Article type
Year
Abstract
Introduction: Community development, a complex intervention following a health promotion model to improve multiple health outcomes, is becoming the focus of much public health practice. Evaluations using randomized controlled trials are neither feasible nor appropriate.
Objective: To develop a method to systematically appraise and summarize evidence on the effectiveness of community development projects in public health nursing (PHN) practice, to assess the current literature for quality, and to draw conclusions about associated health outcomes.
Methods: A comprehensive search, including 3 databases, hand searches, key informants, conference abstracts, library searches and reference lists, yielded 133 articles. Relevance, validity and data extraction tools specific to community development research were developed and tested. Each article was assessed for relevance by a primary reader and a subset was reviewed independently by a second reader (kappa = 0.8). Included articles described projects that met the definition of community development within PHN scope of practice, and gave information on the process or outcome evaluation. 24 relevant articles (evaluating 17 projects) were assessed for quality by two independent readers, using criteria that included description of the project, issue identification, planning and action phases, information gathering and analysis. Data were extracted on the participants, strategies and results.
Results: Four projects were judged to be strong, nine moderate and four weak. Studies most often rated poorly on criteria of planning and evaluation, and most often rated well on action strategies. The majority of projects involved adult populations addressing issues such as nutrition, access to food, crime, recreation and environmental health. Strategies included workshops, lobbying and media campaigns. Positive outcomes measured through social indicators ranged from improved leadership and community services to changes in community structures and legislation. Improved population-related indicators included health care utilization, risk behaviour and knowledge.
Discussion: The methods of systematic review can be usefully applied and criteria can be developed to appraise research on innovative and complex health promotion strategies. Although experimental research does not fit this model of intervention, rigor in other approaches to evaluation is feasible and necessary. Recommendations are made to enhance practice, research and reporting.
Objective: To develop a method to systematically appraise and summarize evidence on the effectiveness of community development projects in public health nursing (PHN) practice, to assess the current literature for quality, and to draw conclusions about associated health outcomes.
Methods: A comprehensive search, including 3 databases, hand searches, key informants, conference abstracts, library searches and reference lists, yielded 133 articles. Relevance, validity and data extraction tools specific to community development research were developed and tested. Each article was assessed for relevance by a primary reader and a subset was reviewed independently by a second reader (kappa = 0.8). Included articles described projects that met the definition of community development within PHN scope of practice, and gave information on the process or outcome evaluation. 24 relevant articles (evaluating 17 projects) were assessed for quality by two independent readers, using criteria that included description of the project, issue identification, planning and action phases, information gathering and analysis. Data were extracted on the participants, strategies and results.
Results: Four projects were judged to be strong, nine moderate and four weak. Studies most often rated poorly on criteria of planning and evaluation, and most often rated well on action strategies. The majority of projects involved adult populations addressing issues such as nutrition, access to food, crime, recreation and environmental health. Strategies included workshops, lobbying and media campaigns. Positive outcomes measured through social indicators ranged from improved leadership and community services to changes in community structures and legislation. Improved population-related indicators included health care utilization, risk behaviour and knowledge.
Discussion: The methods of systematic review can be usefully applied and criteria can be developed to appraise research on innovative and complex health promotion strategies. Although experimental research does not fit this model of intervention, rigor in other approaches to evaluation is feasible and necessary. Recommendations are made to enhance practice, research and reporting.