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Background: Community engagement has proved effective in increasing access to healthcare including health insurance, in developed and developing countries. Aim: The study aims at designing and testing the effectiveness of engaging the community in awareness-raising and increment of health insurance coverage. Methods: The study was a social interventional community-based study, conducted in A-Duiem Administrative Unit, A-Duiem Locality, Sudan. Baseline data on enrollment in health insurance was collected from 800 heads of households, whereas data on knowledge and attitudes about health insurance was collected from 420 heads of non-insured households using a standardized questionnaire. Strategies to scaleup health insurance through community engagement was collected from community leaders, local authorities, and health insurance policymakers through in-depth interviews and focus group discussions. The community promotion package of health insurance was implemented for one year and post-intervention data were collected from 420 heads of households. Quantitative data were analyzed using SPSS version 20. Statistical significance was set at p

Introduction: The community-based intervention was proven as one of the best approaches in combatting malaria. It is widely used to reduce malaria cases worldwide. A multisectoral approach must be made to ensure the success of the intervention. Therefore, this study is aimed is to determine the effectiveness of community-based intervention for malaria based on recent findings. Methods: A search strategy using Pub Med and Cochrane database platform investigating the effectiveness of malaria community-based intervention. There are selected terms and words predefined to obtain a comprehensive search strategy that included text fields within records and Medical Subject Headings (MeSH terms). Results: Eight articles were selected for this study. This review identified six communitybased interventions for malaria and four outcome measures. Most of the studies included a low risk of bias in each criterion except for random sequence and allocation of concealment. The meta-analysis found that the overall incidence difference of the included studies was significant (0.05 CI 0.02, 0.08), while the subgroup analysis of Permethrin LLIN the I2 was reduced to 75%. However, the overall usage percentage difference in health education and community mobilization to improve intervention usage was not significant (0.28 CI -0.02, 0.58). Conclusion: The community-based intervention approach is practical to fight malaria thus, to reduced mortality due to malaria. An integrated approach and engagement with multiagency will ensure outstanding achievement in fighting malaria.

Conflicts between young immigrants and older native populations are widely recognized as a challenge in different parts of the world. In the European context, the following paper focuses on present...

Background: This study tested the feasibility of implementing Healthy Hearts for an Abundant Life (HHAL), a cultural adaptation for African American (AA) women of the evidence-based cardiovascular disease prevention program Strong Women-Healthy Hearts (SWHH). Methods: Using a quasi-experimental pre-post study design, this 12-week program was implemented in four faith-based organizations between 2017 and 2018. Eligible participants were AA women between 40 and 65 years who had a body mass index of 25 or higher and were currently sedentary. HHAL program participants met weekly for 2-h sessions led by program leaders. The curriculum has four modules: total health; relationships, family, and networks; material security and the environment; and emotional wellness. Each class included walking for 30 min, goal-setting session, and a group dialog called “making it work” for building collective efficacy. Results: Of the 27 participants (mean age=54.2±5.9), 24 completed postassessments (93% retention rate). All outcome measures proved feasible and weekly program attendance was 73%. Findings from in-depth interviews show high satisfaction with the program and suggest extending the class time and adding cooking demonstrations. Conclusions: The culturally adapted HHAL proved feasible and was positively received by the participants. Future studies will evaluate the effectiveness of the program.

PURPOSE: The PopART for Youth (P-ART-Y) study was nested within the HPTN 071 (PopART) trial, a three-arm community randomized trial in 21 communities in Zambia and South Africa. The P-ART-Y study evaluated the acceptability and uptake of a combination HIV prevention package among young people. We report on the HIV care cascade for adolescents aged 10-19 years from 14 communities receiving the full HIV prevention package in Zambia and South Africa. METHODS: Adolescents were offered participation in the PopART intervention, which included universal home-based HIV testing, linkage to care, antiretroviral therapy (ART) adherence, and other services. Data were collected from September 2016 to December 2017, covering the third round (R3) of the intervention. RESULTS: We enumerated (listed) 128,241 adolescents (Zambia: 95,295 and South Africa: 32,946). Of the adolescents offered HIV testing, 81.9% accepted in Zambia and 70.3% in South Africa. Knowledge of HIV status was higher among older adolescents and increased from 31.4% before R3 to 88.3% at the end of R3 in Zambia and from 28.3% to 79.5% in South Africa. Overall, there were 1,710 (1.9%) adolescents identified as living with HIV by the end of R3 (515 new diagnoses and 1,195 self-reported). Of the new diagnoses, 335 (65.0%) were girls aged 15-19 years. The median time to initiate ART was 5 months. ART coverage before and after R3 increased from 61.3% to 78.7% in Zambia and from 65.6% to 87.8% in South Africa, with boys having higher uptake than girls in both countries. CONCLUSIONS: The PopART intervention substantially increased coverage toward the first and second UNAIDS 90-90-90 targets in adolescents.

Summary Lung cancer (LC) is the leading cause of cancer death. Barriers to the early presentation for LC include lack of symptom awareness, symptom misappraisal, poor relationship with doctors and lack of access to healthcare services. Addressing such barriers can help detect LC early. This systematic review describes the effect of recent interventions to improve LC awareness, help-seeking and early detection. This review was guided by the Cochrane Handbook for Systematic Reviews of Interventions. Electronic databases MEDLINE, CINAHL, ERIC, APA PsycARTICLES, APA PsycInfo and Psychology and Behavioral Sciences Collection were searched. Sixteen studies were included. Knowledge of LC was successfully promoted in most studies using educational sessions and campaigns. LC screening uptake varied with most studies successfully reducing decision conflicts using decision aids. Large campaigns, including UK-based campaign ‘Be Clear on Cancer’, were instrumental in enhancing LC awareness, promoting help-seeking and yielding an increase in chest X-rays and a decrease in the number of individuals diagnosed with advanced LC. Multimodal public health interventions, such as educational campaigns are best suited to raise awareness, reduce barriers to help-seeking and help detect LC early. Future interventions ought to incorporate targeted information using educational resources, face-to-face counselling and video- and web-based decision aids.

Purpose: This review seeks to summarize selected literature on existing findings on the impacts of community-based interventions on the actual reduction of child maltreatment and to identify the core components of the interventions. Methods: This study systematically searched electronic databases, including PsycInfo, Medline, and Web of Science. The findings of the selected studies were summarized using narrative synthesis. Results: A total of four studies met the inclusion criteria of this study. The studies showed declines in child maltreatment incidences reported by child protective services and hospitals during the study periods. Four major components and approaches were identified among the selected interventions, including (1) the involvement of community members, (2) partnerships with community institutions, (3) multidisciplinary collaboration, and (4) responsiveness to the needs of the communities involved. Conclusions: The results of this review support the need for further development of community-based interventions using a hybrid approach.

This study aims to evaluate the effectiveness of clinical treatment for male survivors of childhood sexual abuse (CSA) who deal with depression, anxiety, stress, and posttraumatic stress disorder (PTSD). Secondary data was used in the study, and a one-group pretest-posttest design was employed to compare pretest (n = 346) with posttest (n = 91) scores. The analysis shows statistically significant improvements with respect to depression, anxiety, stress, and PTSD after treatment. There was no statistically significant difference between individual and mixed treatment (including group and individual counselling) regarding alleviating mental health symptoms. Despite a lack of statistical difference between treatments, the results confirm that interventions were equally effective in reducing negative mental health symptoms. The study contributes to the generation of evidence-based knowledge for treatment and its ability to reduce negative mental health symptoms for adult male survivors of CSA. It also informs practitioners of the utility of a male-specific treatment modality based on trauma-focused cognitive and behavioral therapies (TF-CBT) and the gender role strain paradigm (GRSP).Key Words: Adult Male Survivors, Childhood Sexual Abuse, Mental Health, Evaluation

Background:The changes of plasma retinol binding protein 4 (RBP4) level after a nutrition intervention can indicate the metabolic changes associated with the delivered intervention.Objective:We investigated the changes in plasma RBP4 level among 12- to 18-month-old children after a nutrition intervention and measured its association with subcutaneous adiposity, maternal characteristics, and inflammation.Methods:Data of 520 undernourished children (250 of them had length-for-age Z score [LAZ] Results:At baseline, median RBP4 level was 19.9 mg/L (interquartile range [IQR]: 7.96), and at the end of the intervention, it was 20.6 mg/L (IQR: 9.06). Percentage changes in plasma RBP4 level were not significantly associated ( P > .05) with the percentage changes in child’s height, weight, and subcutaneous adiposity. But maternal height (regression coefficient, β = −1.62, P = .002) and milk intake (β = −0.05, P = .01) were negatively and maternal weight was positively associated (β = 0.56, P = .03) with the changes in RBP4 levels. The GEE models revealed negative association of RBP4 levels with C-reactive protein (CRP; β = −0.14, P < .05) and α-1-acid glycoprotein (AGP; β = −0.03, P < .05).Conclusion:Children whose mothers were taller experienced less increase in plasma RBP4 level, and children whose mothers had a higher weight experienced more increase in the RBP4 level from baseline. We have also found that CRP and AGP levels and intake of whole milk were negatively associated with the plasma RBP4 level.

Catalyst is a science discovery centre and independent museum based in Widnes, United Kingdom. Since 2018, it has collaborated with mental health charity Mind Halton on The MindLab project; a science inspired wellbeing programme for residents local to the museum in an area where access to mental health support is low. As museums in the twenty-first century are being increasingly regarded as community resources capable of producing valuable social impact, this article considers the role of museums in harnessing this potential to enhance community health and wellbeing during the COVID-19 pandemic. It reflects on the challenges encountered during this unprecedented period of lockdown, as well as the emerging opportunities through the perspectives of those delivering The MindLab project.

In 2017, the Institute of Tropical Medicine Pedro Kourí, University of Montreal Public Health Research Institute, and McGill University joined efforts to provide scenarios for scientific exchange and knowledge dissemination about the social science contribution on arboviral research. This commentary describes the scientific collaboration between Cuban and Canadian (Quebec) institutions, illustrating the need and opportunities to facilitate research and effective decision-making processes for arboviral prevention and control, going beyond traditional biomedical aspects. We organized a set of scientific activities within three international events conducted in Cuba between 2017 and 2018. Given the collaborating institutions’ expertise and the knowledge gaps in arboviral research, we selected three main thematic areas: social determinants and equity, community-based interventions and use of evidence for decision-making. The partnership shows that interdisciplinary collaboration and the use and integration of quantitative and qualitative methods from the social sciences is essential to face the current challenges in arbovirus research.

Background: Knowledge of human immunodeficiency virus status is a key tool in the fight against the spread of the human immunodeficiency virus epidemic. Objectives: This study sought to evaluate the impact of community-based intervention towards the prevention and control of human immunodeficiency virus on the voluntary testing for human immunodeficiency virus among allied workers in rural Bonny Kingdom of Rivers, State, Nigeria. Methods: The study comprised two quantitative surveys; the baseline survey conducted before a three years human immunodeficiency virus prevention intervention programs and the post-intervention survey conducted after the interventions. A structured questionnaire was employed to collect information from a representative sample of the allied workers aged 15–49 years. The questionnaire item for this survey is broadly divided into six categories comprising the basic socio-demographic information, the knowledge of HIV testing, desire for HIV testing, self and solution efficacy; access to products and services including voluntary counselling and testing. Data were analyzed using SPSS version 25.0. Results: The study comprised 419 participants in the baseline and 587 in the post-intervention survey. The overall knowledge of voluntary counselling and testing services was 76.8% of which 37.5% have been tested and 88.9% of which 68.0% have been tested at both surveys. Three of every 5(67.0%) had the desire to be tested at baseline while- 4 of every 5(81.1%) were willing to be tested at post-intervention. The major reasons for unwillingness to be screened include poor perception about voluntary counselling and testing and feeling of not being at risk. The prevalence of human immunodeficiency at baseline was 8.5% and 2.0% at the post-intervention survey with a prevalence ratio of 4.3 (p

African American individuals living with HIV and serious mental illness (SMI) may report relatively low treatment engagement, despite treatment engagement being critical to managing both health conditions. Here, we have two aims: to describe the methodology we used to collect focus group data on treatment engagement with a sample of African American individuals living with HIV and SMI, and to describe the results of those focus groups in the context of intervention development. We conducted two focus groups (

Background: Adequate knowledge of HIV is an important tool in preventing and control of the virus. Workers in rural communities may not have assessed to adequate education and counseling on preventing themselves from acquiring the disease unless there is an intervention. This study sought to assess the impact of 3-year community-based intervention programs on the knowledge and risk perception of allied workers about HIV/AIDS in Bonny Kingdom. Methodology: This is a quantitative study that employed a structured questionnaire among a representative sample of allied workers aged 15–49 years. The data obtained included the sociodemographic characteristics such as age, sex, education, occupation, and marital status and information related to HIV/AIDS. Data were analyzed using SPSS version 25.0. Results: This study comprised baseline and postintervention surveys with 419 and 587 respondents, respectively. The overall knowledge of HIV in both the surveys was 77.3% and 86.4%. Baseline respondents showed a poor knowledge of mother-to-child transmission of HIV (28.2%) and injection route of the disease (37.7%) as compared to 66.9% and 73.4% among the intervention group. About 64.0% of the baseline respondents were at significantly higher risk of acquiring HIV as compared to 18.1% among postintervention group (P < 0.001). Thirty-two (7.6%) had multiple sexual partners at baseline, while 21 (3.6%) had in postintervention. The proportion of respondents who had transactional sex or sex with sex workers was 13.4% in baseline and 2.4% in the postintervention survey. Conclusion: This study has found a significant improvement in the knowledge about HIV and reduction in risky sexual behavior among the allied workers in an African rural community; it is advocated that this program be extended to other rural communities on a regular basis.

Background: Childhood obesity represents a public health crisis in the United States, affecting 13.9% of preschool-aged children. Most pathophysiologic mechanisms leading to obesity are introduced in early childhood, making this a critical period to consider. The Food and Fitness Initiative (FFI) is a community-based wellness program that focuses on healthy eating and physical activity, implemented in Northeast Iowa. A previous study showed that FFI lowered the rate of increase of body mass index (BMI) levels in school-aged children exposed to the initiative. Our aim is to describe the impact on BMI after implementing …

Engagement in the HIV care continuum among people living with HIV is essential to prevent ongoing transmission. Although there is evidence for the need for comprehensive approaches (e.g., peer navigation) to improve the HIV care continuum, there is limited knowledge of how the peer navigation model might work to improve the HIV care continuum in low resource settings among Latinx key populations (e.g., persons who inject drugs, female sex workers, men who have sex with men, and transgender women). Therefore, this article aims to qualitatively assess members of key populations' acceptability of Conexiones Saludables (Healthy Connections), a community-based peer navigation intervention implemented in Tijuana, Mexico. This analysis draws upon the postintervention survey data from 34 participants and data from qualitative interviews with 10 participants. Participants found the intervention to be acceptable and discussed the ways in which peer navigators were influential in educating participants about HIV, antiretroviral therapy (ART), linking participants to existing HIV care and ancillary services in Tijuana, and in providing emotional and instrumental support to facilitate engagement in HIV treatment and ART adherence. The intervention emphasized the use of peer navigators who had a deep understanding of the sociostructural barriers (e.g., substance use, homelessness) that HIV-positive key populations face in Tijuana. Findings from this study may inform programs with highly vulnerable populations in similar settings.

Background: Extreme temperatures have negative consequences on the environment, ecosystem, and human health. With recent increases in global temperatures, there has been a rise in the burden of heat-related illnesses, with a disproportionate impact on low- and middle-income countries. Effective population-level interventions are critical to a successful public health response. Objective: This scoping review aims to summarize the evidence on the effectiveness of population-level heat-related interventions and serve as a potential guide to the implementation of these interventions. Methods: Studies that evaluated the effectiveness of community-based interventions to mitigate or reduce the impact of extreme heat on heat-related mortality and morbidity were sought by searching four electronic databases. Studies published in the English language and those that had quantifiable, measurable mortality, morbidity or knowledge score outcomes were included. Results: The initial electronic search yielded 2324 articles, and 17 studies were included. Fourteen studies were based in high-income countries (HICs) (Europe, US, Canada) and discussed multiple versions of (1) heat action plans, which included but were not limited to establishing a heat monitoring system, informative campaigns, the mobilization of health care professionals, volunteers, social workers and trained caregivers in the surveillance and management of individuals with known vulnerabilities, or stand-alone (2) education and awareness campaigns. Multi-pronged heat action plans were highly effective in reducing heat-related mortality and morbidity, especially among vulnerable populations such as the elderly and those with chronic conditions. Conclusions: The heat action plans covered in these studies have shown promising results in reducing heat-related mortality and morbidity and have included instituting early warning systems, building local capacity to identify, prevent or treat and manage heat-related illnesses, and disseminating information. Nevertheless, they need to be cost-effective, easy to maintain, ideally should not rely on a mass effort from people and should be specifically structured to meet the local needs and resources of the community.

Objectives: The purpose of the present study was to: (i) provide timely data on dental caries and periodontal conditions in rural Burkina Faso; (ii) identify the oral health practices carried out in this population, and (iii) to prioritize evidence-based interventions at the community level.Methods: Leaning on WHO recommendations for oral health epidemiological studies, clinical examinations and questionnaire-based surveys were conducted in two different age groups (adolescents: 15–19 years old; adults: 35–44 years old) in the health district of Nouna, Burkina Faso. Caries and tooth status were assessed according to the DMFT Index. The periodontal status was assessed by a modified Community Periodontal Index on all teeth present and measuring the level of attachment-loss of six index teeth. Questionnaire items specifically included utilization of oral health care and oral health behaviors.Results: The prevalence of untreated caries was 38% in adolescents and 73% in adults. In terms of periodontal health, 21% of adolescents and 61% of adults had an attachment loss ≥4 mm. Ninety seven percent of adolescents had not attended a dentist in the previous year and 78% of adults had never seen a dentist in their life. About one third of adolescents and adults cleaned their teeth less often than once per day with equal proportions of toothbrushes and traditional chewing sticks made of tree branches. Fluoride toothpaste was used by Conclusions: Dental caries and periodontitis are highly prevalent in rural Burkina Faso. These findings highlight the key relevance of epidemiological data for identifying people's oral health needs as basis for developing, testing, and implementing oral health interventions and programs. Special emphasis should be put on the design and evaluation of community-based interventions.

Objectives Families facing end-stage nonmalignant chronic diseases (NMCDs) are presented with similar symptom burdens and need for psycho-social–spiritual support as their counterparts with advanced cancers. However, NMCD patients tend to face more variable disease trajectories, and thus may require different anticipatory supports, delivered in familiar environments. The Life Rainbow Programme (LRP) provides holistic, transdisciplinary, community-based end-of-life care for patients with NMCDs and their caregivers. This paper reports on the 3-month outcomes using a single-group, pre–post comparison. Method Patients with end-stage NMCDs were screened for eligibility by a medical team before being referred to the LRP. Patients were assessed at baseline (T0), 1 month (T1), and 3 months (T2) using the Integrated Palliative Outcome Scale (IPOS). Their hospital use in the previous month was also measured by presentations at accident and emergency services, admissions to intensive care units, and number of hospital bed-days. Caregivers were assessed at T0 and T2 using the Chinese version of the Modified Caregiver Strain Index, and self-reported health, psychological, spiritual, and overall well-being. Over-time changes in outcomes for patients, and caregivers, were tested using paired-sample t-tests, Wilcoxon-signed rank tests, and chi-square tests. Results Seventy-four patients and 36 caregivers participated in this research study. Patients reported significant improvements in all IPOS domains at both 1 and 3 months [ranging from Cohen's d = 0.495 (nausea) to 1.793 (depression and information needs fulfilled)]. Average hospital bed-days in the previous month fell from 3.50 to 1.68, comparing baseline and 1 month (p < 0.05). At 3 months, caregiver strain was significantly reduced (r = 0.332), while spiritual well-being was enhanced (r = 0.333). Significance After receiving 3 month's LRP services, patients with end-stage NMCDs and their caregivers experienced significant improvements in the quality of life and well-being, and their hospital bed-days were reduced.

Background/Aims: Postal distribution of a fecal immuno chemical test (FIT) kit has been recommended as an effec tive method of increasing participation in colorectal cancer (CRC) screening. The present study was performed to assess the impact of the round-mailed FIT kit on screening participa tion in underserved regions of Korea and to identify factors related to nonparticipation. Methods: Residents were re cruited from three rural regions of Korea that lack screening units for the National Cancer Screening Program. A package containing a FIT kit for stool self-sampling and a return enve lope addressed to the local health center was postally distrib uted to each subject. Thirty days after the kits were mailed, nonresponders were reminded via telephone as the second intervention. The participation rates and odds ratios with 95% confidence intervals (CIs) for each intervention response were calculated to evaluate the effect of the interventions and factors related to screening participation in response to the interventions. Results: CRC screening participation rates increased from 24.5% (95% CI, 21.6% to 27.4%) to 42.6% (95% CI, 39.3% to 46.0%) as a result of postal screening and increased further to 51.4% (95% CI, 48.0% to 54.9%) after the telephone reminder. After controlling for the sex, age, and household type of each subject, factors associated with poor response to postal screening were identified as low educa tional attainment and poor previous participation in the Na tional Cancer Screening Program. Conclusions: Round-mailed FIT kits with phone call reminders were an effective inter vention, nearly doubling the screening rate in underserved regions of Korea. (Gut Liver 2020;14:323-330)

Introduction: The increasing prevalence of overweight and obesity is one of the most critical issues of urban health. The current study investigated the effects of community-based interventions on modification of overweight and obesity. Methods: A program based on the Urban Health Equity Assessment and Response Tool (Urban HEART) was developed and implemented in 2013-2014. A total of 166 Iranian females aged 15 years or older who were classified as overweight or obese using body mass index (BMI) were randomly selected and gave verbal consent to participate in this study. The intervention was carried out for a duration of 4 months. Results: The mean age of subjects was 43.6±12.2 years. The total number of overweight and obese individuals were 75 (45.2%) and 91 (54.8%), respectively. The mean BMI of the patients before and after the intervention was 30.3 ± 2.7 and 29.4 ± 2.7 kg/m2, respectively (P < 0.05). Higher education level and greater floor area were recognized as valid predictors for reduced BMI after the intervention (P < 0.001). Conclusion: This study successfully represents the collaborative role of the community in improving health status by reducing overweight and obesity. The Urban HEART provided distinct opportunities for presenting the promising results of interventions to health policymakers and managers so they can adjust macro and micro policies for achieving better community health outcomes.

BACKGROUND: Fostering a community-based approach is one of the United Nations Children's Fund (UNICEF) strategies to empower the public with the knowledge and tools required for improving the nutritional status. AIM: The current study was conducted to assess the knowledge of mothers/caregivers towards a healthy, safe, and affordable diet and to cover the detected knowledge gap using a community-based approach. METHODS: A pre-posttest experimental design was carried out at a community level at three Upper Egypt governorates: Assiut, Qena, and Sohag over six months from September 2017 till February 2018. In the preparatory phase, 22 non-governmental organisations (NGOs) were selected per governorate, and 15 trainers were prepared at the central level to train 40 trainees from each governorate. In the implementation phase, 11,000 women were approached, 6548 of them agreed to participate in the baseline knowledge assessment: 1774 women from Assiut, 2337 from Qena, and 2437 from Sohag. RESULTS: A significant improvement in the participants’ subtotal and total knowledge scores in all dimensions of nutrition education which are: food economics, food safety, and a healthy diet. The highest percent change was in Assiut 77.1 (69.3: 109.9), followed by Qena 54.9 (27.2: 93.3), and then Sohag 43.7 (31.6: 61.4) which was noticed among the participants from the 3 governorates. CONCLUSION: This community-based approach was a successful intervention to deliver effective health education messages; thus, improving participants' knowledge regarding food safety, healthy diet, and food economics. It represented the success of NGOs to enhance health and nutrition literacy among the participating women living in underprivileged areas. It is recommended to encourage collaboration with NGOs to move the community towards healthy behaviours.

Purpose: Hypertension is the primary risk factor for development of cardiovascular complications. Community-initiated interventions have proven effective in reducing cardiovascular disease risk among individuals who might otherwise face barriers to care. The purposes of this study were to gain feedback on a church-based hypertension intervention study and assess barriers and facilitators to hypertension control after participation in the study. Design: Qualitative study of 4 focus groups. Setting: Focus groups took place at 4 churches in primarily minority neighborhoods of Chicago, Illinois, in summer 2017. Participants: Thirty-one community members participated in the focus groups. Method: The Community Targeting of Uncontrolled Hypertension (CTOUCH) study was a church-based screening, brief intervention, and referral for treatment program for hypertension. Following the study completion, participants were invited to join a focus group to provide feedback on the study and discuss barriers and facilitators to hypertension control. The authors used the Framework Method to analyze the data. Results: Community Targeting of Uncontrolled Hypertension was well received by participants, particularly the awareness of their individual blood pressure and subsequent education on risk modification. The most common facilitators for hypertension control were social support, knowing how to control hypertension, and community resources. The most common barriers to hypertension control were lack of hypertension knowledge, negative primary care experiences, and lack of disease awareness. Conclusion: Knowledge of barriers and facilitators can inform areas of success and opportunities for improvement in community-based hypertension programs including future renditions in CTOUCH.

Chagas disease (CHD) has become a challenge in Spain due to the high prevalence of immigrants coming from endemic areas. One of the main difficulties for its control and elimination is its underdiagnosis. The identification and integral treatment of CHD are key to increasing rates of diagnosis, overcoming psycho-social barriers and avoiding CHD progression. Community interventions with in situ screening have proven to be a useful tool in detecting CHD among those with difficulties accessing health services. To determine the underdiagnosis rate of the population most susceptible to CHD among those attending two different Bolivian cultural events celebrated in Barcelona; to describe the sociodemographic characteristics of the people screened; and to analyse the results of the screening. The community interventions were carried out at two Bolivian cultural events held in Barcelona in 2017. Participants were recruited through community health agents. A questionnaire was given to determine the participants' prior knowledge of CHD. In situ screening was offered to those who had not previously been screened. Those who did not wish to be screened were asked for the reason behind their decision. Results were gathered in a database and statistical analyses were performed using STATA v14. 635 interviews were carried out. 95% of the subjects reported prior knowledge of CHD. 271 subjects were screened: 71.2% women and 28.8% men, of whom 87.8% were of Bolivian origin. The prevalence of CHD was 8.9%. Community health interventions with in situ screening are essential to facilitating access to diagnosis.

This article intends to the validate measurement model for integrated community intervention strategies (ICIS) and explore the entrepreneurial orientation of community members in ecotourism destinations through ICIS. The study adopted the exploratory sequential method. The study employed focused groups, interviews and structured questionnaires for primary data collection. Confirmatory factor analysis (CFA) and percentage analysis were conducted for testing the hypothesis. Data were gathered from four protected area based ecotourism destinations of Kerala, India, namely, Thenmala, Periyar, Parambikulam and Wayanad. The result indicates that there are three latent constructs for ICIS that is governance intervention strategies, eco-development intervention strategies and commercial intervention strategies. As far as entrepreneurial orientation is concerned, local community members are able to orient themselves in three levels of entrepreneurial requirements positively, namely, exploration, initiation and sustenance. The study gives a pragmatic model of community intervention in tourism and entrepreneurial orientation resulting from such interventions, which can be further explored to establish a standard model to enhance more inclusive and sustainable resource management practices through enterprise development. Accordingly, the results of the study can influence policymakers, stakeholders and tourism practioners.

Cardiovascular disease, the leading cause of death in the USA, poses a unique and multilateral burden to racial/ethnic minorities. The admixture of comorbid conditions, structural barriers, and psychosocial standing complicates the prevention, diagnosis, and management of cardiovascular disease in racial/ethnic minority populations and requires newer approaches to reduce existing disparities. A discussion of the cardiovascular disease risk burden is presented, along with an overview of multi-stratified considerations for improving racial/ethnic minority cardiovascular health via community engagement.

The aim of this study was (1) to examine the long-term effectiveness of the "Multimove for Kids" program, a 30-week fundamental motor skill intervention (approximately 1 hour per week) for typically developing children between 3 and 8 years, and (2) to determine the influence of participation in organized sports on motor competence (MC) six years after the intervention. Of the 992 children who took part in the "Multimove" program, 399 (intervention group: N = 228, control group: N = 171) were tested again at 6-year follow-up. MC was measured with the Test of Gross Motor Development, 2nd Edition. To examine the long-term impact of "Multimove" on MC, and the effect of participation in organized sports a latent growth curve analysis was conducted. After the 30-week intervention, the intervention group outperformed the control group (beta = 5.57, P < .001). However, when the entire study period, including the 6-year follow-up, was considered, the intervention group made less progress in MC than the control group (beta = -0.41, P < .05). Looking at the engagement in organized sports, it was found that years of experience before the intervention had no significant influence on the evolution of MC over time, whereas a positive effect was observed for children's average sports participation (h/week) during the 6-year retention period (beta = 0.14, P < .001). Finally, children practicing predominantly object control-oriented sports during retention obtained slightly better MC scores at follow-up (beta = 0.01, P < .01). The "Multimove" intervention does not have a long-term effect on the development of MC. However, participation in organized sports has a positive influence on MC evolution over time.

Background: Hypertension and diabetes mellitus are the second and third highest leading causes of disability-adjusted life-years (DALY), respectively, in Brazil. The clinical outcomes of chronic diseases are influenced by various factors. Therefore, there is a need for multifaceted interventions to achieve a decrease in the rate of DALY, with a better control of these diseases.Objective: To verify whether sustainable long-term interventions, such as health worker training and provision of health education to the patients, contribute to health improvements in patients with hypertension and diabetes from rural communities.Methods: Over a 6 month period, educational and medical interventions were provided to optimize the treatment of hypertension and diabetes. Furthermore, blood pressure and glycated hemoglobin (HbA1c) measurements were taken at baseline and after the interventions.Results: The monitored hypertensive patients (n = 276) had a reduction of 13.4 mmHg (p = 0.021) and 5.8 mmHg (p < 0.001) in mean systolic and diastolic blood pressure, respectively. Diabetic patients who were followed-up (n = 71) achieved a 0.55% (p = 0.185) reduction in HbA1c level. The desired blood pressure level (Conclusion: The results showed that the interventions improved the blood pressure and HbA1c levels in patients with hypertension and diabetes from rural communities in a municipality in Northeast Brazil.

Due to the continuing high suicide rates among young men, there is a need to understand help-seeking behaviour and engagement with tailored suicide prevention interventions. The aim of this study was to explore help-seeking behaviour and engagement for young men aged 18 to 30 years who attended a therapeutic centre for men in a suicidal crisis. In this prospective cohort study, data were collected from 546 men who were referred into a community-based therapeutic service in North West England. Of the 546 men, 337 (52%) received therapy; 161 (48%) were aged between 18 and 30 years (mean age 24 years, SD=3.4). One third (n=54; 34%) of the men were seen within 48 hours of their referral. Analyses included baseline differences, symptom trajectories for the CORE-34 Clinical Outcome Measure (CORE-OM) and engagement with the therapy. For the CORE 34 there was a clinically significant reduction in mean scores between assessment and discharge (p

Background: Efforts to improve antenatal care have been heightened to reduce global maternal deaths. In resource-limited settings, community-based interventions play a pivotal role in improving antenatal care services. However, effective implementation of community-based interventions is influenced by prevailing community-related factors. Drawing from the community-based interventions implemented in Iringa Region in Tanzania, this paper underscores how community factors influenced implementation and ultimate improvement of antenatal care services.Methods: A qualitative case study design involving interviews (n=86) and focus group discussions (n=6). Data was collected in Kilolo and Mufindi districts in Iringa Region and analysed thematically. Results: The community readiness to adopt the interventions and effective local administrative systems were the key factors that influenced the implementation of the community-based interventions. Stakeholders’ engagement and the local health system support were also pivotal for improving antenatal care services. However, physical environment, bullying of implementers of interventions and family-related challenges constrained the implementation of the interventions.Conclusion: The performance of community-based interventions was highly determined by the community-related factors. In-depth understanding and adequate management of community engagement are important during the planning, development and implementation of the interventions. Inadequate community engagement may lead to community members reluctance to adopt and implement community-based interventions.

(1) Background: The Healthy Kids Community Challenge (HKCC) was a community-based obesity prevention intervention funded by the Government of Ontario (Canada). (2) Methods: A quasi-experimental design was used to examine the impact of the HKCC on physical activity (PA) outcomes using both repeat cross-sectional (T1 2014–2015, n = 31,548, T2 2015–2016, n = 31,457, and T3 2016–2017, n = 30,454) and longitudinal data (n = 3906) from the COMPASS study. Grade 9–12 students in HKCC communities were placed into one of three intervention groups [T2 data collection post-HKCC finishing (IG1), T2 data collection during HKCC (IG2), and T2 data collection pre-HKCC starting (IG3)], Ontario students in non-HKCC communities were Control Group 1 (CG1) and Alberta students were Control Group 2 (CG2). (3) Results: Repeat cross-sectional results show over time the HKCC had no significant impact on PA outcomes in any of the intervention groups. Longitudinal results show a significant decrease in time spent in moderate-to-vigorous PA (IG2: −3.15 min/day) between T1 and T3 in IG2. (4) Conclusions: These results suggest the HKCC did not have an impact on improving PA outcomes among older youth in HKCC communities. Moving forward, there is a need to provide effective and sustainable interventions to promote PA among older youth.

To provide information on the characteristics of elderly epilepsy patients in rural Northeast China.Consecutive patients (aged60) who were diagnosed with convulsive epilepsy in seven counties in Jilin Province, Northeast China, between January 2010 and December 2019 were included in the program and were divided into the EOE (early-onset epilepsy) group and the LOE (late-onset epilepsy) group. The patients were followed up once a month, and demographics and clinical data were recorded.There were 471 patients enrolled in this study, with 329 patients classified into the EOE group and 142 patients recruited into the LOE group. At baseline, the EOE group was younger than the LOE group (t=-9.007, p0.001). The most common etiologies for the EOE and LOE groups were post-trauma (4.0%, n=13) and stroke (9.2%, n=13). Elderly epilepsy patients had a good response to PB monotherapy, and no significant difference was found between the two groups (p0.05). EOE patients complained of more serious adverse events (p0.05), and drowsiness (52%) and ataxia (28%) were the most common adverse events reported by the EOE and LOE groups, respectively; however, more LOE patients were prone to withdrawal due to side effects (p = 0.036). A total of 63 patients withdrew from the study, and nonadherence was the commonest cause for withdrawal (56% in EOE and 50% in LOE). In the entire follow-up period, 112 patients (63 in the EOE group and 49 in the LOE group) died; the most common causes of death were stroke (n=44, 39%) and heart disease (n=36, 32%). The LOE group had a shorter survival time than the EOE group (χElderly epilepsy patients had a good response to PB monotherapy. EOE patients complained of more serious adverse events, but more LOE patients were prone to withdrawal due to side effects. Nonadherence was the commonest cause of drug withdrawal, and it reflects the limited education regarding the impact of seizures and the differences in priorities of rural communities. EOE patients survive longer than LOE patients.

The purpose of this study was to assess the effects of a pilot community-based behavioral intervention on the home food environment in U.S. households. Parents (21 females, 2 males, age = 36 &plusmn, 5.5 years, 78% Hispanic) of elementary school-aged children attended a 10-week dietary improvement behavioral intervention targeting an increase in fruit and vegetable consumption and a reduction in sugar intake. Home food availability of fruit, vegetables, and sugar-laden foods and beverages were assessed before and after the intervention using a modified version of the Home Food Inventory. Relative to baseline, the intervention resulted in significant increases in fruit availability (7.7 &plusmn, 3.2 items vs. 9.4 &plusmn, 3.1 items, p = 0.004) and low sugar cereal (2.3 &plusmn, 1.4 types vs. 2.7 &plusmn, 1.4 types, p = 0.033). There was a significant reduction in sugar-sweetened beverage availability (3.2 &plusmn, 1.9 types vs. 1.7 &plusmn, 1.3 types, p = 0.004). There was a significant increase in the number of households with accessible ready-to-eat vegetables and fruit, and a significant reduction in available prepared desserts, and candy (p &lt, 0.01). There were no significant changes in the availability of vegetables and sugar-laden cereals. The current intervention resulted in positive changes in the home food environment. Further research to confirm these results in a randomized controlled trial is warranted.

Background World Health Organisation (WHO) has approved and recommended several public health measures to halt the Coronavirus Disease 2019 (COVID-19) pandemic. The implementation of recommended interventions vary between higher income and Low and Middle-Income Countries (LMICs). The economical constraints within LMICs posed challenges in accessing resources for COVID-19 prevention. The study aimed to identify the workable community-based interventions being utilised in LMICs.Main body We applied systematic review approach for this study. Included articles were searched in eight online databases. The analysis was guided by the acceptable of best practice developed by the PROSPERO and COCHRANE for systematic search and selection of articles using pre-defined search terms. Furthermore, a PRISMA flow diagram was used to show the number of articles retrieved, retained, excluded with rationales given for every action. Studies conducted on community-based intervention for preventing COVID-19 and levels of knowledge, attitudes and practice (KAP) on community-based intervention for preventing COVID-19 regardless of the design were included. A mixed method appraisal tool (MMAT) was used to appraise studies.Six studies from LMICs were included for detail analysis after the systematic review screening process from 10,100 articles. The quality assessment using MMAT tool appraised these articles were all in highest quality. Among the six articles, 10 community-based interventions were implemented in LMICs. The three key workable and implemented interventions are: use of masks, social distance and hand wash. The review identified varying levels of KAP between LMICs and social-demographical factors affecting KAP in these settings.Conclusion This systematic review has identified the community-based interventions implemented in LMICs to prevent COVID-19 during the pandemic and key factors affecting the level of KAP among the population. This study re-affirms the importance of effective and suitable implementation of the identified interventions. More studies need to be conducted in LMICs to establish the effectiveness and adoption of the implemented and recommended interventions.

Background: Chronic Obstructive pulmonary disease (COPD) results in frequent hospital admissions with a significant impact on quality of life. Glasgow Community Respiratory Team (CRT) manages COPD exacerbations at home with a multidisciplinary, patient centred approach. Patients failing to respond to appropriate management are reviewed at a weekly consultant led “virtual ward round”. Objectives: We aimed to evaluate the efficacy of introducing interventions in the community following MDT discussions as means of reducing hospital admissions and improving quality of life. Methodology: The data of 349 patients was accumulated from Glasgow CRT database from May 2017 to May 2018 who underwent MDT discussion due to failure to respond to CRT management. MDT outcome interventions were defined under the three main phenotypes which are asthmatic, infective and anxiety. We reviewed admissions number and COPD assessment score (CAT score) for 12 months pre and post MDT discussion. Results: The mean age was 69.7 (+/-10.1) and MRC Grade 4.3 (+/-0.6), 96% of patients were GOLD Cat D. Mean FEV1 was 53.7% (+/-21.9%), exacerbation frequency was 6/year. Admission rates reduced post intervention (1.4 vs 1.2 per annum p=0.0383). 176 patients were phenotyped as infective, 103 asthmatic, 7 anxiety. CAT score showed significant improvement post-intervention (29 vs 21.5 p Discussion: Community interventions reduced CAT scores and frequency of admissions in COPD. Virtual ward round review with identification and management of “treatable traits” may improve quality of life in a severe COPD patients managed in the community.

Non-Communicable Diseases (NCDs) are prevalent in the migrant population with increased years of residency in the host country. In this regard, health education and lifestyle interventions have proven to be cost-effective modifying risk factors. The Spanish pilot of the Mig-HealthCare project directly aims to reduce the prevalence of NCDs reducing the well-known “healthy migrant effect” by increasing the levels of health literacy and also turning the lifestyles of the participants into healthier habits in the host country. The Mig-HealthCare pilot in Spain is a one-month group-based Health Education and Lifestyle Intervention to prevent the incidence of non-communicable diseases in Migrant and refugee populations addressing their Acculturation Process (HELP-MAP). Consequently, the pilot intervention addressing 4 topics: health literacy, physical activity, dietary patterns and strategies for coping with stress. The implementation of the pilot will be carried out in two different community services (i) one NGO providing care and accommodation for asylum seekers and (ii) three social care units within primary health care centres. Furthermore, following the Mig-Healthcare study protocol evaluation will focus on acculturation strategies, level of health literacy, physical exercise, change in diet, use of health care access and Quality-Adjusted life-years (QALY)

The aim of Project THANKS (Turning HIV/AIDS into Knowledge for Sisters) was to provide resources for African American women living with a dual diagnosis of HIV and associated comorbidities such as a chronic illness, and substance use disorder. HIV self-management is viewed within a larger context that addresses HIV and comorbidities concurrently. Project THANKS is an evidence-based, culturally competent curriculum that provides African American women with the necessary knowledge and tools to manage their complications associated with having multiple chronic diseases. The intervention was piloted in 2015 and later conducted in 2018 in 3 community-based health centers in New Jersey. Future interventions of Project THANKS will address the social support, mental health, and health literacy needs expressed by participants as well as incorporating a licensed social worker to further improve their physical and mental health outcomes.

There is increasing emphasis on psychological and social approaches to managing and treating mental illness, including a growing evidence base on the effectiveness of community-based social interventions including arts and heritage activities, library programmes, volunteering schemes, nature-based activities and community groups. However, there is a gap in understanding of what the barriers to, and enablers of, working with individuals with mental illness might be for the community and voluntary sector. A qualitative approach was used involving focus groups with non-profit organisations delivering social activities within communities across the United Kingdom. Behaviour Change Theory, the COM-B model and the Theoretical Domains Framework, were employed as the theoretical framework, to develop interventions to address the barriers raised. Representatives of the organisations reported being motivated by the mental health needs of others, and by seeing the benefits of participation. Further motivations included expanding inclusion, and economic motivation to ensure sustainability. Strengths identified included offering innovative, responsive services that were distinct from conventional mental health services. Running these services demanded new and potentially challenging skills, such as understanding statutory responsibilities, and being able to train and support staff. Further challenges included maintaining boundaries between their roles as community organisations and clients' mental health needs and avoiding burn-out. Ability to deliver this work was enhanced by support of peer organisations and opportunities to share practice. However, funding was often short term, and complex to obtain, which could destabilise organisations' sustainability. Lack of transparency around the process, differences in language between the community and health sectors, and confusion around commissioning pathways undermined the potential opportunity offered by social prescribing policy. Interventions to address these barriers were identified, including long term funding to support core costs, training on engaging with the commissioning process, around mental health support and safeguarding, and developing mentoring schemes and local co-operatives of organisations for developing partnerships with the health sector.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: The primary objective is to assess the effectiveness and acceptability of community‐based interventions (randomised controlled trials only) in comparison with controls (no treatment, waiting list, alternative treatment) for preventing and treating mental health problems (major depression, anxiety, post‐traumatic stress disorder, psychological distress) and improving mental health in refugee children and adolescents in high‐income countries. The secondary objective is to comprehensively summarise evidence from non‐randomised quantitative and qualitative studies on community‐based interventions for mental health promotion and preventing and treating mental disorders among refugee children and adolescents in high‐income countries.

Aims This pilot study aimed to assess the acceptability of an intensive community-based intervention, and to get a preliminary estimate of the effect size of the intervention for people with type 2 diabetes in Kupang, Indonesia. Methods Pilot of a cluster randomised trial involving sixty-seven participants. The participants were recruited from four Primary Health Centres (PHCs), and were allocated into groups (intervention: 36; control: 31) based on the PHCs they were registered in. The 3-month intervention consisted of weekly group activities including physical activity and education. Control was usual care. The outcomes were change in HbA1c, medication adherence, and self-management behaviours. To test our intervention, we used a mixed linear model, with participants nested within cluster/health centre. Results Participants were 60% female, mean age 57, and had diabetes for an average of 4.5 years. Groups did not differ at baseline. Counter to prediction, no effects of the intervention over usual care were observed on the outcomes measured. However, both groups made statistically significant improvements in HbA1c (intervention from 8.3% ± 1.9 to 7.8% ± 1.8; control from 8.4% ± 2.6 to 7.9% ± 2.5). Conclusions The effect of the intervention did not differ from usual care. However, both groups made improvements in HbA1c outcome, suggesting that the project might have indirectly triggered more intensive care for diabetes patients.

Background Noncommunicable diseases (NCDs) are the leading causes of deaths globally. Currently, there are limited high-quality data on the epidemiology and usefulness of community-based screening and treatment of NCDs in low-to-middle-income countries (LMIC), like Nepal. We describe the protocol of a community-based, longitudinal epidemiological study of screening and management of NCDs in rural Nepal. Methods We organize monthly mobile health clinics to screen NCDs among 40- to 75-year-old residents from municipal subdivision wards 3, 4, 6, and 7 of Ghorahi submetropolitan city, Dang, Nepal (approximately 406 km west of the capital, Kathmandu). We estimate a total of 7052 eligible participants. After obtaining informed consent, trained personnel will collect sociodemographic and lifestyle data, medical, medication, and family history using validated questionnaires, plus anthropometric measures and capillary glucose levels. We will screen for hypertension, diabetes, obesity, dyslipidemia, tobacco and alcohol use, self-reported physical activity, dietary habits, cardiovascular disease, stroke, chronic lung disease, cancer, and chronic kidney disease. We will also check hemoglobin A1C, lipid panel, serum creatinine, sodium, potassium, urine dipstick, and urine albumin-to-creatinine ratio in high-risk participants. We will offer lifestyle counseling, pharmacotherapy or refer to higher level care, where appropriate; routinely follow participants with NCDs for continuity of care; and follow individuals without NCDs but with elevated glucose, prehypertension or other risk factors every year, and those without risk factors every 2 years. We will monitor participants in the community to reduce attrition and to track all-cause and disease-specific mortality. Discussion Understanding the community burden of NCDs in resource-limited setting and testing effectiveness of community-based screening and management of NCDs will provide insights to develop national policy to address NCD burden in LMIC like Nepal.

Feel4Diabetes (standing for: Families across Europe following a hEalthy Lifestyle for Diabetes prevention, http://feel4diabetes-study.eu/) is a school and community based intervention program, aiming to prevent type 2 diabetes (T2D) among families from vulnerable population groups, in six European countries, by promoting healthy lifestyle. In the current issue of BMC Endocrine Disorders, three reviews and three papers providing a detailed description of the methodology used to obtain measurements related to the trial conduction, as well as two papers using original data collected in the Feel4Diabetes-study are presented.