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Working with community: exploring community empowerment to support non-communicable disease prevention in a middle-incom country
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Epidemiology and Global Health.
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: Non communicable diseases (NCD) are recognized as a major burden of human health globally, especially in low and middle-income countries including Indonesia. This thesis addresses a community intervention program utilizing a community empowerment approach to study whether this is a reasonable strategy to control NCD.

Objective: To explore possible opportunities, common pitfalls, and barriers in the process of developing a pilot community intervention program to prevent NCD in an urban area of a middle-income country.

Methods: The study was conducted in Yogyakarta Municipality. The baseline risk factor survey in 2004 (n=3205) describes the pattern of NCD risk factors (smoking, physical inactivity and low fruit and vegetable intake) and demographic characteristics using STEPwise instrument. A qualitative study was conducted in order to illustrate peoples’ perceptions about NCD risk factors and how NCD might be prevented. A pilot intervention was developed based on the baseline survey and the qualitative data. The pilot intervention was conducted in four intervention communities while one community served as the referent area. The intervention was evaluated using quantitative and qualitative approaches. Finally, a second cross-sectional survey conducted in 2009 (n= 2467) to measure NCD risk factor changes during the five year period.

Results: Baseline qualitative data showed that people in the high SES (Socio Economic Status) group preferred individual activities, whereas people in the low SES group preferred collective activities. Baseline survey data showed that the prevalence of all NCD risk factors were high. The community intervention was designed to promote passive smoking protection, promote healthy diet and physical activity, improve people’s knowledge of NCD, and provide a supporting environment. A mutual understanding between the Proriva team and community leadership was bargained. Several interactive group discussions were performed to increase NCD awareness. A working team was assigned to set goals and develop programs, and the programs were delivered to the community. There were more frequent activities and higher participation rates in the low SES group than in high SES group. The repeated cross-sectional surveys showed that the percentage of men predicted to be at high risk of getting an NCD event had significantly increased in 2009 compared to 2004.

Conclusion: The community empowerment model was a feasible choice as a “moderate”strategy to accommodate with people’s need when implementing a community intervention that also interacts with the service provided by the existing health system. A community empowerment approach may improve program acceptance among the people.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2013. , 81 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1539
Keyword [en]
NCD, cardiovascular disease, community intervention, prevention, community empowerment, middle-incom countries
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Public health
Identifiers
URN: urn:nbn:se:umu:diva-64181ISBN: 978-91-7459-532-1 (print)OAI: oai:DiVA.org:umu-64181DiVA: diva2:589427
Public defence
2013-02-08, Sal 135, by 9A, Allmänmedicin, Norrlands universitetssjukhus, Umeå, 09:00 (English)
Opponent
Supervisors
Available from: 2013-01-18 Created: 2013-01-18 Last updated: 2015-04-29Bibliographically approved
List of papers
1. 'Maintaining balance and harmony': Javanese perceptions of health and cardiovascular disease
Open this publication in new window or tab >>'Maintaining balance and harmony': Javanese perceptions of health and cardiovascular disease
2010 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3Article in journal (Refereed) Published
Abstract [en]

Community intervention programmes to reduce cardiovascular disease (CVD) risk factors within urban communities in developing countries are rare. One possible explanation is the difficulty of designing an intervention that corresponds to the local context and culture.

Objectives: To understand people’s perceptions of health and CVD, and how people prevent CVD in an urban setting in Yogyakarta, Indonesia.

Methods: A qualitative study was performed through focus group discussions and individual research interviews. Participants were selected purposively in terms of socio-economic status (SES), lay people, community leaders and government officers. Data were analysed by using content analysis.

Results: Seven categories were identified: (1) heart disease is dangerous, (2) the cause of heart disease, (3) men have no time for health, (4) women are caretakers for health, (5) different information-seeking patterns, (6) the role of community leaders and (7) patterns of lay people’s action. Each category consists of sub-categories according to the SES of participants. The main theme that emerged was one of balance and harmony, indicating the necessity of assuring a balance between ‘good’ and ‘bad’ habits.

Conclusions: The basic concepts of balance and harmony, which differ between low and high SES groups, must be understood when tailoring community interventions to reduce CVD risk factors. The basic concepts of balance and harmony, which differ between low and high SES groups, must be understood when tailoring community interventions to reduce CVD risk factors.

Keyword
health perception; Javanese philosophy; qualitative content analysis; cardiovascular disease; community intervention
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-39370 (URN)10.3402/gha.v3i0.4660 (DOI)000208160600008 ()20411051 (PubMedID)
Available from: 2011-01-25 Created: 2011-01-25 Last updated: 2017-12-11Bibliographically approved
2. Mobilising a disadvantaged community for a cardiovascular intervention: designing PRORIVA in Yogyakarta, Indonesia
Open this publication in new window or tab >>Mobilising a disadvantaged community for a cardiovascular intervention: designing PRORIVA in Yogyakarta, Indonesia
Show others...
2010 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3, 4661- p.Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Cardiovascular disease (CVD) is a burden for developing countries, yet few CVD intervention studies have been conducted in developing countries such as Indonesia. This paper outlines the process of designing a community intervention programme to reduce CVD risk factors, and discusses experiences with regard to design issues for a small-scale intervention.

DESIGN PROCESS: THE DESIGN PROCESS FOR THE PRESENT COMMUNITY INTERVENTION CONSISTED OF SIX STAGES: (1) a baseline risk factor survey, (2) design of a small-scale intervention by using both baseline survey and qualitative data, (3) implementation of the small-scale intervention, (4) evaluation of the small-scale intervention and design of a broader CVD intervention in the Yogyakarta municipality, (5) implementation of the broader intervention and (6) evaluation of the broader CVD intervention. According to the baseline survey, 60% of the men were smokers, more than 30% of the population had insufficient fruit and vegetable intake and more than 30% of the population were physically inactive, this is why a small-scale population intervention approach was chosen, guided both by the findings in the quantitative and the qualitative study.

EXPERIENCES: A quasi-experimental study was designed with a control group and pre- and post-testing. In the small-scale intervention, two sub-districts were selected and randomly assigned as intervention and control areas. Within them, six intervention settings (two sub-villages, two schools and two workplaces) and three control settings (a sub-village, a school and a workplace) were selected. Health promotion activities targeting the whole community were implemented in the intervention area. During the evaluation, more activities were performed in the low socioeconomic status sub-village and at the civil workplace.

Place, publisher, year, edition, pages
CoAction Publishing, 2010
Keyword
cardiovascular disease, design intervention, community intervention, urban community, developing countries
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-39343 (URN)10.3402/gha.v3i0.4661 (DOI)000208160600019 ()20640246 (PubMedID)
Note

This study was supported by a grant from the Provincial Health Office of Yogyakarta Special Regency, Indonesia, by a scholarship based on a donation from the Swedish Centre Party to Umea International School of Public Health, Umea, Sweden and Umea Centre for Global Health Research.

Available from: 2011-01-24 Created: 2011-01-24 Last updated: 2017-12-11Bibliographically approved
3. Community intervention for behaviour modification: an experience to control cardiovascular diseases in Yogyakarta, Indonesia
Open this publication in new window or tab >>Community intervention for behaviour modification: an experience to control cardiovascular diseases in Yogyakarta, Indonesia
Show others...
(English)In: Article in journal (Refereed) Submitted
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-64075 (URN)
Available from: 2013-01-14 Created: 2013-01-14 Last updated: 2015-04-29Bibliographically approved
4. An increase in risk factors for cardiovascular disease in Yogyakarta, Indonesia: a comparison of two cross-sectional surveys
Open this publication in new window or tab >>An increase in risk factors for cardiovascular disease in Yogyakarta, Indonesia: a comparison of two cross-sectional surveys
2015 (English)In: Southeast Asian Journal of Tropical Medicine and Public Health, ISSN 0125-1562, Vol. 46, no 4, 775-785 p.Article in journal (Refereed) Published
Abstract [en]

This paper aims to describe changes in risk factors for cardiovascular disease (CVD) over a five year period in urban Indonesia. In 2004 (n=3,205) and 2009 (n=2,467) we conducted cross-sectional surveys of residents in Yogjakarta City, Indonesia evaluating risk factors for CVD. Smoking habits, fruit and vegetable intake, physical activity, blood pressure, weight, and height were recorded. The results of these 2 surveys conducted 5 years apart were then compared. The risk for having a CVD event was also calculated. Behavioral CVD risk factors were more common among men. The predicted risk of having a CVD event increased from 8.4% to 11.3% among men between 2004 and 2009. Effective measures need to be taken to change these behaviors among men in Yogyakarta, Indonesia.

Place, publisher, year, edition, pages
Southeast Asian Ministers of Education Organization, 2015
Keyword
non-communicable diseases, chronic diseases, smoking, risk factor, Indonesia
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-64076 (URN)000358186000026 ()
Note

Originally included in thesis in submitted form with the title: "The increasing risk factors of CVD in Yogyakarta, Indonesia : a result from two cross-sectional surveys"

Available from: 2013-01-14 Created: 2013-01-14 Last updated: 2017-12-06Bibliographically approved

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