Promotion and provision of colorectal cancer screening: a comparison of colorectal cancer control program grantees and nongrantees, 2011-2012.

IntroductionSince 2009, the Centers for Disease Control and Prevention (CDC) has awarded nearly $95 million to 29 states and tribes through the Colorectal Cancer Control Program (CRCCP) to fund 2 program components: 1) providing colorectal cancer (CRC) screening to uninsured and underinsured low-income adults and 2) promoting population-wide CRC screening through evidence-based interventions identified in the Guide to Community Preventive Services (Community Guide). CRCCP is a new model for disseminating and promoting use of evidence-based interventions. If the program proves successful, CDC may adopt the model for future cancer control programs. The objective of our study was to compare the colorectal cancer screening practices of recipients of CRCCP funding (grantees) with those of nonrecipients (nongrantees).MethodsWe conducted parallel Web-based surveys in 2012 with CRCCP grantees (N = 29) and nongrantees (N = 24) to assess promotion and provision of CRC screening, including the use of evidence-based interventions.ResultsCRCCP grantees were significantly more likely than nongrantees to use Community Guide-recommended evidence-based interventions (mean, 3.14 interventions vs 1.25 interventions, P < .001) and to use patient navigation services (eg, transportion or language translation services) (72% vs 17%, P < .001) for promoting CRC screening. Both groups were equally likely to use other strategies. CRCCP grantees were significantly more likely to provide CRC screening than were nongrantees (100% versus 50%, P < .001).ConclusionResults suggest that CRCCP funding and support increases use of evidence-based interventions to promote CRC screening, indicating the program's potential to increase population-wide CRC screening rates

A systematic review of interventions in primary care to improve health literacy for chronic disease behavioral risk factors

Background: To evaluate the effectiveness of interventions used in primary care to improve health literacy for change in smoking, nutrition, alcohol, physical activity and weight (SNAPW). Methods: A systematic review of intervention studies that included outcomes for health literacy and SNAPW behavioral risk behaviors implemented in primary care settings. We searched the Cochrane Library, Johanna Briggs Institute, Medline, Embase, CINAHL, Psychinfo, Web of Science, Scopus, APAIS, Australasian Medical Index, Google Scholar, Community of Science and four targeted journals (Patient Education and Counseling, Health Education and Behaviour, American Journal of Preventive Medicine and Preventive Medicine). Study inclusion criteria: Adults over 18 years; undertaken in a primary care setting within an Organisation for Economic Co-operation and Development (OECD) country; interventions with at least one measure of health literacy and promoting positive change in smoking, nutrition, alcohol, physical activity and/or weight; measure at least one outcome associated with health literacy and report a SNAPW outcome; and experimental and quasi-experimental studies, cohort, observational and controlled and non-controlled before and after studies. Papers were assessed and screened by two researchers (JT, AW) and uncertain or excluded studies were reviewed by a third researcher (MH). Data were extracted from the included studies by two researchers (JT, AW). Effectiveness studies were quality assessed. A typology of interventions was thematically derived from the studies by grouping the SNAPW interventions into six broad categories: individual motivational interviewing and counseling; group education; multiple interventions (combination of interventions); written materials; telephone coaching or counseling; and computer or web based interventions. Interventions were classified by intensity of contact with the subjects (High ≥ 8 points of contact/hours; Moderate \u3e3 and \u3c8; Low ≤ 3 points of contact hours) and setting (primary health, community or other). Studies were analyzed by intervention category and whether significant positive changes in SNAPW and health literacy outcomes were reported. Results: 52 studies were included. Many different intervention types and settings were associated with change in health literacy (73% of all studies) and change in SNAPW (75% of studies). More low intensity interventions reported significant positive outcomes for SNAPW (43% of studies) compared with high intensity interventions (33% of studies). More interventions in primary health care than the community were effective in supporting smoking cessation whereas the reverse was true for diet and physical activity interventions. Conclusion: Group and individual interventions of varying intensity in primary health care and community settings are useful in supporting sustained change in health literacy for change in behavioral risk factors. Certain aspects of risk behavior may be better handled in clinical settings while others more effectively in the community. Our findings have implications for the design of programs

Integrating Community-Based Interventions to Reverse the Convergent TB/HIV Epidemics in Rural South Africa.

The WHO recommends integrating interventions to address the devastating TB/HIV co-epidemics in South Africa, yet integration has been poorly implemented and TB/HIV control efforts need strengthening. Identifying infected individuals is particularly difficult in rural settings. We used mathematical modeling to predict the impact of community-based, integrated TB/HIV case finding and additional control strategies on South Africa's TB/HIV epidemics. We developed a model incorporating TB and HIV transmission to evaluate the effectiveness of integrating TB and HIV interventions in rural South Africa over 10 years. We modeled the impact of a novel screening program that integrates case finding for TB and HIV in the community, comparing it to status quo and recommended TB/HIV control strategies, including GeneXpert, MDR-TB treatment decentralization, improved first-line TB treatment cure rate, isoniazid preventive therapy, and expanded ART. Combining recommended interventions averted 27% of expected TB cases (95% CI 18-40%) 18% HIV (95% CI 13-24%), 60% MDR-TB (95% CI 34-83%), 69% XDR-TB (95% CI 34-90%), and 16% TB/HIV deaths (95% CI 12-29). Supplementing these interventions with annual community-based TB/HIV case finding averted a further 17% of TB cases (44% total; 95% CI 31-56%), 5% HIV (23% total; 95% CI 17-29%), 8% MDR-TB (68% total; 95% CI 40-88%), 4% XDR-TB (73% total; 95% CI 38-91%), and 8% TB/HIV deaths (24% total; 95% CI 16-39%). In addition to increasing screening frequency, we found that improving TB symptom questionnaire sensitivity, second-line TB treatment delays, default before initiating TB treatment or ART, and second-line TB drug efficacy were significantly associated with even greater reductions in TB and HIV cases. TB/HIV epidemics in South Africa were most effectively curtailed by simultaneously implementing interventions that integrated community-based TB/HIV control strategies and targeted drug-resistant TB. Strengthening existing TB and HIV treatment programs is needed to further reduce disease incidence

Mystery Shopping in Community Drug shops: Research as Development in Rural Tanzania

Throughout Africa, the private sector plays an important role in malaria treatment complementing formal health\ud services. However this sector is faced by a number of challenges including poor dispensing practices by unqualified staff. The Accredited Drug Dispensing Outlet (ADDO) program was introduced in Tanzania in 2002 to improve\ud the quality of retail services and especially of dispensing practices. The study adapted the often contested mystery\ud shopping methodology and trained local community members to assess practices of ADDO dispensers. The study then compared the assessed dispensers’ practices before and after ADDO interventions. Mystery shoppers were identified in the villages with the assistance of Health Demographic Surveillance System field staff. A total of 865 visits were made to general shops and drug shops between 2004 and 2009. Three case scenarios were developed to assess the quality of treatment; a) child aged 2 - 4 months, with fever/hot body for one day and problems with drinking/breastfeeding, b) child aged 2 - 4 years, with recurring fever/hot body for 3 days problems with drinking, eating, diarrhoea and tiredness/ not playing as usual and c) adult, with recurring fever/hot body for 2 days, headache, dizziness and loss of appetite. Study findings indicate improvements in dispensers’ knowledge and practices in management of fever, especially after the roll out of ADDO program in the study area. A 30 percent increase was noted after ADDO interventions on four assessed indicators developed based on the national malaria control guideline on malaria case management. On the other hand advice on the use of Insecticide Treated Nets as a measure to prevent malaria was not consistent over years even after ADDO interventions.\ud Children aged two to four years and adults were more likely to be provided with anti-malarials than children\ud between two to four months. Despite challenges posed against the methodology, findings reveals how useful\ud the mystery shopping technique can be for community assessments of ADDO interventions in retail outlets.\ud Study findings signify the importance of ADDO interventions in improving malaria case management in drug retail\ud outlets. If ADDOs are closely monitored and strengthened to provide appropriate malaria treatment and the program\ud is rolled throughout the country, a reduction in malaria morbidity and mortality is possible in the country. Innovative community based participatory research approaches and more systematic mystery shopping techniques would allow for comparative community-based assessments of ADDO interventions across regions.\u

Participatory women’s groups and counseling through home visits to improve child growth in rural eastern India: protocol for a cluster randomised controlled trial

Background: Childhood stunting (low height-for-age) is a marker of chronic undernutrition and predicts children’s subsequent physical and cognitive development. An estimated 52 million children in India are stunted. There is a broad consensus on determinants of child undernutrition and interventions to address it, but a lack of operational research testing strategies to increase the coverage of these interventions in high burden areas. Our study aims to assess the impact, costeffectiveness, and scalability of a community intervention involving a government-proposed community-based worker to improve growth in children under two

Sources of Cardiovascular Health Information and Channels of Health Communication Among Urban Population in Nigeria

This study employed mixed methods to investigate the preferred sources of health information and later explored the views of community healthcare workers on the enablers, barriers and ways of overcoming barriers to health communication. The study found that majority of the participants preferred their source of CV (cardiovascular) health information from the healthcare workers including the medical doctors, nurses, and pharmacists. On the other hand, the least preferred source of health information was from friends, family members, and community leaders. Some of the identified enablers to community health communication include awareness programme via Non-Governmental Organisations (NGOs), community-based organisations such as faith-based organisations and healthcare facilities. Others are traditional media and social media. The identified barriers to community-based health communication include lack of knowledge and poverty, language barriers, and other miscellaneous issues including misuse of internet, lack of basic amenities and religious beliefs. The community-based healthcare providers articulated ways to overcome the identified barriers, including enlightenment programmes, using the language of the target audience, funding health awareness programmes, and monitoring of health education interventions. This study concludes that dissemination of health information using numerous channels is essential in ensuring population-wide primary prevention of diseases

Victim Impact Classes and Evidence-Based Practices, Iowa Department of Corrections, August 31, 2007

With the adoption of evidence-based practices as the standard by which offender interventions are evaluated for effectiveness in the Iowa Department of Corrections, the Victim Advisory Council deemed it critical to form an ad hoc committee to evaluate the Victim Impact Class (VIC)intervention used in institutions and community-based corrections across the state to determine its efficacy and adherence to that new standard

Community-based well maintenance in rural Haiti

The international community has pledged $11 billion to Haiti, a country where nongovernmental organizations (NGOs) provide nearly all public goods and services. This raises at least two questions: How can NGOs most effectively perform their own work, and how can NGOs integrate their programs into broader efforts organized by public institutions? This paper addresses these questions by evaluating the community-based model of Haiti Outreach (HO) that focuses on training communities to manage wells after they have been constructed. The effect of this management training is identified by comparing the outcomes of HO’s wells with a control group of wells that were refurbished by HO in the aftermath of the January 12, 2010, earthquake but then subsequently managed by other groups. Wells managed under the community-based approach are 8.7 percentage points more likely to be functioning after only one year. We also propose a social planner’s problem to quantify the tradeoff between equity and efficiency created by user fees that may be applied to many development programs. A social planner indifferent between standard and community-based interventions has strong preferences for sporadically providing water to the poorest members of a community at the expense of sustainably providing water to the majority of community members. Policy-makers deciding between alternative interventions should also give consideration to the community-based approach for its ability to build political institutions.Water-supply ; Rural development

Estimation of Causal Effects of Community Based Interventions

Suppose one assigns two interventions to a small number K of different populations or communities, and one measures covariates and outcomes on a random sample of independent individuals from each of the K populations. We investigate the problem of identification and estimation of the causal effect of the choice of intervention assigned at the community level, and, if the intervention is time-dependent, the causal effect of the changes in the intervention at time t, on the outcome. The challenge one is confronted with is that different populations have different environmental factors and that the intervention and environment are assigned to the whole population instead of to the individual. The question we wish to address is if one can still estimate the causal effect of the intervention one would have obtained if one would have combined all units across the multiple populations, each unit having their assigned environment and individual covariates, randomly assign the intervention among the two possible interventions to the unit, and then compare the outcome distributions for the two treatment groups: i.e., if one would have carried out the ideal experiment of randomizing treatment allocation to the units of the combined population, thereby dealing with confounding due to different units having different environments and corresponding individual covariates. We apply the roadmap based on causal modeling with a nonparametric structural equation model, which involves 1) defining the target causal effect as a parameter on the nonparametric structural equation model, 2) addressing the identifiability from the observed data, and, 3) given an identifiability result under the required assumptions, the efficient estimation of the resulting statistical target parameter through targeted maximum likelihood substitution estimators, using cross-validation to fine tune the estimators. The fundamental identifiability assumption we make is that one collects baseline covariates on the individual that block the effect of the environment on the outcome of interest, which is formulated as an exclusion restriction assumption in the nonparametric structural equation model. In addition, we utilize the understanding of the causal identifiability assumptions to evaluate the matched sampling design in which the units of different communities are matched on individual factors. We present efficient weighted targeted maximum likelihood estimators for these matched sampling designs, and we establish the concrete theoretical gain in information for the target parameter relative to independent sampling, by application of general results on case-control biased sampling in van der Laan (2008). Our methods can be reasonably well applied to the case that the intervention causes infectious behavior among individuals, possibly resulting in an enhanced effect, and to the case that interaction between individuals creates dependence between the individuals. However, the methods would not take into account the effect of this dependence among individuals on the assessment of uncertainty in the point estimates. For that purpose we also propose an estimate of standard error of the point estimate that takes into account arbitrary (and unknown to the user) dependence structures that still permit a central limit theorem based normal approximations. Our framework and methods are extended to the case that the communities are followed up over time and exposed to a single time-dependent treatment regimen, while also being subjected to changes in environment over time. In particular, we consider the case of estimation of a causal effect of a change in treatment over time based on observing a single community over time under a certain time-dependent treatment regimen. We also generalize our results to causal effects of combined community based intervention and individually assigned treatment on an outcome of interest. It is shown that G-computation formulas and corresponding estimators developed for causal effects of individually assigned treatments can be fully utilized to estimate these causal effects. Finally, we consider the case in which one is not willing to assume the exclusion restriction assumption, but many communities are sampled. For that purpose we propose statistical inference that naturally adapts to the degree at which the exclusion restriction assumption is approximated and the number of communities that are sampled. This allows for a unified framework for analyzing studies that involve community based interventions