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Information on the efficacy of wellness protocols in culturally diverse populations is meager. A study was conducted to develop culturally appropriate guidelines to prevent alcohol and drug abuse. Five groups of women participated in focus groups; based on the participants' perceptions, Put Prevention into Practice guidelines for the prevention of alcohol and drug abuse were adapted for each group. Further research studies evaluating these adapted guidelines and developing additional culturally appropriate tools are needed.

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Nurse educators are challenged to revise teaching/learning methods to support community-based primary health care (PHC) systems. The key elements are: integrating education with the realities of practice and people's needs; moving communities to strive towards solving their own health problems; and recognizing the socioeconomic health determinants. Described below are four educational methods based on PHC: inquiry-based learning, IMPACTS (a game to encourage multisectoral collaboration), distance education and community-based education.

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Consistent with the goal of reforming nursing education to support nursing's agenda for health care reform, a community-based, multiprofessional initiative supported by the W.K. Kellogg Foundation began in Hawaii in 1991. This initiative created a partnership among the University of Hawaii Schools of Medicine, Nursing, Social Work, and Public Health, three community health centers, and their communities to provide a community-based, integrated system of health care, education, and research. In response to this initiative, the School of Nursing developed an integrated undergraduate curriculum consisting of: a discipline-specific tutorial using an inquiry-based learning strategy; a multiprofessional tutorial; and a 1-year clinical experience providing culturally competent primary care. Community-based education has stimulated changes in the philosophy, mission, and curriculum of the School of Nursing. The outcomes achieved as a result of this initiative have had a favorable impact on clients using the community health centers, the communities, the School of Nursing, and the students.

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Successful change of the health care system in the United States is linked to successful change in the education of health care professionals. Clearly, a cadre of health care professionals educated for a system that focuses on acute illness and hospital-based technology interventions would not perform well in a health care system that focuses on community-based primary health care. If the discipline of nursing is to continue its major role in the delivery of health care, it must ensure that nurse educators are prepared to revise nursing curricula and teaching strategies in terms of community-based primary health care knowledge and skills.

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The purpose of this article is to describe the use and effectiveness of focus group methodology for curriculum development. This unique approach grew from the investigators' belief in the application of the principles of primary health care in designing a curriculum for community-based nursing education. The specific content and outcomes of the focus groups in relation to three curricular themes are reported in this journal in the article "Community-Based Nursing Education: Research Study from the NLN Vision for Nursing Education--Hawai'i, Phase II." The current article concentrates on the process and methods used.

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Four sites--Hawai'i, Minnesota, Texas, and Massachusetts--were selected by the NLN to participate in the National League for Nursing Vision for Nursing Education: Phase II Project, a one-year initiative focused on community-based nursing education. This initiative, for the year 1995-1996, was funded by the W. K. Kellogg Foundation and coordinated by a national project director. Each site received $100,000 to be used to develop curricular models for community-based nursing. Other components of the initiative as it took place in Hawai'i--an exploration of regulatory issues regarding community-based nursing education and a description of the process of change--are reported elsewhere.

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Areas of growth in nursing are to be found at the points of interprofessional and community contact. The principles of primary health care can guide us toward empowerment to seek "Health for All."

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