scholarly journals Sustaining community-based interventions for people affected by dementia long term: the SCI-Dem realist review

BMJ Open ◽  
2021 ◽  
Vol 11 (7) ◽  
pp. e047789
Author(s):  
Thomas Morton ◽  
Geoff Wong ◽  
Teresa Atkinson ◽  
Dawn Brooker
Keyword(s):  
Financial Management ◽  
Local Community ◽  
Grey Literature ◽  
Realist Review ◽  
Social Needs ◽  
Support Network ◽  
Small Scale ◽  
Community Based Interventions ◽  
Community Based

ObjectivesCommunity-based support for people with earlier-stage dementia and their care partners, such as regularly meeting groups and activities, can play an important part in postdiagnostic care. Typically delivered piecemeal in the UK, by a variety of agencies with inconsistent funding, provision is fragmented and many such interventions struggle to continue after only a short start-up period. This realist review investigates what can promote or hinder such interventions in being able to sustain long term.MethodsKey sources of evidence were gathered using formal searches of electronic databases and grey literature, together with informal search methods such as citation tracking. No restrictions were made on article type or study design; only data pertaining to regularly meeting, ongoing, community-based interventions were included. Data were extracted, assessed, organised and synthesised and a realist logic of analysis applied to trace context–mechanism–outcome configurations as part an overall programme theory. Consultation with stakeholders, involved with a variety of such interventions, informed this process throughout.ResultsAbility to continually get and keep members; staff and volunteers; the support of other services and organisations; and funding/income were found to be critical, with multiple mechanisms feeding into these suboutcomes, sensitive to context. These included an emphasis on socialising and person-centredness; lowering stigma and logistical barriers; providing support and recognition for personnel; networking, raising awareness and sharing with other organisations, while avoiding conflict; and skilled financial planning and management.ConclusionsThis review presents a theoretical model of what is involved in the long-term sustainability of community-based interventions. Alongside the need for longer-term funding and skilled financial management, key factors include the need for stigma-free, person-centred provision, sensitive to members’ diversity and social needs, as well as the need for a robust support network including the local community, health and care services. Challenges were especially acute for small scale and rural groups.

scholarly journals Sustainability of community-based interventions for people affected by dementia: a protocol for the SCI-Dem realist review

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e032109
Author(s):  
Thomas Morton ◽  
Teresa Atkinson ◽  
Dawn Brooker ◽  
Geoffrey Wong ◽  
Shirley Evans ◽  
...  
Keyword(s):  
Real Life ◽  
Realist Review ◽  
Stakeholder Group ◽  
Community Based Interventions ◽  
Community Based ◽  
Funding Model ◽  
People With Dementia ◽  
Ethical Approval ◽  
Academic Search

IntroductionWith numbers set to increase globally, finding ways to better support people with dementia and their families is a matter of growing concern. Community-based interventions can play a key role in supporting people with early to moderate stage dementia postdiagnosis, helping delay decline and hospitalisation. However, provision of such interventions is fragmented, with significant gaps and no reliable funding model, hence innovative groups and schemes catering for a genuine need can struggle long term and frequently fold.Methods and analysisThis realist review aims to expand our understanding of how best to implement and facilitate community-based interventions to run sustainably, focusing on contextually relevant explanations. We will gather and synthesise literature using a realist approach designed to accommodate and account for the complexity of ‘real life’ programmes, as implemented under different conditions in different settings, aiming to draw transferable conclusions about their sustainability that explain how and why context can influence outcomes. Our review will iteratively progress through five steps: (1) locate existing theories; (2) search for evidence (using Academic Search, AMED, CINAHL, EMBASE, MEDLINE, ProQuest, PsycINFO, PubMed, Scopus and Social Care Online, between May and September 2019); (3) article selection; (4) extracting and organising data; (5) synthesising the evidence and drawing conclusions. Data analysis will use a realist logic to explain what works, for whom, in what circumstances, in what respects, how and why. A stakeholder group will provide guidance and feedback throughout.Ethics and disseminationEthical approval was not required. Recommendations drawn from results are likely to be of interest to a range of stakeholders including those commissioning, planning, running, supporting or attending such interventions, as well as policymakers, healthcare professionals and researchers. We will draw on the expertise of our stakeholder group regarding tailoring dissemination to each audience using a variety of materials, formats and channels.

Perceptions of Men With Moderate to Severe Hemophilia Regarding the Management of Their Chronic Disorder and Utilization of Community-Based Support

2014 ◽  
Vol 9 (6) ◽  
pp. 486-495 ◽  
Author(s):  
Erik B. Rolstad
Keyword(s):  
Nonprofit Organizations ◽  
Local Community ◽  
Qualitative Interviews ◽  
Social Needs ◽  
Support Network ◽  
Theory Approach ◽  
Severe Hemophilia ◽  
Psychosocial Needs ◽  
Community Based ◽  
Adult Men

Hemophilia is a genetic bleeding disorder that almost exclusively affects men. There is a nationwide network of nonprofit organizations providing support to men with hemophilia, which are affiliated with localized agencies that serve affected individuals within specific regions of the country. This community-based study was implemented in response to a local Utah agency’s concern that men with hemophilia may be disengaged from and underserved by their local support network. The goal of the study was to gain a better understanding of the (a) unique challenges, (b) adaptations, and (c) physical, financial, psychological, and social needs of adult men with moderate to severe hemophilia from the local community. Over a period of 9 months, verbal qualitative interviews were conducted with 10 affected individuals, and written interviews were obtained from 3 additional participants. Using a grounded-theory approach, six themes were identified, based on men’s commentary from interviews, across a spectrum of physical, social, communal, personal, medical, and vocational dimensions. Resilience theory, which explores internal resources that assist in coping with adverse situations, was used as a framework for interpreting research results. Findings indicate that men value the array of educational, social, and medical services that are available to them but choose to manage their hemophilia independently from the community and access support according to their individual needs. Understanding this dynamic may be helpful in developing services that are more specifically tailored to the physical and psychosocial needs of adult men with hemophilia and, potentially, men with other chronic health disorders.

Socio-cultural web and environmentally-driven community entrepreneurship: a portrayal of Abia Ohafia community in South-Eastern Nigeria

2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Ebere Ume Kalu ◽  
Lp Dana
Keyword(s):  
Social Capital ◽  
Cultural Capital ◽  
Design Methodology ◽  
Local Community ◽  
Social Needs ◽  
Community Based ◽  
Push Factors ◽  
Content Type ◽  
Social And Cultural Capital ◽  
Wide Scale

Purpose This study is aimed at providing a deduction on the necessity of social and cultural capital for entrepreneurial outcomes on a community-wide scale. Design/methodology/approach There is a drift from an individualised form of entrepreneurship to community-based entrepreneurship with a grand focus on social needs of current and emergent nature. This study is both archival and exploratory and has pictured culture and communality as drivers that are needful for enterprising communities. Findings This paper finds communality, social network, social capital and trust as push-factors for community-based entrepreneurship and development drives. Originality/value This study is an original exposé on the Abia Ohafia community’s Model of community-based entrepreneurship which thrives on strong institutions (like the Age Grade System) and age-long practices that have built trust and stability. This local community through its networks, culture and communalities creates relationships, rational innovation, consensual leadership and participatory followership under which resources, opportunities and solutions are deliberately advanced for meeting social and community purposes.

Perspective

1997 ◽  
Vol 18 (4) ◽  
pp. 194-196 ◽  
Author(s):  
John Kregel
Keyword(s):  
Support Services ◽  
Supported Employment ◽  
Local Community ◽  
Community Integration ◽  
Consumer Empowerment ◽  
Community Based ◽  
Significant Disabilities ◽  
Large Numbers ◽  
Sheltered Workshop

Supported employment is an established approach to community-based employment that has provided many individuals with significant disabilities an opportunity to choose between a lifetime of low wages in segregated sheltered workshop settings and the challenges of a real job in their local community. As a service-delivery strategy that embodies the principles of individualized, community-based support services and consumer empowerment, supported employment has become the preferred employment alternative for large numbers of individuals previously excluded from work opportunities (Rusch, Chadsey-Rusch, & Johnson, 1991; Wehman & Kregel, 1994). The purpose of this article is to summarize the present status of supported employment, discuss the major accomplishments of the initiative, and identify those issues that must be addressed in the future to allow the program to achieve its long-term goal of promoting the economic independence and community integration of individuals with significant disabilities.

scholarly journals Contexts and mechanisms that promote access to healthcare for populations experiencing homelessness: a realist review

2020 ◽  
Author(s):  
Rikke Siersbaek ◽  
John Ford ◽  
Sara Burke ◽  
Clíona Ní Cheallaigh ◽  
Steve Thomas
Keyword(s):  
Health System ◽  
Health Systems ◽  
Healthcare Access ◽  
Grey Literature ◽  
Realist Review ◽  
Access To Healthcare ◽  
Staff Retention ◽  
Programme Theory ◽  
Eligibility Criteria

Abstract Objective: The objective of this study was to identify and understand the health system contexts and mechanisms that allow for homeless populations to access appropriate healthcare when needed.Design: A realist review.Data sources: Ovid MEDLINE, embase.com, CINAHL, ASSIA and grey literature until April 2019. Eligibility criteria for selecting studies: The purpose of the review was to identify health system patterns which enable access to healthcare for people who experience homelessness. Peer reviewed articles were first identified through a systematic search, grey literature searching, citation tracking and expert recommendations. Studies meeting the inclusion criteria were assessed for rigour and relevance and coded to identify data relating to contexts, mechanisms and/or outcomes.Analysis: Inductive coding was used to generate Context-Mechanism-Outcome configurations which were refined and then used to build several iterations of the overarching programme theory.Results: Searching identified 330 review articles, of which 24 were included. Additional searching of grey literature yielded 50 records of which 12 were included. An additional 11 grey literature and primary sources were identified through citation tracking and expert recommendation for a total of 47 included sources. The analysis found that healthcare access for populations experiencing homelessness is improved when services are coordinated and delivered in a way that is organised around the person with a high degree of flexibility and a culture that rejects stigma generating trusting relationships between patients and staff/providers. Health systems should provide long-term, dependable funding for services to ensure sustainability and staff retention. Conclusions: With homelessness on the rise internationally, this study will inform health systems policy-making and implementation. It contributes to our understanding how healthcare systems can be more accessible for populations experiencing homelessness by providing long-term stable funding, promoting inclusive cultures and limiting stigma. Health systems should be flexible, timely and connected.

scholarly journals Crossing Boundaries–Tactical Urbanism Practices in Guangzhou City

2019 ◽  
Author(s):  
Fanying Jiang ◽  
SueAnne Ware ◽  
Wei Gao
Keyword(s):  
Local Community ◽  
Small Scale ◽  
Urban Context ◽  
Guangzhou City ◽  
Term Change ◽  
Tactical Urbanism ◽  
Spatial Appropriation ◽  
Community Spaces ◽  
Textile Factory

Tactical Urbanism is a growing movement across the world in which individuals, communities, and municipalities are improving their cities by using short-term, lowcost, and small-scale interventions and policies to catalyze long term change. The aim of this paper is to test the principle sand the approach of tactical urbanism to solve Guangzhou’slocalpublicspacesproblemsbyshowcasingtwotacticalurbanismprojects which have been completed in the Guangzhou urban context. These two cases reveal the opportunities that bottom-up approaches like tactical urbanism can build a bridge to conjunct with long term planning efforts and complete the top-down mechanisms. IntheZhusigangcommunitycase,we examine the spontaneous unplanned practices in the local community,which resemble“Tacticalurbanism” principles,and their spatial appropriation and utilization of marginalized community spaces. We assess how and where daily activities are happening and what other amenities could be provide by temporarily introducing these activities into a local gallery space. In the former textile factory case, we present examples that make the case for temporary, flexible and experimental responses to urban vacant land, then conclude by outlining the potential benefits and drawbacks of this temporary use model. This paper explores the existing practices of appropriation and the potential of temporary occupation in the city and concludes with thoughts on how tactical urbanism, an international movement, might gain a foothold in the context of local Chinese communities

A system dynamic perspective of stop–start prevention interventions in Australia

2019 ◽  
Vol 35 (5) ◽  
pp. 1015-1025
Author(s):  
Véronique Roussy ◽  
Therese Riley ◽  
Charles Livingstone ◽  
Grant Russell
Keyword(s):  
Life Course ◽  
Feedback Loops ◽  
System Dynamic ◽  
Community Based Interventions ◽  
Community Based ◽  
Design Elements ◽  
Design And Implementation ◽  
System Behaviour ◽  
Dynamic Perspective

Abstract Time-limited prevention initiatives are frequently used to address complex and persisting public health issues, such as non-communicable diseases. This often creates issues in terms of achieving sustainable change. In this study, we use a system dynamic perspective to explore the effects of stop–start funding over system behaviour in two community-based initiatives designed to prevent chronic diseases and obesity. We conducted a qualitative exploratory study using complexity theory as an analytical lens of two Healthy Together Communities (HTCs) initiatives in Victoria, Australia. Data were generated from 20 semi-structured interviews with health promotion practitioners and managers, from community health and local government organizations. Template analysis based on properties of complex systems informed the inductive identification of system behaviour narratives across the stop–start life-course of HTCs. A central narrative of system behaviour emerged around relationships. Within it, we identified pre-existing contextual conditions and intervention design elements that influenced non-linearity of system self-organization and adaptation, and emergence of outcomes. Examples include cynicism, personal relationships and trust, and history of collaboration. Feedback loops operated between HTCs and these conditions, in a way that could influence long-term system behaviour. Taking a dynamic life-course view of system behaviour helps understand the pre-existing contextual factors, design and implementation influences, and feedback loops which shape the long-term legacy of short-lived interventions aimed at solving complex issues. In turn, greater awareness of such interactions can inform better design and implementation of community-based interventions.

Community-Based Preventive and Remedial Measures to Prevent Violent Extremism: A Human Security Approach to Help Transform Conflicts, Improve Social Cohesion and Improve Local Security

2018 ◽  
Vol 56 (1-2) ◽  
pp. 198-219
Author(s):  
Keyword(s):  
Social Cohesion ◽  
Local Community ◽  
Human Security ◽  
Local Communities ◽  
Small Scale ◽  
Remedial Measures ◽  
Community Based ◽  
Community Initiatives ◽  
Community Activities ◽  
Violent Extremism

AbstractThis article, presented as part of a panel on “Community-based preventive and remedial measures” at a conference on Responses to Female Migration to ISIS, is on ways in which local communities are able to strengthen social cohesion and prevent growing polarization, especially in areas where radicalization to violent extremism takes place. The analysis is based on the Human Security Collective (HSC)’s work in Palestine, Libya, Tunisia and the Netherlands where we support local communities and the professionals who work with them on addressing systemic causes that lead to exclusion, alienation and possibly radicalization leading to violent extremism. We have learnt that approaches to prevent the attraction to violent extremism networks require methods and processes akin to those developed for conflict transformation. Some of the characteristics of this approach include the inclusion of different stakeholders, local ownership in defining problems and seeking solutions, the building of trusted relationships, the mentoring of young women and men who take on a peer-model role, and the development of innovative small-scale community activities that can then be taken up by the wider community. HSC and its partners connect these local community initiatives to policymakers at municipal, national and international levels. Through the process of facilitated dialogue we aim to create “safe spaces” where persons from different backgrounds and with different interests are able to meet and exchange practices and policies. In this way, policies are validated by lived realities and citizens become aware of the way that policies that influence local security are developed and executed. This dialogue leads to a mutual understanding of and improvement in security-related policies.

scholarly journals Barriers and Facilitators for the Implementation and Evaluation of Community-Based Interventions to Promote Physical Activity and Healthy Diet: A Mixed Methods Study in Argentina

2019 ◽  
Vol 16 (2) ◽  
pp. 213 ◽  
Author(s):  
Maria Belizan ◽  
R. Chaparro ◽  
Marilina Santero ◽  
Natalia Elorriaga ◽  
Nadja Kartschmit ◽  
...  
Keyword(s):  
Physical Activity ◽  
Mixed Methods ◽  
Local Community ◽  
Project Evaluation ◽  
Political Support ◽  
Healthy Diet ◽  
Barriers And Facilitators ◽  
Structured Interviews ◽  
Community Based Interventions ◽  
Community Based

Background: Obesogenic environments promote sedentary behavior and high dietary energy intake. The objective of the study was to identify barriers and facilitators to the implementation and impact evaluation of projects oriented to promote physical activity and healthy diet at community level. We analyzed experiences of the projects implemented within the Healthy Municipalities and Communities Program (HMCP) in Argentina. Methods: A mixed methods approach included (1) in-depth semi-structured interviews, with 44 stakeholders; and (2) electronic survey completed by 206 individuals from 96 municipalities across the country. Results: The most important barriers included the lack of: adequate funding (43%); skilled personnel (42%); equipment and material resources (31%); technical support for data management and analysis (20%); training on project designs (12%); political support from local authorities (17%) and acceptance of the proposed intervention by the local community (9%). Facilitators included motivated local leaders, inter-sectorial participation and seizing local resources. Project evaluation was mostly based on process rather than outcome indicators. Conclusions: This study contributes to a better understanding of the difficulties in the implementation of community-based intervention projects. Findings may guide stakeholders on how to facilitate local initiatives. There is a need to improve project evaluation strategies by incorporating process, outcome and context specific indicators.

The effectiveness of community-based interventions to reduce violence in and around licensed premises: a comparison of three Australian models

1997 ◽  
Vol 24 (4) ◽  
pp. 805-826 ◽  
Author(s):  
Ernie Lang ◽  
Greg Rumbold
Keyword(s):  
Local Community ◽  
National Committee ◽  
Community Based Interventions ◽  
The West ◽  
Community Based ◽  
Licensed Premises ◽  
Early Success ◽  
Action Project ◽  
Industry Associations ◽  
Safety Action

The findings of the Australian National Committee on Violence and the outcomes of a National Symposium on Alcohol and Violence have encouraged an interest in locally based initiatives to deal with the problem of alcohol-related violence in and around licensed premises in Australia. The first initiatives to emerge were in the form of local accords between police and licensees, with varying degrees of input and support from local government, licensing authorities, the various liquor industry associations, and the local community. To date none of these accords has had any legislative backing nor been underpinned by signed agreements, relying solely on the cooperation of the various parties. The early success claimed by the pioneering accords has resulted in their proliferation throughout Australia. This paper reviews three of the better-known accords, the West End Forum Project, the Surfers Paradise Safety Action Project, and the Geelong Local Industry Accord. Some general conclusions are made regarding the factors that are important with respect to the sustainability and efficacy of these approaches.

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