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Beyond the clinic: improving child health through evidence-based community development.

Komro KA, Tobler AL, Delisle AL, O'Mara RJ, Wagenaar AC - BMC Pediatr (2013)

Bottom Line: We examined intervention effects on four key domains of child health and development: cognitive development, social and emotional competence, psychological and behavioral wellbeing, and physical health.We did not limit the review to studies conducted in the United States, but the vast majority of them were U.S.-based, and the results therefore are most applicable to the U.S. context.Based on our synthesis of published literature on community development strategies, we provide an illustration combining a comprehensive set of evidence-based strategies to promote child health and development across a wide-range of child health outcomes.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Health Outcomes and Policy, Institute for Child Health Policy, University of Florida, 1329 SW 16th St, Rm 5285, PO Box 100177, Gainesville, FL 32610-01, USA. komro@ufl.edu.

ABSTRACT

Background: Promoting child wellbeing necessarily goes beyond the clinic as risks to child health and development are embedded in the social and physical environmental conditions in which children live. Pediatricians play a vital role in promoting the health of children in the communities they serve and can maximize their impact by advocating for and supporting efficacious, evidence-based strategies in their communities.

Methods: To provide a succinct guide for community pediatric efforts to advance the wellbeing of all children and particularly disadvantaged children in a community, we conducted a theory-driven and structured narrative review to synthesize published systematic and meta-analytic reviews of policy-relevant, local-level strategies addressing potent and malleable influences on child health and development. An exhaustive list of policy-relevant, local-level strategies for improving child health was used to conduct a comprehensive search of recent (1990-2012), English language peer-reviewed published meta-analyses and systematic reviews in the 10 core databases of scientific literature. Our review of the literature encompassed six key conceptual domains of intervention foci, including distal influences of child health (i.e., income and resources, social cohesion, and physical environment) and proximal influences (i.e., family, school and peer). We examined intervention effects on four key domains of child health and development: cognitive development, social and emotional competence, psychological and behavioral wellbeing, and physical health.

Results: Published reviews were identified for 98 distinct policy-relevant community interventions, evaluated across 288 outcomes. We classified 46 strategies as meeting scientific criteria for efficacy by having consistent, positive outcomes from high-quality trials (e.g., tenant-based rental assistance, neighborhood watch programs, urban design and land use policies, access to quality childcare services, class size reductions, after-school programs that promote personal/social skills). Another 21 strategies were classified as having consistent evidence of positive outcomes from high-quality observational studies only, while 28 strategies had insufficient evidence available to assess their effectiveness based on published reviews. We did not limit the review to studies conducted in the United States, but the vast majority of them were U.S.-based, and the results therefore are most applicable to the U.S. context.

Conclusions: Based on our synthesis of published literature on community development strategies, we provide an illustration combining a comprehensive set of evidence-based strategies to promote child health and development across a wide-range of child health outcomes.

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Related in: MedlinePlus

An illustration of combining efficacious community strategies to improve child health and development. Note. Superscript numbers link evidence-based strategies with corresponding studied outcomes. For example, quality preschool & early childhood education (superscript 17 under School Influences) has been shown to improve multiple primary outcomes in children (i.e., cognitive development, social/emotional competence, absence of psychological & behavioral problems) as well as affect distal and proximal outcomes (i.e., income & resources, school influences) that may positively impact child health and development.
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Figure 3: An illustration of combining efficacious community strategies to improve child health and development. Note. Superscript numbers link evidence-based strategies with corresponding studied outcomes. For example, quality preschool & early childhood education (superscript 17 under School Influences) has been shown to improve multiple primary outcomes in children (i.e., cognitive development, social/emotional competence, absence of psychological & behavioral problems) as well as affect distal and proximal outcomes (i.e., income & resources, school influences) that may positively impact child health and development.

Mentions: In addition to helping select individual efficacious policies to improve child outcomes, another important application of our framework and policy briefs is to facilitate combining multiple strategies across domains of influence. This comprehensive approach contrasts with the narrow and isolated prevention efforts often implemented by local leaders and institutions. Ameliorating the many, and diverse, deleterious consequence of children living in high-poverty neighborhoods requires the mutually reinforcing benefits of multiple effective policy strategies across what have traditionally been viewed as separate areas of action. To illustrate a comprehensive approach to supporting child health and development (Figure 3), we selected 2–4 strategies per intervention domain based on the quality of the evidence (Level 1 or 2), magnitude of effects, and breadth of outcomes. This illustrative combination of evidence-based policy strategies is intended to improve income and resources for disadvantaged families; develop social cohesion within work, school and neighborhood environments; alter the physical environment to protect against risk and to promote physical activity and safety; encourage nurturing and safe home environments; provide high-quality education and educational environments; and support positive, health-promoting peer influences. Combining effective strategies across key intervention domains that influence child health produces multiple, positive reinforcing beneficial effects on intermediate and primary child health outcomes.


Beyond the clinic: improving child health through evidence-based community development.

Komro KA, Tobler AL, Delisle AL, O'Mara RJ, Wagenaar AC - BMC Pediatr (2013)

An illustration of combining efficacious community strategies to improve child health and development. Note. Superscript numbers link evidence-based strategies with corresponding studied outcomes. For example, quality preschool & early childhood education (superscript 17 under School Influences) has been shown to improve multiple primary outcomes in children (i.e., cognitive development, social/emotional competence, absence of psychological & behavioral problems) as well as affect distal and proximal outcomes (i.e., income & resources, school influences) that may positively impact child health and development.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4016148&req=5

Figure 3: An illustration of combining efficacious community strategies to improve child health and development. Note. Superscript numbers link evidence-based strategies with corresponding studied outcomes. For example, quality preschool & early childhood education (superscript 17 under School Influences) has been shown to improve multiple primary outcomes in children (i.e., cognitive development, social/emotional competence, absence of psychological & behavioral problems) as well as affect distal and proximal outcomes (i.e., income & resources, school influences) that may positively impact child health and development.
Mentions: In addition to helping select individual efficacious policies to improve child outcomes, another important application of our framework and policy briefs is to facilitate combining multiple strategies across domains of influence. This comprehensive approach contrasts with the narrow and isolated prevention efforts often implemented by local leaders and institutions. Ameliorating the many, and diverse, deleterious consequence of children living in high-poverty neighborhoods requires the mutually reinforcing benefits of multiple effective policy strategies across what have traditionally been viewed as separate areas of action. To illustrate a comprehensive approach to supporting child health and development (Figure 3), we selected 2–4 strategies per intervention domain based on the quality of the evidence (Level 1 or 2), magnitude of effects, and breadth of outcomes. This illustrative combination of evidence-based policy strategies is intended to improve income and resources for disadvantaged families; develop social cohesion within work, school and neighborhood environments; alter the physical environment to protect against risk and to promote physical activity and safety; encourage nurturing and safe home environments; provide high-quality education and educational environments; and support positive, health-promoting peer influences. Combining effective strategies across key intervention domains that influence child health produces multiple, positive reinforcing beneficial effects on intermediate and primary child health outcomes.

Bottom Line: We examined intervention effects on four key domains of child health and development: cognitive development, social and emotional competence, psychological and behavioral wellbeing, and physical health.We did not limit the review to studies conducted in the United States, but the vast majority of them were U.S.-based, and the results therefore are most applicable to the U.S. context.Based on our synthesis of published literature on community development strategies, we provide an illustration combining a comprehensive set of evidence-based strategies to promote child health and development across a wide-range of child health outcomes.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Health Outcomes and Policy, Institute for Child Health Policy, University of Florida, 1329 SW 16th St, Rm 5285, PO Box 100177, Gainesville, FL 32610-01, USA. komro@ufl.edu.

ABSTRACT

Background: Promoting child wellbeing necessarily goes beyond the clinic as risks to child health and development are embedded in the social and physical environmental conditions in which children live. Pediatricians play a vital role in promoting the health of children in the communities they serve and can maximize their impact by advocating for and supporting efficacious, evidence-based strategies in their communities.

Methods: To provide a succinct guide for community pediatric efforts to advance the wellbeing of all children and particularly disadvantaged children in a community, we conducted a theory-driven and structured narrative review to synthesize published systematic and meta-analytic reviews of policy-relevant, local-level strategies addressing potent and malleable influences on child health and development. An exhaustive list of policy-relevant, local-level strategies for improving child health was used to conduct a comprehensive search of recent (1990-2012), English language peer-reviewed published meta-analyses and systematic reviews in the 10 core databases of scientific literature. Our review of the literature encompassed six key conceptual domains of intervention foci, including distal influences of child health (i.e., income and resources, social cohesion, and physical environment) and proximal influences (i.e., family, school and peer). We examined intervention effects on four key domains of child health and development: cognitive development, social and emotional competence, psychological and behavioral wellbeing, and physical health.

Results: Published reviews were identified for 98 distinct policy-relevant community interventions, evaluated across 288 outcomes. We classified 46 strategies as meeting scientific criteria for efficacy by having consistent, positive outcomes from high-quality trials (e.g., tenant-based rental assistance, neighborhood watch programs, urban design and land use policies, access to quality childcare services, class size reductions, after-school programs that promote personal/social skills). Another 21 strategies were classified as having consistent evidence of positive outcomes from high-quality observational studies only, while 28 strategies had insufficient evidence available to assess their effectiveness based on published reviews. We did not limit the review to studies conducted in the United States, but the vast majority of them were U.S.-based, and the results therefore are most applicable to the U.S. context.

Conclusions: Based on our synthesis of published literature on community development strategies, we provide an illustration combining a comprehensive set of evidence-based strategies to promote child health and development across a wide-range of child health outcomes.

Show MeSH
Related in: MedlinePlus