Community Stakeholder Perspectives Research Articles

Critical Rhetoric Meets Community-Based Participatory Research

ABSTRACT This project responds to a set of methodological challenges for the critical commitments of rhetorical fieldwork and investigates how community-based participatory research (CBPR) methods can help address them. As an example, we draw on Bailey Flynn’s CBPR research with Resilience, a not for-profit “rape crisis center” that provides services and therapy to thousands each year in Illinois. CBPR, like participatory critical rhetoric (PCR) methods, privileges field data as objects of rhetorical analysis. Unlike PCR and other approaches, CBPR methods prioritize the formalization of collaborative relationships with community stakeholders at every stage of research. We argue that greater integration of CBPR methods in rhetorical field methods will aid in privileging the epistemological perspectives of community stakeholders, solidifying critical communication scholarship’s commitment to conducting research with consequences, and providing a common ground for interdisciplinary exchange between critically trained rhetoric scholars and qualitative communication researchers.

Access to primary health care: perspectives of primary care physicians and community stakeholders

BackgroundAction on the social determinants of health is important to strengthen primary health care and promote access among underserved populations. We report on findings from stakeholder consultations undertaken at one of the Canadian sites of the Innovative Models Promoting Access-to-Care Transformation (IMPACT) program, as part of the development of a best practice intervention to improve access to primary health care. The overarching objective of this qualitative study was to understand the processes, barriers, and facilitators to connect patients to health enabling community resources (HERs) to inform a patient navigation model situated in primary care.MethodsFocus groups and interviews were conducted with primary care physicians, and community health and social service providers to understand their experiences in supporting patients in reaching HERs. Current gaps in access to primary health care and the potential of patient navigation were also explored. We applied Levesque et al., (2013) access framework to code the data and four themes emerged: (1) Approachability and Ability to Perceive, (2) Acceptability and Ability to Seek, (3) Availability and Accommodation, and Ability to Reach, and (4) Appropriateness.ResultsDeterminants of access included patient and provider awareness of HERs, the nature of the patient-provider relationship, funding of HERs, integration of primary and community care services, and continuity of information. Participants’ perspectives about the potential scope and role of a patient navigator provided valuable insight for the development of the Access to Resources in the Community (ARC) navigation model and how it could be embedded in a primary care setting.ConclusionAdditional consultation with key stakeholders in the health region is needed to gain a broader understanding of the challenges in caring for primary care patients with social barriers and how to support them in accessing community-based primary health care to inform the design of the ARC intervention.

Perspectives of community and facility stakeholders on community health workers in rural Malawi.

Community health workers (CHWs) bridge the primary health care (PHC) system and communities by providing care in the household. In Malawi, few studies have examined the perspective of users of household-level CHW services, in remote areas, to understand CHW's role in community-based PHC. To explore perspectives of community and facility stakeholders on the enablers and challenges of the CHW role in community-based PHC in Neno District. The study was conducted in the Neno District health facilities, namely, Ligowe, Dambe, Chifunga, and Zalewa. We conducted eight focus group discussions (FGDs) with purposively sampled community members and conveniently sampled facility stakeholders. Data were transcribed and analysed thematically through an adapted COM-B model of behaviour change. Three main themes of perceived behaviour change within the CHW role were identified: (1) capacity - the CHW programme aids health education and promotion within the community; (2) opportunity - the CHW programme facilitates community-based PHC and linkage to the facility; and (3) motivation - the CHW programme enablers and challenges in providing community-based PHC. Community health workers enrich community-based PHC delivery through health education, timely access to care, and linking communities to the facility. Optimising workload and programme support is critical for the help of CHWs. Further studies are required to address programme and cultural challenges to enhance positive health-seeking behaviours.Contribution: This study provides contextual knowledge for further research on bringing together spiritual and formal health practices and considering the cultural background when planning for health interventions in remote areas.

Year 1 Lessons Learned in Building and Sustaining Community-Academic Interdisciplinary Partnerships to Improve Maternal Health

ABSTRACT To understand current maternal health outcomes and growing health disparities, this interdisciplinary project investigates the development of a community advisory board (CAB), guided by the principles of community-based participatory research (CBPR), which explores the perspectives of providers, community stakeholders, and students. This step-by-step process analysis allows for greater clarity and recognition of areas to consider in future CAB initiatives and use of interprofessional education. Both quantitative and qualitative principles were used to assess and evaluate the process, including survey, observation, and content analysis. While this project remains in the early stages, promising results have emerged supporting strong group dynamics and commitment toward change in the local community while identifying improvements to the overall delivery of the CAB and CBPR process.

COVID-19 Containment in Indigenous Communities in North-West Saskatchewan: Community and Multi-Sectoral Stakeholder Perspectives

In the spring of 2020, remote Indigenous communities in the far north-western region of Saskatchewan, Canada, experienced a COVID-19 outbreak that required the collaboration of local leaders, Indigenous governments, and other multi-sectoral organizations. This study shares the stories of those involved in the response and illustrates the challenges, successes, and recommendations for future emergency preparedness. A total of 22 participants were interviewed from the impacted communities, government agencies, and organizations in public health, public safety, and law enforcement between May and August of 2021. Qualitative interviews were analyzed using thematic analysis resulting in the following themes: 1) Challenges, 2) Consequences, 3) Successes, and 4) Recommendations. A final knowledge translation event was held with key stakeholders, including public health professionals and community members, to co-create final recommendations for future public health responses in remote Indigenous communities. Our findings underscored the importance of community leadership, local investment, public health preparedness, and relationship building between organizations and jurisdictions. Lessons and recommendations from these stories can be applied to future pandemic preparedness in the province.

O52 - Optimising abortion care: Perspectives of care providers and community stakeholders in Melbourne's north

O52 - Optimising abortion care: Perspectives of care providers and community stakeholders in Melbourne's north

A qualitative assessment of stakeholder perspectives on barriers and facilitators to emergency care delays in Northern Tanzania through the Three Delays.

Emergency conditions cause a significant burden of death and disability, particularly in developing countries. Prehospital and Emergency Medical Services (EMS) are largely nonexistent throughout Tanzania and little is known about the community's barriers to accessing emergency care. The objective of this study was to better understand local community stakeholder perspectives on barriers, facilitators, and potential solutions surrounding emergency care in the Kilimanjaro region through the Three Delays Model framework. A qualitative assessment of local stakeholders was conducted through semi-structured focus group discussions (FGDs) from February to June 2021 with five separate groups: hospital administrators, emergency hospital workers, police personnel, fire brigade personnel, and community health workers. FGDs were conducted in Kiswahili, audio recorded, and translated to English verbatim. Two research analysts separately coded the first two FGDs using both inductive and deductive thematic analysis. A final codebook was then created to analyze the remaining FGDs. A total of 24 participants were interviewed. Thematic analysis revealed that participants identified significant barriers within the Three Delays Model as well as identified an additional delay centered on community members and first aid provision. Perceived delays in the decision to seek care, the first delay, were financial constraints and the lack of community education on emergency conditions. Limited infrastructure and reduced transportation access were thought to contribute to the second delay. Potential barriers to receiving timely appropriate care, the third delay, included upfront payments required by hospitals and emergency department intake delays. Suggested solutions focused on increasing education and improving communication and infrastructure. The findings outline barriers to accessing emergency care from a stakeholder perspective. These themes can support recommendations for further strengthening of the prehospital and emergency care system. Due to logistical constraints, emergency care workers interviewed were all from one hospital and patients were not included.

Protecting the Autonomy of Patients with Severe Mental Illness Through Psychiatric Advance Directive Peer-Facilitation

Protecting the Autonomy of Patients with Severe Mental Illness Through Psychiatric Advance Directive Peer-Facilitation

Something Has to Give: An Urban Community-Engaged Focus Group Study of Teen Sleep.

Sleep is critical to teen physical and mental health, daily function, and school performance. Yet, sleep deficiency is prevalent among ethnoracially diverse teens. The purpose of this community-engaged focus group study was to explore multilevel influences on teen sleep from teen and community stakeholder perspectives and to use this information to develop a tailored sleep health intervention. We conducted seven focus groups (N = 46) and analyzed data via content analysis. Five themes, each with subthemes, described sleep knowledge/attitudes, sleep habits, the multilevel causes and consequences of decreased nighttime sleep and suggestions for improving teen sleep. Teen health, mood, and school engagement were all impacted by inadequate nighttime sleep. Exhaustion emerged as an overarching theme and coincided with the transition to high school. The data from this study provide insight into important areas of focus for a sleep intervention tailored to the needs of ethnoracially diverse teens living in an urban community.

Lost in transition? Community residential facility staff and stakeholder perspectives on previously incarcerated older adults’ transitions into long-term care

BackgroundEstablishing an effective continuum of care is a pivotal part of providing support for older populations. In contemporary practice; however, a subset of older adults experience delayed entry and/or are denied access to appropriate care. While previously incarcerated older adults often face barriers to accessing health care services to support community reintegration, there has been limited research on their transitions into long-term care. Exploring these transitions, we aim to highlight the challenges of securing long-term care services for previously incarcerated older adults and shed light on the contextual landscape that reinforces the inequitable care of marginalized older populations across the care continuum.MethodsWe performed a case study of a Community Residential Facility (CRF) for previously incarcerated older adults which leverages best practices in transitional care interventions. Semi-structured interviews were conducted with CRF staff and community stakeholders to determine the challenges and barriers of this population when reintegrating back into the community. A secondary thematic analysis was conducted to specifically examine the challenges of accessing long-term care. A code manual representing the project themes (e.g., access to care, long-term care, inequitable experiences) was tested and revised, following an iterative collaborative qualitative analysis (ICQA) process.ResultsThe findings indicate that previously incarcerated older adults experience delayed access and/or are denied entry into long-term care due to stigma and a culture of risk that overshadow the admissions process. These circumstances combined with few available long-term care options and the prominence of complex populations already in long-term care contribute to the inequitable access barriers of previously incarcerated older adults seeking entry into long-term care.ConclusionsWe emphasize the many strengths of utilizing transitional care interventions to support previously incarcerated older adults as they transition into long-term care including: 1) education & training, 2) advocacy, and 3) a shared responsibility of care. On the other hand, we underscore that more work is needed to redress the layered bureaucracy of long-term care admissions processes, the lack of long-term care options and the barriers imposed by restrictive long-term care eligibility criteria that sustain the inequitable care of marginalized older populations.

Social Isolation of Older Adults Living in a Neighbourhood of Montreal: A Qualitative Descriptive Study of the Perspectives of Older Adults and Community Stakeholders.

The purpose of this study was to describe the social isolation of older adults in the Côte-des-Neiges neighbourhood (Montreal, Canada) from the perspectives of older adults and community stakeholders. To do so, a descriptive qualitative study was conducted, involving community-dwelling older adults and a variety of key stakeholders from the neighbourhood. Seven focus groups were held, with a total of 37 participants. Focus group transcripts were analyzed using the approach of Miles, Huberman, and Saldaña. Participants reported that social isolation of older adults is characterized by gaps in social interactions (scarcity of social interactions, lack of social support, and unsatisfying relationships) as well as by low social participation that can be depicted in three ways: (1) exclusion by society, (2) self-restriction of participation, and (3) low eagerness to socialize. This study highlights that there is a diversity in how social isolation of older adults manifests itself. It can be the result of a deliberate choice (or not), as well as being desired (or not). These aspects of the phenomenon of social isolation of older adults are still not well described. However, they offer relevant avenues for rethinking approaches to intervention development.

Resegregation will not happen on our watch: The political and social context surrounding voluntary integration in Wake County Public School System

As resegregation occurs across the country, some school districts are pursuing voluntary integration. This qualitative case study uses critical policy analysis to explore the political and social contexts surrounding the early stages of developing a voluntary integration plan in Wake County Public School System, North Carolina. Through analysis of interviews with school board and community members as well as a range of documents, findings indicate that population growth and residential development, the proliferation of unregulated school choice, varied perspectives of community stakeholders, inequitable distribution of power and resources, and school board politics largely shape the process of developing a voluntary integration plan. Recommendations are provided for school district policies, cross-sector collaboration, and state-level policies that could strengthen the potential success of voluntary integration plans.

The Integration of Primary Care and Public Health in Medical Students' Training Based on Social Accountability and Community-Engaged Medical Education.

Objectives: Primary care and public health comprise the bedrock of health systems, but their divergence has produced two groups of practitioners either focused on individual health or population health. We explored how primary care and public health were integrated in medical students' training in Zamboanga Peninsula, Philippines. Methods: Our qualitative study reviewed community health plans in two municipalities and thematically analyzed the perspectives of medical students, faculty, alumni, and community stakeholders through focus group discussions and in-depth interviews. Results: Integration began by operationalizing a curriculum requiring medical students to serve rural communities during most of their training-a departure from the conventional, hospital-based medical education in the Philippines. The medical students' community immersion provided opportunities for integrating primary care and public health activities that influenced their personal orientations and the health situation in communities. Integration continued after training as alumni found themselves serving as primary care and public health practitioners in the region. Conclusion: Social accountability and community-engaged medical education provided the foundation for medical students to integrate primary care and public health in practice to respond to local needs.

EMBRACING COMMUNITY: ADVANCE CARE PLANNING FOR AFRICAN AMERICAN OLDER ADULTS LIVING WITH DEMENTIA

Abstract Lower socioeconomic status African American older adults living with dementia and their family caregivers face unique advance care planning challenges, including achieving appropriate preference-consistent healthcare near the end of life. The purpose of this project within a larger multi-stakeholder study is to assess community stakeholder perspectives on the needs of African American older adults living with dementia and their family caregivers. Diverse community-based organization leaders (n=9) were interviewed and identified the following thematic needs: Reframing of Advance Care Planning, Clarification of Misinformation, and Expansion of Available Resources. Community leaders expressed strong desires to assist families with advance care planning. The use of creative, culturally-tailored, non-traditional approaches to this process offers innovative ways to promote advance care planning through community engagement. This will change the narrative on advance care planning from a cultural perspective while embracing diversity, enriching discovery, and reimaging aging in the community

Measuring the implementation of media literacy instructional practices in schools: community stakeholder perspectives

ABSTRACT Interest in media literacy education is increasing across the United States and around the world but little is still known about the prevalence of various instructional practices used to implement it in elementary and secondary schools. Surveys and semi-structured interviews with a statewide quota sample of education stakeholders included school leaders, educators, librarians, elected public officials, parents, and members of the community in all 24 school districts in Rhode Island. Results show that only a few instructional practices are implemented with most or nearly all students in the state. However, the implementation of various media literacy instructional practices varied considerably from one community to another but these differences were not due to the size of the community, its geographic location, or its socioeconomic status. Nearly half the variance in instructional practices can be accounted for by obstacles including technology limitations, school policies, academic priorities, perceptions of students, and educator response.

Exploring the perception and socio-cultural barriers to safer sex negotiation among married women in Northwest Nigeria

BackgroundSafer sex negotiation refers to the means through which partners in sexual relationships agree to have intercourse that protects both partners from adverse sexual health outcomes. Evidence is sparse on the socio-cultural barriers to safer sex negotiation, especially in Northwest Nigeria where almost every aspect of women’s lives is influenced by religious and cultural norms. Understanding the socio-cultural barriers requires having knowledge of the perspectives of community stakeholders such as religious leaders, and community leaders. Thus, from the perspectives of community stakeholders, this study explored the perception and socio-cultural barriers to safer sex negotiation of married women in Northwest Nigeria.MethodA qualitative research design was adopted. Participants were purposively selected across six states, namely, Kano, Katsina, Jigawa, Kebbi, Kaduna, and Zamfara. Data were collected through Key Informant Interview (KII). A total of 24 KIIs were conducted using the in-depth interview guide developed for the study. The selection of the participants was stratified between rural and urban areas. The interviews were tape-recorded, transcribed, and translated from the Hausa language into the English language. Verbal and written informed consent were obtained from participants prior to the interviews. Data were analyzed using inductive thematic content analysis.ResultsSafer sex negotiation was well-understood by community stakeholders. Men dominate women in sexual relationships through the suppression of women’s agency to negotiate safer sex. Married women endured domination by males in sexual relationships to sustain conjugal harmony. The practice of complying with traditional, cultural, and religious norms in marital relationships deters women from negotiating safer sex. Other socio-cultural causes of the inability to negotiate safer sex are child marriage, poverty, poor education, and polygyny.ConclusionCommunity stakeholders have a clear understanding of safer sex negotiation in Northwest Nigeria but this has not translated into a widespread practice of safer sex negotiation by married women due to diverse socio-cultural barriers. Strategies that will empower women not only to gain more access to relevant sexual and reproductive health information and services but also to encourage women’s assertiveness in family reproductive health decisions are imperative in Northwest Nigeria.

Provider and community stakeholder perspectives of expanding Medicaid coverage of abortion in Illinois

BackgroundMany people seeking abortion encounter financial difficulties that delay or prevent them from accessing care. Although some patients qualify for Medicaid (a public program that can help cover health care costs), laws in some states restrict the use of Medicaid for abortion care. In 2017, Illinois passed House Bill 40 (HB-40), which allowed patients with Medicaid to receive coverage for their abortion. This study aimed to understand how HB-40 affected abortion affordability from the perspectives of individuals that work directly or indirectly with abortion patients or facilities providing abortion care.MethodsWe conducted interviews with clinicians and administrators from facilities that provided abortion services; staff from organizations that provided resources to abortion providers or patients; and individuals at organizations involved in the passage and/or implementation of HB-40. Interviews were audio-recorded and transcribed. We created codes based on the interview guides, coded each transcript using the web application Dedoose, and summarized findings by code.ResultsInterviews were conducted with 38 participants. Participants reflected that HB-40 seemed to remove a significant financial barrier for Medicaid recipients and improve the experience for patients seeking abortion care. Participants also described how the law led to a shift in resource allocation, allowing financial support to be directed towards uninsured patients. Some participants thought HB-40 might contribute to a reduction in abortion stigma. Despite the perceived positive impacts of the law, participants noted a lack of public knowledge about HB-40, as well as confusing or cumbersome insurance-related processes, could diminish the law’s impact. Participants also highlighted persisting barriers to abortion utilization for minors, recent and undocumented immigrants, and people residing in rural areas, even after the passage of HB-40.ConclusionsHB-40 was perceived to improve the affordability of abortion. However, participants identified additional obstacles to abortion care in Illinois that weakened the impact of HB-40 for patients and required further action, Findings suggest that policymakers must also consider how insurance coverage can be disrupted by other legal barriers for historically excluded populations and ensure clear information on Medicaid enrollment and abortion coverage is widely disseminated.

Perspectives of health and community stakeholders on community-delivered models of malaria elimination in Lao People's Democratic Republic: A qualitative study.

In the Lao People's Democratic Republic (Lao PDR), village health volunteers play an important role in providing health services including those to reduce the burden of malaria. Over the last two decades, the volunteer network has expanded to bring malaria services closer to communities and contributed to the reduction of malaria cases. However, as malaria test positivity rates decreased, many volunteers have lost motivation to continue providing routine malaria services, and other services they provide may not reflect growing healthcare demands for common diseases in the community. This study explored the perspectives, knowledge and inputs of key health stakeholders and community members in southern Lao PDR on community-delivered models in order to refine the volunteer model in the context of Lao PDR's primary health care sector and malaria elimination goals. Semi-structured interviews with multi-level health stakeholders, participatory workshops with community leaders, and focus group discussions with community members and current village health volunteers were conducted. Deductive followed by inductive thematic analysis was used to explore and categorise stakeholders' perspectives on community-delivered models for malaria elimination. Both stakeholders and community members agreed that village health volunteers are essential providers of malaria services in rural communities. Apart from malaria, community members identified dengue, diarrhoea, influenza, skin infections and tuberculosis as priorities (in descending order of importance) and requested community-based primary health care for these diseases. Stakeholders and community members suggested integrating prevention, diagnosis, and treatment services for the five priority diseases into the current malaria volunteer model. A divergence was identified between community members' expectations of health services and the services currently provided by village health volunteers. Stakeholders proposed an integrated model of healthcare to meet the needs of the community and help to maintain volunteers' motivation and the long-term sustainability of the role. An evidence-based, integrated community-delivered model of healthcare should be developed to balance the needs of both community members and stakeholders, with consideration of available resources and current health policies in Lao PDR.

Community Reintegration of Previously Incarcerated Older Adults: Exploratory Insights from a Canadian Community Residential Facility Program

ABSTRACT This paper addresses an immediate gap in knowledge about community reintegration of previously incarcerated older adults. It presents an exploratory case study of a community residential facility program in Ontario, Canada, focusing on the experiences and perspectives of older residents, staff members, and community stakeholders on the community reintegration of previously incarcerated older men. Findings provide insights into the aging-related reintegration issues such as the older men’s ability to access health and medical services upon community reentry, the challenges and opportunities of the continuum of support (or lack thereof) to help ease the reintegration process, and stigma and other barriers the older men face as they attempt to access long-term care upon release from correctional institutions. Emergent questions for research, policy, and practice are highlighted and discussed to set an agenda for expanding the thread of inquiry into the community reintegration of previously incarcerated older adults. Future research calls for further investigation into the diversity of experiences (e.g., gender, race/ethnicity, geographical locale) to advance the field of study as it relates to aging and social policy.

Understanding family planning decision-making: perspectives of providers and community stakeholders from Istanbul, Turkey

BackgroundA number of factors may determine family planning decisions; however, some may be dependent on the social and cultural context. To understand these factors, we conducted a qualitative study with family planning providers and community stakeholders in a diverse, low-income neighborhood of Istanbul, Turkey.MethodsWe used purposeful sampling to recruit 16 respondents (eight family planning service providers and eight community stakeholders) based on their potential role and influence on matters related to sexual and reproductive health issues. Interviews were audio-recorded with participants' permission and subsequently transcribed in Turkish and translated into English for analysis. We applied a multi-stage analytical strategy, following the principles of the constant comparative method to develop a codebook and identify key themes.ResultsResults indicate that family planning decision-making—that is, decision on whether or not to avoid a pregnancy—is largely considered a women’s issue although men do not actively object to family planning or play a passive role in actual use of methods. Many respondents indicated that women generally prefer to use family planning methods that do not have side-effects and are convenient to use. Although women trust healthcare providers and the information that they receive from them, they prefer to obtain contraceptive advice from friends and family members. Additionally, attitude of men toward childbearing, fertility desires, characteristics of providers, and religious beliefs of the couple exert considerable influence on family planning decisions.ConclusionsNumerous factors influence family planning decision-making in Turkey. Women have a strong preference for traditional methods compared to modern contraceptives. Additionally, religious factors play a leading role in the choice of the particular method, such as withdrawal. Besides, there is a lack of men’s involvement in family planning decision-making. Public health interventions should focus on incorporating men into their efforts and understanding how providers can better provide information to women about contraception.