Community-based Resource Research Articles

Barbershop-Facilitated Community-to-Clinic Linkage Implementation Program: Rationale and Protocol for a Novel Program to Prevent Hypertension Among Black Men.

Black men in the United States have higher hypertension (HTN) prevalence than other groups, largely due to adverse social determinants of health, including poor healthcare access. The Community-to-Clinic Linkage Implementation Program (CLIP) is effective for HTN screening in Black-owned barbershops. However, its effect on HTN prevention among Black men is untested. Here, we describe the rationale and study protocol for the development and testing of a barbershop facilitation (BF) strategy, with trained Community Health Workers, to implement and scale CLIP for HTN prevention in Black men. The study is part of the American Heart Association (AHA)-funded RESTORE (Addressing Social Determinants to Prevent Hypertension) Health Equity Research Network. The study is tri-phasic: (i) pre-implementation-qualitative examination of factors affecting adoption of CLIP and development of BF strategy, (ii) implementation-cluster randomized control trial to test the effectiveness of CLIP with and without BF. We will partner with 20 barbershops and enroll 420 Black men with elevated blood pressure (BP)/Stage 1 HTN (2017 ACC/AHA HTN guidelines). Outcomes include reduction in BP, rate of CLIP adoption and linkage to care, and incidence of Stage 2 HTN. The study time frame is 12 months, (iii) post-implementation-we will evaluate program sustainability (6 months post-trial conclusion) and cost-effectiveness (up to 10 years). This study harnesses community-based resources to address HTN prevention in Black men, who are more adversely impacted by HTN than other groups. It has major policy relevance for health departments and other stakeholders to address HTN prevention in Black communities. NCT05447962.

"But I Live Here Too": Social-structural stressors, racial discrimination, and resiliency among urban dwelling black emerging adult men.

For many Black emerging adult men in the United States, social-structural stressors rooted in racial discrimination are daily experiences that place them at greater risk for poor health. Emerging adulthood is a critical life course period marked by greater experimentation with health risk behaviors. Although Black men's health vulnerabilities during this period are connected to their social-structural environments, investigations of these factors among noncollege sampled Black men remain limited. We conduced thirty semi-structured in-depth interviews to examine associations between social-structural challenges and social-structural resources for resiliency. Interviews were audio-recorded, transcribed verbatim, and coded using Dedoose web-based qualitative software. Through open coding, emergent concepts were connected across interviews and major themes were identified. We found three core social-structural stressors: (1) Racial profiling, (2) neighborhood violence, and (3) lack of economic opportunities, and three resilience factors: (1) Positive social networks, (2) community-based resources, and (3) safe environments that foster a sense of community. Collectively, these findings provide insight into developing structural- and community-level interventions tailored to bolster resiliency across multiple levels and counteract the social-structural challenges that young Black men face.

205 Perceived Needs and Access to Community-based Dementia Resources in the Rural Deep South

OBJECTIVES/GOALS: The goal of this project is to investigate dementia caregivers’ needs, barriers to access, and current utilization of community-based dementia-care services in Alabama, and how these vary across rural/urban settings and racial groups. METHODS/STUDY POPULATION: We partnered with Marketry Inc. to recruit and conduct interviews among three groups: dementia caregivers, healthcare providers, and aging services representatives. We recruited caregivers from dementia support groups and aging services in 2 rural and 2 urban Alabama counties. Purposive and snowball sampling was used to recruit healthcare providers and aging services representatives. Interviews were conducted by trained Marketry staff, recorded, and transcribed verbatim. Rapid content analysis was conducted by three investigators using the Social Determinants of Health as a coding framework to assess patterns in barriers and facilitators to utilizing community-based dementia resources. RESULTS/ANTICIPATED RESULTS: We interviewed 5 healthcare providers, 32 caregivers, and 15 aging services representatives. Providers thought that the process of memory loss care is not streamlined and they lack key information necessary to fulfill their role. Caregivers expressed a need for more dementia education, social connection, and access to financial resources. Aging services agencies need more funding and volunteers to sustain community-based dementia services. Dementia resources, like memory clinics, were more available in urban than in rural counties. African-American caregivers mentioned a reluctance to accept outside help for taking care of their loved ones with dementia, potentially due to distrust. DISCUSSION/SIGNIFICANCE: There is a need for more accessible dementia services in rural AL and a need to build service trust and familiarity, especially among African-American caregivers. Future research should develop tools for providers and caregivers to start conversations and increase awareness of service availability.

Exploring social networks in a small tank cascade system in Northcentral Sri Lanka: First steps to establishing adaptive governance

Systems of irrigation governance that are community-led, flexible, and adaptive are better suited to meet the needs of local communities, resolve conflicts and minimize risks posed by a changing climate. Small Tank Cascade Systems (STCS) in Sri Lanka's dry zone have been critical to ensuring food and livelihood securities of local communities, and governance of STCS to reduce future climate risks will assume increased significance. Adaptive co-management (ACM) practices could reconcile complex natural resources management issues by incorporating flexible community-based resource management systems tailored to specific geographical places and contexts, supported by organizations working at various scales. We sought opportunities to enhance existing systems of resource governance through ACM as a response to the uncertainty surrounding changes in climate. The first steps were to identify actors and processes related to the governance of Palugaswewa STCS through the cultivation meeting; a key decision process for resource management. We used social network analysis (SNA) with a survey of 48 farmers to identify key actors, their roles and responsibilities, practices and decision processes. The findings indicate that current decision processes are compartmentalized within the cascade system with less collaboration among actors in the upper, middle and lower parts of the cascade than anticipated. We conclude that governance structures of STCS could be improved by recognizing and incorporating informal actors, farmer subgroups, existing social relationships and community norms. To minimize future climate risks, information provision to farmers needs to recognize existing information flows in local networks, develop strategies to enhance existing relationships, build on existing adaptive/flexible decision processes, foster collaboration across the cascade system and develop governance mechanisms that operate at cascade/catchment level.

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.

Abstract P6-05-59A: Developing a Community Standard of Care for Individuals Diagnosed with Breast Cancer Patients Across Oregon

Abstract Early in the pandemic, cancer centers across the nation and Oregon canceled their cancer support programs as non-essential medical care. Breast cancer patients were forced to look elsewhere for essential assistance and community support to move along their cancer journeys. Pink Lemonade Project (PLP), a Vancouver, WA based community based nonprofit, helped fill the gaps and expanded its local support for breast cancer patients. A virtual format allowed PLP to serve more individuals with our psychological, emotional and financial support programs. Next, PLP convened an informal coalition of all the local breast cancer support organizations including those that offer breast cancer support programs, community including dragon boating and rowing, and others that serve broader communities and more people of color. Then, as Komen National announced its restructuring, and closed the Oregon-Southwest Washington affiliate in Spring 2021, Pink Lemonade Project stepped up again to maintain two locally-grown Komen programs that met critical community need–the MBC Dinner Series and the Treatment Access Program (TAP), a transportation assistance program that served all of Oregon and reduced the geographic barrier to care. Through the coalition, PLP heard patients express concern that they were receiving outdated information and were struggling more to find needed support and resources from their providers. Understandably, nurse navigators and social workers could not maintain and/or update patient resources while they assisted COVID patients. The goal of the coalition was to increase communication across the organizations and to share more event schedules for the ease of patients to understand what support programs are available. This session, delivered by an all breast cancer patient panel, will give an overview of Pink Lemonade Project; its programs that helps with psychological, emotional, community and financial support for breast cancer patients, survivors and those living with metastatic breast cancer; and will highlight the results from the patient point of view of the systematic review of the contents of 6 regional health systems new patient binders and present recommendations for consistent, community-wide content for all future breast cancer patients. The project’s main strength was that Pink Lemonade Project could draw upon on an existing coalition of local, community-based breast cancer organizations to help update and standardize breast cancer support information from the patient point of view. Then by acting as a neutral convener, PLP could request and receive the binders from all the region’s healthcare providers to help standardize and update the community resources across all the region’s cancer centers. The result is that any new breast cancer patient, regardless of where their access to care is, can receive consistent community-based information and resources. Another result of this project showed the importance of the partnership of healthcare and human service agencies, especially in a post-pandemic world. As the pandemic continues to strain healthcare, community-based nonprofits have a unique role to help coordinate community resources and improve the quality of life for those affected by breast cancer. Developing a Community Standard of Care for Individuals Diagnosed with Breast Cancer Across Oregon Developing a Community Standard of Care for Individuals Diagnosed with Breast Cancer Across Oregon Citation Format: Susan Stearns, Thalia Williams, Lisa Peters, Sonja Trytko. Developing a Community Standard of Care for Individuals Diagnosed with Breast Cancer Patients Across Oregon [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-59A.

Barriers and facilitators towards recovery and health service utilization among Haredi Jews with mental illness

IntroductionEvidence suggests that minorities tend to under-utilize mental health services, and may face specific barriers and facilitators towards recovery. One community which remains particularly under-researched in the Western World are Haredi Jews — a diverse group of individuals characterized by a shared devotion to traditional Talmudic and Halakhah teachings and observances.ObjectivesThe overarching aim of this study is to document and analyze barriers and facilitators towards recovery and mental health service utilization among Haredi Jews with a history of mental distress. Specific objectives include: (i) eliciting and understanding participants’ mental health knowledge, beliefs, behaviours & attitudes; (ii) exploring their pathways and barriers to mental health care, especially examining the role of religiosity, religious community and rabbinical advice; and (iii) investigating their experience within the official mental health care system.MethodsTo gain an in-depth understanding, we conducted a qualitative study. This involved semi-structured interviews with 24 participants who (i) identified as Haredi Jews; (ii) had used mental health services; and (iii) were 18+ years of age. It also included interviews with several key stakeholders, for example local Rabbis and other community leaders. Data was analyzed using thematic analysis techniques.ResultsParticipants typically had experienced mild to moderate mental distress, and tended to view mental health services in a positive light, mainly expressing satisfaction with services received. The analysis revealed three important facilitators and three important barriers to recovery. Facilitators comprised of (i) high levels of social support within the community, including specific well-being support groups; (ii) a positive relationship and connection with G-d, considered to provide guidance and support during troubled times; and (iii) the presence of many bridges and resources within the local Haredi community, including community-run health services, and Rabbis who encouraged mental health care utilization where appropriate. Barriers comprised of (i) stigma related to marriageability of self and offspring, inhibiting disclosure and mental health care use; (ii) acknowledged lack of awareness and knowledge about mental health, mental illness, treatments, and therapies; and (iii) generic health service issues, including long waitlists, limited availability and lack of appropriate therapists.ConclusionsStudy participants tended to have positive views of psychiatric services, and utilized different health care and community-based resources to help foster recovery. However, ongoing issues of stigma and low levels of mental health literacy may inhibit mental health care use and recovery. This implies a need for religiously-informed and community-grounded mental health literacy campaigns among Haredi Jewish communities.Disclosure of InterestNone Declared

Engaging Human Services and Behavioral Health Professionals in Youth-led, Adult-guided Social Action Initiatives

Professional and community leaders in Washington, DC have expressed the need for more capacity building and increased resources to address health inequities in the city’s underserved African American communities. Inequities (“food deserts,” community decay, and limited youth opportunities) require equity-informed approaches. Disparities (disproportionate substance use/behavioral health disorders) also require system-level approaches. In response, the Wards 7 and 8 DC Prevention Center (DCPC), a community-based nonprofit, collaborated with residents, community partners, and academic institutions to provide trainings and certifications to its team and community stakeholders.
 Initially, DCPC Staff were trained through evidence-informed approaches including Certified Prevention Specialist (CPS) and Photovoice. CPS training uses workshops and tools from the DC Department of Behavioral Health (DBH) to train staff/students to conduct assessments and build community partnerships. Photovoice provides a less intimidating process for vulnerable populations and professionals to collect data, identify social/environmental factors that impact health and well-being, share concerns, communicate with policymakers, and identify solutions to collectively address issues. 
 In turn, DCPC Staff trained youth and professionals to conduct Photovoice assessments to highlight the misuse of opioids and the negative effects on their communities. Stakeholders continue to request the assistance of CPSs; and community partners seek the trainings for themselves. Academic partners have a community-based resource for students/faculty to learn from and support equity-informed initiatives. This paper presents additional lessons learned/best practices in how to apply this multi-component approach as an effective strategy for preparing professionals and students to engage in social action in similar areas, despite high risks and glaring inequities.

Diagnosing Participation and Inclusion in Collective Decision-Making in the Commons: Lessons from Ecuador

The objectives of our study are to advance our understanding of the micro-level governance conditions that facilitate more inclusive communal decision-making processes. Common-pool resource scholars frequently point to participatory governance arrangements as critical for successful resource management. Recognizing local decision-making rights, however, does not necessarily ensure that the decision process or management outcomes will be inclusive or equitable. Examples from decentralized and community-based resource management illustrate how communities and outside organizations alike can struggle to create decision-making forums that include and recognize the voices of more marginalized members. Our exploratory analysis examines household participation (n = 491) in communal decisions in twelve rural indigenous communities in the central Andes of Ecuador. We use the Institutional Analysis and Development (IAD) framework to structure a set of logit models to identify the household attributes and community governance conditions that make it more likely that a household engages in community meetings (attends, voices opinions, perceives opinion is respected), and agrees with the collective decisions. Our findings reiterate the challenge of gaining full participation, particularly from women, and indicate how local governance characteristics such as frequency of meetings and leader training may promote greater inclusion and overall agreement with communal decisions.

“Second set of eyes:” Family caregivers and post-acute home health care during the COVID-19 pandemic

ObjectivesThis study aimed to explore how the COVID-19 pandemic shaped the experiences of family caregivers of older adults who were hospitalized with COVID-19 and discharged to post-acute, skilled home health care (HHC) services. MethodsThirty semi-structured interviews with family caregivers of older adults who received services from a large, not-for-profit HHC agency following hospitalization with COVID-19 infection were conducted between March-July 2021 and analyzed using thematic analysis. ResultsDuring the pandemic, family caregivers encountered societal and institutional barriers to assisting older adults across post-acute care transitions. These barriers included hospital visitation restrictions as well as difficulties accessing community-based resources and medical equipment. Despite limitations and delays in HHC services, many family caregivers identified post-acute HHC, delivered in-person or via telehealth, as important to addressing care gaps for older adults, as well as their own needs for training and support during the pandemic. ConclusionsPolicies intended to reduce the spread of COVID-19 introduced new challenges for caregivers during HHC. However, HHC agencies and their staff adapted within this context to provide a needed bridge of support.

An Exploration of Community-Based Services and Resources Available to Boost the Capabilities of AIDS-Orphaned Adolescents and Primary Caregivers to Achieve Emotional and Psychosocial Wellbeing

An Exploration of Community-Based Services and Resources Available to Boost the Capabilities of AIDS-Orphaned Adolescents and Primary Caregivers to Achieve Emotional and Psychosocial Wellbeing

Social Prescribing: Link Workers’ Perspectives on Service Delivery

Purpose: In social prescribing (SP) a primary care based “link worker” assesses patient needs and goals, and makes appropriate links and referrals to community-based resources and services. This study explored SP service provision in England’s NHS, investigating social prescribing link worker’s (SPLW’s) perspectives of service delivery, service goals, theories and approaches used, challenges, what works, and barriers to success. Methods: Semi-structured interviews were undertaken with eighteen SPLWs delivering SP. Data were analysed using thematic analysis. Results: Social prescribing mechanisms and frameworks were identified. Five organising themes describe a solution-focused, strengths-based theoretical underpinning; a patient-led process; role of SPLWs as a support person, guide, and facilitator; supporting collaborative networks; patient and wider outcomes; and threats to success of SP. A solution-focused, strengths-based approach underpins many aspects of SP. Conclusion: The effectiveness of SP could be improved by SPLW motivational interviewing and solution-focused training to promote patient behaviour-change, salutogenesis, and positive outcomes, enabling SPLWs to feel they have the skills required. Workload and referrals should be appropriate for the role of SPLWs. Now that there is widespread implementation of SP in the NHS, there is a need to interview patients in receipt of SP to gain their experience, views, and recommendations.

IT’S A FAMILY AFFAIR: COMMUNITY-BASED RESEARCH PARTNERSHIP TO CREATE A FAMILY-CENTERED DEMENTIA CAREGIVER PROGRAM

Abstract People in the Black community are two times more likely to develop dementia than white people. This racial disparity is due to both social and structural factors which shape access to power, resources and exposure to health-damaging conditions by race. Due to the significant cognitive changes that occur, Black families assume substantial caregiving responsibilities to support family members, yet few caregiving programs offer culturally tailored support and training to the preferences and familial care norms of Black caregivers. In response, individuals from two community-based organizations (CBOs) and an academic medical center partnered to develop a culturally tailored, community-based, family-centered dementia caregiving research program for individuals living in far south Chicago. A team of stakeholders identified by the CBOs convened in the Fall 2021 to discuss the need for the proposed program, and together a key informant interview guide was designed. We have conducted 16 of 30 interviews and preliminary analyses of the interviews has revealed that caregivers are largely caring for parents or grandparents and are sharing caregiving responsibilities with other family members. Caregivers endorsed a need for the program; preferred a hybrid format and the need to include content related to 1) education on dementia, 2) emotional coping, and 3) linkage to medical and community-based resources. Anticipated barriers to participation included, time, location, and care for their family member while they participated. Our stakeholder team will continue to conduct key informant interviews, review and interpret data findings, and collectively develop a community-based family-centered caregiving program.

IMPLEMENTATION OF THE ELDER MISTREATMENT EMERGENCY DEPARTMENT TOOLKIT AT HEYWOOD HOSPITAL

Abstract Beginning in 2016, Heywood Hospital, a 134-bed community hospital located in Central Massachusetts, partnered with the National Collaboratory to Address Elder Mistreatment to design and test a care model for identifying and responding to elder mistreatment (EM) in hospital emergency departments (ED). In February 2020, Heywood Hospital began implementing the care model known as the Elder Mistreatment Emergency Department (EMED) Toolkit as part of a five-site feasibility study. This presentation shares local results from the feasibility study and strategies for implementing the EMED Toolkit. 95% of Heywood staff participated in an online training program and, over 9 months, 4,588 (84%) of all older ED patients were screened for EM. Of these, 19 screened positive and 11 were reported to Adult Protective Services, a more than 7-fold (annualized) increase over the prior year. Most of the remaining positive cases were connected with community-based resources through Heywood’s Social Services Program.

Smallholder social networks: Advice seeking and adaptation in rural Kenya

CONTEXTSmallholder farmers in Africa are among those most impacted by climate change. Employing strategies such as planting early maturing or drought tolerant hybrid seeds is one common climate adaptive strategy for these households. However, seed choice has become increasingly complex for farmers. One way farmers look for clarity about seeds is to consult with other farmers. OBJECTIVEWe investigate smallholders' advice seeking within the context of a community water project in rural Kenya, a type of community-based common pool resource management organization. We examine a maize seed advice seeking network and compare it with a more general advice seeking network to better understand the social networks of maize seed advice seeking, and to characterize how peer-to-peer advice networks might factor into farmer decision-making about seeds. METHODSWe use exponential random graph modeling for the maize seed advice and general advice networks to test what factors predict advice-seeking among farmers in 104, or 92% of households in the community water project. RESULTS AND CONCLUSIONSThe maize seed advice network is less dense than the general advice network, with farmers on average seeking out fewer people for advice about maize. The features that shape each network also differ. There are some farmers who are significantly more active in seeking advice about maize seeds, and farmers who are already employing more adaptive practices on their farm are more likely to seek such advice. Farmers also seek each other out based on homophily, kinship, and physical proximity, and some farmers are sought out more often. We find evidence that physical infrastructure of the community water project drives advice-seeking ties, where farmers who are attached to the same branch of the water infrastructure are likely to seek advice from each other. SIGNIFICANCEMaize seed is not a topic about which many farmers in this network seek advice, and those who might be perceived as more experienced or educated are not necessarily those most sought for advice. Farmers hold key information due to their on-farm experience, and in the absence of robust extension services and consistent information about hybrid seeds, it is unclear to what extent the advice seeking that farmers do undertake fills those gaps. In addition, co-management of a common-pool resource facilitates advice sharing in both the maize and general advice networks, that is, on topics outside of the immediate reason for being part of a CWP, which is water management.

Effects of an Alzheimer's and Dementia Care Co-management Program on Quality, Clinical Outcomes, and Utilization.

The quality of care provided to persons living with dementia (PLWD) and their care partners (CPs) is low, clinical outcomes are poor, and costs are high. Co-management of dementia care by Advance Practice Providers (APPs) has the potential to improve all of these metrics. The UCLA Alzheimer's and Dementia Care (ADC) Program is a health system-based co-management model of APP Specialists (DCSs) working with primary care and specialty physicians that is designed to meet dementia care needs. DCSs approach the PLWD and CP as a dyad, providing support, including community-based resources, to both; behavioral and medication management; and care coordination. The program has provided dementia care for over 3400 PLWD and has a current census of over 750 PLWD who are cared for by 4 nurse practitioner DCSs. Quality of care based on established dementia quality indicators assessed by medical record review was 92%. Based on an analysis of the first 1091 PLWD and their CPs, prior to entering our program, many caregivers were poorly informed about dementia caregiving and felt they were fighting this battle alone. One-third had high stress and more than 10 percent were depressed. By the end of a year in the program, confidence in handling problems and complications of Alzheimer's disease and dementia improved by 72 percent. CP strain (Modified Caregiver Strain Index), distress (Neuropsychological Inventory-Distress), and depression (PHQ-9) were reduced (all P<0.001). Moreover, the program reduced emergency department visits by 20%, days spent in the hospital by 26%, admissions to nursing homes for long-term care by 40%, (all P<0.05) and overall Medicare costs by $2404 per person/year. The ADC Program has been disseminated to 18 sites nationwide and more than 5000 PLWD and their CPs have received ADC care. Dementia co-management with APPs can improve quality and clinical outcomes and reduce health care utilization and costs. The ADC Program can be implemented in diverse health systems indicating the potential for widespread dissemination.

Narcotics Anonymous members in recovery from methamphetamine use disorder.

Methamphetamine use disorder (MUD) is a major public health problem, but there are no evidence-based, best-practice, pharmacologic, or behavioral treatments for it. Narcotics Anonymous (NA) may provide an option for referral for such patients. Two waves of surveys were sent to a sample of NA members to evaluate demographic, drug use, and NA-related issues. Of 4445 responses received from US residents, 647 listed themselves as abstinent from their worst drug problem, methamphetamine. Twelve possible sources of support were scored by these latter respondents for how important each was for their own recovery. Methamphetamine respondents were longstanding NA members, with their first NA meeting 30.2 years ago, 84.3% having served as sponsors for other members, and with little current craving (0.65 out of 10). Although now abstinent for an average of 13.4 years, at some point over the course of the membership, 47.4% had experienced a relapse, for an average of 16.7 months. In a factor analysis of resources scored, 29.6% of the variance fell under NA social and 29.2% spiritual; and 11.8% under outside professional support. NA served as a resource for supporting abstinence for some members with MUD. They scored social resources of NA support higher than both spiritual and outside institutional ones. NA can serve as a community-based resource for MUD. Determining the nature of recovery that members with MUD have in NA can be useful for further research of socially grounded support for recovery in substance use disorders.

Utilization of marine taxa within an artisanal shellcraft sector of the Indo-Pacific region

Sustainable utilization of marine taxa is critical for maximizing social and economic goals of livelihood development within the Indo-Pacific. Yet, despite an increasing importance of shellcraft as a livelihood activity within the Indo-Pacific, information on the taxa utilized within shellcraft sectors remains scant. To address this knowledge gap, our study examined diversity, in terms of composition and quantities, of marine taxa utilized by artisan households and, collectively, within an artisanal shellcraft sector of Papua New Guinea. For each taxon, critical source habitats were identified, and the geographic scale of exploitation established. Critically, presented data revealed 73 taxa, representing at least 77 species, were utilized within the studied sector. Many of the taxa utilized had not previously been linked to shellcraft sectors, demonstrating that a broader composition of taxa is utilized than previously acknowledged. In terms of quantity, annual utilization within the sector was close to 500,000 individuals, the majority being mollusks of either class Gastropoda (83.6%), represented by 37 genera, or class Bivalvia (9.6%), represented by four genera. There was a strong bias towards a particular species, Chrysostoma paradoxum (78.5% of all individuals), as indicated by indices for the diversity utilized (H′ = 1.23; D = 0.38). However, substantial variation was evident in the diversity of taxa utilized among households (n = 36) engaged in shellcraft (H′ = 1.09 ± 0.71; D = 0.43 ± 0.27), with each household utilizing a unique composition of 19.1 ± 10.6 taxa. Source habitats for taxa ranged from pelagic to benthic intertidal and subtidal substrates, with the geographic scale of exploitation extending to 34 discrete locations up to 417 km away. The array of sector, household, and taxon-specific information presented provides a basis for supporting greater sustainability within shellcraft sectors across the Indo-Pacific, which is discussed within a context of informing community-based resource management, further developing marine aquaculture, and strengthening existing governance.

Nurses' perception of readiness to care for parents of children with special healthcare needs

PurposeTo describe pediatric nurses' perception of readiness to care for parents of children with special healthcare needs. Design and MethodsThis cross-sectional, exploratory study surveyed 56 pediatric nurses from a large tertiary care center in Appalachia. Participants completed an anonymous electronic survey aimed at evaluating perception of discharge preparation and readiness to care. Data analysis included descriptive statistics and Chi square comparisons. ResultsThe majority of participants (80%) reported spending 12 h or less preparing parents for discharge. The domains rated lowest on readiness to care included financial, psychological, and emotional. Participants anticipate parents spending an average of 13.9 h a day serving as the child's primary caregiver in the home. ConclusionsSubjective, ‘unseen’ domains of readiness are often under-assessed and evaluated. Parents are often discharged with limited preparation to assume around-the-clock care for a child with special healthcare needs, specifically related to their holistic health and wellbeing. Practice ImplicationsStandardization of discharge preparation and readiness evaluation should focus on overall parent preparedness, including financial, psychological, and emotional domains. Discharge preparation should begin at the time of admission to familiarize parents with care. Clear, frequent communication should be used to emphasize realistic expectations and assess unique needs. Provision of accessible community-based resources should be given early to better equip parents with supportive services once home.

Revitalizing Collective Resources in Mountain Areas Through Community Engagement and Knowledge Cocreation

The ongoing global and large-scale changes in markets, demographics, and use of resources are impacting mountain peoples and regions. In mountain areas, resources have been governed through community-based systems for resource management for centuries, ensuring stewardship and local decision-making over the resources. Due to the importance of such systems to mountain societies, there is a need to understand local effects of global changes and reconfigure community-based resource management (CRM) to meet local needs while tackling global challenges. Changes include biodiversity loss and the climate crisis, as well as increasing social and economic disparities. Studies on the role of knowledge cocreation in the process of CRM innovation in response to ongoing changes in mountain social–ecological systems are missing. This study aimed to explore the reconfigurations that enable CRM to foster sustainable development and thriving communities. The study focused on an intervention promoting community entrepreneurship in community-based tourism for the revitalization of collective resources in 2 mountain communities in Northern Italy. We adopted a transdisciplinary approach and a research action methodology to codesign the interventions and research. Data from focus groups, a survey, participatory activities, interviews, and participant observation were collected and analyzed using a qualitative content analysis method. Results show that emerging reconfigurations in CRM include recognition of new values and uses of collective resources, inclusion of new stakeholders, and innovation of the organizational model, shifting the perspective from resource management to resource governance. The study recommends striking a balance between pushing innovation and increasing power imbalances. It is important to pay attention to the inclusivity of the process and to avoid excessive commodification of resources.