poor and their practices for improving data quality at the facility level were woefully inadequate. Therefore, Community Health Nurses need to be given on-job training and proper education on data quality and its dimensions. Also, the health directorate should intensify its continuous supportive supervisory visits at all facilities and feedback should be given to the Community Health Nurses on the data submitted.

Why Multi-Sectoral Approaches Are Rarely Applied in Community Health Interventions in Some Countries in Sub-Saharan Africa?

The objective of this work is to analyze the reasons why community health interventions in Africa do not consider multisectoral approaches. To achieve it, we perform a mini-review of health development policies and plans available online in seven countries from four regions of Sub-Saharan Africa. Thus, two main reasons have been highlighted. First, national strategic plans and policies for health development, in their formulation, neither sufficiently emphasize multisectoral approaches, nor sufficiently make these approaches operational in strategies and activities. Second, the mindset of health professionals due to their initial training orientation based on the biomedical approach, stands that disease is only a result of a physiological imbalance in the body;therefore, to restore health, such an imbalance only needs sophisticated procedures and interventions to be overcome. Such an orientation completely ignores the social, cultural and economic context in which the individual lives, which has an irretrievable influence on the health imbalance. However, health, influenced by the conditions in which people are conceived, born, grow, live, work and aged, cannot be effectively improved in a sustainable way without taking into account all these conditions. Whence the importance of approaches based on every sector of human activity that influences the living conditions.

Community Health Management and Nursing Strategies for Elderly Hypertension

Objective:To explore the therapeutic effects of community health management and nursing strategies for elderly hypertensive patients.Methods:A total of 64 elderly hypertensive patients who were treated in our hospital from March 2020 to March 2021 were selected.The control group took conventional care and guidance.The research group carried out community health management and nursing strategy guidance on the basis of the control group.Then compare the blood pressure levels of the two groups of patients before and after nursing and the patients’satisfaction with nursing.Results:Through comparison,it can be seen that the diastolic and systolic blood pressure levels of the study group and the control group are not significantly different before nursing.After nursing,the diastolic blood pressure of the patients in the study group was 81.22.1 mmHg and the systolic blood pressure was 126.58.7 mmHg.The diastolic blood pressure of the control group was 90.55.4 mmHg and the systolic blood pressure was 136.412.9 mmHg.There are obvious differences in the comparison of the two sets of data.By comparing the two groups of patients’satisfactions with nursing care,it can be seen that among the 32 patients in the study group:31 were very satisfied and basically satisfied,with a satisfaction rate of 96.87%.Among the 32 patients in the control group,28 were very satisfied and basically satisfied,with a satisfaction rate of 87.5%.The data of the two groups of patients are clearly comparable.Conclusion:Through community health management and nursing strategies,the satisfaction and treatment effect of elderly hypertensive patients can be improved,thereby contributing to the recovery of patients.

Systematic Review of Community Type 2 Diabetes Structured Health Education (CT2DSHE)

Aim: This paper aims to evaluate disparities of type 2 diabetes structured health education programmes that is utilised within the communities. Design: systematic review, (a type of secondary research design) aiming to summarize the results of prior primary research studies on available evidence Community type 2 diabetes structured education (CT2DSHE). Methods: Research question: Type 2 diabetic structured health education within a community how effective is it? Qualitative Systematic review, defined as a way to get reliable and objective picture of current available evidence on the specific topic—(CT2DSHE), (Denscombe, 2021) through reflexivity synthesis of available data as an example. This is valuable in time constraints such as project assignments that must be met within specific time and also to bring together available evidence together [1]. Results: This review has shown that CT2DSHE is effective with seven out of the eleven authors supporting, three authors against and one was neutral, further showed that knowledge and skills acquired can last longer with patient activation improved among T2DM patients ideal for sustaining their self-management of T2DM. Conclusion: This research provides suggestive answers to the research question: “Type 2 diabetic structured health education within a community how effective is it?”, This has demonstrated CT2DSHE effectiveness in knowledge acquisition and improving T2DM awareness among T2DM patients, whilst evidencing long effects beyond the study times of 3 - 9 months period in relation to patient activation. Also Identified diabetes education self-management on newly diagnosed (DESMOND) patient as CT2DSHE program for recommendation. Patient or Public Contribution: This work aspires to contribute to CT2DSHE in these areas;Influencing policy decision-making for community diabetes care within the UK and world at large., Contributing to already vast knowledge on diabetes self-management and reasons why?, Influencing educators on how CT2DSHEP are designed, delivered by putting the patient at the Centre and bringing different perspectives on CT2DSHEP in one place that is serving users time of having to consult several resources especially busy clinicians [2] [3].