Implementation Of Interventions Research Articles

Abstract B050: Health and faith in the Korean community: Increasing breast and colorectal cancer education and screening in Los Angeles

Abstract Background: Koreatown in Los Angeles is home to over 115 churches within 3 miles. Korean churches are sanctuaries that provide support and nurture social connections, especially among Korean immigrants with limited English proficiency, who face challenges in accessing cancer care, including language barriers, lack of health insurance, and fears associated with cancer screening procedures and treatments. Koreans experience higher incidence and prevalence rates of breast and colorectal cancers compared to non-Hispanic White and other Asian subgroups, respectively. To address this, a Health and Faith Initiative was launched in 2018, utilizing evidence-based strategies recommended by Center for Disease Control and Prevention Community Guide and the use of a Cancer 101 curriculum developed by the Fred Hutchinson Cancer Center. METHODS: A three-stage Partnership Development Framework (networking, education, program and research development) was used to grow deep connections and sustainable cancer screening programs with church pastors and leaders, patient navigators, Federally Qualified Health Centers, State Breast and Cervical Early Detection Program providers, Diagnostic facilities, Hospitals and Community Outreach and Engagement staff. Bi- lingual church leaders was selected by pastors and elders at churches were trained as lay community navigators to conduct cancer education workshops using a Cancer 101 curriculum, as well as to support for church member to navigate across the cancer continuum. Church pastors and community health clinics determine outreach, engagement, and research priorities through active participation in Community Advisory Board and research studies. The initiative is sustained through coordination of 2 outreach staff and financial assistance from community benefit and research grants at Cedars Sinai Cancer Center. RESULTS: From June 2023 to May 2024, Community Outreach and Engagement (COE) have led the coordination of 6 breast cancer health education workshops and screening events with 165 people screened (128 screening mammograms, 37 diagnostic mammograms & ultra sounds) in partnership with Koryo Health Foundation. Two patients were diagnosed with breast cancer and were referred to Cedars Sinai for treatment. For colorectal cancer, 8 health education workshops were conducted, and 122 Fit Kits were distributed with 72 kits returned, a 59% return rate. Cancer education workshops using American Cancer Society cancer screening guidelines for breast, colorectal, prostate, cervical, lung cancer has reached 810 people during 5 tabling events. Those who were not up to date were referred to our partnered health clinics for screening. CONCLUSION: Engaging Korean church leaders and training community navigators is an effective outreach strategy to build long-lasting partnership for successful implementation of cancer screening interventions but also support patients in needed follow up care that help immigrant populations to navigate across the cancer continuum. Citation Format: Dong Hee Kim, Min Jung Sung, Moon Ju Kim, Jeong Yup Lee, Reener Balingit, Zul Surani. Health and faith in the Korean community: Increasing breast and colorectal cancer education and screening in Los Angeles [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr B050.

Dementia Friendly communities (DFCs) to improve quality of life for people with dementia: a realist review

BackgroundCurrently, there are more than 55 million people living with dementia worldwide. Supporting people with dementia to live as independently as possible in their communities is a global public health objective. There is limited research exploring the implementation of such interventions in the community context. The aim of the review was to create and refine programme theory – in the form of context mechanism-outcome configurations – on how the characteristics of dementia-friendly communities (DFCs) as geographical locations interact with their social and organisational contexts to understand what works for whom and why.MethodsThis realist review sourced literature from 5 electronic databases: Cochrane Library, CINAHL, Medline, Scopus, PsychINFO and Google Scholar, as well as relevant websites such as Alzheimer’s Society to identify grey literature. Methodological rigour was assessed using the Joanna Briggs Institute critical appraisal tool.ResultsSeven papers were included in this realist review that focused on DFCs in a geographical context The implementation of DFC interventions emerged as a process characterised by two pivotal implementation phases, intricately linked with sub-interventions. The first intervention, termed Hierarchy Commitment (I1a/b), involves the formalisation of agreements by businesses and organizations, along with the implementation of dementia-friendly action plans. Additionally, Educational Resources (I1c) play a significant role in this phase, engaging individuals with dementia and their caregivers in educational initiatives. The second phase, Geographical/Environmental Requirements (I2), encompasses the establishment of effective dementia-friendly signage, accessible meeting places, and community support.ConclusionsThis realist review highlighted a theoretical framework that might guide the development of dementia-friendly communities to enhance the experiences of individuals with dementia and their caregivers within DFCs. Emphasising the need for a theoretical framework in developing geographical DFCs, the review outlines contextual elements, mechanisms, and outcomes, providing a foundation for future studies. The ultimate goal is to establish a robust body of evidence for the sustainable implementation of dementia-friendly communities, thereby improving the quality of life for those with dementia.Study registrationThis study is registered as PROSPERO 2022 CRD42022317784.

Implementing an early-life nutrition intervention through primary healthcare: staff perspectives

BackgroundNutrition interventions targeting early childhood can be cost-effective and may provide lifelong, intergenerational benefits. From October 2022 to April 2023 the Nutrition Now (NN) e-learning resource was implemented within Early Childhood Education and Care centres and the Maternal and Child Healthcare Centre (MCHC) in a southern Norwegian municipality. As part of the NN project, the present study aims to explore the MCHC staff’s experiences with implementing the NN resource, to gain insights into measures important to scale up digital early-life nutrition interventions.MethodsThree group interviews were conducted among public health nurses and midwives alongside one individual interview with the department leader of a MCHC in May 2023. An inductive thematic analysis, as described by Braun and Clarke, was conducted to generate the key themes and subthemes regarding the implementation process of NN within the MCHC.ResultsThree main themes were generated: [1] Important resource but not always utilized; [2] Parents are interested but had issues with access; and [3] Staff and stakeholder buy-in and commitment needed from the start. Overall, the staff viewed the NN resource as a potential tool for promoting diet-related topics and believed it could support the guidance they were already providing parents. However, few staff members fully familiarized themselves with the resource. While staff perceived parents as positive when informed about NN, they believed issues such as access challenges, competing platforms, and time constraints reduced parental engagement. Lastly, staff suggested improvements for NN’s implementation, including enhanced training, better planning, assigning champions, and lowering the threshold for access.ConclusionThe findings of this study suggest that the real-world implementation of digital evidence-based health behaviour interventions is feasible but would be enhanced by employing strategies focusing on engagement and utilization.Trial registrationThe main study is registered in the ISRCTN registry with ID ISRCTN10694967, https://doi.org/10.1186/ISRCTN10694967. (Registration date: 19-06-2022).

Practitioner perspectives on equitable implementation of evidence-based interventions for cancer prevention and control

Practitioner perspectives on equitable implementation of evidence-based interventions for cancer prevention and control

Factors Associated with Advance Care Planning Engagement Among Community‐Dwelling Older Adults: A Cross‐Sectional Study

ABSTRACTAimTo explore the associations between depression, anxiety, decisional conflict and advance care planning engagement and the potential mediating role of decisional conflict in the associations between depression, anxiety and advance care planning among community‐dwelling older adults.DesignA cross‐sectional study was conducted with 262 community‐dwelling older Australians across metropolitan, regional and rural communities between August and October 2022.MethodsValidated self‐reported questions were used to collect data on anxiety, depression (Hospital Anxiety and Depression Scale), decisional conflict (Decisional Conflict Scale), advance care planning engagement (Advance Care Planning Engagement Survey) and covariates (demographic characteristics, health literacy [Health Literacy Screening Questions]), overall health status (Short form 36). Data analysis included descriptive statistics, bivariate association analysis, general linear modelling and path analysis.ResultsAnxiety and decisional conflict were directly associated with advance care planning engagement even after controlling for potential effects of demographic characteristics, health literacy and overall health status. The model, including age, gender, country of birth, language spoken at home, education, overall health status, anxiety, depression, decisional conflict and interaction between anxiety and decisional conflict, explained 24.3% of the variance in their advance care planning engagement. Decisional conflict mediated the association between anxiety and advance care planning engagement.ConclusionIncreased anxiety and decisional conflict were associated with reduced advance care planning engagement directly, even among community‐dwelling older adults with higher levels of education and health literacy. Increased anxiety was associated with reduced advance care planning engagement indirectly via increased decisional conflict. Healthcare professionals should assess community‐dwelling older adults' anxiety and implement interventions to manage their anxiety and decisional conflict, as these may facilitate their engagement in advance care planning.ImpactUnderstanding factors associated with advance care planning engagement among community‐dwelling older adults may inform strategies facilitating their future engagement in advance care planning. Findings from this study may be used as evidence for future implementation to facilitate the engagement of community‐dwelling older adults in advance care planning.Reporting MethodThe STROBE statement checklist was used as a guide to writing the manuscript.Patient or Public ContributionThe study was advertised publicly through social media (e.g. Twitter and Facebook) and newsletters (e.g. Advance Care Planning Australia, Centre for Volunteering, Palliative Care Australia and a large home care service provider with approximately 7000 older clients receiving support or services) to recruit participants. People aged 65 years and older living independently in the Australian community who could communicate in English were invited to participate and answer the questionnaire.

Raising the barcode: improving medication safety behaviours through a behavioural science-informed feedback intervention. A quality improvement project and difference-in-difference analysis

Barcode medication administration (BCMA) technology can improve patient safety by using scanning technology to ensure the right drug and dose are given to the right patient. Implementation can be challenging,...

Strengthening China’s National Essential Public Health Services Package for hypertension and diabetes care: protocol for an interrupted time series study with mixed-methods process evaluation and health economic evaluation

BackgroundDespite major primary health care (PHC) reforms in China with the 2009 launch of the National Essential Public Health Service Package, the country experiences many challenges in improving the management of non-communicable diseases in PHC facilities. “EMERALD” is a multifaceted implementation strategy to strengthen the management of hypertension and type-2 diabetes mellitus (T2DM) in PHC facilities. The study aims to: (1) examine the effectiveness of EMERALD in improving hypertension and T2DM management; (2) evaluate the implementation of the interventions; and (3) use the study findings to model the long-term health economic impact of the interventions.MethodsThe EMERALD intervention components include: (1) empowerment for PHC providers through training and capacity building; (2) empowerment for patient communities through multi-media health education; and (3) empowerment for local health administrators through health data monitoring and strengthening governance of local PHC programs. An interrupted time series design will be used to determine the effectiveness of the interventions based on routinely collected health data extracted from local health information systems. The primary effectiveness outcome is the guideline-recommended treatment rates for people with hypertension and T2DM. Secondary effectiveness outcomes include hypertension and T2DM diagnosis and control rates, and enrolment and adherence rates to the recommended care processes in the National Essential Public Health Service Package. A mixed-methods process evaluation will be conducted to evaluate the implementation of the interventions, including the reach of the target population, adequacy of adoption, level of implementation fidelity, and maintenance. Qualitative interviews with policy makers, health administrators, PHC providers, and patients with hypertension and/or T2DM will be conducted to further identify factors influencing the implementation. In addition, health economic modelling will be performed to explore the long-term incremental costs and benefits of the interventions.DiscussionThis study is expected to generate important evidence on the effectiveness, implementation, and health economic impact of complex PHC interventions to strengthen the primary care sector’s contribution to addressing the growing burden of non-communicable diseases in China.Trial registrationThe study has been registered on Chinese Clinical Trial Registry at https://www.chictr.org.cn/ (Registration number ChiCTR2400082036, on March 19th 2024).

Is cancer associated with frailty? Results from a longitudinal study of old Danish twins

Abstract Background While age is an important risk factor for both cancer and frailty, it is unclear whether cancer itself increases the risk of frailty. We aimed to assess the association between cancer and frailty in a longitudinal cohort of older Danish twins, taking familial effect into account. Methods Using the Danish Cancer Registry, cancer cases were identified among participants aged 70 and over in the Longitudinal Study of Aging Danish Twins (LSADT). Frailty was evaluated over 10 years of follow-up using the frailty index (FI) and defined as FI > 0.21. Stratified Cox regressions were performed on discordant twin pairs (pairs where one twin had incident cancer and the other was cancer-free), and on all LSADT individual twins (twin pairs and singletons) with no history of cancer. Results Among the 72 discordant pairs (n=144, median age at inclusion=75) included in the study, the median FI at inclusion was 0.08 for both cancer twins and cancer-free co-twins. From the stratified Cox regression, twins with cancer had an increased hazard of developing frailty (HR=3.67, 95%CI=1.02,13.14) compared to their cancer-free co-twins. The analyses on individual twins (n=4,027) provided similar results, showing an increased hazard of frailty in individuals with cancer (HR=2.57, 95%CI= 1.77,3.74) compared to those without cancer. Conclusions We showed a higher risk of becoming frail following a cancer diagnosis in both discordant twin pairs and individual twins. These findings support the importance of monitoring of frailty in older adults with cancer through geriatric assessments and implementation of frailty interventions.

From conceptualising to modelling structural determinants and interventions in HIV transmission dynamics models: a scoping review and methodological framework for evidence-based analyses

Abstract Background Including structural determinants (e.g. criminalisation, stigma, inequitable gender norms) in dynamic HIV transmission models is important to help quantify their population-level impacts and guide implementation of effective interventions that reduce the burden of HIV and inequalities thereof. However, evidence-based modelling of structural determinants is challenging partly due to a limited understanding of their causal pathways and few empirical estimates of their effects on HIV acquisition and transmission. Methods We conducted a scoping review of dynamic HIV transmission modelling studies that evaluated the impacts of structural determinants, published up to August 28, 2023, using Ovid Embase and Medline online databases. We appraised studies on how models represented exposure to structural determinants and causal pathways. Building on this, we developed a new methodological framework and recommendations to support the incorporation of structural determinants in transmission dynamics models and their analyses. We discuss the data and analyses that could strengthen the evidence used to inform these models. Results We identified 17 HIV modelling studies that represented structural determinants and/or interventions, including incarceration of people who inject drugs (number of studies [n] = 5), violence against women (n = 3), HIV stigma (n = 1), and housing instability (n = 1), among others (n = 7). Most studies (n = 10) modelled exposures dynamically. Almost half (8/17 studies) represented multiple exposure histories (e.g. current, recent, non-recent exposure). Structural determinants were often assumed to influence HIV indirectly by influencing mediators such as contact patterns, condom use, and antiretroviral therapy use. However, causal pathways’ assumptions were sometimes simple, with few mediators explicitly represented in the model, and largely based on cross-sectional associations. Although most studies calibrated models using HIV epidemiological data, less than half (7/17) also fitted or cross-validated to data on the prevalence, frequency, or effects of exposure to structural determinants. Conclusions Mathematical models can play a crucial role in elucidating the population-level impacts of structural determinants and interventions on HIV. We recommend the next generation of models reflect exposure to structural determinants dynamically and mechanistically, and reproduce the key causal pathways, based on longitudinal evidence of links between structural determinants, mediators, and HIV. This would improve the validity and usefulness of predictions of the impacts of structural determinants and interventions.

The development and evaluation of the Designing for Dissemination and Implementation Learning Hub

Abstract There is a growing emphasis on reducing the gap between research and routine practice. Dissemination and Implementation (D&I) science offers theories, models, and frameworks to enhance the implementation, impact, and sustainment of new programs and interventions. Few training opportunities are available that help leaders, researchers, clinicians, and staff (implementers) translate original research into practice settings in a more timely and effective manner without requiring significant time away from their primary clinical duties. To address these needs, we designed a virtual Designing for Dissemination and Implementation (D4D&I) Learning Hub that offered foundational D&I knowledge and opportunities for skill building. We developed the D4D&I Learning Hub curricula to train novice participants in the multicomponent D4D&I implementation strategy bundle when implementing new programs or innovations. The components of the D4D&I strategy bundle include (i) Pre-implementation assessment for proactive planning and multilevel contextual assessment, (ii) Multilevel partner engagement to learn what is important to end-users and obtain buy-in, (iii) Implementation and adaptations guided by a pre-implementation assessment while retaining program fidelity, and (iv) Program evaluation. We utilized a virtual e-learning platform, expert trainers, mentorship, and a Virtual Learning Collaborative to deliver the six-module curricula to support participants’ growth and success. We used quantitative and qualitative methods informed by the Kirkpatrick Evaluation Model to evaluate the D4D&I Learning Hub. Thirty-one participants completed the D4D&I Learning Hub across four cohorts. Participants found the D4D&I curricula relevant and favorable, indicating they acquired the intended knowledge and skills. In presentations of their key takeaways, participants cited a greater understanding of how to apply various D&I theories, models, and frameworks to their research, engage multilevel partners during all phases of implementation and evaluation, and assess fidelity and adaptations. Participants planned to incorporate the acquired D&I knowledge and skills in future publications, grant applications, and when implementing new programs and projects in clinical settings. The D4D&I Learning Hub provides foundational education for novice participants of D&I science. It promotes designing, disseminating, implementing, and evaluating effective programs in clinical settings. This article discusses the development and implementation of the D4D&I Learning Hub. In addition, we evaluated the first four cohorts using the Kirkpatrick Evaluation Model.

Current Evidence of the Application of Music in Tai Chi Exercise: Scoping Review

Background Music has frequently been used in movement exercises to enhance health benefits. However, scientific evidence regarding the application of music to Tai Chi practice is limited. Objective This scoping review aims to understand how music has been used in Tai Chi practice and whether music could be applied to Tai Chi practice to help optimize its benefits. Methods PubMed, CINAHL, CNKI, and Weipu databases were searched. We included studies that compare Tai Chi practice experience or health outcomes between individuals practicing Tai Chi with music and those practicing Tai Chi without music. Studies published through September 2022 were identified. Two researchers (YD and YH) independently performed study selection and data extraction. Thematic analysis was used to summarize and categorize the findings of the included studies. Results Seven studies were included in this review. All 7 included studies are experimental studies. Practicing Tai Chi with music might lead to positive perceptions of Tai Chi practice (eg, motivation, concentration, enjoyment, compliance, and performance) and higher evaluations of Tai Chi instructional quality, especially for Tai Chi beginners. The effects of incorporating music into Tai Chi practice on health outcomes are inconclusive due to the heterogeneities of the sample size, and the intervention components, lengths, and frequencies of the included studies. Conclusions Applying music to Tai Chi practice may result in positive Tai Chi practice experience and adherence, particularly for beginners, which could help improve the dissemination and implementation of Tai Chi interventions for public health. However, whether applying music to Tai Chi practice leads to synergetic effects on health outcomes needs further investigation.

Effectiveness of implemented global dietary interventions: a scoping review of fiscal policies

BackgroundAlthough the World Health Organisation (WHO) has proposed the use of fiscal policies to mitigate consumption externalities such as overweight and obesity-related diseases, very little is known about the impacts of the different types and framing of national and/or regional fiscal policies that have been implemented over the years. There is the need to provide up-to-date evidence on the impact of fiscal policies that have been enacted and implemented across the globe.MethodsWe conducted a scoping review of all implemented government fiscal policies in the food and drinks sector to identify the different types of fiscal policies that exist and the scope of their impact on consumers as well as the food environment. Electronic databases such as the Web of Science and Google Scholar were used to search for appropriate literature on the topic. A total of 4,191 articles were retrieved and 127 were synthesized and charted for emerging themes.ResultsThe results from this review were synthesized in MS Excel following Arksey & O’Malley (2005). Emerging themes were identified across different countries/settings for synthesis. The results confirms that fiscal policies improve consumers’ health; increase the prices of foods that are high in fats, sugar, and salt; increase government revenue; and shift consumption and purchases towards healthier and untaxed foods.ConclusionGovernments already have the optimum tool required to effect changes in consumer behaviour and the food environment.

Implementation of a heart failure disease management program in the rural southern United States: a best practice implementation project.

Heart failure affects thousands of patients annually, often resulting in hospitalization, emergency room visits, and decreased quality of life. The scientific evidence indicates that disease management programs using a multidisciplinary approach improve outcomes for heart failure patients. The overarching aim of this evidence implementation project was to establish a disease management program for heart failure patients. Specifically, the project sought to promote compliance with best practices for the early identification of heart failure exacerbation symptoms to prevent emergency room visits and hospitalizations, thereby reducing morbidity and mortality. This project was guided by the JBI Evidence Implementation Framework, which is grounded in an audit, feedback, and re-audit strategy. A baseline audit was conducted, revealing the need for a heart failure disease management program. A policy was developed to implement a disease management program and virtual relationships were established to create a multidisciplinary team. A follow-up audit was conducted to determine whether the implemented interventions closed the gap in practice identified by the baseline audit. The baseline audit revealed 0% compliance with best practices for the management of patients with heart failure, while the follow-up audit revealed 93.3% compliance. This project enhanced best practices by implementing a protocol in a rural health clinic to ensure that all heart failure patients were enrolled in a disease management program. Recommendations include using the electronic health record to quickly identify heart failure patients and their status in a disease management program. Chart audits should be performed every 6 months to ensure the program's sustainability and to determine heart failure patients' enrollment status. http://links.lww.com/IJEBH/A270.

Health system interventions and responses to anti-microbial resistance: A scoping review of evidence from 15 African countries.

The global rise in antimicrobial resistance (AMR) is claiming the lives of more than 1.2 million people each year. According to the World Health Organization (WHO) this global health crisis is particularly acute in Africa, largely due to fragile and underfunded health systems. Efforts to combat this public health threat have led to the implementation of health system interventions worldwide aimed at managing and containing the spread of AMR. However, the literature on the real time impacts and the barriers that hinder the implementation of these interventions in the African context is limited. The objective of this scoping review was to identify AMR interventions in African health systems, their impact, and the challenges of the implementation. Drawing on Muka and colleague's 24 step approach for scoping reviews, two major public health databases (PubMed and Global Health) were searched for articles in accordance with the PRISMA guidelines resulting in 4,783 records. Screening and retrieval of articles was done using Rayyan software based on specified inclusion criteria and 36 articles included in the final list. These articles were synthesized after extracting specific data on AMR interventions and their impact on African health systems. The review identified four broad impacts of AMR interventions including 1. Reduction in antibiotics use, 2. Increased adherence to guidelines and protocols, 3. Enhanced laboratory-based AMR surveillance, 4. Development of antimicrobial stewardship (AMS) Action Plans and Teams. However, challenges such as poor laboratory infrastructure, logistical challenges, poor financial commitment and inadequate education and training were identified as challenges impeding the successful implementation of AMR interventions in Africa. Our findings reveal a range of successful AMR interventions in African health systems although infrastructural and financial challenges remain. Better standardization and reporting of AMR diagnosis while leveraging the available information is needed to improve the optimization of treatment guidelines across Africa.

Implementation of Postpartum Nutritional Interventions in Healthcare, Community and eHealth: A Systematic Review.

The efficacy of interventions targeting lifestyle habits, particularly dietary habits, among postpartum women is well established. However, whether these results can be translated into tangible changes in the care and services provided to this population remains unclear. Therefore, the aim is to examine the implementation outcomes of postpartum nutritional interventions delivered in healthcare, community, or eHealth settings. A search was conducted in the MEDLINE, EMBASE, Web of Science, CINAHL, and Cochrane Library databases in July 2024, to identify all relevant studies. Included studies had to report at least 1 of the 8 implementation outcomesstudied: acceptability, adoption, appropriateness, implementation cost, feasibility, fidelity, penetration, and sustainability. Study selection and data extraction were performed by two independent reviewers. Descriptive analysis of reported outcomes was performed. CRD42022351411. Of the 8907 unique studies identified, 26 interventions (24 publications) were included.There was a great heterogeneity among interventions studied and implementation outcomes reported. Acceptability, feasibility, and fidelity were the most studied implementation outcomes. Overall, postpartum nutritional interventions were found to be acceptable and useful, but improvements were suggested by participants, such as more frequent contacts and longer programs. Recruitment, retention, participation, and penetration rates widely varied across studies. Challenges hindering the delivery of nutritional interventions were reported by participants, such as lack of time and the presence of medical conditions following delivery. CONCLUSIONSFOR PRACTICE: This review demonstrates the potential forthe delivery and implementation of nutritional interventions in real-world settings during the postpartum period.

Hypertension risk pathways in urban built environment: the case of Yuhui District, Bengbu City, China

IntroductionThe rapid development of urbanization has brought about changes in residents’ living environment and behavior, leading to health challenges such as hypertension. An improvement in the built-up environment in the community could contribute to the construction of a healthy city, promote the active life of the residents, and prevent and relieve hypertension. However, there is little research on the relationship between the built environment of the community and hypertension. This cross-sectional study aims to evaluate the relationship between communities’ built environment, health behavior, and hypertension grade of residents in Yuhui District of Bengbu City.MethodsThis study is based on data from the 2022 Health Survey of Residents in 21 communities. To investigate the impact of the community’s built environment on residents’ hypertension and the underlying mechanisms, regression and structural equation modeling were employed.Results and discussionThe results show that the built environment of urban communities has a significant impact on the residents’ hypertension. The presence of high densities of supermarkets, convenience stores, parks and plazas, but low densities of clinics and hospitals, has been identified as a significant risk factor for the development of high blood pressure among the residents. Nevertheless, the adoption of healthy behaviors, including regular walking, physical activity, and a diet rich in fruit and vegetables, can play an important role in reducing the risk of hypertension. The findings of this study show that enhancements to the built environment in urban neighborhoods could contribute to a reduction in the prevalence of hypertension among residents. Furthermore, the implementation of efficacious health interventions in urban settings would facilitate the alteration of residents’ health behaviors and enhance their overall health status.

Precision prevention in occupational health: a conceptual analysis and development of a unified understanding and an integrative framework

IntroductionPrecision prevention implements highly precise, tailored health interventions for individuals by directly addressing personal and environmental determinants of health. However, precision prevention does not yet appear to be fully established in occupational health. There are numerous understandings and conceptual approaches, but these have not yet been systematically presented or synthesized. Therefore, this conceptual analysis aims to propose a unified understanding and develop an integrative conceptual framework for precision prevention in occupational health.MethodsFirstly, to systematically present definitions and frameworks of precision prevention in occupational health, six international databases were searched for studies published between January 2010 and January 2024 that used the term precision prevention or its synonyms in the context of occupational health. Secondly, a qualitative content analysis was conducted to analyze the existing definitions and propose a unified understanding. Thirdly, based on the identified frameworks, a multi-stage exploratory development process was applied to develop and propose an integrative conceptual framework for precision prevention in occupational health.ResultsAfter screening 3,681 articles, 154 publications were reviewed, wherein 29 definitions of precision prevention and 64 different frameworks were found, which can be summarized in eight higher-order categories. The qualitative content analysis revealed seven themes and illustrated many different wordings. The proposed unified understanding of precision prevention in occupational health takes up the identified themes. It includes, among other things, a contrast to a “one-size-fits-all approach” with a risk- and resource-oriented data collection and innovative data analytics with profiling to provide and improve tailored interventions. The developed and proposed integrative conceptual framework comprises three overarching stages: (1) data generation, (2) data management lifecycle and (3) interventions (development, implementation and adaptation).DiscussionAlthough there are already numerous studies on precision prevention in occupational health, this conceptual analysis offers, for the first time, a proposal for a unified understanding and an integrative conceptual framework. However, the proposed unified understanding and the developed integrative conceptual framework should only be seen as an initial proposal that should be critically discussed and further developed to expand and strengthen both research on precision prevention in occupational health and its practical application in the workplace.

A quality improvement project addressing motion artefact on CTPAs in a district general hospital setting: A complete cycle resulting in changed practice.

Introduction: A still breath hold from the patient is one of the key requirements for a diagnostic computed tomography pulmonary angiogram (CTPA). It is important for the timely identification and treatment of patients with life threatening pulmonary emboli (PEs). Motion artefact on CTPA can cause blurring, double borders, shading and streaking in the lungs, which can either obscure PEs or create artefact that mimics PEs. This risks patient harm from delayed diagnoses, missed PEs, false positives and extra radiation and contrast exposure due to repeat studies. Methods: We devised local standards and methodology for assessing the presence and degree of motion artefact on CTs. The study consisted of initial data collection, implementation of changes to clinical practice, and subsequent repeat data collection 3 months after implementation of interventions. For each data collection round, 100 consecutive inpatient and emergency CTPAs performed in a UK District General Hospital were retrospectively identified and images reviewed to categorise each as having either: ‘no significant’, ‘minor’ or ‘major’ motion artefact. There were no exclusions. Interventions after initial data collection included a multidisciplinary meeting with radiographers, department assistants, and radiologists to devise changes to workflow and practices to build in 'rehearsal' of a breath-hold and explanation of breathing instructions with patients before scanning. A prompting phrase for this was added to our CTPA scanning protocol. Results: Initial results demonstrated that 50% of CTPA showed either minor or major motion artefact, while 50% showed no significant motion artefact. For 2% with minor motion, a clinical reason for why this was unavoidable was provided. Therefore 52% of studies met the proposed local standards. In total, 45% of CTPA were assessed to have minor motion and 5% had major motion artefact (non-diagnostic). 18% of CTPA were positive for PE. Following implementation of changes to practice, repeat data collection demonstrated that 67% of CTPA showed no significant motion artefact. 3% with minor motion provided a clinical reason why this was unavoidable. Therefore 70% of studies met the proposed standard. The increase in compliance with local standards was statistically significant (p=0.00906). Conclusion: Our interventions improved compliance with local standards from 52% to 70%. We recommend rehearsal of breath-holding with patients before CTPA scans as a quick and easy way to improve the diagnostic quality of scans. A prompting phrase within the CTPA scanning protocol has proven effective.

Training healthcare professionals in assessment of health needs in older adults living at home: a scoping review

BackgroundInterprofessional assessment and management of health needs for older adults living at home can help prioritize community service resources and enhance health, yet there is a shortage of professionals with the necessary competencies. Therefore, support and training for healthcare professionals in community settings to assess older adults’ health with the aim of for health promotion are needed.AimTo identify and provide an overview of published papers describing approaches for training healthcare professionals in assessing physical, mental, and social health needs in older adults living at home.MethodA systematic literature search of the Cinahl, Medline, Academic Search Ultimate, Scopus, Embase, and British Nursing Index databases was performed. We considered studies focusing on the training of healthcare professionals in assessing a single or multiple health needs of older adults aged 65 and above living at home. We considered studies published between 1990 – and March 2024. The review evaluated qualitative, quantitative, and mixed methods studies published in English-language peer-reviewed academic journals. A quality appraisal was conducted via the Mixed Methods Appraisal Tool (MMAT).ResultsTwenty-three studies focused on training healthcare professionals to assess health needs and plan care for older adults living at home were included. The majority of the included studies combined teacher-driven pedagogical approaches consisting of educational sessions, written materials or e-learning, and more participant-engaging pedagogical approaches such as knowledge exchange or various forms of interactive learning. Healthcare professionals were trained to detect and manage single and multiple health needs, and some studies additionally incorporated interprofessional collaboration. Healthcare professionals were satisfied with the training content and it increased their confidence and competencies in health needs assessment and care planning for older adults. Moreover, some studies have reported that training interventions foster the implementation of new and effective ways of working and lead to positive outcomes for older adults.ConclusionHealthcare professionals were satisfied with a combination of participant-engaging and teacher-driven pedagogical approaches used to train them in assessing health needs and planning care for older adults living at home. Such training can lead to enhanced assessment skills and facilitate improvements in practice and health promotion for older adults. Future research is recommended on interprofessional simulation training for conducting structured and comprehensive health needs assessments of older adults living at home, as well as on the implementation of such assessments and health-promoting interventions.

The effect of education based on the theory of planned behavior to prevent the consumption of fast food in a population of teenagers

BackgroundConsidering the increasing prevalence of fast food consumption among teenagers, providing the necessary training and self-awareness is the best solution for institutionalizing the prevention of fast food consumption by this group. Therefore, this issue should be taken seriously, as should the implementation of educational interventions to prevent the consumption of fast food. The theory of planned behavior (TPB) is one of the various health education styles and methods that works well. However, given that a number of local data points are crucial in establishing the efficacy of the model employed, this study looks into the impact of TPB-based education in preventing fast food intake among teenagers.MethodsA total of 180 male students, ages 15 to 18, participated in this quasi-experimental study in Shiraz, Iran. Cluster sampling was used in the study, and participants were randomly assigned to two groups: the experimental group (n = 90) and the control group (n = 90). A theory-based questionnaire was used to gather data, and both the control and experimental groups had to complete it before and three months after the intervention. The data were examined using paired t, independent t, and chi-square statistical tests after being entered into SPSS-24.ResultsThe results of the independent t-test showed that there was no significant difference between the two study groups before the intervention in terms of knowledge (P = 0.14), attitude (P = 0.57), subjective norms (P = 0.94), perceived behavioral control (P = 0.81), behavioral intention (P = 0.42), or behavior (P = 0.25). However, following the intervention, there was a significant difference between the two groups with regard to the noted variables (P = 0.001). Furthermore, the McNemar test results demonstrated that the experimental group’s consumption of fast food varied significantly before and after the intervention (P = 0.001), but not in the control group (P = 0.07).ConclusionThe study’s findings demonstrated that TPB-based treatments are successful in helping male students change their habits of consuming fewer amounts of fast food. This study demonstrated that the instructional techniques employed improved the fast food consumption behavior of the intervention group as well as the TPB’s structure (attitude, subjective norms, behavioral intention, and perceived behavioral intention).