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Mathias H, Jackson LA, Buxton JA, Dubé A, Kiepek N, Martin F, Martin P. What features of drug treatment programs help, or not, with access? a qualitative study of the perspectives of family members and community-based organization staff in Atlantic Canada. Subst Abuse Treat Prev Policy 2024; 19:20. [PMID: 38520017 PMCID: PMC10960477 DOI: 10.1186/s13011-024-00602-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/12/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND Withdrawal management and opioid agonist treatment (OAT) programs help to reduce some of the harms experienced by people who use substances (PWUS). There is literature on how features of drug treatment programs (e.g., policies and practices) are helpful, or not helpful, to PWUS when seeking access to, or in, treatment. There is, however, relatively little literature based on the perspectives of family members/family of choice of PWUS and community-based organization staff within the context of Atlantic Canada. This paper explored the perspectives of these two groups on what was helpful, or not, about drug treatment programs in Atlantic Canada in terms of supporting access to, and retention in, treatment. METHODS One-on-one qualitative telephone interviews were conducted in 2020 with the two groups. Interviews focused on government-funded withdrawal management and OAT programs. Data were coded using a qualitative data management program (ATLAS.ti) and analyzed inductively for key themes/subthemes using grounded theory techniques. RESULTS Fifteen family members/family of choice and 16 community-based organization staff members participated (n = 31). Participants spoke about features of drug treatment programs in various places, and noted features that were perceived as helpful (e.g., quick access), as well as not helpful (e.g., wait times, programs located far from where PWUS live). Some participants provided their perceptions of how PWUS felt when seeking or accessing treatment. A number of participants reported taking various actions to help support access to treatment, including providing transportation to programs. A few participants also provided suggestions for change to help support access and retention such as better alignment of mental health and addiction systems. CONCLUSIONS Participants highlighted several helpful and not helpful features of drug treatment programs in terms of supporting treatment access and retention. Previous studies with PWUS and in other places have reported similar features, some of which (e.g., wait times) have been reported for many years. Changes are needed to reduce barriers to access and retention including the changes recommended by study participants. It is critical that the voices of key groups, (including PWUS) are heard to ensure treatment programs in all places support access and retention.
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Affiliation(s)
- Holly Mathias
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy 11405 87 AvenueEdmonton, T6G 1C9, Edmonton, Alberta, Canada.
| | - Lois A Jackson
- School of Health and Human Performance, Dalhousie University, Stairs House, 6230 South Street, B3H 4R2, Halifax, NS, Canada
| | - Jane A Buxton
- School of Population and Public Health, University of British Columbia, 2206 East Mall, V6T 1Z8, Vancouver, BC, Canada
| | - Anik Dubé
- Faculty of Health Sciences and Community Services, School of Nursing, Université de Moncton, 18, avenue Antonine-Maillet, E1A 3E9, Moncton, New Brunswick, Canada
| | - Niki Kiepek
- School of Occupational Therapy, Dalhousie University, Forrest Building, Room 215, 5869 University Avenue, B3H 4R2, Halifax, NS, Canada
| | - Fiona Martin
- Department of Sociology and Social Anthropology, Dalhousie University, Marion McCain Arts and Social Sciences Building, Room 1128, 6135 University Avenue, B3H 4R2, Halifax, NS, Canada
| | - Paula Martin
- Direction 180, 2151 Gottingen Street, B3K 3B5, Halifax, NS, Canada
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Ko LK, Vu T, Bishop S, Leeman J, Escoffery C, Winer RL, Duran MC, Masud M, Rait Y. Implementation studio: implementation support program to build the capacity of rural community health educators serving immigrant communities to implement evidence-based cancer prevention and control interventions. Cancer Causes Control 2023; 34:75-88. [PMID: 37442868 PMCID: PMC10689558 DOI: 10.1007/s10552-023-01743-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 06/21/2023] [Indexed: 07/15/2023]
Abstract
PURPOSE Rural community-based organizations (CBOs) serving immigrant communities are critical settings for implementing evidence-based interventions (EBIs). The Implementation Studio is a training and consultation program focused on facilitating the selection, adaptation, and implementation of cancer prevention and control EBIs. This paper describes implementation and evaluation of the Implementation Studio on CBO's capacity to implement EBIs and their clients' knowledge of colorectal cancer (CRC) screening and intention to screen. METHODS Thirteen community health educators (CHEs) from two CBOs participated in the Implementation Studio. Both CBOs selected CRC EBIs during the Studio. The evaluation included two steps. The first step assessed the CHEs' capacity to select, adapt, and implement an EBI. The second step assessed the effect of the CHEs-delivered EBIs on clients' knowledge of CRC and intention to screen (n = 44). RESULTS All CHEs were Hispanic and women. Pre/post-evaluation of the Studio showed an increase on CHEs knowledge about EBIs (pre: 23% to post: 75%; p < 0.001). CHEs' ability to select, adapt, and implement EBIs also increased, respectively: select EBI (pre: 21% to post: 92%; p < 0.001), adapt EBI (pre: 21% to post: 92%; p < 0.001), and implement EBI (pre: 29% to post: 75%; p = 0.003). Pre/post-evaluation of the CHE-delivered EBI showed an increase on CRC screening knowledge (p < 0.5) and intention to screen for CRC by their clients. CONCLUSION Implementation Studio can address unique needs of low resource rural CBOs. An implementation support program with training and consultation has potential to build the capacity of rural CBOs serving immigrant communities to implementation of cancer prevention and control EBIs. CLINICAL TRIALS REGISTRATION NUMBER NCT04208724 registered.
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Affiliation(s)
- Linda K Ko
- Department of Health Systems and Population Health, Health Promotion Research Center, University of Washington, Seattle, WA, USA.
- Division of Public Health Sciences, Fred Hutchinson Cancer Center, Seattle, WA, USA.
- Department of Health Systems and Population Health, Hans Rosling Center for Population Health, University of Washington, 3980 15Th Avenue NE, 4Th Floor, UW Mailbox 351621, Seattle, WA, 98195, USA.
| | - Thuy Vu
- Department of Health Systems and Population Health, Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | - Sonia Bishop
- Department of Health Systems and Population Health, Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | - Jennifer Leeman
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Cam Escoffery
- Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Rachel L Winer
- Department of Epidemiology, University of Washington, Seattle, WA, USA
| | - Miriana C Duran
- Department of Health Systems and Population Health, Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | - Manal Masud
- Department of Health Systems and Population Health, Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | - Yaniv Rait
- Department of Health Systems and Population Health, Health Promotion Research Center, University of Washington, Seattle, WA, USA
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Evans D, Norrbom C, Schmidt S, Powell R, McReynolds J, Sidibe T. Engaging Community-Based Organizations to Address Barriers in Public Health Programs: Lessons Learned From COVID-19 Vaccine Acceptance Programs in Diverse Rural Communities. Health Secur 2023; 21:S17-S24. [PMID: 37610883 PMCID: PMC10818044 DOI: 10.1089/hs.2023.0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 05/04/2023] [Accepted: 06/22/2023] [Indexed: 08/25/2023] Open
Abstract
Factors such as geography, community hesitancy, the political landscape, and legislative efforts to limit public health authority have contributed to a disproportionate number of COVID-19 infections and deaths in US rural communities. Community-based organizations are trusted entities that provide social and educational services in the communities where they live and have proven to be effective public health partners in response to the COVID-19 pandemic. Recognizing the unique challenges faced by rural communities, coupled with higher rates of vaccine hesitancy, the CDC Foundation awarded grants to 21 community-based organizations serving rural communities in 7 Midwest states to support the equitable uptake and distribution of COVID-19 vaccines. In this case study, 2 grantees, the Missouri Center for Public Health Excellence and the Hmong American Center, provide case studies that document their experiences, challenges, and strategies for overcoming barriers during the implementation of COVID-19 vaccine acceptance projects in diverse rural communities. These case studies provide key lessons learned that can be applied to future public health emergency and nonemergency responses to ensure that all members of communities are served well and protected.
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Affiliation(s)
- Dorothy Evans
- Dorothy Evans, MPH, MEd, is a Program Manager, Response Crisis, and Preparedness Unit, CDC Foundation, Atlanta, GA
| | - Corina Norrbom
- Corina Norrbom, MD, is an Assistant Professor, Medical College of Wisconsin-Central Wisconsin; a Health Policy Fellow, Wisconsin Institute for Public Policy and Service; and Project Director, Hmong and Hispanic Communication Network; all in Wausau, WI
| | - Spring Schmidt
- Spring Schmidt is Executive Director, Missouri Center for Public Health Excellence, and a PhD Candidate and Director, Office of Public Health Practice, St. Louis University College for Public Health and Social Justice, St. Louis, MO
| | - Rachel Powell
- Rachel Powell, PhD, MPH, is Senior Program Manager, Response Crisis, and Preparedness Unit, CDC Foundation, Atlanta, GA
| | | | - Turquoise Sidibe
- Turquoise Sidibe, MPH, is Associate Vice President, Response Crisis, and Preparedness Unit, CDC Foundation, Atlanta, GA
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Powell R, Parker B, Moore M, Xiong T, Evans D, Sidibe T. Importance of Public and Private Partnership Supporting Data Disaggregation to Measure Racial, Sexual Orientation, and Gender Identity Disparities in COVID-19. Health Secur 2023; 21:S35-S41. [PMID: 37733289 DOI: 10.1089/hs.2023.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
The COVID-19 pandemic has exposed shortcomings in the US public health data system infrastructure, including incomplete or disparate processes related to data collection, management, sharing, and analysis. Public health data modernization is critical to ensure health equity is at the core of preparedness and response efforts and policies that prioritize equitable responses to health emergencies. To address the inequitable uptake and distribution of COVID-19 vaccinations in communities most disproportionately impacted by the pandemic, the CDC Foundation's Response Crisis and Preparedness Unit began partnering with community-based organizations in March 2021 to provide education and outreach and facilitate access to vaccines. These organizations engaged with partners and communities to address vaccine-related concerns, develop innovative and culturally appropriate communication strategies, and promote timely vaccination. Two grantees, Out Boulder County in Colorado and the Coalition of Asian American Leaders in Minnesota, experienced issues related to public health data collection standards and practices for COVID-19. Data collection tools often lack the appropriate or necessary demographic variables or level of disaggregation needed to be able to assess prioritization and disparities within racial and ethnic groups and across sexual orientation and gender identity categories. In this case study, both grantee organizations document their experiences, challenges, and strategies to overcome barriers to implementing their projects resulting from a lack of meaningful data. These examples identify inequities and systems-level changes related to data collection and surveillance, and they provide recommendations and lessons learned to improve data surveillance for more equitable public health responses.
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Affiliation(s)
- Rachel Powell
- Rachel Powell, PhD, MPH, is Senior Program Manager, Response, Crisis, and Preparedness Unit, National Foundation for the Centers for Disease Control and Prevention, Atlanta, GA
| | - Bruce Parker
- Bruce Parker, PhD, is Deputy Director, Out Boulder County, Boulder, CO
| | - Mardi Moore
- Mardi Moore is Executive Director, Out Boulder County, Boulder, CO
| | - ThaoMee Xiong
- ThaoMee Xiong, MPA, JD, is Executive and Network Director, The Coalition of Asian American Leaders, St. Paul, MN
| | - Dorothy Evans
- Dorothy Evans MPH, MEd, is Program Manager, Response, Crisis, and Preparedness Unit, National Foundation for the Centers for Disease Control and Prevention, Atlanta, GA
| | - Turquoise Sidibe
- Turquoise Sidibe, MPH, is Associate Vice President of Emergency Response, National Foundation for the Centers for Disease Control and Prevention, Atlanta, GA
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Ramanadhan S, Cruz JL, Weese M, Naveed N, Kirk S, Rivard MK, Kirk J, Whitaker A, Peterson K, Eisenkraft A. Similar skills, different frames: a thematic analysis exploring conceptualizations held by community-based organization practitioners and academics regarding skills to use evidence-based interventions to address cancer inequities. Implement Sci Commun 2023; 4:86. [PMID: 37496041 PMCID: PMC10373222 DOI: 10.1186/s43058-023-00472-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 07/15/2023] [Indexed: 07/28/2023] Open
Abstract
BACKGROUND Community-based organizations (CBOs) are critical partners in delivering evidence-based interventions (EBIs) to address cancer inequities. However, CBO practitioners do not typically have access to opportunities to build the necessary capacity (skills, knowledge, motivation, and resources) for using EBIs. Although capacity-building interventions can offer a solution, inconsistent definitions and measurements of capacity limit the ability to develop and evaluate such efforts. We explored how and why conceptualizations of core skills for EBI use differ between practitioners and academics addressing cancer and other health inequities. We anchored the inquiry with a commonly used set of target skills for EBI capacity-building efforts. METHODS The study was conducted by an interdisciplinary team of academic researchers and CBO practitioners. We gathered data through semi-structured, hour-long interviews with practitioners and academics working to address cancer and other health inequities (n = 19). After hearing a brief vignette about a CBO addressing cervical cancer inequities, participants considered a widely accepted list of skills for EBI use that included assessing needs, engaging stakeholders, and selecting, adapting, implementing, evaluating, and sustaining the EBI. We used a team-based, reflexive thematic analysis approach grounded in critical and constructivist perspectives. RESULTS Overall, the original list resonated with practitioners and academics and they added new skills to the list (cultural humility and systems change). Practitioners' responses described skills from the reference point of addressing broader community needs and context and achieving change over the long term, emphasizing aspects of health promotion in their descriptions. Academics offered a mix of perspectives, with some focused on addressing community needs (and related flexibility regarding EBIs) but more emphasized skills needed to deliver a specific EBI to achieve a focused set of health and equity outcomes. CONCLUSIONS There is a significant opportunity to leverage complementary expertise and perspectives held by practitioners and academics addressing cancer inequities. However, the different frames utilized suggest proactive efforts will be required to find alignment across groups, particularly in valuing diverse contributions and identifying relevant outcomes of interest for each group. Such alignment is critical to designing effective capacity-building interventions and supporting the routine utilization of EBIs to address cancer inequities.
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Affiliation(s)
- Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA.
| | - Jennifer L Cruz
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Maggie Weese
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Natasha Naveed
- University of Massachusetts Boston, 100 William T. Morrissey Blvd, Boston, MA, 02125, USA
| | - Shinelle Kirk
- Conservation Law Foundation, 62 Summer St, Boston, MA, 02110, USA
| | - Madison K Rivard
- Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02115, USA
| | - Judi Kirk
- Boys and Girls Club of Worcester, 65 Boys & Girls Club Way, Worcester, MA, 01610, USA
| | - Albert Whitaker
- American Heart Association, 300 5Th Ave, Waltham, MA, 02451, USA
- St. Mark Congregational Church, 200 Townsend St, Boston, MA, 02121, USA
| | - Karen Peterson
- Tufts Medicine, 800 District Avenue, Suite 520, Burlington, MA, 01803, USA
| | - Arthur Eisenkraft
- University of Massachusetts Boston, 100 William T. Morrissey Blvd, Boston, MA, 02125, USA
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Dubé K, Peterson B, Jones NL, Onorato A, Carter WB, Dannaway C, Johnson S, Hayes R, Hill M, Maddox R, Riley JL, Shull J, Metzger D, Montaner LJ. Community engagement group model in basic and biomedical research: lessons learned from the BEAT-HIV Delaney Collaboratory towards an HIV-1 cure. Res Involv Engagem 2023; 9:39. [PMID: 37291622 DOI: 10.1186/s40900-023-00449-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/16/2023] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Achieving effective community engagement has been an objective of U.S. National Institutes of Health-funded HIV research efforts, including participation of persons with HIV. Community Advisory Boards (CABs) have remained the predominant model for community engagement since their creation in 1989. As HIV cure-directed research efforts have grown into larger academic-industry partnerships directing resources toward both basic and clinical research under the Martin Delaney Collaboratories (MDC), community input models have also evolved. The BEAT-HIV MDC Collaboratory, based at The Wistar Institute in Philadelphia, United States, implemented a three-part model for community engagement that has shown success in providing greater impact for community engagement across basic, biomedical, and social sciences research efforts. DISCUSSION In this paper, we review the case study of the formation of the BEAT-HIV Community Engagement Group (CEG) model, starting with the historical partnership between The Wistar Institute as a basic research center and Philadelphia FIGHT as a not-for-profit community-based organization (CBO), and culminating with the growth of community engagement under the BEAT-HIV MDC. Second, we present the impact of a cooperative structure including a Community Advisory Board (CAB), CBO, and researchers through the BEAT-HIV CEG model, and highlight collaborative projects that demonstrate the potential strengths, challenges, and opportunities of this model. We also describe challenges and future opportunities for the use of the CEG model. CONCLUSIONS Our CEG model integrating a CBO, CAB and scientists could help move us towards the goal of effective, equitable and ethical engagement in HIV cure-directed research. In sharing our lessons learned, challenges and growing pains, we contribute to the science of community engagement into biomedical research efforts with an emphasis on HIV cure-directed research. Our documented experience with implementing the CEG supports greater discussion and independent implementation efforts for this model to engage communities into working teams in a way we find a meaningful, ethical, and sustainable model in support of basic, clinical/biomedical, social sciences and ethics research.
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Affiliation(s)
- Karine Dubé
- Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, San Diego, CA, USA
- Health Policy and Management, UNC Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Beth Peterson
- Wistar Institute, 3601 Spruce Street, Room 480, Philadelphia, PA, 19104, USA
- BEAT-HIV Delaney Collaboratory Community Advisory Board (CAB), Philadelphia, PA, USA
| | - Nora L Jones
- BEAT-HIV Delaney Collaboratory Community Advisory Board (CAB), Philadelphia, PA, USA
| | - Amy Onorato
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - William B Carter
- BEAT-HIV Delaney Collaboratory Community Advisory Board (CAB), Philadelphia, PA, USA
| | - Christine Dannaway
- BEAT-HIV Delaney Collaboratory Community Advisory Board (CAB), Philadelphia, PA, USA
| | - Steven Johnson
- BEAT-HIV Delaney Collaboratory Community Advisory Board (CAB), Philadelphia, PA, USA
| | - Roy Hayes
- BEAT-HIV Delaney Collaboratory Community Advisory Board (CAB), Philadelphia, PA, USA
| | - Marcus Hill
- BEAT-HIV Delaney Collaboratory Community Advisory Board (CAB), Philadelphia, PA, USA
| | - Rease Maddox
- BEAT-HIV Delaney Collaboratory Community Advisory Board (CAB), Philadelphia, PA, USA
| | - James L Riley
- Department of Microbiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Jane Shull
- Philadelphia FIGHT Community Health Centers, Philadelphia, PA, USA
| | - David Metzger
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Luis J Montaner
- Wistar Institute, 3601 Spruce Street, Room 480, Philadelphia, PA, 19104, USA.
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Ramanadhan S, Salvia M, Hanby E, Revette AC, Rivard MK, Scout NFN, Applegate J, Gordon B, Machado A, Lunn MR, Obedin-Maliver J, Potter J, Chen JT, Tan ASL. "We're always an afterthought"- Designing tobacco control campaigns for dissemination with and to LGBTQ +-serving community organizations: a thematic analysis. Cancer Causes Control 2023:10.1007/s10552-023-01706-x. [PMID: 37160611 DOI: 10.1007/s10552-023-01706-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 04/18/2023] [Indexed: 05/11/2023]
Abstract
PURPOSE Evidence-based health communication campaigns can support tobacco control and address tobacco-related inequities among lesbian, gay, bisexual, transgender, and queer (LGBTQ +) populations. Community organizations focused on LGBTQ + health (e.g., nonprofits, community centers, and community health centers) can be prime channels for delivering evidence-based health communication campaigns. However, it is unclear how to balance the goals of a) designing campaigns to support broad adoption/uptake and b) adaptation addressing the needs of diverse communities and contexts. As part of an effort to support "designing for dissemination," we explored the key challenges and opportunities staff and leaders of LGBTQ + -serving community organizations encounter when adopting or adapting evidence-based health communication campaigns. METHODS A team of researchers and advisory committee members conducted this study, many of whom have lived, research, and/or practice experience with LGBTQ + health. We interviewed 22 staff members and leaders of community organizations serving LGBTQ + populations in the US in early 2021. We used a team-based, reflexive thematic analysis approach. RESULTS The findings highlight the challenges of attempting to use health communication campaigns misaligned with the assets and needs of organizations and community members. The three major themes identified were as follows: (1) available evidence-based health communication campaigns typically do not sufficiently center LGBTQ + communities, (2) negotiation regarding campaign utilization places additional burden on practitioners who have to act as "gatekeepers," and (3) processes of using health communication campaigns often conflict with organizational efforts to engage community members in adoption and adaptation activities. CONCLUSIONS We offer a set of considerations to support collaborative design and dissemination of health communication campaigns to organizations serving LGBTQ + communities: (1) develop campaigns with and for LGBTQ + populations, (2) attend to the broader structural forces impacting campaign recipients, (3) support in-house testing and adaptations, and (4) increase access to granular data for community organizations.
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Affiliation(s)
| | - Meg Salvia
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Elaine Hanby
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
| | | | | | | | | | - Bob Gordon
- California LGBT Tobacco Education Partnership, San Francisco, CA, USA
| | | | | | | | - Jennifer Potter
- Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, USA
| | - Jarvis T Chen
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Andy S L Tan
- Annenberg School for Communication, University of Pennsylvania, Philadelphia, PA, USA
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Buetti D, Bourgeois I, Jafary M. Examining the competencies required by evaluation capacity builders in community-based organizations. Eval Program Plann 2023; 97:102242. [PMID: 36736193 DOI: 10.1016/j.evalprogplan.2023.102242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 06/18/2023]
Abstract
Increasing demand for evidence generated through program evaluation has led many community-based organizations (CBOs) to seek external support for evaluation capacity building (ECB). However, studies have yet to explore the essential competencies required by evaluation capacity builders working in the community sector. Our qualitative study aimed to examine the perceptions of ECB practitioners (n = 12) regarding essential competencies for building evaluation capacity in this sector. Our findings reveal that ECB practice requires competencies not found in known evaluation competency frameworks, such as instructional design, knowledge of organizational change models, motivating stakeholders, and understanding of the community sector. Our findings provide valuable information to help guide future education and training related to building the evaluation capacity of community organizations.
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Affiliation(s)
- David Buetti
- Faculty of Education, University of Ottawa, Canada.
| | | | - Maziar Jafary
- School of Sociological and Anthropological Studies, Faculty of Social Sciences, University of Ottawa, Canada.
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Shen AK, Browne S, Srivastava T, Kornides ML, Tan ASL. Trusted messengers and trusted messages: The role for community-based organizations in promoting COVID-19 and routine immunizations. Vaccine 2023; 41:1994-2002. [PMID: 36803894 PMCID: PMC9932688 DOI: 10.1016/j.vaccine.2023.02.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 01/22/2023] [Accepted: 02/13/2023] [Indexed: 02/18/2023]
Abstract
We sought to explore the trust and influence community-based organizations have within the communities they serve to inform public health strategies in tailoring vaccine and other health messages. A qualitative study was conducted between March 15 - April 12, 2021 of key informants in community-based organizations serving communities in and around Philadelphia, Pennsylvania. These organizations serve communities with high Social Vulnerability Index scores. We explored four key questions including: (1) What was and continues to be the impact of COVID-19 on communities; (2) How have trust and influence been cultivated in the community; (3) Who are trusted sources of information and health messengers; and (4) What are the community's perceptions about vaccines, vaccinations, and intent to vaccinate in the context of the COVID-19 pandemic. Fifteen key informants from nine community-based organizations who serve vulnerable populations (e.g., mental health, homeless, substance use, medically complex, food insecurity) were interviewed. Five key findings include: (1) The pandemic has exacerbated disparities in existing social determinants of health for individuals and families and have created new concerns for these communities; (2) components of how to build the trust and influence (e.g., demonstrate empathy, create a safe space, deliver on results)resonated with key informants; (3) regardless of the source, presenting health information in a respectful and understandable manner is key to effective delivery; (4) trust and influence can be transferred by association to a secondary messenger connected to or introduced by the primary trusted source; and (5) increased awareness about vaccines and vaccinations offers opportunities to think differently, changing previously held beliefs or attitudes, as many individuals are now more cognizant of risks associated with vaccine-preventable diseases and the importance of vaccines. Community-based organizations offer unique opportunities to address population-level health disparities as trusted vaccine messengers to deliver public health messages.
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Affiliation(s)
- Angela K Shen
- Children's Hospital of Philadelphia, Vaccine Education Center, Philadelphia, United States; Leonard Davis Institute, University of Pennsylvania, Philadelphia, United States; University of Pennsylvania, Perelman School of Medicine, Department of Medical Bioethics and Health Policy, Philadelphia, United States.
| | - Safa Browne
- Children's Hospital of Philadelphia, Vaccine Education Center, Philadelphia, United States
| | - Tuhina Srivastava
- Leonard Davis Institute, University of Pennsylvania, Philadelphia, United States; University of Pennsylvania, Perelman School of Medicine, Department of Biostatistics, Epidemiology and Informatics, Philadelphia, United States
| | - Melanie L Kornides
- Leonard Davis Institute, University of Pennsylvania, Philadelphia, United States; University of Pennsylvania, School of Nursing, Department of Family and Community Health, United States; University of Pennsylvania, Perelman School of Medicine, Department of Pediatrics, Division of Adolescent Medicine, United States
| | - Andy S L Tan
- Leonard Davis Institute, University of Pennsylvania, Philadelphia, United States; University of Pennsylvania, Annenberg School for Communication, United States
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Tremblay D, Touati N, Usher S, Gentil B, Courval MJ. The challenge of optimizing supports for people living with and beyond cancer: creating proximity between cancer and non-profit community-based providers. Support Care Cancer 2023; 31:108. [PMID: 36625923 PMCID: PMC9831956 DOI: 10.1007/s00520-022-07569-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 12/30/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE Non-profit community-based organizations (CO) remain insufficiently integrated into cancer networks. Drawing on dimensions of proximity, this study explores how and why coordination between cancer teams and COs is established and solidified. METHODS A descriptive interpretive study is undertaken in Québec (Canada), where a cancer program has long promoted the integration of COs in the cancer trajectory. Semi-directed interviews with providers, managers and people living with and beyond cancer (total n = 46) explore the challenges of coordination between cancer and CO providers, along with facilitating or impeding factors. Three main themes related to coordination in cancer networks emerge, which are analyzed by operationalizing the multi-dimensional framework of proximity. RESULTS Findings reveal a lack of cognitive proximity, which calls for efforts to both identify patient needs and increase cancer team knowledge and appreciation of CO resources. Organizational proximity refers to systems and rules that facilitate interactions, and we find that referral mechanisms and communication channels are inadequate, with patients often playing a linking role despite barriers. Coordination improves when relational proximity is established between cancer and CO teams, and this can be enhanced by geographic proximity; in one region, COs have a physical presence within the cancer center. CONCLUSION Integrating COs into the cancer network can help meet the spectrum of needs faced by people living with and beyond cancer. This study offers managers and decision-makers insight into how coordination between cancer teams and COs can be supported. Proximity allows the distinct contributions of actors to be considered in context and contributes to understanding the "how" of integrated practice.
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Affiliation(s)
- Dominique Tremblay
- School of Nursing, Université de Sherbrooke, Longueuil Campus, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8, Canada. .,Centre de Recherche Charles-Le Moyne, 150 Place Charles-Le Moyne, Longueuil, Québec, J4K 0A8, Canada.
| | - Nassera Touati
- École nationale d’administration Publique, 4750 Ave Henri-Julien, 5E Étage, Montréal, Québec H2T 3E5 Canada
| | - Susan Usher
- Centre de Recherche Charles-Le Moyne, 150 Place Charles-Le Moyne, Longueuil, Québec J4K 0A8 Canada ,École nationale d’administration Publique, 4750 Ave Henri-Julien, 5E Étage, Montréal, Québec H2T 3E5 Canada
| | - Barbara Gentil
- Centre de Recherche Charles-Le Moyne, 150 Place Charles-Le Moyne, Longueuil, Québec J4K 0A8 Canada
| | - Marie-Josée Courval
- Centre Intégré de Santé et de Services Sociaux (CISSS) de la Montérégie-Centre, 3120 Boul. Taschereau, Greenfield Park, Québec J4V 2H1 Canada
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Aristegui I, Castro Avila J, Villes V, Delabre RM, Orellano G, Aguilera M, Romero M, Riegel L, Kretzer L, Cardozo N, Radusky PD, Rojas Castro D. Female sex workers and police violence during the Covid-19 health crisis in 2020-2021: results from the EPIC multi-country community-based research program in Argentina. Harm Reduct J 2022; 19:139. [PMID: 36503497 PMCID: PMC9742027 DOI: 10.1186/s12954-022-00714-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 11/14/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Female sex workers (FSW) have been disproportionately impacted by the Covid-19 crisis. Data show increases of police violence toward key populations (KP), likely a consequence of their role in enforcing health government measures. This study aimed to identify factors associated with police violence experienced by FSW during the Covid-19 crisis in Argentina. METHODS EPIC is a multi-country, cross-sectional, community-based research program evaluating the impact of Covid-19 among KP. In Argentina, the study was conducted in collaboration with FSW community-based organizations (CBO). Participants completed an online survey (October 2020-April 2021). Police violence was measured as having experienced episodes of violence (physical, verbal, psychological or sexual) by security forces since the start of the health crisis. Factors associated with police violence were assessed in logistic regression models. RESULTS Among 173 respondents, median age was 34 [IQR 27-42], 39.3% were transgender women (TW), 78.1% declared sex work as their only income and 71.7% mentioned their financial situation has deteriorated with the health crisis. Nearly half of FSW (44.5%) reported experiencing police violence within the first year of the Covid-19 pandemic, and among them, 76.6% declared more frequent violence episodes since the beginning of the health crisis. After adjustment for age, being a TW (aOR [95% CI] = 2.71 [1.21;6.05]), reporting non-injection drug use (2.92 [1.02;8.36]), having a considerably deteriorated financial situation (3.67 [1.47;9.21]), having had a consultation with a CBO worker for medical care/treatments (5.56 [2.15;14.37]) and declaring fear or experiences of discrimination by physicians/other health workers (2.97 [1.21;7.29]), since the beginning of the Covid-19 health crisis, were independently associated with police violence. CONCLUSIONS FSW in Argentina have experienced an increase in police violence since the beginning of the health crisis. Belonging to multiple KP (FSW, TW, people who use drugs) increases the likelihood of experiencing police violence, highlighting the need of an intersectional approach to develop interventions to reduce stigma and violence against FSW. CBOs have provided essential support and services during the crisis to FSWs, and other KPs, who may have avoided traditional healthcare structures due to fear or experiences of discrimination.
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Affiliation(s)
- I. Aristegui
- grid.491017.a0000 0004 7664 5892Fundación Huésped, Research Department, Dr. Carlos Gianantonio 3932, C1202ABB Buenos Aires, Argentina ,grid.441624.10000 0001 1954 9157Department of Research in Psychology, Universidad de Palermo, Buenos Aires, Argentina
| | - J. Castro Avila
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France
| | - V. Villes
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France
| | - R. M. Delabre
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France
| | - G. Orellano
- Asociación de Mujeres Meretrices de Argentina (AMMAR), Buenos Aires, Argentina
| | - M. Aguilera
- Asociación de Travestis Transexuales y Transgénero de Argentina (ATTTA), Buenos Aires, Argentina
| | - M. Romero
- Asociación de Travestis Transexuales y Transgénero de Argentina (ATTTA), Buenos Aires, Argentina
| | - L. Riegel
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France
| | - L. Kretzer
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France
| | - N. Cardozo
- grid.491017.a0000 0004 7664 5892Fundación Huésped, Research Department, Dr. Carlos Gianantonio 3932, C1202ABB Buenos Aires, Argentina ,Asociación de Travestis Transexuales y Transgénero de Argentina (ATTTA), Buenos Aires, Argentina
| | - P. D. Radusky
- grid.491017.a0000 0004 7664 5892Fundación Huésped, Research Department, Dr. Carlos Gianantonio 3932, C1202ABB Buenos Aires, Argentina ,grid.7345.50000 0001 0056 1981Faculty of Psychology, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - D. Rojas Castro
- Community-Based Research Laboratory, Coalition PLUS, Pantin, France ,grid.5399.60000 0001 2176 4817Inserm, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, ISSPAM, Aix Marseille Université, Marseille, France
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Alaybek B, Olsen GP, Kansagra SM, Hogan K, Stratman SE, Honess-Morreale LR, Kriz S. Strategies for recruiting, training, and retaining educators for adolescent pregnancy prevention programs: Insights from organization leaders and educators. Dialogues Health 2022; 1:100052. [PMID: 38515912 PMCID: PMC10953962 DOI: 10.1016/j.dialog.2022.100052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 09/04/2022] [Accepted: 09/25/2022] [Indexed: 03/23/2024]
Abstract
This paper provides insights into how 17 community-based organizations (CBOs) recruited, trained, and retained educators in pregnancy prevention program implementations for underserved adolescents in different areas of the United States. The paper also highlights problems and potential solutions associated with these practices. The study adopted a qualitative descriptive framework. We conducted 41 interviews with leaders and educators of CBOs and conducted qualitative content analysis of the interview data integrating deductive and inductive coding approaches. We found that a commonly emphasized recruitment and selection challenge was finding qualified candidates for short-term project-based employment. Interviewees highlighted limitations of curriculum training in preparing novice educators for program implementation and shared their strategies to overcome these limitations. Post-onboarding professional development opportunities were available for long-term educators, but not for short-term project-based educators. Educators reported receiving sufficient support from their organizations and coworkers to perform their jobs and maintain their well-being. Although none of the educators desired to leave their roles, they shared potential reasons for turnover, such as project-based employment and a desire to explore different career paths. We align the study findings with best practices proposed in the adolescent health education and human resources literatures and present a set of recommendations. Researchers interested in adolescent pregnancy prevention program implementation and organizations that plan to implement programs can benefit from the findings and recommendations presented in this article.
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Matthews AK, Li CC, Bernhardt B, Sohani S, Dong XQ. Factors influencing the well-being of Asian American LGBT individuals across the lifespan: perspectives from leaders of community-based organizations. BMC Geriatr 2022; 22:909. [PMID: 36443664 PMCID: PMC9703657 DOI: 10.1186/s12877-022-03590-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/04/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Lesbian, gay, bisexual, and transgender (LGBT) individuals have documented disparities in mental health that are experienced across the life course. However, limited research has been conducted to identify the factors which contribute to evaluated risk for poor mental health among older Asian Americans who identify as LGBT. The purpose of this study was to determine the perspectives of leaders of community-based organizations about the mental health needs and concerns of their LGBT constituents from diverse Asian backgrounds. METHODS Semi-structured qualitative interviews were conducted with leaders of community-based organizations serving the needs of LGBT individuals. A qualitative framework analysis approach was used to identify, analyze and report themes within the data. RESULTS 11 members of community organizations located in California (54.5%), Chicago (27.2%), and New York (18.1%) were interviewed. Chronic stress was identified as negatively impacting constituents' lives and was attributed to social determinants of health, including inadequate housing, financial insecurity, discrimination, barriers to adequate health care, and immigration status. Ageism, social isolation, language barriers, and limited connections to cultural, religious, or LGBT communities were identified as factors impacting middle-aged and older adults. Participants identified homelessness, violence, and lack of parental acceptance as contributing to distress among youth and younger adults. The most vulnerable community members were identified as gender minorities, undocumented individuals, and individuals with limited English proficiencies. Organizational leaders described strategies to address social determinants. CONCLUSIONS Asian Americans who are LGBT are confronted with substantial risks for poor mental health that are linked to modifiable social determinants of health. Organizations serving these populations play a vital role in meeting the needs of a highly underserved population.
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Affiliation(s)
- Alicia K. Matthews
- grid.185648.60000 0001 2175 0319Department of Population Health Nursing Science, University of Illinois at Chicago, Chicago, IL USA
| | - Chien-Ching Li
- grid.262743.60000000107058297Department of Health Systems Management, Rush University, Chicago, IL USA
| | | | - Shams Sohani
- grid.21729.3f0000000419368729Department of Sociomedical Sciences, Columbia University, New York City, NY USA
| | - Xin Qi Dong
- grid.430387.b0000 0004 1936 8796Health Care Policy and Aging Research, Rutgers University, Institute for Health, New Brunswick, NJ USA
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West R, DiMeo A, Langer A, Shah N, Molina RL. Addressing Racial/Ethnic Inequities in Maternal Health Through Community-Based Social Support Services: A Mixed Methods Study. Matern Child Health J 2022; 26:708-718. [PMID: 34982340 PMCID: PMC8724658 DOI: 10.1007/s10995-021-03363-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 11/24/2022]
Abstract
Introduction In the US, there are striking inequities in maternal health outcomes between racial and ethnic groups. Community-based organizations (CBOs) provide social support services that are critical in addressing the needs of clients of color during and after pregnancy. Methods We conducted a descriptive, cross-sectional mixed methods study of CBOs in Greater Boston that provide social support services to pregnant and postpartum clients. In May–August 2020, we administered an online survey about organizational characteristics, client population, and services offered. In July–August 2020, we conducted semi-structured interviews focused on services provided, gaps in services, and the impact of structural racism on clients. We used descriptive statistics to characterize CBOs and services and used thematic analysis to extract themes from the qualitative data. Results A total of 21 unique CBOs participated with 17 CBOs completing the survey and 14 participating in interviews. CBOs served between 10 and 35,000 pregnant and postpartum clients per year (median = 200), and about half (n = 8) focused their programming on pregnant and postpartum clients. The most significant gaps in social support services were housing and childcare. Respondents identified racism and lack of coordination among organizations as the two primary barriers to accessing social support. Discussion CBOs face multiple challenges to providing social support to pregnant and postpartum clients of color, and significant gaps exist in the types of services currently provided. Improved coordination among CBOs and advocacy efforts to develop community-informed solutions are needed to reduce barriers to social support.
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Affiliation(s)
- Rebecca West
- Boston University School of Public Health, Boston, MA USA
- Ariadne Labs at Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Amanda DiMeo
- Ariadne Labs at Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, MA USA
| | - Ana Langer
- Women and Health Initiative, Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA USA
| | - Neel Shah
- Ariadne Labs at Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, MA USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA USA
| | - Rose L. Molina
- Ariadne Labs at Brigham and Women’s Hospital and Harvard T.H. Chan School of Public Health, Boston, MA USA
- Department of Obstetrics and Gynecology, Beth Israel Deaconess Medical Center, Boston, MA USA
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15
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Schmidt RD, Armstrong FD, Horigian VE, Swilley-Woods G, Alonso B, Jackson D, Natale R, Jent J, Schladant M, Nelson S, Brosco JP. Aiming High: Monitoring Population Level Indicators of Child Wellbeing as a Goal of Community-Academic Partnerships. Matern Child Health J 2022. [PMID: 34982344 DOI: 10.1007/s10995-021-03333-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Community-academic partnerships (CAPs) aim to improve neighborhood population health. Though measuring the impact of partnership activities at a population level can be difficult, evaluating indicators of wellbeing may increase understanding of how communities benefit from CAPs. This study examined child health indicators over time in two low-income, predominantly Black/African American and Hispanic communities where partnerships between an academic child development center and community coalitions were formed with the intention of improving child well-being. METHODS Trends in three child wellbeing indicators (graduation rates, kindergarten readiness, and proportion of youth in school and/or employed) were compared between two CAP communities and several neighboring comparison communities. Data between 2011 and 2017 were analyzed to calculate percent change from baseline and mapped using ArcGIS to visualize trends by zip code. Proportions of youth meeting benchmarks were also determined. RESULTS Kindergarten readiness and high-school graduation rates improved in CAP communities but not in geographically proximal and socioeconomically similar comparison communities. No improvements were found in the proportion of youth in school or employed. DISCUSSION This study revealed population-level indicators improved over time in CAP communities. Because community-level child health and wellbeing are influenced by many factors, this correlation is not proof of a causal relationship. Assessing population level indicators can nonetheless provide insight into the benefit of CAPs, and the commitment to monitoring such outcomes can itself advance how academic and community partners plan activities and set long-term goals.
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Roels NI, Estrella A, Maldonado-Salcedo M, Rapp R, Hansen H, Hardon A. Confident futures: Community-based organizations as first responders and agents of change in the face of the Covid-19 pandemic. Soc Sci Med 2021; 294:114639. [PMID: 34998135 PMCID: PMC8683095 DOI: 10.1016/j.socscimed.2021.114639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 11/07/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022]
Abstract
This comparative study of community organizations serving marginalized youth in New York City and Amsterdam utilized a novel ethnographic approach called reverse engineering to identify techniques for social change that are active in each organization, adaptable and translatable to other contexts. It found that youth-serving organizations led flexible responses to the crisis of COVID-19 as it affected those marginalized by race, immigrant status, housing instability, religion and gender. The organizations employed techniques that they had previously developed to cultivate youth well-being – among them connectivity, safe space, and creativity – to mount tailored responses to COVID-19 related crises. In New York City, these groups addressed crises of material survival resources (personal protective equipment, food, housing) whereas in Amsterdam, youth-serving organizations focused on social connections and emotional well-being as the government met more of participants’ material needs.
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Ramanadhan S, Galbraith-Gyan K, Revette A, Foti A, Rackard James C, Martinez-Dominguez V, Miller E, Tappin J, Tracy N, Bruff C, Donaldson ST, Minsky S, Sempasa D, Siqueira C, Viswanath K. Key considerations for designing capacity-building interventions to support evidence-based programming in underserved communities: a qualitative exploration. Transl Behav Med 2021; 11:452-461. [PMID: 32515481 PMCID: PMC7963294 DOI: 10.1093/tbm/ibz177] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Increasing the use of evidence-based programs (EBPs) in community settings is critical for improving health and reducing disparities. Community-based organizations (CBOs) and faith-based organizations (FBOs) have tremendous reach and trust within underserved communities, but their impact is constrained by limited staff capacity to use EBPs. This exploratory study sought to identify design and delivery considerations that could increase the impact of capacity-building interventions for CBOs and FBOs working with underserved communities. Data come from a community-based participatory research project addressing cancer disparities in Black, Latino, and Brazilian communities from Greater Boston and Greater Lawrence, Massachusetts. We conducted four focus group discussions with program coordinators in CBOs and FBOs (n = 27) and key informant interviews with CBO and FBO leaders (n = 15). Three researchers analyzed the data using a multi-stage coding process that included both prefigured and emergent codes. Key design considerations included embedding customized capacity-building interventions into community networks with local experts, supporting ongoing engagement with the intervention via a range of resources and communication channels, and addressing resource constraints. Regarding the contextual factors that should influence capacity-building intervention content, participants highlighted resource constraints, environments in which EBP use is not the norm, and challenges linking available programs with the multi-level barriers to good health faced by community members. Overall, the study highlights the need for integrated, long-term capacity-building efforts developed in partnership with, and ultimately sustained by, local organizations.
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Affiliation(s)
- Shoba Ramanadhan
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Anna Revette
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Alisa Foti
- Mt. Sinai Healthcare Foundation, Cleveland, OH, USA
| | | | | | - Elecia Miller
- City of Lawrence Mayor's Health Task Force, Lawrence, MA, USA
| | | | - Natalicia Tracy
- Brazilian Worker Center, Boston, MA, USA.,University of Massachusetts - Boston, Boston, MA, USA
| | - Carmenza Bruff
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Sara Minsky
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Doris Sempasa
- Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Kasisomayajula Viswanath
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Center for Community-Based Research, Dana-Farber Cancer Institute, Boston, MA, USA
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Leong J, Jang SH, Bishop SK, Brown EVR, Lee EJ, Ko LK. "We understand our community": implementation of the Healthy Eating Healthy Aging program among community-based organizations. Transl Behav Med 2021; 11:462-469. [PMID: 32582949 DOI: 10.1093/tbm/ibaa049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Cardiovascular disease is the second leading cause of death in the USA among Asian Americans and Pacific Islanders (AAPIs) over the age of 65. Healthy Eating Healthy Aging (HEHA), an evidence-based heart health program, can provide culturally appropriate nutrition education to decrease the risk of cardiovascular disease. Community-based organizations (CBOs) are optimal settings to implement community-based programs. However, there is inadequate research on how evidence-based interventions like HEHA are implemented in CBOs. This study examined processes that facilitated the implementation of HEHA among CBOs serving older AAPIs. Twelve representatives from CBOs that implemented the HEHA program were recruited to participate in a semistructured interview. All the participants were CBO directors or senior managers. A semistructured interview guide was created and informed by the Consolidated Framework for Implementation Research (CFIR) to capture how HEHA played into the five domains of CFIR: (a) intervention characteristics, (b) outer setting, (c) inner setting, (d) characteristics of the individuals, and (e) process. Data analysis captured themes under the CFIR domains. All five CFIR domains emerged from the interviews. Under intervention characteristics, three constructs emerged as facilitating the implementation of HEHA: (a) the participant's beliefs around the quality of the HEHA program and its ability to promote healthy eating, (b) HEHA's adaptability to different AAPI subgroups, and (c) perceptions of how successfully HEHA was bundled and assembled. Under outer setting, the participants described the community's need for healthy eating programs and how the HEHA program meets that need. Four constructs emerged under inner setting: (a) the CBO's structural characteristics and social standing in the community; (b) resources dedicated to the implementation and ongoing operations, including funding, training, education, physical space, and time; (c) the culture of the CBO; and (d) the participant's commitment and involvement in marketing, promotion, and implementation of HEHA. Under characteristics of individuals, participants' described their desire to learn the content of HEHA and deliver them successfully. Under process, participants described strategies to engage relevant individuals to facilitate HEHA implementation. The interviews with CBO representatives provided insights into CFIR domain constructs that facilitated the implementation of HEHA. CBOs are key settings for community health education. Understanding processes that lead to the successful implementation of evidence-based interventions among CBOs is critical for accelerating the dissemination and implementation of best practices.
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Affiliation(s)
- Judy Leong
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, USA
| | - Sou Hyun Jang
- Department of Sociology, Sungkyunkwan University, Seoul, South Korea
| | - Sonia K Bishop
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Emily V R Brown
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Eun Jeong Lee
- Asian American Resource and Information Network, Wood Ridge, NJ, USA
| | - Linda K Ko
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.,Department of Health Services, University of Washington, Seattle, WA, USA
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Sridhar A, Drahota A, Walsworth K. Facilitators and barriers to the utilization of the ACT SMART Implementation Toolkit in community-based organizations: a qualitative study. Implement Sci Commun 2021; 2:55. [PMID: 34039434 PMCID: PMC8157454 DOI: 10.1186/s43058-021-00158-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 05/11/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence-based practices (EBPs) have been shown to improve behavioral and mental health outcomes for children diagnosed with autism spectrum disorder (ASD). Research suggests that the use of these practices in community-based organizations is varied; however, the utilization of implementation guides may bridge the gap between research and practice. The Autism Community Toolkit: Systems to Measure and Adopt Research-Based Treatments (ACT SMART) Implementation Toolkit is a web-based implementation toolkit developed to guide organization-based implementation teams through EBP identification, adoption, implementation, and sustainment in ASD community-based organizations. METHODS This study examined the facilitators and barriers (collectively termed "determinants") to the utilization of this toolkit, based on the perspectives of implementation teams at six ASD community-based organizations. Two independent coders utilized the adapted EPIS framework and the Technology Acceptance Model 3 to guide qualitative thematic analyses of semi-structured interviews with implementation teams. RESULTS Salient facilitators (e.g., facilitation teams, facilitation meetings, phase-specific activities) and barriers (e.g., website issues, perceived lack of ease of use of the website, perceived lack of resources, inner context factors) were identified, highlighting key determinants to the utilization of this toolkit. Additionally, frequent determinants and determinants that differed across adapted EPIS phases of the toolkit were noted. Finally, analyses highlighted two themes: (a) Inner Context Determinants to use of the toolkit (e.g., funding) and (b) Innovation Determinants (e.g., all website-related factors), indicating an interaction between the two models utilized to guide study analyses. CONCLUSIONS Findings highlighted several factors that facilitated the utilization of this implementation guide. Additionally, findings identified key areas for improvement for future iterations of the ACT SMART Implementation Toolkit. Importantly, these results may inform the development, refinement, and utilization of implementation guides with the aim of increasing the uptake of EBPs in community-based organizations providing services to children with ASD and their families. Finally, these findings contribute to the implementation science literature by illustrating the joint use of the EPIS framework and Technology Acceptance Model 3 to evaluate the implementation of a web-based toolkit within community-based organizations.
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Affiliation(s)
- Aksheya Sridhar
- Department of Psychology, Michigan State University, East Lansing, MI, USA.
| | - Amy Drahota
- Department of Psychology, Michigan State University, East Lansing, MI, USA
- Child & Adolescent Services Research Center, San Diego, CA, USA
| | - Kiersten Walsworth
- Department of Psychology, Michigan State University, East Lansing, MI, USA
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Rusch D, Walden AL, DeCarlo Santiago C. A Community-Based Organization Model to Promote Latinx Immigrant Mental Health Through Advocacy Skills and Universal Parenting Supports. Am J Community Psychol 2020; 66:337-346. [PMID: 32880968 DOI: 10.1002/ajcp.12458] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The unique mental health context of children in Latinx immigrant families calls for innovative community-based intervention strategies. We use an ecological public health approach to highlight the importance of community-based organization (CBO) settings, the critical role of community-based paraprofessionals (i.e., non-clinicians, near-peers) and capacity-building, and the expansion of mental health promotion strategies to include realistic, day-to-day supports for Latinx immigrant parents and families. This realigns mental health with the goals and mission of trusted spaces, like CBOs, that can offer more equitable and non-stigmatized access for Latinx immigrant families. We draw upon two strength-based and empowerment-focused interventions that utilize community-based workforces to promote positive parenting skills (Partners Achieving Student Success-PASS; Mehta et al., 2019) and self-advocacy skills (Community Advocacy Project-CAP; Sullivan & Bybee, 1999) to provide the conceptual framework for Family Mental Health Advocacy (FMHA). FMHA aligns mental health promotion with the advocacy mission of CBOs, engages CBO staff with feasible mental health "messages," and empowers immigrant parents as critical change agents in the lives of their children. We acknowledge the challenges associated with implementing mental health promotion strategies and providing workforce support, as well as the importance of local and national policy influences.
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Affiliation(s)
- Dana Rusch
- Department of Psychiatry, Institute for Juvenile Research, University of Illinois at Chicago, Chicago, IL, USA
| | - Angela L Walden
- Department of Psychiatry, Institute for Juvenile Research, University of Illinois at Chicago, Chicago, IL, USA
- Office of the Vice Provost for Diversity, University of Illinois at Chicago, Chicago, IL, USA
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Lengnick-Hall R, Willging CE, Hurlburt MS, Aarons GA. Incorporators, Early Investors, and Learners: a longitudinal study of organizational adaptation during EBP implementation and sustainment. Implement Sci 2020; 15:74. [PMID: 32912237 PMCID: PMC7488112 DOI: 10.1186/s13012-020-01031-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/17/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The majority of literature on evidence-based practice (EBP) adaptation focuses on changes to clinical practices without explicitly addressing how organizations must adapt to accommodate a new EBP. This study explores the process of organizational-rather than EBP-adaptation during implementation and sustainment. To the authors' knowledge, there are no previous implementation studies that focus on organizational adaptation in this way. METHODS This analysis utilizes a case study approach to examine longitudinal qualitative data from 17 community-based organizations (CBOs) in one state and seven county-based child welfare systems. The CBOs had sustained a child-neglect intervention EBP (SafeCare®) for 2 to 10 years. The unit of analysis was the organization, and each CBO represented a case. Organizational-level profiles were created to describe the organizational adaptation process. RESULTS Three organizational-level adaptation profiles were identified as follows: incorporators (n = 7), early investors (n = 6), and learners (n = 4). Incorporators adapted by integrating SafeCare into existing operations to meet contractual or EBP fidelity requirements. Early Investors made substantial organizational adaptations during the early implementation period, then operated relatively consistently as the EBP became embedded in the organization and service system. Learners were characterized by steady and continuous attention to new ways that the organization could adapt to support the EBP. CONCLUSION The profiles demonstrated that there can be multiple effective paths to EBP sustainment. Organizational adaptation was calibrated to fit a CBO's operations (e.g., size of the program) and immediate environmental constraints (e.g., funding levels). Additionally, organizations fulfilled different functional roles in the network of entities involved in EBP implementation. Knowing organizational roles and adaptation profiles can guide implementation planning and help to structure contract designs that bridge the outer (system) and inner (organizational) contexts. Adaptation profiles can also inform the intensity of the implementation strategy tailoring process and the way that strategies are marketed to organizations.
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Affiliation(s)
- Rebecca Lengnick-Hall
- grid.4367.60000 0001 2355 7002The Brown School, Washington University, St. Louis, MO USA
| | - Cathleen E. Willging
- grid.280247.b0000 0000 9994 4271Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, Albuquerque, NM USA
| | - Michael S. Hurlburt
- grid.42505.360000 0001 2156 6853Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA USA
| | - Gregory A. Aarons
- grid.266100.30000 0001 2107 4242Department of Psychiatry, University of California, San Diego, La Jolla, CA USA ,grid.266100.30000 0001 2107 4242UC San Diego Dissemination and Implementation Science Center, La Jolla, CA USA
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Nylen K, Sridharan S. Experiments in evaluation capacity building: Enhancing brain disorders research impact in Ontario. Eval Program Plann 2020; 80:101442. [PMID: 28578855 DOI: 10.1016/j.evalprogplan.2017.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 05/06/2017] [Indexed: 06/07/2023]
Abstract
This paper is the introductory paper on a forum on evaluation capacity building for enhancing impacts of research on brain disorders. It describes challenges and opportunities of building evaluation capacity among community-based organizations in Ontario involved in enhancing brain health and supporting people living with a brain disorder. Using an example of a capacity building program called the "Evaluation Support Program", which is run by the Ontario Brain Institute, this forum discusses multiple themes including evaluation capacity building, evaluation culture and evaluation methodologies appropriate for evaluating complex community interventions. The goal of the Evaluation Support Program is to help community-based organizations build the capacity to demonstrate the value that they offer in order to improve, sustain, and spread their programs and activities. One of the features of this forum is that perspectives on the Evaluation Support Program are provided by multiple stakeholders, including the community-based organizations, evaluation team members involved in capacity building, thought leaders in the fields of evaluation capacity building and evaluation culture, and the funders.
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Affiliation(s)
- Kirk Nylen
- Ontario Brain Institute, University of Toronto, Department of Pharmacology, Canada.
| | - Sanjeev Sridharan
- The Evaluation Centre for Complex Health Interventions, St. Michael's Hospital, Institute for Health Policy, Management and Evaluation, University of Toronto, Canada.
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Funders Support Integrating Health And Human Services. Health Aff (Millwood) 2020; 39:718-9. [PMID: 32250664 DOI: 10.1377/hlthaff.2020.00248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Williams RM, Zhang J, Woodard N, Slade J, Santos SLZ, Knott CL. Development and validation of an instrument to assess institutionalization of health promotion in faith-based organizations. Eval Program Plann 2020; 79:101781. [PMID: 31991309 DOI: 10.1016/j.evalprogplan.2020.101781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 01/19/2020] [Accepted: 01/20/2020] [Indexed: 06/10/2023]
Abstract
Institutionalization of health promotion interventions occurs when the organization makes changes to support the program as a component of its routine operations. To date there has not been a way to systematically measure institutionalization of health promotion interventions outside of healthcare settings. The purpose of the present study was to develop and evaluate the initial psychometric properties of an instrument to assess institutionalization (i.e., integration) of health activities into faith-based organizations (i.e., churches). This process was informed by previous institutionalization models led by a team of experts and a community-based advisory panel. We recruited African American church leaders (N = 91) to complete a 22-item instrument. An exploratory factor analysis revealed four factors: 1) Organizational Structures (e.g., existing health ministry, health team), 2) Organizational Processes (e.g., records on health activities; instituted health policy), 3) Organizational Resources (e.g., health promotion budget; space for health activities), and 4) Organizational Communication (e.g., health content in church bulletins, discussion of health within sermons) that explained 62.3 % of the variance. The measure, the Faith-Based Organization Health Integration Inventory (FBO-HII), had excellent internal consistency reliability (α = .89) including the subscales (α = .90, .82, .81, and .87). This measure has promising initial psychometric properties for assessing institutionalization of health promotion interventions in faith-based settings.
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Affiliation(s)
- Randi M Williams
- University of Maryland, School of Public Health, Department of Behavioral and Community Health, College Park, MD, United States.
| | - Jing Zhang
- University of Maryland, School of Public Health, Department of Epidemiology and Biostatistics, United States.
| | - Nathaniel Woodard
- University of Maryland, School of Public Health, Department of Behavioral and Community Health, College Park, MD, United States.
| | - Jimmie Slade
- Community Ministry of Prince George's County, Upper Marlboro, MD, United States.
| | - Sherie Lou Zara Santos
- University of Maryland, School of Public Health, Department of Behavioral and Community Health, College Park, MD, United States.
| | - Cheryl L Knott
- University of Maryland, School of Public Health, Department of Behavioral and Community Health, College Park, MD, United States.
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Burns PA, Williams MS, Mena LA, Bruce MA, Bender M, Burton ET, Beech BM. Leveraging Community Engagement: The Role of Community-Based Organizations in Reducing New HIV Infections Among Black Men Who Have Sex with Men. J Racial Ethn Health Disparities 2020; 7:193-201. [PMID: 31942692 DOI: 10.1007/s40615-019-00691-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 12/17/2019] [Accepted: 12/27/2019] [Indexed: 12/16/2022]
Abstract
There is growing recognition that a singular focus on biomedical treatments is insufficient to address the HIV prevention and health-care needs of Black men who have sex with men (Black MSM). Ending the HIV epidemic requires a multifactorial approach accounting for the social, cultural, economic, and environmental factors that drive transmission of HIV and other STDs. The two case studies presented were implemented by community-based organizations that have extensive experience with the target population and previous experience implementing HIV prevention-related programs and projects in the Jackson, Mississippi, metropolitan area. Culturally appropriate HIV prevention interventions that explicitly acknowledge the social determinants of health, particularly stigma and discrimination, both racial and sexual, are critical to reducing the number of new infections. These culturally appropriate and locally derived HIV prevention interventions provide a model for HIV health-care providers, public health officials, and community leaders to address the unique needs of Black MSM.
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Affiliation(s)
- Paul A Burns
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS, USA.
| | - Michelle S Williams
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS, USA
| | - Leandro A Mena
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS, USA
| | - Marino A Bruce
- Center for Research on Men's Health, Vanderbilt University, Nashville, TN, USA
| | - Melverta Bender
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS, USA
| | - E Thomaseo Burton
- Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Bettina M Beech
- Department of Population Health Science, John D. Bower School of Population Health, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS, USA
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Nicholas C, Eastman-Mueller H, Barbich N. Empowering Change Agents: Youth Organizing Groups as Sites for Sociopolitical Development. Am J Community Psychol 2019; 63:46-60. [PMID: 30768728 DOI: 10.1002/ajcp.12315] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
In addition to social action campaigns, some youth organizing groups provide formative learning experiences which engage youth in relevant sociopolitical issues through critical approaches. These groups support sociopolitical development (SPD), a self and socially-oriented process which influences youth personally, politically, and professionally into adulthood. This study explored how youth organizing experiences influenced SPD in the professional domain, applying an empowerment lens. Phenomenologically-based interviews were conducted with former sexual health education youth organizers and adult program staff. Former youth participants chose socially-oriented career paths influenced by the group's empowering approach to sexual health education and advocacy. They related meaningful sociopolitical learning experiences (e.g., interpersonal, educational, and civic engagement) to empowerment outcomes (e.g., political efficacy, critical awareness, and participatory behaviors) which informed career decisions. Professionally, participants sought to empower others as the group empowered them, drawing upon youth organizing social and human capital as they worked toward this aim. Combining sociopolitical and empowerment theorizing, the study adds to what is known about how purposefully designed youth organizing experiences support long-term development outcomes for individuals. Viewed as socially-oriented career development sites, youth organizing groups build capacity for social change beyond the groups themselves. Implications for youth organizing scholars and practitioners are provided.
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Affiliation(s)
| | | | - Natalie Barbich
- School of Public Health, Indiana University, Bloomington, IN, USA
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Bautista-Arredondo S, Nance N, Salas-Ortiz A, Akeju D, Oluwayinka AG, Ezirim I, Anenih J, Chima C, Amanze O, Omoregie G, Ogungbemi K, Aliyu SH. The role of management on costs and efficiency in HIV prevention interventions for female sex workers in Nigeria: a cluster-randomized control trial. Cost Eff Resour Alloc 2018; 16:37. [PMID: 30386184 PMCID: PMC6199740 DOI: 10.1186/s12962-018-0107-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/05/2018] [Indexed: 01/20/2023] Open
Abstract
Background While the world has made much global progress toward the reduction of new HIV infections, HIV continues to be an important public health problem. In the face of constantly constrained resources, donors and grantees alike must seek to optimize resources and deliver HIV services as efficiently as possible. While there is evidence that management practices can affect efficiency, this has yet to be rigorously tested in the context of HIV service delivery. Methods The present protocol describes the design of a cluster-randomized control trial to estimate the effect of management practices on efficiency. Specifically, we will evaluate the impact of an intervention focused on improving management practices among community-based organizations (CBOs), on the costs of HIV prevention services for female sex workers (FSW) in Nigeria. To design the intervention, we used a qualitative, design thinking-informed methodology that allowed us to understand management in its organizational context better and to develop a user-centered solution. After designing the suite of management tools, we randomly assigned 16 CBOs to the intervention group, and 15 CBOs to the control group. The intervention consisted of a comprehensive management training and a management “toolkit” to support better planning and organization of their work and better communication between CBOs and community volunteers. Both treatment and control groups received training to record data on efficiency—inputs used, and outputs produced. Both groups will be prospectively followed through to the end of the study, at which point we will compare the average unit cost per FSW served between the two groups using a quasi-experimental “difference-in-differences” (DiD) strategy. This approach identifies the effect of the intervention by examining differences between treatment and control groups, before and after the intervention thus accounting for time-constant differences between groups. Despite the rigorous randomization procedure, the small sample size and diversity in the country may still cause unobservable characteristics linked to efficiency to unbalanced between treatment and control groups at baseline. In anticipation of this possibility, using the quasi-experimental DiD approach allows any baseline differences to be “differenced out” when measuring the effect. Discussion This study design will uniquely add to the literature around management practices by building rigorous evidence on the relationship between management skills and practices and service delivery efficiency. We expect that management will positively affect efficiency. This study will produce valuable evidence that we will disseminate to key stakeholders, including those integral to the Nigerian HIV response. Trial registration This trial has been registered in Clinical Trials (NCT03371914). Registered 13 December 2018 Electronic supplementary material The online version of this article (10.1186/s12962-018-0107-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- S Bautista-Arredondo
- 1National Institute of Public Health, Mexico (INSP), Cuernavaca, Mexico.,2University of California, Berkeley, School of Public Health (UCB), Berkeley, USA
| | - N Nance
- 1National Institute of Public Health, Mexico (INSP), Cuernavaca, Mexico
| | - A Salas-Ortiz
- 1National Institute of Public Health, Mexico (INSP), Cuernavaca, Mexico
| | - D Akeju
- 3University of Lagos (UNILAG), Lagos, Nigeria
| | | | - I Ezirim
- 5National Agency for the Control of AIDS (NACA), Abuja, Nigeria
| | - J Anenih
- 5National Agency for the Control of AIDS (NACA), Abuja, Nigeria
| | - C Chima
- 4Society for Family Health (SFH), Abuja, Nigeria
| | - O Amanze
- 5National Agency for the Control of AIDS (NACA), Abuja, Nigeria
| | - G Omoregie
- 4Society for Family Health (SFH), Abuja, Nigeria
| | - K Ogungbemi
- 5National Agency for the Control of AIDS (NACA), Abuja, Nigeria
| | - S H Aliyu
- 5National Agency for the Control of AIDS (NACA), Abuja, Nigeria
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Holbrook AM, Hunt SR, See MR. Implementation of Dialectical Behavior Therapy in Residential Treatment Programs: A Process Evaluation Model for a Community-Based Agency. Community Ment Health J 2018; 54:921-9. [PMID: 29330697 DOI: 10.1007/s10597-017-0224-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 12/27/2017] [Indexed: 10/18/2022]
Abstract
Dialectical behavior therapy (DBT) can be challenging to implement in community-based settings. Little guidance is available on models to evaluate the effectiveness or sustainability of training and implementation efforts. Residential programs have much to gain from introduction of evidence-based practices, but present their own challenges in implementation. This paper presents a low-cost process evaluation model to assess DBT training piloted in residential programs. The model targets staff and organizational factors associated with successful implementation of evidence-based practices and matches data collection to the four stages of the DBT training model. The strengths and limitations of the evaluation model are discussed.
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Abstract
Background: The community form of palliative care first constructed in Kerala, India has gained recognition worldwide. Although it is the subject of important claims about its replicability elsewhere, little effort has gone into studying how this might occur. Drawing on translation studies, we attend to under-examined aspects of the transfer of a community palliative care intervention into a new geographic and institutional context. Methods: Over a period of 29 months, we conducted an in-depth case study of Sanjeevani, a community-based palliative care organization in Nadia district, West Bengal (India), that is modelled on the Kerala approach. We draw upon primary (semi-structured interviews and field notes) and secondary data sources. Results: We identify the translator’s symbolic power and how it counteracts the organizational challenges relating to socio-economic conditions and weak histories of civil society organizing. We find that unlike the Kerala form, which is typified by horizontal linkages and consensus-oriented decision-making, the translated organizational form in Nadia is a hybrid of horizontal and vertical solidarities. We show how translation is an ongoing, dynamic process, where community participation is infused with values of occupational prestige and camaraderie and shaped by emergent vertical solidarities among members. Conclusions: Our findings have implications for how we understand the relationship between locations, institutional histories, and healthcare interventions. We contribute to translation studies in healthcare, and particularly to conversations about the transfer or ‘roll out’ of palliative care interventions from one geography to another.
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Affiliation(s)
- Devi Vijay
- Organizational Behavior Group, Indian Institute of Management Calcutta , Kolkata, West Bengal, 700104, India
| | - Shahaduz Zaman
- Global Health and Infection Department, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PX, UK
| | - David Clark
- School of Interdisciplinary Studies, University of Glasgow, Dumfries, DG1 4ZL, UK
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Ramanadhan S, Minsky S, Martinez-Dominguez V, Viswanath K. Building practitioner networks to support dissemination and implementation of evidence-based programs in community settings. Transl Behav Med 2018; 7:532-541. [PMID: 28382582 DOI: 10.1007/s13142-017-0488-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Insufficient capacity to use evidence-based programs (EBPs) limits the impact of community-based organizations (CBOs) to improve population health and address health disparities. PLANET MassCONECT was a community-based participatory research (CBPR) project conducted in three Massachusetts communities. Researchers and practitioners co-created an intervention to build capacity among CBO staff members to systematically find, adapt, and evaluate EBPs. The project supported development of trainee social networks and this cross-sectional study examines the association between network engagement and EBP usage, an important goal of the capacity-building program. Trainee cohorts were enrolled from June 2010 to April 2012 and we collected community-specific network data in late 2013. The relationship of interest was communication among network members regarding the systematic approach to program planning presented in the intervention. For Communities A, B, and C, 39/59, 36/61, and 50/59 trainees responded to our survey, respectively. We conducted the full network analysis in Community C. The average degree, or number of connections with other trainees, is a useful marker of engagement; respondents averaged 6.6 reported connections. Degree was associated with recent use of EBPs, in a linear regression, adjusting for important covariates. The results call for further attention to practitioner networks that support the use of research evidence in community settings. Consideration of key contextual factors, including resource levels, turnover rates, and community complexity will be vital for success.
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Affiliation(s)
- Shoba Ramanadhan
- Center for Community-Based Research, Dana-Farber Cancer Institute, 450 Brookline Ave, LW 601, Boston, MA, 02215, USA. .,Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA, 02215, USA.
| | - Sara Minsky
- Center for Community-Based Research, Dana-Farber Cancer Institute, 450 Brookline Ave, LW 601, Boston, MA, 02215, USA
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Chang JS. Health in the Tenderloin: A resident-guided study of substance use, treatment, and housing. Soc Sci Med 2017; 176:166-174. [PMID: 28157570 DOI: 10.1016/j.socscimed.2017.01.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 01/06/2017] [Accepted: 01/09/2017] [Indexed: 10/20/2022]
Abstract
Substance use researchers recognize that environments - our homes, streets, communities, and neighborhoods - set the stage for substance use and treatment experiences by framing interactions, health options, and decision-making. The role of environment is particularly salient in places deemed disadvantaged or risky, such as parts of the Tenderloin neighborhood of San Francisco. Since risk is historically, socially, and structurally situated, an individual's social position in a neighborhood shapes how risk environments are experienced. The purpose of this study was to explore how the environment shapes substance use and treatment experiences, described from the perspective of Tenderloin residents. I conducted docent method interviews with formerly homeless women living in supportive housing in San Francisco (N = 20). The docent method is a three-stage, participant-led, audiotaped, and photographed walking interview. As they guided me through target "sites of interest" (homes, streets, treatment programs, and safe spaces), participants discussed their experiences with substance use and treatment in the environment. First, they described that the risks of a broader drug market are concentrated in the Tenderloin, exposing residents to elevated and disproportionate risk. Second, for structural, economic, social, and physical reasons, participants described a sense of geographic or neighborhood stratification. Third, multiple levels of policing and surveillance were persistent, even in participants' homes. Fourth, despite all the challenges, participants found security and support in the Tenderloin, and considered it their home. In the discussion, I offer that the Tenderloin environment provided residents many advantages, but forms of structural and everyday violence largely defined their experiences in the neighborhood.
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Affiliation(s)
- Jamie Suki Chang
- University of California, San Francisco, Department of Social and Behavioral Sciences, 3333 California Street, Suite 455, San Francisco, CA 94143-0612, United States.
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Stein R, Shapatava E, Williams W, Griffin T, Bell K, Lyons B, Uhl G. Reduced Sexual Risk Behaviors Among Young Men of Color Who Have Sex with Men: Findings from the Community-Based Organization Behavioral Outcomes of Many Men, Many Voices (CBOP-3MV) Project. Prev Sci 2015; 16:1147-58. [PMID: 26031542 DOI: 10.1007/s11121-015-0565-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In 2006, the Centers for Disease Control and Prevention (CDC) funded community-based organizations (CBOs) to deliver Many Men, Many Voices (3MV) to young men of color who have sex with men. Although 3MV, a group-level behavioral intervention designed to reduce human immunodeficiency virus (HIV) risk behaviors of black men who have sex with men (MSM), has shown effectiveness when delivered in a controlled research environment, there is limited evidence that the intervention is associated with similar outcomes in "real world" settings. For the current project, CDC funded three CBOs to conduct outcome monitoring of the 3MV intervention to determine if young MSM of color report changes in HIV risk behaviors postintervention. Using a repeated measures design, risk behaviors were collected at baseline and again at 3 and 6 months postintervention. Changes in risk behaviors were assessed using generalized estimating equations. Participants (n = 337) reported decreases in sexual risk behaviors at both follow-up time points, such as sex without a condom, sex without a condom and multiple partners, and sex without a condom with serodiscordant or status unknown partners. Results suggest that 3MV may be an effective tool for reducing HIV risk behaviors in this critical target population.
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Bloemraad I, Terriquez V. Cultures of engagement: The organizational foundations of advancing health in immigrant and low-income communities of color. Soc Sci Med 2016; 165:214-222. [PMID: 26898114 PMCID: PMC5012884 DOI: 10.1016/j.socscimed.2016.02.003] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 01/26/2016] [Accepted: 02/01/2016] [Indexed: 12/01/2022]
Abstract
A rich civic infrastructure of community-based organizations (CBOs) can help generate, diffuse and maintain a culture of engagement and health that benefits marginalized populations most at risk for illness, disability, and poor health. Attention to CBOs advances “meso-level” frameworks for understanding health cultures and outcomes by going beyond attention to social networks and social identities. We focus on three mechanisms: CBOs can (1) empower individuals by developing civic capacity and personal efficacy; (2) foster solidarity by building networks, social identities and a shared commitment to collective well-being; and (3) mobilize people to have a voice in health-related policies and programming, thereby affecting community well-being. We draw on theory and research in sociology, political science and psychology, and we illustrate the utility of a CBO approach by examining survey and semi-structured interview data from participants in youth civic groups in 13 low-income, predominantly immigrant communities in California. Interview data illustrate the ways in which CBOs enhance members' civic capacities, provide a sense of empowerment and efficacy to engage in healthy behaviors, develop solidarity among diverse participants, and elaborate networks among those committed to community well-being. We also discuss CBO-led campaigns in which youth mobilized for change in policies and practices of local institutions to illustrate possible community-wide health consequences of CBO engagement. CBOs can thus generate individual-level well-being effects, and reduce structural barriers to good health through changes in the broader environment. Civic groups can function as meso-level determinants of health and well-being. Civic groups can empower individuals, build solidarity and facilitate policy change. We illustrate with indepth interviews and surveys of minority youth in California. We discuss cases of community-based organizations' health-related initiatives.
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Affiliation(s)
- Irene Bloemraad
- Department of Sociology, University of California, Berkeley, United States.
| | - Veronica Terriquez
- Department of Sociology, University of California, Santa Cruz, United States
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McCarthy M, Fisher CM, Zhou J, Kneip Pelster AD, Schober D, Baldwin K, Fortenberry J, Goldsworthy R. A Qualitative Exploration of Community-Based Organization Programs, Resources, and Training to Promote Adolescent Sexual Health. Am J Sex Educ 2015; 10:316-332. [PMID: 27790077 PMCID: PMC5078980 DOI: 10.1080/15546128.2015.1091759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
BACKGROUND Youth development professionals (YDPs) working at community-based organizations (CBOs) can promote adolescent sexual health through programs. This study explored the programs and resources that youth access at CBOs and training YDPs receive. METHODS Twenty-one semi-structured interviews were conducted with YDPs. Qualitative content analyses were conducted using NVivo. RESULTS Most YDPs (n = 15, 71.4%) described sexuality-related programs for youth. Some YDPs provided informal information (n = 11, 52.4%) and/or referrals for youth (n = 6, 28.6%). Few YDPs (n = 8, 38.1%) were trained to address adolescent sexuality, but some (n = 10, 47.6%) sought outside resources. CONCLUSIONS YDPs have a unique opportunity to improve adolescent sexual health and sexuality. Five considerations for organizations that develop programs and training for CBOs are suggested.
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Sweet SN, Latimer-Cheung AE, Bourne C, Ginis KAM. Assessing the research use and needs of organizations promoting healthy living for adults with disabilities. Transl Behav Med 2014; 4:86-94. [PMID: 24653779 PMCID: PMC3958592 DOI: 10.1007/s13142-013-0231-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The uptake of research in community-based organizations (CBOs) is low and still unknown in CBOs that promote active and healthy living in adults with a disability. Using the knowledge to action framework, the objectives of this study were to determine if a gap exists regarding the use of research in CBOs, to learn about the preferred method to receive/read research evidence and to identify the barriers and facilitators of research use. Sixty-two employees of CBOs answered an online questionnaire. A research use gap was found as only 53 % of employees indicated they often or always use research. Conferences, emails and short research summaries were the favoured method of receiving/reading research information. Education, time and financial resources were important barriers to research use, while attitudes, intentions and self-efficacy were facilitators. More efforts are needed to develop tools to help CBOs use research.
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Affiliation(s)
- Shane N Sweet
- />School of Kinesiology and Health Studies, Queen’s University, 28 Division Street, Kingston, ON K7L 3N6 Canada
- />Department of Kinesiology and Physical Education, McGill University, 475 Pine Avenue W, Montreal, QC H2W 1S4 Canada
| | - Amy E Latimer-Cheung
- />School of Kinesiology and Health Studies, Queen’s University, 28 Division Street, Kingston, ON K7L 3N6 Canada
| | - Chris Bourne
- />Active Living Alliance for Canadians with a Disability, 720 Belfast Road, Suite 104, Ottawa, Ontario K1G 0Z5 Canada
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McHenry JC, Insel KC, Einstein GO, Vidrine AN, Koerner KM, Morrow DG. Recruitment of Older Adults: Success May Be in the Details. Gerontologist 2012; 55:845-53. [PMID: 22899424 DOI: 10.1093/geront/gns079] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 05/02/2012] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Describe recruitment strategies used in a randomized clinical trial of a behavioral prospective memory intervention to improve medication adherence for older adults taking antihypertensive medication. RESULTS Recruitment strategies represent 4 themes: accessing an appropriate population, communication and trust-building, providing comfort and security, and expressing gratitude. Recruitment activities resulted in 276 participants with a mean age of 76.32 years, and study enrollment included 207 women, 69 men, and 54 persons representing ethnic minorities. Recruitment success was linked to cultivating relationships with community-based organizations, face-to-face contact with potential study participants, and providing service (e.g., blood pressure checks) as an access point to eligible participants. Seventy-two percent of potential participants who completed a follow-up call and met eligibility criteria were enrolled in the study. The attrition rate was 14.34%. IMPLICATIONS The projected increase in the number of older adults intensifies the need to study interventions that improve health outcomes. The challenge is to recruit sufficient numbers of participants who are also representative of older adults to test these interventions. Failing to recruit a sufficient and representative sample can compromise statistical power and the generalizability of study findings.
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Affiliation(s)
| | | | - Gilles O Einstein
- Department of Psychology, Furman University Greenville, South Carolina
| | | | | | - Daniel G Morrow
- Department of Educational Psychology, University of Illinois at Urbana-Champaign
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