Community Members Research Articles

Development cooperation and the stratification of lesbian, gay, bi- and transsexual activism: international donors, elite activists and community members during Uganda Pride 2022

Uganda’s infamous state-sanctioned homo-hostility has resulted in intense international attention, development cooperation and Western funding to local lesbian, gay, bi- and transsexual (LGBT+) organisations. However, Western funders and allies in this context are becoming increasingly questioned. Researchers have highlighted the complexities, opportunities and constraints of an increasingly transnational LGBT+ movement, but how is this manifested on the ground in the Global South? Through an inductive and ethnographically inspired study, we set out to explore the Ugandan LGBT+ community and its intra-community relationships and relations with Western funders and allies in the unique setting of Uganda Pride 2022, to which we had rare first-hand access. The results reveal that security concerns, both from outside and within the community, shaped Uganda Pride 2022. The most salient finding is that competition for international funding distorts activists’ relations, as it stratifies the LGBT+ community based on who has access to Western donors and international funders.

Exploring existing malaria services and the feasibility of implementing community engagement approaches amongst conflict-affected communities in Cameroon: a qualitative study

BackgroundCameroon is one of the countries with the highest burden of malaria. Since 2018, there has been an ongoing conflict in the country, which has reduced access to healthcare for populations in affected regions, and little is known about the impact on access to malaria services. The objective of this study was to understand the current situation regarding access to malaria services in Cameroon to inform the design of interventions to remove barriers and encourage the use of available services.MethodsA qualitative research study was carried out to understand the barriers preventing communities accessing care, the uptake of community health worker (CHW) services, and to gather perceptions on community engagement approaches, to assess whether these could be an appropriate mechanism to encourage uptake of community health worker (CHW) services. Twenty-nine focus group discussions and 11 in-depth interviews were carried out between May and July 2021 in two regions of Cameroon, Southwest and Littoral. Focus group discussions were held with CHWs and community members and semi-structured, in-depth interviews were conducted with key stakeholders including regional government staff, council staff, community leaders and community-based organisations. The data were analysed thematically; open, descriptive coding was combined with exploration of pre-determined investigative areas.ResultsThe study confirmed that access to healthcare has become increasingly challenging in conflict-affected areas. Although the Ministry of Health are providing CHWs to improve access, several barriers remain that limit uptake of these services including awareness, availability, cost, trust in competency, and supply of testing and treatment. This study found that communities were supportive of community engagement approaches, particularly the community dialogue approach.ConclusionCommunities in conflict-affected regions of Cameroon continue to have limited access to healthcare services, in part due to poor use of CHW services provided. Community engagement approaches can be an effective way to improve the awareness and use of CHWs. However, these approaches alone will not be sufficient to resolve all the challenges faced by conflict-affected communities when accessing health and malaria services. Additional interventions are needed to increase the availability of CHWs, improve the supply of diagnostic tests and treatments and to reduce the cost of treatment for all.

SOFTWARE QUALITY EVALUATION USING ISO/IEC 9126 ON THE ITB STIKOM BALI ONLINE ACADEMIC INFORMATION SYSTEM (SION)

The success of the software that is built is seen based on whether or not the software works according to the ongoing business processes. One of the private universities that has used software as a tool in providing the information needed by students and other community members is ITB STIKOM Bali. The problem that occurs at ITB STIKOM Bali is that the Online Information System (SION) as application software has been implemented for a long time but its reliability has not been tested. The method used in this research is observation with a literature study flow, initial data collection, identification of evaluation needs, evaluation specifications, evaluation design, evaluation implementation and conclusions. This research uses the ISO 9126 framework and the characteristics taken are Usability and Functionality. The results obtained by the researchers were a successful evaluation of the ITB STIKOM Bali Online Academic Information System (SION) using a valid and consistent questionnaire and produced Usability results of 88.12% and Functionality results of 99.55%. These results show that the ITB STIKOM Bali Online Academic Information System (SION) can be used and functions well.

Capacity building and community of practice for women community health workers in low-resource settings: long-term evaluation of the Mobile University For Health (MUH).

Lebanon has been facing a series of crises, significantly increasing health challenges, and straining its healthcare infrastructure. This caused deficiencies in the system's ability to attend to population health needs, and it profoundly impacted vulnerable and refugee communities who face additional challenges accessing healthcare services. In response, the Global Health Institute at the American University of Beirut designed and implemented the Mobile University for Health (MUH), which promotes task-shifting through capacity building complemented by communities of practice (CoP). The program aimed to prepare vulnerable women to assume the role of community health workers (CHW) within their communities, and to promote positive health knowledge and behaviours. A mixed-methods approach was used to evaluate MUHs' three certificates (women's health, mental health and psychosocial support, and non-communicable diseases). Implementation took place between 2019 and 2022, with 83 CHWs graduating from the program. Short-term data including knowledge assessments, course evaluations, and community member feedback surveys were collected. 93 semi-structured interviews with CHWs and 14 focus group discussions with community members were conducted to evaluate the long-term impact of the capacity building and CoP components. Data revealed multiple strengths of the initiative, including increased access to education for the community, effectiveness of blended learning modality, successful planning and delivery of CoP sessions, and improved knowledge, skills, and health behaviours over time. The supplementary CoP sessions fostered trust in CHWs, increased community empowerment, and increased leadership skills among CHWs. However, some challenges persisted, including limited access to healthcare services, implementation logistical issues, difficulties with some aspects of the learning modality, and some resistance within the communities. MUH promoted and improved positive health knowledge and behaviours within targeted vulnerable populations in Lebanon. The supplementary CoP component proved instrumental in empowering CHWs and enhancing their impact within their communities. The study highlights the need for ongoing training and support for CHWs and underscores the importance of continued investment and adaptation of such initiatives through a gendered lens. This evaluation provides evidence on the successes of a capacity building model that has strong potential for scale and replication across health topics in conflict-affected contexts.

Barriers and facilitators to community acceptability of integrating point-of-care testing to screen for sickle cell disease in children in primary healthcare settings in rural Upper East Region of Northern Ghana.

Sickle cell disease (SCD) remains a public health problem especially in sub-Saharan Africa including Ghana. While pilot initiatives in Africa have demonstrated that neonatal screening coupled with early intervention reduces SCD-related morbidity and mortality, only 50-70% of screen-positive babies have been successfully retrieved to benefit from these interventions. Point-of-care testing (POCT) with high specificity and sensitivity for SCD screening can be integrated into existing immunization programs in Africa to improve retrieval rates. This study explored community acceptability of integrating POCT to screen for SCD in children under 5 years of age in primary healthcare facilities in Northern Ghana. This was an exploratory study using qualitative research approach where 10 focus group discussions and 20 in-depth interviews were conducted with community members and health workers between April and June 2022. The recorded interviews were transcribed verbatim after repeatedly listening to the recordings. Data was coded into themes using QSR Nvivo 12 software before thematic analysis. Most participants (70.9%) described SCD as serious and potentially life-threatening condition affecting children in the area. Of 148 community members and health workers, 141 (95.2%) said the screening exercise could facilitate diagnosis of SCD in children for early management. However, discrimination, fear of being tested positive, stigmatization, negative health worker attitude linked with issues of maintaining confidentiality were reported by participants as key factors that could affect uptake of the SCD screening exercise. Most participants suggested that intensive health education (78.3%), positive attitude of health workers (69.5%), and screening health workers not being biased (58.8%) could promote community acceptability. A large majority of participants viewed screening of SCD in children as very important. However, opinions expressed by most participants suggest that health education and professionalism of health workers in keeping patients' information confidential could improve the uptake of the exercise.

Inferring the Evolutionary Model of Community-Structuring Traits with Convolutional Kitchen Sinks.

When communities are assembled through processes such as filtering or limiting similarity acting on phylogenetically conserved traits, the evolutionary signature of those traits may be reflected in patterns of community membership. We show how the model of trait evolution underlying community-structuring traits can be inferred from community membership data using both a variation of a traditional eco-phylogenetic metric-the mean pairwise distance (MPD) between taxa-and a recent machine learning tool, Convolutional Kitchen Sinks (CKS). Both methods perform well across a range of phylogenetically informative evolutionary models, but CKS outperforms MPD as tree size increases. We demonstrate CKS by inferring the evolutionary history of freeze tolerance in angiosperms. Our analysis is consistent with a late burst model, suggesting freeze tolerance evolved recently. We suggest that multiple data types that are ordered on phylogenies, such as trait values, species interactions, or community presence/absence, are good candidates for CKS modeling because the generative models produce structured differences between neighboring points that CKS is well-suited for. We introduce the R package kitchen to perform CKS for generic application of the technique.

Perceived conditions of public open spaces (POS) and their associated impact in Kano, Nigeria: resident and patrons account

Purpose The purpose of this study is to examine the impact of public open spaces (POS) on host community in Kano Metropolis. Design/methodology/approach Two sets of questionnaires and participant observation were used to collect data for the study. The questionnaires were used to elicit information on the socioeconomic characteristics of residents and users, a total of 140 residents and 70 users were selected for the study using random sampling without replacement. Findings Findings revealed majority of the residents earn above 25,000 naira monthly with a percentage of 32.85% while patrons were dominated by respondents that earn below 25,000 monthly. Also, majority of the respondents (94%) have received formal education. Further findings revealed that POS in Kano Metropolis plays an important role in encouraging recreational activities; although some of the open spaces were to some extent declined, the study confirmed the existence of 28 open spaces from the underlying 35 POS within the metropolis. It is noteworthy to note that males were found to be more (80.9%) among users of all the open spaces in the study area with the least participation from their female counterparts. The study further revealed that the adverse effects faced by users of POS and members of the host communities comprised of lack of facilities within the open space, inadequate security, inadequate lighting, lack of vegetation cover, poor parking spaces, breaching the public peace while the residents perceived the open space as means of obstruction of public facilities, causes accident, causes traffic congestion, environmental pollution, increase in accident, obstruction of public facilities, increased accident, degrades the environment, breaching of public peace, traffic congestion and obstruction of public facilities. Originality/value The outcome of the study will raise the awareness of the people on the importance, conditions of facilities and the impact associated with the usage of open spaces on adjoining residence. It will also inform stakeholders the modalities to prevent further decline or conversation of open space to other land use and promote proper management of open space facilities and mitigate its likely negative impact on the environment. This will contribute toward achieving Sustainable Development Goal 11.

Transgender health objectives of training for adult Endocrinology and Metabolism programs: Outcomes of a modified-Delphi study.

Transgender people encounter significant barriers when seeking timely, high-quality healthcare, resulting in unmet medical needs with increased rates of diabetes, asthma, chronic obstructive pulmonary disease, and HIV. The paucity of postgraduate medical education to invest in standardization of transgender health training sustains these barriers, leaving physicians feeling unprepared and averse to provide transgender health care. Closing this education gap and improving transgender healthcare necessitates the development of consensus-built transgender health objectives of training (THOOT), particularly in Adult Endocrinology and Metabolism Residency programs. We conducted a two-round modified-Delphi process involving a nationally representative panel of experts, including Adult Endocrinology and Metabolism program directors, physician content experts, residents, and transgender community members, to identify THOOT for inclusion in Canadian Endocrinology and Metabolism Residency programs. Participants used a 5-point Likert scale to assess THOOT importance for curricular inclusion, with opportunities for written feedback. Data was collected through Qualtrics and analyzed after each round. In the first Delphi round, panelists reviewed and rated 81 literature extracted THOOT, achieving consensus on all objectives. Following panelists' feedback, 5 THOOT were added, 9 removed, 34 consolidated into 12 objectives, and 47 were rephrased or retained. In the second Delphi round, panelists assessed 55 THOOT. Consensus was established for 8 THOOT. Program directors' post-Delphi feedback further consolidated objectives to arrive at 4 THOOT for curriculum inclusion. To our knowledge, this is the first time a consensus-based approach has been used to establish THOOT for any subspecialty postgraduate medicine program across Canada or the United States. Our results lay the foundation towards health equity and social justice in transgender health medical education, offering a blueprint for future innovations.

Conflict Transformation in South Omo Zone Pastoralist and Agro-Pastoralist Community of Ethiopia

This study explores conflict transformation practices and actors through an analytical research approach. It reveals that various actors engaged in conflict and peace initiatives have primarily focused on activities cantered around conflict management, prevention, and resolution. This limited emphasis on conflict transformation is attributed to a lack of governmental attention to strategic planning in this regard. Sources of conflict identified include grievances, animal raiding, land disputes, fishing rights, and competition over water and pasture resources. Efforts aimed at conflict transformation encompass resilience-building, rangeland management, NGO interventions in peace dialogues, integration of pastoralism and agro-pastoralism with commercial agriculture, implementation of drought and conflict early warning systems, water resource management and development, range land rehabilitation, and provision of education to affected communities. While these activities have played a significant role in addressing conflicts and transforming relationships, they are deemed insufficient and inadequately executed for comprehensive conflict transformation. Nonetheless, they serve as vital drivers of peace. Although the current conflict transformation mechanisms in place have not resulted in significant changes in the conflict situation, the beginnings are promising and commendable. The government and other stakeholders are urged to engage in proactive conflict intervention mechanisms to effectuate conflict transformation and foster peace or mitigate its adverse impacts. Furthermore, the study advocates for the provision of informal peace education to all adult community members, with the possibility of formalizing this education as an existing conflict transformation option.

Multiple Sclerosis and COVID-19: Health and healthcare access, health information and consumer co-created strategies for future access at times of crisis

BackgroundPersons with multiple sclerosis (MS) need regular access to medical services for optimal health outcomes. During the COVID-19 crisis, evidence indicated some detrimental health changes in persons with MS. Maintaining access to healthcare providers and healthcare information may minimise detrimental health changes during times of crisis. In Australia, there is limited evidence of consultation with people who have chronic health conditions or disabilities regarding government decisions to restrict healthcare access and in the provision of health guidance during the COVID-19 crisis. Yet, there are good examples of government consultation with other minority populations in Australia, leading to beneficial outcomes. ObjectiveTo identify MS community members’ (persons with MS carers, advocates, healthcare providers) concerns about the health and healthcare access of persons with MS, during the second year of the COVID-19 pandemic and to collaborate with consumers in the MS community to co-create strategies to improve future access and health information provision at times of crisis. MethodWe undertook a consumer-co-created mixed-method study in the second year of the COVID-19 pandemic to identify healthcare access needs for MS. We presented results to our stakeholder group to identify support needs during crises. Persons with MS and care providers in the MS community completed an online survey and online interviews, and the stakeholder group participated in a stakeholder workshop. ResultsForty-four people participated in surveys, 33 completed interviews, and seven stakeholders participated in the stakeholder workshops. Three themes were identified from the surveys and interviews: health concerns, accessing healthcare services and communication sources. Healthcare providers (76.9 % of persons with MS and 77.8 % of care providers) and websites specific to the pandemic (76.9 % of persons with MS and 83.3 % of care providers) were identified by most survey respondents as preferred information sources during the COVID-19 crisis. Consultation with stakeholders resulted in the co-creation of strategies directed at communication, health, and lifestyle, as well as policies and protocols to address the needs of the MS community during crises. ConclusionWe listened to persons with MS and care providers to identify strategies to support health-communication, -access, and -lifestyle during crises. Consumer-created strategies are directed at national and local health advocacy organisations and governments. They are relevant for the coordinated healthcare planning of persons with chronic health conditions and disabilities during crises, such as those experienced by persons with MS.

Exploring Game Features and Reframing: the Construction of a Relationship Model

Background Social learning generates reframing when individual and collective values are reflected. This reframing enables community members to move from personal to collective views and actions, resulting in valuable outcomes that improve the community's functioning. This research aims to enhance the development of reframing with the help of role-playing games (RPG), given that digital games are considered particular communities. Method A relationship model was constructed to identify which game features generate reframing and how much they promote reframing. The model’s validity was tested using experts’ feedback and a game experience test (GET). The factor analysis results interpret that the features tested impact reframing. Results The study proposes that RPGs can promote reframing and identifies reframing associated with particular game features (such as game stories). Conclusion Students, game designers, related teachers and researchers can benefit from using the model to encourage reflection using games or require a model to bridge game features with social learning.

Citizen science as a vehicle to address multiple policy objectives: Case studies from Australia.

Despite increasing interest in citizen science as an approach to engage members of the public in research and decision making about health and wellbeing, there is a lack of practical evidence to guide policy and practice organisations to utilise these approaches. In this study we investigated how and why citizen science came to be incorporated into the work of two policy organisations. We offer two in-depth case studies of Australian government organisations which have utilised citizen science in environmental and healthy ageing policy. Interviews with organisational informants and relevant documents were analysed inductively to explore how citizen science came to be adopted, legitimised and supported. Citizen science was utilised to address multiple organisational objectives, including increasing community participation in science; enhancing individuals' wellbeing, learning, and skills, and generating data to support research and policy in a relatively cost-effective manner. In both cases, grant funding was a mechanism to support citizen science, with project delivery facilitated through academic-policy partnerships and led by external academic or community partners. Although citizen science is relatively new in policy and practice settings, this study underscores the value of these approaches in realising co-benefits for organisations, academics, and community members. The support and advocacy of senior managers as 'champions', and a willingness to invest in trialling new approaches to address policy problems are necessary ingredients to foster acceptance and legitimacy of citizen science. SO WHAT?: Citizen science initiatives can be strategically utilised by health promotion organisations to enact priorities related to genuine community involvement, support research and innovation and facilitate collaboration and partnerships between academic, policy and community stakeholders.

Factors influencing adoption of sexual and reproductive health intervention for adolescents in Ebonyi, Nigeria.

School and Community-embedded reproductive health interventions have been implemented in developing countries, with evidence that they led to improved sexual and reproductive health among adolescents. However, this type of intervention is rarely evaluated for its potential adoption and use. This study evaluated the constraints and enablers of the adoption of a school and community-embedded intervention that used community engagement, capacity building, partnerships and collaborations to deliver sexual and reproductive health services to adolescents. The intervention was implemented between 2019 and 2021 in six local government areas in Ebonyi State. The results on adoption presented here were collected four months into the mid-phase of the project, targeting adolescents, parents, adult family members, healthcare providers, local authorities, and community members. Sixteen in-depth interviews were conducted with policymakers, 14 with health service providers and 18 Focus Group Discussions (FGDs) with parents, community leaders and adolescents who were part of the implementation process. The coding reliability approach, a type of thematic data analysis was used, that involves early theme development and the identification of evidence for the themes. The adoption of school and community-embedded reproductive health intervention was strong among stakeholders at the early stages of the implementation process. Multi-stakeholder involvement and its multi-component approach made the intervention appealing, thereby enabling its adoption. However, at the later stage, the adoption was constrained by beliefs and norms about sexual and reproductive health (SRH) and the non-incentivisation of stakeholders who acted as advocates at the community level. The sustainability of the intervention may be threatened by the non-incentivisation of stakeholders and the irregular supply of materials and tools to facilitate SRH advocacy at the community level. The inclusive community-embedded reproductive health intervention was adopted by stakeholders because of the enablers which include timely stakeholder engagement. However, for it to be sustainable, implementers must address the non-incentivising of community-level advocates which serve as constraints.

Nostalgia increases punitiveness by intensifying moral concern

We addressed the relation between nostalgia and moral judgment or behavior. We hypothesized that nostalgia, a social emotion, increases moral concern (H1), nostalgia intensifies punitiveness against moral transgressors (H2), and that the nostalgia—punitiveness link is mediated by moral concern (H3). We conducted three cross-sectional (Studies 1, 2, 4) and one experimental (Study 3) investigations (N = 1145). The investigations, involving distinct operationalizations of the relevant constructs (nostalgia, moral concern, punitiveness) and diverse samples (U.S., Canadian, and European Prolific workers, French business school students, Dutch community members), yielded results consistent with the hypotheses. Nostalgia keeps one’s moral compass in check. The findings enrich the emotions and morality literatures.

Mental Health First Aid for Black Populations: Recommendations From the Neighborhood Healers Project

Community-based participatory action research can facilitate counseling psychologists’ engagement in social justice to benefit Black people’s mental health. One way to improve Black mental health is to equip credible and trustworthy community members with mental health knowledge and skills to support other community members experiencing mental health challenges. This study presents the Neighborhood Healers Project—a community-based participatory action research project that trains Black adults (Neighborhood Healers Fellows) in Mental Health First Aid (MHFA). During the inaugural 12-month fellowship year, we collected longitudinal qualitative data from N = 20 Fellows on the relevance of MHFA to Black people. In this paper, we examined their responses using reflexive thematic analysis. Findings included two themes with affiliated subthemes: (a) Liberatory Paradigm Shift and (b) For Us By Us: Culturally Relevant Curriculum. We conclude with implications for counseling psychologists.

The Collective Domains in the Ecological Transition: A Preliminary Analysis in an Inner Area in the Campania Region, Italy

The growing attention to the sustainable management of territories leads to a reconsideration of common properties, those institutions which concern property rights belonging to all members of a well-defined community. Spread throughout the world in a variety of forms, they can play a crucial role in addressing the challenges posed by the ecological transition promoted by the European Green Deal. In Italy, common properties represent a historical phenomenon, specifically involving rural and mountain areas. Despite the fact that national law regarding collective domains fully recognizes their economic, social, and environmental functions, there is still much to be done in terms of their recognition. As the status of knowledge is lacking, especially in some areas of southern Italy, this article represents a preliminary analysis of the current consistency of collective domains. The introductory section places the topic in the broadest context of ecological transition, tracing its regulatory evolution. Next, collective domains are framed from an economic perspective, highlighting their multidimensional values and emerging assessment issues. The subsequent sections, based on the most recent available data, critically analyze the current supply of collective domains in Italy and in the Campania region. The in-depth analysis of an inner area, characterized by socio-economic marginality, represents the starting point from which it will be possible to identify the demand and to support policy makers and local communities in the valorization of common properties.

Influence of Youth Unemployment on Youth Involvement in Crime in Kakuma Refugee Camp

Youth, constituting an estimated 70% of the total population, play pivotal roles in society due to their energy and dynamism. Conversely, a significant portion of the refugee population comprises young individuals who, despite being provided with various capacity-building programs, sometimes find themselves involved in criminal activities. The study sought to assess the influence of youth unemployment on youth involvement in Crime in Kakuma Refugee Camp. Employing a descriptive research design, the study was guided by Strain theory. The target population included refugees, host community members operating businesses within the study area, government officials, and officials from humanitarian agencies implementing projects in refugee settlements. Stratified random sampling was utilized to select South Sudanese sub-clans, while purposive sampling was employed to select security officers and stakeholders from various departments. Data collection involved the use of questionnaires and interviews, gathering responses from 125 and 20 respondents, respectively. Primary data was obtained through questionnaires and interviews with government officers working in the camp, such as those from the Department of Refugee Services (DRS), law enforcement officers, Non-Governmental Organizations (NGOs), community peace and protection teams (CPPTs), and national and county government administrators overseeing the refugee camp's jurisdiction. Secondary data was sourced from scholarly journals, books, the internet, reports, newspapers, and treaties on refugees, aiding in achieving the study objectives. Data analysis employed descriptive statistics for quantitative data and content analysis for qualitative data, utilizing SPSS and NVIVO software, respectively. Results were presented through tables, charts, and figures. The study found that poverty was a significant factor contributing to youth involvement in crime. Additionally, societal treatment, characterized by suspicion, victimization, lack of recognition, and disharmony influenced youth criminal behaviour. To address these issues, the study recommends that humanitarian organizations and governments provide income-generating activities for youth, intensify initiatives to alleviate community involvement in crime, foster positive societal attitudes towards youth, and provide proper guidance on avoiding negative peer influence, thereby deterring youth from joining criminal groups.

Community Health Workers’ Targeting of Women For Health and Nutrition Home Visits in Rural Tanzania: A Mixed-Methods Study

BackgroundCommunity health workers (CHWs) are utilized in many health systems to provide education and messaging to families in their catchment areas. However, CHWs responsible for large geographic areas often must make important decisions about whom to visit. Factors that influence these decisions are understudied. ObjectivesThis study assessed coverage and targeting for home visits by CHWs within a large social and behavioral change health program in rural Tanzania. MethodsThis implementation research was a cross-sectional, mixed-methods study. Data collection included a census with households and surveys with females, surveys with CHWs, and interviews with CHWs. Survey data also included the collection of household location data for females and CHWs. Quantitative data were analyzed using linear probability models, and qualitative data were analyzed using inductive thematic analysis. ResultsOnly 13% of eligible households in our study sites reported receiving a home visit from a CHW. Although CHWs were more likely to reach households with infants, other program priority populations, such as poor and food insecure households, were frequently missed. Global positioning system data showed that distance was 1 of the greatest barriers for CHWs in providing home visits. Qualitative data indicated that although CHWs were motivated and engaged to improve maternal and child health in their communities, they faced challenges in visiting households that were further away or lacked economic resources to improve their health behaviors. CHWs also found it difficult to provide health education during home visits to mothers with no formal schooling. ConclusionsPrograms relying on community volunteers need to set realistic workloads, especially when volunteer CHWs also work full-time in their primary occupations. Implementation could also be strengthened by providing extra support for CHWs so that they can effectively provide services to community members who are more difficult to visit but may be the most in need.

Local perspectives on marine ecotourism development in a water-insecure island region: the case of Bocas del Toro, Panama

As a dimension of a blue economy, marine ecotourism should, in theory, not only increase economic viability and environmental sustainability but, most importantly, pursue socially equitable outcomes. In tropical and sub-tropical island regions, where substantial tourism development is often coupled with widespread strains on public infrastructure and services, including water access, there exists a need to better understand the expansion of this industry is felt at the community level; more importantly by individuals who are reliant on these infrastructures and services. Through a case study of the Bocas del Toro Archipelago, where water insecurity is becoming acute, we draw on and mobilize stories from local community members, alongside non-participant observations and document collection, to 1) document the experience of some community members with water insecurity and shortages, including how they perceive the roles played by the central government and marine ecotourism sector, and 2) examine how community members feel about how communities feel about policies and investment priorities of the central government regarding water insecurity, including the extent to which they view marine ecotourism development as undermining or promoting local needs. Our results underline the complex nature of marine ecotourism governance and infrastructure development outcomes in a resource-insecure island region, demonstrating that current issues are greatly impacted by historical and social underpinnings of neo-colonialism and systemic racism, misalignments of community vs. government development priorities, and eroded political trust, that shape local experiences with sustainable development and local residents’ perceptions of the ability of marine ecotourism to address issues of water insecurity. Moreover, while our focus is on the marine ecotourism industry, the significance of these findings contributes to a growing body of literature that places local experiences at the forefront of research into the implications of sustainable development in island regions.

'Building our own house' as an insider-only Community-Partnered Participatory Research Council: Co-creating a safe space for Autistic knowledge production.

In recent years, there has been a growing call for participatory Autism research (i.e. research that meaningfully involves Autistic people in its design and delivery). Community Partnered Participatory Research is a research methodology that aims to share power between researchers and members of the researched community. There is some precedent for Community Partnered Participatory Research in Autism research, but it is still quite uncommon. At the start of our new research study (called Autism: From Menstruation to Menopause), we created a community council. For the first six meetings, our council was made up of four Autistic community members who were experienced in Autism advocacy and activism and three Autistic researchers. We seven are the authors of this article. In these first six meetings, we made plans for recruiting a larger number of lay community members who would join us later for the rest of the project (8 years in total). In this article, we describe and reflect what it felt like during these first six meetings to be part of a community research council where everybody is Autistic. We discuss how we co-created a safe space, how we helped each other feel valued and how we worked together to support each other's sometimes-differing access needs so that everyone could fully participate. We provide recommendations for how to support Autistic people to lead research on their own terms with their unique insights.