Community-based Resource Research Articles

Bringing Geospatial Awareness to Community Pediatrics and Primary Care.

Bringing Geospatial Awareness to Community Pediatrics and Primary Care.

Abstract P183: Elevated Phq-9 Scores In Black And Hispanic Young Adults

Background: The ASPIRE study is a NIH funded clinical trial seeking to reduce cardiovascular disease risk factors in young adults who identify as Black and Hispanic through the provision of an individualized, text message-based intervention. The intervention has been developed specifically for this demographic group through formative research and seeks to understand the moderating and mediating effects of depressive symptoms, self-efficacy, and discrimination on weight loss maintenance over the 12 months. The goal of this preliminary analysis is to describe baseline depressive symptoms in this population to both conceptualize the mental health needs of students and increase the accessibility of established resources through developing community informed referral guidelines. Methods: Participants are recruited into a behavior change clinical trial and randomly assigned to either an intervention group with a health coach or an attention control group. Participants completed the Patient Health Questionnaire for adults (PHQ-9) as a part of baseline surveys. This questionnaire assesses depressive symptoms through 10 self-administered questions. Scores ranging from 5-9 indicate mild symptoms 10-14 moderate symptoms, 15-19 moderately severe, and 20-27 severe symptoms of depression. Participant data is stored in REDCap and preliminary analysis was pulled and summarized for total scores from the PHQ-9 for all participants who have completed a baseline visit. There is no missing data. Results: Preliminary baseline data from a large Midwestern community college (N=101; 72% female; mean age = 20.8 (SD=2.02)) indicate the significant experience of depressive symptoms amongst participants. More than 58% of our sample screened for at least mild symptoms of depression. More significantly, greater than 21% of the sample indicates at least moderate symptoms of depression. Discussion and Conclusion: There is no comprehensive nationwide data to which we can compare these results, however the American College Health (ACH) National College Health Assessment completed in undergraduate students indicated that 50% of students surveyed had no significant symptoms of depression on the Kessler 6 scale. Therefore, we believe levels of depressive symptoms may be higher in this population of community college students who identify as Black or Hispanic. Due to high levels of depressive symptoms, the research team has since engaged in participatory research methods with the community advisory board and other members of the community to enhance study protocols and identify community-based resources to serve as referrals for participants who score above 5 on the PHQ-9.

Community-based rangeland management in Namibia improves resource governance but not environmental and economic outcomes

Classic theories suggest that common pool resources are subject to overexploitation. Community-based resource management approaches may ameliorate tragedy of the commons effects. Here we use a randomized evaluation in Namibia’s communal rangelands to study a comprehensive four-year program to support community-based rangeland and cattle management. We find that the program led to persistent and large improvements for eight of thirteen indices of social and behavioral outcomes. Effects on rangeland health, cattle productivity and household economics, however, were either negative or nil. Positive impacts on community resource management may have been offset by communities’ inability to control grazing by non-participating herds and inhibited by an unresponsive rangeland sub-system. This juxtaposition, in which measurable improvements in community resource management did not translate into better outcomes for households or rangeland health, demonstrates the fragility of the causal pathway from program implementation to intended socioeconomic and environmental outcomes. It also points to challenges for improving climate change–adaptation strategies.

Abstract P4-11-19: Utilization of the RE-AIM frameworkfor evaluating the implementation of group medical visit for low-income breast cancer survivors

Abstract Introduction: Providing cost effective comprehensive survivorship care (SC) remains a major challenge for which optimal delivery models are needed. Group medical visits (GMV) are commonly used in chronic diseases to deliver medical care, education, and empower patients. Pilot GMV studies for breast cancer survivors (BCS) have shown increases in peer support and patient education. This pilot study uses the RE-AIM framework for evaluation of the GMV intervention to support breast cancer survivors. RE-AIM is an efficient framework for systematic evaluation of health care interventions. RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) is the evaluation methodology based on the framework developed by a working team of scholars from health care, public health, and implementation science. Methods: The study was conducted at a public hospital in California. GMV consisted of 4, 2-hour, weekly sessions focused on therapy side effects and prevention, emotional health, sexual health, physical activity, and diet. Patient navigator (PN) recruited 3 consecutive GMV groups of 6 English-speaking BCS (n=18). Results: The Reach was determined by the number and proportion of participants in this study. Our participants were primarily English-speaking and were within 1-5 years of completing active breast cancer treatment. Participants of the GMV were from diverse backgrounds and low-income neighborhoods in San Francisco and were representative of breast cancer survivors in our population. Effectiveness of GMV were assessed through self-reported changes with increased knowledge of survivorship care plans, recognition, and management of long-term side effects of cancer treatments and knowledge of community-based resources. There was an increase from baseline in all these domains and in confidence communicating with their primary care provider. Adoption involved initial stakeholder engagement in the intervention and Implementation was assessed by the consistent content and delivery of the intervention. We did not evaluate Maintenance as it was out of the scope of this study. We found that ongoing need for services is extremely high in our BCS, suggesting that this intervention has the potential to be widely adopted by cancer survivors and survivorship programs. Overall, consistent attendance and active participation indicated that GMV are feasible in this setting. 94% of BCS reported GMV increased their awareness and confidence of SC. Participants reported high satisfaction, felt well-informed, and supported through the availability of GMV. BCS highlighted the benefits of integrating treatment, services, emotional support, and education. BCS suggested GMV should be implemented at time of cancer diagnosis and emphasized the key role of PN in GMV and supporting SC. Conclusions: GMVs were specifically designed to address unmet needs for services that are necessary for SC but not readily available. Our pilot data suggests PN facilitated GMV are a feasible and acceptable model to integrate SC in public hospitals. The evaluation of our intervention using the RE-AIM framework can aid potential adopters in developing and implementing GMV intervention to support BCS. Citation Format: Evelin Trejo, Ana I. Velazquez, Elizabeth Castillo, Barbara Cicerelli, Robin McBride, Nancy J. Burke, Niharika Dixit. Utilization of the RE-AIM frameworkfor evaluating the implementation of group medical visit for low-income breast cancer survivors [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-11-19.

Patterns of catch and trophic signatures illustrate diverse management requirements of coastal fisheries in Solomon Islands

Coastal fisheries are a critical component of Pacific island food systems; they power village economies and provide nutritious aquatic foods. Many coastal women and men actively fishing in this region rely on multi-species fisheries, which given their extraordinary diversity are notoriously difficult to both characterize, and to manage. Understanding patterns of fishing, diversity of target species and drivers of these patterns can help define requirements for sustainable management and enhanced livelihoods. Here we use a 12-month data set of 8535 fishing trips undertaken by fishers across Malaita province, Solomon Islands, to create fisheries signatures for 13 communities based on the combination of two metrics; catch per unit effort (CPUE) and catch trophic levels. These signatures are in turn used as a framework for guiding suitable management recommendations in the context of community-based resource management. While a key proximate driver of these patterns was fishing gear (e.g. angling, nets or spearguns), market surveys and qualitative environmental information suggest that community fishing characteristics are coupled to local environmental features more than the market value of specific species they target. Our results demonstrate that even within a single island not all small-scale fisheries are equal, and effective management solutions ultimately depend on catering to the specific environmental characteristics around individual communities.

The Animal Audiogram Database: A community-based resource for consolidated audiogram data and metadata.

Knowledge of hearing ability, as represented in audiograms, is essential for understanding how animals acoustically perceive their environment, predicting and counteracting the effects of anthropogenic noise, and managing wildlife. Audiogram data and relevant background information are currently only available embedded in the text of individual scientific publications in various unstandardized formats. This heterogeneity makes it hard to access, compare, and integrate audiograms. The Animal Audiogram Database (https://animalaudiograms.org) assembles published audiogram data, metadata about the corresponding experiments, and links to the original publications in a consistent format. The database content is the result of an extensive survey of the scientific literature and manual curation of the audiometric data found therein. As of November 1, 2021, the database contains 306 audiogram datasets from 34 animal species. The scope and format of the provided metadata and design of the database interface were established by active research community involvement. Options to compare audiograms and download datasets in structured formats are provided. With the focus currently on vertebrates and hearing in underwater environments, the database is drafted as a free and open resource for facilitating the review and correction of the contained data and collaborative extension with audiogram data from any taxonomic group and habitat.

Assessing the Impact of the Violence Against Women Act

The Violence Against Women Act (VAWA) has been hailed as the federal government's signature legislation responding to gender-based violence. VAWA, passed in 1994 and reauthorized three times since then, has created several new programs and protections for victims of gender-based violence. VAWA is, however, primarily a funding bill and what it primarily funds is the criminal legal system. But the criminal legal response to gender-based violence has not been effective in decreasing rates of gender-based violence or deterring violence. A VAWA that discontinued funding for the criminal legal system and instead focused on economics, prevention, and community-based resources—a noncarceral VAWA—could better meet the needs of victims of gender-based violence and target the underlying causes of that violence.

Intensive Use of Forensic Inpatient Services by People with Intellectual and Developmental Disabilities in Ontario, Canada: Prevalence and Associated Characteristics

People with intellectual/developmental disabilities (IDD) are reportedly intensive users of forensic inpatient services. Using administrative data, we identified people with and without IDD in forensic inpatient settings in Ontario, Canada over a ten-year period. We compared them on sociodemographic, clinical, and admission characteristics and post-discharge healthcare use to explore factors that could account for differences in forensic inpatient resource use. The prevalence of IDD in forensic inpatient settings was 16.7% (vs. 0.8% population prevalence). Those with IDD did use forensic inpatient services more intensively (more historical forensic admissions, longer lengths of stay, greater staff frustration). There were, however, few differences between forensic inpatients with and with IDD in their baseline sociodemographics, upon admission, during their index forensic episode, or in accessing post-discharge healthcare services. The only differences were that those with IDD had higher percentages of forensic inpatient episodes under review board (ORB) supervision and of delayed discharge from hospital in the year post-forensic-discharge. These findings are more consistent with system-level than individual-level explanations and suggest that increasing forensic inpatient and community-based resources for individuals with IDD may be critical for reducing the intensity of their forensic inpatient use and increasing the likelihood of successful transition to the community.

Accelerating Upstream Together: Achieving Infant Health Equity in the United States by 2030.

Accelerating Upstream Together: Achieving Infant Health Equity in the United States by 2030.

Social Prescribing through Primary Care: A Systematic Review of the Evidence

Background: In primary care, social prescribing (SP) is where a patient is referred to a “link worker”, who considers their needs and then “prescribes” or connects them to appropriate community-based resources and services. Recent policy and guidance in the UK has significantly expanded the provision of SP to improve patient health and wellbeing. Methods: This study conducted a systematic review of evidence for SP effectiveness and to report needs addressed, interventions provided, and behaviour change techniques employed. Inclusion criterion was patient referral from primary care to a SP link worker. Online databases were searched for studies published from February 2016 to July 2021. Searches were restricted to English language only. Risk of bias assessment and a narrative analysis were undertaken. Results: Eight studies were included. All studies reported some positive outcomes. There were weaknesses and limitations in study design and in reporting of results: a lack of comparative controls, short duration and single point follow-up, a lack of standardised assessments, missing data, and a failure to consider potential confounding factors. All studies had features which indicated a high risk of bias. Conclusion: Evidence for the value and positive impact of SP is accumulating, but evaluation design remains relatively weak. There is a need to improve evaluation through robust methodological design and the adoption of universal outcome measures and evaluation/analytical framework. SP should seek to assess patient wellbeing, self-management, and quality of lifeoutcomes systematically, and adopt behaviour change techniques to enable healthier lifestyles in the short and long term.

Tackling Health Care Disparities: How to Build a Sarcoidosis Center.

Sarcoidosis is a multi-organ system inflammatory disease of unknown etiology that disproportionately affects women and black patients in the United States. In addition, woman and minority patients have worse outcomes. In 2015, sarcoidosis physicians in cardiology, pulmonary medicine and rheumatology joined forces to create a multidisciplinary sarcoidosis at Virginia Commonwealth University. In 2019, the clinic was recognized as a World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) Center of Excellence. We identify four pillars of a patient-centered sarcoidosis clinic: clinical care, research, teaching, and community outreach. We detail how each of these facets plays a critical role in improving the health of individual patients, creating a strong infrastructure to improve the future of sarcoidosis treatment, and developing community-based resources that can empower patients. Most importantly, we highlight how a multidisciplinary clinic can help identify and combat healthcare disparities.

Macro- and microhabitat use patterns of holothurians in Buena Vista, Nggela, Solomon Islands: rock climber and bottom crawler species

Densities and habitat use patterns of holothurians, including nocturnal species, were assessed in Buena Vista, Nggela, Solomon Islands, for community-based resource management. Nighttime snorkeling surveys were conducted along transects (maximum 1.6 km) with 3 to 5 searchers in nearshore, channel, and outer reef macrohabitats. Only the population in the seagrass macrohabitat was separately assessed in 30 m line transects during the daytime. Microhabitats were clearly separated between species living on 3-dimensional structures (e.g. surfaces of knolls and reef slopes; rock climber group) and those on flat bottoms (bottom crawler group), although they coexisted at macrohabitat scales. Potential shelters adjacent to each individual differed between the 2 groups. Among bottom crawler species, Bohadschia koellikeri, which was recently taxonomically divided from B. vitiensis, occupied macrohabitats intermediately ranging between those of B. argus in the channel and outer reef macrohabitats and those of B. vitiensis and B. marmorata in the nearshore and seagrass macrohabitats. The high-density population was observed in the seagrass macrohabitat, mainly composed of Holothuria scabra, B. marmorata, and H. fuscogilva, although most individuals of these species were smaller than the national legal size limits. Moreover, the body lengths of H. atra and H. fuscogilva increased from the seagrass macrohabitat to the outer reef macrohabitat, implying their migration during growth and the roles of seagrass areas as nurseries. These results revealed diversity of macro- and microhabitat use patterns among species and their growth stages and highlight the importance of considering these factors for conserving diverse species by areal-based protection measures.

Supporting Individuals and Families Impacted by Dementia in Counseling: Case Report.

As more than 6 million people in the United States are living with dementia, it is important to foster and train counselors who are specialized in dementia. This case report explores the process and benefits of counseling when individuals and families are impacted by dementia. By understanding multiple changes in the individual and the family system, a counselor can provide guidance and resources to navigate and adapt changes during the disease process. Based on family systems therapy, a counselor can assist the family by facilitating family involvement and communication. It is critical for a counselor to help the family members in understanding how each one may be in a differing stage of acceptance regarding the diagnosis and loss. In addition, dementia-specific counseling should entail psychoeducation of the disease as well as existing community-based resources that are designed to support community-dwelling people living with dementia.

The Impact of Ambulatory Dementia Care Models on Hospitalization of Persons Living With Dementia: A Systematic Review.

This systematic review presents an overview of the existing dementia care models in various ambulatory care settings under three categories (i.e., home- and community-based care models, partnership between health systems and community-based resources, and consultation models) and their impact on hospitalization among Persons Living with Dementia (PLWD). PRISMA guidelines were applied, and our search resulted in a total of 13 studies focusing on 11 care models. Seven studies reported that utilization of dementia care models was associated with a modest reduction in hospitalization among community-residing PLWD. Only two studies reported statistically significant results. Dementia care models that were utilized in specialty ambulatory care settings such as memory care showed more promising results than traditional primary care. To develop a better understanding of how dementia care models can be improved, future studies should explore how confounders (e.g., stage of dementia) influence hospitalization.

The Practice of Community-Based Water Resource Management in Rural Indonesia

Although The government has issued various regulations and models of water resources governance at the local level, community-based water resources governance is needed in responding to challenges in water resource management. This paper discusses the case of water resources management in Srogol village (Cigombong sub-district, Bogor district) which applies a community-based water resources governance model known as Janggol. Culturally, Janggol has been deeply rooted in the social system in the Bogor area. Janggol in the upstream Cisadane watershed was appointed in 2018 to manage the water supplied to the community from the Ciwaluh spring. However, in practice the community-based management that is implemented is often wrong in its function and creates other quite complex problems. This research aims to analyze why the implementation of community-based water resource management in Srogol village is not optimal and what efforts must be made to encourage sustainable natural resource management using the concept of Community-based natural resource management. This research uses a qualitative approach, by extracting data using an interview process to predetermined stakeholders. Based on the research results, the water management carried out by Janggol is not optimal due to the lack of adaptation of managers in water management, the lack of community participation in water management, and the lack of knowledge of Janggol in providing services as an institution.

Utilization of Home and Community-Based Resources by Family Caregivers in a Native American Community

Family caregiving is uniquely significant for elder care within American Indian/Alaska Native (AI/AN) communities. Compared to other populations, AI/AN older adults are disproportionately impacted by chronic conditions and AI/AN are more likely to be family caregivers. However, AI/AN are underrepresented in aging research. We describe a successful research partnership with the Oneida Nation of Wisconsin and report results of a recent survey of tribal members and affiliates (N=405), covering demographics of caregiving, awareness and use of home and community-based resources, and perceptions of factors impacting service use. Approximately 42% of respondents were current caregivers; of these, roughly one-third knew how to access various resources. Most common sources of knowledge were a health care/social worker or finding information on their own. Traditional cultural values were viewed as variably supportive of resource utilization, depending on service type. Implications for efforts to address disparities for AI/AN aging and support caregivers will be discussed.

Disrupting the Status Quo: The New Normal of Family Caregivers’ Service Use

Family caregivers are essential partners in chronic disease management for older adults. However, being a family caregiver can have negative mental and physical health consequences, making it important for some caregivers to rely on supportive services, either for themselves (e.g. support groups) or to get help with caregiving tasks (e.g. home care). Supportive service use by family caregivers is well documented; yet, this research has often not included specific subgroups of caregivers (e.g. the racially/ethnically, or geographically diverse). Hence, the purpose of this symposium is to share new findings from research on supportive service use in understudied caregiving populations. First, Dr. Cimarolli presents findings from a study on the types of supportive services long-distance caregivers use for themselves and the factors associated with supportive service use in this caregiver population. Then, Dr. Wyman reports findings from a survey on the use of home and community-based resources by family caregivers in a Native American community. Dr. Wright will share the results of a systematic review of self-care interventions designed for caregivers of African Americans living with dementia. Finally, Dr. Mavandadi presents the results of a study examining the effectiveness of a telephone-based, collaborative dementia care program for improving outcomes in caregivers of military veterans living with dementia. Dr. Karen Rose will discuss the implications of each of these study findings for the development and evaluation of supportive interventions for these specialized family caregiver groups.

A Biopsychosocial-Ecological Framework for Family-Framed Dementia Care.

The biopsychosocial model has been applied through collaborative care dementia models to the diagnosis, symptom management, and treatment of dementia with a focus specifically on the person with dementia. Because individuals with dementia are increasingly dependent upon others particularly as the illness advances, dementia care requires the involvement and commitment of others, usually family, along with support from community-based resources. Hence, the quality and effectiveness of a person's dementia care are shaped in large part by the foundation of family relationships and the social and community networks in which they are embedded. While most current dementia care models incorporate biopsychosocial principles and recognize the essential role that family members play as caregivers, they fail to consider a patient's family system and relationships as potential risk factors or social determinants for care outcomes. This paper introduces a biopsychosocial-ecological framework to dementia care that is person-centered and “family-framed” in that it targets factors that influence care considerations at both the individual and relational levels of the social ecological networks that the patient and their family members occupy. We use this model to illustrate how current dementia care practices tend to focus exclusively on the individual patient and caregiver levels but fail to identify and address important relational considerations that cut across levels. We call for the need to add assessment of family relational histories of persons with dementia and family members who care for them in order to better meet the needs of the patient and the caregiver and to prevent harm. This model accentuates the need for interprofessional education on family assessments and caregiver-centered care, as well as interdisciplinary, collaborative models of dementia care that assume more accountability for meeting the needs of family caregivers in addition to those of persons with dementia.

A Relationship-Oriented Model of Research Participation: The Brain Health Community Registry

Historically excluded and minoritized populations are significantly under-included in health studies of Alzheimer’s disease and related dementias (ADRD) despite bearing a disproportionate burden of disease—evidenced by higher incidence, prevalence, and poorer health outcomes. Meaningful progress toward identifying and alleviating causes of health disparities in ADRD necessitate effective and scalable approaches for broadening inclusion in research. Rigorous studies evaluating research participation among minoritized populations are limited and have predominantly focused on individual-level factors and behavioral change (i.e. religiosity, willingness). These approaches frequently overlook the influence of unequally distributed structural and social determinants on participation despite the compounded financial, social, emotional, and logistical consequences that result from ADRD. Using an intersectional and social justice lens, we developed the Participant and Relationship-Oriented Research Engagement Model, which characterizes research as a form of relationship and extends social determinants frameworks to the context of research participation. We report core components of the model and its application in the design and preliminary evaluation of the Brain Health Community (BHC) Registry, which features proactive and systematic evaluation of potential unmet needs among prospective participants, and connections to relevant services (i.e. respite care, adaptive devices). Preliminary testing of the model and participant feedback on the BHC suggest it is a feasible approach to research engagement, and that associated assessment tools and resource protocols are acceptable and sufficiently adaptable to heterogeneous sets of unmet needs. Primary challenges include ongoing assessment of engagement and routine changes in service ability, which can be addressed through community-based resource networks.

Examining Physical and Social Environments of Korean American Family Caregivers of Persons Living with Dementia

IntroductionGrowing research supports the use of older volunteers to provide respite and community-based assistance to persons with ADRD and their caregivers. This study explores the impact of COVID-19 on a face-to-face, peer-led psychoeducational intervention for African American ADRD family caregivers, the Senior Companion Program Plus (SCP-Plus), and its subsequent need to ‘pivot’ during the pandemic. Method: The SCP-Plus was a randomized control trial across three states that assessed program impact on ADRD family caregiver stress/burden, coping, and social support. In spring 2020, the SCP-Plus intervention was halted because of the potential risk to participants due to COVID-19 (n = 20 enrolled dyads). In an effort to maintain rapport and trust, critical to retention in research studies, team members began weekly (March-April) and then bi-weekly calls (May-December) for the purpose of providing a social check-in and to provide updates on the status of the intervention.ResultsA total of 396 calls lasting approximately 10 minutes each were completed. Participants shared concerns around safety, access to food/supplies/masks/testing, feelings of stress and loss, concern for others, and the importance of technology as a means of social connection. Although the intervention aspect of the SCP-Plus ultimately ended due to COVID-19, information gleaned from these check-ins were used to pivot the study. The study moved forward by using a descriptive phenomenological approach to capture dyads’ lived experiences during COVID-19.DiscussionOverall, purposeful participant engagement through weekly/bi-weekly phone calls suggests that this is a promising strategy for participant retention as well as for pivoting research.