Increasing Melanoma Screening among Hispanic/Latino Americans: A Community-Based Educational Intervention

ERIC Educational Resources Information Center

Chung, Grace Y.; Brown, Gina; Gibson, Desmond

2015-01-01

Melanoma incidence is increasing among Hispanics/Latinos in California. This community-based project reached out to a rural Hispanic/Latino community in North San Diego County to provide melanoma prevention and screening education. At a local community health fair, bilingual volunteer lay health workers led 10- to 15-minute-long information…

A Cervical Cancer Community-Based Participatory Research Project in a Native American Community

ERIC Educational Resources Information Center

Christopher, Suzanne; Gidley, Allison L.; Letiecq, Bethany; Smith, Adina; McCormick, Alma Knows His Gun

2008-01-01

The Messengers for Health on the Apsaalooke Reservation project uses a community-based participatory research (CBPR) approach and lay health advisors (LHAs) to generate knowledge and awareness about cervical cancer prevention among community members in a culturally competent manner. Northern Plains Native Americans, of whom Apsaalooke women are a…

Lay navigator model for impacting cancer health disparities.

PubMed

Meade, Cathy D; Wells, Kristen J; Arevalo, Mariana; Calcano, Ercilia R; Rivera, Marlene; Sarmiento, Yolanda; Freeman, Harold P; Roetzheim, Richard G

2014-09-01

This paper recounts experiences, challenges, and lessons learned when implementing a lay patient navigator program to improve cancer care among medically underserved patients who presented in a primary care clinic with a breast or colorectal cancer abnormality. The program employed five lay navigators to navigate 588 patients. Central programmatic elements were the following: (1) use of bilingual lay navigators with familiarity of communities they served; (2) provision of training, education, and supportive activities; (3) multidisciplinary clinical oversight that factored in caseload intensity; and (4) well-developed partnerships with community clinics and social service entities. Deconstruction of healthcare system information was fundamental to navigation processes. We conclude that a lay model of navigation is well suited to assist patients through complex healthcare systems; however, a stepped care model that includes both lay and professional navigation may be optimal to help patients across the entire continuum.

Designing a Community-Based Lay Health Advisor Training Curriculum to Address Cancer Health Disparities

PubMed Central

Gwede, Clement K.; Ashley, Atalie A.; McGinnis, Kara; Montiel-Ishino, F. Alejandro; Standifer, Maisha; Baldwin, Julie; Williams, Coni; Sneed, Kevin B.; Wathington, Deanna; Dash-Pitts, Lolita; Green, B. Lee

2012-01-01

Introduction Racial and ethnic minorities have disproportionately higher cancer incidence and mortality than their White counterparts. In response to this inequity in cancer prevention and care, community-based lay health advisors (LHAs) may be suited to deliver effective, culturally relevant, quality cancer education, prevention/screening, and early detection services for underserved populations. Approach and Strategies Consistent with key tenets of community-based participatory research (CBPR), this project engaged community partners to develop and implement a unique LHA training curriculum to address cancer health disparities among medically underserved communities in a tricounty area. Seven phases of curriculum development went into designing a final seven-module LHA curriculum. In keeping with principles of CBPR and community engagement, academic–community partners and LHAs themselves were involved at all phases to ensure the needs of academic and community partners were mutually addressed in development and implementation of the LHA program. Discussion and Conclusions Community-based LHA programs for outreach, education, and promotion of cancer screening and early detection, are ideal for addressing cancer health disparities in access and quality care. When community-based LHAs are appropriately recruited, trained, and located in communities, they provide unique opportunities to link, bridge, and facilitate quality cancer education, services, and research. PMID:22982709

Changes in blood pressure among users of lay health worker or volunteer operated community-based blood pressure programs over time: a systematic review protocol.

PubMed

Skar, Pål; Young, Lynne; Gordon, Carol

2015-10-01

The objective of this review is to identify studies reporting on lay health worker- or volunteer-led community-based programs for blood pressure screening and cardiovascular awareness in order to determine if these programs contribute to changes in blood pressure among participants over time.The specific question for this review is: What are the changes in blood pressure among adult users of community-based blood pressure screening and awareness programs operated by lay health workers or volunteers as measured by the differences in systolic and diastolic blood pressure between the user's first visit to the program and their last visit to the program? Cardiovascular diseases, such as stroke and heart disease, are quickly becoming global diseases manifesting in countries and communities where they traditionally had not been widespread. The World Health Organization (WHO) has reported that "in the Asia/Pacific region, [cardiovascular disease] has become increasingly prevalent in recent decades, and now accounts for about one third of all deaths". One risk factor that can lead to cardiovascular disease is hypertension. Based on WHO data from 2008, hypertension is now a global problem affecting 27% of the population 25 years of age or older.The risk for cardiovascular disease also appears to be higher among people in urban areas. A recent United Nations population report indicates that in the next 40 years we could see an increase in the world's population by 2.3 billion people. The majority of these people will be residing in urban areas, particularly in developing nations. Between 2011 and 2050, "the population living in urban areas is projected to gain 2.6 billion, passing from 3.6 billion in 2011 to 6.3 billion in 2050". Population growth in urban areas is therefore not only projected to include the expected population growth but also expected to include a shift of rural population to urban centers and "most of the population growth expected in urban areas will be concentrated in the cities and towns of the less developed regions". This growth of urban areas has the potential to put enormous pressures on health care systems that are already struggling to cope with the rapid increase in diseases thought to be more prevalent in Western societies, such as cardiovascular diseases.Hypertension may be difficult to treat due to a number of factors. Globally, access to antihypertensive medications, hypertension screening, and access to medical care vary from one country to another. Lifestyle factors, such as salt and alcohol consumption, stress, smoking, body weight, and exercise, are risk factors for hypertension that may be influenced by culture, which can in turn support or hinder lifestyle decisions that could significantly affect blood pressure. Hypertension, however, is easy to detect. A trained person with access to a low-cost sphygmomanometer can detect abnormal blood pressures quickly; however, access to trained personnel is not universally guaranteed. Globally - according to one model of skilled health care worker density and total requirement offered for discussion by the Global Health Workforce Alliance and WHO - there could currently be an estimated shortage of over seven million skilled health care workers (midwifes, nurses and physicians), as measured against a theoretical density of skilled health care workers to population. The shortage of skilled health care workers in this model could grow to over 12 million by 2035 if the assumptions of the model and population growth estimates are valid. Through rapid urbanization the potential for inequities in access to healthcare is also increased.Over the last few years, a number of community-based blood pressure screening and education initiatives have been established. These initiatives have been created either as part of research, as part of community outreach programs by publicly funded agencies, or as part of an outreach by not-for-profit organizations with a particular interest in reducing cardiovascular disease in specific hard-to-reach populations. Several systematic reviews have been conducted to assess different models for delivering services to people living with high blood pressure to assess community-based programs with a focus on cardiovascular disease, and to assess effectiveness of community health workers (CHW) in a variety of settings. These systematic reviews point to the importance of distinguishing between different categories of health care providers, their training and their roles in program delivery when assessing studies for possible inclusion in a systematic review.In a systematic review of studies from the US by Brownstein et al. focusing on the effectiveness of community health workers (CHWs) in the care of people with hypertension, this category of health care providers went under many different names. Community health workers in this review were defined as "any health workers who carried out functions related to health care deliver, were trained as part of an intervention, had no formal paraprofessional or professional designation, and had a relationship with the community being served". One of the findings from this review was the wide variety of formal training of the CHWs. In other parts of the world, a CHW might be defined differently. In their review of CHW-based programs focusing on children's health, Bhattacharyya, Winch, LeBan and Tien found that "in general CHWs are not paid salaries because the MOH (Ministry of Health) or donors do not consider salaries to be sustainable. Yet CHWs are often held accountable and supervised as if they were employees. Community health worker programs must recognize that CHWs are volunteers (emphasis in original), even if they receive small monetary or nonmonetary incentives. They are volunteering their time to serve the community". One Canadian model for delivering a cardiovascular awareness program designed to reach older adults through their primary care provider is based on volunteers with basic training to perform blood pressure measurements and cardiovascular health information.In a global review of a wide range of public health and health promotion initiatives operated by lay health workers from 2005, Lewin et al. identified over 40 different names or terms for a lay health worker. However, the definition of a lay health worker used by Lewin et al. is very similar to the definition of CHWs offered by Brownstein et al. Lewin et al.'s systematic review was the only study with a global focus that was located that reviewed studies of programs with a cardiovascular component using lay health workers. In this study, the sample size of studies focusing on lay health workers and cardiovascular disease was small (N=3) and the results from two of the studies were inconclusive to the point where the authors felt they could not pool the results.While a lay health worker may or may not receive some compensation for their work, volunteers in higher income areas of the world such as in North America typically do not receive any compensation. Volunteers, as observed by Bhattacharyya et al., are common in many parts of the world, and in some areas they provide delivery of programs and services that reach hundreds of thousands of individuals. One challenge for this systematic review will therefore be to isolate those programs that are delivered by lay health workers or volunteers who receive little or no compensation and programs where staff is paid. The importance of this distinction is on one hand related to cost - as observed by Bhattacharyya et al., many organizations responsible for delivery of community-based programs do not have funding for salaried staff. On the other hand there might be other factors in the relationship between a community being served by a program and the staff delivering the program. One such factor could be linked to the role of the person delivering the program as either a paid health care professional or an unpaid lay health worker or volunteer.Through this proposed JBI systematic review, the reviewers will focus on community-based blood pressure screening and health information programs delivered by either lay health workers or volunteers. Previous systematic reviews have indicated that programs focusing on blood pressure reduction delivered in a variety of settings and delivered by a variety of health care professionals might lower blood pressure among program participants over time. This systematic review will be limited to community-based programs rather than hospital or research facility-based programs, and to programs delivered by lay health workers or volunteers rather than programs delivered by paid community health workers, nurses or teams of health care providers under direction of a primary care provider. Compared to other recent systematic reviews which focused on studies with comparison groups and included few studies where lay health workers were involved, this systematic review will attempt to fill this gap in knowledge about programs delivered by lay health workers or volunteers by focusing on non-randomized controlled studies which report blood pressure changes over time in programs targeting the general population. Community-based programs might have a variety of designs with a number of different interventions, and where possible these designs and interventions will be identified and subgroup analysis conducted as appropriate. It is hoped that this systematic review can extend the work by Lewin et al. by identifying additional studies globally, focusing on programs delivered by lay health workers or volunteers but limited to studies reporting changes in blood pressure over time. Where possible, a meta-analysis of the changes in blood pressure over time among participants in these programs will be conducted. (ABSTRACT TRUNCATED)

Who is a community health worker? - a systematic review of definitions.

PubMed

Olaniran, Abimbola; Smith, Helen; Unkels, Regine; Bar-Zeev, Sarah; van den Broek, Nynke

2017-01-01

Community health workers (CHWs) can play vital roles in increasing coverage of basic health services. However, there is a need for a systematic categorisation of CHWs that will aid common understanding among policy makers, programme planners, and researchers. To identify the common themes in the definitions and descriptions of CHWs that will aid delineation within this cadre and distinguish CHWs from other healthcare providers. A systematic review of peer-reviewed papers and grey literature. We identified 119 papers that provided definitions of CHWs in 25 countries across 7 regions. The review shows CHWs as paraprofessionals or lay individuals with an in-depth understanding of the community culture and language, have received standardised job-related training of a shorter duration than health professionals, and their primary goal is to provide culturally appropriate health services to the community. CHWs can be categorised into three groups by education and pre-service training. These are lay health workers (individuals with little or no formal education who undergo a few days to a few weeks of informal training), level 1 paraprofessionals (individuals with some form of secondary education and subsequent informal training), and level 2 paraprofessionals (individuals with some form of secondary education and subsequent formal training lasting a few months to more than a year). Lay health workers tend to provide basic health services as unpaid volunteers while level 1 paraprofessionals often receive an allowance and level 2 paraprofessionals tend to be salaried. This review provides a categorisation of CHWs that may be useful for health policy formulation, programme planning, and research.

Who is a community health worker? – a systematic review of definitions

PubMed Central

Olaniran, Abimbola; Smith, Helen; Unkels, Regine; Bar-Zeev, Sarah; van den Broek, Nynke

2017-01-01

ABSTRACT Background: Community health workers (CHWs) can play vital roles in increasing coverage of basic health services. However, there is a need for a systematic categorisation of CHWs that will aid common understanding among policy makers, programme planners, and researchers. Objective: To identify the common themes in the definitions and descriptions of CHWs that will aid delineation within this cadre and distinguish CHWs from other healthcare providers. Design: A systematic review of peer-reviewed papers and grey literature. Results: We identified 119 papers that provided definitions of CHWs in 25 countries across 7 regions. The review shows CHWs as paraprofessionals or lay individuals with an in-depth understanding of the community culture and language, have received standardised job-related training of a shorter duration than health professionals, and their primary goal is to provide culturally appropriate health services to the community. CHWs can be categorised into three groups by education and pre-service training. These are lay health workers (individuals with little or no formal education who undergo a few days to a few weeks of informal training), level 1 paraprofessionals (individuals with some form of secondary education and subsequent informal training), and level 2 paraprofessionals (individuals with some form of secondary education and subsequent formal training lasting a few months to more than a year). Lay health workers tend to provide basic health services as unpaid volunteers while level 1 paraprofessionals often receive an allowance and level 2 paraprofessionals tend to be salaried. Conclusions: This review provides a categorisation of CHWs that may be useful for health policy formulation, programme planning, and research. PMID:28222653

Reducing 30-Day Readmission Rates in a High-Risk Population Using a Lay-Health Worker Model in Appalachia Kentucky

ERIC Educational Resources Information Center

Cardarelli, Roberto; Horsley, Mary; Ray, Lisa; Maggard, Nancy; Schilling, Jennifer; Weatherford, Sarah; Feltner, Fran; Gilliam, Kayla

2018-01-01

This exploratory study aimed to address the effectiveness of a lay-health worker (LHW) model in addressing social needs and readmissions of high-risk patients admitted in a rural community hospital. A quasi-experimental study design assessed implementation of a LHW model for assisting high-risk patients with their post-discharge social needs.…

Enabling and sustaining the activities of lay health influencers: lessons from a community-based tobacco cessation intervention study.

PubMed

Castañeda, Heide; Nichter, Mark; Nichter, Mimi; Muramoto, Myra

2010-07-01

The authors present findings from a community-based tobacco cessation project that trained lay health influencers to conduct brief interventions. They outline four major lessons regarding sustainability. First, participants were concerned about the impact that promoting cessation might have on social relationships. "Social risk" must be addressed during training to ensure long-term sustainability. Second, formal training provided participants with an increased sense of self-efficacy, allowed them to embrace a health influencer identity, and aided in further reducing social risk. Third, material resources functioned to mediate social tensions during health intervention conversations. A variety of resources should be made available to health influencers to accommodate type of relationship, timing, and location of the interaction. Finally, project design must be attentive to the creation of a "community of practice" among health influencers as an integral part of project sustainability. These lessons have broad implications for successful health promotion beyond tobacco cessation.

A critique of the design, implementation, and delivery of a culturally-tailored self-management education intervention: a qualitative evaluation.

PubMed

Sidhu, Manbinder S; Gale, Nicola K; Gill, Paramjit; Marshall, Tom; Jolly, Kate

2015-02-07

Self-management education is at the forefront of addressing the increasing prevalence of chronic diseases. For those at greatest risk, such as minority-ethnic and/or socio-economically deprived groups, self-management education can be culturally-tailored to encourage behavioural change. Yet, the application of culturally appropriate material and expertise within health promotion services continues to be debated. We critique the design, implementation, and delivery of a culturally-tailored self-management intervention, with particular focus on the experiences of lay educators. A mixed methods qualitative evaluation was undertaken to understand self-management service provision to culturally diverse communities (i.e. how components such as lay workers, group-based design, and culturally-appropriate educational material are intended to encourage behavioural change). We interviewed lay educators delivering the Chronic Disease Educator programme along with attendees, whilst observing workshops. Data were thematically analysed using a content-based constant comparison approach through a number of interpretative analytical stages. Lay educators felt part of the local community, relating to attendees from different races and ethnicities. However, lay educators faced challenges when addressing health beliefs and changing lifestyle practices. Culturally-tailored components aided communication, with educator's cultural awareness leading to close relationships with attendees, while the group-based design facilitated discussions of the emotional impact of illness. Lay educators bring with them a number of nuanced skills and knowledge when delivering self-management education. The development and training required for this role is inhibited by financial constraints at policy-level. The interpretation of being from the 'community' links with the identity and status of the lay role, overlapping notions of race, ethnicity, and language.

Web-based versus in-person methods for training lay community health advisors to implement health promotion workshops: participant outcomes from a cluster-randomized trial.

PubMed

Holt, Cheryl L; Tagai, Erin K; Santos, Sherie Lou Zara; Scheirer, Mary Ann; Bowie, Janice; Haider, Muhiuddin; Slade, Jimmie

2018-06-28

Project HEAL (Health through Early Awareness and Learning) is an implementation trial that compared two methods of training lay peer community health advisors (CHAs)-in-person ("Traditional") versus web-based ("Technology")-to conduct a series of three evidence-based cancer educational workshops in African American churches. This analysis reports on participant outcomes from Project HEAL. Fifteen churches were randomized to the two CHA training methods and the intervention impact was examined over 24 months. This study was conducted in Prince George's County, MD, and enrolled 375 church members age 40-75. Participants reported on knowledge and screening behaviors for breast, prostate, and colorectal cancer. Overall, cancer knowledge in all areas increased during the study period (p < .001). There were significant increases in digital rectal exam (p < .05), fecal occult blood test (p < .001), and colonoscopy (p < .01) at 24 months; however, this did not differ by study group. Mammography maintenance (56% overall) was evidenced by women reporting multiple mammograms within the study period. Participants attending all three workshops were more likely to report a fecal occult blood test or colonoscopy at 24 months (p < .05) than those who attended only one. These findings suggest that lay individuals can receive web-based training to successfully implement an evidence-based health promotion intervention that results in participant-level outcomes comparable with (a) people trained using the traditional classroom method and (b) previous efficacy trials. Findings have implications for resources and use of technology to increase widespread dissemination of evidence-based health promotion interventions through training lay persons in community settings.

Reactions and coping strategies in lay rescuers who have provided CPR to out-of-hospital cardiac arrest victims: a qualitative study

PubMed Central

Mathiesen, Wenche Torunn; Bjørshol, Conrad Arnfinn; Braut, Geir Sverre; Søreide, Eldar

2016-01-01

Objective Cardiopulmonary resuscitation (CPR) provided by community citizens is of paramount importance for out-of-hospital cardiac arrest (OHCA) victims' survival. Fortunately, CPR rates by community citizens seem to be rising. However, the experience of providing CPR is rarely investigated. The aim of this study was to explore reactions and coping strategies in lay rescuers who have provided CPR to OHCA victims. Methods, participants This is a qualitative study of 20 lay rescuers who have provided CPR to 18 OHCA victims. We used a semistructured interview guide focusing on their experiences after providing CPR. Setting The study was conducted in the Stavanger region of Norway, an area with very high bystander CPR rates. Results Three themes emerged from the interview analysis: concern, uncertainty and coping strategies. Providing CPR had been emotionally challenging for all lay rescuers and, for some, had consequences in terms of family and work life. Several lay rescuers experienced persistent mental recurrences of the OHCA incident and had concerns about the outcome for the cardiac arrest victim. Unknown or fatal outcomes often caused feelings of guilt and were particularly difficult to handle. Several reported the need to be acknowledged for their CPR attempts. Health-educated lay rescuers seemed to be less affected than others. A common coping strategy was confiding in close relations, preferably the health educated. However, some required professional help to cope with the OHCA incident. Conclusions Lay rescuers experience emotional and social challenges, and some struggle to cope in life after providing CPR in OHCA incidents. Experiencing a positive patient outcome and being a health-educated lay rescuer seem to mitigate concerns. Common coping strategies are attempts to reduce uncertainty towards patient outcome and own CPR quality. Further studies are needed to determine whether an organised professional follow-up can mitigate the concerns and uncertainty of lay rescuers. PMID:27225648

The Role of Lay Health Workers in Pediatric Chronic Disease: A Systematic Review

PubMed Central

Raphael, Jean L.; Rueda, Anna; Lion, K. Casey; Giordano, Thomas P.

2013-01-01

Background Children with chronic diseases represent a high-cost and resource-intensive population of children. With continued gaps in chronic disease management and persistent fragmentation in the health care system, stakeholders are seeking new strategies to address the needs of these children. Objective To systematically assess the effectiveness of lay health worker interventions in improving health care utilization, symptom management, and family psychosocial outcomes for children with chronic conditions. Data Source PubMed, PsycINFO, and Web of Science (January 1961- February 2013). Study Eligibility Criteria, Participants, and Interventions We developed a strategy to search citations to identify relevant articles. Search terms included randomized controlled trial (RCT), lay worker, parent mentor, peer mentor, peer educator, community health workers, community health aids, patient advocate, patient facilitator, patient liaison, promotoras (es), care ambassadors, patient navigator, and non-professional. Additional studies were identified by searching the reference lists of retrieved articles and contacting clinical experts. RCTs of lay health worker interventions for children with chronic conditions were included. Studies were restricted to those concentrated on children 0–18 years of age with chronic illnesses. Study Appraisal and Synthesis Methods Abstracts were independently screened by 2 reviewers. Articles with relevant abstracts underwent full text review and were evaluated for inclusion criteria. A structured tool was used to abstract data from selected articles. Due to heterogeneous interventions and outcomes, we did not conduct a meta-analysis. Results The search yielded 736 unique articles, of which 17 met inclusion criteria. All interventions focused on specific conditions: asthma, type I diabetes, obesity, and failure to thrive. Interventions were heterogeneous in frequency, mode, and duration of interactions between lay health workers and subjects. Several interventions were multi-faceted, including both one-on-one and group interactions. Improved outcomes most commonly reported were reduced urgent care use, decreases in symptoms, fewer missed work and school days, and increased parental quality of life. One study demonstrated that lay health worker interventions were cost-effective. Conclusions Lay health workers interventions in children with chronic conditions may lead to modest improvements in urgent care use, symptoms, and parental psychosocial outcomes. Such interventions may also be cost-effective. Future research should focus on interventions targeted toward other chronic conditions such as sickle cell disease or cystic fibrosis and medically complex children whose conditions are non-categorical. PMID:24011745

Latino sexual and gender identity minorities promoting sexual health within their social networks: Process evaluation findings from a lay health advisor intervention

PubMed Central

Sun, Christina J.; García, Manuel; Mann, Lilli; Alonzo, Jorge; Eng, Eugenia; Rhodes, Scott D.

2015-01-01

The HOLA intervention was a lay health advisor intervention designed to reduce the disproportionate HIV burden borne by Latino sexual and gender identity minorities (gay, bisexual, and other men who have sex with men, and transgender persons) living in the United States. Process evaluation data were collected for over a year of intervention implementation from 11 trained Latino male and transgender lay health advisors (Navegantes) to document the activities each Navegante conducted to promote condom use and HIV testing among his or her 8 social network members enrolled in the study. Over 13 months, the Navegantes reported conducting 1,820 activities. The most common activity was condom distribution. Navegantes had extensive reach beyond their enrolled social network members, and they engaged in health promotion activities beyond social network members enrolled in the study. There were significant differences between the types of activities conducted by Navegantes depending on who was present. Results suggest that lay health advisor interventions reach large number of at-risk community members and may benefit populations disproportionately impacted by HIV. PMID:25416309

Food beliefs and practices in urban poor communities in Accra: implications for health interventions.

PubMed

Boatemaa, Sandra; Badasu, Delali Margaret; de-Graft Aikins, Ama

2018-04-02

Poor communities in low and middle income countries are reported to experience a higher burden of chronic non-communicable diseases (NCDs) and nutrition-related NCDs. Interventions that build on lay perspectives of risk are recommended. The objective of this study was to examine lay understanding of healthy and unhealthy food practices, factors that influence food choices and the implications for developing population health interventions in three urban poor communities in Accra, Ghana. Thirty lay adults were recruited and interviewed in two poor urban communities in Accra. The interviews were audio-taped, transcribed and analysed thematically. The analysis was guided by the socio-ecological model which focuses on the intrapersonal, interpersonal, community, structural and policy levels of social organisation. Food was perceived as an edible natural resource, and healthy in its raw state. A food item retained its natural, healthy properties or became unhealthy depending on how it was prepared (e.g. frying vs boiling) and consumed (e.g. early or late in the day). These food beliefs reflected broader social food norms in the community and incorporated ideas aligned with standard expert dietary guidelines. Healthy cooking was perceived as the ability to select good ingredients, use appropriate cooking methods, and maintain food hygiene. Healthy eating was defined in three ways: 1) eating the right meals; 2) eating the right quantity; and 3) eating at the right time. Factors that influenced food choice included finances, physical and psychological state, significant others and community resources. The findings suggest that beliefs about healthy and unhealthy food practices are rooted in multi-level factors, including individual experience, family dynamics and community factors. The factors influencing food choices are also multilevel. The implications of the findings for the design and content of dietary and health interventions are discussed.

A pilot evaluation of Arthritis Self-Management Program by lay leaders in patients with chronic inflammatory arthritis in Hong Kong.

PubMed

Leung, Ying-Ying; Kwan, Jackie; Chan, Patsy; Poon, Peter K K; Leung, Christine; Tam, Lai-Shan; Li, Edmund K; Kwok, Anna

2016-04-01

The objectives of this paper are to evaluate the efficacy of a community-based lay-led Arthritis Self-Management Program (ASMP) among patients with chronic inflammatory arthritis and evaluate the effectiveness of "shared care collaboration" between hospital and community. We trained 17 lay leaders and recruited patients with chronic inflammatory arthritis via a new shared-care model between hospital rheumatology centers and community organizations. Participants were allocated to interventional group or a wait list control group. Evaluations were completed before, after (6 weeks), and 3 months after ASMP. We performed analysis of covariance with adjustment with age, sex, marital status, education, employment, duration of illness, and disability at baseline. A total of 65 participants and 32 controls completed the study. The mean (SD) age and duration of illness were 52.0 (11.4) and 5.6 (7.3) years, 90.7 % were female, 80.4 % had rheumatoid arthritis; 25.8, 53.6, and 12.4 % referrals were from hospitals, community organizations, and patient self-help groups, respectively. The interventional group had significantly less pain (p = 0.049 at 6 weeks), used more cognitive coping methods (p = 0.008 at 6 weeks, p = 0.041 at 3 months) and practiced more aerobic exercise (p = 0.049 at 6 weeks, p = 0.008 at 3 months) after adjustment of covariance. The interventional group had a trend of improvement in self-efficacy, fatigue, self-rated health, and health distress. A community-based lay-led ASMP showed positive beneficial effects on participants with chronic inflammatory arthritis. Shared-care collaboration between hospitals, community organizations, and patient self-help groups was demonstrated.

Development and evaluation of a training workshop for lay health promoters to implement a community-based intervention program in a public low rent housing estate: The Learning Families Project in Hong Kong

PubMed Central

Lai, Agnes Y.; Stewart, Sunita M.; Wan, Alice; Fok, Helen; Lai, Hebe Y. W.; Lam, Tai-hing; Chan, Sophia S.

2017-01-01

This paper presents the development and evaluation of the train-the-trainer (TTT) workshop for lay resident leaders to be lay health promoters. The TTT workshop aimed to prepare the trainees to implement and/or assist in conducting a series of community-based family well-being activities for the residents in a public low rent housing estate, entitled “Learning Families Project”, under the FAMILY project. The four-hour TTT workshop was conducted for 32 trainees (72% women, 43% aged ≥ 60, 41% ≤ elementary school education). The workshop aimed to promote trainees’ knowledge, self-efficacy, attitude and practice of incorporating the positive psychology themes into their community activities and engaging the residents to join these activities and learn with their family members. Post-training support was provided. The effectiveness of the TTT was examined by self-administered questionnaires about trainees’ reactions to training content, changes in learning and practice at three time points (baseline, and immediately and one year after training), and the difference in residents’ survey results before and after participating in the community activities delivered by the trainees. The trainees’ learning about the general concepts of family well-being, learning family, leadership skills and planning skills increased significantly with medium to large effect sizes (Cohen’s d: 0.5–1.4) immediately after the training. The effects of perceived knowledge and attitude towards practice were sustained to one year (Cohen’s d: 0.4–0.6). The application of planning skills to implement community activities was higher at one year (Cohen’s d: 0.4), compared with baseline. At one year, the residents’ survey results showed significant increases in the practice of positive communication behaviours and better neighbour cohesions after joining the family well-being activities of LFP. Qualitative feedback supported the quantitative results. Our TTT workshop could serve as a practical example of development and evaluation of training programs for lay personnel to be lay health promoters. Trial registration: ClinicalTrials.gov NCT02844244 PMID:28841677

Development and evaluation of a training workshop for lay health promoters to implement a community-based intervention program in a public low rent housing estate: The Learning Families Project in Hong Kong.

PubMed

Lai, Agnes Y; Stewart, Sunita M; Wan, Alice; Fok, Helen; Lai, Hebe Y W; Lam, Tai-Hing; Chan, Sophia S

2017-01-01

This paper presents the development and evaluation of the train-the-trainer (TTT) workshop for lay resident leaders to be lay health promoters. The TTT workshop aimed to prepare the trainees to implement and/or assist in conducting a series of community-based family well-being activities for the residents in a public low rent housing estate, entitled "Learning Families Project", under the FAMILY project. The four-hour TTT workshop was conducted for 32 trainees (72% women, 43% aged ≥ 60, 41% ≤ elementary school education). The workshop aimed to promote trainees' knowledge, self-efficacy, attitude and practice of incorporating the positive psychology themes into their community activities and engaging the residents to join these activities and learn with their family members. Post-training support was provided. The effectiveness of the TTT was examined by self-administered questionnaires about trainees' reactions to training content, changes in learning and practice at three time points (baseline, and immediately and one year after training), and the difference in residents' survey results before and after participating in the community activities delivered by the trainees. The trainees' learning about the general concepts of family well-being, learning family, leadership skills and planning skills increased significantly with medium to large effect sizes (Cohen's d: 0.5-1.4) immediately after the training. The effects of perceived knowledge and attitude towards practice were sustained to one year (Cohen's d: 0.4-0.6). The application of planning skills to implement community activities was higher at one year (Cohen's d: 0.4), compared with baseline. At one year, the residents' survey results showed significant increases in the practice of positive communication behaviours and better neighbour cohesions after joining the family well-being activities of LFP. Qualitative feedback supported the quantitative results. Our TTT workshop could serve as a practical example of development and evaluation of training programs for lay personnel to be lay health promoters. ClinicalTrials.gov NCT02844244.

Lay health worker experiences administering a multi-level combination intervention to improve PMTCT retention.

PubMed

DiCarlo, Abby; Fayorsey, Ruby; Syengo, Masila; Chege, Duncan; Sirengo, Martin; Reidy, William; Otieno, Juliana; Omoto, Jackton; Hawken, Mark P; Abrams, Elaine J

2018-01-10

The recent scale-up of prevention of mother-to-child transmission of HIV (PMTCT) services has rapidly accelerated antiretroviral therapy (ART) uptake among pregnant and postpartum women in sub-Saharan Africa. The Mother and Infant Retention for Health (MIR4Health) study evaluates the impact of a combination intervention administered by trained lay health workers to decrease attrition among HIV-positive women initiating PMTCT services and their infants through 6 months postpartum. This was a qualitative study nested within the MIR4Health trial. MIR4Health was conducted at 10 health facilities in Nyanza, Kenya from September 2013 to September 2015. The trial intervention addressed behavioral, social, and structural barriers to PMTCT retention and included: appointment reminders via text and phone calls, follow-up and tracking for missed clinic visits, PMTCT health education at home visits and during clinic visits, and retention and adherence support and counseling. All interventions were administered by lay health workers. We describe results of a nested small qualitative inquiry which conducted two focus groups to assess the experiences and perceptions of lay health workers administering the interventions. Discussions were recorded and simultaneously transcribed and translated into English. Data were analyzed using framework analysis approach. Study findings show lay health workers played a critical role supporting mothers in PMTCT services across a range of behavioral, social, and structural domains, including improved communication and contact, health education, peer support, and patient advocacy and assistance. Findings also identified barriers to the uptake and implementation of the interventions, such as concerns about privacy and stigma, and the limitations of the healthcare system including healthcare worker attitudes. Overall, study findings indicate that lay health workers found the interventions to be feasible, acceptable, and well received by clients. Lay health workers played a fundamental role in supporting mothers engaged in PMTCT services and provided valuable feedback on the implementation of PMTCT interventions. Future interventions must include strategies to ensure client privacy, decrease stigma within communities, and address the practical limitations of health systems. This study adds important insight to the growing body of research on lay health worker experiences in HIV and PMTCT care. Clinicaltrials.gov NCT01962220 .

The development of a lay health worker delivered collaborative community based intervention for people with schizophrenia in India

PubMed Central

2012-01-01

Background Care for schizophrenia in low and middle income countries is predominantly facility based and led by specialists, with limited use of non-pharmacological treatments. Although community based psychosocial interventions are emphasised, there is little evidence about their acceptability and feasibility. Furthermore, the shortage of skilled manpower is a major barrier to improving access to these interventions. Our study aimed to develop a lay health worker delivered community based intervention in three sites in India. This paper describes how the intervention was developed systematically, following the MRC framework for the development of complex interventions. Methods We reviewed the lierature on the burden of schizophrenia and the treatment gap in low and middle income countries and the evidence for community based treatments, and identified intervention components. We then evaluated the acceptability and feasibility of this package of care through formative case studies with individuals with schizophrenia and their primary caregivers and piloted its delivery with 30 families. Results Based on the reviews, our intervention comprised five components (psycho-education; adherence management; rehabilitation; referral to community agencies; and health promotion) to be delivered by trained lay health workers supervised by specialists. The intervention underwent a number of changes as a result of formative and pilot work. While all the components were acceptable and most were feasible, experiences of stigma and discrimination were inadequately addressed; some participants feared that delivery of care at home would lead to illness disclosure; some participants and providers did not understand how the intervention related to usual care; some families were unwilling to participate; and there were delivery problems, for example, in meeting the targeted number of sessions. Participants found delivery by health workers acceptable, and expected them to have knowledge about the subject matter. Some had expectations regarding their demographic and personal characteristics, for example, preferring only females or those who are understanding/friendly. New components to address stigma were then added to the intervention, the collaborative nature of service provision was strengthened, a multi-level supervision system was developed, and delivery of components was made more flexible. Criteria were evolved for the selection and training of the health workers based on participants' expectations. Conclusions A multi-component community based intervention, targeting multiple outcomes, and delivered by trained lay health workers, supervised by mental health specialists, is an acceptable and feasible intervention for treating schizophrenia in India. PMID:22340662

Evaluation of a well-established task-shifting initiative: the lay counselor cadre in Botswana.

PubMed

Ledikwe, Jenny H; Kejelepula, Mable; Maupo, Kabelo; Sebetso, Siwulani; Thekiso, Mothwana; Smith, Monica; Mbayi, Bagele; Houghton, Nankie; Thankane, Kabo; O'Malley, Gabrielle; Semo, Bazghina-Werq

2013-01-01

Evidence supports the implementation of task shifting to address health worker shortages that are common in resource-limited settings. However, there is need to learn from established programs to identify ways to achieve the strongest, most sustainable impact. This study examined the Botswana lay counselor cadre, a task shifting initiative, to explore effectiveness and contribution to the health workforce. This evaluation used multiple methods, including a desk review, a national lay counselor survey (n = 385; response = 94%), in-depth interviews (n = 79), lay counselors focus group discussions (n = 7), lay counselors observations (n = 25), and client exit interviews (n = 47). Interview and focus group data indicate that lay counselors contribute to essentially all HIV-related programs in Botswana and they conduct the majority of HIV tests and related counseling at public health facilities throughout the country. Interviews showed that the lay counselor cadre is making the workload of more skilled health workers more manageable and increasing HIV acceptance in communities. The average score on a work-related knowledge test was 74.5%. However for 3 questions, less than half answered correctly. During observations, lay counselors demonstrated average competence for most skills assessed and clients (97.9%) were satisfied with services received. From the survey, lay counselors generally reported being comfortable with their duties; however, some reported clinical duties that extended beyond their training and mandate. Multiple factors affecting the performance of the lay counselors were identified, including insufficient resources, such as private counseling space and HIV test kits; and technical, administrative, and supervisory support. Lay counselors are fulfilling an important role in Botswana's healthcare system, serving as the entry point into HIV care, support, and treatment services. For this and other similar task shifting initiatives, it is important that lay counselors' responsibilities are clear and that training and support are adequate to optimize their effectiveness.

Evaluation of a Well-Established Task-Shifting Initiative: The Lay Counselor Cadre in Botswana

PubMed Central

Ledikwe, Jenny H.; Kejelepula, Mable; Maupo, Kabelo; Sebetso, Siwulani; Thekiso, Mothwana; Smith, Monica; Mbayi, Bagele; Houghton, Nankie; Thankane, Kabo; O’Malley, Gabrielle; Semo, Bazghina-werq

2013-01-01

Background Evidence supports the implementation of task shifting to address health worker shortages that are common in resource-limited settings. However, there is need to learn from established programs to identify ways to achieve the strongest, most sustainable impact. This study examined the Botswana lay counselor cadre, a task shifting initiative, to explore effectiveness and contribution to the health workforce. Methods This evaluation used multiple methods, including a desk review, a national lay counselor survey (n = 385; response = 94%), in-depth interviews (n = 79), lay counselors focus group discussions (n = 7), lay counselors observations (n = 25), and client exit interviews (n = 47). Results Interview and focus group data indicate that lay counselors contribute to essentially all HIV-related programs in Botswana and they conduct the majority of HIV tests and related counseling at public health facilities throughout the country. Interviews showed that the lay counselor cadre is making the workload of more skilled health workers more manageable and increasing HIV acceptance in communities. The average score on a work-related knowledge test was 74.5%. However for 3 questions, less than half answered correctly. During observations, lay counselors demonstrated average competence for most skills assessed and clients (97.9%) were satisfied with services received. From the survey, lay counselors generally reported being comfortable with their duties; however, some reported clinical duties that extended beyond their training and mandate. Multiple factors affecting the performance of the lay counselors were identified, including insufficient resources, such as private counseling space and HIV test kits; and technical, administrative, and supervisory support. Conclusion Lay counselors are fulfilling an important role in Botswana's healthcare system, serving as the entry point into HIV care, support, and treatment services. Recommendation For this and other similar task shifting initiatives, it is important that lay counselors' responsibilities are clear and that training and support are adequate to optimize their effectiveness. PMID:23585912

Latino sexual and gender identity minorities promoting sexual health within their social networks: process evaluation findings from a lay health advisor intervention.

PubMed

Sun, Christina J; García, Manuel; Mann, Lilli; Alonzo, Jorge; Eng, Eugenia; Rhodes, Scott D

2015-05-01

The HOLA intervention was a lay health advisor intervention designed to reduce the disproportionate HIV burden borne by Latino sexual and gender identity minorities (gay, bisexual, and other men who have sex with men, and transgender persons) living in the United States. Process evaluation data were collected for over a year of intervention implementation from 11 trained Latino male and transgender lay health advisors (Navegantes) to document the activities each Navegante conducted to promote condom use and HIV testing among his or her eight social network members enrolled in the study. Over 13 months, the Navegantes reported conducting 1,820 activities. The most common activity was condom distribution. Navegantes had extensive reach beyond their enrolled social network members, and they engaged in health promotion activities beyond social network members enrolled in the study. There were significant differences between the types of activities conducted by Navegantes depending on who was present. Results suggest that lay health advisor interventions reach large number of at-risk community members and may benefit populations disproportionately affected by HIV. © 2014 Society for Public Health Education.

Reactions and coping strategies in lay rescuers who have provided CPR to out-of-hospital cardiac arrest victims: a qualitative study.

PubMed

Mathiesen, Wenche Torunn; Bjørshol, Conrad Arnfinn; Braut, Geir Sverre; Søreide, Eldar

2016-05-25

Cardiopulmonary resuscitation (CPR) provided by community citizens is of paramount importance for out-of-hospital cardiac arrest (OHCA) victims' survival. Fortunately, CPR rates by community citizens seem to be rising. However, the experience of providing CPR is rarely investigated. The aim of this study was to explore reactions and coping strategies in lay rescuers who have provided CPR to OHCA victims. This is a qualitative study of 20 lay rescuers who have provided CPR to 18 OHCA victims. We used a semistructured interview guide focusing on their experiences after providing CPR. The study was conducted in the Stavanger region of Norway, an area with very high bystander CPR rates. Three themes emerged from the interview analysis: concern, uncertainty and coping strategies. Providing CPR had been emotionally challenging for all lay rescuers and, for some, had consequences in terms of family and work life. Several lay rescuers experienced persistent mental recurrences of the OHCA incident and had concerns about the outcome for the cardiac arrest victim. Unknown or fatal outcomes often caused feelings of guilt and were particularly difficult to handle. Several reported the need to be acknowledged for their CPR attempts. Health-educated lay rescuers seemed to be less affected than others. A common coping strategy was confiding in close relations, preferably the health educated. However, some required professional help to cope with the OHCA incident. Lay rescuers experience emotional and social challenges, and some struggle to cope in life after providing CPR in OHCA incidents. Experiencing a positive patient outcome and being a health-educated lay rescuer seem to mitigate concerns. Common coping strategies are attempts to reduce uncertainty towards patient outcome and own CPR quality. Further studies are needed to determine whether an organised professional follow-up can mitigate the concerns and uncertainty of lay rescuers. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Lay Social Resources for Support of Adherence to Antiretroviral Prophylaxis for HIV Prevention Among Serodiscordant Couples in sub-Saharan Africa: A Qualitative Study.

PubMed

Ware, Norma C; Pisarski, Emily E; Haberer, Jessica E; Wyatt, Monique A; Tumwesigye, Elioda; Baeten, Jared M; Celum, Connie L; Bangsberg, David R

2015-05-01

Effectiveness of antiretroviral pre-exposure prophylaxis (PrEP) for HIV prevention will require high adherence. Using qualitative data, this paper identifies potential lay social resources for support of PrEP adherence by HIV serodiscordant couples in Uganda, laying the groundwork for incorporation of these resources into adherence support initiatives as part of implementation. The qualitative analysis characterizes support for PrEP adherence provided by HIV-infected spouses, children, extended family members, and the larger community. Results suggest social resources for support of PrEP adherence in Africa are plentiful outside formal health care settings and health systems and that couples will readily use them. The same shortage of health professionals that impeded scale-up of antiretroviral treatment for HIV/AIDS in Africa promises to challenge delivery of PrEP. Building on the treatment scale-up experience, implementers can address this challenge by examining the value of lay social resources for adherence support in developing strategies for delivery of PrEP.

Community lay rescuer automated external defibrillation programs: key state legislative components and implementation strategies: a summary of a decade of experience for healthcare providers, policymakers, legislators, employers, and community leaders from the American Heart Association Emergency Cardiovascular Care Committee, Council on Clinical Cardiology, and Office of State Advocacy.

PubMed

Aufderheide, Tom; Hazinski, Mary Fran; Nichol, Graham; Steffens, Suzanne Smith; Buroker, Andrew; McCune, Robin; Stapleton, Edward; Nadkarni, Vinay; Potts, Jerry; Ramirez, Raymond R; Eigel, Brian; Epstein, Andrew; Sayre, Michael; Halperin, Henry; Cummins, Richard O

2006-03-07

Cardiovascular disease is a leading cause of death for adults > or =40 years of age. The American Heart Association (AHA) estimates that sudden cardiac arrest is responsible for about 250,000 out-of-hospital deaths annually in the United States. Since the early 1990s, the AHA has called for innovative approaches to reduce time to cardiopulmonary resuscitation (CPR) and defibrillation and improve survival from sudden cardiac arrest. In the mid-1990s, the AHA launched a public health initiative to promote early CPR and early use of automated external defibrillators (AEDs) by trained lay responders in community (lay rescuer) AED programs. Between 1995 and 2000, all 50 states passed laws and regulations concerning lay rescuer AED programs. In addition, the Cardiac Arrest Survival Act (CASA, Public Law 106-505) was passed and signed into federal law in 2000. The variations in state and federal legislation and regulations have complicated efforts to promote lay rescuer AED programs and in some cases have created impediments to such programs. Since 2000, most states have reexamined lay rescuer AED statutes, and many have passed legislation to remove impediments and encourage the development of lay rescuer AED programs. The purpose of this statement is to help policymakers develop new legislation or revise existing legislation to remove barriers to effective community lay rescuer AED programs. Important areas that should be considered in state legislation and regulations are highlighted, and sample legislation sections are included. Potential sources of controversy and the rationale for proposed legislative components are noted. This statement will not address legislation to support home AED programs. Such recommendations may be made after the conclusion of a large study of home AED use.

Social support among African Americans with heart failure: is there a role for community health advisors?

PubMed

Durant, Raegan W; Brown, Qiana L; Cherrington, Andrea L; Andreae, Lynn J; Hardy, Claudia M; Scarinci, Isabel C

2013-01-01

The study had 2 objectives: (1) to gather the observations of community health advisors (CHAs) on the role of social support in the lives of African Americans; and (2) to develop a lay support intervention framework, on the basis of the existing literature and observations of CHAs, depicting how social support may address the needs of African American patients with heart failure. Qualitative data were collected in semistructured interviews among 15 CHAs working in African American communities in Birmingham, Alabama. Prominent themes included the challenge of meeting clients' overlapping health care and general life needs, the variation in social support received from family and friends, and the opportunities for CHAs to provide multiple types of social support to clients. CHAs also believed that their support activities could be implemented among populations with heart failure. The experience of CHAs with social support can inform a potential framework of a lay support intervention among African Americans with heart failure. Published by Mosby, Inc.

A Community Prevention Approach to Peaceful Schools: Application of Wakanheza

ERIC Educational Resources Information Center

Erickson, Christina L.; Lee, Serita; Mattaini, Mark A.

2009-01-01

Schools have long recognized the importance of creating climates that are peaceful, laying the groundwork for good student academic learning. This article explores the work of a large urban school district as it applies a community violence prevention model developed by the local county public health department to create peaceful communities.…

‘Maintaining balance and harmony’: Javanese perceptions of health and cardiovascular disease

PubMed Central

Dewi, Fatwa S.T.; Weinehall, Lars; Öhman, Ann

2010-01-01

Community intervention programmes to reduce cardiovascular disease (CVD) risk factors within urban communities in developing countries are rare. One possible explanation is the difficulty of designing an intervention that corresponds to the local context and culture. Objectives To understand people's perceptions of health and CVD, and how people prevent CVD in an urban setting in Yogyakarta, Indonesia. Methods A qualitative study was performed through focus group discussions and individual research interviews. Participants were selected purposively in terms of socio-economic status (SES), lay people, community leaders and government officers. Data were analysed by using content analysis. Results Seven categories were identified: (1) heart disease is dangerous, (2) the cause of heart disease, (3) men have no time for health, (4) women are caretakers for health, (5) different information-seeking patterns, (6) the role of community leaders and (7) patterns of lay people's action. Each category consists of sub-categories according to the SES of participants. The main theme that emerged was one of balance and harmony, indicating the necessity of assuring a balance between ‘good’ and ‘bad’ habits. Conclusions The basic concepts of balance and harmony, which differ between low and high SES groups, must be understood when tailoring community interventions to reduce CVD risk factors. PMID:20411051

Zinc and Vitamin Supplementation in an Under-5 Indigenous Population of Guatemala: Influence of Lay Health Promoters in Decreasing Incidence of Diarrhea.

PubMed

Grossmann, Vicki M; Turner, Barbara S; Snyder, Denise; Stewart, Robert D; Bowen, Toni; Cifuentes, Ariadna A; Cliff, Cheryl

2015-09-01

Malnutrition is an urgent problem in the developing world, especially for children under 5 years of age. The article describes the utilization of a standard of practice designed to prevent illness in a malnourished, under-5 indigenous population and reinforced by weekly basic health messages taught by lay community health promoters. The two villages were chosen for observation after administration of the standard of care among the Maya-Kíché, the most numerous Mayan group in Guatemala. The standard of practice, 20 mg of daily oral zinc, was administered for 10 days in the home and followed by daily vitamin supplementation that continued throughout the 3 months of the project. All patients received four monthly clinic visits, with one of the village groups receiving weekly health promoter visits. Data evaluated after the quality improvement project showed significant differences in adherence to the zinc regimen (χ(2) = 3.677, p ≤ .05) as well as lower rates of diarrheal illnesses (χ(2) = 5.850, p ≤ .05), with both of these improved in the health promoter group. This study suggests that the training and implementation of para-health professionals from the lay community in response to specific health care needs could be considered a best practice in developing countries. Public health professionals are key to health promoter training and direction, and their importance in the global setting cannot be understated. © The Author(s) 2014.

Resource Use and Medicare Costs During Lay Navigation for Geriatric Patients With Cancer.

PubMed

Rocque, Gabrielle B; Pisu, Maria; Jackson, Bradford E; Kvale, Elizabeth A; Demark-Wahnefried, Wendy; Martin, Michelle Y; Meneses, Karen; Li, Yufeng; Taylor, Richard A; Acemgil, Aras; Williams, Courtney P; Lisovicz, Nedra; Fouad, Mona; Kenzik, Kelly M; Partridge, Edward E

2017-06-01

Lay navigators in the Patient Care Connect Program support patients with cancer from diagnosis through survivorship to end of life. They empower patients to engage in their health care and navigate them through the increasingly complex health care system. Navigation programs can improve access to care, enhance coordination of care, and overcome barriers to timely, high-quality health care. However, few data exist regarding the financial implications of implementing a lay navigation program. To examine the influence of lay navigation on health care spending and resource use among geriatric patients with cancer within The University of Alabama at Birmingham Health System Cancer Community Network. This observational study from January 1, 2012, through December 31, 2015, used propensity score-matched regression analysis to compare quarterly changes in the mean total Medicare costs and resource use between navigated patients and nonnavigated, matched comparison patients. The setting was The University of Alabama at Birmingham Health System Cancer Community Network, which includes 2 academic and 10 community cancer centers across Alabama, Georgia, Florida, Mississippi, and Tennessee. Participants were Medicare beneficiaries with cancer who received care at participating institutions from 2012 through 2015. The primary exposure was contact with a patient navigator. Navigated patients were matched to nonnavigated patients on age, race, sex, cancer acuity (high vs low), comorbidity score, and preenrollment characteristics (costs, emergency department visits, hospitalizations, intensive care unit admissions, and chemotherapy in the preenrollment quarter). Total costs to Medicare, components of cost, and resource use (emergency department visits, hospitalizations, and intensive care unit admissions). In total, 12 428 patients (mean (SD) age at cancer diagnosis, 75 (7) years; 52.0% female) were propensity score matched, including 6214 patients in the navigated group and 6214 patients in the matched nonnavigated comparison group. Compared with the matched comparison group, the mean total costs declined by $781.29 more per quarter per navigated patient (β = -781.29, SE = 45.77, P < .001), for an estimated $19 million decline per year across the network. Inpatient and outpatient costs had the largest between-group quarterly declines, at $294 and $275, respectively, per patient. Emergency department visits, hospitalizations, and intensive care unit admissions decreased by 6.0%, 7.9%, and 10.6%, respectively, per quarter in navigated patients compared with matched comparison patients (P < .001). Costs to Medicare and health care use from 2012 through 2015 declined significantly for navigated patients compared with matched comparison patients. Lay navigation programs should be expanded as health systems transition to value-based health care.

What do women gain from volunteering? The experience of lay Arab and Jewish women volunteers in the Women for Women's Health programme in Israel.

PubMed

Daoud, Nihaya; Shtarkshall, Ronny; Laufer, Neri; Verbov, Gina; Bar-El, Hagar; Abu-Gosh, Nasreen; Mor-Yosef, Shlomo

2010-03-01

Ambiguous feelings regarding women engaging in formal volunteering and concerns about their exploitation might explain the dearth of studies regarding the volunteering benefits specifically experienced by low socioeconomic status women. The current study examined benefits of volunteering among women participating in Women for Women's Health (WWH), a lay health volunteers (LHV) programme implemented in Jewish and Arab communities in Israel, and aiming at empowering such women to become active volunteers and promote health activities in their communities. Two years after the introduction of WWH in each community, all 45 Jewish and 25 Arab volunteers were contacted by phone and invited to participate in the focus group discussions. Five focus group discussions were conducted with 25/42 Jewish volunteers in 2003 and four with 20/25 Arab volunteers in 2005. The other volunteers could not attend the scheduled meetings or became inactive for personal reasons. Four benefit categories were identified in both ethnic groups: 1. Personal benefits of having increased knowledge, feeling self-satisfaction, mastering new skills and performing healthy behaviours; 2. Group-social benefits of social support and sense of cohesion; 3. Purposive benefits of achieving the WWH mission and goals; 4. Sociopolitical benefits of learning to accept the other and experiencing increased solidarity. However, the relatively less privileged Arab volunteers enumerated more benefits within the personal and purposive categories. They also identified the unique sociocultural category of improving women's status in the community by creating a legitimate space for women by public sphere involvement, traditionally solely a male domain. We conclude that volunteering in community-based health promotion programmes can be an empowering experience for lay women without being exploitative. Positive volunteering benefits will be even more discernable among underprivileged women who enjoy fewer opportunities in the personal and public domains. More studies need to explore volunteering benefits as reported by LHVs, making these benefits more visible and desirable.

Sustaining the future of HIV counselling to reach 90-90-90: a regional country analysis.

PubMed

Bemelmans, Marielle; Baert, Saar; Negussie, Eyerusalem; Bygrave, Helen; Biot, Marc; Jamet, Christine; Ellman, Tom; Banda, Amanda; van den Akker, Thomas; Ford, Nathan

2016-01-01

Counselling services are recommended by the World Health Organization and have been partially adopted by national HIV guidelines. In settings with a high HIV burden, patient education and counselling is often performed by lay workers, mainly supported with international funding. There are few examples where ministries of health have been able to absorb lay counsellors into their health systems or otherwise sustain their work. We document the role of lay cadres involved in HIV testing and counselling and adherence support and discuss approaches to sustainability. We focused on a purposive sample of eight sub-Saharan African countries where Médecins Sans Frontières supports HIV programmes: Guinea, Lesotho, Malawi, Mozambique, South Africa, Swaziland, Zambia and Zimbabwe. We reviewed both published and grey literature, including national policies and donor proposals, and interviewed key informants, including relevant government staff, donors and non-governmental organizations. Lay counsellors play a critical role in scaling up HIV services and addressing gaps in the HIV testing and treatment cascade by providing HIV testing and counselling and adherence support at both the facility and community levels. Countries have taken various steps in recognizing lay counsellors, including harmonizing training, job descriptions and support structures. However, formal integration of this cadre into national health systems is limited, as lay counsellors are usually not included in national strategies or budgeting. The current trend of reduced donor support for lay counsellors, combined with lack of national prioritization, threatens the sustainability of this cadre and thereby quality HIV service delivery.

Medical Judgments Across the Range of Reported Pain Severity: Clinician and Lay Perspectives.

PubMed

Tait, Raymond C; Chibnall, John T; House, Kylie; Biehl, Joann

2016-07-01

While increasing evidence suggests that observers discount high-severity chronic pain, factors that occasion such discounting are poorly understood, particularly regarding health provider vs lay perspectives. This study examined the effects of supporting medical evidence and comorbid psychological distress (pain behavior) on medical student and lay clinical judgments of increasingly severe patient pain reports. In a 2 × 2 × 2 × (7) mixed between- and within-subject design, participants (medical students vs lay) made clinical judgments after reading vignettes describing a hypothetical patient that varied in levels of medical evidence and pain behavior (low vs high) and pain severity (4/10-10/10). Fourth-year medical students (N = 115) and lay persons in the community (N = 300) participated in this research. While both medical student and lay judgments plateaued at high levels of pain severity, judgments regarding cause (medical vs psychological), treatment (opioid prescription), and disability showed growing divergence as levels of reported pain severity increased. Divergence relative to medical and psychological causes of pain was found irrespective of the level of supporting medical evidence; divergence relative to opioid treatment and support for a disability claim was found when supporting medical evidence was low. The results indicate differing expectations of chronic pain treatment for health care providers relative to the lay public that could impact clinical care, especially at high pain severity levels, where lay expectations diverge significantly from those of health professionals. © 2015 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Lay Health Influencers: How They Tailor Brief Tobacco Cessation Interventions

PubMed Central

Yuan, Nicole P.; Castañeda, Heide; Nichter, Mark; Nichter, Mimi; Wind, Steven; Carruth, Lauren; Muramoto, Myra

2014-01-01

Interventions tailored to individual smoker characteristics have increasingly received attention in the tobacco control literature. The majority of tailored interventions are generated by computers and administered with printed materials or Web-based programs. The purpose of this study was to examine the tailoring activities of community lay health influencers who were trained to perform face-to-face brief tobacco cessation interventions. Eighty participants of a large-scale, randomized controlled trial completed a 6-week qualitative follow-up interview. A majority of participants (86%) reported that they made adjustments in their intervention behaviors based on individual smoker characteristics, their relationship with the smoker, and/or setting. Situational contexts (i.e., location and timing) primarily played a role after targeted smokers were selected. The findings suggest that lay health influencers benefit from a training curriculum that emphasizes a motivational, person-centered approach to brief cessation interventions. Recommendations for future tobacco cessation intervention trainings are presented. PMID:21986244

Lay health influencers: how they tailor brief tobacco cessation interventions.

PubMed

Yuan, Nicole P; Castañeda, Heide; Nichter, Mark; Nichter, Mimi; Wind, Steven; Carruth, Lauren; Muramoto, Myra

2012-10-01

Interventions tailored to individual smoker characteristics have increasingly received attention in the tobacco control literature. The majority of tailored interventions are generated by computers and administered with printed materials or web-based programs. The purpose of this study was to examine the tailoring activities of community lay health influencers who were trained to perform face-to-face brief tobacco cessation interventions. Eighty participants of a large-scale, randomized controlled trial completed a 6-week qualitative follow-up interview. A majority of participants (86%) reported that they made adjustments in their intervention behaviors based on individual smoker characteristics, their relationship with the smoker, and/or setting. Situational contexts (i.e., location and timing) primarily played a role after targeted smokers were selected. The findings suggest that lay health influencers benefit from a training curriculum that emphasizes a motivational, person-centered approach to brief cessation interventions. Recommendations for future tobacco cessation intervention trainings are presented.

An innovative method to involve community health workers as partners in evaluation research.

PubMed

Peacock, Nadine; Issel, L Michele; Townsell, Stephanie J; Chapple-McGruder, Theresa; Handler, Arden

2011-12-01

We developed a process through which community outreach workers, whose role is not typically that of a trained researcher, could actively participate in collection of qualitative evaluation data. Outreach workers for a community-based intervention project received training in qualitative research methodology and certification in research ethics. They used a Voice over Internet Protocol phone-in system to provide narrative reports about challenges faced by women they encountered in their outreach activities as well as their own experiences as outreach workers. Qualitative data contributed by outreach workers provided insights not otherwise available to the evaluation team, including details about the complex lives of underserved women at risk for poor pregnancy outcomes and the challenges and rewards of the outreach worker role. Lay health workers can be a valuable asset as part of a research team. Training in research ethics and methods can be tailored to their educational level and preferences, and their insights provide important information and perspectives that may not be accessible via other data collection methods. Challenges encountered in the dual roles of researcher and lay health worker can be addressed in training.

Exploring an increased role for Australian community pharmacy in mental health professional service delivery: evaluation of the literature.

PubMed

Hattingh, H Laetitia; Scahill, Shane; Fowler, Jane L; Wheeler, Amanda J

2016-12-01

Australian general practitioners primarily treat mental health problems by prescribing medication dispensed by community pharmacists. Pharmacists therefore have regular interactions with mental health consumers and carers. This narrative review explored the potential role of community pharmacy in mental health services. Medline, CINAHL, ProQuest, Emerald, PsycINFO, Science Direct, PubMed, Web of Knowledge and IPA were utilised. The Cochrane Library as well as grey literature and "lay" search engines such as GoogleScholar were also searched. Four systematic reviews and ten community pharmacy randomised controlled trials were identified. Various relevant reviews outlining the impact of community pharmacy based disease state or medicines management services were also identified. International studies involving professional service interventions for mental health consumers could be contextualised for the Australian setting. Australian studies of pharmacy professional services for chronic physical health conditions provided further guidance for the expansion of community pharmacy mental health professional services.

Contesting lifestyle risk and gendering coronary candidacy: lay epidemiology of heart disease in Finland in the 1970s.

PubMed

Jauho, Mikko

2017-09-01

This study addresses two issues currently under critical discussion in the epidemiology of cardiovascular diseases (CVD), the relative neglect of women and the individualised nature of key risk factors. It focuses on the North Karelia project (NKP), a community programme aimed at coronary heart disease (CHD) prevention in a predominantly rural Finnish region in the early 1970s, that is, during a period when the epidemiological understanding of CVD still was relatively new and actively promoted. Adopting the notions of lay epidemiology and coronary candidacy, culturally mediated explanatory models lay people use to assess who is likely to develop heart disease and why, the study shows that locals targeted by the project critically engaged with both of these bias. Based on the rich materials resulting from project activities the study shows, first, how many locals subsumed the individualised and lifestyle-based approach to CHD prevention promoted by NKP under a more general framework emphasising the health effects of ongoing structural changes in the area, and second, how women constructed themselves as viable coronary candidates. The case supports the position in the current discussions on lay expertise that wants to integrate lay experiences more firmly into epidemiological studies and public health. © 2017 Foundation for the Sociology of Health & Illness.

Development and evaluation of a genomics training program for community health workers in Texas.

PubMed

Chen, Lei-Shih; Zhao, Shixi; Stelzig, Donaji; Dhar, Shweta U; Eble, Tanya; Yeh, Yu-Chen; Kwok, Oi-Man

2018-01-04

PurposeGenomics services have the potential to reduce incidence and mortality of diseases by providing individualized, family health history (FHH)-based prevention strategies to clients. These services may benefit from the involvement of community health workers (CHWs) in the provision of FHH-based genomics education and services, as CHWs are frontline public health workers and lay health educators, who share similar ethnicities, languages, socioeconomic statuses, and life experiences with the communities they serve. We developed, implemented, and evaluated the FHH-based genomics training program for CHWs.MethodsThis theory- and evidence-based FHH-focused genomics curriculum was developed by an interdisciplinary team. Full-day workshops in English and Spanish were delivered to 145 Texas CHWs (91.6% were Hispanic/black). Preworkshop, postworkshop, and 3-month follow-up data were collected.ResultsCHWs significantly improved their attitudes, intention, self-efficacy, and knowledge regarding adopting FHH-based genomics into their practice after the workshops. At 3-month follow-up, these scores remained higher, and there was a significant increase in CHWs' genomics practices.ConclusionThis FHH-based genomics training successfully educated Texas CHWs, and the outcomes were promising. Dissemination of training to CHWs in and outside of Texas is needed to promote better access to and delivery of personalized genomics services for the lay and underserved communities.GENETICS in MEDICINE advance online publication, 4 January 2018; doi:10.1038/gim.2017.236.

Black Families' Lay Views on Health and the Implications for Health Promotion: A Community-Based Study in the UK

ERIC Educational Resources Information Center

Ochieng, Bertha

2012-01-01

Many studies focusing on beliefs about health and health promotion have paid little attention to the life experiences of Black and other visible minority ethnic families in western societies. This paper is a report of a study exploring Black families' beliefs about health and the implications of such beliefs for health promotion. Ten Black…

The changing role of indigenous lay midwives in Guatemala: new frameworks for analysis.

PubMed

Chary, Anita; Díaz, Anne Kraemer; Henderson, Brent; Rohloff, Peter

2013-08-01

to examine the present-day knowledge formation and practice of indigenous Kaqchikel-speaking midwives, with special attention to their interactions with the Guatemalan medical community, training models, and allopathic knowledge in general. a qualitative study consisting of participant-observation in lay midwife training programs; in-depth interviews with 44 practicing indigenous midwives; and three focus groups with midwives of a local non-governmental organization. Kaqchikel Maya-speaking communities in the Guatemalan highlands. the cumulative undermining effects of marginalization, cultural and linguistic barriers, and poorly designed training programs contribute to the failure of lay midwife-focused initiatives in Guatemala to improve maternal-child health outcomes. Furthermore, in contrast to prevailing assumptions, Kaqchikel Maya midwives integrate allopathic obstetrical knowledge into their practice at a high level. as indigenous midwives in Guatemala will continue to provide a large fraction of the obstetrical services among rural populations for many years to come, maternal-child policy initiatives must take into account that: (1)Guatemalan midwife training programs can be significantly improved when instruction occurs in local languages, such as Kaqchikel, and (2)indigenous midwives' increasing allopathic repertoire may serve as a productive ground for synergistic collaborations between lay midwives and the allopathic medical community. Copyright © 2012 Elsevier Ltd. All rights reserved.

Why some messages speak better: child immunization in the news and on the internet.

PubMed

Rundblad, Gabriella

2015-01-01

Modern health protection generally affords vaccination against infectious diseases along with other environmental health threats. However, with the increase both in development of new vaccines and in making more and more vaccines available to the general public comes an increase in health scares, mainly in the media. In the wake of health scares, we often find government and health organizations launching campaigns to restore faith in current vaccine policies. But health scares are hard to quell and seem to have messages that "speak better" to those unconvinced about the safety of vaccines. This paper seeks to review recent studies on the health messages prevalent in various news outlets and on the internet. Equal focus has been given to messages originating from government and health organizations as well as those that stem from lay organizations, such as parent communities and anti-vaccination groups. Particular emphasis was placed on studies that did not simply look at the content of the message, but which explored the rhetoric of the message. This review revealed that there is a shortage of studies, and that a comprehensive study of health messages and communication outlets across a much wider range of vaccines is urgently warranted. Based on current research, lay-based/lay-oriented dissemination approaches seem to have a greater effect on lay perceptions of vaccines, and potentially parent behavior. In terms of content, these approaches rely heavily on parent stories around adverse effects, and in terms of rhetoric, the language used tends towards dread words.

Community health workers and home-based care programs for HIV clients.

PubMed Central

Johnson, Becky A.; Khanna, Sunil K.

2004-01-01

In Nyanza Province, Kenya, estimated HIV prevalence is 22%. Given that more than 80% of the population resides in rural areas, the majority of individuals in Nyanza Province do not have access to medical facilities on a regular basis. In response to the growing demands the HIV epidemic has placed on the people and communities in this region, hundreds of lay individuals have been trained as community health workers to provide home-based care to sick or dying HIV/AIDS clients in rural areas. This paper discusses the role and impact of these community health workers in Nyanza Province, Kenya. It outlines the collaborative relationship between community health workers and the Ministry of Health, examining community health workers' use of extant biomedical structures at the district level to provide services that government-run health facilities lack the monetary resources or personnel to provide. Finally, it explores the role played by community health workers in providing HIV/AIDS education to individuals in an attempt to prevent further infections. PMID:15101670

The Code Red Project: Engaging Communities in Health System Change in Hamilton, Canada

ERIC Educational Resources Information Center

DeLuca, Patrick F.; Buist, Steve; Johnston, Neil

2012-01-01

The communication of determinants of health and health outcomes normally executed through academic channels often fail to reach lay audiences. In April of 2010, the results of collaboration between academe and mass media were published in the Hamilton Spectator, one of Canada's 10 largest English-language daily newspapers as a 7-day series. The…

Strategies for Community Education Prior to Clinical Trial Recruitment for a Cervical Cancer Screening Intervention in Uganda.

PubMed

Mitchell, Sheona M; Pedersen, Heather N; Sekikubo, Musa; Biryabarema, Christine; Byamugisha, Josaphat J K; Mwesigwa, David; Steinberg, Malcolm; Money, Deborah M; Ogilvie, Gina S

2016-01-01

Community engagement and education can improve acceptability and participation in clinical trials conducted in Kisenyi, Uganda. In preparation for a randomized controlled trial exploring different methods for cervical cancer screening, we explored optimal engagement strategies from the perspective of community members and health professionals. We conducted key informant interviews followed by serial community forums with purposeful sampling and compared the perspectives of women in Kisenyi (N = 26) to health-care workers (HCW) at the local and tertiary care center levels (N = 61) in a participatory, iterative process. Key themes identified included format, content, language, message delivery, and target population. Women in Kisenyi see demonstration as a key part of an educational intervention and not solely a didactic session, whereas health professionals emphasized the biomedical content and natural history of cervical cancer. Using local language and lay leaders with locally accessible terminology was more of a priority for women in Kisenyi than clinicians. Simple language with a clear message was essential for both groups. Localization of language and reciprocal communication using demonstration between community members and HCW was a key theme. Although perceptions of the format are similar between women and HCW, the content, language, and messaging that should be incorporated in a health education strategy differ markedly. The call for lay leaders to participate in health promotion is a clear step toward transforming this cervical cancer screening project to be a fully participatory process. This is important in scaling up cervical cancer screening programs in Kisenyi and will be central in developing health education interventions for this purpose.

Informing mental health policies and services in the EMR: cost-effective deployment of human resources to deliver integrated community-based care.

PubMed

Ivbijaro, G; Patel, V; Chisholm, D; Goldberg, D; Khoja, T A M; Edwards, T M; Enum, Y; Kolkiewic, L A

2015-09-28

For EMR countries to deliver the expectations of the Global Mental Health Action Plan 2013-2020 & the ongoing move towards universal health coverage, all health & social care providers need to innovate and transform their services to provide evidence-based health care that is accessible, cost-effective & with the best patient outcomes. For the primary and community workforce, this includes general medical practitioners, practice & community nurses, community social workers, housing officers, lay health workers, nongovernmental organizations & civil society, including community spiritual leaders/healers. This paper brings together the current best evidence to support transformation & discusses key approaches to achieve this, including skill mix and/or task shifting and integrated care. The important factors that need to be in place to support skill mix/task shifting and good integrated care are outlined with reference to EMR countries.

Participant-Observation and Pile Sorting: Methods for Eliciting Local Understandings and Valuations of Plants as a First Step towards Informed Community Participation in Environment and Health Initiatives in Hawai'i

ERIC Educational Resources Information Center

Gollin, Lisa X.; McMillen, Heather; Wilcox, Bruce

2004-01-01

Semistructured interviews were conducted to explore local, lay perceptions and valuations of native and nonnative flora in order to better understand and anticipate community perceptions of, and potential participation in revegetation or eradication conservation efforts in multiethnic communities of Oahu, Hawai'i. The authors detail the…

Advancing understanding of the sustainability of lay health advisor (LHA) programs for African-American women in community settings.

PubMed

Shelton, Rachel C; Charles, Thana-Ashley; Dunston, Sheba King; Jandorf, Lina; Erwin, Deborah O

2017-09-01

Lay health advisor (LHA) programs have made strong contributions towards the elimination of health disparities and are increasingly being implemented to promote health and prevent disease. Developed in collaboration with African-American survivors, the National Witness Project (NWP) is an evidence-based, community-led LHA program that improves cancer screening among African-American women. NWP has been successfully disseminated, replicated, and implemented nationally in over 40 sites in 22 states in diverse community settings, reaching over 15,000 women annually. We sought to advance understanding of barriers and facilitators to the long-term implementation and sustainability of LHA programs in community settings from the viewpoint of the LHAs, as well as the broader impact of the program on African-American communities and LHAs. In the context of a mixed-methods study, in-depth telephone interviews were conducted among 76 African-American LHAs at eight NWP sites at baseline and 12-18 months later, between 2010 and 2013. Qualitative data provides insight into inner and outer contextual factors (e.g., community partnerships, site leadership, funding), implementation processes (e.g., training), as well as characteristics of the intervention (e.g., perceived need and fit in African-American community) and LHAs (e.g., motivations, burnout) that are perceived to impact the continued implementation and sustainability of NWP. Factors at the contextual levels and related to motivations of LHAs are critical to the sustainability of LHA programs. We discuss how findings are used to inform (1) the development of the LHA Sustainability Framework and (2) strategies to support the continued implementation and sustainability of evidence-based LHA interventions in community settings.

Evaluation of a hepatitis B lay health worker intervention for Chinese Americans and Canadians.

PubMed

Taylor, Vicky M; Hislop, T Gregory; Tu, Shin-Ping; Teh, Chong; Acorda, Elizabeth; Yip, Mei-Po; Woodall, Erica; Yasui, Yutaka

2009-06-01

Hepatitis B testing is recommended for immigrants from countries where hepatitis B infection is endemic. However, only about one-half of Chinese in North America have received hepatitis B testing. We conducted a randomized controlled trial to evaluate the effectiveness of a hepatitis B lay health worker intervention for Chinese Americans/Canadians. Four hundred and sixty individuals who had never been tested for hepatitis B were identified from community-based surveys of Chinese conducted in Seattle, Washington, and Vancouver, British Columbia. These individuals were randomly assigned to receive a hepatitis B lay health worker intervention or a direct mailing of physical activity educational materials. Follow-up surveys were completed 6 months after randomization. Self-reported hepatitis B testing was verified through medical records review. A total of 319 individuals responded to the follow-up survey (69% response rate). Medical records data verified hepatitis B testing since randomization for 9 (6%) of the 142 experimental group participants and 3 (2%) of the 177 control group participants (P = 0.04). At follow-up, a higher proportion of individuals in the experimental arm than individuals in the control arm knew that hepatitis B can be spread by razors (P < 0.001) and during sexual intercourse (P = 0.07). Our findings suggest that lay health worker interventions can impact hepatitis B-related knowledge. However, our hepatitis B lay health worker intervention had a very limited impact on hepatitis B testing completion. Future research should evaluate other intervention approaches to improving hepatitis B testing rates among Chinese in North America.

Evaluation of a Hepatitis B Lay Health Worker Intervention for Chinese Americans and Canadians

PubMed Central

Taylor, Vicky M.; Hislop, T. Gregory; Tu, Shin-Ping; Teh, Chong; Acorda, Elizabeth; Yip, Mei-Po; Woodall, Erica; Yasui, Yutaka

2009-01-01

Hepatitis B testing is recommended for immigrants from countries where hepatitis B infection is endemic. However, only about one-half of Chinese in North America have received hepatitis B testing. We conducted a randomized controlled trial to evaluate the effectiveness of a hepatitis B lay health worker intervention for Chinese Americans/Canadians. Four hundred and sixty individuals who had never been tested for hepatitis B were identified from community-based surveys of Chinese conducted in Seattle, Washington, and Vancouver, British Columbia. These individuals were randomly assigned to receive a hepatitis B lay health worker intervention or a direct mailing of physical activity educational materials. Follow-up surveys were completed six months after randomization. Self-reported hepatitis B testing was verified through medical records review. A total of 319 individuals responded to the follow-up survey (69% response rate). Medical records data verified hepatitis B testing since randomization for nine (6%) of the 142 experimental group participants and three (2%) of the 177 control group participants (p=0.04). At follow-up, a higher proportion of individuals in the experimental arm than individuals in the control arm knew that hepatitis B can be spread by razors (p<0.001) and during sexual intercourse (p=0.07). Our findings suggest that lay health worker interventions can impact hepatitis B-related knowledge. However, our hepatitis B lay health worker intervention had a very limited impact on hepatitis B testing completion. Future research should evaluate other intervention approaches to improving hepatitis B testing rates among Chinese in North America. PMID:19127416

Active Ottumwa: Adapting Evidence-Based Recommendations to Promote Physical Activity in a Micropolitan New Destination Community

PubMed Central

Baquero, Barbara; Ashida, Sato; Daniel-Ulloa, Jason; Laroche, Helena H.; Haines, Heidi; Bucklin, Rebecca; Maldonado, Adriana; Coronado Garcia, Mayra; Berto, Sandy; Sewell, Dan; Janz, Kathleen; Gates, Claudia; Parker, Edith A.

2018-01-01

Background: Evidence-based interventions have been developed and tested to promote physical activity, but fewer studies have focused on identifying effective intervention strategies for mid-size rural communities, especially new immigrant destinations. We report here on the design and implementation of Active Ottumwa, a community-wide intervention using a lay health advisor approach to increase physical activity in a micropolitan new destination community in the rural state of Iowa. Methods: The Active Ottumwa study is part of a community-academic partnership in Ottumwa, IA. Evidence-based strategies recommended by the Community Guide for Preventive Services guided study implementation and included behavioral and social, campaign and informational, and environmental and policy approaches. Evaluation methods for this study are multi-faceted and include a cross-sectional community survey, longitudinal cohort assessment, observational data, key informant interviews, and project records. Results: We are currently in our second year of intervention implementation, with 45 lay health advisors (termed physical activity leaders here) trained to carry out behavioral and social intervention approaches, including walking groups, tai chi, and yoga. We have completed a communication and informational campaign utilizing five channels. Our longitudinal cohort has been recruited, with baseline and 12-month data collection completed. Conclusions: This study will assess the effectiveness and impact of a community-wide intervention to support physical activity. PMID:29734709

Active Ottumwa: Adapting Evidence-Based Recommendations to Promote Physical Activity in a Micropolitan New Destination Community.

PubMed

Baquero, Barbara; Kava, Christine M; Ashida, Sato; Daniel-Ulloa, Jason; Laroche, Helena H; Haines, Heidi; Bucklin, Rebecca; Maldonado, Adriana; Coronado Garcia, Mayra; Berto, Sandy; Sewell, Dan; Novak, Nicole; Janz, Kathleen; Gates, Claudia; Parker, Edith A

2018-05-04

Background : Evidence-based interventions have been developed and tested to promote physical activity, but fewer studies have focused on identifying effective intervention strategies for mid-size rural communities, especially new immigrant destinations. We report here on the design and implementation of Active Ottumwa, a community-wide intervention using a lay health advisor approach to increase physical activity in a micropolitan new destination community in the rural state of Iowa. Methods : The Active Ottumwa study is part of a community-academic partnership in Ottumwa, IA. Evidence-based strategies recommended by the Community Guide for Preventive Services guided study implementation and included behavioral and social, campaign and informational, and environmental and policy approaches. Evaluation methods for this study are multi-faceted and include a cross-sectional community survey, longitudinal cohort assessment, observational data, key informant interviews, and project records. Results : We are currently in our second year of intervention implementation, with 45 lay health advisors (termed physical activity leaders here) trained to carry out behavioral and social intervention approaches, including walking groups, tai chi, and yoga. We have completed a communication and informational campaign utilizing five channels. Our longitudinal cohort has been recruited, with baseline and 12-month data collection completed. Conclusions : This study will assess the effectiveness and impact of a community-wide intervention to support physical activity.

An Innovative Method to Involve Community Health Workers as Partners in Evaluation Research

PubMed Central

Issel, L. Michele; Townsell, Stephanie J.; Chapple-McGruder, Theresa; Handler, Arden

2011-01-01

Objectives. We developed a process through which community outreach workers, whose role is not typically that of a trained researcher, could actively participate in collection of qualitative evaluation data. Methods. Outreach workers for a community-based intervention project received training in qualitative research methodology and certification in research ethics. They used a Voice over Internet Protocol phone-in system to provide narrative reports about challenges faced by women they encountered in their outreach activities as well as their own experiences as outreach workers. Results. Qualitative data contributed by outreach workers provided insights not otherwise available to the evaluation team, including details about the complex lives of underserved women at risk for poor pregnancy outcomes and the challenges and rewards of the outreach worker role. Conclusions. Lay health workers can be a valuable asset as part of a research team. Training in research ethics and methods can be tailored to their educational level and preferences, and their insights provide important information and perspectives that may not be accessible via other data collection methods. Challenges encountered in the dual roles of researcher and lay health worker can be addressed in training. PMID:22021290

Amigas Latinas Motivando el ALMA (ALMA): Development and Pilot Implementation of a Stress Reduction Promotora Intervention

PubMed Central

Green, Melissa A.; Perez, Georgina; Ornelas, India J.; Tran, Anh N.; Blumenthal, Connie; Lyn, Michelle; Corbie-Smith, Giselle

2014-01-01

Use of mental health care services for psychological distress is limited among Latino immigrants. In geographic areas where migration has been rapid, mental health systems possess limited capacity to provide bilingual and bicultural assistance. The development of a bilingual and bicultural workforce is a necessary yet long-term solution. More immediate strategies, however, are needed to meet the needs of immigrant Latinos. This paper describes the development of a stress-reduction focused, lay health advisor training that targets individual behavior change among Latina immigrants. The theoretical foundation, curriculum components, and pilot implementation of the training are discussed. As natural leaders, Latina promotoras disseminated learned strategies and resources within their communities. The lay health advisor model is a salient method for disseminating information regarding mental health and stress reduction among Latinas. PMID:25364312

The Art and Skill of Delivering Culturally Responsive TF-CBT in Tanzania and Kenya

PubMed Central

Kava, Christine M.; Akiba, Christopher F.; Lucid, Leah; Dorsey, Shannon

2016-01-01

Objective This study explored the facilitators, barriers, and strategies used to deliver a child mental health evidence-based treatment (EBT), trauma-focused cognitive behavioral therapy (TF-CBT), in a culturally responsive manner. In low- and middle-income countries most individuals with mental health problems do not receive treatment due to a shortage of mental health professionals. One approach to addressing this problem is task-sharing, in which lay counselors are trained to deliver mental health treatment. Combining this approach with a focus on EBT provides a strategy for bridging the mental health treatment gap. However, little is known how about western-developed EBTs are delivered in a culturally responsive manner. Method Semistructured qualitative interviews were conducted with 12 TF-CBT lay counselors involved in a large randomized controlled trial of TF-CBT in Kenya and Tanzania. An inductive approach was used to analyze the data. Results Lay counselors described the importance of being responsive to TF-CBT participants’ customs, beliefs, and socioeconomic conditions and highlighted the value of TF-CBT for their community. They also discussed the importance of partnering with other organizations to address unmet socioeconomic needs. Conclusion The findings from this study provide support for the acceptability and appropriateness of TF-CBT as a treatment approach for improving child mental health. Having a better understanding of the strategies used by lay counselors to ensure that treatment is relevant to the cultural and socioeconomic context of participants can help to inform the implementation of future EBTs. PMID:27414470

Applying systems thinking to task shifting for mental health using lay providers: a review of the evidence.

PubMed

Javadi, D; Feldhaus, I; Mancuso, A; Ghaffar, A

2017-01-01

This paper seeks to review the available evidence to determine whether a systems approach is employed in the implementation and evaluation of task shifting for mental health using lay providers in low- and middle-income countries, and to highlight system-wide effects of task-shifting strategies in order to better inform efforts to strength community mental health systems. Pubmed, CINAHL, and Cochrane Library databases were searched. Articles were screened by two independent reviewers with a third reviewer resolving discrepancies. Two stages of screens were done to ensure sensitivity. Studies were analysed using the World Health Organization's building blocks framework with the addition of a community building block, and systems thinking characteristics to determine the extent to which system-wide effects had been considered. Thirty studies were included. Almost all studies displayed positive findings on mental health using task shifting. One study showed no effect. No studies explicitly employed systems thinking tools, but some demonstrated systems thinking characteristics, such as exploring various stakeholder perspectives, capturing unintended consequences, and looking across sectors for system-wide impact. Twenty-five of the 30 studies captured elements other than the most directly relevant building blocks of service delivery and health workforce. There is a lack of systematic approaches to exploring complexity in the evaluation of task-shifting interventions. Systems thinking tools should support evidence-informed decision making for a more complete understanding of community-based systems strengthening interventions for mental health.

See what we say: using concept mapping to visualize Latino immigrant's strategies for health interventions.

PubMed

Vaughn, Lisa M; Jacquez, Farrah; Marschner, Daniel; McLinden, Daniel

2016-09-01

Researchers need specific tools to engage community members in health intervention development to ensure that efforts are contextually appropriate for immigrant populations. The purpose of the study was to generate and prioritize strategies to address obesity, stress and coping, and healthcare navigation that are contextually appropriate and applicable to the Latino immigrant community in Cincinnati, Ohio, and then use the results to develop specific interventions to improve Latino health in our area. A community-academic research team used concept mapping methodology with over 200 Latino immigrants and Latino-serving providers. A community intervention planning session was held to share the final concept maps and vote on strategies. The concept maps and results from the intervention planning session emphasized a community lay health worker model to connect the Latino immigrant community with resources to address obesity, stress and coping, and healthcare navigation. Concept maps allowed for the visualization of health intervention strategies prioritized by the larger Latino immigrant community. Concept maps revealed the appropriate content for health interventions as well as the process community members preferred for intervention delivery.

Cultural Leverage: Interventions Using Culture to Narrow Racial Disparities in Health Care

PubMed Central

Fisher, Thomas L.; Burnet, Deborah L.; Huang, Elbert S.; Chin, Marshall H.; Cagney, Kathleen A.

2008-01-01

The authors reviewed interventions using cultural leverage to narrow racial disparities in health care. Thirty-eight interventions of three types were identified: interventions that modified the health behaviors of individual patients of color, that increased the access of communities of color to the existing health care system, and that modified the health care system to better serve patients of color and their communities. Individual-level interventions typically tapped community members’ expertise to shape programs. Access interventions largely involved screening programs, incorporating patient navigators and lay educators. Health care interventions focused on the roles of nurses, counselors, and community health workers to deliver culturally tailored health information. These interventions increased patients’ knowledge for self-care, decreased barriers to access, and improved providers’ cultural competence. The delivery of processes of care or intermediate health outcomes was significantly improved in 23 interventions. Interventions using cultural leverage show tremendous promise in reducing health disparities, but more research is needed to understand their health effects in combination with other interventions. PMID:17881628

Activating lay health influencers to promote tobacco cessation.

PubMed

Muramoto, Myra L; Hall, John R; Nichter, Mark; Nichter, Mimi; Aickin, Mikel; Connolly, Tim; Matthews, Eva; Campbell, Jean Z; Lando, Harry A

2014-05-01

To evaluate the effect of tobacco cessation brief-intervention (BI) training for lay "health influencers," on knowledge, self-efficacy and the proportion of participants reporting BI delivery post-training. Randomized, community-based study comparing In-person or Web-based training, with mailed materials. In-person and Web-training groups had significant post-training cessation knowledge and self-efficacy gains. All groups increased the proportion of individuals reporting BIs at follow-up, with no significant between-group differences. Irrespective of participants' prior intervention experience, 80%-86% reported BIs within the past 90 days; 71%-79% reported >1 in the past 30. Web and In-person training significantly increase health influencer cessation knowledge and self-efficacy. With minimal prompting and materials, even persons without BI experience can be activated to encourage tobacco cessation.

Psychological first aid: a consensus-derived, empirically supported, competency-based training model.

PubMed

McCabe, O Lee; Everly, George S; Brown, Lisa M; Wendelboe, Aaron M; Abd Hamid, Nor Hashidah; Tallchief, Vicki L; Links, Jonathan M

2014-04-01

Surges in demand for professional mental health services occasioned by disasters represent a major public health challenge. To build response capacity, numerous psychological first aid (PFA) training models for professional and lay audiences have been developed that, although often concurring on broad intervention aims, have not systematically addressed pedagogical elements necessary for optimal learning or teaching. We describe a competency-based model of PFA training developed under the auspices of the Centers for Disease Control and Prevention and the Association of Schools of Public Health. We explain the approach used for developing and refining the competency set and summarize the observable knowledge, skills, and attitudes underlying the 6 core competency domains. We discuss the strategies for model dissemination, validation, and adoption in professional and lay communities.

Psychological First Aid: A Consensus-Derived, Empirically Supported, Competency-Based Training Model

PubMed Central

Everly, George S.; Brown, Lisa M.; Wendelboe, Aaron M.; Abd Hamid, Nor Hashidah; Tallchief, Vicki L.; Links, Jonathan M.

2014-01-01

Surges in demand for professional mental health services occasioned by disasters represent a major public health challenge. To build response capacity, numerous psychological first aid (PFA) training models for professional and lay audiences have been developed that, although often concurring on broad intervention aims, have not systematically addressed pedagogical elements necessary for optimal learning or teaching. We describe a competency-based model of PFA training developed under the auspices of the Centers for Disease Control and Prevention and the Association of Schools of Public Health. We explain the approach used for developing and refining the competency set and summarize the observable knowledge, skills, and attitudes underlying the 6 core competency domains. We discuss the strategies for model dissemination, validation, and adoption in professional and lay communities. PMID:23865656

Building skill in heart failure self-care among community dwelling older adults: results of a pilot study.

PubMed

Dickson, Victoria Vaughan; Melkus, Gail D'Eramo; Katz, Stuart; Levine-Wong, Alissa; Dillworth, Judy; Cleland, Charles M; Riegel, Barbara

2014-08-01

Most of the day-to-day care for heart failure (HF) is done by the patient at home and requires skill in self-care. In this randomized controlled trial (RCT) we tested the efficacy of a community-based skill-building intervention on HF self-care, knowledge and health-related quality of life (HRQL) at 1- and 3-months. An ethnically diverse sample (n=75) of patients with HF (53% female; 32% Hispanic, 27% Black; mean age 69.9±10 years) was randomized to the intervention group (IG) or a wait-list control group (CG). The protocol intervention focused on tactical and situational HF self-care skill development delivered by lay health educators in community senior centers. Data were analyzed using mixed (between-within subjects) ANOVA. There was a significant improvement in self-care maintenance [F(2,47)=3.42, p=.04, (Cohen's f=.38)], self-care management [F(2,41)=4.10, p=.02, (Cohen's f=.45) and HF knowledge [F(2,53)=8.00, p=.001 (Cohen's f=.54)] in the IG compared to the CG. The skill-building intervention improved self-care and knowledge but not HRQL in this community-dwelling sample. Delivering an intervention in a community setting using lay health educators provides an alternative to clinic- or home-based teaching that may be useful across diverse populations and geographically varied settings. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Waterborne disease-related risk perceptions in the Sonora River basin, Mexico.

PubMed

Morua, Agustin Robles; Halvorsen, Kathleen E; Mayer, Alex S

2011-05-01

Waterborne disease is estimated to cause about 10% of all diseases worldwide. However, related risk perceptions are not well understood, particularly in the developing world where waterborne disease is an enormous problem. We focus on understanding risk perceptions related to these issues in a region within northern Mexico. Our findings show how waterborne disease problems and solutions are understood in eight small communities along a highly contaminated river system. We found major differences in risk perceptions between health professionals, government officials, and lay citizens. Health professionals believed that a high level of human-waste-related risk existed within the region. Few officials and lay citizens shared this belief. In addition, few officials and lay citizens were aware of poor wastewater-management-related disease outbreaks and water contamination. Finally, aside from health professionals, a few interviewees understood the importance of basic hygiene and water treatment measures that could help to prevent disease. Our results add to the literature on environmentally-related risk perceptions in the developing world. We discuss recommendations for improving future human-wastewater-related risk communication within the region. © 2011 Society for Risk Analysis.

Stirring up the Mud: Using a Community-Based Participatory Approach to Address Health Disparities through a Faith-Based Initiative

PubMed Central

Kaplan, Sue A.; Ruddock, Charmaine; Golub, Maxine; Davis, Joyce; Foley, Robert; Devia, Carlos; Rosen, Rosa; Berry, Carolyn; Barretto, Brenda; Carter, Toni; Irish-Spencer, Evalina; Marchena, Maria; Purcaro, Ellenrita; Calman, Neil

2011-01-01

This case study provides a mid-course assessment of the Bronx Health REACH faith-based initiative four years into its implementation. The study uses qualitative methods to identify lessons learned and to reflect on the benefits and challenges of using a community-based participatory approach for the development and evaluation of a faith-based program designed to address health disparities. Key findings concern the role of pastoral leadership, the importance of providing a religious context for health promotion and health equality messages, the challenges of creating a bilingual/bi-cultural program, and the need to provide management support to the lay program coordinators. The study also identifies lessons learned about community-based evaluation and the importance of addressing community concern about the balance between evaluation and program. Finally, the study identifies the challenges that lie ahead, including issues of program institution-alization and sustainability. PMID:20168022

Increasing Melanoma Screening Among Hispanic/Latino Americans: A Community-Based Educational Intervention.

PubMed

Chung, Grace Y; Brown, Gina; Gibson, Desmond

2015-10-01

Melanoma incidence is increasing among Hispanics/Latinos in California. This community-based project reached out to a rural Hispanic/Latino community in North San Diego County to provide melanoma prevention and screening education. At a local community health fair, bilingual volunteer lay health workers led 10- to 15-minute-long information sessions on melanoma disease, risk factors, and skin self-examination techniques. Pearson chi-square analyses of participants' (N = 34) responses to pre- and postintervention evaluation surveys indicate significant increases in knowledge, risk awareness, and self-efficacy for self-screening. The results revealed that Hispanics/Latinos in a low socioeconomic stratum might be at moderate to high risk for developing melanoma. Their low annual income, low level of education, occupational sun-exposure, and lack of access to health care are likely factors that deter at-risk Hispanics/Latinos from seeking health care. © 2015 Society for Public Health Education.

Using Promotores Programs to Improve Latino Health Outcomes: Implementation Challenges for Community-based Nonprofit Organizations

PubMed Central

Twombly, Eric C.; Holtz, Kristen D.; Stringer, Kimberly

2012-01-01

Promotores are community lay health workers, who provide outreach and services to Latinos. Little research on the promotores programs exists and the focus of this article is to identify the challenges faced by community-based nonprofits when implementing promotores programs. To explore this type of program telephone interviews were conducted with ten promotores academic experts and nonprofit executives. The results suggest that implementation challenges fall into three major categories: the lack of standardized information on promotores programs, labor issues, and organizational costs. Future recommendations are made which highlight promotores recruitment and retention strategies, and the development of a clearinghouse of programmatic implementation information for community-based nonprofits. PMID:23188929

Latino men’s qualitative perspectives on a lay health advisor intervention to promote their sexual health

PubMed Central

Wagoner, Kim G.; Downs, Mario; Alonzo, Jorge; Daniel-Ulloa, Jason; Rhodes, Scott D.

2014-01-01

Lay health advisor (LHA) approaches are a promising strategy to reduce health disparities among communities considered “hard to reach” by researchers and practitioners. LHAs have addressed a variety of health issues, but limited studies have included men as LHAs. The purpose of this to study was to better understand the roles of male LHAs and their male-helping relationships. We used an inductive approach to explore Latino men’s perspectives on serving as LHAs for other Latino men and Latino men’s views on receiving sexual health information from a male LHA. We collected qualitative data in 2009 and 2010 as part of an LHA intervention designed to reduce the risk of HIV infection among immigrant Latinos through the social networks of soccer teams. We analyzed and interpreted data from 30 in-depth interviews with Latino men who served as LHAs and their social networks in North Carolina, USA. Participants shared perceptions on social network importance for immigrant Latinos, facilitators and challenges of helping other men, recommendations for intervention modification, and suggestions for future work involving the Latino community. Findings revealed that Latino men are receptive to fulfilling the roles of health advisors and opinion leaders and can effectively serve as LHAs. Social network members valued the social support they received. Working through sports teams and identifying existing leaders to be LHAs may be a culturally congruent approach to meeting Latino community needs. More research is needed on the potential of male LHAs to address other health issues. PMID:25475213

The art and skill of delivering culturally responsive trauma-focused cognitive behavioral therapy in Tanzania and Kenya.

PubMed

Woods-Jaeger, Briana A; Kava, Christine M; Akiba, Christopher F; Lucid, Leah; Dorsey, Shannon

2017-03-01

This study explored the facilitators, barriers, and strategies used to deliver a child mental health evidence-based treatment (EBT), trauma-focused cognitive behavioral therapy (TF-CBT), in a culturally responsive manner. In low- and middle-income countries most individuals with mental health problems do not receive treatment due to a shortage of mental health professionals. One approach to addressing this problem is task-sharing, in which lay counselors are trained to deliver mental health treatment. Combining this approach with a focus on EBT provides a strategy for bridging the mental health treatment gap. However, little is known about how western-developed EBTs are delivered in a culturally responsive manner. Semistructured qualitative interviews were conducted with 12 TF-CBT lay counselors involved in a large randomized controlled trial of TF-CBT in Kenya and Tanzania. An inductive approach was used to analyze the data. Lay counselors described the importance of being responsive to TF-CBT participants' customs, beliefs, and socioeconomic conditions and highlighted the value of TF-CBT for their community. They also discussed the importance of partnering with other organizations to address unmet socioeconomic needs. The findings from this study provide support for the acceptability and appropriateness of TF-CBT as a treatment approach for improving child mental health. Having a better understanding of the strategies used by lay counselors to ensure that treatment is relevant to the cultural and socioeconomic context of participants can help to inform the implementation of future EBTs. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Conceptualizing the Influence of Social Agents of Behavior Change: A Meta-Analysis of the Effectiveness of HIV-Prevention Interventionists for Different Groups

PubMed Central

Durantini, Marta R.; Albarracín, Dolores; Mitchell, Amy L.; Earl, Allison N.; Gillette, Jeffrey C.

2016-01-01

A meta-analysis of 166 HIV-prevention interventions tested theoretical predictions about the effects of experts, lay community members, and similar and dissimilar others, as agents of change. In general, expert interventionists produced greater behavior change than lay community members, and the demographic and behavioral similarity between the interventionist and the recipients facilitated behavioral change. Equally importantly, there were differences across groups in the efficacy of various sources, especially among populations of low status and/or power. These findings support the hypothesis that unempowered populations are more sensitive to characteristics of the interventionists who can facilitate access to various resources. In addition, they suggest the need to ensure the availability of health professionals from diverse demographic and behavioral backgrounds. PMID:16536642

Community strategies to address cancer disparities in Appalachian Kentucky.

PubMed

Schoenberg, Nancy E; Howell, Britteny M; Fields, Nell

2012-01-01

Central Appalachian residents suffer disproportionate health disparities, including an all-cancer mortality rate 17% higher than the general population. During 10 focus groups and 19 key informant interviews, 91 Appalachian residents identified cancer screening challenges and strategies. Challenges included (1) inadequate awareness of screening need, (2) insufficient access to screening, and (3) lack of privacy. Strategies included (1) witnessing/storytelling, (2) capitalizing on family history, (3) improving publicity about screening resources, (4) relying on lay health advisors, and (5) bundling preventive services. These insights shaped our community-based participatory research intervention and offered strategies to others working in Appalachia, rural locales, and other traditionally underserved communities.

Lay Health Worker Involvement in Evidence-Based Treatment Delivery: A Conceptual Model to Address Disparities in Care.

PubMed

Barnett, Miya L; Lau, Anna S; Miranda, Jeanne

2018-05-07

Mobilizing lay health workers (LHWs) to deliver evidence-based treatments (EBTs) is a workforce strategy to address mental health disparities in underserved communities. LHWs can be leveraged to support access to EBTs in a variety of ways, from conducting outreach for EBTs delivered by professional providers to serving as the primary treatment providers. This critical review provides an overview of how LHW-supported or -delivered EBTs have been leveraged in low-, middle-, and high-income countries (HICs). We propose a conceptual model for LHWs to address drivers of service disparities, which relate to the overall supply of the EBTs provided and the demand for these treatments. The review provides illustrative case examples that demonstrate how LHWs have been leveraged globally and domestically to increase access to mental health services. It also discusses challenges and recommendations regarding implementing LHW-supported or -delivered EBTs.

77 FR 19318 - Notice of Availability of the Draft Integrated Activity Plan/Environmental Impact Statement for...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-30

... communities in Alaska: Anaktuvuk Pass, Anchorage, Atqasuk, Barrow, Fairbanks, Nuiqsut, Point Lay, and..., Nuiqsut, Point Lay, and Wainwright. The dates, times, and locations of the meetings and hearings will be... communities of Anaktuvuk Pass, Atqasuk, Barrow, Nuiqsut, Point Lay, and Wainwright. Ronald L. Dunton, Acting...

How lay health workers tailor in effective health behaviour change interventions: a protocol for a systematic review.

PubMed

Hodgins, Faith; Gnich, Wendy; Ross, Alastair J; Sherriff, Andrea; Worlledge-Andrew, Heather

2016-06-16

Lay health workers (LHWs) are utilised as a channel of delivery in many health interventions. While they have no formal professional training related to their role, they utilise their connections with the target group or community in order to reach individuals who would not normally readily engage with health services. Lay health worker programmes are often based on psychological theories of behaviour change that point to 'tailoring to individuals' needs or characteristics' as key to success. Although lay health workers have been shown to be effective in many contexts, there is, as yet, little clarity when it comes to how LHWs assess individuals' needs in order to tailor their interventions. This study aims to develop a better understanding of the effective implementation of tailoring in lay health worker interventions by appraising evidence and synthesising studies that report evaluations of tailored interventions. Health and psychology electronic databases (EMBASE, CINAHL, MEDLINE and PsycINFO) will be searched. Reference lists of included studies will also be searched. For articles that are deemed to be potentially relevant, we will employ a 'cluster searching' technique in order to identify all published papers related to a relevant intervention. Cluster searching will be undertaken in an effort to maximise the breadth and depth of description of the intervention. Quantitative studies will be assessed using the Quality Assessment Tool for Quantitative Studies, developed by the Effective Public Health Practice Project, ON, Canada. Qualitative studies will be assessed using the Critical Appraisal Skills Programme (CASP) checklist for qualitative research. Sythesising the data will enable the development of a taxonomy of strategies for the criteria used for individual assessment of recipients' needs and the ways in which messages or actions are tailored to these individual criteria by LHWs. This systematic review focuses specifically on how health promotion and support is individually tailored in effective programmes by LHWs. This study will be of value to those involved in the design and implementation of interventions that utilise a LHW. PROSPERO CRD42015030071.

Medication Timing Errors for Parkinson's Disease: Perspectives Held by Caregivers and People with Parkinson's in New Zealand

PubMed Central

Buetow, Stephen; Henshaw, Jenny; Bryant, Linda; O'Sullivan, Deirdre

2010-01-01

Background. Common but seldom published are Parkinson's disease (PD) medication errors involving late, extra, or missed doses. These errors can reduce medication effectiveness and the quality of life of people with PD and their caregivers. Objective. To explore lay perspectives of factors contributing to medication timing errors for PD in hospital and community settings. Design and Methods. This qualitative research purposively sampled individuals with PD, or a proxy of their choice, throughout New Zealand during 2008-2009. Data collection involved 20 semistructured, personal interviews by telephone. A general inductive analysis of the data identified core insights consistent with the study objective. Results. Five themes help to account for possible timing adherence errors by people with PD, their caregivers or professionals. The themes are the abrupt withdrawal of PD medication; wrong, vague or misread instructions; devaluation of the lay role in managing PD medications; deficits in professional knowledge and in caring behavior around PD in formal health care settings; and lay forgetfulness. Conclusions. The results add to the limited published research on medication errors in PD and help to confirm anecdotal experience internationally. They indicate opportunities for professionals and lay people to work together to reduce errors in the timing of medication for PD in hospital and community settings. PMID:20975777

Activating Lay Health Influencers to Promote Tobacco Cessation

PubMed Central

Muramoto, Myra L.; Hall, John R.; Nichter, Mark; Nichter, Mimi; Aickin, Mikel; Connolly, Tim; Matthews, Eva; Campbell, Jean Z.; Lando, Harry A.

2014-01-01

Objective Evaluate the effect of tobacco cessation brief-intervention (BI) training for lay “health influencers,” on knowledge, self-efficacy and the proportion of participants reporting BI delivery post-training. Methods Randomized, community-based study comparing In-person or Web-based training, with mailed materials. Results In-person and Web-training groups had significant post-training cessation knowledge and self-efficacy gains. All groups increased the proportion of individuals reporting BIs at follow-up, with no significant between-group differences. Irrespective of participants’ prior intervention experience, 80–86% reported BIs within the past 90 days; 71–79% reported ≥1 in the past 30. Conclusions Web and In-person training significantly increase health influencer cessation knowledge and self-efficacy. With minimal prompting and materials, even persons without BI experience can be activated to encourage tobacco cessation. PMID:24636035

Nutritional intervention and physical training in malnourished frail community-dwelling elderly persons carried out by trained lay “buddies”: study protocol of a randomized controlled trial

PubMed Central

2013-01-01

Background In elderly persons frailty and malnutrition are very common and can lead to serious health hazards such as increased mortality, morbidity, dependency, institutionalization and a reduced quality of life. In Austria, the prevalence of frailty and malnutrition are increasing steadily and are becoming a challenge for our social system. Physical training and adequate nutrition may improve this situation. Methods/design In this randomized controlled trial, 80 malnourished frail community-dwelling patients (≥ 65 years) hospitalized at wards for internal medicine are recruited. Additionally, 80 lay volunteers (≥ 50 years), named buddies are recruited and subsequently trained regarding health enhancing physical activity and nutrition in four standardized training sessions. These buddies visit the malnourished frail persons at home twice a week for about one hour during an initial period of 10–12 weeks. While participants allocated to the intervention group (n = 40) receive intervention to improve their fluid intake, protein and energy intake, perform strength training and try to increase their baseline activities, the control group (n = 40) only gets home visits without any intervention. After 10–12 weeks, both, the intervention and the control group, receive the nutritional intervention and the physical training. Health, nutritional and frailty status, physical fitness, body composition and chronic inflammation of buddies and frail persons are recorded before the intervention, after 10–12 weeks, 6 and 12 months. Discussion To your knowledge this trial is the first of its kind to provide nutritional and physical activity interventions to malnourished frail community-dwelling persons by trained lay buddies, in which an improvement of the frail persons´ and the buddies’ health status is measured. This study assesses the efficacy of such an intervention and may offer new perspectives for the management of frailty and malnutrition. Trail registration ClinicalTrials.gov, NCT01991639 PMID:24369785

A Community-Engaged Research Approach to Improve Mental Health Among Latina Immigrants: ALMA Photovoice.

PubMed

Perez, Georgina; Della Valle, Pamela; Paraghamian, Sarah; Page, Rachel; Ochoa, Janet; Palomo, Fabiana; Suarez, Emilia; Thrasher, Angela; Tran, Anh N; Corbie-Smith, Giselle

2016-05-01

Recent Latina immigrants are at increased risk of poor mental health due to stressors associated with adapting to life in the United States. Existing social and health care policies often do not adequately address the mental health concerns of new Latino populations. Amigas Latinas Motivando el Alma, a community-partnered research project, seeks to improve immigrant Latinas' mental health outcomes. Using Photovoice methodology, promotoras (lay health advisors) reflected on community factors affecting mental health through photography and guided discussion. Discussions were audio-recorded, transcribed, and coded using content analysis to identify salient themes. Promotoras reviewed codes to develop themes that they presented in community forums to reach local policy makers and to increase community awareness. These forums included an exhibit of the promotoras' photographs and discussion of action steps to address community concerns. Themes included transitioning to life in the United States, parenting, education, and combating racism. Nearly 150 stakeholders attended the community forums and proposed responses to promotoras' photographic themes. Our findings suggest that Photovoice provides an opportunity for Latinas and the larger community to identify issues that they find most important and to explore avenues for action and change by creating sustainable partnerships between the community and forum attendees. © 2015 Society for Public Health Education.

Implementation and quantitative evaluation of chronic disease self-management programme in Shanghai, China: randomized controlled trial.

PubMed Central

Fu, Dongbo; Fu, Hua; McGowan, Patrick; Shen, Yi-e; Zhu, Lizhen; Yang, Huiqin; Mao, Jianguo; Zhu, Shitai; Ding, Yongming; Wei, Zhihua

2003-01-01

OBJECTIVE: To evaluate the effectiveness of the Shanghai Chronic Disease Self-Management Program (CDSMP). METHODS: A randomized controlled trial with six-month follow-up compared patients who received treatment with those who did not receive treatment (waiting-list controls) in five urban communities in Shanghai, China. Participants in the treatment group received education from a lay-led CDSMP course and one copy of a help book immediately; those in the control group received the same education and book six months later. FINDINGS: In total, 954 volunteer patients with a medical record that confirmed a diagnosis of hypertension, heart disease, chronic lung disease, arthritis, stroke, or diabetes who lived in communities were assigned randomly to treatment (n = 526) and control (n = 428) groups. Overall, 430 (81.7%) and 349 (81.5%) patients in the treatment and control groups completed the six-month study. Patients who received treatment had significant improvements in weekly minutes of aerobic exercise, practice of cognitive symptom management, self-efficacy to manage own symptoms, and self-efficacy to manage own disease in general compared with controls. They also had significant improvements in eight indices of health status and, on average, fewer hospitalizations. CONCLUSION: When implemented in Shanghai, the CDSMP was acceptable culturally to Chinese patients. The programme improved participants' health behaviour, self-efficacy, and health status and reduced the number of hospitalizations six months after the course. The locally based delivery model was integrated into the routine of community government organizations and community health services. Chinese lay leaders taught the CDSMP courses as successfully as professionals. PMID:12764513

Lay Health Influencers: How They Tailor Brief Tobacco Cessation Interventions

ERIC Educational Resources Information Center

Yuan, Nicole P.; Castaneda, Heide; Nichter, Mark; Nichter, Mimi; Wind, Steven; Carruth, Lauren; Muramoto, Myra

2012-01-01

Interventions tailored to individual smoker characteristics have increasingly received attention in the tobacco control literature. The majority of tailored interventions are generated by computers and administered with printed materials or web-based programs. The purpose of this study was to examine the tailoring activities of community lay…

Tangible evidence, trust and power: public perceptions of community environmental health studies.

PubMed

Scammell, Madeleine Kangsen; Senier, Laura; Darrah-Okike, Jennifer; Brown, Phil; Santos, Susan

2009-01-01

Communities with environmental health concerns in the USA frequently request studies from their local or state departments of public health. This paper presents findings from three focus groups conducted in communities north of Boston that have been the subject of two different environmental health studies. The focus groups were designed to elicit residents' perceptions of environmental health, and of the particular studies conducted in their communities. In all focus groups, participants had difficulty accepting the findings of health studies that contradicted their own experiences of environmental exposures and illness. Our results suggest that lay knowledge, informed in varying degrees by the experience of what we term "tangible evidence," creates a lens through which communities interpret a health study's findings. The differences in reliance on tangible evidence were related to participants' sense of trust in public officials, and the institutions responsible for conducting health studies. Participants from the wealthier, predominantly white communities discussed trust in study design and methodologies used. In contrast, participants from the lower-income, higher-minority communities assessed health studies with reference to their trust (or lack thereof) in study sponsors and public health institutions. Participants' experience of tangible evidence, trust or distrust in health agencies and research institutions, and a sense of relative community power, influence how they assess the findings of environmental health studies and may have implications for pubic health.

Tangible Evidence, Trust and Power: Public Perceptions of Community Environmental Health Studies

PubMed Central

Scammell, Madeleine Kangsen; Senier, Laura; Darrah-Okike, Jennifer; Brown, Phil; Santos, Susan

2009-01-01

Communities with environmental health concerns in the USA frequently request studies from their local or state departments of public health. This paper presents findings from three focus groups conducted in communities north of Boston that have been the subject of two different environmental health studies. The focus groups were designed to elicit residents’ perceptions of environmental health, and of the particular studies conducted in their communities. In all focus groups, participants had difficulty accepting the findings of health studies that contradicted their own experiences of environmental exposures and illness. Our results suggest that lay knowledge, informed in varying degrees by the experience of what we term “tangible evidence,” creates a lens through which communities interpret a health study’s findings. The differences in reliance on tangible evidence were related to participants’ sense of trust in public officials, and the institutions responsible for conducting health studies. Participants from the wealthier, predominantly white communities discussed trust in study design and methodologies used. In contrast, participants from the lower income, higher minority communities assessed health studies with reference to their trust (or lack thereof) in study sponsors and public health institutions. Participants’ experience of tangible evidence, trust or distrust in health agencies and research institutions, and a sense of relative community power, influence how they assess the findings of environmental health studies and may have implications for pubic health. PMID:18995942

Comparing Lay Community and Academic Survey Center Interviewers in Conducting Household Interviews in Latino Communities.

PubMed

Chan-Golston, Alec M; Friedlander, Scott; Glik, Deborah C; Prelip, Michael L; Belin, Thomas R; Brookmeyer, Ron; Santos, Robert; Chen, Jie; Ortega, Alexander N

2016-01-01

The employment of professional interviewers from academic survey centers to conduct surveys has been standard practice. Because one goal of community-engaged research is to provide professional skills to community residents, this paper considers whether employing locally trained lay interviewers from within the community may be as effective as employing interviewers from an academic survey center with regard to unit and item nonresponse rates and cost. To study a nutrition-focused intervention, 1035 in-person household interviews were conducted in East Los Angeles and Boyle Heights, 503 of which were completed by lay community interviewers. A chi-square test was used to assess differences in unit nonresponse rates between professional and community interviewers and Welch's t tests were used to assess differences in item nonresponse rates. A cost comparison analysis between the two interviewer groups was also conducted. Interviewers from the academic survey center had lower unit nonresponse rates than the lay community interviewers (16.2% vs. 23.3%; p < 0.01). However, the item nonresponse rates were lower for the community interviewers than the professional interviewers (1.4% vs. 3.3%; p < 0.01). Community interviewers cost approximately $415.38 per survey whereas professional interviewers cost approximately $537.29 per survey. With a lower cost per completed survey and lower item nonresponse rates, lay community interviewers are a viable alternative to professional interviewers for fieldwork in community-based research. Additional research is needed to assess other important aspects of data quality interviewer such as interviewer effects and response error.

Community Health Workers as Support for Sickle Cell Care

PubMed Central

Hsu, Lewis L.; Green, Nancy S.; Ivy, E. Donnell; Neunert, Cindy; Smaldone, Arlene; Johnson, Shirley; Castillo, Sheila; Castillo, Amparo; Thompson, Trevor; Hampton, Kisha; Strouse, John J.; Stewart, Rosalyn; Hughes, TaLana; Banks, Sonja; Smith-Whitley, Kim; King, Allison; Brown, Mary; Ohene-Frempong, Kwaku; Smith, Wally R.; Martin, Molly

2016-01-01

Community health workers are increasingly recognized as useful for improving health care and health outcomes for a variety of chronic conditions. Community health workers can provide social support, navigation of health systems and resources, and lay counseling. Social and cultural alignment of community health workers with the population they serve is an important aspect of community health worker intervention. Although community health worker interventions have been shown to improve patient-centered outcomes in underserved communities, these interventions have not been evaluated with sickle cell disease. Evidence from other disease areas suggests that community health worker intervention also would be effective for these patients. Sickle cell disease is complex, with a range of barriers to multifaceted care needs at the individual, family/friend, clinical organization, and community levels. Care delivery is complicated by disparities in health care: access, delivery, services, and cultural mismatches between providers and families. Current practices inadequately address or provide incomplete control of symptoms, especially pain, resulting in decreased quality of life and high medical expense. The authors propose that care and care outcomes for people with sickle cell disease could be improved through community health worker case management, social support, and health system navigation. This report outlines implementation strategies in current use to test community health workers for sickle cell disease management in a variety of settings. National medical and advocacy efforts to develop the community health workforce for sickle cell disease management may enhance the progress and development of “best practices” for this area of community-based care. PMID:27320471

Community Health Workers as Support for Sickle Cell Care.

PubMed

Hsu, Lewis L; Green, Nancy S; Donnell Ivy, E; Neunert, Cindy E; Smaldone, Arlene; Johnson, Shirley; Castillo, Sheila; Castillo, Amparo; Thompson, Trevor; Hampton, Kisha; Strouse, John J; Stewart, Rosalyn; Hughes, TaLana; Banks, Sonja; Smith-Whitley, Kim; King, Allison; Brown, Mary; Ohene-Frempong, Kwaku; Smith, Wally R; Martin, Molly

2016-07-01

Community health workers are increasingly recognized as useful for improving health care and health outcomes for a variety of chronic conditions. Community health workers can provide social support, navigation of health systems and resources, and lay counseling. Social and cultural alignment of community health workers with the population they serve is an important aspect of community health worker intervention. Although community health worker interventions have been shown to improve patient-centered outcomes in underserved communities, these interventions have not been evaluated with sickle cell disease. Evidence from other disease areas suggests that community health worker intervention also would be effective for these patients. Sickle cell disease is complex, with a range of barriers to multifaceted care needs at the individual, family/friend, clinical organization, and community levels. Care delivery is complicated by disparities in health care: access, delivery, services, and cultural mismatches between providers and families. Current practices inadequately address or provide incomplete control of symptoms, especially pain, resulting in decreased quality of life and high medical expense. The authors propose that care and care outcomes for people with sickle cell disease could be improved through community health worker case management, social support, and health system navigation. This paper outlines implementation strategies in current use to test community health workers for sickle cell disease management in a variety of settings. National medical and advocacy efforts to develop the community health workforce for sickle cell disease management may enhance the progress and development of "best practices" for this area of community-based care. Copyright © 2016 American Journal of Preventive Medicine. All rights reserved.

The impact of lay counselors on HIV testing rates: Quasi-experimental evidence from lay counselor redeployment in KwaZulu-Natal, South Africa.

PubMed

Hu, Janice; Geldsetzer, Pascal; Steele, Sarah Jane; Matthews, Philippa; Ortblad, Katrina; Solomon, Tsion; Shroufi, Amir; van Cutsem, Gilles; Tanser, Frank; Wyke, Sally; Vollmer, Sebastian; Pillay, Deenan; Mcconnell, Margaret; Bärnighausen, Till

2018-06-14

This study aimed to determine the causal effect of the number of lay counselors employed at a primary care clinic in rural South Africa on the number of clinic-based HIV tests performed. Fixed effects panel analysis. We collected monthly data on the number of lay counselors employed and HIV tests performed at nine primary care clinics in rural KwaZulu-Natal from January 2014 to December 2015. Using clinic- and month-level fixed effects regressions, we exploited the fact that lay counselors were removed from clinics at two quasi-random time points by a redeployment policy. A total of 24,526 HIV tests were conducted over the study period. 21 of 27 lay counselors were removed across the nine clinics in the two redeployment waves. A ten percent reduction in the number of lay counselors was associated with a 4.9% (95% confidence interval [CI]: 2.8 - 7.0, p < 0.001) decrease in the number of HIV tests performed. In absolute terms, losing one lay counselor from a clinic was associated with a mean of 29.7 (95% CI: 21.2 - 38.2, p < 0.001) fewer HIV tests carried out at the clinic per month. This study provides evidence for the crucial role that lay counselors play in the HIV response in rural South Africa. More broadly, this analysis supports the use of lay cadres in the HIV response and by extension UNAIDS' and the African Union's goal to triple the number of community health workers in sub-Saharan Africa by 2020.

Evaluation and delivery of domestic animal health services in remote communities in the Northwest Territories: A case study of status and needs

PubMed Central

Brook, Ryan K.; Kutz, Susan J.; Millins, Caroline; Veitch, Alasdair M.; Elkin, Brett T.; Leighton, Ted

2010-01-01

Domestic animal health services are supplied to communities in Canada’s Northwest Territories (NT) in diverse ways, including private veterinary practices in 2 of 33 communities, and by mail-order, fly-in, free clinics, and a government-coordinated lay vaccinator program in some of the other 31 communities. We evaluated delivery, needs, and potential uptake of domestic animal health services in the Sahtu Settlement Area, NT by offering free clinics for 225 dogs in 2008 and 2009; and administered questionnaires to 42 dog owners and 67 students in 2008. Owners indicated that 20% of dogs were neutered, 37% had had rabies vaccinations, and 29% had been dewormed. Physical examination of dogs demonstrated that 54% were “thin” and 4% were “emaciated.” Owners and youth showed a range of attitudes toward dogs and supported improved domestic animal health services. Future services need to build on existing programs and collaborate with communities to ensure relevance, ownership, and sustainability. PMID:21197203

Guided preparedness planning with lay communities: enhancing capacity of rural emergency response through a systems-based partnership.

PubMed

McCabe, O Lee; Perry, Charlene; Azur, Melissa; Taylor, Henry G; Gwon, Howard; Mosley, Adrian; Semon, Natalie; Links, Jonathan M

2013-02-01

Community disaster preparedness plans, particularly those with content that would mitigate the effects of psychological trauma on vulnerable rural populations, are often nonexistent or underdeveloped. The purpose of the study was to develop and evaluate a model of disaster mental health preparedness planning involving a partnership among three, key stakeholders in the public health system. A one-group, post-test, quasi-experimental design was used to assess outcomes as a function of an intervention designated Guided Preparedness Planning (GPP). The setting was the eastern-, northern-, and mid-shore region of the state of Maryland. Partner participants were four local health departments (LHDs), 100 faith-based organizations (FBOs), and one academic health center (AHC)-the latter, collaborating entities of the Johns Hopkins University and the Johns Hopkins Health System. Individual participants were 178 community residents recruited from counties of the above-referenced geographic area. Effectiveness of GPP was based on post-intervention assessments of trainee knowledge, skills, and attitudes supportive of community disaster mental health planning. Inferences about the practicability (feasibility) of the model were drawn from pre-defined criteria for partner readiness, willingness, and ability to participate in the project. Additional aims of the study were to determine if LHD leaders would be willing and able to generate post-project strategies to perpetuate project-initiated government/faith planning alliances (sustainability), and to develop portable methods and materials to enhance model application and impact in other health jurisdictions (scalability). The majority (95%) of the 178 lay citizens receiving the GPP intervention and submitting complete evaluations reported that planning-supportive objectives had been achieved. Moreover, all criteria for inferring model feasibility, sustainability, and scalability were met. Within the span of a six-month period, LHDs, FBOs, and AHCs can work effectively to plan, implement, and evaluate what appears to be an effective, practical, and durable model of capacity building for public mental health emergency planning.

Continuity and change: the interpretation of illness in an Anishinaabe (Ojibway) community.

PubMed

Garro, L C

1990-12-01

Rich descriptions of Anishinaabe medical knowledge and the cultural meanings associated with illness are available in the anthropological literature, especially in the writings of A.I. Hallowell. Most of this work is based on fieldwork carried out prior to 1940 and was often motivated by a desire to reconstruct the pre-contact situation. Since that time, there have been numerous changes affecting health status and health care. This paper examines lay medical knowledge in a contemporary Canadian Anishinaabeg community, with particular attention to change and continuity in the way people explain and respond to the occurrence of illness.

Medical students as family-health advocates: Arabian Gulf University experience.

PubMed

Grant, Neil; Gibbs, Trevor; Naseeb, Tawfeeq Ali; Al-Garf, Ahmed

2007-06-01

The Arabian Gulf University is a coeducational Islamic institution in the Kingdom of Bahrain sponsored by the Gulf Cooperative Council. The College of Medicine follows a problem-based curriculum in which science is integrated with professional skills and a community-health programme, comprising of maternal and child health, family studies, and population-health research. The family-studies programme requires all third-year students to complete a wide series of activities under family-physician supervision. The aim of the study was to assess the performance of the programme with specific regard to students' family-health advocacy roles. A trained community-health nurse administered a semistructured questionnaire based on family empowerment to 30 families. Themes included health-knowledge gains, positive changes in lifestyle and communication practices, and accessing community resources. All families reported a gain in relevant health knowledge, and a number of families reported positive changes in lifestyle. Students proved to be valuable advocates for families in this programme. Their principal role lay in the uncovering of psychosocial distress, but they were able also to offer practical help in lifestyle behaviour changes, communication, and community-resource use.

A cervical cancer community-based participatory research project in a Native American community.

PubMed

Christopher, Suzanne; Gidley, Allison L; Letiecq, Bethany; Smith, Adina; McCormick, Alma Knows His Gun

2008-12-01

The Messengers for Health on the Apsáalooke Reservation project uses a community-based participatory research (CBPR) approach and lay health advisors (LHAs) to generate knowledge and awareness about cervical cancer prevention among community members in a culturally competent manner. Northern Plains Native Americans, of whom Apsáalooke women are a part, continue to be disproportionately affected by cervical cancer. This article examines quantitative and qualitative changes that occurred in the community since the inception of the Messengers for Health program. Paired sample t tests are used to evaluate the one-group pretest and posttest interviews of 83 Apsáalooke women in knowledge, comfort, and cancer awareness levels. Results reveal cervical cancer knowledge gains, gains in participants' comfort discussing cancer issues, and gains in awareness of cervical cancer and the Messengers program. Field notes, meeting minutes, and community perceptions are used to qualitatively evaluate the effectiveness of the Messengers program. Practice implications are discussed.

Rural Communities Learn to Help Themselves.

ERIC Educational Resources Information Center

Kelley, Verne R.; And Others

In an effort to prove that mental health services can be lay administered, a training program was implemented in the rural areas of Cedar County (October 1972-April 1973) and Iowa County, Iowa (October 1973-May 1974). Recruited via personal or telephone contact, 20 trainees were selected who demonstrated they: were good listeners; did not impose…

Integrating Health Care for the Most Vulnerable: Bridging the Differences in Organizational Cultures Between US Hospitals and Community Health Centers.

PubMed

Ko, Michelle; Murphy, Julia; Bindman, Andrew B

2015-11-01

Policymakers have increasingly promoted health services integration to improve quality and efficiency. The US health care safety net, which comprises providers of health care to uninsured, Medicaid, and other vulnerable patients, remains a largely fragmented collection of providers. We interviewed leadership from safety net hospitals and community health centers in 5 US cities (Boston, MA; Denver, CO; Los Angeles, CA; Minneapolis, MN; and San Francisco, CA) throughout 2013 on their experiences with service integration. We identify conflicts in organizational mission, identity, and consumer orientation that have fostered reluctance to enter into collaborative arrangements. We describe how smaller scale initiatives, such as capitated model for targeted populations, health information exchange, and quality improvements led by health plans, can help bridge cultural differences to lay the groundwork for developing integrated care programs.

The Influence of Community Health Resources on Effectiveness and Sustainability of Community and Lay Health Worker Programs in Lower-Income Countries: A Systematic Review.

PubMed

de Vries, Daniel H; Pool, Robert

2017-01-01

Despite the availability of practical knowledge and effective interventions required to reduce priority health problems in low-income countries, poor and vulnerable populations are often not reached. One possible solution to this problem is the use of Community or Lay Health Workers (CLHWs). So far, however, the development of sustainability in CLHW programs has failed and high attrition rates continue to pose a challenge. We propose that the roles and interests which support community health work should emerge directly from the way in which health is organized at community level. This review explores the evidence available to assess if increased levels of integration of community health resources in CLHW programs indeed lead to higher program effectiveness and sustainability. This review includes peer-reviewed articles which meet three eligibility criteria: 1) specific focus on CLHWs or equivalent; 2) randomized, quasi-randomized, before/after methodology or substantial descriptive assessment; and 3) description of a community or peer intervention health program located in a low- or middle-income country. Literature searches using various article databases led to 2930 hits, of which 359 articles were classified. Of these, 32 articles were chosen for extensive review, complemented by analysis of the results of 15 other review studies. Analysis was conducted using an excel based data extraction form. Because results showed that no quantitative data was published, a descriptive synthesis was conducted. The review protocol was not proactively registered. Findings show minimal inclusion of even basic community level indicators, such as the degree to which the program is a community initiative, community input in the program or training, the background and history of CLHW recruits, and the role of the community in motivation and retention. Results show that of the 32 studies, only one includes one statistical measure of community integration. As a result of this lack of data we are unable to derive an evidence-based conclusion to our propositions. Instead, our results indicate a larger problem, namely the complete absence of indicators measuring community relationships with the programs studied. Studies pay attention only to gender and peer roles, along with limited demographic information about the recruits. The historicity of the health worker and the community s/he belongs to is absent in most studies reviewed. None of the studies discuss or test for the possibility that motivation emanates from the community. Only a few studies situate attrition and retention as an issue enabled by the community. The results were limited by a focus on low-income countries and English, peer-reviewed published articles only. Published, peer-reviewed studies evaluating the effectiveness and sustainability of CLHW interventions in health programs have not yet adequately tested for the potential of utilizing existing community health roles or social networks for the development of effective and sustainable (retentive) CLHW programs. Community relationships are generally seen as a "black box" represented by an interchangeable CLHW labor unit. This disconnect from community relationships and resources may have led to a systematic and chronic undervaluing of community agency in explanations of programmatic effectiveness and sustainability.

Evaluation of a pilot promotora program for Latino forest workers in southern Oregon.

PubMed

Bush, Diane E; Wilmsen, Carl; Sasaki, Timothy; Barton-Antonio, Dinorah; Steege, Andrea L; Chang, Charlotte

2014-07-01

Forest work, an occupation with some of the highest injury and illness rates, is conducted primarily by Latino immigrant workers. This study evaluates a pilot program where promotoras (lay community health educators) provided occupational health and safety trainings for Latino forest workers. Evaluation methods included a focus group, post-tests, and qualitative feedback. Community capacity to address working conditions increased through (i) increased leadership and community access to information and resources; and (ii) increased worker awareness of workplace health and safety rights and resources. Fear of retaliation remains a barrier to workers taking action; nevertheless, the promotoras supported several workers in addressing-specific workplace issues. For working conditions to significantly improve, major structural influences need to be addressed. A long-term, organizationally supported promotora program can play a key role in linking and supporting change at the individual, interpersonal and community levels, contributing to and supporting structural change. © 2014 Wiley Periodicals, Inc.

A SHARED study-the benefits and costs of setting up a health research study involving lay co-researchers and how we overcame the challenges.

PubMed

Mockford, Carole; Murray, Matt; Seers, Kate; Oyebode, Jan; Grant, Richard; Boex, Sue; Staniszewska, Sophie; Diment, Yvonne; Leach, Jim; Sharma, Uma; Clarke, Rosemary; Suleman, Rashida

2016-01-01

In the United Kingdom (UK), official bodies such as the Department of Health and research funders such as the National Institute for Health Research support and encourage lay involvement in all stages of research studies. The SHARED study has had substantial patient and public involvement (PPI) from developing the idea to dissemination. The aim of the study has been to develop recommendations led by service users for health and social care professionals to use at hospital discharge and in care planning for people living with memory loss and their carers. This article is about how the study started and the benefits, costs and challenges we encountered as the lead and lay co-researchers. Once we were successful with the grant application, we had to recruit and train the lay co-researchers and obtain various approvals before we could start the project. We had various support from funders, the Research Ethics Committee, lay members of Alzheimer's Society and from the lay co-researchers. However, we encountered some challenges with paying the lay co-researchers and with getting the approval for the co-researchers to interview staff on NHS premises. The challenges were overcome eventually but some aspects of the study changed because of this. We suggest that some changes could be made to the research system which would lead to greater inclusion of the lay co-researchers in research studies and would make the process more straightforward for the research team. Background Involving patients and the public in all stages of research has been the focus of the SHARED study. Patient and public involvement (PPI) is an important strategic priority for the Department of Health and funders such as the National Institute for Health Research. The aim of this paper is to describe the benefits, challenges and costs involved in setting up the research study with lay members as part of the research team. The study focused on developing service user-led recommendations for people with memory loss and their carers, on discharge from acute hospital to the community. Methods This began with a discussion of an initial research idea with a lay group of carers and people living with dementia. Once funded, approval was sought from the Research Ethics Committee and NHS Trusts to conduct the research including the active involvement of lay co-researchers. Finally, to recruit, train and pay lay co-researchers in their role. Results The benefits of PPI have included developing ideas which are important to people living with memory loss; support for PPI received from the funders and research ethics committee, high levels of interest from volunteer groups, and lasting enthusiasm from many of the co-researchers. Organisational challenges were met in the requirement for research passports and with payment methods for the co-researchers. Training was beneficial but incurred extra costs for repeated training days. Discussion Overall the benefits outweighed the challenges which were overcome to varying degrees. The lay co-researchers gained membership of a study group and a beneficial partnership developed with the third sector. The biggest challenge was in overcoming the differences in approach to lay co-researchers between NHS Trusts. Organisational culture has been slow to incorporate PPI and this has not yet been fully addressed. It has the potential to delay the start of projects, affect recruitment time, incur extra research costs and disadvantage PPI. Conclusion Buy-in to service user involvement in research studies could be improved by clarifying the requirements for NHS Trust approval and by simplifying the system for financial reimbursement to lay co-researchers. This would improve inclusivity and provide a smoother process for the research team and the co-researchers.

A qualitative assessment of Charlotte REACH: an ecological perspective for decreasing CVD and diabetes among African Americans.

PubMed

DeBate, Rita; Plescia, Marcus; Joyner, Dennis; Spann, LaPronda

2004-01-01

An ecological perspective of health promotion was used as the framework for a Charlotte community-based intervention to eliminate rates of health disparities in cardiovascular disease and diabetes. Interventions are targeted on 5 levels of influences, with interaction between levels creating a supportive system for sustained change. The purpose of this qualitative assessment was to explore changes that have occurred among and between the following levels of influences: intrapersonal, interpersonal, organizational, community, and policy. Data from 10 focus groups were analyzed to identify overarching themes and subthemes. Results support positive changes within and between levels of change. REACH participants reported an increase in knowledge of preventative health behaviors, the development of health-related skills, and the diffusion of knowledge to family. Fellowship was identified as the primary motivator to continue positive health behaviors. Community Lay Health Advisors (LHAs) reported changes in individual health perceptions from disease-to prevention-oriented, and positive community changes, including the establishment of walking groups, and a farmers' market. The REACH program staff reported that collaboration between staff and LHAs was crucial to program success. The results of this assessment provide feedback for improving community health promotion activities and developing program sustainability.

Academic consumer researchers: a bridge between consumers and researchers.

PubMed

Griffiths, Kathleen M; Jorm, Anthony F; Christensen, Helen

2004-04-01

To describe the contributions that consumers, and academic consumer researchers in particular, can make to mental health research. A literature survey and a systematic consideration of the potential advantages of consumer and academic consumer researcher involvement in health research. Consumer researchers may contribute to better health outcomes, but there are significant barriers to their participation in the research process. To date, discussion has focused on the role of nonacademic consumers in the health research process. There has been little recognition of the particular contributions that consumers with formal academic qualifications and research experience can offer. Academic consumer researchers (ACRs) offer many of the advantages associated with lay consumer participation, as well as some unique advantages. These advantages include acceptance by other researchers as equal partners in the research process; skills in research; access to research funding; training in disseminating research findings within the scientific community; potential to influence research funding and research policy; capacity to influence the research culture; and potential to facilitate the involvement of lay consumers in the research process. In recognition of the value of a critical mass of ACRs in mental health, a new ACR unit (the Depression and Anxiety Consumer Research Unit [CRU]) has been established at the Centre for Mental Health Research at the Australian National University. Academic consumer researchers have the potential to increase the relevance of mental health research to consumers, to bridge the gap between the academic and consumer communities and to contribute to the process of destigmatizing mental disorders.

Development of a Fall-Risk Self-Assessment for Community-Dwelling Seniors

PubMed Central

Vivrette, Rebecca L.; Rubenstein, Laurence Z.; Martin, Jennifer L.; Josephson, Karen R.; Kramer, B. Josea

2012-01-01

Objective To determine seniors’ beliefs about falls and design a fall-risk self-assessment and educational materials to promote early identification of evidence-based fall risks and encourage prevention behaviors. Methods Focus groups with community-dwelling seniors, conducted in two phases to identify perceptions about fall risks and risk reduction and to assess face validity of the fall-risk self-assessment and acceptability of educational materials. Results Lay perception of fall risks was in general concordance with evidence-based research. Maintaining independence and positive tone were perceived as key motivators for fall prevention. Seniors intended to use information in the educational tool to stimulate discussions about falls with health care providers. Implications An evidence-based, educational fall-risk self-assessment acceptable to older adults can build on existing lay knowledge about fall risks and perception that falls are a relevant problem and can educate seniors about their specific risks and how to minimize them. PMID:21285473

Myths or theories? Alternative beliefs about HIV and AIDS in South African working class communities.

PubMed

Dickinson, David

2013-09-01

Despite three decades of public health promotion based on the scientific explanation of HIV/AIDS, alternative explanations of the disease continue to circulate. While these are seen as counter-productive to health education efforts, what is rarely analysed is their plurality and their tenacity. This article analyses the 'AIDS myths' collected by African HIV/AIDS workplace peer educators during an action research project. These beliefs about HIV/AIDS are organised, in this article, around core ideas that form the basis of 'folk' and 'lay theories' of HIV/AIDS. These constitute non-scientific explanations of HIV/AIDS, with folk theories drawing on bodies of knowledge that are independent of HIV/AIDS while lay theories are generated in response to the disease. A categorisation of alternative beliefs about HIV/AIDS is presented which comprises three folk theories - African traditional beliefs, Christian theology, and racial conspiracy - and three lay theories, all focused on avoiding HIV infection. Using this schema, the article describes how the plausibility of these alternative theories of HIV/AIDS lies not in their scientific validity, but in the robustness of the core idea at the heart of each folk or lay theory. Folk and lay theories of HIV/AIDS are also often highly palatable in that they provide hope and comfort in terms of prevention, cure, and the allocation of blame. This study argue that there is coherence and value to these alternative HIV/AIDS beliefs which should not be dismissed as ignorance, idle speculation or simple misunderstandings. A serious engagement with folk and lay theories of HIV/AIDS helps explain the continued circulation of alternative beliefs of HIV/AIDS and the slow uptake of behavioural change messages around the disease.

Stakeholder Education for Community-Wide Health Initiatives: A Focus on Teen Pregnancy Prevention.

PubMed

Finley, Cara; Suellentrop, Katherine; Griesse, Rebecca; House, Lawrence Duane; Brittain, Anna

2018-01-01

Teen pregnancies and births continue to decline due in part to implementation of evidence-based interventions and clinical strategies. While local stakeholder education is also thought to be critical to this success, little is known about what types of strategies work best to engage stakeholders. With the goal of identifying and describing evidence-based or best practice strategies for stakeholder education in community-based public health initiatives, we conducted a systematic literature review of strategies used for effective stakeholder education. Over 400 articles were initially retrieved; 59 articles met inclusion criteria. Strategies were grouped into four steps that communities can use to support stakeholder education efforts: identify stakeholder needs and resources, develop a plan, develop tailored and compelling messaging, and use implementation strategies. These strategies lay a framework for high-quality stakeholder education. In future research, it is important to prioritize evaluating specific activities taken to raise awareness, educate, and engage a community in community-wide public health efforts.

A mobile health technology platform for quality assurance and quality improvement of malaria diagnosis by community health workers.

PubMed

Laktabai, Jeremiah; Platt, Alyssa; Menya, Diana; Turner, Elizabeth L; Aswa, Daniel; Kinoti, Stephen; O'Meara, Wendy Prudhomme

2018-01-01

Community health workers (CHWs) play an important role in improving access to services in areas with limited health infrastructure or workforce. Supervision of CHWs by qualified health professionals is the main link between this lay workforce and the formal health system. The quality of services provided by lay health workers is dependent on adequate supportive supervision. It is however one of the weakest links in CHW programs due to logistical and resource constraints, especially in large scale programs. Interventions such as point of care testing using malaria rapid diagnostic tests (RDTs) require real time monitoring to ensure diagnostic accuracy. In this study, we evaluated the utility of a mobile health technology platform to remotely monitor malaria RDT (mRDT) testing by CHWs for quality improvement. As part of a large implementation trial involving mRDT testing by CHWs, we introduced the Fionet system composed of a mobile device (Deki Reader, DR) to assist in processing and automated interpretation of mRDTs, which connects to a cloud-based database which captures reports from the field in real time, displaying results in a custom dashboard of key performance indicators. A random sample of 100 CHWs were trained and provided with the Deki Readers and instructed to use it on 10 successive patients. The CHWs interpretation was compared with the Deki Reader's automatic interpretation, with the errors in processing and interpreting the RDTs recorded. After the CHW entered their interpretation on the DR, the DR provided immediate, automated feedback and interpretation based on its reading of the same cassette. The study team monitored the CHW performance remotely and provided additional support. A total of 1251 primary and 113 repeat tests were performed by the 97 CHWs who used the DR. 91.6% of the tests had agreement between the DR and the CHWs. There were 61 (4.9%) processing and 52 (4.2%) interpretation errors among the primary tests. There was a tendency towards lower odds of errors with increasing number and frequency of tests, though not statistically significant. Of the 62 tests that were repeated due to errors, 79% achieved concordance between the CHW and the DR. Satisfaction with the use of the DR by the CHWs was high. Use of innovative mHealth strategies for monitoring and quality control can ensure quality within a large scale implementation of community level testing by lay health workers.

Community strategies to address cancer disparities in Appalachian Kentucky

PubMed Central

Schoenberg, Nancy E.; Howell, Britteny M.; Fields, Nell

2012-01-01

Central Appalachian residents suffer disproportionate health disparities, including an all-cancer mortality rate 17% higher than the general population. During 10 focus groups and 19 key informant interviews, 91 Appalachian residents identified cancer screening challenges and strategies. Challenges included: (1) inadequate awareness of screening need; (2) insufficient access to screening; and (3) lack of privacy. Strategies included (1) witnessing/storytelling; (2) capitalizing on family history; (3) improving publicity about screening resources; (4) relying on lay health advisors; and (5) bundling preventive services. These insights shaped our CBPR intervention and offer strategies to others working in Appalachia, rural locales, and other traditionally underserved communities. PMID:22143486

Evaluation of a Peer-Led, Low-Intensity Physical Activity Program for Older Adults

ERIC Educational Resources Information Center

Werner, Danilea; Teufel, James; Brown, Stephen L.

2014-01-01

Background: Physical inactivity is a primary contributor to decreasing functional physical fitness and increasing chronic disease in older adults. Purpose: This study assessed the health-related benefits of ExerStart for Lay Leaders, a 20-week, community based, peer-led, low-impact exercise program for older adults. ExerStart focuses on aerobic…

An exploration of the factor structure and development of potentially useful subscales of etiological beliefs about schizophrenia in a general population sample.

PubMed

Goulding, Sandra M; Broussard, Beth; Demir, Berivan; Compton, Michael T

2009-11-01

Given that accessing care, treatment engagement, and course and outcomes among people with schizophrenia may be influenced by beliefs about causes in the larger community, causal beliefs about schizophrenia have been studied in numerous communities around the world. In particular, the 30-item list of etiological attributions developed by Angermeyer and colleagues has been used to describe causal beliefs in patients, family members, and lay community members within such communities. The current study, the first examination of the latent or factorial structure of these 30 causal beliefs, seeks to provide informative subscales that may enhance reliability and validity of groupings of causes for future analyses involving community members. Data were gathered from six separate surveys involving three distinct groups of individuals from the same community within the southeastern United States: lay community members, relatives of individuals with schizophrenia-spectrum disorders, and police officers at the start of a 1-week mental health training program. Exploratory factor analysis in the overall sample (n=577) revealed four factors that were used to define four subscales, termed: personal/family/social stressors (14 items), inconsistent with modern conceptions of risk (8 items), external/environmental insults to the brain (6 items), and consistent with modern biological conceptions (2 items). Cronbach's internal consistency reliability coefficients for these subscales were 0.91, 0.83, 0.71, and 0.65, respectively. These findings suggest that subscales could be derived to provide continuous measures for assessing causal beliefs in order to study how this concept relates to attitudes toward schizophrenia, the people affected by the disorder, and treatments that are recommended by mental health professionals. Replication within similar and dissimilar groups is warranted.

Integrating Health Care for the Most Vulnerable: Bridging the Differences in Organizational Cultures Between US Hospitals and Community Health Centers

PubMed Central

Murphy, Julia; Bindman, Andrew B.

2015-01-01

Policymakers have increasingly promoted health services integration to improve quality and efficiency. The US health care safety net, which comprises providers of health care to uninsured, Medicaid, and other vulnerable patients, remains a largely fragmented collection of providers. We interviewed leadership from safety net hospitals and community health centers in 5 US cities (Boston, MA; Denver, CO; Los Angeles, CA; Minneapolis, MN; and San Francisco, CA) throughout 2013 on their experiences with service integration. We identify conflicts in organizational mission, identity, and consumer orientation that have fostered reluctance to enter into collaborative arrangements. We describe how smaller scale initiatives, such as capitated model for targeted populations, health information exchange, and quality improvements led by health plans, can help bridge cultural differences to lay the groundwork for developing integrated care programs. PMID:26509286

HIV rapid diagnostic testing by lay providers in a key population-led health service programme in Thailand.

PubMed

Wongkanya, Rapeeporn; Pankam, Tippawan; Wolf, Shauna; Pattanachaiwit, Supanit; Jantarapakde, Jureeporn; Pengnongyang, Supabhorn; Thapwong, Prasopsuk; Udomjirasirichot, Apichat; Churattanakraisri, Yutthana; Prawepray, Nanthika; Paksornsit, Apiluk; Sitthipau, Thidadaow; Petchaithong, Sarayut; Jitsakulchaidejt, Raruay; Nookhai, Somboon; Lertpiriyasuwat, Cheewanan; Ongwandee, Sumet; Phanuphak, Praphan; Phanuphak, Nittaya

2018-01-01

Introduction:  Rapid diagnostic testing (RDT) for HIV has a quick turn-around time, which increases the proportion of people testing who receive their result. HIV RDT in Thailand has traditionally been performed only by medical technologists (MTs), which is a barrier to its being scaled up. We evaluated the performance of HIV RDT conducted by trained lay providers who were members of, or worked closely with, a group of men who have sex with men (MSM) and with transgender women (TG) communities, and compared it to tests conducted by MTs. Methods:  Lay providers received a 3-day intensive training course on how to perform a finger-prick blood collection and an HIV RDT as part of the Key Population-led Health Services (KPLHS) programme among MSM and TG. All the samples were tested by lay providers using Alere Determine HIV 1/2. HIV-reactive samples were confirmed by DoubleCheckGold Ultra HIV 1&2 and SD Bioline HIV 1/2. All HIV-positive and 10% of HIV-negative samples were re-tested by MTs using Serodia HIV 1/2. Results:  Of 1680 finger-prick blood samples collected and tested using HIV RDT by lay providers in six drop-in centres in Bangkok, Chiang Mai, Chonburi and Songkhla, 252 (15%) were HIV-positive. MTs re-tested these HIV-positive samples and 143 randomly selected HIV-negative samples with 100% concordant test results. Conclusion:  Lay providers in Thailand can be trained and empowered to perform HIV RDT as they were found to achieve comparable results in sample testing with MTs. Based on the task-shifting concept, this rapid HIV testing performed by lay providers as part of the KPLHS programme has great potential to enhance HIV prevention and treatment programmes among key at-risk populations.

Design and results of a culturally tailored cancer outreach project by and for Micronesian women.

PubMed

Aitaoto, Nia; Braun, Kathryn L; Estrella, Julia; Epeluk, Aritae; Tsark, JoAnn

2012-01-01

In 2005, approximately 26% of Micronesian women aged 40 or older in Hawai'i used mammography for breast cancer screening. We describe an 18-month project to increase screening participation in this population by tailoring educational materials and using a lay educator approach. New immigrants to Hawai'i are Marshallese from the Republic of the Marshall Islands and Chuukese, Pohnpeians, and Kosraeans from the Federated States of Micronesia. In Hawai'i, these 4 groups refer to themselves collectively as Micronesians, although each group has its own distinct culture and language. From 2006 through 2007, we applied principles of community-based participatory research--trust building, joint assessment, cultural tailoring of materials, and skills transfer--to develop and track the reach of Micronesian women lay educators in implementing a cancer awareness program among Micronesian women living in Hawai'i. Using our tailored in-language materials, 11 lay educators (5 Chuukese, 3 Marshallese, 2 Pohnpeians, and 1 Kosraean) provided one-on-one and small group in-language cancer information sessions to 567 Micronesian women (aged 18-75 years). Among the 202 women aged 40 or older eligible for mammography screening, 166 (82%) had never had a mammogram and were assisted to screening appointments. After 6 months, 146 (88%) of the 166 had received a mammogram, increasing compliance from 18% to 90%. Lay educators reported increases in their skills and their self-esteem and want to extend their skills to other health issues, including diabetes management and immunization. Tailoring materials and using the lay educator model successfully increased participation in breast cancer screening. This model may work in other communities that aim to reduce disparities in access to cancer screening.

Prevention of type 2 diabetes in British Bangladeshis: qualitative study of community, religious, and professional perspectives.

PubMed

Grace, Clare; Begum, Reha; Subhani, Syed; Kopelman, Peter; Greenhalgh, Trisha

2008-11-04

To understand lay beliefs and attitudes, religious teachings, and professional perceptions in relation to diabetes prevention in the Bangladeshi community. Qualitative study (focus groups and semistructured interviews). Tower Hamlets, a socioeconomically deprived London borough, United Kingdom. Bangladeshi people without diabetes (phase 1), religious leaders and Islamic scholars (phase 2), and health professionals (phase 3). 17 focus groups were run using purposive sampling in three sequential phases. Thematic analysis was used iteratively to achieve progressive focusing and to develop theory. To explore tensions in preliminary data fictional vignettes were created, which were discussed by participants in subsequent phases. The PEN-3 multilevel theoretical framework was used to inform data analysis and synthesis. Most lay participants accepted the concept of diabetes prevention and were more knowledgeable than expected. Practical and structural barriers to a healthy lifestyle were commonly reported. There was a strong desire to comply with cultural norms, particularly those relating to modesty. Religious leaders provided considerable support from Islamic teachings for messages about diabetes prevention. Some clinicians incorrectly perceived Bangladeshis to be poorly informed and fatalistic, although they also expressed concerns about their own limited cultural understanding. Contrary to the views of health professionals and earlier research, poor knowledge was not the main barrier to healthy lifestyle choices. The norms and expectations of Islam offer many opportunities for supporting diabetes prevention. Interventions designed for the white population, however, need adaptation before they will be meaningful to many Bangladeshis. Religion may have an important part to play in supporting health promotion in this community. The potential for collaborative working between health educators and religious leaders should be explored further and the low cultural understanding of health professionals addressed.

Implementation of oral health initiatives by Australian rural communities: Factors for success.

PubMed

Taylor, Judy; Carlisle, Karen; Farmer, Jane; Larkins, Sarah; Dickson-Swift, Virginia; Kenny, Amanda

2018-01-01

In this paper, we consider factors significant in the success of community participation in the implementation of new oral health services. Our analysis draws on data from the Rural Engaging Communities in Oral Health (Rural ECOH) study (2014-2016). We aimed to assess the Australian relevance of a Scottish community participation framework for health service development; Remote Service Futures. Internationally, community participation in planning of health initiatives is common, but less common in new service implementation. Health managers query the legitimacy of "lay" community members, whether they will persist, and whether they can act as change agents. Our data provide evidence that helps answer these queries. Six communities, located within regions covered by two large rural primary healthcare organisations (Medicare Locals), were selected in two Australian states. Two university-based facilitators worked with a group of local residents (for each community) to monitor implementation of new oral health initiatives designed through participatory processes. Data about implementation were collected through interviews with 28 key stakeholders at the beginning of implementation and 12 months later. Data were coded, themed and analysed abductively. Five themes emerged; the inter-relationship between community motivation to participate with the fortunes of the oral health initiatives, having the "right" people involved, continuing involvement of sponsors and/or significant people, trusting working relationships between participants and perceiving benefits from participation. Findings provide evidence of a role for community participation in implementing new community services if solid partnerships with relevant providers can be negotiated and services are seen to be relevant and useful to the community. © 2017 John Wiley & Sons Ltd.

Lay Crowd-Sourced Expertise (LCE) and Its Influence on the New Role of Patients: Ethical and Societal Issues.

PubMed

Lamas, Eugenia; Salinas, Rodrigo; Ferrer, Marcela; Bousquet, Cedric; Vuillaume, Dominique

2016-01-01

The emergence of social media on the Internet allows patients to discuss about their chronic diseases within online communities sharing common interests. This allows patients to gather other patients' experience, and gain new knowledge that is usually not shared by healthcare professionals. In this context, further studies are required on the actual impact of the use of social networks on the quality of life of patients participating in these online communities, focusing on the evolving role and impact of Lay Crowdsourced expertise (LCE) in improving disease management and control. We present a study on a large number of posts from social networks of different online communities. This study allowed us to choose four pathologies, with distinctive characteristics relevant for our future analysis, and to define the themes that will be covered in future work by online questionnaires. The analysis of responses from patients, who volunteer to participate, will help us in exploring how interactions between patients, on these online communities, may help them to gain useful information for managing their conditions and improving their quality of life. Furthermore, we will identify new ethical issues that arise in the sharing of health data.

Idioms of distress, ethnopsychology, and the clinical encounter in Haiti's Central Plateau.

PubMed

Keys, Hunter M; Kaiser, Bonnie N; Kohrt, Brandon A; Khoury, Nayla M; Brewster, Aimée-Rika T

2012-08-01

Haiti's 2010 earthquake mobilized mental health and psychosocial interventions from across the globe. However, failure to understand how psychological distress is communicated between lay persons and health workers in rural clinics, where most Haitians access care, has been a major limitation in providing mental health services. The goal of this study was to map idioms of distress onto Haitian ethnopsychologies in a way that promotes improved communication between lay persons and clinicians in rural Haiti. In Haiti's Central Plateau, an ethnographic study was conducted in May and June 2010, utilizing participant observation in rural clinics, 31 key informant interviews, 11 focus groups, and four case studies. Key informants included biomedical practitioners, traditional healers, community leaders, and municipal and religious figures. Deductive and inductive themes were coded using content analysis (inter-rater reliability > 0.70). Forty-four terms for psychological distress were identified. Head (tèt) or heart (kè) terms comprise 55% of all qualitative text segments coded for idioms of distress. Twenty-eight of 142 observed patient-clinician contacts involved persons presenting with tèt terms, while 29 of the 142 contacts were presentations with kè terms. Thus, 40% of chief complaints were conveyed in either head or heart terms. Interpretations of these terms differed between lay and clinical groups. Lay respondents had broad and heterogeneous interpretations, whereas clinicians focused on biomedical concepts and excluded discussion of mental health concerns. This paper outlines preliminary evidence regarding the psychosocial dimensions of tèt and kè-based idioms of distress and calls for further exploration. Holistic approaches to mental healthcare in Haiti's Central Plateau should incorporate local ethnopsychological frameworks alongside biomedical models of healthcare. Copyright © 2012 Elsevier Ltd. All rights reserved.

Lay health workers perceptions of an anemia control intervention in Karnataka, India: a qualitative study.

PubMed

Shet, Arun S; Rao, Abha; Jebaraj, Paul; Mascarenhas, Maya; Zwarenstein, Merrick; Galanti, Maria Rosaria; Atkins, Salla

2017-09-18

Lay health workers (LHWs) are increasingly used to complement health services internationally. Their perceptions of the interventions they implement and their experiences in delivering community based interventions in India have been infrequently studied. We developed a novel LHW led intervention to improve anemia cure rates in rural community dwelling children attending village day care centers in South India. Since the intervention is delivered by the village day care center LHW, we sought to understand participating LHWs' acceptance of and perspectives regarding the intervention, particularly in relation to factors affecting daily implementation. We conducted a qualitative study alongside a cluster randomized controlled trial evaluating a complex community intervention for childhood anemia control in Karnataka, South India. Focus group discussions (FGDs) were conducted with trained LHWs assigned to deliver the educational intervention. These were complemented by non-participant observations of LHWs delivering the intervention. Transcripts of the FGDs were translated and analyzed using the framework analysis method. Several factors made the intervention acceptable to the LHWs and facilitated its implementation including pre-implementation training modules, intervention simplicity, and ability to incorporate the intervention into the routine work schedule. LHWs felt that the intervention impacted negatively on their preexisting workload. Fluctuating relationships with mothers weakened the LHWs position as providers of the intervention and hampered efficient implementation, despite the LHWs' highly valued position in the community. Modifiable barriers to the successful implementation of this intervention were seen at two levels. At a broader contextual level, hindering factors included the LHW being overburdened, inadequately reimbursed, and receiving insufficient employer support. At the health system level, lack of streamlining of LHW duties, inability of LHWs to diagnose anemia and temporary shortfalls in the availability of iron supplements constituted potentially modifiable barriers. This qualitative study identified some of the practical challenges as experienced by LHWs while delivering a community health intervention in India. Methodologically, it highlights the value of qualitative research in understanding implementation of complex community interventions. On the contextual level, the results indicate that efficient delivery of community interventions will require streamlining of LHW workloads and improved health system infrastructure support. This trial was registered with ISRCTN.com (identifier: ISRCTN68413407 ) on 23 September 2013.

The Influence of Community Health Resources on Effectiveness and Sustainability of Community and Lay Health Worker Programs in Lower-Income Countries: A Systematic Review

PubMed Central

Pool, Robert

2017-01-01

Background Despite the availability of practical knowledge and effective interventions required to reduce priority health problems in low-income countries, poor and vulnerable populations are often not reached. One possible solution to this problem is the use of Community or Lay Health Workers (CLHWs). So far, however, the development of sustainability in CLHW programs has failed and high attrition rates continue to pose a challenge. We propose that the roles and interests which support community health work should emerge directly from the way in which health is organized at community level. This review explores the evidence available to assess if increased levels of integration of community health resources in CLHW programs indeed lead to higher program effectiveness and sustainability. Methods and Findings This review includes peer-reviewed articles which meet three eligibility criteria: 1) specific focus on CLHWs or equivalent; 2) randomized, quasi-randomized, before/after methodology or substantial descriptive assessment; and 3) description of a community or peer intervention health program located in a low- or middle-income country. Literature searches using various article databases led to 2930 hits, of which 359 articles were classified. Of these, 32 articles were chosen for extensive review, complemented by analysis of the results of 15 other review studies. Analysis was conducted using an excel based data extraction form. Because results showed that no quantitative data was published, a descriptive synthesis was conducted. The review protocol was not proactively registered. Findings show minimal inclusion of even basic community level indicators, such as the degree to which the program is a community initiative, community input in the program or training, the background and history of CLHW recruits, and the role of the community in motivation and retention. Results show that of the 32 studies, only one includes one statistical measure of community integration. As a result of this lack of data we are unable to derive an evidence-based conclusion to our propositions. Instead, our results indicate a larger problem, namely the complete absence of indicators measuring community relationships with the programs studied. Studies pay attention only to gender and peer roles, along with limited demographic information about the recruits. The historicity of the health worker and the community s/he belongs to is absent in most studies reviewed. None of the studies discuss or test for the possibility that motivation emanates from the community. Only a few studies situate attrition and retention as an issue enabled by the community. The results were limited by a focus on low-income countries and English, peer-reviewed published articles only. Conclusion Published, peer-reviewed studies evaluating the effectiveness and sustainability of CLHW interventions in health programs have not yet adequately tested for the potential of utilizing existing community health roles or social networks for the development of effective and sustainable (retentive) CLHW programs. Community relationships are generally seen as a “black box” represented by an interchangeable CLHW labor unit. This disconnect from community relationships and resources may have led to a systematic and chronic undervaluing of community agency in explanations of programmatic effectiveness and sustainability. PMID:28095475

Lay health advisor activity levels: definitions from the field.

PubMed

Altpeter, M; Earp, J A; Bishop, C; Eng, E

1999-08-01

One type of lay health advisor model assumes that an effective mechanism for reaching the underserved is through informal advice-givers called natural helpers. Despite the growing use of this approach, few programs have defined what an active lay health advisor does within the natural helping process. To explore perceptions and definitions of lay health advisors' activity, we conducted semistructured, in-person interviews with four field staff who coordinate the advisors' activities in a breast cancer screening program. These staff viewed lay health advisor activity as fluctuating over the course of a year, occurring along a continuum of participation (inactive, moderately active, active, and superactive), and reflecting varying degrees of proactivity and participation in multiple activities. These results suggest an empirical process for refining the definition of an active lay health advisor, improving advisors' productivity in achieving outreach objectives, and managing and monitoring their ongoing activities.

Whose interests do lay people represent? Towards an understanding of the role of lay people as members of committees

PubMed Central

Hogg, Christine; Williamson, Charlotte

2008-01-01

Increasingly, lay people are appointed as members to health service committees. The term ‘lay’ is used loosely and the reasons for involving lay people are seldom clearly defined. This paper argues that the different roles that lay people play need to be explicitly defined in order for their contributions to be realized. Although lay members of health service committees are generally assumed to be working for patients’ interests, our observations lead us to think that some lay people tend to support professionals’ or managers’ interests rather than patients’ interests as patients would define them. We suggest that lay people fall into three broad categories: supporters of dominant (professional) interests, supporters of challenging (managerial) interests and supporters of repressed (patient) interests. These alignments should be taken into account in appointments to health service bodies. Further research is needed on the alignments and roles of lay members. PMID:11286594

Los Angeles Free-Net: an experiment in interactive telecommunication between lay members of the Los Angeles community and health care experts.

PubMed Central

Bluming, A; Mittelman, P S

1996-01-01

The Los Angeles Free-Net, an interactive community information resource, was established in part to help community members become more effective consumers of health care services. By providing timely, expert answers to anonymously asked medical questions at no charge, we hope to decrease unnecessary physician-patient encounters, encourage effective preventive-health measures, and improve the overall results of health care in our community. Although it is too early to assess health care benefits from this system, the following observations may help guide the development of similar systems around the nation: (1) A small annual registration fee generates both moral and financial public support. (2) Demographic information from registered users can help direct attempts at enfranchising all members of the community. (3) Toll-free access, free public-instruction sessions, moderated forums, extensive volunteer help, and encryption security are encouraged, while Internet censorship is difficult and counterproductive. (4) Access to Internet resources is important, but the strength of a community system lies primarily in the sharing of expertise and resources among members of the community. (5) A critical mass of available physicians to answer questions must be matched with a critical level of question input for this type of interactive medical information resource to function in a time-sensitive fashion. PMID:8826627

Los Angeles Free-Net: an experiment in interactive telecommunication between lay members of the Los Angeles community and health care experts.

PubMed

Bluming, A; Mittelman, P S

1996-04-01

The Los Angeles Free-Net, an interactive community information resource, was established in part to help community members become more effective consumers of health care services. By providing timely, expert answers to anonymously asked medical questions at no charge, we hope to decrease unnecessary physician-patient encounters, encourage effective preventive-health measures, and improve the overall results of health care in our community. Although it is too early to assess health care benefits from this system, the following observations may help guide the development of similar systems around the nation: (1) A small annual registration fee generates both moral and financial public support. (2) Demographic information from registered users can help direct attempts at enfranchising all members of the community. (3) Toll-free access, free public-instruction sessions, moderated forums, extensive volunteer help, and encryption security are encouraged, while Internet censorship is difficult and counterproductive. (4) Access to Internet resources is important, but the strength of a community system lies primarily in the sharing of expertise and resources among members of the community. (5) A critical mass of available physicians to answer questions must be matched with a critical level of question input for this type of interactive medical information resource to function in a time-sensitive fashion.

Impact of family planning health talks by lay health workers on contraceptive knowledge and attitudes among HIV-infected patients in rural Kenya

PubMed Central

Onono, Maricianah; Blat, Cinthia; Miles, Sondra; Steinfeld, Rachel; Wekesa, Pauline; Bukusi, Elizabeth A.; Owuor, Kevin; Grossman, Daniel; Cohen, Craig R.; Newmann, Sara J.

2015-01-01

Objective To determine if a health talk on family planning (FP) by community clinic health assistants (CCHAs) will improve knowledge, attitudes and behavioral intentions about contraception in HIV-infected individuals. Methods A 15-min FP health talk was given by CCHAs in six rural HIV clinics to a sample of 49 HIV-infected men and women. Effects of the health talk were assessed through a questionnaire administered before the health talk and after completion of the participant's clinic visit. Results Following the health talk, there was a significant increase in knowledge about contraceptives (p < .0001), side-effects (p < .0001), and method-specific knowledge about IUCDs (p < .001), implants (p < .0001), and injectables (p < .05). Out of 31 women and 18 men enrolled, 14 (45%) women and 6 (33%) men intended to try a new contraceptive. Participant attitudes toward FP were high before and after the health talk (median 4 of 4). Conclusion A health talk delivered by CCHAs can increase knowledge of contraception and promote the intention to try new more effective contraception among HIV-infected individuals. Practice implications FP health talks administered by lay-health providers to HIV-infected individuals as they wait for HIV services can influence FP knowledge and intention to use FP. PMID:24316053

Impact of family planning health talks by lay health workers on contraceptive knowledge and attitudes among HIV-infected patients in rural Kenya.

PubMed

Onono, Maricianah; Blat, Cinthia; Miles, Sondra; Steinfeld, Rachel; Wekesa, Pauline; Bukusi, Elizabeth A; Owuor, Kevin; Grossman, Daniel; Cohen, Craig R; Newmann, Sara J

2014-03-01

To determine if a health talk on family planning (FP) by community clinic health assistants (CCHAs) will improve knowledge, attitudes and behavioral intentions about contraception in HIV-infected individuals. A 15-min FP health talk was given by CCHAs in six rural HIV clinics to a sample of 49 HIV-infected men and women. Effects of the health talk were assessed through a questionnaire administered before the health talk and after completion of the participant's clinic visit. Following the health talk, there was a significant increase in knowledge about contraceptives (p<.0001), side-effects (p<.0001), and method-specific knowledge about IUCDs (p<.001), implants (p<.0001), and injectables (p<.05). Out of 31 women and 18 men enrolled, 14 (45%) women and 6 (33%) men intended to try a new contraceptive. Participant attitudes toward FP were high before and after the health talk (median 4 of 4). A health talk delivered by CCHAs can increase knowledge of contraception and promote the intention to try new more effective contraception among HIV-infected individuals. FP health talks administered by lay-health providers to HIV-infected individuals as they wait for HIV services can influence FP knowledge and intention to use FP. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Developing theoretically based and culturally appropriate interventions to promote hepatitis B testing in 4 Asian American populations, 2006-2011.

PubMed

Maxwell, Annette E; Bastani, Roshan; Glenn, Beth A; Taylor, Victoria M; Nguyen, Tung T; Stewart, Susan L; Burke, Nancy J; Chen, Moon S

2014-05-01

Hepatitis B infection is 5 to 12 times more common among Asian Americans than in the general US population and is the leading cause of liver disease and liver cancer among Asians. The purpose of this article is to describe the step-by-step approach that we followed in community-based participatory research projects in 4 Asian American groups, conducted from 2006 through 2011 in California and Washington state to develop theoretically based and culturally appropriate interventions to promote hepatitis B testing. We provide examples to illustrate how intervention messages addressing identical theoretical constructs of the Health Behavior Framework were modified to be culturally appropriate for each community. Intervention approaches included mass media in the Vietnamese community, small-group educational sessions at churches in the Korean community, and home visits by lay health workers in the Hmong and Cambodian communities. Use of the Health Behavior Framework allowed a systematic approach to intervention development across populations, resulting in 4 different culturally appropriate interventions that addressed the same set of theoretical constructs. The development of theory-based health promotion interventions for different populations will advance our understanding of which constructs are critical to modify specific health behaviors.

Health Care Workers in the Dominican Republic: Self-perceived role in smoking cessation

PubMed Central

Ossip-Klein, Deborah J.; Diaz, Sergio; Sierra, Essie; Quiñones, Zahira; Armstrong, Latoya; Chin, Nancy P.; McIntosh, Scott

2013-01-01

A Dominican Republic (DR) based multi-community trial of smoking cessation viewed health care workers (HCWs) as potential interventionists. Effectively engaging them, requires a clear understanding of their attitudes and practices regarding smoking. A Rapid Assessment Procedure, conducted among HCWs in six economically disadvantaged communities, included physicians, nurses, other health professionals, paraprofessionals and lay workers. Attitudes and practices about smoking were consistent across the 82 HCWs and mostly reflected community views. HCWs lacked proactiveness related to smoking cessation and had a limited view of their role, attributing clients’ quitting successes to personal will. Prior cessation training was limited although interest was generally high. Material resources about smoking cessation were virtually absent. DR HCWs’ views represented features both distinct from and common to HCWs elsewhere. Any intervention with HCWs must first raise awareness before addressing their role in smoking cessation, discussing implementation barriers and include training and materials about risks and effective interventions. PMID:19448160

Return-on-Investment (ROI) Analyses of an Inpatient Lay Health Worker Model on 30-Day Readmission Rates in a Rural Community Hospital.

PubMed

Cardarelli, Roberto; Bausch, Gregory; Murdock, Joan; Chyatte, Michelle Renee

2017-07-07

The purpose of the study was to assess the return-on-investment (ROI) of an inpatient lay health worker (LHW) model in a rural Appalachian community hospital impacting 30-day readmission rates. The Bridges to Home (BTH) study completed an evaluation in 2015 of an inpatient LHW model in a rural Kentucky hospital that demonstrated a reduction in 30-day readmission rates by 47.7% compared to a baseline period. Using the hospital's utilization and financial data, a validated ROI calculator specific to care transition programs was used to assess the ROI of the BTH model comparing 3 types of payment models including Diagnosis Related Group (DRG)-only payments, pay-for-performance (P4P) contracts, and accountable care organizations (ACOs). The BTH program had a -$0.67 ROI if the hospital had only a DRG-based payment model. If the hospital had P4P contracts with payers and 0.1% of its annual operating revenue was at risk, the ROI increased to $7.03 for every $1 spent on the BTH program. However, if the hospital was an ACO as was the case for this study's community hospital, the ROI significantly increased to $38.48 for every $1 spent on the BTH program. The BTH model showed a viable ROI to be considered by community hospitals that are part of an ACO or P4P program. A LHW care transition model may be a cost-effective alternative for impacting excess 30-day readmissions and avoiding associated penalties for hospital systems with a value-based payment model. © 2017 National Rural Health Association.

A systematic community-based participatory approach to refining an evidence-based community-level intervention: The HOLA intervention for Latino men who have sex with men

PubMed Central

Rhodes, Scott D.; Daniel, Jason; Alonzo, Jorge; Duck, Stacy; Garcia, Manuel; Downs, Mario; Hergenrather, Kenneth C.; Alegria-Ortega, Jose; Miller, AAS, Cindy; Boeving Allen, Alex; Gilbert, Paul A.; Marsiglia, Flavio F.

2014-01-01

Our community-based participatory research (CBPR) partnership engaged in a multi-step process to refine a culturally congruent intervention that builds on existing community strengths to promote sexual health among immigrant Latino men who have sex with men (MSM). The steps were: (1) increase Latino MSM participation in the existing partnership; (2) establish an Intervention Team; (3) review the existing sexual health literature; (4) explore needs and priorities of Latino MSM; (5) narrow priorities based on what is important and changeable; (6) blend health behavior theory with Latino MSM’s lived experiences; (7) design an intervention conceptual model; (8) develop training modules and (9) resource materials; and (10) pretest and (11) revise the intervention. The developed intervention contains four modules to train Latino MSM to serve as lay health advisors (LHAs) known as “Navegantes”. These modules synthesize locally collected data with other local and national data; blend health behavior theory, the lived experiences, and cultural values of immigrant Latino MSM; and harness the informal social support Latino MSM provide one another. This community-level intervention is designed to meet the expressed sexual health priorities of Latino MSM. It frames disease prevention within sexual health promotion. PMID:23075504

A systematic community-based participatory approach to refining an evidence-based community-level intervention: the HOLA intervention for Latino men who have sex with men.

PubMed

Rhodes, Scott D; Daniel, Jason; Alonzo, Jorge; Duck, Stacy; García, Manuel; Downs, Mario; Hergenrather, Kenneth C; Alegría-Ortega, José; Miller, Cindy; Boeving Allen, Alex; Gilbert, Paul A; Marsiglia, Flavio F

2013-07-01

Our community-based participatory research partnership engaged in a multistep process to refine a culturally congruent intervention that builds on existing community strengths to promote sexual health among immigrant Latino men who have sex with men (MSM). The steps were the following: (1) increase Latino MSM participation in the existing partnership, (2) establish an Intervention Team, (3) review the existing sexual health literature, (4) explore needs and priorities of Latino MSM, (5) narrow priorities based on what is important and changeable, (6) blend health behavior theory with Latino MSM's lived experiences, (7) design an intervention conceptual model, (8) develop training modules and (9) resource materials, and (10) pretest and (11) revise the intervention. The developed intervention contains four modules to train Latino MSM to serve as lay health advisors known as Navegantes. These modules synthesize locally collected data with other local and national data; blend health behavior theory, the lived experiences, and cultural values of immigrant Latino MSM; and harness the informal social support Latino MSM provide one another. This community-level intervention is designed to meet the expressed sexual health priorities of Latino MSM. It frames disease prevention within sexual health promotion.

A qualitative evaluation of a faith-based breast and cervical cancer screening intervention for African American women.

PubMed

Matthews, Alicia K; Berrios, Nerida; Darnell, Julie S; Calhoun, Elizabeth

2006-10-01

This article presents a formative evaluation of a CDC Racial and Ethnic Approaches to Community Health (REACH) 2010 faith-based breast and cervical cancer early detection and prevention intervention for African American women living in urban communities. Focus groups were conducted with a sample of women (N=94) recruited from each church participating in the intervention. One focus group was conducted in each of the nine participating churches following completion of the 6-month REACH 2010 intervention. Transcribed data were coded to identify relevant themes. Key findings included (a) the acceptability of receiving cancer education within the context of a faith community, (b) the importance of pastoral input, (c) the effectiveness of personal testimonies and lay health advocates, (d) the saliency of biblical scripture in reinforcing health messages, (e) the effectiveness of multimodal learning aids, and (f) the relationship between cervical cancer and social stigma. Study findings have implications for enhancing faith-based breast and cervical cancer prevention efforts in African American communities.

Multiple and mixed methods in formative evaluation: Is more better? Reflections from a South African study.

PubMed

Odendaal, Willem; Atkins, Salla; Lewin, Simon

2016-12-15

Formative programme evaluations assess intervention implementation processes, and are seen widely as a way of unlocking the 'black box' of any programme in order to explore and understand why a programme functions as it does. However, few critical assessments of the methods used in such evaluations are available, and there are especially few that reflect on how well the evaluation achieved its objectives. This paper describes a formative evaluation of a community-based lay health worker programme for TB and HIV/AIDS clients across three low-income communities in South Africa. It assesses each of the methods used in relation to the evaluation objectives, and offers suggestions on ways of optimising the use of multiple, mixed-methods within formative evaluations of complex health system interventions. The evaluation's qualitative methods comprised interviews, focus groups, observations and diary keeping. Quantitative methods included a time-and-motion study of the lay health workers' scope of practice and a client survey. The authors conceptualised and conducted the evaluation, and through iterative discussions, assessed the methods used and their results. Overall, the evaluation highlighted programme issues and insights beyond the reach of traditional single methods evaluations. The strengths of the multiple, mixed-methods in this evaluation included a detailed description and nuanced understanding of the programme and its implementation, and triangulation of the perspectives and experiences of clients, lay health workers, and programme managers. However, the use of multiple methods needs to be carefully planned and implemented as this approach can overstretch the logistic and analytic resources of an evaluation. For complex interventions, formative evaluation designs including multiple qualitative and quantitative methods hold distinct advantages over single method evaluations. However, their value is not in the number of methods used, but in how each method matches the evaluation questions and the scientific integrity with which the methods are selected and implemented.

The Latina paradox: an opportunity for restructuring prenatal care delivery.

PubMed

McGlade, Michael S; Saha, Somnath; Dahlstrom, Marie E

2004-12-01

Latina mothers in the United States enjoy surprisingly favorable birth outcomes despite their social disadvantages. This "Latina paradox" is particularly evident among Mexican-born women. The social and cultural factors that contribute to this paradox are maintained by community networks--informal systems of prenatal care that are composed of family, friends, community members, and lay health workers. This informal system confers protective factors that provide a behavioral context for healthy births. US-born Latinas are losing this protection, although it could be maintained with the support of community-based informal care systems. We recommend steps to harness the benefits of informal systems of prenatal care in Latino communities to meet the increasing needs of pregnant Latina women.

Managing boundaries between professional and lay nursing following the influenza pandemic, 1918-1919: insights for professional resilience today?

PubMed

Wood, Pamela J

2017-03-01

To examine lay-professional nursing boundaries, using challenges to the New Zealand nursing profession following the 1918-1919 influenza pandemic as the example. The influenza pandemic of 1918-1919 had an overwhelming international impact on communities and the nursing profession. After the pandemic, the expectation for communities to be able to nurse the sick reflects today's increasing reliance on families to care for people at home. It similarly raised questions about the profession's role and professional boundaries in relation to volunteer or lay nursing. In New Zealand, the postpandemic challenge to build community lay nursing capacity tested these boundaries. Historical research. Analysis of historical primary sources of official reports, newspaper accounts, articles in New Zealand's professional nursing journal Kai Tiaki and the memoir of Hester Maclean, the country's chief nurse. Interpretation of findings in relation to secondary sources examining similar historical tensions between professional and lay nursing, and to the more recent notion of professional resilience. Maclean guarded nursing's professional boundaries by maintaining considerable control over community instruction in nursing and by strenuously resisting the suggestion that this should be done in hospitals where professional nurses trained. This historical example shows how the nursing profession faced the perceived threat to its professional boundaries. It also shows how competing goals of building community lay nursing capacity and protecting professional boundaries can be effectively managed. In the context of a global nursing shortage, limited healthcare budgets and a consequently increasing reliance on households to provide care for family members, this historical research shows nurses today that similar issues have been faced and effectively managed in the past. © 2016 John Wiley & Sons Ltd.

The Native Telehealth Outreach and Technical Assistance Program: a community-based approach to the development of multimedia-focused health care information.

PubMed

Dick, Rhonda Wiegman; Manson, Spero M; Hansen, Amy L; Huggins, Annie; Trullinger, Lori

2007-01-01

The development and dissemination of culturally relevant health care information has traditionally taken a "top-down" approach. Governmental funding agencies and research institutions have too often dictated the importance and focus of health-related research and information dissemination. In addition, the digital divide has affected rural communities in such a way that their members often do not possess the knowledge or experience necessary to use technological resources. And, even when they do, their skills may be limited, adequate only for implementing applications and programs designed by others who live and work outside of these communities. This need became the driving force in the creation of the Native Telehealth Outreach and Technical Assistance Program. The goal of the program is to equip Native community members, at both the lay and professional levels, with the means to use technology to address tribal health care needs. The transfer of relevant technical knowledge and skills enables participants to develop projects which enhance the community-wide dissemination of health care information. Nine community health advocates and professionals participated in the initial cohort. Eight of the participants successfully developed multimedia-based projects including Web sites, interactive CD-ROMs, and video focusing on a variety of health concerns. At the conclusion of the 18-month program period, projects were disseminated throughout rural communities. The NTOTAP staff continues to evaluate the use of these projects and their benefits within the rural communities.

The role of a community coalition in the development of health services for the poor and uninsured.

PubMed

Bibeau, D L; Howell, K A; Rife, J C; Taylor, M L

1996-01-01

Access to primary health care for indigent citizens presents a dilemma for many communities in the United States. In response, communities have developed a variety of strategies to effectively deal with the problem. This article describes the evolution of a small free clinic into a comprehensive primary care clinic developed through the actions of a community-based coalition. The clinic originated within an umbrella organization for indigent residents as free medical service provided at a night shelter by a local physician once a week. Through a coalition of business, religious, medical, hospital, foundation, lay volunteer, county health department, and chamber of commerce representatives, the service was enlarged into a formal clinic operation with a small staff and volunteers providing services for about 3,500 patient visits each year. As the demand for services increased beyond resources, an expanded coalition created HealthServe Medical Center, a comprehensive primary care clinic operating 40 hours per week. The HealthServe Board is currently active in supporting service delivery at the clinic, with plans to serve 24,000 medical and dental visits annually by mid-1995. The evolution process was based upon the characteristics of effective community coalitions and the commitment of individuals from diverse community sectors.

A snapshot of how Latino heterosexual men promote sexual health within their social networks: Process evaluation findings from an efficacious community-level intervention

PubMed Central

Rhodes, Scott D.; Daniel, Jason; Alonzo, Jorge; Vissman, Aaron T.; Duck, Stacy; Downs, Mario; Gilbert, Paul A.

2014-01-01

Background HoMBReS was a community-level social network intervention designed to increase sexual health among Latino heterosexual men who were members of a multi-county soccer league. Methods We used process data collected each month during 18 months of intervention implementation from each of 15 trained Latino male lay health advisors (known as Navegantes) to explore the activities that Navegantes conducted to increase condom and HIV testing among their social network members. Results The Navegantes reported conducting 2,364 activities, for a mean of 8.8 activities per Navegante per month. The most common activity was condom distribution. Most activities were conducted with men; about 2% were conducted with women. Among activities conducted with men, half were conducted with soccer teammates and half with non-teammates. Conclusions Latino men’s social networks can be leveraged to promote sexual health within the community. Innovative methods that reach large numbers of community members are needed given the lack of prevention resources for populations disproportionately impacted by HIV and STDs. PMID:23206201

A snapshot of how latino heterosexual men promote sexual health within their social networks: process evaluation findings from an efficacious community-level intervention.

PubMed

Rhodes, Scott D; Daniel, Jason; Alonzo, Jorge; Vissman, Aaron T; Duck, Stacy; Downs, Mario; Gilbert, Paul A

2012-12-01

Hombres Manteniendo Bienestar y Relaciones Saludables (HoMBReS) was a community-level social network intervention designed to increase sexual health among Latino heterosexual men who were members of a multicounty soccer league. Process data were collected each month during 18 months of intervention implementation from each of 15 trained Latino male lay health advisors (known as Navegantes) to explore the activities that Navegantes conducted to increase condom and HIV testing among their social network members. The Navegantes reported conducting 2,364 activities, for a mean of 8.8 activities per Navegante per month. The most common activity was condom distribution. Most activities were conducted with men; about 2% were conducted with women. Among activities conducted with men, half were conducted with soccer teammates and half with nonteammates. Results suggest that Latino men's social networks can be leveraged to promote sexual health within the community. Innovative methods that reach large numbers of community members are needed given the lack of prevention resources for populations disproportionately impacted by HIV and STDs.

Health worker perceptions of integrating mobile phones into community case management of malaria in Saraya, Senegal.

PubMed

Blanas, Demetri A; Ndiaye, Youssoupha; MacFarlane, Matthew; Manga, Isaac; Siddiqui, Ammar; Velez, Olivia; Kanter, Andrew S; Nichols, Kim; Hennig, Nils

2015-05-01

Although community case management of malaria increases access to life-saving care in isolated settings, it contends with many logistical challenges. Mobile phone health information technology may present an opportunity to address a number of these barriers. Using the wireless adaptation of the technology acceptance model, this study assessed availability, ease of use, usefulness, and job relevance of mobile phones by health workers in Saraya, Senegal. This study conducted seven key informant interviews with government health workers, and three focus groups and 76 surveys with lay health workers. Principal findings included that mobile phones are already widely available and used, and that participants valued using phones to address training, stock management, programme reporting, and transportation challenges. By documenting widespread use of mobile phones and health worker perceptions of their most useful applications, this paper provides a framework for their integration into the community case management of malaria programme in Saraya, Senegal. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Perceptions of health stakeholders on task shifting and motivation of community health workers in different socio demographic contexts in Kenya (nomadic, peri-urban and rural agrarian).

PubMed

Ochieng, Beverly; Akunja, Edith; Edwards, Nancy; Mombo, Diana; Marende, Leah; Kaseje, Dan C O

2014-01-01

The shortage of health professionals in low income countries is recognized as a crisis. Community health workers are part of a "task-shift" strategy to address this crisis. Task shifting in this paper refers to the delegation of tasks from health professionals to lay, trained volunteers. In Kenya, there is a debate as to whether these volunteers should be compensated, and what motivation strategies would be effective in different socio-demographic contexts, based type of tasks shifted. The purpose of this study was to find out, from stakeholders' perspectives, the type of tasks to be shifted to community health workers and the appropriate strategies to motivate and retain them. This was an analytical comparative study employing qualitative methods: key informant interviews with health policy makers, managers, and service providers, and focus group discussions with community health workers and service consumers, to explore their perspectives on tasks to be shifted and appropriate motivation strategies. The study found that there were tasks to be shifted and motivation strategies that were common to all three contexts. Common tasks were promotive, preventive, and simple curative services. Common motivation strategies were supportive supervision, means of identification, equitable allocation of resources, training, compensation, recognition, and evidence based community dialogue. The study concluded that inclusion of curative tasks for community health workers, particularly in nomadic contexts, is inevitable but raises the need for accreditation of their training and regulation of their tasks.

Qualitative study of the role of men in maternal health in resource-limited communities in western Kenya.

PubMed

Brubaker, Kathryn; Nelson, Brett D; McPherson, Heather; Ahn, Roy; Oguttu, Monica; Burke, Thomas F

2016-12-01

To better understand the beliefs of men and women in western Kenya regarding the appropriate role of men in maternal health and to identify barriers to greater involvement. Between June 1 and July 31, 2014, a cross-sectional qualitative study enrolled lay men, lay women, and community health workers from Kisumu and Nyamira counties in western Kenya. Semi-structured focus group discussions were conducted and qualitative approaches were utilized to analyze the transcripts and identify common themes. In total, 134 individuals participated in 18 focus group discussions. Participants discussed the role of men and a general consensus was recorded that it was a man's duty to protect women during pregnancy. When discussing obstacles to male involvement, female participants highlighted gender dynamics and male participants raised financial limitations. There was considerable discrepancy between how men described their roles and how they actually behaved, although educated men appeared to describe themselves as performing more supportive behaviors compared with male participants with less education. It is suggested that interventions aimed at increasing male involvement should incorporate the existing culturally sanctioned roles men perform as a foundation upon which to build, rather than attempting to construct roles that oppose prevailing norms. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

Pertussis control in the Asia-Pacific region: a report from the Global Pertussis Initiative.

PubMed

Forsyth, Kevin; Thisyakorn, Usa; von König, Carl Heinz Wirsing; Tan, Tina; Plotkin, Stanley

2012-05-01

The Global Pertussis Initiative (GPI) is an expert, scientific forum that seeks to address the worldwide burden of pertussis. To reduce the global incidence of pertussis, the GPI recommends reinforcing and/or improving current infant and toddler immunization strategies, universal booster dosing of pre-school children, universal booster dosing of adolescents and adults (where appropriate), and cocooning to protect infants. To tailor these global recommendations to local needs, the GPI has hosted two meetings in Asia-Pacific. Pertussis vaccination practices differ across Asia-Pacific, with only some countries recommending booster dosing. Given the limited use of laboratory diagnostics, disease surveillance was considered inadequate. To make informed health policy decisions on pertussis prevention, more robust epidemiological data are needed. Because of its unique clinical presentation, adolescent and adult pertussis is under-recognized by lay and medical communities. Consequently, adolescent and adult disease likely exists even in Asian-Pacific countries where epidemiological data are presently lacking. In Asia-Pacific, there exist issues with health care access and costs. Fragmented health care will negatively impact the effectiveness of any proposed immunization strategies. The GPI recommends-in Asia-Pacific and elsewhere-that countries first educate lay and medical communities on pertussis, while simultaneously implementing robust surveillance practices. Once armed with sufficient epidemiological evidence, the prevention strategies recommended by the GPI can then be appropriately (and more effectively) introduced.

Estimating the effect of lay knowledge and prior contact with pulmonary TB patients, on health-belief model in a high-risk pulmonary TB transmission population.

PubMed

Zein, Rizqy Amelia; Suhariadi, Fendy; Hendriani, Wiwin

2017-01-01

The research aimed to investigate the effect of lay knowledge of pulmonary tuberculosis (TB) and prior contact with pulmonary TB patients on a health-belief model (HBM) as well as to identify the social determinants that affect lay knowledge. Survey research design was conducted, where participants were required to fill in a questionnaire, which measured HBM and lay knowledge of pulmonary TB. Research participants were 500 residents of Semampir, Asemrowo, Bubutan, Pabean Cantian, and Simokerto districts, where the risk of pulmonary TB transmission is higher than other districts in Surabaya. Being a female, older in age, and having prior contact with pulmonary TB patients significantly increase the likelihood of having a higher level of lay knowledge. Lay knowledge is a substantial determinant to estimate belief in the effectiveness of health behavior and personal health threat. Prior contact with pulmonary TB patients is able to explain the belief in the effectiveness of a health behavior, yet fails to estimate participants' belief in the personal health threat. Health authorities should prioritize males and young people as their main target groups in a pulmonary TB awareness campaign. The campaign should be able to reconstruct people's misconception about pulmonary TB, thereby bringing around the health-risk perception so that it is not solely focused on improving lay knowledge.

Perceived Quality of Care of Community Health Worker and Facility-Based Health Worker Management of Pneumonia in Children Under 5 Years in Western Kenya: A Cross-Sectional Multidimensional Study

PubMed Central

Shaw, Brian I.; Asadhi, Elijah; Owuor, Kevin; Okoth, Peter; Abdi, Mohammed; Cohen, Craig R.; Onono, Maricianah

2016-01-01

Integrated community case management (iCCM) programs that train lay community health workers (CHWs) in the diagnosis and treatment of diarrhea, malaria, and pneumonia have been increasingly adopted throughout sub-Saharan Africa to provide services in areas where accessibility to formal public sector health services is low. One important aspect of successful iCCM programs is the acceptability and utilization of services provided by CHWs. To understand community perceptions of the quality of care in an iCCM intervention in western Kenya, we used the Primary Care Assessment Survey to compare caregiver attitudes about the diagnosis and treatment of childhood pneumonia as provided by CHWs and facility-based health workers (FBHWs). Overall, caregivers rated CHWs more highly than FBHWs across a set of 10 domains that capture multiple dimensions of the care process. Caregivers perceived CHWs to provide higher quality care in terms of accessibility and patient relationship and equal quality care on clinical aspects. These results argue for the continued implementation and scale-up of iCCM programs as an acceptable intervention for increasing access to treatment of childhood pneumonia. PMID:26976883

A cluster randomized controlled trial of lay health worker support for prevention of mother to child transmission of HIV (PMTCT) in South Africa.

PubMed

Peltzer, Karl; Weiss, Stephen M; Soni, Manasi; Lee, Tae Kyoung; Rodriguez, Violeta J; Cook, Ryan; Alcaide, Maria Luisa; Setswe, Geoffrey; Jones, Deborah L

2017-12-16

We evaluate the impact of clinic-based PMTCT community support by trained lay health workers in addition to standard clinical care on PMTCT infant outcomes. In a cluster randomized controlled trial, twelve community health centers (CHCs) in Mpumalanga Province, South Africa, were randomized to have pregnant women living with HIV receive either: a standard care (SC) condition plus time-equivalent attention-control on disease prevention (SC; 6 CHCs; n  = 357), or an enhanced intervention (EI) condition of SC PMTCT plus the "Protect Your Family" intervention (EI; 6 CHCs; n  = 342). HIV-infected pregnant women in the SC attended four antenatal and two postnatal video sessions and those in the EI, four antenatal and two postnatal PMTCT plus "Protect Your Family" sessions led by trained lay health workers. Maternal PMTCT and HIV knowledge were assessed. Infant HIV status at 6 weeks postnatal was drawn from clinic PCR records; at 12 months, HIV status was assessed by study administered DNA PCR. Maternal adherence was assessed by dried blood spot at 32 weeks, and infant adherence was assessed by maternal report at 6 weeks. The impact of the EI was ascertained on primary outcomes (infant HIV status at 6 weeks and 12 months and ART adherence for mothers and infants), and secondary outcomes (HIV and PMTCT knowledge and HIV transmission related behaviours). A series of logistic regression and latent growth curve models were developed to test the impact of the intervention on study outcomes. In all, 699 women living with HIV were recruited during pregnancy (8-24 weeks), and assessments were completed at baseline, at 32 weeks pregnant (61.7%), and at 6 weeks (47.6%), 6 months (50.6%) and 12 months (59.5%) postnatally. Infants were tested for HIV at 6 weeks and 12 months, 73.5% living infants were tested at 6 weeks and 56.7% at 12 months. There were no significant differences between SC and EI on infant HIV status at 6 weeks and at 12 months, and no differences in maternal adherence at 32 weeks, reported infant adherence at 6 weeks, or PMTCT and HIV knowledge by study condition over time. The enhanced intervention administered by trained lay health workers did not have any salutary impact on HIV infant status, ART adherence, HIV and PMTCT knowledge. Trial registration clinicaltrials.gov: number NCT02085356.

Making and Maintaining Lifestyle Changes with the Support of a Lay Health Advisor: Longitudinal Qualitative Study of Health Trainer Services in Northern England

PubMed Central

Visram, Shelina; Clarke, Charlotte; White, Martin

2014-01-01

Objective To explore and document the experiences of those receiving support from a lay health trainer, in order to inform the optimisation and evaluation of such interventions. Design Longitudinal qualitative study with up to four serial interviews conducted over 12 months. Interviews were transcribed and analysed using the constant comparative approach associated with grounded theory. Participants 13 health trainers, 5 managers and 26 clients. Setting Three health trainer services targeting disadvantaged communities in northern England. Results The final dataset comprised 116 interviews (88 with clients and 28 with staff). Discussions with health trainers and managers revealed a high degree of heterogeneity between the local services in terms of their primary aims and activities. However, these were found to converge over time. There was agreement that health trainer interventions are generally ‘person-centred’ in terms of being tailored to the needs of individual clients. This led to a range of self-reported outcomes, including behaviour changes, physical health improvements and increased social activity. Factors impacting on the maintenance of lifestyle changes included the cost and timing of health-promoting activities, ill-health or low mood. Participants perceived a need for ongoing access to low cost facilities to ensure that any lifestyle changes can be maintained in the longer term. Conclusions Health trainers may be successful in terms of supporting people from socio-economically disadvantaged communities to make positive lifestyle changes, as well as achieving other health-related outcomes. This is not a ‘one-size-fits-all’ approach; commissioners and providers should select the intervention models that best meet the needs of their local populations. By delivering holistic interventions that address multiple lifestyle risks and incorporate relapse prevention strategies, health trainers could potentially have a significant impact on health inequalities. However, rigorous, formal outcome and economic evaluation of the range of health trainer delivery models is needed. PMID:24801173

Developing Theoretically Based and Culturally Appropriate Interventions to Promote Hepatitis B Testing in 4 Asian American Populations, 2006–2011

PubMed Central

Bastani, Roshan; Glenn, Beth A.; Taylor, Victoria M.; Nguyen, Tung T.; Stewart, Susan L.; Burke, Nancy J.; Chen, Moon S.

2014-01-01

Introduction Hepatitis B infection is 5 to 12 times more common among Asian Americans than in the general US population and is the leading cause of liver disease and liver cancer among Asians. The purpose of this article is to describe the step-by-step approach that we followed in community-based participatory research projects in 4 Asian American groups, conducted from 2006 through 2011 in California and Washington state to develop theoretically based and culturally appropriate interventions to promote hepatitis B testing. We provide examples to illustrate how intervention messages addressing identical theoretical constructs of the Health Behavior Framework were modified to be culturally appropriate for each community. Methods Intervention approaches included mass media in the Vietnamese community, small-group educational sessions at churches in the Korean community, and home visits by lay health workers in the Hmong and Cambodian communities. Results Use of the Health Behavior Framework allowed a systematic approach to intervention development across populations, resulting in 4 different culturally appropriate interventions that addressed the same set of theoretical constructs. Conclusions The development of theory-based health promotion interventions for different populations will advance our understanding of which constructs are critical to modify specific health behaviors. PMID:24784908

Social entrepreneurship in religious congregations' efforts to address health needs.

PubMed

Werber, Laura; Mendel, Peter J; Derose, Kathryn Pitkin

2014-01-01

Examine how religious congregations engage in social entrepreneurship as they strive to meet health-related needs in their communities. Multiple case studies. Los Angeles County, California. Purposive sample of 14 congregations representing diverse races/ethnicities (African-American, Latino, and white) and faith traditions (Jewish and various Christian). Congregations were recruited based on screening data and consultation of a community advisory board. In each congregation, researchers conducted interviews with clergy and lay leaders (n = 57); administered a congregational questionnaire; observed health activities, worship services, and neighborhood context; and reviewed archival information. Interviews were analyzed by using a qualitative, code-based approach. Congregations' health-related activities tended to be episodic, small in scale, and local in scope. Trust and social capital played important roles in congregations' health initiatives, providing a safe, confidential environment and leveraging resources from-and for-faith-based and secular organizations in their community networks. Congregations also served as "incubators" for members to engage in social entrepreneurship. Although the small scale of congregations' health initiatives suggest they may not have the capacity to provide the main infrastructure for service provision, congregations can complement the efforts of health and social providers with their unique strengths. Specifically, congregations are distinctive in their ability to identify unmet local needs, and congregations' position in their communities permit them to network in productive ways.

Preventing Caries in Preschoolers: Successful Initiation of an Innovative Community-Based Clinical Trial in Navajo Nation Head Start

PubMed Central

Quissell, David O.; Bryant, Lucinda L.; Braun, Patricia A.; Cudeii, Diana; Johs, Nikolas; Smith, Vongphone L.; George, Carmen; Henderson, William G.; Albino, Judith

2014-01-01

Navajo Nation children have the greatest prevalence of early childhood caries in the United States. This protocol describes an innovative combination of community-based participatory research and clinical trial methods to rigorously test a lay native Community Oral Health Specialists-delivered oral health intervention, with the goal of reducing the progression of disease and improving family knowledge and behaviors. Methods/Design This cluster-randomized trial designed by researchers at the Center for Native Oral Health Research at the University of Colorado in conjunction with members of the Navajo Nation community compares outcomes between the manualized 2-year oral health fluoride varnish-oral health promotion intervention and usual care in the community (child-caregiver dyads from 26 Head Start classrooms in each study arm; total of 1016 dyads). Outcome assessment includes annual dental screening and an annual caregiver survey of knowledge, attitudes and behaviors; collection of cost data will support cost-benefit analyses. Discussion The study protocol meets all standards required of randomized clinical trials. Aligned with principles of community-based participatory research, extended interaction between members of the Navajo community and researchers preceded study initiation, and collaboration between project staff and a wide variety of community members informed the study design and implementation. We believe the benefits of adding CBPR methods to those of randomized clinical studies outweigh the barriers and constraints, especially in studies of health disparities and in challenging settings. When done well, this innovative mix of methods will increase the likelihood of valid results that communities can use. PMID:24469238

The voices of older women in a disadvantaged community: issues of health and social capital.

PubMed

Boneham, Margaret Anne; Sixsmith, Judith A

2006-01-01

The voices of older women are rarely heard in debates about the health of disadvantaged groups. Despite growing interest in health in old age, the health experiences of older women as gendered social beings have yet to be fully explored. Their potential to contribute positively to family and community health is seldom acknowledged. The aim of this article is to present findings from a qualitative British Health Development Agency funded project on the relationship between social capital, health and gender, focusing on the health and social networks of older women in a socially disadvantaged community in the north of England. Seventy-seven community members were interviewed, of these 19 were older women aged 55-78 years. Their accounts of ill health in the context of ageing were analysed to explore the intricate ways in which social capital was created, maintained and linked to health. Findings suggest that social constructions of motherhood and caring underpinned responsibility for their own and others' health. Their experiences of dealing with health matters, together with frequent health talk, gave the women confidence as lay health experts, enabling them to contest medical advice. Drawing on personal experiences of trust and reciprocity, they recognised the importance of social networking in alleviating the problems of loneliness and isolation. At stressful times in their lives they were able to draw on existing support networks and, in spite of occasional personal conflicts, some benefited from the empowering and health-enhancing role of formal and informal participation in community life. These findings indicate that older women can operate autonomously in health matters and can substantially influence the development of healthy communities, although this can sometimes be at a personal cost.

Contextual variations in costs for a community health strategy implemented in rural, peri-urban and nomadic sites in Kenya.

PubMed

Wafula, Charles Ouma; Edwards, Nancy; Kaseje, Dan C O

2017-02-28

Many low and middle income countries have developed community health strategies involving lay health workers, to complement and strengthen public health services. This study explores variations in costing parameters pertinent to deployment of community health volunteers across different contexts outlining considerations for costing program scale-up. The study used quasi experimental study design and employed both quantitative and qualitative methods to explore community health unit implementation activities and costs and compare costs across purposively selected sites that differed socially, economically and ecologically. Data were collected from November 2010 to December 2013 through key informant interviews and focus group discussions. We interviewed 16 key informants (eight District community health strategy focal persons, eight frontline field officers), and eight focus group discussions (four with community health volunteers and four with community health committee) and 560 sets of monthly cost data. Cost data were tabulated using Microsoft Excel. Qualitative data were transcribed and coded using a content analysis framework. Four critical elements: attrition rates for community health volunteers, geography and population density, livelihood opportunity costs and benefits, and social opportunity benefits, drove cost variations across the three sites. Attrition rate was highest in peri-urban site where population is highly mobile and lowest in nomadic site. More households were covered by community health workers in the peri-urban area making per capita costs considerably less than in the nomadic settings where long distances had to be covered to reach sparsely distributed households. Livelihood opportunity costs for Community Health Volunteers were highest in nomadic setting, while peri-urban ones reported substantial employability benefits resulting from training. Social opportunity benefits were highest in rural site. Results show that costs of implementing community health strategy varied due to different area contextual factors in Kenya. This study identified four critical elements that drive cost variations: attrition rates for community health volunteers, geography and population density, livelihood opportunity costs and benefits, and social opportunity benefits. Health programme managers and policy-makers need to pay attention to details of contextual factors in costing for effective implementation of community health strategies.

Human subjects protection training for community workers: an example from "Faith Moves Mountains".

PubMed

Hatcher, Jennifer; Schoenberg, Nancy E

2007-01-01

Despite widespread agreement on the necessity of protecting human subjects, questions regarding ethical treatment and protection of human subjects remain and are particularly vexing for community-based participatory research (CBPR). There has been a notable lack of attention paid to what type of training should be provided and how to balance "real-life" concerns with official requirements. The purpose of this article is to demonstrate how, in consultation with the Office of Research Integrity (ORI) at our institution and our community partners, we developed training that overcame concerns related to instruction of community workers on protection of human subjects. We developed a training module written in lay terms and containing only information pertinent to non-key personnel and their role in the CBPR project. We designed and piloted this material in collaboration with our community partners who work with us to recruit and train lay health advisors (LHAs) and oversee the day-to-day operations of the CBPR project. The educational module was presented to the community workers as a part of a day-long training session. The written materials were a part of a notebook of information accompanied by an oral Power Point presentation. Each of the workers was given a written test to evaluate knowledge of the content presented. The test was administered by the project director, a community member herself, and then sent to our institution for grading by personnel not involved in this project. To date, all community workers have passed the written test. The community members, research partners, and the ORI are satisfied with the scope and simplicity of the training program developed. Our team's collaborative approach to community-based human subjects training contributes to advancing a grounded, feasible, and rigorous process of protecting human subjects while implementing CBPR ideals.

Can Cultural Competency Reduce Racial And Ethnic Health Disparities? A Review And Conceptual Model

PubMed Central

Brach, Cindy; Fraserirector, Irene

2016-01-01

This article develops a conceptual model of cultural competency’s potential to reduce racial and ethnic health disparities, using the cultural competency and disparities literature to lay the foundation for the model and inform assessments of its validity. The authors identify nine major cultural competency techniques: interpreter services, recruitment and retention policies, training, coordinating with traditional healers, use of community health workers, culturally competent health promotion, including family/community members, immersion into another culture, and administrative and organizational accommodations. The conceptual model shows how these techniques could theoretically improve the ability of health systems and their clinicians to deliver appropriate services to diverse populations, thereby improving outcomes and reducing disparities. The authors conclude that while there is substantial research evidence to suggest that cultural competency should in fact work, health systems have little evidence about which cultural competency techniques are effective and less evidence on when and how to implement them properly. PMID:11092163

What do men who serve as lay health advisors really do?: Immigrant Latino men share their experiences as Navegantes to prevent HIV

PubMed Central

Vissman, Aaron T.; Eng, Eugenia; Aronson, Robert E.; Bloom, Fred R.; Leichliter, Jami S.; Montaño, Jaime; Rhodes, Scott D.

2018-01-01

Background HoMBReS was a lay health advisor (LHA) intervention designed to reduce sexual risk among recently-arrived, non-English-speaking Latino men who were members of a multi-county soccer league in central NC. Methods Our community-based participatory research (CBPR) partnership collected, analyzed, and interpreted qualitative life-story narratives to characterize the roles of male LHAs known as Navegantes. Results Nine Navegantes were interviewed. Their mean age was 39 years (range 26–62 years); 6 were from Mexico and 3 from El Salvador. Navegantes described the function and facilitators of serving as LHAs and identified leverage points for future HIV and STD prevention strategies. They highlighted psychosocial and sociocultural influences on HIV risk, settings for risky behavior, and personal changes from serving as Navegantes. Conclusions This study provides preliminary evidence that an LHA approach is feasible and appropriate for Latino men, and can be effective in reaching men who might otherwise be difficult to reach. PMID:19519237

Pilot test of a peer-led small-group video intervention to promote mammography screening among Chinese American immigrants

PubMed Central

Maxwell, Annette E.; Wang, Judy H.; Young, Lucy; Crespi, Catherine M.; Mistry, Ritesh; Sudan, Madhuri; Bastani, Roshan

2010-01-01

This study evaluated the feasibility, acceptability and potential effect of a small-group video intervention led by trained Chinese American lay educators who recruited Chinese American women not up to date on mammography screening. Nine lay educators conducted 14 “breast health tea time workshops” in community settings and private homes that started with watching a culturally tailored video promoting screening followed by a question and answer session and distribution of print materials. Many group attendees did not have health insurance or a regular doctor, had low levels of income and were not proficient in English. Forty-four percent of the attendees reported receipt of a mammogram within 6 months after the small-group session with higher odds of screening among women who had lived in the U.S. less than 10% of their lifetime. Four of the educators were very interested in conducting another group session in the next 6 months. PMID:20720095

Community perceptions of genomic research: implications for addressing health disparities.

PubMed

Isler, Malika Roman; Sutton, Karey; Cadigan, R Jean; Corbie-Smith, Giselle

2013-01-01

Increasing the engagement of racial and ethnic minorities in genomic research may help alleviate health disparities. This paper examines community perceptions of the relationships between race, genes, environment, and health disparities, and it discusses how such perceptions may influence participation in genomic research. We conducted semi-structured interviews with 91 African American, Latino, and white lay community members and community leaders in North Carolina. Using constant comparison methods, we identified, compared, and developed linkages between conceptual categories and respondent groups. Participants described gene-environment interactions as contributing to group differences in health outcomes, expressed the belief that genetic predisposition to disease differs across groups, and said that social conditions trigger group-level genetic differences and create poorer health outcomes among African Americans. Given the regional presence of major research institutions and the relatively high education level of many participants, this sample may not reflect the perspectives of those most disparately affected by health disparities. Members from multiple community sectors share perceptions and may respond to similar approaches when attempts are made to increase participation in genomic research. Researchers may inadvertently fuel the perception that health disparities experienced by minorities are rooted in the shared genomes of a particular group as distinct from those of other groups. The way researchers use race and ethnicity in recruitment, analysis, and communication of research findings inaccurately implies that there are genetic differences between races, when categories of social experience or ancestry may more accurately characterize health differences. Understanding these issues is crucial to designing effective community engagement strategies, recruitment plans, and messages about genomic research, which could ultimately help to lessen health disparities.

Trying to keep a balance: the meaning of health and diabetes in an urban aboriginal community.

PubMed

Thompson, S J; Gifford, S M

2000-11-01

Although the predominant paradigm of epidemiological investigation continues to focus narrowly on the individual and on individual risk factors, there is a growing body of work that calls for a rethinking of the current epidemiological models. In this paper we illustrate the need for a more comprehensive epidemiological approach towards understanding the risks for diabetes, by exploring the lived experiences of diabetes and lay meanings of risk among Aborigines living in Melbourne, Australia. Ethnographic fieldwork was conducted within the Melbourne Aboriginal community in the state of Victoria over a 22-month period (1994-1996). Melbourne Aborigines see non-insulin dependent diabetes mellitus (NIDDM) as the result of living a life out of balance, a life of lost or severed connections with land and kin and a life with little control over past, present or future. The lay model regarding diabetes that is derived from the narratives of Melbourne Aborigines, consists of three levels of connectedness important in determining an individual's susceptibility not only to diabetes but to all disease--(1) family, (2) community and (3) society. This structure of interactive systems at successive levels from the individual to the population fits within the framework of an ecological paradigm. The strength of ethnography as applied to epidemiology is that it has the capacity to discover previously unknown components of a system at several different levels, and to build models to explain how these components interact. This framework, developed using an ethno-epidemiological approach, has application in other indigenous populations who have been dispossessed of their land, their pasts and their future. There is great potential to apply this approach to the major public health challenges presented by rapid global socio-cultural and environmental change that are impacting negatively on population health.

Women front and center: the opportunities of involving women in participatory health research worldwide.

PubMed

Decker, Martha; Hemmerling, Anke; Lankoande, Fatimata

2010-11-01

Participatory research involving communities, especially women, is increasingly recognized as a valuable and scientifically sound approach to improve the relevance of a study, the accuracy of data collection and interpretation, the adherence to study procedures, and the likelihood of adopting any resulting intervention. This approach has interdisciplinary roots dating back more than half a century. Although widely used in community-based conservation and development projects worldwide, international public health research has yet to fully embrace this inclusive approach, which requires the sharing of power with research participants and a more involved relationship building process with communities. In return, the gap between publication and public action can be narrowed because ownership of the research process by an empowered community can lay the foundation for an accelerated implementation of interventions tailored to community needs and based on research results. This article draws on the professional experiences of the authors as well as published examples of international participatory health research with women. Factors critical for the success of participatory research are discussed, including attention to initial planning, early community involvement, conceptual clarity, defined community benefits, and joint interpretation of results, as well as translation to action. It includes common challenges and strategies to overcome them, such as conflict resolution and data ownership.

The Meaning of Patient Empowerment in the Digital Age: The Role of Online Patient-Communities.

PubMed

Lamas, Eugenia; Salinas, Rodrigo; Coquedano, Carla; Simon, Marie-Pierre; Bousquet, Cedric; Ferrer, Marcela; Zorrilla, Sergio

2017-01-01

Traditionally, patient empowerment has been used as a strategy for health promotion. The rise of online communities of patients represents a good example of how patient empowerment occurs, independently of the intervention of existing healthcare providers and insurers, allowing thus a more accurate definition of meaning of this concept. We describe two situations related with the development of health-related social networks: (1) The emergence of a new biomedical research model in which patients lead research, shifting the equilibrium of power from the professionals to research subjects themselves, and (2) The emergence of Lay Crowd-Sourced Expertise in these communities, arising from the daily exchange among patients affected by chronic conditions and their relatives, giving place to a new era of bottom-up data generation, previously unknown in biomedical sciences. We enrich these descriptions by analyzing interviews to key actors of these "on line" communities": Michael Chekroun, founder of "Carenity, France", and Paul Wicks Vice President at "PatientsLikeMe, USA".

Barriers and Facilitators to Adoption of a Lay-Delivered Community-Based Strength Training Program for Women in Rural Areas

ERIC Educational Resources Information Center

Washburn, Lisa T.; Cornell, Carol E.; Traywick, LaVona; Felix, Holly C.; Phillips, Martha E.

2017-01-01

Background: Limited access to fitness programs for rural older adults make lay or volunteer delivery approaches potentially desirable to extend reach. However, factors affecting adoption of such approaches are not well explored. Purpose: This study sought to identify barriers and facilitators affecting adoption of a volunteer lay delivery approach…

Lay beliefs about emotional problems and attitudes toward mental health care among parents and adolescents: Exploring the impact of immigration.

PubMed

Verhulp, Esmée E; Stevens, Gonneke W J M; Pels, Trees V M; Van Weert, Caroline M C; Vollebergh, Wilma A M

2017-04-01

Individuals' lay beliefs about mental health problems and attitudes toward mental health care are thought to be influenced by the cultural background of these individuals. In the current study, we investigated differences between immigrant Dutch and native Dutch parents and adolescents in lay beliefs about emotional problems and attitudes toward mental health care. Additionally, among immigrant Dutch parents, we examined the associations between acculturation orientations and lay beliefs about emotional problems as well as attitudes toward mental health care. In total, 349 pairs of parents and their adolescent children participated in our study (95 native Dutch, 85 Surinamese-Dutch, 87 Turkish-Dutch, 82 Moroccan-Dutch). A vignette was used to examine participants' lay beliefs. Immigrant Dutch and native Dutch parents differed in their lay beliefs and attitudes toward mental health care, whereas hardly any differences were revealed among their children. Turkish-Dutch and Moroccan-Dutch parents showed more passive and fewer active solutions to emotional problems compared to native Dutch parents. Additionally, Moroccan-Dutch and Surinamese-Dutch parents reported greater fear of mental health care compared to native Dutch parents. Furthermore, the results showed that immigrant Dutch parents who were more strongly oriented toward the Dutch culture reported less fear of mental health care. Our results showed clear differences in lay beliefs and attitudes toward mental health care between immigrant Dutch and native Dutch parents but not between their children. Substantial differences were also found between parents from different immigrant Dutch populations as well as within the population of immigrant Dutch parents. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Lay Worker Health Literacy: A Concept Analysis and Operational Definition.

PubMed

Cadman, Kathleen Paco

2017-10-01

The concept of lay worker health literacy is created by concurrently analyzing and synthesizing two intersecting concepts, lay workers and health literacy. Articulation of this unique intersection is the result of implementing a simplified Wilson's Concept Analysis Procedure. This process incorporates the following components: a) selecting a concept, b) determining the aims/purposes of analysis, c) identifying all uses of the concept, d) determining defining attributes, e) identifying a model case, f) identifying borderline, related, contrary, and illegitimate cases, g) identifying antecedents and consequences, and h) defining empirical referents. Furthermore, as current literature provides no operational definition for lay worker health literacy, one is created to contribute cohesion to the concept. © 2017 Wiley Periodicals, Inc.

INTERFACING INFANT MENTAL HEALTH KNOWLEDGE SYSTEMS: REFLECTIONS ON THE NARRATIVES OF LAY HOME VISITORS' EXPERIENCES OF LEARNING AND APPLYING RELATIONAL CONCEPTS OF DEVELOPMENT IN A SOUTH AFRICAN INTERVENTION PROGRAM.

PubMed

Baradon, Tessa; Bain, Katherine

2016-07-01

The question of interfacing research and clinically generated knowledge in the field of infant mental health (IMH) with local cultural knowledge and belief systems has provoked extended discussion in recent years. This article explores convergences and divergences between current research-based, relational IMH mental health models and "community" knowledge held by a group of South African lay home visitors from a socioeconomically deprived township. These women were trained in a psychoanalytic and attachment-informed infant mental health program that promotes a relational model of infant development. They provide an intervention that supports high risk mother-infant relationships in the same locality. A two-tiered approach was taken to the analysis of the home visitor interviews and focused on the home visitors' constructed narratives of infant development posttraining as well as the personal impact of the training and work on the home visitors themselves. The study found that psychoanalytic and attachment-informed thinking about development makes sense to those operating within the local South African cultural context, but that the accommodation of this knowledge is a complex and challenging process. © 2016 Michigan Association for Infant Mental Health.

Community-based reports of morbidity, mortality, and health-seeking behaviours in four Monrovia communities during the West African Ebola epidemic.

PubMed

McLean, Kristen E; Abramowitz, Sharon Alane; Ball, Jacob D; Monger, Josephine; Tehoungue, Kodjo; McKune, Sarah Lindley; Fallah, Mosoka; Omidian, Patricia A

2018-05-01

The goal of this study was to assess morbidity, mortality, and health-seeking behaviours during the 2014 Ebola outbreak in Monrovia, Liberia. This study examined commonly reported symptoms of illness, pre-clinical diagnostic practices, typical healthcare-seeking strategies, and health resources available to populations, in order to identify salient needs and gaps in healthcare that would inform local emergency response efforts. Semi-structured interviews were conducted with household members in four Monrovia neighbourhoods. Researchers used a multi-stage cluster approach to recruit participants. Within 555 households sampled, 505 individuals were reported sick (69%) or recently sick (38%) or deceased (7%). Common self-diagnoses included malaria, hypertension, influenza, typhoid, and Ebola. The most cited health-seeking strategy was to purchase medications from the private sector. Respondents also obtained healthcare from community members known to have medical experience. Findings suggest that non-formal healthcare systems played an important role in managing morbidity during the West African Ebola virus disease (EVD) outbreak. Lay community members engaged in complex assessments of health symptoms and sought biomedical care at rates perhaps higher than anticipated during the response. This study highlights how informal networks of healthcare providers can play an important role in preventing and curbing future emerging disease outbreaks.

Laying the foundation for Connect to Protect: a multi-site community mobilization intervention to reduce HIV/AIDS incidence and prevalence among urban youth.

PubMed

Ziff, Mauri A; Harper, Gary W; Chutuape, Kate S; Deeds, Bethany Griffin; Futterman, Donna; Francisco, Vincent T; Muenz, Larry R; Ellen, Jonathan M

2006-05-01

Despite the considerable resources that have been dedicated to HIV prevention interventions and services over the past decade, HIV incidence among young people in the United States remains alarmingly high. One reason is that the majority of prevention efforts continue to focus solely on modifying individual behavior, even though public health research strongly suggests that changes to a community's structural elements, such as their programs, practices, and laws or policies, may result in more effective and sustainable outcomes. Connect to Protect is a multi-city community mobilization intervention that focuses on altering or creating community structural elements in ways that will ultimately reduce youth HIV incidence and prevalence. The project, which spans 6 years, is sponsored by the Adolescent Medicine Trials Network for HIV/AIDS Interventions at multiple urban clinical research sites. This paper provides an overview of the study's three phases and describes key factors in setting a firm foundation for the initiation and execution of this type of undertaking. Connect to Protect's community mobilization approach to achieving structural change represents a relatively new and broad direction in HIV prevention research. To optimize opportunities for its success, time and resources must be initially placed into laying the groundwork. This includes activities such as building a strong overarching study infrastructure to ensure protocol tasks can be met across sites; tapping into local site and community expertise and knowledge; forming collaborative relationships between sites and community organizations and members; and fostering community input on and support for changes at a structural level. Failing to take steps such as these may lead to insurmountable implementation problems for an intervention of this kind.

Social Entrepreneurship in Religious Congregations’ Efforts to Address Health Needs

PubMed Central

Werber, Laura; Mendel, Peter J.; Derose, Kathryn Pitkin

2013-01-01

Purpose Examine how religious congregations engage in social entrepreneurship as they strive to meet health-related needs in their communities. Design Multiple case studies. Setting Los Angeles County, California. Participants Purposive sample of 14 congregations representing diverse races-ethnicities (African American, Latino, and white) and faith traditions (Jewish and various Christian). Method Congregations were recruited based on screening data and consultation of a community advisory board. In each congregation, researchers conducted interviews with clergy and lay leaders (n=57); administered a congregational questionnaire; observed health activities, worship services, and neighborhood context; and reviewed archival information. Interviews were analyzed using a qualitative, code-based approach. Results Congregations’ health-related activities tended to be episodic, small in scale, and local in scope. Trust and social capital played important roles in congregations’ health initiatives, providing a safe, confidential environment and leveraging resources from – and for – faith-based and secular organizations in their community networks. Congregations also served as “incubators” for members to engage in social entrepreneurship. Conclusion Although the small scale of congregations’ health initiatives suggest they may not have the capacity to provide the main infrastructure for service provision, congregations can complement the efforts of health and social providers with their unique strengths. Specifically, congregations are distinctive in their ability to identify unmet local needs, and congregations’ position in their communities permit them to network in productive ways. PMID:23875986

Medieval monastic mortality: hazard analysis of mortality differences between monastic and nonmonastic cemeteries in England.

PubMed

DeWitte, Sharon N; Boulware, Jessica C; Redfern, Rebecca C

2013-11-01

Scholarship on life in medieval European monasteries has revealed a variety of factors that potentially affected mortality in these communities. Though there is some evidence based on age-at-death distributions from England that monastic males lived longer than members of the general public, what is missing from the literature is an explicit examination of how the risks of mortality within medieval monastic settings differed from those within contemporaneous lay populations. This study examines differences in the hazard of mortality for adult males between monastic cemeteries (n = 528) and non-monastic cemeteries (n = 368) from London, all of which date to between AD 1050 and 1540. Age-at-death data from all cemeteries are pooled to estimate the Gompertz hazard of mortality, and "monastic" (i.e., buried in a monastic cemetery) is modeled as a covariate affecting this baseline hazard. The estimated effect of the monastic covariate is negative, suggesting that individuals in the monastic communities faced reduced risks of dying compared to their peers in the lay communities. These results suggest better diets, the positive health benefits of religious behavior, better living conditions in general in monasteries, or selective recruitment of healthy or higher socioeconomic status individuals. Copyright © 2013 Wiley Periodicals, Inc.

A review of hair product use on breast cancer risk in African American women.

PubMed

Stiel, Laura; Adkins-Jackson, Paris B; Clark, Phyllis; Mitchell, Eudora; Montgomery, Susanne

2016-03-01

The incidence rate of breast cancer for African American women has recently converged with that of non-Hispanic White women in the United States, although African Americans have a higher mortality rate due to this disease. Although most research exploring health disparities associated with this phenomenon has focused on differences between women based on biology and behavior, both the academic and lay communities have begun to explore the potential role of environmental exposure to estrogen and endocrine disrupting chemicals (EDCs). This study reviews the current state of the science associating one such means of exposure, hair products containing EDCs, with breast cancer risk in African American women. We found a growing body of evidence linking: (1) environmental estrogen and EDC exposures to breast cancer risk, (2) the presence of such chemicals in personal care products, including hair products, and (3) the use of certain hair products with potential breast cancer risk in African Americans. At the same time, there is also increasing concern in the lay community about this risk. These results indicate the need for additional research, and the opportunity to benefit from strategic partnerships in community-collaborative approaches in order to better understand the potential "cost of beauty." © 2016 The Authors. Cancer Medicine published by John Wiley & Sons Ltd.

Types of lay health influencers in tobacco cessation: a qualitative study.

PubMed

Yuan, Nicole P; Wind, Steven; Nichter, Mimi; Nichter, Mark; Castañeda, Heide; Carruth, Lauren; Muramoto, Myra

2010-01-01

To identify types of health influencers in tobacco cessation based on the frequency and characteristics of brief intervention activities. Longitudinal qualitative interviews were completed with 28 individuals posttraining. Four individuals were categorized as Rarely Active, 5 as Active With Family and Friends, 9 as Active in the Workplace, and 10 as Proactive in Multiple Settings. Unique motivators, intervention behaviors, and barriers were documented. Some individuals displayed high levels of self-efficacy necessary for expanding the reach of community-based interventions. Training programs need to address the impact of contextual factors on initiating and sustaining intervention activities.

Faith Moves Mountains: an Appalachian cervical cancer prevention program.

PubMed

Schoenberg, Nancy E; Hatcher, Jennifer; Dignan, Mark B; Shelton, Brent; Wright, Sherry; Dollarhide, Kaye F

2009-01-01

To provide a conceptual description of Faith Moves Mountains (FMM), an intervention designed to reduce the disproportionate burden of cervical cancer among Appalachian women. FMM, a community-based participatory research program designed and implemented in collaboration with churches in rural, southeastern Kentucky, aims to increase cervical cancer screening (Pap tests) through a multiphase process of educational programming and lay health counseling. We provide a conceptual overview to key elements of the intervention, including programmatic development, theoretical basis, intervention approach and implementation, and evaluation procedures. After numerous modifications, FMM has recruited and retained over 400 women, 30 churches, and has become a change agent in the community.

Applying the concept of culture to reduce health disparities through health behavior research.

PubMed

Kagawa Singer, Marjorie

2012-11-01

Culture is often cited as an underlying cause of the undue burden of disease borne by communities of color along the entire life cycle. However, culture is rarely defined or appropriately measured. Scientifically, culture is a complex, integrated, and dynamic conceptual framework that is incongruent with the way it is operationalized in health behavior theories: as a unidimensional, static, and immutable character element of a homogeneous population group. This paper lays out this contradiction and proposes a more scientifically grounded approach to the use of culture. The premise is that if the concept of culture were better operationalized, results from studies of diverse population groups would produce findings that are more scientifically valid and relevant to the community. Practitioners could then use these findings to develop more effective strategies to reduce health disparities and improve the health of all population groups. Six steps are proposed to increase our ability to achieve greater clarity on what culture is and to identify how it impacts health behavior and ultimately health outcomes, enabling researchers to build a stronger science of cultural diversity. Copyright © 2012. Published by Elsevier Inc.

Synthetic social support: Theorizing lay health worker interventions.

PubMed

Gale, Nicola K; Kenyon, Sara; MacArthur, Christine; Jolly, Kate; Hope, Lucy

2018-01-01

Levels of social support are strongly associated with health outcomes and inequalities. The use of lay health workers (LHWs) has been suggested by policy makers across the world as an intervention to identify risks to health and to promote health, particularly in disadvantaged communities. However, there have been few attempts to theorize the work undertaken by LHWs to understand how interventions work. In this article, the authors present the concept of 'synthetic socialsupport' and distinguish it from the work of health professionals or the spontaneous social support received from friends and family. The authors provide new empirical data to illustrate the concept based on qualitative, observational research, using a novel shadowing method involving clinical and non-clinical researchers, on the everyday work of 'pregnancy outreach workers' (POWs) in Birmingham, UK. The service was being evaluated as part of a randomized controlled trial. These LHWs provided instrumental, informational, emotional and appraisal support to the women they worked with, which are all key components of social support. The social support was 'synthetic' because it was distinct from the support embedded in spontaneous social networks: it was non-reciprocal; it was offered on a strictly time-limited basis; the LHWs were accountable for the relationship, and the social networks produced were targeted rather than spontaneous. The latter two qualities of this synthetic form of social support may have benefits over spontaneous networks by improving the opportunities for the cultivation of new relationships (both strong and weak ties) outside the women's existing spontaneous networks that can have a positive impact on them and by offering a reliable source of health information and support in a chaotic environment. The concept of SSS can help inform policy makers about how deploying lay workers may enable them to achieve desired outcomes, specify their programme theories and evaluate accordingly. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Systematic medical assessment, referral and treatment for diabetes care in China using lay family health promoters: protocol for the SMARTDiabetes cluster randomised controlled trial.

PubMed

Peiris, David; Sun, Lei; Patel, Anushka; Tian, Maoyi; Essue, Beverley; Jan, Stephen; Zhang, Puhong

2016-08-17

Type 2 diabetes (T2DM) affects 113.9 million people in China, the largest number of any country in the world (JAMA 310:948-59, 2013). T2DM prevalence has risen dramatically from around 1 % in the 1980s to now over 10 % and is expected to continue rising. Despite the growing disease burden, few people with T2DM are achieving adequate management targets to prevent complications. Health system infrastructure in China is struggling to meet these gaps in care, and innovative, cost-effective and affordable solutions are needed. One promising strategy that may be particularly relevant to the Chinese context is improving support for lay family members to care for their relatives with T2DM. We hypothesise that an interactive mobile health management system can support lay family health promoters (FHP) and healthcare staff to improve clinical outcomes for family members with T2DM through medical assessment, regular monitoring, lifestyle advice and the prescribing of guidelines recommended medications. This intervention will be implemented as a cluster randomised controlled trial involving 80 communities (40 communities in Beijing and 40 rural villages in Hebei province) and 2000 people with T2DM. Outcome analyses will be conducted blinded to intervention allocation. The primary outcome is the proportion of patients achieving ≥2 "ABC" goals (HbA1c <7.0 %, blood pressure (BP) <140/80 mmHg and LDL cholesterol <100 mg/dl or 2.6 mmol/L) at the end of follow-up (Diabetes Care 36(Supplement 1):S11-S66, 2013). Secondary outcomes include the proportion of patients achieving individual ABC targets; mean changes in HbA1c, BP, LDL, renal function (serum creatinine and urinary albumin), body mass index, quality of life (QOL, EQ-5D), and healthcare utilisation from baseline; and cost-effectiveness/utility of intervention. Trial outcomes will be accompanied by detailed process and economic evaluations. The Chinese government has prioritised prevention and treatment of diabetes as 1 of 11 National Basic Public Health Services. Despite great promise for mHealth interventions to improve access to effective health care, there remains uncertainty about how this can be successfully achieved. The findings are likely to inform policy on a scalable strategy to overcome sub-optimal access to effective health care in China. Clinicaltrials.gov NCT02726100.

Outcomes from a community-based, participatory lay health advisor HIV/STD prevention intervention for recently arrived immigrant Latino men in rural North Carolina, USA

PubMed Central

Rhodes, Scott D.; Hergenrather, Kenneth C.; Bloom, Fred R.; Leichliter, Jami S.; Montaño, Jaime

2012-01-01

Background Latinos in the United States are at increased risk for HIV and sexually transmitted disease (STD) infection. We evaluated the efficacy of a pilot, lay health advisor (LHA) intervention designed to increase condom use and HIV testing among Latino men. Methods Fifteen LHAs (mean age=35.6; range 23–60 years) from 15 Latino soccer teams were trained and worked with their teammates for 18 months. Another 15 teams served as the control group. Data were collected at baseline and 18-months post-LHA training from a random sample of teammates from intervention and control teams. Results Data were collected from 222 men (mean age=29 years) who participated in one of the 30 teams. Relative to the control condition, participants in the intervention reported more consistent condom use in the 30 days preceding follow-up (unadjusted analysis, intervention, 65.6% vs. control, 41.3%; P<.001). Participants in the intervention were more likely to report condom use (adjusted odds ratio=2.3; CI=1.2–4.3) and HIV testing (adjusted odds ratio=2.5; CI=1.5–4.3). Conclusions LHA interventions for Latino men that are developed in partnership with community members, rely on male-centered intrapersonal networks, and are culturally congruent can enhance preventive behaviors and may reduce HIV infection. PMID:19824838

Cultural translation of refugee trauma: Cultural idioms of distress among Somali refugees in displacement.

PubMed

Im, Hyojin; Ferguson, Aidan; Hunter, Margaret

2017-01-01

Westernized approaches to mental health care often place limited emphasis on refugees' own experiences and cultural explanations of symptoms and distress. In order to effectively assess community mental health needs and develop interventions grounded in local needs, mental health programs need to be informed by an understanding of cultural features of mental health, including cultural idioms of distress (CIDs). The current study aims to explore CIDs among Somali refugees displaced in Kenya to understand mental health needs in cultural context and serve the community in a culturally responsive and sensitive manner. This research was conducted as a two-phase qualitative study. First, key informant interviews with Somali mental health stakeholders generated a list of 7 common Somali CIDs: buufis, buqsanaan, welwel, murug, qaracan, jinn, and waali. Typologies of each CID were further explored through four focus group interviews with Somali community members. The findings from a template analysis revealed Somali lay beliefs on how trauma and daily stressors are experienced and discussed in the form of CIDs and how each term is utilized and understood in attributing symptoms to associated causes. This study highlights the need to incorporate colloquial terms in mental health assessment and to adopt a culturally relevant framework to encourage wider utilization of services and religious/spiritual support systems.

Lay obligations in professional relations.

PubMed

Benjamin, M

1985-02-01

Little has been written recently about the obligations of lay people in professional relationships. Yet the Code of Medical Ethics adopted by the American Medical Association in 1847 included an extensive statement on "Obligations of patients to their physicians'. After critically examining the philosophical foundations of this statement, I provide an alternative account of lay obligations in professional relationships. Based on a hypothetical social contract and included in a full specification of professional as well as lay obligations, this account requires lay people to honor commitments and disclose relevant information. Ethically, the account assumes that all parties in lay-professional relationships should be given equal consideration and respect in determining rights and obligations. Factually, it assumes that the treatment of many illnesses and injuries required collaboration and cooperation among lay persons and health professionals, that medical resources and personnel are limited, and that medicine, nursing, and related health professions, are, in MacIntyre's sense, practices.

The status of community water fluoridation in the United States.

PubMed Central

Easley, M W

1990-01-01

Community water fluoridation has served the American public extremely well as the cornerstone of dental caries prevention activities for 45 years. The dental and general health benefits associated with the ingestion of water-borne fluorides have been well known by researchers for an even longer period. Continued research has repeatedly confirmed the safety, effectiveness, and efficiency of community water fluoridation in preventing dental caries for Americans regardless of age, race, ethnicity, religion, educational status, or socioeconomic level. Despite the obvious benefits associated with this proven public health measure, slow progress has been made toward achieving the 1990 national fluoridation objectives as listed in "Promoting Health/Preventing Disease: Objectives for the Nation." This paper documents the lagging pace of community fluoridation by reviewing and analyzing data reported in "Fluoridation Census, 1985," a document published in late 1988 by the Public Health Service's Centers for Disease Control. Failure to attain the 1990 objectives is attributable to a combination of circumstances, including their low priority within many local, State, and Federal health agencies, inadequate funding at all levels of government, lack of a coordinated and focused national fluoridation effort, failure of most States to require fluoridation, lack of Federal legislation mandating fluoridation, general apathy of most health professional organizations toward fluoridation, misconceptions by the public about effectiveness and safety and, finally, unrelenting opposition by a highly vocal minority of the lay public.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:2116635

User involvement in clinical governance

PubMed Central

Pickard, Susan; Marshall, Martin; Rogers, Anne; Sheaff, Rod; Sibbald, Bonnie; Campbell, Stephen; Halliwell, Shirley; Roland, Martin

2002-01-01

Objectives To investigate the involvement of users in clinical governance activities within Primary Care Groups (PCGs) and Trusts (PCTs). Drawing on policy and guidance published since 1997, the paper sets out a framework for how users are involved in this agenda, evaluates practice against this standard and suggests why current practice for user involvement in clinical governance is flawed and why this reflects a flaw in the policy design as much as its implementation. Design Qualitative data comprising semi‐structured interviews, reviews of documentary evidence and relevant literature. Setting Twelve PCGs/PCTs in England purposively selected to provide variation in size, rurality and group or trust status. Participants Key stakeholders including Lay Board members (n=12), Chief Executives (CEs) (n= 12), Clinical Governance Leads (CG leads) (n= 14), Mental Health Leads (MH leads) (n= 9), Board Chairs (n=2) and one Executive Committee Lead. Results Despite an acknowledgement of an organizational commitment to lay involvement, in practice very little has occurred. The role of lay Board members in setting priorities and implementing and monitoring clinical governance remains low. Beyond Board level, involvement of users, patients of GP practices and the general public is patchy and superficial. The PCGs/PCTs continue to rely heavily on Community Health Councils (CHCs) as a conduit or substitute for user involvement; although their abolition is planned, their role to be fulfilled by new organizations called Voices, which will have an expanded remit in addition to replacing CHCs. Conclusions Clarity is required about the role of lay members in the committees and subcommittees of PCGs and PCTs. Involvement of the wider public should spring naturally from the questions under consideration, rather than be regarded as an end in itself. PMID:12199658

Primary prevention of lead poisoning in rural Native American children: behavioral outcomes from a community-based intervention in a former mining region.

PubMed

Kegler, Michelle C; Malcoe, Lorraine Halinka; Fedirko, Veronika

2010-01-01

The current study examined the effectiveness of a community-based lay health advisor intervention, combined with youth engagement, in improving lead poisoning prevention behaviors and associated beliefs in a rural Native American population located in and near a Superfund site containing mining waste. Three sequential (1997, 2000, and 2004) cross-sectional assessments involving in-person interviews with Native American and White caregivers of young children were conducted. Results showed significant improvements over time for Native American, but not for White, for children washing their hands before meals and snacks, and for annual blood lead testing of both Native American and White children. Findings lend support to the value of community-based education for primary prevention of lead poisoning in Native American and rural communities.

Engaging communities to improve mental health in African and African Caribbean groups: a qualitative study evaluating the role of community well-being champions.

PubMed

Mantovani, Nadia; Pizzolati, Micol; Gillard, Steve

2017-01-01

Over the last decade, Britain has undergone reforms to promote engagement in local structures of governance. These reforms have encouraged the promotion of active citizenship and have been central to the government's public service modernisation agenda. This article presents the findings from a study evaluating a pilot outreach intervention which adopted a community engagement model to address the mental health needs of African and African Caribbean groups, which entailed a partnership between faith-based organisations, local public services and community organisations to co-produce the pilot project. Lay people were trained to raise awareness about mental health among these communities in South London. Between 2012 and 2013, a qualitative participatory approach was used to evaluate the pilot project, which enabled a researcher to take part in the engagement phase of the pilot project, and the project co-ordinators to be involved in the research process. Semi-structured, one-to-one interviews were carried out with 13 community and well-being champions (CWBCs) recruited from African and African Caribbean communities (seven male and six female). This study examines the impact of the relationship between the intervention and community through the participants' engagement in the pilot outreach project and the action undertaken as champions. We found that although CWBCs used circles of influence to share ideas about mental health and well-being and to encourage change, they encountered resistance on the part of the people they engaged with, which resulted from a lack of knowledge about mental health, taboos and ascribed stigma. We argue that CWBCs acted as healthy examples to communicate mental health knowledge to those approached, but that they needed to be equipped with bespoke communication skills to be able to talk about such sensitive issues as mental health. © 2015 The Authors. Health and Social Care in the Community Published by John Wiley & Sons Ltd.

Training and deployment of lay refugee/internally displaced persons to provide basic health services in camps: a systematic review.

PubMed

Ehiri, John E; Gunn, Jayleen K L; Center, Katherine E; Li, Ying; Rouhani, Mae; Ezeanolue, Echezona E

2014-01-01

Training of lay refugees/internally displaced persons (IDPs) and deploying them to provide basic health services to other women, children, and families in camps is perceived to be associated with public health benefits. However, there is limited evidence to support this hypothesis. To assess the effects of interventions to train and deploy lay refugees and/or IDPs for the provision of basic health service to other women, children, and families in camps. PubMed, Science and Social Science Citation Indices, PsycINFO, EMBASE, POPLINE, CINAHL, and reference lists of relevant articles were searched (from inception to June 30, 2014) with the aim of identifying studies that reported the effects of interventions that trained and deployed lay refugees and/or IDPs for the provision of basic health service to other women, children, and families in camps. Two investigators independently reviewed all titles and abstracts to identify potentially relevant articles. Discrepancies were resolved by repeated review, discussion, and consensus. Study quality assessment was undertaken using standard protocols. Ten studies (five cross-sectional, four pre-post, and one post-test only) conducted in Africa (Guinea and Tanzania), Central America (Belize), and Asia (Myanmar) were included. The studies demonstrated some positive impact on population health associated with training and deployment of trained lay refugees/IDPs as health workers in camps. Reported effects included increased service coverage, increased knowledge about disease symptoms and prevention, increased adoption of improved treatment seeking and protective behaviors, increased uptake of services, and improved access to reproductive health information. One study, which assessed the effect of peer refugee health education on sexual and reproductive health, did not demonstrate a marked reduction in unintended pregnancies among refugee/IDP women. Although available evidence suggests a positive impact of training and deployment of lay refugees/IDPs as health workers in camps, existing body of evidence is weak, and calls for a re-examination of current practices. Interventions that promote training and deployment of lay refugees/IDPs as health workers in camps should include strong evaluation components in order to facilitate assessment of effects on population health.

Training and deployment of lay refugee/internally displaced persons to provide basic health services in camps: a systematic review

PubMed Central

Ehiri, John E.; Gunn, Jayleen K.L.; Center, Katherine E.; Li, Ying; Rouhani, Mae; Ezeanolue, Echezona E.

2014-01-01

Background Training of lay refugees/internally displaced persons (IDPs) and deploying them to provide basic health services to other women, children, and families in camps is perceived to be associated with public health benefits. However, there is limited evidence to support this hypothesis. Objectives To assess the effects of interventions to train and deploy lay refugees and/or IDPs for the provision of basic health service to other women, children, and families in camps. Methods PubMed, Science and Social Science Citation Indices, PsycINFO, EMBASE, POPLINE, CINAHL, and reference lists of relevant articles were searched (from inception to June 30, 2014) with the aim of identifying studies that reported the effects of interventions that trained and deployed lay refugees and/or IDPs for the provision of basic health service to other women, children, and families in camps. Two investigators independently reviewed all titles and abstracts to identify potentially relevant articles. Discrepancies were resolved by repeated review, discussion, and consensus. Study quality assessment was undertaken using standard protocols. Results Ten studies (five cross-sectional, four pre-post, and one post-test only) conducted in Africa (Guinea and Tanzania), Central America (Belize), and Asia (Myanmar) were included. The studies demonstrated some positive impact on population health associated with training and deployment of trained lay refugees/IDPs as health workers in camps. Reported effects included increased service coverage, increased knowledge about disease symptoms and prevention, increased adoption of improved treatment seeking and protective behaviors, increased uptake of services, and improved access to reproductive health information. One study, which assessed the effect of peer refugee health education on sexual and reproductive health, did not demonstrate a marked reduction in unintended pregnancies among refugee/IDP women. Conclusion Although available evidence suggests a positive impact of training and deployment of lay refugees/IDPs as health workers in camps, existing body of evidence is weak, and calls for a re-examination of current practices. Interventions that promote training and deployment of lay refugees/IDPs as health workers in camps should include strong evaluation components in order to facilitate assessment of effects on population health. PMID:25280734

From smallpox eradication to contemporary global health initiatives: enhancing human capacity towards a global public health goal.

PubMed

Tarantola, Daniel; Foster, Stanley O

2011-12-30

The eradication of smallpox owes its success first and foremost to the thousands of lay health workers and community members who, throughout the campaign and across continents, took on the roles of advocates, educators, vaccinators, care providers and contributors to epidemic surveillance and containment. Bangladesh provides a good example where smallpox eradication and the capacity enhancement needed to achieve this goal resulted in a two-way mutually beneficial process. Smallpox-dedicated staff provided community members with information guidance, support and tools. In turn, communities not only created the enabling environment for smallpox program staff to perform their work but acquired the capacity to perform essential eradication tasks. Contemporary global health programmes can learn much from these core lessons including: the pivotal importance of supporting community aspirations, capacity and resilience; the critical need to enhance commitment, capacity and accountability across the workforce; and the high value of attentive human resources management and support. We owe to subsequent global disease control, elimination and eradication ventures recognition of the need for social and behavioural science to inform public health strategies; the essential roles that civil society organizations and public-private partnerships can play in public health discourse and action; the overall necessity of investing in broad-based health system strengthening; and the utility of applying human rights principles, norms and standards to public health policy and practice. Crown Copyright © 2011. Published by Elsevier Ltd. All rights reserved.

Individualized Risk Communication and Outreach for Primary Cardiovascular Disease Prevention in Community Health Centers: Randomized Trial.

PubMed

Persell, Stephen D; Brown, Tiffany; Lee, Ji Young; Shah, Shreya; Henley, Eric; Long, Timothy; Luther, Stephanie; Lloyd-Jones, Donald M; Jean-Jacques, Muriel; Kandula, Namratha R; Sanchez, Thomas; Baker, David W

2015-11-01

Many eligible primary cardiovascular disease prevention candidates are not treated with statins. Electronic health record data can identify patients with increased cardiovascular disease risk. We performed a pragmatic randomized controlled trial at community health centers in 2 states. Participants were men aged ≥35 years and women ≥45 years, without cardiovascular disease or diabetes mellitus, and with a 10-year risk of coronary heart disease of at least 10%. The intervention group received telephone and mailed outreach, individualized based on patients' cardiovascular disease risk and uncontrolled risk factors, provided by lay health workers. Main outcomes included: documented discussion of medication treatment for cholesterol with a primary care clinician, receipt of statin prescription within 6 months, and low-density lipoprotein (LDL)-cholesterol repeated and at least 30 mg/dL lower than baseline within 1 year. Six hundred forty-six participants (328 and 318 in the intervention and control groups, respectively) were included. At 6 months, 26.8% of intervention and 11.6% of control patients had discussed cholesterol treatment with a primary care clinician (odds ratio, 2.79; [95% confidence interval, 2.25-3.46]). Statin prescribing occurred for 10.1% in the intervention group and 6.0% in the control group (odds ratio, 1.76; [95% confidence interval, 0.90-3.45]). The cholesterol outcome did not differ, and the majority of patients did not repeat lipid levels during follow-up. Risk communication and lay outreach increased cholesterol treatment discussions with primary care clinicians. However, most discussions did not result in statin prescribing. For outreach to be successful, it should be combined with interventions to encourage clinicians to follow contemporary risk-based cholesterol treatment guidelines. URL: http://www.clincialtrials.gov. Unique identifier: NCT01610609. © 2015 American Heart Association, Inc.

The effects, safety and acceptability of compact, pre-filled, autodisable injection devices when delivered by lay health workers.

PubMed

Glenton, Claire; Khanna, Rajesh; Morgan, Chris; Nilsen, Elin Strømme

2013-08-01

To systematically assess (i) the effects and safety and (ii) the acceptability of using lay health workers (LHWs) to deliver vaccines and medicines to mothers and children through compact pre-filled autodisable devices (CPADs). We searched electronic databases and grey literature. For the systematic review of effects and safety, we sought randomised and non-randomised controlled trials, controlled before-after studies and interrupted time series studies. For the systematic review of acceptability, we sought qualitative studies. Two researchers independently carried out data extraction, study quality assessment and thematic analysis of the qualitative data. No studies met our criteria for the review exploring the effects and safety of using LHWs to deliver CPADs. For the acceptability review, six qualitative studies assessed the acceptability of using LHWs to deliver hepatitis B vaccine, tetanus toxoid vaccine, gentamicin or oxytocin using Uniject™ devices. All studies took place in low- or middle-income countries and explored the perceptions of community members, LHWs, supervisors, health professionals or programme managers. Most of the studies were of low quality. Recipients generally accepted the intervention. Most health professionals were confident that LHWs could deliver the intervention with sufficient training and supervision, but some had problems delivering supervision. The LHWs perceived Uniject™ as effective and important and were motivated by positive responses from the community. However, some LHWs feared the consequences if harm should come to recipients. Evidence of the effects and safety of using CPADs delivered by LHWs is lacking. Evidence regarding acceptability suggests that this intervention may be acceptable although LHWs may feel vulnerable to blame. © 2013 John Wiley & Sons Ltd.

Women living with AIDS in rural Southern India: Perspectives on mental health and lay health care worker support

PubMed Central

Srivastava, Neha; Nyamathi, Adeline M.; Sinha, Sanjeev; Carpenter, Catherine; Satyanarayana, Veena; Ramakrishna, Padma; Ekstrand, Maria

2017-01-01

In this study, focus groups were conducted with 16 rural Women Living with AIDS (WLA) from Andhra Pradesh, India who had previously participated in a clinical trial wherein 68 WLA were randomized into either an Accredited Social Health Activists (ASHA) – Life (AL) intervention or a Usual Care program. Findings are discussed in terms of: a) mental health issues, b) perceived stressors, c) individual resources for coping with mental health issues, and d) role of Asha support in coping with mental health issues. These findings highlight the salience of mental health issues in the lives of WLA and the role played by Asha in addressing some of these issues. The discussion section makes a case for increased emphasis on mental health care in future community-based interventions for this population. PMID:29056879

Development of a community-based participatory colorectal cancer screening intervention to address disparities, Arkansas, 2008-2009.

PubMed

Yeary, Karen; Flowers, Eric; Ford, Gemessia; Burroughs, Desiree; Burton, Jackie; Woods, Delores; Stewart, Chara; Mehta, Paulette; Greene, Paul; Henry-Tillman, Ronda

2011-03-01

The death rate from colorectal cancer is high and affects poor and medically underserved populations disproportionately. In the United States, health disparities are particularly acute in the Lower Mississippi River Delta region. Because many in the region have limited access to basic health care resources, they are not screened for cancer, even though screening is one of the most effective strategies to prevent colorectal cancer. Community-based participatory research is a promising approach to prevent colorectal cancer in this population. The Empowering Communities for Life program was implemented in 2 underserved counties in the Arkansas Lower Mississippi River Delta. The program arose from a 9-year partnership between the University of Arkansas for Medical Sciences and 9 cancer councils across Arkansas. Empowering Communities for Life is a community-based participatory intervention designed to increase colorectal cancer screening in rural, underserved communities through fecal occult blood testing. Community and academic partners collaborated to develop research infrastructure, intervention materials and methods, and the assessment instrument. Project outcomes were strengthened community-academic partnerships, certification of community partners in conducting human subjects research, development of a randomized controlled design to test the intervention's efficacy, an interactive PowerPoint presentation, an informational pamphlet, the certification of 6 lay health advisors and 22 role models to provide the intervention, and an assessment tool using an audience response system. Lessons learned in working collaboratively with diverse groups include the importance of meeting face to face and listening.

Should trained lay providers perform HIV testing? A systematic review to inform World Health Organization guidelines.

PubMed

Kennedy, C E; Yeh, P T; Johnson, C; Baggaley, R

2017-12-01

New strategies for HIV testing services (HTS) are needed to achieve UN 90-90-90 targets, including diagnosis of 90% of people living with HIV. Task-sharing HTS to trained lay providers may alleviate health worker shortages and better reach target groups. We conducted a systematic review of studies evaluating HTS by lay providers using rapid diagnostic tests (RDTs). Peer-reviewed articles were included if they compared HTS using RDTs performed by trained lay providers to HTS by health professionals, or to no intervention. We also reviewed data on end-users' values and preferences around lay providers preforming HTS. Searching was conducted through 10 online databases, reviewing reference lists, and contacting experts. Screening and data abstraction were conducted in duplicate using systematic methods. Of 6113 unique citations identified, 5 studies were included in the effectiveness review and 6 in the values and preferences review. One US-based randomized trial found patients' uptake of HTS doubled with lay providers (57% vs. 27%, percent difference: 30, 95% confidence interval: 27-32, p < 0.001). In Malawi, a pre/post study showed increases in HTS sites and tests after delegation to lay providers. Studies from Cambodia, Malawi, and South Africa comparing testing quality between lay providers and laboratory staff found little discordance and high sensitivity and specificity (≥98%). Values and preferences studies generally found support for lay providers conducting HTS, particularly in non-hypothetical scenarios. Based on evidence supporting using trained lay providers, a WHO expert panel recommended lay providers be allowed to conduct HTS using HIV RDTs. Uptake of this recommendation could expand HIV testing to more people globally.

The skin microbiome of cow-nose rays (Rhinoptera bonasus) in an aquarium touch-tank exhibit.

PubMed

Kearns, Patrick J; Bowen, Jennifer L; Tlusty, Michael F

2017-05-01

Public aquaria offer numerous educational opportunities for visitors while touch-tank exhibits offer guests the ability to directly interact with marine life via physical contact. Despite the popularity of touch-tanks, there is a paucity of research about animal health in these exhibits and, in particular, there is little research on the microbial communities in these highly interactive exhibits. Microbial community structure can have implications for both host health and habitat function. To better understand the microbiome of a touch-tank we used high-throughput sequencing of the 16S rRNA gene to analyze the microbial community on the dorsal and ventral surfaces of cow-nose rays (Rhinoptera bonasus) as well as their environment in a frequently visited touch-tank exhibit at the New England Aquarium. Our analyses revealed a distinct microbial community associated with the skin of the ray that had lower diversity than the surrounding habitat. The ray skin was dominated by three orders: Burkholderiales (∼55%), Flavobacteriales (∼19%), and Pseudomonadales (∼12%), taxonomic groups commonly associated with other fish species. Our results provide a survey of ray-associated bacterial communities in a touch-tank environment, thereby laying the foundation for future studies examining the role of potential challenges to ray microbiota and their associated health. © 2017 Wiley Periodicals, Inc.

Unique governance for a national ministry. Catholic Health Initiatives' board structure empowers laity, supports mission.

PubMed

Poe, J E

1998-01-01

The three original founding healthcare systems and 10 sponsoring religious institutes of Catholic Health Initiatives (CHI) have developed an unprecedented governance model to support their vision of a national Catholic health ministry in the twenty-first century. The new organization spans 22 states; annual revenues exceed $4.7 billion. Religious institutes choose either active or honorary status before consolidating with CHI, depending on their desired involvement in the organization. Currently, nine are active and two are honorary. CHI's civil corporation comprises one representative from each active congregation. These representatives approve major changes in mission or philosophical direction. They control board membership by appointing three to five congregation representatives as sponsorship trustees, who are responsible for approving the remaining members of the Board of Stewardship Trustees. This half-religious, half-lay governing board is responsible for leading CHI. CHI has only two levels of governance, a national board and boards of market-based organizations, for instance a network of facilities with one management structure, or a community board of an individual facility. This avoids multiple administrative layers and approval processes. The organization has a civil identity as CHI and a canonical identity as a public juridic person of pontifical right, called Catholic Health Care Federation (CHCF). The governing board members of CHI, as members of CHCF, serve as the religious sponsors for all CHI health facilities. Some facilities have already been "alienated" (turned over) to CHI by their religious institutes; others will be alienated in the future. CHI's recent consolidation with Sisters of Charity of Nazareth Health System added an 11th sponsor, a sixth geographic region, and two members--one religious and one lay--to the governing board. The governance model assists such growth through the appeal of an equal religious-lay partnership and a flexible sponsorship model.

Spirituality, social capital and service: factors promoting resilience among Expert Patients living with HIV in Ethiopia.

PubMed

Hussen, Sophia Ahmed; Tsegaye, Mulugeta; Argaw, Meron Gurji; Andes, Karen; Gilliard, Danielle; del Rio, Carlos

2014-01-01

People living with HIV (PLHIV) in Ethiopia and other developing nations face numerous challenges to their health and well-being, including poverty, limited healthcare infrastructure and high levels of societal stigma. Despite these challenges, resilient trajectories have been observed even within such resource-limited settings. In Ethiopia, such resilience is exemplified by the 'Expert Patients (EPTs)', HIV-positive lay health workers who function as adherence counsellors, health educators, outreach workers and community advocates. We conducted a multi-method qualitative study with 20 EPTs in Addis Ababa, Ethiopia in order to understand pathways to resilience in this selected population. Participants described three key mechanisms of resilient coping: (1) the use of spirituality and faith-based practices to manage psychological difficulties associated with living with HIV; (2) utilisation of social capital from family and community networks as a buffer against the psychological and economic consequences of societal stigma; and (3) serving others as a mechanism for finding optimism and purpose in life. Interventions designed to facilitate and/or augment these social processes in the wider community may be promising strategies for improving health among PLHIV in Ethiopia and other resource-limited settings.

Strength training in community settings: impact of lay leaders on program access and sustainability for rural older adults.

PubMed

Washburn, Lisa T; Cornell, Carol E; Phillips, Martha; Felix, Holly; Traywick, LaVona

2014-09-01

The effect of volunteer lay leaders on availability and sustainability of strength-training programs for older adults has not been well explored. We describe implementation of the StrongWomen strength training program by the Arkansas Cooperative Extension Service, and report on the relationship between delivery approach (agent-led, lay-led, or combination of agent- and lay-led) and program access and sustainability. All state Extension agents (n = 66) were surveyed on program implementation, continuance, and use of lay leaders. Program records were used to identify the number of trained lay leaders. Regression models were used to examine the relationship between delivery approach and group availability. Counties using lay leaders had twice as many groups as counties using only agents. There was a significant, positive relationship between the number of lay leaders and the number of groups. Counties using lay leaders were 8.3 times more likely to have continuing groups compared with counties not using lay leaders. Program continuance was significantly and positively associated with lay leader use. Lay delivery expanded access to strength training programs and increased the likelihood that programs would continue. This approach can be used to increase access to and sustainability of strength training programs, particularly in resource-constrained areas.

A case study of engaging hard-to-reach participants in the research process: Community Advisors on Research Design and Strategies (CARDS)®

PubMed Central

Kaiser, Betty L.; Thomas, Gay R.; Bowers, Barbara J.

2016-01-01

Lack of diversity among study participants in clinical research limits progress in eliminating health disparities. The engagement of lay stakeholders, such as patient or community advisory boards (CABs), has the potential to increase recruitment and retention of underrepresented groups by providing a structure for gathering feedback on research plans and materials from this target population. However, many CABs intentionally recruit prominent stakeholders who are connected to or comfortable with research and academia and thus may not accurately represent the perspectives of underrepresented groups who have been labeled hard-to-reach, including racial minorities and low-income or low-literacy populations. We developed a partnership between the University of Wisconsin-Madison School of Nursing and two community centers to deliberately engage hard-to-reach people in two lay advisory groups, the Community Advisors on Research Design and Strategies (CARDS)®. Community center staff recruited the CARDS® from center programs, including parenting and childcare programs, women’s support groups, food pantries, and senior meal programs. The CARDS® model differs from other CABs in its participants, processes, and outcomes. Since 2010, the CARDS® have met monthly with nurses and other researchers, helping them understand how research processes and the language, tone, appearance, and organization of research materials can discourage people from enrolling in clinical studies. We have successfully used the CARDS® model to bring hard-to-reach populations into the research process and have sustained their participation. The model represents a promising strategy for increasing the diversity of participants in clinical research. PMID:27686421

Task-shifting point-of-care CD4+ testing to lay health workers in HIV care and treatment services in Namibia.

PubMed

Kaindjee-Tjituka, Francina; Sawadogo, Souleymane; Mutandi, Graham; Maher, Andrew D; Salomo, Natanael; Mbapaha, Claudia; Neo, Marytha; Beukes, Anita; Gweshe, Justice; Muadinohamba, Alexinah; Lowrance, David W

2017-01-01

Access to CD4+ testing remains a common barrier to early initiation of antiretroviral therapy among persons living with HIV/AIDS in low- and middle-income countries. The feasibility of task-shifting of point-of-care (POC) CD4+ testing to lay health workers in Namibia has not been evaluated. From July to August 2011, Pima CD4+ analysers were used to improve access to CD4+ testing at 10 selected public health facilities in Namibia. POC Pima CD4+ testing was performed by nurses or lay health workers. Venous blood samples were collected from 10% of patients and sent to centralised laboratories for CD4+ testing with standard methods. Outcomes for POC Pima CD4+ testing and patient receipt of results were compared between nurses and lay health workers and between the POC method and standard laboratory CD4+ testing methods. Overall, 1429 patients received a Pima CD4+ test; 500 (35.0%) tests were performed by nurses and 929 (65.0%) were performed by lay health workers. When Pima CD4+ testing was performed by a nurse or a lay health worker, 93.2% and 95.2% of results were valid ( p = 0.1); 95.6% and 98.1% of results were received by the patient ( p = 0.007); 96.2% and 94.0% of results were received by the patient on the same day ( p = 0.08). Overall, 97.2% of Pima CD4+ results were received by patients, compared to 55.4% of standard laboratory CD4+ results ( p < 0.001). POC CD4+ testing was feasible and effective when task-shifted to lay health workers. Rollout of POC CD4+ testing via task-shifting can improve access to CD4+ testing and retention in care between HIV diagnosis and antiretroviral therapy initiation in low- and middle-income countries.

Priority setting for health in the context of devolution in Kenya: implications for health equity and community-based primary care

PubMed Central

McCollum, Rosalind; Theobald, Sally; Otiso, Lilian; Martineau, Tim; Karuga, Robinson; Barasa, Edwine; Molyneux, Sassy; Taegtmeyer, Miriam

2018-01-01

Abstract Devolution changes the locus of power within a country from central to sub-national levels. In 2013, Kenya devolved health and other services from central government to 47 new sub-national governments (known as counties). This transition seeks to strengthen democracy and accountability, increase community participation, improve efficiency and reduce inequities. With changing responsibilities and power following devolution reforms, comes the need for priority-setting at the new county level. Priority-setting arises as a consequence of the needs and demand for healthcare resources exceeding the resources available, resulting in the need for some means of choosing between competing demands. We sought to explore the impact of devolution on priority-setting for health equity and community health services. We conducted key informant and in-depth interviews with health policymakers, health providers and politicians from 10 counties (n = 269 individuals) and 14 focus group discussions with community members based in 2 counties (n = 146 individuals). Qualitative data were analysed using the framework approach. We found Kenya’s devolution reforms were driven by the need to demonstrate responsiveness to county contexts, with positive ramifications for health equity in previously neglected counties. The rapidity of the process, however, combined with limited technical capacity and guidance has meant that decision-making and prioritization have been captured and distorted for political and power interests. Less visible community health services that focus on health promotion, disease prevention and referral have been neglected within the prioritization process in favour of more tangible curative health services. The rapid transition in power carries a degree of risk of not meeting stated objectives. As Kenya moves forward, decision-makers need to address the community health gap and lay down institutional structures, processes and norms which promote health equity for all Kenyans. PMID:29846599

Where There is No EMS: Lay Providers in Emergency Medical Services Care - EMS as a Public Health Priority.

PubMed

Debenham, Sierra; Fuller, Matthew; Stewart, Matthew; Price, Raymond R

2017-12-01

By 2030, road traffic accidents are projected to be the fifth leading cause of death worldwide, with 90% of these deaths occurring in low- and middle-income countries (LMICs). While high-quality, prehospital trauma care is crucial to reduce the number of trauma-related deaths, effective Emergency Medical Systems (EMS) are limited or absent in many LMICs. Although lay providers have long been recognized as the front lines of informal trauma care in countries without formal EMS, few efforts have been made to capitalize on these networks. We suggest that lay providers can become a strong foundation for nascent EMS through a four-fold approach: strengthening and expanding existing lay provider training programs; incentivizing lay providers; strengthening locally available first aid supply chains; and using technology to link lay provider networks. Debenham S , Fuller M , Stewart M , Price RR . Where there is no EMS: lay providers in Emergency Medical Services care - EMS as a public health priority. Prehosp Disaster Med. 2017;32(6):593-595.

Exploring How Lay Rescuers Overcome Barriers to Provide Cardiopulmonary Resuscitation: A Qualitative Study.

PubMed

Mathiesen, Wenche Torunn; Bjørshol, Conrad Arnfinn; Høyland, Sindre; Braut, Geir Sverre; Søreide, Eldar

2017-02-01

Survival rates after out-of-hospital cardiac arrest (OHCA) vary considerably among regions. The chance of survival is increased significantly by lay rescuer cardiopulmonary resuscitation (CPR) before Emergency Medical Services (EMS) arrival. It is well known that for bystanders, reasons for not providing CPR when witnessing an OHCA incident may be fear and the feeling of being exposed to risk. The aim of this study was to gain a better understanding of why barriers to providing CPR are overcome. Using a semi-structured interview guide, 10 lay rescuers were interviewed after participating in eight OHCA incidents. Qualitative content analysis was used. The lay rescuers were questioned about their CPR-knowledge, expectations, and reactions to the EMS and from others involved in the OHCA incident. They also were questioned about attitudes towards providing CPR in an OHCA incident in different contexts. The lay rescuers reported that they were prepared to provide CPR to anybody, anywhere. Comprehending the severity in the OHCA incident, both trained and untrained lay rescuers provided CPR. They considered CPR provision to be the expected behavior of any community citizen and the EMS to act professionally and urgently. However, when asked to imagine an OHCA in an unclear setting, they revealed hesitation about providing CPR because of risk to their own safety. Mutual trust between community citizens and towards social institutions may be reasons for overcoming barriers in providing CPR by lay rescuers. A normative obligation to act, regardless of CPR training and, importantly, without facing any adverse legal reactions, also seems to be an important factor behind CPR provision. Mathiesen WT , Bjørshol CA , Høyland S , Braut GS , Søreide E . Exploring how lay rescuers overcome barriers to provide cardiopulmonary resuscitation: a qualitative study. Prehosp Disaster Med. 2017;32(1):27-32.

The social context of hormone and silicone injection among Puerto Rican transwomen.

PubMed

Padilla, Mark B; Rodríguez-Madera, Sheilla; Ramos Pibernus, Alixida G; Varas-Díaz, Nelson; Neilands, Torsten B

2018-05-01

This paper draws on ethnographic, qualitative and survey data with transwomen in Puerto Rico to examine the social and political-economic context of lay injection with hormone and silicone - common practices within this community. We describe specific practices of hormone and silicone injection, the actors that govern them, the market for the sale and distribution of syringes and the networks of lay specialists who provide services to a population that is neglected by and largely excluded from biomedical settings. Our data derive from ethnographic observations, sociodemographic questionnaires, surveys and semi-structured interviews conducted with a diverse group of transwomen in metropolitan San Juan, Puerto Rico. Our analysis focuses on four overlapping social domains or processes that shape the practices of lay silicone and hormone injection among transwomen: (1) the circulation of gender transitioning technologies within local and global markets; (2) the tension between the social exclusion of transwomen and their resilient sub-cultural responses; (3) the cultural meanings that shape transwomen's attitudes about injection; and (4) the perceived consequences of injection. We conclude with a discussion of the kinds of intervention and policy changes that would respond to the factors that most endanger transwomen's health.

[The analysis of health related behavior after using health information on the Internet].

PubMed

Jo, Heui-Sug; Kim, Hwa-Jong; Song, Yea-Li-A

2008-03-01

This study investigated the health information such as the general health information, the health product information, and the hospital information, and we wanted to identify the association between internet health information and the health related behavior by analyzing the process after people search the Internet. A telephone survey with structured questionnaire was performed by trained surveyors. The respondents were sampled proportionate to the Korean demographic distribution with considering the city size and the populations' ages and gender. The survey was conducted from October 2006 to November 2006. Out of 3,758 successfully connected persons of age 20 or more, 871(23.2%) respondents had used Internet health information during the last year. The purposes of searching the Internet for health was, 1) to get general health information (717 cases, 81.0%), 2) shopping for health product (109 cases, 12.3%) and 3) seeking information about hospital selection (59 cases, 6.7%). Our research showed that the process after searching the Internet for health information depends on the purpose of the search. 68.8% of the searchers for general health information, 67% of the searchers for health product shopping and 64.4% of the searchers seeking information to guide hospital selection were satisfied with their Internet search. However one third of the respondents reported not being satisfied with the result of the search. Unsatisfied consumers with internet health information tended to ask lay referrals from others or they gave up seeking health information. The health information system should be improved to increase the accessibility and to provide reliable and effective information. Also, a more user-centric community is needed in order to strengthen the effective role of lay referrals among the internet users.

Faith Moves Mountains: An Appalachian Cervical Cancer Prevention Program

PubMed Central

Schoenberg, Nancy E.; Hatcher, Jennifer; Dignan, Mark B.; Shelton, Brent; Wright, Sherry; Dollarhide, Kaye F.

2009-01-01

Objective To provide a conceptual description of Faith Moves Mountains (FMM), an intervention designed to reduce the disproportionate burden of cervical cancer among Appalachian women. Methods FMM, a community-based participatory research program designed and implemented in collaboration with churches in rural, southeastern Kentucky, aims to increase cervical cancer screening (Pap tests) through a multiphase process of educational programming and lay health counseling. Results We provide a conceptual overview to key elements of the intervention, including programmatic development, theoretical basis, intervention approach and implementation, and evaluation procedures. Conclusions After numerous modifications, FMM has recruited and retained over 400 women, 30 churches, and has become a change agent in the community. PMID:19320612

"One Big Family": Pastoral Care and Treatment Seeking in an Egyptian Coptic Church in England.

PubMed

Shenouda, John E A; Cooper, Maxwell J F

2017-08-01

Little is known about Coptic migrants' chronic disease health beliefs and treatment-seeking behaviours. Interviews to explore these issues and their relationship with church membership were conducted with 15 Coptic migrants in Southern England. Obesity and cardiovascular disease (CVD) were most frequently identified as health risks for Coptic migrants. CVD was ascribed to stress and considered amenable to spiritual healing. Lay referral to medical practitioners who were church members was common but may devalue perceptions of family medicine. The Coptic Church functions as a community that addresses members' wider vulnerability. Central to this is the "parish nurse" role of the priest.

Types of Lay Health Influencers in Tobacco Cessation: A Qualitative Study

PubMed Central

Yuan, Nicole P.; Wind, Steven; Nichter, Mimi; Nichter, Mark; Castañeda, Heide; Carruth, Lauren; Muramoto, Myra L.

2014-01-01

Objective To identify types of health influencers in tobacco cessation based on the frequency and characteristics of brief intervention activities. Methods Longitudinal qualitative interviews were completed with 28 individuals post-training. Results Four individuals were categorized as Rarely Active, 5 as Active with Family and Friends, 9 as Active in the Workplace, and 10 as Proactive in Multiple Settings. Unique motivators, intervention behaviors, and barriers were documented. Some individuals displayed high levels of self-efficacy necessary for expanding the reach of community-based interventions. Conclusion Training programs need to address the impact of contextual factors on initiating and sustaining intervention activities. PMID:20524890

Disentangling the Exposure Experience: The Roles of Community Context and Report-back of Environmental Exposure Data

PubMed Central

Adams, Crystal; Brown, Phil; Morello-Frosch, Rachel; Brody, Julia Green; Rudel, Ruthann; Zota, Ami; Dunagan, Sarah; Tovar, Jessica; Patton, Sharyle

2011-01-01

This article examines participants’ responses to receiving their results in a study of household exposure to endocrine disrupting compounds and other pollutants. We study how the “exposure experience” —the embodied, personal experience and understanding of chronic exposure to environmental pollutants— is shaped by community context and the report-back process itself. In addition, we investigate an activist, collective form of exposure experience. We analyze themes of expectations and learning, trust, and action. The findings reveal that while participants interpret scientific results to affirm lay knowledge of urban industrial toxics, they also absorb new information regarding other pollutant sources. By linking the public understanding of science literature to the illness and exposure experience concepts, this study unravels the complex relationship between lay experience and lay understanding of science. It also shows that to support policy development and/or social change, community-based participatory research efforts must attend to participants’ understanding of science. PMID:21673146

Community Researchers Conducting Health Disparities Research: Ethical and other insights from fieldwork journaling

PubMed Central

Mosavel, Maghboeba; Ahmed, Rashid; Daniels, Doria; Simon, Christian

2011-01-01

Lay persons who are trained to conduct research in their own communities form an essential part of many research projects. However, the effects of conducting research in their own communities have not been adequately explored. This paper examines the experiences, perceptions, and challenges faced by a group of community researchers during their involvement in a research project that examined if, and how, the relationships between mothers and their adolescent daughters could be harnessed to develop a daughter-initiated cervical cancer intervention. Seven community researchers interviewed 157 mother-daughter pairs in Cape Town, South Africa. We examine the use of journaling as a tool to document the experiences of community researchers, and we consider how journaling may help the community-based researcher grapple with the research process, and, more broadly, what such journal content illustrates with respect to the nature and challenges of community-engaged health research. An analysis of the content of the journals provides a strong indication of how personal and intimate the research process can be for community researchers by virtue of the background that they bring into the process as well as the additional weight of the research process itself. The complexities of navigating dual and somewhat oppositional roles – the role of impartial scientist or researcher and the role of invested community person - has been both underestimated and insufficiently researched. PMID:21680071

Task-shifting of CD4 T cell count monitoring by the touchscreen-based Muse™ Auto CD4/CD4% single-platform system for CD4 T cell numeration: Implication for decentralization in resource-constrained settings.

PubMed

Kouabosso, André; Mossoro-Kpinde, Christian Diamant; Bouassa, Ralph-Sydney Mboumba; Longo, Jean De Dieu; Mbeko Simaleko, Marcel; Grésenguet, Gérard; Bélec, Laurent

2018-04-01

The accuracy of CD4 T cell monitoring by the recently developed flow cytometry-based CD4 T cell counting Muse™ Auto CD4/CD4% Assay analyzer (EMD Millipore Corporation, Merck Life Sciences, KGaA, Darmstadt, Germany) was evaluated in trained lay providers against laboratory technicians. After 2 days of training on the Muse™ Auto CD4/CD4% analyzer, EDTA-blood samples from 6 HIV-positive and 4 HIV-negative individuals were used for CD4 T cell counting in triplicate in parallel by 12 trained lay providers as compared to 10 lab technicians. Mean number of CD4 T cells in absolute number was 829 ± 380 cells/μl by lay providers and 794 ± 409 cells/μl by technicians (P > 0.05); and in percentage 36.2 ± 14.8%CD4 by lay providers and 36.1 ± 15.0%CD4 by laboratory technician (P > 0.05). The unweighted linear regression and Passing-Bablok regression analyses on CD4 T cell results expressed in absolute count revealed moderate correlation between CD4 T cell counts obtained by lay providers and lab technicians. The mean absolute bias measured by Bland-Altman analysis between CD4 T cell/μl obtained by lay providers and lab technicians was -3.41 cells/μl. Intra-assay coefficient of variance (CV) of Muse™ Auto CD4/CD4% in absolute number was 10.1% by lay providers and 8.5% by lab technicians (P > 0.05), and in percentage 5.5% by lay providers and 4.4% by lab technicians (P > 0.05). The inter-assay CV of Muse™ Auto CD4/CD4% in absolute number was 13.4% by lay providers and 10.3% by lab technicians (P > 0.05), and in percentage 7.8% by lay providers and 6.9% by lab technicians (P > 0.05). The study demonstrates the feasibility of CD4 T cell counting using the alternative flow cytometer Muse™ Auto CD4/CD4% analyzer by trained lay providers and therefore the practical possibility of decentralization CD4 T cell counting to health community centers. Copyright © 2018. Published by Elsevier B.V.

Using Community-Based Participatory Research (CBPR) to Develop a Community-Level HIV Prevention Intervention for Latinas: A Local Response to a Global Challenge

PubMed Central

Rhodes, Scott D.; Kelley, Casey; Simán, Florence; Cashman, Rebecca; Alonzo, Jorge; McGuire, Jamie; Wellendorf, Teresa; Hinshaw, Kathy; Allen, Alex Boeving; Downs, Mario; Brown, Monica; Martínez, Omar; Duck, Stacy; Reboussin, Beth

2013-01-01

Introduction and Background The arsenal of interventions to reduce the disproportionate rates of HIV and sexually transmitted disease (STD) infection among Latinos in the United States lags behind what is available for other populations. The purpose of this project was to develop an intervention that builds on existing community strengths to promote sexual health among immigrant Latinas. Methods Our community-based participatory research (CBPR) partnership engaged in a multistep intervention development process. The steps were to (1) increase Latina participation in the existing partnership, (2) establish an intervention team, (3) review the existing sexual health literature, (4) explore health-related needs and priorities of Latinas, (5) narrow priorities based on what is important and changeable, (6) blend health behavior theory with Latinas’ lived experiences, (7) design an intervention conceptual model, (8) develop training modules and (9) resource materials, and (10) pretest and (11) revise the intervention. Results The MuJEReS intervention contains five modules to train Latinas to serve as lay health advisors (LHAs) known as “Comadres.” These modules synthesize locally collected data with other local and national data, blend health behavior theory with the lived experiences of immigrant Latinas, and harness a powerful existing community asset, namely, the informal social support Latinas provide one another. Conclusion This promising intervention is designed to meet the sexual health priorities of Latinas. It extends beyond HIV and STDs and frames disease prevention within a sexual health promotion framework. It builds on the strong, preexisting social networks of Latinas and the preexisting, culturally congruent roles of LHAs. PMID:22483581

Effects of labeling and interpersonal contact upon attitudes towards schizophrenia: implications for reducing mental illness stigma in urban China.

PubMed

Yang, Lawrence H; Lo, Graciete; WonPat-Borja, Ahtoy J; Singla, Daisy R; Link, Bruce G; Phillips, Michael R

2012-09-01

As mental illness stigma contributes to poor outcomes for schizophrenia in China, locating strategies to reduce public stigma is imperative. It is currently unknown whether diagnostic labeling and contact with different help-seeking sources increase or decrease public stigma in China. Further, it remains unresolved whether prior personal contact acts to reduce stigma in this context. Advancing understanding of these processes may facilitate stigma-reduction strategies. We administered an experimental vignette randomly assigning one of four labeling conditions to respondents to assess social distance towards a psychotic vignette individual in a sample of 160 Northern, urban Chinese community respondents. As expected, respondents given a "non-psychiatric, indigenous label" + "lay help-seeking" condition endorsed the least social distance. Unexpectedly, the labeling condition with a "psychiatric diagnostic label" + "lay help-seeking" condition elicited the greatest social distance. Unlike Western studies, personal contact did not independently decrease community stigma. However, prior contact reduced social distance to a greater extent in the labeling condition with a "non-psychiatric, indigenous label" + "lay help-seeking" condition when compared with all other labeling conditions. The results indicate that cultural idioms do provide some protection from stigma, but only among respondents who are already familiar with what mental illness is. Our finding that the condition that depicted untreated psychosis elicited the greatest amount of stigma, while the "treated psychosis" condition was viewed relatively benignly in China, suggests that improved access to mental health services in urban China has the potential to decrease public stigma via labeling mechanisms.

Children's Perceptions of Health and Illness: Images and Lay Concepts in Preadolescence

ERIC Educational Resources Information Center

Piko, Bettina F.; Bak, Judit

2006-01-01

Despite a growing body of research into children's concepts of illness, many basic questions still remain. This study aims to describe 8- to 11-year olds' lay beliefs of health, illness, health promotion and disease prevention. Children responded to open-ended questions about health and illness by drawing and writing their responses. Two primary…

Salud Para Su Corazon-NCLR: a comprehensive Promotora outreach program to promote heart-healthy behaviors among hispanics.

PubMed

Balcazar, Hector; Alvarado, Matilde; Hollen, Mary Luna; Gonzalez-Cruz, Yanira; Hughes, Odelinda; Vazquez, Esperanza; Lykens, Kristine

2006-01-01

This article describes results of year-1 implementation of the Salud Para Su Corazón (Health For Your Heart)-National Council of la Raza (NCLR) promotora (lay health worker) program for promoting heart-healthy behaviors among Latinos. Findings of this community outreach initiative include data from promotora pledges and self-skill behaviors, cardiovascular disease risk factors of Latino families, family heart-health education delivery, and program costs associated with promotora time. Participation included 29 trained promotoras serving 188 families from three NCLR affiliates in Escondido, California; Chicago, Illinois; and Ojo Caliente, New Mexico. Using several evaluation tools, the results showed that the promotora approach worked based on evidence obtained from the following indicators: changes in promotora's pre-post knowledge and performance skills, progress toward their pledge goals following training, recruiting and teaching families, providing follow-up, and organizing or participating in community events. Strengths and limitations of the promotora model approach are also discussed.

Improving transplantation programs and patient care.

PubMed

Shaheen, F A M; Souqiyyeh, M Z

2005-09-01

Organ transplantation is the preferred mode of replacement therapy. Currently acceptable 5-year posttransplantation survival rates are 85% for renal grafts, 70% for liver, and 65% for heart. Organ donation, however, remains a significant factor in organ transplantation, as humans are the only possible donors and the numbers of patients on waiting lists remain high. Several factors affect organ transplantation in countries in the Middle East Society for Organ Transplantation (MESOT) region, including inadequate preventive medicine, differing health infrastructures, poor awareness within the medical community and lay public regarding the importance of organ donation and transplantation, a high level of ethnicity, and poor government support of organ transplantation. Moreover, there is lack of team spirit among transplant physicians, a lack of coordination between groups that manage organ procurement and the transplant centers, and a lack of effective health insurance coverage for many persons. Three models of organ donation and transplantation exist in the MESOT region-the Saudi, Iranian, and Pakistani models. Living-organ donation, the most widely practiced form of donation in countries in the MESOT region, includes kidney and partial liver. Cadaveric organ donation has significant potential in the MESOT region. However, numerous obstacles must be overcome in MESOT countries. Resolution of these obstacles will require continuous work on many fronts. Experiences from all sources must be incorporated into new and improved models that can overcome current inadequacies. Solutions will require continued focus within the medical community, steady support from the lay public and religious institutions, as well as governmental assistance.

Abortion and public health: Time for another look

PubMed Central

McCurdy, Stephen A.

2016-01-01

Four decades after Roe v. Wade, abortion remains highly contentious, pitting a woman's right to choose against a fetal claim to life. Public health implications are staggering: the US annual total of more than one million induced abortions equals nearly half the number of registered deaths from all causes. Sentiment regarding abortion is roughly evenly split among the general public, yet fundamental debate about abortion is largely absent in the public health community, which is predominantly supportive of its wide availability. Absence of substantive debate on abortion separates the public health community from the public we serve, jeopardizing the trust placed in us. Traditional public health values—support for vulnerable groups and opposition to the politicization of science—together with the principle of reciprocity weigh against abortion. Were aborted lives counted as are other human lives, induced abortion would be acknowledged as the largest single preventable cause of loss of human life. Lay Summary: Four decades after Roe v. Wade, abortion remains highly divisive. Public sentiment regarding abortion is roughly evenly split, yet fundamental debate is largely absent in the public health community, which supports abortion’s wide availability. Absence of substantive debate separates the public health community from the public it serves. Traditional public health values—support for vulnerable populations and opposition to politicization of science—and the principle of reciprocity (“the Golden Rule”) weigh against abortion. Were aborted lives counted as are other human lives, induced abortion would be acknowledged as the largest single preventable cause of loss of human life. PMID:27833179

Self-Medication Practices among a Sample of Latino Migrant Workers in South Florida

PubMed Central

Sánchez, Jesús

2014-01-01

Introduction: Although the literature on self-medication among Latino migrant workers (LMWs) is sparse, a few existing studies indicate that this practice is common in this community. The purpose of this paper is to estimate health status, access to health care, and patterns of self-medication practices of a cohort of LMWs in South Florida. Methods: A stratified network-based sample was utilized to recruit 278 LMWs in the Homestead area. After screening for eligibility, participants were administered a structured questionnaire that collected data on their health status, access to health care services, and self-medication practices. A convenience sample of 24 LMWs, who participated in the parent study were invited back to participate in 3 focus groups to look more in depth into self-medication practices in the LMW community. Results: Study findings indicate that LMWs are affected by a vast array of health problems yet lack access to health care services. Participants already engaged in self-medication practices in the countries of origin and, upon their arrival in the US, these practices continue and, in many cases, increase. Conclusion: Long-held traditions and lack of access to the formal health care system in the US contribute to the high prevalence of self-medication among LMWs. Self-medication practices such as the use of prescription medications without a prescription and lay injection are high risk practices that can have harmful consequences. Prevention interventions that address self-medication in the LMW community are likely to be most effective if they are culturally adapted to the community and facilitate access to health care services. PMID:25140297

Telephone based self-management support by 'lay health workers' and 'peer support workers' to prevent and manage vascular diseases: a systematic review and meta-analysis.

PubMed

Small, Nicola; Blickem, Christian; Blakeman, Tom; Panagioti, Maria; Chew-Graham, Carolyn A; Bower, Peter

2013-12-27

Improved prevention and management of vascular disease is a global priority. Non-health care professionals (such as, 'lay health workers' and 'peer support workers') are increasingly being used to offer telephone support alongside that offered by conventional services, to reach disadvantaged populations and to provide more efficient delivery of care. However, questions remain over the impact of such interventions, particularly on a wider range of vascular related conditions (such as, chronic kidney disease), and it is unclear how different types of telephone support impact on outcome. This study assessed the evidence on the effectiveness and cost-effectiveness of telephone self-management interventions led by 'lay health workers' and 'peer support workers' for patients with vascular disease and long-term conditions associated with vascular disease. Systematic review of randomised controlled trials. Three electronic databases were searched. Two authors independently extracted data according to the Cochrane risk of bias tool. Random effects meta-analysis was used to pool outcome measures. Ten studies were included, primarily based in community settings in the United States; with participants who had diabetes; and used 'peer support workers' that shared characteristics with patients. The included studies were generally rated at risk of bias, as many methodological criteria were rated as 'unclear' because of a lack of information.Overall, peer telephone support was associated with small but significant improvements in self-management behaviour (SMD = 0.19, 95% CI 0.05 to 0.33, I2 = 20.4%) and significant reductions in HbA1c level (SMD = -0.26, 95% CI -0.41 to -0.11, I2 = 47.6%). There was no significant effect on mental health quality of life (SMD = 0.03, 95% CI -0.12 to 0.18, I2 = 0%). Data on health care utilisation were very limited and no studies reported cost effectiveness analyses. Positive effects were found for telephone self-management interventions via 'lay workers' and 'peer support workers' for patients on diabetes control and self-management outcomes, but the overall evidence base was limited in scope and quality. Well designed trials assessing non-healthcare professional delivered telephone support for the prevention and management of vascular disease are needed to identify the content of effective components on health outcomes, and to assess cost effectiveness, to determine if such interventions are potentially useful alternatives to professionally delivered care.

Strategies to enhance resilience post-natural disaster: a qualitative study of experiences with Australian floods and fires.

PubMed

van Kessel, Gisela; Gibbs, Lisa; MacDougall, Colin

2015-06-01

Disasters have a significant impact on mental health that may be mitigated by promoting resilience. This study explores the lay perspective on public health interventions that have the potential to facilitate resilience of adults who experience a natural disaster. Semi-structured interviews were conducted 6 months post-disaster between June 2011 and January 2012 with 19 people who experienced the 2010/11 Victorian floods. Twenty lay witness statements from people who presented to the 2009 Victorian Bushfires Royal Commission were also selected for analysis. Transcripts were analysed using an interpretive and comparative content analysis to develop an understanding of disaster resilience interventions in an ecological framework. The participants identified resilience focused interventions such as information that help individuals manage emotions and make effective decisions and plans, or enable access to resources; face-to-face communication strategies such as public events that restore or create new social connections; rebuilding of community capacity through coordination of volunteers and donations and policies that manage disaster risk. Disaster recovery interventions designed within an ecological model can promote a comprehensive integrated systems approach to support resilience in affected populations. © The Author 2014. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Application of systems thinking: 12-month postintervention evaluation of a complex health system intervention in Zambia: the case of the BHOMA.

PubMed

Mutale, Wilbroad; Ayles, Helen; Bond, Virginia; Chintu, Namwinga; Chilengi, Roma; Mwanamwenge, Margaret Tembo; Taylor, Angela; Spicer, Neil; Balabanova, Dina

2017-04-01

Strong health systems are said to be paramount to achieving effective and equitable health care. The World Health Organization has been advocating for using system-wide approaches such as 'systems thinking' to guide intervention design and evaluation. In this paper we report the system-wide effects of a complex health system intervention in Zambia known as Better Health Outcome through Mentorship and Assessment (BHOMA) that aimed to improve service quality. We conducted a qualitative study in three target districts. We used a systems thinking conceptual framework to guide the analysis focusing on intended and unintended consequences of the intervention. NVivo version 10 was used for data analysis. The addressed community responded positively to the BHOMA intervention. The indications were that in the short term there was increased demand for services but the health worker capacity was not severely affected. This means that the prediction that service demand would increase with implementation of BHOMA was correct and the workload also increased, but the help of clinic lay supporters meant that some of the work of clinicians was transferred to these lay workers. However, from a systems perspective, unintended consequences also occurred during the implementation of the BHOMA. We applied an innovative approach to evaluate a complex intervention in low-income settings, exploring empirically how systems thinking can be applied in the context of health system strengthening. Although the intervention had some positive outcomes by employing system-wide approaches, we also noted unintended consequences. © 2015 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons, Ltd.

Culturally Competent Training Program: A Key to Training Lay Health Advisors for Promoting Breast Cancer Screening

ERIC Educational Resources Information Center

Yu, Mei-yu; Song, Lixin; Seetoo, Amy; Cai, Cuijuan; Smith, Gary; Oakley, Deborah

2007-01-01

The lay health advisor (LHA) training program for breast cancer screening was conducted among Chinese-English bilingual trainees residing in Southeast Michigan. Guided by Bandura's Social Learning Theory, the development of the training curriculum followed the health communication process recommended by the National Cancer Institute. Data analysis…

Formation and Uses of Lay Advisory Groups for the Humanities. Project Report No. 14.

ERIC Educational Resources Information Center

Beckwith, Miriam M.

Based on the experiences of several community colleges, this report examines successful and unsuccessful strategies utilized in the formation of lay advisory committees for the humanities. The report first presents brief descriptions of successful committee organization efforts at five institutions: Clark College (Vancouver, WA), Brevard Community…

Socially Indigenous Help: The Community Cares for Itself.

ERIC Educational Resources Information Center

Curry, Ronald; Young, Richard D.

Recently, interest has increased in self-help groups, lay referral networks, social support networks, natural helpers, and others which may be placed under a single conceptual umbrella--socially indigenous help--because they all deal with the issue of how people use other people, social groups, and lay institutions to alleviate problems in living,…

A Case Study of Engaging Hard-to-Reach Participants in the Research Process: Community Advisors on Research Design and Strategies (CARDS)®.

PubMed

Kaiser, Betty L; Thomas, Gay R; Bowers, Barbara J

2017-02-01

Lack of diversity among study participants in clinical research limits progress in eliminating health disparities. The engagement of lay stakeholders, such as patient or community advisory boards (CABs), has the potential to increase recruitment and retention of underrepresented groups by providing a structure for gathering feedback on research plans and materials from this target population. However, many CABs intentionally recruit prominent stakeholders who are connected to or comfortable with research and academia and thus may not accurately represent the perspectives of underrepresented groups who have been labeled hard-to-reach, including racial minorities and low-income or low-literacy populations. We developed a partnership between the University of Wisconsin-Madison School of Nursing and two community centers to deliberately engage hard-to-reach people in two lay advisory groups, the Community Advisors on Research Design and Strategies (CARDS)®. Community center staff recruited the CARDS from center programs, including parenting and childcare programs, women's support groups, food pantries, and senior meal programs. The CARDS model differs from other CABs in its participants, processes, and outcomes. Since 2010, the CARDS have met monthly with nurses and other researchers, helping them understand how research processes and the language, tone, appearance, and organization of research materials can discourage people from enrolling in clinical studies. We have successfully used the CARDS model to bring hard-to-reach populations into the research process and have sustained their participation. The model represents a promising strategy for increasing the diversity of participants in clinical research. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

Recruitment, training outcomes, retention, and performance of community health advisors in two tobacco control interventions for Latinos.

PubMed

Woodruff, Susan I; Candelaria, Jeanette I; Elder, John P

2010-04-01

Community Health Advisors (CHAs) are indigenous lay health advisors who, with training, can create health awareness, disseminate health information and support behavior change in their communities. Little data are available that describe the characteristics, recruitment, training, retention, and performance of CHAs. The present study described the characteristics, recruitment process, training outcomes, retention activities, and performance of two sets of CHAs who delivered tobacco-related interventions in the local Latino community. The Tobacco Control in Latino Communities (TCLC) Center trained 35 CHAs to conduct either a smoking cessation program for Spanish-speaking adult smokers or a behavioral problem-solving intervention to reduce environmental tobacco smoke (ETS) exposure among low-income Latino children. Theoretical psychosocial constructs related to behavior change, general self-esteem, general self-efficacy, and demographics were collected from CHAs before and after training. Additional measures captured the level of professionalism exercised and effort undertaken by the CHAs, as well actual outcomes of their efforts. Of the 33 women and 2 men CHAs recruited, 86% were originally from Mexico, most had a high school education, most were married, and the average monthly household income was $1,100-$1,400. Mean participant age was 42 years, and level of acculturation was relatively low. There were changes in the desired direction pre-to-post training for both ETS and smoking cessation program CHAs for most of the psychosocial constructs. Expert ratings of CHA performance were good, and recipients of the CHAs' efforts showed positive changes in behavior. This information may aid in planning for recruitment and evaluation of CHAs for future tobacco control programs.

Primary health care nurses implement and evaluate a community outreach approach to health care in the South African agricultural sector.

PubMed

Dick, J; Clarke, M; van Zyl, H; Daniels, K

2007-12-01

Early detection and effective case management of tuberculosis (TB) among a high-risk group of materially poor farm workers in an area of the Cape Winelands, South Africa, presents special challenges to the health community, where resource constraints lead to service reduction. In order to address this problem, local nurses established a collaborative partnership between permanent farm workers and their families, their employers, selected non-governmental organizations and the public health sector. In consultation with stakeholders, they developed an intervention primarily focusing on having peer selected trained lay health workers (LHWs) on farms, mentored and managed by nurses. To describe the complex process of implementation and evaluation of the LHW project, and provide a summary of a number of discrete studies evaluating the effectiveness, cost implications, and the perceptions and experiences of key stakeholders of the intervention. Quantitative and qualitative research methods conducted within the context of a pragmatic unblinded community cluster randomized control trial were used. Emphasis was placed on an iterative participatory interaction between the researchers and key stakeholders. The intervention contributed to significantly better successful treatment completion rates among adult new smear-positive TB cases. The process implemented proved cost-effective and was pivotal in initiating a community-based social development programme. The use of peer-selected LHWs within a wider programme of integrated care designed to merge technical biomedical approaches to disease management with more holistic social development activities, appears essential to meet the complex health needs in conjunction with public health of the rural poor.

Power to the people: To what extent has public involvement in applied health research achieved this?

PubMed

Green, Gill

2016-01-01

Public involvement is required for applied health research funded in the UK. One of the largest funders, the National Institute of Health Research (NIHR), makes it clear that it values the knowledge of patients and the public. As a result, there are now many resources to make sure that the public voice is included in decision-making about research. However, there is concern that the public voice still has limited impact on research decision-making. This article asks to what extent has power shifted from the scientific research community to the public? It looks at how much power and impact patients and members of the public have about research by asking: How do the public contribute to deciding which research areas and which research projects should be funded? How do they influence how the research is carried out? The article argues that there is evidence that the public voice is present in research decision-making. However, there is less evidence of a change in the power dynamic between the scientific research community and the public. The public involved in research are not always equal partners. The scientific research community still has the loudest voice and patients and the public do not always feel sufficiently empowered to challenge it. Public involvement in applied health research is a pre-requisite for funding from many funding bodies. In particular the National Institute of Health Research (NIHR) in the UK, clearly states that it values lay knowledge and there is an expectation that members of the public will participate as research partners in research. As a result a large public involvement infrastructure has emerged to facilitate this. However, there is concern that despite the flurry of activity in promoting public involvement, lay knowledge is marginalised and has limited impact on research decision-making. This article asks to what extent has power shifted from the scientific research community to the public? It discusses the meaning of power and models of public involvement and examines the development of public involvement in applied health research. It identifies public involvement in a range of decision-making: identifying priority areas for commissioning research; making decisions about which projects are funded; decisions about details of research design. Whilst there is evidence that the public voice is present in the composition of research proposals submitted to NIHR and in the decision-making about which projects are funded and how they are carried out, there is less evidence of a change in the power dynamic manifest in social relations between the scientific research community and the public. As a result the biomedical model remains dominant and largely unchallenged in research decision-making.

Protegiendo Nuestra Comunidad: empowerment participatory education for HIV prevention.

PubMed

McQuiston, C; Choi-Hevel, S; Clawson, M

2001-10-01

To be effective, HIV/AIDS interventions must be culturally and linguistically appropriate and must occur within the context of the specific community in which they are delivered. In this article, the development of a culture-specific lay health advisor (LHA) program, Protegiendo Nuestra Comunidad, for recently immigrated Mexicans is described. This program is one component of a collaborative inquiry research project involving community participants and researchers working as partners in carrying out and assessing a program for the prevention of HIV/AIDS. The collaborative inquiry process was applied as an empowerment philosophy and methodology of Paulo Freire and an ecological framework was used for the development of Protegiendo Nuestra Comunidad. The use of principles of empowerment for curriculum development, teaching methodology, and program delivery are described.

Disaster averted: Community resilience in the face of a catastrophic flood.

PubMed

O'Neill, H Katherine; McLean, Andrew J; Kalis, Renetta; Shultz, James M

2016-01-01

In the spring of 2009, the Fargo, North Dakota, metropolitan area had 5 days to lay millions of sandbags to avoid devastation from record flooding of the Red River of the North. The community was able to successfully mitigate the flooding and escape potentially catastrophic economic, physical, and mental health consequences. We hypothesized that Fargo flood protection efforts reflected the community resilience factors proposed by Norris, Stevens, Pfefferbaum, et al. (2008): citizen involvement in mitigation efforts, effective organizational linkages, ongoing psychosocial support, and strong civic leadership in the face of rapidly changing circumstances. This community case report utilizes an extensive review of available sources, including news reports, government documents, research articles, and personal communication. Results demonstrate that Fargo's response to the threat of catastrophic flooding was consistent with Norris et al.'s (2008) factors of community resilience. Furthermore, success in 2009 carried over into future flood prevention and response efforts, as well as a structured approach to building psychological resilience. This case study contributes to the literature on community resilience by describing a community's successful efforts to avert a potentially catastrophic disaster.

Disaster averted: Community resilience in the face of a catastrophic flood

PubMed Central

O'Neill, H. Katherine; McLean, Andrew J.; Kalis, Renetta; Shultz, James M.

2016-01-01

ABSTRACT In the spring of 2009, the Fargo, North Dakota, metropolitan area had 5 days to lay millions of sandbags to avoid devastation from record flooding of the Red River of the North. The community was able to successfully mitigate the flooding and escape potentially catastrophic economic, physical, and mental health consequences. We hypothesized that Fargo flood protection efforts reflected the community resilience factors proposed by Norris, Stevens, Pfefferbaum, et al. (2008): citizen involvement in mitigation efforts, effective organizational linkages, ongoing psychosocial support, and strong civic leadership in the face of rapidly changing circumstances. This community case report utilizes an extensive review of available sources, including news reports, government documents, research articles, and personal communication. Results demonstrate that Fargo's response to the threat of catastrophic flooding was consistent with Norris et al.'s (2008) factors of community resilience. Furthermore, success in 2009 carried over into future flood prevention and response efforts, as well as a structured approach to building psychological resilience. This case study contributes to the literature on community resilience by describing a community's successful efforts to avert a potentially catastrophic disaster. PMID:28229016

HIV in Indian MSM: reasons for a concentrated epidemic & strategies for prevention.

PubMed

Thomas, Beena; Mimiaga, Matthew J; Kumar, Senthil; Swaminathan, Soumya; Safren, Steven A; Mayer, Kenneth H

2011-12-01

Men who have sex with men (MSM) in India are disproportionately likely to be HIV-infected, and face distinct psychosocial challenges. Understanding the unique socio-cultural issues of MSM in India and how they relate to HIV risk could maximize the utility of future prevention efforts. This review discusses: (i) the importance of addressing co-occurring mental health issues, such as depression, which may interfere with MSM's ability to benefit from traditional risk reduction counselling, (ii) reducing HIV-related stigma among health providers, policymakers and the lay public, and (iii) the role for non-governmental organizations that work with the community to play in providing culturally relevant HIV prevention programmes for MSM.

School Health: an essential strategy in promoting community resilience and preparedness for natural disasters.

PubMed

Takahashi, Kenzo; Kodama, Mitsuya; Gregorio, Ernesto R; Tomokawa, Sachi; Asakura, Takashi; Waikagul, Jitra; Kobayashi, Jun

2015-01-01

The Third UN World Conference on Disaster Risk Reduction recommended the implementation of the Sendai Framework for Disaster Risk Reduction 2015-2030, which aims to achieve substantial risk reduction and to avoid various disaster-associated losses, including human lives and livelihoods, based on the lessons from the implementation of the Hyogo framework. However, the recommendations did not lay enough stress on the school and the Safe School Concept, which are the core components of a disaster response. To raise the issue of the importance of schools in disaster response. For human capacity building to avoid the damage caused by natural disasters, we should focus on the function of schools in the community and on school health framework. Schools perform a range of functions, which include being a landmark place for evacuation, acting as a participatory education hub among communities (students are usually from the surrounding communities), and being a sustainable source of current disaster-related information. In 2007, the Bangkok Action Agenda (BAA) on school education and disaster risk reduction (DRR) recommended the integration of DRR into education policy development, the enhancement of participatory mechanisms to improve DRR education, and the extension of DRR education from schools to communities. Based on our discussion and the recommendations of the BAA, we suggest that our existing challenges are to construct a repository of disaster-related lessons, develop training materials based on current information drawn from previous disasters, and disseminate the training to schools and communities. Schools linked with school health can provide good opportunities for DRR with a focus on development of school health policy and a community-oriented participatory approach.

In search of the cancer candidate: can lay epidemiology help?

PubMed

Macdonald, Sara; Watt, Graham; Macleod, Una

2013-05-01

First published in 1991, the ideas embedded in 'Lay epidemiology and the prevention paradox' offered a novel and rational explanation for the lay public's failure to fully engage with the lifestyle messages offered by health educators. During the course of a large ethnographic study in South Wales, Davison and colleagues described the emergence of what they termed the coronary candidate. Candidacy provides a 'cultural mechanism' that facilitates the estimation of risk for coronary heart disease. The model has rarely been applied to other major illnesses. This article presents findings from a study that sought to explore the lay epidemiology model, candidacy and cancer. In a series of in-depth individual interviews, members of the lay public discussed their ideas about cancer, and what emerged was an explanatory hierarchy to account for cancer events. Yet the random and unpredictable nature of cancer was emphasised as well as a general reluctance to accept the idea of cancer candidacy. © 2012 The Authors. Sociology of Health & Illness © 2012 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

Program Guide for Brick and Block Laying 8721200 (IN46.011200) and Masonry BCT0400 (IN46.010200).

ERIC Educational Resources Information Center

University of South Florida, Tampa. Dept. of Adult and Vocational Education.

This competency-based program guide provides course content information and procedures for secondary schools, postsecondary vocational schools, and community colleges in Florida that conduct programs in brick and block laying and masonry. The first section is on legal authority, which applies to all vocational education programs in Florida. The…

Public and patient involvement in needs assessment and social innovation: a people-centred approach to care and research for congenital disorders of glycosylation.

PubMed

de Freitas, Cláudia; Dos Reis, Vanessa; Silva, Susana; Videira, Paula A; Morava, Eva; Jaeken, Jaak

2017-09-26

Public and patient involvement in the design of people-centred care and research is vital for communities whose needs are underserved, as are people with rare diseases. Innovations devised collectively by patients, caregivers, professionals and other members of the public can foster transformative change toward more responsive services and research. However, attempts to involve lay and professional stakeholders in devising community-framed strategies to address the unmet needs of rare diseases are lacking. In this study, we engaged with the community of Congenital Disorders of Glycosylation (CDG) to assess its needs and elicit social innovations to promote people-centred care and research. Drawing on a qualitative study, we conducted three think tanks in France with a total of 48 participants, including patients/family members (n = 18), health care professionals (n = 7), researchers (n = 7) and people combining several of these roles (n = 16). Participants came from 20 countries across five continents. They were selected from the registry of the Second World Conference on CDG through heterogeneity and simple random sampling. Inductive and deductive approaches were employed to conduct interpretational analysis using open, axial and selective coding, and the constant-comparison method to facilitate the emergence of categories and core themes. The CDG community has unmet needs for information, quality health care, psychosocial support and representation in decision-making concerned with care and research. According to participants, these needs can be addressed through a range of social innovations, including peer-support communities, web-based information resources and a CDG expertise platform. This is one of the few studies to engage lay and professional experts in needs assessment and innovation for CDG at a global level. Implementing the innovations proposed by the CDG community is likely to have ethical, legal and social implications associated with the potential donation of patients' clinical and biological material that need to be assessed and regulated with involvement from all stakeholders. To promote people-centred care for the CDG community, and increase its participation in the governance of care and research, it is necessary to create participatory spaces in which the views of people affected by CDG can be fully expressed.

Impact of the lay-off length on +Gz tolerance.

PubMed

Mikuliszyn, Romuald; Kowalski, Wieslaw; Kowalczuk, Krzysztof

2002-07-01

There are many factors affecting pilots' +Gz-tolerance. Recently, attention of the aviation community has been focused on lay-off and it's impact on +Gz-tolerance. Pilots of the Polish Air Force (PAF) have dealt with that problem for several years now. The aim of the study was to provide insight on how lay-off periods with different duration impact +Gz-tolerance. 95 male jet pilots from the PAF participated in the study. Every one had at least two weeks lay-off period (non-medical reasons). Subjects were divided into four groups according to the length of lay-off period (2-4 weeks; 5-13 weeks; 14-26 weeks; 27-154 weeks), All pilots were subjected to a centrifuge exposure in GOR (0.1 G/s) or ROR (1.0 G/s) profiles, depending on the pre-lay-off exposure. Post-lay-off exposures were carried out directly after lay-off. 18 jet pilots without any lay-off constituted the control group. The difference between pre- and post-lay-off G-tolerance limit (-0,93 +/- 0,53) was statistically significant (p<0.01) only for one group, where lay-off period ranged between two and four weeks. No statistically significant differences were found where influence of other factors like total and yearly flight hours, heart rate gain (AHR) or physical activity measured as maximal oxygen intake were considered. 2-4 weeks of lay-off period decreases +Gz tolerance is statistically significant manner. Subsequent increase of lay-off period does not result in mean tolerance changes for group, however in certain individuals critical decrement of +Gz tolerance occurs. Total and last year flying hours, physical fitness does not modify impact of lay-off period on +Gz tolerance.

Effects of labeling and interpersonal contact upon attitudes towards schizophrenia: implications for reducing mental illness stigma in urban China

PubMed Central

Lo, Graciete; WonPat-Borja, Ahtoy J.; Singla, Daisy R.; Link, Bruce G.; Phillips, Michael R.

2013-01-01

Purpose As mental illness stigma contributes to poor outcomes for schizophrenia in China, locating strategies to reduce public stigma is imperative. It is currently unknown whether diagnostic labeling and contact with different help-seeking sources increase or decrease public stigma in China. Further, it remains unresolved whether prior personal contact acts to reduce stigma in this context. Advancing understanding of these processes may facilitate stigma-reduction strategies. Methods We administered an experimental vignette randomly assigning one of four labeling conditions to respondents to assess social distance towards a psychotic vignette individual in a sample of 160 Northern, urban Chinese community respondents. Results As expected, respondents given a “non-psychiatric, indigenous label” + “lay help-seeking” condition endorsed the least social distance. Unexpectedly, the labeling condition with a “psychiatric diagnostic label” + “lay help-seeking” condition elicited the greatest social distance. Unlike Western studies, personal contact did not independently decrease community stigma. However, prior contact reduced social distance to a greater extent in the labeling condition with a “non-psychiatric, indigenous label” + “lay help-seeking” condition when compared with all other labeling conditions. Conclusion The results indicate that cultural idioms do provide some protection from stigma, but only among respondents who are already familiar with what mental illness is. Our finding that the condition that depicted untreated psychosis elicited the greatest amount of stigma, while the “treated psychosis” condition was viewed relatively benignly in China, suggests that improved access to mental health services in urban China has the potential to decrease public stigma via labeling mechanisms. PMID:22075964

Age-Related Variations in Intestinal Microflora of Free-Range and Caged Hens.

PubMed

Cui, Yizhe; Wang, Qiuju; Liu, Shengjun; Sun, Rui; Zhou, Yaqiang; Li, Yue

2017-01-01

Free range feeding pattern puts the chicken in a mixture of growth materials and enteric bacteria excreted by nature, while it is typically unique condition materials and enteric bacteria in commercial caged hens production. Thus, the gastrointestinal microflora in two feeding patterns could be various. However, it remains poorly understood how feeding patterns affect development and composition of layer hens' intestinal microflora. In this study, the effect of feeding patterns on the bacteria community in layer hens' gut was investigated using free range and caged feeding form. Samples of whole small intestines and cecal digesta were collected from young hens (8-weeks) and mature laying hens (30-weeks). Based on analysis using polymerase chain reaction-denaturing gradient gel electrophoresis and sequencing of bacterial 16S rDNA gene amplicons, the microflora of all intestinal contents were affected by both feeding patterns and age of hens. Firmicutes, Bacteroidetes, Actinobacteria, Proteobacteria, and Fusobacteria were the main components. Additionally, uncultured environmental samples were found too. There were large differences between young hens and adult laying hens, the latter had more Firmicutes and Bacteroidetes, and bacterial community is more abundant in 30-weeks laying hens of all six phyla than 8-weeks young hens of only two phyla. In addition, the differences were also observed between free range and caged hens. Free range hens had richer Actinobacteria, Bacteroidetes, and Proteobacteria. Most of strains found were detected more abundant in small intestines than in cecum. Also the selected Lactic acid bacteria from hens gut were applied in feed and they had beneficial effects on growth performance and jejunal villus growth of young broilers. This study suggested that feeding patterns have an importance effect on the microflora composition of hens, which may impact the host nutritional status and intestinal health.

Explanatory models of diabetes in the U.S. and Mexico: the patient-provider gap and cultural competence.

PubMed

Weller, Susan C; Baer, Roberta D; Garcia de Alba Garcia, Javier; Salcedo Rocha, Ana L

2012-09-01

Successful management of type 2 diabetes requires support and collaboration between diabetic patients, their health care providers, family and community. Using data collected in 1994-2001, we describe illness beliefs of physicians, patients, and representative samples of community members in the US and Mexico. We test whether differences in conceptualizations of diabetes are greater across national and linguistic boundaries or between physicians and lay groups. Interviews were conducted in southern Texas on the Mexican border and in Guadalajara, Mexico. Culturally appropriate interview materials were developed with a mixed-methods approach. Qualitative interviews elicited beliefs about causes, risks, symptoms, and treatments for diabetes and salient themes were incorporated into structured interviews. A cultural consensus analysis was used to verify salient themes within each of the six samples. The consistency in responses in each of the six samples indicated a shared core of beliefs that transcended individual variations. The greatest differences occurred between physician and lay samples; patient and community models were more similar to one another than to the physician models. Differences between physicians and patients may affect optimal management of diabetes, but these differences do not appear to be simply a function of differences in national culture and language, as the largest differences occurred in Mexico. This suggests that rather than cultural competence per se, formal educational levels and class differences may also play an important role in patient understanding and the gap in patient-provider understanding. Copyright © 2012 Elsevier Ltd. All rights reserved.

A new spin on research translation: the Boston Consensus Conference on Human Biomonitoring.

PubMed

Nelson, Jessica W; Scammell, Madeleine Kangsen; Altman, Rebecca Gasior; Webster, Thomas F; Ozonoff, David M

2009-04-01

Translating research to make it more understandable and effective (research translation) has been declared a priority in environmental health but does not always include communication to the public or residents of communities affected by environmental hazards. Their unique perspectives are also commonly missing from discussions about science and technology policy. The consensus conference process, developed in Denmark, offers a way to address this gap. The Boston Consensus Conference on Human Biomonitoring, held in Boston, Massachusetts, in the fall of 2006, was designed to educate and elicit input from 15 Boston-area residents on the scientifically complex topic of human biomonitoring for environmental chemicals. This lay panel considered the many ethical, legal, and scientific issues surrounding biomonitoring and prepared a report expressing their views. The lay panel's findings provide a distinct and important voice on the expanding use of biomonitoring. In some cases, such as a call for opt-in reporting of biomonitoring results to study participants, they mirror recommendations raised elsewhere. Other conclusions have not been heard previously, including the recommendation that an individual's results should be statutorily exempted from the medical record unless permission is granted, and the opportunity to use biomonitoring data to stimulate green chemistry. The consensus conference model addresses both aspects of a broader conception of research translation: engaging the public in scientific questions, and bringing their unique perspectives to bear on public health research, practice, and policy. In this specific application, a lay panel's recommendations on biomonitoring surveillance, communication, and ethics have practical implications for the conduct of biomonitoring studies and surveillance programs.

Training of Lay Health Educators to Implement an Evidence-Based Behavioral Weight Loss Intervention in Rural Senior Centers

ERIC Educational Resources Information Center

Krukowski, Rebecca A.; Lensing, Shelly; Love, ShaRhonda; Prewitt, T. Elaine; Adams, Becky; Cornell, Carol E.; Felix, Holly C.; West, Delia

2013-01-01

Purpose of the Study: Lay health educators (LHEs) offer great promise for facilitating the translation of evidence-based health promotion programs to underserved areas; yet, there is little guidance on how to train LHEs to implement these programs, particularly in the crucial area of empirically validated obesity interventions. Design and Methods:…

Life course experiences and lay diagnosis explain low-income parents' child dental decisions: a qualitative study.

PubMed

Muirhead, Vanessa; Levine, Alissa; Nicolau, Belinda; Landry, Anne; Bedos, Christophe

2013-02-01

This study aimed to better understand low-income parents' child dental care decisions through a life course approach that captured parents' experiences within the social context of poverty. We conducted 43 qualitative life history interviews with 10 parents, who were long-term social assistance recipients living in Montreal, Canada. Thematic analysis involved interview debriefing, transcript coding, theme identification and data interpretation. Our interviews identified two emergent themes: lay diagnosis and parental oral health management. Parents described a process of 'lay diagnosis' that consisted of examining their children's teeth and interpreting their children's oral signs and symptoms based on their observations. These lay diagnoses were also shaped by their own dental crises, care experiences and oral health knowledge gained across a life course of poverty and dental disadvantage. Parents' management strategies included monitoring and managing their children's oral health themselves or by seeking professional recourse. Parents' management strategies were influenced both by their lay diagnoses and their perceived ability to manage their children's oral health. Parents felt responsible for their children's dental care, empowered to manage their oral health and sometimes forgo dental visits for their children because of their own self-management life history. This original approach revealed insights that help to understand why low-income parents may underutilize free dental services. Further research should consider how dental programs can nurture parental empowerment and capitalize on parents' perceived ability to diagnose and manage their children's oral health.

After epidemiological research: what next? Community action for health promotion.

PubMed

Cwikel, J G

1994-01-01

The underlying purpose of all epidemiological research is ultimately to use inferences in order to prevent disease and promote health and well-being. Effective skills in translating results into appropriate policy, programs, and interventions are inherently tricky, and often politically controversial. Generally they are not taught to epidemiologists formally, even though they are a traditionally part of public health practice. To move from findings to policy change requires that the informed and committed epidemiologist should known how to: (1) organize affected parties to negotiate successfully with government and industry; (2) activate populations at risk to protect their health (3) communicate responsibly with lay persons about their health risks so as to encourage effective activism; (4) collaborate with other professionals to achieve disease prevention and health promotion goals. The paper presents and discusses four case studies to illustrate these strategies: (1) the grass-roots social action that was the response of the community to the environmental contamination at Love Canal, New York; (2) mobilization of recognized leaders within the gay community to disseminate HIV risk reduction techniques; (3) collaboration with an existing voluntary organization interested in community empowerment through health promotion in a Chicago slum by using existing hospital, emergency room admissions, and local motor vehicle accident data; (4) a self-help group, MADD (mothers against drunk driving) which fought to change public policy to limit and decrease drunk driving. In addition, the importance of multidisciplinary collaboration and responsible communication with the public is emphasized. Factors that limit the ability of the epidemiologist to move into public health action are discussed, including who owns the research findings, what is the degree of scientific uncertainty, and the cost-benefit balance of taking affirmative public action. Putting epidemiological knowledge to good use should be an integral part of an epidemiologist's repertoire.

The acceptability, feasibility and impact of a lay health counsellor delivered health promoting schools programme in India: a case study evaluation

PubMed Central

2012-01-01

Background Studies in resource-limited settings have shown that there are constraints to the use of teachers, peers or health professionals to deliver school health promotion interventions. School health programmes delivered by trained lay health counsellors could offer a cost-effective alternative. This paper presents a case study of a multi-component school health promotion intervention in India that was delivered by lay school health counsellors, who possessed neither formal educational nor health provider qualifications. Methods The intervention was based on the WHO’s Health Promoting Schools framework, and included health screening camps; an anonymous letter box for student questions and complaints; classroom-based life skills training; and, individual psycho-social and academic counselling for students. The intervention was delivered by a lay school health counsellor who had attained a minimum of a high school education. The counsellor was trained over four weeks and received structured supervision from health professionals working for the implementing NGO. The evaluation design was a mixed methods case study. Quantitative process indicators were collected to assess the extent to which the programme was delivered as planned (feasibility), the uptake of services (acceptability), and the number of students who received corrective health treatment (evidence of impact). Semi-structured interviews were conducted over two years with 108 stakeholders, and were analysed to identify barriers and facilitators for the programme (feasibility), evaluate acceptability, and gather evidence of positive or negative effects of the programme. Results Feasibility was established by the high reported coverage of all the targeted activities by the school health counsellor. Acceptability was indicated by a growing number of submissions to the students’ anonymous letter-box; more students self-referring for counselling services over time; and, the perceived need for the programme, as expressed by principals, parents and students. A minority of teachers complained that there was inadequate information sharing about the programme and mentioned reservations about the capacities of the lay health counsellor. Preliminary evidence of the positive effects of the programme included the correction of vision problems detected in health screening camps, and qualitative evidence of changes in health-related knowledge and behaviour of students. Conclusion A task-shifting approach of delegating school health promotion activities to lay school health counsellors rather than education or health professionals shows promise of effectiveness as a scalable model for promoting the health and well being of school based adolescents in resource constrained settings. PMID:22630607

The acceptability, feasibility and impact of a lay health counsellor delivered health promoting schools programme in India: a case study evaluation.

PubMed

Rajaraman, Divya; Travasso, Sandra; Chatterjee, Achira; Bhat, Bhargav; Andrew, Gracy; Parab, Suraj; Patel, Vikram

2012-05-25

Studies in resource-limited settings have shown that there are constraints to the use of teachers, peers or health professionals to deliver school health promotion interventions. School health programmes delivered by trained lay health counsellors could offer a cost-effective alternative. This paper presents a case study of a multi-component school health promotion intervention in India that was delivered by lay school health counsellors, who possessed neither formal educational nor health provider qualifications. The intervention was based on the WHO's Health Promoting Schools framework, and included health screening camps; an anonymous letter box for student questions and complaints; classroom-based life skills training; and, individual psycho-social and academic counselling for students. The intervention was delivered by a lay school health counsellor who had attained a minimum of a high school education. The counsellor was trained over four weeks and received structured supervision from health professionals working for the implementing NGO. The evaluation design was a mixed methods case study. Quantitative process indicators were collected to assess the extent to which the programme was delivered as planned (feasibility), the uptake of services (acceptability), and the number of students who received corrective health treatment (evidence of impact). Semi-structured interviews were conducted over two years with 108 stakeholders, and were analysed to identify barriers and facilitators for the programme (feasibility), evaluate acceptability, and gather evidence of positive or negative effects of the programme. Feasibility was established by the high reported coverage of all the targeted activities by the school health counsellor. Acceptability was indicated by a growing number of submissions to the students' anonymous letter-box; more students self-referring for counselling services over time; and, the perceived need for the programme, as expressed by principals, parents and students. A minority of teachers complained that there was inadequate information sharing about the programme and mentioned reservations about the capacities of the lay health counsellor. Preliminary evidence of the positive effects of the programme included the correction of vision problems detected in health screening camps, and qualitative evidence of changes in health-related knowledge and behaviour of students. A task-shifting approach of delegating school health promotion activities to lay school health counsellors rather than education or health professionals shows promise of effectiveness as a scalable model for promoting the health and well being of school based adolescents in resource constrained settings.

Using a digital storytelling assignment to teach public health advocacy.

PubMed

de Castro, A B; Levesque, Salem

2018-03-01

The need and expectation for advocacy is central to public health nursing practice. Advocacy efforts that effectively call attention to population health threats and promote the well-being of communities rely on strategies that deliver influential messaging. The digital story is a lay method to capture meaningful, impactful stories that can be used to advocate for public health concerns. Readily available, user-friendly digital technologies allow engagement in digital media production to create digital stories. This paper describes how digital story making can be utilized as an academic assignment to teach public health advocacy within an undergraduate nursing curriculum. Providing nursing students this artistic outlet can facilitate meeting academic learning goals, while also equipping them with creative skills that can be applied in future professional practice. Nursing educators can take advantage of institutional resources and campus culture to support the use of novel digital media assignments that facilitate application of advocacy concepts. © 2017 Wiley Periodicals, Inc.

Creating Nurturing Environments: A Science-Based Framework for Promoting Child Health and Development within High-Poverty Neighborhoods

PubMed Central

Komro, Kelli A.; Flay, Brian R.; Biglan, Anthony

2013-01-01

Living in poverty and living in areas of concentrated poverty pose multiple risks for child development and for overall health and wellbeing. Poverty is a major risk factor for several mental, emotional, and behavioral disorders, as well as for other developmental challenges and physical health problems. In this paper, the Promise Neighborhoods Research Consortium describes a science-based framework for the promotion of child health and development within distressed high-poverty neighborhoods. We lay out a model of child and adolescent developmental outcomes, and integrate knowledge of potent and malleable influences to define a comprehensive intervention framework to bring about a significant increase in the proportion of young people in high-poverty neighborhoods who will develop successfully. Based on a synthesis of research from diverse fields, we designed the Creating Nurturing Environments framework to guide community-wide efforts to improve child outcomes and reduce health and educational inequalities. PMID:21468644

Contributions of Peer Support to Health, Health Care, and Prevention: Papers from Peers for Progress.

PubMed

Fisher, Edwin B; Ayala, Guadalupe X; Ibarra, Leticia; Cherrington, Andrea L; Elder, John P; Tang, Tricia S; Heisler, Michele; Safford, Monika M; Simmons, David

2015-08-01

SUBSTANTIAL: evidence documents the benefits of peer support provided by community health workers, lay health advisors, promotores de salud, and others. The papers in this supplement, all supported by the Peers for Progress program of the American Academy of Family Physicians Foundation, contribute to the growing body of literature addressing the efficacy, effectiveness, feasibility, reach, sustainability, and adoption of peer support for diabetes self-management. They and additional papers supported by Peers for Progress contribute to understanding how peer support can be implemented in real world settings. Topics include examination of the peers who provide peer support, reaching the hardly reached, success factors in peer support interventions, proactive approaches, attention to emotions, peer support in behavioral health, dissemination models and their application in China, peer support in the patient-centered medical home, research challenges, and policy implications. © 2015 Annals of Family Medicine, Inc.

Improvement of Rural Children's Asthma Self-Management by Lay Health Educators

ERIC Educational Resources Information Center

Horner, Sharon D.; Fouladi, Rachel T.

2008-01-01

Background: The purpose of the present analysis is to examine changes in rural children's asthma self-management after they received lay health educator (LHE)-delivered classes. Methods: Elementary schools were randomly assigned to the treatment or attention-control condition and their participating students received either asthma education or…

30 CFR 56.19024 - Retirement criteria.

Code of Federal Regulations, 2012 CFR

2012-07-01

... lay rope, more than one broken wire in the valley between strands in one rope lay length. (c) A loss... SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-SURFACE METAL AND NONMETAL MINES Personnel Hoisting Wire Ropes § 56.19024 Retirement criteria. Unless damage or deterioration is removed by cutoff, wire ropes...

30 CFR 56.19024 - Retirement criteria.

Code of Federal Regulations, 2011 CFR

2011-07-01

... lay rope, more than one broken wire in the valley between strands in one rope lay length. (c) A loss... SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-SURFACE METAL AND NONMETAL MINES Personnel Hoisting Wire Ropes § 56.19024 Retirement criteria. Unless damage or deterioration is removed by cutoff, wire ropes...

30 CFR 56.19024 - Retirement criteria.

Code of Federal Regulations, 2014 CFR

2014-07-01

... lay rope, more than one broken wire in the valley between strands in one rope lay length. (c) A loss... SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-SURFACE METAL AND NONMETAL MINES Personnel Hoisting Wire Ropes § 56.19024 Retirement criteria. Unless damage or deterioration is removed by cutoff, wire ropes...

30 CFR 56.19024 - Retirement criteria.

Code of Federal Regulations, 2013 CFR

2013-07-01

... lay rope, more than one broken wire in the valley between strands in one rope lay length. (c) A loss... SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-SURFACE METAL AND NONMETAL MINES Personnel Hoisting Wire Ropes § 56.19024 Retirement criteria. Unless damage or deterioration is removed by cutoff, wire ropes...

Treatment Adherence in a Lay Health Adviser Intervention to Treat Tobacco Dependence

ERIC Educational Resources Information Center

Hood, N. E.; Ferketich, A. K.; Paskett, E. D.; Wewers, M. E.

2013-01-01

Lay health advisers (LHAs) are increasingly used to deliver tobacco dependence treatment, especially with low-socioeconomic status (SES) populations. More information is needed about treatment adherence to help interpret mixed evidence of LHA intervention effectiveness. This study examined adherence to behavioral counseling and nicotine patches in…

Lay Patient Navigators' Perspectives of Barriers, Facilitators and Training Needs in Initiating Advance Care Planning Conversations With Older Patients With Cancer.

PubMed

Niranjan, Soumya J; Huang, Chao-Hui S; Dionne-Odom, J Nicholas; Halilova, Karina I; Pisu, Maria; Drentea, Patricia; Kvale, Elizabeth A; Bevis, Kerri S; Butler, Thomas W; Partridge, Edward E; Rocque, Gabrielle B

2018-04-01

Respecting Choices is an evidence-based model of facilitating advance care planning (ACP) conversations between health-care professionals and patients. However, the effectiveness of whether lay patient navigators can successfully initiate Respecting Choices ACP conversations is unknown. As part of a large demonstration project (Patient Care Connect [PCC]), a cohort of lay patient navigators underwent Respecting Choices training and were tasked to initiate ACP conversations with Medicare beneficiaries diagnosed with cancer. This article explores PCC lay navigators' perceived barriers and facilitators in initiating Respecting Choices ACP conversations with older patients with cancer in order to inform implementation enhancements to lay navigator-facilitated ACP. Twenty-six lay navigators from 11 PCC cancer centers in 4 states (Alabama, George, Tennessee, and Florida) completed in-depth, one-on-one semistructured interviews between June 2015 and August 2015. Data were analyzed using a thematic analysis approach. This evaluation identifies 3 levels-patient, lay navigator, and organizational factors in addition to training needs that influence ACP implementation. Key facilitators included physician buy-in, patient readiness, and navigators' prior experience with end-of-life decision-making. Lay navigators' perceived challenges to initiating ACP conversations included timing of the conversation and social and personal taboos about discussing dying. Our results suggest that further training and health system support are needed for lay navigators playing a vital role in improving the implementation of ACP among older patients with cancer. The lived expertise of lay navigators along with flexible longitudinal relationships with patients and caregivers may uniquely position this workforce to promote ACP.

Interventions to Improve Care for Patients with Limited Health Literacy

PubMed Central

Sudore, Rebecca L.; Schillinger, Dean

2009-01-01

Objective To propose a framework and describe best practices for improving care for patients with limited health literacy (LHL). Methods Review of the literature. Results Approximately half of the U.S. adult population has LHL. Because LHL is associated with poor health outcomes and contributes to health disparities, the adoption of evidence-based best practices is imperative. Feasible interventions at the clinician-patient level (eg, patient-centered communication, clear communication techniques, teach-to-goal methods, and reinforcement), at the system-patient level (eg, clear health education materials, visual aids, clear medication labeling, self-management support programs, and shame-free clinical environments), and at the community-patient level (eg, adult education referrals, lay health educators, and harnessing the mass media) can improve health outcomes for patients with LHL. Conclusion Because LHL is prevalent, and because the recommended communication strategies can benefit patients of all literacy levels, clinicians, health system planners, and health policy leaders should promote the uptake of these strategies into routine care. PMID:20046798

A Systematic Review of Community Health Workers' Role in Occupational Safety and Health Research.

PubMed

Swanberg, Jennifer E; Nichols, Helen M; Clouser, Jessica M; Check, Pietra; Edwards, Lori; Bush, Ashley M; Padilla, Yancy; Betz, Gail

2018-03-03

We systematically reviewed the literature to describe how community health workers (CHWs) are involved in occupational health and safety research and to identify areas for future research and research practice strategies. We searched five electronic databases from July 2015 through July 2016. Inclusion criteria were as follows: (1) study took place in the United States, (2) published as a full peer-review manuscript in English, (3) conducted occupational health and safety research, and (4) CHWs were involved in the research. The majority of 17 included studies took place in the agriculture industry (76%). CHWs were often involved in study implementation/design and research participant contact. Rationale for CHW involvement in research was due to local connections/acceptance, existing knowledge/skills, communication ability, and access to participants. Barriers to CHW involvement in research included competing demands on CHWs, recruitment and training difficulties, problems about research rigor and issues with proper data collection. Involving CHWs in occupational health and safety research has potential for improving inclusion of diverse, vulnerable and geographically isolated populations. Further research is needed to assess the challenges and opportunities of involving CHWs in this research and to develop evidence-based training strategies to teach CHWs to be lay-health researchers.

Weaved into the cultural fabric: a qualitative exploration of alcohol consumption during pregnancy among tribal women in Odisha, India.

PubMed

Pati, Sanghamitra; Chauhan, Abhimanyu Singh; Mahapatra, Pranab; Hansdah, Devraj; Sahoo, Krushna Chandra; Pati, Sandipana

2018-02-20

Evidence-based research has documented the association between alcohol intake during pregnancy and increased risk of miscarriage, stillbirth and congenital birth defects. Alcohol consumption is a complex behavior whose origins lay in cultural norms and the social structure. In tribal communities in India, alcohol misuse among women is a public health problem. This study is intended to explore perceptions and beliefs among tribal women and the community towards alcohol consumption during pregnancy. A qualitative study was conducted in a tribal-dominated district of Odisha, India. The WHO AUDIT tool was used to identify women who consumed alcohol during their pregnancies. In-depth interviews were conducted with 19 eligible women and 18 family members. Additionally, two focused group discussions were held with local community leaders and health workers. The data was transcribed, systematically coded and analyzed following the thematic framework approach. The findings suggest that a complex interplay of drivers contributes to the unrestricted intake of alcohol by pregnant women. This could be attributed to: a lack of social monitoring, easy access to alcohol, low alcohol literacy and alcohol's normative status in daily customs and traditions. Another contributing factor is a community-wide perception that home-made alcohol poses no ill effects. Alcohol consumption is deeply embedded in the daily rituals of indigenous tribal women. To address this issue, community counselling utilizing platforms of RMNCHA and VHND could be Ideal. A well-designed, culture-based intervention encompassing alcohol researchers, mental health specialists, public health workers and anthropologists is necessary.

Ready To Read: Laying the Foundation for School Success. Satellite Town Meeting #77: March 20, 2001. Spanish Language Version. [Videotape].

ERIC Educational Resources Information Center

Department of Education, Washington, DC.

This interactive teleconference (in VHS format, Spanish language version) presents renowned national experts, local educators, and community leaders who share ideas on how to improve schools and reach the National Educational Goals. The 60-minute Satellite Town Meeting focuses on laying the foundation for school success through readiness to read.…

Ready To Read: Laying the Foundation for School Success. Satellite Town Meeting #77 (March 20, 2001). [Videotape].

ERIC Educational Resources Information Center

Department of Education, Washington, DC.

This videotape (in either VHS of 3/4 inch format) presents an interactive teleconference where renowned national experts, local educators, and community leaders share ideas on how to improve schools and reach the National Educational Goals. This 60-minute Satellite Town Meeting focuses on laying the foundation for school success through readiness…

Impact of community-based support services on antiretroviral treatment programme delivery and outcomes in resource-limited countries: a synthetic review.

PubMed

Wouters, Edwin; Van Damme, Wim; van Rensburg, Dingie; Masquillier, Caroline; Meulemans, Herman

2012-07-09

Task-shifting to lay community health providers is increasingly suggested as a potential strategy to overcome the barriers to sustainable antiretroviral treatment (ART) scale-up in high-HIV-prevalence, resource-limited settings. The dearth of systematic scientific evidence on the contributory role and function of these forms of community mobilisation has rendered a formal evaluation of the published results of existing community support programmes a research priority. We reviewed the relevant published work for the period from November 2003 to December 2011 in accordance with the guidelines for a synthetic review. ISI Web of Knowledge, Science Direct, BioMed Central, OVID Medline, PubMed, Social Services Abstracts, and Sociological Abstracts and a number of relevant websites were searched. The reviewed literature reported an unambiguous positive impact of community support on a wide range of aspects, including access, coverage, adherence, virological and immunological outcomes, patient retention and survival. Looking at the mechanisms through which community support can impact ART programmes, the review indicates that community support initiatives are a promising strategy to address five often cited challenges to ART scale-up, namely (1) the lack of integration of ART services into the general health system; (2) the growing need for comprehensive care, (3) patient empowerment, (4) and defaulter tracing; and (5) the crippling shortage in human resources for health. The literature indicates that by linking HIV/AIDS-care to other primary health care programmes, by providing psychosocial care in addition to the technical-medical care from nurses and doctors, by empowering patients towards self-management and by tracing defaulters, well-organised community support initiatives are a vital part of any sustainable public-sector ART programme. The review demonstrates that community support initiatives are a potentially effective strategy to address the growing shortage of health workers, and to broaden care to accommodate the needs associated with chronic HIV/AIDS. The existing evidence suggests that community support programmes, although not necessarily cheap or easy, remain a good investment to improve coverage of communities with much needed health services, such as ART. For this reason, health policy makers, managers, and providers must acknowledge and strengthen the role of community support in the fight against HIV/AIDS.

Impact of community-based support services on antiretroviral treatment programme delivery and outcomes in resource-limited countries: a synthetic review

PubMed Central

2012-01-01

Background Task-shifting to lay community health providers is increasingly suggested as a potential strategy to overcome the barriers to sustainable antiretroviral treatment (ART) scale-up in high-HIV-prevalence, resource-limited settings. The dearth of systematic scientific evidence on the contributory role and function of these forms of community mobilisation has rendered a formal evaluation of the published results of existing community support programmes a research priority. Methods We reviewed the relevant published work for the period from November 2003 to December 2011 in accordance with the guidelines for a synthetic review. ISI Web of Knowledge, Science Direct, BioMed Central, OVID Medline, PubMed, Social Services Abstracts, and Sociological Abstracts and a number of relevant websites were searched. Results The reviewed literature reported an unambiguous positive impact of community support on a wide range of aspects, including access, coverage, adherence, virological and immunological outcomes, patient retention and survival. Looking at the mechanisms through which community support can impact ART programmes, the review indicates that community support initiatives are a promising strategy to address five often cited challenges to ART scale-up, namely (1) the lack of integration of ART services into the general health system; (2) the growing need for comprehensive care, (3) patient empowerment, (4) and defaulter tracing; and (5) the crippling shortage in human resources for health. The literature indicates that by linking HIV/AIDS-care to other primary health care programmes, by providing psychosocial care in addition to the technical-medical care from nurses and doctors, by empowering patients towards self-management and by tracing defaulters, well-organised community support initiatives are a vital part of any sustainable public-sector ART programme. Conclusions The review demonstrates that community support initiatives are a potentially effective strategy to address the growing shortage of health workers, and to broaden care to accommodate the needs associated with chronic HIV/AIDS. The existing evidence suggests that community support programmes, although not necessarily cheap or easy, remain a good investment to improve coverage of communities with much needed health services, such as ART. For this reason, health policy makers, managers, and providers must acknowledge and strengthen the role of community support in the fight against HIV/AIDS. PMID:22776682

Lay Concepts of the Relative Importance of Different Influences on Health; Are There Major Socio-Demographic Variations?

ERIC Educational Resources Information Center

Macintyre, Sally; McKay, Laura; Ellaway, Anne

2006-01-01

There is an extensive literature within anthropology, sociology and psychology about lay concepts of determinants of health and illness. Many of these studies have used single sex or social class samples, often in narrow age bands, and many are qualitative in approach. We asked respondents in a health survey to say how important (on a five-point…

Health literacy training for public health nurses in fukushima: a case-study of program adaptation, implementation and evaluation.

PubMed

Goto, Aya; Rudd, Rima E; Lai, Alden Yuanhong; Yoshida-Komiya, Hiromi

2014-05-01

Health literacy comprises not only an individual's ability to gain access to, understand and use health information, but also health care providers' ability to make health information accessible and usable. The Fukushima nuclear accident has posed challenges related to the communication of radiation-related health information. Public health nurses are gatekeepers of community health in Japan, and have primary responsibility for communicating this complex information about science and risk to lay members of the community. A health literacy training program was designed to augment communication skills of participating nurses with two primary goals: changing communication practices and norms among public health nurses, and improving access to information for community residents. Training content incorporated an overview of health literacy skills (including numeracy), processes for assessing written materials and visual displays, as well as guidelines for text improvement. The workshop was spread across two days with two-hour sessions each day. A proximal post-training evaluation survey was conducted, followed by a more distal one-month follow-up evaluation to assess the application of learned skills in practice. Twenty-six nurses in Fukushima City attended the first trial. Post-training evaluations were highly positive, with agreement from 85-100% of participants on the appropriateness and usefulness of the workshop. During a one-month follow-up, the nurses reported applying new knowledge and skills to develop written materials. However, they faced difficulties sharing their new skills with colleagues and challenges changing work norms. Participants also encountered difficulties using graphics and explaining risks in practice. This paper highlights the importance of providing health literacy training opportunities for professionals to strengthen health system's ability to accessible information and services. This program also serves as important reference for future disaster management efforts.

Antenatal depression case-finding by community health workers in South Africa: feasibility of a mobile phone application

PubMed Central

Tsai, Alexander C.; Tomlinson, Mark; Dewing, Sarah; le Roux, Ingrid M.; Harwood, Jessica M.; Chopra, Mickey; Rotheram-Borus, Mary Jane

2014-01-01

Purpose Randomised controlled trials conducted in resource-limited settings have shown that once women with depressed mood are evaluated by specialists and referred for treatment, lay health workers can be trained to effectively administer psychological treatments. We sought to determine the extent to which community health workers could also be trained to conduct case finding using short and ultra-short screening instruments programmed into mobile phones. Methods Pregnant, Xhosa-speaking women were recruited independently in two cross-sectional studies (N=1,144 and N=361) conducted in Khayelitsha, South Africa and assessed for antenatal depression. In the smaller study, community health workers with no training in human subjects research were trained to administer the Edinburgh Postnatal Depression Scale (EPDS) during the routine course of their community-based outreach. We compared the operating characteristics of 4 short and ultra-short versions of the EPDS with the criterion standard of probable depression, defined as an EPDS-10 ≥13. Results The prevalence of probable depression (475/1144 [42%] and 165/361 [46%]) was consistent across both samples. The 2-item subscale demonstrated poor internal consistency (Cronbach’s α ranged from 0.55-0.58). All 4 subscales demonstrated excellent discrimination, with area under the receiver operating characteristic curve (AUC) values ranging from 0.91-0.99. Maximal discrimination was observed for the 7-item depressive symptoms subscale: at the conventional screening threshold of ≥10, it had 0.97 sensitivity and 0.76 specificity for detecting probable antenatal depression. Conclusions The comparability of the findings across the two studies suggests that it is feasible to use community health workers to conduct case finding for antenatal depression. PMID:24682529

Antenatal depression case finding by community health workers in South Africa: feasibility of a mobile phone application.

PubMed

Tsai, Alexander C; Tomlinson, Mark; Dewing, Sarah; le Roux, Ingrid M; Harwood, Jessica M; Chopra, Mickey; Rotheram-Borus, Mary Jane

2014-10-01

Randomized controlled trials conducted in resource-limited settings have shown that once women with depressed mood are evaluated by specialists and referred for treatment, lay health workers can be trained to effectively administer psychological treatments. We sought to determine the extent to which community health workers could also be trained to conduct case finding using short and ultrashort screening instruments programmed into mobile phones. Pregnant, Xhosa-speaking women were recruited independently in two cross-sectional studies (N = 1,144 and N = 361) conducted in Khayelitsha, South Africa and assessed for antenatal depression. In the smaller study, community health workers with no training in human subject research were trained to administer the Edinburgh Postnatal Depression Scale (EPDS) during the routine course of their community-based outreach. We compared the operating characteristics of four short and ultrashort versions of the EPDS with the criterion standard of probable depression, defined as an EPDS-10 ≥ 13. The prevalence of probable depression (475/1144 [42 %] and 165/361 [46 %]) was consistent across both samples. The 2-item subscale demonstrated poor internal consistency (Cronbach's α ranged from 0.55 to 0.58). All four subscales demonstrated excellent discrimination, with area under the receiver operating characteristic curve (AUC) values ranging from 0.91 to 0.99. Maximal discrimination was observed for the 7-item depressive symptoms subscale: at the conventional screening threshold of ≥10, it had 0.97 sensitivity and 0.76 specificity for detecting probable antenatal depression. The comparability of the findings across the two studies suggests that it is feasible to use community health workers to conduct case finding for antenatal depression.

Structural and Community Change Outcomes of the Connect-to-Protect Coalitions: Trials and Triumphs Securing Adolescent Access to HIV Prevention, Testing, and Medical Care.

PubMed

Miller, Robin Lin; Reed, Sarah J; Chiaramonte, Danielle; Strzyzykowski, Trevor; Spring, Hannah; Acevedo-Polakovich, Ignacio D; Chutuape, Kate; Cooper-Walker, Bendu; Boyer, Cherrie B; Ellen, Jonathan M

2017-09-01

Connect to Protect (C2P), a 10-year community mobilization effort, pursued the dual aims of creating communities competent to address youth's HIV-related risks and removing structural barriers to youth health. We used Community Coalition Action Theory (CCAT) to examine the perceived contributions and accomplishments of 14 C2P coalitions. We interviewed 318 key informants, including youth and community leaders, to identify the features of coalitions' context and operation that facilitated and undermined their ability to achieve structural change and build communities' capability to manage their local adolescent HIV epidemic effectively. We coded the interviews using an a priori coding scheme informed by CCAT and scholarship on AIDS-competent communities. We found community mobilization efforts like C2P can contribute to addressing the structural factors that promote HIV-risk among youth and to community development. We describe how coalition leadership, collaborative synergy, capacity building, and local community context influence coalitions' ability to successfully implement HIV-related structural change, demonstrating empirical support for many of CCAT's propositions. We discuss implications for how community mobilization efforts might succeed in laying the foundation for an AIDS-competent community. © Society for Community Research and Action 2017.

Engaging the community to improve nutrition and physical activity among houses of worship.

PubMed

Evans, Kiameesha R; Hudson, Shawna V

2014-03-13

Obesity, physical inactivity, and poor nutrition have been linked to many chronic diseases. Research indicates that interventions in community-based settings such as houses of worship can build on attendees' trust to address health issues and help them make behavioral changes. New Brunswick, New Jersey, has low rates of physical activity and a high prevalence of obesity. An adapted community-based intervention was implemented there to improve nutrition and physical activity among people who attend houses of worship and expand and enhance the network of partners working with Rutgers Cancer Institute of New Jersey. An adapted version of Body & Soul: A Celebration of Healthy Living and Eating was created using a 3-phase model to 1) educate lay members on nutrition and physical activity, 2) provide sustainable change through the development of physical activity programming, and 3) increase access to local produce through collaborations with community partners. Nineteen houses of worship were selected for participation in this program. Houses of worship provided a questionnaire to a convenience sample of its congregation to assess congregants' physical activity levels and produce consumption behaviors at baseline using questions from the Health Information National Trends Survey instrument. This information was also used to inform future program activities. Community-based health education can be a promising approach when appropriate partnerships are identified, funding is adequate, ongoing information is extracted to inform future action, and there is an expectation from all parties of long-term engagement and capacity building.

Effect of perches on liver health of hens.

PubMed

Jiang, S; Hester, P Y; Hu, J Y; Yan, F F; Dennis, R L; Cheng, H W

2014-07-01

Fatty liver is a common energy metabolic disorder in caged laying hens. Considering that the egg industry is shifting from conventional cages to alternative housing systems such as enriched cages, the objective of this study was to determine the effects of perches on fat deposition and liver health in laying hens. Three hundred twenty-four 17-wk-old White Leghorn hens were housed in 1 of 4 treatments with 9 hens per cage. Treatment 1 hens never had access to perches during their life cycle. Treatment 2 hens had access to perches during the pullet phase only. Treatment 3 hens had access to perches during the laying phase only. Treatment 4 hens always had access to perches. Liver weight, abdominal fat pad weight, BW, liver fat, and circulating alanine transaminase, aspartate transaminase, and adiponectin were determined. Provision of perches during either the rearing or laying phase did not affect liver health in 71-wk-old hens. However, perch access compared with no perch access during the egg laying phase reduced relative fat pad weight. These results suggest that providing perches as a means of stimulating activity reduced abdominal fat deposition in caged hens during the laying period. However, perch access in caged hens was ineffective in reducing fat deposition in the liver and altering enzyme activities related to improved liver function. © 2014 Poultry Science Association Inc.

Prevention and control of mental illnesses and mental health: National Action Plan for NCD Prevention, Control and Health Promotion in Pakistan.

PubMed

Nishtar, Sania; Minhas, Fareed A; Ahmed, Ashfaq; Badar, Asma; Mohamud, Khalif Bile

2004-12-01

As part of the National Action Plan for Non-communicable Disease Prevention, Control and Health Promotion in Pakistan (NAP-NCD), mental illnesses have been grouped alongside non-communicable diseases (NCD) within a combined strategic framework in order to synchronize public health actions. The systematic approach for mental illnesses is centred on safeguarding the rights of the mentally ill, reducing stigma and discrimination, and de-institutionalisation and rehabilitation of the mentally ill in the community outlining roles of healthcare providers, the community, legislators and policy makers. The approach has implications for support functions in a number of areas including policy building, manpower and material development and research. Priority action areas for mental health as part of NAP-NCD include the integration of surveillance of mental illnesses in a comprehensive population-based NCD surveillance system; creating awareness about mental health as part of an integrated NCD behavioural change communication strategy; integration of mental health with primary healthcare; the development of sustainable public health infrastructure to support community mental health initiatives; building capacity of the health system in support of prevention and control activities; effective implementation of existing legislation and harmonizing working relationships with law enforcing agencies. NAP-NCD also stresses on the need to integrate mental health into health services as part of a sustainable and integrated medical education programme for all categories of healthcare providers and the availability of essential psychotropic drugs at all healthcare levels. It lays emphasis on protecting the interests of special groups such as prisoners, refugees and displaced persons, women, children and individuals with disabilities. Furthermore, it promotes need-based research for contemporary mental health issues.

Optimizing lay counsellor services for chronic care in South Africa: a qualitative systematic review.

PubMed

Petersen, Inge; Fairall, Lara; Egbe, Catherine O; Bhana, Arvin

2014-05-01

To conduct a qualitative systematic review on the use of lay counsellors in South Africa to provide lessons on optimizing their use for psychological and behavioural change counselling for chronic long-term care in scare-resource contexts. A qualitative systematic review of the literature on lay counsellor services in South Africa. Twenty-nine studies met the inclusion criteria. Five randomized control trials and two cohort studies reported that lay counsellors can provide behaviour change counselling with good outcomes. One multi-centre cohort study provided promising evidence of improved anti-retroviral treatment adherence and one non-randomized controlled study provided promising results for counselling for depression. Six studies found low fidelity of lay counsellor-delivered interventions in routine care. Reasons for low fidelity include poor role definition, inconsistent remuneration, lack of standardized training, and poor supervision and logistical support. Within resource-constrained settings, adjunct behaviour change and psychological services provided by lay counsellors can be harnessed to promote chronic care at primary health care level. Optimizing lay counsellor services requires interventions at an organizational level that provide a clear role definition and scope of practice; in-service training and formal supervision; and sensitization of health managers to the importance and logistical requirements of counselling. Copyright © 2014 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Social capital and health: implication for health promotion by lay citizens in Japan.

PubMed

Miyamoto, Keiko; Iwakuma, Miho; Nakayama, Takeo

2015-12-01

A non-profit organization was formed in 2009 by lay citizens of Nagahama, Japan in response to a community-based genome-epidemiologic study, the 'Nagahama Zero(0)-ji Prevention Cohort Project (N0PCP)'. This organization aims to promote health by taking advantage of citizens' social networks. The Ottawa Charter for Health Promotion affirms the importance of creating supportive environments and coordinating social relationships. Supportive environments (infrastructure) and social relationships (resources) work together as aspects of social capital. This study sought to examine the association between self-rated health and social capital, at both individual and neighborhood levels, and to discuss suitable health promotion strategies for local circumstances.A cross-sectional survey was conducted in 2011, using a self-administered postal questionnaire. Social capital indicators included aspects of support in the environment (social support, neighborhood connectedness, informal social controls, neighborhood trust, general trust, and attachment to place) and social relationships (number of activities; participation in neighborhood activities; participation in recreational activities; and social leverage regarding physical health, mental health, and acquisition of health information). Neighborhood-level social capital was calculated as the percentage of individuals in a neighborhood in the 'high social capital' category. At the individual level, participation in recreational activities, high general trust, and discussion regarding mental health problems with family members were associated with self-rated health positively, whereas discussion of mental health problems with acquaintances had a negative correlation. At the neighborhood level, a highly supportive environment did not contribute to good health, whereas aggregated attachment to place had a positive correlation. There were no significant inter-regional health differences.The results of this study suggest that health promotion activities should aim at promoting the formation of empathetic friendships through individual networks, based on bringing individuals who need support to compatible places. Attachment to place should be incorporated into activities as an important and effective tool. © The Author(s) 2014.

Social capital and health: implication for health promotion by lay citizens in Japan

PubMed Central

Miyamoto, Keiko; Iwakuma, Miho; Nakayama, Takeo

2015-01-01

A non-profit organization was formed in 2009 by lay citizens of Nagahama, Japan in response to a community-based genome-epidemiologic study, the ‘Nagahama Zero(0)-ji Prevention Cohort Project (N0PCP)’. This organization aims to promote health by taking advantage of citizens’ social networks. The Ottawa Charter for Health Promotion affirms the importance of creating supportive environments and coordinating social relationships. Supportive environments (infrastructure) and social relationships (resources) work together as aspects of social capital. This study sought to examine the association between self-rated health and social capital, at both individual and neighborhood levels, and to discuss suitable health promotion strategies for local circumstances. A cross-sectional survey was conducted in 2011, using a self-administered postal questionnaire. Social capital indicators included aspects of support in the environment (social support, neighborhood connectedness, informal social controls, neighborhood trust, general trust, and attachment to place) and social relationships (number of activities; participation in neighborhood activities; participation in recreational activities; and social leverage regarding physical health, mental health, and acquisition of health information). Neighborhood-level social capital was calculated as the percentage of individuals in a neighborhood in the ‘high social capital’ category. At the individual level, participation in recreational activities, high general trust, and discussion regarding mental health problems with family members were associated with self-rated health positively, whereas discussion of mental health problems with acquaintances had a negative correlation. At the neighborhood level, a highly supportive environment did not contribute to good health, whereas aggregated attachment to place had a positive correlation. There were no significant inter-regional health differences. The results of this study suggest that health promotion activities should aim at promoting the formation of empathetic friendships through individual networks, based on bringing individuals who need support to compatible places. Attachment to place should be incorporated into activities as an important and effective tool. PMID:25319376

Local perceptions of causes of death in rural South Africa: a comparison of perceived and verbal autopsy causes of death.

PubMed

Hussain-Alkhateeb, Laith; Fottrell, Edward; Petzold, Max; Kahn, Kathleen; Byass, Peter

2015-01-01

Understanding how lay people perceive the causes of mortality and their associated risk factors is important for public health. In resource-limited settings, where verbal autopsy (VA) is used as the most expedient method of determining cause of death, it is important to understand how pre-existing concepts of cause of death among VA-informants may influence their VA-responses and the consequential impact on cause of death assessment. This study describes the agreement between VA-derived causes of death and informant-perceived causes and associated influential factors, which also reflects lay health literacy in this setting. Using 20 years of VA data (n=11,228) from the Agincourt Health and Demographic Surveillance System (HDSS) site in rural South Africa, we explored the agreement between the causes of death perceived by the VA-informants and those assigned by the automated Inter-VA tool. Kappa statistics and concordance correlation coefficients were applied to measure agreement at individual and population levels, respectively. Multivariable regression models were used to explore factors associated with recognised lay perceptions of causes of mortality. Agreement between informant-perceived and VA-derived causes of death at the individual level was limited, but varied substantially by cause of death. However, agreement at the population level, comparing cause-specific mortality fractions was higher, with the notable exception of bewitchment as a cause. More recent deaths, those in adults aged 15-49 years, deaths outside the home, and those associated with external causes showed higher concordance with InterVA. Overall, informant perception of causes of death was limited, but depended on informant characteristics and causes of death, and to some extent involved non-biomedical constructs. Understanding discordance between perceived and recognised causes of death is important for public health planning; low community understanding of causes of death may be detrimental to public health. These findings also illustrate the importance of using rigorous and standardised VA methods rather than relying on informants' reported causes of death.

"In my house": laying the foundation for youth HIV prevention in the Black church.

PubMed

Lightfoot, Alexandra F; Woods, Briana A; Jackson, Melvin; Riggins, Linda; Krieger, Kathleen; Brodie, Kimberly; Gray, Phyllis; Howard, Daniel L

2012-01-01

This article describes the process our community-academic partnership used to lay the groundwork for successful implementation of an adolescent-focused, evidence-based HIV/AIDS prevention curriculum in two Black churches. We highlight the challenges encountered and lessons learned in building a relationship with two churches, garnering the pastor's support, and implementing the curriculum within church youth groups. We engaged a Community Advisory Board (CAB) made up of youth, parents, and diverse faith leaders to ensure community relevance and guide project development, implementation, and evaluation. Using a community-based participatory research (CBPR) approach helped us to (1) engage diverse, intergenerational community members, (2) initiate a "culturally humble" process to build relationships with faith leaders, (3) remain responsive to stakeholder concerns, and (4) open the door to HIV prevention in the Black church. Finding effective and responsive ways to implement HIV/AIDS prevention in faith settings is facilitated by engaging diverse partners throughout the research process.

Claim More™: Empowering African American Women to Make Healthy Choices.

PubMed

Tkatch, Rifky; Musich, Shirley; Draklellis, Jennifer; Hetzel, Marla; Banks, Jo; Dugan, Jessica; Thompson, Kaylene; Hawkins, Kevin

2018-03-01

Diabetes is a serious issue for African American women. The purpose of this project was to develop and test the feasibility of a culturally appropriate and faith-based healthy eating program for African American women at risk for developing diabetes. At total of 30 women from two churches completed a 12-week, faith-based program using a community-based approach with lay health educators in the church setting. Participants set healthy eating goals, attended weekly education classes, and received daily text messaging reminders related to their goals. Outcomes included high levels of social support, frequent engagement with the program, and improved healthy eating. This program demonstrated the ability to target African American women at risk for diabetes and engage them in a health-related program.

Lay involvement in the analysis of qualitative data in health services research: a descriptive study.

PubMed

Garfield, S; Jheeta, S; Husson, F; Jacklin, A; Bischler, A; Norton, C; Franklin, B D

2016-01-01

There is a consensus that patients and the public should be involved in research in a meaningful way. However, to date, lay people have been mostly involved in developing research ideas and commenting on patient information.We previously published a paper describing our experience with lay partners conducting observations in a study of how patients in hospital are involved with their medicines. In a later part of the same study, lay partners were also involved in analysing interviews that a researcher had conducted with patients, carers and healthcare professionals about patient and carer involvement with medicines in hospital. We therefore wanted to build on our previous paper and report on our experiences with lay partners helping to conduct data analysis. We therefore interviewed the lay members and researchers involved in the analysis to find out their views.Both lay members and researchers reported that lay partners added value to the study by bringing their own perspectives and identifying further areas for the researcher to look for in the interviews. In this way researchers and lay partners were able to work together to produce a richer analysis than would have been possible from either alone. Background It is recognised that involving lay people in research in a meaningful rather than tokenistic way is both important and challenging. In this paper, we contribute to this debate by describing our experiences of lay involvement in data analysis. Methods We conducted semi-structured interviews with the lay partners and researchers involved in qualitative data analysis in a wider study of inpatient involvement in medication safety. The interviews were transcribed verbatim and coded using open thematic analysis. Results We interviewed three lay partners and the three researchers involved. These interviews demonstrated that the lay members added value to the analysis by bringing their own perspectives; these were systematically integrated into the analysis by the lead researcher to create a synergistic output. Some challenges arose, including difficulties in recruiting a diverse range of members of the public to carry out the role; however there were generally fewer challenges in data analysis than there had been with our previous experience of lay partners' involvement in data collection. Conclusions Lay members can add value to health services research by being involved in qualitative data analysis.

Understanding Genomic Knowledge in Rural Appalachia: The West Virginia Genome Community Project.

PubMed

Mallow, Jennifer A; Theeke, Laurie A; Crawford, Patricia; Prendergast, Elizabeth; Conner, Chuck; Richards, Tony; McKown, Barbara; Bush, Donna; Reed, Donald; Stabler, Meagan E; Zhang, Jianjun; Dino, Geri; Barr, Taura L

Rural communities have limited knowledge about genetics and genomics and are also underrepresented in genomic education initiatives. The purpose of this project was to assess genomic and epigenetic knowledge and beliefs in rural West Virginia. A total of 93 participants from three communities participated in focus groups and 68 participants completed a demographic survey. The age of the respondents ranged from 21 to 81 years. Most respondents had a household income of less than $40,000, were female and most were married, completed at least a HS/GED or some college education working either part-time or full-time. A Community Based Participatory Research process with focus groups and demographic questionnaires was used. Most participants had a basic understanding of genetics and epigenetics, but not genomics. Participants reported not knowing much of their family history and that their elders did not discuss such information. If the conversations occurred, it was only during times of crisis or an illness event. Mental health and substance abuse are topics that are not discussed with family in this rural population. Most of the efforts surrounding genetic/genomic understanding have focused on urban populations. This project is the first of its kind in West Virginia and has begun to lay the much needed infrastructure for developing educational initiatives and extending genomic research projects into our rural Appalachian communities. By empowering the public with education, regarding the influential role genetics, genomics, and epigenetics have on their health, we can begin to tackle the complex task of initiating behavior changes that will promote the health and well-being of individuals, families and communities.

Comparison of health outcomes among affiliated and lay disaster volunteers enrolled in the World Trade Center Health Registry.

PubMed

Debchoudhury, Indira; Welch, Alice E; Fairclough, Monique A; Cone, James E; Brackbill, Robert M; Stellman, Steven D; Farfel, Mark R

2011-12-01

Volunteers (non-professional rescue/recovery workers) are universally present at man-made and natural disasters and share experiences and exposures with victims. Little is known of their disaster-related health outcomes. We studied 4974 adult volunteers who completed the World Trade Center Health Registry 2006-07 survey to examine associations between volunteer type (affiliated vs. lay) and probable posttraumatic stress disorder (PTSD); new or worsening respiratory symptoms; post-9/11 first diagnosis of anxiety disorder, depression, and/or PTSD; and asthma or reactive airway dysfunction syndrome (RADS). Affiliated volunteers reported membership in a recognized organization. Lay volunteers reported no organizational affiliation and occupations unrelated to rescue/recovery work. Adjusted odds ratios (OR(adj)) were calculated using multinomial regression. Lay volunteers were more likely than affiliated volunteers to have been present in lower Manhattan, experience the dust cloud, horrific events and injury on 9/11 and subsequently to report unmet healthcare needs. They had greater odds of early post-9/11 mental health diagnosis (OR(adj) 1.6; 95% CI: 1.4-2.0) and asthma/RADS (1.8; 1.2-2.7), chronic PTSD (2.2; 1.7-2.8), late-onset PTSD (1.9; 1.5-2.5), and new or worsening lower respiratory symptoms (2.0; 1.8-2.4). Lay volunteers' poorer health outcomes reflect earlier, more intense exposure to and lack of protection from physical and psychological hazards. There is a need to limit volunteers' exposures during and after disasters, as well as to provide timely screening and health care post-disaster. Copyright © 2011 Elsevier Inc. All rights reserved.

Collaboration across private and public sector primary health care services: benefits, costs and policy implications.

PubMed

McDonald, Julie; Powell Davies, Gawaine; Jayasuriya, Rohan; Fort Harris, Mark

2011-07-01

Ongoing care for chronic conditions is best provided by interprofessional teams. There are challenges in achieving this where teams cross organisational boundaries. This article explores the influence of organisational factors on collaboration between private and public sector primary and community health services involved in diabetes care. It involved a case study using qualitative methods. Forty-five participants from 20 organisations were purposively recruited. Data were collected through semi-structured interviews and from content analysis of documents. Thematic analysis was used employing a two-level coding system and cross case comparisons. The patterns of collaborative patient care were influenced by a combination of factors relating to the benefits and costs of collaboration and the influence of support mechanisms. Benefits lay in achieving common or complementary health or organisational goals. Costs were incurred in bridging differences in organisational size, structure, complexity and culture. Collaboration was easier between private sector organisations than between private and public sectors. Financial incentives were not sufficient to overcome organisational barriers. To achieve more coordinated primary and community health care structural changes are also needed to better align funding mechanisms, priorities and accountabilities of the different organisations.

Human ecology and behaviour in malaria control in tropical Africa

PubMed Central

MacCormack, C. P.

1984-01-01

Since about 250 BC, human modification of African environments has created increasingly favourable breeding conditions for Anopheles gambiae. Subsequent adaptations to the increased malaria risk are briefly described and reference is made to Macdonald's mathematical model for the disease. Since values for the variables in that model are high in tropical Africa, there is little possibility that simple, inexpensive, self-help primary health care initiatives can control malaria in the region. However, in combination with more substantial public health initiatives, simple primary health care activities might be done by communities to (1) prevent mosquitos from feeding on people, (2) prevent or reduce mosquito breeding, (3) destroy adult mosquitos, and (4) eliminate malaria parasites from human hosts. Lay methods of protection and self-care are examined and some topics for further research are indicated. Culturally appropriate health education methods are also suggested. PMID:6335685

Making the links: do we connect climate change with health? A qualitative case study from Canada.

PubMed

Cardwell, Francesca S; Elliott, Susan J

2013-03-08

Climate change has been described as the biggest global health threat of the 21st century. Typically framed as an environmental issue, some suggest this view has contributed to public ambivalence and hence a lack of public engagement. The lack of understanding of climate change as a significant environmental health risk on the part of the lay public represents a significant barrier to behaviour change. We therefore need to think about reframing the impact of climate change from an environmental to a health issue. This paper builds on calls for increased understanding of the public's views of human health risks associated with climate change, focusing on facilitators and barriers to behaviour change. Semi-structured in-depth interviews (n = 22) with residents of the Golden Horseshoe region of Southern Ontario were conducted between August 2010 and January 2011. Topics included individual and community health, climate change, and facilitators and barriers to behaviour change. Few participants recognized the role of the environment in the context of either individual and community health. When asked about health concerns specific to their community, however, environmental issues were mentioned frequently. Health effects as possible impacts of global environmental change were mentioned by 77% of participants when prompted, but this link was not described in great detail or within the context of impacting their communities or themselves. Participants were willing to act in environmentally friendly ways, and possible incentives to undertake behaviour change such as decreasing cost were described. Health co-benefits were not identified as incentives to engaging in mitigative or adaptive behaviours. The results support recent calls for reframing the impact of climate change from an environmental to a public health issue in order to increase public engagement in adaptive and mitigative behaviour change. While previous research has touched on public awareness of the human health risks of climate change, we have further explored the attitude-action link through the examination of facilitators and barriers to behaviour change.

Empowering Lay-Counsellors with Technology: Masivukeni, a Standardized Multimedia Counselling Support Tool to Deliver ART Counselling.

PubMed

Gouse, H; Robbins, R N; Mellins, C A; Kingon, A; Rowe, J; Henry, M; Remien, R H; Pearson, A; Victor, F; Joska, J A

2018-05-19

Lay-counsellors in resource-limited settings convey critical HIV- and ART-information, and face challenges including limited training and variable application of counselling. This study explored lay-counsellors and Department of Health (DoH) perspectives on the utility of a multimedia adherence counselling program. Masivukeni, an mHealth application that provides scaffolding for delivering standardized ART counselling was used in a 3-year randomized control trail at two primary health care clinics in Cape Town, South Africa. In this programmatic and descriptive narrative report, we describe the application; lay-counsellors' response to open-ended questions regarding their experience with using Masivukeni; and perspectives of the City of Cape Town and Western Cape Government DoH, obtained through ongoing engagements and feedback sessions. Counsellors reported Masivukeni empowered them to provide high quality counselling. DoH indicated strong support for a future implementation study assessing feasibility for larger scale roll-out. Masivukeni has potential as a counselling tool in resource-limited settings.

Feasibility of community-based screening for cardiovascular disease risk in an ethnic community: the South Asian Cardiovascular Health Assessment and Management Program (SA-CHAMP).

PubMed

Jones, Charlotte A; Nanji, Alykhan; Mawani, Shefina; Davachi, Shahnaz; Ross, Leanne; Vollman, Ardene; Aggarwal, Sandeep; King-Shier, Kathryn; Campbell, Norman

2013-02-21

South Asian Canadians experience disproportionately high rates of cardiovascular disease (CVD). The goal of this qualitative study was to determine the feasibility of implementing a sustainable, culturally adapted, community-based CVD risk factor screening program for this population. South Asians (≥ 45 years) in Calgary, Alberta underwent opportunistic cardiovascular risk factor screening by lay trained volunteers at local religious facilities. Those with elevated blood pressure (BP) or ≥ 1 risk factor underwent point of care cholesterol testing, 10-year CVD risk calculation, counseling, and referral to family physicians and local culturally tailored chronic disease management (CDM) programs. Participants were invited for re-screening and were surveyed about health system follow-up, satisfaction with the program and suggestions for improvement. Changes in risk factors from baseline were estimated using McNemar's test (proportions) and paired t-tests (continuous measures). Baseline assessment was completed for 238 participants (median age 64 years, 51% female). Mean TC, HDL and TC/HDL were 5.41 mmol/L, 1.12 mmol/L and 4.7, respectively. Mean systolic and diastolic blood pressures (mmHg) were 129 and 75 respectively. Blood pressure and TC/HDL ratios exceeded recommended targets in 36% and 58%, respectively, and 76% were at high risk for CVD. Ninety-nine participants (47% female) attended re-screening. 82% had accessed health care providers, 22% reported medication changes and 3.5% had attended the CDM programs. While BP remained unchanged, TC and TC/HDL decreased and HDL increased significantly (mean differences: -0.52 mmol/L, -1.04 and +0.07 mmol/L, respectively). Participants were very satisfied (80%) or satisfied (20%) with the project. Participants suggested screening sessions and CDM programs be more accessible by: delivering evening or weekends programs at more sites, providing transportation, offering multilingual programs/translation assistance, reducing screening wait times and increasing numbers of project staff. SA-CHAMP demonstrated the feasibility and value of implementing a lay volunteer-led, culturally adapted, sustainable community-based CVD risk factor screening program in South Asian places of worship in Calgary, Alberta, Canada. Subsequent screening and CDM programs were refined based on the learnings from this study. Further research is needed to determine physician and patient factors associated with uptake of and adherence to risk reduction strategies.

Perceptions of health stakeholders on task shifting and motivation of community health workers in different socio demographic contexts in Kenya (nomadic, peri-urban and rural agrarian)

PubMed Central

2014-01-01

Background The shortage of health professionals in low income countries is recognized as a crisis. Community health workers are part of a “task-shift” strategy to address this crisis. Task shifting in this paper refers to the delegation of tasks from health professionals to lay, trained volunteers. In Kenya, there is a debate as to whether these volunteers should be compensated, and what motivation strategies would be effective in different socio-demographic contexts, based type of tasks shifted. The purpose of this study was to find out, from stakeholders’ perspectives, the type of tasks to be shifted to community health workers and the appropriate strategies to motivate and retain them. Methods This was an analytical comparative study employing qualitative methods: key informant interviews with health policy makers, managers, and service providers, and focus group discussions with community health workers and service consumers, to explore their perspectives on tasks to be shifted and appropriate motivation strategies. Results The study found that there were tasks to be shifted and motivation strategies that were common to all three contexts. Common tasks were promotive, preventive, and simple curative services. Common motivation strategies were supportive supervision, means of identification, equitable allocation of resources, training, compensation, recognition, and evidence based community dialogue. Further, in the nomadic and peri-urban sites, community health workers had assumed curative services beyond the range provided for in the Kenyan task shifting policy. This was explained to be influenced by lack of access to care due to distance to health facilities, population movement, and scarcity of health providers in the nomadic setting and the harsh economic realities in peri-urban set up. Therefore, their motivation strategies included training on curative skills, technical support, and resources for curative care. Data collection was viewed as an important task in the rural site, but was not recognized as priority in nomadic and peri-urban sites, where they sought monetary compensation for data collection. Conclusions The study concluded that inclusion of curative tasks for community health workers, particularly in nomadic contexts, is inevitable but raises the need for accreditation of their training and regulation of their tasks. PMID:25079588

Pilgrimage to Wellness: An Exploratory Report of Rural African American Clergy Perceptions of Church Health Promotion Capacity

PubMed Central

Carter-Edwards, Lori; Hooten, Elizabeth Gerken; Bruce, Marino A.; Toms, Forrest; Lloyd, Cheryl LeMay; Ellison, Calvin

2013-01-01

Churches serve a vital role in African American communities and may be effective vehicles for health promotion in rural areas where disease burden is disproportionately greater and healthcare access is more limited than other communities. Endorsement by church leadership is often necessary for the approval of programs and activities within churches; however, little is known about how church leaders perceive their respective churches as health promotion organizations. The purpose of this exploratory pilot was to report perceptions of church capacity to promote health among African American clergy leaders of predominantly African American rural churches. The analysis sample included 27 pastors of churches in Eastern NC who completed a survey on church health promotion capacity and perceived impact on their own health. Capacities assessed included perceived need and impact of health promotion activities, church preparedness to promote health, health promotion actions to take, and the existence and importance of health ministry attributes. The results from this pilot study indicated a perceived need to increase the capacity of their churches to promote health. Conducting health programs, displaying health information, collaborations within the church (i.e., kitchen committee working with the health ministry), partnerships outside of the church, and funding were most commonly reported needed capacities. Findings from this exploratory work lay the foundation for the development of future, larger observational studies that can specify some of the key factors associated with organizational change and ultimately health promotion in these rural church settings. PMID:22694157

[The growing importance of ethics in medical care and research].

PubMed

Sass, Hans-Martin

2009-01-01

The integration of medical humanities into future patient care and medical research will become as importance for trust, care and health as the natural sciences were during the last 100 years. In particular, improvements of lay health literacy and responsibility, new forms of physician-nurse partnership and expert-lay interaction, also revisions of clinical research towards models of informed contract will improve trust and health on a global scale, allow for healthier and happier citizens and populations and eventually might reduce health care costs.

Tailored Lay Health Worker Intervention Improves Breast Cancer Screening Outcomes in Non-Adherent Korean-American Women

ERIC Educational Resources Information Center

Han, Hae-Ra; Lee, H.; Kim, M. T.; Kim, K. B.

2009-01-01

Despite rapidly increasing incidence rates of breast cancer, recent immigrants such as Korean-American (KA) women report disproportionately lower utilization of screening tests compared with other ethnic groups. Early screening of breast cancer for this population may be greatly facilitated by indigenous lay health workers (LHWs). We conducted an…

A Comparative Analysis of Tasks Essential to Successful Performance in Three Veterinarian Lay Occupations. Summary Research 5.

ERIC Educational Resources Information Center

McCracken, J. David; Cooke, Frederick C.

The occupational survey's purpose was to identify the skills which are performed and essential for success in three veterinary lay occupations: animal health assistant, animal hospital receptionist, and animal health technician. Survey objectives were accomplished by constructing an initial task inventory of 21 duty areas, validating the initial…

Lay perceptions of risk factors for Rift Valley fever in a pastoral community in northeastern Kenya.

PubMed

Ng'ang'a, Caroline M; Bukachi, Salome A; Bett, Bernard K

2016-01-13

Human behavioral factors have been found to be central in the transmission of Rift Valley fever. Consumption of contaminated meat and milk in particular have been identified as one of the key risk factors for the transmission of Rift Valley fever in humans. In pastoral communities, livestock is the main source of livelihood from which many benefits such as food as well as economic and cultural services are derived. Zoonotic diseases therefore have a great impact on pastoral communities livelihoods. However, lay perceptions regarding the transmission of these diseases including Rift Valley fever hampers their effective control. This study investigated the lay perceptions of risks for Rift Valley fever transmission in a pastoral community in northeastern Kenya. A qualitative study was carried out in Ijara district, Kenya which was one of the hotspots of Rift Valley during the 2006/2007 outbreak. Data were collected using focus group discussions and narratives guided by checklists. Eight focus group discussions consisting of 83 participants and six narratives were conducted. Data was transcribed, coded and analysed according to Emergent themes. The participants reported that they had experienced Rift Valley fever in their livestock especially sheep and in humans both in 1997/1998 and 2006/2007. However, they believed that infections in humans occurred as a result of mosquito bites and had little to do with their consumption of meat, milk and blood from infected livestock. The participants in this study indicated that they had heard of the risks of acquiring the disease through consumption of livestock products but their experiences did not tally with the information they had received hence to them, Rift Valley fever was not transmissible through their dietary practices. Though the communities in this region were aware of Rift Valley fever, they did not have elaborate information regarding the disease transmission dynamics to humans. To avoid misconception about transmission of the disease, intervention strategies, require to be accompanied by comprehensive explanations of the dynamics of its transmission. It is necessary to develop appropriate interventions that take into consideration, lay perceptions of risk factors for the disease and communities' livelihood strategies.

The Expert and the Lay Public: Reflections on Influenza A (H1N1) and the Risk Society

PubMed Central

Williams-Jones, Bryn

2012-01-01

Trust between the lay public and scientific experts is a key element to ensuring the efficient implementation of emergency public health measures. In modern risk societies, the management and elimination of risk have become preeminent drivers of public policy. In this context, the protection of public trust is a complex task. Those actors involved in public health decision-making and implementation (e.g., mass vaccination for influenza A virus) are confronted with growing pressures and responsibility to act. However, they also need to accept the limits of their own expertise and recognize the ability of lay publics to understand and be responsible for public health. Such a shared responsibility for risk management, if grounded in participative public debates, can arguably strengthen public trust in public health authorities and interventions. PMID:22397338

Digital Networked Information Society and Public Health: Problems and Promises of Networked Health Communication of Lay Publics.

PubMed

Kim, Jeong-Nam

2018-01-01

This special issue of Health Communication compiles 10 articles to laud the promise and yet confront the problems in the digital networked information society related to public health. We present this anthology of symphony and cacophony of lay individuals' communicative actions in a digital networked information society. The collection of problems and promise of the new digital world may be a cornerstone joining two worlds-pre- and postdigital network society-and we hope this special issue will help better shape our future states of public health.

A study of human resource competencies required to implement community rehabilitation in less resourced settings.

PubMed

Gilmore, Brynne; MacLachlan, Malcolm; McVeigh, Joanne; McClean, Chiedza; Carr, Stuart; Duttine, Antony; Mannan, Hasheem; McAuliffe, Eilish; Mji, Gubela; Eide, Arne H; Hem, Karl-Gerhard; Gupta, Neeru

2017-09-22

It is estimated that over one billion persons worldwide have some form of disability. However, there is lack of knowledge and prioritisation of how to serve the needs and provide opportunities for people with disabilities. The community-based rehabilitation (CBR) guidelines, with sufficient and sustained support, can assist in providing access to rehabilitation services, especially in less resourced settings with low resources for rehabilitation. In line with strengthening the implementation of the health-related CBR guidelines, this study aimed to determine what workforce characteristics at the community level enable quality rehabilitation services, with a focus primarily on less resourced settings. This was a two-phase review study using (1) a relevant literature review informed by realist synthesis methodology and (2) Delphi survey of the opinions of relevant stakeholders regarding the findings of the review. It focused on individuals (health professionals, lay health workers, community rehabilitation workers) providing services for persons with disabilities in less resourced settings. Thirty-three articles were included in this review. Three Delphi iterations with 19 participants were completed. Taken together, these produced 33 recommendations for developing health-related rehabilitation services. Several general principles for configuring the community rehabilitation workforce emerged: community-based initiatives can allow services to reach more vulnerable populations; the need for supportive and structured supervision at the facility level; core skills likely include case management, social protection, monitoring and record keeping, counselling skills and mechanisms for referral; community ownership; training in CBR matrix and advocacy; a tiered/teamwork system of service delivery; and training should take a rights-based approach, include practical components, and involve persons with disabilities in the delivery and planning. This research can contribute to implementing the WHO guidelines on the interaction between the health sector and CBR, particularly in the context of the Framework for Action for Strengthening Health Systems, in which human resources is one of six components. Realist syntheses can provide policy makers with detailed and practical information regarding complex health interventions, which may be valuable when planning and implementing programmes.

The future of community pharmacy practice in South Africa in the light of the proposed new qualification for pharmacists: implications and challenges.

PubMed

Malangu, Ntambwe

2014-08-15

Community or retail pharmacies are regarded as one of the most common sources of health services throughout the world. In South Africa, community pharmacies have been providing some primary health care services to clients who could afford to pay. These services included screening, family planning, and emergency care for minor ailments. With the introduction of the new qualification, community pharmacies are poised to become providers of expanded services.  This paper describes the contents, the implications and challenges of the new qualification in light with future directions for community pharmacy practice in South Africa. Its purpose is to inform relevant stakeholders in South Africa and those outside South Africa that may pursue similar offerings. Published papers were identified through searches in MEDLINE and Google Scholar using a combination of search terms, namely: 'community, retail pharmacy, pharmacist/non-medical prescribing, South Africa'. Only articles published in English were considered. In addition, documents from the Ministry of Health of South Africa, the South African Pharmacy Council and curricula materials from schools of pharmacy were also reviewed. Laureates of the new qualification will essentially have the right to examine, diagnose, prescribe and monitor the treatment of their clients or patients. In doing so, this expanded function of prescribing for primary healthcare will imply several practice and infrastructural adjustments; and with many challenges laying ahead in need to be addressed. In conclusion, the authorized pharmacist prescriber qualification augurs a new era for community pharmacy practice in South Africa. This has many implications and some challenges that need to be managed. The pharmacy profession, academia, legislators and political decision-makers need to work together to resolve outstanding issues in a constructive manner.

Motivations and Limitations Associated with Vaping among People with Mental Illness: A Qualitative Analysis of Reddit Discussions

PubMed Central

Sharma, Ratika; Wigginton, Britta; Meurk, Carla; Ford, Pauline; Gartner, Coral E.

2016-01-01

This study aims to understand the nature and significance of online lay discussions about e-cigarettes and mental illness. We systematically searched the website Reddit.com using keywords related to e-cigarettes and mental illness. We coded relevant posts into themes under the framework of motivations for and limitations of vaping for people with mental illness. The thematic analysis included 3263 comments from 133 discussion threads. Six themes were classified as motivations to vape for people with mental illness: Self-medication; Quitting smoking; Freedom and control; Hobby; Social connectedness; and Motivation from caregivers and online communities. The limitations of vaping included: Unsatisfactory substitute for cigarettes and psychiatric medicines; Drug interactions; Nicotine addiction; Risks of e-liquid; Practical difficulties and Cost. People with mental illness; and their carers; use online discussion boards like Reddit to discuss the benefits and limitations of e-cigarettes for people with mental illness. Both positive and negative views exist. Media platforms like Reddit may shape the opinions of stakeholders and generate lay expertise about contentious health topics such as e-cigarettes. These findings have implications for policy and practice concerning assisting smokers with mental illness to reduce their health risk through switching to e-cigarettes. PMID:28025516

Motivations and Limitations Associated with Vaping among People with Mental Illness: A Qualitative Analysis of Reddit Discussions.

PubMed

Sharma, Ratika; Wigginton, Britta; Meurk, Carla; Ford, Pauline; Gartner, Coral E

2016-12-22

This study aims to understand the nature and significance of online lay discussions about e-cigarettes and mental illness. We systematically searched the website Reddit.com using keywords related to e-cigarettes and mental illness. We coded relevant posts into themes under the framework of motivations for and limitations of vaping for people with mental illness. The thematic analysis included 3263 comments from 133 discussion threads. Six themes were classified as motivations to vape for people with mental illness: Self-medication; Quitting smoking; Freedom and control; Hobby; Social connectedness; and Motivation from caregivers and online communities. The limitations of vaping included: Unsatisfactory substitute for cigarettes and psychiatric medicines; Drug interactions; Nicotine addiction; Risks of e-liquid; Practical difficulties and Cost. People with mental illness; and their carers; use online discussion boards like Reddit to discuss the benefits and limitations of e-cigarettes for people with mental illness. Both positive and negative views exist. Media platforms like Reddit may shape the opinions of stakeholders and generate lay expertise about contentious health topics such as e-cigarettes. These findings have implications for policy and practice concerning assisting smokers with mental illness to reduce their health risk through switching to e-cigarettes.

Using the Rose Angina Questionnaire cross-culturally: the importance of consulting lay people when translating epidemiological questionnaires.

PubMed

Hanna, Lisa C; Hunt, Sonja M; Bhopal, Raj S

2012-01-01

The Rose Angina Questionnaire (RAQ) is an important measure of coronary heart disease prevalence. It has been shown to perform inconsistently across some ethnic groups in Britain. This study investigates whether the best available versions of the RAQ in Punjabi and Cantonese were linguistically equivalent to the English version. Interviews were carried out with lay people from the Pakistani, Chinese and European-origin communities in Scotland to assess the versions of the RAQ used in the Newcastle Heart Project (the best available versions). For each questionnaire item, participants were asked to elaborate on their understanding of the question and the meaning of keywords or phrases. Problems were discovered with the Punjabi and Cantonese translations of the RAQ. For example, the translation for 'chest' was interpreted by some Pakistani and Chinese women to mean 'breasts'. 'Walking uphill' was translated in Chinese as 'walking the hill', without stipulation of the direction, so that some Cantonese speakers interpreted the question as pertaining to walking downhill. Many Chinese interpreted RAQ items to be referring to breathlessness rather than chest pain due to ambiguous wording. Existing versions of the RAQ are unlikely to be yielding data that are cross-culturally valid or comparable. For robust health survey research in languages other than that in which the questionnaire was developed, lay assessment of questionnaires prior to and after translation is a necessity rather than a luxury.

Demand and access to mental health services: a qualitative formative study in Nepal

PubMed Central

2014-01-01

Background Nepal is experiencing a significant ‘treatment gap’ in mental health care. People with mental disorders do not always receive appropriate treatment due to a range of structural and individual issues, including stigma and poverty. The PRIME (Programme for Improving Mental Health Care) programme has developed a mental health care plan to address this issue in Nepal and four other low and middle income countries. This study aims to inform the development of this comprehensive care plan by investigating the perceptions of stakeholders at different levels of the care system in the district of Chitwan in southern Nepal: health professionals, lay workers and community members. It focuses specifically on issues of demand and access to care, and aims to identify barriers and potential solutions for reaching people with priority mental disorders. Methods This qualitative study consisted of key informant interviews (33) and focus group discussions (83 participants in 9 groups) at community and health facility levels. Data were analysed using a framework analysis approach. Results As well as pragmatic barriers at the health facility level, mental health stigma and certain cultural norms were found to reduce access and demand for services. Respondents perceived the lack of awareness about mental health problems to be a major problem underlying this, even among those with high levels of education or status. They proposed strategies to improve awareness, such as channelling education through trusted and respected community figures, and responding to the need for openness or privacy in educational programmes, depending on the issue at hand. Adapting to local perceptions of stigmatised treatments emerged as another key strategy to improve demand. Conclusions This study identifies barriers to accessing care in Nepal that reach beyond the health facility and into the social fabric of the community. Stakeholders in PRIME’s integrated care plan advocate strategic awareness raising initiatives to improve the reach of integrated services in this low-income setting. PMID:25084826

Demand and access to mental health services: a qualitative formative study in Nepal.

PubMed

Brenman, Natassia F; Luitel, Nagendra P; Mall, Sumaya; Jordans, Mark J D

2014-08-02

Nepal is experiencing a significant 'treatment gap' in mental health care. People with mental disorders do not always receive appropriate treatment due to a range of structural and individual issues, including stigma and poverty. The PRIME (Programme for Improving Mental Health Care) programme has developed a mental health care plan to address this issue in Nepal and four other low and middle income countries. This study aims to inform the development of this comprehensive care plan by investigating the perceptions of stakeholders at different levels of the care system in the district of Chitwan in southern Nepal: health professionals, lay workers and community members. It focuses specifically on issues of demand and access to care, and aims to identify barriers and potential solutions for reaching people with priority mental disorders. This qualitative study consisted of key informant interviews (33) and focus group discussions (83 participants in 9 groups) at community and health facility levels. Data were analysed using a framework analysis approach. As well as pragmatic barriers at the health facility level, mental health stigma and certain cultural norms were found to reduce access and demand for services. Respondents perceived the lack of awareness about mental health problems to be a major problem underlying this, even among those with high levels of education or status. They proposed strategies to improve awareness, such as channelling education through trusted and respected community figures, and responding to the need for openness or privacy in educational programmes, depending on the issue at hand. Adapting to local perceptions of stigmatised treatments emerged as another key strategy to improve demand. This study identifies barriers to accessing care in Nepal that reach beyond the health facility and into the social fabric of the community. Stakeholders in PRIME's integrated care plan advocate strategic awareness raising initiatives to improve the reach of integrated services in this low-income setting.

How home HIV testing and counselling with follow-up support achieves high testing coverage and linkage to treatment and prevention: a qualitative analysis from Uganda.

PubMed

Ware, Norma C; Wyatt, Monique A; Asiimwe, Stephen; Turyamureeba, Bosco; Tumwesigye, Elioda; van Rooyen, Heidi; Barnabas, Ruanne V; Celum, Connie L

2016-01-01

The successes of HIV treatment scale-up and the availability of new prevention tools have raised hopes that the epidemic can finally be controlled and ended. Reduction in HIV incidence and control of the epidemic requires high testing rates at population levels, followed by linkage to treatment or prevention. As effective linkage strategies are identified, it becomes important to understand how these strategies work. We use qualitative data from The Linkages Study, a recent community intervention trial of community-based testing with linkage interventions in sub-Saharan Africa, to show how lay counsellor home HIV testing and counselling (home HTC) with follow-up support leads to linkage to clinic-based HIV treatment and medical male circumcision services. We conducted 99 semi-structured individual interviews with study participants and three focus groups with 16 lay counsellors in Kabwohe, Sheema District, Uganda. The participant sample included both HIV+ men and women (N=47) and HIV-uncircumcised men (N=52). Interview and focus group audio-recordings were translated and transcribed. Each transcript was summarized. The summaries were analyzed inductively to identify emergent themes. Thematic concepts were grouped to develop general constructs and framing propositional statements. Trial participants expressed interest in linking to clinic-based services at testing, but faced obstacles that eroded their initial enthusiasm. Follow-up support by lay counsellors intervened to restore interest and inspire action. Together, home HTC and follow-up support improved morale, created a desire to reciprocate, and provided reassurance that services were trustworthy. In different ways, these functions built links to the health service system. They worked to strengthen individuals' general sense of capability, while making the idea of accessing services more manageable and familiar, thus reducing linkage barriers. Home HTC with follow-up support leads to linkage by building "social bridges," interpersonal connections established and developed through repeated face-to-face contact between counsellors and prospective users of HIV treatment and male circumcision services. Social bridges link communities to the service system, inspiring individuals to overcome obstacles and access care.

Predictors of activity level and retention among African American lay health advisors (LHAs) from The National Witness Project: Implications for the implementation and sustainability of community-based LHA programs from a longitudinal study.

PubMed

Shelton, Rachel C; Dunston, Sheba King; Leoce, Nicole; Jandorf, Lina; Thompson, Hayley S; Crookes, Danielle M; Erwin, Deborah O

2016-03-22

Lay health advisor (LHA) programs are increasingly being implemented in the USA and globally in the context of health promotion and disease prevention. LHAs are effective in addressing health disparities when used to reach medically underserved populations, with strong evidence among African American and Hispanic women. Despite their success and the evidence supporting implementation of LHA programs in community settings, there are tremendous barriers to sustaining LHA programs and little is understood about their implementation and sustainability in "real-world" settings. The purpose of this study was to (1) propose a conceptual framework to investigate factors at individual, social, and organizational levels that impact LHA activity and retention; and (2) use prospective data to investigate the individual, social, and organizational factors that predict activity level and retention among a community-based sample of African American LHAs participating in an effective, evidence-based LHA program (National Witness Project; NWP). Seventy-six LHAs were recruited from eight NWP sites across the USA. Baseline predictor data was collected from LHAs during a telephone questionnaire administered between 2010 and 2011. Outcome data on LHA participation and program activity levels were collected in the fall of 2012 from NWP program directors. Chi-square and ANOVA tests were used to identify differences between retained and completely inactive LHAs, and LHAs with high/moderate vs. low/no activity levels. Multivariable logistic regression models were conducted to identify variables that predicted LHA retention and activity levels. In multivariable models, LHAs based at sites with academic partnerships had increased odds of retention and high/moderate activity levels, even after adjusting for baseline LHA activity level. Higher religiosity among LHAs was associated with decreased odds of being highly/moderately active. LHA role clarity and self-efficacy were associated with retention and high/moderate activity in multivariable models unadjusted for baseline LHA activity level. Organizational and role-related factors are critical in influencing the retention and activity levels of LHAs. Developing and fostering partnerships with academic institutions will be important strategies to promote successful implementation and sustainability of LHA programs. Clarifying role expectations and building self-efficacy during LHA recruitment and training should be further explored to promote LHA retention and participation.

Lay beliefs about the causes and cures of schizophrenia.

PubMed

Park, Subin; Lee, Minji; Furnham, Adrian; Jeon, Mina; Ko, Young-Mi

2017-09-01

Lay beliefs about schizophrenia are an important factor associated with treatment-seeking behavior. This study was conducted to investigate the lay beliefs about the causes and treatments of schizophrenia in South Korea. A total of 654 adults (mean age, 35.96 ± 11.33 years) completed two questionnaires assessing their views on the causes and cures of schizophrenia. The factor structures of lay beliefs about the causes and treatments of schizophrenia were then analyzed and the correlations between the resultant factors investigated. From the cause items, four factors were extracted: Health/Lifestyle, God/Fate, Social/Environmental and Biological. Four factors were also extracted from the treatment items: Self-Help/Stress Management, Physical Treatment/Health Management, Religious Help and Mental Health Service Utilization. Notably, most participants believed that items in the Social/Environmental and Biological factors were the causes of schizophrenia, while they believed that items in the Mental Health Service Utilization and Self-Help/Stress Management factors were the treatments. Participants' beliefs about the causes and treatments of schizophrenia were systematically correlated. Overall, laypeople have reasonably accurate beliefs and a multidimensional view of the causes and treatments of schizophrenia. Nevertheless, our results suggest that public education about the etiology and treatment of schizophrenia are necessary to increase actual usage of mental health services and treatments for schizophrenia.

Lay Outreach Workers and the Ohio Migrant and Seasonal Farm Workers Health Education Needs Assessment.

ERIC Educational Resources Information Center

Alvarez, Olga L.

The Migrant and Seasonal Farm Workers Project sought to determine the health education needs of this indigent population in Ohio using the help of lay outreach workers. A bilingual needs assessment survey was developed containing questions on demographics, place of permanent residence, points of travel after working in Ohio, and type of work and…

Practitioner and lay perspectives of the service provision of nutrition information leaflets in primary care.

PubMed

McClinchy, Jane; Dickinson, Angela; Barron, Duncan; Thomas, Hilary

2011-12-01

In primary care, leaflets are often used to communicate health information. Increasingly, primary healthcare practitioners need to provide dietary advice. There is limited research exploring how nutrition information leaflets are used in primary care. The present study explored practitioner and lay experiences with respect to providing and receiving nutrition information in primary care, focusing in particular on the use of leaflets for nutrition information. A qualitative design was used incorporating focus groups with 57 practitioners based at seven general practitioner practices and a purposive sample of 30 lay participants attending six Consumer Health Organisations within one primary care trust. Focus groups were taped and transcribed verbatim and data were analysed thematically, assisted by computer software n6® (QSR International Pty Ltd, Melbourne, Australia). Practitioners discussed barriers to giving nutritional advice, access to leaflets, lay receptiveness to advice and their perceptions about the value of leaflets to lay people. Food was not considered in terms of its nutritional components by lay participants and the need for nutritional information was not perceived to be relevant until they had received a medical diagnosis. Lay participants discussed the importance of receiving nutritional advice relating to their medical diagnosis and the altered status of written information that was delivered personally. Practitioner and lay groups suggested improvements to ensure that nutritional advice be supported by relevant and appropriate written information. This research has underlined the continuing importance of nutrition information leaflets and concludes that there is particular value in involving lay participants in the development of nutrition information leaflets. © 2011 The Authors. Journal of Human Nutrition and Dietetics © 2011 The British Dietetic Association Ltd.

Community recommendations on biobank governance: Results from a deliberative community engagement in California.

PubMed

Dry, Sarah M; Garrett, Sarah B; Koenig, Barbara A; Brown, Arleen F; Burgess, Michael M; Hult, Jen R; Longstaff, Holly; Wilcox, Elizabeth S; Madrigal Contreras, Sigrid Karina; Martinez, Arturo; Boyd, Elizabeth A; Dohan, Daniel

2017-01-01

United States-based biorepositories are on the cusp of substantial change in regulatory oversight at the same time that they are increasingly including samples and data from large populations, e.g. all patients in healthcare system. It is appropriate to engage stakeholders from these populations in new governance arrangements. We sought to describe community recommendations for biorepository governance and oversight using deliberative community engagement (DCE), a qualitative research method designed to elicit lay perspectives on complex technical issues. We asked for stakeholders to provide input on governance of large biorepositories at the University of California (UC), a public university. We defined state residents as stakeholders and recruited residents from two large metropolitan areas, Los Angeles (LA) and San Francisco (SF). In LA, we recruited English and Spanish speakers; in SF the DCE was conducted in English only. We recruited individuals who had completed the 2009 California Health Interview Survey and were willing to be re-contacted for future studies. Using stratified random sampling (by age, education, race/ethnicity), we contacted 162 potential deliberants of whom 53 agreed to participate and 51 completed the 4-day DCE in June (LA) and September-October (SF), 2013. Each DCE included discussion among deliberants facilitated by a trained staff and simultaneously-translated in LA. Deliberants also received a briefing book describing biorepository operations and regulation. During the final day of the DCE, deliberants voted on governance and oversight recommendations using an audience response system. This paper describes 23 recommendations (of 57 total) that address issues including: educating the public, sharing samples broadly, monitoring researcher behavior, using informative consent procedures, and involving community members in a transparent process of biobank governance. This project demonstrates the feasibility of obtaining meaningful input on biorepository governance from diverse lay stakeholders. Such input should be considered as research institutions respond to changes in biorepository regulation.

Broadening participation in community problem solving: a multidisciplinary model to support collaborative practice and research.

PubMed

Lasker, Roz D; Weiss, Elisa S

2003-03-01

Over the last 40 years, thousands of communities-in the United States and internationally-have been working to broaden the involvement of people and organizations in addressing community-level problems related to health and other areas. Yet, in spite of this experience, many communities are having substantial difficulty achieving their collaborative objective, and many funders of community partnerships and participation initiatives are looking for ways to get more out of their investment. One of the reasons we are in this predicament is that the practitioners and researchers who are interested in community collaboration come from a variety of contexts, initiatives, and academic disciplines, and few of them have integrated their work with experiences or literatures beyond their own domain. In this article, we seek to overcome some of this fragmentation of effort by presenting a multidisciplinary model that lays out the pathways by which broadly participatory processes lead to more effective community problem solving and to improvements in community health. The model, which builds on a broad array of practical experience as well as conceptual and empirical work in multiple fields, is an outgrowth of a joint-learning work group that was organized to support nine communities in the Turning Point initiative. Following a detailed explication of the model, the article focuses on the implications of the model for research, practice, and policy. It describes how the model can help researchers answer the fundamental effectiveness and "how-to" questions related to community collaboration. In addition, the article explores differences between the model and current practice, suggesting strategies that can help the participants in, and funders of, community collaborations strengthen their efforts.

Human resources for mental health care: current situation and strategies for action.

PubMed

Kakuma, Ritsuko; Minas, Harry; van Ginneken, Nadja; Dal Poz, Mario R; Desiraju, Keshav; Morris, Jodi E; Saxena, Shekhar; Scheffler, Richard M

2011-11-05

A challenge faced by many countries is to provide adequate human resources for delivery of essential mental health interventions. The overwhelming worldwide shortage of human resources for mental health, particularly in low-income and middle-income countries, is well established. Here, we review the current state of human resources for mental health, needs, and strategies for action. At present, human resources for mental health in countries of low and middle income show a serious shortfall that is likely to grow unless effective steps are taken. Evidence suggests that mental health care can be delivered effectively in primary health-care settings, through community-based programmes and task-shifting approaches. Non-specialist health professionals, lay workers, affected individuals, and caregivers with brief training and appropriate supervision by mental health specialists are able to detect, diagnose, treat, and monitor individuals with mental disorders and reduce caregiver burden. We also discuss scale-up costs, human resources management, and leadership for mental health, particularly within the context of low-income and middle-income countries. Copyright © 2011 Elsevier Ltd. All rights reserved.

Lessons Learned in Community Research Through The Native Proverbs 31 Health Project

PubMed Central

Kimes, Caroline M.; Golden, Shannon L.; Maynor, Rhonda F.; Spangler, John G.

2014-01-01

Background American Indian women have high rates of cardiovascular disease largely because of their high prevalence of hypertension, diabetes, and obesity. This population has high rates of cardiovascular disease-related behaviors, including physical inactivity, harmful tobacco use, and a diet that promotes heart disease. Culturally appropriate interventions are needed to establish health behavior change to reduce cardiovascular disease risk. Community Context This study was conducted in Robeson County, North Carolina, the traditional homeland of the Lumbee Indian tribe. The study’s goal was to develop, deliver, and evaluate a community-based, culturally appropriate cardiovascular disease program for American Indian women and girls. Methods Formative research, including focus groups, church assessments, and literature reviews, were conducted for intervention development. Weekly classes during a 4-month period in 4 Lumbee churches (64 women and 11 girls in 2 primary intervention churches; 82 women and 8 girls in 2 delayed intervention churches) were led by community lay health educators. Topics included nutrition, physical activity, and tobacco use cessation and were coupled with messages from the Proverbs 31 passage, which describes the virtuous, godly woman. Surveys collected at the beginning and end of the program measured programmatic effects and change in body mass index. Outcome Churches were very receptive to the program. However, limitations included slow rise in attendance, scheduling conflicts for individuals and church calendars, and resistance to change in cultural traditions. Interpretation Churches are resources in developing and implementing health promotion programs in Christian populations. Through church partnerships, interventions can be tailored to suit the needs of targeted groups. PMID:24742392

The HoMBReS and HoMBReS Por un Cambio Interventions to Reduce HIV Disparities Among Immigrant Hispanic/Latino Men

PubMed Central

Rhodes, Scott D.; Leichliter, Jami S.; Sun, Christina J.; Bloom, Fred R.

2016-01-01

Summary Hispanics/Latinos in the United States are affected disproportionately by human immunodeficiency virus (HIV) infection, acquired immunodeficiency syndrome (AIDS), and other sexually transmitted diseases (STDs); however, few effective evidence-based prevention interventions for this population exist. This report describes the Hombres Manteniendo Bienestar y Relaciones Saludables (Men Maintaining Wellbeing and Healthy Relationships) (HoMBReS) intervention, which was developed by a community-based, participatory research partnership in North Carolina and initially implemented during 2005–2009. HoMBReS is an example of an effective intervention that uses lay health advisors (known as Navegantes [navigators]) in the context of existing social networks (i.e., recreational soccer teams) to promote consistent condom use and HIV and STD testing among Hispanic/Latino men. In 2012, HoMBReS was classified as a best-evidence community-level HIV prevention intervention (CDC. Compendium of evidence-based behavioral interventions and best practices for HIV prevention. Atlanta, GA: US Department of Health and Human Services, CDC; 2015). The intervention has been implemented elsewhere, enhanced, and further evaluated in longitudinal intervention and implementation studies. HoMBReS has been adapted for other populations, including men who have sex with men and transgender persons. Additional evaluation has found that Navegantes continue in their roles as health advisors, opinion leaders, and community advocates after study support ends. Hispanic/Latino men’s social networks can be leveraged to promote sexual health within the community by decreasing HIV risk behaviors among Hispanics/Latinos in the United States. PMID:26916740

Evaluation of Lay Support in Pregnant women with Social risk (ELSIPS): a randomised controlled trial.

PubMed

Kenyon, Sara; Jolly, Kate; Hemming, Karla; Ingram, Lucy; Gale, Nicola; Dann, Sophie-Anna; Chambers, Jacky; MacArthur, Christine

2012-02-29

Maternal, neonatal and child health outcomes are worse in families from black and ethnic minority groups and disadvantaged backgrounds. There is little evidence on whether lay support improves maternal and infant outcomes among women with complex social needs within a disadvantaged multi-ethnic population in the United Kingdom (UK). The aim of this study is to evaluate a lay Pregnancy Outreach Worker (POW) service for nulliparous women identified as having social risk within a maternity service that is systematically assessing social risks alongside the usual obstetric and medical risks. The study design is a randomised controlled trial (RCT) in nulliparous women assessed as having social risk comparing standard maternity care with the addition of referral to the POW support service. The POWs work alongside community midwifery teams and offer individualised support to women to encourage engagement with services (health and social care) from randomisation (before 28 weeks gestation) until 6 weeks after birth. The primary outcomes have been chosen on the basis that they are linked to maternal and infant health. The two primary outcomes are engagement with antenatal care, assessed by the number of antenatal visits; and maternal depression, assessed using the Edinburgh Postnatal Depression Scale at 8-12 weeks after birth. Secondary outcomes include maternal and neonatal morbidity and mortality, routine child health assessments, including immunisation uptake and breastfeeding at 6 weeks. Other psychological outcomes (self efficacy) and mother-to-infant bonding will also be collected using validated tools.A sample size of 1316 will provide 90% power (at the 5% significance level) to detect increased engagement with antenatal services of 1.5 visits and a reduction of 1.5 in the average EPDS score for women with two or more social risk factors, with power in excess of this for women with any social risk factor. Analysis will be by intention to treat. Qualitative research will explore the POWs' daily work in context. This will complement the findings of the RCT through a triangulation of quantitative and qualitative data on the process of the intervention, and identify other contextual factors that affect the implementation of the intervention. The trial will provide high quality evidence as to whether or not lay support (POW) offered to women identified with social risk factors improves engagement with maternity services and reduces numbers of women with depression. MREC NUMBER: 10/H1207/23 ISRCTN: ISRCTN35027323.

Development of a Behavior Change Intervention to Encourage Timely Cancer Symptom Presentation Among People Living in Deprived Communities Using the Behavior Change Wheel.

PubMed

Smits, Stephanie; McCutchan, Grace; Wood, Fiona; Edwards, Adrian; Lewis, Ian; Robling, Michael; Paranjothy, Shantini; Carter, Ben; Townson, Julia; Brain, Kate

2018-05-18

Targeted public awareness interventions are needed to improve earlier cancer diagnosis and reduce socioeconomic inequalities in cancer outcomes. The health check (intervention) is a touchscreen questionnaire delivered by trained lay advisors that aims to raise awareness of cancer symptoms and risk factors and encourage timely help seeking. This study aimed to apply the Behavior Change Wheel to intervention refinement by identifying barriers and facilitators to timely symptom presentation among people living in socioeconomically deprived communities. Primary data (six focus groups with health professionals, community partners and public) and secondary data (systematic review of barriers and facilitators to cancer symptom presentation) were mapped iteratively to the Behavior Change Wheel. Barriers and facilitators were identified from the systematic review and focus groups comprising 14 members of the public aged over 40, 14 community partners, and 14 healthcare professionals. Barriers included poor symptom knowledge and lack of motivation to engage in preventive or proactive behaviors. Facilitators included cues/prompts to action, general practitioner preparedness to listen, and social networks. The following behavior change techniques were selected to address identified barriers and facilitators: information about health consequences, prompts/cues, credible sources, restricting physical and social environment, social support, goal setting, and action planning. The Behavior ChangeWheel triangulated findings from primary and secondary data sources. An intervention combining education and enablement could encourage timely symptom presentation to primary care among people living in socioeconomically deprived communities. Social encouragement and support is needed to increase symptom knowledge, challenge negative cancer beliefs, and prompt decisions to engage with the healthcare system.

Quantifying links between stroke and risk factors: a study on individual health risk appraisal of stroke in a community of Chongqing.

PubMed

Wu, Yazhou; Zhang, Ling; Yuan, Xiaoyan; Wu, Yamin; Yi, Dong

2011-04-01

The objective of this study is to investigate the risk factors of stroke in a community in Chongqing by setting quantitative criteria for determining the risk factors of stroke. Thus, high-risk individuals can be identified and laid a foundation for predicting individual risk of stroke. 1,034 cases with 1:2 matched controls (2,068) were chosen from five communities in Chongqing including Shapingba, Xiaolongkan, Tianxingqiao, Yubei Road and Ciqikou. Participants were interviewed with a uniform questionnaire. The risk factors of stroke and the odds ratios of risk factors were analyzed with a logistic regression model, and risk exposure factors of different levels were converted into risk scores using statistical models. For men, ten risk factors including hypertension (5.728), family history of stroke (4.599), and coronary heart disease (5.404), among others, were entered into the main effect model. For women, 11 risk factors included hypertension (5.270), family history of stroke (4.866), hyperlipidemia (4.346), among others. The related risk scores were added to obtain a combined risk score to predict the individual's risk of stoke in the future. An individual health risk appraisal model of stroke, which was applicable to individuals of different gender, age, health behavior, disease and family history, was established. In conclusion, personal diseases including hypertension, diabetes mellitus, etc., were very important to the prevalence of stoke. The prevalence of stroke can be effectively reduced by changing unhealthy lifestyles and curing the positive individual disease. The study lays a foundation for health education to persuade people to change their unhealthy lifestyles or behaviors, and could be used in community health services.

Building an online community to promote communication and collaborative learning between health professionals and young people who self-harm: an exploratory study.

PubMed

Owens, Christabel; Sharkey, Siobhan; Smithson, Janet; Hewis, Elaine; Emmens, Tobit; Ford, Tamsin; Jones, Ray

2015-02-01

Online communities are known to break down barriers between supposed experts and non-experts and to promote collaborative learning and 'radical trust' among members. Young people who self-harm report difficulties in communicating with health professionals, and vice versa. We sought to bring these two groups together online to see how well they could communicate with each other about self-harm and its management, and whether they could agree on what constituted safe and relevant advice. We allocated 77 young people aged 16-25 with experience of self-harm and 18 recently/nearly qualified professionals in relevant health-care disciplines to three separate Internet discussion forums. The forums contained different proportions of professionals to young people (none; 25%; 50% respectively) to allow us to observe the effect of the professionals on online interaction. The young people were keen to share their lived experience of self-harm and its management with health professionals. They engaged in lively discussion and supported one another during emotional crises. Despite registering to take part, health professionals did not actively participate in the forums. Reported barriers included lack of confidence and concerns relating to workload, private-professional boundaries, role clarity, duty of care and accountability. In their absence, the young people built a vibrant lay community, supported by site moderators. Health professionals may not yet be ready to engage with young people who self-harm and to exchange knowledge and experience in an anonymous online setting. Further work is needed to understand and overcome their insecurities. © 2012 John Wiley & Sons Ltd.

Nurse led versus lay educators support for those with asthma in primary care: a costing study

PubMed Central

2012-01-01

Background Regular review and support for asthma self-management is promoted in guidelines. A randomised controlled trial suggested that unscheduled health care usage was similar when patients were offered self management support by a lay-trainer or practice nurses. Methods Following the RCT, a costing study was undertaken using the trial data to account for the cost of delivery of the service under both strategies and the resulting impact on unscheduled healthcare (measure of effectiveness) in this trial. Results One year data (n = 418) showed that 29% (61/205) of the nurse group required unscheduled healthcare (177 events) compared with 30.5% (65/213) for lay-trainers (178 events). The training costs for the lay-trainers were greater than nurses (£36 versus £18 respectively per patient, p<0.001), however, the consultation cost for lay-trainers were lower than nurses (£6 per patient versus £24, p<0.001). If the cost of unscheduled healthcare are accounted for then the costs of nurses is £161, and £135 for lay-trainers (mean difference £25, [95% CI = −£97, £149, p = 0.681]). The total costs (delivery and unscheduled healthcare) were £202 per patient for nurses versus £178 for lay-trainers, (mean difference £24, [95%CI = −£100, £147, p = 0.707]). Conclusions There were no significant differences in the cost of training and healthcare delivery between nurse and lay trainers, and no significant difference in the cost of unscheduled health care use. PMID:22958541

Roles, responsibilities and characteristics of lay community health workers involved in diabetes prevention programmes: A systematic review

PubMed Central

Oldenburg, Brian

2017-01-01

Aim To examine the characteristics of community health workers (CHWs) involved in diabetes prevention programmes (DPPs) and their contributions to expected outcomes. Methods Electronic databases including PubMed-MEDLINE, EBSCOHost, and SCOPUS/EMBASE were searched for studies published between January 2000 and March 2016. All studies that used CHWs to implement DPP in ≥18-year-old participants without diabetes but at high risk for developing the condition, irrespective of the study design, setting or outcomes measured, were included. Results were synthesized narratively. Results Forty papers of 30 studies were identified. Studies were mainly community-based and conducted in minority populations in USA. Sample sizes ranged from 20 participants in a single community to 2369 participants in 46 communities. Although CHWs were generally from the local community, their qualifications, work experience and training received differed across studies. Overall the training was culturally sensitive and/or appropriate, covering topics such as the importance of good nutrition and the benefits of increased physical activity, communication and leadership. CHWs delivered a variety of interventions and also screened or recruited participants. The shared culture and language between CHWs and participants likely contributed to better programme implementation and successful outcomes. Conclusions The complexity of DPPs and the diverse CHW roles preclude attributing specific outcomes to CHW involvement. Nevertheless, documenting potential CHW roles and the relevant training required may optimise CHW contributions and facilitate their involvement in DPPs in the future. PMID:29216263

Roles, responsibilities and characteristics of lay community health workers involved in diabetes prevention programmes: A systematic review.

PubMed

Hill, Jillian; Peer, Nasheeta; Oldenburg, Brian; Kengne, Andre Pascale

2017-01-01

To examine the characteristics of community health workers (CHWs) involved in diabetes prevention programmes (DPPs) and their contributions to expected outcomes. Electronic databases including PubMed-MEDLINE, EBSCOHost, and SCOPUS/EMBASE were searched for studies published between January 2000 and March 2016. All studies that used CHWs to implement DPP in ≥18-year-old participants without diabetes but at high risk for developing the condition, irrespective of the study design, setting or outcomes measured, were included. Results were synthesized narratively. Forty papers of 30 studies were identified. Studies were mainly community-based and conducted in minority populations in USA. Sample sizes ranged from 20 participants in a single community to 2369 participants in 46 communities. Although CHWs were generally from the local community, their qualifications, work experience and training received differed across studies. Overall the training was culturally sensitive and/or appropriate, covering topics such as the importance of good nutrition and the benefits of increased physical activity, communication and leadership. CHWs delivered a variety of interventions and also screened or recruited participants. The shared culture and language between CHWs and participants likely contributed to better programme implementation and successful outcomes. The complexity of DPPs and the diverse CHW roles preclude attributing specific outcomes to CHW involvement. Nevertheless, documenting potential CHW roles and the relevant training required may optimise CHW contributions and facilitate their involvement in DPPs in the future.

The self-care for people initiative: the outcome evaluation.

PubMed

White, Alan; South, Jane; Bagnall, Anne-Marie; Forshaw, Mark; Spoor, Chris; Marchant, Paul; Witty, Karl

2012-10-01

To determine the effects of a community-based training programme in self-care on the lay population. Self Care is recognised as being a cornerstone of the populations health, but to date there have been few large-scale studies of its effectiveness on the general public. This paper reports on an evaluation of a self-care skills training course delivered in small group sessions within workplace and parent and toddler group settings to a lay population. A quasi-experimental longitudinal study of 12-month duration was conducted in three intervention primary care trusts (PCTs) and two similar comparison PCTs in England. The sample comprised 1568 self-selecting participants: 868 received the intervention and 700 did not. No changes were seen in usage of General Practitioner services, the primary outcome, however, statistical analysis suggested that being in the intervention group may be associated with increased use of out-of-hours and secondary care services. At six months' follow-up small but statistically significant positive effects of being in the intervention group were seen on self-esteem, well-being and anxiety scores. At 12 months' follow-up small but statistically significant positive effects of being in the intervention group were also seen on recovery locus of control, health literacy and self-esteem scores, and on knowledge of adult cough. The clinical significance of these very small changes is unclear. The training programme had a small but positive effect, which was still evident at 12 months, on individuals' knowledge and confidence levels with regard to managing their own health, but did not lead to reductions in health service use.

Lay health supporters aided by a mobile phone messaging system to improve care of villagers with schizophrenia in Liuyang, China: protocol for a randomised control trial.

PubMed

Xu, Dong Roman; Gong, Wenjie; Caine, Eric D; Xiao, Shuiyuan; Hughes, James P; Ng, Marie; Simoni, Jane; He, Hua; Smith, Kirk L; Brown, Henry Shelton; Gloyd, Stephen

2016-01-20

Schizophrenia is a severe, chronic and disabling mental illness. Non-adherence to medication and relapse may lead to poorer patient function. This randomised controlled study, under the acronym LEAN (Lay health supporter, e-platform, award, and iNtegration), is designed to improve medication adherence and high relapse among people with schizophrenia in resource poor settings. The community-based LEAN has four parts: (1) Lay health supporters (LHSs), mostly family members who will help supervise patient medication, monitor relapse and side effects, and facilitate access to care, (2) an E-platform to support two-way mobile text and voice messaging to remind patients to take medication; and alert LHSs when patients are non-adherent, (3) an Award system to motivate patients and strengthen LHS support, and (4) iNtegration of the efforts of patients and LHSs with those of village doctors, township mental health administrators and psychiatrists via the e-platform. A random sample of 258 villagers with schizophrenia will be drawn from the schizophrenic '686' Program registry for the 9 Xiang dialect towns of the Liuyang municipality in China. The sample will be further randomised into a control group and a treatment group of equal sizes, and each group will be followed for 6 months after launch of the intervention. The primary outcome will be medication adherence as measured by pill counts and supplemented by pharmacy records. Other outcomes include symptoms and level of function. Outcomes will be assessed primarily when patients present for medication refill visits scheduled every 2 months over the 6-month follow-up period. Data from the study will be analysed using analysis of covariance for the programme effect and an intent-to-treat approach. University of Washington: 49464 G; Central South University: CTXY-150002-6. Results will be published in peer-reviewed journals with deidentified data made available on FigShare. ChiCTR-ICR-15006053; Pre-results. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Cross-cultural perspectives on physician and lay models of the common cold.

PubMed

Baer, Roberta D; Weller, Susan C; de Alba García, Javier García; Rocha, Ana L Salcedo

2008-06-01

We compare physicians and laypeople within and across cultures, focusing on similarities and differences across samples, to determine whether cultural differences or lay-professional differences have a greater effect on explanatory models of the common cold. Data on explanatory models for the common cold were collected from physicians and laypeople in South Texas and Guadalajara, Mexico. Structured interview materials were developed on the basis of open-ended interviews with samples of lay informants at each locale. A structured questionnaire was used to collect information from each sample on causes, symptoms, and treatments for the common cold. Consensus analysis was used to estimate the cultural beliefs for each sample. Instead of systematic differences between samples based on nationality or level of professional training, all four samples largely shared a single-explanatory model of the common cold, with some differences on subthemes, such as the role of hot and cold forces in the etiology of the common cold. An evaluation of our findings indicates that, although there has been conjecture about whether cultural or lay-professional differences are of greater importance in understanding variation in explanatory models of disease and illness, systematic data collected on community and professional beliefs indicate that such differences may be a function of the specific illness. Further generalizations about lay-professional differences need to be based on detailed data for a variety of illnesses, to discern patterns that may be present. Finally, a systematic approach indicates that agreement across individual explanatory models is sufficient to allow for a community-level explanatory model of the common cold.

Claim More™: Empowering African American Women to Make Healthy Choices

PubMed Central

Tkatch, Rifky; Musich, Shirley; Draklellis, Jennifer; Hetzel, Marla; Banks, Jo; Dugan, Jessica; Thompson, Kaylene; Hawkins, Kevin

2017-01-01

Diabetes is a serious issue for African American women. The purpose of this project was to develop and test the feasibility of a culturally appropriate and faith-based healthy eating program for African American women at risk for developing diabetes. At total of 30 women from two churches completed a 12-week, faith-based program using a community-based approach with lay health educators in the church setting. Participants set healthy eating goals, attended weekly education classes, and received daily text messaging reminders related to their goals. Outcomes included high levels of social support, frequent engagement with the program, and improved healthy eating. This program demonstrated the ability to target African American women at risk for diabetes and engage them in a health-related program. PMID:29172987

Lay Led Ministries in USAREUR: Impact on Command and Community.

DTIC Science & Technology

1985-04-17

Second Coming. However, with the exception of the Jewish program, these church groups appeared to generally fall into two (2) categories: Black/Ethnic and...same denomination-- Church of God in Christ. Summary Statement: The data which was received from the group of inter- viewed lay ministers could generally ...Chaplain Center and School at Fort Monmouth, New Jersey. 3. Questionnaires distributed to those persons most closely connected with the issue in the

Linking community programs in environment to programs in population: towards sustainable communities that sustain sanctuaries.

PubMed

Cincotta, R P

1994-01-01

This article briefly reviews several nongovernmental organization (NGO) programs that address environmental and population issues. A framework is constructed that identifies how linked programs are supposed to work. The potential for sustainable communities is explored. It is concluded that sanctuaries in developing countries will not survive unless population in surrounding communities is stabilized and the economic and ecological relationships between the community and the sanctuary ecosystem are sustainable. In developed countries resource needs must be identified in regional planning in order for environmental protection to occur. The author finds that NGOs can be instrumental in securing community participation in environmental protection. NGOs operating in Chiapas, Mexico, provide management assistance and public health and family planning awareness to displaced indigenous farmers and conservative professionals. Another NGO outside the Ranthambhore National Park in Rajasthan, India, works to promote alternative fuel and grazing sources among local farmers. Near Chautara, in Nepal, farmers are aided by NGOs in laying sanitary water pipes, which reduces the amount of women's time required for fetching water and increases the amount of time women can spend gardening or getting involved in environmental projects. NGO efforts that reduce women's time absorbed by domestic burdens help women fulfill family planning desires and allow for greater investment in the education of children. Environmental sustainability will be dependent on family planning and other population-related processes and on the awareness that public health is an environmental issue. Opposition to integrated environment and population programs stems from donor opposition, opposition to investment in low-density areas, and a priority on biodiversity issues over development of public health services near sanctuaries. This paper was presented at an international forum at the George Washington University before the 1994 Cairo conference.

Understanding Genomic Knowledge in Rural Appalachia: The West Virginia Genome Community Project

PubMed Central

Mallow, Jennifer A.; Theeke, Laurie A.; Crawford, Patricia; Prendergast, Elizabeth; Conner, Chuck; Richards, Tony; McKown, Barbara; Bush, Donna; Reed, Donald; Stabler, Meagan E.; Zhang, Jianjun; Dino, Geri; Barr, Taura L.

2016-01-01

Purpose Rural communities have limited knowledge about genetics and genomics and are also underrepresented in genomic education initiatives. The purpose of this project was to assess genomic and epigenetic knowledge and beliefs in rural West Virginia. Sample A total of 93 participants from three communities participated in focus groups and 68 participants completed a demographic survey. The age of the respondents ranged from 21 to 81 years. Most respondents had a household income of less than $40,000, were female and most were married, completed at least a HS/GED or some college education working either part-time or full-time. Method A Community Based Participatory Research process with focus groups and demographic questionnaires was used. Findings Most participants had a basic understanding of genetics and epigenetics, but not genomics. Participants reported not knowing much of their family history and that their elders did not discuss such information. If the conversations occurred, it was only during times of crisis or an illness event. Mental health and substance abuse are topics that are not discussed with family in this rural population. Conclusions Most of the efforts surrounding genetic/genomic understanding have focused on urban populations. This project is the first of its kind in West Virginia and has begun to lay the much needed infrastructure for developing educational initiatives and extending genomic research projects into our rural Appalachian communities. By empowering the public with education, regarding the influential role genetics, genomics, and epigenetics have on their health, we can begin to tackle the complex task of initiating behavior changes that will promote the health and well-being of individuals, families and communities. PMID:27212895

A community-engaged infection prevention and control approach to Ebola.

PubMed

Marais, Frederick; Minkler, Meredith; Gibson, Nancy; Mwau, Baraka; Mehtar, Shaheen; Ogunsola, Folasade; Banya, Sama S; Corburn, Jason

2016-06-01

The real missing link in Ebola control efforts to date may lie in the failure to apply core principles of health promotion: the early, active and sustained engagement of affected communities, their trusted leaders, networks and lay knowledge, to help inform what local control teams do, and how they may better do it, in partnership with communities. The predominant focus on viral transmission has inadvertently stigmatized and created fear-driven responses among affected individuals, families and communities. While rigorous adherence to standard infection prevention and control (IPC) precautions and safety standards for Ebola is critical, we may be more successful if we validate and combine local community knowledge and experiences with that of IPC medical teams. In an environment of trust, community partners can help us learn of modest adjustments that would not compromise safety but could improve community understanding of, and responses to, disease control protocol, so that it better reflects their 'community protocol' (local customs, beliefs, knowledge and practices) and concerns. Drawing on the experience of local experts in several African nations and of community-engaged health promotion leaders in the USA, Canada and WHO, we present an eight step model, from entering communities with cultural humility, though reciprocal learning and trust, multi-method communication, development of the joint protocol, to assessing progress and outcomes and building for sustainability. Using examples of changes that are culturally relevant yet maintain safety, we illustrate how often minor adjustments can help prevent and treat the most serious emerging infectious disease since HIV/AIDS. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Health care decisions by Sukuma 'peasant intellectuals': a case of radical empiricism?

PubMed

Stroeken, Koen

2012-04-01

Health care decisions in Sukuma-speaking rural communities in Tanzania reproduce a practical epistemology that could be described as radically empiricist, rather than just pluralist; their point of reference is the deeper 'relation' between events, which collective traditions articulate and subjects may experience, but which escapes the atomistic perception privileged by biomedicine. This analysis relies on a diverse portfolio of ethnographic data, including the use and structure of medicinal recipes, the choices of mental health care according to experienced 'effectiveness', and lay discussions on the correct aetiology and treatment of reproductive disorder. Combining two dimensions for a given medical epistemology, the (empirical/ habitual) basis of its transmission and the (open/closed) relation with other epistemologies, four types are proposed: monism, dualism, pluralism, and radical empiricism. The concept of peasant intellectuals, it is argued, needs to be rethought in contexts of medicinal initiation.

Dimensions of sustainability for a health communication intervention in African American churches: a multi-methods study.

PubMed

Scheirer, Mary Ann; Santos, Sherie Lou Z; Tagai, Erin K; Bowie, Janice; Slade, Jimmie; Carter, Roxanne; Holt, Cheryl L

2017-03-28

Sustainability of evidence-based health promotion interventions has received increased research attention in recent years. This paper reports sustainability data from Project HEAL (Health through Early Awareness and Learning) a cancer communication implementation trial about early detection, based in African American churches. In this paper, we used a framework by Scheirer and Dearing (Am J Publ Health 101:2059-2067, 2011) to evaluate multiple dimensions of sustainability from Project HEAL. We examined the following dimensions of sustainability: (a) continued benefits for intervention recipients, (b) continuation of intervention activities, c) maintaining community partnerships, (d) changes in organizational policies or structures, (e) sustained attention to the underlying issues, (f) diffusion to additional sites, or even (g) unplanned consequences of the intervention. Project HEAL provided a three-workshop cancer educational series delivered by trained lay peer community health advisors (CHAs) in their churches. Multiple sources of sustainability were collected at 12 and 24 months after the intervention that reflect several levels of analysis: participant surveys; interviews with CHAs; records from the project's management database; and open-ended comments from CHAs, staff, and community partners. Outcomes differ for each dimension of sustainability. For continued benefit, 39 and 37% of the initial 375 church members attended the 12- and 24-month follow-up workshops, respectively. Most participants reported sharing the information from Project HEAL with family or friends (92% at 12 months; 87% at 24 months). For continuation of intervention activities, some CHAs reported that the churches held at least one additional cancer educational workshop (33% at 12 months; 24% at 24 months), but many more CHAs reported subsequent health activities in their churches (71% at 12 months; 52% at 24 months). No church replicated the original series of three workshops. Additional data confirm the maintenance of community partnerships, some changes in church health policies, and continued attention to health issues by churches and CHAs. The multiple dimensions of sustainability require different data sources and levels of analysis and show varied sustainability outcomes in this project. The findings reinforce the dynamic nature of evidence-based health interventions in community contexts.

Feasibility of Utilizing Ethnic Beauty Salons for Cervical Cancer Screening Education

PubMed Central

Carvallo, Mauricio; Lee, Eunice

2014-01-01

The purpose of this study was to assess the feasibility of using ethnic beauty salons to reach out to Vietnamese and Korean American women for cervical cancer screening education. Participants (N = 62) were conveniently recruited from ethnic beauty salons located in Albuquerque, NM. Two feasibility questionnaires were separately administered to cosmetologists and their customers. Findings support the view that ethnic beauty salons can be used as a gateway to reach out to these populations, and cosmetologists have the potential to operate as community lay health workers to deliver cervical cancer screening education aimed at reducing disparities in cervical cancer and screening to their ethnic customers. PMID:24698810

A design thinking framework for healthcare management and innovation.

PubMed

Roberts, Jess P; Fisher, Thomas R; Trowbridge, Matthew J; Bent, Christine

2016-03-01

The business community has learned the value of design thinking as a way to innovate in addressing people's needs--and health systems could benefit enormously from doing the same. This paper lays out how design thinking applies to healthcare challenges and how systems might utilize this proven and accessible problem-solving process. We show how design thinking can foster new approaches to complex and persistent healthcare problems through human-centered research, collective and diverse teamwork and rapid prototyping. We introduce the core elements of design thinking for a healthcare audience and show how it can supplement current healthcare management, innovation and practice. Copyright © 2015 Elsevier Inc. All rights reserved.

Continuous subcutaneous infusion in palliative care: a review of current practice.

PubMed

Thomas, Tabitha; Barclay, Stephen

2015-02-01

Syringe drivers are widely used in palliative care, and this article reviews the challenges and outstanding questions associated with their use. Misperceptions among the lay public and some health professionals can be addressed by sensitive communication with patients and families and clear thinking in clinical teams concerning the drugs and doses used, particularly in non-malignant disease. Good levels of knowledge concerning syringe driver use has been found among GPs and community nurses, although this is not the case in some nursing home teams. The advantages of newer devices, safety and efficacy of drug combinations, selection of diluent, and management of site reactions are discussed.

Heritage tourism development in rural Russia: A case study in collaborative tourism planning in an international setting

Treesearch

Roy Ramthun; Susan Williams; Vladimir Shalaev; Svetlana Guseva; Irina Polinkova; Sofia Chervakova; Svetlana Ivanova; Anna Pahkmutova; Anastasia Shalaev

2010-01-01

In the United States, advisers from such organizations as universities and extension services often assist rural communities with community planning and development efforts. These outside groups typically facilitate communication and discussion among stakeholders and help to lay out a process by which the community may proceed towards its shared goals. Faculty members...

Working with lay people in health service research: a model of co-evolution based on complexity theory.

PubMed

Kernick, David; Mitchell, Annie

2010-01-01

Involving lay researchers is an important part of Government policy in the United Kingdom within the context of the National Health Service. Here we draw upon insights from complexity theory to suggest a model that we call consensual qualitative research where lay researchers and professionals are co-producers of knowledge. The focus of attention is on understanding and facilitating the patterns that emerge from non-linear interaction at a local level. We describe some core principles that can facilitate the development of such a model and conclude that the resources in terms of time and effort that such an approach requires, should not be underestimated.

The blurred boundary between professional and lay home nursing knowledge and practice in New Zealand, 1900-1935.

PubMed

Wood, Pamela J

2013-02-01

In New Zealand, the state registration of nurses was instituted in 1901. This was a marker that nursing had achieved professional status. Although many registered nurses (RNs) worked in private practice or as district nurses in people's homes, lay home nurses had an essential role in caring for the sick. This article reports a comparative analysis of information available to lay home nurses in domestic health guides with information for RNs in professional nursing textbooks, for the period 1900-1935. It shows that despite RNs' professional status, domestic health guides gave more detailed information than nursing textbooks on many subjects until the end of the research time period. The boundary between registered and lay home nurses' knowledge and practice was therefore blurred. Exploring this indistinct boundary challenges understandings about the clear division between professional and lay knowledge and practice. This has particular relevance in a time when health systems increasingly depend on care provided in the home by family members. Home nursing has always been a crucial component in any system for the care of the sick. Historically, caring for people at the end of life or those with chronic and acute illnesses depended largely on the commitment of untrained women, nursing their own family members at home and supporting neighbors to care for the ill in other households.

Experimental control of Triatoma infestans in poor rural villages of Bolivia through community participation.

PubMed

Lardeux, Frédéric; Depickère, Stéphanie; Aliaga, Claudia; Chavez, Tamara; Zambrana, Lilian

2015-02-01

Triatoma infestans is the main vector of Chagas disease in the southern cone countries. Present control strategies based on indoor and outdoor residual insecticide spraying are not sufficient to control disease transmission, particularly in Bolivia. Techniques based on the management of the human environment may be good alternatives or supplements. Social and entomological surveys were carried out in four villages of Bolivia situated in the dry inter-Andean Valleys and the Chaco region. Risk factors for house infestation by T. infestans were identified, and an eco-health intervention based on education and community participation was carried out to reduce the risks of house infestation. It consisted of implementing simple and low cost vector control techniques such as coating of mud walls, cleaning activities and removal of poultry that enter rooms to lay eggs. The eco-health intervention significantly reduced the number of infested bedrooms, the mean abundance of T. infestans in bedrooms and beds, especially in the Chaco region. Mud wall coating was well accepted and could be proposed as a supplementary tool to the National Program of Chagas Disease Control to enhance the effects of insecticide sprayings. Even if cleaning activities were still neglected, community participation proved to be effective in reducing house infestation. © The author 2015. The World Health Organization has granted Oxford University Press permission for the reproduction of this article.

Community engagement to inform the development of a sickle cell counselor training and certification program in Ghana.

PubMed

Anie, Kofi A; Treadwell, Marsha J; Grant, Althea M; Dennis-Antwi, Jemima A; Asafo, Mabel K; Lamptey, Mary E; Ojodu, Jelili; Yusuf, Careema; Otaigbe, Ayo; Ohene-Frempong, Kwaku

2016-07-01

Sickle cell disease (SCD) and sickle cell trait (SCT) are highly prevalent in Africa. Despite public health implications, there is limited understanding of community issues for implementing newborn screening and appropriate family counseling. We conducted a 3-day workshop in Kumasi, Ghana, with community leaders as lay program development advisors to assist the development and implementation of a Sickle Cell Counselor Training and Certification Program. We employed qualitative methods to understand cultural, religious, and psychosocial dimensions of SCD and SCT, including the advisors' attitudes and beliefs in relation to developing a culturally sensitive approach to family education and counseling that is maximally suited to diverse communities in Ghana. We collated advisors' discussions and observations in order to understand community issues and potential challenges and guide strategies for advocacy in SCD family education and counseling. Results from the workshop revealed that community leaders representing diverse communities in Ghana were engaged constructively in discussions about developing a culturally sensitive counselor training program. Key findings included the importance of improved knowledge about SCD among the public and youth in particular, the value of stakeholders such as elders and religious and traditional leaders, and government expectations of reduced SCD births. We submitted a report to the Ministry of Health in Ghana with recommendations for the next steps in developing a national sickle cell counselor training program. We named the program "Genetic Education and Counseling for Sickle Cell Conditions in Ghana" (GENECIS-Ghana). The first GENECIS-Ghana Training and Certification Program Workshop was conducted from June 8 to 12, 2015.

A theory-based model of translation practices in public health participatory research.

PubMed

Clavier, Carole; Sénéchal, Yan; Vibert, Stéphane; Potvin, Louise

2012-06-01

This article explores the innovative practices of actors specifically mandated to support interactions between academic researchers and their partners from the community during public health participatory research. Drawing on the concept of translation as developed in actor-network theory and found in the literature on knowledge transfer and the sociology of intermediate actors, we build a theory-based model of the translation practices developed by these actors at the interface between community and university. We refine this model by using it to analyse material from two focus groups comprising participants purposively selected because they work at the nexus between research and practice. Our model of translation practices includes cognitive (dealing with the contents of the research), strategic (geared to facilitating the research process and balancing power relationships among the partners) and logistic practices (the hands-on tasks of coordination). Combined, these three types of translation practices demonstrate that actors working at the interface in participatory research contribute to multidirectional exchanges and the co-construction of knowledge among research partners. Beyond the case of participatory research, theorising translation practices helps understand how knowledge is produced at the interface between academic and experiential (or lay) knowledge. © 2011 The Authors. Sociology of Health & Illness © 2011 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

Impact of a Household Environmental Intervention Delivered by Lay Health Workers on Asthma Symptom Control in Urban, Disadvantaged Children With Asthma

PubMed Central

Kurian, Cizely; Guo, Rong; Zhao, Hauqing

2009-01-01

Objectives. We examined whether a home-based educational and environmental intervention delivered by lay health educators would improve asthma symptom control in inner-city children with asthma. Methods. Children 2 to 16 years of age with diagnosed asthma and at least 1 asthma-related hospitalization or 2 emergency visits in the prior year were randomly assigned into 2 groups (immediate and delayed intervention) in a crossover study. Each group participated in the active phase (intervention) and the inactive phase. Outcomes included asthma symptoms, albuterol use, emergency department visits, hospitalizations, and trigger reduction. Results. A total of 264 primarily Black (94%) children were enrolled. The mean number of emergency visits decreased by 30% and inpatient visits decreased by 53% (P < .001) after the intervention. Reductions were seen in pests, presence of carpets in bedrooms, and dust. Nighttime wheezing was significantly reduced after the intervention in both groups (P < .001). Conclusions. Lay health educators effectively reduced asthma triggers and increased caregiver asthma knowledge, which resulted in reduced emergency department visits, hospitalizations, and asthma symptoms. The relationships formed between the caregivers and the lay health educators appeared to positively impact asthma outcomes in this disadvantaged population. PMID:19890172

Lay information mediary behavior uncovered: exploring how nonprofessionals seek health information for themselves and others online.

PubMed

Abrahamson, Jennie A; Fisher, Karen E; Turner, Anne G; Durrance, Joan C; Turner, Tammara Combs

2008-10-01

This research studied motivations for, barriers to, and effects of online health information seeking and explored lay information mediary behavior (LIMB) characteristics in the consumer health information domain. Lay information mediaries (LIMs) seek information on behalf or because of others, without necessarily being asked to do so or engaging in follow up, and have represented more than 50% of health information seekers in prior studies. A web-based survey was posted on NC Health Info (NCHI) with 211 respondents, self-identified per the information need that brought them to NCHI as 20% LIMs (n = 43), 58% direct users (n = 122), and 22% health or information providers (n = 46). Follow-up telephone interviews were performed with 10% (n = 21). Interview analysis focused on lay participants (n = 15 LIMs and direct users combined). Interviewees were reclassified post-survey as 12 LIMs and 3 direct users when studied information behavior extended beyond NCHI search. Interview data were analyzed using grounded theory approach. Surveyed LIMs were 77% female (n = 33) and searched on behalf or because of family members (81%, n = 35) and people they felt "extremely close" to (77%, n = 33). LIMs reported various information seeking barriers "sometimes" to "often." LIMs searched mostly without prompting (51%, n = 22). Interview results triangulated survey findings regarding gender, tie strength, and prompting. LIMB may be related to gender and relationship tie strength and appears more internally than externally motivated. Further LIMB research is warranted.

Building a culture of health: A new framework and measures for health and health care in America.

PubMed

Trujillo, Matthew D; Plough, Alonzo

2016-09-01

For generations, Americans' health has been unequally influenced by income, education, ethnicity, and geography. Health care systems have operated largely apart from each other and from community life. The definition of health has been the "absence of illness," rather than the recognition that all aspects of our lives should support health. Today, a growing number of communities, regions, and states are working to redefine what it means to get and stay healthy by addressing the multiple determinants of health. The requirements of federal health care reform are changing who has access to care, how care is paid for and delivered, and how patients and providers interact. Coordinated efforts to promote wellness and prevent diseases are proliferating among a diverse set of stakeholders. These developments in health and in society present a window of opportunity for real societal transformation-a chance to catalyze a national movement that demands and supports a widely shared, multifaceted vision for a Culture of Health. To address this challenge, the Robert Wood Johnson Foundation has embarked on a strategic direction to use the tools of a large national philanthropy to catalyze a social movement which we are calling Building a Culture of Health. This article presents the Foundation's new model for a Culture of Health, the trans-disciplinary research that developed a set of metrics that tie to the model, and the community engagement activities undertaken in the development of both the model and metrics. The model and associated metrics and extensive communication, in addition to partnership, and grant funding strategies, represent a culture change strategy being implemented over 20 years. Addressing underlying inequities in health affirming life conditions and improving social cohesion across diverse groups to take action to improve theses condition lay at the heart of this strategy. Copyright © 2016 Elsevier Ltd. All rights reserved.

Tested in the Faith Community: The Congregational Hermeneutics of the Mennonites.

ERIC Educational Resources Information Center

Siebert, Bradley G.

The social epistemic that the Mennonite-Anabaptists have been cultivating as their hermeneutic method for 470 years focuses on local congregations as discourse communities of faith, promoting egalitarian lay participation equal to that of members with formal ministries. "The Confession of Faith in a Mennonite Perspective" features a…

Community-Academic Partnership to Implement a Breast and Cervical Cancer Screening Education Program in Puerto Rico.

PubMed

Colón-López, Vivian; González, Daisy; Vélez, Camille; Fernández-Espada, Natalie; Feldman-Soler, Alana; Ayala-Escobar, Kelly; Ayala-Marín, Alelí M; Soto-Salgado, Marievelisse; Calo, William A; Pattatucci-Aragón, Angela; Rivera-Díaz, Marinilda; Fernández, María E

2017-12-01

To describe how a community-academic partnership between Taller Salud Inc., a community-based organization, and the Puerto Rico Community Cancer Control Outreach Program of the University of Puerto Rico was crucial in the adaptation and implementation of Cultivando La Salud (CLS), an evidencebased educational outreach program designed to increase breast and cervical cancer screening among Hispanic women living in Puerto Rico. This collaboration facilitated the review and adaptation of the CLS intervention to improve cultural appropriateness, relevance, and acceptability for Puerto Rican women. A total of 25 interviewers and 12 Lay Health Workers (LHWs) were recruited and trained to deliver the program. The interviewers recruited women who were non-adherent to recommended screening guidelines for both breast and cervical cancer. LHWs then provided one-on-one education using the adapted CLS materials. A total of 444 women were recruited and 48% of them were educated through this collaborative effort. Our main accomplishment was establishing the academic-community partnership to implement the CLS program. Nevertheless, in order to promote better collaborations with our community partners, it is important to carefully delineate and establish clear roles and shared responsibilities for each partner for the successful execution of research activities, taking into consideration the community's needs.

Vulnerable Populations in Hospital and Health Care Emergency Preparedness Planning: A Comprehensive Framework for Inclusion.

PubMed

Kreisberg, Debra; Thomas, Deborah S K; Valley, Morgan; Newell, Shannon; Janes, Enessa; Little, Charles

2016-04-01

As attention to emergency preparedness becomes a critical element of health care facility operations planning, efforts to recognize and integrate the needs of vulnerable populations in a comprehensive manner have lagged. This not only results in decreased levels of equitable service, but also affects the functioning of the health care system in disasters. While this report emphasizes the United States context, the concepts and approaches apply beyond this setting. This report: (1) describes a conceptual framework that provides a model for the inclusion of vulnerable populations into integrated health care and public health preparedness; and (2) applies this model to a pilot study. The framework is derived from literature, hospital regulatory policy, and health care standards, laying out the communication and relational interfaces that must occur at the systems, organizational, and community levels for a successful multi-level health care systems response that is inclusive of diverse populations explicitly. The pilot study illustrates the application of key elements of the framework, using a four-pronged approach that incorporates both quantitative and qualitative methods for deriving information that can inform hospital and health facility preparedness planning. The conceptual framework and model, applied to a pilot project, guide expanded work that ultimately can result in methodologically robust approaches to comprehensively incorporating vulnerable populations into the fabric of hospital disaster preparedness at levels from local to national, thus supporting best practices for a community resilience approach to disaster preparedness.

From bioactive substances to research on breast-feeding promotion.

PubMed

Morrow, A L; Guerrero, M L

2001-01-01

Despite known health benefits, exclusive breast-feeding for at least 4 months is uncommon in many countries. In Mexico, most mothers initiate breast-feeding but few breast-feed exclusively. The objective was to examine the effectiveness of home visits by lay peer counselors to increase exclusive breast-feeding among mothers in a periurban area of Mexico. An ethnographic assessment conducted in 1994 that identified key maternal beliefs, practices, and needs was used to guide educational strategies. Lay counselors were recruited from the same community and trained by La Leche League. From March 1995 through September 1996, pregnant women were identified by community census and invited to participate. Women were enrolled into a randomized, controlled study of 3 groups: no intervention (control), 3 visits, and 6 visits during pregnancy and early postpartum. Data collection was performed by a social worker apart from the counselors. Exclusive breast-feeding was defined by WHO criteria. The study enrolled 130 women; 52 were in the 3-visit group, 44 in the 6-visit group, and 34 in the control group. Study groups did not differ in the maternal characteristics or initiation of breast-feeding (96%). At 3 months postpartum, exclusive breast-feeding was practiced by only 12% of controls vs. 52% in the 3-visit group and 67% in the 6-visit group (P < 0.001, log rank test). In the first 3 months, significantly (P = 0.037) fewer intervention than control infants had an episode of diarrhea (11% vs. 26%, respectively). Intervention effectiveness was independent of maternal factors or birth hospital. This unique experimental study demonstrated a dramatic increase in exclusive breast-feeding and a significant reduction in infant illness in an urban community through well-designed maternal support including early intervention and repeated contact.

Reporting pesticide assessment results to farmworker families: development, implementation, and evaluation of a risk communication strategy.

PubMed Central

Quandt, Sara A; Doran, Alicia M; Rao, Pamela; Hoppin, Jane A; Snively, Beverly M; Arcury, Thomas A

2004-01-01

The collection of environmental samples presents a responsibility to return information to the affected participants. Explaining complex and often ambiguous scientific information to a lay audience is a challenge. As shown by environmental justice research, this audience frequently has limited formal education, increasing the challenge for researchers to explain the data collected, the risk indicated by the findings, and action the affected community should take. In this study we describe the development and implementation of a risk communication strategy for environmental pesticide samples collected in the homes of Latino/a migrant and seasonal farmworkers in a community-based participatory research project. The communication strategy was developed with community input and was based on face-to-face meetings with members of participating households. Using visual displays of data effectively conveyed information about individual household contamination and placed it in the context of community findings. The lack of national reference data and definitive standards for action necessitated a simplified risk message. We review the strengths and weaknesses of such an approach and suggest areas for future research in risk communication to communities affected by environmental health risks. PMID:15064174

The effect of perch availability during pullet rearing and egg laying on musculoskeletal health of caged White Leghorn hens.

PubMed

Hester, P Y; Enneking, S A; Haley, B K; Cheng, H W; Einstein, M E; Rubin, D A

2013-08-01

A major skeletal problem of conventionally caged hens is increased susceptibility to osteoporosis mainly due to lack of exercise. Osteoporosis is characterized by a progressive decrease in mineralized structural bone. Whereas considerable attention has been given to enriching laying cages, little research has been conducted on providing caged pullets with furnishments, in particular perches. The objective of the current study was to determine if metal perches during all or part of the life cycle of White Leghorns affected hen musculoskeletal health, especially at end of lay. Treatments during the pullet phase (hatch to 16.9 wk) entailed cages with and without perches. Four treatments were used during the laying phase (17 to 71 wk of age). Treatment 1 chickens never had access to perches at any point during their life cycle, typical of egg industry practices in the United States for conventional cages. Treatment 2 chickens had access to perches only during the egg-laying phase, which was from 17 to 71 wk of age. Treatment 3 chickens had access to perches only during the pullet phase (0 to 16.9 wk of age). Treatment 4 chickens had perch access throughout their entire life cycle (0 to 71 wk of age). Musculoskeletal health was assessed by measuring muscle weights, bone mineralization, bone fracture incidence, and keel bone deviations. Muscle deposition of 71-wk-old hens increased when given access to perches as pullets. Bone mineralization of 71-wk-old hens also increased if given perch access as adults. However, the disadvantage of the adult perch was the higher incidence of keel deviations and keel fractures at end of lay. The increase in bone mineralization of the keel bone as a result of perch access during the pullet and laying phases was not great enough to prevent a higher incidence of keel bone fractures at end of lay. Perch redesign and placement of perches within the cage to minimize keel fractures and deviations are possible solutions.

Human resources and models of mental healthcare integration into primary and community care in India: Case studies of 72 programmes

PubMed Central

Maheedhariah, Meera S.; Ghani, Sarah; Raja, Anusha; Patel, Vikram

2017-01-01

Background Given the scarcity of specialist mental healthcare in India, diverse community mental healthcare models have evolved. This study explores and compares Indian models of mental healthcare delivered by primary-level workers (PHW), and health workers’ roles within these. We aim to describe current service delivery to identify feasible and acceptable models with potential for scaling up. Methods Seventy two programmes (governmental and non-governmental) across 12 states were visited. 246 PHWs, coordinators, leaders, specialists and other staff were interviewed to understand the programme structure, the model of mental health delivery and health workers’ roles. Data were analysed using framework analysis. Results Programmes were categorised using an existing framework of collaborative and non-collaborative models of primary mental healthcare. A new model was identified: the specialist community model, whereby PHWs are trained within specialist programmes to provide community support and treatment for those with severe mental disorders. Most collaborative and specialist community models used lay health workers rather than doctors. Both these models used care managers. PHWs and care managers received support often through multiple specialist and non-specialist organisations from voluntary and government sectors. Many projects still use a simple yet ineffective model of training without supervision (training and identification/referral models). Discussion and conclusion Indian models differ significantly to those in high-income countries—there are less professional PHWs used across all models. There is also intensive specialist involvement particularly in the community outreach and collaborative care models. Excessive reliance on specialists inhibits their scalability, though they may be useful in targeted interventions for severe mental disorders. We propose a revised framework of models based on our findings. The current priorities are to evaluate the comparative effectiveness, cost-effectiveness and scalability of these models in resource-limited settings both in India and in other low- and middle- income countries. PMID:28582445

Making the links: do we connect climate change with health? A qualitative case study from Canada

PubMed Central

2013-01-01

Background Climate change has been described as the biggest global health threat of the 21st century. Typically framed as an environmental issue, some suggest this view has contributed to public ambivalence and hence a lack of public engagement. The lack of understanding of climate change as a significant environmental health risk on the part of the lay public represents a significant barrier to behaviour change. We therefore need to think about reframing the impact of climate change from an environmental to a health issue. This paper builds on calls for increased understanding of the public’s views of human health risks associated with climate change, focusing on facilitators and barriers to behaviour change. Methods Semi-structured in-depth interviews (n = 22) with residents of the Golden Horseshoe region of Southern Ontario were conducted between August 2010 and January 2011. Topics included individual and community health, climate change, and facilitators and barriers to behaviour change. Results Few participants recognized the role of the environment in the context of either individual and community health. When asked about health concerns specific to their community, however, environmental issues were mentioned frequently. Health effects as possible impacts of global environmental change were mentioned by 77% of participants when prompted, but this link was not described in great detail or within the context of impacting their communities or themselves. Participants were willing to act in environmentally friendly ways, and possible incentives to undertake behaviour change such as decreasing cost were described. Health co-benefits were not identified as incentives to engaging in mitigative or adaptive behaviours. Conclusions The results support recent calls for reframing the impact of climate change from an environmental to a public health issue in order to increase public engagement in adaptive and mitigative behaviour change. While previous research has touched on public awareness of the human health risks of climate change, we have further explored the attitude-action link through the examination of facilitators and barriers to behaviour change. PMID:23496814

Attitudes about depression and its treatment among mental health professionals, lay persons and immigrants and refugees in Norway.

PubMed

Erdal, Kristi; Singh, Namrita; Tardif, Annette

2011-10-01

Internationally, depression is a common psychological disorder whose treatment depends upon its identification by treating professionals as well as patient utilization of mental health care systems; the latter often being hampered by cultural differences between patients and health professionals. The current study used vignettes of depressed patients which varied the culture and/or social circumstances of the patient to assess whether these variables influenced the conceptualization of depression and its treatment. Participants (N=722) included mental health professionals, lay people, immigrants, and refugees in Norway. We found that immigrants and refugees, particularly those of non-western origin, endorsed different types of depression treatments from native Norwegians and mental health professionals, and judged who deserved treatment and who was overreacting based on the patient's culture and social circumstances, while native Norwegians did not. While widely used cross-culturally, vignette methodology is limited in its generalizability to real clinical situations. Acculturation was not evaluated, which may have influenced the results. Findings support the integration of cultural competency ideals not only into treatment, but also into public health promotions of mental health services for lay people. Copyright © 2011 Elsevier B.V. All rights reserved.

Delivery arrangements for health systems in low-income countries: an overview of systematic reviews

PubMed Central

Ciapponi, Agustín; Lewin, Simon; Herrera, Cristian A; Opiyo, Newton; Pantoja, Tomas; Paulsen, Elizabeth; Rada, Gabriel; Wiysonge, Charles S; Bastías, Gabriel; Dudley, Lilian; Flottorp, Signe; Gagnon, Marie-Pierre; Garcia Marti, Sebastian; Glenton, Claire; Okwundu, Charles I; Peñaloza, Blanca; Suleman, Fatima; Oxman, Andrew D

2017-01-01

Background Delivery arrangements include changes in who receives care and when, who provides care, the working conditions of those who provide care, coordination of care amongst different providers, where care is provided, the use of information and communication technology to deliver care, and quality and safety systems. How services are delivered can have impacts on the effectiveness, efficiency and equity of health systems. This broad overview of the findings of systematic reviews can help policymakers and other stakeholders identify strategies for addressing problems and improve the delivery of services. Objectives To provide an overview of the available evidence from up-to-date systematic reviews about the effects of delivery arrangements for health systems in low-income countries. Secondary objectives include identifying needs and priorities for future evaluations and systematic reviews on delivery arrangements and informing refinements of the framework for delivery arrangements outlined in the review. Methods We searched Health Systems Evidence in November 2010 and PDQ-Evidence up to 17 December 2016 for systematic reviews. We did not apply any date, language or publication status limitations in the searches. We included well-conducted systematic reviews of studies that assessed the effects of delivery arrangements on patient outcomes (health and health behaviours), the quality or utilisation of healthcare services, resource use, healthcare provider outcomes (such as sick leave), or social outcomes (such as poverty or employment) and that were published after April 2005. We excluded reviews with limitations important enough to compromise the reliability of the findings. Two overview authors independently screened reviews, extracted data, and assessed the certainty of evidence using GRADE. We prepared SUPPORT Summaries for eligible reviews, including key messages, 'Summary of findings' tables (using GRADE to assess the certainty of the evidence), and assessments of the relevance of findings to low-income countries. Main results We identified 7272 systematic reviews and included 51 of them in this overview. We judged 6 of the 51 reviews to have important methodological limitations and the other 45 to have only minor limitations. We grouped delivery arrangements into eight categories. Some reviews provided more than one comparison and were in more than one category. Across these categories, the following intervention were effective; that is, they have desirable effects on at least one outcome with moderate- or high-certainty evidence and no moderate- or high-certainty evidence of undesirable effects. Who receives care and when: queuing strategies and antenatal care to groups of mothers. Who provides care: lay health workers for caring for people with hypertension, lay health workers to deliver care for mothers and children or infectious diseases, lay health workers to deliver community-based neonatal care packages, midlevel health professionals for abortion care, social support to pregnant women at risk, midwife-led care for childbearing women, non-specialist providers in mental health and neurology, and physician-nurse substitution. Coordination of care: hospital clinical pathways, case management for people living with HIV and AIDS, interactive communication between primary care doctors and specialists, hospital discharge planning, adding a service to an existing service and integrating delivery models, referral from primary to secondary care, physician-led versus nurse-led triage in emergency departments, and team midwifery. Where care is provided: high-volume institutions, home-based care (with or without multidisciplinary team) for people living with HIV and AIDS, home-based management of malaria, home care for children with acute physical conditions, community-based interventions for childhood diarrhoea and pneumonia, out-of-facility HIV and reproductive health services for youth, and decentralised HIV care. Information and communication technology: mobile phone messaging for patients with long-term illnesses, mobile phone messaging reminders for attendance at healthcare appointments, mobile phone messaging to promote adherence to antiretroviral therapy, women carrying their own case notes in pregnancy, interventions to improve childhood vaccination. Quality and safety systems: decision support with clinical information systems for people living with HIV/AIDS. Complex interventions (cutting across delivery categories and other health system arrangements): emergency obstetric referral interventions. Authors' conclusions A wide range of strategies have been evaluated for improving delivery arrangements in low-income countries, using sound systematic review methods in both Cochrane and non-Cochrane reviews. These reviews have assessed a range of outcomes. Most of the available evidence focuses on who provides care, where care is provided and coordination of care. For all the main categories of delivery arrangements, we identified gaps in primary research related to uncertainty about the applicability of the evidence to low-income countries, low- or very low-certainty evidence or a lack of studies. Effects of delivery arrangements for health systems in low-income countries What is the aim of this overview? The aim of this Cochrane Overview is to provide a broad summary of what is known about the effects of delivery arrangements for health systems in low-income countries. This overview is based on 51 systematic reviews. These systematic reviews searched for studies that evaluated different types of delivery arrangements. The reviews included a total of 850 studies. This overview is one of a series of four Cochrane Overviews that evaluate health system arrangements. What was studied in the overview? Delivery arrangements include changes in who receives care and when, who provides care, the working conditions of those who provide care, coordination of care amongst different health care providers, where care is provided, the use of information and communication technology to deliver care, and quality and safety systems. How services are delivered can have impacts on the effectiveness, efficiency and equity of health systems. This overview can help policymakers and other stakeholders to identify evidence-informed strategies to improve the delivery of services. What are the main results of the overview? When focusing only on evidence assessed as high to moderate certainty, the overview points to a number of delivery arrangements that had at least one desirable outcome and no evidence of any undesirable outcomes. These include the following: Who receives care and when - Queuing strategies - Group antenatal care Who provides care – role expansion or task shifting - Lay or community health workers supporting the care of people with hypertension - Community-based neonatal packages that include additional training of outreach workers - Lay health workers to deliver care for mothers and children or for infectious diseases - Mid-level, non-physician providers for abortion care - Health workers providing social support during at-risk pregnancies - Midwife-led care for childbearing women and their infants - Non-specialist health workers or other professionals with health roles to help people with mental, neurological and substance-abuse disorders - Nurses substituting for physicians in providing care Coordination of care - Structured multidisciplinary care plans (care pathways) used by health care providers in hospitals to detail essential steps in the care of people with a specific clinical problem - Interactive communication between collaborating primary care physicians and specialist physicians in outpatient care - Planning to facilitate patients’ discharge from hospital to home - Adding a new health service to an existing service and integrating services in health care delivery - Integrating vaccination with other healthcare services - Using physicians rather than nurses to lead triage in emergency departments - Groups or teams of midwives providing care for a group of women during pregnancy and childbirth and after childbirth Where care is provided – site of service delivery - Clinics or hospitals that manage a high volume of people living with HIV and AIDS rather than smaller volumes - Intensive home-based care for people living with HIV and AIDS - Home-based management of malaria in children - Providing care closer to home for children with long-term health conditions - Community-based interventions using lay health workers for childhood diarrhoea and pneumonia - Youth HIV and reproductive health services provided outside of health facilities - Decentralising care for initiation and maintenance of HIV and AIDS medicine treatment to peripheral health centres or lower levels of healthcare Information and communication technology - Mobile phone messaging for people with long-term illnesses - Mobile phone messaging reminders for attendance at healthcare appointments - Mobile phone messaging to promote adherence to antiretroviral therapy - Women carrying their own case notes in pregnancy - Information and communication interventions to improve childhood vaccination coverage Quality and safety systems - Establishing clinical information systems to organize patient data for people living with HIV and AIDS Packages that include multiple interventions - Interventions to improve referral for emergency care during pregnancy and childbirth How up to date is this overview? The overview authors searched for systematic reviews that had been published up to 17 December 2016. PMID:28901005

Interconnected microbiomes and resistomes in low-income human habitats

PubMed Central

Pehrsson, Erica C.; Tsukayama, Pablo; Patel, Sanket; Mejía-Bautista, Melissa; Sosa-Soto, Giordano; Navarrete, Karla M.; Calderon, Maritza; Cabrera, Lilia; Hoyos-Arango, William; Bertoli, M. Teresita; Berg, Douglas E.; Gilman, Robert H.; Dantas, Gautam

2016-01-01

Summary Antibiotic-resistant infections annually claim hundreds of thousands of lives worldwide. This problem is exacerbated by resistance gene exchange between pathogens and benign microbes from diverse habitats. Mapping resistance gene dissemination between humans and their environment is a public health priority. We characterized the bacterial community structure and resistance exchange networks of hundreds of interconnected human fecal and environmental samples from two low-income Latin American communities. We found that resistomes across habitats are generally structured by bacterial phylogeny along ecological gradients, but identified key resistance genes that cross habitat boundaries and determined their association with mobile genetic elements. We also assessed the effectiveness of widely-used excreta management strategies in reducing fecal bacteria and resistance genes in these settings representative of low- and middle-income countries. Our results lay the foundation for quantitative risk assessment and surveillance of resistance dissemination across interconnected habitats in settings representing over two-thirds of the world’s population. PMID:27172044

Whose voices? Patient and public involvement in clinical commissioning.

PubMed

O'Shea, Alison; Chambers, Mary; Boaz, Annette

2017-06-01

This paper aims to explore patient and public representation in a NHS clinical commissioning group and how this is experienced by staff and lay members involved. Patient and public involvement is believed to foster greater public representativeness in the development and delivery of health care services. However, there is widespread debate about what representation is or what it should be. Questions arise about the different constructions of representation and the representativeness of patients and the public in decision-making structures and processes. Ethnographic, two-phase study involving twenty-four observations across two types of clinical commissioning group meetings with patient and public involvement, fourteen follow-up interviews with NHS staff and lay members, and a focus group with five lay members. Perceptions of what constitutes legitimate representativeness varied between respondents, ranging from representing an individual patient experience to reaching large numbers of people. Consistent with previous studies, there was a lack of clarity about the role of lay members in the work of the clinical commissioning group. Unlike previous studies, it was lay members, not staff, who raised concerns about their representativeness and legitimacy. Although the clinical commissioning group provides resources to support patient and public involvement, there continues to be a lack of clarity about roles and scope for impact. Lay members are still some way from constituting a powerful voice at the table. © 2016 The Authors. Health Expectations Published by John Wiley & Sons Ltd.

Feasibility of community-based screening for cardiovascular disease risk in an ethnic community: the South Asian Cardiovascular Health Assessment and Management Program (SA-CHAMP)

PubMed Central

2013-01-01

Background South Asian Canadians experience disproportionately high rates of cardiovascular disease (CVD). The goal of this qualitative study was to determine the feasibility of implementing a sustainable, culturally adapted, community-based CVD risk factor screening program for this population. Methods South Asians (≥ 45 years) in Calgary, Alberta underwent opportunistic cardiovascular risk factor screening by lay trained volunteers at local religious facilities. Those with elevated blood pressure (BP) or ≥ 1 risk factor underwent point of care cholesterol testing, 10-year CVD risk calculation, counseling, and referral to family physicians and local culturally tailored chronic disease management (CDM) programs. Participants were invited for re-screening and were surveyed about health system follow-up, satisfaction with the program and suggestions for improvement. Changes in risk factors from baseline were estimated using McNemar’s test (proportions) and paired t-tests (continuous measures). Results Baseline assessment was completed for 238 participants (median age 64 years, 51% female). Mean TC, HDL and TC/HDL were 5.41 mmol/L, 1.12 mmol/L and 4.7, respectively. Mean systolic and diastolic blood pressures (mmHg) were 129 and 75 respectively. Blood pressure and TC/HDL ratios exceeded recommended targets in 36% and 58%, respectively, and 76% were at high risk for CVD. Ninety-nine participants (47% female) attended re-screening. 82% had accessed health care providers, 22% reported medication changes and 3.5% had attended the CDM programs. While BP remained unchanged, TC and TC/HDL decreased and HDL increased significantly (mean differences: -0.52 mmol/L, -1.04 and +0.07 mmol/L, respectively). Participants were very satisfied (80%) or satisfied (20%) with the project. Participants suggested screening sessions and CDM programs be more accessible by: delivering evening or weekends programs at more sites, providing transportation, offering multilingual programs/translation assistance, reducing screening wait times and increasing numbers of project staff. Conclusions SA-CHAMP demonstrated the feasibility and value of implementing a lay volunteer–led, culturally adapted, sustainable community-based CVD risk factor screening program in South Asian places of worship in Calgary, Alberta, Canada. Subsequent screening and CDM programs were refined based on the learnings from this study. Further research is needed to determine physician and patient factors associated with uptake of and adherence to risk reduction strategies. PMID:23432996

A spatial and genetic analysis of Cowbird host selection

USGS Publications Warehouse

Hahn, D.C.; Sedgwick, J.A.; Painter, I.S.; Casna, N.J.; Morrison, Michael L.; Hall, Linnea S.; Robinson, Scott K.; Rothstein, Stephen I.; Hahn, D. Caldwell; Rich, Terrell D.

1999-01-01

Our study of brood parasitism patterns in forest communities revealed the egg-laying frequency and host selection patterns of female cowbirds. By integrating molecular genetics and spatial data, we have the first published estimate on cowbird laying rates in field studies. The 29 females in the study laid only 1-5 eggs each, much lower than previous estimates from captive cowbirds and extrapolations from ovarian development in capture/recapture studies that had suggested that as many as 40 eggs could be laid per individual cowbird. Cowbird females also were shown for the first time to lay significantly more eggs within the home range areas they established rather than outside the home range. No patterns were uncovered for individual females preferentially parasitizing particular host species

Culture and Dehydration: A Comparative Study of Caída de la Mollera (Fallen Fontanel) in Three Latino Populations.

PubMed

Pachter, Lee M; Weller, Susan C; Baer, Roberta D; de Alba Garcia, Javier E Garcia; Glazer, Mark; Trotter, Robert; Klein, Robert E; Gonzalez, Eduardo

2016-10-01

A sunken soft-spot or fontanel is a sign for dehydration in infants. Around the world, folk illnesses, such as caída de la mollera in some Latin American cultures, often incorporate this sign as a hallmark of illness, but may or may not incorporate re-hydration therapies in treatment strategies. This report describes a study of lay descriptions of causes, symptoms, and treatments for caída de la mollera in three diverse Latin American populations. A mixed-methods approach was used. Representative community-based samples were interviewed in rural Guatemala, Guadalajara, Mexico, and Edinburgh, Texas, with a 132 item questionnaire on the causes, susceptibility, symptoms, and therapies for caída de la mollera. Cultural consensus analysis was used to estimate community beliefs about caída. Interviews conducted in rural Guatemala (n = 60), urban Mexico (n = 62), and rural Texas on the Mexican border (n = 61) indicated consistency in thematic elements within and among these three diverse communities. The high degree of consistency in the illness explanatory models indicated shared beliefs about caída de la mollera in each of the communities and a core model shared across communities. However, an important aspect of the community beliefs was that rehydration therapies were not widely endorsed. The consistency in explanatory models in such diverse communities, as well as the high degree of recognition and experience with this illness, may facilitate communication between community members, and health care providers/public health intervention planners to increase use of rehydration therapies for caída de la mollera. Recommendations for culturally informed and respectful approaches to clinical communication are provided.

Primary health care teams and the patient perspective: a social network analysis.

PubMed

Cheong, Lynn H M; Armour, Carol L; Bosnic-Anticevich, Sinthia Z

2013-01-01

Multidisciplinary care (MDC) has been proposed as a potential strategy to address the rising challenges of modern health issues. However, it remains unclear as to how patients' health connections may impact on multidisciplinary processes and outcomes. This research aims to gain a deeper understanding of patients' potential role in MDC: i) describe patients' health networks, ii) compare different care groups, iii) gain an understanding of the nature and extent of their interactions, and iv) identify the role of pharmacists within patient networks. In-depth, semi-structured interviews were conducted with asthma patients from Sydney, Australia. Participants were recruited from a range of standard asthma health care access points (community group) and a specialized multidisciplinary asthma clinic (clinic group). Quantitative social network analysis provided structural insight into asthma networks while qualitative social network analysis assisted in interpretation of network data. A total of 47 interviews were conducted (26 community group participants and 21 clinic group participants). Although participants' asthma networks consisted of a range of health care professionals (HCPs), these did not reflect or encourage MDC. Not only did participants favor minimal interaction with any HCP, they preferred sole-charge care and were found to strongly rely on lay individuals such as family and friends. While general practitioners and respiratory specialists were participants' principal choice of HCP, community pharmacists were less regarded. Limited opportunities were presented for HCPs to collaborate, particularly pharmacists. As patients' choices of HCPs may strongly influence collaborative processes and outcomes, this research highlights the need to consider patient perspectives in the development of MDC models in primary care. Copyright © 2013 Elsevier Inc. All rights reserved.

‘Much clearer with pictures’: using community-based participatory research to design and test a Picture Option Grid for underserved patients with breast cancer

PubMed Central

Durand, Marie-Anne; Alam, Shama; Grande, Stuart W; Elwyn, Glyn

2016-01-01

Objective Women of low socioeconomic status (SES) diagnosed with early stage breast cancer experience decision-making, treatment and outcome disparities. Evidence suggests that decision aids can benefit underserved patients, when tailored to their needs. Our aim was to develop and test the usability, acceptability and accessibility of a pictorial encounter decision aid targeted at women of low SES diagnosed with early stage breast cancer. Design Community-based participatory research (CBPR) using think-aloud protocols (phases 1 and 2) and semistructured interviews (phase 3). Setting Underserved community settings (eg, knitting groups, bingo halls, senior centres) and breast clinics. Participants In phase 1, we recruited a convenience sample of clinicians and academics. In phase 2, we targeted women over 40 years of age, of low SES, regardless of breast cancer history, and in phase 3, women of low SES, recently diagnosed with breast cancer. Intervention The pictorial encounter decision aid was derived from an evidence-based table comparing treatment options for breast cancer (http://www.optiongrid.org). Outcome measures We assessed the usability, acceptability and accessibility of the pictorial decision aid prototypes using the think-aloud protocol and semistructured interviews. Results After initial testing of the first prototype with 18 academics and health professionals, new versions were developed and tested with 53 lay individuals in community settings. Usability was high. In response to feedback indicating that the use of cartoon characters was considered insensitive, a picture-only version was developed and tested with 23 lay people in phase 2, and 10 target users in phase 3. Conclusions and relevance Using CBPR methods and iterative user testing cycles improved usability and accessibility, and led to the development of the Picture Option Grid, entirely guided by multiple stakeholder feedback. All women of low SES recently diagnosed with early stage breast cancer found the Picture Option Grid usable, acceptable and accessible. PMID:26839014

Experimental control of Triatoma infestans in poor rural villages of Bolivia through community participation

PubMed Central

Lardeux, Frédéric; Depickère, Stéphanie; Aliaga, Claudia; Chavez, Tamara; Zambrana, Lilian

2015-01-01

Background Triatoma infestans is the main vector of Chagas disease in the southern cone countries. Present control strategies based on indoor and outdoor residual insecticide spraying are not sufficient to control disease transmission, particularly in Bolivia. Techniques based on the management of the human environment may be good alternatives or supplements. Methods Social and entomological surveys were carried out in four villages of Bolivia situated in the dry inter-Andean Valleys and the Chaco region. Risk factors for house infestation by T. infestans were identified, and an eco-health intervention based on education and community participation was carried out to reduce the risks of house infestation. It consisted of implementing simple and low cost vector control techniques such as coating of mud walls, cleaning activities and removal of poultry that enter rooms to lay eggs. Results The eco-health intervention significantly reduced the number of infested bedrooms, the mean abundance of T. infestans in bedrooms and beds, especially in the Chaco region. Mud wall coating was well accepted and could be proposed as a supplementary tool to the National Program of Chagas Disease Control to enhance the effects of insecticide sprayings. Conclusions Even if cleaning activities were still neglected, community participation proved to be effective in reducing house infestation. PMID:25604766

Alaska communities and forest environments: a problem analysis and research agenda.

Treesearch

Linda E. Kruger; Rhonda L. Mazza

2006-01-01

This problem analysis describes a variety of human-resource interaction issues and identifies related social science research and development needs that serve as the foundation for the Alaska Communities and Forest Environments Team within the Pacific Northwest Research Station. The document lays out a research agenda that focuses on understanding relations between...

Food Preservation Manual: A Guide for School-Community Canneries in Virginia.

ERIC Educational Resources Information Center

Lee, Jasper S., Ed.; Wood, Charles B.

The manual was intended primarily for use by lay instructors and assistants involved in the daily operation of school-community canneries under the supervision of a high school agricultural education instructor. The first half deals in detail with the fundamentals of food preparation and cannery operation. Food preservation by canning, sanitation…

A Legal Discourse Community: Text Centered and Interdisciplinary in Social and Political Context.

ERIC Educational Resources Information Center

Griggs, Karen

1996-01-01

Reviews recent studies of legal discourse and nonacademic writing and presents the results of a historical case study on an environmental public policy. Finds that a dynamic discourse community changed writing roles among government employees, lay members of the audience, and water pollution control board members. States that controversial…

Building Blocks: Laying the Groundwork for Guided Pathways Reform in Ohio

ERIC Educational Resources Information Center

Jenkins, Davis; Lahr, Hana; Fink, John

2017-01-01

This report describes how Ohio's two-year colleges are approaching guided pathways reforms, based on on-site interviews with faculty, administrators, staff, and students at six selected community colleges and telephone interviews with representatives from all 23 Ohio community colleges. In these interviews participants were asked to describe their…

Clean Community System Multi-Material Recycling Manual.

ERIC Educational Resources Information Center

Keep America Beautiful, Inc., New York, NY.

This manual is designed to assist communities in recycling the greatest possible volume of materials in ways which will: (1) benefit the local economy; (2) encourage cooperation between public and private sectors; and (3) prove valuable to municipal and county sanitation services. The manual is divided into five sections. Section 1 lays out the…

Measuring governance at health facility level: developing and validation of simple governance tool in Zambia.

PubMed

Mutale, Wilbroad; Mwanamwenge, Margaret Tembo; Balabanova, Dina; Spicer, Neil; Ayles, Helen

2013-08-09

Governance has been cited as a key determinant of economic growth, social advancement and overall development. Achievement of millennium development goals is partly dependant on governance practices. In 2007, Health Systems 20/20 conducted an Internet-based survey on the practice of good governance. The survey posed a set of good practices related to health governance and asked respondents to indicate whether their experience confirmed or disconfirmed those practices. We applied the 17 governance statements in rural health facilities of Zambia. The aim was to establish whether the statements were reliable and valid for assessing governance practices at primary care level. Both quantitative and qualitative methods were used. We first applied the governance statements developed by the health system 20/20 and then conducted focus group discussion and In-depth interviews to explore some elements of governance including accountability and community participation. The target respondents were the health facility management team and community members. The sample size include 42 health facilities. Data was analyzed using SPSS version 17 and Nvivo version 9. The 95% one-sided confidence interval for Cronbach's alpha was between 0.69 and 0.74 for the 16 items.The mean score for most of the items was above 3. Factor analysis yielded five principle components: Transparency, community participation, Intelligence & vision, Accountability and Regulation & oversight. Most of the items (6) clustered around the transparency latent factor. Chongwe district performed poorly in overall mean governance score and across the five domains of governance. The overall scores in Chongwe ranged between 51 and 94% with the mean of 80%. Kafue and Luangwa districts had similar overall mean governance scores (88%). Community participation was generally low. Generally, it was noted that community members lacked capacity to hold health workers accountable for drugs and medical supplies. The study successfully validated and applied the new tool for evaluating health system governance at health facility level. The results have shown that it is feasible to measure governance practices at health facility level and that the adapted tool is fairly reliable with the 95% one-sided confidence interval for Cronbach's alpha laying between 0.69 and 0.74 for the 16 items. Caution should be taken when interpreting overall scores as they tended to mask domain specific variations.

Engaging stakeholder communities as body image intervention partners: The Body Project as a case example.

PubMed

Becker, Carolyn Black; Perez, Marisol; Kilpela, Lisa Smith; Diedrichs, Phillippa C; Trujillo, Eva; Stice, Eric

2017-04-01

Despite recent advances in developing evidence-based psychological interventions, substantial changes are needed in the current system of intervention delivery to impact mental health on a global scale (Kazdin & Blase, 2011). Prevention offers one avenue for reaching large populations because prevention interventions often are amenable to scaling-up strategies, such as task-shifting to lay providers, which further facilitate community stakeholder partnerships. This paper discusses the dissemination and implementation of the Body Project, an evidence-based body image prevention program, across 6 diverse stakeholder partnerships that span academic, non-profit and business sectors at national and international levels. The paper details key elements of the Body Project that facilitated partnership development, dissemination and implementation, including use of community-based participatory research methods and a blended train-the-trainer and task-shifting approach. We observed consistent themes across partnerships, including: sharing decision making with community partners, engaging of community leaders as gatekeepers, emphasizing strengths of community partners, working within the community's structure, optimizing non-traditional and/or private financial resources, placing value on cost-effectiveness and sustainability, marketing the program, and supporting flexibility and creativity in developing strategies for evolution within the community and in research. Ideally, lessons learned with the Body Project can be generalized to implementation of other body image and eating disorder prevention programs. Copyright © 2015 Elsevier Ltd. All rights reserved.

A Report on: The National Seminar of American Indian Women [and] the North American Indian Women's Association Established by Delegates of this Seminar.

ERIC Educational Resources Information Center

Extension Service (USDA), Washington, DC.

A report on the National Seminar of American Indian Women is presented. This meeting was planned to provide an opportunity for American Indian women to discuss the needs of Indian communities and expand their understanding of what constitutes an adequate community. The delegates were lay people selected from their home communities. Sixty-eight of…

Health communication, genetic determinism, and perceived control: the roles of beliefs about susceptibility and severity versus disease essentialism.

PubMed

Parrott, Roxanne; Kahl, Mary L; Ndiaye, Khadidiatou; Traeder, Tara

2012-08-01

This research examined the lay public's beliefs about genes and health that might be labeled deterministic. The goals of this research were to sort through the divergent and contested meanings of genetic determinism in an effort to suggest directions for public health genomic communication. A survey conducted in community-based settings of 717 participants included 267 who self-reported race as African American and 450 who self-reported race as Caucasian American. The survey results revealed that the structure of genetic determinism included 2 belief sets. One set aligned with perceived threat, encompassing susceptibility and severity beliefs linked to genes and health. The other set represents beliefs about biological essentialism linked to the role of genes for health. These concepts were found to be modestly positively related. Threat beliefs predicted perceived control over genes. Public health efforts to communicate about genes and health should consider effects of these messages for (a) perceived threat relating to susceptibility and severity and (b) perceptions of disease essentialism. Perceived threat may enhance motivation to act in health protective ways, whereas disease essentialist beliefs may contribute to a loss of motivation associated with control over health.

United States Air Force 611th Air Support Group Civil Engineering Squadron, Elmendorf AFB, Alaska. Remedial investigation and feasibility study Point Lay Radar Installation, Alaska. Final report

DOE Office of Scientific and Technical Information (OSTI.GOV)

Karmi, S.

1996-03-04

The United States Air Force (Air Force) has prepared this Remedial Investigation/Feasibility Study (RI/FS) report to present the results of RI/FS activities at four sites located at the Point Lay radar installation. The remedial investigation (RI) field activities were conducted at the Point Lay radar installation during the summer of 1993. The four sites at Point Lay were investigated because they were suspected of being contaminated with hazardous substances. RI activities were conducted using methods and procedures specified in the RI/FS Work Plan, Sampling and Analysis Plan (SAP), and Health and Safety Plan.

Effectiveness of a brief behavioural intervention on psychological distress among women with a history of gender-based violence in urban Kenya: A randomised clinical trial

PubMed Central

Schafer, Alison; Anjuri, Dorothy; Mulili, Caroline; Ndogoni, Lincoln; Koyiet, Phiona; Sijbrandij, Marit; Ulate, Jeannette; Harper Shehadeh, Melissa; Hadzi-Pavlovic, Dusan; van Ommeren, Mark

2017-01-01

Background Gender-based violence (GBV) represents a major cause of psychological morbidity worldwide, and particularly in low- and middle-income countries (LMICs). Although there are effective treatments for common mental disorders associated with GBV, they typically require lengthy treatment programs that may limit scaling up in LMICs. The aim of this study was to test the effectiveness of a new 5-session behavioural treatment called Problem Management Plus (PM+) that lay community workers can be taught to deliver. Methods and findings In this single-blind, parallel, randomised controlled trial, adult women who had experienced GBV were identified through community screening for psychological distress and impaired functioning in Nairobi, Kenya. Participants were randomly allocated in a 1:1 ratio either to PM+ delivered in the community by lay community health workers provided with 8 days of training or to facility-based enhanced usual care (EUC) provided by community nurses. Participants were aware of treatment allocation, but research assessors were blinded. The primary outcome was psychological distress as measured by the total score on the 12-item General Health Questionnaire (GHQ-12) assessed at 3 months after treatment. Secondary outcomes were impaired functioning (measured by the WHO Disability Adjustment Schedule [WHODAS]), symptoms of posttraumatic stress (measured by the Posttraumatic Stress Disorder Checklist [PCL]), personally identified problems (measured by Psychological Outcome Profiles [PSYCHLOPS]), stressful life events (measured by the Life Events Checklist [LEC]), and health service utilisation. Between 15 April 2015 and 20 August 2015, 1,393 women were screened for eligibility on the basis of psychological distress and impaired functioning. Of these, 518 women (37%) screened positive, of whom 421 (81%) were women who had experienced GBV. Of these 421 women, 209 were assigned to PM+ and 212 to EUC. Follow-up assessments were completed on 16 January 2016. The primary analysis was intention to treat and included 53 women in PM+ (25%) and 49 women in EUC (23%) lost to follow-up. The difference between PM+ and EUC in the change from baseline to 3 months on the GHQ-12 was 3.33 (95% CI 1.86–4.79, P = 0.001) in favour of PM+. In terms of secondary outcomes, for WHODAS the difference between PM+ and EUC in the change from baseline to 3-month follow-up was 1.96 (95% CI 0.21–3.71, P = 0.03), for PCL it was 3.95 (95% CI 0.06–7.83, P = 0.05), and for PSYCHLOPS it was 2.15 (95% CI 0.98–3.32, P = 0.001), all in favour of PM+. These estimated differences correspond to moderate effect sizes in favour of PM+ for GHQ-12 score (0.57, 95% CI 0.32–0.83) and PSYCHLOPS (0.67, 95% CI 0.31–1.03), and small effect sizes for WHODAS (0.26, 95% CI 0.02–0.50) and PCL (0.21, 95% CI 0.00–0.41). Twelve adverse events were reported, all of which were suicidal risks detected during screening. No adverse events were attributable to the interventions or the trial. Limitations of the study include no long-term follow-up, reliance on self-report rather than structured interview data, and lack of an attention control condition. Conclusions Among a community sample of women in urban Kenya with a history of GBV, a brief, lay-administered behavioural intervention, compared with EUC, resulted in moderate reductions in psychological distress at 3-month follow-up. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12614001291673 PMID:28809935

Promotor(a)s, the organizations in which they work, and an emerging paradox: how organizational structure and scope impact promotor(a)s' work.

PubMed

May, Marlynn L; Contreras, Ricardo B

2007-07-01

To analyze how organizational structures and scope (geographic and programmatic) generate dissonance between the organization and its workers, creating a paradox with policy implications for access to health care in hard-to-reach populations. The workers are lay community health workers called promotor(a)s. The organizations are community based organizations in which the promotor(a)s work, either as volunteers, part-time or as full-time wage staff. Ethnographic study of 12 organizations and their promotor(a)s. Data gathering included interviews with organization directors, promotor(a)s, service providers working with the organizations, and community residents served by the organizations and workers. In addition, promotor(a)s were observed in the course of their work. Sampling was a non-probability, snowball procedure for identifying the organizations and the workers within them. A paradox is emerging between (a) promotor(a)s who perceive their work to be locally focused and tightly integrated with the communities they serve and live in, and (b) the employing organizations that are expanding in geographical and programmatic scope because the work promotor(a)s do is in increasing demand by agencies and funding sources external to the communities served. The paradox potentially threatens to undermine and transform the work and working environment of the promotor(a)s. The challenge is to find a balance that will sustain a workable and working relationship among the organization, the workers, and the communities served. Care is needed in setting out policies that translate the paradox into greater congruence among organization, workers and communities. Policy needs discussed focus on (a) worker training, (b) worker employment and deployment, and (c) funding source recognition of the paradox.

A qualitative interview study exploring pregnant women's and health professionals' attitudes to external cephalic version.

PubMed

Say, Rebecca; Thomson, Richard; Robson, Stephen; Exley, Catherine

2013-01-16

Women who have a breech presentation at term have to decide whether to attempt external cephalic version (ECV) and how they want to give birth if the baby remains breech, either by planned caesarean section (CS) or vaginal breech birth. The aim of this study was to explore the attitudes of women with a breech presentation and health professionals who manage breech presentation to ECV. We carried out semi-structured interviews with pregnant women with a breech presentation (n=11) and health professionals who manage breech presentation (n=11) recruited from two hospitals in North East England. We used purposive sampling to include women who chose ECV and women who chose planned CS. We analysed data using thematic analysis, comparing between individuals and seeking out disconfirming cases. Four main themes emerged from the data collected during interviews with pregnant women with a breech presentation: ECV as a means of enabling natural birth; concerns about ECV; lay and professional accounts of ECV; and breech presentation as a means of choosing planned CS. Some women's attitudes to ECV were affected by their preferences for how to give birth. Other women chose CS because ECV was not acceptable to them. Two main themes emerged from the interview data about health professionals' attitudes towards ECV: directive counselling and attitudes towards lay beliefs about ECV and breech presentation. Women had a range of attitudes to ECV informed by their preferences for how to give birth; the acceptability of ECV to them; and lay accounts of ECV, which were frequently negative. Most professionals described having a preference for ECV and reported directively counselling women to choose it. Some professionals were dismissive of lay beliefs about ECV. Some key challenges for shared decision making about breech presentation were identified: health professionals counselling women directively about ECV and the differences between evidence-based information about ECV and lay beliefs. To address these challenges a number of approaches will be required.

Public involvement in suicide prevention: understanding and strengthening lay responses to distress.

PubMed

Owens, Christabel; Owen, Gareth; Lambert, Helen; Donovan, Jenny; Belam, Judith; Rapport, Frances; Lloyd, Keith

2009-08-23

The slogan "Suicide prevention is everyone's business" has been used in a number of campaigns worldwide in recent years, but most research into suicide prevention has focused on the role of medical professionals in identifying and managing risk. Little consideration has been given to the role that lay people can play in suicide prevention, or to the resources they need in order to do so.The majority of people who take their own lives are not under the care of specialist mental health services, and around half have not had recent contact with their general practitioner. These individuals are not known to be 'at risk' and there is little or no opportunity for clinical intervention. Family members and friends may be the only ones to know that a person is troubled or distressed, and their capacity to recognise, assess and respond to that distress is therefore vitally important. This study aims to discover what the suicidal process looks like from the point of view of relatives and friends and to gain insight into the complex and difficult judgements that people have to make when trying to support a distressed individual. The study uses qualitative methods to build up a detailed picture of 15-20 completed suicides, aged 18-34. Data are gathered by means of in-depth interviews with relatives, friends and others who knew the deceased well. In each case, as many informants as possible are sought using a purposive snowballing technique. Interviews focus on the family and social network of the deceased, the ways in which relatives and friends interpreted and responded to his/her distress, the potential for intervention that may have existed within the lay network and the knowledge, skills and other resources that would have helped members to support the distressed individual more effectively. The study will inform interventions to promote public mental health awareness and will provide a basis on which to develop community-focussed suicide prevention strategies.

Exploring lay views on physical activity and their implications for public health policy. A case study from East Belfast.

PubMed

Prior, L; Scott, D; Hunter, R; Donnelly, M; Tully, M A; Cupples, M E; Kee, F

2014-08-01

It is now recognised that inactive lifestyles underpin much of the disease burden evident in the richer nations of the world. Indeed, the WHO has identified physical inactivity as a 'global public health problem' and has established minimum physical activity (PA) targets for people at different stages of the life-course. Yet, according to WHO, just under 1/3 of working age adults across the globe meet those targets and it is not at all clear how the disjunction between the recommendations of policy makers and the behaviour of ordinary people might be surmounted. Using an opportunity to examine the impact of an urban regeneration project on community residents in East Belfast (Northern Ireland) this paper examines the views of some 113 people on how to increase rates of PA in an area of multiple deprivation. The results of the analysis suggest that lay people rarely consider PA as a discrete issue, or one that centres on individuals and their motivation, but rather as one component in a complex web of concerns, processes and events that include such things as the actions of neighbours and relatives, material and political environments, vandalism, violence, and the weather. We explore and unravel the nature of those concerns using novel methods of content analysis that generate 'issue webs'. Particular attention is paid to the ways in which lay people conceptualize 'activity' and to the manner in which they point to ways of encouraging activity that are rooted in everyday life rather than in the corpocentric, agent-centred and often sport dominated strategies favoured by local policy makers. Our results support those who argue that interventions to increase rates of PA need to move beyond behavioural approaches that focus on individuals and consider the social, political and material contexts in which 'activity' occurs. Copyright © 2014 Elsevier Ltd. All rights reserved.

Misconceptions about Ebola virus disease among lay people in Guinea: Lessons for community education.

PubMed

Kpanake, Lonzozou; Gossou, Komlantsè; Sorum, Paul Clay; Mullet, Etienne

2016-05-01

To characterize the perception of Ebola virus disease (EVD) in Guinea, we administered, from November 2014 to February 2015, a questionnaire to a convenience sample of 200 lay people in Conakry and a group of 8 physicians. We found widespread misconceptions among lay people, including that praying to God can protect against EVD, that traditional healers are more competent than physicians in treating EVD, that people get infected through physical proximity without contact, that the Ebola epidemic is the result of Western bioterrorism experiments, that Western medical staff disseminated the virus, and that the purpose of quarantine measures is to hasten the death of Ebola patients. Major educational interventions, sensitive to local cultural beliefs, are needed to overcome the misconceptions about Ebola in Guinea.

Biomarkers in Sports and Exercise: Tracking Health, Performance, and Recovery in Athletes.

PubMed

Lee, Elaine C; Fragala, Maren S; Kavouras, Stavros A; Queen, Robin M; Pryor, John Luke; Casa, Douglas J

2017-10-01

Biomarker discovery and validation is a critical aim of the medical and scientific community. Research into exercise and diet-related biomarkers aims to improve health, performance, and recovery in military personnel, athletes, and lay persons. Exercise physiology research has identified individual biomarkers for assessing health, performance, and recovery during exercise training. However, there are few recommendations for biomarker panels for tracking changes in individuals participating in physical activity and exercise training programs. Our approach was to review the current literature and recommend a collection of validated biomarkers in key categories of health, performance, and recovery that could be used for this purpose. We determined that a comprehensive performance set of biomarkers should include key markers of (a) nutrition and metabolic health, (b) hydration status, (c) muscle status, (d) endurance performance, (e) injury status and risk, and (f) inflammation. Our review will help coaches, clinical sport professionals, researchers, and athletes better understand how to comprehensively monitor physiologic changes, as they design training cycles that elicit maximal improvements in performance while minimizing overtraining and injury risk.

An analysis of community perceptions of mosquito-borne disease control and prevention in Sint Eustatius, Caribbean Netherlands

PubMed Central

Leslie, Teresa E.; Carson, Marianne; van Coeverden, Els; De Klein, Kirsten; Braks, Marieta; Krumeich, Anja

2017-01-01

ABSTRACT Background: In the Caribbean, mosquito-borne diseases are a public health threat. In Sint Eustatius, dengue, Chikungunya and Zika are now endemic. To control and prevent mosquito-borne diseases, the Sint Eustatius Public Health Department relies on the community to assist with the control of Aedes aegypti mosquito. Unfortunately, community based interventions are not always simple, as community perceptions and responses shape actions and influence behavioural responses Objective: The aim of this study was to determine how the Sint Eustatius population perceives the Aedes aegypti mosquito, mosquito-borne diseases and prevention and control measures and hypothesized that increased knowledge of the virus, vector, control and prevention should result in a lower AQ1 prevalence and incidence of mosquito-borne diseases. Methods: This study was conducted in Sint Eustatius island in the Eastern Caribbean. We combined qualitative and quantitative designs. We conducted interviews and focus groups discussions among community member and health professional in 2013 and 2015. We also conducted cross-sectional survey to assess local knowledge on the vector, virus, and control and prevention. Results: The population is knowledgeable; ©however, mosquito-borne diseases are not the highest health priority. While local knowledge is sometimes put into action, it happens on the 20 household/individual level as opposed to the community level. After the 2014 CHIK outbreak, there was an increase in knowledge about mosquito control and mosquito-borne diseases. Discussion: In the context of Sint Eustatius, when controlling the Aedes population it may be a strategic option to focus on the household level rather than the community and build collaborations with households by supporting them when they actively practice mosquito 25 control. To further increase the level of knowledge on the significance of mosquito-borne diseases, it may also be an option to contextualize the issue of the virus, vector, prevention and control into a broader context. Conclusion: As evidenced by the increasing number of mosquito-borne diseases on the island, it appears that knowledge amongst the lay community may not be transferred into 30 action. This may be attributed to the perception of the Sint Eustatius populations that mosquitoes and the viruses they carry are not a high priority in comparison to other health concerns. PMID:28766466

An analysis of community perceptions of mosquito-borne disease control and prevention in Sint Eustatius, Caribbean Netherlands.

PubMed

Leslie, Teresa E; Carson, Marianne; Coeverden, Els van; De Klein, Kirsten; Braks, Marieta; Krumeich, Anja

2017-01-01

In the Caribbean, mosquito-borne diseases are a public health threat. In Sint Eustatius, dengue, Chikungunya and Zika are now endemic. To control and prevent mosquito-borne diseases, the Sint Eustatius Public Health Department relies on the community to assist with the control of Aedes aegypti mosquito. Unfortunately, community based interventions are not always simple, as community perceptions and responses shape actions and influence behavioural responses Objective: The aim of this study was to determine how the Sint Eustatius population perceives the Aedes aegypti mosquito, mosquito-borne diseases and prevention and control measures and hypothesized that increased knowledge of the virus, vector, control and prevention should result in a lower AQ1 prevalence and incidence of mosquito-borne diseases. This study was conducted in Sint Eustatius island in the Eastern Caribbean. We combined qualitative and quantitative designs. We conducted interviews and focus groups discussions among community member and health professional in 2013 and 2015. We also conducted cross-sectional survey to assess local knowledge on the vector, virus, and control and prevention. The population is knowledgeable; ©however, mosquito-borne diseases are not the highest health priority. While local knowledge is sometimes put into action, it happens on the 20 household/individual level as opposed to the community level. After the 2014 CHIK outbreak, there was an increase in knowledge about mosquito control and mosquito-borne diseases. In the context of Sint Eustatius, when controlling the Aedes population it may be a strategic option to focus on the household level rather than the community and build collaborations with households by supporting them when they actively practice mosquito 25 control. To further increase the level of knowledge on the significance of mosquito-borne diseases, it may also be an option to contextualize the issue of the virus, vector, prevention and control into a broader context. As evidenced by the increasing number of mosquito-borne diseases on the island, it appears that knowledge amongst the lay community may not be transferred into 30 action. This may be attributed to the perception of the Sint Eustatius populations that mosquitoes and the viruses they carry are not a high priority in comparison to other health concerns.

Essential Ingredients for Trusteeship at Today's Catholic Colleges

ERIC Educational Resources Information Center

Byron, William J.

2011-01-01

In the late 1940s and throughout the decade of the '50s, Catholic colleges began to shift governance control from members of the sponsoring religious community to lay men and women. Typically, a "one-third plus one" rule addressed the required presence of representatives of the religious community on the board, a measure intended to…

Laying Tracks to Graduation: The First Year of Implementing Diplomas Now

ERIC Educational Resources Information Center

Corrin, William; Sepanik, Susan; Gray, Aracelis; Fernandez, Felix; Briggs, Ashley; Wang, Kathleen K.

2014-01-01

Too many students in high-poverty, urban communities drop out of high school, and too few graduate prepared for college and careers. Three national organizations--Talent Development Secondary, City Year, and Communities In Schools--have formed Diplomas Now in an effort to transform urban secondary schools so fewer students drop out and more…

Patient-centered communication of community treatment assistants in Tanzania predicts coverage of future mass drug administration for trachoma.

PubMed

Jenson, Alexander; Roter, Debra L; Mkocha, Harran; Munoz, Beatriz; West, Sheila

2018-06-01

Prevention of Trachoma, the leading cause of infectious blindness, requires community treatment assistants (CTAs) to perform mass drug administration (MDA) of azithromycin. Previous research has shown that female CTAs have higher MDA coverage, but no studies have focused on the content of conversation. We hypothesize that female CTAs had more patient-centered communication and higher MDA coverage. In 2011, CTAs from 23 distribution sites undergoing MDA as part of the Partnership for Rapid Elimination of Trachoma were selected. CTA - villager interactions were audio recorded. Audio was analyzed using an adaptation of the Roter Interaction Analysis System. The outcome of interest was the proportion of adults receiving MDA in 2011 who returned in 2012. 58 CTAs and 3122 interactions were included. Sites with female CTAs had significantly higher patient-centeredness ratio (0.548 vs 0.400) when compared to sites with male CTAs. Sites with more patient-centered interactions had higher proportion of patients return (p = 0.009). Female CTAs had higher proportion of patient-centered communication. Patient centered communication was associated with higher rates of return for MDA. Greater patient-centered connection with health care providers affects participation in public health efforts, even when those providers are lay health workers. Copyright © 2018 Elsevier B.V. All rights reserved.

#Stupidcancer: Exploring a Typology of Social Support and the Role of Emotional Expression in a Social Media Community.

PubMed

Myrick, Jessica Gall; Holton, Avery E; Himelboim, Itai; Love, Brad

2016-01-01

Social network sites (SNSs) like Twitter continue to attract users, many of whom turn to these spaces for social support for serious illnesses like cancer. Building on literature that explored the functionality of online spaces for health-related social support, we propose a typology that situates this type of support in an SNS-based open cancer community based on the type (informational or emotional) and the direction (expression or reception) of support. A content analysis applied the typology to a 2-year span of Twitter messages using the popular hashtag "#stupidcancer." Given that emotions form the basis for much of human communication and behavior, including aspects of social support, this content analysis also examined the relationship between emotional expression and online social support in tweets about cancer. Furthermore, this study looked at the various ways in which Twitter allows for message sharing across a user's entire network (not just among the cancer community). This work thus begins to lay the conceptual and empirical groundwork for future research testing the effects of various types of social support in open, interactive online cancer communities.

'Keep complaining til someone listens': Exchanges of tacit healthcare knowledge in online illness communities.

PubMed

Foster, Drew

2016-10-01

This article examines online exchanges of advice and knowledge among patients. It draws a distinction between explicit healthcare knowledge (i.e., facts about symptoms and treatments) and tacit healthcare knowledge (i.e., know-how about navigating the healthcare system). Based on analysis of message board interactions at a prominent online illness community, I find that patients routinely encourage one another to exercise agency strategically in clinical encounters by honing specific interactional skills. I isolate three major techniques that are advocated within the community (affect regulation, information management, and treatment persistence) and frame them as discrete examples of tacit healthcare knowledge. I argue that tacit healthcare knowledge constitutes a potentially potent source of empowerment for patients that can help them to receive their desired form of care from the health system and to negotiate relationships with medical professionals and institutions. I conclude by discussing how the concept of tacit healthcare knowledge further clarifies the wide variety of lay knowledge exchanged among patients online. Copyright © 2016 Elsevier Ltd. All rights reserved.

Evaluation of the HIV lay counselling and testing profession in South Africa.

PubMed

Mwisongo, Aziza; Mehlomakhulu, Vuyelwa; Mohlabane, Neo; Peltzer, Karl; Mthembu, Jacque; Van Rooyen, Heidi

2015-07-22

With the launch of the national HIV Counselling and Testing (HCT) campaign in South Africa (SA), lay HIV counsellors, who had been trained in blood withdrawal, have taken up the role of HIV testing. This study evaluated the experiences, training, motivation, support, supervision, and workload of HIV lay counsellors and testers in South Africa. The aim was to identify gaps in their resources, training, supervision, motivation, and workload related to HCT services. In addition it explored their experiences with providing HIV testing under the task shifting context. The study was conducted in eight of South Africa's nine provinces. 32 lay counsellors were recruited from 67 HCT sites, and were interviewed using two questionnaires that included structured and semi-structured questions. One questionnaire focused on their role as HIV counsellors and the other on their role as HIV testers. Ninety-seven percent of counsellors reported that they have received training in counselling and testing. Many rated their training as more than adequate or adequate, with 15.6% rating it as not adequate. Respondents reported a lack of standardised counselling and testing training, and revealed gaps in counselling skills for specific groups such as discordant couples, homosexuals, older clients and children. They indicated health system barriers, including inadequate designated space for counselling, which compromises privacy and confidentiality. Lay counsellors carry the burden of counselling and testing nationally, and have other tasks such as administration and auxiliary duties due to staff shortages. This study demonstrates that HCT counselling and testing services in South Africa are mainly performed by lay counsellors and testers. They are challenged by inadequate work space, limited counselling skills for specific groups, a lack of standardised training policies and considerable administrative and auxiliary duties. To improve HCT services, there needs to be training needs with a standardised curriculum and refresher courses, for HIV counselling and testing, specifically for specific elderly clients, discordant couples, homosexuals and children. The Department of Health should formally integrate lay counsellors into the health care system with proper allocation of tasks under the task shifting policy.

Advancing a conceptual model to improve maternal health quality: The Person-Centered Care Framework for Reproductive Health Equity.

PubMed

Sudhinaraset, May; Afulani, Patience; Diamond-Smith, Nadia; Bhattacharyya, Sanghita; Donnay, France; Montagu, Dominic

2017-11-06

Background: Globally, substantial health inequities exist with regard to maternal, newborn and reproductive health. Lack of access to good quality care-across its many dimensions-is a key factor driving these inequities. Significant global efforts have been made towards improving the quality of care within facilities for maternal and reproductive health. However, one critically overlooked aspect of quality improvement activities is person-centered care. Main body: The objective of this paper is to review existing literature and theories related to person-centered reproductive health care to develop a framework for improving the quality of reproductive health, particularly in low and middle-income countries. This paper proposes the Person-Centered Care Framework for Reproductive Health Equity, which describes three levels of interdependent contexts for women's reproductive health: societal and community determinants of health equity, women's health-seeking behaviors, and the quality of care within the walls of the facility. It lays out eight domains of person-centered care for maternal and reproductive health. Conclusions: Person-centered care has been shown to improve outcomes; yet, there is no consensus on definitions and measures in the area of women's reproductive health care. The proposed Framework reviews essential aspects of person-centered reproductive health care.

Lay and health care professional understandings of self-management: A systematic review and narrative synthesis

PubMed Central

Wolfe, Charles DA; McKevitt, Christopher

2014-01-01

Objectives: Self-management is widely promoted but evidence of effectiveness is limited. Policy encourages health care professionals to support people with long-term conditions to learn self-management skills, yet little is known about the extent to which both parties share a common understanding of self-management. Thus, we compared health care professional and lay understandings of self-management of long-term conditions. Methods: Systematic review and narrative synthesis of qualitative studies identified from relevant electronic databases, hand-searching of references lists, citation tracking and recommendations by experts. Results: In total, 55 studies were included and quality was assessed using a brief quality assessment tool. Three conceptual themes, each with two subthemes were generated: traditional and shifting models of the professional–patient relationship (self-management as a tool to promote compliance; different expectations of responsibility); quality of relationship between health care professional and lay person (self-management as a collaborative partnership; self-management as tailored support) and putting self-management into everyday practice (the lived experience of self-management; self-management as a social practice). Conclusion: Self-management was conceptualised by health care professionals as incorporating both a biomedical model of compliance and individual responsibility. Lay people understood self-management in wider terms, reflecting biomedical, psychological and social domains and different expectations of responsibility. In different ways, both deviated from the dominant model of self-management underpinned by the concept of self-efficacy. Different understandings help to explain how self-management is practised and may help to account for limited evidence of effectiveness of self-management interventions. PMID:26770733

Pride in Parenting Training Program: A Curriculum for Training Lay Home Visitors.

ERIC Educational Resources Information Center

Jarrett, Marian H.; Katz, Kathy S.; Sharps, Phyllis; Schneider, Susan; Diamond, Linda T.

1998-01-01

Describes the Pride in Parenting Training Curriculum developed by an interdisciplinary team to reduce infant mortality in minority populations. The program has been used to train lay home visitors to deliver a home-visiting curriculum focused on effective use of health-care services and improved infant development. (Author/CR)

The effect of perch availability during pullet rearing and egg laying on musculoskeletal health of caged White Leghorn hens

USDA-ARS?s Scientific Manuscript database

A major skeletal problem of conventionally caged hens is increased susceptibility to osteoporosis mainly due to lack of exercise. Osteoporosis is characterized by a progressive decrease in mineralized structural bone. Whereas considerable attention has been given to enriching laying cages, little r...

Developing Written Information for Cancer Survivors from Culturally and Linguistically Diverse Backgrounds: Lessons Learnt.

PubMed

Wiley, Georgina; Piper, Amanda; Phyllis Butow, A M; Schofield, Penny; Douglas, Fiona; Roy, Jane; Nolte, Linda; Jefford, Michael

2018-01-01

Australia is a multicultural nation with a large migrant population. Migrants with cancer report inferior quality of life and the need for more information in their own language. This paper describes lessons learnt from developing culturally appropriate written information resources with and for Arabic, Italian, and Vietnamese cancer survivors and carers. The information needs of survivors from these language groups as well as guidelines for the development of written resources for culturally diverse populations were identified through literature review. Community consultation was undertaken with focus groups. The content was developed and tested with health professionals who spoke the appropriate language and focus group participants, ensuring relevance and appropriateness. Resource design and dissemination were informed through community consultation. A number of key tasks for developing resources were identified as follows: (1) community engagement and consultation; (2) culturally sensitive data collection; (3) focus group facilitators (recruitment and training); (4) content development; (5) translation and review process; (6) design; and (7) sustainability. This project reinforced literature review findings on the importance of cultural sensitivity in the development of resources. Engaging with community groups and incorporating culturally appropriate recruitment strategies optimises recruitment to focus groups and facilitates content development. Stakeholders and lay persons from the intended ethnic-minority communities should be involved in the development and formative evaluation of resources to ensure appropriateness and relevance and in the dissemination strategy to optimize penetration. We believe the lessons we have learnt will be relevant to any group intending to develop health information for culturally and linguistic diverse groups.

Developing Written Information for Cancer Survivors from Culturally and Linguistically Diverse Backgrounds: Lessons Learnt

PubMed Central

Wiley, Georgina; Piper, Amanda; Phyllis Butow, AM; Schofield, Penny; Douglas, Fiona; Roy, Jane; Nolte, Linda; Jefford, Michael

2018-01-01

Australia is a multicultural nation with a large migrant population. Migrants with cancer report inferior quality of life and the need for more information in their own language. This paper describes lessons learnt from developing culturally appropriate written information resources with and for Arabic, Italian, and Vietnamese cancer survivors and carers. The information needs of survivors from these language groups as well as guidelines for the development of written resources for culturally diverse populations were identified through literature review. Community consultation was undertaken with focus groups. The content was developed and tested with health professionals who spoke the appropriate language and focus group participants, ensuring relevance and appropriateness. Resource design and dissemination were informed through community consultation. A number of key tasks for developing resources were identified as follows: (1) community engagement and consultation; (2) culturally sensitive data collection; (3) focus group facilitators (recruitment and training); (4) content development; (5) translation and review process; (6) design; and (7) sustainability. This project reinforced literature review findings on the importance of cultural sensitivity in the development of resources. Engaging with community groups and incorporating culturally appropriate recruitment strategies optimises recruitment to focus groups and facilitates content development. Stakeholders and lay persons from the intended ethnic-minority communities should be involved in the development and formative evaluation of resources to ensure appropriateness and relevance and in the dissemination strategy to optimize penetration. We believe the lessons we have learnt will be relevant to any group intending to develop health information for culturally and linguistic diverse groups. PMID:29379844

Still too little qualitative research to shed light on results from reviews of effectiveness trials: a case study of a Cochrane review on the use of lay health workers.

PubMed

Glenton, Claire; Lewin, Simon; Scheel, Inger B

2011-05-27

Qualitative research is used increasingly alongside trials of complex interventions to explore processes, contextual factors, or intervention characteristics that may have influenced trial outcomes. Qualitative research conducted alongside trials can also be used to shed light on the results of systematic reviews of effectiveness by looking for factors that can help explain heterogeneous results across trials. In a Cochrane review on the effects of using lay health workers on maternal and child health and infectious disease control, we identified 82 trials. These trials showed promising benefits but results were heterogeneous. To use qualitative studies conducted alongside these trials to explore factors and processes that might have influenced intervention outcomes. We attempted to identify qualitative research carried out alongside the trials by contacting trial authors, checking papers for references to qualitative research, searching Pubmed for related studies, and carrying out citation searches. For those qualitative studies that we included, we extracted information regarding study objective, data collection and analysis methods, and key themes and categories. For 52 (63%) of the trials, we found no qualitative research that had been conducted alongside the trials. For 16 (20%) trials, some form of qualitative data collection had been done but was unavailable or had been done before the trial. For 14 (17%) trials, qualitative research had been done during or shortly after the trial, although descriptions of qualitative methods and results were often sparse. Most of these 14 studies aimed to elicit trial participants' perspectives and experiences of the intervention. A common theme was participants' appreciation of the lay health workers' shared circumstances, for instance with regard to social background or experience of the health condition. In six studies, researchers explored the experiences of the lay health workers themselves. Issues included the importance of regular supervision and health professionals' support or lack of support. Qualitative studies carried out alongside trials of complex interventions could offer opportunities to authors of systematic reviews of effectiveness wishing to understand the heterogeneity of trial results. For interventions of lay health worker programmes at least, too few such studies exist at present for these opportunities to be realised.

Healthy Families Study: Design of a Childhood Obesity Prevention Trial for Hispanic Families

PubMed Central

Zoorob, Roger; Buchowski, Maciej; Beech, Bettina M.; Canedo, Juan R.; Chandrasekhar, Rameela; Akohoue, Sylvie; Hull, Pamela C.

2013-01-01

Background The childhood obesity epidemic disproportionately affects Hispanics. This paper reports on the design of the ongoing Healthy Families Study, a randomized controlled trial testing the efficacy of a community-based, behavioral family intervention to prevent excessive weight gain in Hispanic children using a community-based participatory research approach. Methods The study will enroll 272 Hispanic families with children ages 5–7 residing in greater Nashville, Tennessee, United States. Families are randomized to the active weight gain prevention intervention or an alternative intervention focused on oral health. Lay community health promoters implement the interventions primarily in Spanish in a community center. The active intervention was adapted from the We Can! parent program to be culturally-targeted for Hispanic families and for younger children. This 12-month intervention promotes healthy eating behaviors, increased physical activity, and decreased sedentary behavior, with an emphasis on parental modeling and experiential learning for children. Families attend eight bi-monthly group sessions during four months then receive information and/or support by phone or mail each month for eight months. The primary outcome is change in children’s body mass index. Secondary outcomes are changes in children’s waist circumference, dietary behaviors, preferences for fruits and vegetables, physical activity, and screen time. Results Enrollment and data collection are in progress. Conclusion This study will contribute valuable evidence on efficacy of a childhood obesity prevention intervention targeting Hispanic families with implications for reducing disparities. PMID:23624172

Intraarticular Facet Injections for Low Back Pain: Design Considerations, Consensus Methodology to Develop the Protocol for a Randomized Controlled Trial.

PubMed

Mars, Tom; Ellard, David R; Antrobus, James H L; Cairns, Melinda; Underwood, Martin; Haywood, Kirstie; Keohane, Susie; Sandhu, Harbinder; Griffiths, Frances

2015-01-01

Since the publication of guidelines by the UK National Institute for Health and Care Excellence (NICE) and the American Pain Society guidelines for low back pain in 2009 there have been deep divisions in the pain treatment community about the use of therapeutic intraarticular facet joint injections. While evidence for the effectiveness or not of intraarticular facet joint injections remains sparse, uncertainty will remain. The Warwick feasibility study, along with a concurrent study with a different design led by another group, aims to provide a stable platform from which the effectiveness and cost effectiveness of intraarticular facet joint injections added to normal care could be evaluated in randomized controlled trials (RCTs). To reach consensus on key design considerations for the Warwick facet feasibility study from which the study protocol and working manuals will be developed. A consensus conference involving expert professionals and lay members. Preliminary work identified 5 key design considerations for deliberation at our consensus conference. Three concerned patient assessment and treatment: diagnosis of possible facet joint pain, interaarticular facet joint injection technique, and best usual care. Two concerned trial analysis: a priori sub-groups and minimally important difference and are reported elsewhere. We did systematic evidence reviews of the design considerations and summarized the evidence. Our design questions and evidence summaries were distributed to all delegates. This formed the basis for discussions on the day. Clinical experts in all aspects of facet joint injection from across the UK along with lay people were invited via relevant organizations. Nominal group technique was used in 15 facilitated initial small group discussions. Further discussion and ranking was undertaken in plenary. All small group and plenary results were recorded and checked and verified post conference. Where necessary participants were contacted via email to resolve outstanding issues. Fifty-two delegates attended the conference with lay people and all relevant professions represented. Consensus was reached on the details of how to assess patients for facet joint pain, undertake the injections, and deliver usual care. Where post conference checking of results revealed errors in calculating ranking results on the day, consensus was reached by email consultation. All but 3 delegates agreed to be associated with the outcome. Allocating one day for discussing a wide range of topics imposed time pressure on discussion and calculation of the numerous rankings. Through the use of an evidence-based, systematic, inclusive, and transparent process we have established consensus from expert health professionals in the UK, with lay input, on the clinical assessment of suspected facet joint pain, interaarticular injection for facet joint pain, and best usual care for use in a feasibility study for a proposed pragmatic clinical trial of interaarticular facet joint injections. This provides a strong basis for a clinical trial that will be acceptable to the pain treatment community.

Lay Health Trainers Supporting Self-Management amongst Those with Low Heath Literacy and Diabetes: Lessons from a Mixed Methods Pilot, Feasibility Study.

PubMed

Bartlam, Bernadette; Rathod, Trishna; Rowlands, Gillian; Protheroe, Joanne

2016-01-01

This article reports a mixed methods process evaluation of a pilot feasibility randomised controlled trial comparing a Lay Health Trainer (LHT) intervention and usual care for those with poorly controlled Type 2 Diabetes Melitus (T2DM). Set in a deprived area in the UK, this research explores patient and health care practitioner (HCP) views on whether a structured interview between a patient and a Lay Health Trainer (LHT), for the purpose of developing a tailored self-management plan for patients, is acceptable and likely to change health behaviours. In doing so, it considers the implications for a future, randomised controlled trial (RCT). Participants were patients, LHTs delivering the intervention, service managers, and practice nurses recruiting patients to the study. Patients were purposively sampled on their responses to a baseline survey, and semistructured interviews were conducted within an exploratory thematic analysis framework. Findings indicate that the intervention is acceptable to patients and HCPs. However, LHTs found it challenging to work with older patients with long-term and/or complex conditions. In order to address this, given an ageing population and concomitant increases in those with such health needs, LHT training should develop skills working with these populations. The design of any future RCT intervention should take account of this.

Increasing black, asian and minority ethnic (bame) patient & community awareness--using the peer educator model.

PubMed

Jain, Neerja

2014-09-01

Kidney Research UK, have been working since 2001 to raise health awareness, fund and oversee research into kidney related issues disproportionately affecting the BAME communities in the UK. Almost 10 years ago, the charity initiated its Peer Educator model which uses the natural skills of lay people and patients to raise awareness in these communities. This article will describe the work of the Charity in relation to patient and public engagement, describing the Peer Educator model and providing examples of how it has been used. It will then focus on the deployment and impact of Peer Educators in an end of life project that the charity was involved in. Peer Educators (PEs) are ordinary people from the targeted community. In the case of our health improvement work, this has largely been the BAME communities. These people do not need any prior knowledge, training or experience in the subject matter. However, they do need to have a desire to give something back to their community in terms of health messages and also be passionate about the subject matter. They tend to have a natural empathy with the target groups in terms of culture, religion and language. The Peer Educator model, is it has been found, to be a flexible and highly adaptable approach to addressing health issues in the BAME communities. It has been utilised by the charity to address everything from early disease detection, prevention, management, organ donation awareness, right through to end of life issues. The model has been well evaluated in the area of organ donation whereby its effectiveness has been proven. Moreover, there have been several notable outcomes from the end of life work including training and deployment of 10 Peer Educators who reached over 2,700 people from diverse South Asian communities, providing important information on who does what, when, and how to access it--in a culturally competent manner. Kidney Research UK's Peer Educator initiative has been well established as an effective and flexible way to raise awareness and reach out to BAME patients and the communities at risk. The model has been deployed across the kidney disease spectrum including from early detection to diabetes management, right through to addressing organ donation and end of life issues. © 2014 European Dialysis and Transplant Nurses Association/European Renal Care Association.

Using formative research to lay the foundation for community level HIV prevention efforts: an example from the AIDS Community Demonstration Projects.

PubMed Central

Higgins, D L; O'Reilly, K; Tashima, N; Crain, C; Beeker, C; Goldbaum, G; Elifson, C S; Galavotti, C; Guenther-Grey, C

1996-01-01

The AIDS Community Demonstration Projects provided community-level HIV prevention interventions to historically hard-to-reach groups at high risk for HIV infection. The projects operated under a common research protocol which encompassed formative research, intervention delivery, process evaluation, and outcome evaluation. A formative research process specifically focusing on intervention development was devised to assist project staff in identifying, prioritizing, accessing, and understanding the intervention target groups. This process was central to the creation of interventions that were acceptable and unique to the target populations. Intended to be rapid, the process took 6 months to complete. Drawn from the disciplines of anthropology, community psychology, sociology, and public health, the formative research process followed distinct steps which included (a) defining the populations at high-risk for HIV; (b) gathering information about these populations through interviews with persons who were outside of, but who had contact with, the target groups (such as staff from the health department and alcohol and drug treatment facilities, as well as persons who interacted in an informal manner with the target groups, such as clerks in neighborhood grocery stores and bartenders); (c) interviewing people with access to the target populations (gatekeepers), and conducting observations in areas where these high-risk groups were reported to gather (from previous interviews); (d) interviewing members of these groups at high risk for HIV infection or transmission; and (e) systematically integrating information throughout the process. Semistructured interview schedules were used for all data collection in this process. This standardized systematic method yielded valuable information about the focal groups in each demonstration project site. The method, if adopted by others, would assist community intervention specialists in developing interventions that are culturally appropriate and meaningful to their respective target populations. PMID:8862154

Achieving Equity in Physical Activity Participation: ACSM Experience and Next Steps.

PubMed

Hasson, Rebecca E; Brown, David R; Dorn, Joan; Barkley, Lisa; Torgan, Carol; Whitt-Glover, Melicia; Ainsworth, Barbara; Keith, Nicole

2017-04-01

There is clear and consistent evidence that regular physical activity is an important component of healthy lifestyles and fundamental to promoting health and preventing disease. Despite the known benefits of physical activity participation, many people in the United States remain inactive. More specifically, physical activity behavior is socially patterned with lower participation rates among women; racial/ethnic minorities; sexual minority youth; individuals with less education; persons with physical, mental, and cognitive disabilities; individuals >65 yr of age; and those living in the southeast region of the United States. Many health-related outcomes follow a pattern that is similar to physical activity participation. In response to the problem of inequities in physical activity and overall health in the United States, the American College of Sports Medicine (ACSM) has developed a national roadmap that supports achieving health equity through a physically active lifestyle. The actionable, integrated pathways that provide the foundation of ACSM's roadmap include the following: 1) communication-raising awareness of the issue and magnitude of health inequities and conveying the power of physical activity in promoting health equity; 2) education-developing educational resources to improve cultural competency for health care providers and fitness professionals as well as developing new community-based programs for lay health workers; 3) collaboration-building partnerships and programs that integrate existing infrastructures and leverage institutional knowledge, reach, and voices of public, private, and community organizations; and 4) evaluation-ensuring that ACSM attains measurable progress in reducing physical activity disparities to promote health equity. This article provides a conceptual overview of these four pathways of ACSM's roadmap, an understanding of the challenges and advantages of implementing these components, and the organizational and economic benefits of achieving health equity.

Deciding to opt out of childhood vaccination mandates.

PubMed

Gullion, Jessica Smartt; Henry, Lisa; Gullion, Greg

2008-01-01

We explore the attitudes and beliefs of parents who consciously choose not to vaccinate their children and the ways in which these parents process information on the pros and cons of vaccines. In-depth, semistructured interviews were conducted. The study population consisted of 25 parents who do not vaccinate their children, identified through snowball and targeted sampling. Participants were asked about their processes and actions when choosing not to vaccinate their children. Interviews were taped and transcribed, and the content was analyzed for emergent themes. Two predominant themes emerged in our data: a desire to collect information on vaccines and trust issues with the medical community. Evidence of sophisticated data collection and information processing was a repeated theme in the interview data. Simultaneously, while participants placed a high value on scientific knowledge, they also expressed high levels of distrust of the medical community. The challenge for public health is to balance scientific data with popular epidemiology and to maintain legitimacy. Understanding the differences in lay versus expert knowledge has implications for crafting health messages. How experts frame knowledge for consumption has an important impact on this group and their decision-making processes.

Smoking and Ill Health: Does Lay Epidemiology Explain the Failure of Smoking Cessation Programs Among Deprived Populations?

PubMed Central

Lawlor, Debbie A; Frankel, Stephen; Shaw, Mary; Ebrahim, Shah; Smith, George Davey

2003-01-01

The resistance of disadvantaged groups to anti-smoking advice is remarkable. In relation to the study of differing cultures, there is a long-standing academic tradition assuming that behavior that may otherwise be difficult to understand is indeed rational within particular cultural contexts. Persistent smoking among the most deprived members of society may represent a rational response to their life chances informed by a lay epidemiology. Health promotion initiatives designed to reduce smoking among members of these groups may continue to fail unless the general health and life chances of such individuals are first improved. PMID:12554581

Improving the Care of Youth With Type 1 Diabetes With a Novel Medical-Legal Community Intervention: The Diabetes Community Care Ambassador Program.

PubMed

Malik, Faisal S; Yi-Frazier, Joyce P; Taplin, Craig E; Roth, Christian L; Whitlock, Kathryn B; Howard, Waylon; Pihoker, Catherine

2018-04-01

Purpose The purpose of this study was to examine the feasibility and efficacy of the Diabetes Community Care Ambassador (DCCA) Program, a novel medical-legal community intervention designed to support high-risk youth with type 1 diabetes. Methods Study eligibility criteria: ages 3-19 years, A1C ≥8.5% (≥69 mmol/mol) and/or recent diabetic ketoacidosis hospitalization, type 1 diabetes duration ≥1 year, and English- or Spanish-speaking. Eighty-nine youth and their caregivers participated in the 9- to 12-month intervention, which included diabetes education and support through 3 home visits, 1 to 2 school visits, and phone support from a lay health worker, as well as legal support from a medical-legal partnership attorney. Feasibility was assessed; change in A1C was compared in a linear mixed model. Results Of the 89 DCCA Program participants, 80% completed the program, with the majority of participants rating their DCCA favorably. Sixty-two percent reported ≥1 unmet legal need, of whom 29% accepted legal counsel. Youth enrolled in the DCCA Program demonstrated an improvement in glycemic control as their mean A1C decreased from 9.71% (83 mmol/mol) at the start of the program to 9.40% (79 mmol/mol) at the end of the intervention period ( P = .03). Participants with public health insurance experienced the greatest differential A1C reduction (9.79% to 9.11%, 83 mmol/mol to 76 mmol/mol). Conclusions The DCCA Program represents a promising intervention for improving care of high-risk youth with type 1 diabetes. A significant proportion of caregivers of youth reported having an unmet legal need. Participants remained highly engaged and demonstrated improved glycemic control, particularly youth with public health insurance.

Healthy Eating and Activity Across the Lifespan (HEAL): A call to action to integrate research, clinical practice, policy, and community resources to address weight-related health disparities.

PubMed

Berge, Jerica M; Adamek, Margaret; Caspi, Caitlin; Loth, Katie A; Shanafelt, Amy; Stovitz, Steven D; Trofholz, Amanda; Grannon, Katherine Y; Nanney, Marilyn S

2017-08-01

Despite intense nationwide efforts to improve healthy eating and physical activity across the lifespan, progress has plateaued. Moreover, health inequities remain. Frameworks that integrate research, clinical practice, policy, and community resources to address weight-related behaviors are needed. Implementation and evaluation of integration efforts also remain a challenge. The purpose of this paper is to: (1) Describe the planning and development process of an integrator entity, HEAL (Healthy Eating and Activity across the Lifespan); (2) present outcomes of the HEAL development process including the HEAL vision, mission, and values statements; (3) define the planned integrator functions of HEAL; and (4) describe the ongoing evaluation of the integration process. HEAL team members used a theoretically-driven, evidence-based, systemic, twelve-month planning process to guide the development of HEAL and to lay the foundation for short- and long-term integration initiatives. Key development activities included a review of the literature and case studies, identifying guiding principles and infrastructure needs, conducting stakeholder/key informant interviews, and continuous capacity building among team members. Outcomes/deliverables of the first year of HEAL included a mission, vision, and values statements; definitions of integration and integrator functions and roles; a set of long-range plans; and an integration evaluation plan. Application of the HEAL integration model is currently underway through community solicited initiatives. Overall, HEAL aims to lead real world integrative work that coalesce across research, clinical practice, and policy with community resources to inspire a culture of health equity aimed at improving healthy eating and physical activity across the lifespan. Copyright © 2017 Elsevier Inc. All rights reserved.

Community-supported models of care for people on HIV treatment in sub-Saharan Africa.

PubMed

Bemelmans, Marielle; Baert, Saar; Goemaere, Eric; Wilkinson, Lynne; Vandendyck, Martin; van Cutsem, Gilles; Silva, Carlota; Perry, Sharon; Szumilin, Elisabeth; Gerstenhaber, Rodd; Kalenga, Lucien; Biot, Marc; Ford, Nathan

2014-08-01

Further scale-up of antiretroviral therapy (ART) to those in need while supporting the growing patient cohort on ART requires continuous adaptation of healthcare delivery models. We describe several approaches to manage stable patients on ART developed by Médecins Sans Frontières together with Ministries of Health in four countries in sub-Saharan Africa. Using routine programme data, four approaches to simplify ART delivery for stable patients on ART were assessed from a patient and health system perspective: appointment spacing for clinical and drug refill visits in Malawi, peer educator-led ART refill groups in South Africa, community ART distribution points in DRC and patient-led community ART groups in Mozambique. All four approaches lightened the burden for both patients (reduced travel and lost income) and health system (reduced clinic attendance). Retention in care is high: 94% at 36 months in Malawi, 89% at 12 months in DRC, 97% at 40 months in South Africa and 92% at 48 months in Mozambique. Where evaluable, service provider costs are reported to be lower. Separating ART delivery from clinical assessments was found to benefit patients and programmes in a range of settings. The success of community ART models depends on sufficient and reliable support and resources, including a flexible and reliable drug supply, access to quality clinical management, a reliable monitoring system and a supported lay workers cadre. Such models require ongoing evaluation and further adaptation to be able to reach out to more patients, including specific groups who may be challenged to meet the demands of frequent clinic visits and the integrated delivery of other essential chronic disease interventions. © 2014 John Wiley & Sons Ltd.

Training Lay Interventionists to Support Tobacco Cessation among Teachers in India.

PubMed

Aghi, Mira; Nagler, Eve; Lando, Harry; Pednekar, Mangesh; Gupta, Prakash; Sorensen, Glorian

2016-01-01

Despite the rapidly increasing burden of tobacco-related morbidity and mortality in low- and middle-income countries, tobacco control initiatives - especially cessation - receive little emphasis. This is true despite low-cost methods that have potential for widespread dissemination. The purpose of this paper is to provide a case study example of how lay interventionists may be trained and supported to facilitate tobacco use cessation, based on the successful Tobacco Free Teachers-Tobacco Free Society program (TFT-TFS) implemented in Bihar, India. This school-based program included multiple components, with lay interventionists having a crucial role. The lay interventionists included health educators and lead teachers, both of whom were selected based on formative research, underwent extensive training and received continuing support. We emphasized encouraging and supporting teachers to quit tobacco use and engaging both tobacco users and nonusers to create a supportive environment for cessation. We also stressed that neither the health educators nor lead teachers were being trained as counselors or as cessation experts. We focused on the importance of respecting teachers as individuals and identifying locally relevant methods of cessation. Although we cannot isolate the precise contribution of the lay interventionists to the successful TFT-TFS intervention, the abstinence findings in favor of the intervention at follow up are highly encouraging. Teachers have been neglected as lay interventionists for tobacco cessation despite the fact that they tend to be highly respected and credible. The approach used for TFT-TFS could be disseminable in multiple low- and middle-income country contexts through train-the-trainer programs targeted to teachers.

Drama, Theatre, and Education in a Changing World. IDEA '95: Reflections in the River. The IDEA Advocacy Video. [Videotape].

ERIC Educational Resources Information Center

1995

This 30-minute videotape was created as an advocacy tool for performing arts educators to use with lay people. It is aimed at community leaders; parents; school, college, and university principals; primary and secondary teachers in inservice and preservice workshops; education officers and committees; community funding agencies; ministers of…

The Community College and the Homeless: A Model for the Nation. Job Training for the Homeless Demonstration Program Final Evaluation Report.

ERIC Educational Resources Information Center

Moehrlin, Cynthia D.

Established in 1981, the Alternatives Program at Elgin Community College (ECC) has provided services for displaced homemakers, single parents, welfare recipients, and homeless women, laying the groundwork for the 1988 formation of the Fox Valley Consortium for Job Training and Placement of the Homeless. Using federal funding, the Consortium offers…

NASA to study effects of jet lag on pilot performance

NASA Technical Reports Server (NTRS)

1980-01-01

Existing scientific literature on circadian rhythm was translated into lay terms and disseminated to the aviation community. The effects of rest, sleep, dietary, and drug use patterns of commercial airline crews were investigated.

Frequency and persistence of fecal shedding of Salmonella Enteritidis by experimentally infected laying hens housed in enriched colony cages at different stocking densities

USDA-ARS?s Scientific Manuscript database

Human infections with Salmonella Enteritidis are often attributed to the consumption of contaminated eggs, so the prevalence of this pathogen in egg-laying poultry is an important public health risk factor. Numerous and complex environmental influences on Salmonella persistence and transmission are ...

Lay Public's Knowledge and Decisions in Response to Symptoms of Acute Myocardial Infarction

ERIC Educational Resources Information Center

Cytryn, Kayla N.; Yoskowitz, Nicole A.; Cimino, James J.; Patel, Vimla L.

2009-01-01

Despite public health initiatives targeting rapid action in response to symptoms of myocardial infarction (MI), people continue to delay in going to a hospital when experiencing these symptoms due to lack of recognition as cardiac-related. The objective of this research was to characterize lay individuals' knowledge of symptoms of acute myocardial…

Family Caregivers as Lay Trainers: Perceptions of Learning and the Relationship between Life Experience and Learning

ERIC Educational Resources Information Center

Conceição, Simone C.O.; Johaningsmeir, Sarah; Colby, Holly; Gordon, John

2014-01-01

This article describes an initiative to train lay people, predominantly parents of children and youth with special health care needs (CYSHCN), to teach "Bridge to Independence"--a care coordination curriculum--to other family caregivers of CYSHCN. Using a model based on Kirkpatrick and Kirkpatrick's levels of evaluation, the goal…

Colonization of internal organs by Salmonella Enteritidis in experimentally infected laying hens of four commercial genetic lines in conventional cage and enriched colony housing

USDA-ARS?s Scientific Manuscript database

Human infections with Salmonella Enteritidis are often attributed to the consumption of contaminated eggs, so the prevalence of this pathogen in commercial egg-laying flocks is a significant public health concern. Internal contamination of the edible contents of eggs results from bacterial colonizat...

Immune response of laying hens exposed to 30 ppm ammonia for 25 weeks

USDA-ARS?s Scientific Manuscript database

Ammonia is one of the most prominent aerial pollutants inside poultry production facilities, affecting chicken health and well-being based on its levels and exposure durations. The aim of this study was to investigate the effect of 30 ppm ammonia on the immune response of laying hens. Hens at 18 wk ...

Frequency and persistence of fecal shedding of Salmonella Enteritidis by experimentally infected laying hens housed in enriched colony cages at different stocking densities

USDA-ARS?s Scientific Manuscript database

Human Salmonella Enteritidis infections are often linked with consuming contaminated eggs, so the prevalence of this pathogen in egg-laying poultry is an important risk factor for public health. Salmonella persistence and transmission in commercial egg producing flocks are influenced by the complex ...

Programmes for advance distribution of misoprostol to prevent post-partum haemorrhage: a rapid literature review of factors affecting implementation.

PubMed

Smith, Helen J; Colvin, Christopher J; Richards, Esther; Roberson, Jeffrey; Sharma, Geeta; Thapa, Kusum; Gülmezoglu, A Metin

2016-02-01

Recent efforts to prevent post-partum haemorrhage (PPH) in low-income countries have focused on providing women with access to oral misoprostol during home birth. The WHO recommends using lay health workers (LHWs) to administer misoprostol in settings where skilled birth attendants are not available. This review synthesizes current knowledge about the barriers and facilitators affecting implementation of advance community distribution of misoprostol to prevent PPH, where misoprostol may be self-administered or administered by an LHW.We searched for and summarized available empirical evidence, and collected primary data from programme stakeholders about their experiences of programme implementation.We present key outcomes and features of advanced distribution programmes that are in operation or have been piloted globally. We categorized factors influencing implementation into those that operate at the health system level, factors related to the community and policy context and those factors more closely connected to the end user.Debates around advance distribution have centred on the potential risks and benefits of making misoprostol available to pregnant women and community members during pregnancy for administration in the home. However, the risks of advance distribution appear manageable and the benefits of self-administration, especially for women who have little chance of expert care for PPH, are considerable. © The Author 2015. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.

Improving access to health care amongst vulnerable populations: a qualitative study of village malaria workers in Kampot, Cambodia.

PubMed

Liverani, Marco; Nguon, Chea; Sok, Ra; Kim, Daro; Nou, Panharith; Nguon, Sokhan; Yeung, Shunmay

2017-05-08

There is growing interest in the expansion of community health workers programmes in low- and middle-income countries as a cost-effective approach to address shortages of health professionals. However, our understanding of the reception of large-scale programmes and how to improve them remains limited, with knowledge gaps about factors that may promote or discourage equitable access to services. This paper examines the case of the Village Malaria Workers (VMW) programme in Cambodia, an extensive community-based intervention for the management of malaria cases in remote rural areas. Fieldwork was conducted in Kampot province, in six case villages characterised by different programme configuration, population size, and distance to the nearest public health facility. In these locations, in-depth interviews (n = 71) with VMWs, village authorities, and residents were conducted to identify facilitators and challenges to service utilisation. Data analysis was informed by a conceptual framework based on five domains of access to services: awareness, accessibility, accommodation, availability, and acceptability. Factors that influenced the utilisation of VMW services in our research sites include: the nature of dissemination activities and their ability to reach different population groups; the village topography and the changing road infrastructure; the involvement of VMWs in other community roles and activities; perceptions about the type of disease after the onset of symptoms; the need for comprehensive diagnosis and care; perceptions about the status of VMWs as medical providers; length of VMW appointment. This study highlights the complexity and diversity of contextual factors that may influence the uptake of a community health programme. As in other countries, continued use of lay health workers in Cambodia to deliver diagnostic and curative services has the potential for great health and economic impact. However, further consideration should be given to the problem of access in different categories of residents and different contexts of implementation. In addition, a comprehensive mapping of changes in disease epidemiology, road infrastructure and the geography of access to services is crucial to inform policy development in this area.

Community dissemination and genetic research: moving beyond results reporting.

PubMed

Trinidad, Susan Brown; Ludman, Evette J; Hopkins, Scarlett; James, Rosalina D; Hoeft, Theresa J; Kinegak, Annie; Lupie, Henry; Kinegak, Ralph; Boyer, Bert B; Burke, Wylie

2015-07-01

The community-based participatory research (CBPR) literature notes that researchers should share study results with communities. In the case of human genetic research, results may be scientifically interesting but lack clinical relevance. The goals of this study were to learn what kinds of information community members want to receive about genetic research and how such information should be conveyed. We conducted eight focus group discussions with Yup'ik Alaska Native people in southwest Alaska (N = 60) and 6 (N = 61) with members of a large health maintenance organization in Seattle, Washington. Participants wanted to receive genetic information they "could do something about" and wanted clinically actionable information to be shared with their healthcare providers; they also wanted researchers to share knowledge about other topics of importance to the community. Although Alaska Native participants were generally less familiar with western scientific terms and less interested in web-based information sources, the main findings were the same in Alaska and Seattle: participants wished for ongoing dialogue, including opportunities for informal, small-group conversations, and receiving information that had local relevance. Effective community dissemination is more than a matter of presenting study results in lay language. Community members should be involved in both defining culturally appropriate communication strategies and in determining which information should be shared. Reframing dissemination as a two-way dialogue, rather than a one-way broadcast, supports the twin aims of advancing scientific knowledge and achieving community benefit. © 2015 Wiley Periodicals, Inc.

Community Dissemination and Genetic Research: Moving Beyond Results Reporting

PubMed Central

Trinidad, Susan Brown; Ludman, Evette J.; Hopkins, Scarlett; James, Rosalina D.; Hoeft, Theresa J.; Kinegak, Annie; Lupie, Henry; Kinegak, Ralph; Boyer, Bert B.; Burke, Wylie

2015-01-01

The community-based participatory research (CBPR) literature notes that researchers should share study results with communities. In the case of human genetic research, results may be scientifically interesting but lack clinical relevance. The goals of this study were to learn what kinds of information community members want to receive about genetic research and how such information should be conveyed. We conducted 8 focus group discussions with Yup’ik Alaska Native people in southwest Alaska (N=60) and 6 (N=61) with members of a large health maintenance organization in Seattle, Washington. Participants wanted to receive genetic information they “could do something about” and wanted clinically actionable information to be shared with their healthcare providers; they also wanted researchers to share knowledge about other topics of importance to the community. Although Alaska Native participants were generally less familiar with western scientific terms and less interested in web-based information sources, the main findings were the same in Alaska and Seattle: participants wished for ongoing dialogue, including opportunities for informal, small-group conversations and receiving information that had local relevance. Effective community dissemination is more than a matter of presenting study results in lay language. Community members should be involved in both defining culturally appropriate communication strategies and in determining which information should be shared. Reframing dissemination as a two-way dialogue, rather than a one-way broadcast, supports the twin aims of advancing scientific knowledge and achieving community benefit. PMID:25900516

Effectiveness of a theory-based intervention to increase colorectal cancer screening among Iranian health club members: a randomized trial.

PubMed

Salimzadeh, Hamideh; Eftekhar, Hassan; Majdzadeh, Reza; Montazeri, Ali; Delavari, Alireza

2014-10-01

Colorectal cancer is the third most commonly diagnosed cancer and the fourth leading cause of death in the world. There are few published studies that have used theory-based interventions designed to increase colorectal cancer screening in community lay health organizations. The present study was guided by the theoretical concepts of the preventive health model. Twelve health clubs of a municipal district in Tehran were randomized to two study groups with equal ratio. The control group received usual services throughout the study while the intervention group also received a theory-based educational program on colorectal cancer screening plus a reminder call. Screening behavior, the main outcome, was assessed 4 months after randomization. A total of 360 members aged 50 and older from 12 health clubs completed a baseline survey. Participants in the intervention group reported increased knowledge of colorectal cancer and screening tests at 4 months follow-up (p's < .001). Moreover, exposure to the theory-based intervention significantly improved self-efficacy, perceived susceptibility, efficacy of screening, social support, and intention to be screened for colorectal cancer, from baseline to 4 months follow-up (p's < .001). The screening rate for colorectal cancer was significantly higher in the intervention group compared to the control group (odds ratio = 15.93, 95% CI = 5.57, 45.53). Our theory-based intervention was found to have a significant effect on colorectal cancer screening use as measured by self-report. The findings could have implications for colorectal cancer screening program development and implementation in primary health care settings and through other community organizations.

Metabolite exchange between microbiome members produces compounds that influence Drosophila behavior

PubMed Central

Fischer, Caleb N; Trautman, Eric P; Crawford, Jason M; Stabb, Eric V; Handelsman, Jo; Broderick, Nichole A

2017-01-01

Animals host multi-species microbial communities (microbiomes) whose properties may result from inter-species interactions; however, current understanding of host-microbiome interactions derives mostly from studies in which elucidation of microbe-microbe interactions is difficult. In exploring how Drosophila melanogaster acquires its microbiome, we found that a microbial community influences Drosophila olfactory and egg-laying behaviors differently than individual members. Drosophila prefers a Saccharomyces-Acetobacter co-culture to the same microorganisms grown individually and then mixed, a response mainly due to the conserved olfactory receptor, Or42b. Acetobacter metabolism of Saccharomyces-derived ethanol was necessary, and acetate and its metabolic derivatives were sufficient, for co-culture preference. Preference correlated with three emergent co-culture properties: ethanol catabolism, a distinct volatile profile, and yeast population decline. Egg-laying preference provided a context-dependent fitness benefit to larvae. We describe a molecular mechanism by which a microbial community affects animal behavior. Our results support a model whereby emergent metabolites signal a beneficial multispecies microbiome. DOI: http://dx.doi.org/10.7554/eLife.18855.001 PMID:28068220

A qualitative study exploring health perceptions and factors influencing participation in health behaviors in colorectal cancer survivors.

PubMed

Hardcastle, Sarah J; Maxwell-Smith, Chloe; Zeps, Nik; Platell, Cameron; O'Connor, Moira; Hagger, Martin S

2017-02-01

The purpose of the study was to explore colorectal cancer survivors' health perceptions following cessation of active treatment for cancer and to explore the factors influencing participation in health-promoting behaviors that may help reduce cardiovascular disease risk. Face-to-face interviews were conducted with participants that had completed active treatment for cancer within the previous 2 years. Participants were colorectal cancer survivors (N = 24, men = 11, women = 13, M age = 69.38 years, SD = 4.19) recruited from a private hospital in Perth, Australia on the basis that they had existing morbidities that put them at increased risk of cardiovascular disease. Interview transcripts were analyzed using thematic analysis. Five main themes emerged: back to normal; the pleasures in life: 'is it worth it?'; beliefs about health behavior; skepticism of eating guidelines; and lack of motivation. The majority of participants felt they were in good health and had made a full recovery. Participants questioned whether it was worth changing their lifestyle given their life stage and referred to the desire to enjoy life. Lay health beliefs, skepticism of eating guidelines, and a lack of motivation were barriers to change. Interventions should target lay beliefs and skepticism in relation to health behaviors in order to reinforce the importance and value of participating in health-related behavior. Findings may inform the development of effective, patient-centered interventions that target lay health beliefs and build motivation for health behavior change. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

The development and validation of an instrument to measure the quality of health research reports in the lay media.

PubMed

Zeraatkar, Dena; Obeda, Michael; Ginsberg, Jeffrey S; Hirsh, Jack

2017-04-20

The media serves as an important link between medical research, as reported in scholarly sources, and the public and has the potential to act as a powerful tool to improve public health. However, concerns about the reliability of health research reports have been raised. Tools to monitor the quality of health research reporting in the media are needed to identify areas of weakness in health research reporting and to subsequently work towards the efficient use of the lay media as a public health tool through which the public's health behaviors can be improved. We developed the Quality Index for health-related Media Reports (QIMR) as a tool to monitor the quality of health research reports in the lay media. The tool was developed according to themes generated from interviews with health journalists and researchers. Item and domain characteristics and scale reliability were assessed. The scale was correlated with a global quality assessment score and media report word count to provide evidence towards its construct validity. The items and domains of the QIMR demonstrated acceptable validity and reliability. Items from the 'validity' domain were negatively skewed, suggesting possible floor effect. These items were not eliminated due to acceptable content and face validity. QIMR total scores produced a strong correlation with raters' global assessment and a moderate correlation with media report word count, providing evidence towards the construct validity of the instrument. The results of this investigation indicate that QIMR can adequately measure the quality of health research reports, with acceptable reliability and validity.

A qualitative interview study exploring pregnant women’s and health professionals’ attitudes to external cephalic version

PubMed Central

2013-01-01

Background Women who have a breech presentation at term have to decide whether to attempt external cephalic version (ECV) and how they want to give birth if the baby remains breech, either by planned caesarean section (CS) or vaginal breech birth. The aim of this study was to explore the attitudes of women with a breech presentation and health professionals who manage breech presentation to ECV. Methods We carried out semi-structured interviews with pregnant women with a breech presentation (n=11) and health professionals who manage breech presentation (n=11) recruited from two hospitals in North East England. We used purposive sampling to include women who chose ECV and women who chose planned CS. We analysed data using thematic analysis, comparing between individuals and seeking out disconfirming cases. Results Four main themes emerged from the data collected during interviews with pregnant women with a breech presentation: ECV as a means of enabling natural birth; concerns about ECV; lay and professional accounts of ECV; and breech presentation as a means of choosing planned CS. Some women’s attitudes to ECV were affected by their preferences for how to give birth. Other women chose CS because ECV was not acceptable to them. Two main themes emerged from the interview data about health professionals’ attitudes towards ECV: directive counselling and attitudes towards lay beliefs about ECV and breech presentation. Conclusions Women had a range of attitudes to ECV informed by their preferences for how to give birth; the acceptability of ECV to them; and lay accounts of ECV, which were frequently negative. Most professionals described having a preference for ECV and reported directively counselling women to choose it. Some professionals were dismissive of lay beliefs about ECV. Some key challenges for shared decision making about breech presentation were identified: health professionals counselling women directively about ECV and the differences between evidence-based information about ECV and lay beliefs. To address these challenges a number of approaches will be required. PMID:23324533

Health Care Provider Initiative Strategic Plan

ERIC Educational Resources Information Center

National Environmental Education & Training Foundation, 2012

2012-01-01

This document lays out the strategy for achieving the goals and objectives of NEETF's "Health Care Provider Initiative." The goal of NEETF's "Health Care Provider Initiative" is to incorporate environmental health into health professionals' education and practice in order to improve health care and public health, with a special emphasis on…

The effect of perches in cages during pullet rearing and egg laying on hen performance, foot health, and plumage.

PubMed

Hester, P Y; Enneking, S A; Jefferson-Moore, K Y; Einstein, M E; Cheng, H W; Rubin, D A

2013-02-01

Enrichment of pullet cages with perches has not been studied. Our objective was to determine if access to metal perches during all or part of the life cycle of caged White Leghorns affected egg traits, foot health, and feather condition. Treatment 1 represented control chickens that never had access to perches during their life cycle. Treatment 2 hens had perches only during the egg laying phase of the life cycle (17 to 71 wk of age), whereas treatment 3 chickens had perches during the pullet phase (0 to 16.9 wk of age). Treatment 4 chickens always had access to perches (0 to 71 wk of age). Comparisons between chickens that always had perches with controls that never had perches showed similar performance relative to egg production, cracked eggs, egg weight, shell weight, % shell, and shell thickness. More dirty eggs occurred in laying cages with perches. Feed usage increased resulting in poorer feed efficiency in hens with perch exposure during the pullet phase with no effect during egg laying. Perches did not affect hyperkeratosis of toes and feet. The back claw at 71 wk of age broke less if hens had prior experience with perches during the pullet phase. In contrast, during egg laying, the back claw at 71 wk of age broke more due to the presence of perches in laying cages. Perches in laying cages resulted in shorter trimmed claws and improved back feather scores, but caused poorer breast and tail feather scores. In conclusion, enriching conventional cages with perches during the entire life cycle resulted in similar hen performance compared with controls. Fewer broken back claws but poorer feed efficiency occurred because of prior experience with perches as pullets. Perch presence during egg laying improved back feather scores with more trimmed nails but caused more dirty eggs, broken back claws, and poorer breast and tail feather scores. Although perches allow chickens to express their natural perching instinct, it was not without causing welfare problems.

Lay Understanding of the Causes of Binge Drinking in the United Kingdom and Australia: A Network Diagram Approach

ERIC Educational Resources Information Center

Keatley, David A.; Ferguson, Eamonn; Lonsdale, Adam; Hagger, Martin S.

2017-01-01

Binge drinking is associated with deleterious health, social and economic outcomes. This study explored the lay understanding of the causes of binge drinking in members of the general public in the United Kingdom and Australia. Participants in the United Kingdom (N = 133) and Australia (N = 102) completed a network diagram exercise requiring them…

The effect of perch access during pullet rearing and egg laying on physiological measurements of stress in 71-week-old White Leghorns

USDA-ARS?s Scientific Manuscript database

Egg laying strains of chickens have a strong motivation to perch. Providing caged chickens with perches allows them to perform their natural perching instinct and also improves their musculoskeletal health due to exercise. Little is known about the effect of perch access by hens on physiological mea...

International Cooperation in Popular Education. A Report on the Study and Work Visit to Brazil, February to April 1986.

ERIC Educational Resources Information Center

Workers Educational Association, Sunderland (England). Northern District.

Four adult educators from the North East/Brazil Project spent three months in Brazil in 1986 on "pilot" education ventures. The areas selected for collaboration were health and safety for lay officers and induction/leadership training for women. "Methods" courses were selected as the means to train lay officers as discussion…

"There are more things in heaven and earth!" How knowledge about traditional healing affects clinical practice: interviews with conventional health personnel.

PubMed

Langås-Larsen, Anette; Salamonsen, Anita; Kristoffersen, Agnete Egilsdatter; Hamran, Torunn; Evjen, Bjørg; Stub, Trine

2017-01-01

People with Sami and Norwegian background are frequent users of traditional folk medicine (TM). Traditional healing, such as religious prayers of healing (reading) and the laying on of hands, are examples of commonly used modalities. The global aim of this study is to examine whether health personnel's knowledge, attitudes and experiences of traditional healing affect their clinical practice. Semi-structured individual interviews (n=32) and focus group interviews (n=2) were conducted among health personnel in two communities in Northern Norway. The text data was transcribed verbatim and analysed based on the criteria for content analysis. Six themes were identified. The participants had acquired their knowledge of traditional healing through their childhood, adolescence and experience as health personnel in the communities. They all expressed that they were positive to the patients' use of traditional healing. They justified their attitudes, stating that "there are more things in heaven and earth" and they had faith in the placebo effects of traditional healing. The health personnel respected their patients' faith and many facilitated the use of traditional healing. In some cases, they also applied traditional healing tools if the patients asked them to do so. The health personnel were positive and open-minded towards traditional healing. They considered reading as a tool that could help the patients to handle illness in a good way. Health personnel were willing to perform traditional healing and include traditional tools in their professional toolkit, even though these tools were not documented as evidence-based treatment. In this way they could offer their patients integrated health services which were tailored to the patients' treatment philosophy.

“There are more things in heaven and earth!” How knowledge about traditional healing affects clinical practice: interviews with conventional health personnel

PubMed Central

Langås-Larsen, Anette; Salamonsen, Anita; Kristoffersen, Agnete Egilsdatter; Hamran, Torunn; Evjen, Bjørg; Stub, Trine

2017-01-01

ABSTRACT People with Sami and Norwegian background are frequent users of traditional folk medicine (TM). Traditional healing, such as religious prayers of healing (reading) and the laying on of hands, are examples of commonly used modalities. The global aim of this study is to examine whether health personnel’s knowledge, attitudes and experiences of traditional healing affect their clinical practice. Semi-structured individual interviews (n=32) and focus group interviews (n=2) were conducted among health personnel in two communities in Northern Norway. The text data was transcribed verbatim and analysed based on the criteria for content analysis. Six themes were identified. The participants had acquired their knowledge of traditional healing through their childhood, adolescence and experience as health personnel in the communities. They all expressed that they were positive to the patients’ use of traditional healing. They justified their attitudes, stating that “there are more things in heaven and earth” and they had faith in the placebo effects of traditional healing. The health personnel respected their patients’ faith and many facilitated the use of traditional healing. In some cases, they also applied traditional healing tools if the patients asked them to do so. The health personnel were positive and open-minded towards traditional healing. They considered reading as a tool that could help the patients to handle illness in a good way. Health personnel were willing to perform traditional healing and include traditional tools in their professional toolkit, even though these tools were not documented as evidence-based treatment. In this way they could offer their patients integrated health services which were tailored to the patients’ treatment philosophy. PMID:29130420

Lay people's and health professionals' views about breaking bad news to children.

PubMed

Muñoz Sastre, M T; Sorum, P C; Mullet, E

2014-01-01

Bad health news is difficult to communicate, especially when parents must give bad news to their children. We had 170 lay persons, 33 nurses and six physicians in Toulouse, France, judge the appropriateness of the parents' behaviour in 64 scenarios of parents dealing with this problem. The scenarios were composed according to a four within-subject orthogonal design: child's age (4, 6, 8 or 10), severity of disease (lethal or worrisome but curable), child's concern or not about his illness and parents' decision about communicating the news (tell nothing, minimize, tell the truth or ask the physician to tell the truth). Cluster analysis revealed four clusters, labelled 'Always Tell the Truth' (33%, including a majority of doctors and nurses), 'Tell Nothing or Minimize' (16%, with an older average age), 'Tell the Truth Except in Cases of Incurable Illness' (22%) and 'Depends on Child's Characteristics' (29%). Physicians in training and in practice need to be aware that lay people--and likely parents as well--have diverse and complex opinions about when and how parents should give bad health news to their children. © 2012 John Wiley & Sons Ltd.

Lay Health Trainers Supporting Self-Management amongst Those with Low Heath Literacy and Diabetes: Lessons from a Mixed Methods Pilot, Feasibility Study

PubMed Central

Rathod, Trishna; Rowlands, Gillian

2016-01-01

This article reports a mixed methods process evaluation of a pilot feasibility randomised controlled trial comparing a Lay Health Trainer (LHT) intervention and usual care for those with poorly controlled Type 2 Diabetes Melitus (T2DM). Set in a deprived area in the UK, this research explores patient and health care practitioner (HCP) views on whether a structured interview between a patient and a Lay Health Trainer (LHT), for the purpose of developing a tailored self-management plan for patients, is acceptable and likely to change health behaviours. In doing so, it considers the implications for a future, randomised controlled trial (RCT). Participants were patients, LHTs delivering the intervention, service managers, and practice nurses recruiting patients to the study. Patients were purposively sampled on their responses to a baseline survey, and semistructured interviews were conducted within an exploratory thematic analysis framework. Findings indicate that the intervention is acceptable to patients and HCPs. However, LHTs found it challenging to work with older patients with long-term and/or complex conditions. In order to address this, given an ageing population and concomitant increases in those with such health needs, LHT training should develop skills working with these populations. The design of any future RCT intervention should take account of this. PMID:27840834

What is healthy food? Objective nutrient profile scores and subjective lay evaluations in comparison.

PubMed

Bucher, T; Müller, B; Siegrist, M

2015-12-01

To date, it is unclear how consumers evaluate the healthiness of individual foods and meals and how consumers' perceptions are related to expert opinions. This knowledge is essential for efficient communication of nutrition information with the goal of promoting healthy eating. This study used the fake food buffet method to investigate health perceptions of selected meals and of 54 individual foods and beverages. Lay consumers' subjective healthiness evaluations of meals and foods were compared to objective nutrient profile scores, which were previously shown to correlate highly with expert opinions. The results show that nutrition profile scores and lay evaluations were highly correlated, which indicates that lay people used similar criteria as experts to evaluate the healthiness of foods. However, lay consumers tended to neglect the amount of saturated fat, protein and sodium for their judgments. Also, it was found that while lay consumers were quite able to evaluate single food products, they had difficulties in evaluating entire meals. Future interventions should focus particularly on educating the consumer about the negative effects of diets high in salt and saturated fat and they should improve the consumer's abilities to evaluate entire meals. Copyright © 2015 Elsevier Ltd. All rights reserved.

A joining of forces. The promise of community health information management systems (CHIMSs).

PubMed

Hendren, S

1993-11-01

Every time you buy a bag of Frito-Lay corn chips, information regarding your purchase becomes part of a customer database within hours. America's snack food "needs" are analyzed and decisions are made about filling the shelves of every corner convenience store in the nation with exactly the right product. This system has saved the company more than $20 million a year through increased efficiency. But when you buy a diagnostic test to identify a potentially life-threatening condition, results can remain unavailable for days. If we can bring computerized efficiencies to marketing corn chips, why aren't we doing it for healthcare? Imagine--managers of community health systems who know their customers' needs so precisely that they "fill the shelves" of local "convenience health stops" with exactly the right services to maximize the health of the customers. As a by-product, they save a few million dollars per year in costs. Managers of other industries use information technology to deliver the right product or service to customers at just the right time, to differentiate their services by adding value, to compete effectively on cost and/or quality. Many members of the healthcare industry, where only 2.6 percent of expenditures go to information systems (compared to 5 percent in manufacturing and 7 percent in banking) and where the basic unit of work--the patient record--is still a manual process, are years behind in their thinking about how information systems can make their business better.

"By working together and caring for one another we can win this fight": A qualitative exploration of a traditional healer's perspectives of care of people with epilepsy in a South African urban township in Cape Town.

PubMed

Keikelame, Mpoe Johannah; Swartz, Leslie

2018-02-01

There is a gap in knowledge about the construction of care in the Global South where biomedical care remains largely inaccessible to many people, resulting in people seeking health care from the indigenous sector of health care. As part of a larger study, in this, article we present findings from a single individual interview with an indigenous healer using a semi-structured interview guide that was based on Kleinman's Explanatory Model Framework. Key themes that emerged from the thematic analysis of our indigenous healer's audio-recorded transcribed transcript were about "care". The four overarching subthemes were the following: (i) care in the family, (ii) care in the community, (iii) care in the health system, and (iv) respondents' construction of care. A key feature of care, for this healer, is its explicit location in lineages of community - care is seen not as an individual or organizational issue, but part of the shared social fabric. We argue that it is crucial to attend to the lay understandings and practices of care which reflect diverse ways of understanding care and relationality in context. Future research is needed to close this gap. Copyright © 2017 Elsevier Inc. All rights reserved.

A cancer screening intervention for underserved Latina women by lay educators.

PubMed

Larkey, Linda K; Herman, Patricia M; Roe, Denise J; Garcia, Francisco; Lopez, A M; Gonzalez, J; Perera, Prasadini N; Saboda, Kathylynn

2012-05-01

Inadequate screening adherence for breast, cervical, and colorectal cancer among Latinas places them at greater risk for poor survival rates, once diagnosed. The purpose of this study was to examine two delivery methods of lay health educators (promotoras de salud) to increase screening behavior and evaluate costs. This community-based group randomized trial assigned Latinas due for breast, cervical, or colorectal cancer screening (n=1006) to promotora-taught cancer screening/prevention classes delivered individually (IND) or in social support groups (SSG) over 8 weeks. Screening behaviors were assessed immediately after and 3 and 15 months after intervention. Intervention costs per study arm were compared. Screening and maintenance behaviors were not significantly different between SSG and IND for any one type of cancer screening, but with a study entry requirement that participants were either never screened or due for screening, postintervention screening rates (that is, completing a screening that was due) were notable (39.4% and 45.5%, respectively). The cost of achieving any one screening was much higher for IND participants. SSG vs. IND delivery did not significantly affect cancer screening behaviors, but both interventions produced robust achievement of screenings for previously nonadherent participants. Group-based promotora-led interventions supporting social involvement are recommended as a more cost-effective approach to achieving cancer screening among Latina women.

Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective.

PubMed

Wainberg, Milton L; Scorza, Pamela; Shultz, James M; Helpman, Liat; Mootz, Jennifer J; Johnson, Karen A; Neria, Yuval; Bradford, Jean-Marie E; Oquendo, Maria A; Arbuckle, Melissa R

2017-05-01

Globally, the majority of those who need mental health care worldwide lack access to high-quality mental health services. Stigma, human resource shortages, fragmented service delivery models, and lack of research capacity for implementation and policy change contribute to the current mental health treatment gap. In this review, we describe how health systems in low- and middle-income countries (LMICs) are addressing the mental health gap and further identify challenges and priority areas for future research. Common mental disorders are responsible for the largest proportion of the global burden of disease; yet, there is sound evidence that these disorders, as well as severe mental disorders, can be successfully treated using evidence-based interventions delivered by trained lay health workers in low-resource community or primary care settings. Stigma is a barrier to service uptake. Prevention, though necessary to address the mental health gap, has not solidified as a research or programmatic focus. Research-to-practice implementation studies are required to inform policies and scale-up services. Four priority areas are identified for focused attention to diminish the mental health treatment gap and to improve access to high-quality mental health services globally: diminishing pervasive stigma, building mental health system treatment and research capacity, implementing prevention programs to decrease the incidence of mental disorders, and establishing sustainable scale up of public health systems to improve access to mental health treatment using evidence-based interventions.

Removing user fees for health services: A multi-epistemological perspective on access inequities in Senegal.

PubMed

Mladovsky, Philipa; Ba, Maymouna

2017-09-01

Plan Sésame (PS) is a user fee exemption policy launched in 2006 to provide free access to health services to Senegalese citizens aged 60 and over. Analysis of a large household survey evaluating PS echoes findings of other studies showing that user fee removal can be highly inequitable. 34 semi-structured interviews and 19 focus group discussions with people aged 60 and over were conducted in four regions in Senegal (Dakar, Diourbel, Matam and Tambacounda) over a period of six months during 2012. They were analysed to identify underlying causes of exclusion from/inclusion in PS and triangulated with the household survey. The results point to three steps at which exclusion occurs: (i) not being informed about PS; (ii) not perceiving a need to use health services under PS; and (iii) inability to access health services under PS, despite having the information and perceived need. We identify lay explanations for exclusion at these different steps. Some lay explanations point to social exclusion, defined as unequal power relations. For example, poor access to PS was seen to be caused by corruption, patronage, poverty, lack of social support, internalised discrimination and adverse incorporation. Other lay explanations do not point to social exclusion, for example: poor implementation; inadequate funding; high population demand; incompetent bureaucracy; and PS as a favour or moral obligation to friends or family. Within a critical realist paradigm, we interpret these lay explanations as empirical evidence for the presence of the following hidden underlying causal mechanisms: lacking capabilities; mobilisation of institutional bias; and social closure. However, social constructionist perspectives lead us to critique this paradigm by drawing attention to contested health, wellbeing and corruption discourses. These differences in interpretation lead to subsequent differential policy recommendations. This demonstrates the need for the adoption of a "multi-epistemological" perspective in studies of health inequity and social exclusion. Copyright © 2017 Elsevier Ltd. All rights reserved.

Rewarding altruism: addressing the issue of payments for volunteers in public health initiatives.

PubMed

South, Jane; Purcell, Martin E; Branney, Peter; Gamsu, Mark; White, Judy

2014-03-01

Lay involvement in public health programmes occurs through formalised lay health worker (LHW) and other volunteer roles. Whether such participation should be supported, or indeed rewarded, by payment is a critical question. With reference to policy in England, UK, this paper argues how framing citizen involvement in health only as time freely given does not account for the complexities of practice, nor intrinsic motivations. The paper reports results on payment drawn from a study of approaches to support lay people in public health roles, conducted in England, 2007-9. The first phase of the study comprised a scoping review of 224 publications, three public hearings and a register of projects. Findings revealed the diversity of approaches to payment, but also the contested nature of the topic. The second phase investigated programme support matters in five case studies of public health projects, which were selected primarily to reflect role types. All five projects involved volunteers, with two utilising forms of payment to support engagement. Interviews were conducted with a sample of project staff, LHWs (paid and unpaid), external partners and service users. Drawing on both lay and professional perspectives, the paper explores how payment relates to social context as well as various motivations for giving, receiving or declining financial support. The findings show that personal costs are not always absorbed, and that there is a potential conflict between financial support, whether sessional payment or expenses, and welfare benefits. In identifying some of the advantages and disadvantages of payment, the paper highlights the complexity of an issue often addressed only superficially. It concludes that, in order to support citizen involvement, fairness and value should be considered alongside pragmatic matters of programme management; however policy conflicts need to be resolved to ensure that employment and welfare rights are maintained. Copyright © 2013 Elsevier Ltd. All rights reserved.

Treatment of Posttraumatic Stress Disorder by Trained Lay Counselors in an African Refugee Settlement: A Randomized Controlled Trial

ERIC Educational Resources Information Center

Neuner, Frank; Onyut, Patience Lamaro; Ertl, Verena; Odenwald, Michael; Schauer, Elisabeth; Elbert, Thomas

2008-01-01

Traumatic stress due to conflict and war causes major mental health problems in many resource-poor countries. The objective of this study was to examine whether trained lay counselors can carry out effective treatment of posttraumatic stress disorder (PTSD) in a refugee settlement. In a randomized controlled dissemination trial in Uganda with 277…

Co-producing public involvement training with members of the public and research organisations in the East Midlands: creating, delivering and evaluating the lay assessor training programme.

PubMed

Horobin, Adele; Brown, George; Higton, Fred; Vanhegan, Stevie; Wragg, Andrew; Wray, Paula; Walker, Dawn-Marie

2017-01-01

Members of the public share their views with researchers to improve health and social care research. Lay assessing is one way of doing this. This is where people, drawing upon personal and general life experience, comment on material, such as grant applications and patient information, to highlight strengths and weaknesses and to suggest improvements. This paper reports on setting up a training programme for lay assessors. Meetings were held between interested public and staff from research organisations. People discussed what lay assessing is, why they want to do it, skills and support needed and if training was wanted. They were invited to form a group to develop the training together. Training was delivered in the East Midlands. People who attended gave their thoughts about it by completing questionnaires and joining a feedback event. The group developed the structure of the training programme together and it oversaw the development of the training content by individual members. People who attended training reported feeling more confident about lay assessing. This was particularly so for those who had not done lay assessing before. They indicated how valuable it was to talk with others at the training. Our findings support the National Institute for Health Research recommendations for improving learning and development for public involvement in research. This project has created a solid base for local research organisations to work together in public involvement training. Lay assessor training is now part of a wider programme of shared resources called the Sharebank. Background Involving members of the public in research can improve its quality and incorporate the needs and views of patients. One method for doing this is lay assessing, where members of the public are consulted to improve research materials. This paper documents the establishment of a pilot training programme for lay assessors. It describes a way of working that embodies a regional, cross-organisational approach to co-producing training with members of the public. Methods Open meetings, led by AH, were held for existing and aspiring lay assessors to define lay assessing, motivations for doing it, skills required, associated learning and development needs, and to gauge interest for training. Those who attended meetings, including members of the public and staff, were invited to form a working group to co-produce the training programme. Training was delivered in modules at two centres in the East Midlands and evaluated through participant feedback at the end of each module and at an evaluation event. Feedback was through a mix of Likert scale scoring, open text and verbal responses. Results Discussions from the open meetings informed the development of the training by the working group. Led by AH, the working group, as a whole, co-produced the structure and format of the training and oversaw training content development by individuals within the group. Training was well-received by participants. Feedback through Likert scoring ( n  = 14) indicated higher feelings of confidence in knowledge of relevant subject matter and in fulfilling the lay assessor role, particularly amongst those who had not done lay assessing before. Opportunities that the training afforded for interaction between participants - sharing of varied experiences and knowledge - and a 'learn by doing' approach was of particular value, as indicated by 10 responses to open-ended questions. Conclusions This project has created a solid foundation for collaboration between research organisations in the East Midlands in devising and delivering training in public involvement together. Our evaluation provides evidence in support of National Institute for Health Research (NIHR) recommendations on principles for learning and development for public involvement in research.

A Natural Language Processing System That Links Medical Terms in Electronic Health Record Notes to Lay Definitions: System Development Using Physician Reviews

PubMed Central

Druhl, Emily; Polepalli Ramesh, Balaji; Houston, Thomas K; Brandt, Cynthia A; Zulman, Donna M; Vimalananda, Varsha G; Malkani, Samir; Yu, Hong

2018-01-01

Background Many health care systems now allow patients to access their electronic health record (EHR) notes online through patient portals. Medical jargon in EHR notes can confuse patients, which may interfere with potential benefits of patient access to EHR notes. Objective The aim of this study was to develop and evaluate the usability and content quality of NoteAid, a Web-based natural language processing system that links medical terms in EHR notes to lay definitions, that is, definitions easily understood by lay people. Methods NoteAid incorporates two core components: CoDeMed, a lexical resource of lay definitions for medical terms, and MedLink, a computational unit that links medical terms to lay definitions. We developed innovative computational methods, including an adapted distant supervision algorithm to prioritize medical terms important for EHR comprehension to facilitate the effort of building CoDeMed. Ten physician domain experts evaluated the user interface and content quality of NoteAid. The evaluation protocol included a cognitive walkthrough session and a postsession questionnaire. Physician feedback sessions were audio-recorded. We used standard content analysis methods to analyze qualitative data from these sessions. Results Physician feedback was mixed. Positive feedback on NoteAid included (1) Easy to use, (2) Good visual display, (3) Satisfactory system speed, and (4) Adequate lay definitions. Opportunities for improvement arising from evaluation sessions and feedback included (1) improving the display of definitions for partially matched terms, (2) including more medical terms in CoDeMed, (3) improving the handling of terms whose definitions vary depending on different contexts, and (4) standardizing the scope of definitions for medicines. On the basis of these results, we have improved NoteAid’s user interface and a number of definitions, and added 4502 more definitions in CoDeMed. Conclusions Physician evaluation yielded useful feedback for content validation and refinement of this innovative tool that has the potential to improve patient EHR comprehension and experience using patient portals. Future ongoing work will develop algorithms to handle ambiguous medical terms and test and evaluate NoteAid with patients. PMID:29358159

Community perspectives on dengue transmission in the city of Dhaka, Bangladesh.

PubMed

Dhar-Chowdhury, Parnali; Emdad Haque, C; Michelle Driedger, S; Hossain, Shakhawat

2014-12-01

The recurrence of dengue has become a growing public health threat. This research examines the knowledge, beliefs, attitudes and practice of local community members regarding dengue transmission in the city of Dhaka, Bangladesh. It also investigates explanatory demographic and socioeconomic factors that affect community knowledge, beliefs and practices. In July-August 2011, a random sample of household heads or alternatives (n=300) was surveyed in 12 wards of Dhaka. This survey was supplemented by 12 focus group discussions (n=107) and 18 key informant interviews in three selected wards. Most community members had heard about dengue (91.3%; 274/300) and knew (93.7%; 281/300) that mosquitoes act as the primary vector of its transmission. In contrast, most (87.3%; 262/300) was unaware that Aedes mosquitoes prefer to lay their eggs in water containers. Multivariate logistic regression modeling revealed that the respondents in age group 45-60 years were 2.83 times more likely to have positive attitudes towards undertaking precautionary measures to prevent dengue than the respondents aged <25 years. These findings confirm the presence in local communities of misconceptions and considerable knowledge gaps about dengue transmission that could be improved by formulating interventions targeting specific subgroups of the population. © The Author 2014. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Lay health educators and print materials for the promotion of colorectal cancer screening among Korean Americans: A randomized comparative effectiveness study.

PubMed

Jo, Angela M; Nguyen, Tung T; Stewart, Susan; Sung, Min J; Gildengorin, Ginny; Tsoh, Janice Y; Tong, Elisa K; Lo, Penny; Cuaresma, Charlene; Sy, Angela; Lam, Hy; Wong, Ching; Jeong, Matthew; Chen, Moon S; Kagawa-Singer, Marjorie

2017-07-15

Colorectal cancer (CRC) is the second most commonly diagnosed cancer among Korean American men and women. Although CRC screening is effective in reducing the burden of this disease, studies have shown that Korean Americans have low screening rates. The authors conducted a 2-arm cluster randomized controlled trial comparing a brochure (print) with a brochure and lay health educator (LHE) outreach (print + LHE) in increasing CRC screening rates among Korean American individuals. Self-administered written surveys at baseline and at 6 months assessed knowledge of CRC and its screening, ever screening, and being up to date with screening. A total of 28 LHEs recruited 348 participants aged 50 to 75 years from their social networks. Significant percentages of participants reported not having health insurance (29.3%) or a usual source of care (35.6%). At 6 months postintervention, the print + LHE participants had a greater increase in knowledge compared with those in the print arm (P = .0013). In multivariable analyses, both groups had significant increases in ever screening (print plus LHE: odds ratio [OR], 1.60 [95% confidence interval (95% CI), 1.26-2.03] and print: OR, 1.42 [95% CI, 1.10-1.82]) and being up to date with screening (print plus LHE: OR, 1.63 [95% CI, 1.23-2.16] and print: OR, 1.40 [95% CI, 1.04-1.89]). However, these increases did not differ significantly between the study arms. Having insurance and having seen a provider within the past year were found to be positively associated with screening. Compared with a brochure, LHE outreach yielded greater increases in knowledge but resulted in similar increases in CRC screening in a Korean American population with barriers to health care access. More work is needed to appropriately address logistical and system barriers in this community. Cancer 2017;123:2705-15. © 2017 American Cancer Society. © 2017 American Cancer Society.

Wound closure with Karydakis flap is decreasing the perioperative costs after pilonidal sinus excision as compared to lay-open approach.

PubMed

Borel, F; Gaudin, C; Duchalais, E; Lehur, P-A; Meurette, G

2017-12-01

To assess the impact of a simple flap closing procedure by Karydakis flap (KF) after pilonidal sinus excision on the costs and healing time as compared to routine lay-open technique. Out of 44 consecutive patients operated on for pilonidal excision (November 2013-March 2015), 17 had a Karydakis flap and 27 a lay-open procedure. For each patient, the length of stay, the operating time (OT), the time needed for complete healing and postoperative care resources were recorded. The global costs included OT, nursing care quantity, and modalities until complete scar healing. One reoperation in the lay-open group was necessary during the follow-up (8±5months). No recurrence occurred. Postoperative morbidity was similar in both groups. Results showed that KF global cost was inferior as compared to lay-open technique (941±178€ vs. 1601±399€; P=0.0001), KF healed faster (32±17 vs. 59±22days; P=0.0001), whereas OT was longer in KF group (16±7 vs. 25±4min; P=0.001). KF allows a faster healing time and a 41% lower cost than lay-open technique. Preferential use of KF rather than lay-open procedure could allow a significant health cost saving. Copyright © 2017. Published by Elsevier Masson SAS.

Increasing Cervical Cancer Screening Among US Hispanics/Latinas: A Qualitative Systematic Review

PubMed Central

Mann, Lilli; Foley, Kristie L.; Tanner, Amanda E.; Sun, Christina J.; Rhodes, Scott D.

2014-01-01

Purpose Hispanic/Latina women experience the highest cervical cancer incidence rates of any racial/ethnic group in the United States (US), and tend to present with more severe cases and experience higher mortality compared to most other populations. The goal of this qualitative systematic review was to explore existing interventions to increase cervical cancer screening among US Hispanics/Latinas and to identify characteristics of effective interventions and research gaps. Materials and Methods Six online databases were searched from their inception through June 30, 2013, using designated search terms and keywords. Peer-reviewed articles that documented an intervention designed to improve screening for cervical cancer among Hispanics/Latinas ages 18 years and older living in the US were reviewed. Data were abstracted using a standardized form to document intervention characteristics and results. Results Forty-five articles, describing 32 unique interventions, met inclusion criteria. Identified interventions consisted primarily of educational programs and/or provision of screening. Interventions used lay health advisors (LHAs), clinic-based outreach/delivery strategies, partnerships with churches, and mass media campaigns. Twelve interventions resulted in significant increases in cervical cancer screening rates. Conclusions Interventions developed utilizing theory, applying community-based participatory research approaches, and using lay health advisors were identified as having the greatest potential for improving cervical cancer screening among Hispanics/Latinas. There continues to be a need for the development of interventions in geographic areas with new and emerging Hispanic/Latino populations and that are comprehensive, follow participants for longer periods of time, and broaden the roles and build the capacities of LHAs. PMID:25154515

Fair reckoning: a qualitative investigation of responses to an economic health resource allocation survey.

PubMed

Giacomini, Mita; Hurley, Jeremiah; DeJean, Deirdre

2014-04-01

To investigate how participants in an economic resource allocation survey construct notions of fairness. Qualitative interview study guided by interpretive grounded theory methods. Qualitative interviews were conducted with volunteer university- (n=39) and community-based (n =7) economic survey participants. INTERVENTION OR MAIN VARIABLES STUDIED: We explored how participants constructed meanings to guide or explain fair survey choices, focusing on rationales, imagery and additional desired information not provided in the survey scenarios. Data were transcribed and coded into qualitative categories. Analysis iterated with data collection iterated through three waves of interviews. Participants compared the survey dilemmas to domains outside the health system. Most compared them with other micro-level, inter-personal sharing tasks. Participants raised several fairness-relevant factors beyond need or capacity to benefit. These included age, weight, poverty, access to other options and personal responsibility for illness; illness duration, curability or seriousness; life expectancy; possibilities for sharing; awareness of other's needs; and ability to explain allocations to those affected. They also articulated a fairness principle little considered by equity theories: that everybody must get something and nobody should get nothing. Lay criteria for judging fairness are myriad. Simple scenarios may be used to investigate lay commitments to abstract principles. Although principles are the focus of analysis and inference, participants may solve simplified dilemmas by imputing extraneous features to the problem or applying unanticipated principles. These possibilities should be taken into account in the design of resource allocation surveys eliciting the views of the public. © 2012 John Wiley & Sons Ltd.

The effect of leprotic infection on the risk of death in medieval rural Denmark.

PubMed

Kelmelis, K Saige; Price, Michael Holton; Wood, Jim

2017-12-01

Paleopathological studies of leprosy in Danish skeletal collections show that many individuals suffered from this stigmatized disease during the Middle Ages. This study examines the risk of death associated with leprotic infection in individuals from the Danish rural cemetery of Øm Kloster (AD 1172-1536). Specifically, we modeled the influence of leprotic infection on age-specific mortality accounting also for sex and social status (lay person / monastic). The sample consisted of 311 adult individuals from the Øm Kloster skeletal collection housed at the Institute of Forensic Medicine, University of Southern Denmark (ADBOU). We modeled morbidity and mortality using a three-state illness-death model with the following parameterizations for the three transition hazards: (1) nonlesioned to lesioned: constant; (2) nonlesioned to dead: Gompertz-Makeham; and (3) lesioned to dead: Gompertz-Makeham, directly proportional to the hazard of the well to dead transition. The mortality hazard of lesioned individuals exceeded that of nonlesioned individuals by a factor of 1.4 (40%) across all individuals, 1.7 for females, 1.0 for males, 1.3 for lay persons, and 1.7 for monastics. Overall, 15% of the sample died with skeletal manifestations of leprosy, though it is likely that a higher percentage of the population carried the bacterium. This study improves understanding of past health and population dynamics focusing on a chronic infectious disease. The methods employed could informatively be applied to larger analyses of community health from skeletal collections by incorporating more than one disease into the multistate model and inferring individual frailty using various skeletal markers. © 2017 Wiley Periodicals, Inc.

Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: integrating scalable psychological interventions in eight countries.

PubMed

Sijbrandij, Marit; Acarturk, Ceren; Bird, Martha; Bryant, Richard A; Burchert, Sebastian; Carswell, Kenneth; de Jong, Joop; Dinesen, Cecilie; Dawson, Katie S; El Chammay, Rabih; van Ittersum, Linde; Jordans, Mark; Knaevelsrud, Christine; McDaid, David; Miller, Kenneth; Morina, Naser; Park, A-La; Roberts, Bayard; van Son, Yvette; Sondorp, Egbert; Pfaltz, Monique C; Ruttenberg, Leontien; Schick, Matthis; Schnyder, Ulrich; van Ommeren, Mark; Ventevogel, Peter; Weissbecker, Inka; Weitz, Erica; Wiedemann, Nana; Whitney, Claire; Cuijpers, Pim

2017-01-01

The crisis in Syria has resulted in vast numbers of refugees seeking asylum in Syria's neighbouring countries as well as in Europe. Refugees are at considerable risk of developing common mental disorders, including depression, anxiety, and posttraumatic stress disorder (PTSD). Most refugees do not have access to mental health services for these problems because of multiple barriers in national and refugee specific health systems, including limited availability of mental health professionals. To counter some of challenges arising from limited mental health system capacity the World Health Organization (WHO) has developed a range of scalable psychological interventions aimed at reducing psychological distress and improving functioning in people living in communities affected by adversity. These interventions, including Problem Management Plus (PM+) and its variants, are intended to be delivered through individual or group face-to-face or smartphone formats by lay, non-professional people who have not received specialized mental health training, We provide an evidence-based rationale for the use of the scalable PM+ oriented programmes being adapted for Syrian refugees and provide information on the newly launched STRENGTHS programme for adapting, testing and scaling up of PM+ in various modalities in both neighbouring and European countries hosting Syrian refugees.

Strengthening mental health care systems for Syrian refugees in Europe and the Middle East: integrating scalable psychological interventions in eight countries

PubMed Central

Sijbrandij, Marit; Acarturk, Ceren; Bird, Martha; Bryant, Richard A; Burchert, Sebastian; Carswell, Kenneth; de Jong, Joop; Dinesen, Cecilie; Dawson, Katie S.; El Chammay, Rabih; van Ittersum, Linde; Jordans, Mark; Knaevelsrud, Christine; McDaid, David; Miller, Kenneth; Morina, Naser; Park, A-La; Roberts, Bayard; van Son, Yvette; Sondorp, Egbert; Pfaltz, Monique C.; Ruttenberg, Leontien; Schick, Matthis; Schnyder, Ulrich; van Ommeren, Mark; Ventevogel, Peter; Weissbecker, Inka; Weitz, Erica; Wiedemann, Nana; Whitney, Claire; Cuijpers, Pim

2017-01-01

ABSTRACT The crisis in Syria has resulted in vast numbers of refugees seeking asylum in Syria’s neighbouring countries as well as in Europe. Refugees are at considerable risk of developing common mental disorders, including depression, anxiety, and posttraumatic stress disorder (PTSD). Most refugees do not have access to mental health services for these problems because of multiple barriers in national and refugee specific health systems, including limited availability of mental health professionals. To counter some of challenges arising from limited mental health system capacity the World Health Organization (WHO) has developed a range of scalable psychological interventions aimed at reducing psychological distress and improving functioning in people living in communities affected by adversity. These interventions, including Problem Management Plus (PM+) and its variants, are intended to be delivered through individual or group face-to-face or smartphone formats by lay, non-professional people who have not received specialized mental health training, We provide an evidence-based rationale for the use of the scalable PM+ oriented programmes being adapted for Syrian refugees and provide information on the newly launched STRENGTHS programme for adapting, testing and scaling up of PM+ in various modalities in both neighbouring and European countries hosting Syrian refugees. PMID:29163867

Unplanned health care tourism.

PubMed

Powell, Suzanne K

2015-01-01

Health care tourism is often a preplanned event carefully laying out all the details. Sometimes, when one least expects it, medical care is needed outside of the mainland. This Editorial speaks to an unplanned experience.

Human trafficking and exploitation: A global health concern.

PubMed

Zimmerman, Cathy; Kiss, Ligia

2017-11-01

In this collection review, Cathy Zimmerman and colleague introduce the PLOS Medicine Collection on Human Trafficking, Exploitation and Health, laying out the magnitude of the global trafficking problem and offering a public health policy framework to guide responses to trafficking.

Scientific strategy and ad hoc response: the problem of typhoid in America and England, C. 1910-50.

PubMed

Hardy, Anne

2014-01-01

In the early twentieth century, death rates from typhoid in European cities reached an all time low. By contrast, death rates in America were six times as high, and the American public health community began a crusade against the disease in 1912. In the 1920s, hopes for greater control of the disease focused not just on sewers and drinking water supplies, but on the newly established scientific means of immunization, the supervision of food-related pathways of infection, and the management of healthy carriers. The management of carriers, which lay at the core of any typhoid control program, proved an intractable problem, and typhoid remained a public health concern. America and England both struggled with control of the disease during the interwar period. Coming from different starting points, however, their approaches to the problem differed. This paper compares and contrasts these different public health strategies, considers the variable quality of support provided by bacteriological laboratories, and demonstrates that "accidental" typhoid outbreaks continued to happen up to the outbreak of World War II.

In Defense of Flossing: Part II-Can We Agree It's Premature to Claim Flossing Is Ineffective to Help Prevent Periodontal Diseases?

PubMed

Vernon, Lance T; Da Silva, Andre Paes B; Seacat, Jason D

2017-09-01

Periodontal diseases are complex, multifactorial disorders. Effective daily plaque control promotes gingival/periodontal health. Recent meta-analyses and other reviews have found inconclusive evidence to support that tooth flossing promotes gingival/periodontal health. Ideally, the claim should have been that, "at present, we do not have high-quality evidence from well-designed randomized clinical trials to determine whether flossing lowers the risk for periodontal diseases." Rather than "not proven to be effective," the lay public may now think that flossing is "almost entirely unhelpful and/or unnecessary." How does the dental community communicate the nuances of this topic? Herein, we examine the key structural issues underlying this area of research. We assert that effective flossing between specific teeth can promote gingival/periodontal health. Furthermore, we explore the nuances for whom this may be true and untrue, why our evidence is lacking, and what can be done to clarify the effectiveness of flossing on clinical outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

"How the other half live": Lay perspectives on health inequalities in an age of austerity.

PubMed

Garthwaite, Kayleigh; Bambra, Clare

2017-08-01

This paper examines how people living in two socially contrasting areas of Stockton on Tees, North East England experience, explain, and understand the stark health inequalities in their town. Participants displayed opinions that fluctuated between a variety of converging and contrasting explanations. Three years of ethnographic observation in both areas (2014-2017) generated explanations which initially focused closely on behavioural and individualised factors, whilst 118 qualitative interviews subsequently revealed more nuanced justifications, which prioritised more structural, material and psychosocial influences. Findings indicate that inequalities in healthcare, including access, the importance of judgemental attitudes, and perceived place stigma, would then be offered as explanations for the stark gap in spatial inequalities in the area. Notions of fatalism, linked to (a lack of) choice, control, and fear of the future, were common reasons given for inequalities across all participants. We conclude by arguing for a prioritisation of listening to, and working to understand, the experiences of communities experiencing the brunt of health inequalities; especially important at a time of austerity. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Structural Barriers to Diagnosis and Treatment of Cancer in Low- and Middle-Income Countries: The Urgent Need for Scaling Up

PubMed Central

Magrath, Ian; Kingham, T. Peter; Elzawawy, Ahmed

2016-01-01

Noncommunicable diseases are now recognized by the United Nations and WHO as a major public health crisis. Cancer is a main part of this problem, and health care systems are facing a great challenge to improve cancer care, control costs, and increase systems efficiency. The disparity in access to care and outcomes between high-income countries and low- and middle-income countries is staggering. The reasons for this disparity include cost, access to care, manpower and training deficits, and a lack of awareness in the lay and medical communities. Diagnosis and treatment play an important role in this complex environment. In different regions and countries of the world, a variety of health care systems are in place, but most of them are fragmented or poorly coordinated. The need to scale up cancer care in the low- and middle-income countries is urgent, and this article reviews many of the structural mechanisms of the problem, describes the current situation, and proposes ways for improvement. The organization of cancer services is also included in the analysis. PMID:26578618

A cluster randomised controlled trial of a manualised cognitive behavioural anger management intervention delivered by supervised lay therapists to people with intellectual disabilities.

PubMed

Willner, P; Rose, J; Jahoda, A; Stenfert Kroese, B; Felce, D; MacMahon, P; Stimpson, A; Rose, N; Gillespie, D; Shead, J; Lammie, C; Woodgate, C; Townson, J K; Nuttall, J; Cohen, D; Hood, K

2013-05-01

Anger is a frequent problem for many people with intellectual disabilities, and is often expressed as verbal and/or physical aggression. Cognitive-behaviour therapy (CBT) is the treatment of choice for common mental health problems, but CBT has only recently been adapted for people with intellectual disabilities. Anger is the main psychological presentation in which controlled trials have been used to evaluate CBT interventions for people with intellectual disabilities but these do not include rigorous randomised studies. To evaluate (1) the impact of a staff-delivered manualised CBT anger management intervention on (a) reported anger among people with mild to moderate intellectual disabilities, and (b) anger coping skills, aggression, mental health, quality of life and costs of health and social care; (2) factors that influence outcome; and (3) the experience of service users, lay therapists and service managers. A cluster randomised controlled trial based on 30 day centres (15 intervention and 15 control). Intention-to-treat comparisons of outcomes used a two-level linear regression model to allow for clustering within centres with baseline outcome levels as a covariate. Comparison of cost data used non-parametric bootstrapping. Qualitative analysis used interpretative phenomenological analysis and thematic analysis. Recruited day centres had four-plus service users with problem anger who were prepared to participate, two-plus staff willing to be lay therapists, a supportive manager and facilities for group work, and no current anger interventions. A total of 212 service users with problem anger were recruited. Thirty-three were deemed ineligible (30 could not complete assessments and three withdrew before randomisation). Retention at follow-up was 81%, with 17 withdrawals in each arm. Two to four staff per centre were recruited as lay therapists. Eleven service users, nine lay therapists and eight managers were interviewed. The manualised intervention comprised 12 weekly 2-hour group sessions supplemented by 'homework'. Lay therapists received training and ongoing supervision from a clinical psychologist. Treatment fidelity, group attendance and resources used in intervention delivery were monitored. The primary outcome was the service user-rated Provocation Index (PI), a measure of response to hypothetical situations that may provoke anger. Secondary trial outcomes were the key worker-rated PI; the service user- and key worker-rated Profile of Anger Coping Skills (PACS); the service user-rated PACS imaginal provocation test (PACS-IPT), a measure of response to actual situations known to provoke anger; aggression; mental health; self-esteem; quality of life; and health and social care resource use. Assessments were administered before randomisation and at 16 weeks and 10 months after randomisation. Fourteen treatment groups were delivered, each with 12 sessions lasting an average of 114 minutes, with a mean of 4.9 service users and 2.0 lay therapists. The mean hourly cost per service user was £ 25.26. The mean hourly excess cost over treatment as usual was £ 12.34. There was no effect of intervention on the primary outcome - self-rated PI. There was a significant impact on the following secondary outcomes at the 10-month follow-up: key worker-rated PI, self-rated PACS-IPT and self- and key worker-rated PACS. Key workers and home carers reported significantly lower aggression at 16 weeks, but not at 10 months. There was no impact on mental health, self-esteem, quality of life or total cost of health and social care. Service users, key workers and service managers were uniformly positive. The intervention was effective at changing anger coping skills and staff-rated anger. Impact on self-rated anger was equivocal. With hindsight there are reasons, from an analysis of factors influencing outcomes, to think that self-rated PI was not a well-chosen primary outcome. Widespread implementation of manualised lay therapist-led but psychologist-supervised anger management CBT for people with mild to moderate intellectual disabilities is recommended.

Effects of taurine and housing density on renal function in laying hens*

PubMed Central

Ma, Zi-li; Gao, Yang; Ma, Hai-tian; Zheng, Liu-hai; Dai, Bin; Miao, Jin-feng; Zhang, Yuan-shu

2016-01-01

This study investigated the putative protective effects of supplemental 2-aminoethane sulfonic acid (taurine) and reduced housing density on renal function in laying hens. We randomly assigned fifteen thousand green-shell laying hens into three groups: a free range group, a low-density caged group, and a high-density caged group. Each group was further divided equally into a control group (C) and a taurine treatment group (T). After 15 d, we analyzed histological changes in kidney cells, inflammatory mediator levels, oxidation and anti-oxidation levels. Experimental data revealed taurine supplementation, and rearing free range or in low-density housing can lessen morphological renal damage, inflammatory mediator levels, and oxidation levels and increase anti-oxidation levels. Our data demonstrate that taurine supplementation and a reduction in housing density can ameliorate renal impairment, increase productivity, enhance health, and promote welfare in laying hens. PMID:27921400

Cultivating Global Competencies in Costa Rica: One Community College's Innovative Approach to Taking Early Childhood Education Global

ERIC Educational Resources Information Center

Delafield, Julia

2018-01-01

Giving an immersive global experience to preservice early childhood educators lays the foundation for building their global competencies and thereby helping them provide their own students with 21st century skills.

The effect of grapefruit juice on drug disposition

USDA-ARS?s Scientific Manuscript database

Since their initial discovery in 1989, grapefruit juice-drug interactions have received extensive interest from the scientific, medical, regulatory, and lay communities. Although knowledge regarding the effects of grapefruit juice on drug disposition continues to expand, the list of drugs studied in...

Lay perceptions of current and future health, the causes of illness, and the nature of recovery: explaining health and illness in Malaysia.

PubMed

Swami, Viren; Arteche, Adriane; Chamorro-Premuzic, Tomas; Maakip, Ismail; Stanistreet, Debbi; Furnham, Adrian

2009-09-01

This study examined beliefs about the causes and determinants of health, illness, and recovery in an opportunistic sample from Malaysia. In all, 371 women and 350 men completed the Health and Illness Scale, a 124-item scale that examined beliefs about current and future health, and beliefs about the causes of illness and recovery. Each of the four subscales of the Health Illness Scale were factor analysed to reveal the underlying structure. Results showed the emergence of a number of distinct factors in the case of each subscale, of which environmental, life-style, psychological, religious, and fate-related factors were fairly stable across subscales. Results also showed a number of differences in beliefs between religious groups, and that religiosity and sex were the strongest predictors of beliefs across the four subscales. The results are discussed in terms of the available cross-cultural literature on lay beliefs about health.

Exploring the Role of Community Health Workers in Providing Cancer Navigation: Perceptions of African American Older Adults

PubMed Central

Wenzel, Jennifer; Jones, Randy; Klimmek, Rachel; Szanton, Sarah; Krumm, Sharon

2013-01-01

Purpose/Objectives To obtain experiential data regarding African American older adult survivors’ perceptions of and recommendations on the role of community health workers (CHWs) in providing a cancer navigation intervention. Research Approach Focus groups. Setting Rural Virginia and urban Maryland. Participants 48 African American solid-tumor cancer survivors, aged 65 years or older, with Medicare insurance. Methodologic Approach Analysis was accomplished through a reflexive process of transcript review, categorization, and interpretation. Findings Themes and accompanying categories identified were uneasiness surrounding the CHW role (disconnect between identified support needs and CHW role, essential CHW characteristics, and potential application of CHWs), recommendations to adequately address cancer needs (coordinating cancer treatment and unmet needs during cancer), and the importance of individualized interventions. Participants provided specific recommendations regarding the role of the CHW and how to develop supportive interventions. Conclusions Study participants had surprisingly limited prior exposure to the CHW role. However, they stated that, in certain circumstances, CHWs could effectively assist older adult African Americans undergoing cancer diagnosis or treatment. Interpretation Study findings can be helpful to researchers and to healthcare providers engaged in assisting older African Americans during cancer diagnosis and treatment. The results lay a foundation for developing culturally appropriate interventions to assist this at-risk population. PMID:22543400

Lay-screeners and use of WHO growth standards increase case finding of hospitalized Malawian children with severe acute malnutrition.

PubMed

LaCourse, Sylvia M; Chester, Frances M; Preidis, Geoffrey; McCrary, Leah M; Maliwichi, Madalitso; McCollum, Eric D; Hosseinipour, Mina C

2015-02-01

Strategies to effectively identify and refer children with severe acute malnutrition (SAM) to Nutritional Rehabilitation units (NRU) can reduce morbidity and mortality. From December 2011 to May 2012, we conducted a prospective study task-shifting inpatient malnutrition screening of Malawian children 6-60 months to lay-screeners and evaluated World Health Organization (WHO) criteria vs. the National Center for Health Statistics (NCHS) guidelines for SAM. Lay-screeners evaluated 3116 children, identifying 368 (11.8%) with SAM by WHO criteria, including 210 (6.7%) who met NCHS criteria initially missed by standard clinician NRU referrals. Overall case finding increased by 56.7%. Mid-upper arm circumference (MUAC) and bipedal edema captured 86% (181/210) NCHS/NRU-eligible children and 89% of those who died (17/19) meeting WHO criteria. Mortality of NCHS/NRU-eligible children was 10 times greater than those without SAM (odds ratio 10.5, 95% confidence interval 5.4-20.6). Ward-based lay-screeners and WHO guidelines identified high-risk children with SAM missed by standard NRU referral. MUAC and edema detected the majority of NRU-eligible children. © The Author [2014]. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Emotional wellbeing and mental health: an exploration into health promotion in young people and families.

PubMed

Coverdale, Gillian E; Long, Andrew F

2015-01-01

Promoting mental health and emotional wellbeing (EWB) in children and young people (YP) is vitally important for their psycho-social development. Critical review of the literature reveals a dearth of research that has explored the perspective of the child, adolescent or adult in this concept, with much research being intervention focused and promoted at crisis level. The current study aims to address this gap in understanding of young persons' and parents' perspectives. A small-scale, exploratory qualitative study was conducted with YP, and parents of YP aimed at exploring the meaning of EWB and how it could be promoted. Data were collected via focus groups with 15 YP (aged 18-24 years) and 15 interviews with parents of a different group of YP. Study participants identified key constructs for good EWB as stability, coping ability, happiness, confidence, balance, empathy and being grounded. Feeling comfortable with self, managing and controlling emotions and having the confidence to persevere with challenges were all felt to contribute to a positive sense of EWB. Sources of support were overwhelmingly cited as family and friends, with schools identified as a potentially good environment for supporting and promoting the EWB of pupils. Participants stressed the need for a positive attitude change towards YP, advocating this as promoting a sense of belonging and community citizenship. A lay-informed 'recipe' for successful EWB promotion is drawn out, centred on the core goal of raising awareness and understanding of YP's EWB, in the YP themselves, their parents, schools and the wider community. This research provides key messages for society, policy makers, education and public health and healthcare practitioners for integration into the delivery of services for YP and families that include education on supporting EWB, activities for YP and a multi-agency approach to supporting families within the community. © Royal Society for Public Health 2014.

Does the use of psychiatrists as sources of information improve media depictions of mental illness? A pilot study.

PubMed

Nairn, R

1999-08-01

The aim of this study is to determine whether mental illnesses are depicted in less negative ways in print media when psychiatrists rather than lay persons are the source of information. Seven items from a special report on mental health, four derived from lay sources and three from psychiatrists, were subjected to a discourse analysis informed by knowledge of media practices. The psychiatrists were clearly distinguished and deployed as experts in contrast to lay sources. Two of the psychiatrists presented mental illnesses in less negative ways than in the other items. These more positive depictions were undermined by the devices that the journalists used to give authority to the portrayals of mental illness and by the need to create 'newsworthy' items. If psychiatrists and other mental health professionals are to have a positive effect on how media depict mental illness, they will have to develop closer relationships with journalists and a better appreciation of media priorities and practices.

Disability, employment and work performance among people with ICD-10 anxiety disorders.

PubMed

Waghorn, Geoff; Chant, David; White, Paul; Whiteford, Harvey

2005-01-01

To ascertain at a population level, patterns of disability, labour force participation, employment and work performance among people with ICD-10 anxiety disorders in comparison to people without disability or long-term health conditions. A secondary analysis was conducted of a probability sample of 42 664 individuals collected in an Australian Bureau of Statistics (ABS) national survey in 1998. Trained lay interviewers using ICD-10 computer-assisted interviews identified household residents with anxiety disorders. Anxiety disorders were associated with: reduced labour force participation, degraded employment trajectories and impaired work performance compared to people without disabilities or long-term health conditions. People with anxiety disorders may need more effective treatments and assistance with completing education and training, joining and rejoining the workforce, developing career pathways, remaining in the workforce and sustaining work performance. A whole-of-government approach appears needed to reduce the burden of disease and increase community labour resources. Implications for clinicians, vocational professionals and policy makers are discussed.

Effectively Communicating the Uncertainties Surrounding Ebola Virus Transmission.

PubMed

Kilianski, Andy; Evans, Nicholas G

2015-10-01

The current Ebola virus outbreak has highlighted the uncertainties surrounding many aspects of Ebola virus virology, including routes of transmission. The scientific community played a leading role during the outbreak-potentially, the largest of its kind-as many of the questions surrounding ebolaviruses have only been interrogated in the laboratory. Scientists provided an invaluable resource for clinicians, public health officials, policy makers, and the lay public in understanding the progress of Ebola virus disease and the continuing outbreak. Not all of the scientific communication, however, was accurate or effective. There were multiple instances of published articles during the height of the outbreak containing potentially misleading scientific language that spurred media overreaction and potentially jeopardized preparedness and policy decisions at critical points. Here, we use articles declaring the potential for airborne transmission of Ebola virus as a case study in the inaccurate reporting of basic science, and we provide recommendations for improving the communication about unknown aspects of disease during public health crises.

Ethical considerations for vaccination programmes in acute humanitarian emergencies

PubMed Central

Hardie, Kate; Selgelid, Michael J; Waldman, Ronald J; Strebel, Peter; Rees, Helen; Durrheim, David N

2013-01-01

Abstract Humanitarian emergencies result in a breakdown of critical health-care services and often make vulnerable communities dependent on external agencies for care. In resource-constrained settings, this may occur against a backdrop of extreme poverty, malnutrition, insecurity, low literacy and poor infrastructure. Under these circumstances, providing food, water and shelter and limiting communicable disease outbreaks become primary concerns. Where effective and safe vaccines are available to mitigate the risk of disease outbreaks, their potential deployment is a key consideration in meeting emergency health needs. Ethical considerations are crucial when deciding on vaccine deployment. Allocation of vaccines in short supply, target groups, delivery strategies, surveillance and research during acute humanitarian emergencies all involve ethical considerations that often arise from the tension between individual and common good. The authors lay out the ethical issues that policy-makers need to bear in mind when considering the deployment of mass vaccination during humanitarian emergencies, including beneficence (duty of care and the rule of rescue), non-maleficence, autonomy and consent, and distributive and procedural justice. PMID:23599553

Increasing persistency in lay and stabilising egg quality in longer laying cycles. What are the challenges?

PubMed Central

Bain, M. M.; Nys, Y.; Dunn, I.C.

2016-01-01

Abstract In the past 50 years, selection starting initially at the breed level and then using quantitative genetics coupled with a sophisticated breeding pyramid, has resulted in a very productive hybrid for a variety of traits associated with egg production.One major trait currently being developed further is persistency of lay and the concept of the “long life” layer. Persistency in lay however cannot be achieved without due consideration of how to sustain egg quality and the health and welfare of the birds in longer laying cycles. These multiple goals require knowledge and consideration of the bird’s physiology, nutritional requirements, which vary depending on age and management system, reproductive status and choice of the selection criteria applied.The recent advent of molecular genetics offers considerable hope that these multiple elements can be balanced for the good of all in the industry including the hens.The “long life” layer, which will be capable of producing 500 eggs in a laying cycle of 100 weeks, is therefore on the horizon, bringing with it the benefits of a more efficient utilisation of diminishing resources, including land, water, raw materials for feed as well as a reduction in waste, and an overall reduced carbon footprint. PMID:26982003

Increasing persistency in lay and stabilising egg quality in longer laying cycles. What are the challenges?

PubMed

Bain, M M; Nys, Y; Dunn, I C

2016-06-01

In the past 50 years, selection starting initially at the breed level and then using quantitative genetics coupled with a sophisticated breeding pyramid, has resulted in a very productive hybrid for a variety of traits associated with egg production. One major trait currently being developed further is persistency of lay and the concept of the "long life" layer. Persistency in lay however cannot be achieved without due consideration of how to sustain egg quality and the health and welfare of the birds in longer laying cycles. These multiple goals require knowledge and consideration of the bird's physiology, nutritional requirements, which vary depending on age and management system, reproductive status and choice of the selection criteria applied. The recent advent of molecular genetics offers considerable hope that these multiple elements can be balanced for the good of all in the industry including the hens. The "long life" layer, which will be capable of producing 500 eggs in a laying cycle of 100 weeks, is therefore on the horizon, bringing with it the benefits of a more efficient utilisation of diminishing resources, including land, water, raw materials for feed as well as a reduction in waste, and an overall reduced carbon footprint.

The Good Life: New Zealand Children's Perspectives on Health and Self

ERIC Educational Resources Information Center

Burrows, Lisette; Wright, Jan

2004-01-01

In New Zealand, the introduction of a new health and physical education curriculum, coupled with extraordinary levels of lay and professional concern about children's health (as recorded by the Adolescent Health Research Group in 2003) has contributed to a reconceptualisation of health education practices in schools. Policy and professional…

Complementary Spiritist Therapy: Systematic Review of Scientific Evidence

PubMed Central

Lucchetti, Giancarlo; Lucchetti, Alessandra L. Granero; Bassi, Rodrigo M.; Nobre, Marlene Rossi Severino

2011-01-01

Spiritism is the third most common religion in Brazil, and its therapies have been used by millions worldwide. These therapies are based on therapeutic resources including prayer, laying on of hands, fluidotherapy (magnetized water), charity/volunteering, spirit education/moral values, and disobsession (spirit release therapy). This paper presents a systematic review of the current literature on the relationship among health outcomes and 6 predictors: prayer, laying on of hands, magnetized/fluidic water, charity/volunteering, spirit education (virtuous life and positive affect), and spirit release therapy. All articles were analyzed according to inclusion/exclusion criteria, Newcastle-Ottawa and Jadad score. At present, there is moderate to strong evidence that volunteering and positive affect are linked to better health outcomes. Furthermore, laying on of hands, virtuous life, and praying for oneself also seem to be associated to positive findings. Nevertheless, there is a lack of studies on magnetized water and spirit release therapy. In summary, science is indirectly demonstrating that some of these therapies can be associated to better health outcomes and that other therapies have been overlooked or poorly investigated. Further studies in this field could contribute to the disciplines of Complementary and Alternative Medicine by investigating the relationship between body, mind, and soul/spirit. PMID:21687790

Leadership networks in Catholic parishes: Implications for implementation research in health

PubMed Central

Negrón, Rosalyn; Leyva, Bryan; Allen, Jennifer; Ospino, Hosffman; Tom, Laura; Rustan, Sarah

2014-01-01

Through two case studies of Catholic parishes in Massachusetts, this study explores the implications of leader-centered versus distributed leadership in Catholic parishes for the implementation of evidence-based health interventions. The two parishes involved in the study differ from each other in several ways. In the first, parishioners are less engaged in leadership activities at the decision-making level in the parish. A small group of lay volunteers work with the parish priest and other ordained leaders on parish activities. In the second parish, a large and active lay volunteer leadership have forged an organizational structure that allows more independence from the pastor's direct oversight. In this parish, lay volunteer leaders are the prime drivers of organizational programs and events. In 2012–2013, three types of networks were assessed at each parish: discussion, collaboration, and outside-of-parish ties. The contrasts between each parish include differences in density of collaboration, in frequency of discussion, and network centrality of the respective parish priests. We further identified key actors in the network structures at each parish. We discuss the implications of these findings for understanding organizational capacity in the context of health program implementation. PMID:25441317

Leadership networks in Catholic parishes: implications for implementation research in health.

PubMed

Negrón, Rosalyn; Leyva, Bryan; Allen, Jennifer; Ospino, Hosffman; Tom, Laura; Rustan, Sarah

2014-12-01

Through two case studies of Catholic parishes in Massachusetts, this study explores the implications of leader-centered versus distributed leadership in Catholic parishes for the implementation of evidence-based health interventions. The two parishes involved in the study differ from each other in several ways. In the first, parishioners are less engaged in leadership activities at the decision-making level in the parish. A small group of lay volunteers work with the parish priest and other ordained leaders on parish activities. In the second parish, a large and active lay volunteer leadership have forged an organizational structure that allows more independence from the pastor's direct oversight. In this parish, lay volunteer leaders are the prime drivers of organizational programs and events. In 2012-2013, three types of networks were assessed at each parish: discussion, collaboration, and outside-of-parish ties. The contrasts between each parish include differences in density of collaboration, in frequency of discussion, and network centrality of the respective parish priests. We further identified key actors in the network structures at each parish. We discuss the implications of these findings for understanding organizational capacity in the context of health program implementation. Copyright © 2014 Elsevier Ltd. All rights reserved.

Strategies to improve health coverage and narrow the equity gap in child survival, health, and nutrition.

PubMed

Chopra, Mickey; Sharkey, Alyssa; Dalmiya, Nita; Anthony, David; Binkin, Nancy

2012-10-13

Implementation of innovative strategies to improve coverage of evidence-based interventions, especially in the most marginalised populations, is a key focus of policy makers and planners aiming to improve child survival, health, and nutrition. We present a three-step approach to improvement of the effective coverage of essential interventions. First, we identify four different intervention delivery channels--ie, clinical or curative, outreach, community-based preventive or promotional, and legislative or mass media. Second, we classify which interventions' deliveries can be improved or changed within their channel or by switching to another channel. Finally, we do a meta-review of both published and unpublished reviews to examine the evidence for a range of strategies designed to overcome supply and demand bottlenecks to effective coverage of interventions that improve child survival, health, and nutrition. Although knowledge gaps exist, several strategies show promise for improving coverage of effective interventions-and, in some cases, health outcomes in children-including expanded roles for lay health workers, task shifting, reduction of financial barriers, increases in human-resource availability and geographical access, and use of the private sector. Policy makers and planners should be informed of this evidence as they choose strategies in which to invest their scarce resources. Copyright © 2012 Elsevier Ltd. All rights reserved.

Interorganizational relationships among family support organizations and child mental health agencies.

PubMed

Acri, Mary C; Palinkas, Larry; Hoagwood, Kimberly E; Shen, Sa; Schoonover, Diana; Reutz, Jennifer Rolls; Landsverk, John

2014-07-01

This study examined: (1) qualitative aspects of close working relationships between family support organizations and child mental health agencies, including effective and ineffective characteristics of the relationship and aspects that they would change, and (2) the impact of the working relationship upon the family support organization. Semi-structured interviews were conducted with 40 directors of family support organizations characterized as having a close working relationship with a child mental health agency. Three main themes emerged regarding the quality of the working relationship: (a) interactional factors, including shared trust, communication, collaboration and service coordination; (b) aspects of the inner context of the family support organization, mental health agency, or both, including alignment of goals and values and perceptions of mental health services; and (c) outer contextual factors external to the organizations, such as financial and county regulations. Responses to the perceived impact of the relationship was divided into two themes: positive impacts (e.g. gained respect, influence and visibility), and negative impacts (e.g. lack of trust). This study lays the foundation for future research to better understand the mechanisms underlying interorganizational relationships in communities among different types of providers to create a more seamless continuum of services for families of children with mental health conditions.

Biomarkers in Sports and Exercise: Tracking Health, Performance, and Recovery in Athletes

PubMed Central

Fragala, Maren S.; Kavouras, Stavros A.; Queen, Robin M.; Pryor, John Luke; Casa, Douglas J.

2017-01-01

Abstract Lee, EC, Fragala, MS, Kavouras, SA, Queen, RM, Pryor, JL, and Casa, DJ. Biomarkers in sports and exercise: tracking health, performance, and recovery in athletes. J Strength Cond Res 31(10): 2920–2937, 2017—Biomarker discovery and validation is a critical aim of the medical and scientific community. Research into exercise and diet-related biomarkers aims to improve health, performance, and recovery in military personnel, athletes, and lay persons. Exercise physiology research has identified individual biomarkers for assessing health, performance, and recovery during exercise training. However, there are few recommendations for biomarker panels for tracking changes in individuals participating in physical activity and exercise training programs. Our approach was to review the current literature and recommend a collection of validated biomarkers in key categories of health, performance, and recovery that could be used for this purpose. We determined that a comprehensive performance set of biomarkers should include key markers of (a) nutrition and metabolic health, (b) hydration status, (c) muscle status, (d) endurance performance, (e) injury status and risk, and (f) inflammation. Our review will help coaches, clinical sport professionals, researchers, and athletes better understand how to comprehensively monitor physiologic changes, as they design training cycles that elicit maximal improvements in performance while minimizing overtraining and injury risk. PMID:28737585

A classification of errors in lay comprehension of medical documents.

PubMed

Keselman, Alla; Smith, Catherine Arnott

2012-12-01

Emphasis on participatory medicine requires that patients and consumers participate in tasks traditionally reserved for healthcare providers. This includes reading and comprehending medical documents, often but not necessarily in the context of interacting with Personal Health Records (PHRs). Research suggests that while giving patients access to medical documents has many benefits (e.g., improved patient-provider communication), lay people often have difficulty understanding medical information. Informatics can address the problem by developing tools that support comprehension; this requires in-depth understanding of the nature and causes of errors that lay people make when comprehending clinical documents. The objective of this study was to develop a classification scheme of comprehension errors, based on lay individuals' retellings of two documents containing clinical text: a description of a clinical trial and a typical office visit note. While not comprehensive, the scheme can serve as a foundation of further development of a taxonomy of patients' comprehension errors. Eighty participants, all healthy volunteers, read and retold two medical documents. A data-driven content analysis procedure was used to extract and classify retelling errors. The resulting hierarchical classification scheme contains nine categories and 23 subcategories. The most common error made by the participants involved incorrectly recalling brand names of medications. Other common errors included misunderstanding clinical concepts, misreporting the objective of a clinical research study and physician's findings during a patient's visit, and confusing and misspelling clinical terms. A combination of informatics support and health education is likely to improve the accuracy of lay comprehension of medical documents. Published by Elsevier Inc.

Medical ethics and education for social responsibility.

PubMed

Roemer, M I

1980-01-01

The physician, said Henry Sigerist in 1940, has been acquiring an increasingly social role. For centuries, however, codes of medical ethics have concentrated on proper behavior toward individual patients and almost ignored the doctor's responsibilities to society. Major health service reforms have come principally from motivated lay leadership and citizen groups. Private physicians have been largely hostile toward movements to equalize the economic access for people to medical care and improve the supply and distribution of doctors. Medical practice in America and throughout the world has become seriously commercialized. In response, governments have applied various strategies to constrain physicians and induce more socially responsible behavior. But such external pressures should not be necessary if a broad socially oriented code of medical ethics were followed. Health care system changes would be most effective, but medical education could be thoroughly recast to clarify community health problems and policies required to meet them. Sigerist proposed such a new medical curriculum in 1941; if it had been introduced, a social code of medical ethics would not now seem utopian. An international conference might well be convened to consider how physicians should be educated to reach the inspiring goals of the World Health Organization.

Medical ethics and education for social responsibility.

PubMed Central

Roemer, M. I.

1980-01-01

The physician, said Henry Sigerist in 1940, has been acquiring an increasingly social role. For centuries, however, codes of medical ethics have concentrated on proper behavior toward individual patients and almost ignored the doctor's responsibilities to society. Major health service reforms have come principally from motivated lay leadership and citizen groups. Private physicians have been largely hostile toward movements to equalize the economic access for people to medical care and improve the supply and distribution of doctors. Medical practice in America and throughout the world has become seriously commercialized. In response, governments have applied various strategies to constrain physicians and induce more socially responsible behavior. But such external pressures should not be necessary if a broad socially oriented code of medical ethics were followed. Health care system changes would be most effective, but medical education could be thoroughly recast to clarify community health problems and policies required to meet them. Sigerist proposed such a new medical curriculum in 1941; if it had been introduced, a social code of medical ethics would not now seem utopian. An international conference might well be convened to consider how physicians should be educated to reach the inspiring goals of the World Health Organization. PMID:7405276

Disorders of sex development (DSDs), their presentation and management in different cultures.

PubMed

Warne, Garry L; Raza, Jamal

2008-09-01

The way disorders of sex development (DSD) are viewed and managed in different cultures varies widely. They are complex conditions and even well-educated lay people find them difficult to understand, but when families are very poor and lacking in basic education, and the health system is starved of resources, traditional beliefs, folk remedies and prejudice combine to make the lives of children and adults with DSD extremely difficult and sad. Rumour and discrimination isolate them from their communities and they become devalued. People with DSDs desire the same things in life as everyone else-to find someone who will love them, to be valued as human beings, to feel at home in their own bodies, to be able to have satisfactory sexual relations should these be desired, to be able to trust their medical advisers and to be integrated into the general community. Long term outcome studies have been published from many countries, but these studies have not necessarily been critical of the values that underpinned the type of treatment given to the patients. There is a need for standardized instruments that would allow a true comparison of the quality of outcomes from the patients' perspective. Much could be done to improve equity between rich and poor countries for the benefit of people with DSDs. A focus on developing cheap, robust diagnostic tests, making essential medicines available for all, training surgeons to do better operations, educating health professionals, families and the general community in order to break down prejudice against people with DSDs, and training mental health workers in this specialized field, would do much to alleviate the burden of the condition.

Reactions of staff members and lay people to family presence during resuscitation: the effect of visible bleeding, resuscitation outcome and gender.

PubMed

Itzhaki, Michal; Bar-Tal, Yoram; Barnoy, Sivia

2012-09-01

This article is a report on a study conducted to examine the views of healthcare professionals and lay people regarding the effect of family presence during resuscitation on both the staff performing the resuscitation and the relatives who witness it. Family presence during resuscitation is controversial. Although many professional groups in different countries have recently issued position statements about the practice and have recommended new policy moves, the Israel Ministry of Health has not issued guidelines on the matter. Study design is factorial within-between subjects. Data were collected in Israel in 2008 from a convenience sample of 220 lay people and 201 healthcare staff (52 physicians and 149 nurses) using a questionnaire based on eight different resuscitation scenarios and manipulating blood involvement and resuscitations outcome. Data were analysed using one-way analysis of variance. Overall, both staff and lay people perceived family presence during resuscitation negatively. Visible bleeding and an unsuccessful outcome significantly influenced both staff's and lay people's perceptions. Female physicians and nurses reacted more negatively to family presence than did male physicians and nurses; lay men responded more negatively than lay women. Changing the current negative perceptions of family presence at resuscitation requires (a) establishing a new national policy, (b) educating healthcare staff to the benefits of the presence of close relatives and (c) training staff to support relatives who want to be present. © 2011 Blackwell Publishing Ltd.

Laying date, incubation and egg breakage as determinants of bacterial load on bird eggshells: experimental evidence.

PubMed

Soler, Juan José; Ruiz-Rodríguez, Magdalena; Martín-Vivaldi, Manuel; Peralta-Sánchez, Juan Manuel; Ruiz-Castellano, Cristina; Tomás, Gustavo

2015-09-01

Exploring factors guiding interactions of bacterial communities with animals has become of primary importance for ecologists and evolutionary biologists during the last years because of their likely central role in the evolution of animal life history traits. We explored the association between laying date and eggshell bacterial load (mesophilic bacteria, Enterobacteriaceae, Staphylococci, and Enterococci) in natural and artificial magpie (Pica pica) nests containing fresh commercial quail (Coturnix coturnix) eggs. We manipulated hygiene conditions by spilling egg contents on magpie and artificial nests and explored experimental effects during the breeding season. Egg breakage is a common outcome of brood parasitism by great spotted cuckoos (Clamator glandarius) on the nests of magpie, one of its main hosts. We found that the treatment increased eggshell bacterial load in artificial nests, but not in magpie nests with incubating females, which suggests that parental activity prevents the proliferation of bacteria on the eggshells in relation to egg breakage. Moreover, laying date was positively related to eggshell bacterial load in active magpie nests, but negatively in artificial nests. The results suggest that variation in parental characteristics of magpies rather than climatic variation during the breeding season explained the detected positive association. Because the eggshell bacterial load is a proxy of hatching success, the detected positive association between eggshell bacterial loads and laying date in natural, but not in artificial nests, suggests that the generalized negative association between laying date and avian breeding success can be, at least partially, explained by differential bacterial effects.

Medicinal plants used for the treatment of various skin disorders by a rural community in northern Maputaland, South Africa.

PubMed

De Wet, Helene; Nciki, Sibongile; van Vuuren, Sandy F

2013-07-19

Skin diseases have been of major concern recently due to their association with the Human Immunodeficiency Virus and Acquired Immunity Deficiency Syndrome (HIV/AIDS). The study area (northern Maputaland) has the highest HIV infection rate in South Africa, which made them more prone to a wide range of skin conditions. Fungal infections due to the hot climate and overcrowding households are common in this area, as well as burn accidents due to the use of wood as the major fuel for cooking. It is known that the lay people in this area depend on medicinal plants for their primary health care. However no survey has been done in northern Maputaland to document the medicinal plants used to treat various skin disorder. Interviews were undertaken at 80 homesteads, using structured questionnaires. The focus was on plants used for dermatological conditions and information regarding vernacular plant names, plant parts used, preparation (independently and in various combinations) and application was collected. A total of 87 lay people, both male (22%) and female (78%) were interviewed on their knowledge of medicinal plants used to treat disorders of the skin. Forty-seven plant species from 35 families were recorded in the present survey for the treatment of 11 different skin disorders including abscesses, acne, burns, boils, incisions, ringworm, rashes, shingles, sores, wounds and warts. When searching the most frequently used scientific databases (ScienceDirect, Scopus and Pubmed), nine plant species (Acacia burkei, Brachylaena discolor, Ozoroa engleri, Parinari capensis, subsp. capensis, Portulacaria afra, Sida pseudocordifolia, Solanum rigescens, Strychnos madagascariensis and Drimia delagoensis) were found to be recorded for the first time globally as a treatment for skin disorders. Fourteen plant combinations were used. Surprisingly, the application of enema's was frequently mentioned. The preference of traditional medicine over allopathic medicine by most of the interviewees strengthens previous studies on the importance that traditional medicine can have in the primary health care system in this rural community. Studies to validate the potential of these plants independently and in their various combinations is underway to provide insight into the anti-infective role of each plant.

Medicinal plants used for the treatment of various skin disorders by a rural community in northern Maputaland, South Africa

PubMed Central

2013-01-01

Background Skin diseases have been of major concern recently due to their association with the Human Immunodeficiency Virus and Acquired Immunity Deficiency Syndrome (HIV/AIDS). The study area (northern Maputaland) has the highest HIV infection rate in South Africa, which made them more prone to a wide range of skin conditions. Fungal infections due to the hot climate and overcrowding households are common in this area, as well as burn accidents due to the use of wood as the major fuel for cooking. It is known that the lay people in this area depend on medicinal plants for their primary health care. However no survey has been done in northern Maputaland to document the medicinal plants used to treat various skin disorder. Methods Interviews were undertaken at 80 homesteads, using structured questionnaires. The focus was on plants used for dermatological conditions and information regarding vernacular plant names, plant parts used, preparation (independently and in various combinations) and application was collected. Results A total of 87 lay people, both male (22%) and female (78%) were interviewed on their knowledge of medicinal plants used to treat disorders of the skin. Forty-seven plant species from 35 families were recorded in the present survey for the treatment of 11 different skin disorders including abscesses, acne, burns, boils, incisions, ringworm, rashes, shingles, sores, wounds and warts. When searching the most frequently used scientific databases (ScienceDirect, Scopus and Pubmed), nine plant species (Acacia burkei, Brachylaena discolor, Ozoroa engleri, Parinari capensis, subsp. capensis, Portulacaria afra, Sida pseudocordifolia, Solanum rigescens, Strychnos madagascariensis and Drimia delagoensis) were found to be recorded for the first time globally as a treatment for skin disorders. Fourteen plant combinations were used. Surprisingly, the application of enema’s was frequently mentioned. Conclusions The preference of traditional medicine over allopathic medicine by most of the interviewees strengthens previous studies on the importance that traditional medicine can have in the primary health care system in this rural community. Studies to validate the potential of these plants independently and in their various combinations is underway to provide insight into the anti-infective role of each plant. PMID:23870616

Sustainable development goals for health promotion: a critical frame analysis.

PubMed

Spencer, Grace; Corbin, J Hope; Miedema, Esther

2018-05-25

The Sustainable Development Goals (SDGs) lay the foundations for supporting global health and international development work for the next 15 years. Thirty years ago, the Ottawa Charter defined health promotion and outlined key principles for global action on health, including the importance of advocating, enabling and mediating for health equity. Advocacy underscores a human right to health and suggests political action to support its attainment. Enabling speaks to health promotion's focus on the empowerment of people and communities to take control over their health and aspirations. Mediation draws attention to the critical intersectoral partnerships required to address health and social inequities. Underpinned by this approach, the aim of this paper is to consider how key health promotion principles, namely, rights, empowerment and partnership feature (and are framed) within the SDGs and to consider how these framings may shape future directions for health promotion. To that end, a critical frame analysis of the Transforming Our World document was conducted. The analysis interrogated varying uses and meanings of partnerships, empowerment and rights (and their connections) within the SDGs. The analysis here presents three framings from the SDGs: (1) a moral code for global action on (in)equity; (2) a future orientation to address global issues yet devoid of history; and (3) a reductionist framing of health as the absence of disease. These framings raise important questions about the underpinning values of the SDGs and pathways to health equity - offering both challenges and opportunities for defining the nature and scope of health promotion.

EFFECTS OF CHLORINATION ON THE PERSISTENCE OF PHARMACEUTICALS IN THE ENVIRONMENT

EPA Science Inventory

In the past decade, the identification of pharmaceuticals in surface (Jones et al. 2001; Ternes 1998), ground (Sacher et al. 2001) and drinking (Heberer 2002) waters has attracted the attention of both the scientific and lay communities. Although the concentrations of these comp...

Serving the Undocumented

ERIC Educational Resources Information Center

Pluviose, David

2007-01-01

Undocumented immigrant students in California are eligible to receive only private scholarships that "[aren't] enough to support a very expensive education," says CCLC CEO Scott Lay. Dr. Gerardo E. de los Santos, CEO of the League for Innovation in the Community College, calls "serving the undocumented" one of the major…

Intermediate Outcomes, Strategies, and Challenges of Eight Healthy Start Projects

PubMed Central

Walker, Deborah Klein; Hargreaves, Margaret; Rosenbach, Margo

2008-01-01

Site visits were conducted for the evaluation of the national Healthy Start program to gain an understanding of how projects design and implement five service components (outreach, case management, health education, depression screening and interconceptional care) and four system components (consortium, coordination/collaboration, local health system action plan and sustainability) as well as program staff’s perceptions of these components’ influence on intermediate outcomes. Interviews with project directors, case managers, local evaluators, clinicians, consortium members, outreach/lay workers and other stakeholders were conducted during 3-day in-depth site visits with eight Healthy Start grantees. Grantees reported that both services and systems components were related to self-reported service achievements (e.g. earlier entry into prenatal care) and systems achievements (e.g. consumer involvement). Outreach, case management, and health education were perceived as the service components that contributed most to their achievements while consortia was perceived as the most influential systems component in reaching their goals. Furthermore, cultural competence and community voice were overarching project components that addressed racial/ethnic disparities. Finally, there was great variability across sites regarding the challenges they faced, with poor service availability and limited funding the two most frequently reported. Service provision and systems development are both critical for successful Healthy Start projects to achieve intermediate program outcomes. Unique contextual and community issues influence Healthy Start project design, implementation and reported accomplishments. All eight projects implement the required program components yet outreach, case management, and health education are cited most frequently for contributing to their perceived achievements. PMID:19011959

Cervical Cancer Control for Hispanic Women in Texas: Effective Strategies from Research and Practice

PubMed Central

Fernandez, Maria E.; Savas, Lara S.; Lipizzi, Erica; Smith, Jennifer S.; Vernon, Sally W.

2014-01-01

Purpose Hispanic women in Texas have among the highest rates of cervical cancer incidence and mortality in the country. Increasing regular Papanicolaou test screening and HPV vaccination are crucial to reduce the burden of cervical cancer among Hispanics. This paper presents lessons learned from community-based cervical cancer control programs in Texas and highlights effective intervention programs, methods and strategies. Methods We reviewed and summarized cervical cancer control efforts targeting Hispanic women in Texas, focusing on interventions developed by researchers at the University of Texas, School of Public Health. We identified commonalities across programs, highlighted effective methods, and summarized lessons learned to help guide future intervention efforts. Results Community-academic partnerships were fundamental in all steps of program development and implementation. Programs reviewed addressed psychosocial, cultural, and access barriers to cervical cancer control among low-income Hispanic women. Intervention approaches included lay health worker (LHW) and navigation models and used print media, interactive tailored media, photonovellas, client reminders, one-on-one and group education sessions. Conclusions Small media materials combined with LHW and navigation approaches were effective in delivering Pap test screening and HPV vaccination messages and in linking women to services. Common theoretical methods included in these approaches were modeling, verbal persuasion, and facilitating access. Adaptation of programs to an urban environment revealed that intensive navigation was needed to link women with multiple access barriers to health services. Collectively, this review reveals 1) the importance of using a systematic approach for planning and adapting cervical cancer control programs; 2) advantages of collaborative academic-community partnerships to develop feasible interventions with broad reach; 3) the use of small media and LHW approaches and the need for tailored phone navigation in urban settings; and 4) coordination and technical assistance of community-based efforts as a way to maximize resources. PMID:24398135

Knowledge, attitudes and practices regarding tuberculosis among immigrants of Somalian ethnic origin in London: a cross-sectional study.

PubMed

Shetty, N; Shemko, M; Abbas, A

2004-03-01

The objectives were to study knowledge, attitudes, and practices (KAP) regarding tuberculosis (TB) among Somalian subjects in inner London. We administered structured, fixed response KAP questionnaires to 23 patients (culture proved TB), and two groups of controls: 25 contacts (family members) and 27 lay controls (general Somali immigrant population). Responses were summed on a five-point scale. Most were aware of the infectious nature of TB but uncertain of other risk factors. Many were uncertain about coping with the disease and its effect on lifestyle. Belief in biomedicine for TB was unequivocal with men having a significantly higher belief score than women (p = 0.02); the need to comply with TB medication was unambiguously understood. Somalians interviewed were educated, multilingual, and aware of important health issues. Uncertainties in core TB knowledge need to be addressed with direct educational input, especially in women and recent entrants into the country. Volunteers from the established Somalian community could play a valuable part as links in the community to fight TB.

Relationships between woody vegetation and geomorphological patterns in three gravel-bed rivers with different intensities of anthropogenic disturbance

NASA Astrophysics Data System (ADS)

Sitzia, T.; Picco, L.; Ravazzolo, D.; Comiti, F.; Mao, L.; Lenzi, M. A.

2016-07-01

We compared three gravel-bed rivers in north-eastern Italy (Brenta, Piave, Tagliamento) having similar bioclimate, geology and fluvial morphology, but affected by different intensities of anthropogenic disturbance related particularly to hydropower dams, training works and instream gravel mining. Our aim was to test whether a corresponding difference in the interactions between vegetation and geomorphological patterns existed among the three rivers. In equally spaced and sized plots (n = 710) we collected descriptors of geomorphic conditions, and presence-absence of woody species. In the less disturbed river (Tagliamento), spatial succession of woody communities from the floodplain to the channel followed a profile where higher elevation floodplains featured more developed tree communities, and lower elevation islands and bars were covered by pioneer communities. In the intermediate-disturbed river (Piave), islands and floodplains lay at similar elevation and both showed species indicators of mature developed communities. In the most disturbed river (Brenta), all these patterns were simplified, all geomorphic units lay at similar elevations, were not well characterized by species composition, and presented similar persistence age. This indicates that in human-disturbed rivers, channel and vegetation adjustments are closely linked in the long term, and suggests that intermediate levels of anthropogenic disturbance, such as those encountered in the Piave River, could counteract the natural, more dynamic conditions that may periodically fragment vegetated landscapes in natural rivers.

Lay Meanings of Health among Rural Older Adults in Appalachia

ERIC Educational Resources Information Center

Goins, R. Turner; Spencer, S. Melinda; Williams, Kimberly

2011-01-01

Purpose: Self-perceptions of health vary depending on one's social and cultural context. Rural residents have been characterized as having a distinct culture, and health differences by residence have been well documented. While there is evidence of poor health among rural older adults, little research has examined how they perceive and define…

Challenges and Opportunities in Global Mental Health: a Research-to-Practice Perspective

PubMed Central

Wainberg, Milton L.; Scorza, Pamela; Shultz, James M.; Helpman, Liat; Mootz, Jennifer J.; Johnson, Karen A.; Neria, Yuval; Bradford, Jean-Marie E.; Oquendo, Maria A.; Arbuckle, Melissa R.

2017-01-01

Purpose of Review Globally, the majority of those who need mental health care worldwide lack access to high-quality mental health services. Stigma, human resource shortages, fragmented service delivery models, and lack of research capacity for implementation and policy change contribute to the current mental health treatment gap. In this review, we describe how health systems in low- and middle-income countries (LMICs) are addressing the mental health gap and further identify challenges and priority areas for future research. Recent Findings Common mental disorders are responsible for the largest proportion of the global burden of disease; yet, there is sound evidence that these disorders, as well as severe mental disorders, can be successfully treated using evidence-based interventions delivered by trained lay health workers in low-resource community or primary care settings. Stigma is a barrier to service uptake. Prevention, though necessary to address the mental health gap, has not solidified as a research or programmatic focus. Research-to-practice implementation studies are required to inform policies and scale-up services. Summary Four priority areas are identified for focused attention to diminish the mental health treatment gap and to improve access to high-quality mental health services globally: diminishing pervasive stigma, building mental health system treatment and research capacity, implementing prevention programs to decrease the incidence of mental disorders, and establishing sustainable scale up of public health systems to improve access to mental health treatment using evidence-based interventions. PMID:28425023

The "trust" heuristic: arguments from authority in public health.

PubMed

Cummings, Louise

2014-01-01

The work of public health depends on a relationship of trust between health workers and members of the public. This relationship is one in which the public must trust the advice of health experts, even if that advice is not always readily understood or judged to be agreeable. However, it will be argued in this article that the pact of trust between public health workers and members of the public has been steadily eroded over many years. The reasons for this erosion are examined as are attempts to characterize the concept of trust in empirical studies. The discussion then considers how a so-called informal fallacy, known as the "argument from authority," might contribute to attempts to understand the trust relationship between the public and health experts. Specifically, this argument enables the lay person to bridge gaps in knowledge and arrive at judgements about public health problems by attending to certain logical and epistemic features of expertise. The extent to which lay people are able to discern these features is considered by examining the results of a study of public health reasoning in 879 members of the public.