Identification of Predictive Factors of BMI and High Risk Hypertension in Rural Nicaraguan Community

Thesis (Master's)--University of Washington, 2013

Community Care Access Centre accountability reforms: executive director perceptions /

The purpose of this study was to explore how four purposefully selected executive directors of Community Care Access Centres (CCACs) understood the idea of accountability, and how they viewed the accountability reforms that had been imposed on their sector of health care over the previous three years. Data were collected through personal interviews and a reflective journal. An analysis of key documents and the reflective journal informed the data analysis. The findings suggest that executive directors perceive that accountability relationships have shifted since reforms have been implemented. They noted that CCACs have become more accountable to the provincial government at the expense of accountability to the local community. From their perspective, the demand for greater standardization and bureaucratization has left fewer opportunities to adapt programs to meet particular community needs and has slowed the ability to respond quickly to community inquiries and concerns.

Exploring the Ethical Decision-Making Processes of Community Care Providers

While there has been a recent shift away from isolated, institutionalized living conditions, persons with Intellectual Disabilities (ID) may still experience restricted access to choice when it comes to making decisions about the basic aspects of their lives. A tension remains between protecting individuals from harm and promoting their right to independence and personal liberties. This tension creates complex questions and ethical concerns for care providers supporting persons with ID. This study explored the ethical decision-making processes of care providers and specifically, how care providers describe the balance of protecting supported individuals from harm while promoting their right to self-determination. Semi-structured interviews were conducted with six care providers employed by a local community agency that supports young and older adults with ID. Data were analysed using thematic analysis and broader themes were developed following phases of open and selective coding. Results indicated that care providers described ethical decision-making processes as frequent, complex, subjective, and uncomfortable. All participants described the importance of promoting independent decision-making among the individuals they support and assisting supported individuals to make informed decisions. Participants also reported work colleagues and supervisors as primary sources of information when resolving ethical concerns. This suggests that complex ethical decision-making processes are being taken seriously by care providers and supervising staff. The results of this study are well-positioned to be applied to the development of a training program for frontline care providing staff supporting individuals in community care settings.

Les stratégies d'intervention de l'Association des Paysans de Vallue (APV) dans le développement local

Ce mémoire porte sur le mouvement de l’Association des Paysans de Vallue (APV), qui a vu le jour après la chute de la dictature des Duvalier en Haïti en 1986. La recherche vise à cerner les stratégies mises en œuvre par l’APV dans le développement local, la portée et les impacts de ses initiatives locales sur les conditions de vie des paysans et sur leur relation avec le territoire de Vallue. Elle vise également à identifier les modes de participation des paysans dans la dynamique de développement local qui est implantée par l’APV à Vallue. Après avoir présenté une brève revue de littérature sur le développement local en Haïti, nous évoquons les problèmes confrontés par les paysans et les stratégies qu’ils ont développées en vue de trouver des moyens de survie. Pour comprendre et étudier l’expérience de l’APV à Vallue, nous nous sommes inspirés des perspectives théoriques portant sur le développement local et sur les stratégies d’intervention. La recherche est de type qualitatif ; elle est articulée autour de dix-sept (17) entretiens réalisés avec les vingt-et-un (21) participants recrutés à Vallue. Les résultats de la recherche indiquent que l’APV a su orchestrer des stratégies variées pour réaliser un développement qui est ancré localement et qui répond aux besoins des paysans. En misant sur l’éducation, la sensibilisation, la négociation, la concertation, le partenariat et en mobilisant des ressources locales et externes, l’APV a su réaliser des interventions qui provoquent tout un changement de mentalité et une conscience collective chez les paysans qui développent de nouvelles manières de faire dans l’éducation de leurs enfants et dans la protection de l’environnement de la zone. La route construite par l’association rend Vallue accessible et ouverte, ce qui facilite le développement et permet l’organisation d’une activité comme la foire de la montagne qui met en valeur les produits locaux et la culture locale. L’APV a su apporter des éléments de solution aux problèmes confrontés par les paysans et ses interventions ont des impacts sur leurs conditions de vie et sur leur relation avec le territoire de Vallue. Ils s’identifient mieux au territoire et développent toute une fierté par rapport à leur espace. En outre, la participation des paysans tant dans les élections, la prise de décision et les projets, constitue un élément important. Toutefois, cette participation comporte certaines limites liées au niveau d’éducation des membres de certains groupes. Enfin, il importe de souligner qu’à travers le dernier chapitre de la recherche nous dégageons les points de convergence et de divergence entre la partie théorique et la partie empirique.

Standard of Living and Community Perception in the Community Based Ecotourism (CBET) Sites of Kerala: An Inter Zone Analysis

This study is an attempt to situate the quality of life and standard of living of local communities in ecotourism destinations inter alia their perception on forest conservation and the satisfaction level of the local community. 650 EDC/VSS members from Kerala demarcated into three zones constitute the data source. Four variables have been considered for evaluating the quality of life of the stakeholders of ecotourism sites, which is then funneled to the income-education spectrum for hypothesizing into the SLI framework. Zone-wise analysis of the community members working in tourism sector shows that the community members have benefited totally from tourism development in the region as they have got both employments as well as secured livelihood options. Most of the quality of life-indicators of the community in the eco-tourist centres show a promising position. The community perception does not show any negative impact on environment as well as on their local culture.

The local population and museums. An analysis based on the use of museums in the Alt Pirineu and Aran Region (Catalonia, Spain)

His paper is based on a study of visitors to the museums in the Alt Pirineu and Aran region (Catalonia, Spain). We describe the characteristics of the museums’ users and analyse the relationship between the museums and the local community. We highlight the importance of these facilities for local development, and the need to consider and prioritize their role as culture centres for the region’s population.

Establishing a community of practice of researchers, practitioners, policy-makers and communities to sustainably manage environmental health risks in Ecuador

The Sustainably Managing Environmental Health Risk in Ecuador project was launched in 2004 as a partnership linking a large Canadian university with leading Cuban and Mexican institutes to strengthen the capacities of four Ecuadorian universities for leading community-based learning and research in areas as diverse as pesticide poisoning, dengue control, water and sanitation, and disaster preparedness. By 2009, train-the-trainer project initiation involved 27 participatory action research Master’s theses in 15 communities where 1200 community learners participated in the implementation of associated interventions. This led to establishment of innovative Ecuadorian-led master’s and doctoral programs, and a Population Health Observatory on Collective Health, Environment and Society for the Andean region based at the Universidad Andina Simon Bolivar. Building on this network, numerous initiatives were begun, such as an internationally funded research project to strengthen dengue control in the coastal community of Machala, and establishment of a local community eco-health centre focusing on determinants of health near Cuenca. Alliances of academic and non-academic partners from the South and North provide a promising orientation for learning together about ways of addressing negative trends of development. Assessing the impacts and sustainability of such processes, however, requires longer term monitoring of results and related challenges.

Facebook faith - social networking in a faith based community

This paper views the increasing social networking as an efficient emerging ministry to the moveable generation. Through social network such as Facebook, ministry from a pastoral perspective can become more authentic and meaningful. Ministry is relational. Social Networking sites provide a strong platform to being part in other people’s life. Social networking and living online builds community beyond geographical boarders. Young adults and youths digital identity often reflects their faith, this is supported by research which suggests a practice of more openness to share and expose private issues online. Spiritual and religious views are freely shared, creating sacred spaces in the midst of life practising a holistic faith identity in a secular community. Providing a strong platform for information flow, Social Network is attractive in a postmodern society where inviting people to join in events are perceived as non threatening, making church community events transparent and available to people who do not attend church, inviting spiritual friendships and relationships. Social Networking strengthens relationship in a non hierarchical manner and invites the minister into lives where there previously would have been barriers, engaging in prayer and bible study as well as pastoral care through social networking, thus relationships deepens via social networking making people real. It has been observed that, although community building happens on the net, church affiliation loyalty remains to the local community. Therefore presence ministry though social networks emerges as a core form of ministry, where relations to youth who move from local church to university campuses are kept alive. The asynchronous nature of communication within social networking eases the minister in her work. The minister is able to engage with many individuals at the same time. Before the minister could visit one person at a time, now she visits 5-6 individuals at any given time. Therefore social networking not only increases the quality of the work, but also empowers the minister to be more efficient.

Community perceptions of four protected areas in the Northern portion of the Cerrado hotspot, Brazil

Establishing effective networks of protected areas (PAS) is one of the major goals of conservation strategies worldwide. However, the success of PAS in promoting biodiversity conservation depends on their integration to local and regional contexts, reducing and mitigating human impacts originating from buffer zones. Community perceptions affect interactions between residents and PAS, and thereby conservation effectiveness. Research at Tocantins state (northern Brazilian Cerrado), aimed to analyse local community perceptions of four PAs, discussing how different factors may influence these. Perceptions were assessed through standardized interviews applied to PA employees and 275 local inhabitants. There was modest community participation in PA establishment and management. Residents were aware of the PAS` existence, but were unfamiliar with their goals. Length of residency and occupation of inhabitants influenced their PA perceptions, shaping different people-park relations in each of the four studied PAs. Involvement of local residents in PA planning and management represents a central strategy to strengthen local support for PAS over the long term. In those areas that still have settlements inside their boundaries, community relocation should follow a careful participatory process to avoid significant changes in local perceptions and attitudes towards these PAS, crucial for conserving Brazilian biodiversity.

Rethinking schools and community : the knowledge producing school

Schools appear in some accounts of community informatics as part of community, one of a number of organisations that need to be taken into account, perhaps on the basis of them being useful physical or human resources around which community informatics might be based. For their part, schools, at least in Australia, have been an important, early element in the broad take-up of computing and communication technologies (CCTs) by the community. Apart from the possibility of using school resources to support community access out of school time and based on what is published in both fields, schools and work in community informatics have tended to operate independently of one another. There are, nonetheless, interesting parallels in these two broad areas of activity which promote the use of CCTs. This chapter outlines a new research agenda in which schools produce knowledge for local community and in doing so develop new and productive community partnerships. The development provides interesting opportunities for the transformation of regions via this approach to community informatics. The background to this project is based in the long history of using CCTs in schools. The chapter will argue that the way in which schools understand CCTs is crucial to shaping what is possible to be done with CCTs in schools. Shifting the emphasis from information to relationships opens up alternatives that provide opportunities for significant, new relationships with community.

Health status and participation in a range of activities in an Australian community

Introduction: The aim of the research was to determine the relationship between levels of participation in a community and self-assessed health status of people in a rural and regional setting.
Method: A cross-sectional design, using a mailed, self-administered questionnaire was used. Questionnaires were mailed to a random sample of people aged 18 years and over who were registered on the electoral roll of a regional city and rural area, the Barwon and Otway regions of Victoria, Australia. The sample consisted of 1752 participants: 990 females (57%), 739 males (42%) and 23 sex undisclosed (1%). The range of participants was 18-98 years, and the mean age was 50.53 years (SD = 17.19).
Results: Self-assessed physical and mental health were measured using the SF-12 scale. Participants with low incomes, and those with low self-assessed physical and mental health scores, were significantly more likely than other participants to agree with one or more of the social isolation items, indicating that they experienced some social isolation. Low levels of participation in social, sports, leisure or support activities were associated with low self-assessed physical and mental health. Disengagement with the local community was associated with low levels of self-assessed mental health. While younger people were more likely than older people to participate in social, sports, leisure or support activities, they were less involved as members of their community. Females were more likely than males to have been involved in five or more sports, leisure or support activities. Participation in civic activities was associated with high income. Levels of participation in the four different types of activities were combined (social activities, sport, leisure or support activities, community and group activities, and civic activities). Participants classified as low participators were more likely to be older participants, to have a low income and to have low scores for both physical and mental health.
Conclusions: An association was found between health and community participation in a range of activities, and between health and engagement with the community in this rural and regional population. These findings are consistent with those reported from similar research with a metropolitan population sample. The current research suggests that the groups of people of most concern in terms of low participation rates, are people who have low incomes, people aged over 65 years, people who may be defined as possessing poor physical health and people who may be defined as possessing poor mental health. The relationship between age, community participation and health is complex and needs further exploration because it is not known whether poor health reduces community participation or whether reduced community participation results in poor health. However, current research suggests that developing and implementing strategies to promote people's engagement with and involvement in their local community is one important way of promoting the health of the community as a whole.

The theory and practice of coastal area planning: linking strategic planning to local communities

Integrated coastal management (ICM) has been slowly accepted over the last decade as a unifying approach for coastal planning and management throughout the world. Coastal planning aimed at achieving the objectives of ICM can be implemented by varying processes and faces many challenges. One major challenge for coastal planning is to adapt the well-developed theoretical principles of ICM to practical and understandable outcomes in local areas. Associated with this challenge is the need to balance coastal planning objectives for conservation and economic development of a nation or state/province with the objectives of the local community. This article describes a three-tiered approach to coastal planning in Victoria, Australia, which will be of value to other countries, particularly those with subnational coastal planning jurisdictions. This approach not only has the aim of balancing subnational (e.g., state government) and local objectives, but also of applying the theoretical concept of ICM in practice on the ground. In addition, the approach sets out to achieve a sense of ownership of the planning process by local communities by maximizing their involvement at all levels of planning and also by making the state strategy as easy to understand and follow as possible.

Linking human and ecosystem health: the benefits of community involvement in conservation groups

This study explored the health, well-being, and social capital benefits gained by community members who are involved in the management of land for conservation in six rural communities across Victoria. A total of 102 people participated in the study (64 males; 38 females) comprising 51 members of a community-based land management group and 51 controls matched by age and gender. Mixed methods were employed, including the use of an adapted version of Buckner’s (1988) Community Cohesion Scale. The results indicate that involvement in the management of land for conservation may contribute to both the health and well-being of members, and to the social capital of the local community. The members of the land management groups rated their general health higher, reported visiting the doctor less often, felt safer in the local community, and utilized the skills that they have acquired in their lifetime more frequently than the control participants. Male members reported the highest level of general health, and the greatest satisfaction with daily activities. Members also reported a greater sense of belonging to the local community and a greater willingness to work toward improving their community than their control counterparts. Of equal importance is evidence that involvement in voluntary conservation work constitutes a means of building social capital in rural communities which may help reduce some of the negative aspects of rural life.

Community governance in rural Victoria: Rethinking grassroots democracy?

The development of local community associations in small rural towns in Victoria has engendered a sense of local self-governing that can be described as a shift from government to governance. This ‘more flexible’ approach extends beyond government, and the place of its agencies, to a greater sharing of power between the state, the market and civil society via new network and partnership structures. The question arises whether  community networks and partnerships bring with them a new sense of  democracy as well. The paper begins with a discussion of governance, its  relationship to two democratic frameworks - liberal minimalism (or representative governance) and associationalism - and the implications for democracy in community governance. Focusing on three internal factors (accountability of the leadership, inclusiveness and the scope of  responsibility), and two external factors (relationships to the state and types of relationships with other groups), the paper then explores the ways that community governance has been adopted in rural Victoria using in-depth interviews and a survey of community groups in 35 small rural towns. The ensuing discussion argues that while these community associations may be involved in forms of associational democracy, there is still some doubt about the inclusiveness of their membership and the extent to which their advocacy represents all sections of their communities. The paper then  concludes by suggesting that representative and associational forms of democracy need not be seen as opposites but as a more enhanced form of local governance.

Changing community perceptions of 'place'

In May 2002 the Australian Department of Defence announced its intention to divest the Defence land at Portsea on the Mornington Peninsula, Victoria. At the same time nominations were invited for membership of the Community Reference Group (CRG) established as part of the Portsea Defence Land Master Planning Project. The author actively participated in this voluntary advisory group which provided input on matters of interest to the community relating to the project, provided a medium for information sharing and addressed the sometimes competing needs of different stakeholder groups (such as government, business and residents). A major role of the CRG was to provide a focus for community input on aspects of technical issues, particularly in relation to the planning for the future use of the site, flora and fauna issues, infrastructure provision, traffic and access management, heritage and archaeology, and the integration of the site with both the natural environment and existing community facilities, including the township of Portsea. The author's professional background in art and architectural history, in teaching and in research specifically in heritage related areas; her record of community work both in hands on work and in leadership positions, in Melbourne and on the Nepean Peninsula, enabled her to make a significant and useful contribution to the CRG in contributing to the understanding of the rich, diverse, multilayered cultural and natural heritage of the entire site.

Using this specific example, this paper examines the process of participating in Australian society through engaging communities - engaging women. It examines the invitation to participate, the nomination and selection process, the brief given to the community reference group, the development of the consultative process over the six months of deliberations, and the important role that women played in the project. It looks at what can be learned from the experience: how women in particular led the way in changing perceptions of place within the local community, and consequently in the broader framework of the project. It examines the success of the outcomes both in terms of the specific task of writing the Master Plan for the Portsea Defence site and of the process of community participation: the dynamic inter-relationships in the group; between the group and the consultants; between the group and the Department of Defence and between the group and the Federal Government. It comments reflectively and critically on the effectiveness of the whole process.