A tailored approach to horizon scanning for cancer medicines

BACKGROUND

Horizon scanning (HS) is the systematic identification of emerging therapies to inform policy and decision-makers. We developed an agile and tailored HS methodology that combined multi-criteria decision analysis weighting and Delphi rounds. As secondary objectives, we aimed to identify new medicines in melanoma, non-small cell lung cancer and colorectal cancer most likely to impact the Australian government's pharmaceutical budget by 2025 and to compare clinician and consumer priorities in cancer medicine reimbursement.

METHOD

Three cancer-specific clinician panels (total n = 27) and a consumer panel (n = 7) were formed. Six prioritisation criteria were developed with consumer input. Criteria weightings were elicited using the Analytic Hierarchy Process (AHP). Candidate medicines were identified and filtered from a primary database and validated against secondary and tertiary sources. Clinician panels participated in a three-round Delphi survey to identify and score the top five medicines in each cancer type.

RESULTS

The AHP and Delphi process was completed in eight weeks. Prioritisation criteria focused on toxicity, quality of life (QoL), cost savings, strength of evidence, survival, and unmet need. In both curative and non-curative settings, consumers prioritised toxicity and QoL over survival gains, whereas clinicians prioritised survival. HS results project the ongoing prevalence of high-cost medicines. Since completion in October 2021, the HS has identified 70 % of relevant medicines submitted for Pharmaceutical Benefit Advisory Committee assessment and 60% of the medicines that received a positive recommendation.

CONCLUSION

Tested in the Australian context, our method appears to be an efficient and flexible approach to HS that can be tailored to address specific disease types by using elicited weights to prioritise according to incremental value from both a consumer and clinical perspective.

POLICY SUMMARY

Since HS is of global interest, our example provides a reproducible blueprint for adaptation to other healthcare settings that integrates consumer input and priorities.

Legal effectiveness in promoting development policies: A case study of North Aceh Indonesia

This research evaluated the effectiveness of the Law on the Governing of Aceh (LoGA) as the legal basis for regional development policies in the North Aceh District, Indonesia. Despite its enactment in 2006, the district has faced persistent challenges, including high poverty rates and poor economic growth. The LoGA was intended to accelerate development in Aceh after the conflict and tsunami, reflecting the legal aspirations of the region (reconsidered). Therefore, using a qualitative approach, including interviews, observations, and analysis of secondary data, this research evaluated the effectiveness of the LoGA based on its provisions, enforcement, infrastructure and facilities, political landscape, cultural factors, and societal impacts. The result showed significant substantive, institutional, and societal challenges, which led to legal uncertainty, ineffective policy implementation, and the necessity for policy revision and community involvement.

Risk communication and community engagement with vulnerable groups: Perceptions of social-services CSOs during Covid-19

Risk communication enables people to be prepared, respond and recover from public health risks which can only be realized with a considerable amount of community engagement. Enabling community involvement is necessary in order to reach and protect vulnerable people during epidemics. In situations of acute emergency, it is difficult to reach everyone, which makes it necessary to work with intermediaries such as social and care facilities and civil society organizations (CSOs) who work to support the most vulnerable in our societies. This paper analyses the perceptions of experts working in social facilities or CSOs of Covid-19 RCCE efforts in Austria. It starts from a broad understanding of vulnerability which combines medical, social and economic determinants. We conducted 21 semi-structured interviews with CSO and social facility managers. The UNICEF core community engagement standards (2020) were used as a framework for qualitative content analysis. The results show that CSO's and social facilities were essential for allowing community involvement of vulnerable people in Austria during the pandemic. For the CSO's and social facilities participation of their vulnerable clients was a real challenge especially because direct contact was difficult and public services were switched to digital only. Nonetheless, they all put a lot of effort into adapting and discussing Covid-19 regulations and measures with their clients and employees which in many cases led to acceptance of public health measures. The study gives recommendations on how community engagement could be enhanced especially from government actors and how CSO's could be addressed more as essential partners.

"It's research, our input can grow": identifying health research priorities with Aboriginal and Torres Strait Islander communities-study protocol

BACKGROUND

In Australia, Aboriginal and Torres Strait Islander (Indigenous) families have strong, cohesive, and nurturing cultural practices that contribute to effective family functioning and child rearing. These practices can lead to positive effects on children and communities, and include kinship relations, traditional knowledge systems, collective community focus, respect for Elders contributions, and spirituality. However, poor health and wellbeing outcomes exist across the lifespan for Indigenous Australians. Health programs, services and research that support Indigenous women, babies and their families are a critical investment to improve birthing and health outcomes and impact the life trajectories of Indigenous Australians.

AIM

The Indigenous Health Research Priorities study aims to identify the research priorities for families during the perinatal and early childhood period through a co-designed and collaborative process. This has been led by communities to determine the priorities identified with and for local Indigenous families in Queensland. This paper aims to report on engagement and involvement with Indigenous communities to identity health research priorities for families and presents preliminary findings of the research process including participants' demographic information and feedback on the yarning sessions, as part of the study protocol.

METHODS

The study protocol showcases the Participatory Action Research approach, yarning sessions with clients and staff of three community-controlled health services to date, and Delphi workshop methods to prioritise the health issues identified during the yarns with corresponding communities. The study will undertake qualitative data collection and analysis to identify and report on community and health service research priorities for Indigenous families in Queensland. A short survey was conducted to collect participants' demographic information. A feedback form with five open-ended questions was also administered to collect data on participants' views and satisfaction with the research process.

PRELIMINARY RESULTS

This protocol paper reports on the participant demographic information and feedback on the research process and reactions to participating in the yarning sessions. There have been 12 yarning sessions in Far North Queensland to date. The qualitative analysis of these will be reported on in future, with South East Queensland and further sites to follow. Feedback from 61 community members and health professionals has highlighted they valued sharing stories, being heard, and feeling hopeful. Preliminary findings will be reported.

DISCUSSION

Identification of health research priorities will allow each organisation and region of Queensland to develop research initiatives and the translational outcomes that are a focus for their community members.

The written history of plant phenology: shaping primary sources for secondary publications

Phenological research establishes the science of nature's natural calendar. This research, the monitoring and analysis of seasonal rhythms of plants and animals, is commonly based on citizen science data. Such data may be digitized from primary sources provided by the citizen scientist's original phenological diaries. Secondary data sources are formed by historical publications (for example, yearbooks and climate bulletins). While primary data has the advantage of first-hand notetaking, its digitization may, in practice, be time-consuming. Contrastingly, secondary data can contain well-organized typesetting, making digitization less labour-intensive. However, secondary data can be reshaped by the motivations of the historical actors who were collating the data. This study compared data from 1876-1894 gathered originally by citizen scientists (primary data) and the secondary data founded upon the previous primary data, later published by the Finnish Society of Sciences and Letters as a series of phenological yearbooks. In the secondary data, the recorded numbers of taxa and their phenological stages appeared to be fewer and phenological events standardized, with an increased prevalence of agricultural phenology (at the cost of autumn phenology). Moreover, it seems the secondary data had been screened for potential outliers. While secondary sources may provide current phenologists with coherent sets of relevant data, future users must be aware of potential data reshaping resulting from the preferences of historical actors. These actors may weigh and limit the original observations according to their own criteria and preferences.

What values drive communities' nutrition priorities in a resource constrained urban area in South Africa?

BACKGROUND

Voices of under-resourced communities are recognised as important yet are often unheard in decisions about healthcare resource allocation. Deliberative public engagement can serve as an effective mechanism for involving communities in establishing nutrition priorities. This study sought to identify the priorities of community members of a South African township, Soweto, and describe the underlying values driving their prioritisation process, to improve nutrition in the first 1000 days of life.

METHODS

We engaged 54 community members (28 men and 26 women aged > 18 years) from Soweto. We conducted seven group discussions to determine how to allocate limited resources for prioritising nutrition interventions. We used a modified public engagement tool: CHAT (Choosing All Together) which presented 14 nutrition intervention options and their respective costs. Participants deliberated and collectively determined their nutritional priorities. Choices were captured quantitatively, while group discussions were audio-recorded. A thematic analysis was undertaken to identify the reasons and values associated with the selected priorities.

RESULTS

All groups demonstrated a preference to allocate scarce resources towards three priority interventions-school breakfast provisioning, six-months paid maternity leave, and improved food safety. All but one group selected community gardens and clubs, and five groups prioritised decreasing the price of healthy food and receiving job search assistance. Participants' allocative decisions were guided by several values implicit in their choices, such as fairness and equity, efficiency, social justice, financial resilience, relational solidarity, and human development, with a strong focus on children. Priority interventions were deemed critical to supporting children's optimal development and well-being, interrupting the intergenerational cycle of poverty and poor human development in the community.

CONCLUSION

Our study demonstrates how public engagement can facilitate the incorporation of community values and programmatic preferences into nutrition priority setting, enabling a responsive approach to local community needs, especially in resource constrained contexts. Findings could guide policy makers to facilitate more appropriate decisions and to improve nutrition in the first 1000 days of life.

Uncharted risk measures for the management of sustainable mining

Governments commit to ensuring the welfare of their citizens by drafting and enforcing regulations that ultimately ensure the sustainability of mining. This study contributes to improving the sustainability of mining throughout the mine's lifecycle until the final destination of the mining products. We propose recommendations that address the sustainability of mining from a global perspective, framed around the United Nations Sustainable Development Goals (SDGs), following waste hierarchy with Common Agricultural Policies, and policies from the Green Deal on climate, energy, transport, and taxation. Tailings are the most significant source of environmental impact in mining operations and, therefore, must comply with controlling regulations through Tailings Management Facilities (TMFs). However, there have been several mining accidents involving TMFs worldwide. The recommendations begin during planning, preconstruction, and construction with practices such as fair consultations, tax revenue fairness, and mandatory insurance. The operation and management support parallel industries to mining and supporting health and education. Emergency planning involves the surrounding communities in mock drills and environmental monitoring. In the closure and rehabilitation, remediation technologies such as phytoremediation, carbon sequestration incentives, and biomass valorization are recommended. Finally, supporting a circular economy by prioritizing ethical consumption, resource reduction, material recovery, and replacing toxic minerals and materials from the start with "benign by design" is recommended. The strategies involve stakeholders directly or indirectly related to the mining companies' contamination and demonstrate a commitment to the SDGs, offering a holistic perspective on scientific, social, and regulatory issues. Integr Environ Assess Manag 2023;00:1-12. © 2023 The Authors. Integrated Environmental Assessment and Management published by Wiley Periodicals LLC on behalf of Society of Environmental Toxicology & Chemistry (SETAC).

Status, sexual capital, and intraminority body stigma in a size-diverse sample of gay men

Gay men are more likely than heterosexual men to experience social pressure based on body weight, shape, and muscularity, which may drive disparities in body image concerns and eating disorders. Utilizing a sample of 1723 gay men living in the United States, the present study examined whether sociodemographic factors (used as proxies for status and sexual capital) and frequency of attending gay-specific establishments or gatherings (community involvement) were associated with gay men's experiences of negative or discriminatory pressures based on body size and shape specifically from other gay men (intraminority body stigma). Experiences of intraminority body stigma were significantly more common among gay men who identified as higher-weight (r = 0.28), less masculine (r = -0.21), less wealthy (r = -0.21), younger (r = -0.21), or people of color (ds = 0.25-0.28). Furthermore, indicators of low status and sexual capital were indirectly associated with less frequent community involvement via more frequent experiences of intraminority body stigma. In addition to frequency, the valence of interactions between gay men should be considered when assessing body image and eating disorder risk in this population. Future research is encouraged to examine intraminority body stigma as an intersectional source of intraminority stress to inform prevention and treatment efforts for gay men.

The Role of School and Community Involvement in the Psychosocial Health Outcomes of Black and Latinx LGBTQ Youth

PURPOSE

Lesbian, gay, bisexual, transgender, and queer-identified (LGBTQ) youth of color face poorer psychosocial health outcomes than their non-LGBTQ peers. Research suggests school-based and community activities promote psychosocial health for LGBTQ youth, but study samples are predominantly White. This study tested whether school enrollment and seven community activities were associated with LGBTQ community connectedness, happiness, and health among Black and Latinx LGBTQ youth.

METHODS

This study used a subsample of Black and Latinx LGBTQ adolescents and young adults (N = 472) from the Social Justice Sexuality project. Mean differences in study variables were examined across intersectional racial/gender identity categories. Multiple regression analyses assessed the association of school enrollment and community activities with psychosocial health outcomes, accounting for covariates.

RESULTS

Social activities for LGBTQ people (ß = 0.19) and LGBTQ people of color (POC; ß = 0.15) were associated with greater LGBTQ connectedness. While moderate religious services attendance (ß = -0.13) was associated with lower LGBTQ connectedness, high attendance was associated with greater happiness (ß = 0.13) and health (ß = 0.12). Social activities for LGBTQ-POC (ß = 0.13) were also associated with better health. School enrollment was not significantly associated with any outcomes and Latinx transgender and diverse youth had the lowest happiness and health.

DISCUSSION

Social activities for LGBTQ people and LGBTQ-POC may play a role in the social connectedness and health of Black and Latinx LGBTQ youth, while frequent religious service attendance may support health and happiness. Schools and faith institutions should ensure their institutions are welcoming to LGBTQ youth. Public health workers might facilitate the involvement and inclusion of LGBTQ youth, while policy should support funding for community activities.

Revitalization of tourism and hospitality sector: preempting pandemics through lessons learned

The devastating effects of the COVID-19 pandemic have left many repercussions for the tourism industry to preempt any future catastrophe of this nature. The research aims to propose recommendations for the post-COVID-19 business world to revitalize and reclaim their market space and win back their volumes without any fear of indefinite closures and continued lockdowns in the industry. Drawing from the literature, the study assumed revitalization through responsiveness, use of advanced technology, customers' and employees' willingness, enhanced skills, adherence to standard operating procedures and protective measures, and restructuring via a public-private partnership. For the purpose, survey method was employed to collect data from the industry. After confirmation of the reliability and validity, the regression analyses supported effective revitalization through government responsiveness, use of digital technology, psychological recouping of customers' willingness, enhancing technical skills through training, strict adherence to protective measures, and destination restructuring and reorganization through a public-private partnership. The study proclaimed that Pakistan's tourism and hospitality sector development has evolved through the COVID-19 situation, and is likely to revamp and revitalize into a sustainable business. Once achieving sustainability, the revamped industry will likely to increase revenue, generate employment, and alleviate poverty through thriving public-private partnerships, community involvement, and community well-being without compromising people's health.

The urgency of strengthening health information to support public perception and involvement in the COVID-19 vaccine

OBJECTIVE

To identify the driving and inhibiting factors and to find a prototype of community involvement in the COVID-19 vaccine.

METHOD

Data sources from PubMed database, Google Scholar, Web of Science, and ProQuest. The data were obtained based on searches using the keyword COVID-19 (n=11,.599), focusing on community acceptance (n=813), community involvement (n=86), and types of articles (n=46). Articles that meet the inclusion criteria are seven, and the data were analyzed with ATLAS Ti.9 software.

RESULTS

Engagement and driving factors have the highest correlation (0.38). The drivers, perceptions of vulnerability, and inhibiting factors determine community involvement. The perception of exposure can be a supporting or inhibiting factor influenced by information reinforcement.

CONCLUSIONS

Strengthening positive information can alter the sense of community vulnerability, making it a driving force for participation in the COVID-19 vaccine campaign. This finding is an appropriate strategy to expand the reach and resolve public doubts about accepting the vaccine.

Breaking the Cycle of Marginalization: How to Involve Local Communities in Multi-stakeholder Initiatives?

While the benefits of including local communities in multi-stakeholder initiatives have been acknowledged, their successful involvement remains a challenging process. Research has shown that large business interests are regularly over-represented and that local communities remain marginalized in the process. Additionally, little is known about how procedural fairness and inclusion can be managed and maintained during multi-stakeholder initiatives. The aim of this study was therefore to investigate how marginalized stakeholders, and local communities in particular, can be successfully involved during the course of a multi-stakeholder initiative. An action research approach was adopted where the first author collaborated with a social housing association on an initiative to involve the local community in the design and implementation of circular economy approaches in a low-income neighbourhood. This study contributes to the multi-stakeholder initiative literature by showing that the successful involvement of marginalized stakeholders requires the initiators to continuously manage a balance between uncertainty-certainty, disagreement-agreement and consensus- and domination-based management strategies. Furthermore, our study highlights that factors which are regularly treated as challenges, including uncertainty and disagreement, can actually play a beneficial role in multi-stakeholder initiatives, emphasizing the need to take a temporally sensitive approach. This study also contributes to the circular economy literature by showing how communities can play a bigger role than merely being consumers, leading to the inclusion of a socially oriented perspective which has not been recognized in the previous literature.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10551-022-05252-5.

Addressing COVID-19 vaccine hesitancy: Lessons from the role of community participation in previous vaccination programs

The acceptance of the coronavirus disease 2019 (COVID-19) vaccine has been described as a gateway to attaining herd immunity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The critical role of community participation (CP) has been successfully demonstrated in previous vaccination programs globally. This perspective therefore aimed to describe how CP could be used to promote COVID-19 vaccination acceptance. To promote COVID-19 vaccine acceptance, it is required that a mapping of community assets, resources, civil-based organizations, and stakeholders is done to gain insight into the community culture and value in relation to COVID-19 vaccine. This will help to address the misconceptions while prompting COVID-19 vaccination sensitization activities that are relevant to each community. It is required that policy makers understand that the adoption of a comprehensive grassroots approach lends a voice to the community and helps to utilize community-initiated and community-driven ideas on promoting COVID-19 vaccine acceptance.

Making community voices heard in a research-health service alliance, the evolving role of the Community Advisory Group: a case study from the members' perspective

BACKGROUND

The Melbourne Genomics Health Alliance (the Alliance) is a collaboration of leading hospitals, research and academic organisations, supported by its member organisations and the Victorian Government. The Alliance was set up by its members in 2013 to steer the translation of genomics, making it an integral part of health care in Victoria, Australia. The Community Advisory Group (CAG) was formed soon after, to give input and advice across the program. This was to ensure consideration of community values, perspectives and priorities, and knowledge translation for patient care. The CAG was charged with providing a strong community voice for the duration of the program. Appointed members were experienced consumer advocates with developed connections to the community.

MAIN BODY

The Alliance progressed from an initial Demonstration Project (2013-2015) to a multifaceted program (2016-2020). The CAG worked strategically to help address complex issues, for example, communication, privacy, informed consent, ethics, patient experience, measurement and evaluation standards and policies, data storage and re-use of genomic data. Many aspects of translating genomics into routine care have been tackled, such as communicating with patients invited to have genomic testing, or their caregivers, and obtaining informed consent, clinical questions across 16 areas of health care, training and education of health and laboratory professionals, genomic data management and data-sharing. Evidence generated around clinical utility and cost-effectiveness led to government funding of testing for complex genetic conditions in children.

CONCLUSION

The CAG activities, recorded in a CAG-inspired Activity register, span the full spectrum of information sharing and consultation to co-design and partnership. The CAG were involved at multiple levels of participation and in all tiers of activity including governance, development of policies and procedures, program planning and evaluation. Working relationships were built up and a level of trust instilled to advance the Alliance work program in ensuring an effective patient-care model of delivery of genomics. CAG input into project deliverables has been tangible. Less tangible contributions included presentations at external meetings and conferences, direct interactions at meetings with Alliance members, interactions with visitors and external experts, taking part in consultations with experts, state and federal government.

Sitting on the Sidelines: Disparities in Social, Recreational, and Community Participation Among Adolescents with Autism Spectrum Disorder

Participation in extracurricular activities and community involvement during secondary school is important for the healthy social, emotional, mental, and physical development of adolescents, especially those with autism spectrum disorder (ASD). The current study utilized three waves of data (2016, 2017, and 2018) from the National Survey of Children's Health (NSCH) to examine disparities in extracurricular participation among 12- to 17-year old adolescents with ASD. Across the three waves, data demonstrate clear sociodemographic disparities among adolescents with ASD. These disparities were more evident in adolescents with caregivers that had less education and lower household income, as well as males. These disparities suggest a continued need for targeted interventions to promote engagement among adolescents with ASD to narrow this social disparity gap.

Integrating minority stress theory and the tripartite influence model: A model of eating disordered behavior in sexual minority young adults

Eating disorders are serious mental illnesses associated with high mortality rates and health complications. Prior research has found increased rates of eating pathology in sexual minority (SM; e.g., lesbian, gay, bisexual) individuals compared to sexual majority (i.e., heterosexual) individuals. Two prominent models have potential to explain these differences: the tripartite influence model and minority stress theory. While both models separately have promise for explaining the pathway of eating disordered behavior in SM individuals, research has indicated that both models have unexplained variance. Therefore, a comprehensive, integrative model could further explain unique variance. 479 men and 483 women between 18 and 30 years old were recruited through Qualtrics; all participants endorsed attraction to same-gender partners. Two models were estimated by gender using structural equation modeling. For men and women, community involvement accelerated the positive association of heterosexist discrimination with internalized homophobia. Minority stressors were associated with dissatisfaction and muscularity behavior, indicating the importance of incorporating minority stress. For women, community involvement accelerated both the association of pressures with muscularity internalization and the association of muscularity-based dissatisfaction with muscle building behaviors. If confirmed by prospective studies, this model could help refine prevention and intervention efforts with this vulnerable population.

The role of sexual minority stress and community involvement on disordered eating, dysmorphic concerns and appearance- and performance-enhancing drug misuse

Prior research has established that sexual minority (SM) individuals are more likely to experience disordered body image behaviors and concerns than heterosexual individuals. This increased risk may be explained by minority stress theory - that SM individuals are subject to SM-specific stressors, leading to health disparities - but this has not yet been fully examined. Furthermore, this theory states that SM community involvement may mitigate negative outcomes. The current study examines whether minority stress is associated with screening positive for an eating disorder, screening positive for body dysmorphic disorder, and appearance- and performance-enhancing drug misuse in a sample of SM individuals (483 women and 479 men) in the US. This study also examines whether the effect of minority stress is moderated by SM community involvement. Logistic regressions were conducted for each type of minority stress (internalized homophobia, sexual orientation concealment, and heterosexist discrimination) interacting with community involvement. After correction for multiple comparisons, all minority stressors and community involvement were positively associated with increased odds of disordered body image behaviors and concerns, with no evidence of a buffering effect for community involvement. The lack of a buffering effect is contrary to minority stress theory and may inform future prevention efforts.

Peer driven or driven peers? A rapid review of peer involvement of people who use drugs in HIV and harm reduction services in low- and middle-income countries

Introduction

Peer involvement of people who use drugs within HIV and harm reduction services is widely promoted yet under-utilised. Alongside political and financial barriers is a limited understanding of the roles, impacts, contexts and mechanisms for peer involvement, particularly in low- and middle-income settings. We conducted a rapid review of available literature on this topic.

Methods

Within a community-academic partnership, we used a rapid review approach, framed by realist theory. We used a network search strategy, focused on core journals and reference lists of related reviews. Twenty-nine studies were included. We developed thematic summaries framed by a realist approach of exploring interventions, their mechanisms, outcomes and how they are shaped by contexts.

Results

Reported outcomes of peer involvement included reduced HIV incidence and prevalence; increased service access, acceptability and quality; changed risk behaviours; and reduced stigma and discrimination. Mechanisms via which these roles work were trust, personal commitment and empathy, using community knowledge and experience, as well as ‘bridge’ and ‘role model’ processes. Contexts of criminalisation, under-resourced health systems, and stigma and discrimination were found to shape these roles, their mechanisms and outcomes. Though contexts and mechanisms are little explored within the literature, we identified a common theme across contexts, mechanisms and outcomes. Peer outreach interventions work through trust, community knowledge and expertise, and ‘bridge’ mechanisms (M) to counter criminalisation and constraining clinic and service delivery environments (C), contributing towards changed drug-using behaviours, increased access, acceptability and quality of harm reduction services and decreased stigma and discrimination (O).

Conclusion

Peer involvement in HIV and harm reduction services in low- and middle-income settings is linked to positive health outcomes, shaped by contexts of criminalisation, stigma, and resource scarcity. However, peer involvement is under-theorised, particularly on how contexts shape mechanisms and ultimately outcomes. Efforts to study peer involvement need to develop theory and methods to evaluate the complex mechanisms and contexts that have influence. Finally, there is a need to expand the range of peer roles, to embrace the capacities and expertise of people who use drugs.

Addressing inequities in maternal health among women living in communities of social disadvantage and ethnic diversity

The response to the coronavirus outbreak and how the disease and its societal consequences pose risks to already vulnerable groups such those who are socioeconomically disadvantaged and ethnic minority groups. Researchers and community groups analysed how the COVID-19 crisis has exacerbated persisting vulnerabilities, socio-economic and structural disadvantage and discrimination faced by many communities of social disadvantage and ethnic diversity, and discussed future strategies on how best to engage and involve local groups in research to improve outcomes for childbearing women experiencing mental illness and those living in areas of social disadvantage and ethnic diversity. Discussions centred around: access, engagement and quality of care; racism, discrimination and trust; the need for engagement with community stakeholders; and the impact of wider social and economic inequalities. Addressing biomedical factors alone is not sufficient, and integrative and holistic long-term public health strategies that address societal and structural racism and overall disadvantage in society are urgently needed to improve health disparities and can only be implemented in partnership with local communities.

Scope of Practice of the Rural Surgeon

The scope of practice of a rural surgeon depends not only the individual skillset of the surgeon, but also local resources.

How to Host A Domestic Hand Surgery Outreach Day

Domestic outreach is an integral yet often overlooked aspect of medical volunteerism. Since 2016, the American Society for Surgery of the Hand's Touching Hands initiative has supported domestic outreach Hand Days in the United States. The purpose of this article is to provide information and guidance to hand surgeons interested in hosting their own domestic hand surgery outreach. Thorough planning is essential to a successful outreach, particularly because each outreach site will have unique considerations. Surgeon team leaders must navigate the infrastructure and legal factors specific to their practice site. Outreach patients should be screened for both financial and surgical eligibility, although there are multiple pathways for the referral and screening process. Patient evaluation also requires coordination of imaging and diagnostic testing for a low-resource population. Multidisciplinary volunteer teams are necessary to provide all perioperative services and are typically recruited from the host practice site. Some potential challenges of domestic outreach include institutional charity care policies, legal concerns, and operative space availability. Because of complex socioeconomic situations, it may be difficult to contact and coordinate care for outreach patients. Despite these potential barriers, domestic outreach offers tremendous benefit for patients who otherwise lack access to surgical care. Even one yearly outreach day can avert years of disability and can have an incredible impact on patients' functional ability and quality of life. Volunteer teams also reap the benefits of outreach by promoting intraorganizational volunteerism, renewing commitment to medical professionalism, and decreasing symptoms of burnout. Hand surgeons have a unique opportunity to provide subspecialized surgical care to underserved patients as the Touching Hands initiative continues to grow and develop. We hope that hand surgeons will consider participating in advancing the Touching Hands mission to provide life-changing surgical care in the world's poorest communities, including our own.

An annotated and critical glossary of the terminology of inclusion in healthcare and health research

The importance of including members of the public has been accorded a significant position in health planning, service delivery and research. But this position masks a lack of clarity about terms that are used. This paper identifies terms that are in common use in the lexicon of community based involvement and engagement in health with the intention of clarifying meaning and thus reducing ambiguity. We define and distinguish between key terms related to inclusion, we consider the terminology attached to community processes and to the challenges of inclusion and we engage with the strengths and weaknesses of the commonly used metaphor of "a ladder of participation". We wish to contribute to the clear communication of intentions, challenges and achievements in pursuing varied forms of inclusion in health.

An annotated and critical glossary of the terminology of inclusion in healthcare and health research

The importance of including members of the public has been accorded a significant position in health planning, service delivery and research. But this position masks a lack of clarity about terms that are used. This paper identifies terms that are in common use in the lexicon of community based involvement and engagement in health with the intention of clarifying meaning and thus reducing ambiguity. We define and distinguish between key terms related to inclusion, we consider the terminology attached to community processes and to the challenges of inclusion and we engage with the strengths and weaknesses of the commonly used metaphor of "a ladder of participation". We wish to contribute to the clear communication of intentions, challenges and achievements in pursuing varied forms of inclusion in health.

Community involvement in the development and implementation of chronic condition programmes across the continuum of care in high- and upper-middle income countries: A systematic review

BACKGROUND

Community involvement is an important component of health programme development and implementation, including those focused on chronic condition treatment and management. Yet, few studies explore the manifestations of community involvement in chronic care programmes. Our review aims to examine the evidence on how communities are involved in planning and implementing chronic condition programmes in high and upper-middle income countries.

METHODS

Eligible studies included those that involved the community in the planning, implementation, monitoring and evaluation of health services, policy or health interventions. We searched Medline, Embase, Global Health, Scopus, and LILACs from 2000 to 2016, independently screened articles for inclusion, conducted data extraction, and assessed studies for risk of bias.

RESULTS

27,232 records were identified and after screening, 32 met inclusion criteria. We conducted a narrative synthesis to report on the forms and processes of community involvement used across mental health programmes and contrast this with the paucity of evidence on comparable programmes addressing other chronic conditions. Challenges reported included user factors, organisational factors, and social challenges such as stigma.

CONCLUSION

Our review adds to the evidence supporting community involvement in chronic condition management and the processes that contribute to successful and sustainable involvement. We report on a model, derived from inductive analysis, that considers social and cultural components, organisational factors and stakeholder relationships as underpinning the development of community interventions across the care continuum.

Not being heard: barriers to high quality unplanned hospital care during young people's transition to adult services - evidence from 'this sickle cell life' research

Background

Young people’s experiences of healthcare as they move into adult services can have a major impact on their health, and the transition period for young people with sickle cell disease (SCD) needs improvement. In this study, we explore how young people with SCD experience healthcare during this period of transition.

Methods

We conducted a co-produced longitudinal qualitative study, including 80 interviews in 2016–2017 with young people with SCD aged 13–21 (mean age 16.6) across two cities in England. We recruited 48 participants (30 female, 18 male): 27 interviews were one-off, and 53 were repeated 2–3 times over approximately 18 months. We used an inductive analytical approach, combining elements of Grounded Theory and thematic analysis.

Results

Participants reported significant problems with the care they received in A&E during painful episodes, and in hospital wards as inpatients during unplanned healthcare. They experienced delays in being given pain relief and their basic care needs were not always met. Participants said that non-specialist healthcare staff did not seem to know enough about SCD and when they tried to work with staff to improve care, staff often seemed not prepared to listen to them or act on what they said. Participants said they felt out of place in adult wards and uncomfortable with the differences in adult compared with paediatric wards. Because of their experiences, they tried to avoid being admitted to hospital, attempting to manage their painful episodes at home and accessing unplanned hospital care only as a last resort. By contrast, they did not report having problems within SCD specialist services during planned, routine care.

Conclusions

Our study underscores the need for improvements to make services youth-friendly and youth-responsive, including training staff in SCD-specific care, compassionate care and communication skills that will help them elicit and act on young people’s voices to ensure they are involved in shaping their own healthcare. If young people are prevented from using transition skills (self-management, self-advocacy), or treated by staff who they worry do not have enough medical competency in their condition, they may well lose their trust in services, potentially compromising their own health.

A framework for increasing sustainability and reducing risk to ecological resources through integration of remediation planning and implementation

Remediation of lands contaminated with radionuclides and hazardous chemicals provides an ongoing challenge for many countries. It is particularly problematic for remediation of old industrial sites remaining from World War II and the Cold War. Remediating and restoring large sites is often costly, time-consuming, and involves complex planning and sequencing, as well as consideration of future land use policies. The goal of remediation is to reduce contamination, reduce risk to humans and the environment, and restore land to productive land uses, and ultimately, to sustainability. Often reducing risk to people takes precedence over protecting ecological resources in overall planning, characterization, and execution of remediation strategies. This paper examines when and how stakeholders, including anyone interested and affected by remediation on ecological resources, can become involved in the planning, decision-making, and implementation of remediation. There is a formal process under federal law (e.g. CERCLA) in the US for examining risk to resources, including indicator species. However, there are other informal points during the cleanup process when managers should consider the value of ecological resources, the public may express their concerns for particular ecological resources, and ecologists may provide data and expert advice early in the process as critical decisions are being made about remediation that impact ecological resources. The framework presented in this paper for increasing sustainability of ecological resources has three periods of intervention 1) major decision points, 2) process interdiction points, and 3) remediation action points. Major decision points include site and problem identification, regional ecological resource and local land use practice determination, remediation goals and options determination, and other local issues. Interdiction points include examining remediation options, and in-depth assessments of ecological resources on-site. Remediation action points are aimed at reducing risk to ecological resources during remediation, and include defining the remediation site and buffer, understanding the effects of timing and sequencing of remediation, education of all remediation personnel, and specific suggestions for reducing risk during active remediation. While this framework was developed for Department of Energy remediation sites, it is applicable to brownfields and other contaminated lands world-wide. The overall goal is to provide interested and affected parties with a framework for protecting and enhancing ecological resources during the planning and execution of remediation on contaminated lands.

Characterization of indigenous community engagement in arthritis studies conducted in Canada, United States of America, Australia and New Zealand

BACKGROUND

Research adhering to community engagement processes leads to improved outcomes. The level of Indigenous communities' engagement in rheumatology research is unknown.

OBJECTIVE

To characterize the frequency and level of community engagement reporting in arthritis studies conducted in Australia (AUS), Canada (CAN), New Zealand (NZ) and the United States of America (USA).

METHODS

Studies identified through systematic reviews on topics of arthritis epidemiology, disease phenotypes and outcomes, health service utilization and mortality in Indigenous populations of AUS, CAN, NZ and USA, were evaluated for their descriptions of community engagement. The level of community engagement during inception, data collection and results interpretation/dissemination stages of research was evaluated using a custom-made instrument, which ranked studies along the community engagement spectrum (i.e. inform-consult-involve-collaborate-empower). Meaningful community engagement was defined as involving, collaborating or empowering communities. Descriptive analyses for community engagement were performed and secondary non-parametric inferential analyses were conducted to evaluate the possible associations between year of publication, origin of the research idea, publication type and region of study; and meaningful community engagement.

RESULTS

Only 34% (n = 69) of the 205 studies identified reported community engagement at ≥ 1 stage of research. Nearly all studies that engaged communities (99% (n = 68)) did so during data collection, while only 10% (n = 7) did so at the inception of research and 16% (n = 11) described community engagement at the results' interpretation/dissemination stage. Most studies provided community engagement descriptions that were assessed to be at the lower end of the spectrum. At the inception of research stage, 3 studies reported consulting communities, while 42 studies reported community consultation at data collection stage and 4 studies reported informing or consulting communities at the interpretation/dissemination of results stage. Only 4 studies described meaningful community engagement through all stages of the research. Inferential statistics identified that studies with research ideas that originated from the Indigenous communities involved were significantly more associated with achieving meaningful community engagement.

CONCLUSIONS

The reporting of Indigenous community engagement in published arthritis studies is limited in frequency and is most frequently described at the lower end of the community engagement spectrum. Processes that support meaningful community engagement are to be promoted.

Assessment of students' attitude and level of community involvement in community-based education at training sites in Gedeo zone, South Ethiopia

OBJECTIVE

This study was aimed to assess the students' attitude towards community based education and the level of community involvement in community-based education.

RESULT

Among the 634 community members participated in this study, 64.4% were aware of the community-based education program and 86.5% of these participants have favorable attitude towards the program. The level of community involvement in the activities of students in this study is 40.9%. About 72% of the students have favorable attitude towards community based education. Female students were more likely to have favorable attitude toward the program [AOR: 7.64 (CI 1.80, 32.50)]. On the other hand, students who have low participation during group assignment [AOR: 0.07 (CI 0.01, 0.95)] and those with lower socially conscious attitude [AOR: 0.02 (0.01, 0.08)] were less likely to have favorable attitude.

Community involvement in biomedical research conducted in the global health context; what can be done to make it really matter?

BACKGROUND

Community involvement in research has been advocated by researchers, communities, regulatory agencies, and funders with the aim of reinforcing subjects' protection and improving research efficiency. Community involvement also has the potential to improve dissemination, uptake, and implementation of research findings. The fields of community based participatory research conducted with indigenous populations and of participatory action research offer a large base of experience in community involvement in research. Rules on involving the population affected when conducting research have been established in these fields. But what is the role of community engagement in clinical research and observational studies conducted in biomedical research outside of these specific areas? More than 20 years ago, in the field of HIV medicine, regulatory bodies and funding agencies (such as the US National Institutes of Health) recommended the constitution of a formal organism, the Community Advisory Board (CAB), as part of the study requirements for HIV trials. More recently, CABs have been adopted and used in other fields of medical research, such as malaria. CABs are not without limitations, however, and there is little research on the effectiveness of their use in achieving community protection and participation. Nevertheless, CABs could be a model to import into clinical trials and observational research where no alternative model of community representation is currently being used.

CONCLUSIONS

Allocating more resources to training and shifting more power to community representatives could be part of the solution to current CAB limitations. However, for researchers to be able to apply these recommendations on community involvement, certain conditions need to be met. In particular, funding agencies need to recognize the human and financial resources required for serious community involvement, and the academic environment needs to take community involvement into account when appraising, mentoring, and training researchers.

Experiences of community members and researchers on community engagement in an Ecohealth project in South Africa and Zimbabwe

Background

Community engagement (CE) models have provided much needed guidance for researchers to conceptualise and design engagement strategies for research projects. Most of the published strategies, however, still show very limited contribution of the community to the engagement process. One way of achieving this is to document experiences of community members in the CE processes during project implementation. The aim of our study was to explore the experiences of two research naïve communities, regarding a CE strategy collaboratively developed by researchers and study communities in a multicountry study.

Methods

The study was carried out in two research naïve communities; Gwanda, Zimbabwe and uMkhanyakude, South Africa. The multicentre study was a community based participatory ecohealth multicentre study. A qualitative case study approach was used to explore the CE strategy. Data was collected through Focus Group Discussions, Key Informant Interviews and Direct Observations. Data presented in this paper was collected at three stages of the community engagement process; soon after community entry, soon after sensitisation and during study implementation. Data was analysed through thematic analysis.

Results

The communities generally had positive experiences of the CE process. They felt that the continuous solicitation of their advice and preferences enabled them to significantly contribute to shaping the engagement process. Communities also perceived the CE process as having been flexible, and that the researchers had presented an open forum for sharing responsibilities in all decision making processes of the engagement process.

Conclusions

This study has demonstrated that research naïve communities can significantly contribute to research processes if they are adequately engaged. The study also showed that if researchers put in maximum effort to demystify the research process, communities become empowered and participate as partners in research.

Community engagement practices in Southern Africa: Review and thematic synthesis of studies done in Botswana, Zimbabwe and South Africa

Community Engagement (CE) is intended to enhance the participation of community stakeholders in research. CE is usually mentioned in publications as researchers discuss how they carried out community entry, consent and retained study participants but the actual CE activities are not always well documented. This paper reviews CE strategies employed in health research in Botswana, South Africa and Zimbabwe with reference to the development of a CE strategy for a multi-centre study to be conducted in these countries. The search was conducted using JANE (Journal/Author Name Estimator), Google Scholar and PubMed with known institutions and researchers providing context-specific material. The final synthesis includes 35 publications, 2 reports and 2 abstracts. There is evidence of CE being practiced in health research and eight closely related CE strategies were revealed. We conclude that since communities are heterogeneous and unique, CE activities will not have similar results in different settings. Even though there was insufficient evidence to determine which CE strategy is most effective, the review provides sufficient information to develop a CE strategy for a multi-centre study using the various strategies and activities described.

Predictors of Early Community Involvement: Advancing the Self and Caring for Others

Recent research on community involvement points to the importance of both agentic (advancing the self) and communal motives (serving others) as key predictors, though few studies have examined both simultaneously. At the same time, research has identified generativity, defined as concern for future generations as a legacy of the self, as particularly relevant for community involvement. Moreover, generativity involves both agentic and communal motives, meaning that advancing personal goals and caring for others are integrated in this construct. Therefore, the purpose of this study was to examine how individual differences in attributes pertaining to self and to others-specifically, self-esteem, initiative, and empathy-related to both generativity and community involvement. A sample of adolescents (N = 160; 64% female, M_age  = 17) and a sample of young adults (N = 237; 84% female, M_age  = 20) completed a survey including measures of community involvement and generativity. Generative concern fully mediated the associations between individual differences (self-esteem, initiative, and empathy) and community involvement, suggesting that the early generativity has a role in fostering capacities and contribution in youth. These developmental indicators pertaining to self and others link to actions that benefit the community through a desire to benefit future generations.

Integrating consumer engagement in health and medical research - an Australian framework

Background

Quality practice of consumer engagement is still in its infancy in many sectors of medical research. The South Australian Health and Medical Research Institute (SAHMRI) identified, early in its development, the opportunity to integrate evidence-driven consumer and community engagement into its operations.

Process

SAHMRI partnered with Health Consumers Alliance and consumers in evidence generation. A Partnership Steering Committee of researchers and consumers was formed for the project. An iterative mixed-method qualitative process was used to generate a framework for consumer engagement. This process included a literature review followed by semi-structured interviews with experts in consumer engagement and lead medical researchers, group discussions and a consensus workshop with the Partnership Steering Committee, facilitated by Health Consumer Alliance.

Outcomes

The literature revealed a dearth of evidence about effective consumer engagement methodologies. Four organisational dimensions are reported to contribute to success, namely governance, infrastructure, capacity and advocacy. Key themes identified through the stakeholder interviews included sustained leadership, tangible benefits, engagement strategies should be varied, resourcing, a moral dimension, and challenges. The consensus workshop produced a framework and tangible strategies.

Conclusion

Comprehensive examples of consumer participation in health and medical research are limited. There are few documented studies of what techniques are effective. This evidence-driven framework, developed in collaboration with consumers, is being integrated in a health and medical research institute with diverse programs of research. This framework is offered as a contribution to the evidence base around meaningful consumer engagement and as a template for other research institutions to utilise.

Understanding and encouraging volunteerism and community involvement

Volunteerism and community involvement have been demonstrated to offer benefits both to communities and to volunteers themselves. However, not every method to encourage these behaviors is equally effective in producing committed volunteers. Drawing on relevant theoretical and empirical literatures, we identify features of efforts that are likely to produce intrinsically motivated other-oriented volunteers and those that may produce extrinsically motivated self-oriented volunteers. In particular, we explore ways to socialize young people to help and ways to build a sense of community focused on particular issues. We also examine requirements for community service and other approaches that highlight self-oriented benefits that volunteers may obtain. Finally, we return to a focus on the importance of intrinsic motivation for promoting sustained involvement in volunteers, even as we acknowledge that volunteers who come with extrinsic or self-oriented reasons can still offer much to communities and can be satisfied when their activities match their motivations.

Social Integration and Maternal Smoking: A Longitudinal Analysis of a National Birth Cohort

Objectives Social support and engagement are related to smoking behavior in general populations, but it is unknown whether these measures of social integration as experienced by recent mothers are related to longitudinal maternal smoking patterns. The purpose of this study is, first, to describe longitudinal patterns of maternal smoking before, during, and after pregnancy through the early childhood parenting years, as well as variation in these patterns; and second, to examine these patterns in relation to social integration, emotional, behavioral, and sociodemographic factors. Methods Among 9050 mothers of the Early Childhood Longitudinal Study-Birth Cohort (a nationally representative probability sample of children born in 2001), we estimated trajectories of maternal smoking with a general growth mixture model and examined how baseline predictors are associated with these patterns over a 5-6 year period beginning 3 months prior to pregnancy. Results A 5-class solution identified trajectories of nonsmokers (70.5 %), temporary quitters (9.4 %), pregnancy-inspired quitters (3.3 %), delayed initiators (5.1 %), and persistent smokers (11.7 %). Modifiable risk factors included postpartum alcohol consumption and behavioral cues from co-resident smokers, while breastfeeding beyond 6 months and social engagement through religious service attendance were protective characteristics. Conclusions for Practice Prevention of and treatment for maternal perinatal and postpartum smoking is best informed by mothers' emotional, behavioral and sociodemographic characteristics. Religious service attendance, but not measures of social support or social engagement, was a protective factor for maternal smoking trajectories.

"You didn't just consult community, you involved us": transformation of a 'top-down' Aboriginal mental health project into a 'bottom-up' community-driven process

OBJECTIVE

Recently, there has been a consistent call for Indigenous health research to be community-driven. However, for a variety of reasons, many projects, such as the one featured here, start as 'top-down'. Using ten accepted principles for Aboriginal health research, the present article illustrates how a top-down project can be transformed into a 'bottom-up' community-driven project.

METHOD

A table of examples is provided to show how the ten principles were translated into practice to create a bottom-up process.

RESULTS

We suggest that key elements for creating a bottom-up process are iterative conversations and community involvement that goes beyond notional engagement. A feature of community involvement is generating and sustaining ongoing conversations with multiple levels of community (organisations, health professionals, Elders, community members, project-specific groups) in a variety of different forums across the entire duration of a project. Local research teams, a commitment to building capacity in the local Indigenous workforce, and adequate timelines and funding are other factors that we hypothesise may contribute to successful outcomes.

CONCLUSION

The article contributes to a much-needed evidence base demonstrating how appropriate structures and strategies may create bottom-up processes leading to successful outcomes.

Guidelines and training initiatives that support communication in cross-cultural primary-care settings: appraising their implementability using Normalization Process Theory

BACKGROUND

Guidelines and training initiatives (G/TIs) available to support communication in cross-cultural primary health care consultations are not routinely used. We need to understand more about levers and barriers to their implementation and identify G/TIs likely to be successfully implemented in practice.

OBJECTIVE

To report a mapping process used to identify G/TIs and to prospectively appraise their implementability, using Normalization Process Theory (NPT).

METHODS

RESTORE is a 4-year EU FP-7 project. We used purposeful and network sampling to identify experts in statutory and non-statutory agencies across Austria, England, Greece, Ireland, Scotland and the Netherlands who recommended G/TI data from the grey literature. In addition, a peer review of literature was conducted in each country. Resulting data were collated using a standardized Protocol Mapping Document. G/TIs were identified for inclusion by (i) initial elimination of incomplete G/TI material; (ii) application of filtering criteria; and (iii) application of NPT.

RESULTS

20 G/TIs met selection criteria: 8 guidelines and 12 training initiatives. Most G/TIs were identified in the Netherlands (n = 7), followed by Ireland (n = 6) and England (n = 5). Fewer were identified in Scotland (n = 2), and none in Greece or Austria. The majority (n = 13) were generated without the inclusion of migrant service users. All 20 were prospectively appraised for potential implementability by applying NPT.

CONCLUSIONS

NPT is useful as a means of prospectively testing G/TIs for implementability. Results indicate a need to initiate meaningful engagement of migrants in the development of G/TIs. A European-based professional standard for development and assessment of cross-cultural communication resources is advised.

Factors associated with Spanish older people's membership in political organizations: the role of active aging activities

This study explores older people's membership in political organizations by using data from the Survey on older people 2010, carried out by Spain's National Institute for older people and social services. The objectives were to describe the extent of this kind of participation among Spaniards aged 65 and over, and to analyze the factors that are associated with it. Results show that only slightly less than 7 % of the sample belonged to a political organization. To analyze the factors related to this membership, a set of models of multivariate analyses were run, including socioeconomic resources and participation in other types of active aging activity (participation in leisure, learning, and productive activities). Educational level, leisure activities, learning activities, and only volunteering in the case of productive activities were found to be associated with membership in political organizations. Results provide partial support for the socioeconomic resources model and suggest that engagement in leisure activities, learning activities, and volunteering might have an enhancing effect on membership in political organizations.

Community interaction and child maltreatment

The way in which parents interact with their environment may have implications for their likelihood of abuse and neglect. This study examines the parent-environment relationship through community involvement and perception, using social disorganization theory. We hypothesize mothers who participate in their communities and have positive perceptions of them may be less likely to maltreat their children because of the potential protective capacity of neighborhood supports. Using information from the 5 year Fragile Families and Child Wellbeing Study (n=2991), the mother's self-reported acts of psychological and physical maltreatment and neglect are measured. A mother's community involvement index is the number of community activities a mother was involved in, and community perception is measured by two five-item Likert scales assessing perception of community collective efficacy. We analyze the relationship between community variables and each of mother's maltreatment behaviors as well as the interaction between community factors using a series of nested logistic regressions. Higher levels of community involvement are associated with lower levels of psychological aggression. More positive perception of community social control is associated with lower levels of physical assault. A moderation effect of community perception suggests that a mother's perception of her community changes the relationship between community involvement and psychological child abuse. The results provide important policy and empirical implications to build positive and supportive communities as a protective factor in child maltreatment. Getting parents involved in their communities can improve the environment in which children and families develop, and decrease the likelihood that maltreatment will occur.

New models for elevating the practice and status of community-based nursing across the spectrum of cancer care in Central and Eastern Europe

PURPOSE

This supplement comprises an evaluation of Bridging Cancer Care, an initiative of the Bristol-Myers Squibb Foundation first conceived in 2007, addressing disparities in cancer care between Central and Eastern Europe and Western Europe. The strategic focus was refined in 2010 to put particular emphasis on capacity building of nurses in terms of education, training and empowerment.

METHODS

The evaluation was based on review of data and information from the program's monitoring and evaluation framework and from biannual reports submitted by grantees to the Bristol-Myers Squibb Foundation. Eleven of the grantees were selected to develop case studies, which illustrate a) the role of nurses in tobacco cessation, b) expansion of the scope of practice for general practice nurses in health promotion, prevention and early detection of cancer, c) capacity building for nurses in contemporary models of cancer care, care navigation and psychosocial support and d) establishment of nurse training programs in palliative care in Central and Eastern Europe.

RESULTS

Between 2010 and 2013, 22 grants were awarded in Russia, Poland, Czech Republic, Hungary and Romania. The evaluation characterized the program's impact in terms of improved health equity, health outcomes, capacity building of nurses and public awareness about cancer. With regard to health equity, all projects targeted disproportionately affected populations (children, poor, rural, ethnic) among whom 35,493 individuals were reached either through cancer screening or community and clinical care. In relation to capacity building, overall 5724 healthcare workers, primarily nurses, received training in various aspects of cancer care, while more than 50,000 patients and more than 470,000 members of the general public were reached through educational initiatives. Most of the programs have been sustained beyond Bristol-Myers Squibb Foundation funding.

CONCLUSION

The positive results were achieved predominantly through greater nurse empowerment, supported by the development of 17 different, customized and nurse-focused curricula. Such training can increase nurses' knowledge and skills as demonstrated by examination testing and evaluation of nurses in the workplace. Several projects also resulted in enhanced nurse leadership attributes and eleven lead to positive changes in models of clinical or community care involving nurses. In eight cases, these changes were subsequently embodied in new health policies.

Disaster management as part of curriculum for undergraduate and postgraduate courses: The Symbiosis model

From times immemorial disasters in some form or the other have been regularly visiting humankind and humans have been trying to manage these upheavals. Noah's arch is the first such endeavor. The United Nations declared 1990-1999 as International Decade for Disaster Reduction. The Indian Government passed the Disaster Management Act 2005. As a consequence of the Act, the National Disaster Management Authority was setup. All states were given the guide lines for disaster risk reduction. The objective of this article is to get a clearer picture of what various states, educational authorities and international bodies have done and what Symbiosis International University (SIU) has done so far. Inputs from various States of the Indian Union and neighboring countries were studied. The moot question that figured all the time was “Is there a conscious effort to include Disaster Management in the curricula of various courses at the college and university level” and what are the achievements. It was seen that the Central Board for Secondary Education with support from the Ministry of Home Affairs, Ministry of Human Resource Development and United Nations Development Project have incorporated DM, as part of its frontline curriculum. Most of the Universities in the disaster prone states have enunciated policies for including DM in the curriculum, but palpable results are still awaited. In the SIU, DM has been incorporated in the curriculum and is mandatory for all undergraduate and postgraduate courses.

Engaging community to support HIV prevention research

Actively engaging communities in effective partnerships is considered critical for ethically robust and locally relevant HIV prevention research. This can be challenging in developing countries that have little prior experience in this area. This paper summarizes processes and lessons learnt while setting up the Community Involvement Plan of National AIDS Research Institute, Pune, India. Formal partnerships were established with voluntary agencies. The focus was on using strategies adapted from participatory learning and action techniques. The community program was implemented through peer educators specifically identified from the communities where partner non-governmental organizations function. At the grass root level, peer educators imparted education to the common people about research studies and helped to implement community based recruitment and retention activities. The focus was on facilitating periodic interaction between the outreach workers of the research team and the peers and modifying the strategies till they were found locally implementable and appropriate. Through adequate time investment, mutually beneficial and respectful partnerships with community based organizations and grass root level workers, the community became actively involved in clinical research. The program helped in developing a sense of partnership among the peers for the research conducted by the research organization, widening the net of community education and identification of research participants. By building trust in the community and implementing research within an ethical framework, culturally sensitive matters were appropriately addressed. The community involvement process is long, laborious and ever-evolving. Effective community engagement requires institutional leadership support, adequate funding and commitment by researchers. It is possible to sustain such a model in a resource limited setting.