Effectiveness Of Community-based Interventions Research Articles

Corneal ulcers and the risk of visual impairment in a matched cohort study in Nepal

PurposeWe estimated the association between corneal ulcer and two outcomes: visual impairment and vision-related quality of life. We investigated for differential effects by rural/urban location. DesignPopulation-based matched prospective cohort study. MethodsWe followed 540 incident corneal ulcer cases identified in a cluster randomized trial in Nepal. Cases were pair-matched to individuals without incident corneal ulcers by age, sex and location using incidence density sampling. Clinical examinations were performed to assess outcomes in both groups after 12 months, which included visual acuity and a modified version of the Hong Kong vision-related quality of life questionnaire. Results392 matched pairs had complete outcome data and were included in the analyses. Median age was 42 years (interquartile range [IQR]: 28, 53) and 63.8 % were female. After controlling for education and occupation, corneal ulcer was associated with an approximately 1-line reduction in visual acuity (0.11 logMAR units, 95 % CI 0.06 to 0.15, P < 0.001), and with an increased risk of low vision/blindness (adjusted risk ratio 1.89, 95 % CI 1.44 to 2.48, P < 0.001). Corneal ulcer was associated with lower vision-related quality of life on the 20-question questionnaire (adjusted mean difference in score -1.69, 95 % CI -2.78 to -0.61, P = 0.002). We were unable to demonstrate effect modification for any outcome by rural/urban status. ConclusionsWe observed worse visual acuity and lower vision-related quality of life among those with incident corneal ulcers compared to those without. The population-based design, which captured the full spectrum of disease, confirms that corneal ulcers are an important cause of vision loss in the general population of Nepal and highlights the need for effective community-based corneal ulcer prevention interventions.

Understanding the enablers to implementing sustainable health and well-being programs for older adults in rural Australia: A scoping review.

Supporting the health and well-being of older Australians necessitates the implementation of effective and sustainable community-based interventions. Rural settings, however, pose unique challenges to intervention implementation and sustainability, with limited research exploring strategies employed to overcome these complexities. To identify enabling strategies that support the sustainable implementation of community-based health and well-being interventions for older adults in rural Australia. A scoping review, following methods by Arksey and O'Malley and enhanced by elements of the Joanna Briggs Institute methodology for scoping reviews and Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR), was conducted. An electronic search of seven databases was completed in April 2023. A thematic analysis was applied to provide a comprehensive and contextualised understanding of the phenomenon of interest. Of 1277 records screened, 15 studies were identified and included for review. Five themes identified key enablers for rural implementation: (1) Co-designing for the local context; (2) Embedding local champions; (3) Leveraging existing local resources; (4) Maintaining impact beyond the end of the funded period and (5) Flexibility in funding models. The sustainable implementation of interventions requires active community involvement and consultation through all stages of program design and delivery to effectively meet the health and well-being needs of older rural-dwelling Australians. Our findings advocate for clear implementation guidelines to support the design, delivery and adaptation of community-based programs that appropriately reflect the unique contextual needs and strengths of rural communities.

Patterns of help-seeking behavior among people with mental illness in Ethiopia: a systematic review and meta-analysis.

Despite the availability of evidence-based and effective treatments, significant numbers of people living with mental illness do not receive treatment or do not seek help from providers of formal modern treatment. Although numerous primary studies have been conducted on patterns of help-seeking behavior among individuals with mental illness with respect to modern therapy, the evidence has not been aggregated nationwide. Therefore, the aim of this review was to investigate pooled data on patterns of help-seeking behavior among individuals with mental illness in Ethiopia. All available primary studies were searched via the Google Scholar, HINARI, and PubMed databases from June 22 to December 20, 2023; 912 articles were identified. Sixteen articles were included in the final review; data from them were extracted to an Excel spreadsheet and exported to Stata version 17 for analysis. The search terms used were: "Pattern of help-seeking behavior'' OR "Pattern of treatment-seeking behavior" OR "Health care-seeking behavior" OR "Help-seeking intention" OR "Help-seeking preferences" OR "Perceived need" OR "Pathways to psychiatric care", AND "Common mental disorders" OR "Mental illness" OR "Mental health problems" OR "Depression", AND "Predictors" OR "Determinate factors" OR "Associated factors", AND "Ethiopia". The quality of the studies included was critically appraised using the modified The Joanna Briggs Institute (JBI) Joanna Briggs Institute quality assessment tool, adapted for observational studies. During critical appraisal, disagreements between the two authors conducting the assessment were resolved by the involvement of a third author. Effect sizes were pooled using the random effects model, and the presence of publication bias was detected based on asymmetry of the funnel plot and a statistically significant result of Egger's test (p<0.05). The pooled rate of positive help-seeking behavior with respect to modern treatment among people living with mental illness was 42.21% (95% CI: 29.29, 55.12; I2 = 99.37%, P=0.00). Factors significantly associated with a positive pattern of help-seeking behavior were: having a secondary education or above (AOR=5.47, 95% CI: 2.33, 12.86); believing that mental illness requires treatment (AOR=2.76, 95% CI: 2.02, 3.78); having strong social support (AOR=2.00, 95% CI: 1.64, 2.44); having a family history of mental illness (AOR=2.68, 95% CI: 1.38, 3.97); having awareness of the availability of treatment (AOR=2.92, 95% CI: 1.56, 5.46); having previously engaged in positive help-seeking behavior (AOR=3.28, 95% CI: 1.63, 6.60); having comorbid disorders (AOR=4.25, 95% CI: 1.69, 10.66); not using alcohol (AOR=3.29, 95% CI: 1.73, 6.27); and the perceived severity of mental illness (AOR=2.54, 95% CI: 1.490, 4.33). The majority of people with mental illness in Ethiopia exhibited a poor pattern of help-seeking behavior with respect to modern treatment. Therefore, mobilization of the community should be encouraged via regular public awareness campaigns regarding mental illness and the availability of evidence-based and effective modern treatment in Ethiopia. Moreover, the design of effective community-based mental health interventions is recommended in order to improve public attitudes and rates of help-seeking behavior in relation to mental health problems.

PROTOCOL: Effects of social prescribing for older adults: An evidence and gap map.

Objectives This is the protocol for an evidence and gap map. The objectives are as follows: The aim of this evidence and gap map is to map the available evidence on the effectiveness of social prescribing interventions addressing a non-medical, health-related social need for older adults in any setting. Specific objectives are as follows: 1.To identify existing evidence from primary studies and systematic reviews on the effects of community-based interventions that address non-medical, health-related social needs of older adults to improve their health and wellbeing.2.To identify research evidence gaps for new high-quality primary studies and systematic reviews.3.To highlight evidence of health equity considerations from included primary studies and systematic reviews.

Effect of Intrapersonal and Interpersonal Behavior Change Strategies on Physical Activity Among Older Adults

Despite guidelines that recommend physical activity (PA), little is known about which types of behavior change strategies (BCSs) effectively promote sustained increases in PA in older adults who are insufficiently active. To determine whether intrapersonal BCSs (eg, goal setting) or interpersonal BCSs (eg, peer-to-peer sharing or learning) combined with the Otago Exercise Program (17 strength and balance exercises and a walking program that are learned and individually tailored, with instruction to perform 3 times per week at home or location of choice) and a wearable PA monitor help older adults sustain increases in their PA. This 2 × 2 factorial randomized clinical trial (Community-Based Intervention Effects on Older Adults' Physical Activity) of community-dwelling older adults 70 years or older with PA levels below minimum national PA guidelines was conducted in urban community centers. Dates of enrollment were from November 17, 2017, to June 15, 2021, with final follow-up assessments completed on September 2, 2022. Participants were randomized to intrapersonal (eg, goal setting) BCSs, interpersonal (eg, problem-solving with peer-to-peer sharing and learning) BCSs, intrapersonal and interpersonal BCSs, or an attention control group. All interventions included a PA monitor and 8 weekly small-group meetings with discussion, practice, and instructions to implement the exercise program and relevant BCSs independently between meetings and after the intervention. The primary outcome was daily minutes of objectively measured total PA (light, moderate, or vigorous intensities) averaged over 7 to 10 days, measured at baseline and after the intervention at 1 week, 6 months, and 12 months. Among 309 participants (mean [SD] age, 77.4 [5.0] years; 240 women [77.7%]), 305 (98.7%) completed the intervention, and 302 (97.7%) had complete data. Participants receiving PA interventions with interpersonal BCS components exhibited greater increases in total PA than did those who did not at 1 week (204 vs 177 PA minutes per day; adjusted difference, 27.1 [95% CI, 17.2-37.0]; P < .001), 6 months (195 vs 175 PA minutes per day; adjusted difference, 20.8 [95% CI, 10.0-31.6]; P < .001), and 12 months (195 vs 168 PA minutes per day; adjusted difference, 27.5 [95% CI, 16.2-38.8]; P < .001) after the intervention. Compared with participants who did not receive interventions with intrapersonal BCS components, participants who received intrapersonal BCSs exhibited no significant changes in total PA at 1 week (192 vs 190 PA minutes per day; adjusted difference, 1.8 [95% CI, -8.6 to 12.2]; P = .73), 6 months (183 vs 187 PA minutes per day; adjusted difference, -3.9 [95% CI, -15.0 to 7.1]; P = .49), or 12 months (177 vs 186 PA minutes per day; adjusted difference, -8.8 [95% CI, -20.5 to 2.9]; P = .14) after the intervention. Interactions between intrapersonal and interpersonal BCSs were not significant. In this randomized clinical trial, older adults with low levels of PA who received interpersonal BCSs, the exercise program, and a PA monitor exhibited significant increases in their PA for up to 12 months after the intervention. Intrapersonal BCSs elicited no significant PA changes and did not interact with interpersonal BCSs. Our findings suggest that because effects of a PA intervention on sustained increases in older adults' PA were augmented with interpersonal but not intrapersonal BCSs, approaches to disseminating and implementing the intervention should be considered. ClinicalTrials.gov Identifier: NCT03326141.

The effectiveness of a suicide prevention program in primary care clinics supported by community public health resources: A difference-in-differences analysis

The importance of appropriate and intensive follow-up management for individuals identified with suicide risk through screening is highlighted. The Link between Primary Care Clinic and Public Health Resources Intervention(LinkPC-PH), a suicide prevention program in primary care clinics supported by community public health resources, was implemented at the district level in 2017. The purpose of the present study is to evaluate the effectiveness of the LinkPC-PH intervention by comparing suicide rates before(2014-2016) and after(2017-2019) implementation of the intervention using a difference-in-differences design. The LinkPC-PH comprises several dimensions of intervention including screening, risk assessment of suicidality, and referral in primary care clinics and crisis contact within 24 hours, case management, and safety planning led by public health professionals. After adjustment for district-level confounders, an intervention-implemented district had 2.87 fewer suicide deaths per 100,000 people in a population sample at post-intervention than would have been expected from the same trend in suicide rates as non-implemented intervention districts. In other words, the suicide rate in the intervention area decreased by 25% following the intervention. These results empirically substantiate suicide prevention programs in primary care clinics by community public health resources for reduced suicide rates to support effective community-based suicide prevention interventions.

Effectiveness of Community-Based Programs on Aggressive Behavior Among Children and Adolescents: A Systematic Review and Meta-Analysis.

Adolescent aggressive behavior has increasingly become a central issue affecting the safety of both school campuses and the broader society. Despite the existence of numerous community interventions targeting this issue, there has been a paucity of efforts to consolidate the findings on the effectiveness of community-based programs in preventing aggressive behavior. This meta-analysis sought to address this gap by reviewing and assessing the impact of community-based initiatives on reducing adolescent aggression. A thorough search was carried out on 12 electronic databases: EBSCO, ERIC, PubMed, PsycINFO, MEDLINE, EMBASE, Scopus, Web of Science, ProQuest Dissertations and Theses, the China National Knowledge, Wanfang Databases, and China Science and Technology Journal Database. Sixteen studies were finalized, and meta-analyses were performed using a random effect model on RevMan v5.4 software developed by Cochrane. The analysis encompassed 16 published studies, involving a total of 2,585 participants. The key components of existing programs for aggression reduction included providing behavioral skills and training for adolescents, employing a problem-solving approach to address behavioral issues, offering psychological treatment, and emphasizing community supervision. The results indicate a significant positive effect of community-based interventions on aggression reduction (standardized mean difference = -0.26, 95% confidence intervals [-0.39, -0.13], Z = 3.84, p < .001). The subgroup analyses revealed that the intervention's effectiveness was moderated by the duration of the intervention, its theoretical foundation, and the sample size. This study furnishes empirical evidence supporting the enhancement of policies and practices to foster community engagement in mitigating aggressive behavior.

Effectiveness of community-based interventions for older adults living alone: a systematic review and meta-analysis.

This study examined the effectiveness of community-based interventions designed for older adults living alone through a systematic review and meta-analysis. The study incorporated 4 randomized controlled trials (RCTs) and 5 non-RCTs to evaluate various interventions. The methodological quality of these studies was assessed using the Downs and Black checklist, while Q-statistic and I-square tests were performed to examine statistical heterogeneity. Additionally, visual inspection of funnel plots and the trim-and-fill method were employed to investigate potential publication bias. Of the 2,729 identified studies, 9 met the criteria for inclusion in this review. Independent variables were categorized into 5 groups (physical activity, nutrition, social relationships, social participation, and combined intervention) to examine their effects. Dependent variables were similarly classified into 5 subgroups to identify the specific effects of the interventions. Interventions focusing on nutrition and combined approaches were the most effective, yielding effect sizes of 0.96 (95% confidence interval [CI], 0.66 to 1.25) and 0.43 (95% CI, 0.26 to 0.60), respectively. The interventions had the greatest impacts on the health behavior and mental health of the participants, with effect sizes of 0.98 (95% CI, 0.73 to 1.22) for health behavior and 0.67 (95% CI, 0.19 to 1.16) for mental health. This study suggests a direction for the development of community-based interventions tailored to the needs of older adults living alone. Additionally, it provides evidence to inform policy decisions concerning this demographic.

Promoting community resilience through disaster education: Review of community-based interventions with a focus on teacher resilience and well-being.

Teachers play a pivotal role, both as educators and community leaders at the heart of any communities. This study seeks to address: "How do community-based interventions influence teacher resilience and well-being in the context of disaster education, and consequently, how does this affect overall community resilience?" Employing the rigorous PRISMA systematic review approach, we examined relevant studies, emphasizing the relationship between teacher resilience, well-being, and the efficacy of community-based disaster education interventions. 47 studies met the specific inclusion criteria and were included in in-depth analysis. This study identified a set of key interventions that have demonstrably boosted teacher resilience and well-being. There was a discernible positive relationship between teacher resilience and the effectiveness of community disaster education initiatives. The relationship between teacher resilience, their well-being, and effective community-based disaster education interventions is intricate and multifaceted. Enhanced teacher resilience contributes substantially to the success of disaster education programs. The interplay between teacher and community resilience emerged as a complex, symbiotic relationship, with teacher well-being acting as a cornerstone for effective community-based interventions. Reinforcing teacher resilience and well-being is integral to the success of community-based disaster education initiatives. Ensuring their well-being not only enhances educational outcomes but also fortifies community resilience. Teachers play a pivotal role in not only educating the younger generation but also in enhancing community resilience. Thus, any strategy aimed at supporting community resilience must integrate comprehensive measures to ensure the well-being and resilience of teachers. This nexus between education and community resilience emphasizes the necessity for integrated, holistic, and community-centric approaches to disaster management.

The Effect of Community-Based Intervention on Dengue Awareness and Prevention Among Poor Urban Communities in Delhi, India.

This study aimed to assess the efficacy of a dengue intervention program in economically deprived urban regions of India, with a particular emphasis on housing conditions and community involvement. Given the global significance of dengue fever as a vector-borne disease, successful vector management requires effective community engagement. Study Design: A quasi-experimental study. This study was conducted with 314 participants from Delhi's Sanjay Colony, divided into control and intervention groups. The study spanned 14 months (August 2020 to September 2021). The intervention program comprised two educational sessions held one month apart, covering dengue awareness, health self-care, and environmental maintenance. Data were collected at baseline, after each intervention session, and during a final follow-up assessment three months later. The primary outcome, the house index (HI), revealed statistically significant differences (P<0.001) favoring the intervention group. The total score (TS) for mosquito-borne disease, TS of knowledge, TS of attitude, and TS of practices all exhibited significant improvements in the intervention group. Participants showed an enhanced understanding of dengue causes, symptoms, and mosquito behavior related to breeding and biting. The HI in the intervention group decreased significantly from 21.65% to 4.45% (P<0.05). This study, grounded in the health belief model (HBM), demonstrated the effectiveness of the intervention program in reducing HI and improving knowledge and preventive practices regarding dengue fever in impoverished urban neighborhoods of Delhi. The intervention program may be beneficial in such a poor urban community.

Effects of community-based interventions for stillbirths in sub-Saharan Africa: a systematic review and meta-analysis

Sub-Saharan Africa (SSA) alone contributed to 42% of global stillbirths in 2019, and the rate of stillbirth reduction has remained slow. There has been an increased uptake of community-based interventions to combat stillbirth in the region, but the effects of these interventions have been poorly assessed. Our objectives were to examine the effect of community-based interventions on stillbirth in SSA. In this systematic review and meta-analysis, we searched eight databases (MEDLINE [OvidSP], Embase [OvidSP], Cochrane Central Register of Controlled Trials, Global Health, Science Citation Index and Social Science Citation index [Web of Science Core Collection], CINAHL [EBSCOhost] and Global Index Medicus) and four grey literature sources from January 1, 2000 to July 7, 2023 for relevant studies from SSA. Community-based interventions targeting stillbirths solely or as part of complex interventions, with or without hospital interventions were included, while hospital-only interventions, microcredit schemes and maternity waiting home interventions were excluded. Study quality was assessed using the Cochrane risk of bias and National Heart, Lung and Blood Institute's tools. The study outcome was odds of stillbirth in intervention versus control communities. Pooled odds ratios (ORs) were estimated using random-effects models, and subgroup analyses were performed by intervention type and strategies. Publication bias was evaluated by funnel plot and Egger's test. This study is registered with PROSPERO, CRD42021296623. Of the 4223 records identified, seventeen studies from fifteen SSA countries were eligible for inclusion. One study had four arms (community only, hospital only, community and hospital, and control arms), so information was extracted from each arm. Analysis of 13 of the 17 studies which had community-only intervention showed that the odds of stillbirth did not vary significantly between community-based intervention and control groups (OR 0.96; 95% CI 0.78-1.17, I2=57%, p≤0.01, n=63,884). However, analysis of four (out of five) studies that included both community and health facility components found that in comparison with community only interventions, this combination strategy significantly reduced the odds of stillbirth by 17% (OR 0.83; 95% CI 0.79-0.87, I2=11%, p=0.37, n=244,868), after excluding a study with high risk of bias. The quality of the 17 studies were graded as poor (n=2), fair (n=9) and good (n=6). Community-based interventions alone, without strengthening the quality and capacity of health facilities, are unlikely to have a substantial effect on reducing stillbirths in SSA. Nuffield Department of Population Health, Balliol College, the Clarendon Fund, Medical Research Council.

Effectiveness of Community-based Interventions in Improving the Oral &amp; Dental Health of the Elderly People: A Systematic Review and Meta-analysis

Introduction: Considering the rapid growth in the number of aged people and their oral &amp; dental health problems, there is a need for effective community-based interventions to improve their oral health. Objective: This study aims to investigate the effectiveness of community-based interventions in improving the oral &amp; dental health of elderly people. Materials and Methods: This is a systematic review and meta-analysis. The related studies published from January 2000 to March 2023 were searched in PubMed, Scopus, Cochrane Oral Health’s Trials Register, and Web of Science databases. The risk of bias in the included studies was assessed using the Cochrane tool. Results: Nineteen articles were included in the review. Interventions were divided into four groups: educational interventions, oral &amp; dental health care interventions, chewing gum, and combined interventions. A total of 95 indicators were examined in the studies, 53 of which were not statistically significant. Regarding the overall effectiveness of the interventions, 10 studies reported them as completely effective, 5 studies as relatively effective, and 4 as ineffective. Chewing gum had the highest effectiveness. The results of the meta-analysis showed that the mean difference in the dental plaque index between the intervention and control groups was -0.65 (95% CI; -2.03%, 0.74%, Q=59.6, df=5, P=0.001, I2=97.8%) the mean difference in the denture plaque index was -0.20 (95% CI; -0.38%, -0.02%, Q=3.22, df=3, P=0.36, I2=21.3%), and the mean difference in the gingival index was -0.36 (95% CI; -0.99%, 0.27%; Q=5.2, df=1, P=0.02, I2=80.9%). Conclusion: There are no clear advantages or evidence about the effectiveness of community-based interventions in improving the oral &amp; dental health of elderly people.

Meta-analysis of community-based interventions on fruits and vegetables consumption in adults

PurposeDespite the well-known positive effects of fruits and vegetables, their consumption in many countries is lower than those recommended. This study aims to systematically examine the effects of community-based interventions on fruits and vegetables consumption in adults.Design/methodology/approachTo collect relevant publications, the authors searched electronic databases including PubMed/MEDLINE, Scopus and Web of Science from January 2000 to July 2021. Considering random models, this study analyzed the data using weighted mean differences (WMD) and 95% confidence intervals (CI).FindingsAmong 1,621 retrieved publications, 21 articles met the inclusion criteria. The overall effect size demonstrated that, at the end of the trials, the educational interventions increased the consumption of aggregated fruits and vegetables (WMD: 0.55 serving/day, 95%CI: 0.34, 0.77), and vegetables (WMD: 0.15, 95%CI: 0.09, 0.21, I2: 33.2%; p = 0.103) in the intervention groups, compared to the control groups.Practical implicationsThe subgroup analyses that were based on the type of interventions (face-to-face education compared to online interventions), location (home-based compared to the other types of interventions) and duration (24 weeks and higher) of interventions, and accompanied financial support reduced between-group heterogeneity. An efficient interventional program on increasing fruits and vegetables consumption should be part of a multi-component project.Originality/valueTo the best of the authors’ knowledge, no systematic review and meta-analysis has provided a summary of the effects of community-based interventions on fruits and vegetables consumption in adult populations, and there is no fixed conclusion that could be drawn in this regard.

Stress Among the Adult Population During COVID-19 Pandemic in Kedah, Malaysia: Association Between Sociodemographics and the Movement Control Order Period.

Background The COVID-19 pandemic has led to a significant increase in the prevalence of stress worldwide. However, the extent and factors associated with psychological distress during COVID-19 among the local population in Kedah, Malaysia, have not been adequately explored. This study aimed to determine the prevalence and factors associated with stress among the adult population in Kedah, Malaysia, during the COVID-19 pandemic. Materials and methods We conducted a cross-sectional study using a retrospective record review. A simple random sampling was applied among the adult population of Kedah who were screened for mental health well-being from January 2021 until March 2022. A proforma checklist that consists of sociodemographic and clinical factorsand the date of screening was used to collect the data. A descriptive and multiple logistic regression was conducted, and analysis was done by SPSS version 26 (IBM Inc., Armonk, New York). The dependent variables were the presence of stress incorporated self-reported symptoms ranging from mild to very severe. The independent variables were sociodemographic, clinical factors, and movement control order period, which refers to the period when the state of Kedah experienced all the different phases of movement control order (MCO), which were from 1 January 2021 until 28 June 2021. Results In total, 562 adults were included. The mean age was 31.75 years, and the majority were female (69.6%). The prevalence of stress was 45.7% (95% CI 41.6%, 49.8%), with a total of 257 people. The majority of them did not have stress, consisting of 305 people (54.3%), followed by 69 people (12.3%) who reported severe stress, 67 people (11.9%) who reported moderate, 66 people (11.7%) who reported mild, and 55 people (9.8%) who reported very severe stress. The significant factor associated with stress among the adult population in Kedah, Malaysia, during the COVID-19 pandemicwas the female gender (Adj OR 3.035 95% CI: 2.007 to 4.591, p-value <0.001). Being unemployed (Adj OR 2.171 95% CI: 1.480 to 3.185, p-value <0.001) and being under movement control order period was also associated with stress (Adj OR 0.383 95% CI: 0.264 to 0.555, p-value <0.001). Conclusion The prevalence of stress among the adult population during the COVID-19 pandemic in Kedah was 45.7%, with a total of 257 people, higher than other studies. Being female and unemployed wasassociated with stress, while the movement control order period was a protective factor against stress. Preventive strategies should be tailored based on the vulnerabilities of these groups, such as the development of more effective community-based interventions for safeguarding the mental health of the general public during future pandemics.

1.35 CHATogether is an Effective and Adaptable Community-Based Intervention for Addressing Asian American Mental Health Needs: A Mixed Methods Study

1.35 CHATogether is an Effective and Adaptable Community-Based Intervention for Addressing Asian American Mental Health Needs: A Mixed Methods Study

Vitalizing Community for Health Promotion Against Modifiable Risk Factors of Noncommunicable Diseases (V-CaN) in Rural Central India: Protocol for a Hybrid Type II Implementation Effectiveness Trial.

Low- and middle-income countries are facing the emerging burden of chronic noncommunicable diseases (NCDs). Apart from loss of human lives and premature deaths, NCDs result in huge costs for treatment to individuals and the health system. Although NCDs develop in later life, the risk factors begin at an early age. The key to the control of the global epidemic of NCDs is primary prevention based on comprehensive community-based programs. This study aims to develop, implement, and evaluate the effect of a participatory health promotion initiative utilizing the existing mechanisms of Village Health Nutrition and Sanitation Committees (VHNSCs), women's self-help groups (SHGs), and schools on modifiable risk factors for NCDs among young people aged 10-30 years. The proposed type II hybrid effectiveness implementation cluster randomized field trial will be conducted in the catchment area of 4 primary health centers (PHCs) in Wardha district, India, comprising 100 villages with a population of 144,000. Each PHC will be randomly allocated to one of the 3 intervention arms or the control arm. The 3-intervention arm PHCs will utilize a unique strategy with either VHNSC or SHG members or school students as change agents for health action against common modifiable NCD risk factors. This study will be implemented in 3 phases from January 2022 to December 2024. First, the preparatory phase for baseline assessments includes anthropometry, behavioral and biochemical risk factors for NCDs, and participatory development of the health promotion intervention modules. Second, the implementation phase will focus on capacity building of the change agents and implementation of the participatory health promotion initiative. The implementation will include organization of community-based events, 6-monthly participatory assessment of change, and preparation of a sustainability and exit plan toward the end of this phase. Third, the evaluation phase will consist of studying the effectiveness of each intervention strategy in the reduction of risk factor prevalence at the population level. We will assess 12,000 (3000 in each arm) randomly selected individuals for behavioral risk factors and 1600 (400 in each arm) individuals for biochemical risk factors during baseline as well as endline assessments. Difference in differences, ANOVA or multivariate analysis of covariance, and regression analysis will be performed to assess the effectiveness of the interventions. Qualitative methods such as focus group discussions and stories of change will be documented and analyzed using thematic framework analysis. The implementation outcomes will be reported using the PRISM (Practical Robust Implementation and Sustainability Model) RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. The results are expected to be published by mid-2025. This study will show the magnitude of risk factors for NCDs, its determinants, feasibility, effectiveness of community-based interventions, and health promotion models for NCD prevention. Clinical Trials Registration India CTRI/2020/10/028700; https://ctri.nic.in/Clinicaltrials/showallp.php?mid1=47597&EncHid=&userName=V-CaN. DERR1-10.2196/42450.

The impact of the residential environment on Chinese older people's aging-in-place intentions: A mediation and moderation analysis

Aging populations around the world are growing rapidly. Older people prefer to age in place, but they have health needs that require environmental support at the community level. Drawing on Sen's capability approach, we argue that as chronic conditions are inevitable when older people become frail, the policy should focus on providing conversion factors to support older people's capabilities to live independently. The empirical studies, therefore, investigate how residential environment characteristics as conversion factors influence aging-in-place intentions. This study conceptualizes the aging-in-place concept as an intention predicted by three constructs of the theory of planned behavior (TPB) (attitude, subjective norm, and perceived behavioral control). Drawing on a survey of older respondents in Beijing, this study used mediation and moderation analysis to examine the effects of environmental conversion factors on aging-in-place intentions, particularly if these factors increase the perceived behavioral control to live independently. The results show that home accessibility and meeting opportunities positively correlate with aging-in-place intentions. Three TPB components fully mediate such positive effects, with perceived behavioral control having the largest mediation effect. Additionally, meeting opportunities are more influential on aging-in-place intentions for non-frail older adults due to the more significant influence meeting opportunities have on their perceived behavioral control. The results contribute to understanding how the residential environment supports aging in place by supporting older people's capabilities. The results can be used to provide policy recommendations for developing more effective community-based interventions for older people.

Household food waste generation during COVID-19 pandemic and unprecedented economic crisis: The case of Lebanon

BackgroundThe COVID-19 pandemic has interrupted economies and food systems globally, leading to substantial consequences on food waste, which is also influenced by political and economic factors. To date, information on the attitudes and behaviors of households regarding food waste generation in developing countries like Lebanon, witnessing a multifaceted economic and COVID-19 crisis, is scarce. Previous studies reported that around one third of the food produced in Lebanon gets lost or wasted. This study aims to update the attitudes and behaviors determining household food waste in Lebanon in light of the COVID-19 pandemic and unprecedented economic crisis. MethodsParticipants (n = 1251) from the five governorates of the country filled out a structured questionnaire composed of 3 sections and 31 questions. The variable “eat everything prepared” was used as a proxy for food waste. The effects of different socio-behavioral and demographic characteristics on household food waste generation in the country were estimated using a Logistic regression on STATA. ResultsMost participants (69%) reported that the economic crisis had a greater impact on their food shopping and eating behaviors compared to the COVID-19 pandemic. In comparison, 65% reported that their household food waste generation did not change because of the COVID-19 pandemic, and 47% reported that their household food waste generation decreased because of the economic crisis. Employment status, income, educational level, and the number of householders did not affect food waste generation. Feelings of guilt, thinking of ways to use leftovers, and frequent preparation of more dishes were negatively associated with food waste generation while eating out and buying special offers showed the opposite effect. ConclusionOur findings provide a better understanding of more effective community-based food waste-related interventions in Lebanon. Future research is still needed to explain the medium and long-term effects of COVID-19 and the economic crisis on food waste-related behaviors in the country since the behavioral changes uncovered in the current study might be temporary during the pandemic and the economic crisis and not permanent. This issue should be verified in the future using longitudinal surveys.

Pneumonia knowledge and care seeking behavior for children under-five years in Jigawa, Northwest Nigeria: a cross-sectional study.

Between 2013 and 2022, Nigeria did not meet globally defined targets for pneumonia control, despite some scale-up of vaccinations, oxygen and antibiotics. A deliberate focus on community-based programs is needed to improve coverage of protective, preventive and treatment interventions. We therefore aimed to describe caregiver knowledge and care seeking behaviour for childhood pneumonia, in a high child mortality setting in Nigeria, to inform the development of effective community-based interventions for pneumonia control. We conducted a cross-sectional household survey in Kiyawa Local Government Area, Jigawa State, Nigeria between December 2019 and March 2020. We asked caregivers about their knowledge of pneumonia symptoms, prevention, risks, and treatment. A score of 1 was assigned for each correct response. We showed them videos of pneumonia specific symptoms and asked (1) if their child had any respiratory symptoms in the 2-weeks prior; (2) their subsequent care-seeking behaviour. Multivariate regressions explored socio-demographic and clinical factors associated with care seeking. We surveyed 1,661 eligible women, with 2,828 children under-five. Only 4.9% of women could name both cough and difficulty/fast breathing as pneumonia symptoms, and the composite knowledge scores for pneumonia prevention, risks and treatment were low. Overall, 19.0% (536/2828) of children had a report of pneumonia specific symptoms in the prior two-weeks, and of these 32.3% (176/536) were taken for care. The odds of care seeking was higher among children: with fever (AOR:2:45 [95% CI: 1.38-4.34]); from wealthiest homes (AOR: 2:13 [95% CI: 1.03-4.38]) and whose mother first married at 20-26 years compared to 15-19 years (AOR: 5.15 [95% CI: 1.38-19.26]). Notably, the caregiver's knowledge of pneumonia was not associated with care seeking. While some socio-demographic factors were associated with care seeking for children with symptoms of Acute Respiratory Infection (ARI), caregiver's knowledge of the disease was not. Therefore, when designing public health interventions to address child mortality, information-giving alone is likely to be insufficient.

A systematic review of the effectiveness of community-based interventions aimed at improving health literacy of parents/carers of children.

The aim of this systematic review was to examine the effectiveness of community-based health literacy interventions in improving the health literacy of parents. A systematic review of six databases - MEDLINE, PsycINFO, CINAHL, Cochrane Library, Embase, and Education Source - was conducted to identify relevant articles. Risk of bias was assessed using version two of the Cochrane risk of bias tool for randomised controlled trials or the Cochrane collaboration risk of bias in non-randomised studies of interventions. The study findings were grouped and synthesised following the synthesis without meta-analysis framework. Eleven community-based health literacy interventions for parents were identified. Study design included randomised controlled trials (n = 4), non-randomised studies with comparison group (n = 4), and non-randomised studies without a comparison group (n = 3). Interventions were delivered digitally, in person or a combination of the two. The risk of bias was high in over half the studies (n = 7). The main findings of the studies showed some potential for both in person and digital interventions to increase parental health literacy. Studies were heterogeneous preventing a meta-analysis. Community-based, health literacy interventions have been identified as potential methods for enhancing parental health literacy. Due to the small number of included studies and their potential for bias, these results must be interpreted with caution. This study emphasises the need for additional theory and evidence-based research on the long-term effects of community interventions.