A Greater Variety of Social Activities Is Associated With Lower Mortality Risk

OBJECTIVES

More frequent engagement in social activity is often associated with better physical health outcomes. Yet, less is known about whether engagement in a greater variety of social activities such as a mix of volunteering and attending club meetings (social activity variety) is important for health. The current study assessed whether social activity variety relates to mortality risk after adjusting for social activity frequency, nonsocial activity frequency and variety, and sociodemographic covariates, and how this relationship varies depending on age.

METHODS

Using data from the Health and Retirement Study, we included 5,017 adults aged 51 and older who completed questions about social activity participation in 2008 and whose mortality status was recorded up to 2019. We also examined whether age moderated the relationship between social activity variety and mortality risk.

RESULTS

Cox proportional hazard model analyses revealed that those with higher activity variety in social activities were more likely to survive over the following 11 years than those with low social activity variety. Moreover, age moderation indicated that the association between social activity variety with mortality risk was stronger among the oldest adults.

DISCUSSION

Findings suggest that a greater variety of social activities is linked to mortality risk even after adjusting for social activity frequency, nonsocial activities, and health status across adulthood.

Moral Challenges of Nurses and Volunteers in Dutch Palliative Care. A Qualitative Study

Objective: To identify moral challenges experienced by nurses and volunteers in palliative care. Methods: A qualitative hermeneutic research design was used. Interviews with nurses (N = 10) and volunteers (N = 4) working in palliative care, in-home care, and hospice setting. Participants were recruited through maximum variation, a purposive sampling technique. Transcriptions were analyzed using qualitative thematic content analysis and open coding. Results: Two themes were identified, each with three subthemes: theme (A) Moral challenges regarding organizational and professional aspects contained the subthemes (1) dealing with protocols and regulations, (2) different professional perspectives on good care, and (3) limits of professionalism. Theme (B) Moral challenges regarding the patient and their family members contained the subthemes (1) dealing with the patient's wishes, (2) the patient's wish to die, and (3) dealing with family members. Conclusion: Nurses and volunteers working in palliative care are confronted with a wide range of moral challenges. Insight into 'real-world ethical challenges' of healthcare providers is important to provide adequate support to nurses and volunteers working in palliative care.

Volunteering experience during emergencies: Comparative analysis of a military operation and a pandemic

The aim of this study was to investigate differences in the volunteering experience in two states of emergency in Israel: Operation Protective Edge (a military man-made emergency) and the first wave of the COVID-19 pandemic (a natural emergency). The sample included 993 volunteers, of whom 498 volunteered during Operation Protective Edge and 504 during the COVID-19 pandemic. A quantitative research design was used to investigate three aspects of the volunteering experience: motives for volunteering, satisfaction from volunteering, and commitment to volunteer. Social solidarity was the most prominent motive for volunteering in both emergencies. The level of the egoistic motives, the intrinsic satisfaction from volunteering, and long-term commitment to volunteering were higher during the COVID-19 pandemic than among the volunteers during the military operation. We used a qualitative research design to investigate the experience of special moments in volunteering. The profile of special moments experienced by the COVID-19 volunteers combined self and client experiences, whereas among Operation Protective Edge volunteers, special moments are reflected mainly in experiences related to the clients and the community.

Engaging Female Community Health Volunteers (FCHVs) for cardiovascular diseases risk screening in Nepal

Introduction

Non-Communicable Diseases (NCDs) have become the leading public health problems worldwide and the cardiovascular diseases (CVDs) is one of the major NCDs. Female Community Health Volunteers (FCHVs) in Nepal are the key drivers to implementing frontline health services. We explored the potential for engaging FCHVs for CVD risk screening at the community level in Nepal.

Methods

We used multiple approaches (quantitative and qualitative) for data collection. The trained FCHVs administered CVD risk screening questionnaire among 491 adults in rural and urban areas and calculated the CVD risk scores. To maintain consistency and quality, a registered medical doctor also, using the same risk scoring chart, independently calculated the CVD risk scores. Kappa statistics and concordance coefficient were used to compare these two sets of risk screening results. Sensitivity and specificity analyses were conducted. Two focus group discussions among the FCHVs were conducted to determine their experiences with CVD risk screening and willingness to engage with CVD prevention and control efforts.

Results

The mean level of agreement between two sets of risk screening results was 94.5% (Kappa = 0.77, P<0.05). Sensitivity of FCHV screening was 90.3% (95% CI: 0.801–0.964); and the specificity was 97% (95% CI: 0.948, 0.984). FCHVs who participated in the FGDs expressed a strong enthusiasm and readiness to using the CVD risk screening tools. Despite their busy workload, all FCHVs showed high level of motivation and willingness in using CVD risk screening tools and contribute to the prevention and control efforts of NCDs. The FCHVs recommended needs for providing additional training and capacity building opportunities.

Conclusion

We conclude that there is a potential for engaging FCHVs to use simple CVD risk screening tools at the community level. The findings are promising, however, further studies engaging larger number of FCHVs and larger population would warrant feasibility of such tools within the existing healthcare systems in Nepal.

Volunteer contributions to Wikipedia increased during COVID-19 mobility restrictions

Wikipedia, the largest encyclopedia ever created, is a global initiative driven by volunteer contributions. When the COVID-19 pandemic broke out and mobility restrictions ensued across the globe, it was unclear whether contributions to Wikipedia would decrease in the face of the pandemic, or whether volunteers would withstand the added stress and increase their contributions to accommodate the growing readership uncovered in recent studies. We analyze [Formula: see text] million edits contributed from 2018 to 2020 across twelve Wikipedia language editions and find that Wikipedia's global volunteer community responded resiliently to the pandemic, substantially increasing both productivity and the number of newcomers who joined the community. For example, contributions to the English Wikipedia increased by over [Formula: see text] compared to the expectation derived from pre-pandemic data. Our work sheds light on the response of a global volunteer population to the COVID-19 crisis, providing valuable insights into the behavior of critical online communities under stress.

The Impact of Volunteering at a Family Camp for Children and Adolescents With Cancer: The Experience of Pediatric Intensive Care Nurses

OBJECTIVE

This study explored the experience of pediatric ICU (PICU) nurses who volunteered at a camp for families of children and adolescents with cancer.

BACKGROUND

PICU nurses are at risk of developing symptoms of posttraumatic stress disorder, compassion fatigue, depression, and burnout due to exposure(s) to traumatic events. Spending time with patients, families, and nurse colleagues at camp may reduce the effects of this exposure.

METHODS

A qualitative descriptive study was conducted using content analysis. Fifteen nurse participants completed a precamp questionnaire and semistructured focus groups immediately following camp. Individual interviews were conducted 6 months after camp.

RESULTS

Three categories emerged: 1) personal factors, changes in the nurses themselves; 2) patient and family factors, changes in how nurses perceived patients and families; and 3) work-related factors, relationships with colleagues.

CONCLUSIONS

Supporting PICU nurses to participate with patients, families, and colleagues outside of the hospital may reduce burnout and support nurses' well-being.

'She come like a sister to me': a qualitative study of volunteer social support for disadvantaged women in the transition to motherhood in England

This qualitative study explores the ways in which disadvantaged women benefit from social support from a trained volunteer during pregnancy and the postnatal period, using the theoretical frameworks of stress and coping and a multi-dimensional model of social support. Forty-seven mothers took part in semi-structured interviews. The mothers, who had received social support through nine volunteer projects in England, faced many potentially stressful challenges besides having a baby (such as poverty, poor housing, histories of abuse, motherhood at a young age, living with physical or mental health difficulties, migration and insecure immigration status). Analysis was in two distinct stages: first, an inductive thematic analysis of mothers' experiences, and second, mapping of the results onto the theoretical frameworks chosen. Volunteers built relationships of trust with mothers and gave skilled emotional support, positive appraisal support, informational support and practical support according to mothers' individual needs, thereby assisting mothers exposed to multiple stressors with problem-focused, emotion-focused and perception-focused coping. This helped to reduce social isolation, increase effective access to services and community resources, and build mothers' confidence, self-esteem and self-efficacy. Volunteer social support may have particular salience for mothers who lack structural support and need skilled functional support. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.

Exposure to Workplace Trauma and Posttraumatic Stress Disorder Among Intern Physicians

IMPORTANCE

Physicians are exposed to traumatic events during their work, but the impact and outcomes of these exposures are understudied.

OBJECTIVE

To determine the prevalence and associations of work-related trauma exposure and posttraumatic stress disorder (PTSD) among a cohort of resident physicians in their internship year of training.

DESIGN, SETTING, AND PARTICIPANTS

This cohort study involved physicians entering internship at US residency programs nationwide in 2018. Participants completed a baseline survey 1 to 2 months before commencing internship, as well as follow-up surveys at 4 time points during internship. Statistical analysis was performed from April 2020 to January 2021.

EXPOSURES

Twelve months of internship.

MAIN OUTCOMES AND MEASURES

Prevalence of work-related trauma and prevalence of PTSD among those who experienced work-related trauma. Trauma exposure and PTSD symptoms were assessed using the Primary Care PTSD Screen for Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PC-PTSD-5). Risk factors assessed included depression, anxiety, early family environment, stressful life experiences, medical specialty, hours worked, and concern about medical errors.

RESULTS

Among 1134 interns who completed the PC-PTSD-5 at month 12 of internship, 665 (58.6%) were female and 695 (61.6%) were non-Hispanic White; the mean (SD) age was 27.52 (2.50) years. There were 640 interns (56.4%) who reported work-related trauma exposure; among these interns with trauma exposure, 123 (19.0%) screened positive for PTSD. Overall, 123 of 1134 training physicians (10.8%) screened positive for PTSD by the end of internship year, as compared with a 12-month PTSD prevalence rate of 3.6% in the general population. Multivariable logistic regression analyses, adjusting for demographic characteristics, indicated that risk factors associated with trauma exposure included non-Hispanic White race/ethnicity (odds ratio [OR], 1.51 [95% CI, 1.14-2.01]; P = .004), more hours worked (OR, 1.01 [95% CI, 1.00-1.03]; P = .03), early family environment (OR, 1.03 [95% CI, 1.01-1.05]; P < .001), and stressful life experiences at baseline (OR, 1.46 [95% CI, 1.06-2.01]; P = .02). Risk factors associated with PTSD were being unmarried (OR, 2.00 [95% CI, 1.07-3.73]; P = .03) and non-Hispanic White (OR, 1.77 [95% CI, 1.01-3.11]; P = .05), concern about medical errors (OR, 1.21 [95% CI, 1.00-1.46]; P = .05), stressful life experiences during internship (OR, 1.43 [95% CI, 1.14-1.81]; P = .002), depression at month 12 of internship (OR, 2.52 [95% CI = 1.36-4.65], P = .003), and anxiety at month 12 of internship (OR, 2.14, [95% CI, 1.13-4.04]; P = .02).

CONCLUSIONS AND RELEVANCE

This study found that work-related PTSD was 3 times more prevalent among intern physicians than the general population. These findings suggest that effective interventions to reduce trauma exposure and mitigate the effects of trauma are needed.

Training Appalachian Kentucky Youth Cancer Advocates

OBJECTIVES

Kentucky has the highest cancer incidence and mortality rates in the United States, with the Appalachian region experiencing the highest of those rates. Cancer advocacy, which is defined as providing support to cancer patients and their communities, represents a means of decreasing the cancer cases in Appalachian Kentucky. This exploratory study examined the effects of advocacy training and experiential learning on Appalachian high school students' cancer advocacy attitudes and self-efficacy.

METHODS

The design of this study was a mixed-methods, one-group repeated measure with a group of participants from the Appalachian Career Training in Oncology (ACTION) Program (N = 9). The study assessed advocacy attitudes and self-efficacy before and after participants were provided advocacy training and participated in an advocacy event.

RESULTS

Participating students' attitudes and self-efficacy did not substantially change following the training and their participation in an advocacy event. Through their comments after the event, however, students seem eager to use their voices to influence the actions of state legislators. At the same time, they worry about the apathy of their community members to their cancer advocacy message.

CONCLUSIONS

Youth represent potentially powerful agents of advocacy that could help address the cancer burden in Kentucky. Participants in this study likely overestimated their advocacy abilities before learning more about advocacy and participating in the process. As such, additional trainings are likely necessary to increase students' self-efficacy, encourage them to share their stories, and help them overcome perceived barriers.

Paradigms about the COVID-19 pandemic: knowledge, attitudes and practices from medical students

BACKGROUND

As the disease caused by the novel coronavirus has spread globally, there has been significant economic instability in the healthcare systems. This reality was especially accentuated in Ecuador where, the shortage of healthcare workers combined with cultural and macroeconomic factors has led Ecuador to face the most aggressive outbreak in Latin America. In this context, the participation of final-year medical students on the front line is indispensable. Appropriate training on COVID-19 is an urgent requirement that universities and health systems must guarantee. We aimed to describe the knowledge, attitudes, and practices of Ecuadorian final-year medical students that could potentially guide the design of better medical education curricula regarding COVID-19.

METHODS

This was a cross-sectional 33-item online survey conducted between April 6 to April 2020 assessing the knowledge, attitudes, and practices toward the diagnosis, treatment, prevention, and prognosis toward COVID-19 in Ecuadorian final-year medical students. It was sent by email, Facebook, and WhatsApp.

RESULTS

A total of 309 students responded to the survey. Out of which 88% of students scored high (≥ 70% correct) for knowledge of the disease. The majority of students were pessimistic about possible government actions, which is reflected in the negative attitude towards the control of COVID-19 and volunteering during the outbreak in Ecuador (77%, and 58% of the students, respectively). Moreover, 91% of students said they did not have adequate protective equipment. The latter finding was significantly associated with negative attitudes.

CONCLUSIONS

Although a large number of students displayed negative attitudes, the non-depreciable percentage of students who were willing to volunteer and the coexisting high level of knowledge displayed by students, suggests that Ecuador has a capable upcoming workforce that could benefit from an opportunity to strengthen, improve and advance their training in preparation for COVID-19. Not having personal protective equipment was significantly associated to negative attitudes. Providing the necessary tools and creating a national curriculum may be one of the most effective ways to ensure all students are trained, whilst simultaneously focusing on the students' most pressing concerns. With this additional training, negative attitudes will improve and students will be better qualified.

The Impact of Volunteering and Its Characteristics on Well-being After State Pension Age: Longitudinal Evidence From the English Longitudinal Study of Ageing

OBJECTIVES

Volunteering after retirement age is beneficial to well-being. This study furthers previous research by presenting a longitudinal analysis of the well-being of volunteers, compared to non-volunteers, based on characteristics of the voluntary work in which they participate.

METHOD

Participants were 3,740 people aged State Pension Age and over from the English Longitudinal Study of Ageing. Longitudinal regression models were used to determine whether frequent volunteers saw beneficial changes in well-being (depression, satisfaction with life, CASP-19, and social isolation) compared to non-volunteers. The initial model used a hierarchical approach so that we could also examine the impact of social and health factors. Models were then run to determine whether well-being in relation to volunteering was influenced by its continuity, the number of activities engaged in, whether the volunteering was formal or informal in nature, and whether or not the respondent reported feeling appreciated for their efforts.

RESULTS

Although sociodemographic and health circumstances reduce the magnitude of the effects of volunteering on well-being, the effect of volunteering remained significant in almost all analyses. The beneficial effect of volunteering appeared to stop among respondents who stopped volunteering between waves. The best outcomes were observed among those participating in higher numbers of activities, regardless of whether or not these were classed as formal or informal, and who felt appreciated for their work.

DISCUSSION

Certain aspects of volunteering might be especially beneficial to the well-being of older people. That these effects stop when volunteering stops suggest a causal element to this relationship.

Cognitive and social activities and long-term dementia risk: the prospective UK Million Women Study

BACKGROUND

Although dementia is associated with non-participation in cognitive and social activities, this association might merely reflect the consequences of dementia, rather than any direct effect of non-participation on the subsequent incidence of dementia. Because of the slowness with which dementia can develop, unbiased assessment of any such direct effects must relate non-participation in such activities to dementia detection rates many years later. Prospective studies with long-term follow-up can help achieve this by analysing separately the first and second decade of follow-up. We report such analyses of a large, 20-year study.

METHODS

The UK Million Women Study is a population-based prospective study of 1·3 million women invited for National Health Service (NHS) breast cancer screening in median year 1998 (IQR 1997-1999). In median year 2001 (IQR 2001-2003), women were asked about participation in adult education, groups for art, craft, or music, and voluntary work, and in median year 2006 (IQR 2006-2006), they were asked about reading. All participants were followed up through electronic linkage to NHS records of hospital admission with mention of dementia, the first mention of which was the main outcome. Comparing non-participation with participation in a particular activity, we used Cox regression to assess fully adjusted dementia risk ratios (RRs) during 0-4, 5-9, and 10 or more years, after information on that activity was obtained.

FINDINGS

In 2001, 851 307 women with a mean age of 60 years (SD 5) provided information on participation in adult education, groups for art, craft, or music, and voluntary work. After 10 years, only 9591 (1%) had been lost to follow-up and 789 339 (93%) remained alive with no recorded dementia. Follow-up was for a mean of 16 years (SD 3), during which 31 187 (4%) had at least one hospital admission with mention of dementia, including 25 636 (3%) with a hospital admission with dementia mentioned for the first time 10 years or more after follow-up began. Non-participation in cognitive or social activities was associated with higher relative risks of dementia detection only during the first decade after participation was recorded. During the second decade, there was little association. This was true for non-participation in adult education (RR 1·04, 99% CI 0·98-1·09), in groups for art, craft, or music (RR 1·04, 0·99-1·09), in voluntary work (RR 0·96, 0·92-1·00), or in any of these three (RR 0·99, 0·95-1·03). In 2006, 655 118 women provided information on reading. For non-reading versus any reading, there were similar associations with dementia, again with strong attenuation over time since reading was recorded, but longer follow-up is needed to assess this reliably.

INTERPRETATION

Life has to be lived forwards, but can be understood only backwards. Long before dementia is diagnosed, there is a progressive reduction in various mental and physical activities, but this is chiefly because its gradual onset causes inactivity and not because inactivity causes dementia.

FUNDING

UK Medical Research Council, Cancer Research UK.

Exploring the participation of young citizen scientists in scientific research: The case of iNaturalist

Online citizen science projects have broadened options for accessing science and enabled different forms of participation in scientific research for adult and young volunteers. Yet, little is known regarding participation patterns among youth participants. Quantitative approaches were used to investigate the contribution of 183 young volunteers to citizen science on the iNaturalist platform and the participation behaviour that relates to their contribution. The participants accessed and used iNaturalist as part of one-day field-based events (bioblitzes) facilitated by museums. Compared to the observation behaviour of all iNaturalist users, as documented on the platform, the young volunteers observe fewer plants and birds, and more molluscs, arachnids and insects. The average daily contributions of young volunteers were found to be positively associated with a large proportion of active days on iNaturalist and a systematic contribution behaviour, yet negatively related to a long duration on the platform. This study enhances our understanding of young volunteers' contributions to citizen science and provides insights for research on participation in online citizen science. Our findings have implications on how museums design the field-based events to encourage follow-up systematic participation and maintain active contribution.

Community demand for comprehensive primary health care from malaria volunteers in South-East Myanmar: a qualitative study

BACKGROUND

Malaria volunteers have contributed significantly to malaria control achieving a reduction of annual parasite incidence to pre-elimination levels in several townships across Myanmar. However, the volunteers' role is changing as Myanmar transitions from a malaria control to elimination programme and towards the goal of universal health coverage. The aim of the study is to explore the perspectives of community leaders, members and malaria volunteers in South-East Myanmar on community-delivered models to inform an optimal design that targets malaria elimination in the context of primary health care in Myanmar.

METHODS

Qualitative methods including focus group discussions (FGDs) with community members and current or ex-malaria volunteers, and participatory workshops with community leaders were conducted. All data collection tools were pilot tested with similar participants. The FGDs were stratified into male and female participants in consideration of diverse gender roles among the ethnic groups of Myanmar. Data saturation was the key cut-off point to cease recruitment of participants. Inductive thematic analysis was used.

RESULTS

Community members were willing to be tested for malaria because they were concerned about the consequences of malaria although they were aware that malaria prevalence is low in their villages. Malaria volunteers were the main service providers for malaria and other infectious diseases in the community. Apart from malaria, the community identified common health problems such as the flu (fever, sneezing and coughing), diarrhoea, skin infections and tuberculosis as priority diseases in this order. Incorporating preventive, and whenever possible curative, services for those diseases into the current malaria volunteer model was recommended.

DISCUSSION AND CONCLUSION

There was a gap between the communities' expectations of health services and the health services currently being delivered by volunteers in the community that highlights the need for reassessment and reform of the volunteer model in the changing context. An evidence-based, community preferred, pragmatic community-delivered integrated model should be constructed based on the context of malaria elimination and progressing towards universal health coverage in Myanmar.

A Bibliographic Analysis of the Most Cited Articles in Global Neurosurgery

OBJECTIVE

Global neurosurgery is the practice of neurosurgery with the primary purpose of delivering timely, safe, and affordable neurosurgical care to all who need it. The aim of this study is to identify the most frequently cited articles in global neurosurgery through a bibliographic review to characterize articles and trends around this growing topic.

METHODS

The top most-cited articles in global neurosurgery were determined by searching the Web of Science database using a priori search terms. Articles with at least 5 citations were selected, and there were no time period or language restrictions. The data were extracted from each included article and all characteristics were summarized.

RESULTS

A total of 932 articles were identified using the search terms; 69 articles fulfilled inclusion criteria and 17 articles were selected that had more than 5 citations. The articles' number of citations ranged from 6 to 98 for the most-cited article. Authors from, or affiliated with, 14 countries contributed to the 17 articles, and the country that had the greatest representation was the United States. The main topic discussed was surgical capacity, the second topic was the treatment of different neurosurgical conditions, and volunteerism was the third topic.

CONCLUSIONS

There is currently a deficit in both the amount of literature surrounding the topic of global neurosurgery and how much that literature is cited. Developing innovative ways to increase academic productivity within, or in collaboration with, low-middle income countries is essential to contribute to global neurosurgery.

Occupational inequalities in volunteering participation: Using detailed data on jobs to explore the influence of habits and circumstances

In this paper we present empirical results that show that detailed occupations have distinctive patterns of association with voluntary participation. We draw upon data from four secondary survey datasets from the UK (coverage 1972-2012). Occupations are shown to link to volunteering in a wide range of scenarios and in individual, household, and longitudinal contexts. We argue that these linkages provide insight into social inequalities in volunteering, and that they can help us to understand the relative influence of "circumstance" and "habits" in enabling or inhibiting voluntary participation.

Buffering PTSD in Canine Search and Rescue Teams? Associations with Resilience, Sense of Coherence, and Societal Acknowledgment

Rescue workers present an elevated risk for posttraumatic stress disorder (PTSD) and recently, research has begun to focus on coping styles and social support as protective factors in this population. Associations in the particular group of search and rescue dog handlers still lack evidence. The aim of the study is to investigate if functional cognitions and social support also decrease the risk for PTSD. Active voluntary rescue dog handlers (n = 116) rated levels of resilience, sense of coherence, and social acknowledgment (SAQ; subscales general disapproval, familial disapproval, recognition), in addition to a trauma checklist and PTSD symptoms. Linear regression analyses and two different graph models were calculated to explore associations, as well as potential pathways. Controlling for trauma exposure, the SAQ general disapproval emerged as the only significant predictor in the regression model. In the graph models, SAQ familial disapproval was linked to SAQ recognition and SAQ general disapproval. The latter, together with a sense of coherence manageability, affected PTSD re-experiencing symptoms through resilience. The findings are in line with earlier work. The study underlines the importance of targeting resilience and manageability, as well as enhancing social support in prevention programs for PTSD in canine search and rescue teams. Future research is warranted to further investigate model stability and replicate findings.

Breastfeeding peer support by telephone in the RUBY randomised controlled trial: A qualitative exploration of volunteers' experiences

BACKGROUND

There is growing evidence that peer support programs may be effective in supporting breastfeeding mothers. A randomised controlled trial (RCT) (the RUBY study) that tested peer support in the Australian context found that infants of first-time mothers who received proactive telephone peer support were more likely to be receiving breastmilk at six months of age.

METHODS

This qualitative sub-study of the RUBY RCT explores the experiences and views of peer volunteers who delivered the intervention. Focus groups were conducted with 17 peers from the RUBY RCT between November 2015 and March 2016. All had provided peer support to at least one mother.

RESULTS

We found that volunteers identified strongly with the mothers' need for support when establishing breastfeeding. Key components of the support were strengthening the mothers' self-belief through affirmation and sharing experiential knowledge. Volunteers found the role rewarding and personally therapeutic although some women reported challenges initiating and maintaining contact with some mothers. Data were analysed using a hybrid approach to thematic analysis combining inductive and deductive techniques.

CONCLUSIONS

Breastfeeding peer support programs are reliant on recruitment of motivated volunteers who can provide empathetic mother-to-mother support. This study provides important information regarding volunteers' experiences that may support the upscaling of breastfeeding peer support for new mothers.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry, ACTRN 12612001024831.

Collective action among US veterans: Understanding the importance of self-efficacy, collective efficacy, and social support

The purpose of this study was to examine the relationship between collective action, collective efficacy, self-efficacy, and social support among US veterans who formally volunteered in their communities upon their return from military service. The participants were 323 post-9/11/01-era veterans who completed a national nonprofit administered civic service program. Results from the structural equation model indicate that appraisal social support is negatively, directly associated with collective action, while belonging social support is positively, directly associated with collective action. In addition, appraisal social support is positively, indirectly associated with collective action via self-efficacy and collective efficacy. About 44% of the relationship between self-efficacy and collective action is associated via collective efficacy. The model accounts 19.9% of the variance in self-efficacy, 16.5% of the variance in collective efficacy, and 23.7% of the variance in collective action. The role of social support in the model provides additional evidence for the importance of strong social ties in facilitating collective action as veterans gather to volunteer in programs across the country. Results have implications for how national, nonprofit, and community volunteering programs may want to engage veterans and community members in collective action efforts.

"Sex Offender" Versus "Person": The Influence of Labels on Willingness to Volunteer With People Who Have Sexually Abused

The present study examined the effect of offense-based labels on community members' willingness to volunteer with people convicted for varying offenses and any priming effect of labeling language. Participants (N = 310) were randomly assigned to a label condition or a neutral condition and completed an anonymous online survey about their willingness to volunteer with different groups. The labeling condition utilized labels (e.g., "sex offenders," "murderers"), whereas the control condition utilized neutral descriptors (e.g., "people who have committed crimes of a sexual nature"). Overall, findings supported the hypothesis that offense-based labels were associated with less willingness to volunteer, with findings most pronounced for the "sex offender" and "child sex offender" labels. Participants in the labeling condition showed greater voluntary use of labels compared with neutral language and were more likely to use labels compared with participants in the neutral condition. Implications for influencing public opinion are discussed.

Using qualitative evaluation components to help understand context: case study of a family planning intervention with female community health volunteers (FCHVs) in Nepal

BACKGROUND

Evaluations of health interventions are increasingly concerned with measuring or accounting for 'context'. How to do this is still subject to debate and testing, and is particularly important in the case of family planning where outcomes will inevitably be influenced by contextual factors as well as any intervention effects. We conducted an evaluation of an intervention where female community health volunteers (FCHVs) in Nepal were trained to provide better interpersonal communication on family planning. We included a context-orientated qualitative component to the evaluation. Here, we discuss the evaluation findings, specifically focusing on what was added by attending to the context. We explore and illustrate important dimensions of context that may also be relevant in future evaluation work.

METHODS

The evaluation used a mixed methods approach, with a qualitative component which included in-depth interviews with women of reproductive age, FCHVs, and family planning service providers. We conducted iterative, thematic analysis.

RESULTS

The life-history fertility and contraception narratives generated from the in-depth interviews contextualised the intervention, yielding nuanced data on contraceptive choices, needs, and areas for future action. For instance, it highlighted how women generally knew about effective contraceptive methods and were willing to use them: information was not a major barrier. Barriers instead included reports of providers refusing service when women were not in the fifth day of their menstrual cycle when this was unnecessary. Privacy and secrecy were important to some women, and risked being undermined by information sharing between FCHVs and health services. The qualitative component also revealed unanticipated positive effects of our own evaluation strategies: using referral slips seemed to make it easier for women to access contraception.

CONCLUSIONS

Life history narratives collected via in-depth interviews helped us understand pathways from intervention to effect from the user point of view without narrowly focusing only on the intervention, highlighting possible areas for action that would otherwise have been missed. By attending to context in a nuanced way in evaluations, we can build a body of evidence that not only informs future interventions within that context, but also builds better knowledge of contextual factors likely to be important elsewhere.

Communication and information exchange between primary healthcare employees and volunteers - Challenges, needs and possibilities for technology support

In light of the challenges posed by an ageing population and tighter public budgets, governments worldwide are seeking innovative ways of improving health service delivery. Volunteers can contribute to such improvement, but this requires effective coordination and communication between volunteers and healthcare employees. In this case study, conducted in two Norwegian municipalities during September-October 2017, the aim was to understand how collaboration and coordination is carried out between several stakeholders: volunteers, volunteer family members of healthcare service users and healthcare employees. Our results show that daily cooperation was largely unsystematic, and stakeholders employed various informal communication procedures. Recruitment of volunteers was based on word of mouth and was coordinated by telephone and email. All processes were paper based, including contracting and confidential agreements. This unsystematic approach resulted in uncoordinated activities characterised by time-consuming processes, with no quality assurance. We concluded that stakeholders would benefit from a technology solution that supports more systematic processes of recruitment, management and monitoring. This article outlines the challenges and needs for information exchange and communication between stakeholders. Furthermore, it describes possible functionality in a digital system that can address these needs, and hence improve coordination, quality of services and resource use.

Factors associated with child health service delivery by female community health volunteers in Nepal: findings from a national survey

BACKGROUND

Nepal has made a significant improvement in child survival in the last few decades and the involvement of female community health volunteers (FCHVs) has been crucial in such achievement. While there have been many studies on child health in Nepal however, rarely explored the status and factors associated with the child health service provided by these volunteers. This study aimed to identify the factors associated with the child health service delivery by FCHVs.

METHODS

A national survey was conducted in 2014 in Nepal that included 4302 FCHVs using the structured questionnaire across the 13 geopolitical domains of the country. Factors associated with the use of child health services was examined using Chi-square test (χ2) followed by logistic regression.

RESULTS

Overall, 62.6% of FCHVs provided at least one child health service. Those FCHVs who utilized money from the FCHV fund, conducted health mothers' group meeting, involved in local committees and those who supported antenatal care and outreach clinics related activities had higher odds of providing child health services. Similarly, FCHVs equipped with the stock of Cotrimoxazole tablet, Zinc tablet, Oral Rehydration Salt packets were more likely to provide child health services. The province-wise analysis showed that FCHVs from Province 5 and Sudur Paschim Province were more likely to provide child health services compared to their counterparts from province 1. Technology-wise, FCHVs who were using mobile were more likely to provide child health services.

CONCLUSIONS

FCHVs are important human resource in providing child health services in Nepal. To improve child health service delivery by FCHVs; availability of key commodities, involvement of FCHVs in regular health mothers' group meeting, use of mobile phone, involvement in other public health programs and social networks, and utilization of the FCHV fund need to be taken into consideration.

Civic engagement among student veterans

Objective: The purpose of this study was to assess participation rates in civic volunteering among service member and veteran students. Participants: Data for the present cross-sectional study were obtained from the American College Health Association's (ACHA) 2011-2014 National College Health Assessment II (NCHA). Methods: Demographic characteristics of the study sample were explored by calculating frequencies and percentages by military service status. Research questions were explored with either Fisher's exact test or maximum likelihood multiple logistic regression. Results: Service member and veteran students were more likely to engage in volunteerism than their non-veteran counterparts. Additionally, student veterans and non-veteran students reported that engagement in volunteer efforts both reduces their feelings of depression and increases their use of mental health services. Conclusion: The findings of this research suggest that the promotion of civic engagement and participation in volunteerism for service member and veteran students on college campuses might contribute to successful reintegration outcomes.

An "Army of Volunteers"? Engagement, Motivation, and Barriers to Volunteering among the Baby Boomers

Aging baby boomers are expected to provide a large reservoir for the nonprofit sector. We find evidence which while broadly supportive of this idea also suggest limitations as to what can realistically be expected. Using data from the third (2017) wave of the Norwegian life-course, aging, and generation study (n = 2,993, age 53-71), we find that a sizable proportion is already engaged (65-68% in the past year) and around half of non-volunteers (from 58% among the youngest to 43% among the oldest) express interest in volunteering. However, most volunteering is sporadic and less than half of volunteers participate on a weekly basis. Furthermore, most of the non-volunteers who express interest seem unlikely to realize their interest as they simultaneously report important motivational and ability-related barriers to volunteering. A further challenge is that few boomers are willing to make a major commitment to volunteering. Findings suggest that to mobilize boomers, nonprofit organizations need to accommodate more self-interested and flexible forms of involvement.

Formal Volunteering Buffers the Negative Impact of Unemployment among Older Workers: A Longitudinal Analysis

Guided by Jahoda's Latent Deprivation Theory, this study examined whether engaging in formal volunteering could moderate the negative impact of unemployment on older workers' mental health. This study also explored the optimal intensity/hours of volunteering required to have a positive effect. This study analyzed six waves (12 years) of longitudinal data from the Health and Retirement Study using fixed effects modeling. The outcome variable was depressive symptoms, and the independent variables were labor force status and volunteering status. Observed time-varying confounders were controlled. There was a significant interaction between engaging in formal volunteering and unemployment status. Unemployed older workers who participated in volunteering fared better than those unemployed workers who did not volunteer. Further, those unemployed older workers who volunteered over 100 hours/year did not benefit from volunteering. Results from this study have important implications for future intervention development targeting the mental health of unemployed older workers.

Seroprevalence of Entamoeba histolytica at a voluntary counselling and testing centre in Tokyo: a cross-sectional study

BACKGROUND

Amebiasis, which is caused by Entamoeba histolytica, is a re-emerging public health issue owing to sexually transmitted infection (STI) in Japan. However, epidemiological data are quite limited.

METHODS

To reveal the relative prevalence of sexually transmitted E. histolytica infection to other STIs, we conducted a cross-sectional study at a voluntary counselling and testing (VCT) centre in Tokyo. Seroprevalence of E. histolytica was assessed according to positivity with an ELISA for E. histolytica-specific IgG in serum samples collected from anonymous VCT clients.

RESULTS

Among 2083 samples, seropositive rate for E. histolytica was 2.64%, which was higher than that for HIV-1 (0.34%, p<0.001) and comparable to that for syphilis (rapid plasma reagin (RPR) 2.11%, p=0.31). Positivity for Chlamydia trachomatis in urine by transcription-mediated amplification (TMA) was 4.59%. Seropositivity for E. histolytica was high among RPR/Treponema pallidum hemagglutination (TPHA)-positive individuals and it was not different between clients with and without other STIs. Both seropositivity of E. histolytica and RPR were high among male clients. The seropositive rate for anti-E. histolytica antibody was positively correlated with age. TMA positivity for urine C. trachomatis was high among female clients and negatively correlated with age. Regression analysis identified that male sex, older age and TPHA-positive results are independent risk factors of E. histolytica seropositivity.

CONCLUSIONS

Seroprevalence of E. histolytica was 7.9 times higher than that of HIV-1 at a VCT centre in Tokyo, with a tendency to be higher among people at risk for syphilis infection. There is a need for education and specific interventions against this parasite, as a potentially re-emerging pathogen.

Accuracy of long-term volunteer water monitoring data: A multiscale analysis from a statewide citizen science program

An increasing number of citizen science water monitoring programs is continuously collecting water quality data on streams throughout the United States. Operating under quality assurance protocols, this type of monitoring data can be extremely valuable for scientists and professional agencies, but in some cases has been of limited use due to concerns about the accuracy of data collected by volunteers. Although a growing body of studies attempts to address accuracy concerns by comparing volunteer data to professional data, rarely has this been conducted with large-scale datasets generated by citizen scientists. This study assesses the relative accuracy of volunteer water quality data collected by the Texas Stream Team (TST) citizen science program from 1992–2016 across the State of Texas by comparing it to professional data from corresponding stations during the same time period. Use of existing data meant that sampling times and protocols were not controlled for, thus professional and volunteer comparisons were refined to samples collected at stations within 60 meters of one another and during the same year. Results from the statewide TST dataset include 82 separate station/year ANOVAs and demonstrate that large-scale, existing volunteer and professional data with unpaired samples can show agreement of ~80% for all analyzed parameters (DO = 77%, pH = 79%, conductivity = 85%). In addition, to assess whether limiting variation within the source datasets increased the level of agreement between volunteers and professionals, data were analyzed at a local scale. Data from a single partner city, with increased controls on sampling times and locations and correction of a systematic bias in DO, confirmed this by showing an even greater agreement of 91% overall from 2009–2017 (DO = 91%, pH = 83%, conductivity = 100%). An experimental sampling dataset was analyzed and yielded similar results, indicating that existing datasets can be as accurate as experimental datasets designed with researcher supervision. Our findings underscore the reliability of large-scale citizen science monitoring datasets already in existence, and their potential value to scientific research and water management programs.

Getting more than "claps": incentive preferences of voluntary community-based mobilizers in Tanzania

BACKGROUND

Marie Stopes Tanzania works with a voluntary cadre of 66 community-based mobilizers (CBMs), who are tasked with raising awareness, generating demand and providing referral to potential clients for family planning, comprehensive post-abortion care and cervical cancer screening. CBMs extend the reach of urban clinics to peri-urban communities, enhancing access to sexual and reproductive health services. In an effort to optimize performance of CBMs, a study was conducted to explore the drivers of CBM motivation and inform the design of an incentive scheme.

METHODS

Three focus group discussions with 17 CBMs and 11 interviews with CBM supervisors and managers were conducted in three clinics and the head office. After thematic analysis of transcripts, findings on motivational factors were discussed in a reflection workshop and informed the development of a discrete choice experiment (DCE) involving 61 CBMs as respondents. The DCE included eight choice questions on two incentive schemes, each consisting of five attributes related to remuneration, training, supervision, benefits and identification. For each attribute, different incentive options were presented, based on the outcomes of the qualitative assessment. The DCE results were analysed using conditional logistic regression.

RESULTS

A variety of factors motivated CBMs. Most CBMs were motivated to conduct their work because of an intrinsic desire to serve their community. The most mentioned extrinsic motivational factors were recognition from the community and supervisors, monthly allowance, availability of supporting materials and identification, trainings, supervision and feedback on performance. Recommendations for improvement were translated into the DCE. Incentive attributes that were found to be significant in DCE analysis (p < 0.05), in preference order, were carrying an ID card, bi-monthly training, supervision conducted via both monthly meetings at clinics and visits from the head office, and a monthly flat rate remuneration (over pay for performance).

CONCLUSION

Despite the recognition that being a CBM is voluntary, incentives, especially those of non-financial nature, are important motivators. Incentive schemes should include basic compensation with a mix of other incentives to facilitate CBMs' work and enhance their motivation. Programme designs need to take into account the voices of community-based workers, to optimize their performance and service delivery to communities they serve.

Adolescents' Civic Engagement: Concordant and Longitudinal Associations Among Civic Beliefs and Civic Involvement

Associations between adolescent civic and organized activities (volunteering, standard political, social movement, school/community, religious) and civic beliefs (comprised of should, obligation, and respect judgments) were examined. Cross-sectional models (N = 703, M_age  = 15.87) indicated domain specificity between adolescent civic beliefs and behaviors. Longitudinal models (n = 219, M_age  = 15.39) indicated that adolescents' standard political beliefs predicted greater levels of standard political involvement one year later, and school/community activities predicted greater standard political beliefs a year later. Youth volunteering predicted lower standard political beliefs, and standard political involvement predicted lower community service beliefs one year later. Findings support the assessment of adolescent sociomoral civic beliefs and demonstrate how civic experiences and civic beliefs can mutually promote each other during adolescence.

Communities as 'renewable energy' for healthcare services? a multimethods study into the form, scale and role of voluntary support for community hospitals in England

OBJECTIVE

To examine the forms, scale and role of community and voluntary support for community hospitals in England.

DESIGN

A multimethods study. Quantitative analysis of Charity Commission data on levels of volunteering and voluntary income for charities supporting community hospitals. Nine qualitative case studies of community hospitals and their surrounding communities, including interviews and focus groups.

SETTING

Community hospitals in England and their surrounding communities.

PARTICIPANTS

Charity Commission data for 245 community hospital Leagues of Friends. Interviews with staff (89), patients (60), carers (28), volunteers (35), community representatives (20), managers and commissioners (9). Focus groups with multidisciplinary teams (8 groups across nine sites, involving 43 respondents), volunteers (6 groups, 33 respondents) and community stakeholders (8 groups, 54 respondents).

RESULTS

Communities support community hospitals through: human resources (average=24 volunteers a year per hospital); financial resources (median voluntary income = £15 632); practical resources through services and activities provided by voluntary and community groups; and intellectual resources (eg, consultation and coproduction). Communities provide valuable supplementary resources to the National Health Service, enhancing community hospital services, patient experience, staff morale and volunteer well-being. Such resources, however, vary in level and form from hospital to hospital and over time: voluntary income is on the decline, as is membership of League of Friends, and it can be hard to recruit regular, active volunteers.

CONCLUSIONS

Communities can be a significant resource for healthcare services, in ways which can enhance patient experience and service quality. Harnessing that resource, however, is not straight forward and there is a perception that it might be becoming more difficult questioning the extent to which it can be considered sustainable or 'renewable'.

The CORE Group Polio Project's Community Volunteers and Polio Eradication in Ethiopia: Self-Reports of Their Activities, Knowledge, and Contributions

In 2001, the CORE Group Polio Project (CGPP) began to support polio eradication initiatives in hard-to-reach pastoralist and semi-pastoralist high-risk border areas of Ethiopia by training and supporting community volunteers (CVs) for immunization promotion and community-based surveillance activities. This article describes the development and current status of the CGPP CV network in Ethiopia. It also reports the results of a 2016 survey of CVs. Community volunteers are selected jointly by the local community, local government officials, and local health facility staff. They work closely with the health extension worker in their area and are responsible for 50-100 households. More than 12,000 CVs have been trained and have reached six million people. They make routine home visits to 1) provide education on vaccine-preventable diseases, 2) promote healthy behaviors, 3) inform parents on how to access immunization services, and 4) report cases of acute flaccid paralysis, neonatal tetanus, and measles as well as births. The 2016 survey of 675 CVs demonstrated that 84.1% had conducted home visits in the previous month to 1) identify and register pregnant mothers and newborns, 2) provide health education, 3) conduct disease surveillance, and 4) search for and register immunization defaulters. Of the CVs, 98.2% reported that their work had led to improvements in the community. Knowledge of CVs about vaccine-preventable diseases was suboptimal. CVs expressed a desire for more training. Community volunteers have made notable contributions to polio eradication efforts in high-risk areas of Ethiopia as well as to immunization promotion and disease control more broadly.

Higher levels of self-efficacy and readiness for a future career of Spanish speaking physician assistant students after their volunteer work in a student-run free clinic in the United States

Volunteering at a free clinic may influence career choice amongst health profession students. The purpose of this research is to explore knowledge, skill, attitudes, self-efficacy, interest in future work with the underserved, and interest in primary care amongst physician assistant (PA) students through the analysis of demographic characteristics of PA students at a student-run free clinic in the United States. Data were collected from 56 PA students with a quantitative survey collection in October 2018 after their participation at a student-run free clinic in Intermountain West, Salt Lake City, Utah, USA. Out of three sub-scales i. e. attitudes, effect, and readiness, students responded most positively to effect of experience of participating in free clinic. Students who spoke Spanish showed higher levels of self-efficacy and readiness for a future career in comparison to non-Spanish speakers.

"A Mile in Her Shoes": A qualitative exploration of the perceived benefits of volunteer led running groups for homeless women

"A Mile in Her Shoes" is a volunteer-led charity which provides running groups for homeless women. The objective of this study was to explore the experiences of homeless women attending these running groups and to establish how participation in a supported running group impacted their lives. This exploratory qualitative study was carried out across two sites in London UK during February and April 2017. All regular attenders of the running groups were invited to participate in the study; subsequently, a self-selected sample of 11 women consented to being interviewed. Data were collected by female interviewers on a one-to-one basis, steered by a semi-structured topic guide. All interviews were digitally recorded, transcribed verbatim, and analysed using thematic analysis. Themes were cross-referenced by the research team and findings were supported by direct quotes. Five main themes emerged from the findings: the positive impact of the charity; homeless women's motivations and barriers to participating in running groups; the benefits of participating on physical and mental health; the importance and value of social support from the group; and the value of being provided with quality running kit. This study concludes that volunteer-led running groups are valued by homeless women by helping them take control of their health. It provides insight into their engagement in physical activity, thus potentially helping prevent injury or illness, and aiding recovery and rehabilitation. One implication of this study is that gathering homeless women's views helps to steer how community-based physical activity programmes can benefit their wellbeing. However, this small-scale study may have limited generalisability, with the topic warranting further research.

The Measurement of Elderly Volunteers' Optic Nerve Sheath Diameters by Ocular Ultrasonography

BACKGROUND AND OBJECTIVES

The optic nerve is a component of the central nervous system, and the optic nerve sheath is connected to the subarachnoid space. For this reason, intracranial pressure (ICP) increases are directly transmitted to the optic nerve sheath. Knowing the normal optic nerve sheath diameter (ONSD) range in a healthy population is necessary to interpret this measurement as a sign of intracranial pressure in clinical practice and research. In this study, we aimed to determine the standard ONSD value in healthy adultsaged65 years of age or older who had not previously been diagnosed with a disease that could increase the ICP.

MATERIALS AND METHODS

The right and left ONSD values and ONSD differences were compared, according to the gender of the patients. The patients were divided into 3 groups, according to their age. The age groups were assigned as follows: Group 1: 65-74 years of age; Group 2: 75-84 years of age; and Group 3: 85 years of age or older. The ONSDs and the ONSD difference between the left and right eyes of Group 1, Group 2 and Group 3 were compared.

RESULTS

The study included 195 volunteers. The mean ONSD of both eyes was 4.16±0.69 mm, and the difference between the ONSD of the left and right eyes was 0.16±0.18 mm. There was no difference between genders in terms of right ONSD, left ONSD, mean ONSD and ONSD difference between the left and right eyes. There was no correlation between age and ONSD and ONSD difference. When the age groups and ONSD were compared, no difference was found between the groups.

CONCLUSIONS

In conclusion, the ONSDs of both eyes do not vary with age in healthy adults aged65 years or older. ONSD does not vary between genders. The calculation of ONSD difference can be used to determine ICP increase.

The role of health animators in malaria control: a qualitative study of the health animator (HA) approach within the Majete malaria project (MMP) in Chikwawa District, Malawi

BACKGROUND

Malaria continues to place a high burden on communities due to challenges reaching intervention target levels in Chikwawa District, Malawi. The Hunger Project Malawi is using a health animator approach (HA) to address gaps in malaria control coverage. We explored the influence of community-based volunteers known as health animators (HAs) in malaria control. We assessed the impact of HAs on knowledge, attitudes, and practices towards malaria interventions.

METHODS

This paper draws on the qualitative data collected to explore the roles of communities, HAs and formal health workers attending and not attending malaria workshops for malaria control. Purposive sampling was used to select 78 respondents. We conducted 10 separate focus group discussions (FGDs)-(n = 6) with community members and (n = 4) key informants. Nine in-depth interviews (IDIs) were held with HAs and Health Surveillance Assistants (HSAs) in three focal areas near Majete Wildlife Reserve. Nvivo 11 was used for coding and analysis. We employed the framework analysis and social capital theory to determine how the intervention influenced health and social outcomes.

RESULTS

Using education, feedback sessions and advocacy in malaria workshop had mixed outcomes. There was a high awareness of community participation and comprehensive knowledge of the HA approach as key to malaria control. HAs were identified as playing a complementary role in malaria intervention. Community members' attitudes towards advocacy for better health services were poor. Attendance in malaria workshops was sporadic towards the final year of the intervention. Respondents mentioned positive attitudes and practices on net usage for prevention and prompt health-seeking behaviours.

CONCLUSION

The HA approach is a useful strategy for complementing malaria prevention strategies in rural communities and improving practices for health-seeking behaviour. Various factors influence HAs' motivation, retention, community engagement, and programme sustainability. However, little is known about how these factors interact to influence volunteers' motivation, community participation and sustainability over time. More research is needed to explore the acceptability of an HA approach and the impact on malaria control in other rural communities in Malawi.

Volunteer doulas' experiences supporting cesarean births: A qualitative analysis for preliminary program evaluation

BACKGROUND

Cesarean birth is common in the United States and associated with increased incidence of medical complications and maternal dissatisfaction. Doula support is associated with improved maternal and newborn outcomes but is often restricted to vaginal birth. The aim of this scoping study was to explore the experiences of volunteer doulas who provide support to women during cesarean birth.

METHODS

Qualitative study using semi-structured interviews with nine doula volunteers from one program to assess their experiences caring for clients in the operating room (OR).

RESULTS

Doulas described their experiences supporting cesarean births in relation to four different relationship-level themes, relationships between: doulas and their clients (and clients' support persons); doulas and the physical environment (OR, labor and delivery unit); doulas and the OR interprofessional team; and doulas and the program culture. Doulas described perceived strengths and weaknesses of the OR-based program, and suggested improvements and future development opportunities.

CONCLUSION

Doulas volunteering within this program highly valued their perceived role in the care of women experiencing cesarean birth, including reports of increasing evidence-based practices such as SSC and early breastfeeding initiation in the OR. These doulas reported successfully working around the physically challenging OR environment and alongside the cesarean interprofessional team.

A Five-year Review of the Designated Leadership Positions of Pediatric Orthopaedic Society of North America: Where Do Women Stand?

Despite the growing number of women entering medical school, female representation among orthopedic surgery is the lowest compared with all areas of medicine. In 2014, 47.7% of students entering medical school were women, but only 13.7% of orthopedic residents were women. Pediatric orthopedics have been successful in enrolling women compared with other orthopedic subspecialties. This is an investigation of female representation among the Pediatric Orthopaedic Society of North America membership roster, providing insight into the effect on the increased gender diversity in the membership of an organization and its correlation with leadership positions at different levels within the organization.

Volunteer involvement in the organisation of palliative care: A survey study of the healthcare system in Flanders and Dutch-speaking Brussels, Belgium

Ageing populations increasingly face chronic and terminal illnesses, emphasising the importance of palliative care and quality of life for terminally ill people. Facing resource constraints in professional healthcare, some governments expect informal caregivers like volunteers to assume a greater share of care provision. We know volunteers are present in palliative care and perform many roles, ranging from administration to providing companionship. However, we do not know how involved they are in the organisation of care and how healthcare organisations appraise their involvement. To address this, we provide an extensive description of the involvement of volunteers who provide direct patient palliative care across the Flemish healthcare system in Belgium. We conducted a cross-sectional postal survey of 342 healthcare organisations in Flanders and Brussels in 2016, including full-population samples of palliative care units, palliative day care centres, palliative home-care teams, medical oncology departments, sitting services, community home-care services, and a random sample of nursing homes. Volunteer involvement was measured using Sallnow and Paul's power-sharing model, which describes five hierarchical levels of engagement, ranging from being informed about the organisation of care to autonomy over certain aspects of care provision. Response was obtained for 254 (79%) organisations. Volunteers were often informed about and consulted regarding the organisation of care, but healthcare organisations did not wish for more autonomous forms of volunteer involvement. Three clusters of volunteer involvement were found: "strong involvement" (31.5%), "restricted involvement" (44%), and "uninvolved" (24.5%). Degree of involvement was found to be positively associated with volunteer training (p < 0.001) and performance of practical (p < 0.001) and psychosocial care tasks (p < 0.001). Dedicated palliative care services displayed a strong degree of volunteer involvement, contrary to generalist palliative care services, suggesting volunteers have a more important position in dedicated palliative care services. A link is found between volunteer involvement, training, and task performance.

Relationship between the Well-Being of Elderly Men and Cohabiting with Women Who Have Had Experience as a Health Promotion Volunteer in Japan: A Cross-Sectional Study

In Japan, there are traditionally many health promotion volunteer activities. However, the effects these activities have on the volunteers’ families are not clear. This study examined whether the well-being of Japanese elderly men was affected by cohabiting with women who have had experience as a health promotion volunteer. The study area was Suzaka City, where more than 7500 women have been elected and served as health promotion volunteers for over 60 years. A cross-sectional survey targeting all residents aged 65 years or over was conducted in 2014 using a self-administered questionnaire and 10,758 (77.7%) residents participated. Of those, married men who lived with married women were analyzed (n = 2370). Functional capacity and depressive symptoms were analyzed as outcomes respectively. Of the 2370 men, 1434 (60.5%) lived with women who had experience as a health promotion volunteer in the past. Modified Poisson regression analysis adjusting for covariates showed that living with women who had this experience was inversely associated with depressive symptoms (adjusted Prevalence Ratio; 0.84, 95% Confidence Interval; 0.73–0.97), but not with low functional capacity. These results suggest that living with women who had the experience as health promotion volunteer might affect depressive symptoms of elderly men.