CATCH across Texas: Building a model for the diffusion of effective school-based health promotion programs

The impact of health promotion programs is related to both program effectiveness and the extent to which the program is implemented among the target population. The purpose of this dissertation was to describe the development and evaluation of a school-based program diffusion intervention designed to increase the rate of dissemination and adoption of the Child and Adolescent Trial for Cardiovascular Health, or CATCH program (recently renamed the Coordinated Approach to Child Health). ^ The first study described the process by which schools across the state of Texas spontaneously began to adopt the CATCH program after it was tested and proven effective in a multi-site randomized efficacy trial. A survey of teachers and administrator representatives of all schools on record that purchased the CATCH program, but were not involved in the efficacy trial, was used to find out who brought CATCH into the schools, how they garnered support for its adoption, why they decided to adopt the program, and what was involved in deciding to adopt. ^ The second study described how the Intervention Mapping framework guided the planning, development and implementation of a program for the diffusion of CATCH. An iterative process was used to integrate theory, literature, the experience of project staff and data from the target population into a meaningful set of program determinants and performance objectives. Proximal program objectives were specified and translated into both media and interpersonal communication strategies for program diffusion. ^ The third study assessed the effectiveness of the diffusion program in a case-comparison design. Three of the twenty Education Service Center regions in Texas were chosen, selected based on similar demographic criteria, and were followed for adoption of the CATCH curriculum. One of these regions received the full media and interpersonal channel intervention; a second received a reduced media-only intervention, and a third received no intervention. Results suggested the use of the interpersonal channels with media follow-up is an effective means to facilitate program dissemination and adoption. The media-alone condition was not effective in facilitating program adoption. ^

A Case Study on Using the Via Christi Breastfeeding Assessment Tool in a Clinical Setting

Aims- The goal of this study is to obtain a subjective point of view of the use, benefits, and shortcomings of the Via Christi breastfeeding Assessment Tool in a clinical setting. Methods- This case study is based on a single yet detailed interview with a lactation consultant who has utilized the Via Christi Breastfeeding Tool in a clinical setting. Findings- Advantages of the Via Christi Breastfeeding Assessment Tool include that the tool is practical and concrete, encompassing both a subjective dimension and the basic elements of breastfeeding. Shortcomings of the tool include its non-specificity in focus on the feeding technique only and excluding other factors involved with the birth and mother- baby couplet. Conclusion- The Via Christi Breastfeeding Tool serves as a good initial screening of breastfeeding, which in result leads to the recommendation of further and more extensive study of a specific mother-baby couplet breastfeeding measures if needed.

Household risk factors and the health and nutritional status of children in rural Honduras

During this cross-sectional study, both quantitative and qualitative research methods were used to elucidate the role that household environment and sanitation play in the nutritional status of children in a rural Honduran community. Anthropometric measurements were taken as measures of nutritional status among children under five years of age, while interviews regarding the household environment were conducted with their primary caregivers. Community participatory activities were conducted with primary caregivers, and results from water quality testing were analyzed for E. coli contamination. Anthropometric results were compared using the 1977 NCHS Growth Charts and the 2006 WHO Child Growth Standard to examine the implications of using the new WHO standard. The references showed generally good or excellent agreement between z-score categories, except among height-for-age classifications for males 24-35.9 months and weight-for-age classifications for males older than 24 months. Comparing the proportion of stunted, underweight, and wasted children, using the WHO standard generally resulted in higher proportions of stunting, lower underweight proportions, and higher overweight proportions. Logistic regression was used to determine which household and sanitation factors most influenced the growth of children. Results suggest only having water from a spring, stream, or other type of surface water as the primary source of drinking water is a significant risk factor for stunting. A protective association was seen between the household wealth index and stunting. Through participatory activities, the community provided insight on health issues important for improving child health. These activities yielded findings to be harnessed as a powerful resource to unify efforts for change. The qualitative findings were triangulated with the quantitative interview and water testing results to provide intervention recommendations for the community and its primary health care clinic. Recommendations include educating the community on best water consumption practices and encouraging the completion of at least some primary education for primary caregivers to improve child health. It is recommended that a community health worker program be developed to support and implement community interventions to improve water use and household sanitation behaviors and to encourage the involvement of the community in targeting and guiding successful interventions. ^

Resource Review: Child Food Insecurity: The Economic Impact on Our Nation

A review of Child Food Insecurity: The Economic Impact on our Nation. A Report on Research on the Impact of Food Insecurity and Hunger on Child Health, Growth and Development Commissioned by Feeding America and the ConAgra Foods Foundation by John Cook and Karen Jeng.

The interorganizational implementation of state health policy: A network approach

This is an implementation analysis of three consecutive state health policies whose goal was to improve access to maternal and child health services in Texas from 1983 to 1986. Of particular interest is the choice of the unit of analysis, the policy subsystem, and the network approach to analysis. The network approach analyzes and compares the structure and decision process of six policy subsystems in order to explain program performance. Both changes in state health policy as well as differences in implementation contexts explain evolution of the program administrative and service unit, the policy subsystem. And, in turn, the evolution of the policy subsystem explains changes in program performance. ^

Water to Thrive health needs assessment for Robit, Ethiopia

Developing countries suffer from an array of diseases, of which the developed world is unfamiliar. In order to facilitate the development of community interventions and streamline NGO partnership, needs assessments in targeted areas are conducted. The purpose of this assessment was to attain baseline descriptive data to further understand the needs of the village of Robit, Ethiopia. A trained team collected data from Austin based non-profit Water to Thrive (W2T) on June 1st and 2nd, 2011 through focus groups, key informant interviews, and individual surveys. Qualitative and quantitative data were paired to affirm the results of one another through triangulation. The results identified an apparent need for health intervention and education. Malaria, water-borne disease, respiratory issues (asthma, Upper respiratory tract infections), and maternal and child health were among the evident problems in Robit. There was a clear need for midwife training as well as water sanitation, latrine building, and general illness treatment. Poor road conditions and annual flooding of Robit plays an important role in the poor health and lack of food security of the village. While some evidence of social desirability and recall bias was found in the interview and survey data, the triangulation of findings provided important insights and validity to the needs assessment. ^

Observations from the Balcony: Directions for Pediatric Health Disparities Research and Policy

In 2002, the Institute of Medicine released Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare, a landmark monograph documenting health disparities in the U.S. health care system. Since the publication of Unequal Treatment, the field of pediatric health disparities research has advanced significantly with a proliferation of studies examining a wide array of topics concerning inequities in child health. Advances in health care policy and legislation have also added to a heightened discourse on pediatric health disparities. While there has been substantial activity in efforts to address pediatric health disparities, questions remain regarding whether these efforts have changed the trajectory of health equity among children. The aim of this paper is to examine the practical challenges of addressing pediatric health disparities in the dynamic context of global changes in health care research, policy, and legislation relevant to children. Using the Adaptive Leadership framework, this paper outlines a conceptual model for assessing the scope of progress made in addressing pediatric health disparities, diagnoses the continued adaptive challenges of pediatric health disparities, and provides an agenda for further work and future investment.

Considering Social Factors and Potential Moderation Effects in Children’s Health Research

In light of dramatic changes in American family demography in recent decades, there is a growing recognition that family structure is one of a host of important social factors contributing to children’s health and well-being. The article by Augustine and Kimbro contributes to a growing body of research linking children’s family structure and health outcomes, focusing specifically on the association between family living arrangements and children’s risk of obesity. Their analyses are especially helpful in suggesting that family scholars should pay more attention to potential heterogeneity in relationships between family structure and children’s outcomes.

A Tele-Health Communication and Information System for Underserved Children in Rural Areas of Nicaragua

Millennium Development Goals point out the necessity of actively promoting maternal-child health care status, especially in underserved areas. This article details the development actions carried out between 2008 and 2011 in some rural communities of Nicaragua with the aim to provide a low-cost tele-health communication service. The service is managed by the health care center of Cusmapa, which leads the program and maintains a communication link between its health staff and the health brigades of 26 distant communities. Local agents can use the system to report urgent maternal-child health care episodes to be assessed through WiMAX-WiFi voice and data communications attended by two physicians and six nurses located at the health care center. The health and nutritional status of the maternal-child population can be monitored to prevent diseases, subnutrition, and deaths. The action approach assumes the fundamentals of appropriate technology and looks for community- based, sustainable, replicable, and scalable solutions to ensure future deployments according to the strategies of the United Nations.

Análise do ganho de peso gestacional em mulheres da região Sudeste do Brasil e desfechos perinatais

Introdução: A obesidade é um dos grandes problemas de Saúde Pública e atinge níveis epidêmicos em grande parte do mundo. A maioria dos indivíduos com excesso de peso são mulheres, no Brasil o tamanho desta população também é expressivo, as em idade fértil são as que apresentam maior risco para o desenvolvimento da obesidade, o que está associado ao ganho de peso excessivo durante a gestação e a retenção de peso após o nascimento. O excesso de peso materno está relacionado a desfechos negativos para saúde materno-infantil. Objetivo: Analisar o peso gestacional e desfechos perinatais em mulheres da região sudeste do Brasil. Método: estudo transversal, com a utilização de dados provenientes de uma coorte nacional, com base hospitalar denominada: Nascer no Brasil: Inquérito Nacional sobre Parto e Nascimento, inquérito realizado no período de 2011 e 2012.Partindo da amostra inicial total do Sudeste composta por 10.154 mulheres entrevistadas e considerando os fatores de inclusão e exclusão para esta pesquisa, chegou-se a uma amostra de 3.405 binômios (mãe /recém-nascido).As variáveis estudadas foram ganho de peso, idade materna, peso pré-gestacional, Índice de Massa Corporal inicial e final, idade gestacional, tipo de parto e peso ao nascer. Análise foi realizada através das medidas de tendência central. Foi utilizado teste de Mann-Whitney para dados de distribuição normal e coeficiente de Pearson para variáveis contínuas. Foram considerados como significante os resultados com um p a 0,05. Resultados: A maioria das participantes apresentou faixa etária entre 21 e 30 anos, os nascimentos ocorreram entre a 38ª e 39ª semana gestacional, e seus recém-nascidos tiveram peso mediano de 3.219 g. Grande parte das pesquisadas (61,04 por cento ) iniciaram a gestação com um estado nutricional considerado adequado e 31,51 por cento apresentavam excesso de peso anterior à gestação. O ganho de peso excessivo ocorreu em todas as categorias de IMC pré-gestacional representando 49,6 por cento da população total estudada. O peso anterior à gestação apresentou elevada correlação com ganho de peso total ao final da gestação. Também foi observada influência do ganho de peso na gestação com a via de parto, idade gestacional e peso do bebê ao nascer. Conclusão: A maioria da população iniciou a gestação com estado nutricional adequado, porém, houve ganho de peso excessivo considerável em todas as categorias de IMC, este influenciou na via de parto onde a maioria aconteceu por operação cesariana e no peso ao nascer. O estado nutricional inicial influencia fortemente o estado nutricional ao final da gestação. Por isto, é importante que os programas de intervenção atuem em todas as etapas deste período, inclusive na conscientização da importância de um peso adequado anterior a concepção. Além de promover ações que auxiliem nos cuidados quanto ao ganho de peso na gestação.

Apoyo social formal a un grupo de madres con hijos menores de un año

Objetivo: este trabajo pretende analizar el apoyo social formal a un grupo de madres con hijos menores de un año. Método: estudio cualitativo, descriptivo interpretativo, en el cual participaron diez mujeres en un grupo focal que se reunió en siete ocasiones. Resultados: a partir del análisis de contenido de las dinámicas grupales se detecta que el apoyo formal informativo es el más frecuente y resulta difícil separarlo del emocional. Los profesionales, a través del apoyo informativo, tratan temas relacionados con la promoción de la salud y prevención de la enfermedad y acompañan a las madres en este rol. Conclusión: para las madres el apoyo formal brindado por el personal de enfermería es positivo y percibido como un refuerzo en su vivencia de la maternidad, y debe estar enmarcado en un contexto cultural.

Satisfacción en la provisión de redes de apoyo social en grupos de acompañamiento a la maternidad

Objetivos: Conocer la percepción del grado de satisfacción que tienen las madres, con hijos menores de un año y que participan en las dinámicas grupales que los CAP ofrecen, en relación al contenido y redes de provisión del Apoyo Social (AS) así como las causas que disminuyen la satisfacción en el receptor de este apoyo. Material y métodos: Estudio con diseño cualitativo y enfoque fenomenológico. La población objeto de estudio estaba constituida por madres participantes en dinámicas grupales de cinco CAP de la provincia de Barcelona. Como instrumento de recogida de datos se empleó la entrevista semiestructurada, entre julio de 2011 y julio de 2012; todas fueron grabadas, transcritas y analizadas. Resultados: AS informal: la mayoría de las madres están muy satisfechas-completamente satisfechas con el AS informativo, emocional y evaluativo procedente de las enfermeras; identificándose 4 categorías que contribuyen en esta percepción: contacto profesional/accesibilidad, disparidad y/o actualización, confianza y no procede. AS formal, la mayoría de las madres están muy satisfechas-completamente satisfechas con el AS informativo, emocional, evaluativo y técnico procedente de la pareja y madre (abuela materna); identificándose 8 categorías en esta percepción: disparidad y/o actualización en los consejos, exigencia, empatía, confianza, inseguridades, tiempo, distancia y no procede. Conclusiones: Los factores identificados deberían considerarse en los planes de mejora de la satisfacción y acompañamiento de las madres en este momento de profundos cambios en su vida; dado que aportar un AS satisfactorio repercute en la promoción de la salud y prevención de la enfermedad.

Percepción de la transición a la maternidad: estudio fenomenológico en la provincia de Barcelona

Objetivos: Describir necesidades y experiencias de madres con hijos menores de un año, identificar los factores que dificultan la transición a la maternidad y orientar en el contenido de un programa de promoción de la salud a desarrollar en sesiones grupales de apoyo a la maternidad. Diseño: Estudio cualitativo con enfoque fenomenológico. Emplazamiento: Ocho centros de Atención Primaria de la provincia de Barcelona, entre julio de 2011 y julio de 2012. Participantes: Un total de 21 madres que participan en dinámicas grupales de apoyo a la maternidad. Método: Selección opinática de las participantes en las entrevistas semiestructuradas. Las transcripciones se analizaron en su estructura (análisis de contenido latente) y contenido (análisis de contenido manifiesto), obteniéndose diferentes categorías. Resultados: Las participantes en el estudio definen el constructo de la maternidad en torno a 3 categorías: los cambios en el estilo de vida, los sentimientos y las percepciones. Identifican como momentos más estresantes: «el nuevo rol», «los cambios en la relación de pareja», «sentimientos encontrados», «experiencias del embarazo y parto», «la idealización», «la falta de apoyo», «llantos», «cólicos», «interpretar las señales del niño», «baño», «descanso», «opiniones contradictorias», «aprendizaje» y «adquisición de nuevas habilidades». Destacan como temas principales para las dinámicas grupales: alimentación, desarrollo, relación afectiva, confianza materna, participación de los padres, papel de la familia, aspectos emocionales, descanso, masaje, baño, prevención de accidentes, cólicos, primeros auxilios, puericultura, recursos y vacunas. Conclusión: Las dinámicas grupales deben contextualizarse de acuerdo a las necesidades percibidas por las madres y permitir la participación de otras figuras familiares.