Using GPS and Self-Report Data to Examine the Relationship Between Community Mobility and Community Participation Among Autistic Young Adults

IMPORTANCE

Community participation of autistic adults is important for health and well-being. Many clinical efforts and interventions aim to enhance community participation in this population.

OBJECTIVE

To empirically examine the relationship between community participation and community mobility.

DESIGN

A randomized controlled trial using data from baseline and 4- to 6-wk follow-up.

SETTING

Community organizations serving autistic adults in Philadelphia.

PARTICIPANTS

Sixty-three autistic young adults with data on community mobility and participation from a prior study on public transportation use.

OUTCOMES AND MEASURES

Participants were tracked with GPS-enabled cell phones over a 2-wk period. A spatiotemporal data mining algorithm was used to compute the total number of destinations, nonhome destinations, unique destinations, percentage of time spent outside the home, and median daily activity space area from the GPS data. The Temple University Community Participation measure was used to collect self-report data in 21 different areas, and total amount, breadth, and sufficiency of participation were calculated.

RESULTS

Moderate and statistically significant associations were found between community mobility and participation variables at baseline and follow-up. However, changes in community mobility were not related to changes in community participation.

CONCLUSION

Health policymakers and providers should consider community mobility as a factor that can affect community participation in autistic individuals. Plain-Language Summary: Lower levels of community participation among autistic young adults affect health outcomes and overall quality of life. Community mobility is often a barrier to community participation. An understanding of the relationship between community mobility and community participation can lead to occupational therapists tailoring specific interventions and policies that support autistic young adults to engage in important life activities within the community.

Community Participation of Individuals with Mental Illnesses in Rural Areas: Stakeholder Perspectives on Barriers and Facilitators

Community inclusion and participation are social determinants of physical and mental health. This study examines activity preferences, barriers to engagement, and potential strategies for facilitating community participation for individuals with serious mental illness living in rural communities. Data for this qualitative study were collected in a series of focus groups with a stakeholders in rural Pennsylvania. Written responses to questions on activities, barriers, facilitators, and solutions were analyzed by members of the research team. The activities that are important to our participants included both those readily accessible in rural areas and those only accessible in more urban areas. Many of the barriers identified aligned with prior research (e.g., poverty, community mobility issues). A number of novel and feasible solutions to overcome barriers were provided at the policy, program, and practice levels, some of which that can be implemented immediately, to increase participation, and improve overall health of people with mental illnesses.

Constructing the public in public perceptions research: A case study of forest genomics

Contemporary scientific and technological endeavours face public and political pressure to adopt open, transparent and democratically accountable practices of public engagement. Prior research has identified different ways that experts 'imagine publics' - as uninformed, as disengaged, as a risk to science, and as co-producers of knowledge - but there has yet to be a systematic exploration of how these views emerge, interact and evolve. This article introduces a typology of imagined publics to analyse how publics are constructed in the field of forest genomics. We find that deficit views of publics have not been replaced by co-production. Instead, deficit and co-productive approaches to publics co-exist and overlap, informing both how publics are characterized and how public perceptions are studied. We outline an agenda for deepening and expanding research on public perceptions of novel technologies. Specifically, we call for more diverse and complex methodological approaches that account for relational dynamics over time.

Transdisciplinary science and the importance of Indigenous knowledge

As we move ever closer to the brink of global environmental collapse, it is vital that we work collaboratively and collectively as global, national, and local communities to design multiscale change. Protecting future generations and reversing (or substantively slowing) the current trends require rapid sustainable progress at the required scale. It is more urgent than ever that we understand and more fully realize the power of transdisciplinary (Td) research to support sustainable practice. A defining factor of Td is the focus on collaboration and codesign and the extent that participation and attention to local context is integral to the knowledge building. Specifically, there is greater ability for community knowledge, values, and aspirations to influence and shape research inquiries to effect meaningful change in real-world decision-making and outcomes. Business-as-usual (BAU) approaches that perpetuate unequal knowledge sharing and dismiss other forms of knowledge beyond traditional science no longer suffice. Transdisciplinary approaches seek to achieve and support sustainable change, but the extent of transformation required to meet ecological protection and regenerative sustainability requires very different operating models for knowing and doing science than the limited traditions of positivist science. However, these powerful defaults and operating paradigms are more deeply ingrained than we might realize, and so challenges persist. This article illustrates how Td science differs from typical research paradigms, particularly in terms of the underlying epistemology; the focus on knowledge and/or power; attention to boundaries and scope; and the degree to which local knowledge, context, and community participation underpin the research process. Active conversations are required to better identify and overcome fundamental challenges for science and Td research approaches to support the necessary transformational change. Importantly, we suggest that Indigenous partnerships, knowledge, and values are vital in achieving the potential of Td research to provide transformational interventions to address complex social and environmental issues such as pollution. Integr Environ Assess Manag 2024;20:805-816. © 2023 SETAC.

Does engagement matter? The impact of patient and community engagement on implementation of cardiovascular health materials in primary care settings

BACKGROUND

Engaging patients and community members in healthcare implementation, research and evaluation has become more popular over the past two decades. Despite the growing interest in patient engagement, there is scant evidence of its impact and importance. Boot Camp Translation (BCT) is one evidence-based method of engaging communities in research. The purpose of this report is to describe the uptake by primary care practices of cardiovascular disease prevention materials produced through four different local community engagement efforts using BCT.

METHODS

EvidenceNOW Southwest (ENSW) was a randomized trial to increase cardiovascular disease (CVD) prevention in primary care practices. Because of its study design, Four BCTs were conducted, and the materials created were made available to participating practices in the "enhanced" study arm. As a result, ENSW offered one of the first opportunities to explore the impact of the BCT method by describing the uptake by primary care practices of health messages and materials created locally using the BCT process. Analysis compared uptake of locally translated BCT products vs. all other products among practices based on geography, type of practice, and local BCT.

RESULTS

Within the enhanced arm of the study that included BCT, 69 urban and 13 rural practices participated with 9 being federally qualified community health centers, 14 hospital owned and 59 clinician owned. Sixty-three practices had 5 or fewer clinicians. Two hundred and ten separate orders for materials were placed by 43 of the 82 practices. While practices ordered a wide variety of BCT products, they were more likely to order materials developed by their local BCT.

CONCLUSIONS

In this study, patients and community members generated common and unique messages and materials for cardiovascular disease prevention relevant to their regional and community culture. Primary care practices preferred the materials created in their region. The greater uptake of locally created materials over non-local materials supports the use of patient engagement methods such as BCT to increase the implementation and delivery of guideline-based care. Yes, patient and community engagement matters.

TRIAL REGISTRATION AND IRB

Trial registration was prospectively registered on July 31, 2015 at ClinicalTrials.gov (NCT02515578, protocol identifier 15-0403). The project was approved by the Colorado Multiple Institutional Review Board and the University of New Mexico Human Research Protections Office.

Decision analysis of PPP project's parties based on deep consumer participation

Although PPP(Public-private partnership) mode has been applied for a long time in infrastructural project, the success rate is not very high. The sustainability of PPP projects is still influenced by many factors. In order to examine the evolutionary stable strategies (ESSs) of social capital, government, and paying consumers, a tripartite evolutionary game model is established in this work. In order to further promote consumer participation, it is necessary to make the assumption that customer oversight and review can have an impact on service prices. The results show: i)The strategy choice of consumer depends on the comparison between supervision cost of consumer and price coefficient for consumer to social capital. ii)Consumer supervision can promote the provision of high-quality services by social capital. iii)The difference between high-quality cost and low-quality cost, subsidy coefficient, price coefficient and supervision cost of consumer are critical factors influencing both evolutionary results and trajectories. This paper also puts forward policy implications for the three stakeholders to promote social capital's high-quality strategy so as to maintain the sustainability of PPP projects.

Ending "domestic helicopter research"

"Helicopter research" refers to a practice where researchers from wealthier countries conduct studies in lower-income countries with little involvement of local researchers or community members. This practice also occurs domestically. In this Commentary, we outline strategies to curb domestic helicopter research and to foster equity-centered collaborations.

A review of strategies and levels of community engagement in strengths-based and needs-based health communication interventions

Background

Community engagement is key in health communication interventions that seek to incorporate community voices in their planning and implementation. Understanding what approaches and strategies are currently being used can help tailor programs in different social and cultural contexts. This review explores needs-based and strengths-based approaches and consensus and conflict strategies in community-based global health communications programs. Our objective is to examine the current state of the field, outline lessons learned, and identify gaps in existing programming to help guide future interventions.

Methods

PubMed and Web of Science were searched for articles published between 2010 and 2023. Studies were included if they described a community-based health communication intervention and an ongoing or completed implementation. Interventions were coded then categorized according to their level of community engagement and as single, hybrid, or complex, depending upon the number of approaches and strategies used.

Results

The search yielded 678 results and 42 were included in the final review and analysis. A vast majority 34 (81.0%) interventions utilized a needs-based approach and 24 (57.1%) utilized a strengths-based approach. Consensus as a strategy was utilized in 38 (90.5%) of the manuscripts and 9 (21.4%) implemented a conflict strategy. Interventions that combined approaches and strategies were more likely to leverage a higher level of community engagement.

Conclusion

These results showcase the complicated nature of global health communication program planning and implementation. There is a lack of interventions that use conflict as a strategy to empower communities to act on their own behalf, even when at odds with existing power structures. Complex interventions that include all approaches and strategies demonstrate the potential for global health communication interventions to be at the cutting edge of public health practice.

Consumer and community involvement in preventive health: current insights and considerations for future best practice

Consumer and community involvement (CCI) in preventive research and health initiatives is not only encouraged but is expected within a rapidly evolving landscape across health policy, practice and research. Here, we summarise the fundamental principles of CCI, as well as outline the barriers and current developments in working towards best practices at organisational and systems levels. CCI stands at a critical juncture. Best practice emphasises meaningful partnerships with consumers and communities to deliver impactful research and prevention activities, yet complex challenges and systematic barriers remain. We need further evidence to demonstrate both 'what' and 'how' CCI should be best implemented in these settings. We present key considerations for researchers, organisations and systems to catalyse the transition of CCI from mere recognition of its importance to pragmatic and optimum implementation and, ultimately, to systemic reform. These include changes to capacity building, funding structures, equitable engagement and transparent evaluation. These must be underpinned by evidence-based approaches, partnership, trust and broad consensus processes to achieve meaningful and impactful CCI in research and healthcare improvement through a lens of inclusivity.

A community-engaged approach to translate a Vaccine Hesitancy Scale into Haitian Creole

OBJECTIVE

Accurately translated health materials are needed to achieve equity in vaccine uptake among U.S. individuals with non-English language preferences. Verbatim translations may not capture the cultural and linguistic vernacular required to understand vaccine hesitancy. We leveraged a community-engaged approach to translate the Vaccine Hesitancy Scale (VHS) into Haitian Creole.

METHODS

Following the "WHO Guidelines on Translation and Adaptation of Instruments" and a community-engaged framework, a validated 10-question Vaccine Hesitancy Scale (VHS) underwent forward translation, expert panel review, back translation, and focus group pilot testing.

RESULTS

Haitian Creole-speaking translators included two community leaders, one community partner, one study team member, and 13 Haitian, greater Boston-based community members who participated in a focus group to pretest the survey. After four iterations, a linguistic and cultural translation of the VHS was created.

CONCLUSION

A community-engaged framework strengthened community partnerships and resulted in a culturally relevant Haitian Creole vaccine hesitancy scale.

Profiling the medical, functional, cognitive, and psychosocial care needs of adults assessed for home care in Ontario, Canada: The case for long-term 'life care' at home

Calls to leverage routinely collected data to inform health system improvements have been made. Misalignment between home care services and client needs can result in poor client, caregiver, and system outcomes. To inform development of an integrated model of community-based home care, grounded in a holistic definition of health, comprehensive clinical profiles were created using Ontario, Canada home care assessment data. Retrospective, cross-sectional analyses of 2017-2018 Resident Assessment Instrument Home Care (RAI-HC) assessments (n = 162,523) were completed to group home care clients by service needs and generate comprehensive profiles of each group's dominant medical, functional, cognitive, and psychosocial care needs. Six unique groups were identified, with care profiles representing home care clients living with Geriatric Syndromes, Medical Complexity, Cognitive Impairment and Behaviours, Caregiver Distress and Social Frailty. Depending on group membership, between 51% and 81% of clients had identified care needs spanning four or more Positive Health dimensions, demonstrating both the heterogeneity and complexity of clients served by home care. Comprehensive clinical profiles, developed from routinely collected assessment data, support a future-focused, evidence-informed, and community-engaged approach to research and practice in integrated home-based health and social care.

Sustaining health obesity prevention programs: Lessons from real-world population settings

Current understanding of what sustains public health programs is derived primarily from evaluations of programs delivered for only a few years. To improve program planning and knowledge on program sustainment, we examined real-world population programs that have been delivered for >2 years. Our focus was physical activity and nutrition programs for obesity prevention. We identified programs through published literature and searched through publicly available information on the theoretical factors determining sustainment. We reviewed 90 programs and explored intervention characteristics, provider, delivery and process level factors, and the outer environment influences. Programs were sustained on average 15 years and more frequently characterised as behavioural change skills programs targeting children, funded by non-government organisations and delivered by community organisations. Most programs had undergone some modification (n = 55). Differences between programs were observed across key factors: Programs sustained 15+ years were mainly behaviour skills programs (n = 21); and characterised by interactive designs (i.e., face-to-face or digital) over static innovations (i.e., print material) compared with those sustained <15 years (p = 0.024). While government funding supported many of the programs (n = 45;), those sustained 15+ years were more likely to have been commercially funded (p = 0.044); and were less likely to have current community involvement (p = 0.013). Differences in ownership and funding were also observed across countries. While multiple factors may influence program sustainment, longer delivered programs where distinguished by their program characteristics and outer contextual factors, suggesting such factors may have an important role in sustaining programs in the longer-term.

Parent coaching to enhance community participation in young children with developmental disabilities: A pilot randomized controlled trial

BACKGROUND

Parent coaching emerges as a preferred approach for enhancing performance and participation of children with developmental disabilities (DD), but limited clinical trials examine its effects on community participation.

AIM

To evaluate whether parent coaching, specifically using Occupational Performance Coaching (OPC), enhances community participation among young children with DD.

METHOD AND PROCEDURES

A pilot double-blind randomized controlled trial was conducted. Parents of 50 children with DD (31 male, 19 female, mean age 4 years 10 months) were randomly assigned to the OPC group (n = 25) or parent consultation group (n = 25). Each parent received a maximum of eight coaching sessions or consultations. The primary outcome was children's community participation as assessed through parent-report measures at baseline, pre-intervention, post-intervention, and an 8-week follow-up.

OUTCOMES AND RESULTS

Both groups showed significant improvements in parent-identified, goal-specific community participation after the intervention (mean difference [MD]=2.26-2.56), and these improvements were sustained during the follow-up. Despite a trend favoring parent coaching, the group difference in the improvements was not evident (MD=0.18-0.28). Both groups displayed positive improvements in children's overall community involvement post-intervention (MD=0.32); however, the time effects were not statistically significant.

CONCLUSIONS AND IMPLICATIONS

OPC, by coaching parents, could enhance goal-specific community participation in children with DD, producing effects similar to those achieved through parent consultation.

LGBTQ+ Inclusivity Training and Education: A Toolkit for Skilled Nursing Facilities

OBJECTIVES

The objective of this study was to develop the LGBTQ+ Inclusivity Training and Education (LITE) toolkit and to examine the usability and acceptability of the LITE toolkit to health care workers and staff who work within skilled nursing facilities (SNFs).

DESIGN

A community-engaged approach using human-centered design to develop the LITE toolkit. To test the usability and acceptability of the LITE toolkit, we provided a posttest survey to users after a 9-week period.

SETTING AND PARTICIPANTS

The LITE toolkit was distributed to 25 SNFs throughout a 7-county area in North Carolina.

METHODS

Development processes included an LGBTQ+ community advisory board, development of resource topics and a list of best practices, and development of a website. The LITE toolkit comprised a website of LGBTQ+ resources, poster of 6 Best Practices to LGBTQ+ Care, rainbow lapel pins, and writing pens with the LITE logo. Online surveys were distributed to SNF administrators to share with health care workers and staff to collect data on the usability and acceptability of the LITE toolkit. Descriptive statistics were used for data analysis.

RESULTS

Fifteen participants completed the survey. Answering all survey questions was not a requirement. Seventy-nine percent (n = 14) of SNF health care workers indicated that the LITE toolkit was "easy to understand" and that they were satisfied with the contents. Fifty-three percent (n = 15) responded that the LITE toolkit would improve the way they care for patients. Sixty-six percent (n = 15) of health care workers and staff strongly agreed the LITE toolkit was applicable to their job role.

CONCLUSIONS AND IMPLICATIONS

Providing useful and acceptable LGBTQ+-focused training and education for members of the SNF community addresses the need for health care worker and staff training to foster equitable care and inclusive environments for the LGBTQ+ older adult community. Additional work focused on understanding the facilitators and barriers to using the LITE toolkit in the SNF setting is needed.

Identifying and prioritising strategies to optimise community gym participation for young adults with cerebral palsy: an e-Delphi study

PURPOSE

Identify and prioritise strategies to optimise physical activity participation in the community gym setting for young adults with cerebral palsy.

METHODS

An e-Delphi method was implemented over three rounds with four stakeholder groups (young adults with cerebral palsy, their families, gym staff or exercise professionals, and health professionals). Strategies for change were identified by the stakeholders in round 1. In rounds 2 and 3, strategies for change were rated on the importance for implementation using a 7-point Likert scale (1 being lowest importance, 7 being highest). The consensus was achieved if ≥70% of participants identified a strategy as high importance.

RESULTS

Seventy participants (20 young adults 10 family members, 21 health professionals, and 19 exercise professionals) identified 83 strategies for improving gym participation. Of these, 44 strategies met the consensus criteria. The highest priority strategies related to changing the physical environment, addressing cost barriers, gym staff training, and developing partnerships between sectors.

CONCLUSIONS

Addressing physical accessibility, cost of attendance and the skills of gym staff were agreed upon by the stakeholder groups as priority areas for future resource allocation and research translation. Clinicians and community leisure facilities must work with consumers to implement strategies in their local contexts.

Building citizen science intelligence for outbreak preparedness and response: a mixed-method study in nine countries to assess knowledge, readiness and feasibility

INTRODUCTION

Citizen science (CS) is an emerging approach in public health to harness the collective intelligence of individuals to augment traditional scientific efforts. However, citizens' viewpoint, especially the hard-to-reach population, is lacking in current outbreak-related literature. We aim to understand the awareness, readiness and feasibility of outbreak-related CS, including digitally enabled CS, in low-income and middle-income countries.

METHODS

This mixed-method study was conducted in nine countries between October 2022 and June 2023. Recruitment through civil society targeted the general population, marginalised/indigenous groups, youth and community health workers. Participants (aged ≥18 years) completed a quantitative survey, and a subset participated in focus group discussions (FGDs).

RESULTS

2912 participants completed the survey and 4 FGDs were conducted in each country. Incorporating participants' perspectives, CS is defined as the practice of active public participation, collaboration and communication in all aspects of scientific research to increase public knowledge, create awareness, build trust and facilitate information flow between citizens, governments and scientists. In Bangladesh, Indonesia, the Philippines, Cameroon and Kenya, majority were unaware of outbreak-related CS. In India and Uganda, majority were aware but unengaged, while in Nepal and Zimbabwe, majority participated in CS before. Engagement approaches should consider different social and cultural contexts, while addressing incentivisation, attitudes and practicality factors. Overall, 76.0% expressed interest in digital CS but needed training to build skills and confidence. Digital CS was perceived as convenient, safer for outbreak-related activities and producing better quality and quantity of data. However, there were concerns over non-inclusion of certain groups, data security and unclear communication.

CONCLUSION

CS interventions need to be relatable and address context-specific factors influencing CS participation. Digital CS has the potential to facilitate collaboration, but capacity and access issues must be considered to ensure inclusive and sustainable engagement.

Culturally Adapting Mind-Body Interventions for Black Individuals with Chronic Pain: Arguments and Recommendations Towards a Task-Sharing Approach

Compared to non-Hispanic White individuals, non-Hispanic Black Individuals report worse chronic pain from a variety of medical issues. Among the options for non-pharmacological pain treatment, mind-body interventions (MBI) are a promising modality to help Black individuals manage their chronic pain effectively. MBIs such as mindfulness meditation improve chronic pain and chronic pain-related outcomes by shifting the individual's perception of pain away from stress-related cognitive appraisals, emotional reactions, and behaviors. MBIs may also address disparities in chronic pain outcomes between Black and White individuals because of their contextual overlap with (1) centering and contemplative prayer, (2) racial empowerment, and (3) social support. Despite this overlap, the demand for MBIs among Black individuals has generally been low due to lingering access and acceptability barriers. To reduce these barriers for Black individuals with chronic pain, we must adopt a community-engaged approach and culturally adapt MBIs for the specific historic, environmental, financial, and psychosocial needs of Black individuals. Example adaptations include increasing Black representation among MBI instructors, reducing geographical access barriers, accommodating the financial and personal realities of Black adults, and explicitly allowing relevant attitudes, practices, and terms.

Factors influencing public participation behavior relating to government microblogs on COVID-19 updates

Introduction

During the global COVID-19 pandemic, densely populated megacities engaged in active international exchanges have faced the most severe impacts from both the disease and the associated infodemic. This study examines the factors influencing public participation behavior on government microblogs in these megacities during the pandemic. It guides megacities in disseminating epidemic information, promoting knowledge on epidemic prevention, managing public opinion, and addressing related matters.

Methods

Utilizing the elaboration likelihood model's central and peripheral routes, drawing on an empirical analysis of 6,677 epidemic-related microblogs from seven Chinese megacities, this study analyses the influence mechanisms influencing public participation behavior and reveals the regulatory role of confirmed case numbers. Meanwhile,a qualitative comparative analysis examines and discusses diferent confgurations of ixn fuential factors.

Results

The study reveals that microblog content richness demonstrates a U-shaped impact on public participation behavior. Conversely, content interaction, content length, and the number of fans positively impact participation, while update frequency has a negative impact. Additionally, the number of new confrmed cases positively regulates the impact of microblog content and publisher characteristics on public participation behavior. Public participation behavior also varies based on publishing time and content semantic features. This study further revealed the different confgurations of influential factors by QCA method.

Conclusion

This study reveals the impact mechanism of the microblog content and publisher characteristics on public participation behavior. It also demonstrates the regulatory role of newly confrmed cases in the way content and publishers' characteristics influence public participation behavior. This study is of great significance for the operation of government microblogs, the release of emergency information, and the promotion of public participation.

Prescribed safer supply during dual public health emergencies: a qualitative study examining service providers perspectives on early implementation

BACKGROUND

Within North America and worldwide, drug related overdoses have increased dramatically over the past decade. COVID-19 escalated the need for a safer supply to replace unregulated substances and to reduce toxicity and overdoses. Service providers play an integral role in the delivery of safer supply but there is little empirical evidence that conceptualizes effective safer supply from their perspectives. This study explored early implementation and impacts of a safer supply program, capturing the perspectives of an interdisciplinary team of service providers on tensions and issues encountered in the development of the SAFER program.

METHODS

Using a community-based participatory approach, we conducted individual interviews with program providers (n = 9). The research team was composed of researchers from a local drug user organization, a local harm reduction organization, and academic researchers. The Consolidated Framework for Implementation Research (CFIR) informed the interview guide. Data was analyzed using thematic analysis.

RESULTS

There are six themes describing early implementation: (1) risk mitigation prescribing as context for early implementation; (2) developing SAFER specific clinical protocols; (3) accessibility challenges and program innovations; (4) interdisciplinary team and wraparound care; (5) program tensions between addiction medicine and harm reduction; (6) the successes of safer supply and future visions.

CONCLUSION

Early implementation issues and tensions included prescriber concerns about safer supply prescribing in a highly politicized environment, accessibility challenges for service users such as stigma, encampment displacement, OAT requirements, program capacity and costs, and tensions between addiction medicine and harm reduction. Navigating these tensions included development of clinical protocols, innovations to reduce accessibility challenges such as outreach, wraparound care, program coverage of medication costs and prescribing safer supply with/without OAT. These findings contribute important insights for the development of prescribed safer supply programs.

[Participation in primary care research - From the idea to the constitution of a citizens advisory board]

INTRODUCTION

Public participation in research processes is becoming increasingly important and is justified with positive effects for research. The first successful initiatives can also be found in general practice and health services research. The transparent presentation of these projects is essential to the discussion about participation. The aim of this article is to present and discuss the conception and implementation of the initiative at the Institute of General Practice and Health Services Research at the Technical University of Munich and the kick-off event for the participation of patients, citizens and patient representatives.

METHODS

This article reports the planning, recruitment, implementation, and evaluation of the kick-off event. Frameworks for future events are described.

RESULTS

In total, twelve persons were recruited through various recruitment channels to participate in the kick-off event. The participants showed a diverse structure of motives with regard to participation in research. All participants shared the essential goal of improving research and care by adding their perspectives to research processes. However, the specific opportunities for participation and the role of patients and citizens in research processes were unclear. During the event, future workshops were planned to address these challenges. The focus was on strengthening relationships and communicating the basics of primary care research in order to enable sustainable participation.

DISCUSSION

The participants' different motivations resulted in the need to explore the concrete possibilities of participation. One of the specific requirements was to focus on role identification and the structure of the initiative. The question of self-description and -identification as a patient and/or citizen seemed crucial. Furthermore, a concise introduction to the topic of participation in research processes, as well as patient and citizen qualifications, is considered necessary.

CONCLUSION

Establishing an advisory board for patients and citizens in primary care research is associated with specific requirements. In addition to fundamental necessities such as the joint clarification of the possibilities of participation, defining the role and establishing the identity of the initiative should be promoted.

"They didn't think we'd do it!": Community gardening as an act of resistance for people with dementia

People living with dementia commonly report negative experiences such as disempowerment, stigma, and oppression. Community gardening has demonstrated its potential as a forum for the practice of resistance against the oppressions experienced by other marginalised groups; however, this element of the experience of community gardening has yet to be explored in the context of dementia. A collaboratively-designed community gardening project took place over six weeks, involving six people with dementia. The participants selected all activities undertaken in the garden. Data were collected through semi-structured group interviews with the gardeners and researcher observations. Context-setting semi-structured individual interviews were conducted with four day centre staff members, and three key informants who had experienced working with people with dementia in the garden. The garden acted as a platform for the articulation of both verbal and embodied expressions of resistance against the disempowerment and loss of agency experienced by many people with dementia. The participatory design of the gardening sessions enabled the gardeners to assert their autonomy and independence, and defy the negative stereotypes associated with dementia, which some of the group members appeared to have internalised. Community gardening activities may offer a forum for expressions of resistance against the structures oppressing individuals with dementia. However, in order for this potential to be unlocked, such initiatives must be collaboratively designed, following an approach which recognises the strengths and enduring abilities of people living with dementia. Additionally, the empowering impact of community gardening should not be diluted by positioning the activity as a substitute for adequate statutory health and social care provision, thereby individualising responsibility for the wellbeing of people with dementia.

Emotional, Behavioral, and Cognitive Symptom Associations With Community Participation in Chronic Traumatic Brain Injury

OBJECTIVES

To determine the association between self-reported emotional and cognitive symptoms and participation outcomes in chronic traumatic brain injury (TBI) and to explore the relative contribution of self-reported versus performance-based cognition to participation outcomes.

SETTING

Community.

PARTICIPANTS

Community-dwelling adults ( n = 135) with a lifetime history of mild to severe TBI.

DESIGN

Secondary analysis of a cross-sectional study on neurobehavioral symptoms in chronic TBI.

MAIN MEASURES

Behavioral Assessment Screening Tool (BAST) (Negative Affect, Fatigue, Executive Dysfunction, Impulsivity, Substance Abuse subscales) measured self-reported neurobehavioral symptoms; Participation Assessment with Recombined Tools (Productivity, Social Relations, and Out and About) measured self-reported participation outcomes; and Brief Test of Adult Cognition by Telephone (BTACT) measured performance-based cognition (Episodic Memory and Executive Function summary scores) in a subsample ( n = 40).

RESULTS

The BAST Executive Dysfunction was significantly associated with less frequent participation and had the strongest effect on participation in all participation domains. No other BAST subscales were associated with participation, after adjusting for all subscale scores and age, with the exception of BAST Impulsivity, which was associated with more frequent Social Relationships. Exploratory analysis in the sample including the BTACT revealed that, after accounting for subjective Executive Dysfunction using the BAST, performance-based Executive Function was associated with Productivity and Working Memory was associated with Social Relations, but neither was associated with being Out and About; the BAST Executive Dysfunction remained significant in all models even after including BTACT scores.

CONCLUSIONS

Self-reported Executive Dysfunction contributed to participation outcomes after mild to severe TBI in community-dwelling adults, whereas self-reported emotional and fatigue symptoms did not. Performance-based cognition measures may capture different variability in participation after injury.

Are We the Problem? A Call to Action for Addressing Institutional Challenges to Engaging Community Partners in Research

Community-engaged research (CEnR) is a potent tool for addressing health inequities and fostering equitable relationships among communities, researchers, and institutions. CEnR involves collaboration throughout the research process, demonstrating improvements in study recruitment and retention, intervention efficacy, program sustainability, capacity building among partners, and enhanced cultural relevance. Despite the increasing demand for CEnR, institutional policies, particularly human participation protection training (HPP), lag behind, creating institutional barriers to community partnerships. Here, we highlight challenges encountered in our ongoing study, Fostering Opportunities in Research through Messaging and Education (FOR ME), focused on promoting shared decision-making around clinical trial participation among Black women diagnosed with breast cancer. Grounded in CEnR methods, FOR ME has a partnership with a community-based organization (CBO) that addresses the needs of Black women with breast cancer. Our CBO partner attempted to obtain HPP training, which was administratively burdensome and time-consuming. As CEnR becomes more prevalent, academic and research institutions, along with researchers, are faced with a call to action to become more responsive to community partner needs. Accordingly, we present a guide to HPP training for community partners, addressing institutional barriers to community partner participation in research. This guide outlines multiple HPP training pathways for community partners, aiming to minimize institutional barriers and enhance their engagement in research with academic partners.

Community engagement approaches for malaria prevention, control and elimination: a scoping review

INTRODUCTION

Globally malaria programmes have adopted approaches to community engagement (ACE) to design and deliver malaria interventions. This scoping review aimed to understand, map, and synthesise intervention activities guided by ACE and implemented by countries worldwide for the prevention, control and elimination of malaria.

METHODS

Three databases (Web of Science, Proquest, and Medline) were searched for peer-reviewed, primary studies, published in English between 1 January 2000 and 31 December 2022. Advanced Google was used to search for grey literature. The five levels of the International Association for Public Participation were used to categorise ACE - (1) Inform, (2) Consult, (3) involve, (4) Collaborate, and (5) Co-lead. Intervention activities were categorised as health education (HE), and/or health services (HS), and/or environmental management (EM). Outcomes were collected as knowledge, attitude, behaviour, help-seeking, health and HS and environment. Enablers and barriers were identified. Malaria intervention phases were categorised as (1) prevention (P), or (2) control (C), or (3) prevention and control (PC) or prevention, control and elimination (PCE).

RESULTS

Seventy-five studies were included in the review. Based on ACE levels, most studies were at the inform (n=37) and involve (n=26) level. HE (n=66) and HS (n=43) were the common intervention activities. HE informed communities about malaria, its prevention and vector control. EM activities were effective when complemented by HE. Community-based HS using locally recruited health workers was well-accepted by the community. Involvement of local leaders and collaboration with local stakeholders can be enablers for malaria intervention activities.

CONCLUSION

Involving local leaders and community groups in all stages of malaria prevention programmes is vital for successful interventions. Key elements of successful ACE, that is, consult, collaborate, and co-lead were under-represented in the literature and require attention. National programes must consult and collaborate with community stakeholders to develop ownership of the interventions and eventually co-lead them.

Sustainable political commitment is necessary for institutionalizing community participation in health policy-making: Insights from Iran

BACKGROUND

Community participation is currently utilized as a national strategy to promote public health and mitigate health inequalities across the world. While community participation is acknowledged as a civic right in the Constitution of Iran and other related upstream documents, the government has typically failed in translating, integrating and implementing community participation in health system policy. The present study was conducted to determine the level of public voice consideration within the health policy in Iran and address fundamental interventions required to promote the public voice in the context of Islamic Republic of Iran (IRI). This study has originality because there is no study that addresses the requirements of institutionalizing community participation especially in low-middle-income countries, so Iran's experience can be useful for other countries.

METHODS

Methodologically, this study utilized a multi-method and multi-strand sequential research design, including qualitative, comparative and documentary studies. In the first phase, the current level of community participation in the health policy cycle of Iran was identified using the International Association for Public Participation (IAP2) spectrum. In the second phase, a comparative study was designed to identify relevant interventions to promote the community participation level in the selected countries under study. In the third phase, a qualitative study was conducted to address the barriers, facilitators and strategies for improving the level of public participation. Accordingly, appropriate interventions and policy options were recommended. Interventions were reviewed in a policy dialogue with policy-makers and community representatives, and their effectiveness, applicability and practical feasibility were evaluated.

RESULTS

Based on the IAP2 spectrum, the level of community participation in the health policy-making process is non-participation, while empowerment is set at the highest level in the upstream documents. Moreover, capacity-building, demand, mobilization of the local population, provision of resources and setting a specific structure were found to be among the key interventions to improve the level of community participation in Iran's health sector. More importantly, "political will for action" was identified as the driving force for implementing the necessary health interventions.

CONCLUSIONS

To sum up, a paradigm shift in the governing social, economic and political philosophy; establishing a real-world and moral dialogue and communication between the government and the society; identifying and managing the conflicts of interest in the leading stockholders of the healthcare system; and, more importantly, maintaining a stable political will for action are integral to promote and institutionalize participatory governance in the health sector of Iran. All of the above will lead us to scheme, implement and institutionalize suitable interventions for participatory governance in health and medicine.

Communities catalyzing change with data to mitigate an invisible menace, traffic-related air pollution

OBJECTIVES

To identify strategies and tactics communities use to translate research into environmental health action.

METHODS

We employed a qualitative case study design to explore public health action conducted by residents, organizers, and public health planners in two Massachusetts communities as part of a community based participatory (CBPR) research study. Data sources included key informant interviews (n = 24), reports and direct observation of research and community meetings (n = 10) and project meeting minutes from 2016-2021. Data were coded deductively drawing on the community organizing and implementation frameworks.

RESULTS

In Boston Chinatown, partners drew broad participation from community-based organizations, residents, and municipal leaders, which resulted in air pollution mitigation efforts being embedded in the master planning process. In Somerville, partners focused on change at multiple levels, developer behavior, and separate from the funded research, local legislative efforts, and litigation.

CONCLUSIONS

CBPR affords communities the ability to environmental health efforts in a way that is locally meaningful, leveraging their respective strengths. External facilitation can support the continuity and sustainment of community led CBPR efforts.

Exploring the impact of social media on tourist behavior in rural mountain tourism during the COVID-19 pandemic: The role of perceived risk and community participation

PURPOSE

This research article aims to assess the behavior of tourists in sustainable rural mountain tourism during the COVID-19 pandemic, focusing on the role of social media usage. It investigates the key social media features that influence tourist behavior and introduces the concept of perceived risk as a novel variable within the Technology Acceptance Model (TAM) to deepen our understanding of the relationship between social media use and tourist behavior.

DESIGN/METHODOLOGY/APPROACH

The study conducts an extensive literature review and utilizes survey analysis. Three parameters-perception of risk, perception of value, and trust in social media-are employed to measure the impact of influential social media features. Statistical tests are applied to validate the new variable of perceived risk within the TAM.

FINDINGS

The study unveils that tourists' perception of risk associated with social media has the most significant influence on their behavior in rural mountain tourism during the pandemic. Additionally, it identifies that active engagement of tourists in online discussions positively affects both tourist behavior and social media usage, emphasizing the importance of community participation.

RESEARCH LIMITATIONS/IMPLICATIONS

The research acknowledges limitations, including the need for further validation of the perceived risk variable and the consideration of contextual influences. Future studies should explore additional variables and encompass diverse tourist populations to expand the understanding of social media usage and tourist behavior in rural mountain regions.

CONTRIBUTION OF RESEARCH

This research significantly advances the understanding of tourist behavior in sustainable rural mountain tourism during the COVID-19 pandemic by introducing the novel variable of "perceived risk" within the Technology Acceptance Model. The study identifies influential social media features and underscores the positive effects of participatory habits, providing valuable insights for promoting sustainable tourism through targeted social media interventions.

PRACTICAL IMPLICATIONS

This research holds significant practical implications for practitioners and policymakers seeking to promote sustainable tourism in rural mountain regions, particularly during the COVID-19 pandemic. The identification of influential social media features and the emphasis on participatory habits among tourists offer actionable insights. Practitioners can leverage these findings to design targeted social media interventions that foster community engagement and enhance tourists' perception of value while mitigating perceived risks. Policymakers can use this information to shape strategies that encourage interactive online platforms, creating a sense of community participation to boost sustainable tourism.

Dark citizen science

Citizen science is often celebrated. We interrogate this position through exploration of socio-technoscientific phenomena that mirror citizen science yet are disaligned with its ideals. We term this 'Dark Citizen Science'. We identify five conceptual dimensions of citizen science - purpose, process, perceptibility, power and public effect. Dark citizen science mirrors traditional citizen science in purpose and process but diverges in perceptibility, power and public effect. We compare two Internet-based categorisation processes, Citizen Science project Galaxy Zoo and Dark Citizen Science project Google's reCAPTCHA. We highlight that the reader has, likely unknowingly, provided unpaid technoscientific labour to Google. We apply insights from our analysis of dark citizen science to traditional citizen science. Linking citizen science as practice and normative democratic ideal ignores how some science-citizen configurations actively pit practice against ideal. Further, failure to fully consider the implications of citizen science for science and society allows exploitative elements of citizen science to evade the sociological gaze.

Racial and ethnic inequities in stillbirth in the US: Looking upstream to close the gap: Seminars in Perinatology

Though stillbirth rates in the United States improved over the previous decades, inequities in stillbirth by race and ethnicity have persisted nearly unchanged since data collection began. Black and Indigenous pregnant people face a two-fold greater risk of experiencing the devastating consequences of stillbirth compared to their White counterparts. Because race is a social rather than biological construct, inequities in stillbirth rates are a downstream consequence of structural, institutional, and interpersonal racism which shape a landscape of differential access to opportunities for health. These downstream consequences can include differences in the prevalence of chronic health conditions as well as structural differences in the quality of health care or healthy neighborhood conditions, each of which likely plays a role in racial and ethnic inequities in stillbirth. Research and intervention approaches that utilize an equity lens may identify ways to close gaps in stillbirth incidence or in responding to the health and socioemotional consequences of stillbirth. A community-engaged approach that incorporates experiential wisdom will be necessary to create a full picture of the causes and consequences of inequity in stillbirth outcomes. Investigators working in tandem with community partners, utilizing a combination of qualitative, quantitative, and implementation science approaches, may more fully elucidate the underpinnings of racial and ethnic inequities in stillbirth outcomes.

Bridging scales for landscape-level wildfire adaptation: A case study of the Kittitas Fire Adapted Communities Coalition

Federal-level strategies or guidance for addressing wildfire risk encourage adaptation activities that span progressively larger scales, often focusing on landscape-level action that necessitates coordination between decision-makers and socially diverse communities. Collaborative organizations are increasingly explored as one approach for coordinating local efforts that address wildfire risk and adaptation, offering a platform for scaling and adjusting federal and state guidance that align with the needs of local landscapes. We conducted semi-structured interviews with members and supporters of the Kittitas Fire Adapted Communities Coalition (KFACC) and later facilitated two workshops at the behest of the organization. The goal of our interviews and workshops were to better understand how organizations such as KFACC emerge, function, and evolve in complex social and ecological landscapes, with a focus on their role in addressing landscape-level wildfire adaptation. We use an existing theoretical analogy of fire adaptation that crosses institutional and physical scales to help conceive of lessons from in-depth analysis of KFACC functioning. We found that KFACC originated from a need to establish a shared local mission for fire adaptation and a recognition that federal and state initiatives surrounding wildfire management needed further contextualization to be effective among diverse local social conditions. Later organizational foci included identifying key audiences for targeted adaptation efforts, including the identification of key messages and communities where specific mitigation actions might be needed. KFACC members were effective in strategically advocating for fire adaptation resources and policies at broader scales that might increase adaptation within Kittitas County, including caveats to local planning efforts designed for wildfire risk reduction. Likewise, the organization had begun to focus on tailoring mitigation efforts to different communities in the landscape as an effective means of catalyzing sustained, realistic fire adaptation actions. We suggest that organizations like KFACC are well-positioned to act as "board hoppers" who can integrate community-based needs into wildfire management, but caution that the functioning and 'niche' of such organizations may require strategic development or regular reflection on organizational goals.

Implementation of a strengths-based approach in a traumatic brain injury community service; perspectives of community workers

Background The strengths-based approach (SBA) was initially developed for people living with mental health issues but may represent a promising support option for community participation of people living with a traumatic brain injury (TBI). A community-based organisation working with people living with TBI is in the process of adapting this approach to implement it in their organisation. No studies explored an SBA implementation with this population. This study explores the implementation of key components of the SBA in a community-based organisation dedicated to people living with TBI. Methods A qualitative descriptive design using semi-structured interviews (n  = 10) with community workers, before and during implementation, was used. Transcripts were analysed inductively and deductively. Deductive coding was informed by the SBA fidelity scale. Results Group supervision and mobilisation of personal strengths are key SBA components that were reported as being integrated within practice. These changes led to improved team communication and cohesiveness in and across services, more structured interventions, and greater engagement of clients. No changes were reported regarding the mobilisation of environmental strengths and the provision of individual supervision. Conclusion The implementation of the SBA had positive impacts on the community-based organisation. This suggests that it is valuable to implement an adaptation of the SBA for people living with TBI.

Mirai Chatterjee: community action for women's health equity

Mirai Chatterjee talks to Fid Thompson about overcoming inequity and tackling the social determinants of health impacting female informal sector workers through collective action.

Community engagement in the development of health-related data visualizations: a scoping review

OBJECTIVE

This scoping review aims to address a gap in the literature on community engagement in developing data visualizations intended to improve population health. The review objectives are to: (1) synthesize literature on the types of community engagement activities conducted by researchers working with community partners and (2) characterize instances of "creative data literacy" within data visualizations developed in community-researcher partnerships.

METHODS

Using the 2018 PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines, the review focuses on peer-reviewed journal articles from 2010 to 2022 in PubMed, Web of Science, and Google Scholar. A community engagement tool was applied to the studies by independent reviewers to classify levels of community engagement, social determinants, and vulnerable populations.

RESULTS

Twenty-seven articles were included in the scoping review. Twelve articles worked with vulnerable populations. Four articles attempted to alleviate barriers to representation in their respective studies, with addressing language barriers being the most prevalent approach. Thirteen articles considered social determinants of health. Sixteen studies engaged in iterative approaches with intended users when developing the visualization or tool.

DISCUSSION

Only a few significant examples of creative data literacy are incorporated in the studies. We recommend a specific focus on engaging intended users at every step of the development process, addressing language and cultural differences, and empowering intended users as data storytellers.

CONCLUSIONS

There is room for deeper and more meaningful community involvement in the development of health-related data visualizations geared towards them.

A scoping review of health inequities in alcohol use disorder

Background: Alcohol Use Disorder (AUD) poses a significant health burden on individuals. The burden occurs more frequently in the medically underserved, as well as racial and sexual minority populations. Ameliorating health inequities is vital to improving patient-centered care.Objectives: The objective of this scoping review is to chart the existing evidence on health inequities related to AUD and identify existing knowledge gaps to guide future equity-centered research.Methods: We performed a literature search using the Ovid (Embase) and MEDLINE (PubMed) databases for articles on AUD that were published in the 5-year period spanning from 2017 to 2021 and written in English. The frequencies of each health inequity examined were analyzed, and findings from each included study were summarized.Results: Our sample consisted of 55 studies for analysis. The most common inequity examined was by race/ethnicity followed by sex or gender. The least reported inequities examined were rural under-resourced areas and occupational status. Our findings indicate that significant research gaps exist in education, rural under-resourced populations, and LGBTQ+ communities with AUD.Conclusions: This scoping review highlights the gaps in research on inequities in AUD. To bridge the current gaps, we recommend research on the following: 1) triage screening tools and the use of telemedicine for rural, under-resourced populations; 2) interventions to increase treatment engagement and retention for women; and 3) community-based participatory methodologies for the LGBTQ+ communities.

Institutionalization for good governance to reach sustainable health development: a framework analysis

BACKGROUND

This article explores the concept of institutionalization, which is the process of transforming ideas into programs and automating actions, in the context of health system governance and sustainable development. Institutionalization is a key mechanism for creating accountable and transparent institutions, which are essential for achieving health system resilience and sustainability. This study identifies the components and dimensions of institutionalization in the health system and its relationship with good governance and sustainable health development.

MAIN TEXT

We applied a scoping review method in five steps. First, we formulated a question for our research. Then, we concluded a comprehensive literature search in five electronic databases for identifying relevant studies. This review has two phases: identifying the concept of institutional approach and its components in health system, and its relationship with good governance to reach Sustainable Health Development (SHD). The third step was study selection, and the 1st author performed data abstraction. The key issues which are identified in our review, related to the concepts of SDH, its goals, pillars and principles; positive peace; good governance; components of institutional approach components, and their relations. Finally, we summarized and organized our findings in a format of a proposed conceptual framework, to underpin the role of institutionalization in the health system to achieve sustainable development.

CONCLUSION

Institutionalization is a key concept for achieving positive peace and good governance, which requires meaningful involvement of leaders, politicians, civil society, and public participation. It also depends on the conditions of justice, human rights, transparency, accountability and rule of law. In the wake of COVID-19, institutionalization is more crucial than ever for advancing sustainable development, especially in the context of low and middle-income countries (LMICs).

Sense of community affects community satisfaction: Mediating role of community participation

Community satisfaction is a central component of community development because it indicates the overall contentment of residents with their community. As such, it can indicate the directions for community development. This study is aimed at examining a sense of community and community participation as factors influencing community satisfaction in the Yirgachefe district of Ethiopia. We collected data from 360 randomly selected household heads (male = 80.2%, female = 19.2%) residing in 12 rural communities. We used structural equation modeling to analyze the data. Results revealed that residents with a higher sense of community were more likely to have participated in their community and to be satisfied with their community. However, sense of community only indirectly influenced community satisfaction and had an insignificant direct effect on community satisfaction. There is a fully mediating effect of community participation between sense of community and community satisfaction. We propose policy implications based on the study.

[The influence of the institutions on local health councils]

OBJECTIVE

To analyze the influences of the institutions in the operation of the Local Health councils.

DESIGN

qualitative, descriptive and exploratory study.

STUDY SETTING

02 Primary Health Care services of a municipality in the inland of the state of São Paulo, Brazil.

PARTICIPANTS

twenty-four members of the Local Health Councils and 4 key informants.

METHODS

Supported by the theoretical methodological framework of Institutional Analysis. Data were produced through 28 semi-structured interviews, observation and participation in the activities of the councils and recording in the research diary. Data were organized and analyzed by the process of transcription, transposition and reconstitution.

RESULTS

The institutions act in the territories represented by social actors who occupy positions and functions within the Primary Health Care services, evidencing the perpetuation of hierarchization with valorization of the speeches of professionals and managers to the detriment of patients and predominance of bureaucratized meetings. The social actors reproduce the ideals of the collective to which they belong in these spaces.

CONCLUSIONS

The health management teams do not recognize the different forces that act in the health territory, however, these forces interfere in the activities performed and in health care. The groups act both in formal spaces through official representatives who meet and discuss issues in collegiate meetings and in informal spaces, and constitute forces in dispute in the health territory.

Understanding Community Participation in Tree Planting and Management in Deforested Areas in Cameroon's Western Highlands

Deforestation and forest degradation continue to take place at alarming rates in Africa despite global net forest loss reductions. This is prompting large-scale forest restoration involving community volunteers to prevent, halt and reverse the loss of biodiversity for the sustainable development of forest landscapes in Africa. The study explored the motivations, challenges, barriers and negotiation strategies of community volunteers in ecosystem restoration and conservation initiatives in Cameroon's Western Highlands (Mount Bamboutos landscape), given that many such interventions are not achieving desired targets and goals. A total of 134 respondents involving farmers and local implementing NGO workers were interviewed, using semi-structured open-ended questionnaires. One focus group discussion was held with paramount traditional rulers to assess the strength, weaknesses, opportunities and threats (SWOT) of the community-led ecosystem restoration and conservation initiative. The principal components analysis with oblique (Direct oblimin) rotation was used to reduce the number of constitutive items in each dimension of motivation, challenge and barrier to community participation. Linear regression analysis was used to examine how the different dimensions of motivations, challenges and barriers influence community participation. Community participation was initially driven more by environmental motivations given the highly deforested and degraded Mount Bamboutos landscape, but later on driven more by economic and community motivations. Social factors were least expressed and non-significant predictors of participation. Community participation was primarily limited by management, financial, psychological, personal, and information challenges and barriers. Providing financial incentives to cover daily subsistence costs of food and transport was a key negotiation strategy that increased community participation. Conservation organisations should capitalise on environment, community and social motivational appeals during community education and awareness campaigns to increase voluntary community participation. The local knowledge on ecosystem restoration and conservation motivations, challenges, barriers, negotiation strategies, recommendations and SWOT analysis provide relevant baseline information for environment management decision-makers in Cameroon and other Sub-Saharan African countries.

Ethical Challenges of Advances in Vaccine Delivery Technologies

Strategies to address misinformation and hesitancy about vaccines, including the fear of needles, and to overcome obstacles to access, such as the refrigeration that some vaccines demand, strongly suggest the need to develop new vaccine delivery technologies. But, given widespread distrust surrounding vaccination, these new technologies must be introduced to the public with the utmost transparency, care, and community involvement. Two emerging technologies, one a skin-patch vaccine and the other a companion dye and detector, provide excellent examples of greatly improved delivery technologies for which such a careful approach should be developed in order to increase vaccine uptake. Defusing fears and conspiracy mongering must be a key part of their rollout.

Community Participation Challenges for Young Adults with Autism Spectrum Disorders During COVID-19 A Photovoice Study

Autistic Individuals with or without co-occurring Mental Health Conditions Experience Challenges with Community Participation that can Affect Quality of life. These Challenges Involve, but are not Limited to, Transportation, Finances, Accessibility, Attitude towards Participation, and Infrastructure Issues. COVID-19 Added a new Layer of Community Participation Barriers for all Individuals, Especially Autistic Individuals. The purpose of this study is to understand the perceived community participation barriers and facilitators encountered by autistic individuals during a public health crisis using the Photovoice methodology. The study will compare these perceptions of autistic individuals with and without co-occurring mental health conditions during a public health crisis to determine if any distinctions can be determined. Photovoice, an established qualitative outreach methodology, was the foundation for the methods. Participants completed a narrative answering the question "what is a barrier or facilitator to your community participation?" Data were analyzed using grounded theory. Seventeen autistic participants with a mean age of 23 completed the Photovoice study. Eleven (65%) reported at least one co- occurring mental health condition. Data analysis resulted in two major themes COVID-19 and Transportation; and six subthemes access, safety, technology, leisure, shared experiences, and sensory. Autistic individuals with and without co-occurring mental health conditions chose to identify barriers more than facilitators. Participants without co-occurring mental health conditions viewed COVID-19 as a facilitator almost twice as often as those without. Participants with co-occurring mental health conditions reported transportation more as a barrier than those without. In this study conducted during COVID-19 regulations, autistic individuals identified COVID-19 and transportation as the primary barriers to community participation. COVID-19 was identified as both a barrier and a facilitator. Autistic individuals identified that COVID-19 enabled more on-line participation. Autistic individuals with co-occurring mental health conditions can experience a greater increase in symptoms when daily routines and participation are affected. Disruption and changes in participation for the autistic community during the COVID-19 pandemic can have future implications on this population's ability to reintroduce themselves into community participation. Identified facilitators; technology, shared experiences, and leisure are useful tools to combat the participation barriers.

"Everything Changed, Would You Like Me to Elaborate?": A Qualitative Examination of the Impact of the COVID-19 Pandemic on Community Participation Among Young Adults with Early Psychosis and Their Families

OnTrackNY provides early intervention services to young people with early psychosis throughout New York State. This report describes the impact of the COVID-19 pandemic on community participation of OnTrackNY program participants and their families. Thirteen participants and nine family members participated in five focus groups and three individual semi-structured interviews. Data were analyzed using a summary template and matrix analysis approach. Major themes highlight the negative impacts of the pandemic with reports of decreased socializing or using online means to connect, unemployment, challenges with online learning and a decrease in civic engagement. Positive impacts include more time to deepen connections with family and valued friendships and engage in activities that promote wellness and goal attainment. Implications for coordinated specialty care programs include adapting services to promote mainstream community integration and creating new strategies for community involvement of young people within a new context brought forth by the pandemic.

Equitable Policies Need Equitable Practices: Alcohol- and Substance-Exposed Pregnancy as a Case Study

There is clear need for more effective public health policies. Coupled with calls for more effective policies, increasing demand to address public health disparities experienced by systemically marginalized and historically oppressed groups emphasizes the long-standing need for policies that improve public health equity. Such need is highlighted when examining public health issues such as alcohol- and substance-exposed pregnancy (ASEP): Current policies are ineffective at reducing ASEP, and marginalized groups experience disproportionately lower benefits and higher negative consequences as a result of such policies. Powerful strategies to develop more effective policies that can account for the complexity of such issues, such as systems science methods (SSMs), are becoming popular. However, current best practices for such methods often do not emphasize the additional efforts that will be required to develop equitable, not just effective policies. Using ASEP as an example of a crucial complex issue requiring new policy, we suggest additional steps to include in SSM projects for developing more effective policies that will also help stakeholders determine high-equity policies to reduce health disparities. These steps include modeling structural differences experienced by marginalized groups via systemic racism and oppression, incorporating existing cultural and community sources of strength and resilience as key areas for policy development, and evaluating the sustainability of policies as a dimension of efficacy. We also discuss using community-based participatory approaches as a framework for all SSM processes to ensure that policy development itself is grounded in equitable shared decision-making for marginalized individuals.