Evaluation schedule for use in the study and appraisal of community health programs.

Mode of access: Internet.

The Michigan Community Health Service Project; an evaluation and interpretation.

Project sponsored by the Dept. of Public Instruction and the Dept. of Health.

Framingham monograph. Framingham community health and tuberculosis demonstration of the National Tuberculosis Association.

Mode of access: Internet.

A conceptual model of organized primary care and comprehensive community health services.

Mode of access: Internet.

The role of Community Health Workers. Historical perspective of facilitators and barriers. Case study in Vaupés, Colombia

Thesis (Master's)--University of Washington, 2016-06

Developing a protocol for the use of telenursing in community health in Australia

As the first step in developing a protocol for the use of video-phones in community health, we carried out a feasibility study among clients with a range of health needs. Clients were equipped with a commercially available video-phone connected using the client's home telephone line. A hands-free speaker-phone and a miniature video-camera (for close-up views) were connected to the video-phone. Ten clients participated: five required wound care, two palliative care, two long-term therapy monitoring and one was a rural client. All but two were aged 75 years or more. Each client had a video-phone for an average of two to three weeks. During the six months of the study, 43 client calls were made, of which 36 (84%) were converted to video-calls. The speaker-phone was used on 24 occasions (56%) and the close-up camera on 23 occasions (53%). Both clients and nurses rated the equipment as satisfactory or better in questionnaires. None of the nurses felt that the equipment was difficult to use, including unpacking it and setting it up; only one client found it difficult. Taking into account the clients' responses, including their free-text comments, a judgement was made as to whether the video-phone had been useful to their nursing care. In seven cases it was felt to be unhelpful and in three cases it was judged helpful. Although the study sample was small, the results suggest that home telenursing is likely to be useful for rural clients in Australia, unsurprisingly, because of the distances involved.

Information systems design for the community health services

This system is concerned with the design and implementation of a community health information system which fulfils some of the local needs of fourteen nursing and para-medical professions in a district health authority, whilst satisfying the statutory requirements of the NHS Korner steering group for those professions. A national survey of community health computer applications, documented in the form of an applications register, shows the need for such a system. A series of general requirements for an informations systems design methodology are identified, together with specific requirements for this problem situation. A number of existing methodologies are reviewed, but none of these were appropriate for this application. Some existing approaches, tools and techniques are used to define a more suitable methodology. It is unreasonable to rely on one single general methodology for all types of application development. There is a need for pragmatism, adaptation and flexibility. In this research, participation in the development stages by those who will eventually use the system was thought desirable. This was achieved by forming a representative design group. Results would seem to show a highly favourable response from users to this participation which contributed to the overall success of the system implemented. A prototype was developed for the chiropody and school nursing staff groups of Darlington health authority, and evaluations show that a significant number of the problems and objectives of those groups have been successfully addressed; the value of community health information has been increased; and information has been successfully fed back to staff and better utilised.

The role of the general practice pharmacist in community health care

DUE TO COPYRIGHT RESTRICTIONS ONLY AVAILABLE FOR CONSULTATION AT ASTON UNIVERSITY LIBRARY AND INFORMATION SERVICES WITH PRIOR ARRANGEMENT

Response process and test-retest reliability of the Context Assessment for Community Health tool in Vietnam

BACKGROUND: The recently developed Context Assessment for Community Health (COACH) tool aims to measure aspects of the local healthcare context perceived to influence knowledge translation in low- and middle-income countries. The tool measures eight dimensions (organizational resources, community engagement, monitoring services for action, sources of knowledge, commitment to work, work culture, leadership, and informal payment) through 49 items. OBJECTIVE: The study aimed to explore the understanding and stability of the COACH tool among health providers in Vietnam. DESIGNS: To investigate the response process, think-aloud interviews were undertaken with five community health workers, six nurses and midwives, and five physicians. Identified problems were classified according to Conrad and Blair's taxonomy and grouped according to an estimation of the magnitude of the problem's effect on the response data. Further, the stability of the tool was examined using a test-retest survey among 77 respondents. The reliability was analyzed for items (intraclass correlation coefficient (ICC) and percent agreement) and dimensions (ICC and Bland-Altman plots). RESULTS: In general, the think-aloud interviews revealed that the COACH tool was perceived as clear, well organized, and easy to answer. Most items were understood as intended. However, seven prominent problems in the items were identified and the content of three dimensions was perceived to be of a sensitive nature. In the test-retest survey, two-thirds of the items and seven of eight dimensions were found to have an ICC agreement ranging from moderate to substantial (0.5-0.7), demonstrating that the instrument has an acceptable level of stability. CONCLUSIONS: This study provides evidence that the Vietnamese translation of the COACH tool is generally perceived to be clear and easy to understand and has acceptable stability. There is, however, a need to rephrase and add generic examples to clarify some items and to further review items with low ICC.

Improving access for community health and sub-acute outpatient services: protocol for a stepped wedge cluster randomised controlled trial

BACKGROUND: Waiting lists for treatment are common in outpatient and community services, Existing methods for managing access and triage to these services can lead to inequities in service delivery, inefficiencies and divert resources from frontline care. Evidence from two controlled studies indicates that an alternative to the traditional "waitlist and triage" model known as STAT (Specific Timely Appointments for Triage) may be successful in reducing waiting times without adversely affecting other aspects of patient care. This trial aims to test whether the model is cost effective in reducing waiting time across multiple services, and to measure the impact on service provision, health-related quality of life and patient satisfaction.

METHODS/DESIGN: A stepped wedge cluster randomised controlled trial has been designed to evaluate the impact of the STAT model in 8 community health and outpatient services. The primary outcome will be waiting time from referral to first appointment. Secondary outcomes will be nature and quantity of service received (collected from all patients attending the service during the study period and health-related quality of life (AQOL-8D), patient satisfaction, health care utilisation and cost data (collected from a subgroup of patients at initial assessment and after 12 weeks). Data will be analysed with a multiple multi-level random-effects regression model that allows for cluster effects. An economic evaluation will be undertaken alongside the clinical trial.

DISCUSSION: This paper outlines the study protocol for a fully powered prospective stepped wedge cluster randomised controlled trial (SWCRCT) to establish whether the STAT model of access and triage can reduce waiting times applied across multiple settings, without increasing health service costs or adversely impacting on other aspects of patient care. If successful, it will provide evidence for the effectiveness of a practical model of access that can substantially reduce waiting time for outpatient and community services with subsequent benefits for both efficiency of health systems and patient care.

Agente Comunitário de Saúde (ACS): construção do percurso identitário a partir da história de vida

Esta pesquisa busca compreender a construção do percurso identitário do Agente Comunitário de Saúde (ACS) a partir da história de vida. Os objetivos colocados neste estudo foram analisar as formas como se constituíram os princípios e valores que orientam as práticas de cuidado do ACS e de construir uma narrativa que contemplasse como as contingências e os acasos produziram os sentidos para o seu percurso identitário. Para isto, utilizou-se a metodologia qualitativa heterogênea através da abordagem da História de Vida e da Análise de Conteúdo. A primeira - História de Vida, segundo Becker (1994) é a expressão de uma forma de vida, de conhecer crenças, valores e desejos de uma população estudada dentro do contexto da vida destes sujeitos. Para tanto, foram realizadas entrevistas com seis ACS que atuam há pelo menos dois anos no município do Rio de Janeiro. As entrevistas foram gravadas e, parcialmente, transcritas após o aceite e a assinatura do termo de consentimento. Acredito que os agentes podem operar entre si diferentes modos de fazer, uma vez que afetam e sofrem afetamentos, atravessam e ao mesmo tempo são atravessados por diferentes micro redes que geram solidariedade ou individualismo, humanidade ou animosidade nas inter-relações. Neste contexto, o estudo conclui que ainda que a maioria dos entrevistados não escolhesse a carreira de ACS, houve uma disponibilidade para aprender o ofício e um compromisso com as atribuições definidas para o exercício profissional. Aliado a isso, constatou-se também, que a inserção na profissão foi uma forma de conseguir um emprego formal que garanta uma renda fixa mensal. Não há o desejo de permanecer por muito tempo nesta profissão pelo desgaste físico e emocional que é fortemente sentido já no primeiro ano de trabalho. Em relação à construção dos sentidos para o percurso identitário dos ACS, os depoimentos apresentam uma identificação com as ações de ajuda e solidariedade presentes na vida dos sujeitos. E, dentre os valores ou princípios que constituíram a formação de um caráter ou identidade pessoal, que são determinantes para a atuação no cuidado à saúde das pessoas, destacam-se a sensibilidade, a escuta, o afeto, o acolhimento, a ética, a amizade e alteridade. Na discussão sobre a necessidade deste profissional ser morador da área que vai atuar, observou-se, a partir das narrativas, que esta exigência pode facilitar a abordagem. Contudo, a qualidade do cuidado não está diretamente relacionada a este critério que pode gerar distanciamento e desconfiança dos outros moradores. Logo, estudos como este se justificam para que se possa reafirmar a importância de trabalhadores do SUS, em especial, o ACS. Estes representam hoje mais de 200 mil trabalhadores da saúde pública e se espera que sejam profissionais responsáveis por um cuidado em saúde que respeitem as diferenças entre as pessoas, que não sobreponham a doença ao sujeito e não minimizem o sofrimento em função do cumprimento de metas e produção de dados a serem planilhados. Lutem, acima de tudo, pela defesa de qualquer vida.

O agente comunitário de saúde frente ao processo de trabalho em equipe: facilidades e dificuldades

O estudo propõe-se a analisar as dificuldades e facilidades dos Agentes Comunitários de Saúde (ACS) frente ao trabalho em equipe. A análise pautou-se na perspectiva hermenêutica-dialética, tendo como referência os princípios do método de interpretação dos sentidos. As dificuldades e facilidades apontadas por eles revelam que trabalhar em equipe demanda relações efetivas, com ênfase na comunicação, respeito e cooperação, sendo as reuniões de equipe estratégia importante para isso. Depreende-se a necessidade de constantes investimentos nas relações entre os membros da equipe.