Community-based Research Study Research Articles

50 Co-designing an intervention with asylum seeking youth to improve access to healthcare in Canada using human-centered design

Abstract Background Asylum seeking youth in Canada and the United States face multiple barriers to accessing healthcare, leaving them at greater risk of worse health outcomes. In a previous study, we found that limited knowledge of the Canadian health care system and few navigation supports were a key barrier to care for asylum seeking youth, yet no youth-developed intervention existed to support this population. Human-centered design (HCD) develops meaningful interventions with communities who have been historically marginalized. Objectives This study sought to co-design an intervention to increase youth empowerment and access to health care for asylum seeking youth in Canada. Design/Methods This was a community-based participatory-action research (CBPAR) study, and combined human-centered design (HCD) methodologies. We obtained research ethics board approval for this study (#SMH REB 22-117). In partnership with two community organizations that supported asylum seeking youth in a large Canadian city, a youth advisory board was created. In multiple co-creation sessions over a calendar year, an intervention was developed in rapid prototyping sessions and refined with feedback, to develop a final pilot intervention. Results A total of 7 asylum-seeking youth participated in the youth advisory board, ranging in age from 12-19, representing 3 different languages and included youth who self-identified with chronic medical conditions. Over a 15-month period, they participated in 6 co-creation sessions to develop a multi-lingual, web-based tool; youth specifically stated they did not believe an app would be helpful, but rather a resource that could be easily accessed. The youth advisory board shared they had limited understanding of the Canadian healthcare system, as well as interim and provincial health insurance. Youth felt the tool should answer questions about how health insurance worked, be brightly colored, use dyslexia-friendly font and be easily saved on a smartphone as an image. A multi-lingual wallet card was developed for youth to easily present at healthcare encounters, particularly if they did not have provincial health insurance, to help youth communicate their coverage, language and needs. Conclusion To our knowledge, we developed the first co-designed tool in Canada for youth asylum seekers, by youth, to improve and empower youth to receive health care services they are entitled to through navigation support. Given the high degree of marginalization faced by asylum seeking youth, this intervention has the promise to improve health outcomes. Feasibility and acceptability of this study will be evaluated in subsequent studies.

COVID-19 vaccination intention among people who use drugs in France in 2021: results from the international community-based research program EPIC

BackgroundCOVID-19 vaccination is crucial to reduce the incidence of severe forms of the disease in the population. However, people who use drugs (PWUD) face structural and individual barriers to vaccination, and little is known about vaccination intention and factors associated with that intention among PWUD. This study aimed to estimate vaccination intention in PWUD and associated factors in the early stage of vaccination campaigns.MethodsWe conducted cross-sectional study in France among PWUD, as part of the international EPIC program, a community-based research study coordinated by Coalition PLUS. It included 166 unvaccinated PWUD attending harm reduction centers. A questionnaire collected data on sociodemographic characteristics, COVID-19 related difficulties, and mental health, among other things. Multivariate logistic regression was used to identify factors associated with low vaccination intention.ResultsOnly 19% of participants reported strong intention to get vaccinated against COVID-19. Factors independently associated with low vaccination intention were younger age (aOR = 0.90, 95%CI = 0.85–0.95), lower education level (aOR = 2.67, 95% CI = 0.95–7.55), and unstable housing (aOR = 6.44, 95% CI = 1.59–40.34). The most-cited reasons for low intention were mistrust in COVID-19 vaccines (66.1%), fear of side effects (48.7%), and non-belief in vaccinations in general (25.2%).ConclusionsThis study highlights the need for targeted COVID-19 information and interventions to increase vaccine uptake in PWUD, especially those living in precarity. Community-based interventions and targeted government assistance could play a crucial role in addressing vaccine hesitancy in this population, not only for COVID-19 but for future epidemics.

Contextualizing HIV testing experiences within the HIV prevention cascade: qualitative insights from refugee youth in Bidi Bidi refugee settlement, Uganda

BackgroundThere remain key knowledge gaps regarding HIV testing needs and priorities among refugee youth in low and middle-income country (LMIC) humanitarian settings. The HIV prevention cascade framework focuses on three domains (motivation, access, effective use) central to prevention uptake, yet is understudied in relationship to HIV testing, particularly among refugee youth. Uganda is an exemplar context to explore refugee youth HIV testing needs and priorities as it hosts 1.5 million refugees and is Africa’s largest refugee hosting nation. In this study, we explored perceptions and experiences regarding HIV testing among refugee youth living in Bidi Bidi refugee settlement, Uganda.MethodsWe conducted a community-based research study in Bidi Bidi Refugee Settlement, one of the world’s largest refugee settlements with over 195,000 residents. This qualitative study involved four focus groups (2 with young women, 2 with young men) with refugee youth aged 16–24 living in Bidi Bidi refugee settlement. We applied thematic analysis informed by the HIV prevention cascade to understand domains of motivation, access, and effective use that emerged as salient for HIV testing engagement.ResultsParticipants (n = 40; mean age: 20 years, standard deviation: 2.2) included refugee young women (n = 20) and young men (n = 20), of whom 88% had a lifetime HIV test and 58% had ever heard of HIV self-testing. Participant discussions described HIV testing motivation was influenced by dimensions of: HIV treatment and testing knowledge; risk perception; positive and negative consequences of use; and social norms regarding gender and age. Access to HIV testing was shaped by: limited availability; distance and language barriers; confidentiality concerns; and affordability. Effective use of and engagement with HIV testing was related to HIV serostatus knowledge self-efficacy and in/equitable partner dynamics.ConclusionsComplex, multi-level factors shape motivation for, access to, and effective use of HIV testing among refugee youth in Bidi Bidi. Findings align with the HIV prevention cascade framework that helps to identify gaps to inform intervention development with youth in humanitarian settings. HIV testing approaches tailored for refugee youth in contexts such as Bidi Bidi can foster HIV prevention and treatment literacy, gender equity, gender-based violence prevention, and intersectional stigma reduction.

Validation of case-ascertainment algorithms using health administrative data to identify people who inject drugs in Ontario, Canada

ObjectivesHealth administrative data can be used to improve the health of people who inject drugs by informing public health surveillance and program planning, monitoring, and evaluation. However, methodological gaps in the use of these data persist due to challenges in accurately identifying injection drug use (IDU) at the population level. In this study, we validated case-ascertainment algorithms for identifying people who inject drugs using health administrative data in Ontario, Canada. Study Design and SettingData from cohorts of people with recent (past 12 months) IDU, including those participating in community-based research studies or seeking drug treatment, were linked to health administrative data in Ontario from 1992 to 2020. We assessed the validity of algorithms to identify IDU over varying look-back periods (ie, all years of data [1992 onwards] or within the past 1–5 years), including inpatient and outpatient physician billing claims for drug use, emergency department (ED) visits or hospitalizations for drug use or injection-related infections, and opioid agonist treatment (OAT). ResultsAlgorithms were validated using data from 15,241 people with recent IDU (918 in community cohorts and 14,323 seeking drug treatment). An algorithm consisting of ≥1 physician visit, ED visit, or hospitalization for drug use, or OAT record could effectively identify IDU history (91.6% sensitivity and 94.2% specificity) and recent IDU (using 3-year look back: 80.4% sensitivity, 99% specificity) among community cohorts. Algorithms were generally more sensitive among people who inject drugs seeking drug treatment. ConclusionValidated algorithms using health administrative data performed well in identifying people who inject drugs. Despite their high sensitivity and specificity, the positive predictive value of these algorithms will vary depending on the underlying prevalence of IDU in the population in which they are applied.

Middle Class African American Parents’ Aspirations for Rigor and Reading Curriculum During the Pandemic Era in Detroit Schools

This community-based research study examined the perspectives of African American parents of middle-class economic status who participated in a social network pertaining to school choice decisions during the pandemic era of virtual schooling. Their residency and school choices emerged against the grain of urban schools that have racially charged histories and decades of residential mobility trends. I examined parents’ aspirations for academic rigor and perspectives of literacy practices at select schools as well as public school district official perspectives of supporting the enrollment process and attracting families to the district. Parent interview and survey data revealed confidence in public, private, and charter school selections prior to enrolling, but uncertainty with the virtual literacy curriculum once enrolled in school. School district official interviews revealed enhanced awareness of parents’ concerns surrounding school choice and need to be proactive to the needs of middle-class families.

Storage, Reuse and Disposal Practices of Home - Stored Medicines in Urban Households in Pune, India

Background: Improper home medicine storage is a global issue that leads to medicine wastage contributing to adverse effects. There have only been a few community-based research studies for in-home drug storage methods, reasons for use and its disposal ways among the consumers of India, until date. Methodology: A descriptive, cross-sectional study was done from April 2023 to June 2023. Data were collected by face-to-face interview of household representative using pretested structured questionnaire on medicines in households, their utilization, storage and disposal practices. Results: Most of the participants (78.3%) were educated to the level of graduation and above and their common reported source of procurement for stored medicines was doctor’s previous prescriptions (61.79%) where 42.5% of them stored medicines for anticipated future use. Commonly stored drugs in households were analgesics and antihistaminics and drugs for digestive system while only 5.3% stored antibiotics mostly for ongoing treatment. Unsafe storage practices like storing medicines without proper labelling (65%) and within reach of children (33.49%) were found in the study. Also, 42.45% participants reported to share stored medicines with family members and friends. Major practice for drug disposal was reported as throwing in household garbage (93.1%). Conclusion: In current study, 100% prevalence of in-home storage medication practices among the well-educated consumers without proper care taken for their use, storage and disposal which may pose a risk to the environment as well as humans.

Impact of the COVID-19 Health Crisis on Key Populations at Higher Risk for, or Living With, HIV or Hepatitis C Virus and People Working With These Populations: Multicountry Community-Based Research Study Protocol (EPIC Program).

Information concerning the impact of the COVID-19 health crisis on populations most affected by HIV and hepatitis C virus (HCV; or key populations [KP]), and those working with these populations in community settings, is limited. Community-based organizations working in the field of HIV and viral hepatitis are well placed to identify and meet the new needs of KP owing to the health crisis. This study aims to describe the development and implementation of an exploratory and descriptive multicountry, community-based research program, EPIC (Enquêtes Pour évaluer l'Impact de la crise sanitaire covid en milieu Communautaire), within an international network of community-based organizations involved in the response to HIV and viral hepatitis. The EPIC program aimed to study the impact of the COVID-19 health crisis on KP or people living with HIV or HCV and people working with these populations at the community level (community health workers [CHWs]) and to identify the key innovations and adaptations in HIV and HCV services. A general protocol and study documents were developed and shared within the Coalition PLUS network. The protocol had a built-in flexibility that allowed participating organizations to adapt the study to local needs in terms of the target population and specific themes of interest. Data were collected using surveys or interviews. From July 2020 to May 2022, a total of 79 organizations participated in the EPIC program. Across 32 countries, 118 studies were conducted: 66 quantitative (n=12,060 among KP or people living with HIV or people living with HCV and n=811 among CHWs) and 52 qualitative (n=766 among KP or people living with HIV or people living with HCV and n=136 among CHWs). The results of the EPIC program will provide data to describe the impact of the health crisis on KP and CHWs and identify their emerging needs. Documentation of innovative solutions that were put into place in this context may help improve the provision of services after COVID-19 and for future health crises. DERR1-10.2196/45204.

Improving access to palliative care for people experiencing socioeconomic inequities: findings from a community-based pilot research study.

In Canada, people experiencing socioeconomic inequities have higher rates of late diagnosis and lower survival rates than the general population. Palliative care services focussed on this population are scarce. We developed a community-based nursing intervention to improve access to palliative care for people experiencing socioeconomic inequities and living with life-limiting illnesses in an urban Canadian setting. This community-based, qualitative research study combined critical and participatory research methodologies. The study was conducted in partnership with the Palliative Care Outreach Advocacy Team (PCOAT) based in Edmonton, Alberta, a team dedicated to serving populations experiencing socioeconomic inequities who require palliative care. Following an exploratory phase that served to delineate the intervention, we undertook a one-year pilot implementation during which a part-time registered nurse (RN) joined PCOAT. The RN engaged in trust building, resolution of health and practical needs and complex care coordination. Twenty-five patients participated in the intervention. Participants were interviewed at least once to explore their experiences with the intervention. Data were analyzed through thematic analysis. Most participants were men, were Indigenous and had advanced cancer. Participants had significant financial concerns, lived or had lived in precarious housing situations and had previously faced serious challenges accessing health care. Participants reported social and health needs including housing, finances, transportation, symptom control, harm reduction and end-of-life care. Participants reported improved access to health and social services and expressed satisfaction with the study intervention. Study findings suggest the study intervention may have contributed to improved access to palliative care, improved experiences for participants and increased equity in the delivery of care.

Non-disclosure of drug injection practices as a barrier to HCV testing: results from the PrebupIV community-based research study

BackgroundHepatitis C virus (HCV) infection prevalence is particularly high in people who inject drugs (PWID), a population that faces many barriers to HCV testing and care. A better understanding of the determinants of access to HCV testing is needed to improve their engagement in the HCV care cascade. We used data from a cross-sectional survey of people who inject drugs, mainly opioids, to identify factors associated with recent HCV testing.MethodsSelf-reported data on HCV antibody testing were analyzed for 550 of the 557 PWID enrolled in PrebupIV, a French cross-sectional community-based survey which assessed PWID acceptability of injectable buprenorphine as a treatment. Factors associated with recent (i.e., in the previous six months) HCV antibody testing were identified performing multivariable logistic regression.ResultsAmong the study sample, 79% were men and 31% reported recent HCV antibody testing. Multivariable analysis found that PWID who did not disclose their injection practices to anyone (aOR [95% CI] 0.31 [0.12,0.82], p = 0.018), older PWID (aOR [95% CI] 0.97 [0.95,1.00], p = 0.030) and employed respondents (aOR [95% CI] 0.58 [0.37,0.92], p = 0.019) were all less likely to report recent HCV testing. No association was found between opioid agonist therapy and HCV testing.ConclusionsOur findings suggest that non-disclosure of injection practices, employment and age were all barriers to HCV antibody testing. Preventing stigma around injection practices, developing the HCV testing offer in primary care and addiction care services, and training healthcare providers in HCV care management could improve HCV testing and therefore, the HCV care cascade in PWID.

Maternal Mortality Review, an Open Window on the Experience of Safe Motherhood in Low-Resource Countries

Maternal mortality (MM) is unacceptably high in many parts of the world, including Sudan, despite the effort to reduce it. This paper will review MM in Elgadarif State in Sudan and how to improve obstetric care quality. This is a hospital- and community-based prospective research study of MM by counting every MD (MD) in the state that has occurred in Elgadaref State, Sudan, during the study period. The state and central offices are notified of the data collected with respect to MD. An expert reviews every MD in a hospital. The investigator looks into every MD in the community. There were 72 MDs; 68 cases were avoidable, while four were unavoidable. The MMR was 176/100000/ live births. Significant factors associated with MM are gestational age, the direct cause of death, existing medical problems and co-morbidities, shortage of antenatal care services, lack of delivery services, and preterm labor (p-value <0.05). Most women who died in this study were hospitalized seriously ill (85.7%) or at home (10.7%). The common cause of MD is postpartum haemorrhage19 (26.5%). In this area, there is a considerable contribution of the Kalazar 6 (8.5%). Poorly financed and weak referral systems are critical determinants of maternity outcomes. Other determinants include poor access, equity of services, lack of skilled birth attendance, protocols, and essential drug availability. Maternal Mortality Review provides a valuable opportunity to learn from each maternal death and take action to prevent future deaths. By prioritizing safe motherhood and investing in maternal health services, we can ensure that all women have access to the care they need during pregnancy and childbirth.

Disruptions of sexually transmitted and blood borne infections testing services during the COVID-19 pandemic: accounts of service providers in Ontario, Canada

BackgroundSince the onset of the COVID-19 pandemic in March 2020 in Canada, the availability of sexual health services including sexually transmitted and blood-borne infection (STBBI) testing has been negatively impacted in the province of Ontario due to their designation as “non-essential” health services. As a result, many individuals wanting to access sexual healthcare continued to have unmet sexual health needs throughout the pandemic. In response to this, sexual health service providers have adopted alternative models of testing, such as virtual interventions and self-sampling/testing. Our objective was to investigate service providers’ experiences of disruptions to STBBI testing during the COVID-19 pandemic in Ontario, Canada, and their acceptability of alternative testing services.MethodsBetween October 2020-February 2021, we conducted semi-structured virtual focus groups (3) and in-depth interviews (11) with a diverse group of sexual health service providers (n = 18) including frontline workers, public health workers, sexual health nurses, physicians, and sexual health educators across Ontario. As part of a larger community-based research study, data collection and analysis were led by three Peer Researchers and a Community Advisory Board was consulted throughout the research process. Transcripts were transcribed verbatim and analysed with NVivo software following grounded theory.ResultsService providers identified the reallocation of public health resources and staff toward COVID-19 management, and closures, reduced hours, and lower in-person capacities at sexual health clinics as the causes for a sharp decline in access to sexual health testing services. Virtual and self-sampling interventions for STBBI testing were adopted to increase service capacity while reducing risks of COVID-19 transmission. Participants suggested that alternative models of testing were more convenient, accessible, safe, comfortable, cost-effective, and less onerous compared to traditional clinic-based models, and that they helped fill the gaps in testing caused by the pandemic.ConclusionsAcceptability of virtual and self-sampling interventions for STBBI testing was high among service providers, and their lived experiences of implementing such services demonstrated their feasibility in the context of Ontario. There is a need to approach sexual health services as an essential part of healthcare and to sustain sexual health services that meet the needs of diverse individuals.

Relationship and Gender Equity Measurement Among Gender-Inclusive Young Women and Non-Binary Youth in British Columbia (RE-IMAGYN BC): Planning a Youth-Led, Community-Based, Qualitative Research Study

Gender-based power dynamics within intimate relationships such as controlling behaviours are driven by inequitable gender norms that perpetuate intimate partner violence (IPV). Yet, the ways in which we understand and measure gender-based power dynamics focus on the relationships of monogamous, cisgender, white, heterosexual women. This paper outlines our process of planning and implementing a qualitative, youth-led, community-based research (CBR) study exploring how diverse youth with intersecting identities perceive existing measures of gender equity and understand gender equity based on their own relationships. Between August-November 2022, we used purposive sampling to recruit 30 gender-inclusive young women and non-binary youth aged 17–29 with diverse identities, who live in British Columbia (BC), and have recent experience in a non-heterosexual and/or non-monogamous relationship (within prior 12 months). Using CBR methods, we hired and trained three Youth Research Associates (YRAs) and convened a 10-member Youth Advisory Committee (YAC) comprised of youth aged 19–28 years with queer, trans, and/or non-monogamous identities and experiences to consult on all aspects of our study. YRAs conducted cognitive interviews using an interview guide co-developed and piloted in partnership with the YAC and YRAs. Cognitive interviews explored youth perceptions of gender equity and two gender equity measures widely used in health research today. Interview data will be analyzed collaboratively using intersectional descriptive and thematic analysis. Results from our CBR study will be used to make recommendations to advance gender equity measurement to be more inclusive of and applicable to a diversity of youth relationships, experiences, and identities.

Building capacity in quantitative research and data storytelling to enhance knowledge translation: a training curriculum for peer researchers

BackgroundMany community-based HIV research studies incorporate principles of greater involvement and meaningful engagement of people living with HIV (GIPA/MEPA) by training people with HIV as peer researchers. Unfortunately, there are still some aspects of research (e.g., quantitative data analysis and interpretation) where many projects fall short in realizing GIPA/MEPA principles. To address these gaps, we developed an eight-week training course that aimed to build the capacity of peer researchers around the understanding and interpretation of quantitative data and incorporating lived experience to increase the impact of the knowledge transfer and exchange phase of a study.MethodsPeer researchers (n = 8) participated from British Columbia, Alberta, and Ontario and lessons learned from the training were implemented throughout the dissemination of research findings from the People Living with HIV Stigma Index study. This paper presents the curriculum and main training components, course evaluation results, and challenges and lessons learned. The manuscript was created in collaboration with and includes the perspectives of both the peer researchers involved in the training, as well the course facilitators.ResultsThroughout the course, peer researchers’ self-assessed knowledge and understanding of quantitative research and data storytelling improved and, through interactive activities and practice, they gained the confidence to deliver a full research presentation. This improved their understanding of research findings, which was beneficial for discussing results with community partners and study participants. The peer researchers also agreed that learning about integrating lived experience with quantitative data has helped them to make research findings more relatable and convey key messages in a more meaningful way.ConclusionsOur training curriculum provides a template for research teams to build capacity in areas of research where peer researchers and community members are less often engaged. In doing so, we continue to uphold the principles of GIPA/MEPA and enhance the translation of research knowledge in communities most greatly affected.

Culturally Responsive Civic Engagement: A Pathway to Mental Health Equity for Latinx Youth.

Description The COVID-19 pandemic magnified the existing inequities in the mental healthcare system that disproportionately affects communities of color, especially Latinx youth. This population faces disparities in the availability, accessibility, and quality of mental health services. This call to action to combat current mental health disparities entails ongoing collaborative efforts that address the plights of this community through community-based research studies. These studies inform efforts to mobilize health professionals, policymakers, and community partners across sectors to collaboratively dismantle systemic disparities and promote culturally-responsive initiatives.

Obstacles and Pathways on the Journey to Access Home and Community Care by Older Adults Living With HIV/AIDS in British Columbia, Canada: Thrive, a Community-Based Research Study

Older adults living with HIV (OALHIV) (i.e., age ≥50) now constitute over 50% of all people accessing HIV treatment in British Columbia (BC), Canada. As OALHIV age, the need for supportive care in non-acute settings, including home and community care (HCC), is increasing. The Thrive research project was co-created alongside OALHIV in BC to support people to thrive with a good quality of life (as contrasted with just surviving). Phase 1 of the project linked treatment and demographic records for 5603 OALHIV accessing care in BC. Phase 2 took a community-based research approach with semi-structured interviews to understand obstacles and pathways experienced by 27 OALHIV in accessing HCC. This article summarizes previously published Phase 1 findings and explores Phase 2 findings in-depth. On the HCC journey traveled by OALHIV in BC, there are four main junctures at which obstacles and pathways appear: (1) before referral, (2) during the referral process, (3) at the assessment, and (4) while receiving services. Obstacles are largely related to fluctuating HCC priorities and funding cuts tied to election cycles, requiring systemic and policy changes to enable positive outcomes and impacts in the provision of HCC services. These obstacles can be transformed into pathways through public policy and client-centered, culturally safe care.

Prevalence and Correlates of Incarceration Among Trans Men, Nonbinary People, and Two-Spirit People in Canada.

In the United States, sexual and gender minority populations are known to experience both higher rates of incarceration and more harmful experiences while incarcerated. However, little is known about incarceration rates or experiences among these populations in Canada or among trans men, nonbinary people, and Indigenous Two-Spirit people. This community-based research study analyzed anonymous self-completed survey data from gay, bisexual, trans, and queer men, and nonbinary and Two-Spirit people to determine the prevalence and correlates of lifetime incarceration among trans men, nonbinary, and Two-Spirit participants. Overall, 5.7% of trans participants, 10.6% of nonbinary participants, and 19.7% of Two-Spirit participants reported being incarcerated in their lifetime, all higher than the prevalence among cisgender non-Two-Spirit participants (3.7%). Multivariable logistic regression models revealed both similar and different correlates of incarceration for trans, nonbinary, and Two-Spirit participants, including older age, less education, experiences of forced sex as a minor, hepatitis C virus (HCV) and HIV diagnoses, substance use, and being less out about one's sexuality. Our findings highlight the disproportionate and inequitable incarceration of trans men, nonbinary, and Two-Spirit people and underscore the need for access to gender diverse, culturally competent HCV and HIV screening, prevention, treatment, and harm reduction in correctional facilities.

A community-based participatory approach to engaging Congolese migrants in intervention co-design

Abstract Issue The World Health Organization has called for tailored, community-based interventions to address disparities in vaccination uptake affecting migrant and minoritised populations, however few exist. This study directly responds to global calls for community-centred and participatory approaches to engaging migrants in routine and COVID-19 vaccination. Problem description Black and African migrants are known to be at risk of under-immunisation and have lower COVID-19 vaccine uptake rates in high-income countries. This UK study will use community-based participatory approaches to engage Congolese migrants in co-developing a tailored intervention to increase vaccine uptake. A community-academic coalition will lead the study. Community members will be trained as peer researchers and financially compensated. The final output will be an intervention strategy tailored to and embedded within the Congolese migrant community. Preliminary results The coalition held 20 hours of planning meetings and peer researcher training in 2021 and co-developed a phased study involving 1) community days with poster walls and qualitative in-depth interviews with Congolese migrants, 2) interviews and workshops with local stakeholders, and 3) co-design workshops with Congolese migrants. Following outreach and pre-engagement, approximately 80 migrants attended the community days, with more than 50 interviews and 100% left positive feedback (including: felt valued, welcomed, Congolese language recognised). Lessons Community-academic partnerships are resource-intensive but can be an effective means to build and maintain trust required to deliver a community-based research study. Academic partners should support community partners in understanding the research process to help manage expectations and provide financial compensation for their time and effort. This study offers an innovative engagement model and study design that can be adapted to other underserved populations. Key messages • Global policy-setting organisations have called urgently for participatory research that engages migrants in the co-production of tailored initiatives to address vaccination inequalities. • This study uses a novel, theory-driven, participatory approach to engage with and identify barriers to vaccination in Congolese migrants and co-design a tailored strategy to increase uptake.

Research Paper of the Year 2021: relevant to training and beyond.

<h3>Objectives</h3> To define the prevalence of severe chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and its clinical characteristics in a geographically defined area of Northern England. To understand the feasibility of a community-based research study in the severely affected CFS/ME group. <h3>Design</h3> A two-phase clinical cohort study to pilot a series of investigations in participants own homes. <h3>Setting</h3> Participants were community living from the area defined by the Northern clinical network of the UK. <h3>Participants</h3> Adults with either a medical or a self-reported diagnosis of CFS/ME. Phase 1 involved the creation of a database. Phase 2: five participants were selected from database, dependent on their proximity to Newcastle. <h3>Interventions</h3> The De Paul fatigue questionnaire itemised symptoms of CFS/ME, the Barthel Functional Outcome Measure and demographic questions were collected via postal return. For phase 2, five participants were subsequently invited to participate in the pilot study. <h3>Results</h3> 483 questionnaire packs were requested, 63 were returned in various stages of completion. 56 De Paul fatigue questionnaires were returned: all but 12 met one of the CFS/ME criteria, but 12 or 22% of individuals did not fulfil the Fukuda nor the Clinical Canadian Criteria CFS/ME diagnostic criteria but 6 of them indicated that their fatigue was related to other causes and they barely had any symptoms. The five pilot participants completed 60% of the planned visits. <h3>Conclusions</h3> Severely affected CFS/ME individuals are keen to participate in research, however, their symptom burden is great and quality of life is poor. These factors must be considered when planning research and methods of engaging with such a cohort.

Factors Associated With the Nutritional Status of Infants and Young Children From Rural Honduras

ObjectivesMalnutrition is a major public health problem in children. Undernutrition and excessive weight at young ages are associated with life-long consequences. The main objective of this study was to characterize the sociodemographic and food insecurity factors associated with the nutritional status of rural children ages 6 to 24 months living in 27 rural communities in Intibucá, Honduras. MethodsThis secondary analysis of baseline data included a total of 402 children ages 6 to 24 months who were recruited to participate in a cluster-non-randomized trial of a community-based nutrition intervention. Data were collected in January 2021 through a survey that assessed food insecurity and dietary diversity, and measurement of weight and length by community health workers. The associations between explanatory variables (sociodemographic and food insecurity factors) and binary outcomes including stunting (length-for-age z-score < –2); underweight (weight-for-age z-score < –2); overweight (weight-for-length > 2); and wasting (weight-for-length < –2), were explored using generalized linear mixed models with community cluster as a random effect. ResultsParticipant’s mean age was of 15.54 ± 5.63 months. The prevalence of stunting, underweight, overweight, and wasting were 18.41%, 4.49%, 6.00%, and 1.00%, respectively. The 74.8% of households reported being food insecure. The odds of being stunted decreased by 15% in children with more diverse diets [AOR = 0.85; 95% CI (0.73–0.98)]; females had 71% lower odds of being underweight [AOR = 0.29; 95% CI (0.09–0.93)]. More time breastfeeding was associated with 10% lower odds of being overweight [AOR = 0.90; 95% CI (0.84–0.97)]. No factors were associated with wasting. ConclusionsContinued breastfeeding up to two years of age may be beneficial to avoid excessive weight in young children from rural areas in Honduras. Increased dietary diversity may help prevent stunting in the region. A community-based implementation research study is undergoing. This intervention includes the provision of vouchers to mothers of 6 to 24 month-old children. Vouchers are exchanged for locally produced eggs intended to be offered to the child daily. Further research characterizing complementary feeding practices and child gender in rural Honduras is needed. Funding SourcesThis study is funded by Shoulder to Shoulder Inc.

Community-based research during a pandemic: reflections from the multi-country EPIC project

In 2020, the COVID-19 health crisis affected all regions of the world, not sparing people already vulnerable to other viral epidemics such as HIV or HCV and/or those in precarious or socially marginalized situations. This is particularly the case for drug users or sex workers.Coalition PLUS, a network of associations fighting against HIV and viral hepatitis which defends and promotes the community-based approach, and its partners, have set up a multi-country community-based research project aimed at documenting the impact of the health crisis on the fight against HIV and viral hepatitis (key populations and community workers/activists), as well as the community responses put in place (EPIC survey).The objective of this paper is to reflect on the implementation of this community-based research study during the COVID-19 health crisis, and in particular the unforeseen difficulties to which the community-based research process had to confront and adapt. The goal is to draw lessons on what worked (and what did not work) in order to capitalize on community-based research practices during this pandemic and subsequently, facilitate the implementation of new research projects in similar contexts.