People In Community Settings Research Articles

Practices and settings which promote a psychological sense of community among young people who experience social marginalization: A scoping review

AIMSExperiencing a psychological sense of community (PSOC) may buffer against adverse outcomes associated with oppression and exclusion for young people who endure social marginalization. Limited prior research has captured what, specifically, promotes PSOC among young people. METHODS: This scoping review systematically surveys literature (N = 13 articles) to understand what practices and settings foster PSOC among young people who experience social marginalization. RESULTS: Six broad practices are found to foster PSOC: adult/mentor support, peer/social support, youth power and influence, community participation/involvement, connecting by shared identity, and specific program features. Community settings are the predominant settings in which PSOC appears to be fostered. CONCLUSION: Practitioners who work with young people in community settings may consider foregrounding these practices within their work when seeking to foster a psychological sense of community. Future research should partner with young people to understand what they desire when seeking out supportive settings and communities.

Ethical challenges for nurses delivering coercive interventions in community mental health settings: A scoping review.

The number of Australians subject to coercive interventions in community mental health services continues to increase. This is in the context of a growing awareness of the harms from coercion, increasing concerns about potential breaches of human rights and an ongoing uncertainty regarding the clinical benefits of community treatment orders, the primary instrument of legislated coercion in community mental health services. Nurses in community mental health services are on the frontline with regard to coercion. They police the requirements of the community treatment order, administer medication to people in community settings without their consent and facilitate re-hospitalisation if indicated. Coercive practice contradicts the person-centred, recovery-oriented and trauma-informed care principles that inform contemporary mental health nursing. This contradiction may generate ethical challenges for nurses and result in ethical distress. The aim of this scoping review was to map the research literature on how nurses in community mental health settings recognise and manage the harm associated with the administration of coercive interventions and consider the ethical challenges that may arise within this practice. The search strategy yielded 562 studies with author consensus determining a total of three articles as meeting the inclusion criteria. The resulting literature identified three themes: (1) maintaining the therapeutic relationship, (2) promoting autonomy and (3) using subtle forms of control. This review demonstrated that there is minimal research that has considered the ethical challenges related to the use of coercion by nurses in community mental health settings.

Transitioning from dementia‐related stigma to a Community Level Dementia Screening Program in Rural Kenya (DEM‐SKY)

AbstractBackgroundPrimary health care providers face the challenge of making timely dementia diagnosis due to limited time available to interact with patients resulting in stigma, neglect and abuse. With training, these providers can collaborate with Community Health Workers (CHWs) to improve dementia detection and articulate the needs of communities whilst mobilizing resources that are salient in decision‐making, care coordination and service delivery processes. In this study, we outline the process that led to integration of a Community Level Dementia Screening Program in Rural Kenya (DEM‐SKY).MethodAs part of the Strengthening Responses to Dementia in Developing Countries (STRiDE) project, ten CHWs were trained to deliver a dementia anti‐stigma intervention to 59 members of the general public in rural Kenya, through four bi‐weekly psycho‐education sessions. This led to increased number of people turning up for dementia screening at a county referral hospital. However, due to lack of knowledge and busy waiting lines at the hospital, discussions on how to integrate dementia screening within the hospital began.ResultFindings from the STRiDE project formed the basis of integrating a community‐level dementia screening programme in Makueni County Referral Hospital in Kenya, a program that has seen more than 600 adults aged 60 and above screened for dementia by CHWs in a period of one month. Through partnership and collaboration with the hospital, a recording and reporting system for people living with dementia was established to provide an indication of the number of dementia cases and individuals referred from the community. This was made possible through: (i) training formal and informal providers on importance of dementia screening, (ii) continued awareness in communities to change existing negative dementia perceptions and (iii) motivating CHWs through project visibility materials and recognizing them in community events.ConclusionPublic awareness and stigma reduction using CHWs can be a precursor to strengthening health care systems through routine dementia screening for older people in community settings. This integration process also requires using task‐sharing approaches in order to promote timely detection and improve care coordination at all levels of care, thus forming a basis for formulation, implementation of policy and service planning.

Palliative physiotherapy in community settings for people with terminal illness

ObjectivesThe need for palliative care is constantly growing worldwide. Palliative care is typically provided by a multidisciplinary team in community-based facilities. As part of this team, physiotherapists can effectively address...

Point-of-care testing of HbA1c levels in community settings for people with established diabetes or people at risk of developing type 2 diabetes: a systematic review and meta-analysis protocol

IntroductionDiabetes mellitus has increased in prevalence worldwide and is causing an increasing burden on health services. The best patient outcomes occur with early diagnosis to prevent health complications. Glycated haemoglobin...

A theory of change for community-initiated mental health care in the United States.

Mental health service delivery needs radical reimagination in the United States where unmet needs for care remain large and most metrics on the burden of mental health problems have worsened, despite significant numbers of mental health professionals, spending on service provision and research. The COVID-19 pandemic has exacerbated the need for mental health care. One path to a radical reimagination is "Community Initiated Care (CIC)" which equips and empowers communities to address by providing brief psychosocial interventions by people in community settings. We co-developed a theory of change (ToC) for CIC with 24 stakeholders including representatives from community-based, advocacy, philanthropic and faith-based organizations to understand how CIC could be developed and adapted for specific contexts. We present a ToC which describes ways in which the CIC initiative can promote and strengthen mental health in communities in the United States with respect to community organization and leadership; community care and inclusion and normalizing mental health. We propose 10 strategies as part of CIC and propose a way forward for implementation and evaluation. This CIC model is a local, tailored approach which can expand the role of community members to strengthen our response to mental health needs in the United States.

Effect of social prescribing link workers on health outcomes and costs for adults in primary care and community settings: a systematic review

ObjectivesTo establish the evidence base for the effects on health outcomes and costs of social prescribing link workers (non-health or social care professionals who connect people to community resources) for...

Current state of the evidence on community treatments for people with complex emotional needs: a scoping review

BackgroundImproving the quality of care in community settings for people with ‘Complex Emotional Needs’ (CEN—our preferred working term for services for people with a “personality disorder” diagnosis or comparable needs) is recognised internationally as a priority. Plans to improve care should be rooted as far as possible in evidence. We aimed to take stock of the current state of such evidence, and identify significant gaps through a scoping review of published investigations of outcomes of community-based psychosocial interventions designed for CEN.MethodsWe conducted a scoping review with systematic searches. We searched six bibliographic databases, including forward and backward citation searching, and reference searching of relevant systematic reviews. We included studies using quantitative methods to test for effects on any clinical, social, and functioning outcomes from community-based interventions for people with CEN. The final search was conducted in November 2020.ResultsWe included 226 papers in all (210 studies). Little relevant literature was published before 2000. Since then, publications per year and sample sizes have gradually increased, but most studies are relatively small, including many pilot or uncontrolled studies. Most studies focus on symptom and self-harm outcomes of various forms of specialist psychotherapy: most result in outcomes better than from inactive controls and similar to other specialist psychotherapies. We found large evidence gaps. Adaptation and testing of therapies for significant groups (e.g. people with comorbid psychosis, bipolar disorder, post-traumatic stress disorder, or substance misuse; older and younger groups; parents) have for the most part only reached a feasibility testing stage. We found little evidence regarding interventions to improve social aspects of people’s lives, peer support, or ways of designing effective services.ConclusionsCompared with other longer term mental health problems that significantly impair functioning, the evidence base on how to provide high quality care for people with CEN is very limited. There is good evidence that people with CEN can be helped when specialist therapies are available and when they are able to engage with them. However, a much more methodologically robust and substantial literature addressing a much wider range of research questions is urgently needed to optimise treatment and support across this group.

Assessment of coding-based frailty algorithms for long-term outcome prediction among older people in community settings: a cohort study from the Shizuoka Kokuho Database.

To assess the applicability of Electronic Frailty Index (eFI) and Hospital Frailty Risk Score (HFRS) algorithms to Japanese administrative claims data and to evaluate their association with long-term outcomes. A cohort study using a regional government administrative healthcare and long-term care (LTC) claims database in Japan 2014-18. Plan enrollees aged ≥50years. We applied the two algorithms to the cohort and assessed the scores' distributions alongside enrollees' 4-year mortality and initiation of government-supported LTC. Using Cox regression and Fine-Gray models, we evaluated the association between frailty scores and outcomes as well as the models' discriminatory ability. Among 827,744 enrollees, 42.8% were categorised by eFI as fit, 31.2% mild, 17.5% moderate and 8.5% severe. For HFRS, 73.0% were low, 24.3% intermediate and 2.7% high risk; 35 of 36 predictors for eFI, and 92 of 109 codes originally used for HFRS were available in the Japanese system. Relative to the lowest frailty group, the highest frailty group had hazard ratios [95% confidence interval (CI)] of 2.09 (1.98-2.21) for mortality and 2.45 (2.28-2.63) for LTC for eFI; those for HFRS were 3.79 (3.56-4.03) and 3.31 (2.87-3.82), respectively. The area under the receiver operating characteristics curves for the unadjusted model at 48months was 0.68 for death and 0.68 for LTC for eFI, and 0.73 and 0.70, respectively, for HFRS. The frailty algorithms were applicable to the Japanese system and could contribute to the identifications of enrollees at risk of long-term mortality or LTC use.

An Educational Intervention to Raise Awareness of Contraceptive Options Among Young People.

Background: Young people in the United States know little about contraceptive options available to them, although method use is sensitive to individual preferences, and method switching is common. For young people to gain reproductive autonomy, a first step is to be aware of different contraceptives, including hormonal and nonhormonal methods. We tested whether an educational intervention delivered on community college campuses was effective in increasing contraceptive awareness. Materials and Methods: We developed a low-cost educational intervention featuring youth-friendly visual tools and tested its impact on method awareness and knowledge among 1,051 students of all genders, aged 18-25 years, at five community colleges. We used generalized estimating equations to test changes in awareness of a range of methods, including male and female (internal) condoms, the pill, patch, vaginal ring, shot, intrauterine devices, implant, and emergency contraception. Results: Over 90% of participants were aware of male condoms and the pill at baseline, but fewer had heard of other options (ranging from 31% to 76% for different methods). Across all methods, awareness increased to a mean of 88% among female participants and 82% among male participants postintervention. Awareness of the full range of methods increased from 31% to 55% (adjusted odds ratio [aOR]: 4.4, 95% confidence interval [CI]: 3.1-6.2]) among female participants and 11% to 36% (aOR: 10.8, 95% CI: 5.3-21.8) among male participants postintervention. The intervention was similarly effective by sexual orientation, race/ethnicity, nativity, or insurance coverage. Conclusion: This educational intervention significantly improved all students' awareness of a range of contraceptives, supporting one important aspect of reproductive health for young people in community settings.

Stereoscopic visual stimuli for examining biological motion perception and unanticipated steering manoeuvres in people with Parkinson's disease

Community falls in people with Parkinson's disease (PwPD) are common, costly, and often unanticipated. Aside from static obstacles, it has been reported that oncoming people in community settings pose problems for PwPD when navigating. This suggests that PwPD may have difficulty (i) perceiving biological motion and action possibilities, and (ii) steering out of the way of oncoming persons. To date, laboratory research that investigated unanticipated steering manoeuvres in PwPD have only incorporated light- or arrow-based visual stimuli to simulate the spatiotemporal demands of these movements. However, such simple stimuli are not ecologically valid for examining biological motion perception and unanticipated steering manoeuvres used in avoiding oncoming people. To improve the generalisability of laboratory research in this field, a set of stereoscopic visual stimuli that feature an oncoming person initiating a sudden change in direction was developed for PwPD to engage with. Specifically, we modified and improved existing cinematographic techniques, software, and stereoscopic display technology to bring about:•Ambulatory scenarios that were quasi-immersed with the laboratory environment.•Enhanced realism.•Better temporal consistency in video playback.

Assessment of the validity and acceptability of the online FRAIL scale in identifying frailty among older people in community settings

ObjectivesTo assess the validity and acceptability of the online FRAIL scale in identifying frailty in community settings. MethodsFrailty was assessed using the online version of the FRAIL scale (a simple frailty questionnaire). Validity of the scale was examined in a sample of 1882 persons aged 60 years or older (inlcuding a pilot sample of 65 persons for assessing the face validity) recruited from 24 elderly centres in Hong Kong. Convergent validity was estimated using correlation coefficients between scores on the FRAIL, SARC-F (a simple questionnaire for assessing sarcopenia) and AMIC (Abbreviated Memory Inventory for the Chinese). Predictive validity was examined by logistic regression using IADL (Instrumental Activities of Daily Living) limitations and hospitalization as outcomes. Acceptability of the scale was assessed from the perspective of a sub-sample of 205 older persons and 33 centre staff. ResultsFollowing minor revisions, all participants were able to understand and answer the online FRAIL scale. The FRAIL scale correlated with SARC-F (r = 0.627, p < 0.001) and AMIC (r = 0.302, p < 0.001). Being pre-frail and frail were associated with incident IADL limitations (OR = 1.58, 95 %CI = 1.11−2.25 and OR = 3.01, 95 %CI = 1.87−4.84, respectively) and incident hospitalization (OR = 1.38, 95 %CI = 1.03−1.85 and OR = 2.79, 95 %CI = 1.89−4.12, respectively) at year 2, after controlling for age, sex, marital status, and educational level. 77.8 % of participants agreed that the scale would enable them to understand their health status. However, only 35.0 % accepted a digital approach for conducting health assessment or accessing assessment results. 90.9 % of centre staff agreed that the scale could be used to identify their members who are potential candidates for frailty intervention. ConclusionsThe online FRAIL scale is valid for use in community elderly centres in identifying frailty. Further effort is required to improve the acceptability of the online FRAIL scale among older persons.

Use of mask in COVID-19 era: absence of evidence is not evidence of absence

World Health Organization (WHO) in its interim guidance of 6 April 2020 advises policy makers on the use of masks for healthy people in community settings. The rationale for mask use by healthy person is prevention from COVID-19, when there is risk of exposure, like working in close contact with public, people with comorbidities, where physical distancing cannot be maintained such as travelling in buses, staying in slum areas. Furthermore, WHO says the purpose and reason for mask use should be clear– whether it is to be used for source control (used by infected persons) or prevention of COVID-19 (used by healthy persons).1&#x0D; Centers for Disease Control (CDC) United States of America (USA) updated its advisory on 4 Apr 2020, and recommended everyone (except some) should wear at least a cloth face covering when they have to go out in public. It will protect other people in case you are infected.2,3 This advisory of no strict demand on use of face masks could be possibly due to unavailability of disposable masks.

Evaluating a potential role for community pharmacists in post-bariatric patient nutritional support.

Physiological changes to the body from bariatric surgery necessitate lifelong vitamin and mineral supplementation to prevent potential nutritional deficiencies. Presently, there is no consensus on appropriate long-term follow-up in community settings for people who have undergone bariatric surgery. Current UK guidelines recommend annual monitoring of nutritional status, but little else. Semi-structured interviews were carried out with members of a high volume bariatric surgical unit and community pharmacists working in a variety of settings and locations. Data were collected between June and August 2018 and analysed using a thematic analytic framework. Twenty-five participants were recruited. Bariatric staff (n = 9) reported negligible interaction with community pharmacists but felt establishing communication and developing a potential pathway to collaborate, would provide additional support and potentially improved levels of patient compliance. Community pharmacists (n = 16) reported poor knowledge of bariatric surgery, indicating they were unable to routinely identify people who had bariatric surgery, but understood issues with absorption of vitamins. There is evident potential to involve community pharmacists in post-bariatric patient care pathways. Pharmacists possess knowledge of absorption and metabolism of supplements which could be used to actively support people who have had bariatric surgery in their changed physiological status. Education ought to focus on the functional impact of bariatric surgical procedures and interventions and the consequent nutritional recommendations required. Communication between bariatric units and community pharmacies is needed to construct a clear and formalized infrastructure of support, with remuneration for pharmacy specialist expertise agreed to ensure both financial viability and sustainability.

A Comparison of App-Based Video-Modeling Interventions to Teach Physical Activity Skills to People With Autism in a Community Setting

App-based technologies that utilize video-modeling components are an area that can increase the independence of people with autism spectrum disorder (ASD) in community settings; however, less is known about their impact in facilitating acquisition of physical activity (PA) skills in inclusive community fitness sites. It is important to consider how to increase PA skills in community settings for people with ASD given the known benefits of community inclusion and exercise. This study used an adaptive alternating treatment design to explore differences in three participants’ ability to perform exercises independently in a community site when using commercial video-models (i.e., video-models available in the app) compared to custom-made video-models (i.e., developed by the researchers). Two participants performed the PA skills more independently when watching the custom-made videos while the third performed the PA skill more independently when watching the commercial video-models. All participants indicated they enjoyed using the app and videos to learn new PA skills. Limitations of the study as well as implications for future research are discussed.

'If there were doctors who could understand our problems, I would already be better': dissatisfactory health care and marginalisation in superdiverse neighbourhoods.

How people in community settings describe their experience of disappointing health care, and their responses to such dissatisfaction, sheds light on the role of marginalisation and underlines the need for radically responsive service provision. Making the case for studying unprompted accounts of dissatisfaction with healthcare provision, this is an original analysis of 71 semi‐structured interviews with healthcare users in superdiverse neighbourhoods in four European cities. Healthcare users spontaneously express disappointment with services that dismiss their concerns and fail to attend to their priorities. Analysing characteristics of these healthcare users show that no single aspect of marginalisation shapes the expression of disappointment. In response to disappointing health care, users sought out alternative services and to persuade reluctant service providers, and they withdrew from services, in order to access more suitable health care and to achieve personal vindication. Promoting normative quality standards for diverse and diversifying populations that access care from a range of public and private service providers is in tension with prioritising services that are responsive to individual priorities. Without an effort towards radically responsive service provision, the ideal of universal access on the basis of need gives way to normative service provision.

Promoting the rational use of masks in community, home, and hospital settings in COVID-19 pandemic

The coronavirus disease-2019 (COVID-19) pandemic has been reported across 216 nations and territories since its emergence in the Wuhan city of China. It has been envisaged that the use of medical mask is one of the preventive strategies to limit the spread of transmission for many respiratory infections, including COVID-19. However, it is important to note that the use of the mask alone cannot provide complete protection, unless it is coupled with other infection prevention and control measures like hand hygiene. At present, the extensive usage of masks by healthy people in the community setting is not advocated owing to the shortage of masks for health-care personnel and the lack of evidence to support that wearing a mask by healthy people in community settings will prevent the acquisition of infection. In conclusion, in the fight against COVID-19 infection, the use of masks in community, home, and health-care settings needs to be clearly defined and streamlined to promote its rational usage. These masks play an important role in reducing the risk of transmission, provided it is supplemented with other infection prevention and control measures.

Implementing professional behaviour change in teams under pressure: results from phase one of a prospective process evaluation (the Implementing Nutrition Screening in Community Care for Older People (INSCCOPe) project)

ObjectivesTo evaluate the implementation of a new procedure for screening and treatment of malnutrition for older people in community settings and to identify factors promoting or inhibiting its implementation as...

Social design for inclusive local learning ecosystems: an entrepreneurial cultural affinity approach

INTRODUCTION: The ECAS (Entrepreneurial Cultural Affinity Spaces) framework seeks to transform social design theory and practice, through an emergent instructional paradigm of heritage-led, local learning ecosystem approaches, to leverage on diverse assets of people in community settings. OBJEC

What factors influence community wound care in the UK? A focus group study using the Theoretical Domains Framework

ObjectivesResearch has found unwarranted variation across community wound care services in the North of England, with underuse of evidence-based practice and overuse of interventions where there is little or no...