Karen Bullock

Understanding the variability in the effectiveness of community heart health programs: a meta-analysis.

Over the past 25 years, community interventions to reduce cardiovascular disease (CVD) have been conducted around the world with very mixed results. This study uses meta-analysis to assess whether the variation in the observed effectiveness of community heart health programs (CHHP) is related to characteristics of the intervention program, the population under study, or the evaluation methods. A CHHP is defined as any primary prevention program that attempted to reduce the population burden of CVD by shifting the distribution of risk factors in a general population. To be included in the meta-analysis, a study must have utilized a reference group in the evaluation, employed a repeated independent cross-sectional measurement design, and reported sufficient outcome information for at least one of four major risk factors: smoking, total cholesterol, blood pressure, and body weight. Results of these studies are summarized with the effect size measure (Yi1-Yi2)-(Yr1-Yr2)Sr1 where Y = outcome measure, S = standard deviation of the outcome measure, 1 = baseline, 2 = follow-up. i = intervention, and r = reference community. This measure, which reports the net change in the intervention group in terms of the variability in the reference population before the start of the intervention, permits comparison across different outcome measures and facilitates the aggregation of effects across studies. Generalized least squares regression, which permits the incorporation of multiple, dependent effect sizes from a single study, was used to assess the impact of characteristics of the intervention (prevention strategy, type of mass communication, community organization, and environmental change), the population (setting, gender, year of follow-up measurement), and the evaluation design and implementation (the number of communities, matching of communities, the follow-up time, the response rate, and covariate adjustment in the analysis) on the effect sizes. The results of this analysis suggest that the characteristics of the evaluation method account for much of the heterogeneity in the outcome of CHHPs, though some intervention characteristics also play a role.

The Changing Role of Grandparents in Rural Families: The Results of an Exploratory Study in Southeastern North Carolina

Increasingly, the subject of grandparents raising their grandchildren is the focus in social service literature. In this article, the author explores the changing role of grandparents and provides a basis for assessment and intervention in rural communities. Grandmothers who were primary caregivers for at least 1 grandchild in southeastern North Carolina completed qualitative interviews regarding their experiences in transitioning from the role of grandparent to parent. The results suggest that raising grandchildren may cause financial stress, cramped living quarters, role restriction, and social isolation in this population. However, advantages to this role for grandparents can include greater life satisfaction and a positive influence on future generations within the family. Several key assumptions to guide practitioners in both assessing rural families and planning intervention are emphasized.

What Matters to Older African Americans Facing End-of-Life Decisions? A Focus Group Study

BACKGROUND To better understand what matters to African American elders who are faced with issues of death, dying, and end-of-life care, a qualitative study was conducted to elicit their perspective. METHODS Focus groups were convened across the state of Connecticut. A total of 196 individuals participated in the 90-minute interview sessions. Using an interview guide, a trained moderator conducted the racially homogeneous discussion groups. Transcriptions of the group narratives with 22 older African Americans were coded to identify themes. Data were organized and analyzed using NUD-IST 4 and constant comparative method of qualitative data analysis. RESULTS Five major themes emerged from the focus group data on older African Americans: (1) spirituality, (2) burden on family, (3) trust, (4) health insurance coverage, and (5) cultural concerns. CONCLUSION Recommendations are made for outreach education, involvement of informal helpers, and a level of acceptability in practice for diverse care needs.

Educating Gerontologists for Cultural Proficiency in End-of-life Care Practice

An educational program was developed to train practitioners to provide care for patients and families that are responsive to cultural concerns. The aim was to increase knowledge and improve attitudes toward providing culturally proficient and culturally sensitive care for patients and families facing life-threatening illnesses. The program consisted of six half-day sessions on key areas in end-of-life care practice. The modules integrated and infused content related to ethnically and culturally diverse populations in a comprehensive training format. Evaluation results suggested that the program was successful in increasing participant knowledge and attitudes towards cross-cultural interdisciplinary practice of end-of-life care.

The vulnerablility for elder abuse among a sample of custodial grandfathers: an exploratory study.

ABSTRACT Older adults have been known to make sacrifices in their caregiving roles. Gerontology literature on custodial grandparents has primarily focused on grandmothers and the challenges they face when they assume primary care for grandchildren. Little is known about the risks that older men face when they become custodial grandparents. This article highlights types and warning signs of abuse, exploitation and neglect. Exploratory study was undertaken with a racially diverse group of custodial grandfathers to fill a gap in the literature about the vulnerability for elder abuse, exploitation and neglect as expressed by older Black, Latino and White custodial grandfathers. To provide a more inclusive understanding of elder abuse, areas of vulnerability were identified for consideration by practitioners, educators and researchers. The implications of this research point to the need to rethink elder abuse assessment, prevention and intervention strategies with older men.

Chapter 7: Ahora le Voy a Cuidar Mis Nietos

SUMMARY The abuse of alcohol and other substances has long been the source of disruption in family structures and lifestyles. Yet, the impact on Latino grandparent-headed households in rural communities has received little attention to date. Health and social services agencies can reach out to rural elderly Latinos by involving community representatives in the intervention process and making culturally sound recommendation for practice and program development.

Book Review: Prevention from the Inside-Out. Jack Pransky. Bloomington, IN: Authorhouse, 2003,

Jack Pranksy’s (2003) Prevention from the Inside-Out describes an innovative approach to the prevention of problem behaviors and health promotion. The author introduces the reader to the topic by posing the question of “how effective have we been in preventing problem behaviors and promoting health and well-being” (p. xvii)? He argues that prevention approaches have fallen short of their goals and even he in earlier attempts “missed something” (p. xx) in “espousing that the answer to prevention lay primarily in changing external conditions” (p. ix). Pranksy takes on the difficult task of trying to convince the audience that each individual has within him/herself all the wisdom and common sense they will ever need to overcome any problem behavior or difficulty they encounter. He handles this task in a manner that makes this book useful for practitioners and academicians. In the introduction of the book, Pransky explains how the “Inside-Out” approach to prevention recognizes that true change comes from within and is achieved only through a perspective that leads to a change in consciousness. The reference to “inside” connotes the point where the intervention begins. This is the initial focal point of the action or effort to bring about change. Likewise, “out” refers to the intent of the action or effort and points to where we would expect to see the results. This shift in paradigm from traditional prevention approaches, which tend to focus on fixing problems in the surrounding or external environment, creates mechanisms for empowering individuals to draw upon the strengths they possess internally. The first chapter opens with an interview with Helen, a client who was abused, depressed and suicidal. According to the author’s report, the client made rapid improvement through the use of an inside-out intervention. This narrative was to be illustrative of how a shift of enormous magnitude can occur with clients. In a less than smooth transition, Chapter II provides a discussion of the meaning of inside-out prevention and refers to Helen in Chapter I as an example of what this change might look like in certain clients. Then, the