Community-based Health Promotion Interventions Research Articles

Evaluating the effectiveness of a community-based health promotion intervention on knowledge improvement regarding low birth weight and its determinants among antenatal couples in Sri Lanka

BackgroundImprovement of the knowledge of pregnant mothers and their partners related to low birth weight (LBW) is a vital factor in preventing LBW and reducing its prevalence.ObjectivesImplement and evaluate the effectiveness of a community based health promotion intervention on pregnant mothers and their partners to increase knowledge on birth weight and its determinants. The second objective is to determine the difference of the birth weight after implementing the intervention.MethodsA quasi experimental study design was used, and the setting was 806 pregnant mothers, 403 each in two districts. In 26 ANCs, twenty six initial training sessions were conducted as a group, with an average of three hours for each session. Three follow up sessions were conducted in each ANC over 04 months (in total 104 sessions). All sessions were conducted in groups of 10 to 20 antenatal couples. The pregnant mothers and their partners completed interviewer-administered questionnaires. Pre and post data were analysed based on four major knowledge categories using statistical methods. The McNemar’s Chi Square test; Chi Square test, Fisher’s Exact test, Paired t test, Student’s independent sample t test, Wilcoxon Signed Ranks test and Mann Whitney U test methods were applied as appropriate.ResultsBoth mothers and their partners in the intervention group (IG) reached significantly higher gains in knowledge than in the comparison group (CG). The participants who got the lowest scores for knowledge, at the pre assessment, in IG, also improved more than the CG {mothers (p = 0.002) and partners (p = 0.007)}. The mean birth weight shows that the IG has significantly improved for both mothers (p < 0.001) and partners (p = 0.013) with low knowledge scores (< 50% of total).ConclusionsKnowledge about birth weight and its determinants among pregnant mothers and their partners improved significantly.

Empowering communities to use healthy lifestyle centres: an implementation research from Sri Lanka

ObjectiveHealthy lifestyle centres (HLCs), a state service that screens for major non-communicable disease (NCD) risk factors and promotes lifestyle modifications in Sri Lanka, report underutilisation. The study aimed to assess...

Using dialogue-centered approaches to community-engaged research: an application of dialectical inquiry

Rural communities across the United States experience increased risk and prevalence of chronic diseases associated with both individual and community-based factors. Thus, there is a need for rural capacity development for chronic disease prevention. Traditional health promotion and intervention approaches often focus on diet-related health disparities from a positivist, evidence-based paradigm. To counter positivist bias within health promotion research, a hybridized approach is proposed using a critical-constructivist paradigm incorporating dialectical thinking, appreciative inquiry, and dialectical inquiry to address cultural and structural barriers, as well as community-based social norms, through evaluation of community-based health promotion interventions. Three dialectical models were identified through interviews with community coalition members: social ties, infrastructure, and worldviews, examining underlying assumptions and counter assumptions. By revealing the dialectic assumptions and counter assumptions within project implementation, practitioners can engage in constructive dialogue with communities to determine more effective and culturally responsive pathways for project development.

Effectiveness of a community-based participatory health promotion intervention to address knowledge, attitudes and practices related to intimate partner violence: a quasi-experimental study.

Intimate partner violence is the most common form of violence experienced by women. It has detrimental consequences. A range of determinants cause intimate partner violence and to reduce it, effective interventions are required to address the determinants. Health promotion interventions have been recommended as effective to enable people to control over the determinants and to improve health. Hence, a community based participatoryhealth promotion intervention was developed and tested in a selected study setting. The objective was to evaluate the effectiveness of a health promotion intervention in terms of addressing knowledge, attitudes and practices related to intimate partner violence. A quasi-experimental study was conducted by recruiting ninety women aged 15 to 49years separately from two health administrative areas identified as the intervention area and the control area from the Kandy district of Sri Lanka. A pretested interviewer-administered questionnaire was used in both pre- and post-assessments. Selected groups of women from the intervention area were facilitated with a health promotion intervention to improve knowledge, attitudes and practices related to intimate partner violence. To evaluate the effectiveness of the intervention descriptive summaries and bivariate analysis were used. The response rate was 90.9% (N = 90) during the pre-assessment and 87.9% (n = 87) and 82.8% (n = 82) from the intervention and control areas, respectively, during the post-assessment. Statistically significant improvement was reported in the total mean score comprising knowledge, attitudes, practices and identification of determinants from 59.6 to 80.8 in the intervention area [Pre-assessment: Mean = 59.6 (standard deviation-SD) = 17.5; Post-assessment: Mean = 80.8, SD = 19.0; p < 0.001) compared to the improvement in the control area from 62.2 to 63.0 (Pre-assessment: Mean = 62.2, SD = 17.3; Post-assessment: Mean = 63.0, SD = 18.9; p = 0.654). The intervention was effective to improve knowledge, attitudes and practices related to intimate partner violence. Hence, the present approach can be used in similar contexts to address the knowledge, attitudes and certain practices related to intimate partner violence.

The Limitations and Potentials of Evaluating Economic Aspects of Community-Based Health Promotion: A Critical Review.

Community-based health promotion (CBHP) interventions are promising approaches to address public health problems; however, their economic evaluation presents unique challenges. This review aims to explore the opportunities and limitations of evaluating economic aspects of CBHP, focusing on the assessment of intervention costs and outcomes, and the consideration of political-level changes and health equity. A systematic search of the PubMed, Web of Science and PsycInfo databases identified 24 CBHP interventions, the majority of which targeted disadvantaged communities. Only five interventions included a detailed cost/resource assessment. Outcomes at the operational level were mainly quantitative, related to sociodemographics and environment or health status, while outcomes at the political level were often qualitative, related to public policy, capacity building or networks/collaboration. The study highlights the limitations of traditional health economic evaluation methods in capturing the complexity of CBHP interventions. It proposes the use of cost-consequence analysis (CCA) as a more comprehensive approach, offering a flexible and multifaceted assessment of costs and outcomes. However, challenges remain in the measurement and valuation of outcomes, equity considerations, intersectoral costs and attribution of effects. While CCA is a promising starting point, further research and methodological advancements are needed to refine its application and improve decision making in CBHP.

A Socio-Ecological Approach to A Community-Based Health Promotion Intervention on the U.S.-Mexico Border: Insights and Lessons Learned During the COVID-19 Pandemic

The Healthy Families Healthy Kids Initiative (HFHKI) is a community-based initiative developed based on the socio-ecological model to address preventive health care needs in El Paso County, Texas, one of the most economically and health-challenged border communities in the United States. HFHKI’s three main goals are to increase access to experiential learning and health education, service delivery, and sustainable systems/linkages of care. These were accomplished through seven critical activities. We present the rationale, background, setting, and conceptual framework for the initiative, followed by the methods used to develop and assess the success of the activities and results of our project outcomes. We end with a discussion of lessons learned and future directions. We also share insights gained from our community health promotion intervention during the COVID-19 pandemic, which will enrich current conversations among applied social scientists. Overall, our project served 2,347 participants of all age ranges during our first year of project implementation across all 7 activities. We recommend the use of the socio-ecological model in designing, implementing, and improving health interventions aimed at enhancing family and community health, with each intervention tailored to the needs of different segments of the community. While the need to contain the COVID-19 virus amid the pandemic has created challenges in health promotion efforts, the need to help affected communities regain control of their health cannot be stressed enough. Our project can serve as an implementation framework for community-based projects on the U.S.-Mexico border.

Tingbjerg Changing Diabetes: Experiencing and navigating complexity in a community-based health promotion initiative in a disadvantaged neighborhood in Copenhagen, Denmark

Abstract Background As a response to the complexity of reducing health inequity there has been a rise in community-based health promotion interventions adhering to the principles of complexity thinking. Such interventions often work with adaptive practice and constitute themselves in complex webs of collaborations between multiple stakeholders. However, few efforts have been made to articulate how complexity can be navigated and addressed by stakeholders in practice. This study explores how partners experience and navigate complexity in the partnership behind Tingbjerg Changing Diabetes (TCD), a community-based intervention addressing health and social development in the disadvantaged neighborhood of Tingbjerg in urban Copenhagen. The study thus contributes with important insights on the role of context and how it contributes complexity in community-based health promotion. Methods The study is based on 18 months of ethnographic action research in the local community where the first author participated in the development and implementation of one of TCD's activities, a community restaurant, alongside partner representatives and residents, including participant observations and 9 in-depth interviews with key partner representatives. Findings Findings show that complexity in TCD can be characterized by unpredictability in actions and outcomes, undefined purpose and direction, and differing organizational logics. Factors that support partners’ navigation in complexity include connectivity, embracing a flexible intervention framework, autonomy, and quick responsiveness. Conclusions The study showcases the interdependency between the intervention and the context of the disadvantaged neighborhood of Tingbjerg and encourages stakeholders and researchers to embrace the messiness of complexity, and to pay attention to ways through which messiness and unpredictability can be handled.

O.4.6-4 Engagement and knowledge in a participatory systems approach to promote physical activity and mental health at vocational schools in Denmark: the Data Health study

Abstract Purpose Strong community engagement and capacity have been associated with positive intervention outcomes in community-based participatory health promotion interventions. The Data-driven Health Promotion at Vocational schools (Data Health) study aims to catalyze systems change in vocational school settings through community-led collective health promoting actions targeting physical activity and mental health among students. Three Group Model Building (GMB 1-3) sessions were delivered at eight intervention sites to build capacity and engage schools, municipalities, and communities. As part of the process evaluation, we assessed level of stakeholder knowledge, used as an indicator for capacity, and engagement prior to implementation of actions. Methods Data were collected among participants at GMB-3 during 2022 using a modified version of the validated Stakeholder-driven Community Diffusion Survey assessing two factors: knowledge (eight items) and engagement (16 items). Five-point Likert scale scores were recoded to values between 0 (strongly disagree) to 1 (strongly agree) and means for each factor were calculated. T-tests and one-way ANOVA were used to compare level of knowledge and engagement by type of community actor and health theme. Results Across intervention sites, 120 completed the survey; &amp;gt;95% of all participants. Four sites (71 respondents) had chosen mental health as their focus area prior to GMB-3 while four sites had chosen physical activity (49 respondents). Most respondents were students (58%), followed by Civic society actors (19%), vocational school staff (19%), Municipal staff (6%) and vocational management (3%) (2% missing). Mean level of engagement was 0.89 and mean level of knowledge was 0.78. Significant differences were found for both factors by chosen health theme (with lower levels at mental health sites, p &amp;lt; 0.05) and type of community actor (with lower levels among student and municipal staff, p &amp;lt; 0.001). Conclusions High levels of knowledge among local stakeholders are needed to understand and support diffusion of evidence-informed interventions through the community; high levels of engagement are a prerequisite for inducing collaborative and sustainable efforts. Assessment of knowledge and engagement prior to implementation of actions is important to understand outcomes across intervention sites in the Data Health study. Support/Funding Source The Danish Regions, Tværspuljen, Helsefonden, University of Southern Denmark, in-kind contributions.

Using the Socioecological Model to Explore Barriers to Health Care Provision in Underserved Communities in the Philippines: Qualitative Study.

The Philippines' primary care is delivered via local health centers called barangay health centers (BHCs). Barangays are the most local government units in the Philippines. Designed to promote and prevent disease via basic health care, these BHCs are staffed mainly by barangay health workers (BHWs). However, there has been limited research on the social and environmental factors affecting underserved communities' access to health care in underserved areas of the Philippines. Given the importance of BHCs in disease prevention and health promotion, it is necessary to identify obstacles to providing their services and initiatives. This study aimed to explore multilevel barriers to accessing and providing basic health care in BHCs. We used a qualitative approach and the socioecological model as a framework to investigate the multilevel barriers affecting basic health care provision. A total of 18 BHWs from 6 BHCs nationwide participated in focus group interviews. Traditional thematic content analysis was used to analyze the focus group data. After that, we conducted individual semistructured interviews with 4 public health nurses who supervised the BHWs to confirm findings from focus groups as a data source triangulation. The final stage of thematic analysis was conducted using the socioecological model as the framework. Findings revealed various barriers at the individual (lack of staff motivation and misperceptions of health care needs), interpersonal (lack of training, unprofessional behaviors, and lack of communication), institutional (lack of human resources for health, lack of accountability of staff, unrealistic expectations, and lack of physical space or supplies), community (lack of community support, lack of availability of appropriate resources, and belief in traditional healers), and policy (lack of uniformity in policies and resources and lack of a functional infrastructure) levels. Examining individual-, interpersonal-, institutional-, community-, and policy-level determinants that affect BHCs can inform community-based health promotion interventions for the country's underserved communities. Given the multidimensional barriers identified, a comprehensive program must be developed and implemented in collaboration with health care providers, community leaders, local and regional health care department representatives, and policy makers.

Efficacy of the Nutrition &amp; Exercise for Wellness &amp; Recovery: A Randomized Controlled Trial of a Community-Based Health Promotion Intervention

Abstract Date Presented 04/20/2023 The purpose of this randomized controlled trial (RCT) was to examine the efficacy of the Nutrition and Exercise for Wellness and Recovery (NEW-R) Intervention in improving competency and behaviors related to weight management for individuals with psychiatric disabilities. The intervention group improved more than the control group on healthy lifestyle behaviors and perceived competence. Participants at only some of the sites had significant weight loss, suggesting a supportive setting is important when providing the intervention. Primary Author and Speaker: Catana Brown Contributing Authors: Judith A. Cook, Jessica A. Jonikas, Pamela J. Steigman, Jane K. Burke-Miller

Community Wise—effects and participant perceptions of a community- based -positive health intervention for older inhabitants of low SES neighbourhoods: a mixed-methods approach

BackgroundThe Community Wise (CW) intervention applies a community-based approach to improve the physical fitness, self-management ability, loneliness, social cohesion, and well-being of older adults living in neighbourhoods characterized by lower socioeconomic status (SES).MethodsParticipants (N = 108) were recruited using several strategies, including door-to-door visits and community key peers. The study was based on a pre-test/post-test design. Outcomes were assessed through mixed methods using questionnaires, performance tests, semi-structured interviews, and focus-group sessions.ResultsResults showed significant improvements on aerobic endurance and shoulder flexibility, but no significant improvements on self-management ability, social cohesion, loneliness, or well-being. Qualitative data analysis did indicate that participants experienced improvements on social connectedness with members of the group, as well as on self-management ability.ConclusionThe results of the intervention seem to depend on programme fidelity and method of assessment. Adapting the intervention and including more older adults with poor health status could lead to better outcomes in the future. This results of this study should be interpreted in light of the complexity and methodological challenges of conducting a community-based health-promotion intervention for this target group.Trail registrationRetrospective registration.

Evaluation of community-based health promotion interventions in children and adolescents in high-income countries: a scoping review on strategies and methods used

BackgroundIn recent decades, community-based interventions have been increasingly adopted in the field of health promotion and prevention. While their evaluation is relevant for health researchers, stakeholders and practitioners, conducting these evaluations is also challenging and there are no existing standards yet. The objective of this review is to scope peer-reviewed scientific publications on evaluation approaches used for community-based health promotion interventions. A special focus lies on children and adolescents’ prevention.MethodsA scoping review of the scientific literature was conducted by searching three bibliographic databases (Medline, EMBASE, PsycINFO). The search strategy encompassed search terms based on the PCC (Population, Concept, Context) scheme. Out of 6,402 identified hits, 44 articles were included in this review.ResultsOut of the 44 articles eligible for this scoping review, the majority reported on studies conducted in the USA (n = 28), the UK (n = 6), Canada (n = 4) and Australia (n = 2). One study each was reported from Belgium, Denmark, Germany and Scotland, respectively. The included studies described interventions that mostly focused on obesity prevention, healthy nutrition promotion or well-being of children and adolescents. Nineteen articles included more than one evaluation design (e.g., process or outcome evaluation). Therefore, in total we identified 65 study designs within the scope of this review. Outcome evaluations often included randomized controlled trials (RCTs; 34.2%) or specific forms of RCTs (cluster RCTs; 9.8%) or quasi-experimental designs (26.8%). Process evaluation was mainly used in cohort (54.2%) and cross-sectional studies (33.3%). Only few articles used established evaluation frameworks or research concepts as a basis for the evaluation.ConclusionFew studies presented comprehensive evaluation study protocols or approaches with different study designs in one paper. Therefore, holistic evaluation approaches were difficult to retrieve from the classical publication formats. However, these publications would be helpful to further guide public health evaluators, contribute to methodological discussions and to inform stakeholders in research and practice to make decisions based on evaluation results.

Tingbjerg Changing Diabetes: experiencing and navigating complexity in a community-based health promotion initiative in a disadvantaged neighbourhood in Copenhagen, Denmark

As a response to the complexity of reducing health inequity there has been a rise in community-based health promotion interventions adhering to the principles of complexity thinking. Such interventions often work with adaptive practice and constitute themselves in complex webs of collaborations between multiple stakeholders. However, few efforts have been made to articulate how complexity can be navigated and addressed by stakeholders in practice. This study explores how partners experience and navigate complexity in the partnership behind Tingbjerg Changing Diabetes (TCD), a community-based intervention addressing health and social development in the disadvantaged neighborhood of Tingbjerg in urban Copenhagen. The study provides important insights on the role of context and how it contributes complexity in community-based health promotion.The study is based on 18 months of ethnographic fieldwork in the local community including participant observations and 9 in-depth interviews with key partner representatives. Findings show that complexity in TCD can be characterized by unpredictability in actions and outcomes, undefined purpose and direction, and differing organizational logics. Factors that support partners’ navigation in complexity include connectivity, embracing a flexible intervention framework, autonomy, and quick responsiveness. The study showcases the interdependency between the intervention and the context of the disadvantaged neighborhood of Tingbjerg and encourages stakeholders and researchers to embrace the messiness of complexity, and to pay attention to ways through which messiness and unpredictability can be handled.

The Effects of A Community-based Health Program on Adolescents’ Smoking Prevention – A Quasi-Experimental Study

Background: Tobacco Smoking is considerably high among adolescents in Indonesia, indicating the potential proportion of tobacco smoking effects experienced by young Indonesians in the future and the need of program interventions to halt the tendency. This study aims to investigate effects of a community-based health promotion intervention on smoking prevention among Indonesians’ adolescents.Methods: The quasi-experimental study with a pre-and-posttest control group design involved 104 adolescents aged between 12 to 14 years. The adolescents were convieniently assigned into one intervention (55 adolescents) or a control group group (49 adolescents), with participants in the intervention group received four health promotion sessions using smoking prevention videos for one month. Effects of the intervention were measured by a questionnaire at one week before and after the intervention completed and then analyzed by an approprite data analysis technique.Results: After the intervention completion, there was a significant positive effect of the community-based health promotion intervenstion program in improving adolescents tobacco smoking knowledge, attitude, intention and behavior (p = &lt;0.001).Conclusion: Community-based health promotion program provides positive impact on adolescents smoking prevention and therefore should be considered as one of stretegies for tobacco smoking prevention program.

Factors associated with COVID-19 vaccine hesitancy: a community-based household survey in Pune district of Maharashtra, India

Background In the wake of the coronavirus (COVID-19) pandemic, the development of the COVID-19 vaccine became a game-changing tool. However, the rapid development of the COVID-19 vaccine gave rise to various myths, misconceptions and hesitancies among people. Methods A community-based household survey was conducted by the trained healthcare workers, i.e., Accredited Social Health Activist (ASHA) and Anganwadi Worker (AWW) in their respective villages. Information on socio-demographic profile, vaccination status and reasons for vaccine hesitancy in community members was collected during the survey. Details of the vaccination status of community members were cross-examined with government vaccination data. After survey administration, continuous sensitisation to every individual was carried out by trained healthcare workers making people aware and motivating them to vaccinate. Healthcare workers constantly followed up on individuals showcasing hesitancy, thereby building up vaccine confidence in them. Results Out of the total study population (N=12,812), 90.1% were found eligible for COVID-19 vaccination (&gt;18 years), 57.8% individuals had received both doses of COVID-19 vaccine, and 23.2% had received only the first dose (partially vaccinated), whereas 9.1% were unvaccinated. The most reported vaccine hesitancy response was being worried about vaccine side effects at 9.2%. The other set of reasons reported among aged 60 years and above were being old (1.6%) and having a co-morbid condition (1.1%). Having an underlying illness was also reported in both age groups (45-60 years, and 60 years and older). Additionally, 18.2% of the unvaccinated and partially vaccinated eligible individuals reported planning to get vaccinated soon. Conclusions The study reported many myths and misconceptions, and hesitancies related to the COVID-19 vaccine among the community members being a major lag in the vaccine acceptance and uptake. Therefore, adequate vaccine education is much needed to engage the non-medical group, as they mostly tend to have positive interactions with the community members. On that account, sustained community-based health promotion intervention can be effective.

Prevalence and pattern of misuse of insecticide treated nets among household heads in Apete Community of Oyo State, Nigeria

Insecticide Treated Net (ITN) has been established to be the most cost effective malaria vector control measure if used correctly. However, the use of ITN for other purposes other than its primary purpose is common. The objective of this study is to investigate the prevalence and pattern of misuse of ITNs among household heads.&#x0D; A descriptive cross sectional survey was conducted among 422 household heads selected through multi stage sampling procedure using a validated interviewer administered questionnaire (r= 0.72) and analyzed with SPSS software&#x0D; The result of this study revealed the mean age of respondents’ was 33.38±7.46 and 39.5% was in the 40-49 age brackets. Only 37.4% of the respondents slept inside the nets the night prior to data collection.72.5% of the respondents were found in possession of net not used for sleeping out of which more than half (38.7%) used ITNs as window curtains, 19.3% used as night wrapper, 12.9% as fishing nets, 11.3% as protective device from garden animals, 10.5% used as football goal post and 7.3% used the net to cover market goods. There was a statistically significant relationship between ITN misuse and respondents’ educational attainment (r=.304) and gender (r=.399) at (p&lt;0.05).&#x0D; In conclusion, the study revealed a high prevalence of ITN misuse among the respondents in the community. There is need for community based health promotion intervention to encourage correct usage of ITNs and reduce misuse.

Multidimensional health literacy profiles and health-related behaviors in the elderly: A cross-sectional survey

ObjectivesTo investigate health literacy profiles using a multidimensional tool in the elderly, analyze the factors related to health literacy, and explore the relationships between health literacy and health-related behaviors. MethodsA cross-sectional survey including 440 participants was conducted at a community health center and a village health center in Changsha, Hunan Province, between June 2020 and August 2020. We used the Health Literacy Questionnaire (HLQ) to assess the elderly’s health literacy. Sociodemographic data and health-related behaviors of them were surveyed with a self-designed questionnaire. Latent profile analysis, Pearson’s chi-squared and ordinal logistic regression were used to analyze the data. ResultsThe median age of the 440 respondents was 68 years. The participants had the lowest scores in the “appraisal of health information” subscale (2.22 ± 0.52), followed by “navigating the healthcare system” subscale (2.89 ± 0.81) of HLQ. Based on the analysis of three profiles, respondents who were 60–74 years (OR = 2.06, 95% CI: 1.23–3.42, P = 0.006), living in urban areas (OR = 3.28, 95% CI: 2.17–4.94, P < 0.001), with secondary education or above (OR = 2.86, 95% CI: 1.92–4.27, P < 0.001), and having health insurance (OR = 1.89, 95% CI: 1.02–3.51, P = 0.042) were significantly associated with health literacy. Statistically significant associations were found between health literacy level and health-related behaviors, including medical service-seeking behavior (χ2 = 25.14, P < 0.001), exercising regularly (χ2 = 34.08, P < 0.001), and taking a medical examination in the past 12 months (χ2 = 24.76, P < 0.001). ConclusionThe multidimensional health literacy survey has identified the low health literacy level among the elderly in community settings. It revealed the relationships of sociodemographic characteristics, including age, education level and residence, with health literacy. These findings emphasized the importance of health literacy in promoting health behaviors, guiding a profound understanding of the Chinese elderly’s health needs and health literacy to develop community-based health promotion interventions.

The presence of neighbours in informal supportive interactions is important for mental health in later life

BackgroundPrevious studies have shown the social support-mental health associations varied in different bonding social networks. However, a further study is needed to determine these network-specific associations for mutually supportive interaction in a wider social network include bridging relationship members. MethodWe conducted a self-reported questionnaire in Osaka, Japan. The study included 659 pre-old age participants (age 65–74 years) and 888 old age participants (age 75–89 years). SF-36v2 was used to measure mental health. We measured three types of social network members (kin, friends, or neighbours) and divided them into recipients or sources of emotional or instrumental social support. We performed multiple regressions to investigate which network member is beneficial in terms of the impact of social support on mental health. ResultsOnly the neighbour social support was positively related with mental health in all subtypes. Associations were inconsistent amongst kin or friend social support subtypes. Positive associations were only found within the pre-old group. ConclusionFor pre-old people, only the presence of neighbours, not kin members, or friends, in social supportive interactions has consistently beneficial associations with mental health, regardless of the roles or functions. Accessibility of neighbour social support should be considered into community-based mental health promotion interventions along with the social network transformation in later life.

'You Are Kind of Like One of Us': Exploring Researcher Positioning in Studying Community-Based Health Promotion Interventions Among Social Housing Residents of Danish, Turkish and Pakistani Origin.

The practice of qualitative research demands reflexivity throughout the entire research process, with special attention directed towards researcher positioning. In this article, I explore how aspects and characteristics of my social situation positioned me contrary to my expectations regarding researcher positioning. I draw on individual interviews, focus group discussions and field notes about community-based health promotion interventions among residents of Danish, Turkish and Pakistani origin in a deprived social housing area in Denmark. Rather than insider-outsider positioning, the concept represented by the term 'halfie' unfolds the complexity of my researcher positioning: less minority ethnic than the residents of Turkish and Pakistani origin and less Danish than the residents of Danish origin, but similar to both, being a descendant of Sri Lankan Tamil origin brought up in a Danish social housing area. Finally, I present methodological and ethical implications of being a halfie in the context of qualitative health research.

Abstract 12770: Using the Socioecological Model to Explore Barriers to Healthcare Provision in Rural Communities in the Philippines

Background: Basic healthcare in the Philippines is provided via rural healthcare clinics (RHC) located in barangays and supervised by provincial health centers. These RHC are the cornerstone of the country's public health system and were designed to promote and prevent disease through basic healthcare services and education. However, RHC became nonfunctional during the COVID pandemic leaving the community without the resources necessary to address the acute problems associated with COVID and chronic conditions. Given the crucial role of RHC in disease prevention and control, identifying barriers to providing its services and programs is warranted. Aims: The purpose of this qualitative study was to explore multilevel barriers to the provision of healthcare services and education in RHC. Methods: We used a qualitative approach and the socioecological model as a framework to investigate the multilevel barriers affecting resource access at RHC. Four public health nurses and fifteen community healthcare workers (CHW) from five RHC across the country participated in individual interviews and group discussions. Traditional content analysis was used to examine the data. Results: Findings revealed barriers at the individual (insufficient motivation, incorrect beliefs), interpersonal (insufficient ability of CHW to provide services, and lack of training, unrealistic expectations, and lack of supervision and monitoring of CHW), organizational (excessive workload for CHW, lack of resources, inadequacy of evaluation and monitoring of CHW), community (lack of trust in CHW by people, lack of motivation to seek healthcare, continued belief in traditional healers), and policy (lack of financial support for RHC, lack of an organized system to meet community needs) levels. Conclusion: Examining individual, interpersonal, community, and policy level determinants that affect RHC can inform community-based health promotion interventions for the country's rural communities. Given the multidimensional barriers identified, it is recommended that a comprehensive program be developed and implemented in collaboration with licensed healthcare providers, CHW, district and regional healthcare department representatives, and healthcare policymakers.