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Naar S, Pettus C, Anderson N, Pooler-Burgess M, Ralston P, Flynn H, Combs T, Baquet C, Schatschneider C, Luke D. Study protocol for transforming health equity research in integrated primary care: Antiracism as a disruptive innovation. PLoS One 2024; 19:e0306185. [PMID: 38935743 PMCID: PMC11210870 DOI: 10.1371/journal.pone.0306185] [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: 11/06/2023] [Accepted: 06/11/2024] [Indexed: 06/29/2024] Open
Abstract
Among the consequences of systemic racism in health care are significant health disparities among Black/African American individuals with comorbid physical and mental health conditions. Despite decades of studies acknowledging health disparities based on race, significant change has not occurred. There are shockingly few evidence-based antiracism interventions. New paradigms are needed to intervene on, and not just document, racism in health care systems. We are developing a transformative paradigm for new antiracism interventions for primary care settings that integrate mental and physical health care. The paradigm is the first of its kind to integrate community-based participatory research and systems science, within an established model of early phase translation to rigorously define new antiracism interventions. This protocol will use a novel application of systems sciences by combining the qualitative systems sciences methods (group model building; GMB) with quantitative methods (simulation modeling) to develop a comprehensive and community-engaged view of both the drivers of racism and the potential impact of antiracism interventions. Community participants from two integrated primary health care systems will engage in group GMB workshops with researchers to 1) Describe and map the complex dynamic systems driving racism in health care practices, 2) Identify leverage points for disruptive antiracism interventions, policies and practices, and 3) Review and prioritize a list of possible intervention strategies. Advisory committees will provide feedback on the design of GMB procedures, screen potential intervention components for impact, feasibility, and acceptability, and identify gaps for further exploration. Simulation models will be generated based on contextual factors and provider/patient characteristics. Using Item Response Theory, we will initiate the process of developing core measures for assessing the effectiveness of interventions at the organizational-systems and provider levels to be tested under a variety of conditions. While we focus on Black/African Americans, we hope that the resulting transformative paradigm can be applied to improve health equity among other marginalized groups.
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Affiliation(s)
- Sylvie Naar
- Center for Translational Behavioral Science, Florida State University, Tallahassee, FL, United States of America
| | - Carrie Pettus
- Wellbeing & Equity Innovations, Tallahassee, FL, United States of America
| | - Norman Anderson
- Office of Vice President for Research and College of Social Work, Florida State University, Tallahassee, FL, United States of America
| | - Meardith Pooler-Burgess
- Center for Translational Behavioral Science, Florida State University, Tallahassee, FL, United States of America
| | - Penny Ralston
- Center on Better Health and Life for Underserved Populations, Florida State University, Tallahassee, FL, United States of America
| | - Heather Flynn
- Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL, United States of America
| | - Todd Combs
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Claudia Baquet
- Hope Institute, LLC and UM School of Pharmacy, Baltimore, Maryland, United States of America
| | | | - Douglas Luke
- Center for Public Health Systems Science, Brown School, Washington University in St. Louis, St. Louis, Missouri, United States of America
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Cohen AK, Snyder RE. Community-Based Participatory Research for Epidemiology, Health Equity, and Community Goals: Insights From Brazil, France, and USA. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024:2752535X241262857. [PMID: 38885632 DOI: 10.1177/2752535x241262857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
BACKGROUND Community-based participatory research coproduces knowledge by emphasizing bidirectional exchanges between participants, communities, and researchers. PURPOSE, RESEARCH DESIGN, AND STUDY SAMPLE We highlight three studies in historically marginalized communities on separate continents (Richmond, CA, USA; Rio de Janeiro, Brazil; Marseille industrial zone, France) to exemplify how community-based participatory research improves research, offers tangible community benefits, and values residents more than traditional research methods. DATA ANALYSIS We provide insights into the process of conducting meaningful community-based participatory epidemiologic research. RESULTS In each of these communities, community-based participatory research led to high-quality research that helped inform context-appropriate policies and programs to improve health and advance health equity in these communities. CONCLUSIONS We recommend that researchers consistently engage with community members during all phases of research so that they can engage more participants, more deeply in the research process, build local capacity, improve data collection and data quality, as well as increase our understanding of research findings to inform future applied research and practice.
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Affiliation(s)
- Alison K Cohen
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Robert E Snyder
- School of Public Health, Division of Epidemiology, University of California Berkeley, Berkeley, CA, USA
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Oetzel JG, Bragg C, Wilson Y, Reddy R, Simpson ML, Nock S. Cultural and co-designed principles for developing a Māori kaumātua housing village to address health and social wellbeing. BMC Public Health 2024; 24:1313. [PMID: 38750473 PMCID: PMC11094867 DOI: 10.1186/s12889-024-18771-9] [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: 10/09/2023] [Accepted: 05/03/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND The current study is a case study of a Māori (Indigenous people of New Zealand) organisation and their developmental processes in creating a kaumātua (older people) housing village for health and social wellbeing. This study identifies how a set of established co-design and culturally-centred principles were enacted when creating and developing the village. METHOD A mixed-method concurrent design was used in creating the case with interviews (n = 4), focus groups (N = 4 with 16 total participants) and survey questionnaires (n = 56) involving kaumātua and organisation members. RESULTS Survey results illustrate that suitable and affordable housing are associated with self-rated health, loneliness, and life satisfaction. The primary purpose of the housing village was to enable kaumātua to be connected to the marae (community meeting house) as part of a larger vision of developing intergenerational housing around the marae to enhance wellbeing. Further, key themes around visioning, collaborative team and funding, leadership, fit-for-purpose design, and tenancy management were grounded in cultural elements using te ao Māori (Māori worldview). CONCLUSION This case study illustrates several co-design and culturally-centred principles from a previously developed toolkit that supported the project. This case study demonstrates how one community enacted these principles to provide the ground for developing a housing project that meets the health and social wellbeing of kaumātua.
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Affiliation(s)
| | | | | | | | | | - Sophie Nock
- University of Waikato, Hamilton, New Zealand
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O'Halloran SA, Hayward J, Valdivia Cabrera M, Felmingham T, Fraser P, Needham C, Poorter J, Creighton D, Johnstone M, Nichols M, Allender S. The common drivers of children and young people's health and wellbeing across 13 local government areas: a systems view. BMC Public Health 2024; 24:847. [PMID: 38504205 PMCID: PMC10949822 DOI: 10.1186/s12889-024-18354-8] [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: 11/30/2023] [Accepted: 03/13/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND System dynamics approaches, including group model building (GMB) and causal loop diagrams (CLDs), can be used to document complex public health problems from a community perspective. This paper aims to apply Social Network Analysis (SNA) methods to combine multiple CLDs created by local communities into a summary CLD, to identify common drivers of the health and wellbeing of children and young people. METHODS Thirteen community CLDs regarding children and young people health and wellbeing were merged into one diagram involving three steps: (1) combining variable names; (2) CLD merging, where multiple CLDs were combined into one CLD with a set of unique variables and connections; (3) paring, where the Decision-Making Trial and Evaluation Laboratory (DEMATEL) method was used to generate a cut-point to reduce the number of variables and connections and to rank the overall importance of each variable in the merged CLD. RESULTS Combining variable names resulted in 290 variables across the 13 CLDS. A total of 1,042 causal links were identified in the merged CLD. The DEMATEL analysis of the merged CLD identified 23 common variables with a net importance between 1.0 and 4.5 R + C values and 57 causal links. The variables with the highest net importance were 'mental health' and 'social connection & support' classified as high net receivers of influence within the system. CONCLUSIONS Combining large CLDs into a simple diagram represents a generalisable model of the drivers of complex health problems.
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Affiliation(s)
- Siobhan A O'Halloran
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia.
| | - Joshua Hayward
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
| | - Melissa Valdivia Cabrera
- Institute for Intelligent Systems Research and Innovation, Deakin University, 75 Pigdons Rd, Waurn Ponds, VIC, 3216, Australia
| | - Tiana Felmingham
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
| | - Penny Fraser
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
| | - Cindy Needham
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
| | - Jaimie Poorter
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
| | - Doug Creighton
- Institute for Intelligent Systems Research and Innovation, Deakin University, 75 Pigdons Rd, Waurn Ponds, VIC, 3216, Australia
| | - Michael Johnstone
- Institute for Intelligent Systems Research and Innovation, Deakin University, 75 Pigdons Rd, Waurn Ponds, VIC, 3216, Australia
| | - Melanie Nichols
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
| | - Steven Allender
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, 3220, Australia
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Sørensen SO, Larsen KT, Høy TV, Hansen ABG, Jago R, Kristensen PL, Toftager M, Grøntved A, Gejl AK. Study protocol for the Screen-Free Time with Friends Feasibility Trial. Pilot Feasibility Stud 2024; 10:33. [PMID: 38374084 PMCID: PMC10875870 DOI: 10.1186/s40814-024-01462-y] [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: 04/26/2023] [Accepted: 02/06/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Children are spending less leisure time with their friends in person and an increasing amount of time with digital screens. These changes may negatively affect children's physical and mental health. The Screen-Free Time with Friends Feasibility Trial will test the feasibility, including acceptability and compliance, of an intervention designed to reduce screen media usage and encourage physical interaction with friends during leisure time in 9-11-year-old children. METHODS A non-randomized single-group feasibility trial will be conducted from March to October 2023 including approximately 75 children (aged 9-11 years) and 75 parents (at least 1 per child) from 3 different schools recruited from 3 different municipalities in Denmark. The Screen-Free Time with Friends intervention is a multicomponent intervention targeting families, afterschool clubs, and local communities. It has been developed using a systematic process guided by the Medical Research Council UK's framework for developing and evaluating complex interventions. With a systems perspective in mind, the intervention and implementation approach has been designed to facilitate adaptation to the specific needs of diverse local communities while maintaining the core components of the intervention. Feasibility and acceptability of the intervention will be assessed during the intervention using process evaluation inspired by the RE-AIM framework including questionnaires and interviews with the municipality project managers, research team members, local ambassadors and stakeholders, parents and school, and afterschool club personnel. In addition, participation, recruitment, retention rate, and compliance to the outcome measurements will be investigated and presented. DISCUSSION The trial will investigate the feasibility and acceptability of the Screen-Free Time with Friends intervention, the recruitment strategy, and the planned outcome measurements. This feasibility study will investigate necessary refinements before the implementation of the intervention program in a larger cluster randomized controlled trial to evaluate its impact. TRIAL REGISTRATION CLINICALTRIALS gov, ID: NCT05480085. Registered 29 July 2022. https://clinicaltrials.gov/ct2/show/NCT05480085?cond=Screen+free+time+with+friends&draw=2&rank=1.
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Affiliation(s)
- Sarah Overgaard Sørensen
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - Kristian Traberg Larsen
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Teresa Victoria Høy
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Russell Jago
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- NIHR Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Peter Lund Kristensen
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Mette Toftager
- Research Unit for Active Living, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anders Grøntved
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Anne Kær Gejl
- Research Unit for Exercise Epidemiology, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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Deutsch AR, Jalali MS, Stout S, Frerichs L. Equitable Policies Need Equitable Practices: Alcohol- and Substance-Exposed Pregnancy as a Case Study. Health Promot Pract 2024; 25:17-21. [PMID: 35778898 PMCID: PMC10071566 DOI: 10.1177/15248399221107605] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is clear need for more effective public health policies. Coupled with calls for more effective policies, increasing demand to address public health disparities experienced by systemically marginalized and historically oppressed groups emphasizes the long-standing need for policies that improve public health equity. Such need is highlighted when examining public health issues such as alcohol- and substance-exposed pregnancy (ASEP): Current policies are ineffective at reducing ASEP, and marginalized groups experience disproportionately lower benefits and higher negative consequences as a result of such policies. Powerful strategies to develop more effective policies that can account for the complexity of such issues, such as systems science methods (SSMs), are becoming popular. However, current best practices for such methods often do not emphasize the additional efforts that will be required to develop equitable, not just effective policies. Using ASEP as an example of a crucial complex issue requiring new policy, we suggest additional steps to include in SSM projects for developing more effective policies that will also help stakeholders determine high-equity policies to reduce health disparities. These steps include modeling structural differences experienced by marginalized groups via systemic racism and oppression, incorporating existing cultural and community sources of strength and resilience as key areas for policy development, and evaluating the sustainability of policies as a dimension of efficacy. We also discuss using community-based participatory approaches as a framework for all SSM processes to ensure that policy development itself is grounded in equitable shared decision-making for marginalized individuals.
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Affiliation(s)
- Arielle R Deutsch
- Avera Health, Sioux Falls, SD, USA
- University of South Dakota, Vermillion, SD, USA
| | - Mohammad S Jalali
- Harvard Medical School, Boston, MA, USA
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | | | - Leah Frerichs
- The University of North Carolina at Chapel Hill, NC, USA
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Barre I, Cunningham-Erves J, Moss J, Parham I, Alexander LR, Davis J. Motivators and Barriers to COVID-19 Research Participation at the Onset of the COVID-19 Pandemic in Black Communities in the USA: an Exploratory Study. J Racial Ethn Health Disparities 2023; 10:2890-2899. [PMID: 36512311 PMCID: PMC9746576 DOI: 10.1007/s40615-022-01466-5] [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: 03/31/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Black individuals in the USA continue to be underrepresented in clinical trials with low participation rates in COVID-19 research studies. Identifying participation barriers is necessary as we develop more vaccines and other treatments to address SARS-CoV-2 and associated sequelae. The purpose of this explorative, qualitative study is to apply the theory of planned behavior to understand motivators and barriers to COVID-19 research participation at the early stages of the COVID-19 pandemic. Understanding these factors is important to ultimately lead to increased vaccination rates among Black individuals, especially in strategies that increase preparedness in response to public health emergencies. METHODS A phenomenological qualitative study design was conducted between May and September 2020 among 62 Black participants. The participants were purposefully selected from vulnerable subgroups of the Black population: essential workers, young adults, parents, and individuals with underlying medical conditions. An inductive-deductive content analysis approach was used to analyze the interview data. RESULTS Majority (54.8%) reported willingness to participate in COVID-19 research. The following themes emerged from the interviews: (1) positivity toward research exists yet fear and distrust remain; (2) views toward COVID-19 research vary; (3) motivators to COVID-19 research participation; (4) barriers to COVID-19 research participation; and (5) potential strategies to increase COVID-19 research participation. CONCLUSIONS Based on our findings, majority of the participants reported willingness to participate in research with observational research being the most commonly cited type of research. Providing data on the attitudes and perspectives of Black individuals and their intentions for COVID-19 research participation using TPB informs intervention targets for healthcare providers and policy makers for an equitable emergency response. Our results suggest improved communication on the research process, research opportunities, and participant testimonial through trusted sources could increase the likelihood of participation. This is especially important as we continue through the pandemic and new treatments for COVID-19 vaccines become readily available.
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Affiliation(s)
- Iman Barre
- School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN, 37208, USA
| | - Jennifer Cunningham-Erves
- Department of Internal Medicine, School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN, 37208, USA
| | - Jamal Moss
- School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN, 37208, USA
| | - Imari Parham
- School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN, 37208, USA
| | - Leah R Alexander
- Division of Public Health Practice, School of Graduate Studies and Research, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN, 37208, USA
| | - Jamaine Davis
- Department of Biochemistry, Cancer Biology, Neuroscience & Pharmacology, School of Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd, Second Floor of Harold West Basic Science Building, Suite 2007, Nashville, TN, 37208-3599, USA.
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Chebli P, Đoàn LN, Thompson RL, Chin M, Sabounchi N, Foster V, Huang TTK, Trinh-Shevrin C, Kwon SC, Yi SS. Identifying opportunities for collective action around community nutrition programming through participatory systems science. Cancer Causes Control 2023; 34:1043-1058. [PMID: 37481755 PMCID: PMC10979368 DOI: 10.1007/s10552-023-01751-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 07/04/2023] [Indexed: 07/25/2023]
Abstract
PURPOSE To apply principles of group model building (GMB), a participatory systems science approach, to identify barriers and opportunities for collective impact around nutrition programming to reduce cancer risk for immigrant communities in an urban environment. METHODS We convened four in-person workshops applying GMB with nine community partners to generate causal loop diagrams (CLDs)-a visual representation of hypothesized causal relationships between variables and feedback structures within a system. GMB workshops prompted participants to collaboratively identify programmatic goals and challenges related to (1) community gardening, (2) nutrition education, (3) food assistance programs, and (4) community-supported agriculture. Participants then attended a plenary session to integrate findings from all workshops and identify cross-cutting ideas for collective action. RESULTS Several multilevel barriers to nutrition programming emerged: (1) food policies center the diets and practices of White Americans and inhibit culturally tailored food guidelines and funding for culturally appropriate nutrition education; (2) the lack of culturally tailored nutrition education in communities is a missed opportunity for fostering pride in immigrant food culture and sustainment of traditional food practices; and (3) the limited availability of traditional ethnic produce in food assistance programs serving historically marginalized immigrant communities increases food waste and worsens food insecurity. CONCLUSION Emergent themes coalesced around the need to embed cultural tailoring into all levels of the food system, while also considering other characteristics of communities being reached (e.g., language needs). These efforts require coordinated actions related to food policy and advocacy, to better institutionalize these practices within the nutrition space.
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Affiliation(s)
- Perla Chebli
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, 8th Floor, New York, NY, 10016, USA.
| | - Lan N Đoàn
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, 8th Floor, New York, NY, 10016, USA
| | - Rachel L Thompson
- Center for Systems and Community Design, CUNY Graduate School of Public Health and Health Policy, 55 W 125th St, New York, NY, 10027, USA
| | - Matthew Chin
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, 8th Floor, New York, NY, 10016, USA
| | - Nasim Sabounchi
- Center for Systems and Community Design, CUNY Graduate School of Public Health and Health Policy, 55 W 125th St, New York, NY, 10027, USA
| | - Victoria Foster
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, 8th Floor, New York, NY, 10016, USA
| | - Terry T K Huang
- Center for Systems and Community Design, CUNY Graduate School of Public Health and Health Policy, 55 W 125th St, New York, NY, 10027, USA
| | - Chau Trinh-Shevrin
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, 8th Floor, New York, NY, 10016, USA
| | - Simona C Kwon
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, 8th Floor, New York, NY, 10016, USA
| | - Stella S Yi
- Section for Health Equity, Department of Population Health, NYU Grossman School of Medicine, 180 Madison Ave, 8th Floor, New York, NY, 10016, USA
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Ferrari RM, Leeman J, Brenner AT, Correa SY, Malo TL, Moore AA, O'Leary MC, Randolph CM, Ratner S, Frerichs L, Farr D, Crockett SD, Wheeler SB, Lich KH, Beasley E, Hogsed M, Bland A, Richardson C, Newcomer M, Reuland DS. Implementation strategies in the Exploration and Preparation phases of a colorectal cancer screening intervention in community health centers. Implement Sci Commun 2023; 4:118. [PMID: 37730659 PMCID: PMC10512568 DOI: 10.1186/s43058-023-00485-5] [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: 09/16/2022] [Accepted: 08/06/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Adoption of colorectal cancer (CRC) screening has lagged in community health center (CHC) populations in the USA. To address this implementation gap, we developed a multilevel intervention to improve screening in CHCs in our region. We used the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to guide this effort. Here, we describe the use of implementation strategies outlined in the Expert Recommendations for Implementing Change (ERIC) compilation in both the Exploration and Preparation phases of this project. During these two EPIS phases, we aimed to answer three primary questions: (1) What factors in the inner and outer contexts may support or hinder colorectal cancer screening in North Carolina CHCs?; (2) What evidence-based practices (EBPs) best fit the needs of North Carolina CHCs?; and (3) How can we best integrate the selected EBPs into North Carolina CHC systems? METHODS During the Exploration phase, we conducted local needs assessments, built a coalition, and conducted local consensus discussions. In the Preparation phase, we formed workgroups corresponding to the intervention's core functional components. Workgroups used cyclical small tests of change and process mapping to identify implementation barriers and facilitators and to adapt intervention components to fit inner and outer contexts. RESULTS Exploration activities yielded a coalition of stakeholders, including two rural CHCs, who identified barriers and facilitators and reached consensus on two EBPs: mailed FIT and navigation to colonoscopy. Stakeholders further agreed that the delivery of those two EBPs should be centralized to an outreach center. During Preparation, workgroups developed and refined protocols for the following centrally-delivered intervention components: a registry to identify and track eligible patients, a centralized system for mailing at-home stool tests, and a process to navigate patients to colonoscopy after an abnormal stool test. CONCLUSIONS This description may be useful both to implementation scientists, who can draw lessons from applied implementation studies such as this to refine their implementation strategy typologies and frameworks, as well as to implementation practitioners seeking exemplars for operationalizing strategies in early phases of implementation in healthcare.
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Affiliation(s)
- Renée M Ferrari
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA.
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA.
| | - Jennifer Leeman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
- School of Nursing, University of North Carolina at Chapel Hill, 120 North Medical Drive, Chapel Hill, NC, 27599, USA
| | - Alison T Brenner
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
- School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, Chapel Hill, NC, 27599, USA
| | - Sara Y Correa
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
| | - Teri L Malo
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
| | - Alexis A Moore
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
| | - Meghan C O'Leary
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Connor M Randolph
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
| | - Shana Ratner
- School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, Chapel Hill, NC, 27599, USA
- UNC Institute for Healthcare Quality Improvement, CB #8005, Chapel Hill, NC, 27599, USA
| | - Leah Frerichs
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Deeonna Farr
- College of Health and Human Performance, East Carolina University, 2307 Carol G. Belk Building, Greenville, NC, 27858, USA
| | - Seth D Crockett
- School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, Chapel Hill, NC, 27599, USA
- Division of Gastroenterology & Hepatology, Oregon Health & Science University, 3161 SW Pavilion Loop, Portland, OR, 97239, USA
| | - Stephanie B Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Kristen Hassmiller Lich
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
| | - Evan Beasley
- Blue Ridge Health, UNC Health, 2579 Chimney Rock Road, Hendersonville, NC, 28792, USA
| | - Michelle Hogsed
- Blue Ridge Health, 2759 Chimney Rock Road, Hendersonville, NC, 28792, USA
| | - Ashley Bland
- Blue Ridge Health, 2759 Chimney Rock Road, Hendersonville, NC, 28792, USA
| | - Claudia Richardson
- Ahoskie Comprehensive Care, Roanoke Chowan Community Health Center, 120 Health Center Drive, Ahoskie, NC, 27910, USA
| | - Mike Newcomer
- Digestive Health Partners, 191 Biltmore Avenue, Asheville, NC, 28801, USA
- Western Carolina Medical Society, 304 Summit Street, Asheville, NC, 28803, USA
| | - Daniel S Reuland
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC, 27599, USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC, 27599, USA
- School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, Chapel Hill, NC, 27599, USA
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10
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Wali S, Seidel J, Spence G, Innes L, Innes E, Simard A, Mashford-Pringle A, Ssinabulya I, Cafazzo JA, Ross H. Heart Health Begins With Community: Community-Based Research Exploring Innovative Strategies to Support First Nations Heart Health. CJC Open 2023; 5:661-670. [PMID: 37744661 PMCID: PMC10516713 DOI: 10.1016/j.cjco.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 06/27/2023] [Indexed: 09/26/2023] Open
Abstract
Background Indigenous people have displayed their strength through their holistic practices and spiritual connection to the land. Despite overcoming the impact of discriminatory and disempowering policies within Western institutions, Indigenous people continue to experience a higher risk of cardiovascular disease, compared to the general population. To move toward improving Indigenous health outcomes, researchers need to work in partnership with communities to develop heart health strategies centred on their experienced barriers and sources of healing. We conducted a community-based explorative study in Moosonee, Ontario to explore the local community's needs and priorities regarding heart health and wellness. Methods A convenience sample of community members and healthcare professionals were invited to participate in a sharing circle. Qualitative data were analyzed using conventional content analysis and the Indigenous method of two-eyed seeing. Results Eight community members and 5 healthcare professionals participated in the sharing circle. Four dominant themes were identified: (1) heart health is more than metrics; (2) honouring our traumas; (3) destigmatizing care through relationship building; and (4) innovative solutions start with community. With the history of mistreatment among Indigenous people, strength-based solutions involved rebuilding clinical relationships. To bring care closer to home, digital health tools were widely accepted, but the design of these tools needs to integrate both Western and Indigenous approaches to healing. Conclusions Indigenous health upholds the physical, emotional, psychological, and spiritual needs of an individual as being of equal importance. To improve community heart health, strategies should start by strengthening broken bonds and bridging multiple worldviews of healing.
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Affiliation(s)
- Sahr Wali
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto, Ontario, Canada
| | - Justice Seidel
- Minomathasowin Healthy Living Public Health Department, Weeneebayko Area Health Authority, Moose Factory, Ontario, Canada
| | - Greg Spence
- Weeneebayko General Hospital, Weeneebayko Area Health Authority, Moose Factory, Ontario, Canada
| | - Lynne Innes
- Weeneebayko General Hospital, Weeneebayko Area Health Authority, Moose Factory, Ontario, Canada
| | - Elaine Innes
- Weeneebayko General Hospital, Weeneebayko Area Health Authority, Moose Factory, Ontario, Canada
| | - Anne Simard
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
| | - Angela Mashford-Pringle
- Waakebiness-Bryce Institute for Indigenous Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Isaac Ssinabulya
- Uganda Initiative for Integrated Management of Non-Communicable Diseases, Kampala, Uganda
- Uganda Heart Institute, Mulago National Referral Hospital, Kampala, Uganda
| | - Joseph A. Cafazzo
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Digital Therapeutics, Techna Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada
| | - Heather Ross
- Ted Rogers Centre for Heart Research, University Health Network, Toronto, Ontario, Canada
- Institute of Medical Sciences, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
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11
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Tracy M, Gordis E, Strully K, Marshall BDL, Cerdá M. Applications of agent-based modeling in trauma research. PSYCHOLOGICAL TRAUMA : THEORY, RESEARCH, PRACTICE AND POLICY 2023; 15:939-950. [PMID: 36136775 PMCID: PMC10030380 DOI: 10.1037/tra0001375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Trauma, violence, and their consequences for population health are shaped by complex, intersecting forces across the life span. We aimed to illustrate the strengths of agent-based modeling (ABM), a computational approach in which population-level patterns emerge from the behaviors and interactions of simulated individuals, for advancing trauma research; Method: We provide an overview of agent-based modeling for trauma research, including a discussion of the model development process, ABM as a complement to other causal inference and complex systems approaches in trauma research, and past ABM applications in the trauma literature; Results: We use existing ABM applications to illustrate the strengths of ABM for trauma research, including incorporating interactions between individuals, simulating processes across multiple scales, examining life-course effects, testing alternate theories, comparing intervention strategies in a virtual laboratory, and guiding decision making. We also discuss the challenges of applying ABM to trauma research and offer specific suggestions for incorporating ABM into future studies of trauma and violence; Conclusion: Agent-based modeling is a useful complement to other methodological advances in trauma research. We recommend a more widespread adoption of ABM, particularly for research into patterns and consequences of individual traumatic experiences across the life course and understanding the effects of interventions that may be influenced by social norms and social network structures. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Melissa Tracy
- Department of Epidemiology and Biostatistics, University at Albany, State University of New York, 1 University Place, Rensselaer, NY 12144, United States
| | - Elana Gordis
- Department of Psychology, University at Albany, State University of New York, 1400 Washington Ave, Albany, NY 12222, United States
| | - Kate Strully
- Department of Sociology, University at Albany, State University of New York, 1400 Washington Ave, Albany, NY 12222, United States
| | - Brandon D. L. Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Providence, RI, 02912, United States
| | - Magdalena Cerdá
- Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York, NY 10016, United States
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12
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Bauer KL, Haapanen KA, Demeke N, Fort MP, Henderson KH. Increasing use of systems science in cardiovascular disease prevention to understand how to address geographic health disparities in communities with a disproportionate burden of risk. Front Cardiovasc Med 2023; 10:1216436. [PMID: 37522076 PMCID: PMC10374219 DOI: 10.3389/fcvm.2023.1216436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
Objective Marginalized communities shoulder a disproportionate burden of cardiovascular disease (CVD) driven by concentrated neighborhood social risk factors. We provide a case study of systems science application to address geographic CVD health disparities at the community level - informing the science of CVD health disparities research. Methods We conducted a two-phased, multi-methods needs assessment in the Denver, Colorado area. Phase I consisted of a social network analysis to map a two-mode network of existing CVD prevention interventions and their implementing organizations. In Phase II, group model building (GMB) sessions with key community, public health, and healthcare provider stakeholders, were utilized to identify and visualize community factors contributing to disparities in CVD risk, producing a consensus-based causal loop diagram. Results Between May 2021 and June 2022, we conducted 24 virtual, semi-structured interviews in Phase I to describe CVD prevention interventions, and 7 virtual GMB sessions in Phase II to describe experiences of disparities in CVD risk. For the purposes of this paper, we focus on a subset of results for both phases. In Phase I we identified 89 active CVD prevention interventions, 29 of which addressed tobacco use. In Phase II, causal loop diagrams revealed root causes of disparities in CVD risk. We provide an example of a causal loop diagram that focuses on the community prevalence of tobacco use, identifying stress as a key underlying factor driving disparities. The integration of findings from both phases highlighted the alignment and misalignment between quit tobacco intervention goals and how they are being experienced in marginalized communities. Conclusion Systems science methods were useful to organize a large number of CVD prevention efforts, and evaluate the root causes of CVD health disparities in a high risk community. By integrating these two aspects, interventions may be reoriented to more effectively address the root causes of CVD health disparities.
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Affiliation(s)
- Kyla L. Bauer
- Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Krista A. Haapanen
- Department of Human and Organizational Development, Vanderbilt University, Nashville, TN, United States
| | - Nathaniel Demeke
- Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Meredith P. Fort
- Department of Health Systems, Management and Policy, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Kamal H. Henderson
- Department of Cardiology, University of Colorado Denver School of Medicine, Aurora, CO, United States
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13
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Allender S, Munira SL, Bourke S, Lancsar E. Participatory systems science for enhancing health and wellbeing in the Indian Ocean territories. Front Public Health 2023; 11:1013869. [PMID: 37397744 PMCID: PMC10310353 DOI: 10.3389/fpubh.2023.1013869] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 05/09/2023] [Indexed: 07/04/2023] Open
Abstract
Objectives Co-creation of diabetes and obesity prevention with remote communities allows local contextual factors to be included in the design, delivery, and evaluation of disease prevention efforts. The Indian Ocean Territories (IOT) comprise the Christmas (CI) and Cocos Keeling Islands (CKI) and are remote Australian external territories located northwest of the mainland. We present results of a co-design process conducted with residents of IOT using realist inquiry and system mapping. Methods Interviews with 33 community members (17 CI, 14 CKI, 2 off Islands) on causes and outcomes of diabetes (2020/21) comprising community representatives, health services staff, dietitians, school principals and government administrators. Interviews were used to create causal loop diagrams representing the causes of diabetes in the IOT. These diagrams were used in a participatory process to identify existing actions to address diabetes, identify areas where more effort would be valuable in preventing diabetes, and to described and prioritize actions based on feasibility and likely impact. Findings Interviews identified 31 separate variables categorized into four themes (structural, food, knowledge, physical activity). Using causa loop diagrams, community members developed 32 intervention ideas that included strengthening healthy behaviors like physical activity, improving access to healthy and culturally appropriate foods, and overcoming the significant cost and availability limitations imposed by remoteness and freight costs. Interventions included relatively unique Island issues (e.g., freight costs, limited delivery timing), barriers to healthy food (e.g., limited fresh food availability), physical activity (e.g., transient workforce) and knowledge (e.g., multiple cultural backgrounds and language barriers, intergenerational knowledge).
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Affiliation(s)
- Steven Allender
- Global Centre for Preventive Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Syarifah Liza Munira
- Department of Health Services, Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Siobhan Bourke
- Department of Health Services, Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Emily Lancsar
- Department of Health Services, Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
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14
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Sohl SJ, Befus D, Tooze JA, Levine B, Golden SL, Puccinelli-Ortega N, Pasche BC, Weaver KE, Lich KH. Feasibility of Systems Support Mapping to guide patient-driven health self-management in colorectal cancer survivors. Psychol Health 2023; 38:602-622. [PMID: 34570677 PMCID: PMC8957632 DOI: 10.1080/08870446.2021.1979549] [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: 11/13/2020] [Revised: 06/30/2021] [Accepted: 09/02/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate feasibility of System Support Mapping (MAP), a systems thinking activity that involves creating a diagram of existing self-management activities (e.g. symptom management, health behaviors) to facilitate autonomous engagement in optimal self-management. DESIGN One-arm pilot study of MAP in colorectal cancer survivors (NCT03520283). MAIN OUTCOME MEASURES Feasibility of recruitment and retention (primary outcome), acceptability, and outcome variability over time. RESULTS We enrolled 24 of 66 cancer survivors approached (36%) and 20 completed follow-up (83%). Key reasons for declining participation included: not interested (n = 18), did not perceive a need (n = 9), and emotional distress/overwhelmed (n = 7). Most participants reported that MAP was acceptable (e.g. 80% liked MAP quite a bit/very much). Exploratory analyses revealed a -4.68 point reduction in fatigue from before to 2 weeks after MAP exceeding a minimally important difference (d = -0.68). There were also improvements in patient autonomy (d = 0.63), self-efficacy (for managing symptoms: d = 0.56, for managing chronic disease: d = 0.44), psychological stress (d = -0.45), anxiety (d = -0.34), sleep disturbance (d = -0.29) and pain (d = -0.32). Qualitative feedback enhanced interpretation of results. CONCLUSIONS MAP feasibility in colorectal cancer survivors was mixed, predominantly because many patients did not perceive a need for this approach. MAP was acceptable among participants and showed promise for improving health outcomes.
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Affiliation(s)
- Stephanie J Sohl
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Deanna Befus
- Arthur Labatt Family School of Nursing, University of Western Ontario, London, ON, Canada
| | - Janet A Tooze
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Beverly Levine
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Shannon L Golden
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | | | - Boris C Pasche
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Kathryn E Weaver
- Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, USA
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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15
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Kahkoska AR, Smith C, Thambuluru S, Weinstein J, Batsis JA, Pratley R, Weinstock RS, Young LA, Hassmiller Lich K. "Nothing is linear": Characterizing the determinants and dynamics of CGM use in older adults with type 1 diabetes. Diabetes Res Clin Pract 2023; 196:110204. [PMID: 36509180 PMCID: PMC9974816 DOI: 10.1016/j.diabres.2022.110204] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 11/29/2022] [Accepted: 12/04/2022] [Indexed: 12/13/2022]
Abstract
AIMS Continuous glucose monitoring (CGM) can reduce hypoglycemia in older adults with type 1 diabetes (T1D). We aimed to characterize factors that influence effective use in this age group. METHODS Older adults with type T1D (age ≥ 65) and their caregivers participated in one of a series of parallel group model building workshops, a participatory approach to system dynamics involving drawing and scripted group activities. Data were synthesized in a qualitative model of the hypothesized system of factors producing distinct patterns of CGM use in older adults. The model was validated through virtual follow-up interviews. RESULTS Data were collected from 33 participants (four patient-caregiver dyads, mean age 73.8 ± 4.4 years [range 66-85 years]; 16 % non-CGM users, 79 % pump users). The system model delineates drivers of CGM uptake, drivers of ongoing CGM use, and feedback loops that either reinforce or counteract future CGM use. Participants emphasized the importance of different sets of feedback loops at different points in the duration of CGM use. CONCLUSIONS The holistic system model underscores that factors and feedback loops driving effective CGM use in older adults are both individualized and dynamic (e.g., changing over time), suggesting opportunities for staged and tailored age-specific education and support.
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Affiliation(s)
- Anna R Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Division of Endocrinology and Metabolism, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Center for Aging and Health, School of Medicine, University of North Carolina at Chapel Hill, NC, USA.
| | - Cambray Smith
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Sirisha Thambuluru
- Division of Endocrinology and Metabolism, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Joshua Weinstein
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - John A Batsis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Division of Geriatric Medicine, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Center for Aging and Health, School of Medicine, University of North Carolina at Chapel Hill, NC, USA.
| | - Richard Pratley
- AdventHealth Translational Research Institute, Orlando, FL, USA.
| | | | - Laura A Young
- Division of Endocrinology and Metabolism, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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16
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Pronk NP, Mabry PL, Bond S, Arena R, Faghy MA. Systems science approaches to cardiovascular disease prevention and management in the era of COVID-19: A Humpty-Dumpty dilemma? Prog Cardiovasc Dis 2023; 76:69-75. [PMID: 36563922 PMCID: PMC9764826 DOI: 10.1016/j.pcad.2022.12.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Accepted: 12/11/2022] [Indexed: 12/24/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic necessitated the implementation and prioritizing of strict public health strategies to mitigate COVID-19 transmission and infection over all else. As we enter a 'recovery' phase in which the impact of the virus recedes (but does not relent), we ask, "How do we develop a game plan that considers prevention over management of public health threats of a more chronic nature, including cardiovascular disease?" We frame this choice point as a "Humpty-Dumpty" moment for public health with enduring and potentially irreversible consequences. Citing clear examples of other public health successes and failures, we outline in detail how sustaining cardiovascular population health under complex post-pandemic conditions will necessitate decision-making to be informed with a systems science approach, in which interventions, goals, outcomes and features of complex systems are carefully aligned.
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Affiliation(s)
- Nicolaas P Pronk
- HealthPartners Institute, Minneapolis, MN, USA; Department of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA.
| | | | - Sam Bond
- Department of Biomedical and Health Information Sciences, University of Illinois at Chicago, Chicago, USA; Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA
| | - Ross Arena
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA; Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, USA
| | - Mark A Faghy
- Healthy Living for Pandemic Event Protection (HL-PIVOT) Network, Chicago, IL, USA; Department of Physical Therapy, College of Applied Health Sciences, University of Illinois at Chicago, USA; Biomedical Research Theme, School of Human Sciences, University of Derby, UK
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17
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Simpson ML, Ruru S, Oetzel J, Meha P, Nock S, Holmes K, Adams H, Akapita N, Clark M, Ngaia K, Moses R, Reddy R, Hokowhitu B. Adaptation and implementation processes of a culture-centred community-based peer-education programme for older Māori. Implement Sci Commun 2022; 3:123. [DOI: 10.1186/s43058-022-00374-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022] Open
Abstract
Abstract
Background
Health inequities experienced by kaumātua (older Māori) in Aotearoa, New Zealand, are well documented. Examples of translating and adapting research into practice that identifies ways to help address such inequities are less evident. The study used the He Pikinga Waiora (HPW) implementation framework and the Consolidated Framework for Implementation Research (CFIR) to explore promising co-design and implementation practices in translating an evidence-based peer-education programme for older Māori to new communities.
Methods
The study was grounded in an Indigenous methodology (Kaupapa Māori) and a participatory research approach. Data were collected from research documentation, community meeting and briefing notes, and interviews with community researchers.
Results
The data analysis resulted in several key promising practices: Kaumātua mana motuhake (kaumātua independence and autonomy) where community researchers centred the needs of kaumātua in co-designing the programme with researchers; Whanaungatanga (relationships and connectedness) which illustrated how community researchers’ existing and emerging relationships with kaumātua, research partners, and each other facilitated the implementation process; and Whakaoti Rapanga (problem-solving) which centred on the joint problem-solving undertaken by the community and university researchers, particularly around safety issues. These results illustrate content, process, and relationship issues associated with implementation effectiveness.
Conclusions
This study showed that relational factors are central to the co-design process and also offers an example of a braided river, or He Awa Whiria, approach to implementation. The study offers a valuable case study in how to translate, adapt, and implement a research-based health programme to Indigenous community settings through co-design processes.
Trial registration
The project was registered on 6 March 2020 with the Australia New Zealand Clinical Trial Registry: ACTRN12620000316909. Prospectively registered.
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18
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Oetzel J, Sika-Paotonu D, Penetito-Hemara D, Henry A. Healthier Lives Implementation Research Network for Māori and Pacific community health providers in Aotearoa New Zealand: a study protocol with an observational mixed methods design. Implement Sci Commun 2022; 3:122. [PMID: 36419125 PMCID: PMC9686062 DOI: 10.1186/s43058-022-00373-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 11/06/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Despite incremental gains in the Aotearoa New Zealand health sector, Māori and Pacific peoples still experience poorer health outcomes than non-Māori and non-Pacific. Access to the latest research and innovation is critical to improving and addressing health outcomes and health inequities in particular. However, there are numerous challenges to translating research into practice including that there is currently no known a specific infrastructure in Aotearoa New Zealand to facilitate this process. The aim of the project is to develop a network of community providers, researchers and health systems representatives that can help facilitate the implementation of novel and innovative programmes and products that help to meet the health needs of Māori and Pacific communities. METHODS This project has three stages, one of which has been completed. In Stage 1, we engaged with key leaders of organisations from various components in the health system through a co-design process to identify parameters and infrastructure of the network. In Stage 2, we propose to construct the network involving approximately 20-30 community providers (and other affiliated researchers and health system representatives) and refine its parameters through an additional co-design process. Additionally, we will use a mixed methods research design using survey and interviews to identify perceived implementation needs, facilitators and barriers to help inform the work in the third stage. In Stage 3, we will support the active implementation of evidence-based programmes with a smaller number of providers (approximately four to eight community providers depending on the complexity of the implementation). Mixed methods research will be conducted to understand facilitators and barriers to implementation processes and outcomes. DISCUSSION The proposed network infrastructure is an equity-oriented strategy focused on building capacity through a strength-based approach that can help address inequities over time. Our "proof-of-concept" study will not be able to change inequities in that time period given its relatively small scale and time period, but it should set the foundation for continued equity-oriented work.
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Affiliation(s)
- John Oetzel
- University of Waikato, Hamilton, New Zealand.
| | | | | | - Akarere Henry
- South Waikato Pacific Islands Community Services, Tokoroa, New Zealand
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19
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Brown AD, Bolton KA, Clarke B, Fraser P, Lowe J, Kays J, Hovmand PS, Allender S. System dynamics modelling to engage community stakeholders in addressing water and sugar sweetened beverage consumption. Int J Behav Nutr Phys Act 2022; 19:118. [PMID: 36088361 PMCID: PMC9463801 DOI: 10.1186/s12966-022-01363-4] [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: 12/16/2021] [Accepted: 09/04/2022] [Indexed: 08/24/2023] Open
Abstract
Abstract
Background
Participatory approaches to develop community-based system dynamics models to tackle complexity are promising, but research is needed in how simulation models can be developed with community stakeholders to yield significant system insights. This study presents the results of a community-based system dynamics modelling process to increase water consumption and decrease sugar sweetened beverage consumption in Portland, Victoria, a regional town in Australia.
Methods
A series of group model building workshops with 11 community stakeholders addressing the topic of water and sugar sweetened beverage consumption was conducted in Portland. A simulating system dynamics model was built with stakeholders to inform action planning.
Results
A system dynamics model was created to provide insight into water and sugar sweetened beverage consumption in Portland. The model included six feedback loops describing the causal effects of sugar sweetened beverage consumption habits and norms, water taste, water consumption norms, public water availability, and public health benefits. For example, the sugar sweetened beverage consumption norm loop modelled how people overestimating others’ consumption may motivate an increase in their own consumption, feeding back and further amplifying an increase in sugar sweetened beverage consumption. The model contributed to the foundation of a strong partnership to improve the taste of water and educate the public on water consumption.
Conclusions
Engaging stakeholders in system dynamics modelling about water and sugar sweetened beverage consumption increased engagement and collaboration to address the problem among community stakeholders.
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Kenzie ES, Patzel M, Nelson E, Lovejoy T, Ono S, Davis MM. Long drives and red tape: mapping rural veteran access to primary care using causal-loop diagramming. BMC Health Serv Res 2022; 22:1075. [PMID: 35999540 PMCID: PMC9396592 DOI: 10.1186/s12913-022-08318-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 07/04/2022] [Indexed: 11/27/2022] Open
Abstract
Background Rural veterans experience more challenges than their urban peers in accessing primary care services, which can negatively impact their health and wellbeing. The factors driving this disparity are complex and involve patient, clinic, health system, community and policy influences. Federal policies over the last decade have relaxed requirements for some veterans to receive primary care services from community providers through their VA benefits, known as community care. Methods We used a participatory systems mapping approach involving causal-loop diagramming to identify interrelationships between variables underlying challenges to veteran access to primary care and potential opportunities for change—known as leverage points in systems science. Our methods involved a secondary analysis of semi-structured qualitative interviews with rural veterans, VA staff, non-VA clinic staff and providers who serve rural veterans, and veteran service officers (VSOs) in the Northwest region of the US, followed by a two-part participatory modeling session with a study advisory board. We then applied Meadows’s leverage point framework to identify and categorize potential interventions to improve rural veteran access to primary care. Results The final model illustrated challenges at the veteran, clinic, and system levels as experienced by stakeholders. Main components of the diagram pertained to the choice of VA or non-VA primary care, veteran satisfaction with the VA, enrollment in VA benefits and other insurance, community care authorization, reimbursement of non-VA care, referrals to specialty care, record sharing and communication between VA and non-VA providers, institutional stability of the VA, and staffing challenges. Fourteen interventions, including administrative and communications changes, were identified by analyzing the model using the leverage points framework. Conclusions Our findings illustrate how challenges rural veterans face accessing health care are interconnected and persist despite recent changes to federal law pertaining to the VA health care system in recent years. Systems mapping and modeling approaches such as causal-loop diagramming have potential for engaging stakeholders and supporting intervention and implementation planning. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08318-2.
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Affiliation(s)
- Erin S Kenzie
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, OR, USA.
| | - Mary Patzel
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, OR, USA
| | - Erik Nelson
- Independent Veteran Advocate, Portland, OR, USA
| | - Travis Lovejoy
- VA Office of Rural Health, Veterans Rural Health Resource Center, Portland, OR, USA.,Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Sarah Ono
- VA Office of Rural Health, Veterans Rural Health Resource Center, Portland, OR, USA.,Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, OR, USA.,Department of Psychiatry, Oregon Health & Science University, Portland, OR, USA
| | - Melinda M Davis
- Oregon Rural Practice-Based Research Network, Oregon Health & Science University, Portland, OR, USA.,Department of Family Medicine and School of Public Health, Oregon Health & Science University, Portland, OR, USA
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21
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Abstract
Population-based solutions are needed to stabilize and then reverse the continued upward trends in obesity prevalence in the US population and worldwide. This review focuses on the related, urgent issue of disparities in obesity prevalence affecting US racial/ethnic minority and other socially marginalized populations. The review provides background on these disparities from a health equity perspective and highlights evidence of progress in equity-focused obesity efforts. Five recommendations for advancing equity efforts are offered as potential approaches to build on progress to date: (a) give equity issues higher priority, (b) adopt a health equity lens, (c) strengthen approaches by using health equity frameworks, (d) broaden the types of policies considered, and (e) emphasize implementation science concepts and tools. Potential challenges and opportunities are identified, including the prospect of longer-term, transformative solutions that integrate global and national initiatives to address obesity, undernutrition, and climate change.
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Affiliation(s)
- Shiriki K Kumanyika
- Dornsife School of Public Health, Drexel University, and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA;
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22
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Practical Approaches for Promoting Health Equity in Communities. Matern Child Health J 2022; 26:82-87. [PMID: 35920955 PMCID: PMC9482601 DOI: 10.1007/s10995-022-03456-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2022] [Indexed: 12/04/2022]
Abstract
The Maternal and Child Health workforce, public health practitioners, researchers, and other groups need clear, practical guidance on how to promote health equity in the communities they serve. The National Maternal and Child Health Workforce Development Center’s Health Equity Team synthesized eight approaches for promoting health equity that drew on their experience working with public health practitioners and communities. The approaches are to: Expand the understanding of the drivers of health and work across sectors; Take a systems approach; Reflect on your own organization; Follow the lead of communities who experience injustices; Work with community members, decision-makers, and other stakeholders to prioritize action; Foster agency within individuals and collective action within groups; Identify and collect data to show where health inequities currently exist to inform equitable investment of resources; and Be accountable to outcomes that reflect real improvements in people’s lives. The fields of maternal and child health and public health more broadly is already engaged in the complex work of promoting equity and social justice, and in doing so, should refine, challenge, add to, and build upon these approaches.
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23
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Leston J, Wenger H, Reilley B, Craig Rushing S, Rink E, Warren H, Howe J, Bloomquist P, Tah T, Jeffries I, Iralu J, Thorpe P, Apostolou A, Taylor MM. Creating a path forward: understanding the context of sexual health and sexually transmitted infections in American Indian/Alaska Native populations – a review. Sex Health 2022; 19:286-298. [PMID: 35760766 PMCID: PMC11081199 DOI: 10.1071/sh22040] [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: 03/04/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022]
Abstract
This review assessed sexual health and sexually transmitted infection (STI) burden among American Indian/Alaska Native (AI/AN) peoples within the context of current clinical and public health services. We conducted a review of published literature about sexual health and bacterial STIs among AI/AN populations in the United States using Medline (OVID), CINAHL (EbscoHost) and Scopus. Peer-reviewed journals published during 1 January 2005-2 December 2021 were included and supplemented by other publicly available literature. A total of 138 articles from reference lists met inclusion criteria, including 85 peer-review articles and 53 additional references. Results indicate a disproportionate burden of STIs is carried by AI/AN populations compared to non-Hispanic Whites. Risk for STIs in AI/AN people has origins in historical trauma and structural and social determinants of health. STI services are available for AI/AN populations, but many barriers to care exist. Community-based sexual health programming has been successful, but has thus far focused primarily on adolescents and young adults. A myriad of factors contributes to high rates of STIs among AI/AN populations. Longstanding disparities show a clear need to increase the availability of integrated, low-barrier STI prevention and treatment services. Implementation of multi-level (individual, physician, clinic, healthcare organisation, and/or community level), culturally relevant sexual health and STI interventions should be community-based and person-centred, acknowledge social determinants of health, and grounded in deep respect and understanding of AI/AN histories and cultures.
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Affiliation(s)
- Jessica Leston
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | | | - Brigg Reilley
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | | | | | - Hannah Warren
- Alaska Native Tribal Health Consortium, Anchorage, AK, USA
| | - Jean Howe
- Northern Navajo Medical Center, Indian Health Service, Shiprock, NM, USA
| | | | - Tina Tah
- Indian Health Service Headquarters, Rockville, MD, USA
| | - Itai Jeffries
- Northwest Portland Area Indian Health Board, Portland, OR, USA
| | - Jonathan Iralu
- Gallup Indian Medical Center, Indian Health Service, Gallup, NM, USA
| | - Phoebe Thorpe
- U.S. Centers for Disease Control and Prevention, Division of STD Prevention, Atlanta, GA, USA
| | | | - Melanie M. Taylor
- U.S. Centers for Disease Control and Prevention, Division of HIV Prevention, Atlanta, GA, USA
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24
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Rink E, Firemoon P, Anastario M, Johnson O, GrowingThunder R, Ricker A, Peterson M, Baldwin J. Rationale, Design, and Methods for Nen Unkumbi/Edahiyedo ("We Are Here Now"): A Multi-Level Randomized Controlled Trial to Improve Sexual and Reproductive Health Outcomes in a Northern Plains American Indian Reservation Community. Front Public Health 2022; 10:823228. [PMID: 35910931 PMCID: PMC9326233 DOI: 10.3389/fpubh.2022.823228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 04/29/2022] [Indexed: 12/01/2022] Open
Abstract
American Indian (AI) youth in the United States experience disproportionate sexual and reproductive health (SRH) disparities relative to their non-Indigenous, white counterparts, including increased rates of sexually transmitted infections (STIs), earlier sexual debut, increased rates of teen birth, and reduced access to SRH services. Past research shows that to improve SRH outcomes for AI youth in reservation communities, interventions must address complex factors and multiple levels of community that influence sexual risk behaviors. Here, we describe development of a multi-level, multi-component randomized controlled trial (RCT) to intervene upon SRH outcomes in a Northern Plains American Indian reservation community. Our intervention is rooted in a community based participatory research framework and is evaluated with a stepped wedge design that integrates 5 reservation high schools into a 5-year, cluster-randomized RCT. Ecological Systems Theory was used to design the intervention that includes (1) an individual level component of culturally specific SRH curriculum in school, (2) a parental component of education to improve parent-child communication about SRH and healthy relationships, (3) a community component of cultural mentorship, and (4) a systems-level component to improve delivery of SRH services from reservation healthcare agencies. In this article we present the rationale and details of our research design, instrumentation, data collection protocol, analytical methods, and community participation in the intervention. Our intervention builds upon existing community strengths and integrates traditional Indigenous knowledge and values with current public health knowledge to reduce SRH disparities.
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Affiliation(s)
- Elizabeth Rink
- Department of Health and Human Development, Montana State University, Bozeman, MT, United States
| | | | - Michael Anastario
- AHC5, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, United States
| | | | - Ramey GrowingThunder
- Language and Culture Department, Fort Peck Assiniboine and Sioux Tribes, Poplar, MT, United States
| | - Adriann Ricker
- School of Nursing, Johns Hopkins University, Baltimore, MD, United States
| | - Malory Peterson
- Department of Health and Human Development, Montana State University, Bozeman, MT, United States
| | - Julie Baldwin
- Center for Health Equity Research, Northern Arizona University, Flagstaff, AZ, United States
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25
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Simpson ML, Oetzel J, Wilson Y, Nock S, Johnston K, Reddy R. Codesigning a Culture-Centered Age-Friendly Community for Māori Kaumātua: Cultural Principles and Practices. J Gerontol B Psychol Sci Soc Sci 2022; 77:2265-2275. [PMID: 35796864 PMCID: PMC9799182 DOI: 10.1093/geronb/gbac092] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES This study examined a Māori (Indigenous people of Aotearoa New Zealand) age-friendly housing development. Two Māori community groups worked with multiple stakeholders to codesign a culture-centered, kaumātua (older adults) urban housing community. The purpose was to identify codesign and culture-centered principles in the development. METHODS Kaupapa Māori (Māori-centered) and participatory research methodologies guided the culture-centered research design. Data collection included 27 interviews with 19 residents and 12 organizational stakeholders; three focus groups with residents' families, service providers, and nonresident kaumātua (n = 16); and project documents. Data analysis used the framework method. RESULTS Three codesign process themes emerged: (a) Kaumātua-centered vision; (b) realizing the vision; and (c) living the shared vision. DISCUSSION Accounting for cultural practices in codesigning age-friendly and culture-centered housing for and with Indigenous older adults helps meet their cultural, social, health, and economic needs. The research offers a practical pathway to developing age-friendly housing environments for Māori kaumātua, their communities, wider society, and other Indigenous people.
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Affiliation(s)
- Mary Louisa Simpson
- Address correspondence to: Mary Louisa Simpson, PhD, Waikato Management School, University of Waikato, PB 3105, Hamilton 3240, New Zealand. E-mail:
| | - John Oetzel
- Waikato Management School, University of Waikato, Hamilton, New Zealand
| | | | - Sophie Nock
- Faculty of Māori and Indigenous Studies, University of Waikato, Hamilton, New Zealand
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26
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Deutsch AR, Lustfield R, Jalali MS. Community-based system dynamics modelling of stigmatized public health issues: Increasing diverse representation of individuals with personal experiences. SYSTEMS RESEARCH AND BEHAVIORAL SCIENCE 2022; 39:734-749. [PMID: 36337318 PMCID: PMC9635333 DOI: 10.1002/sres.2807] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/02/2021] [Indexed: 06/16/2023]
Abstract
Utility of community-based system dynamics (CBSD) models on stigmatized public health issues and health disparities depends upon how representative the model is to real-world experience within the community. "Personal experience" participants (PEP), especially from marginalized groups, are essential model contributors, but are often underrepresented in modeling groups due to multiple barriers. This study details a method to increase PEP representation for models on stigmatized issues. We use a case study from a CBSD project on health disparities within the association between alcohol misuse (AM) and intimate partner violence (IPV) for Northern Plains Indigenous women. Short group model building sessions were held at three community organizations providing relevant resources. Each model contributed unique system components, and there were few similarities between models. A consolidated model provided a rich picture of the complex system. Adding brief PEP-based group modeling sessions can enhance PEP representation in model development for stigmatized public health issues.
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Affiliation(s)
- Arielle R Deutsch
- Avera Research Institute; University of South Dakota School of Medicine, Pediatrics
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27
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Graetz N, Boen CE, Esposito MH. Structural Racism and Quantitative Causal Inference: A Life Course Mediation Framework for Decomposing Racial Health Disparities. JOURNAL OF HEALTH AND SOCIAL BEHAVIOR 2022; 63:232-249. [PMID: 35001689 PMCID: PMC11251000 DOI: 10.1177/00221465211066108] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Quantitative studies of racial health disparities often use static measures of self-reported race and conventional regression estimators, which critics argue is inconsistent with social-constructivist theories of race, racialization, and racism. We demonstrate an alternative counterfactual approach to explain how multiple racialized systems dynamically shape health over time, examining racial inequities in cardiometabolic risk in the National Longitudinal Study of Adolescent to Adult Health. This framework accounts for the dynamics of time-varying confounding and mediation that is required in operationalizing a "race" variable as part of a social process (racism) rather than a separable, individual characteristic. We decompose the observed disparity into three types of effects: a controlled direct effect ("unobserved racism"), proportions attributable to interaction ("racial discrimination"), and pure indirect effects ("emergent discrimination"). We discuss the limitations of counterfactual approaches while highlighting how they can be combined with critical theories to quantify how interlocking systems produce racial health inequities.
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Affiliation(s)
- Nick Graetz
- Department of Sociology, Princeton University
- Population Studies Center, University of Pennsylvania
| | - Courtney E. Boen
- Population Studies Center, University of Pennsylvania
- Department of Sociology, Population Aging Research Center, Leonard Davis Institute for Health Economics, University of Pennsylvania
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28
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Afifi RA, Parker EA, Dino G, Hall DM, Ulin B. Reimagining Rural: Shifting Paradigms About Health and Well-Being in the Rural United States. Annu Rev Public Health 2022; 43:135-154. [PMID: 34910581 PMCID: PMC11295601 DOI: 10.1146/annurev-publhealth-052020-123413] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Rural health disparities have attracted increased national attention, compelling an expanded focus on rural health research. In this article, we deconstruct the definitions and narratives of "rural" communities and suggest that a paradigm shift is needed that centers the complexity and strength of rural places. We discuss the relevance of health equity frameworks, implementation science, and community-engaged approaches to promote rural well-being. Focusing on rural in its own right will lead to intervention innovations and reinvention with implications beyond rural areas. We conclude with suggestions for research and practice to inspire renewed interest in partnering with rural communities to promote health equity.
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Affiliation(s)
- R A Afifi
- Department of Community and Behavioral Health, and Prevention Research Center for Rural Health, College of Public Health, University of Iowa, Iowa City, Iowa, United States; ,
| | - E A Parker
- Department of Community and Behavioral Health, and Prevention Research Center for Rural Health, College of Public Health, University of Iowa, Iowa City, Iowa, United States; ,
| | - G Dino
- Department of Social and Behavioral Sciences, and West Virginia Prevention Research Center, School of Public Health, West Virginia University, Morgantown, West Virginia, United States;
| | - D M Hall
- Office of the Associate Director for Policy and Strategy, Centers for Disease Control and Prevention, Atlanta, Georgia, United States;
| | - B Ulin
- Division of Population Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, United States;
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29
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Stadnick NA, Cain KL, Oswald W, Watson P, Ibarra M, Lagoc R, Ayers LO, Salgin L, Broyles SL, Laurent LC, Pezzoli K, Rabin B. Co-creating a Theory of Change to advance COVID-19 testing and vaccine uptake in underserved communities. Health Serv Res 2022; 57 Suppl 1:149-157. [PMID: 35243622 PMCID: PMC9108217 DOI: 10.1111/1475-6773.13910] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/29/2021] [Accepted: 11/02/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To describe the use of a Theory of Change to meaningfully engage community members from or support underserved communities in two National Institutes of Health-funded implementation science projects aimed at promoting equitable access to COVID-19 testing and vaccination for underserved communities. STUDY SETTING Both projects focused on Latino, Black, and immigrant and refugee communities in South/Central San Diego and/or individuals accessing care at a federally qualified health center near the US/Mexico border during December 2020-April 2021. STUDY DESIGN By using a participatory action research design, Community Advisory Boards (CABs) were established for each project with 11 and 22 members. CAB members included community organizers, promotores de salud (community health workers), clinic providers and administrators, and public health researchers. The CABs were guided through a seven-session Theory of Change process, focused on identifying necessary conditions that must exist to eliminate COVID-19 disparities along with specified actions to create those conditions and a blueprint for assessing the impact of those actions. DATA COLLECTION Each session lasted 2 h hosted virtually and was augmented by interactive web-based activities. There was a live interpreter who facilitated the participation of Spanish-speaking CAB members. A Theory of Change for each project was completed in approximately 4 months. PRINCIPAL FINDINGS Nine necessary conditions were identified related to (1) accessible and available services; (2) culturally and linguistically competent programming; (3) investment in trusted community and faith leaders; (4) social safety nets to provide ancillary services. Corresponding actions to create these conditions and measures to indicate success in creating these conditions were operationalized by the CAB. CONCLUSIONS While resource-intensive, a CAB-led Theory of Change process yielded a rich opportunity to engage diverse groups that typically are not invited to inform these processes.
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Affiliation(s)
- Nicole A Stadnick
- Department of Psychiatry, University of California San Diego, La Jolla, California, USA.,Dissemination and Implementation Science Center, UC San Diego Altman Clinical and Translational Research Institute, La Jolla, California, USA.,Child and Adolescent Services Research Center, San Diego, California, USA
| | - Kelli L Cain
- The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
| | - William Oswald
- The Global Action Research Center, San Diego, California, USA
| | - Paul Watson
- The Global Action Research Center, San Diego, California, USA
| | - Marina Ibarra
- The Global Action Research Center, San Diego, California, USA
| | - Raphael Lagoc
- The Global Action Research Center, San Diego, California, USA
| | - Lawrence O Ayers
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, California, USA
| | - Linda Salgin
- San Ysidro Health, San Diego, California, USA.,San Diego State University/University of California San Diego Joint Doctoral Program in Public Health, San Diego, California, USA
| | - Shelia L Broyles
- Department of Pediatrics, University of California San Diego, La Jolla, California, USA.,Community Engagement Unit, UC San Diego Altman Clinical and Translational Research Institute, La Jolla, California, USA
| | - Louise C Laurent
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California San Diego, La Jolla, California, USA
| | - Keith Pezzoli
- Department of Urban Studies and Planning, University of California San Diego, La Jolla, California, USA.,Bioregional Center for Sustainability Science, Planning and Design, University of California San Diego, La Jolla, California, USA.,Superfund Research Center, Community Engagement and Research Translation Cores, University of California, San Diego, La Jolla, California, USA
| | - Borsika Rabin
- Dissemination and Implementation Science Center, UC San Diego Altman Clinical and Translational Research Institute, La Jolla, California, USA.,The Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
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30
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Winkler MR, Mui Y, Hunt SL, Laska MN, Gittelsohn J, Tracy M. Applications of Complex Systems Models to Improve Retail Food Environments for Population Health: A Scoping Review. Adv Nutr 2021; 13:1028-1043. [PMID: 34999752 PMCID: PMC9340968 DOI: 10.1093/advances/nmab138] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 09/10/2021] [Accepted: 11/17/2021] [Indexed: 12/11/2022] Open
Abstract
Retail food environments (RFEs) are complex systems with important implications for population health. Studying the complexity within RFEs comes with challenges. Complex systems models are computational tools that can help. We performed a systematic scoping review of studies that used complex systems models to study RFEs for population health. We examined the purpose for using the model, RFE features represented, extent to which the complex systems approach was maximized, and quality and transparency of methods employed. The PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews) guidelines were followed. Studies using agent-based modeling, system dynamics, discrete event simulations, networks, hybrid, or microsimulation models were identified from 7 multidisciplinary databases. Fifty-six studies met the inclusion criteria, including 23 microsimulation, 13 agent-based, 10 hybrid, 4 system dynamics, 4 network, and 2 discrete event simulation models. Most studies (n = 45) used models for experimental purposes and evaluated effects of simulated RFE policies and interventions. RFE characteristics simulated in models were diverse, and included the features (e.g., prices) customers encounter when shopping (n = 55), the settings (e.g., restaurants, supermarkets) where customers purchase food and beverages (n = 30), and the actors (e.g., store managers, suppliers) who make decisions that influence RFEs (n = 25). All models incorporated characteristics of complexity (e.g., feedbacks, conceptual representation of multiple levels), but these were captured to varying degrees across model types. The quality of methods was adequate overall; however, few studies engaged stakeholders (n = 10) or provided sufficient transparency to verify the model (n = 12). Complex systems models are increasingly utilized to study RFEs and their contributions to public health. Opportunities to advance the use of these approaches remain, and areas to improve future research are discussed. This comprehensive review provides the first marker of the utility of leveraging these approaches to address RFEs for population health.
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Affiliation(s)
| | - Yeeli Mui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shanda L Hunt
- Health Sciences Library, University of Minnesota, Minneapolis, MN, USA
| | - Melissa N Laska
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Joel Gittelsohn
- Center for Human Nutrition, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Melissa Tracy
- Department of Epidemiology and Biostatistics, University at Albany School of Public Health, Rensselaer, NY, USA
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31
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Rieder E, Larson LR, 't Sas-Rolfes M, Kopainsky B. Using Participatory System Dynamics Modeling to Address Complex Conservation Problems: Tiger Farming as a Case Study. FRONTIERS IN CONSERVATION SCIENCE 2021. [DOI: 10.3389/fcosc.2021.696615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Conservation practitioners routinely work within complex social-ecological systems to address threats facing biodiversity and to promote positive human-wildlife interactions. Inadequate understanding of the direct and indirect, short- and long-term consequences of decision making within these dynamic systems can lead to misdiagnosed problems and interventions with perverse outcomes, exacerbating conflict. Participatory system dynamics (SD) modeling is a process that encourages stakeholder engagement, synthesizes research and knowledge, increases trust and consensus and improves transdisciplinary collaboration to solve these complex types of problems. Tiger conservation exemplifies a set of interventions in a complex social-ecological system. Wild tigers remain severely threatened by various factors, including habitat constraints, human-wildlife conflict, and persistent consumer demand for their body parts. Opinions differ on whether commercial captive tiger facilities reduce or increase the threat from poaching for trade, resulting in policy conflict among diverse stakeholder groups. This paper explains how we are working with international conservation partners in a virtual environment to utilize a participatory SD modeling approach with the goal of better understanding and promoting coexistence of humans and wild tigers. We highlight a step-by-step process that others might use to apply participatory SD modeling to address similar conservation challenges, building trust and consensus among diverse partners to reduce conflict and improve the efficacy of conservation interventions.
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32
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Bonney T, Welter C, Jarpe-Ratner E, Velonis A, Conroy L. Role of technical assistance in U.S. labor and health sector collaboration to address precarious work. Health Promot Int 2021; 36:1095-1104. [PMID: 33351056 DOI: 10.1093/heapro/daaa124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Precarious work has recognized adverse impacts on the health of workers; however, there are few policy, systems and environmental (PSE) change public health interventions that target the causes and consequences of precarious work. To build the capacity of health organizations to develop and implement such interventions, researchers engaged representatives from health organizations in a six-session learning process, entitled the healthy work collaborative. Representatives of labor organizations were engaged as technical assistance (TA) providers, which involved sharing content and skill knowledge with health participants. Semi-structured interviews were conducted with providers and participants to examine perceptions of the role of TA; providers' motivations for providing TA; and providers' and participants' perceptions of the impact of TA on learning and preparing for subsequent intervention. Results suggest that the provider-participant engagement evolved from one-way knowledge translation to a robust, two-way knowledge exchange with potential for collaborative intervention development and implementation. These results highlight the ways in which this provider-participant model facilitated engagement between representatives from sectors that had not previously worked together and suggests that such a model may be effective in catalyzing multi-level, multi-sectoral PSE change to address precarious work.
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Affiliation(s)
| | | | | | - Alisa Velonis
- Community Health Sciences, School of Public Health, University of Illinois at Chicago, 1603 W. Taylor St., Chicago, IL, 60612, USA
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Browne J, Walker T, Brown A, Sherriff S, Christidis R, Egan M, Versace V, Allender S, Backholer K. Systems thinking for Aboriginal Health: Understanding the value and acceptability of group model building approaches. SSM Popul Health 2021; 15:100874. [PMID: 34355056 PMCID: PMC8325093 DOI: 10.1016/j.ssmph.2021.100874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 12/25/2022] Open
Abstract
Systems thinking is increasingly applied to understand and address systemic drivers of complex health problems. In Australia, group model building, a participatory method from systems science, has been applied in various locations to engage communities in systems-based health promotion projects. To date there is limited evidence regarding GMB use with Australian Aboriginal communities. This study aimed to determine the value and acceptability of group model building (GMB) as a methodological approach in research with Aboriginal communities and identify any adaptations required to optimise its utility. Semi-structured interviews were undertaken with 18 Aboriginal health and university staff who had prior experience with a GMB research project. Interview transcripts were inductively analysed using thematic analysis and key themes were organised using an Indigenous research framework. Participants reported that GMB methods generally aligned well with Aboriginal ways of knowing, being, and doing. Participants valued the holistic, visual and collaborative nature of the method and its emphasis on sharing stories and collective decision-making. Group model building was viewed as a useful tool for identifying Aboriginal-led actions to address priority issues and advancing self-determination. Our findings suggest that by bringing together Aboriginal and non-Aboriginal knowledge, GMB is a promising tool, which Aboriginal communities could utilise to explore and address complex problems in a manner that is consistent with their worldviews. In adapting group model building methods, non-Aboriginal researchers should aspire to move beyond co-design processes and enable Aboriginal health research to be entirely led by Aboriginal people. Group model building is a promising method for research with Aboriginal communities that is generally consistent with Aboriginal worldviews. Group Model Building may be a useful tool for identifying actions to address priority issues and advancing Aboriginal self-determination. Capacity building is required so that Group Model Building workshops, and ideally entire research projects, can be led by Aboriginal people.
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Affiliation(s)
- Jennifer Browne
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Locked Bag, 20000, Geelong Victoria, Australia
| | - Troy Walker
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Locked Bag, 20000, Geelong Victoria, Australia
| | - Andrew Brown
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Locked Bag, 20000, Geelong Victoria, Australia
| | - Simone Sherriff
- Sax Institute, Level 3/30C Wentworth St, Glebe, NSW, Australia
| | - Rebecca Christidis
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Locked Bag, 20000, Geelong Victoria, Australia
| | - Mikaela Egan
- Victorian Aboriginal Community Controlled Health Organisation, 17-23, Sackville St Collingwood, Victoria, Australia
| | - Vincent Versace
- Deakin Rural Health, School of Medicine, Deakin University, PO Box 423, Warrnambool Victoria, Australia
| | - Steven Allender
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Locked Bag, 20000, Geelong Victoria, Australia
| | - Kathryn Backholer
- Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Locked Bag, 20000, Geelong Victoria, Australia
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O'Flaherty M, Lloyd-Williams F, Capewell S, Boland A, Maden M, Collins B, Bandosz P, Hyseni L, Kypridemos C. Modelling tool to support decision-making in the NHS Health Check programme: workshops, systematic review and co-production with users. Health Technol Assess 2021; 25:1-234. [PMID: 34076574 DOI: 10.3310/hta25350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Local authorities in England commission the NHS Health Check programme to invite everyone aged 40-74 years without pre-existing conditions for risk assessment and eventual intervention, if needed. However, the programme's effectiveness, cost-effectiveness and equity impact remain uncertain. AIM To develop a validated open-access flexible web-based model that enables local commissioners to quantify the cost-effectiveness and potential for equitable population health gain of the NHS Health Check programme. OBJECTIVES The objectives were as follows: (1) co-produce with stakeholders the desirable features of the user-friendly model; (2) update the evidence base to support model and scenario development; (3) further develop our computational model to allow for developments and changes to the NHS Health Check programme and the diseases it addresses; (4) assess the effectiveness, cost-effectiveness and equity of alternative strategies for implementation to illustrate the use of the tool; and (5) propose a sustainability and implementation plan to deploy our user-friendly computational model at the local level. DESIGN Co-production workshops surveying the best-performing local authorities and a systematic literature review of strategies to increase uptake of screening programmes informed model use and development. We then co-produced the workHORSE (working Health Outcomes Research Simulation Environment) model to estimate the health, economic and equity impact of different NHS Health Check programme implementations, using illustrative-use cases. SETTING Local authorities in England. PARTICIPANTS Stakeholders from local authorities, Public Health England, the NHS, the British Heart Foundation, academia and other organisations participated in the workshops. For the local authorities survey, we invited 16 of the best-performing local authorities in England. INTERVENTIONS The user interface allows users to vary key parameters that represent programme activities (i.e. invitation, uptake, prescriptions and referrals). Scenarios can be compared with each other. MAIN OUTCOME MEASURES Disease cases and case-years prevented or postponed, incremental cost-effectiveness ratios, net monetary benefit and change in slope index of inequality. RESULTS The survey of best-performing local authorities revealed a diversity of effective approaches to maximise the coverage and uptake of NHS Health Check programme, with no distinct 'best buy'. The umbrella literature review identified a range of effective single interventions. However, these generally need to be combined to maximally improve uptake and health gains. A validated dynamic, stochastic microsimulation model, built on robust epidemiology, enabled service options analysis. Analyses of three contrasting illustrative cases estimated the health, economic and equity impact of optimising the Health Checks, and the added value of obtaining detailed local data. Optimising the programme in Liverpool can become cost-effective and equitable, but simply changing the invitation method will require other programme changes to improve its performance. Detailed data inputs can benefit local analysis. LIMITATIONS Although the approach is extremely flexible, it is complex and requires substantial amounts of data, alongside expertise to both maintain and run. CONCLUSIONS Our project showed that the workHORSE model could be used to estimate the health, economic and equity impact comprehensively at local authority level. It has the potential for further development as a commissioning tool and to stimulate broader discussions on the role of these tools in real-world decision-making. FUTURE WORK Future work should focus on improving user interactions with the model, modelling simulation standards, and adapting workHORSE for evaluation, design and implementation support. STUDY REGISTRATION This study is registered as PROSPERO CRD42019132087. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 35. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | | | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Angela Boland
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Brendan Collins
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Lirije Hyseni
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Chris Kypridemos
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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Yi SS, Lee M, Russo R, Li Y, Trinh-Shevrin C, Kwon SC. Dietary Policies and Programs: Moving Beyond Efficacy and Into "Real-World" Settings. Health Equity 2021; 5:194-202. [PMID: 33937605 PMCID: PMC8080927 DOI: 10.1089/heq.2020.0050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2020] [Indexed: 12/19/2022] Open
Abstract
Purpose: Dietary behaviors are key modifiable risk factors in averting cardiovascular disease (CVD), the leading cause of morbidity, mortality, and disability in the United States. Before investing in adoption and implementation, community-based organizations, public health practitioners, and policymakers—often working with limited resources—need to compare the population health impacts of different food policies and programs to determine priorities, build capacity, and maximize resources. Numerous reports, reviews, and policy briefs have synthesized across evidence-based policies and programs to make recommendations, but few have made a deep acknowledgment that dietary policies and programs are not implemented in a vacuum, and that “real-world” settings are complex, multifaceted and dynamic. Methods: A narrative review was conducted of currently recommended evidence-based approaches to improving dietary behaviors, to describe and characterize applied and practical factors for consideration when adopting and implementing these dietary policies and programs across diverse settings. Results: From the narrative review, six key considerations emerged to guide community-based organizations, public health practitioners, and policymakers on moving from the evidence base, toward implementation in local and community settings. Conclusions: Considerations of “real-world” contextual factors are necessary and important when adopting and selecting evidence-based policies and programs to improve dietary behaviors and ultimately improve CVD outcomes. Promising approaches include those that apply community-partnered research and systems science to examine the equitable implementation of evidence-based dietary policies and programs.
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Affiliation(s)
- Stella S Yi
- Department of Population Health, NYU School of Medicine, New York, New York, USA
| | - Matthew Lee
- Department of Population Health, NYU School of Medicine, New York, New York, USA.,Department of Sociomedical Sciences, Columbia Mailman School of Public Health, New York, New York, USA
| | - Rienna Russo
- Department of Population Health, NYU School of Medicine, New York, New York, USA
| | - Yan Li
- Department of Population Health Science and Policy, Mt. Sinai Icahn School of Medicine, New York, New York, USA
| | - Chau Trinh-Shevrin
- Department of Population Health, NYU School of Medicine, New York, New York, USA
| | - Simona C Kwon
- Department of Population Health, NYU School of Medicine, New York, New York, USA
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Morais LMDO, Kuhlberg J, Ballard E, Indvik K, Rocha SC, Sales DM, de Oliveira Cardoso L, Gouveia N, de Lima Friche AA, Caiaffa WT. Promoting knowledge to policy translation for urban health using community-based system dynamics in Brazil. Health Res Policy Syst 2021; 19:53. [PMID: 33794907 PMCID: PMC8015032 DOI: 10.1186/s12961-020-00663-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 11/19/2020] [Indexed: 11/25/2022] Open
Abstract
Background Effectively bridging the knowledge–policy gap to support the development of evidence-based policies that promote health and well-being remains a challenge for both the research and policy communities. Community-based system dynamics (CBSD) is a participatory modelling approach that aims to build stakeholders’ capacity to learn and address complex problems collaboratively. However, limited evidence is available about the contributions of CBSD to knowledge-generating and policy processes across sectors and policy spheres. In the context of a multi-country research project focused on creating an evidence base to inform urban health policies across Latin America, a series of CBSD workshops convened stakeholders from research, policy-making, and other backgrounds working in food and transportation systems. Diverse participants were selected aiming to incorporate multiple perspectives relevant to understanding complex urban systems linked to food and transportation. This study focuses on one of these workshops, whose avenue was São Paulo, Brazil, assembling country-based participants representing local, regional, national, and international institutions with multidisciplinary backgrounds linked to food and transportation systems. Objective The aim of this case study is to explore the perceived influence of one of these workshops on attendees’ understandings of food and transportation systems and their relationship to healthy urban environments, with attention to the role of the workshop in supporting knowledge to policy translation for urban health. Methods We conducted 18 semi-structured qualitative interviews with attendees one year after their participation in a CBSD workshop held in São Paulo, Brazil. A framework method approach was used to code participants’ responses and identify emerging themes. Results Participants reported that the workshop’s group model-building activities influenced their understanding of the knowledge–policy process as it relates to food and transport systems. Workshop contributed to participants’ (1) abilities to engage with multisectoral stakeholders, (2) construct a shared language and understanding of urban challenges, (3) improve understanding of the interconnectedness across food and transportation systems, (4) facilitate dialogue across sectors, and (5) apply a systems thinking approach within their sector and professional context. Participants continued to draw on the tools developed during the workshop, and to apply systems thinking to their research and policy-making activities. Conclusions CBSD may offer valuable opportunities to connect the research sector to the policy-making process. This possibility may contribute to knowledge to policy translation in the interconnection between the urban context, food and transportation systems, and health. Supplementary information Supplementary information accompanies this paper at 10.1186/s12961-020-00663-0.
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Affiliation(s)
- Lidia Maria de Oliveira Morais
- Observatory for Urban Health in Belo Horizonte, Federal University of Minas Gerais, Av. Pres. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, MG, 31270-901, Brazil.
| | - Jill Kuhlberg
- System Stars, St. Louis, MO, United States of America
| | - Ellis Ballard
- System Stars, St. Louis, MO, United States of America.,Social System Design Lab, Brown School At Washington University in St. Louis, 1 Brookings Drive, St. Louis, MO, 63130, United States of America
| | - Katherine Indvik
- Dornsife School of Public Health, Urban Health Collaborative, Drexel University, 3215 Market Street, Philadelphia, PA, 19104, United States of America
| | - Solimar Carnavalli Rocha
- Observatory for Urban Health in Belo Horizonte, Federal University of Minas Gerais, Av. Pres. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, MG, 31270-901, Brazil
| | - Denise Marques Sales
- Observatory for Urban Health in Belo Horizonte, Federal University of Minas Gerais, Av. Pres. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, MG, 31270-901, Brazil
| | - Letícia de Oliveira Cardoso
- Oswaldo Cruz Foundation - National School of Public Health, Rio de Janeiro, R Leopoldo Bulhoes, 1480, room 813, Manguinhos, Rio de Janeiro, CEP 21041-210, Brazil
| | - Nelson Gouveia
- Department of Preventive Medicine, University of São Paulo Medical School, Brazil. Av. Dr. Arnaldo, 455, São PauloCerqueira César, CEP 01246903, Brazil
| | - Amélia Augusta de Lima Friche
- Observatory for Urban Health in Belo Horizonte, Federal University of Minas Gerais, Av. Pres. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, MG, 31270-901, Brazil
| | - Waleska Teixeira Caiaffa
- Observatory for Urban Health in Belo Horizonte, Federal University of Minas Gerais, Av. Pres. Antônio Carlos, 6627 - Pampulha, Belo Horizonte, MG, 31270-901, Brazil
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Schwartz AE, Munsell EGS, Schmidt EK, Colón-Semenza C, Carolan K, Gassner DL. Impact of COVID-19 on services for people with disabilities and chronic health conditions. Disabil Health J 2021; 14:101090. [PMID: 33715986 DOI: 10.1016/j.dhjo.2021.101090] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/18/2021] [Accepted: 02/20/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND People with disabilities and chronic health conditions rely on a range of services and supports to complete daily tasks, maintain health, and participate in the community. Preliminary research suggests the COVID-19 pandemic greatly disrupted these services and this population may be particularly susceptible to unemployment. OBJECTIVE Describe employment and service disruptions for individuals with disabilities and chronic health conditions during the onset of community-based spread of COVID-19 in the United States. METHODS Adults with disabilities and chronic health conditions completed online surveys to report employment and service changes via multiple choice and open-ended questions. Multiple choice questions were analyzed using descriptive statistics; open-ended responses were coded using content analysis. RESULTS Participants (n = 109): 79.8% female, 88.1% white, 77.121% completed a 4-year college degree or greater, 61.4% had annual income ≥$45,000. Only 14.9% of survey respondents reported disruptions in employment. On average, 54.0% of service changes were due to discontinuation, including loss of physical therapy, job coaching, community organizations, transportation, and peer supports. Other changes included a shift to virtual service delivery and family members taking the role of service providers. CONCLUSIONS Individuals with chronic health conditions and disabilities experienced service disruptions, even in a sample with considerably more economic, social, and educational privilege than the general population of people with chronic health conditions and disabilities in the United States.
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Affiliation(s)
- Ariel E Schwartz
- Boston University Center for Psychiatric Rehabilitation, 940 Commonwealth Avenue, Boston, MA, 02215, USA.
| | - Elizabeth G S Munsell
- Boston University, College of Health and Rehabilitation Sciences: Sargent College, 635 Commonwealth Ave, Boston, MA, 02215, USA.
| | - Elizabeth K Schmidt
- Boston University, College of Health and Rehabilitation Sciences: Sargent College, 635 Commonwealth Ave, Boston, MA, 02215, USA.
| | - Cristina Colón-Semenza
- University of Connecticut, Kinesiology Department, Doctor of Physical Therapy Program, 3107 Horsebarn Hill Road, Storrs, CT, 06269, USA.
| | - Kelsi Carolan
- University of Connecticut School of Social Work, 38 Prospect Street, Hartford, CT, 06103, USA.
| | - Dena L Gassner
- Adjunct Faculty Towson University, Adelphi University, USA.
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Abstract
As increasing value is placed on community engagement, co-creation, and transdisciplinarity as essential ingredients to improve policies; participatory health research has gained popularity as a promising avenue for stakeholders to collaborate and solve problems in innovative ways. Participatory research has a history of success but important caveats caution against romanticizing the approach. The assumption that participation will empower participants overlooks potential feelings of disappointment or exploitation amid power imbalances, vested interest, and representativeness issues. This article outlines a multilevel conceptual framework that explicitly situates power dynamics within a wider system of bidirectional interconnections operating at the individual, interpersonal, and structural levels. It then provides a practical tool to examine and address these dynamics in a comprehensive and systematic way. This can be helpful for researchers and community practitioners working in contexts where democratic principles are not broadly endorsed and where power dynamics operate in subtle ways.
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Woods-Jaeger B, Daniel-Ulloa J, Kleven L, Bucklin R, Maldonado A, Gilbert PA, Parker EA, Baquero B. Building Leadership, Capacity, and Power to Advance Health Equity and Justice through Community-Engaged Research in the Midwest. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 67:195-204. [PMID: 33040375 DOI: 10.1002/ajcp.12462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The Health Equity Advancement Lab (HEAL) at the University of Iowa College of Public Health began in 2012 to support students, researchers, and community members interested in tackling persistent health inequities through a community-based participatory research (CBPR) approach. Using concepts from critical consciousness theory, we developed an approach to building students', faculty members', and community partners' capacity to engage in CBPR to promote health equity that involved immersion in developing CBPR projects. Our paper describes the evolution of HEAL as a facilitating structure that provides a support network and engages diverse stakeholders in critical reflection as they participate in research to advance health equity, and resulting political efficacy and social action. We describe one HEAL-affiliated research project that employs a CBPR approach and has a strong focus on providing transformative learning experiences for students, faculty, and community members. We highlight challenges, successes, and lessons learned in the application of critical consciousness as a framework that engages diverse academic and community partners seeking to promote health equity. We argue that critical consciousness is a relevant theoretical framework to promote transformative learning among students, faculty, and community partners to promote health equity research in diverse communities.
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Affiliation(s)
- Briana Woods-Jaeger
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
- Department of Developmental and Behavioral Health, Children's Mercy Hospital, Kansas City, MO, USA
| | - Jason Daniel-Ulloa
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
- School of Nursing and Health Studies, University of Washington, Bothell, Bothell, WA, USA
| | - Lauren Kleven
- Department of Developmental and Behavioral Health, Children's Mercy Hospital, Kansas City, MO, USA
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Rebecca Bucklin
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Adriana Maldonado
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Paul A Gilbert
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Edith A Parker
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
| | - Barbara Baquero
- Department of Community and Behavioral Health, University of Iowa College of Public Health, Iowa City, IA, USA
- Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
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Bazargan M, Cobb S, Assari S. Discrimination and Medical Mistrust in a Racially and Ethnically Diverse Sample of California Adults. Ann Fam Med 2021; 19:4-15. [PMID: 33431385 PMCID: PMC7800756 DOI: 10.1370/afm.2632] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 10/30/2020] [Accepted: 11/02/2020] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Although we know that racial and ethnic minorities are more likely to have mistrust in the health care system, very limited knowledge exists on correlates of such medical mistrust among this population. In this study, we explored correlates of medical mistrust in a representative sample of adults. METHODS We analyzed cross-sectional study data from the Survey of California Adults on Serious Illness and End-of-Life 2019. We ascertained race/ethnicity, health status, perceived discrimination, demographics, socioeconomic factors, and medical mistrust. For data analysis, we used multinomial logistic regression models. RESULTS Analyses were based on 704 non-Hispanic Black adults, 711 Hispanic adults, and 913 non-Hispanic White adults. Racial/ethnic background was significantly associated with the level of medical mistrust. Adjusting for all covariates, odds of reporting medical mistrust were 73% higher (adjusted odds ratio [aOR] = 1.73; 95% CI, 1.15-2.61, P <.01) and 49% higher (aOR = 1.49; 95% CI, 1.02-2.17, P <.05) for non-Hispanic Black and Hispanic adults when compared with non-Hispanic White adults, respectively. Perceived discrimination was also associated with higher odds of medical mistrust. Indicating perceived discrimination due to income and insurance was associated with 98% higher odds of medical mistrust (aOR = 1.98; 95% CI, 1.71-2.29, P <.001). Similarly, the experience of discrimination due to racial/ethnic background and language was associated with a 25% increase in the odds of medical mistrust (aOR = 1.25; 95% CI, 1.10-1.43; P <.001). CONCLUSIONS Perceived discrimination is correlated with medical mistrust. If this association is causal, that is, if perceived discrimination causes medical mistrust, then decreasing such discrimination may improve trust in medical clinicians and reduce disparities in health outcomes. Addressing discrimination in health care settings is appropriate for many reasons related to social justice. More longitudinal research is needed to understand how complex societal, economic, psychological, and historical factors contribute to medical mistrust. This type of research may in turn inform the design of multilevel community- and theory-based training models to increase the structural competency of health care clinicians so as to reduce medical mistrust.
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Affiliation(s)
- Mohsen Bazargan
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
- Department of Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, California
- Physician Assistant Program, Charles R. Drew University of Medicine and Science, Los Angeles, California
- Department of Family Medicine, University of California, Los Angeles, Los Angeles, California
| | - Sharon Cobb
- School of Nursing, Charles R. Drew University of Medicine and Science, Los Angeles, California
| | - Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, California
- Department of Public Health, Charles R. Drew University of Medicine and Science, Los Angeles, California
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Perceptions of co-designing health promotion interventions with Indigenous communities in New Zealand. Health Promot Int 2020; 36:964-975. [DOI: 10.1093/heapro/daaa128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Summary
Health inequities among Indigenous and non-Indigenous communities are well documented and the research literature includes robust discussions about innovative ways to reduce inequities including co-design. Co-designing health promotion interventions with Indigenous communities presents many benefits and challenges for researchers, health professionals and communities involved in the process. The purpose of this study was to identify the facilitators and barriers of co-designing a health promotion intervention with Māori communities. Additionally, this study considers a specific Māori co-design framework, He Pikinga Waiora (HPW). HPW is a participatory approach to creating interventions emphasizing community engagement, systems thinking and centred on Kaupapa Māori (an approach grounded in Māori worldviews). The research design for this study was Kaupapa Māori. Participants (n = 19) in this study were stakeholders in the New Zealand health sector. Participants were interviewed using an in-depth, semi-structured protocol. Thematic analysis was employed to analyse the data. Facilitators for co-designing health promotion interventions with Māori communities were collaboration and community voice. Barriers identified were mismanaged expectations and research constraints. Finally, facilitators for the HPW framework included providing clear guidelines and being grounded in Māori perspectives, while barriers included limited concrete case studies, jargon and questions about sustainability. Collaboration and inclusion of community voice supports the development of more effective co-design health promotion interventions within Māori communities which may address health inequities. The HPW framework offers clear guidelines and Māori perspectives which may assist in the development of effective co-design health promotion interventions, although areas for improvement were suggested.
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Wang L, Ren J, Fiscella KA, Bullock S, Sanders MR, Loomis EL, Eliav E, Mendoza M, Cacciato R, Thomas M, Kopycka-Kedzierawski DT, Billings RJ, Xiao J. Interprofessional collaboration and smartphone use as promising strategies to improve prenatal oral health care utilization among US underserved women: results from a qualitative study. BMC Oral Health 2020; 20:333. [PMID: 33228617 PMCID: PMC7685586 DOI: 10.1186/s12903-020-01327-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/12/2020] [Indexed: 12/12/2022] Open
Abstract
Background Data on barriers and facilitators to prenatal oral health care among low-income US women are lacking. The objective of this study was to understand barriers/facilitators and patient-centered mitigation strategies related to the use of prenatal oral health care among underserved US women.
Methods We used community-based participatory research to conduct two focus groups with eight pregnant/parenting women; ten individual in-depth interviews with medical providers, dental providers and community/social workers; and one community engagement studio with five representative community stakeholders in 2018–2019. Using an interpretive description research design, we conducted semi-structured interviews and focus groups which were audio-recorded, transcribed, and analyzed for thematic content. Results We identified individual and systemic barriers/facilitators to the utilization of prenatal oral health care by underserved US women. Strategies reported to improve utilization included healthcare system-wide changes to promote inter-professional collaborations, innovative educational programs to improve dissemination and implementation of prenatal oral health care guidelines, and specialized dental facilities providing prenatal oral health care to underserved women. Moreover, smartphones have the potential to be an innovative entry point to promote utilization of prenatal oral care at the individual level. Conclusions Low-income women face multiple, addressable barriers to obtaining oral health care during pregnancy. Inter-professional collaboration holds strong promise for improving prenatal oral health care utilization.
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Affiliation(s)
- Lin Wang
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA.,Peking University School of Stomatology, Beijing, China
| | - Johana Ren
- University of Rochester River Campus, Rochester, NY, USA
| | - Kevin A Fiscella
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | | | - Mechelle R Sanders
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Elizabeth L Loomis
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA
| | - Eli Eliav
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Michael Mendoza
- Department of Family Medicine, University of Rochester Medical Center, Rochester, NY, USA.,Monroe County Department of Public Health, Rochester, NY, USA
| | - Rita Cacciato
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Marie Thomas
- University of Rochester River Campus, Rochester, NY, USA
| | | | - Ronald J Billings
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Jin Xiao
- Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA.
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Novel participatory methods for co-building an agent-based model of physical activity with youth. PLoS One 2020; 15:e0241108. [PMID: 33170862 PMCID: PMC7654780 DOI: 10.1371/journal.pone.0241108] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 10/09/2020] [Indexed: 12/15/2022] Open
Abstract
Public health scholarship has increasingly called for the use of system science approaches to understand complex problems, including the use of participatory engagement to inform the modeling process. Some system science traditions, specifically system dynamics modeling, have an established participatory practice tradition. Yet, there remains limited guidance on engagement strategies using other modeling approaches like agent-based models. Our objective is to describe how we engaged adolescent youth in co-building an agent-based model about physical activity. Specifically, we aim to describe how we communicated technical aspects of agent-based models, the participatory activities we developed, and the resulting visual diagrams that were produced. We implemented six sessions with nine adolescent participants. To make technical aspects more accessible, we used an analogy that linked core components of agent-based models to elements of storytelling. We also implemented novel, facilitated activities that engaged youth in the development, annotation, and review of graphs over time, geographical maps, and state charts. The process was well-received by the participants and helped inform the basic structure of an agent-based model. The resulting visual diagrams created space for deeper discussion among participants about patterns of daily activity, important places for physical activity, and interactions between social and built environments. This work lays a foundation to develop and refine engagement strategies, especially for translating qualitative insights into quantitative model specifications such as ‘decision rules’.
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Clauss-Ehlers CS. Exploration of Psychological Well-Being, Resilience, Ethnic Identity, and Meaningful Events Among a Group of Youth in Northern England: An Autobiographical Narrative Intervention Pilot Study. ADOLESCENT PSYCHIATRY 2020. [DOI: 10.2174/2210676610666200226090427] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Autobiographical narrative (i.e., the process through writing or storytelling
where one recalls life experiences and their impact on identity) has been found to
effectively help adolescents cope with a range of medical and psychological issues.
Objective. :
The current study addressed the overall preliminary research question: How does
implementing an autobiographical narrative approach promote resilience, psychological
well- being, and ethnic identity among adolescents? A secondary study aim was to explore
how central the memories evoked by each workshop were to participant identity. The
study’s third goal was to promote life skill development and self-awareness through participation
in the autobiographical narrative intervention.
Methods:
The intervention incorporated a community-based participatory research (CBPR)
framework in its partnership with a community centre in Northern England. The intervention
consisted of an 8-week autobiographical program with youth participants from working and
lower middle-class backgrounds. Socioeconomic status was operationalized by self-report on
a demographic data sheet completed by participants.
Results.:
Analyses indicated that participants viewed the events discussed in the 8-week program
as being more central to their lives after their participation. Maladaptive coping appeared
to decrease after participation in the intervention.
Conclusion:
Results suggest interventions that incorporate an autobiographical narrative
approach within a CBPR framework may promote positive outcomes among adolescents
with limited economic resources.
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Alang S, Batts H, Letcher A. Interrogating academic hegemony in community-based participatory research to address health inequities. J Health Serv Res Policy 2020; 26:215-220. [PMID: 33076709 DOI: 10.1177/1355819620963501] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Community-based participatory research holds promise for addressing health inequities. It focuses on issues salient to specific populations, prioritizes community engagement and amplifies the voices of marginalized populations in policy formulation and designing interventions. Although communities are partners, academic hegemony limits their level of influence over the research initiative. Drawing from our own collaborative research experiences, we raise questions for community-engaged health services researchers to reflect upon as a means of interrogating academic hegemony in partnerships that seek to address health inequities. We describe what it means for researchers to acknowledge and relinquish the power they wield in the community-engaged health services research enterprise. We propose three guiding principles for advancing equity: authentic engagement, defining and living values, and embracing accountability.
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Affiliation(s)
- Sirry Alang
- Associate Professor, Department of Sociology and Anthropology, and Program in Health, Medicine, and Society, Lehigh University, USA
| | - Hasshan Batts
- Executive Director, Promise Neighborhoods of the Lehigh Valley, USA.,Robert Wood Johnson Culture of Health Leader, Lehigh University, USA
| | - Abby Letcher
- Clinical Associate Professor and Family Physician, Lehigh Valley Health Network, USA.,Medica Director, Neighborhood Health Centers of the Lehigh Valley, USA
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A Systems Thinking Methodology for Studying Prevention Efforts in Communities. SYSTEMIC PRACTICE AND ACTION RESEARCH 2020. [DOI: 10.1007/s11213-020-09544-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Mills SD, Coffey T, Newcomer JW, Proctor SL, Leifman S, Hassmiller Lich K. The Eleventh Judicial Circuit Criminal Mental Health Project: Improving Access to Mental Health Treatment in Miami-Dade County. Psychiatr Serv 2020; 71:1091-1094. [PMID: 32998659 DOI: 10.1176/appi.ps.201900572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The Eleventh Judicial Circuit Criminal Mental Health Project (CMHP), a court-based jail diversion program, was established to divert individuals with serious mental illness from the criminal justice system into treatment and support services. The CMHP's success is built on collaboration among a diverse array of community stakeholders. This column describes the establishment and maintenance of these partnerships. CMHP's success is the result of several factors, including motivated local champions, acquisition of grant funding, formalized communication support, and use of the sequential intercept model. As the CMHP grows, system science methods will be useful for supporting optimization and sustainment.
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Affiliation(s)
- Sarah D Mills
- Department of Health Behavior (Mills) and Department of Health Policy and Management (Lich), Gillings School of Global Public Health, and Lineberger Comprehensive Cancer Center (Mills), University of North Carolina, Chapel Hill; Eleventh Judicial Circuit Criminal Mental Health Project, Miami (Coffey, Leifman); Thriving Mind South Florida, Miami (Newcomer, Proctor); Department of Psychiatry, Washington University School of Medicine, St. Louis (Newcomer). Debra A. Pinals, M.D., is editor of this column
| | - Tim Coffey
- Department of Health Behavior (Mills) and Department of Health Policy and Management (Lich), Gillings School of Global Public Health, and Lineberger Comprehensive Cancer Center (Mills), University of North Carolina, Chapel Hill; Eleventh Judicial Circuit Criminal Mental Health Project, Miami (Coffey, Leifman); Thriving Mind South Florida, Miami (Newcomer, Proctor); Department of Psychiatry, Washington University School of Medicine, St. Louis (Newcomer). Debra A. Pinals, M.D., is editor of this column
| | - John W Newcomer
- Department of Health Behavior (Mills) and Department of Health Policy and Management (Lich), Gillings School of Global Public Health, and Lineberger Comprehensive Cancer Center (Mills), University of North Carolina, Chapel Hill; Eleventh Judicial Circuit Criminal Mental Health Project, Miami (Coffey, Leifman); Thriving Mind South Florida, Miami (Newcomer, Proctor); Department of Psychiatry, Washington University School of Medicine, St. Louis (Newcomer). Debra A. Pinals, M.D., is editor of this column
| | - Steven L Proctor
- Department of Health Behavior (Mills) and Department of Health Policy and Management (Lich), Gillings School of Global Public Health, and Lineberger Comprehensive Cancer Center (Mills), University of North Carolina, Chapel Hill; Eleventh Judicial Circuit Criminal Mental Health Project, Miami (Coffey, Leifman); Thriving Mind South Florida, Miami (Newcomer, Proctor); Department of Psychiatry, Washington University School of Medicine, St. Louis (Newcomer). Debra A. Pinals, M.D., is editor of this column
| | - Steven Leifman
- Department of Health Behavior (Mills) and Department of Health Policy and Management (Lich), Gillings School of Global Public Health, and Lineberger Comprehensive Cancer Center (Mills), University of North Carolina, Chapel Hill; Eleventh Judicial Circuit Criminal Mental Health Project, Miami (Coffey, Leifman); Thriving Mind South Florida, Miami (Newcomer, Proctor); Department of Psychiatry, Washington University School of Medicine, St. Louis (Newcomer). Debra A. Pinals, M.D., is editor of this column
| | - Kristen Hassmiller Lich
- Department of Health Behavior (Mills) and Department of Health Policy and Management (Lich), Gillings School of Global Public Health, and Lineberger Comprehensive Cancer Center (Mills), University of North Carolina, Chapel Hill; Eleventh Judicial Circuit Criminal Mental Health Project, Miami (Coffey, Leifman); Thriving Mind South Florida, Miami (Newcomer, Proctor); Department of Psychiatry, Washington University School of Medicine, St. Louis (Newcomer). Debra A. Pinals, M.D., is editor of this column
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Abrams JA, Odlum M, Tillett E, Haley D, Justman J, Hodder S, Vo L, O'Leary A, Frew PM. Strategies for increasing impact, engagement, and accessibility in HIV prevention programs: suggestions from women in urban high HIV burden counties in the Eastern United States (HPTN 064). BMC Public Health 2020; 20:1340. [PMID: 32883248 PMCID: PMC7469400 DOI: 10.1186/s12889-020-09426-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 08/23/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Merely having the tools to end HIV is insufficient. Effectively ending the epidemic necessitates addressing barriers that impede engagement in biomedical and behavioral prevention and wide scale implementation and utilization of existing interventions. This qualitative study identifies suggestions for increasing access to, engagement in, and impact of HIV prevention among women living in cities in high HIV burden counties in the eastern US. METHODS Data analyzed for the current study were collected via a qualitative sub-study within the HIV Prevention Trials Network Study 064 (HPTN 064), a multisite observational cohort study designed to estimate HIV incidence among women residing in communities with elevated HIV prevalence who also reported personal or partner characteristics associated with increased risk of HIV acquisition. Focus group and interview participants in the qualitative sub-study (N = 288) were from four cities in the eastern US. RESULTS Thematic analyses revealed four themes describing women's most frequently stated ideas for improving prevention efforts: 1) Promote Multilevel Empowerment, 2) Create Engaging Program Content, 3) Build "Market Demand", and 4) Ensure Accessibility. We conducted additional analyses to identify contradictory patterns in the data, which revealed an additional three themes: 1) Address Structural Risk Factors, 2) Increase Engagement via Pleasure Promotion, 3) Expand Awareness of and Access to Prevention Resources. CONCLUSIONS Findings may be useful for enhancing women's engagement in and uptake of behavioral and biomedical HIV prevention resources, improving policy, and addressing multilevel risk factors. TRIAL REGISTRATION Clinicaltrials.gov: NCT00995176 , prospectively registered.
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Affiliation(s)
- Jasmine A Abrams
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue (Crosstown Center), Rm 434, Boston, MA, 02118, USA.
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA.
| | - Michelle Odlum
- Columbia University School of Nursing, New York, NY, USA
| | - Emily Tillett
- Department of Psychology, University of Maryland, Baltimore County, Baltimore, MD, USA
| | - Danielle Haley
- Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue (Crosstown Center), Rm 434, Boston, MA, 02118, USA
| | - Jessica Justman
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Sally Hodder
- West Virginia Clinical and Translational Science Institute, West Virginia University, Morgantown, WV, USA
| | - Linda Vo
- Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA
| | - Ann O'Leary
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Paula M Frew
- School of Public Health, University of Nevada, Las Vegas, NV, USA
- Population Health & Health Equity Initiative, University of Nevada, Las Vegas, NV, USA
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Lloyd-Williams F, Hyseni L, Guzman-Castillo M, Kypridemos C, Collins B, Capewell S, Schwaller E, O'Flaherty M. Evaluating stakeholder involvement in building a decision support tool for NHS health checks: co-producing the WorkHORSE study. BMC Med Inform Decis Mak 2020; 20:182. [PMID: 32778087 PMCID: PMC7418313 DOI: 10.1186/s12911-020-01205-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 07/29/2020] [Indexed: 11/16/2022] Open
Abstract
Background Stakeholder engagement is being increasingly recognised as an important way to achieving impact in public health. The WorkHORSE (Working Health Outcomes Research Simulation Environment) project was designed to continuously engage with stakeholders to inform the development of an open access modelling tool to enable commissioners to quantify the potential cost-effectiveness and equity of the NHS Health Check Programme. An objective of the project was to evaluate the involvement of stakeholders in co-producing the WorkHORSE computer modelling tool and examine how they perceived their involvement in the model building process and ultimately contributed to the strengthening and relevance of the modelling tool. Methods We identified stakeholders using our extensive networks and snowballing techniques. Iterative development of the decision support modelling tool was informed through engaging with stakeholders during four workshops. We used detailed scripts facilitating open discussion and opportunities for stakeholders to provide additional feedback subsequently. At the end of each workshop, stakeholders and the research team completed questionnaires to explore their views and experiences throughout the process. Results 30 stakeholders participated, of which 15 attended two or more workshops. They spanned local (NHS commissioners, GPs, local authorities and academics), third sector and national organisations including Public Health England. Stakeholders felt valued, and commended the involvement of practitioners in the iterative process. Major reasons for attending included: being able to influence development, and having insight and understanding of what the tool could include, and how it would work in practice. Researchers saw the process as an opportunity for developing a common language and trust in the end product, and ensuring the support tool was transparent. The workshops acted as a reality check ensuring model scenarios and outputs were relevant and fit for purpose. Conclusions Computational modellers rarely consult with end users when developing tools to inform decision-making. The added value of co-production (continuing collaboration and iteration with stakeholders) enabled modellers to produce a “real-world” operational tool. Likewise, stakeholders had increased confidence in the decision support tool’s development and applicability in practice.
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Affiliation(s)
- Ffion Lloyd-Williams
- Department of Public Health and Policy. Institute of Population Health Science, University of Liverpool, The Quadrangle, University of Liverpool, Liverpool, L69 3GB, UK
| | - Lirije Hyseni
- Department of Public Health and Policy. Institute of Population Health Science, University of Liverpool, The Quadrangle, University of Liverpool, Liverpool, L69 3GB, UK
| | - Maria Guzman-Castillo
- Department of Public Health and Policy. Institute of Population Health Science, University of Liverpool, The Quadrangle, University of Liverpool, Liverpool, L69 3GB, UK.,Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Chris Kypridemos
- Department of Public Health and Policy. Institute of Population Health Science, University of Liverpool, The Quadrangle, University of Liverpool, Liverpool, L69 3GB, UK
| | - Brendan Collins
- Department of Public Health and Policy. Institute of Population Health Science, University of Liverpool, The Quadrangle, University of Liverpool, Liverpool, L69 3GB, UK
| | - Simon Capewell
- Department of Public Health and Policy. Institute of Population Health Science, University of Liverpool, The Quadrangle, University of Liverpool, Liverpool, L69 3GB, UK
| | - Ellen Schwaller
- Department of Public Health and Policy. Institute of Population Health Science, University of Liverpool, The Quadrangle, University of Liverpool, Liverpool, L69 3GB, UK
| | - Martin O'Flaherty
- Department of Public Health and Policy. Institute of Population Health Science, University of Liverpool, The Quadrangle, University of Liverpool, Liverpool, L69 3GB, UK.
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50
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Russo R, Li Y, Chong S, Siscovick D, Trinh-Shevrin C, Yi S. Dietary policies and programs in the United States: A narrative review. Prev Med Rep 2020; 19:101135. [PMID: 32551216 PMCID: PMC7289763 DOI: 10.1016/j.pmedr.2020.101135] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 05/14/2020] [Accepted: 05/23/2020] [Indexed: 01/18/2023] Open
Abstract
School-based and youth targeted programs and policies were most frequently studied. Research has rather neglected older adult, Asian, Native Hawaiian and American Indian populations. Despite existing research indicating effectiveness, faith-based were understudied.
Prior reviews describing approach, methodological quality and effectiveness of dietary policies and programs may be limited in use for practitioners seeking to introduce innovative programming, or academic researchers hoping to understand and address gaps in the current literature. This review is novel, assessing the “where, who, and in whom” of dietary policies and programs research in the United States over the past decade – with results intended to serve as a practical guide and foundation for innovation. This study was conducted from October 2018 to March 2019. Papers were selected through a tailored search strategy on PubMed as well as citation searches, to identify grey literature. A total of 489 papers were relevant to our research objective. The largest proportion of papers described school-based strategies (31%) or included economic incentives (19%). In papers that specified demographics, the study populations most often included children, adults and adolescents (54%, 46%, and 42% respectively); and White, Black and Hispanic populations (77%, 76% and 70%, respectively). Results highlight opportunities for future research within workplace and faith-based settings, among racial/ethnic minorities, and older adults.
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Affiliation(s)
- Rienna Russo
- NYU School of Medicine, Department of Population Health, New York, NY, United States
| | - Yan Li
- Icahn School of Medicine at Mount Sinai, Department of Population Health Science and Medicine, New York, NY, United States
| | - Stella Chong
- NYU School of Medicine, Department of Population Health, New York, NY, United States
| | - David Siscovick
- New York Academy of Medicine, Center for Health Innovation, New York, NY, United States
| | - Chau Trinh-Shevrin
- NYU School of Medicine, Department of Population Health, New York, NY, United States
| | - Stella Yi
- NYU School of Medicine, Department of Population Health, New York, NY, United States
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