Understanding Social Determinants of Cardiometabolic Disease Risk in Rural Women

Measuring Shifts in Mental Models in the Prevention of Childhood Obesity in Rural Australia

Group model building is a participatory workshop technique used in system dynamics for developing community consensus to address complex problems by consensus building on individual assumptions. This study examines changes in individual mental models of the complex problem of childhood obesity following participation in group model building (GMB), as part of a larger community-based system dynamics project. Data are drawn from GMB participants across six community sites in the Whole of Systems Trial of Prevention Strategies for Childhood Obesity (WHO STOPS) in rural and regional Victoria, Australia. Each community participated in two GMB sessions resulting in a causal loop diagram (CLD) of drivers of childhood obesity for each community. Presurvey and postsurvey captured participants' perspectives before and after (n = 25) participation in both GMB sessions and a blend of inductive and deductive qualitative content analysis was used to code individual responses. Three calculations were used to determine the number of responses, whether responses were a result of persuasion from others, and comparison of responses to those found in the CLD. Our study found participant mental models shifted during the course of the GMB sessions, with some responses persuaded by others and 75% of new insights identified in CLDs created by communities. The GMB process created a platform for participants to share ideas and learn from each other. In addition, participants listed new insights about childhood obesity in their community through developing CLDs.

The charm of country life? Impact of rural childhood residence on physical and mental health in later life

BACKGROUND

Most studies of geographic health disparities are focused on adult rural residence. However, previous studies have shown that the residential area in which one grows up during childhood has lasting impacts on adult health. In one of the only studies to date to examine the impact of rural childhood residence on mental health in middle-aged and older adults, Murchland and colleagues (2019) evaluated inequalities by childhood residence and noted elevated depressive symptoms were more common among those living in rural areas compared to those living in non-rural areas.

AIMS

The current study expands the model proposed by Murchland and colleagues to include further antecedents related to rural childhood residence, and to include multiple outcomes of physical and mental health among middle-aged and older adults.

METHOD

Participants included 4614 individuals aged 40 or older recruited as part of the Midlife in the United States (MIDUS) study.

RESULTS

Consistent with Murchland's model, childhood rurality played an important part in middle-aged and older adult's health, despite not having a direct influence. Rurality status was impacted by parental education level and SES during childhood, and was associated with the level of education obtained by the participants (and thus their occupation), which played a direct role in their current health status. Mental and physical health had differential predictors.

LIMITATIONS

The study was limited by its non-diverse sample and self-reported measures.

CONCLUSION

Further research into the impact of childhood rurality on health is needed, utilizing comprehensive self-reported and observed outcome measures.

The Alaska Native Tumour Registry: fifty years of cancer surveillance data for Alaska Native people

Like other Indigenous Circumpolar populations, Alaska Native (AN) people experience different patterns of cancer than their non-Indigenous counterparts. Every 5 years, the Alaska Native Tumour Registry releases a comprehensive report on cancer among AN people; this study provides 50 years of cancer surveillance data. Five-year annual-average age-adjusted incidence rates were calculated for time-periods ranging 1969-2018. AN data were compared with data for US whites (SEER 9). Mortality rates were calculated for 1994-2018 using data from the National Center for Health Statistics. During 2014-2018, there were 2,401 cases of invasive cancer among AN people. Among these, the most commonly diagnosed cancers were colorectal (405 cases, 17% of all cancers), lung and bronchus (373 cases, 16% of all cancers), and female breast (340 cases, 14% of all cancers). Lung cancer was the leading cause of cancer death, followed by colorectal and female breast cancers. These leading cancers are screenable, and preventable through lifestyle modifications including tobacco cessation, healthy eating and engaging in physical activity. These data provide important information to support cancer prevention and control among AN people. Cancer surveillance has been a valuable tool throughout the Circumpolar North to support reducing the burden of cancer among Indigenous populations.Abbreviations: ANAI: Alaska Native/American Indian; AN: Alaska Native; USW: U.S. White(s); ANMC: Alaska Native Medical Center; ANTR: Alaska Native Tumour Registry; IR: Incidence Rate; CI: Confidence Interval; RR: Rate Ratio; ICD-O-3: International Classification of Diseases for Oncology - Third Edition; SEER: Surveillance, Epidemiology and End Results.

School-based obesity prevention programs in rural communities: a scoping review

OBJECTIVE

The objective of this review was to examine existing literature and conceptually map the evidence for school-based obesity prevention programs implemented in rural communities, as well as identify current gaps in the literature.

INTRODUCTION

Pediatric obesity is a significant public health condition worldwide. Rural residency places children at increased risk of obesity. Schools have been identified as an avenue for obesity prevention in rural communities.

INCLUSION CRITERIA

We considered citations focused on children (5 to 18 years of age) enrolled in a rural educational setting. We included obesity prevention programs delivered in rural schools that focused on nutrition or dietary changes, physical activity or exercise, decreasing screen time, or combined nutrition and physical activity that aimed to prevent childhood obesity. We included all quantitative, qualitative, and mixed methods research designs, as well as text and opinion data.

METHODS

A search was conducted of published and unpublished studies in English from 1990 through April 2020 using PubMed, CINAHL Complete, ERIC, Embase, Scopus, Academic Search Premier, Cochrane Register of Controlled Trials, and ClinicalTrials.gov. Gray literature was also searched. After title and abstract review, potentially relevant citations were retrieved in full text. The full texts were assessed in detail against the inclusion criteria by 2 independent reviewers. Included citations were reviewed and data extracted by 2 independent reviewers and captured on a spreadsheet targeting the review objectives.

RESULTS

Of the 105 studies selected for full-text review, 72 (68.6%) were included in the final study. Most of the studies (n = 50) were published between 2010 and 2019 and were conducted in the United States (n = 57). Most studies included children in rural elementary or middle schools (n = 57) and targeted obesity prevention (n = 67). Teachers implemented the programs in half of the studies (n = 36). Most studies included a combination of physical activity and nutrition components (n = 43). Other studies focused solely on nutrition (n = 9) or physical activity (n = 9), targeted obesity prevention policies (n = 9), or other components (n = 8). Programs ranged in length from weeks to years. Overall, weight-related, physical activity-specific, and nutrition-specific outcomes were most commonly examined in the included citations.

CONCLUSIONS

Obesity prevention programs that focused on a combination of physical activity and nutrition were the most common. Multiple outcomes were examined, but most programs included weight-specific and health behavior-specific outcomes. The length and intensity of rural school-based obesity prevention programs varied. More research examining scientific rigor and specific outcomes of rural school-based obesity prevention programs is needed.

Improvements and Maintenance of Clinical and Functional Measures Among Rural Women: Strong Hearts, Healthy Communities-2. 0 Cluster Randomized Trial

BACKGROUND

Cardiovascular disease is the leading cause of death in the United States; however, women and rural residents face notable health disparities compared with male and urban counterparts. Community-engaged programs hold promise to help address disparities through health behavior change and maintenance, the latter of which is critical to achieving clinical improvements and public health impact.

METHODS

A cluster-randomized controlled trial of Strong Hearts, Healthy Communities-2.0 conducted in medically underserved rural communities examined health outcomes and maintenance among women aged ≥40 years, who had a body mass index >30 or body mass index 25 to 30 and also sedentary. The multilevel intervention provided 24 weeks of twice-weekly classes with strength training, aerobic exercise, and skill-based nutrition education (individual and social levels), and civic engagement components related to healthy food and physical activity environments (community, environment, and policy levels). The primary outcome was change in weight; additional clinical and functional fitness measures were secondary outcomes. Mixed linear models were used to compare between-group changes at intervention end (24 weeks); subgroup analyses among women aged ≥60 years were also conducted. Following a 24-week no-contact period, data were collected among intervention participants only to evaluate maintenance.

RESULTS

Five communities were randomized to the intervention and 6 to the control (87 and 95 women, respectively). Significant improvements were observed for intervention versus controls in body weight (mean difference: -3.15 kg [95% CI, -4.98 to -1.32]; P=0.008) and several secondary clinical (eg, waist circumference: -3.02 cm [-5.31 to -0.73], P=0.010; systolic blood pressure: -6.64 mmHg [-12.67 to -0.62], P=0.031; percent body fat: -2.32% [-3.40 to -1.24]; P<0.001) and functional fitness outcomes; results were similar for women aged ≥60 years. The within-group analysis strongly suggests maintenance or further improvement in outcomes at 48 weeks.

CONCLUSIONS

This cardiovascular disease prevention intervention demonstrated significant, clinically meaningful improvements and maintenance among rural, at-risk older women.

REGISTRATION

URL: https://www.

CLINICALTRIALS

gov; Unique identifier: NCT03059472.

The Prevalence of Scoliosis Screening Positive and Its Influencing Factors: A School-Based Cross-Sectional Study in Zhejiang Province, China

Objective

Early detection of scoliosis is of great significance to patients with scoliosis and the whole society. This paper aims to learn the prevalence of scoliosis screening positive among students in primary and secondary schools and to explore the influencing factors.

Methods

In 2019, a stratified cluster sampling technique was employed in this school-based cross-sectional study. The sampling covers all prefecture-level cities in Zhejiang Province. Based on the whole class, at least 80 students in each grade of primary school, junior high school, and senior high school were selected. Physical examination and scoliosis screening were performed in the school-based investigation. The distribution of demographic characteristics and nutritional status of children and adolescents with scoliosis screening positive were explored.

Results

A total of 45,547 students were screened. The overall prevalence of children and adolescents with scoliosis screening positive were 3.9%. Higher prevalence of scoliosis screening positive was found in students living in urban area (4.1%), women students (4.1%), students with low weight (5.3%) (p < 0.05), and the prevalence increased with age (p < 0.05). In logistic analysis, we found age (OR = 1.145; 95% Cis: 1.128, 1.162), gender (OR = 1.118; 95% Cis: 1.016, 1.230) and low weight (OR = 1.48; 95% Cis: 1.25, 1.751) were the influencing factors for prevalence of scoliosis screening positive (p < 0.05).

Conclusions

There were no disparities between living areas, but there was a significant difference between genders, among different ages, and among different nutritional statuses of children and adolescents with or without scoliosis screening positive. In multi-analysis, age, gender, and low weight were the influencing factors for the prevalence of scoliosis screening positive. Age and gender-specific scoliosis screening strategies and nutritional public health policies for children and adolescents are needed.

The Influence of COVID-19 Stress and Self-Concealment on Professional Help-Seeking Attitudes: A Cross-Sectional Study of University Students

PURPOSE

The fourth wave of the COVID-19 pandemic has dramatically influenced many aspects of individuals' lives, putting the general population's mental health at high risk, especially university students in Vietnam. The present study aims to investigate the relationship between current living status and COVID-19 stress and test whether COVID-19 stress mediates the effect of self-concealment on help-seeking attitudes among university students.

PATIENTS AND METHODS

A sample of 478 university students was recruited online to complete the survey. Parametric tests, correlation, regression, and simple mediation analyses were used to analyze the data.

RESULTS

Our results show that students living alone experience more COVID-19 stress levels than those living with family or friends. Additionally, there is a significant positive association between self-concealment and professional help-seeking attitudes that is partially mediated by COVID-19 stress. Individuals who tend to conceal personal information have high COVID-19 stress levels, leading to positive professional help-seeking attitudes.

CONCLUSION

University administrators, social workers, counselors, clinicians, and therapists must consider students living alone as prioritized vulnerable groups for early mental health interventions. Clinicians should be aware of self-concealment and professional help-seeking attitudes that could influence psychological treatment.

COVID-19 Prevention Practices and Associated Factors Among Farmers in Peri-Urban Areas of Northeastern Ethiopia

BACKGROUND

COVID-19 is a global health threat due to its rapid spread and ability to kill millions of people. The majority of pandemic-fighting approaches rely on prevention activities, which can be influenced by a variety of factors. Farmers are more vulnerable to COVID-19, so evaluating existing prevention practices and associated factors is critical to prevent the COVID-19 pandemic.

OBJECTIVE

To assess COVID-19 prevention practices and associated factors among farmers in peri-urban areas of Northeastern Ethiopia.

METHODS

A community-based cross-sectional study design was conducted among 409 selected farmers. Data were collected using face-to-face interviews and on-the-spot-observational checklist. Data were analyzed using bivariable logistic regression model at 95% CI (confidence interval). During the bivariable analysis (crude odds ratio [COR]), varibales having a p-value of less than 0.250 were included into the multivariable analysis (adjsuted odds ratio [AOR]). Factors associated with COVID-19 preventive practices were determined using a multivariable analysis at a p-value of 0.050.

RESULTS

Of 409 participants, 206 (63.6%), 157 (38.4%), and 117 (28.6%) of them had satisfactory knowledge, positive attitude, and good prevention practices about COVID-19, respectively. Age of the farmers with greater than or equal to 45 years (AOR: 3.2; 95% CI: 1.7-6.1), educational status of secondary school and above (AOR: 3.1; 95% CI: 1.4-6.6), and income level of having greater than or equal to 2,001.00 Ethiopian birr (ETB) (AOR: 1.9; 95% CI: 1.1-3.4) were all found to be significantly associated with the COVID-19 prevention practices.

CONCLUSION

Even though the majority of farmers had satisfactory knowledge, a considerable proportion of them had a negative attitude and poor COVID-19 prevention practices. Age, educational status, and income level are factors associated with COVID-19 prevention practices. Hence, health education should be given to improve the farmers' knowledge, attitudes and prevention practices to minimize the risk of COVID-19 among farmers in semi-urban areas of northestern Ethiopia.

Health care need and health disparities: Findings from the Regional South Australia Health (RESONATE) survey

Regional South Australia has some of the highest rates of psychological distress, chronic disease and multimorbidity of any Australian State or Territory. Yet, the healthcare needs of this population are still not completely understood. To better understand the healthcare needs of regional South Australians, we invited adults living in the region to complete the 44-item consumer utilisation, expectations and experiences of healthcare instrument (CONVERSATIONS), online or in hard-copy. The survey was conducted between April 2017 and March 2018. A multi-modal recruitment campaign was utilised to promote the survey. We examined associations between study outcomes and remoteness area, and drew comparisons between our findings and other surveys reporting pertinent outcomes in the urban SA population. The questionnaire was completed by 3,926 adults (52.5% females; 37.6% aged 60 + years). Among the 264 distinct health conditions reported by participants, the most prevalent were hypertension (31.6%), depression (25.7%), anxiety (23.5%) and hypercholesterolaemia (22.9%). The lifetime prevalence of these conditions among participants exceeded rates reported in urban SA. The largest regional-urban health disparities were observed for eczema/dermatitis, skin cancer, other cancer types and cataracts, where prevalence rates were 2075%, 400%, 373% and 324% higher, respectively, than that reported in urban SA. Participants also reported higher levels of multimorbidity (37.7% higher) relative to urban South Australians. By contrast, participants appeared to be exposed to fewer lifestyle risk behaviours (e.g. smoking, alcohol, inadequate fruit or vegetable intake) than their urban counterparts. In summary, there was a high level of healthcare need, and considerable health disparity among participants when compared with urban settings (particularly for skin and eye conditions). These findings highlight the need for a more targeted approach to delivering health services and health promotion activities in regional areas.

Perception of COVID-19 Prevention Methods Efficacy and Intention to Use Among Patients with Chronic Disease in Dessie Town, Northeast Ethiopia: A Multicentered Cross-sectional Study

Background

In Ethiopia, people infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been increasing dramatically. COVID-19 precaution measures are essential for highly susceptible groups. However, it was not known previously to what extent chronic disease patients were perceived to know about the efficacy of prevention measures. Hence, the aim of this study was to assess perception of patients with chronic disease toward the efficacy of COVID-19 preventive measures and their intention to carry out those measures.

Methods

A multicentered institutional-based cross-sectional study was conducted among 413 patients attended in selected hospitals of Dessie town from July 21 to August 5, 2020. Hospitals were selected using the lottery method and systematic random sampling was utilized to select study participants. An interviewer-administered structured questionnaire was used to collect the data and the tool had four dimensions which include sociodemographic, clinical profile and risk assessment, perceived efficacy of prevention measures, and patient’s intention to carry out measures. In multivariable analysis, variables were declared statistically significant at a p-value of <0.05.

Results

In this study, the mean age of participants was 48.2 years (SD ±15.8 years) and 52.1% were females. In overall, 42.1% of participants had low perception on the efficacy of prevention measures and 28.3% had low intention to carry out measures. In this study, young adults (AOR=2.48; 95%CI: 1.42–4.31), male gender (AOR=2.75; 95%CI: 1.73–4.37), low literacy (AOR=3.42; 95%CI: 1.47–7.94) and face mask nonusers (AOR=1.64; 95%CI: 1.03–2.61) were significantly associated with low perceived efficacy of COVID-19 prevention methods.

Conclusion

In this study, a significant proportion of patients had low perception about the efficacy of COVID-19 prevention measures and nearly one-third of them had low intention to carry out prevention measures. Therefore, health education programs about efficacy of preventive measures should be provided by health professionals targeting high risk groups.

Knowledge, Attitudes, Practices, and Related Factors Towards COVID-19 Prevention Among Patients at University Medical Center Ho Chi Minh City, Vietnam

AIM

This study measured the level of knowledge, attitudes and practices towards COVID-19 prevention and examined associated factors among patients at a national tertiary general hospital in Vietnam.

METHODS

Adult patients admitted to University Medical Center during research period were recruited in a cross-sectional study, which employed a convenience sampling method with a 4-component questionnaire in order to examine the patients' consciousness towards COVID-19 spreading prevention based on four aspects: demographic characteristics (10 items), knowledge (14 items), attitudes (6 items), and practices (7 items).

RESULTS

The study involved 2769 respondents (18-90 years) with the mean age of 38.05±13.91 years. About two thirds of the respondents obtained diploma degree or higher (63.4%) and shared their living space with others (64.4%). The majority of patients settled in urban area (74.9%). All participants stayed informed about COVID-19, with the most commonly used channels like television (75.2%), the Internet (72.2%) and phone (69.8%). The vast majority showed sufficient knowledge (93.7%) and positive attitudes (76.3%). Just over half of participants remained good practiced of COVID-19 prevention (57.7%). On average, the factors of younger age, higher educational level, frequency and department of admission, and the number of COVID-19 informative channels were significantly associated with sufficient knowledge, positive attitudes, and good practices regarding preventive action against COVID-19 spreading. The optimistic attitude and having more undergoing chronic diseases were associated with the likelihood of well-practiced COVID-19 preventive measures (OR 3.63, 95% CI 1.54-8.55, p=0.003 and OR 0.86, 95% CI 0.78-0.98, p=0.02, respectively).

CONCLUSION

The results of this study demonstrated that the likelihood of good preventive practices in the fight against COVID-19 pandemic was influenced by attitudes and several sociodemographic factors. More drastic interventions for the prevention of COVID-19 should be widely furnished and equipped in hospitals, through various routes to maximize the efficiency and adherence to prevention practices.

Perceived Risk of COVID-19 and Related Factors Among University Students in Ethiopia During School Reopening

BACKGROUND

The novel coronavirus disease 2019 (COVID-19) has posed a great threat to the public. University students living in school compound with groups and sharing a common cafeteria are more susceptible to contract and spread the virus. Risk perception multiplies fear and anxiety that triggers precautionary action. However, research is scant in this particular field.

OBJECTIVE

To assess the perceived risk of COVID-19 and its associated factors among University Students in Northeast Ethiopia during school reopening.

METHODS

Institution-based cross-sectional study was conducted among 682 Debre Berhan University students from December 1-15, 2020, when students just get back to school. Data was collected using a structured and pre-tested questionnaire. A multistage sampling technique was used to select study subjects. Data were cleaned and entered into Epi-Data version 4.6 and exported to SPSS version 25 software for analysis. Descriptive statistics, bivariable and multivariable logistic regression analysis were run to summarize the results.

RESULTS

The overall perceived risk of COVID-19 was 296 (43.4%), 95% CI (39.4-47.4). Age (AOR (CI) =3.27 (1.87-5.71), open relationship (AOR (CI) =3.17 (1.73-5.79), fathers' education (AOR (CI) =2.29 (1.31-4.02), having diabetes (AOR (CI) =2.64 (1.15-6.07), and information source from ministry of health (MOH) (AOR (CI) =1.87 (1.27-2.75) had significantly high-risk perception. However, students who use Facebook (AOR (CI) =0.57 (0.39-0.82) and Websites/articles (AOR (CI) =0.14 (0.06-0.34) had significantly low-risk perception. Television (59.8%) and Telegram (66.6%) were the primary sources of information, while the World Health Organization (68.3%) was the most trusted source of information.

CONCLUSION

University students perceived a low risk towards COVID-19 pandemics at the time of school resumption. It was influenced by students' demographic characteristics, co-morbidities, social media, and information sources. The Ministry of Health and Ministry of Education should properly promote risk communication among university students.

Knowledge, Attitude and Practice Toward COVID-19 Pandemic Among Population Visiting Dessie Health Center for COVID-19 Screening, Northeast Ethiopia

BACKGROUND

Coronavirus 2019 (COVID-19) is currently a global health threat and an international public health emergency. As of 21 January 2021, 97.8 million cases with more than two million deaths were recorded worldwide while in Ethiopia 132,326 confirmed cases and 2057 deaths were reported. Hence, the aim of the present study was to determine the magnitude of knowledge, attitude, and practice toward COVID-19 among the population who visited the health center for COVID-19 screening.

METHODS

A health institution-based cross-sectional study was conducted among the 384 study population visiting Dessie health center for COVID-19 screening from September 1, to October 21, 2020 using a simple random sampling technique. A structured questionnaire was used to obtain information related to sociodemographic characteristics, Knowledge (eleven questions), attitude (six questions) and practice (nin questions). Both bivariable and multivariable logistic regression analyses with a 95% confidence interval were used to identify factors associated with poor knowledge and practice. A P-value of <0.05 was considered statistically significant.

RESULTS

Out of the total study participants 61.5% were males, 52.6% of them were aged between 30 and 49 years and 85.2% of them were living in urban areas. The magnitude of poor knowledge and poor practice was 187 (48.7%) and 160 (41.7%), respectively. Poor knowledge had statistically significant association with Illiteracy (AOR= 5.53, 95%CI= 1.03-29.68, P= 0.046) and having no contact history (AOR=0.39, 95%CI=0.21-0.73, P=0.003). Statistically significant association existed between poor practice and parameters which addressed educational status, travel history, and poor knowledge level of study participants.

CONCLUSION

Alarmingly high poor knowledge, negatively skewed attitude, and poor practice regarding the COVID-19 pandemic was indicated. Therefore, health education programs aimed at mobilizing and improving COVID-19-related knowledge, attitude, and practice are urgently needed, especially for those who are illiterate, having travel and contact history, or generally among underprivileged populations.

COVID-19 is viewed as severe as tumor and HIV; perceptions towards COVID-19

Since its first emergence, people have been having different attitudes and perceptions towards the COVID-19 pandemic. Perceptions (e.g. perception of disease threat) have profound consequences on behavior (e.g medication adherence). If adequately available, perception studies guide public awareness efforts or help in understanding behavior. In this study , repeated cross-sectional data were collected from 376 randomly selected globally located respondents over two periods. Participants perceived COVID-19 as severe as Tumor and AIDS (F (2,722) = 2.347; p = .096), and as more severe than other 14 illnesses; e.g. Diabetes and High blood pressure. Age-wise, participants above 50 age group perceived COVID-19 as more severe than the under 50 (F (1,240) = 10.378, p < .001). In addition, the magnitude of severity perception was found to be dependent on the different stages of the outbreak in the respondents' corresponding countries. In a gap of a month time, depression surpassed COVID-19 to be perceived as more severe. Majority of respondents attributed COVID-19 as a physical (vs mental) illness, thus considered it as more severe (vs less severe). Implications of this study could mean; (1) COVID-19 patients might be susceptible to social stigmatization as HIV patients, and (2) severity perception is shaping intervention friendly behaviors.

Are Community Health Center Patients Interested in Self-Measured Blood Pressure Monitoring (SMBP) - And Can They Do It?

Introduction

Self-measured blood pressure monitoring (SMBP) helps diagnose and manage hypertension from outside the clinic, which has implications for patient empowerment and outcomes, continuity of care, and resilience in care communities catering to vulnerable populations.

Methods

We instituted a protocol for SMBP among hypertensive patients at 9 community health centers in 3 states and administered questionnaires to patients before and after the protocol was instituted to assess knowledge and engagement with disease management, beliefs and attitudes towards, and experience doing SMBP. Questionnaires included 16 items designed to evaluate patient perceptions and beliefs about SMBP. These included a series of questions using a 5-point Likert scale, binary questions related to their perceived ability to comply with specific SMBP guidelines and open-ended questions to obtain descriptions of experiences with SMBP.

Results

The pre-questionnaire was completed by 478 patients and the post-questionnaire was completed by 372. Seventy-seven percent of respondents knew their ideal blood pressure and their engagement with blood pressure management increased significantly (p=0.0024) after completing the protocol. Additionally, 85% of respondents said that they had a positive experience doing SMBP. Open-ended responses revealed insight regarding why patients chose to do SMBP and factors patients appreciated about SMBP.

Discussion

When trained properly and supported, community health center patients are capable of and motivated to perform accurate SMBP. Our study provides evidence that health center patients can follow detailed SMBP protocols and monitor their own blood pressure from the safety of their homes, which is critical to their care continuum, particularly in days of a pandemic.

Knowledge and Practice Toward Prevention of SARS-CoV-2 Among Healthcare Workers at Delghi Primary Hospital During a Massive Test Campaign in Northwest Gondar, Ethiopia: Institution-Based Descriptive Cross-Sectional Survey

BACKGROUND

Since December 29, 2019, severe acute respiratory syndrome coronavirus (SARS-CoV-2) has been spreading and is associated with notoriously increased morbidity and mortality of populations worldwide, including Ethiopia. Medicine and the healthcare system have been challenged by both first and second-waves of SARS-CoV-2. During this entire crisis, the main purpose of this study was to determine the current evidence on the level of awareness and prevention practice of healthcare workers (HCWs) at the district primary hospital, Delghi Primary Hospital (DPH) regarding COVID-19 in the overall effort to control the spread of the virus.

METHODS

Institutional-based descriptive cross-sectional analysis was performed between late August and September 20, 2020. Participants of the study were HCWs with various occupations at DPH, North West Gondar, Ethiopia. In this study, among 112 health professions, we included a total of 104 HCWs. Written consent was obtained for willingness of the study participants from the DPH administrative office. Then, using a pre-tested, structured, and self-administered questionnaire, data were collected. The questionnaire included socio-demographics, sources of information, knowledge, and practice measures regarding COVID-19. The collected data were analyzed through IBM SPSS version 20. As a cut-off value, ≥8 out of 15 knowledge questions and ≥7 out of 14 practice questions were considered good knowledge and practice, respectively.

RESULTS

The result of this study showed the majority of the respondents were male (71/104, (68.3%)), with a median age of 28 (minimum age 20 and maximum age 50) years. Thus, 94.2% (n=98/104) was the overall rate of correctly answered questions out of 15 knowledge questions. However, 40.6% of them had poor prevention practices. 73.1% of participants used regular hand-washing with soap and 64.4% used hand sanitizer and handshake avoidance equally for prevention purposes. Whereas, social distancing rule and mask-wearing were reported as impracticable by 55.8% and 44.2%, respectively.

CONCLUSION

94.2% of HCWs had a good level of knowledge about COVID-19; in contrast, lack of preventive practice was observed. This implies that there is a gap between knowledge and implementation of preventive measures toward the disease.

Adherence with COVID-19 Preventive Measures and Associated Factors Among Residents of Dirashe District, Southern Ethiopia

INTRODUCTION

COVID-19 is one of the huge general wellbeing crisis for the planet. Since its first recognition, over 90.2 and 1.9 million people are infected and dead, respectively. Although it is not easily available for low-income countries, after many trials vaccination is initiated by some industrialized nations. However, still now there is no effective treatment for the infection. Henceforth, adherence with COVID-19 preventive and control measures is the only option to stop its spread and minimize its disastrous impact, especially, in developing nations like Ethiopia. Knowledge and behavior change are pillars to engage with preventive measures. Thus, the motivation behind this study was to assess communities' adherence with COVID-19 preventive measures and its associated factors among inhabitants of Dirashe district, Southern Ethiopia.

MATERIALS AND METHODS

A cross-sectional study was directed among 648 inhabitants in Dirashe district from June 20 to July 5, 2020. A multistage sampling technique was applied to select the participants. A pretested, validated and reliable interviewer-administered survey tool comprising the socio-demographic characteristics, knowledge (α = 0.78), and adherence with COVID-19 preventive measures (α = 0.73) was used. The data were assorted electronically using Open Data Kit (ODK) collect version 1.17.2 android application and exported to Stata version 15.0 for analysis. Adjusted odds ratio (aOR) with 95% CI was used to identify variables associated with the community's adherence with COVID-19 preventive measures.

RESULTS

An aggregate of 644 inhabitants were participated in this study; of them, only 12.3% [95% confidence interval (CI): 9.8, 15.1] adhered to the recommended COVID-19 preventive measures. Likewise, 63.51% [95% CI: 59.7, 67.2] and 54.5% [95% CI: 50.6, 58.4] of the participants had good knowledge and favorable attitude towards COVID-19 preventive measures, respectively. Urban residence [aOR: 9.74, 95% CI: 4.72, 20.10], favorable attitude [aOR: 1.97, 95% CI: 1.05, 3.68] and concerned about COVID-19-related stigma [aOR: 2.43, 95% CI: 1.02, 5.79] were independently associated with communities adherence with COVID-19 preventive measures.

CONCLUSION

In general, communities' adherence to the recommended COVID-19 preventive measures was very low in the area. Addressing underprivileged population groups, disseminating teaching aids in local languages, behavioral change communications, and law enforcement is imperative to strengthen COVID-19 prevention practice.

Cardiovascular Diseases Health Literacy among Patients, Health Professionals, and Community-Based Stakeholders in a Predominantly Medically Underserved Rural Environment

OBJECTIVE

The central Appalachian region of the United States is disproportionately burdened with cardiovascular disease (CVD); however, the level of literacy about CVD among residents has not been well studied. This study aimed to examine the prevalence and factors of CVD health literacy (HL) among a sample of patients/caregivers, providers/professionals, and community stakeholders.

METHODS

In 2018, data were collected from central Appalachian residents in six states: Kentucky, North Carolina, Ohio, Tennessee, Virginia, and West Virginia. CVD HL status was determined by assessing correct responses to five interrelated questions about basic knowledge of CVD. Multiple logistic regression analyses were used to examine the associations between potential factors and CVD HL status.

RESULTS

Of the total respondents (N = 82), <50% correctly answered all 5 CVD HL questions. Multiple logistic regression analyses showed that compared with respondents with advanced college degrees, those with a college degree or less were more likely to have low HL for "typical symptom of CVD," "physical exercise and CVD," "blood pressure and CVD," and "stress and CVD." In addition, compared with respondents younger than 50 years, those 50 years and older were 3.79 times more likely to have low HL for "physical exercise and CVD."

CONCLUSIONS

These results suggest the incorporation of CVD HL into CVD care and that educational attainments should be part of CVD policies and programs in the region.

Rural SNAP Participants and Food Insecurity: How Can Communities Leverage Resources to Meet the Growing Food Insecurity Status of Rural and Low-Income Residents?

The burden of obesity disproportionately influences poor health outcomes in rural communities in the United States. Various social and environmental factors contribute to inadequate food access and availability in rural areas, influencing dietary intakes and food insecurity rates. This study aims to identify patterns related to food insecurity and fruit and vegetable consumption within a SNAP-eligible and low-income, highly obese rural Appalachian community. A prospective cohort was implemented to identify gaps in resources addressing obesity and food insecurity challenges. SAS 9.4 software was used to examine differences in dietary intakes and shopping practices among SNAP participants. Among participants (n = 152), most reported an annual household income less than USD 20,000 (n = 90, 60.4%), 29.1% reported food insecurity, and 39.5% reported receiving SNAP benefits within the last month. The overall mean FV intake was 3.46 daily servings (95% CI: 3.06–3.91) among all participants. SNAP participation was associated with food insecurity (p = 0.007) and those participating in SNAP were two times more likely to report being food insecure (OR = 2.707, 95% CI: 1.317, 5.563), relative to non-participants. These findings further depict the need for intervention, as the burden of food insecurity persists. Tailoring health-promoting initiatives to consider rurality and SNAP participation is vital for sustainable success among these populations.