Community-driven Interventions Research Articles

Understanding the Interplay of Race in the Criminal Justice System

Purpose: The purpose of this study was to investigate and understand the interplay of race in the criminal justice system. Methodology: The study adopted a desktop research methodology. Desk research refers to secondary data or that which can be collected without fieldwork. Desk research is basically involved in collecting data from existing resources hence it is often considered a low cost technique as compared to field research, as the main cost is involved in executive’s time, telephone charges and directories. Thus, the study relied on already published studies, reports and statistics. This secondary data was easily accessed through the online journals and library. Findings: The findings reveal that there exists a contextual and methodological gap relating to the interplay of race, class and gender in the criminal justice system. Preliminary empirical review revealed that that pervasive racial disparities exist within this institution, as evidenced by disproportionate treatment of racial minorities at various stages of the criminal justice process. It found that despite efforts to promote fairness and equity, implicit biases and systemic racism continued to influence decision-making, leading to disparities in arrests, prosecutions, and sentencing. The study highlighted the interconnectedness of race with other social factors such as socioeconomic status and neighborhood characteristics and underscored the urgency of implementing evidence-based interventions and policy reforms to address racial disparities effectively. Recommendations included diversifying law enforcement agencies, implementing implicit bias training programs, and reforming sentencing guidelines to promote fairness and reduce disparities in incarceration rates. Unique Contribution to Theory, Practice and Policy: The Critical Race theory, Labeling theory and Structural Functionalism may be used to anchor future studies on the interplay between race and the outcomes within criminal justice. The study provided recommendations that contributed to theory, practice, and policy. It integrated critical race theory into the analysis to explore systemic racism's role in perpetuating racial disparities. Practically, evidence-based policing strategies and procedural justice principles were emphasized, alongside community policing initiatives and accountability measures to address bias and misconduct. Policy recommendations included reforming sentencing laws, investing in alternatives to incarceration, and addressing social determinants of crime. The study contributed to theory by examining intersecting identities' impact and advocated for community-driven interventions, trauma-informed approaches, and reforms to reduce racial bias and enhance accountability within the criminal justice system.

The impact of the COVID-19 pandemic on HIV treatment gap lengths and viremia among people living with HIV British Columbia, Canada, during the COVID-19 pandemic: Are we ready for the next pandemic?

The SARS-CoV-2 (COVID-19) pandemic has impacted the care of people living with HIV (PLWH). This study aims to characterize the impact of the pandemic on the length of HIV treatment gap lengths and viral loads among people living with HIV (PLWH) in British Columbia (BC), Canada, with a focus on Downtown Eastside (DTES), which is one of the most impoverished neighbourhoods in Canada. We analyzed data from the HIV/AIDS Drug Treatment Program from January 2019 to February 2022. The study had three phases: Pre-COVID, Early-COVID, and Late-COVID. We compared results for individuals residing in DTES, those not residing in DTES, and those with no fixed address. Treatment gap lengths and viral loads were analyzed using a zero-inflated negative binomial model and a two-part model, respectively, adjusting for demographic factors. Among the 8982 individuals, 93% were non-DTES residents, 6% were DTES residents, and 1% had no fixed address during each phase. DTES residents were more likely to be female, with Indigenous Ancestry, and have a history of injection drug use. Initially, the mean number of viral load measurements decreased for all PLWH during the Early-COVID, then remained constant. Treatment gap lengths increased for all three groups during Early-COVID. However, by Late-COVID, those with no fixed address approached pre-COVID levels, while the other two groups did not reach Early-COVID levels. Viral loads improved across each phase from Pre- to Early- to Late-COVID among people residing and not residing in DTES, while those with no fixed address experienced consistently worsening levels. Despite pandemic disruptions, both DTES and non-DTES areas enhanced HIV control, whereas individuals with no fixed address encountered challenges. This study offers insights into healthcare system preparedness for delivering HIV care during future pandemics, emphasizing community-driven interventions with a particular consideration of housing stability.

Mother Support Groups for Raising Awareness in the Community About Kangaroo Mother Care and Breastfeeding in the Era of COVID-19: Experiential Learning

Introduction This article explores the establishment and subsequent challenges faced by a Mother Support Group (MSG) initiated in Gujarat, India, focusing on promoting Kangaroo Mother Care (KMC) and exclusive breastfeeding, particularly amid the COVID-19 era. Methods The methodology involved adapting to COVID-19 restrictions, utilizing online platforms for training and webinars, and collaborating with ASHA workers for community outreach. The MSG members received training on breastfeeding and KMC, followed by practical demonstrations and community visits. Although initial efforts were promising, the group’s sustainability faltered when key stakeholders withdrew, revealing challenges in maintaining community-driven interventions. Results and discussion The article underscores the importance of sustained efforts in establishing and retaining parent support groups. The lack of comprehensive data collection limits the ability to evaluate specific outcomes, but we highlight the potential benefits of MSG, including improved breastfeeding practices and KMC adherence. We acknowledge the need for robust frameworks and standard operating procedures to enhance the sustainability of such initiatives, emphasizing the importance of community involvement and leadership in supporting disadvantaged newborns. Conclusion We draw attention to the complexities of sustaining grassroots initiatives and call for further research to develop effective models that address the unique needs of marginalized communities, particularly regarding the care of preterm newborns.

Assessing the Environmental and Health Implications of Waste Disposal: A Case Study of Africa's Largest Dumping Site

This study investigates the environmental and health repercussions of generated and distributed waste stemming from dumpsites scattered across various Sub-Saharan Africa countries. Through a comprehensive examination of data gleaned from scholarly databases, published reports, to analyze the characteristics and impacts of dumpsites on the environment and public health; key findings illuminate the profound challenges posed by these dumpsites. Notably, large dumpsites such as Olusosun in Nigeria, Dandora in Kenya, and Agbogbloshie in Ghana emerge as focal points due to their staggering size and heightened risk profiles and the significant risk to nearby communities. The analysis underscores pervasive issues including air and water contamination, soil degradation, and the propagation of diseases within nearby communities. There are indications of progress and improvements being made in some dumpsites, and initiatives such as waste-to-energy projects, recycling programs, and community-driven interventions are emerging to address these challenges and mitigate the adverse effects of dumpsites on surrounding environments and human health. Considering these findings, recommendations are put forth for bolstering waste management strategies, advocating for meticulous site selection, promoting waste segregation practices, and fostering community engagement. These measures are essential to mitigate the adverse effects of dumpsites, safeguard environmental integrity, and uphold public health standards across the African continent.

Promoting COVID-19 Vaccine Confidence and Access among Youth Experiencing Homelessness: Community-Engaged Public Health Practice

Abstract: Background: Youth experiencing homelessness (YEH) face a wide range of complex barriers to COVID-19 vaccine confidence and access. Objectives: Describe our process for engaging a cross-sector team centering equity and youth voice; outline our intervention strategies to enhance COVID-19 vaccine confidence and access among YEH; and discuss lessons learned through this community-engaged process. Methods: We engaged partners from across sectors, including youth-serving agencies, healthcare organizations, public health organizations, and YEH. We used focus groups, key informant interviews, and other community engagement strategies to develop and implement a series of interventions aimed to increase COVID-19 vaccine confidence and access among YEH. Results: We identified youths' key concerns about vaccine confidence and access. To address these concerns, we implemented four community-driven interventions: youth-friendly messaging, health events, vaccine aftercare kits, and staff training. Conclusions: This community-engaged project highlighted the value of cross-sector partnership and consistent youth engagement in addressing vaccine confidence among YEH.

Cultivating Foundations: A Research-Driven Community Service for Enhancing Early-Grade Education at SD Negeri OKAS

This abstract highlights the major features and outcomes of the calistung training community service effort done at SD Negeri OKAS. The community service, done on January 10, 2024, aims to increase the core skills of early-grade pupils in reading, writing, and counting through a research-driven, holistic approach. The process involves a detailed needs assessment, collaborative curriculum design, and interactive, culturally sensitive teaching methods. The good and beneficial effects include a noticeable improvement in students' skills, strengthened community bonds, overwhelming favorable comments, heightened awareness of educational relevance, and the formation of lasting collaborations. The endurance of the effort is shown through continued support, mentorship programs, and its significance as a model for similar ventures. As a researcher committed to community service, the success of this effort illustrates the transformative potential of combining research, community participation, and sustainable planning in educational interventions. The reported experiences and outcomes serve as useful tools for shaping future initiatives and add to the greater conversation on effective community-driven educational interventions.

TB NOTIFICATION IN CHILDREN: THE EXPERIENCE OF TARGETED COMMUNITY DEMAND CREATION AMIDST INSECURITY IN IMO STATE, NIGERIA

This paper explores the challenges and successes of tuberculosis (TB) notification in children amidst a backdrop of insecurity in Imo State, Nigeria. Emphasizing targeted community demand creation strategies, the study investigates the intricate relationship between insecurity, community engagement, and pediatric TB detection. Drawing upon a comprehensive literature review, this research delves into the epidemiology, diagnosis, and treatment of TB in children, the ramifications of insecurity on healthcare access in Imo State, and effective community engagement strategies in healthcare initiatives. The literature findings underscore the substantial burden of TB among children and the distinct hurdles faced in environments characterized by insecurity. The prevailing insecurity in Imo State significantly disrupts healthcare services, leading to delays in TB diagnosis and treatment initiation. Nevertheless, the review identifies community engagement approaches as a promising avenue for bolstering TB notification rates in pediatric populations. These approaches empower local communities to actively participate in the identification and management of TB cases, ultimately contributing to the enhancement of pediatric TB notification. A conceptual framework, derived from amalgamated literature, elucidates the intricate interplay between insecurity, community engagement, and TB notification. This study highlights the pivotal role of community-driven interventions in mitigating the challenges posed by insecurity in Imo State, Nigeria, and presents actionable recommendations for the development of healthcare policies and programs tailored to the region. This research not only augments our comprehension of TB notification among children within insecure contexts but also provides valuable insights into the broader domain of community-based healthcare interventions. It underscores the exigency for customized strategies to address TB in pediatric populations in regions marked by insecurity, ultimately contributing to the amelioration of health outcomes for children in Imo State, Nigeria, and analogous settings
 Keywords: TB, Children, Community, Nigeria.

Protocol: identifying policy, system, and environment change interventions to enhance availability of blood for transfusion in Kenya, a mixed-methods study

BackgroundSafe blood is essential for the care of patients with life-threatening anemia and hemorrhage. Low blood donation rates, inefficient testing procedures, and other supply chain disruptions in blood administration affect patients in low-resource settings across Sub-Saharan countries, including Kenya. Most efforts to improve access to transfusion have been unidimensional, usually focusing on only point along the blood system continuum, and have excluded community stakeholders from early stages of intervention development. Context-appropriate interventions to improve the availability of safe blood at the point of use in low-resource settings are of paramount importance. Thus, this protocol proposes a multifaceted approach to characterize the Kenyan blood supply chain through quantitative and qualitative analyses as well as an industrial engineering approach.MethodsThis study will use a mixed-methods approach in addition to engineering process mapping, modeling and simulation of blood availability in Kenya. It will be guided by a multidimensional three-by-three-by-three matrix: three socioeconomic settings, three components of the blood system continuum, and three levels of urgency of blood transfusion. Qualitative data collection includes one-on-one interviews and focus group discussions with stakeholders across the continuum to characterize ground-level deficits and potential policy, systems, and environment (PSE) interventions. Prospectively-collected quantitative data will be used to estimate blood collection and transfusion of blood. We will create a process map of the blood system continuum to model the response to PSE changes proposed by stakeholders. Lastly, we will identify those PSE changes that may have the greatest impact on blood transfusion availability, accounting for differences across socioeconomic settings and levels of urgency.DiscussionIdentifying and prioritizing community-driven interventions to improve blood supply in low-resource settings are of utmost importance. Varied constraints in blood collection, processing, delivery, and use make each socioeconomic setting unique. Using a multifaceted approach to understand the Kenyan blood supply and model the response to stakeholder-proposed PSE changes may lead to identification of contextually appropriate intervention targets to meet the transfusion needs of the population.

CATCH-UP vaccines: protocol for a randomized controlled trial using the multiphase optimization strategy (MOST) framework to evaluate education interventions to increase COVID-19 vaccine uptake in Oklahoma

BackgroundOklahoma’s cumulative COVID-19 incidence is higher in rural than urban counties and higher than the overall US incidence. Furthermore, fewer Oklahomans have received at least one COVID-19 vaccine compared to the US average. Our goal is to conduct a randomized controlled trial using the multiphase optimization strategy (MOST) to test multiple educational interventions to improve uptake of COVID-19 vaccination among underserved populations in Oklahoma.MethodsOur study uses the preparation and optimization phases of the MOST framework. We conduct focus groups among community partners and community members previously involved in hosting COVID-19 testing events to inform intervention design (preparation). In a randomized clinical trial, we test three interventions to improve vaccination uptake: (1) process improvement (text messages); (2) barrier elicitation and reduction (electronic survey with tailored questions/prompts); and (2) teachable moment messaging (motivational interviewing) in a three-factor fully crossed factorial design (optimization).DiscussionBecause of Oklahoma’s higher COVID-19 impact and lower vaccine uptake, identifying community-driven interventions is critical to address vaccine hesitancy. The MOST framework provides an innovative and timely opportunity to efficiently evaluate multiple educational interventions in a single study.Trial RegistrationClinicalTrials.gov: NCT05236270, First Posted: February 11, 2022, Last Update Posted: August 31, 2022.

Impact of community-driven interventions on dietary and physical activity outcomes among a cohort of adults in a rural Appalachian county in Eastern Kentucky, 2019-2022.

Several environmental level factors exacerbate poor health outcomes in rural populations in the United States, such as lack of access to healthy food and locations to be physically active, which support healthy choices at the individual level. Thus, utilizing innovative place-based approaches in rural locations is essential to improve health outcomes. Leveraging community assets, like Cooperative Extension, is a novel strategy for implementing community-driven interventions. This prospective cohort study (n = 152), recruited in 2019 and surveyed again in 2020 and 2021, examined individual level changes in diet and physical activity in one rural Appalachian county. During this time, multiple community-driven interventions were implemented alongside Cooperative Extension and several community partners. Across the three-year study, the cohort indicated increases in other vegetables and water and reductions in fruits and legumes. There were also reductions in less healthy items such as French fries and sugar-sweetened beverages. The cohort also reported being less likely to engage in physical activity. Our findings suggest that key community-driven programs may have indirect effects on dietary and physical activity choices over time. Outcomes from this study are relevant for public health practitioners and community organizations working within rural Appalachian communities to address health-related behaviors.

Getting Further Faster: Illuminating Opportunities for Health Departments to Support Community-Driven Social Determinants of Health Interventions.

Getting Further Faster: Illuminating Opportunities for Health Departments to Support Community-Driven Social Determinants of Health Interventions.

Influence of Gender Equality in the Management Committee on Community-Led Monitoring of Borehole Water Projects

In recent years, governments and development practitioners have emphasized the involvement of all stakeholders, especially the intended beneficiaries in the project cycle to accelerate the achievement of development objectives and sustain the realized gains. Various approaches are being used to intensify the involvement of people in the planning, implementation, monitoring, and evaluation of community-driven development interventions. In Kenya, County governments are constitutionally mandated to promote the participation of the people in development and governance at the local level. Since their inception, the County governments have been putting in place local governance structures and avenues for members of the community to participate in development projects and programs. In Kenya, these participatory local governance structures and avenues have not been widely studied. The study assessed the influence of gender equality in the management committee on community-led monitoring of borehole water projects. The study was based on the theory of participation which attributes the success of engagement between project stakeholders to four favorable factors: context, design, power, and scale of the engagement. A case study research design was used. The study population comprised the household heads, borehole water project management committee members, and officials of the County government of Meru County, as key informants. Interview schedules and a questionnaire were used to collect both qualitative and quantitative data. Systematic random sampling was used to select 38 household heads. All the 12 members of the Mbeu cattle dip community borehole management committee, one Mbeu Ward administration official, and 10 officials of the Directorate of Monitoring and Evaluation in Meru County formed part of the study sample. The study showed that superficially, there is no gender-based discrimination in community-led monitoring of borehole water projects. The study showed that County Government of Meru policies meant to promote gender equality are not well cascaded or implemented at the local level. The study concluded that the management committee is pivotal in community-led monitoring of borehole water projects and broadly, implementation of community-led development initiatives. The study recommends that authorities ought to educate members of the community about patterns of gender-based discrimination.

Analyzing Police Communication Strategies for Preventing Teenage Drug Abuse in Simpang Kanan Subdistrict, Rokan Hilir Regency

This research delves into the efficacy of police communication strategies in combating drug abuse among teenagers in Simpang Kanan Subdistrict, situated within the Rokan Hilir Regency of Indonesia. Utilizing a mixed-methods approach, the study navigates the intricate interplay of cultural dynamics, community engagement, and the effectiveness of varied communication channels employed by law enforcement agencies. Quantitative analysis unveils statistical trends in drug abuse prevalence among teenagers, shedding light on the impact of specific communication strategies. Concurrently, qualitative exploration delves into perceptions, experiences, and stakeholder feedback, offering depth to the understanding of the multifaceted issue. Findings underscore the strengths of community engagement initiatives and diverse communication channels, showcasing heightened awareness and positive behavioral shifts among teenagers. Yet, limitations such as data constraints, sampling intricacies, and resource limitations temper the comprehensiveness of the analysis. The implications drawn from this research advocate for tailored, culturally sensitive approaches, community-driven interventions, and continuous evaluation mechanisms in future policy changes. These insights transcend regional boundaries, offering a framework adaptable to analogous contexts worldwide. This research serves as a beacon, illuminating pathways toward combating teenage drug abuse.

Structural vulnerability as a conceptual framework for transgender health research: findings from a community needs assessment of transgender women of colour in Detroit

The concept of structural vulnerability explains how systems of oppression drive health inequities by reducing access to survival resources (e.g. food, housing) for marginalised populations. Indicators of structural vulnerability such as housing instability, violent victimisation and poverty are often interconnected and result from intersectional oppression. We sought to demonstrate the utility of the structural vulnerability framework for transgender health research by examining patterns of structural vulnerability indicators among transgender women of colour in Detroit. We conducted latent class analysis and tested associations between classes and mental health and substance use outcomes. Membership to the Lowest Vulnerability class was negatively associated with post-traumatic stress disorder (PTSD) (aOR = 0.10, 95% CI: 0.02-0.59). High Economic Vulnerability membership was associated with daily marijuana use (aOR = 4.61, 95% CI: 1.31-16.16). Complex Multi-Vulnerability membership was associated with PTSD (aOR = 9.75, 95% CI: 2.55-37.29), anxiety (aOR = 4.12, 95% CI: 1.22-13.97), suicidality (aOR = 6.20, 95% CI: 1.39-27.70), and club drug use (aOR = 4.75, 95% CI: 1.31-17.29). Substantively different findings emerged when testing relationships between each indicator and each outcome, highlighting the value of theoretically grounded quantitative approaches to understanding health inequities. Community-driven interventions and policy changes that reduce structural vulnerability may improve mental health and substance use outcomes among structurally vulnerable trans women of colour.

Three-year follow-up of a multi-component community-driven health promotion intervention in Denmark.

The article presents a follow-up study of a multi-component community-driven health promotion intervention in Denmark. The study examines the perceptions and actions of professional stakeholders 3 years after completion of a 19 months intervention period addressing healthy living, well-being and social engagement among families with young children living in three rural communities on the Danish island of Bornholm. The intervention was implemented within the framework of Project Health and Local Community, also referred to as Project SoL. Qualitative in-depth interviews were conducted with diverse professional stakeholders of the project. They represented local government, public institutions, private enterprises, civil society organizations and local mass media. The interviews addressed the extent to which the project had sustained its influence on professional stakeholders' perceptions and actions following project completion. Efforts were made to understand if persisting influences were value-based and/or manifested as concrete community-driven actions. The study showed that the project had succeeded in sustaining a positive long-term post-intervention influence among informants regarding the values and principles of the project. Despite their sustained motivation and preparedness to continue implementing coordinated community-driven actions this was severely hampered by lack of coordination after project completion. Instead, some of the stakeholders continued developing and implementing actions based on the values and principles of the project within the framework of their own professional networks. The article discusses the structural factors that are required to sustain complex community-driven interventions and the need to reconsider the nature of external support to community development from being project-based to integrated, strategic and long term.

68415 Neural Impact of Neighborhood Disadvantage in Traumatically-Injured Adults: a Multi-Modal Investigation

ABSTRACT IMPACT: Neighborhood disadvantage was significantly associated with brain structure and function in trauma-exposed adults, providing evidence that contextual factors should be assessed in mental health research, particularly in high-risk populations. OBJECTIVES/GOALS: Over 13 percent of Americans live in a socioeconomically disadvantaged neighborhood. Previous work has linked lower individual socioeconomic position to alterations in brain structure and function. However, the neural effects of area-level socioeconomic factors, such as neighborhood disadvantage, are unclear. METHODS/STUDY POPULATION: We recruited two-hundred and fifteen traumatically-injured participants from an Emergency Department in southeastern Wisconsin. An Area Deprivation Index (ADI) score, a national measure of neighborhood socioeconomic disadvantage, was derived from each participant’s home address. Two-weeks post-trauma, participants underwent a battery of self-report measures and functional magnetic resonance imaging (fMRI) scans. Using a multi-modal approach, we investigated the impact of ADI on brain structure as well as neural activation during rest and during an emotional uncertainty task. We sought to disentangle the relationship between neighborhood and individual socioeconomic position and neural activity in the context of trauma. RESULTS/ANTICIPATED RESULTS: We demonstrated that neighborhood disadvantage is associated with decreased volume and alterations of resting state functional connectivity of structures implicated in affect processing, including the hippocampus, amygdala, and ventromedial prefrontal cortex. These results held even after controlling for relevant individual variables, including acute post-traumatic stress symptoms and years of education. Moreover, individuals from disadvantaged neighborhoods exhibited heighted activation of these same structures in response to aversive stimuli. Thus, brain regions critical for recognizing and processing negative stimuli are susceptible to the effects of area-level socioeconomic factors. DISCUSSION/SIGNIFICANCE OF FINDINGS: The results offer additional evidence that neurobiological mechanisms clarify how stress ‘gets under the skin’. Changes to key brain regions may explain why those living in disadvantaged neighborhoods are at a heighted risk of PTSD. Broadly, these findings should inform future policies and community-driven interventions aimed at reducing poverty.

Does Spousal Engagement Improve Cervical Cancer Screening Discussions and Uptake? Lessons from a Before-After Study in a Rural Nigerian Community.

This study determined spousal involvement and the effect of community-based spousal engagement on cervical cancer screening-related discussions and uptake in a rural Nigerian community. A before-after mixed methods study was conducted among 245 married men in a rural Nigerian community. Spousal engagement involved advocacy to men groups, awareness creation, and monthly meeting-based announcements/reminders about screening. Three months post-intervention, uptake was determined from facility registers. Thematic analysis and SPSS were used for data analysis. A large minority of respondents were aged 29-39 years (95/245, 38.8%). At baseline, respondents generally had poor spousal involvement. Post-intervention, inter-spousal discussion on screening increased from 17.2% to 46.9% (p<.001). There was no significant increase in uptake post-intervention. Having more than 5 children was a predictor of screening discussions (AOR=2.017; CI=1.196-3.403; p=.009). Despite increased inter-spousal discussions on cervical cancer screening, uptake remained low. We recommend community-driven interventions on cervical cancer screening with a gender-transformative perspective.

Community factors affecting participation in larval source management for malaria control in Chikwawa District, Southern Malawi

BackgroundTo further reduce malaria, larval source management (LSM) is proposed as a complementary strategy to the existing strategies. LSM has potential to control insecticide resistant, outdoor biting and outdoor resting vectors. Concerns about costs and operational feasibility of implementation of LSM at large scale are among the reasons the strategy is not utilized in many African countries. Involving communities in LSM could increase intervention coverage, reduce costs of implementation and improve sustainability of operations. Community acceptance and participation in community-led LSM depends on a number of factors. These factors were explored under the Majete Malaria Project in Chikwawa district, southern Malawi.MethodsSeparate focus group discussions (FGDs) were conducted with members from the general community (n = 3); health animators (HAs) (n = 3); and LSM committee members (n = 3). In-depth interviews (IDIs) were conducted with community members. Framework analysis was employed to determine the factors contributing to community acceptance and participation in the locally-driven intervention.ResultsNine FGDs and 24 IDIs were held, involving 87 members of the community. Widespread knowledge of malaria as a health problem, its mode of transmission, mosquito larval habitats and mosquito control was recorded. High awareness of an association between creation of larval habitats and malaria transmission was reported. Perception of LSM as a tool for malaria control was high. The use of a microbial larvicide as a form of LSM was perceived as both safe and effective. However, actual participation in LSM by the different interviewee groups varied. Labour-intensiveness and time requirements of the LSM activities, lack of financial incentives, and concern about health risks when wading in water bodies contributed to lower participation.ConclusionCommunity involvement in LSM increased local awareness of malaria as a health problem, its risk factors and control strategies. However, community participation varied among the respondent groups, with labour and time demands of the activities, and lack of incentives, contributing to reduced participation. Innovative tools that can reduce the labour and time demands could improve community participation in the activities. Further studies are required to investigate the forms and modes of delivery of incentives in operational community-driven LSM interventions.

It is time to mobilize suicide prevention for sexual and gender minorities in Canada

Suicide is a significant health issue among sexual and gender minority adults (SGMA); yet, there are no tailored suicide prevention programs for these marginalized populations in Canada. We hosted two world cafés with community leaders, health professionals, policymakers, and researchers to identify recommendations for mobilizing SGMA-focused suicide prevention programs. We identified five priorities: (1) make society safer for sexual and gender minorities; (2) decrease barriers to mental health services; (3) support community-driven and community-based interventions; (4) increase suicide knowledge and reduce stigma; (5) expand the knowledge base on SGMA suicide. In the absence of a national Canadian SGMA suicide prevention policy, these priorities provide a starting point in addressing SGMA suicide inequities by advancing SGMA-tailored interventions.

Commentary on Conigrave et al. (2020): Meta-analysis of drinking patterns in Aboriginal and Torres Strait Islander populations highlights policy and research opportunities.

Tailored community-driven alcohol interventions require information regarding local alcohol consumption patterns and the factors driving alcohol consumption behaviours. Future research could focus on the moderators of risky drinking patterns so that local interventions can be successfully developed. Routinely, policy in this area is informed using national statistics regarding alcohol consumption, resulting in what Conigrave and colleagues refer to as ‘broad-stroke’ interventions that are not tailored to the communities in which they are implemented. This problem is further exacerbated by the heterogeneous nature of drinking behaviours between different Indigenous Australian subgroups, as described by this meta-analysis [1]. In response, the authors call for community-controlled responses to risky drinking at a local level, which is a promising approach given evidence for improved health outcomes among Indigenous people who receive health care from Aboriginal community-controlled health services (ACCHS) rather than mainstream general practice [2]. However, it is unclear exactly how these ACCHS, or other organizations, could deliver interventions reducing risky drinking behaviours. This lack of clarity regarding how to achieve this is not unique to this article [3, 4]. It does, however, highlight a clear need for further research on the ‘solution’ in the future, rather than further quantification of the ‘problem’ of high levels of risky alcohol use. For example, a randomized controlled trial currently under way, which involves several of the authors of this meta-analysis [5], is addressing this gap by investigating the effectiveness of a model of tailored and collaborative support for ACCHS in increasing use of alcohol use screening and treatment provision. Conigrave and colleagues [1] also highlight the often damaging sporadic drinking patterns in ‘dry’ communities propagated by current policy aimed at encouraging abstinence. Future research could examine these patterns more fully. For instance, studies could explore how community-driven social marketing approaches may impact upon such episodic patterns. These approaches employ the use of marketing concepts with the purpose of eliciting positive behaviour changes among their target audiences [6]. Social marketing, which has been used effectively to promote positive life-style changes in Canadian First Nation's communities, is underutilized in Australian Indigenous communities [7], despite evidence for its effectiveness in promoting healthy behaviour changes [7, 8], including reductions in risky drinking behaviours [6]. While this approach does not take into account the social determinants that potentially drive risky alcohol use among Australian Indigenous people, it may have the potential to be a pragmatic solution allowing adaption to suit the needs of individual communities. Conigrave and colleagues also highlighted the influence of moderators such as gender and age on drinking patterns among Australian Indigenous people, reflecting the findings of a number of other studies conducted among non-Indigenous populations [9, 10]. We agree with the authors that future research examining these moderating factors, especially from a socio-cultural perspective, is critical. It should be coupled with research into other moderating factors, such as socio-economic status, which was poorly reported in the studies reviewed [1], and past experience of trauma or violence, which has a known impact but was not examined [11]. Furthermore, as many studies in this area have traditionally been guided by western paradigms [11], there is clearly an urgent need for the involvement of Indigenous researchers and Elders in the design and implementation of future studies, and for the culturally appropriate adaptation of instruments measuring alcohol consumption for an Indigenous context [1]. In conclusion, the meta-analysis by Conigrave et al. [1] highlights a number of critical directions for policy and research policy, including strengthening the evidence base for effective interventions targeting risky drinking patterns (especially by ACCHS) and the crucial need for future research to consider the benefits of a social marketing approach, and the roles of socio-economic status and a broader range of other moderating factors on risky drinking patterns among Australian Indigenous populations. None. Cheneal Puljević: Conceptualization; data curation; formal analysis; funding acquisition; investigation; methodology; project administration; resources; software; supervision; validation; visualization. Helen Haydon: Conceptualization; data curation; formal analysis; funding acquisition; investigation; methodology; project administration; resources; software; supervision; validation; visualization. Centaine Snoswell: Conceptualization; data curation; formal analysis; funding acquisition; investigation; methodology; project administration; resources; software; supervision; validation; visualization.