Health Promotion Practice

Falls among people aged ≥65 years are the leading cause of both injury deaths and emergency department visits for trauma. Research shows that many falls are preventable. In the clinical setting, an effective fall intervention involves assessing and addressing an individual’s fall risk factors. This individualized approach is recommended in the American and British Geriatrics Societies’ (AGS/BGS) practice guideline. This article describes the development of STEADI (Stopping Elderly Accidents, Deaths, and Injuries), a fall prevention tool kit that contains an array of health care provider resources for assessing and addressing fall risk in clinical settings. As researchers at the Centers for Disease Control and Prevention’s Injury Center, we reviewed relevant literature and conducted in-depth interviews with health care providers to determine current knowledge and practices related to older adult fall prevention. We developed draft resources based on the AGS/BGS guideline, incorporated provider input, and addressed identified knowledge and practice gaps. Draft resources were reviewed by six focus groups of health care providers and revised. The completed STEADI tool kit, Preventing Falls in Older Patients—A Provider Tool Kit, is designed to help health care providers incorporate fall risk assessment and individualized fall interventions into routine clinical practice and to link clinical care with community-based fall prevention programs.

Health communicators at the Centers for Disease Control and Prevention (CDC) have developed an integrated model titled Crisis and Emergency Risk Communication (CERC) as a tool to educate and equip public health professionals for the expanding communication responsibilities of public health in emergency situations. This essay focuses on CERC as a general theoretical framework for explaining how health communication functions within the contexts of risk and crisis. Specifically, the authors provide an overview of CERC and examine the relationship of risk communication to crisis communication, the role of communication in emergency response, and the theoretical underpinnings of CERC. The article offers an initial set of propositions based on the CERC framework and concludes with a discussion of future directions.

Để hiểu biết về các con đường truyền bá và sử dụng thông tin sức khỏe của các thành viên trong cộng đồng Bản địa, nhóm nghiên cứu đã áp dụng phương pháp nghiên cứu hành động tham gia của Bản địa, kết hợp với một cộng đồng Inuit đô thị, một cộng đồng Métis đô thị và một cộng đồng Đệ nhất Quốc gia nửa thành phố ở Ontario, Canada. Một nghiên cứu trường hợp cộng đồng mô tả đã được tiến hành tại mỗi cộng đồng thông qua việc sử dụng các nhóm tập trung, phỏng vấn những người cung cấp thông tin chủ chốt, và khảo sát tài liệu. Các kết quả đã được xác nhận bởi các cộng đồng. Mỗi cuộc tham vấn cộng đồng tạo ra những dữ liệu rõ nét và nổi bật về các nguồn thông tin sức khỏe và chiến lược truyền bá; quy trình ra quyết định; các khái niệm sức khỏe liên quan tại địa phương, dịch vụ sức khỏe địa phương và các chương trình; cấu trúc cộng đồng; cùng với các cơ chế tương tác với các hệ thống không thuộc cộng đồng. Thêm vào đó, một số chủ đề tổng hợp đã được xác định. Phương pháp nghiên cứu tham gia đã thành công trong việc thu hút các đối tác cộng đồng. Các phát hiện này hỗ trợ giả thuyết rằng việc hiểu biết về các quy trình tạo ra, truyền bá và sử dụng kiến thức tại địa phương của người Bản địa là điều kiện tiên quyết cần thiết để chuyển đổi kiến thức hiệu quả trong bối cảnh Bản địa.

Although there has been an increase in the availability of effective, evidence-based physical activity interventions in school settings during the past decade, there is a paucity of published research focusing on the translation of these effective interventions into real-world practice. The purpose of this research was to examine the translatability of an existing school-based physical activity intervention. More specifically, this research sought to identify the barriers and facilitators in adopting, implementing, and maintaining a school-based physical activity intervention using RE-AIM as a theoretical evaluation framework. It was concluded that interventions that consider issues around complexity and compatibility with the school setting are more likely to be adopted, implemented, and maintained. It was recommended that future evaluations of physical activity interventions should not be limited to testing internal validity, but should consider external validity and ecological aspects, relevant to increasing dissemination in real-world settings.

Enthusiasm for community-based participatory research (CBPR) is increasing among health researchers and practitioners in addressing health disparities. Although there are many benefits of CBPR, such as its ability to democratize knowledge and link research to community action and social change, there are also perils that researchers can encounter that can threaten the integrity of the research and undermine relationships. Despite the increasing demand for CBPR-qualified individuals, few programs exist that are capable of facilitating in-depth and experiential training for both students and those working in communities. This article reviews the Partnerships in Community Health Research (PCHR), a training program at the University of British Columbia that between 2001 and 2009 has equipped graduate student and community-based learners with knowledge, skills, and experience to engage together more effectively using CBPR. With case studies of PCHR learner projects, this article illustrates some of the important successes and lessons learned in preparing CBPR-qualified researchers and community-based professionals in Canada.

The “Newest Vital Sign” (NVS) is a validated health literacy assessment tool typically administered by clinicians. The objective of this study was to assess if the NVS could be self-administered in adolescents to measure health literacy. Sixth graders in a Colorado middle school were provided a self-administered survey containing the NVS, a section for parent permission, and a section for the student’s age, gender, grade, and previous elementary school. In all, 167 sixth graders returned usable surveys (45% return rate), and the average health literacy score was 3.75 ± 1.70. Almost two thirds (62.9%) of the students scored in the adequate health literacy range, while only 12.6% scored in the limited health literacy range. Health literacy scores were similar when evaluated based on gender. However, when students were grouped based on prior elementary school attendance, students who matriculated from one elementary school had an average NVS score significantly lower than two other elementary schools (p < .001 and p < .05). Self-administration of the NVS was successful and showed similar health literacy scores compared to other studies in adolescents. Using the NVS as a self-administered tool could greatly increase its function as a quick health literacy assessment for adolescents, both in clinical practice and in school-based health education.

This article presents preliminary findings of the impact of an innovative care management model for diabetic patients. The model was implemented by seven Federally Qualified Health Centers serving 10,000 diabetic patients in Miami-Dade County. A primary intervention of this model is a centralized care management team that makes previsit phone calls to diabetic patients who have scheduled appointments. These previsit phone calls optimize patient knowledge and self-management goals, and provide patient care coordinators with relevant clinical information to optimize the office visit and help to ensure completion of recommended diabetic preventive and chronic care services. Data suggest that following the implementation of this care management model, more diabetic patients are receiving regular care, and compliance with recommended tests and screenings has improved.

This article presents a framework for developing and carrying out an implementation monitoring plan of a complex structural intervention in an organizational setting and describes seven steps for analyzing and reporting results for fidelity and completeness of implementation. This process is illustrated using the Environmental Interventions in Children’s Homes (ENRICH) Wellness Project. ENRICH aimed to promote physical activity and healthful nutrition behaviors among children residing in children’s group homes by working collaboratively with organizational staff. A comprehensive implementation monitoring plan was developed based on the particulars of the setting, context, and the program framework and used multiple data sources, criteria for evidence of implementation, and data triangulation to examine evidence for organizational implementation. Eleven of 17 organizations (65%) met the criteria for nutrition implementation whereas 9 of 17 (53%) met the criteria for physical activity implementation. Implementation data can be used descriptively, as described here, and may also be used in future outcome analyses to better understand project outcomes. The framework and evaluation approach are applicable to complex interventions in other organizational settings.

This article describes strategies used to develop a survey interview training manual for use on the Apsáalooke (Crow Indian) Reservation and delineates how this process and product differed from those discussed in the extant literature on survey interview training. Working to ensure cultural appropriateness is especially important due to past research improprieties with Native American populations. This manual was developed as a part of a cervical health intervention program, Messengers for Health. Areas covered include goals of survey research, recruitment and enrollment, manner of the interviewer, nonverbal behavior, beginning the interview, and language use. Limitations of this work and suggestions for conducting survey research with Native American populations are also included.

This study describes and provides results from a process evaluation of a lay health advisor (LHA) model to enhance participation in a clinical trial of the effectiveness of motivational interviewing on smoking cessation in college fraternity and sorority members. The implementation of the model had two phases: (a) the selection and training of LHAs as liaisons between research staff and participants and (b) LHAs’ roles in recruitment and retention. Perceptions of the LHA model were explored using survey questionnaires. Trial participants (N = 118) and LHAs (N = 8) were generally satisfied with the model and identified LHAs as helpful to participation. Seventy-four percent of chapter members were screened and 73% of participants received three of the four motivational interviewing sessions. These results indicate the LHA model was well received and met the needs of the research project.