Community-based behavioral health interventions: Developing strong community partnerships

Overcoming structural violence through community-based safe-spaces: Qualitative insights from young women on oral HIV pre-exposure prophylaxis (PrEP) in Kisumu, Kenya

Biomedical and behavioral interventions have led to significant success in the prevention of HIV/AIDS. However, in rural communities, structural violence persists and continues to create barriers to the uptake and utilization of health services, especially among young women. To overcome these barriers, community-led initiatives have provided a range of interventions, including safe spaces (i.e., vetted meeting venues where girls come together to discuss issues affecting their wellbeing and access health services, such as PreP) for young women. Although these spaces provide a safe haven for at-risk girls and young women, the role of community safe spaces in overcoming structural violence remains under-explored in literature. Using the structural violence framework, this study explored how community-led safe spaces for HIV prevention programs can overcome structural forces - policies, norms, or practices - that perpetuate structural violence and prevent access to healthcare services among young girls and women in Kisumu, Kenya. We purposively recruited young women (n = 36) enrolled in the Pamoja Community-Based Organization's DREAMS program in Kisumu, Kenya. Data were collected from the 2022-2023 cohort between June and July 2023 using semi-structured, in-depth interviews (n = 20) and two focused group discussions (n = 16). Guided by thematic analysis, data were analyzed in Atlas.Ti and organized into themes. This study found that community approaches such as safe spaces are instrumental in overcoming structural violence among young women by addressing three forms of barriers - institutional, sociocultural, and economic barriers - that limit HIV support service access. Institutional barriers encompassed distance and time to health facilities and provider attitude, while sociocultural barriers included knowledge gaps, stigma, cultural norms, beliefs, and practices, limiting health service access. Lastly, the socioeconomic barriers highlighted inadequate income, financial literacy, and financial dependency. Community safe spaces are vital for decreasing vulnerability and serve as critical points for accessing services and building capacity for young women. This is particularly important in rural areas where retrogressive societal norms create obstacles to obtaining essential health services. To effectively overcome structural violence, however, government support and a suitable policy environment are essential for implementing interventions to address the underlying root causes of structural violence and sustaining community-based safe spaces.

Peer effects of health behaviors and the moderating role of Internet use among middle-aged and older adults: a nationally representative cross-sectional survey in China

Objective

This study investigates peer effects on the health behaviors of middle-aged and older adult people in China and examines the moderating role of Internet use.

Methods

A total of 16,188 respondents were selected from the China Health and Retirement Longitudinal Study (CHARLS) 2020 data set. Ordinary Least Squares and Quantile Regression were used to validate the peer effect of health behaviors on middle-aged and older adults, and a moderating effects model was used to test the moderating roles of Internet use and Internet proficiency. Finally, the peer effect was analyzed for heterogeneity according to Internet use preferences.

Results

The peer effect had a positive influence on the individual health behaviors of middle-aged and older adult people in China (β = 0.5341, p < 0.001). Middle-aged and older adult people were more sensitive to the average health behavior level of the community when they lived in rural communities and/or had a low level of education. Internet use positively moderated the health behavior peer effect in the older adult population (β = 0.0094, p < 0.1), and Internet proficiency negatively moderated the peer effect of the health behaviors of the middle-aged population (β = 0.1589, p < 0.1). According to the magnitude of the influence of peer effect, the Internet preference type can be ranked from social and entertainment (β = 0.6250, p < 0.01), to cultural and entertainment (β = 0.5835, p < 0.01), to comprehensive (β = 0.4622, p < 0.01).

Conclusion

There is a peer effect on the health behaviors of middle-aged and old-aged individuals, in which Internet use plays a moderating role. The construction of healthy communities should be promoted, giving full play to the community's active role in health promotion. Attention should be paid to the health-enabling function of the Internet, encouraging middle-aged and older adult people to use the Internet actively, moderately, and diversely, and making full use of the advantages of short videos for online health education.

A systematic review of rural community-based mental health interventions in the United States

BACKGROUND

Mental health impacts a person's quality of life and ability to engage in healthy behaviors. Rural communities in the United States have limited access to mental and behavioral health treatment.

AIM

To conduct a systematic review to identify existing rural community-based mental health interventions and identify commonalities and differences by extracting study attributes and intervention components.

METHODS

March 2022 CINAHL, EMBASE, PsycInfo, Scopus, and Academic Search Complete were searched for studies that met the inclusion criteria of rural, community-based mental health interventions in the United States.

RESULTS

Ten publications satisfied the criteria for this review. The most common intervention components identified were peer interaction, developed coping skills, and activity-based interventions.

CONCLUSION

While this review excluded a meta-analysis, it did illuminate the components of existing community-based mental health interventions and highlighted gaps in the current research. Our findings suggest that future community-based mental health interventions would benefit from the inclusion of peer interaction, coping skills development, activity-based, cultural & historical context, service referral, and spirituality.

Building capacity to create community change (BC4): A model to support successful program planning and implementation

Community-based interventions (CBIs) are increasingly used to address health problems and are usually implemented by organizations outside and/or inside the community. CBIs are complex and organizations need to have, or be able to build the capacity needed to implement CBIs effectively. The importance of organizational capacity building is well established in the literature, but less attention is focused on how to build capacity, particularly for prevention-focused and mental health CBIs. As part of the longitudinal process evaluation of a national initiative to promote the mental health and wellbeing of men and boys in the United States, this study developed a capacity-building model to identify areas and associated factors that were integral to grantee organizations' ability to build capacity to create change in their communities. The findings identified five domains used to comprise the Building Capacity to Create Community Change model, which contributed to organizational capacity building and as a result, implementation progress: Administrative Support, Leadership, Vision and Mission, Partnership Development, and Community Engagement. Strength in each domain increased grantees' capacity to impact the lives of participants and progress towards the goal of creating community change.

The Role of Anti-Racist Community-Partnered Praxis in Implementing Restorative Circles Within Marginalized Communities in Southern California During the COVID-19 Pandemic

The COVID-19 pandemic has exacerbated the adverse influence of structural racism and discrimination experienced by historically marginalized communities (e.g., Black, Latino/a/x, Indigenous, and transgender people). Structural racism contributes to trauma-induced health behaviors, increasing exposure to COVID-19 and restricting access to testing and vaccination. This intersection of multiple disadvantages has a negative impact on the mental health of these communities, and interventions addressing collective healing are needed in general and in the context of the COVID-19 pandemic. The Share, Trust, Organize, and Partner COVID-19 California Alliance (STOP COVID-19 CA), a statewide collaborative of 11 universities and 75 community partners, includes several workgroups to address gaps in COVID-19 information, vaccine trial participation, and access. One of these workgroups, the Vaccine Hesitancy Workgroup, adopted an anti-racist community-partnered praxis to implement restorative circles in historically marginalized communities to facilitate collective healing due to structural racism and the COVID-19 pandemic. The project resulted in the development of a multilevel pre-intervention restorative process to build or strengthen community-institutional partnerships when procurement of funds has been sought prior to community partnership. This article discusses this workgroup's role in advancing health justice by providing a community-based mental health intervention to marginalized communities in Southern California while using an antiracist praxis tool to develop a successful community-institutional partnership and to live up to the vision of community-based participatory research.

Promoting hope in minoritized and economically disadvantaged students

Minoritized and economically disadvantaged (MED) students encounter a host of detrimental factors within the academic setting (e.g., racism, classism, low expectations). In order for them to be successful, ways must be found to help them achieve academically despite their disadvantageous academic environments. Recent research indicates that hope theory might provide a pathway for MED students to have a higher chance at success. In this review, how hope has the potential to take on a special significance for MED students as well as how it can be leveraged to increase their odd of academic and life success is discussed. In addition, recent research centered around promoting hope in MED students, both formally and informally, is reviewed. Altogether, this review has implications for cultivating hope in schools.

Interventions to enhance testing and linkage to treatment for hepatitis C infection for people who inject drugs: A systematic review and meta-analysis

BACKGROUND

With the advent of direct acting antiviral (DAA) therapies for the treatment of hepatitis C virus (HCV), the World Health Organization recommended a goal to eliminate HCV as a public health threat globally by 2030. With the majority of new and existing infections in high income countries occurring among people who inject drugs, achieving this goal will require the design and implementation of interventions which address the unique barriers to HCV care faced by this population.

METHODS

In this systematic review and meta-analysis, we searched bibliographic databases and conference abstracts to July 21, 2020 for studies assessing interventions to improve the following study outcomes: HCV antibody testing, HCV RNA testing, linkage to care, and treatment initiation. We included both randomised and non-randomised studies which included a comparator arm. We excluded studies which enrolled only paediatric populations (<18 years old) and studies where the intervention was conducted in a different healthcare setting than the control or comparator. This analysis was restricted to studies conducted among people who inject drugs. Data were extracted from the identified records and meta-analysis was used to pool the effect of interventions on study outcomes. This study was registered in PROSPERO (CRD42020178035).

FINDINGS

Of 15,342 unique records, 45 studies described the implementation of an intervention to improve HCV testing, linkage to care and treatment initiation among people who inject drugs. These included 27 randomised trials and 18 non-randomised studies with the risk of bias rated as "critical" for most non-randomised studies. Patient education and patient navigation to address patient-level barriers to HCV care were shown to improve antibody testing uptake and linkage to HCV care respectively although patient education did not improve antibody testing when restricted to randomised studies. Provider care coordination to address provider level barriers to HCV care was effective at improving antibody testing uptake. Three different interventions to address systems-level barriers to HCV care were effective across different stages of HCV care: point-of-care antibody testing (linkage to care); dried blood-spot testing (antibody testing uptake); and integrated care (linkage to care and treatment initiation).

INTERPRETATION

Multiple interventions are available that can address the barriers to HCV care for people who inject drugs at the patient-, provider-, and systems-level. The design of models of care to improve HCV testing and treatment among people who inject drugs must consider the unique barriers to care that this population faces. Further research, including high-quality randomised controlled trials, are needed to robustly assess the impact these interventions can have in varied populations and settings.

A “random group of misfits” or being “part of something bigger”? Exploring experiences of attending a non-religious congregation

Purpose

Religion is an important part of many people’s lives and there is some evidence that attending church or other religious congregations is positively associated with psychological well-being. However, religious participation is declining in Western Europe and North America. Sunday Assembly is a non-religious gathering that intends to provide a similar communal experience and a sense of spirituality to the church, but without the religious element. In the current study, we aimed to explore the experiences of and motivations for attending a non-religious congregation in relation to well-being.

Methods

A qualitative approach was taken, gathering data through semi-structured interviews with participants from Sunday Assembly congregations across England.

Results

Thematic analysis was used and three key themes were found: (1) searching for meaning and community, (2) Sunday Assembly as protective of mental health, and (3) loneliness in a crowd.

Conclusions

Sunday Assembly can provide a sense of belonging and improvement in mental health through shared experience and spirituality, and it can act as a coping mechanism during difficult times. Further research could explore the benefits of Sunday Assembly upon attendee’s mental health, test the effectiveness of Sunday Assembly as a coping mechanism, and whether continued attendance improves mood over time.

Community resilience and psychological distress in Chinese older adults amid COVID-19: the roles of perceived community prevention effectiveness and risk perception

Objectives: The COVID-19 pandemic is sweeping the world, bringing a disaster for not only public physical but also mental health. As older adults are more vulnerable than those in other age groups in this disaster, their psychological distress in this pandemic is of particular concern. Considering the importance of communities in combating the pandemic, we examined the role of a community in relieving older adults' psychological distress and the heterogeneous effect by older adults' different levels of risk perception.Method: We collected data through a questionnaire survey of 272 older adults in 12 communities in the Sichuan province of China in April 2020, and used the structural equation model to analyze the data.Results: we found that community resilience was negatively associated with older adults' psychological distress (depression, anxiety, stress), and this association was mediated by perceived community prevention effectiveness. However, this indirect effect was stronger for older adults with low risk perceptions than for ones with high risk perceptions (including self-risk perception and group-risk perception).Conclusion: These findings underlined a community's vital significance in alleviating older adults' psychological distress amid the COVID-19 pandemic and moreover indicated that tailored interventions for facilitating community pandemic prevention should be designed for older adults with different risk perceptions.

Initial conditions and functioning over time among community coalitions

Developing operationally strong community coalitions is critical to actualizing their potential for public health improvement. The purpose of this study was to measure how substance use prevention coalitions in Mexico functioned across their first 1.5 years, and to test associations between initial community contextual factors and subsequent coalition functioning and outcomes. Members of 19 coalitions participated in three waves of surveys about coalition context and functioning. We used paired t-tests to assess changes in coalition functioning and outcomes. Regression models estimated associations between coalition functioning and outcomes and initial community context. Among coalition functioning factors, over coalitions' first 1.5 years, member engagement increased, as did coordinator skill and participatory leadership style. Two initial community context factors - community support for prevention and community champions - predicted several measures of process competence, but only community champions predicted perceived community improvement. Thus, community champions may play a pivotal role in later coalition success. The observed increases in member engagement and process competence may support subsequent coalition sustainability, a crucial component to realizing their potential impact on public health.

The Urban Youth Trauma Center: A Trauma-Informed Continuum for Addressing Community Violence Among Youth

Contemporary community violence has escalated into a national public health crisis with urban youth, particularly ethnic minorities, suffering disproportionate negative impacts. The Urban Youth Trauma Center (UYTC) promotes a trauma-informed continuum of prevention-to-intervention services that combines community-based and clinic-based manualized protocols designed to reduce and prevent community violence for youth and families. Based on a socio-ecological model, UYTC has the main goals of addressing community violence and related traumatic stress as well as co-occurring conditions of substance abuse and disruptive behavior problems in urban youth by: (1) raising public awareness; (2) disseminating specialized trauma-informed training; and (3) mobilizing service system coalitions. UYTC employs this evidence-based yet flexible structure for disseminating, implementing, and evaluating trauma-informed training as a means of contributing to the reduction and prevention of community violence for low-income urban minority youth and families who bear the biggest burden of this current crisis.

Marine Online Platforms of Services to Public End-Users—The Innovation of the ODYSSEA Project

Recently, various Earth Observation Networks (EONs) have been designed, developed and launched by in-situ, on-site and off-site collected data from fixed and moving marine sensors and remote sensing (RS) satellite data. This information can significantly help a wide range of public and private end-users better understand the medium- and high-resolution numerical models for regional, national and global coverage. In this context, such EON core services’ operational numerical data can be seen of the growing demand result for marine sustainability development of developing countries and the European Union (EU). In this case, marine platforms can offer a wide range of benefits to users of human communities in the same environment using meticulous analyses. Furthermore, marine platforms can contribute to a deeper discourse on the ocean, given the required regulations, technical and legal considerations and users to a common typology using clear scientific terminology. In this regard, firstly, the following six steps have been used to develop a better understanding of the essential data structure that is commensurate with the efficiency of the marine end-user’s service: (1) steps and challenges of collecting data, (2) stakeholder engagement to identify, detect and assess the specific needs of end-users, (3) design, develop and launch the products offered to meet the specific needs of users, (4) achieve sustainable development in the continuous provision of these products to end-users, (5) identify future needs and challenges, and (6) online platform architecture style related to providing these products to end-users. Secondly, the innovation of the ODYSSEA (Operating a Network of Integrated Observatory Systems in the Mediterranean Sea) platform project has been evaluated and reviewed as a successful project on marine online platforms to better understand how marine online platforms are being used, designed, developed and launched. The ODYSSEA platform provides a system that bridges the gap between operational oceanographic capabilities and the need for information on marine conditions, including for the end-user community. The project aims to develop a fully integrated and cost-effective cross-platform, multi-platform network of observation and forecasting systems across the Mediterranean Sea.

Exploring How Public Health Partnerships with Community-Based Organizations (CBOs) can be Leveraged for Health Promotion and Community Health

The Academic Public Health Corps (APHC) works to support local public health in Massachusetts through varying models of collaboration. In the setting of the COVID-19 pandemic, one initiative of the APHC has been to partner with community-based organizations (CBOs) to address vaccine hesitancy and improve overall community health. The purpose of this article is to share how the APHC partnered with CBOs in Massachusetts to address COVID-19 concerns within their respective communities, and present strategies to empower communities, share resources, and increase health promotion. The APHC partnered with 2 CBOs who received the Massachusetts COVID-19 Community Grants distributed by Health Resources in Action (HRiA). These CBOs include the Association of Islamic Charitable Projects Massachusetts (AICP) and the Somali Parents Advocacy Center for Education (SPACE). Culturally relevant educational and promotional materials were created and tailored toward the communities of interest within the CBOs. Additionally, in response to the community's desire for more informational events, the APHC hosted a virtual COVID-19 Q&A panel with Muslim health care professionals that included live Arabic translation. The model of outreach that the APHC has employed illustrates an intentional way of addressing key public health issues within local communities. The success of these partnerships highlights the importance of including CBOs in conversations about public health and health equity.

CCOUC Ethnic Minority Health Project: A Case Study for Health EDRM Initiatives to Improve Disaster Preparedness in a Rural Chinese Population

Disasters disproportionately impact poor and marginalised populations due to greater vulnerability induced by various risk determinants, such as compromised living conditions, language barriers, and limited resources for disaster risk management. Health Emergency and Disaster Risk Management (Health EDRM) emphasises a people- and community-centred approach for building stronger capacities in communities and countries since community members are often the first responders to health emergencies and should be central to effective risk management. A key action for promoting community disaster preparedness is the provision of Health EDRM education interventions. The Ethnic Minority Health Project (EHMP) has provided community-based Health EDRM education interventions in 16 ethnic minority-based villages in remote areas of China since 2009. It aims to enhance community disaster preparedness and resilience by improving health-risk literacy and self-help capacity at the individual and household levels. This case study outlines the first EHMP project in an ethnic minority-based community (Ma’an Qiao Village) in Sichuan Province, China. It highlights the key elements for planning and managing such a project and is a good demonstration of an effective Health EDRM workforce development project in rural communities. This report concludes with five recommendations for setting up a sustainable and effective Health EDRM education intervention in similar contexts.

Health Workforce Development in Health Emergency and Disaster Risk Management: The Need for Evidence-Based Recommendations

The Sendai Framework for Disaster Risk Reduction 2015–2030 placed human health at the centre of disaster risk reduction, calling for the global community to enhance local and national health emergency and disaster risk management (Health EDRM). The Health EDRM Framework, published in 2019, describes the functions required for comprehensive disaster risk management across prevention, preparedness, readiness, response, and recovery to improve the resilience and health security of communities, countries, and health systems. Evidence-based Health EDRM workforce development is vital. However, there are still significant gaps in the evidence identifying common competencies for training and education programmes, and the clarification of strategies for workforce retention, motivation, deployment, and coordination. Initiated in June 2020, this project includes literature reviews, case studies, and an expert consensus (modified Delphi) study. Literature reviews in English, Japanese, and Chinese aim to identify research gaps and explore core competencies for Health EDRM workforce training. Thirteen Health EDRM related case studies from six WHO regions will illustrate best practices (and pitfalls) and inform the consensus study. Consensus will be sought from global experts in emergency and disaster medicine, nursing, public health and related disciplines. Recommendations for developing effective health workforce strategies for low- and middle-income countries and high-income countries will then be disseminated.

Leadership that promotes successful implementation of community-based mental health interventions

Community-based interventions (CBIs) have become an effective approach to promote mental well-being. To increase organizational capacity and effectively deliver CBIs, leadership is crucial. The current study aims to identify leadership qualities that are facilitators of CBI implementation. This paper presents evaluation findings from a national effort emphasizing CBIs for improving the mental well-being of men and boys in 16 local communities. The study utilized a mixed-method design, including both examining each grantee as a case study and conducting a cross-site evaluation. Findings revealed five leadership qualities that contributed to CBIs' success: personal vision, value-based leadership, relationship-oriented leadership, task-oriented leadership, and leadership development. The results outline strategies for strengthening organizational capacity through these leadership qualities. This study adds to the limited literature on leadership qualities that strengthen organizational capacity to successfully implement CBIs and can serve as a guide for funders, program planners, and evaluators.

Quality of collaboration within health promotion partnerships: Impact on sense of community, empowerment, and perceived projects' outcomes

Community coalitions or intersectoral partnerships have long been advocated for the promotion of population health. In the present study, we assessed the quality of the functioning of health promotion partnerships created within a large community health promotion program implemented by the Emilia-Romagna region located in the north-east of Italy (2014-2016). In particular, we aimed to test the effectiveness of partnership working in strengthening participants' empowerment, sense of community and ultimately, the outcomes of a well-functioning partnership, conceptualized as including perceived effectiveness of health promotion interventions developed by the partnership, trust in their implementation and personal commitment in health promotion in the future. Participants were 238 stakeholders (e.g., health professionals, representatives of local administrations, teachers, representative of community and volunteer organizations, and citizens) formally included in six partnerships lead by six major local health services. Using Bayesian structural equation modeling, we found that a higher perceived quality of collaboration within the partnership enhances the outcomes of a well-functioning partnership, by strengthening their sense of a health-promoting community and empowerment. Sense of community responsibility did not predict future commitment in health promotion. The study findings suggest that community members' ownership and feeling of responsibility, as well as empowerment constitute positive partnership processes.

Community Empowerment and Community Partnerships in Nursing Decision-Making

Community empowerment has been studied as a process and result phenomenon throughout the last 40 years. Community partnership, which has been studied during the last 20 years, has been identified as a key process to promote intervention and research within communities. In this paper, we introduce the relation between these two concepts, from the research that is being developed at the Centre for Interdisciplinary Health Research (CIIS) in Universidade Católica Portuguesa. We comment on the available evidence regarding community partnership and community empowerment within the Nursing Decision-Making process. There is a particular focus on Community Health Nursing Specialists (CHNS) and the aim to promote the identification of CHNS as potential community partnership developers within society. It is also important to analyze how community partnership processes are intentionally integrated as a nursing intervention within the nursing process. This analysis should occur from the nursing diagnosis to the evaluation of health gains in communities sensitive to CHNS care in a Nursing Theoretical Model developed from a Nursing PhD process—the Community Assessment, Intervention, and Empowerment Model.