Review of community-based research: assessing partnership approaches to improve public health

Community-Engaged Data Science (CEDS): A Case Study of Working with Communities to Use Data to Inform Change

Data-informed decision making is a critical goal for many community-based public health research initiatives. However, community partners often encounter challenges when interacting with data. The Community-Engaged Data Science (CEDS) model offers a goal-oriented, iterative guide for communities to collaborate with research data scientists through data ambassadors. This study presents a case study of CEDS applied to research on the opioid epidemic in 18 counties in Ohio as part of the HEALing Communities Study (HCS). Data ambassadors provided a pivotal role in empowering community coalitions to translate data into action using key steps of CEDS which included: data landscapes identifying available data in the community; data action plans from logic models based on community data needs and gaps of data; data collection/sharing agreements; and data systems including portals and dashboards. Throughout the CEDS process, data ambassadors emphasized sustainable data workflows, supporting continued data engagement beyond the HCS. The implementation of CEDS in Ohio underscored the importance of relationship building, timing of implementation, understanding communities' data preferences, and flexibility when working with communities. Researchers should consider implementing CEDS and integrating a data ambassador in community-based research to enhance community data engagement and drive data-informed interventions to improve public health outcomes.

Perceptions of abused Chinese women on community-based participatory approach programme in addressing their needs

BACKGROUND

The community-based participatory approach (CBPA) has gained increasing recognition worldwide for enhancing the effectiveness of intervention. It is relatively new in Chinese societies and participants' perceptions are underexplored. This study aims to explore abused Chinese women's perceptions on the CBPA programme in addressing their needs.

METHODS

A total of 11 abused Chinese women were recruited for a focus group and individual interviews. A semi-structured interview guide was used. All interviews were audio-recorded and data were transcribed verbatim. Conventional content analysis was used for analysis.

RESULTS

Four themes were identified regarding the women's perceptions and experiences of the community-based participatory approach programme: (1) Women's perceived acceptability of the CBPA programme; (2) Women's perceived usefulness of the CBPA programme; (3) Women's perceived feasibility of the CBPA programme; and (4) Empowering the women through participating in CBPA.

CONCLUSIONS

Abused Chinese women had high perceived acceptance and positive experiences towards the community-based participatory approach. Women benefited from their robust participation throughout the process. The findings confirm the potential of using the community-based participatory approach in designing interventions for future programme planning and intervention to address the needs of abused Chinese women.

The Consequences of Misdiagnosing Race-Based Trauma Response in Black Men: A Critical Examination

Mental illness is a significant public health concern prevalent in America. Over one in five U.S. adults are affected, yet less than half receive treatment. Among African Americans, only one in three seek treatment with statically lower rates among Black males. Therefore, an accurate diagnosis is crucial for appropriate treatment, while misdiagnosis leads to stigma, discrimination, and untreated illness. This paper examines the implications of misdiagnosing trauma responses in Black men, highlighting systemic biases that impede suitable care and perpetuate negative narratives. The authors propose a conceptual framework incorporating historical trauma, discrimination, and traumatic stress reactions, emphasizing the need for cultural competence and humility. This framework involves public narratives that influence perceptions and judgments, reviewing research evidence, advocating for competent trauma assessments, community empowerment, and future research directions. This paper underscores the importance of understanding and addressing the unique challenges Black men face in mental health diagnosis and treatment.

Conducting a Community-Level Needs Assessment Through Dynamic Engagement With Stakeholders

This paper presents the process of conducting a community-wide needs assessment that initially focused on soliciting information about childcare needs of families with school-aged children. The researchers were interested in understanding whether the method designed to conduct the needs assessment helped to foster collaboration, trust, and increased participation amongst multiple levels of stakeholders and subcommunities. Utilizing community-based participatory research principles, the authors will present a 3-phase approach to gaining community support through multiple levels of stakeholder engagement. While initially the needs assessment was focused on childcare, the scope broadened to learning about other needs that families with school-aged children faced. The strategic use of Survey Ambassadors throughout the community who could access families that were typically underrepresented and could provide feedback to the researchers in real time regarding modifications to the process was vital. Lessons learned included the need for further investigation into strategic methods for gaining family voices in underrepresented populations.

Understanding the experiences of older adult participants and individuals involved in the delivery of a physical activity programme based on participatory approaches: A qualitative analysis

BACKGROUND

The present study aimed to understand the experiences of older adult participants and service deliverers involved in a UK-based physical activity programme, developed using participatory approaches.

METHODS

Focus groups and one-to-one interviews were conducted with 34 older adults (aged 55+ years) and 13 service providers. Inductive thematic analysis was conducted, structured using the framework approach.

FINDINGS

Four themes were identified: (1) Co-designed activities met needs and encouraged attendance; (2) engagement and access of programme activities; (3) enjoyment and perceived benefits of sessions; and (4) support needs of individuals delivering activities. Co-designed activities appeared to meet participant needs and instil a sense of ownership of the programme. Feeling able to relate to other participants seemed important and of potential relevance to attracting older adults to the programme. Peer support may help to increase confidence in attending sessions; place-based approaches (using resources in local communities) and a flexible approach to involvement also seemed to facilitate engagement. Enjoyment of the programme appeared to be enhanced through activity variety and opportunity for socializing, with a sense of community being created through the support and encouragement of fellow participants. It was considered important that volunteers had appropriate recognition and ongoing support.

CONCLUSIONS

These findings suggest that using participatory approaches may facilitate enjoyment and sustained engagement of older adults. Provision based on local community assets may contribute to sustainability of services. However, providing ongoing support is imperative, requiring further costs and resources over the longer-term.

Barriers Experienced by First Nations Deaf People in the Justice System

Anecdotal evidence strongly suggests that members of the First Nations Deaf community experience more barriers when engaging with the criminal justice system than those who are not deaf. Therefore, our purpose for writing this article is to highlight legal and policy issues related to First Nations Deaf people, including perspectives of professionals working with these communities, living in Australia who have difficulty in accessing supports within the criminal justice system. In this article, we present data from semi-structured qualitative interviews focused on four key themes: (a) indefinite detention and unfit to plead, (b) a need for an intersectional approach to justice, (c) applying the maximum extent of the law while minimizing social services-related resources, and (d) the need for language access and qualified sign language interpreters. Through this article and the related larger sustaining project, we seek to center the experiences and needs of First Nations Deaf communities to render supports for fair, just, and equitable access in the Australian criminal justice system to this historically marginalized group.

Exploring the Use of Multiple Participatory Tools to Engage Community Health Workers in Program Evaluation and Implementation: A Case Study From the Philippines

This study explored the use of three participatory tools within a Philippines-based case study with community health workers (CHWs) by comparing and contrasting the process and data generated across the tools, and critically reflecting on adaptations and facilitation considerations that affected the tools' use. Facilitator notes and audio-recordings of discussions were integrated and analyzed thematically. Tools differed by the type of data generated: program-specific data related to CHWs' roles and responsibilities or data on broader structural factors. A stepwise approach within each tool facilitated focused, in-depth sharing, as did initial paired discussions that allowed exchange of knowledge and experiences among CHWs. Facilitators required topic- and context-specific knowledge to guide discussion effectively. CHWs discussed challenges and successes in their roles; program recommendations; and broader challenges related to healthcare delivery in their communities. This study contributes critical insights on the use of participatory tools to promote the inclusion of implementer perspectives in health program co-design, implementation, and evaluation.

Study of dog population dynamics and rabies awareness in Thailand using a school-based participatory research approach

Rabies is a neglected disease primarily related to dog-mediated transmission to humans. Accurate dog demographic and dynamic data are essential for effectively planning and evaluating population management strategies when designing interventions to prevent rabies. However, in Thailand, longitudinal survey data regarding dog population size are scarce. A school-based participatory research (SBPR) approach was conducted to survey owned dogs for one year in four high-risk provinces (Chiang Rai, Surin, Chonburi, and Songkhla) of Thailand, aiming to understand dog population dynamics and raise awareness about rabies. 'Pupify' mobile application was developed to collect data on dog population and observe the long-term population dynamics in this study. At the end of the data collection period, telephone interviews were conducted to gain insight into contextual perceptions and awareness regarding both animal and human rabies, as well as the social responsibility of dog owners in disease prevention and control. Among 303 high school students who registered in our study, 218 students reported at least one update of their dog information throughout the one-year period. Of 322 owned dogs from our survey, the updates of dog status over one year showed approximately 7.5 newborns per 100-dog-year, while deaths and missing dogs were 6.2 and 2.7 per 100-dog-year, respectively. The male to female ratio was approximately 1.8:1. Twenty-three students (10%) voluntarily participated and were interviewed in the qualitative study. The levels of rabies awareness and precautions among high-school students were relatively low. The high dropout rate of the survey was due to discontinuity in communication between the researcher and the students over the year. In conclusion, this study focused on using the SBPR approach via mobile application to collect data informing dog population dynamics and raising awareness regarding rabies in Thailand Other engaging platforms (e.g. Facebook, Instagram, Twitter, and other popular applications) is necessary to enhance communication and engagement, thereby sustaining and maintaining data collection. Further health education on rabies vaccination and animal-care practices via social media platforms would be highly beneficial. For sustainable disease control, engaging communities to raise awareness of rabies and increase dog owners' understanding of their responsibilities should be encouraged.

The Promise and Challenges of Integrating Biological and Prevention Sciences: A Community-Engaged Model for the Next Generation of Translational Research

Beginning with the successful sequencing of the human genome two decades ago, the possibility of developing personalized health interventions based on one's biology has captured the imagination of researchers, medical providers, and individuals seeking health care services. However, the application of a personalized medicine approach to emotional and behavioral health has lagged behind the development of personalized approaches for physical health conditions. There is potential value in developing improved methods for integrating biological science with prevention science to identify risk and protective mechanisms that have biological underpinnings, and then applying that knowledge to inform prevention and intervention services for emotional and behavioral health. This report represents the work of a task force appointed by the Board of the Society for Prevention Research to explore challenges and recommendations for the integration of biological and prevention sciences. We present the state of the science and barriers to progress in integrating the two approaches, followed by recommended strategies that would promote the responsible integration of biological and prevention sciences. Recommendations are grounded in Community-Based Participatory Research approaches, with the goal of centering equity in future research aimed at integrating the two disciplines to ultimately improve the well-being of those who have disproportionately experienced or are at risk for experiencing emotional and behavioral problems.

"Close to My Community": A Qualitative Study of Community Health Worker-Supported Teleaudiology Hearing Aid Services

OBJECTIVES

Given well-documented disparities in rural and minority communities, alternative service delivery models that help improve access to hearing care are needed. This article reports on a study of older Latino adults with hearing loss who received hearing aid services with Community Health Workers (CHWs) providing support via teleaudiology. The present study used qualitative data to explore perceptions of this novel service delivery model.

DESIGN

Participants completed semistructured interviews related to their experiences in the intervention approximately 17 weeks after the hearing aid fitting appointment. Two coders independently coded the data, using an iterative deductive and inductive thematic analysis approach. Inter-rater reliability was good (κ = 0.80).

RESULTS

Of the 28 participants, 19 were interviewed (CHW group: n = 9, 8 females; non-CHW group: n = 10, 9 females). Both groups of participants reported experiencing barriers in access to care and reported positive experiences with teleaudiology and with hearing aids as part of the trial. CHW group participants reported interactions with patient-site facilitators that were indicative of patient-centeredness.

CONCLUSIONS

Results demonstrate the feasibility and potential effectiveness of trained CHWs as patient-site facilitators in teleaudiology-delivered hearing aid services for adults.

Community design of the Brooklyn Health Equity Index

Health equity drives quality care. Few reliable metrics that capture patients' perceptions of health equity exist. We report on the development of a patient-centered metric for health systems change in central Brooklyn, which stands out as an outlier in New York City with a disproportionate burden of poverty, disease, and death. A community-engaged, sequential, mixed-methods research design was used. Qualitative interviews were conducted with 80 community and health care stakeholders across central Brooklyn. Candidate items were derived from qualitative themes and examined for face, interpretive validity, and language. Interitem reliability and confirmatory factor analysis was assessed using data collected via text and automated discharge calls among 368 patients from a local hospital. Qualitative data analysis informed the content of 11 draft questions covering 3 broad domains: trust-building, provider appreciation of social determinants of health, and experiences of discrimination. Psychometric testing resulted in a Cronbach's alpha of 0.774 and led to deletion of 1 item, resulting in a 10-item Brooklyn Health Equity Index (BKHI). The 10-item BKHI is a novel, brief, and reliable measure that captures patients' perceptions of inequities and offers a real-time measure for health systems and payors to monitor progress toward advancing health equity.

"To smoke feels gender": Exploring the transformative and emancipatory capacities of cannabis among transgender, non-binary and gender non-conforming (TGNC) youth

BACKGROUND

Transgender, non-binary and gender non-conforming (herein, "TGNC") youth (15-24 years old) face overlapping minority stressors (e.g., gender discrimination, lack of access to gender-affirming care, rejection, violence) that contribute to mental health inequities. TGNC youth also use substances at higher rates when compared to cisgender youth, including some of the highest rates of cannabis use in Canada.

METHODS

This community-based participatory research study provides an in-depth qualitative, photovoice-based analysis examining how cannabis use features within the gender experiences of a sample of TGNC youth in British Columbia (BC). We conducted in-depth, semi-structured interviews with 27 TGNC youth (15-24 years old) from across British Columbia. Interviews were designed to elicit discussions about the photos youth had taken as well as various gender and mental health experiences related to their cannabis use. Analysis and identification of emergent themes was guided by social constructivist grounded theory as well as queer and trans theorizing and informed by community-based research approaches through regular meetings with our team's Substance Use Beyond the Binary Youth Action Committee comprised of TGNC youth who use substances.

RESULTS

Three overarching themes pertaining to cannabis use and gender experiences amongst TGNC youth in our study were generated. First, participants used cannabis purposefully and strategically to enact diverse gender expressions and embodiments. Second, participants leveraged cannabis to support introspection whilst mobilizing identity discovery and development. Finally, participants mobilized cannabis as a vehicle for accessing moments of gender euphoria and affirmation.

CONCLUSIONS

These findings identify how some TGNC youth use cannabis to purposefully and strategically facilitate their mental health, well-being, identity development and self-expression. This research reveals critically important experiential and embodied dimensions of cannabis use that have not historically been considered in cannabis-related policy and the provision of care, including mental health and substance use-related care.

Community-Engaged Implementation Strategies in Occupational Therapy: A Scoping Review

IMPORTANCE

 Despite the potential of community-engaged implementation research (CEIR) in developing strategies to accelerate the translation of evidence-based interventions (EBIs), there is a noticeable knowledge gap in the current state of CEIR in occupational therapy. A synthesis of the concept, purpose, and operationalization of CEIR is necessary.

OBJECTIVE

 To identify the contexts, purposes, and operationalization of CEIR, focusing on implementation strategies in occupational therapy.

DATA SOURCES

 PubMed/MEDLINE, Embase, CINAHL, Scopus, and Web of Science.

STUDY SELECTION AND DATA COLLECTION

 We included studies that were explicit and intentional about CEIR and that focused on implementation strategies to support the translation of occupational therapy interventions, clinical guidelines, practice models, theories, or assessments. We extracted the research context (e.g., partners, recruitment), purpose (e.g., why community-engaged research was used), and operationalization (e.g., community engagement [CE] activities, how their findings inform the research) using thematic analysis.

FINDINGS

 Of 3,219 records, 6 studies were included. Involved partners were mainly occupational therapy practitioners from existing networks. CEIR that focuses on implementation strategies informs various aspects of research design, ranging from study design to sustainability, by developing community-academia partnerships, building implementation capacity, and creating implementation strategies across diverse research areas. Current research has used various but mostly traditional CE activities (e.g., focus groups).

CONCLUSIONS AND RELEVANCE

 We synthesized evidence on CEIR focused on implementation strategies in occupational therapy. Intentional efforts are needed to collaborate with diverse partners, explore innovative CE activities, produce equitable outputs, and develop multilevel implementation strategies to accelerate the translation of EBIs into practice. Plain-Language Summary: In this review, we synthesize evidence on the contexts, purposes, and operationalization of community-engaged implementation research (CEIR), focusing on implementation strategies in occupational therapy research. We found that current implementation efforts mainly rely on occupational therapy practitioners as community partners and use traditional recruitment methods and community engagement activities. In turn, they develop implementation strategies that mainly target practitioners without comprehensive, multilevel implementation support. We suggest more equitable collaboration with diverse partners to effectively promote the implementation and dissemination of evidence-based interventions in occupational therapy practice.

The Use of Social Marketing in Community-Wide Physical Activity Programs: A Scoping Review

BACKGROUND

Previous community-wide physical activity trials have been criticized for methodological limitations, lack of population-level changes, and insufficient reach among underserved communities. Social marketing is an effective technique for community-wide behavior change and can coincide with principles of community-based participatory research (CBPR).

PURPOSE

A systematic scoping review of community-wide interventions (system-level) targeting physical activity and/or weight loss was conducted to (i) describe and critically discuss how social marketing strategies are implemented; (ii) identify which populations have been targeted, including underserved communities; (iii) evaluate the use of CBPR frameworks; (iv) assess retention rates; and (v) identify gaps in the literature and formulate future recommendations.

METHODS

Eligible studies included those that: aimed to improve physical activity and/or weight loss on a community-wide level, used social marketing strategies, and were published between 2007 and 2022.

RESULTS

Approximately 56% of the studies reported a positive impact on physical activity. All studies described social marketing details in alignment with the five principles of social marketing (product, promotion, place, price, and people). Only two studies explicitly identified CBPR as a guiding framework, but most studies used one (k = 8, 32%) or two (k = 12, 48%) community engagement strategies. Few studies included at least 50% representation of African American (k = 2) or Hispanic (k = 3) participants.

CONCLUSIONS

This review highlights key gaps in the literature (e.g., lack of fully-developed CBPR frameworks, reach among underserved communities, randomized designs, use of theory), highlights examples of successful interventions, and opportunities for refining community-wide interventions using social marketing strategies.

Kick Vaping: Feasibility, acceptability, and preliminary impact of a vaping cessation text messaging intervention for Latino young adults

OBJECTIVE

To assess the feasibility, acceptability, and preliminary impact of Kick Vaping among Latino young adults.

METHODS

Forty Latino young adults (ages 18 to 25) who were currently vaping received Kick Vaping, a vaping cessation text messaging intervention available in English and Spanish. Feasibility was measured by the eligibility, enrollment, and follow-up rates. Acceptability was measured by overall satisfaction with the intervention. Preliminary impact was measured by self-reported 7-day point prevalence abstinence and changes in self-efficacy.

RESULTS

Two hundred three individuals were identified, 61 were assessed for eligibility, and 55 were eligible. Forty individuals consented to participate and were enrolled in Kick Vaping. At baseline, most participants used disposable devices (70%), vaped daily (97.5%), had low (37.5%) or medium (35.0%) e-cigarette dependence, and had attempted to quit in the past year (72.5%). At Month 3, the follow-up rate was 90% (36/40). Treating those lost to follow-up as participants who continued vaping, 75% (30/40) of participants self-reported 7-day point prevalence abstinence. Self-efficacy mean scores significantly increased from 30.65 (SD 8.07) at baseline to 50.11 (SD 10.57) at follow-up (p < 0.01). Most participants (88.9%, 32/36) reported being satisfied/extremely satisfied with Kick Vaping.

CONCLUSION

It is feasible to recruit and retain Latino young adults in a vaping cessation text messaging intervention. Kick Vaping generated high satisfaction among Latino young adults, significantly increased self-efficacy, and resulted in a notable vaping cessation rate at Month 3. Additional testing in a randomized controlled trial is warranted to assess the efficacy of the intervention.

Local Health Equity Action Teams (LHEATS) as a Novel and Emerging Practice of the Communities Organizing to Promote Equity (COPE) Project in Kansas

The Communities Organizing to Promote Equity (COPE) Project was implemented in 20 counties across Kansas to build capacity to address health equity by forming local health equity action teams (LHEATS), hiring and training community health workers, facilitating state-wide learning collaboratives, and tailoring communication strategies. We conducted interviews and focus groups with project stakeholders who identified pragmatic recommendations related to LHEAT formation and leadership, establishing trust, nurturing autonomy, and optimizing impact. Insights can improve future community-based health equity efforts. (Am J Public Health. Published online ahead of print August 28, 2024:e1-e5. https://doi.org/10.2105/AJPH.2024.307802).

Linking affected community and academic knowledge: a community-based participatory research framework based on a Shichigahama project

Earthquakes that cause extensive damage occur frequently in Japan, the most recent being the Noto Peninsula earthquake on January 1, 2024. To facilitate such a recovery, we introduce a community-based participatory research program implemented through cooperation between universities and local communities after the 2011 Great East Japan Earthquake. In this project, the university and the town of Shichigahama, one of the affected areas, collaborated to hold annual workshops in the target area, which evolved into a climate monitoring survey. Even in Japan, where disaster prevention planning is widespread, various problems arise in the process of emergency response, recovery and reconstruction, and building back better when disasters occur. As is difficult for residents and local governments to solve these problems alone, it is helpful when experts participate in the response process. In this study, we interviewed town hall and university officials as representatives of local residents regarding this project and discussed their mutual concerns. The community-based participatory research framework developed in the Shichigahama project could be used in the recovery from the Noto Peninsula Earthquake as well as in future reconstruction and disaster management projects.

CASCADE: A Community-Engaged Action Model for Generating Rapid, Patient-Engaged Decisions in Clinical Research

Background

Integrating patient and community input is essential to the relevance and impact of patient-focused research. However, specific techniques for generating patient and community-informed research decisions remain limited. Here, we describes a novel CASCADE method (Community-Engaged Approach for Scientific Collaborations and Decisions) that was developed and implemented to make actionable, patient-centered research decisions during a federally funded clinical trial.

Methods

The CASCADE approach includes 7 key pillars: (1) identifying a shared, specific, and actionable goal; (2) centering community input; (3) integrating both pre-registered statistical analyses and exploratory "quests"; (4) fixed-pace scheduling, supported by technology; (5) minimizing opportunities for cognitive biases typical to group decision making; (6) centering diversity experiences and perspectives, including those of individual patients; (7) making decisions that are community-relevant, rigorous, and feasible. Here, we implemented these pillars within a three-day CASCADE panel, attended by diverse members of a research project team that included community interest-holders. The goal of our panel was to identify ways to improve an algorithm for matching patients to specific types of telehealth programs within an active, federally funded clinical trial.

Results

The CASCADE panel was attended by 27 participants, including 5 community interest-holders. Data reviewed to generate hypotheses and make decisions included (1) pre-registered statistical analyses, (2) results of 12 "quests" that were launched during the panel to answer specific panelist questions via exploratory analyses or literature review, (3) qualitative and quantitative patient input, and (4) team member input, including by staff who represented the target patient population for the clinical trial. Panel procedures resulted in the generation of 18 initial and 12 final hypotheses, which were translated to 19 decisional changes.

Conclusions

The CASCADE approach was an effective procedure for rapidly, efficiently making patient-centered decisions during an ongoing, federally funded clinical trial. Opportunities for further development will include exploring best-practice structural procedures, enhancing greater opportunities for pre-panel input by community interest-holders, and determining how to best standardize CASCADE outputs.

Trial registration

The CASCADE procedure was developed in the context of NCT05999448.

Community-engaged randomised controlled trial to disseminate COVID-19 vaccine-related information and increase uptake among Black individuals in two US cities with rheumatic conditions

INTRODUCTION

Inequities in COVID-19 infection and vaccine uptake among historically marginalised racial and ethnic groups in the USA persist. Individuals with rheumatic conditions, especially those who are immunocompromised, are especially vulnerable to severe infection, with significant racialised inequities in infection outcomes and in vaccine uptake. Structural racism, historical injustices and misinformation engender racial and ethnic inequities in vaccine uptake. The Popular Opinion Lleader (POL) model, a community-based intervention that trains trusted community leaders to disseminate health information to their social network members (eg, friends, family and neighbours), has been shown to reduce stigma and improve care-seeking behaviours.

METHODS AND ANALYSIS

This is a community-based cluster randomised controlled trial led by a team of community and academic partners to compare the efficacy of training POLs with rheumatic or musculoskeletal conditions using a curriculum embedded with a racial justice vs a biomedical framework to increase COVID-19 vaccine uptake and reduce vaccine hesitancy. This trial began recruitment in February 2024 in Boston, Massachusetts and Chicago, Illinois, USA. Eligible POLs are English-speaking adults who identify as Black and/or of African descent, have a diagnosis of a rheumatic or musculoskeletal condition and have received >=1 COVID-19 vaccine after 31 August 2022. POLs will be randomised to a 6-module virtual educational training; the COVID-19 and vaccine-related content will be the same for both groups however the framing for arm 1 will be with a racial justice lens and for arm 2, a biomedical preventative care-focused lens. Following the training, POLs will disseminate the information they learned to 12-16 social network members who have not received the most recent COVID-19 vaccine, over 4 weeks. The trial's primary outcome is social network member COVID-19 vaccine uptake, which will be compared between intervention arms.

ETHICS AND DISSEMINATION

This trial has ethical approval in the USA. This has been approved by the Mass General Brigham Institutional Review Board (IRB, 2023P000686), the Northwestern University IRB (STU00219053), the Boston University/Boston Medical Center IRB (H-43857) and the Boston Children's Hospital IRB (P00045404). Results will be published in a publicly accessible peer-reviewed journal.

TRIAL REGISTRATION NUMBER

NCT05822219.

Exploring community- and systemic-level gender-based violence in visible minority women across five countries from an intersectionality lens: protocol for a mixed-methods systematic review

INTRODUCTION

The intersection of sexism with racism and xenophobia disproportionately exposes visible minority women to gender-based violence (GBV) at the community and systemic levels. This study aims to understand the knowledge strengths and gaps on GBV against visible minority women with an intersectional lens, revealing systemic barriers to accessing support and how these barriers intensify GBV and its effects. It will also identify effective and ineffective policies and practices in the literature to develop strategies addressing the root causes of GBV and supporting survivors.

METHODS AND ANALYSIS

We will conduct a mixed-methods systematic review using a convergent integrated approach to examine current literature on community- and systemic-level GBV against visible minority women. We will follow Joanna Briggs Institute's guidelines to converge data from both qualitative and quantitative studies to obtain an integrated qualitative synthesis on GBV in five countries: Canada, the USA, the UK, Australia and New Zealand. This analysis will be conducted following Thomas and Harden's thematic synthesis guidelines. Community members with lived experience of GBV will actively contribute to improving the relevance and interpretation of results, following a community-engaged research approach. Themes are expected to unveil various aspects of community- and systemic-level GBV due to the intersection of racism, xenophobia and sexism, alongside barriers in addressing GBV and research gaps.

ETHICS AND DISSEMINATION

Since this study does not involve primary data collection or the use of identifiable human data, no ethical approval will be needed. Results will be disseminated through integrated knowledge translation, involving collaboration with participants who have lived experience of GBV. The findings will be used to identify specific areas of policy intervention, including adopting culturally sensitive approaches, improving school and workplace policies and promoting rights of visible minority women.

Structural Racism and Obesity-Related Cancer Inequities in the United States: Challenges and Research Priorities

Structural racism has been identified as a fundamental cause of health disparities. For example, racial, ethnic, and economic neighborhood segregation; concentrated poverty; community disinvestment; and sociocultural context influence obesity and cancer disparities. Effects of structural racism are also evident through neighborhood obesogenic conditions such as limited access to affordable and healthy foods and physical activity opportunities within segregated communities that contribute to obesity and obesity-related cancer disparities. This article describes and expands on cross-cutting themes raised during a webinar held by the National Cancer Institute (NCI): (1) how structural factors, including neighborhood segregation and obesogenic conditions within racial and ethnic disadvantaged communities, influence disparities in the United States; (2) current research challenges and best ways to address them; and (3) selected priorities of the NCI aimed at addressing multilevel and intersecting factors that influence obesity-related cancer disparities. Further research is needed to understand how residential segregation and neighborhood obesogenic conditions influence cancer prevention and control across the continuum. Identifying the best approaches to address obesity and cancer disparities using social determinants of health framework and community-engaged approaches guided by a structural racism lens will allow researchers to move beyond individual-level approaches.

Scale up of the learning circles: a participatory action approach to support local food systems in four diverse First Nations school communities within Canada

BACKGROUND

Addressing Indigenous food security and food sovereignty calls for community-driven strategies to improve access to and availability of traditional and local food. Participatory approaches that integrate Indigenous leadership have supported successful program implementation. Learning Circles: Local Healthy Food to School is a participatory program that convenes a range of stakeholders including food producers, educators and Knowledge Keepers to plan, implement and monitor local food system action. Pilot work (2014-2015) in Haida Gwaii, British Columbia (BC), showed promising results of the Learning Circles (LC) approach in enhancing local and traditional food access, knowledge and skills among youth and adolescents. The objective of the current evaluation was therefore to examine the process of scaling-up the LC vertically within the Haida Nation; and horizontally across three diverse First Nations contexts: Gitxsan Nation, Hazelton /Upper Skeena, BC; Ministikwan Lake Cree Nation, Saskatchewan; and Black River First Nation, Manitoba between 2016 and 2019.

METHODS

An implementation science framework, Foster-Fishman and Watson's (2012) ABLe Change Framework, was used to understand the LC as a participatory approach to facilitate community capacity building to strengthen local food systems. Interviews (n = 52), meeting summaries (n = 44) and tracking sheets (n = 39) were thematically analyzed.

RESULTS

The LC facilitated a collaborative process to: (1) build on strengths and explore ways to increase readiness and capacity to reclaim traditional and local food systems; (2) strengthen connections to land, traditional knowledge and ways of life; (3) foster community-level action and multi-sector partnerships; (4) drive actions towards decolonization through revitalization of traditional foods; (5) improve availability of and appreciation for local healthy and traditional foods in school communities; and (6) promote holistic wellness through steps towards food sovereignty and food security. Scale-up within Haida Gwaii supported a growing, robust local and traditional food system and enhanced Haida leadership. The approach worked well in other First Nations contexts, though baseline capacity and the presence of champions were enabling factors.

CONCLUSIONS

Findings highlight LC as a participatory approach to build capacity and support iterative planning-to-action in community food systems. Identified strengths and challenges support opportunities to expand, adopt and modify the LC approach in other Indigenous communities with diverse food systems.

"As a patient I do not belong to the clinic, I belong to the community": co-developing multi-level, person-centred tuberculosis stigma interventions in Cape Town, South Africa

Background

Anticipated, internal, and enacted stigma are major barriers to tuberculosis (TB) care engagement and directly impact patient well-being. Unfortunately, targeted stigma interventions are lacking. We aimed to co-develop a person-centred stigma intervention with TB-affected community members and health workers in South Africa.

Methods

Using a community-based participatory research approach, we conducted ten group discussions with people diagnosed with TB (past or present), caregivers, and health workers (total n = 87) in Khayelitsha, Cape Town. Group discussions were facilitated by TB survivors. Discussion guides explored experiences and drivers of stigma and used human-centred design principles to co-develop solutions. Recordings were transcribed, coded, thematically analysed, and then further interpreted using the socio-ecological model and behaviour change wheel framework.

Results

Intervention components across socio-ecological levels shared common functions linked to effective behaviour change, namely education, training, enablement, persuasion, modelling, and environmental restructuring. At the individual level, participants recommended counselling to improve TB knowledge and provide ongoing support. TB survivors can guide messaging to nurture stigma resilience by highlighting that TB can affect anyone and is curable, and provide lived experiences of TB to decrease internal and anticipated stigma. At the interpersonal level, support clubs and family-centred counselling were suggested to dispel TB-related myths and foster support. At the institutional level, health worker stigma reduction training informed by TB survivor perspectives was recommended to decrease enacted stigma. Participants discussed how integration of TB/HIV care services may exacerbate TB/HIV intersectional stigma and ideas for restructured service delivery models were suggested. At the community level, participants recommended awareness-raising events led by TB survivors, including TB information in school curricula. At the policy level, solutions focused on reducing the visibility generated by a TB diagnosis and resultant stigma in health facilities and shifting tasks to community health workers.

Conclusions

Decreasing TB stigma requires a multi-level approach. Co-developing a person-centred intervention with affected communities is feasible and generates stigma intervention components that are directed and implementable. Such community-led multi-level intervention components should be prioritised by TB programs, including integrated TB/HIV care services.

Supplementary Information

The online version contains supplementary material available at 10.1186/s44263-024-00084-z.

Systems thinking for local food environments: a participatory approach identifying leverage points and actions for healthy and sustainable transformations

BACKGROUND

Current local food environments encourage poor diets, posing a significant threat to public and planetary health. Acknowledging and addressing its inherent complexity is vital to making meaningful improvements to the food environment. Using a participatory approach with local stakeholders, this study aims to gain insight into the factors and mechanisms underlying the local food environment and to identify leverage points and system-based actions to foster healthy and sustainable local food environments.

METHODS

A systems-thinking approach was used in a Dutch municipality in 2022. Two group model building (GMB) workshops were held with community stakeholders (e.g. local policymakers, retailers and residents). During the first workshop (June 2022), factors and mechanisms influencing the local food environment were identified and visualized through a causal loop diagram (CLD). During the second workshop, leverage points and system-based actions to improve food environments were identified by the stakeholders. Four months after (October 2022), an action-implementation meeting was organized to stimulate the implementation of selected actions. Progress was monitored through brief telephone interviews 6 and 12 months after the second workshop.

RESULTS

The CLD visualises the factors and mechanisms influencing the local food environment from the point of view of the community stakeholders. The CLD consists of 46 factors shaping the local food environment, which were categorized into four identified subsystems: societal factors, individual, socio-economic factors, commercial factors and political factors. Eight leverage points were identified within the CLD, for example, 'lobby from food industry', 'governmental food policies' and 'e-commerce and platform economy'. Stakeholders formulated 20 actions targeting the identified leverage points. During the action-implementation meeting, long-term plans were created for five actions. After 1 year, only one participant (policy advisory role) remained actively engaged in three of these actions.

CONCLUSIONS

This study yields insight into the numerous factors and mechanisms underlying the local food environment and identified system-based actions as perceived by local stakeholders to improve this food environment locally. The CLD offers stakeholders valuable insights on employing a systems approach when enhancing food environments. More research is necessary, especially into the long-term processes and effects of implementing system-oriented actions to improve local food environments.

Designing measures of complex collaborations with participatory, evidence-centered design

An increasingly popular form of collaboration involves forming partnerships among researchers, educators, and community members to improve or transform education systems through research inquiry. However, not all partnerships are successful. The field needs valid, reliable, and useful measures to help with assessing progress toward partnership goals. In this community case study, we present a participatory, mixed-methods approach for creating measures to assess the progress of education research-practice partnerships (RPPs). The case illustrates a novel approach to measurement design, driven by perspectives and feedback of over 300 members of 80 partnerships. As a result, the measures align with the values and practices of the very collaborations the measures were intended to assess.

Strength-based strategies for addressing racial stressors in African American families: lessons learned from developing the LEADS health promotion intervention

Recognizing the real-life impact of racial stress on physical and psychological health is vital for creating impactful health promotion interventions among African American families. Despite the known link between racial stress and poor physical health outcomes, no existing intervention to date has targeted stress management strategies to buffer racial stress and build positive health behaviors among African American families. The current study outlines the lessons learned throughout the development of the Linking Exercise for Advancing Daily Stress (LEADS) Management and Resilience program, a 10-week family-based health promotion, stress management, and resilience intervention that aimed to improve physical activity, healthy eating, and well-being among African American adolescents and parents. We highlight the evolution of the LEADS intervention from a health promotion and stress management intervention to a culturally salient health promotion, stress management, and resilience intervention utilizing community-based participatory research strategies. This paper chronicles our systematic journey in making those changes and the lessons we learned along the way. We provide specific recommendations and implications for future health promotion interventions developed for African American families. Overall, we argue for a research orientation that respects cultural and racial contexts, embraces diversity within research teams and self-reflection, recognizes the heterogeneity among African American populations, and applies strength-based approaches.

Development and Evaluation of a Web-Based Platform for Personalized Educational and Professional Assistance for Dementia Caregivers: Proposal for a Mixed Methods Study

BACKGROUND

Alzheimer disease (AD) and AD-related dementia are prevalent concerns for aging populations. With a growing older adult population living in the United States, the number of people living with dementia is expected to grow, posing significant challenges for informal caregivers. The mental and physical burdens associated with caregiving highlight the importance of developing novel and effective resources to support caregivers. However, technology solutions designed to address their needs often face low adoption rates due to usability issues and a lack of contextual relevance. This study focuses on developing a web-based platform providing financial and legal planning information and education for dementia caregivers and evaluating the platform's usability and adoptability.

OBJECTIVE

The goal of this project is to create a web-based platform that connects caregivers with personalized and easily accessible resources. This project involves industrial, academic, and community partners and focuses on two primary aims: (1) developing a digital platform using a Dementia Care Personalization Algorithm and assessing feasibility in a pilot group of caregivers, and (2) evaluating the acceptability and usability of the digital platform across different racial or ethnic populations. This work will aid in the development of technology-based interventions to reduce caregiver burden.

METHODS

The phase I study follows an iterative Design Thinking approach, involving at least 25 dementia caregivers as a user feedback panel to assess the platform's functionality, aesthetics, information, and overall quality using the adapted Mobile Application Rating Scale. Phase II is a usability study with 300 dementia caregivers in Texas (100 African American, 100 Hispanic or Latinx, and 100 non-Hispanic White). Participants will use the digital platform for about 4 weeks and evaluate its usefulness and ease of use through the Technology Acceptance Survey.

RESULTS

The study received funding from the National Institute on Aging on September 3, 2021. Ethical approval for phase I was obtained from the Texas A&M University Institutional Review Board on December 8, 2021, with data collection starting on January 1, 2022, and concluding on May 31, 2022. Phase I results were published on September 5, 2023, and April 17, 2024, respectively. On June 21, 2023, ethical approval for human subjects for phase II was granted, and participant recruitment began on July 1, 2023.

CONCLUSIONS

Upon completing these aims, we expect to deliver a widely accessible digital platform tailored to assist dementia caregivers with financial and legal challenges by connecting them to personalized, contextually relevant information and resources in Texas. If successful, we plan to work with caregiving organizations to scale and sustain the platform, addressing the needs of the growing population living with dementia.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/64127.

Stock Inhalers: A Qualitative Data Analysis of Illinois Health Policy Trials and Triumphs

BACKGROUND

Asthma reliever medication access is critical, especially in schools. Policies that "stock" reliever inhalers in schools provide failsafe medication access. This research aims to understand barriers and facilitators to Illinois stock inhaler policy implementation.

METHODS

We conducted 18 semi-structured interviews in 2021-2022 with key school-based and non-school-based partners (school administrators, nurses, governmental agencies, and advocacy leaders). Through Atlas.ti, code frequencies compared (Fisher's exact test), and a thematic analysis performed.

RESULTS

Four themes emerged: facilitators, barriers, program rationale, and process considerations. The common facilitators were "Finding a provider," having a "Champion," and "Funding". Barriers included "Not enough school nurses," "Pharmacy refusal to fill prescriptions," and "Feeling overwhelmed." All were supportive of the rationale for stock inhalers. Non-school-based informants (p < .01) were more likely to mention medication donations, while school staff reported having enough nurses as a facilitator (p < .01). School staff reported concerns about children with asthma not having their medication significantly more than other partners (p = .02).

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Our analysis revealed that school partners recognize the value of stock inhalers. Barrier mitigation to support the funding, prescription access and processing, and training are essential to success of stock inhaler programming. Multilevel collaborative efforts through coalitions could be a potential solution.

Development of sport policy and practice recommendations for pregnant, postpartum and parenting Canadian high-performance athletes

Our objective is to describe the development of evidence-based policy and practice recommendations for pregnant, postpartum and parenting Canadian high-performance athletes. A community-based participatory research approach was employed as the study design, and data were generated via a rapid review of existing sport policy for pregnant and postpartum athletes, followed by an extensive consultation and engagement process with key sport stakeholders via survey and one-on-one and group interviews. 102 sport stakeholders participated via the survey (n=56), individual and group interviews (n=33), and follow-up interviews (n=13). Individuals represented a range of summer/winter Olympic and Paralympic athletes, medical and support staff, National Sport Organisations and Sport Canada representatives. Seven evidence-based policy and practice recommendations were developed for Sport Canada decision-makers. Recommendations include the need for Sport Canada to (a) establish two new cards for pregnant and parenting athletes, (b) develop a policy to support pregnant, postpartum and parenting athletes, (c) create new funding sources for facilities that accommodate the needs of pregnant, postpartum and parenting athletes, (d) create new funding source for athletes to train and/or compete during infants' first year, (e) develop training and educational modules related to pregnant, postpartum and parenting athletes, (f) increase visibility of pregnant, postpartum and parenting athletes and (g) invest in research on high-performance sport participation during and following pregnancy. The collaborative processes employed in this research serve as a model for sports organisations to develop evidence-based policies and practices that can support pregnant, postpartum and parenting athletes.

Examining identity disclosure: Racial and ethnic identity amongst Multiracial/ethnic adults in the United States

OBJECTIVES

Providing personal demographic information is routine practice in the United States, and yet, little is known about the impacts of this process. This study aims to examine the experiences and perspectives of Multiracial/ethnic adults in the United States when disclosing racial/ethnic identity.

METHODS

Seventeen semistructured interviews were conducted with adults identifying as Multiracial/ethnic. The Multiracial/ethnic identities of participants included Black or African American and White; Black or African American, American Indian or Alaska Native (AI/AN) and Hispanic or Latino; Black or African American and Hispanic or Latino; Black or African American and AI/AN; AI/AN and White and Asian, Native Hawaiian or Pacific Islander and White. Multiple participants reported identifying with multiple ethnic groups for any single broad category. Three identified as sexual minorities. Nine were Millennials; six were Gen X; one was Gen Z; one was Baby Boomer. Qualitative data were analyzed using staged hybrid inductive-deductive thematic analysis.

RESULTS

Disclosure of racial and ethnic identities presents a unique stressor for Multiracial/ethnic populations due to methods used to obtain data, perceived mismatch of identity and phenotype and exposure to prejudice. Social norms, constructs and movements impact the categories that a Multiracial/ethnic person indicates to external parties.

CONCLUSIONS

The stress and negative feelings that Multiracial/ethnic adults face when identifying their race/ethnicity underscore the broader implications of standard demographic questions on feelings of inclusivity and visibility within a population.

PATIENT OR PUBLIC CONTRIBUTION

Gathering data on individuals' racial and ethnic backgrounds is a standard practice, and yet, it can pose challenges for those who identify with multiple groups or do not see their identities reflected in the options provided. Such individuals may feel excluded or experience unfair treatment when disclosing their identity, leading to significant stress. As the frequency of this data collection increases, it is essential that the questions are posed empathetically and equitably, with a strong commitment to enhancing inclusivity throughout the process.

The Bidirectional Engagement and Equity (BEE) Research Framework to Guide Community-Academic Partnerships: Developed From a Narrative Review and Diverse Stakeholder Perspectives

BACKGROUND

The engagement of community partners in equitable partnerships with academic teams is necessary to achieve health equity. However, there is no standardized approach to support bidirectional engagement among research stakeholders in the context of partnership equity at each phase of the research process.

OBJECTIVE

We describe the development of a systematic framework along with competencies and tools promoting bidirectional engagement and equity within community-academic partnerships at each phase of the research process.

DESIGN

We conducted a four-step research process between November 2020 and December 2023 for framework development: (1) a narrative literature review; (2) expansion of existing bidirectional, equitable framework; (3) a scientific review with two groups of cognitive interviews (five community engagement researchers and five community leaders and members); and (4) three community-based organization leader focus groups. Thematic analysis was used to analyse focus group data.

RESULTS

Using results of each step, the framework was iteratively developed, yielding four phases of the bidirectional engagement and equity (BEE) research framework: Relationship building and assessment of goals and resources (Phase I); form a community-academic partnership based on shared research interests (may include multilevel stakeholders) (Phase II); develop a research team comprising members from each partnering organization (Phase III); and implement the six-step equitable research process (Phase IV). Bidirectional learning and partnership principles are at the core of the partnership, particularly in Phases II-IV. Competencies and tools for conducting an equitable, engaged research process were provided.

DISCUSSION

This conceptual framework offers a novel, stepwise approach and competencies for community-academic partners to successfully partner and conduct the research process equitably.

CONCLUSION

The BEE research framework can be implemented to standardize the conduct of an equitable, engaged research process within a community-academic partnership, while improving knowledge and trust across partners and, ultimately, an increased return on investment and sustainability to benefit both partners in the area of health outcomes and ultimately health equity.

PATIENT OR PUBLIC CONTRIBUTION

The development of this framework was co-led with a community organization in which two leaders in the organization were equitably involved in each phase of the research process, including grant development, study design, participant recruitment, protocol development for focus groups and community and researcher review, framework design and content and dissemination of this manuscript as a co-author. For grant development, the community leader completed the give-get grid components for them as a partner. They also wrote up their lived experience in the research process for the progress report. For the focus groups, one community leader co-led the focus group with the academic partner. For the narrative review, the community leaders did not actively conduct the narrative review but observed the process through the academic partners. One community leader wrote the section 'relationship building' and 'bidirectional learning' sections with the assistance of the academic partner, while they both equally provided input on other sections of the manuscript alongside academic partners. The community leaders have extensive experience in leading programmes, along with partnering with researchers to address health equity issues and improve health outcomes.

Impact of veteran-led peer mentorship on posttraumatic stress disorder

Peer mentorship shows promise as a strategy to support veteran mental health. A community-academic partnership involving a veteran-led nonprofit organization and institutions of higher education evaluated a collaboratively developed peer mentor intervention. We assessed posttraumatic stress disorder (PTSD), postdeployment experiences, social functioning, and psychological strengths at baseline, midpoint, and 12-week discharge using the PTSD Checklist for DSM-5 (PCL-5), Deployment Risk and Resilience Inventory-2, Social Adaptation Self-evaluation Scale, and Values in Action Survey. Brief weekly check-in surveys reinforced mentor contact and assessed retention. The sample included 307 veterans who were served by 17 veteran peer mentors. Mixed-effects linear models found a modest effect for PTSD symptom change, with a mean PCL-5 score reduction of 4.04 points, 95% CI [-6.44, -1.64], d = 0.44. More symptomatic veterans showed a larger effect, with average reductions of 9.03 points, 95% CI [-12.11, -5.95], d = 0.77. There were no significant findings for other outcome variables. Compared to younger veterans, those aged 32-57 years were less likely to drop out by 6 weeks, aORs = 0.32-0.26. Week-by-week hazard of drop-out was lower with mentors ≥ 35 years old, aHR = 0.62, 95% CI [0.37, 1.05]. Unadjusted survival differed by mentor military branch, p = .028, but the small mentor sample reduced interpretability. Like many community research efforts, this study lacked a control group, limiting the inferences that can be drawn. Continued study of veteran peer mentorship is important as this modality is often viewed as more tolerable than therapy.

Anxiety in Turner syndrome: Engaging community to address barriers and facilitators to diagnosis and care

Turner syndrome (TS), caused by complete or partial loss of the second sex chromosome, is associated with complex medical manifestations. The TS community identifies anxiety as a major contributor to reduced quality of life. The study aimed to improve understanding of anxiety symptomatology, diagnosis, and care in individuals with TS. A mixed methods design integrated community engagement, including community leaders as co-investigators and a community advisory board, an online survey (N = 135), and in-depth interviews (N = 10). The majority of respondents reported that anxiety symptoms occur two or more days per week, with self-advocates reporting more frequent symptoms than caregivers (p = 0.03). Self-advocates reported feeling anxious more often at school/work; both rater groups reported anxiety-related behaviors were most likely to be expressed at home. Insomnia was the most common symptom of anxiety endorsed across age and rater groups (>70%). Anxiety symptoms and triggers changed with age and often were undiagnosed or untreated during childhood. Therapy and medication were reported as helpful by most respondents who had tried these strategies. Qualitative themes included: 'Triggers for anxiety are related to TS', 'Anxiety impacts the whole family', and 'Opportunities for early identification and intervention'.

From Streets to Tables: Bottom-Up Co-creation Case Studies for Healthier Food Environments in Vietnam and Nigeria

Current food systems fail to provide equity, sustainability, and positive health outcomes, thus underscoring the critical need for their transformation. Intervening in food environments holds substantial promise for contributing to this much-needed transformation. Despite scholars and practitioners often recognizing the necessity for bottom-up approaches, there is a dearth of empirical investigations evaluating the potential of these approaches to contribute to food system transformations in low- and middle-income countries (LMICs). Our study aimed to address this research gap, providing a unique perspective in this regard. Drawing on evidence from two co-creation case studies conducted with small-scale informal fruit and vegetable vendors and poor consumers in Vietnam and Nigeria from January 2020 to December 2021, we explored the relevance of bottom-up community-engaged co-creation processes in intervening within LMICs' food retail environments. Employing a mixed-methods approach that includes quantitative surveys, qualitative interviews, participatory workshops, and focus group discussions, we demonstrated that bottom-up co-creation processes involving marginalized socioeconomic groups can generate retail-level innovations that are tailored to informal retail contexts, whereas remaining aligned with established top-down theories and literature pertaining to food environments and healthy diets. We provided empirical evidence highlighting how both vendors and consumers respond positively to the co-created innovations. Expanding upon our results, we offered methodological insights applicable to interventions targeted at food environments in LMICs, and considerations for future research or development initiatives in this domain. Our findings revealed the capacity of vulnerable stakeholders to actively engage in public health initiatives and contribute to developing innovative solutions that are context-specific and conducive to the adoption of healthier dietary practices. These results confirm the potential of bottom-up, co-creation, real-world interventions within informal settings to contribute toward fostering inclusive transformation of food systems.

Aiming for transformations in power: lessons from intersectoral CBPR with public housing tenants (Québec, Canada)

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.

"There's a little bit of mistrust": Red River Métis experiences of the H1N1 and COVID-19 pandemics

We examined the perspectives of the Red River Métis citizens in Manitoba, Canada, during the H1N1 and COVID-19 pandemics and how they interpreted the communication of government/health authorities' risk management decisions. For Indigenous populations, pandemic response strategies play out within the context of ongoing colonial relationships with government institutions characterized by significant distrust. A crucial difference between the two pandemics was that the Métis in Manitoba were prioritized for early vaccine access during H1N1 but not for COVID-19. Data collection involved 17 focus groups with Métis citizens following the H1N1 outbreak and 17 focus groups during the COVID-19 pandemic. Métis prioritization during H1N1 was met with some apprehension and fear that Indigenous Peoples were vaccine-safety test subjects before population-wide distribution occurred. By contrast, as one of Canada's three recognized Indigenous nations, the non-prioritization of the Métis during COVID-19 was viewed as an egregious sign of disrespect and indifference. Our research demonstrates that both reactions were situated within claims that the government does not care about the Métis, referencing past and ongoing colonial motivations. Government and health institutions must anticipate this overarching colonial context when making and communicating risk management decisions with Indigenous Peoples. In this vein, government authorities must work toward a praxis of decolonization in these relationships, including, for example, working in partnership with Indigenous nations to engage in collaborative risk mitigation and communication that meets the unique needs of Indigenous populations and limits the potential for less benign-though understandable-interpretations.

Multidisciplinary Perspectives on the Implementation of a Comprehensive Sexual Assault Telehealth Program in Rural Communities: A Qualitative Study

Access to quality sexual assault (SA) care in rural communities is limited by challenges surrounding building and sustaining a skilled SA nurse examiner workforce. Telehealth can facilitate access to expert care while cultivating a local sexual assault response. The Sexual Assault Forensic Examination Telehealth (SAFE-T) Center aims to decrease disparities in SA care by providing expert, live, interactive mentoring, quality assurance, and evidence-based training via telehealth. This study examines multidisciplinary perceptions of pre-implementation barriers and SAFE-T program impact using qualitative methods. Implications for the implementation of telehealth programs to support access to quality SA care are considered.

A systematic review of recruitment and retention of ethnic minorities and migrants in obesity prevention randomised controlled trials

BACKGROUND

Participants' recruitment and retention into community-based interventions can be challenging, especially in research involving ethnic minorities and migrants. Despite known challenges, there are limited reviews that probe recruitment and retention strategies involving ethnic minorities and migrants in the Organisation for Economic Cooperation and Development (OECD) countries. This systematic review aimed to measure recruitment and retention rates and identify the barriers and facilitators to effective recruitment and retention of ethnic minorities and migrants in community-based obesity prevention Randomised Control Trials (RCTs) in OECD countries.

METHODS

This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five databases (CINAHL, Cochrane, Embase, Medline and PsychInfo) were searched from January 2000 to March 2022, in addition to Google and Google Scholar. Methodological quality and risk of bias were assessed, and pooled analysis and meta-ethnographic analysis were conducted on the included studies.

RESULTS

Twenty-five studies were included in the review. The pooled analysis found a 64% rate of recruitment of ethnic minorities in RCTs, with a retention rate of 71%. Key facilitators identified were-use of multiple communication channels, incentives, recruiting community champions, participant convenience and employing culturally sensitive strategies. Key barriers to participation were limited access to study sites, time constraints, limited trust, perceived fear, and anxiety.

CONCLUSION

Findings suggest the importance of undertaking culturally appropriate recruitment and retention strategies to minimise barriers and facilitate effective recruitment and retention of low-income ethnic minorities and migrants in community-based research.

Youth Perspectives on the Flint Water Crisis and Its Health Effects

Background

While the youth of Flint are at risk from the effects of the water crisis, little is known about their perspective of the impact of the water on their health.

Objective

To explore adolescents' perceptions of living in Flint during the water crisis, its impact on their health, and ways to address the crisis and rebuild trust.

Methods

In summer 2018, four focus groups were conducted with adolescents in Flint (ages 13 to 17 years). Group sessions were conducted by trained facilitators who were Flint residents along with members of the community-academic research team. Group sessions were audio-recorded and transcribed. Transcripts were reviewed and themes identified by the research team and youth from the focus groups.

Results

Of the 53 participants, most identified as Black (66%) and male (64%). Participants expressed concern about the impact of the water on their health. They knew people who developed rashes, experienced cognitive changes, and who died, they believed, owing to the water. The crisis also led to psychological consequences for youth. They expressed ongoing mistrust of the water and of institutions that should protect them, as well as concern that exposure may have long-term effects on their health and their children's health. Despite these concerns, participants expressed resilience and a desire to share that they had the potential to live successful lives.

Conclusion

Youth expressed concern about current and long-term health sequelae of the water crisis. Further work is needed to monitor the consequences of the crisis and to identify resident-informed approaches to mitigate its effects and rebuild trust.

Exploring power and power sharing in participatory health research partnerships: A scoping review protocol

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.

Promotion of environmental public health and environmental justice in communities affected by large and long lasting industrial contamination: methods applied and lessons learned from the case study of Porto Torres (Italy)

Introduction

Communities affected by large scale and long lasting industrial contamination are often keen to understand whether their health has been impaired by such contamination. This requires answers that integrate environmental public health and environmental justice perspectives. At these sites, exposure scenarios from environmental contamination over time by multiple chemicals, often involving different environmental matrices, are complex and challenging to reconstruct.

Methods

An approach for describing the health of such communities in association with environmental contamination is presented, with the methods applied across the three domains of environmental contamination, population exposure and toxicology, environmental and social epidemiology, and environmental public health communication. The approach is described with examples from its application to the case study of Porto Torres, a town with a substantial industrially conditioned evolution.

Results

Activities in the field of environmental contamination, population exposure and toxicology focus on the collection and systematization of available contamination data, the identification of priority pollutants based on their toxicological profiles, the qualitative assessment of the likelihood of exposure for the population to priority pollutants and their known health effects. Environmental and social epidemiology methods are applied to describe the health profiles and socioeconomic conditions of the local population, taking into account multiple health outcomes from local information systems and considering specific diseases based on exposure and toxicological assessments. The environmental public health communication methods are directed to produce a communication plan and for its implementation through interaction with local institutional and social actors. The interpretation of health profiles benefits from a transdisciplinary analysis of the results.

Discussion

The proposed approach combines the needs of environmental public health and environmental justice allowing the integration of multidisciplinary knowledge to define recommendations for reducing and/or preventing hazardous environmental exposures and adverse health effects, stimulating the interactions between stakeholders, and making the study results more accessible to citizens.

Implementing evidence-based practices in rural settings: a scoping review of theories, models, and frameworks

Background

Rural healthcare has unique characteristics that affect the dissemination and implementation of evidence-based interventions. Numerous theories, models, and frameworks have been developed to guide implementation of healthcare interventions, though not specific to rural healthcare. The present scoping review sought to identify the theories, models, and frameworks most frequently applied to rural health and propose an approach to rural health research that harnesses selected constructs from these theories, models, and frameworks. This resulting synthesis can serve as a guide to researchers, policy makers, and clinicians seeking to employ commonly used theories, models, and frameworks to rural health.

Methods

We used the Scopus abstract indexing service to identify peer-reviewed literature citing one or more of theories, models, or frameworks used in dissemination and implementation research and including the word "rural" in the Title, Abstract, or Keywords. We screened the remaining titles and abstracts to ensure articles met additional inclusion criteria. We conducted a full review of the resulting 172 articles to ensure they identified one or more discrete theory, model, or framework applied to research or quality improvement projects. We extracted the theories, models, and frameworks and categorized these as process models, determinant frameworks, classic theories, or evaluation frameworks.

Results

We retained 61 articles of which 28 used RE-AIM, 11 used Community-Based Participatory Research (CBPR) framework, eight used the Consolidated Framework for Implementation Research (CFIR), and six used the integrated-Promoting Action on Research Implementation in Health Services (iPARIHS). Additional theories, models, and frameworks were cited in three or fewer reports in the literature. The 14 theories, models, and frameworks cited in the literature were categorized as seven process models, four determinant frameworks, one evaluation framework, and one classic theory.

Conclusions

The RE-AIM framework was the most frequently cited framework in the rural health literature, followed by CBPR, CFIR, and iPARIHS. A notable advantage of RE-AIM in rural healthcare settings is the focus on reach as a specified outcome, given the challenges of engaging a geographically diffuse and often isolated population. We present a rationale for combining the strengths of these theories, models, and frameworks to guide a research agenda specific to rural healthcare research.

Systematic Review Registration

https://osf.io/fn2cd/.

"These are our children and we got to set them free": A public health approach to reading reproductive justice in black literature

This paper explores reproductive justice themes in different works of Black literature and juxtaposes that literature with modern scholarship to consider a reproductive justice agenda for public health researchers. Incorporating multiple disciplines including public health, critical geography, and anthropology, this paper goes on to suggest that public health researchers would benefit from engagement with works from beyond academia. Specifically looking into Black fiction, nonfiction, and autobiographical writing, this paper traces reproductive justice themes and suggests that attention to these themes will bolster academic public health scholarship aligned with the reproductive justice movement.

Mutual capacity building model for adaptation (MCB-MA): a seven-step procedure bidirectional learning and support during intervention adaptation

Global health reciprocal innovation emphasizes the movement of technologies or interventions between high- and low-income countries to address a shared public health problem, in contrast to unidirectional models of "development aid" or "reverse innovation". Evidence-based interventions are frequently adapted from the setting in which they were developed and applied in a new setting, presenting an opportunity for learning and partnership across high- and low-income contexts. However, few clear procedures exist to guide researchers and implementers on how to incorporate equitable and learning-oriented approaches into intervention adaptation across settings. We integrated theories from pedagogy, implementation science, and public health with examples from experience adapting behavioral health interventions across diverse settings to develop a procedure for a bidirectional, equitable process of intervention adaptation across high- and low-income contexts. The Mutual capacity building model for adaptation (MCB-MA) is made up of seven steps: 1) Exploring: A dialogue about the scope of the proposed adaptation and situational appraisal in the new setting; 2) Developing a shared vision: Agreeing on common goals for the adaptation; 3) Formalizing: Developing agreements around resource and data sharing; 4) Sharing complementary expertise: Group originating the intervention supporting the adapting group to learn about the intervention and develop adaptations, while gleaning new strategies for intervention implementation from the adapting group; 5) Reciprocal training: Originating and adapting groups collaborate to train the individuals who will be implementing the adapted intervention; 6) Mutual feedback: Originating and adapting groups share data and feedback on the outcomes of the adapted intervention and lessons learned; and 7) Consideration of next steps: Discuss future collaborations. This evidence-informed procedure may provide researchers with specific actions to approach the often ambiguous and challenging task of equitable partnership building. These steps can be used alongside existing intervention adaptation models, which guide the adaptation of the intervention itself.

Exploring participatory health research and its application to speech and language therapy research practices

BACKGROUND

The role of participatory health research (PHR) is increasingly acknowledged by funding bodies, researchers and civil society globally; however, it continues to be under-represented in the speech and language therapy (SLT) research literature. This collaborative research approach is associated with the increased application of research evidence, and the generation of positive impacts in practice, policy, health systems and society.

AIMS

To increase researchers' and other participatory partners' understanding of PHR, and to demonstrate its applicability to research in the SLT field.

METHODS & PROCEDURES

This aim is achieved through a discussion on PHR, its principles, benefits and challenges, and the evaluation of its impact. A recently developed evaluation framework to support the implementation of best engagement practices is examined, and recommendations for how this framework can be used to plan and evaluate engagement in participatory stuttering research is presented.

MAIN CONTRIBUTION

This paper serves as an important conversation on the value of PHR to SLT research, and presents guidance to support its increased implementation in this research field.

CONCLUSIONS & IMPLICATIONS

Conclusions & Implications: PHR remains an under-represented research approach in the SLT literature, despite increasing evidence demonstrating its effectiveness and value. It offers a potential solution to the research-practice gap, and challenges the ongoing research hierarchies by democrating the process of knowledge production.

WHAT THIS PAPER ADDS

What is already known on this subject PHR is increasingly attracting the attention of funders, researchers and decision-makers due to a growing body of evidence in support of this collaborative research approach. Despite its potential to bridge the research-practice gap, PHR remains significantly under-represented in the SLT research literature. What this paper adds to the existing knowledge This paper discusses the principles, benefits, challenges and impact evaluation of PHR. A recently developed evaluation framework for supporting the implementation of best engagement practices is examined. A demonstration of how this framework can be used to plan and evaluate engagement in participatory stuttering research is presented. What are the potential or actual clinical implications of this work? Speech and language therapists play a key role in PHR, as co-researchers contributing essential context-based knowledge. It is therefore imperative that they understand the principles and practices of this approach in order to maximize their input in future participatory partnerships.

Associations Between Sociodemographic Variables, Social Determinants of Health, and Diabetes: Findings From a Congregational Health Needs Assessment

PURPOSE

To examine associations between sociodemographic variables, social determinants of health (SDOHs) and diabetes using health needs assessment data.

DESIGN

Cross-sectional study.

SETTING

Faith-based communities in the Mid-South U.S.

SAMPLE

Of the 378 churches, 92 participated in the study (24% response rate); N = 828 church leaders and members completed the survey.

MEASURE

The Mid-South Congregational Health Survey assessed perceived health-related needs of congregations and the communities they serve.

ANALYSIS

Generalized linear mixed modeling examined the associations between sociodemographic variables (age, sex, race/ethnicity, educational level), SDOHs (affordable healthcare, healthy food, employment), and diabetes.

RESULTS

Individuals with less education had lower odds of reporting all SDOHs as health needs compared to individuals with more education (ORrange = .59-.63). Men had lower odds of reporting diabetes as a health need or concern compared to women (OR = .70; 95% CI = .50, .97). African Americans had greater odds of reporting diabetes as a health need compared to individuals in the 'Other' race/ethnicity category (OR = 3.91; 95% CI = 2.20, 6.94). Individuals who reported affordable healthcare (OR = 2.54; 95% CI = 1.73, 3.72), healthy food (OR = 2.24; 95% CI = 1.55, 3.24), and employment (OR = 3.33; 95% CI = 2.29, 4.84) as health needs had greater odds of reporting diabetes as a health need compared to those who did not report these SDOHs as needs.

CONCLUSIONS

Future studies should evaluate strategies to merge healthcare and faith-based organizations' efforts to address SDOHs impacting diabetes.

Creating Healthy Environments for Schools: A Comprehensive Approach to Improving Nutrition in Arkansas Public Schools

BACKGROUND

Nutrition plays a vital role in children's physical and emotional health. More than half of school age children's calories are provided in the school food environment, making school interventions an opportunity to address child nutrition.

METHODS

The Creating Health Environments for Schools (CHEFS) program is designed to leverage local resources to create customized solutions that improve the nutritional content of school food and encourage children to choose healthier food. There are 8 components: (1) customizing nutrition plans, (2) modifying/replacing menu items, (3) helping procure healthier food, (4) providing equipment grants, (5) training cafeteria staff, (6) implementing environmental changes and nudges, (7) engaging students and parents, and (8) supporting sustainability. Supporting child nutrition directors is key to facilitating cooperation with schools.

IMPLICATIONS FOR SCHOOL HEALTH POLICY, PRACTICE, AND EQUITY

Menu modifications and procurement are interrelated and depend on successfully collaborating with corporate, independent, and local food services organizations. Limited school budgets require low or no-cost solutions and staff training. Student and parent engagement are critical to facilitate culturally-appropriate solutions that increase awareness of healthy food.

CONCLUSIONS

Every school district has particular resources and constraints. CHEFs engaged stakeholders to design customized solutions and encourage healthier nutrition for school children.

SI-CBPAR: Towards structural indicators of community-based participatory action research

INTRODUCTION

Structural aspects of community-engaged research are not well measured yet have critical implications for community research empowerment. This is particularly so with people who use drugs. We introduce the Structural Indicators of Community-Based Participatory Action Research (SI-CBPAR) to measure structural indicators of community-research entity relationships.

METHODS

A three-phased process of iterative development, feasibility and applicability assessment was used to examine the instrument with community-engaged studies as a first stage of instrument development. The development team included people with university, non-government organisation and lived/ing drug use experience. Four studies on the health of people who use drugs were reviewed for indicator evidence followed by iterative discussion about construct and item discrepancies. Indicators were measured for the degree to which they were observed using a three-point scale.

RESULTS

All but two constructs were confirmed for meaning. Constructs of 'community' and 'coalition' required revision and explanation. The need for further exploration of power differentials between community and community-based organisations was identified. Indicator evidence was found for all six categories across studies. The instrument was deemed applicable and easy to use. It was observed that categories could apply to studies with various degrees of community engagement and to other research focal areas.

DISCUSSION AND CONCLUSIONS

SI-CBPAR applicability testing and initial category confirmation indicate its potential utility for community research collaboratives. The next phase of development involves cognitive interviewing with researchers from across community engaged research orientations, and with communities engaged in research beyond drug user health.

Ongoing Challenges Related to the COVID-19 Pandemic Among People With Brain Injury

The COVID-19 pandemic exacerbated social isolation among people with traumatic brain injury (TBI). Yet, little is known about how changes in personal factors, environmental factors, or the characteristics of activities affected social participation. We examined experiences with social isolation and barriers to social participation using the person-environment-occupation-performance model as a framework. Twelve adults with TBI participated in a series of three focus groups. Data were analyzed using thematic analysis. We identified two primary themes with sub-themes: (1) social isolation experiences: (1a) emotional impact and (1b) managing personal risk; and (2) greater barriers but a lack of strategies to address them: (2a) access and opportunities and (2b) social and societal factors. New environmental barriers and task demands affected occupational performance, and participants identified few successful strategies to overcome these barriers. Occupational therapy can develop new strategies to re-balance the person-environment fit and enhance social participation.