Disseminating Online Tools for Building Capacity Among Community Practitioners

Behavioral Interventions Contributing to Reducing Poverty and Inequities

Behavioral science has a long history of engaging in efforts to understand and address socially important issues. Poverty and inequities in health and development are among the most important and complex social issues facing the world today. With its Sustainable Development Goals (SDGs), the United Nations (2015) has focused attention and guidance on addressing key global challenges, including to "end poverty" (SDG 1), "ensure good health and well-being for all" (SDG3), and "reduce inequality within and among countries" (SDG 10). In this paper, we provide a framework and illustrative examples of contributions of behavioral science to these issues. We feature illustrative behavioral interventions at the individual, relationship, community, and societal levels. We highlight the diversity of issues, intervention methods, and settings reflected in applications of behavioral science. By joining methods from behavioral science, public health, and other disciplines-and the experiential knowledge of those most affected by inequities-behavioral methods can make significant contributions to collaborative efforts to assure health and well-being for all.

Understanding Sociocultural Influences on Physical Activity in Relation to Overweight and Obesity in a Rural Indigenous Community of Fiji Islands

INTRODUCTION

Given health disparities and increased rates of obesity and non-communicable diseases seen in Indigenous populations worldwide and the evidence connecting sociocultural knowledge with physical activity, health, and wellbeing, this research was undertaken to understand the social and cultural components contributing to obesity in the Indigenous Fijian rural areas.

METHODS

This research is a community-based participatory research (CBPR) project, which engaged community members from a rural iTaukei village in the Fiji Islands. Data collection was carried out through community consultation and semi-structured interviews. The data was analysed using descriptive thematic analysis.

RESULTS

Four major themes emerged associated with sociocultural, economic, political, and physical environmental factors. Males emphasised sports and working on farmlands as preferred types of physical activity, while females focused on family activities and daily activities and support for females' separate playgrounds. There was a focus on previous health promotion programs that did not incorporate the cultural values, cultural competence beliefs, and traditional ways of the rural Indigenous Fijian community.

CONCLUSION

The healthcare providers and policymakers need to recognise the iTaukei community culture and appreciate traditional methods to promote equitable community participation in decision-making for health promotion. These findings should inform future research and community-based health programs to address the physical activity levels of the rural Indigenous community and may be relevant to other Indigenous peoples.

Factors influencing sustainability of online platforms for professionals: a mixed-method study in OECD countries

Online platforms can support health and educational professionals in their daily work; however, it is challenging to keep online platforms sustainable. This paper aims to indicate the most important factors of platform sustainability from the perspective of professionals involved in online platforms. Further, it aims to understand how these factors operate. A mixed methods study was carried out among professionals from Europe, Australia, the USA and Canada. In the first phase, the importance of 54 factors from the literature was assessed with a questionnaire among 17 professionals. The relative importance of the factors and the consensus regarding this importance were calculated using median scores and interquartile deviations. In total, 19 factors were selected representing general characteristics, characteristics related to the platform, communication, visitor and context. In the second phase, insight was gained regarding the experiences with those factors through 12 individual Skype interviews. The most frequently mentioned important factors of platform sustainability were (i) having sufficient time, resources and expertise, (ii) user friendliness and (iii) creating a sense of belonging. Platforms should use a planned approach to address a combination of factors directly from platform development. Gaining long-term resources is challenging and should be considered from the start of a project by building partnerships. To promote user friendliness, platforms should be simple, have a clear set-up and provide high-quality tools. Finally, establishing a sense of belonging could be supported by branding and face-to-face networking activities. For all aspects, involving visitors and stakeholders is essential.

Understanding socio-cultural influences on food intake in relation to overweight and obesity in a rural indigenous community of Fiji Islands

ISSUE ADDRESSED

Obesity and non-communicable diseases (NCDs) are largely preventable by understanding the connection between socio-cultural knowledge, yet intervention effectiveness may hinder changes in lifestyles and behaviours in Indigenous health. This study performed to understand the social and cultural components, which contribute to obesity in rural areas of the Indigenous Fijian.

METHODS

This study is a Community-Based Participatory Research (CBPR) project, which engaged community members from a rural iTaukei village in the Fiji Islands. Data collection was carried out through community consultation and semi-structured interviews. The data were analysed using descriptive thematic analysis.

RESULTS

Food intake was associated with socio-cultural, economic, political and physical environmental factors. Participants reveal previous health promotion programs did not incorporate the cultural values, cultural competence beliefs and traditional ways of rural Indigenous Fijian community.

CONCLUSION

The health care providers and policymakers need to be involved in recognising iTaukei community culture and appreciate traditional methods to promote equitable community participation in decision-making for health promotion. SO WHAT?: Community-wide lifestyle interventions, conceptual approaches based on communal perceptions of the problem at hand can also be the basis for future research on identifying socio-cultural factors, for example, the community and family support that can help shape behaviours.

A minimum evaluation protocol and stepped-wedge cluster randomized trial of ACCESS Open Minds, a large Canadian youth mental health services transformation project

BACKGROUND

Many Canadian adolescents and young adults with mental health problems face delayed detection, long waiting lists, poorly accessible services, care of inconsistent quality and abrupt or absent inter-service transitions. To address these issues, ACCESS Open Minds, a multi-stakeholder network, is implementing and systematically evaluating a transformation of mental health services for youth aged 11 to 25 at 14 sites across Canada. The transformation plan has five key foci: early identification, rapid access, appropriate care, the elimination of age-based transitions between services, and the engagement of youth and families.

METHODS

The ACCESS Open Minds Research Protocol has multiple components including a minimum evaluation protocol and a stepped-wedge cluster randomized trial, that are detailed in this paper. Additional components include qualitative methods and cost-effectiveness analyses. The services transformation is being evaluated at all sites via a minimum evaluation protocol. Six sites are participating in the stepped-wedge trial whereby the intervention (a service transformation along the key foci) was rolled out in three waves, each commencing six months apart. Two sites, one high-population and one low-population, were randomly assigned to each of the three waves, i.e., randomization was stratified by population size. Our primary hypotheses pertain to increased referral numbers, and reduced wait times to initial assessment and to the commencement of appropriate care. Secondary hypotheses pertain to simplified pathways to care; improved clinical, functional and subjective outcomes; and increased satisfaction among youth and families. Quantitative measures addressing these hypotheses are being used to determine the effectiveness of the intervention.

DISCUSSION

Data from our overall research strategy will help test the effectiveness of the ACCESS Open Minds transformation, refine it further, and inform its scale-up. The process by which our research strategy was developed has implications for the practice of research itself in that it highlights the need to actively engage all stakeholder groups and address unique considerations in designing evaluations of complex healthcare interventions in multiple, diverse contexts. Our approach will generate both concrete evidence and nuanced insights, including about the challenges of conducting research in real-world settings. More such innovative approaches are needed to advance youth mental health services research.

TRIAL REGISTRATION NUMBER

Clinicaltrials.gov, ISRCTN23349893 (Retrospectively registered: 16/02/2017).

Leveraging youths' digital literacies: The E-Responder social media violence interruption model and pilot evaluation

Increasingly, altercations and arrests have been traced to youths' actions on social media. The present paper describes E-Responder, an intervention developed through a university-community partnership to address three key goals for youth at risk of legal system involvement and firearms-related violence: (1) preventing the escalation of online provocation to in-person violence; (2) supporting youth in enhancing social media self-efficacy; and (3) supporting Violence Prevention Professionals (VPPs), already working with youth, in using social media as a tool to interrupt potential violence and leverage youth's digital citizenship. This paper describes the E-Responder mixed-methods pilot; findings suggest that E-Responder sites identified over 100 instances of risky online behavior (22% high risk) and effectively addressed 97% of these instances. Youth participants reported significantly greater social media self-efficacy over time and compared to matched-comparison youth. Focus group (n = 12) results corroborate these patterns. Implications for future intervention, research, and policy are discussed.

Promoting state health department evidence-based cancer and chronic disease prevention: a multi-phase dissemination study with a cluster randomized trial component

Background

Cancer and other chronic diseases reduce quality and length of life and productivity, and represent a significant financial burden to society. Evidence-based public health approaches to prevent cancer and other chronic diseases have been identified in recent decades and have the potential for high impact. Yet, barriers to implement prevention approaches persist as a result of multiple factors including lack of organizational support, limited resources, competing emerging priorities and crises, and limited skill among the public health workforce. The purpose of this study is to learn how best to promote the adoption of evidence based public health practice related to chronic disease prevention.

Methods/design

This paper describes the methods for a multi-phase dissemination study with a cluster randomized trial component that will evaluate the dissemination of public health knowledge about evidence-based prevention of cancer and other chronic diseases. Phase one involves development of measures of practitioner views on and organizational supports for evidence-based public health and data collection using a national online survey involving state health department chronic disease practitioners. In phase two, a cluster randomized trial design will be conducted to test receptivity and usefulness of dissemination strategies directed toward state health department chronic disease practitioners to enhance capacity and organizational support for evidence-based chronic disease prevention. Twelve state health department chronic disease units will be randomly selected and assigned to intervention or control. State health department staff and the university-based study team will jointly identify, refine, and select dissemination strategies within intervention units. Intervention (dissemination) strategies may include multi-day in-person training workshops, electronic information exchange modalities, and remote technical assistance. Evaluation methods include pre-post surveys, structured qualitative phone interviews, and abstraction of state-level chronic disease prevention program plans and progress reports.

Trial registration

clinicaltrials.gov: NCT01978054.