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Riccardi M, Pettinicchio V, Di Pumpo M, Altamura G, Nurchis MC, Markovic R, Šagrić Č, Stojanović M, Rosi L, Damiani G. Community-based participatory research to engage disadvantaged communities: Levels of engagement reached and how to increase it. A systematic review. Health Policy 2023; 137:104905. [PMID: 37716190 DOI: 10.1016/j.healthpol.2023.104905] [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: 01/28/2022] [Revised: 05/12/2023] [Accepted: 09/02/2023] [Indexed: 09/18/2023]
Abstract
Community-based participatory research (CBPR) is one of the most used community engagement frameworks to promote health changes in vulnerable populations. The more a community is engaged, the more a program can impact the social determinants of health. The present study aims to measure the level of engagement reached in randomized controlled trials (RCTs) using CBPR in disadvantaged populations, and to find out the CBPR components that better correlate with a higher level of engagement. A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Embase, Web of Science, MEDLINE, Cochrane and Scopus databases were queried. Engagement level was assessed using the revised version of IAP2 spectrum, ranging from "inform" to "shared leadership" . Fifty-one RCTs were included, belonging to 36 engagement programs. Fourteen CBPR reached the highest level of engagement. According to the multivariate logistic regression, a pre-existing community intervention was associated with a higher engagement level (OR = 10.08; p<0.05). The variable "institutional funding" was perfectly correlated with a higher level of engagement. No correlation was found with income status or type of preventive programs. A history of collaboration seems to influence the effectiveness in involving communities burdened with social inequities, so starting new partnerships remains a public health priority to invest on. A strong potentiality of CBPR was described in engaging disadvantaged communities, addressing social determinants of health. The key findings described above should be taken into account when planning a community engagement intervention, to build up an effective collaborative field between researchers and population.
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Affiliation(s)
- MariaTeresa Riccardi
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | | | - Marcello Di Pumpo
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Gerardo Altamura
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Mario Cesare Nurchis
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Roberta Markovic
- University of Niš, Faculty of Medicine, Niš, Serbia; Public Health Institute Niš, Niš, Serbia
| | | | - Miodrag Stojanović
- University of Niš, Faculty of Medicine, Niš, Serbia; Public Health Institute Niš, Niš, Serbia
| | - Luca Rosi
- Department of Infectious Diseases, National Institute of Health (Istituto Superiore di Sanità, ISS), Rome, Italy
| | - Gianfranco Damiani
- Department of Health Sciences and Public Health, Section of Hygiene, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168 Rome, Italy
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Tietyen Mullins J, Walters J, Najor J, Mikuška J, Courtney A, Norman-Burgdolf H. Evaluation of a social marketing approach to healthy, home-cooked family meals for low-income mothers of young children. Transl Behav Med 2021; 10:1312-1321. [PMID: 33421080 DOI: 10.1093/tbm/ibaa037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cooking is a complex behavior associated with more frequent and nutrient-dense family meals. The Cook Together, Eat Together (CTET) social marketing program used formative, process, and outcome evaluations over a 3-year period to design a program to increase fruit and vegetable intake and frequency of family meals. We used a quasi-experimental, mixed-methods design with a nonequivalent comparison group to evaluate fruit and vegetable intake and family meals. Eight focus groups of mothers in low-income families with young children revealed two predominant behavioral mediators: (i) importance of family time and (ii) desire for children to learn to cook and become self-sufficient adults. Program design was grounded in formative evaluation and organized by the four Ps of social marketing: (i) product-learning to prepare healthy meals while teaching children to cook; (ii) price-lowered by reducing barriers of food cost, kitchen clean-up, meal planning, grocery shopping; (iii) placement-in neighborhood gathering places with a "cooking social"; and (iv) promotion-flyers, newsletters, and social media. Outcome indicators were assessed pre/post intervention with questions from instruments validated for the audience. Significant changes (n = 68, p ≥ .002, Bonferroni adjustment for p = .05, Cohen's d = .50 medium effect size) were found in consumption of fruits and vegetables with an average increase of half cup each per day. CTET participation significantly increased fruits and vegetables served and eaten at family meals. A social marketing approach can help families with young children increase fruit and vegetable consumption.
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Affiliation(s)
- Janet Tietyen Mullins
- Department of Dietetics and Human Nutrition, University of Kentucky, Lexington, KY, USA
| | - Jackie Walters
- Nutrition Education Programs, Kentucky Cooperative Extension Service, Lexington, KY, USA
| | - Jean Najor
- Nutrition Education Programs, Kentucky Cooperative Extension Service, Lexington, KY, USA
| | - Jakub Mikuška
- Department of Family Sciences, University of Kentucky, Lexington, KY, USA
| | - Anita Courtney
- Purple Carrots Public Health Nutrition Consulting, Lexington, KY, USA
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Snell-Rood C, Jaramillo ET, Hamilton AB, Raskin SE, Nicosia FM, Willging C. Advancing health equity through a theoretically critical implementation science. Transl Behav Med 2021; 11:1617-1625. [PMID: 33904908 PMCID: PMC8367016 DOI: 10.1093/tbm/ibab008] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
While implementation science is driven by theory, most implementation science theories, models, and frameworks (TMF) do not address issues of power, inequality, and reflexivity that are pivotal to achieving health equity. Theories used in anthropology address these issues effectively and could complement prevailing implementation science theories and constructs. We propose three broad areas of theory that complement and extend existing TMF in implementation science to advance health equity. First, theories of postcoloniality and reflexivity foreground attention to the role of power in knowledge production and to the ways that researchers and interventionists may perpetuate the inequalities shaping health. Second, theories of structural violence and intersectionality can help us to better understand the unequal burden of health disparities in the population, thereby encouraging researchers to think beyond single interventions to initiate partnerships that can impact overlapping health vulnerabilities and influence the upstream causes of vulnerability. Finally, theories of policy and governance encourage us to examine the social-political forces of the "outer context" crucial for implementation and sustainability. The incorporation of critical theories could enhance implementation science and foster necessary reflexivity among implementation scientists. We contend that a theoretically critical implementation science will promote better science and, more importantly, support progress toward health equity.
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Affiliation(s)
- Claire Snell-Rood
- School of Public Health, University of California Berkeley, Berkeley, CA, USA
| | - Elise Trott Jaramillo
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, Albuquerque, NM, USA
| | - Alison B Hamilton
- VA Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, and Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA
| | - Sarah E Raskin
- L. Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University, Richmond, VA, USA
| | - Francesca M Nicosia
- Institute for Health & Aging, University of California, Integrative Health, San Francisco VA Health Care System, San Francisco, CA, USA
| | - Cathleen Willging
- Behavioral Health Research Center of the Southwest, Pacific Institute for Research and Evaluation, UNM Science and Technology Park, Albuquerque, NM, USA
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Leme ACB, Haines J, Tang L, Dunker KLL, Philippi ST, Fisberg M, Ferrari GL, Fisberg RM. Impact of Strategies for Preventing Obesity and Risk Factors for Eating Disorders among Adolescents: A Systematic Review. Nutrients 2020; 12:nu12103134. [PMID: 33066501 PMCID: PMC7602154 DOI: 10.3390/nu12103134] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 02/07/2023] Open
Abstract
An effective behavior change program is the first line of prevention for youth obesity. However, effectiveness in prevention of adolescent obesity requires several approaches, with special attention paid to disordered eating behaviors and psychological support, among other environmental factors. The aim of this systematic review is to compare the impact of two types of obesity prevention programs, inclusive of behavior change components, on weight outcomes. "Energy-balance" studies are aimed at reducing calories from high-energy sources and increasing physical activity (PA) levels, while "shared risk factors for obesity and eating disorders" focus on reducing disordered eating behaviors to promote a positive food and eating relationship. A systematic search of ProQuest, PubMed, PsycInfo, SciELO, and Web of Science identified 8825 articles. Thirty-five studies were included in the review, of which 20 regarded "energy-balance" and 15 "shared risk factors for obesity and eating disorders". "Energy-balance" studies were unable to support maintenance weight status, diet, and PA. "Shared risk factors for obesity and eating disorders" programs also did not result in significant differences in weight status over time. However, the majority of "shared risk factors for obesity and eating disorders" studies demonstrated reduced body dissatisfaction, dieting, and weight-control behaviors. Research is needed to examine how a shared risk factor approach can address both obesity and eating disorders.
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Affiliation(s)
- Ana Carolina B. Leme
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil; (S.T.P.); (R.M.F.)
- Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada; (J.H.); (L.T.)
- Correspondence:
| | - Jess Haines
- Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada; (J.H.); (L.T.)
| | - Lisa Tang
- Family Relations and Applied Nutrition, University of Guelph, Guelph, ON N1G 2W1, Canada; (J.H.); (L.T.)
| | - Karin L. L. Dunker
- Department of Psychiatric, Federal University of São Paulo, São Paulo 04038-000, Brazil;
| | - Sonia T. Philippi
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil; (S.T.P.); (R.M.F.)
| | - Mauro Fisberg
- Nutrition and Feeding Difficulties Excellence Center, PENSI Institute, Sabará Children’s Hospital, São Paulo 01228-200, Brazil;
- Department of Pediatrics, Escola Paulista, Federal University of São Paulo, São Paulo 04023-062, Brazil
| | - Gerson L. Ferrari
- Laboratorio de Ciencias de la Actividad Física, el Deporte y la Salud, Facultad de Ciencias Médicas, Universidad de Santiago de Chile, Santiago 8320000, Chile;
| | - Regina M. Fisberg
- Department of Nutrition, School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil; (S.T.P.); (R.M.F.)
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Looijmans A, Jörg F, Bruggeman R, Schoevers RA, Corpeleijn E. Multimodal lifestyle intervention using a web-based tool to improve cardiometabolic health in patients with serious mental illness: results of a cluster randomized controlled trial (LION). BMC Psychiatry 2019; 19:339. [PMID: 31690281 PMCID: PMC6833253 DOI: 10.1186/s12888-019-2310-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/09/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Unhealthy lifestyle behaviours contribute to alarming cardiometabolic risk in patients with serious mental illness (SMI). Evidence-based practical lifestyle tools supporting patients and staff in improving patient lifestyle are lacking. METHODS This multi-site randomized controlled pragmatic trial determined the effectiveness of a twelve-month multimodal lifestyle approach, including a web-based tool to improve patients' cardiometabolic health, versus care-as-usual. Using the web tool, nurses (trained in motivational interviewing) assisted patients in assessing their lifestyle behaviours, creating a risk profile and constructing lifestyle goals, which were discussed during fortnightly regular care visits. Twenty-seven community-care and sheltered-living teams were randomized into intervention (N = 17) or control (N = 10) groups, including 244 patients (140 intervention/104 control, 49.2% male, 46.1 ± 10.8 years) with increased waist circumference (WC), BMI or fasting glucose. The primary outcomes concerned differences in WC after six and twelve months intervention, while BMI and metabolic syndrome Z-score were secondary outcome measures. RESULTS General multilevel linear mixed models adjusted for antipsychotic medication showed that differences in WC change between intervention and control were - 0.15 cm (95%CI: - 2.49; 2.19) after six and - 1.03 cm (95%CI: - 3.42; 1.35) after twelve months intervention; however, the differences were not statistically significant. No intervention effects were found for secondary outcome measures. The intervention increased patients' readiness to change dietary behaviour. CONCLUSION A multimodal web-based intervention facilitating nurses to address lifestyle changes in SMI patients did not improve patient cardiometabolic health. Web-tool use was lower than expected and nurses need more lifestyle coaching knowledge and skills. The type of intervention and delivery mode need optimization to realize effective lifestyle care for SMI patients. TRIAL REGISTRATION Dutch Trial Registry, www.trialregister.nl , NTR3765, 21 December 2012.
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Affiliation(s)
- Anne Looijmans
- Department of Health Psychology, University Medical Center Groningen, Hanzeplein 1, PO Box 30.001, 9700, RB, Groningen, The Netherlands.
| | - Frederike Jörg
- Rob Giel Research Centre, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands ,Research Department, Friesland Mental Health Services, Leeuwarden, The Netherlands
| | - Richard Bruggeman
- Rob Giel Research Centre, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands ,0000 0000 9558 4598grid.4494.dDepartment of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Robert A. Schoevers
- 0000 0000 9558 4598grid.4494.dDepartment of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Eva Corpeleijn
- 0000 0000 9558 4598grid.4494.dDepartment of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Hoogland AI, Hoogland CE, Bardach SH, Tarasenko YN, Schoenberg NE. Health Behaviors in Rural Appalachia. South Med J 2019; 112:444-449. [PMID: 31375842 DOI: 10.14423/smj.0000000000001008] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES To better understand the disproportionate burdens from cancer, cardiovascular disease, diabetes mellitus, stroke, and other chronic conditions related to energy balance, we studied diet and physical activity patterns in younger and older adults in rural Appalachia by using a nonclinical, cross-sectional, community-based sampling approach. METHODS A total of 651 younger (ages 18-59) and 254 older (ages ≥60) Appalachians were recruited from 43 churches or community organizations. Participants answered questions about fruit and vegetable intake and physical activity. Analyses were adjusted for clustering within churches. RESULTS Compared with older Appalachians, younger Appalachians consumed significantly fewer fruits and vegetables (P = 0.01) and reported significantly more moderate-to-vigorous physical activity (P = 0.01). Regardless of age, engagement in healthy behaviors was suboptimal and well below national averages. CONCLUSIONS This community-based sample demonstrated elevated behavioral risk factors that likely contribute to some of the nation's highest rates of premature mortality. Despite suboptimal dietary intake and physical activity, results indicate some potential leverage points between the generations that may be used to improve health. For example, the older generation could benefit from engaging with their younger relatives in physical activities while advocating for a better-rounded diet. Given traditions of intergenerational connectedness, mutual aid, and self-reliance, transmission of healthier behaviors across the generations may be beneficial in the rural Appalachian context.
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Affiliation(s)
- Aasha I Hoogland
- From the Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, the Department of Psychology, University of South Florida, Tampa, the Sanders Brown Center on Aging, Graduate Center for Gerontology, University of Kentucky, Lexington, the Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, and the Department of Behavioral Science, University of Kentucky, Lexington
| | - Charles E Hoogland
- From the Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, the Department of Psychology, University of South Florida, Tampa, the Sanders Brown Center on Aging, Graduate Center for Gerontology, University of Kentucky, Lexington, the Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, and the Department of Behavioral Science, University of Kentucky, Lexington
| | - Shoshana H Bardach
- From the Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, the Department of Psychology, University of South Florida, Tampa, the Sanders Brown Center on Aging, Graduate Center for Gerontology, University of Kentucky, Lexington, the Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, and the Department of Behavioral Science, University of Kentucky, Lexington
| | - Yelena N Tarasenko
- From the Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, the Department of Psychology, University of South Florida, Tampa, the Sanders Brown Center on Aging, Graduate Center for Gerontology, University of Kentucky, Lexington, the Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, and the Department of Behavioral Science, University of Kentucky, Lexington
| | - Nancy E Schoenberg
- From the Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida, the Department of Psychology, University of South Florida, Tampa, the Sanders Brown Center on Aging, Graduate Center for Gerontology, University of Kentucky, Lexington, the Department of Health Policy and Management, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, and the Department of Behavioral Science, University of Kentucky, Lexington
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