Designing a quality improvement intervention: a systematic approach.
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Most quality improvement or change management interventions are currently designed intuitively and their results are often disappointing. While improving the effectiveness of interventions requires systematic development, no specific methodology for composing intervention strategies and programmes is available. This paper describes the methodology of systematically designing quality of care improvement interventions, including problem analysis, intervention design and pretests. Several theories on quality improvement and change management are integrated and valuable materials from health promotion are added. One method of health promotion-intervention mapping-is introduced and applied. It describes the translation of knowledge about barriers to and facilitators of change into a concrete intervention programme. Systematic development of interventions, although time consuming, appears to be worthwhile. Decisions that have to be made during the design process of a quality improvement intervention are visualised, allowing them to serve as a starting point for a systematic evaluation of the intervention. (+info)
Genetics in dental practice: social and ethical issues surrounding genetic testing.
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It is evident that human genetic variation is associated with many if not all human diseases including the more prevalent chronic diseases. As a result, genetics is becoming integrated into health care in all medical specialties, including oral medicine and its specialties. At the level of public health, genetic information will become increasingly important in research, policy, and program development. As application of genome technologies moves from the research laboratory to the clinical setting, a complex array of challenges will face dental clinicians in their efforts to use genetic information to improve health care and prevent disease on an individual, family, and community level. The broader social, ethical, and legal implications raised by the clinical use of genomic information have not received the same attention as did recent gene identification aspects of the Human Genome Project. The goal of this review is to foster attention and dialogue within the dental community of the ethical and social issues emerging from the availability of genetic information. Specific areas addressed include genetic testing, confidentiality, discrimination, informed consent, risk communication, and professional education. (+info)
The aging of Israel's Arab population: needs, existing responses, and dilemmas in the development of services for a society in transition.
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The Arab population of Israel is relatively young. However, a significant increase is expected in the number of elderly Arabs in the coming years. At the end of 2001 there were 38,500 Arab elderly, but their number is expected to reach 92,100 by 2020. This will represent a nearly 2.5-fold increase in absolute numbers. As the population ages, the number and percentage of people with chronic diseases and related disabilities will rise significantly. While the Arab elderly are much younger than the Jewish elderly, they are more disabled and therefore have greater medical and nursing needs. An extremely important measure of the need for formal services is an elderly person's functional ability, especially the ability to live independently. The percentage of Arab elderly who are disabled and need help with activities of daily living is twice as high as that of the Jewish elderly population. At present, 30% of the Arab elderly (39% of the women and 20% of the men), compared to 14% of Jewish elderly (17% of the women and 11% of the men), need help in at least one ADL (bathing, dressing, eating, mobility in the home, rising and sitting, getting in and out of bed). Concomitant with demographic changes are forces that affect the ability of informal support systems to provide care. For example, the rising number of Arab women in the labor force together with changes in elderly peoples' living arrangements have increased the need for formal services to share responsibility for the elderly with families. As services are developed, questions arise regarding the extent to which they have been adapted to the culture and norms of Arab society and meet that society's unique needs. This paper elaborates on some of these issues. (+info)
Characterizing a sustainability transition: goals, targets, trends, and driving forces.
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Sustainable development exhibits broad political appeal but has proven difficult to define in precise terms. Recent scholarship has focused on the nature of a sustainability transition, described by the National Research Council as meeting the needs of a stabilizing future world population while reducing hunger and poverty and maintaining the planet's life-support systems. We identify a small set of goals, quantitative targets, and associated indicators that further characterize a sustainability transition by drawing on the consensus embodied in internationally negotiated agreements and plans of action. To illustrate opportunities for accelerating progress, we then examine current scholarship on the processes that influence attainment of four such goals: reducing hunger, promoting literacy, stabilizing greenhouse-gas concentrations, and maintaining fresh-water availability. We find that such analysis can often reveal "levers of change," forces that both control the rate of positive change and are subject to policy intervention. (+info)
Long-term trends and a sustainability transition.
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How do long-term global trends affect a transition to sustainability? We emphasize the "multitrend" nature of 10 classes of trends, which makes them complex, contradictory, and often poorly understood. Each class includes trends that make a sustainability transition more feasible as well as trends that make it more difficult. Taken in their entirety, they serve as a checklist for the consideration of global trends that impact place-based sustainability studies. (+info)
The road to advocacy--searching for the rainbow.
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The essence of public health advocacy is spreading the word-spreading the word to members of one's community about ways to protect and promote health, and spreading the word to decision makers about health policies that need to be enacted. The authors profile 2 women who spread the word-one who focuses on breast cancer in the Asian American community and one who works in cooperation with churches in the fight against HIV/AIDS in African and African American communities-and discuss the importance of "creating shoulders for others to stand on" in the fight for social change. (+info)
Changing health-seeking behaviour in Matlab, Bangladesh: do development interventions matter?
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It is generally assumed that socioeconomic development interventions for the poor will enhance their material and social capacities to prevent ill health and to seek appropriate and timely care. Using cross-sectional data from surveys undertaken in 1995 and 1999 as part of the BRAC-ICDDR,B Joint Research Project in Matlab, Bangladesh, this paper explores patterns of health-seeking behaviour over time, with the hypothesis that exposure to integrated socioeconomic development activities will enhance gender equity in care-seeking and the use of qualified medical care. While there is tentative evidence of greater gender equity in treatment choice among households benefiting from development interventions, a preference for qualified medical care is not apparent. Findings reveal a striking and generalized rise in self-treatment over the 4-year period that is attributed to the economic repercussions of a major flood in 1998, and greater heath awareness due to the density of community health workers in Matlab. Also noteworthy is the substantial reliance on informal and often unqualified practitioners (over 20%) such as pharmacists and itinerant drug sellers. Factors associated with the type of health care sought were identified using logistic regression. Self-care is associated with female gender, the absence of low cost health services and illnesses of relatively short duration. Medical care, on the other hand, is positively predicted by male gender, geographic location, greater socioeconomic status and serious illness of long duration. The paper concludes by emphasizing the importance of enhancing local capacities to determine whether self-treatment is indicated, to self-treat appropriately, or in cases where health care is sought, to judge provider competence and evaluate whether treatment costs are justified. The provision of pharmaceutical training to the full spectrum of health care providers is also recommended. (+info)
The built environment and its relationship to the public's health: the legal framework.
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The built environment significantly affects the public's health. This was most obvious when infectious disease was the primary public health threat during the industrial revolution; unsanitary conditions and overcrowded urban areas facilitated the spread of infection. However, even today in the age of chronic diseases there remains an important connection between population health and the built environment. Physical spaces can expose people to toxins or pollutants and influence lifestyles that contribute to diabetes, coronary vascular disease, and asthma. Public health advocates can help shape the design of cities and suburbs in ways that improve public health, but to do so effectively they need to understand the legal framework. This article reviews the connection between public health and the built environment and then describes the legal pathways for improving the design of our built environment. (+info)