Broadening participation in community problem solving: a multidisciplinary model to support collaborative practice and research

Problem solving is embedded in context… so how do we measure it?

Problem solving encompasses the broad domain of human, goal-directed behaviors. Though we may attempt to measure problem solving using tightly controlled and decontextualized tasks, it is inextricably embedded in both reasoners' experiences and their contexts. Without situating problem solvers, problem contexts, and our own experiential partialities as researchers, we risk intertwining the research of information relevance with our own confirmatory biases about people, environments, and ourselves. We review each of these ecological facets of information relevance in problem solving, and we suggest a framework to guide its measurement. We ground this framework with concrete examples of ecologically valid, culturally relevant measurement of problem solving.

Enhancing COVID-19 Vaccine Uptake among Tribal Communities: A Case Study on Program Implementation Experiences from Jharkhand and Chhattisgarh States, India

Tribal populations in India have health care challenges marked by limited access due to geographical distance, historical isolation, cultural differences, and low social stratification, and that result in weaker health indicators compared to the general population. During the pandemic, Tribal districts consistently reported lower COVID-19 vaccination coverage than non-Tribal districts. We assessed the MOMENTUM Routine Immunization Transformation and Equity (the project) strategy, which aimed to increase access to and uptake of COVID-19 vaccines among Tribal populations in Chhattisgarh and Jharkhand using the reach, effectiveness, adoption, implementation, and maintenance framework. We designed a qualitative explanatory case study and conducted 90 focus group discussions and in-depth interviews with Tribal populations, community-based nongovernmental organizations that worked with district health authorities to implement the interventions, and other stakeholders such as government and community groups. The active involvement of community leaders, targeted counseling, community gatherings, and door-to-door visits appeared to increase vaccine awareness and assuage concerns about its safety and efficacy. Key adaptations such as conducting evening vaccine awareness activities, holding vaccine sessions at flexible times and sites, and modifying messaging for booster doses appeared to encourage vaccine uptake among Tribal populations. While we used project resources to mitigate financial and supply constraints where they arose, sustaining long-term uptake of project interventions appears dependent on continued funding and ongoing political support.

Does engagement matter? The impact of patient and community engagement on implementation of cardiovascular health materials in primary care settings

BACKGROUND

Engaging patients and community members in healthcare implementation, research and evaluation has become more popular over the past two decades. Despite the growing interest in patient engagement, there is scant evidence of its impact and importance. Boot Camp Translation (BCT) is one evidence-based method of engaging communities in research. The purpose of this report is to describe the uptake by primary care practices of cardiovascular disease prevention materials produced through four different local community engagement efforts using BCT.

METHODS

EvidenceNOW Southwest (ENSW) was a randomized trial to increase cardiovascular disease (CVD) prevention in primary care practices. Because of its study design, Four BCTs were conducted, and the materials created were made available to participating practices in the "enhanced" study arm. As a result, ENSW offered one of the first opportunities to explore the impact of the BCT method by describing the uptake by primary care practices of health messages and materials created locally using the BCT process. Analysis compared uptake of locally translated BCT products vs. all other products among practices based on geography, type of practice, and local BCT.

RESULTS

Within the enhanced arm of the study that included BCT, 69 urban and 13 rural practices participated with 9 being federally qualified community health centers, 14 hospital owned and 59 clinician owned. Sixty-three practices had 5 or fewer clinicians. Two hundred and ten separate orders for materials were placed by 43 of the 82 practices. While practices ordered a wide variety of BCT products, they were more likely to order materials developed by their local BCT.

CONCLUSIONS

In this study, patients and community members generated common and unique messages and materials for cardiovascular disease prevention relevant to their regional and community culture. Primary care practices preferred the materials created in their region. The greater uptake of locally created materials over non-local materials supports the use of patient engagement methods such as BCT to increase the implementation and delivery of guideline-based care. Yes, patient and community engagement matters.

TRIAL REGISTRATION AND IRB

Trial registration was prospectively registered on July 31, 2015 at ClinicalTrials.gov (NCT02515578, protocol identifier 15-0403). The project was approved by the Colorado Multiple Institutional Review Board and the University of New Mexico Human Research Protections Office.

Neurodiversity and cognitive load in online learning: A focus group study

It is widely accepted that cognitive load plays a crucial role in online learning. However, despite neurodevelopmental conditions being the largest category of qualifying disabilities in education, and the rise of online learning, there is little understanding of the factors impacting cognitive load in online learning for neurodivergent students and how these factors differ from those affecting neurotypical students. This study used qualitative comparison groups with neurotypical and neurodivergent students to examine their experiences of cognitive load in online learning. A sample of 26 university students (14 neurotypical and 12 neurodivergent) participated in focus group discussions. While neurodivergent students reported many similar experiences of cognitive load in online learning compared to their neurotypical peers-such as confusion in navigating the content and technical issues-some difficulties were more present for neurodivergent students-such as transcripts including mistakes and inaccessible content presentation-creating additional barriers in effectively engaging with the educational content. The results suggest that neurotypical and neurodivergent students experience similar challenges, albeit to differing degrees of intensity, and that more research is needed to explore the relationship between neurodiversity and cognitive load in online learning.

Validation of the Measurement Approaches to Partnership Success (MAPS) Questionnaire

Conceptualizing and testing factors that contribute to the success of community-academic partnerships are critical to understanding their contributions to the health and well-being of communities. Most measures to date focus on factors that contribute to the development of new partnerships, and only a few have been adequately tested and validated. Methods. The Measurement Approaches to Partnership Success (MAPS) study followed a community-based participatory research (CBPR) approach and a multiphase process that included the construction and pilot testing of a questionnaire, and a national survey to validate the psychometric properties of the questionnaire in long-standing CBPR partnerships (existing ≥ six years). All members within partnerships were recruited to complete the survey (55 partnerships with 563 partners). We used confirmatory factor analysis (CFA), Cronbach's alpha statistics, and a pairwise correlations approach to assess discriminant and convergent validity, and assessed internal consistency, and test-retest reliability. Results. All MAPS Questionnaire dimensions demonstrated strong validity and reliability and demonstrated agreement over time. Conclusion. The MAPS Questionnaire includes seven dimensions and 81 items related to the MAPS conceptual model and provides a scientific, in-depth measurement tool that allows long-standing CBPR partnerships to evaluate their work toward achieving health equity.

A scoping review of the globally available tools for assessing health research partnership outcomes and impacts

BACKGROUND

Health research partnership approaches have grown in popularity over the past decade, but the systematic evaluation of their outcomes and impacts has not kept equal pace. Identifying partnership assessment tools and key partnership characteristics is needed to advance partnerships, partnership measurement, and the assessment of their outcomes and impacts through systematic study.

OBJECTIVE

To locate and identify globally available tools for assessing the outcomes and impacts of health research partnerships.

METHODS

We searched four electronic databases (Ovid MEDLINE, Embase, CINAHL + , PsychINFO) with an a priori strategy from inception to June 2021, without limits. We screened studies independently and in duplicate, keeping only those involving a health research partnership and the development, use and/or assessment of tools to evaluate partnership outcomes and impacts. Reviewer disagreements were resolved by consensus. Study, tool and partnership characteristics, and emerging research questions, gaps and key recommendations were synthesized using descriptive statistics and thematic analysis.

RESULTS

We screened 36 027 de-duplicated citations, reviewed 2784 papers in full text, and kept 166 studies and three companion reports. Most studies originated in North America and were published in English after 2015. Most of the 205 tools we identified were questionnaires and surveys targeting researchers, patients and public/community members. While tools were comprehensive and usable, most were designed for single use and lacked validity or reliability evidence. Challenges associated with the interchange and definition of terms (i.e., outcomes, impacts, tool type) were common and may obscure partnership measurement and comparison. Very few of the tools identified in this study overlapped with tools identified by other, similar reviews. Partnership tool development, refinement and evaluation, including tool measurement and optimization, are key areas for future tools-related research.

CONCLUSION

This large scoping review identified numerous, single-use tools that require further development and testing to improve their psychometric and scientific qualities. The review also confirmed that the health partnership research domain and its measurement tools are still nascent and actively evolving. Dedicated efforts and resources are required to better understand health research partnerships, partnership optimization and partnership measurement and evaluation using valid, reliable and practical tools that meet partners' needs.

The Measurement Approaches to Partnership Success (MAPS) Questionnaire and Facilitation Guide: A Validated Measure of CBPR Partnership Success

Partnerships that effectively engage in certain key structural and process functions are more likely to meet their research goals and contribute to longer-term health equity outcomes. Ongoing evaluation of partnerships' level of achievement of these key functions, along with their fidelity to the guiding principles of community-based participatory research (CBPR), is therefore essential to understand how they can achieve desired partnership outcomes. This article describes the validated Measurement Approaches to Partnership Success (MAPS) Questionnaire and the use of an accompanying Facilitation Guide in helping members of CBPR partnerships evaluate their partnership's state of development and interpret findings to improve its structure, processes, and outcomes. We describe the conceptual framework guiding the development of the MAPS Questionnaire and its 81-item across seven key outcome dimensions, along with 28 items measuring precursor characteristics of CBPR partnership outcomes. The Facilitation Guide provides general guidelines for sharing, interpreting, and applying results within partnerships using a participatory process, definitions and items for each dimension, an example of presenting summary means, and dimension-specific reflective questions for discussion. We offer recommendations for practical uses of the MAPS Questionnaire and Facilitation Guide. Whether used as a comprehensive tool or by dimension, the MAPS Questionnaire is conceptually sound and empirically validated for evaluating how CBPR partnerships can achieve long-standing success. CBPR partnerships at any stage of development will find the MAPS Questionnaire and Facilitation Guide useful in measuring and interpreting indicators of partnership success, sharing results, and improving their ability to contribute to achieving health equity goals.

Gang Membership Among Adolescents from Distinct Racial and Ethnic Backgrounds: The Roles of Neighborhood Conditions and Victimization

Adolescent gang participation has been noted as a major public health concern. Therefore, researchers have placed a growing emphasis on identifying processes that propel adolescents toward gang membership. Previous studies have highlighted as relevant risk factors victimization experiences as well as neighborhood conditions, which reflect sociopolitical and socioeconomic disparities and precipitate social disorganization. However, research to date has not considered potential dynamic interrelations among these risk factors, which are suggested by an integrated trauma-informed developmental-ecological perspective. Additionally, given that minoritized youth are disproportionately represented in gangs and differentially exposed to many of the risk factors for gang membership, it is important to examine whether gang membership pathways are similar or distinct across racial and ethnic groups. In order to address these gaps, the present study examined longitudinal self-report data, including neighborhood conditions (Baseline), direct and witnessed victimization (12-month follow-up), and gang membership versus nonmembership (24-month follow-up) gathered from 1,284 adolescents identified as serious offenders (22% non-Hispanic White, 36% Latinx, and 43% African American) who participated in the Pathways to Desistance Study. Findings from structural equation modeling showed that pathways toward gang membership were similar across racial and ethnic groups. Results further demonstrated that neighborhood conditions increased the likelihood of adolescent gang participation through direct and witnessed victimization. These findings highlight the value of examining gang membership from an integrated trauma-informed developmental-ecological frameworks. Further, these findings emphasize the need for prevention and intervention initiatives at different levels of the social ecology.

Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 7. The empowering effect of Care Groups

BACKGROUND

While there is extensive published evidence regarding the effectiveness of the Care Group Approach in promoting community-wide health behavior change, there is no published evidence regarding its empowering effect on its participants. Our study aimed to understand if the Care Group Approach as applied in the Curamericas/Guatemala Maternal and Child Health Project in isolated rural mountainous communities in Guatemala produced evidence of empowerment among the female participants. This is the seventh of 10 papers describing the expanded Census-Based, Impact-Oriented (CBIO+) Approach in improving the health and well-being of mothers and children in the rural highlands of the Department of Huehuetenango, Guatemala.

METHODS

We conducted semi-structured individual and group interviews with 96 female Care Group participants -including Level-1 Care Group Promoters, Care Group Volunteers, and Self-Help Group participants. The participants were from six communities - two from each of the three municipalities making up the Project Area. Data were analyzed both using deductive thematic and by exploring the following social constructs: perceived social status, self-efficacy, decision-making autonomy, and formation of social capital.

RESULTS

The findings supported the hypothesis that Care Group participation was an empowering process. The primary themes that emerged included increased respect accorded to women in the community, women's willingness and ability to make decisions and their confidence in making those decisions, and the development of stronger bonds among Care Group members, with other community members, and with community leaders.

CONCLUSION

Through increased theoretical and practical knowledge about important maternal and child health matters and through the social experience of obtaining this knowledge and sharing it with other community members, participation in the Care Group Approach empowered participants to make positive health behavior changes for themselves and for their children and families. This, in turn, led many participants to become more engaged in community activities for improved health and beyond, thereby enhancing social capital in the community. We conclude that the Care Group Approach, as applied in this setting, has made it possible for marginalized indigenous women living in a male-dominated society to become more empowered.

The networked micro-decision context: a new lens on transformative urban governance

Recent large-scale societal disruptions, from the COVID-19 pandemic to intensifying wildfires and weather events, reveal the importance of transforming governance systems so they can address complex, transboundary, and rapidly evolving crises. Yet current knowledge of the decision-making dynamics that yield transformative governance remains scant. Studies typically focus on the aggregate outputs of government decisions, while overlooking their micro-level underpinnings. This is a key oversight because drivers of policy change, such as learning or competition, are prosecuted by people rather than organizations. We respond to this knowledge gap by introducing a new analytical lens for understanding policymaking, aimed at uncovering how characteristics of decision-makers and the structure of their relationships affect their likelihood of effectuating transformative policy responses. This perspective emphasizes the need for a more dynamic and relational view on urban governance in the context of transformation.

Patient-Identified Solutions to Primary Care Access Barriers in Canada: The Viewpoints of Nepalese Immigrant Community Members

BACKGROUND

Accessing healthcare for immigrants in Canada is complicated by many difficulties. With the continued and upward trend of immigration to Canada, it is crucial to identify the solutions to the barriers from the perspectives of different immigrant communities as they encounter them including the relatively smaller and less studied population groups of immigrants. As such, Nepalese immigrants in Canada are a South Asian ethnic group who have their own distinct language, culture, and socio-economic backgrounds, however, their experience with accessing healthcare in Canada is scarce in the literature.

METHODS

We conducted 12 focus group discussions with first-generation Nepalese immigrants who had experiences with primary care use in Canada. Informed consent and demographic information were obtained before each focus group discussion. The verbatim transcription of the focus groups was analyzed using thematic analysis.

RESULTS

The participants expressed a range of potential solutions to overcome the barriers, which we presented using the socio-ecological framework into 4 different levels. This includes individual-, community-, service provider-, and government/policy-levels. Individual-level actions included improving self-awareness and knowledge of health in general and navigating the healthcare system and proactively improving the language skills and assimilating into the Canadian culture. Examples of community-level actions included community events to share health information with immigrants, health literacy programs, and driving/carpooling to clinics or hospitals. Actions at the service provider level were mainly focused on enhancing communications, cultural competency training for providers, and ensuring to hire primary care workforce representing various ethnocultural backgrounds. Overall, focus group participants believed that the provincial and federal government, as appropriate, should increase support for dental and vision care support and take actions to increase the healthcare capacity, particularly by employing internationally graduated health professionals.

CONCLUSIONS

Access to primary care is essential for the health of immigrant populations in Canada. Individuals, community organizations, health service providers, and governments need to work both individually and collaboratively to improve immigrants' primary care access.

The public and patient involvement imperative in Ireland: Building on policy drivers

What can we learn from the history of Public and Patient Involvement (PPI) in healthcare and research across global jurisdictions? Depending on region and context, the terminology and heritage of involvement in research vary. In this paper, we draw on global traditions to explore dominant themes and key considerations and critiques pertaining to PPI in order to inform a PPI culture shift in Ireland. We then describe the heritage of PPI in Ireland and present the case for combining methodological imperatives with policy drivers to support and encourage meaningful involvement. Specifically, we propose that PPI can be enriched by the theory and processes of participatory health research (PHR); and that implementation requires concurrent capacity building. We conclude with a call for Irish researchers (authors of this paper included) to consider the conceptual complexities and nuances of a participatory approach to build on the policy imperatives driving PPI and to contribute to the international evidence base and research culture. Specifically, we call for Irish health researchers and funders to consider and reflect on: (1) the rich literature of PHR as a resource for enacting meaningful PPI; (2) the roots and origins of varying participatory health research methods; (3) how community/patient groups can lead health research; and (4) co-learning and partnership synergy to create space for both academic and community expertise; and (5) the importance of using standardized reporting tools.

Patient-reported experiences in primary health care access of Nepalese immigrant women in Canada

Purpose

Canada has a globally recognized universal health-care system. However, immigrants experience a number of obstacles in obtaining primary health care (PHC) that may differ within various communities due to the intersection of culture, gender and other identities. To date, no research has been done on the difficulties Nepalese immigrant women in Canada may face accessing PHC. The purpose of this study was to learn about their perceptions of barriers to PHC access and to share the findings with a wide range of stakeholders, including health-care providers and policymakers.

Design/methodology/approach

The authors conducted a community-engaged qualitative study in Calgary, Alberta, Canada. A total of six focus group discussions (FGD) among 34 participants (each FGD consisted of 5–7 participants) were conducted. The authors collected demographic information before each focus group. The FGDs were audio recorded and transcribed verbatim. The transcriptions were coded and analysed thematically.

Findings

The focus groups identified long wait times as a major barrier to receiving PHC services. Long wait times in emergency rooms, unable to see family doctors when they were sick, tedious referral procedures, long waits at the clinic even after scheduling an appointment, family responsibilities and work all impacted their access to PHC. Further, a lack of proficiency in English was another significant barrier that impeded effective communication between physicians and immigrant women patients, thus compromising the quality of care. Other barriers mentioned included lack of access to medical records for walk-in doctors, insufficient lab/diagnostic services, a lack of urgent care services and unfamiliarity with the Canadian health-care system.

Originality/value

Accessible PHC is essential for the health of immigrant populations in Canada. This study recognizes the extent of the barriers among a relatively less studied immigrant population group, Nepalese immigrant women, which will help effectively shape public policy and improve access to PHC for the versatile immigrant population fabric in Canada.

Applying network analysis to assess the development and sustainability of multi-sector coalitions

Background

Accountable Communities of Health (ACH) models have been popularized through Center for Medicare and Medicaid Innovation (CMMI) grants, including the State Innovation Model (SIM), to encourage the development of community-based coalitions across medical, public health, and social service delivery systems. These models enhance care coordination for patients and are better equipped to address Social Determinants of Health (SDH) needs.

Methods

Network data was collected from participating organizations in seven ACH sites established across Iowa. The application of network analysis quantitatively characterized the relational context of the interorganizational, cross-sector networks which are foundational to achieving the ACH goal of systematic, comprehensive care. Our analysis primarily used logistic network regression modeling (LNRM) to identify network structures and characteristics of organizations that facilitate or impede sustainable connections.

Results

Our findings suggest that the ACH was effective at stimulating sustainable connections across sectors and disparate positions of centrality in the network. Factors associated with sustainable connections between organizations included the strength of relationships and the type of collaboration, namely data sharing and resource sharing. Leadership roles designated by the ACH structure were associated with stimulating connections during the grant, but not with sustainment. Network measures of density and transitivity, which peaked during the grant period (compared to pre- and post-grant networks), further implied possible attrition of the ACH intervention effects without incentive to maintain collaborations.

Conclusions

Multi-sector care coordination networks were established, but our findings suggest depreciation of ACH intervention momentum and structure without incentive to maintain collaborations beyond the three-year duration of the grant. Sustainability could be bolstered and ACH goals actualized with reliable long-term funding.

Building local decision-making competencies during COVID-19: Accelerating the transition from learning healthcare systems to learning health communities

Introduction

The persisting and evolving COVID-19 pandemic has made apparent that no singular policy of mitigation at a regional, national or global level has achieved satisfactory and universally acceptable results. In the United States, carefully planned and executed pandemic policies have been neither effective nor popular and COVID-19 risk management decisions have been relegated to individual citizens and communities. In this paper, we argue that a more effective approach is to equip and strengthen community coalitions to become local learning health communities (LLHCs) that use data over time to make adaptive decisions that can optimize the equity and well-being in their communities.

Methods

We used data from the North Carolina (NC) county and zip code levels from May to August 2020 to demonstrate how a LLHC could use statistical process control (SPC) charts and simple statistical analysis to make local decisions about how to respond to COVID-19.

Results

We found many patterns of COVID-19 progression at the local (county and zip code) levels during the same time period within the state that were completely different from the aggregate NC state level data used for policy making.

Conclusions

Systematic approaches to learning from local data to support effective decisions have promise well beyond the current pandemic. These tools can help address other complex public health issues, and advance outcomes and equity. Building this capacity requires investment in data infrastructure and the strengthening of data competencies in community coalitions to better interpret data with limited need for advanced statistical expertise. Additional incentives that build trust, support data transparency, encourage truth-telling and promote meaningful teamwork are also critical. These must be carefully designed, contextually appropriate and multifaceted to motivate citizens to create and sustain an effective learning system that works for their communities.

Testing a digitally distributed method to recruit a network of community organizations to fight the consequences of the drug epidemic: A study in 13 American states

To mitigate the opioid epidemic, a concerted effort to educate, prevent, diagnose, treat, and engage residents is required. In this study, a digitally distributed method to form a large network of organizations was tested with 99 counties in regions with high vulnerability to hepatitis C virus (HCV). The method involved a cascade of contacts going from email to phone calls, to videoconferencing and measuring the number of contacts required, amount of time taken, and the proportion of success at recruiting at least one community organization per county. A recruitment period of 5 months and 2118 contact attempts led to the recruitment of organizations from 73 out of our 99 target counties. Organizations belonging to health departments required more attempts and time to recruit but ultimately enrolled at higher rates than did other organizations such as coalitions and agencies. Organizations from counties more (vs. less) vulnerable to HCV outbreaks required more attempts to recruit and, using multiple recruitment methods (e.g., emails, phone calls, and Zoom meetings), improved enrollment success. Overall, this method proved to be successful at remotely engaging a large-scale network of communities with different levels of risk within a large geographic region.

Relational experiences of community members participating in a rural health initiative with interprofessional students

Background. A South African faculty of health sciences created a forum for the community to voice their relational experiences with interprofessional students through visual projections. No other studies that explore such experiences using the Mmogo method could be located. Objective. To gain an understanding of the relational experiences of community members participating in Lifestyle-groups as part of a rural health initiative with interprofessional student groups. Methods. The Mmogo method is a qualitative, structured, observation technique. Participants constructed visual projections representing specific relationships. Thereafter, during a group discussion, participants explained the meaning of their projections. The visual data were analysed according to their literal presentation and subjective, symbolic meaning. A thematic analysis was used for the transcribed data. Results. Thirteen of the 24 visual projections were of a quality that allowed visual analysis; all 24 members participated in the discussions. Light was identified as an overarching theme to represent the community-student interaction. Sub-themes and categories associated with light were healthier lifestyles (knowledge sharing, lifestyle transformation, improved health outcomes), solidarity (reciprocity, collaboration, person centredness, multidimensional approach) and affirmation (gratitude and acceptance). Conclusion. Though some statements by participants related to health education as opposed to health dialogue highlighted areas requiring improvement, the findings correlated with the outcomes prescribed for students by this rural health initiative. Emotional connections in relational experiences could facilitate higher levels of self-efficacy in communities. The question is whether a stronger emphasis on health dialogue can be a catalyst for improved self-efficacy.

Defining, conceptualising and operationalising community empowerment: a scoping review protocol

INTRODUCTION

Community empowerment is a core concept in health promotion theory and practice. Several authors have defined and conceptualised the term differently. However, we did not find any synthesis of the various definitions of, and meanings attached to, community empowerment and the various conceptualisations, operationalisations, and the indicators for measuring community empowerment in the health promotion literature. The aim of this scoping review is to characterise and synthesise various definitions, conceptualisations, operationalisations and indicators for measuring community empowerment in the literature.

METHODS AND ANALYSIS

This scoping review will follow scoping review methods outlined by Arksey and O'Malley. We will identify relevant studies from 1986 onwards, written in any language, conducted anywhere in the world, and published in PubMed, PsycINFO, CINAHL, Web of Science and Medline. Two reviewers will independently screen titles, abstracts and full-text articles, after which they will carry out data extraction and analysis. We will develop a numerical and narrative synthesis of the definitions, conceptualisations, operationalisations and measurements of community empowerment in relation to health promotion and/health outcomes.

ETHICS AND DISSEMINATION

This scoping review does not require ethics approval, as we will only include information from previously conducted studies and we will not involve human participants.

Network-building by community actors to develop capacities for coproduction of health services following reforms: A case study

INTRODUCTION

Responsive, integrated and sustainable health systems require that communities take an active role in service design and delivery. Much of the current literature focuses on provider-led initiatives to gain community input, raising concerns about power imbalances inherent in invited forms of participation. This paper provides an alternate view, exploring how, in a period following reforms, community actors forge network alliances to (re)gain legitimacy and capacities to coproduce health services with system providers.

METHODS

A longitudinal case study traced the network-building efforts over 3 years of a working group formed by citizens and community actors working with seniors, minorities, recent immigrants, youth and people with disabilities. The group came together over concerns about reforms that impacted access to health services and the ability of community groups to mediate access for vulnerable community residents. Data were collected from observation of the group's meetings and activities, documents circulated within and by the group, and semi-directed interviews. The first stage of analysis used social network mapping to reveal the network development achieved by the working group; a second traced network maturation, based on actor-network theory.

RESULTS

Network mapping revealed how the working group mobilized existing links and created new links with health system actors to explore access issues. Problematization appeared as an especially important stage in network development in the context of reforms that disrupted existing collaborative relationships and introduced new structures and processes.

CONCLUSION

Network-building strategies enable community actors to enhance their capacity for coproduction. A key contribution lies in the creation of 'organizational infrastructure'.

PATIENT OR PUBLIC CONTRIBUTION

The lead researcher was embedded over 3 years in the activities of the community groups and community residents. Several group members provided comments on an initial draft of this paper. To preserve the anonymity of the group, their names do not appear in the acknowledgements section.

A Conceptual Framework for Analysing Partnership and Synergy in a Global Health Alliance: Case of the UK Public Health Rapid Support Team (UK-PHRST)

Partnerships have become increasingly important in addressing complex global health challenges, a reality exemplified by the COVID-19 pandemic and previous infectious disease epidemics. Partnerships offer opportunities to create synergistic outcomes by capitalizing on complimentary skills, knowledge and resources. Despite the importance of understanding partnership functioning, research on collaboration is sparse and fragmented, with few conceptual frameworks applied to evaluate real-life partnerships in global health. In this study, we aimed to adapt and apply the Bergan Model of Collaborative Functioning (BMCF) to analyse partnership functioning in the UK Public Health Rapid Support Team (UK-PHRST), a government–academic partnership, dedicated to outbreak response and research in low- and middle-income countries. We conducted a literature review identifying important elements to adapt the framework, followed by a qualitative case study to characterize how each element, and the dynamics between them, influenced functioning in the UK-PHRST, exploring emerging themes to further refine the framework. Elements of the BMCF that our study reinforced as important included the partnership’s mission, partner resources (skills, expertise and networks), leadership, the external environment, management systems and communication. Additional elements identified in the literature and critical to partnership functioning of the UK-PHRST included governance and financial structures adopted, trust and power balance, organizational culture, strategy and evaluation and knowledge management. Because of the way the UK-PHRST was structured, fostering team cohesion was an important indicator of synergy, alongside collaborative advantage. Dividing the funding and governance equally between organizations was considered crucial for maintaining institutional balance; however, diverse organizational cultures, weak communication practices and perceived power imbalances compromised team cohesion. Our analysis allowed us to make recommendations to improve partnership functioning at a critical time in the evolution of the UK-PHRST. The analysis approach and framework presented here can be used to evaluate and strengthen the management of global health partnerships to realize synergy.

Physical activity promotion in an urban district: Analyzing the mechanisms of interorganizational cooperation

Past research has identified the importance of cooperation among community-based organizations from different sectors to address public health problems such as insufficient physical activity. However, little is known about how and why interorganizational cooperation occurs. The present study sought to analyze the structure and emergent patterns of interorganizational cooperation within a network promoting physical activity based in an urban district neighborhood of a city in Southwestern Germany. Survey data on cooperative relations among 61 network organizations and organizational attributes (e.g., possession of sport facilities) were collected. Social network analysis was applied to examine network properties and exponential random graph models were estimated to test hypotheses concerning mechanisms and conditions of cooperative tie formation. The results show that the network of cooperation is sparse but characterized by a tendency for cooperation to occur in triangular structures. Other significant mechanisms of cooperative tie formation are preferential attachment, with the community department for education and sports being the most central network actor, and heterophily regarding the cooperation of organizations from different sectors. This study provides valid and reliable findings on conditions of network formation and significant mechanisms of interorganizational cooperation in the field of physical activity promotion. Knowledge about these mechanisms can help to manage networks effectively and efficiently and reveal potentials for improvement and intensification of interorganizational cooperation in both the present and other research areas of health promotion.

Sustaining participation in multisector health care alliances: The role of personal and stakeholder group influence

BACKGROUND

Cross-sectoral collaborative organizations (e.g., alliances, coalitions) bring together members from different industry sectors to ameliorate multifaceted problems in local communities. The ability to leverage the diverse knowledge and skills of these members is predicated on their sustained participation, which research has shown to be a significant challenge.

PURPOSE

The purpose of this study was to investigate how alliance member perceptions of decision-making influence relate to sustained participation in the alliance and its activities.

METHODOLOGY

An Internet-based survey of 638 members of 15 multistakeholder health care alliances participating in the Robert Wood Johnson Foundation's Aligning Forces for Quality program was conducted. Ordinal logistic regression path analysis was used to estimate the relationship between two types of influence (personal influence and general stakeholder influence), perceived value of alliance participation, and intentions regarding future participation.

FINDINGS

Alliance members saw less participation value when their personal influence was believed to be lower than the influence of other alliance members (b = -0.09, p < .05). This type of influence was not significantly associated with the anticipated level of future participation. In contrast, imbalances in general stakeholder group influence was not significantly associated with perceived value, but greater imbalances were associated with a decreased likelihood of future participation (OR = 0.52, 95% CI [0.32, 0.83]).

PRACTICE IMPLICATIONS

Our findings highlight the important yet complicated task of balancing perceptions of influence; leaders must keep the desired outcomes in mind when considering what type of influence to attend to.

Attitudes towards lockdown, trust in institutions, and civic engagement: A study on Sicilians during the coronavirus lockdown

Italy was the first European country to be affected by the Covid-19. To limit the contagion, an emergency protocol was triggered on March 10, 2020, which imposed a lockdown for 69 days. Many Italians considered the restrictions imposed by the government excessive and unnecessary. We hypothesized that agreement with government restrictions and compliance with imposed rules was positively correlated with trust in institutions, civic engagement, and the sense of community. To this end, during the lockdown period, we administered an online questionnaire to 189 Sicilians. The results showed that trust in institutional organizations and the attitude component of civic engagement facilitate the approval of limitations imposed during the lockdown period and the acceptance of future restrictions. Unexpectedly, the behavioral component of civic engagement leads to the rejection of restrictions and behaviors that could contain a further spread of the virus. Indeed, participants who declared that they were engaged in beneficial actions for their community disapproved of the measures already adopted and were unwilling to adopt future behaviors to limit the spread of the virus.

Measurement Approaches to Partnership Success: Theory and Methods for Measuring Success in Long-Standing Community-Based Participatory Research Partnerships

BACKGROUND

Numerous conceptual frameworks have been developed to understand how community-based participatory research (CBPR) partnerships function, and multiple measurement approaches have been designed to evaluate them. However, most measures are not validated, and have focused on new partnerships. To define and assess the meaning of success in long-standing CBPR partnerships, we are conducting a CBPR study, Measurement Approaches to Partnership Success (MAPS). In this article we describe the theoretical underpinnings and methodological approaches used.

OBJECTIVES

The objectives of this study are to 1) develop a questionnaire to evaluate success in long-standing CBPR partnerships, 2) test the psychometric qualities of the questionnaire, 3) assess the relationships between key variables and refine the questionnaire and theoretical model, and 4) develop mechanisms and a feedback tool to apply partnership evaluation findings.

METHODS

Methodological approaches have included: engaged a community-academic national Expert Panel; conducted key informant interviews with Expert Panel; conducted a scoping literature review; conducted a Delphi process with the Expert Panel; and revised the measurement instrument. Additional methods include: conduct cognitive interviews and pilot testing; revise and test final version of the questionnaire with long-standing CBPR partnerships; examine the reliability and validity; analyze the relationship among variables in the framework; revise the framework; and develop a feedback mechanism for sharing partnership evaluation results.

CONCLUSIONS

Through the application of a theoretical model and multiple methodological approaches, the MAPS study will result in a validated measurement instrument and will develop procedures for effectively feeding back evaluation findings in order to strengthen authentic partnerships to achieve health equity.

Community Engagement and Outreach Programs for Lead Prevention in Mississippi

The objective of the project was to encourage health promotion through education, outreach, and community-based training. The people attending health fairs (n = 467), community events (n = 469), and Kindergarten classes (n = 241) were the study participants. Hands-on training was offered at homebuilding retail stores (n = 25). U.S. Department of Housing and Urban Development (HUD)'s online visual training was given to realtors (n = 220), and inspectors, contractors, and Do-It-Yourself (DIY) workers (n = 75). Training workshops were attended by home-buyers and rental home owners at the Neighborhood Association Meetings (n = 91). The impact of training was evaluated by pre- and posttests. Nearly, 90% of the participants (n = 25) reported the hands-on training was useful. At posttest after the HUD online training, 59.4%, 67.9%, 65.1% of the participants (n = 220) identified soil, car batteries, and paint as sources of lead in the environment, respectively. Nearly 70% identified lead as a poison in the environment while 77.5% and 47.2% demonstrated two behaviors which help prevent lead poisoning. A total of 62.3%, 48.1%, and 58.5%, at posttest identified three complications or illnesses-behavioral, physical, and psychological, respectively. The home owners are required to get permission from the City for housing repair. In coordination with the federally funded housing repair or lead abatement programs, the trained inspectors are authorized to certify the renovation or repair works. These outreach activities were successful in improving the knowledge of the community people on lead poisoning prevention.

Jurisdictional Coordination of Integrated HIV Prevention and Patient Care Planning and Implementation

Jacksonville, Florida, provides services to persons living with the HIV. A federal call for integrated HIV prevention and treatment was published on June 19, 2015. This study unveils the principles that guided the local response to that call. Service providers have not systematically engaged in strategic planning for system improvement, the absence of which defines the boundaries and properties of the service system. Integration requires a unifying strategy as it draws leaders from their respective silos. Directed leadership, community-based participatory research, and action research provided a science-based framework for integration. Quantitatively, one-third of the planning implementation journey has elapsed, and 46% of the 75 planned activities have either reached fulfillment or are ongoing. Another one-fourth is in progress and slightly more than one-fourth (28%) are pending. Qualitatively, this study recorded 7 system-level changes. Progress to date is a harbinger of future system-level changes.

Doing What We Know, Knowing What to Do: Californians Linking Action with Science for Prevention of Breast Cancer (CLASP-BC)

Given the lack of progress in breast cancer prevention, the California Breast Cancer Research Program (CBCRP) plans to apply current scientific knowledge about breast cancer to primary prevention at the population level. This paper describes the first phase of Californians Linking Action with Science for Prevention of Breast Cancer (CLASP-BC). The foci of Phase 1 are building coalitions and coalition capacity building through community engagement in community-based participatory research (CBPR) and dissemination and implementation (D&I) research training. Based on the successful implementation and evaluation of Phase 1, the foci of Phase 2 (presented separately in this special issue) will be to translate the California Breast Cancer Prevention Plan overarching goal and specific intervention goals for 23 breast cancer risk and protective factors strategies into evidence-informed interventions (EIIs) that are disseminated and implemented across California. CLASP-BC is designed to identify, disseminate and implement high-impact, population-based prevention approaches by funding large scale EIIs, through multi-jurisdictional actions, with the intent to decrease the risk of breast cancer and other chronic diseases (sharing common risk factors), particularly among racial/ethnic minorities and medically underserved populations in California.

The Impact of Comprehensive Community Initiatives on Population-Level Child, Youth, and Family Outcomes: A Systematic Review

Comprehensive community initiatives (CCIs) represent a popular method for creating systemic change, yet there is a dearth of evidence on their effectiveness (Zaff, Pufall Jones, Donlan, Lin, & Anderson, 2016). This article presents a systematic review of the evidence on the population-level impact of CCIs, focusing specifically on documented effects from studies using an experimental or quasi-experimental design. Of 1,947 articles identified through a database and hand search, 25 articles examining six different CCIs-most of which employed prevention science frameworks-met the review inclusion criteria. The results of this review show that CCIs can strengthen protective factors and reduce risk factors, delay initiation of and reduce substance use, and reduce the likelihood of, and delay engagement in, violent and/or delinquent behaviors. Impacts have been documented as soon as one year after initial intervention, and as early as 7^th grade, with effects sustained as long as seven years post-intervention, and as late as a year post-high school. However, relative to the prevalence of CCIs as a practical intervention, the evidence base is small, potentially dated, and focused on a narrow set of outcomes and populations. Recommendations for interpreting the evidence base are discussed, including methodological limitations and implications for future work.

Changing the Focus: Viewing Design-Led Events within Collaborative Planning

Design-led planning events typically seek to involve stakeholders in collaborative decision-making about their built environment. In the literature, such events are often treated as one-off or standalone. In this paper, which draws on a survey of the experience of stakeholders involved in them, design-led events are seen in the context of, and in relation to, the collaborative planning process as a whole. Such events are portrayed as being critically affected by how they are instigated; how they are framed; how they are conducted; and, just as importantly, how they are implemented. Three separable strands of activity in collaborative planning processes are identified—design, stakeholder management, and event facilitation—along with the roles played in each of those by those responsible for initiating and then maintaining the engagement and enrolment of participating stakeholder groups in collaborative decision-making. Based on the captured experience of those who have participated in them, the value of design-led events is portrayed not as standing alone but as being crucially dependent on (a) prior decisions made long before any participants gather to engage in them and (b) subsequent decisions made long after the participants have departed. The originality of this paper lies in a desire to begin to construct an empirical base that can be employed for discussing and recommending improvements to collaborative planning processes. The three strands of activity identified by event participants—design, stakeholder management, and facilitation—may individually be relatively weak. But their contributions to collaborative planning can be strengthened by being bound tightly together into a more integrated and coherent whole.

Development of Guidelines to Improve the Effectiveness of Community Advisory Boards in Health Research

BACKGROUND

Community advisory boards (CABs) are a common community engagement strategy. Tools for developing CABs that are accessible to academic-community partnerships are limited. This article describes the process and partnership with the Hopi Tribe to develop CAB guidelines as a tool for research funded by the Center for Indigenous Environmental Health Research (CIEHR) and nonaffiliated projects.

METHODS

The CAB guidelines consist of three sections: formation, operation, and sustainability and evaluation. Each section includes best practices and interactive worksheets. The CAB guidelines were piloted with the Hopi Tribe to determine feasibility and relevance.

RESULTS

The CAB guidelines were well-received by the tribal CAB. Some of the worksheets were difficult to complete because they did not represent their perspectives or introduced potential tension in CAB interactions. Revisions were made accordingly.

CONCLUSIONS

Future evaluation and broad dissemination of the CAB guidelines will promote the use and effectiveness of CABs in health research.

Success in Long-Standing Community-Based Participatory Research (CBPR) Partnerships: A Scoping Literature Review

Background. Community-based participatory research (CBPR) is increasingly used by community and academic partners to examine health inequities and promote health equity in communities. Despite increasing numbers of CBPR partnerships, there is a lack of consensus in the field regarding what defines partnership success and how to measure factors contributing to success in long-standing CBPR partnerships. Aims. To identify indicators and measures of success in long-standing CBPR partnerships as part of a larger study whose aim is to develop and validate an instrument measuring success across CBPR partnerships. Methods. The Joanna Briggs Institute framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guided searches of three databases (PubMed, CINAHL, Scopus) for articles published between 2007 and 2017 and evaluating success in CBPR partnerships existing longer than 4 years. Results. Twenty-six articles met search criteria. We identified 3 key domains and 7 subdomains with 28 underlying indicators of success. Six partnerships developed or used instruments to measure their success; only one included reliability or validity data. Discussion. CBPR partnerships reported numerous intersecting partner, partnership, and outcome indicators important for success. These results, along with data from key informant interviews with community and academic partners and advisement from a national panel of CBPR experts, will inform development of items for an instrument measuring CBPR partnership success. Conclusion. The development of a validated instrument measuring indicators of success will allow long-standing CBPR partnerships to evaluate their work toward achieving health equity and provide a tool for newly forming CBPR partnerships aiming to achieve long-term success.

Our Healthy Clarence: A Community-Driven Wellbeing Initiative

In 2015–2016, the Clarence Valley in Northern New South Wales, Australia, experienced an unexpectedly high number of deaths by suicide, and the resulting distress was exacerbated by unhelpful press coverage. The local response was to adopt a community-wide positive mental health and wellbeing initiative. This paper describes the process and achievements of the initiative called ‘Our Healthy Clarence’. Key stakeholders were interviewed at year two and relevant documents reviewed. Data were analysed using document and thematic analysis. Our Healthy Clarence was established following community consultation, including forums, interviews, surveys and workshops. It adopted a strengths-based approach to suicide prevention, encompassing positive health promotion, primary and secondary prevention activities, advocacy, and cross-sectoral collaboration. A stakeholder group formed to develop and enact a community mental health and wellbeing plan. Factors contributing to its successful implementation included a collective commitment to mental health and wellbeing, clarity of purpose, leadership support from key local partners, a paid independent coordinator, and inclusive and transparent governance. Stakeholders reported increased community agency, collaboration, optimism and willingness to discuss mental health, suicide and help-seeking. Our Healthy Clarence draws ideas from mental health care, community development and public health. This initiative could serve as a model for other communities to address suicide, self-harm and improve wellbeing on a whole-of-community scale.

Measuring coordination between women's self-help groups and local health systems in rural India: a social network analysis

OBJECTIVES

To assess how the health coordination and emergency referral networks between women's self-help groups (SHGs) and local health systems have changed over the course of a 2-year learning phase of the Uttar Pradesh Community Mobilization Project, India.

DESIGN

A pretest, post-test programme evaluation using social network survey to analyse changes in network structure and connectivity between key individuals and groups.

SETTING

The study was conducted in 18 villages located in three districts in Uttar Pradesh, India.

INTERVENTION

To improve linkages and coordination between SHGs and government health providers by building capacity in leadership, management and community mobilisation skills of the SHG federation.

PARTICIPANTS

A purposeful sampling that met inclusion criteria. 316 respondents at baseline and 280 respondents at endline, including SHG members, village-level and block-level government health workers, and other key members of the community (traditional birth attendants, drug sellers, unqualified rural medical providers, pradhans or elected village heads, and religious leaders).

MAIN OUTCOME MEASURES

Social network analysis measured degree centrality, density and centralisation to assess changes in health services coordination networks at the village and block levels.

RESULTS

The health services coordination and emergency referral networks increased in density and the number of connections between respondents as measured by average degree centrality have increased, along with more diversity of interaction between groups. The network expanded relationships at the village and block levels, reflecting the rise of bridging social capital. The accredited social health activist, a village health worker, occupied the central position in the network, and her role expanded to sharing information and coordinating services with the SHG members.

CONCLUSIONS

The creation of new partnerships between traditionally under-represented communities and local government can serve as vehicle for building social capital that can lead to a more accountable and accessible community health delivery system.

Advancing Coalition Health Equity Capacity Using a Three-Dimensional Framework

Purpose: We examined coalition health equity capacity using a three-dimensional conceptual framework in a 3-year study (2011–2014) of 28 local coalitions engaged in health promotion.

Methods: Coalition health equity capacity was defined according to (1) conceptual foundations, (2) collective action and impact, and (3) civic orientation. This framework was used to qualitatively assess progress in capacity building efforts at two time points. Coalition materials and archival documents were analyzed qualitatively for indications of each dimension of coalition health equity capacity.

Results: The overall cohort of coalitions was initially determined to be near mid-range in conceptual foundations, above mid-range on collective impact, and below mid-range on civic orientation. As part of ongoing training and technical assistance, coalitions were offered examples of high coalition health equity capacity in each dimension. At time point two, growth in health equity capacity was observed in a majority of coalitions.

Conclusions: These findings indicate that a multidimensional approach to coalition health equity capacity can be useful for both analysis and practical purposes of community capacity building, which may, in turn, produce long-term gains in health equity.

Health in Action: Evaluation of a Participatory Grant-Making Project in East Harlem

Decision-making processes that include resident input have been shown to be effective in addressing community needs. However, few examples discuss the role of a local health department in leading a participatory decision-making process. In 2016, the New York City Department of Health and Mental Hygiene implemented a participatory grant-making process to allocate grant funds to community organizations in East Harlem. Findings from the evaluation suggest that a participatory grant-making process can be an effective way to include community member as decision makers. It can also build capacity among organizations and foster meaningful community engagement with a local health department.

A stakeholder analysis of community-led collaboration to reduce health inequity in a deprived neighbourhood in South Korea

Intersectoral collaboration amongst health and other sectors, as well as between government and non-governmental organisations, has been highlighted as a way to improve health equity. We used a mixed-methods approach to assess collaborative relationships between multiple government sectors and civil society and to suggest possible health promotion interventions and policy alternatives for the urban poor in deprived neighborhoods. A total of 18 participants involved in health promotion interventions and policy processes related to the inner-city area of Seoul were recruited using purposive sampling methods. Participants included stakeholders working for or engaging in governments (3), public health care institutions (5), social service providers (3), community-based organisations (CBOs) (4) and faith-based organisations (3). We conducted semi-structured, one-on-one interviews and then collected survey data. Quantitative data were analysed using social network analysis, and qualitative data were analysed through iterative and consensus processes. The social network analysis indicated that a CBO plays the most substantial role in sharing and controlling informational resources to promote health. A stakeholder analysis showed that the CBO neutrally and negatively viewed the possibility of collaboration with other stakeholders. Three themes related to challenges to intersectoral collaboration emerged: (1) lack of trust and communication, (2) need of a coalition with a committed leading actor for future collaboration and (3) organisational and political silos within and across public sectors. Increased understanding of the current status of and challenges to collaboration can inform the planning and implementation of complex intervening strategies and policies tailored to vulnerable people in deprived neighborhoods. Community-led collaborative actions empower people in marginalised communities to envision a healthier community.

A conceptual framework for evaluating health equity promotion within community-based participatory research partnerships

Community-based participatory research (CBPR) approaches present strong opportunities to promote health equity by improving health within low-income communities and communities of color. CBPR principles and evaluation frameworks highlight an emphasis on equitable group dynamics (e.g., shared leadership and power, participatory decision-making, two-way open communication) that promote both equitable processes within partnerships and health equity in the communities with whom they engage. The development of an evaluation framework that describes the manner in which equitable group dynamics promote intermediate and long-term equity outcomes can aid partners in assessing their ability to work together effectively and improve health equity in the broader community. CBPR principles align with health equity evaluation guidelines recently developed for Health Impact Assessments (HIAs), which emphasize meaningful engagement of communities in decision-making processes that influence their health. In this paper, we propose a synergistic framework integrating contributions from CBPR and HIA evaluation frameworks in order to guide efforts to evaluate partnership effectiveness in addressing health inequities. We suggest specific indicators that might be used to assess partnership effectiveness in addressing health equity and discuss implications for evaluation of partnership approaches to address health equity.

Urban HEART Detroit: a Tool To Better Understand and Address Health Equity Gaps in the City

The Urban Health Equity Assessment Response Tool (Urban HEART) combines statistical evidence and community knowledge to address urban health inequities. This paper describes the process of adopting and implementing this tool for Detroit, Michigan, the first city in the USA to use it. The six steps of Urban HEART were implemented by the Healthy Environments Partnership, a community-based participatory research partnership made up of community-based organizations, health service providers, and researchers based in academic institutions. Local indicators and benchmarks were identified and criteria established to prioritize a response plan. We examine how principles of CBPR influenced this process, including the development of a collaborative and equitable process that offered learning opportunities and capacity building among all partners. For the health equity matrix, 15 indicators were chosen within the Urban HEART five policy domains: physical environment and infrastructure, social and human development, economics, governance, and population health. Partners defined the criteria and ranked them for use in assessing and prioritizing health equity gaps. Subsequently, partners generated a series of potential actions for indicators prioritized in this process. Engagement of community partners contributed to benchmark selection and modification, and provided opportunities for dialog and co-learning throughout the process. Application of a CBPR approach provided a foundation for engagement of partners in the Urban HEART process of identifying health equity gaps. This approach offered multiple opportunities for discussion that shaped interpretation and development of strategies to address identified issues to achieve health equity.

Interjurisdictional Variance in US Workers' Benefits for Emergency Response Volunteers

Volunteers who are deployed during times of disaster are critical public health system assets. These individuals share concerns about a variety of subjects with public health law implications, including whether they are entitled to employment benefits before, during, and after disaster response. We examined and analyzed state employment benefit laws pertaining to emergency response volunteers. We used the Emergency Law Inventory (ELI; https://legalinventory.pitt.edu )-an informatics tool developed at the University of Pittsburgh Graduate School of Public Health that contains more than 1300 statutory and regulatory provisions affecting volunteer activities-to access certain employment laws in 60 jurisdictions. Analyses of the laws revealed that fewer than half of the jurisdictions have laws that protect seniority, vacation time, sick time, or overtime privileges. Additionally, there is tremendous variance and lack of uniformity among the jurisdictions concerning employment status requirements, geographic constraints, time limitations, and economic impacts. Major disasters often necessitate interjurisdictional response. To facilitate effective deployment of volunteers, employment laws should be uniform across the states. Furthermore, limitations that impede volunteer responders should be eliminated.

The feasibility and promise of mobile technology with community health worker reinforcement to reduce rural preterm birth

OBJECTIVES

(1) Assess feasibility of a smartphone platform intervention combined with Community Health Worker (CHW) reinforcement in rural pregnant women; (2) Obtain data on the promise of the intervention on birth outcomes, patient activation, and medical care adherence; and (3) Explore financial implications of the intervention using return on investment (ROI).

SAMPLE

A total of 98 rural pregnant women were enrolled and assigned to intervention or control groups in this two-group experimental design.

INTERVENTION

The intervention group received usual prenatal care plus a smartphone preloaded with a tailored prenatal platform with automated texting, chat function, and hyperlinks and weekly contact from the CHW. The control group received usual prenatal care and printed educational materials.

MEASUREMENTS

Demographics, health risk data, interaction with platform, medical records, hospital billing charges, Client Satisfaction Questionnaire-8, satisfaction comments, and the Patient Activation Measure.

RESULTS

A total of 77 women completed the study. The intervention was well-received, showed promise for improving birth outcomes, patient activation, and medical care adherence. Financial analysis showed a positive ROI under two scenarios.

CONCLUSIONS

Despite several practical issues, the study appears feasible. The intervention shows promise for extending prenatal care and improving birth outcomes in rural communities. Further research is needed with a larger and more at-risk population to appreciate the impact of the intervention.

Successfully Managing Diabetes in a Community Setting: Evidence From the YMCA of Greater Richmond Diabetes Control Program

Purpose The purpose of this study was to describe how a community-academic partnership developed and implemented a shared goal of evaluating the impact of a large community-based diabetes self-management program on diabetes care and mental health outcomes. Methods Data came from the YMCA of Greater Richmond Diabetes Control Program (DCP), a 12-week, group-format self-management program led by lay health coaches. Adults with type 2 diabetes (N = 312) completed baseline assessments of sociodemographic characteristics, diabetes history, and mental health. Four outcomes were assessed pre- and post-DCP on 141 participants who completed the program: hemoglobin A1C (A1C), weight, depressive symptoms (Patient Health Questionnaire-8), and glucose monitoring. The team worked with a Community Advisory Board throughout the research process. Results The DCP had wide geographic reach, including lower-income neighborhoods. The average age of the participants was 53.9 years, 71.4% were female, and 69% were African American. During the DCP, A1C declined from 8.4% to 7.6% (P < .001), but weight was unchanged (229.2 vs 227.9, P < .282). During the DCP, the proportion of participants with clinically significant depressive symptoms declined from 32.4% to 15.5% (P < .001), and frequency of glucose monitoring significantly increased. Conclusions The YMCA of Greater Richmond DCP has wide reach into underserved populations throughout the metropolitan area. This program is effective at improving diabetes self-management and mental health. Findings have implications for supporting academic-community partnerships to address diabetes disparities.

A qualitative exploration of contextual factors that influence dissemination and implementation of evidence-based chronic disease prevention across four countries

BACKGROUND

Little is known about the contextual factors affecting the uptake of evidence-based chronic disease interventions in the United States and in other countries. This study sought to better understand the contextual similarities and differences influencing the dissemination and implementation of evidence-based chronic disease prevention (EBCDP) in Australia, Brazil, China, and the United States.

METHODS

Between February and July 2015, investigators in each country conducted qualitative, semi-structured interviews (total N = 50) with chronic disease prevention practitioners, using interview guides that covered multiple domains (e.g., use of and access to EBCDP interventions, barriers and facilitators to the implementation of EBCDP interventions).

RESULTS

Practitioners across the four countries reported only a few programmatic areas in which repositories of EBCDP interventions were used within their workplace. Across countries, academic journals were the most frequently cited channels for accessing EBCDP interventions, though peers were commonly cited as the most useful. Lack of time and heavy workload were salient personal barriers among practitioners in Australia and the United States, while lack of expertise in developing and implementing EBCDP interventions was more pertinent among practitioners from Brazil and China. Practitioners in all four countries described an organizational culture that was unsupportive of EBCDP. Practitioners in Brazil, China and the United States cited an inadequate number of staff support to implement EBCDP interventions. A few practitioners in Australia and China cited lack of access to evidence. Partnerships were emphasized as key facilitators to implementing EBCDP interventions across all countries.

CONCLUSIONS

This study is novel in its cross-country qualitative exploration of multilevel constructs of EBCDP dissemination and implementation. The interviews produced rich findings about many contextual similarities and differences with EBCDP that can inform both cross-country and country-specific research and practice to address barriers and improve EBCDP implementation among the four countries long-term.

Peer Connect for African American breast cancer survivors and caregivers: a train-the-trainer approach for peer support

Racial disparities in breast cancer survivorship are a major concern nationally. How survivors cope with cancer and re-frame their lives is a critical part of survivorship. Community-academic research partnerships may facilitate access to much-needed psychosocial support for African American survivors and caregivers in rural areas, but drivers of successful intervention implementation are not well understood. The purpose of this study was to describe the training and evaluation of Community Coaches and Guides (i.e., peer supporters) using the Peer Connect program for African American breast cancer survivors and caregivers. Community engagement strategies were used to implement the training component of Peer Connect, an evidence-based program grounded in the Diffusion of Innovation Theory utilizing motivational interviewing techniques (MI) and a "train-the-trainer" model. Quantitative and qualitative methods examined implementation outcomes of feasibility, MI fidelity, and acceptability-precursor outcomes that must be achieved before examining intervention impact vis-à-vis changes in support care. Training was feasible to implement and replicable by the trained Community Coaches. Beyond feasibility and replicability, success was modest regarding MI fidelity. Benefits (e.g., serving as role models and having safe sources of support) and lessons learned (e.g., need for additional quality control) were identified as both facilitators and barriers to implementation and as factors that could impact the effectiveness of community-engaged programs to improve survivorship outcomes. Peer Connect, like other programs that employ community-engagement strategies, holds promise to meet the psychosocial support needs of diverse rural cancer survivor populations.

Learning from games: stakeholders' experiences involved in local health policy

Since public health problems are complex and the related policies need to address a wide range of sectors, cross-sectoral collaboration is beneficial. One intervention focusing on stimulating collaboration is a 'policy game'. The focus on specific problems facilitates relationships between the stakeholders and stimulates cross-sectoral policymaking. The present study explores stakeholders' learning experiences with respect to the collaboration process in public health policymaking. This was achieved via their game participation, carried out in real-life stakeholder networks in the Netherlands, Denmark and Romania. The policy game (In2Action) was developed and implemented as a 1-day role-play. The data consisted of: (i) observations and evaluation notes during the game and (ii) participant questionnaire after the game. All three countries showed similar results in learning experience during the collaboration processes in local policymaking. Specific learning experiences were related to: (i) the stakeholder network, (ii) interaction and (iii) relationships. The game also increased participant's understanding of group dynamics and need for a coordinator in policymaking. This exploratory study shows that the game provides participants with learning experiences during the collaboration process in policymaking. Experiencing what is needed to establish cross-sectoral collaboration is a first step towards enhancing knowledge exchange and more effective public health policies.

Using a Community-Engaged Research (CEnR) approach to develop and pilot a photo grid method to gain insights into early child health and development in a socio-economic disadvantaged community

PLAIN ENGLISH SUMMARY

This paper reports on the use of a Community-Engaged Research (CEnR) approach to develop a new research tool to involve members of the community in thinking about priorities for early child health and development in a deprived area of the UK. The CEnR approach involves researchers, professionals and members of the public working together during all stages of research and development.Researchers used a phased approach to the development of a Photo Grid tool including reviewing tools which could be used for community engagement, and testing the new tool based on feedback from workshops with local early years professionals and parents of young children.The Photo Grid tool is a flat square grid on which photo cards can be placed. Participants were asked to pace at the top of the grid the photos they considered most important for early child health and development, working down to the less important ones at the bottom. The findings showed that the resulting Photo Grid tool was a useful and successful method of engaging with the local community. The evidence for this is the high numbers of participants who completed a pilot study and who provided feedback on the method. By involving community members throughout the research process, it was possible to develop a method that would be acceptable to the local population, thus decreasing the likelihood of a lack of engagement. The success of the tool is therefore particularly encouraging as it engages "seldom heard voices," such as those with low literacy.

ABSTRACT

BACKGROUND

The aim of this research was to consult with professionals and parents to develop a new research toolkit (Photo Grid), to understand community assets and priorities in relation to early child health and development in Blackpool, a socio-economic disadvantaged community. A Community-Engaged Research (CEnR) approach was used to consult with community members. This paper describes the process of using a CEnR approach in developing a Photo Grid toolkit.

METHODS

A phased CEnR approach was used to design, test and pilot a Photo Grid tool. Members of the Blackpool community; parents with children aged 0-4 years, health professionals, members of the early year's workforce, and community development workers were involved in the development of the research tool at various stages. They were recruited opportunistically via a venue-based time-space sampling method. In total, 213 parents and 18 professionals engaged in the research process.

RESULTS

Using a CEnR approach allowed effective engagement with the local community and professionals, evidence by high levels of engagement throughout the development process. This approach improved the acceptability and usability of the resulting Photo Grid toolkit. Community members found the method accessible, engaging, useful, and thought provoking.

CONCLUSIONS

The Photo Grid toolkit was seen by community members as accessible, engaging, useful and thought provoking in an area of high social deprivation, complex problems, and low literacy. The Photo Grid is an adaptable tool which can be used in other areas of socio-economic disadvantage to engage with the community to understand a wide variety of complex topics.

Promotion of Civic Engagement with the Family Leadership Training Institute

In this efficacy study, both quantitative and qualitative data were used to gauge the effects of the Family Leadership Training Institute (FLTI) on civic knowledge and empowerment, civic engagement, and community health. The sample of 847 FLTI participants and 166 comparison adults completed pretest and posttest surveys. Medium to very large short-term effects were observed in civic literacy, empowerment, and engagement. Results mapping interviews were conducted with a stratified random sample of FLTI graduates (n = 52) to assess long-term (M = 2.73 years) program impact. Most FLTI graduates (86%) sustained meaningful, sometimes transformative, levels of civic engagement after program completion. This engagement involved multiple forms of leadership, most often advocacy, program implementation, and media campaigns; 63% of graduates directed at least some of their activities to marginalized populations. Content analyses of graduates' civic (capstone) projects and results mapping story maps indicated that 81-90% of community activities aligned with public health priorities. Thus, one promising means to promote community health is to empower families to develop leadership skills, become engaged in civic life, and forge connections with diverse constituents.

Citizen science for water quality monitoring: Data implications of citizen perspectives

Citizen science, where citizens play an active role in the scientific process, is increasingly used to expand the reach and scope of scientific research while also achieving engagement and educational goals. Despite the emergence of studies exploring data outcomes of citizen science, the process and experience of engaging with citizens and citizen-lead groups through participatory science is less explored. This includes how citizen perspectives alter data outcomes, a critical upshot given prevalent mistrust of citizen versus scientist data. This study uses a citizen science campaign investigating watershed impacts on water quality to interrogate the nature and implications of citizen involvement in producing scientifically and societally relevant data. Data representing scientific outcomes are presented alongside a series of vignettes that offer context regarding how, why, and where citizens engaged with the project. From these vignettes, six specific lessons are examined towards understanding how integration of citizen participation alters data outcomes relative to 'professional' science. In particular, elements of participant social identity (e.g., their motivation for participation), and contextual knowledge (e.g., of the research program itself) can shape participation and resulting data outcomes. Such scientific outcomes are particularly relevant given continued concerns regarding the quality of citizen data, which could hinder scientific acceptance of citizen sciences. Importantly, the potential for meaningful engagement with citizen and participants within citizen groups - given significant capacity within the community - represents a substantial and under-realized opportunity.