Geographical, economic, social and cultural barriers to accessing services in rural areas are widely reported. Less widely discussed are dilemmas posed by individual and community reluctance to address sensitive health issues. This article, focusing on the highly sensitive area of mental health, and employing a participatory action approach,…

Strategies to avoid the penalties of extra variation described by J. Cornfield and reduced degrees of freedom in community-level trials were compared in Monte Carlo simulations. The three conditions necessary to ensure nominal Type I and Type II error rates are detailed. (SLD)

Background: This paper describes a portion of a larger evaluation project of a state hepatitis prevention program. Purpose: The study explored the suggestions of key informants related to the delivery of hepatitis services in the state. Methods: Researchers conducted key informant interviews lasting 30 to 45 minutes. Results: Important findings…

Suggestions are made for using radio, television, and newspapers to publicize community health services. (JD)

A Monte Carlo study compared performance of linear and logistic mixed-model analyses of simulated community trials having specific event rates, intraclass correlations, and degrees of freedom. Results indicate that in studies with adequate denominator degrees of freedom, the researcher may use either method of analysis, with certain cautions. (SLD)

A method is described for increasing residual degrees of freedom in a community experiment without substantially increasing cost or difficulty by dividing experimental subunits into batches. Theoretical advantages of batch sampling are described and illustrated with data from the Pawtucket Heart Health Program. (SLD)

Articles in this special issue consider different aspects of community-level evaluation research and demonstrate the emerging sophistication and promise of this field. Process evaluation, qualitative research, and meta-analysis are promising new directions for ensuring more appropriate levels of analysis and more appropriate outcomes. (SLD)

The effectiveness of the state of Maryland's Community Home Care Services (CHCS) program was evaluated in this study. The CHCS's major goal is to enable persons 65 and over and their spouses (regardless of age) to remain in their own homes or in other independent living arrangements, consistent with their desires, ability and safety; or to assist…

A methodology is presented for collection of cost data in evaluation of community-level health interventions that coincides with the intervention implementation. The seven discrete steps of the analysis are described, and the Minimal Contact Education for Cholesterol Change study is used as an example of how the strategy is used. (SLD)

In the past five years, there has been a surge in the attention shown to community and community-based health programs among Native Americans, particularly for chronic health problems such as diabetes. Community participation in health programming--from the efforts of community health workers (CHWs), to participatory research, to the impact of…

There is an extensive body of research on the factors that are associated with reproductive health, focusing on factors within the adolescent as well as within the various components of the adolescents environment. This paper presents a selective review of the research pertaining to each layer of the adolescent's ecosystem. Emphasized are (1)…

Purpose: To describe clinical services and health communication needs for recent immigrants. Methods: A review of relevant health behavior and policy research published in the past 20 years was conducted. Results: Health coverage for primary care, prenatal and safety net services needs to be continued for all immigrants. Legislative bodies should…

The Buffalo School Health Demonstration Plan is an innovative model program designed to expand and improve the delivery of health services and health education to school-age children attending Buffalo (New York) schools, with emphasis on lower socioeconomic youth. It seeks to develop a primarily preventive program that attempts to modify attitudes…

Utilizing the professional expertise of school nurses, the Des Moines (Iowa) Public School system is committed to providing professional health services and health education for students, employees, and the community in order to promote success in the learning process. The health services program is an integral part of the total school program in…

Health needs and health services in rural America are key issues directly related to education as well as community well-being. This report examines rural America's access to basic health care services and discusses options for congressional consideration. The focus is on trends in availability of primary and acute rural health care and on factors…