Health Outreach Research Articles

Distinguishing trans women in men who have sex with men populations and their health access in East Africa: A Tanzanian study.

BackgroundFew data are available on the presence and characteristics of transgender populations in sub-Saharan Africa (SSA), which makes the provision of health services for key populations difficult.AimThis study aimed to ascertain the presence and characteristics of trans women in seven cities in Tanzania, East Africa.SettingTanzania, East Africa.MethodsOutreach to men who have sex with men (MSM) in seven large cities in Tanzania was carried out by non-governmental organisation (NGO) staff familiar with this community. Survey questions administered via interviews were used to identify participants who self-identify as trans. From the self-identification data, an estimate of the relative size of the trans women population in this sample was calculated.ResultsIn the sample of 300 participants, 17.0% of participants were identified as ‘transsexual or transgender’ (survey wording); 70.1% of these trans participants indicated that they identify themselves as a woman. Of those identifying themselves as transsexual or transgender, 43.1% reported living part- or full-time as a woman and eight (15.0%) reported hormone use. The highest percentage of hormone use (40.0%) was found in those living as a woman full-time. Notably, there was significant ignorance amongst the sample of the terms ‘transsexual and transgender’ or their explanation in Swahili, reported by interviewers.ConclusionIn this study, it is clear that trans women populations exist in Tanzania, with high levels of stigmatisation and threats to their lives. They should be included in health outreach and services to key populations. One in six self-identified as trans women, although the lack of knowledge of this concept in Swahili or English may have inaccurately represented numbers.

Efficacy of a Student-Run Ophthalmology Service in Managing Diabetic Retinopathy: A Five-Year Retrospective Review

Background:
 Diabetic retinopathy is one of the leading causes of blindness in the world, and its development and progression can be prevented with appropriate glycemic control. The Health Outreach Partnership of EVMS Students (HOPES) Student-Run Free Clinic at Eastern Virginia Medical School (Norfolk, VA) provides both primary care and ophthalmology care to patients from underserved backgrounds. The purpose of this retrospective chart review is to assess whether a student-run free clinic’s primary care and ophthalmology services are effective in preventing the development and progression of diabetic retinopathy.
 Methods:
 Inclusion criteria were a diagnosis of Type 2 Diabetes Mellitus (T2DM), two or more HOPES Ophthalmology Clinic appointments separated by at least 4 months between January 2015 and July 2019, and medical management of T2DM by the HOPES Primary Care Clinic. Objective patient data collected were HbA1c, visual acuity, and documented dilated fundus examination findings.
 Results:
 There were 174 HOPES Ophthalmology visits and 66 diabetic eye exam appointments in this five-year time period. The average HbA1c for patients at the initial appointment with the Ophthalmology Clinic was 7.77% ± 1.65% and the average HbA1c at the most recent appointment was 7.4% ± 2.28%. Among all patients, there was no statistically significant change in visual acuity in either eye from baseline to the most recent visit. There was no change in fundus examination findings in any of the patients from their initial visit to their most recent visit.
 Conclusions:
 The HOPES Clinic has been effective in preventing the development and progression of diabetic retinopathy in its patients who regularly follow up with both the primary care and ophthalmology clinics. This study highlights that a student-run free clinic is capable of making an impact in the community by preventing the development of a potentially blinding disease, but that further strategies to enable consistent patient follow-up are needed.

Assessing Equity in Mental Health Outreach Services to People Experiencing Unsheltered Homelessness.

The study aimed to evaluate differences in age, gender, race, and ethnicity between a population served by a street psychiatry team and the local community of people experiencing unsheltered homelessness in order to identify intersectional inequities in care. We tested for bivariate associations between patient affiliation and age, gender, race, and ethnicity using a Welch two sample t-test for the continuous term (age) and Pearson's chi-squared test with Yates' continuity correction for the categorical terms (gender, race, and ethnicity). The CMHC Street Psychiatry Team served a population (N = 200) that was significantly older (p<.001) and composed of proportionally fewer women (p = .010) and people of color (p<.001) than the local population experiencing unsheltered homelessness (N = 944). This process of critical evaluation identified disparities in service provision which prompted re-evaluation of services to target efforts to those most at risk of marginalization.

The impact of politics, religion, and rurality on COVID-19 vaccine hesitancy in Oregon: a cross-sectional study.

Vaccine hesitancy has been a major barrier to mitigating the effects of COVID-19, especially in rural Oregon, USA. This study assessed the influence of political affiliation, religious identity, and rurality on vaccine hesitancy in counties across Oregon. Cross-sectional association analysis was performed using public data on US President Trump votership in the 2020 election, White Christian identity, population density, and COVID-19 vaccination data for adults as of 29 August 2021. By 29 August 2021, 68.0% of adults had been fully vaccinated in Oregon. Trump votership was the strongest independent association with vaccination status in Oregon (r=0.90, p<0.01), followed by White Christian identity (r= -0.69, p<0.01), and population density (r=0.55, p<0.01). In multivariate analysis, White Christian identity and political affiliation with Trump in the 2020 election explained 84.1% of the variability in COVID-19 vaccination status in Oregon counties. White Christian identity, Trump affiliation, and rurality were identified as factors in vaccine hesitancy among counties in Oregon. Without addressing these factors in public health outreach, vaccine hesitancy is likely to continue unabated.

Perceptions and attitudes of black men in a rural district of South Africa towards depression and its treatment.

BackgroundDepression is a major contributor to the overall global burden of disease, impacting social life, family life and occupational functioning if left untreated. Despite its high prevalence and morbidity, the evidence suggests that men are hesitant to seek help, with a large percentage remaining undiagnosed. This study aimed to determine the attitudes and perceptions related to depression and its treatment amongst black men in a rural district of South Africa.MethodsThe design used was an exploratory descriptive qualitative design. Participants were selected by purposive sampling. Individual semistructured interviews were conducted, which were audio-recorded and transcribed verbatim. The data were subsequently analysed thematically to develop themes and subthemes.ResultsParticipants described depression as a psychological problem associated with lack of sleep, loneliness, feeling unwanted, increased stress, deep sadness, weight loss, forgetfulness, crying over small things and lack of concentration. Collectively, the interviews with participants showed a good understanding of the psychosocial determinants of depression but exposed a lack of awareness of its biological determinants. A large proportion (n = 13; 68.4%) of participants reported not having knowledge of available services in their area for people seeking treatment for depression. Barriers to help-seeking behaviours were fear of social stigma, fear of expressing their feelings, gender norms and stereotypes and lack of trust in others.ConclusionInterventions such as support groups and mental health awareness programmes to counteract personal perceptions may help to improve and expand the effectiveness of depression treatment. The results highlight the future need to raise awareness of depressive symptoms and expand health outreach programmes.

Patient-Reported Experiences and Satisfaction with Rural Outreach Clinics in New South Wales, Australia: A Cross-Sectional Study.

Introduction: Many studies have been conducted on how physicians view outreach health services, yet few have explored how rural patients view these services. This study aimed to examine the patient experience and satisfaction with outreach health services in rural NSW, Australia and the factors associated with satisfaction. Methods: A cross-sectional study was conducted among patients who visited outreach health services between December 2020 and February 2021 across rural and remote New South Wales, Australia. Data on patient satisfaction were collected using a validated questionnaire. Both bivariate (chi-squared test) and multivariate analyses (logistic regression) were performed to identify the factors associated with the outcome variable (patient satisfaction). Results: A total of 207 participants were included in the study. The mean age of respondents was 58.6 years, and 50.2% were men. Ninety-three percent of all participants were satisfied with the outreach health services. Respectful behaviours of the outreach healthcare practitioners were significantly associated with the higher patient satisfaction attending outreach clinics. Conclusions: The current study demonstrated a high level of patient satisfaction regarding outreach health services in rural and remote NSW, Australia. Further, our study findings showed the importance of collecting data about patient satisfaction to strengthen outreach service quality.

Peer-Presented Versus Mental Health Service Provider-Presented Mental Health Outreach Programs for University Students: Randomized Controlled Trial.

BackgroundUniversity students are reporting concerning levels of mental health distress and challenges. University mental health service provider initiatives have been shown to be effective in supporting students’ mental health, but these services are often resource-intensive. Consequently, new approaches to service delivery, such as web-based and peer support initiatives, have emerged as cost-effective and efficient approaches to support university students. However, these approaches have not been sufficiently evaluated for effectiveness or acceptability in university student populations.ObjectiveThus, the overarching goal of this study was to evaluate a mental health service provider–presented versus peer-presented web-based mental health resilience–building video outreach program against a wait-list comparison group.MethodsParticipants were 217 undergraduate students (mean age 20.44, SD 1.98 years; 171/217, 78.8% women) who were randomly assigned to one of the intervention groups (mental health service provider–presented: 69/217, 31.8%; peer-presented: 73/217, 33.6%) or the wait-list comparison group (75/217, 34.6%). Participants in the intervention groups were asked to watch 3 brief skill-building videos addressing strategies for building mental health resilience, whereas the comparison group was wait-listed. The mental health service provider–presented and peer-presented video series were identical in content, with presenters using a script to ensure consistency across delivery methods, but the videos differed in that they were either presented by mental health service providers or university students (peers). All participants were asked to complete web-based self-report measures of stress, coping self-efficacy, social support, social connectedness, mindfulness, and quality of life at baseline (time 1), 6 weeks later (time 2, after the intervention), and 1-month follow-up (time 3).ResultsResults from a series of 2-way ANOVAs found no significant differences in outcomes among any of the 3 groups. Surprisingly, a main effect of time revealed that all students improved on several well-being outcomes. In addition, results for program satisfaction revealed that both the mental health service provider–presented and peer-presented programs were rated very highly and at comparable levels.ConclusionsThus, findings suggest that a web-based mental health resilience–building video outreach program may be acceptable for university students regardless of it being mental health service provider–presented or peer-presented. Furthermore, the overall increases in well-being across groups, which coincided with the onset and early weeks of the COVID-19 pandemic, suggest an unexpected pattern of response among university students to the early period of the pandemic. Limitations and barriers as well as research implications are discussed.Trial RegistrationClinicalTrials.gov NCT05454592; https://clinicaltrials.gov/ct2/show/NCT05454592

Nurses' experiences of an outreach interprofessional mental health service for nursing homes: a qualitative descriptive study.

Accessible SummaryWhat is known on the subject? Treatment and mental health care in familiar environments are beneficial for older people experiencing mental health issues. But there are not enough qualified and specialized nurses who can meet the complex needs of nursing home residents experiencing mental health issues.The University Hospital of Psychiatry Zurich, Switzerland, established an outreach interprofessional mental health service to foster the care for residents experiencing mental health issues in nursing homes. Based on existing studies, little can be said about whether nurses in nursing homes find these types of services helpful. What does this paper add to existing knowledge? Nurses in nursing homes caring for residents experiencing mental health issues felt relieved by having inclusive support from the interprofessional mental health service. Nurses appreciated the mental health team and felt accompanied and more confident in their daily work.Results showed that nurses wanted to be included in the care and treatment processes and to work as partners on an equal footing with the mental health team. What are the implications for practice? Outreach interprofessional mental health services for nursing homes should take into account nurses' views and professional experience, and value and respect their role as nurses.Outreach interprofessional mental health services for nursing homes should offer further training in psychiatric nursing, include an accessible contact person in the team, and develop clear processes and responsibilities. IntroductionOutreach interprofessional mental health services for nursing homes can increase the quality of care for residents experiencing mental health issues but research on how nurses in nursing homes experience such a service is lacking worldwide.AimTo describe how nurses experience the involvement of an outreach interprofessional mental health team in the care for older people experiencing mental health issues in nursing homes and to identify barriers to and facilitators of interprofessional collaboration.MethodQualitative descriptive analysis based on 13 semi‐structured interviews. Framework analysis and complex adaptive systems theory were applied.ResultsOne core theme with two main categories: Nurses experienced relief from burden through inclusive support provided by the mental health team. Main categories were feeling accompanied and confident as a nurse and partnership‐based collaboration.DiscussionResults showed for the first time that nurses felt supported by the mental health team and were encouraged to find new ways of coping with challenging situations.Implications for PracticeTo empower nurses, mental health teams should take into account nurses' perceptions in the treatment process, value and respect their role as nurses, transfer knowledge in both formal and informal settings, establish a steady and reliable contact person, and define processes and responsibilities.

Funding Precarity and Women's Peace Work in Colombia, Nepal, and Northern Ireland

Abstract Civil society supports peace work in many ways, including through education, advocacy, health outreach, data gathering, expertise- and experience-sharing, event-running, community mobilization, conflict prevention, and peacebuilding. However, there are limited funds available to support this work, even though key development, peace, and security actors, including the United Nations Secretary-General, have acknowledged that developing the capacity of civil society to support peacebuilding efforts required increased investment. Scarcity of funding has created important political dynamics that affect the work that civil society can do. This study uses a qualitative semi-structured interview design to elicit information about donor funding dynamics and imperatives from expert research informants across three conflict-affected countries: Colombia, Nepal, and Northern Ireland. We explore funding dynamics, various organizational features that influence mobilization strategies, and the impact of COVID-19 on women's civil society groups working on peacebuilding. We argue that, while it is an ongoing concern, scarcity of funding is not the only inhibitor to effective peace work. Donor priorities, and embedded assumptions about the value of peace work—largely undertaken by women and women-led organizations—also challenge the viability of continued efforts toward sustainable peace.

Online Sexual Health Information Seeking Patterns Differentiated by Social Location and Physical Location among Gay and Bisexual Men in Ontario, Canada

Objective This research aimed to understand the varying needs of diverse gay and bisexual men (GBM) in relation to online sexual health information-seeking dependent upon differing social sociodemographic variables and geographic location. Methods A total of 1802 GBM in Ontario participated in this study. Multivariable regressions were conducted to analyze differences in information-seeking based on ethnicity group, HIV status, recent sexual behavior and regionality (urban and rural location). Results There were significant differences in online sexual health information-seeking content based on these demographic variables. Conclusions Implications for sexual health outreach and service provision for diverse GBM are discussed as well.

Knowledge and Awareness of Vitamin D Among Pregnant or Lactating Iraqi Refugee Women: a Call for Different Approaches in Health Education and Outreach

Vitamin D deficiency during pregnancy and lactation has negative impacts on maternal, fetal, and infant health. Low health literacy and other social determinants of health may increase the risk of deficiency among refugee women. This qualitative study used a survey and in-depth individual interviews to examine knowledge of vitamin D among ten pregnant or breastfeeding Iraqi refugee women in the United States, and sought participants’ recommendations on culture-centered and participatory health promotion strategies. All participants reported having insufficient information and understanding of vitamin D, its health benefits, and the risks of deficiency. The four primary themes that emerged from the interviews were the quality of available vitamin D information, barriers to seeking such information, intersectionality of health and environment, and power differentials and the control of the health agenda. Participants’ recommendations included bridging the language barrier and training health care providers to deliver the information needed to raise awareness. The findings of this study provide an opportunity for public health systems to design culture-centered health education and promotion strategies to ensure vitamin D adequacy among this vulnerable population.

Case-control study to identify risk factors for SARS-CoV-2 infection among university students in the northeastern USA.

Curbing the coronavirus disease 2019 (COVID‐19) pandemic requires a thorough understanding of risk factors for transmission of SARS‐CoV‐2, the etiologic agent. Institutions of higher education present unique challenges for controlling disease spread because of features inherent to these settings. Our objective was to determine risk factors for SARS‐CoV‐2 infection among a university student population in the northeastern USA during the spring and fall 2021 semesters, using the case–control study design. Cases were defined as students with a newly diagnosed SARS‐CoV‐2 infection detected either through the robust PCR‐based surveillance testing program on campus or through healthcare testing if symptoms compatible with COVID‐19 were present. Controls were defined as students with negative SARS‐CoV‐2 status, based on consistently negative PCR results at the time of selection. A comprehensive questionnaire was administered to each student enrolled in the study, covering a broad range of campus life activities. A total of 446 cases and 1,185 controls were included in this study. Multivariable logistic regression analysis showed that recent party attendance (adjusted OR = 2.3, p < .0001), recently visiting a bar (aOR = 1.6, p = .007), living in a campus residence hall (aOR = 1.6, p = .001), fraternity/sorority membership (aOR = 1.8, p = .002), and recent travel (aOR = 1.3, p = .04) were associated with being a COVID‐19 case. Having an on‐campus job was negatively associated with being a COVID‐19 case (aOR = 0.6, p = .0003). Among cases, the most commonly reported symptoms were cough (43.9%), fatigue (38.1%) and sore throat (30.3%). These findings can be used to inform the development of COVID‐19 mitigation strategies and public health outreach efforts in university settings, thus reducing SARS‐CoV‐2 transmission among students and helping to preserve the vital education and research missions of these institutions.

Student pharmacists' perspectives on health equity following a co‐curricular activity

AbstractIntroductionIncreasing awareness of the social determinants of health and their effect on health disparities is essential to developing clinicians prepared to practice in today's health care environment. Co‐curricular programs often include service learning, which provides an opportunity for students to advance their learning on health equity.ObjectivesDescribe student learning using reflections written after participation in a health fair that provided free health services to the homeless population in the downtown area of a metropolitan city.MethodsOpen‐ended responses from a standardized post‐activity reflection exercise were content analyzed for key themes. Data were analyzed with immersion‐crystallization qualitative methods.ResultsA total of 14 reflections were included with four themes emerging. First, students applied concepts related to the social determinants of health and identified barriers to accessing health services for underserved patient populations. Second, students reflected on how language and other elements of communication supported positive patient interactions. Third, students demonstrated self‐awareness, which included personal and professional growth, through observations and interactions with community members. Fourth, students reflected on the importance of trust and mutual respect within the patient‐provider relationship.ConclusionPublic health outreach is a frequent component of co‐curricular programs and service learning. Student reflections demonstrated how engagement in an activity focused on an underserved population increased awareness of the social determinants of health and health equity, as well as resulted in self‐awareness and growth as future health care professionals. Future research should further examine what learning occurs across a broader scope of service activities with the long‐term goal of fostering engagement and empowering students to actively address health disparities.

Vaccine network design to maximize immunization coverage

PurposeThe COVID-19 pandemic has forced countries to consider how to reach vulnerable communities with extended outreach services to improve vaccination uptake. The authors created an optimization model to align with decision-makers' objective to maximize immunization coverage within constrained budgets and deploy resources considering empirical data and endogenous demand.Design/methodology/approachA mixed integer program (MIP) determines the location of outreach sites and the resource deployment across health centers and outreach sites. The authors validated the model and evaluated the approach in consultation with UNICEF using a case study from The Gambia.FindingsResults in The Gambia showed that by opening new outreach sites and optimizing resource allocation and scheduling, the Ministry of Health could increase immunization coverage from 91.0 to 97.1% under the same budget. Case study solutions informed managerial insights to drive gains in vaccine coverage even without the application of sophisticated tools.Originality/valueThe research extended resource constrained LMIC vaccine distribution modeling literature in two ways: first, endogenous calculation of demand as a function of distance to health facility location enabled the effective design of the vaccine network around convenience to the community and second, the model's resource bundle concept more accurately and flexibly represented complex requirements and costs for specific resources, which facilitated buy-in from stakeholders responsible for managing health budgets. The paper also demonstrated how to leverage empirical research and spatial analysis of publicly available demographic and geographic data to effectively represent important contextual factors.

Asian Americans suffer within-community discrimination related to COVID-19

Asian Americans suffer within-community discrimination related to COVID-19

#SurgOnc: Global discussions about surgical cancer care on Twitter during COVID-19.

11045 Background: Social media platforms such as Twitter are highly utilized to communicate about cancer care. Although surgery is the primary treatment for solid malignancies, little is known about public perceptions or communication behaviors regarding this treatment modality. Further, prolonged lockdowns and widespread delays of planned operations during the COVID-19 pandemic have magnified the importance of virtual communication about surgical cancer care. Methods: Tweets referencing cancer surgery were collected from January 2018 to January 2022 using Twitter’s Application Programming Interface. Account metadata was used to predict user demographic information and to compare tweeting metrics across users. Natural language processing models were applied to tweet content to resolve common topics of conversation and to classify tweets by cancer type. Results: There were 442,840 original tweets about cancer surgery by 262,168 users. Individuals accounted for most users (65%) while influencers accounted for the least (1.4%). Influencers made the most median impressions (19,139). Of 240,713 tweets discussing surgery for specific cancers, breast (20%) and neurologic (17%) cancers were most mentioned. When adjusting for national rates of procedures performed, tweets about surgery for neurologic cancers were the most common (231 tweets per 1000 procedures) whereas those for urologic cancers were the least common (15 tweets per 1000 procedures). Discussions about cancer surgery research made up 31% of tweets before the pandemic but only 11% of tweets during the pandemic. During the pandemic, concern regarding COVID-19 related delays was the most tweeted topic (23%). Cancer surgery research was most cited by oncologists, as well as in tweets about hepatopancreatobiliary and colorectal cancers. The cost of surgery was commonly mentioned in tweets about breast and gynecologic cancers and contained the most negative sentiment score (-0.7). Conclusions: Twitter was highly utilized to discuss surgical cancer care during the COVID-19 pandemic. During the pandemic, conversations shifted focus from research to survivorship and reflected real-time events such as COVID-19-related surgical delays. We identified the financial burden of cancer care as a commonly held concern among patients discussing cancer surgery on social media. Future public health outreach about cancer surgery may be optimized by coordinating with influencers and by targeting topics of concern like cost of surgery and undermentioned content like urologic cancers. Twitter’s role as a platform for research dissemination was disrupted by the COVID-19 pandemic, and further tracking is needed regarding online research discussions after the pandemic.

Contesting Deaths’ Despair: Local Public Religion, Radical Welcome and Community Health in the Overdose Crisis, Massachusetts, USA

Abstract In the United States, the first decades of the twenty-first century have been marked by a worsening fatal drug overdose epidemic leading life expectancy to decline for the first time in a century. Often termed deaths of despair, this development is attributed to declines in civic life, including lessening religious participation, wrought by long-term deindustrialization. Despite this, civil society has responded by contesting despair and the conditions hastening fatal overdose trends. This article examines faith-based community responses to the American overdose crisis through an extended case study of a church-led campaign in Massachusetts. In the summer of 2017, the state of Massachusetts released its fatal overdose numbers to the public: 2,069 people died of fatal overdose in 2016. In response, Trinity Church of Wrentham, Massachusetts, launched the #2069 campaign resulting in over 2,000 billboards and lawn signs emblazoned with #2069 displayed across the state. The memorial project fostered conversation, but also forged new community active in its work of social support, public health outreach and nonpartisan political engagement. The article considers the role of faith-based public health efforts and the potential for further interfaith and interracial collaboration on public health issues and the role of public religion in contesting conditions of despair.

0157 Sleep Icebreakers and Behavioral Change: If You Could Tell People Only One Thing About Sleep, What Should It Be?

Abstract Introduction Insufficient sleep is widespread in the general population, but education and outreach can combat this problem. Informal learning settings, like museums, provide unique opportunities for educating a local community. However, in such settings, engagement with the content relies on the topic’s ability to immediately incite interest. Therefore, we developed and tested a series of sleep “icebreakers” (brief, informal facts) to determine their effectiveness in eliciting interest in sleep science and encouraging behavioral change. Methods Five hundred and twenty-one participants were recruited via the local museum (n=103) and Amazon Mechanical Turk (n=418). Participants viewed eight sleep icebreakers (randomly-selected from a bank of 16 icebreakers) and rated whether they knew it already, if they found it interesting, and if it made them want to learn more. Participants also completed questionnaires on demographics, sleep health/attitudes, and future intended sleep behaviors. Results Both the museum member and general population samples showed substantial interest in sleep science, regardless of age, gender, race/ethnicity, socioeconomic status, neighborhood disadvantage, prior sleep knowledge, and prior sleep health/attitudes. The most effective icebreakers related to REM sleep behavior disorder, sleep in Alzheimer’s disease, unihemispheric sleep, dreaming, and sleep state misperception. Importantly, the more the icebreakers interested participants, the more likely they were to formulate a specific plan to change their sleep behaviors (OR: 1.55, p = .001), express willingness to post to social media platforms (OR: 1.46, p &amp;lt; .01), and indicate willingness to donate to an exhibit on sleep (OR: 2.51, p &amp;lt; .001), even after controlling for psychosocial, sleep health/attitudes, and demographic measures. Conclusion If you could only tell someone one thing about sleep, there are a lot of good options. This interest in sleep science was enjoyed by individuals regardless of psychosocial, educational, and demographic backgrounds, and the icebreakers encouraged half of participants to form an intention to change their sleep behaviors. Coupling icebreakers with opportunities for personalized learning, and providing structure to formulate specific plans to change sleep behaviors, are promising directions for sleep health outreach efforts. Support (If Any) National Science Foundation (1920730 and 1943323)

Measuring equity of access to eye health outreach camps in rural Malawi.

IntroductionEquity in the access and use of health services is critical if countries are to make progress towards universal health coverage and address the systematic exclusion of the most vulnerable groups. The purpose of this study was to assess if the Co-ordinated Approach To Community Health programme implemented by Sightsavers was successful in reaching the poorest population, women, and people living with disabilities in Kasungu district, Malawi.MethodsBetween April and September 2017, data on socio-economic status, household characteristics and functional disability were collected from patients attending at eye camps in Kasungu district, Malawi. Using asset-based tools to measure household wealth (EquityTool© and Simple Poverty Scorecard©) and the Washington Group Short Set of Questions, individuals were categorised by wealth quintiles, poverty status, and functional disability status and then compared to relevant representative national household surveys. In addition, a follow-up household survey was conducted to check the validity of self-reported household characteristics at eye camps.ResultsA total of 1,358 individuals participated in the study. The study shows that self-reported data on household characteristics and assets are reliable and can be collected in clinical settings (instead of relying on direct observations of assets). Individuals attending outreach camps were poorer in terms of relative wealth and absolute poverty rates compared to the rest of the population in Kasungu. It was estimated that 9% of the participants belonged to the poorest quintile compared to 4% for the population in Kasungu (DHS 2015–2016). The ultra-poverty rate was also lower among respondents (13%) compared to 15% for Kasungu district (IHS 2017). The functional disability rate was 27.5% for study participants, and statistically higher than the general population (5.6%, SENTIF 2017). Even though women are more at risks than men, 54% of the participants were men.ConclusionsOur study shows that existing tools can be reliably used, and combined, if based on recent population data, to assess equity of access to health services for vulnerable groups of the population. The findings suggest that the programme was successful in reaching the poorest people of the Kasungu district population as well as those with disabilities through outreach camps but that more men than women were reach through the programme. Subsequently, our study showed that self-reported household characteristics are a reliable method to measure asset-based wealth of camps’ attendee. However, it is essential to use sub-national data (district or regional level) from recent surveys for the purpose of benchmarking in order to produce accurate results.

“We’re Essential Because You’re Essential”: How Louisiana Sexual Assault and Domestic Violence Organizations Adapted Outreach Efforts and Health Messaging during COVID-19

ABSTRACT Within weeks of the World Health Organization declaring the COVID-19 outbreak a global pandemic, domestic violence and sexual assault incidents increased. To adhere to new health protocols, social service providers were encouraged to move outreach efforts to virtual formats. We draw on 21 in-depth interviews with Louisiana organizations working in violence against women to examine how they 1) transitioned to online outreach efforts and 2) adapted their messaging to the COVID-19 context. We found that organizations who successfully moved to virtual efforts credited their success to thinking creatively and properly matching educational activities to digital media platforms, while those who struggled pointed to obstacles such as digital media fatigue and funding limitations (RQ1). We also identified three changes to message framing (RQ2): 1) Empathy and reassurance, especially, reiterating that centers “are there” for victims 2) Addressing racial justice issues, and 3) describing COVID-19 protocols and conducting lockdown-focused education efforts.