Abstract:Study objective: To explore the role of 'Community Nutrition Assistants' (CNAs) in helping to increase coverage, by increasing access to local community dietetic services, and to bring about positive changes in the determinants of healthy eating, within low income areas of Bolton, England. Study design:A descriptive evaluation of programme development and field-testing (1995)(1996)(1997) in the community. Non-experimental design.Setting: community, less affluent neighbourhoods in Bolton, North West England.Subjects: 1272 people in total, individuals and members of community groups, recorded as CNA contacts during 2 discreet monitoring periods; an opportunistic or purposive sampling strategy was used; subjects were randomly selected for group interview (n=8) and telephone interviews (n=41) out of a traceable sample of contacts (n=94) over a randomly selected 1month collection period.Findings: compared with professional only service, CNAs efforts resulted in a fourfold increase in coverage of community nutrition services in the local community. CNAs demonstrated unique attributes, which positively influence their ability to work well with local people, but particularly those considered hard to reach. At least half the subjects interviewed reported positive behaviour changes such as changes to foods bought, cooking methods or foods eaten in the home. Conclusions:This study has shown some benefits in training local people to work alongside existing community dietitians. This may help to reduce inequalities in health, address barriers to healthy eating experienced by low income families, and improve cost effectiveness. Before expansion continues on an ad hoc basis further research is needed to test generalisability, to assess health outcomes, and to quantify the value of using local people. The findings here are useful in guiding further developments.

Pillars for the Care of Older Persons in the Caribbean: A Comprehensive Community-Based Framework (Pillars) is a hybrid of multiple public health frameworks developed through community-based participatory research processes. Health and social service professionals, governmental organizations, elderly persons, and others from across the English-speaking Caribbean countries developed the Pillars framework to address the growing elderly population and with an aim to increase the number of healthy and active years of life. The Pillars framework consists of four interrelated pillars organized across multiple sectors of society: primary care with care management; integrated services coordination; population-based health promotion and disease prevention; and planning and accountability. Pillars is enabled by an envisioned integrated system of information technology that will increase community-based services delivery, interprofessional communication and coordination, and will aggregate data with all identifiers removed for surveillance, planning, forecasting, policy making, evaluation, and research.