Community support for families affected by dementia

This paper provides and overview of the community support services that may be available for people with dementia and their family carers. The authors introduce dementia, including the impact of the diagnosis on both the person with dementia and the wider family. Using a case study approach, the authors describe the support available, spanning health and social care and third sector organisations. They discuss how this support can enable people with dementia and their carers to maintain wellbeing and cope with the impact of dementia. This article will be of interest to community nurses, and health and social care professionals more generally, who may encounter families affected by dementia in community settings. Having a good knowledge of the support available and how to access it will allow community nurses to capitalise on the health promotion opportunities presented to them, when they come into contact with families affected by dementia in the course of their day-to-day practice.

Medical tourism and medical tourists: providing a sustainable course to integrating health treatments with tourism

Medical tourism (MT) is an expanding multidisciplinary economic activity that combines the healthcare and tourist industries, with patients increasingly travelling worldwide for medical treatments. MT provides economic benefits to destinations while raising ethical, quality, informed, and risk concerns for medical tourists. Greater cross-disciplinary studies and collaboration across sectors are advocated.

Helping behaviours of community members towards older adults and the related factors: a cross-sectional study

BACKGROUND

Community members can play important roles in helping older adults in their community. This study aimed to clarify the actual situation of community members' helping behaviours towards older adults and examine the related factors.

METHODS

This cross-sectional study was conducted using an online survey system with a sample of 1000 community members in the Tokyo metropolitan area selected using quota sampling. Participants were asked about their experiences with helping an older adult, involvement with older adults with dementia, knowledge of dementia and care resources in the community, and perceptions regarding the community. Content analysis was used to classify participants' freely answered responses about helping behaviours, with logistic regression analysis subsequently used to examine the related factors.

RESULTS

Community members provided older adults with various types of spontaneous help, including help with walking (20.0%), accident care (16.8%), giving directions to a destination (11.6%), accompanying them to a destination (12.9%), and support in daily life (10.4%). In the multinominal logistic regression analysis, advanced helping behaviours were associated with having a family member with dementia, experiences involving people living with dementia, knowledge of dementia and community support centres, and a stronger sense of community integration (P < 0.05). The reasons for not being able to help included being physically unable to (42.5%), not feeling responsible (19.3%), not knowing how to help (17.4%), and hesitating to help (14.4%).

CONCLUSION

The results suggest that providing learning opportunities for community members could further promote their helping behaviours for older adults. These could include interacting with older adults, especially those living with dementia; promoting a sense of community integration; or receiving training in helping actions. Such efforts could support the development of an effective community-based care system for older adults.

An Ecological Inquiry on Young People's Suicidal Ideation at University: Individual, Relational and Cultural Factors and Their Interactions

To understand the factors related to suicidal ideation in university students, we examined individual and microsystemic variables with an ecological model organizing bidirectional influences between different dimensions. Suicidal ideation, psychological distress, multidimensional self-concept, loneliness, community social support, life satisfaction, family functioning, bullying victimization, and problematic use of virtual social networks were measured in a sample of 376 Mexican university students (67% women) from 18 to 34 years of age (M = 20.8). Data were collected in March 2020, before mandatory confinement for COVID started in Mexico. Discriminant analyses showed that psychological distress, loneliness, self-concept, life satisfaction, family functioning, internet violence/rejection, and informal social support predicted belonging to high or no suicidal ideation groups with 88% accuracy. Only psychological distress and family self-concept predicted suicidal ideation in multilinear regression analyses. There were differences by gender in multilinear regression, with family self-concept significant for women and physical self-concept, but not family self-concept for boys. Conclusions: Early Suicide prevention in universities should include periodic screening of psychological distress, loneliness, and virtual social media use to identify students that need further evaluation and intervention. University-based strategies of mental health promotion that strengthen family relationships and the sense of community, including gender-sensitive orientation, could enhance the effect of protective factors.

Muslim Collegiate Student-Athletes' Experience with Fasting During Ramadan While Participating in Sport

CONTEXT

As colleges and universities continue to focus on creating diverse, equitable, and inclusive environments, it is important to gain more knowledge on the experiences that Muslim student-athletes have while fasting during the month of Ramadan. While previous researchers have investigated the physical effects of fasting on the body, little is known about the challenges or support Muslim student athletes experience while fasting and participating in sport during Ramadan.

OBJECTIVE

To explore the experiences of Muslim collegiate student-athletes regarding fasting during Ramadan while participating in sports.

DESIGN

Consensual qualitative research.

SETTING

Individual video interviews.

PARTICIPANTS

12 Muslim collegiate student-athletes (4 women, 8 men; age = 19.9±1.4 years) from 7 universities across 7 states were interview.

DATA COLLECTION AND ANALYSIS

semi-structured interview guide consisting of questions pertaining to the Muslim student-athletes' beliefs, challenges, experiences, and feelings were used to gather perceptions of fasting during Ramadan while participating in sport. Data were analyzed by a multi-analyst research team and coded into common themes and categories via a multi-phase consensus process.

RESULTS

Four major themes emerged from the interview process, including the significance of fasting and Ramadan (familial influence, religious belief, introspection and spiritual growth), intrinsic challenges (physical mental and emotional, time constraints), extrinsic challenges (lack of available resources, knowledge and curiosity of others, lack of understanding by others) and various support (sport-specific support, community support, desired support) that impacted participants' experiences with fasting during Ramadan while participating in sport.

CONCLUSIONS

The athletic community should seek to better support Muslim student-athletes and respect the importance of fasting during Ramadan. Parties interested in the success of these athletes in sport should improve their understanding regarding Ramadan and the desired support of Muslim student-athletes during fasting.

Understanding care plans in a psychiatric mother-baby unit

INTRODUCTION

Care plans outline collaborative goals and strategies for recovery. While care planning is recommended across international mental health guidelines, scant attention has examined the unique nature of care planning within psychiatric mother-baby units. This retrospective audit aims to explore the content of care planning goals, compare against the World Health Organisation's (WHO) International Classification of Functioning, Disability, and Health (ICF), and devise a care plan framework to support development of admission goals.

METHODOLOGY

A total of 63 care plans across admission, mid-admission and discharge were analysed. Using deductive content analysis, care plan goals were compared to the WHO ICF codes. Inductive content analysis was used to generate a framework for care plans.

RESULTS

When compared to the WHO ICF codes, care plans were most commonly coded against d570 (looking after one's health) and d7600 (parent-child relationships). Care plans covered six main themes: mental health recovery, physical health, connecting with baby, caring for baby, relationships, and community supports.

DISCUSSION

This study is the first to examine the nature of recovery goals in care plans within a mother-baby unit. The results inform a framework to support care planning and thereby facilitate holistic well-being and recovery for a mother with mental illness.

The Effectiveness of a Community Nurse-Led Support Program for Dementia Caregivers in Chinese Communities: The Chongqing Ageing and Dementia Study

Background

As the primary caregivers for people with dementia in China, family caregivers face a significant care burden that can negatively impact their mental and physical health. It is vital to investigate ways to support these caregivers.

Objective

To assess the effectiveness of a program led by community nurses to support caregivers of individuals with dementia.

Methods

A total of 30 caregivers received nurse-led support in addition to usual care, while 28 caregivers received only usual care. The primary outcome was caregivers' sense of competency in providing dementia care, which was measured using the Short Sense of Competence Questionnaire (SSCQ). Secondary outcomes included caregivers' ability to perform daily activities, behavioral and psychological symptoms of dementia (BPSD) using a neuropsychiatric inventory questionnaire, and quality of life using the short form health survey (SF-36). The trial was registered at the Chinese Clinical Trial Registry (ChiCTR 2300071484).

Results

Compared to the control group, the intervention group had significantly higher SSCQ scores and a lower caregiver distress index over time. Physical and mental health-related quality of life also improved significantly among caregivers in the intervention group. However, there was no significant difference between the two groups in terms of activities of daily living and BPSD.

Conclusions

The community nurse-led support program significantly improved caregivers' competency in providing dementia care and quality of life and reduced distress. These findings have important implications for dementia care policies, resources, and workforce development in China, including strengthening community dementia care services through collaboration with specialists in hospitals.

Exploring community perspectives on the impacts of COVID-19 on food security and food sovereignty in Nunavut communities

BACKGROUND

In Nunavut, where 70% of children are food insecure, many households rely on school breakfast or community food programmes for nourishment. The COVID-19 pandemic and resulting policies to reduce the spread of the disease have the potential to exacerbate existing issues, including increasing food insecurity in households. Funding programmes were implemented to limit the impact of public-health measures on household and community food security. The overall effects of the actions are not yet understood.

METHODS

This project used a qualitative approach to examine the determinants of food security and sovereignty and the impact of the COVID-19 pandemic policy responses on these determinants in Arviat and Iqaluit. Narrative analysis applied within a relational epistemology was used to describe the experiences of community members in Iqaluit and Arviat during the COVID-19 pandemic.

RESULTS

Seven participants were interviewed in Iqaluit (n=3) and Arviat (n=4). Key themes included the importance of decolonisation for food sovereignty, the importance of food sharing to communities and the resilience of communities during COVID-19. Community members wished to see greater support and strengthening of the country (locally harvested) food economy to increase knowledge of food and harvesting skill, and for communities to find ways to reach residents who may fall through the cracks during times of need or crisis.

CONCLUSIONS

This study is one of the first to document Nunavummiut experiences and perspectives of food security and sovereignty in Arviat and Iqaluit during the COVID-19 pandemic.

Social determinants of health and lung cancer surgery: a qualitative study

Introduction

Social determinants of health (SDOH) are non-clinical factors that may affect the outcomes of cancer patients. The purpose of this study was to describe the influence of SDOH factors on quality of life (QOL)-related outcomes for lung cancer surgery patients.

Methods

Thirteen patients enrolled in a randomized trial of a dyadic self-management intervention were invited and agreed to participate in semi-structured key informant interviews at study completion (3 months post-discharge). A conventional content analysis approach was used to identify codes and themes that were derived from the interviews. Independent investigators coded the qualitative data, which were subsequently confirmed by a second group of independent investigators. Themes were finalized, and discrepancies were reviewed and resolved.

Results

Six themes, each with several subthemes, emerged. Overall, most participants were knowledgeable about the concept of SDOH and perceived that provider awareness of SDOH information was important for the delivery of comprehensive care in surgery. Some participants described financial challenges during treatment that were exacerbated by their cancer diagnosis and resulted in stress and poor QOL. The perceived impact of education varied and included its importance in navigating the healthcare system, decision-making on health behaviors, and more economic mobility opportunities. Some participants experienced barriers to accessing healthcare due to insurance coverage, travel burden, and the fear of losing quality insurance coverage due to retirement. Neighborhood and built environment factors such as safety, air quality, access to green space, and other environmental factors were perceived as important to QOL. Social support through families/friends and spiritual/religious communities was perceived as important to postoperative recovery.

Discussion

Among lung cancer surgery patients, SDOH factors can impact QOL and the patient's survivorship journey. Importantly, SDOH should be assessed routinely to identify patients with unmet needs across the five domains. SDOH-driven interventions are needed to address these unmet needs and to improve the QOL and quality of care for lung cancer surgery patients.

"My Home Away From Home": Community Support for International Pediatric and Young Adult Patients and Their Families in End-of-Life Care and Bereavement

Background: Foreign national patients and families can face life-limiting illness and end-of-life care far from home; this palliative need has not been well described. Case Description: We present a case of a 20-year-old Ugandan patient diagnosed with metastatic alveolar rhabdomyosarcoma who presented to a pediatric academic medical center in California. Despite treatment, her disease progressed and she was unable to return to Uganda due to symptom burden. The patient and her family met regularly with palliative care during their hospital stay; the palliative approach included cross-cultural sharing, connecting across differences, and fostering community. The family additionally cultivated a support system within the hospital and local African communities. This was illustrated in the memory album the patient created, and in her family's extensive bereavement support. Conclusions: This case explores opportunities for individualized psychosocial care and community-based support to enhance palliative care for foreign national patients and families.

Kintsugi: Comprehensive repair of Australia's fractured psychiatric care system

OBJECTIVE

We provide an update of the current challenges facing public and private psychiatric care sector in Australia, contextualised by international and national information on factors affecting health system performance.

CONCLUSIONS

There are practical and sustainable repairs that may bridge the gaps between primary care, private psychiatrists, and the public psychiatric system. These are based upon foundations of better linkages, adequate infrastructure, improved social support, and reforming public and private sector workplaces to retain healthcare workers despite pandemic-related attrition. Professional organisations need to redouble their efforts as advocates to governments, in the media matrix, and the general public.

Social support for overcoming fear of contagion at the start of the COVID-19 pandemic. Cross-sectional study in Latin America

Background

The psychological impact of the COVID-19 pandemic on healthcare professionals has been widely studied, along with different strategies to minimize it. However, professionals' assessment of the social support received and the factors that mitigated their fear of contagion have not been described. This study aimed to assess healthcare professionals' satisfaction with the social support and information received and their efforts to self-isolate to avoid infecting loved ones in Chile, Colombia, and Ecuador.

Methods

A cross-sectional online survey, conducted from July to September 2020 in three Latin American countries, elicited healthcare professionals' satisfaction with social support from colleagues, their community, the media, and scientific societies; as well as the information received about the evolution of the pandemic and measures to avoid contagion. The EASE scale was used to measure acute stress.

Results

Survey responses were received from 700 professionals. The response rate per country exceeded the estimated sample size except in the case of Colombia, which was 81.4%. In general, peer support was highly valued, though satisfaction was lower in high-risk units (p < 0.001). Those who directly assisted COVID-19 patients perceived the least community support (p = 0.023). Professionals from high-risk units (p = 0.013) and those who experienced greater acute stress (p = 0.05) assigned the lowest rating to the information offered by the centre on the pandemic. Men perceived more support from colleagues and better information from the centre than women (p < 0.05). Just 10.7% of professionals changed their residence during the pandemic, but those who worked in high-risk areas self-isolated more frequently (p = 0.026).

Conclusion

In the early stages of the COVID-19 pandemic, healthcare professionals in Chile, Colombia, and Ecuador greatly valued the support received from their peers. Being infected with COVID-19, working in high-risk areas, experiencing higher self-reported acute stress, and having an infected co-worker were predictors for self-isolation to protect their relatives. These results point to the appropriateness of putting in place institutional resources based on peer support and specific communication strategies and action protocols to build resilience and responsiveness to future health crises.

Evaluation of Integrative Community Therapy with Domestic Violence Survivors in Quito, Ecuador

Integrative community therapy (ICT) is a methodology used in the public health arena to deal with problems facing communities such as depression, substance abuse, and stress. This approach is unique as it builds on critical pedagogy, cultural anthropology, communication, resilience, and systems theory. Additionally, creative arts therapies point to the utility of music as a therapeutic tool. This study employed ICT and a music workshop with domestic violence survivors in Quito, Ecuador, via a pre-post comparison group design. A total of 87 women completed the six-week study-49 in the intervention group and 38 in the comparison group. Measures were taken on self-esteem, general health, resilience, dating violence attitudes, and social support. Additionally, the intervention group answered open-ended questions about their experience, and some participated in a focus group (n = 21). The quantitative results indicated that there was improvement in the domains of general health, self-esteem, and social support for the intervention group compared to the comparison group. Themes from the qualitative responses indicated changes in the relationship with the aggressor, psychological and emotional changes, changes in feelings of social support, and changes for the future. The study found promising results for this approach with domestic violence survivors, possibly leading to a community-grounded, non-hierarchical, culturally-responsive intervention for this population.

Safe, supportive neighborhoods: Are they associated with childhood oral health?

OBJECTIVE

There has been limited examination of how community-level supports may influence oral health metrics among children. The purpose of our study is to examine the association between two types of community-level positive childhood experiences and oral healthcare and oral health outcomes among children ages 6 to 17 years of age.

METHODS

This study uses a cross-sectional data set from the 2018-2019 National Survey of Children's Health. Two oral health metrics were used: preventive dental care, measured as one or more preventive dental visits in the past 12 months, and tooth decay, measured as tooth decay or cavities in the last 12 months. To quantify living in safe, stable, equitable environments, questions on residing in a safe and supportive neighborhood were used. Descriptive statistics and bivariate analyses were used to calculate frequencies, proportions, and unadjusted associations for each variable (n = 40,290). Multivariable logistic regression models were used.

RESULTS

In an adjusted analysis, children who lived in a supportive neighborhood had a higher likelihood of receiving a preventive dental visit than children who did not live in a supportive neighborhood (aOR 1.41; 95% CI 1.21-1.65). Children who lived in a safe neighborhood were less likely to have tooth decay than children who did not live in a safe neighborhood (aOR 0.75; 95% CI 0.65-0.86).

CONCLUSIONS

The findings from this study highlight the role of social structures in tightening the safety net for oral healthcare in children.

Physical, Psychiatric, and Social Comorbidities of Individuals with Schizophrenia Living in the Community in Japan

The physical, psychiatric, and social comorbidities interfere with the everyday activities of community-dwelling individuals with schizophrenia and increase the risk of their readmission. However, these comorbidities have not been investigated comprehensively in Japan. We conducted a self-reported internet survey in February 2022 to identify individuals aged 20-75 years with and without schizophrenia using a prevalence case-control study. The survey compared physical comorbidities such as being overweight, hypertension, and diabetes; psychiatric comorbidities such as depressive symptoms and sleep disturbances; social comorbidities such as employment status, household income, and social support between participants with and without schizophrenia. A total of 223 participants with schizophrenia and 1776 participants without schizophrenia were identified. Participants with schizophrenia were more likely to be overweight and had a higher prevalence of hypertension, diabetes, and dyslipidemia than participants without schizophrenia. Additionally, depressive symptoms, unemployment, and non-regular employment were more prevalent in participants with schizophrenia than those without schizophrenia. These results highlight the necessity of comprehensive support and interventions addressing physical, psychiatric, and social comorbidities in individuals with schizophrenia in the community. In conclusion, effective interventions for managing comorbidities in individuals with schizophrenia are necessary to enable them to continue to live in the community.

The serial mediating effects of social isolation and resilience on the relationship between fear of dementia and insomnia in community-dwelling older adults

AIMS

This study aims to explore the correlation between fear of dementia and insomnia among community-dwelling older adults and to examine the mediating roles of social isolation and resilience on this correlation.

METHODS

A total of 259 community-dwelling older adults from Mianyang, China were recruited from June 2021 to August 2021 using convenience sampling. The Chinese versions of the Fear of Dementia Scale (FODS), Lubben Social Network Scale (LSNS-6), 25-item Connor-Davidson Resilience Scale (CD-RISC-25) and Athens Insomnia Scale (AIS) were used to collect specific, study-related information from the subjects. Correlations between variables of interest were examined by Pearson analysis, and mediation analysis was conducted to explore the direct, indirect and total effects of the fear of dementia on insomnia vis-à-vis social isolation and resilience.

RESULTS

Results from 259 older adults indicated that fear of dementia and insomnia in older adults are positively correlated, that social isolation and resilience mediate the relationship between them, and that social isolation and resilience also had a statistically significant serial mediating effect.

CONCLUSION

Fear of dementia is positively related to insomnia in older community-dwelling Chinese adults, but resilience and social support may buffer the negative impact of fear of dementia and improve sleep quality.

IMPACT

Fear of dementia is becoming more and more common in community-dwelling older adults in China, and this emotional response to ageing and disease anxiety may be to blame for the poor sleep quality of some ageing populations. However, social support and resilience may buffer the negative impact of fear of dementia. The findings in this study indicate a need for well-trained community nurses and other health practitioners to implement targeted strategies to reduce insomnia among older adults with fear of dementia. These strategies should strengthen resilience as well as social support.

Sense of community, meaning in life, and satisfaction with life among Ultra-Orthodox Jews: A mediation model

The Ultra-Orthodox community in Israel, characterized by close-knit ties and strong community values, has been particularly vulnerable to COVID-19, both epidemiologically and socially. Accordingly, the current study examined whether the connection between the sense of community and life satisfaction in this population is mediated by meaning in life (MIL). Three hundred and fifty-eight Ultra-Orthodox participants (age range: 30-70; M = 49.50, SD = 10.24) filled out scales assessing MIL, sense of community, and satisfaction with life (SWL), as well as sociodemographic and COVID-19-related scales. Sense of community was linked with increased MIL and life satisfaction. Moreover, the connection between sense of community and life satisfaction was mediated by MIL. This study highlights the roles of sense of community and MIL for Ultra-Orthodox individuals and emphasizes the importance of both concepts for maintaining SWL during COVID-19. Practical implications for Ultra-Orthodox communities are suggested.

Community support, family resilience and mental health among caregivers of youth with autism spectrum disorder

BACKGROUND

Caregivers of children with autism spectrum disorder (ASD) have been shown to have unique mental health vulnerabilities that community support may buffer. Positive caregiver mental health can stimulate family resilience behaviours, such as strong communication and problem-solving. Further, community support has been found to be related to caregiver mental health, as well as improved child functioning. The current study aims to investigate caregiver mental health as a mediator between community support and family resilience in families of a child with an autism spectrum disorder.

METHODS

Data obtained from caregivers of 654 children with a reported diagnosis of ASD were utilized from the 2016 National Survey of Children's Health (NSCH) public database.

RESULTS

Community support was positively correlated with family resilience and caregiver mental health. Bivariate correlations indicated significant positive associations between community support and family resilience. Caregiver mental health, significantly, partially mediated the relationship between community support and family resilience.

CONCLUSIONS

The present study provides important insight into fostering caregiver health as a strategy to promote family resilience behaviours. Interventions designed to address family resilience behaviours among families of children with ASD should focus on ways that positively impact caregiver mental health.

Understanding the Early Impacts of the COVID-19 Pandemic on Brain Injury Associations Across Canada: A Qualitative Study

The COVID-19 pandemic has increased challenges for people living with brain injury and community associations to support this vulnerable population. This study aimed to gain an in-depth understanding of the challenges faced by brain injury survivors during the first year of the pandemic and how community brain injury associations adapted their services to respond to these needs. Findings from seven focus-group with 31 representatives of Canadian brain injury associations revealed 4 main themes: (1) Addressing evolving client needs; (2) Keeping clients safe; (3) Challenges and opportunities navigating the digital world; and (4) Sustaining brain injury associations in the face of uncertainties and disruptions. To comply with public health measures, associations reported pivoting their service delivery online, despite recognizing the difficulties this could create for many brain injury survivors in accessing and using technology. Our findings also highlight concrete directions for not-profit organizations providing instrumental help with activities, acting as a liaison and interpreter of public health guidelines, and in connecting with clients using technology while handling potential cognitive and technological challenges. Addressing these issues has the potential to protect people living with brain injury and community associations from external threats, like pandemics, in the future.

The Use of an Incentive to Improve Breastfeeding Outcomes: The Effectiveness of Offering a Free Family YMCA Membership to Increase Support Group Participation

BACKGROUND

Suboptimal breastfeeding can result in negative health consequences for mother and infant and economic consequences for families and communities. Breastfeeding outcomes improve when multifaceted interventions spanning the perinatal period are implemented. Incentives to increase participation in effective, existing community-based breastfeeding support programs have the potential to create behavioral change and improve breastfeeding outcomes but results to date are inconclusive.

RESEARCH AIM

The aim of this pilot study was to investigate the effectiveness of offering a Young Men's Christian Association membership as an incentive to increase attendance at an existing breastfeeding support program to improve breastfeeding duration and exclusivity.

METHOD

This was a two-group, quasi-experimental study using demographic information and pre- and post-intervention participant surveys. Attendance at a breastfeeding support program was incentivized with an offer of a free family Young Men's Christian Association membership. Surveys and demographic information were used to compare attendance, maternal interest, and perceived significant other and family support for attendance with a non-incentivized control group in an adjacent city.

RESULTS

The groups differed demographically and socioeconomically. Significantly more at-risk participants both attended the incentivized group and perceived support from their families to attend. There was a significant increase in the incentivized group's attendance: 62% (n = 26) of participants in the incentivized group attended three or more times compared to 36% (n = 50) of participants in the control group (p = .03). Both groups exceeded national breastfeeding averages for exclusive breastfeeding at six months.

CONCLUSION

Offering an incentive increased breastfeeding support group attendance by participants at risk for suboptimal breastfeeding and improved their breastfeeding outcomes, thus closing the breastfeeding disparity gap in this population.

Impacts of psychological resources, social network support and community support on social participation of older adults in China: Variations by different health-risk groups

Social participation comprises comprehensive interactions between individual health and relevant environmental characteristics, which play an increasingly important role in promoting older adults' health and quality of life. Although many studies have examined impacts of various factors on the social participation of older adults, some internal mechanisms between health characteristics and environmental characteristics have not been revealed. This study aimed to examine the moderating effects of health characteristics on the relationships among psychological resources, social network support, community support and social participation of Chinese older adults. Based on some key health indicators, this study used the two-step cluster algorithm to divide the participants aged over 60 years from the Chinese Longitudinal Aging Social Survey in 2016 (N = 8669) into low (47.2%), moderate (33.8%) and high (18%) health risk groups. A multiple-group structural equation model was then built to examine the effects of psychological resources, social network support and community support on social participation across the three groups. The results suggested that with the increase in health risks, the contributions of psychological resources and community support to social participation decreased from 28.6% to 23.7% and from 61.5% to 50.7%, respectively, while that of social network support increased from 9.9% to 25.6%. These variations suggest that individual health has a significant moderating effect on the psychological and social compensating mechanisms of the social participation among Chinese older adults.

Transgender community resilience on YouTube: Constructing an informational, emotional, and sociorelational support exchange

This strength-based, mixed-methods study explored how trans individuals utilize transvlogs as a community building and resilience resource. Eighty-six transvlog viewers explained their motivation for viewing transvlogs and additionally rated their self-efficacy and well-being. Narrative analyses indicate that participants viewed transvlogs to gain informational, emotional, and sociorelational resources. Twelve percent of participants additionally shared those resources with others and contributed to a relational resilience exchange. In addition, transvlog viewers' self-efficacy and well-being scores were higher than previously reported means. While prior research has noted the benefits of transvlog creation, the present study furthers this study by suggesting that transvlog viewers interactionally benefit as well. Participants in this study were not passive viewers, but rather active, agentive contributors to a trans community resilience exchange. Building on this study, we conclude with a discussion of how therapists can incorporate extant trans-created resources to foster trans community resilience.

The Influence of Internal and External Stakeholder Mechanisms on Entrepreneurial Success: The Moderating Role of Digital Technology Adoption

The purpose of this research is to investigate the associations of internal and external support mechanisms with entrepreneurial success, in the context of China's entrepreneurial sector from network theory perspective. The role of digital technology, as a moderator, has also been analyzed. Data has been obtained from 500 entrepreneurs in Jiangsu, a province in China. All hypotheses were tested using structural equation modeling. It has been found that family support, business partner support, community support and external stakeholder relationships have positive effects on entrepreneurial success. It has also been discovered that digital technology adoption strengthens the positive relationship between business partner support and entrepreneurial success. Theoretical and practical implications have been highlighted and future research suggestions have been provided.

Costs of an Alcohol Measurement Intervention in Three Latin American Countries

Alcohol measurement in health care settings is an effective intervention for reducing alcohol-related harm. However, in many countries, costs related to alcohol measurement have not yet been transparently assessed, which may hinder its adoption and implementation. Costs of an alcohol measurement programme in three upper-middle-income Latin American countries were assessed via questionnaires and compared, as part of the quasi-experimental SCALA study. Additional to the intervention costs, the costs of three implementation strategies: standard training and clinical package, intensive training and clinical package, and community support, were assessed and subsequently translated into costs per additional alcohol measurement session. Results demonstrated that costs for one alcohol measurement session ranged between Int$ 0.67 and Int$ 1.23 in Colombia, Int$ 1.19 and Int$ 2.57 in Mexico, and Int$ 1.11 and Int$ 2.14 in Peru. Costs were mainly driven by the salaries of the health professionals. Implementation strategies costs per additional alcohol measurement session ranged between Int$ 1.24 and Int$ 6.17. In all three countries, standard training and a clinical package may be a promising implementation strategy with a relatively low cost per additional alcohol measurement session.

How do people support each other in emergencies? A qualitative exploration of altruistic and prosocial behaviours during the COVID-19 pandemic

The Ball State University Center for Peace and Conflict Studies in the United States has compiled altruistic stories from different countries such as India, Australia, the United States, and England since the onset of the COVID-19 pandemic. We examined those stories to understand (1) who receives the most support, (2) what type of support is provided, (3) who those supporters are, and (4) why people support each other during the pandemic. Conducting a qualitative content analysis of 104 altruistic stories, we first identified that (a) older individuals , (b) people with sensitive health conditions, and disabilities, (c) frontline workers, and (d) working class and marginalized communities received the primary support. Second, we identified three types of support: (a) material, (b) social/emotional, and (c) psychological. Third, we found that support was coming from (a) different organizations, (b) advantaged groups, and (c) volunteers. Last, (a) sharing a community/humanity identity, (b) allyship, and (c) showing gratitude were the reasons behind altruistic and prosocial behavior. Our findings contribute to the literature by providing some possible reasons and ways that allies have supported disadvantaged communities via sharing the available resources and how showing gratitude can be a reason for altruism and prosocial behavior in a pandemic.

An Integrative Review on the Feasibility and Acceptability of Delivering an Online Training and Mentoring Module to Volunteers Working in Community Organizations

Background: Volunteer programs that support older persons can assist them in accessing healthcare in an efficient and effective manner. Community-based initiatives that train volunteers to support patients with advancing illness is an important advance for public health. As part of implementing an effective community-based volunteer-based program, volunteers need to be sufficiently trained. Online training could be an effective and safe way to provide education for volunteers in both initial training and/or continuing education throughout their involvement as a volunteer.

Method: We conducted an integrative review that synthesized literature on online training programs for volunteers who support older adults. The review included both a search of existing research literature in six databases, and an online search of online training programs currently being delivered in Canada. The purpose of this review was to examine the feasibility and acceptability of community-based organizations adopting an online training format for their volunteers.

Results: The database search identified 13,626 records, these went through abstract and full text screen resulting in a final 15 records. This was supplemented by 2 records identified from hand searching the references, for a total of 17 articles. In addition to identifying Volunteers Roles and Responsibilities; Elements of Training; and Evaluation of Feasibility and Acceptability; a thematic analysis of the 17 records identified the categories: (1) Feasibility Promoting Factors; (2) Barriers to Feasibility; (3) Acceptability Promoting Factors; and (4) Barriers to Acceptability. Six programs were also identified in the online search of online training programs. These programs informed our understanding of delivery of existing online volunteer training programs.

Discussion: Findings suggested that feasibility and acceptability of online training were promoted by (a) topic relevant training for volunteers; (b) high engagement of volunteers to prevent attrition; (c) mentorship or leadership component. Challenges to online training included a high workload; time elapsed between training and its application; and client attitude toward volunteers. Future research on online volunteer training should consider how online delivery can be most effectively paced to support volunteers in completing training and the technical skills needed to complete the training and whether teaching these skills can be integrated into programs.

More Than a COVID-19 Response: Sustaining Mutual Aid Groups During and Beyond the Pandemic

Mutual aid groups have been an indispensable part of the public response to the COVID-19 pandemic. They have provided many forms of support, in particular grocery shopping which has enabled people to self-isolate if required. While community solidarity during emergencies and disasters is common, previous studies have shown that such solidarity behaviors tend to decline over time, even when needs remain high. In this study, we address how mutual aid groups can be sustained over time in the context of the COVID-19 pandemic. We conducted 32 interviews with organizers of COVID-19 mutual aid and community support groups in the United Kingdom between September 2020 and January 2021. Based on a reflexive thematic analysis, we identified several community and group level experiences and strategies that were related to sustained participation in COVID-19 mutual aid groups. Meeting community needs over time with localized action and resources and building trust and community-based alliances were foundational elements in the COVID-19 mutual aid groups. Group processes strategies, such as a culture of care and support and regular group meetings, were used to help to sustain involvement. Some experiences resulting from participation in COVID-19 mutual aid groups were also related to sustained participation, including positive emotions (e.g., joy, pride), well-being and sense of efficacy, and an increasing sense of local community belonging and cohesion. Based on these findings, we propose four practical recommendations for sustaining mutual aid groups to assist public engagement with protective behaviors in the COVID-19 pandemic and beyond. We recommend providing practical and financial support to COVID-19 mutual aid groups; to mobilize the knowledge and the experiences acquired by COVID-19 mutual aid groups for developing programs and interventions for addressing the medium and long-term impacts of COVID-19; to prioritize community-level interventions; and to recognize the role of group processes as these have the potential to lead to long-term community responses. These approaches will be key for ensuring that communities effectively recover from the COVID-19 pandemic.

More Than a COVID-19 Response: Sustaining Mutual Aid Groups During and Beyond the Pandemic

Mutual aid groups have been an indispensable part of the public response to the COVID-19 pandemic. They have provided many forms of support, in particular grocery shopping which has enabled people to self-isolate if required. While community solidarity during emergencies and disasters is common, previous studies have shown that such solidarity behaviors tend to decline over time, even when needs remain high. In this study, we address how mutual aid groups can be sustained over time in the context of the COVID-19 pandemic. We conducted 32 interviews with organizers of COVID-19 mutual aid and community support groups in the United Kingdom between September 2020 and January 2021. Based on a reflexive thematic analysis, we identified several community and group level experiences and strategies that were related to sustained participation in COVID-19 mutual aid groups. Meeting community needs over time with localized action and resources and building trust and community-based alliances were foundational elements in the COVID-19 mutual aid groups. Group processes strategies, such as a culture of care and support and regular group meetings, were used to help to sustain involvement. Some experiences resulting from participation in COVID-19 mutual aid groups were also related to sustained participation, including positive emotions (e.g., joy, pride), well-being and sense of efficacy, and an increasing sense of local community belonging and cohesion. Based on these findings, we propose four practical recommendations for sustaining mutual aid groups to assist public engagement with protective behaviors in the COVID-19 pandemic and beyond. We recommend providing practical and financial support to COVID-19 mutual aid groups; to mobilize the knowledge and the experiences acquired by COVID-19 mutual aid groups for developing programs and interventions for addressing the medium and long-term impacts of COVID-19; to prioritize community-level interventions; and to recognize the role of group processes as these have the potential to lead to long-term community responses. These approaches will be key for ensuring that communities effectively recover from the COVID-19 pandemic.

Monitoring changes in community support for policies on obesity prevention

OBJECTIVE

To investigate the New South Wales (NSW) community's support for obesity prevention policies and concern for food marketing and promotion issues, and to determine any demographic differences or changes over time.

METHODS

In 2013 (n=2474), 2016 (n=1602) and 2019 (n=1613) a sample of adults who were representative of the NSW population for age, gender, education and location was asked about support for policy initiatives that influence the food environment. Analysis identified the characteristics of those who supported policies and variation in support over time.

RESULTS

There were limited changes in support over time; however, support for many policies was strong and sustained. In 2019, support was highest for regulation of claims about nutrition (77.2%), and health warning labels (75.7%). Support for a ban on unhealthy food advertising that targets children (64.6%) had decreased since 2013. Women, older people and those who were aware that obesity was a risk factor for cancer were generally more likely to support policies. Parents were more likely than non-parents to be concerned about positioning unhealthy food at supermarket checkouts (OR 1.32) and unhealthy outdoor advertisements (OR 1.22). Concern increased in 2019 for unhealthy marketing on the internet (OR 1.21).

CONCLUSIONS

This study shows public support for policy options at moderate to high levels but not increasing in the six-year study period. Implications for public health: These results form part of a package that, along with the well-established evidence, makes the case for policy action in Australia.

Exploring community support on safe motherhood: A case of Lilongwe District, Malawi

BACKGROUND

Malawi is grappling with a high maternal mortality of 439 per 100 000 live births. It is estimated that 80% of maternal deaths can be prevented by actively engaging the community in the country. However, community support on safe motherhood remains unknown.

AIM

This study, therefore, explored community support rendered to mothers and babies during antenatal, intrapartum and postpartum periods.

SETTING

This study was conducted in the Lilongwe District, Malawi.

METHODS

This was a qualitative study that collected data from 30 village health committee members through Focus Group Discussions (FGDs). Data were analysed using thematic analysis.

RESULTS

This study found that community support on safe motherhood rendered to women varied. The following five themes emerged from FGDs data on community support on safe motherhood: antenatal support, intrapartum support, postpartum support, bylaws reinforced by chiefs in the community and safe motherhood support groups. Community members encourage pregnant women to attend antenatal care, escorted pregnant women to the hospital for delivery and assisted women to care for a child and go for postpartum checkups. Community bylaws were considered as a necessary tool for encouraging women to attend antenatal care, deliver at the health facility and attend postpartum checkups.

CONCLUSION

This study suggests that community members play a crucial role in providing support to women and newborns during antenatal, intrapartum and postpartum periods.

Relational Approaches to Community-Based Health Promotion Across Scales of Practice

In this article, we describe a personalized approach to meeting individual and community health needs that foregrounds relational learning. This article analyzes how relational approaches to learning expand participants' objectives and result in more enduring learning. We report on mixed methods data from interviews, focus groups, surveys, and goal setting and monitoring. Analyses reveal that relationships de confianza served as a central tool in supporting participants' agency to enact change across scales of practice to promote the health of themselves, their families, and their communities.

A case report of COVID-19 colitis and a sports medicine driven community outreach program that contributed to a successful outcome

This case illustrates a lesser seen presentation of SARS-CoV-2 (henceforth to be termed COVID-19): acute ascending colitis in the community setting. In a broader context, however, this case demonstrates the importance of community, spirituality and a social support network while fighting a life-threatening illness, especially one that demands social and physical isolation while convalescing. Many are attracted to practice in the field of sports medicine due to a sense of community and teamwork that parallels the goals of the individual athlete. This case illustrates the unconventional role sports medicine physicians, orthopedic surgeons and team sports chiropractors have undertaken in the battle versus Covid-19, specifically consulting on the patient while creating an outreach program in the hopes of contributing to the patient’s sense of wellness. In this unique case, our patient is a current soccer coach and former professional soccer player known well in the American and El Salvadorian soccer communities. The community he has devoted his life’s work to played a pivotal role in his battle against COVID-19. While this disease has undoubtedly resulted in global upheaval, community support, particularly that of the Washington D.C. Soccer community and the D.C. United Major League outreach program, played a large role in the psychosocial wellness of the patient and ultimately his recovery.

Neighborhood Social Cohesion and Sleep Health by Age, Sex/Gender, and Race/Ethnicity in the United States

Although low neighborhood social cohesion (nSC) has been linked with poor sleep, studies of racially/ethnically diverse participants using multiple sleep dimensions remain sparse. Using National Health Interview Survey data, we examined overall, age, sex/gender, and racial/ethnic-specific associations between nSC and sleep health among 167,153 adults. Self-reported nSC was categorized into low, medium, and high. Very short sleep duration was defined as <6 h; short as <7 h, recommended as 7–9 h, and long as ≥9 h. Sleep disturbances were assessed based on trouble falling and staying asleep, waking up feeling unrested, and using sleep medication (all ≥3 days/times in the previous week). Adjusting for sociodemographics and other confounders, we used Poisson regression with robust variance to estimate prevalence ratios (PRs) and 95% confidence intervals (CIs) for sleep dimensions by low and medium vs. high nSC. The mean age of the sample was 47 ± 0.1 years, 52% of those included were women, and 69% were Non-Hispanic (NH)-White. Low vs. high nSC was associated with a higher prevalence of very short sleep (PR = 1.29; (95% CI = 1.23–1.36)). After adjustment, low vs. high nSC was associated with very short sleep duration among NH-White (PR = 1.34 (95% CI = 1.26–1.43)) and NH-Black (PR = 1.14 (95% CI = 1.02–1.28)) adults. Low nSC was associated with shorter sleep duration and sleep disturbances.

Individualized Apartment Accommodation for People With Intellectual Disability: Protocol for a Qualitative Study Examining the Well-Being and Support Outcomes Linking Housing and Health

Background

Understanding the outcomes associated with both receiving and providing support to people with intellectual disability in specific settings can facilitate the alignment of health providers, community care providers, architects, and urban planners to strengthen levels of autonomy and community participation of people with intellectual disability living in the community. This study explores the impact of providing support (available 24 hours a day) for people with intellectual disability in a high-density apartment. It seeks the perspectives of people with intellectual disability who have moved into an apartment from a group home (where 4-6 people with disability live), their families, and support staff. It will enable comparison between two models of supported accommodation, group homes and individualized apartments, in a community setting.

Objective

The aims of this study are to explore the impact of an individualized apartment model of supported accommodation in a high-density setting on the well-being, autonomy, and participation of people with intellectual disability living and receiving support; the experience of providing care or support; and how this setting impacts the logistics of how quality support is provided.

Methods

Qualitative research methods were employed as the primary means of collecting and analyzing data. There are two main sources of data in this study: (1) semistructured interviews with participants in up to 3 waves (pre, post 1, and post 2) and (2) pre- and postoccupancy evaluation data on the design, layout, and location details of the built environments. Coded interview data will be paired with pre- and postoccupancy evaluations of the two accommodation settings.

Results

As of May 2020, we have recruited 55 participants. There have been 96 interviews conducted in 2 waves with people who have moved into supported accommodation, families, and staff. Collected data are currently being analyzed. We expect the results of the trial to be published in a peer-reviewed journal in late 2020.

Conclusions

This paper sets out a study of an alternative housing and support model for people with intellectual disability. It will capture personal experiences of people with intellectual disability receiving support in an apartment compared to their experiences in a group home. It will also capture the experiences of support staff working in the new setting and reveal how this differs from a group home setting. The inclusion of pre (group home) and post (apartment integrated into a community setting) measures addresses evaluative and comparative questions around the nature and impacts of the small-scale apartment and support model for both those who live and receive support, and those who support them.

International Registered Report Identifier (IRRID)

DERR1-10.2196/18248

Examining the Baby Café Model and Mothers' Breastfeeding Duration, Meeting of Goals, and Exclusivity

Objective: Accessible community lactation support impacts a woman's breastfeeding success by offering timely intervention and solutions, thereby allowing mothers to achieve breastfeeding goals and improve overall breastfeeding rates. Although the impact of breastfeeding support has been well established, there is a lack of consistency in the development and evaluation of support models. This report examines two differing populations of Baby Café attendees. The study evaluated the mother's achievement of personal and nationally recommended breastfeeding goals, the frequency of attending a Baby Café, and their ratings of the program as helpful in solving breastfeeding problems. Methods: A total of 559 mothers attending two Baby Cafés, one in Massachusetts and the other in southern Texas, were surveyed when their babies were 6 months old and again over age 12 months. Actual breastfeeding duration was compared with the mothers' initially stated goals and American Academy of Pediatrics (AAP) recommended goals, and then evaluated against the number of Café attendances. The mother's rating of the Café for helpfulness was measured using a 1-5 effectiveness scale. Results: Results show that mothers attending either of the surveyed Baby Cafés that served distinctly different populations reported higher breastfeeding exclusivity rates and higher rates of 12-month breastfeeding duration than national rates reported by the Centers for Disease Control and Prevention (CDC). More than 70% of all mothers surveyed rated the Café as most effective. Conclusions: The Baby Café model was shown to be effective at helping mothers reach breastfeeding goals regardless of the Café's different geographical settings and the socioeconomic characteristics of the populations served.

Determinants of Active and Healthy Ageing in Sub-Saharan Africa: Evidence from Cameroon

This paper examines the determinants and policy implications of active and healthy ageing in Sub-Saharan Africa, taking the case of Bamenda, in Cameroon. Specifically, the study sought to identify and explore the determinants of active and healthy ageing using a mixed-methods approach involving qualitative and quantitative data collection and analysis. Focus group discussions were conducted complemented by a survey (random and snowball sampling) using a structured questionnaire. Narratives and thematic analysis were used to analyze the data generated from the focus group discussion and Tobit regression was employed to analyze the multiple determinants of active ageing by dimensions and on a global scale in Cameroon. Results identified three key dimensions of active and healthy ageing: employment/livelihood options (EL), community support and health (CH) and housing and living in Bamenda (HL). The regression results reveal gender bias in active ageing, a non-effect of education and health on active ageing, and a positive effect of income on active and healthy ageing. This study contributes, among others, to the competence-environmental press theory on active ageing with regards to unbundling context specific determinants of active and healthy ageing. It equally derives policy considerations with regards to gender mainstreaming and the identification of age friendly income earning options to enhance the active and healthy ageing process.

Family Readiness Groups: Helping deployed Army National Guard soldiers and their families

Many have espoused the benefits of Family Readiness Groups (FRGs) for families of deployed soldiers. These include fostering family well-being (main effect) and buffering the family against the negative effects of stressful life events (moderating effect). Yet, few published studies have tested these hypothesized relationships. Survey responses gathered from returning deployed Army National Guard soldiers (N = 4,568 soldiers in 50 company-sized units) gave the opportunity to test hypothesized benefits of FRGs, both main and buffering effects. Half the sample of soldiers reported their families as having used FRGs. Two-thirds of the soldiers reported FRGs as being helpful to their families. On the whole, results supported hypotheses: More effective coping among family members was associated with FRG use (main effect), and FRGs appeared most beneficial to spouses who experienced more stressful events (buffering effect). FRG use and its associations with helpfulness to family and with family coping suggest FRGs are important resources for families of deployed soldiers, in particular, for families of reservists. Future directions for research and practice are proposed.

Causes, comorbidities and current status of chronic kidney disease: A community perspective from North Kerala

Context

Chronic kidney disease is an upcoming public health problem characterized by premature mortality and expensive treatment in low resource settings where diabetes is highly prevalent.

Aim

To find out the causes and comorbidities and to explore the community support systems for treatments availed.

Settings and Design

Community based cross sectional design.

Materials and Methods

Interview of known chronic kidney disease patients above 18 years registered under palliative clinics.

Statistical Analysis Used

Mean, SD, proportions, and 95% Confidence interval, chi square test at significance level P = 0.05.

Results

Majority of patients were males, below 60 years. Mean duration was 5.26 years and mean age at onset was 48.6 years and 62% were in advanced stages of disease. The commonest cause was diabetic nephropathy (44.6%) followed by hypertensive nephropathy (33.3%). The comorbidities included hypertension (61.4%), diabetes (47.3%), cardiovascular disease (30.6%), Chronic obstructive pulmonary disease (10%) malignancies (2.6%), and retinopathy (28%). Considering treatment status 60.6% were on dialysis 13.3% had undergone transplantation, mostly from private institutions with help of public donations and both at significant underutilization by women. Though 44.6% were protected by social security schemes, the median monthly cost of disease management amounted to Rs. 10,500 which was unaffordable for the majority who were below the poverty line.

Conclusions

There is an impending need for strengthening management, high-risk screening among diabetic and hypertensive patients and provision for specialist care to delay the onset of end-stage renal disease. The social security support system should be improvised for our setting to facilitate dialysis and transplantation to minimize out of the pocket expenditure.

Mental Health Care for Survivors and Healthcare Workers in the Aftermath of an Outbreak

When pandemics sweep across communities, they leave behind tremendous suffering in their wake. It is not only the illness that becomes a pandemic, but the same can be inferred about fear, mourning, and despair. The reverberations of loss are felt in a multitude of ways by those left behind. Often times, the mental health issues of affected persons and entire communities do not receive the attention they deserve in the light of other competing, immediate needs imparted by the devastation of the pandemic. This chapter aims to develop strategies for providing psychiatric care to survivors and their families, in the aftermath of a pandemic outbreak. Lastly, special considerations in the application of psychopharmacological interventions are reviewed.

The lived experience of paroled offenders with fetal alcohol spectrum disorder and comorbid psychiatric disorder

This case study presents the life history and postincarceration experiences of two forensic psychiatric patients diagnosed with comorbid mental illness and fetal alcohol spectrum disorder (FASD). The men first met in prison and a few years after their release became roommates at the suggestion of their community support worker and parole officer. With shared and coordinated clinical and mentorship supports, the men were able to establish stability in their lives and manage their mental illness. However, changes in support and gaps within the continuum of care contributed to a sudden breakdown in their stability. The life history and experiences of the two men illustrate the importance in establishing and maintaining positive social networks and coordinated supports for the postincarceration success of offenders living with FASD and comorbid mental illness. The findings highlight areas of patient and system vulnerability that should be addressed to reduce recidivism and strengthen the stability in the lives of these individuals.

National Survey of Convention Centers' Lactation Facilities

BACKGROUND

There is little published about lactation accommodations in public spaces.

OBJECTIVE

The objective of this study was to determine what lactation facilities, if any, convention centers in the United States are providing to accommodate breastfeeding moms.

METHODS

A list of national convention centers was collected from meetings-conventions.com and recorded in an Excel spreadsheet, with the name of the center, total meeting square feet, number of meeting rooms, address, and telephone number. Each convention center was contacted by phone and administered the survey. Questions were asked as to what type of lactation accommodations were available, if any.

RESULTS

A response rate of 78.7% (326 of 414 convention centers) was achieved. A mere 5.5% reported permanently designated lactation rooms, whereas 32% made temporary accommodations. While the phone survey was conducted, a wide variety of qualitative responses were provided by participants, demonstrating an overall lack of awareness of this as a public health issue.

CONCLUSION

Return to work and breastfeeding in public are commonly reported barriers to breastfeeding. This survey clearly demonstrates a lack of accommodations in very public areas that are visited by women on a regular basis. Policy changes are necessary so all women can be supported in reaching their personal breastfeeding goals.

Art and mental health in Samoa

OBJECTIVES

To pilot an art and mental health project with Samoan and Australian stakeholders. The aim of this project was to provide a voice through the medium of art for people experiencing mental illness, and to improve the public understanding in Samoa of mental illness and trauma.

METHODS

Over 12 months, a series of innovative workshops were held with Samoan and Australian stakeholders, followed by an art exhibition. These workshops developed strategies to support the promotion and understanding of mental health in Samoa. Key stakeholders from both art making and mental health services were engaged in activities to explore the possibility of collaboration in the Apia community.

RESULTS

The project was able to identify the existing resources and community support for the arts and mental health projects, to design a series of activities aimed to promote and maintain health in the community, and to pilot these programs with five key organizations.

CONCLUSIONS

This project demonstrates the potential for art and mental health projects to contribute to both improving mental health and to lowering the personal and social costs of mental ill health for communities in Samoa.

An Evaluation of the CDC's Community-Based Breastfeeding Supplemental Cooperative Agreement: Reach, Strategies, Barriers, Facilitators, and Lessons Learned

BACKGROUND

Community-based organizations (CBOs) have an important role to play in promoting breastfeeding continuation among mothers. The Centers for Disease Control and Prevention's Nutrition, Physical Activity, and Obesity Program's Cooperative Agreement Breastfeeding Supplement funded 6 state health departments to support CBOs to implement community-based breastfeeding support activities.

OBJECTIVES

Study objectives were to (1) describe the reach of the Cooperative Agreement, (2) describe breastfeeding support strategies implemented by state health departments and CBOs, and (3) understand the barriers and facilitators to implementing community-based breastfeeding support strategies.

METHODS

Qualitative and quantitative data were abstracted from state health departments' final evaluation reports. Qualitative data were analyzed for common themes using deductive and inductive approaches.

RESULTS

Within the 6 states funded by the Cooperative Agreement, 66 primary CBOs implemented breastfeeding support strategies and reported 59 256 contacts with mothers. Support strategies included incorporating lactation services into community-based programs, training staff, providing walk-in locations for lactation support, connecting breastfeeding mothers to resources, and providing services that reflect community-specific culture. Community partnerships, network building, stakeholders' commitment, and programmatic and policy environments were key facilitators of program success.

CONCLUSION

Key lessons learned include the importance of time in creating lasting organizational change, use of data for program improvement, choosing the right partners, taking a collective approach, and leveraging resources.

Breastfeeding-Friendly Erie County: Establishing the New York State Breastfeeding Friendly Practice Designation

BACKGROUND

Primary care providers play an important role in encouraging and counseling pregnant and postpartum women to successfully breastfeed.

OBJECTIVE

One objective of this 1-year grant was to establish the Breastfeeding Friendly Practice Designation criteria and process to identify and designate at least 5 primary care practices as New York State Breastfeeding Friendly Practices in a high-need, racially/ethnically diverse, urban county in New York with very low prevalence of breastfeeding initiation, exclusivity, and duration.

METHODS

A partnership between the New York State Department of Health and the P(2) Collaborative of Western New York and United Way of Buffalo & Erie County's Healthy Start Healthy Future for All Coalition facilitated the development of the New York State Ten Steps to a Breastfeeding Friendly Practice, accompanying implementation guide, designation criteria, and model office policies. Practice staff and providers received on-site training and materials and participated in a virtual learning network to share their experiences, celebrate successes, and overcome challenges in implementing system changes. Practice staff completed a self-assessment survey at baseline and after implementation of the Ten Steps and submitted their written office breastfeeding policy for review.

RESULTS

Fourteen practices met the criteria for designation and were recognized by the New York State Health Commissioner.

CONCLUSION

The number of practices designated as Breastfeeding Friendly far exceeded the grant objective. Future efforts are directed at expanding this initiative statewide and determining the impact of the designation on breastfeeding outcomes.

Breastfeeding-Friendly Erie County: Establishing a Baby Café Network

Community-based lactation support groups help improve breastfeeding duration by offering practical peer and professional help and counseling through the sharing of information and experiences in a relaxed setting. The objective of this project, funded by the Centers for Disease Control and Prevention, was to establish at least 5 Baby Cafés in organizations that reach low-income women living in a high-need, racially/ethnically diverse, urban county with 1 of the lowest rates of breastfeeding initiation, exclusivity, and duration in New York. The New York State Department of Health partnered with the P(2) Collaborative of Western New York and United Way of Buffalo & Erie County's Healthy Start Healthy Future for All Coalition to facilitate the recruitment of 11 community-based agencies in Erie County, New York, to provide and/or enhance breastfeeding support. Six organizations were funded to establish licensed Baby Cafés, which provided skilled, free-of-charge, drop-in lactation support and counseling to mothers at easily accessible locations. The organizations provided staff training and staffing at the Baby Cafés, established coordinated hours of operation between all locations, and jointly marketed their services. Collectively, the 6 Baby Cafés provided 11 drop-in sessions per week. During the 7-month start-up time, mothers/babies made 276 visits and they averaged 75 visits per month, representing at least 150 clients. After the funding ended, 5 organizations continued to support and staff the Baby Cafés whereas 1 organization added another Baby Café. Future evaluation is needed to determine their effect on breastfeeding exclusivity and duration.

The Bosom Buddy Project: A Breastfeeding Support Group Sponsored by the Indiana Black Breastfeeding Coalition for Black and Minority Women in Indiana

In 2012, the Indiana Black Breastfeeding Coalition (IBBC) used grant funds to increase participation in the Bosom Buddy Project, an original breastfeeding support group that pairs breastfeeding mothers with trained mentors. Resources for local organizations that support breastfeeding are extremely limited, making it difficult to expand programs and services. This article describes a variety of strategies used by the IBBC to expand programs and services. These activities provide a template for other community-based organizations that wish to provide culturally sensitive breastfeeding support in their community.

The role of national policies and mental health care systems in the development of community care and community support: an international analysis

BACKGROUND

The development of adequate community support of persons with severe mental health problems is an ongoing effort. National policies and national health and social care systems play an important role in the effectiveness of these efforts.

AIMS

To get a better understanding of the ways in which national policies and (mental) health care systems can enhance the development of community support and social inclusion for people with severe mental illness.

METHOD

A comparison was made between the experiences of 75 key persons on regional community support development regarding national policies and systems in Denmark, England and the Netherlands respectively.

RESULTS

Four themes stood out as being particularly instrumental in the development of community support: - implementation of a national policy on social inclusion, - development of a national framework of responsibilities, entitlements and services, - solid funding and social inclusion incentivizing reimbursement systems, - integrated care.

CONCLUSION

National governments do have opportunities to take or retake the lead to ensure that community support and social inclusion of persons with severe mental illness health problems are not just ideological slogans but solid policy.