Community-level Interventions Research Articles

Challenges in Evaluating a Community-Level Intervention to Address Root Causes of Youth Violence

Violence disproportionately impacts Black American youth, representing a major health disparity. Addressing the possible root causes of structural inequities to reduce violence may increase the impact of prevention strategies. However, efforts to evaluate the impact of such interventions pose numerous methodological challenges, particularly around selecting an effective evaluation design to detect change at the community level, with adequate power and sampling, and appropriate constructs and measurement strategies. We propose a multiple baseline experimental design to evaluate the impact of a community-level youth violence and suicidality prevention strategy. A multiple baseline experimental design with multiple community units balances the need for scientific rigor with practical and values-based considerations. It includes randomization and plausible counterfactuals without requiring large samples or placing some communities in the position of not receiving the intervention. Considerations related to the conceptualization of the logic model, mechanisms of change, and health disparity outcomes informed the development of the measurement strategy. The strengths and weaknesses of a multiple baseline experimental design are discussed in comparison to versions of randomized clinical trials. Future health disparity intervention evaluation research will benefit from (1) building a shared sense of urgent public need to promote health; (2) respecting the validity of values- and partnership-based decision-making; and (3) promoting community-based and systems-level partnerships in scientific grant funding. The described study has been registered prospectively at clinicaltrials.gov, Protocol Record 21–454.

Parental Knowledge, Beliefs, Practices, and Barriers Related to Children's Bladder Health in the School Environment.

Pediatric lower urinary tract symptoms (LUTS) are a set of common childhood problems. Community-level interventions that target behavioral change among children with LUTS can improve symptoms outside of the clinic environment. Parents, navigating the home and school environments, are key in supporting healthy bladder behaviors. Thus, we asked parents about their perceptions and barriers related to pediatric bladder health. English-speaking parents (n = 30) of children ages 5-10 years with and without LUTS were interviewed. Transcripts were coded iteratively by two independent coders using deductive and inductive approaches that emphasized consensus coding and peer debriefing. Ninety-three percent of participants were women, 50% were 30-39 years old, and 60% held a graduate degree. Parents identified school-, classroom-, and child-based barriers to bladder health. These included the bathroom environment, restrictive policies for bathroom use, and anxiety on how and when to use the bathroom. Addressing school-, classroom-, and child-based barriers is necessary to promote healthy bladder habits among children in the school environment and beyond. Recommended school-based interventions include bathroom use and sanitation policies that support students' voiding needs, teachers' professional development, and school readiness initiatives. Limitations include participation of English-speaking parents only.

Cultivating a "Feminine" Surgical Culture: Lessons from Indonesia.

Although the number of female physicians in the United States has been increasing, most practicing surgeons in the United States are men. By contrast, Indonesia has achieved notable gender parity among surgeons, with the number of women practicing as plastic surgeons projected to soon surpass that of men. Achieving greater female representation in plastic surgery is important for delivering high-quality care, especially in the face of physician shortages and high burnout rates. This survey study was conducted at the 26th annual scientific meeting of the Indonesian Association of Plastic Reconstructive and Aesthetic Surgeons, in Manado, Indonesia, in August 2023. Respondents were asked about their perceptions of plastic surgery, mentorship, career motivations, and caregiving responsibilities. Responses were scored using a 3-point Likert scale of agreement with statements (disagree, neutral, or agree); χ 2 and Fisher exact tests were performed to assess differences in responses by sex. In this validated survey of 175 plastic surgeon trainees and attendings, there were no significant differences between sexes in the perception and roles of mentorship in preparing for a career in plastic surgery. Respondents from both sexes espoused optimistic views on work-life balance items, including time for family and friends and flexibility of work schedules. Indonesia can serve as a model for encouraging greater gender parity in plastic surgery. Community-level interventions, such as family leave policies, childcare provisions, and initiatives to promote an inclusive culture, will create a more supportive workplace to increase women's representation in plastic surgery in the United States and around the world.

The costs of Suaahara II, a complex scaled-up multisectoral nutrition programme in Nepal.

Limited evidence exists on the costs of scaled-up multisectoral nutrition programmes. Such evidence is crucial to assess intervention value and affordability. Evidence is also lacking on the opportunity costs of implementers and participants engaging in community-level interventions. We help to fill this gap by estimating the full financial and economic costs of the United States Agency for International Development-funded Suaahara II (SII) programme, a scaled-up multisectoral nutrition programme in Nepal (2016-2023). We applied a standardized mixed methods costing approach to estimate total and unit costs over a 3.7-year implementation period. Financial expenditure data from national and subnational levels were combined with economic cost estimates assessed using in-depth interviews and focus group discussions with staff, volunteers, community members, and government partners in four representative districts. The average annual total cost was US$908,948 per district, with economic costs accounting for 47% of the costs. The annual unit cost was US$132 per programme participant (mother in the 1000-day period between conception and a child's second birthday) reached. Annual costs ranged from US$152 (mountains) to US$118 (plains) per programme participant. Personnel (63%) were the largest input cost driver, followed by supplies (11%). Community events (29%) and household counselling visits (17%) were the largest activity cost drivers. Volunteer cadres contributed significant time to the programme, with female community health volunteers spending a substantial amount of time (27 h per month) on SII activities. Multisectoral nutrition programmes can be costly, especially when taking into consideration volunteer and participant opportunity costs. This study provides much-needed evidence of the costs of scaled-up multisectoral nutrition programmes for future comparison against benefits.

The Loud Silent Side of Single Parenthood in Europe: Health and Socio-Economic Circumstances from a Gender Perspective

AbstractLone parenthood is one of the multiple accepted family types that make up today’s societies. In Europe, 3.2% of total households were single adults with children in 2019. Understanding the socioeconomic and demographic transformations that have led to the relatively high rates of single-parent families have attracted the attention and concern of researchers and policy makers. This study contributes to the literature by exploring trends in and predictors of health outcomes, lifestyle factors (obesity, smoking and alcohol) and social support among single-parent families and cohabiting couples in 20 European countries. To do so, microdata from the European Health Interview Survey-EHIS (2013–2015 and 2018–2020) is used. Running multivariate logistic regressions, we estimate the impact of individual factors associated with single parents’ health status, lifestyle factors and social support, adjusting by demographic characteristics and stressors. Our analysis suggests that both single mothers and fathers are left behind in several respects compared to their couple counterparts: lower education levels, lower income and worse economic conditions, worse physical health, and poorer social support relationships. Differences in health status, lifestyle factors and social support between single and couple parents, both mothers and fathers could be associated with the unequal distribution of demographic and stress factors found in this article. Understanding these characteristics of single-parent families could enable the establishment of community-level interventions to mitigate the adverse effects of lone parenthood and their children.

“We don’t separate out these things. Everything is related”: Partnerships with Indigenous Communities to Design, Implement, and Evaluate Multilevel Interventions to Reduce Health Disparities

Multilevel interventions (MLIs) are appropriate to reduce health disparities among Indigenous peoples because of their ability to address these communities’ diverse histories, dynamics, cultures, politics, and environments. Intervention science has highlighted the importance of context-sensitive MLIs in Indigenous communities that can prioritize Indigenous and local knowledge systems and emphasize the collective versus the individual. This paradigm shift away from individual-level focus interventions to community-level focus interventions underscores the need for community engagement and diverse partnerships in MLI design, implementation, and evaluation. In this paper, we discuss three case studies addressing how Indigenous partners collaborated with researchers in each stage of the design, implementation, and evaluation of MLIs to reduce health disparities impacting their communities. We highlight the following: (1) collaborations with multiple, diverse tribal partners to carry out MLIs which require iterative, consistent conversations over time; (2) inclusion of qualitative and Indigenous research methods in MLIs as a way to honor Indigenous and local knowledge systems as well as a way to understand a health disparity phenomenon in a community; and (3) relationship building, maintenance, and mutual respect among MLI partners to reconcile past research abuses, prevent extractive research practices, decolonize research processes, and generate co-created knowledge between Indigenous and academic communities.

A Qualitative Study of the Meaning of Food and Religious Identity

ObjectiveTo identify common themes of the meaning of food among people who identify with a specific religious tradition, particularly focusing on potential applications for nutrition education and professional practice at multiple levels of the Social-Ecological Model. DesignVirtual and in-person focus groups were used to collect qualitative data. SettingA midsized city in eastern Washington State. ParticipantsNine focus groups (n = 35), each representing a distinct religious congregation. Phenomenon of InterestMeaning of food in the context of religion. AnalysisQualitative, reflexive thematic analysis using web-based software to organize data. ResultsFour key themes were identified that applied to both of the overarching focus group topic areas (general and religious): (1) food fosters connection, (2) food influences health, (3) relationships with food are complicated, and (4) food choices reflect values. Subthemes were specific to topic areas. In religious contexts, the meaning of food was more likely understood at a community level in addition to individual and relational levels of the Social-Ecological Model. Conclusions and ImplicationsAcknowledgment and consideration of the religious identities of patients and clients may provide greater opportunities for community connection, which may have potential implications for community-level nutrition interventions.

The impact of social-environmental factors on IQ in syndromic intellectual developmental disabilities.

Despite having the same underlying genetic etiology, individuals with the same syndromic form of intellectual developmental disability (IDD) show a large degree of interindividual differences in cognition and IQ. Research indicates that up to 80% of the variation in IQ scores among individuals with syndromic IDDs is attributable to nongenetic effects, including social-environmental factors. In this narrative review, we summarize evidence of the influence that factors related to economic stability (focused on due to its prevalence in existing literature) have on IQ in individuals with syndromic IDDs. We also highlight the pathways through which economic stability is hypothesized to impact cognitive development and drive individual differences in IQ among individuals with syndromic IDDs. We also identify broader social-environmental factors (e.g., social determinants of health) that warrant consideration in future research, but that have not yet been explored in syndromic IDDs. We conclude by making recommendations to address the urgent need for further research into other salient factors associated with heterogeneity in IQ. These recommendations ultimately may shape individual- and community-level interventions and may inform systems-level public policy efforts to promote the cognitive development of and improve the lived experiences of individuals with syndromic IDDs.

Smart cities and communities in the GCC region: from top-down city development to more local approaches

City planners are seeking ways to incorporate human-centric urban projects that combine smart technology, good infrastructure and people’s perception as well as their participation. Smart city developments are increasingly being applied to smaller scales at which communities can co-design hard infrastructure and the resulting services. Experiences from city projects at this level have produced a plethora of designs, challenges and success factors, particularly from cases in countries with long legacies in city development. In the Gulf Cooperation Council region, young cities and new planned cities house the bulk of the population and face environmental challenges related to urban segregation, urban sprawl and large consumption footprints. The political-economy of this region in terms of central urban planning and government-led economic development offers valuable insights on the limits and challenges in implementing projects related to smart and connected communities (SCC). SCC as a label for smart urban interventions towards more connectedness between hard and soft (human-related) infrastructure can provide opportunities for participatory and sustainable urban planning in the region. This paper analyzes the role of community-level interventions within the smart city policies of Gulf countries. It shows that only few local-level projects exist, while the barriers to large-scale SCC initiatives are related to demographics, community characteristics, technological sophistication, lack of conducive regulations, and the prevalence of central urban planning. The success of local smart city approaches in the Gulf is dependent on public leadership in terms of clearing obstacles, designing broader strategies, and expanding projects to include the residential sector. Considering the potential of SCC projects to enhance the transition to sustainability in the predominantly urban Gulf societies, broader engagement of local governments, utilities, and community-level developers can result in tangible benefits in terms of more sustainable, smart and tailored local services.

Cost of start-up activities to implement a community-level opioid overdose reduction intervention in the HEALing Communities Study

BackgroundCommunities That HEAL (CTH) is a novel, data-driven community-engaged intervention designed to reduce opioid overdose deaths by increasing community engagement, adoption of an integrated set of evidence-based practices, and delivering a communications campaign across healthcare, behavioral-health, criminal-legal, and other community-based settings. The implementation of such a complex initiative requires up-front investments of time and other expenditures (i.e., start-up costs). Despite the importance of these start-up costs in investment decisions to stakeholders, they are typically excluded from cost-effectiveness analyses. The objective of this study is to report a detailed analysis of CTH start-up costs pre-intervention implementation and to describe the relevance of these data for stakeholders to determine implementation feasibility.MethodsThis study is guided by the community perspective, reflecting the investments that a real-world community would need to incur to implement the CTH intervention. We adopted an activity-based costing approach, in which resources related to hiring, training, purchasing, and community dashboard creation were identified through macro- and micro-costing techniques from 34 communities with high rates of fatal opioid overdoses, across four states—Kentucky, Massachusetts, New York, and Ohio. Resources were identified and assigned a unit cost using administrative and semi-structured-interview data. All cost estimates were reported in 2019 dollars.ResultsState-level average and median start-up cost (representing 8–10 communities per state) were $268,657 and $175,683, respectively. Hiring and training represented 40%, equipment and infrastructure costs represented 24%, and dashboard creation represented 36% of the total average start-up cost. Comparatively, hiring and training represented 49%, purchasing costs represented 18%, and dashboard creation represented 34% of the total median start-up cost.ConclusionWe identified three distinct CTH hiring models that affected start-up costs: hospital-academic (Massachusetts), university-academic (Kentucky and Ohio), and community-leveraged (New York). Hiring, training, and purchasing start-up costs were lowest in New York due to existing local infrastructure. Community-based implementation similar to the New York model may have lower start-up costs due to leveraging of existing infrastructure, relationships, and support from local health departments.

Identifying research gaps in climate-related mental health outcomes in North America and Europe: a qualitative framework analysis

BackgroundClimate change and mental health outcomes are two of the most pressing global crises. Despite the increasing global mental health burden, climate-related mental health outcomes research is nascent and isolated, with substantial gaps across regions and disciplines. Connecting Climate Minds is a global initiative connecting researchers, experts, and people with lived experience of adverse mental health outcomes to identify regional research needs and create a community to support improved climate-related mental health outcomes. MethodsWe focused on North America and Europe as part of the global Connecting Climate Minds effort, using semi-structured interviews, focus groups, regional dialogues (ie, discussions between experts in climate health, planetary health, human health, and mental health and with lived experience to discuss the climate threats most affecting their communities, their effects on mental health, and opportunities for action), and a literature review to identify crucial research gaps in climate change and mental health. We collected insights into priorities when addressing mental health outcomes related to climate change in Europe and North America; requirements for effective research, policy, and practice; and encouraging collaboration from a diverse community that included experts, researchers, practitioners from multiple disciplines, indigenous groups, and youth representatives. We used a qualitative framework analysis to identify consensus priorities. FindingsSeveral themes emerged regarding research gaps. First, research into the effects of climate change on mental health is needed (eg, how pre-existing mental health outcomes are affected by climate disaster events, risk factors and protective factors, the effects of climate action or inaction on mental health, and economic costs). Second, investigating connections between climate-related mental health outcomes and Indigenous and other cultural practices (eg, the effects of climate change on Indigenous peoples and practices, cultural variations in mental health responses, and the effectiveness of integrating Indigenous and cultural knowledge into mental health interventions). Third, mixed-methods research is needed to explore the relationships between climate change, global and national economies, and governance and their associations with mental health outcomes. Fourth, evaluating social and cultural connectedness in mental health outcomes and climate change, community-level interventions, and the effectiveness of climate-education programmes that incorporate mental health considerations are research priorities. Finally, understanding how emerging technology can be used to understand climate-related mental health outcomes and use of technology to collect, analyse, and respond to population health data (with ethical considerations). InterpretationConnecting Climate Minds aims to psychologically equip people in Europe and North America to navigate the challenges of a changing climate. Climate-related mental health experts in should collaborate and encourage research and action that are proactive, community-led, and accessible. FundingImperial College London, the Wellcome Trust, and the Planetary Health Alliance via Harvard University.

Examination of community-level interventions addressing early childhood obesity in Los Angeles County

ObjectiveTo help inform decisions regarding the equitable implementation of obesity interventions, we examined whether interventions were equitably reaching the most vulnerable communities, identified communities that received fewer interventions than expected, and estimated the effect of ‘dose’ of interventions on obesity prevalence. MethodsWe created a database to identify and characterize obesity-related interventions implemented in Los Angeles County from 2005 to 2015 linked to community-level sociodemographic and obesity prevalence data. We ran generalized linear models with a Gamma distribution and log link to determine if interventions were directed toward vulnerable communities and to identify communities that received fewer interventions than expected. We ran fixed-effects models to estimate the association between obesity prevalence and intervention strategy count among preschool-aged children enrolled in the Special Supplemental Nutrition Assistance Program for Women Infants and Children. ResultsWe found that interventions targeted vulnerable communities with high poverty rates and percentages of minority residents. The small cluster of communities that received fewer interventions than expected tended to have poor socioeconomic profiles. Communities which received more intervention strategies saw greater declines in obesity prevalence (β = -0.023; 95 % CI: −0.031, −0.016). ConclusionsIt is important to determine if interventions are equitably reaching vulnerable populations as resources to tackle childhood obesity become available. Evaluating the population impact of multiple interventions implemented simultaneously presents methodological challenges in measuring intervention dose and identifying cost-effective strategies. Addressing these challenges must be an important research priority as community-wide interventions involve multiple intervention strategies to reduce health disparities.

Abstract 797: Area deprivation, rurality, healthcare utilization, quality of life, and health status among cancer patients

Abstract Background: Living in deprived or rural neighborhoods can negatively influence individual health through various mechanisms, including limited access to care due to scarce resources, medical facilities, or health professionals. Prior ecological studies have shown an association between living in rural or disadvantaged areas and higher cancer morbidity or mortality, but research on the association between neighborhood of residence and cancer patients’ healthcare utilization, health status, or quality of life has been limited. Method: We used survey and electronic health records data on cancer patients aged ≥18 years (N=16,606) from All of US Controlled Tier Dataset v7 (summer 2017-July 1, 2022). Area deprivation index (ADI) was based on six items, including 3-digit zip code-level median household income, proportions of high school graduation, vacant housing, recipients of public assistance income, and individual without health insurance or with incomes below the poverty level. Rural-urban status was defined at the 3-digit zip code-level as urban (100% urban), mostly urban (≥50%-<100% urban), and rural (>50% rural). Logistic regression models were used to estimate the association between ADI or rurality and health care utilization (general doctor, specialist, mental health, or nurse practitioner/physical assistant [NP/PA] visits) or health outcome (fair/poor physical and mental health status, quality of life), controlling for various covariates. Results: Cancer patients living in the most deprived areas (ADI 5th quintile) were less likely to have general doctor visits (OR=0.73; 95% CI=0.54-0.85), NA/PA visits (OR=0.87; 95% CI=0.77-0.99), or mental health professional visits (OR=0.85; 95% CI=0.74-0.98), and more likely to have fair or poor quality of life (OR=1.31; 95% CI=1.06-1.62), compared to those living in the least deprived areas (ADI 1st quintile), controlling for all covariates. Similarly, rural cancer patients were less likely to have general doctor visits (OR=0.58; 95% CI=0.42-0.79) or mental health professional visits (OR=0.53; 95% CI=0.41-0.67), and more likely to have fair/poor physical health (OR=1.27; 95% CI=1.03-1.57), compared with urban cancer patients. However, rural cancer patients were more likely to have NA/PA visits (OR=1.29; 95% CI=1.04-1.58) and less likely to have fair/poor mental health (OR=0.66; 95% CI=0.48-0.92). Cancer patients in mostly urban areas showed similar patterns to those in rural areas but the magnitudes of associations were smaller. Conclusions: In this study, cancer patients living in deprived or rural areas were less likely to have general doctor or mental health professional visits and more likely to have poor physical health compared to patients in the least deprived or urban area. Community-level interventions in deprived or rural areas are required to mitigate disparities in healthcare and health among cancer patients. Citation Format: Hyunjung Lee, Dongjun Lee, Ding Quan Ng, Daniel Wiese, Ahmedin Jemal, Farhad Islami. Area deprivation, rurality, healthcare utilization, quality of life, and health status among cancer patients [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 797.

Abstract P198: Developing a Practical, Evidence-Based Framework for Evaluating Community Nutrition Security Interventions

Introduction: Addressing nutrition insecurity at a population level is complex and requires changing policies, systems, and environments. The American Heart Association (AHA) has identified 17 research informed systemic interventions that have the potential to increase nutrition security over time. These interventions can be leveraged individually or together based on community needs and assets. Evaluating these interventions is essential for understanding impact, improving implementation, and allocating resources to effective strategies. This project sought to establish a pragmatic yet rigorous framework for evaluating the health impact of these strategies in communities across the United States. Hypothesis: We assessed the hypothesis that we could evaluate community nutrition security interventions by using program records, secondary data sources, and judicious use of primary data collection. Methods: Researchers reviewed details from the AHA's community impact database detailing 188 research informed nutrition security projects in communities across 29 states and the District of Columbia. Impacts were assessed for reach of intervention and strength of evidence to determine relative population dose of interventions. Seven interventions were determined to be ‘high dose,’ and researchers identified community and proximal outcomes for three high-dose interventions where the AHA is typically the catalyst that is leading and influencing work with community partners. Researchers reviewed 11 national databases to identify existing community-level data aggregated at the county, city, zip code, or census track that may be associated with the three high dose impact opportunities. Researchers then reviewed the evidence-based literature associated with proximal outcomes - organizational, environmental, policy, or individual/household changes - that have been documented in research studies in association with the three high dose interventions. Using the insight from both reviews, researchers were able to develop a model evaluation framework for assessing the impact of community level interventions over time. Results: Researchers were able to identify 17 proximal outcomes and two community level outcomes with evidence associated with the three high dose interventions. Conclusion: Demonstrating the impact of community level nutrition security interventions is challenging given the complexity of the environments in which they are implemented and the limitations of evaluation resources. This approach prioritizes high dose evidence-based interventions and then leverages existing community level datasets and organizational measures to assess impact. It provides a framework for other organizations to prioritize specific systemic interventions to evaluate and further informs the evidence base for future interventions.

Immigrant Perspectives of Social Connection in a Nontraditional Migration Area.

Social connection is a core dimension of health and wellness among all populations, yet the experience of moving to and living in a new country makes social and community-level influences particularly salient for immigrants. We interviewed 38 Latino immigrants living in a nontraditional migration area to explore the social and community foundations of health and wellness. Using hybrid (inductive/deductive) qualitative analysis, we identified seven domains of social connection from the perspective of the interviewed participants: (1) lens of the individual; (2) immigrant experience; (3) interpersonal support; (4) community belonging; (5) community capital; (6) community navigation; and (7) social acceptance. Social connection domains generated by participants are consistent with the scientific literature, but this study identifies the specific social factors that immigrants describe as most salient to their own health and wellness. Our community-generated understanding of social connection can be used by healthcare providers to reduce risks and build on assets that will improve the health of immigrants living in nontraditional migration areas. Additionally, these results might serve as a foundation for a quantitative measure that can be used by providers to more accurately and comprehensively assess the social connection of their patients and by researchers to evaluate the effectiveness of community-level interventions for immigrants.

A multi-sectoral community development intervention has a positive impact on diet quality and growth in school-age children in rural Nepal.

Poor diet quality (diet diversity and animal-source food [ASF] consumption) during childhood negatively affects growth, development, behaviourand physiologic function in later life. Relatively less is known about the impact of poor diet on the growth of school-age children compared to children <5 years of age, especially in low/middle-income countries. A better understanding of delivery strategies for effective interventions to improve diet and hence growth in school-age children is needed. A 36-month longitudinal controlled impact evaluation in rural Nepal assessed the nutrition and growth of children <5 years of age in families assigned via community clusters to full package intervention (community development, training in nutrition [during pregnancy and for children <5 years] and livestock husbandry), partial package (training only)or control (no inputs). Concurrent data werecollected prospectively (baseline plus additional four rounds) on school-age children (5-8 years at baseline) in these households; the present study analysed findings in the cohort of school-age children seen at all five study visits (n = 341). Diet quality improved more in the full package school-age children compared to those in partial package or control households. full package children consumed more ASF (β +0.40 [CI 0.07,0.73], p < 0.05), more diverse diets (β +0.93 [CI 0.55,1.31], p < 0.001)and had better head circumference z-scores (β +0.21 [CI 0.07,0.35], p < 0.01) than control children. In conclusion, a multi-sectoral community development intervention was associated with improvements in diet and growth of school-age children in rural Nepal even though the intervention focused on the diet of children <5 years of age. The diet and growth of school-age children can be favourably influenced by community-level interventions, even indirectly.

Effectiveness of Millet-Pulse-Groundnut Based Formulations in Improving the Growth of Pre-School Tribal Children in Telangana State, India.

A community-level nutritional intervention was implemented among tribal children (3 to 6 years of age) in Telangana, India. The one-year intervention involved six nutrient-rich formulations of millet-pulse-groundnut-based products suited to local taste preferences. Anthropometric measurements of height, weight, and mid-upper-arm circumference (MUAC) along with haemoglobin (Hb) levels were monitored at baseline and endline. The treatment group showed considerable gains in height (3.2 cm), weight (1.68 kg), and MUAC (0.33 cm) over the control group. The paired t-test indicated significant differences (p < 0.01) between the pre- and post-intervention anthropometric measurements. Positive shifts were observed in terms of wasting (WHZ; -1.2 ± 1.3 to -0.9 ± 1), stunting (HAZ; -1.8 ± 1.6 to -0.3 ± 1.3), and underweight (WAZ; -1.9 ± 1.2 to -0.7 ± 1) in the treatment group. The Hb levels in the treatment group also improved significantly from 9.70 ± 0.14 g/dL (moderately anaemic) to 11.08 ± 0.13 g/dL (non-anaemic). Post-intervention focus group discussions (FGDs) involving mothers and teachers confirmed these positive impacts. Thus, a nutritional intervention formulated using climate-resilient millets, pulses, and groundnuts promotes dietary diversity and improves the nutrition and health statuses of children.

Co-designing community-level integral interventions for active ageing: a systematic review from the lens of community-based participatory research

BackgroundWhile community-level interventions for promoting active ageing have received increasing attention and there is a trend to leverage technology to support traditional physical or social interventions, little hands-on guidance exists for designing these integral interventions. This study aimed to examine the interventions reported in the literature guided by Community-Based Participatory Research (CBPR) principles. The goal is to extract insights that inform future practices in co-designing integral interventions for active ageing.MethodsThe systematic review focused on community-level interventions promoting active ageing that integrated physical, social, and digital elements, i.e., integral interventions. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The included interventions were analysed abductively based on the CBPR principles.ResultsA total of 13 studies were included, and 24 design considerations were generated under eight categories. Further reflection identified the interrelated nature of these design considerations and pinpointed the gaps in current research. This study highlights the urgency and importance of sharing recruitment methods and resource allocation details, recording and reporting collaboration specifics, and disseminating findings to stakeholders beyond academia.ConclusionsThis study offers valuable insights and practical guidance to researchers and practitioners developing community-level integral interventions for active ageing. The findings also serve as a starting point for accumulating knowledge and practice in co-designing integral interventions for active ageing at the community level. The next crucial phase involves evaluating these design considerations within real-world cases to assess their applicability and identify potential areas for improvement.

Longitudinal Associations of Experienced and Perceived Community Stigma With Antiretroviral Therapy Adherence and Viral Suppression in New-to-Care People With HIV: Mediating Roles of Internalized Stigma and Depression Symptoms.

Although cross-sectional studies have suggested that HIV-related stigma and depression symptoms may result in poor HIV treatment and health outcomes, few studies have investigated potential longitudinal mechanisms in these relationships. Furthermore, longitudinal effects of HIV-related stigma on health outcomes have not been examined in people with HIV (PWH) newly initiating HIV clinical care. We examined longitudinal associations between experienced and perceived community stigma and health outcomes (antiretroviral therapy [ART] adherence and viral load), mediated by internalized stigma and depression symptoms among new-to-care PWH in the United States. Data were obtained from 371 PWH who initiated HIV medical care at 4 HIV sites at baseline and 48 weeks later between December 2013 and 2018. Validated measures were used to assess experienced stigma, perceived community stigma, internalized stigma, depression symptoms, and ART adherence, and viral load was obtained from medical records at the final study visit. Serial mediation models revealed significant indirect effects of experienced stigma and perceived community stigma on ART adherence and on viral suppression, first through internalized stigma and then through depression symptoms. These results suggest that PWH may tend to internalize HIV-related stigma when they experience acts of stigmatization or perceive negative attitudes in society, which in turn may result in negative effects on psychological and physical well-being. These findings about how stigma in society may be an antecedent mechanism for PWH to develop internalized stigma, which in turn affects individual health outcomes, can be used to tailor both individual-level and community-level interventions.

The Effects of Previous Experiences of Healthcare Discrimination on HIV Intervention Outcomes.

Although several healthcare interventions have been developed to address HIV among young Black/African American men who have sex with men (YBMSM), the HIV epidemic in the United States continues to disproportionately burden this population. The current study examines previous healthcare discrimination and how it affects HIV intervention delivery. One hundred seventy-two YBMSM participated in the Peer Promotion of Wellness and Enhanced Linkage to Resources (PPOWER) project, which used a short, multi-faceted, community-level intervention based on Community Peers Reaching Out and Modeling Intervention Strategies (Community PROMISE). Data were collected at baseline, a 45-day follow up, and a 90-day follow up. Generalized Estimating Equations (GEE) were used to examine the effects of previous healthcare discrimination on outcomes related to HIV testing, alcohol and drug use, and sexual behaviors. Previous healthcare discrimination was found to moderate the relationship between time and intentions to test for HIV, perceptions of sexual risk, problem marijuana use, and problem other drug use, such that those who had experienced more healthcare discrimination showed greater improvements over time compared to those who had experienced less healthcare discrimination. The results of the current study suggest that a community-level peer intervention, in combination with a component to promote cultural competency and address prior experiences of discrimination in healthcare settings, may be highly effective for people who have experienced a barrier in their continuum of care as a result of racial discrimination.