Community Outreach Workers Research Articles

Community outreach workers: Perceived practices and impacts on families and young children

Abstract Background Community outreach workers support individuals accessing healthcare and other services that could be useful to respond to their needs. Even though community outreach workers have been working in the province of Quebec (Canada) for the past 40 years, their practice is poorly documented and evaluated, especially with respect to young children aged 0 to 5 years. This study aimed to document the practice of community outreach workers and its perceived impacts among children and families. Methods A qualitative methodology with a descriptive research design was used. We performed a content analysis on 55 scientific and grey literature documents, 24 individual interviews, and 3 focus groups with stakeholders including parents, community outreach workers, healthcare employees, and inter-sectoral partners. Results Our analysis reveals three main themes: 1) characteristics of the population served, 2) concrete actions performed by community outreach workers, and 3) perceived impacts of community outreach on families and children. Community outreach workers were perceived as essential to reach families with vulnerable circumstances and children with special needs. With respect to concrete actions, community outreach workers were reported to tailor their interventions to respond in different but complementary ways to the healthcare system. Perceived impacts included increased access for children and families to appropriate services, decreased social isolation, increased empowerment (especially with respect to parental abilities), increased social capital of families, and confidence towards the healthcare system. Results showed that community outreach workers helped to reduce inequalities in health Conclusions Community outreach work help the healthcare system to fulfill its legal mandate to protect citizen and increase health and well-being. It is crucial that such type of proximity approaches be not only encouraged but also sustained. Key messages Community outreach workers adapt their practices to act in a complementary way to the healthcare system. Community outreach workers help to reduce inequalities in health.

Barriers and facilitators to implement community outreach work and collaboration with partners

Abstract Background Community outreach workers support individuals to access health and community services through various form of proximity approaches. Even though community outreach work is present in the province of Quebec (Canada) since the past 40 years, it is still difficult to implement and sustained, especially with families with young children. The aim of this study was to document barriers and facilitators to implement community outreach work, and to describe how such workers collaborate with sectoral (e.g. healthcare) and intersectoral (e.g. municipality, community organizations, schools) partners. Methods A content analysis was performed on 55 scientific and grey literature documents, and on the transcriptions of 24 individual interviews and 3 focus groups with stakeholders including parents, community outreach workers, healthcare employees, and inter-sectoral partners. Results This study reveals four categories of barriers and facilitators acting on the implementation of community outreach work: factors related to organizational factors, to the nature of community outreach work, to the intervention with families, and external/uncontrollable factors. With regards to collaboration, community outreach workers collaborate with many partners. Good interprofessional collaboration is achieved with a positive interaction and communication, shared or co-constructed activities for the families, co-intervention with the families, and strategies to be known and intersectoral meetings. Conclusions Results highlighted that many factors interact and can either influence positively or negatively the opportunity to implement community outreach work. The collaborative practices identified might help maximizing facilitators and overcoming barriers. Advocacy and a better understanding of how to integrate community outreach work within health services while maintaining the workers' flexibility are needed to sustain this practice. Key messages Advocacy and a better understanding of how to integrate community outreach work within health services while maintaining the workers’ flexibility are needed to sustain this practice. Community outreach workers help to reduce inequalities in health.

Barriers and Facilitators to Implementing Community Outreach Work, and Inter-professional Collaboration with Regional Partners.

Community outreach workers support individuals in accessing the health and community services they require through various forms of proximity approaches. Even though community outreach has been available in the province of Quebec (Canada) for the past 40years, it is still difficult to implement and sustain, especially with families of young children. The aim of this study was to document barriers and facilitators to implementing community outreach practices, and to describe how such workers collaborate with sectoral (e.g. health care) and inter-sectoral (e.g. municipalities, community organizations, schools) partners. We performed a content analysis on 55 scientific and grey literature documents, and transcriptions of 24 individual interviews and 3 focus groups with stakeholders including parents, community outreach workers, health care employees, and inter-sectoral partners. This study reveals four categories of barriers and facilitators to the implementation of community outreach work (i.e. organizational factors, nature of the work and worker-related factors, family-related factors, external factors). With regards to collaboration, community outreach workers deal with various partners. Good inter-professional collaboration is achieved through positive interactions and communication, shared or co-developed activities for the families, co-intervention with families, and strategies to enhance role awareness and inter-sectoral meetings. Results highlighted that many factors interact and can either influence, positively or negatively, the opportunity to implement community outreach work. The collaborative practices identified may help to maximize facilitators and overcome barriers. Advocacy and a better understanding of how to integrate community outreach work within health services while maintaining the workers' flexibility are needed to sustain this practice.

IMPROVING FOOD AND NUTRITION SECURITY OF VULNERABLE COMMUNITIES - AN INTEGRATED NUTRITION SENSITIVE APPROACH

Background: Food and Nutrition Security is a multilevel and complex construct, needing a holistic developmental approach, including multiple stakeholders. These projects were implemented by local partners, Lasoona and Doaba Foundation addressing food availability, access, use, utilization, and sustainability through a multi-sectoral approach. The aim of the evaluation was to provide a comprehensive assessment of Food and Nutrition Security projects (1086 and 1087) based on OECD DAC evaluation criteria. Methods: Mixed method approach, quasi-experimental design was used, including desk review, key informant interviews, focus group discussions with target communities, structured interviews of beneficiaries using Household Food Insecurity Assessment Scale (HIFAS) and Months of Adequate Household Food Provisioning (MAHFP) scale. Results: According to the HIFAS results, Districts of Khyber Pakhtunkhwa (KP) including Kohistan & Sawat were vulnerable with 34% and 15.78 % households facing food insecurity respectively. While in Muzaffargarh, a district of Punjab, 47% households were facing food insecurity. HDDS and IDDS improved considerably in all districts of KP and Punjab. Conclusion: The evaluated projects were social change projects sowing the seeds of a major social paradigm shift - changing the status of women at household and community level. Awareness of malnutrition and balanced diet through community volunteers, peer educators, social mobilizers and outreach workers played a pivotal role. Access and availability of diversified and nutritious food via kitchen gardens and plantation of trees with the use of organic fertilizers was encouraged.

Ethnic differences in bowel cancer awareness: findings from a pharmacy-based community survey

BackgroundWe used London-based multilingual community pharmacies to better understand ethnic inequalities in levels of bowel cancer awareness. MethodsWe invited 206 community pharmacies for this study through the Middlesex Group of Local Pharmaceutical Committees. Participating pharmacies interviewed customers (aged 60 years or older) using a modified version of the Bowel Cancer Awareness Measure. Awareness was divided into symptom, risk factor, and screening awareness. Variation in risk factor and symptom awareness were assessed using stepwise linear regression, whereas variation in screening awareness was assessed using logistic regression. The fully-adjusted model controlled for main spoken language, age, gender, and pharmacy postcode-based index of multiple deprivation rank. No ethical monitoring was required due to complete anonymity of responders and implied consent by return of questionnaire. Findings40 community pharmacies (19% of those invited) interviewed 913 customers. There was no statistically significant difference in area-level deprivation between participating and non-participating community pharmacies (p=0·50). To minimise confounding, individuals who reported a history of bowel cancer were excluded from the analysis (n=49; 5%) leaving 864 participants (95% of the full sample). Among these 864 participants, the sample comprised 578 (67%) English speakers, 412 (48%) women, 406 (47%) men, 406 (47%)white-British, 228 (26%) Indian, 43 (5%) white-Irish, 39 (5%) black Caribbean, 23 (3%) Pakistani, 21 (2%) black African, 16 (2%) of other white ethnicity, and 29 (3%) of other ethnicity. At the univariate level, ethnicity was associated with symptom awareness (p=0·0021) and screening awareness (p<0·0001), but not risk factor awareness (p=0·41). In a fully-adjusted model, screening awareness was statistically significantly lower among black African (adjusted odds ratio 0·37 [95% CI 0·17–0·80; p=0·012), black Caribbean (0·28 [0·10–0·83]; p=0·022), and participants from other ethnic groups (0·19 [0·07–0·48]; p=0·0014), compared with white-British participants. However, symptom awareness was no longer associated with ethnicity. Screening awareness was also higher in pharmacies situated in more affluent areas (7·83 [2·14–28·65]; p=0·002) even after adjusting for other demographics. There was however no association between levels of area-level deprivation and symptom or risk awareness. InterpretationOverall, administering bowel cancer awareness measure was feasible. Although participation of community pharmacies was low, the number of surveys completed was substantial and there was little evidence to suggest selection bias in terms of deprivation. The association between ethnicity and screening awareness was independent of language, which means that unlike symptom awareness, campaigns trying to reduce inequalities in awareness of screening programmes cannot just rely on providing materials in people's native language. Instead, academics and community outreach workers should work with community pharmacies and their customers to co-create materials to improve awareness of the bowel cancer screening programme. Future Bowel Cancer Awareness Measure surveys would also benefit from larger sample sizes among individual ethnic groups and the least and most deprived. FundingNorgine, St Mark's Bowel Cancer Screening Centre.

2559. A Novel Approach to Interprofessional Education to Expand HIV Workforce Pipeline

BackgroundEffective care for persons living with HIV (PLWH) requires a coordinated, multi-disciplinary approach that includes social workers, physicians, advanced practice providers, pharmacists, social workers and community outreach workers. Unfortunately, these individuals often work and train independently of one another without a full sense of the responsibilities and contributions of others. Too often, this results in fragmented or ineffective care.MethodsIn response to the need to improve exposure to both HIV and coordinated interdisciplinary care, the Kentucky AIDS Education and Training Center at the University of Kentucky developed the HIV Interprofessional Education (IPE) Program in 2016. This dynamic IPE links students in multiple professional training programs (including pharmacy, medical, social work, and physician assistant students) to a year-long curriculum designed to acquire advanced skill sets for the treatment of HIV/AIDS. This curriculum includes inpatient and outpatient shadowing opportunities with multiple departments, didactic seminars, flexible mentored learning, and a collaborative capstone project designed to impact the local HIV community.ResultsWe report on the development of this program as well as a comprehensive assessment of the quantitative and qualitative experiences of our trainees. Participants reported significant improvements in their understanding of not only the complexities of the continuum of care for PLWH but also on how to improve care by enhancing collaboration between disciplines. They also reported development of critical and generalizable skills including taking a social history, addressing co-morbid mental health and substance abuse issues, cultural competency, screening and prevention strategies for HIV. ConclusionAs we strive to provide comprehensive and effective care for PLWH aimed at achieving the goals of universal test and treat and retention in care, we must find way to improve crosstalk and understanding of the interdisciplinary nature of modern medical care. Ideally, this begins during training. We present our experience in the development of a novel and highly effective program which has spanned multiple departments and has substantially impacted the approach to HIV care in our trainees. Disclosures All authors: No reported disclosures.

MAANASI - A Sustained, Innovative, Integrated Mental Healthcare Model in South India

Studies in low and middle-income countries (LMICs) point to a significant association of common mental disorders with female gender, low education, and poverty. Depression and anxiety are frequently complicated by lack of disease awareness and non-adherence, the absence of care and provider resources, low value given to mental health by policy-makers, stigma, and discrimination towards the mentally ill. This paper aims to show that female village leaders/ community health and outreach workers (CHWs) can be used to overcome the lack of psychiatric resources for treatment of common mental disorders in rural areas. A multidisciplinary team was set up to evaluate and treat potential clients in the villages. A program of care delivery was planned, developed and implemented by: (a) targeting indigent women in the region; (b) integrating mental health care with primary care; (c) making care affordable and accessible by training local women as CHWs with ongoing continued supervision; and (d) sustaining the program long-term. Indigenous CHWs served as a link between the centre and the community. They received hands-on training, ongoing supervision, and an abridged but focused training module to identify common mental disorders, help treatment compliance, networking, illness literacy and community support by outreach workers. They used assessment tools translated into the local language, and conducted focus groups and client training programs. As a result, mental healthcare was provided to clients from as many as 150 villages in South India. Currently the services are utilized on a regular basis by about 50 villages around the central project site. The current active caseload of registered clients is 1930. Empowerment of treated clients is the final outcome, assisting them in self-employment. Rural mental healthcare must be culturally congruent, and must integrate primary care and local CHWs for success. Training, supervision, ongoing teaching of CHWs, on-site resident medical officers, research and outreach are essential to continued success over two decades.

3125 Acceptability of a Narrative Video to Enhance the Use of Genetic Counseling in Latina Women at-risk of Hereditary Breast and Ovarian Cancer: Community Health Worker’s Perspective

OBJECTIVES/SPECIFIC AIMS: The goal of the study was to assess the acceptability of a culturally targeted narrative video and identify potential avenues for dissemination in a sample of bilingual community health workers who provide services to the Latino community in the United States. METHODS/STUDY POPULATION: We piloted the video in a sample of bilingual community health workers who provide services to Latinos (n=31). After watching the video, participants filled out a survey. The survey captured sociodemographic data (e.g. education), their role and experience working with Latinos (e.g. patient navigators), acceptability of the video (e.g. general satisfaction, length of the video, amount of information), and potential dissemination (e.g., dissemination channels, preferred settings to watch the video, and preferred context). Three open ended questions captured information about how the video could be useful for the Latino community, what they liked the most from the video, and suggestions for improvement. Data was entered in SPSS version 25. We used descriptive statistics to analyze the survey, and content analysis to summarize the feedback from the open-ended questions. RESULTS/ANTICIPATED RESULTS: Participants (n = 31) had an average age of 46 years (SD=16.99), all self-identified as Hispanic or Latinos, most were female (90.3%), and worked as patient navigators (29%) or community outreach workers (25.8%). The video’s general acceptability was very high. Participants reported high ratings for overall satisfaction, how much they liked the video, enjoyed it, and considered it to be interesting (all means &gt;9.6, range 1-10). Most participants strongly agreed or agreed that the length was adequate (80.7%), that the information presented was very helpful (100%), that the video could be useful for the Latina community (96.8%), and that they would share the video with women at-risk of HBOC (100%). The highest endorsed channels for dissemination were Facebook (90.3) and YouTube (87.1%). The highest endorsed settings were community centers (100%), churches (96.8%), and hospitals (80.6%). Most participants (90.3%) considered that the best context to watch the video would be with relatives, followed by watching with other women at-risk of HBOC (71.0%), friends (71.0%), and lastly by oneself (41.9%) DISCUSSION/SIGNIFICANCE OF IMPACT: This study represents a multidisciplinary approach to intervention development that aims to reduce well-documented knowledge gaps and disparities in the use of GCRA among at-risk Latinas. A culturally targeted video has the potential to reach underserved populations with low literacy and English proficiency and it can be widely disseminated. The video was well received by community health workers who reported high acceptability. These findings are promising given that community health workers could play a key role in the dissemination of the video if it is proven to be efficacious.

The need for service change and community outreach work to support trans-cultural cognitive behaviour therapy with Black and Minority Ethnic communities

AbstractRecently there have been a number of developments in cognitive behaviour therapy (CBT) that have led to cultural adaptations of specific interventions and a greater awareness of how in general CBT might be adapted for Black and Minority Ethnic (BME) service users. These developments, however, involve change at the level of the individual therapist and particular treatment approach, but involve very few considerations of what needs to happen at the levels of teams or services in order to best meet the mental health needs of British South Asian and other BME populations. This paper summarizes the way that services need to understand how minority populations use services and how to involve those populations in developing services in order to ensure their needs are best met.

It takes a village: The vital role of community organizations in enhancing fistula patient identification, referral, and reintegration in Kenya

Action on Fistula, Kenya, is a multi-year initiative (2014-present) focused on expanding access to fistula care and building the national capacity for fistula treatment, training, and community mobilization. Led by Fistula Foundation in partnership with the Ministry of Health, public and private hospitals, and community-based outreach organizations, over 4,000 fistula repair surgeries have been performed at six hospitals throughout the country. One of key factors in driving the success of the program is the use of extensive community outreach networks to increase patient referrals, improve community awareness and knowledge of fistula, and facilitate reintegration for women following fistula repair surgery. Through this community initiative, women from all of Kenya’s 47 counties have been treated and over 85% of patients have come through the AOF partner outreach efforts. &#x0D; Varied mobilization strategies have been utilized to maximize results, including training and engagement of community outreach workers, media engagement through radio spots and live talk shows, partnerships with health facilities and training of health center staff, community outreaches and rallies, and the use of “Kick Fistula out of Africa” soccer team to raise awareness and help destigmatize the condition. In the second phase of the initiative, reintegration programs were also initiated by the same community organizations and enhanced follow-up measures were put in place to assess longer-term outcomes for continence status, social and psychological wellbeing, and economic health.

Effect of Educational Intervention on Self-Sampling Acceptability and Follow-Up Paps in Border Dwelling Hispanic Females.

The aims of the study were to evaluate the effect of a community outreach worker (promotora)-led high-intensity educational intervention compared with control without promotora-led intervention on cervical cancer screening preference (Pap smear vs self-sampling) and to determine the effect of this preference on subsequent screening completion. This randomized controlled trial compared the effect of educational intervention on women's preferences for self-sampling for human papillomavirus. Inclusion criteria were women aged 30 to 65 years and no cervical cancer screening in 3 years or more. Community-based study with intervention group receiving culturally tailored education by promotora vs control group who received written education pamphlet. We evaluated participants' test preference, knowledge, and Pap completion at 12-months postintervention. Two hundred one predominantly Hispanic women were randomly assigned to high-intensity (n = 100) education vs low-intensity education (n = 101). The mean age was 46.4 years (SD = 8.2 years). There was no difference in test preference between high- and low-intensity groups (49% vs 41%, both tests equally; 28.6% vs 35.1%, self-sampling; and 22% vs 23%, Pap, p = .536). High-intensity intervention resulted in a significantly higher self-sampling acceptability score (25.02 vs 24.06, p = .039).Testing preference did not significantly affect Pap completion (Pap vs self-sampling vs unsure/both equally, 60.0% vs 43.6% vs 48.9%, p = 0.24). Human papillomavirus knowledge was found to be significantly associated with completion of Pap at 12 months. Human papillomavirus-positive result on self-sampling trended toward increased likelihood of screening completion (16.3% vs 7.8%, p = .058). We found a high level of acceptability of self-sampling regardless of intensity of education in a largely Hispanic female population living on the US-Mexico border and a trend toward increased Pap smear follow-up in participants who tested positive.

The Effectiveness of Community Outreach in Increasing the Coverage of Community Based Management of Acute Malnutrition (CMAM) Program, in Rural Kassala Locality

Community based Management of Acute Malnutrition (CMAM) is an innovative approach for managing acute malnutrition within the community. This study is a community based cross sectional study among communities covered by CMAM program in Rural Kassala locality, Kassala state, Sudan. The main objective was to evaluate the effectiveness of community outreach workers / volunteers in improving and increasing the coverage of the CMAM program. ENA SMART software was used to calculate the sample size of children under five, a total of (309) was subjected for MUAC and bilateral edema measurements to assess their nutritional status, and their households (200) were interviewed to obtain relevant data. All the community outreach workers / volunteers (62) were targeted by the study. The study revealed that, the prevalence of acute malnutrition (wasting) was 17.1%, and no significant difference in the prevalence of acute malnutrition between boys and girls (p=0.477). A point coverage calculation was used to estimate services coverage, the coverage of the program estimated by 64.2%. Also the result showed that 67.7% of the cases attending the feeding program were referred by the community outreach workers / volunteers. The study concluded that the community outreach workers / volunteers doing an effective job, but needs more to strengthen their roles of identification and early detection cases.

Interventions to mitigate the effects of poverty and inequality on mental health.

To review psychosocial and policy interventions which mitigate the effects of poverty and inequality on mental health. Systematic reviews, controlled trials and realist evaluations of the last 10years are reviewed, without age or geographical restrictions. Effective psychosocial interventions on individual and family level, such as parenting support programmes, exist. The evidence for mental health impact of broader community-based interventions, e.g. community outreach workers, or service-based interventions, e.g. social prescribing and debt advice is scarce. Likewise, the availability of evidence for the mental health impact of policy level interventions, such as poverty alleviation or youth guarantee, is quite restricted. The social, economic, and physical environments in which people live shape mental health and many common mental disorders. There are effective early interventions to promote mental health in vulnerable groups, but it is necessary to both initiate and facilitate a cross-sectoral approach, and to form partnerships between different government departments, civic society organisations and other stakeholders. This approach is referred to as Mental Health in All Policies and it can be applied to all public policy levels from local policies to supranational.

Community engagement and education: addressing the needs of South Asian families with genetic disorders.

Consanguineous marriage is common among the South Asian heritage community in the UK. While conferring social and cultural benefits, consanguinity is associated with an increased risk of autosomal recessive disorders and an increase in childhood death and disability. We have previously developed a genetic service to address the needs of this community. We report the extension of this service to include community-based initiatives aimed at promoting understanding of genetic issues related to consanguinity and improving access to genetic services. Our approach was to develop integrated clinical, educational and community engagement initiatives that would be sustainable on a long-term basis. The service provided for South Asian families by a specialist genetic counsellor was extended, and a series of genetics education and awareness sessions were provided for a diverse range of frontline healthcare workers. Two community genetic outreach worker posts were established to facilitate the engagement of the local South Asian population with genetics. The education and awareness sessions helped address the lack of genetic knowledge among primary health care professionals and community workers. Engagement initiatives by the genetic outreach worker raised awareness of genetic issues in the South Asian community and families affected by autosomal recessive disorders. All three elements of the extended service generated positive feedback. A three-stranded approach to addressing the needs of consanguineous families affected by autosomal recessive disorders as recommended by the World Health Organisation is suggested to be an acceptable, effective and sustainable approach to delivery of service in the UK.

Home Visits: Advancing Pediatric Training by Preserving Past Traditions.

* Abbreviations: ACGME — : Accreditation Council for Graduate Medical Education CSHCN — : children with special health care needs HCH — : home-centered health After a short ride from resident clinic, we drove into 1 of the city’s low-income housing complexes. Walking up to the third floor of a dilapidated building and noticing the flimsy railing, we realized our anticipatory guidance on child proofing the home must also include outdoor areas. In fact, it was the motivation to see just how appropriate our recommendations were for families living in urban poverty that led us to join a community outreach worker on a routine home visit. When we arrived at apartment 3A, Janelle and her daughter Mia were warmly awaiting us. We followed them into a small living room where Mia, the fearless 2-year-old, quickly went back to her favorite game of jumping off the furniture. The sight of an easily accessible open window with no screen gave us pause, and we suggested several ways to prevent Mia from accidently falling out. Janelle, a first-time mom, thanked us for the advice. She soon became more relaxed and began speaking candidly about the importance of supporting her daughter. In the less personal atmosphere of a clinic examination room, the interaction with a young mother might not reveal the parent’s strengths, but by visiting Janelle in her home environment and watching her interactions with Mia, we could appreciate just how committed she was. Just over half a century ago, 40% of physician–patient encounters were in the home.1 It was … Address correspondence to Igor Shumskiy, MD, Boston Medical Center, 720 Harrison Ave, Boston, MA 02118. E-mail: igor.shumskiy{at}childrens.harvard.edu

Acceptability of HIV Testing Sites Among Rural and Urban African Americans Who Use Cocaine.

African Americans (AAs) who use cocaine in the Southern region of the U.S. have a relatively high risk of HIV and need for HIV testing. Among this group, those residing in rural areas may have less favorable opinions about common HIV testing sites, which could inhibit HIV testing. We examined rural/urban variations in their acceptability of multiple HIV testing sites (private physician clinic, local health department, community health center, community HIV fair, hospital emergency department, blood plasma donation center, drug abuse treatment facility, and mobile van or community outreach worker). Results from partial proportional odds and logistic regression analyses indicate that rural AA who use cocaine have lower odds of viewing local health departments (OR=0.09, 95% CI=0.03-0.21), physician offices (OR=0.19, 95% CI=0.09-0.42), and drug use treatment centers (OR=0.49; 95% CI=0.30-0.80) as acceptable relative to their urban counterparts. The findings have implications for further targeting HIV testing toward AAs who use of cocaine, particularly those residing in the rural South.

O18.5 Examining hpv prevalence and uptake of cervical cancer screening among hiv positive and negative women participating in a pilot rct in uganda comparing self-collection based hpv testing to via

Introduction With innovations in cervical cancer prevention, researchers must define best practices for cervical cancer screening in diverse populations and contexts. This pilot RCT compares the standard of care in most resource constrained settings, visual inspection with acetic acid (VIA), to self collected sampling for detection of high risk human papillomavirus (HR-HPV) DNA. We compared HPV prevalence and uptake of screening among women living with HIV (WHIV) and HIV negative (HIV-) women who participated in the trial. Methods The pilot RCT was conducted between April and June 2014 when 500 women were recruited by community outreach workers in Kisenyi and completed a survey for demographic and risk factors including self-identified HIV status. Women were randomised to self-collected HR-HPV testing or VIA screening at the local health unit. Women who were HPV positive were referred for VIA. Women who tested positive at VIA were provided treatment with cryotherapy at the same visit or referred for colposcopy. Uptake rates of screening and HPV status in WHIV vs HIV- women were compared using Chi-square or Fisher’s exact test. Results Uptake of self-collected HR-HPV testing was 95.5% (21/22) in WHIV and 99.6% (226/227) in HIV- women (p = 0.17). Among WHIV, 42.9% (9/21) were HPV positive compared to 28.3% (64/226) HIV- women (p = 0.25). A greater proportion of WHIV were infected with HPV genotype 16 or 18 (28.6%, 6/21) than HIV- women (5.3%, 12/226) (p = 0.004). All 9 WHIV who were HPV positive attended VIA follow up, compared to 24/64 HIV- women. In the VIA arm, 64.0% (16/25) WHIV attended screening compared to 46.7% (105/225) HIV- women (p = 0.23). Conclusion Self-collection based screening had high uptake in WHIV and HIV- women, suggesting that this method is highly acceptable and improves access compared to VIA. As more WHIV were HR-HPV infected, there is additional benefit to providing this type of screening given their increased risk for cervical cancer. Disclosure of interest statement None of the authors have any conflicts to declare.

‘Women now wear trousers’: men's perceptions of family planning in the context of changing gender relations in western Kenya

Gender inequity has been closely linked with unmet need for family planning among women in sub-Saharan Africa but the factors related to male family planning disapproval are not well-understood. This qualitative study explored men's perspectives of gender roles and cultural norms as they pertain to family planning. Twelve small group meetings were held with 106 married men in Nyanza Province, Kenya. Shifting gender relations made the definitions of manhood more tenuous than ever. Men's previous identities as sole breadwinners, which gave them significant control over decision-making, were being undermined by women's increasing labour force participation. While many men viewed family planning positively, fears that family planning would lead to more female sexual agency and promiscuity or that male roles would be further jeopardised were widespread and were major deterrents to male family planning approval. By addressing such fears, gender-sensitive programmes could help more men to accept family planning. Increased family planning education for men is needed to dispel misconceptions regarding family planning side-effects. Focusing on the advantages of family planning, namely financial benefits and reduced conflict among couples, could resonate with men. Community leaders, outreach workers and healthcare providers could help shift men's approval of joint decision-making around family size to other reproductive domains, such as family planning use.

Obituary: A Remembrance of Henry Phil Gross MD (1930-2014).

Obituary: A Remembrance of Henry Phil Gross MD (1930-2014).

Home visits to improve breast health knowledge and screening practices in a less privileged area in Jordan.

BackgroundBreast cancer is the most common cancer afflicting women in Jordan. This study aimed to assess the effects of an educational intervention through home visits, including offering free mammography screening vouchers, on changing women’s breast health knowledge and screening practices for early detection of breast cancer in a less privileged area in Jordan.MethodsTwo thousand four hundred breast health awareness home visits were conducted and 2363 women aged 20-79 years (median: 41) answered a pre-test interview-administrated questionnaire to assess their breast health knowledge and practices at the baseline. After a home-based educational session, 625 women aged 40 years or older were referred to free mammography screening. Five hundred and ninety six homes were revisited six months later and out of these 593 women participated in a post-test. The women’s retained breast health knowledge, the changes in their reported breast health practices and their usage of the free mammography voucher, were assessed.ResultsThe mean knowledge score increased significantly (p < 0.001) from 11.4 in the pre-test to 15.7 in the post-test (maximum score: 16). At the six month follow-up the post-test showed significant (p < 0.001) improvement in women’s perceived breast self-examination (BSE) knowledge, reported BSE practice and mammography screening. Out of 625 women that received a voucher for free mammography screening 73% attended the mammography unit, while only two women without a voucher went for mammography screening at the assigned unit. Women who received a follow-up visit were more likely to use the free mammography voucher compared to those who were not followed-up (83% vs. 67%; p < 0.001).ConclusionsHome visits by local community outreach workers that incorporated education about breast cancer and breast health in addition to offering free mammography screening vouchers were effective in improving women’s breast health knowledge and practices in a less privileged area in Jordan.