Implementation contextual factors related to youth advocacy for healthy eating and active living

Healthy eating and active living are critical to youth health and development. Youth advocacy can improve health-related behaviors and environments by empowering youth to act as change agents in their community. This mixed-method study examined implementation contextual factors in relation to implementation success in high school youth advocacy projects targeting healthy eating and active living. Semi-structured interviews were conducted with key informants from each of the 21 participating youth groups. Interviews gathered information on implementation processes, barriers and facilitators, and Implementation Outcomes (Progress, Penetration, Health Impact, Sustainability, and an overall Implementation Success Composite). Interview responses were coded using the Consolidated Framework for Implementation Research (CFIR). Each identified construct was rated for its impact on implementation and ratings were tested for their association with the Implementation Outcomes. Cosmopolitanism (leveraging connections within the community; rated in 20 groups) and Internal Intervention Source (rated in 9 groups) showed consistent moderate/large associations with the Implementation Outcomes and Implementation Success Composite. Other moderate/large associations were outcome specific, with Student Group Leader Engagement, External Change Agents, and Student and Community Needs and Resources also being associated with the Implementation Success Composite. Implementation contextual factors, particularly community-connectedness, group functioning, and internal project idea development are important factors for implementing youth advocacy projects that will reach large numbers of people and be likely to lead to sustained health improvements. Implementation strategies that target these factors need to be developed and tested in partnership with community organizations to maximize success of youth advocacy efforts.

Feasibility and Outcomes of an HIV Testing Intervention in African American Churches

The updated National HIV/AIDS Strategy recommends widespread HIV education and testing and calls the faith community to assist in these efforts. Yet, limited information exist on church-based HIV testing interventions. This study examined feasibility and assessed HIV testing outcomes of Taking It to the Pews (TIPS), a multilevel HIV education and testing intervention. Four African American churches were matched and randomized to TIPS or a standard-information control arm. Intervention churches delivered the religiously-tailored TIPS Tool Kit, which included educational materials to individuals and ministry groups; pastoral activities (e.g., sermons preached, receipt of HIV testing role-modeled), responsive readings, and church bulletin inserts in church services; and HIV testing during church services and church outreach events. All churches delivered 2-3 tools/month and coordinated 3 HIV testing events. At 12 months, significant increases in receipt of HIV testing (59% vs. 42%, p = 0.008), and particularly church-based testing (54% vs. 15%, p < 0.001), relative to controls were found. TIPS has great potential to increase reach, feasibility, and impact of HIV testing in African American churches.

Managing the risk of intimacy: accounts of disclosure and responsiveness among people with HIV and intimate partners of people with HIV

It is well known that concerns about sexual risk tend to decline among people in intimate relationships where there is established commitment and trust. In the context of relationships at increased risk for HIV transmission, interactions involving disclosure and partner responsiveness are key to maintaining intimacy and physical safety. This paper explores concepts of risk and sexual intimacy articulated by a community sample of 30 people living with HIV and their intimate relationship partners. Data revealed the shifts in intimate relationship dynamics upon the disclosure of an HIV diagnosis, the importance of intimacy in the context of managing one or both partners' HIV care and responses to new advances in HIV prophylaxis. Findings suggest that participants' experiences of self-disclosure and partner responsiveness most often resulted in an increased sense of protectiveness from and for partners. This suggests that health-promoting messaging should be adapted to be more relevant to intimate couple communication and mutual support.

Evaluation of the Healthy Lifestyles Initiative for Improving Community Capacity for Childhood Obesity Prevention

PURPOSE AND OBJECTIVES

Policy, systems, and environmental approaches are recommended for preventing childhood obesity. The objective of our study was to evaluate the Healthy Lifestyles Initiative, which aimed to strengthen community capacity for policy, systems, and environmental approaches to healthy eating and active living among children and families.

INTERVENTION APPROACH

The Healthy Lifestyles Initiative was developed through a collaborative process and facilitated by community organizers at a local children's hospital. The initiative supported 218 partners from 170 community organizations through training, action planning, coalition support, one-on-one support, and the dissemination of materials and sharing of resources.

EVALUATION METHODS

Eighty initiative partners completed a brief online survey on implementation strategies engaged in, materials used, and policy, systems, and environmental activities implemented. In accordance with frameworks for implementation science, we assessed associations among the constructs by using linear regression to identify whether and which of the implementation strategies were associated with materials used and implementation of policy, systems, and environmental activities targeted by the initiative.

RESULTS

Each implementation strategy was engaged in by 30% to 35% of the 80 survey respondents. The most frequently used materials were educational handouts (76.3%) and posters (66.3%). The most frequently implemented activities were developing or continuing partnerships (57.5%) and reviewing organizational wellness policies (46.3%). Completing an action plan and the number of implementation strategies engaged in were positively associated with implementation of targeted activities (action plan, effect size = 0.82; number of strategies, effect size = 0.51) and materials use (action plan, effect size = 0.59; number of strategies, effect size = 0.52). Materials use was positively associated with implementation of targeted activities (effect size = 0.35).

IMPLICATIONS FOR PUBLIC HEALTH

Community-capacity-building efforts can be effective in supporting community organizations to engage in policy, systems, and environmental activities for healthy eating and active living. Multiple implementation strategies are likely needed, particularly strategies that involve a high level of engagement, such as training community organizations and working with them on structured action plans.

Using Participatory System Dynamics Modeling to Examine the Local HIV Test and Treatment Care Continuum in Order to Reduce Community Viral Load

Achieving community-level goals to eliminate the HIV epidemic requires coordinated efforts through community consortia with a common purpose to examine and critique their own HIV testing and treatment (T&T) care system and build effective tools to guide their efforts to improve it. Participatory system dynamics (SD) modeling offers conceptual, methodological, and analytical tools to engage diverse stakeholders in systems conceptualization and visual mapping of dynamics that undermine community-level health outcomes and identify those that can be leveraged for systems improvement. We recruited and engaged a 25-member multi-stakeholder Task Force, whose members provide or utilize HIV-related services, to participate in SD modeling to examine and address problems of their local HIV T&T service system. Findings from the iterative model building sessions indicated Task Force members' increasingly complex understanding of the local HIV care system and demonstrated their improved capacity to visualize and critique multiple models of the HIV T&T service system and identify areas of potential leverage. Findings also showed members' enhanced communication and consensus in seeking deeper systems understanding and options for solutions. We discuss implications of using these visual SD models for subsequent simulation modeling of the T&T system and for other community applications to improve system effectiveness.

Do Black Women's Religious Beliefs About Body Image Influence Their Confidence in Their Ability to Lose Weight?

INTRODUCTION

Black women are disproportionately burdened by obesity but maintain body satisfaction and strong religious commitment. Although faith-based weight-loss interventions have been effective at promoting weight loss among blacks, little is known about how body image and religious views contribute to weight-related beliefs among religious black women. The purpose of this study was to examine whether demographic and health history factors, religious involvement, and beliefs about body image could explain motivation and confidence to lose weight among a church-affiliated sample of black women.

METHODS

We recruited 240 church-affiliated black women aged 18 to 80 years (average age, 55 y; SD, 12.3) in 2014 from 6 black churches that participated in a larger study, Project FIT (Faith Influencing Transformation), a clustered, diabetes/heart disease/stroke intervention among black women and men. We used baseline data from Project FIT to conduct a cross-sectional study consisting of a survey. Variables approaching significance in preliminary correlation and χ² analyses were included in 2 multiple linear regression models examining motivation and confidence in ability to lose weight.

RESULTS

In final regression models, body mass index was associated with motivation to lose weight (β = 0.283, P < .001), and beliefs about body image in relation to God predicted confidence to lose weight (β = 0.180, P = .01).

CONCLUSION

Faith-based, weight-loss interventions targeting black women should emphasize physical well-being and highlight the health benefits of weight management rather than the benefits of altering physical appearance and should promote positive beliefs about body image, particularly relating to God.

Exploring HIV Risk and Ex-Offender Status Among African American Church Populations: Considerations for Faith-Based Settings

Studies with the general population indicate that involvement in the correctional system is strongly associated with the risk of contracting HIV and other sexually transmitted infections. However, limited studies have examined ex-offender status and HIV risk among African Americans-a population disproportionately impacted by incarceration and HIV-and even fewer have examined these risks among African American church-affiliated populations. This study examined ex-offender status, HIV risks, and perceptions of church involvement in HIV prevention strategies among 484 participants affiliated with African American churches. Findings indicate ex-offender participants were more likely to have been tested for HIV and believed the church should be involved in HIV prevention strategies. Future research, practice, and recommendations on the design of culturally and religiously tailored interventions for ex-offender HIV prevention, screening, and linkage to care in African American church settings are discussed.

Physical Health Screenings Among African-American Church and Community Members

This study sought to identify characteristics, including religiosity, related to having received health screenings among persons who attend African-American churches or receive church-based community outreach services. A sample of 602 was recruited during two phases as part of a larger project. Blood pressure, cholesterol, and blood glucose screenings were the most frequently reported screenings ever and in the last 12 months. Although religiosity was significantly related to several of the health screenings in bivariate analysis, it is not a predictor of health screenings in multivariate analyses. Innovative strategies are needed to promote screenings such as church-based health fairs.

A Poisson limit theorem for incomplete symmetric statistics

Silverman and Brown (1978) have derived Poisson limit theorems for certain sequences of symmetric statistics, based on a sample of independent identically distributed random variables. In this paper an incomplete version of these statistics is considered and a Poisson limit result shown to hold. The powers of some tests based on the incomplete statistic are investigated and the main results of the paper are used to simplify the derivations of the asymptotic distributions of some statistics previously published in the literature.

An HIV Testing Intervention in African American Churches: Pilot Study Findings

Background

African Americans are disproportionately burdened by HIV. The African American church is an influential institution with potential to increase reach of HIV prevention interventions in Black communities.

Purpose

This study examined HIV testing rates in African American churches in the Taking It to the Pews pilot project. Using a community-engaged approach, church leaders delivered religiously-tailored HIV education and testing materials/activities (e.g., sermons, brochures/bulletins, testimonials) to church and community members.

Methods

Four African American churches (N=543 participants) located in the Kansas City metropolitan area were randomized to intervention and comparison groups. Receipt of an HIV test was assessed at baseline and 6 months.

Results

Findings indicated intervention participants were 2.2 times more likely to receive an HIV test than comparisons at 6 months. Church leaders delivered about 2 tools per month.

Conclusions

Church-based HIV testing interventions are feasible and have potential to increase HIV testing rates in African American communities.