Community Engagement using World Café: The Well London Experience

A critical look to community wisdom: Applying the World Café method to health promotion and prevention

Patient experiences and ideas are key components for improving health promotion and prevention. Engaging patients and other stakeholders in sharing their practices and ideas is nowadays crucial to increase the legitimacy, credibility, and acceptability of the decisions in these fields, by fostering community wisdom. The World Café is a participatory method suitable to involve a large number of actors to propose creative solutions based on their different knowledge and experiences. However, the diffusion of this approach is not uniform in the various countries and health topics. This review summarises the specific topic, the study design, the number and the characteristics of participants, as well as the main findings and the purpose of the studies regarding the application of this method to health promotion and prevention. Among other results, it was found that the World Café is an appreciated, inspiring, and flexible participatory process often used in association with one or more other methods, to explore emergent themes or topics, to collect best practices or suggestions, to generate improvements or recommendations, and to define priorities for the implementation of projects or research agendas. The results highlight the potentiality of the World Café whenever an issue is not well defined and needs to be explored through deep and several insights. The method allows the exploitation of creativity and collective wisdom when qualitative and in-dept results-more than quantitative and statistically rigorous ones-are appropriate.

Tackling health inequalities in a public health organization: the case of the Barcelona Public Health Agency

Background

Municipalities are important actors in the implementation of policies to tackle health inequalities, which requires political will, the availability of financial support, and technical and human resources. With the aim of aligning with local government political priorities, in 2017 the Barcelona Public Health Agency (Agència de Salut Pública de Barcelona, henceforth ASPB), which is responsible for the public health functions of the city, launched a strategy to improve the approach to tackling health inequalities in all its services. The objectives of this study were to show how social health inequalities were addressed in the ASPB from 2017 to 19 and to describe which actions were proposed after a participatory process aiming to create a plan to systematically incorporate health inequalities in ASPB actions.

Methods

The ASPB has 304 workers, 8 directors and 20 services or departments. Participatory methodologies were carried out: 1) semi-structured interviews with department heads (N = 12, 60%); 2) world cafe workshops open to a group of workers (N = 63, 37%); 3) a Quick and Colorful voting session open to a group of workers (N = 108, 63%); and 4) Hanlon matrix with 19 actions to be prioritized (N = 12 services, 60%).

Results

Semi-structured interviews and world cafe workshops provided 40 potential actions. After a step by step process of participatory prioritization, seven lines of action emerged: 1) to make progress in collaborative networking; 2) to promote policy evaluation; 3) to increase the ability of the ASPB to evaluate policies to reduce health inequalities; 4) to incorporate the axes of inequalities in all ASPB products; 5) to improve information on vulnerable groups; 6) to incorporate the gender perspective; and 7) to participate in an internal training plan to address health inequalities.

Conclusions

The participation of ASPB public health professionals and staff allowed the organization to design a shared plan of actions to address health inequalities. This experience could be useful for other municipalities whose political agendas include tackling inequalities in health.

Serious Game for Change in Behavioral Intention Toward Lifestyle-Related Diseases: Experimental Study With Structural Equation Modeling Using the Theory of Planned Behavior

BACKGROUND

Health activities should be tailored to individual lifestyles and values. To raise awareness of health behaviors, various practices related to health education, such as interactive activities among individuals with different backgrounds, have been developed. Moreover, serious games have been used as a tool for facilitating communication. However, there have been few investigations that are based on the framework of the theory of planned behavior on the mechanisms of health-related behavioral intention change from playing serious games.

OBJECTIVE

We aimed to investigate the mechanisms of behavioral intention change among various age groups after an intervention using a serious game to increase awareness of lifestyle-related diseases.

METHODS

Adults, undergraduates, and high school students played a serious game, called Negotiation Battle, and answered a questionnaire-Gaming Event Assessment Form for Lifestyle-related Diseases-before, immediately after, and 2-4 weeks after the game. The questionnaire was composed of 16 items based on the theory of planned behavior. We used structural equation modeling to compare responses from the 3 groups.

RESULTS

For all 3 age groups (adults: mean 43.4 years, range 23-67 years; undergraduates: mean 20.9 years, range 19-34 years; high school students: mean 17.9 years, 17-18 years), perceived behavior control was the key factor of behavioral intention change. Immediately after the game, causal relationships between perceived behavioral control and behavioral intention were enhanced or maintained for all groups-adults (before: path coefficient 1.030, P<.001; after: path coefficient 2.045, P=.01), undergraduates (before: path coefficient 0.568, P=.004; after: path coefficient 0.737, P=.001), and high school students (before: path coefficient 14.543, P=.97; after: path coefficient 0.791, P<.001). Analysis of free descriptions after intervention suggested that experiencing dilemma is related to learning and behavioral intention.

CONCLUSIONS

The study revealed that the serious game changed the behavioral intention of adolescents and adults regarding lifestyle-related diseases, and changes in perceived behavioral control mediated the alteration mechanism.

A collaborative approach to adopting/adapting guidelines. The Australian 24-hour movement guidelines for children (5-12 years) and young people (13-17 years): An integration of physical activity, sedentary behaviour, and sleep

Abstract

Background

In 2018, the Australian Government updated the Australian Physical Activity and Sedentary Behaviour Guidelines for Children and Young People. A requirement of this update was the incorporation of a 24-hour approach to movement, recognising the importance of adequate sleep. The purpose of this paper was to describe how the updated Australian 24-Hour Movement Guidelines for Children and Young People (5 to 17 years): an integration of physical activity, sedentary behaviour and sleep were developed and the outcomes from this process.

Methods

The GRADE-ADOLOPMENT approach was used to develop the guidelines. A Leadership Group was formed, who identified existing credible guidelines. The Canadian 24-Hour Movement Guidelines for Children and Youth best met the criteria established by the Leadership Group. These guidelines were evaluated based on the evidence in the GRADE tables, summaries of findings tables and recommendations from the Canadian Guidelines. We conducted updates to each of the Canadian systematic reviews. A Guideline Development Group reviewed, separately and in combination, the evidence for each behaviour. A choice was then made to adopt or adapt the Canadian recommendations for each behaviour or create de novo recommendations. We then conducted an online survey (n=237) along with three focus groups (n=11 in total) and 13 key informant interviews. Stakeholders used these to provide feedback on the draft guidelines.

Results

Based on the evidence from the Canadian systematic reviews and the updated systematic reviews in Australia, the Guideline Development Group agreed to adopt the Canadian recommendations and, apart from some minor changes to the wording of good practice statements, maintain the wording of the guidelines, preamble, and title of the Canadian Guidelines. The Australian Guidelines provide evidence-informed recommendations for a healthy day (24-hours), integrating physical activity, sedentary behaviour (including limits to screen time), and sleep for children (5-12 years) and young people (13-17 years).

Conclusions

To our knowledge, this is only the second time the GRADE-ADOLOPMENT approach has been used to develop movement behaviour guidelines. The judgments of the Australian Guideline Development Group did not differ sufficiently to change the directions and strength of the recommendations and as such, the Canadian Guidelines were adopted with only very minor alterations. This allowed the Australian Guidelines to be developed in a shorter time frame and at a lower cost. We recommend the GRADE-ADOLOPMENT approach, especially if a credible set of guidelines that was developed using the GRADE approach is available with all supporting materials. Other countries may consider this approach when developing and/or revising national movement guidelines.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12966-021-01236-2.

Research Priorities in Family Caregiving: Process and Outcomes of a Conference on Family-Centered Care Across the Trajectory of Serious Illness

The number of older adults living with functional decline and serious illness is growing exponentially at a time when availability of both family and professional caregivers is strained. Achieving optimal outcomes for this vulnerable population involves advancing the knowledge needed to improve the quality of care delivered by families, health professionals, and community programs. Recent reports from National Institute of Health and the National Academy of Science, Engineering and Medicine have called for the identification of gaps in key areas of family caregiving intervention research. In March 2018, the Family Caregiving Institute at UC Davis convened an invitational meeting of over 50 thought leaders in family caregiving-representing service agencies, funding organizations, and academia-to participate in the Research Priorities in Caregiving Summit: Advancing Family-Centered Care across the Trajectory of Serious Illness. Using an iterative process, attendees identified the top 10 research priorities and created research priority statements that incorporated a definition of the priority topic, rationale for the priority; problem(s) to address; priority population(s); and example research topics. The research priority statements serve as a roadmap for research development that will address the most significant gaps in the caregiving field.

Research Priorities for Optimizing Long-term Community Integration after Brain Injury

OBJECTIVE

This paper reports on a funded summit, which convened a multidisciplinary group of experts to provide consensus on the research priorities necessary for improving long-term community integration of individuals with traumatic brain injury (TBI) and their caregivers.

METHODS

The 2-day summit was directed using the World Café Methodology, to engage stakeholders and collaboratively arrive at a consensus on the problems to be targeted in research. Participants (n=54), drawn from two Canadian provinces, included an interdisciplinary group of researchers, clinicians, representatives from brain injury associations, individuals with TBI, and caregivers. In small groups, participants discussed challenges to long-term community integration and potential initiatives that would address these barriers. Field notes from the discussions were analyzed using qualitative content analysis.

RESULTS

The consensus on prioritized research directions included developing interventions to optimize the functioning and participation of individuals with TBI, reducing caregiver burden, and evaluating how emerging technology can facilitate delivery of care.

CONCLUSIONS

The World Café Methodology was an effective method for developing research priorities. The breadth of expertise of participants and the collegial environment allowed for the identification of a broad perspective on important future research directions with potential to enhance the long-term community integration of individuals with brain injury.

Engaging the Transgender Community to Improve Medical Education and Prioritize Healthcare Initiatives

Phenomenon: Transgender patients experience discrimination, limited access to care, and inadequate provider knowledge in healthcare settings. Medical education to address transgender-specific disparities is lacking. Research that engages transgender community members may help address health disparities by empowering patients, increasing trust, and informing medical curricula to increase competence.

APPROACH

A 2015 Community Forum on Transgender Health Care was hosted at the University of Louisville School of Medicine, which included healthcare professionals and transgender community members to facilitate dialogue among mixed-participant groups using a World Café model. Fifty-nine participants discussed the status of transgender healthcare and made recommendations for local improvements. A follow-up survey was administered to 100 individuals, including forum participants and their referrals. The forum discussion and survey responses were analyzed to determine common perceptions of transgender healthcare, priorities for improvement interventions, and themes to inform curriculum.

FINDINGS

The community forum discussion showed that local transgender care is overwhelmingly underdeveloped and unresponsive to the needs of the transgender community. The follow-up survey revealed that priorities to improve transgender care included a multidisciplinary clinic for lesbian, gay, bisexual, and transgender (LGBT) patients, an LGBT-friendly network of physicians, and more training for providers and support staff. This mutually constructive engagement experience influenced reform in undergraduate curricula and continuing education opportunities. Insights: Community engagement in healthcare disparities research can cultivate improbable discussions, yield innovative insight from marginalized populations, and build relationships with community members for future collaborations and interventions. Societal acceptance of transgender identities, which could be promoted through healthcare providers, could stimulate significant progress in transgender healthcare. Supplemental educational interventions for practicing physicians will improve the current conditions of transgender healthcare, but a comprehensive medical school curriculum specifically for transgender health that includes interactions between the transgender community and medical students could be particularly impactful.

Crime, fear of crime and mental health: synthesis of theory and systematic reviews of interventions and qualitative evidence

Background

Crime and fear of crime may impact negatively on health and well-being. Interventions to reduce crime and fear of crime, particularly interventions in the physical environment, may be a promising way to improve population-level well-being.

Project components

(1) Mapping review of theories and pathways; (2) systematic review of effectiveness; (3) systematic review of UK qualitative data; and (4) focus groups and interviews with stakeholders.

Methods

(1) The mapping review was a pragmatic non-systematic review focusing on theoretical literature and observational quantitative studies and development of a theoretical model of pathways. (2 and 3) The systematic reviews followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidance. In total, 18 databases including EMBASE, MEDLINE, PsycINFO and Science Citation Index were searched from inception to 2010. Studies presenting data on the built environment and the fear of crime were included. Quality assessment was conducted. Data synthesis was conducted narratively for the intervention review, with harvest plots to synthesise data on inequalities, and by thematic analysis for the review of qualitative evidence. (4) Semistructured interviews with nine stakeholders working in community safety and two focus groups with members of the public were conducted to inform the methods of the project and the dissemination of findings. Data were analysed thematically.

Results

(1) There are complex and often indirect links between crime, fear of crime, environment, and health and well-being at both individual and population levels. Fear of crime is associated with poorer health outcomes. There is considerable debate about the measurement of fear of crime. Both fear of crime and crime are associated with a range of environmental factors. (2) A total of 12,093 references were screened on abstract for the two systematic reviews. Of these, 47 effectiveness studies (22 controlled and 25 uncontrolled) were included in the systematic review of effectiveness, with 36 conducted in the UK, 10 in the USA and one in the Netherlands. There is some evidence that home security improvements and non-crime-related environmental improvements may improve some fear of crime outcomes. There is little evidence that the following reduce fear of crime: street lighting improvements, closed-circuit television, multicomponent environmental crime prevention programmes or regeneration programmes. The evidence on housing improvement is mixed. Very few data on the health and well-being outcomes of crime reduction interventions were located and the study quality overall is poor. (3) A total of 39 studies were included in the systematic review of qualitative data. Several factors in the physical environment are perceived to impact on fear of crime. However, factors in the local social environment appear to be more important as drivers of fear of crime. There is considerable evidence for limitations on physical activity as a result of fear of crime, but less for mental health impacts. (4) Stakeholders see fear of crime as harder to address than crime and as linked to health and well-being. Environmental interventions, such as Secured by Design, are widely used and positively regarded.

Limitations

The review is relatively restricted in its scope and a number of relevant interventions and themes are excluded. The underlying evidence base is of limited quality, particularly for the effectiveness review, and is heterogeneous.

Conclusions

Broader social interventions appear more promising than crime-focused environmental interventions as a means of improving fear of crime, health and well-being. The qualitative evidence suggests that fear of crime may impact on physical activity. More broadly, crime and fear of crime appear to be linked to health and well-being mainly as aspects of socioeconomic disadvantage. This review indicates the following gaps in the literature: evaluation research on the health impacts of crime reduction interventions; more robust research on interventions to reduce fear of crime; systematic reviews of non-environmental interventions to reduce fear of crime and systematic reviews of qualitative evidence on other crime-related topics.

Funding

The National Institute for Health Research Public Health Research programme.