Engagement Of Community Leaders Research Articles

Preventive Nursing, Community Engagement, Health Promotion: The Pathway to Improving Health Care in Nigeria

The article explores the many obstacles that the Nigerian healthcare system encounters and suggests a holistic strategy that includes preventive nursing, health promotion, and community participation to improve healthcare provision. The research underscores the significance of community participation, emphasising its function in cultivating a feeling of affiliation and possession, as well as establishing a connection between the community and healthcare programmes. The text extensively examines the notion of preventative nursing, highlighting its multiple character as both a specialised nursing practice and a subject rooted in public health. The objectives and constituents of preventive nursing are delineated, highlighting its function in timely identification, proactive interventions, and its influence on national health results. Health promotion is presented as a vital component of healthcare reforms, with the goal of enabling people to make knowledgeable decisions about their well-being. The article outlines the objectives of health promotion, with a particular focus on minimising risk factors and encouraging a proactive approach to maintaining good health. The text discusses strategies for efficacious health promotion in Nigeria, including the engagement of community leaders and the use of both conventional and digital approaches. The text examines the notion of community participation, characterising it as a multifaceted and all-encompassing process that entails a dynamic interchange of ideas and resources among many stakeholders. The research highlights the significance of active community engagement in decision-making processes, emphasising its role in fostering inclusivity and collaborative decision-making. The paper finishes by underscoring the crucial significance of nurses in the domains of preventive nursing, health promotion, and community involvement. This highlights the need of adopting a comprehensive and interdisciplinary strategy to tackle the difficulties encountered by the healthcare system in Nigeria. The report promotes urgent and cooperative measures, emphasising the potential of the suggested ways to improve healthcare in Nigeria.

Building Community Health Literacy with a Social Network Perspective

Abstract Background The COVID-19 pandemic underscored the vital importance of health literacy to combat misinformation, increase trust, and ensure health equity. Health literacy is a collective responsibility, including for organizations to “equitably enable individuals to find, understand, and use information and services.” This presentation will share key insights concerning health literacy in a social context. from a 2-year regional effort to build a sustainable, health literate community by growing trusted, multi-sectorial partnerships, relationships, and networks. Methods Advancing Health Literacy Franklin County is a 2-year project initiated in June 2021 with a goal of building a sustainable, health literate community in Franklin County, Ohio, USA. The project is a collaboration among public health departments, health care organizations, an academic institution, and community organizations. Evaluations include social network analysis of organizational relationships over time, training outcomes, validated organizational health literacy (OHL) measures, and key informant interviews. Results Social network analysis show growth in the number of engaged organizations and stronger ties in these relationships. Training outcomes reveal increased knowledge, skills, and recognition of the importance of health literacy. OHL measures show engagement and improved capacity. Key informant interviews highlight the importance of the social perspective for health literacy. Conclusions Considering health literacy in a social context is important to building community-level health literacy in a sustainable way, including networks of organizations working together and the engagement of community leaders to share trusted, community relevant health information in their professional and personal social networks. Insights from this real-world implementation can inform future practice, policy, and research.

Effects of Farmers-Herders Clashes on the Supply and Demand of Foodstuffs: A Case Study of Selected States in Nigeria

The study examined the effects of farmers-herders clashes on foodstuffs supply and demand in Nigeria with special reference to Oyo, Benue, and Ebonyi States in Nigeria. The institutional and environmental factors influencing the clashes, associated effects on foodstuffs supply and demand, and the relevance of management options including modern cattle ranching were explored with the use of the descriptive research approach. The study employed well-structured questionnaire to collect data from 582 farmers in villages across the States. Findings of the study indicated that the farmers-herders clashes involving conflicts over land, water resources, and grazing continue to have significant effect on foodstuffs supply and demand in Nigeria. These have affected agricultural activities and the overall food production system in Nigeria. Addressing these clashes requires a holistic and multi-faceted approach that involves collaboration among government agencies, local communities, civil society organisations, and international partner through careful planning, community engagement, and focus on sustainability to ensure long-term benefits for both food production and economic development. The study therefore recommends Government active adoption of a bottom-top approach to policy decisions that facilitate dialogue and mediation between farmers and herders through engagement of community leaders, religious figures, and local authorities to hold the clashes at bay and sustainably increase foodstuffs supply and demand in Nigeria. Keywords: Foodstuffs, Clashes, Herders, Farmers. Demands, Supply, Nigeria Journal Reference Format: Adewale, A.O. & Ishaku, A. (2023): Effects of Farmers-Herders Clashes on the Supply and Demand of Foodstuffs: A Case Study of Selected States in Nigeria. Humanities, Management, Arts, Education & the Social Sciences Journal. Vol. 11. No. 3, Pp 59-68. www.isteams.net/humanitiesjournal. dx.doi.org/10.22624/AIMS/HUMANITIES/V11N3P5

A scoping review of facilitators and barriers influencing the implementation of surveillance and oral cholera vaccine interventions for cholera control in lower- and middle-income countries

BackgroundCholera still affects millions of people worldwide, especially in lower- and middle-income countries (LMICs). The Global Task Force on Cholera Control (GTFCC) has identified surveillance and oral cholera vaccines as two critical interventions to actualise the global roadmap goals—reduction of cholera-related deaths by 90% and decreasing the number of cholera endemic countries by half by 2030. Therefore, this study aimed to identify facilitators and barriers to implementing these two cholera interventions in LMIC settings.MethodsA scoping review using the methods presented by Arksey and O’Malley. The search strategy involved using key search terms (cholera, surveillance, epidemiology and vaccines) in three databases (PubMed, CINAHL and Web of Science) and reviewing the first ten pages of Google searches. The eligibility criteria of being conducted in LMICs, a timeline of 2011–2021 and documents only in English were applied. Thematic analysis was performed, and the findings were presented according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension.ResultsThirty-six documents met the predefined inclusion criteria, covering 2011 to 2021. There were two themes identified regarding the implementation of surveillance: timeliness and reporting (1); and resources and laboratory capabilities (2). As for oral cholera vaccines, there were four themes identified: information and awareness (1); community acceptance and trusted community leaders (2); planning and coordination (3); and resources and logistics (4). Additionally, adequate resources, good planning and coordination were identified to be operating at the interface between surveillance and oral cholera vaccines.ConclusionFindings suggest that adequate and sustainable resources are crucial for timely and accurate cholera surveillance and that oral cholera vaccine implementation would benefit from increased community awareness and engagement of community leaders.

Barriers and Facilitators to COVID-19 Vaccine Uptake among Polish Patients: A Qualitative Interview Study

The decision to receive a COVID-19 vaccine is influenced by a variety of individual and contextual factors. However, there are very few studies that analyse individual vaccination decisions using a qualitative methodology. To close this gap, we conducted a qualitative interview study to examine the opinions and experiences with the vaccine among patients previously hospitalized due to COVID-19, including barriers and facilitators to vaccine uptake. An exploratory qualitative study, using semi-structured telephone interviews, was conducted among 22 patients admitted for COVID-19 in Poland in 2022. Opinions of patients previously hospitalized with COVID-19 on vaccination were varied. Barriers to COVID-19 vaccine uptake stemmed from concerns about vaccine safety, patients' religious beliefs, and negative stories. High disease severity and anxiety over personal and family health were important arguments in favour of receiving the COVID-19 vaccine. The study findings indicated the need for ongoing health education by healthcare staff as well as coordination and integration of multi-sectoral institutional measures regarding COVID-19 prevention strategies as well as increased public health initiatives on social media and engagement of community leaders for awareness about vaccines and vaccination. It is crucial to build trust in COVID-19 vaccinations among the general public by disseminating reliable information through trustworthy and credible sources. However, it ought to be emphasised that, regardless of the measures taken, some individuals will remain unconvinced about receiving a COVID-19 vaccine.

Results of community-based TB and HIV screening among transgender women and male sex workers in Pakistan.

In Pakistan and globally, a large proportion of people with TB who are not receiving treatment are key populations with poor access to diagnosis and care. Transgender women and male sex workers (MSW) are heavily stigmatized and marginalized groups. While HIV rates are well documented among these key populations, little such data exists for TB. We engaged local organizations working with transgender women and MSW communities in Karachi and five urban cities in Sindh Province. People from the communities served as screening facilitators and treatment supporters. Verbal screening was followed by testing with Xpert MTB/RIF and HIV testing was offered. People with TB were supported through treatment. We screened 18,272 transgender women and 24,253 MSW. 8,921 (21.0%) individuals had presumptive TB and 7,472 (83.8%) provided sputum samples. We detected 438 (5.9%) people with positive results including 140 transgender women and 298 MSW. Including people diagnosed clinically, 625 people with TB were identified and 98.1% initiated treatment. Overall, 1.5% of people screened had TB, 1.7% among MSW and 1.1% among transgender women. Of 1,508 people tested for HIV, 243 had HIV infection (HIV+). The rates of TB among HIV+ transgender women (8.8%) were slightly lower than among MSW (10.3%). Previously, few attempts have been made to address TB in transgender women and MSW. Our work shows that these groups carry a significant burden of both TB and HIV in Pakistan and do not regularly access services. Effective interventions should include the engagement of community leaders and peers.

Barriers and Facilitators to Accessing Digital Health Tools Faced by South Asian Canadians in Surrey, British Columbia: Community-Based Participatory Action Exploration Using Photovoice.

BackgroundSouth Asian community members in Canada experience a higher burden of chronic disease than the general population. Digital health innovations provide a significant opportunity to address various health care challenges such as supporting patients in their disease self-management. However, South Asian community members are less likely to use digital tools for their health and face significant barriers in accessing them because of language or cultural factors.ObjectiveThe aim of this study is to understand the barriers to and facilitators of digital health tool uptake experienced by South Asian community members residing in Canada.MethodsThis study used a qualitative community-based participatory action research approach. Residents from Surrey, British Columbia, Canada, who spoke 1 of 4 South Asian languages (Hindi, Punjabi, Urdu, or Tamil) were invited to participate in focus group discussions. A subsample of the participants were invited to use photovoice methods in greater depth to explore the research topics.ResultsA total of 197 participants consented to the focus group discussions, with 12 (6.1%) participating in the photovoice phase. The findings revealed several key obstacles (older age, lack of education, and poor digital health literacy) and facilitators (social support from family or community members and positive attitudes toward technology) to using digital health tools.ConclusionsThe results support the value of using a community-based participatory action research approach and photovoice methods to engage the South Asian community in Canada to better understand digital health competencies and needs. There were several important implications for policy makers and future research, such as continued engagement of community leaders by health care providers and administrators to learn about attitudes and preferences.

How Do Rural Communities Sustain Sanitation Gains? Qualitative Comparative Analyses of Community-Led Approaches in Cambodia and Ghana

Community-led Total Sanitation (CLTS) is a popular intervention for eliminating open defecation in rural communities. Previous research has explored the contextual and programmatic factors that influence CLTS performance. Less is known about the community-level conditions that sustain latrine coverage and use. We hypothesized three categories of community conditions underlying CLTS sustainability: (i) engagement of community leaders, (ii) follow-up intensity, and (iii) support to poor households. We evaluated these among communities in Cambodia and Ghana, and applied fuzzy-set Qualitative Comparative Analysis (fsQCA) to identify combinations of conditions that influenced current latrine coverage and consistent latrine use. In Cambodia, latrine coverage was highest in communities with active commune-level leaders rather than traditional leaders, and with leaders who used casual approaches for promoting latrine construction. Latrine use in Cambodia was less consistent among communities with intense commune engagement, higher pressure from traditional leaders, high follow-up and high financial support. In Ghana, by contrast, active leaders, high follow-up, high pro-poor support, and continued activities post-implementation promoted latrine coverage and consistent use. The different responses to CLTS programming emphasize that rural communities do not have homogenous reactions to CLTS. Accounting for community perceptions and context when designing community-led interventions can foster long-term sustainability beyond short-term achievement.

Project ACCLAIM: Intervention Effect on Community Knowledge, Attitudes and Beliefs of Maternal and Child Health and HIV/AIDS in Eswatini, Uganda and Zimbabwe

The ACCLAIM Study aimed to assess the effect of a package of community interventions on the demand for, uptake of, and retention of HIV-positive pregnant/postpartum women in maternal and child health (MCH) and prevention of mother-to-child HIV transmission (PMTCT) services. The study occurred from 2013 to 2015 in Eswatini, Uganda, and Zimbabwe. The three interventions were: (1) a social learning and action component for community leaders, (2) community days, and (3) peer discussion groups. Household cross-sectional surveys on community members’ MCH and PMTCT knowledge, attitudes, and beliefs were analyzed pre- and post-intervention, using MCH, HIV stigma, and gender-equitable men (GEM) indicators. We used t-tests to measure the significance of mean pre- vs. post-intervention score changes stratified by gender within each intervention arm and generalized linear models to compare mean score changes of the cumulative intervention arms with the community leaders-only intervention. Response rates were over 85% for both surveys for men and women, with a total of 3337 pre-intervention and 3162 post-intervention responses. The combined package of three interventions demonstrated a significantly greater increase in MCH scores for both women (diff = 1.34, p ≤ 0.001) and men (diff = 2.03, p < 0.001). The arms that included interventions for both community leader engagement and community days (arms 2 and 3)led to a greater increase in mean GEM scores compared to the community leader engagement intervention alone (arm 1), for both women (diff = 1.32, p = 0.002) and men (diff = 1.37, p = 0.004). Our findings suggest that a package of community interventions may be most effective in increasing community MCH/HIV knowledge and improving gender-equitable norms.

Access to maternal-child health and HIV services for women in North-Central Nigeria: A qualitative exploration of the male partner perspective.

BackgroundIn much of sub-Saharan Africa, male partners play influential roles in women's access to maternal-child healthcare, including prevention of mother-to-child transmission of HIV services. We explored male partner perspectives on women’s access to maternal-child healthcare in North-Central Nigeria.MethodsThree focus groups were conducted with 30 men, purposefully-selected on the basis of being married, and rural or urban residence. Major themes explored were men’s maternal-child health knowledge, gender power dynamics in women’s access to healthcare, and peer support for pregnant and postpartum women. Data were manually analyzed using Grounded Theory, which involves constructing theories out of data collected, rather than applying pre-formed theories.ResultsMean participant age was 48.3 years, with 36.7% aged <40 years, 46.7% between 41 and 60 years, and 16.6% over 60 years old. Religious affiliation was self-reported; 60% of participants were Muslim and 40% were Christian. There was consensus on the acceptability of maternal-child health services and their importance for optimal maternal-infant outcomes. Citing underlying patriarchal norms, participants acknowledged that men had more influence in family health decision-making than women. However, positive interpersonal couple relationships were thought to facilitate equitable decision-making among couples. Financial constraints, male-unfriendly clinics and poor healthcare worker attitudes were major barriers to women’s access and male partner involvement. The provision of psychosocial and maternal peer support from trained women was deemed highly acceptable for both HIV-positive and HIV-negative women.ConclusionsStrategic engagement of community leaders, including traditional and religious leaders, is needed to address harmful norms and practices underlying gender inequity in health decision-making. Gender mainstreaming, where the needs and concerns of both men and women are considered, should be applied in maternal-child healthcare education and delivery. Clinic fee reductions or elimination can facilitate service access. Finally, professional organizations can do more to reinforce respectful maternity care among healthcare workers.

Implementing nationwide measles supplemental immunization activities in Ethiopia in the context of COVID-19: process and lessons learnt.

The COVID-19 pandemic has disrupted immunization activities in many countries, causing declines in the delivery of routine doses of antigens, and the postponement of scheduled supplemental immunization activities (SIAs). Following the declaration of the pandemic, Ethiopia postponed nationwide follow-up measles preventive vaccination campaign which was scheduled for April 2020. The disruptions to routine services and the postponement of the SIAs increased the risk for measles outbreaks. The national authorities, in consultation with the secretariat of the National COVID-19 Pandemic Prevention and Control Ministerial Coordination Committee, subnational level authorities, technical partner agencies and stakeholders, reviewed the risks for measles outbreaks and decided to implement the nationwide measles SIAs, with strict implementation of COVID prevention measures. The revised micro-plans accommodated the additional human resource and logistics needs for COVID prevention, for which partner resources were mobilized to fill the gaps. The key SIAs preparatory and implementation activities including training, logistics, social mobilization, service delivery and supervision were modified to take into consideration the COVID context. Infection prevention and control supplies were procured and distributed as a package with the bundled vaccines and other supplies. The SIAs were completed in July 2020 and reached 102.8% administrative coverage nationwide, with 78% of the 1123 woredas attaining the target of 95% coverage. The strong commitment of the leadership, the coordination role of the national and regional COVID prevention and control taskforces, the engagement of community leaders, the use of multi-channel communication, the timely availability of additional resources and modification of the service delivery approaches contributed to the success of the SIAs.

Implementing nationwide measles supplemental immunization activities in Ethiopia in the context of COVID-19: process and lessons learnt

The COVID-19 pandemic has disrupted immunization activities in many countries, causing declines in the delivery of routine doses of antigens, and the postponement of scheduled supplemental immunization activities (SIAs). Following the declaration of the pandemic, Ethiopia postponed nationwide follow-up measles preventive vaccination campaign which was scheduled for April 2020. The disruptions to routine services and the postponement of the SIAs increased the risk for measles outbreaks. The national authorities, in consultation with the secretariat of the National COVID-19 Pandemic Prevention and Control Ministerial Coordination Committee, subnational level authorities, technical partner agencies and stakeholders, reviewed the risks for measles outbreaks and decided to implement the nationwide measles SIAs, with strict implementation of COVID prevention measures. The revised micro-plans accommodated the additional human resource and logistics needs for COVID prevention, for which partner resources were mobilized to fill the gaps. The key SIAs preparatory and implementation activities including training, logistics, social mobilization, service delivery and supervision were modified to take into consideration the COVID context. Infection prevention and control supplies were procured and distributed as a package with the bundled vaccines and other supplies. The SIAs were completed in July 2020 and reached 102.8% administrative coverage nationwide, with 78% of the 1123 woredas attaining the target of 95% coverage. The strong commitment of the leadership, the coordination role of the national and regional COVID prevention and control taskforces, the engagement of community leaders, the use of multi-channel communication, the timely availability of additional resources and modification of the service delivery approaches contributed to the success of the SIAs.

Culturally Safe Didactic Dialogue Circles: Student and Cultural Community Leader Engagement.

Culturally Safe Didactic Dialogue Circles: Student and Cultural Community Leader Engagement.

Risk communication during disease outbreak response in post-Ebola Liberia: experiences in Sinoe and Grand Kru counties.

IntroductionLessons learned from the Ebola virus disease (EVD) outbreak enabled Liberia to develop a health plan for strengthening public health capacity against potential public health threats. risk communication is one of the core pillars that provide life-saving information and knowledge for the public to take preventive and proactive actions against public health threats. These were applied in response to the post-ebola meningococcal septicemia and meningitis outbreaks in Sinoe and Grand Kru counties. This paper documents risk communication experiences in these post-ebola outbreaks in Liberia.MethodsRisk Communication and health promotion strategies were deployed in developing response plans and promptly disseminating key messages to affected communities to mitigate the risks. Other strategies included engagement of community leaders, partnership with the media and dissemination of messages through the community radios, active monitoring community risk perceptions and compliance, rumor management, mobile stage and interpersonal communication (IPC) during the Meningococcal disease outbreaks in Sinoe and Grand Kru counties.ResultsIn Sinoe, about 36,891 households or families in 10 health districts were reached through IPC and dialogue. Circulating rumors such as “Ebola” was the cause of deaths was timely and promptly mitigated. There was increased trust and adherence to health advice including prompt reporting of sick people to the nearest health facility in the two counties.ConclusionRisk communication and health promotion encouraged community support and involvement in any response to public threats and events. No doubt, risk communication and health promotion play an important role in preparedness and response to public health emergencies.

Leadership In Community Public-Private Partnership Health And Social Care Initiatives

Although the public–private partnerships in health have been adopted as the best pathway to improving health outcomes in many developing nations, implementation lacks collaborative leadership. The purpose of this empirical qualitative case study was to determine key factors that promote leadership synergy (LS) between partners that enhance ownership and accountability of community health and social initiatives in Tanzania. The diffusion of innovation theory and public–private integrated partnership module were the theoretical framework guided this study. Diffusion of innovation theory is based on the importance of effective communication to spread new ideas and foster change in behavior in a social group such as public and private partnership integrations (Roger, 2003). Twenty-six participants responded to in-depth, one-on-one interviews and the related documents were reviewed. With the use of directed content analysis and NVivo program, six themes emerged. Findings confirmed that integrated supportive supervision, teamwork, and strategic communications promote partnership LS. On the other hand, findings also showed that unclear roles and responsibilities, weak data, and limited understanding of the benefits of public–private partnerships at the community level hinder ownership and accountability. The potential positive social change of this study includes improving LS that promotes community leader engagement and ultimately improving access and use of community health and social programs in Tanzania.

Strategies to improve male involvement in PMTCT Option B+ in four African countries: a qualitative rapid appraisal

BackgroundThe World Health Organization recommends that antiretroviral therapy be started as soon as possible, irrespective of stage of HIV infection. This ‘test and treat’ approach highlights the need to ensure that men are involved in prevention of mother-to-child HIV transmission (PMTCT). This article presents findings from a rapid appraisal of strategies to increase male partner involvement in PMTCT services in Uganda, Democratic Republic of Congo, Malawi, and Côte d'Ivoire in the context of scale-up of Option B+ protocol.DesignData were collected through qualitative rapid appraisal using focus groups and individual interviews during field visits to the four countries. Interviews were conducted in the capital city with Ministry of Health staff and implementing partners (IPs) and at district level with district management teams, facility-based health workers and community health cadres in each country.ResultsCommon strategies were adopted across the countries to effect social change and engender greater participation of men in maternal, child and women's health, and PMTCT services. Community-based strategies included engagement of community leaders through dialogue and social mobilization, involving community health workers and the creation and strengthening of male peer cadres. Facility-based strategies included provision of incentives such as shorter waiting time, facilitating access for men by altering clinic hours, and creation of family support groups.ConclusionsThe approaches implemented at both community and facility levels were tailored to the local context, taking into account cultural norms and geographic regional variations. Although intentions behind such strategies aim to have positive impacts on families, unintended negative consequences do occur, and these need to be addressed and strategies adapted.A consistent definition of ‘male involvement’ in PMTCT services and a framework of indicators would be helpful to capture the impact of strategies on cultural and behavioral shifts. National policies around male involvement would be beneficial to streamline approaches across IPs and ensure wide-scale implementation, to achieve significant improvements in family health outcomes.

Evaluating the effectiveness of selected community-level interventions on key maternal, child health, and prevention of mother-to-child transmission of HIV outcomes in three countries (the ACCLAIM Project): a study protocol for a randomized controlled trial.

BackgroundEfforts to scale up and improve programs for prevention of mother-to-child transmission of HIV (PMTCT) have focused primarily at the health facility level, and limited attention has been paid to defining an effective set of community interventions to improve demand and uptake of services and retention. Many barriers to PMTCT are also barriers to pregnancy, childbirth, and postnatal care faced by mothers regardless of HIV status. Demand for maternal and child health (MCH) and PMTCT services can be limited by critical social, cultural, and structural barriers. Yet, rigorous evaluation has shown limited evidence of effectiveness of multilevel community-wide interventions aimed at improving MCH and HIV outcomes for pregnant women living with HIV. We propose to assess the effect of a package of multilevel community interventions: a social learning and action component, community dialogues, and peer-led discussion groups, on the demand for, uptake of, and retention of HIV positive pregnant/postpartum women in MCH/PMTCT services.Methods/designThis study will undertake a three-arm randomized trial in Swaziland, Uganda, and Zimbabwe. Districts/regions (n = 9) with 45 PMTCT-implementing health facilities and their catchment areas (populations 7,300–27,500) will be randomly allocated to three intervention arms: 1) community leader engagement, 2) community leader engagement with community days, or 3) community leader engagement with community days and male and female community peer groups. The primary study outcome is HIV exposed infants (HEIs) returning to the health facility within 2 months for early infant diagnosis (EID) of HIV. Secondary study outcomes include gestational age of women attending for first antenatal care, male partners tested for HIV, and HEIs receiving nevirapine prophylaxis at birth. Changes in community knowledge, attitudes, practices, and beliefs on MCH/PMTCT will be assessed through household surveys.DiscussionImplementation of the protocol necessitated changes in the original study design. We purposively selected facilities in the districts/regions though originally the study clusters were to be randomly selected. Lifelong antiretroviral therapy for all HIV positive pregnant and lactating women, Option B+, was implemented in the three countries during the study period, with the potential for a differential impact by study arm. Implementation however, was rapidly done across the districts/regions, so that there is unlikely be this potential confounding. We developed a system of monitoring and documentation of potential confounding activities or actions, and these data will be incorporated into analyses at the conclusion of the project. Strengthens of the study are that it tests multilevel interventions, utilizes program as well as study specific and individual data, and it is conducted under “real conditions” leading to more robust findings. Limitations of the protocol include the lack of a true control arm and inadequate control for the potential effect of Option B+, such as the intensification of messages as the importance of early ANC and male partner testing.Trial registrationClinicalTrials.gov (study ID: NCT01971710) Protocol version 5, 30 July 2013, registered 13 August 2013.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-016-1202-y) contains supplementary material, which is available to authorized users.

Enhancing the usefulness of results from economic evaluations of behavioral health interventions

The Ayala and Elder article succinctly summarizes the best practices for designing and evaluating social-behavioral interventions to reduce oral health disparities. As a community-based researcher, I would like to add a few points on design and implementation for consideration. I have always been impressed by the level of sophistication and knowledge of community members 1, 2. Community members know that researchers work to promote specific aims and are under pressure to deliver to their funders. Consequently, there is a chance that participation in focus groups and interview sessions could be biased by the belief that researchers have already defined what they want to hear. The Ayala and Elder paper describes many tools and models; however, to design outcome-driven interventions, researchers should engage with community members and listen to cues and stories. Focus groups and interviews, while useful, are not sufficient. Ayala and Elder state that “participants are not provided with a complete intervention to evaluate.” I advise that engaging community members in evaluation of the final intervention is necessary as well. The piecemeal development of an intervention does not portray the full scope of final outcomes to community members. It is imperative that after completing the development phase, focus groups and interviews should be organized to evaluate the acceptability of the full intervention. Building trust in community-based participatory research requires more than just engagement in the development phases of a study. The authors suggest inviting or preselecting community members to participate in focus groups or interviews. Although this is a standard approach in organizing focus groups, often these invitees are friends of staff, members of organizations with experience in dealing with researchers, or members of community centers or programs affiliated with universities which can result in significant selection bias. At worse, selected participants may give responses they believe the researchers want to hear. Another possible bias to consider is how different choices are presented to interviewees. For example, in a large study evaluating the utility of current and new interventions for toothache, a large representative sample was selected for one-to-one interviews at the participants' homes 1. The interviews indicated that the participants preferred a new treatment over conventional ones. Further exploration identified that the participants were providing the research team with answers that they thought the team preferred. Bias in design and execution can be subtle and require in-depth semi-structured interviews. A final suggestion is to engage the community members to think in “systems of interventions.” Logic models provide a great tool for engagement of community leaders 3. Adding this exercise to the design phase of a study would significantly enhance the acceptability, and maybe even the relevance of any intervention to underserved communities. Community-based research is difficult to plan and execute and most researchers are not well trained to work with and approach communities. Without an in-depth understanding of underserved communities, research to reduce disparities will have limited impact. The author has been the recipient of an NIDCR grant.

Exploring the Hypothesis of Ethnic Practice as Social Capital: Violence Among Asian/Pacific Islander Youth in Hawaii

Studies of youth violence have usually examined social capital using qualitative methods, but remain limited by small sample sizes. In addition, few studies examine violence among Asian/Pacific Islander (API) youth, even though they are one of the fastest-growing youth populations in the USA. To contribute to a better understanding of culture and ethnicity in youth violence among Asian Americans and Pacific Islanders by quantifying ethnic forms of social capital. We use an n = 326 sample of three API groups from Oahu, Hawaii. Defining social capital as ethnic practice, we test Filipino, Hawaiian and Samoan forms of youth social capital on intimate and non-intimate violence. Bivariate findings associate lower violence with language ability among Filipinos, coming-of-age practices among Hawaiians, and community leader engagement among Samoans. Multivariate tests showed language to be the strongest correlation. Bivariate tests also suggested potentially risky forms of social capital. results lead us to hypothesize that social capital that deliberately places individuals within their respective ethnic communities are risk-reducing, as are those that promote formal ethnic community structures. Those that formalize ethnic practice and social capital into commercial activities may be associated with higher risk of violence. Given the relatively small sample size and the exploratory approach for the present investigation, further research is needed to determine whether the findings can be replicated and to extend the findings of the present preliminary study.

Lessons learned engaging Hispanic communities in cancer research

1551 Background: Community involvement is critical to advance cancer education and prevention in minority communities. Researchers must be knowledgeable of the target community's basic cultural beliefs and linguistic needs. This study sought to identify the best approach for conducting community based cancer research in South Texas Hispanic communities. We report our experiences and lessons learned with participants and site recruitment and retention. Methods: We introduced a community based, culturally relevant breast and cervical cancer screening and early detection program, Esperanza y Vida, to address barriers and disparities in four border communities (urban, rural, colonia, and small border town). These areas represent the diverse South Texas Mexican American population in terms of language use, immigration status, and length of time in the US. Within these communities we recruited a grassroots community organization, faith-based health center, rural hospital district, and federally qualified health center. Results: Focus groups were conducted with women and men to assess knowledge, attitudes, and beliefs about women's cancers. To successfully recruit participants, we implemented various techniques to engage the community and establish sustainable relationships. These included community health worker recruitment of community members, traditional recruitment (flyers, posters, word of mouth), key community and cultural leader support, and discussions with local groups and health organizations. We and our community partners identified and overcame investigator/community barriers (lack of community knowledge, community integration into the research process, community understanding of research methods, reluctance to develop innovative approaches). Consequently, participants are eager to remain with the program and are individually and collectively mobilizing others to create a sustainable and durable program. Conclusions: 1. Cultural leader engagement worked best for participant recruitment in the small border town and colonia settings, while key community leader engagement was most effective in the small city urban and rural settings. 2. Research/community partners must identify and discuss project barriers regardless of the fear of creating discordance to reach solutions. No significant financial relationships to disclose.