Community Mental Health Programs Research Articles

98 Seeing the Unseen– A Retrospective Review of the Demographic Characteristics of a Place-based, Inner-City Social Paediatrics Program

Abstract Background Social paediatrics is a holistic approach to child and youth health that considers the society and environment the child lives in, and aims to address social determinants of health (SDoH) to improve health equity. Place-based social paediatrics clinics minimize health disparities through outreach programs, navigational support, and facilitating access to specialty care services. This model of care was developed in the past few decades as it became widely accepted that SDoH and adverse childhood events have a direct impact on child health. Typical clinic demographics and most prevalent care needs are not well described. Objectives Identify key demographic features and common diagnoses seen by a social paediatrics program’s primary and specialty care services. Design/Methods Ethical approval was obtained from institutional REB. A retrospective chart review of patients accessing the program between Jan 1, 2018 and April 30, 2021, with no additional exclusion criteria, was conducted. Demographic information, factors influencing SDoH, and past medical history were collected. Basic descriptive statistics were used for analysis of the data collected. Results 144 charts have been reviewed to date. The mean age in years at initial assessment was 6.22 (0.07–25.84). The most commonly documented ethnicity was Indigenous (30%), followed by Latinx (8%) and Middle Eastern (8%); 45% of patients were unspecified, as race is not consistently collected in Canadian health records. Poverty was mentioned as an issue in 52 (36%) patients’ charts, ministry involvement noted in 29 (20%), and substance use in 45 (31%) of households. 74 (51%) of charts had evidence of at least one adverse SDoH (e.g. financial and/or housing instability, food insecurity) that could negatively influence health equity. The most frequently documented diagnoses were skin disorders (38%), ADHD (31%), upper respiratory tract infections (29%), learning disability (27%), and speech delay (25%). Developmental disorders were diagnosed in 79 (55%) patients and 45 (31%) had at least one incidence of being seen by a nurse practitioner or general paediatrician for a mental health concern. Conclusion Place-based, equity-oriented social paediatrics clinics see more socially and developmentally complex individuals than traditional paediatric clinics or community health programs. Data analysis of the population seen by our inner-city program found 55% and 31% of patients had developmental and mental concerns, respectively. This suggests that clinicians planning or working in similar programs should be prepared to support neurodevelopmental, mental health, and common medical conditions (e.g. skin disorders and infections).

Unpacking the challenges of fragmentation in community-based maternal newborn and child health and health system in rural Ethiopia: A qualitative study.

In Ethiopia, country-wide community-based primary health programs have been in effect for about two decades. Despite the program's significant contribution to advancing Maternal Newborn and Child Health (MNCH), Ethiopia's maternal and child mortality is still one of the highest in the world. The aim of this manuscript is to critically examine the multifaceted fragmentation challenges of Ethiopia's Community Health Workers (CHWs) program to deliver optimum MNCH and build a resilient community health system. We conducted a qualitative case study in West Shewa Zone, rural Ethiopia. A purposive sampling technique was used to recruit participants. Data sources were two focus group discussions with sixteen CHWs, twelve key informant interviews with multilevel public health policy actors, and a policy document review related to the CHW program to triangulate the findings. Thematic analysis of the qualitative data was conducted. The World Health Organization's health systems framework and socio-ecological model guided the data collection, analysis, and interpretation. The CHWs program has been an extended arm of Ethiopia's primary health system and has contributed to improved health outcomes. However, the program has been facing unique systemic challenges that stem from the fragmentation of health finance; medical and equipment supply; working and living infrastructures; CHWs empowerment and motivation, monitoring, supervision, and information; coordination and governance; and community and stakeholder engagement. The ongoing COVID-19 and volatile political and security issues are exacerbating these fragmentation challenges. This study emphasized the gap between the macro (national) level policy and the challenge during implementation at the micro (district)level. Fragmentation is a blind spot for the community-based health system in rural Ethiopia. We argue that the fragmentation challenges of the community health program are exacerbating the fragility of the health system and fragmentation of MNCH health outcomes. This is a threat to sustain the MNCH outcome gains, the realization of national health goals, and the resilience of the primary health system in rural Ethiopia. We recommend that beyond the current business-as-usual approach, it is important to emphasize an evidence-based and systemic fragmentation monitoring and responsive approach and to better understand the complexity of the community-based health system fragmentation challenges to sustain and achieve better health outcomes. The challenges can be addressed through the adoption of transformative and innovative approaches including capitalizing on multi-stakeholder engagement and health in all policies in the framework of co-production.

Key Lessons From a Systematic Behavior Change Communication Process Used in a Pneumonia Prevention Program in Five African Countries.

A systematic behavior change communication (BCC) process was designed to enable local partners to effectively conduct formative research and develop a comprehensive BCC strategy, as part of a pneumonia prevention and control program implemented from 2017 to 2021 by the Red Cross Red Crescent in Ethiopia, Ivory Coast, Mali, Sudan, and Zambia. Qualitative content analysis was used to identify, categorize, and summarize key results, lessons, and recommendations related to the BCC process from country evaluation data. Key elements to success of a locally implemented BCC process include: (1) through simple formative research, understanding household decision-making dynamics for timely health seeking and coexistence of modern and traditional medicine; (2) explicitly analyze motivators for uptake of protective behaviors, with strong and deliberate community participation to validate and tailor BCC messages and channels; (3) ensuring that the challenges to access basic services, such as water and sanitation facilities, are adequately addressed as critical enabling factors for behavior change. Other implications include a need for innovative solutions to physical and economic barriers in areas where large distances, lack of transportation, or cost hinder caregivers seeking care for sick children. Community health programs that apply a BCC process through local partners can be effective in achieving behavioral outcomes. Participatory planning and involvement of the community in iterative rounds of validation improved the relevance, appropriateness, and impact. Further research is needed to determine the effectiveness of different communication methods and sustained impact on health outcomes.

INCREASING KNOWLEDGE AND SKILLS IN THE EARLY DETECTION OF MENTAL DISORDERS THROUGH TRAINING MENTAL HEALTH CADRES AT CITY HEALTH CENTERS

Mental disorders are still a global concern, including in Indonesia. According to basic health research conducted by the Indonesian Ministry of Health, as much as 0.14% of Indonesia's population has severe mental disorders. This is mainly due to the lack of mental health services, especially in remote areas such as East Nusa Tenggara which have limited health services. The purpose of community service is to optimize the role of mental health cadres in community mental health programs by providing mental health cadre training so that cadres can carry out their roles which include primary, secondary, and tertiary prevention. This research method was carried out by providing educational training to mental health cadres. This training is expected to be able to help puskesmas increase the coverage and sustainability of mental health services to ODGJ by optimizing the role of the community, in this case, especially mental health cadres by carrying out early detection and mobilizing ODGJ and their families to carry out treatment so that there are no more ODGJ who are shackled but can instead recover and be productive.

Suboptimal birth spacing practice and its predictors among reproductive-age women in Sub-Saharan African countries: a multilevel mixed-effects modeling with robust Poisson regression

BackgroundDespite the availability of exempted family planning services, a significant proportion of women in African countries continue to experience inadequately spaced pregnancies. To the authors’ knowledge, evidence of suboptimal birth intervals at the SSA level is lacking and previous studies have been limited to specific geographic area. Therefore, this analysis was aimed to estimate the pooled prevalence of suboptimal birth spacing and its predictors among childbearing women in SSA.MethodsPooled DHS data from 35 SSA countries were used and a weighted sample of 221,098 reproductive-age women was considered in the analysis. The survey across all countries employed a cross-sectional study design and collected data on basic sociodemographic characteristics and different health indicators. Forest plot was used to present the overall and country-level prevalence of suboptimal birth spacing. Multilevel mixed-effects models with robust Poisson regression were fitted to identify the predictors of suboptimal birth spacing. Akaike’s and Bayesian information criteria and deviance were used to compare the models. In a multivariable regression model, a p-value less than 0.05 and an adjusted prevalence ratio with the corresponding 95% CI were used to assess the statistical significance of the explanatory variables.ResultsThe pooled prevalence of suboptimal birth spacing among women in SSA was 43.91% (43.71%-44.11%), with South Africa having the lowest prevalence (23.25%) and Chad having the highest (59.28%). It was also found that 14 of the 35 countries had a prevalence above the average for SSA. Rural residence [APR (95% CI) = 1.10 (1.12–1.15)], non-exposure to media [APR (95% CI) = 1.08 (1.07–1.11)], younger maternal age [APR (95% CI) = 2.05 (2.01–2.09)], non-use of contraception [APR (95% CI) = 1.18 (1.16–1.20)], unmet need for family planning [APR (95% CI) = 1.04 (1.03–1.06)], higher birth order [APR (95% CI) = 1.31 (1.28–1.34)], and desire to have at least six children [APR (95% CI) = 1.14 (1.13–1.16)] were the predictors of suboptimal birth spacing practice.ConclusionMore than four out of ten reproductive-age women in SSA countries gave birth to a subsequent child earlier than the recommended birth spacing, with considerable variations across the countries. Thus, interventions designed at enhancing optimal birth spacing should pay particular attention to young and socioeconomically disadvantaged women and those residing in rural regions. Strengthening community health programs and improving accessibility and availabilities of fertility control methods that ultimately impacts optimal reproductive behaviors is crucial to address contraceptive utilization and unmet need.

Fostering the community participation of individuals with psychiatric disabilities: Effectiveness of a new peer-led photovoice-based intervention.

Having meaningful social roles and full community participation have been examined as a central tenet of the recovery paradigm. We undertook this study to test a new multimodal, peer-led intervention, which we have developed with the aim of fostering the self-efficacy of individuals with psychiatric disabilities to pursue involvement in community activities of their choice. We evaluated the effectiveness of the 6-month manualized peer-delivered "Bridging Community Gaps Photovoice (BCGP)" program with a multisite randomized trial (N = 185), with recipients of services at five community mental health programs. Mixed-effects regression models were used to examine the impact of the program on community participation, loneliness, personal stigma, psychosocial functioning, and personal growth and recovery when compared to services as usual. Individuals who were randomized to the BCGP intervention were also invited to participate in exit focus groups, exploring the program's perceived active ingredients of mechanisms of impact. Participation in the BCGP program facilitated ongoing involvement in community activities and contributed to a decreased sense of alienation from other members of the community due to internalized stigma of mental illness. In addition, greater attendance of group BCGP sessions had a significant impact on participants' sense of self-efficacy in pursuing desired community activities. This study provided initial evidence about the promise of the BCGP program in enhancing community participation. Its implementation in community mental health agencies can further expand the recovery-oriented services provided to people with psychiatric disabilities. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Beneficiaries perceptions on motivation to family planning intervention in a community of Karachi Pakistan

Background: Pakistan is facing a great challenge in planning, implementing, and sustaining family planning and birth control policies. Considering this, one of the community health programs in the outskirts of a community health worked led family planning counselling. The purpose of this research study is to highlight perceptions of the beneficiaries regarding the benefits of the same. Methods: A qualitative descriptive study was undertaken for this investigation using a non-random sampling technique. The sample was chosen from the community population who were part of this intervention, with an inclusion criterion. The data was collected using in-depth interviews from 13 participants in total. Results: The key themes emerged across the interviews: Unfolding myths: Participants’ recognized that using family planning mediums does not mean that there is a medical deficiency outcome to it but a way to prevent large families, societal pressure: Participants shared the issues and cultural taboos attached to the family planning and how it is conceived in their societies, program support: participants shared that having a female lady health worker coming to the home brings in more access to the family planning and benefits: they found that effective and structured family planning is contributing to their enhanced personal life relations, economic gains and social comfort. Conclusions: A community health program model can be one of the outlets the government can collaborate to offer door to door provision, service quality and access to family planning to such communities in need.

"A Much Wider Field in Which to Operate": Early Black Women Physicians in Public Health.

In a profession shaped by Whiteness and masculinity, the few Black women physicians who earned medical degrees prior to the Second World War found some of their rare professional opportunities in public health. Though their choices were often constrained by racism and sexism, they embraced public health work as a means of carrying out their "mission" in marginalized communities and as a way of practicing medicine with a more expansive definition than treating individual patients or illnesses. Black women physicians shaped public health by creating unique programming to meet the needs of the communities they served, including mobile health clinics and community health weeks. The first Black women physicians who worked in public health in the nineteenth and early twentieth centuries applied the new tool of public health "vital" statistics to Black lives and questioned the limits of their utility when created by White practitioners with racial biases. In the 1930s, some Black women physicians began earning some of the first master's degrees in public health, just as the field was beginning to professionalize. Throughout the twentieth century, Black women physicians pioneered community health programming and, though born from exclusionary policies that limited where they could practice, experimented with alternative clinical spaces, even as the hospital and laboratory became the primary sites of medicine for White clinicians. By embracing public health, Black women physicians shaped the field and used it as a tool to address racial health disparities in the communities they served, acting on their belief that Black health could be improved, thereby contesting notions of biological inferiority.

Caregivers’ Reports of the Complex Impacts of the Pandemic on Family Food and Physical Activity Behaviors by Race, Ethnicity, Urbanicity, and Income

ABSTRACT Background The COVID-19 pandemic affected health and well-being worldwide, but little is known about how the pandemic specifically impacted families with young children. Evidence suggests a relationship between well-being and health behaviors (diet, physical activity) and that preexisting health disparities were exacerbated during the pandemic. Purpose This project sought caregiver perspectives on pandemic impacts, overall and by race, ethnicity, urbanicity, and household income. Methods Caregivers of 4- to 11-year-olds were randomly selected to complete a mixed-mode survey in the winter of 2021–22 to evaluate ongoing community health education and programming. Qualitative content analysis of open-ended survey responses was conducted. Data were analyzed blind to demographic characteristics; later, differences by population were explored. Results Survey analysis (n = 1,429, response rate 27%) identified positive and negative impacts of the pandemic on youth diet and physical activity. Caregivers, unprompted, provided responses about the interconnected impacts on mental and physical health and health behaviors. Pandemic stress was described, including reduced energy, social isolation, and “fear of spread.” Significant differences by key characteristics were found. Discussion These findings reflect patterns that could underlie growing disparities. Translation to Health Education Practice: This work provides context for designing interventions that equitably promote healthy behaviors for young families.

Racial Concordance on Healthcare Use within Hispanic Population Subgroups

ObjectiveTo examine the association of patient-provider racial and ethnic concordance on healthcare use within Hispanic ethnic subgroups.MethodsWe estimate multivariate probit models using data from the Medical Expenditure Panel Survey, the only national data source measuring how patients use and pay for medical care, health insurance, and out-of-pocket spending. We collect and utilize data on preventive care visits, visits for new health problems, and visits for ongoing health problems from survey years 2007–2017 to measure health outcomes. Additionally, we include data on race and ethnicity concordance, non-health-related socioeconomic and demographic factors, health-related characteristics, provider communication characteristics, and provider location characteristics in the analysis. The sample includes 59,158 observations: 74.3% identified as Mexican, 10.6% identified as Puerto Rican, 5.1% identified as Cuban, 4.8% identified as Dominican, and 5.2% classified in the survey as Other Hispanics. Foreign-born respondents comprised 56% of the sample. A total of 8% (4678) of cases in the sample involved Hispanic provider-patient concordance.ResultsHispanic patient-provider concordance is statistically significant and positively associated with higher probabilities of seeking preventive care (coef=.211, P<.001), seeking care for a new problem (coef=.208, P<.001), and seeking care for an ongoing problem (coef=.208, P<.001). We also find that the association is not equal across the Hispanic subgroups. The association is lowest for Mexicans in preventive care (coef=.165, P<.001) and new problems (coef=.165, P<.001) and highest for Cubans in preventive care (coef=.256, P<.001) and ongoing problems (coef=.284, P<.001). Results are robust to the interaction of the Hispanic patient-provider concordance for the Hispanic patient categories and being foreign-born.ConclusionsIn summary, racial disparities were observed in health utilization within Hispanic subgroups. While Hispanic patient-provider concordance is statistically significant in associating with healthcare utilization, the findings indicate that this association varies across Hispanic subpopulations. The observations suggest the importance of disaggregating Hispanic racial and ethnic categories into more similar cultural or origin groups. Linked with the existence of significant differences in mortality and other health outcomes across Hispanic subgroups, our results have implications for the design of community health promotion activities which should take these differences into account. Studies or community health programs which utilize generalized findings about Hispanic populations overlook differences across subgroups which may be crucial in promoting healthcare utilization.

Factors Related to Burnout Among Perinatal Home Visiting Nurses.

Risks for burnout among nurses have been understudied in public and community health settings. This qualitative descriptive study aimed to describe the experiences of nurses working in a perinatal community health program for high-risk families with a focus on challenges and risks for burnout. We conducted field observation and semistructured individual interviews in 2019 with nurses at 2 sites implementing Prenatal Care Coordination (PNCC), a Medicaid benefit for high-risk pregnant people and infants in Wisconsin. A larger parent study assessed the implementation of PNCC overall through a thematic analysis process. Initial deductive coding was guided by the Consolidated Framework for Implementation Research. Emergent themes demonstrated that PNCC nurses face several significant barriers and known risks for burnout, including role strain related to scope of practice and training, discordant racial and socioeconomic identities leading to role conflict, and low control combined with high psychological demand. Given that the COVID-19 pandemic has exacerbated burnout risk among nurses in hospital settings, and that nurses addressing social determinants of health may be at increased risk for burnout, these findings represent a critical perspective on the experiences and needs of perinatal nurses in public and community health settings.

Effect of a Tobacco Cessation Intervention Incorporating Weight Management for Adults With Serious Mental Illness

Tobacco smoking drives markedly elevated cardiovascular disease risk and preventable death in persons with serious mental illness, and these risks are compounded by the high prevalence of overweight/obesity that smoking cessation can exacerbate. Guideline-concordant combined pharmacotherapy and behavioral smoking cessation treatment improves abstinence but is not routinely offered in community settings, particularly to those not seeking to quit smoking immediately. To determine the effectiveness of an 18-month pharmacotherapy and behavioral smoking cessation intervention incorporating weight management and support for physical activity in adults with serious mental illness interested in quitting smoking within 1 or 6 months. This was a randomized clinical trial conducted from July 25, 2016, to March 20, 2020, at 4 community health programs. Adults with serious mental illness who smoked tobacco daily were included in the study. Participants were randomly assigned to intervention or control, stratified by willingness to try to quit immediately (within 1 month) or within 6 months. Assessors were masked to group assignment. Pharmacotherapy, primarily varenicline, dual-form nicotine replacement, or their combination; tailored individual and group counseling for motivational enhancement; smoking cessation and relapse prevention; weight management counseling; and support for physical activity. Controls received quitline referrals. The primary outcome was biochemically validated, 7-day point-prevalence tobacco abstinence at 18 months. Of the 298 individuals screened for study inclusion, 192 enrolled (mean [SD] age, 49.6 [11.7] years; 97 women [50.5%]) and were randomly assigned to intervention (97 [50.5%]) or control (95 [49.5%]) groups. Participants self-identified with the following race and ethnicity categories: 93 Black or African American (48.4%), 6 Hispanic or Latino (3.1%), 90 White (46.9%), and 9 other (4.7%). A total of 82 participants (42.7%) had a schizophrenia spectrum disorder, 62 (32.3%) had bipolar disorder, and 48 (25.0%) had major depressive disorder; 119 participants (62%) reported interest in quitting immediately (within 1 month). Primary outcome data were collected in 183 participants (95.3%). At 18 months, 26.4% of participants (observed count, 27 of 97 [27.8%]) in the intervention group and 5.7% of participants (observed count, 6 of 95 [6.3%]) in the control group achieved abstinence (adjusted odds ratio [OR], 5.9; 95% CI, 2.3-15.4; P < .001). Readiness to quit within 1 month did not statistically significantly modify the intervention's effect on abstinence. The intervention group did not have significantly greater weight gain than the control group (mean weight change difference, 1.6 kg; 95% CI, -1.5 to 4.7 kg). Findings of this randomized clinical trial showed that in persons with serious mental illness who are interested in quitting smoking within 6 months, an 18-month intervention with first-line pharmacotherapy and tailored behavioral support for smoking cessation and weight management increased tobacco abstinence without significant weight gain. ClinicalTrials.gov Identifier: NCT02424188.

Emotional and Behavioral Problems among Preschool Children

It is essential to recognize the rapid pace of growth and maturation from birth to age 5, which has multiple implications for assessment and treatment. For the primary types of problem behaviour discussed in this chapter (i.e., disruptive and emotional problems), identification and diagnosis based purely on child behaviour have been shown to have limited stability and prognostic implications until at least 24 months of age. Objectives To assess psychological issues (behaviour and psychological problems) among preschool children and To find out the relationship between psychological issues with child and parent personal characteristics (age, gender, father life, mother live, father job, mother job, level of education, residence area, and monthly income). Methodology A descriptive design cross-sectional study was carried out throughout the present study to identify psychological issues among preschool children, starting from 1st February 2018 to 1st May 2018 in Najaf city. A non-probability purposive sample of (269) children with psychological issues among preschool children, who were children of the schools of education directorate at Najaf. The data are collected through the use utilization of the developed questionnaire and utilizing a checklist technique, which consists of two parts (1) A socio-demographic characteristics form that consists of 10 items (2) Child Symptom Inventory-4 (CSI-4) is a DSM-IV-referenced rating scale that screens for emotional and behavioural symptoms of childhood disorders. Parent (97 items) and teacher versions (77 items). The CSI-4: Parent Checklist contains screens for 15 emotional and behavioural disorders, and the CSI-4: Teacher Checklist contains screens for 13 emotional and behavioural disorders. The CSI-4 can be scored to derive Symptom Count Scores or Symptom Severity scores. The reliability of the questionnaire is determined through a pilot study and the validity through a panel of (15) experts. Results The findings of the present study indicate that preschool children's socio-characteristics affect the emotional and behavioural problems domains. The maximal effect is presented by the father and mother characteristics domains. There is a significant relationship between a live father, alive mother, father job, and mother job with emotional and behavioural symptoms of childhood disorders domains. There is a non-significant relationship between the age of the child, gender, class number, and sequence of a child with emotional and behavioural symptoms of childhood disorders domains. Conclusion: The study concludes that the emotional and behavioural symptoms of childhood disorders most commonly occurs among preschool children in male than in the female child. Emotional and behavioural problems in children most occur at the age of five years. Behavioural problems in children do not affect a child's age, gender, and sequence. Also, the study confirmed that the behavioral problems of children affect negatively the parent's jobs. Recommendations The study recommends providing support for families of children with emotional and behavioural problems, especially psychological ones, and working on introducing caregivers to know wide information about the early detection of emotional and behavioural problems in children to prevent them and ways to deal with behaviours of odd and Family to Family Education Programs to existing services in community mental health programs. And health-oriented mass media approach should be employed by the Ministry of Health and Ministry of Education to increase population knowledge and awareness about emotional and behavioural problems among preschool children.

Understanding the scope of practice of physician associate/physician associate comparable professions using the World Health Organization global competency and outcomes framework for universal health coverage

BackgroundPhysician Associate and Physician Associate comparable (PA/PA-comparable) professions are classified by the 2012 International Labour Classification of Occupations within ISCO group 2240 paramedical practitioners. However, to date, there is no single global framework which categorizes and/or describes their scopes of practice, or a single unifying occupational group name. In 2022, the World Health Organization (WHO) published its Global Competency and Outcomes Framework for Universal Health Coverage which focuses on the practice activities for health workers with a pre-service training pathway of 12–48 months, thus including many PA/PA-comparable roles. In this study we describe the similarities and differences between the SOP documents for PA/PA-comparable professions with a pre-service pathway of 12–48 months, thus excluding any extra-training and specializations, from 25 countries using the WHO Framework as a frame of reference.MethodsSOP documents were collected from 25 countries and mapped to the WHO Framework by 3 independent reviewers. We used descriptive statistics to examine the percent agreement between the WHO Framework and SOP documents by country, as well as the ubiquity of each WHO practice activity across the examined documents. To test the hypothesis that country-specific economic indicators and healthcare workforce metrics may be linked to the presence or absence of specific SOP elements, we utilized Wilkoxon and Fisher Exact tests to examine associations between World Bank economic indicators and country specific healthcare workforce metrics and presence/absence of specific WHO Framework practice activities within each SOP.ResultsWe identified significant heterogeneity between the WHO practice activities reported in the 25 SOP documents, particularly related to the provision of individual health services. We also identified statistically significant associations between World Bank economic indicators and country specific healthcare workforce metrics and presence/absence of the following seven practice activities relating to Individual Health, Population Health, and Management and Organization practice domains: (1) “Formulating a judgement following a clinical encounter,” (2) “Assessing community health needs” (3) “Planning and delivering community health programmes,” (4) “Managing public health communication,” (5) “Developing preparedness for health emergencies and disasters, including disease outbreaks,” (6) “Providing workplace-based learning and supervision,” and (7) “Participating in evaluation and research.” In each case, presence of the above practice activities was associated with lower health economic and workforce indicators, suggesting that these SOP practice activities are more common in lower income countries and countries with a smaller per-capita health workforce.ConclusionsThe WHO practice activities provide an effective framework to catalogue and compare the responsibilities of PA/PA-comparable professions recorded by country specific SOP documents. This approach could also be used to compare different occupational SOPs within a country, as well as SOPs between countries. The authors propose that additional information relating to the types of procedures and the level of supervision or autonomy would enable a more comprehensive comparison of SOPs, going beyond the granularity offered by the WHO framework. At that level, the evaluation could then be used to inform gap analyses for training needs in the context of migration, or to better understand the health team skill mixes across different countries. The study also offers reflections on the importance of clarity of intended meaning within the SOP documents.

Meaningful Community-Engaged Partnerships: Lessons Learned from Implementing a Community Health Needs Survey among Asian American and Pacific Islander Subgroups.

Community-based needs assessments are instrumental to address gaps in data collection and reporting, as well as to guide research, policy, and practice decisions to address health disparities in under-resourced communities. The New York University Center for the Study of Asian American Health collaboratively developed and administered a large-scale health needs assessment in diverse, low-income Asian American and Pacific Islander communities in New York City and three U.S. regional areas using an in-person or web-based, community-engaged approach. Community-engaged processes were modified over the course of three survey rounds, and findings were shared back to communities of interest using community preferred channels and modalities. Sustaining multiyear, on-the-ground engagement to drive community research efforts requires active bidirectional communication and delivery of tangible support to maintain trust between partners. Findings to facilitate community health programming and initiatives were built from lessons learned and informed by new and existing community-based partners.

Knowledge, Perception and Feasibility of Community Health Influencers, Promoters and Service (CHIPS) Program Among Community Health Workers in Nkanu West and Awgu Local Government Areas, Enugu State, Nigeria

Background: Primary health care (PHC) is the bedrock of our National Health Policy. PHC has two components: Community level and Primary health care facility level. Universal Health Cover cannot be achieved without significant investment in the community level component. Hitherto, the community component of PHC remains a neglected area of PHC program. CHIPS, a community-based programme was designed to allow traditional institution to select individuals who will administer basic medical needs and referring people in their communities to designated medical facilities when necessary. Method: This is a cross-sectional descriptive community-based study that was conducted among community health workers in Nkanu West and Awgu Local Government Areas of Enugu State Nigeria using self-administered questionnaire. Convenience sampling technique was used to select community health workers in the two local government areas. Results: 77.4% of the study population were not aware of the program. 26.9% are of the opinion that the families in the communities will welcome the idea of home visits. 23.3% perceived the implementation process to be slow, there was poor community awareness (22.0%), poor community participation (19.3%) and no community mobilization (19.3%) yet. Conclusion: From our study, the response rate on how best to organize CHIPS and the challenges it may face, is low. The striking thing is that the challenges of the past community health workers are still that of the present. So it is of utmost importance to constructively look at the content of the planning, implementation and its evaluation, and then draw strength from the weaknesses of the already existing community health programs.

Comparing Implementation Strategies for an Evidence-Based Weight Management Program Delivered in Community Mental Health Programs: Protocol for a Pilot Randomized Controlled Trial.

Among people with serious mental illness (SMI), obesity contributes to increased cardiovascular disease (CVD) risk. The Achieving Healthy Lifestyles in Psychiatric Rehabilitation (ACHIEVE) randomized controlled trial (RCT) demonstrated that a behavioral intervention tailored to the needs of individuals with SMI results in clinically significant weight loss. While the research team delivered the ACHIEVE intervention in the trial, community mental health program staff are needed to deliver sessions to make scale-up feasible. Therefore, we adapted the ACHIEVE-Dissemination (ACHIEVE-D) curriculum to ease adoption and implementation in this setting. Designing and testing of implementation strategies is now needed to understand how to support ACHIEVE-D delivery by community mental health program staff coaches. This study aims to conduct a pilot trial evaluating standard and enhanced implementation interventions to support the delivery of ACHIEVE-D in community mental health programs by examining effects on staff coaches' knowledge, self-efficacy, and delivery fidelity of the curriculum. We will also examine the effects on outcomes among individuals with SMI taking part in the curriculum. The trial will be a cluster-randomized, 2-arm parallel pilot RCT comparing standard and enhanced implementation intervention at 6 months within community mental health programs. We will randomly assign programs to either the standard or enhanced implementation interventions. The standard intervention will combine multimodal training for coaches (real-time initial training via videoconference, ongoing virtual training, and web-based avatar-assisted motivational interviewing practice) with organizational strategy meetings to garner leadership support for implementation. The enhanced intervention will include all standard strategies, and the coaches will receive performance coaching. At each program, we will enroll staff to participate as coaches and clients with SMI to participate in the curriculum. Coaches will deliver the ACHIEVE-D curriculum to the clients with SMI. Primary outcomes will be coaches' knowledge, self-efficacy, and fidelity to the ACHIEVE-D curriculum. We will also examine the acceptability, feasibility, and appropriateness of ACHIEVE-D and the implementation strategies. Secondary outcomes among individuals with SMI will be weight and self-reported lifestyle behaviors. Data collection started in March 2021, with completion estimated in March 2023. We recruited 9 sites and a total of 20 staff coaches and 72 clients with SMI. The expected start of data analyses will occur in March 2023, with primary results submitted for publication in April 2023. Community mental health programs may be an ideal setting for implementing an evidence-based weight management curriculum for individuals with SMI. This pilot study will contribute knowledge about implementation strategies to support the community-based delivery of such programs, which may inform future research that definitively tests the implementation and dissemination of behavioral weight management programs. ClinicalTrials.gov NCT03454997; https://clinicaltrials.gov/ct2/show/NCT03454997. DERR1-10.2196/45802.

Sustainability of community health programme using community-based organizations: a challenge for stakeholders

A community tuberculosis programme was implemented in Burkina Faso with funding from the Global Fund to fight HIV tuberculosis and malaria. Three years after the end of the funding, it seemed necessary to examine what remains of this innovative programme, which used civil society organizations for implementation. The objective of this study was to assess the factors that influence the capacity for sustainability and the level of sustainability of the programme.Methods The case study approach was used to retrospectively identify the factors that influence the capacity for sustainability and the level of sustainability of the programme. Semi structured interviews were conducted with key informants. The data were analysed according to the theoretical frameworks of Schell and Pluye. Data was analysed using NVivo 12.Results Strong support at the national level enabled the acquisition of funding for this programme, while the instability of financial resources was a drawback to sustainability. The lack of leadership of some associations did not allow the continuation of activities after the end of the funding. The irregularity of funding and the failure to conduct a final evaluation of the programme were the weakest links in the sustainability of the programme. Thus, the analysis of our data showed precarious sustainability at the time of the study.Conclusion A well-designed community programme with a strong capacity for sustainability is not necessarily maintained after funding is withdrawn. The implementation of a community programme must ensure that it is integrated into the existing organizational system. The objectives and operating rules of the host structures must be in line with those of the programme to be implemented.

Strategies to Operationalize Health Equity in Island Area Health Departments.

Strategies to Operationalize Health Equity in Island Area Health Departments.

Measuring Health System Responsiveness in a national community health worker primary care program in rural Liberia.

As many low- and middle-income countries scale up community health worker (CHW) programs to achieve universal health coverage, ensuring quality as well as access is critical. Health system responsiveness (HSR) is a core domain of quality patient-centred care, but has not been widely measured in CHW-delivered care. We report results from a household survey measuring HSR and health systems quality of CHW-delivered care in two Liberian counties where the national CHW program of Community Health Assistants (CHAs) for communities five kilometres or more from a health center has been implemented. We conducted a cross-sectional population-based household survey in 2019 in Rivercess (RC) and Grand Gedeh (GG) counties, using a two-stage cross-sectional cluster sampling approach. We included validated HSR questions on six responsiveness domains and patient-reported health system outcomes, such as satisfaction and trust in the CHA's skills and abilities. The HSR questions were administered to women aged 18-49 who reported seeking care from a CHA in the three months prior to the survey. A composite responsiveness score was calculated and divided into tertiles. Multivariable analysis using Poisson regression with log link and adjusting for respondent characteristics was used to determine the association between responsiveness and patient-reported health system outcomes. The proportion of individuals rating responsiveness as very good or excellent were similar across all domains within a district, with ratings were lower in RC (23-29%) than GG (52-59%). High ratings in both counties were seen for high trust in the CHA's skills and abilities (GG 84%, RC 75) and high confidence in CHA (GG 58%, RC 60%). Compared with women in the lowest responsiveness tertile (score ≤3), women in the highest tertile (score 4.25) were significantly more likely to report high quality of CHA-delivered care (prevalence ratio, PR=14.1), very good/excellent at meeting health needs (PR=8.0), high confidence in the CHA to provide future care (PR=2.4), and high level of trust in CHA's skills and abilities (PR=1.4). Controlling for respondent characteristics, the composite responsiveness score was significantly associated with all patient-reported health system outcomes (P<0.001). We found that HSR was associated with important patient-reported health system quality outcomes, including satisfaction, trust, and confidence in the CHA. Measuring patients' experience and outcomes of care is important to complement more common measures of technical quality for CHW-delivered care to ensure that this domain of quality is central to community health program design and delivery.