Challenges in Sustaining Public Health Interventions

Center for Creative Leadership, Greensboro, NC 27438-6300, USA.
Health Education & Behavior (Impact Factor: 2.23). 03/2009; 36(1):24-8; discussion 29-30. DOI: 10.1177/1090198107299788
Source: PubMed


Sustainability remains a key challenge in public health. The perspective article by Fagen and Flay adds to our understanding of technical factors associated with sustaining health interventions in schools. In this commentary, the Fagen and Flay article (2009) is considered within the broader literature on sustainability. By taking a broad view, public health theory and practice might be advanced further. Fagen and Flay illustrate that we have much to learn about sustainability. Questions for future research include: (a) what can we put into place at the systems level to ensure that the short-term efficacy of interventions have a fighting chance to be sustained? (b) considering the challenges inherent in sustainability, what are realistic goals against which to evaluate the cost-effectiveness of interventions found effective in the short-term? and (c) what theories, methods, and strategies in fields outside of public health can be drawn upon to improve work in public health?

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    • "The majority of public health research has explored only the sustainability of a single program or program type, rather than the cohesive elements of community-based partnerships for policy change (Cooper et al., 2013). Understanding the community as the level of analysis, as well as the system in which a coalition operates, is key to improving insight about sustainability and may account for some of the complexity inherent in community-based research (Altman, 2009; Brown, Feinberg, & Greenberg, 2010; Feinberg, Gomez, Puddy, & Greenberg, 2008). The growing emphasis on sustainability has resulted in an increased interest in, and focus on, health policies. "

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    • "The challenges discussed in the present study may be overcome by systematically distributing information through existing channels, such as migrant organizations, and by providing communication training and awareness programmes for GPs to meet migrant needs better (20). "
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    ABSTRACT: Little is known about how migrants adapt to first-world public health systems. In Norway, patients are assigned a registered general practitioner (RGP) to provide basic care and serve as gatekeeper for other medical services. To explore determinants of migrant compliance with the RGP scheme and obstacles that migrants may experience. Individuals in leadership positions within migrant organizations for the 13 largest migrant populations in Norway in 2008 participated in this qualitative study. Semi-structured interviews, with migrants serving as key informants, were used to elucidate possible challenges migrant patients face in navigating the local primary health-care system. Conversations were structured using an interview guide covering the range of challenges that migrant patients meet in the health-care system. According to informants, integration into the RGP scheme and adequacy of patient-physician communication varies according to duration of stay in Norway, the patient's country of origin, the reason for migration, health literacy, intention to establish permanent residence in Norway, language proficiency, and comprehension of information received about the health system. Informants noted as obstacles: doctor-patient interaction patterns, conflicting ideas about the role of the doctor, and language and cultural differences. In addressing noted obstacles, one strategy would be to combine direct intervention by migrant associations with indirect intervention via the public-health system. Our results will augment the interpretation of forthcoming quantitative data on migrant integration into the public-health system and shed light on particular obstacles.
    Full-text · Article · Nov 2010 · The European journal of general practice
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    • "Health promoters and public health practitioners have existing knowledge about what 'works' in health promotion, however the evidence suggests that the majority of the positive outcomes are not sustained [1]. The focus therefore needs to be on ways to make the impacts of public health and health promotion initiatives sustainable, and community capacity building has emerged as one such approach [2]. "
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    ABSTRACT: Obesity is a major public health issue; however, only limited evidence is available about effective ways to prevent obesity, particularly in early childhood. Romp & Chomp was a community-wide obesity prevention intervention conducted in Geelong Australia with a target group of 12,000 children aged 0-5 years. The intervention had an environmental and capacity building focus and we have recently demonstrated that the prevalence of overweight/obesity was lower in intervention children, post-intervention. Capacity building is defined as the development of knowledge, skills, commitment, structures, systems and leadership to enable effective health promotion and the aim of this study was to determine if the capacity of the Geelong community, represented by key stakeholder organisations, to support healthy eating and physical activity for young children was increased after Romp & Chomp. A mixed methods evaluation with three data sources was utilised. 1) Document analysis comprised assessment of the documented formative and intervention activities against a capacity building framework (five domains: Partnerships, Leadership, Resource Allocation, Workforce Development, and Organisational Development); 2) Thematic analysis of key informant interviews (n = 16); and 3) the quantitative Community Capacity Index Survey. Document analysis showed that the majority of the capacity building activities addressed the Partnerships, Resource Allocation and Organisational Development domains of capacity building, with a lack of activity in the Leadership and Workforce Development domains. The thematic analysis revealed the establishment of sustainable partnerships, use of specialist advice, and integration of activities into ongoing formal training for early childhood workers. Complex issues also emerged from the key informant interviews regarding the challenges of limited funding, high staff turnover, changing governance structures, lack of high level leadership and unclear communication strategies. The Community Capacity Index provided further evidence that the project implementation network achieved a moderate level of capacity. Romp & Chomp increased the capacity of organisations, settings and services in the Geelong community to support healthy eating and physical activity for young children. Despite this success there are important learnings from this mixed methods evaluation that should inform current and future community-based public health and health promotion initiatives. ANZCTRN12607000374460.
    Full-text · Article · Aug 2010 · BMC Public Health
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