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Gobin R, Thomas T, Goberdhan S, Sharma M, Nasiiro R, Emmanuel R, Rambaran M, McFarlane S, Elia C, Van-Veen D, Govia I, Palmer T, Read U, Cruickshank JK, Samuels TA, Wilks R, Harding S. Readiness of primary care centres for a community-based intervention to prevent and control noncommunicable diseases in the Caribbean: A participatory, mixed-methods study. PLoS One 2024; 19:e0301503. [PMID: 38683831 PMCID: PMC11057736 DOI: 10.1371/journal.pone.0301503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 03/15/2024] [Indexed: 05/02/2024] Open
Abstract
INTRODUCTION Epidemiological transition to NCDs is a challenge for fragile health systems in the Caribbean. The Congregations Taking Action against NCDs (CONTACT) Study intervention proposes that trained health advocates (HAs) from places of worship (PoWs), supervised by nurses at nearby primary healthcare centres (PHCs), could facilitate access to primary care among vulnerable communities. Drawing on participatory and systems thinking, we explored the capacity of local PHCs in three Caribbean countries to support this intervention. METHODS Communities in Jamaica (rural, urban), Guyana (rural) and Dominica (Indigenous Kalinago Territory) were selected for CONTACT because of their differing socio-economic, cultural, religious and health system contexts. Through mixed-method concept mapping, we co-developed a list of perceived actionable priorities (possible intervention points ranked highly for feasibility and importance) with 48 policy actors, healthcare practitioners and civic society representatives. Guided in part by the concept mapping findings, we assessed the readiness of 12 purposefully selected PHCs for the intervention, using a staff questionnaire and an observation checklist to identify enablers and constrainers. RESULTS Concept mapping illustrated stakeholder optimism for the intervention, but revealed perceptions of inadequate primary healthcare service capacity, resources and staff training to support implementation. Readiness assessments of PHCs identified potential enablers and constrainers that were consistent with concept mapping results. Staff support was evident. Constraints included under-staffing, which could hinder supervision of HAs; and inadequate essential NCD medicines, training in NCDs and financial and policy support for embedding community interventions. Despite a history of socio-political disadvantage, the most enabling context was found in the Kalinago Territory, where ongoing community engagement activities could support joint development of programmes between churches and PHCs. CONCLUSION Multi-sectoral stakeholder consultation and direct PHC assessments revealed viability of the proposed POW-PHC partnership for NCD prevention and control. However, structural and policy support will be key for implementing change.
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Affiliation(s)
- Reeta Gobin
- College of Medical Sciences, University of Guyana, Georgetown, Guyana
| | - Troy Thomas
- Faculty of Natural Sciences, University of Guyana, Georgetown, Guyana
| | | | - Manoj Sharma
- College of Medical Sciences, University of Guyana, Georgetown, Guyana
| | | | - Rosana Emmanuel
- School of Life Course and Population Sciences, King’s College London, London, United Kingdom
| | - Madan Rambaran
- Institute of Health Science Education, Georgetown Public Hospital Corporation, Georgetown, Guyana
| | - Shelly McFarlane
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | | | - Davon Van-Veen
- College of Medical Sciences, University of Guyana, Georgetown, Guyana
| | - Ishtar Govia
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Tiffany Palmer
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | | | - J. Kennedy Cruickshank
- School of Life Course and Population Sciences, King’s College London, London, United Kingdom
| | - T. Alafia Samuels
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Rainford Wilks
- Caribbean Institute for Health Research, University of the West Indies, Kingston, Jamaica
| | - Seeromanie Harding
- School of Life Course and Population Sciences, King’s College London, London, United Kingdom
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Cameron DB, Grage L, Van Wyck R, Edwards A, Chavez Mapaye J, Cheng A, Garcia G. Identifying trusted local sources and predicting behavior change pathways according to COVID-19 vaccination status: Results of a 2022 statewide survey of Alaskan adults. Vaccine 2024; 42:2592-2607. [PMID: 38490821 PMCID: PMC11005074 DOI: 10.1016/j.vaccine.2024.03.027] [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] [Received: 09/28/2023] [Revised: 03/08/2024] [Accepted: 03/09/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Low rates of COVID-19 vaccination remain a substantial public health challenge. Despite early successes, vaccinations of Alaskans trail the US average, drawing attention to the need for better-designed and targeted vaccine confidence interventions. Our objective was to assess levels of community trust and theory-driven predictors of vaccination status to inform the design of future programs. METHODS We conducted a cross-sectional, telephone-based survey of 940 Alaskan adults between May and June 2022. Data were collected on vaccination status (including initial vaccination and receipt of booster shots), trust in local community members, demographic characteristics, and thematic questions designed using the Capability, Opportunity, Motivation - Behavior (COM-B) model to examine possible predictors (barriers/facilitators) of vaccination status. FINDINGS Among those who are not fully vaccinated and boosted, we observe significantly lower trust placed in many immediate community members, especially health workers (e.g., doctors, nurses, specialty care physicians, health administrators). Firefighters and emergency medical technicians enjoy the most community trust, followed by medical professionals. Among those who received only a primary vaccine series, we find that perceptions of whether close friends are vaccinated, a sense of professional responsibility, and age were the strongest predictors vaccination status. Among the unvaccinated, we find significant predictive power from the same variables, as well as perceptions of whether family members are vaccinated, perceived risks from non-vaccination and whether vaccination is a healthy choice. CONCLUSIONS These findings will help inform the design and targeting of future vaccine promotion interventions to adult populations in Alaska. Interventions that leverage reflective motivation and social opportunity domains of the COM-B framework may be most effective. Local community members including firefighters and emergency medical technicians, as well as medical professionals may be perceived as the most trustworthy and influential messengers among those who are not fully vaccinated and boosted.
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Affiliation(s)
- Drew B Cameron
- Department of Health Policy and Management, Yale School of Public Health, Yale University, 60 College Street, New Haven, CT 06502, United States.
| | - Laura Grage
- Information Insights, PO Box 83070, Fairbanks, AK 99708, United States.
| | - Rebecca Van Wyck
- DPHS Institute for Circumpolar Health Sciences, University of Alaska, Anchorage, 3211 Providence Dr., Anchorage, AK 99508, United States; Institute for Social and Economic Research, University of Alaska, Anchorage, 3211 Providence Dr., Anchorage, AK 99508, United States.
| | - Alexandra Edwards
- Institute for Social and Economic Research, University of Alaska, Anchorage, 3211 Providence Dr., Anchorage, AK 99508, United States; Center for Behavioral Health Research & Services, University of Alaska, Anchorage, 3211 Providence Dr., Anchorage, AK 99508, United States.
| | - Joy Chavez Mapaye
- Department of Journalism and Public Communications, Fine Arts Building, 3211 Providence Drive, Anchorage, AK 99508, United States.
| | - Ann Cheng
- Department of Social and Behavioral Sciences, Yale School of Public Health, Yale University, 60 College Street, New Haven, CT 06502, United States; L&M Policy Research, 1743 Connecticut Ave NW, Suite 200, Washington, DC 20009, United States.
| | - Gabriel Garcia
- Division of Population Health Sciences, University of Alaska, 3211 Providence Dr., PSB 206J, Anchorage, AK 99508, United States.
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Khan MA, Khan SA, Annadurai K, Parajuli SB, Ahmed WN, Altamimi S, Ashok T, Shah D, Sayyad Y, Dubey A, Tariq A, Riyaz R, Hasan F, Amiri S, Faris M. Determinants of body weight changes during Ramadan fasting in India amid COVID-19: A cross-sectional study. Medicine (Baltimore) 2024; 103:e37040. [PMID: 38277572 PMCID: PMC10817079 DOI: 10.1097/md.0000000000037040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 01/03/2024] [Indexed: 01/28/2024] Open
Abstract
Ramadan intermittent fasting (RIF) presents unique challenges and opportunities for public health and clinical practice, especially in populations with a high prevalence of non-communicable diseases. This study aims to investigate the impact of RIF on weight change among Indian Muslims and explore the associated demographic, dietary, and behavioral factors. A cross-sectional survey was conducted with a sample of Indian Muslim adults who observed RIF. Participants were asked to report their demographic information, family and personal health history, and dietary and lifestyle behaviors before and during Ramadan month. The primary outcome was body weight change, with secondary outcomes including changes in dietary patterns, physical activity, and other health-related lifestyle behaviors. The study found that during Ramadan, nearly half of the participants (48.5%) self-reported a retained initial weight, while a significant fraction (30.9%) self-reported a modest weight reduction between 0.5 to 2.5 kg at the end of Ramadan. Additionally, self-reported eating practices demonstrated moderately altered by about half (48.4%) of the study participants, with 32.2% reporting minor changes and 8.2% indicating substantial changes. An urban residence was associated with a higher likelihood of weight gain, where urban residents showed 3 times the odds of increased weight compared to rural inhabitants. Employment status emerged as a significant determinant for weight fluctuation, influencing both weight gain and loss. During Ramadan, there was a significant rise in snacking frequency, increasing from 21.7% to 32.6% in comparison with pre-Ramadan. The consumption of large quantities of food more frequently grew from 14.9% to 36%, and the incidence of eating despite not being hungry went up from 17.4% to 33.2%. The study demonstrates that RIF is associated with variable changes in body weight among adult Indian Muslims, influenced by urbanization, employment status, and dietary changes. The findings suggest that clinicians should provide tailored advice about body weight regulation during Ramadan and consider integrating community-based health initiatives within religious settings to improve health outcomes.
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Affiliation(s)
- Moien A.B. Khan
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Abu Dhabi, UAE
- Primary Care, NHS North West London, London, United Kingdom
| | | | - Kalaivani Annadurai
- Bhaarath Medical College & Hospital, Chennai, BIHER University, Chennai, Tamil Nadu, India
| | - Surya Bahadur Parajuli
- Department of Community Medicine, Birat Medical College Teaching Hospital, Morang, Nepal
| | | | - Saoud Altamimi
- Department of Family Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Abu Dhabi, UAE
| | | | | | | | - Ashish Dubey
- Orenburg State Medical University, Orenburg, Russia
| | - Abdullah Tariq
- Indian Institute of Medical Science and Research, Warudi, Maharashtra, India
| | - Romana Riyaz
- Shadan Institute of Medical Sciences and Research, Hyderabad, Telangana, India
| | - Fayeza Hasan
- College of Food and Agriculture, United Arab Emirates University, Abu Dhabi, UAE
| | - Sohrab Amiri
- Quran and Hadith Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Moezalislam Faris
- Department of Clinical Nutrition and Dietetics, College of Health Sciences/Research Institute of Medical and Health Sciences (RIMHS), University of Sharjah, Sharjah, United Arab Emirates
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Khanji MY, Nassar S, Waqar S. Public access of automated electrical defibrillators through mosques and other places of worship-towards saving lives and reducing health inequalities. Eur Heart J 2024; 45:156-158. [PMID: 37947281 DOI: 10.1093/eurheartj/ehad705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2023] Open
Affiliation(s)
- Mohammed Y Khanji
- Newham University Hospital, Barts Health NHS Trust, London, E13 8SL, UK
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, EC1A 7BE, UK
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - Sameen Nassar
- County Durham and Darlington NHS Foundation Trust, Darlington DL3 6HX
| | - Salman Waqar
- Department of Primary Care and Public Health, Imperial College London, W6 8RP, UK
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Hakizimana D, Shitu K, Rankin KC, Alemie GA, Walson J, Guthrie BL, Means AR. Optimising scale-up for public health impact: a multimethod implementation science research protocol to improve infant health outcomes in Ethiopia. BMJ Open 2023; 13:e075817. [PMID: 38011972 PMCID: PMC10685948 DOI: 10.1136/bmjopen-2023-075817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023] Open
Abstract
INTRODUCTION Child mortality rates remain high in sub-Saharan Africa, including Ethiopia. We are conducting a cluster randomised control trial in the Gondar zone of the Amhara region to determine the impact of pairing Orthodox priests with community health workers, known locally as the Health Development Army (HDA), on newborns' nutritional status, early illness identification and treatment, and vaccination completeness.Ensuring intervention efficacy with scientific rigour is essential, but there are often delays in adopting evidence into policy and programmes. Here, we present a protocol for conducting parallel implementation research alongside an efficacy study to understand intervention implementability and scalability. This will help develop a scale-up strategy for effective elements of the intervention to ensure rapid implementation at scale. METHODS AND ANALYSIS We will conduct a stakeholder analysis of key implementation stakeholders and readiness surveys to assess their readiness to scale up the intervention. We will conduct semistructured interviews and focus group discussions with stakeholders, including HDA members, health workers, Orthodox priests, and caregivers, to determine the core intervention elements that need to be scaled, barriers and facilitators to scaling up the intervention in diverse sociocultural settings, as well as the human and technical requirements for national and regional implementation. Finally, to determine the financial resources necessary for sustaining and scaling the intervention, we will conduct activity-based costing to estimate implementation costs from the provider's perspective. ETHICS AND DISSEMINATION The study received approval from the University of Gondar Institutional Review Board (approval no: VP/RTT/05/1030/2022) and the University of Washington Human Subjects Division (approval no: STUDY00015369). Participants will consent to participate. Results will be disseminated through workshops with stakeholders, local community meetings, presentations at local and international conferences, and journal publications. The study will provide evidence for factors to consider in developing a scale-up strategy to integrate the intervention into routine health system practices.
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Affiliation(s)
| | - Kegnie Shitu
- Department of Health Education and Behavioral Sciences, University of Gondar, Gondar, Ethiopia
| | - Katherine C Rankin
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Getahun A Alemie
- College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Judd Walson
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Brandon L Guthrie
- Department of Global Health/Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | - Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, Washington, USA
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