Process evaluation of a knowledge translation intervention using facilitation of local stakeholder groups to improve neonatal survival in the Quang Ninh province, Vietnam

BACKGROUND: Annually, 2.8 million neonatal deaths occur worldwide, despite the fact that three-quarters of them could be prevented if available evidence-based interventions were used. Facilitation of community groups has been recognized as a promising method to translate knowledge into practice. In northern Vietnam, the Neonatal Health - Knowledge Into Practice trial evaluated facilitation of community groups (2008-2011) and succeeded in reducing the neonatal mortality rate (adjusted odds ratio, 0.51; 95 % confidence interval 0.30-0.89). The aim of this paper is to report on the process (implementation and mechanism of impact) of this intervention. METHODS: Process data were excerpted from diary information from meetings with facilitators and intervention groups, and from supervisor records of monthly meetings with facilitators. Data were analyzed using descriptive statistics. An evaluation including attributes and skills of facilitators (e.g., group management, communication, and commitment) was performed at the end of the intervention using a six-item instrument. Odds ratios were analyzed, adjusted for cluster randomization using general linear mixed models. RESULTS: To ensure eight active facilitators over 3 years, 11 Women's Union representatives were recruited and trained. Of the 44 intervention groups, composed of health staff and commune stakeholders, 43 completed their activities until the end of the study. In total, 95 % (n = 1508) of the intended monthly meetings with an intervention group and a facilitator were conducted. The overall attendance of intervention group members was 86 %. The groups identified 32 unique problems and implemented 39 unique actions. The identified problems targeted health issues concerning both women and neonates. Actions implemented were mainly communication activities. Communes supported by a group with a facilitator who was rated high on attributes and skills (n = 27) had lower odds of neonatal mortality (odds ratio, 0.37; 95 % confidence interval, 0.19-0.73) than control communes (n = 46). CONCLUSIONS: This evaluation identified several factors that might have influenced the outcomes of the trial: continuity of intervention groups' work, adequate attributes and skills of facilitators, and targeting problems along a continuum of care. Such factors are important to consider in scaling-up efforts.

The relationship between lower body strength and obstructed gait in community-dwelling older adults

OBJECTIVES: To determine the relationship between lower body strength of community-dwelling older adults and the time to negotiate obstructed gait tasks.

DESIGN: A correlational study.

SETTING: The Biomechanics Laboratory, Deakin University, Australia.

PARTICIPANTS: Twenty-nine women and 16 men aged 62 to 88 were recruited using advertisements placed in local newspapers. The participants were independent community dwellers, healthy and functionally mobile.

MEASUREMENTS: Maximal isometric strength of the knee extensors and dynamic strength of the hip extensors, hip flexors, hip adductors, hip abductors, knee extensors, knee flexors, and ankle plantar flexors were assessed. The times to negotiate four obstructed gait tasks at three progressively challenging levels on an obstacle course and to complete the course were recorded. The relationship between strength and the crossing times was explored using linear regression models.

RESULTS: Significant associations between the seven strength measures and the times to negotiate each gait task and to walk the entire course at each level were obtained (r = -0.38 to -0.55; P < .05). In addition, the percentage of the variance explained by strength (R2), consistently increased as a function of the progressively challenging level. This increase was particularly marked for the stepping over task (R2 = 19.3%,25.0%, and 27.2%, for levels 1, 2, and 3, respectively) and the raised surface condition (R2 = 17.1%,21.1%, and 30.8%, for levels 1,2, and 3, respectively) .

CONCLUSION: The findings of the study showed that strength is a critical requirement for obstructed locomotion. That the magnitude of the association increased as a function of the challenging levels suggests that intervention programs aimed at improving strength would potentially be effective in helping community-dwelling older adults negotiate environmental gait challenges.

Partnerships for capacity building: community, governments and universities working together

This paper summarises initiatives in the area of capacity building between communities, governments and universities since Rio 1992.

First the global advances through the UN and associated agencies are described with lessons learned and challenges remaining being highlighted. This is followed by a similar approach for first regionally based initiatives and finally some of the better examples of nationally based approaches.

Among the key findings from the review were: trying to keep the initial message simple, asking the “user” what they want and what they need from capacity building, the use of local experts in capacity building where ever possible, universities extending themselves to engage in genuine partnerships as well as offering new courses, subjects, etc., attempting to match the strengths and weaknesses of partners in capacity building, concentrating on improving regional partnerships across national boundaries, deriving methods to sustain capacity building programs over the long term, questioning the absence of the private sector from capacity building partnerships, questioning whether capacity building is receiving the attention, funding and centrality to ICM promotion that it warrants, a proposal to build a global ICM capacity building network, the need for greater critical analysis of capacity building programs, integrating capacity building into ICM practices and recognising that effective capacity building practice may require some time and effort to build up, i.e. there are no universal “quick-fixes”.

New community governance in small rural towns: the Australian experience

State and federal governments in Australia have developed a range of policy instruments for rural areas in Australia that are infused with a new sense of ‘community’, employing leading concepts like social capital, social enterprise, community development, partnerships and community building. This has encouraged local people and organisations to play a greater role in the provision of their local services and has led to the development of a variety of ‘community’ organisations aimed at stemming social and economic decline. In Victoria, local decision-making, before municipal amalgamations, gave small towns some sense of autonomy and some discretion over their affairs. However, following municipal amalgamations these small towns lost many of the resources—legal, financial, political, informational and organisational—associated with their former municipal status. This left a vacuum in these communities and the outcome was the emergence of local development groups. Some of these groups are new but many of them are organisations that have been reconstituted as groups with a broader community focus. The outcomes have varied from place to place but overall there has been a significant shift in governance processes at community level. This paper looks at the processes of ‘community governance’ and how it applies in a number of case studies in Victoria.

Governance at community level : small towns in rural Victoria

The 'blurring' of the boundaries between and within public and private sectors has led to new styles of governing that affect the way that rural communities organise themselves. Some have called this a shift from 'government' to 'governance' where there has been a convergence of neo-liberal and communitarian ideologies to form the basis of a new relationship between the state, the market and civil society. We analyse the impact of these converging ideologies using a survey of development groups in 35 towns in rural Victoria and explore the types of community governance that have emerged as a response to changes in those towns that lost their local government authorities in the last decade of the twentieth century.

Changing communities: international students in local government schools

Although fewer than 10% of international students are in the primary and secondary educational sectors, recent figures show the number of these students to have increased exponentially making Australia a leading player in school education provision along with Britain and the United States. The impact of these changes on local schools and the correspondent negotiation of globalising trends on secondary schools alter the ways that identity and difference are understood and played out and the ways that policy and practice in participating schools can be understood At the same time the terms and conditions that define these demands - particularly as they characterize them as marketable commodities. English language and as global and western education need to spelt out and interrogated. In this paper 1 interrogate the ways that community members within local government schools speak about the impact of fee-paying international students on their school. 1 suggest that these discussions are defined by the material and conceptual relations of identity and difference crisscrossed by the politics of consumption and production.

Walkability of local communities: using geographic information systems to objectively assess relevant environmental attributes.

Geographic Information Systems (GIS) can be used to objectively measure features of the built environment that may influence adults’ physical activity, which is an important determinant of chronic disease. We describe how a previously developed index of walkability was operationalised in an Australian context, using available spatial data. The index was used to generate a stratified sampling frame for the selection of households from 32 communities for the PLACE (Physical Activity in Localities and Community Environments) study. GIS data have the potential to be used to construct measures of environmental attributes and to develop indices of walkability for cities, regions or local communities.

Collaborative online projects in a global community

What is evident in recent literature reviews of the use of Information and Communication Technologies (ICT) in Education is the lack of accessible documentation on the development of, and participation in, collaborative online projects by educationalists. (Blackmore et. al. 2002, Downes et. al. 2001). The major source of information comes in the form of anecdotal evidence from teachers, project facilitators and organisations (Gragert 2000, Carr 2001, Tate 1998, Robertson 1999). Other literature reviews and research that focus on the use of ICT in education have significant gaps in this area and yet it is increasingly promoted in educational policy and supported and promoted by education systems.

This paper identifies and explores the extent and impact of educational technology in the context of collaborative online projects in a global educational community. A general identification of a wide range of local and international collaborative online projects and the groups/communities in which they operate, is followed by a closer look at a selection of case study projects. The case study projects have been selected for their potential to provide new perspectives on the role of technology in education and its potential impact on teaching and learning in a global context.

This paper provides definitions and examples of collaborative online projects, their history and their diversity. It explores the level of participation afforded by the projects and presents a detailed section that focuses on a sample of projects. The collaborative online projects in the case study section are The Environmental Mystery Competition, The First People's Project, Lewin - an Anthology of Children's' Writing and The Teddy Bear Project. The case study projects will be looked at from the perspective of the project facilitators and project participants. In many of the projects items such as books and calendars are products of the projects. Examples of these items will be shown in the presentation.

Data infrastructure for evidence-based local government policy

This paper outlines an approach for collecting and integrating data useful for evidence based planning and decision making in the not-for-profit sector, in particular for local government policy and planning. Given the methodological advances in multi-level analysis and the nature of rigorous policy analysis, leading academics and practitioners are advocating that policy driven research to be undertaken at a number of levels of analysis. Recent years have brought an explosion of public domain data in many aspects of social, economic and cultural aspects of society (cites and examples) and with this comes the opportunity, as outlined here, to integrate relevant public domain data in order to construct community profiles for local government areas in Victoria.

Community valuations of historic pocket parks: a Melbourne study

The internal reserve, an historic form of planned open space creating semi-private parks at the rear of residential allotments and without street frontages, can be found in Australian suburban areas of diverse socio-economic status. Internal reserves commonly express the idealism of the early town planning movement, which envisaged the internal reserve as an embedded community-building mechanism with multiple potential uses. En vogue from 1910-1930, the internal reserve concept proved problematical from the outset. Even today, while many residents agree that their reserves are responsible for the special nature of their domestic environment, others are apprehensive about safety, maintenance and custodianship. Two surveys of residents living around internal reserves in four Melbourne suburbs, conducted in 1979 and 2002, reveal a variety of opinions on the potential and importance of these spaces. Local communities were found for the most part to have negative and ambiguous perceptions of these reserves. With one exception, residents did not value the parks highly as community spaces and alternative uses may need to be explored. The results suggest that a more innovative set of tools and incentives may be needed to reinvigorate the internal reserve as a significant recreation resource for local communities.

Victorian local government and women's political participation in small towns.

Rural women were involved in the struggle for women's suffrage in Victoria but their entry into local government has been slower than in urban centres. This paper takes as its starting point Ken Dempsey's analysis of the hegemonic masculine structure of small Victorian towns in the 1980s and Amanda Sinclair's notion of the maternal feminist being the prototype of the rural woman councillor at that time. My study, which is based upon a qualitative interview study with 12 women councillors across rural Victoria during February 2004, reveals that women in small towns are now much more likely to challenge the notion of masculine hegemony by playing a more proactive role in community affairs in small towns. For them, local government service is a logical and practical way to help improve the quality of life in their constituencies. This is also because the traditional rural definition of local government with its main function to ensure adequate infrastructure provision for its ratepayers to maintain viable farming and other productive operations is changing. Furthermore, these women challenged the notion of the maternal feminist by embracing broader political agendas and operating with different representational styles than those associated with previous generation of women on local councils in small towns. On a theoretical level, the paper concludes by suggesting that while the notion of a 'critical mass' in terms of women's political participation is important, there is also a need to explore women's accounts of ‘critical acts’ in the everyday decision-making of local government.

Objectively assessing "Walkability" of local communities: using GIS to identify the relevant environmental attributes.

Geographic Information Systems (GIS) may be used to measure objectively, those features of the built environment that may influence walking. Public health research on environmental determinants of physical activity in adults shows that different factors can influence walking for recreation, compared to walking for transport. Most studies have used perceived (self-report) rather than objective measures of potentially relevant environmental attributes. We describe how a previously-developed index of ‘walkability’ was operationalized in an Australian context, using available spatial data.               Attributes believed to be of relevance to walking for transport, that are measurable using GIS, are: Dwelling density (higher-density neighborhoods support greater retail and service variety, resulting in shorter, walkable distances between facilities; driving and parking are more difficult and time consuming). Connectivity (higher intersection densities provide people with a greater variety of potential routes, easier access to major roads where public transport is available and shorter times to get to destinations). Land use mix (the more varied the land use mix and built form, then the more conducive it is to walk to various destinations). Net retail area (there are more options for destinations where goods and services may be purchased and more local employment opportunities that can be reached by walking). The associations of these attributes with walking behaviors can be  examined separately, or in combination. Such GIS data are very helpful in fundamental studies of the environmental determinants of behavior, and also in applied policy research for cities, regions or local communities, to
address public health and environmental issues.

Measuring wellness through interdisciplinary community development: linking the physical, economic and social environment

The aim of this study is to answer the question: Is there evidence that the quality of life of residents in a community that has had community development intervention is different as compared to the quality of life of residents in a nearby community that did not have community development initiatives? This was done by administering community development initiatives in a local area and comparing it to a similar community that did not receive this intervention. The residents of these communities rated the quality of their lives and communities in two purposively selected suburbs in Perth, Western Australia using the Australian Unity Wellbeing Index to measure individual and neighbourhood well-being. The quality of life of residents in both communities is then compared to national averages for quality of life or well-being. Answering this question provides empirical evidence of variation between ratings of quality of life of residents in different communities and highlights the utility of the Wellbeing Index for the evaluation of interdisciplinary community development

Does walking in the neighbourhood enhance local sociability?

The walkability of urban neighbourhoods has emerged as a strong component in policy and design models for active, liveable communities. This paper examines the proposition that more walkable neighbourhoods encourage local social interaction, a sense of community, informal social control and social cohesion; and that the relationship is explained by walking for transport or for recreation. Multilevel analyses of data from an Australian sample showed a modest association between the walkability of a neighbourhood and sense of community only. Walking for transport, but not recreation, mediated this relationship although the effect was small. These results support contentions that 'walkability' is more complex than usually defined and that factors influencing neighbourhood sociability extend beyond issues of urban form.

Local health policy development processes in the Netherlands: an expanded toolbox for health promotion

Although much research has been done on the existence and formation of risk and issue based health policies, there is only little insight in health policy development processes in a broader context. This hampers intervention in these policy processes to adequately develop integrated and effective health policies.

Legislation in the Netherlands requires municipalities to develop and implement local health policies. These policies are supposed to aim at the promotion of health across sectors and with a strong community involvement. Health policy development processes have been studied in four Dutch municipalities. For each case, we identified a range of stakeholders and monitored the change or stability of their characteristics over 3 years. In addition, for each case, three overlaying maps of networks were made addressing communication and collaboration actions within the defined set of stakeholders. We point out a number of barriers which impede integrated policy development at the local level: the importance given to local health policy, the medical approach to health development, the organizational self-interest rather than public health concern, the absence of policy entrepreneurial activity.

Furthermore, this article advocates the use of complementary theoretical frameworks and the expansion of the methodological toolbox for health promotion. The value of stakeholder and network analysis in the health promotion domain, at this stage, is two-fold. First, mapping relevant actors, their positions and connections in networks provides us with insight into their capacity to participate and contribute to health policy development. Second, these new tools contribute to a further understanding of policy entrepreneurial roles to be taken up by health promotion professionals and health authorities in favour of the socio-environmental approach to health.

Notwithstanding the value of this first step, more research is required into both the practical application as well as in the theoretical connections with, for example, Multiple Streams theory.