Implementation Of Interventions Research Articles

Protocol for COACH, an evidence-based intervention for improved head impact safety in youth American football developed using a community-engaged approach.

Subconcussive, repetitive head impacts sustained in collision sports may negatively affect brain health. American football practices are controlled environments amenable to intervention. Engaging community members is essential for successful development, implementation, and sustainability of viable interventions. The objective of this study is to develop and pilot test an evidence-based intervention to reduce head impact exposure in youth American football (i.e., football), using a community-engaged approach. This manuscript describes the co-design of the intervention and associated implementation plan and the study protocol for evaluating the effectiveness and feasibility of the intervention and implementation plan. In the first part of this study, focus groups with parents and coaches, and individual interviews with organizational leaders associated with two teams at the middle school level were conducted. An anonymous survey assessing beliefs and perceptions of non-concussive head impacts was given to parents, coaches, and organizational leaders within the local youth football league. Following the football season, qualitative and quantitative data describing determinants of head acceleration events in football were shared with 12 stakeholders of coaches, league and school administrators, parents, an athletic trainer, and local university player development director. Together, we co-designed COACH (COmmunities Aligned to reduce Concussion and Head impact exposure) and implementation plan using a strategic planning approach. The preliminary effectiveness and feasibility were assessed in the second part of this study. Youth football players participating on the teams in year 1 (control teams) were fitted with mouthpiece-based head kinematic sensors which measure head acceleration events (HAEs). HAEs were collected and quantified during team activities. Preliminary effectiveness of the intervention to reduce HAEs was measured among two new teams pilot testing COACH with mouthpiece-based sensors, while simultaneously monitoring implementation of the intervention. We report our study design and evaluation, and opportunities and challenges with our approach. The results will inform a future full-scale pragmatic trial to assess the implementation and effectiveness of the intervention program. NCT04908930.

An Outdoor Walking Program for Immigrant Muslim Older Adults: A Community-Based Participatory Intervention.

To explore Muslim immigrant older adults' experiences of a modified community-based outdoor walking program and identify factors that facilitate or hinder program acceptance and participation. An exploratory qualitative description single-group pilot study was designed and implemented in three phases: (1) pre-intervention focus group interviews; (2) intervention implementation with tracking of physical activity levels using personal activity monitors; and (3) postintervention individual interviews. Participants were recruited using a convenience sampling strategy in a mosque in Edmonton, Canada, in June 2019. After focus group discussions with participants, walking sessions were conducted for 10 weeks in a local accessible park with required amenities such as benches and restrooms. A fitness instructor delivered the weekly program that was followed by individual semistructured interviews to explore participants' satisfaction and program acceptance. Content analysis was used for qualitative data and sociodemographic, health and physical activity level (via step counts) data was documented for all participants. Thirteen participants with a mean age of 66.9 years completed the program. The majority of participants led a sedentary lifestyle. Participants identified three motivators that increased program satisfaction, which were socialising with peers, having a fitness instructor, and using Fitbit activity trackers. Difficulties with transportation and lack of appropriate educational components were areas for improvement that could enhance acceptability of the program. This study suggests that early incorporation of older immigrants' preferences increases acceptance of physical activity programs. Nurses' engaging in healthy lifestyle support for older immigrants can identify the influences on positive uptake of physical activity programs in this population. Immigrant Muslim older adults lack access to evidence-based physical activity programming that meets their cultural and religious preferences. This study provides some insights into ways to engage this population in similar programs. Community-dwelling older adults who participated in this study completed focus groups and interviews and engaged in the 10-week pilot intervention. Their input informed the modifications to the intervention.

Impact of Village Savings and Loans Associations Participation on Cocoa Farmers’ Livelihood in the Western North Region, Ghana

The study examined the impact of Village Savings and Loans Associations (VSLA) participation on cocoa farmers livelihoods in the Western North region of Ghana. The study analyzes the factors that influence VSLA participation and the intensity of savings. The sample size for the study was 301. The Heckman two-stage model was used to analyze the factors that influence VSLA participation and the intensity of savings. Propensity Score Matching (PSM) was used to examine the impact of VSLA participation on cocoa farmers livelihoods. The results demonstrated a positive and statistically significant relationship between VSLA participation and the following variables: age, gender, household size, education, children’s education, and social contributions. However, variables such as respect, income, and gender had a negative influence on VSLA participation. The result also established a positive and significant relationship among extension contact, respect, income, and intensity of savings. VSLA participation had a negative impact on natural capital (land size), a positive impact on human capital (children’s capital) and on financial capital (total income), and no impact on social capital (community social distributions) and physical capital (home assets). Policy makers should therefore consider these factors or attributes of beneficiaries in the development and implementation of future interventions. It is recommended that government of Ghana through Ghana COCOBOD should implement policies that intensify sensitization and education on need for farmers to participate in VSLAs. Additionally, policies that support community-building activities such as VSLAs, can be implemented to foster community engagement and build social capital in cocoa growing communities.

Upregulation of cAMP/PKA/CREB signaling mediated by GABABR might contribute to the amelioration effects of sea cucumber peptides (Acaudina leucoprocta) on cognitive dysfunction in mice

This study aimed to determine the effects and underlying mechanisms of sea cucumber peptides (SCP) obtained from Acaudina leucoprocta in mitigating induced by D-galactose cognitive dysfunction in mice. Additionally, it aimed to validate the cognitive-enhancing potential of peptides identified via in silico and peptidomics using SH-SY5Y cells. The results demonstrated significant improvement in behavioral performance with oral administration of SCP. Additionally, SCP normalized oxidative stress and neurotransmitter imbalances (especially gamma-aminobutyric acid, GABA). Also, SCP effectively rectified gut microbiota dysbiosis. Mechanistically, SCP activated the γ-aminobutyric acid type B receptors (GABABR)/ cyclic adenosine monophosphate (cAMP)/ cAMP-dependent protein kinase A (PKA)/ cAMP response element-binding protein (CREB) axis to promote GABA release and alleviate neuronal and oxidative stress damage, which subsequently ameliorated cognitive dysfunction. Furthermore, docking analysis predicted the binding of fourteen peptides with high abundance and PeptideRanker scores to GABABR. Notably, Lys-Gly-Phe-Pro (KGFP) had the strongest binding affinities and actively interacted with GABABR sites through hydrogen bonds, van der Waals, hydrophobic, and electrostatic interactions. The capacity of KGFP to improve cognitive function was further demonstrated when the SH-SY5Y cells were subjected to D-galactose. These results imply that the implementation of SCP intervention could be a useful tactic for improving cognitive function.

Changes in the epidemiology of under-5 mortality in China from 2016 to 2022: an observational analysis of population-based surveillance data

Sustainable Development Goal (SDG) 3.2 aims to end preventable deaths of newborns and children younger than 5 years. China's progress towards SDG 3.2 has not been evaluated on multiple dimensions. We aimed to assess mortality rates in children younger than 5 years (hereafter referred to as under-5 mortality) and to quantify preventable child mortality and geospatial and temporal trends in child mortality in China from 2016 to 2022. In this observational analysis, we used data from the Chinese National Maternal and Child Health Surveillance System (MCHSS) for the period Jan 1, 2016, to Dec 31, 2022 and conducted all-cause mortality and cause-specific mortality analyses for different age groups (age 0-6 days, 7-27 days, 0-27 days, 1-5 months, 6-11 months, 12-23 months, 24-59 months, and birth to 59 months) separately at the national, residential (rural vs urban), and regional (eastern vs central vs western China) levels. All mortality rates were adjusted by age group, type of residency, region, and region-residency strata using a 3-year moving average of the under-reporting rates. National deaths were estimated using the number of livebirths from 2016 to 2022 from the Health Statistics Yearbook of China. Estimated national-level and regional-level mortality rates were weighted by the proportion of the population living in urban and rural areas from the 2010 national census. Optimal survival metrics for neonates and children younger than 5 years were calculated by cause of death in 2020-22 (termed the national optimum), on the basis of the lowest mortality observed among the six region-residency strata. In 2022, approximately 65 700 (95% CI 62 700-68 800) children younger than 5 years died in China, with 45·1% (42·7-47·4) of these deaths occurring in the neonatal period (age <28 days). China's under-5 mortality rate decreased from 10·2 deaths (9·9-10·5) per 1000 livebirths in 2016 to 6·8 deaths (6·5-7·2) per 1000 livebirths in 2022; the neonatal mortality rate decreased from 4·9 deaths (4·7-5·1) per 1000 livebirths in 2016 to 3·1 deaths (2·9-3·3) per 1000 livebirths in 2022. The relative risk of death in children younger than 5 years in rural areas compared with urban areas decreased from 2·4 (2·2-2·6) in 2016 to 1·9 (1·7-2·1) in 2022, and in the western region compared with the eastern region decreased from 3·4 (3·0-3·9) in 2016 to 2·3 (1·9-2·8) in 2022. The leading causes of under-5 mortality in 2022 were injuries (23·1% [21·1-25·1] of all-cause deaths), congenital malformations (14·8% [13·1-16·4]), preterm birth complications (14·1% [12·5-15·7]), intrapartum-related events (10·1% [8·7-11·5]), and acute respiratory infections (9·5% [8·2-10·9]). The leading cause of death in the neonatal period was preterm birth complications (12·8% [11·4-14·2] of deaths in children younger than 5 years). Under-5 mortality in China declined between 2016 and 2022. Disparities across regions and in urban versus rural areas narrowed over time, but they still exist. Therefore, efforts should be made to further reduce child mortality in China, including consistent investments and implementing of policies, programmes, and interventions, especially for the western rural areas. None. For the Chinese translation of the abstract see Supplementary Materials section.

Breadth and Depth of Patient and Caregiver Supportive Services in Community Oncology (WF-1803CD).

Providing supportive services to patients and their caregivers is essential to quality cancer care, yet the depth, availability, and infrastructure underlying these services remains unknown in community practice. We assessed these factors among practices within the National Cancer Institute Community Oncology Research Program (NCORP) to guide priorities for comprehensive supportive service(s) development and inform implementation of evidence-based interventions in clinical practice. Supportive care leaders at NCORP practices completed online surveys regarding availability of services to patients and caregivers within seven domains, service infrastructure (e.g., staffing, technology), and implementation recommendations for caregiver-specific services. Primary outcomes were the proportion of practices offering at least one service in each domain to both populations and the proportion offering caregiver training/education. Of the 103 participating practice groups, only 15.5% offered at least one service in each domain to both populations; 21.4% offered caregiver training/education. Psychological (83.5%) and spiritual/religious (75.7%) services were most widely available to both; health promotion (28.2%) services were least available to both. Services offered were largely available on-site with dedicated staff; caregiver-specific services were nearly always off-site and typically self-pay. Practices most often used the patient health portal to communicate with patients and caregivers (54.4%). Only 28.9% provided bilingual staff for services. Social workers (35.7%) and navigators (34.7%) were recommended to support caregiver services. To meet national recommendations for supportive service provision, practices should invest in caregiver education/training programs, expand health promotion programs, and increase interpretation services. Future interventions should leverage existing resources (e.g., recommended staff, patient portal).

The implementation and evaluation of a family-led novel intervention for delirium prevention and management in adult critically ill patients: A mixed-methods pilot study.

Family-led interventions have been identified as effective in many areas of care including the management of delirium. However, because of the heterogeneity and ambiguity of family-led interventions, they are not consistently applied within intensive care units. A user-friendly digital intervention may therefore support consistent family integration into delirium management. To explore the feasibility and acceptability of a family member's voice reorientation intervention for delirium prevention and management in an adult intensive care unit. Parallel, convergent mixed-methods pilot study was conducted in a general adult intensive care unit in the United Kingdom. Thirty participants (15 patients and 15 family members) were enrolled in the study. For the qualitative component, 17 participants (three patients, six family members and eight nurses) contributed to the evaluation. The median frequency of the family member's voice reorientation intervention was 2.3 times per day (range 3.3), and the median Richmond Agitation-Sedation Scale score was -1 (range 2.5). Qualitative data revealed seven themes: acceptance of the intervention, communication, delirium awareness, reactions to the intervention, cognitive state, perception of the intensive care unit and psychological well-being. Nurses can involve family members in person-centred care within the intensive care unit. Results from this study indicate that the family member's voice reorientation programme is feasible and acceptable and may be an effective strategy for providing ongoing orientation, reassurance and comfort to critically ill adult patients to prevent or manage delirium. A larger study is needed to evaluate its impact on delirium. The family member's voice reorientation intervention offers critical care nurses a feasible, family-centred approach to support delirium care in the intensive care unit. Integrating this non-invasive tool into practice may enable nurses to enhance patient outcomes, reduce anxiety and strengthen collaboration between patients, families and health care professionals.

Orthorexia nervosa tendencies and risk of eating disorders among culinary arts students: A comparative study with dietetics students.

Students pursuing food-related academic fields such as dietetics have higher orthorexia nervosa (ON) tendencies and are at a greater risk of developing eating disorders (EDs). However, there is limited research available on ON tendencies and on the risk of EDs in the culinary arts field, which also revolves around food. The present study explored ON tendencies and the risk of EDs among culinary arts students and compared them with those of dietetics students. A cross-sectional study was conducted in France, using the eating habits questionnaire (EHQ) to measure ON tendencies, and the SCOFF as well as the eating disorders examination questionnaire (EDEQ) to evaluate the risk of EDs and ED symptoms. The study also included questions about sports practice. In total, 267 students participated in the study, including 144 culinary arts students (51 women, 92 men and one other) and 123 dietetics ones (106 women, 15 men and two others). Culinary arts students exhibited similar means of EHQ scores as dietetics ones (32.99 vs. 33.34) but higher SCOFF scores (52.8% vs.39.8%). In addition, a gender difference was evidenced: women in culinary arts showed higher EHQ, SCOFF and EDEQ scores than men in culinary arts. Linear regression models showed no effect of the type of academic field (culinary arts vs. dietetics) on the EDEQ score but revealed effects of gender, body mass index and hours of sports practice. The study emphasises the need to monitor culinary students and implement interventions to prevent EDs. It also suggests a correlation between food-related education and the risk of EDs, which requires further research.

Interventions for comorbid learning disabilities

AbstractComorbidity, the simultaneous or successive co‐occurrence of two or more disorders in one individual, is common among individuals with learning disabilities (LDs). The topic has garnered much attention in the field of LD, with advances over the past three decades in describing, predicting, and explaining comorbid LDs. However, efforts to design, evaluate, and implement interventions for individuals with comorbid LDs have received far less attention. In this article, we focus on these critical matters. After discussing how comorbidity and LDs have been conceptualized, defined, and explained, we consider what the field has learned about how individuals with comorbid LDs respond to academic interventions and what approaches may be effective for supporting their educational development.

Evaluating the feasibility of “Friends in Nature,” a complex nature-based social intervention to address loneliness and quality of life in six cities worldwide

BackgroundLoneliness, a major public health concern, could be alleviated through social interventions with nature contact as a primary component. “Friends in Nature” is a complex nature-based social intervention designed to be implemented as part of “Reimagining Environments for Connection and Engagement: Testing Actions for Social Prescribing in Natural Spaces" (RECETAS). This project aims to alleviate loneliness and promote health-related quality of life in six different geographic areas worldwide. Feasibility studies are crucial to assess the viability of complex interventions and study procedures before conducting definitive studies. This paper aims to describe the design, implementation, and evaluation of the six-related feasibility studies on the “Friends in Nature” intervention. These studies specifically evaluate feasibility of recruitment and study procedures, intervention implementation, and data collection and distribution.MethodsWe defined a comprehensive set of indicators to assess the feasibility of “Friends in Nature.” For the first domain, recruitment procedures were assessed to determine their adequacy, while attrition rates were examined to assess participant retention. For the second domain, the implementation of interventions was evaluated, along with the study design’s ability to adapt to unexpected situations and participant adherence to the intervention. Finally, for the third domain, completion rates and the acceptability of the study activities were also analyzed. The feasibility of using specific scales to assess loneliness and well-being was also explored.ResultsThe feasibility indicators defined for this study were useful to assess the feasibility of “Friends in Nature.” Recruitment procedures were generally found to be adequate, and the number of dropouts was low. Interventions were implemented with minor adjustments, and facilitators played a vital role in the well-functioning of the interventions. Although some unexpected situations occurred during the study, adaptations were made, and participants were generally satisfied with the activities proposed. Scales used to assess loneliness and quality of life showed potential for measuring the effects of nature-based social prescribing in the full trial.ConclusionThis paper offers valuable insights into the design and execution of feasibility studies for complex interventions like “Friends in Nature.” Findings from these assessments explore the feasibility of “Friends in Nature” and will inform the main RECETAS studies, which are designed to strengthen the evidence base to support the use of nature-based social prescribing to reduce loneliness and promote quality of life.Trial registrationBarcelona trial: NCT05488496, Prague trial: NCT05522140, and Helsinki trial: NCT05507684.

A Systematic Review of Research Trends in Water, Sanitation, and Hygiene (WASH) in Indonesia

This study offers a comprehensive review of research trends in WASH in Indonesia from 1975 to April 2021. A total of 272 articles related to Sustainable Development Goals 6.1 and 6.2 were analyzed, sourced from the Web of Science and Scopus databases. The analysis found that water-related research (41%) was more prominent than topics related to sanitation (22%) or hygiene (13%). Social aspects (39%) were the most common focus in literature, particularly studies exploring the factors influencing WASH-related behaviors. However, there was a noticeable lack of studies on the implementation of WASH programs or interventions aimed at changing behavior, highlighting a disconnect between research findings and their application in policy and practice. In contrast, topics on hygiene (14%) and WASH financing (6%) were among the least covered. There was also a significant amount of research that combined multiple topics (23%) and themes (15%), reflecting a growing recognition of the need to address WASH challenges from a holistic, multi-faceted perspective. Geographically, most WASH research was centered in central Indonesia, even though WASH issues, such as inadequate services and poor behavior, tend to be more acute in other areas. This study also identifies several research gaps relating to topic selection, thematic focus, and regional coverage that should be addressed in future WASH studies in Indonesia.

Efficacy of lifestyle interventions in preventing cardiovascular disease in Nigeria: A review

Cardiovascular diseases (CVD) represent a critical public health issue worldwide, with Nigeria experiencing a marked increase in prevalence due to rapid urbanization, lifestyle changes, and socioeconomic factors. Lack of sufficient exercise and increased consumption of fatty foods, salty, and processed foods are causal factors of the risk factors associated with hypertension, hypercholesterolemia and obesity. Consequently, this review assesses the effectiveness of lifestyle intervention in dietary modifications, exercising, smoking cessation, and stress reduction on these factors among the Nigerian populace. Clinical studies support that communicating specific dietary measures together with the DASH modified for Nigerian foods and moderate aerobic exercise duration decreases blood pressure and cholesterol levels by dropping 12-15mm Hg and LDL cholesterol by 20mg/dL-Anticipated empirical analysis results show the significance of smoking cessation and stress management on CVD intervention. For instance, nicotine replacement therapy accompanied by behavioural counselling produced a 30% abstinence rate among the participants, and MBSR stress reduction programmes reduced the participants' blood pressure by 10 %. It also reflects the fact that cultural orientation to preventive measures needs to be culturally appropriate for the Nigerian setting, given that socioeconomic factors perpetuate risks. The findings of statistical studies in this review are presented regarding the changes in CVD indicators, which are valuable for forming subsequent public health policies. Because the burden of CVD is increasing in Nigeria and most low and middle-income countries, the use of lifestyle approaches to address risk factors is a good strategy. However, success is determined by countering systemic barriers such as poorly preventing or treating diseases and having a favourable perception of traditional diets. Within these developments, this article seeks to advance the implementation of these efficacious interventions into the Nigerian context, but with ideas for improving its accessibility, cost and receptiveness to accept these innovative practises in the country's health care system.

Parasites of Innovation – The Dual Models of Neoliberal Urban Creativity

This critical interrogation of the neoliberal agenda pivots around its usurpation of creativity as crystalized in the creative city and related urban politics in the global North. Cities being the engines of the economy (Jane Jacobs and Peter Hall), Florida and Landry advocate the creative city as the real motor force of the neoliberal economy – a kind of creativity that has little to do with spontaneous imaginative bottom-up urban regeneration but rather the fostering of a factitious or cultivated creativity through the top-down implementation of specific policy interventions. It is theorized that this artificially created creativity is incarnated in a direct and indirect model respectively that function differently to foster economic growth. While the direct model is glaringly invasive and overtly top-down, the indirect model is more insidious because more subtle and unobtrusive by utilizing negative planning measures to let the informal creative margins and interstices flourish “organically” – the latter serving as breeding ground upon which the former parasitizes. Together the direct and indirect models permeate the entire register of power operative in the creative city from macropolitical urban interventions to the microphysics of the individual creaworker. This contribution critically unpacks the dual models of neoliberal urban creativity and concludes by briefly touching upon the crucial question of resistance.

Efficacy of a Brief Intervention to Improve the Levels of Nutrition and Physical Exercise Knowledge Among Primary School Learners in Tshwane, South Africa: A Quasi-Experimental Study

The prevalence of childhood obesity in South Africa necessitates the design and implementation of interventions to improve the levels of physical activity and nutrition among school-age children. This study aimed to evaluate the efficacy of a brief intervention to improve knowledge regarding exercise and nutrition among primary school learners in Tshwane, South Africa, using a quasi-experimental single-group, pre–post-test design. A total of 86 primary school learners from two primary schools participated in the intervention, which was guided by the Analysis Grid for Obesity-Linked Environments (ANGELO). Descriptive statistics were analysed using the frequency distribution while inferential statistics used the t-test to compare the means of nutrition and exercise knowledge pre- and post-intervention. All primary school learners were able to access the nutrition and exercise information. The mean nutrition knowledge (pre- and post-test) was 0.914 and the mean exercise knowledge (pre- and post-test) was 0.8464. The primary school learners’ levels of knowledge on diet and physical exercise were improved by the brief intervention. It is recommended that this initiative be supported, continued, and duplicated in schools throughout Tshwane.

Prevalence of mental disorders in adult populations from the Global South following exposure to natural hazards: a meta-analysis.

Although natural hazards (e.g., tropical cyclones, earthquakes) disproportionately affect developing countries, most research on their mental health impact has been conducted in high-income countries. We aimed to summarize prevalences of mental disorders in Global South populations (classified according to the United Nations Human Development Index) affected by natural hazards. To identify eligible studies for this meta-analysis, we searched MEDLINE, PsycINFO and Web of Science up to February 13, 2024, for observational studies with a cross-sectional or longitudinal design that reported on at least 100 adult survivors of natural hazards in a Global South population and assessed mental disorders with a validated instrument at least 1 month after onset of the hazard. Main outcomes were the short- and long-term prevalence estimates of mental disorders. The project was registered on the International Prospective Register of Systematic Reviews (CRD42023396622). We included 77 reports of 75 cross-sectional studies (six included a non-exposed control group) comprising 82,400 individuals. We found high prevalence estimates for post-traumatic stress disorder (PTSD) in the general population (26.0% [95% CI 18.5-36.3]; I2 = 99.0%) and depression (21.7% [95% CI 10.5-39.6]; I2 = 99.2%) during the first year following the event, with similar prevalences observed thereafter (i.e., 26.0% and 23.4%, respectively). Results were similar for regions with vs. without recent armed conflict. In displaced samples, the estimated prevalence for PTSD was 46.5% (95% CI 39.0-54.2; k = 6; I2 = 93.3). We furthermore found higher symptom severity in exposed, versus unexposed, individuals. Data on other disorders were scarce, apart from short-term prevalence estimates of generalised anxiety disorder (15.9% [95% CI 4.7-42.0]; I2 = 99.4). Global South populations exposed to natural hazards report a substantial burden of mental disease. These findings require further attention and action in terms of implementation of mental health policies and low-threshold interventions in the Global South in the aftermath of natural hazards. However, to accurately quantify the true extent of this public health challenge, we need more rigorous, well-designed epidemiological studies across diverse regions. This will enable informed decision making and resource allocation for those in need.

Context, mechanisms and community engagement in implementation strategies: a systematic review protocol of implementation strategies designed using implementation mapping

IntroductionImplementation Mapping (IM) has increasingly been used for the design and/or selection and tailoring implementation strategies to promote the effective translation of evidence-based interventions into practice. IM is a tool...

Interventions and implementation considerations for reducing pre-treatment loss to follow-up in adults with pulmonary tuberculosis: A scoping review

Background Tuberculosis (TB) is a leading cause of death worldwide with over 90% of reported cases occurring in low- and middle-income countries (LMICs). Pre-treatment loss to follow-up (PTLFU) is a key contributor to TB mortality and infection transmission. Objectives We performed a scoping review to map available evidence on interventions to reduce PTLFU in adults with pulmonary TB, identify gaps in existing knowledge, and develop a conceptual framework to guide intervention implementation. Methods We searched eight electronic databases up to February 6 2024, medRxiv for pre-prints, and reference lists of included studies. Two review authors independently selected studies and extracted data using a predesigned form. We analysed data descriptively, presented findings in a narrative summary and developed a conceptual framework based on the Practical, Robust Implementation, and Sustainability Model to map the factors for effective intervention implementation. Results We reviewed 1262 records and included 17 studies. Most studies were randomized controlled trials (8/17, 47%). Intervention barriers included stigma and inadequate resources; enablers included mobile phones and TB testing and results on the same day. We identified eight interventions that reduced PTLFU: treatment support groups; mobile notifications; community health workers; integrated HIV/TB services; Xpert MTB/RIF as the initial diagnostic test; computer-aided detection with chest radiography screening; active linkage to care; and multi-component strategies. Conclusion Given the variation of healthcare settings, TB programs should consider contextual factors such as user acceptability, political commitment, resources, and infrastructure before adopting an intervention. Future research should utilize qualitative study designs, be people-centred, and include social and economic factors affecting PTLFU.

Identifying CFIR Inner Setting Factors in the Implementation of a Salon-Based Intervention to Reduce Barriers and Improve Pre-Exposure Prophylaxis (PrEP) Uptake Among Black Women in US South.

US Black women are disproportionally represented in new HIV diagnoses. PrEP is effective in HIV prevention, but Black women's uptake is low. The UPDOs salon-based intervention is effective in overcoming barriers to care but scaling implementation is needed. This mixed-method pilot study sought to understand how salon organizational factors may have influenced UPDOs implementation with a focus on organizational culture, team culture, relational connection, and communication within a Consolidated Framework for Implementation Research (CFIR) inner setting lens. Organizational culture and team culture were measured using the Organizational Culture Survey (OCS) and Team Psychological Safety Scale (TPS). Relational connection and communication were explored qualitatively using participant observations and semi-structured interviews. Findings were positive towards teamwork, morale, information flow, involvement, and supervision as well as reflected positive organizational environment that were supportive of developing knowledge and skills. Relational connection and communication created a trusting environment that facilitated implementation. Future research can benefit from examining organizational environment when scaling interventions to overcome HIV and PrEP inequities.

Using normalisation process theory to evaluate the implementation of a digital health intervention in community and secondary care long COVID clinics

ObjectivesThe potential and expected benefits of digital health interventions (DHI) have long been discussed, yet substantial challenges are associated with deploying DHI at scale. Insights are presented concerning the implementation...

Prevention of maternal mortality with interventions in primary care services: What can we do?

Despite global progress and a marked reduction in maternal mortality ratio worldwide, the burden of maternal death and morbidity remains a huge challenge, especially among low- and middle-income settings. Maternal mortality is determined by multiple components. As a result, sustainable strategies require not only the implementation of effective health policies but also social development. In this narrative review, we discuss strategies to improve the maternal mortality ratio based on recent advances in public health. Primary care plays a key role in identifying background conditions, risk factors and early signs of some major causes of maternal mortality and morbidity. Antenatal care also addresses other conditions that influence outcomes: unwanted pregnancies, nutrition, sexually transmitted illnesses, family planning, immunization, and child health. Therefore, awareness about major causes of maternal mortality, direct and indirect targeted interventions to adequately identify risk factors, implement prophylactic interventions when available and guarantee early diagnosis, can certainly impact outcomes.