Integrating an ecological approach into an Aboriginal community-based chronic disease prevention program

a longitudinal process evaluation

Margaret Cargo, Marks Elisabeth, Julie Brimblecombe, Maria Scarlett, Elaine Maypilama, Joanne Garnggulkpuy Dhurrkay, Mark Daniels

Research output: Contribution to journalArticleResearchpeer-review

1 Downloads (Pure)

Abstract

Background: Public health promotes an ecological approach to chronic disease prevention, however, little research has been conducted to assess the integration of an ecological approach in community-based prevention programs. This study sought to contribute to the evidence base by assessing the extent to which an ecological approach was integrated into an Aboriginal community-based cardiovascular disease (CVD) and type 2 diabetes prevention program, across three-intervention years.

Methods: Activity implementation forms were completed by interview with implementers and participant observation across three intervention years. A standardised ecological coding procedure was applied to assess participant recruitment settings, intervention targets, intervention strategy types, extent of ecologicalness and organisational partnering. Inter-rater reliability for two coders was assessed at Kappa = 0.76 (p < .0.001), 95% CI (0.58, 0.94).

Results: 215 activities were implemented across three intervention years by the health program (HP) with some activities implemented in multiple years. Participants were recruited most frequently through organisational settings in years 1 and 2, and organisational and community settings in year 3. The most commonly utilised intervention targets were the individual (IND) as a direct target, and interpersonal (INT) and organisational (ORG) environments as indirect targets; policy (POL), and community (COM) were targeted least. Direct (HP ? IND) and indirect intervention strategies (i.e., HP ? INT ? IND, HP ? POL ? IND) were used most often; networking strategies, which link at least two targets (i.e., HP?[ORG-ORG] ? IND), were used the least. The program did not become more ecological over time.

Conclusions: The quantity of activities with IND, INT and ORG targets and the proportion of participants recruited through informal cultural networking demonstrate community commitment to prevention. Integration of an ecological approach would have been facilitated by greater inter-organisational collaboration and centralised planning. The upfront time required for community stakeholders to develop their capacity to mobilise around chronic disease is at odds with short-term funding cycles that emphasise organisational accountability.
Original languageEnglish
Pages (from-to)299-307
Number of pages9
JournalBMC Public Health
Volume11
DOIs
Publication statusPublished - 2011

Fingerprint

Chronic Disease
Health
Social Responsibility
Type 2 Diabetes Mellitus
Cardiovascular Diseases
Public Health
Observation
Interviews
Research

Cite this

Cargo, Margaret ; Elisabeth, Marks ; Brimblecombe, Julie ; Scarlett, Maria ; Maypilama, Elaine ; Garnggulkpuy Dhurrkay, Joanne ; Daniels, Mark. / Integrating an ecological approach into an Aboriginal community-based chronic disease prevention program : a longitudinal process evaluation. In: BMC Public Health. 2011 ; Vol. 11. pp. 299-307.
@article{f40bc157152f48ad83f9fb28052a14d9,
title = "Integrating an ecological approach into an Aboriginal community-based chronic disease prevention program: a longitudinal process evaluation",
abstract = "Background: Public health promotes an ecological approach to chronic disease prevention, however, little research has been conducted to assess the integration of an ecological approach in community-based prevention programs. This study sought to contribute to the evidence base by assessing the extent to which an ecological approach was integrated into an Aboriginal community-based cardiovascular disease (CVD) and type 2 diabetes prevention program, across three-intervention years. Methods: Activity implementation forms were completed by interview with implementers and participant observation across three intervention years. A standardised ecological coding procedure was applied to assess participant recruitment settings, intervention targets, intervention strategy types, extent of ecologicalness and organisational partnering. Inter-rater reliability for two coders was assessed at Kappa = 0.76 (p < .0.001), 95{\%} CI (0.58, 0.94). Results: 215 activities were implemented across three intervention years by the health program (HP) with some activities implemented in multiple years. Participants were recruited most frequently through organisational settings in years 1 and 2, and organisational and community settings in year 3. The most commonly utilised intervention targets were the individual (IND) as a direct target, and interpersonal (INT) and organisational (ORG) environments as indirect targets; policy (POL), and community (COM) were targeted least. Direct (HP ? IND) and indirect intervention strategies (i.e., HP ? INT ? IND, HP ? POL ? IND) were used most often; networking strategies, which link at least two targets (i.e., HP?[ORG-ORG] ? IND), were used the least. The program did not become more ecological over time. Conclusions: The quantity of activities with IND, INT and ORG targets and the proportion of participants recruited through informal cultural networking demonstrate community commitment to prevention. Integration of an ecological approach would have been facilitated by greater inter-organisational collaboration and centralised planning. The upfront time required for community stakeholders to develop their capacity to mobilise around chronic disease is at odds with short-term funding cycles that emphasise organisational accountability.",
keywords = "Aborigine, article, Australia, cardiovascular disease, community care, evaluation, female, health promotion, human, interview, longitudinal study, male, methodology, non insulin dependent diabetes mellitus, Cardiovascular Diseases, Community Networks, Diabetes Mellitus, Type 2, Female, Health Promotion, Humans, Interviews as Topic, Longitudinal Studies, Male, Oceanic Ancestry Group",
author = "Margaret Cargo and Marks Elisabeth and Julie Brimblecombe and Maria Scarlett and Elaine Maypilama and {Garnggulkpuy Dhurrkay}, Joanne and Mark Daniels",
year = "2011",
doi = "10.1186/1471-2458-11-299",
language = "English",
volume = "11",
pages = "299--307",
journal = "BMC Public Health",
issn = "1471-2458",
publisher = "BioMed Central",

}

Integrating an ecological approach into an Aboriginal community-based chronic disease prevention program : a longitudinal process evaluation. / Cargo, Margaret; Elisabeth, Marks; Brimblecombe, Julie; Scarlett, Maria; Maypilama, Elaine; Garnggulkpuy Dhurrkay, Joanne; Daniels, Mark.

In: BMC Public Health, Vol. 11, 2011, p. 299-307.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Integrating an ecological approach into an Aboriginal community-based chronic disease prevention program

T2 - a longitudinal process evaluation

AU - Cargo, Margaret

AU - Elisabeth, Marks

AU - Brimblecombe, Julie

AU - Scarlett, Maria

AU - Maypilama, Elaine

AU - Garnggulkpuy Dhurrkay, Joanne

AU - Daniels, Mark

PY - 2011

Y1 - 2011

N2 - Background: Public health promotes an ecological approach to chronic disease prevention, however, little research has been conducted to assess the integration of an ecological approach in community-based prevention programs. This study sought to contribute to the evidence base by assessing the extent to which an ecological approach was integrated into an Aboriginal community-based cardiovascular disease (CVD) and type 2 diabetes prevention program, across three-intervention years. Methods: Activity implementation forms were completed by interview with implementers and participant observation across three intervention years. A standardised ecological coding procedure was applied to assess participant recruitment settings, intervention targets, intervention strategy types, extent of ecologicalness and organisational partnering. Inter-rater reliability for two coders was assessed at Kappa = 0.76 (p < .0.001), 95% CI (0.58, 0.94). Results: 215 activities were implemented across three intervention years by the health program (HP) with some activities implemented in multiple years. Participants were recruited most frequently through organisational settings in years 1 and 2, and organisational and community settings in year 3. The most commonly utilised intervention targets were the individual (IND) as a direct target, and interpersonal (INT) and organisational (ORG) environments as indirect targets; policy (POL), and community (COM) were targeted least. Direct (HP ? IND) and indirect intervention strategies (i.e., HP ? INT ? IND, HP ? POL ? IND) were used most often; networking strategies, which link at least two targets (i.e., HP?[ORG-ORG] ? IND), were used the least. The program did not become more ecological over time. Conclusions: The quantity of activities with IND, INT and ORG targets and the proportion of participants recruited through informal cultural networking demonstrate community commitment to prevention. Integration of an ecological approach would have been facilitated by greater inter-organisational collaboration and centralised planning. The upfront time required for community stakeholders to develop their capacity to mobilise around chronic disease is at odds with short-term funding cycles that emphasise organisational accountability.

AB - Background: Public health promotes an ecological approach to chronic disease prevention, however, little research has been conducted to assess the integration of an ecological approach in community-based prevention programs. This study sought to contribute to the evidence base by assessing the extent to which an ecological approach was integrated into an Aboriginal community-based cardiovascular disease (CVD) and type 2 diabetes prevention program, across three-intervention years. Methods: Activity implementation forms were completed by interview with implementers and participant observation across three intervention years. A standardised ecological coding procedure was applied to assess participant recruitment settings, intervention targets, intervention strategy types, extent of ecologicalness and organisational partnering. Inter-rater reliability for two coders was assessed at Kappa = 0.76 (p < .0.001), 95% CI (0.58, 0.94). Results: 215 activities were implemented across three intervention years by the health program (HP) with some activities implemented in multiple years. Participants were recruited most frequently through organisational settings in years 1 and 2, and organisational and community settings in year 3. The most commonly utilised intervention targets were the individual (IND) as a direct target, and interpersonal (INT) and organisational (ORG) environments as indirect targets; policy (POL), and community (COM) were targeted least. Direct (HP ? IND) and indirect intervention strategies (i.e., HP ? INT ? IND, HP ? POL ? IND) were used most often; networking strategies, which link at least two targets (i.e., HP?[ORG-ORG] ? IND), were used the least. The program did not become more ecological over time. Conclusions: The quantity of activities with IND, INT and ORG targets and the proportion of participants recruited through informal cultural networking demonstrate community commitment to prevention. Integration of an ecological approach would have been facilitated by greater inter-organisational collaboration and centralised planning. The upfront time required for community stakeholders to develop their capacity to mobilise around chronic disease is at odds with short-term funding cycles that emphasise organisational accountability.

KW - Aborigine

KW - article

KW - Australia

KW - cardiovascular disease

KW - community care

KW - evaluation

KW - female

KW - health promotion

KW - human

KW - interview

KW - longitudinal study

KW - male

KW - methodology

KW - non insulin dependent diabetes mellitus

KW - Cardiovascular Diseases

KW - Community Networks

KW - Diabetes Mellitus, Type 2

KW - Female

KW - Health Promotion

KW - Humans

KW - Interviews as Topic

KW - Longitudinal Studies

KW - Male

KW - Oceanic Ancestry Group

UR - http://www.scopus.com/inward/record.url?scp=79955781834&partnerID=8YFLogxK

U2 - 10.1186/1471-2458-11-299

DO - 10.1186/1471-2458-11-299

M3 - Article

VL - 11

SP - 299

EP - 307

JO - BMC Public Health

JF - BMC Public Health

SN - 1471-2458

ER -