Health Service Partnership Research Articles

A qualitative exploration of the implementation facilitators and challenges of a community health worker program to address health disparities for people recently released from incarceration using the consolidated framework for implementation research

BackgroundDespite the potential for community health worker (CHW)-led programs to improve the health of people with justice involvement (PWJI), little is known about the practical implementation of such models. We explored barriers and facilitators to implementation of a municipal CHW program, the Health Justice Network (NYC HJN), led by the New York City Department of Health and Mental Hygiene (DOHMH) in partnership with three reentry-focused community-based organizations (CBOs) and three federally qualified health centers (FQHCs) that was designed to serve the health and social service needs of PWJI.MethodsEighteen in-depth qualitative interviews were conducted with a purposive sample of CHWs, partner site supervisors, and DOHMH staff. Interviews were conducted virtually and transcribed verbatim. Codes and themes were developed using the Consolidated Framework for Implementation Research (CFIR) to understand facilitators and barriers to NYC HJN implementation.ResultsImportant facilitators to implementation included: lived experience of CHWs, as well as NYC HJN’s voluntary nature, lack of onerous eligibility criteria, and prioritization of participant needs. One barrier was the lack of a formal implementation protocol. Themes identified as facilitators in some instances and barriers in others were CHW integration into site partners, the expansive scope of work for CHWs, the integration of a trauma-informed approach, values alignment and existing infrastructure, leadership engagement, CHW training and support, and input, feedback, and communication.ConclusionsFindings will help inform how to successfully implement future CHW-led interventions for PWJI with municipal, health, and social service partners.

Integrative Empowerment Of Health Cadres In Efforts To Monitor Stunting Risk Through The Use Of Smartphone-Based Electronic Child Card Applications In Ngiliran Village, Panekan District, Magetan Regency

ABSTRACT The Community Engagement activity, conducted from May to August 2024, aimed to empower various stakeholders, such as early childhood integrated health service cadres, prospective brides and grooms, pregnant women, and mothers of young children, in their endeavors to monitor early stunting effectively. It addressed the pressing issue of stunting prevalence in Ngiliran Village, which had reached an alarming 18.6%, surpassing the national target set for 2024, which is 14%. Partners, including integrated health service cadres, prospective brides and grooms, pregnant women, and mothers, faced challenges like limited knowledge in measuring children's nutritional status, inconsistent monitoring, and inadequate stunting prevention education. To address these issues, the activity utilized the Electronic Child Card (KARANEL) smartphone application. KARANEL accurately measured children's height and weight, stored data electronically, presented nutritional status visually, and offered guidance. It empowered partners to identify, prevent, and manage stunting effectively. The results demonstrated that KARANEL enhanced the knowledge, skills, and motivation of integrated health service cadres and partners. Conclusion: the smartphone-based KARANEL application proved highly beneficial for early stunting monitoring in Ngiliran Village, providing a practical solution to combat stunting

Using System Dynamics for Local Authority Public Health practice in England

A key function of local authority public health teams in England is to undertake a regular health needs assessment of their population. This involves forecasting, among other things, prevalence and incidence of long term conditions and health care service demand. Over the last few years, Kent County Council Public Health has adopted the use of system dynamics modelling (SDM) to not only do this but generate scenarios to simulate the impact of different interventions across different cohorts defined by age groups and diagnosable conditions. These include “no conditions” as well as understand the combined effects of different interventions, demographic changes and wider health determinants. Risk factors, such as smoking, diet and physical activity, were calculated using local linked data for the incidence of single conditions, progression toward complex needs and levels of morbidity including frailty. These were used to create the dynamics of the model. Incidence, prevalence and mortality for each cohort were projected over 25 years with “do nothing” and “Better Health” scenarios. The size of the “no conditions” cohort increased, and the other cohorts decreased in size. The impact of the interventions on life expectancy at birth and healthy life expectancy was significant. SDM heavily influenced local authority commissioning decisions for health improvement services redesign such as smoking cessation, weight management as well as other secondary prevention measures such as hypertension management and cardiovascular disease screening delivered by General Practice and other health service partners.

Nurses' experiences of hospital‐acquired pressure injury prevention in acute healthcare services in Victoria, Australia: A qualitative study using the Theoretical Domains Framework

AbstractWe investigated nurses' experiences of hospital‐acquired pressure injury (PI) prevention in acute care services to better understand how PI prevention may be optimised. We used the Theoretical Domains Framework to systematically identify barriers and enablers to evidence‐based preventive practices as required by the International Guideline. This study was one element of a complex capacity building project on PI surveillance and prevention within the acute health service partners of Monash Partners Academic Health Science Centre, an accredited academic health partnership located in Melbourne, Australia. We adopted a qualitative descriptive design. We interviewed 32 nurses that provided care in intensive care units, general wards and COVID wards of four acute care services. Nurses were recruited from four large acute care services (three public, one private) located in Melbourne. Most of them worked with patients who were at high risk of hospital‐acquired PI on a daily basis. Interview transcripts were coded and analysed using thematic analysis guided by the Theoretical Domains Framework. The domains referred to most frequently by all participants included: Knowledge, Skills, Social/Professional Role and Identity, Beliefs about Capabilities, and Environmental Context and Resources. The key barriers discussed by nurses included gaps in nurses' knowledge and skills related to identification and staging of PI, heavy nursing workload and inadequate staffing levels, stigma and self‐blame related to PI identification, and exacerbating impacts of the COVID‐19 pandemic. Main facilitators discussed were training programmes, nursing audits and feedback, and teamwork. Participants suggested improvements including accessible and tailored training, visual reminders, and addressing heavy workloads and emotional barriers nurses face. Investing in tailored training initiatives to improve nurses' knowledge and organisational changes to address low level staffing and heavy workloads are urgently needed to support nurses in delivering optimal care and preventing hospital‐acquired PI.

Communities organizing to promote equity: engaging local communities in public health responses to health inequities exacerbated by COVID-19-protocol paper.

The COVID-19 pandemic has disproportionately impacted rural and under-resourced urban communities in Kansas. The state's response to COVID-19 has relied on a highly decentralized and underfunded public health system, with 100 local health departments in the state, few of which had prior experience engaging local community coalitions in a coordinated response to a public health crisis. To improve the capacity for local community-driven responses to COVID-19 and other public health needs, the University of Kansas Medical Center, in partnership with the Kansas Department of Health and Environment, will launch Communities Organizing to Promote Equity (COPE) in 20 counties across Kansas. COPE will establish Local Health Equity Action Teams (LHEATs), coalitions comprised of community members and service providers, who work with COPE-hired community health workers (CHWs) recruited to represent the diversity of the communities they serve. CHWs in each county are tasked with addressing unmet social needs of residents and supporting their county's LHEAT. LHEATs are charged with implementing strategies to improve social determinants of health in their county. Monthly, LHEATs and CHWs from all 20 counties will come together as part of a learning collaborative to share strategies, foster innovation, and engage in peer problem-solving. These efforts will be supported by a multilevel communications strategy that will increase awareness of COPE activities and resources at the local level and successes across the state. Our mixed methods evaluation design will assess the processes and impact of COPE activities as well as barriers and facilitators to implementation using aspects of both the Consolidated Framework for Implementation Research (CFIR) and Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) models. This protocol is designed to expand community capacity to strategically partner with local public health and social service partners to prioritize and implement health equity efforts. COPE intentionally engages historically resilient communities and those living in underserved rural areas to inform pragmatic strategies to improve health equity.

The Alfred Health Covid Community Pathway (AHCCP): development of a multidisciplinary, collaborative, and integrated model of care for supporting covid positive patients in the community during the Covid-19 pandemic.

Background: The second wave of Covid-19 in Victoria in July 2020 revealed health system vulnerabilities including access to primary care and community readiness to provide care in the home to large numbers of Covid-19 positive patients. The health system risked being overwhelmed, and patients risked deteriorating at home with unmet clinical and psychosocial needs. The requirement for isolation of positive cases necessitated a rapid switch to remote and virtual models of care. In response to a successful pilot in Northwest Melbourne [1], the Department of Health (DH) implemented the Covid Positive Pathways program, which directed health services to provide a similar service in their local catchment areas.
 Purpose of this report: To describe the design, implementation and evolution of the AHCCP, including challenges, lessons learnt and opportunities for use of such an integrated model of care in future epidemic/pandemic situations, as well as to support broader health and social care needs beyond covid.
 Methods: This descriptive study describes the model of care developments and changes, and commentary with descriptive statistics from the cohort of patients who were referred to the pathway, and key learning points.
 Service aim, stakeholders and implementation: In September 2020, the AHCCP was established with the aim of providing comprehensive care to patients in isolation with Covid-19. The service was established as a partnership between several stakeholders, including:
 
 Alfred Health, a quaternary hospital in south-east Melbourne.
 Connect Health and Star Health, community health orgsanisations.
 South East Melbourne Primary Health Network.
 Victorian DH, and the South East Melbourne Public Health Unit.
 South East Melbourne Health Service Partnership, Monash Health and Peninsula Health.
 
 Patients referred from the Victoria DH were triaged and risk-stratified. Clinical monitoring was provided by the health service (medium pathway) or community health team in partnership with GPs (low pathway), with clear escalation pathways for management of acute deterioration. Support for psychosocial needs was also provided, including for those unable to safely meet isolation requirements.
 Results: 91 patients were referred in the first nine months of the pathway’s operation, however subsequent surges in cases have resulted in 172,306 referrals as of 31st August 2022. Rapid upscaling, changing public health directives, and the availability of vaccination and treatments led to major challenges and need for constant redesign. Significant developments included: the introduction of web-based symptom surveys, risk stratification modifications incorporating vaccinations and variants of concern, streaming lower-risk patients to usual care outside the pathway, and use of logistics services to aid distribution of monitoring equipment and medications. Significant opportunities for hospital avoidance were observed, along with minimal adverse outcomes and a high level of acceptability for patients and carers as well as staff.
 Learnings: Collaboration across the partner organisations, including daily huddles with a non-hierarchical structure, was key to the success of the program. Virtual care, including use of information systems (Covid Monitor platform) emerged as essential to scalability. The pathway was successfully decentralised and integrated within community health and Alfred Health’s core models of care in September 2022 to ensure sustainability.

Systematic review of Indigenous cultural safety training interventions for healthcare professionals in Australia, Canada, New Zealand and the United States

ObjectiveTo synthesise and appraise the design and impact of peer-reviewed evaluations of Indigenous cultural safety training programmes and workshops for healthcare workers in Australia, Canada, New Zealand and/or the United...

National public health response to an outbreak of toxigenic Corynebacterium diphtheriae among asylum seekers in England, 2022: a descriptive epidemiological study

In July, 2022, an increase in diphtheria cases caused by toxigenic Corynebacterium diphtheriae (C diphtheriae) was reported among asylum seekers arriving by small boats to England. Rising case numbers presented challenges for case and contact management in initial reception centres, prompting changes to national guidance and implementation of population-based control measures. This study aimed to describe the outbreak of toxigenic C diphtheriae among asylum seekers arriving by small boats to England during 2022 by use of national surveillance data. We undertook a descriptive epidemiological analysis of cases of toxigenic C diphtheriae among asylum seekers arriving by small boats to England during 2022, incorporating genomic sequencing data, antibiotic susceptibility testing results, and epidemiological data obtained through the UK Health Security Agency's national enhanced surveillance programme. Health Protection Teams conducted risk assessments, and operational data (including details regarding offer and uptake of antibiotics and vaccinations) were obtained from National Health Service partners supporting the intervention programme. In 2022, C diphtheriae isolates from 86 asylum seekers arriving by small boats were submitted to the National Reference Laboratory for confirmation and testing. Toxigenic C diphtheriae was confirmed for 72 (84%) cases and one individual with typical diphtheritic lesions but from whom no C diphtheriae was isolated from clinical swabs was also included as a probable case, resulting in 73 cases of diphtheria. 71 (97%) were male, 39 (53%) were younger than 18 years, and 36 (49%) presented with cutaneous diphtheria. The prevalence of diphtheria was highest among Afghans (1·3%) compared with all other nationalities (<0·1%). Local antibiotic susceptibility testing identified six cases with a macrolide resistant strain. The increase in diphtheria coincided with a high volume of asylum seekers arriving by small boats to England during 2022, and subsequently increased clinical awareness of the disease among this population. Long-term disruption to vaccination programmes in origin countries along with barriers to accessing health care along migrant routes puts asylum seekers arriving by small boats at risk of disease. With arrivals expected to continue in 2023, the UK Health Security Agency has recommended continuation of population-based control measures in England until October, 2023, subject to ongoing review. The UK Health Security Agency.

Nursing care and health promotion competencies in cardiometabolic diseases: A scoping review

Objective: The aim was to map, in the scientific literature, nursing care and health promotion competencies in cardiometabolic diseases in the light of the Galway Consensus.Methods: This is a scoping review carried out in accordance with the JBI recommendations, from November 2021 to January 2022, in five databases. The studies were analyzed according to the Galway Consensus competency domains: catalysing change, leadership, assessment, planning, implementation, evaluation, advocacy and partnerships.Results: A total of 85 studies were included in the review, and existing scientific production points out that nurses carry out comprehensive actions, which involve educational interventions, follow-up of nursing at home and at the health institution for individuals/families, health service management and partnership articulation to guarantee longitudinal, comprehensive, qualified and network-integrated care. The most highlighted domain was catalysing change, followed by assessment, planning, implementation, partnerships, advocacy and evaluation. Care such as health education, guidance on healthy eating habits, physical activity, weight reduction, smoking cessation and foot care/shoe use stood out, in addition to guidance on drug treatment, counseling, care/support for the family, home visits, follow-up by telephone and referral to a nutritionist and other professionals.Conclusions: It is necessary to strengthen competencies such as leadership and health advocacy in health promoting nurses, considering that few studies related to such themes were identified.

Positive impacts of oral health services provision by a student-led primary care clinic to an Australian rural indigenous community.

This study aimed to determine whether oral health services provision by a dental student clinical outplacement embedded within a Community Controlled Health Service positively impacted a rural Indigenous community and to explore the nature of these benefits. Aggregated and de-identified 2017, 2018 and 2019 student-led clinic services provision data were retrospectively analysed. The change in services mix over time was measured. Rural outplacement clinic operational costs to the university were estimated. Government-funded local public dental clinic waiting list and services provision data were used to identify any student clinic establishment effect. The student-led clinic services mix shifted over time from mainly acute care for toothache towards prevention of disease and tooth restoration, indicating an improvement in patient oral health and correspondingly reduced system costs. Imputed value of 2017-2019 student-led clinic services provision totalled almost AUD$1 million. Government public clinic waiting list times decreased after full establishment of the student-led clinic, indicating decreased pressure on the public system. The Community Controlled Health Service and university partnership improved community oral health care access, its timely delivery and simultaneously provided valuable human capital development from the student training experience. The student-led clinic's targeted Indigenous community showed oral health improvement over time. © 2023 Australian Dental Association.

Maximizing value in healthcare partnerships: A case examining an inter‐organizational relationship in the public and non‐profit sectors

AbstractHealthcare organizations around the world are striving to find the right balance between using their resources effectively and providing personalized care to patients. Health care is shifting from a reactive, towards a more person‐centric approach to improve health outcomes. To achieve quality improvements and efficiencies, health care organizations are forming inter‐organizational relationships. Despite the benefits, little is known about how organizations capture value from strategic partnership. In this context, this paper aims to examine the processes that occur as part of a public and non‐profit sector relationship within health care that directly relate to how the partnering organization acts to capture value. Using a qualitative case study of an Australian public‐sector health service partnership, the study employs a value mapping framework to distinguish between different types of value (captured, missed, destroyed, and opportunity), and presents an integrated model consisting of three process phases: (1) inter‐organizational cooperation effort, (2) organizational effect, and (3) social value. The study highlights the potential for negative and unintended consequences and discusses implications for management.

‘We are the (simulation) champions – evaluating the role of simulation champions to enrich the diversity of simulation practice placements within higher education institutions undergraduate healthcare programmes’

Due to the COVID-19 pandemic, there has been a significant impact on undergraduate healthcare practice placement education [1]. In response, the Scottish Government, committed to ensuring Adult and Mental Health Nursing, Midwifery, and Paramedic Science students have adequate provision to student placements, awarded Higher Education Institutions (HEIs) funding to develop simulation placements. Within our HEI a Clinical Skills and Simulation Team (CSST) has been created comprising 3 Lecturers, a Simulation Technician, and a Digital Technologist. The team then built a Simulation Champions group (n=30) through fostering working relationships, to help promote simulation-based education (SBE) pedagogy across the HEI. The purpose of this study is to explore whether creating a simulation champions group has any impact on the delivery of simulated practice placements within undergraduate healthcare programmes. The Simulation Champions are a diverse group comprised of internal academic faculty and external National Health Service (NHS) partners (such as practice education facilitators) who are passionate educators in SBE. Each external partner has a contact within the HEI, aligned to their area of clinical expertise. Through an agreed Terms of Reference, their aim is to enhance, resource, and assist the delivery of high-quality, high-fidelity simulation placements to students by working collaboratively in line with the relevant professional body standards and proficiencies [2]. The CSST oversee the Simulation Champions, providing strategic direction, leadership, following the HEI strategy [3], and support the delivery of Simulation Placements. The group meets every quarter to discuss simulation practices, explore Continuous Professional Development (CPD) opportunities, and share knowledge and learning. The impact of this team will be measured through staff and student reflection using a framework to objectively analyse scenario diversity, achievement of learning outcomes, and alignment to professional body proficiencies. Following ethical approval, a group of Year 1 Adult Nursing students (n=60) will have completed a 40-hour Simulated Practice Placement designed and delivered by Simulation Champions (n=10). This study will then evaluate and conclude whether there is a need to create and develop a diverse, multi-professional Simulation Champions Group before successful Simulated Practice Placements can be achieved. It will also help determine if securing strong working relationships ensures a smooth transfer of knowledge and skills from clinical practice to the simulation setting within a HEI, and if all of this enhances the student experience. 1. Caplan J, Clements R, Chadwick C, Kadirgamar J, Morgan J, Rao A. Medical education in 2020: developing COVID secure undergraduate hospital placements. Medical Science Educator. 2020;30(4):1677–83. 2. NMC 2018a, 2018b, 2018c, 2018d: Nursing and Midwifery Council. The Code. Professional standards of practice and behaviour for nurses, midwives and nursing associates. Nursing and Midwifery Council. Realising professionalism: Standards for education and training. Part 3: Standards for pre-registration midwifery programmes. Nursing and Midwifery Council. Realising professionalism: Standards for education and training. Part 3: Standards for pre-registration nursing programmes. 3. University of the West of Scotland. Strategy 2025. 2020. uws-strategy-2025.pdf. [Accessed on 25/01/2022]

P02-08 This has just given me life back’ – mixed method evaluation of the Wild Skills, Wild Spaces ecotherapy project, Wales, UK

Wild Skills Wild Spaces (WSWS) is a Welsh Government funded project which aims to deliver and evaluate an ecotherapy programme to improve the health, skills, and wellbeing of local communities in rural Montgomeryshire, Wales. Montgomeryshire Wildlife Trust (a third sector organisation) deliver the programme which is evaluated by Cardiff Metropolitan University.The 2-year project, which began in April 2020, involves the running of 12-week interventions of weekly physically active ecotherapy activities such as tree pruning, woodwork, growing vegetables, walking and bushcraft skills. Participants (n = 40; mean age = 24.75 SD = 15.22) are people with mental health and/or behavioral problems referred via the National Health Service, health and social care partners, and schools.The mixed method evaluation includes two phases: (i) a quantitative phase which involves pre and post intervention measures concerning connectedness to nature, wellbeing, and physical activity level; and, (ii) a qualitative phase which involves interviews and focus groups with participants, referrers, and programme leaders.At this early stage in the data collection, to date no significant changes in pre and post ecotherapy intervention quantitative scores have been apparent. However, 100% of respondents have stated that they would like to continue taking part in ecotherapy programme. From the qualitative phase, participants described positive experiences of the programme particularly referring to how the programme supported their mental health, wellbeing, and social interactions. Additionally, participants highlighted the importance of the programme leaders in facilitating an enjoyable and safe environment in which they could relax, interact with others, and learn new skills.Findings from year 1 of the 2-year evaluation provide promising results that ecotherapy programmes have the potential to attract socially excluded individuals into purposeful programmes. These programmes appear, through the qualitative findings to date, to benefit participants' self-reported holistic health but are also valued by them, for their contribution to supporting the environment through playing a part in the management of outdoor, green space in our communities.

Community-Institutional Partnerships to Strengthen Maternal Health Care: Case Study of the First Obstetrics and Gynecology Specialty Training Program in Liberia.

Despite major setbacks to its health infrastructure and health workforce capacity, Liberia began its first post-graduate training program for physicians in 2013. Specialty training in Internal Medicine, Pediatrics, General Surgery and Obstetrics and Gynecology were the four inaugural Residency programs that recruited graduates from the country's only medical school, A.M. Dogliotti College of Medicine. The Obstetrics and Gynecology residency program was designed to combat the rising maternal mortality and strengthen health systems to improve maternal care. The program adapted in the face of challenges posed by limited financial support, lack of specialist-faculty and general physician shortages and the Ebola virus outbreak. The manuscript discusses the challenges and successes of the program and demonstrates how the shortage of teaching faculty was addressed by developing a collaboration between local government and educational communities, a United States (US) academic institution and volunteers from the Global Health Service Partnership.

Resiliency, Stress, and Culture Shock: Findings from a Global Health Service Partnership Educator Cohort

Background:Global health field assignments for medical and nursing professionals include a wide variety of opportunities. Many placements often involve individuals practicing in settings very different from their home environments, relying on their professional experience to help bridge cultural and clinical divides.Objectives:There is limited information about the individual factors that might lead to successful longer-term global health experiences in non-disaster settings. In this paper, we report on one cohort of health professionals’ experiences of culture shock, stress, and resiliency as volunteers within the Global Health Service Partnership (GHSP), a public-private collaboration between Seed Global Health, the US Peace Corps, and the US Presidents Plan for Emergency Aids Relief (PEPFAR) that placed American medical and nursing educators in five African countries facing a shortage of health professionals.Methods:Using the tools of Project PRIME (Psychosocial Response to International Medical Electives) as a basis, we created the GHSP Educator Support Survey to measure resiliency, stress, and culture shock levels in a cohort of GHSP volunteers during their year of service.Findings:In our sample, participants were likely to experience lower levels of resiliency during initial quarters of global health placements compared to later timepoints. However, they were likely to experience similar stress and culture shock levels across quarters. Levels of preparedness and resources available, and medical needs in the community where the volunteer was placed played a role in the levels of resiliency, stress, and culture shock reported throughout the year.Conclusion:The GHSP Educator Support Survey represented a novel attempt to evaluate the longitudinal mental well-being of medical and nursing volunteers engaged in intense, long-term global health placements in high acuity, low resource clinical and teaching settings. Our findings highlight the need for additional research in this critical area of global health.

The Development of a Surgical Oncology Center During the COVID-19 Pandemic.

Coronavirus disease 2019 (COVID-19) was declared a pandemic by the World Health Organization on March 11, 2020. By mid-March, London had emerged as the epicenter in the United Kingdom, accounting for 45% of the COVID-19-related mortality. A cancer COVID-19-free "cold hub," through National Health Service partnership with independent institutions, was established to maintain a throughput of surgical oncology patients with an accessible triage system for oncologic specialties. The high population density, commuter volume, and rising COVID-19 incidence heightened the challenge of segregating a vulnerable population that was already at high risk for surgical morbidity and mortality.The aim of this review is to report the experience of developing a multicenter COVID-19-free cold hub with the aim of providing safe surgery for surgical oncology patients. We discuss the timeline, structure, and infection control policy and suggest practical points that may guide other health care systems.The surgical oncology hub treated 1542 patients between March 1 and July 1, 2020. There were no cases of COVID-19-related mortality in a 30-day follow-up. Key strategies for the restructuring of the cancer service included the following: (1) formation of an accessible referral pathway, (2) creation and structuring of cold hub hospitals, (3) development of protocols for infection control and preoperative testing, (4) rapid reorganization of services based on initial feedback, and (5) clear communication and leadership.It has been shown that a surgical oncology cold hub with an accessible referral system and an effective system of preoperative screening system can minimize COVID-19 transmission, morbidity, and mortality, in a region with heavy disease prevalence. This structure represents a safe, ethical, and viable system that can be replicated in other health care systems.

Partnering to Build Human Resources for Health Capacity in Africa: A Descriptive Review of the Global Health Service Partnership's Innovative Model for Health Professional Education and Training From 2013-2018.

Several Sustainable Development Goals (SDGs) (3, 16, 17) point to the need to systematically address massive shortages of human resources for health (HRH), build capacity and leverage partnerships to reduce the burden of global illness. Addressing these complex needs remain challenging, as simple increases in absolute numbers of healthcare providers trained is insufficient; substantial investment into long-term high-quality training programs is needed, as are incentives to retain qualified professionals within local systems of care delivery. We describe a novel HRH initiative, the Global Health Service Partnership (GHSP), involving collaboration between the US government (President's Emergency Plan for AIDS Relief [PEPFAR], Peace Corps), 5 African countries, and a US-based non-profit, Seed Global Health. GHSP was formed to enlist US health professionals to assist in strengthening teaching and training capacity and focused on pre-and in-service medical and nursing education in Malawi, Tanzania, Uganda, Eswatini and Liberia. From 2013-2018, GHSP sent 186 US health professionals to 27 institutions in 5 countries, helping to train 16 280 unique trainees of all levels. Qualitative impacts included cultivating a supportive classroom learning environment, providing a pedagogical bridge to clinical service, and fostering a supportive clinical learning and practice environment through role modeling, mentorship and personalized learning at the bedside. GHSP represented a novel, multilateral, public-private collaboration to help address HRH needs in Africa. It offers a plausible, structured template for engagement and partnership in the field.

Abstract B094: Impact of a multi-theory-driven community-based intervention to increase mammographic screening in a Midwest American Indian tribe

Abstract Purpose: The “No Squeeze Can Defeat Me: Mammograms for Life!” study is locally known as “My Life Matters: Mammograms for Life!” and is funded by the Minnesota Department of Health. The intervention's purpose with one Midwest tribe is to increase American Indian women's regular participation in yearly mammographic screening beginning at age 40. At study initiation, mid-year 2016, adherence with annual screening guidelines stood at 36% for women 40 and older. Using previous work that significantly differentiated nonadherent women from adherent women, we are working with tribal health and the Indian Health Service partners to utilize differentiating theoretical models and elements of those models in an attempt to increase screening and adherence through poster messaging. Posters incorporated six elements of the Health Beliefs Model, two components of the Social Norms and Social Support Models, and three features of the Theory of Planned Behavior model. Multiple elements or features of each model are employed in the poster messaging. Procedures: No Squeeze works through a Community Advisory Project Board (CAPB) and a Project Implementation Team (PIT) consisting of tribal health, Indian Health Service, and community members of varied ages, screening status, and cancer history status. CAPB members take the lead on all decisions regarding messaging, message placement, frequency of new message placements, messaging evaluation and radiology performance figures. The PIT is responsible for executing CAPB decisions. Mayo Clinic is responsible for development of poster messages and data analysis. Evaluation of the intervention considers changes in screening participation and no-show (unfilled scheduled appointments) rates and collection and analysis of community women's evaluations of posted messages. The intermediate analysis takes into account comparable months from July-June of 2016/17 and 2017/18. Analysis is primarily descriptive. Where appropriate, chi-square statistics are calculated. Results: In the first half of each of the two years of the intervention (2017 and 2018), the average number of mammograms increased by 8 and 10, respectively, over an average of 36 at baseline (2016). In the same period, monthly no-show mammogram appointment rates decreased from an average of 47% to 39%. Community women's poster evaluations indicate that messages are likely to contribute to increased mammogram screening (p = &amp;lt;0.004). Among notable evaluation findings: Women of all ages like the posters and will continue to read them. They find the messages personally important and important to other women of the tribe. Use of community women's images in the posters adds interest in the posters and has a positive effect on women's future screening (p = 0.0002). Conclusions: To date, poster messaging appears to be associated with increased screening, decreased no-show rates and community receptiveness. Further study will be necessary to determine whether it can be employed with other tribes. Citation Format: Wesley Petersen, Ann Nicometo, Robert A. Vierkant. Impact of a multi-theory-driven community-based intervention to increase mammographic screening in a Midwest American Indian tribe [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B094.

The Compassionate Communities Connectors model for end-of-life care: a community and health service partnership in Western Australia.

Background:There is an international drive towards increasing provision of community-led models of social and practical support for people living with advanced illness.Aim:This feasibility project aims to develop, implement and evaluate a model of community volunteers, identified as Compassionate Communities Connectors, to support people living with advanced life limiting illnesses/palliative care needs. The aims also include the development and evaluation of a training programme for volunteers and assessment of the feasibility, acceptability and preliminary effectiveness of this model of care.Methods:The approach seeks to map and mobilise people’s personal networks of care through the Connectors enlisting Caring Helpers (community volunteers). Up to 10 Connectors will be trained to work with at least 30 families selected by the palliative care service as requiring support. The primary outcome is the effect of the intervention on social connectedness. Secondary outcomes are the intervention’s effect on unplanned hospital utilisation, caregiver support needs, advance care plans and satisfaction with intervention for patients/carers, volunteers and service providers.Conclusion:It is expected that this intervention will enhance patient, carer and family social, psychological and practical support and reduce the need for dying people to be admitted to a hospital.

The Concept Dictionary and Glossary at MCHP: Tools and Techniques to Support a Population Research Data Repository.

The Manitoba Centre for Health Policy’s Concept Dictionary and Glossary, and the Data Repository they document, broaden the analytic possibilities associated with administrative data. The aim of the Repository is to describe and explain patterns of health care and illness, while the Concept Dictionary and Glossary create consistency in documenting research methodologies. The Concept Dictionary alone contains detailed operational definitions and programming code for measures used in MCHP research that are reusable in future projects.Making these tools available on the internet allows reaching a heterogeneous audience of academic and government health service partners, epidemiologists, planners, programmers, clinicians, and students extending around the globe. They aid in the retention of corporate knowledge, facilitate researcher/analyst communication, and enhance the Centre’s knowledge translation activities. Such documentation has saved countless hours for programmers, analysts and researchers who frequently need to tread paths previously taken by others.