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References

Limitations of Programs

Ader, M., Berensson, K. and Carlsson, P. (2001). Quality indicators for health promotion programmes.Health Promotion International, [online] 16(2), pp.187-195. Available at: http://www.ncbi.nlm.nih.gov/pubmed/11356757 [Accessed 18 May 2016].

Australian Government Community Life (2005) A framework for effective community-based suicide prevention draft for consultation. Available at: http://www.livingisforeveryone.com.au/uploads/docs/Framework_community_SP.pdf (Accessed: 19 May 2016).

Berkowitz, B. (2001). Studying the Outcomes of Community-Based Coalitions. American Journal of Community Psychology, 29(2), pp.213-227.

Button, K., Ioannidis, J., Mokrysz, C., Nosek, B., Flint, J., Robinson, E. and Munafò, M. (2013). Power failure: why small sample size undermines the reliability of neuroscience. Nature Reviews Neuroscience, 14(5), pp.365-376.

Boston University School of Public Health (2016) Diffusion of innovation theory. Available at: http://sphweb.bumc.bu.edu/otlt/MPH-Modules/SB/SB721-Models/SB721-Models4.html (Accessed: 19 May 2016).

Centers for Disease Control and Prevention, (2016). The Social-Ecological Model: A Framework for Prevention|Violence Prevention|Injury Center|CDC. [online] Cdc.gov. Available at: http://www.cdc.gov/violenceprevention/overview/social-ecologicalmodel.html [Accessed 23 May 2016].

Clemson, L., Cumming, R., Kendig, H., Swann, M., Heard, R. and Taylor, K. (2004). The Effectiveness of a Community-Based Program for Reducing the Incidence of Falls in the Elderly: A Randomized Trial. Journal of the American Geriatrics Society, [online] 52(9), pp.1487-1494. Available at: https://www.researchgate.net/publication/8370150_The_Effectiveness_of_a_Community-Based_Program_for_Reducing_the_Incidence_of_Falls_in_the_Elderly_A_Randomized_Trial [Accessed 22 May 2016].

De Negreiros Cabral, K., Perracini, M., Soares, A., de Cristo Stein, F., Sera, C., Tiedemann, A., Sherrington, C., Filho, W. and Paschoal, S. (2013). Effectiveness of a multifactorial falls prevention program in community-dwelling older people when compared to usual care: study protocol for a randomised controlled trial (Prevquedas Brazil). BMC Geriatr, [online] 13(1), p.27. Available at: http://bmcgeriatr.biomedcentral.com/articles/10.1186/1471-2318-13-27 [Accessed 23 May 2016].

Donaldson, S.I. and Grant-Vallone, E.J. (2002) ‘UNDERSTANDING SELF-REPORT BIAS IN ORGANIZATIONAL BEHAVIOR RESEARCH’, Journal of Business and Psychology, 17(2).

Elder, J., Schmid, T., Dower, P. and Hedlund, S. (1993). Community Heart Health Programs: Components, Rationale, and Strategies for Effective Interventions. Journal of Public Health Policy, [online] 14(4), pp.463-79. Available at: http://www.jstor.org/stable/3342878?origin=crossref&seq=1#page_scan_tab_contents [Accessed 22 May 2016].

Fishbein, M. (1996). Great expectations, or do we ask too much from community-level interventions?.American Journal of Public Health, [online] 86(8), pp.1075-1076. Available at: https://www.researchgate.net/publication/14490613_Great_expectations_or_do_we_ask_too_much_from_community-level_interventions [Accessed 22 May 2016].

Gillespie, L., Gillespie, W., Robertson, M., Lamb, S., Cumming, R. and Rowe, B. (2003). Interventions for preventing falls in elderly people. Physiotherapy, 89(12), pp.692-693.

Holah (2006) Glossary of Terms and Concepts. Available at: http://www.holah.karoo.net/glossary.htm (Accessed: 19 May 2016).

Kreuter, M. (2000). Evaluating Community-Based Collaborative Mechanisms: Implications for Practitioners. Health Promotion Practice, [online] 1(1), pp.49-63. Available at: http://hpp.sagepub.com/content/1/1/49.abstract [Accessed 23 May 2016].

McLeroy, K., Bibeau, D., Steckler, A. and Glanz, K. (1988). An Ecological Perspective on Health Promotion Programs. Health Education & Behavior, 15(4), pp.351-377.

Merzel, C. and D’Afflitti, J. (2003). Reconsidering Community-Based Health Promotion: Promise, Performance, and Potential. Am J Public Health, [online] 93(4), pp.557-574. Available at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1447790/ [Accessed 18 May 2016].

Nilsen, P. (2004). What makes community based injury prevention work? In search of evidence of effectiveness. Injury Prevention, [online] 10(5), pp.268-274. Available at: http://injuryprevention.bmj.com/content/10/5/268.abstract [Accessed 22 May 2016].

Raine, K., Plotnikoff, R., Schopflocher, D., Lytvyak, E., Nykiforuk, C., Storey, K., Ohinmaa, A., Purdy, L., Veugelers, P. and Wild, T. (2013). Healthy Alberta Communities: Impact of a three-year community-based obesity and chronic disease prevention intervention. Preventive Medicine, [online] 57(6), pp.955-962. Available at: https://www.researchgate.net/publication/256478979_Healthy_Alberta_Communities_Impact_of_a_three-year_community-based_obesity_and_chronic_disease_prevention_intervention [Accessed 20 May 2016].

Rogers, E. and King, S. (2013). Intervention based on social cognitive theory: Evaluating adolescents' knowledge of OTC pain medications. Journal of the American Pharmacists Association, [online] 53(1), pp.30-38. Available at: http://www.ncbi.nlm.nih.gov/pubmed/23636153 [Accessed 17 May 2016].

Stokols, D. (1996). Translating Social Ecological Theory into Guidelines for Community Health Promotion.

American Journal of Health Promotion, [online] 10(4), pp.282-298. Available at: http://ajhpcontents.org/doi/abs/10.4278/0890-1171-10.4.282 [Accessed 22 May 2016].

World Health Organisation 2016, The Ottawa Charter for Health Promotion, viewed 1 May 2016, < http://www.who.int/healthpromotion/conferences/previous/ottawa/en/index1.html>.

OTC pain medications

Stepping on

  • Limited duration - 4 weeks. (Merzel and D’Afflitti, 2003) which states “Programs of such short duration may have difficulty in achieving community wide impact, given the level and intensity of program activities”
  • Small sample size, 203 high school students from 10 classrooms, larger the study the more reliable the results - can produce false-positive results, or they over-estimate the magnitude of an association as supported in (Button et al., 2013)
  • Classrooms rather than student participants were randomly assigned to experimental or control groups, thus the results are not generalizable beyond this population
  • Sharing of information between students in the two groups could not be controlled
  • Did not follow up with the students beyond 2 weeks after the intervention
  • Design type : self-report of falls,
  • Potential validity problems - not always truthful, deceive the researcher, may not be able to provide the level of detail (Donaldson and Grant-Vallone, 2002)
  • Small sample size - a larger number of participants.(Holah, 2006) states a measurement is said to be reliable or consistent if the measurement can produce similar results if used again in similar circumstance
  • limited duration of the program only following subjects for 14 months - (Ader, Berensson and Carlsson, 2001) many programs have a latency period, thus a long term program viability is a prerequisite for meaningfully assessing effects.

Community Based Health Promotion

Limitations of Programs

  • Health promotion program must be able to modify community norms and standards of behaviour (World Health Organization, 2012)
  • Little to no research on the relationship between member participation and inter sectoral collaboration (Berkowitz, 2001).
  • limited duration and intensity
  • Insufficient scope of activities
  • insufficiency of resources
  • lack of program reach
  • study design and analysis
  • unrealistically high expectations
  • (Kreuter, 2000, Clemson et al., 2004, Clemson et al., 2004, De Negreiros Cabral et al., 2013, Elder et al., 1993 and Raine et al., 2013)

By Jess Fazio, Laura Mason

& Dzenet Tinjak

Public Policy Influence

  • "Virtually all aspects of public policy impact on health, and it is self-evidently desirable that all public policy should be healthy public policy (kemm, 2001)
  • Public policy takes into account; morals, health, general wellbeing and an organisations own agenda. (MILIO)
  • Healthy public policy has "an explicate concern for health and equity in all areas of policy and by an accountability for health impact" (World Health organizsation, 1986)

The effectiveness of a community-based program for reducing the incidence of falls in the elderly: a randomized trial

  • public policy does not always create outcomes that are beneficial to health.
  • policy makers need to weight outcomes and create trade offs so the best out come is reached for the community.

Outcome expectations ( P < 0.05)

Behavioral capabilities ( P < 0.05)

no significant changes were observed for situational perception, outcome expectancies or self efficacy in any analyses

Evaluating adolescents knowledge of OTC pain medications

  • Stepping On, a multifaceted community based program using small group learning environment, is effective in reducing falls in at-risk individuals living at home (Clemson et al., 2004)
  • Randomised trial with subsets followed for 14 month
  • Two-hour sessions conducted weekly for 7 weeks
  • Improve fall self-efficacy, encourage behavioral change, and reduce falls
  • Ecological model
  • 31% reduction in falls
  • Emphasising that cognitive behaviours learning in a small group can reduce falls dramatically
  • Multifaceted interventions conducted by health professionals with skills in geriatric medicine can prevent falls (Gillespie et al., 2003)
  • A bottoms up approach
  • For community based health promotion to be successful it must work along side citizens and organisations.
  • Vision Australia's public policies aim to eliminate barriers and shift community thinking so that people who are blind or have low vision are able to live the life they choose".

Comparison of posttest scores (adjusted for pretest scores) of the dependent variables and results of statistical testing between the

groups (n = 203) (Rogers and King, 2013)

  • Five constructs of social cognitive theory; situational perception, behavioural capability, Outcomes expectations, Outcome expectancies and Self-efficacy (Rogers and King, 2013)
  • Possess the knowledge and skills for safe OTC pain medication use
  • 203 high school from 10 classrooms
  • Pre- and posttest data were collected from each group 2 weeks before and 2 weeks after the intervention was delivered

The community based setting aims to empower individuals and communities to gain control over the determinants of their own health.

Community Based Setting

Results

Effectiveness of Programs

Relative risk (RR)=0.69, 95%

Confidence interval (CI)=0.50-0.96; P=.025, this was a clinically meaningful result

Secondary analysis of subgroups showed that it was particularly effective for men (n=80; RR=0.32, 95% CI=0.17-0.59).

- The Ottawa Charter states "health promotion works through concrete and effective community action in setting priorities, making decisions, planning strategies and implementing them to achieve better health". (1986)

- Community based theories and models including: the Community Mobilization ( planning, action, development) Theory, the Organizational Change Theory and the Diffusion of Innovation Theory

Falls per month for control and intervention groups (Clemson et al., 2004)

  • Attaining change in the social and environmental conditions
  • Evident throughout current trends in studies including (McLeroy et al., 1988, Stokols, 1996, Elder et al., 1993, Rogers and King, 2013, Merzel and D’Afflitti, 2003 and Clemson et al., 2004)
  • Shift in emphasis from individually focused explanations
  • Ecological model of health : complex interplay between individual, relationship, community, and societal factors (Centers for Disease Control and Prevention, 2016) programs are taking into consideration an individual's interactions with the social environment
  • Influences at the interpersonal, organisational, community and policy levels
  • Empower collaborative efforts
  • (Fishbein, 1996, Raine et al., 2013, Nilsen, 2004) present inconsistent evidence, with many programs demonstrating modest or no effects at all

WHO states that people cannot achieve their fullest health potential unless they are able to take control of those things which determine their health.

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