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AbstractPublic libraries support community health needs, including responding to the opioid epidemic with events, services, and information. However, we lack insight into why libraries respond to problematic opioid use in their communities, what tensions are associated with responding to community opioid use, and how their responses fit within the scope of public libraries. We conducted a multimethod study to solicit the perspectives of Ohio public library directors. They characterized responding to the opioid epidemic in their communities as aligning with both the mission and attributes of public libraries, while also facing tensions that emerged from balancing the demand for expansive social services with pressure to protect the sanctity of libraries. [ABSTRACT FROM AUTHOR]

This study, centered around a survey of library directors (N = 83), examines community health programming (CHP) in Michigan's public libraries within the broader context of national CHP initiatives. Reponses indicate that while physical activity classes and food skills programs are popular, there are still challenges to overcome. These findings led us to recommendations for cultivating partnerships that can help CHP grow and flourish. [ABSTRACT FROM AUTHOR]

To estimate the effect of neighborhood-level modification on the efficacy of the MyPEEPS Mobile intervention on the reduction of condomless anal sex acts among same-sex attracted adolescent men. A series of generalized linear mixed model was used to examine if the effect of the MyPEEPS Mobile intervention on condomless anal sex acts was moderated by neighborhood-level factors using data from the 2019 American Community Survey US Census Bureau. The magnitudes of intervention were significantly smaller at both 6- and 9-month follow-up among adolescents living in neighborhood with high proportions of Hispanic or Latino residents (IRR6M = 1.02, 95 % CI: 1.01, 1.02; IRR9M = 1.03, 95 % CI: 1.01, 1.05) and high proportions of families with income below the poverty level (IRR6M = 1.07, 95 % CI: 1.01, 1.12; IRR9M = 1.05, 95 % CI: 1.01, 1.10), which indicated that living in communities with a higher concentration of residents living under poverty or of Hispanic/and Latino ethnicity significantly modified the effective of program intervention on condomless sex among adolescent MSM. Understanding how neighborhood characteristics modify the effect of HIV prevention interventions may be useful in better targeting delivery and tailoring content of interventions based on neighborhood level characteristics such as the ones identified in this study.

In recent years, mind–body exercises have arisen as a popular type of physical exercise among older adults in both Eastern and Western countries. In the last 10 years, yoga has been established as a key physical activity intervention for older adults. Thus, the literature on yoga interventions delivered in community settings for older adults warrants a formal appraisal. This scoping review synthesized information on intervention contents and outcomes and summarized data on attrition, adherence, and adverse events for community health practitioners. In addition, this review used the Template for Intervention Description and Replication and the Population, Intervention, Comparator, Outcome checklist to identify areas of depth and gaps in the literature on yoga interventions. [ABSTRACT FROM AUTHOR]

Evidence suggests that being evicted harms health. Largely ignored in the existing literature is the possibility that evictions exert community-level health effects, affecting evicted individuals social networks and shaping broader community conditions. In this narrative review, we summarize evidence and lay out a theoretical model for eviction as a community health exposure, mediated through four paths: 1) shifting ecologies of infectious disease and health behaviors, 2) disruption of neighborhood social cohesion, 3) strain on social networks, and 4) increasing salience of eviction risk. We describe methods for parsing evictions individual and contextual effects and discuss implications for causal inference. We conclude by addressing evictions potentially multilevel consequences for policy advocacy and cost-benefit analyses.

We developed and tested MivacunaLA/MyshotLA, a community-informed mobile phone intervention, to increase COVID-19 vaccination among Latino parents/caretakers of minors in under-resourced areas of Los Angeles by addressing misinformation and building trust. We recruited Latino parents/caregivers with at least one unvaccinated child in East and South Los Angeles in the summer of 2021 and evaluated MivacunaLA as a randomized controlled trial with a wait-list control group. A difference-in-difference analysis showed Latino parents/caregivers that participated in MivacunaLA (n = 246), in comparison to the control group, were 15 percentage points more likely (p = 0.04) to report vaccination of minors aged 12-17 years, and 12 percentage points more likely (p = 0.03) to report a positive intention to vaccinate minors aged 2-11 years (when COVID-19 vaccines became available). Mobile phone-delivered digital interventions using videos and culturally tailored educational material to promote COVID-19 vaccine confidence can be an effective way to combat misinformation and deliver timely information to marginalized communities. Community-based participatory research approaches are crucial to advance health equity among minority communities, especially immigrant Spanish-speaking underserved communities.

This study examines the association between state laws limiting local control (preemption laws) and local smoke-free policies. We utilized policy data from the American Nonsmokers' Rights Foundation. The primary outcome variable is the presence of a "100% smoke-free policy," across any of 4 indoor settings: workplaces, restaurants, bars, and gaming venues. We employed generalized structural equation modeling to investigate the relationship between state laws pre-empting smoke-free indoor air regulation and local adoption of policies requiring smoke-free air in any public venues, or for specific venues, adjusting for sociodemographic characteristics. Our findings reveal a significant association between state preemption laws and the presence of a local 100% smoke-free indoor policy as of 2023. In states with preemption laws, cities were less likely to have a 100% smoke-free indoor policy at any venue than cities in states without preemption laws (OR = 0.07, 95% CI = 0.05-0.10). When considering specific smoke-free venues, cities in states with preemption laws were less likely to have a 100% smoke-free indoor policy covering workplaces (OR = 0.05, 95% CI = 0.03-0.09), restaurants (OR = 0.04, 95% CI = 0.02-0.07), bars (OR = 0.04, 95% CI = 0.03-0.08), and gaming venues (OR = 0.03, 95% CI = 0.01-0.09) compared to cities in states without preemption laws. Our study suggests that state preemption laws limit local decision-making and the implementation of public health policies focused on tobacco harms. [ABSTRACT FROM AUTHOR]

AbstractUnderstanding the various roles and their corresponding evolving patterns is essential for evaluating the health of learning communities, such as in Asynchronous Online Discussion (AOD) forums. Existing research primarily focuses on identifying specific roles without considering the dynamics of role evolution, which are significant to ongoing community development. Guided by the Reader-to-Leader Framework (RtLF), this study employs multiple machine learning approaches to identify and predict the evolution of roles over time in a learning community. Our approach was applied to a K-12 Math online learning community, using data from 51,821 students to evaluate the community’s health over two years. First, a Gaussian Mixture Model was used to cluster students into five groups that represent their roles roughly in RtLF using the first nine months of learning activities. We then trained an XGBoost model to classify learner roles for subsequent periods based on meta-data. Third, we evaluate the health of the community by comparing the distribution of different roles over time and argue it is a healthy community. This study demonstrates how machine learning approaches can identify learner roles and support the health and development of learning communities. [ABSTRACT FROM AUTHOR]

BACKGROUND: Despite historical and contemporary trauma, American Indian and Alaska Native (AIAN; Indigenous) communities responded with resilience to the COVID‐19 pandemic. However, AIANs experienced disproportionate rates of infection, hospitalization, death, and reduced life expectancy. School closures exacerbated disparities, leading to learning loss, economic instability, and mental health challenges among AIAN youth. METHODS: The Project SafeSchools cohort study employed a comprehensive longitudinal convergent mixed‐methods approach, integrating community‐based participatory research principles. The study enrolled Navajo Nation caregivers whose children were eligible to attend local reservation‐based schools. We conducted an analysis of caregiver self‐report baseline data collected between August 2021 and May 2022. RESULTS: A total of 242 caregivers completed at least part of the baseline assessment and were included in data analysis. Caregivers were primarily female (88.7%), non‐Hispanic (97%), and Indigenous (97%). Most caregivers were in their late 30s (mean age 38), with varying educational backgrounds and employment statuses. Children were evenly split between males and females and distributed across different age groups. Most children attended school at baseline in various formats, including in‐person, hybrid, and online‐only settings. Caregivers reported a range of psychosocial and behavioral risks, including general mental distress, depressive symptoms, and anxiety for themselves and their children. Furthermore, caregivers and children exhibited various protective factors, such as strong cultural identity, resilience, and academic self‐efficacy. CONCLUSIONS: This study highlights the higher rates of mental health distress among participating caregivers and children compared to national averages. Despite these challenges, cultural protective factors remained strong and should guide future crisis response efforts. [ABSTRACT FROM AUTHOR]

The age of Canada's population is increasing, necessitating innovative methods and tools for assessing the needs of older adults and identifying effective health and social prescriptions. In Alberta, a community-based, senior-serving organization undertook the development and piloting of the Healthy Aging Asset Index, an assessment tool and social prescribing guide for use by a variety of professionals within the community. Tool development was rooted in medical complexity assessment and social work practice, and adhered to the determinants of healthy aging established by Alberta's Healthy Aging Framework, which is based on the determinants of healthy aging published by the World Health Organization. Results from the pilot showed improvement in the functionality of older adults within the determinants over time, as they were supported in addressing areas of personal vulnerability. Adopting tools such as the Healthy Aging Asset Index can bring cohesiveness to the support that older adults receive across the care continuum and has the potential to shift the balance of care away from the health system and towards the community, thus improving the capacity of health systems and government to meet the needs of Canada's older adults. [ABSTRACT FROM AUTHOR]

AbstractUngoverned spaces refer to systems that are evasive of government regulations. They manifest in health systems when health authorities struggle to regulate certain healthcare providers. The current study underscored Informal Health Providers (IHPs) such as Patent Medicine Vendors (PMVs), Herbalists, Traditional Birth Attendants (TBAs), etc., as typical of ungoverned heath spaces in Nigeria and a threat to citizens’ health security. Interviews and group discussions were used to collect data from 90 participants. The findings showed some groups of IHPs without interface with government health authorities. Although PMVs and TBAs had some interface with the government, the study still found many aspects of their practices that were not governed. Unions of the IHPs could be parallel to health authorities. Indeed, IHPs can provide care in difficult contexts where formal healthcare is lacking, however, their continuous ungoverned operations could undermine citizens’ rights to quality healthcare, which conflicts with the ideals of the social service workforce. Therefore, future research should focus on co-designing policies and programs that can help to pull IHPs into an effectively governed pool. [ABSTRACT FROM AUTHOR]

Background: Over the years, low-and middle-income countries have adopted several policy initiatives to strengthen community health systems as means to attain Universal Health Coverage (UHC). In this regard, Zambia passed a Community Health Strategy in 2017 that was later halted in 2019. This paper explores the processes that led to the halting and re-issuing of this strategy with the view of drawing lessons to inform the development of such strategies in Zambia and other similar settings. Methods: We employed a qualitative case study comprising 20 semi-structured interviews with key stakeholders who had participated in either the development, halting, or re-issuing of the two strategies, respectively. These stakeholders represented the Ministry of Health, cooperating partners and other non-government organizations. Inductive thematic analysis approach was used for analysis. Results: The major reasons for halting and re-issuing the community health strategy included the need to realign it with the national development framework such as the 7th National Development Plan, lack of policy ownership, political influence, and the need to streamline the coordination of community health interventions. The policy process inadequately addressed the key tenets of community health systems such as complexity, adaptation, resilience and engagement of community actors resulting in shortcomings in the policy content. Furthermore, the short implementation period, lack of dedicated staff, and inadequate engagement of stakeholders from other sectors threatened the sustainability of the re-issued strategy. Conclusion: This study underscores the complexity of community health systems and highlights the challenges these complexities pose to health policymaking efforts. Countries that embark on health policymaking for community health systems must reflect on issues such as persistent fragmentation, which threaten the policy development process. It is crucial to ensure that these complexities are considered within similar policy engagement processes. [ABSTRACT FROM AUTHOR]

Introduction/Objectives: Exposure to adverse social determinants of health (SDoH) in childhood is associated with poorer long-term health outcomes. Within structurally marginalized populations, there are disproportionately high rates of developmentally vulnerable children. The RICHER (Responsive, Intersectoral, Child and Community Health, Education and Research) social pediatric model was designed to increase access to care in marginalized neighborhoods. The purpose of this study was to describe the children and youth engaged with the RICHER model of service and characterize the needs of the population. Methods: A retrospective chart review was conducted on children and youth who accessed primary care services through the program between January 1, 2018 and April 30, 2021. Basic descriptive data analysis was done using Stata v15.1. Results: A total of 210 charts were reviewed. The mean age in years at initial assessment was 6.32. Patients most commonly identified their race/ethnicity as Indigenous (33%) and 15% were recent newcomers to Canada. Evidence of at least 1 adverse SDoH was noted in 41% of charts; the most common included material poverty (34%), food insecurity (11%), and child welfare involvement (20%). The median number of diagnoses per patient was 4. The most frequently documented diagnoses were neurodevelopmental disorders (50%) including developmental delay (39%), ADHD (32%), and learning disability (26%). The program referred 72% of patients to general pediatricians and/or other subspecialists; 34% were referred for tertiary neuropsychological assessments and 35% for mental health services. Conclusions: Our data suggests that this low-barrier, place-based primary care RICHER model was able to reach a medically, developmentally, and socially complex population living in disenfranchised urban neighborhoods. Half of the patients identified in our review had neurodevelopmental concerns and a third had mental health concerns, in contrast to an estimated 17% prevalence for mental health, behavioral, or developmental disorders in North American general pediatric aged populations. This highlights the impact adverse SDoH can have on child health and the importance of working with community partners to identify developmentally vulnerable children and support place-based programs in connecting with children who may be missed, overlooked, or disadvantaged through traditional models of care. [ABSTRACT FROM AUTHOR]

Hand-foot-and-mouth disease (HFMD), which is typically seen in the younger pediatric population, is uncommon in older adolescent and young adult populations. We report on an atypical outbreak of HFMD among college students at a mid-size university in the mid-Atlantic U.S. The outbreak included 138 qualifying cases of HFMD among students at the institution between August and November 2018. All tested samples were positive for CVA6, a less common cause of HFMD. Signs and symptoms and campus mitigation strategies are described. This case report aims to highlight an atypical outbreak of HFMD for clinicians who care for older adolescent and college-aged patients in primary care and community settings, and may see cases and/or outbreaks of HFMD in these populations. [ABSTRACT FROM AUTHOR]

National opinions on a wide variety of public health topics can change over time and have highly contextual nuances. This study is a follow-up to prior inquiries into the knowledge of wastewater-based epidemiology, privacy concerns surrounding sample collection, and the use of data acquired, along with privacy awareness from an online survey conducted in the metropolitan United States during the winter of 2023. Mentions of wastewater-surveillance-related terms in the media remained common. Towards the outbreak tail in 2023, public support for surveillance of toxins (91%), diseases (91%), terrorist threats (87%), illicit drugs (70%), prescription medications (69%), and gun residue (60%) remained high. There was less support for surveillance of alcohol consumption (49%), mental illness (46%), healthy eating (37%), and lifestyle behaviors (35%). In terms of geographic scale, most respondents supported citywide surveillance (85%) with markedly lower levels of support for smaller (less anonymous) geographic scales covered by specific locations. Wastewater surveillance does not receive the public pushback that other COVID-19-related health system actors have witnessed. Instead, the public supports the expansion of wastewater surveillance as a standard to complement public health tools in other areas of health protection. [ABSTRACT FROM AUTHOR]

Objective: During public health emergencies such as the ongoing COVID-19 illness pandemic, it is essential to rapidly disseminate crisis messages which often contain embedded health directives. This study investigated which of three variants of the same messages (neutral tone, positive/compassionate tone, negative/fear-inducing tone) were most likely to motivate readers to engage in the health behavior proscribed in the message. Participants: Participants were 87 female and 41 male undergraduates at an urban university in the northeast U.S. Methods: A survey with three versions of eight different COVID messages containing health directives was administered. Results: Those who indicated stronger influence of positive/compassionate crisis messages (i.e., had higher Crisis Messages Survey scores) had higher adaptive health engagement scores, lower worry scores, and were likely to have had a past diagnosis of COVID-19. Moreover, a regression model including COVID-19 status and worry scores accounted for a significant proportion of variance in Crisis Messages Survey scores. Conclusions: Findings indicate that the use of neutral and compassionate language is optimal in motivating health behaviors embedded in university crisis messages. [ABSTRACT FROM AUTHOR]

To determine the prevalence and characteristics of food insecurity among female collegiate athletes. NCAA Division I female athletes attending a public university located in East Texas in 2018. A prospective cross-sectional online survey was employed to gather quantitative and qualitative data regarding food security status. Participants were instructed to complete the 26-item questionnaire, including the six-item USFSSM. Participants (N = 78) were 18–22 years of age, largely white (75%). Despite most (89.74%) receiving some form of scholarship and 80% reporting provision of some meals, 32.10% were classified as food insecure. Barriers to food intake were two-fold higher among the food insecure (88% vs 43%, p <.001); limited time (43.6%) and finances (23.1%) were the most frequently reported barriers. Despite university support, food insecurity exists in female collegiate athletes. Outcomes warrant screening for food insecurity, referral to support resources throughout matriculation, and tailored intervention programs. [ABSTRACT FROM AUTHOR]

To examine how public health policy was reinforced by peer workers who were called Public Health Ambassadors (PHAs) at a West Coast university during the COVID-19 pandemic. Descriptions of PHA community interactions were collected. Analyses were conducted using data from the 12-weeks of the 2020 Fall Quarter. In total, there were 5,112 interactions of which there were three types: (1) educational (4%), (2) noncompliance (90%), and (3) thanking (6%). About 1.3% of interactions were met with resistance. Overall, compliance with campus public health guidance was high. Trends suggest compliance fatigue may have occurred after the first four weeks as evidenced by increased noncompliance rates and test positivity rates. These results suggest the feasibility of the implementing US Centers for Disease Control and Prevention recommendations of using trusted messengers to reinforce critical behaviors to support community health. [ABSTRACT FROM AUTHOR]

In 2021, national leaders in the United States declared a "national youth mental health crisis." Still, only 1-in-4 children receive adequate mental healthcare access. Patient Navigator Programs (PNPs) can improve children's referral-to-connection to mental health services. We examined patient- and community-level factors associated with pediatric mental healthcare access. Pediatric Support Services (PSS) is a PNP that triages mental and behavioral health referrals within a large health system in a southeastern state. This study analyzes PSS data from September 2017-March 2023 and Child Opportunity Index 2.0 state-normed zip-code level data to assess social drivers of health estimates. Structural equation modeling was conducted between patient- and community-level factors and connection to mental health services. Overall, 62.7% of children connected to mental health services since PSS' inception. Regardless of SDOH, as children get older, they are more likely to connect with mental health services (β =.053, SE =.010, p <.001). Children with greater number of referral needs are more likely to connect with mental health services (β =.034, SE =.011, p =.002). Further, children who live in communities with higher opportunity levels are more likely to connect with mental health services (β =.016, SE =.008, p =.040), suggesting that children who live in low-income communities experience more barriers to mental healthcare. Social drivers may inform referral practices and tiered navigation support for optimal mental healthcare access among children. Further research should demonstrate the effectiveness of PNPs integrated within healthcare and community-based settings. [ABSTRACT FROM AUTHOR]

Research on Black maternal populations often focuses on deficits that can reinforce biases against Black individuals and communities. The research landscape must shift towards a strengths-based approach focused on the protective assets of Black individuals and communities to counteract bias. This study engaged the local Black community using a strengths-based approach to discuss the assets of Black maternal populations and to inform the design of a future clinical trial focused on reducing Black maternal health disparities. Guided by the Theory of Maternal Adaptive Capacity, we conducted three purposive focus group sessions with Black adult community members. The focus groups were semi-structured to cover specific topics, including the strengths of the local community, strengths specific to pregnant community members, how the strengths of community members can support pregnant individuals, and how the strengths of pregnant community members can facilitate a healthy pregnancy. The focus group interviews were transcribed verbatim and analyzed using thematic content analysis. Three focus group sessions were conducted with sixteen female individuals identifying as Black or African American. Central themes include (1) the power of pregnancy and motherhood in Black women, (2) challenging negative perceptions and media representation of Black mothers, (3) recognizing history and reclaiming cultural traditions surrounding birth, and (4) community as the foundation of Black motherhood. Black community members identified powerful themes on Black maternal health through a strengths-based lens. These focus groups fostered relationships with the Black community, elucidated possible solutions to improve Black women's health and wellness, and offered direction on our research design and intervention. [ABSTRACT FROM AUTHOR]

Aim: To identify attitudes towards HIV/STI screening guidelines and explore the acceptability of assessing sexual positioning practices among Black sexual minority men (SMM). Background: Risks for HIV/STIs vary by sexual positioning practices. However, clinicians and Black SMM do not always discuss sexuality with each other. Therefore, HIV/STI screening and testing remain suboptimal. Design: Qualitative study using focus groups. Methods: Data were obtained from 12 focus groups and one in‐depth interview conducted in Baltimore, MD among HIV‐negative Black SMM between October 2019 and May 2020 (N = 39). Groups were stratified into three age categories: 18–24, 25–34 and 35+. Participants were given the "5 P's" from the CDC's 2015 Sexual History Screening Guidelines and asked to discuss attitudes towards existing questions regarding sexual positioning practices. Themes were identified using an electronic pile sorting approach. Results: Most identified as homosexual/gay/same gender‐loving (68%), were employed (69%) and single (66%). Additionally, 34% had ever been diagnosed with an STI, of whom 38% had a history of repeated STI acquisition in their lifetime. Participants across age groups said clinicians should use the words "top" and "bottom" to demonstrate cultural familiarity and build trust. Some said that screening for sexual positioning was unnecessary and intrusive; others said that questions should be justified. Younger men wanted clinicians to ask questions in ways that make them feel cared for. Discussion: Guidelines should include language for clinicians to use culturally specific language and better ways to prepare Black SMM patients for screening. Impact to Nursing Practice: Some Black SMM will not discuss sexual positioning practices without clinicians' demonstration of cultural understanding and respect. Screening should incorporate culturally responsive language, justification and convey care. Reporting Method: Consolidated criteria for reporting qualitative research (COREQ). No Patient or Public Contribution: There was no patient or public involvement in the design or drafting of this discursive paper. [ABSTRACT FROM AUTHOR]

This article explores HIV awareness and prevention in a Latinx seasonal farmworker community of south Miami-Dade County in the USA. The study took place as part of a larger community assessment that aimed to determine community needs and resources related to substance abuse, violence and HIV in the Latinx seasonal farmworker communities of south Miami-Dade County, with a particular focus on fathers' and their male sons' relationships. The study collected data on HIV knowledge and prevention, healthcare-seeking behaviours, cultural norms, and communication barriers about HIV prevention between fathers and sons. Data were collected through in-depth interviews with community leaders, two focus groups with social and health services providers, and four focus groups involving fathers and their adolescent sons. A deductive approach to data analysis was undertaken. Five major themes were identified: (1) HIVrelated knowledge and perception; (2) HIV prevention strategies; (3) barriers and needs for tailored preventive health and care services in the community; (4) stress over sex-related communication; and (5) the dominance of traditional masculine gender norms in the household and the community. [ABSTRACT FROM AUTHOR]

Introduction Methodology Results Discussion Although menstruation is a natural biological process, many people feel embarrassed of their menses and struggle to discuss it. To mitigate menstrual communication stigma, it is necessary to first elucidate communication experiences and perceptions. Thus, we qualitatively explore menstrual communication among cisgender women who menstruate and their family, friends, healthcare providers, and community.In partnership with No More Secrets (NMS), a Philadelphia menstrual health non‐profit, we conducted a community‐based participatory research (CBPR) project in Fall 2020. Cisgender, menstruating individuals ages 18–45 recruited from NMS' catchment in Philadelphia participated in semi‐structured interviews about their menstrual experiences and communication (N = 20). A deductive, theory‐driven approached based on the social‐ecological model was used to analyze the data.Varying emotional responses arose across social‐ecological levels: communication was awkward and simplistic with family; positive and supportive with friends and community members; and uncomfortable and frustrating with healthcare providers. Participants echoed the importance of menstrual communication as a means of sharing information, feeling less alone, and decreasing menstrual stigma.Findings can inform future CBPR workshops that address stigma in familial, healthcare, and community‐based discussions to improve menstrual health and experiences for cisgender girls and women, transgender men, and gender non‐binary individuals who menstruate. [ABSTRACT FROM AUTHOR]

(1) Introduction: Effective control of stroke risk factors can reduce stroke incidence. Motivation for participatory action of community dwellers to practice self-care to modify stroke risk after providing them with knowledge of stroke risk factors is considered useful under a situation of limited healthcare resources. This study aimed to evaluate the outcomes of integrating the sufficiency economy philosophy (SEP), a royal economic philosophy in Thailand, and the participatory action research (PAR) approach on stroke risk factors control among selected communities. (2) Methods: Villagers who had medium to high stroke risk from two provinces with leading stroke incidences in southern Thailand were invited to participate in an eight-month SEP-PAR program conducted in 2019. Group meetings among the study participants, local healthcare providers, the researchers, and relevant stakeholders in the communities were held to co-design a health behaviors program targeting lower waist circumference (WC), body weight (BW), blood pressure (BP), fasting blood sugar, blood lipids, and smoking and alcohol consumption rates. Follow-up physical measurements and blood tests were compared with the baseline results for significant differences by descriptive statistics (p < 0.05) using the R program. (3) Results: Of 126 participants, 75.4% were female. Moderate and high stroke risk levels were found in 58.2% and 19.8%, respectively. Elevated baseline WC, BW, BP, and blood test results were found in 50–80% of the participants. The co-designed health behaviors in this study were dietary control, regular exercise, relieving psychological stress, and stopping smoking and alcohol consumption. Overall, the participants had significant adherence to the co-designed health behaviors. At the end of the program, the follow-up tests showed significant reductions in BW, BP, fasting blood sugar, and lipids, but not in WC. (4) Conclusions: A combined SEP and PAR approach was effective for stroke risk factors control among the community dwellers. Motivation for self-care is a significant strategic outcome expected of this approach. Longer follow-up studies in larger populations are needed. [ABSTRACT FROM AUTHOR]

Aims: To shed light on the process of advocacy in the context of community health nursing, through a methodology inspired by the epistemologies of the South. Design: We conducted a collaborative ethnography in a community health centre in Canada. Methods: de Sousa Santos' epistemologies of the South, a typology of advocacy and main themes from historic research informed the methodology. Data were collected between 2016 and 2018 through 420 h of fieldwork observations and three group discussions, including a collective process to co‐construct interpretations with participants. Twenty‐one nurses participated in the study. Results: Nurses had sufficient work flexibility to practice advocacy actions focused on individuals and groups. They also engaged in attempts at policy reform in the form of defending access to appropriate care and changing the mode of care organization. However, these were curbed by bureaucracy and administrative rules, resulting in the eventual dismissal of health promotion actions and experiences of moral distress. Conclusion: Despite the political climate of their work environment impeding social justice agendas, nurses' advocacy practices showed a persistence of moral values and ideals in coherence with the regional nursing legacy. Implications for the Profession and/or Patient Care: Acting at the organizational level and involving field nurses in decision making are potential avenues for increasing policy advocacy efficacy. Impact: Examining contexts through another epistemic lens and methods of research drawing on history and anthropology has shed light on a process of advocacy. This research shows that organizations need to equip themselves with mechanisms to promote the sharing of realities between nurses, thereby building collective advocacy. Reporting Method: The research adheres to the EQUATOR guidelines with SRQR and COREQ methods. Patient or Public Contribution: No patient or public contribution. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the impact of a novel multicomponent nutrition education program (United for Healthier Kids; U4HK) on the diet consumed during school lunch among preschool children. The program comprised four tools: hero plates, hero content, hero menus, and hero books and stickers. The program was implemented for 16 weeks. Food consumption and the quality of the menus were examined pre- and post-intervention. The lunch nutrient profiling scores for fat and vitamin C improved from moderate (9.95) to good (10.87) and moderate (9.50) to very good (13.83), respectively. Vegetable and fruit consumption also increased significantly by 127.2% (6.0 (3.2, 12.9) grams to 13.7 (6.7, 18.9) grams, p<0.001) and 44.8% (8.1 (3.9, 12.4) grams to 11.7 (5.4, 21.8) grams, p<0.001), respectively. Compared to those in the Thai school lunch guidelines, the percentages of vegetable and fruit consumed increased by 16.0% (12.1% (6.4, 25.9) to 28.1% (13.4, 43.4)) and 8.8% (14.0% (6.8, 28.3) to 22.8% (8.5, 33.4)), respectively. Energy, carbohydrate, and fat intake increased significantly by 13.2% (179.1 (137.9, 220.8) to 202.7 (163.0, 243.2) kcal), 18.9% (18.1 (14.3, 21.7) to 21.6 (17.2, 25.6) grams), and 23.2% (6.7 (4.9, 9.9) to 8.2 (6.7, 10.2) grams), respectively. The U4HK program adopted all aspects that foster healthy eating, including a healthy environment, an attractive role model and increased repeatability of the exposure to healthy foods. [ABSTRACT FROM AUTHOR]

Background: Influenza (flu) and COVID-19 vaccination rates are subpar across the US, especially in racial and/or socioeconomic minority groups who are understudied in public health literature. Objective: The objective of this mixed-methods study was to elucidate attitudes of patients at the Turtle Creek Primary Care Center, a clinic that cares for ∼70% non-white patients, towards flu and COVID-19 vaccines, with the goal of establishing vaccine education gaps and increasing vaccine uptake in minority communities. Design/Patients: This study was conducted as a cross-sectional analysis. Authors completed 123 patient phone surveys of patients cared for at the Turtle Creek clinic inquiring about flu and COVID-19 infection status and vaccination uptake (August 26–October 10, 2021). Approach/Key Results: We found that rates of vaccination were subpar in the Turtle Creek community, with only 54% having received the COVID-19 vaccine and only 44% receiving the flu vaccine regularly. There was a strong association between COVID-19 and flu vaccine acceptance and a notable correlation between vaccine acceptance and age. When assessing how vaccine acceptance was influenced by trusted sources of information, those who cited trusting "medical professionals" and "word of mouth" had higher odds of COVID-19 vaccine acceptance but those who cited trusting "social media" had decreased odds of acceptance. Finally, we uncovered 14 common factors for either vaccine acceptance or refusal that clustered into four overarching themes of trust, need, safety, and availability. Conclusion: These data highlight the necessity of improved vaccine education and reveal targetable populations and approaches for disseminating vaccine information. [ABSTRACT FROM AUTHOR]

Introduction: In 2018, The Live Well Allegheny: Lifting Wellness for African Americans (LWA2) Initiative was developed to support six priority, Black communities in Allegheny County, Pennsylvania to address health equity in chronic disease. The LWA2 coalition members participated in ongoing anti-racism and racial equity sessions with a nationally recognized anti-racist facilitation team. The sessions included a 2-days experience in January 2020 along with follow up meetings throughout 2020. Methods: Surveys were administered to understand their perceptions related to anti-racism and oppression and subsequent actions as a result of the sessions. Additionally, we conducted nine in-depth interviews with organizational partners (January -May 2020) to evaluate the overall effectiveness of the coalition and inform future activities. Results: Ten participants completed the post session surveys. Seven out of 10 survey respondents felt they had a good understanding of how oppression (racism, sexism, capitalism) influenced their life and work. However, the majority indicated needing the tools to implement anti-racist strategies in their work. The in-depth interviews with organizational partners revealed that racial equity was of concern to all partners but there was variability in intentionality around racial equity as a core element of each organization's mission, goals and subsequent actions. Discussion: As a result of the interviews, coalition members developed a racial equity statement and theory of change for implementation in the coalition work and within individual organizations along with a plan for implementing an equity audit of the coalition. Coalitions of this kind should be intentional about implementing continuous strategies related to anti-racism for structural changes toward achieving racial equity in their overall work. [ABSTRACT FROM AUTHOR]

This study built a predefined rule-based risk stratification paradigm using 19 factors in a primary care setting that works with rural communities. The factors include medical and nonmedical variables. The nonmedical variables represent 3 demographic attributes and one other factor represents transportation availability. Medical variables represent major clinical variables such as blood pressure and BMI. Many risk stratification models are found in the literature but few integrate medical and nonmedical variables, and to our knowledge, no such model is designed specifically for rural communities. The data used in this study contain the associated variables of all medical visits in 2021. Data from 2022 were used to evaluate the model. After our risk stratification model and several interventions were adopted in 2022, the percentage of patients with high or medium risk of deteriorating health outcomes dropped from 34.9% to 24.4%, which is a reduction of 30%. The medium-complex patient population size, which had been 29% of all patients, decreased by about 4% to 5.7%. According to the analysis, the total risk score showed a strong correlation with 3 risk factors: dual diagnoses, the number of seen providers, and PHQ9 (0.63, 0.54, and 0.45 correlation coefficients, respectively). [ABSTRACT FROM AUTHOR]

Faith community nurses (FCNs) are well positioned to serve individuals needing community-based healthcare within local healthcare systems, large church denominations, or through the support and resources of nonprofit faith community nursing organizations. This article briefly outlines development of the specialty of faith community nursing and proposes areas of research needed to grow the impact of this nursing specialty. Examples of FCNs working in and collaborating with healthcare systems, educational institutions, and congregations illustrate the value and diversity of FCN services for impacting community-based care. An exhaustive list of national, denominational, and regional organizations supporting FCN practice is included. [ABSTRACT FROM AUTHOR]

The traditional image of the 'doctor' is someone in a clinic or hospital directly treating patients. However, today there are opportunities for medical professionals in diverse fields of medicine and healthcare. Doctors are now playing a much wider role in enhancing healthcare, diagnosis, research, developing new treatments, and shaping the foundation and functioning of a country's healthcare system. They are also making significant contributions to public health and wellness. This editorial discusses significant alternative medical fields where doctors are building lucrative careers, contributing to society, and playing an equally important role as those in clinical practice. [ABSTRACT FROM AUTHOR]

Introduction: From 2013 to 2019, Black women comprised 73% of pregnancy‐related deaths in Philadelphia. There is currently a dearth of research on the continuity of midwifery care from initiation of prenatal care through birth in relation to characteristics such as race/ethnicity and income. The aim of this study was to investigate whether race/ethnicity and insurance status were associated with the likelihood of a pregnant person who begins prenatal care with a midwife to remain in midwifery care for birth attendance. Methods: This was a retrospective cohort study of a diverse population of pregnant patients who gave birth in a large tertiary care hospital and had their first prenatal visit with a certified nurse‐midwife (CNM) between June 2, 2009, and June 30, 2020 (n = 5121). We used multivariable, log‐binomial regression models to calculate risk ratios of transferring to physician care (vs remaining within CNM care), adjusted for age, race/ethnicity, prepregnancy body mass index, insurance type, and comorbidities. Results: After adjusting for pregnancy‐related risk factors, non‐Hispanic Black patients (adjusted relative risk [aRR], 1.14; 95% CI, 1.04‐1.24) and publicly insured patients (aRR, 1.11; 95% CI, 1.01‐1.22) were at higher risk of being transferred to physician care compared with non‐Hispanic White and privately insured patients. Secondary analysis revealed that non‐Hispanic Black patients had higher risk of transferring and having an operative birth (aRR, 1.35; 95% CI, 1.18‐1.55), whereas publicly insured patients were at higher risk of being transferred for reasons other than operative births (aRR, 1.35; 95% CI, 1.18‐1.54). Discussion: These findings indicate that Black and publicly insured patients were more likely than White and privately insured patients to transfer to physician care even after adjustment for comorbid conditions. Thus, further research is needed to identify the factors that contribute to racial and economic disparity in continuity of midwifery care. [ABSTRACT FROM AUTHOR]

BackgroundGlobal prevalence of diabetes is increasing, causing widespread morbidity, mortality and increased healthcare costs. Providing quality care in a timely fashion to people with diabetes in low-resource settings can be challenging. In the underserved state of Chiapas, Mexico, which has some of the lowest diabetes detection and control rates in the country, there is a need to implement strategies that improve care for patients with diabetes. One such strategy is shared medical appointments (SMAs), a patient-centred approach that has proven effective in fostering patient engagement and comprehensive care delivery among underserved populations.ObjectiveThis study aimed to understand the perceptions, experiences and insights of both patients living with diabetes and healthcare providers, who took part in a pilot SMA strategy implemented in five outpatient clinics in rural Chiapas.MethodsFollowing an exploratory qualitative approach, we conducted 50 in-depth interviews with patients and providers involved in diabetes SMAs and five focus group discussions with community health workers providing patient support and education.ResultsThe implementation of an SMA model changed how diabetes care is perceived, structured and delivered. Patients felt sheltered by group interactions based on trust, which allowed for the exchange of experiences, learning and increased engagement in treatment and lifestyle changes. Providers gained insights into their patients' context and lived experiences, which resulted in improved rapport and quality of care. SMAs also restructured some operational aspects in the clinics and fostered the sharing of power and responsibilities amongst the staff.ConclusionsThe SMAs model transformed care by providing a patient-centred, collaborative approach to diabetes care, education and support. Additionally, it reshaped the health-care team resulting in power-shifting and role-sharing among members of the interdisciplinary team. We therefore encourage decision-makers to expand the use of SMAs to improve care for patients with diabetes in low-resource settings.

BackgroundIntegration of community health workers/promotores in community-based participatory research is an efficient strategy to advance research and health initiatives. We build on the principles of the interactive and contextual model of community-university collaboration for research and action, the public health critical race framework, and the situated learning theory to propose the community-driven research framework for the development of culturally appropriate research methods training and integration of promotores as co-researchers.ObjectivesTo present the community-driven research framework as a model that trains and integrates promotores in research methodologies.Application of the Community-Driven Research Framework: By showcasing three case studies (March 2019 to December 2021) we describe the promotores' levels of involvement through the various research stages highlighting the effectiveness of the community-driven research framework.ConclusionsThe community-driven research framework fills a gap in the literature by providing a process through which researchers can engage in a culturally relevant learning process that allows entry to the community, fostering trust, and initiating a mutual collaboration that is embedded within the local context and needs of the community. The implementation of the community-driven research framework has implications for the development of culturally sensitive community partnerships as well as for designing research that is centered around the cultural and social context of the community.

Understanding how neighborhood environments are related to older adults quality of life (QoL) and physical activity (PA) is important for public health actions on healthy ageing in sub-Saharan Africa. We examined associations of perceived neighborhood environment attributes with QoL among older adults in Nigeria and investigated the moderating effects of PA on these associations. We conducted a cross-sectional study of 353 older adults (mean age = 68.9 ± 9.1 years) selected from 5 high- and low-income communities in Maiduguri, Nigeria. QoL, attributes of the neighborhood environments and PA were self-reported using validated questionnaires. Multi-level models were used to examine the direct associations between neighborhood environment attributes and each of the four domains of QoL (physical health, psychological health, social relationships, and environmental health), as well as the moderating effects of leisure-time and total PA. Seven of nine neighborhood environment features were positively associated with multiple domains of QoL. Residential density, land-use diversity, land-use mix-access, walking infrastructure, traffic safety and overall walkability were positively related to both or either physical health and environmental health QoL among those who are physically active. In contrast, walking infrastructure, traffic safety, and overall walkability were negatively related to psychological health QoL among those not physically active. Our findings suggest being physically active moderates the association of neighborhood environments with QoL among Nigerian older adults. We suggest that designing age-friendly communities and simultaneously promoting PA may be needed to improve QoL and help prepare the Nigerian society for the predicted increase in the older adult population.

Objectives The total population of Korea began to decline in 2019; in particular, the population in rural areas has been rapidly decreasing and is aging. Therefore, the government has designated depopulation areas and is seeking ways to support them. In this study, we determined that observing whether health gaps occurred due to population decline in local areas was necessary. Therefore, we attempted to examine changes in health behavior in depopulation areas in a time series manner using Community Health Survey data. Methods The analysis used Community Health Survey data from 2010 to 2019, and regional classification was divided by depopulation areas designated by the Ministry of the Interior and Safety. Trends in health behavior and chronic disease prevalence between depopulation and non-depopulation areas were analyzed. All analyses were conducted using complex sample analysis procedures in SAS 9.4 software. Results The smoking rate steadily decreased in both depopulation and non-depopulation areas, whereas the high-risk drinking rate increased slightly. The walking practice rate did not improve in depopulation areas compared to non-depopulation areas. Furthermore, nutritional labeling usage rate was consistently lower in depopulation areas than in non-depopulation areas, with the gap being the largest. The prevalence of obesity, diabetes, and hypertension showed that the gap between depopulation and non-depopulation areas is continuously increasing. Conclusions Health behaviors in depopulation areas have not improved, and the prevalence of chronic diseases is increasing rapidly. Therefore, the demand for health care services that support healthy lifestyle practices and chronic disease management in these areas is expected to increase.

Grace Ping Ping Tan,1 Chompoonut Topothai,1,2 Yvette van der Eijk1 1Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore; 2International Health Policy Program, Ministry of Public Health, Nonthaburi, ThailandCorrespondence: Grace Ping Ping Tan, Email grace.tan@nus.edu.sgIntroduction: In Singapore, the healthcare system strongly encourages mothers to breastfeed and breastfeeding initiation is near-universal. However, sustained breastfeeding rates remain low. Little is currently known about how breastfeeding information disseminated in the healthcare setting influences women’s breastfeeding experiences. This study explored breastfeeding promotion and educational resources from the perspective of Singaporean mothers and healthcare workers.Methods: Semi-structured interviews with 14 mothers of infants aged 1– 5 months and who had used obstetric, maternity, and/or paediatric services in Singapore, and 20 health workers with experience in general, obstetric, maternal, or paediatric care recruited using purposive sampling methods. Interview transcripts were coded using an inductive method.Results: Breastfeeding communications were viewed as too moralized and too focused on nudging women to breastfeed, with relatively little emphasis on timely, practical information or solutions for mothers unable to latch. Hence mothers tended to rely on alternative resources such as blogs. They lacked in-depth knowledge of the benefits of breastfeeding and viewed it as detrimental to maternal mental wellbeing due to the perceived stress and guilt when experiencing difficulties, notably with milk supply and latching, and from the inability to meet breastfeeding expectations. Husbands, older family members, confinement nannies, and employers were considered influential individuals to encourage breastfeeding, but they commonly discouraged breastfeeding due to social and cultural factors which led to supplementation with formula.Conclusion: For better breastfeeding outcomes, future informational sources on breastfeeding should be morally neutral, practical, set realistic expectations for the demands of breastfeeding, and target influential individuals such as family members, confinement nannies and employers.Keywords: breastfeeding, communications, community health, health promotion, lactation, maternal health

Abstract Background Over the years, low-and middle-income countries have adopted several policy initiatives to strengthen community health systems as means to attain Universal Health Coverage (UHC). In this regard, Zambia passed a Community Health Strategy in 2017 that was later halted in 2019. This paper explores the processes that led to the halting and re-issuing of this strategy with the view of drawing lessons to inform the development of such strategies in Zambia and other similar settings. Methods We employed a qualitative case study comprising 20 semi-structured interviews with key stakeholders who had participated in either the development, halting, or re-issuing of the two strategies, respectively. These stakeholders represented the Ministry of Health, cooperating partners and other non-government organizations. Inductive thematic analysis approach was used for analysis. Results The major reasons for halting and re-issuing the community health strategy included the need to realign it with the national development framework such as the 7th National Development Plan, lack of policy ownership, political influence, and the need to streamline the coordination of community health interventions. The policy process inadequately addressed the key tenets of community health systems such as complexity, adaptation, resilience and engagement of community actors resulting in shortcomings in the policy content. Furthermore, the short implementation period, lack of dedicated staff, and inadequate engagement of stakeholders from other sectors threatened the sustainability of the re-issued strategy. Conclusion This study underscores the complexity of community health systems and highlights the challenges these complexities pose to health policymaking efforts. Countries that embark on health policymaking for community health systems must reflect on issues such as persistent fragmentation, which threaten the policy development process. It is crucial to ensure that these complexities are considered within similar policy engagement processes.

PurposeThe goals of this cross-sectional community-based survey study were to assess the impact of the Covid-19 pandemic on actionable factors which are known to contribute to worse cancer outcomes, and to determine whether race and ethnicity-based differences exist.MethodsA survey study which captured demographic information and changes in cancer outcomes-related factors since the start of the Covid-19 pandemic, was conducted at a public Covid-19 vaccination clinic over a period of 10 days during March 2021. Surveys were administered in multiple languages. Chi-square tests and ANOVA followed by post-hoc Dunnett testing assessed for race and ethnicity-based differences.ResultsA total of 949 people participated (61.6% participation rate). Ninety-three surveys were removed based on inclusion criteria giving a final participant number of 856. Many participants reported postponing cancer screenings (17.8%) and cancellation of medical appointments (22.8% and 25.8% reported cancelled appointments by providers or themselves, respectively) due to the pandemic. Participants also reported decreased physical activity (44.7%) and increased tobacco and/or marijuana usage (7.0%). Conversely, participants reported consuming more fruits and vegetables (21.4%) and decreasing alcohol consumption (21.4%). Several race-related differences but no ethnicity-related differences were observed.ConclusionOur data can be used to help guide pharmacist-led targeted outreach in our community which will help mitigate Covid-19 pandemic-driven changes in behaviors associated with worse cancer outcomes and exacerbation of cancer health disparities. To our knowledge, this is the first cancer outcomes-related study to be conducted at a public Covid-19 vaccination site and is the first pharmacist-led study in this area.

Air pollution is a pervasive global public health threat. The purpose of this study was to assess the content of 100 widely viewed English language YouTube videos on air pollution using the search term 'air pollution.' Content categories were created using comprehensive fact sheets and were coded as being present or not in each video. Cumulatively, the 100 videos sampled received 32,826,294 views and 303,692 likes, with averages of 328,263 and 3,068 respectively. The majority of videos (n = 72) were created by broadcast or internet-based news, 12 of the videos were created by professionals, 7 were created by a consumer and 9 were created by others. Three kinds of content were featured in a majority (> 50%) of the videos: "sources of pollution," "environmental impacts," and "solutions offered" and the videos covering each of these topics collectively garnered more than 26 million views and 249,000 likes. Independent one-tailed t-tests (α = 0.05) showed an association between covering sources of pollution and the number of views and likes. For both, videos featuring this content had a higher average number of views (467,391.08 vs. 80,924.03, p =.0383) and likes (4,450.78 vs. 647.03, p =.0383). Additionally, videos showing environmental impacts received more views than those that did not (547,901.49 vs. 80,585.43, p =.0373). This research can serve as a starting point to describe information being conveyed about an important global public health problem. Future research is needed to improve understanding about ways to utilize YouTube and other social media for public health education and advocacy to increase consumers' awareness and facilitate the informed decision-making process. [ABSTRACT FROM AUTHOR]

Abstract Background Global progress on malaria control has stalled recently, partly due to challenges in universal access to malaria diagnosis and treatment. Community health workers (CHWs) can play a key role in improving access to malaria care for children under 5 years (CU5), but national policies rarely permit them to treat older individuals. We conducted a two-arm cluster randomized trial in rural Madagascar to assess the impact of expanding malaria community case management (mCCM) to all ages on health care access and use. Methods Thirty health centers and their associated CHWs in Farafangana District were randomized 1:1 to mCCM for all ages (intervention) or mCCM for CU5 only (control). Both arms were supported with CHW trainings on malaria case management, community sensitization on free malaria care, monthly supervision of CHWs, and reinforcement of the malaria supply chain. Cross-sectional household surveys in approximately 1600 households were conducted at baseline (Nov–Dec 2019) and endline (Nov–Dec 2021). Monthly data were collected from health center and CHW registers for 36 months (2019–2021). Intervention impact was assessed via difference-in-differences analyses for survey data and interrupted time-series analyses for health system data. Results Rates of care-seeking for fever and malaria diagnosis nearly tripled in both arms (from less than 25% to over 60%), driven mostly by increases in CHW care. Age-expanded mCCM yielded additional improvements for individuals over 5 years in the intervention arm (rate ratio for RDTs done in 6–13-year-olds, RRRDT6–13 years = 1.65; 95% CIs 1.45–1.87), but increases were significant only in health system data analyses. Age-expanded mCCM was associated with larger increases for populations living further from health centers (RRRDT6–13 years = 1.21 per km; 95% CIs 1.19–1.23). Conclusions Expanding mCCM to all ages can improve universal access to malaria diagnosis and treatment. In addition, strengthening supply chain systems can achieve significant improvements even in the absence of age-expanded mCCM. Trial registration The trial was registered at the Pan-African Clinical Trials Registry (#PACTR202001907367187).

Abstract Background Community health workers (CHWs) had important roles mitigating the impact of the COVID-19 pandemic in vulnerable communities. We described how CHWs supported the dissemination of COVID-19 information and services during the early pandemic response. Methods Online article searches were conducted across five scientific databases, with review article reference lists hand searched to identify grey/unpublished literature. Articles were included if they reported on a program that engaged CHWs and aimed to prevent/control COVID-19. Results Nineteen relevant programs were identified from 18 included articles. CHWs were widely engaged in the pandemic response, especially in low- and middle-income countries and in vulnerable communities. CHWs’ ability to effectively disseminate COVID-19 information/services was enabled by community trust and understanding community needs. CHWs were often underfunded and required to work in difficult conditions. Pre-existing services incorporating CHWs rapidly adapted to the new challenges brought by the pandemic. Conclusions We recommend establishing programs that employ CHWs to disseminate health information and services in communities at-risk of misinformation and poor health outcomes during non-pandemic times. CHWs are well-placed to deliver interventions should an infectious disease outbreak arise. Having pre-existing trusted relationships between CHWs and community members may help protect vulnerable groups, including when outbreaks occur.

Abstract Background Cervical cancer is a leading cause of cancer death among women of reproductive age despite being treatable if it is diagnosed early. Early diagnosis is possible through regular screening through the public health system. However, screening rates remain low in many low- and middle-income countries, including Kenya, where the screening rate currently stands at 16–18%. The low screening rates are attributed to, among other factors, low knowledge about cervical cancer and the available screening options among women of reproductive age. The current study evaluated the effectiveness of dialogue-based community health education by trained community health volunteers (CHVs) in improving cervical cancer knowledge among women of reproductive age (WRA) in rural Kisumu County. Methods This was a longitudinal pre- and post-intervention study with a control group. The knowledge of women of reproductive age was assessed at baseline in both the intervention and control groups, followed by dialogue-based community health education in the intervention arm. A final end-line knowledge assessment was performed. The scores at baseline and at the end of the study were compared to assess changes in knowledge due to the intervention. The proportion of WRA with improved knowledge was also calculated, and statistical significance was considered at p ≤ 0.05. Results There was no significant difference between the participants in the two arms, except for the level of education (p = 0.002). The knowledge of the WRA in the intervention arm improved significantly (p

Abstract Background Quality of Life (QoL) is an individual’s subjective perception of well-being within their cultural context. While most QoL studies focus on individuals with certain health conditions, factors such as sex, marital status, education, and family structure can influence QoL beyond age and health conditions. Considering the limited studies on QoL in the general Indian population, especially from rural areas, the present study aims to explore the QoL and sociodemographic factors affecting QoL among community-dwelling adults in rural Punjab. Methods This community-based cross-sectional study was conducted among 931 individuals of both sexes (59.6% female) aged 20–75 years residing in rural areas of Mansa, Punjab, India. Sociodemographic data were collected using an interview schedule, and QoL was measured using the WHOQOL-BREF. Results The overall mean QoL score was found to be 67.44 ± 14.7. The most affected QoL was in the physical domain (mean = 60.203 ± 13.49), followed by psychological (mean = 65.67 ± 18.3), social-relationship (mean = 69.88 ± 26.43), and environmental domains (mean = 74.05 ± 20.58). Adjusted logistic regression analysis revealed female sex, advanced age (age group ≥ 60 years), illiteracy, and unmarried status to be positively associated and family size of 6–10 members to be negatively associated with poor QoL. Conclusion The study suggests that females, elderlies, illiterates, and unmarried individuals may be at a higher risk of poor QoL. Further, education and a bigger family size appear to increase subjective well-being among participants.

Abstract Background Individuals experiencing homelessness face unique physical and mental health challenges, increased morbidity, and premature mortality. COVID -19 creates a significant heightened risk for those living in congregate sheltering spaces. In March 2020, the COVID-19 Community Response Team formed at Women’s College Hospital, to support Toronto shelters and congregate living sites to manage and prevent outbreaks of SARS-CoV-2 using a collaborative model of onsite mobile testing and infection prevention. From this, the Women’s College COVID-19 vaccine program emerged, where 14 shelters were identified to co-design and support the administration of vaccine clinics within each shelter. This research seeks to evaluate the impact of this partnership model and its future potential in community-centered integrated care through three areas of inquiry: (1) vaccine program evaluation and lessons learned; (2) perceptions on hospital/community partnership; (3) opportunities to advance hospital-community partnerships. Methods Constructivist grounded theory was used to explore perceptions and experiences of this partnership from the voices of shelter administrators. Semi-structured interviews were conducted with administrators from 10 shelters using maximum variation purposive sampling. A constructivist-interpretive paradigm was used to determine coding and formation of themes: initial, focused, and theoretical. Results Data analysis revealed five main categories, 16 subcategories, and one core category. The core category “access to healthcare is a human right; understand our communities” emphasizes access to healthcare is a consistent barrier for the homeless population. The main categories revealed during a time of confusion, the hospital was seen as credible and trustworthy. However, the primary focus of many shelters lies in housing, and attention is often not placed on health resourcing, solidifying partnerships, accountability, and governance structures therein. Health advocacy, information sharing tables, formalized partnerships and educating health professionals were identified by shelter administrators as avenues to advance intersectoral relationship building. Conclusion Hospital-community programs can alleviate some of the ongoing health concerns faced by shelters – during a time of COVID-19 or not. In preparation for future pandemics, access to care and cohesion within the health system requires the continuous engagement in relationship-building between hospitals and communities to support co-creation of innovative models of care, to promote health for all.

Background In Australia, we are not meeting our goals in relation to breastfeeding overall, and in particular, promoting and supporting breastfeeding rates for Aboriginal and Torres Strait Islander babies especially breastfeeding to at least six months. The WHO has recognised the importance of exclusively breastfeeding a baby for a minimum of six months to ensure a healthy start to life. Breastfeeding has been shown to be a protective factor against asthma and allergy development, ear disease, infections, respiratory illness and gastrointestinal issues. This study aims to improve predominant breastfeeding rates of Aboriginal and Torres Strait Islander babies in the Perth Metropolitan area (Western Australia, Australia). Methods and analysis We will use an interrupted time series design to determine the effectiveness of a continuous quality improvement (CQI) program delivered over 6 months by selected community health staff. The intervention will be delivered at two community health regions and the remaining 17 community health regions will be the control group. The primary outcomes will be predominant breastfeeding rates at two and four months, and secondary outcomes will include any breastfeeding at two and four months, and hospital admissions, emergency department presentations and immunisation data at 6 months. Discussion The study will allow us to determine the breastfeeding rates of Aboriginal babies, identify the barriers and enablers to initiating and maintaining breastfeeding and determine whether a CQI program can achieve improvements in breastfeeding rates.

In the realm of innovation, relying solely on the creativity of researchers may not fully unleash their potential. Previous studies revealed the positive impact of academic justice climate on researchers' behavior, the impact of individual characteristics and work state on the effect has been underexplored. Based on the theory of the job demands resource, this study proposed the connotation of academic justice climate, spiritual creativity and spiritual depletion, and explore the impact of academic justice climate on innovation performance was investigated from two paths: spiritual creativity and spiritual depletion. Which involved the mediating role of work involvement and job burnout, along with the moderating roles of sensitivity and perceived organizational support. Data were collected from 289 researchers in universities and research institutions in China. Statistical analysis was conducted using regression analysis. On the one hand, the result shows respectively the definition about three terms, Academic justice climate refers to work resource availability including resource acquisition and resource created by research leaders from their own subjective preferences and profit-orientation. Spiritual creativity refers to individual under certain security environment can fully stimulate their personal potential to produce creation. Spiritual depletion refers to individual under certain insecurity or threatened environment, would be stuck in a painful situation, or negative mood and unable to move on. On the other hand, the results of analysis statistically support the hypothesized indirect relationship between the academic justice climate and researchers' innovation performance. Work involvement and job burnout play a completely mediating role in the above relationships. Sensitivity positively regulates the impact of the academic justice climate on work involvement. Perceived organizational support positively regulates the impact of academic justice climate on job burnout. This research results show how and when academic justice climate can enhance researchers' innovation performance, these findings not only contribute to enrich job demand resource theory, but also provide research organizations and researchers valuable reference about spiritual health management. [ABSTRACT FROM AUTHOR]

Background: Global progress on malaria control has stalled recently, partly due to challenges in universal access to malaria diagnosis and treatment. Community health workers (CHWs) can play a key role in improving access to malaria care for children under 5 years (CU5), but national policies rarely permit them to treat older individuals. We conducted a two-arm cluster randomized trial in rural Madagascar to assess the impact of expanding malaria community case management (mCCM) to all ages on health care access and use. Methods: Thirty health centers and their associated CHWs in Farafangana District were randomized 1:1 to mCCM for all ages (intervention) or mCCM for CU5 only (control). Both arms were supported with CHW trainings on malaria case management, community sensitization on free malaria care, monthly supervision of CHWs, and reinforcement of the malaria supply chain. Cross-sectional household surveys in approximately 1600 households were conducted at baseline (Nov–Dec 2019) and endline (Nov–Dec 2021). Monthly data were collected from health center and CHW registers for 36 months (2019–2021). Intervention impact was assessed via difference-in-differences analyses for survey data and interrupted time-series analyses for health system data. Results: Rates of care-seeking for fever and malaria diagnosis nearly tripled in both arms (from less than 25% to over 60%), driven mostly by increases in CHW care. Age-expanded mCCM yielded additional improvements for individuals over 5 years in the intervention arm (rate ratio for RDTs done in 6–13-year-olds, RRRDT6–13 years = 1.65; 95% CIs 1.45–1.87), but increases were significant only in health system data analyses. Age-expanded mCCM was associated with larger increases for populations living further from health centers (RRRDT6–13 years = 1.21 per km; 95% CIs 1.19–1.23). Conclusions: Expanding mCCM to all ages can improve universal access to malaria diagnosis and treatment. In addition, strengthening supply chain systems can achieve significant improvements even in the absence of age-expanded mCCM. Trial registration: The trial was registered at the Pan-African Clinical Trials Registry (#PACTR202001907367187). [ABSTRACT FROM AUTHOR]