Community Health Research Articles

Differences in community health nursing learning outcomes based on simulation modality

BackgroundVarious modalities of community health nursing simulation have been useful in improving confidence, communication, and meeting learning objectives. Research focusing on comparing community health nursing learning outcomes in simulation with standardized patients versus mannequins is limited. This study aimed to explore differences in clinical reasoning, clinical learning, knowledge, communication, self-confidence, and learner satisfaction among community health students participating in standardized patient simulation compared to mannequins. MethodsA cross-sectional study was conducted with a convenience sample of 66 prelicensure students in community health nursing. Students completed a pre- and post-knowledge quiz, Satisfaction with Simulation Experience scale, and a simulation evaluation survey. ResultsCompared to simulation with mannequins, clinical reasoning, clinical learning, knowledge, communication, realism, and learner satisfaction scores were significantly higher with standardized patient simulation. ConclusionsSimulation with standardized patients can be useful for increasing community health nursing knowledge while enhancing clinical reasoning and realism. Future research including larger samples and more comprehensive community health topics is needed.

Health Care Delivery Site- and Patient-Level Factors Associated With COVID-19 Primary Vaccine Series Completion in a National Network of Community Health Centers.

Objectives. To assess multilevel factors associated with variation in COVID-19 vaccination rates in a US network of community health centers. Methods. Using multilevel logistic regression with electronic health record data from ADVANCE (Accelerating Data Value Across a National Community Health Center Network; January 1, 2022-December 31, 2022), we assessed associations between health care delivery site-level (n = 1219) and patient-level (n = 1 864 007) characteristics and COVID-19 primary vaccine series uptake. Results. A total of 1 337 440 patients completed the COVID-19 primary vaccine series. Health care delivery site characteristics were significantly associated with lower series completion rates, including being located in non-Medicaid expansion states and isolated or rural communities and serving fewer patients. Patient characteristics associated with significantly lower likelihood of completing the vaccine series included being Black/African American or American Indian/Alaska Native (vs White), younger age, lower income, being uninsured or publicly insured (vs using private insurance), and having fewer visits. Conclusions. Both health care delivery site- and patient-level factors were significantly associated with lower COVID-19 vaccine uptake. Community health centers have been a critical resource for vaccination during the pandemic. (Am J Public Health. 2024;114(11):1242-1251. https://doi.org/10.2105/AJPH.2024.307773).

Assessment of Lifetime Risk for Cardiovascular Disease: Time to Move Forward.

Over the past decades, there has been a notable increase in the risk of Cardiovascular Disease (CVD), even among younger individuals. Policymakers and the health community have revised CVD prevention programs to include younger people in order to take these new circumstances into account. A variety of CVD risk assessment tools have been developed in the past years with the aim of identifying potential CVD candidates at the population level; however, they can hardly discriminate against younger individuals at high risk of CVD.Therefore, in addition to the traditional 10-year CVD risk assessment, lifetime CVD risk assessment has recently been recommended by the American Heart Association/American College of Cardiology and the European Society of Cardiology prevention guidelines, particularly for young individuals. Methodologically, the benefits of these lifetime prediction models are the incorporation of left truncation observed in survival curves and the risk of competing events which are not considered equivalent in the common survival analysis. Thus, lifetime risk data are easily understandable and can be utilized as a risk communication tool for Public Health surveillance. However, given the peculiarities behind these estimates, structural harmonization should be conducted in order to create a sex-, race-specific tool that is sensitive to accurately identifying individuals who are at high risk of CVD. In this review manuscript, we present the most commonly used lifetime CVD risk tools, elucidate several methodological and critical points, their limitations, and the rationale behind their integration into everyday clinical practice.

Advancing preventive health care for men across the lifespan.

Historically, cisgender men have been found to be reluctant to utilize healthcare services, particularly preventive care services. NPs can bridge this gap to address health disparities among men, who are more likely to develop life-threatening conditions and who generally face higher mortality at younger ages than women. Focusing on advancing preventive care among men strengthens family, community, and societal health, and the NP is crucial in fostering a culture of preventive care in this population. To help drive this change, use of a life-stage approach that incorporates a preventive care mindset is critical. The NP should tailor health strategies to each life phase to ensure that men receive the best preventive care possible across the lifespan.

Association Between Hypertensive Disorders of Pregnancy and Interval Neurocognitive Decline: An Analysis of the Hispanic Community Health Study/Study of Latinos.

Association Between Hypertensive Disorders of Pregnancy and Interval Neurocognitive Decline: An Analysis of the Hispanic Community Health Study/Study of Latinos.

Pharmacists in global primary healthcare systems: A comprehensive model for community health empowerment

Pharmacists play an increasingly important role in global primary healthcare systems, evolving from traditional dispensers to active participants in patient-centered care. This paper advocates for the stronger integration of pharmacists into healthcare teams to improve patient outcomes, medication adherence, and overall healthcare delivery. Through a comprehensive review, we examine the evolving role of pharmacists, the key challenges to their full integration, and the substantial opportunities they present, particularly in managing chronic diseases, providing preventative care, and enhancing patient education. We propose a model for empowering pharmacists to contribute more effectively to community health, especially in underserved areas. The paper also highlights the potential global impact of pharmacists in reducing healthcare costs, improving disease management, and promoting public health initiatives. Lastly, recommendations for future policy reforms, education enhancements, and research directions are offered to support the continued expansion of pharmacists' roles in primary healthcare systems worldwide.

Artificial Intelligence in public health: A case study

Artificial Intelligence technology has become an innovative tool in global healthcare that helps to manage various problems of scale and complexity. Its use in public health is multifaceted and multivariate extending across early outbreak detection, risk modeling and prediction, efficient vaccine logistics and administration, reducing health disparities, aiding assist in diagnosis, everyday monitoring of chronic diseases, telemedicine and virtual chatbots especially for elderly care, mental health and oncology patients, and community engagement. Despite these huge generational advantages, multiple challenges exist in data quality, security and misuse, individual privacy, contextual application, accountability and oversight and remain primary concerns for universal adoption of artificial intelligence. There is a need for safeguards and a global regulatory framework to responsibly harvest the benefits of artificial intelligence for the advancement of public and community health.

Factors of unmet dental care needs due to the time, economic, and physical constraints among older people

Objectives: We aim to identify factors associated with unmet dental care needs in older adults and explore the impact of time, economic and physical constraints on each. Methods: The analysis was based on the 2023 Community Health Survey. Statistical analyses were conducted using chi-square test and multinomial logistic regression for 65,952 people aged 65 years and older. Results: First, we looked whether subjects experienced unmet dental care needs and found that 8.4% did. Second, according to the type of unmet dental care needs, 54.1% of the time, economic, and physical constraints were economic constraints. Analyzing each of the time, economic, and physical constraints, we found that time constraints were associated with younger age. For economic constraints, lower education level and health security type of recipients in medical aid program were more likely to experience unmet dental care needs. In terms of physical constraints, those living in rural areas were more than three times more likely to experience unmet dental care needs than those living in urban areas. Conclusions: The results showed that time constraints were related to age, economic constraints were related to household income level, and physical constraints were related to residential area.

Innovative healthcare solutions for resource-limited settings expanding pharmaceutical care to remote populations

Access to essential healthcare and pharmaceutical services remains a significant challenge in resource-limited settings. This paper explores innovative strategies for expanding pharmaceutical care to remote populations, focusing on the integration of mobile health technologies and community-based interventions. Mobile health (mHealth) technologies, including telemedicine and mobile pharmacies, offer a cost-effective means of delivering healthcare services, enhancing access, and improving real-time monitoring. Community-based interventions, such as the deployment of community health workers, health education campaigns, and peer support groups, play a critical role in addressing healthcare disparities and improving health literacy and medication adherence. The paper also discusses the integration of pharmaceutical care models, emphasizing the importance of collaboration among healthcare providers, pharmacists, and community health workers. Future directions highlight emerging innovations like AI and blockchain technology, while policy recommendations emphasize the need for investment in healthcare infrastructure, professional training, and regulatory support. By leveraging these strategies and innovations, healthcare outcomes and equity in resource-limited settings can significantly improve.

Exploring the impact of obesity and community health programs on enhancing endometrial cancer detection among low-income and native American women through a public health lens

This review examines the intricate relationship between obesity, endometrial cancer detection, and the role of community health programs, with a particular focus on low-income and Native American populations. Obesity is identified as a significant modifiable risk factor for endometrial cancer, disproportionately affecting vulnerable communities, which exacerbates existing health disparities. The paper explores the epidemiological link between obesity and endometrial cancer, highlighting disparities in detection and the compounded risks faced by underserved populations. It also reviews the effectiveness of public health initiatives aimed at improving cancer screening rates and obesity prevention among these groups. Despite the progress made through various community health programs, substantial gaps remain, particularly in ensuring culturally competent, accessible, and sustainable care. A lack of longitudinal studies evaluating the long-term impact of these programs on cancer detection and obesity management underscores the need for more robust research. Additionally, social, psychological, and systemic barriers continue to hinder screening uptake, further perpetuating health inequities. This review concludes by emphasizing the need for integrated public health approaches that combine obesity prevention with cancer screening, as well as policy reforms to enhance healthcare access and provider availability in underserved communities. Recommendations are provided for future research that addresses these gaps, with the goal of improving early detection and overall health outcomes for low-income and Native American women.

11.F. Scientific session: If we build it, will they come? Evaluation of citywide park redesign and renovation in NYC

Abstract Urban environments, such as parks, play a crucial role in shaping the health of their residents. However, the relationship between parks and health remains inconclusive. This workshop will present findings from the Physical Activity and Redesigned Community Spaces (PARCS) Study that examined the community health impacts of the Community Parks Initiative (CPI), a citywide park equity initiative of the New York City Department of Parks and Recreation (NYC Parks) that led to citywide park redesign and renovation across 67 low-income neighborhoods in NYC. Using a quasi-experimental design with socio-demographically matched control parks, we evaluated longitudinal changes in park use, physical activity, and psychosocial well-being as a result of CPI. There will be a total of 3 presentations. The first presentation will focus on the impact of CPI on park use before and after park renovation, relative to control parks, using data collected from the System for Observing Play and Recreation in Communities (SOPARC). Results showed that CPI led to a significant net increase in park use, especially among adults. The second presentation will report on changes in perceived stress pre- and post-renovation among adults. Results showed that a greater decrease in perceived stress was associated with a sustained high or increased park use frequency in the context of high-quality CPI intervention parks. In contrast, the same association was not found in lower quality control parks. The third presentation will showcase a study that demonstrated a significant increase in children’s physical well-being, a dimension of quality of life, at CPI vs. control sites. The analysis also showed that children in the lowest socio-economic group might have benefited the greatest from CPI. PARCS is one of the largest intervention studies on the effects of park renovation on health. This workshop will engage participants in considering how these insights can be translated into actionable programs and policies in service of community health and health equity. Findings from PARCS will help inform future public health and urban planning interventions in the use of the built environment to promote population well-being. Key messages • Urban park renovations may contribute significantly to community health, demonstrating a vital link between the built environment and public health. • Investments in green spaces may enhance the physical and mental well-being of low-income urban communities, promoting social equity.

4.A. Skills building seminar: Waves of community health engagement and governance: innovating through a design-as-policy approach

Abstract In this workshop we will engage our participants in a practice oriented exercise to experiment with a collaborative design-as-policy approach for a community health action plan. The exercise will be based on the lessons learned in two large evaluation projects: 1) an 8-year evaluation of the Dutch All about Health (AaH) platform of social health initiatives on the local, regional and national level; and 2) a comparative multiple case study, including Portugal, building a framework for sustainable citizen engagement, published in the WHO Handbook ‘Voice, Agency, Empowerment: The Handbook on Social Participation for UHC’. Both projects show striking similarities in findings, and developed guidance for devising collaborative action through (a) the use of community platforms, (b) concrete engagement mechanisms and (c) mediating civil society organizations. These will be brought together in a Guidance Tool that participants will work with in the exercise. The aim of the tool is to support initiatives to bring together both top-down participatory efforts and bottom-up grassroots movements in order to anchor community and minority voices into policy decision-making for a more level playing field for policy influence. The aim of the workshop is to let participants experiment with the Guidance Tool and develop collaborative design-as-policy skills. The outline of the skills building exercise: 1. Group introductions using Mentimeter and invitation to pick a particular complex health issue from participants’ own work or community setting (5 mins). 2. Three pitches on the projects, the Portugal case and the Guidance Tool (10 mins). 3. Exercise instructions (5 mins). 4. Exercise (35 mins) a. Upon room entrance participants receive a colored badge based on their professional background: public health professional/practitioner, community resident, researcher or policymaker; b. Form small sub groups of 6-8 participants with different backgrounds (2 mins); c. Introduce with key words on paper their respective complex community health issues and sub group jointly selects one issue for which most information and experience is present (6 mins); d. First round in duos within sub group: participants work through the guidance steps to an initial idea for the collaborative action approach consisting of a community platform, engagement mechanisms, and mediating civil society organizations, drawn out on paper (10 mins); e. Second round in duos within the sub group: duos review another duos initial design idea and conduct an intuitive SWOT analysis of feasibility, acceptability, and practicability (8 mins); f. Third round in sub group: compare the three proposals in SWOT perspective, select the most salient one, and improve with strong elements from other proposals (8 mins); g. Summarize in key words the final proposal and enter into Mentimeter. 5. Plenary wrap up using Mentimeter: select the winning proposal, and evaluate the exercise (5 mins). Key messages • Collaborative action is enhanced considerably through (a) the use of community platforms, (b) concrete engagement mechanisms and (c) mediating civil society organizations. • The Guidance Tool offers concrete steps for designing a reflexive and adaptive structure and process for community collaborative action and self-governance. Speakers/Panelists Marleen Bekker Wageningen University & Research, Wageningen, Netherlands Dheepa Rajan WHO, Brussels, Belgium Goncalo Figueiredo Augusto National Health Council, Lisbon, Portugal

Surfing a culturally-relevant physical activity: a new wave for health promotion

Abstract Background Surfing originated with Native Hawaiians prior to Western contact. It has since gained worldwide popularity, with an estimated 50 million surfers globally, and recently became an official Olympic sport. Associations have been reported between surfing and mental and physical health outcomes, greater community cohesion, and stronger intra-family relationships. Despite this evidence, surfing is deeply understudied in the context of health promotion. Purpose Surfing was analyzed from a mixed methods perspective to explore factors associated with lifetime participation and current engagement, including gender, race/ethnicity, chronic disease, social context, meaning, and average time of participation. Methods Hawai’i adult residents (n = 1066) completed an online or phone questionnaire. Modified Poisson regression models were fit for lifetime engagement and having a self-reported chronic disease, adjusting for primary race/ethnicity, age, gender, and education. Results Over their lifetime, 42% of respondents (50% men and 37% women) had participated in surfing. Engagement was highest during youth and young adulthood, and decreased with age, yet trends varied notably by race/ethnicity, gender, and generation. Lifetime surfing engagement was significantly related to lower likelihood of diabetes (aPR:0.72; 95%CI:0.56-0.92;p=0.009). Individuals who regularly participated in surfing typically did so with friends (78%) or family (61%); average surfing session duration was 209 minutes. Qualitative results revealed the relevance of surfing across levels of influence for health and wellbeing from physical fitness to community, culture, history and spirituality. Conclusions This work provides insights on the health promotion opportunities of surfing across the life-course and populations, including disease prevention and management. This study has implications for planning and policy locally and globally to achieve optimal community and planetary health. Key messages • Surfing is not only a sport for elite athletes, but also an activity that can support community and individual health and wellbeing in many populations over the lifespan. • Promotion of surfing and public ocean access can support multidimensional influences for wellbeing and should be a focus of cross sector collaborations for optimal community and planetary health.

"There's Going to be a Tipping Point Where I'm Not Gonna Be Able to Work": Communicative Resilience Amidst Precarity in the Careers of Individuals with Autoimmune Diseases.

Throughout their career, people living with autoimmune diseases must navigate workplace precarity amidst ongoing disruptions to health and wellbeing. Informed by the communication theory of resilience (CTR), we conduct semi-structured, narrative interviews with 25 individuals living with autoimmune diseases to examine their career-related disruptions and communicative resilience enactments. Data analysis reveals two major themes: (1) disability as a discursive-material disruption and (2) career-triggering illness complications. Theoretically, our findings extend anticipatory and adaptive-transformative CTR tensions through the moment-to-moment disruptions that intersect this community's careers and health journeys. Practically, we seek to re-imagine workplace accommodations and disability to better meet both the health and work needs of stigmatized and chronically ill individuals, such as individuals with autoimmune diseases.

A lifestyle program for socially vulnerable community-dwelling elderly

Abstract Problem Socially vulnerable older adults often face lower health literacy and limited access to health care. Description of the problem Current lifestyle programs are often insufficiently adapted to this socially vulnerable target group. As a result, these older adults are underrepresented in lifestyle programs. From a public health perspective, lifestyle programs that improve the poorer physical and mental health of these older adults, should be made more accessible by involving the expertise, participation and needs of this group. The aim of this study was to develop and implement a lifestyle program adapted to the expectations and needs of socially vulnerable older adults. Results Both the target group and the local community (health) centers were involved during the co-creative phase of development. A neighborhood analysis was used to identify and reach out to the target group. Motivators and barriers for a healthy lifestyle were identified through focus groups. The developed program consisted of 10 weekly group sessions. Various health aspects were integrated, including exercise, nutrition, stress, sleep, positive psychology, meaningful living, and motivation. Nine centers for community dwelling older adults in Flanders and Brussels were included. In total, 93 older adults were recruited out of which 76 completed the full program. In the final phase, the program was evaluated by means of objective and subjective measuring methods. Finally, the local community (health) centers are currently involved in the program’s sustainability through a trainers’ program. Lessons The belongingness, the catering, the empowering attitude of the trainer and the ‘fun’ factor turned out to be success factors for the adherence to the program. The participating centres experienced an increase in numbers of older adults that were attracted to their activities that are focused on healthy lifestyle behaviors. The continuity of the program is currently being examined. Key messages • A neighbourhood analysis in collaboration with local partners helped to reach the target group. • The program was made attractive by the involvement of the older adults, the fun-factor and the small groups.

Scoping Review of Health Literacy Interventions among Migrant Communities in Europe

Abstract Background The increase in migration trends in Europe has brought attention to the significant health disparities between migrant and native populations, which are largely rooted in social determinants of health such as economic difficulties, language barriers, and limited access to services. Tailored health literacy (HL) interventions can serve as an intermediate factor between social determinants of health and health outcome, thereby holding great potential for addressing these disparities. Despite a growing body of research on migrant health, there remains a gap in our understanding of effective HL interventions for this population. Methods A scoping review was conducted following the Joanna Briggs Institute (JBI) updated guidelines and the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. Electronic searches were carried out across five databases (PubMed, SCOPUS, Web of Science, PsychINFO, and CINHAL) and supplemented by a manual search. We included European studies on migrant HL interventions, conducted between 2011 and 2023, and published in English or Portuguese language. Results Out of 1018 records, 7 studies met eligibility criteria. Predominantly situated in Northern and Western Europe (85.5%), interventions primarily targeted female migrants (71.4%) through in-person courses (42.9%). Identified intervention strengths included culturally adapted content, migrant engagement, and access to written materials. Gaps included mental health interventions and community outreach. Conclusions This scoping review provides a comprehensive overview of HL interventions targeting migrant populations, highlighting their characteristics, strengths, and gaps. These findings serve as a foundational step towards developing guidelines for effective HL interventions within migrant communities. Key messages • Most European health literacy interventions for migrants target women and are conducted in North or West Europe. • Cultural adaptation and community engagement are key strengths of migrant health literacy interventions, yet gaps remain in mental health support and community outreach efforts.

Asking to thrive: structures supporting young men’s behavioural health in Belfast, Northern Ireland

Abstract Background Men in Northern Ireland are three times more likely to die by suicide and psychiatric morbidity is significantly higher than for the United Kingdom overall, in part due to the Troubles, a 30-year conflict during which there were 34,000 shootings, 14,000 bombings, and 3,500 deaths. Prior studies suggest strong friendships and high collective efficacy in communities are protective against suicide and self-harm in adolescents and that inquiring about supportive people and structures directly-rather than through parental intermediaries-yields more accurate responses. Methods Semi-structured interviews were conducted with 30 adolescent males aged 16-19 from working-class communities across Belfast. Participants were recruited via trusted community partners and often had experiences with sectarianism and restorative justice. A deductive thematic analysis was conducted of interview transcripts, supplemented by responses to the Self-Harm Inventory and a modified Collective Efficacy Scale. Analyses were completed in NVivo and RStudio. Results In addition to male peer friendships in which they could share confidences, participants strongly endorsed the value of youth work organisations as keystones in supporting not only their own behavioural health through positive modelling but also the reduction of antisocial and sectarian behaviours in their communities. Participants named specific aspects of these structures they found most useful, including demonstrating “masculine success” though community engagement and family life, providing a safe venue for socialising, and delivering restorative justice programming. Conclusions Findings from this study suggest that youth work programming is an important component of both adolescent behavioural health promotion and community safety through the reduction of sectarian and other antisocial behaviours. Participants expressed dismay at the reduction of these services and endorsed both their personal and wider community importance. Key messages • Youth workers may provide valuable positive modelling and behavioural health support to the young men. • Youth work programmes may function both for behavioural health promotion and community violence reduction in Belfast, Northern Ireland.

NCD prevention and control in Kenya: feasibility study of health kiosks in markets “HEKIMA Study”

Abstract Introduction Non-communicable diseases (NCDs) account for 50% of hospital admissions and 55% of hospital mortality in Kenya. Cardiovascular diseases (CVDs) lead NCD mortality at 14% due to high prevalence of multiple risk factors. Community markets are social institutions with untapped potential for public health. HEKIMA is a multi-phased theoretically driven intervention exploring whether health kiosks in community markets, manned by community health workers (CHWs) and supervised by health centre (HC) nurses, can improve the reach of preventive care to vulnerable communities. Methods A mixed methods study in Vihiga County targeting 320 participants aged 15 years and above. Nurses and CHWs were trained to deliver evidence-based CVD health promotion, risk screening, and early intervention. Multi-sector stakeholder consultations, readiness assessments of markets and HCs, and semi-structured interviews informed intervention development. Evaluation use the Re-AIM framework. Results At 6 months of intervention there 2224 kiosk users which exceeded target of 300; 61% primary school education; 77% females; median age - males 48y, females 52y. Proportion with high blood pressure, overweight, obesity, and diabetes 48%, 32%, 25% and 12% respectively. 30% were referred to HC, and 34% followed up at least once at the kiosk. High acceptability of HEKIMA among CHWs, nurses and market users led to HEKIMA kiosks being integrated in the primary healthcare pathway. Key enablers were multi-sectoral alliance of government, civic organisations, community market champions, local businesses and health sector; culture centred coproduction and capacity building Challenges included understaffing, commodity supplies and seasonality. Conclusions HEKIMA successfully promoted NCD prevention and control, particularly among vulnerable populations. Scaling up across Kenya is planned to explore translational impacts in different contexts. Key messages • Multisectoral alliance critical for prevention of NCDs. • Theoretically underpinned complex systems interventions addresse inequities.

Support mechanisms and obstacles for developing public health practitioners’ core competences

Abstract Community health needs assessment is one of the central activities for local governments in Estonia, specifically under the health promotion strategic planning, and this includes developing health and well-being profiles for evidence-based public health promotion. For effective implementation of the profile, sufficiently trained public health practitioners are needed. Therefore, analysis of the needs of the additional study programmes according to the core competences of professional standard for health promotion was carried out among public health practitioners and the leaders of local governments. The study was based on the 19 semi-structured interviews carried out in 2022-2023 with leaders (10) and public health practitioners (9) in Estonian local governments. Based on the local government’s size, status of the health and well-being profile and the employment and educational background of the public health practitioner three sub-groups were developed. The collected data was analysed using qualitative content analysis with focus on support mechanisms and obstacles of core competences of public health practitioners. The respondents indicated the need for training on communication (leadership and advocacy) and analytical skills (evaluation and research). Core competence training is however limited by resources (time, energy, motivation, funding), employer expectations (overload at work) and working full-time. Training is supported by personal motivation (e.g., wish to stay competent, understanding the need for training), employer support (including flexible work arrangements), and curriculum support (funding is covered). The results indicate there is a need for flexible education as the need for developing and maintaining core competences emerges in practical work. The results can be used for developing the public health curriculum, to assess and provide training for public health practitioners to better meet the needs of the labor market in the future. Key messages • Local government employees performing health promotion tasks feel the need to upgrade various core competences: e.g., communication, management, data analysis and assessment. • In health promotion, there is a growing need for flexible education, which creates challenges for higher educational institutions to meet the needs of the labor market.

Impact of AI on public health emergency communication in Europe and Central Asia: A Delphi study

Abstract Background Artificial Intelligence (AI) holds the potential to fundamentally transform public health communication - presenting promising opportunities alongside profound challenges and risks. This two-wave Delphi study therefore invited practitioners and scholars to assess the potential impact of AI on the risk communication, community engagement, and infodemic management (RCCE-IM) of public health authorities in European and Central Asian countries. Methods In two successive online surveys, 54 experts - both RCCE-IM practitioners and scholars with expertise in (digital) health communication, risk communication, and AI - from 28 countries provided their assessment of the following analytical dimensions: (1) opportunities, challenges, and risks of AI, (2) conditions for the responsible use of AI, (3) potential future scenarios, and (4) prioritized actions. The first Delphi wave followed an open and exploratory approach, while the second wave sought to prioritize and rank key findings from the previous round. The survey instruments included open-ended and closed-ended questions that were analyzed through statistical analysis, inductive and deductive coding. Results Results showed that AI holds various opportunities for the RCCE-IM of public health communicators. Challenges and risks, such as algorithmic bias or concerns about inclusivity, equally affect RCCE-IM efforts. Experts identified seven principles for the responsible use of AI (e.g., fair, human-centered) and predicted optimistic (e.g., optimized workflows) and pessimistic (e.g., flood of (mis)information) scenarios for the future impact of AI. Prioritized actions range from regulation, resource allocation, and feedback to capacity building, public trust, and education. Conclusions To responsibly navigate the opportunities, challenges, and risks of AI for public health emergency communication, clear guiding principles, ongoing critical evaluation, and multi-sectoral collaboration are needed. Key messages • AI is likely to transform public health emergency communication. • A set of agreed-upon principles will support public health authorities in the responsible management of the opportunities, challenges, and risks of AI.