Community Gatekeepers Research Articles

Challenges and support needs among persons with a migration background who use drugs in four European metropolitan cities

BackgroundPersons who migrate for economic reasons, along with asylum seekers and refugees, face multiple personal experiences and societal inequalities that increase the risk of mental health problems and substance dependency, compounded by intersectional social and economic vulnerabilities. The precarious situation and limited access to care of persons with a migration background who use drugs (PMWUD) in Europe raises concern. Therefore, this qualitative study explores the challenges and support needs of a sample of PMWUD in vulnerable situations living in Amsterdam, Athens, Berlin and Paris.MethodsThis study employed a community-based participatory approach. Through semi-structured interviews with PMWUD (n = 99), we identified (service) needs of a diversity of PMWUD in Europe. Participants were recruited through a combination of community gatekeepers, venue-based sampling, and snowball sampling. Trained community researchers conducted the interviews, which focused on participants’ living situation, substance use, physical and mental health, and employment opportunities.ResultsDespite substantial heterogeneity among the PMWUD, several common themes emerged across all groups. Participants frequently mentioned early childhood adversity, limited social networks leading to loneliness, medical, psychological, and substance use issues, histories of personal violence or poverty, homelessness, lack of necessary documents for health care, social security, and employment, and encounters with the criminal justice system. These intertwined and mutually reinforcing factors simultaneously functioned as barriers to care and support, alongside other barriers such as linguistic and cultural differences, and stigma and discrimination. Due to social exclusion, migration, and substance dependence, participants had limited reliable social networks. Therefore, they often had to rely on accessible and low-threshold services. Harm reduction services played a significant role in providing support to PMWUD. Most PMWUD indicated that basic needs for hygiene and food were met thanks to local organizations. Differences in housing opportunities and access to harm reduction services were identified in each city.ConclusionStructural barriers toward treatment and care, often related to administrative requirements, stand in the way of appropriate care for PMWUD. Linguistically and culturally sensitive outreach activities with limited practical requirements could break down social and treatment barriers.

Cultural filters in processing information on COVID vaccines among minoritized groups in London, UK

Abstract Introduction Vaccination coverage among minoritized groups, including migrants, is low in the United Kingdom. Cultural factors are often cited as barriers, yet the broader impact of minoritization on vaccine acceptance remains understudied. We explored the intersection of culture with individual, familial, and systemic factors in shaping trust and perceptions of COVID-19 vaccines in East London, UK. Methods We conducted focus group discussions (n = 6) and interviews (n = 19) with individuals from minoritized backgrounds in East London to elicit their perceptions and experiences of COVID-19 and the vaccination programme. Thematic analysis was used to identify individual, social, and systemic factors influencing the processing of perceived value of information on COVID vaccines. Findings Culture was rarely cited as an explicit barrier to vaccine uptake. Instead, participants’ linked their perceived vulnerability and immunity to COVID-19 with age, sex and health status. Information about COVID vaccines was processed and acted upon in the context of gendered family dynamics and support. Community identity, gatekeepers and social networks further influenced the perceived legitimacy of information received. Some participants voiced how their minoritized status shaped trust/mistrust in the national health system’s and government’s delivery of the COVID-19 information and vaccination campaigns Conclusions Unpacking cultural filters is crucial for addressing vaccine-related information barriers in minoritized groups. Going beyond mere language translation, tailored communication materials should address social enablers and systemic barriers. Further, closer collaboration between community gatekeepers and healthcare professionals to facilitate optimal use of these materials is needed to improve vaccine uptake. Key messages • Culture should not be assumed to be the main factor contributing to non-adherence and non-uptake of public health vaccine. • Vaccine uptake can be improved by healthcare workers and key community gate-keepers working collaboratively with minoritized groups.

Conceptualizing Community Engagement for Mental and Brain Health Research in Low- and Middle-Income Countries: A Case of Kilifi County, Kenya.

Community engagement (CE) has increasingly been recognized as a critical element for successful health promotion and intervention programs. However, the term CE has been used to mean different things in different settings. In this article, we explore how CE has been conceptualized in the field of mental and brain health in Kilifi County, Kenya. We used ethnographic methods encompassing focused group discussions, key informant interviews, and observations with 65 participants, purposively recruited from Kilifi County. Data were transcribed verbatim and thematically analyzed. Our findings show that community members and stakeholders had diverse perceptions of and experiences with CE. Factors such as trust between researchers and community members, sensitization, and awareness creation were key for acceptance of research projects. Partial involvement in research, lack of access to information, poverty and socio-economic challenges, and financial expectations from researchers hindered CE and led to resistance to participation in research projects. For effective CE, there is a need to work closely with community gatekeepers, create awareness of the research projects, use local languages, and ensure continuous engagement that promotes equitable research participation. Our findings suggest that tacit knowledge, context, and mechanisms for research are all critical features of CE and should be considered to enhance acceptance and sustainability of mental and brain health interventions in Kenya.

COVID-19 vaccine preferences for pregnant and lactating women in Bangladesh and Kenya: a qualitative study.

COVID-19 was responsible for more than 7 million deaths globally, as well as numerous morbidities and social and economic effects. While COVID-19 vaccines were seen as a marvel of science by the scientific community, much of the public had concerns related to COVID-19 vaccines, with certain groups-such as pregnant and lactating women-having specific concerns related to vaccine effects on their pregnancy and breast milk. In this qualitative study, we interviewed stakeholders in Bangladesh (n = 26) and Kenya (n = 94) who affect the decision-making process related to COVID-19 vaccine acceptance among pregnant and lactating women. These included pregnant and lactating women themselves, community gatekeepers or family members, healthcare workers, and policymakers. Several themes related to confidence and vaccine preference emerged. Stakeholders indicated a lack of confidence related to non-mRNA vaccines due to safety concerns, number of doses, and media coverage; lack of confidence related to mRNA vaccines due to safety concerns; and preference for non-mRNA vaccines due to health system compatibility and availability. While COVID-19 vaccine availability in much of the world-particularly in low-and middle-income countries-affected the public's ability to have a choice in the vaccine they received, there were evident vaccine preferences. As the public health world will continue to face other infectious disease outbreaks, bolstering vaccine confidence broadly and specifically related to new technologies will be paramount to realize the individual-and population-level benefits of life-saving vaccines.

A community case detection tool to promote help-seeking for mental health care among children and adolescents in Ugandan refugee settlements: a stepped wedge cluster randomised trial

Strategies to promote mental health care help-seeking among children are needed, especially in low-income and middle-income countries and in complex settings. The aim of this trial was to compare a vignette-based, community-level, proactive case detection tool (CCDT) against standard awareness raising for promoting mental health help-seeking among children and adolescents. This stepped wedge cluster randomised trial was conducted in the Bidi Bidi, Kyaka II, Kyangwali, Omugo, and Rhino refugee settlements in Uganda. Community gatekeepers received a 2-day training session on using the CCDT to proactively detect children with mental health concerns and encourage children (or their caregivers) to use the mental health-care service run by Transcultural Psychosocial Organization Uganda. At baseline, organisations implemented routine detection or mental health awareness-raising activities. At cross-over to CCDT implementation, gatekeepers used the tool in their daily activities. The primary outcome was mental health-care service use by children and adolescents. Child population size estimates at the zone level were not available. Therefore, service use was calculated using total population size. We report the effect of CCDT implementation as an incidence rate ratio (IRR), which we produced from a model that accounts for calendar time, exposure time, and person-time. IRRs were estimated for the analysis of effect over time in the per-protocol and intention-to-treat populations. The trial is registered with the ISRCTN registry, number ISRCTN19056780. 28 administrative zones were selected for trial participation by October, 2021. Between Jan 1, and Nov 8, 2022, seven clusters of four zones sequentially crossed over from routine care to CCDT implementation in 1-month intervals. The CCDT was implemented by 177 trained community gatekeepers. In 9 months, 2385 children visited a mental health-care service; of these, 1118 (47%) were girls and 1267 (53%) were boys (mean age 12·18 years [SD 4.03]). 1998 children made a first or re-entry visit to a service; of these, 937 (47%) were girls and 1061 (53%) were boys (mean age 12·08 years [SD 4·06]). Compared to standard awareness-raising activities, CCDT implementation was associated with an increase in mental health-care service use in the first month after implementation (20·91-fold change [95% CI 12·87-33·99]). Despite a slight decline in service use over time in both the CCDT and pre-CCDT zones, CCDT zones maintained a time-average 16·89-fold increase (95% CI 8·15-34·99) in mental health service use. The CCDT enabled community gatekeepers to increase mental health-care service use by children and adolescents. Vignette-based strategies rooted in the community could become a valuable contribution towards reducing the mental health-care gap among children, especially when accompanied by accessible mental health-care services. Sint Antonius Stichting Projects. For the Arabic, French and Spanish translations of the abstract see Supplementary Materials section.

Balancing Ethics and Culture: A Scoping Review of Ethico-Cultural and Implementation Challenges of the Individual-Based Consent Model in African Research.

Objective: This review explores the ethico-cultural and implementation challenges associated with the individual-based informed consent (IC) model in the relatively collectivistic African context and examines suggested approaches to manage them. Methods: We searched four databases for peer-reviewed studies published in English between 2000 to 2023 that examined the ethico-cultural and implementation challenges associated with the IC model in Africa. Results: Findings suggest that the individual-based IC model largely misaligns with certain African social values and ethos and subverts the authority and functions of community gatekeepers. Three recommendations were proffered to manage these challenges, that researchers should: adopt a multi-step approach to IC, conduct a rapid ethical assessment, and generate an African-centered IC model. Conclusions: A pluriversal, context-specific, multi-step IC model that critically harmonizes the cultural values of the local population and the general principles of IC can minimize ethics dumping, safeguard the integrity of the research process, and promote respectful engagement.

The four "R"s: Strategies for tailoring science for religious publics and their prices.

A recent wave of studies has diversified science communication by emphasizing gender, race, and disability. In this article, we focus on the understudied lens of religion. Based on an analysis of ultra-Orthodox (Haredi) science journalism and its readership, we identify four main strategies for tailoring science, which we call the four "R"s-removing, reclaiming, remodeling, and rubricating science. By analyzing how science communication is produced by and for a particular religious group, we reveal the diverse ways a religious-sensitive science communication is shaped by community gatekeepers, while also exploring the ethical and epistemological tensions this tailoring entails.

To what extent did implementing a community-embedded intervention align with the goals and roles of stakeholders in adolescent sexual and reproductive health?

Adolescents' sexual and reproductive health (SRH) needs are largely unmet due to poor access to SRH information and services. A multicomponent community-embedded intervention, comprising advocacy to policymakers and community leaders, training of health workers on the provision of youth-friendly SRH services, and establishment of school health clubs, was implemented in Ebonyi State, Nigeria, to improve access to SRH information and services for adolescents aged 13-18years in selected communities and secondary schools. This study explored the extent to which the intervention aligned with goals and roles of stakeholders in the State. Qualitative in-depth interviews (30) were conducted with key stakeholders in adolescent health programming in the State, and community gatekeepers (traditional and religious leaders) in the intervention communities. Sex-disaggregated focus group discussions (10) were conducted with health service providers, parents/guardians of adolescents. Data was analyzed deductively based on fit of strategy and two constructs of the Theoretical Framework for Acceptability - burden, and opportunity cost. The transcripts were coded in NVivo 12, and the subthemes that emerged from each construct were identified. Stakeholders perceived the ASRH intervention activities to align with their individual goals of sense of purpose from serving the community and organizational goals of improving the visibility of adolescent reproductive health programs and aligned with their routine work. Hence, implementing or participating in the interventions was not considered a burden by many. Although the delivery of the interventions constituted additional workload and time commitment for the implementers, the benefits of partaking in the intervention were perceived to outweigh the inputs that they were required to make. Some of the community health workers in the intervention felt that provision of financial incentive will help with making the intervention less burdensome. To participate in the intervention, opportunity cost included forgoing work and business activities as well as family commitments. Findings from the study show that the intervention aligned with individual/organizational goals of stakeholders. To improve acceptability of the ASRH interventions, interventions should leverage on existing programs and routine work of people who will deliver the interventions.

Perceptions and beliefs of community gatekeepers about genomic risk information in African cleft research

BackgroundA fundamental ethical issue in African genomics research is how socio-cultural factors impact perspectives, acceptance, and utility of genomic information, especially in stigmatizing conditions like orofacial clefts (OFCs). Previous research has shown that gatekeepers (e.g., religious, political, family or community leaders) wield considerable influence on the decision-making capabilities of their members, including health issues. Thus, their perspectives can inform the design of engagement strategies and increase exposure to the benefits of genomics testing/research. This is especially important for Africans underrepresented in genomic research. Our study aims to investigate the perspectives of gatekeepers concerning genomic risk information (GRI) in the presence of OFCs in a sub-Saharan African cohort.MethodsTwenty-five focus group discussions (FGDs) consisting of 214 gatekeepers (religious, community, ethnic leaders, and traditional birth attendants) in Lagos, Nigeria, explored the opinions of participants on genomic risk information (GRI), OFC experience, and the possibility of involvement in collaborative decision-making in Lagos, Nigeria. Transcripts generated from audio recordings were coded and analyzed in NVivo using thematic analysis.ResultsThree main themes—knowledge, beliefs, and willingness to act—emerged from exploring the perspective of gatekeepers about GRI in this group. We observed mixed opinions regarding the acceptance of GRI. Many participants believed their role is to guide and support members when they receive results; this is based on the level of trust their members have in them. However, participants felt they would need to be trained by medical experts to do this. Also, religious and cultural beliefs were crucial to determining participants’ understanding of OFCs and the acceptance and utilization of GRI.ConclusionsIncorporating cultural sensitivity into public engagement could help develop appropriate strategies to manage conflicting ideologies surrounding genomic information in African communities. This will allow for more widespread access to the advances in genomics research in underrepresented populations. We also recommend a synergistic relationship between community health specialists/scientists, and community leaders, including spiritual providers to better understand and utilize GRI.

Acceptability of a community-embedded intervention for improving adolescent sexual and reproductive health in south-east Nigeria: A qualitative study

Introduction Adolescents have limited access to quality sexual and reproductive health (SRH) services that are key to healthy sexual lives in many low and middle-income countries such as Nigeria. Hence, context-specific interventions are required to increase adolescents’ access to and utilisation of SRH. This paper provides new knowledge on the acceptability of a community-embedded intervention to improve access to SRH information and services for adolescents in Ebonyi state, southeast Nigeria. Methods A community-embedded intervention was implemented for six months in selected communities. Thereafter the intervention was assessed for its acceptability using a total of 30 in-depth interviews and 18 focus group discussions conducted with policymakers, health service providers, school teachers, community gatekeepers, parents and adolescents who were purposively selected as relevant stakeholders on adolescent SRH. The interview transcripts were coded in NVivo 12 using a coding framework structured according to four key constructs of the theoretical framework for acceptability (TFA): affective attitude, intervention coherence, perceived effectiveness, and self-efficacy. The outputs of the coded transcripts were analysed, and the emergent themes from each of the four constructs of the TFA were identified. Results The intervention was acceptable to the stakeholders, from the findings of its positive effects, appropriateness, and positive impact on sexual behaviour. Policymakers were happy to be included in collaborating with multiple stakeholders to co-create multi-faceted interventions relevant to their work (positive affective attitude). The stakeholders understood how the interventions work and perceived them as appropriate at individual and community levels, with adequate and non-complex tools adaptable to different levels of stakeholders (intervention coherence). The intervention promoted mutualistic relations across stakeholders and sectors, including creating multiple platforms to reach the target audience, positive change in sexual behaviour, and cross-learning among policymakers, community gatekeepers, service providers, and adolescents (intervention effectiveness), which empowered them to have the confidence to provide and access SRH information and services (self-efficacy). Conclusions Community-embedded interventions were acceptable as strong mechanisms for improving adolescents’ access to SRH in the communities. Policymakers should promote the community-embedded strategy for holistic health promotion of adolescents.

Changing climates, compounding challenges: a participatory study on how disasters affect the sexual and reproductive health and rights of young people in Fiji

Pacific youth are at the forefront of the climate crisis, which has important implications for their health and rights. Youth in Fiji currently bear a disproportionate burden of poor experiences...

Surviving stomach bugs in UK ethnic groups: a qualitative study

BackgroundThe exposure patterns across ethnic groups are unclear for stomach bugs that cause self-limiting symptoms, significantly burdening UK health-care services and the economy. This study seeks to fill this gap by exploring how inequalities arise in managing stomach bugs in UK ethnic groups. MethodsA qualitative study using semi-structured interviews was undertaken. Ethics approval was given by the University of Liverpool, and data were collected by IZ over 11 months from July 26, 2022, and May 26, 2023. Purposive sampling was used to recruit a general UK population sample (excluding health-care professionals) who were adults, partners, and parents, from an ethnic minority group, with recent diarrhoea, vomiting, or a stomach bug over the past 6 months. Recruitment was conducted through community gatekeepers using flyers. Participants were interviewed in person or virtually and gave written informed consent. An incentive of an Amazon voucher of £10 was imbursed to participants for their time. Interviews were audio-recorded using a password-protected digital recorder, transcribed verbatim, and analysed using reflexive thematic analysis. Findings36 interviews (median age 31·5 years) were conducted with 11 women of Pakistani (n=6), Bangladeshi (n=2), Indian (n=2) and Arab ethnicity (n=1), and 25 men of Black (n=22), Pakistani (n=2), and Indian (n=1) ethnicity. This sample enabled an exploration of within-ethnic group experiences of stomach bugs in participants who self-defined their age, sex, and ethnicity. Themes such as managing food preparation (n=16), travel abroad (n=17), and personal cleanliness (n=3) were consistently reported across transcripts. The findings corroborate existing literature that there are more similarities than divergences in the management of stomach bugs across ethnic groups, such as the burden of care disproportionately affecting women and using over-the-counter medication to manage symptoms. InterpretationWe do not know if the impact of these experiences across ethnic groups is entirely representative of the broader ethnic categories (ie, Asian vs Indian, Pakistani, and Bangladeshi) they belong to or if there are inequalities in their impact on ethnic groups living in different circumstances (ie, UK born vs migrant). FundingNational Institute for Health and Care Research (NIHR).

The Certified QPR Pathfinder Training Program: A Description of a Novel Public Health Gatekeeper Training Program to Mitigate Suicidal Ideation and Suicide Deaths

Suicide represents a significant public health concern. One approach to reducing suicide rates is to train gatekeepers—community members who, through their day-to-day practices, interact with a substantial proportion of the population—to detect individuals at elevated suicide risk and refer them to appropriate mental health care services. One of the most well-known community gatekeeper training programs is Question, Persuade, and Refer (QPR), which has been delivered to millions worldwide. Gatekeeper training, including QPR, shows considerable promise in reducing suicide risk. However, one limitation of existing gatekeeper training programs is that they rely on referrals to mental health services, which are often non-existent, understaffed, and/or undertrained regarding suicide risk. As such, novel approaches are needed to equip community gatekeepers with primary mental health first aid and suicide-focused counseling. This article describes, for the first time, the fundamental concepts of a newly developed and more expansive version of QPR, the QPR Pathfinder Training. The QPR Pathfinder Training is web-based training program designed to create a cadre of “super gatekeepers” to address suicide at scale. The QPR Pathfinder Training will equip communities to address the critical shortage of mental health care services around the globe and, in turn, reduce mental health morbidities and decrease the suicide rates.

Understanding sexual behaviors of youth from the lens of caregivers, teachers, local leaders and youth in Homabay County, Kenya

In Kenya similar to other countries in Eastern and Southern Africa There is a disproportionately high burden of the global HIV incidence among youth ages 15–24 years, and where adolescent girls and young women account for up to a third of all incident HIV infections and more than double the burden of HIV compared to their male peers. Previous work has shown early sexual debut as entry point into risks to sexual and reproductive health among young people including STI/HIV acquisition. This was a formative assessment of the local context of three sexual risk behaviors among youth ages of 15–24 years: early sexual debut, multiple sexual partnerships, and age-mixing /intergenerational sex for purposes of informing comprehensive combination HIV intervention program design. We conducted a cross-sectional formative qualitative study in four sub-counties within Homabay county a high HIV prevalence region of Kenya. Participants were recruited through youth groups, schools, government offices and, community gatekeepers using approved fliers, referred to a designated venue for focus group discussion (FGD). After oral informed consent, twelve FGDs of 8–10 participants were carried out. Transcripts and field notes were uploaded to Atlas.ti qualitative data analysis and research software (version 8.0, 2017, ATLAS.ti GmbH). Open coding followed by grouping, categorization of code groups, and thematic abstraction was used to draw meaning for the data. A total of 111 youth participated in the FGD, 65 males and 46 females. The main findings were that youth engaged in early sex for fear of being labeled ‘odd’ by their peers, belief (among both male and female) that ‘practice makes perfect’, curiosity about sex, media influence, need to prove if one can father a child (among male), the notion that sex equals love with some of the youth using this excuse to coerce their partners into premature sex, and the belief that sex is a human right and parents/guardians should not intervene. Male youth experienced more peer-pressure to have sex earlier. Female youths cited many reasons to delay coitarche that included fear of pregnancy, burden of taking care of a baby, and religious doctrines. Having multiple sexual partners and intergenerational sexual relationships were common among the youth driven by perceived financial gain and increased sexual prowess. HIV prevention strategies need to address gender vulnerabilities, as well as promoting a protective environment, hence application of combination prevention methods is a viable solution to the HIV pandemic.Trial registration number: The study was approved by the KNH/UoN Ethics review committee (KNH/UoN ERC-P73/03/2011) and New York University (NYU Reg no.–00000310).

The first mass drug administration campaign for schistosomiasis control in Lagos, Nigeria: lessons for future control programs

BackgroundIn this study we summarized the lessons learnt during the first effective mass drug administration (MDA) campaign in one of the most urbanized states in Nigeria. We particularly discuss the implementation approach including associated challenges and future prospects.MethodsWe implemented schistosomiasis MDA with praziquantel in seven endemic districts of the state, using a sub-district/ward-level implementation approach. Upon completion, we conducted desk reviews of field reports and a high-level stakeholder meeting among 95 key personnel involved in the MDA. We reviewed excerpts from the meetings to highlight the strengths, weaknesses, threats and opportunities (SWOT) of the sub-district/ward-level implementation approach. Quantitative data were summarized using basic descriptive statistics, while qualitative data were analyzed to identify emerging themes.ResultsAbout 1.45 million children between age 5 and 15 were targeted for treatment, and a geographic (100%) and therapeutic coverage of 85.5% was achieved. Therapeutic coverage was optimal (>75%), across all the implementation districts (Range:76.2- 95.3%). Ifako-Ijaiye had the highest therapeutic coverage (95.3%), while Oshodi-Isolo as the least (76.2%). Strategies supporting high coverage includes; (1) adequate delineation of hard-to reach areas and allocation of commensurate resources, (2) improved consultation and microplanning among programmers, (3) addressing traffic congestion on transportation routes, (4) strengthened engagements and collaborations with community gatekeepers, (5) optimizing cash flow to mitigate financial risk, (6) capacity building of field stakeholders and, (7) regular advocacy and sensitization among stakeholders.ConclusionThis study provides possible directions for implementation of schistosomiasis control by programs and agencies at sub-district/ward-level in a cosmopolitan and urbanized state, like that of Lagos, Nigeria.

Community Gatekeepers: Power, Pitfalls and Possibilities When Recruiting and Researching Black, Asian, and Minority Ethnic (BAME) Participants

Using data from a large primarily qualitative research project on how people from Black, Asian and Minority Ethnic (BAME) communities experience and access health services, this methodological article focuses on the role of the community gatekeeper – a role that has significance for research teams globally when attempting to involve those facing multiple forms of exclusion. Drawing on standpoint feminist principles and using a reflexive approach, researcher positionality, situated knowledges, and the power dynamics between researchers, participants, and community gatekeepers are reflected upon. Addressing a gap in the literature by providing real-life examples of the power and influence of gatekeepers at all stages of the research process, the findings reveal: the extent to which gatekeepers of research with BAME participants are facilitative or obstructive during the research process; how they affect processes such as the recruitment of participants, access to community venues, the conduct of the research interview, and the dissemination of findings; and finally, the implications for future research with so called “hard-to-reach” groups.

Determinants of awareness, value perception, and societal support for sexual and reproductive health services among in-school adolescents in South-eastern Nigeria

BackgroundAdolescents are vulnerable to sexual and reproductive health (SRH) risks yet, have poor utilisation of SRH services due to personal, social, and demographic influences. This study aimed to compare the experiences of adolescents that had received targeted adolescent SRH interventions and those that did not and evaluated the determinants of awareness, value perception, and societal support for SRH service utilisation among secondary school adolescents in eastern Nigeria.MethodsWe undertook a cross-sectional study of 515 adolescents in twelve randomly selected public secondary schools, grouped into schools that had received targeted adolescent SRH interventions and those that did not, across six local government areas in Ebonyi State, Nigeria. The intervention comprised training of schools’ teachers/counsellors and peer educators and community sensitisation and engagement of community gatekeepers for demand generation. A pre-tested structured questionnaire was administered to the students to assess their experiences with SRH services. Categorical variables were compared using the Chi-square test, and predictors were determined through multivariate logistic regression. The level of statistical significance was determined at p < 0.05 and a 95% confidence limit.ResultsA higher proportion of adolescents in the intervention group, 126(48%), than in the non-intervention group, 35(16.1%), were aware of SRH services available at the health facility (p-value < 0.001). More adolescents in the intervention than the non-intervention group perceived SRH services as valuable– 257(94.7%) Vs 217(87.5%), p-value = 0.004. Parental/community support for SRH service utilisation was reported by more adolescents in the intervention group than in the non-intervention group- 212 (79.7%) Vs 173 (69.7%), p-value = 0.009. The predictors are (i) awareness-intervention group (β = 0.384, CI = 0.290–0.478), urban residence (β=-0.141, CI=-0.240-0.041), older age (β-0.040, CI = 0.003–0.077) (ii) value perception - intervention group (β = 0.197, 0.141–0.253), senior educational class (β = 0.089, CI = 0.019–0.160), work-for-pay (β=-0.079, CI=-0.156–0.002), awareness (β = 0.192, CI = 0.425–0.721) (iii) parental/community support - work-for-pay (β = 0.095, CI = 0.003–0.185).ConclusionsAdolescents’ awareness, value perception, and societal support for sexual and reproductive health services were influenced by the availability of SRH interventions and socio-economic factors. Relevant authorities should ensure the institutionalisation of sex education in schools and communities, targeting various categories of adolescents, to reduce disparity in the utilisation of sexual and reproductive health services and promote adolescents’ health.

METHODOLOGICAL AND ETHICAL ISSUES OF RESEARCH WITH OLDER ADULTS IN PUERTO RICO DURING COVID-19

Abstract Engaging diverse groups of older adults is essential to addressing health disparities. In this presentation, we will describe how we used our research team’s networks and knowledge of the target population to engage key stakeholders in our KAP project. We will address our partnerships with clergy, NGO staff and administrators, housing authorities, colleagues at Puerto Rican universities, and older adults who serve as informal community and institutional gatekeepers. We will discuss how these partnerships facilitated our ability to identify and access study sites and participants; conduct telephone and in-person interviews; ensure data quality through training and monitoring; and, assure safety through adherence to COVID-19 protocols. Finally, we will describe key cultural and ethical issues of conducting research with older adults through community partnerships during a pandemic. The presentation has implications for developing beneficial partnerships with local community leaders and enhancing the representation of diverse groups of older adults in research.

Implementing SMS reminders for routine immunization in Northern Nigeria: a qualitative evaluation using the RE-AIM framework

BackgroundShort Message Service (SMS) reminders have improved vaccine uptake in low- and middle-income countries (LMICs). However, the limited use of SMS reminders in LMICs requires evaluating the intervention’s internal and external validity to improve adoption and sustainability. Using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we qualitatively assessed the impact of a SMS reminder intervention implemented in Kebbi State, Northwest Nigeria between May 20, 2019 and May 31, 2020. This will guide and inform future SMS reminder interventions to improve childhood immunization uptake in LMICs.MethodsIn June 2020, we conducted 14 focus group discussions, 13 in-depth interviews, and 20 key informant interviews among 144 purposively selected participants from five local government areas of Kebbi State. For analysis, we used a deductive approach to develop preliminary codes based on the RE-AIM framework and the inductive approach to generate themes that emerged from the interviews.ResultsThe perceived importance and impact of the SMS reminder in improving demand and uptake for vaccinations were the consistent contributing factors that encouraged participants’ participation. Other facilitators included the involvement of health workers in supporting SMS reminder registration and community gatekeepers using existing structures to convey messages on scheduled immunization services. Policymakers adopted the intervention because it aligns with the state’s priority to improve immunization coverage. Similarly, the SMS reminder appealed to health workers and program managers because it reduced their workload and served as a performance monitoring tool to track immunization and intervention defaulters. Despite these, low mobile phone ownership and the inability to read text messages due to the low literacy level were the main barriers during implementation. Finally, data availability on cost-effectiveness and the intervention’s impact on improving coverage was critical for scalability.ConclusionsOur study demonstrated that SMS reminders in local languages could improve vaccination demand and uptake in resource-constrained settings due to their perceived importance and impact. Addressing the cited implementation barriers and promoting the facilitators is critical to its adoption and sustainability. Costing and impact data are needed to collaborate findings on the effectiveness of the SMS reminder to improve childhood vaccination uptake.

Generating Trust in Participatory Research on Plasmodium knowlesi Malaria: A Study with Rural Community Gatekeepers during the COVID-19 Pandemic

Plasmodium knowlesi malaria is a zoonotic infection that affects rural communities in South East Asia. Although the epidemiology of the disease has been extensively researched, the voices of individuals within affected communities often go unheard. Here, we describe a study that explores the importance of gatekeepers in conducting research among rural communities, their perspectives on the challenges encountered when attempting to avoid malaria infection, and their views on participatory research. Between 1 November 2021 and 28 February 2022, we conducted a study in Kudat district, Sabah, using a multi-method design. All participants consented to the study, which included health care workers (HCWs) (n = 5), community leaders (n = 8), and faith leaders (n = 1). We conducted interviews, transect walks, and observations with gatekeepers to ensure data trustworthiness. All interviews were conducted in the Sabah Malay dialect. The sessions were audio- and video-recorded, transcribed into English and analyzed using thematic analysis. Between 2017 and 2021, the number of cases of P. knowlesi malaria detected in humans ranged from 35 to 87 in villages under the care of the Lotong primary health care clinic. The challenges in controlling malaria include social norms, lifestyles, socioeconomic factors, environmental factors, and limitations of basic resources. Critical discussions regarding participation with the gatekeepers identified that face-to-face interviews were preferable to online discussions, and influenced willingness to participate in future research. This study was conducted among village gatekeepers during the COVID-19 pandemic and generated information to drive methodological changes, opening up new ideas by sharing perspectives on challenges in P. knowlesi malaria control among vulnerable communities. The study generated trust in the community and expanded knowledge regarding participation that is critical for future community-based studies.