Community Health Practice Research Articles

Evidence-Based Ethical Practice: Role of Health Promotion

This review article discusses the various ethical standards on which community health practice is founded. From autonomy, justice, privacy, paternalism and beneficence, the practice of health promotion is strongly underpinned by ethics. From private practice to community-wide health promotion, this article reminds practitioners of their obligation to uphold ethics in their evidence-based ethical practice. Finally, the article highlights common ethical dilemmas that are common in community health practice and how practitioners can navigate these situations. Keywords: Ethics, Empowerment, Health Promotion

Re-orienting healthcare for healthy living communities: A qualitative exploration of nursing students utilising the salutogenic theory for community health practice

BackgroundSalutogenesis is a resource-oriented approach that focuses on health creation. With the shift in focus from healthcare to health, there is a need to develop salutogenic inquiry and capacity of future nurses to promote good health and well-being in the community. ObjectiveThis study explored nursing students' perspectives on utilising the salutogenic theory in the community for health promotion, including the scope, perceived benefits, and challenges of theory application. DesignA qualitative study using framework analysis. SettingA tertiary institution in Singapore. ParticipantsNursing students who were taught the salutogenic theory for ‘Healthy Community Living’ module. MethodsData were gathered from four focus group discussions (n = 18) and 32 students' written assignments. They were analysed based on five components of knowledge framework. ResultsFour themes were identified: re-orienting healthcare for healthy living communities; ambivalent learning experiences; attracting early adopters of salutogenic paradigm; and practices for positive health development in complex systems: future directions. Findings reflected the value, versatility, and usefulness of introducing the salutogenic paradigm into the curriculum of healthcare education. Practical know-hows of applying the theory in community practice and development of health intervention were elicited. ConclusionMuch work is needed to future-proof the next generation of nurses in embracing and unifying the concept of salutogenic science into the existing pathogenic-driven care model. The real challenge would be the continual support of nursing education and health system to provide salutogenic care in the community.

Core competencies of peer workers who use pulse oximeters to supplement their overdose response in British Columbia.

IntroductionPeer workers (those with lived/living experience of substance use) are at the forefront of overdose response initiatives in British Columbia, Canada. The onset of the coronavirus disease pandemic has significantly compounded the impact of the overdose crisis. Peer workers are integral in supporting people who use substances. However, despite the important work they do, peer workers often lack formalized credibility and do not have the same resources available to them as service providers without lived experience. The peer-led project titled the Peer2Peer Project implemented several support programs for peer workers, including providing pulse oximeters to peer workers to supplement their overdose response procedures.Materials and methodsThis study was a component of a larger evaluation of the pulse oximeter program at two organizations in BC. The study aims to highlight the competencies of peer workers who use pulse oximeters. Telephone interviews were conducted with seven peer workers who were given pulse oximeters. The transcripts were thematically coded using Covert et al.’s framework of core competencies of community health workers to compare our sample with other widely recognized professions.FindingsWe found that peer workers who used pulse oximeters described several core competencies in their work and these were aligned with Covert et al.’s core competencies for community health workers, including assessment, community health practice, communication, diversity and inclusion, professional practice, and disease prevention and management.ConclusionBy aligning peer workers’ skills to those of community health workers, we create awareness on the competencies of peer workers in using oximeters to supplement overdose response and advocate for them to receive more recognition and respect within the workplace. Further, our findings act as groundwork for future research in identifying the professional proficiencies of peer workers.

Ethical implications of COVID-19 surveillance in Karnataka using Nancy Kass Framework

Numerous public health hurdles, including pandemics such as COVID-19, have led to concerns about community health practices in relation, necessitating the application of an ethical perspective. International research ethics guidelines are only used in a restricted range of contexts of public health. As a result, a variety of frameworks have been established to assist ethical analysis of public health concerns. In this study, we have used the Nancy Kass framework for analyzing COVID-19 surveillance in Karnataka state of India, which is a six-step approach that can assist public health practitioners in evaluating the ethical consequences of interventions, policy initiatives, services, and so on. In order to supervise the compliance of home quarantine, the government of Karnataka mandated uploading selfies as a digital tracking surveillance measure for the COVID-19 outbreak. However, these measures raised several ethical questions, especially related to an individual’s privacy, confidentiality, autonomy, and liberty. An established state surveillance mechanism with includes enforced measures for data security along with the moral duty of an individual to protect the health of the community can probably balance the principles of ethics.

Examining the Collegiality of Marxist and Naturalist Social Justice Ethical Pedagogy and Global Social Development Educational Commitment for Action for Community Disability Services

This paper examines the collegiality of the Marxists and Naturalists of Social Justice theories toward ethical education in enhancing collegial management and leadership for community disability services for the benefit of community health and social work practices pertaining to post-COVID-19. Consequently, the collegiality of the Marxists and Naturalists of social justice theoretical ethical education was addressed within and linked with the four goals of the Global Social Work and Social Development Educational Commitment (GSDEC) for Action, thus, interconnecting the concepts above with the community disability services of health and social work practices and add clarity about their implementation for post-COVID-19 evaluation. The researchers argued that reimagining social justice education in improving the benefits of innovative and stimulating multisensory approaches pursued by higher education globally would expand the characteristics of collegial imagination and inventiveness. This paper suggests an effervescent hypothetical context concerning the critical elements desirable to galvanize and endorse collegiality in Marxists' and Naturalists' social justice ethical education for a post-COVID-19 era.

Stress and Health Status Among Members of a Disadvantaged Community in Flint, Michigan in the Early Phase of the COVID-19 Pandemic.

The COVID-19 pandemic creates psychological concerns and stress and its impacts are more extreme for those with health concerns residing in socially and economically disadvantaged communities, such as residents of Flint, Michigan. This study assesses the stress level among people who received community assistance in the first 3 months of COVID lockdowns. Further, it examines associations between stress and physical and mental health status. We measured perceived stress, health concerns, mental distress, and perceived physical and mental health from 106 survey respondents. Comparisons of stress levels by demographics showed that females, high school graduates, and homeowners had higher stress levels than its counterparts. Results from general linear models showed that stress was highest among those with high levels of psychological distress, perceived poor mental health, and more health concerns. The associations between poor perceived physical health and stress were marginal. Homeowners and high school diploma holders showed lower stress levels. This research suggests community health practices tailored to community characteristics and culture will have the greatest impact on stress and health problems in underserved communities.

Utilizing Community Partnerships to Devise a Framework for Cultural Adaptations to Evidence-Based Mental Health Practice in Diverse Communities

Mental health disparities for diverse communities (particularly immigrants and people of color) in terms of access to evidence-based treatments, lack of education/awareness about mental health symptoms and treatment options, and lack of culturally responsive treatments have been frequently documented. Hence, diversity considerations in the diagnosis, assessment, and treatment of psychological disorders remain vital and imperative in clinical practice. There is also substantial work indicating that cultural values likely play an essential role in shaping how individuals conceptualize and experience mental or emotional health. Therefore, the present study was developed for community-engaged clinicians and researchers to outline the process by which to create a culturally responsive, evidence-based treatment framework for community mental health interventions in close partnership with communities of color. This study was conceptualized and designed collaboratively with community leaders across five different communities of color: African American/Black, Latino/a, Native American, Pacific Islander, and African immigrant communities in a major U.S. city. This paper describes the mixed methods for such a community-engaged collaboration, highlighting critical elements for ongoing culturally engaged clinical work/research, and providing recommendations for culturally adapted interventions for mental health based on specific process observations made in the current example.

The Collegiality of Ethical Social Justice Pedagogy for Community Health Disability Services in the Post-COVID-19 Era

The recent deaths of mentally disabled persons at the hands of police, both in the United States and South Africa, during the earlier COVID-19 pandemic and the subsequent other similar issues, call for justice for victims, which are some of the sampled evidence of the precarious position persons with disabilities find themselves in. This article responds as an inquiry from the viewpoint of the collegiality on post-COVID-19 repercussions on community disability services. The researchers peruse evidence of the prioritization of social justice ethical education toward enhancing collegiality in community disability services for the benefit of community health and social work practices in the eventual post- COVID-19 aftermath in Africa. The articles’ reviews, synthesis, and concept-plotting applications utilize a systematic review of literature that rely on secondary data. The article made use of 110 out of 235 articles that were inspected, analyzed, and reckoned to be appropriate and incorporated the views gleaned from scoping searches of JAMA, The Lancet, Scopus, Elsevier, Cochrane, Wiley-online, Pro-Quest, Sabinet, Ebsco-Host, Science-Direct, Sage-Pub, and SAGE-Journals libraries. Thus, this article utilized three of the five main social justice theories for community disability services. The connected issues on collegiality in terms of its management and leadership for ethical, social justice pedagogy angled that prioritizing social justice and ethical education should improve practices of education in Africa. Consequently, we argued that the collegiality in the prioritization of social and ethical education should be addressed and offered a vibrant hypothetical framework regarding the essential ingredients needed to activate and enact collegiality in social justice ethical education for a post-COVID-19 era.

A Survey of Interventions for Cancer Survivors Provided by Occupational Therapy Practitioners

Purpose: Currently, there is a lack of research exploring evidence-based occupational therapy intervention practices at the activity level in survivorship care, which is important to identify for future research and clinical needs of the profession. The purpose of this study was to describe what activity level interventions OT practitioners are using and report any practice trends that might exist. Method: A cross-section design was used with non-probability purposive sampling to recruit occupational therapy practitioners working with adults living with and beyond cancer. A three-phase process for survey development and implementation was used, as recommended by the literature, for improving content validity and minimizing measurement error. Results: A total of 267 surveys were distributed and 70 surveys returned (26.20% response rate). Given the range and frequency of responses, it is suggested that occupational therapy practitioners focus on individual needs for function and participation and are not limiting practice to physical impairments. There were several areas that only a small percentage of respondents identified addressing with clients, including shopping (range 5.83-9.23%), driving and community mobility (range 5.90-9.58%), and financial management (range .74-10.20%) that typically fall into outpatient and community health practice settings. Conclusion: We reviewed current oncology intervention and referral practice trends for occupational therapy and pose several implications for advancing clinical practice in oncology. Future research into interventions not supported by literature that occupational therapists identified currently using in practice is needed.

Does social capital influence community health worker knowledge, attitude and practices towards COVID-19? Findings from a cross-sectional study in Malang district, Indonesia

Community health workers (CHWs) are the first point of contact with the primary health care system in many low- and middle-income countries and are situated to play a critical role in the public health response to the COVID-19 pandemic. The knowledge, attitude and practices of CHWs regarding COVID-19 may be influenced by their level of trust and participation in the community, collectively defined as their level of social capital. To assess whether social capital influences CHWs’ knowledge, attitude and practices related to COVID-19, we conducted a web-based survey of CHWs (n = 478) in Malang district, Indonesia between October 2020 and January 2021. CHW social capital was measured using the Shortened Adapted Social Capital Assessment Tool. Multiple logistic regression results show that cognitive social capital was associated with higher self-reported knowledge of COVID-19, more confidence in answering COVID-related questions from the community and feeling safe from COVID-19 when working. Membership of community organisations was associated with a higher number of COVID-related tasks conducted. Thus, CHWs in Malang district with higher levels of cognitive social capital were more likely to be confident in their knowledge and ability to respond to COVID-19, and CHWs embedded in their community were more likely to be engaged in pandemic response duties. Our findings suggest that policies aimed at promoting CHW embeddedness, targeted recruitment and addressing training needs hold promise in strengthening the positive contribution of the community health workforce to the COVID-19 response.

32-LB: Role of Telehealth in Improving Health Care Quality in Type 2 Diabetes in a Rural Community-Based Clinical Practice

Use of continuous glucose monitoring (CGM) facilitates better management of type 2 diabetes (T2D) in outpatient clinics in academic medical centers. In a Quality Improvement project, we evaluated the effects of telehealth aided by CGM on HbA1c and percent time in range (TIR 70-180 mg/dl) in patients with T2D over a 6-month duration. Diabetes management advice based on intermittent CGM use was provided via phone by an academic endocrinologist to the clinical pharmacist at a rural community clinic. Inadequately controlled (HbA1c > 8%) T2D patients (n=27) on at least one antidiabetic drug were included and were monitored over a 6 month period, baseline (V1) , 3 months (V2) and 6 months (V3) . All patients received standard of care (SOC) treatment. On each visit, 12 patients (age 59 8y, BMI 36.2 3.6kg/m2, HbA1C 9.3 1.3%) received a professional CGM for 2 weeks. Thereafter, the devices were removed and analyzed. The PCP implemented medication changes based on recommendations by the endocrinologist to the clinical pharmacist. The other 15 patients (age 60 8y, BMI 32 4 kg/m2, HbA1C 9.1 1.6%) underwent the same schedule without CGM or telehealth consultations. There were no significant differences in age or HbA1c between groups at baseline. HbA1c (%) decreased (Δ -1.0 ± 1.4; p=0.03) , and CGM TIR (%) increased (Δ +24.3 ± 38.7; p=0.05) at V3 vs. V1 in the telehealth group. However, weight, CGM time below and above ranges (%) did not differ (p>0.05) statistically. In contrast, there were no significant differences in HbA1c (Δ +0.4 ± 1.7; p=0.3) between V3 and V1 in the SOC without telehealth group. Our results show that intermittent CGM use coupled with tele-consultation with diabetes expert improves glucose control and care quality in patients with T2D in community based health practice. This strategy could potentially mitigate existing health care disparities between suburban/rural-based community health practices and academic medical centers, thus closing the gaps in quality of care. Disclosure S. Gururaj: None. A. Asfa: None. L. C. Hanley: None. Y. R. Yadav: None. R. T. Bashore: None. R. Basu: Consultant; Sparrow Pharmaceuticals Inc, Research Support; Abbott Diabetes, AstraZeneca. A. Basu: Speaker’s Bureau; Zealand Pharma A/S. Funding Virginia Department of Health (GS11963)

Knowledge and Opinions of Interns of Faculty of Medicine About Community Health Centers

Aim: In the study, it was aimed to determine the knowledge and opinions about community health center structuring and practices among the interns of Eskişehir Osmangazi University Faculty of Medicine.Methods: The study is a qualitative study conducted on interns who received Public Health Internship at Eskişehir Osmangazi University Medicine Faculty between January-April 2018. The study groupconsisted of 57 interns. In the study in which the interview method was used, the data were collected with an interview form containing 7 open-ended questions. The responses given by the interns were coded and evaluated by descriptive analysis. The numbers and percentages of coded responses were calculated.Results: Interns reported the most frequent among the community health center duties, activities to improve and promote health, plan and program, infectious diseases, immunization and epidemic control;among the community health center physician's duties, to take part in the protection and promotion of the community health, conduct programs related to infectious diseases and immunization and public health education. Items included in the Community Health Center and Affiliated Units Regulation, but not specified by the interns as the duties of the community health center and community health centerphysician, were determined. 59.7% (n=34) of the interns reported that the practices related to community health center in the Public Health internship were beneficial in terms of contributing to their futureprofessional life. While 70.2% (n=40) of the interns thought that community health centers have an important role in improving the health level in our country; 49.1% (n=28) of them reported that they donot want to work at community health center after graduation. Conclusions: It was determined that the interns could not fully comprehend the duties of the community health center and community health center physicians. Despite the fact that community health center education was found to be beneficial and community health centers were considered important, the high number of interns who did not want to work in community health centers in their professional life drew attention.

Evaluation of a Pharmacist-Led Telephonic Medication Therapy Management Program in Rural Arizona: Implications for Community Health Practice

This study evaluated a pharmacist-led telephonic Medication Therapy Management (MTM) program for rural patients in Arizona with poor access to healthcare services. A pharmacist provided telephonic MTM services to eligible adult patients living in rural Arizona communities with a diagnosis of diabetes and/or hypertension. Data were collected and summarized descriptively for demographic and health conditions, clinical values, and medication-related problems (MRPs) at the initial consultation, and follow-up data collected at 1 and 3 months. A total of 33 patients had baseline and one-month follow-up data, while 15 patients also had three-month follow-up data. At the initial consultation, the following MRPs were identified: medication adherence issues, dose-related concerns, adverse drug events (ADE), high-risk medications, and therapeutic duplications. Recommendations were made for patients to have the influenza, herpes zoster, and pneumonia vaccines; and to initiate a statin, angiotensin converting enzyme inhibitor, angiotensin receptor blocker, beta-blocker, and/or rescue inhaler. In conclusion, this study demonstrated that while pharmacists can identify and make clinical recommendations to patients, the value of these interventions is not fully realized due to recommendations not being implemented and difficulties with patient follow-up, which may have been due to the COVID-19 pandemic. Additional efforts to address these shortcomings are therefore required.

‘Swallow medicine, eat rice, pray about health’: health, health care and health-seeking experiences of South-East Asian older refugees

AbstractSouth-East Asian refugees have lived in the United States of America for nearly four decades, with early refugee immigrants experiencing ageing and later life within the refugee context. As refugees age, health concerns of this older population grow, highlighting the need for ongoing assessment of refugee health and health-seeking behaviours. This study builds on previous literature that assessed the health and health-seeking patterns of South-East Asian refugees in the early years following resettlement, exploring how health and health-seeking is understood among older refugees 40 years after immigration. This paper includes a subset of 37 older refugees from a larger, community-based participatory, mixed-methods intergenerational study of Cambodian and Laotian refugee families conducted over four years (quantitative N = 433; qualitative N = 183). Thematic analysis of 34 semi-structured interviews with these older refugees in coastal Alabama revealed trends in health and health-seeking practices. Older refugees reported high rates of diabetes and hypertension within their generational cohort, and indicated a shift in health-seeking behaviours, whereby Western biomedicine is sought first for such chronic concerns, followed by traditional medicines for mild ailments such as headaches or colds. Older refugees underscored barriers of language, finances and transportation as limiting access to Western health care. Implications for engaging in community health practices and incorporating services to specifically meet the needs of the ageing refugee population are discussed.

Consultation to review clinical placement processes: A quality assurance project

AimWorking in partnership is a key goal for nursing and community health practice. This case study reports the quality assurance process employed to enhance the process of allocating clinical places for postgraduate Maternal and Child Health nurses in Victoria, Australia. BackgroundThe review of the clinical placement process occurred because councils (placement providers) reported being overwhelmed with inquiries and applications for places, time-line issues and some confusion about processes. This situation was further compounded as these clinical placements were provided by Councils at no cost to universities or students. DesignThe Quality Assurance consultation process was guided by an action research approach and systematically explored the experience of municipalities hosting students. MethodThis involved five discrete phases: Online survey 1, Focus group, Draft consultation report, Online survey 2 and Distribution of Maternal and Child Health clinical placement process packages. Feedback was reported regarding what was working well, challenges with existing student placements and suggested strategies to improve the student placement process. ResultsCollaboration led to improvements in the clinical placement process and produced key resources for stakeholders. An unexpected outcome of the process was the development of a List of Expectations and Responsibilities for all stakeholders. ConclusionThe councils providing MCH clinical experience are highly valued by the universities and their students as clinical placement is provided voluntarily as a contribution to the MCH profession. All parties indicated it was very beneficial to collaborate to optimise this process.

2021 CDC Update: Treatment and Complications of Sexually Transmitted Infections (STIs)

The Centers for Disease Control and Prevention (CDC) recently updated their Sexually-Transmitted Infection (STI) Treatment Guidelines with a revision to the approach to gonococcal infections in December 2020 and other STIs in July 2021. This article reviews the new recommendations and highlights important updates from the 2015 iteration that are crucial for primary care and community health practice.

Orange County, California COVID-19 Vaccine Equity Best Practices Checklist: A Community-Centered Call to Action for Equitable Vaccination Practices.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has exacerbated longstanding inequities throughout the United States, disproportionately concentrating adverse social, economic, and health-related outcomes among low-income communities and communities of color. Inequitable distribution, prioritization, and uptake of COVID-19 vaccines due to systemic and organizational barriers add to these disproportionate impacts across the United States. Similar patterns have been observed within Orange County, California (OC).Methods: In response to COVID-19 vaccine inequities unfolding locally, the Orange County Health Equity COVID-19 community–academic partnership generated a tool to guide a more equitable vaccine approach. Contents of the OC vaccine equity best practices checklist emerged through synthesis of community-level knowledge about vaccine inequities, literature regarding equitable vaccination considerations, and practice-based health equity guides. We combined into a memo: the checklist, a written explanation of its goals and origins, and three specific action steps meant to further strengthen the focus on vaccine equity. The memo was endorsed by partnership members and distributed to county officials.Discussion: Since the initial composition of the checklist, the local vaccine distribution approach has shifted, suggesting that equitable pandemic responses require continual re-evaluation of local needs and adjustments to recommendations as new information emerges. To understand and address structural changes needed to reduce racial and socioeconomic inequities exacerbated by the pandemic, authentic partnerships between community, academic, and public health practice partners are necessary.Conclusion: As we face continued COVID-19 vaccine rollout, booster vaccination, and future pandemic challenges, community knowledge and public health literature should be integrated to inform similar equity-driven strategic actions.

Addressing Needs of Older Adults in Low-Income Independent Living Facilities in Community Health

Access to quality care in long-term care settings including independent living facilities is needed for a diverse high-risk aging U.S. population. There is an urgent need to assess and address complex care needs of older adults living longer with chronic conditions and serious illness. However, a system to assess and identify health problems, intervene, and evaluate outcomes is lacking. This session presents learnings from a pilot study developed in collaboration with Nurse Managed Centers at low-income independent living facilities for older adults and undergraduate nursing students in community health practice. We will discuss the adaptation of the Omaha System for provision of care in independent living facilities to address complex care needs. Finally, we will discuss the impact of this project and its potential for healthcare transformation in independent living facilities and transformation of education in undergraduate nursing programs.

Improving Quality and Access to Care in Long-Term Care Settings

Innovative delivery models that assure access to quality care in long-term care settings are needed for the diverse high-risk aging U.S. population. The 2008 National Academy of Medicine report, “Retooling for an Aging America: Building the Health Care Workforce” highlighted the need for changing the roles of health care providers in order to provide high-quality and cost-effective care to older Americans. Moreover, from the providers’ perspective, workplace violence in health care institutions, such as nursing homes, negatively affect the delivery, quality, and accessibility of health care. In this symposium, we identify needs and care provisions in the context of older adults aging in long-term care settings and discuss the implications for policy and health care transformation. This symposium comprises three distinct presentations: (1) identifying and addressing the needs of diverse older adults aging in low-income independent living facilities in community health practice; and based on pilot survey results from nurses in the State of New Hampshire, (2) reframing residents’ violence directed toward providers as self-protection and (3) proposing legislative and policy changes designed to meet the needs of staff and residents of long-term care facilities. These presentations represent efforts across long-term care settings to improve access and quality of care in the context of diverse older adults aging in the U.S.

Rectal specimen self-collection for chlamydia and gonorrhea screening: a cross-sectional feasibility study at a community health center

BackgroundMen who have sex with men (MSM) are at increased risk for extra-genital sexually transmitted infections (STIs). Without extra-genital screening, many chlamydia and gonorrhea infections would be missed among MSM. Yet, many barriers exist to extra-genital testing, and, in particular, to rectal collection. Self-collection increases screening and detection of asymptomatic chlamydia and gonorrhea among at-risk MSM and transgender women. This feasibility study assessed use of rectal self-collection and its acceptance among patients and primary care providers (PCPs) at a large, general practice community health center. The primary objective of this project was to assess the feasibility of including rectal self-collection as part of an implementation study looking to embed an STI care program in a safety-net primary care setting that would shift routine screening tasks to non-provider clinical team members such as medical assistants and nurses.MethodsThree PCPs identified and offered rectal self-collection to their MSM and transgender female patients who were due for routine or risk-based STI screening. For those patients who elected to participate in the study, the PCP’s medical assistant (MA) reviewed the self-collection instructions with them as part of their routine preventive care duties, and patients collected their own sample. Patients and PCPs completed brief cross-sectional surveys assessing the self-collection process.ResultsOf 1191 patients with sexual orientation and gender identity (SOGI) data on file who were seen for a medical visit by one of the three PCPs, 87 (7.3%) identified as MSM or transgender female. Seventy-five were due for rectal screening, of whom 33 (44%) were offered and completed rectal self-collection. Survey results indicated that self-collection was acceptable to and preferred over clinician-collection by both PCPs and patients.ConclusionsThis study demonstrated that rectal self-collection is feasible as part of STI screening in a high-volume primary care setting, and can be administered as part of the clinical tasks that MAs routinely conduct. The overall acceptance by both PCPs and patients will allow the inclusion of rectal self-collection in an implementation study looking to increase STI screening at a large community health center by facilitating MA-led collection during medical provider visits and by establishing standalone nurse-led STI visits.