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4 Community-Based Intervention
Pages 151-186

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From page 151...
... The chapter then discusses other interventions, including self-management, disease management, treatment adherence management, complementary and alternative medicine, cognitive training, and efforts to increase access for and mobility among those with chronic illness. Finally, it makes the case for monitoring and evaluating implementation of these interventions and their effects and commenting on the need for dissemination and dissemination research.
From page 152...
... Lifestyle Behaviors Physical Activity Increasing physical activity has a number of benefits for those with chronic illnesses, including decreasing the risk of cardiovascular disease, some cancers, and diabetes, as well as improving physical functioning (Physical Activity Guidelines Advisory Committee, 2008)
From page 153...
... . Physical activity appears to be helpful to people with other chronic illnesses as well.
From page 154...
... Finally, recommended policy changes and environmental interventions include community-scale and street-scale urban design and land use policies, increased access to places for physical activity combined with informational outreach, and point of decision prompts to use stairs (Community Preventive Services Task Force, [d]
From page 155...
... Eating can become a challenge for those who have to navigate making healthy food choices adhering to the multiple public health messages to consume less sodium, less fat, more unsaturated fats, less transfat, fewer triglycerides, more fruits and vegetables, as well as other dietary modifications associated with managing their chronic illness. Tobacco Smoking cessation is an important behavior-change target for people with chronic illnesses, particularly those whose illness is related to their tobacco use (HHS, 1990)
From page 156...
... More research is needed to determine optimal smoking cessation intervention approaches for individuals with chronic illnesses, as well as whether existing smoking cessation services are effective and accessible to individuals with chronic illness. A state of the science conference held by the National Institutes of Health (NIH)
From page 157...
... Recommended interventions for smoking cessation include mass media campaigns when combined with other interventions, an increase in the unit price of tobacco products, provider reminders with and without provider education, reduced out-of-pocket costs for tobacco cessation, and multicomponent interventions that include telephone counseling (Community Preventive Services Task Force, [a]
From page 158...
... . Because these clinical preventive services are for the most part delivered through health care settings, and individuals with chronic illnesses may have more contact with the health care system, they may have increased opportunities to receive preventive care.
From page 159...
... . The Guide to Community Preventive Services recommends a number of measures to increase uptake of screening in the general population, which would be likely to impact those with chronic illnesses as well.
From page 160...
... Disparities such as these point to the need for environmental and policy approaches to supporting healthy lifestyle behavior among individuals with chronic illnesses (Brownson et al., 2006) , including availability and accessibility of outlets for physical activity and healthy eating, and addressing violence in the community (Cohen et al., 2010)
From page 161...
... Disease management programs seek to detect patients with chronic illnesses and to increase their use of self-management and coordinated care with an eye toward improving outcomes and controlling costs (Bernstein et al., 2010)
From page 162...
... . The effects of disease management programs have been well studied for a number of chronic diseases, including asthma, chronic obstructive pulmonary disease, congestive heart failure, coronary artery disease, depression, and diabetes but not for others, including Alzheimer's disease, cancer, dementia, and musculoskeletal disorders (Mattke et al., 2007)
From page 163...
... Patients may find medical recommendations complicated, expensive, or inconvenient, particularly for chronic illnesses (Stephenson et al., 1993)
From page 164...
... . Data from the National Health Interview Study conducted in 1999 indicate that, of those who use complementary and alternative medicine, almost 31 percent were non-Hispanic whites, 20 percent were Hispanics, and 24 percent were non-Hispanic blacks (Ni et al., 2002)
From page 165...
... . A study conducted in Hong Kong compared two interventions for improving cognitive function in older adults.
From page 166...
... . Behavior, diet, and exercise programs have also been shown to improve both behavioral and cognitive symptoms in mild cognitive impairment (Hahn and Andel, 2011)
From page 167...
... ; therefore it is important to make weight control programs available to the public for health promotion. Participants in communitybased weight management programs that implement national treatment guidelines can achieve significant weight loss, regardless of age or gender, which improves cardiovascular and other chronic illness risk factors (Graffagnino et al., 2006)
From page 168...
... . The YMCA provides weight management programs, such as Diabetes Prevention Programs, at a community level with proven success rates with significant improvement in weight loss (Ackermann et al., 2011; Thorpe and Yang, 2011)
From page 169...
... . Evidence has consistently found that support groups are beneficial for addressing a variety of chronic illnesses -- especially groups related to maintaining self-management regimens.
From page 170...
... MONITORING, EVALUATION, AND RESEARCH As discussed earlier in this chapter, a number of community-based interventions have been developed and evaluated for their efficacy in serving individuals with chronic illness. These evidence-based programs include lifestyle interventions for physical activity, smoking cessation, and diet and
From page 171...
... Lack of dissemination and evaluation research and policy advocacy is one component that limits the impact of evidenced-based physical activity interventions on public health (Owen et al., 2006) , particularly underserved groups.
From page 172...
... Recommendations have recently been made that interventions should be developed from the outset with dissemination and scalability in mind, with greater attention paid to replication and robustness (Kessler and Glasgow, 2011; Kleges et al., 2005) .There are considerable challenges to assessing community and public health interventions, and the evidence is often far from complete (Community Preventive Services Task Force, 2005b; Leyland, 2010; Weatherly et al., 2009)
From page 173...
... Although CDC's Community Guide clearly notes the prospect of adverse effects (Community Preventive Services Task Force, 2005b) , many of the "logic diagrams" of specific intervention do not even consider the possibility that they occur.
From page 174...
... Although some interventions, such as physical activity, have been well studied and shown to improve the lives of persons living with many types of chronic illness, all interventions could benefit from further research on effectiveness, adaptation, and maintenance. Persons living with chronic illness also need interventions aimed at controlling and limiting the effects of their illness.
From page 175...
... Recommendation 11 The committee recommends that public and private research funders increase support for research on and evaluation of the adoption and long-term maintenance of healthy lifestyles and effective preventive services (e.g., promoting physical activity, healthy eating patterns, ap propriate weight, effective health care) in persons with chronic illness.
From page 176...
... 2008. Healthcare cost differences with participation in a community-based group physical activity benefit for Medicare managed care health plan members.
From page 177...
... 2008. A randomized controlled trial of the people with arthritis can exercise program: symptoms, function, physical activity, and psychosocial outcomes.
From page 178...
... Physical activity. In The Guide to Community Preventive Services: What Works to Promote Health?
From page 179...
... 2010. Physical activity and incident cognitive impairment in elderly persons: The INVADE study.
From page 180...
... 2005. Characteristics of physical activity programs for older adults: Results of a multisite survey.
From page 181...
... 2001. Physical activity and risk of cognitive impairment and dementia in elderly persons.
From page 182...
... 2006. Evidence-based approaches to dissemi nation and diffusion of physical activity interventions.
From page 183...
... 2011. A systematic review of the effects of physical activity on physical functioning, quality of life and depression in older people with dementia.
From page 184...
... 2010. An update of controlled physical activity trials in cancer survivors: A systematic review and meta analysis.
From page 185...
... 2004. Socioeconomic status and perceptions of access and safety for physical activity.


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