Community-based Prevention Programs Research Articles

Sustainability Planning for a Community Network to Increase Participation in Evidence-Based Lifestyle Change Programs: A Mixed-Methods Approach.

Community-based chronic disease prevention programs can have long-term, broad public health benefits. Yet, only 40 to 60% of evidence-based health programs are sustained. Using established frameworks and evidence-based tools to characterize sustainability allows programs to develop structures and processes to leverage resources effectively to sustain effective program activities and systems. This study used a mixed-methods, partner-engaged approach to identify barriers and facilitators to sustaining a community network (the Alliance program) aimed to increase participation in evidence-based lifestyle change programs delivered in the community. Surveys and qualitative interviews were conducted with the Alliance partners based on the Program Sustainability Assessment Tool and Consolidated Framework for Implementation Research. Overall, partners felt Alliance had a high capacity for sustainability. Strategic planning, communication, and partnerships were areas partners prioritized to improve the potential for sustaining the program. Results informed the co-development of a sustainability action plan. This paper furthers our understanding of factors critical for the sustainability of community-based programs for chronic disease prevention and health equity and presents a process for developing action plans to build sustainability capacity.

Co-Developing Theories of Change for Improved Community-Based Violence Intervention Evaluation.

Community-based violence intervention (CVI) programs are considered important strategies for preventing community violence and promoting health and safety. Mixed and inconclusive results from some prior CVI evaluations-and our general lack of understanding about the reasons for such varied findings-may be explained in part by misalignment of program theories of change and evaluation measures. Further, most prior evaluations have focused solely on deficit-based outcomes; this narrow focus is inconsistent with the premise of CVI and may fail to capture improvements in health and wellbeing that are on the hypothesized pathway from intervention to violence reduction. This paper describes the process and results of co-developing a theory of change for community-based youth firearm violence intervention and prevention programs in Washington state through a community-researcher partnership. We followed a multi-step iterative process, involving 1) CVI program documentation review, 2) individual meetings, and 3) a day-long workshop. The theory of change included 6 key domains: 1) root causes, 2) promotive factors, 3) activities, 4) inter-mediate outcomes, 5) longer-term outcomes, and 6) multi-level context (youth/family, staff/organizational, community, and societal). Root causes were social and structural drivers of community violence. Promotive factors were assets and resources among the community, youth/their families, and community organizations that promote health and safety. Activities were supports and services the program provided to youth and their families, staff, and potentially the broader community. Inter-mediate and longer-term outcomes were the changes among youth, their families, staff, and the community that resulted from program activities. Inter-mediate outcomes may be felt within 6 months to 1 year and longer-term outcomes may be felt after 1-2 years and beyond. The theory of change we co-developed provides a common lens to conceptualize, compare, and evaluate CVI programs in Washington state and may support more rigorous and equity-centered evaluations.Study type: original investigation. N/A.

IDF23-0528 Participation in a long-lasting community-based diabetes prevention program during the COVID-19 pandemic

IDF23-0528 Participation in a long-lasting community-based diabetes prevention program during the COVID-19 pandemic

Optimizing and Implementing a Community-Based Group Fall Prevention Program: A Mixed Methods Study.

Falls and fall-related injuries among older adults are associated with decreased health. Therefore, fall prevention programs (FPPs) are increasingly important. However, the translation of such complex programs into clinical practice lacks insight into factors that influence implementation. Therefore, the aim of this study was to identify how to optimize and further implement a widely used group-based FPP in the Netherlands among participants, therapists and stakeholders using a mixed methods study. FPP participants and therapists filled out a questionnaire about their experiences with the FPP. Moreover, three focus groups were conducted with FPP participants, one with therapists and one with other stakeholders. Data were analysed according to the thematic analysis approach of Braun and Clarke. Overall, 93% of the 104 FPP participants were satisfied with the FPP and 86% (n = 12) of the therapists would recommend the FPP to older adults with balance or mobility difficulties. Moreover, six themes were identified regarding further implementation: (1) recruiting and motivating older adults to participate; (2) structure and content of the program; (3) awareness, confidence and physical effects; (4) training with peers; (5) funding and costs; and (6) long-term continuation. This study resulted in practical recommendations for optimizing and further implementing FPPs in practice.

The critical role of primary care health care professionals in referring older adults to community-based fall prevention programs.

The critical role of primary care health care professionals in referring older adults to community-based fall prevention programs.

Community-Based Crime Prevention Programs and Central American Migration: A Difference in Differences Analysis

Community-based crime prevention programs are emerging as a crucial alternative for addressing violence in Central America, a significant driver of migration from the region to the United States. Comprehensive analyses of the impact of the adoption of programs on migration intentions, especially among individuals who have been victims of crime, are lacking. Using a distinctive survey dataset derived from randomized-controlled experiments conducted in Guatemala, El Salvador, and Honduras, this study shows that community-based crime prevention programs are associated with an increase in migration intentions in Guatemala but are not linked to migration intentions in El Salvador and Honduras. This finding holds even when considering whether these programs address neighborhood factors and perceived risk of future victimization. Further examination of these programs is warranted.

URBANIZATION, FALLS, AND FEAR OF FALLING IN COMMUNITY-DWELLING OLDER ADULTS IN THAILAND

Abstract Nearly half of the Thai population lives in urban areas without retirement pensions. Urbanization may increase physical inactivity, falls, and other non-communicable diseases. Little is known about the urban-rural differences in falls and fear of falling among community-dwelling older in Thailand. We surveyed a random sample of 433 persons who were: i) aged 60 years and older; and ii) had no cognitive impairment (Chula Mental Test ≥ 16/36). The participants had the mean age was 70.40 (± 7.53) years, included 62.9 % female, 22% having poor balance, 85% having limits in doing vigorous physical activity, 71% having limits in performing moderate physical activity, and 63.5% having pain interfere with normal activities. About half had financial problems sometimes, and 68 % reported living with a spouse and children. 30% had hypertension and took antihypertensive medication. 16% felt tired most of the time, and 11% felt nervous all the time. We found that urban older adults had a higher fall rate than rural older adults (52.8% vs. 40.4%, p =.034). Urban older adults also had a higher level of fear of falling than rural older adults (43.9% vs. 28.4%, p = .000016). Additionally, urban older adults had significantly worse general health than rural older adults (p =.0046). There were no significant differences in balance performance and fall self-efficacy scores. It is important to recognize and identify fall risk factors among urban older adults and provide access to systematic community-based fall prevention programs incorporating screening and tailored interventions based on those risk factors.

Weathering the Storm: Syringe Services Program Laws and Human Immunodeficiency Virus During the COVID-19 Pandemic

Background: Syringe services programs (SSPs) are community-based prevention programs that provide a range of harm reduction services to persons who inject drugs. Despite their benefits, SSP laws vary across the United States. Little is known regarding how legislation surrounding SSPs may have influenced HIV transmission over the COVID-19 pandemic, a period in which drug use increased. This study examined associations between state SSP laws and HIV transmission among the Medicaid population before and after the COVID-19 pandemic. Methods: State-by-month counts of new HIV diagnoses among the Medicaid population were produced using administrative claims data from the Transformed Medicaid Statistical Information System from 2019 to 2020. Data on SSP laws were collected from the Prescription Drug Abuse Policy System. Associations between state SSP laws and HIV transmission before and after the start of the COVID-19 pandemic were evaluated using an event study design, controlling for the implementation of COVID-19 nonpharmaceutical interventions and state and time fixed effects. Results: State laws allowing the operation of SSPs were associated with 0.54 (P = 0.044) to 1.18 (P = 0.001) fewer new monthly HIV diagnoses per 100,000 Medicaid enrollees relative to states without such laws in place during the 9 months after the start of the COVID-19 pandemic. The largest effects manifested for population subgroups disproportionately affected by HIV, such as male and non-Hispanic Black Medicaid enrollees. Conclusion: Less restrictive laws on SSPs may have helped mitigate HIV transmission among the Medicaid population throughout the COVID-19 pandemic. Policymakers can consider implementing less restrictive SSP laws to mitigate HIV transmission resulting from future increases in injection drug use. Disclaimer: The findings and conclusions in this report are those of the author(s) and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Reducing Falls Among Community-Dwelling Older Adults From Clinicians' Perspectives: A Systems Modeling Approach.

Falls among older adults are a significant health problem globally. Studies of multicomponent fall prevention programs in randomized controlled trials demonstrate effectiveness in reducing falls; however, the translation of research into the community remains challenging. Although there is an increasing interest to understand the factors contributing to implementation barriers, the dynamic relationships between factors are less well examined. Furthermore, evidence on implementation barriers from Asia is lacking as most of these studies originate from the West. As such, this study aims to engage stakeholders in uncovering the factors that facilitate or inhibit implementing community-based fall prevention programs in Singapore, with a focus on the interrelationship between those factors. Health care professionals familiar with fall prevention programs were invited to discuss the enablers and challenges to the implementation. This effort was facilitated using a systems modeling methodology of Group Model Building (GMB) to share ideas and create a common conceptual model of the challenges. The GMB employs various engagement techniques to draw on the experiences and perceptions of all stakeholders involved. This process led to the development of a Causal Loop Diagram (CLD), a qualitative conceptual model of the dynamic relationships between the barriers and facilitators of implementing fall prevention programs. Results from the CLD show that implementation is influenced by two main drivers: health care provider factors that influenced referrals, and patient factors that influenced referral acceptance and long-term adherence. Key leverage points for potential interventions were identified as well. The overall recommendation emphasized closer coordination and collaboration across providers to ensure sustainable and effective community-based fall prevention programs. This has to be supported by a national effort, involving a multidisciplinary stakeholder advisory group. These findings generated would be promising to guide future approaches to fall prevention.

Development and validation of a questionnaire (GHOST) to assess sudden, unexplained communication exclusion or “ghosting"

The topic of “ghosting” as a method of terminating a relationship has been discussed in both popular media and academic circles. Although research on this issue is scarce, the concept has acquired popularity and gained scholarly attention. A reliable and valid measure of this phenomenon does not, however, exist. GHOST (The Ghosting Questionnaire) was designed and psychometrically tested to explore ghostee experiences. A total of 811 adults participated in an online survey to test this instrument. It was developed based on a thorough analysis of research on the topic of ghosting using a phenomenological qualitative method to identify ghosting domains and generate questionnaire items. In terms of content validity and construct validity, the final version of the measure was found to be satisfactory. GHOST was found to have adequate internal consistency - scores of 0.74, 0.74, and 0.80, indicating acceptable Cronbach's alpha, McDonald's omega, and ordinal's alpha coefficients, respectively. Factor analyses found the GHOST questionnaire to be a valid and reliable instrument that can be used for screening ghosting experiences and for designing community-based distress prevention and intervention programs. A dynamic fit index (DFI) cutoffs approach was also used and showed robust fitting.

Prevalence and factors associated with depression, anxiety and stress symptoms among construction workers in Nepal.

The construction industry in Nepal, which employs a significant proportion of the population, ranks as one of the largest industries in the country. Construction work is physically demanding and can be risky due to the use of heavy machinery and the presence of intense physical labor. However, the physical and mental health of construction workers in Nepal is often neglected. This study aimed to assess psychological distress (depression, anxiety, and stress symptoms) and its association with socio-demographic, lifestyle, and occupational factors among construction workers in Kavre district, Nepal. We conducted a cross-sectional study from 1st October 2019 to 15th January 2020 among 402 construction workers in Banepa, and Panauti municipalities of Kavre district, Nepal. We collected data with face-to-face interviews using a structured questionnaire consisting of a) socio-demographic characteristics; b) lifestyle and occupational characteristics; and c) depression, anxiety and stress symptoms. We collected data using electronic forms in KoboToolbox and imported them into R version 3.6.2 for statistical analysis. We present parametric numerical variables as mean and standard deviation, and categorical variables as percentage and frequency. The confidence interval around proportion was estimated with the Clopper-Pearson method. We applied univariate and multivariable logistic regression to determine factors associated with depression symptoms, anxiety, and stress. The result of logistic regression was presented as crude odds ratio, adjusted odds ratio (AOR), and their 95% confidence interval (CI). The prevalence of depression, anxiety and stress symptoms were 17.1% (95%CI: 13.6-21.2), 19.2% (95%CI: 15.5-23.4) and 16.4% (95%CI: 12.9-20.4), respectively. In multivariable logistic regression analysis, depression symptom was positively associated with poor sleep quality (AOR = 3.51; 95%CI: 1.5-8.19; p-value: 0.004); stress symptom was positively associated with Brahmin ethnicity (AOR = 3.76; 95%CI:1.34-10.58; p-value: 0.012) and current smoking (AOR = 2.0; 95%CI: 1.11-3.82 p-value: 0.022). But anxiety symptoms were not associated with any of the variables. The prevalence of depression, anxiety, and stress symptoms were high among construction workers. Developing evidence-based and appropriate community-based mental health prevention programs among laborers and construction workers is recommended.

Early adolescents’ experiences of a school- and community-based prevention program: perceived ‘bridges’ and ‘walls’ to promoting mental health and wellbeing

ABSTRACT Objective The prevalence of mental health difficulties among children and adolescents is rising. This study aimed to explore early adolescents’ lived experiences of a school- and community-based prevention program, including what helps, why, and when. Method Seventy-eight semi-structured interviews were conducted with early adolescents (aged 10 to 13) as part of the evaluation of HeadStart, a UK-based program. A reflexive thematic analysis was conducted and a typology was developed to facilitate comparisons between participants' experiences. Results The typology consisted of five groups, including early adolescents who described positive or helpful experiences of HeadStart support, those who wanted more support, those who described more mixed or unhelpful experiences of support, and those who did not report receiving much or any support. Cross-group themes highlighted the ‘bridges’ that interventions can build to promote mental health and wellbeing, e.g. learning new coping or problem-solving skills. There was more variation between the groups in terms of the ‘walls’ (e.g. issues with intervention content, timing, or location) that may limit intervention effectiveness. There were also some group differences in terms of the other sources of social support that participants had access to and the level of difficulties that they were facing in their lives. Discussion The findings suggest that intervention developers should tailor design and delivery according to different profiles of early adolescents who may be more or less able or willing to accept help, and who may experience different formats, structures, and content of support as either more or less useful.

Educating and Promoting Health - A Community-based Prevention and Control Program for Soil-Transmitted Helminth Infections in a Community in Rodriguez, Rizal

The impact of soil-transmitted helminthiases on the overall health of an individual may lead to significant morbidity related to the number of worms harbored by the person. Light intensity infections usually present no significant effect on the individual except in times of more massive infections, in which complications may lead to impaired growth and physical development. With this, international and local health programs aim to increase the proportion of community households aware of proper helminthiases prevention and control strategies. Access to potable water, and drainage and disposal or reuse of household water, to safe and sanitary facilities, safe human excreta disposal, and proper management of solid waste appropriate information on prevention and treatment of soil-transmitted helminthiases (STH), and dissemination of key messages to promote safe water storage, hand washing, bathing practices, safe food handling, latrine use and wearing of shoes and regular deworming practices are recommended points of intervention to reduce the prevalence of helminthiases in children and other high-risk population groups. Guided with the principles of health promotion and education and the health program framework of the Department of Health (DOH) and World Health Organization (WHO), community health may be achieved equitably by leveraging accurate information, community mobilization, and sustainable health partnerships. Key words: Soil-Transmitted Helminths, Health Promotion, Health Education, Infectious Disease, Public Health

Impact of the Comprehensive Awareness Modification of Mouth, Chewing and Meal (CAMCAM) Program on the Attitude and Behavior Towards Oral Health and Eating Habits as Well as the Condition of Oral Frailty: A Pilot Study.

Preserving sufficient oral function and maintaining aadequate nutrition are essential for preventing physical frailty and the following long-term care. We recently developed the 6-month Comprehensive Awareness Modification of Mouth, Chewing And Meal (CAMCAM) program, in which participants gather monthly to learn about oral health and nutrition while eating a textured lunch together. This study examined whether the CAMCAM program could improve attitude and behavior towards oral health, mastication, and diet as well as ameliorate oral frailty in community-dwelling older adults. Single-arm pre-post comparison study. A total of 271 community-dwelling adults (72.3 ± 5.7 years of age; 159 women [58.7%]) in 4 Japanese municipalities were recruited, of which 249 participants (92%) were assessed at the final evaluation. Participants gathered once a month at community centers to learn about oral health and nutrition while eating a "munchy" textured lunch containing proper nutrition. Oral frailty, frailty, and eating behavior were evaluated with the Oral Frailty Index-8 (OFI-8), Kihon checklist (KCL), and CAMCAM checklist, respectively. Participants were divided into Oral frailty (OF) and Robust groups according to OFI-8 scores. The differences in KCL and CAMCAM checklist results between the OF and Robust groups were statistically tested along with changes in scores after the program. KCL and CAMCAM checklist scores were significantly lower in the OF group at the initial assessment. OFI-8 and KCL findings were significantly improved in the OF group after completing the program (all P <0.05). Regarding the CAMCAM checklist, awareness of chewing improved significantly in the Robust group (P=0.009), with a similar tendency in the OF group (P=0.080). The findings of this pilot study suggest that the CAMCAM program may improve both oral and systemic frailty in addition to attitudes towards chewing, oral health, and meals, especially in individuals with oral frailty. The CAMCAM program merits expansion as a community-based frailty prevention program.

Effectiveness of Incentivized Peer Referral to Increase Enrollment in a Community-Based Chlamydia Screening and Treatment Study Among Young Black Men.

Young Black men are under-represented in sexual health services and research, a condition likely magnified during COVID-19 shutdowns due to disruption of STI screening and treatment services. We examined the effect of incentivized peer referral (IPR) increasing peer referral among young Black men in a community-based chlamydia screening program. Young Black men in New Orleans, LA, age 15-26years enrolled in a chlamydia screening program between 3/2018 and 5/2021 were included. Enrollees were provided with recruitment materials to distribute to peers. Starting July 28, 2020, enrollees were also offered a $5 incentive for each peer enrolled. Enrollment was compared before and after the incentivize peer referral program (IPR) was implemented using multiple time series analysis (MTSA). The percentage of men referred by a peer was higher during IPR compared to pre-IPR (45.7% vs. 19.7%, p < 0.001). After the COVID-19 shutdown was lifted, there were 2.007 more recruitments per week (p = 0.044, 95% CI (0.0515, 3.964)) for IPR, compared to pre-IPR. Overall, there was a trending increase in recruitments in the IPR era relative to the pre-IPR era (0.0174 recruitments/week, p = 0.285, 95% CI (- 0.0146, 0.0493)) with less recruitment decay during IPR compared to pre-IPR. IPR may be an effective means of engaging young Black men in community-based STI research and prevention programs, particularly when clinic access is limited. Clinicaltrials.gov identifier NCT03098329.

Analysis of the effect of a community based injury prevention program using synthetic control method

Objectives: The purpose of this study is to examine how residents’ injury mortality varies depending on the implementation of a community-based injury prevention program with an international safe community model and to analyze the program’s effectiveness. Methods: The study analyzed descriptive statistics and annual variation to understand the targeted regions’ characteristics and applied the synthetic control method (SCM) to determine whether significant changes occurred before and after the region’s designation as International Safe Community. Results: The age-adjusted injury death rate by years and regions fluctuated but often tended to increase for intentional injury, whereas it continually decreased for unintentional injury. Additionally, although the mortality in designated regions tended to be similar to that of the control group before the designation as International Safe Community, the mortality in the former was substantially lower than after the designation. Conclusion: At the community level, It is necessary to continuously plan a project including comprehensive strategies for injury prevention, which match regional characteristics, and to promote a targeted and customized program based on injury mechanisms.

Continuity of CVD treatment during the COVID-19 pandemic: evidence from East Java, Indonesia

BackgroundIn Indonesia, the world's fourth most populous country, cardiovascular diseases (CVDs) are a leading cause of death and disability. Government efforts to reduce the burden of CVD include a community-based prevention and early detection programme, and the provision of medicines to prevent cardiovascular events. Disruptions to medicine supply chains, service provision, and movement during the COVID-19 pandemic potentially threatened the continuity of these efforts. We investigated the distribution and dispensing of common CVD medicines in Malang district, East Java, before the pandemic and early in its course.MethodsFrom January to October 2020, we collected monthly data on stock levels, sales or dispensing volumes, and price for five common CVD medicines (amlodipine, captopril, furosemide, glibenclamide and simvastatin), from a public and a private distributor, and from public health facilities (n = 4) and private pharmacies (n = 2). We further complied monthly data on patient numbers in two primary health centres. We tracked changes in stocks held and volumes dispensed by medicine type and sector, comparing the three months before the local COVID-19 response was mobilised with the subsequent seven months. We conducted interviews with pharmacists (n = 12), community health workers (n = 2) and a supply chain logistics manager to investigate the reasons for observed changes, and to learn details of any impacts or mitigation measures.ResultsThe pandemic affected demand more than supply, causing medicine stocks to rise. Restricted service provision, lock-down measures and fear of infection contributed to a sharp drop in patient numbers and dispensing volumes in the public sector. Meanwhile private sector sales, especially of lower-priced CVD medicines, rose. Community health workers attributed some poor health outcomes to interruption in regular patient check-ups; this interruption was aggravated by formal mitigation policies.ConclusionsFears that COVID-19 would interrupt medicine availability were unfounded in East Java. Public sector patients may have compensated for reduced service access by switching to private pharmacies. Mitigation policies that ignored administrative procedures were not effective.

Social deprivation, the Area Deprivation Index, and emergency department utilization within a community-based primary and preventive care program at a Florida medical school

Social deprivation, the Area Deprivation Index, and emergency department utilization within a community-based primary and preventive care program at a Florida medical school

Supporting Healthy Aging and Older Adult Health: The Role of State and Territorial Health Agencies.

Supporting Healthy Aging and Older Adult Health: The Role of State and Territorial Health Agencies.

How do contextual factors influence naloxone distribution from syringe service programs in the USA: a cross-sectional study

BackgroundNaloxone is a medication that can quickly reverse an opioid overdose. Syringe service programs (SSPs) are community-based prevention programs that provide a range of evidence-based interventions in the USA, including naloxone distribution. Attributes of SSPs make them ideal settings for naloxone distribution—they have staff and delivery models that are designed to reach people who use drugs where they are. We assessed which outer and inner setting factors of SSPs were associated with naloxone distribution in the USA.MethodsWe surveyed SSPs in the USA known to the North American Syringe Exchange Network in 2019. Using the exploration, preparation, implementation and maintenance framework, we assessed inner and outer contextual factors associated with naloxone distribution among SSPs (n = 263 or 77% of SSPs). We utilized negative binomial regression to assess which factors were associated with the number of naloxone doses distributed and people receiving naloxone.ResultsSSPs reported distributing 710,232 naloxone doses to 230,506 people in the prior year. Regarding outer setting, SSPs located in areas with high levels of community support had a higher level of naloxone distribution (aIRR = 3.07; 95% confidence interval (CI): 2.09–4.51; p < 0.001) and 110% (p = 0.022) higher rate of people receiving naloxone (aIRR = 2.10; 95% CI 1.46–3.02; p < 0.001) in the past 12 months. The legal status of SSPs and the level of need was not significantly associated with naloxone distribution. Regarding inner setting, SSPs with proactive refill systems (aIRR = 2.08; 95% CI 1.27–3.41; p = 0.004), greater number of distribution days (aIRR = 1.09 per day; 95% CI 1.06–1.11; p < 0.001) and older programs (aIRR = 1.06 per year; 95% CI 1.02–1.11; p = 0.004) were associated with higher levels of naloxone distribution. Also, SSPs with proactive refill systems (aIRR = 2.23; 95% CI 1.38–3.58; p = 0.001); greater number of distribution days (aIRR = 1.04; 95% CI 1.02–1.07; p < 0.001) and older programs (aIRR = 1.11; 95% CI 1.05–1.17; p < 0.001) were associated with a higher number of people receiving naloxone.ConclusionWe identified outer and inner setting factors of SSPs that were associated with greater naloxone distribution. It is critical to ensure SSPs are adequately resourced to build community support for services and develop service delivery models that maximize naloxone distribution to address the nation’s opioid overdose crisis.