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Cardiac rehabilitation is an essential part of treatment for patients with cardiovascular disease. Cardiac rehabilitation is increasingly organized outside hospital in community healthcare services. However, this transition may be challenging. The aim of this study was to examine assumptions and perspectives among healthcare professionals on how facilitators and challenges influence the transition from hospital to community healthcare services for patients in cardiac rehabilitation. The study followed the Interpretive Description methodology and data consisted of participant observations and focus group interviews. The analysis showed that despite structured guidelines aimed to support the collaboration, improvements could be made. Facilitators and challenges could occur in the collaboration between the healthcare professionals, in the collaboration with the patient, or because of the new reality for patients when diagnosed with cardiovascular disease. [ABSTRACT FROM AUTHOR]

Given the recent call to strengthen collaboration between researchers and relevant practitioners, we consider participatory design as a way to advance Cognitive Science. Building on examples from the Learning Sciences and Human−Computer Interaction, we (a) explore what, why, who, when, and where researchers can collaborate with community members in Cognitive Science research; (b) examine the ways in which participatory‐design research can benefit the field; and (c) share ideas to incorporate participatory design into existing basic and applied research programs. Through this article, we hope to spark deeper discussions on how cognitive scientists can collaborate with community members to benefit both research and practice. [ABSTRACT FROM AUTHOR]

HIV/AIDS disproportionately impacts underserved communities in the USA. This study evaluated the acceptability of partnering with faith communities to improve HIV prevention, screening, and engagement in care with a focus on Hispanic/Latinx (H/L) communities. We engaged faith-based leaders to identify how the cultural competence and foundations of trust within these communities may be leveraged to improve HIV-related healthcare access for underserved groups including H/L individuals. Using a semi-structured qualitative interview approach, we interviewed N = 20 faith-based leaders in Providence County, Rhode Island (RI). Data were analyzed using the framework approach which utilized inductive generation of themes and systematic grouping into predetermined categories. Seven of the 20 interviewees self-identified as H/L faith leaders and discussed needs specific to H/L communities including destigmatization of HIV, increased access to care, and partnerships founded on mutual respect. The other 13 faith leaders did not personally identify as H/L but all served communities with significant H/L populations. We included these individuals given their communities already performed HIV and/or other health outreach and could provide insight into what approaches could be adapted to the needs expressed by H/L leaders. All interviewees were accepting of developing partnerships with outside organizations to engage in HIV prevention, and all identified potential solutions to identified barriers. Results suggested that faith-based outreach should be further investigated as a method of improving HIV prevention in the general and H/L populations. [ABSTRACT FROM AUTHOR]

This study investigated whether the content of different community-based intergenerational programs (IGPs) affects their perceived impact on older and younger participants. Data were collected through direct structured questionnaires administered to 84 older, and 96 younger participants, and were assessed using both quantitative and qualitative analyses. Different IGP types involved participants with differing background characteristics and were associated with different benefits and challenges. In art programs, older participants reported being more active and younger participants indicated more awareness of others, but also greater stress. Learning programs contributed to older persons' happiness, and younger persons' acquisition of new skills, but were also associated with divergent expectations between young and old, and a perception that young participants lacked commitment. Assistance programs attracted older participants with greater needs, and were associated with such benefits as alleviating older persons' loneliness, improving younger participants' satisfaction from helping, but also involved challenges pertaining to the relationship termination. Generally, older participants reported more benefits than younger persons. The results highlight the need to differentiate between IGP types, a distinction not addressed in previous studies. The combination of activity content and participant characteristics and needs may lead to different perceived program impacts. [ABSTRACT FROM AUTHOR]

Human papillomavirus (HPV) self-sampling offers a cervical cancer (CC) screening alternative that can address certain barriers to the Papanicolaou test. As part of a larger community-based participatory project in Nunavik, Northern Québec, we travelled to two communities to gather perspectives from Inuit women and healthcare professionals (HCPs) on CC screening services and the possible implementation of HPV self-sampling. We held 10 group discussions with 28 Inuit women and 10 semi-structured interviews with 20 HCPs. The thematic analysis extracted themes reflecting one barrier and seven facilitators to accessing CC screening and the implementation of HPV self-sampling in Nunavik. Themes included, though not limited to, language and communication in health settings, access to culturally responsive educational resources on CC, and the noninvasive nature of HPV self-sampling. This study may serve to contribute to the co-development of a strategy for implementation that is designed according to the needs and priorities of the communities. [ABSTRACT FROM AUTHOR]

Human trafficking survivors experience elevated suicide risk in comparison to the general population. Anti-trafficking service providers in the Philippines have identified capacity building in suicide prevention as a critical priority given the insufficient number of trained mental health professionals and lack of culturally adapted evidence-based interventions in the Philippines. We conducted a focused ethnography exploring the experiences of non-mental health professionals working in the anti-human trafficking sector in the Philippines in responding to suicidality among survivors of human trafficking (n = 20). Themes included: emotional burden on service providers, manifestations of stigma regarding suicide, lack of clarity regarding risk assessment, lack of mental health services and support systems, transferring responsibility to other providers, and the need for training, supervision, and organizational systems. We discuss implications for training service providers in the anti-human trafficking sector, as well as cultural adaptation of suicide prevention interventions with human trafficking survivors in the Philippines. [ABSTRACT FROM AUTHOR]

Background: Socioeconomic status (SES), race, ethnicity, and medical comorbidities may contribute to Alzheimer's disease and related disorders (ADRD) health disparities.Objective: Analyze effects of social and medical determinants on cognition in 374 multicultural older adults participating in a community-based dementia screening program.Methods: We used the Montreal Cognitive Assessment (MoCA) and AD8 as measures of cognition, and a 3-way race/ethnicity variable (White, African American, Hispanic) and SES (Hollingshead index) as predictors. Potential contributors to health disparities included: age, sex, education, total medical comorbidities, health self-ratings, and depression. We applied K-means cluster analyses to study medical and social dimension effects on cognitive outcomes.Results: African Americans and Hispanics had lower SES status and cognitive performance compared with similarly aged Whites. We defined three clusters based on age and SES. Cluster #1 and #3 differed by SES but not age, while cluster #2 was younger with midlevel SES. Cluster #1 experienced the worse health outcomes while cluster #3 had the best health outcomes. Within each cluster, White participants had higher SES and better health outcomes, African Americans had the worst physical performance, and Hispanics had the most depressive symptoms. In cross-cluster comparisons, higher SES led to better health outcomes for all participants.Conclusion: SES may contribute to disparities in access to healthcare services, while race and ethnicity may contribute to disparities in the quality and extent of services received. Our study highlights the need to critically address potential interactions between race, ethnicity, and SES which may better explain disparities in ADRD health outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Programs and services available through the aging services network can help community-dwelling older adults to age in place but are often not discussed in routine primary care. The primary care liaison was developed as a novel integration intervention to address this disconnect.Methods: Employed by an Area Agency on Aging, primary care liaisons performed outreach to primary care with the goal of raising awareness of community-based programs, resources, and services available to older adults and their caregivers and facilitating referrals. The evaluation of the primary care liaison model, conducted from December 2015 to February 2019, used the Reach, Effectiveness, Adoption, Implementation, Maintenance framework and assessed reach (number of clinics contacted), adoption (number of referrals to the Area Agency on Aging), implementation (number of follow-up contacts with a practice), and effectiveness (proportion of referrals reached and provided relevant resources).Results: The primary care liaisons contacted a median of 18.5 clinics per month (IQR=15-31). Primary care referrals averaged >100 per month, and referrals increased over time. Successful follow-up outreach visits had a median of 3 (IQR=2-10), and follow-up contacts had a median of 3 (IQR=1-7) per practice. Three quarters of caregivers for people with dementia reached by Area Agency on Aging staff were provided with information about relevant resources.Conclusions: The primary care liaison model is feasible, fosters ongoing interactions between primary care and Area Agencies on Aging, and connects older adults and their caregivers to relevant programs and services. Adoption of the primary care liaison model by other Area Agencies on Aging across the U.S. may help further the vision of optimized health and well-being of older adults. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the effectiveness of an information-motivation-behavioral skills (IMB) model-based multi-component intervention on engagement and the quality of preventive behaviors against respiratory infections among community-dwelling older adults.Methods: This study was a controlled pretest-posttest study in which 91 community-dwelling older adults aged above 65 years were included. The intervention group (n = 42) received the six-week intervention theoretically based on the IMB model that comprised weekly group education and 5-10 min of tele-counseling per week.Results: The results showed that, after the intervention, the improvement in the level of knowledge, self-efficacy, self-reported engagement, and the quality of respiratory infection preventive behaviors was significantly greater in the intervention group compared to the control group. There was no significant difference between the two groups for the perceived threat of respiratory infection.Conclusion: The IMB model-based intervention improved the engagement and quality of preventive behaviors by increasing the level of knowledge and self-efficacy in community-dwelling older adults.Practice Implications: The IMB model-based multi-component intervention can be an effective approach to improve preventive behaviors and will contribute to the preparation of communities for outbreaks of respiratory infections. [ABSTRACT FROM AUTHOR]

Background: Vaccine-preventable diseases are a major public health issue. Underserved communities are at heightened risk in New York City, where influenza morbidity and mortality remain elevated. Pharmacists and student pharmacists can play important roles in these communities through vaccine-based initiatives.Objectives: Enhance student experiences in encounters with underserved individuals; determine patient satisfaction with pharmacist-administered vaccines; assess for gaps in immunization care among the underserved.Practice Description: St. John's University, College of Pharmacy and Health Sciences (CPHS) prioritizes public health outreach to underserved neighborhoods through various initiatives organized by its Urban Institute. The CPHS's annual Pam Shea-Byrnes community outreach immunization initiative was developed to increase access to influenza vaccinations for the indigent population through the establishment of new community partnerships.Practice Innovation: The partnership between CPHS and community-based organizations resulted in influenza vaccines administered at no cost to beneficiaries, while offering students experiences in immunization initiatives and care for the underserved.Evaluation Methods: Participating students completed a pre- and postexperience survey. After vaccine administration, patients completed an immunization history survey from the Centers for Disease Control and Prevention (CDC), in addition to a satisfaction survey.Results: A total of 105 patients received the influenza vaccine. Of these, 53 (50.5%) patients completed both the CDC assessment and satisfaction surveys. Of the survey respondents, 81% agreed that the pharmacists and student pharmacists were friendly and professional. Most of the patients (92.5%) were satisfied with the service. Fourteen student pharmacists participated in the initiative and completed both pre-and postsurveys. Student pharmacists indicated in postsurveys a stronger personal responsibility for caring for those in need. They also agreed that there is a clear responsibility for pharmacists to personally care for those in need.Conclusion: Student experiences during interactions with the underserved were enriched, and patients were satisfied with the pharmacist-run initiative. Further expansion of the initiative will be considered. [ABSTRACT FROM AUTHOR]

The objectives of this study were to profile the landscape of women's alcohol use programs in Canada. We explored service users' and providers' beliefs about alcohol use problems and how this affected treatment choices for alcohol use problems. Data were collected through standardized measures alongside in-depth semi-structured narrative interviews in six women's alcohol treatment sites in Canada. Findings demonstrated that service users and service providers often supported an abstinence choice and were ambivalent about the viability of controlled or managed use in both abstinence- and harm reduction–based programs. Findings showed that women service users in this study had significant rates of trauma and depression which were associated with their alcohol use; the majority still adopted dominant alcohol addiction discourse which emphasizes the need for abstinence. We offer a number of recommendations to improve the viability of harm reduction for alcohol use in women's treatment programs. [ABSTRACT FROM AUTHOR]

Objectives: Caregivers for people with dementia (PWD) have reported needing emotional and social support, improved coping strategies, and better information about the illness and available support services. In this study, we aimed to determine the effectiveness of an Australian multicomponent community-based training program that we adapted and implemented in a non-medical Dutch health care setting.Methods and Design: A randomized controlled trial was performed: 142 dyads of cohabiting caregivers and PwD were randomized to control (care as usual) or intervention (training program) groups and outcomes were compared. Programs lasted 1 week, comprised 14 sessions, and were delivered by specialist staff. We included 16 groups of two to six caregivers. The primary outcome was care-related quality of life (CarerQol-7D) at 3 months. The main secondary outcomes for caregivers were self-rated burden, health and mood symptoms, and for PwD were neuropsychiatric symptoms, quality of life, and agitation.Results: No significant difference was observed for the primary outcome. However, caregivers experienced fewer role limitations due to physical function (adjusted mean difference, 13.04; 95% confidence interval [95%CI], 3.15-22.93), emotional function (13.52; 95%CI, 3.76-23.28), and pain reduction (9.43; 95%CI, 1.00-17.86). Positive outcomes identified by qualitative analysis included better acceptance and coping and improved knowledge of dementia and available community services and facilities.Conclusion: Quantitative analysis showed that the multicomponent course did not affect care-related quality of life but did have a positive effect on experienced role limitations and pain. Qualitative analysis showed that the course met the needs of participating dyads. [ABSTRACT FROM AUTHOR]

Background: Fatigue is a burdensome and prevailing symptom in patients with COPD. Pulmonary rehabilitation (PR) improves fatigue; however, interpreting when such improvement is clinically relevant is challenging. Minimal clinically important differences (MCIDs) for instruments assessing fatigue are warranted to better tailor PR and guide clinical decisions.Research Question: This study estimated MCIDs for the Functional Assessment of Chronic Illness Therapy-Fatigue Subscale (FACIT-FS), the modified FACIT-FS, and the Checklist Individual Strength-Fatigue Subscale in patients with COPD following PR.Study Design and Methods: Data from patients with COPD who completed a 12-week community-based PR program were used to compute the MCIDs. The pooled MCID was estimated by calculating the arithmetic weighted mean, resulting from the combination of anchor-based (weight, two-thirds) and distribution-based (weight, one-third) methods. Anchors were patients' and physiotherapists' Global Rating of Change Scale, COPD Assessment Test, St. George's Respiratory Questionnaire (SGRQ), and exacerbations. To estimate MCIDs, we used mean change, receiver-operating characteristic curves, and linear regression analysis for anchor-based approaches, and 0.5 × SD, SE of measurement, 1.96 × SE of measurement, and minimal detectable change for distribution-based approaches.Results: Fifty-three patients with COPD (79% male, 68.4 ± 7.6 years of age, and FEV1 48.7 ± 17.4% predicted) were included in the analysis. Exacerbations and the SGRQ-impact and the SGRQ-total scores fulfilled the requirements to be used as anchors. Pooled MCIDs were 4.7 for FACIT-FS, 3.8 for the modified FACIT-FS, and 9.3 for the Checklist Individual Strength-Fatigue Subscale.Intrpretation: The MCIDs proposed in this study can be used by different stakeholders to interpret PR effectiveness.Clinical Trial Registration: ClinicalTrials.gov; No.: NCT03799666; URL: www.clinicaltrials.gov. [ABSTRACT FROM AUTHOR]

Health systems are increasingly engaging in mission development around the quadruple aim of patient experience of care, population health, cost of care, and work-life balance of clinicians. This integrated approach is closely aligned with the education principles and competencies of health systems science (HSS), which includes population health, high-value care, leadership, teamwork, collaboration, and systems thinking. Influenced by health outcomes research, the systems-based practice competency, and the Clinical Learning Environment Review, many medical schools and residency programs are taking on the challenge of comprehensively incorporating these HSS competencies into the education agenda. General internal medicine physicians, inclusive of hospitalists, geriatricians, and palliative and primary care physicians, are at the frontlines of this transformation and uniquely positioned to contribute to and lead health system transformation, role model HSS competencies for trainees, and facilitate the education of a new workforce equipped with HSS skills to accelerate change in healthcare. Although GIM faculty are positioned to be early adopters and leaders in evolving systems of care and education, professional development and changes with academic health systems are required. This Perspective article explores the conceptualization and opportunities to effectively link GIM with healthcare and medical education transformation. [ABSTRACT FROM AUTHOR]

Food insecurity results in poor health among seniors. Food and nutrition assistance targeted to seniors experiencing or at risk of food insecurity prevents poor health outcomes and enables seniors to age in place. Currently, the primary modes of service delivery are targeted to seniors who are older and frailer than average, rendering these modes less responsive to the needs of the broader population of food-insecure seniors and limiting the preventive potential of food assistance. This study aimed to understand needs among seniors for food and food assistance and to develop a comprehensive taxonomy for these needs. The taxonomy depicts seniors' self-identified needs that relate to their ability to access and use food and nutrition assistance across three domains: physical abilities, consuming food, and access and use of transportation. The results of this study are intended to provide in-depth information to support effective alignment of programs with seniors' needs. [ABSTRACT FROM AUTHOR]

Community Health Workers (CHWs) are often incorporated into efforts to reduce health disparities for vulnerable populations. However, their voices are rarely the focus of research when considering how to increase their job effectiveness and sustainability. The current study addresses this gap by privileging the voices of 28 CHWs who work with Latinx communities in Nebraska through in-depth, semistructured interviews. Using a multilevel, Culture-Centered Approach (CCA) to Health Communication, we identified two key structural communication issues: (a) increasing language accommodation and (b) increasing (and stabilizing) network integration across three ecological levels of health behavior (individual, microsystem, and exosystem). This study shows the uniquely valuable perspective that CHWs have as they navigate hierarchical health care structures and community cultures to meet the needs of their Latinx clients. Findings suggest that CHWs should be included in health care organization and policy discussions to reduce health disparities for Latinx populations. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Background: To understand real-world human papillomavirus (HPV) vaccine impact, continuous evaluation using population-based data is critical. We evaluated the early impact of the school-based HPV immunization program on cervical dysplasia in women in British Columbia, Canada.Methods: Data linkage was performed using records from provincial cervical screening and immunization registries. Precancerous outcomes were compared between unvaccinated and HPV-vaccinated women born 1994-2005. Incidence rate, relative rate (RR), and vaccine effectiveness (VE), using unadjusted and adjusted Poisson regression of cytology (HSIL) and histopathology (CIN2, CIN3, and CIN2+) outcomes, were compared across vaccination status groups.Results: Women who received a complete series of vaccine on schedule between age 9 and 14 years had an adjusted RR = 0.42 (95% confidence interval [CI], 0.31-0.57) for CIN2+ over 7 years of follow-up compared to unvaccinated women, resulting in a VE of 57.9% (95% CI, 43.2%-69.0%). Adjusted RR for HSIL was 0.53 (95% CI, .43-.64), resulting in a VE of 47.1% (95% CI, 35.6%-56.7%).Conclusion: Women vaccinated against HPV have a lower incidence of cervical dysplasia compared to unvaccinated women. Immunization between 9 and 14 years of age should be encouraged. Continued program evaluation is important for measuring long-term population impact. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate a healthy eating and physical activity intervention for immigrant families, derived through community-based participatory research.Design: The Healthy Immigrant Families study was a randomized controlled trial with delayed intervention control group, with families as the randomization unit.Setting: US Midwest city.Participants: Participants were recruited by community partners from Hispanic, Somali, and Sudanese immigrant communities.Intervention: Family health promoters from participating communities delivered 6 healthy eating modules, 4 physical activity modules, and 2 modules synthesizing information in 12 home visits (60-90 minutes) within the first 6 months. Up to 12 follow-up phone calls to each participant occurred within the second 6 months.Measures: Primary measures were dietary quality measured with weekday 24-hour recall and reported as Healthy Eating Index score (0-100) and physical activity measured with accelerometers (14 wear days) at baseline, 6, 12, and 24 months.Results: In total, 151 persons (81 adolescents and 70 adults; 44 families) were randomly assigned. At 12 months, significant improvement occurred in Healthy Eating Index scores for adults in the intervention group compared with controls (change, +8.6 vs -4.4; P < .01) and persisted at 24 months (+7.4 from baseline; P < .01). No differences were observed for adolescents and no significant differences occurred between groups for physical activity.Conclusion: This intervention produced sustained dietary quality improvement among adults but not among adolescents. Program outcomes are relevant to communities working to decrease cardiovascular risk among immigrant populations. [ABSTRACT FROM AUTHOR]

A randomized control trial involving 806 youth (ages 10-16; 85.4% low-income households) served in U.S. Big Brothers Big Sisters affiliates investigated effects of incorporating activities to promote youth thriving into mentoring relationships over a 15-month period. Outcomes included support for thriving in youths' relationships with adults, youths' personal resources for thriving, and levels of problem behavior. Intent-to-treat analyses revealed no differences in outcomes based on assignment to thriving promotion or standard services. There was substantial variability in youth exposure to thriving promotion activities, primarily in association with premature endings of mentoring relationships. In path analyses, positive engagement with the activities predicted enhanced support for thriving from adults and, via this support, increased personal resources for thriving and reduced problem behavior. [ABSTRACT FROM AUTHOR]

This article presents a description of how an interdisciplinary network of academic researchers, community-based programs, parents, and state agencies have joined together to design, test, and scale a suite of innovative intervention strategies rooted in new knowledge about the biology of adversity. Through a process of cocreation, collective pilot testing, and the support of a measurement and evaluation hub, the Washington Innovation Cluster is using rapid cycle iterative learning to elucidate differential impacts of interventions designed to build child and caregiver capacities and address the developmental consequences of socioeconomic disadvantage. Key characteristics of the Innovation Cluster model are described and an example is presented of a video-coaching intervention that has been implemented, adapted, and evaluated through this distinctive collaborative process. [ABSTRACT FROM AUTHOR]

This qualitative inquiry explored the processes and practices of collaboration as experienced by a group of Australian multidisciplinary Aboriginal and non-Aboriginal health workers. Each worker had participated, for a period of 2 to 5 years, in an Australian Government–funded project in which a range of health initiatives led to improved access to cancer services by Aboriginal communities in a rural region of South Eastern Australia. Initiatives which addressed high rates of mortality from cancer, poor access to cancer screening, and engagement with cancer treatment were developed through the formation of close working relationships between Aboriginal and non-Aboriginal health workers. These relationships were regarded as personally and professionally transformative. Through the sharing of knowledge, skills, and experiences, new ways of knowing, being, and doing emerged. Developing a deeper understanding of cross-cultural collaboration is one way of addressing complex health problems and building the capacity of the health workforce. [ABSTRACT FROM AUTHOR]

Youth mental health (YMH) services are greatly underutilized, particularly for migrant youth. Collaborative models of care offer promising avenues, but research on these treatment modalities is still scarce, particularly for migrants. The goal of this exploratory study is to better understand quality of care including factors improving access to care and collaborative YMH services use, efficacy and satisfaction, for this vulnerable population. This qualitative study relies on a multi-informants (youth, parents, clinicians) and multiple case study design to explore YMH collaborative services for migrant youth living in an urban setting (Montreal, Canada). Participants are five young patients (12-15 years old), one of their parents and their primary care therapist ( N = 15). They come from migrant families, have a psychiatric diagnosis and have been receiving mental health services in a collaborative care setting for at least 6 months. Transcripts of semi-structured interviews for the five triads were thematically analyzed to draw similarities and contrasts between actors, across and within case-studies. Based on these findings, four themes emerged concerning the optimal care setting for collaborative YMH services for migrant families: (1) providing an equilibrium between communication, collaboration and privacy/confidentiality, (2) special attention to ensuring the continuity of care and the creation of a welcoming environment where trusting relationships can develop, (3) the inclusion of family intervention, and (4) the provision of collaborative decision-making pathways to care, addressing interprofessional and interinstitutional collaboration as well as cultural differences in explanatory models and values. [ABSTRACT FROM AUTHOR]

A quality improvement intervention for maternal and newborn health was carried out in southern Tanzania at the community level. It sought to improve health-seeking behaviors and uptake of community-level maternal and newborn health practices. A process evaluation populated using data primarily from in-depth interviews and focus group discussions with the intervention’s implementers was undertaken in four villages receiving the intervention to evaluate the intervention’s implementation, uncover facilitators and barriers of quality improvement, and highlight contextual factors that might have influenced implementation. Performance implementation scores were used to rank the villages. Identifying higher- and lower-performing villages highlighted key facilitators and barriers of community-level quality improvement related to support from local leaders, motivation through use of local quality improvement data, and regular education around quality improvement and maternal and newborn health. These findings can be taken formatively in the design of similar interventions in the future. [ABSTRACT FROM AUTHOR]

To understand health, research needs to move outside of controlled research settings into the environments where health activities occur—homes, streets, and neighborhoods. I offer the docent method as a qualitative place-based approach for exploring health in a participant-driven, structured, and flexible way. The docent method is a participant-led, audiotaped, and photographed walking interview through broad “sites of interest” (SOIs). It is rooted in grounded theory and influenced by community-based participatory research and walking interviews. The three stages of the docent method involve: (a) a warm-up interview focusing on positionality, participant background, and mapping/planning SOIs; (b) a participant-led, photographed walking interview to and around the SOI; and (c) a wind-down interview in the community. I describe the methodological influences, development, and procedures of the docent method drawing from my own experiences conducting it with formerly homeless women living in permenant supportive housing in the Tenderloin neighborhood of San Francisco. [ABSTRACT FROM AUTHOR]

Community-based participatory research has been seen to hold great promise by researchers aiming to bridge research and action in global health programs and practice. However, there is still much debate around whether achieving authenticity in terms of in-depth collaboration between community and academic partners is possible while pursuing academic expectations for quality. This article describes the community-based methodology for a qualitative study to explore intimate partner violence and HIV/AIDS among women in sex work, or female sex workers, and their male partners in Karnataka, South India. Developed through collaborative processes, the study methodology followed an interpretive approach to qualitative inquiry, with three key components including long-term partnerships, knowledge exchange, and orientation toward action. We then discuss lessons learned on how to pursue authenticity in terms of truly collaborative processes with inherent value that also contribute to, rather than hinder, the instrumental goal of enhancing the quality and relevance of the research outcomes. [ABSTRACT FROM AUTHOR]

Background: Most major cancer organizations seek to reduce sociodemographic disparities in high-risk cancers partly by increasing access to theoretically high-quality, academic-oriented cancer care. The objective of this study was to determine whether academic centers have less sociodemographic treatment disparities than community centers using high-risk prostate cancer as a test case.Methods: The National Cancer Data Base was used to identify 138,019 patients who were diagnosed with nonmetastatic, high-risk prostate cancer from 2004 to 2012. Multivariable logistic analysis was used to identify independent determinants of definitive therapy. The Gray test and multivariable Cox regression were used to analyze the timing of therapy. All analyses were stratified by academic versus community cancer center.Results: Compared with white or privately insured patients, black, Hispanic, and uninsured patients with prostate cancer were less likely to receive definitive therapy at both community centers (adjusted odds ratio: 0.60 [95% confidence interval (CI), 0.56-0.64], 0.69 [95% CI, 0.61-0.78], and 0.25 [95% CI, 0.22-0.30], respectively) and academic cancer centers (adjusted odds ratio: 0.50 [95% CI, 0.46-0.54], 0.56 [95% CI, 0.50-0.64], and 0.31 [95% CI, 0.28-0.36], respectively). Among patients who received definitive therapy, black, Hispanic, and uninsured patients were more likely to experience treatment delays at both community centers (≥15, ≥ 10, and ≥19 days, respectively; all Gray P < .001) and academic centers (≥19, ≥ 11, and ≥18 days, respectively); treatment delays were observed among the aforementioned groups even after multivariable Cox regression analysis (P < .001 for all adjusted hazard ratios).Conclusions: Nationally, academic cancer centers demonstrate similarly high rates of sociodemographic disparities in cancer treatment patterns as community cancer centers. Making community centers conform to academic center standards may not necessarily reduce treatment disparities. Cancer 2016;122:3371-3377. © 2016 American Cancer Society. [ABSTRACT FROM AUTHOR]

Case management has been widely implemented in the community aged care setting. In this study, we aimed to explore influences on case-managed community aged care practice from the perspectives of community aged care case managers. We conducted 33 semistructured interviews with 47 participants. We drew these participants from a list of all case managers working in aged care organizations that provided publicly funded case management program(s)/packages in Victoria, Australia. We used a multilevel framework that included such broad categories of factors as structural, organizational, case manager, client, and practice factors to guide the data analysis. Through thematic analysis, we found that policy change, organizational culture and policies, case managers’ professional backgrounds, clients with culturally and linguistically diverse backgrounds, and case management models stood out as key influences on case managers’ practice. In the future, researchers can use the multilevel framework to undertake implementation research in similar health contexts. [ABSTRACT FROM AUTHOR]

This study assesses the potential of social work–facilitated patient navigation to help mothers with depression engage with mental health care. We conducted a randomized pilot trial (N = 47) in Head Start—a U.S. preschool program for low-income children. Seven lay navigators received training and supervision from professional social workers. After 6 months, more navigated participants engaged with a psychologist, therapist, or social worker (45% vs. 13%, 95% confidence interval [CI] [2, 57]); engaged with any provider, (55% vs. 26%, 95% CI [1, 56]); and reported having a “depression care provider” (80% vs. 41%, 95% CI [9, 65]). Community-based navigation appears feasible; however, more definitive testing is necessary. [ABSTRACT FROM PUBLISHER]

In this article, we use qualitative methods to understand the ways in which community involvement in a community-based mental health promotion conference encourages mental health care in an African-American community. We collected data through key informant interviews, focus groups, and participant observations at conference planning meetings and conferences, as well as archival documents related to the conference. We identify community partnerships and shared commitment as drivers of the outreach to people in the community, creators of a culturally relevant and supportive environment for mental health education, and, consequently, promoters of mental health care in the African-American community. [ABSTRACT FROM AUTHOR]

Improving public awareness of cancer and encouraging health behavior change are important aspects of cancer control. We investigated whether a community-based roadshow was an effective way of communicating with the public about cancer and encouraging behavior change. Data were from 1196 people who completed questionnaires at a Cancer Research UK Cancer Awareness Roadshow in 2013. Of these, 511 (43%) completed questionnaires immediately before their visit (pre-visit group) and 685 (57%) completed questionnaires immediately after their visit (post-visit group). Among the post-visit sample, 217 (32%) were retained after two months. Self-reported data were available on risk factor and symptom awareness, help-seeking barriers, use of healthcare services and health behaviors. Compared with the pre-visit sample, the post-visit group had greater awareness of cancer risk factors and was more positive about aspects of help-seeking but awareness of potential symptoms was similar. Most effects were maintained over two months. Intentions to eat more fruit and vegetables and to exercise more were comparable between the groups but more people in the post-visit sample intended to quit smoking. At 2-month follow-up, smoking prevalence had significantly reduced but fruit and vegetable consumption decreased and there was no change to physical activity. User of weight loss services and general practitioner visits were high at follow-up and largely attributed to the Roadshow. The Cancer Research UK Roadshow appears to improve risk factor awareness, promote positive attitudes towards help-seeking and increase smoking cessation. This approach could be a useful building block for additional cancer prevention and control strategies. [ABSTRACT FROM AUTHOR]

Despite the burgeoning U.S. Latino population and their increased risk of chronic disease, little emphasis had been placed on developing culturally sensitive lifestyle interventions in this area. This article examines older Latinas’ sociocultural context relative to health with the goal of developing a culturally sensitive health behavior intervention. Photo-elicitation indicated two emerging themes that influenced lifestyle choices: family caregiving and religion. Researchers partnered with a faith-based organization to develop and implement a 6-month lifestyle intervention for Latinas ages 50 and older: Abuelas en Acción (AEA). At completion, interviews were conducted to understand women’s experiences and the influence AEA had on their lifestyles and health. Findings suggest that religious content empowered and deeply affected women; however, the intergenerational content presented significant challenges for instruction, retention, and implementation. We discuss findings in relation to the health intervention literature and provide suggestions for future interventions drawing on religion, family, and health behavior change. [ABSTRACT FROM AUTHOR]

In this article, we present the findings of a participatory realistic evaluation of a 5-year program of health care research intended to promote the translation of knowledge into routine clinical practice. The program was one of the nine pilot Collaborations for Leadership in Applied Health Research and Care funded by the English National Institute for Health Research between 2008 and 2013. Our aim was to delineate the mechanisms by which, and circumstances in which, some projects carried out under the program achieved success in knowledge translation while others were frustrated. Using qualitative methods, we examined how closer collaboration between academics and clinicians worked in four purposefully chosen case studies. In a synthesis of the findings, we produced a “black box” model of how knowledge translation was enabled by the activation of nine mechanisms. These are summarized in the form of five simple rules for promoting knowledge translation through collaborations based on principles of coproduction. [ABSTRACT FROM AUTHOR]

The article discusses how middle school students use morphemes, or units of meaning within a word, to conclude the meaning of an unknown word and what teaching methods can be used to promote this. The authors note that many students use morphological knowledge, or awareness of a root word's meaning, along with morphological awareness, or the ability to relate a morpheme to a word's meaning, to improve their vocabulary, spelling, and reading comprehension. Particular attention is given to how this learning strategy is used by English language learners (ELs) as well as on a study of effective teaching methods for U.S. middle school students.

There is minimal existing research providing detailed, reliable data characterizing usual community-based psychotherapy practice, and, thus, limited established methods for such research. This article identifies methodological challenges of usual care descriptive research, including, (a) general design considerations, (b) measurement, (c) data analytic, and (d) ethical challenges. Case examples drawn from studies reported in this special issue are used to illustrate the implications, strengths, and weaknesses of different methodological decisions. Central themes include achieving an acceptable balance of scientific rigor, feasibility, and generalizable practice relevance, as well as working collaboratively with practice partners to select and implement study methods. [ABSTRACT FROM AUTHOR]

Background/Purpose: Information about sex difference is important for the development of better prevention and intervention strategies for geriatric depression. We investigated sex differences in prevalence and risk indicators associated with geriatric depression among community-dwelling elderly people in Shih-Pai, Taipei, Taiwan. Methods: A cross-sectional community-based survey was conducted from June 1999 to November 2002 among non-institutionalized residents aged =65 years in Shih-Pai community. Trained interviewers collected data through home visits. Geriatric depression was defined as a score of = 5 on the Geriatric Depression Scale-Short Form. Results: The prevalence of geriatric depression was 9.8% in 3970 participants, with a higher rate in women (12.4%) than men (7.8%). Geriatric depression was significantly associated with women [odds ratio (OR) =1.49, 95% confidence interval (CI) =1.07–2.07), separated/divorced marital status (OR =3.29, 95% CI = 1.51–7.18), living alone (OR = 2.56, 95% CI = 1.38–4.77), past history of stroke (OR = 3.63, 95% CI = 2.09–6.31), and cognitive impairment (OR =2.83, 95% CI =1.96–4.09). Living alone (OR = 3.56, 95% CI = 1.48–8.57), living with children (OR = 1.97, 95% CI = 1.02–3.78), and past history of gouty arthritis (OR =2.46, 95% CI = 1.27–4.79) were significantly associated with depression in women, but not in men. Conclusion: Women have a higher prevalence of geriatric depression than men. Our data support the differential exposure hypothesis and the differential vulnerability hypothesis of sex difference in geriatric depression. [Copyright &y& Elsevier]

Objective: To explore the use of photovoice as a research methodology to identify and explore community health and disability priorities. Methods: Published studies (n=31) that applied photovoice as a research methodology to promote and enhance individual and community change were identified and reviewed. Results: Findings are explored and organized by community concerns and priorities; participant recruitment, training, and camera instruction; identification of photo assignment; photo assignment discussion; data analysis; outcomes; and evaluation of program and policy changes. Conclusions: Despite the limitations of the studies and/or how they are reported, findings from this review support further application of photovoice to facilitate community change. [ABSTRACT FROM AUTHOR]

Background: School-based programs are the most convenient interventions to tackle substance use among youth. "Unplugged" is a Social Influence universal school curriculum developed and tested in the "EU-Dap" project. In 2015, Nigeria implemented a large-scale project to promote healthy lifestyles in schools, families and communities. Within the project, the effectiveness of "Unplugged" was evaluated through a cluster randomized controlled trial.Methods: The program was adapted to the Nigerian context, assembling suggestions from monitoring forms and interviews, and performing fidelity checks on content and method. Thirty-two secondary schools were extracted from a list provided by the Federal Ministry of Education, and randomly allocated to intervention and control arms. A self-completed anonymous questionnaire was used for baseline and follow-up surveys. The analysis sample finally included 2685 pupils (mean age 14.2 years). Multilevel models were run to estimate program effects on prevalence of self-reported cigarettes, alcohol, and marijuana use. Mediation analysis was performed to identify possible mediators of program effect on alcohol use.Results: Unplugged significantly reduced the prevalence of recent alcohol use in intervention vs control pupils. The effect on prevalence of cigarette and marijuana use was not statistically significant. The program prevented progress and encouraged regress across stages of intensity of alcohol use. Negative beliefs, risk perceptions, and class climate mediated the effect of Unplugged on alcohol use.Conclusions: Unplugged was effective in preventing alcohol use improving beliefs, class climate and risk perceptions among Nigerian students. The implementation of the program at a larger scale in the country should be supported. [ABSTRACT FROM AUTHOR]

Hospitals and clinics are increasingly interested in building partnerships with community-based organizations to address the social determinants of health. Choosing among community-based health programs can be complex given that programs may have different effectiveness levels and implementation costs. This study develops a decision-making model that can be used to evaluate multiple key factors that would be relevant in resource allocation decisions related to a set of community-based health programs. The decision-making model compares community-based health programs by considering funding limitations, program duration, and participant retention until program completion. Specifically, the model allows decision makers to select the optimal mix of community-based health programs based on the profiles of the population given the above constraints. The model can be used to improve resource allocation in communities, ultimately contributing to the long-term goal of strengthening cross-sector partnerships and the integration of services to improve health outcomes. [ABSTRACT FROM AUTHOR]

Background: Due to multiple and interacting factors, Latino children are disproportionately at risk for overweight and obesity in the United States. Childhood obesity increases the risk for adverse physical and psychosocial outcomes throughout the lifespan. Intensive behavioral interventions recommended in primary care settings may not conform to current practices, and the most vulnerable populations are often unable to access these services. Community Health Workers (CHWs) offer a promising approach to bridging the gap between vulnerable communities and culturally competent services. La Vida Buena (The Good Life) is an 8-week family-focused intervention for Latino children 5-8 years old and their parents or caregivers who are patients at a Federally-Qualified Community Health Center (FQHC). It is a culturally and linguistically appropriate curriculum, facilitated by CHWs, that targets family behaviors to foster a healthy lifestyle in order to prevent and mitigate childhood overweight and obesity.Methods: The primary objective is to test the effectiveness of the La Vida Buena (LVB) childhood obesity program among Latino children 5-8 years old and their families as compared with a single educational session. This study uses a parallel two-arm quasi-experimental design. The intervention group receives the 8-week La Vida Buena intervention and the comparison group receives a single educational session. The primary outcome is the change in the child's BMI z-score from baseline to 6 months.Discussion: The implementation and evaluation of La Vida Buena may inform research and practice for linking Latino patients in FQHCs to culturally responsive community-based childhood obesity interventions. It will also contribute to the literature about CHWs as facilitators of behavior change for families underserved by health services and preventive programs. La Vida Buena can serve as a culturally and linguistically appropriate early intervention curriculum that will foster a healthy home environment for childhood obesity mitigation and prevention.Trial Registration: The trial was retrospectively registered on December 18, 2018. The ClinicalTrials.gov Identifier is NCT03781856. [ABSTRACT FROM AUTHOR]

Background: Severe acute malnutrition (SAM) in children is the most serious form of malnutrition and is associated with very high rates of morbidity and mortality. For sustainable SAM management, United Nations recommends integration of community based management of acute malnutrition (CMAM) into the health system. The objective of the study was to assess the preparedness of the health system to implement CMAM in Bangladesh.Methods: The assessment was undertaken during January to May 2014 by conducting document review, key informant interviews, and direct observation. A total of 38 key informant interviews were conducted among government policy makers and program managers (n = 4), nutrition experts (n = 2), health and nutrition implementing partners (n = 2), development partner (n = 1), government health system staff (n = 5), government front line field workers (n = 22), and community members (n = 2). The assessment was based on: workforce, service delivery, financing, governance, information system, medical supplies, and the broad socio-political context.Results: The government of Bangladesh has developed inpatient and outpatient guidelines for the management of SAM. There are cadres of community health workers of government and non-government actors who can be adequately trained to conduct CMAM. Inpatient management of SAM is available in 288 facilities across the country. However, only 2.7% doctors and 3.3% auxiliary staff are trained on facility based management of SAM. In functional facilities, uninterrupted supply of medicines and therapeutic diet are not available. There is resistance and disagreement among nutrition stakeholders regarding import or local production of ready-to-use therapeutic food (RUTF). Nutrition coordination is fragile and there is no functional supra-ministerial coordination platform for multi-sectoral and multi-stakeholder nutrition.Conclusion: There is an enabling environment for CMAM intervention in Bangladesh although health system strengthening is needed considering the barriers that have been identified. Training of facility based health staff, government community workers, and ensuring uninterrupted supply of medicines and logistics to the functional facilities should be the immediate priorities. Availability of ready-to-use therapeutic food (RUTF) is a critical component of CMAM and government should promote in-country production of RUTF for effective integration of CMAM into the health system in Bangladesh. [ABSTRACT FROM AUTHOR]