Physical inactivity is a leading cause of death worldwide and contributes significantly to the burden of non-communicable diseases (NCDs). Physical inactivity has become a global pandemic with the highest prevalence in the region of the Americas. There is strong evidence on the effectiveness of community-based PA interventions, including behavioral and social interventions, campaigns and informational approaches, and policy and environmental modifications to increase physical activity at the population level. The purpose of this dissertation was to examine the impact of two types of community-based interventions to promote leisure-time physical activity using public spaces and their applicability and transferability from the Latin American to the US context. Specifically, three programs were examined: (1) Atlanta Streets Alive (ASA) (the Open Streets initiative inspired by the Bogota Ciclovia, hosted in the city of Atlanta, Georgia, US); (2) the Bogota Recreovia (free PA classes in community settings in the city of Bogota, Colombia); and, (3) Academia Fit (the PA-classes in community settings program adapted from the Brazilian ACP for Latino Communities in San Diego, California, US). This dissertation shows different assessment approaches including a descriptive study, a pre-post natural experiment with multiple control groups, and a translation and implementation study using an evidence-based approach such as the RE-AIM framework. Some of the overall findings include: community-based interventions implemented in public spaces such as Open Streets and PA-classes are promising for increasing moderate-to-vigorous PA (MVPA) on leisure-time within the communities where they are implemented. Besides, these interventions are effective to reach vulnerable populations including low income, women and ethnic minorities such as Hispanics in the US. Finally, the implementation of an Open Streets initiative and a free PA-classes program was feasible (applicable) in Atlanta, GA, in the US and San Diego, CA, respectively.

Mentally ill patients need to be treated with dignity and their basic human rights must be respected. Community-based interventions are commonly used in many areas after deinstitutionalisation of mentally ill patients. However, it is unfortunate that mental health and mental disorders are neglected in many areas with no proper or standardized services in the community for treatment and support. As a result, most of the mentally ill patients roam in the streets in the rural communities. Exploring community-based interventions in rural areas could assist to improve the quality care of the mentally ill patients. The communities need to be aware of the interventions available to support the mentally ill patients and their family members so that community members who give care to mentally ill patients can be able to identify, implement, monitor and sustain effective interventions to meet the needs of the mentally ill patients in rural areas. Suggestions could also be made to the Department of Health with regard to the community-based interventions in order to improve quality of patient care. The aim of this research was to explore and describe the current community-based interventions for the mentally ill patients as well as explore recommendations by the professional nurses and community caregivers about the utilization of community-based interventions to support mentally ill patients in a rural community. In order to obtain rich in-depth data, a qualitative research approach was followed. A case study design was used to complement the holistic in-depth investigation. Purposive sampling was used to identify professional nurses as participants in the community and snow-ball sampling was used to identify further community caregivers who meet the inclusion criteria. Ethics was considered during the identification and selection of participants. Triangulation of data collection method was undertaken where structured interviews, field notes and documents were used as methods of data collection. A semi-structured interview schedule was formulated which was evaluated by experts in qualitative research. A trial run interview was conducted prior to data collection. Voice recorders were used for the purpose of audio taping the interviews, thereafter the interviews were transcribed and prepared for data analysis. The researcher ensured that field notes were taken immediately after each interview. Data was collected until saturation was reached after ten interviews and analysis of six documents. Data was analysed by means of a written record or transcripts as suggested by Neuwenhuis (2011:89). A specialist qualitative researcher was appointed as a co-coder to analyse the data. The interpretative pattern of data analysis for qualitative data analysis was followed and the guidelines prescribed by Terre Blanche, Durrheim and Kelly (2011:321) were adopted. The identified themes were current interventions and utilizing current suggested interventions. Thus conclusions were drawn in relation to identified themes that with current interventions there are different categories of caregivers that are involved in the care of mentally ill patients in rural communities. Included are the health caregivers, non-governmental organisations, police officers, faith/spiritual healers, traditional healers, families and community members. However challenges were still identified for an example defaulting of treatment, relapse and readmissions of mentally ill patients. With regard to utilizing suggested interventions, participants emphasised more on the need to develop structures in order to support the mentally ill patients in their rural communities and continued community education mental illness and mental health. The recommendations were made to nursing practice, nursing research and nursing education. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

Mentally ill patients need to be treated with dignity and their basic human rights must be respected. Community-based interventions are commonly used in many areas after deinstitutionalisation of mentally ill patients. However, it is unfortunate that mental health and mental disorders are neglected in many areas with no proper or standardized services in the community for treatment and support. As a result, most of the mentally ill patients roam in the streets in the rural communities. Exploring community-based interventions in rural areas could assist to improve the quality care of the mentally ill patients. The communities need to be aware of the interventions available to support the mentally ill patients and their family members so that community members who give care to mentally ill patients can be able to identify, implement, monitor and sustain effective interventions to meet the needs of the mentally ill patients in rural areas. Suggestions could also be made to the Department of Health with regard to the community-based interventions in order to improve quality of patient care. The aim of this research was to explore and describe the current community-based interventions for the mentally ill patients as well as explore recommendations by the professional nurses and community caregivers about the utilization of community-based interventions to support mentally ill patients in a rural community. In order to obtain rich in-depth data, a qualitative research approach was followed. A case study design was used to complement the holistic in-depth investigation. Purposive sampling was used to identify professional nurses as participants in the community and snow-ball sampling was used to identify further community caregivers who meet the inclusion criteria. Ethics was considered during the identification and selection of participants. Triangulation of data collection method was undertaken where structured interviews, field notes and documents were used as methods of data collection. A semi-structured interview schedule was formulated which was evaluated by experts in qualitative research. A trial run interview was conducted prior to data collection. Voice recorders were used for the purpose of audio taping the interviews, thereafter the interviews were transcribed and prepared for data analysis. The researcher ensured that field notes were taken immediately after each interview. Data was collected until saturation was reached after ten interviews and analysis of six documents. Data was analysed by means of a written record or transcripts as suggested by Neuwenhuis (2011:89). A specialist qualitative researcher was appointed as a co-coder to analyse the data. The interpretative pattern of data analysis for qualitative data analysis was followed and the guidelines prescribed by Terre Blanche, Durrheim and Kelly (2011:321) were adopted. The identified themes were current interventions and utilizing current suggested interventions. Thus conclusions were drawn in relation to identified themes that with current interventions there are different categories of caregivers that are involved in the care of mentally ill patients in rural communities. Included are the health caregivers, non-governmental organisations, police officers, faith/spiritual healers, traditional healers, families and community members. However challenges were still identified for an example defaulting of treatment, relapse and readmissions of mentally ill patients. With regard to utilizing suggested interventions, participants emphasised more on the need to develop structures in order to support the mentally ill patients in their rural communities and continued community education mental illness and mental health. The recommendations were made to nursing practice, nursing research and nursing education. / Thesis (MCur)--North-West University, Potchefstroom Campus, 2013.

abstract: Globally, more than 350 000 women die annually from complications during pregnancy and childbirth (UNFPA, 2011). Nearly 99% of these, according to World Health Organization (WHO) trends (2010) occur in the developing world outside of a hospital setting with limited resources including emergency care (WHO, 2012; UNFPA, 2011). The most prevalent cause of death is postpartum hemorrhage (PPH), accounting for 25% of deaths according to WHO statistics (2012). Conditions in Afghanistan are reflective of the scope and magnitude of the problem. In Afghanistan, maternal mortality is thought to be among the highest in the world. The Afghan Mortality Survey (AMS) data implies that one Afghan woman dies about every 2 hours from pregnancy-related causes (AMS, 2010). Lack of empowerment, education and access to health care resources increase a woman's risk of dying during pregnancy (AMS, 2010). This project aims to investigate the prospects of scaling-up the correct use of misoprostol, a prostaglandin E1 analogue, to treat PPH in developing countries where skilled assistance and resources are scant. As there has been little published on the lessons learned from programs already in place, this study is experience-driven, based on the knowledge of industry experts. This study employs a concurrent triangulation approach to synthesize quantitative data obtained from previous studies with qualitative information gathered through the testimonies of key personnel who participated in pilot programs involving misoprostol. There are many obstacles to scaling-up training initiatives in Afghanistan and other low-resource areas. The analysis concludes that the most crucial factors for scaling-up community-based programs include: more studies analyzing lessons learns from community driven approaches; stronger partnerships with community health care workers; overcoming barriers like association with abortion, misuse and product issues; and a heightened global and community awareness of the severity of PPH without treatment. These results have implications for those who actively work in Afghanistan to promote maternal health and other countries that may use Afghanistan's work as a blueprint for reducing maternal mortality through community-based approaches. Keywords: Afghanistan, community-based interventions, community-driven, maternal mortality, MDG5, misoprostol, postpartum hemorrhage, reproduction, scale-up / Dissertation/Thesis / M.S.Tech Technology 2013

Early childhood development, care and education interventions coordinate resources and services that are aimed at stimulating growth for young children. Resource constraints in low and middle-income countries contribute towards a lag in childhood development initiatives compared to high-income countries. This thesis focused on the context of South Africa where the government has a long-term objective of ensuring that all children have access to quality services. However, the attainment of this goal is currently not a financially viable option, and many community-based organisations resort to alternative provisions of early childhood interventions to ensure that poor children are served. This thesis investigated implementation and associated outcomes for the Family in Focus (FiF) programme. This home-based early education programme that is targeted at young children between the ages of 0-6 years, who live in poor and marginalised communities where access and resources for care and stimulation are limited, was the programme of interest. A small sample theory-driven evaluation approach was applied to this programme to assess its viability to alleviate service access issues and produce meaningful outcomes for marginalised children. Evaluation questions were posed and a descriptive research design and a pre-post non-equivalent group quasi-experimental design that compared the results of the FiF programme to a traditional pre-school were utilised. Qualitative descriptions, descriptive statistics (mean and standard deviation) and inferential statistics (t-tests) were used to analyse the results. The FiF programme theory, although not initially clearly defined, was found to be plausible with moderate change expected for the beneficiaries of the programme. The programme, however, had a very low implementation fidelity level of 37.5%, meaning that the programme was not being implemented according to design. This was further associated with poor outcomes for the small sample of children in the FiF programme group utilised. Across the five developmental outcomes of cognitive, language, motor, social and emotional development, outcomes were particularly poor for the first three development domains against South African norms and the comparison group used in the evaluation. Early childhood education home-visiting programmes have the ultimate goal of improving child development outcomes. However, evidence shows that these programmes seem to be more successful in improving parenting skills and caregiver coping, without reaching the former ultimate goal. The comprehensive approach to assessing child development in underserved areas in this evaluation provided a novel overview of the interaction of multiple factors in school readiness in impoverished communities. There is still a lingering question as to the benefits of home visiting programmes that are increasingly being implemented across the country as an alternative provision of early childhood care and education services.

Yes / Activities running in community-based-settings offer a method of delivering multimodal interventions to older adults beyond cognitive training programmes. This systematic review and meta-analysis investigated the impact of randomised controlled trials (RCTs) of ‘real-world’ interventions on the cognitive abilities of healthy older adults. Database searches were performed between October 2016 and September 2018. Forty-three RCTs were eligible for inclusion with 2826 intervention participants and 2234 controls. Interventions to enhance cognitive ability consisted of participation in activities that were physical (25 studies), cognitive (9 studies), or mixed (i.e., physical and cognitive; 7 studies), and two studies used other interventions that included older adults assisting schoolchildren and engagement via social network sites. Meta-analysis revealed that Trail Making Test (TMT) A, p =  0.05, M = 0.43, 95% CI [-0.00, 0.86], digit symbol substitution, p =  0.05, M = 0.30, 95% CI [0.00, 0.59], and verbal fluency, p =  0.04, M = 0.31, 95% CI [0.02, 0.61], improved after specific types of interventions versus the control groups (which were either active, wait-list or passive controls). When comparing physical activity interventions against all control groups, TMT A, p =  0.04, M = 0.25, 95% CI [0.01, 0.48], and digit span forward, p =  0.05, M = 0.91, 95% CI [-0.00, 1.82], significantly improved. Results remained non-significant for all outcomes when comparing cognitive activity interventions against all control groups. Results therefore suggest that healthy older adults are more likely to see cognitive improvements when involved in physical activity interventions. In addition, TMT A was the only measure that consistently showed significant improvements following physical activity interventions. Visuospatial abilities (as measured by TMT A) may be more susceptible to improvement following physical activity-based interventions, and TMT A may be a useful tool for detecting differences in that domain. / Velux Stiftung, Switzerland, (Project No. 1034)

Although interventions that take an individualized, holistic approach to service delivery have been recommended for homeless youth, few such interventions have been described in the literature. This study sought to examine a unique, multi-faceted, community-based intervention developed in 2009 in Tampa, FL to provide services to homeless adolescents who are no longer living in the custody of a parent or guardian (i.e. unaccompanied youth). The intervention, titled Starting Right, Now (SRN), has served over 100 youth to date. The program provides residential, educational, recreational, and professional development services, as well as mental and physical health care. Each youth also receives a trained mentor who is in frequent contact with the youth. Other individualized services are provided as needed. Although SRN has been in existence for six years, the program has only been evaluated using measures such as changes in GPA, absentee rates, etc. In the current study, individual interviews with nine program participants who had been in SRN for at least one year were analyzed to explore how the youth themselves perceived that their lives had been impacted. Thematic analysis of interviews provided an opportunity to examine common themes among participants. Results showed that despite encountering some challenges, participants perceived that they had been lifted to higher educational and personal levels through obtainment of resources; adult and peer support systems; renewed trust in adults; increased hope; improved mental health; and a heightened sense of community. Practical implications for practice and research are discussed.

Covid-19 shed a light on how disparities, influenced by institutional racism and social determinants of health, led to negative healthcare outcomes. This inspired community organizations such as the Black Doctor’s COVID-19 Consortium to take matters into their own hands and play their part in meeting the needs of the community. With evident gaps in healthcare for marginalized communities, I believe that community-based health interventions are an ethical approach to ensure care for marginalized communities. To ensure that a proper intervention is being crafted for these communities, it is important to define what community-based means. This paper explores four models for categorizing community-based: community as setting, target, resource, and agent. While traditional research focuses on the voice of the academic, using Community Based Participatory Research amplifies and recenters the voice of the community, while providing a means to increase their capacity, fostering agency, and promoting solidarity. This paper explores local community-based health interventions in North Philadelphia and emphasizes partnering with the community to determine their needs before creating an intervention. Using community-based interventions to increase access to healthcare for marginalized communities in tandem with existing models of healthcare, follows a utilitarian approach to ensure that the greatest number of individuals can benefit. Community-based health interventions are the most ethical approach to bringing healthcare to marginalized communities. / Urban Bioethics / Accompanied by 1 PDF file: Francois_temple_0225M_171/Step 2 Recall.pdf

Includes bibliographical references (p. 51-57). / Exclusive breastfeeding (mother's milk only, with the exclusion of all other food or drink) reduces breast milk transmission of HIV compared with mixed feeding. This study was part of formative work for a community-based un-blinded randomised controlled trial (RCT) in an urban township with high antenatal HIV prevalence in KwaZulu-Natal (KZN), South Africa. The RCT sought to determine whether an integrated package of home-based care delivered by community health workers (CHWs) increases uptake of prevention of mother-to-child-transmission (PMTCT) interventions and improves neonatal outcomes. One example of where counselling is used is in Behaviour Change Communication (BCC) approaches. A counselling booklet, used by CHWs during home visits, was part of the integrated package. The primary objective of this study was to document the socio-cultural context in which infant feeding and caring decisions were made. The secondary objective was to field test the draft counselling booklet for the RCT. Methods This qualitative study used focus groups (n=8 groups) and individual interviews (n=6). All participants, of unknown HIV status, were purposively sampled from the study site. The focus group participants included, in separate groups, eight MRC researchers; 14 pregnant women (two separate groups of seven each); six non-pregnant women; eight older women; five men and 15 CHWs (separated into two groups). Results Data showed that socio-cultural factors, like the lack of social support systems; uncertainty regarding the role of men in infant feeding and caring issues; local beliefs and practices that encouraged risky infant caring practices; the lack of supply of formula and CHWs' lack of breastfeeding knowledge and experience; and HIV-related stigma may directly or indirectly, drive mothers to practice non-exclusive infant feeding. BCC principles acknowledge that people are affected greatly by social pressures exerted not only by their peers, but also by their larger communities (Bentley et al., 1999). For vi example, with regard to the support systems, both pregnant as well as younger women felt that feeding and caring decisions regarding their infants were mostly made by older women ' their husbands were seldom involved in such decisions. In relation to HIV-related stigma, many pregnant women felt that some clinics were not very supportive regarding HIV disclosure. In terms of health system factors, CHWs said that they were sometimes ill-equipped to deal with issues of disclosure due to a lack of training and confusion around the key feeding and caring messages. With regard to infant caring practices, the data revealed risky practices (using soap enemas and inappropriate hand washing practices), even amongst CHWs. Participants said they would share the booklet with others in the community as it taught them important lessons regarding infant feeding and caring practices. For some, the pictures in the booklet enhanced their understanding of 'old' messages. Participants identified several weaknesses in the booklet and suggested that it be less repetitive; that voluntary counselling and testing (VCT) be given priority in earlier rather than later visits; that unfamiliar terms is explained; more pictures included; and the general tone of messages improved. Literacy rates were low among older women and some men in the study. Conclusion and Recommendations Socio-cultural factors drive mothers to practice non-exclusive feeding and care for their infants in ways that may unwittingly increase the risk of HIV transmission. There is a need for CHWs to include family members in discussions about feeding so that they can change their thinking around infant-feeding and caring issues. The data suggests that VCT is not given priority in the counselling booklet and support is lacking in some clinics, therefore policy makers should ensure that support for VCT becomes a priority in the future. Furthermore, some CHWs were confused about the messages they are disseminating, therefore, the training that facility managers give to CHWs should be adapted to suit socio-cultural contexts so that CHWs are better equipped to communicate messages pertaining to infant feeding and caring appropriately to mothers. With the data revealing general acceptability of risky infant caring practices, even amongst CHWs, the vii health system needs to look at how it will effectively change health-related practices among health professionals. With literacy rates being low among older women and some men in the study, it was therefore recommended that gaining skills in materials design and improving CHWs' understanding of the BCC process, booklets such as this one needs to be designed together with the primary user in mind.

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