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The well-connected community : a networking approach to community development
Government policy is increasingly focused on the contribution that communities can make to civil society and democratic renewal. This book demonstrates how informal and formal networks strengthen community capacity and improve cross-sectoral working.
Book
Findings from the SASA! Study: a cluster randomized controlled trial to assess the impact of a community mobilization intervention to prevent violence against women and reduce HIV risk in Kampala, Uganda
Background
Intimate partner violence (IPV) and HIV are important and interconnected public health concerns. While it is recognized that they share common social drivers, there is limited evidence surrounding the potential of community interventions to reduce violence and HIV risk at the community level. The SASA! study assessed the community-level impact of SASA!, a community mobilization intervention to prevent violence and reduce HIV-risk behaviors.
Methods
From 2007 to 2012 a pair-matched cluster randomized controlled trial (CRT) was conducted in eight communities (four intervention and four control) in Kampala, Uganda. Cross-sectional surveys of a random sample of community members, 18- to 49-years old, were undertaken at baseline (n = 1,583) and four years post intervention implementation (n = 2,532). Six violence and HIV-related primary outcomes were defined
a priori
. An adjusted cluster-level intention-to-treat analysis compared outcomes in intervention and control communities at follow-up.
Results
The intervention was associated with significantly lower social acceptance of IPV among women (adjusted risk ratio 0.54, 95% confidence interval (CI) 0.38 to 0.79) and lower acceptance among men (0.13, 95% CI 0.01 to 1.15); significantly greater acceptance that a woman can refuse sex among women (1.28, 95% CI 1.07 to 1.52) and men (1.31, 95% CI 1.00 to 1.70); 52% lower past year experience of physical IPV among women (0.48, 95% CI 0.16 to 1.39); and lower levels of past year experience of sexual IPV (0.76, 95% CI 0.33 to 1.72). Women experiencing violence in intervention communities were more likely to receive supportive community responses. Reported past year sexual concurrency by men was significantly lower in intervention compared to control communities (0.57, 95% CI 0.36 to 0.91).
Conclusions
This is the first CRT in sub-Saharan Africa to assess the community impact of a mobilization program on the social acceptability of IPV, the past year prevalence of IPV and levels of sexual concurrency. SASA! achieved important community impacts, and is now being delivered in control communities and replicated in 15 countries.
Trial registration
ClinicalTrials.gov #
NCT00790959
,
Study protocol available at
http://www.trialsjournal.com/content/13/1/96
Journal Article
Whole of Systems Trial of Prevention Strategies for Childhood Obesity: WHO STOPS Childhood Obesity
Background: Community-based initiatives show promise for preventing childhood obesity. They are characterized by community leaders and members working together to address complex local drivers of energy balance. Objectives: To present a protocol for a stepped wedge cluster randomized trial in ten communities in the Great South Coast Region of Victoria, Australia to test whether it is possible to: (1) strengthen community action for childhood obesity prevention, and (2) measure the impact of increased action on risk factors for childhood obesity. Methods: The WHO STOPS intervention involves a facilitated community engagement process that: creates an agreed systems map of childhood obesity causes for a community; identifies intervention opportunities through leveraging the dynamic aspects of the system; and, converts these understandings into community-built, systems-oriented action plans. Ten communities will be randomized (1:1) to intervention or control in year one and all communities will be included by year three. The primary outcome is childhood obesity prevalence among grade two (ages 7–8 y), grade four (9–10 y) and grade six (11–12 y) students measured using our established community-led monitoring system (69% school and 93% student participation rate in government and independent schools). An additional group of 13 external communities from other regions of Victoria with no specific interventions will provide an external comparison. These communities will also allow us to assess diffusion of the intervention to control communities during the first three years of the trial. Conclusion: This trial will test effectiveness, over a five-year period, of community-owned, -supported and -led strategies designed to address complex and dynamic causes of childhood obesity.
Journal Article
Reducing Racial Inequities in Health: Using What We Already Know to Take Action
This paper provides an overview of the scientific evidence pointing to critically needed steps to reduce racial inequities in health. First, it argues that communities of opportunity should be developed to minimize some of the adverse impacts of systemic racism. These are communities that provide early childhood development resources, implement policies to reduce childhood poverty, provide work and income support opportunities for adults, and ensure healthy housing and neighborhood conditions. Second, the healthcare system needs new emphases on ensuring access to high quality care for all, strengthening preventive health care approaches, addressing patients’ social needs as part of healthcare delivery, and diversifying the healthcare work force to more closely reflect the demographic composition of the patient population. Finally, new research is needed to identify the optimal strategies to build political will and support to address social inequities in health. This will include initiatives to raise awareness levels of the pervasiveness of inequities in health, build empathy and support for addressing inequities, enhance the capacity of individuals and communities to actively participate in intervention efforts and implement large scale efforts to reduce racial prejudice, ideologies, and stereotypes in the larger culture that undergird policy preferences that initiate and sustain inequities.
Journal Article
Heroes & cowards : the social face of war
Heroes and Cowards demonstrates the role that social capital plays in people's decisions. The makeup of various companies--whether soldiers were of the same ethnicity, age, and occupation--influenced whether soldiers remained loyal or whether they deserted. Costa and Kahn discuss how the soldiers benefited from friendships, what social factors allowed some to survive the POW camps while others died, and how punishments meted out for breaking codes of conduct affected men after the war. The book also examines the experience of African-American soldiers and makes important observations about how their comrades shaped their lives. --from publisher description
Book
The Network Collective
The network paradigm once dominated immunological research and even garnered its originator a Nobel Prize. It has since been criticized and largely abandoned. This book is a firsthand account of the network paradigm's rise and fall.
eBook
Aging together : dementia, friendship, and flourishing communities
Never in human history have there been so many people entering old age—roughly one-third of whom will experience some form of neurodegeneration as they age. This seismic demographic shift will force us all to rethink how we live and deal with our aging population. Susan H. McFadden and John T. McFadden propose a radical reconstruction of our societal understanding of old age. Rather than categorizing elders based on their cognitive consciousness, the McFaddens contend that the only humanistic, supportive, and realistic approach is to find new ways to honor and recognize the dignity, worth, and personhood of those journeying into dementia. Doing so, they argue, counters the common view of dementia as a personal tragedy shared only by close family members and replaces it with the understanding that we are all living with dementia as the baby boomers age, particularly as early screening becomes more common and as a cure remains elusive. The McFaddens' inclusive vision calls for social institutions, especially faith communities, to build supportive, ongoing friendships that offer hospitality to all persons, regardless of cognitive status. Drawing on medicine, social science, philosophy, and religion to provide a broad perspective on aging, Aging Together offers a vision of relationships filled with love, joy, and hope in the face of a condition that all too often elicits anxiety, hopelessness, and despair.
eBook
Bridging Science to Practice: Achieving Prevention Program Implementation Fidelity in the Community Youth Development Study
This paper describes the development, application, and results of an implementation monitoring component of the Communities That Care (CTC) prevention framework used in the Community Youth Development Study (CYDS) to ensure high-fidelity prevention program implementation. This system was created based on research that community-based implementation of evidence-based prevention programs often includes adaptations in program design, content, or manner of delivery (Gottfredson and Gottfredson,
Journal of research in crime and delinquency, 39
, 3–35, 2002; Hallfors and Godette,
Health Education Research, 17
, 461–470, 2002; Wandersman and Florin,
American Psychologist, 58
, 441–448, 2003). A lack of fidelity to the implementation standards delineated by program designers is one indicator of a gap between prevention science and practice which can lessen the likelihood that communities will realize the positive participant effects demonstrated in research trials. By using the CTC model to select and monitor the quality of prevention activities, the 12 CYDS communities replicated 13 prevention programs with high rates of adherence to the programs’ core components and in accordance with dosage requirements regarding the number, length, and frequency of sessions. This success indicates the potential of the CTC program implementation monitoring system to enhance community Prevention Delivery Systems (Wandersman et al.
American Journal of Community Psychology
, this issue) and improve the likelihood of desired participant changes.
Journal Article