Community-based Participatory Research Project Research Articles

Mental Health First Aid for Black Populations: Recommendations From the Neighborhood Healers Project

Community-based participatory action research can facilitate counseling psychologists’ engagement in social justice to benefit Black people’s mental health. One way to improve Black mental health is to equip credible and trustworthy community members with mental health knowledge and skills to support other community members experiencing mental health challenges. This study presents the Neighborhood Healers Project—a community-based participatory action research project that trains Black adults (Neighborhood Healers Fellows) in Mental Health First Aid (MHFA). During the inaugural 12-month fellowship year, we collected longitudinal qualitative data from N = 20 Fellows on the relevance of MHFA to Black people. In this paper, we examined their responses using reflexive thematic analysis. Findings included two themes with affiliated subthemes: (a) Liberatory Paradigm Shift and (b) For Us By Us: Culturally Relevant Curriculum. We conclude with implications for counseling psychologists.

Immersive virtual reality for prospective memory and eye fixation recovery following traumatic brain injury: A pilot study

Rehabilitation is crucial for the recoveriy from traumatic brain injuries (TBI); yet, only 77 – 88% of TBI patients are receipients of rehabilitation. Particularly, individuals lacking insurance coverage or facing transportation hurdles, notably within the Hispanic community, are less likely to undergo rehabilitation. Virtual reality (VR), known for its mobility and affordability, is recommended as a rehabilitation alternative. This community-based participatory research project aimed to evaluate the acceptability, feasibility, and potential of VR scenarios in addressing common rehabilitative needs. Focus groups involving TBI patients (N = 12) were conducted to identify rehabilitative needs and design VR scenarios. Two novel scenarios were created to enhance prospective memory and eye tracking. The impact of the prospective memory VR scenario was assessed among individuals with brain injuries 1 year post-TBI (N = 11), who were divided into intervention and delayed-intervention groups. In addition, six participants underwent the eye-tracking VR scenario to evaluate its effectiveness. Data from memory tests and screen recordings were gathered. In the objective memory test, participants in the VR intervention group (66%) exhibited greater improvement than those in the memory card delayed intervention group (0%) after 12 sessions. However, there was no statistically significant difference in mean scores on a Prospective and Retrospective Memory Questionnaire memory scale between the intervention and delayed-intervention groups after 6 weeks. Nonetheless, all participants demonstrated enhanced eye tracking skills after completing the eye tracking VR scenario between the 6th and 12th sessions. In conclusion, the VR scenarios exhibited promise, acceptability, and feasibility in improving prospective memory and eye tracking for individuals with TBI 1 year post-injury.

Assessing mental health and technology use in the time of COVID-19 among farmworkers in the U.S. – Mexico border

Purpose The purpose of this paper is to present findings on a community-based participatory research project where the authors examined access and ability to use technology, attitudes and perceptions of technology, and COVID-19 and mental health beliefs in the time of COVID-19, among predominantly Hispanic/Latinx farmworker males residing in the US–Mexico border city of El Paso, Texas. Design/methodology/approach This paper used a qualitative narrative analysis which consisted of in-person interviews in Spanish with male farmworkers (n = 10) between the ages of 49–60 years. This paper applied a research approach designed to engage researchers and community stakeholders as equal partners with the goal of improving practice. Findings Of the participants, eight reported having a phone and only three reported knowing how to use the internet. Before the COVID-19 pandemic, the participants reported living a relatively stress-free life. When the pandemic impacted their community, they reported experiencing heightened anxiety and stress. To relieve stress, all participants used healthy coping strategies (e.g. walking and gardening). Originality/value The findings suggest that farmworker males are receptive to obtaining mental health services. In addition, they would benefit from resources highlighting healthy stress coping mechanisms. Due to their limited knowledge of current internet technology, efforts on how to promote and deliver mental health services and resources to farmworkers should be strategic and appropriate.

Concevoir un centre alimentaire communautaire pour favoriser la sécurité alimentaire

Objective: The objective of this community-based participatory action research (CBPAR) project was to gain an in-depth understanding of the needs, interest and opportunities that exist within a post-secondary institution with respect to supporting food security among students via a food hub. Methods: The project was undertaken on the campus of the University of British Columbia-Vancouver. The CBPAR approach included 4 phases: 1) information gathering, 2) relationship development, 3) implementation of the community engagement strategy, and 4) shareback of findings to the community. Results: Phase 1 identified key components that formed the research process including campus partners for relationship development (phase 2) and subsequent engagement through their networks (phase 3). Phase 3 included engagement of 62, 111, 156, and 154 students, who participated in facilitated dialogues, community meals, a survey and targeted survey, respectively. Food insecurity related experiences were prevalent, with 37% to 75% indicating they worried about running out of food in the last year. Over 90% of all survey respondents affirmed that they would access a community food hub (CFH). Preferences for the CFH were inclusion of emergency food access, community meals, and financial support and planning, while prioritizing foods that meet cultural needs, and a low cost grocery store within the CFH. Conclusion: There is a demonstrated need and desire among students for innovative approaches to support food security at a post-secondary institution. The process outlined may serve as a road map for other communities who are seeking to move beyond emergency food relief.

Beyond individual responsibility towards healthy food choices: A qualitative study among Pakistani women in Hong Kong

While biomedical understandings of food and diet coupled with discourses on individual responsibility towards healthy food choices are nowadays prominent, other social and cultural meanings attached to food and diet are largely devalued. The limits of such a reductionist approach are more evident when related to the experiences of migrant and ethnic populations, whose alternative knowledge(s) and practices about food and health are especially neglected. A multicultural city with a public healthcare system inherited from the British colonial times and largely shaped by biomedical ideas of health, Hong Kong offers a lens into the limits of such a reductionist approach. Due to their vulnerability in the context of Hong Kong as shaped by intersecting social identities, 72 women from Pakistan were recruited to be our community partners in a community-based participatory action research project to investigate their health needs and concerns. 12 focus group discussions were conducted, exploring their experiences of “healthy” food and overweight especially related to their encounters with the Hong Kong public healthcare system, as these issues emerged as key health concerns within the community. Four major themes emerged: unmet expectations of care, health is beyond the individual, constraints to a healthy diet in the context of migration, and beyond health: food as care for diasporic women. This study highlights the limit of a reductionist approach to healthy food as merely based on nutrition and individual responsibility. It stresses the need of a counter-discourse in the field of public health, emphasizing not only alternative cultural ideas of health and food, but also enlarging the field of health in biomedical terms to embrace “care” and acknowledging the structural constraints shaping migrant and ethnic population's vulnerability in making “healthy” food choices.

Community-Based Organizations Leading Research Efforts: Preliminary Findings from the Chicagoland CEAL Program's COVID-19 Vaccine Uptake and Intention Survey.

To foster community engaged research in the communities most impacted by COVID-19, the National Institutes of Health (NIH) formed 21 teams of Community Engagement Alliance Against COVID-19 Disparities (CEAL). The national CEAL initiative developed a Common Survey to investigate attitudes and behaviors to the COVID-19 vaccine and clinical trials. This article describes survey implementation at the Chicagoland CEAL Program (CCP). This community-based participatory research project was the result of a strong collaboration between academic institutions, and a community-based non-profit health equity-focused partner organization. The survey implementation was developed and refined with strong input from CHWs, participants, and staff in the partner organizations and institutions. Survey data were collected with Qualtrics, a web-based survey tool. Survey implementation resulted in data collection for 852 participants during the period 12/18/2021-02/18/2023. Excluding participants on the basis of missing data resulted in a sample of 690, 601 of which (87.10%) indicated that they had received at least one dose or intended to get vaccinated. Overall, 54 (7.83%) respondents reported that they had not received the vaccine and were not planning to. Hard to reach populations present two unique challenges in emerging infectious disease events. Reaching populations vulnerable to poor outcomes with vaccines was essential to addressing the COVID-19 pandemic. Additionally, learning about barriers and hesitancy toward vaccine uptake is difficult in these communities. CCP's partnership of five academic institutions, a community research center, and a community-based non-profit health equity-focused organization shows what is possible when traditional models of research and inquiry are reconsidered for community-based participatory research. Results shown here are drawn from a collaboratively designed and implemented survey, collected in person, with over 90% completion.

“The spirit of a fighter”: Mixed‐status Latine immigrant families' experiences during COVID

AbstractObjectiveUsing a community‐based participatory research (CBPR) approach, this study documents Latine immigrant families' work, childcare, and education experiences during the COVID‐19 pandemic to inform policy and practice to support Latine families.BackgroundLatine immigrant communities, comprising undocumented and mixed‐status families, were among the hardest hit by the COVID‐19 pandemic. In addition to employment and housing challenges, children and families lost access to the important academic supports and social services built into childcare programs and schools.MethodFor this study, we collected in‐depth qualitative interview data from mothers who were immigrants from Central America and Mexico (N = 23) as part of an ongoing CBPR project. Using community coding techniques, data were analyzed in partnership with our Community Advisory Board, Amigas de la Comunidad.ResultsIn the context of illegality, participants and their families who already feared deportation and family separation, faced added burdens during the pandemic including job loss, school and childcare closures, and isolation. Parents worried about meeting their families' basic needs, getting sick, losing loved ones to COVID‐19, and being evicted from their housing.ConclusionWhile participants shared stories of resilience and resistance, they also reflected on stories loss and hardship—experiences that were exacerbated by anti‐immigrant laws and policies that made navigating the pandemic especially punishing for immigrant families.ImplicationsOn the basis of study findings, program and policy implications for serving Latine children and youth and their immigrant parents, especially those with mixed documentation status, are discussed.

Mobilizing faith-based COVID-19 health ambassadors to address COVID-19 health disparities among African American older adults in under-resourced communities: A hybrid, community-based participatory intervention.

The COVID-19 pandemic disproportionately affected older adults, particularly those with pre-existing chronic health conditions. To address the health disparity and challenges faced by under-resourced African American older adults in South Los Angeles during this period, we implemented a hybrid (virtual/in-person), pre-post, community-based participatory intervention research project utilizing a faith-based lay health advisor model (COVID-19 Health Ambassador Program (CHAP)). We recruited COVID-19 Health Ambassadors (CHAs) and African American older adults (participants) from faith-based organizations who partook in CHA-led meetings and follow-ups that educated and supported the participants. This paper seeks to evaluate this intervention's implementation using the Consolidated Framework for Implementation Research (CFIR) as a reporting tool with an emphasis on fidelity, challenges, and adaptations based on data collected via stakeholder interviews and surveys. CHAP was delivered to 152 participants by 19 CHAs from 17 faith-based organizations. CHAs assisted with chronic disease management, resolved medication-related challenges, encouraged COVID-19 vaccination, reduced psychological stress and addressed healthcare avoidance behaviors such as COVID-19 vaccine hesitancy among the participants. Challenges encountered include ensuring participant engagement and retention in the virtual format and addressing technological barriers for CHAs and participants. Adaptations made to better suit the needs of participants included providing communication tools and additional training to CHAs to improve their proficiency in using virtual platforms in addition to adapting scientific/educational materials to suit our participants' diverse cultural and linguistic needs. The community-centered hybrid approach in addition to our partnership with faith-based organizations and their respective COVID-19 health ambassadors proved to be essential in assisting underserved African American older adults manage chronic health conditions and address community-wide health disparities during the COVID-19 pandemic. Adaptability, cultural sensitivity, and teamwork are key to implementing health interventions especially in underserved populations.

Factors of success, barriers, and the role of frontline workers in Indigenous maternal-child health programs: a scoping review

BackgroundDespite considerable investment in maternal-child programs in Canada, there has been little positive impact on the health of Indigenous mothers and their children. The reasons for this are unclear and there is a need to identify how such programs can be successfully implemented. Community input is essential for successful programs; however, it is unclear what the contributions of frontline workers have been in the health program process, i.e., program development, delivery, and evaluation. Based on these identified gaps, this scoping review aimed to: (1) identify factors of success and barriers to successful Indigenous maternal-child community health programs for mothers and their children aged 0–6 years; and (2) explore how frontline workers are included in the program process.MethodsThis scoping review was completed using the Arksey and O’Malley framework, informed by Levac et al. Four data bases (Medline, CINAHL, Embase, and Scopus), grey literature, and reference lists were searched for relevant materials from 1990–2019. Data was extracted from included articles and analysed using descriptive statistics, thematic analysis with the Braun and Clarke framework, and a Principal Component Analysis.ResultsForty-five peer-reviewed and grey articles were included in the review. Factors of program success included: relationship building; cultural inclusion; knowledge transmission styles; community collaboration; client-centred approaches; Indigenous staff; and operational considerations. Barriers included: impacts of colonization; power structure and governance; client and community barriers to program access; physical and geographical challenges; lack of staff; and operational deficits. Frontline workers were found to have a role in program delivery (n = 45) and development (n = 25). Few (n = 6) had a role in program evaluation.ConclusionAlthough a better understanding of the frontline worker role in maternal-child health programs was obtained from the review, in a large proportion of literature the authors could not determine if the role went beyond program delivery. In addition, no direct input from frontline workers and their perspectives on program success or barriers were identified, suggesting areas to explore in future research. This review's findings have been applied to inform a community-based participatory research project and may also help improve the development, delivery, and evaluation of Indigenous maternal-child health programs.

Leveraging community advisory boards within travel medicine to help reduce malaria incidence in refugees, immigrants and migrants visiting friends and relatives abroad: reflections from the Minnesota Malaria Community Advisory Board on patient-provider interactions.

Refugees, immigrants and migrants often have barriers to travel medicine. Community Advisory Boards (CAB) are a vital but underutilized tool for understanding and meeting healthcare needs and challenges, providing communities with a voice, and finding solutions. The paper discusses a malaria prevention community-based participatory research project informed by a CAB.

My Best Alaskan Life: Addressing Adolescent Mental and Reproductive Health in Alaska.

Since 2020, a multisector research team has coordinated a youth-driven, community-based participatory research project to adapt a reproductive life plan for application in a statewide initiative called My Best Alaskan Life (MBAL). The RLP is adapted for Alaskan youth and is intended to support teens in decision-making processes reflecting cultural priorities, personal goals, and sexual and reproductive health. Background. With 46% of youth in Alaska reporting not having used a condom during their last sexual intercourse and 15% not having used contraception, unintended pregnancy and transmission of STIs will continue. Furthermore, Alaskan youth also cite high rates of hopelessness and suicidality, and research shows that poor mental health among adolescents is correlated with developing and maintaining high-risk sexual behaviors. An intervention focusing on supporting mental wellness and developing personal goals in the context of sexual health decision-making may encourage adolescents to adopt safer sexual health behaviors. The MBAL research team completed a statewide pilot assessing the design and implementation of the tool, gathering feedback from over 700 survey responses (youth, ages 14-20); conducted 10 in-depth interviews (adult partners at community organizations and clinics); and hosted two youth-led design review sessions. Questionnaire respondents were overwhelmingly positive about the tool (91% "liked or loved" the tool) and its potential applicability in their community (86% cited "very applicable"). Project next steps include incorporating design recommendations, a statewide randomized control trial and ultimately, open source access for all interested parties.

"That's like therapy"-A qualitative study on socially disadvantaged women's views on the effects of a community-based participatory research project on their health and health behavior.

Regular physical activity has positive effects on both physical and mental health. Nevertheless, socially disadvantaged women are often insufficiently physically active. Through needs-based physical activity offers, community-based participatory research (CBPR) projects have the potential to reach these women and increase the effectiveness of physical activity interventions by supporting women's empowerment, health, and health behaviors. This study aimed to examine socially disadvantaged women's views on the effects of long-term participation in Bewegung als Investition in Gesundheit (BIG, i.e., movement as an investment in health), a long-standing German CBPR project, on their health and health behavior. Semi-structured qualitative interviews were conducted with 30 participating women at five BIG sites across Germany between April and August 2022. The interviews were recorded, transcribed verbatim, and analyzed using framework analysis. Women reported that participation in BIG classes contributed to their physical, mental, and social health. For many women, the positive effects on their mental and social wellbeing were most important. In addition to increased fitness and improved physical endurance, many participating women were able to expand their social networks, thus receiving further social support, and improve their self-esteem, self-confidence, and self-efficacy. Furthermore, participation in BIG physical activity classes positively influenced the health awareness of many women helping them to improve their activity level and diet over time. Our results suggest that CBPR projects, such as the BIG project, can increase physical activity among socially disadvantaged groups and contribute to their overall health and wellbeing. CBPR projects could thus be considered a key element of health promotion for this target group. Future interventional research is required to confirm and further explore the effects of CBPR interventions and to examine whether the effects can be replicated in other settings.

Co-Producing access(ible) Knowledge: Methodological Reflections on a Community-Based Participatory Research

This paper is a methodological reflection on a community-based participatory research (CBPR) project that used the photovoice method to unravel the educational experiences of disabled college students in China’s higher education institutions. Although CBPR endeavors to nurture equitable community engagement in research processes, there are practical challenges to address the full participation of people with divergent disabilities and access needs. Drawing upon the critical disability studies literature, and particularly upon the activist scholarship of disability justice that revolves around interdependency, collective access, and cross-disability solidarity, we provide an open discussion on the complexities, tensions, and challenges of envisioning and creating access for participants with different disabilities in a visuality-centered CBPR. Our findings suggest that access creation in CBPR should go beyond the checklist style of accommodation and instead be approached as relational, dynamic, and iterative processes that require ongoing reflection, (re)learning, and negotiation among researchers and participants. We implemented nonvisual photography to adapt to the visuality-centered bias in the photovoice method. Nonvisual photography empowered participants with visual disabilities to evoke multiple sensorialities in their photo-taking, displaying, and interpretation. Moreover, the participants without visual disabilities also learned and practiced collective access and interdependency through co-transforming the CBPR into an accessible space for all. The heterogeneity among participants with divergent disabilities and access needs challenged CBPR’s envisioning of a unified community with recognized commonalities. The inclusion of participants across disability groups created an opportunity for all participants to draw meaning from the ableist social and political circumstances that forged them as a community and to develop a sense of belonging and bonding in and through CBPR. In that light, disability justice and access should be reimagined and incorporated into CBPR.

Vulnerability in Inclusive Research: Exploring Co- and Professional Researchers’ Experiences in a Community-Based Participatory Project on the Disability Family

In the transition to a less protectionist research ethics paradigm—in which vulnerable groups are no longer excluded from participating in research—academic researchers need to think differently about vulnerability. By means of a collective autoethnographic investigation of professional and co-researcher’s experiences in a community-based participatory research (CBPR) project, this article explores how vulnerability is experienced and perceived in the work process and how to respond to vulnerability. It finds that vulnerability manifests in two main ways—that of feeling “emotional hurt” and “epistemic self-doubt”—and that it comes from two main layers: the lived life and from working within CBPR. The main argument in the article is that vulnerability is inevitable in qualitative research like CBPR, when involving persons in vulnerable life situations. We propose four key recommendations for future research: (a) accept vulnerability as an inevitable part of CBPR, (b) balance protection with participant autonomy in situ and together as a team, (c) use a processual approach because ethical risks in the research context might alter over time, and (d) accept that placing co-researchers at the center of interpretative authority can increase professional researcher’s vulnerability. The article expands existing understandings of ethical issues and risk in inclusive research through a combined and innovative focus on both professional and co-researcher’s lived experiences.

A Christian Faith-Based Facebook Intervention for Smoking Cessation in Rural Communities (FAITH-CORE): Protocol for a Community Participatory Development Study.

Tobacco smoking remains the leading cause of preventable morbidity and mortality in the United States, with significant rural-urban disparities. Adults who live in rural areas of the United States have among the highest tobacco smoking rates in the nation and experience a higher prevalence of smoking-related deaths and deaths due to chronic diseases for which smoking is a causal risk factor. Barriers to accessing tobacco use cessation treatments are a major contributing factor to these disparities. Adults living in rural areas experience difficulty accessing tobacco cessation services due to geographical challenges, lack of insurance coverage, and lack of health care providers who treat tobacco use disorders. The use of digital technology could be a practical answer to these barriers. This report describes a protocol for a study whose main objectives are to develop and beta test an innovative intervention that uses a private, moderated Facebook group platform to deliver peer support and faith-based cessation messaging to enhance the reach and uptake of existing evidence-based smoking cessation treatment (EBCT) resources (eg, state quitline coaching programs) for rural adults who smoke. We will use the Integrated Theory of Health Behavior Change, surface or deep structure frameworks to guide intervention development, and the community-based participatory research (CBPR) approach to identify and engage with community stakeholders. The initial content library of moderator postings (videos and text or image postings) will be developed using existing EBCT material from the Centers for Disease Control and Prevention Tips from Former Smokers Campaign. The content library will feature topics related to quitting smoking, such as coping with cravings and withdrawal and using EBCTs with faith-based message integration (eg, Bible quotes). A community advisory board and a community engagement studio will provide feedback to refine the content library. We will also conduct a beta test of the intervention with 15 rural adults who smoke to assess the recruitment feasibility and preliminary intervention uptake such as engagement, ease of use, usefulness, and satisfaction to further refine the intervention based on participant feedback. The result of this study will create an intervention prototype that will be used for a future randomized controlled trial. Our CBPR project will create a prototype of a Facebook-delivered faith-based messaging and peer support intervention that may assist rural adults who smoke to use EBCT. This study is crucial in establishing a self-sufficient smoking cessation program for the rural community. The project is unique in using a moderated social media platform providing peer support and culturally relevant faith-based content to encourage adult people who smoke to seek treatment and quit smoking. PRR1-10.2196/52398.

Peer-Led Focus Groups Identify Barriers to Healthy Lifestyle in African American Adolescents from Baltimore City

Objectives Black youth are disproportionately affected by the US obesity epidemic. Early-age obesity often continues into adulthood and is associated with a higher risk of diabetes, cardiovascular disease, and premature death. Few studies have incorporated community-based participatory research (CBPR) facilitated by youth to provide frank discussions among teens living in inner cities about challenges and facilitators in maintaining a healthy weight and to design teen-identified interventions. Design Black youth (n=10) were recruited from a Baltimore City high school during the 2019 to 2020 academic year and were trained by seasoned investigators and mentored by graduate and undergraduate students on qualitative methods using CBPR. These youth then implemented focus groups with their peers aged 15 to 18 years (10 focus groups of 10 teens each). Topics included healthy lifestyle knowledge, behaviors, attitudes, and suggested interventions. Content analyses were conducted using dual-rater techniques. Results Focus group themes yielded strengths and challenges of weight maintenance for Black youth at various levels, including in their personal lives, families, school, and community. Themes also suggested several technology-based possibilities using social media to reach Black youth about healthy living practices. Conclusions Engagement of Black youth in CBPR projects can yield valuable data to design more culturally responsive and developmentally appropriate interventions. Youth are competent collectors of information to identify needed changes in their schools/communities and about the use of technology/social media to facilitate improved health practices among their peers and should be involved early in the process of developing targeted obesity prevention interventions and/or programs.

Virtually Prioritizing a Community's Needs: What Would Make it Easier for People who are Experiencing Homelessness to Manage Their Diabetes?

Introduction: During the pandemic, a group of people with lived experience (co-researchers) was convened for a community-based participatory research (CBPR) project in Calgary, AB that aimed to explore and address barriers to managing diabetes while experiencing homelessness. The group met bi-weekly using a videoconferencing platform on internet-enabled tablets. Objectives: Our aim is to explain the process we undertook to virtually engage in priority setting to identify a research priority for the CBPR project. Methods: Co-researchers participated in 17 focus group discussions about barriers to managing diabetes while experiencing homelessness, following which they were asked to brainstorm responses to the question, “What would make it easier for people who are experiencing homelessness to manage their diabetes?” In subsequent meetings, the responses were grouped to form categories. From those, the group chose the priority using a modified nominal group process, which involved sequentially ranking, then rating the categories. Ranking involved picking 1st, 2nd, 3rd and 4th choices, and rating involved distributing 0 to 10 points amongst the categories. Results: Seven categories were formed: Healthcare; Screening for Diabetes; Housing and Shelter; Access to Medications and Supplies; Healthy Food; Diabetes Awareness; and Diabetes Education. Among these, Diabetes Awareness was given the most votes during the ranking and the most points during the rating exercises. Therefore, this is the topic our research will be focused on. Conclusion: We will conduct research for the purpose of increasing diabetes awareness, among shelter staff specifically, and use forum theatre and a short narrative film to share the findings.

Does Where You Work and What You Do Matter? Testing the Role of Organizational Context and Job Type for Future Study of Occupation-Based Secondary Trauma Intervention Development.

Organizational context (e.g., criminal justice, community-based, and healthcare) and job type (e.g., police, social workers, and healthcare providers) may impact the extent of occupation-based secondary trauma (OBST). Survey data collected from a multiphase community-based participatory research project were analyzed from a variety of professionals, who were likely to "encounter the consequences of traumatic events as part of their professional responsibilities" (n = 391, women = 55%, White = 92%). Results document high trauma exposure (adverse childhood experiences [ACEs] and workplace) and OBST-related outcomes (Maslach Burnout Inventory, Secondary Traumatic Stress Scale, post-traumatic stress disorder symptom checklist for DSM-5) for the entire sample with important differences across organizational context and job type. Using multivariate regression, the strongest determinants of suffering, however, were not related to a provider's specific profession but to their number of years on the job and their ACEs (e.g., adjusted R2 = 0.23, b = 2.01, p < .001). Likewise, the most protective factors were not profession specific but rather the provider's age and perceived effectiveness of OBST-related training (e.g., b = 2.26, p < .001). These findings inform intervention development and have implications for rural and other often under-resourced areas, where the same OBST-related intervention could potentially serve many different types of providers and organizations.

Food Is Medicine for Individuals Affected by Homelessness: Findings from a Participatory Soup Kitchen Menu Redesign.

Health disparities among people experiencing homelessness are likely exacerbated by limited access to healthy, fresh, and minimally processed foods. Soup kitchens and shelters serve as essential food safety nets for preventing hunger in this population, and community interest is growing in the potential of "food is medicine" interventions to improve the mental and physical wellbeing of people who receive meals from these providers. This study describes our two-phase approach to first identify and prioritize nutrition needs within an urban soup kitchen community and then test and implement new recipes and menu guidelines to help the standard soup kitchen menu better align with those priorities. We began by first conducting a nutrition needs assessment, including a collection of intercept surveys from a convenience sample of soup kitchen guests to better understand their nutrition-related health needs, dental issues, food preferences, and menu satisfaction (n = 112), as well as a nutrition analysis of the standard menu based on seven randomly selected meals. Most respondents reported at least one chronic health condition, with depressive disorders (50.9%) and cardiovascular diseases (49.1%) being the most common. Nearly all guests requested more fruits and vegetables at mealtimes, and results from the menu analysis revealed opportunities to lower meal contents of sodium, saturated fat, and added sugars and to raise micronutrient, fiber, and omega-3 content. We then applied these nutrition needs assessment findings to inform the second phase of the project. This phase included the identification of new food inventory items to help support cardiovascular and mental health-related nutrition needs, taste test sampling of new healthy menu items with soup kitchen guests, and hands-on culinary medicine training to kitchen staff on newly-developed "food is medicine" guidelines to support menu transformation. All taste tests of new menu items received over 75% approval, which exceeded satisfaction ratings of the standard menu collected during the phase 1 needs assessment. Findings from this community-based participatory research project confirm the great potential for hunger safety net providers to support critical nutrition needs within this vulnerable population through strategic menu changes. However, more research is needed on the longitudinal impacts of such changes on health indicators over time.

Hear my voice: understanding how community health workers in the Peruvian Amazon expanded their roles to mitigate the impact of the COVID-19 pandemic through community-based participatory research

IntroductionThe COVID-19 pandemic led to the collapse of the Peruvian health system, disrupting healthcare access for indigenous communities in the Amazon. Our study analysed how community health workers (CHWs) from...