Community Gender Norms Change as a Part of a Multilevel Approach to Sexual Health Among Married Women in Mumbai,India

Inequitable gender norms in societies and communities negatively contribute to women’s sexual and reproductive health. While the need for change in gender norms is well recognized, the task is highly challenging in terms of intervention design, implementation and assessment of impact. This paper describes a methodology for identification of gender norms, the design of community level intervention, community participation and the assessment of intervention impact in a low income, predominately Muslim community of 600,000 people in Mumbai, India. Formative research focused on in‐depth interviews with women, men and couples yielding gender normative statements and assessment of community resources to facilitate change. A Gender Equity Scale (GES) based on this formative research was developed and administered annually for a three‐year period to random, cross‐sectional samples in the intervention and control communities, and to community based, non‐governmental organizations (NGO) staff and Imams (religious leaders) in the intervention community. NGO staff disseminated gender oriented messages to their female constituency through their regular outreach activities and through special events and festivals in the community. Imams disseminated gender messages through lectures on social issues for men attending Friday prayers. The results showed that the NGO staff and Imams, assumed more gender equitable attitudes across time. The intervention was associated with a significant improvement in attitudes towards gender equity in the intervention relative to the control community. Men showed a dramatic change in more positive gender attitudes, while women lagged behind in their GES scores. The meaning of these results are explored and the implications assessed for the generalizability of the methodology for other countries, cultures and communities.     

Digital Animation as a Method to Disseminate Research Findings to the Community Using a Community-Based Participatory Approach

Community-based participatory research (CBPR) has garnered increasing interest over the previous two decades as researchers have tackled increasingly complex health problems. In academia, professional presentations and articles are major ways that research is disseminated. However, dissemination of research findings to the people and communities who participated in the research is many times forgotten. In addition, little scholarly literature is focused on creative dissemination of research findings to the community using CBPR methods. We seek to fill this gap in the literature by providing an exemplar of research dissemination and partnership strategies that were used to complete this project. In this paper, we present a novel approach to the dissemination of research findings to our targeted communities through digital animation. We also provide the foundational thinking and specific steps that were taken to select this specific dissemination product development and distribution strategy.     

The Application of Community Psychology Practice Competencies to Reduce Health Disparities

This article demonstrates the application of community psychology practice competencies to health disparities reduction. It begins with a discussion of changes and evolution of the maternal child health field over nearly three decades, then describes implications for community psychology practice and the application of practice competencies.     

Applying a Theory of Change Approach to Interagency Planning in Child Mental Health

One of the challenges facing nonprofit organizations today is the demand for measurable results. Increasingly, these organizations are focusing less on program outputs and program outcomes in favor of community outcomes or changes demonstrated in the larger community. Success by 6(R) is a popular United Way initiative that emphasizes defining and measuring community outcomes. In this paper, we describe our work with 24 Success by 6(R) initiatives around the country. It is clear that not all of these initiatives are measuring community outcomes. Of those initiatives that are experiencing some success measuring community outcomes, similar measurement strategies are reported. Additionally, our experience suggests several United Way employees express dissatisfaction with the logic model as a framework for defining and measuring community outcomes although no preferred alternative model is identified. Evaluators working with community-wide initiatives must find ways to communicate the differences between program and community outcomes to key stakeholders and funders.     

Community Resilience as a Metaphor, Theory, Set of Capacities, and Strategy for Disaster Readiness

Communities have the potential to function effectively and adapt successfully in the aftermath of disasters. Drawing upon literatures in several disciplines, we present a theory of resilience that encompasses contemporary understandings of stress, adaptation, wellness, and resource dynamics. Community resilience is a process linking a network of adaptive capacities (resources with dynamic attributes) to adaptation after a disturbance or adversity. Community adaptation is manifest in population wellness, defined as high and non-disparate levels of mental and behavioral health, functioning, and quality of life. Community resilience emerges from four primary sets of adaptive capacities--Economic Development, Social Capital, Information and Communication, and Community Competence--that together provide a strategy for disaster readiness. To build collective resilience, communities must reduce risk and resource inequities, engage local people in mitigation, create organizational linkages, boost and protect social supports, and plan for not having a plan, which requires flexibility, decision-making skills, and trusted sources of information that function in the face of unknowns.     

Gender Differences in the Effects of Community Violence on Mental Health Outcomes in a Sample of Low-Income Youth Receiving Psychiatric Care

Previous research suggests that community violence impacts mental health outcomes, but much of this research has not (a) distinguished between different types of community violence, (b) examined gender differences, and (c) focused on youth living in urban poverty. The current study addresses these questions. Participants were 306 youth (23 % girls) and one parent/guardian receiving outpatient psychiatric services for disruptive behavior disorders in a large urban city. Youth and parents reported on youth’s experience of different types of community violence (being a direct victim, hearing reports, and witnessing violence), and whether violence was directed toward a stranger or familiar. Outcomes included youth externalizing, internalizing, and posttraumatic stress symptoms assessed via parent and youth reports. Being a direct victim of violence accords risk for all mental health outcomes similarly for both boys and girls. However, gender differences emerged with respect to indirect violence, such that girls who hear reports of violence against people they know are at increased risk for all assessed mental health outcomes, and girls who witness violence against familiars are at increased risk for externalizing mental health symptoms in particular. There are gender differences in violence-related mental health etiology, with implications for intervention assessment and design.     

Unikkaartuit: Meanings of Well-Being, Unhappiness, Health, and Community Change Among Inuit in Nunavut, Canada

Suicide among young Inuit in the Canadian Arctic is at an epidemic level. In order to understand the distress and well-being experienced in Inuit communities, a first step in understanding collective suicide, this qualitative study was designed. Fifty Inuit were interviewed in two Inuit communities in Nunavut, Canada, and questionnaires asking the same questions were given to 66 high school and college students. The areas of life investigated here were happiness and wellbeing, unhappiness, healing, and community and personal change. Three themes emerged as central to well-being: the family, talking/communication, and traditional Inuit cultural values and practices. The absence of these factors were most closely associated with unhappiness. Narratives about community and personal change were primarily about family, intergenerational segregation, an increasing population, more trouble in romantic relationships among youth, drug use, and poverty. Change over time was viewed primarily as negative. Discontinuity of kinship structure and function appears to be the most harmful effect of the internal colonialism imposed by the Canadian government in the 1950s and 1960s. Directions toward community control and action are encouraging, and are highlighted. Inuit community action toward suicide prevention and community wellness is part of a larger movement of Indigenous self-determination.     

The Primary Care Health System as a Core Resource in Response to Terrorism

Abstract

Living through a terrorist event or under threat of attack affects both mental and physical health. A nation's primary care system plays a critical role under such circumstances. This article reviews the American experience after September 11, 2001 and advocates for integration of mental and physical health services in primary care settings as a key counter-terrorism strategy. Americans put their trust in primary care providers. The nation's healthcare system must develop and implement a strategy that informs and supports primary care providers in meeting the mental health needs of a nation confronted by terrorism.     

Mental Health Problems,Recovery, and the Impact of Green Care Services: A Qualitative,Participant-Focused Approach

This study aimed at gaining knowledge of users' experience of green care services (interventions using nature to improve health) for people with mental health or drug problems. Data were obtained from interviews with 20 participants in green care services and were analyzed qualitatively. Findings revealed that work in a social context close to nature and work with animals increased mastery and meaningfulness. Participation resulted in personal changes, new practical skills, improved social networks, and feelings of well-being. There appears to be powerful potential in using green care services as a recovery tool for people with mental health or drug-related problems.     

The Latent Threat of Community Violence: Indirect Exposure to Local Homicides and Adolescents’ Mental Health in Colombia

This study examines the relation between adolescents’ indirect exposure to local homicides and mental health disorders and post‐traumatic stress disorder (PTSD) symptoms. We employ a sample of 300 adolescents ( representative for Bogotá, Colombia, and geocoded data on violent crimes recorded by the national police. Findings show that one SD increment in local homicides is associated with increments by 0.17 SD in the mental health disorder index and a 0.14 SD increase in the PTSD score index, even after accounting for adolescents’ direct exposure to violence. The estimated effect for PTSD was larger for adolescents’ who were directly exposed to violence and for those living in multidimensionally poor households, whereas no detectable effects were found for adolescents who perceived their residential neighborhood as relatively safe.     

Sense of Community, Neighboring, and Social Capital as Predictors of Local Political Participation in China

This study examines the state of sense of community, neighboring behavior, and social capital in the People’s Republic of China, and explores their ability to predict local political participation, in the form of voting in elections for Urban Resident/Rural Villager Committees. Using a nationally representative survey, rural, older and married residents and those with a primary or high school education and higher perceived socio-economic status are more likely to participate. In rural areas, men are more likely than women to vote. For urban residents, knowing one’s neighbors is more important whereas in rural areas, neighboring behavior is more important, but both predict voting. Social capital does not generally predict Chinese people’s local political participation. Western definitions of social capital derived from theories about networking, bonding and bridging ties may be too culturally individualistic for China, whose collectivist society and agrarian kinship networks predate Communism. Simply knowing and helping one’s neighbors, rather than more abstract notions of trust, reciprocity or membership, may lead to the development of local democracy.     

Structural and Community Change Outcomes of the Connect‐to‐Protect Coalitions: Trials and Triumphs Securing Adolescent Access to HIV Prevention,Testing, and Medical Care

Connect to Protect (C2P), a 10‐year community mobilization effort, pursued the dual aims of creating communities competent to address youth's HIV‐related risks and removing structural barriers to youth health. We used Community Coalition Action Theory (CCAT) to examine the perceived contributions and accomplishments of 14 C2P coalitions. We interviewed 318 key informants, including youth and community leaders, to identify the features of coalitions’ context and operation that facilitated and undermined their ability to achieve structural change and build communities’ capability to manage their local adolescent HIV epidemic effectively. We coded the interviews using an a priori coding scheme informed by CCAT and scholarship on AIDS‐competent communities. We found community mobilization efforts like C2P can contribute to addressing the structural factors that promote HIV‐risk among youth and to community development. We describe how coalition leadership, collaborative synergy, capacity building, and local community context influence coalitions’ ability to successfully implement HIV‐related structural change, demonstrating empirical support for many of CCAT's propositions. We discuss implications for how community mobilization efforts might succeed in laying the foundation for an AIDS‐competent community.     

Collective Efficacy as a Task Specific Process: Examining the Relationship Between Social Ties, Neighborhood Cohesion and the Capacity to Respond to Violence, Delinquency and Civic Problems

In the neighborhood effects literature, collective efficacy is viewed as the key explanatory process associated with the spatial distribution of a range of social problems. While many studies usefully focus on the consequences of collective efficacy, in this paper we examine the task specificity of collective efficacy and consider the individual and neighborhood factors that influence residents’ perceptions of neighborhood collective efficacy for specific tasks. Utilizing survey and administrative data from 4,093 residents nested in 148 communities in Australia, we distinguish collective efficacy for particular threats to social order and assess the relative importance of social cohesion and neighborhood social ties to the development of collective efficacy for violence, delinquency and civic/political issues. Our results indicate that a model separating collective efficacy for specific problems from social ties and the more generalized notions of social cohesion is necessary when understanding the regulation potential of neighborhoods.     

Family Empowerment as a Mediator between Family-Centered Systems of Care and Changes in Child Functioning: Identifying an Important Mechanism of Change

We investigated the associations among perceived fidelity to family-centered systems of care, family empowerment, and improvements in children's problem behaviors. Participants included 79 families, interviewed at two time points across a one-year period. Paired samples t-tests indicated that problem behaviors decreased significantly across a one-year period. Hierarchical multiple regressions indicated that both fidelity to family-centered systems of care and family empowerment independently predicted positive change in children's problem behavior over a one-year period. However, when family empowerment is entered first in the regression, the relationship between fidelity to family-centered systems of care and change in children's problem behavior drops out, indicating that family empowerment mediates the relationship between family-centered care and positive changes in problem behaviors. Consistent with other literature on help-giving practices, family empowerment appears to be an important mechanism of change within the system of care philosophy of service delivery. Implications for practice and staff training are discussed.     

以新型农村合作医疗为平台 加强农村妇幼保健工作

住院分娩是否应该纳入新型农村合作医疗的补偿范围,目前在学术界和实践中仍然存在争议。以陕西省镇安县为案例,从公共政策分析的角度,通过对该县定额住院分娩制度运行效果的分析,论证了把住院分娩纳入合作医疗补偿范围的积极意义,同时针对该制度运行过程中出现的问题提出了相应的政策建议。     

Applying a Theory of Change Approach to Interagency Planning in Child Mental Health

This paper describes the use of a theory of change approach to community-based cross-agency service planning for children with serious emotional disturbance and their families. Public agency planners in Contra Costa County, California used the theory of change approach to organize service planning for a population of youth who had been arrested and involved with juvenile probation. The theory of change process described in this paper links community outcomes with planned activities with the assumptions or principles that underlie the community planning efforts. When complete, a theory of change logic model can serve as a guide for implementation, ensuring that community plans for service delivery remain true to their intent. The theory of change development process includes twelve stages and is based on a step-by-step approach. Theory of change logic models establish a context for articulating a community's shared beliefs and prompt local stakeholders to establish logical connections between the population to be served, expected results, and strategies intended to achieve those results.     

以新型农村合作医疗为平台加强农村妇幼保健工作

住院分娩是否应该纳入新型农村合作医疗的补偿范围,目前在学术界和实践中仍然存在争议。以陕西省镇安县为案例,从公共政策分析的角度,通过对该县定额住院分娩制度运行效果的分析,论证了把住院分娩纳入合作医疗补偿范围的积极意义,同时针对该制度运行过程中出现的问题提出了相应的政策建议。     

以新型农村合作医疗为平台加强农村妇幼保健工作

住院分娩是否应该纳入新型农村合作医疗的补偿范围,目前在学术界和实践中仍然存在争议.以陕西省镇安县为案例,从公共政策分析的角度,通过对该县定额住院分娩制度运行效果的分析,论证了把住院分娩纳入合作医疗补偿范围的积极意义,同时针对该制度运行过程中出现的问题提出了相应的政策建议.