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Porthé V, Fernández A, Barbieri N, Vázquez N, González I, Bastida A, Pasarín MI. Community health action and COVID-19 in Barcelona neighbourhoods: responses and challenges. Health Promot Int 2024; 39:daae076. [PMID: 38980688 DOI: 10.1093/heapro/daae076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024] Open
Abstract
The COVID-19 pandemic exacerbated pre-existing social, economic and political inequalities. The evidence describes the use of community engagement approaches to support appropriate COVID-19 prevention and control measures. We aimed to delve deeper into the community response to COVID-19 in Barcelona neighbourhoods with different pre-existing levels of development of community health action (CHA). A qualitative phenomenological study was conducted in six Barcelona neighbourhoods with different types of CHAs. The sample included 37 in-depth interviews with community agents with good knowledge of the territory. The content analysis focused on three dimensions: symbolic (conceptions motivating action), substantive (the content and resources of the action) and operational (interactions between agents). Regardless of their CHA typology, all neighbourhoods responded to the needs generated by the pandemic. Symbolic: strong-CHA development, characterized by well-established participatory structures, facilitated responses to the crisis. In medium-CHA neighbourhoods, the emergency exacerbated previous tensions. In emerging-CHA neighbourhoods, previous participatory structures, although not health-specific, favoured the coordination of responses. Substantive: technology influenced the way CHA activities were conducted. Operative: in the strong-CHA neighbourhood, new participants were able to join previous participatory structures. In medium-CHA neighbourhoods, power dynamics hindered coordination. In conclusion, strong CHA can play a key role in addressing the adverse consequences of social and health crisis. Empowering citizens and communities should be a primary objective of public policy that integrates the 'health-in-all-policies' approach. This approach entails allocating public resources to strengthen the role of community action and power.
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Affiliation(s)
- Victoria Porthé
- CIBER de Epidemiología y Salud Pública (CIBERESP), Avenida Montforte de Lemos, 3-5 (Pabellón 11, Planta 0), 28029 Madrid, Spain
- Agència de Salut Pública de Barcelona, Servei de Salut i Barris (SESiB), Plaza Lesseps 1, 08023 Barcelona, Spain
| | - Ana Fernández
- CIBER de Epidemiología y Salud Pública (CIBERESP), Avenida Montforte de Lemos, 3-5 (Pabellón 11, Planta 0), 28029 Madrid, Spain
- Agència de Salut Pública de Barcelona, Servei de Salut i Barris (SESiB), Plaza Lesseps 1, 08023 Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Carrer de Sant Pau Quintí, 77, 08041 Barcelona, Spain
| | - Nicolás Barbieri
- Universitat Oberta de Catalunya, Estudios de Artes y Humanidades, Rambla del Poblenou, 156, 08018 Barcelona, Spain
| | - Noelia Vázquez
- Agència de Salut Pública de Barcelona, Servei de Salut i Barris (SESiB), Plaza Lesseps 1, 08023 Barcelona, Spain
| | - Inmaculada González
- Agència de Salut Pública de Barcelona, Servei de Salut i Barris (SESiB), Plaza Lesseps 1, 08023 Barcelona, Spain
| | - Andrea Bastida
- Agència de Salut Pública de Barcelona, Servei de Salut i Barris (SESiB), Plaza Lesseps 1, 08023 Barcelona, Spain
| | - M Isabel Pasarín
- CIBER de Epidemiología y Salud Pública (CIBERESP), Avenida Montforte de Lemos, 3-5 (Pabellón 11, Planta 0), 28029 Madrid, Spain
- Agència de Salut Pública de Barcelona, Servei de Salut i Barris (SESiB), Plaza Lesseps 1, 08023 Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), Carrer de Sant Pau Quintí, 77, 08041 Barcelona, Spain
- Universitat Pompeu Fabra, Department of Experimental and Health Sciences, Doctor Aiguader, 88,08003 Barcelona, Spain
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Radziszewski S, Houle J, Montiel C, Fontan JM, Torres J, Frolich K, Boivin A, Coulombe S, Gaudreau H. Aiming for transformations in power: lessons from intersectoral CBPR with public housing tenants (Québec, Canada). Health Promot Int 2024; 39:daae085. [PMID: 39110009 PMCID: PMC11304601 DOI: 10.1093/heapro/daae085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
Intersectoral collaborations are recommended as effective strategies to reduce health inequalities. People most affected by health inequalities, as are people living in poverty, remain generally absent from such intersectoral collaborations. Community-based participatory research (CBPR) projects can be leveraged to better understand how to involve people with lived experience to support both individual and community empowerment. In this paper, we offer a critical reflection on a CBPR project conducted in public housing in Québec, Canada, that aimed to develop intersectoral collaboration between tenants and senior executives from four sectors (housing, health, city and community organizations). This single qualitative case study design consisted of fieldwork documents, observations and semi-structured interviews. Using the Emancipatory Power Framework (EPF) and the Limiting Power Framework (LPF), we describe examples of types of power and resistance shown by the tenants, the intersectoral partners and the research team. The discussion presents lessons learned through the study, including the importance for research teams to reflect on their own power, especially when aiming to reduce health inequalities. The paper concludes by describing the limitations of the analyses conducted through the EPF-LPF frameworks and suggestions to increase the transformative power of future studies.
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Affiliation(s)
- Stephanie Radziszewski
- Department of Physical Education, Université Laval, 2300, rue de la Terrasse, Québec, G1V 0A6, Canada
| | - Janie Houle
- Department of Psychology, Université du Québec à Montréal, 100, rue Sherbrooke Ouest, Montréal, Québec, H2X 3P2, Canada
| | - Corentin Montiel
- Department of Psychology, Université du Québec à Montréal, 100, rue Sherbrooke Ouest, Montréal, Québec, H2X 3P2, Canada
| | - Jean-Marc Fontan
- Department of Sociology, Université du Québec à Montréal, 1255, St-Denis, Montréal, Québec, H2X 3R9, Canada
| | - Juan Torres
- School of Urban Planning, Université de Montréal, 2940, chemin de la Côte-Sainte-Catherine, Montréal, Québec, H3T 1B9, Canada
| | - Kate Frolich
- School of Public Health, Université de Montréal, 7101, avenue du Parc, Montréal, Québec, H3N 1X9, Canada
| | - Antoine Boivin
- Faculty of Medicine, Université de Montréal, 2900, boulevard Édouard-Montpetit, Montréal, Québec, H3T 1J4, Canada
| | - Simon Coulombe
- Department of Industrial Relations, Université Laval, 1030, avenue des Sciences-Humaines, Québec, G1V 0A6, Canada
| | - Hélène Gaudreau
- Department of Psychology, Université du Québec à Montréal, 100, rue Sherbrooke Ouest, Montréal, Québec, H2X 3P2, Canada
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Burduladze N, Jones LP, Jones BD, Msowoya U, Salsberg J, Whitney A, Gilfoyle M. Exploring power and power sharing in participatory health research partnerships: A scoping review protocol. PLoS One 2024; 19:e0303799. [PMID: 39024348 PMCID: PMC11257268 DOI: 10.1371/journal.pone.0303799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Accepted: 06/25/2024] [Indexed: 07/20/2024] Open
Abstract
INTRODUCTION Participatory health research (PHR) as a research paradigm, guides the research process and strives to achieve positive change in society in the interest of people's health. In this scoping review, PHR will be used as an umbrella term considering a wide range of collaborative research approaches in the health context. PHR is conducted 'with' or 'by' those it intends to benefit, as opposed to 'on' and 'for' them. Their involvement throughout the research process seeks to shift power and decision-making from where they traditionally lay within academia toward community, patient and public end-users. Research cannot be truly participatory without concurrently addressing power dynamics within the partnership and power imbalances in decision making. Therefore, power sharing can be defined as a major factor in building effective academic-community collaborations. This scoping review aims to identify, clarify, and map existing literature on power and power sharing in PHR from both theoretical and practical perspectives. Specifically, we will explore how power is conceptualised throughout the literature, and how power and power sharing are applied and addressed in real-life PHR partnerships. MATERIALS AND METHODS This scoping review will be conducted in accordance with the guidelines outlined in the Joanna Briggs Institute (JBI) Reviewer's Manual. This scoping review will consider both empirical and non-empirical research that report on understanding power and power sharing in participatory health research partnerships. All appropriate studies will be retrieved from the following five electronic databases: PubMed, Scopus, Embase, PsycINFO, SocIndex. This review will be limited to articles published in English and from January 1998 to March 2024. As the scoping review aims to capture more than peer-reviewed and published literature, it will also include grey literature such as theses and dissertations, reports, conference proceedings, and editorials. Data from the included literature will be extracted based on the data extraction tool, defined in advance. ETHICS AND DISSEMINATION As primary data will not be collected, ethical approval is not required to conduct the scoping review. The findings of this study will be disseminated through peer-reviewed publications.
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Affiliation(s)
- Nino Burduladze
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Laundette P. Jones
- University of Maryland School of Medicine, Baltimore, MD, United States of America
| | - Brian D. Jones
- Community Consultant, The Prized Apex, Baltimore, Maryland, United States of America
| | - Uchizi Msowoya
- School of Medicine, University of Limerick, Limerick, Ireland
| | - Jon Salsberg
- School of Medicine, University of Limerick, Limerick, Ireland
- PPI Research Unit, School of Medicine, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Anna Whitney
- Department of Psychiatry, School of Medicine, Community Health Specialist, University of Maryland, Baltimore, MD, United States of America
| | - Meghan Gilfoyle
- School of Medicine, University of Limerick, Limerick, Ireland
- PPI Research Unit, School of Medicine, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Tupper E, Morris S, Lawlor ER, Summerbell C, Panter J, Jago R, Pollard T. Children's experiences of care on walking and cycling journeys between home and school in Healthy New Towns: Reframing active school travel. Health Place 2024; 85:103147. [PMID: 38103412 DOI: 10.1016/j.healthplace.2023.103147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/19/2023]
Abstract
The Healthy New Town programme in England set out to 'put health into place' by supporting the design and construction of healthy places to live, including by creating safe environments for active travel. To explore the impact of this approach, this study examined how children and their families experienced school journeys in two contrasting Healthy New Towns in England, one an affluent new town in the early stages of construction and the other more economically deprived and established. We undertook photo-elicitation and go-along interviews with 24 children aged 7-12 years and semi-structured interviews with 17 caregivers. We found that experiences of care were important for children's school travel. In the 'deprived' town, opportunities for children to care and to be cared for were enjoyed, facilitated by routes with limited traffic, pockets of 'nature', and possibilities to encounter meaningful others. For families living in a town under construction, the need to negotiate unfinished travel infrastructure, and a sense of being 'in limbo', was experienced as an absence of care by planners and developers. Interventions to promote children's active travel should consider the role of care-full planning in facilitating walking and cycling journeys.
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Affiliation(s)
- Emily Tupper
- Department of Anthropology, Durham University, Dawson Building, South Road, Durham, DH1 3LE, UK; Department of Sport and Exercise Sciences, Durham University, 42 Old Elvet, Durham, DH1 3HN, UK; Fuse, The Centre for Translational Research in Public Health, UK
| | - Stephanie Morris
- Department of Anthropology, Durham University, Dawson Building, South Road, Durham, DH1 3LE, UK; Department of Sport and Exercise Sciences, Durham University, 42 Old Elvet, Durham, DH1 3HN, UK; Fuse, The Centre for Translational Research in Public Health, UK. http://www.fuse.ac.uk
| | - Emma R Lawlor
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, Durham University, 42 Old Elvet, Durham, DH1 3HN, UK; Fuse, The Centre for Translational Research in Public Health, UK. http://www.fuse.ac.uk
| | - Jenna Panter
- MRC Epidemiology Unit, University of Cambridge School of Clinical Medicine, Box 285, Institute of Metabolic Science, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, UK
| | - Russell Jago
- Centre for Exercise, Nutrition & Health Sciences, School for Policy Studies, University of Bristol, Bristol, BS8 1TZ, UK; Centre for Public Health, Bristol Medical School, University of Bristol, UK
| | - Tessa Pollard
- Department of Anthropology, Durham University, Dawson Building, South Road, Durham, DH1 3LE, UK; Fuse, The Centre for Translational Research in Public Health, UK.
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Karuga R, Khan S, Kok M, Moraa M, Mbindyo P, Broerse J, Dieleman M. Teamwork in community health committees: a case study in two urban informal settlements. BMC Health Serv Res 2023; 23:1373. [PMID: 38062432 PMCID: PMC10702094 DOI: 10.1186/s12913-023-10370-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Community health committees (CHCs) are mechanisms for community participation in decision-making and overseeing health services in several low-and middle-income countries (LMICs). There is little research that examines teamwork and internal team relationships between members of these committees in LMICs. We aimed to assess teamwork and factors that affected teamwork of CHCs in an urban slum setting in Nairobi, Kenya. METHODS Using a qualitative case-study design, we explored teamwork of two CHCs based in two urban informal settlements in Nairobi. We used semi-structured interviews (n = 16) to explore the factors that influenced teamwork and triangulated responses using three group discussions (n = 14). We assessed the interpersonal and contextual factors that influenced teamwork using a framework for assessing teamwork of teams involved in delivering community health services. RESULTS Committee members perceived the relationships with each other as trusting and respectful. They had regular interaction with each other as friends, neighbors and lay health workers. CHC members looked to the Community Health Assistants (CHAs) as their supervisor and "boss", despite CHAs being CHC members themselves. The lay-community members in both CHCs expressed different goals for the committee. Some viewed the committee as informal savings group and community-based organization, while others viewed the committee as a structure for supervising Community Health Promoters (CHPs). Some members doubled up as both CHPs and CHC members. Complaints of favoritism arose from CHC members who were not CHPs whenever CHC members who were CHPs received stipends after being assigned health promotion tasks in the community. Underlying factors such as influence by elites, power imbalances and capacity strengthening had an influence on teamwork in CHCs. CONCLUSION In the absence of direction and support from the health system, CHCs morph into groups that prioritize the interests of the members. This redirects the teamwork that would have benefited community health services to other common interests of the team. Teamwork can be harnessed by strengthening the capacity of CHC members, CHAs, and health managers in team building and incorporating content on teamwork in the curriculum for training CHCs.
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Affiliation(s)
- Robinson Karuga
- LVCT Health, P.O. Box 19835, Nairobi, 00202, Kenya.
- Athena Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, Amsterdam, 1081 HV, The Netherlands.
| | - Sitara Khan
- Athena Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, Amsterdam, 1081 HV, The Netherlands
| | - Maryse Kok
- KIT Royal Tropical Institute, Mauritskade 64, 1092 AD, Amsterdam, Netherlands
| | - Malkia Moraa
- Directorate of Preventive and Promotive Health, Nairobi City County, City Hall Way, P.O Box 30075-00100, Nairobi, Kenya
| | - Patrick Mbindyo
- Jomo Kenyatta University of Agriculture and Technology, P.O. Box 62 000, Nairobi, 00200, Kenya
| | - Jacqueline Broerse
- Athena Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, Amsterdam, 1081 HV, The Netherlands
| | - Marjolein Dieleman
- KIT Royal Tropical Institute, Mauritskade 64, 1092 AD, Amsterdam, Netherlands
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Cassetti V, López-Ruiz MV, Gallego-Royo A, Egea-Ronda A, Gea-Caballero V, Aviñó Juan Ulpiano D, Baraza Cano MP, Romero Rodríguez E. [Attend, consult, involve: do we need to redefine the concept of community engagement?]. GACETA SANITARIA 2023; 37:102344. [PMID: 38039621 DOI: 10.1016/j.gaceta.2023.102344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVE To describe how a sample of people working in community health promotion projects perceive and implement community engagement approaches. METHOD Mixed qualitative-quantitative study. Data was collected through: semi-structured interviews with 10 people representing the projects, and workshops in which 53 people participated and responded to a questionnaire prepared ad hoc to identify levels of community engagement. Descriptive statistical analysis of the questionnaires and framework analysis of the interviews, observations and workshops recordings. RESULTS Although the projects are described as highly participatory, community engagement appeared mainly in the form of attending events, with few examples of consultation or community involvement. CONCLUSIONS This difference may be due to the lack of a culture of participation, both in individuals and institutions, and lack of training in community engagement. It is proposed to change the language from participation-attendance to using expressions such as consulting or involving people.
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Affiliation(s)
| | - María Victoria López-Ruiz
- Unidad de Gestión Clínica Palma del Río, Distrito Córdoba Guadalquivir, Servicio Andaluz de Salud, Palma del Río (Córdoba), España; Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España
| | - Alba Gallego-Royo
- Servicio de Medicina Preventiva, Hospital Miguel Servet, Servicio Aragonés de Salud, Zaragoza, España; Grupo de Investigación en Atención Primaria Aragón (GIIS011), IIS Aragón, Universidad de Zaragoza, Zaragoza, España
| | - Ana Egea-Ronda
- Departamento de Salud Valencia Arnau de Vilanova-Llíria, San Antonio de Benagéber (Valencia), España.
| | - Vicente Gea-Caballero
- Facultad de Ciencias de la Salud, Valencian International University, Valencia, España; Research Group Community Health and Care, Valencian International University, Valencia, España
| | - Dory Aviñó Juan Ulpiano
- Área de Desigualdades en Salud, Fundación para la Investigación Sanitaria y Biomédica de la Comunitat Valenciana (FISABIO-Salud Pública), Valencia, España
| | - María Pilar Baraza Cano
- Unidad de Gestión Clínica Vicar-La Mojonera, Distrito de Atención Primaria Poniente de Almería, Servicio Andaluz de Salud, Almería, España
| | - Esperanza Romero Rodríguez
- Instituto Maimónides de Investigación Biomédica de Córdoba, Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, España; Distrito Sanitario de Atención Primaria de Córdoba, Servicio Andaluz de Salud, Córdoba, España
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Popay J, Halliday E, Mead R, Townsend A, Akhter N, Bambra C, Barr B, Anderson de Cuevas R, Daras K, Egan M, Gravenhorst K, Janke K, Kasim AS, McGowan V, Ponsford R, Reynolds J, Whitehead M. Investigating health and social outcomes of the Big Local community empowerment initiative in England: a mixed method evaluation. PUBLIC HEALTH RESEARCH 2023; 11:1-147. [PMID: 37929801 DOI: 10.3310/grma6711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2023] Open
Abstract
Background Most research on community empowerment provides evidence on engaging communities for health promotion purposes rather than attempts to create empowering conditions. This study addresses this gap. Intervention Big Local started in 2010 with £271M from the National Lottery. Ending in 2026, it gives 150 relatively disadvantaged communities in England control over £1M to improve their neighbourhoods. Objective To investigate health and social outcomes, at the population level and among engaged residents, of the community engagement approach adopted in a place-based empowerment initiative. Study design, data sources and outcome variables This study reports on the third wave of a longitudinal mixed-methods evaluation. Work package 1 used a difference-in-differences design to investigate the impact of Big Local on population outcomes in all 150 Big Local areas compared to matched comparator areas using secondary data. The primary outcome was anxiety; secondary outcomes included a population mental health measure and crime in the neighbourhood. Work package 2 assessed active engagement in Big Local using cross-sectional data and nested cohort data from a biannual survey of Big Local partnership members. The primary outcome was mental well-being and the secondary outcome was self-rated health. Work package 3 conducted qualitative research in 14 Big Local neighbourhoods and nationally to understand pathways to impact. Work package 4 undertook a cost-benefit analysis using the life satisfaction approach to value the benefits of Big Local, which used the work package 1 estimate of Big Local impact on life satisfaction. Results At a population level, the impacts on 'reporting high anxiety' (-0.8 percentage points, 95% confidence interval -2.4 to 0.7) and secondary outcomes were not statistically significant, except burglary (-0.054 change in z-score, 95% confidence interval -0.100 to -0.009). There was some effect on reduced anxiety after 2017. Areas progressing fastest had a statistically significant reduction in population mental health measure (-0.053 change in z-score, 95% confidence interval -0.103 to -0.002). Mixed results were found among engaged residents, including a significant increase in mental well-being in Big Local residents in the nested cohort in 2018, but not by 2020; this is likely to be COVID-19. More highly educated residents, and males, were more likely to report a significant improvement in mental well-being. Qualitative accounts of positive impacts on mental well-being are often related to improved social connectivity and physical/material environments. Qualitative data revealed increasing capabilities for residents' collective control. Some negative impacts were reported, with local factors sometimes undermining residents' ability to exercise collective control. Finally, on the most conservative estimate, the cost-benefit calculations generate a net benefit estimate of £64M. Main limitations COVID-19 impacted fieldwork and interpretation of survey data. There was a short 4-year follow-up (2016/20), no comparators in work package 2 and a lack of power to look at variations across areas. Conclusions Our findings suggest the need for investment to support community organisations to emerge from and work with communities. Residents should lead the prioritisation of issues and design of solutions but not necessarily lead action; rather, agencies should work as equal partners with communities to deliver change. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research Programme (16/09/13) and will be published in full in Public Health Research; Vol. 11, No. 9. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Jennie Popay
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Emma Halliday
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Rebecca Mead
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Anne Townsend
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Nasima Akhter
- Department of Anthropology, Durham University, Durham, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Ben Barr
- Department of Public Health, Policy and Systems, The University of Liverpool, Liverpool, UK
| | | | - Konstantinos Daras
- Department of Public Health, Policy and Systems, The University of Liverpool, Liverpool, UK
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene & Tropical Medicine, London, UK
| | - Katja Gravenhorst
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Katharina Janke
- Division of Health Research, Lancaster University, Lancaster, UK
| | | | - Victoria McGowan
- Population Health Sciences Institute, Newcastle University, Newcastle-upon-Tyne, UK
| | - Ruth Ponsford
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Joanna Reynolds
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Margaret Whitehead
- Department of Public Health, Policy and Systems, The University of Liverpool, Liverpool, UK
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Sanchez-Youngman S, Adsul P, Gonzales A, Dickson E, Myers K, Alaniz C, Wallerstein N. Transforming the field: the role of academic health centers in promoting and sustaining equity based community engaged research. Front Public Health 2023; 11:1111779. [PMID: 37457247 PMCID: PMC10345346 DOI: 10.3389/fpubh.2023.1111779] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 05/08/2023] [Indexed: 07/18/2023] Open
Abstract
Community-based participatory research (CBPR) and community engaged research (CEnR) are key to promoting community and patient engagement in actionable evidence-based strategies to improve research for health equity. Rapid growth of CBPR/CEnR research projects have led to the broad adoption of partnering principles in community-academic partnerships and among some health and academic organizations. Yet, transformation of principles into best practices that foster trust, shared power, and equity outcomes still remain fragmented, are dependent on individuals with long term projects, or are non-existent. This paper describes how we designed our Engage for Equity PLUS intervention that leverages the leadership and membership of champion teams (including community-engaged faculty, community partners and patient advocates) to improve organizational policies and practices to support equity based CBPR/CEnR. This article describes the feasibility and preliminary findings from engaging champion teams from three very different academic health centers. We reflect on the learnings from Engage for Equity PLUS; the adaptation of the intervention design and implementation, including the development of a new institutional assessment using mixed research methods; and our organizational theory of change. In summary, our design and preliminary data from the three academic health centers provide support for new attention to the role of institutional practices and processes needed to sustain equity-based patient and community-engaged research and CBPR and transform the field.
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Affiliation(s)
| | - Prajakta Adsul
- Department of Internal Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Amber Gonzales
- College of Population Health, University of New Mexico, Albuquerque, NM, United States
| | - Elizabeth Dickson
- College of Nursing, University of New Mexico, Albuquerque, NM, United States
| | - Katie Myers
- School of Medicine, University of New Mexico, Albuquerque, NM, United States
| | - Christina Alaniz
- College of Population Health, University of New Mexico, Albuquerque, NM, United States
| | - Nina Wallerstein
- College of Population Health, University of New Mexico, Albuquerque, NM, United States
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Abstract
The substantial literature on interactions between places/spaces and well-being/health often differentiate between physical and social aspects of geographical location. This paper sidesteps this dualism, instead considering places as sociomaterial assemblages of human and non-human materialities. It uses this posthuman and 'new materialist' perspective to explore how place-assemblages affect human capacities, in terms of both health and social dis/advantage. Based on secondary analysis of interview data on human/place interactions, it analyses the physical, sociocultural, psychological and emotional effects of place-assemblages, assessing how these produce opportunities for, and constraints upon human bodies. It than assesses how these emergent capacities affect both social dis/advantage and well-being. This analysis of how place-assemblages contribute positively or negatively to health and dis/advantage offers possibilities for further research and for social and public health policy.
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Affiliation(s)
- Nick J. Fox
- Nick J. Fox, University of
Huddersfield, Queensgate, Huddersfield HD1 3DH, UK.
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Munford L, Khavandi S, Bambra C. COVID-19 and deprivation amplification: An ecological study of geographical inequalities in mortality in England. Health Place 2022; 78:102933. [PMID: 36417814 PMCID: PMC9637535 DOI: 10.1016/j.healthplace.2022.102933] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Revised: 10/04/2022] [Accepted: 10/21/2022] [Indexed: 11/09/2022]
Abstract
'Deprivation amplification' is used to understand the relationship between deprivation, scale and COVID-19 mortality rates. We found that more deprived Middle Super Output Areas (MSOAs) in the more deprived northern regions suffered greater COVID-19 mortality rates. Across England, the most deprived 20% of MSOAs had higher mortality than the least deprived (44.1% more COVID-19 deaths/10,000). However, the most deprived MSOAs in the north fared worse than equally deprived areas in the rest of England (14.5% more deaths/10,000, beta = 0.136, p < 0.01). There was also strong evidence of spatial clustering and spill-overs. We discuss these findings in relation to 'deprivation amplification', the 'syndemic pandemic', and the health and place literature.
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Affiliation(s)
- Luke Munford
- Health Organisation, Policy and Economics Research Team, School of Health Sciences, University of Manchester, UK and NIHR Applied Research Collaboration Greater Manchester ARC-GM, United Kingdom
| | - Sam Khavandi
- Health Organisation, Policy and Economics Research Team, School of Health Sciences, University of Manchester, UK and NIHR Applied Research Collaboration Greater Manchester ARC-GM, United Kingdom
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, UK and NIHR Applied Research Collaboration North East and North Cumbria ARC-NENC, United Kingdom.
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11
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Cheetham M, Gorman S, Pollard F, Ward S, Wiseman A. "I think people have been in survival mode": a qualitative study of community connectivity in a neighbourhood of North East England before and during COVID-19. BMJ Open 2022; 12:e052623. [PMID: 35820763 PMCID: PMC9277025 DOI: 10.1136/bmjopen-2021-052623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The aim of the study was to examine whether and how community-centred approaches facilitate community connectivity by exploring changes that matter to communities. DESIGN Qualitative study comprising ethnographic methods, participant observation and interviews.Setting Economically deprived neighbourhood of North East England. PARTICIPANTS Interviews with community members (n=14) and staff and stakeholders (n=14) involved in a National Lottery Community-funded initiative and 567 hours of participatory observation were undertaken between September 2019 and July 2020. Data were thematically analysed using a community-centred public health framework. RESULTS Communities experiencing disadvantage approached the pandemic adversely affected by stigma, austerity and reductions in public sector funding. Community members' priorities centred on the environment, housing, activities for children and young people, crime, community safety and area reputation. Multiagency efforts to promote connectivity, led by voluntary and community sector organisations, were prerequisites in community-centred approaches to public health. Stakeholders reported that these approaches can help alleviate some of the health, social and financial burdens facing communities that are marginalised. Findings suggest community-centred responses were facilitated by trusting relationships, visionary leadership and lived experience of adversity among staff. Issues which appeared to hamper progress included interorganisational power dynamics and attempts to impose solutions. The strength of stakeholders' connections to the area and to people living there contributed to laying the foundations for local responses to the COVID-19 pandemic. Relational, values-informed work with communities provided a platform to mobilise recovery assets. CONCLUSIONS Whole-system approaches, codesigned with communities most affected, can help address the long-term consequences of COVID-19 and its negative effects on health and social inequalities. Further comparative implementation research is needed to examine the partnerships, values and principles that drive success and inclusion.
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Affiliation(s)
- Mandy Cheetham
- Department of Nursing, Midwifery and Health, Northumbria University, Newcastle upon Tyne, UK
- National Institute for Health and Care Research (NIHR), Applied Research Collaboration North East and North Cumbria (NIHR 200173), Newcastle upon Tyne, UK
| | | | | | - Stephen Ward
- Neighbourhood Management and Volunteering Team, Housing, Environment and Healthy Communities, Gateshead Council, Gateshead, UK
| | - Alice Wiseman
- Public Health, Gateshead Council, Gateshead, UK
- NIHR Local Clinical Research Network, North East and North Cumbria, UK
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12
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Popay J, Whitehead M, Ponsford R, Egan M, Mead R. Power, control, communities and health inequalities I: theories, concepts and analytical frameworks. Health Promot Int 2021; 36:1253-1263. [PMID: 33382890 PMCID: PMC8515177 DOI: 10.1093/heapro/daaa133] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This is Part I of a three-part series on community empowerment as a route to greater health equity. We argue that community 'empowerment' approaches in the health field are increasingly restricted to an inward gaze on community psycho-social capacities and proximal neighbourhood conditions, neglecting the outward gaze on political and social transformation for greater equity embedded in foundational statements on health promotion. We suggest there are three imperatives if these approaches are to contribute to increased equity. First, to understand pathways from empowerment to health equity and drivers of the depoliticisation of contemporary empowerment practices. Second, to return to the original concept of empowerment processes that support communities of place/interest to develop capabilities needed to exercise collective control over decisions and actions in the pursuit of social justice. Third, to understand, and engage with, power dynamics in community settings. Based on our longitudinal evaluation of a major English community empowerment initiative and research on neighbourhood resilience, we propose two complementary frameworks to support these shifts. The Emancipatory Power Framework presents collective control capabilities as forms of positive power. The Limiting Power Framework elaborates negative forms of power that restrict the development and exercise of a community's capabilities for collective control. Parts II and III of this series present empirical findings on the operationalization of these frameworks. Part II focuses on qualitative markers of shifts in emancipatory power in BL communities and Part III explores how power dynamics unfolded in these neighbourhoods.
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Affiliation(s)
- Jennie Popay
- Division of Health Research, Lancaster University, Health Innovation One, Lancaster, LA1 4AT, UK
| | - Margaret Whitehead
- Department of Public Health and Policy, Whelan Building, University of Liverpool, Liverpool, L69 3GB, UK
| | - Ruth Ponsford
- Health Services Research & Policy, London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK
| | - Matt Egan
- Health Services Research & Policy, London School of Hygiene and Tropical Medicine, Tavistock Place, London, WC1H 9SH, UK
| | - Rebecca Mead
- Division of Health Research, Lancaster University, Health Innovation One, Lancaster, LA1 4AT, UK
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13
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Ponsford R, Collins M, Egan M, Halliday E, Lewis S, Orton L, Powell K, Barnes A, Salway S, Townsend A, Whitehead M, Popay J. Power, control, communities and health inequalities. Part II: measuring shifts in power. Health Promot Int 2021; 36:1290-1299. [PMID: 33383585 DOI: 10.1093/heapro/daaa019] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
In the health field, there is great interest in the role empowerment might play in reducing social inequalities in health. Empowerment is understood here as the processes of developing capabilities that individuals and/or communities need to exercise control over decisions and actions impacting on their lives and health. There is a fundamental problem, however, in identifying and measuring capabilities for collective control that emerge at the level of the collective, with much of the existing literature focusing on individual measures even where community-level processes are concerned. Collective measures need to capture the dynamics of interactions within and between groups, not simply aggregate individual-level measures. This article, Part 2 in a three-part series, takes up the challenge of identifying qualitative markers of capabilities for collective control. We applied the emancipatory power framework (EPF) reported in Part 1 of the series, to qualitative data generated during a longitudinal evaluation of a major English area-based empowerment initiative, the Big Local (BL). We identified empirical 'markers' of shifts towards greater collective control pertaining to each of the 'power' dimensions in the EPF-'power within', 'power with' and 'power to'-and markers of communities exercising 'power over' other institutions/community members. These markers can usefully be applied in the evaluation planning and evaluation of empowerment initiatives. Part 3 in the series uses these markers and a second analytical framework developed during our evaluation of BL to explore how power dynamics unfold in participatory spaces in BL neighbourhoods.
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Affiliation(s)
- Ruth Ponsford
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, Health Services Research & Policy, London, UK
| | - Michelle Collins
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Matt Egan
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, Health Services Research & Policy, London, UK
| | - Emma Halliday
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Sue Lewis
- Department of Geography, University of Durham, Durham, UK
| | - Lois Orton
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Kate Powell
- School of Health and Related Research, Public Health Section, University of Sheffield, Sheffield, UK
| | - Amy Barnes
- School of Health and Related Research, Public Health Section, University of Sheffield, Sheffield, UK
| | - Sarah Salway
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - Anne Townsend
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Margaret Whitehead
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Jennie Popay
- Division of Health Research, Lancaster University, Lancaster, UK
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14
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MacFarlane A, Dowrick C, Gravenhorst K, O'Reilly-de Brún M, de Brún T, van den Muijsenbergh M, van Weel Baumgarten E, Lionis C, Papadakaki M. Involving migrants in the adaptation of primary care services in a 'newly' diverse urban area in Ireland: The tension between agency and structure. Health Place 2021; 70:102556. [PMID: 34214893 DOI: 10.1016/j.healthplace.2021.102556] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 02/13/2021] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
In line with World Health Organization policy (WHO, 2016; 2019), primary care services need to be adapted to effectively meet the needs of diverse patient populations. Drawing from a European participatory implementation study, we present an Irish case study. In a hybrid participatory space, migrants, general practice staff and service planners (n = 11) engaged in a project to implement the use of trained interpreters in primary care over 17 months. We used Normalisation Process Theory to analyse data from 15 Participatory Learning and Action research focus groups and related sources. While stakeholders' agency and expertise produced relevant positive results for the introduction of changes in a general practice setting, structural factors limited the range and scope for sustained changes in day-to-day practice.
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Affiliation(s)
- Anne MacFarlane
- School of Medicine, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland.
| | | | | | | | - Tomas de Brún
- Centre for Participatory Strategies, Clonbur, Co. Galway, Ireland
| | - Maria van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, Netherlands
| | - Evelyn van Weel Baumgarten
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, Gelderland, Netherlands
| | - Christos Lionis
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Maria Papadakaki
- Clinic of Social and Family Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece; Technological Educational Institute of Crete, Irákleion, Crete, Greece
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15
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Francés-García F, La Parra-Casado D. [A multidimensional tool to measure quality of social participation in health]. GACETA SANITARIA 2021; 36:60-63. [PMID: 34034927 DOI: 10.1016/j.gaceta.2021.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 12/11/2022]
Abstract
Health strategies, programs and activities have historically been the result of institutional practices with a limited participatory component. Traditionally, institutional action is mainly determined by the criteria of the political actors and, in the best of cases, by the criteria of healthcare professionals. New forms of governance for health equity advocate for the inclusion of the community in the design of strategies, programmes and activities in health. For this reason, a growing concern in the field of participation in health is the measurement of the participatory quality of new designs of institutional practices. This article aims to develop an operational proposal to design, measure or describe the scope in participatory terms of the health planning processes. The proposal elaborates six dimensions for the measurement and assessment of participatory process: inclusivity, information flow, deliberative quality, decision making, institutional commitment and community empowerment.
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16
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Townsend A, Abraham C, Barnes A, Collins M, Halliday E, Lewis S, Orton L, Ponsford R, Salway S, Whitehead M, Popay J. "I realised it weren't about spending the money. It's about doing something together:" the role of money in a community empowerment initiative and the implications for health and wellbeing. Soc Sci Med 2020; 260:113176. [PMID: 32717663 DOI: 10.1016/j.socscimed.2020.113176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/02/2020] [Accepted: 06/25/2020] [Indexed: 11/29/2022]
Abstract
Community initiatives aiming to reduce health inequalities are increasingly common in health policy. Though diverse many such initiatives aim to support residents of disadvantaged places to exercise greater collective control over decisions/actions that affect their lives - which research suggests is an important determinant of health - and some seek to achieve this by giving residents control over a budget. Informed by theoretical work in which community capabilities for collective control are conceptualised as different forms of power, and applying a relational lens, this paper presents findings on the potential role of money as a mechanism to enhance these capabilities from an on-going evaluation of a major place-based initiative being implemented in 150 neighbourhoods across England:The Big Local (BL). The research involved semi-structured interviews with 116 diverse stakeholders, including residents and participant observation in a diverse sample of 10 BL areas. We took a thematic constant comparative approach to the analysis of data from across the sites. The findings suggest that the money enabled the development of capabilities for collective control in these communities primarily by enhancing connectivity amongst residents and with external stakeholders. However, residents had to engage in significant 'relational work' to achieve these benefits and tensions around the money could hinder communities' 'power to act'. Greater social connectivity has been shown to directly affect individual and population health by increasing social cohesion and reducing loneliness. Additionally, supporting enhanced collective control of residents in these disadvantaged communities has the potential to improve population health and reduce health inequalities.
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Affiliation(s)
- A Townsend
- Division of Health Research, Faculty of Health & Medicine, Lancaster University, United Kingdom.
| | - C Abraham
- Melbourne School of Psychological Sciences, University of Melbourne, Australia
| | - A Barnes
- School of Health and Related Research, University of Sheffield, United Kingdom
| | - M Collins
- Division of Health Research, Faculty of Health & Medicine, Lancaster University, United Kingdom
| | - E Halliday
- Division of Health Research, Faculty of Health & Medicine, Lancaster University, United Kingdom
| | - S Lewis
- School of Social and Political Science, University of Edinburgh, United Kingdom
| | - L Orton
- Department of Public Health, Policy and Systems, University of Liverpool, United Kingdom
| | - R Ponsford
- Public Health Environments and Society, London School of Hygiene and Tropical Medicine, United Kingdom
| | - S Salway
- School of Health and Related Research, University of Sheffield, United Kingdom; Department of Sociological Studies, University of Sheffield, United Kingdom
| | - M Whitehead
- Department of Public Health, Policy and Systems, University of Liverpool, United Kingdom
| | - J Popay
- Division of Health Research, Faculty of Health & Medicine, Lancaster University, United Kingdom
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