Community Organizations Research Articles

Effectiveness of government policy interventions towards enhancing access to pre-primary and primary education by street children in North Rift Kenya

An estimated 150 million children live on the streets globally, with many not enrolled in school. This growing issue requires urgent attention. UN Sustainable Development Goal 4, Target 5, aims to eliminate educational disparities for marginalized groups like street children, emphasizing the need to address prejudice in education access.The Kenyan government has developed measures to improve all children's access to education, particularly at the pre-primary and primary levels, in light of its signature on the United Nations convention. Government funding for the creation and execution of policy initiatives targeted at improving the access to education for these socially marginalised populations has been consistently large. Many street children still do not go to school though. In this regard a study was conducted to assess the effectiveness of government policy interventions towards enhancing access to pre-primary and primary education by street children. The study used mixed method research and pragmatic paradigm. By using both purposeful and random sampling, a sample size of 322 was selected. The respondents comprised of Street children, county directors of education, quality assurance officers, officers in the Department of Children Welfare, urban primary school teachers, non-governmental organisations, and community-based organisations that assist street children. Data was collected using observation guides, in-depth interviews, and questionnaires. Descriptive and inferential statistics as well as theme analysis were used to analyse the data, respectively. The results showed a statistically significant relationship between government policy interventions and street children's access to pre-primary and primary education in North Rift Kenya; specifically, the national pre-primary education policy had a Pearson correlation coefficient of 0.711, while the inclusive education policy had a coefficient of 1.0. The research additionally demonstrated the necessity of reinforcing the involvement of other relevant parties in improving street children's access to pre-primary and primary education.

Personalized customer journeys for underserved communities: Tailoring solutions to address unique needs

In today's diverse marketplace, creating personalized customer journeys for underserved communities is essential for fostering inclusion and promoting equitable access to services. This review explores the significance of tailoring solutions to address the unique needs of these communities, emphasizing the role of personalized experiences in enhancing customer satisfaction and loyalty. Underserved communities often face systemic barriers, including limited access to resources, information, and services. Traditional customer journey models may overlook these specific challenges, leading to ineffective engagement and unmet needs. By adopting a personalized approach, businesses can better understand the distinctive characteristics, preferences, and pain points of these communities. This understanding allows for the development of targeted strategies that resonate with individuals' cultural, social, and economic contexts. The framework for personalized customer journeys involves several key components. First, comprehensive data collection is crucial for identifying the unique demographics and psychographics of underserved communities. Utilizing qualitative and quantitative research methods, businesses can gather insights on customer behaviors, preferences, and challenges. Next, leveraging advanced analytics and artificial intelligence can enhance the personalization of interactions, ensuring that offerings align with the specific needs and aspirations of these communities. Additionally, fostering collaboration with community organizations and leaders is vital. Engaging with local stakeholders helps businesses build trust and credibility, facilitating the co-creation of solutions that genuinely address the community's needs. This collaborative approach can lead to the development of tailored products and services, targeted marketing strategies, and supportive customer service frameworks. Ultimately, personalized customer journeys for underserved communities not only improve customer satisfaction but also drive business growth and social impact. By prioritizing equity and inclusion, businesses can enhance their brand reputation, foster customer loyalty, and contribute to the economic empowerment of these communities. In conclusion, a commitment to understanding and addressing the unique needs of underserved communities through personalized customer journeys is essential for fostering inclusive growth and creating lasting positive change.

E-Cigarettes in the Young Population

E-cigarettes have gained notable popularity among youth in recent years, posing a serious societal issue that has elicited much concern from public health professionals and legislators. The increase in e-cigarette consumption among adolescents can be ascribed to assertive marketing strategies employed by corporations that focus on appealing to young consumers through flavored offerings and aesthetically pleasing designs. This rise is concerning because of the possible long-term health ramifications linked to vaping, such as nicotine addiction and exposure to hazardous chemicals found in numerous e-cigarette formulations. The normalization of e-cigarette usage in social contexts may result in heightened peer pressure and the endorsement of detrimental conduct. To properly address this issue, government agencies must enforce stronger rules on e-cigarette sales and marketing directed at minors, while schools and community organizations should educate youth about the risks of vaping.

A university-based counseling program for perpetrators of family violence in Greece: initial evidence

Abstract Penal mediation is defined in Greek Law 3500/2006 and aims at repairing the harm caused to the victim of family violence and rebuild family relationships. Mediation process starts upon victims’ unreserved consent and perpetrators’ willingness to stop further acts of violence, attend a counseling program and restore any harm/damage caused to the victim. Then the prosecutor ceases the case for 3 years and refers the perpetrator to counseling. If any of the previous conditions are violated during this period the criminal procedure continues at the stage before mediation. A university lab in Crete, Greece (LaHeRS, HMU) offers one of the few in Greece perpetrators’ behavior change programs in collaboration with the Prosecutor’s Office. LaHeRS counseling program consists of a minimum of 24 sessions per offender based on an individual or group approach. Emphasis is placed on perceptions of power and control, anger management, trauma management, emotional expression, and social/communication skills. Each perpetrator is offered 2 sessions (intake/violence documentation and assessment of individual/couples’ needs), 2-3 sessions for psychiatric and risk assessment, 12-15 individual or group counseling sessions (combined with couples’ sessions, as necessary), 2-4 individual social support sessions. Sessions are conducted by trained psychologists and social workers. The current presentation reports on the Intimate partner violence (IPV) cases referred between February 2022 and December 2023. A total of 70 IPV cases attended the program (male n = 65; mean age 43.4; Greek n = 56; urban residence n = 49; children average=1.92). Physical violence was reported in 54 cases and verbal aggression in 43 cases. Four perpetrators had mental health problems and 6 were identified with some form of drug and alcohol misuse. Lack of communication and emotional skills, lack of parent emotional support, gender roles stereotypes and patriarchal attitudes were common among perpetrators. Key messages • It is important for perpetrators’ programs to address the underlying causes of criminal behavior to promote positive changes in perpetrators’ lives. • Effective penal mediation programs require collaboration and partnership between justice agencies, academia and community organizations.

Agricultural activities reduce the risk of requiring long-term care among older Japanese

Abstract Introduction Controlling the risks that lead to requiring long-term care for the older adults is a crucial medical and socio-economic issue. This study investigated the impact of agricultural activities (AAs) on the risk of requiring long-term care. Methods A 5-year follow-up was conducted on 1,009 healthy individuals aged 65-80 years (mean age 72 years; 44% men) living in a rural area (Wakayama, Japan). Requiring long-term care was assessed as requiring support or nursing care (RSNC) according to the Japanese criteria. Health status including frailty and metabolic syndrome were also assessed using Japanese criteria. Work status and lifestyle habits were assessed using self-administered questionnaires. The main outcome was the probability of RSNC. COX proportional hazards regressions were performed, stratified by occupation (agricultural worker or other) or frequency of AAs (none, less than or >150 days/year), adjusted for sex, age, frailty, metabolic syndrome and household as possible confounding factors. Results Approximately 35% of the participants were in agriculture, forestry, and fisheries as occupation, and 78% engaged in AAs. A total of 85 participants RSNC and 39 deaths were observed during the follow-up. The cumulative survival probability did not differ according to occupation or frequency of AAs, whereas the probability of RSNC was significantly lower in participants engaged in AAs (hazard ratio 0.37 [95% CI 0.22, 0.62]; <150 days/year, 0.29 [95% CI 0.17, 0.50]; >150 days/year). Participants engaged in AAs were significantly more likely to engage in low- and vigorous-intensity physical activity, and to participate in industry and community organizations and relating events. Conclusions These findings suggest that AAs may promote a physically and socially active lifestyle, independent of frailty or metabolic syndrome, and reduce the risk of RSNC. Key messages • Prevention of long-term care is important in the older population. • A lifestyle associated with agricultural activities may contribute to healthy aging.

Effective Strategies to Improve the South African Police Service's (SAPS) Capacity to Reduce Crime and Enhance Public Safety

This research delves into the critical issues of crime reduction and police service improvement in South Africa. South Africa faces a significant challenge: high crime rates, particularly violent crime and gender-based violence. This undermines public safety and necessitates a multifaceted approach to achieve a safer society. This research explores evidence-based strategies for crime reduction and police service improvement within the South African context. Main Topics: Crime reduction strategies we examine how evidence-based policing, situational crime prevention, and social crime prevention can be adapted and implemented effectively in South Africa. Strengthening the South African Police Service (SAPS): We analyze how to enhance the SAPS through improved resource allocation, specialized training programs, and a focus on community policing and trust- building. Key Arguments crime reduction requires a multi-pronged approach that addresses both criminal behavior and the underlying social factors that contribute to it. Evidence-based policing, situational crime prevention, and social crime prevention offer promising strategies when tailored to the specific contexts of South African communities. Strengthening the SAPS through improved resources, training, and community relations is crucial for building trust and enhancing public safety. Approach This research employs a literature review approach, analyzing existing research on crime reduction strategies, police service improvement, and the South African context. Significance this research has the potential to inform policymakers, police leadership, community organizations, and future research endeavors. By identifying effective strategies and outlining practical recommendations, this research can contribute to a safer and more just South Africa. Audience this research is targeted towards a broad audience, including Policymakers involved in developing and implementing crime reduction strategies. Police leadership seeking to improve the effectiveness and efficiency of the SAPS. Community organizations working to address crime and promote safety in their neighborhoods. Researchers interested in furthering the understanding of crime and policing in South Africa. Conclusion by critically examining crime reduction strategies and exploring ways to strengthen the SAPS, this research lays the groundwork for a safer and more secure South Africa. Implementing the recommendations outlined here can contribute to a future where all South Africans feel safe and secure in their communities.

Understanding influences of cervical screening attendance among women of low socio-economic position

Abstract Women of lower socio-economic position (SEP) have a higher incidence of cervical cancer and lower uptake of cervical screening. The Integrated Screening Action Model (I-SAM) is a behaviour model aimed to guide intervention development that considers how individuals engage with screening through their environment, capability, opportunity, and motivation. The I-SAM can be used to understand behaviour of cervical screening. We aimed to understand perceptions and awareness of HPV screening among women aged 25-65 of low SEP living in an urban area in Ireland. Semi-structured interviews were conducted with women who self-reported regular or irregular screening attendance, no university-level education, low-income employment or not working, aged 25-65 and living in Dublin. Participants were recruited via community organisations. Data were analysed using I-SAM in a framework analysis to map barriers and enablers of attendance of regular and irregular attenders. Of the seventeen women interviewed, seven attended screening irregularly. Participants thought they had opportunity to attend when they were reminded and supported to attend by peers and healthcare professionals. Participants wanted to promote screening in the community and to normalise conversations on sexual health. Participants felt fear of cancer was a driver and deterrent to attend screening due to cancer running in the family, past health issues and abnormal cell treatments, and wanting to be there for their family. Few were aware of HPV or the switch to HPV screening. Irregular attenders were unsure how to book or find information on screening. Campaigns should involve communities that are less likely to attend to improve visibility of screening. Healthcare professionals could opportunistically promote HPV screening in primary care and community settings. Campaigns should be aimed at improving literacy of HPV screening, address concerns of cancer risk and support navigation through screening. Key messages • Understanding of HPV cervical screening is limited and campaigns are needed to improve awareness and literacy. • Public health campaigns should engage with communities to promote screening via community groups and healthcare professionals.

Leveraging digital tools to enhance diversity and inclusion in clinical trial recruitment

Clinical research is pivotal in assessing the safety and efficacy of new treatments in healthcare. However, the success of such research depends on the inclusion of a diverse and representative participant sample, which is currently lacking. This lack of diversity in biomedical research participants has significant repercussions, limiting the real-world applicability and accessibility of medical interventions, especially for underrepresented groups. Barriers to diverse participation include historical mistrust, logistical challenges, and financial constraints. Recent guidelines by government agencies and funding bodies emphasize the need for diversity in clinical trials, but specific strategies for inclusive recruitment are often lacking. This paper explores the use of digital methods to enhance diversity and inclusion in research recruitment. Digital tools, such as electronic medical records, social media, research registries, and mobile applications, offer promising opportunities for reaching diverse populations. Strategies include culturally tailored messaging, collaborations with community organizations, and the use of SEO to improve visibility and engagement. However, challenges such as privacy concerns, digital literacy gaps, and ethical considerations must be addressed. The promotion of diversity in clinical research recruitment is crucial for advancing health equity. By leveraging digital tools and adopting inclusive strategies, study teams can improve the diversity of study participants, ultimately leading to more applicable and equitable healthcare outcomes.

Single Mothers Association of Kenya (SMAK) and the Fight to Stay Put on the Ziwani Estate in Nairobi

This Reflection discusses the fight to stay put on the Ziwani Estate in Nairobi, in the face of the redevelopment (gentrification) of one of the first East African public housing projects developed in Kenya under colonial rule. The Single Mothers Association of Kenya (SMAK), a community-based organization founded on the Ziwani Estate, is leading the fight for/with Ziwani residents. SMAK is focused on land and housing rights, capacity building for the community on these rights, advocating against illegal eviction, and fighting against gentrification, densification, and homelessness. Under immediate threat SMAK found local and global allies in academia, civil society, and in UN bodies. They have had some important wins on the preservation and conservation of Ziwani historic places and people based on unexpected academic collaborations and on their own activism which they believe requires civic education, domestic and international lobbying, and possibly legal struggle.

Healthcare accessibility of individuals at increased risk of STIs: a cross-sectional survey in Italy

Abstract Access to STI prevention and sexual health services in Italy, especially among vulnerable and marginalized groups, is inadequately documented. With the support of community organizations, a cross-sectional survey was conducted between September 2023 and March 2024 to assess health services accessibility among individuals at increased risk of STIs. A total of 1456 responses were analyzed. The respondents comprised 1327 (91.14%) cisgender men, 58 (3.98%) cisgender women, 11 (0.76%) transgender men, 10 (0.69%) transgender women, and 47 (3.23%) non-binary individuals. Overall, 93.8% were men who have sex with men, and 2.8% were women who have sex with women. Mean age was 38 (SD 12). Among respondents, 1284 (88.2%) had undergone HIV testing at least once [102 (7%) living with HIV; 45.1% diagnosed during prior year]. Overall, 563 (38.7%) had been diagnosed with at least one STI in the prior year. Chemsex was reported by 106 (7.3%), with 4.7%, 75.5%, and 35.5% using injective, inhaled or oral substances. Despite a high risk for STIs, 728 (50%) and 410 (28.2%) individuals, respectively, did not visit a specialist in infectious diseases or their primary care provider in the prior year. PrEP awareness was high: 1286 (88.2%) respondents were knowledgeable about it, but only 342 (23.5%) attended PrEP centers and 297 (20.4%) used it. Among PrEP users, 27 (7.9%) encountered difficulties obtaining the drug and 174 (50.9%) considered the cost prohibitive (before it became free). Additionally, 27 (7.9%) of those attending PrEP centers felt judged or disrespected. Overall, 1179 (80.9%) had heard of Mpox, and 1012 (69.5%) were aware of the vaccine, with 301 (20.6%) being vaccinated. Among those vaccinated, 18 (5.2%) felt judged or disrespected. Out of 55 (3.8%) individuals tested for Mpox, 13 (23.6%) tested positive, among which one reported feeling disrespected. The survey highlights critical gaps in healthcare access and awareness among individuals at increased risk of STIs in Italy. Key messages • In a final open-ended question, responders commented on various issues including high costs of services, insufficient provider training and the necessity for improved inclusion of LGBTQ+ individuals. • The robust response from typically hard-to-reach groups underscores the pivotal role of community involvement in enhancing awareness and accessibility of sexual health services, fostering inclusivity.

Unveiling Cervical Cancer Inequities Among Georgia Immigrant Latinas: A Robust Qualitative Examination of the Facilitators and Barriers to Prevention, with Emphasis on the Impact of Community-Based Organizations.

This qualitative study delves into the facilitators and barriers surrounding cervical cancer prevention among Latina women in Georgia, with a specific focus on the impact of community-based organizations (CBOs). Employing semi-structured interviews with healthcare providers and representatives from CBOs, faith-based organizations, and other key stakeholders, the study uncovers key themes and subthemes shaping cervical cancer disparities. Themes such as challenges in cross-cultural healthcare access, difficulties due to lack of US citizenship, and limited mobility emerge as significant barriers, while community and family support stand out as crucial facilitators to cancer prevention. Additionally, the study examines community intervention methods from CBOs to target cervical cancer disparity, highlighting the importance of public awareness campaigns, building trust within the Latina community, and providing medical support tailored to immigrant populations. Through this comprehensive examination, the study not only offers invaluable insights into the intricate web of issues surrounding cervical cancer prevention but also endeavors to serve as a catalyst for targeted interventions and evidence-based policies aimed at ameliorating cervical cancer disparities among immigrant Latinas in Georgia and beyond.

Uptake of Digital Health Interventions for Cardiometabolic Disease in British South Asian Individuals: Think Aloud Study.

Digital health interventions (DHIs) could support prevention and management of cardiometabolic disease. However, those who may benefit most often experience barriers to awareness and adoption of these interventions. Among South Asian individuals, we evaluated user experience of DHIs for prevention and management of cardiometabolic disease, aiming to understand barriers and facilitators to initial and ongoing use. Among South Asian individuals recruited via primary care, community organizations, and snowball methods (n=18), we conducted "think-aloud" interviews using a reflective and reactive approach. Participants included nonusers, as well as those that used a range of DHIs as part of monitoring and improving their health. Participants were asked to think aloud while completing a task they routinely do in a familiar DHI, as well as while setting up and completing a search task in a novel DHI; they were encouraged to behave as if unobserved. Lack of cultural specificity was highlighted as reducing relevance and usability, particularly relating to dietary change. Preferred features reflected individual health beliefs and behaviors, digital skills, and trust in DHIs. For example, tracking blood glucose was considered by some to be positive, while for others it caused distress and anxiety. Similarly, some users found the novel DHI to be extremely simple to set up and use, and others grew frustrated navigating through initial interfaces. Many participants raised concerns about data privacy and needing to agree to terms and conditions that they did not understand. Participants expressed that with information and support from trusted sources, they would be interested in using DHIs as part of self-management. DHIs may support South Asians to prevent and manage cardiometabolic disease, but it is important to consider the needs of specific user groups in DHI development, design, and implementation. Despite motivation to make health changes, digital barriers are common. Cultural appropriateness and trusted sources (such as health care providers and community organizations) have roles in increasing awareness and enabling individuals to access and use DHIs.

An exploration of factors leading to readiness for organizational health literacy change in community-based health organizations.

Healthcare systems have a responsibility to improve organizational health literacy (OHL) to increase health equity. This study explored two organizational cultural factors, leadership support and staff buy-in, for organizations planning OHL change. Ten community-based health organizations participated in an OHL program. The study design was mixed methods. The qualitative inquiry was interviews with senior leaders to explore awareness of OHL and: impetus to transform, leadership commitment, staff engagement, alignment to organizational goals, and integration of health literacy change with current practices. The quantitative assessment was the Organizational Readiness for Implementing Change (ORIC) questionnaire to assess staff's perceptions about OHL change readiness. Senior leaders articulated the effects of low health literacy in their patient and client population. Support for OHL change was seen at both leadership and staff levels. Impetus for change was primarily a response to a community need or for quality improvement. Most of the non-clinical organizations had higher ORIC scores than the clinical organizations, indicating a perceived higher level of readiness for OHL change. Leadership commitment and staff buy-in are important factors of readiness for OHL change. A novel finding is that community-based health organizations are able and willing to engage in OHL change.

Effects of religion, politics and distance to providers on HPV vaccine attitudes and intentions of parents in rural Utah.

Human papillomavirus (HPV) causes an estimated 300,000 high grade cervical dysplasias and 36,000 preventable cancers each year in the United States alone. Despite having a safe, effective and long lasting vaccine since 2006, the rate of uptake has been suboptimal, particularly in rural areas. In 2020, Utah ranked near last in teenage HPV vaccination rates with rural areas trailing urban areas by about 18 percent. In this study, we identified factors that affect the intent of rural Utah parents to vaccinate their children against HPV. A survey was distributed electronically to Utah residents in rural areas. Recruitment was carried out through targeted advertising, community organizations, and professional survey panels. The survey was open from Nov. 15, 2022 to April 15, 2023. A total of 410 respondents were used for analysis. Survey results were analyzed using exploratory factor analysis, confirmatory factor analysis, and structural equation modeling. Distance to care was shown to negatively influence direct intent to vaccinate, while trust in government, general vaccine attitudes, and HPV knowledge positively influence intent to vaccinate. It was found that religious practice decreased vaccine hesitancy while cautious sexual attitudes, distance to care, and general negative vaccine attitudes increased vaccine hesitancy. Conservative political identity and high income were both shown to decrease vaccine hesitancy as covariates.

Imagining peace and enacting utopias in Puerto Rico

ABSTRACT Local groups in Puerto Rico are often described as being at the forefront of climate transformation. This article explores active struggles towards alternate futures, using a critical concept of utopia in a phenomenological study alongside women at a community organisation in Culebra, Puerto Rico. I use feminist ethics of care as a theory of knowledge to study how cognitive, embodied, and affective visions influence struggles towards utopian futures. The empirical study reveals how women experientially understand climate change through food, livelihoods, and identity in Culebra. They express and imagine futures through orienting dependencies towards reciprocal care; foster place-based belonging through collective relations; and envision alternatives through longing that intertwines past, current, and yet-to-come temporalities. This study contributes to knowledge production about transformation and peace, and underlines the importance of imagination as part of the politics of knowledge.

Preparing Teachers for the ‘Ummah’: A Case Study of Hayat Foundation

This preliminary study initiates an exploration into a novel informal Islamic teacher education programme developed by a community organisation. The presented case study explores the Afghan Muslim inspired Hayat Foundation’s communal educational initiative, the Marefat programme. The programme, derived from Islamic educational theoriesis ‘imbued with notions of reflective, critical, and reflexive thinking’, which are designed to recognise the individual levels of development for every educator and simultaneously elevate their efficacy, agency, and person. Adopting an interpretivist-narrative methodology conveyed through a dialogical approach, this study focuses on the lived experiences of this social-welfare organisation by seeking to decipher the teleological nature of the programme. This examination is guided by three questions which seek to identify its intended audience, the specificity of the issue it attempts to address, and the approaches it has adapted to implement its programme. The findings suggest that the overarching purpose of this educational initiative is to foster empowering liberatory pedagogical responses to counter oppressive narratives in the reading of the Islamic tradition.

50 Co-designing an intervention with asylum seeking youth to improve access to healthcare in Canada using human-centered design

Abstract Background Asylum seeking youth in Canada and the United States face multiple barriers to accessing healthcare, leaving them at greater risk of worse health outcomes. In a previous study, we found that limited knowledge of the Canadian health care system and few navigation supports were a key barrier to care for asylum seeking youth, yet no youth-developed intervention existed to support this population. Human-centered design (HCD) develops meaningful interventions with communities who have been historically marginalized. Objectives This study sought to co-design an intervention to increase youth empowerment and access to health care for asylum seeking youth in Canada. Design/Methods This was a community-based participatory-action research (CBPAR) study, and combined human-centered design (HCD) methodologies. We obtained research ethics board approval for this study (#SMH REB 22-117). In partnership with two community organizations that supported asylum seeking youth in a large Canadian city, a youth advisory board was created. In multiple co-creation sessions over a calendar year, an intervention was developed in rapid prototyping sessions and refined with feedback, to develop a final pilot intervention. Results A total of 7 asylum-seeking youth participated in the youth advisory board, ranging in age from 12-19, representing 3 different languages and included youth who self-identified with chronic medical conditions. Over a 15-month period, they participated in 6 co-creation sessions to develop a multi-lingual, web-based tool; youth specifically stated they did not believe an app would be helpful, but rather a resource that could be easily accessed. The youth advisory board shared they had limited understanding of the Canadian healthcare system, as well as interim and provincial health insurance. Youth felt the tool should answer questions about how health insurance worked, be brightly colored, use dyslexia-friendly font and be easily saved on a smartphone as an image. A multi-lingual wallet card was developed for youth to easily present at healthcare encounters, particularly if they did not have provincial health insurance, to help youth communicate their coverage, language and needs. Conclusion To our knowledge, we developed the first co-designed tool in Canada for youth asylum seekers, by youth, to improve and empower youth to receive health care services they are entitled to through navigation support. Given the high degree of marginalization faced by asylum seeking youth, this intervention has the promise to improve health outcomes. Feasibility and acceptability of this study will be evaluated in subsequent studies.

Gather "Round": An Integrated Care Model for the Emergency Department Multi-Visit Patient.

Emergency departments (EDs) are a vital component of the United States healthcare system and care for over 130 million patient visits annually. Nonurgent ED visits can contribute to crowding, delays in care, and adverse effects. Many high-utilizing ED patients may present with complex medical, behavioral, and social needs that are not necessarily emergent or urgent in nature. The authors created an Integrated Care Model, called the Multi-Visit Patient (MVP) program, for patients with 5 or more visits to the ED in a rolling 12-month period. The MVP program incorporated an interdisciplinary group of ED leadership and case management (CM) to identify, engage, and intervene with ED MVPs, aiming to improve their ED utilization. Patients received comprehensive screenings for depression, falls, alcohol use disorder, caregiver support, social determinants of health, and more. Based on these screenings, the CM team implemented interventions such as connecting patients with outpatient specialists and linking patients to community-based organizations to optimize stability, wellness, and reduce ED utilization. The collaboratively developed MVP program was implemented in the ED of a large, suburban, tertiary care academic hospital. The MVP program identified 221 MVP patients over a 20-month period and successfully connected with 89% of them. Of these 221 patients, 78% (172 patients) chose to engage in the MVP program, with 160 completing their engagement with an outcome. Among the patients who completed their engagement and for whom the study could match separate utilization data (151 patients), the study observed a 57% reduction in ED visits. Case managers play a crucial role in the effectiveness of the MVP program by coordinating comprehensive care for high-utilizing ED patients. The MVP program includes transition of care initiatives designed to improve patient outcomes. Through screenings and targeted interventions, case managers identify and address the complex medical, behavioral, and social needs of MVP patients. This collaborative, interdisciplinary approach underscores the importance of timely and coordinated care, benefiting both patients and the health system. The MVP program exemplifies the critical role of case managers in reducing unnecessary ED visits and enhancing overall patient care.

Association between food security status and dietary patterns in a cohort of first-time food-aid users.

To examine the associations between food security status and dietary patterns among first-time food-aid users. From September 2018 to January 2020, a sample of 1001 newly registered food-aid users from 106 community-based food donation organizations were recruited across urban, rural, and peri-urban areas in four administrative regions of the province of Quebec, Canada. The Household Food Security Survey Module (HFSSM) and the Short Diet Questionnaire (SDQ) were used to assess food security status and food intake, respectively. A posteriori dietary patterns were identified through principal component analysis. Regression analyses were performed on 987 participants with complete data to quantify the association between food security status and dietary patterns. Three main dietary patterns were identified: prudent (intake of fruits and fruit juice, plant-based beverages and legumes, green salad, carrots, other vegetables, whole grains, and fish), western (intake of poultry, red meat, potatoes and fried potatoes, rice, and pasta and refined grains), and snack foods (intake of salty snacks, cheese, butter and margarine, sweets, condiments, sweet beverages, and processed meat). Food insecurity was negatively associated with the prudent dietary pattern and positively associated with the snackfood dietary pattern. This study highlights the complexity of dietary patterns in a vulnerable population of first-time food-aid users, especially among those who are severely food insecure.

Initiatives to increase breast and cervical cancer-related knowledge, screening, and health behaviours among Black women.

In Canada, racialized and immigrant women are typically under-screened for breast and cervical cancer. Under-screening is linked to numerous barriers to access, including lack of awareness, fear of pain, the stigma of cancer, socio-cultural factors like language, and various socio-economic factors. To address these barriers, our team developed a series of initiatives to promote awareness of breast and cervical health among Black women. Building on the development of a breast cancer resource hub for Black women, and in partnership with relevant community organizations, we implemented a series of virtual educational and cancer screening events (two of each thus far). Both event series were targeted towards Black women and tailored to their needs. Each educational event attracted more than 450 attendees and had average attendance times > 1h. Most (> 87%) survey respondents agreed that an event specifically for Black women helped them feel supported. The 2022 and 2023 screening events provided breast and/or cervical cancer screening for 46 and 48 women, respectively. In both years, most women (> 90% of question respondents) noted that they were (extremely) likely to go for a mammogram or Pap test when next due. Both event series provided targeted opportunities for Black women to learn about prevention, risk factors, resources, and screening related to women's cancers. It is possible that, over time, such culturally tailored events can reduce or remove the stigmas associated with cancer and decrease differences in cancer-related knowledge and behaviours between racialized and non-racialized groups.