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Shelton RC, Hailemariam M, Iwelunmor J. Making the connection between health equity and sustainability. Front Public Health 2023; 11:1226175. [PMID: 37822544 PMCID: PMC10562623 DOI: 10.3389/fpubh.2023.1226175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 09/05/2023] [Indexed: 10/13/2023] Open
Abstract
Sustainability and health inequities are key challenges in public health and healthcare. Research suggests that only about half of evidence-based interventions (EBIs) are sustained over time, and settings and populations experiencing systemic and structural barriers to health (e.g., poverty, racism, stigma, and discrimination) experience even greater challenges to sustainability. In this article, we argue that an enhanced focus on sustainability in the field of implementation science is critical in order to maximize the long-term health benefits and broader societal impacts of EBIs for all populations and settings. From an equity perspective, a focus on sustainability is particularly critical to prioritize among population sub-groups that have not historically received the benefits of health-related EBIs. We discuss how a health equity framing is essential to sustaining EBIs in under-resourced communities, and requires moving away from a deficit mindset that focuses on why EBIs are challenging to sustain, to one that focuses more on identifying and nurturing existing assets within individuals and communities to increase the likelihood that EBIs are sustained. We conclude with a discussion of future directions as well as recommendations and resources (e.g., frameworks, tools) to advance and make progress toward sustainability from a health equity mindset, including: (1) Actively planning early for sustainability alongside key partners; (2) Tracking progress toward enhancing sustainability and being accountable in doing so equitably for all settings and populations; and (3) Focusing on both equity and engagement early and often throughout the research process and all implementation phases.
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Affiliation(s)
- Rachel C. Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Maji Hailemariam
- C. S. Mott Department of Public Health and Department of OBGYN and Reproductive Biology, Michigan State University, Flint, MI, United States
| | - Juliet Iwelunmor
- Behavioral Science and Health Education, College for Public Health and Social Justice, St. Louis University, St. Louis, MO, United States
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Adeyemi O, Phorbee O, Samuel F, Sanusi R, Afolabi W, Covic N, Onabolu A, Ajieroh V. Training to Build Nutrition Capacity in the Nigerian Agricultural Sector: Initial Assessment and Future Directions. Food Nutr Bull 2023; 44:S85-S91. [PMID: 36127833 DOI: 10.1177/03795721221123870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In response to calls to increase nutrition-sensitive agriculture (NSA), the Federal Ministry of Agriculture and Rural Development developed the Nigeria Agricultural Sector Food Security and Nutrition Strategy 2016-2025 (AFSNS). Capacity development activities to facilitate the AFSNS implementation subsequently commenced. OBJECTIVE This study analyzed the processes and outputs of initial capacity development efforts, examined findings from the analysis using existing literature, and identified critical next steps for nutrition capacity development in the Nigerian agriculture sector. METHODS The study reviewed documents including a proposal for nutrition training of agriculture sector actors, reports of meetings held among 6 resource persons who designed and/or delivered training, training reports, participants' pre- and posttraining assessments, and participants' training evaluation. Interviews were conducted with 2 resource persons involved in training design and delivery. Documents and interviews were coded and analyzed to identify emergent themes. Participants' pre- and posttests results were compared using paired t test in Stata 12.0. RESULTS Knowledge and practice gaps were more extensive than had been anticipated. Training had some but limited effects on knowledge scores at the federal level. Modules addressing implementation practices had to be scaled down for participants to keep up with the learning pace. Existing literature indicates that such training would have been better planned as part of a broader sectoral nutrition workforce strategy, to facilitate greater tailoring of training to participants' job roles. CONCLUSION Effective AFSNS implementation requires developing and operationalizing a comprehensive short-, medium- and long-term Agriculture Sector Nutrition Capacity Development Strategy for Nigeria.
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Affiliation(s)
- Olutayo Adeyemi
- Department of Human Nutrition and Dietetics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
- Formerly of Food and Agriculture Organization of the United Nations, Abuja, Nigeria
| | - Olapeju Phorbee
- International Institute of Tropical Agriculture, Ibadan, Nigeria
- Food Agriculture Nutrition Network, Abuja, Nigeria
| | - Folake Samuel
- Department of Human Nutrition and Dietetics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Rasaki Sanusi
- Department of Human Nutrition and Dietetics, Faculty of Public Health, University of Ibadan, Ibadan, Nigeria
| | - Wasiu Afolabi
- Federal University of Agriculture, Abeokuta, Ogun State, Nigeria
| | - Namukolo Covic
- International Livestock Research Institute, Addis Ababa, Ethiopia
| | - Adeyinka Onabolu
- Federal Ministry of Agriculture and Rural Development, Abuja, Nigeria
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Ramanadhan S, Cruz JL, Weese M, Naveed N, Kirk S, Rivard MK, Kirk J, Whitaker A, Peterson K, Eisenkraft A. Similar skills, different frames: a thematic analysis exploring conceptualizations held by community-based organization practitioners and academics regarding skills to use evidence-based interventions to address cancer inequities. Implement Sci Commun 2023; 4:86. [PMID: 37496041 PMCID: PMC10373222 DOI: 10.1186/s43058-023-00472-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 07/15/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Community-based organizations (CBOs) are critical partners in delivering evidence-based interventions (EBIs) to address cancer inequities. However, CBO practitioners do not typically have access to opportunities to build the necessary capacity (skills, knowledge, motivation, and resources) for using EBIs. Although capacity-building interventions can offer a solution, inconsistent definitions and measurements of capacity limit the ability to develop and evaluate such efforts. We explored how and why conceptualizations of core skills for EBI use differ between practitioners and academics addressing cancer and other health inequities. We anchored the inquiry with a commonly used set of target skills for EBI capacity-building efforts. METHODS The study was conducted by an interdisciplinary team of academic researchers and CBO practitioners. We gathered data through semi-structured, hour-long interviews with practitioners and academics working to address cancer and other health inequities (n = 19). After hearing a brief vignette about a CBO addressing cervical cancer inequities, participants considered a widely accepted list of skills for EBI use that included assessing needs, engaging stakeholders, and selecting, adapting, implementing, evaluating, and sustaining the EBI. We used a team-based, reflexive thematic analysis approach grounded in critical and constructivist perspectives. RESULTS Overall, the original list resonated with practitioners and academics and they added new skills to the list (cultural humility and systems change). Practitioners' responses described skills from the reference point of addressing broader community needs and context and achieving change over the long term, emphasizing aspects of health promotion in their descriptions. Academics offered a mix of perspectives, with some focused on addressing community needs (and related flexibility regarding EBIs) but more emphasized skills needed to deliver a specific EBI to achieve a focused set of health and equity outcomes. CONCLUSIONS There is a significant opportunity to leverage complementary expertise and perspectives held by practitioners and academics addressing cancer inequities. However, the different frames utilized suggest proactive efforts will be required to find alignment across groups, particularly in valuing diverse contributions and identifying relevant outcomes of interest for each group. Such alignment is critical to designing effective capacity-building interventions and supporting the routine utilization of EBIs to address cancer inequities.
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Affiliation(s)
- Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.
| | - Jennifer L Cruz
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Maggie Weese
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Natasha Naveed
- University of Massachusetts Boston, 100 William T. Morrissey Blvd, Boston, MA, 02125, USA
| | - Shinelle Kirk
- Conservation Law Foundation, 62 Summer St, Boston, MA, 02110, USA
| | - Madison K Rivard
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Judi Kirk
- Boys and Girls Club of Worcester, 65 Boys & Girls Club Way, Worcester, MA, 01610, USA
| | - Albert Whitaker
- American Heart Association, 300 5Th Ave, Waltham, MA, 02451, USA
- St. Mark Congregational Church, 200 Townsend St, Boston, MA, 02121, USA
| | - Karen Peterson
- Tufts Medicine, 800 District Avenue, Suite 520, Burlington, MA, 01803, USA
| | - Arthur Eisenkraft
- University of Massachusetts Boston, 100 William T. Morrissey Blvd, Boston, MA, 02125, USA
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Ramanadhan S, Weese M, Rosas SR, Cruz JL, Chwa C, Rivard MK, Kirk S, Whitaker A, Kirk J, Peterson K, Eisenkraft A. Priority skills for equity-focused, evidence-based cancer control in community-based organizations: A group concept mapping analysis with academics and practitioners. J Clin Transl Sci 2023; 7:e164. [PMID: 37588678 PMCID: PMC10425867 DOI: 10.1017/cts.2023.586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 06/14/2023] [Accepted: 06/27/2023] [Indexed: 08/18/2023] Open
Abstract
Introduction Community-based organizations (CBOs) are important equity-promoting delivery channels for evidence-based interventions (EBIs). However, CBO practitioners often cannot access needed support to build EBI skills. Additionally, the capacity-building literature is hindered by inconsistent definitions, limited use of validated measures, and an emphasis on the perspectives of EBI developers versus implementers. To address these gaps, we explored commonalities and differences between CBO practitioners and academics in conceptualizing and prioritizing core EBI skills. Methods We utilized Group Concept Mapping, a mixed-methods approach connecting qualitative data (e.g., regarding the range of critical EBI skills) and quantitative data (e.g., sorting and ranking data regarding unique skills) to create conceptual maps integrating perspectives from diverse participants. A total of 34 practitioners and 30 academics working with cancer inequities participated in the study. Results Participants nominated 581 core skills for EBI use, and our team (including practitioners and academics) identified 98 unique skills from this list. Participants sorted them into conceptual groups, yielding five clusters: (1) using data and evaluation, (2) selecting and adapting EBIs, (3) connecting with community members, (4) building diverse and equitable partnerships, and (5) managing EBI implementation. The ordering of importance and presence of skill clusters were similar across groups. Overall, importance was rated higher than presence, suggesting capacity gaps. Conclusions There are helpful commonalities between practitioners' and academics' views of core EBI skills in CBOs and apparent capacity gaps. However, underlying patterns suggest that differences between the groups' perceptions warrant further exploration.
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Affiliation(s)
- Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Maggie Weese
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Scott R. Rosas
- Concept Systems, Inc., Ithaca, NY, USA
- SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jennifer L. Cruz
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Cindy Chwa
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Madison K. Rivard
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, Boston, MA, USA
| | | | - Albert Whitaker
- American Heart Association, Waltham, MA, USA
- St. Mark Congregational Church, Boston, MA, USA
| | - Judi Kirk
- Boys and Girls Club of Worcester, Worcester, MA, USA
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Marzan-Rodríguez M, Muniz-Rodriguez K, Morales LM, Martínez IS, Torres-Borrero N, Castro-Figueroa EM. Epidemiological intelligence community network intervention: a community response for COVID-19 community transmission. BMC Public Health 2023; 23:1044. [PMID: 37264399 DOI: 10.1186/s12889-023-15727-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 04/22/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Expanding and providing access to early detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) through testing community-based strategies among socially vulnerable communities (SVC) are critical to reducing health disparities. The Epidemiological Intelligence Community Network (EpI-Net) community-based intervention sought to increase coronavirus 2019 (COVID-19) testing uptake and prevention practices among SVC in Puerto Rico (PR). We evaluated EpI-Net's community leaders' capacity-building component by assessing pre-post COVID-19 public health workshops' tests' score changes and satisfaction among trained community leaders. METHODS A total of 24 community leaders from SVC in PR have completed four community workshops. Pre- and post-assessments were completed as part of the health promotors training program to evaluate participants' tests score changes and satisfaction outcomes. RESULTS Preliminary results showed: (1) high intervention retention levels of community leaders (85.7% acceptance rate); (2) change in post-test scores for community engagement strategies (p = 0.012); (3) change in post-test educational scores in COVID-19 prevention practices (p = 0.014); and (4) a change in scores in public health emergency management strategies (p < 0.001). CONCLUSIONS The overall workshop satisfaction was 99.6%. Community leaders have shown the importance of community capacity building as a key component for intervention feasibility and impact. TRIAL REGISTRATION Our study was retrospectively registered under the ClinicalTrial.gov ID NCT04910542.
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Affiliation(s)
- Melissa Marzan-Rodríguez
- Public Health Program, Ponce Health Sciences University, Ponce, PR, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, Ponce, PR, Puerto Rico
| | | | - Luisa M Morales
- Public Health Program, Ponce Health Sciences University, Ponce, PR, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, Ponce, PR, Puerto Rico
| | - Iris S Martínez
- Public Health Program, Ponce Health Sciences University, Ponce, PR, Puerto Rico
- Ponce Research Institute, Ponce Health Sciences University, Ponce, PR, Puerto Rico
| | | | - Eida M Castro-Figueroa
- Ponce Research Institute, Ponce Health Sciences University, Ponce, PR, Puerto Rico
- School of Behavioral Sciences, Ponce Health Sciences University, Ponce, PR, Puerto Rico
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Arredondo EM, Haughton J, Ayala GX, Slymen D, Sallis JF, Perez LG, Serrano N, Ryan S, Valdivia R, Lopez NV, Elder JP. Two-year outcomes of Faith in Action/Fe en Acción: a randomized controlled trial of physical activity promotion in Latinas. Int J Behav Nutr Phys Act 2022; 19:97. [PMID: 35907867 PMCID: PMC9338625 DOI: 10.1186/s12966-022-01329-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 07/08/2022] [Indexed: 11/10/2022] Open
Abstract
Background Latina women are less likely to report engaging in leisure-time physical activity (PA) than non-Latina white women. This study evaluated the 24-month impact of a faith-based PA intervention targeting Latinas. Methods The study is a cluster randomized controlled trial of a PA intervention or cancer screening comparison condition, with churches as the randomization unit. A total of 436 Latinas (aged 18-65 years) from 16 churches who engaged in low levels of self-report and accelerometer-based PA were enrolled. The experimental condition was a 24-month PA intervention, with in-person classes, social support, and environmental changes, led by community health workers (i.e., promotoras). At baseline, 12-, and 24 months, we assessed changes in accelerometer-based and self-reported moderate to vigorous physical activity (MVPA; primary outcomes). Secondary outcomes were light intensity activity, sedentary time, body mass index (BMI), and waist circumference. Results After adjusting for sociodemographic factors, a mixed effects analysis found significant increases in self-reported leisure time MVPA (p < 0.005) and marginal increases in accelerometer-assessed MVPA (p < 0.08) 24 months post-baseline in the intervention compared to the attention-control condition. Data showed significant associations between PA class attendance and engaging in MVPA as assessed by self-report and accelerometry. No significant changes were found for light activity, sedentary time, BMI, or waist circumference. Conclusions Participants who attended the PA classes at least once a month engaged in significantly higher MVPA compared to those who did not. Maximizing engagement and maintenance strategies to enhance PA maintenance could contribute to important long-term health benefits. Trial registration NCT01776632, Registered March 18, 2011. Supplementary Information The online version contains supplementary material available at 10.1186/s12966-022-01329-6.
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Affiliation(s)
- Elva M Arredondo
- Department of Psychology, San Diego State University and the Institute for Behavioral and Community Health, 9245 Sky Park Ct, San Diego, CA, 92123, USA.
| | - Jessica Haughton
- Institute for Behavioral and Community Health, San Diego State University, San Diego, USA
| | - Guadalupe X Ayala
- School of Public Health, San Diego State University and the Institute for Behavioral and Community Health, San Diego, USA
| | - Donald Slymen
- School of Public Health, San Diego State University, San Diego, USA
| | - James F Sallis
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, USA.,Australian Catholic University, Melbourne, Australia
| | - Lilian G Perez
- Behavioral and Policy Sciences Department, RAND Corporation, Santa Monica, USA
| | - Natalicio Serrano
- School of Public Health, University of Illinois at Chicago, Chicago, USA
| | - Sherry Ryan
- School of Public Affairs, San Diego State University, San Diego, USA
| | | | - Nanette V Lopez
- Health Sciences, Northern Arizona University, Flagstaff, USA
| | - John P Elder
- School of Public Health, San Diego State University, San Diego, USA
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Ramanadhan S, Donaldson ST, Siqueira CE, Rackard-James C, Miller E, Tappin J, Tracy N, Minsky S, Maldonado-Campos AA, Bruff C, Mahtani S, Teixeira MS, Viswanath V. Connecting Implementation Science, Community-Engaged Research, and Health Promotion to Address Cancer Inequities in Massachusetts: The UMB/DF-HCC U54 Outreach Core. Am J Health Promot 2022; 36:597-601. [PMID: 34939446 PMCID: PMC10580298 DOI: 10.1177/08901171211062800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Outreach Core of the U54 Partnership between the Dana-Farber/Harvard Cancer Center and the University of Massachusetts Boston created a new model for addressing cancer inequities that integrates implementation science, community-engaged research, and health promotion. Key elements of the approach include engaging a Community Advisory Board, supporting students from underrepresented minority backgrounds to conduct health promotion and community-engaged research, increasing the delivery of evidence-based cancer prevention programs to underserved communities (directly and by training local organizations), supporting research-practice partnerships, and disseminating findings. Our model highlights the need for long-term investments to connect underserved communities with evidence-based cancer prevention.
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Affiliation(s)
| | | | | | | | - Elecia Miller
- City of Lawrence Mayor’s Health Task Force, Lawrence, MA, USA
| | | | | | - Sara Minsky
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | | | | | | | - Vish Viswanath
- Harvard TH. Chan School of Public Health, Boston, MA, USA
- Dana-Farber Cancer Institute, Boston, MA, USA
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Korin MR, Araya F, Idris MY, Brown H, Claudio L. Community-Based Organizations as Effective Partners in the Battle Against Misinformation. Front Public Health 2022; 10:853736. [PMID: 35372214 PMCID: PMC8964516 DOI: 10.3389/fpubh.2022.853736] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/16/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maya Rom Korin
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Faven Araya
- Arthur Ashe Institute for Urban Health, Brooklyn, NY, United States
| | | | - Humberto Brown
- Arthur Ashe Institute for Urban Health, Brooklyn, NY, United States
| | - Luz Claudio
- Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Measuring capacity to use evidence-based interventions in community-based organizations: A comprehensive, scoping review. J Clin Transl Sci 2022; 6:e92. [PMID: 36003212 PMCID: PMC9389281 DOI: 10.1017/cts.2022.426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 06/30/2022] [Accepted: 07/06/2022] [Indexed: 11/14/2022] Open
Abstract
Introduction: Community-based organizations (CBOs) are well-positioned to incorporate research evidence, local expertise, and contextual factors to address health inequities. However, insufficient capacity limits use of evidence-based interventions (EBIs) in these settings. Capacity-building implementation strategies are popular, but a lack of standard models and validated measures hinders progress in the field. To advance the literature, we conducted a comprehensive scoping review. Methods: With a reference librarian, we executed a comprehensive search strategy of PubMed/Medline, Web of Science Core Collection, and EBSCO Global Health. We included articles that addressed implementation science, capacity-building, and CBOs. Of 5527 articles, 99 met our inclusion criteria, and we extracted data using a double-coding process Results: Of the 99 articles, 47% defined capacity explicitly, 31% defined it indirectly, and 21% did not define it. Common concepts in definitions were skills, knowledge/expertise, and resources. Of the 57 articles with quantitative analysis, 48 (82%) measured capacity, and 11 (23%) offered psychometric data for the capacity measures. Of the 99 studies, 40% focused exclusively on populations experiencing inequities and 22% included those populations to some extent. The bulk of the studies came from high-income countries. Conclusions: Implementation scientists should 1) be explicit about models and definitions of capacity and strategies for building capacity, 2) specify expected multi-level implementation outcomes, 3) develop and use validated measures for quantitative work, and 4) integrate equity considerations into the conceptualization and measurement of capacity-building efforts. With these refinements, we can ensure that the necessary supports reach CBO practitioners and critical partners for addressing health inequities.
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Ramanadhan S, Revette AC, Lee RM, Aveling EL. Pragmatic approaches to analyzing qualitative data for implementation science: an introduction. Implement Sci Commun 2021; 2:70. [PMID: 34187595 PMCID: PMC8243847 DOI: 10.1186/s43058-021-00174-1] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 06/11/2021] [Indexed: 11/10/2022] Open
Abstract
Qualitative methods are critical for implementation science as they generate opportunities to examine complexity and include a diversity of perspectives. However, it can be a challenge to identify the approach that will provide the best fit for achieving a given set of practice-driven research needs. After all, implementation scientists must find a balance between speed and rigor, reliance on existing frameworks and new discoveries, and inclusion of insider and outsider perspectives. This paper offers guidance on taking a pragmatic approach to analysis, which entails strategically combining and borrowing from established qualitative approaches to meet a study's needs, typically with guidance from an existing framework and with explicit research and practice change goals.Section 1 offers a series of practical questions to guide the development of a pragmatic analytic approach. These include examining the balance of inductive and deductive procedures, the extent to which insider or outsider perspectives are privileged, study requirements related to data and products that support scientific advancement and practice change, and strategic resource allocation. This is followed by an introduction to three approaches commonly considered for implementation science projects: grounded theory, framework analysis, and interpretive phenomenological analysis, highlighting core analytic procedures that may be borrowed for a pragmatic approach. Section 2 addresses opportunities to ensure and communicate rigor of pragmatic analytic approaches. Section 3 provides an illustrative example from the team's work, highlighting how a pragmatic analytic approach was designed and executed and the diversity of research and practice products generated.As qualitative inquiry gains prominence in implementation science, it is critical to take advantage of qualitative methods' diversity and flexibility. This paper furthers the conversation regarding how to strategically mix and match components of established qualitative approaches to meet the analytic needs of implementation science projects, thereby supporting high-impact research and improved opportunities to create practice change.
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Affiliation(s)
- Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
| | - Anna C Revette
- Division of Population Sciences, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
| | - Rebekka M Lee
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Emma L Aveling
- Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
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Galbraith-Gyan KV, Lee SJ, Ramanadhan S, Viswanath K. Disparities in HPV knowledge by race/ethnicity and socioeconomic position: Trusted sources for the dissemination of HPV information. Cancer Causes Control 2021; 32:923-933. [PMID: 33999315 DOI: 10.1007/s10552-021-01445-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 05/06/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To examine the differences in HPV and HPV vaccine awareness, knowledge, and beliefs by race/ethnicity and socioeconomic position (SEP) among a national sample of non-Hispanic whites (NH-Whites), non-Hispanic Blacks (NH-Blacks), and Hispanics in the United States. We also examine differences in trusted health information sources by race/ethnicity and SEP. METHODS Data were obtained from the Health Information National Trends Survey, Cycle 1, conducted from January to April 2017. Descriptive statistics, bivariate analyses, multivariate logistic regression, and listwise deletion were used to examine HPV and HPV vaccine awareness and knowledge-related items, and trust in health information sources among NH-Whites, NH-Blacks, and Hispanics 18-49 years old. RESULTS HPV vaccine awareness was moderate with no significant differences across racial/ethnic groups. NH-Whites had significantly higher knowledge that HPV causes cervical cancer than NH-Blacks and Hispanics (p < 0.001). High SEP NH-Blacks (OR = 0.42, 95% CI = [0.24-0.73], p = 0.002]) and Hispanics (OR = 0.49, 95% CI = [0.31-0.79, p = 0.003]) had lower odds of knowing HPV causes a sexually transmitted disease than their white counterparts. Low SEP NH-Blacks (OR = 11.03, 95% CI = [3.05-39.86, p < 0.001]) had 11 times the odds of ever hearing about the HPV vaccine than low SEP NH-Whites. NH-Blacks had twice the odds of trusting health information from television (OR = 2.39, 95% CI = [1.52-3.78]. p < 0.001), and almost six times the odds of trusting health information from religious organizations than low SEP NH-Whites (OR = 5.76, 95% CI = [2.02-16.44, p < 0.001]). CONCLUSION Tailored communication strategies may address the low HPV knowledge among NH-Blacks and Hispanics from high and low SEP.
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Affiliation(s)
- Kayoll V Galbraith-Gyan
- School of Nursing, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA.
| | - Stella Juhyun Lee
- Department of Media and Communication, Konkuk University, Seoul, Republic of Korea
| | - Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Kasisomayajula Viswanath
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Harvard University, Boston, MA, USA
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, USA
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