Multilevel community-based culturally situated interventions and community impact: an ecological perspective

Family model diabetes self-management education and support in faith-based organizations in the Republic of the Marshall Islands: A study protocol

INTRODUCTION

The Republic of the Marshall Islands (RMI) is an independent nation and a member of the United States (US) Affiliated Pacific Islands through a Compact of Free Association. Health disparities in the RMI are striking, with high rates of type 2 diabetes mellitus (T2DM). The International Diabetes Federation has documented age-adjusted prevalence of T2DM at 23.0 %, compared to the US (13.2 %) and globally (9.8 %). T2DM has a devastating impact on patients and their families.

METHODS

The purpose of this article is to present the study protocol for the fully powered two-arm cluster randomized controlled trial using a wait-list control to evaluate the effectiveness of a Family Diabetes Self-Management Education and Support (Family DSMES) program when delivered in a group setting by community health workers (CHWs) in faith-based organizations (FBOs) in the RMI. The study used a community engaged approach, and the study protocol includes adaptations based on the results of our one-arm pilot study.

SUMMARY

This study will provide new and innovative information on the effectiveness of Family DSMES delivered in a group setting by CHWs in FBOs in the RMI. The knowledge gained from this research will inform DSMES interventions conducted with Marshallese and other Pacific Islander communities, as well as DSMES interventions conducted in other low-resource countries.

Environmental and social framework to protect marine bivalves under extreme weather events

Rising ocean temperatures, a consequence of anthropogenic climate change, are increasing the frequency, intensity, and magnitude of extreme marine heatwaves (MHWs). These persistent anomalous warming events can have severe ecological and socioeconomic impacts, threatening ecologically and economically vital organisms such as bivalves and the ecosystems they support. Developing robust environmental and social frameworks to enhance the resilience and adaptability of bivalve aquaculture is critical to ensuring the sustainability of this crucial food source. This review synthesizes the current understanding of the physiological and ecological impacts of MHWs on commercially important bivalve species farmed globally. We propose an integrated risk assessment framework that encompasses environmental monitoring, farm-level preparedness planning, and community-level social support systems to safeguard bivalve aquaculture. Specifically, we examine heatwave prediction models, local mitigation strategies, and social programs that could mitigate the impacts on bivalve farms and vulnerable coastal communities economically dependent on this fishery. At the farm level, adaptation strategies such as selective breeding for heat-tolerant strains, optimized site selection, and adjustments to culture practices can improve survival outcomes during MHWs. Robust disease surveillance and management programs are essential for early detection and rapid response. Furthermore, we highlight the importance of stakeholder engagement, knowledge exchange, and collaborative governance in developing context-specific, inclusive, and equitable safeguard systems. Proactive measures, such as advanced forecasting tools like the California Current Marine Heat Wave Tracker developed by NOAA's Southwest Fisheries Science Center, enable preemptive action before losses occur. Coordinated preparation and response, underpinned by continuous monitoring and adaptive management, promise to protect these climate-vulnerable food systems and coastal communities. However, sustained research, innovation, and cross-sector collaboration are imperative to navigate the challenges posed by our rapidly changing oceans.

Core Principles and Practices for the Design, Implementation, and Evaluation of Social and Behavior Change for Nutrition in Low- and Middle-Income Contexts with Special Applications for Nutrition-Sensitive Agriculture

Background

There is currently no cogent set of standards to guide the design, implementation and evaluation of nutrition social and behavior change (SBC), including for nutrition-sensitive agriculture (NSA).

Objectives

We aimed to capture, consolidate, and describe SBC core principles and practices (CPPs), reflecting professional consensus, and to offer programmatic examples that illustrate their application for NSA projects in low- and middle-income countries.

Methods

We conducted a narrative review following a 4-step iterative process to identify and describe SBC CPPs. We first reviewed general SBC frameworks and technical documents and developed a preliminary list of CPPs and their definitions. Following review and feedback from 8 content experts, we revised the CPPs, incorporating the panel's feedback, and conducted a more specific search of the peer-reviewed and gray literature. We presented a revised draft of the CPPs to 26 NSA researchers, practitioners, and implementers at the 2022 Agriculture, Nutrition and Health Academy annual conference. We then conducted a focused review of each CPP, and 3 content experts rereviewed the final draft.

Results

We reviewed ∼475 documents and resources resulting in a set of 4 core principles: 1) following a systematic, strategic method in designing, implementing, and evaluating SBC activities; 2) ensuring design and implementation are evidence-based; 3) grounding design and implementation in theory; and 4) authentically engaging communities. Additionally, we identified 11 core practices and mapped these to the different stages in the SBC design, implementation, and evaluation cycle. Detailed descriptions, illustrative examples and resources for implementation are provided for each CPP.

Conclusions

An explicit set of CPPs for SBC can serve as a guide for design, research, implementation, and evaluation of nutrition and NSA programs; help standardize knowledge sharing and production; and contribute to improved quality of implementation. Broader consultation with SBC practitioners and researchers will further consensus on this work.

Principles, policies, and practices: Thoughts on their integration over the rise of the developmental psychopathology perspective and into the future

Developmental psychopathology has, since the late 20th century, offered an influential integrative framework for conceptualizing psychological health, distress, and dysfunction across the lifespan. Leaders in the field have periodically generated predictions about its future and have proposed ways to increase the macroparadigm's impact. In this paper, we examine, using articles sampled from each decade of the journal Development and Psychopathology's existence as a rough guide, the degree to which the themes that earlier predictions have emphasized have come to fruition and the ways in which the field might further capitalize on the strengths of this approach to advance knowledge and practice in psychology. We focus in particular on two key themes first, we explore the degree to which researchers have capitalized on the framework's capacity for principled flexibility to generate novel work that integrates neurobiological and/or social-contextual factors measured at multiple levels and offer ideas for moving this kind of work forward. Second, we discuss how extensively articles have emphasized implications for intervention or prevention and how the field might amplify the voice of developmental psychopathology in applied settings.

Undiagnosed hypertension and type 2 diabetes mellitus among Marshallese adults in the Republic of the Marshall Islands

Background

Given the lack of healthcare access in the Republic of the Marshall Island (RMI) and the potential for complications related to type 2 diabetes mellitus (T2DM) and hypertension, it is crucial to examine these conditions among Marshallese in the RMI.

Objectives

This study aims to identify the proportion of Marshallese adults in the RMI with undiagnosed T2DM and hypertension.

Design

Using a community-based participatory research approach, screening events were conducted at 20 churches in Majuro Atoll.

Methods

Participants completed a questionnaire and biometric data measures, including hemoglobin A1c and blood pressure.

Results

Among participants with blood pressure data (N = 528), 11.9% had readings indicative of hypertension, and 38.1% were undiagnosed. Among participants with hemoglobin A1c (HbA1c) data (N = 450), 45.3% had readings indicative of T2DM, and 39.2% were undiagnosed.

Conclusion

This study utilized a community-based participatory research approach that promotes equitable and ethical research. Results reaffirm the need to identify strategies for increasing healthcare access and for research to address health disparities in the RMI.

Faith-based health screenings for Marshallese adults living in the Republic of the Marshall Islands: Study design and results

Introduction

Striking health disparities exist in the Republic of the Marshall Islands (RMI). The RMI has one of the highest age-adjusted type 2 diabetes mellitus (T2DM) rates in the world (23.0%) compared to global (9.3%) and United States (US; 13.3%) rates. We conducted health screenings including clinical indicators of T2DM and hypertension among Marshallese in the RMI.

Methods

Screenings were conducted at 20 churches on Majuro Atoll. Participants completed questionnaires and biometric data collection assessing glycated hemoglobin (HbA1c), blood pressure, and body mass index.

Results

Screenings included 528 participants and showed a high prevalence of T2DM, obesity, and hypertension. One-third of participants were referred to the non-communicable disease clinic. The percent of adults in this study with T2DM-indicative HbA1c (48.5%) is higher than observed at the national level (23.0%).

Discussion

Results highlight the need for non-communicable disease-related programs in the RMI.

Associations between depression and diabetes among Latinx patients from low-income households in New Mexico

Depression and diabetes are co-occurring epidemics. This article explores the association between depression and diabetes in a cohort of Latinx patients with diabetes from low-income households. Data were gathered in Albuquerque, New Mexico (U.S.) between 2016 and 2020 as part of a patient-engaged comparative effectiveness trial comparing two culturally appropriate diabetes self-management programs-the Chronic Care Model (CCM) and the standard of care, Diabetes Self-Management Support Empowerment Model (DSMS). We proposed that the program most culturally and contextually situated in the life of the patient would have the greatest impact on diabetes self-management. Participants were enrolled as dyads-226 Latinx diabetes patient participants (PPs) from low-income households and 226 social support participants (SSPs). Data gathered at baseline, 3, 6, and 12 months included a measure of depression and A1c testing. Outcomes between programs were analyzed using longitudinal linear mixed modeling, adjusted for patient demographic characteristics and other potential confounding covariates. Patient A1c had an initial slight decrease at 3 months in both programs. At CCM, patients with a very high A1c (greater than 10%) demonstrated a clinically meaningful decrease in A1c over time. Patients at CCM experienced a large initial decrease in depression and continued to decrease throughout the study, while patients at DSMS showed a slight initial decrease through 6 months, but depression increased again by 12 months, nearly rebounding to baseline levels. A subgroup analysis revealed that a higher baseline A1c was associated with higher depression, and patients with higher A1c achieved greater reductions in depression at CCM than at DSMS. CCM scored higher on Consumer Assessment of Healthcare Providers and Systems cultural competence (CAHPS-CC). Interpretation of results suggests that the more culturally, contextually situated program, CCM, had better outcomes. This study demonstrates that culturally and contextually situating a diabetes intervention can deliver improved benefits for Latinx patients.

A patient-centered comparative effectiveness research study of culturally appropriate options for diabetes self-management

This project compared the effectiveness of two evidence-based models of culturally competent diabetes health promotion: The Diabetes Self-Management Support Empowerment Model (DSMS), and The Chronic Care Model (CCM). Our primary outcome was improvement in patient capacity for diabetes self-management as measured by the Diabetes Knowledge Questionnaire (DKQ) and the Patient Activation Measure (PAM). Our secondary outcome was patient success at diabetes self-management as measured by improvement in A1c, depression sores using the PHQ-9, and Body Mass Index (BMI). We also gathered data on the cultural competence of the program using the Consumer Assessment of Healthcare Providers and Systems Cultural Competence Set (CAHPS-CC). We compared patient outcomes in two existing sites in Albuquerque, New Mexico that serve a large population of Latino diabetes patients from low-income households. Participants were enrolled as dyads-a patient participant (n=226) and a social support participant (n=226). Outcomes over time and by program were analyzed using longitudinal linear mixed modeling, adjusted for patient participant demographic characteristics and other potential confounding covariates. Secondary outcomes were also adjusted for potential confounders. Interactions with both time and program helped to assess outcomes. This study did not find a difference between the two sites with respect to the primary outcome measures and only one of the three secondary outcomes showed differential results. The main difference between programs was that depression decreased more for CCM than for DSMS. An exploratory, subgroup analysis revealed that at CCM, patient participants with a very high A1c (>10) demonstrated a clinically meaningful decrease. However, given the higher cultural competence rating for the CCM, statistically significant improvement in depression, and the importance of social support to the patients, results suggest that a culturally and contextually situated diabetes self-management and education program design may deliver benefit for patients, especially for patients with higher A1c levels.

Sexually Transmitted Infections and Health Literacy: A Community-Based Preventive Program

BACKGROUND

Sexually transmitted infections (STIs) are a public health problem with a high risk of morbidity and community transmissibility. Evidence points to their continuous increase. This study describes the design, development, and implementation of a community-based STI prevention program for community healthcare users.

METHODS

Based on the Health Planning Process design method, a structured, community-based intervention program on STI counseling and detection was conducted in a primary health care unit in Lisbon. Two data collection instruments were applied in the diagnosis of the situation, namely the Health Literacy Survey Portugal (ILS-PT) and the STD Attitude Scale, to 47 patients who attended the health consultation on STI counseling and detection in a primary care unit in Lisbon. Two interventions were implemented, the health education session and the provision of an educational poster. In the evaluation of the project, the acceptance and satisfaction of the patients with the implemented interventions were considered as outcome indicators. A descriptive statistical analysis of the data was performed.

RESULTS

The participants shows considerably low levels of health literacy and high-risk behaviors for acquiring STIs. After an intervention, a high percentage of the participants point out the project as exciting and valuable and reveal having acquired knowledge that allowed them to improve their health. Furthermore, the patients were very satisfied with the implemented health education session and the educational poster.

CONCLUSION

This project revealed the urgent and important need to implement community intervention projects to prevent STIs and promote health literacy among the most vulnerable groups.

"The bucket of gold at the end of the rainbow": personal experiences of hope after acquired brain injury

PURPOSE

To investigate personal experiences of, and factors influencing hope following Acquired Brain Injury (ABI).

METHODS

A qualitative phenomenological approach was adopted consisting of semi-structured interviews with 15 adults with ABI. Interviews were transcribed and analysed using thematic analysis, and the Social Ecological Model (SEM) applied as a guiding framework to discuss findings and implications for policy and practice.

RESULTS

Five themes emerged: the importance of hope, changes in hope over time, the connection between hope and positivity, factors influencing hope and the importance of fostering hope. Participants reported varying experiences, with increased levels of hope influenced by: faith; supportive networks and professionals; goals; experiencing progress; having something to look forward to; and seeing others achieve. Professional attitudes were reported to either foster or negatively impact hope after brain injury.

CONCLUSIONS

These findings suggest that hope can play an important and often essential role in the lives of people with ABI. Factors influencing experiences of hope are organised against a SEM framework, identifying intrapersonal, interpersonal, institutional, community, and state and national implications for policy, professional practice and research.Implications for rehabilitationHope plays a critical role in the lives of people following acquired brain injury.Factors which positively influence hope include faith, supportive networks, goals, experiencing progress, and having something to look forward to.Professionals can impact an individual's experience of hope through person-centred and supportive therapeutic relationships.

A Study of a Culturally and Contextually Situated Multimedia Approach to Recruit a Hard-to-Reach Spanish-Speaking Population for a Randomized Control Trial (RCT)

Study designs involving randomization can be difficult to communicate to participants, especially those with low literacy. The literature on strategies to explain research concepts is limited, especially for non-English speakers. We measured the effectiveness of a culturally and contextually situated multimedia approach to recruit a cohort of 60 female Mexican immigrants (FMI) to a randomized control trial (RCT) to reduce social isolation and depression. This strategy was designed to explain the concept of randomization, explain what participating in the research study entailed, and ensure informed consent. Potential participants viewed a presentation explaining the study and a video including animation with voice-over explaining the concept of randomization. We administered a pre/post survey. Respondents (N = 59) reported an increase in their understanding of randomization, intention to enroll, and attitude towards participating in research. We conclude that a culturally and contextually situated multimedia approach is an effective model when recruiting underrepresented populations with low literacy for RCTs.

Study protocol for family model diabetes self-management education with Marshallese participants in faith-based organizations

Background

Culturally-appropriate family models of diabetes self-management education and support (DSMES) using community health workers (CHWs) have been shown to help address barriers to improving type 2 diabetes mellitus (T2DM) self-management for racial/ethnic minority communities; however, there is limited DSMES research among Marshallese and other Pacific Islanders. Using a community-based participatory research approach, we engaged community stakeholders to co-design a study to implement a culturally adapted family model DSMES (F-DSMES) intervention in faith-based organizations (FBOs) (i.e., churches).

Methods

Using a cluster-randomized controlled trial design, we will assess the effectiveness of the F-DSMES intervention for Marshallese patients with T2DM in Arkansas and Oklahoma. Twenty-four FBOs (with 12 primary participants per FBO) will be randomized to one of two study arms: the intervention arm or the wait-list control arm. Primary participants must have at least one family member willing to attend education sessions and data collection events. The F-DSMES intervention consists of ten h of diabetes education delivered by CHWs over eight to ten weeks. Data will be collected from the intervention arm at pre-intervention (baseline), immediate post-intervention (12 weeks), and three months post-intervention. The wait-list control arm will complete a second pre-intervention data collection before receiving the intervention. The primary study outcome will be glycemic control, as measured by HbA1c. Secondary measures include glucose, weight, body mass index, blood pressure, diabetes self-management behaviors, and diabetes management self-efficacy.

Conclusion

The knowledge gained from this research will inform future DSMES and other health promotion interventions conducted with Marshallese and other Pacific Islander communities.

'No test, no disease': Multilevel barriers to HIV testing among young men who have sex with men and transgender women in three semi-urban areas in Thailand

Young gay and other men who have sex with men and young transgender women in Thailand continue to be at high risk for HIV infection. We explored multilevel influences on HIV testing in order to inform the design of tailored interventions. We conducted four focus group discussions with 16-20-year-old gay men and transgender persons (n = 25) and 17 key informant interviews with healthcare providers, NGO leaders, and youth advocates. Focus groups and interviews were transcribed and reviewed using thematic analysis in Thai and English language by a bilingual team. We identified intersecting, culturally situated barriers at individual (lack of HIV knowledge, low HIV risk perception, denial), social (intersectional sexual- and HIV-related stigma, lack of family communication), institutional (inadequate and non-LGBT-inclusive sexual health education in schools, lack of youth-friendly clinics) and policy levels (parental consent requirements for HIV testing by minors). Multilevel and multisystem factors coalesce to form extensive barriers to HIV testing access and utilisation and promote disengagement from HIV prevention more broadly. Multicomponent, youth-engaged interventions informed by Thai sociocultural history and practices are needed in renewed approaches to HIV prevention and testing to end the epidemic among young gay and transgender people in Thailand.

What Are Complex Interventions in Suicide Research? Definitions, Challenges, Opportunities, and the Way Forward

It has been argued that effective action towards addressing a complex concern such as suicide requires a combination of evidence-based strategies. While these complex public health approaches have recently gained importance, little is known about their characteristics and what contributes to their complexity. The use of interchangeable terms such as multilevel, multicomponent, community based, and inconsistent definitions of these approaches creates confusion around what it is and what it is not. In practice, this disorder is reflected in a substantial variation in the design, implementation, and evaluation of complex approaches in suicide research. While it is impossible to resolve all existing inconsistencies in terminology, this review explores a range of terms and definitions to connote complex interventions. It aims to unpack multiple meanings of these terms and their diverse usage in suicide literature. The potential implications of this fluidity and plausible pathways to make sense of this complexity for suicide research are also discussed. With a shared understanding of what constitutes a complex intervention, we can expect to see an improved representation of the real-world complexities in our efforts to address suicide. This common language can also contribute toward quality implementation and dissemination and thereby advance our understanding of complex interventions.

“Many people have no idea”: a qualitative analysis of healthcare barriers among Yazidi refugees in the Midwestern United States

Background

The COVID-19 pandemic has shed new light on inequities in healthcare access faced by immigrant and refugee communities. To address ongoing disparities, there is an urgent need for ecological approaches to better understand the barriers that hinder and resources that facilitate access to healthcare. This study investigates barriers to healthcare system access faced by Yazidi refugees in the Midwestern United States.

Methods

Informed by the Interpretative Phenomenological Approach, three focus group meetings with a community advisory board were conducted between September 2019 and January 2020. The nine-member focus group included social workers, healthcare providers, and members of the Yazidi community. Meeting recordings were transcribed into English, coded for themes, and validated.

Results

We describe themes related to specific barriers to healthcare access; analyze the influence of relational dynamics in the focus group; explore experiential themes related to healthcare access in the Yazidi community, and finally interpret our findings through a social-ecological lens.

Conclusion

Community agencies, healthcare organizations, policymakers, and other stakeholders must work together to develop strategies to reduce systemic barriers to equitable care. Community representation in priority-setting and decision-making is essential to ensure relevance, acceptability, and utilization of developed strategies.

Advancing Diabetes Prevention and Control in American Indians and Alaska Natives

As with many Indigenous populations globally, American Indians and Alaska Natives (AI/ANs) experience high rates of type 2 diabetes. Prevention efforts, ongoing medical care, patient self-management education, and support to prevent and reduce the risk of long-term complications must be developed to limit the impact of diabetes on individuals, families, and communities. Diabetes prevention and control require both individual- and community-level efforts as well as policies that attempt to mitigate contributing adverse socioeconomic factors. Congressional funding since 1998 continues to address the epidemic of diabetes in AI/AN groups with the Special Diabetes Program for Indians (SDPI), which has resulted in significant outcomes and key lessons that can inform new efforts to prevent diabetes in other populations and communities. The purpose of this review is to understand the context behind the epidemic of diabetes in AI/ANs, review the impact of the SDPI on prevention and control of diabetes as well as the translation of these strategies into clinical practice and their influence on health practice, and identify lessons learned for future efforts to address this ongoing challenge for AI/AN and other communities suffering from type 2 diabetes.

Mobilizing bystanders to address microaggressions in the workplace: The case for a systems-change approach to Getting A (Collective) GRIP

Microaggressions present significant barriers to the entry and advancement of individuals from marginalized groups within the workplace. Their ubiquity, coupled with their harmful impact, creates an urgent need for organizations to mitigate them to foster truly equitable and inclusive work environments. In this paper, we present a bystander-focused approach to address this particular form of workplace bias. Informed by the empirical literature and grounded in socioecological principles, we underscore the importance of a systems-change approach to the development and implementation of any bystander program. We describe ways to incorporate social-ecological sensibilities into the substance of the training itself by outlining our "Get A (Collective) GRIP" framework. This framework emphasizes the need for active bystanders to employ an ecological scan that includes Assessing what happened, determining one's Goals for intervening, considering the Relationships among those involved in the incident (target/s, transgressor/s, and witness/es), taking into account the Institutional context in which the incident occurs, and being attuned to structural issues and Power dynamics within the context. Finding ways to address microaggressions that embody systemic analyses has transformative potential for the workplace and doing so through activating bystanders to alter local social norms is an area that has tremendous promise in this regard.

A model for sustainable, partnership-based telehealth services in rural India: An early process evaluation from Tuver village, Gujarat

Background

Telehealth can improve access to high-quality healthcare for rural populations in India. However, rural communities often have other needs, such as sanitation or employment, to benefit fully from telehealth offerings, highlighting a need for systems-level solutions. A Business of Humanity approach argues that innovative solutions to wicked problems like these require strategic decision-making that attends to a) humaneness, e.g., equity and safety and b) humankind, or the needs and potential of large and growing markets comprised of marginalized and low-income individuals. The approach is expected to improve economic performance and long-term value creation for partners, thus supporting sustainability.

Methods

A demonstration project was conducted in Tuver, a rural and tribal village in Gujarat, India. The project included seven components: a partnership that emphasized power-sharing and complementary contributions; telehealth services; health promotion; digital services; power infrastructure; water and sanitation; and agribusiness. Core partners included the academic partner, local village leadership, a local development foundation, a telehealth provider, and a design-build contractor. This early process evaluation relies on administrative data, field notes, and project documentation and was analyzed using a case study approach.

Results

Findings highlight the importance of taking a systems perspective and engaging inter-sectoral partners through alignment of values and goals. Additionally, the creation of a synergistic, health-promoting ecosystem offers potential to support telehealth services in the long-term. At the same time, engaging rural, tribal communities in the use of technological advances posed a challenge, though local staff and intermediaries were effective in bridging disconnects.

Conclusion

Overall, this early process evaluation highlights the promise and challenges of using a Business of Humanity approach for coordinated, sustainable community-level action to improve the health and well-being of marginalized communities.

Farmer Mental Health Interventions: A Systematic Review

The prevalence of mental health disorders and suicide amongst agricultural producers is a global problem. Community leaders, researchers, policymakers, and clinicians have mobilized to develop programs to address this issue. This study reviewed a wide range of mental health interventions targeting farmer mental health spanning over 50 years and examined their reported effectiveness and constraints. A total of ninety-two articles on farmer mental health were included in a final systematic review. Most articles were written concerning mental health literacy and peer and paraprofessional support interventions in the United States and Australia. Among the 56 studies reporting empirical evaluative data, 21 were mixed-method, 20 quantitative, 11 qualitative, and 5 literature synthesis. Non-experimental, self-reported, and qualitative data suggest efficacy of mental health literacy programs, peer and paraprofessional support, and community-based and agroecological interventions. However, most interventions were not subject to rigorous evaluation and only one intervention was evaluated using a control condition. The heterogeneity of existing studies and paucity of rigorous evaluation proscribes firm conclusions related to program-type efficacy. This review demonstrates that there is still a need for a stronger and broader evidence base in the field of farmer mental health interventions, which should focus on both holistic, multi-component programs and targeted approaches.

Wheel of Wellbeing (WoW) health promotion program: Australian participants report on their experiences and impacts

Background

Community-based mental health promotion programs focus on improving individual and community wellbeing by strengthening resilience and building capacity to support positive health outcomes. The Wheel of Wellbeing (WoW) is an example of such a program, promoting activities that support social engagement and positive emotions within a holistic framework underpinned by positive psychology. WoW is intended to be flexibly implemented in each community, training community members who implement behaviour change activities in their local community, workplace and educational settings.

Method

This study aimed to understand the opinions and experiences of a sample of individuals who had participated in a range of WoW training programs; documenting the impact on participant behaviours and professional practices, and how the WoW framework was subsequently employed within their communities. Using Ripple Effects Mapping evaluation processes to guide a focus group, nine WoW training participants collectively reflected on the program impacts, generating consensus themes and a mind map. Mind map qualitative data were entered into XMIND mapping software and reviewed with the focus group transcription and field notes.

Results

Thematic analysis identified three themes: increased community involvement and engagement (strengthening community connections); improved health, emotions and behaviour (motivating change to health behaviours); and flexible resources which could be utilised in a range of settings (easily incorporated in the existing organisational cultures).

Conclusions

The results of this study support the premise that the WoW framework can be an effective framework for guiding wellbeing promotion activities, with participants championing a ‘ripple effect’ across individual, family, friendship, professional and community networks.

"This was 1976 reinvented": The role of framing in the development of a South African youth movement

The literature on contemporary youth organizing has documented psychological benefits associated with participation and some evidence of local political impact. But how do local organizing campaigns transform into regional or national movements? This is a practical question facing youth organizers and one that calls for attention from researchers. In this article, we draw on 3 years of ethnographic fieldwork with South Africa's Equal Education (EE) to analyze collective action frames that enabled EE youth to assert legitimacy and construct shared aims across locales. Our findings focus on how youth constructed historical continuity frames that lent them legitimacy as upholders of the South African freedom struggle and flexible problem frames that linked young people's local struggles, such as inadequate sanitation or broken windows at their schools, to a national policy agenda. We discuss connections to other youth movements and implications for the interdisciplinary youth organizing field.

Cumulative Effects of Adding a Small Group Intervention to Social Network Testing on HIV Testing Rates Among Crack Users in San Salvador, El Salvador

The present study evaluates a combination prevention intervention for crack users in San Salvador, El Salvador that included social network HIV testing, community events and small group interventions. We examined the cumulative effects of the social network HIV testing and small group interventions on rates of HIV testing, beyond the increase that we saw with the introduction of the social network HIV testing intervention alone. HIV test data was converted into the number of daily tests and analyzed the immediate and overtime impact of small group interventions during and in the twelve weeks after the small group intervention. The addition of the small group interventions to the baseline of monthly HIV tests resulted in increased rates of testing lasting 7 days after the small group interventions suggesting a reinforcing effect of small group interventions on testing rates.

Engage for Equity: Advancing the Fields of Community-Based Participatory Research and Community-engaged Research in Community Psychology and the Social Sciences

Community Based Participatory Research (CBPR), as the most cited Community-Engaged Research (CEnR) approach in the health fields, mirrors community-psychology's long-term interest in participatory action research and community empowerment. This article introduces the Engage for Equity study, a long-term National Institutes of Health-funded inquiry to identify best partnering and collaborative practices that contribute to community capacity, empowerment and policy outcomes, and to long-term improved health and health equity. Four articles present facets of the study: psychometrics of partnering process and outcome measures, measures and outcomes of shared governance, and description of the CBPR Model as a new equity- and partnership based implementation framework; and as a tool for organizational learning and quality improvement. Finally a review of CBPR and CEnR in psychology offers recommendations for the field. Though focusing on CBPR and CEnR, Engage for Equity offers lessons for all forms of participatory action research.

Development and Feasibility of an Obesity Prevention Intervention for Black Adolescent Daughters and Their Mothers

Black female adolescents and women have disproportionately higher rates of obesity than their racial/ethnic counterparts. There is an urgent need to address obesity prevention in Black adolescent females through interventions that enhance lifestyle physical activity and improve dietary behaviors. Middle adolescence presents an important opportunity to strengthen the daughter-mother bond and improve healthy behaviors such as physical activity and dietary intake. Because of the intersection of adolescent development, culture and structural racism, it is essential to include mothers; however, this approach is understudied in the literature. This pre-pilot proof of concept study, Black Girls Move, was conducted using a 12-week pre-post within-subjects design to assess feasibility of conducting and delivering the BGM intervention, program satisfaction, and ability to obtain outcome measures in Black ninth and tenth grade daughters and their mothers. Twenty-two dyads were recruited and 14 dyads completed baseline assessments; however, only eight daughters and their mothers attended the first session and remained for the entire study. All dyads had valid objective and self-reported physical activity data. However, two of eight daughters and one mother provided self-reported dietary data that were considered invalid. All individual sessions were rated highly. Excellent attendance, retention, and satisfaction among participants suggest that we succeeded in developing an accepted, culturally relevant intervention. This lifestyle intervention would be strengthened by modifications to recruitment and retention, as well as incorporation of a computerized dietary assessment tool, a tailored dietary app for self-monitoring, and increased photo-based and group homework activities.

Evaluating the Impact of the Healthy Kids Community Challenge (HKCC) on Physical Activity of Older Youth

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

Family model diabetes self-management education and support in faith-based organizations in the republic of the Marshall Islands study protocol

BACKGROUND

Marshallese living in the Republic of the Marshall Islands (RMI) experience significant health disparities, with high rates of type 2 diabetes mellitus. In addition to health disparities, the RMI experienced nuclear testing that exposed inhabitants to nuclear fallout, unethical research practices, and contaminated natural food sources.

OBJECTIVES

This research uses a community-based participatory research (CBPR) approach to effectively engage community partners and honor their contributions in all stages of the research. A CBPR approach will leverage culturally situated knowledge and practices of the Marshallese community in the RMI to ensure the success of the research.

METHODS

This manuscript describes the methods used to test the feasibility of delivering a culturally adapted family model of diabetes self-management education and support in faith-based organizations in the RMI.

CONCLUSIONS

This manuscript describes the protocol for creating working with community partners and implementing a feasibility study in the RMI.

Multilevel and Community-Level Interventions with Native Americans: Challenges and Opportunities

Multilevel and community-level interventions that target the social determinants of health and ultimately health disparities are seldom conducted in Native American communities. To contextualize the importance of multilevel and community-level interventions, major contributors to and causes of health disparities in Native communities are highlighted. Among the many documented socioeconomic factors influencing health are poverty, low educational attainment, and lack of insurance. Well-recognized health disparities include obesity, diabetes, and hypertension. Selected challenges of implementing community-level and multilevel interventions in Native communities are summarized such as the shortage of high-quality population health data and validated measurement tools. To address the lack of multilevel and community-level interventions, the National Institutes of Health created the Intervention Research to Improve Native American Health (IRINAH) program which solicits proposals that develop, adapt, and test strategies to address these challenges and create interventions appropriate for Native populations. A discussion of the strategies that four of the IRINAH grantees are implementing underscores the importance of community-based participatory policy work, the development of new partnerships, and reconnection with cultural traditions. Based on the work of the nearly 20 IRINAH grantees, ameliorating the complex social determinants of health disparities among Native people will require (1) support for community-level and multilevel interventions that examine contemporary and historical factors that shape current conditions; (2) sustainability plans; (3) forefronting the most challenging issues; (4) financial resources and time to collaborate with tribal leaders; and (5) a solid evidence base.

A randomized control trial to test a peer support group approach for reducing social isolation and depression among female Mexican immigrants

BACKGROUND

Female Mexican Immigrants (FMIs) experience high rates of depression compared with other populations. For this population, depression is often exacerbated by social isolation associated with the experience of immigration. Aim 1. To measure whether a culturally situated peer group intervention will reduce depression and stress associated with the experience of immigration. Aim 2. To test whether an intervention using a "women's funds of knowledge" approach results in improved resilience, knowledge and empowerment. Aim 3. To investigate whether a culturally situated peer group intervention using a women's funds of knowledge approach can give participants a sense and experience of social and physical connection ("emplacement") that is lost in the process of immigration.

METHODS

This mixed-methods study will implement "Tertulias" ("conversational gatherings" in Spanish), a peer support group intervention designed to improve health outcomes for FMI participants in Albuquerque, New Mexico. We will document results of the intervention on our primary hypotheses of a decrease in depression, and increases in resilience and social support, as well as on our secondary hypotheses of decreased stress (including testing of hair cortisol as a biomarker for chronic stress), and an increase in social connectedness and positive assessment of knowledge and empowerment.

DISCUSSION

This project will address mental health disparities in an underserved population that experiences high rates of social isolation. Successful completion of this project will demonstrate that health challenges that may appear too complex and too hard to address can be using a multi-level, holistic approach. Our use of hair samples to test for the 3-month average levels of systemic cortisol will contribute to the literature on an emerging biomarker for analyzing chronic stress.

TRIAL REGISTRATION

This study was registered with ClinicalTrials.gov on 2/3/20, Identifier # NCT04254198 .

The Impact of Syrian Refugee Arrivals on Local Systems of Support in Canada

This article reports on the findings of a 10-month study designed to collaboratively explore the impact of the arrival of Syrian refugee newcomers in 2015-2016 on the way local communities support newcomers. Waterloo Region, a mid-size urban centre in Ontario, Canada, was the focus of study. The study used a mixed-method design involving four methods (document review, key informant interviews, organisational survey focus groups). Findings are presented following a systems change analytical framework that included (1) an emerging vision for local refugee support in the Waterloo Region, (2) the adaptation of local structures, (3) the emergence of collaborative processes and (4) an overall assessment of impact. Three main lessons are discussed. The first lesson demonstrates how local systems change is negotiated within a broader migration landscape (contextualizing local systems change). The second lesson acknowledges that a community's historical migration response can be a springboard for local change (initiating local systems change). The third lesson suggests that expanding and coordinating community engagement in the refugee support system is integral for lasting change (sustaining local systems change). Combined, these lessons provide a comprehensive analysis into how local communities can be adaptive in supporting refugee newcomers.

Exploring young women's menstruation-related challenges in Uttar Pradesh, India, using the socio-ecological framework

Menstruation frequently poses psychological, social, and health challenges for young women living in low- and middle-income countries. In countries such as India, where menstruation is stigmatised, it can be particularly difficult. This paper examines challenges related to menstruation for young women living in slums in Lucknow, Uttar Pradesh, India. The research was informed by the socio-ecological model. Life course interviews were conducted with 70 young women ages 15-24 living in the slums of Lucknow. Thematic analysis was used to identify salient themes regarding individual, social, and systemic challenges related to menstruation. On the individual level, young women lack knowledge about menstruation. In the social sphere, young women experience stigma around menstruation, lack opportunities to discuss menstruation, and experience limitations around mobility and other activities during menstruation. At the institutional level, for example in school, there are few resources to support menstruating young women as toilets are dirty and doors are broken. Therefore, menstruating adolescents and young women in Lucknow, Uttar Pradesh, India, face an array of challenges at multiple levels. These findings suggest that multi-level interventions are warranted to create a supportive context for menstruation.

Considering the Human-Dimension to Make Sustainable Transitions Actionable

Sustainable innovation and transitions are increasingly gaining traction within academia, industries, and policymakers. Despite the research efforts, sustaining innovation and operationalizing transitions still remains a barely explored field. The pragmatic step from understanding towards doing is often not made explicit in the literature. In fact, it results in an unclear and vague grip on how to operationalize these understandings, or differently put on how to make this understanding pragmatic. In the current article, we conducted an integrative literature review using human-centeredness lenses that informs the so-called ‘Human-Dimension’ framework. We argue that adding the Human-Dimension to the existing models for analysis, such as the Multi-Level Perspective framework, might clarify the different meanings that emerge within the network of actors in a transition, and knowing how to translate those individual meanings towards a collective construction of meaning might be enabled. To illustrate the framework’s contribution, we applied it to the context of a local sustainable development project. The results show how human-centeredness could serve as a domain to make the Human-Dimension of sustainable transitions actionable.

Scholarship for Social Change: Reflections of an Accidental Academic

In this article, I describe how I stumbled my way into an academic career doing research to promote social change toward greater equity and inclusion. I reflect on how my path has been informed by my own experiences with harassment, marginalization, and privilege. These reflections build upon the belief that we are all informed by our histories, vantage points, and social locations and that those forces shape the questions we ask, the way we ask them, how and where we look for evidence, and what we do with the results once we get them. My diverse, urban high school experience combined with my circuitous educational path did not portend great potential to become an academic. I describe experiences that expanded my awareness and opened up opportunities to grow and expand upon my role as an activist scholar. Through examples from my own work, I explore three possible functions of research that can contribute to social change: (a) NAMING, which leads to awareness, recognition, and engagement; (b) FRAMING, which expands our view beyond the moment and specific instances and leads to the identification and disruption of constraining contextual circumstances and assumptions; and (c) CATALYZING action, which builds momentum and promotes capacity for action.

"Now, I am Empowered. Now, I am a Woman With Spirit": Evaluating CARE's Public Health Work Through a Community-Organizing Framework in Sri Lanka and Bangladesh

Community-based interventions are crucial to reducing health-care disparities throughout the world. CARE, an international development nongovernmental organization (NGO), is a global leader in using a community-based approach in public health. This qualitative study sought to understand the processes through which community organizing functions to effectively facilitate change and improve health among underserved populations in three programs in Sri Lanka and Bangladesh. Sixteen in-depth interviews and two focus groups were conducted with NGO staff, partner organization staff, and community change agents. Programs are assessed through Ganz's community-organizing model, which includes (a) leadership development, (b) storytelling strategies, and (c) team building. Our findings confirm existing literature showing that public health approaches can be augmented by using community organizing to develop local engagement. Results show that program success relates to developing community members' understanding of social inequality and its impact on society. Other important strategies include systems strengthening, political engagement, coalition building, and government outreach. Empowered communities were created through recruiting, activating, and investing in community members, their stories, and their collaborative potential, at least in the sites studied here. Collectively, these programs have begun to create empowered communities among some of the most marginalized people in Sri Lanka and Bangladesh.

Lazos Hispanos: Promising Strategies and Lessons Learned in the Development of a Multisystem, Community-Based Promotoras Program

U.S. Latinos face multiple inter-related barriers to access health and social services. Researchers and practitioners have called upon community-based participatory research (CBPR) to address such challenges and health disparities, with the community health worker-or promotoras-model evidencing positive outcomes. What is less clear, however, are the promising strategies to support the development of a multisystem, community-based promotoras program. In response, the current study applied a CBPR conceptual model as an organizing framework to develop a promotora program. Lazos Hispanos (Hispanic Links) was developed to enhance the health and well-being of Latinx residing in low-income communities in the Southeastern United States. This study highlights 16 lessons learned, anchored in the first two dimensions of the CBPR conceptual model: community context and partnership development. First, the community assessment and activities leading to Lazos Hispanos took nearly 2 years but were crucial to develop a strong basis for the program. Second, the development of a multicultural and interdisciplinary research team enriched every aspect of the program and enhanced culturally responsive community engagement. Selection, training, and ongoing support of the promotoras were fundamental to program success. Particularly important were the following: receiving mentorship from a successful promotora organization; delineating mutually agreed upon roles and responsibilities; following national training standards for community health workers; and, holding monthly meetings for training, support, and data collection. The engagement of community service providers as partners was facilitated by building upon existing community relationships, signing a memorandum of understanding that specified roles and responsibilities, conducting tours of provider facilities with the promotoras, and keeping providers abreast of the program via bi-annual community gatherings. The development process showed fidelity to the conceptual model. Lazos Hispanos has proven an asset to participants, the promotoras, and service providers as the program continues to develop a community-based, health supportive infrastructure.

Participatory learning and action to address type 2 diabetes in rural Bangladesh: a qualitative process evaluation

BACKGROUND

Diabetes is 7th largest cause of death worldwide, and prevalence is increasing rapidly in low-and middle-income countries. There is an urgent need to develop and test interventions to prevent and control diabetes and develop the theory about how such interventions can be effective. We conducted a participatory learning and action (PLA) intervention with community groups in rural Bangladesh which was evaluated through a cluster randomised controlled trial. There was a large reduction in the combined prevalence of type 2 diabetes and intermediate hyperglycaemia in the PLA group compared with the control group. We present findings from qualitative process evaluation research to explore how this intervention was effective.

METHODS

We conducted group interviews and focus group discussions using photovoice with purposively sampled group attenders and non-attenders, and intervention implementers. Data were collected before the trial analysis. We used inductive content analysis to generate theory from the data.

RESULTS

The intervention increased the health literacy of individuals and communities - developing their knowledge, capacity and self-confidence to enact healthy behaviours. Community, household and individual capacity increased through social support and social networks, which then created an enabling community context, further strengthening agency and enabling community action. This increased opportunities for healthy behaviour. Community actions addressed lack of awareness about diabetes, gendered barriers to physical activity and lack of access to blood glucose testing. The interaction between the individual, household, and community contexts amplified change, and yet there was limited engagement with macro level, or 'state', barriers to healthy behaviour.

CONCLUSIONS

The participatory approach enabled groups to analyse how context affected their ability to have healthy behaviours and participants engaged with issues as a community in the ways that they felt comfortable. We suggest measuring health literacy and social networks in future interventions and recommend specific capacity strengthening to develop public accountability mechanisms and health systems strengthening to complement community-based interventions.

TRIAL REGISTRATION

Registered at ISRCTN on 30th March 2016 (Retrospectively Registered) Registration number: ISRCTN41083256 .

Western Bulldogs Sons of the West Program ripple effects: building community capacity

Professional sporting organisations can provide lifestyle-based community health improvement programs. Since 2014, the Western Bulldogs Australian Football League Club, through its Western Bulldogs Community Foundation (WBCF), has invested with community partners in the Sons of the West (SOTW) Program, a 10-week program targeted at hard-to-reach men aged ≥18 years living in Victoria's West. The SOTW Program aims to increase its participants' physical activity, social connectedness and overall health. Evaluations by the WBCF revealed the SOTW is positively contributing to improved healthier lifestyles and health of participants. Anecdotal reports revealed the SOTW was creating ripples far beyond the Program's expectations. In 2016-17, the WBCF funded the University of Melbourne to evaluate the SOTW Program ripple effects. An adapted 'Ripple Effect Mapping' approach was used, including 13 focus group discussions with 100 SOTW participants. The SOTW Program is improving men's social connections, health promoting behaviours, health literacy and creating ripple effects including: local community participation; increased volunteerism; enhanced reciprocity; and increased leadership. Community capacity-building frameworks can explain the SOTW Program ripple effects. Professional sporting organisations can provide lifestyle-based health improvement programs and empower men to contribute to building community capacity.

Collaboration with Urban Community Stakeholders: Refining Paraprofessional-led Services to Promote Positive Parenting

This paper describes the process of a community-academic partnership to navigate implementation challenges for a school-based service model led by paraprofessionals to promote positive parenting in high poverty urban communities. We describe the process by which we (a) identified implementation challenges, (b) sustained a university-community collaboration to redesign the paraprofessional service model, and (c) assessed the feasibility of the new model involving four social service agencies in 16 schools with over 600 families. The structure and process of the collaboration and refinement are described with attention to who was best positioned to engage in the collaboration and how the partnership worked to balance scientific rigor with responsiveness to paraprofessional workforce strengths. Feasibility data indicated that the revised model was successfully implemented by paraprofessional staff; 92.2% of possible staff monthly reports were completed and discussion of key goals was incorporated into 94.2% of interactions. Continual monitoring provided critical feedback from stakeholders as we drew on and interpreted these various sources of information to build and refine the service model. We suggest that these processes are critical steps to bridge the research-to-practice gap, by promoting practices that are aligned with the needs of children and families, and the staff who serve them.

Co-producing active lifestyles as whole-system-approach: theory, intervention and knowledge-to-action implications

Population health interventions tend to lack links to the emerging discourse on interactive knowledge production and exchange. This situation may limit both a better understanding of mechanisms that impact health lifestyles and the development of strategies for population level change. This paper introduces an integrated approach based on structure-agency theory in the context of 'social practice'. It investigates the mechanisms of co-production of active lifestyles by population groups, professionals, policymakers and researchers. It combines a whole system approach with an interactive knowledge-to-action strategy for developing and implementing active lifestyle interventions. A system model is outlined to describe and explain how social practices of selected groups co-produce active lifestyles. Four intervention models for promoting the co-production of active lifestyles through an interactive-knowledge-to-action approach are discussed. Examples from case studies of the German research network Capital4Health are used to illustrate, how intervention models might be operationalized in a real-world intervention. Five subprojects develop, implement and evaluate interventions across the life-course. Although subprojects differ with regard to settings and population groups involved, they all focus on the four key components of the system model. The paper contributes new strategies to address the intervention research challenge of sustainable change of inactive lifestyles. The interactive approach presented allows consideration of the specificities of settings and scientific contexts for manifold purposes. Further research remains needed on what a co-produced knowledge-to-action agenda would look like and what impact it might have for whole system change.

Intervention Reach and Sexual Risk Reduction of a Multi-level, Community-Based HIV Prevention Intervention for Crack Users in San Salvador, El Salvador

This article examines the effects of a multi-level, community-based HIV prevention intervention for crack users residing in low-income neighborhoods in San Salvador, El Salvador conducted between August 2011 and June 2016. The intervention consisted of three components introduced sequentially: (1) rapid HIV testing in community settings; (2) a social network HIV testing intervention; and (3) small group interventions with crack users who were members of the same social network. The intervention was evaluated with an interrupted time series design in which we used respondent-driven sampling to conduct 7 cross-sectional surveys with crack users along a 3-4 month period for each assessment (total n = 1597). Results revealed a significant increase in exposure to the intervention over time with 50% of the participants reporting exposure to one or more of the three components. Getting an HIV test at the community site was associated with reductions in total times each individual had sex without a condom (p < 0.05) compared to those who had been exposed to no intervention components. Being referred by another crack user through the Social Network HIV intervention was also associated with reductions in total numbers of condomless sex (p < 0.05) The cumulative effect of being exposed to more than one intervention component was associated with reductions in total number of times individuals had condomless sex (p < 0.05). In spite of the high level of intervention reach and that self-reported exposure to intervention components was associated with lower sexual risk, reductions in sexual risk over time were not observed in the full sample, indicating that the penetration of HIV prevention components was not sufficient to produce population level change.

No Easy Answers: Avoiding Potential Pitfalls of De-implementation

In 2012, the Centers for Disease Control and Prevention (CDC) began to de-emphasize and de-implement multiple evidence-based HIV prevention practices that had been around for 20 years, thus changing the scope of implementation across the globe. The authors provide evidence how existing interventions (e.g., CDC HIV interventions) may influence implementation of interventions that came after the program was discontinued. De-implementation is an ecological event that influences, and is influenced by, many parts of a system, for instance, implementation of one type of intervention may influence the implementation of other interventions (biomedical and/or behavioral) after a long-running program is discontinued. Researchers and policy makers ought to consider how de-implementation of behavioral interventions is influenced by biomedical interventions mass-produced by companies with lobbying power. The scientific study of de-implementation will be inadequate without consideration of the political climate that surrounds de-implementation of certain types of interventions and the promotion of more-profitable ones.

Ecology, Wicked Problems, and the Context of Community Interventions

The concept of ecology has, over time, become increasingly important as a frame for conducting community interventions. While multiple ecological frameworks have been proposed both within and outside public health, most have drawn on Bronfenbrenner’s work and the concern with multiple levels of the ecological context. The present article presents an ecological metaphor for community intervention developed in community psychology over the past 50 years. This perspective was specifically developed to conduct community research and intervention in the spirit of community development. The article begins with a brief discussion of social problems as “wicked problems” defying preordained and prescribed solutions. It then organizes the presentation of the ecological metaphor around five Cs that, together, provide an overview of the main points of the perspective: contextualist philosophy of science, community as a multilevel concept, culture and diversity as critical community-defining concepts, collaboration as a fundamental part of the ecology of intervention, and commitment (to community over time). Each of these five Cs adds to an appreciation of the differing aspects of the community intervention process as an ecological enterprise. Embedded in the five Cs are four ecological processes drawn from field biology that are metaphorically useful in providing a cognitive map for understanding community and assessing community impact: interdependence, cycling of resources, adaptation, and succession. Together, this ecological perspective both reflects and differs from extant perspectives in public health and, as such, is intended to contribute to furthering ecological thinking and acting more generally in community interventions.

Improving access to specialized care for first-episode psychosis: an ecological model

Psychotic spectrum disorders are serious illnesses with symptoms that significantly impact functioning and quality of life. An accumulating body of literature has demonstrated that specialized treatments that are offered early after symptom onset are disproportionately more effective in managing symptoms and improving outcomes than when these same treatments are provided later in the course of illness. Specialized, multicomponent treatment packages are of particular importance, which are comprised of services offered as soon as possible after the onset of psychosis with the goal of addressing multiple care needs within a single care setting. As specialized programs continue to develop worldwide, it is crucial to consider how to increase access to such specialized services. In the current review, we utilize an ecological model of understanding barriers to care, with emphasis on understanding how individuals with first-episode psychosis interact with and are influenced by a variety of systemic factors that impact help-seeking behaviors and engagement with treatment. Future work in this area will be important in understanding how to most effectively design and implement specialized care for individuals early in the course of a psychotic disorder.

Prevention of Underage Drinking on California Indian Reservations Using Individual- and Community-Level Approaches

OBJECTIVES

To evaluate combined individual- and community-level interventions to reduce underage drinking by American Indian/Alaska Native (AI/AN) youths on rural California Indian reservations.

METHODS

Individual-level interventions included brief motivational interviewing and psychoeducation for Tribal youths. Community-level interventions included community mobilization and awareness activities, as well as restricting alcohol sales to minors. To test effects, we compared 7 waves of California Healthy Kids Survey data (2002-2015) for 9th- and 11th-grade AI/AN and non-AI/AN students in intervention area schools with California AI/AN students outside the intervention area (n = 617, n = 33 469, and n = 976, respectively).

RESULTS

Pre- to postintervention mean past 30-day drinking frequency declined among current drinkers in the intervention group (8.4-6.3 days) relative to comparison groups. Similarly, heavy episodic drinking frequency among current drinkers declined in the intervention group (7.0-4.8 days) versus the comparison groups.

CONCLUSIONS

This study documented significant, sustained past 30-day drinking or heavy episodic drinking frequency reductions among AI/AN 9th- and 11th-grade current drinkers in rural California Indian reservation communities exposed to multilevel interventions. Public Health Implications. Multilevel community-partnered interventions can effectively reduce underage alcohol use in this population.

The Power of Academic-Practitioner Collaboration to Enhance Science and Practice Integration: Injury and Violence Prevention Case Studies

One of the most substantial challenges facing the field of injury and violence prevention is bridging the gap between scientific knowledge and its real-world application to achieve population-level impact. Much synergy is gained when academic and practice communities collaborate; however, a number of barriers prevent better integration of science and practice. This article presents 3 examples of academic-practitioner collaborations, their approaches to working together to address injury and violence issues, and emerging indications of the impact on integrating research and practice. The examples fall along the spectrum of engagement with nonacademic partners as coinvestigators and knowledge producers. They also highlight the benefits of academic-community partnerships and the engaged scholarship model under which Centers for Disease Control and Prevention-funded Injury Control Research Centers operate to address the research-to-practice and practice-to-research gap.

Evaluating Structural Change Approaches to Health Promotion: An Exploratory Scoping Review of a Decade of U.S. Progress

Structural change approaches—also known as policy and environmental changes—are becoming increasingly common in health promotion, yet our understanding of how to evaluate them is still limited. An exploratory scoping review of the literature was conducted to understand approaches and methods used to evaluate structural change interventions in health promotion and public health literature. Two analysts—along with health sciences librarian consultation—searched PubMed, Web of Science, and EMBASE for peer-reviewed U.S.-based, English language studies published between 2005 and 2016. Data were extracted on the use of evaluation frameworks, study designs, duration of evaluations, measurement levels, and measurement types. Forty-five articles were included for the review. Notably, the majority (73%) of studies did not report application of a specific evaluation framework. Studies used a wide range of designs, including process evaluations, quasi- or nonexperimental designs, and purely descriptive approaches. In addition, 15.6% of studies only measured outcomes at the individual level. Last, 60% of studies combined more than one measurement type (e.g., site observation + focus groups) to evaluate interventions. Future directions for evaluating structural change approaches to health promotion include more widespread use and reporting of evaluation frameworks, developing validated tools that measure structural change, and shifting the focus to health-directed approaches, including an expanded consideration for evaluation designs that address health inequities.