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AimWe conducted this study to determine key community-level factors associated with higher tobacco control programme performance.MethodsA combination of surveys, administrative and fiscal data were collected to measure local county-level health department performance over a 7-year period. Longitudinal analyses were performed using generalised estimating equations to examine whether counties that exerted higher effort were successful in creating more tobacco retail licensing (TRL) and secondhand smoke policies. Several social, political and contextual factors were examined as confounders.ResultsLocal county health departments (CHDs) that demonstrated high effort on their work plans increased the proportion of residents covered by TRL policies (7.2%; 95% CI −1.7 to 16.1%) compared to CHDs with lower levels of effort. Having legislators who voted in favour of tobacco control bills was found to significantly increase the passage of local TRL policies. CHDs demonstrating higher efforts also increased the proportion of residents covered by secondhand smoke policies (9.2%; 95% CI −3.5 to 21.9%).ConclusionThere was strong evidence that higher county-level efforts predicted an increasing number of local tobacco control policies. Evaluations using integrated designs are recommended as effective strategies to provide a more accurate assessment of how well community-level interventions catalyse community-wide change.

A recent study documented the efficacy of the Early Start Denver Model (ESDM) delivered in a 1:1 fashion. In the current study we investigated the effectiveness and feasibility of the ESDM in the context of a long-day care community service, with a child-staff ratio of 1:3. Outcomes of 27 preschoolers with ASD undergoing 15–25 h per week of ESDM over 12 months were compared to those of 30 peers with ASD undergoing a different intervention program delivered in a similar community long-day care service. Children in both groups made gains in cognitive, adaptive and social skills. Participants in the ESDM group showed significantly higher gains in developmental rate and receptive language.

A randomized feasibility trial of a parent coaching (PC) intervention was conducted across 16 community agencies in a Canadian province. Parents of toddlers with suspected autism were assigned to either a PC group (n = 24) or an enhanced community treatment (ECT) group (n = 25). PC participants received 24 weeks of coaching support from community service providers trained in the project. Children in both groups also received available community services and supplementary materials. PC children made significantly greater gains in word understanding and PC parents had significantly higher quality of life, satisfaction, and self-efficacy scores. Results are discussed in terms of the challenges of conducting feasibility studies in community settings and the lessons learned in the project.

Community health workers (CHWs) are increasingly recognized as an integral component of the health workforce needed to achieve public health goals in lowand middle-income countries (LMICs). Many factors influence CHW performance. A systematic review was conducted to identify intervention design related factors influencing performance of CHWs. We systematically searched six databases for quantitative and qualitative studies that included CHWs working in promotional, preventive or curative primary health services in LMICs. One hundred and forty studies met the inclusion criteria, were quality assessed and double read to extract data relevant to the design of CHW programmes. A preliminary framework containing factors influencing CHW performance and characteristics of CHW performance (such as motivation and competencies) guided the literature search and review. A mix of financial and non-financial incentives, predictable for the CHWs, was found to be an effective strategy to enhance performance, especially of those CHWs with multiple tasks. Performance-based financial incentives sometimes resulted in neglect of unpaid tasks. Intervention designs which involved frequent supervision and continuous training led to better CHW performance in certain settings. Supervision and training were often mentioned as facilitating factors, but few studies tested which approach worked best or how these were best implemented. Embedment of CHWs in community and health systems was found to diminish workload and increase CHW credibility. Clearly defined CHW roles and introduction of clear processes for communication among different levels of the health system could strengthen CHW performance. When designing community-based health programmes, factors that increased CHW performance in comparable settings should be taken into account. Additional intervention research to develop a better evidence base for the most effective training and supervision mechanisms and qualitative research to inform policymakers in development of CHW interventions are needed. Le personnel de santé communautaire (PSC) est de plus en plus reconnu comme élément prépondérant du personnel de santé nécessaire pour atteindre les objectifs de santé publique dans les pays à faible et moyen revenu. Beaucoup de facteurs influencent les performances des PSC. Nous avons mené une revue systématique pour identifier les facteurs lors de la conception d’initiatives qui ont une influence sur les performances des PSC. Nous avons cherché systématiquement dans six bases de données provenant d’études quantitatives et qualitatives incluant les PSC travaillant pour la promotion, la prévention et les soins curatifs dans les services de santé primaires pour les pays à faible et moyen revenu. Nous avons trouvé 140 études correspondant aux critères d’inclusion et dont la qualité a été évaluée ainsi qu’une relecture pour extraire les données pertinentes pour la conception de programmes de PSC. Un cadre préliminaire contenant des facteurs influençant la performance des PSC ainsi que les caractéristiques des performances des PSC (telles que la motivation et les compétences) a permis de diriger la recherche de documents et leur analyse. Un mixe d’incitations financières ou non financières, prévisibles pour le PSC, semble être une stratégie efficace pour améliorer la performance, spécialement pour les PSC qui ont plusieurs rôles. Les incitations financières pour encourager la performance peuvent parfois entrainer une négligence sur les t âches non rémunérées. La conception des initiatives, qui implique une supervision fréquente et une formation continue, a entrainé une meilleure performance des PSC dans certains cas. La supervision et la formation ont souvent été mentionnées comme éléments facilitateurs mais peu d’études ont testé quelle approche marchait le mieux et quel est le meilleur moyen de les mettre en place. L’intégration du PSC dans la communauté et dans le système de santé a permis de diminuer la charge de travail et d’augmenter la crédibilité du PSC. Le fait de clairement définir le rôle du PSC et d’introduire un processus de communication clair entre les différents niveaux du système de santé pourrait renforcer la performance du PSC. Lorsque les programmes de santé communautaire sont conçus, les éléments qui favorisent l’amélioration des performances du PSC dans des contextes comparables doivent être pris en compte. Nous avons besoins d’initiatives supplémentaires afin de développer un meilleur cadre pour une formation efficace, pour des mécanismes de supervisions ainsi que pour des recherches qualitatives afin d’informer les législateurs du développement des initiatives du PSC. 在低收入和中等收入国家（LMICs）中，为了达到公共医疗 目标，社区医疗工作者（CHWs）越来越多得被认为是医疗 工作者的一个组成部分。很多因素影响社区医疗工作者的绩 效。本文对这些影响因素做了一个系统评价。我们对六个数 据库定量和定性的研究进行了系统搜索，包括了在低收入和 中等收入国家中在促进、预防和基础医疗服务领域工作的社 区医疗工作者。达到我们标准的 140 个研究被进行了质量评 估，并被再次阅读提取出与社区医疗工作者项目设计相关的 数据。我们提前设计好了一个框架来指导文献搜索和综述工 作，框架里包括了影响社区医疗工作者绩效的因素和绩效的 特点（比如动机和能力）。 经济和非经济动机的混合，可以预见到，是提高绩效的有效 措施，特别是对于有多项工作的社区医疗工作者来说。以绩 效为基础的经济刺激有时会导致对一些不支付金钱的工作的 忽视。在一些情景中，包含了经常性监督和持续培训的干预 措施的设计能够带来更好的绩效。监督和培训是经常被提到 的影响因素，但是很少有研究试验哪种方式最有效或者如何 实施最有效。将社区工作者融入社区和医疗系统中能减少工 作量并增加社区工作者的可信度。清晰地界定社区工作者的 角色和引入医疗系统中不同层面的人的对话机制也能加强绩 效。 当设计以社区为基础的医疗项目时，应该考虑在对比情境下 增加社区医疗工作者绩效的因素。还应该进行额外的干预措 施研究建立一个证据库用以找出最有效的培训和监督机制和 为政策制定者设计干预措施提供定性研究。 Los trabajadores de salud comunitaria (TSCs) son reconocidos cada vez más como un componente integral del personal de la salud necesario para lograr los objetivos de la salud pública en los países de ingresos bajos y medianos (PIBMs). Muchos factores influyen en el rendimiento de los TSCs. Se realizó una revisión sistemática para identificar los factores relacionados con el diseño de la intervención que influyen en el rendimiento de los TSCs. De forma sistemática usamos seis bases de datos para buscar estudios cuantitativos y cualitativos que incluyeron los TSCs que trabajan en servicios promocionales, preventivos o curativos de atención primaria de salud en PIBMs. Ciento cuarenta estudios cumplieron los criterios de inclusión y fueron evaluados en materia de calidad. Se hizo doble lectura para extraer datos relevantes al diseño de programas de los TSCs. Un marco preliminar que contiene los factores que influyen en el rendimiento de los TSC y sus características de rendimiento (tales como motivación y competencias) orientaron la búsqueda bibliográfica y la revisión. Una combinación de incentivos financieros y no financieros, previsibles para los TSCs, resultó ser una estrategia efectiva para mejorar el rendimiento, especialmente para aquellos TSCs con múltiples tareas. Los incentivos financieros basados en el rendimiento resultaron a veces en el abandono de las tareas no pagadas. Los diseños de las intervenciones que implicaron la supervisión frecuente y la formación continua llevaron a un mejor rendimiento de los TSC en ciertos contextos. La supervisión y la capacitación se mencionaron a menudo como factores facilitadores, pero pocos estudios probaron cual enfoque funcionó mejor o cómo éstas se implementaron de mejor manera. Se encontró que el arraigamiento de los TSCs en los sistemas comunitarios disminuyó la carga de trabajo y aumentó su credibilidad. Funciones de los TSCs claramente definidas y la introducción de procesos claros para la comunicación entre los diferentes niveles del sistema de salud podrían fortalecer el rendimiento de los TSCs. Al diseñar los programas de salud basados en la comunidad, los factores que aumentan el rendimiento de los TSCs en contextos comparables deben ser tenidos en cuenta. Son necesarias investigaciones adicionales sobre la intervención para desarrollar una mejor base de pruebas sobre los mecanismos de formación y supervisión más eficaces, e investigaciones cualitativas para informar a los responsables de las políticas en el desarrollo de las intervenciones de los TSCs.

[...]the same intervention may have different consequences if implemented in a different setting, or among different subgroups. [...]while process evaluation is an increasingly common component of grant applications, study protocols and published evaluations of public health interventions approaches are highly variable. 9 The appearance of variability in approaches is perhaps heightened further by inconsistency in reporting, perhaps stemming from challenges reporting process data in a single article while remaining within journal word limits.

BackgroundCommunity-based health interventions have been implemented as a key strategy for achieving improved health outcomes in Ghana. Effectiveness, however, largely depends on the successful implementation of patient–public engagement (PPE). Although several PPE studies have been conducted in Ghana, little research has been done to understand the specific role of PPE in the context of implementing community-based health programmes. This paper, therefore, examines the extent of PPE implementation in three selected community-based health programmes (Community-based Health Planning and Service [CHPS], Community-based Maternal and Child Health and Buruli Ulcer) to understand their specific effects on health outcomes.MethodsThree focus groups, involving 26 participants, were held in three districts of the Ashanti region of Ghana. Participants were mainly health service users involving community health committee members/volunteers, residents and health professionals. They were invited to participate based on their roles in the design and implementation of the programmes. Participants focused on each of Rifkin's spider-gram components. Data were transcribed and analysed descriptively using NVIVO 12 Plus.ResultsPPE implementation was found to be extensive across the three programmes in specific areas such as organisation and resource mobilisation. PPE was more restricted in relation to community needs assessment, leadership and management, particularly for the CHPS and Buruli Ulcer programmes.ConclusionFindings suggest that benefits from community-based health interventions are likely to be greater if PPE can be widely implemented across all dimensions of the spider-gram framework.

Background Community engagement is crucial for the design and implementation of community-based early childhood development (ECD) programmes. This paper aims to share key components and learnings of a community engagement process for an integrated ECD intervention. The lessons shared are drawn from a case study of urban informal settlement with embedded refugees in Nairobi, Kenya. Methods We conducted three stakeholder meetings with representatives from the Ministry of Health at County and Sub-County, actors in the ECD sector, and United Nations agency in refugee management, a transect walk across five villages (Ngando, Muslim, Congo, Riruta and Kivumbini); and, six debrief meetings by staff from the implementing organization. The specific steps and key activities undertaken, the challenges faced and benefits accrued from the community engagement process are highlighted drawing from the implementation team’s perspective. Results Context relevant, well-planned community engagement approaches can be integrated into the five broad components of stakeholder engagement, formative research, identification of local resources, integration into local lives, and shared control/leadership with the local community. These can yield meaningful stakeholder buy-in, community support and trust, which are crucial for enabling ECD programme sustainability. Conclusion Our experiences underscore that intervention research on ECD programmes in urban informal settlements requires a well-planned and custom-tailored community engagement model that is sensitive to the needs of each sub-group within the community to avoid unintentionally leaving anyone out.

This paper examines the added-value that multisystem approaches bring to research and intervention in contexts of war and forced displacement. I highlight what is useful and truly innovative about systems-level work, aware that providing data-related evidence is only part of the story when connecting research to policy and practice. I discuss four types of added-value: these are conceptual, instrumental, capacity-building, and connectivity impacts that, respectively, aim to change current knowledge, improve implementation, build research skills, and strengthen network connectivity. Specifically, systems-based research can help transform the key frames of humanitarian work, fostering the more integrated and distributive models of professional assistance known as resilience and network humanitarianism. I argue that systems-level approaches on resilience and flourishing in war-affected and refugee populations help to articulate new mindsets, methodologies, partnerships, and ways of working relevant for humanitarian research, policy and practice. I focus attention on interdisciplinary, interventionist, prospective, transgenerational, and network-building initiatives. My specific examples cover the family context of mental health and trauma memory in Afghanistan, as well as program evaluation with Syrian refugees in Jordan, connecting stress biology to human experience, and social networks to psychological empowerment. The paper suggests future directions to support more effective and impactful systems-level work in protracted humanitarian crises.

As resources for health promotion become more constricted, it is increasingly important to collaborate across sectors, including the private sector. Although many excellent models for cross-sector collaboration have shown promise in the health field, collective impact (CI), an emerging model for creating larger scale change, has yet to receive much study. Complementing earlier collaboration approaches, CI has five core tenets: a shared agenda, shared measurement systems, mutually reinforcing activities, continuous communication, and a central infrastructure. In this article, we describe the CI model and its key dimensions and constructs. We briefly compare CI to community coalition action theory and discuss our use of the latter to provide needed detail as we apply CI in a critical case study analysis of the Tenderloin Healthy Corner Store Coalition in San Francisco, California. Using Yin's multimethod approach, we illustrate how CI strategies, augmented by the community coalition action theory, are being used, and with what successes or challenges, to help affect community- and policy-level change to reduce tobacco and alcohol advertising and sales, while improving healthy, affordable, and sustainable food access. We discuss the strengths and weaknesses of CI as a framework for health promotion, as well as the benefits, challenges, and initial outcomes of the healthy retail project and its opportunities for scale-up. Implications for health promotion practice and research also are discussed.