Community Health Equity Research & Policy

This article describes how the principles of participatory research were applied to the study of non-insulin dependent diabetes (NIDDM) in an urban Aboriginal community in Melbourne, Australia. The process of developing an appropriate questionnaire and method for the epidemiological study of diabetes was combined with community-controlled initiatives for diabetes management and prevention. A close to full time presence in the community and the flexibility of qualitative methods facilitated the development of a quality working relationship between the researcher and community members and the modification of the research to increase direct community benefit. Creating a balance between the priorities of research and action proved one of the major challenges during the collection of data. Flexibility and communication beyond the completion of the research component were crucial for the development of community-owned diabetes education materials and for consultation and collaboration in the publication of the research results.

Despite increasing efforts to reduce smoking among young women, they remain one of the fastest growing groups of cigarette smokers in the United States. A Means-end Chain framework, derived from marketing theory, is presented as a way to create effective anti-smoking messages. The intent is to explain how advertisers influence women to smoke in spite of repeated health warnings and public knowledge of the problems associated with tobacco products. After describing this marketing framework, a Means-end Chain analysis is applied to contemporary Virginia Slims advertisements, highlighting the associations between product attributes and women's values. The usefulness of this framework in developing anti-smoking messages is then demonstrated.

Vitamin supplements are an effective means of obtaining adequate folate but little is known about vitamin use during the postpartum period, a time when women may be at risk of folate deficiency and associated health risks. This cross-sectional study evaluated factors associated with supplemental vitamin use to facilitate development of educational programs. Personal interviews were conducted among 188 Hispanic women at WIC clinics in El Paso, Texas. Most women (91%) used vitamin supplements during pregnancy; however, the majority (65%) discontinued use by the first postpartum month. Hispanic women born in Mexico (versus U.S. born), multiparas, younger mothers, and women who never breast fed were significantly less likely to take supplemental vitamins. Educational programs on the importance of vitamin supplements during the postpartum period are needed to insure that women receive adequate folate. On the U.S./Mexico border, programs should be tailored to younger, Mexican-born women.

Keeping accurate health records at the village level is a challenge since many rural dwellers have low or no literacy skills. The African Programme for Onchocerciasis Control (APOC) is distributing the drug ivermectin at the village level by villagers themselves, and requires an accounting of drugs dispensed and villagers treated. Recently, pictorial tally sheets were developed for Community Directed Distributors (CDDs) of ivermectin. At that same time a question arose concerning indigenous record keeping methods and whether such methods could also be adapted to ivermectin distribution. This study identified two indigenous methods, counting beans/pebbles and chalk/charcoal marks on walls and compared them with the pictorial tally sheets in three clusters of onchocerciasis-endemic villages in Kajola Local Government Area (LGA) of Oyo State, Nigeria. Field staff trained the CDDs using standard APOC procedures and after distribution, collected their treatment records. A household survey was then conducted for comparison with CDD records. The tally sheet users scored the lowest mean and median percentage point difference between reported and surveyed coverage (6.6 and 4.8) compared to chalk boards (19.0, 5.6) and pebbles (15.2, 9.2), but since the village was the unit of analysis, the differences observed were of only boarderline significance (p = 0.08). Because the tally sheets proved to be both cheaper and easier to use, they are recommended for community ivermectin programs as well as other primary health care activities at the village level.

The article reports the process of carrying out an AIDS awareness campaign, and its effect on the villagers' knowledge about AIDS in a remote rural area of Bangladesh. The campaign was carried out on the occasion of the “Worlds AIDS Day, 1996,” by the volunteers of the village-based traditional self-help organizations. Surveys were carried out both before and after the campaign. As for the effectiveness of the program, the campaign was effective insofar as only managing to familiarize the word “AIDS” among the villagers. It did not succeed in creating an impact on the knowledge about transmission, prevention, and high-risk behavior. Thirty-nine percent of the respondents in the post-intervention survey reported having heard about AIDS compared to 19 percent in the pre-intervention survey. The improvement in knowledge was somewhat similar across all gender, age, and religious groups. The effect of the campaign was greater among illiterate respondents, having relatively smaller effect on the educated respondents. The findings suggest that awareness-raising activities about AIDS can be carried out in conservative Bangladeshi villages in a participatory manner. However, a content-focused approach will be needed to make such a program more effective.

This study assesses the relationships between health behaviors of health professionals in South Korea and their perceived stress, job satisfaction, and role as positive models of health behaviors. The data were collected using a series of three mailings (n = 207). Based on factor analysis, the following four health behavior constructs were developed as measures of respondents' health behaviors: eating regular meals and fruit, drinking alcohol and smoking cigarettes, eating out and consuming snacks and caffeine, and engaging in regular physical activity and relaxation. Several items were used to measure the perception of stress, job satisfaction, and a role model of positive health behaviors. The results showed significant relationships between health behaviors and health professionals' perceptions on stress, job satisfaction and role modeling (p < .05). The results suggested that practicing positive health behaviors could have an influence on job performance as well as creating positive self-perception of health professionals. Implications for further study of health behaviors in South Korea are discussed.